bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaginal Preparation Prior to Planned Cesarean Delivery to Reduce Postpartum Endometritis: A Quality Improvement Study [ID: 1378331]
Authors: Howse Brittany , Adefisoye James , Cicero Andra , Kram Jessica , Michelson Elizabeth
Published: May 2023

INTRODUCTION:

Infection prophylaxis is an important part of perioperative care. Studies have demonstrated that incorporation of pre-cesarean vaginal preparation reduces postoperative rates of endometritis in laboring patients or those with ruptured membranes. Our study aimed to identify whether vaginal preparation decreases the risk of postpartum endometritis among scheduled cesarean deliveries.

METHODS:

We retrospectively reviewed all pregnant people with scheduled cesarean deliveries in one urban, teaching hospital between April 2018 and November 2020. Deliveries were excluded if they were laboring, had ruptured membranes prior to surgery, had known iodine allergy, or had other intraoperative complications. Deliveries were divided into three groups based on vaginal preparation protocol implementation: preimplementation (April 2018 to March 2019), implementation (April 2019 to November 2019), and postimplementation (December 2019 to November 2020). Only deliveries in the preimplementation versus postimplementation group were compared given implementation learning curve. Descriptive and inferential statistics were computed; χ2 or Fisher’s exact test was used to assess differences in rates of endometritis or other postpartum complications.

RESULTS:

Overall, 320 scheduled cesarean deliveries were included (N=162 preimplementation; N=158 postimplementation). Rates of endometritis was not different between groups (1.2% versus 2.5% postimplementation; P=.44). Similarly, postpartum complication rates for fever (1.2% versus 3.8% postimplementation, P=.17), wound infection (3.7% versus 3.2% postimplementation, P=.79), sepsis (0% versus 0.6% postimplementation, P=.49), and 30-day readmission unrelated to preeclampsia (3.7% versus 3.3% postimplementation, P=.12) were not different between groups.

CONCLUSION:

While there was no reduction in postpartum endometritis in patients undergoing planned cesarean delivery, universal implementation may still be a reasonable intervention given its low cost and known benefit in laboring patients or those with ruptured membranes.
Tailored, Just-in-Time Education and Resources for Birthing Individuals and Newborn Caregivers After Hospital Discharge: Developing a Chatbot Experience [ID: 1376023]
Authors: Arem Hannah , Auguste Tamika , Danielson Aimee , Ganacias Karen , Patchen Loral , Rethy Janine
Published: May 2023

INTRODUCTION:

The District of Columbia has some of the highest rates of maternal mortality in the United States, which disproportionally affects Black birthing individuals. Chatbots are a particularly promising platform as they can offer tailored, just-in-time information to birthing individuals and newborn caregivers through active outreach.

METHODS:

We developed an interactive chatbot experience to focus on warning signs (physical and mental health), education, and reconnecting with health care teams in the 42 days after discharge. We solicited input from expert stakeholders with expertise in obstetrics, pediatrics, social work, psychiatry, mHealth, and health equity to develop content for a clinical setting where patients mostly utilize public insurance. Feedback was also solicited from end users through virtual and in-person testing and feedback sessions. The chatbot experience was launched on August 30, 2022, whereby all birthing individuals at a large, urban hospital in Washington, DC, began to receive messaging 24 hours after discharge. The IRB protocol was approved by MedStar Health Research Institute.

RESULTS:

In the first 60 days, 418 messages were sent out, and 230 individuals engaged with the chatbot. 66% of users engaged through SMS, while 34% engaged through email. Nine users (not all of whom engaged) were recruited to provide in-depth feedback. Positive feedback included ease of navigation, enthusiasm for resources, and checkup reminders. Users suggested additional content on barriers to care and community-based resources.

CONCLUSION:

Digital platforms may be an additional channel to offer birthing individuals information about warning signs and connect them to care where needed. Next steps include testing effect on health disparities.
Postpartum Mood Assessment and Intervention Using a Smartphone-Based Application [ID: 1376272]
Authors: Varma Deepthi , Dhillon Karamveer , Goodin Amie , Maguire Michael , Roussos-Ross Dikea , Wen Tony
Published: May 2023

INTRODUCTION:

Postpartum depression affects up to 15% of women after childbirth, and those with a history of depression are at higher risk. Depression symptoms may develop at any time postpartum, but the current postdelivery follow-up schedule typically accommodates only one examination in the immediate 6 weeks after birth. Gator MOMitor, a smartphone application, was developed to provide real-time assessment of postpartum mental health and to facilitate early intervention.

METHODS:

After obtaining signed consent, the study participants downloaded the Gator MOMitor application to their phones before hospital discharge after delivery. The app prompted participants to complete a mood assessment via the Edinburgh Postpartum Depression Scale (EPDS) sent through the app daily in the first 2 weeks and once per week in postpartum weeks 3 through 6. Assessments could be completed within a 1-hour window, after which they were flagged as incomplete. Participants received two reminders. A greater than or equal to 12 score on EPDS or three consecutive nonresponses triggered a phone call from a nurse for follow-up.

RESULTS:

Among 401 women enrolled, 1,599 mood assessments were completed. Seventy-six of these were positive screens triggering calls from the nurse, where the same participant could have multiple positive screens. Fifty-six participants with positive screens were successfully contacted by a nurse, 11 were referred for a wellness check, 5 were referred to a specialist, and 2 were admitted to the hospital for further evaluation.

CONCLUSION:

Smartphone applications such as Gator MOMitor are effective tools for real-time mood assessment, early symptom recognition, and intervention for postpartum women.
Association Between Mode of Delivery and Abnormal Scores on Psychometric Scales After Stillbirth [ID: 1379988]
Authors: Dang Dung , Ayala Nina , Cersonsky Tess , Dudley Donald , Lewkowitz Adam
Published: May 2023

INTRODUCTION:

Those who deliver a stillborn infant are at increased risk of postpartum depression (PPD), postpartum anxiety (PPA), and lower post-trauma recovery. We aimed to explore whether PPD, PPA, or post-traumatic growth (PTGI) scores differed among women who had stillborn infants via vaginal delivery (VD) versus cesarean delivery (CD).

METHODS:

This is a secondary analysis of case–control study from the Stillbirth Collaborative Research Network. Longitudinal pregnancy, delivery, and postpartum data were collected between people who had stillbirth and live birth between 2006 and 2009. Those with stillborn infants who completed psychological assessments for PPD (Edinburg Postpartum Depression Scale), PPA (State-Trait Anxiety Inventory), and PTGI were included. The primary outcome was screening positive for PPD (score >10 on the Edinburgh Postnatal Depression Scale). Secondary outcomes were screening positive for PPA (score >40 on the State-Trait Anxiety Inventory), and PTGI score, measured continuously. Outcomes were compared between those who had VD versus CD. Multivariable analysis controlling for demographic or obstetric differences between groups was conducted.

RESULTS:

Of 982 stillbirths, 269 patients (27.4%) completed postpartum psychological assessments and were included. Of these, 41 (15.2%) had CD. Those who had CD were more likely to be Hispanic (48.8% versus 27.2%, P=.006) and have older gestational age (34.4±4.3 weeks versus 26.9±6.5 weeks, P<.001). Mode of delivery (MOD) was not associated with differences in screening positive for PPD (CD odds ratio [OR] 1.62 [95% CI 0.79–3.27]) or PPA (CD OR 1.52 [95% CI 0.75–3.05]). However, MOD was associated with lower PTGI score. This difference persisted after controlling for confounders (beta coefficient −0.17 [standard error 0.07, P=.0141]).

CONCLUSION:

After stillbirth, MOD is not associated with differences in screen-positive rates for PPD or PPA. However, delivering a stillborn infant via CD was associated with lower PTGI score, which suggests additional support resources may be needed in this population to promote positive psychological growth.
Postpartum Titration of Antihypertensives in Patients With Hypertensive Disorders of Pregnancy [ID: 1380430]
Authors: Lafferty Ashlyn , Duryea Elaine , Garner William , Nelson David , Reddy Meghana , Spong Catherine
Published: May 2023

INTRODUCTION:

Postpartum hypertension is observed in up to 20% of patients within 6 weeks of delivery. While blood pressure evaluation is an integral component of prenatal care, effective blood pressure follow-up postpartum is uncertain. The objective of this study was to evaluate the use of antihypertensive medications and subsequent dosage adjustments in the postpartum period.

METHODS:

This was a retrospective qualitative observational study of patients with hypertensive disorders of pregnancy who delivered at a single quaternary care safety net hospital from July to December 2021. Patients with at least one of the following diagnoses: chronic hypertension (cHTN), gestational hypertension (gHTN), and/or severe preeclampsia (SPE), were included. Data collected included initiation and/or titration of antihypertensives during delivery admission, postpartum visit attendance, outpatient antihypertensive dose adjustments, and emergency department visits.

RESULTS:

From July to December 2021, 1,232 pregnancies were complicated by hypertensive disorders: gHTN only, 577 (46.8%); both gHTN and cHTN, 34 (2.8%); both gHTN and SPE, 499 (40.5%); and all three, 122 (9.9%). Of these, 256 (20.8%) required initiation and/or titration of antihypertensives during delivery admission with over 90% of these complicated by SPE. Of the 197 (77.0%) attending at least one follow-up, medication was stopped in 26 (13%), increased in 9 (5%), decreased in 22 (11%), and continued unchanged in 140 (71%). The majority of medication adjustment occurred in the first 2 weeks postpartum.

CONCLUSION:

Postpartum hypertensive therapy management occurs predominantly within 2 weeks postpartum, with nearly one-fourth decreasing and only 5% requiring increased medication.
Pilot Program to Assess Effectiveness of a Meal Supplementation Program in Addressing Food Insecurity in Pregnancy [ID: 1376240]
Authors: Murphy Lauren , Duckworth Megan , Griffin Laurie , Lefkowitz Janet , Lewkowitz Adam
Published: May 2023

INTRODUCTION:

Food insecurity (FI) has been associated with adverse pregnancy outcomes including hypertension, decreased birth weight, and increased prenatal depression, and can be reduced by meal supplementation programs. However, screening for FI is not universal during pregnancy, and few studies address the feasibility of screening and implementation of interventions such as meal supplementation programs within prenatal clinics.

METHODS:

A novel pilot program was designed in collaboration with Meals on Wheels (MoW) to provide meal supplementation to positively screened pregnant individuals and their households. Universal FI screening for all patients occurred during their obstetrical intake visit using the “Hunger Vital Sign.” Those screening positive were offered enrollment in the program. To address the feasibility of incorporating enrollment into routine obstetric care, clinic practitioners were surveyed anonymously on the program and its potential effect on clinic workflow.

RESULTS:

In the first 3 months of the program, one in five (42/211 [20%]) of new prenatal patients screened positive for FI; of these, more than half (23/42 [55%]) of those with FI desired enrollment in the program. Nearly all clinic practitioners (35/36 [97%]) felt the program was beneficial to patients and 91% (32/35) agreed the program “does not significantly interfere” with their work. 97% (35/36) felt the program should continue.

CONCLUSION:

Food insecurity is prevalent among pregnant patients, but more than half of eligible patients declined meal supplementation program enrollment. Although incorporating such a program into a prenatal clinic is feasible from a provider perspective, feedback on the program from eligible participants is urgently needed to increase uptake rates.
Comparison of Pregnancy and COVID-19 Complications Stratified by Maternal Vaccination Status [ID: 1363064]
Authors: Abuzeid Omar , Garretto Diana , Garry David , Heiselman Cassandra , Pattanaik Rakasa , Shinder Eliane
Published: May 2023

INTRODUCTION:

COVID-19 vaccination has been shown to reduce disease severity. However, it is unclear how vaccination status may affect complications of both pregnancy and COVID. This study aims to determine whether maternal vaccination status affects COVID-19 and pregnancy complications.

METHODS:

This was a retrospective study of pregnant women diagnosed with SARS-CoV-2 during the Alpha/Delta or Omicron wave (February 1, 2021 to April 1, 2022) at a single academic tertiary care center. Study was approved by the IRB. Women were divided into groups based on vaccination status. The primary outcome was COVID-19 complications (venous thromboembolism, stroke, myocardial infarction, pneumonia [PNA], acute respiratory failure [ARF], renal or hepatic failure, transaminitis). Pregnancy complications (pregnancy-induced hypertension, postpartum hemorrhage, fetal demise, preterm labor, blood transfusion, pyelonephritis, preterm prelabor rupture of membranes [PPROM]) and maternal characteristics were collected from chart review. Statistical analysis was performed using SPSS using chi-square tests and Student t tests with significance defined as P<.05.

RESULTS:

A total of 463 pregnant patients were included in this study. One hundred fifty-nine were fully or partially vaccinated, while 304 were not vaccinated. There was a significantly higher incidence of COVID-19 complications in patients who did not receive the vaccine (3.3%) compared to those who received the vaccine (0%) (P=.02). No patients who were vaccinated had PNA or ARF. Chronic hypertension and pregestational diabetes were also significantly associated with COVID complications. Vaccination status was not associated with any pregnancy complication. Incidence of preeclampsia without severe features was higher in vaccinated women (5.7 versus 1.6, P=.02). Of the patients who received the booster, 10.4% (5/48) had PPROM compared to 3.5% (13/372) who did not receive the booster (P<.05).

CONCLUSION:

Our data suggest that vaccination status is not related to obstetrical outcomes; however pregnant women who received the COVID-19 vaccine are protected from COVID-19 complications.
The Effect of the COVID-19 Pandemic on the Management and Telehealth Care of Spontaneous Abortions [ID: 1378351]
Authors: Cucci Ariana , DeAngelo Lydia , Oladeji Temiloluwa , Schwartz Kaia , Seibert Jonathan , Walker Claudia
Published: May 2023

INTRODUCTION:

The purpose of this study was to explore the influence of the COVID-19 pandemic on the management of early pregnancy loss. Additionally, we aimed to identify differences in the use of virtual health care for the management of spontaneous abortions (SABs) before and after the COVID-19 pandemic.

METHODS:

Retrospective cohort study was conducted of patients aged 18–40 receiving obstetric care at Cleveland Clinic hospitals between March 2019 and September 2019 (pre-COVID-19), and between March 2020 and September 2020 (post-COVID-19). SABs were defined as spontaneous pregnancy losses occurring before the 20th week of pregnancy, excluding induced abortions and ectopic pregnancies. Baseline demographic information, medical history, type of SAB management, and use of virtual visits were compared between the pre-COVID-19 and post-COVID-19 groups.

RESULTS:

Two thousand two hundred eleven patients met inclusion criteria, 1,159 with SAB pre-COVID-19 and 1,052 with SAB post-COVID-19. Demographic factors including race (P=.64) and age (P=.46) did not differ between the two groups. Overall management of SAB differed between the two cohorts, with a higher proportion of post-COVID-19 patients opting for expectant management (49.9%) compared to only 38.1% choosing expectant management in the pre-COVID-19 group (P<.001). Virtual visits for consultation and management of SAB were more prevalent in the post-COVID period with 11.1% of patients choosing to utilize telehealth compared to only 0.09% of patients in the pre-COVID-19 cohort (P<.001).

CONCLUSION:

The COVID-19 pandemic affected many aspects of the delivery of health care, and women's health is no exception. Our study shows that the pandemic changed the way SABs were managed, with a higher proportion of health care providers and patients opting for expectant management as compared to the pre-pandemic time period. We also saw a change in the way health care was delivered with virtual appointments becoming more popular post-COVID-19, emphasizing the growing role of telehealth in women's health care and in the management of SAB.
Maternal Cigarette and Electronic Cigarette Use Before Pregnancy Associated With the Risk of Hypertension and Gestational Hypertension [ID: 1380637]
Authors: Sana Meghana , Hagblom Farrah , Hand Mariana , Pezzino Alexia , Wen Xiaozhong
Published: May 2023

INTRODUCTION:

Despite the rapid increase in electronic cigarettes (e-cigarette) use, little is known regarding its effects on maternal health. We examined the association between maternal e-cigarette use before pregnancy and hypertension (preexisting and gestational).

METHODS:

We obtained data from phase 8 (2016–2019) of the Pregnancy Risk Assessment Monitoring System (PRAMS; N=153,336). Postpartum mothers reported their e-cigarette and combustible cigarette use within the 3 months before pregnancy. They also reported hypertension status before pregnancy and gestational hypertension. We used multivariable logistic regression models to estimate the adjusted odds ratio (aOR) of hypertension associated with maternal e-cigarette use and cigarette use before pregnancy, controlling for sociodemographic and pregnancy confounders.

RESULTS:

Compared to nonusers, mothers who exclusively used cigarettes (7.0% versus 4.8%, aOR 1.33 [95% CI 1.32–1.35]) and dual users (8.4% versus 4.8%, aOR 1.98 [95% CI 1.95–2.02]) before pregnancy had an increased risk of hypertension before pregnancy, whereas exclusive e-cigarette smokers had a decreased risk of hypertension before pregnancy (4.5% versus 4.8%, aOR 0.95 [95% CI 0.92–0.98]). Exclusive cigarette users (10.1% versus 9.0%, aOR 1.03 [95% CI 1.02–1.04]), exclusive e-cigarette users (11.3% versus 9.0%, aOR 1.22 [95% CI 1.20–1.25]), and dual users (10.4% versus 9.0%; aOR 1.13 [95% CI 1.11–1.15]) in the 3 months before pregnancy had a higher risk of gestational hypertension compared to nonusers.

CONCLUSION:

Combustible cigarette use and dual use before pregnancy was associated with an increased risk of hypertension before pregnancy and gestational hypertension. E-cigarette use before pregnancy was associated with increased risk for gestational hypertension only.
Patient Characteristics Associated With Optimal Telemedicine Experience in Maternal–Fetal Medicine (MFM) [ID: 1368093]
Authors: Rep Miranda , Gillenwater Jordan , Mackeen A. Dhanya , Power Michael , Troy Adam
Published: May 2023

INTRODUCTION:

Data regarding patient satisfaction with telemedicine use in obstetrics are limited. Our objective was to identify demographics and their effect on patient satisfaction with telemedicine in maternal–fetal medicine (MFM) to better identify patients who may prefer this modality.

METHODS:

An IRB-approved prospective survey was offered to patients in MFM from March 2022 to May 2022. Telemedicine experience was not required. Demographics and responses to statements comparing telemedicine versus in-person appointments were collected via a 5-point Likert scale. Telemedicine was defined as an appointment where provider–patient interaction occurred via telecommunications technology. The primary outcome was patient characteristics associated with telemedicine satisfaction. Exploratory factor analysis was performed to identify components affecting patient satisfaction.

RESULTS:

Surveys were completed by 327 patients. Factor analysis yielded two components from eight statements: “attentiveness” from the provider and “technology” comfort. Telemedicine was viewed neutrally for attentiveness-related questions and favorably for technology-related questions. While both factors were significantly associated with desire for future telemedicine option, the effect of attentiveness was twice as strong as that of technology in multiple regression. Higher education level and being married were significantly associated with lower levels of perceived attentiveness. Employment and telemedicine experience were significantly associated with increased technology comfort. Those with telemedicine experience and higher technology comfort experienced statistically fewer connection problems.

CONCLUSION:

Telemedicine was viewed neutrally or favorably for the factors studied. Perceived provider attentiveness and technology comfort affected patient satisfaction with telemedicine; each is associated with certain patient demographics. Once validated, this scale can be used to identify patients who may prefer telemedicine appointments.
Outcomes of Evidence-Based Stratification of Placenta Accreta Spectrum (PAS) Disorders for Team-Based Management [ID: 1375468]
Authors: Munoz Jessian , Blankenship Logan , McCann Georgia , Ramsey Patrick
Published: May 2023

INTRODUCTION:

Placenta accreta spectrum (PAS) is characterized by placental invasion and adherence to underlying uterine myometrium resulting in significant maternal morbidity and mortality. Despite knowledge that greater placental depth results in worse outcomes, many centers approach PAS with a single uniform management protocol. We aimed to undercover the effect of surgical planning stratification by antenatal suspicion of placental depth.

METHODS:

This study was a preimplementation and postimplementation of analysis of PAS surgical stratification by suspected depth of placental invasion, accreta (less invasion) or increta/percreta (greater invasion), from 2019 to 2022. Depth of placenta invasion was determined by ultrasonography and/or magnetic resonance imaging. As a control, 4-year (2015–2018) preimplementation group was used to assess the effect of the protocol. This protocol included utilization of a hybrid operating room, uniform uterine artery embolization, as well as staffing by advanced pelvic surgeons. Patient demographics and clinically relevant outcomes were obtained from electronic medical records. Exclusion criteria included pregnancy less than 20 weeks of gestation, fetal demise, and multifetal gestation.

RESULTS:

During the 8-year time period, a total of 93 patients were managed by our PAS team. Forty-six patients were in the preimplementation period, of which 17 (37%) were suspected increta/percreta. During the postimplementation period, 24 of 53 (45%) cases were suspected increta/percreta. In cases of placenta accreta, no significant differences were noted in blood loss, blood transfusion rates, or operative time. When analyzing outcomes of the suspected increta/percreta cohort, our protocol was associated with lower blood loss (2,500 versus 1,500 mL, P=.008), lower blood transfusion rates (88% versus 54%, P=.03), and longer operative time (240 versus 384 minutes, P=.009). Final pathology confirmed increta/percreta suspicion in 23 of the 24 cases (96%).

CONCLUSION:

A protocol for the management of PAS cases by antenatally suspected degree of placenta invasion is not only feasible but results in optimal outcomes for patients with the most complex obstetric conditions.
The Association Between Medical Distrust and the Intention to Initiate Preexposure Prophylaxis (PrEP) in HIV-Seronegative Cisgender Women of Color Within the DC Area [ID: 1377701]
Authors: Hull Shawnika , Alade Tami , Moriarty Patricia , Scott Rachel , Sinks Hannah , Zack Jennifer
Published: May 2023

INTRODUCTION:

Black cisgender women bear a disproportionate burden of the U.S. human immunodeficiency virus (HIV) epidemic, compared to women of other racial groups. Preexposure prophylaxis (PrEP) is a highly effective prevention tool. Evidence indicates that Black women are interested in initiating PrEP, but low utilization persists in this population. Historical mistreatment of women of color and the resulting distrust erect barriers to open communication and shared decision-making with health care providers.

METHODS:

Using an IRB-approved questionnaire, we surveyed 186 consenting adults (83% Black, 9% White, 3% American Indian/Alaskan Native, 4% Other), who were PrEP eligible, HIV seronegative, cisgender women, recruited from family planning and obstetrics and gynecology specialty clinics in Washington, DC. We tested the interaction of patient racial identification and group-based medical mistrust on intentions to use PrEP, as mediated by intentions to discuss PrEP with a health care provider during the imminent clinical interaction.

RESULTS:

Results indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months (index −0.3093, SE 0.1886, 95% CI [–0.7455,–0.0122]) and 12 months (index −0.3248, SE 0.1987, 95% CI [–0.7827,–0.0040]) through anticipated discussion with a provider.

CONCLUSION:

When distrust is low, Black women had stronger intentions to utilize PrEP (relative to women of other racial groups). This was explained by stronger intentions to discuss PrEP with the provider during the clinical visit. This relationship was nonsignificant at moderate and high levels of distrust. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity.
A Randomized Trial on the Effectiveness of Five Water-Based Personal Lubricants in Premenopausal and Postmenopausal Women [ID: 1376759]
Authors: Krychman Michael , Abakah-Phillips Temitayo , Hood Sarah , Palacios Santiago , Savania Nina
Published: May 2023

INTRODUCTION:

Vaginal dryness is generally associated with postmenopausal women; however, it may occur at all ages. Personal lubricants can relieve discomfort associated with vaginal dryness, although clinical data supporting the efficacy of many lubricants are limited.

METHODS:

An open-label, parallel-design study was performed in heterosexual women in monogamous relationships, aged 18–65 years with mild-to-moderate vaginal dryness and dyspareunia. The study population (n=174) included an approximate 50:50 ratio of premenopausal to postmenopausal women. The randomization schedule was stratified by menopausal status. Participants were randomized to use one of five water-based lubricants and instructed to use their lubricant during vaginal intercourse at least once a week over a 4-week period. The Female Sexual Function Index (FSFI) measured sexual functioning after 4 weeks of use as an indicator of lubricant performance. The total FSFI comprises six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain reduction. A greater than 4-point increase in total FSFI is considered clinically important.

RESULTS:

An increase in FSFI total score of greater than 4 points was found for all lubricants in the total population and for four of five lubricants in the premenopausal subgroup, as indicated by the mean differences to baseline. The number of participants in sexual function (total FSFI >26.55) after treatment was significantly greater than the number in sexual function before treatment for both subgroups (premenopausal, 19.3–78.4%; postmenopausal, 22.3–75.3%; P<.0001 for both).

CONCLUSION:

These lubricants can be used not only to relieve symptomatology of vaginal dryness and dyspareunia, but to enhance overall sexual satisfaction regardless of menopausal status.
A Look at Social Media and Misinformation in Regard to Abortion [ID: 1379920]
Authors: Potter Kaylee , Bauer Callie Cox , Laiwalla Rahim , Lanza Shannon
Published: May 2023

INTRODUCTION:

Social media is an increasingly utilized source for medical information. There is a paucity of data for the amount and source of medical misinformation on social media for women's health topics. Our study aimed to define the rate of medical misinformation for abortion on Instagram and evaluate its source.

METHODS:

Open-source posts through the platform Instagram were collected using a web-scraper program. Posts met the following preset parameters; greater than or equal to 250 likes, posted January 1, 2022 to July 11, 2022, and containing at least one prespecified hashtag: #AbortionPill, #AbortionFacts, #UnplannedPregnancy. Posts were analyzed for poster self-identification as a physician, nonphysician provider, or nonmedical provider and for presence and accuracy of medical content.

RESULTS:

Ninety-seven percent of posts were from nonmedical providers, 1.5% from physicians and 1.5% from nonphysician providers. Of posts containing medical information, 63.5% were accurate, and 36.5% contained misinformation. Seventy-nine percent of posts with inaccurate information were from nonmedical providers, 10.5% from physicians, and 10.5% from nonphysician providers. 47.9% of all posts were pro-abortion, 34.8% were anti-abortion, and 17.3% took no stance. Of posts containing medical misinformation, 84.2% were anti-abortion, and 15.8%, pro-abortion.

CONCLUSION:

This study demonstrates that social media is being used to distribute accurate and inaccurate medical information by both medical providers and nonmedical providers and from both pro- and anti-abortion beliefs. It demonstrates the responsibility of the physician to share medically accurate information when participating in social media and opens the question of the effect this misinformation may have on patient experience and care.
Development of a Pap-Hub to Ensure Up-to-Date Cervical Cancer Screening and Follow-Up [ID: 1375247]
Authors: Looby Anna Ayers , Asche Steve , Carlson Kathryn , Chandra Abhishek , Das Kamalini
Published: May 2023

INTRODUCTION:

Complex American Society for Colposcopy and Cervical Pathology guidelines for cervical cancer screening compound challenges in ensuring proper follow-up for patients. We describe a “Pap-Hub” system for coordinating up-to-date screening and follow-up for patients and report preliminary outcomes on 10 years of data.

METHODS:

A retrospective analysis of Pap smear screening and follow-up data was conducted for patients in two health care systems (A and B) using the “Pap-Hub.” Clinician and patient surveys were administered to detail thoughts on systems effect on care coordination.

RESULTS:

Institution A managed 99,708 patients over 3 years. 76,842 patients (77%) had all recommended screening, follow-up, and or HPV vaccinations. Of these patients, 56,910 (74%) were screened and 60,744 (79%) completed their vaccination series. Institution B managed 81,795 patients over 3 years. 61,484 (75%) had all recommended screening, follow-up, and or HPV vaccinations. Of these patients, 46,630 (76%) were screened, and 46,756 (76%) completed their vaccination series. Screening rates at both institutions equaled or exceeded national rates each year. 50 patient survey responses have been completed. Forty-four patients (88%) reported that the system made results “much easier to understand” compared to electronic messages or letters. Ten percent (n=5) and 76% (n=38) of patients felt that it made them “more likely” or “much more likely” to follow up, respectively.

CONCLUSION:

The Pap-Hub system simplifies cervical cancer screening and follow-up. With ongoing data analysis and increasing patient and clinician survey responses, we aim to describe the scope of its effect for over 200,000 patients over 10 years.
Gender and Race Discrepancies in Resident Research Output at a Tertiary Care Center [ID: 1374349]
Authors: McNitt Megan , Ayyash Mariam , Gear Gabrielle , Swain Monique
Published: May 2023

INTRODUCTION:

The Accreditation Council for Graduate Medical Education requires residents to complete scholarly activity prior to graduation, but this does not necessarily translate into peer-reviewed publications. However, level of scholarly activity has been directly linked to successful fellowship match, and those who identify as women, African American, Hispanic, or Native American (underrepresented in medicine [URiM]) are not well represented in fellowship positions. We therefore evaluated for race and gender-based discrepancy in scholarly activity as it relates to research involvement.

METHODS:

An IRB-approved (#15746) survey was sent to all residents at a tertiary hospital. This survey asked residents to share demographic information, when they got involved with research, number of first-author articles, and experience with presentations. Chi-square analysis was used.

RESULTS:

Analysis demonstrated that women began researching earlier than men (P=.0027). However, this did not translate to a significant increase in poster presentations (P=.270), oral presentations (P= .0522), or number of first-author publications (P=.492). When broken down by race, URiM men were exposed to research later than White men, White women, and URiM women (P<.005). There was no difference in poster presentations (P=.350) or first-author publications (P=.718), but White and URiM men had more experience giving oral presentations at conferences compared to their female colleagues (P<.005).

CONCLUSION:

The responses demonstrate that there is not a lack of involvement in research leading to less research output. In fact, despite earlier introduction to research, women have similar research outcomes as their peers. Therefore, effort needs to be placed on ensuring access to resources that assist with publishing research.
Online CME Effectively Improves Obstetrician–Gynecologists' Clinical Knowledge and Confidence Related to Cytomegalovirus [ID: 1368765]
Authors: Larkin Amy , Misiuta Iwona
Published: May 2023

INTRODUCTION:

We sought to determine whether an online continuing medical education (CME) series could improve the clinical knowledge and confidence of obstetrician–gynecologists related to cytomegalovirus (CMV).

METHODS:

Two online, 30-minute panel discussions, with educational effects assessed for matched learners completing all pre/post questions. The McNemar's test assessed differences from pre to post (P<.05 are statistically significant). The activities launched in March and April 2022, and data were collected for 3 months for each activity.

RESULTS:

Overall, 50–51% of obstetrician–gynecologists demonstrated improvements. For activity 1 (N=147), 31% improved at recognizing the burden of CMV (P<.01, 44% need additional education); 20% improved at selecting CMV acquisition risk reduction strategies (P<.01, 25% need additional education); 24% improved at identifying complications of congenital CMV (P<.01, 26% need additional education); 51% increased confidence at educating pregnant women about CMV risk reduction (P<.01), with an average confidence shift of +78% among those who improved. For activity 2 (N=130), 32% improved at recognizing the lifecycle of CMV (P<.01, 32% need additional education); 24% improved at selecting factors associated with CMV seropositivity (P<.01, 35% need additional education); 15% improved at identifying common complications of CMV at birth (P<.01, 35% need additional education); 48% increased confidence at understanding of the role of CMV serostatus in pregnant patients (P<.01), with an average confidence shift of +79% among those who improved.

CONCLUSION:

This study demonstrates the success of an online, serial learning initiative at improving clinical knowledge and confidence of obstetrician–gynecologists related to CMV. Continued gaps were identified for future education.
Advance Care Planning in Obstetrics: Effectiveness of a Didactic Intervention on Provider Comfort and Knowledge [ID: 1373348]
Authors: Johnson Corey , Oliver Emily , Ramsey Frederick , Rose Marisa
Published: May 2023

INTRODUCTION:

Within obstetrics care, it can be difficult to discuss death and advances directives (AD). Recent maternal illnesses and deaths secondary to COVID-19 highlight the importance of these conversations. There is little available research regarding AD in obstetrics, especially within medical education. This study aimed to establish a baseline of obstetric provider comfort and knowledge with this material, provide education, and then reassess comfort and knowledge.

METHODS:

Institutional review board committee approval was waived for this study. A pre-intervention survey, including a unique identifier to allow for pairing of pre/post-surveys, was emailed to residents of a large university obstetrics and gynecology department with questions assessing comfort and knowledge of AD. The intervention was a 45-minute lecture covering definitions and local state laws relating to AD. A postsurvey, with identical questions to the presurvey, was sent 2 weeks after the intervention. Only paired responses were analyzed, using paired t test.

RESULTS:

Twenty-three residents (96% of program) participated in the presurvey; 17 (71%) participated in the postsurvey. All were matched to presurvey responses and analyzed. In the presurvey, 41% of respondents were usually or always comfortable identifying surrogate decision makers, which increased to 82% in the postsurvey, a 41% difference (P=.01). With regards to the knowledge-based questions, the mean correct response was 56% in the presurvey and 87% in the postsurvey, a 31% difference (P<.001).

CONCLUSION:

A simple didactic intervention showed improvement in comfort and knowledge surrounding topics of AD for ob-gyn residents. Additional research relating to patient awareness of AD during pregnancy could be explored.
Development of a Departmental Resident Educational Program to Increase Knowledge and Confidence Related to Obstetric Anal Sphincter Injuries [ID: 1375536]
Authors: Patel Reena , Anna Zdroik , Matthews Catherine
Published: May 2023

INTRODUCTION:

Obstetric anal sphincter injuries (OASIS) have been reported in up to 35% of vaginal deliveries; thus, understanding these injuries is a critical part of obstetrics and gynecology training. Formal educational programs with incorporated simulation training can have an advantageous effect, particularly when provided as part of residency education. This project seeks to evaluate the positive effect of departmental resident education related to OASIS, on confidence and knowledge of obstetrics and gynecology residents at Wake Forest University.

METHODS:

A structured OASIS curriculum was developed by the urogynecology program, including 2 hours of didactic lecture followed by stepwise simulation with swine models to demonstrate and practice anatomic repair techniques. Participants completed pre- and post-class surveys including skill confidence assessments via Likert scale (range 1–10), and standardized knowledge assessments adapted from ACOG Obstetric Laceration Repair Module, along with educational experience reports. These items were scored and analyzed.

RESULTS:

In August 2022, 16 residents (4 per residency year) participated. Prior to education, mean confidence level with techniques was 4.2 among all areas (range 1.6–7.4), with mean knowledge assessment score 64% (range 33–100%). Post-education, confidence improved across several domains including effectively applying perineal support (7.3–7.9), identifying lacerations and performing rectal examinations (6.1–8.0), and OASIS repair (1.9–5.4) (P<.05). Knowledge assessment scores remained similar, at 70% (P>.05). In qualitative analysis, all individuals reported beneficial aspects of the program.

CONCLUSION:

Introduction of an OASIS curriculum including repair simulation utilizing an animal model, increased resident skill confidence. Future research will investigate longitudinal data to improve outcomes.
Resident Perception of Obstetrics and Gynecology Pelvic Anatomy Curriculum: A National Survey [ID: 1377994]
Authors: Holtzman Sharonne , Friedman Frederick , Ghofranian Atoosa , Nentin Farida , Sifri Yara
Published: May 2023

INTRODUCTION:

As a surgical subspeciality, mastering pelvic anatomy for the ob-gyn resident is imperative in performing successful surgical procedures. The objective of this study was to conduct a national survey to examine the ob-gyn resident perspective on their residency's pelvic anatomy curriculum.

METHODS:

An 18-question survey was distributed to all 241 Accreditation Council for Graduate Medical Education program coordinators. The survey was circulated electronically on four different dates, and all information was collected anonymous. All statistical analysis was done using SPSS 2.0.

RESULTS:

A total of 180 (31.0%) residents responded out of 582 possible residents from the 28 programs that responded to our survey. The majority of residents, 172 (95.5%), were between the ages 25 and 34, 155 (86.1%) identified as female, and 25 (69.4%) programs were academic. Out of the respondents, 104 (58.10%) experienced formal education on pelvic anatomy and 138 (77.53%) had a formal surgical simulation. There were 159 (88.83%) residents who had protected lecture time for pelvic anatomy, and only 100 (62.9%) found the lectures to be educational. On a scale of 1–10, the average was 7.5 when residents were asked whether they felt that obstetrics and gynecology programs should have time in an anatomy lab and 9.0 when asked if they felt that formal training in anatomy lab would help them become a better surgeon. On multivariable analysis, residents who had formal education on pelvic anatomy and a surgical simulation curriculum felt that their residency program was more likely to adequately train them in all aspects of obstetrics and gynecology (P<.05).

CONCLUSION:

Pelvic anatomy education is a important for ob-gyn residents. Only 60% of programs have a formal pelvic anatomy curriculum and 89% had formal lectures on pelvic anatomy, with most residents finding pelvic anatomy lectures to be unhelpful. Residency programs should consider adding hands-on anatomy program to their curriculum to adequately train their residents in the field of obstetrics and gynecology.
Analysis of Current Medical Student Mistreatment on the Obstetrics and Gynecology Clerkship [ID: 1342315]
Authors: Hazen Nicholas , Leffler Grace , Nunn Sophia
Published: May 2023

INTRODUCTION:

At our institution, there are a high proportion of mistreatment reports by medical students stemming from interactions with residents during their obstetrics and gynecology training. There is minimal published data on this issue. This project reviewed and categorized mistreatment reports from medical students during their obstetrics and gynecology rotations to identify factors contributing to medical student mistreatment in this setting and establish a basis for targeted interventions.

METHODS:

After receiving IRB approval, student responses from post-rotation surveys were compiled from the three most recent academic years. The responses were de-identified and compiled into a database encompassing all student responses to mistreatment questions. The study authors used an existing taxonomy for unprofessional behavior, established by Cullen et al, to classify responses in the database into categories. Up to three categories could be selected per response.

RESULTS:

9.2% (34/369) of students documented some form of mistreatment while on their obstetrics and gynecology rotation. Of the responses evaluating individual residents, 2.0% (86/4248) reported mistreatment. Of responses where mistreatment was reported, 48.33% were categorized as “Ineffective or negligent teaching/mentoring,” 25.00% as “Indirect abuse, aggression, or disrespect,” and 21.67% as “Ineffective or incomplete communication.” All of the remaining categories comprised less than 15% of the total. Category proportions were similar when looking at responses related to individual residents and to the rotation overall.

CONCLUSION:

Most concerns stemmed from perceived neglect from residents and staff, rather than overt bad-acting. Interventions to reduce this type of perceived mistreatment should focus on enhancing student engagement and interaction, effective teaching, and clear communication between students, residents, and staff.
Virtual Platform Adaptation of Perinatal Depression Support Group: A Quality Improvement Study [ID: 1365608]
Authors: White Samantha , Brescia Sara , Gurram Padmalatha , McCumiskey Karen , Mover Kelly
Published: May 2023

INTRODUCTION:

Group therapy interventions have shown to improve scores on postpartum depression and anxiety inventories. Our institution underwent transition from in-person (IP) to virtual platform (VP) over the course of the COVID-19 pandemic. The study's objective is to examine whether VP has similar participation rates and outcomes as IP.

METHODS:

This is a retrospective study of women who attended the perinatal mood disorders (PMD) support group. Between January 2019 and June 2021, the group transitioned from IP to VP sessions. Participants attending both IP and VP sessions were excluded. The participation rates and outcomes of IP and VP support groups were compared. Edinburgh Postnatal Depression Score (EPDS) and Mills Inventory (MI) were used to assess clinical improvement. P value of .05 is considered significant.

RESULTS:

One hundred thirty-seven women (85 [62%] IP and 52 [38%] VP) participated. Baseline characteristics were similar (P>.05). Most of the participants were 1–6 months postpartum (P=.38). The average number of sessions attended by IP was 3.86 versus 3.76 by VP (P=.41). The preintervention average EPDS scores were 15.56 in IP versus 14.76 in VP (P=.79), and MI scores were 52.48 (IP) versus 46.06 in VP (P=.07). The EPDS and MI mean scores decreased postintervention. The average decrease in EPDS score is 5.08 in IP versus 6 in VP (P=.36). The average decrease in MI score is 17.86 in IP versus 15.56 in VP (P=.25).

CONCLUSION:

The VP has similar participation and outcomes as IP format. The VP is a feasible and effective method of delivering support to women with PMD.