bluuebunny/crossref_metadata_2025 huggingface dataset:
Levonorgestrel Intrauterine Device Complications Among Obese Women in a Multiracial Population [21F]
Authors: Saito-Tom Lynne , Ahn Hyeong Jun , Kaneshiro Bliss
Published: May 2017

INTRODUCTION:

Intrauterine device insertion may be more challenging as a patient’s body mass index (BMI) increases leading to a higher incidence of complications. However, few studies have evaluated this, particularly in a diverse population. This study aims to describe levonorgestrel intrauterine device (LNG-IUD) complications in obese women.

METHODS:

We evaluated BMI in relation to difficulty with IUD insertion (utilization of additional instruments or anesthesia beyond standard practice), 12-month IUD continuation, and IUD complications (expulsion, infection, perforation, pregnancy, and malposition) in a retrospective cohort study of women with a LNG-IUD inserted at Kaiser Permanente-Hawaii between January 2009 and December 2010.

RESULTS:

Of the 1,071 eligible patients, 36% were obese (18% Class I obesity; 10% Class II obesity; 8% Class III obesity). The most common races were Native Hawaiian/Pacific Islander (36%) and Asian (31%). No differences in difficulty with insertion (P=.59) and 12-month continuation (P=.69) were noted between BMI groups. Class III obese women had a higher proportion of any complication [Class III obesity 24% (20/82); Class II obesity 13% (14/107); Class I obesity 10% (19/199); P=.001]. In multivariable logistic regression, Class III obese patients had a 3.06 times higher odds (OR 3.06 95% CI 1.69-5.57) of LNG-IUD expulsion compared to the control group (normal weight, overweight, and Class I obesity) when adjusting for age, insurance, race and breastfeeding.

CONCLUSION:

Class III obesity was associated with higher rates of LNG-IUD complications, particularly expulsions. Further studies that include a larger number of obese women are needed to better understand these findings.
Investigating Pregnancy Outcomes After Abnormal Cell-Free Fetal DNA Test Results [25F]
Authors: Lu Jessica , Saller Devereux N. , Fraer Luanne M. , Chen Beatrice A.
Published: May 2017

INTRODUCTION:

Cell-free fetal DNA (cfDNA) testing has increased sensitivity and specificity compared to other prenatal screening methods, but invasive diagnostic testing (IDT) is recommended for confirmation. We examined factors associated with pregnancy continuation or termination after abnormal cfDNA results.

METHODS:

We conducted a retrospective chart review of 39 women with abnormal cfDNA results between March 2012 and September 2015 at an urban academic hospital. We analyzed data using descriptive statistics, Fisher exact, and Wilcoxon rank-sum tests.

RESULTS:

Mean age was 33.9±7.6 years; 64% (25/39) were advanced maternal age and 67% (26/39) had abnormal ultrasounds. Median gestational age at time of cfDNA testing was 18 3/7 weeks (interquartile range 12 2/7, 20 5/7). CfDNA results included trisomy 21 (90%, 35/39), trisomy 18 (8%, 3/39), and both trisomy 21/monosomy X (3%, 1/39). Of 39 women, 22 (56%) continued and 10 (26%) terminated the pregnancy; six (15%) had fetal demises and one was lost to follow-up. For women continuing or terminating the pregnancy, pregnancy outcomes were not associated with cfDNA results (P>.99), maternal age (P=.74), race (P=.23), or having abnormal ultrasounds (P=.68). Only 13 women underwent IDT; all had trisomy 21. Of women continuing their pregnancies, 55% (12/22) declined further genetic counseling and 73% (16/22) declined IDT. Most women terminating their pregnancies (80%, 8/10) underwent IDT. Not pursuing IDT was associated with continuing the pregnancy (P=.006).

CONCLUSION:

Over half of women with abnormal cfDNA results continued the pregnancy and declined IDT. Most women terminating their pregnancy pursued IDT, suggesting that women considering termination undergo more confirmatory tests.
Influences of Ethnicity on Perceptions of Contraceptive Use in Postpartum Women With Unintended Pregnancies [26F]
Authors: Skanes-DeVold Heather , Benoit Candace , Erby Brittainy , Ochs Katherine , Maxwell Rose , Lindheim Steven
Published: May 2017

INTRODUCTION:

Unintended pregnancies (UIP) account for nearly 50% of pregnancies. Studies suggest that minority women are less compliant and less likely to use contraception. We assessed knowledge and attitudes associated with pre- and postpartum contraception use in women with UIP.

METHODS:

A 21-question survey was given to 350 full-term women between the ages of 18 and 40 within 48 hours of delivery from August 2014 to August 2016.

RESULTS:

Of the 195 respondents, 56% were women with UIP. With regards to UIP, 42% were Caucasian (CA), 49% African American (AA), 3% Hispanic and 6% other. The latter two groups were excluded from analysis. CA and AA were similar in education level (61% vs 59% greater than high school), contraception access/insurance coverage (96% vs 96%), use prior to (61% vs 47%) and at the time of conception (14% vs 24%), P-NS. There was no difference in negative perceptions of contraception (CA- 42% and AA-49% P-NS), though weight gain was high in both (CA 72% vs AA 71%, P-NS). AA were less likely to identify benefits of contraception compared to CA (AA 81% vs CA 93%, P < .001), including a reduction in acne (AA 10% vs CA 39% P < .001) and prevention of further UIP (AA 46% vs CA 78%, P < .001).

CONCLUSION:

Understanding the disbelief among AA that birth control has non-contraceptive benefits in addition to effectively preventing pregnancy, may be the first step in the development of culturally targeted education and further aid in the reduction of disparities in UIP.
Pregnancy Outcomes Following Cardiac Transplant [31F]
Authors: Zaffa Nusrat , Bhagra Catriona , Murphy Kellie , Sermer Mathew , Ross Heather , D'Souza Rohan
Published: May 2017

INTRODUCTION:

We report a single-center experience of pregnancy outcomes for women following cardiac transplantation.

METHODS:

This is a retrospective cohort of all women with pregnancies following cardiac transplantation followed at Mount Sinai Hospital, Toronto, between 2001-2015.

RESULTS:

Five women had five singleton pregnancies following cardiac transplantation. The mean maternal age was 28.4 (±7.7) years and transplant-to-pregnancy interval was 7.1 (±3.6) years. Pre-existing comorbidities included hypertension in three and diabetes in one. Two women experienced graft rejection prior to conception, but had normal left ventricular (LV) function at the start of pregnancy. Three women were on a calcineurin inhibitor (cyclosporine or tacrolimus) with 5-10 mg prednisone per day, one was on tacrolimus + mycophenolate mofetil and one was on cyclosporine, azathioprine and prednisone. There were no maternal deaths. Maternal complications included preeclampsia in one and graft rejection in two. There were four live births (80%) with a mean gestational age of 33+3 (27+6 - 37+3) weeks. There were no fetal anomalies or cases of growth restriction, but two preterm births, one from spontaneous labor at 27+6 weeks and the other from labor induction for preeclampsia at 34+2 weeks. The infant delivered at 27+6 weeks had no residual sequelae at four months post-term age. Three women (75%) had caesarean deliveries for obstetric indications.

CONCLUSION:

With appropriate multidisciplinary care, women with cardiac transplants can have successful pregnancies. Although rates of fetal loss and congenital malformations are low on current immunosuppressive regimens, women may continue to be at risk for preterm birth.
Pregnancy Outcomes in Underweight Versus Ideal Weight Women at Time of Delivery [33F]
Authors: Gennette Sarah , Varlamov Anna , Eason Ron
Published: May 2017

INTRODUCTION:

Maternal pre-pregnancy body mass index (BMI) and gestational weight gain are factors influencing neonatal birth weight. Underweight women have a higher risk of spontaneous preterm birth and small for gestational age infants. Whether underweight women at the time of delivery have the same risks, regardless of pre-pregnancy weight and weight gain during pregnancy, has not been reported for our region.

METHODS:

Ideal weight was defined as a BMI greater than 18.4 and less than 25. Underweight was defined as a BMI less than 18.5. The pre-pregnancy weight and weight gain were not included. This was a retrospective study of all deliveries at our hospital from 12/14/2009 to 10/1/2013 greater than 23 weeks. There was a total of 45,961 singleton deliveries. Thirty-six women were underweight versus 5,343 women considered ideal weight at the time of delivery.

RESULTS:

Major demographic variables were similar between the groups. Rates of preterm birth were higher in the underweight group (P < .05). Rates of induction of labor were higher in the ideal weight group (P < .05). There was no difference in cesarean section rates, Apgar’s, or cord pH. The neonatal birth weight was significantly smaller for the underweight patients (P < .05). However, the rate of NICU admissions was significantly higher in the underweight group vs the ideal weight (P < .05).

CONCLUSION:

Maternal weight at birth has the same implication on prematurity and low birth weight as maternal pre-pregnancy weight when underweight women are compared to ideal weight women.
Impact of Posterior Tibial Nerve Stimulation in Treatment of Refractory Overactive Bladder Syndrome [3G]
Authors: Carr Danielle , Kurdoğlu Zehra , Kurdoğlu Mertihan , Kilic Gokhan
Published: May 2017

INTRODUCTION:

Overactive bladder (OAB) affects approximately 16% of adults in the United States. Posterior tibial nerve stimulation (PTNS) is the least invasive form of neuromodulation to treat OAB after failure of conservative therapies. In this study, we aimed to evaluate the impact of PTNS on OAB syndrome.

METHODS:

A retrospective study was conducted in Urogynecology Clinic between 2013 and 2016. Inclusion criteria consisted of female gender, documented clinic visit during the year before first PTNS, and completion of 12 weekly treatments. Medications used within the year before PTNS and at last follow up after PTNS were recorded. Symptom severity at first PTNS visit and after completion of PTNS was collected. Episodes of urinary frequency, leakage, and nocturia were recorded in discrete values. Urgency was reported subjectively using a scale from 1-4, with 4 being most extreme. The Wilcoxon Signed Rank Test was used for comparisons of symptom severity.

RESULTS:

Sixty patients in the clinic were identified with refractory OAB. Of the 46 patients receiving PTNS, 24 met inclusion criteria. Mean age was 70.25 ± 1.11 years. Mean follow up was 9.42 months. 54.17% did not require pharmacotherapy after completion of PTNS. The number of urgency episodes decreased from 3.12 to 1.79 (p=0.001), daytime frequency decreased from 7.29 to 5.58 (p=0.002), nocturia decreased from 3.33 to 2.17 (p=0.01), and leakage decreased from 2.62 to 1.33 (p=0.002).

CONCLUSION:

In this single center study, refractory OAB bladder responding to PTNS is slightly greater than 50% in selected patients, which agrees with the literature.
Correlation Between Sexual Function and Strength of the Pelvic Floor Muscles in Women With Dyspareunia [6G]
Authors: Carvalho Hellen B. , Macedo Lorena C. , Vasconcelos Danilo A. , Amorim Melania M. , Katz Leila
Published: May 2017

INTRODUCTION:

Dyspareunia is defined as persistent or recurrent genital pain that occurs just prior to, during or after sexual intercourse, causing intense suffering or interpersonal conflict. Evaluating sexual function and strength of the pelvic floor muscles represents an important element when assessing dysfunctions such as dyspareunia.

METHODS:

A cross-sectional study involving 50 sexually active women of 18-35 years of age, 25 with dyspareunia and 25 without dyspareunia. Questionnaires were used to obtain the eligible women’s biological, sociodemographic and urogynecological characteristics. The Female Sexual Function Index was used to evaluate sexual function. Clinical evaluation of the pelvic floor was conducted to verify the presence of perineal contraction, with dynamometry being performed immediately afterwards. The Shapiro-Wilk and Mann-Whitney tests were used in the statistical analysis, together with Spearman’s rank correlation coefficient. Significance was established as 5%.

RESULTS:

Dynamometric measurements of superficial (p=0.01) and deep muscle strength (p=0.04) during pelvic floor muscle contraction were also lower in the dyspareunia group. A fair positive correlation (r=0.382; p=0.03) between the pain during sexual intercourse domain and dynamometric measurements of superficial muscle strength.

CONCLUSION:

A reduction was found in the dynamometric measurements of pelvic floor muscle strength in women with dyspareunia compared to those without dyspareunia and a correlation was found between pain and dynamometric measurements of superficial muscle strength.
SNS Retention Rates in the Treatment of Refractory OAB, Urinary Retention, and Idiopathic Fecal Incontinence [7G]
Authors: Hamouie Angie , Ünlü Serdar , Kilic Gokhan
Published: May 2017

INTRODUCTION:

Sacral nerve stimulation (SNS) has proven to be an effective treatment of refractory overactive bladder (OAB), urinary retention, and idiopathic fecal incontinence. Many studies assessing the effectiveness of this treatment, however, often focus on the short- to medium-term effectiveness (less than 24 months) with a few studies extending up to five years. The purpose of this study is to determine whether patients continue to retain SNS 5 years after implantation.

METHODS:

This study was performed using health insurance claims data from Clinformatics DataMart. Data were collected between January 1st, 2002 and September 30th, 2014. Diagnoses and procedures were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes. Data were initially screened for patients who had completed SNS implantation (n=2248). Inclusion criteria included women aged 18-65 who had had continuous insurance enrollment in the prior year (n=1231). Patients were excluded if they had had procedures associated with SNS treatment in the prior year (n=884). For each year, we assessed the number of patients who still had the SNS implant compared to the number of patients who had the SNS implant removed during follow-up.

RESULTS:

At year one, 85.8% of patients had retained the SNS implant (549/640). At year two, 81.4% (341/419). At year three, 78.1% (210/269). At year four, 79.0% (124/157). And at year five, 72.0% (67/93).

CONCLUSION:

The retention rate for SNS as a treatment for refractory OAB, urinary retention, and idiopathic fecal incontinence continues to be high at five years follow-up.
Diagnosis and Treatment of Positive Urine Cultures in Women With Pelvic Organ Prolapse [8G]
Authors: Solouki Shirly
Published: May 2017

INTRODUCTION:

UTIs are one of the most common complications of Pelvic organ prolapse. The rate of urinary tract infections in patients prior to undergoing pelvic organ prolapse surgery is reported to be between 9.5-14%. The hypothesis of this study is that clean catch is a less accurate collection method in women with advanced pelvic organ prolapse.

METHODS:

A retrospective chart review of all women presenting to a single outpatient Urogynecologic center at NSLIJ for pelvic organ prolapse surgery between January of 2012 and December of 2015 was conducted. Inclusion criteria: female patients scheduled for surgical management of symptomatic pelvic organ prolapse with objective prolapse on Pelvic Organ Prolapse Quantification (POPQ) system. Exclusion criteria included active urinary tract infection, and symptomatic urinary tract infection.

RESULTS:

Charts were reviewed for 593 patients. A total of 550 patients met inclusion criteria. Of the 550 patients, 222 (40.36%) specimens were obtained by midstream clean catch and 319 (58.00%) by straight catheterization. When comparing mid-stream clean catch versus straight catheterization, there was a significant association between method of urine culture and urine culture result (P < 0.0001). There was a significantly greater number of positive cultures in specimens obtained via clean catch versus catheterization 60/231 (25.2%) vs 32/319 (10.0%), p < 0.0001). 76/231 (32%) of clean catch specimen had some growth or contamination.

CONCLUSION:

Altered anatomy of women with POP may affect their ability to provide a proper clean catch sample. This may lead to overtreatment of women with antibiotics. Straight catheterization may be more specific.
Financial Impact of Percutaneous Tibial Nerve Stimulation (PTNS) Treatment [10G]
Authors: Harmouche Jihad , Kurdoğlu Zehra , Kilic Gokhan
Published: May 2017

INTRODUCTION:

To estimate average quarterly medication and physician visit costs for patients with refractory overactive bladder, before and after 12 sessions of Percutaneous Tibial Nerve Stimulation (PTNS) treatment.

METHODS:

This is a retrospective case series for patients undergoing PTNS for the treatment of refractory overactive bladder. 23 patients had 12 weekly sessions of initial PTNS treatment; 18 met the criteria for 3-month follow-up before and after treatment. Number of follow-up visits, PTNS maintenance visits, and medications were collected quarterly for a year before and after treatment. Using known medication and visit costs, we calculated mean quarterly costs, and standard deviations for patients, and measured their significance using a 2-tailed paired t-test.

RESULTS:

The average quarterly medication cost decreased from $656.40 ±292.45 to $375.51 ±331.80 after PTNS (p=0.01). The average number of quarterly provider follow-up visits decreased from 1.34 ±0.78 to 0.40 ±0.63 (p=0.001). The average quarterly total provider cost was calculated using the cost of follow-up visits in addition to PTNS maintenance visits. The average quarterly total provider cost increased from $136.96 ±81.50 to $ 181.04 ±146.34 (p=0.286). However, the total provider cost for the last quarter decreased from $169.04 ±103.69 to $55.14 ±94.62 (p=.005).

CONCLUSION:

PTNS treatment significantly reduced the average quarterly cost of medications and the average number of provider follow-up visits on patients with refractory overactive bladder. The average total provider cost initially increased in the first three quarters following PTNS and decreased the last quarter due to a higher number of PTNS maintenance visits immediately after treatment.
Moms in Medicine: Factors Associated with Job Satisfaction Among Physician-Mothers in Obstetrics & Gynecology [11G]
Authors: Gibbins Karen J. , Heuser Cara C. , Herrera Christina A. , Theilen Lauren H. , Holmgren Calla M.
Published: May 2017

INTRODUCTION:

Physician satisfaction is linked to improved patient outcomes. While the proportion of physicians who are also mothers is increasing, little information is available regarding the impact of motherhood on physician satisfaction. Our study aims to assess factors that affect physician satisfaction among ob/gyn physicians who are also mothers.

METHODS:

We constructed and validated a Redcap survey and invited members of an online ob/gyn-mom group to participate. Characteristics of participants’ professional and personal lives were evaluated for possible association with the satisfaction outcomes. These characteristics were reported as frequency (%) or mean (standard error). Comparison testing was performed using Chi-squared test or Fisher’s exact test for categorical variables, Student’s t-test for parametric variables, and Wilcoxon Rank-Sum test for non-parametric variables.

RESULTS:

Responses were received from 232 participants. Women who rated their morale as very or somewhat positive worked fewer hours per week than women who with neutral or negative responses (43.6 vs 49.7, p=0.01). Women with positive morale were also less likely to work over 50 h/week (39.5% vs 56.8%, p=0.04). Women who said they would chose medicine again as a career were more likely to have a physician-spouse (29.8% vs 7.7%, p=0.01) and were more likely to use a nanny/au-pair for childcare (45.1% vs 13.9%, p=0.01). Longer clinical hours, especially over 50 h/week, correlated with dissatisfaction regarding time spent with children, spouse, and on personal activities.

CONCLUSION:

Longer clinical hours strongly correlate with personal and professional satisfaction based on several measurements. Spouse occupation and childcare method may also contribute to satisfaction.
The Second Victim: Can We Identify Those Most At Risk? [18G]
Authors: Benham Joshua , Liebermann Joan , Gaba Nancy , Amdur Richard , Margulies Samantha , Keller Jennifer
Published: May 2017

INTRODUCTION:

Maternal and perinatal deaths impact those providing care to these patients (“second victims”). Limited research exists to determine who is likely to experience post traumatic stress disorder (PTSD), depression or anxiety after a maternal or perinatal death.

METHODS:

A survey was distributed by email to all Women’s Services staff (including Neonatal ICU) at an urban university hospital. The survey asked about experiences with perinatal and maternal death and included questions from validated screening tools for PTSD (PC-PTSD) and depression (PQH4).

RESULTS:

There were 105 responses to the survey. 43 of the responders were physicians. The remaining responders were midwives, nurses, techs and administrative staff. A multivariate model was used to test the independent association of predictors with outcomes and was used to develop prediction models. Four variables were predictive of a “negative outcome” (defined as experiencing anxiety, depression, post-traumatic stress symptoms, or work problems). These included: (1) a non-physician role, (2) substance use, (3) career change consideration, and (4) seeking mental health treatment after an event. With each additional risk factor, the negative outcome score increased significantly. Age, sex, religious beliefs, marital or parental status, and level of clinical involvement with patient/baby were not significantly correlated with negative outcomes.

CONCLUSION:

When providing support for team members involved in a maternal or perinatal death, individuals at risk for PTSD, anxiety, depression and work related problems should be identified and supported. Future studies will focus on the best way to assist those impacted by these events.
Social Media Etiquette Among Healthcare Professionals [20G]
Authors: Davis Jay , Folse Katherine , Billiot Angelle , Bissonnette Rosella , Hagan Joseph , Stafford Irene
Published: May 2017

INTRODUCTION:

Social media (SM) use among healthcare professionals (HCPs) has skyrocketed. It is uncertain whether HCPs, including medical students, residents, and attending physicians, are aware of appropriate SM conduct. This study was conducted to survey HCPs on SM practices and knowledge of SM policy.

METHODS:

A survey was conducted among HCPs pertaining to SM usage that included reasons for use and applicable policy. The chi-square test was used to compare different occupations’ proportion of SM use, awareness of the AMA policy regarding SM and the proportion having received lectures regarding appropriate use. SAS version 9.4 was used for analysis. A 5% significance level was used for hypothesis tests.

RESULTS:

Six hundred forty-six participants responded: 524 (81%) medical students, 91 (14%) residents, 25 (4%) attending-physicians, and 6 (1%) unknown. Ninety-eight percent of participants stated they used SM. Only 33% were aware of the AMA SM policy and 43% received prior education on SM usage. The proportion of respondents reporting that they use SM more than 2 hours per week differed significantly by occupational group (p = 0.002) with attendings least likely to do so (41% compared to 71% for all others). A significantly smaller proportion (p < 0.001) of students(28%) were aware of the AMA policy compared to residents(56%) and attendings(63%). Students were also less likely (p < 0.001) to have received lectures regarding appropriate SM use compared to residents(64%) and attendings(54%).

CONCLUSION:

Our study demonstrated that medical students were more likely to use SM but were least likely to receive information on SM policy, a potential gap in medical education.
Research in Pregnancy: The Ethics of Risk-Benefit Tradeoffs Between Woman, Fetus, and Future Child [21G]
Authors: Little Maggie , Wickremsinhe Marisha , Lyerly Anne
Published: May 2017

INTRODUCTION:

In contrast to many areas of health research, the field of HIV/AIDS has pursued research with pregnant women as a key component of its research agenda. Several large trials have made vivid a number of critical ethical questions for research with pregnant women broadly--including how risks and benefits can and should be traded off between the woman, the fetus, and the future child--offering an important opportunity for building an adequate ethical framework for research in pregnancy, more generally.

METHODS:

As a part of a multidisciplinary research project addressing barriers and opportunities to conducting research with pregnant women (the PHASES project--Pregnancy and HIV/AIDS: Seeking Equitable Study), we examined several large HIV network studies conducted in the last five years that required risk/benefit tradeoffs between woman, fetus and future child in conjunction with U.S. research regulations and the research ethics literature. Selected studies were analyzed in conjunction with U.S. research regulations and the research ethics literature.

RESULTS:

We describe three challenging tradeoff scenarios encountered in HIV network studies and develop an approach that is consistent with US regulations governing research with pregnant women.

CONCLUSION:

The inclusion of pregnant women in clinical research can be justified based on 1) the prospect of direct and indirect benefit to fetus; 2) the imposition of no more than minimal risk for studies involving no prospect of benefit to fetus; or 3) a reasonable ratio of maternal benefit to fetal risk. Tradeoffs between the fetus and the future child risk should be responsive to potential participants’ values.
Listening to Women's Comments: Text Mining Will Revolutionize How We Organize and Act on Women's Concerns [23G]
Authors: Adams Ted , Mo Wenbin , Amey Annette , Burlingame Esther
Published: May 2017

INTRODUCTION:

Listening and acting upon women's comments is central to the relationship we have with patients. Doing this systematically and scientifically is difficult and sometimes involves thematic analyses which are time consuming and costly to perform. We present a new way of analyzing thousands of comments and seeing how each comment affects the HCAHPs rate hospital score (RHS).

METHODS:

We utilized text mining to analyze 27,335 free text comments. Comments were provided by women from Jan 2008 to June 2014 as supplemental comments to the HCAPHs survey. We used SAS text miner (v13.1). Similar words were combined. We then calculated the frequency of each word and the frequency of its relationships to other words using an expectation maximization algorithm. This produced a set of most frequently linked words which are statistically significantly related to each other. We then performed multiple regression analyses to determine magnitude of positive or negative effect on HCAHPs RHS.

RESULTS:

Negative comments have a larger effect on rate hospital score than positive comments. Comments regarding midwives had the highest positive effect on RHS. Topics generated were helpfulness of staff, cleanliness, feeding, pain control and postpartum care. All these areas had a statistically significant effect (p=0.05) on the RHS given by the person giving the comment.

CONCLUSION:

The systematic nature of this analysis is important. Our output is not subject to interpretation bias or comment reading fatigue. Whilst we present national level data the analysis could be performed on different subsets of data, providing results at regional or hospital level.
Obstetric Informatics: Quality Improvement Using Peer-Based Anonymous Physician Score Card [24G]
Authors: Labbad Gabriel , Martens Mark
Published: May 2017

INTRODUCTION:

With the widespread adoption of Computerized Physician Order Entry, auditing physician prescribing practices is technically simplified. We propose leveraging data from aggregate audits to develop a visual tool for quality improvement - the peer-based anonymous physician score card.

METHODS:

For our pilot quality improvement project, we have selected the prescribing of ondansetron for nausea and vomiting of pregnancy. This is a common condition for which recent evidence based recommendations have been updated by APGO and the American College of Obstetricians and Gynecologists in 2014 and 2015 respectively. Data was collected through a retrospective database query from our EMR for all medical records associated with pregnant patients who received a prescription of ondansetron in the ambulatory setting from January 2012 through August 2016 at our suburban hospital. Aggregate prescribing data was then tabularized onto bar graphs and anonymized.

RESULTS:

A total of 56 physicians were identified prescribing ondansetron as a first line medication. A total 484 patients were identified as having received ondansetron. 344 (71%) of which were not prescribed a first line medication. Of the 140 (29%) patients that did receive a first line medication only 64 (13%) patients received the prescription prior to or on the same date as ondansetron.

CONCLUSION:

By presenting peer prescribing habits to our physicians in an anonymous fashion, we propose this will serve as a non-invasive tool to raise awareness and reveal barriers to adoption of recent clinical guidelines. We will track prescribing patterns for an additional 6 months and re-evaluate individual and aggregate prescribing patterns after this intervention.
Multidisciplinary Approach to the Perinatal Care of Families Affected by Fetal Anomalies [25G]
Authors: Kodeih Hanna , Maher James , Schlabritz-Lutsevich Natalia , Angelis Dimitrios , Kelly Randall , Hampton Moss
Published: May 2017

INTRODUCTION:

The prenatal diagnosis of a congenital anomaly occurs in 2-3% of all pregnancies and affects 120,000 births annually. Ultrasonographic diagnosis has dramatically changed the neonatal care of affected infants, allowing for effective matching of the delivery site with the neonate’s post-delivery needs, when instability is anticipated. We believe our perinatal conference improves neonatal outcomes, resource utilization, and patient satisfaction. Additionally, this conference offers coordination of care essential for optimal delivery planning, patient education, and neonatal consultation. We would like to study these parameters.

METHODS:

At Texas Tech University Health Sciences Center School of Medicine Permian Basin Obstetrics and Gynecology Department, perinatal conference is a multidisciplinary conference which is used as a tool for: 1) Dissemination of information about complex problems to the health care team 2) Discussion of core needs and delivery plans, 3) Education in ultrasound for residents and faculty in families affected by fetal anomalies. This conference includes review of antenatal patients with fetal anomalies, followed by review of ultrasound images and discussion of care plan. Fetuses with structural problems often require delivery at a surgical center. This conference aids in avoiding inappropriate local deliveries, emergent delivery, and neonatal transport. This conference serves to facilitate communication on status of affected pregnancies, updates of delivered babies, and quality improvement opportunities for future infants.

RESULTS:

Retrospective analysis has shown fewer inappropriate deliveries and associated decrease in utilization of resources.

CONCLUSION:

Prenatal ultrasound diagnosis of congenital anomalies in combination with multidisciplinary management provides a critical opportunity to improve patients’ care and physician education.
Class I Medical Device Recalls in Women’s Health: 2002 - 2016 [27G]
Authors: Janetos Timothy , Ghobadi Comeron , Xu Shuai , Walter Jessica
Published: May 2017

INTRODUCTION:

Class I recalls are defined by the Food and Drug Administration (FDA) as the most serious type of recall where a medical device problem could lead to death or serious health problems. Understanding the factors leading to these events in women’s health may provide policy implications to improve medical device safety.

METHODS:

We performed a retrospective review of the FDA’s database for Class I device recalls in women’s health from 2002-2016. The reason for recall was defined as either a premarket (e.g. device design problems) or a postmarket (e.g. manufacturing problems) issue.

RESULTS:

75 unique Class I recalls affecting more than 88,000 medical devices were identified from 2002-2016. Recalls included diagnostic assays for chlamydia/gonorrhea, a laparoscopic tissue morcellator, and surgical kits used in women’s health. 95% of recalls were due to postmarketing problems such as improper packaging and labeling. Only 5% of recalls were due to premarket issues (device or software design). In regards to the original approval pathway, 4% of recalled products were cleared via the 510K pathway, while 96% were essentially exempt from premarket approval by the FDA. No recalls were attributed to devices approved along the most stringent post-market approval pathway. The majority of recalls occurred after 2013 with 93% of total recalls occurring in 2014; this spike was attributed to sterility problems with surgical kits used in obstetrics and gynecological procedures.

CONCLUSION:

The majority of recalled devices in women’s health required minimal regulatory scrutiny prior to approval suggesting the need for continued postmarket vigilance.
Ulipristal Acetate Treatment of Uterine Fibroids in Black and Obese Women: Venus I Subgroup Analyses [28G]
Authors: Simon James A. , Catherino William , Blakesley Rick , Chan Anna , Sniukiene Vilma , Al-Hendy Ayman
Published: May 2017

INTRODUCTION:

Ulipristal acetate (UPA) is an oral selective progesterone receptor modulator. This phase 3, multicenter, prospective, randomized, double-blind, study (VENUS I; NCT02147197) was designed to evaluate the efficacy of UPA for treatment of uterine fibroids (UF) and included a large proportion of Black (self-identification) and obese (BMI ≥30 kg/m2) patients.

METHODS:

Premenopausal women (18-50 years) with cyclic excessive uterine bleeding, and ≥1 discrete UF were randomized to once daily UPA 10 mg, UPA 5 mg, or placebo for 12 weeks, with a 12-week drug-free follow-up. Amenorrhea was defined as no bleeding (spotting permitted) for the last 35 days of treatment. Least squares mean change in activity scores were assessed using the UF symptom and quality of life questionnaire revised activity subscale.

RESULTS:

Of 157 patients randomized, 68.8% were Black and 50.3% were obese. In Black and non-Black patients, amenorrhea rates were higher with UPA 10 mg (59.5% and 54.5%) and UPA 5 mg (44.4% and 52.9%) versus placebo (0.0% and 4.8%); activity scores were also improved with UPA 10 mg (60.5 and 43.6) and UPA 5 mg (51.4 and 50.9) versus placebo (16.9 and 26.0). For obese and non-obese patients, amenorrhea rates were higher with UPA 10 mg (66.7% and 47.6%) and UPA 5 mg (50.0% and 44.4%) versus placebo (3.8% and 0.0%); activity scores were also improved with UPA 10 mg (66.4 and 48.7) and UPA 5 mg (54.2 and 49.1) versus placebo (18.0 and 24.1).

CONCLUSION:

In this first US-based phase 3 study, UPA efficacy was observed regardless of race and BMI.
Characterization of Hysterectomy/Uterine Ablation Rates in VWD and Undiagnosed Bleeding Using Claims Data [32G]
Authors: Sidonio Robert F. , Woods Kalinda , Fallaize Dana
Published: May 2017

INTRODUCTION:

Heavy menstrual bleeding (HMB) is common in women and adolescents post menarche, in some cases resulting in hysterectomy or uterine ablation. Based on retrospective studies 10-62% of women with HMB may have an underlying bleeding disorder (BD), such as von Willebrand Disease (VWD), the most common bleeding disorder. Despite public awareness campaigns, a diagnosis of a potential bleeding disorder is often missed or significantly delayed. Here we characterize the rates of hysterectomy/uterine ablation in a symptomatic undiagnosed (SUD) vs. symptomatic diagnosed VWD (SVWD) population.

METHODS:

We utilized the IMS Health Real-World Data Adjudicated Claims, looking at patients continuously enrolled for 2+ years (July 2013 ‒ July 2015) with 1+ severe bleed or 2+ bleed claims. These symptomatic patients were classified based on presence (SVWD; n=837) or absence (SUD; n=2,760) of a VWD diagnosis claim.

RESULTS:

The incidence of hysterectomies/uterine ablation was similar between the SUD vs. the SVWD patients (5.9% and 7.3% respectively). However, the mean age at the time of hysterectomy was significantly (P < 0.05) younger in SUD (35 years) versus the SVWD patients (42 years). 8% of the procedures performed in the SUD occurred in patients 18-25 years old versus 1% in the SVWD patients.

CONCLUSION:

Treatment options for HMB require an evaluation of the etiology, which may be, in many cases, an underlying BD. A timely diagnosis of VWD allows patients access to therapies specifically targeting VWD, including antifibrinolytics, DDAVP and factor replacement, potentially avoiding or delaying the need for more terminal therapies such as hysterectomy/uterine ablation.
Pregnant Women Experiencing Violent Trauma Have Higher Death Rates Despite Less Severe Injuries [36G]
Authors: Deshpande Neha , Kucirka Lauren , Deshpande Sujay , Smith Randi , Oxford Corrina
Published: May 2017

INTRODUCTION:

Trauma is the leading non-obstetric cause of maternal death with 5-8% incidence in the United States. We compared violence-related outcomes between pregnant women and their non-pregnant counterparts.

METHODS:

We studied 197 pregnant and 4658 non-pregnant women of reproductive age (14-49) who experienced violent trauma between 2005-2015 as captured in the Pennsylvania Trauma Outcomes Study. We used modified Poisson regression to estimate relative rates of trauma-related outcomes. All models were adjusted for injury severity score and age.

RESULTS:

Compared to non-pregnant women, pregnant women were younger (mean age=24.3 versus 30.6 years, p < 0.001), more likely to be African-American (54.3% versus 40.1%, p< 0.001), and to have Medicaid insurance (63.1% versus 57.6%, p=0.04). They were less likely to have preexisting psychiatric, drug use, and alcohol use disorders (18.8%, 8.6%, and 2.0% for pregnant women versus 30.1%, 14.2%, and 8.8% for non-pregnant women, respectively, p < 0.03 for all). Pregnant women had a mean injury severity score of 8.7 compared to 9.5 for non-pregnant women (p=0.3), and were significantly more likely to suffer trauma secondary to assault (adjusted relative rate-aRR)=1.06, 95%CI: 1.00-1.12, p=0.04). Pregnant women were more likely to require surgery (aRR=1.06, 95%CI1.01-1.12, p=0.03), and were 3.4 times more likely to undergo hospital transfer (aRR=3.41, 95%CI: 2.32-5.00, p < 0.001). Pregnant women had mortality rates twice that of their non-pregnant counterparts despite lower injury severity scores (aRR=1.98, 95%CI: 1.24-3.07, p=0.004).

CONCLUSION:

After violent trauma, pregnant women have twice the death rate of their non-pregnant counterparts. Screening for violence during pregnancy is paramount for prevention of trauma-related death.
Five Year Experience With Total Vaginal Hysterectomy [7H]
Authors: Morano Jessica Y. , Tiu Andrew C.
Published: May 2017

INTRODUCTION:

The vast majority of hysterectomies in our country are done through the abdominal route. A minimally invasive approach is recommended due to better outcomes, lower rates of complications, and shorter operative time. This study is to present our five year experience with total vaginal hysterectomy.

METHODS:

We reviewed the medical records of 470 patients from 2009 ‒ 2013 who underwent hysterectomy in a community hospital. We had a total of 183 patients who underwent total vaginal hysterectomy.

RESULTS:

We averaged 93 hysterectomies per year and total vaginal hysterectomies comprised 39% while total abdominal, total laparoscopic, and laparoscopy-assisted vaginal hysterectomy comprised 10%, 2%, and 49%, respectively. The total minimally invasive rate was 90%. Concomitant bilateral oophorectomy was 61.7%. The mean patient age was 48 ± 14 years with mean BMI of 30.07 ± 7.83 kg/m2. Thirteen percent had no previous vaginal deliveries. The top three preoperative indications for the procedure were prolapsed uterus (36%), postmenopausal bleeding with thickened endometrium (27%), and enlarged fibroid uterus (18%). The mean uterine weight, operative time, estimated blood loss, and length of hospital stay were 102 ± 70 grams, 34.51 ± 16.86 minutes, 89 ± 91 ml, and 1.09 ± 0.39 days, respectively, which were all smaller compared with our experience with laparoscopy-assisted vaginal hysterectomy and abdominal hysterectomy. There were 2 patients who had bladder injuries, all repaired without sequelae.

CONCLUSION:

Total vaginal hysterectomy is safe, effective, with short learning curve and a low rate of complications. Enlarged (fibroid) uterus and nulliparity are not contraindications for the procedure.
A 10 Year Analysis of Chronic Pelvic Pain (CPP) and Chronic Narcotic Use (CNU) in the Female Veteran Population [8H]
Authors: Cichowski Sara , Rogers Rebecca , Murata Allison , Murata Erin , Murata Glen
Published: May 2017

INTRODUCTION:

Narcotics are prescribed to treat debilitating pelvic pain without proved efficacy, and with significant harm risk. Our objective was to compare chronic narcotic use (CNU) and average narcotic doses prescribed 5 years prior and following chronic pelvic pain (CPP) diagnosis.

METHODS:

We used the validated Veteran’s affairs corporate database warehouse. Time 0 was the 1st CPP diagnosis date by ICD-9 codes. Outpatient narcotic prescriptions were summed for the 5 years preceding and following CPP diagnosis; oral narcotics were converted to morphine equivalents (ME). CNU was defined as greater than 90 narcotic use days per year; drug abuse/overdose rates were defined by ICD-9 codes.

RESULTS:

73,319 women met inclusion criteria of non-cancer CPP with average age of 40.1 ± 11.5 years; 37.3% minority, with an average BMI of 29.4± 6.0 kg/m2 and 34.6% had a history of military sexual trauma. Five years prior to CPP diagnosis, 10-12% of women were on CNU. Five years following diagnosis, CNU increased to 14-16% (or by 10,477 women/5 years, p < 0.001). Average narcotic doses ranged from 31.4 mg to 37.7 mg ME per dose and did not increase over the years (p=0.158). During the 10 year period, 12.7% (9,304) women were diagnosed as drug abusers and 3.3% (2,384 women) had an overdose. Drug overdose significantly increased after the diagnosis of CPP from 1.2% (954 women) to 2.0% (1430 women) of the entire CPP population (P < 0.001).

CONCLUSION:

Drug abuse is common in women with CPP, CNU increases after CPP diagnosis, as does drug overdose.
Management of Abnormal Uterine Bleeding in the Emergency Department Setting: Trends Over the Last 10 Years [10H]
Authors: Sidana Neetika , Liu Grace , Kroft Jamie , Kung Rose , Murji Ally , Robertson Deborah
Published: May 2017

INTRODUCTION:

Abnormal uterine bleeding is an issue facing many premenopausal women. Despite the risks of parenteral estrogen it continues to be first line treatment in clinical guidelines (AJOG 2016, American College of Obstetricians and Gynecologists 2013). We hypothesize that prescribing practices will demonstrate a decreased reliance on parenteral estrogen.

METHODS:

A retrospective chart review is underway to analyze emergency department charts for premenopausal women presenting to academic centers located in the Toronto area, between 2006 and 2016. 144 charts have been sampled from a proposed sample size of 6,412. Exclusion criteria included: postmenopausal bleeding, pregnancy related, malignancy or iatrogenic.

RESULTS:

The average patient in our pool was 37 years old (range 16-56). Hemoglobin at presentation ranged between 34 to 145 with 9.72% of patients requiring transfusion. The average length of stay was 5.18 hours. 50.69% of women did not receive tranexamic acid and NSAIDs were used only 6.25% of the time. OCP use occurred in only 4.86% of cases compared to 1.39% of women being treated with progestins. Parenteral estrogen was used in 2.08% of cases. Selective progesterone receptor modulators and GnRH agonists were never prescribed or utilized. Endometrial biopsy was performed in less than 1% of patients.

CONCLUSION:

Our data demonstrates that clinical practice guidelines are out of date. Parenteral estrogen is not being used as first line treatment. Despite average lengths of stay greater than 5 hours, endometrial biopsies are still not being performed for undiagnosed abnormal uterine bleeding. Revised guidelines and better utilization of newer medical therapies by physicians in the emergency setting are needed.
Safety and Efficacy of Dinoprostone and Misoprostol Vaginal Inserts for Labor Induction [11H]
Authors: Miller Hugh , Billips Benjamin , Dutia Roxanne , Raymond Kyle , Powers Barbara
Published: May 2017

INTRODUCTION:

The purpose of this study was to compare the safety and efficacy of the removable dinoprostone vaginal inserts (DVI) and misoprostol vaginal inserts (MVI) using a pooled analysis.

METHODS:

Data were obtained from a pooled analysis of three phase II/III trials that randomized 1,925 women with longer than 36 0/7 weeks gestation with a modified Bishop score of 4 or less to DVI (mean release rate 0.3 mg/h) (n=1,116) or MVI (mean release rate 7 µg/h) (n=809). The distribution of time to vaginal delivery in both treatment groups was assessed using a log-rank test. Fisher exact test was used to test whether treatment was associated with peripartum adverse events. Data are presented as mean±standard deviation.

RESULTS:

Certain adverse events were significantly less common with DVI compared to MVI, including meconium in amniotic fluid (12.2% vs 17.6%; P=.001), abnormal labor affecting fetus (ie, hyperstimulation syndrome) (4.2% vs 10.6%; P < .001), and fetal acidosis (0.04% vs 1.2%; P=.030), while chorioamnionitis was more common with DVI compared to MVI (7.3% vs 4.9%, P=.037). There were no significant differences between treatment groups for fetal heart rate disorder, postpartum hemorrhage, and arrested labor; neonatal intensive care unit admissions and cesarean delivery incidence were similar between groups. Time to vaginal delivery (hours) was longer with DVI compared to MVI (25.2±12.8 vs 19.0±10.7, P < .001).

CONCLUSION:

DVI use was associated with decreased rates of meconium, abnormal labor affecting fetus, and fetal acidosis as well as with higher rates of chorioamnionitis and a slower time to delivery compared to MVI.