bluuebunny/crossref_metadata_2025 huggingface dataset:
Referral Patterns for Genetic Counseling for Hereditary Breast and Ovarian Cancer Syndromes [40D]
Authors: Hong Leah , Roberson Jacquelyn , Sangha Roopina
Published: April 2018

INTRODUCTION:

BRCA 1 or 2 mutation carriers have a 45–85% risk of developing breast cancer and a 39–46% risk of developing ovarian cancer by age 70.

METHODS:

A retrospective electronic chart review was conducted to identify women who were referred to the Henry Ford Health System Genetics department for counseling, as new consultations between 01/01/16 to 12/31/16 with a diagnosis that contained “breast”, “ovarian”, “ovary”, or “adnexa”. Women with a known cancer diagnosis were excluded. Information on age, race, if genetic testing was collected including if testing was offered and/or accepted, results of genetic testing, insurance type and referring provider specialty.

RESULTS:

A total of 184 women with an average age of 46 years was included. 93 (50.5%) referrals were from obstetricians/gynecologists, 44 (23.9%) from internal medicine, 23 (12.5%) from family medicine, 13 (7.1%) from surgery, and 11 (6%) self-referrals. Of the 20 women who were not offered genetic testing, 5 (25%) had federal assisted insurance. The reasons documented for lack of genetic testing was due to inability to meet Medicare criteria or lack of clinical indication. 164 women were offered genetic testing, of which 147 accepted. Of the 147/164 (89.6%) a total of 14/147 (9.5%) women identified with positive hereditary breast and ovarian cancer mutation. 10/147 (6.8%) women were noted to have a variant mutation.

CONCLUSION/IMPLICATIONS:

Patients at high risk for hereditary cancer syndromes should be provided with a referral for genetic counseling based on extensive review of family history on both sides, including the ages of onset of cancer.
Immediate Postpartum LARC Placement May Decrease the Risk of Short-Interval Pregnancy [3E]
Authors: Higgins Stephanie , Morosky Christopher , Nelson Amy
Published: April 2018

INTRODUCTION:

Short interval pregnancies are associated with an increased incidence of preterm birth, low birth weight, and small for gestational age infants. LARC devices have been shown to be safe and effective in helping women achieve an optimal inter-pregnancy interval, however those studies did not evaluate LARC placed in the immediate postpartum time period.

METHODS:

This is a retrospective cohort study of clinic patients who delivered at Hartford Hospital and requested immediate postpartum LARC. LARC devices were supplied by periodic shipments from the Ryan program. Near the end of shipment periods, there were often insufficient devices to meet demand. This led to a pseudo-random intervention in which some patients received their requested LARC device immediately postpartum and others were given a temporary method and asked to follow-up for outpatient LARC placement. The primary outcome was the percentage of patients in each group who experienced a short interval pregnancy

RESULTS:

345 women qualified for study inclusion. 264 of those women received immediate postpartum LARC (76.5%). The overall number of short interval pregnancies was 39 (11.3%). Among women who received LARC, the percentage of short interval pregnancy was 9.8%. Among women who did not receive LARC, the percentage was 16.0%. Chi-squared comparison resulted in P=0.12

CONCLUSION:

Due to a lower than expected overall incidence of short interval pregnancy, this study was underpowered to detect its primary outcome. This study may serve as a useful pilot study to aid future prospective studies examining the effect of immediate postpartum LARC placement on short interval pregnancy.
The TelAbortion Project: Delivering the Abortion Pill to your Doorstep by Telemedicine and Mail [5E]
Authors: Chong Erica , Raymond Elizabeth , Kaneshiro Bliss , Baldwin Maureen , Priegue Esther , Winikoff Beverly
Published: April 2018

INTRODUCTION:

In the United States, many women struggle to obtain an abortion due to ever-increasing barriers to access. The TelAbortion Project provides medical abortion directly to women in their homes using telemedicine and mail, enabling them to receive services without going to a clinic. We will report data from the pilot phase of this project, which will be completed by October 2017.

METHODS:

TelAbortion was available in Hawaii, New York, Oregon, and Washington. Interested women contacted implementing sites and interacted with clinicians by videoconference. After obtaining screening tests at radiology and lab facilities close to them, eligible women were mailed packages containing mifepristone and misoprostol. Women took the medications at home, obtained follow-up tests and had another consultation with the clinician.

RESULTS:

Through August 2017, 105 women had a videoconference, 93 had received abortion drugs, and 60 had completed follow-up. Among women who took mifepristone and misoprostol, one had a surgical completion, and no serious adverse events were reported. All women reported being very satisfied or satisfied, and 59 of 60 would recommend this service to a friend. Convenience and privacy were commonly valued features.

CONCLUSION:

Direct-to-patient telemedicine abortion is feasible and can potentially increase access to abortion care in a safe and acceptable manner. Although telemedicine bans and other restrictions are on the rise, more than 60% of all abortions in the US are currently performed in states where this service would be legally feasible. Going forward, we plan to scale up this service to women in other states.
Wake Forest Preterm Birth Prevention Clinic: Is PTB a Modifiable Risk Factor with a Standardized Approach? [11E]
Authors: Quinn Kristen H. , Luper Allison , Mertz Heather , Denney Jeffrey M.
Published: April 2018

INTRODUCTION:

Risk of recurrent spontaneous PTB is 15-30% and > 50% for women who have delivered ≥2 babies prior to 32 weeks. Women with inadequate access to care are at risk for PTB. We hypothesized standardized management in a designated prevention clinic would reduce risk of PTB in high risk women.

METHODS:

Retrospective cohort study evaluating pregnancies at risk for PTB. Women were managed with a standardized protocol of surveillance and medical/surgical interventions under care of a consistent team in a designated preterm birth prevention clinic. Patients’ recurrence risk of PTB was calculated adjusting for race, number of prior PTB, and gestational age of prior PTB. Calculated recurrence risk was compared to outcomes when followed in our clinic. Compliance with prenatal visits and reason for delivery were tracked. Univariate and multivariate analyses were used where appropriate.

RESULTS:

188 women with PTB history were enrolled and had complete data. Mean calculated recurrence risk of PTB was 42.6% (SD 25.9; 16-100). 87.3% were compliant with all scheduled appointments. Mean GA at delivery 36.3 weeks. Calculated risk score for PTB at enrollment was not predictive of PTB after care in our clinic (R=0.017). Enrollment in our prematurity clinic significantly reduced the risk of PTB from predicted (42.6% to 24.5%, p=0.0002, OR 0.44; 95% CI 0.28-0.68).

CONCLUSION:

Enrollment in our prematurity clinic significantly decreased the risk of PTB from predicted. In our high risk population only 8% delivered <32 weeks. Standardized evidenced-based intensive surveillance and appropriate medical/surgical interventions with consistent team can significantly reduce risk of PTB.
Characteristics and Outcomes Associated with Hepatic Infarction in Pregnancy [13E]
Authors: Gray Jordan , Fresquez Arianna , Ireland Kayla E. , Boyd Angela R. , Roman Tania , Ramsey Patrick S.
Published: April 2018

INTRODUCTION:

Hepatic infarction is a rare pregnancy complication. We sought to review the literature to characterize risk factors, presentation, and outcomes associated with hepatic infarction in pregnancy.

METHODS:

We performed a systematic literature review using PUBMED and MEDLINE 1966-2017 with relevant search terms to identify reported cases of hepatic infarction in pregnancy. Maternal demographics, comorbidities, risk factors, presenting signs and symptoms, diagnostic tests, management, and outcomes were abstracted.

RESULTS:

We identified 45 cases (33 articles) of hepatic infarction in pregnancy. Average maternal age was 29 ± 5 years. Majority of cases occurred in nulliparous women (56%). Mean gestational age at presentation was 28 ± 8 weeks. The most common risk factors were preeclampsia/HELLP syndrome (67%) and antiphospholipid syndrome (53%). The most common presenting symptoms were abdominal pain (89%), elevated blood pressure (77%), nausea/vomiting (50%), and fever (34%). Abdominal pain was typically right upper quadrant (52%) or epigastric (39%). An upper abdominal ultrasound was performed in 50% of cases; however, 91% did not demonstrate hepatic infarction. Diagnosis was typically made with computerized tomography. Therapeutic anticoagulation and corticosteroids were the most common therapy used. Preterm birth occurred in 82% of cases and fetal demise was common (45%).

CONCLUSION:

Hepatic infarction is a rare complication of pregnancy that is associated with preeclampsia and antiphospholipid antibody syndrome and has a high rate of fetal demise. Additional imaging is required if initial ultrasound is normal and there is a concern for hepatic infarction.
National Trends for Reporting Opiate Use Disorder in Pregnancy and Available Treatment Resources [16E]
Authors: Oben Ayamo , Nelson Chelsea , Paraison Lauren , Vasichko Paula E. , Ramsey Patrick S. , Acosta Ometeotl M.
Published: April 2018

INTRODUCTION:

Between 1999 and 2013, the prevalence of neonatal abstinence syndrome (NAS) in the United States increased almost 300%. Regional differences in the NAS prevalence highlight the need for comprehensive prevention strategies for opioid use disorder (OUD) in pregnancy. Our objective was to assess the presence of legislation requiring reporting of OUD in pregnancy, as well as available treatment resources.

METHODS:

We surveyed each state for existing laws or pending legislation requiring reporting of OUD in pregnancy by searching state government websites for keywords/phrases and contacted state officials directly to confirm the presence or absence of pertinent legislation. Information treatment resources offered and priority access to pregnant women was also collected.

RESULTS:

Fifteen states have active legislation for reporting OUD in pregnancy. Eighteen states treat OUD in pregnancy as child abuse. Twenty-five states provide priority access to pregnant women with OUD. The states not requiring reporting of OUD in pregnancy had a higher prevalence of NAS.

CONCLUSION:

Less than half of states have active legislation requiring OUD in pregnancy reporting. The rising prevalence and healthcare costs associated with NAS continue to confirm the need for legislation and comprehensive guidelines for opioid prescribing in each state, as well as the establishment of treatment resources for our pregnant patient population.
Nuchal Fold Thickness (NFT) in Male versus Female Fetus in Gender Discordant Twins [17E]
Authors: Soni Shelly , Rochelson Burton , Blitz Matthew J. , Vohra Nidhi , Pessel Caroline D.
Published: April 2018

INTRODUCTION:

To evaluate second trimester nuchal fold thickness (NFT) in male versus female fetuses in gender-discordant dizygotic twin pregnancies.

METHODS:

Case control study of dizygotic twin pregnancies receiving second trimester fetal nuchal fold measurements identified from a search of ultrasound and cytogenetic databases. Structurally normal fetuses that delivered beyond 30 weeks of gestational age without known chromosomal aberrations were included. NFT was compared in male versus female fetuses using paired t-test.

RESULTS:

220 dizygotic twin pregnancies were included. Male fetuses had a higher mean NFT as compared to female fetuses in the entire cohort (3.7 mm in males versus 3.5 mm in females, p < 0.0001, 95% CI 0.3-0.1). Data was stratified based on gestational age. There was a gradual increase in NFT with an increase in gestational age. Male fetuses had a higher NFT through all the gestational ages.

CONCLUSION:

Male fetuses had a higher mean NFT as compared to female fetuses in gender-discordant dizygotic twin pregnancies.
Outcomes of Mothers and Children at Five Years After Cesarean Versus Vaginal Delivery [22E]
Authors: Ranjit Anju , Jiang Wei , Little Sarah , Witkop Catherine , Haider Adil , Robinson Julian
Published: April 2018

INTRODUCTION:

The objective of this study was to determine whether outcomes of mothers and children at five years vary after cesarean versus vaginal delivery.

METHODS:

TRICARE (universal insurance coverage to all members of US Armed Services and their dependents) data was used to identify mother-infant pairs who delivered between 2007 and 2009 and had continuous enrollment for 5 years. Maternal complications (chronic pelvic pain, endometriosis, fistula, prolapse), and infant complications (asthma, acute respiratory illness (ARI) (>2/year), chronic respiratory illness (CRI), gastrointestinal allergies) within five years were compared between women delivered via cesarean as compared with those with a vaginal delivery using logistic regression adjusted for demographic, clinical and hospital characteristics.

RESULTS:

A total of 141,317 mother-infant pairs were identified:105,980 (74.9%) had a vaginal delivery and 35,337 (25.1%) had a cesarean delivery. Women with gestational diabetes (8.7%vs.4.9%) and pregnancy-related hypertension (17.3%vs.8.3%) were more likely to have had a cesarean delivery (p<0.001 for both). Mothers who had a cesarean delivery were more likely to have chronic pelvic pain (13.9%vs.4.6%, OR[CI]: 4.07[3.61-4.47]) and endometriosis (4.2%vs.2.9%, OR[CI]: 1.59[1.32-1.91]) within 5 years of delivery. Similarly, children born via a cesarean delivery were more likely to have asthma (OR[CI]:1.16[1.02-1.64]), ARI(OR[CI]: 1.19[1.13-1.37]) and CRI(OR[CI]: 1.16[1.04-1.29]) within 5 years of delivery.

CONCLUSION:

Cesarean delivery is associated an increased risk of maternal complications (chronic pain, endometriosis) and infant complications (asthma and acute/chronic respiratory illness) within the first 5 years of delivery. Such findings can inform decisions about mode of delivery, when cesarean delivery is not otherwise indicated.
The Effect of Hospitalization on Mood in Pregnancy [24E]
Authors: Hines Katherine N. , Mead Julia , Pelletier Carole-Anne , Hanson Shannon , Lovato James , Quinn Kristen H.
Published: April 2018

INTRODUCTION:

Depression and stress in pregnancy have been linked with poor obstetrical outcomes. It is unknown whether hospitalization in pregnancy increases depression or stress. The goal of this study is to determine the effect of hospitalization and length of stay on depression and stress levels.

METHODS:

Prospective cohort study evaluating patients admitted to the High Risk Obstetrics Antepartum Service. Demographic data was collected. The Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered on admission, weekly, and upon discharge. Primary outcome was to determine effects of hospitalization on levels of depression/stress; and evaluate effects of length of stay. Data were evaluated using the Wilcoxon signed rank sum test and linear regression as appropriate.

RESULTS:

Data on 40 women are included. Mean gestational age on admission was 27.2 (range: 6.6-36.1) weeks, mean length of stay was 16.3 (range: 2-37) days. No difference was observed between median admission and discharge EPDS scores; 10 (inter-quartile range (IQR) 5-13);8.5 (IQR 4.0-15.5) (P=.63). Similarly, no difference was observed between median admission and discharge PSS-10 scores; 19.5 (IQR 14.5-24.0); 17.0 (IQR 12.0-23.0) (P=.42). Length of stay did not significantly impact scores (PSS: P=.88, EPDS: P=.22). Half of our cohort demonstrated signs of clinical depression on admission. 20% (n=8) of patients indicated thoughts of self- harm during their hospitalization.

CONCLUSION:

While we found no effect of length of stay on our measures of stress and depression, our data highlight the significant psychological needs of hospitalized pregnant patients and demonstrate the prevalence of thoughts of self-harm and depression.
Tay-Sachs: An Ashkenazi Jewish Disease or Not? [26E]
Authors: Echeverri Natalia , Terhaar Catherine , Bardos Jonah D. , Longman Ryan
Published: April 2018

INTRODUCTION:

Tay-Sachs disease (TSD) is an autosomal recessive disorder characterized by progressive neurodegeneration leading to total incapacitation and death by age four. Currently, carrier testing for TSD is recommended for the Ashkenazi Jewish (AJ) population. A joint ACOG/ACMG statement highlighted the increasingly multi-ethnic society as consideration for pan-ethnic carrier testing, and recent ACOG committee opinion states that pan-ethnic carrier testing is a reasonable strategy. This study assesses how many non-AJ Caucasian individuals screened positive for TSD when pan-ethnic carrier screening was implemented.

METHODS:

Retrospective database analysis of individuals that received expanded carrier testing utilizing a genotyping panel for nine pathologic variants of TSD (1278+TATC, IVS12+1G>C, IVS7+1G>A, IVS9+1G>A, p.G269S, p.R178H, p.R247W, P.R249W, del7.6kb). Expected number of positive carriers for TSD in AJ and Caucasian groups were calculated and compared to observed rates. Chi-square analysis was performed to assess for statistical significance (p < 0.01).

RESULTS:

A total of 71,829 individuals were tested for TSD. A higher than expected number of Caucasian individuals screened positive for TSD (110 observed vs 58.48 expected, p<0.001). The number of AJ individuals that screened positive was consistent with expected values (33 observed vs 31.14 expected, p<0.88).

CONCLUSION:

Caucasian carriers of TSD were more common than expected in this cohort. Pan-ethnic expanded carrier testing will increase the detection of carriers for TSD compared with current ethnicity based screening recommendations. Importantly, carriers of TSD, who would be missed by ethnicity based testing convention, will be identified allowing for more complete genetic counseling and family planning options for those who choose testing.
Factors Associated with Patient Satisfaction during Labor: A Quality Improvement Study [28E]
Authors: Menichini Daniela , Longo Monica , Chen Han-Yang , Viteri Molina Oscar A. , Blackwell Sean C. , Sibai Baha M.
Published: April 2018

INTRODUCTION:

It is known that a positive birth experience is associated with an increased mother-child bond and maternal self-esteem. Thus, it is important to identify those factors playing a role with a positive birth experience. Our goal was to evaluate the association between patient satisfaction and maternal characteristics, management of labor and neonatal outcome using a patient satisfaction survey as a tool of health care quality.

METHODS:

A validated Labor and Delivery Satisfaction Index (LADSI) survey was administered to puerperal women on the first day post-partum, from November 2016 to January 2017. The primary outcome was patient satisfaction, defined as the total LADSI score. Maternal demographics, obstetrics characteristics and neonatal outcomes, relevant to maternal satisfaction, were collected. Univariate analysis, followed by a multivariate quantile regression analysis, were performed to examine the association between the study variables and LADSI score.

RESULTS:

Of the 312 women that participated in the study, 93% completed the survey. Our findings show that women managed by private providers are more satisfied than those managed by university providers (220, 201-226 vs 212, 196-223), p=0.017. Vaginal delivery is associated with a better birthing experience compared to cesarean section (220, 205-228 vs 210.5, 200-227, p=0.001). Patient satisfaction score is not associated with other demographics/obstetrics variables and neonatal outcomes. Multivariate quantile regression confirmed that private provider (βcoefficient=7.79, p=0.04) and vaginal delivery (βcoefficient=8.97, p=0.02) were significantly associated with a higher LADSI score.

CONCLUSION:

This study showed that women undergoing labor have a better birth experience when managed by a private provider and delivered vaginally.
Predictive Factors for the Development of Severe Hypocalcaemia during Surgery for Morbidly Adherent Placenta (MAP) [29E]
Authors: Erfani Hadi , Fox Karin A. , Shamshirsaz Amir , Hui Shiu-Ki , Shamshirsaz Alireza , Belfort Michael A.
Published: April 2018

INTRODUCTION:

Acute severe hypocalcemia is a life-threatening complication of massive blood transfusion that requires prompt treatment. Our objective was to determine potential predictive factors for severe hypocalcaemia in patients undergoing cesarean hysterectomy for MAP.

METHODS:

Retrospective study of 123 patients with pathologically proven MAP (accreta, increta or percreta) who underwent cesarean hysterectomy in our center between January 2011 and February 2017. Cases: critically low (“panic level”) serum total Calcium (≤ 7mg/dL) and Controls: normal serum total Calcium (≥8.5). Regression and ROC analyses were performed.

RESULTS:

There 13 cases with critically low Calcium and 18 controls with normal Calcium levels. Baseline patient characteristics were not different. The median estimated blood loss (EBL), units of PRBC’s and volume of crystalloid (CT), were higher in the low Calcium group. 6/13 (46.2%) cases had received > 4 units of PRBC’s during surgery versus 2/18 (11.1%) controls (P = 0.04). ROC showed that EBL, units of PRBC’s and CT were useful in distinguishing patients who developed severe hypocalcaemia. Moreover, univariate regression analysis revealed that patients with EBL > 1500ml, those who received ≥4 units of PRBC’s [OR = 6.9 (1.1-42.8)] and those with CT ≥4L [OR = 16.7 (2.8-99.7)] were at increased risk of developing severe hypocalcaemia.

CONCLUSION:

Transfusion of ≥4 units PRBC’s and ≥4L crystalloid predict severe hypocalcaemia in MAP. These interventions are causally linked to EBL>1500ml. These data support the empiric replacement of calcium chloride after >4 units of PRBC’s or >4L of crystalloid are rapidly transfused during cesarean hysterectomy for MAP.
Factors Associated with Cesarean Delivery in Myelomeningocele Pregnancies [35E]
Authors: Rossi Robert , DeFranco Emily
Published: April 2018

INTRODUCTION:

Myelomeningocele (MMC) complicates 1 in 2000 pregnancies in the United States. Mode of delivery for myelomeningocele (MMC) is controversial but there is limited data to support the benefit of cesarean delivery (CD). We sought to determine the rate of CD and characteristics associated with CD in MMC pregnancies.

METHODS:

Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of CD, obtained from birth certificate data, was reported for women with a singleton, isolated MMC pregnancy. Obstetric characteristics were compared between women who underwent CD compared to vaginal delivery (VD).

RESULTS:

Of 1,409,231 live births in Ohio during the 10-year study period, 355 (0.02%) women had a singleton infant with MMC. Of these pregnancies, 70.7% (n=251/355) underwent a CD. While the rate of CD increased from 64.7 to 76.1% (p=0.02) in births after 2010 (2011-2015) compared to before (2006-2010), the rate of induction decreased (15.7 vs 8.5%, p=0.04). The CD rate for women delivering at an academic center was 83.8 vs 62.6% (p<0.001) compared to those who delivered at a community hospital. Factors associated with CD included delivery at an academic center (aOR 4.2, 95%CI 2.3-7.8) and delivery in the latter-half of the study period (aOR, 2.0, 95%CI 1.2-3.5).

CONCLUSION:

Approximately 7 in 10 women with MMC pregnancy delivered by cesarean. Delivery at an academic center was associated with a 4-fold increase in CD. Additionally, there was a temporal rise in CD rates across the 10-yr period correlating with decreased IOL suggesting a rise in planned CD by providers, particularly at academic centers.
An Evaluation of the Impact of Global Health Training Programs in Obstetrics and Gynecology Residency Programs [3M]
Authors: Trivedi Shivika , Haddad Lisa , Narvaez Jennifer , Walker Elizabeth , Jamieson Denise J. , Lathrop Eva
Published: April 2018

INTRODUCTION:

Although the number of Global Health Training (GHT) programs in obstetrics and gynecology (OB/GYN) residencies has increased, few studies exist describing their programmatic work. We aimed to evaluate the contributions of GHT programs by assessing impact, reciprocity and whether global health goals were addressed.

METHODS:

This cross-sectional observational study identified all U.S. OB/GYN residencies with GHT programs and evaluated the publications resulting from them. Eligible articles included those published in 2009-2014 about work done in a GHT location by GHT faculty. All eligible articles were used to calculate an H-index for each institution as a proxy for impact. The inclusion of host authors on articles served as a proxy for reciprocity. Article content was assessed to evaluate whether programs addressed Millennium Development Goals (MDG).

RESULTS:

Among 245 OB/GYN residencies, 193 (80%) had GHT programs. Of these, 26 (14%) had faculty who had published articles meeting inclusion criteria and the H-indices per institution ranged from zero to 17. Of 698 articles reviewed, 95% of articles included one or more host country authors and 78% addressed at least one MDG, including 39% that addressed improving maternal health (MDG 5).

CONCLUSION:

Most OB/GYN residencies are offering GHT. The majority of programmatic work addresses MDG and thus is aligned with global health priorities. The impact and reciprocity of GHT programs varies across institutions. Residencies could benefit from internal analysis of their GHT programs to evaluate if knowledge gained is being disseminated, and to ensure equitable partnerships and the creation of sustainable, impactful initiatives.
Spring Into Wellness: An ACOG District VI Initiative [4M]
Authors: Barnard Emily , Zeal Carley , Mallen Adrianne , Hall Evelyn , Lyerly Kristin , Brincat Cynthia
Published: April 2018

INTRODUCTION:

In the setting of physician shortages and increasing burnout, we sought to challenge the historically competing interests of wellness and residency. The aim of our project, Spring Into Wellness, was to foster well-being in our District while encouraging community and collaboration between residency programs.

METHODS:

Prior to initiating the project, we used the WHO-5 Well Being Index, a validated assessment tool measuring five aspects of wellness, to survey Junior Fellows in Training (JFs) from ACOG District VI. A JF Wellness committee planned weekly themes during April 2017, highlighting Nutritional, Emotional, Physical, and Community Wellness. Daily e-mails encouraged participation which was tracked using postings on social media (Facebook®). Funding for weekly winning residency programs was provided by Fellows in District VI.

RESULTS:

110 out of 466 eligible residents completed surveys (23.6%). More than half of the time JFs were “interested” in their work (76.4%) and “felt cheerful” (77.3%). However, less than half of the time 78.0% “woke up feeling fresh and rested” and 67.9% “felt active and vigorous.” 8 of 24 programs participated in wellness month, posting 72 entries on social media. Three winning programs received cash prizes. Social media posts declined from week one (23) to week four (0).

CONCLUSION:

A wellness initiative meets an obvious need in JF training programs. While our program met with initial enthusiasm, as the month progressed this waned. Our initiative is accessible and could translate to other Districts and residencies. Future improvements include transitioning to a condensed wellness week, a follow up survey, and encouraging faculty participation.
The Knowledge and Comfort of Urban Obstetricians and Gynecologists In Taking Patient Sexual Histories [11M]
Authors: Kon Maria , Brustman Lois , Ganz Eric
Published: April 2018

INTRODUCTION:

Public awareness of sexual-orientation and gender-identity diversity has grown, yet studies show that physicians are not comfortable taking complete sexual histories, which would address this diversity in behaviors, to benefit the physical and mental health of their patients. Medical schools and residency programs provide insufficient preparation. The objective of this study was to raise the physician participants’ awareness and gauge their interest in additional education.

METHODS:

We conducted an anonymous online survey among New York City (NYC) resident and attending obstetrician-gynecologists (OB/GYN’s). Likert items were used to gauge comfort levels in discussing sexual behavior generally, and regarding specific acts. Chi-square and Fisher-exact tests were used in the analysis.

RESULTS:

92 OB/GYN’s responded to the survey. 19 of 92 (20.6%) were uncomfortable or only somewhat comfortable discussing general sexual behavior with patients. Responder’s gender did not affect the distribution of responses. Physicians with more training (PGY-5 and beyond) were significantly more likely to be comfortable discussing masturbation and sex toys (22/34 vs 22/52, P=.042); libido and dyspareunia (35/35 vs 36/52, P=.0003), and sexual activity of elderly patients (31/34 vs 35/52, P=.01). 72 of 88 respondents (81.8%) wanted to learn more about the topic. 83 of 88 respondents (94.3%) would appreciate further education.

CONCLUSION:

This survey demonstrated the need for more formal education on sexual behavior, sexual health, and especially, alternative lifestyles, for both newly trained and experienced gynecologists. We hope to promote curriculum changes at Mount Sinai St. Luke’s and Mount Sinai West, for the diverse patient population in NYC.
Resident Advocate Development Program: Feasibility of a Novel Advocacy Curriculum in Obstetrics and Gynecology [12M]
Authors: Aksel Sarp
Published: April 2018

INTRODUCTION:

Lawmakers across the United States are increasingly passing legislation that interferes with the patient-physician relationship and ignores physician voices. Residents must learn to critically assess healthcare policy and develop the skills necessary to advocate for their patients and their specialty. Despite the Council on Resident Education in Obstetrics and Gynecology’s inclusion of advocacy as an educational objective, no longitudinal, comprehensive curriculum on advocacy education exists in obstetrics and gynecology residencies. The Resident Advocate Development (RAD) Program was developed as a comprehensive, multi-faceted resident education program, integrating didactics, peer-reviewed articles, skills-building workshops, and legislative lobby days. The purpose of this study is to evaluate feasibility of and resident satisfaction with a novel advocacy training curriculum.

METHODS:

Obstetrics and gynecology residents at Montefiore Medical Center were recruited for participation in the pilot program between January 2017 and June 2017. Qualitative interviews were conducted with program participants at the end of the pilot program to gain insight into the curriculum’s perceived importance, strengths, and weaknesses.

RESULTS:

Nine residents participated in the pilot program. In-person interviews with each demonstrated high levels of satisfaction with didactics, skills-building workshops, and participation in legislative lobby days. Notable areas for improvement included increasing acceptance of advocacy as a resident responsibility and use of legislative visit simulations.

CONCLUSION:

This feasibility study demonstrates how a residency advocacy curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
Assessing Screening Process at Wesley Women’s Clinic to Improve HPV Vaccination [15M]
Authors: Woods Maggie , Markham Claire , Duong Jennifer , Kuhlmann Zachary
Published: April 2018

INTRODUCTION:

The lifetime cumulative risk of developing a human papilloma virus (HPV) infection is at least 80%. HPV infection has been shown to cause cervical cell abnormalities that serve as precursors to dysplasia and cancerous changes. This project aimed to evaluate the HPV vaccination screening process at Wesley Women’s Clinic (WWC) in order to increase the number of patients who are offered the HPV vaccine.

METHODS:

We retrospectively reviewed well-woman visits and postpartum visits at WWC for women ages 20-26 from January through February 2017. Only non-immune patients (have not received any HPV vaccination) were included. Cases were assessed to determine whether clinicians discussed the HPV immunization, recommended the HPV vaccination, and whether it was administered.

RESULTS:

Of 48 patients reviewed, 36 were included. The majority of the patients (52.8%, n=19) were seen for a postpartum visit, and mean age was 22.9±2.14 years old (range: 20-26). Eight (22.2%) patients had the HPV vaccination discussed at their appointment. Six (16.7%) patients were offered vaccination. Two (5.6%) patients declined the vaccine before the physician offered vaccination. Four (11.1%) patients received a HPV vaccination dose. When vaccination was discussed, it was not administered to 50% (4/8) of patients due to inability to afford the vaccine and patient refusal.

CONCLUSION:

HPV vaccination is poor due to lack of physician discussion at routine health maintenance visits and patient refusal. Steps to improve HPV vaccination rates include modifying the electronic medical record to include a vaccination history on the postpartum visit template, and creating a well-woman exam visit template.
Upstream Care: Examining Preconception Diabetes Education Among At-Risk Adolescent Women in an Academic Setting [14M]
Authors: Boevers Emily , Andrews Janet , Syrop Craig
Published: April 2018

INTRODUCTION:

Diabetes mellitus (DM) in pregnancy produces adverse outcomes with significant human and economic costs. Potential lifetime cost savings of preventative preconception counseling for women with diabetes may reach $4.3 billion (U.S.) (Peterson et al, 2015). What opportunity exists to impact glycemic control before, and during, pregnancy by effective preconception diabetes education for adolescent women? This study assessed the current extent of preconception DM-related reproductive risk education to better inform the opportunity for an intervention.

METHODS:

We reviewed the electronic medical records (EMR) of females (N=70), ages 16-19, seen in the Pediatric Endocrinology clinic (2013-2016) and diagnosed with type 1 DM, type 2 DM, or insulin resistance. Any reproductive risks education documentation by providers, nursing or educators within Pediatric Endocrinology, or within consults to Nutrition or Obstetrics and Gynecology was accepted.

RESULTS:

According to EMR documentation, patient education for non-reproductive medical needs and complications of DM were consistently present in this population: 95.7% of patients received general education with at least 4/8 components. However, documented education regarding DM reproductive risks occurred for only 18.5% of the same patients while contraceptive use discussion occurred for 20%.

CONCLUSION:

The potential benefits of upstream, or preconception, education may include achieving recommended glucose control preceding and during pregnancy with fewer downstream maternal and fetal adverse outcomes. Although limited by the single site, retrospective design and the unknown rate of reproductive education documentation failure, our findings reveal a performance gap of potential downstream medical significance. Recognizing this deficiency provides an opportunity for a population-based intervention to improve health outcomes.
Provider-Patient Communication of Personal Breast Cancer Risk (BCR): Providers’ Beliefs [18M]
Authors: Abittan Baruch , Herman Sarah , Herman Jonathan
Published: April 2018

INTRODUCTION:

A woman’s understanding of her own breast cancer risk (BCR) is an important precursor for care. Patients rely on their providers for accurate information and advice. The objective of this study was to understand the beliefs, practices and perceptions of providers in the primary female healthcare field, considering three areas: communication of mammography results, discussion of BCR with patients, and calculation of BCR for patients.

METHODS:

An online questionnaire consisting of 47 questions was administered between July and September of 2013 to Long Island-based women’s health providers. Participants (N=174) consisted of 88 physicians (51%), 44 obstetric and gynecology resident physicians (25%), 29 midwives (17%), 7 nurse practitioners (4%), and 6 physician assistants (3%).

RESULTS:

82% of providers agree that it is important to convey mammography results to their patients. 79% believe that it is important to discuss personal BCR with one’s patient, but only 40% feel that it is important to calculate a patient's BCR. 14% of providers reported that they actually calculate personal BCR at every well visit, and an additional 19% report calculating personal BCR if prompted by the patient. 57% admit to not calculating personal BCR for their patients. 51% of providers report that they actually discuss personal BCR at every well visit, and another 30% discuss BCR if prompted by their patient. 9% of practitioners report that they do not discuss personal BCR.

CONCLUSION:

Understanding of providers’ beliefs and practices is an initial step in improving communication of personal breast cancer risk between provider and patient.
Effects of Adverse Childhood Experiences on Female Sexual Quality of Life [22M]
Authors: Mae Delara Rykoff Ritchie , Cottrell Connie , Savitski Jennifer
Published: April 2018

INTRODUCTION:

Sexual quality of life serves a prominent role in overall patient health and well-being. Adverse childhood events have been shown to not only factor into the development of chronic disease such as ischemic heart disease and cancer but to also negatively impact sexual health. Our study sought to determine the association between reported adverse childhood experiences and female sexual quality of life.

METHODS:

This is a cross-sectional survey study that included 100 women seeking care at a Cleveland Clinic Akron General obstetrical and/or gynecologic office in Akron, Ohio. Two validated surveys, Adverse Childhood Experiences (ACE) and Sexual Quality of Life-Female (SQOL-F), were distributed to women age 18 and older. SQOL-F questionnaire items were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. Spearman’s rank correlation was employed to determine the relationship between ACE scores and overall sexual quality of life and the four SQOL-F sub-scales.

RESULTS:

There was no significant correlation between ACE score and overall sexual quality of life. An increasing ACE score was significantly correlated to feelings of self-worthlessness and poor psychosexual feelings (p = 0.01).

CONCLUSION:

Data indicated that adverse childhood experiences do not play a role in the overall sexual quality of life for women however instead may influence self-confidence and personal perceptions towards sexual experiences. Primary care physicians should consider screening for adverse childhood experiences and possibly suggesting psychological interventions to improve patient perception of self and in turn improve sexual quality of life.
The Impact of Obstetric Mental Health Services on Delivery Location [25M]
Authors: Nguyen Diem-Tran , Valji Farida , Prescott Jessica E. , Ihenacho Ugonna , Sobrinho Giovanna , Dossett Emily C.
Published: April 2018

INTRODUCTION:

Women who receive prenatal care at our urban, safety-net hospital frequently deliver at outside hospitals. For perinatal women with mental illness, lack of continuity is problematic. We assessed whether participation in Obstetric Mental Health services (OBMH), a program integrating mental health services with prenatal care, is associated with increased delivery rates at our medical center compared to outside hospitals.

METHODS:

Referrals to OBMH between July 2014 and October 2016 were retrospectively identified. Prenatal care and OBMH adherence were defined per ACOG guidelines and attending at least two OBMH appointments respectively. An exploratory analysis defined OBMH adherence as five or more appointments. The association of OBMH and prenatal care adherence to delivery location was determined with chi-squared tests. Stratified analysis based on prenatal care adherence was used to determine the relative contribution of OBMH.

RESULTS:

A total of 138 pregnant patients with live births were identified. Seventy were adherent to prenatal care, 76 were adherent to 2 OBMH appointments, and 100 delivered at our hospital. Adherence to prenatal care, OBMH, and to both were each associated with delivery at our hospital (P<0.0001, P=0.0232, and P<0.0001 respectively). After stratification by prenatal care adherence, OBMH adherence was not associated with delivery location. More stringent OBMH adherence was associated with delivery location (P=0.0261), but not after adjustment for multiple comparisons.

CONCLUSION:

Prenatal care and OBMH adherence are associated with delivery location. Fewer OBMH appointments did not independently contribute to delivery at our hospital, and more appointments - suggesting greater engagement with care - may contribute.
Assessing Barriers to Cervical Cancer Screening in a Rural Nicaraguan Community [26M]
Authors: Pargas Anaisy , Wood Nicole , Romero Stephanie
Published: April 2018

INTRODUCTION:

Cervical cancer is the leading cause of cancer-related deaths in Nicaragua - an estimated 18.43 deaths per 100,000 females in 2011. Access to health care is difficult in many Latin American countries due to educational, socioeconomic, and cultural barriers. The objective of this study was to identify specific barriers to screening adherence in a rural Nicaraguan community through qualitative measures in an effort to create a protocol to address them.

METHODS:

Through a community health initiative, eligible women (n=40) were invited to attend small group sessions hosted by local community leaders (n=11). Sessions were private to encourage candid conversation amongst participants. Data collected through questionnaires and structured discussion. All discussion topics were archived by researchers and coded for categories for qualitative analysis.

RESULTS:

Participants identified multiple barriers to effective cervical cancer prevention in their community based on personal experience. Qualitative data was assigned to categories to develop the following themes: 1-Education barriers - poor health literacy, 2-Financial or physical barriers - Travel and clinic availability, 3-Familial, marital, religious barriers - community stigma, and 4-Fear of diagnosis or cancer. All participants agreed on the need to prevent cervical cancer and increase awareness in their community.

CONCLUSION:

Our findings suggest that barriers to adequate cervical cancer prevention encompass several aspects of daily living for women in rural Nicaragua. Addressing these barriers to facilitate solutions may make the difference between life and death for these women. Additional studies will use identified themes for further survey development and program improvement to enhance cervical cancer prevention in this community.
Risk Screening for Hereditary Cancer During Obstetrical Care: Barriers to Testing and Health Disparities [27M]
Authors: Lua Lannah L. , Jackson David , Foggia Megan , Rosenbaum Amy
Published: April 2018

INTRODUCTION:

Hereditary cancer screening performed during routine prenatal care may identify mutation positive women years before disease progression. Our primary goal was to quantify the acceptance and efficacy of a focused cancer screening program initiated during pregnancy intake. Our secondary goal was to determine if at-risk patients who accept gene testing have barriers to obtaining mutation screening.

METHODS:

In this prospective study, a self-administered cancer history questionnaire was obtained at the first prenatal visit in three urban clinics from February 2015 to April 2016. National Comprehensive Cancer Network criteria identified patients for additional information regarding BRCA or Lynch mutation testing. Patients at increased risk received immediate physician counseling and were also offered genetic counseling. Desire for mutation screening and barriers to completing genetic testing were quantified.

RESULTS:

There were 942 patients screened. The at-risk prevalence was 11.4% (n=107/942). Acceptance for gene testing was 33.6% (n=36/107). Mean age of at-risk/criteria-positive patients was 27.9 +/- 6.8 years (range 15-43). Among at-risk patients, 33.6% were Non-Hispanic White, 29.0% were Hispanic, and 27.1% were African American. Financial barriers, insurance denials, and poor access to genetic counselors limited testing to less than 5% of those who requested it.

CONCLUSION:

Obstetrical consultation is a potential “teachable moment” in hereditary cancer screening. A health disparity exists when patients cannot obtain the desired testing due to financial limitations. Future studies should be structured to remove financial barriers to genetic counseling and mutation testing. If successful, the paradigm of screening during obstetrical care could potentially identify at-risk women decades before disease development.
Satisfaction with Subsequent Delivery Route Among Women Following Obstetric Anal Sphincter Injury [38M]
Authors: Edwards Madeline G. , Suresh Shriya , Kobernik Emily , Fenner Dee , Swenson Carolyn W.
Published: April 2018

INTRODUCTION:

We sought to assess women’s satisfaction with delivery route of their subsequent delivery following one with an obstetric anal sphincter injury (OASIS).

METHODS:

A survey study was conducted from July to September 2017 among women seen in a specialty postpartum perineal clinic at a tertiary teaching hospital following a vaginal delivery with an OASIS and who had a subsequent delivery from March 2012 to December 2016. Women were mailed a 13-item questionnaire addressing counseling after their OASIS and satisfaction with route of subsequent delivery. Satisfaction was assessed with a modified Decision Regret Scale. Bivariate analyses were used to compare women who were and were not satisfied with route of subsequent delivery.

RESULTS:

Among 115 eligible women, 43 completed the survey. The majority (n=35, 81.4%) had a subsequent vaginal delivery, and 8 (18.6%) had a subsequent cesarean delivery. 34.9% (n=15) reported the counseling they received after the OASIS influenced their decision regarding route of subsequent delivery. Half (48.8%, N=21) had no regret regarding their decision on subsequent delivery route while 16 (36%) had mild, and 6 (14%) had moderate/severe regret. Regret was associated with age, (none: 36.2 ± 3.9 vs mild: 36.5 ± 3.3 vs moderate/severe: 41.1 ± 53.4 years, p = 0.02) and with difficulty holding stool (none: 9.5% vs mild: 18.8% vs moderate/severe: 83.3%, p=.002).

CONCLUSION:

Most women with an obstetric anal sphincter injury laceration will choose a repeat vaginal delivery and half are satisfied with this decision. Age and difficulty holding stool were associated with regret regarding subsequent delivery mode.