bluuebunny/crossref_metadata_2025 huggingface dataset:
24-Hour Compared With 12-Hour Mifepristone–Misoprostol Interval for Second-Trimester Abortion: A Randomized Controlled Trial [ID 2683386]
Authors: Meyer Raanan , Toussia-Cohen Shlomi , Shats Maya , Segal Omri , Blumenthal Paul D. , Mashiach Roy
Published: May 2024

INTRODUCTION:

We aimed to compare 24- and 12-hour mifepristone to misoprostol intervals for second-trimester medical abortion.

METHODS:

This was a prospective randomized controlled trial. Women were allocated to receive mifepristone either 24 or 12 hours before misoprostol administration. The primary outcome was time from mifepristone administration to fetal expulsion and from first misoprostol administration to fetal expulsion.

RESULTS:

Eighty women were enrolled between July 2020 and June 2023, 40 women per group. Baseline characteristics were comparable between groups. Median time from mifepristone to fetal expulsion was 33.0 and 24.5 hours in the 24- and 12-hour interval groups, respectively (P<.001). Median time from first misoprostol dose to fetal expulsion was 9.5 and 12.5 hours in the 24- and 12-hour interval arms, respectively (P=.028). At 12 hours from misoprostol administration, 25 (62.5%) and 18 (45.0%) of women in the 24- and 12-hour arms completed abortion (P=.178). At 24 hours from misoprostol administration, 36 (90.0%) and 30 (75.0%) in the 24- and 12-hour arms had complete abortion (P=.139). Need for additional medical and/or surgical treatment for uterine evacuation were comparable between groups. Pain scores, side effects, and satisfaction levels were similar in both groups.

CONCLUSION:

A 12-hour mifepristone-to-misoprostol regimen for medical abortion in the second trimester provides an 8.5-hour shorter mifepristone-to-fetal-expulsion rate compared with the 24-hour interval. However, misoprostol-to-fetal-expulsion time is 3 hours longer in the 12-hour interval regimen. Medical regimen success rate, side effects, and satisfaction levels are also similar. These findings can aid in shared decision-making prior to medical abortion in the second trimester.
Effect of Dobbs v. Jackson Women's Health on Obstetrics and Gynecology Residency Applicants [ID 2683390]
Authors: Frame Brianna , Vrooman Hannah , Beckham Aileen J.
Published: May 2024

INTRODUCTION:

Abortion restrictions affect not only provision of abortion care but also experience for trainees. Data from the 2023 match showed a decrease in obstetrics and gynecology residency applications in restrictive states. Our national survey of medical students applying to obstetrics and gynecology residency sought to assess the effects of the Dobbs decision on their application process.

METHODS:

Medical students who applied to obstetrics and gynecology residency for the 2023 match were surveyed via an electronic questionnaire. Convenience sampling was used. Institutional review board waiver was granted.

RESULTS:

One hundred seventy-eight students, from 39 different states, completed the survey. The average age was 27.8 years, and the majority identified as women (89%) and White (80.9%). The majority (72.7%) of respondents reported that the Dobbs decision influenced which residency programs they applied to, and of those, 96.9% report that they applied to programs in states with fewer abortion restrictions. Similarly, 66.5% reported that the decision influenced their rank list, and of those, 98.3% report they ranked programs in states that are less restrictive on abortion services higher.

CONCLUSION:

Access to abortion training was identified as important to a majority of survey respondents. Students reported applying to states with less abortion restrictions and that access to abortion training influenced their rank list. Prior studies have surveyed third- and fourth-year students about predicted effects of the Dobbs decision on residency applications. This is the first to assess perspectives among students who completed the residency application process.
Microbiome Knowledge in the General Community [ID 2683664]
Authors: Pisciotti Alexa K. , Bachmann Gloria A. , Phillips Nancy , Rocktashel Maria
Published: May 2024

INTRODUCTION:

The Human Microbiome Project (2007–2016) has contributed to the characterization of the microbiome and its relationship to health and disease processes. This information is only beginning to be fully understood. The aim of this study was to assess the general knowledge about the microbiome in the lay population.

METHODS:

A five-question survey was administered to the general population who attended Rutgers Day 2023, an informational open house showcasing the activities of Rutgers University. The survey was distributed by our study personnel.

RESULTS:

A total of 148 useable surveys were collected. We found that 73% of respondents had heard of the microbiome. Respondents were most aware of the gut microbiome (95.2%), followed by skin (51.4%), mouth (48.6%), and nose (45.9%). Respondents recognized microbiome altering factors as follows: dietary effects (89.2%), antibiotics (79.7%), exercise (60.8%), soap (42.6%), and pets (39.2%). Relationship to disease states was recognized for weight (83.1%), diabetes (72.0%), and heart disease (62.8%). Almost 20% of respondents took a probiotic, most often for gut health. However, 8.8% felt the microbiome influenced hair and eye color, and 13.5% thought it was influenced by music.

CONCLUSION:

This brief survey confirmed that there is a general awareness of the microbiome in the lay population, but a deficit of knowledge in many areas. Despite this, almost one in five respondents used a probiotic. As further microbiome research and its ability to affect disease becomes available, accurate and evidence-based information needs to be distributed to the community.
Sexual Orientation, Gender Identity, and COVID-19 Vaccine Skepticism: A Global Assessment [ID 2683475]
Authors: Dye Timothy D. , Eckert Cody , Levandowski Brooke A. , Farovitch Lorne , Alcántara Lisette , Pressman Eva K.
Published: May 2024

INTRODUCTION:

The effect of sexual orientation (SO) and gender identity (GI) on pandemic-related behaviors is poorly understood, with conflicting prevention adherence in communities. We sought to delineate how SOGI relates to COVID vaccine skepticism to understand sexual orientation’s effect on COVID risks.

METHODS:

This analytical cross-sectional study in seven languages examined SOGI and COVID-19 vaccine skepticism in 158 countries. SO was the primary independent variable, with 4,360 people self-identifying as heterosexual, lesbian/gay, bisexual, queer, or another SO. Primary outcome was a summative scale of six four-point Likert-scale questions ascertaining COVID-19 vaccine skepticism (VSS; range: 0–18). Multivariate logistic regression rendered adjusted odds ratios (aORs) with 95% CIs. Our IRB determined that STUDY00004825 met federal/university criteria for exemption.

RESULTS:

Heterosexual men had the highest mean VSS (mVSS: 7.6; 95% CI, 7.3, 7.9), significantly higher than heterosexual women (mVSS: 6.7; 6.5, 6.9), lesbian women (mVSS: 4.8; 3.2, 6.4), and gay men (mVSS: 4.6; 3.5, 5.7). mVSS for people identifying as bisexual was 5.4 (95% CI, 4.9, 6.1), as queer was 4.5 (3.3, 5.7), and as another SO was 5.8 (4.8, 6.8). Adjusting psychosocial factors, social media use, perceived oppression, science/health care attitudes, geography, and gender, heterosexuals (aOR 2.6; 95% CI, 1.5, 4.5) and bisexuals (aOR 2.9; 1.4, 5.8) were significantly more likely to have VSS over mean than did lesbians/gays.

CONCLUSION:

Those with lesbian/gay SO were significantly less likely than those of other SOs to be skeptical of the COVID vaccine, even after controlling for important confounders, including gender. Better understanding dynamics in lesbian/gay communities that promote lower vaccine skepticism could help generate novel public health strategies for the LGBTQ+ and other communities.
ACE Scores and STI Rates Among Pregnant and Postpartum Persons at a University Hospital [ID 2683476]
Authors: Dutra Karley , Lazenby Gweneth B. , Moore Miyonta (Tay)
Published: May 2024

INTRODUCTION:

Sexually transmitted infections (STIs) have increased across the United States. Universal screening for HIV, hepatitis B, hepatitis C, and syphilis is recommended each pregnancy. Risk-based screening is recommended for chlamydia, gonorrhea, and trichomonas. Adverse childhood experiences (ACEs) quantify exposure to adverse events at age less than 18 years and are associated with risky sexual behavior. Little is known about ACEs and risk of STIs. Risk-based STI screening utilizing ACE score has the potential to improve STI diagnosis and treatment in pregnancy.

METHODS:

This is a retrospective observational cohort study of pregnant and postpartum persons who underwent ACE scoring from 2015 to 2019. High ACE score was greater than or equal to 4. Using bivariate analyses, we compared percentages of individuals with high versus low ACE scores. We used logistic regression to determine factors associated with cervicitis (gonorrhea, chlamydia, and/or trichomonas positive) and any STI positive (gonorrhea, chlamydia, trichomonas, HIV, syphilis, and/or HSV positive).

RESULTS:

Adverse childhood experience scores were available for 808 participants. 44% had Medicaid/no insurance. 71% reported White race, 28% Black, and 1.7% other. Mean ACE score was 2.9 (SD 2.5); 37% (n=300) had high ACE score. High ACE was associated with cervicitis (adjusted odds ratio [aOR] 1.762; 95% CI, 0.886–3.503) and any STI positive (aOR 1.187; 95% CI, 0.776–1.815), but not significant.

CONCLUSION:

Persons with high ACE scores were not more likely to have cervicitis or any STI positivity despite previous studies demonstrating an association to risky sexual behaviors. Our small sample size may contribute to the lack of a statistically significant association. More research is needed to determine if ACE score can be utilized in risk-based STI screening.
Human Papillomavirus Vaccination Hesitancy, Screening Disparities, and Associated Factors Among Sexual and Gender Minority Women: A Systematic Review of Global Literature [ID 2683547]
Authors: Skiba Bartosz , Nussbaum Abigail , Otero Christopher Acevedo , Khikmatov Murod
Published: May 2024

INTRODUCTION:

Human papillomavirus (HPV) ranks as the most prevalent sexually transmitted infection globally, with a significant association with cervical cancer in cervix-having individuals. Understanding the epidemiological patterns of HPV vaccination rates and behaviors within the context of sexual and gender minority (SGM) women is essential in identifying factors hindering the initiation of HPV vaccination and screening.

METHODS:

A systematic review was conducted by searching five databases (PubMed, CINAHL, Embase, Web of Sciences, MedLine). Eligibility criteria included the following: reported HPV vaccination or screening outcomes, conducted among SGM women, data collected since 2010. All studies were independently screened and synthesized following PRISMA guidelines. Of 44 items, 13 studies met the criteria.

RESULTS:

Sexual and gender minority women reported substantial HPV vaccine hesitancy and decreased screening practices compared to their non-SGM peers, with the degree of vaccine hesitancy and delayed screening varying among bisexual, lesbian, and transgender individuals. Individual factors associated with HPV vaccine hesitancy and decreased screening include socioeconomic status, vaccination awareness, and SGM identity. Meanwhile, interpersonal and structural factors include community biases, family support, lack of provider LGBTQ+ health education, and structural racism.

CONCLUSION:

Sexual and gender minority women experience a substantial health care disparity surrounding HPV vaccination hesitancy and screening status. Results from this study substantiate the need for the standardization of health care practice, individual patient vaccine counseling, and the expansion of sexual and gender minority health training at all tiers of medical education. Furthermore, additional disaggregated research is needed to understand the unique health circumstances of bisexual, lesbian, and transgender individuals, as the current research landscape fails to capture the community’s health needs.
Social Determinants of Health and Patient-Reported Difficult Removal of Long-Acting Reversible Contraception [ID 2683430]
Authors: Hall Bianca E. , Atrio Jessica , Evans Thomas A. , Danvers Antoinette
Published: May 2024

INTRODUCTION:

Lack of access to high-quality reproductive health care has been reported by persons negatively affected by social determinants of health (SDH). The inability to discontinue a contraceptive method when desired can deleteriously affect a person’s reproductive autonomy. The objective of this study is to evaluate the association of SDH with participant-reported difficult long-acting reversible contraception (LARC) removal.

METHODS:

A retrospective cross-sectional analysis of data from the 2017–2019 cycle of the National Survey of Family Growth was conducted. The main outcome was patient-reported difficulty discontinuing a LARC method (intrauterine device or implant) in the last 10 years. Descriptive statistics were used to identify demographic characteristics and SDH domains. Multivariable logistic regression models were used to estimate associations across SDH domains with difficult LARC removal.

RESULTS:

Seven hundred fifty-four respondents reported wanting to have their LARC removed. One-third of respondents experienced one or more SDH, notably food insecurity (26%) or transportation barriers (30%). 105 (11%) reported difficult LARC removal. After adjusting for age, race, education, geographic location, parity, and body mass index, persons with one or more SDH had an increased adjusted odds ratio (aOR) for difficult LARC removal compared to respondents without any SDH (2.11 [95% CI: 1.21, 3.69]). Transportation barriers demonstrated the largest aOR of 2.90 [95% CI: 1.07, 7.87].

CONCLUSION:

Social determinants of health are unique risk factors that can negatively affect reproductive justice. Social determinants of health are associated with participant-reported difficult LARC removal. Consideration of SDH at the time of contraceptive selection may be a critical step in addressing equitable and safe access to contraceptives with attention to method discontinuation.
Evaluating Contraception Counseling and Desire for Immediate Postpartum Long-Acting Contraception in Publicly Insured Adolescents [ID 2683512]
Authors: Kaak Katherine , Zite Nikki , Mastronardi Alicia , Maples Jill M. , Young Megan Lacy
Published: May 2024

INTRODUCTION:

Adolescent pregnancy is associated with a high prevalence of short interval birth and unplanned pregnancy, along with other risks. Immediate postpartum long-acting reversible contraception (IPP LARC) has the potential to improve these outcomes. This study aimed to examine the presence of counseling, desire, and obtainment of IPP LARC during hospitalization.

METHODS:

This retrospective cohort analysis used electronic health records to capture demographics, pregnancy details, and contraceptive discussions and plans for pregnant patients admitted for delivery in one East Tennessee hospital. Exclusion criteria included those with private insurance or received permanent sterilization during hospitalization. Adolescence was defined as age less than 20 years at the time of delivery. Data were extracted from March 2018 to June 2023. Chi-squared tests were conducted in SPSS.

RESULTS:

10,492 patients that met inclusion criteria delivered between March 2018 and June 2023. Of these, 10.8% (n=1,128) were adolescents. Desire for IPP LARC upon admission was higher among adolescents (31.6% versus 25.1%; P<.001). IPP LARC placement was significantly higher among adolescents (overall, 24.0% [n=2,523]; adolescents, 27.5%, versus age 20 and older, 23.6%; P=.005). Adolescents who self-reported receiving contraceptive counseling during prenatal care were more likely to receive IPP LARC (66.5% versus 42.4%; P<.001).

CONCLUSION:

In this study, prenatal contraception counseling increased patient obtainment of desired postpartum contraceptive plan, including IPP LARC. Adolescents both desired and obtained IPP LARC more frequently than their older counterparts. Improved contraceptive counseling and access to all contraceptive options, including IPP LARC, may improve teen pregnancy and birth rates.
Hospitals Are Closing in Tennessee: Investigating the Effect of Closures on Contraceptive Access and Short-Interval Birth [ID 2683524]
Authors: Young Megan Lacy , Mastronardi Alicia , Shelton Zachary , Maples Jill M. , Zite Nikki
Published: May 2024

INTRODUCTION:

Access to maternity care (MC) and providers are important factors for contraception access and health outcomes for pregnant-capable individuals. After a series of hospital closures in Tennessee in the last decade, this study investigated the relationship between maternal county of residence and short-interval birth (SIB) rates statewide.

METHODS:

Tennessee birth certificate data for 2015–2020 from the Tennessee Department of Health was coded using March of Dimes 2022 definitions of access to MC overall, a hospital with obstetric (OB) care or birth center, and an OB provider (per 10k births) based on maternal county of residence. Short-interval birth was defined as birth interval 6–23 months. Nulliparous births and those with missing last living birth interval were excluded. Analysis was completed in SPSS 29.0, and Pearson χ2 tests compared SIB proportions between MC access groups.

RESULTS:

Overall, 269,908 births were analyzed. Of these, 78.1% maternal counties of residence had full MC access, 13.9% had low access, and 8.0% resided in a MC desert. Short-interval births were highest (24.4%; CI, 23.8–25.0) in MC deserts followed by areas with full access (23.7%; CI, 23.5–23.9) and low access (22.4%; CI, 22.0–22.8) (P<.001). Those with no access to an OB provider had highest rates of SIB (24.3%: CI, 23.7–24.8) compared to other categories (P<.001).

CONCLUSION:

Lacking access to maternity care likely corresponds with lacking access to contraception and higher rates of SIB in Tennessee. Prenatal and postpartum contraception counseling are important components of care for all individuals but especially those without acceptable access to OB providers and hospitals.
Evaluating the Accuracy and Utility of Large Language Models in Answering Common Contraception Questions [ID 2683633]
Authors: Patel Anisha V. , Jasani Sona , AlAshqar Abdelrahman , Panakam Aisvarya , Amin Kanhai , Sheth Sangini S.
Published: May 2024

INTRODUCTION:

Traditional web resources that provide information on contraception produce varied results demanding user synthesis. However, direct answers provided by large language models (LLMs) can offer accessible contraception counseling. This study examines the efficacy of four LLMs, OpenAI's ChatGPT 4.0, OpenAI's ChatGPT 3.5, Google Bard, and Microsoft Bing, in answering common contraception questions.

METHODS:

Contraception questions and responses in a recent American Academy of Family Physicians (AAFP) review were used as reference text. We presented GPT-4.0, GPT-3.5, Bard, and Bing with six contraception questions from the AAFP text, ensuring no prior chat bias. Response formatting was standardized for analysis. Two ob-gyn physician reviewers (S.J. and A.A.), blinded to the source LLM, assessed responses via a 5-point Likert scale on the following criteria: response specificity, evidence basis, completeness, referrals to outside resources, and avoiding speaking in absolutes. Responses were analyzed using the Kruskal–Wallis test (SAS 9.4).

RESULTS:

The AAFP review scored highest in response specificity, evidence basis, and completeness. Large language models differed significantly on whether responses were evidence based (P<.0001), made referrals to outside resources (P<.001), or spoke in absolutes (P<.05). Notably, GPT-3.5 and Bard consistently provided referrals across all six questions, outperforming the AAFP text on this criteria. No significant differences were found across LLMs in response specificity or response completeness.

CONCLUSION:

Despite promising LLM-generated responses, the AAFP review outperformed LLMs in critical areas including evidence basis and completeness. Nonetheless, LLMs, especially GPT-3.5 and Bard, demonstrated strong potential as supplementary resources for reproductive health education.
Sterilization Surgery Trends in Texas After Passage of the Texas Heartbeat Act [ID 2683648]
Authors: Mohr-Sasson Aya , Weitzel Lindsay L. , Carlisle Steven G. , Bhalwal Asha
Published: May 2024

INTRODUCTION:

On September 1, 2021, abortion became illegal in Texas once electric embryonic cardiac activity can be detected. Before that, elective abortions were allowed up to 20 weeks postfertilization. In order to primarily avoid unwanted pregnancy, a trend for younger women to seek a definite contraception method has been observed; however, this has not been studied yet. The aim of this study was to compare the characteristics of women requesting surgical sterilization before and after the Texas Heartbeat Act went into effect.

METHODS:

This is a retrospective study including all women who underwent bilateral salpingectomy for surgical sterilization between May 2020 and November 2022. Women who underwent surgery 15 months before the new laws (controls) were compared to women who underwent surgery 15 months after the change (study group). Demographic, clinical characteristics, operative, and postoperative data were collected from women's medical files.

RESULTS:

Two hundred five women met inclusion criteria, of them 131 (64%) in the study group and 74 (36) controls. The rate of women with managed care insurance was significantly higher in the study population (P=.04). Median age was similar between the groups (P=.98). Parity was significantly higher in the controls (P=.004); however, the rate of nulliparous women more than doubled in the study population (37 [28%] versus 8 [11%]; P=.004). Surgery as first contraception method was reported in 63 (48%) and 41 (19%) of the women in the study and control groups, respectively (P=.58). Complication rate was found higher for the study group, but the difference did not reach significance [4 (3.1%) versus 0 (0); P=.13].

CONCLUSION:

Since the passage of the Texas Heartbeat Act, more women with managed care insurance were undergoing surgical sterilization. Although the mean age to undergo the surgery did not change compared to the period before the change in the law, the rate of nulliparous women preferring this method for contraception significantly increased.
Case Report of a Large Endometrioma Precipitating a Hypertensive Emergency [ID 2683395]
Authors: Vishwanath Varnita , Marchand Greg J. , Azadi Ali
Published: May 2024

INTRODUCTION:

This is a rare case of a 25-cm endometrioma in a woman who presented in a hypertensive emergency. The hypertension was believed to be secondary to the mass effect of the endometrioma on renal vasculature.

METHODS:

A 20-year-old female presented to the ED with diffuse abdominal pain, severe hypertension (190/121), and acute kidney injury (AKI) (Cr 2.4, GFR 38). At presentation, management of hypertension required intravenous hydralazine and adequate pain control. The workup included an abdominal CT that revealed a large 25×18×12-cm cystic mass. The mass was suspected to have a significant mass-effect on adjacent structures that caused bilateral hydroureteronephrosis secondary to distal ureteral compression. Management of this case began with the placement of bilateral nephrostomy tubes to improve renal function. The pelvic mass was removed with a minimally invasive robotic approach. The patient had an uneventful postoperative course with normalization of blood pressure and resolution of the AKI. Pathology confirmed the diagnosis of endometriosis. Prior to the removal of nephrostomy tubes, a nephrostogram was performed, which demonstrated appropriate drainage bilaterally. At 1 year follow-up, the patient was asymptomatic and was able to conceive. This case report was IRB-exempt.

CONCLUSION:

A multidisciplinary approach to the management of endometriosis is often warranted as it may affect organs outside of the reproductive system. In this case, the etiology of hypertension is believed to be due to mass effect of the cyst on the renal arteries. Low renal perfusion activates the renin–angiotensin–aldosterone system, releasing Angiotensin II and aldosterone, causing systemic vasoconstriction and secondary hypertension. In this case, a minimally invasive approach to remove the mass and ureterolysis resulted in the resolution of the pelvic pain, AKI, and normalization of blood pressure.
Case Series: Medical Versus Surgical Management of Cesarean Scar Pregnancy [ID 2683419]
Authors: Kadesh Amanda , Liao Connie , Sangal Alisha , Davis Patricia C. , Wieczorek William E. , DeFilippis David J.
Published: May 2024

INTRODUCTION:

Although cesarean scar pregnancy (CSP) is rare, it is a potentially fatal condition, and the incidence is rising. Treatment of CSP may consist of medical management with methotrexate or surgical management; however, a consensus regarding optimal treatment has not been well defined. This series reports our experience with management of CSP.

METHODS:

Our series included a chart review that identified 10 cases of CSP from 2020 to 2023 at a high-volume, community-based, academic hospital that serves as a surgical referral center in a metropolitan area. We obtained IRB exemption.

RESULTS:

At diagnosis of CSP, gestational age by ultrasound ranged from 5 6/7 weeks to 11 4/7 weeks. None of the pregnancies had ruptured. Eight cases reported symptoms including bleeding or abdominal pain. Six underwent surgical management: one dilation and evacuation (D&E), one D&E converted to laparotomy, two combined D&Es with robotic-assisted laparoscopic excisions, and two laparotomies with excision. Four received methotrexate: one intragestational, two dual-dose intramuscular, and one single-dose intramuscular. All surgical cases resulted in definitive resolution. Of those treated with methotrexate, three of four cases required additional methotrexate treatment. Time from initial dose of methotrexate to resolution ranged from 29 to 95 days.

CONCLUSION:

In our experience, the advancement of gynecologic surgical modalities has broadened options for CSP treatment to allow for definitive and timely management. Methotrexate remains a viable option; however, treatment failures occur and may prolong a potentially life-threatening condition. Our findings strengthen the recommendation for surgical management, consistent with SMFM guidelines. Furthermore, there is an opportunity to provide surgical training to better equip gynecologists with the ability to treat this challenging condition.
Patient Experiences With Dismissal, Delay, and Uncertainty in Diagnosis of Polycystic Ovary Syndrome [ID 2683465]
Authors: Zhang Alexander , McKenney Kathryn , Ross Kaitlin V. , Sehrt Madeleine N. , Ley Sara A. , Phimphasone-Brady Phoutdavone
Published: May 2024

INTRODUCTION:

Polycystic ovary syndrome (PCOS) affects approximately 10% of females and is underdiagnosed, undertreated, and underresearched. A majority of people with PCOS report dissatisfaction with their care experiences. We conducted focus groups to identify factors contributing to suboptimal PCOS care.

METHODS:

We conducted 60- to 90-minute virtual focus groups. Patients receiving PCOS care at a university hospital obstetrics and gynecology clinic were recruited. Participants were asked about PCOS symptoms and experiences of care. Rapid qualitative analysis was performed to identify major themes.

RESULTS:

Twenty-four participants completed focus groups. Three identified as any non-White race and eight as Hispanic or Latino; median age was 29 years. Participants' most bothersome symptoms were menstrual irregularity, unwanted hair, cystic acne, and pelvic pain. Time from symptom onset to diagnosis ranged from 2 months to 13 years. Providers’ dismissal of symptoms and failure to perform diagnostic testing contributed to diagnostic delays. Once diagnosed, participants reported feeling confused, overwhelmed, and fearful, and received little education from providers. Participants desired more information about treatment options and implications of PCOS on fertility and long-term health. Regarding initial treatment, recommendations for weight loss and prescriptions for oral contraceptives, metformin, and spironolactone were common. Referrals to nutrition and behavioral health services were rare and non-existent, respectively. Treatments focused on individual manifestations of PCOS more often than comprehensive well-being.

CONCLUSION:

Dismissal of symptoms, delays in diagnosis, and uncertainty about future health are common patient experiences in PCOS care. Our findings identify a need for improved patient resources and provider education about PCOS manifestations, diagnosis, and treatments.
Evaluating the Effect of Chronic Pelvic Pain Among Hispanic Women in Puerto Rico [ID 2683625]
Authors: Salgado-Avilés Juan , Cárdenas-Suárez Natalia , Rosado Torres Claudia S. , Seguinot-Tarafa Inevy I. , Lozada-Capriles Yolianne , Romaguera Josefina
Published: May 2024

INTRODUCTION:

Chronic pelvic pain (CPP) substantially impairs the quality of life of women, often persisting despite treatment. This study aims to describe the clinical features and evaluate the quality of life in Hispanic patients with chronic pelvic pain.

METHODS:

This was a cross-sectional study of Hispanic women aged 21–55 diagnosed with CPP. Recruitment was performed via social media and at gynecology clinics in Puerto Rico. A self-administered questionnaire was employed to inquire about their sociodemographic profile, medical history, and details to characterize their CPP. The SF-20 survey was used to evaluate quality of life. Institutional review board approval from the University of Puerto Rico was obtained for this study.

RESULTS:

Preliminary data included 92 participants with an average age of 33 (±7.4) years. Most (57.3%, 59) reported having endometriosis, in addition to their diagnosed CPP. Most participants described their suffered pain as a range from strong (30, 33.0%) to insufferable (23, 25.3%). On average, participants reported a physical function score of 60.2% (13.2) and a pain score of 60.7% (4.0). Most noted that their ability to perform their work (76.1%, 70) and their mental health (75.0%, 69) had been affected by their condition. In addition, 55.4% (51) reported an effect on their relationships with friends and 64.1% (59) reported an effect on their relationships with their partners.

CONCLUSION:

Our study highlights the effect of CPP on the quality of life of this population with notable disruptions in various aspects of daily living, including work, social relationships, and mental health.
#PapSmear on TikTok: User Sentiments and Health Information [ID 2683630]
Authors: McElrath Madelaine E. , Robb Carolyn , Akbar Aneesah , Banerjee Ipsha , D'Ascanio Antonella M. , Stifani Bianca
Published: May 2024

INTRODUCTION:

TikTok has emerged as a leading social media platform, with many users using the app for educational purposes, including for discussions about obstetrics and gynecology. We assessed tone, content, and quality of health information of TikTok videos tagged with #PapSmear.

METHODS:

One hundred videos tagged with #PapSmear on TikTok were collected using the data-scraping program, Apify (Prague, Czech Republic). Videos were extracted with their number of views, likes, comments, and shares, and analyzed for tone, themes, creator demographics and health information quality. Two modified standardized scales were used: DISCERN, for health information quality and Patient Education Materials Assessment Tool (PEMAT), for understandability and actionability.

RESULTS:

We reviewed 93 of 100 videos tagged with #PapSmear. Videos received 237 million views, 19 million likes, and 241 thousand comments in total. Videos were coded as positive (26.9%), negative (37.6%), and neutral (35.5%). Medical professionals created most of the positive videos (68.0%), whereas most negative video creators were not medical professionals (91.4%). Nearly half of positive videos were educational (48.0%), and most negative videos recounted personal patient experiences (60.0%). Videos scored high on understandability (average 73.4%, SD 16.3%) but low on actionability (average 31.9%, SD 34.1%) and quality of health information (2.12, SD 0.4).

CONCLUSION:

There is a discrepancy in tone between patients and medical professionals in videos tagged with #PapSmear. Videos with educational material were easy to understand, but provided low-quality health information and did not effectively highlight opportunities for patient action. Negative influence from TikTok should be considered in patient–provider communication about Pap smears.
The Effect of Homelessness on Management of Menstruation and Dysmenorrhea in Pomona, California [ID 2683481]
Authors: Ahuja Grace , Holtzman Stone A. , Gilmore Elisabeth , Nelson Anita L. , Fuchs Sebastien
Published: May 2024

INTRODUCTION:

Given the challenges to menstrual hygiene many women face and the high rate of homelessness in Pomona, California, we suspected women without housing would have increased difficulty managing their menstrual hygiene and dysmenorrhea primarily due to resource inaccessibility.

METHODS:

After IRB approval and beta testing, we partnered with local homeless shelters and a student-run clinic to screen for eligible participants, obtain verbal consent, and conduct anonymous interviews. Each interview lasted 15 minutes with 26 questions spanning demographics, menstrual hygiene and dysmenorrhea management, and history of homelessness.

RESULTS:

Analysis of 50 surveys (96% response rate) revealed that 37% of participants reportedly relied on shelter pantries for access to menstrual hygiene products, 27% of participants admitted to stealing their preferred products, and almost 10% of participants reported resorting to using alternate methods such as free bleeding and old clothes to catch their menstrual flow. For management of dysmenorrhea-associated painful cramping, 96% of participants reported preferring medication management but not having access to it when homeless so instead their only option was to “just deal with it” (60%).

CONCLUSION:

The results of this study illuminate the gap in existing literature regarding the specific struggles that homeless people face when managing their menstrual hygiene and dysmenorrhea. The discrepancies in management of hygiene and pain when housed versus unhoused come down to lack of access to essential resources. Shelter pantries do not have enough funding to effectively support the size and demand of the growing menstruating homeless population.
Exploring Disparities in Cancer Screening Among Women With Disabilities [ID 2683490]
Authors: Aslam Anam , Waxman Andrea , Maran Patricia
Published: May 2024

INTRODUCTION:

Unequal access to health care for individuals with disabilities is an increasingly relevant disparity. Further, accessibility to cancer screening remains inadequate. Steele et al. (2017) reported a lower prevalence of women with disabilities undergoing screening for cancer versus women overall in the 2013 National Health Interview Study. The purpose of this study is to compare screening rates for breast, cervical, and colon cancer among female patients with and without disabilities within our health network.

METHODS:

The study is a retrospective review of patient charts between January 1, 2015 and January 1, 2020. Sample size calculations yielded need for 450 charts to achieve adequate power to detect a 10% reduction in each of the three screening rate analyses. Sample was drawn from electonic medical records and identified female patients ages 21–75 receiving gynecologic care at an eastern Pennsylvania health network. ICD-10-CM codes for disabilities identified patients with cognitive, mobility, speech, or hearing impairments. Statistical analyses included chi-squared goodness-of-fit tests.

RESULTS:

Cancer screening rates were significantly lower in the sample population. For cervical cancer, patients with disabilities had a 43.3% screening rate versus 66.0% in the general population. For breast cancer, the sample screened at 67.6% versus the general population at 75.0%. For colorectal cancer screening, the sample was at 54.8%, whereas the general population had a 66.0% screening rate (P<.001).

CONCLUSION:

Understanding the mechanisms behind lower preventive care rates can help to improve health outcomes for this patient population. The future goal is to offer solutions to address disparities in cancer screening.
Demographic Disparities in Uterine Fibroid Incidence Are Not Reflected in Treatment Practice Patterns Among U.S. Women: A Systematic Review and Meta-analysis [ID 2683522]
Authors: Srinivas Tara , Lulseged Bethlehelm , Mirza-Aghazadeh-Attari Mohammad , Weiss Clifford R. , Borahay Mostafa A. A.
Published: May 2024

INTRODUCTION:

Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UF) and experience severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than hysterectomy and may improve UF outcomes. We reviewed demographic characteristics associated with UAE utilization compared to hysterectomy for symptomatic UF among U.S. women.

METHODS:

Systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051). 1,350 articles (January 1, 1995, to July 15, 2023) outlining demographic characteristics of UAE versus hysterectomy patients were identified. Two readers screened for inclusion criteria, yielding 11 full-text U.S.-based cohort and randomized controlled-trial studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed (STATA v18.0). Egger’s regression test was used to quantify publication bias.

RESULTS:

Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio [OR] 3.35; p50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance.

CONCLUSION:

Current knowledge of demographic characteristics of UF patients receiving UAE versus hysterectomy is sparse (n=11 studies). Among these studies, racial disparities in UF incidence do not appear to affect UAE utilization; rather, Black race may predict utilization of UAE compared to hysterectomy. Further research is warranted to determine the effects of clinical and demographic covariates on UF treatment outcomes.
Exploring the Association of Intimate Partner Violence and Statewide Abortion Restrictiveness [ID 2683529]
Authors: Neff Katherine E. , Hall Stephanie V. , Pangori Andrea , Zivin Kara R. , Dalton Vanessa
Published: May 2024

INTRODUCTION:

Intimate partner violence (IPV) in pregnancy may result in poor maternal and infant health outcomes. Intimate partner violence may lead to unintended pregnancy, and denial of wanted abortions can increase the risk of future IPV. Prior to the 2022 reversal of Roe v. Wade, many states had already enacted policies hindering access to abortion. Whether state-level abortion restrictions are associated with IPV remains unknown. This study aims to investigate the relationship between IPV during pregnancy and abortion restrictions.

METHODS:

We analyzed data from 38 states participating in the CDC Pregnancy Risk Assessment Monitoring System in 2020 representing 1,368,237 deliveries. We divided states into restrictive (N=16) and nonrestrictive (N=22) categories based on the Guttmacher Abortion Policy Hostility Index. We used weighted logistic regression to assess the relationship between state abortion restrictiveness and self-reported IPV.

RESULTS:

Those who lived in restrictive states reported 1.52 times (95% CI, 1.24, 1.87) higher likelihood of experiencing IPV during pregnancy compared to those in nonrestrictive states, adjusting for confounding factors. Among Black individuals, those who lived in restrictive states reported 1.64 times (95% CI, 1.15, 2.34) higher likelihood of experiencing IPV compared to those in nonrestrictive states. White individuals in restrictive states reported 1.48 times (95% CI, 1.15, 1.91) higher likelihood of experiencing IPV than those in nonrestrictive states.

CONCLUSION:

Even when abortion was federally protected, individuals in restrictive states had an increased likelihood of experiencing IPV. These findings highlight potential detrimental effects of recent abortion bans on health and health inequities.
Using the Life Course Model to Develop, Validate, and Apply a State Reproductive Health Scorecard to Investigate Trends in Abortion Restrictions [ID 2683672]
Authors: Ramachandran Lakshmi , Vinekar Kavita , Koch Mikaela
Published: May 2024

INTRODUCTION:

Current health care scorecards either omit reproductive health metrics altogether or include a limited list of indicators to characterize a diverse population. In this study, we aimed to use the life course model to develop and validate a comprehensive state-level reproductive scorecard and apply the scorecard to explore the relationship between a state’s reproductive health score and its abortion restrictions.

METHODS:

We expanded the reproductive component of a previously validated health scorecard to include a total of 30 indicators. We collected publicly available data across five domains: health outcomes, prevention, access/infrastructure, insurance, and equity. We created standardized z-scores for each indicator, which were subsequently averaged—and therefore equally weighted—to yield composite state scores. The scorecard was validated by comparing composite scores to scores using the original indicators. We then conducted independent t-tests using Excel and Stata to compare states with and without abortion bans post-Roe reversal.

RESULTS:

States without abortion bans ranked an average of 20.7 out of 50, or 60th percentile, whereas states that banned abortion ranked 37 on average, or 24th percentile (P<.001). States that banned abortion exhibited notably lower reproductive health scores in key domains including health care outcomes, access, and insurance (P<.01). There were not statistically significant differences in prevention or equity scores.

CONCLUSION:

A reproductive health scorecard can serve as a powerful framework to investigate the interplay between health outcomes and policy. In this application, we found that state-level reproductive scores correlated with abortion legality across metrics including health outcomes, access, and insurance.
Standardization of Evaluation and Management of Early Pregnancy Concerns in the Emergency Department: A Quality Improvement Initiative [ID 2683509]
Authors: Taper Gabrielle , Thaxton Lauren D. , Tristan Sigrid , Alvarez Miriam J.
Published: May 2024

INTRODUCTION:

This study explored the effect of a standardized protocol for gynecologic consultation on readmissions for early pregnancy concerns in the emergency department (ED).

METHODS:

We conducted a retrospective cohort study of pregnant patients presenting to the ED for first trimester pregnancy concerns from January 2020 to March 2023. In October 2022, ED protocols were standardized such that gynecology was consulted for all pregnant patients without intrauterine pregnancy and cardiac motion. Patients seen before implementation (January 2020 to June 2021) were compared to patients seen after (October 2022 to March 2023). Chi-squared test and Fisher's exact test were used to investigate the association between readmission and reason for readmission to intervention period. The primary outcome, preventable readmission rate, was defined as a readmission that could have been prevented if the patient received correct counseling, diagnosis, or management at the index admission. This protocol was approved for IRB exemption by the University of Texas at Austin Dell Medical School.

RESULTS:

We identified 383 patients in the pre-implementation cohort compared to 130 patients seen after. There was an increase in the rate of gynecologic consultation for all concerns (30% before versus 40% after; P=.06). Fewer readmissions occurred after implementation (31% before versus 26% after) and preventable readmission decreased significantly (28% before versus 0% after; P<.001). Documented counseling about diagnosis also increased (74% versus 96%; P<.001) post-implementation.

CONCLUSION:

Readmission to the ED is common in early pregnancy; standardization of gynecologic consultation for early pregnancy care in the ED can improve quality of care and reduce readmissions.
Vaginal Cuff Self-Suspension Technique: A Novel Apical Suspension Technique for Patients With Uterovaginal Prolapse and Poor Tissue Integrity [ID 2683606]
Authors: Martingano Daniel J. S. , Theodros Mahelate , Nguyen Ashley , Martingano Francis X.
Published: May 2024

INTRODUCTION:

Of all surgical approaches to correct apical prolapse, transvaginal native tissue repair (TNTR) accounts for 80–90% of cases. Conditions such as uncontrolled diabetes lead to poor tissue integrity, often rendering the anatomical structures necessary insufficient, resulting in recurrent prolapse or immediate procedure failure. We present a novel TNTR technique, called “vaginal cuff self-suspension technique” (VCST) that can be used in such cases to provide a potentially more reliable and efficient means of apical suspension.

METHODS:

We conducted a prospective observational study from July 2022 to July 2023 and followed all patients who underwent a total hysterectomy and subsequent TNTR for advanced uterovaginal prolapse and concurrent stage IV endometriosis or uncontrolled diabetes. Advanced uterovaginal prolapse was defined as either a POP-Q score of 3 or 4 or Baden-Walker Grade 3 or 4. Patients receiving VCST were compared with matched controls receiving other TNTR methods. The primary outcomes were recurrent apical prolapse at 6 months or failure at initial surgery, as discrete events. All appropriate IRB approvals were obtained.

RESULTS:

The study included 88 patients with 33 receiving VCST and 55 controls. Of the 55 controls, 42 utilized uterosacral ligament suspensions (USLS) and 13 utilized sacrospinous ligament fixations. Demographic factors were not significantly different. Patients receiving VCST had lower rates of initial failed suspension (6% versus 23%; P=.002) as well as a 37% decreased risk in confounder-adjusted models (risk ratio [RR] 0.63; 95% CI, 0.36–0.81; P=.003). Among patients with poorly controlled diabetes, the VCST had lower rates of recurrent prolapse (9% versus 47%) and a 81% decreased risk in confounder-adjusted models (RR 0.19; 95% CI, 0.08–0.31; P<.001).

CONCLUSION:

Vaginal cuff self-suspension technique offers a simple and effective way to potentially prevent recurrent apical prolapse and/or immediate procedure failure for patients with advanced uterovaginal prolapse and concurrent stage IV endometriosis or poorly controlled diabetes.