bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopy Compared With Laparotomy as a Risk Factor for Intra-abdominal Adhesion Formation [ID 2683454]
Authors: Maghsoudlou Parmida , Cohen Rassier Sarah L. , Ajao Mobolaji , King Louise Perkins , Clark Nisse , Greenberg James A.
Published: May 2024

INTRODUCTION:

The objective of this study is to compare the incidence and severity of abdominal and pelvic adhesions after laparoscopy versus laparotomy.

METHODS:

All patients undergoing laparoscopic surgery with study staff were included in this IRB-approved study. Postoperatively, surgeons filled out data collection forms to capture pertinent details. Patients with a history of only laparoscopy or only laparotomy were included, whereas those with known past inflammatory events, no prior surgeries, or a combination of laparoscopic and open procedures were excluded.

RESULTS:

Seventy-six laparoscopy-only and 83 laparotomy-only patients were included in this cohort. Adhesions were noted in 31 laparoscopy patients (40.8%) versus 74 laparotomy patients (89.2%; P<.001). Filmy adhesions were noted in 22 laparoscopy patients (28.9%) versus 37 laparotomy patients (44.6%), without statistical significance (P=.06098). Higher-grade adhesions were significantly more prominent in the laparotomy group. Laparotomy group had significantly more dense adhesions (55.4% versus 11.8%; P<.001) and cohesive adhesions with attached surfaces (32.5% versus 10.5%; P=.001614). By location, the laparotomy group had significantly more periumbilical adhesions (34.9% versus 3.9%; P<.001). Adhesiolysis time was shorter in laparoscopy (3 versus 10 minutes; P=.008439).

CONCLUSION:

Our data demonstrate that not only does laparotomy present a greater risk for adhesion formation than laparoscopy, but they are more likely to be present in the periumbilical area and the quality of those adhesions are significantly more likely to be dense and/or cohesive in nature, subjecting patients to more risk and requiring more surgical time to address.
Patient Preferences Regarding the Cervix, Ovaries, and Fallopian Tubes at the Time of Hysterectomy: A Qualitative Study [ID 2683453]
Authors: Louie Michelle , Adams Jenna C. , Conner Madelyn , Wong Jacqueline , Knittel Andrea Kathleen K.
Published: May 2024

INTRODUCTION:

Although hysterectomy is one of the most common surgical procedures performed in the United States, preoperative patient counseling regarding removal or preservation of the cervix, fallopian tubes, and ovaries during benign hysterectomy is far from standardized. We aimed to understand patients' preexisting values, beliefs, and preferences regarding removal or preservation of the cervix, ovaries, and fallopian tubes at the time of benign hysterectomy.

METHODS:

We performed a qualitative study using semistructured interview of patients referred for benign hysterectomy with a minimally invasive gynecologic surgery division. Participants were recruited according to prespecified diversity axes. The interview guide was informed by literature review, expert stakeholders, and pilot testing. Telephone interviews occurred prior to their scheduled consultation with a surgeon. Responses were analyzed for themes using Rapid and Rigorous Data Qualitative Analysis. IRB approval was obtained.

RESULTS:

Age of participants (n=13) ranged from 24 to 60. Participants reported their race as non-Hispanic White (n=6), non-Hispanic Black (n=3), Hispanic (n=2), and multiracial or another race (n=2). Participants reported use of commercial insurance (n=8), Medicaid/Medicare (n=2), or self-pay/financial assistance (n=3). Identified themes included knowledge, decision making, treatment goals, short- and long-term consequences, fertility, identity, and lack of concern. Many participants expressed lacking necessary knowledge of the risks and benefits of removing the cervix and adnexa. Treatment goals included symptom relief and definitive treatment. Long-term consequences included concerns about menopause and future cancer.

CONCLUSION:

Prior to counseling, many patients express some degree of lack of knowledge, desire to remove most or all pelvic structures, and no attachment to their reproductive organs. Many patients expressed making decisions based on how organ removal will relieve current symptoms and long-term consequences, rather than immediate surgical risk, which can inform patient-centered counseling by their surgeon.
Time Is Ovary: Assessment of Current Latencies and Areas for Improvement in the Initial Assessment of Ovarian Torsion [ID 2683553]
Authors: Ekhteraei Setareh , Wilcox Mark
Published: May 2024

INTRODUCTION:

Ovarian torsion is a gynecologic emergency with potential complications including reduced ovarian function, ovarian necrosis, and peritonitis. There are few studies that examine the effect of time from initial presentation to surgery on ovarian preservation.

METHODS:

We conducted an IRB-waived retrospective review of patients cared for at a single academic center from August 2018 to August 2023. The SlicerDicer tool in Epic was used to identify diagnostic laparoscopy performed by gynecologists for suspicion of ovarian torsion (n=60). We extracted times of key events and calculated corresponding latencies, including from initial presentation to examination, imaging, gynecologic consultation, and start of anesthesia. Patient characteristics, imaging findings, and surgical outcomes were noted.

RESULTS:

Patients undergoing diagnostic laparoscopy for suspected ovarian torsion were age 33 years on average. A pelvic examination was performed on initial evaluation in 20% of patients. Torsion was confirmed in 58% of patients (n=35), and 40% of these patients underwent oophorectomy. The average ovarian volume for patients with confirmed torsion was 241 and 57 cm3 in patients without torsion (P=.01, two-sample t-test). Although not statistically significant, patients who underwent oophorectomy experienced a longer time from presentation to anesthesia (n=14; 516 minutes) compared to those who underwent ovarian preservation procedures (n=21; 474 minutes).

CONCLUSION:

Patients with confirmed torsion had higher ovarian volumes on ultrasound. Interventions to reduce latencies may include strategies to expedite imaging results and fast-tracking consultation for patients with higher ovarian volumes.
Mixed-Methods Evaluation of the Implementation of a Hereditary Cancer Risk Screening Questionnaire in a Safety Net Hospital [ID 2683409]
Authors: Zielenbach Molly , De Leon Wendy Cervantes , Hamilton Alison , Marsh Leah , Mendoza Marlene , Holschneider Christine
Published: May 2024

INTRODUCTION:

Patients belonging to medically underserved groups who meet testing criteria for hereditary cancer syndromes are less likely to be referred for genetic services and to complete testing. In our safety net hospital women’s health clinics, we introduced a novel National Comprehensive Cancer Network (NCCN)-based screening questionnaire as part of a community health worker (CHW)-supported hereditary cancer risk assessment and testing program.

METHODS:

We quantified program effect and conducted semistructured interviews with nurses and providers (n=12). We used rapid qualitative analysis to assess familiarity with screening questionnaire and barriers to its utilization. Institutional review board approval was obtained.

RESULTS:

Since January 2020, 2,282 patients were screened: 169 via provider referral and 2,113 via questionnaire. 312 met NCCN criteria for testing, with 30 ultimately testing positive. Nurses were familiar with the screening questionnaire and assumed an active role in facilitating completion. They reported minimal familiarity with the process after questionnaire completion. Providers reported minimal familiarity with the screening questionnaire but did assess family history and refer for genetic services. Barriers to successful utilization of the questionnaire included time constraints, patient literacy, language barriers, and gaps in patients' knowledge of their family history.

CONCLUSION:

Implementation of a targeted questionnaire may increase access to testing for hereditary cancer syndromes. We identified the following opportunities for implementation improvement: staff education, increased clinic efficiency, and CHW support with collection of accurate histories from patients with limited literacy/knowledge of their family's health history. Replication of a CHW-supported questionnaire-based screening program could reduce disparities in access to genetic services for patients in safety net settings.
Concurrent Chemoradiotherapy Compared With Neoadjuvant Chemotherapy Followed by Radical Hysterectomy for FIGO Stage IIB Cervical Cancer Patients: A Systematic Review and Meta-analysis [ID 2683429]
Authors: Soliman Ahmed , Adel Rawda , Elnaggar Mohamed , Soliman Amr
Published: May 2024

INTRODUCTION:

Cervical cancer is the fourth most common malignant disease and cause of cancer death in women worldwide. FIGO stage IIB includes cervical carcinomas with invasion of the parametria. Despite innovative treatment approaches, recurrence and mortality rates among patients with locally advanced cervical cancer (LACC) have not been significantly reduced. The current treatment recommendation for FIGO stage IIB is concurrent chemoradiotherapy (CCRT). Neoadjuvant chemotherapy followed by radical hysterectomy (NACT+HE) represents a valid alternative.

METHODS:

According to the PRISMA guidelines and Cochrane handbook recommendations, we systematically searched the following databases up to January 2023: PubMed, Scopus, Web of Science, and Cochrane CENTRAL for relevant studies and reports that compare NACT+HE versus CCRT for patients with LACC and specifically with FIGO stage IIB.

RESULTS:

Our search results revealed 1,034 records, of them only 6 studies (n=2,055); 2 clinical trials and 4 observational cohorts were eligible to be included in both qualitative and quantitative analyses. Patients with FIGO stage IB2–IVA showed no advantage for 5-year overall survival (OS), disease-free survival (DFS), or progression-free survival (PFS) with NACT+HE compared to CCRT (hazard ratio [HR] 0.66 [95% CI: 0.43–1.01]; HR 0.62 [95% CI: 0.23–1.65]; and HR 0.88 [95% CI: 0.51–1.50]). A subgroup analysis for patients with FIGO stage IIB showed a significantly better 5-year DFS for CCRT compared to NACT+HE (HR 1.86 [95% CI: 1.23–2.81]); however, no significant improvement was shown for 5-year OS and 5-year PFS (HR 0.88 [95% CI: 0.52–1.49] and HR 0.85 [95% CI: 0.56–1.29]), respectively.

CONCLUSION:

This meta-analysis did not show any advantage for women with LACC treated with the NACT+HE approach compared to those treated with the CCRT approach. However, in a stage-specific analysis of patients with FIGO stage IIB cervical cancer, CCRT was superior to NACT+HE in terms of DFS, whereas no significant difference was shown for OS or PFS.
Embryonic Parameters Associated With Outcomes of Single Blastocyst Frozen Transfer [ID 2683440]
Authors: Ahart Erin R. , Shu Yimin
Published: May 2024

INTRODUCTION:

It is unclear how various in vitro fertilization cycle characteristics may ultimately influence the fertility outcomes of patients utilizing assisted reproductive technology. This study investigates embryo characteristics to determine which features are most associated with clinical intrauterine pregnancy after frozen embryo transfer.

METHODS:

This retrospective study evaluates 535 single blastocyst frozen embryo transfers (FETs) in 2022 and received IRB approval from the University of Kansas. Logistic regression analyses were used to evaluate embryo characteristics and likelihood of clinical intrauterine pregnancy (IUP), defined as positive fetal cardiac activity on ultrasound after 12 weeks of gestation. Blastocyst survival (percentage of live cells), blastocoele re-expansion, and morphological grade were evaluated prior to embryo transfer. Significant embryonic parameters included blastocyst developmental stage and blastocyst grade before cryopreservation, usage of preimplantation genetic testing for aneuploidy (PGT-A), post-warm blastocyst survival (percentage of live cells), degree of blastocoele re-expansion, blastocyst grading before transfer, and presence of zona pellucida.

RESULTS:

Among 535 FET cycles, 257 (48.0%) resulted in clinical IUP. Multivariate logistic regression analysis showed a significant independent influence of blastocyst development time (day 5/6) (odds ratio [OR] 0.571; P=.003), morphological grade before cryopreservation (day 5/6) (OR 0.648; P=.013), usage of PGT-A (OR 1.704; P=.010), and percentage of post-thaw live cells (OR 0.322; P=.001) on embryo transfer success rates. While fully expanded blastocysts showed a significantly higher rate of clinical IUP, the degree of blastocoele re-expansion did not appear to be independently related to ongoing pregnancy when multivariate logistic regression analysis was employed (OR 2.886; 95% CI: 0.824–10.105; P=.097).

CONCLUSION:

In addition to blastocyst quality prior to cryopreservation, post-thaw blastocyst survival is an independent predictor of embryo recovery and further development potential. Additional understanding of the potential contributors to failed FETs can inform strategies for improvement. Further investigation is needed to determine how to minimize embryonic cell damage during the vitrification and warming process.
Effects of Non-Cavity-Distorting Intramural Fibroids on IVF Outcomes in Patients With Recurrent IVF Failure: Does Myomectomy Change IVF Outcomes? [ID 2683663]
Authors: Buyuker Ceyda
Published: May 2024

INTRODUCTION:

Uterine fibroids are the most common benign smooth muscle tumors of the uterus. However, there is no consensus on whether myomectomy improves IVF success in women with non-cavity-distorting intramural fibroids. The aim of this study was to compare the IVF and pregnancy outcomes of women who had non-cavity-distorting intramural fibroids and underwent myomectomy versus women who had intramural fibroids, but did not undergo myomectomy.

METHODS:

This was a retrospective cohort study at Acibadem Maslak Hospital, IVF Center, between 2019 and 2020. The Acibadem University Ethical Committee approved the study protocol, which complied with the Declaration of Helsinki (2021-05/02). Data of 128 women aged between 25 and 43 years who have at least two intramural non-cavity-distorting fibroids of 2–6 cm in size were used. All patients had at least two IVF failures. The intervention group comprised women who decided to proceed to myomectomy before IVF (group 1, n=56). The control group was established women with intramural fibroids who reject myomectomy (group 2, n=71).

RESULTS:

In regard to IVF result parameters and perinatal outcomes, there was no statistically significant difference between the two groups. Between study groups, there were no statistically significant differences in the perinatal outcomes. Myomectomy surgery did not increase miscarriage and biochemical pregnancy rate (odds ratio [OR] 0.9; 95% CI, 2.8–3.7).

CONCLUSION:

Myomectomy does not substantially affect pregnancy or live birth rates according to the results of this study.
Correlates for Transfusion at Delivery Among Latinx Birthing Patients at a Tertiary Care Center [ID 2683569]
Authors: Castellon Loren , Martinez-King L. Carolina , Hitti Jane
Published: May 2024

INTRODUCTION:

We observed a higher transfusion rate among Latinx compared to non-Latinx individuals. We sought to determine whether this disparity resulted from preexisting anemia or acute blood loss at delivery, to devise targeted prevention strategies.

METHODS:

We conducted a retrospective cohort study of 1,960 births between April 1, 2021, and March 31, 2022. Demographic and obstetric factors, hematocrit (Hct), pregnancy outcomes, and anemia treatment were abstracted. Anemia was defined as Hct less than 33%. Statistical differences between groups were evaluated by chi-squared or independent-sample t-tests. Odds ratios (ORs) and 95% CIs were calculated by logistic regression, adjusting for confounders.

RESULTS:

Transfusion at delivery occurred among 21 (8.0%) Latinx and 77 (4.5%) non-Latinx patients (OR 1.84; 95% CI, 1.12–3.04; P=.015). Latinx patients were younger (mean 30 versus 32 years; P<.001), more likely to receive Medicaid (85% versus 80%; P=.05), not speak English (21% versus 6%; P<.001), deliver preterm less than 37 weeks (33% versus 19%; P<.001), and have complex cesarean delivery (CD) (5.7% versus 3.2%; P=.049). Preexisting anemia was statistically associated with transfusion (P<.001) but not with Latinx ethnicity. Oral and intravenous iron did not differ between groups. After adjustment for anemia and CD, Latinx ethnicity remained significantly associated with transfusion (adjusted OR 1.73; 95% CI, 1.18–2.28; P=.04).

CONCLUSION:

Latinx patients were more likely to require complex CD; with preexisting anemia, this likely increased the risk for transfusion. Recognition of risk factors for complex CD in addition to prompt diagnosis and management of anemia are key for preventing transfusions.
Intravenous Iron Supplementation in Pregnancy: Comparisons of Dosage and Latency of Infusion Based on a Quality Improvement Project on Maternal Transfusion Reduction [ID 2683380]
Authors: Pfeiffer Alixandria F. , Chang Nathalie H. , Byrne John J. , Berkus Michael , Doyle Nora M.
Published: May 2024

INTRODUCTION:

Optimal dosing of intravenous iron supplementation (IVFe) and latency of the infusion for pregnant patients with iron deficiency anemia has been minimally evaluated. We analyzed the effects of specific IVFe dosage parameters as part of an institution-based protocol on maternal peripartum hemoglobin (Hb) levels stratifying by time of infusion to delivery.

METHODS:

We reviewed average changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by IVFe dosage forms (800 mg) and infusion latency (by 2-week increments). We excluded patients with known antepartum blood transfusion. Maternal demographics and all comparison groups were analyzed among each other using GraphPad Prism software.

RESULTS:

Two hundred ninety-five patients met inclusion criteria. Demographics of maternal age, body mass index (BMI), nulliparity, and ferritin levels were similar in all groups. We found a statistically significant difference in improved pre-delivery Hb with larger IVFe doses (P=.002) and longer infusion-delivery periods (P=.049). A Tukey post-hoc test revealed that the highest yield on mean delta Hb was after 6–8 weeks or longer of latency with doses greater than 800 mg versus less than 2 weeks at doses of 800 mg or lower (2.6–3.1 g/dL; P<.0001).

CONCLUSION:

Latency periods of at least 6 weeks with IVFe dosages of 800 mg or greater, regardless of maternal BMI or starting ferritin, may markedly improve pre-delivery Hb levels and ultimately reduce maternal morbidity hemorrhage complications.
COVID-19 and Hypertensive Disorders of Pregnancy: Is the Placenta the Problem? [ID 2683611]
Authors: Siblini Tamara , Kulkarni Sanjana , Aslam Muhammad F. , Baracy Michael G.
Published: May 2024

INTRODUCTION:

The objective of this study is to evaluate the association between COVID-19 infection in pregnancy and placental pathology in order to assess the mechanism of its association with hypertensive disorders of pregnancy (HDP).

METHODS:

This was a retrospective cohort study that compared placentas of patients who tested positive for COVID-19 during their pregnancy (n=70) to placentas of patients who tested negative for COVID-19 (controls, n=210). Patient demographics, comorbid conditions, and pregnancy complications were obtained from the electronic medical record.

RESULTS:

Compared with pregnancies negative for COVID-19 infection, maternal COVID-19 infection was not associated with increased incidence of placental pathology including acute funisitis, acute chorioamnionitis, chronic villitis, chorionic pseudocysts, decidual necrosis, Tenney Parker changes, intervillous hemorrhage, infarcts, villous calcifications, meconium-stained amniotic fluid, inflammatory changes, or vascular VTE changes. Based on the logistic regression analysis, after controlling for other variables in the model, the risk of developing HDP was 72.4% higher in patients who tested positive for COVID-19 versus those who did not (odds ratio 1.72; 95% CI [1.09, 2.73]; P=.02).

CONCLUSION:

Patients who test positive for COVID-19 during pregnancy have an increased risk of HDP. However, there is no association between COVID-19 infection in pregnancy and pathologic findings on placental histology. This suggests that COVID-19 does not exert its effects of increasing the risk of HDP via placental infection or inflammation. Rather, COVID-19 may contribute to the pathogenesis of HDP through cytokine storm, dysregulation of the renin–angiotensin–aldosterone system, or systemic hyperinflammatory response.
The Effect of Food Environment on Pregnancy Outcomes [ID 2683379]
Authors: Clinton Tiffany Alexis , Pitts D’Angela S. , Flint Jessica , Speak Alicia C. , Fly Allison , Kim Sun Kwon
Published: May 2024

INTRODUCTION:

In large urban cities, fast food restaurants and convenient stores dominate the food sector leaving limited access to quality healthy foods. Food insecurity is a modifiable risk factor of social drivers of health. We hypothesize that low-access food environment is associated with gestational diabetes, preterm deliveries, hypertensive disorders, and other comorbidities.

METHODS:

A retrospective cohort study was performed to determine the effects of food environment on pregnancy outcome using geographic data from 3,898 patients who delivered after 20 weeks of gestation in a large inner-city hospital between 2014 and 2019. The USDA Food Access Research Atlas was used to extrapolate census tract data from neighborhoods that have been previously identified as low-access areas. Demographics were obtained by chart abstraction. Chi-squared tests were used for analysis.

RESULTS:

Of the 3,684 patients, 1,377 (37.4%) of the population lived in low-access food environments. There is a higher rate of neonatal intensive care unit (NICU) admission in low-access food environments compared to high access (8.6% versus 7.5%; P<.001). Contrarily, there is a lower rate of gestational diabetes mellitus (11.3% versus 13.6%; P=.0381) and preterm delivery (13.2% versus 16.7%; P=.0043) in women living in low-access food environments. There was no significant difference between hypertensive disorders (P=.0874) and fetal growth restriction (P=.8465).

CONCLUSION:

This study demonstrates that low-access food environment is associated with statistically significant higher rates of NICU admission. Unlike other risk factors, food environment is a modifiable risk factor, and as women's health providers, it is important to address all social drivers of health, including food insecurity.
Epidemiologic Look at Teen Birth [ID 2683394]
Authors: Russo-Sikes Heather R. , Amin Raid W. , Leiro Alberto , Decesare Julie
Published: May 2024

INTRODUCTION:

To take an epidemiologic look at the most up-to-date geographical variation in the average teenage birth rates by county in the United States.

METHODS:

Data from the National Center for Health Statistics were used in this retrospective cohort to count the total number of live births to females aged 15–19 years by county between 2003 and 2020. Software for disease surveillance and spatial cluster analysis was used to identify clusters of high or low birth rates in counties or areas of greater than 100,000 teenage females. The data were then further analyzed by unemployment rate, no high school diploma rate, Hispanic rate, African American rate, and poverty rate per county as influence on the prediction of teenage birth rate.

RESULTS:

Spatial analysis identified 94 significant spatial clusters of teenage births. When adjusted for time and space, there were three significant clusters within Texas, all within 2013–2020, showing a steep increase in teenage birth rates. The top cluster with a 60% higher chance of teenage birth than the remainder of the country. Individual covariates examined showed the best predicter of teenage birth is unemployment followed by low education.

CONCLUSION:

Nationally, teenage births have declined over the last 30 years; however, clusters of elevated teenage birth rates remain predominantly in the southeastern United States and Texas. When adjusting for covariates of social determinants of health, some of these clusters remained, indicating other factors with influence on teenage birth rate.
Limited Access to Obstetric Services for the American Indian and Alaska Native Population [ID 2683412]
Authors: Baker Hailey A. , Calac Alec , Interrante Julia
Published: May 2024

INTRODUCTION:

American Indian and Alaska Native (AI/AN) people face one of the highest rates of maternal mortality in the United States. Access to maternity care is correlated with health outcomes; however, research on availability of maternity care in areas largely composed of AI/AN populations is limited.

METHODS:

We identified the 69 counties and county-equivalents in the United States with greater than or equal to 25% of the population self-identifying as AI/AN. Counties and county-equivalents were further classified as rural (micropolitan and non-core) or urban (metropolitan). We then determined the availability of hospitals with obstetric care, obstetric providers (obstetricians and certified nurse-midwives), and the number of live births in counties and county-equivalents. Maternity care deserts were defined as counties and county-equivalents having no hospitals providing obstetric care nor obstetric providers. Limited access to maternity care services was defined as counties and county-equivalents having one or less hospital offering obstetric services and fewer than 60 obstetric providers per 10,000 births.

RESULTS:

These counties and county-equivalents spanned 13 states, and 65 (94.2%) were classified as rural. 39 counties and county-equivalents (56.5%) were classified as maternity care deserts, and 10 were classified as having limited access to maternity care (14.5%).

CONCLUSION:

The findings of this study suggest that access to maternity care is limited for AI/AN populations. Increasing access to care in counties and county-equivalents largely composed of AI/AN populations is a potential avenue to improve maternal health outcomes.
Obtaining Patients' Perspective for Advancing Health Equity in Maternal Depression Screening for Black Women in a Federally Qualified Health Center [ID 2683414]
Authors: Zeeshan Quratulain , Ascher Amanda F.
Published: May 2024

INTRODUCTION:

One in eight women experience symptoms of postpartum depression. At Sun River Health, efforts to improve postpartum depression screening rates led to an increase from 76% in January 2022 to 80% in January 2023. However, we continue to see a persistent racial disparity in postpartum depression screening: For Black/African American women, postpartum depression screening rates are 77.4%, whereas White women have screening rates of 88%.

METHODS:

A focus group of English-speaking Black/African American women (n=7) who were not screened for postpartum depression was conducted in May 2023. We administered a series of questions aimed at gathering insight into patients' understanding of and beliefs around postpartum depression, patients' experiences, and barriers to care. The responses were recorded and interpreted using qualitative data analysis.

RESULTS:

Eighty-three percent of group participants reported that they experienced postpartum depression. Fifty-seven percent reported not receiving depression screening, and 71% reported no discussion on mental health with their clinicians. Among the barriers to care the participants described, social stigma was a common influence and the majority described clinicians as dismissive of their symptoms. Only 14% of patients voiced comfort in discussing mental health with their clinician.

CONCLUSION:

Further work is needed to better educate clinicians on mental health conditions in pregnancy and postpartum and the importance of engaging patients in discussion on mental health issues. The organization should propagate the survey to obtain additional patients’ feedback and further our understanding of barriers to screening and treatment of depression in Black/African American pregnant women.
The Effects of Acknowledgment of Paternity and Marital Status on Infant Morbidity and Mortality [ID 2683463]
Authors: Wells Brittney , Hennessy Elizabeth , Salamanca Ghajarieh Alyssa P. , Townson Lauren , Halfar Matthew A.
Published: May 2024

INTRODUCTION:

Research shows that maternal behavior during the perinatal period has a significant effect on neonatal outcomes and that instability in the social support structure can cause undue perinatal stress. With unmarried women accounting for nearly one in three births in the United States, this analysis reviewed how marital status and paternity acknowledgment (AOP) affected infant morbidity and mortality utilizing national 2017–2019 data from the CDC-WONDER databases.

METHODS:

A series of chi-squared analysis and logistic regressions were performed to assess for differences in infant outcomes between married women, unmarried women with AOP, and unmarried women without AOP, as well as assess the effect of socioeconomic covariates.

RESULTS:

Results demonstrated that marital and AOP status had significant correlation on frequency of preterm birth, low birth weight, newborn need for assisted ventilation, antibiotics for suspected sepsis, and neonatal intensive care unit admission (P<.0001). Additionally, there were significant differences in Apgar scores found at 5 and 10 minutes for AOP and at 5 minutes for marital status. Furthermore, significant differences in rate of prenatal complication related infant mortality, as well as overall infant mortality up to 1 year of age were seen. These trends persisted when accounting for mother's age, race, nativity, education, insurance status, and select maternal health risk factors.

CONCLUSION:

It is evident that infants born to unmarried women and women without AOP are at increased risk for development of complex infant morbidity and mortality. This suggests that increased monitoring, precautions, and social support may be indicated. Further studies are needed to evaluate the role of paternal and other support during pregnancy.
Public Perspectives on the Inclusion of Pregnant People in Clinical Trials [ID 2683498]
Authors: Wood Megan L. , Kons Kelly , Hershberger Sarah , Peck Lindsey , Sznajder Kristin , Horvath Sarah
Published: May 2024

INTRODUCTION:

Pregnant people remain underrepresented in clinical trials despite extensive efforts to increase participation. The public’s perception about including pregnant people in research is limited, and no publications to date specifically include self-identified males. This research aims to elucidate the attitudes of reproductive-aged people in the United States regarding the inclusion of pregnant individuals in clinical trials.

METHODS:

An IRB-approved survey including five Likert-scale questions concerning the inclusion of pregnant patients in research was distributed via Facebook Marketing. Self-reported gender, race, ethnicity, education level, political affiliation, religion, relationship status, and contraceptive use and method were analyzed in bivariate analyses. Variables significant in the bivariate analyses were included in multivariable logistic regression models.

RESULTS:

Among 743 respondents, 405 (54.6%) agreed that pregnant people should be excluded from clinical trials and 392 (52.8%) agreed that the risks of including pregnant people in clinical trials outweigh the benefits. Females had lower odds of agreement (odds ratio [OR] 0.46 [95% CI, 0.33–0.65] and 0.39 [95% CI, 0.28–0.54], respectively). Most respondents (74.2%) agreed that pregnant people should obtain partner consent prior to participation; notably, males had 3.9 times greater odds of agreement (95% CI: 2.51–6.10). Paradoxically, 504 people (67.9%) agreed that including pregnant people in research is important for providing evidence-based medicine.

CONCLUSION:

Most participants agreed with excluding pregnant people from clinical research; however, self-identifying females were more likely than males to value the safe inclusion of pregnant people in clinical research to advance evidence-based obstetrical care. This juxtaposition highlights an important challenge to achieving equitable inclusion of pregnant people in clinical research and the importance of public perception in improving maternal and child health outcomes.
Gestational Diabetes Significantly Associated With Food Insecurity and Insurance Status in the United States [ID 2683536]
Authors: Nandwani Jaan , Nandwani Roshni , Mitra Ayon , Nelson Tracy
Published: May 2024

INTRODUCTION:

Gestational diabetes (GD) is on the rise in the United States, posing risks to women's cardiovascular health, pregnancy, and their offspring's well-being. We sought to characterize the association between food insecurity and health care access and GD prevalence.

METHODS:

We analyzed data from 29,732 females aged 18+ in the 2021–2022 National Health Interview Survey to determine the prevalence of self-reported GD and its relationship with food security and health insurance status. We used χ2 tests to compare GD rates across different food security classifications and insurance statuses. Additionally, we cross-examined GD rates within food security groups based on insurance coverage.

RESULTS:

The overall GD prevalence among females was 5.70%. Stratified by food security, significant differences emerged (P<.05): 5.23% for high security, 7.99% for marginal security, 7.72% for low security, and 11.85% for very low security. We observed significant differences in GD rates by insurance coverage (P<.05): 5.57% for insured and 7.72% for uninsured respondents. Notably, when individuals were not highly food secure, there was no significant difference in the prevalence of GD between those who were insured or uninsured.

CONCLUSION:

This study highlights the significant associations between food insecurity, insurance coverage, and GD prevalence, although our cross-sectional analysis indicated that food insecurity may be the more salient factor. To combat GD's rise, policies should prioritize providing nutritious food access to pregnant women, potentially through mobile food units. Further research should explore whether food insecurity causally affects GD.
Developing a Maternal Health Worker Training Program in Rural Mississippi [ID 2683576]
Authors: Davis Julia O. , Flore Barbara J. , ME  , Ragunanthan Braveen , Burrell Raven , Boyles Robin , Ragunanthan Nina W.
Published: May 2024

INTRODUCTION:

Mississippi faces the highest infant mortality rate and maternal mortality rate in the United States, with rates for Black women four times higher than for White women. Using community maternal health workers (MHWs) to support patients during pregnancy and postpartum has proven beneficial in other locations and could be transformative in rural Mississippi. We aimed to identify key patient needs to create a MHW training program in the rural Mississippi Delta, as a component of a broader maternal health quality improvement project.

METHODS:

We conducted quality improvement interviews with 18 obstetric patients (10 prenatal, 8 postpartum) at Delta Health Center, a federally qualified health center in Mound Bayou, Mississippi. We queried patients about strengths and gaps in their prenatal care and their opinions on MHWs. We also queried the obstetrics and gynecology and pediatrics teams at Delta Health Center to identify key pregnancy, postpartum, and infant care and development topics needed for MHW training.

RESULTS:

17/18 (94%) of the patients interviewed were in support of the MHW program. The following themes emerged in patient interviews: desire for psychologic support, connection to community resources, and help managing high-risk pregnancy conditions. We designed a 2-week training for MHWs that covers: MHW Responsibilities, Pregnancy Care, Childbirth, Postpartum Care, and Newborn Care and Infant Development. Based on patient feedback, the training prioritizes content related to psychological support and high-risk pregnancy care.

CONCLUSION:

Patients expect MHWs to be valuable assets for their care. Maternal health workers have the potential to support pregnant women in rural health care settings, ultimately enhancing maternal–fetal health outcomes.
Evaluating TeamBirth's Effect on Autonomy for Minoritized Populations in Labor [ID 2683585]
Authors: Oliphant Morcquess , Moore Simas Tiffany A. , Leung Katherine
Published: May 2024

INTRODUCTION:

Prioritization of maternal autonomy and communication can greatly affect obstetric care experiences. We implemented TeamBirth—an initiative designed to center the patient, their preferences, and autonomy through standardized team communication in labor. We sought to understand how TeamBirth affected obstetric care experiences, through self-reported autonomy, for minority populations.

METHODS:

TeamBirth “huddles” in labor included patients, labor support persons, physicians, and nursing team members participating in standardized communication approaches, supplemented with whiteboard and decision-support guides. From May 2021 to May 2022, surveys administered postpartum inpatient were collected from birthing persons. We used the Mother’s Autonomy in Decision Making Scale (MADM) to measure autonomy. MADM scores in the highest quartile (scores ranged 34–42) were considered as having high autonomy.

RESULTS:

Over one-third (36.4%) of the 762 respondents were of minoritized populations (eg, Black, Hispanic) versus White (63.3%). When considering race/ethnicity, high autonomy was not related to minoritized group (P=.944). The majority (86%) of high autonomy respondents had one or more huddles, compared to 71% with low autonomy (P<.001). When evaluating the relationship of number of huddles to high autonomy, the minority group was not different compared to White patients (interaction P=.915).

CONCLUSION:

Patients who experienced huddles during intrapartum care reported higher autonomy regardless of minority status. Use of the TeamBirth initiative has potential to increase autonomy and improve obstetric experiences. Early data indicate that patient experiences of minoritized populations can be improved with TeamBirth; additional investigation is indicated.
Exploring Trust in Pregnancy Care Clinicians Among Latine Patients in Spanish and English: A Qualitative Study [ID 2683628]
Authors: Molina Rose L. , Casul Giuliana Rivera , Bazan Maria , Del Pilar Pazos Herencia Yessamin , Hacker Michele R. , Guise Jeanne-Marie
Published: May 2024

INTRODUCTION:

Trust between patients and clinicians is critical for better experiences and outcomes, yet there is no consensus on how trust is defined and measured in pregnancy care. We aimed to explore how patients define trust in clinicians; facilitators and barriers to building trust; and how trust may be eroded and rebuilt over time.

METHODS:

A bilingual, multicultural team led this qualitative focus group study. The semistructured discussion guide included definitions of trust based on a literature review, how trust is built, when trust is lost, external factors that influence the patient–clinician relationship, previous pregnancy experiences, and sources of trustworthy information during pregnancy. The discussions were audiorecorded and transcribed in the language in which they were held. We performed thematic content analysis on transcripts using both deductive and inductive approaches in each language. Codes were organized and synthesized according to emerging themes. The IRB approved this study.

RESULTS:

We held eight focus groups of Hispanic/Latine pregnant and postpartum patients; five were held in Spanish and three in English with a total of 35 participants. We identified five constructs of trust: communication, comfort, caring, competency, and accompaniment (“acompañamiento”). Facilitators of trust were warm interpersonal dynamics, continuity with clinician and care team, rapid direct communication with clinician, and language concordance. Barriers of trust were inadequate or inaccurate information, rotating clinicians, cold interpersonal dynamics, and language discordance. There were few differences between Spanish and English groups.

CONCLUSION:

Patient perspectives about building trust with clinicians are critical for improving the quality of patient–clinician relationships, especially when language barriers exist.
Voices From the Field: Amplifying Clinicians' Perspectives for Black Maternal Equity [ID 2683631]
Authors: Chachere Breanna , Rhone Tonia J. , Shin Grace , Marroquin Hyacinthe Raquel A. , Amutah-Onukagha Ndidiamaka N. , Meadows Audra R.
Published: May 2024

INTRODUCTION:

Nationally, Black birthing individuals face a disproportionate burden of maternal mortality and severe maternal morbidity. Although there is growing research interest in tackling these inequities, a significant gap exists in incorporating the insights and perspectives of interprofessional front-line clinicians. This study sought to learn the experiences and viewpoints of physicians, certified nurse-midwives (CNMs), and registered nurses (RNs) to identify strategies for addressing maternal care inequities.

METHODS:

In collaboration with our community advisory board, we constructed semistructured questions to conduct interviews and focus groups with obstetrical clinicians. Transcripts were coded using NVIVO, utilizing inductive and deductive approaches, and content and narrative analysis to identify themes. Participant consent and IRB exemption status were obtained.

RESULTS:

We interviewed 20 clinicians: 6 ob-gyn physician interviews, 3 CNMs, and 14 RNs across two focus groups between January and July 2023. Key themes emerged regarding systemic challenges and opportunities. Identified challenges include 1) clinician bias and poor communication, 2) unequal care, 3) patient mistrust, and 4) lack of administrative data. Opportunities for future directions include 1) implementation of clinician training and simulation with an equity lens, 2) standardization of maternal care with safety bundles, 3) incorporation of group prenatal care and expansion of postpartum wraparound services, and 4) disaggregation of clinical operations data by race.

CONCLUSION:

This study identifies key challenges and opportunities to address the Black maternal health crisis. Our findings inform priorities to guide ACOG's collective action and commitment to eliminating racial inequities that lead to disparate health outcomes.
Oxytocin Compared With Prostaglandin as First Agent in Prelabor Rupture of Membranes [ID 2683446]
Authors: O'Neill Margaret R. , Birchall Courtney , Leung Katherine , Leftwich Heidi K.
Published: May 2024

INTRODUCTION:

Prelabor rupture of membranes (PROM) occurs in 8% of term deliveries. After PROM, induction of labor (IOL) is recommended to decrease risk of intra-amniotic infection and time to delivery. Therefore, finding the safest, most effective way to induce labor in this patient population is important to clinical practice.

METHODS:

The goal of this investigation is to compare rate of vaginal delivery among patients receiving oxytocin versus prostaglandin as a first-line agent for IOL after PROM. Secondary outcomes include time to vaginal delivery, parity, and cervical dilation. This study involves a secondary analysis of an IRB-approved retrospective chart review investigating cervical ripening in all patients who delivered from 2020 to 2021 at our institution.

RESULTS:

A total of 365 patients presented with term PROM during the study period. The sample was primarily nulliparous (61.8%) with mean gestational age of 39.1 weeks. More patients in the oxytocin group than the prostaglandin group delivered vaginally (86.2% versus 82%). Patients treated with oxytocin as first agent were found to have faster time to any delivery than prostaglandin as first agent (median 14.9 versus 25.7 hours; P<.001). This result was regardless of parity or whether a cervical exam was documented at time of presentation.

CONCLUSION:

In our study population, patients induced with oxytocin had a faster time to vaginal delivery without affecting risk of cesarean, regardless of nulliparity status or cervical dilation at time of presentation, supporting a more standard use of oxytocin as a first-line for term PROM IOL.
YouTube Video Characteristics as Indicators for Adherence to Accurate Water Birth Guidelines [ID 2683502]
Authors: Chen Jamie , Fleming Erika G. , Collamore Katherine , Oladipo Antonia F.
Published: May 2024

INTRODUCTION:

The accessibility of YouTube videos has made it a popular platform for seeking and sharing pregnancy advice, especially experiences related to “natural” delivery methods like water births. Therefore, it is important to understand which video characteristics amassed more views as well as explore the relationship between characteristics and accuracy of information. We aim to assess what components of water birth YouTube videos are predictive of more accurate content with evidence based on American College of Obstetricians and Gynecologists (ACOG) guidelines.

METHODS:

A YouTube search on “water birth” was conducted using the filter “most viewed.” The first 100 videos were selected using a strict inclusion criteria, and video characteristics were recorded. Video views ranged from 457,296 to 78,035,874. Reviewers scored videos in accordance with published guidelines using the “ACOG Water Birth Rubric.” Chi-squared goodness-of-fit and independence tests were performed to assess significance of differences between groups.

RESULTS:

Out of 96 videos, 13.1% from North America were scored as accurate, versus 15% from other continents (P=.5754). Only 14.4% of videos from personal channels were accurate, despite comprising 71.8% of all videos in the top 100. All videos from doulas and midwives scored neutral, and there were no videos from health care professionals with advanced degrees. Commercial videos had the highest amount of accurate videos at 16.6%. Videos with a supportive figure in the thumbnail had significantly less videos graded as inaccurate (3.5%) compared to those without (18%; P=.0003).

CONCLUSION:

Patients use YouTube videos as a resource for pregnancy information, particularly for alternative birthing practices. North America has some of the most popular videos and personal channels that often deviate from ACOG guidelines. Our findings highlight an urgent need for health care professionals to guide patients towards evidence-based resources, especially for alternative birth practices, and contribute accurate and informative content on such platforms.