bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Immediate Postpartum Long-Acting Reversible Contraception on Short Interpregnancy Intervals [7H]
Authors: Wu Min , Eisenberg Ruth , Negassa Abdissa , Levi Erika
Published: May 2019

INTRODUCTION:

Short interpregnancy interval (IPI) pregnancies, defined as a pregnancy conceived within 18 months of a prior delivery, are associated with adverse maternal and fetal outcomes. Given the well-established efficacy of long-acting reversible contraceptives (LARC) in decreasing unintended pregnancy, the provision of immediate postpartum LARC offers an excellent opportunity to increase access to highly-effective contraception and optimize interpregnancy intervals. We aim to evaluate the effect of immediate postpartum LARC on rates of short IPI pregnancy.

METHODS:

We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 to June 2016 (N=9,561). Using logistic regression models, we assessed the association between receiving immediate postpartum LARC and rates of short IPI delivery and short IPI pregnancy, adjusting for potential confounders. This study was approved by the Albert Einstein College of Medicine Institutional Review Board.

RESULTS:

In our cohort, 12.3% of patients received immediate postpartum LARC. The overall rate of short IPI delivery was 2.79%, and the rate of short IPI pregnancy was 12.2%. Patients who received immediate postpartum LARC were less likely to have a short IPI delivery (OR 0.20, 95% CI 0.09-0.45) or short IPI pregnancy (OR 0.44, 95% CI 0.33-0.58). These associations remained significant after adjusting for potential confounders including age, mode of delivery, socioeconomic status, and race.

CONCLUSION:

This study is the first to examine the effect of immediate postpartum LARC on short interpregnancy intervals. The findings suggest that immediate provision of postpartum LARC is a promising method of improving interpregnancy intervals.
Essure Removal via Salpingectomy With Cornual Resection vs. Total Laparoscopic Hysterectomy—A Case Series [8H]
Authors: Cho Yonghee Kristina , Kim Daniel , Harkins Gerald Joseph , Valentine Lindsey N. , Deimling Timothy Allen , Benton Andrea
Published: May 2019

INTRODUCTION:

The Essure is most commonly removed by bilateral salpingectomy with cornual resection (BS-CR) or total laparoscopic hysterectomy with bilateral salpingectomy (TLH-BS); however, limited data exists on Essure removal. The purpose of this study is to evaluate the safety and efficacy of Essure removal via BS-CR and TLH-BS.

METHODS:

A retrospective chart review and follow-up patient survey were conducted at an academic institute of patients undergoing surgical removal of the Essure device via BS-CR or TLH-BS between 2014 and 2017.

RESULTS:

58 patients underwent Essure removal-33 via BS-CR and 25 via TLH-BS. The mean operative time for BS-CR was 61 minutes vs. 70.5 minutes for TLH-BS. All procedures had an estimated blood loss of less than 50mL. There were no intraoperative complications. Mean length of stay for BS-CR was 572.6 minutes vs. 772.4 minutes for TLH-BS. Postoperatively, 1 patient who underwent BS-CR presented to the emergency room (ER) due to subjective fevers; no pathology was identified. One TLH-BS patient was admitted with vaginal cuff cellulitis, and one presented to the ER for vaginal bleeding without cuff separation/dehiscence. Satisfaction was noted in 30/32 (93.8%) patients who underwent BS-CR vs. 20/20 (100%) who underwent TLH-BS. Improved quality of life was reported in 29/32 (90.6%) of patients who underwent BS-CR vs. 19/20 (95.0%) who underwent TLH-BS. 31/32 (96.9%) patients who underwent BS-CR reported they would undergo removal again vs. 19/20 (95.0%) who underwent TLH-BS.

CONCLUSION:

Bilateral salpingectomy with cornual resection and TLH-BS are likely comparable methods for Essure removal, with overall high satisfaction.
An Interprofessional Approach to Training in Cervical Cancer Screening in a Low Resource Setting of Rural Haiti [12H]
Authors: Mansour Trina , Tustison Kimberly , Debay Marc , Tran Mai Linh , Ngo Anh Tuan , Li Angie
Published: May 2019

INTRODUCTION:

Cervical cancer continues to be a public health concern mostly affecting low-resource countries and has a high prevalence in Haiti, where no national prevention program exists. To address this gap, Hospital Albert Schweitzer (HAS) launched a cervical cancer screening and treatment program. The first step consisted of a two-week workshop providing didactic and supervised clinical training to healthcare professionals.

METHODS:

A US-based interprofessional team developed a comprehensive curriculum focusing on visual inspection with acetic acid, cytology-based screening, colposcopy, cryotherapy and loop electrosurgical excisional procedure. 3 Ob/Gyns, 2 general practitioners, 3 nurse-midwives and 2 nurses were trained. The course consisted of half-day didactic sessions and half-day supervised clinical practice sessions during the first week. The second week involved high-volume practice of skills. Pre-and post-tests were utilized during didactics, and clinical competency assessment were utilized at the end of each week. These tools will also be used during the 6-month follow-up evaluation.

RESULTS:

All trainees attended all didactic and clinical training sessions. They screened a total of 988 women. Based on the pre- and post-tests, trainees demonstrated an average increase of knowledge of cervical cancer screening by 9.5%. They all demonstrated satisfactory clinical competency by the end of the second week.

CONCLUSION:

Implementation of an interprofessional training event in a low-resource setting proved to be effective in teaching healthcare professionals to perform cervical cancer screening and treatment services on a clinically competent level. Results of the 6-month.
Analysis of Gender of Presenters at the 2018 ACOG Annual Clinical and Scientific Meeting [13H]
Authors: Koniares Katherine G. , Kellogg Emily , Evans Megan L.
Published: May 2019

INTRODUCTION:

In 2017, 58.7% of practicing OB/GYNs were female and in 2016, 82.3% of OB/GYN residency matches were female. Previous studies have demonstrated that female speakers are underrepresented at medical conferences. The objective of this study was to determine if the number of female speakers at the 2018 ACOG Annual Clinical and Scientific Meeting was proportional to the number of females practicing OB/GYN.

METHODS:

All presentations in the 2018 ACOG Annual Clinical and Scientific Meeting program were included in this study. The title, topic, and type of presentation, as well as the speaker's name, degrees held by the speaker, and gender of the speaker were analyzed.

RESULTS:

There were 1021 presentations by 897 speakers. 227 speakers (25.3%) were male, 653 speakers (72.8%) were female, and gender was unknown for 17 speakers (1.9%). There were 13 types of presentations; 538/698 (77.0%) of Eposters and 22/25 (88%) of oral presentations were made by female speakers. There were 20 topics; 344/463 (74.2%) of obstetrics, 115/174 (66.7%) of gynecology, 3/3 (100%) of domestic violence, and 1/5 (20%) of “cutting-edge” presentations were made by female speakers.

CONCLUSION:

Overall, female speakers were well represented at the conference, outnumbering male speakers 3:1, which correlates with the increasing proportion of OB/GYNs. Limitations of this study include that the number of male and female conference attendees and the stage of speakers' careers (i.e. resident, fellow, or attending) were unavailable.
Correlating the Length of Medical School Clerkship and OB/GYN Specialty Selection [14H]
Authors: Shanks Anthony L. , Christman Megan Ann , Scott Nicole Parker , Fadel William , Hoffman Mark Richard
Published: May 2019

INTRODUCTION:

Third year medical school clerkships provide students an opportunity to see specialties first hand and observe mentors in the field. Shorter clerkships have the potential to negatively affect their decision on specialty selection. We sought to describe clerkship length at US medical schools with OB/GYN clerkships and correlate this to the OB/GYN residency match rate in 2017.

METHODS:

This was an observational cohort study of US allopathic medical schools with OB/GYN clerkships. Medical school websites were reviewed and clerkship coordinators contacted when necessary to determine clerkship length. The 2017 GME Track Resident Survey was utilized to determine medical schools for first-year residents. Mean number of programs and students matching into OB/GYN were reported with standard deviations.

RESULTS:

147 US allopathic medical schools were identified and complete clerkship information was available for 137. The majority of medical schools provided a 5-6 week clerkship (n = 101; 73.7%) followed by 7-8 weeks (n = 28; 20.4%) and 4 weeks (n = 8; 5.8%). Residency Survey data was available for 94.8% of first year residents. Four-week, 5-6 week and 7-8 week clerkships were associated with a 3.96% (SD 0.88), 4.77 (SD 2.38) and 5.19 (2.21) match rate into OB/GYN respectively.

CONCLUSION:

The majority of US allopathic medical schools provide a 6-week OB/GYN clerkship experience. There was an increase in the percentage of medical students entering OB/GYN based on clerkship length that was not statistically significant. As medical schools undergo curriculum change, it is important that adequate exposure to the specialty be provided.
Does a Structured Formative Feedback System Improve Learner Perception of the Obstetrics and Gynecology Clerkship? [16H]
Authors: Edwards Allison , Sabourin Jeanelle
Published: May 2019

INTRODUCTION:

Medical students are more likely to pursue specialty training in fields they perceived positively during their training. This can be influenced by their satisfaction with feedback during a rotation. We investigated whether a structured formative feedback system would improve learner perception of the Obstetrics and Gynecology clerkship.

METHODS:

This observational cohort study included medical students from the Class of 2017 (control cohort) and 2018 (intervention cohort). Institutional ethics board approval was obtained. A formative feedback system was implemented during Obstetrics and Gynecology rotations for the Class of 2018. It consisted of a set of electronic forms asking for strengths and requirements for improvement in the student's assessment of a patient with a particular presenting complaint. Students were invited to complete a survey about their overall rotation experience during their final year of training using Likert Scales. The primary outcome was the proportion of students who reported a positive experience during their rotation. Chi-squared analysis was used to compare the proportion of positive responses between each group.

RESULTS:

190/286 (66.4%) students responded to the survey. 72/103 (70.6%) and 65/87 (74.7%) students reported a positive experience on their rotation (good, very good or excellent) in the control and intervention cohorts, respectively (P=.5). 27/83 (31.0%) of students felt the system positively influenced the rotation.

CONCLUSION:

Implementation of this structured formative feedback system did not improve learner perception of the rotation. Further research is needed to determine if mechanisms that ensure students receive specific and actionable feedback would affect this outcome during an Obstetrics and Gynecology rotation.
Cervical Elongation Among Patients Undergoing Vaginal Hysterectomy for Prolapse Versus Other Benign Indications [22H]
Authors: Elio Zeno Aldene Olia , Takashima Yoko , Ghayouri Sara , Yazdany Tajnoos
Published: May 2019

INTRODUCTION:

Surgeons have cited anterior colpotomy as a barrier to performing vaginal hysterectomy (VH); cervical elongation (CE) may make this difficult. This study aims to understand CE and its significance among patients undergoing VH for pelvic organ prolapse (POP) versus those undergoing VH for other benign indications.

METHODS:

VH from 2015-2017 were identified through CPT codes. Study variables were obtained from operating room and pathology reports. CE was identified according to four definitions reported in three different studies. Twenty-three patients per study arm were estimated to be necessary to detect a statistically significant difference in CL >33.8mm between VH patients with versus without POP.

RESULTS:

Chart review yielded 217 cases. Number of included VH cases was 128. There were 51 VH for POP, and 77 VH for other indications. CE prevalence was higher among patients undergoing VH for POP based on uterine corpus to cervical length ratio (UC:CL) > 0.79 (25.5% versus 15.6%) and CL > 33.8mm (66.7% versus 51.9%). Other CE parameters demonstrated no statistically significant difference between groups. In regression analysis, postmenopausal status was not associated with CL > 3.38 (OR 0.138, 95% CI 0.02-0.941); and VH not for POP were more likely to have longer-than-average operating time (mean=210).

CONCLUSION:

CE was more prevalent in patients undergoing VH for POP compared to those having VH for other indications. CE was not associated with perioperative outcomes. These results refute existing literature regarding CE, particularly that CE may not be of consequence with regards to clinical outcomes during and after VH.
Cervical Length as a Predictor of Latency Interval in Twin Pregnancies With Preterm Prelabor Rupture of Membranes [35H]
Authors: Jayesh Tigdi , Luksts Jessica , Stewart Andrew , Morais Michelle
Published: May 2019

INTRODUCTION:

Preterm prelabor rupture of membranes (PPROM) is a significant risk factor for preterm birth, carrying medical, financial and psychological burden. Predicting onset of labor after PPROM can result in timely interventions, including appropriate transfer to tertiary care centers. Ultrasound-measured cervical length can predict preterm delivery in singleton pregnancies with PPROM, but no data exists in twins. Therefore, we sought to determine whether cervical length could predict latency interval in twin pregnancies with PPROM.

METHODS:

Using the BORN Database, we performed a retrospective study identifying 43 twin pregnancies between 2012-2016 complicated by PPROM at McMaster University, Canada. Cervical length was determined by ultrasound measurement. We then compared our primary outcome, latency to labor in those pregnancies with cervical lengths less than 25 mm to those greater than 25 mm and results were analyzed by Mann-Whitney statistical analysis. Additional secondary measures compared the groups on length of stay, PPROM parameters and neonatal outcomes.

RESULTS:

We determined that the average latency interval in those twin pregnancies with cervical lengths less than 25 mm is statistically significantly shorter than in those with cervical lengths greater than 25 mm (49.2 vs. 196.0 hours, p=0.035). The average length of stay was also significantly greater in those with longer cervical lengths (5.52 vs. 11.05 days, p=0.03). Potential confounders such as parity, chorionicity, erythromycin or magnesium sulfate did not have any significant effect by ANCOVA regression analysis.

CONCLUSION:

In those twin pregnancies complicated by PPROM, cervical lengths less than 25 mm are associated with shorter latency intervals, which may prompt critical, timely intervention in this group.
Challenges in Providing OB Services in a Rural State: An Iowa Statewide Perinatal Care Program Study [36H]
Authors: Hunter Stephen K. , Dunbar Amy , Smith Penny , Dagle John , Segar Jeffrey
Published: May 2019

INTRODUCTION:

Over half the hospitals providing maternity services to the state of Iowa are rural Level I centers. OB services at these hospitals are closing annually at an increasing rate (21 in the last 15 years with 8 in 2018). We determined the current obstetrical provider workforce and identified reasons for the closures of these rural OB services.

METHODS:

Current OB provider workforce data were obtained by contacting all Level I hospitals via email, SurveyMonkey®'’ or telephone. Reasons for rural hospital OB service closures were identified through a six question survey mailed to the chief executive officers of all 93 Level I Iowa hospitals.

RESULTS:

46 rural level 1 hospitals provide OB services in Iowa. Only 35% have an obstetrician (OB) on staff, while 65% are staffed solely by Family Medicine (FM) physicians. Cesarean sections performed in these rural hospitals are done by FM only (5), general surgeons only (8) or a combination of FM and GS (13). Thus 56.5% of these rural hospitals have no OB on staff to perform surgical deliveries or respond to obstetrical hemorrhagic emergencies. Only 1/46 rural hospitals has an anesthesiologist on staff; 45/46 utilizes only certified registered nurse anesthetists. Primary reason for rural OB service closures was the inability to recruit or retain physicians willing or capable of providing obstetric care. Additional reasons included concerns regarding quality of obstetric care, medical-legal liability and financial concerns.

CONCLUSION:

Several issues must be addressed to avoid a decline in access to high quality maternal healthcare in rural Iowa.
Perinatal Outcomes of Uncontrolled Pregestational Diabetics in California State [38H]
Authors: Thayer Sydney Marie , Owens Sarah N. , Skeith Ashley , Valent Amy , Caughey Aaron B.
Published: May 2019

INTRODUCTION:

Our objective was to compare the maternal and neonatal outcomes of pregnancies complicated by controlled and uncontrolled pregestational diabetes in a large cohort in California state.

METHODS:

This is a retrospective cohort study of singleton gestations among women with diabetes between 2007 and 2011 using linked vital statistics and ICD-9 data. Chi-square tests were used to compare perinatal outcomes between patients with controlled and uncontrolled diabetes during pregnancy. Uncontrolled diabetes status was defined by the delivering clinician. Outcomes of interest included preeclampsia, gestational hypertension, congenital anomalies, preterm delivery, birthweight, neonatal death, shoulder dystocia, and adverse neonatal outcomes such as respiratory distress syndrome, jaundice and hypoglycemia. Multivariable logistic regression was used to estimate adjusted odds ratio (aOR), controlling for maternal age, education, parity, previous diagnosis of chronic hypertension, race, insurance status and tobacco use.

RESULTS:

In a cohort of 18,198 pregnant diabetic women consisting of 785 uncontrolled and 17,413 controlled, we found that women with uncontrolled diabetes have worse maternal and neonatal outcomes overall. Uncontrolled diabetic patients have significantly higher prevalence of preeclampsia, gestational hypertension, fetal anomalies, preterm deliveries, and neonatal death when compared with controlled diabetics. After controlling for confounders of interest, all relationships remained significant except for shoulder dystocia and stillbirth. A non-significant relationship was demonstrated between uncontrolled diabetes and neonatal hypoglycemia.

CONCLUSION:

Pregnancies complicated by uncontrolled diabetes have worse perinatal outcomes. Improving diabetic control in pregnant diabetic women is warranted to decrease risk of adverse maternal and neonatal outcomes.
Access and Barriers to Fertility Preservation for Women Prior to Gonadotoxic or Sterilizing Treatment [39H]
Authors: Anhut Jennifer L. , Barnard Emily P. , Steimer Sarah , Orwig Kyle E. , Valli-Pulaski Hanna
Published: May 2019

INTRODUCTION:

Fertility preservation (FP) is a process through which individuals undergoing reproductive capacity-limiting treatments may retain the option to produce genetic offspring. It is important to understand referral patterns to access FP and barriers to pursuing procedures.

METHODS:

Institutional Review Board approval was obtained from the University of Pittsburgh. A survey was distributed to female patients or their guardians during initial consultation for FP to explore indications for FP, method of referral, and decision to pursue FP after counseling.

RESULTS:

Thirty-six respondents completed the survey; 19 were incomplete and excluded. The average age was 27 (range 7-40). Thirty-three (91.7%) patients were referred for FP consultation. Twenty-four (66.7%) had FP conversations initiated by a referring physician. Patients were pursuing treatment for brain (3, 8.3%), breast (10, 27.8%), hematological (10, 27.8%), gynecological (8, 22.2%), and other (5, 13.9%) disorders. Of these diagnoses, 80.6% were malignant. Thirty-two (88.9%) patients intended to pursue FP [ovarian tissue cryopreservation (10, 31.3%), oocyte cryopreservation (10, 31.3%), embryo cryopreservation (3, 9.4%), ovulation suppression with leuprolide acetate (1, 3.1%), or multiple therapies (8, 25%)]. Three (8.3%) declined FP; citing cost, concern about primary diagnosis, and unacceptable risk of morbidity associated with future pregnancy. Ultimately, 26 (81.3%) patients underwent an FP procedure.

CONCLUSION:

Females presenting for FP consultation were largely referred by a physician after malignant diagnoses; most planned to pursue treatment. Barriers to FP included cost and concern for health risk based on the primary diagnosis. Future directions include expanding the survey to referral centers to explore why patients decline FP.
Comparing Semen Parameters in Adolescents With Gender Dysphoria With Adolescents Undergoing Gonadotoxic Therapy [40H]
Authors: Dilday Elizabeth A. , Bukulmez Orhan , Saner Karla , Lopez Ximena , Jarin Jason
Published: May 2019

INTRODUCTION:

Application of fertility preservation techniques has been expanded from adolescents with cancer undergoing gonadotoxic therapy to include transgender children and adolescents. This study aims to compare sperm parameters between young males with cancer and transgender patients undergoing hormonal transition at Dallas Children’s Medical Center and to characterize differences between sperm samples.

METHODS:

Records of male-to-female transgender adolescents and adolescent males with cancer undergoing sperm cryopreservation between March 2015 and September 2017 were reviewed. For transgender patients, cryopreserved sperm samples were obtained prior to hormonal transition. For adolescents with cancer, sperm was collected prior to treatment. Demographic data and sperm parameters (count, total count, motility, total motile) were collected. When available, hormone levels (luteinizing hormone, follicle-stimulating hormone, testosterone and estradiol) and Tanner stages were assessed. Data were compared using chi-square analysis and two-sample t-test.

RESULTS:

9 male-to-female transgender adolescents and 13 male cancer patients were included. Mean age at sperm cryopreservation was similar (15.2 vs 15.9, respectively) and mean documented Tanner stage was almost identical (4.55 vs 4.5). There were no statistically significant differences in height, weight and BMI. Mean semen volumes were significantly less for transgender patients as well as sperm counts (49.0 million/mL vs 56.2).

CONCLUSION:

Prior to hormone or gonadotoxic treatment, sperm parameters for both populations were less than expected for their age. Despite similar age and tanner stage, transgender adolescents have lower sperm parameters than their oncology counterparts do. Results support feasibility and practicality of sperm cryopreservation in both populations and open questions for research about factors affecting sperm quality.
Effect of Opioid Prescribing Education for Ob/Gyn Residents in a Safety-Net Hospital [3I]
Authors: Evans Casey , Yorkgitis Brian , Best Kelly , McCullough Deanna
Published: May 2019

INTRODUCTION:

The U.S. opioid epidemic calls for urgent need to evaluate providers’ prescribing habits. The purpose of this study was to educate Ob/Gyn residents regarding opioid abuse, amounts typically used post-operatively, and strategies to decrease adverse outcomes. Our hypothesis is residents will prescribe fewer opiate doses for patients’ post-operative pain management following provider education.

METHODS:

Ob/Gyn residents at UF Health Jacksonville were given a pre-intervention survey to gauge opioid prescribing patterns and utilization of resources like Prescription Monitoring Programs (PMP) and Opioid Risk Tool (ORT). Residents then attended a didactic session reviewing rates of adverse outcomes from overprescribing, resources to reduce adverse outcomes, and amount of opioids considered appropriate post-operatively. Residents completed a post-intervention survey to re-evaluate prescribing patterns.

RESULTS:

13 residents completed both pre- and post-surveys. For cesarean delivery, 100% of residents prescribed at least 30 pills prior to education, but none prescribed more than 20 pills after intervention (p=<0.0001). Similar but less distinct shifts can be seen in laparoscopic hysterectomy (TLH) and use of pre-operative gabinoids. 54% prescribed 20 pills or more following TLH initially while only 7.7% prescribed more than 20 pills after education (p=0.0382). Pre-operative gabinoid usage consideration increased from 15.4% to 100% following intervention.

CONCLUSION:

Focused opioid education can greatly reduce the amount of opioids prescribed in a post-operative setting. This study highlights the impact educational curriculums can have on prescribing patterns by allowing providers to better understand the current epidemic as well as how to optimize stepwise multimodal analgesia to avoid over-prescribing opioids.
Evaluating the Bell Pepper Model for Teaching Operative Hysteroscopy [5I]
Authors: Seaman Sierra , Han Esther , Arora Chetna , Lee Minyi , Kim Jin Hee
Published: May 2019

INTRODUCTION:

This study was performed to evaluate the effectiveness of an operative hysteroscopic simulation using a bell pepper model in improving skills and confidence in trainees performing resection of a polyp in a high fidelity virtual reality (VR) simulation with a loop electrode.

METHODS:

Ob/Gyn residents at a tertiary academic center completed a bell pepper exercise during which they assembled and practiced handling a resectoscope. They were asked to insert the resectoscope, visualize the inside of a bell pepper and resect portions of the flesh. A pre- and post-test assessment on a validated high-fidelity VR simulator was used to compare skill acquisition. Pre- and post-test questionnaires were used to compare confidence and perception of gained skills.

RESULTS:

Seventeen residents in post-graduate years 1 to 4 participated in the study. There was significant improvement in overall VR polypectomy score (P=.0008), economy of motion (P<0.0001), fluid handling (P=0.03), and safety (P=0.02). There was a decrease in total visualization scores (P=0.007). Overall change in performance did not differ significantly based on post-graduate year in training or hysteroscopic experience. Trainees had significantly improved confidence in performing hysteroscopic polypectomy (P=0.002) and myomectomy (P=0.01), and in using electrosurgical cut and coagulation functions (P=0.01).

CONCLUSION:

The bell pepper model improves operative hysteroscopy skills and confidence in trainees and can be used as a low-cost, easily reproducible training model. There are some deficiencies of the model with its inability to accurately simulate cervical and uterine anatomy and, particularly, the inability to simulate cervical entry, which can be difficult.
Impact of Multidisciplinary Ultrasound Education in a Low-Middle-Income Country [6I]
Authors: La Rosa Mauricio , Webb Camille , Marrs Caroline Carter , Hadley Emily Elizabeth , Cabada Miguel , Olson-Koutrouvelis Gayle
Published: May 2019

INTRODUCTION:

The objective of our study is to evaluate the ultrasound knowledge before and after a hands-on workshop, designed to increase basic ultrasound knowledge among physicians and midwives from rural health centers in the Cusco region of Peru.

METHODS:

A basic three-day ultrasound curriculum tailored to specific needs was created by fellows. It included lectures, hands-on training. Thirty-three physicians and midwives attended the conference. A pretest was completed prior to starting the course. A posttest was given at the end of the course. The tests evaluated basic ultrasound knowledge, fetal biometry and anatomy, placenta and amniotic fluid, and hydatid cysts. The primary outcome was total test scores. Secondary outcomes included the scores in specific areas. Statistical analysis was performed using univariate analyses and a P<0.05 was considered statistically significant.

RESULTS:

Twenty-nine pretests and thirty-two posttests were completed. The mean percentage of correct answers in the pretest was 29.8% (IQR 21.1-31.6) and in the posttest was 77.1% (IQR 73.7-84.2), (p<0.0001) Participants showed significant improvement in scores in 13 out of the 19 questions included. The areas with most improvement were basic ultrasound knowledge and fetal biometry and anatomy. The percentages of correct answers on each area were: basic ultrasound knowledge: 25.6% vs. 78.6% (p<0.0001), fetal biometry and anatomy: 24.1% vs. 86.5% (p<0.0001), placenta and amniotic fluid: 35.3% vs. 60.2% (p<0.0001), and hydatic cyst: 50% vs. 78.1% (p<0.0001).

CONCLUSION:

A multidisciplinary 3-day ultrasound course tailored to identified needs of a Low-Middle-Income Country setting had a significant impact on the knowledge acquired by the participants.
Forceps-Assisted Vaginal Deliveries: What Is the Training Landscape of Current MFM Fellows? [7I]
Authors: Rose Kelsey , Afshar Yalda , Datkhaeva Ilina , Shih-Chi Han Christina
Published: May 2019

INTRODUCTION:

The goal of this study is to determine the current landscape of forceps-assisted vaginal delivery (FAVD) training across the United States (U.S.) amongst MFM fellows.

METHODS:

An online survey was created on REDCap and sent to MFM Fellowship Program Directors for distribution to current MFM fellows in the U.S. Geographic regions were determined using Census Bureau-designated regions.

RESULTS:

The survey was completed by 106 MFM fellows (42% of U.S. fellows). Only 22.6% of fellows had performed >30 FAVDs, with 33% having performed ≤10 FAVDs. In comparison, 35.8% of fellows had performed more than 30 vacuum-assisted vaginal deliveries (VAVD). While 95.2% of fellows feel prepared to perform a VAVD independently, only 59.4% feel prepared to do FAVDs independently. Nonetheless, 53% of MFM fellows favor performing a FAVD. There is no significant difference in the percent of fellows by geographic region who have performed >30 FAVD (P=0.87). MFM fellows in the West are most likely to have performed >30 FAVD at 57.8%, compared to 42.3%, 35% and 11.4% in the Midwest, South and Northeast, respectively.

CONCLUSION:

MFM fellows are more confident with VAVD compared to FAVD. Despite lower confidence with FAVD, the majority of MFM fellows feel comfortable performing FAVDs independently. Region of training does not significantly affect one's training in FAVDs. A coordinated nationwide effort to increase exposure to and confidence for FAVDs should be considered.
Date Rape Drugs in Las Vegas: Detection After the Fact [11I]
Authors: Paul Anthea , Mahesan Arnold
Published: May 2019

INTRODUCTION:

Date rape drugs (DRDs) are drugs which can be used to conduct drug-facilitated sexual assault. The three major drugs classified by the U.S Department of Health & Human Services misused for this purpose are Rohypnol (Flunitrazepam), Gamma hydroxybutyric acid (GHB) and Ketamine. Existing studies in the literature analyze self-reported incidents in women which likely underestimate the prevalence of this problem. Our study aimed to evaluate how frequently there was clinical or criminal suspicion of DRD use prior to autopsy evaluation in a group of deceased DRD positive women.

METHODS:

This study was a retrospective analysis of all female decedents aged 20-55 who tested positive for Flunitrazepam, GHB and Ketamine referred to the Clark County medical examiner from 2000-2015. Medical records, police report, and autopsy findings were reviewed. All decedents underwent standard toxicology screening from whole blood toxicology analysis. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.

RESULTS:

23 women referred to the Clark County medical examiner tested positive for DRDs. At autopsy 6 women were positive for Rohypnol, 15 for GHB, and 2 for ketamine. After clinical, autopsy and police report review, 74% of 17/23 women had no clinical suspicion of DRD involvement at the time of death. Specifically, 83% (n=5) women had no suspicion of flunitrazepam use prior to toxicology results.

CONCLUSION:

Only a small minority of cases raised suspicion of DRD use upon police or clinical assessment. DRD use may be more prevalent in society than previously thought posing a significant public health threat.
Delayed Uterine Inversion [16I]
Authors: Carney Casey , Boyd Bronwyn , Goldberg Jay
Published: May 2019

INTRODUCTION:

Uterine inversion is a rare obstetric emergency that typically presents immediately following the third stage of labor with hemorrhage, shock, and possible maternal death if not promptly diagnosed and treated. We report a rare delayed postpartum uterine inversion.

METHODS:

28-year-old gravida 1 para 0 with an uncomplicated antenatal course and normal labor curve, delivered a full term infant via vacuum assisted vaginal delivery. The placenta was delivered spontaneously. Five weeks postpartum, the patient presented with ongoing vaginal bleeding. An erythematous friable mass filling her vagina. A pelvic ultrasound noted that the suspected pelvic hematoma measured 7.3 x 5.3 x 5.2 cm. The suspected hematoma was managed conservatively. Three months postpartum, due to acutely increasing vaginal bleeding, an exam under anesthesia was performed. Uterine inversion was diagnosed, with attempted uterine replacement unsuccessful. A total abdominal hysterectomy was then performed without postoperative complication.

CONCLUSION:

Delayed postpartum uterine inversion may present with persistent vaginal bleeding and an erythematous friable mass protruding through the cervix into the vagina. Given the risk of acute hemorrhage, uterine replacement should be attempted soon following the diagnosis of delayed postpartum uterine inversion, with hysterectomy if unsuccessful.
Comparison of Pregnancy Dating in Rural and Urban Rwanda and its Impact on Pregnancy Outcomes [28I]
Authors: Gashema Hertier , Small Maria Jacqueline , Kitessa Doee , Magriples Urania , Rulisa Stephen
Published: May 2019

INTRODUCTION:

Optimal management of pregnancy and delivery is dependent upon dating. In low resource settings, pregnancies are predominantly dated by LMP. Little is known about dating methods and their impact on outcomes in different geographic areas in Rwanda. This study compared pregnancy dating and its impact on perinatal management and outcomes.

METHODS:

We performed a retrospective study at the largest teaching hospital (KUTH) and a rural district hospital (Kibogora) in Rwanda. All patients with antenatal care and delivery at the studied institution between March 1 and September 30, 2017 were included. Methods of pregnancy dating were: certain LMP, uncertain LMP and ultrasound before 20 weeks. If the clinician intervened and acted to medically to delay or expedite delivery, management was “active” and if they were managed expectantly it was defined as “passive”.

RESULTS:

We enrolled 239 patients from urban (57.3%) and rural (42.7%) settings. Among urban women, 91.2% were certain of their LMP and 58.8% of rural women reported certainty (p<0.001). US prior to 20 weeks was performed in 90.5% (urban) and 16.7% (rural) settings (p<0.001). At KUTH, LMP dating only was 0 v. 57.8% at Kibogora (p<0.001). All urban women (100%) were actively managed v. 3.9% of rural women. There was no difference in mode of delivery or maternal complications. There was no difference in APGARs, however, NICU admissions occurred in 5.8% of urban and 24.5% in the rural hospital (p<0.001).

CONCLUSION:

In this comparison of urban and rural hospitals, ultrasound prior to 20 weeks gestation significantly impacted maternal and neonatal outcomes.
Corticosteroids’ Effect on Neonatal Outcomes in Prelabor Rupture of Membranes During Late Preterm [31I]
Authors: Kidd Jennifer M. J.
Published: May 2019

INTRODUCTION:

Recent recommendations from SMFM and ACOG now include administration of corticosteroids in the late preterm period to decrease complications of prematurity. This study attempts to understand if prelabor rupture of membranes during this time experience benefits and/or complications from corticosteroids.

METHODS:

This study was a retrospective IRB approved cohort study from 2015-2017. It included singleton liveborn pregnancies diagnosed with prelabor rupture of membranes from 34-36 weeks that had not received corticosteroids earlier in the pregnancy. The study excluded fetal anomalies, multiple gestations, prior uterine surgery, placenta previa, malpresentation, active genital herpes, and delivery outside the hospital. Chart review of maternal data included medical history, administration of corticosteroids, intrapartum complications, delivery information, and postpartum complications. Infant data included length of stay, neonatal hospital course, and readmission within 1 month after discharge.

RESULTS:

The administration and completion of corticosteroids course prior to delivery increased during the study. Mode of delivery between groups was not statistically significant. The length of stay for neonates decreased from 6.8 days to 5.1 days in 2017. The occurrence of hyperbilirubinemia and hypoglycemia decreased by half during the/or study period. Neonatal readmission rate was highest in 2015 secondary to cases of hyperbilirubinemia with no readmissions in 2017.

CONCLUSION:

This study provides support for administration of antenatal corticosteroids with prelabor rupture of membranes in the late preterm period. This study reviews potential secondary outcomes of decrease in length of stay, hyperbilirubinemia, and readmission for this population. These findings have clinical benefits to the neonates and decreased cost to the health system.
Does Adjunctive Azithromycin Treatment at the Time of Cesarean Delivery Improve Maternal and Neonatal Outcomes [32I]
Authors: Johnson Christina , Dagum Camilla , Persad Malini D. , Herrera Kimberly M. , Buckley Ayisha , Garretto Diana J.
Published: May 2019

INTRODUCTION:

Postpartum (PP) infections are more common after Cesarean section (CS) compared to vaginal deliveries. Preoperative Cefazolin is commonly used, recent evidence indicates that adding azithromycin (AZI) as extended antibiotic coverage decreases the risk of infectious comorbidities for non-elective CS (nCS). Since 2017, our L&D used AZI + cefazolin in nCS. Goal was to determine if adding preoperative AZI lowers PP infections.

METHODS:

An IRB approved retrospective cohort study conducted. ST antibiotics (1st generation cephalosporin or clindamycin and gentamycin with allergy). Women placed in 2 groups: ST+AZI versus ST. Exclusion criteria: elective CD, no preoperative antibiotics, AZI allergy. The primary outcome: composite of maternal wound infection, endomyometritis, maternal morbidity, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, neonatal morbidity. Statistical analyses performed with p value <0.05 significant.

RESULTS:

100 women in study, 28 in the ST+AZI group and 72 in ST group. Women were more likely to be younger (29.2 vs 31.3 years, p 0.04), have rupture of membranes (78.6% vs 50%, p 0.03) in ST+AZI versus ST. The demographics, indication for delivery, gestational age at delivery, type of skin incision, closure, preparation were similar. There was no difference in the composite outcome between the ST and ST + AZI group (5.6% vs 10.6%, RR 1.3 [CI 0.7-2.5] p 0.55); the rate of NICU admission was nearly statistically significantly higher in ST group versus ST+AZI (36% vs 14.2%, RR 0.8 [CI 0.6-0.9] p value 0.05).

CONCLUSION:

Adjunctive AZI at time of CD does not appear to improve maternal and neonatal outcomes in our population.
Does Introduction of Normal Saline Tip the Electrolyte Balance in Preeclampsia? [33I]
Authors: Yule Casey S. , Ambia Anne M. , Duryea Elaine L. , McIntire Donald D. , Nelson David B.
Published: May 2019

INTRODUCTION:

Due to a nationwide shortage of Ringer's lactate, normal saline became the intravenous fluid of choice at our institution in 5/2018. Recent studies have raised concern on safety of administration of normal saline in critically ill patients. We sought to evaluate the impact of normal saline on the outcomes of women with preeclampsia receiving magnesium sulfate.

METHODS:

Prospective observational study of women with preeclampsia with severe features receiving normal saline. The amount of normal saline administered was calculated and a basic metabolic panel was surveyed approximately 12 hours after initiation of magnesium sulfate prophylaxis. Laboratory analytes were examined according to the amount of intravenous fluid received.

RESULTS:

From 5/2018 to 7/2018, a total of 124 patients were identified. The mean intravenous fluid volume received was 1.84 ± 0.9 L. Serum creatinine and chloride levels remained unchanged over time and across quartiles of amount of fluid received (p=0.322 and p=0.822, respectively). Incidentally, a significant relationship was found between calcium levels and both the amount of normal saline received (p=0.0003) and concurrent magnesium levels (p<.0001). When testing for interaction between calcium, magnesium, and normal saline, both of the latter contributed to an increased risk of hypocalcemia.

CONCLUSION:

There does not appear to be a significant consequence to either chloride levels or renal function when utilizing normal saline in women with preeclampsia receiving magnesium sulfate. Coincidentally, calcium levels significantly declined as the amount of intravenous fluid increased, which given the association with magnesium levels is suspected to be a function of magnesium sulfate exposure.
Does Universal Cervical Length Screening Impact Cerclage Practice Patterns? [36I]
Authors: Griffin Myah Maria-Nelson , Hogg James Preston , Stephenson Courtney D. , Temming Lorene Atkins , Pollack Rebecca Epstein
Published: May 2019

INTRODUCTION:

We sought to evaluate the impact of universal cervical length screening (UCLS) on the placement rate of history-indicated (HIC), ultrasound (USIC)-indicated, & physical exam (PEIC)-indicated cerclages.

METHODS:

A retrospective cohort study compared women with a CL of <3 cm on US between 16 and 20 weeks for 2 years before and after implementation of UCLS at a single institution from April 2013 to April 2017. Multivariable logistic regression was used to evaluate the changes in the rate of overall cerclage placement and types of cerclages along with impact on preterm birth (PTB) rates.

RESULTS:

4350 were evaluated in the pre-screening period and 3959 in the post-screening period. Detection rate of short cervix was increased after implementation of screening, but rates of cerclage placement were similar (P=0.11). Among 67 patients with cerclages, demographics (race, BMI, prior PTB, CL, tobacco use) were similar. There was decrease in HIC placement post implementation (RR 0.6 95% CI 0.4-0.9) and a non-significant trend toward an increased placement rate of USIC (RR 1.9 95% CI 0.9-3.9). The rate of PE-indicated cerclages was similar. Among women with cerclage, there were no differences in PTB before and after screening implementation.

CONCLUSION:

Cerclage placement rate was unchanged with UCLS. Rates of USIC and PEIC were unchanged, while the rate of HIC was significantly decreased. This was likely related to increased reliance on US screening. While this may have increased utilization of ultrasound, this change in practice pattern did not impact rates of PTB.
Safety of AG200-15, an Investigational Transdermal Patch, in Three Phase 3 Studies [1J]
Authors: Nelson Anita L. , Kaunitz Andrew M. , Kroll Robin , Simon James A. , Castano Paula M. , Garner Elizabeth I. O.
Published: May 2019

INTRODUCTION:

AG200-15 (Twirla®) is an investigational transdermal contraceptive delivery system (TCDS), which delivers daily exposure of approximately 120 µg of levonorgestrel and 30 μg of ethinyl estradiol. We report the safety from three Phase 3 studies - the SECURE (ATI-CL23) study, ATI-CL12, and ATI-CL-13.

METHODS:

SECURE was a single-arm, 13-cycle, open-label study conducted in 2014-2016. ATI-CL12 (13-cycles) and ATI-CL13 (6-cycles) were conducted in 2010-2011 and were open-label, randomized, active-controlled (an approved oral contraceptive (OC)) safety and efficacy studies. Subjects reported all treatment emergent adverse events (TEAEs) and serious adverse events (SAEs). TEAEs were defined as adverse events with an onset date on or after the first patch application through Day 28 of the subject's final treatment cycle. The results reported represent combined safety data.

RESULTS:

For AG200-15 in all studies combined, 54% of 3,481 subjects had at least one TEAE, 26% had at least one study drug-related TEAE, 5% had TEAEs of severe intensity, and 11% had TEAEs resulting in study drug discontinuation. Fewer than 2 percent of subjects (n=56) had SAEs, and 0.5% (n=18) had study drug-related SAEs. The SAEs occurring in >2 subjects were cholelithiasis (n=4), deep vein thrombosis (3), pulmonary embolism (3), and depression (3). No deaths were reported. The most common TEAEs (≥-2%) included nasopharyngitis (5.7%), upper respiratory tract infection (4.5%), nausea (4.3%), headache (3.6%), and urinary tract infections (3.5%).

CONCLUSION:

The percentages of TEAEs and SAEs were generally similar across the Phase 3 studies. The adverse event profile of AG200-15 appears to be similar to approved OCs.
A Novel Skin Closure Device for Minimally Invasive Surgery: Patient and Provider Assessments [2J]
Authors: Mihalov Linda S. , Berenson Ronald
Published: May 2019

INTRODUCTION:

Patient and surgeon experience with a novel skin closure device combining microstaples with adhesive film for multiport laparoscopic surgery (general, urologic or gynecologic) evaluated.

METHODS:

Case cohort prospective observation study, 18 patients served as their own controls. Each surgeon closed at least one incision with their standard suture and at least one with the device. Day 0, surgeons rated ease of use and speed of application of the device and sutures. POD 10 and 30, patients rated comfort of the incisions, comfort of device removal, wound appearance, surgeons rated wound appearance.

RESULTS:

Surgeons rated the device as much (28%) or somewhat better (56%) than suture for ease of use, much (44%) or somewhat (34%) better for wound closure speed. On day 30, surgeons rated appearance of device-closed wounds as much (36%) or somewhat (57%) better than suture, none rated appearance as worse than sutured wounds. On day 30, patients rated device-closed incision comfort as much (19%) or somewhat (38%) better, comfort of removal of the device as much (18%) or somewhat (29%) better, and overall appearance as much (58%) or somewhat (33%) better than the sutured incisions. Nine percent of patients rated the appearance of the wounds as the same, and none rated the device-closed incisions as worse than sutured on any measure.

CONCLUSION:

Laparoscopic skin incision closure speed and ease and patient comfort and wound appearance can still be improved. This novel device incorporates the strength of staples with adhesive film and was highly acceptable to both surgeons and patients.