bluuebunny/crossref_metadata_2025 huggingface dataset:
Decreased Narcotic Use After the Implementation of ERAS Guidelines in Gynecologic Oncology at an Academic Center [24H]
Authors: Plasencia Elizabeth , Mamani Semiramis Carbajal , Schweer David , Goicoechea Joel Cardenas
Published: April 2020

INTRODUCTION:

The Enhanced Recovery after Surgery (ERAS) program was made to provide a standard approach to pre- and post-operative care in order to decrease narcotics requirements for surgical pain. Also, improve peri-operative outcomes such as surgical complications, and readmission rates.

Objective:

To assess the impact on narcotic use before and after ERAS in gynecologic oncology patients.

METHODS:

IRB approved study. Retrospective cohort study in patients with newly diagnose endometrial cancer who underwent robotic assisted laparoscopic surgery from May 2016 to February 2019 at an Academic Center. Patient’s narcotic used, demographics, surgical outcomes, intra- and post-operative complications, blood loss, pain medication administered, length of stay, and hospital readmission was analyzed.

RESULTS:

One hundred thirty nine patients met study criteria. Forty-three and ninety-six patients were before and after the implementation of ERAS. Both groups were similar regarding demographics, age, body mass index, comorbidities, cancer histology, grade and stage. Narcotic use was significantly decreased in patients after ERAS introduction (26.73 vs 45.53 morphine equivalents, 95% CI 30.79 to 56.3; P=.008). The post-ERAS cohort also had increased use of multimodal drug therapy for pain (85% vs 63%, n=0.004) and increase gabapentin (12% vs 62%, P=.000) and NSAID use. (36% vs 16%, P=.017). ERAS introduction did not result in decreased length of stay, hospital readmissions, or surgical complications.

CONCLUSION:

ERAS incorporation decreased narcotics used and increased multimodal drug use for postoperative pain without compromising peri-operative outcomes.
Endometriosis Associated Ovarian Cancer: A Single Gynecologic Oncology Practice [25H]
Authors: White Michael , Retes Benjamin Z. , Nezhat Farr
Published: April 2020

INTRODUCTION:

There is increasing evidence of the association between endometriosis and ovarian cancer. Data is limited regarding stage, subtype, and recurrence for this specific subset of patients. We report and analyze findings from cases with histologically confirmed ovarian cancer associated with endometriosis at time of surgery.

METHODS:

Retrospective review surgical cases from a single gynecologic oncology practice between 2003-2019. Selection criteria of surgical cases included final pathology reports showing endometriosis and ovarian malignancy with adequate follow up.

RESULTS:

31 cases were diagnosed. Average patient age was 52.4 (29-83). Histologic subtypes diagnosed were high grade serous 9/31 patients (29%), clear cell 12/31 patients (39%), endometrioid 8/31 (26%), and mucinous 2/31 (6%). Surgical staging ranged from 1A-IIIC. 18/31 patients (58%) were diagnosed with Stage I (A: 6, B: 1, C: 11), 5/31 patients (16%) with Stage II, 8/31 patients (26%) with Stage III. All patients underwent surgical staging/debulking with 5 patients (15%) receiving neoadjuvant chemotherapy. 28/31 patients (90%) received adjuvant chemotherapy with Carboplatin/Taxol while 3/31 patients (10%) did not require further treatment. Surgical staging/debulking was performed by Laparotomy 6/31 patients (19%) or Laparoscopy/Robotic 24/31 patients (78%) with 1 case converted to Laparotomy (3%). Recurrence noted with clear cell histology 6/10 (60%) all stage I, high grade serous 3/10 (30%) all stage IIIC, and mucinous 1/10 (10%) stage I.

CONCLUSION:

The most common endometriosis associated ovarian cancers were early stage clear cell and endometrioid subtypes. Clear cell histology in spite of early stage was the most significant factor for recurrence.
Adverse Neonatal Outcomes Associated With Pregestational Diabetes in Infants Born Premature [08F]
Authors: Tse Beverly , Yao Ruofan
Published: April 2020

INTRODUCTION:

Pregestational diabetes (PGDM) is a known risk factor for preterm delivery. It is unclear if infants born preterm to PGDM mothers are at higher risk of adverse outcomes compared to other premature infants. The objective of this study is to quantify the neonatal complications associated with PGDM in infants born premature.

METHODS:

This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006-2014. Analysis was limited to births between 24 and 36 weeks gestation. Results were stratified by PGDM status. Neonatal outcomes of interest included infant death, neonatal intensive care unit (NICU) admission, low 5 minute APGAR scores, assisted ventilation >6 hrs, surfactant administration and seizures. Multivariate logistic regression analysis was performed to estimate the association between PGDM and neonatal outcomes controlling for potential confounding variables.

RESULTS:

After exclusions, 277,210 births were analyzed. The prevalence of PGDM was 1.5%. In infants born premature, PGDM was associated with an increased risk of infant death (2.3% vs. 2.0%, aOR 1.39; 95% CI [1.12, 1.73]), risk of low 5 min Apgar score (8.1% vs. 6.2%, aOR 1.50; 95% CI [1.33, 1.70]), risk of prolonged assisted ventilation (9.4% vs. 6.2%, aOR 1.61; 95% CI [1.44, 1.80]), risk of requiring surfactant treatment (3.1% vs. 2.1%, aOR 1.61; 95% CI [1.33, 1.93]), risk of NICU admission (49.4% vs. 036.1%, aOR 1.72; 95% CI [1.61, 1.84]) and risk of seizures (0.19% vs. 0.06%, aOR 3.06; 95% CI [1.49, 6.29]).

CONCLUSION:

PGDM is associated with high risk of neonatal adverse outcomes in infants born premature.
Discrepancies in Prenatal Urine Drug Screening During Marijuana Legalization in Washington State [12F]
Authors: Pflugeisen Bethann M. , Mou Jin , Straub Heather , Drennan Kathryn
Published: April 2020

INTRODUCTION:

This study evaluated demographic patterns related to prenatal cannabinoid urine drug screening (UDS) over a five-year period during which recreational marijuana was legalized and became accessible in Washington State.

METHODS:

Using electronic health record data, we performed a retrospective analysis for deliveries occurring between the 20 months prior to legalization and following legal accessibility. For three cohorts of women (delivering prior to, between, and following legalization and accessibility), the UDS completion rate and screening demographic characteristics were assessed using Chi-squared tests and multivariate logistic regression.

RESULTS:

25,514 deliveries occurred between March 2011 and March 2016. Significantly more women underwent UDS post-accessibility (24.5%) compared to pre-legalization (20.0%, P<.001). A corresponding increase was not observed in marijuana-positive UDS in tested patients (22.7% vs. 23.3%, P=.86). African American women were more likely than women of any other race to be screened (aOROtherRace=1.4, aORWhite=1.7, aORAsian=2.1, and aORLatina=2.8, all P<.001). Odds of positive UDS increased only for white women following legalization (aOR 1.29, 95% CI 1.05-1.59, P=.02), but not for any other race. Subsidized insurance status was strongly associated with increased likelihood of testing (aOR 3.5, P<.001).

CONCLUSION:

Prenatal UDS patterns changed as policy surrounding recreational marijuana possession and accessibility evolved. Demographic discrepancies in testing reveal biases related to race and insurance status. As such they are potential contributors to health outcome disparities. It is important for providers of healthcare and health care systems to examine their practices and ensure they are being equally and justly applied.
Medical-Legal Partnerships: Supporting the Legal Needs of Women in Their Perinatal Care [16F]
Authors: Gutierrez Griselda , Saleeby Erin , Celaya Anna , Clouse Julia , Hoffman Catherine , Kornberg Jessie
Published: April 2020

INTRODUCTION:

Medical-legal partnership (MLP) aims to address the numerous social determinants of health. In July 2018 we added an MLP service for pregnant and postpartum women in an underserved safety net hospital in Los Angeles County. Here, we examine the prevalence of legal needs ascertained by self-administered legal needs assessments and the conversion rate of referrals to legal cases.

METHODS:

The MLP service was implemented as part of the continuum of clinical care. Referrals are tracked as part of case management. Review of self-administered screenings provided our referral screen-positive rates. Of those clients referred, a case conversion rate was calculated when legal cases were generated.

RESULTS:

Legal needs were identified in the following areas: family law (27%), employment (25%), housing (11%), and immigration (11%). A 72% screen positive rate (79 of 110) was found when clinic staff (provider, nursing, or social worker) directly referred to the MLP. Legal advice was often provided to those who screened positive (64%). Conversion rates were also high with 58% of those referred for formal legal action resulting in open cases (46 of 79 referred).

CONCLUSION:

Legal needs, such as assistance with employment law for pregnancy related disability accommodations, may have direct impacts on perinatal outcomes. Incorporating the MLP in resource-limited clinical settings can be achieved by including stakeholders in its development. The high conversion rate of referrals to cases illustrates the ability of the medical staff and patients to effectively identify legal needs and then partner with legal aid groups to address these concerns.
Patient and Provider Perspectives on Managing Pain With Opioids After Cesarean Delivery or Hysterectomy [18F]
Authors: Shi Carol , Risica Patricia M. , Danilack Valery A. , Sunday Joyce , Collins Erica , Matteson Kristen A.
Published: April 2020

INTRODUCTION:

Despite the prevalence of opioid prescribing after Cesarean delivery (CD) and hysterectomy in the United States, little is known about patients’ concerns regarding pain management and physicians’ attitudes regarding opioid prescribing practices. We conducted focus groups to characterize patient and provider perspectives on prescription opioid utilization, storage, and disposal.

METHODS:

We recruited women who had a recent CD or hysterectomy and physicians who perform CD and/or hysterectomy. Focus group discussions covered barriers to individualized opioid prescriptions, content of pain management conversations, and preferences for educational materials for safe opioid utilization, storage, and disposal. Approval was obtained from Women & Infants' Institutional Review Board.

RESULTS:

We conducted a total of 6 focus group sessions: 2 CD (n=21), 2 hysterectomy (n=18), and 2 with physicians who perform CDs and/or hysterectomies (n=12). Patient experiences with postoperative pain management were highly varied. While some avoided opioids despite maximum doses prescribed, others described concerns such as fear of pain that motivated them to consume more opioids. Patients reported that physicians often did not consult them about medication preferences or pain control expectations. Physicians were unsure how other members of the medical team counseled patients about opioid utilization and were unaware of best practices for safe opioid disposal. Patients’ concerns regarding pain management with opioids often coincided with absent, inconsistent, or unclear counseling from providers.

CONCLUSION:

Optimizing physician-patient discussions of pain expectations, individualized opioid prescribing, and education about safe opioid storage and disposal throughout the perioperative period may improve patient experiences and adherence to best practices for opioid utilization.
Reproductive Healthcare Provision in the Veterans Healthcare Administration: A Mixed Methods Evaluation [20F]
Authors: Gawron Lori M. , Callegari Lisa S. , Galyean Patrick , Young Jeanette , Yang Serena , Zickmund Susan L.
Published: April 2020

INTRODUCTION:

Despite efforts to prioritize comprehensive care for women Veterans within the Veterans Health Administration (VHA), disparities in reproductive health services exist, especially for those accessing care in rural VHA community-based outpatient clinics (CBOCs). We sought to understand barriers and facilitators to VHA reproductive health service provision, including in rural settings.

METHODS:

We performed a mixed methods study, including a quantitative survey and semi-structured, qualitative interviews. We recruited women’s health primary care providers and support staff from the Salt Lake City medical center and 8 surrounding CBOCs. We employed a Likert scale to assess comfort with 17 reproductive health services and performed descriptive analyses. In qualitative interviews, we explored provider/staff training, current care processes, and improvement opportunities. We audio-recorded, transcribed, and used Crabtree and Mill’s Editing Approach to identify dominant themes.

RESULTS:

We recruited 15 participants across 9 sites (4 physicians, 7 nurse practitioners and 4 registered nurses). Mean age was 49.6 years, 86.7% were women, and 93.3% were white. Comfort scores were lowest for fertility counseling and intrauterine device or implant management. In qualitative analyses, barriers included inability to attain/maintain proficiency, staff turnover, inability to order or maintain supplies, referral challenges, and lack of Veteran awareness of available services. We identified few facilitators, including reproductive health experience outside the VHA, invested support staff, and care coordination relationships at the VHA medical center or in the community.

CONCLUSION:

Addressing barriers to VHA reproductive healthcare provision is needed to overcome disparities related to clinic location and to improve reproductive health outcomes for all women Veterans.
Use and Utility of Endocervical Curettage at Colposcopy [21F]
Authors: Guan Yue , Class Quetzal A. , Litwiller Abigail
Published: April 2020

INTRODUCTION:

Few studies have investigated the diagnostic utility of endocervical curettage (ECC) since the 2013 ASCCP Updated Consensus Guidelines. We evaluate the use of ECC at colposcopy for detection of ≥ cervical intraepithelial neoplasia (CIN) two.

METHODS:

IRB approved retrospective chart review included patients attending colposcopy clinic at a large urban hospital from January 2017 to January 2019 (N=402). From electronic medical records we extracted demographic characteristics, medical comorbidities, insurance status, pap smear cytology, HPV results, and colposcopy results including biopsy or ECC pathology. We used Chi-square to evaluate the use and diagnostic utility of ECC at time of colposcopy for detection of ≥ CIN two.

RESULTS:

An ECC was performed in 66.9% of colposcopies and 7.8% of those returned with pathology of ≥ CIN two. Transplant recipients were significantly more likely to have an ECC performed during colposcopy (X2(1, N=402)=7.23, P<.05) while ECC was less frequent for those with unsatisfactory pap cytology (70% did not receive ECC, P<.001). Inadequate colposcopy was associated with a higher likelihood of receiving ECC (P<.0001). ECCs were significantly more likely to be performed when cervical biopsy was also performed (74% vs 58% with no biopsy; X2(2, N=402, P<.05). Cervical biopsy CIN results agreed with ECC CIN results (X2(1, N=151)=20.62, P<.0001). In 4.2% of colposcopies, when cervical biopsy revealed no dysplasia or CIN 1, ECC revealed ≥ CIN 2.

CONCLUSION:

ECCs were performed more frequently in transplant patients, inadequate colposcopy, and when cervical biopsy was also obtained. In most cases ECC did not change management.
Reproductive Healthcare Experiences of Incarcerated Women: A Qualitative Study [30F]
Authors: O'Connor Sarah , Perkins Rebecca
Published: April 2020

INTRODUCTION:

The U.S. prison population has reached an all-time high, with women representing the fastest growing sub-population. Recently, national medical organizations recognized inadequate correctional health care as a major problem. Despite this awareness, the U.S. correctional health care system remains fragmented and non-uniform in practice, particularly in women’s healthcare, with poor transitions between incarceration and the community. The purpose of this study was to examine how formerly incarcerated women navigate this system to address their reproductive healthcare needs.

METHODS:

Adult, English-speaking women with history of incarceration within the last 10 years were interviewed using a semi-structured interview tool. Interviews were analyzed using modified grounded theory and stopped upon thematic saturation. Interview themes were used to create a conceptual framework to describe this fragmentation.

RESULTS:

21 women completed the study interview. They were on average 43 years old, with 7 periods of incarceration. 80% had children, and 52% were pregnant while incarcerated. Most women described fragmentation of care with inability to consistently access reproductive and prenatal healthcare services. Frequent transitions between institutions exacerbated problems with access. A high prevalence of mental health issues, including high rates of substance use disorder contributed to difficulty accessing needed services. Women suggested better coordination of care could improve their long-term health.

CONCLUSION:

This study illuminates the persistent reproductive health barriers that face formerly incarcerated women. Programs are needed to address the physical and mental health needs for women transitioning from incarceration back into the community.
Seroprevalence of HPV Infections in the Cervix and Penis in Unvaccinated Individuals: A Study of 3,143 Participants [31F]
Authors: Abel Mary Kathryn , Mann Amandeep , Kapp Daniel , Chan John
Published: April 2020

INTRODUCTION:

To determine the seroprevalence of cervical and penile HPV infections in unvaccinated, sexually-active adults in the United States.

METHODS:

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. HPV serotypes were determined by cervicovaginal swabs in females and penile specimens in males. Chi-square was used for statistical analysis.

RESULTS:

Of 3,143 unvaccinated, sexually-active adults (median age: 28 years), 2,608 (83%) were female and 535 (17%) were male. Median lifetime sexual partners was 5 for women and 6 for men. 59.1% of females and 45.8% of males were infected with HPV. For unvaccinated women, of the top five HPV serotypes, only HPV 16 and 51 were considered high-risk and comprised 6.81% and 5.45%, respectively. The additional serotypes included HPV 53 (6.9%), 89 (6.0%), and 84 (5.7%). Of the top five HPV serotypes in unvaccinated men, HPV 51 and 66 were considered high-risk and comprised 7.2% and 5.8% of all infections; the remaining serotypes included HPV 62 (7.3%), 53 (5.5%), and 89 (5.4%). Infection with HPV serotypes covered by the 9-valent vaccine represented 21.8% of infections in females and 22.1% of infections in males in this study cohort (P=.96).

CONCLUSION:

In unvaccinated individuals, both men and women are at risk for infection for cancer-associated HPV types with varying seroprevalence. The efficacy of the 9-valent vaccination may have varying efficacy depending on gender and site of infection.
Cuff Dehiscence in Endometrial Cancer Patients After Robotic Laparoscopic Total Hysterectomy [35F]
Authors: Griggs Paige , Duong Jennifer , Okut Hayrettin , Morgan Jacqueline , Kolojeski Maria , Miller Kevin
Published: April 2020

INTRODUCTION:

Cuff dehiscence (CD) is a serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for malignant or benign indications. The primary objective of this study was to evaluate if there is a difference in incidence and risk factors of CD following RLTH among patients with endometrial cancer compared to patients without endometrial cancer.

METHODS:

This retrospective study included women 18 years or older who underwent RLTH performed by one of two surgeons from a single institution from January 1, 2013 through March 31, 2018. Conversion to open laparotomy, chemotherapy/radiation within a year before or after RLTH, and malignancies other than endometrial cancer were excluded. Data were abstracted from patient medical records. This study received IRB approval.

RESULTS:

Of 950 patients meeting inclusion criteria, 50.7% (n=482) had endometrial cancer. CD was reported in 2.5% (n=24) of all patients. While holding other variables constant, obese patients were 25.1% less likely than normal weight patients to experience CD, χ2(1, N=675)=6.49, P=.011. Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon 1 compared to surgeon 2 while other variables in the model were held constant, χ2(1, N=675)=4.87, P=.027. No other variables (cancer status, age, sexual activity after surgery, distance from home to location of surgery, time interval from surgery to loss to follow-up) predicted CD.

CONCLUSION:

Endometrial cancer patients were at no greater risk of experiencing CD compared to non-cancer patients. This study suggests that BMI and surgical technique are the only variables associated with incidence of CD.
Predicting Surgical Failure of Midurethral Sling Placement: The Value of Preoperative Pelvic Floor Strength [38F]
Authors: Timmons Douglas B. , Grady Mary , Ibrahim Catrine , Garcia Alexandra , Garcia Mercedes , Medina Carlos
Published: April 2020

INTRODUCTION:

Pelvic floor muscle training is the first line nonsurgical intervention for urinary incontinence. Midurethral sling placement is the first line surgical intervention. Our objective was to evaluate the impact of pelvic floor muscle strength on success of surgical intervention.

METHODS:

A retrospective chart review was performed of all patients whom underwent an isolated RPMUS for either USI or MUI. Patients were divided into two groups based on PFMS determine pre-operatively utilizing a Modified Oxford Scale (0-5). Group 1-W (W=weak, PFMS=MOS ≤ 2) and group 2-S (S=strong, PFMS=MOS>2. Failure was defined as any patient reporting SUI or urge urinary incontinence (UUI) on the first postoperative visit. P-value<0.05 was considered significant.

RESULTS:

64 patients met inclusion criteria and each group was composed of 32 each (group 1-W, n=32 and group 2-S, n=32). Weaker or stronger pelvic floor muscle strength did not make a significant difference in the overall continence outcome among patients with preoperative SUI and or SUI and urgency only. However, in patients with MUI there was significantly more recurrence (USI/UUI) in the weaker PFMS (group 1-W) compared to the stronger PFMS (group 2-S), Table 2.

CONCLUSION:

Our results indicate that patients with MUI are at greater risk for failure if the PFMS is weaker compared to if stronger. Patients with weak PFMS and MUI should be counselled regarding the higher risk for failure. More importantly this study reinforces the value of strengthening the pelvic floor muscles prior to undergoing surgery, specifically in patients with MUI.
Understanding Women's Treatment Preferences for Pelvic Floor Disorders [40F]
Authors: Spiers Alaina , Vardeman Jennifer , Antosh Danielle
Published: April 2020

INTRODUCTION:

One in four women 20-years and older have at least one pelvic floor disorder (PFD). Studies show there is a lack of awareness and incorrect perception of PFDs among women of all ages. These factors may affect how women treat PFDs. Therefore, this study assessed women of different ages and risk levels knowledge, attitudes, and behaviors around PFDs to understand treatment decisions.

METHODS:

Researchers sought and gained informed consent from women of varying ages, ethnicities, and risk levels to participate in qualitative one-on-one interviews (n=20) and a focus group (n=6). After data collection, the participants' data were split into four groups for thematic analysis: women under 50 without PFD (n=12), women under 50 with PFD (n=3), women 50 or over without PFD (n=2), and women 50 or over with PFD (n=9).

RESULTS:

Age and risk level were not variables in participants’ treatment decisions. The majority of participants were not aware PFDs are a medical issue; they were more likely to say that they wouldn’t seek treatment from physicians, instead saying they would just wear pads or do Kegels. Once participants were made aware of PFDs being a legitimate medical issue, factors like time, income, convenience/ease of use, and perceived efficacy were cited as prefaces to treatment. Generally, noninvasive measures were the first choice of women of each category. Four out of five women who had a PFD-related surgery regretted it.

CONCLUSION:

Women of all categories need to be better informed of PFDs by their gynecologists in order to make more informed treatment decisions.
Are Obstetrics and Gynecology Residents Equipped to Care for Transgender Patients? A National Survey Study [04G]
Authors: Qin Lei , Estevez Samantha , Radcliffe Ella , Rabin Jill M. , Rosenthal David
Published: April 2020

INTRODUCTION:

Obstetricians and gynecologists (OB-GYNs) play an important role in the medical and surgical management of transgender and gender nonconforming (TGNC) patients. Our study aims to assess three self-reported outcomes: (1) comfort, (2) competency, and (3) curricular satisfaction of OB-GYN residents in TGNC care topics.

METHODS:

Our survey tool consisted of thirty questions on a 4-point Likert scale and was distributed electronically by program coordinators. The survey tool was deemed exempt by the Northwell Health Institutional Review Board. Descriptive statistics and Kruskal-Wallis test by ranks were performed using SPSS 26.0.

RESULTS:

One-hundred and six surveys were completed by OB-GYN residents (response rate=12.0%). Composite mean scores were calculated in the three self-reported outcome domains: comfort (2.8±0.7), competency (2.7±0.6), and satisfaction (2.4±0.7). No statistically significant difference in comfort, competency, and satisfaction scores between residency training level was observed. Male residents were more likely (χ2(1)=5.285, P=.022) to have higher self-reported competency scores than female residents (3.0±0.7 versus 2.5±0.6, respectively). LGBTQ residents were more likely (χ2(1)=5.509, P=.019) to have higher self-reported comfort scores than those who identified as heterosexual (3.1±0.6 versus 2.7±0.7, respectively).

CONCLUSION:

To our knowledge, this is the first study to assess the comfort, competency, and satisfaction of OB-GYN residents in TGNC care topics. Residents reported being more competent and comfortable than satisfied, which suggests that further curricular and clinical exposure is necessary to address the unique healthcare needs of this underserved patient population and to meet the educational needs of residents. LGBTQ residents may be able to share knowledge with peers to increase heterosexual residents’ comfort.
Assessment of Human Trafficking Knowledge Among Staff in a Tertiary Care Academic Medical Center [05G]
Authors: Engler Lauren A. , Mercer Laura
Published: April 2020

INTRODUCTION:

Millions of men, women, and children are trafficked around the world every year, a number that continues to increase annually. Victims of human trafficking frequently interact with the healthcare system, yet often go unnoticed. Healthcare practitioners hold an important role in recognizing, caring for, and referring victims of trafficking. This study aimed to assess the baseline level of knowledge related to human trafficking amongst staff at a large university hospital.

METHODS:

A previously validated survey was distributed to all employees at Banner University Medical Center using an online module format. A gift card raffle was utilized as incentive to participate. The study was IRB approved.

RESULTS:

There were a total of 2,042 survey responses. Respondents were stratified into groups based on role, specialty, and primary practice setting. A total of 81% have never received human trafficking training. Those who indicated prior training demonstrated a higher level of knowledge of human trafficking-related questions, and also felt more confident identifying and treating victims of trafficking. All groups of respondents indicated that the preferred method of additional training be pre-recorded online modules.

CONCLUSION:

These results support the need for targeted training related to human trafficking. This will allow a thoughtful and targeted approach to education and resource sharing within and among hospital staff. Moreover, the results indicate that additional training allows staff to feel more equipped to identify and intervene when interacting with victims of human trafficking.
Changing the Narrative; Peer Based Training on Reproductive Health: A Six Year Experience [08G]
Authors: Heger Julie , Shah Nayna , Maguire Karla , Chitters Celeste
Published: April 2020

INTRODUCTION:

Despite the American College of Obstetricians & Gynecologists recommendations, many medical students are not taught to counsel patients on their reproductive health options. Since 2013, medical students at the University of Miami, under faculty guidance, implemented a curriculum for volunteers who wish to help women in South Florida access long-acting reversible contraception and abortion services.

METHODS:

Students in their third- and fourth-year designed a training program. Second-year students who had undergone the training and had at least one year of experience as a Reproductive Health Advocate (RHA) led the program. The learning objectives were to train new RHAs in contraception, pregnancy termination, patient counseling, laws and finances. Pre- and post-training surveys assessed knowledge, attitudes, and barriers regarding reproductive health.

RESULTS:

Over the past six years, eighty-seven students with an average age of 24 years completed pre-training and post-training surveys. The cohort includes five males, eighty females and two declined to identify gender. Reproductive health knowledge scores improved with a pre-training average score of 58.6% and a post-training score of 83.2%, P<.008. Attitudes towards abortion also changed. Before training, 53% of students “strongly agreed” that abortion is safe; after training 86% “strongly agreed.” Prior to training, only 41% of the students strongly agreed that “abortion access is a problem in the hospital I train.” Post-training assessments showed that 63% of students strongly agreed.

CONCLUSION:

Student-run training improved medical students' understanding of reproductive health and barriers accessing care. To determine generalizability, future studies should replicate this training at different institutions.
Educational Modalities for Teaching Surgical Techniques for Obstetric Anal Sphincter Injuries: A Randomized Trial [09G]
Authors: Jackson Lindsey , Byrne John J. , Lupo Andrew , Florian-Rodriguez Maria , Wai Clifford , Balgobin Sunil
Published: April 2020

INTRODUCTION:

Decreasing rates of obstetrical anal sphincter injuries (OASIS) has posed challenges for the clinical training of residents in repairing this highly morbid injury. The aim of this study is to compare an OASIS repair model to an educational video for resident education.

METHODS:

IRB Exemption was obtained. OB/GYN residents completed a baseline questionnaire and written knowledge test evaluating OASIS epidemiology, anatomy, complications, and surgical technique. In addition, they performed a baseline graded hands-on repair with a beef tongue model using a validated objective structured assessment of technical skills (OSATS). Subjects were randomized to either viewing an OASIS educational video (“video”) or attending a workshop using a synthetic anal sphincter trainer model (“model”). 6-10 weeks later, post-intervention knowledge and practical assessments were completed.

RESULTS:

53 residents (n=28 “video,” n=25 “model”) participated in the study. There were no pre-intervention differences in knowledge or skill scores between groups. Mean±SD knowledge and skill scores improved from baseline regardless of intervention (Model knowledge 6±2 vs 8±2, P=.01, skill 14±3 vs 18±1, P<.01; Video knowledge 6±1 vs 8±2, P=.03, skill -14±2 vs 16±1, P<.01). The “model” group had greater improvement in skill level than the “video” group (18±1 vs 16±1, P<.01). By training level, all but the PGY-4 class significantly improved (P<.05). 100% of residents in model group and 92% in video group believed the intervention to be very educational.

CONCLUSION:

Although both educational modalities improve OASIS knowledge and skills, the model is more effective at improving technical skills.
Effectiveness of ABOG’s Article-Based Questions on Diplomates’ Retention of Knowledge [10G]
Authors: Novak Amanda R. , Shivraj Pooja R. , Ramin Susan R.
Published: April 2020

INTRODUCTION:

As part of continuing certification, the American Board of Obstetrics and Gynecology (ABOG) diplomates complete article-based assessments annually. Diplomates read articles, respond to article questions, and must score above a certain threshold to demonstrate competence in their understanding. There is a paucity of evidence that diplomates retain the information after reading articles. The study objective was to evaluate the effectiveness of the two question types (understanding and application) at measuring diplomates’ retention of knowledge over time.

METHODS:

A sample of 344 diplomates who chose selected articles between January-March 2019 volunteered for the study. Diplomates completed article questions in a business-as-usual setting (with article access) and were assessed again during summer 2019 (without article access). Each participant received 2 questions (one of each type) from 5 of the selected articles, for a total of 10 questions. The timed summer assessment was used as a proxy for retention. Diplomates’ scores, by item type, from each assessment setting were compared using a t-test to determine whether information was retained from the articles.

RESULTS:

The information assessed by application items was retained at a significantly higher rate (80.58%) than understanding items (60.75%), as demonstrated by mean scores on the assessment (P<.05).

CONCLUSION:

Application items yielded a higher knowledge retention rate. Understanding items ensure diplomates comprehend the article while application questions ensure diplomates can generalize and apply their understanding from the article. A combination of both item types for article-based assessments is necessary and this study demonstrates that diplomates retain the information they read from articles.
Evaluation of a Novel Pediatric & Adolescent Gynecology Sub-Internship for Medical Students [12G]
Authors: Solotke Michael T. , Crabtree Janice A. , Encandela John , Vash-Margita Alla
Published: April 2020

INTRODUCTION:

Although Pediatric and Adolescent Gynecology (PAG) is an important and growing field, training opportunities are limited, especially at the medical school level. To address this gap, we developed a PAG sub-internship and elective course for medical students. Our course represents the fourth PAG sub-internship available in North American medical schools; by contrast, other available sub-internships include 113 in Maternal Fetal Medicine and 82 in Gynecologic Oncology.

METHODS:

Our four-week PAG sub-internship and two-week elective include a multi-pronged evaluation system with three components: a written test taken on the first and last day of the sub-internship, direct observation and evaluation of clinical skills using the Entrustable Professional Activities (EPAs) framework, and a 360-degree feedback system allowing students to provide anonymous feedback regarding the sub-internship.

RESULTS:

In the first year of our sub-internship, seven students applied and five students enrolled; in the second year, eight students have applied. Mean overall EPA entrustability scores were 2.3 and 3.7 on the first and final day of the sub-internship, respectively. Preliminary evaluation data showed a mean score of 5.0 (strongly agree) for the evaluation question “Were you satisfied with the clinical teaching in this elective/sub-internship?” Excerpts from the written feedback provided via anonymous evaluations included “This elective provided an excellent cross-section between pediatrics and gynecology.”

CONCLUSION:

We have developed, implemented, and evaluated a PAG sub-internship for medical students. We share our evaluation data to demonstrate the value of such training opportunities and help other institutions who wish to create a PAG sub-internship.
Follow Up of Newborns Exposed to Paclitaxel in Utero Evident by Metabolites in First Meconium Sample [28H]
Authors: Cardonick Elyce , Akoto Serwaa , Doan Mary , Xu Peining J. , Snyder Nathaniel , Broadrup Robert
Published: April 2020

INTRODUCTION:

Paclitaxel is excluded from breast cancer treatment during pregnancy due to limited neonatal follow up. We confirmed fetal paclitaxel exposure by detection of chemotherapeutics in the first newborn meconium. Birth details and follow up of these newborns are reported.

METHODS:

Women receiving chemotherapy during pregnancy consented to submit their newborns’ initial meconium. Liquid chromatography-high resolution mass spectrometry screened for chemotherapeutics, while blinded to maternal treatment. Medical record review and questionnaires completed by obstetricians and pediatricians provided newborn details. The institutional review board approved of this study.

RESULTS:

Mean gestational age (GA) at first taxane was 27.0 +/- 5.8 weeks, following anthracycline based treatment for breast cancer. Paclitaxel and metabolites were identified in meconium of all exposed newborns. Birthweight was less than ten percent in three infants. Three congenital anomalies: hip dysplasia (breech presentation); mitral valve stenosis; Cleidocranial Dysostosis. Mean age at follow up 13.2.5 + 5.5 months, ranges from 6 to 25 months. Pediatricians report treatment for eczema, recurrent otitis media, iron deficiency anemia and sinusitis. One child, not initially born with growth restriction is less than ten percent for height and weight at 15 months of age. However, all children are meeting developmental milestones.

CONCLUSION:

Detection of taxane or metabolites was not significantly related to GA at first taxane, GA at delivery, number of taxane cycles, birthweight, or days between last taxane and birth. Despite in utero fetal exposure to taxane, all are meeting milestones at a median age of 19 months.
Site of Prenatal Care Impacts Aspirin Prophylaxis for Preeclampsia Prevention [29C]
Authors: Ragunanthan Nina , Lamb Jordan , Hauspurg Alisse , Beck Stacy
Published: April 2020

INTRODUCTION:

Low-dose aspirin prophylaxis is recommended for preeclampsia prevention among high-risk women, but not all eligible women receive it. We investigated whether site of prenatal care impacts rates of aspirin prophylaxis among a cohort of women with chronic hypertension (cHTN).

METHODS:

This is a single institution, retrospective cohort study of women with cHTN who delivered between 2016–2018. Women with no prenatal care or care outside the hospital system were excluded (n=196). Medical records were reviewed to determine prenatal care site and to assess counseling and prescription of aspirin. Demographic and obstetric outcomes were compared by prenatal care site in univariate analysis. Multivariable logistic regression analysis was performed with adjustment for race, blood pressure and gestational age at first prenatal visit.

RESULTS:

We included 870 women. 126 (14.5%) had prenatal care in a hospital-based academic practice, 280 (32.2%) in a resident clinic, 303 (34.8%) in private practice, 76 (8.7%) in Maternal-Fetal Medicine (MFM) practice and 85 (9.8%) in a midwife or family practice. There were no differences in blood pressure or gestational age at first prenatal visit. Overall 64.6% of women were counseled or prescribed aspirin. Rates differed by prenatal care site (P<.001) ranging from 44.4% (academic practice) to 92.1% (MFM practice). Counseling rates were 70.4% in resident clinic, 58.1% in private practice, 72.9% in midwife/family practice. Differences in counseling persisted in multivariable models.

CONCLUSION:

In a cohort of women at high-risk for preeclampsia, aspirin counseling was not universal and rates varied by prenatal care site, which is an area for quality improvement.
A Novel Surgical Technique for Placenta Accreta Spectrum: Comparisons of Intra- and Post-operative Outcomes [01N]
Authors: Cojocaru Liviu , Shannon Allison , Desai Andrea , Goetzinger Katherine , Turan Ozhan
Published: April 2020

INTRODUCTION:

A novel surgical technique to reduce blood loss during cesarean hysterectomy (Chyst) for placenta accreta spectrum disorder (PAS) was previously described (LC-VSS: hysterotomy using linear cutter and dissection of the bladder using vessel sealing system before clamping uterine arteries). We hypothesized that LC-VSS reduces intra- and post-operative complications.

METHODS:

After IRB approval, PAS cases from 2014 to 2019 were reviewed. Gravid hysterectomy, interval hysterectomy and focal resection were excluded. Data collected includes patient demographics, estimated blood loss (EBL), number of intra-operative blood products, massive transfusion, organ injuries and post-operative complications (intensive care unit (ICU) admission, re-laparotomy, hospital stay). Chyst without using LC-VSS was marked as control. Impact of LC-VSS was analyzed using univariate analysis. Predictors for transfusion of more than 4 packed red blood cells (PRBCs) were assessed using regression analysis including pathology (accreta-increta vs percreta), surgical technique and urgency.

RESULTS:

Of 59 cases, LC-VSS was used in 39 cases (66%). EBL was significantly lower in LC-VSS cases compared to controls (1200 vs 3330 ml, P=.0001) as well as the number of PRBCs and fresh frozen plasma transfused (0 vs. 4, P<.0001, and 0 vs 2, P=.0007, respectively). The number of massive transfusions was lower in LC-VSS cases (1 vs. 7, P=.002). Need for re-laparotomy was lower in LC-VSS patients (0 vs. 20%, P=.01). Median hospital stay was similar between groups. LC-VSS was the only predictor of blood transfusion less than 4 units of PRBCs (P=.004).

CONCLUSION:

Use of this novel surgical technique (LC-VSS) during Chyst for PAS improves intra- and post-operative outcomes.
Adherence to a Vaginal Breech Protocol and Success of Vaginal Breech Delivery [03N]
Authors: Marko Kathryn I. , Abbasi Annam , Halaseh Rami , Sparks Andrew , Madkour Amr
Published: April 2020

INTRODUCTION:

At the George Washington University, we have established a Vaginal Breech Initiative (VBI) to increase access to, and training in, vaginal breech delivery as a component of a cesarean prevention strategy. The VBI is a collaborative team consisting of physicians and nurse midwives using strict antepartum and intrapartum guidelines to facilitate safe and successful vaginal breech delivery. The purpose of this study was to examine adherence to our protocol.

METHODS:

We performed a retrospective chart review of all women undergoing a breech trial of labor between 8/2011 and 6/2019. Our primary outcome measure was adherence to protocol. Women were considered adherent if they had an EFW 2500–3800 g, gestational age of 34–42 weeks, singleton pregnancy, frank or complete breech, and had appropriate breech counseling. Our secondary outcome was successful breech vaginal delivery and adverse maternal/fetal outcomes.

RESULTS:

Of all women undergoing a breech trial of labor (n=63), 47 adhered to our protocol (74.6%). Of those, 37/47 (78.7%) had a successful breech delivery. Of the patients who underwent a breech trial out-of-protocol (n=16), 12/16 (75%) had a successful breech delivery (P=.74). Overall, we had an 77.8% vaginal breech success rate. When in-protocol women were compared with those out-of-protocol, there were no statistically significant adverse maternal/fetal outcomes.

CONCLUSION:

While we adhered to our established protocol in 74.6% of women undergoing a breech trial of labor, we found this did not correlate to successful breech delivery. We will continue to examine our protocol and identify which components are most highly correlated with vaginal breech success and safety.
Timing of Delivery in Intrahepatic Cholestasis of Pregnancy With Total Bile Acids 40–99 µmol/L: A Decision Analysis [39N]
Authors: Frank Zoe C. , Nienow-Birch Mary N. , Lo Jamie , Shaffer Brian L. , Caughey Aaron B.
Published: April 2020

INTRODUCTION:

Our study models the trade-off between preterm neonatal morbidity and stillbirth for women with intrahepatic cholestasis of pregnancy (ICP) with total bile acids (TBA) between 40 and 99 µmol/L in order to determine the optimal gestational age for delivery.

METHODS:

A decision analytic model was created to compare the outcomes of delivery at 33 through 40 weeks gestation in women with TBA between 40 and 99 µmol/L. Baseline morbidity and mortality risks were derived from the literature and adjusted where appropriate for peak TBA and administration of antenatal steroids. We assumed a population of 10,000 women with ICP and calculated total quality-adjusted life years (QALYs) for each strategy, taking into account both maternal and neonatal perspectives. Univariate sensitivity analysis was performed for all variables to test the robustness of the model.

RESULTS:

In women with TBA between 40 and 99 µmol/L, delivery at 39 weeks maximized QALYs, resulting in 700.6 more QALYs but 5.3 more stillbirths than delivery at 36 weeks. Sensitivity analysis demonstrated that delivery at 38 weeks became optimal when the relative risk of stillbirth given TBA between 40 and 99 µmol/L rose from a baseline of 1.00 to 4.91. Monte Carlo analysis demonstrated that when variation was incorporated into the model, delivery at 39 weeks was optimal 38% of the time and delivery at 38 weeks 25% of the time.

CONCLUSION:

In women with ICP with TBA between 40 and 99 µmol/L, delivery between 38 and 39 weeks may be optimal.
Obstetric and Cardiac Outcomes of Pregnant Women With Congenital Heart Disease by Functional Class [25N]
Authors: Steiner Jill , Lokken Erica , Buber Yonatan , Albright Catherine
Published: April 2020

INTRODUCTION:

Women with adult congenital heart disease (ACHD) are at risk for adverse outcomes during pregnancy. There are limited data on type and extent of adverse outcomes given the small population size and lack of centralized health data.

METHODS:

We conducted a retrospective cohort study of women with ACHD who received obstetric care at the University of Washington between 2010 and 2018 using medical record review.

RESULTS:

We identified 169 women who contributed 232 pregnancies (mean age at first pregnancy 29±5.7 years; median number total pregnancies 2, range 1–13). Most women had moderate ACHD lesions (70%); 38% were ACHD functional class C/D, and 20% were WHO pregnancy class III/IV. There were 3 induced abortions related to maternal cardiac disease and 15 miscarriages; no maternal deaths. Of 212 continuing pregnancies, 18% were preterm birth <37 weeks, 45% were cesarean deliveries, 7% had intrauterine growth restriction, and 2% were small for gestational age. There were 2 neonatal deaths. 23% of women did not have concurrent ACHD care. Hospitalizations for cardiac reasons occurred for 22% of pregnancies. Women experienced arrhythmias with 12% of pregnancies, heart failure with 3%, and 1 woman had a stroke. Combined cardiac outcome varied by functional class (OR for class C/D 8.10, 95% CI 1.01–64.68) but not ACHD lesion or WHO risk. Key obstetric outcomes (preterm birth, cesarean delivery, IUGR) did not vary by ACHD predictors.

CONCLUSION:

Maternal and fetal health outcomes were generally favorable. Preterm delivery and hospitalization rates were high. ACHD functional class may predict adverse events.