bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity and Cell Free DNA Testing [24R]
Authors: Cabrera Camila , Dean Kathryn , Teal Elizabeth , Romero Stephanie T.
Published: May 2017

INTRODUCTION:

Cell free fetal DNA is first detected in maternal serum at seven weeks gestation and the quantity increases during pregnancy. Non-invasive prenatal testing (NIPT) can be used as a screening test to aid in prenatal diagnosis of fetal aneuploidy. Recommendations for use are limited to women at “high risk.” There are no current guidelines for use in special populations including obese women, “low risk” women, or smokers. In obese women, the amount of maternal cfDNA is greater than in non-obese women. We hypothesize that obese women will have greater rates of “no result” than lean women.

METHODS:

A retrospective review was performed evaluating all pregnant women at our institution who had NIPT drawn From 1/1/11-1/1/15 (n=805). Women with BMI between 25.0-29.9 at initial prenatal visit were excluded. Categorical variables were compared using chi square or Fisher's exact test, continuous variables were assessed using a student t test.

RESULTS:

A total of 473 women met inclusion criteria (277 obese, 196 normal weight). A larger proportion of obese women had “no result” than lean women but this was not statistically significant (3.2% vs 1.5%, p=0.24). The mean BMI in those with “no result” was 36.2+/-13.0. One obese woman had a female result on NIPT and male genitalia on ultrasound and confirmed at birth to be 46, XY.

CONCLUSION:

There was a trend toward more “no result” in obese vs lean women. A larger study is needed to further elucidate the differences in performance of NIPT for lean vs obese women.
Outcomes in Oligohydramnios: The Role of Etiology in Predicting Pulmonary Morbidity/Mortality [28R]
Authors: Hesson Ashley , Langen Elizabeth
Published: May 2017

INTRODUCTION:

Early-onset oligohydramnios is most commonly secondary to renal-urinary anomalies (RUA) or preterm premature rupture of membranes (PPROM). We compared pulmonary outcomes between these etiologies.

METHODS:

A single tertiary care center's ultrasound database was searched for women with decreased amniotic fluid before 24 weeks gestation due to either PPROM or suspected RUA. Patients were excluded if they delivered elsewhere or if there were other major congenital anomalies or aneuploidy. Obstetrical/neonatal outcomes were recorded. Respiratory morbidity was assessed by need for oxygen at 36 corrected weeks or at hospital discharge if this occurred prior to 36 corrected weeks, or respiratory cause of neonatal death.

RESULTS:

118 identified patients included 56 with oligohydramnios secondary to PPROM and 62 with RUA. 54 women elected to terminate their pregnancies. 36.4% of PPROM and 35.0% of RUA pregnancies that remained experienced an IUFD or pre-viable delivery (n=16/44 vs.7/20; χ2=6.23e-32, p=1.00). 18.2% of the PPROM pregnancies (n=8/44) resulted in neonatal respiratory mortality, as opposed to 40.0% (n=8/20) of the RA pregnancies (χ2=2.42, p=0.12). 25.0% of prior PPROM infants required oxygen at 36 weeks/discharge (n=11/44), while 10.0% of the RUA infants did (n=2/20; χ2=2.00, p=0.25). The collective incidence of respiratory morbidity/mortality was not different between etiologies (χ2=0.06, p=0.81).

CONCLUSION:

This analysis suggests that the prognoses for oligohydramnios due to pre-viable PPROM vs. ultrasound-identified renal anomalies are similarly grave. The trend towards increased respiratory mortality in neonates with RUA warrants further investigation.
Patient Reported Experiences Associated With Mode of Delivery [37R]
Authors: Brousseau E. Christine , Danilack Valery , Matteson Kristen
Published: May 2017

INTRODUCTION:

Patient perceived experience during labor and delivery is not often considered as a birth outcome, but a better understanding could help strengthen the physician-patient relationship and improve the experience for many women.

METHODS:

We recruited equal numbers of women with a vaginal or cesarean delivery to complete a survey during their post-delivery hospital stay and obtained additional clinical information from medical records.

RESULTS:

Among 200 postpartum women, 99 had a vaginal delivery and 101 had a cesarean delivery (59 planned and 42 unplanned). Endorsing that delivery experience was similar to what was expected differed by delivery type (p < 0.001) with more women delivered by cesarean completely disagreeing. Delivering by cesarean section was associated with increased feelings of fear (64% compared to 37%, p < 0.001), but was not associated with believing that there were any problems encountered during the labor or delivery process (19% compared to 12%, p=0.191). Compared to planned cesarean deliveries, unplanned cesarean deliveries were more likely to report that their delivery experience was not what they expected (p < 0.001), and more likely to think they had problems during labor and delivery (p=0.029), but were not more likely to report increased feelings of fear (p=0.211). Intention to breastfeed differed by delivery type and was higher in women who had a vaginal delivery (88% compared to 74%, p=0.045).

CONCLUSION:

Patient reported experiences differ by delivery type. Future research should evaluate whether patient experience in labor and delivery affects downstream outcomes such as postpartum depression and breastfeeding.
Pattern and Outcome of Obstetric Admissions Into the Intensive Care Unit of a South-east Nigerian Hospital [38R]
Authors: Ozumba Benjamin , Ajah Leonard O. , Obi Vitus
Published: May 2017

INTRODUCTION:

Although pregnancy and labor are considered physiological processes, the potential for catastrophic complications is constant and may develop rapidly. There is growing evidence that admission of high risk patients into the intensive care unit is associated with a reduction in maternal mortality. This study was aimed at reviewing all obstetric patients admitted into the intensive care unit (ICU) of Federal Teaching Hospital, Abakaliki.

METHODS:

This was a retrospective study of all obstetric patients who were admitted into the ICU between January 1st 2012 and December 31st 2013.

RESULTS:

During the study period, there were 5176 deliveries. Over the same period there were 89 obstetric patients admitted and managed in the ICU, accounting for 1 in 58 deliveries. A total of 53 (59.0%) patients were between 21 and 30 years. The mean age was 28.4±5.8 years and most of the patients were primiparous. Two thirds of the patients were unbooked. The mean duration of admission was 4.5±3.2 days. All the patients were admitted at postpartum period. The most common indication for admission was ruptured uterus 32 (36.0%) with a case fatality rate of 18.8% and contributing 50% of the overall maternal mortality. There were 12 (13.5%) maternal deaths and booking status was significantly associated with maternal death (P = 0.046).

CONCLUSION:

The commonest indication for admission was ruptured uterus. Almost all the maternal mortalities were among unbooked patients. These maternal deaths can be prevented by booking for antenatal care and the presence of skill birth attendants at delivery.
The Impact of Pregnancy on the Work-Up of Chest Pain and Shortness of Breath in the Emergency Department [14Q]
Authors: Wagner Stephen , Waldman Ian , Kunselman Allen R. , Smith Emily , Deimling Timothy
Published: May 2017

INTRODUCTION:

This study investigates the comparative rates of imaging studies between pregnant and non-pregnant patients who presented for emergent evaluation of angina and dyspnea.

METHODS:

All reproductive age females presenting to the Emergency Department at an academic teaching institution with a chief complaint of “chest pain” or “shortness of breath” from 2010-2015 were identified. Cohorts were divided based on pregnancy status and chief complaint. The rate of utilization was calculated for each imaging study. Rates were compared between cohorts utilizing odds ratios and p-values.

RESULTS:

Over the study period, 4,834 women were included. One hundred and seventy-four were pregnant. Pregnant patients with chest pain were significantly more likely to undergo a venous duplex (9.2% vs 1.5%), but less likely to undergo a chest x-ray (52.3% vs 85%) as compared to non-pregnant patients. The same disparity was present among pregnant patients presenting with shortness of breath: venous duplex 9.2% vs 2.7% and chest x-ray 26.15% vs 76.9% as compared to non-pregnant patients. There was no difference in the rates of chest CT imaging or MRI.

CONCLUSION:

Imaging studies are an integral adjunct for evaluation in patients reporting angina or dyspnea. Pregnancy places patients at an increased risk of severe sequelae requiring prompt diagnosis to prevent harm to the mother and fetus. The American College of Obstetricians and Gynecologists clearly states that, with few exceptions, radiography should not be withheld from pregnant patients. This study suggests that pregnant patients are significantly less likely to undergo radiography, which could place them at increased risk for delayed diagnosis and treatment.
Evaluation of Pain Management During First Trimester Surgical Abortions Using Moderate Sedation [3A]
Authors: Falik Rebecca , Alton Katie , Hathi Sejal , Semere Luwam
Published: May 2017

INTRODUCTION:

The Green Journal has emphasized that abortions continue to be painful and has called for research into improving the comfort of therapeutic abortions (TABs). Anesthesia literature defines >4 out of 10 on the Pasero Pain Intensity Scale as unacceptable, which we refer to as “significant pain”.

METHODS:

We performed a retrospective observational study evaluating pain scores, moderate sedation dosages, and incidence of anesthetic reversal agents among all patients undergoing TAB aspiration procedures by all sixteen providers at an outpatient procedure center from 2012-2014.

RESULTS:

Of 539 patients, 16% experienced significant pain just before TAB from misoprostol placed pre-procedure, 28% experienced significant pain during the TAB procedure, and 18% experienced pain beyond their stated comfort threshold. Half of procedures started with low doses of ≤1mg midazolam and ≤100mcg fentanyl. Additional doses of fentanyl and/or midazolam were received intraoperatively by 54% of patients; these patients were more likely to report significant pain (P < .0001). Reversal agents were never needed.

CONCLUSION:

Over one quarter of patients experienced unacceptable levels of pain in this study of first trimester surgical TABs. Obstetrician-gynecologists administering conscious sedation may not be aware of under-medicating their patients. In over half of TAB cases, the provider recognized part-way through the short procedure that the patient required additional sedation. Obstetrician-gynecologists performing TABs and similar procedures such as diagnostic hysteroscopy may consider administering higher initial sedative doses, with minimal risk of oversedation. Future study of preoperative analgesia, such as ibuprofen administration concomitant with miso placement, is warranted to evaluate improvement in intra-procedural pain.
Evaluation of Postpartum Contraceptive Plan and Actual Use [4A]
Authors: Vuong Elizabeth , Chiu Chiao An , Habib Shaddi , Rafie Sally , Mody Sheila , Bayer Lisa
Published: May 2017

INTRODUCTION:

Using effective contraception postpartum can help women achieve recommended interpregnancy intervals. This study evaluated women’s postpartum contraception plan and actual use.

METHODS:

Medical record data was retrieved for women with at least one prenatal visit and a live birth between July 1, 2014–June 30, 2015 at a single academic medical center. Of those with a postpartum visit, a random sample of 200 women was selected for retrospective chart review. Records were reviewed up to three months postpartum to identify contraceptive method plan and actual use postpartum.

RESULTS:

Data was retrieved for 2445 women meeting criteria, of whom 23.1% (565/2445) had no postpartum visit. Among the sample of women with a postpartum visit, 33.5% (67/200) of actual contraception used postpartum diverged from the prenatal plan, of whom 59.7% (40/67) changed from higher to lower effectiveness. Prenatally, 47.0% (94/200) planned to use highly effective (tubal ligation, intrauterine device, implant, lactational amenorrhea), 26.0% (52/200) effective (pill, patch, ring, injection), 22.5% (45/200) less effective (barrier), and 4.5% (9/200) no method. Postpartum, 35.0% (70/200) used highly effective, 41.0% (82/200) effective, 23.5% (47/200) less effective, and 0.5% (1/200) no method. Breastfeeding was not included in analysis. There was no difference in effectiveness of contraception used between women seeing Ob/Gyn physicians and Nurse Midwives (P=0.413). Number of prenatal visits did not influence use of highly effective contraception (P=0.945).

CONCLUSIONS:

Most women adhered to the postpartum contraceptive plan made prenatally. Over half the women who deviated from their prenatal contraceptive plan used a less effective method.
Does Age Influence Knowledge and Attitudes About Intrauterine Devices (IUDs)? [7A]
Authors: Edwards Sara , Perriera Lisa , Mercier Rebecca
Published: May 2017

INTRODUCTION:

The IUD is considered excellent birth control, but United States usage lags behind that of similar countries. Barriers to usage include patient attitudes and lack of education, fueling misperceptions and unawareness. We sought to identify if attitudes and knowledge about the IUD vary by age.

METHODS:

From June 13 to July 18, 2016, all women in an obstetrics & gynecology outpatient office of a large urban academic medical center were asked to participate in a 94 question survey. Women were excluded if they could not read English or were younger than 14 years of age. Surveys included detailed questions about participant demographic characteristics and knowledge and opinions of IUDs. We hypothesized that older women would hold more negative opinions. We performed an exploratory bivariable analysis using t tests and chi square testing to determine which outcomes differed by participant age. For those appearing to differ significantly by age, we performed regression analysis to assess for confounding by other demographic factors.

RESULTS:

Of 1,366 women approached, 521 completed the survey. Few survey items differed significantly by age. Self-reported IUD knowledge (P=.024), having ever used an IUD (P=.009), thinking the IUD is reliable (P=.025), and agreement with the statements “IUD insertion requires surgery” (P=.046) and “Hormonal birth control is safe and effective” (P=.012) were statistically significantly different. After controlling for confounders only responses to the statement “Hormonal birth control is safe and effective” retained significance.

CONCLUSION:

Our results suggest that attitudes and knowledge about IUDs do not differ significantly by age.
Do Women Undergoing Surgical Abortion Versus Medical Abortion Choose Different Methods of Contraception? [9A]
Authors: Bogdanov Anton , Molaei Michael , Schubert Finn , Kesavan Meera
Published: May 2017

INTRODUCTION:

Elective termination of pregnancy (TOP) is an option for unwanted pregnancy. Effective contraception can prevent these unplanned pregnancies and terminations. The purpose of this study was to identify differences in post-abortion contraception among women who underwent surgical and medical abortion. Contraceptive choices were reviewed based on patient demographics.

METHODS:

A retrospective cohort study was conducted on 330 patients receiving abortions from January 1st through 15th, 2014 by review of electronic medical records from a private outpatient family planning clinic specializing in abortion services. Data analysis was conducted using Chi Square test.

RESULTS:

The 330 reviewed procedures were 53 medical TOPs, 219 1st trimester, and 58 2nd trimester surgical abortions. Of all patients 4.2% desired LARC, 78.2% desired other methods, 17.6% declined contraception. Patients with a medical TOP were most likely to have received a LARC method (22.6%) followed by those having first trimester procedures (10.5%) and second trimester procedures (8.6%), p=0.003. Significant loss of follow up was observed with medical TOPs (38.2%), 1st trimester surgical TOPs (68.0%) and 2nd trimester surgical TOPs (82.8%). Other factors influencing these choices are age, parity, prior abortion, insurance, and education. 18.2% of all patients returned pregnant within 18 months.

CONCLUSION:

Differences are seen in contraceptive choice and type of abortion. Age, parity, and a history of prior abortions may influence these choices. High follow-up failure and return pregnancy rates may suggest immediate contraception at time of procedure should be considered. Comparing these demographics with multivariate analysis could provide further understanding about these influencing factors.
Access to Abortion for Minors Following Implementation of the Illinois Parental Notice of Abortion Act in 2013 [13A]
Authors: Dries Alissa , Cowett Allison , York Sloane
Published: May 2017

INTRODUCTION:

With 85% of adolescent pregnancies unintended, access to safe abortion is vital for teens. Several social, economic and legal barriers impede this access. In August 2013, Illinois implemented the Parental Notice of Abortion Act, requiring providers to notify an adult family member of women under the age of 18 seeking abortion 48 hours prior to the procedure.

METHODS:

We performed a retrospective charts review to assess changes in care of a randomly selected sample of 180 minors seeking abortion at a freestanding clinic in Chicago for one year before and one year following implementation of the law. The primary outcome was mean gestational age at presentation.

RESULTS:

Mean gestational age at presentation did not differ before and after implementation (15.9 versus 14.8 weeks, respectively, P=0.8833). No difference was found between the distance travelled for care (42.1 before versus 51.2 miles after, P=0.73) or the number of out-of-state subjects (n=14 before versus n=18 after, P=0.40). Fewer teens presenting following the law obtained an abortion (95.6% before versus 78.4% after, P=0.001). The number of teens unable to obtain an abortion for advanced gestational age increased from 2 prior to 10 following implementation.

CONCLUSION:

While our study did not find a difference in gestational age at presentation or distance traveled to the clinic, we noted a decrease in the percentage of presenting teens who obtained an abortion and an increase in the number of teens who were turned away secondary to advanced gestational age following the implementation of parental notice in Illinois.
Sterilization Procedures: A Missed Opportunity to Prevent Cancer in Patients Treated at U.S. Residency Programs? [16A]
Authors: Redfern Tiffany , Levine Lyuba , Richardson Gwyn
Published: May 2017

INTRODUCTION:

A recent paradigm shift indicates that the origin of ovarian high grade papillary serous carcinoma is the fallopian tube. The American College of Obstetricians and Gynecologists and Society of Gynecologic Oncology now recommend prophylactic salpingectomies as a preferred method of sterilization. This study sought to evaluate current practices of sterilization across U.S. Obstetrics and Gynecology (OB/Gyn) residency programs.

METHODS:

This is an IRB-approved study. An electronic cross-sectional survey of 13 questions was sent to all OB/Gyn program coordinators for distribution to their residents. There are 5,258 filled residency slots in OB/Gyn for the 2016-2017 academic year.

RESULTS:

Response rate was 6.4%, with even distribution across years. The majority of residents are in an academic setting (64.8%). For patients undergoing post-partum sterilization, 55% of patients were counselled about bilateral salpingectomy and tubal ligation. Postpartum tubal ligation only is offered at 51% of programs. For non-pregnant patients, 40.6% of residents counsel patients about bilateral tubal ligation, hysteroscopic sterilization and bilateral salpingectomy. The most common procedure performed is a bilateral salpingectomy (47.4%), followed by bipolar coagulation (21.8%), spring clips (19.3%), Silicone band method (6.9%) and hysteroscopic sterilization(4.7%). The most common reason cited for performing ligation instead of salpingectomy was perceived increased surgical risk such as bleeding or infection (45.2%).

CONCLUSION:

Though limited in our response rates, this study has several important implications. Despite recommended practice changes, prophylactic salpingectomy to prevent ovarian cancer has not gained widespread acceptance for either postpartum or interim sterilization. Many patients treated in residency are uninsured or socioeconomically disadvantaged and such procedures may offer a unique opportunity for cancer prevention.
Generic or Branded? Oral Contraception Prescription Patterns in an Academic Medical Center [18A]
Authors: Zhang Shiliang , Sridhar Aparna
Published: May 2017

INTRODUCTION:

Oral contraceptive pills (OCPs) are the most widely used form of reversible contraception in the United States. Most OCPs are no longer patent-protected and are available in FDA-approved generic forms, demonstrating bioequivalence and interchangeability with branded OCPs. This study analyzes OCP prescription patterns within the University of California Los Angeles (UCLA) Health System.

METHODS:

Information on electronically-generated OCP prescriptions within UCLA Health was collected and de-identified. The data was then analyzed using univariate statistics for prescription patterns based on physician specialty, estrogen dose, progestin dose and type.

RESULTS:

43,719 prescriptions for OCPs were generated by physicians from 7/1/14-6/30/15. Physicians most frequently prescribing OCPs belonged to internal medicine, family medicine and obstetrics and gynecology. 63-65% of these prescriptions were generic. Outside of these three primary care departments, other departments accounted for 8% of total OCP prescriptions. These other specialties prescribed generics 57% of the time. The most common progestin forms were norethindrone acetate, norgestimate, and levonorgestrel. 99% of all OCPs prescribed contained ethinyl estradiol and 56% were low dose (from 0.01mg to 0.025 mg) while 44% were high dose pills (0.03 mg to 0.05mg).

CONCLUSION:

The proportion of generic OCP prescriptions was similar in all three of the departments that accounted for the majority of all OCP prescriptions. In specialties with lesser volumes of OCP prescription, physicians tend to prescribe generic OCPs at a lower rate. Regulations establishing bioequivalence between generic and branded OCPs have been in place for over 20 years, yet lack of awareness over bioequivalence continues.
High Self-Efficacy Correlates With Use of Long-Acting Reversible Contraceptives [20A]
Authors: Hamidi Odessa , Deimling Timothy , Lehman Erik , Weisman Carol , Cynthia Chuang
Published: May 2017

INTRODUCTION:

The American College of Obstetrics and Gynecology recommends long-acting reversible contraceptives (LARCs) as the safest and most effective reversible contraceptives. In the US, only 7% of women use LARCs, and 45% of pregnancies continue to be unintended. Barriers to LARC use can be intrinsic or extrinsic. While previous studies focus on extrinsic barriers to LARC use, our study evaluates intrinsic barriers. We hypothesize that two psychological traits, locus of control (LOC) and contraceptive self-efficacy (SE), influence use of LARCs.

METHODS:

Data are from the baseline survey of an IRB-approved randomized control trial. The study population was 874 privately insured Pennsylvania residents aged 18-40, who were not intending pregnancy for 12 months. LOC (internal vs external) and contraceptive SE (high vs low) were measured using composite scores from 5 and 8-item scales respectively. The association of LOC and SE with LARC use was determined using multivariable logistic regression adjusting for future pregnancy intention, education, and history of unintended pregnancy.

RESULTS:

LARC use was predicted by high SE (Adjusted OR 1.90, 95% CI 1.13, 3.19), but not by internal LOC (Adjusted OR 0.86, 95% CI 0.53-1.42). LARC use was also predicted by ambivalence about future pregnancy and history of previous unintended pregnancy.

CONCLUSION:

Women with high SE had an increased use of LARCs. Efforts to identify patients with low self-efficacy may provide opportunity for increased counseling and interventions to promote use of LARCs.
Results From the SECURE Trial, a Phase 3 Study of the AG200-15 Investigational Transdermal Contraceptive Patch [22A]
Authors: Garner Elizabeth , Chiodo Joseph
Published: May 2017

INTRODUCTION:

AG200-15 is an investigational low-dose transdermal contraceptive patch being developed for prevention of pregnancy. AG200-15 is designed to deliver approximately 120 µg of LNG and 30 µg of EE per day, comparable to current low-dose oral contraceptives. AG200-15 is a 21-7 regimen, with patches applied once a week for three weeks, followed by a patch-free week. The Phase 3 Study to Evaluate Contraceptive Use, Reliability and Effectiveness (SECURE) was designed to assess efficacy, safety and tolerability of AG200-15.

METHODS:

SECURE was a single-arm, open-label, multicenter Phase 3 study of AG200-15 that enrolled approximately 2,000 reproductive-aged women to use the patch for up to one year. Primary efficacy was assessed using the Pearl Index in women 35 years of age and under. Cycles in which an alternate method of contraception was used or no sexual activity occurred were excluded. Safety and tolerability were assessed via adverse event reporting. An electronic diary was utilized for subject reporting of bleeding, patch site irritation, itching, and adhesion.

RESULTS:

Enrollment in SECURE began in September, 2014 and ended in October, 2015. Approximately 2,000 women were enrolled at 102 sites in the United States. The study population demographics were broadly representative of the population intended to use AG200-15. New users to hormonal contraception represented fewer than 20% of enrolled subjects. Top-line results including demographics, subject disposition, efficacy and safety will be available for ACOG 2017.

CONCLUSION:

The AG200-15 patch has the potential, if approved by the FDA, to provide women with a new low-dose combined hormonal contraceptive option.
An EPIC Hierarchical Data Collection Schema to Assess Contraceptive Counseling in Primary Care [24A]
Authors: Roser Brittany , Rubin Susan , Nagarajan Nisha , Benfield Nerys
Published: May 2017

INTRODUCTION:

In 2011 the Institute of Medicine designated contraceptive counseling and provision an essential service. Electronic medical record (EMR) systems provide large volumes of clinical data but the quality of this data varies, especially when no billing, lab or prescription is given. As part of a quality improvement initiative, we sought to develop a reliable algorithm using EPIC EMR to measure rates of contraception counseling at outpatient primary care sites.

METHODS:

We constructed an initial hierarchical data collection schema using prescription data, ICD and CPT codes, and text searching, in this order. We refined the schema through an iterative validation process including three cycles of manual chart review. We applied the schema to eight outpatient urban family medicine, general obstetrics and gynecology, and family planning sites affiliated with one academic medical center.

RESULTS:

From August 2015 to May 2016, the eight sites averaged 2500 unique monthly visits by women aged 14-45. Among visits where contraception counseling and/or provision was documented, 18.6% were captured by prescriptions, 8.9% by ICD and CPT codes, and 69.7% by text search. Among visits where contraceptive counseling was documented but no method was provided, 15.7% were captured by diagnosis codes and 84.3% by text search.

CONCLUSION:

This hierarchical data collection schema allowed us to obtain robust measures of contraception counseling and provision in primary care practices. Inclusion of text search in addition to prescription and ICD/CPT coding is crucial for data accuracy and comprehensiveness. This schema could be adapted by other EPIC EMR users interested in real-time quality assessment.
Racial and Ethnic Disparities in Contraceptive Use in Young Women [27A]
Authors: Bahamon Cecilia , Leung Katherine , Ireland Luu
Published: May 2017

INTRODUCTION:

Young women have the highest rates of unintended pregnancies among reproductive-aged women. Black and Latina women are at highest risk. Few studies have examined reasons for these differences. In this study, we examined disparities in contraceptive use and contraceptive counseling by race and ethnicity among young women.

METHODS:

Using the 2011-2013 National Survey of Family Growth (NSFG), a cross-sectional, nationally representative database, our analysis included women aged 15-24 years who had sexual intercourse within the past year, and were not pregnant or seeking pregnancy. The primary outcomes were contraceptive use and receipt of contraceptive services within the past 12 months.

RESULTS:

We found no difference in overall contraceptive use or rates of contraceptive counseling. However, Hispanics (H) and Non-Hispanic Blacks (NHB) primarily relied on Tier 3 methods of contraception (H: 56.7%, NHB: 60.2%, Non-Hispanic Whites (NHW): 45.1%, Non-Hispanic Others (NHO): 40.2%), despite being more likely than NHW and NHO to use Tier 1 methods (H: 9.2%, NHB: 9.9%, NHW: 8.2%, NHO: 8.3%). NHW and NHO were most likely to use Tier 2 methods (H: 34.1%, NHB: 29.8%, NHW: 46.7%, NHO: 51.48%; p=0.026). Additionally, NHW and NHO were most likely to have been prescribed contraception within the last 12 months (H: 49.6%, NHB: 49.0%, NHW: 60.1%, NHO: 64.8; p=0.047).

CONCLUSION:

Black and Latina women are more likely to rely on Tier 3 methods for pregnancy prevention despite similar rates of contraceptive counseling. Future studies should explore reasons for the predominance of the use of less effective contraceptive methods among young black and Latina women.
Cost-effectiveness of State Policies Banning Pregnancy Termination After Down Syndrome Diagnosis [28A]
Authors: Scrivner Karen , Rodriguez Maria , Savitsky Leah , Zwerling Blake , Bullard Kimberley , Caughey Aaron
Published: May 2017

INTRODUCTION:

Three states have passed recent laws prohibiting abortion in cases of fetal abnormality, most notably Down syndrome. Data to demonstrate the impact of these restrictions are lacking. Our study sought to evaluate the cost-effectiveness of these policies for pregnancies affected by Down syndrome.

METHODS:

A decision-analytic model was constructed using TreeAge 2016 software. Probabilities, costs and utilities were derived from the literature. Our primary outcome was cost, and our secondary outcomes included: cost per quality adjusted life year (QALY), procedure-related fetal loss (PRL), births affected by Down syndrome, intrauterine fetal demise (IUFD), and pregnancy termination. The cost-effectiveness threshold was set to $100,000 per QALY. Sensitivity analysis was performed to determine the robustness of the model.

RESULTS:

In a theoretical cohort of 159,936 women representing annual live births in states affected by this ban, this policy results in an additional annual cost of $340 million, which corresponds to $2,124 per pregnant woman. It also results in a greater number of live births affected by Down syndrome—223 compared to 124 with no policy. The policy would not be expected to change the rates of PRL and IUFD, while 99 fewer abortions would be expected with a decrease of 494 QALYs.

CONCLUSION:

Although policies restricting abortion in cases of a Down syndrome diagnosis result in fewer pregnancy terminations, they do lead to a greater economic burden. States should keep this in mind along with the ethical implications of these policies when deciding whether to enact them.
Prevalence and Attitudes Regarding Withdrawal Use for Pregnancy and HIV Prevention in HIV-Positive Youth [31A]
Authors: Powell Anna , Vessa Blake , Law Sarah , Lazenby Gweneth
Published: May 2017

INTRODUCTION:

The use of withdrawal is undervalued as a means of preventing pregnancy and sexually transmitted infections. Withdrawal use among high-risk sexually active youths may be as high as 48%. Withdrawal has not been well investigated as a method for HIV transmission prevention.

METHODS:

This is an interval analysis of a survey-based study of sexually active 18-25 year old HIV-infected individuals. Inclusion criteria was self-selection for survey participation. Statistical analysis was performed using SAS 9.4 (Cary, NC). Continuous variables were compared with Student’s t-test and Wilcoxon Rank Sum Tests. Categorical variables were compared using χ2 test and Fisher’s exact test. Multi-logistic regression was performed to investigate variables associated with withdrawal for HIV prevention.

RESULTS:

36 males and 34 females of 88 responded to date. Users of withdrawal for HIV prevention (WU) did not significantly differ from non-users in age, race, engagement in sexual activity within the last 3 months, reports of taking HIV medications, partner disclosure of HIV serostatus, condom use, or duration of monogamous relationship. WU were significantly more likely to report 100% compliance with HIV therapy (86% vs 65%, p=0.05), and to use a condom with additional sex partners (68.4% vs 51%, p= 0.038). In multivariable logistic regression, withdrawal use for HIV prevention was predicted by ever use of withdrawal as contraception after adjusting for additional factors.

CONCLUSION:

Better risk reduction counseling can be targeted to at-risk youths once more information is available about the prevalence of withdrawal use and its application towards pregnancy and HIV prevention.
Prenatal Patient Knowledge of the Interpregnancy Interval [33A]
Authors: Bergin Ashlee , Rankin Kristin , Stumbras Katrina , Handler Arden , Haider Sadia
Published: May 2017

INTRODUCTION:

Short and long interpregnancy intervals (IPIs) are associated with adverse perinatal and maternal outcomes. While patients receive contraceptive counseling, it is unclear if they receive counseling about the IPI. Because little is known about women's knowledge regarding pregnancy spacing, this survey study aimed to determine whether pregnant women are familiar with the IPI.

METHODS:

Among patients greater than 24 weeks’ gestation seeking prenatal care at the University of Illinois at Chicago Center for Women’s Health between November 2014 and April 2015, 330 patients were approached and 281 completed the survey. Chi-square tests and multivariable logistic regression were used for data analysis.

RESULTS:

Forty-nine of the 281 women (17.8%) reported knowing that the recommended IPI is between 18 and 24 months. Women with a high school education or less were less likely to be familiar with the IPI (OR 0.38 95% CI 0.17-0.82) or know the recommended IPI (OR 0.4 95% CI 0.19-0.86) compared to women that have completed some college, a bachelor's, or a graduate degree. Compared to non-Hispanic White race/ethnicity, non-Hispanic Black race/ethnicity was associated with a decreased likelihood of familiarity with the IPI (0.33 95% CI 0.14-0.76) and knowledge that short IPIs can adversely affect maternal health (OR 0.23 95% CI 0.09-0.62).

CONCLUSION:

Women receiving prenatal care did not know the recommended IPI nor the potential for adverse outcomes with short IPIs. Prenatal care providers should discuss reproductive life plans, and include discussion about the IPI to help women achieve optimal birth spacing, improved birth outcomes, and fewer unintended pregnancies.
Understanding Adolescent Sexual & Reproductive Health Behavior & Care Access in a Rwandan Community [36A]
Authors: Pitotti Jennifer A. , McGuire Chelsea , Chhabra Rosy , Bakundukize Emmanuel , Peskin-Stolze Melissa R. , Nathan Lisa M.
Published: May 2017

INTRODUCTION:

The prevalent sexual norms and behaviors of rural Rwandan adolescents, including barriers to accessing and utilizing reproductive healthcare services, were explored qualitatively.

METHODS:

Focus groups were conducted with adolescents in the rural community of Kibogora, Rwanda. Participants included students from local secondary schools and adolescents not in school. Interview guides were adapted from validated World Health Organization guides. Trained midwives conducted focus groups in the local language. All were recorded, interpreted, transcribed and coded for themes. Interviewers were matched in gender with interviewees. Each subject completed a demographic survey with questions pertaining to sex and personal relationships.

RESULTS:

One hundred twenty-six adolescents (14-24 years) participated. Fourteen focus groups were conducted. Predominant themes include prevalence of transactional sex, need for sexual and reproductive health knowledge, need for increased access to condoms and services, fear of pregnancy and sexually transmitted infections, and confidentiality issues related to obtaining care. Adolescents correctly identify risks of having unsafe sex (infectious disease and pregnancy) but feel obtaining services is socially prohibitive. Adolescents consistently overestimate the number of sexually active peers when compared to the low number of adolescents reporting sexual activity on anonymous surveys.

CONCLUSION:

It is not only important to involve the local community, including adolescents, in designing and implementing any sexual and reproductive health educational program but it is also important to create safe and comfortable avenues for adolescents to access confidential services.
Medicaid Patients With Immediate Postpartum Contraceptive Implants: Continuation & Rapid Repeat Pregnancy Rates [38A]
Authors: Garza Elizabeth de la , Mazzoni Sara , Krull Mona , Stickrath Elaine
Published: May 2017

INTRODUCTION:

To determine the 6 and 12-month rates of contraceptive continuation and rapid repeat pregnancy (RRP) for publicly insured patients receiving an immediate postpartum etonogestrel contraceptive implant.

METHODS:

This prospective cohort study recruited Medicaid insured women, who delivered between April 2014 and 2015, and received a postpartum etonogestrel contraceptive implant prior to discharge from a safety-net institution. Patients were surveyed at placement regarding contraceptive decision-making and counseling. Medical records were reviewed at 6 and 12 months to assess implant continuation and if RRP had occurred. If this information was unable to be ascertained by medical record review, the participant was contacted by telephone.

RESULTS:

Of the 413 eligible participants, 223 (54%) enrolled. Data were available for 198 patients (89%) at 6 months where 14 (7%) discontinuations and 1 RRP (0.5%) occurred. Data were available for 168 participants (75%) at 12 months, where 40 (24%) discontinuations and 7 RRPs (4.2%) occurred. There were not any pregnancies among participants who retained their implant. Overall, black participants were more likely to discontinue the implant and have a RRP than non-black women (16% versus 2%, p < 0.009). Participants who continued their implant at 12 months were more likely to report at enrollment prior use of a hormonal implant (OR 2.91, CI 1.04-8.17) and plans to keep the implant for all 3 years (OR 2.42, CI 1.04-5.66).

CONCLUSION:

Among Medicaid patients receiving an immediate postpartum etonogestrel implant at a safety-net hospital, continuation rates were high and rapid repeat pregnancy rates were low.
Uterine Anomalies and Hypertensive Disorders of Pregnancy: A Retrospective Study [1B]
Authors: Kurtz Jillian , Stempel Laurence
Published: May 2017

INTRODUCTION:

Pregnancies associated with uterine anomalies have higher rates of recurrent pregnancy loss, preterm delivery and malpresentation necessitating cesarean delivery. Smaller studies have suggested the link between hypertensive disorders and uterine anomalies as well but thus far, there still remains little data regarding the subject. The purpose of this study was to compare rates of hypertensive disorders in pregnant women with a known uterine anomaly and compare it to the rate in the normal pregnant population.

METHODS:

Demographic and clinical characteristics of patients who were gravid for more than 20 weeks, had an uterine anomaly, and were seen at OhioHealth facilities from January 1, 2010 to October 7, 2015 were examined. The rate of hypertensive disorders among women with uterine anomalies was calculated and compared to the rate of hypertensive disorders among women without uterine anomalies (i.e., the normal pregnant population).

RESULTS:

From January 1, 2010 to October 7, 2015, there were 80 women seen at OhioHealth facilities who were gravid for more than 20 weeks and had a uterine anomaly. A greater proportion of women with a uterine anomaly had a hypertensive disorder (15.0%) than women without a uterine anomaly (5.0%) (p=0.001).

CONCLUSION:

A greater proportion of women with a uterine anomaly had a hypertensive disorder (15.0%) than women without a uterine anomaly (5.0%) (p=0.001). With increasing use of assisted reproductive technology, the OB/GYN community will begin seeing a greater number of these pregnancies. Understanding the specific pregnancy outcomes that are associated with these high risk pregnancies will be crucial for appropriate management.
Diamine Oxidase Deficiency as a Proposed Mechanism for Anaphylaxis After the Third Stage of Labor: A Case Report [2B]
Authors: Whittaker Naomi , Asam-Jensen Teresa , Stalling Jillian , Jimenez Catherine , Dunniway Diane
Published: May 2017

INTRODUCTION:

Previous case reports have demonstrated post-partum anaphylaxis associated with breast-feeding, thought to be due to destabilization of mast cells, but none associated with delivery of the placenta. The histamine-degrading enzyme diamine oxidase is produced in large amounts by the placenta as a metabolic barrier preventing bioactive histamine from entering the maternal or fetal circulation.

METHODS:

Case report.

RESULTS:

A 29 yo G5P3 admitted at 39w1d with ruptured membranes. Her obstetrical history is significant for 3 vaginal deliveries with subsequent anaphylaxis after delivery of the placenta, unrelated to narcotic administration. Medical history includes sensitive skin, seasonal allergies, and negative allergy testing. During her first two deliveries, she experienced angioedema (eye and lip swelling) after delivery of the placenta. After her third delivery, she required supplemental oxygen, steroids and epinephrine secondary to laryngeal edema refractory to diphenhydramine. With her fourth delivery, the patient was given 125 mg IV Solumedrol 2 hours prior to delivery, in addition to IV diphenhydramine. Two hours after delivery, she complained of eye and lip swelling and throat “itchiness” but remained hemodynamically stable. She did not improve with a second dose of IV Diphenhydramine. Due to her history, 0.3 mg Epinephrine IM was given with full resolution of symptoms.

CONCLUSION:

A proposed mechanism of decreased diamine oxidase after delivery of the placenta may provide insight into the maternal–fetal immune system interface in our unusual case. In retrospect, a proposed prevention of anaphylaxis in this patient would be diamine oxidase supplementation in the third trimester.
Georgia State Obstetrician Counseling Practices Regarding Prenatal Environmental Toxin Exposures [3B]
Authors: Gupta Shabnam , Green Victoria L. , Martinuzzi Kurt
Published: May 2017

INTRODUCTION:

Recent studies have underscored the adverse effects of prenatal exposure to bisphenol-A (BPA), pesticides, mercury, and lead. The purpose of this pilot study was to assess the counseling practices and level of comfort discussing prenatal environmental exposures among obstetricians in the state of Georgia.

METHODS:

We surveyed 100 practicing obstetricians, including Georgia private practice physicians in addition to residents and faculty from the largest residency training program in the state.

RESULTS:

The majority (72%) of physicians agreed that assessing environmental exposures during prenatal care is important in preventing adverse pregnancy outcomes. While 97.9% felt confident discussing cigarette smoking, few felt confident discussing the impact of other toxin exposures on pregnancy as follows: BPA (48.4%), pesticides (46.2%), mercury (42.1%), and lead (36.8%). Furthermore, less than 1 in 4 obstetricians reported routinely discussing each of these exposures as part of prenatal care: BPA (3.2%), pesticides (16.1%), mercury (22.6%), and lead (8.6%). There was no significant difference in either counseling practices or comfort discussing these topics when stratified by age, years in practice, and percentage of practice dedicated to obstetrics.

CONCLUSION:

Prenatal exposure to environmental toxins can have a significant impact on reproductive and developmental health, yet many obstetricians are not confident discussing the effect of environmental exposures on health outcomes with their patients. Currently most Georgia obstetricians are only evaluating a fraction of the environmental exposures recommended by the American College of Obstetricians and Gynecologists experts. There is a profound opportunity for improvement in counseling patients and educating reproductive health providers on this topic.
Use of Vacuum Extraction During Cesarean Delivery: Is It Safe? [7B]
Authors: Persad Malini D. , Nunziato Jaclyn , Vahanian Sevan , Demishev Michael , Quirk James , Garry David
Published: May 2017

INTRODUCTION:

The complications of vacuum-assisted vaginal deliveries are well documented; however, complications with its use during cesarean delivery (CD) is limited. The objective of the study is to determine if there is an increased risk of maternal and neonatal morbidity in vacuum-assisted CD.

METHODS:

This is a retrospective cohort study of vacuum-assisted CD identified from a university-based surgical case log from 5/2014–7/2015. Term, singleton gestations with cephalic presentation vacuum-assisted CDs were matched 1:1 with non-vacuum-assisted CDs by CD type (primary or repeat). The 2 groups were compared with respect to maternal composite outcome (hysterotomy extension, postpartum hemorrhage, blood transfusion, SICU admission, hospital stay more than 5 days) and neonatal composite outcome (NICU admission, cephalohematoma, subgaleal hematoma, nerve injury, seizure, respiratory distress syndrome, jaundice, ventilation, fracture). Data was analyzed using parametric and non-parametric tests with a p less than 0.05 considered significant.

RESULTS:

Ninety-five vacuum-assisted CD were compared with 95 matched controls. The most common indication for vacuum use was “difficulty delivering the fetal head” (n=26/40). Baseline characteristics were not different. Vacuum-assisted CD was associated with increased adverse maternal composite outcome (OR 3.5; 95% CI 1.44–14.0, p = 0.01) but not adverse neonatal composite outcome (OR 1.89; 95% CI 0.98–3.62, p =0.06); however, neonatal jaundice was increased (18.9% vs 6.3%, p = 0.01). There were no major neonatal injuries or deaths in either group.

CONCLUSION:

Vacuum-assisted CD is associated with increased rates of maternal morbidity and neonatal jaundice.