bluuebunny/crossref_metadata_2025 huggingface dataset:
Body Mass Index and Adverse Neonatal Outcomes in Women Undergoing Elective Cesarean: A Nationwide Cohort Study [25O]
Authors: Vincent Sophie , Czuzoj-Shulman Nicholas , Spence Andrea R. , Abenhaim Haim Arie
Published: May 2017

INTRODUCTION:

To examine the association between pre-pregnancy body mass index (BMI) and neonatal outcomes among women who underwent elective cesarean section (CS).

METHODS:

We conducted a retrospective cohort study using data from the Center for Disease Control and Prevention (CDC) for all reported births by elective CS in 2011-2013. Women's pre-pregnancy BMI was categorized as underweight (“less than”18.5), normal (18.5-24.5), overweight (25-29.9), obese (30-39.9) and morbidly obese (“equal or above”40). Odds ratio (OR) and 95% confidence intervals (CIs) adjusted for baseline characteristics were calculated to estimate the neonatal risks in relation to pre-pregnancy BMI, using normal BMI as our reference.

RESULTS:

Our cohort was composed of 737,548 women with available BMI data, of whom 2.8% were underweight, 38.8% had normal BMI, 26.3% were considered overweight, 25.0% obese, and 7.2% morbidly obese. Infant mortality rates were of 4.2/1000 births for normal weight women, and 5.5/1000 births among the morbidly obese group (OR 1.43; 95% CI 1.25-1.64). A dose-dependent relationship between maternal pre-pregnancy BMI and assisted ventilation was seen. Furthermore, infants born to morbidly obese women were at significantly increased risk for assisted ventilation over 6 hours (OR 1.24; 95% CI 1.15-1.35) and admission to intensive care units (OR 1.17; 95% CI 1.13-1.21). Risk for adverse outcomes is higher with elective CS at earlier gestational age, and this effect is intensified with abnormally elevated maternal BMI.

CONCLUSION:

Increasing maternal pre-pregnancy BMI in women undergoing elective CS was found to be associated with progressively higher risks of adverse neonatal outcomes and mortality.
Comparison of Analgesic Efficacy of Paracetamol and Tramadol for Pain Relief in Active Labor [26O]
Authors: Dahiya Krishna
Published: May 2017

INTRODUCTION:

Labor pain has been described as the most severe pain experienced by women in their lives. To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of tramadol for intrapartum analgesia.

METHODS:

In a randomized prospective study,200 women in active labor were allocated to received either paracetamol (n=100) or tramadol (n=100). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events.

RESULTS:

As recorded by the VAS score, there was significant pain reduction at 30 minutes, and at 1 and 2 hours in both groups (P < 0.01). On comparison between group I and II, significantly higher rate of nausea and vomiting in tramadol group (14% vs 8%; P < 0.03) patients. Similarly, drowsiness (0% vs 11%; P < 0.01), dry mouth (0% vs 8%; P < 0.04) and dizziness (0% vs 9%; P < 0.02) was also significant in group II.

CONCLUSION:

Due to difficulty in administering epidural analgesia to all parturients, administration of paracetamol and tramadol infusion for analgesia is simple and less invasive alternative. In the present study both paracetamol and tramadol were equally effective for labor analgesia but paracetamol has emerged as safe alternative as compared to tramadol due to low incidence of side effects.
To Ligate or Not to Ligate: Comparing Outcomes in Cesarean Hysterectomy With or Without Hypogastric Artery Ligation [29O]
Authors: Ballah Deddeh , Kohi Maureen
Published: May 2017

INTRODUCTION:

To determine if hypogastric artery ligation during cesarean hysterectomy (Chyst) for patients with invasive placentas results in less blood loss and transfusion requirements.

METHODS:

Retrospective review of consecutive patients with invasive placenta who underwent Chyst at one institution between 1/2011 until 5/2016 was performed. Patient characteristics, surgical technique, laboratory parameters and patient outcomes were reviewed.

RESULTS:

A total of 35 patients (median age 35 years range: 22-42 years) were identified. Mean gestation age at Chyst was 34 weeks ± 3 weeks and 6 days. Thirteen of 35 patients underwent hypogastric artery ligation during Chyst. The mean intraoperative estimated blood loss (EBL) for the ligation group was 2,992 ± 2,420 mL and 2757 ± 2131 mL for the non-ligation group, p=0.77. The mean intraoperative transfusion requirements were 4.2 ± 4.7 units of packed red blood cells for the ligation group and 3.9 ± 6.5 units of packed red blood cells for the non-ligation group, p=0.91. The mean intraoperative time for the ligation group was 248 minutes ± 96 minutes and 190 minutes ± 70 minutes for the non-ligation group, p=0.09. The gestational age, length of post-operative intensive care unit hospital stay and total postoperative hospital stay were not significantly different between the two groups (p>0.05).

CONCLUSION:

As hypogastric artery ligation becomes less prevalent in obstetrical and gynecological surgical curriculum, interventional radiology may assume a more prominent role for Chyst in patients with invasive placentas. Furthermore, hypogastric artery ligation during Chyst may not result in different intraoperative estimated blood loss or transfusion requirements.
Transatlantic Air Travel in the Third Trimester of Pregnancy: Does It Affect the Fetus? [31O]
Authors: Petrikovsky Boris , Terrani Michael , Sichinava Lali
Published: May 2017

INTRODUCTION:

Prolonged air travel has numerous risk factors potentially affecting pregnancy including cosmic radiation, aircraft noise and vibration, decreased partial PO2, etc. Airline policies regarding travel in pregnancy vary. Most airlines allow flying until 36 weeks of pregnancy in low risk patients. Immediate effects of the transatlantic flights on 3rd trimester fetus had not been reported.

METHODS:

112 patients between 34 and 37 weeks of gestation underwent NST before and within 12 hours after the transatlantic flight, and 24 hours later. Patients were asked to report fetal movement (FM) during takeoff, flight itself, and landing. Statistical evaluation was made using SPSS for Windows V 15.0 (SPSS Inc.). Data were shown as frequency (percentage) or mean ± standard deviation.

RESULTS:

NST was reactive in 104 patients (93%) before the flight, in 82 patients (73%) patients within 12 hours after this flight (p < 0.05), and in 110 patients (98%) 24 hours later. Variable decelerations were reported in 7 cases (6%) before the flight, 16 (14%) within 12 hours after (p < 0.05), and in 9 (8%) 24 hours later. Increased FM during take-off was reported by 17 patients (15%), no change in 62 (35%), decreased in 4 (3.6%). During flight itself, increased FM was reported by 6 pregnant passengers (5.4%), no change in 70 (63%), decreased in 8 (7%).

CONCLUSION:

Transatlantic flights are associated with temporary changes in fetal status – increased frequency of non-reactive NST and appearance of variable decelerations as well as maternal perception of FM.
Transcervical Foley Bulb (TFB) and Risk of Subsequent Preterm Delivery [32O]
Authors: Fiest Kristen , Alexander Tamika , Wedoff Michael , Mastrogiannis Dimitrios
Published: May 2017

INTRODUCTION:

To evaluate if the use of a transcervical Foley balloon (TFB) for induction of labor (IOL) increases the risk of preterm delivery in subsequent pregnancies.

METHODS:

This was a retrospective cohort study evaluating methods of induction and subsequent pregnancy outcomes.

RESULTS:

151 women were identified to have a term IOL followed by a subsequent pregnancy within a 10-year span meeting study's criteria. Patients were in the study group if a TFB was used alone or in combination with prostaglandins and/or oxytocin for IOL while the control group did not include TFB. Age, race, BMI (in first pregnancy and subsequent pregnancy), tobacco use, previous LEEP, previous D&C, indication for IOL, and birth weight (in first pregnancy and subsequent pregnancy) were all not significantly different between the groups. Bishop score was significantly higher in the control group (p=0.003). Mode of delivery for the initial pregnancy was significantly different between the two groups (p=0.019) with a higher rate of cesarean section in the study group. Mean gestational age at delivery of the subsequent pregnancy was 39 and 39.1 weeks for the control and study groups respectively (p=0.747).

CONCLUSION:

The use of TFB for IOL did not have an impact on gestational age of subsequent pregnancy when compared to other modes of induction. The cesarean section rate was higher in the TFB group in the initial pregnancy, which was likely related to the lower bishop score and increased difficulty of IOL which required the TFB in addition to the other methods to begin with.
Drugs and Death in Las Vegas: A Novel Use of Coroner Data to Create a Toxicology Surveillance System in Pregnant Women [33O]
Authors: Mahesan Arnold , Paul Anthea B. , Mahesan Andrew , Simms Lary
Published: May 2017

INTRODUCTION:

Existing studies in the literature analyze self-reported use of substances or utilize prenatal laboratory testing to assess the prevalence of illicit substances in pregnant women. Our study explores a novel use of quantitative autopsy toxicology to understand trends and associations in maternal mortality.

METHODS:

This study was a retrospective review of pregnant women referred to the Clark County medical examiner from 2000-2015. Medical records were reviewed. These patients were all confirmed pregnant by autopsy diagnosis, and underwent whole blood toxicology analysis. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.

RESULTS:

67 women were included in the analysis. 40% had positive toxicology for any drug, and 28% were positive for illegal drugs. Methamphetamine was most prevalent (16%), followed by ethanol (15%). Individuals not receiving prenatal care had a significantly higher prevalence of illicit drugs 44% vs 7% (p=0.0121), ethanol 25% vs 3% (p=0.0437), and methamphetamine 30% vs 7% (p=0.0051). A positive marijuana result in those not receiving prenatal care, though increased, did not reach significance at 16% vs 7% (p=0.689). Some other trends were noted in the data. 30% (n=20) had documented mental illness. Further, the first trimester had the highest prevalence of illicit drugs and ethanol. Also, 39% (n=26) were victims of domestic violence with non-married women significantly more so than married women (p=0.0001).

CONCLUSION:

As Vital Statistics does not record routine toxicology in non-overdose cases, a toxicology surveillance system using Coroner data would provide important insights into the growing national problem of substance abuse in pregnancy.
Institution of a Postpartum Hemorrhage Bundle at an Academic Center Does Not Immediately Reduce Maternal Morbidity [36O]
Authors: Hamm Rebecca F. , Wang Eileen , O'Rourke Kathleen , Romanos April , Srinivas Sindhu
Published: May 2017

INTRODUCTION:

Obstetric hemorrhage is a leading cause of morbidity and mortality. The Council for Patient Safety in Women's Health released a postpartum hemorrhage (PPH) bundle in 2015 designed to improve patient safety and reduce the use of blood products. We sought to assess whether institution of such a bundle could improve maternal morbidity in our population.

METHODS:

Pre-intervention data (PRE) data was collected on all deliveries at the Hospital of the University of Pennsylvania between 10/15/13 and 12/15/13. Deliveries were included if estimated blood loss (EBL), admission hemoglobin, and 12-hour postpartum hemoglobin were collected. A two-pronged, multidisciplinary educational and procedural intervention related to PPH, including institution of quantitative blood loss, was instituted from 3/2015 to 6/2015. Post-intervention data (POST) was collected on all deliveries from 10/20/2015 to 12/20/2015. Chi-square was used to compare proportions.

RESULTS:

592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. The rates of PPH by EBL ≥1000 cc and by 3 g hemoglobin drop were not significantly different from PRE to POST (9.0% vs 12.2%, p=0.07 and 10.5% vs. 13.5%, p=0.10, respectively). There was no significant change in transfusion rate (3.4% vs. 5.1% p=0.13). Use of uterotonics was reduced from 9.8% to 6.3% from PRE to POST (p=0.03).

CONCLUSION:

While institution of a PPH bundle is designed to improve the morbidity of PPH, our data demonstrates that it cannot be expected to do so within 6 months of implementation. Further studies will need to assess the long term effects of such a resource intensive protocol.
Impact of Gestational Weight Gain on Trial of Labor After Cesarean Success [38O]
Authors: Havard Alexandra , Mei Jenny , Mularz Amanda , Maykin Melanie , Valderramos Stephanie
Published: May 2017

INTRODUCTION:

Maternal obesity has been associated with decreased success of a trial of labor after cesarean delivery (TOLAC). We aimed to investigate the BMI and gestational weight changes on TOLAC success in a modern cohort.

METHODS:

This is a retrospective cohort study of women attempting TOLAC at a single institution from May 2007 to April 2016. Exclusion criteria included age less than 19 years, fetal demise, lethal fetal anomalies, or incomplete medical records. Clinical data collected included maternal demographics, comorbidities, obstetric history, obstetric complications and outcomes, and BMI prior to and throughout pregnancy. Chi squared analysis was used to detect differences between groups.

RESULTS:

614 patients met inclusion criteria. The overall TOLAC success rate was 72.31% (n=444) and average BMI at delivery was 30.7. Compared to normal weight women, we found no difference in success rates among women who were obese prior to pregnancy (73.2% vs 72.1%, P=.794), became obese during pregnancy (69.8% vs 73.3%, P=.379), or were obese at the time of delivery (71.1% vs 73.6%, P=.483). Appropriate weight gain during pregnancy (within Institute of Medicine recommendations) also did not impact TOLAC success (74.1% normal vs 71.4% excess P=.483). A post-hoc power analysis showed that we were powered to detect a 12.5% difference in TOLAC success rates.

CONCLUSION:

In contrast with prior studies, we found no difference in TOLAC success rates with maternal obesity or excess gestational weight gain. Our findings suggest that obesity may not have a negative impact on TOLAC success as previously reported.
Changing the Timing of the Postpartum Visit: Decreasing Short Interval Pregnancy Rates [39O]
Authors: Paredes Ingrid , Gonzalez Aaron Herrera , Row Kelsey , Shi Audrey , Anasti James
Published: May 2017

INTRODUCTION:

Over 50% of pregnancies in the USA are unintended. Current contraception is very effective, if available and used correctly. We surmised the postpartum visit to be a key time to provide education and access to contraception. Thus we wanted to decrease our short interval pregnancy (less than 18 months, SIP) incidence as a simple measure of decreasing unintended pregnancies.

METHODS:

We retrospectively compared patients with SIP and those without with respect to age, race, parity, work status, attendance at postpartum visit (PPV), insurance status, breast feeding, and immediate postpartum medroxyprogesterone use. Modifiable risk factors would then be adjusted and the SIP incidence would be reassessed.

RESULTS:

We noted out of 991 deliveries that occurred from 5/2011 to 1/2013, 89 (8.9%) had an SIP. Only age (26.7 vs. 28.4 y, p=0.01) and PPV (40.9% vs. 67.4%, p=0.03) were significantly different in the SIP patients. Therefore, we changed our PPV timing from 6 weeks to 3 weeks in an effort to increase our PPV attendance. In the subsequent prospective time period from 1/2014 to 5/2016, we had 1021 births and 49 SIP births. Thus we had a decrease in our SIP from 8.9% to 4.8% (p=0.02) after changing the timing of our PPV. In addition, we increase our overall PPV attendance from 61% to 73% (p=0.04).

CONCLUSION:

Altering the timing of postpartum visit from 6 weeks to 3 weeks increased the frequency of attendance and may have decrease the unintended pregnancy rate.
Language Barriers Between Providers and Patients: Does It Equal to Patient Dissatisfaction? [2E]
Authors: Mustafa Nourhan , Rondeau Nancy , Mendez Melissa
Published: May 2017

INTRODUCTION:

It is important for providers and patients to effectively communicate and understand each other. According to the U.S. Census, 21% of individuals reported speaking another language other than English at home, and out of this group 62% spoke Spanish. This study examined patient satisfaction secondary to patient-perceived language barriers in a predominately Hispanic Obstetrics and Gynecology clinical setting.

METHODS:

Data were collected using a 10 question self-administered survey at an academic institution clinic. Participants were Hispanic above the age of 18 who preferred to speak Spanish. Unadjusted and adjusted prevalence ratios (PR) for the dichotomous outcome of patient dissatisfaction with the care provided were estimated using log-binomial regression.

RESULTS:

A total of 420 surveys were collected. The mean age of the respondents was 37, and 30.6% had a high school diploma. Seventy two percent of the respondents reported being satisfied (32.8%) or very satisfied (40.0%) with their provider. The unadjusted PR for the outcome of patient dissatisfaction comparing patients who experienced a language barrier to those who did not experience a language barrier was 1.11 (95% CI: 0.63 ‒ 1.93, P=0.72). After controlling for the patient’s primary residence and educational level, the PR for patient dissatisfaction for the presence of a language barrier decreased to 1.02 (95% CI: 0.58 ‒ 1.78, P=0.95).

CONCLUSION:

Further studies are necessary to determine if additional provider training on Spanish provider-patient communication is necessary to improve the overall patient satisfaction for Spanish speaking patients visiting Ob/Gyn clinics.
Pain Perception After Office Hysteroscopy Alone vs. Hysteroscopy With Endometrial Biopsy [3E]
Authors: New Erika , Mikhail Emad , Sappenfield Elisabeth , Sarkar Papri , Plosker Shayne , Imudia Anthony
Published: May 2017

INTRODUCTION:

Prior to performing office based gynecologic procedures, patients require appropriate preoperative counseling on anticipated pain. This study investigates the difference in patients’ pain perception when office hysteroscopy (OH) is performed alone compared with OH and concurrent endometrial biopsy (EMB).

METHODS:

A prospective study of patients presenting to USF for OH alone or OH with EMB between 10/2015 and 7/2016 was performed. Pre-procedure instructions were similar for all patients, and patients knew whether they were undergoing OH alone or OH with EMB. Patients described their pain perception using the visual analogue scale from 0-10 at the end of the procedure(s) and data was compared between groups using SPSS version 23.

RESULTS:

A total of 173 patients were enrolled in the study. Group 1 had OH alone (n=133) and group 2 had OH with EMB (n=40). Patients in group 1 were significantly younger than group 2 (36±6 vs 41±7, p-value less than 0.0001) but there was no significant difference in mean gravity or parity. Procedure indications included fibroids, endometrial polyps, fertility testing, and recurrent pregnancy loss. The median (range) global pain perception was 6 (0-10) vs 7 (0-10) between group 1 and 2 respectively, which was not significantly different (p=0.12). There was no difference in tenaculum use, uterine perforation or vasovagal reaction between the groups.

CONCLUSION:

Patient reported pain assessment was similar in women undergoing OH with or without endometrial biopsy. Similar preoperative instructions and preparation can be given to these patients.
Exploring the Patient Decision-Making Process in Choosing Route of Hysterectomy [5E]
Authors: van der Does Louise , Baxi Rupen P. , MacKoul Paul , Danilyants Natalya , Washington Kelly
Published: May 2017

INTRODUCTION:

Laparoscopic hysterectomy offers clear benefits to patients when compared to abdominal (open) hysterectomy, yet a large percentage of women continue to undergo the latter procedure. The purpose of this study is to explore the patient decision-making process in choosing the route of hysterectomy.

METHODS:

A questionnaire survey was mailed to all patients (N=3,878) who underwent hysterectomy at a suburban community hospital between 2011-2013. Questions addressed preoperative education, patient involvement, and patient satisfaction. Quantitative data was summarized in contingency tables and analyzed using Pearson chi-square; qualitative data was analyzed using content analysis.

RESULTS:

The overall response rate was 10.3%. Nearly a third of respondents underwent open hysterectomy. Of those respondents, 48.2% indicated the route of hysterectomy “didn’t matter” to them and 13.7% “didn’t know about other surgical options,” compared to 14.8% and 8.5%, respectively of the laparoscopic group. Of the open group, nearly one third (31.7%) indicated their surgeon “did not talk about alternatives to open hysterectomy.” Compared to the laparoscopic group, open respondents were less likely to seek a second opinion, opting to have the surgery performed by their OB/GYN (44%), because “they trusted their OB/GYN” (76.6%). Only 1% of the open group performed on-line research regarding their surgical options. Of the open group, only 76% said they would recommend the same route of surgery, compared to 90.32% of the laparoscopic group.

CONCLUSION:

The outcomes of this study point to a need for improved preoperative patient education and patient involvement in the surgical informed consent process.
Factors Influencing Medication Adherence in High Risk Pregnant Patients [6E]
Authors: Mastrogiannis Dimitrios , Della Torre Micaela , DiGiovanni Laura , Wedoff Michael
Published: May 2017

INTRODUCTION:

Pregnant patients’ non-adherence with prescription medications is a challenging problem. The purpose of this study was to investigate factors influencing medication adherence in our urban high risk obstetric clinic.

METHODS:

This is a prospective cross-sectional study performed February through June 2016 at the Maternal Fetal Medicine clinic at UIC. Participants were ≥24 weeks, English-speaking adults, and taking ≥1 prescription medication. After obtaining consent, study participants were surveyed by questionnaire. Answers were entered into 3 adherence scoring scales: Morisky 8 medication adherence score (MMAS-8), medication adherence reasons scale (MARS), and rapid estimate of adult literacy.

RESULTS:

A total of 69 patients completed the questionnaire; 60% had unplanned pregnancies, and 45% had health literacy < 8th grade level. Adherence scores were low in 42%, moderate in 38%, and high in 20% of participants. Pregnant women with low adherence score were significantly more likely to be on higher number of medications (p=0.044) and had trended towards missed prenatal visits (p=0.056). 31.9% had asthma, 52.2% had diabetes, 44.9% had hypertension, 11.6% had thyroid disorders, and 4.3% had seizure disorders. Patients with hypertension had higher non-adherence compared to all other categories (p=0.037), and more commonly used marijuana (p < 0.001). Being employed, having a smartphone, dependents, and partner did not affect adherence scores. Women reporting forgetfulness, carelessness, medication side-effects, stopping medication when symptom free, travel, inconvenience, and difficulty calculating dose had low adherence scores.

CONCLUSION:

Understanding the reasons for medication non-adherence in an urban high risk obstetric population may allow providers to tailor motivational interviewing to improve individual adherence.
Gestational Weight Gain in Diabetic Women: Do Supportive Text Messages Make a Difference? [7E]
Authors: Gupta Angela , Buchanan Christopher , Gavard Jeffrey , Hostetter Sarah , Miller Collin , Mostello Dorothea
Published: May 2017

INTRODUCTION:

Weight gain during pregnancy can lead to adverse health outcomes. The purpose of this study was to examine the effect of different text message regimens on gestational weight gain in women with diabetes.

METHODS:

Data from a prospective, controlled trial of women with gestational or Type 2 diabetes mellitus were analyzed. Women were randomized to receive either general pregnancy supportive text messages (Text4Baby) or diabetes-specific text messages (Text4Diabetes). Women also received nutrition education to limit their weight gain to the Institute of Medicine (IOM) gestational weight gain guidelines based on pre-pregnancy BMI. Groups were compared on gestational weight gain from study entry to delivery using independent students t-test, Kolmogorov-Smirnov, chi-square, and Fisher Exact tests.

RESULTS:

The final analysis had 71 patients: Text4Baby (n=35) and Text4Diabetes (n=36). Most women were obese at study entry (87.5%). Demographics did not differ between groups. There was no difference in maternal weight at entry, duration of participation, or total maternal weight gain. More women receiving Text4Baby text messages exceeded IOM guidelines for weekly weight gain compared to women receiving Text4Diabetes text messages (57.7% vs. 48.1%). Of all overweight and obese women, 52.8% gained more weight than IOM guidelines, while only 32.1% gained less and 15.1% gained within IOM guidelines.

CONCLUSION:

While general pregnancy and diabetes-specific text message groups did not differ in weight gain during pregnancy, most women in both groups gained more than IOM guidelines recommend. Text message interventions for women with diabetes in pregnancy should address the importance of avoiding excessive weight gain during pregnancy.
An Exploration of Clinician's Personal Experience of Trauma and Its Impact on Screening Female Patients For Trauma [8E]
Authors: Cooper Conisha , Antoine Denis , Lee Amy S.D. , Irvin Nathan , Coleman Jenell
Published: May 2017

INTRODUCTION:

Physical and sexual trauma can impact the health of patients, yet screening rates are low. Factors associated with screening are needed. We sought to determine whether clinician's personal experience of physical and sexual trauma was associated with screening their female patients for trauma.

METHODS:

We conducted an online survey of clinicians at a single academic institution. Self-reported screening of female patients was assessed using a 5-point Likert scale and scored 1 (never) to 5 (always). Separate validated tools were used to assess physical and sexual trauma. Descriptive and univariate statistics were performed.

RESULTS:

Among 134 participants, 83% were female, median was age 39.5 (interquartile range [IQR] 32-50). The majority were white (78.4%) and were nurses (53.7%). Disciplines included Ob/Gyn (32.3%), Emergency Medicine (27.1%), Psychiatry (27.8%) and Primary Care (12.8%). The median (IQR) screening score was 3.9 (3.3-4.3). Overall, 88.7% of clinicians reported personal experiences of sexual and/or physical trauma. There were no significant differences in screening scores between any trauma (3.9, [3.3-4.3]) vs no trauma (4.1 [3.5-4.4], P=.42). Greater number of years in practice was associated with higher screening scores (P=.03), but having a departmental policy was not (P=.63). Scores were significantly higher in Ob/Gyn (4.2 [3.7-4.4]) vs Emergency Medicine (3.56 [3.3-3.9], P=.007) and Primary Care (3.6 [3.1-3.8] P=.01). There were no differences between nurses and physicians (P=.50).

CONCLUSION:

Screening scores were high among our clinician cohort and a personal experience of trauma was not associated with screening. Successful strategies in Ob/Gyn should be further explored and disseminated to other specialties.
Analysis of Screening Women for Cervical Cancer Following an Excision for Cervical Intraepithelial Neoplasia [14E]
Authors: Talbot Ethan , Hunt Kimberly , Morosky Christopher
Published: May 2017

INTRODUCTION:

This study assessed if the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests can be successfully applied to a group of women who were treated with an excisional procedure for cervical dysplasia.

METHODS:

This retrospective longitudinal study encompassed all patients at an academic medical center who underwent an excisional procedure for cervical intraepithelial neoplasia from 2001 to 2013. We performed a comparative model analysis by applying the 2012 updated management and screening guidelines to a patient population that had previously undergone traditional screening. Our primary outcomes were identification of dysplasia recurrence and over-screening. We also identified characteristics associated with an increased risk of dysplasia recurrence.

RESULTS:

A total of 493 subjects contributed 505 specimens and 2247 subsequent pap smears to the final study population. Eighteen subjects (3.65%) underwent an intervention for recurrence. Compared to traditional screening, the 2012 management guidelines identified less recurrence (100% vs. 97.0%, P=0.001), but greatly reduced over-screening (39.2% vs 8.5%, P

CONCLUSION:

Application of the 2012 updated consensus guidelines to patients who have undergone an excisional procedure for cervical dysplasia results in a marginal decrease in identification of dysplasia recurrence which is balanced by a significant decrease in over-screening.
Postpartum Cervical Cancer Screening Adequacy and Results: Comparison of Results 2-3 Versus 6-8 Weeks Postpartum [20E]
Authors: Carty Jenava , Batig Alison
Published: May 2017

INTRODUCTION:

Postpartum follow up earlier than the traditional 6-8 week interval has been proposed as a means to enhance care provision to women after childbirth. Our study’s objective was to compare cervical cancer screening adequacy and results when screening was performed either 2-3 or 6-8 weeks postpartum.

METHODS:

The data for this study was obtained as part of a randomized controlled trial that recruited primiparous women who delivered at term with an expressed intent to breastfeed to postpartum appointment intervals of either 2-3 or 6-8 weeks following childbirth. When cervical cancer screening was performed, the results were reviewed for adequacy and findings. The results were compared for each group using chi-squared analysis; adequacy was compared using an odds ratio with 95% confidence interval.

RESULTS:

The rates of cytologic adequacy were comparable between the group (95.0 versus 100% in the 6-8 week group, p=0.21); the odds ratio for “unsatisfactory” cytology in the 2-3 week follow up group was 0.06 (95% CI < 0.01-41.8). The distribution of cytologic results was comparable between the group (p=0.09); no one in either group had a high-grade cytologic result or cervical cancer. When performed, the rates of positive and negative high-risk human papillomavirus results was comparable between the groups (p=0.92).

CONCLUSION:

Our study indicates that cervical cancer screening can be completed earlier during the postpartum period than traditionally accepted without compromising cytologic adequacy or results. This information may be useful in shaping future recommendations regarding the timing and medical services provided during the postpartum period.
Trends in Chlamydia Screening Provision During Outpatient Visits for Young Women in the United States [26E]
Authors: Flagler Emily , Kobernik Emily , Kamdar Neil , Dalton Vanessa
Published: May 2017

INTRODUCTION:

The purpose of this study was to 1) examine rates of chlamydia screening between 2005 and 2012, and 2) to identify visit characteristics associated with chlamydia screening during encounters with young women.

METHODS:

We used data from the 2005-2012 National Ambulatory Medical Care Survey, a nationally representative sample of physician-reported, office-based medical visits. Bivariate analysis was performed to compare office visit characteristics among women 14-20 yo and 21-25 yo, respectively, and by time period of screening (period 1: 2005-2008, period 2: 2009-2012). Multivariable logistic regression with appropriate survey weights was performed for all office visits to identify predictors of chlamydia screening and subsequent age-stratified models were developed to identify independent predictors of chlamydia screening.

RESULTS:

Among 16,707 office visits, the overall chlamydia screening rate was 2.7% and 4.2% among 14-20 yo and 21-25 yo, respectively. Age, race, provider type, and visit type were associated with screening during an office visit. After risk adjustment, the odds of receiving chlamydia screening were significantly higher during period 2 (aOR=1.28, 95%CI: 1.01-1.63), among women aged 21-25 (aOR=1.56, 95%CI: 1.22-1.99), among non-Hispanic blacks (aOR=2.12, 95%CI: 1.60-2.81), and during preventive care visits (preventive care: aOR=12.95, 95%CI: 7.93-21.2). In age stratified models, preventive care visits, and being seen by an obstetrician-gynecologist were significant predictors of screening in both age groups, however non-Hispanic black race was a predictor only for visits among 21-25 yo.

CONCLUSION:

Chlamydia screening rates during outpatient visits remain low despite clinical guidelines. Visit characteristics are associated with screening and suggest intervention strategies to improve screening rates.
Compliance With ASCCP Guidelines for Evaluation and Management of Abnormal Pap Smears [28E]
Authors: Hedman Elizabeth , Thompson Paul , Hansen Keith
Published: May 2017

INTRODUCTION:

American Society for Colposcopy and Cervical Pathology (ASCCP) 2012 revised guidelines were developed to improve the detection and management of cervical dysplasia. A recent study revealed that not all health care providers are knowledgeable or aware of the 2012 national cervical cancer screening guidelines (Teoh et al., 2015). The goal of this study was to determine if primary care providers and Gynecologists manage abnormal PAP smears according to ASCCP current guidelines.

METHODS:

This was a retrospective study conducted at a Midwestern, regional medical center. An electronic search was conducted for abnormal PAP smears during a 12-month period performed by Gynecologists, Internal Medicine, and Family Medicine providers. The patients’ charts were reviewed and entered into an electronic database. The results of the PAP smear and its optimal management according to the 2012 ASCCP guidelines were compared to the providers’ next step in the treatment and management of the abnormal PAP smear. Proportions and 95% confidence intervals were determined for age of patient, type of provider and field of medicine.

RESULTS:

284 charts were reviewed. The proportion of PAP smears that were managed appropriately was 0.658 (95% CI 0.603-0.714). The proportion of ASCCP guideline managed PAP smears were similar for age of patient, type of provider (physician or Advanced Practice Provider) and field of medicine.

CONCLUSION:

In this study, providers were not always managing abnormal PAP smears according to the current ASCCP guidelines. These results may reflect that providers are unaware of the recent guidelines or the guidelines are too complicated.
Prevalence and Genotyping of HPV in Women With Cervical and Anal Neoplasia [32E]
Authors: Amorim Melania , Heraclio Sandra , Rolland de Souza Alex Sandro , Katz Leila
Published: May 2017

INTRODUCTION:

Persistent human papillomavirus (HPV) infection has been strongly associated with the development of anogenital cancer precursor lesions. Therefore, the objective of this study was to determine the prevalence of oncogenic HPV genotypes and associated factors in women with anal neoplasia.

METHODS:

A cross-sectional study was conducted in 152 women with anal intraepithelial or invasive neoplasia, to identify HPV genotypes.

RESULTS:

Fourteen different HPV types were identified. HPV 16 and 18 were found in 53% (n=30) of anal high-grade squamous intraepithelial lesions (HSIL). HPV 31 and 33 were identified in 37% (n=21) of anal HSIL. In the logistic regression analysis, the factors that remained associated with high-risk HPV types were: an anal histopathology report of HSIL or worse (OR=8·96; 95%CI: 3·40-23·57; p < 0·0001) and alcohol consumption (OR: 2·20; 95%CI: 1·01-4·80; p=0·04) as risk factors, and condom use as a protective factor (OR=0·33; 95%CI: 0·12-0·87; p=0·02).

CONCLUSION:

The prevalence of HR-HPV in women with high grade AIN and cervical neoplasia is high. Fourteen different HPV types were found, and HPV16, 31,33 and 18 were the four major genotypes identified.
Evaluation of African American Women at High Risk for Ovarian Cancer in the Southeast [34E]
Authors: Barrington David A. , Champion Macie , Farmer Meagan , Haygood Christy , Boitano Teresa , Leath Charles A.
Published: May 2017

INTRODUCTION:

This study aimed to describe patient characteristics in African American (AA) women seen at a large southeastern comprehensive cancer center.

METHODS:

We reviewed an IRB approved, prospectively gathered cohort of patients seen in an Ovarian Cancer Risk Assessment Clinic. Data evaluated included family history, frequency of genetic testing, frequency and types of genetic mutations, and frequency of surgical intervention and development of ovarian cancer.

RESULTS:

1227 patients were evaluated from 2003-2015, of which 97 (7.9%) were AA. Eighteen patients had a personal history of ovarian cancer. Sixty-eight (70%) underwent genetic testing and 29 (30%) elected for genetic counseling only. Of women tested 38 (56%) had abnormal results. Nine and 14 patients had deleterious mutations for BRCA 1 and 2 respectively. Twelve had BRCA variants of undetermined significance. Two were found to have PALB2 mutations and one MLH 1 mutation was identified. Of the patients with abnormal testing, five of 23 women with BRCA deletions underwent risk reducing salpingo-oophorectomy (RRSO).

CONCLUSION:

Our study demonstrates that in a region where AAs represent 27% of the population, the proportion of AA patients referred to an Ovarian Cancer Risk Assessment Clinic remains low. Rates of genetic testing were comparable to Caucasians, potentially signifying that barriers to genetic counseling may be overcome when evaluated in a dedicated clinic. Mutation and variant rates were high in patients tested, possibly representing a selection bias of high risk patients. Endeavors should continue to identify minorities at risk for ovarian cancer and institute measures to provide thorough genetic counseling and testing.
Association of Planned Natural Childbirth With Spontaneous Vaginal Delivery, Interventions, and Complications [36E]
Authors: Cohen Lauren , Waldron Carolyn , Brustman Lois
Published: May 2017

INTRODUCTION:

There is a paucity of literature suggesting that women who deliver in a birthing center are more likely to achieve a normal spontaneous vaginal delivery (NSVD). This led us to compare outcomes between laboring women admitted to our hospital-based birthing center (BC) and those admitted to our labor and delivery unit (L&D).

METHODS:

A retrospective chart review included all nulliparous patients admitted to the BC in 2013. BC patients were defined as low risk based on maternal age (18-43), gestational age (37-41 weeks), and estimated fetal weight (10th-90th percentile). All BC patients were matched to low-risk patients admitted in active labor to L&D. Univariate analysis was conducted with Chi-square and Fisher’s exact tests. Multivariate logistic regression identified factors associated with mode of delivery.

RESULTS:

The 161 women admitted to BC were significantly more likely to have an NSVD than patients initially admitted to L&D (144 (89%) vs. 107 (66%), respectively; p < 0.0001). Significant predictors of operative and cesarean deliveries were epidural anesthesia (OR 2.943, CI 1.462-5.926; p=0.0025), initial admission to L&D (OR 2.105, CI 1.012-4.376; p=0.0464), non-white race (OR 1.972, CI 1.075-3.618; p=0.02830), and increasing maternal age (OR 1.7, CI 1.119-2.621; p=0.0131). If labor care was initiated in the BC versus L&D, significantly-lower rates of Pitocin augmentation (16 (10%) vs. 36 (22%); p=0.0025), episiotomy (5 (3%) vs.18 (11%); p=0.046) and epidural anesthesia (21 (13%) vs. 115 (71%); p=0.001), resulted. There were no significant differences in maternal or fetal morbidity.

CONCLUSION:

Planning for and starting care in a hospital-based BC appears to enhance outcomes and should be encouraged for appropriate patients.
Association Between Time of Hysterotomy to Delivery and 5-Minute Neonatal Apgar Score: A Retrospective Cohort Study [37E]
Authors: Dogal Natalie , Cotton-Caballero Amaya , Dudley Donald
Published: May 2017

INTRODUCTION:

We investigated the association between time of hysterotomy to delivery greater than or equal to 3 minutes and 5-minute neonatal Apgar score less than 7.

METHODS:

Women undergoing cesarean delivery of a live birth at UVA Health System were included. Data was extracted from electronic medical records. Means and SDs were calculated for all continuous variables. Potential confounders were categorized and univariate chi-squared tests were performed. Logistic regression was used for multivariable analysis.

RESULTS:

The mean time from hysterotomy to delivery was 2.39 minutes, mean Apgar score was 8.28, mean birth weight was 3082.97 grams with mean gestational age at delivery of 37.63 weeks. Neither time greater than or equal to 3 minutes (p=.85) or time greater than or equal to 5 minutes (p=.90) appeared associated with Apgar score. Preterm delivery (p< .001) and size for gestational age at delivery (p< .001) both appeared associated with Apgar score less than 7. Time from incision greater than or equal to 3 minutes was not associated with Apgar score (P=.54) when adjusting for size-for-gestational age at delivery and preterm delivery. Small for gestational age had an OR=3.21 (95%CI 1.39-7.44), large-for gestational age had an OR=.75 (95%CI .31-1.83). Preterm delivery also increased the odds (P=.01) of Apgar score less than 7 by OR=2.78 (95%CI 1.36-5.70). Time from incision greater than or equal to 5 minutes was not associated with Apgar score less than 7 (p=0.90) when confounders were considered.

CONCLUSION:

Our data are reassuring that time from hysterotomy to delivery is not associated with adverse neonatal outcomes.
What Women Want From Their Doctors About Pregnancy Options Counseling [3F]
Authors: French Valerie , Steinauer Jody , Kimport Katrina
Published: May 2017

INTRODUCTION:

The recommendations on pregnancy options counseling by many professional organizations conflict with some doctors’ desire to exercise their personal beliefs. To understand a patient-centered framework for pregnancy options counseling, we explored pregnant women’s preferences for pregnancy options counseling from doctors.

METHODS:

We conducted semi-structured interviews with 28 pregnant women recruited from a prenatal clinic and an abortion clinic. We asked women about recent discussions—or lack thereof—about pregnancy options (parenting, adoption and abortion) with a doctor, and what they would want their doctor to discuss about pregnancy options. We analyzed transcripts using modified grounded theory.

RESULTS:

Most participants, in both prenatal and abortion care, said doctors should discuss pregnancy options, including abortion, with pregnant women. In counseling, participants wanted physicians to: 1) respect patient autonomy, 2) avoid assumptions about a woman’s desired pregnancy outcome, and 3) consider the patient as a whole person. In general, participants wanted their doctors to assess a pregnancy’s particular circumstances to determine the appropriateness of options counseling. A few participants reported not wanting options counseling. Explaining this preference, they cited preservation of privacy, having already made a decision for the pregnancy, or not wanting to discuss abortion. Regarding best practices for providing options counseling, participants said it should be done in a routine manner, with discretion, and early in pregnancy.

CONCLUSION:

Pregnant women seeking both prenatal and abortion care broadly support options counseling. These findings suggest options counseling that includes discussion of abortion is consistent with providing patient-centered care and supports women’s preferences.
Pregnancy Risk, Contraception and Sexually Transmitted Infections in the Transgender Patient [4F]
Authors: Jasani Sona , Balica Adrian , Marshall Ian , Ayers Charletta , Bachmann Gloria , Francis Amanda
Published: May 2017

INTRODUCTION:

Reproductive risk assessment, STI prevention and contraception counseling represent an emerging challenge in the transgender population. Despite increased awareness of transgender healthcare needs, provider templates of care based on evidence based data that address the reproductive healthcare needs of transgender individuals are limited.

METHODS:

We performed a literature search using Pub Med, Scopus and Google Scholar between 2010-2016. Search terms used included transgender, pregnancy, contraception, and STI. Of the six relevant articles, three were cross sectional surveys and three were retrospective cohort studies.

RESULTS:

Among transgender youth, contraception use did not differ between those at risk for pregnancy vs those not at risk. As expected, sexual activity was associated with higher STI risk. Positive HIV status did not differ in transmen compared to transwomen: overall HIV prevalence was higher in the trans vs non-trans population. Unprotected sex may be a factor with STI. In one study, 88% of transmen reported using no protection. Further, pregnancy appears to be desired in select transmen, as one study noted that 68% in their cohort had a planned gestation while 32% had an unplanned one.

CONCLUSION:

There are limited data to formulate guidelines regarding pregnancy, STI counseling and contraceptive management of transgender individuals. Both pregnancy risk/desire exists in this population and should be a counseling topic. In addition, contraceptive and STI counseling is essential during all clinical encounters. For those at risk for HPV coinfection continued gynecological surveillance should be part of their preventive health management.
Perspectives on a Quality Abortion Care Experience: A Patient Centered Approach [9F]
Authors: Mnuk Rachel , Mariam Savabi , Bayat Lily , Pereda Brenda
Published: May 2017

INTRODUCTION:

A third of US women have an abortion—often a painful and emotional experience—during their reproductive years. Few studies have examined patients’ experience in abortion care, resulting in limited evidence to guide clinicians on aspects of abortion care most important to women. Similarly, providers’ perceptions of the patient experience have not been studied. Our study objective was to better understand women’s and providers’ perspectives on a high quality abortion experience to inform patient-centered abortion care.

METHODS:

We conducted semi-structured interviews with 10 abortion providers at the University of New Mexico Center for Reproductive Health, and 25 women seeking first-trimester surgical abortion. Participants underwent a pre-procedure in-person interview as well as a post-procedure phone interview. New participant interviews were performed until thematic saturation was achieved. Interviews were transcribed and coded using Dedoose.™

RESULTS:

Women and providers value similar aspects of abortion care. When evaluating perspectives, an inverse hierarchy of priorities was observed. Providers consistently cited health metrics such as safety, procedure length, and pain control as primary determinants of providing quality abortion care. In contrast, patients desired empathy, a genuine connection with their abortion provider and clinic staff, as well as feeling heard and understood in a non-judgmental environment.

CONCLUSION:

Women and providers valued somewhat different but complementary aspects of abortion care. The global clinical care, including all clinic personnel’s attention to women’s psychosocial needs, is integral to high quality abortion care.