bluuebunny/crossref_metadata_2025 huggingface dataset:
Awareness of Sexually Transmitted Infection and Cervical Cancer in Nigerian Female Adolescents [12F]
Authors: Eli Sukarime , Inimgba Nestor , Okpani Anthony
Published: May 2017

INTRODUCTION:

Cervical cancer is a sequel of Human Papillomavirus infection. Female adolescents in Nigeria are at high risk for future occurrence of this malignancy because of multiple concurrent sexual partners, and unprotected sex. High incomes and sophisticated lifestyles induced by the Niger Delta crude oil operations, youth unrest, peer group pressure, and substance abuse promote these sexually transmitted infections. Data should be collected from these adolescents to facilitate sexual behavioral change.

METHODS:

To determine the level of awareness of the relationship between sexually transmitted infection and cervical cancer. Information was collected from Two hundred and forty female adolescent secondary school students and undergraduates attending a holiday camp in Port Harcourt, South Nigeria.

RESULTS:

The mean age of the subjects was 15 years. Forty- eight (20%) subjects were under 13 years. 51% were aged 14 years to 16 years, and 29% were aged 17 years to 19 years. Forty-five per cent of the subjects were aware of cervical cancer but only 4% knew there was a relationship between unprotected sex and cervical cancer. The commonest sources of information were the media (50%), and hospitals (30%). None of the subjects was aware of the Human Papillomavirus vaccine.

CONCLUSION:

Adolescents are at increased risk for sexually transmitted infections, but have low levels of knowledge about their sequel. Promotion of sexual behavior attitudinal change facilitated by collection of data on sexuality will assist in reducing the incidence of cervical cancer in Nigeria.
A Prospective Study on the Effects of Medicaid Regulation and Other Barriers to Immediate Postpartum Sterilization [14F]
Authors: Hahn Taylor , Tucker-Edmonds Brownsyne , Layman Shelley , Daggy Joanne
Published: May 2017

INTRODUCTION:

To assess the rate of and reasons for unfulfilled sterilization requests, specifically regarding issues with the Medicaid Consent for sterilization, and to determine the proportion of patients who subsequenstly receive interval sterilization by 3 months postpartum.

METHODS:

Prospective observational cohort study of women delivering over an 8 month period and requesting immediate postpartum sterilization. Records of women with unfulfilled requests were reviewed up to 3 months postpartum to determine rates of postpartum follow up and interval sterilization. Primary analysis examined unfulfilled sterilization requests associated with the Medicaid Consent form and secondarily all other reasons for unfulfilled requests and alternative contraceptive methods chosen. Bivariate analyses were performed to evaluate the relationship between unfulfilled sterilization and sociodemographic characteristics.

RESULTS:

334 women delivered and requested immediate postpartum sterilization. 173 women (52%) received requested sterilization while 161 women (48%) did not. Medicaid Consent was the primary reason for unfulfilled request for 61 women (37.9%). Within this group, six women (9.8%) received interval sterilization by 3 months postpartum, while the remaining 90.2% were still awaiting interval sterilization (14.8%), had chosen an alternative contraceptive method (52.5%), or did not receive postpartum care (23.0%). Of the sociodemographic factors assessed, only advanced age was associated with increased sterilization (p=0.02).

CONCLUSION:

A sizable proportion of women requesting postpartum sterilization continue to have unfulfilled requests due to an issue with the Medicaid Consent and they have a low likelihood of receiving interval sterilization. This has important implications for ongoing reproductive justice efforts to protect vulnerable populations while minimizing barriers to desired sterilization.
Complications Associated With Second Trimester Inductions Requiring Over Five Doses of Misoprostol [15F]
Authors: Diaz Nicole M. , Kuchta Kristine , Ouyang David W.
Published: May 2017

INTRODUCTION:

The objective of this study was to evaluate outcomes associated with second trimester inductions requiring greater than five (>5) doses of misoprostol as compared to those that delivered with five or less (≤5). The American College of Obstetricians and Gynecologists recommends a maximum of five misoprostol doses for second trimester induction terminations.

METHODS:

A retrospective cohort study was conducted that included women between 14 and 23 weeks who underwent induction for termination or demise from 2005 to 2015. During this timeframe, inductions undelivered after five doses of vaginal misoprostol continued further doses without delay. Characteristics and outcomes between inductions requiring >5 doses versus ≤5 were assessed.

RESULTS:

Of 478 women included in our analysis, 396 delivered with ≤5 doses of misoprostol, while 82 required >5 doses. Those requiring >5 doses were more likely to be nulliparous, have an unfavorable cervix and have greater gestational age. The groups were similar in terms of age and prior cesarean. No significant differences in chorioamnionitis, retained placenta, postpartum hemorrhage, transfusion, or uterine rupture were noted in spite of the >5 cohort taking significantly longer to deliver (29.7 hours vs 10.1 hours, P < .0001). Regional anesthesia was more common in the >5 group (OR 1.69, P=0.035). The only uterine rupture occurred in the ≤5 group after one dose of misoprostol.

CONCLUSION:

The frequency of complications associated with second trimester inductions requiring >5 doses of misoprostol is comparable to those requiring ≤5. These data suggest women should be able to continue induction following the fifth dose without delay.
Essure and Pelvic Pain: Risk Factors for Device Removal and Reintervention [18F]
Authors: Hijaz Miriana , Walton Edward Michael , Tsafrir Ziv , Aoun Joelle , Eisenstein David
Published: May 2017

INTRODUCTION:

The FDA recently announced actions to provide information about the risks of using the Essure device, requiring a mandatory postmarket study to determine its heightened risks. In this study, we aim to look at our experience with the Essure device and analyze its outcomes and complications, focusing on pelvic pain and the risks associated with re-operation.

METHODS:

We conducted a retrospective cohort study of 319 patient who underwent Essure placement between 2002 and 2016. Patient characteristics included age, race, BMI, parity, history of chronic pelvic pain, prior gynecological surgery or pelvic infections, and documented nickel allergies. Measured outcomes included new or worsening pelvic pain, need for device removal or subsequent pelvic surgery. Logistic regression models were used to test the association between each predictor variable and measured outcomes.

RESULTS:

Out of the total patients, 64 had undergone re-operation and 255 did not. Most common procedure was hysterectomy with bilateral salpingectomy (6.58%) followed by endometrial ablation (5.96%), 3.3% of patients underwent Essure removal. The average time between Essure placement and re-operation was 9 years. Only 4.39% of re-operation were performed due to pelvic pain. There was a significant correlation between incidence of re-operation and illicit drug use (p 0.026), and prior gynecological surgery (p 0.008).

CONCLUSION:

We re-demonstrate the rarity of new onset pelvic pain after Essure placement. However, illicit drug use, especially marijuana, and prior pelvic surgery were significant risk factors in re-operation following Essure placement and should be considered as part of the consent process.
Necessity for Short Interval Intrauterine Device String Check [19F]
Authors: Hylton Jordan , Milton Sarah , Cheang Kai , Sima Adam
Published: May 2017

INTRODUCTION:

The purpose of the study was to determine the necessity for the short interval IUD string check that is recommended by most IUD manufacturers. The primary objective was to determine if a routine short interval follow up visit after IUD insertion identifies expelled or malpositioned IUDs.

METHODS:

The study is a retrospective chart review of data collected from ICD 9 and 10 codes for “IUD placement” at Virginia Commonwealth University from January 2011 to December 2015. One thousand charts were reviewed. In addition to data on malpositioned or expelled IUDs, information was collected regarding symptoms at time of string check, obstetric and gynecologic history, string check intervals and visits related to IUD complaints. Statistical analysis was accomplished using t-tests and chi square tests.

RESULTS:

There was no difference in identification of malpositioned or expelled intrauterine devices among patients who attended short interval string check visits compared with those who did not, p=0.8269. There were statistically significant differences in breastfeeding status, menstrual bleeding patterns, gravidity and parity between attendees and non-attendees.

CONCLUSION:

There was not a difference in the incidence of IUD malposition or expulsion in patients who attended the short interval string check visit versus those who did not attend. There were, however, statistically significant differences in the two study groups. The CDC’s 2016 U.S. Selected Practice Recommendations for Contraceptive Use sites poor quality and limited data regarding the utility of routine follow up visits following IUD insertion. This study further validates the CDC assertion that routine string check visits are unnecessary.
Male Knowledge of His Partner’s Contraceptive Method and Likelihood of Fathering a Pregnancy [20F]
Authors: Hicks-Courant Katherine , Dubinskaya Alexandra , Baer Samantha
Published: May 2017

INTRODUCTION:

Many forms of contraception are female-dependent and may not be evident to sexual partners. Less than half of men who are sexually active but do not want to father a child have partners who consistently use contraception. This study examines whether male knowledge of his partner’s birth control method is associated with having impregnated a partner.

METHODS:

We used data from the 2011-2013 National Surveys of Family Growth. Our sample included sexually active men 15-45 years of age who had never been married. Unadjusted t-tests and linear regression assessed whether knowledge of his last partner’s birth control method was associated with having fathered a pregnancy.

RESULTS:

Our sample included 1,845 males. 477 (25.85%) had fathered a pregnancy. At last sexual intercourse, 45.20% (n=834) reported that their partner used female-dependent contraception, defined as a contraceptive method other than male condoms, withdrawal or male sterilization. 49.70% (n=917) reported that their partner did not use female-dependent contraception, and 5.09% (n=94) did not know what contraception, if any, their partner used. There were no significant differences in rates of having fathered a pregnancy in unadjusted comparisons between groups. When adjusting for age, number of sexual partners, use of male-dependent contraception, and knowledge of contraception prior to first sex there remained no statistically significant association between male’s knowledge of his partner’s contraceptive method and having fathered a pregnancy.

CONCLUSION:

Among unmarried men, knowledge of a current partner’s contraceptive method is not significantly associated with having fathered a pregnancy.
IUDs in the Twittersphere: Sentiment Analysis of IUD-Related Tweets [23F]
Authors: Jung Christina , Richter Felix , Lunde Britt , Chen Katherine
Published: May 2017

INTRODUCTION:

Twitter has allowed for rapid sharing of user-created content. Researchers have begun to study sentiment in Twitter by building a word lexicon scored for valence from negative to positive sentiment, creating a method of validated sentiment analysis. However, few studies have looked at Twitter and health—much less, in relation to contraception and women’s health.

METHODS:

Publicly posted tweets from January 1, 2007 to January 1, 2016 with hashtags referencing IUD and brands Mirena, Skyla, and Liletta were separated into the following sources: 1) “individual”, 2) “medical provider”, 3) “health organization”, and 4) “legal organization” based on username, Twitter handle, and full name. Tweet content was interpreted with a validated sentiment analysis, and compared across source and brand.

RESULTS:

We found that Tweets by individuals were significantly more positive than Tweets by healthcare organizations (p < 0.005). Tweets by law organizations were significantly more negative than all other sources (p < 0.0005) Tweets about IUD brands across all sources spiked in number at the time of each device’s release into the market. Tweets about the newer IUD brands, Skyla and Liletta, were more positive than those about the Mirena (p < 0.0005).

CONCLUSION:

Our study shows how Twitter data can reflect temporal and sentiment patterns in lay perception of and reaction to IUDs over time. Studying how information about contraception is shared on social media platforms like Twitter can help us better understand the context in which patients make decisions about their health.
Is Perceived Discrimination Associated With Contraceptive Method Use in a National Sample of Women? [24F]
Authors: Loder Charisse , Hall Kelli Stidham , Kusunoki Yasamin , Harris Lisa , Dalton Vanessa
Published: May 2017

INTRODUCTION:

Patient race, class and ethnicity influence physician recommendations for contraception. Moreover, patient’s perceived discrimination has been linked to health outcomes and healthcare utilization. We investigated associations between patients’ perceived discrimination and contraceptive method use in premenopausal, sexually active U.S. women.

METHODS:

We used population-based data from the 2013 Women’s Health Care Experiences and Preferences study of 18-55 year olds. The survey included items measuring health history and social wellbeing, including the Everyday Discrimination Scale (EDS). We focused on one EDS item, “People act as if they think you are not smart,” which we call “perceived discrimination based on intelligence” (PDI). We analyzed relationships between PDI and contraceptive method use (sterilization; highly effective methods [IUC/implant/injectable]; moderately effective methods [pill/patch/ring]; barrier; no method). We conducted multivariable binary logistic regression, controlling for sociodemographic characteristics.

RESULTS:

We surveyed 730 premenopausal, sexually active women. Logistic regression models showed that PDI was positively associated with use of a highly effective contraceptive method compared to all other methods, controlling for race, ethnicity, marital status and education (OR 1.5, 95% CI 1.14-2.07, p=0.005). PDI was not associated with the use of any other category of contraceptive method.

CONCLUSION:

Perceived discrimination based on intelligence is associated with use of highly effective contraceptive method use. Further research is needed to determine the reasons for these associations, and whether patient autonomy and/or provider bias influence this relationship.
Pregnancy Characteristics and Clinical Outcomes for Varying Severity of Morbidly Adherent Placenta [29F]
Authors: Erfani Hadi , Bateni Zhoobin H. , Salmanian Bahram , Belfort Michael A. , Fox Karin A.
Published: May 2017

INTRODUCTION:

To compare the characteristics and outcomes of morbidly adherent placenta (MAP) in two groups of placenta accreta and placenta increta or percreta.

METHODS:

All patients with pathology proven morbidly adherent placenta (MAP, including placenta accreta, increta or percreta), who underwent cesarean hysterectomy from January 2000 to June 2016, were included in the study retrospectively. Data were reported using descriptive statistics and appropriate statistical methods were used based on the normality of the data.

RESULTS:

We reviewed total of 189 pathologically proven MAP from January 2000 to June 2016, 157 of which were singletons who underwent cesarean hysterectomy. Twenty-six out of 56 (46.4%) patients with placenta accreta versus 78 out of 101 (77.2%) patients with placenta increta or percreta had antenatal diagnosis for placenta previa (P < 0.001). On the other hand the rate of unsuspected cases who did not have antenatal diagnosis was higher in placenta accreta in comparison to those with increta or percreta (P < 0.001). Moreover, the rate of positive history of previous cesarean delivery was higher in the group of increta or percreta than accreta patients (P < 0.01). Interestingly there were no statistically significant difference between the two groups regarding the blood loss or blood products transfusion.

CONCLUSION:

Our study showed that the prevalence of placenta previa is higher in deeper depth of MAP. The rate of unsuspected cases that are diagnosed at the surgery was higher in placenta accreta probably due to less severe ultrasound features used to render a pre-delivery diagnosis.
Chronic Histiocytic Intervillositis – Clinical, Biochemical and Radiological Associations [30F]
Authors: Koby Lawrence , Keating Sarah , Malinowski Ann , Murphy Kellie , D'Souza Rohan
Published: May 2017

INTRODUCTION:

To determine the clinical, biochemical and radiological features associated with a histopathologic diagnosis of chronic histiocytic intervillositis (CHI), and propose surveillance strategies for pregnancies at risk for this condition.

METHODS:

A retrospective chart review was conducted to identify cases with a diagnosis of CHI between 2001 and 2014. Adverse pregnancy outcomes included pregnancy loss, preterm birth, small for gestational age (SGA) and preeclampsia. Maternal tests included serum alkaline phosphatase (ALKP) and prenatal screening bioanalytes. Mid-trimester placental ultrasound reported placental dimensions, echotexture, echogenic cystic lesions, infarcts and uterine artery pulsatility indices. Late-trimester ultrasound reported umbilical artery Dopplers and amniotic fluid volume. Outcomes were described as proportions.

RESULTS:

Of the 261 cases of intervillositis identified, 33 were cases of CHI. Fetal demise was noted in 13/33 (39.4%) of which 11 (35.5%) were stillbirths. Of the 18 live births, 16 (88.9%) delivered prematurely; 6 of these (33.3%) before 34 weeks and 12 (66.7%) required neonatal unit admission. All babies born after 22 weeks were SGA, with 15/23 (65.2%) under the 3rd centile. Preeclampsia complicated 9/33 (27.3%) of pregnancies. 12/16 (75.0%) had at least one abnormal prenatal screening bioanalyte and 6/19 (31.57%) ALKP levels 2.5 times above normal. 15/20 (75.0%) had at least one abnormal mid-trimester placental ultrasound marker.

CONCLUSION:

CHI is associated with a cluster of clinical, biochemical or radiological findings. Given the high recurrence rate and no available treatment, individualized care plans based on a combination of clinical, biochemical and radiological tests have been proposed to improve outcomes in subsequent pregnancies.
Pregnancy Outcomes in Gestational Hypertension and Preeclampsia Without Severe Features [32F]
Authors: Rincon Monica P. , Kuo Kelly , Sabol Bethany , Burwick Richard
Published: May 2017

INTRODUCTION:

Guidelines recommend that women with gestational hypertension (GHTN) be managed similarly to preeclampsia (PE) without severe features (SF). We sought to compare pregnancy outcomes in a cohort of subjects with GHTN or PE without SF.

METHODS:

Retrospective cohort of singleton pregnancies delivering greater than or equal to 23 weeks gestational age from September 2015 to March 2016 in a single institution. Charts were first screened for hypertension in pregnancy utilizing ICD9 and ICD 10 discharge codes. Individual chart review was utilized to identify sub-groups of women with GHTN or PE without SF, using 2013 American College of Obstetricians and Gynecologists criteria.

RESULTS:

Our cohort included 1,399 total deliveries. GHTN and PE without SF complicated 95 pregnancies (6.71%). Women with GHTN and PE without SF were of similar age, BMI, race, parity, and diabetes status. Delivery occurred slightly later in women with GHTN, but this was not statistically significant (38.6 vs. 37.9 wks., p=0.11). Women with PE without SF had higher peak systolic blood pressure (p=0.024), lower hemoglobin (p=0.007) and lower platelet counts (p=0.036) prior to delivery. While maternal adverse outcomes were no different between groups, women with PE without SF tended to have higher rates of PTB less than 37 wks (p=0.11), SGA neonates (p=0.067), NICU admission (p=0.10), and RDS (p=0.11).

CONCLUSION:

Our results support the concept that women with GHTN and PE without SF are generally similar in nature. However, compared to women with PE without SF, women with GHTN tend to have more modest blood pressure elevations at delivery and better neonatal outcomes.
Pregnancy Outcomes in Women With Neuromuscular Dystrophies: A Retrospective Study [34F]
Authors: AlShehri Eman , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim
Published: May 2017

INTRODUCTION:

Neuromuscular dystrophies (NMD) are a group of rare genetic diseases characterized by weakness and muscular wasting. Data on NMD in pregnancy is limited. Our aim is to determine the prevalence of muscular dystrophies at delivery, and related maternal and newborn outcomes.

METHODS:

Using the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 1999 to 2013, we conducted a population-based retrospective cohort study to compare women with and without any form of NMD at delivery. We used multivariate logistic regression analyses to estimate the associated risks of maternal and neonatal outcomes.

RESULTS:

Of the 12,592,178 births in our cohort, 914 deliveries were to women carrying a NMD. Over the 15-year period, there was an increased prevalence rate from 3 to 10 cases per 100 000 deliveries per year (p < 0.001). Births to women with NMD were more likely to be premature (OR 1.60, 95% CI 1.26-2.02), have intrauterine growth restriction (OR 2.08,95% CI 1.50-2.90) and congenital malformation (OR 4.93, 95% CI 3.30-7.38). Compared with controls, women with muscular dystrophies were more likely to deliver by cesarean section (OR 1.87,95% CI 1.62-2.17), have forceps assisted deliveries (OR 1.76, 95% CI 1.01-3.04), were at higher risk of major morbidities including cardiac dysrhythmia (OR 4.97,95% CI 3.02-8.20) and increased requirements for blood transfusion (OR 2.44,95% CI 1.56-3.83).

CONCLUSION:

Pregnancies in NMD patients are associated with an increased risk of maternal and fetal morbidities and, as such, they should be cared for in a tertiary care center.
Investigating Parity as a Risk Factor for Developing Preeclampsia in Gestational Diabetes Mellitus [36F]
Authors: Bernard Kimberly , Gabbur Nagaraj
Published: May 2017

INTRODUCTION:

It is well established that patients with Gestational Diabetes Mellitus (GDM) are at a greater risk of developing preeclampsia than those not diagnosed with GDM. It has also been shown that nulliparous women are at an increased risk of developing preeclampsia compared to multiparous women. This study investigates the role of parity as a risk factor for preeclampsia in patients already diagnosed with GDM.

METHODS:

A retrospective chart review was conducted at SUNY Downstate Medical Center. Exact Mantel-Haenszel tests of trend were conducted for the outcome of preeclampsia (yes vs. no) from the following predictors: number of full-term deliveries, number of pre-term deliveries, and number of spontaneous/elective abortions. Step-down Bonferroni corrections to p-values were applied to correct for multiple testing.

RESULTS:

636 patients with GDM and no prior history of diabetes were included. The population was composed of 30.3% nulliparous patients with a median age of 31 y/o and 37 weeks 2 days at delivery. The multipara (69.7%) population was similar with a median age of 32 y/o and 37 weeks 2 days at delivery. The results revealed that the frequency of developing preeclampsia in nulliparous women with GDM was more than twice that of multiparous women (8.81 to 4.06, p=0.086).

CONCLUSION:

As this value was approaching statistical significance, it warrants the necessity of further investigation of nulliparity as a risk factor for preeclampsia in GDM patients. This research was created in the effort to help physicians understand which patients are more at risk for preeclampsia thus aiding in counseling and management.
Six Years Experience With Porcine Extracellular Matrix: A New Paradigm for Pelvic Floor Repair [1G]
Authors: Storey Jean , Yordan-Jovet Raul , Kambiss Scott
Published: May 2017

INTRODUCTION:

Retrospective case series report on the efficacy and safety of using the porcine extracellular matrix Matristem® (ACell, Columbia, MD) in the surgical management of pelvic organ prolapse (POP).

METHODS:

Charts of patients treated surgically for POP with a porcine bladder graft at our institution between 2010 and 2015 were reviewed. Pre and postoperative POP-Q scores were compared. Surgical complications and adverse events were surveilled.

RESULTS:

84 patients were identified with POP including 93 pelvic reconstructive procedures performed. 61 anterior repairs (AR) including 17 total vaginal hysterectomies with modified McCall's uterosacral ligament cuff suspensions, and 6 concurrent posterior repairs (PR). 27 additional posterior repairs, 2 vaginal para vaginal repairs (VPVR), and 3 bilateral sacrospinous ligament colpopexies (SSLC). Preoperative POP-Q scores measuring level 1 and level 2 support ranged from -2 to +6. POP-Q scores obtained 3 to 72 months (median = 54) postoperatively revealed durable global level 1 and 2 support with most at -3 scores. 2 anatomical failures to anterior or apical -1 scores, but only 1 symptomatic case needed reoperation. No significant surgical or product complications were identified.

CONCLUSION:

Secondary to procurement inconsistencies associated with synthetic and cadaveric products, and the risk of erosion, fibrosis, retraction, or dyspareunia with synthetic materials, our preliminary data shows that Matristem xenografts offers a safe and efficacious alternative in the surgical repair of level 1 and 2 POP.
Identifying and Rating Urogynecology Applications Using the APPLICATIONS Scoring System [4G]
Authors: Wallace Shannon , Mehta Shailja , Farag Sara , Kelley Robert , Chen Katherine
Published: May 2017

INTRODUCTION:

Thousands of medical applications (apps) are available for mobile devices. Finding accurate, provider-directed apps may be time-consuming and frustrating for urogynecologists. This study’s objective is to identify and rate urogynecology (urogyn) apps using an adapted APPLICATIONS scoring system.

METHODS:

Urogyn apps were identified from the Apple iTunes and Google Play Stores using the following ten MESH terms: urogynecology, incontinence, prolapse, urinary tract infection, pelvic surgery, fecal incontinence, defecation disorder, voiding disorder, urethral diverticulum and fistula. Consumer-based and inaccurate apps were excluded. Remaining apps were rated with the APPLICATIONS scoring system, which uses objective and subjective criteria to evaluate comprehensiveness (the extent of ability to aid in clinical-decision making and to provide informational data). Objective rating components included price, paid subscription, literature used, in-app purchases, Internet connectivity, advertisements, text search field, interplatform compatibility and incorporated images, figures, videos and special features. Subjective rating components were ease of navigation and presentation.

RESULTS:

The urogyn-related MESH terms identified 137 and 238 apps in the Apple iTunes and Google Play stores, respectively. Only 8 apps (5 of which were in both stores) were found to be accurate and useful and were rated using the APPLICATIONS scoring system. The top rated apps were Practical Urology for Gynecologists and Practical Urology.

CONCLUSION:

Few accurate clinical-decision making and informational apps exist for urogynecologists. Apps varied by comprehensiveness and quality. This study highlights the importance of systematically reviewing and rating medical apps. It also emphasizes the need for developing accurate apps for urogynecologists that improve health provider performance and patient outcomes.
Risk Factors for Postpartum Depression Among Women at High Risk for Pelvic Floor Symptoms [9G]
Authors: DePorre Julia , Haefner Jessica , Berger Mitchell , Fenner Dee , Swenson Carolyn
Published: May 2017

INTRODUCTION:

We sought to identify risk factors associated with a positive postpartum depression screen among women at high risk for pelvic floor symptoms and referred to a specialty postpartum clinic.

METHODS:

We performed a retrospective chart review of women seen between March 2012 and May 2016 at the Michigan Healthy Healing After Delivery Clinic at the University of Michigan, where patients are referred for early follow-up of obstetric anal sphincter injuries or pelvic floor symptoms related to childbirth. All new patients are screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score greater than or equal to 10 (positive screen) were compared to those with a score under 10 (negative screen). Logistic regression was used to identify factors independently associated with a positive EPDS screen.

RESULTS:

Among 294 women, 46 (15.6%) had a positive EPDS screen. Women with a positive versus negative EPDS screen were more commonly referred for pain (30.4% vs 14.1%, P=.006), and had higher prevalences of urinary incontinence (35.6% vs 20.5%, P=0.027) and history of depression/anxiety (37.0% vs 17.7%, P=0.003). In multivariable logistic regression modeling controlling for age and race, factors that remained independently associated with a positive EPDS screen were non-white race (aOR 0.35, P=.006), referral for pain (aOR 3.03, P=.005), urinary incontinence (aOR 2.20, P=.04), and history of depression/anxiety (aOR 3.33, P=.003).

CONCLUSION:

Among women at high risk for postpartum pelvic floor symptoms, persistent pain and urinary incontinence may be risk factors of postpartum depression.
Moms in Medicine: A Descriptive Study of Job Satisfaction Among Physician-Mothers in Obstetrics & Gynecology [12G]
Authors: Heuser Cara C. , Gibbins Karen J. , Herrera Christina A. , Theilen Lauren H. , Holmgren Calla M.
Published: May 2017

INTRODUCTION:

Physician satisfaction improves patient outcomes. The number of physicians who are also mothers is increasing. Our study aims to describe experiences of ob/gyn physicians who are also mothers.

METHODS:

Constructed and validated a Redcap survey. Invited members of an online ob/gyn-mom group to participate.

RESULTS:

We obtained 232 responses. Over 50% are hospital-employed, 20% in academics, and 20% in private practice. 70% work with trainees and half do research. Median clinical hours per week is 45, non-clinical 5. Over 75% perform deliveries and 60% have at least some in-house call. Most commonly used child-care are daycare/pre-school, K-12 school, and nanny/au-pair. Eighty-percent rate professional morale as very or somewhat positive and 80% would choose medicine as a career again although half would retire today if possible. Patient relationships and intellectual stimulation were the most important factors contributing to satisfaction; long-hours and liability/defensive medicine were the most common negative factors. Sixty-percent were unsatisfied with amount of time available to spend with children, 70% about time with partner, and 75% about time spent in personal hobbies/activities. 90% agree that motherhood has improved them as physicians; half agree that being a physician has made them better mothers. 80% agree that female physicians face unequal treatment; 75% agree that physician-parents face unequal treatment.

CONCLUSION:

Ob/gyn physician-mothers have high professional morale but are dissatisfied with amount of time available for extra-professional activities, especially family-time. Almost all respondents feel that motherhood had made them better physicians but only half feel that being a physician has made them better mothers.
Social Media Practices and Patient Interactions Among Healthcare Professionals [13G]
Authors: Davis Jay , Tompkins Emily , Chen Lian , Lai Monica , Hagan Joseph , Stafford Irene
Published: May 2017

INTRODUCTION:

Social media (SM) has become widespread among healthcare professionals (HCPs) including attending-physicians, residents and medical students. It is unknown if engagement in social activity with patients on SM differs according to level of training. This study was conducted to survey HCPs on their SM practices as it pertains to personal disclosure and patient interactions.

METHODS:

A survey was conducted among HCPs pertaining to SM usage and patient-friendship requests. The chi-square test was used to compare different occupations’ frequency of and response to patient-friendship requests and disclosure of personal information on SM. SAS version 9.4 was used for analysis. A 5% significance level was used for hypothesis tests.

RESULTS:

Six hundred forty-six participants responded: 524 (81%) medical students, 91 (14%) residents, 25 (4%) attending-physicians, and 6 (1%) unknown. The proportion of respondents who display a personal photograph (59% of attending-physicians vs. 93% for other HCPs, p < 0.001) or their name on their SM profile (55% of attending-physicians vs. 84% for other HCPs, p < 0.001) differed by occupation with attending-physicians least likely to do so. The proportion of respondents reporting that they have received a patient-friendship request differed significantly with attending-physicians most likely to have received a request (36% vs 4% for other HCPs, p < 0.001) and students most likely to decide on an individual basis or accept (41% of students vs. 22% for other HCPs, p < 0.001).

CONCLUSION:

Although attending-physicians were more likely to receive a patient-friendship request, they were less likely to accept and disclose personal information on SM demonstrating concern for safety.
Sex Differences in Patient Satisfaction With Outpatient Obstetrics/Gynecology Care [14G]
Authors: Haunschild Carolyn , Altamirano Jonathan , Fassiotto Magali , Rogo-Gupta Lisa
Published: May 2017

INTRODUCTION:

Sex differences in medicine are discussed in medical and lay literature. Female physicians receive lower compensation and are less likely to be promoted compared to males. Reimbursement may now include results of patient questionnaires which is concerning given the paucity of literature demonstrating validity in quality of care assessment. Obstetrics/Gynecology is especially subject to the impact of sex differences as discussing reproductive organs is inherently intimate. We hypothesize sex differences exist in patient evaluation of outpatient Obstetrics/Gynecology care measured by patient satisfaction surveys.

METHODS:

We analyzed 909 Press-Ganey patient satisfaction surveys linked to outpatient Obstetrics/Gynecology visits at Stanford Hospitals and Clinics (March 2013-June 2014). Likelihood to Recommend Physician (LTR) was rated on a 5-point scale and, due to its frequency distribution, was evaluated as receiving a 5 compared to 1-4 rating. Patient-physician demographic concordance was evaluated using chi-square tests. Office, Access, and Physician Assessments were generated from correlated PG questions and confirmed using factor analysis. Models to understand LTR controlling for patient, physician, and care environment characteristics were analyzed using generalized estimating equations (GEE), clustered by physician.

RESULTS:

Age and race concordance increased LTR (p=.01 and p < .0001, respectively) while sex concordance decreased LTR (p=.03). After controlling for patient, physician, and care environment characteristics, female physicians show a 49% decrease in odds of receiving a top LTR score (p=.003).

CONCLUSION:

Analysis of 909 patient satisfaction surveys demonstrates male Obstetricians/Gynecologists are rated higher than females in multivariate analysis, supporting our hypothesis that sex differences exist in patient evaluation and contrary to patient self-reported data.
Post-Approval Clinical Studies of Essure: Quality of Evidence and Future Outlook [16G]
Authors: Ukoha Erinma P. , Drury Kerry , Ghobadi Comeron , Xu Shuai , Walter Jessica
Published: May 2017

INTRODUCTION:

Approved in 2002, Essure offers a method to achieve permanent sterilization via an office-based procedure. In late 2015, the FDA to re-investigated the device due to a rise in patient complaints ultimately leading to a new black box warning and the requirement of a new post-marketing study. Understanding the post-marketing clinical data surrounding the device’s safety and efficacy would inform clinicians in their patient counseling.

METHODS:

MEDLINE was queried using the search terms: Essure; hysteroscopic sterilization; postmarket approval; efficacy. The FDA and the manufacturers’ executive summaries on Essure, published in 2015, were mined as well. The quality of each study was rated using the Oxford Centre for Evidence-based Medicine Levels of Evidence scheme. A Grade 1 rating indicates a well-designed systematic review or randomized controlled trial while a Grade 5 rating indicates the weakest evidence quality (e.g. expert opinion).

RESULTS:

The search produced 231 unique references, of which 61 were considered relevant based on title and abstract. In aggregate, a total of 110,546 women were involved. The number of participants in each study ranged from 18 to 71,875. Overall, the majority of studies (74%) were rated Grade 4 (e.g. retrospective cohort, case-series, or case-controlled studies). Only 13% of studies were rated Grade 1 or Grade 2.

CONCLUSION:

The available post-marketing data is not of ideal quality, but the available evidence suggests that Essure is a safe and effective device for permanent female sterilization. The controversy will likely continue until completion of the new post-marketing study (n=2,800) comparing Essure with laparoscopic tubal sterilization.
Outcomes Associated With a Trial of Labor After Cesarean Section [22G]
Authors: Westbrook Brett , Felini Martha , Flood-Shaffer Kelly , Baker Austin , Papa Tracy , Anderson Ralph
Published: May 2017

INTRODUCTION:

To examine the intrapartum outcomes of women attempting a trial of labor after cesarean section (TOLAC).

METHODS:

A retrospective chart review was performed on all patients who attempted a TOLAC from June 2012 to May 2016 at our county hospital. Primary outcomes assessed were successful vaginal delivery, labor onset, and prevalence of adverse maternal and infant outcomes.

RESULTS:

We identified 660 patients who attempted a TOLAC (2% of total births during the study period). The vaginal birth after Cesarean (VBAC) success rate was 67%, with significant differences by prior vaginal delivery, gestational age, and race/ethnicity. Successful VBAC was significantly more likely when the patient presented in spontaneous labor versus labor induction (74% vs 49%, P < 0.01). Conversely, more neonatal intensive care admissions occurred with labor induction (P=0.01), a difference not observed across delivery type (P=0.15). Maternal complications were more common in patients who required a cesarean delivery. There were 12 (1.8%) uterine ruptures. When compared to a previous TOLAC study conducted at the same hospital from 2004 through 2008, the VBAC success rate had decreased (67% vs 84%) and the rate of labor induction had increased (27% vs 4%).

CONCLUSION:

The overall VBAC success rate of 67% is within the expected range based on published data. However, our findings suggest the decrease in success across two time periods may be associated with an increase in induction of labor. To ensure patient safety and quality outcomes, targeted strategies are needed to assess the appropriate utilization of induction.
A Look Through Time: Analysis of William’s Obstetrics and Te Linde’s Operative Gynecology [26G]
Authors: Roeckner Jared , Peebles Amy B.
Published: May 2017

INTRODUCTION:

In Obstetrics and Gynecology, few tomes are as well-respected as William’s Obstetrics and Te Linde’s Operative Gynecology. Tracing the changes in these texts provides a window to enlighten us on the history of our specialty. Our objective is to systematically analyze the Preface and Foreword of each edition of William’s and Te Linde’s to gain insight into historical changes in our field.

METHODS:

The Preface and Foreword from 24 editions of William’s Obstetrics and 11 editions of Te Linde’s Operative Gynecology were obtained. Documents were assessed for the inclusion of predefined keywords/topics including: gender-specific pronoun usage, insurance, sterilization/contraception, government regulation/laws, documentation burden, malpractice, race, medicine as art/science, and others. Data were extracted and analyzed using Excel.

RESULTS:

Changing pronoun usage was evident across both texts. From 1941-1950, physicians were referred to as male 19 times and only once as female. The ratio of male-to-female pronoun usage became 1:1 in the 1990s. From the 1970s onward, “Physician Woes” including malpractice, documentation burden, regulation and insurance were mentioned at increasing rates. Governmental regulation and evidence-based medicine were first mentioned in the 2000’s. Medicine was increasingly referred to as a “science” rather than an “art” within the last two decades. Race was not mentioned. “Change” and “Improvement” were noted almost universally.

CONCLUSION:

Female pronoun usage reflects the increasing role of women in medicine. Analysis shows the trend from a less regulated field to one of increasing outside influence. “Physician Woes” have increased and likely contribute to physician burnout, which is on the rise.
Variations in Cervical Cytology Testing Among Women of Different Ethnicities [29G]
Authors: Martingano Daniel , Renson Audrey , Martingano Francis X.
Published: May 2017

INTRODUCTION:

Current information about ethnic differences in the progression and regression of intraepithelial lesions on cervical cytology is undefined, with existing studies looking solely at ethnic differences in compliance with follow-up and treatment. The purpose of this study was to investigate variation in progression and regression of cervical cytology screening results among an ethnically diverse population.

METHODS:

A retrospective review of was conducted for women receiving cervical cytology evaluation from January 1, 2006 through September 30, 2015. Differences in intraepithelial lesion diagnoses on cervical cytology for patients were reviewed. We fit Markov multi-state models to estimate self-reported race/ethnicity-specific expected wait times and hazard rates for each possible regression and progression, and compared a model with race to an intercept-only model using a chi-square likelihood ratio test.

RESULTS:

The sample consisted of 7635 patients, with mean baseline age 34±12, and was 31% Hispanic, 26% White, 17% Black, and 9% Asian, Middle Eastern or other. We estimated a total of 24 hazard ratios and 95% confidence intervals comparing rates of transition to and from ASCUS, ASCH, LGSIL, and HGSIL, for the race/ethnicity categories of Black, Hispanic, and a category for Asian, Middle Eastern, or other, compared to White. The model including race fit significantly better than the intercept-only model (p < 0.001). Visual inspection of expected wait time curves indicated that Black and Hispanic women had a slower progression as well as a slower regression.

CONCLUSION:

Preliminary analysis suggests that the progression/regression of precancerous lesions on cervical cytology may behave differently among women of different ethnicities.
How Has the FDA Morcellation Warning Affected Rates of Minimally Invasive Hysterectomy? [30G]
Authors: Saadat Saba , Arden Deborah
Published: May 2017

INTRODUCTION:

In 2014 the FDA issued a warning against the use of laparoscopic power morcellation in the majority of women undergoing myomectomy and hysterectomy for the treatment of fibroids, citing the risk of dissemination of an occult malignancy. Since the FDA statement, many institutions have banned or restricted the use of power morcellators.

METHODS:

This is a retrospective time-series analysis on all the hysterectomies performed for benign indications at Southern California Kaiser Foundation Hospitals between April 17, 2014 and April 17, 2016. Rate of abdominal vs. minimally invasive hysterectomies, estimated blood loss, length of operation and hospital stay, major post-operative complications, and hospital re-admission were compared in the one year before and the second year after the FDA warning.

RESULTS:

This study included total of 12,565 hysterectomies. Compared to one year before, there was a 5% increase in the rate of hysterectomies performed via laparotomy after the FDA warning (p < 0.001). There was no increase in the estimated blood loss, operative time, length of hospital stay, rate of re-admission, and post-operative complications (except pulmonary embolism). Similar results were obtained when sub-analysis was performed for hysterectomies with fibroid uterus as an indication for surgery.

CONCLUSION:

There was an increase in the rate of laparotomy for hysterectomy after the FDA morcellation warning. Despite this relative increase, there is no significant increase in the rate of immediate (30 day) post-operative complications or length of operation or hospital stay. This study did not assess parameters such as length of recovery or pain after surgery.
Diagnostic Accuracy of Transvaginal Sonography for Abnormal Uterine Bleeding [31G]
Authors: Vasquez Diego , Patel Marcia Klein , Scioscia Eugene
Published: May 2017

INTRODUCTION:

The prevalence of intrauterine abnormalities in patients with abnormal uterine bleeding is 46%. Historical data gives the transvaginal sonography (TVS) a sensitivity and specificity of 56% and 73% for detecting intracavitary pathology respectively, however the image resolution of the ultrasound machines has improved significantly since those studies. The objective of this study is to calculate the sensitivity, specificity, positive and negative predictive values of TVS.

METHODS:

Retrospective chart review of patients who had a TVS and a subsequent hysteroscopy performed in the operating room at The Western Pennsylvania Hospital. 500 patients were needed for a 95% Confidence Interval of 0.06%

RESULTS:

Between January 2013 and September 2015, 2351 hysteroscopies were performed. Using a randomization software, 500 randomly selected patients that met inclusion criteria underwent chart review. The hysteroscopic findings were: normal cavity (243), endometrial polyp (157), atrophic endometrium (34), submucosal fibroid (25), other (41). We found a sensitivity of 63%, specificity 80.9%, positive and negative predictive values 67.9% and 77.4% respectively, a significant improvement comparing to historical data, however far from the most accurate studies, the sonohysterogram and diagnostic hysteroscopy.

CONCLUSION:

A false positive rate of 11% is still high if the next step in management will be a hysteroscopy performed in the operating room. In the last 2 years 258 hysteroscopies were performed in the operating room with a false positive diagnosis of intracavitary lesion. This results support the current recommendations of performing a sonohysterogram or office hysteroscopy after a TVS finding of intracavitary pathology.