bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac Arrest Management in Pregnancy: Review of Team Performance in High-Fidelity Simulations [A337]
Authors: Buttle Rae A. , Detlefs Sarah , Crump Cade , Goffman Dena , Foley Michael R. , Deering Shad
Published: June 2022

INTRODUCTION:

Management of cardiac arrest during pregnancy has several unique components when compared to resuscitation of non-pregnant patients. These interventions are not emphasized in current national training courses but are critical to optimizing outcomes for the mother and fetus. The objective of the current study was to evaluate team performance during high-fidelity maternal cardiac arrest simulations to identify areas of focus for future training.

METHODS:

At a national course, multidisciplinary teams participated in high-fidelity simulation cases of obstetric emergencies to include maternal cardiac arrest. Critical actions were determined by review of evidence-based recommendations for care. Trained facilitators completed standardized checklist assessments for each team’s performance, with each action documented as “not done”, “poorly done”, or “well done”. Descriptive statistics for all elements of performance were evaluated. The study was reviewed and determined to be exempt by the hospital institutional review board.

RESULTS:

One hundred thirty multidisciplinary teams with complete data participated in simulations from 2014-2019. Less than two-thirds of teams were rated “well done” for standard resuscitation skills such as airway management, defibrillation, and chest compressions. Pregnancy specific modifications, such as left uterine displacement, was rated as “poorly done” or “not done” by 23.8% of teams.

CONCLUSION:

Overall resuscitation skills by teams during high-fidelity simulations were suboptimal for both routine and pregnancy-specific interventions. This cohort of providers routinely care for pregnant women, so we expect that other providers may be even less familiar with these interventions and suggest there is a gap in education and training that needs to be addressed.
Maternal Race and Ethnicity and Risk of Cesarean Delivery in Large for Gestational Age Pregnancies [A343]
Authors: Gould Alexander J. , Esposito Matthew A. , Lord Megan G.
Published: June 2022

INTRODUCTION:

To compare the rate of Cesarean delivery in pregnancies complicated by large for gestational age (LGA) fetuses in non-Hispanic White (NHW) patients to patients who identified as non-White and/or Hispanic.

METHODS:

This secondary analysis of a large institutional review board-approved retrospective cohort study included deliveries of live singleton fetuses at a tertiary-care hospital from 2007-2019. Deliveries of LGA fetuses, defined by an estimated fetal weight at 90th percentile or greater for gestational age on third trimester ultrasound, were identified and maternal characteristics and mode of delivery extracted. The primary outcome was Cesarean delivery for any indication.

RESULTS:

Of 3,593 eligible patients, 1,314 self-identified as NHW and 1,913 as non-White and/or Hispanic. NHW patients were older, taller, more likely to have type 1 diabetes and/or commercial insurance, and less likely to have gestational diabetes (P<.01 for all). Rates of type 2 diabetes were similar between groups (P=0.41). Overall, 48.1% of LGA pregnancies delivered by Cesarean, with a higher rate of Cesarean among NHW patients (50.88% vs. 45.32%; relative risk [RR] 1.11; 95% CI, 1.05–1.18). This relationship persisted after adjusting for differences in maternal age (adjusted RR [aRR] 1.10; 95% CI, 1.03–1.17), height (aRR 1.16; 95% CI, 1.07–1.26), payor status (aRR 1.08; 95% CI, 1.003–1.16]), and prevalence of diabetes (aRR 1.13; 95% CI, 1.05–1.22]) between groups.

CONCLUSION:

Among LGA pregnancies, NHW patients were more likely to undergo Cesarean delivery than patients who identified as non-White and/or Hispanic. This stands in contrast to existing data showing that NHW patients are less likely to deliver by Cesarean overall.
A Clinical–Community Partnership to Improve Home Visiting Referrals and Engagement [A298]
Authors: Backus-Walzer Michelle , Gorby Jammie , Peterman Jennifer , Boughey Shauna , VanderMuelen Peggy , Raffo Jennifer E.
Published: June 2022

INTRODUCTION:

A Michigan integrated health system used clinical–community partnerships to promote health equity and improve population health by increasing referrals and participation in a Medicaid-sponsored enhanced prenatal care (EPC) home visiting program. The statewide program is federally designated and evidence based for reducing the risk for adverse birth outcomes, with a quarter of eligible women enrolled. The objective of this study was to explore early implementation of a quality-improvement initiative to increase EPC referral and enrollment in 16 obstetrics and gynecology practices in eight counties.

METHODS:

The strategies used were dashboard tracking, shared goals, engagement of OB nurse educators/social workers, and electronic medical records. Referrals and enrollments were tracked from January 1, 2021 to September 30, 2021 in nine obstetrics and gynecology practices, with the goal of referring all Medicaid-insured women and enrolling 50% of eligible referrals, especially women of color at greater risk, to the health system's internal EPC program. From June 1, 2021 to September 30, 2021, seven practices in six counties linked to external health department EPC programs and targeted a 50% referral rate.

RESULTS:

Overall, practices connected to internal EPC services achieved the 50% enrollment target (1,247 referrals, 744 eligible [60%], with 394 enrolled [53%]). Enrollment ranged from 24% to 62% by site; of these, 49.5% of participants were women of color. Practices connected to external EPC programs achieved a 51% referral rate (568 eligible, 289 referrals).

CONCLUSION:

The health system increased referral and enrollment of Medicaid-insured pregnant women, many of whom were women of color, into prenatal home visiting. Clinical–community linkages, aligned with Alliance for Innovation on Maternal Health Community Care Initiative goals, can help practices address equity in maternal morbidity and mortality.
Underserved Patients' Experiences Using Telemedicine for Gynecologic Care During COVID-19 [A299]
Authors: Ahsan Muhammad Danyal , Kulkarni Amita A. , Monu Ngozi , Ma Xiaoyue , Cantillo Evelyn , Chapman-Davis Eloise
Published: June 2022

INTRODUCTION:

The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated the experience of underserved women using telemedicine for gynecologic visits at an urban teaching hospital.

METHODS:

We conducted a prospective study of patient experiences using telemedicine for outpatient gynecologic visits from January 2021–September 2021. Demographic/clinical data were obtained. Participants completed a modified, previously validated Telemedicine Usability Questionnaire (TUQ), with responses on a 1-5 Likert scale. Statistical analyses used the Wilcoxon signed-rank test or t test.

RESULTS:

One hundred ninety two patients agreed to participate, of which 157 completed the surveys. A total of 87% had video visits, whereas 13% had telephone visits. The majority of patients were ethnic minorities (non-Hispanic White 16%, Hispanic 32%, Black 28%, and Asian 10%), median age 40 years (range 18–69 years), with 63% having income (44 vs.<39, P=.02). Race/ethnicity, income, education level, and prior experience with telemedicine had no effect on responses for this subscale.

CONCLUSION:

Underserved women utilizing telemedicine for outpatient gynecologic visits report largely positive experiences overall. Although telemedicine holds promise in increasing access to healthcare services, attention needs to be paid to ensure reliability among telehealth visits, particularly for older populations.
Operationalizing Aspirin to Reduce Preeclampsia Risk and Related Morbidity and Mortality [A302]
Authors: Gross Maya , Hughes Ainsley E. , Sampene Katherine
Published: June 2022

INTRODUCTION:

Low-dose aspirin (ASA) reduces the incidence of preeclampsia and related morbidity and mortality when given to pregnant patients at moderate to high risk of disease. The United States Preventive Services Task Force (USPSTF) provides clear guidelines for identifying patients who warrant a prescription for ASA; however, complexity of the algorithm may inhibit comprehensive screening and implementation. We aimed to implement a standardized approach to ASA screening and prescription in an academic obstetrics and gynecology practice.

METHODS:

Using a quality improvement framework, we implemented universal prenatal screening according to the USPSTF recommendations for ASA to prevent preeclampsia. Pre-intervention, we analyzed prescription adherence at 201 new obstetric (NOB) visits. A multistep intervention was then implemented. Nurses utilized a checklist created from USPSTF guidelines to identify high-risk patients, defined as having 1 or more high-risk factors or 2 or more moderate-risk factors. ASA orders were signed by physicians. Three months after implementation, 199 NOB visits were reviewed. The primary outcome was the percent of patients screened (goal=90%). The secondary outcome was the percent of patients who screened positive that received the ASA recommendation (goal=90%).

RESULTS:

Pre-intervention, 47% of patients met criteria for ASA, and 28% of those patients received a recommendation for ASA. Post-intervention, 99% were screened. Half (48%) met criteria for an ASA recommendation and 78% of those patients received a recommendation for ASA.

CONCLUSION:

It is feasible to standardize screening and implementation of ASA to patients at elevated risk for preeclampsia. Providers can easily reproduce our processes to improve delivery of reliable preventative obstetric care.
Impact of CervixChat, a Text Message–Based Chatbot, on Patients Needing Colposcopy [A312]
Authors: Dayaratna Sandra D. , Slamon Rachel , Claxton Nabaala , Granda-Cameron Clara , Wen Kuang-Yi
Published: June 2022

INTRODUCTION:

Low rates of adherence to colposcopy and follow-up recommendations, particularly among underserved women, are a barrier to providing appropriate care. We evaluated a novel education intervention to assess the effects on patient knowledge and compliance with colposcopy in an urban inner-city population.

METHODS:

Institutional review board approval was obtained. We assessed the feasibility and acceptability of a mobile health patient education and support intervention, CervixChat, guided by cognitive-behavioral theory and health communication best practices. Evidence-based intervention content was developed in English and Spanish to address the purpose of colposcopy, understanding of HPV, fatalistic beliefs about cancer, worries about necessary procedures, and progression of disease. Patients received real-time tailored counseling content via text messaging.

RESULTS:

Fifty eligible women with upcoming colposcopies were contacted, and 30 (60%) consented to the study. The average age of participants was 30 years old, and 53% identified as non-Hispanic White. A total of 73% completed baseline and follow-up assessments. Knowledge about cervical cancer and screening improved from 67% to 90%. Participants' beliefs about cervical cancer screening and perceived self-regulatory skills about managing their colposcopy appointment were also improved from baseline to follow-up. Colposcopy appointment adherence, extracted from the EHR, demonstrated 93% compliance.

CONCLUSION:

Participants reported high satisfaction and utility with the intervention. Overall increased knowledge about abnormal pap smears and a high level of visit compliance demonstrate the feasibility and acceptability of our CervixChat text messaging approach among a group of underserved diverse patients.
Advanced Directive Documentation in Gynecologic Oncology Inpatient Admissions [A317]
Authors: Kaufman Virginia , George Joshua S. , Corey Logan , Morris Robert
Published: June 2022

INTRODUCTION:

Code-status documentation (CD) is an essential component to advance care planning (ACP). Our aim was to identify institutional CD compliance for admissions to gynecology oncology services (GYO) and analyze effectiveness of interventions on CD rates.

METHODS:

Retrospective chart review of inpatient GYO admissions for CD pre and post intervention in history and physical (HP) and progress notes (PN) was performed. Admissions were categorized as chemotherapy (CA), surgical (OR), or problem visit (PV). Interventions utilized Plan-Do-Study-Act (PDSA) methodology and included educational training, text reminders, and EMR reconfiguration. Chi-square test of independence was performed to examine the relationship between CD rates before/after intervention with a significance value set at 0.05.

RESULTS:

The pre-intervention group had 158 admissions with 21% of HP and 54% of PN containing CD. The post-intervention group had 150 admissions with 58% of HP and 94% of PN containing CD. X2 (1, N=306)=43.5, p For HP by admission type, 9.4% of CA, 3.7% of OR, and 39% of PV contained CD as compared to 64% of CA, 30% of OR, and 73% of PV post-intervention. In pre-intervention PN, 44% of CA, 50% of OR, and 62% of PV contained CD as compared to 92% of CA, 96% of OR, and 96% of PV post-intervention.

CONCLUSION:

Pre-intervention CD was suboptimal across note and admission types. Explanations for low CD were identified including provider discomfort discussing ACP and electronic medical record (EMR) limitations. Education and EMR interventions resulted in a statistically significant improvement in CD. Further PDSA cycles are planned to test further interventions.
Using Fine Needle Aspiration (FNA) as a Tool to Establish Cancer Burden in Resource-Limited Settings: Liberia, 2018 [A319]
Authors: Tumas Jordyn , Lieb Whitney , Beddoe Ann Marie
Published: June 2022

INTRODUCTION:

Low- and middle-income countries (LMICs) have a disproportionate cancer burden, greater mortality, and later diagnosis compared to higher resource countries. This ultimately portends worse outcomes for patients with few survivors. Fine needle aspiration (FNA) is a well-known procedure for pathologic diagnosis that can be implemented in LMICs to diagnose malignancy with low cost, high efficiency, and minimal invasiveness. We present data from an FNA clinic established in Liberia, a LMIC, demonstrating these qualities.

METHODS:

This is a retrospective review of data from an FNA clinic in Liberia between January 2018 and December 2018 whose patients presented with palpable masses and underwent uncomplicated FNA biopsies. Institutional review board approval was waived for this study.

RESULTS:

478 FNA biopsies were performed in the study period. A total of 64% of findings were benign, 26% were malignant, and 6% were suspicious for malignancy. Four percent of samples were unsatisfactory for analysis. The most common malignancies were breast cancer (40%, N=51), metastasis from unknown primary (12%, N=16), hematogenous cancer (11%, N=14), and cervical cancer (10%, N=13). Among children's cancers, Burkitt lymphoma comprised more than half of cases (58.3%, N=7). There were no reported complications from the FNA procedures (N=0).

CONCLUSION:

Efforts to reduce the tumor burden of LMICs like Liberia should include the funding and establishment of FNA clinics for early tumor diagnosis. Additional steps include increasing cancer awareness among the population to encourage earlier presentation, training local providers to hone their skill in performing FNA biopsies, and building a cancer registry in order to direct national funding toward further cancer screening, diagnosis, and treatment.
Human Papillomavirus (HPV) Vaccine Effect on Incidence of in Situ and Invasive Squamous Cell Cancer of the Vulva, 2001-2018 [A322]
Authors: Berenson Abbey B. , Chang Mihyun , Hawk Ernest , Ramondetta Lois M. , Hoang Thao
Published: June 2022

INTRODUCTION:

A recent study found that the incidence of invasive squamous cell carcinoma of the vulva (VSCC) is increasing among U.S. women, but rates of VSCC in situ (VIS) have not been reported since 2000. In 2008, indications for the human papillomavirus (HPV) vaccine were extended to include prevention of vulvar cancers. To examine its impact, we compared 2001–2018 incidence trends of VIS and VSCC among different populations of U.S. women.

METHODS:

This study was a secondary analysis of 88,942 vulvar cancer cases among adults aged 20 years and older reported in the U.S. Cancer Statistics 2001-2018 databases. We stratified data by tumor behavior (in situ/invasive) and age (20-44, 45-64, 65+ years old), race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic), and U.S. census region (Northeast, South, Midwest, West). Incidence rates and annual percentage changes (APC) were calculated by group.

RESULTS:

VIS incidence significantly decreased from 2001 to 2018 (APC –4.3, 95% CI –4.7 to −3.8) among all groups. Invasive VSCC decreased among 20- to 44-year old women (APC –0.8, 95% CI –1.3 to −0.3), but increased among older women. Regardless of tumor behavior, incidence was highest among non-Hispanic White women and those living in the Midwest.

CONCLUSION:

Rates of VIS are decreasing in women of all ages over 20 years old as well as in invasive VSCC among vaccine-eligible 20- to 44-year-old women. Since the trend began before the vaccine was available, this is probably due to multiple factors. Additional time is needed to fully realize the benefit of HPV vaccination on this cancer.
The Burden of Maternal Mental Health During COVID-19: Impact Analysis Through Perinatal Mood and Anxiety Disorders Screening [A272]
Authors: Brow Katherine , Kar Ayesha , Andrews Celine Marlin , Engel Casey , Lee Grace , James Jaclyn N.
Published: June 2022

INTRODUCTION:

The American College of Obstetrics and Gynecology (ACOG) recommends screening for depression and anxiety at least once during the perinatal period and again during postpartum checks. The delivery of validated screening tools varies amongst institutions and individual obstetricians. The objectives of this study were to assess our institution's baseline screening rates and the impact of the COVID-19 pandemic on maternal mental health.

METHODS:

Our patient population was pregnant and postpartum patients at Carilion Clinic from January 2019 to July 2020. Data collected from medical records included scores of the Edinburgh Perinatal Depression Screening (EPDS), Personal Health Questionnaire (PHQ) 2 and 9, demographics, and psychiatric history. Screening rates and incidence of mood disorders were compared between pre– and intra–COVID-19 cohorts.

RESULTS:

Of the 850 women included, 43.5% (n=370) were screened during perinatal visits and 49.8% (n=424) postpartum. Screenings were completed more frequently during postpartum checks pre–COVID-19 compared to during the pandemic with PHQ-2 (27.4% vs. 16.1%, P=.0001) and PHQ-9 (10.3% vs. 5.4%, P=.011). More women screened positive for depression at perinatal checks during the pandemic compared to pre-pandemic (13.2% vs. 4.7%, P=.0377).

CONCLUSION:

The COVID-19 pandemic has affected rates of maternal depression screening and has significant mental health impacts on this population. This study reveals baseline rates of screening in perinatal and postpartum visits at our institution, which is critical to delivery of quality care. This information will help inform strategies to increase rates of screening and ensure that mental health needs are being addressed, especially in times of emergency.
Maternal Race/Ethnicity and Mode of Delivery in Twin Gestations [A273]
Authors: Pinson Kelsey , Mims Joseph R. , Ballas Jerasimos , Pettit Kate E. , Ramos Gladys
Published: June 2022

INTRODUCTION:

Women of color in the United States have an increased risk of maternal morbidity and a higher risk of cesarean delivery (CD) compared to White women. This study aims to determine whether maternal race/ethnicity influenced mode of delivery (MOD) of twin gestations.

METHODS:

This was an IRB-approved, retrospective cohort study of all twin deliveries at a single institution between 1/1/2001 and 12/31/2018. Pregnancies delivered<24 weeks or with intrauterine fetal demise were excluded. The primary exposure, self-reported race/ethnicity, was categorized into five groups: White, Hispanic, non-Hispanic Black, Asian/Pacific Islander (PI)/Alaska Native (AN), and Other/Mixed. The primary outcome was CD. Statistical analyses included univariate analysis via Chi-square and ANOVA and logistic regression analysis.

RESULTS:

A total of 796 pregnancies were included; 377 (47.8%) of participants identified as White, 236 (29.9%) as Hispanic, 83 (10.5%) as Asian/PI/AN, 44 (5.6%) as Black, and 50 (6.3%) as Other/Mixed. BMI, maternal age at delivery, chorionicity, and parity were different by race/ethnicity groups, but gestational age at delivery was not. The overall rate of CD was 71.1% and did not vary by race/ethnicity (P=.51). There were no differences by race/ethnicity when analysis was limited to those delivering>34 weeks and birthweights>2,500 g (P=.07) or among only nulliparous women (P=.77). In multivariable analysis, only nulliparity was associated with increased risk of CD (P<.01).

CONCLUSION:

Rate of CD for twin gestations is high but was not related to maternal race/ethnicity in this cohort. Further study is needed to evaluate the indications for cesarean deliveries across racial/ethnic groups in twin gestations as this was not examined in this cohort.
Experience, Training, and Tools: A Mixed-Methods Study of Decision-Making for Obstetric Transport in a Rural State [A279]
Authors: Yi Avalon , Miller Bailey , Sandoval-Belt Payton , Patel Juhee , Quiner Trevor
Published: June 2022

INTRODUCTION:

New Mexico relies heavily on emergency obstetric transport due to the widely separated rural communities and limited centers for providing advanced maternal, fetal, and neonatal care. Emergency transport requires careful decision making and efficient use of resources. This study aims to evaluate perceived adequacy with respect to training, experience, and resources for obstetricians who make transport decisions.

METHODS:

An interview guide and survey questions were developed to evaluate the perception of different aspects of emergency obstetric transport in New Mexico. Interviews were performed with obstetrics and gynecology providers who participate in emergency obstetric transport, both sending and receiving, throughout the state of New Mexico in both rural and urban communities. Interviews were recorded, transcribed, and coded for qualitative analysis.

RESULTS:

The majority (75%) of participating providers had no formal training in emergency transport during their medical education, and there was a common sentiment that targeted training in obstetric transports would be beneficial. However, providers who reported being uncomfortable in making transport decisions at the beginning of their current positions reported quickly gaining the experience needed to feel comfortable. Although tools to assess preterm labor are extremely limited in some settings (transvaginal cervical length available to only 40% of interviewees), all providers felt that they had the necessary tools to make transport decisions.

CONCLUSION:

Obstetric transport is essential in rural obstetric care. Although experience is an excellent teacher, obstetric training is generally lacking in transport-focused education. Development of obstetric transport-centered training may improve the comfort level of providers in new settings.
Does Vaginal Bleeding in the Presence of a Subchorionic Hematoma Increase Adverse Pregnancy Outcomes? [A283]
Authors: Thakkar Meera , Dinglas Cheryl , Rosner Jonathan
Published: June 2022

INTRODUCTION:

Subchorionic hematomas occur when there is bleeding between the chorionic membrane and uterine wall. The incidence is approximately 1.3–3.1%. Multiple studies have evaluated subchorionic hematomas and demonstrate inconsistent findings regarding their association with adverse pregnancy outcomes. Our aim in this project was to evaluate whether vaginal bleeding in the presence of a subchorionic hematoma increases adverse pregnancy outcomes.

METHODS:

This was a retrospective chart review of all pregnant patients who had a first trimester sonogram at our Maternal Fetal Medicine center from 8/2015 to 5/2020. Inclusion criteria included patients with diagnosis of subchorionic hematoma in the first trimester. Exclusion criteria included multiple gestation, vanishing twin, and pregnancies complicated by fetal anomalies or chromosomal abnormalities.

RESULTS:

A total of 100 patients with diagnoses of first-trimester hematomas were analyzed. Approximately 37% presented with first-trimester bleeding. There was no significant difference between those who presented with vaginal bleeding and those who did not, in the following categories: spontaneous abortion (2.7% vs. 0%, P=.74), intrauterine fetal death (0% vs. 3.1%, P=.67), gestational hypertension (5.4% vs. 6.3%, P=.81), preeclampsia (10.8% vs. 7.9%, P=.79), intrauterine growth restriction (0% vs. 4.7%, P=.97), oligohydramnios (2.7% vs. 6.3%, P=.73), and preterm delivery (5.4% vs. 3.1%, P=.98).

CONCLUSION:

No significant association was found with adverse pregnancy outcomes, in patients with or without bleeding. There was a trend toward an increased rate of spontaneous abortion, pre-eclampsia, and preterm delivery in those with bleeding. Further research would investigate a broader subset of patients, including age-matched controls, and investigate the impact of hematoma size on pregnancy outcomes.
Diabetic Pregnant Patients Prefer Digital Glucose Logging To Traditional Paper Glucose Logging [A285]
Authors: Holthaus Emily , Patton Kathryn , Goodman Jean R. , Sprawka Nicole , Alrahmani Layan , Lal Ann
Published: June 2022

INTRODUCTION:

Recent diabetes research has evaluated use of digital glucose logging and smartphone apps, and suggests improvement in glucose control with the new technology. A quality initiative was implemented in a maternal fetal medicine division at a tertiary care center which transitioned from paper glucose logging to digital glucose logging for diabetic patients. Our objective was to assess patient perspectives of logging methods before and after the change.

METHODS:

The quality initiative was started in July 2021, when all diabetic patients were instructed on digital glucose logging and communication. The digital log system involved logging glucose values in an app integrated with the electronic medical record and communicating with providers via the electronic medical record. Patients were asked to complete a questionnaire both before and after the quality initiative, assessing ease of use, real-time logging, daily compliance, communication quality, and overall satisfaction with paper logging. The scoring system was based on a Likert scale: 1 (strongly disagree) to 5 (strongly agree).

RESULTS:

From July to October 2021, 11 patients transitioned from paper to digital logging and completed both questionnaires. Of those, 88% preferred digital logging. Digital logging had higher scores for ease of use (4 vs. 3.6) and overall satisfaction (3.9 vs. 3.3). Digital logging had lower scores for real-time logging (2.8 vs. 3.1) and effective communication (3.8 vs. 4.1).

CONCLUSION:

Because of the higher ease of use and satisfaction scores, ultimately digital glucose logging could lead to improved compliance and, thus, better glycemic control during pregnancy.
Implementation and Evaluation of A Gynecology eConsult Service Within A Large Health System [A287]
Authors: Buddemeyer Katherine , Hernandez Sean , Dharod Ajay , Shalowitz David
Published: June 2022

INTRODUCTION:

Electronic consultations (eConsults) between primary care providers (PCPs) and specialty clinicians offer specialists' input into patient care without in-person consultation. However, limited data exist on process outcomes associated with implementing systemwide eConsult services for gynecologic care.

METHODS:

We reviewed all gynecology eConsults at our institution from program start in February 2020 to September 2021. Analyzed variables included content, completion time, and provider satisfaction. The eConsult data were contextualized within systemwide data regarding in-person consultation processes.

RESULTS:

Implementation required identification of gynecologists willing to answer eConsults through the electronic medical record and development of consult template text to ensure adequate information was presented. Educational outreach was provided to PCP practices on workflow. A total of 71 gynecology eConsults were analyzed. Mean time from submission to completion was 0.73 days; 85% required less than 15 minutes of specialists' time. Most common eConsults involved cervical cancer screening (32%), abnormal uterine bleeding (14%), contraception (14%), imaging (13%), and menopause (10%). Systemwide, 85% of eConsults were perceived as appropriate by specialists; 93% of PCPs reported being satisfied or extremely satisfied. Of the PCPs, 30% reported they would have initiated in-person consultations if eConsults were unavailable; systemwide, time from referral to in-person consultation was 32.8 days.

CONCLUSION:

Implementation of a gynecology eConsult program is feasible, minimally burdensome to specialists, and associated with high satisfaction among PCPs. In our system, successful eConsults improved timeliness of access to gynecologists' recommendations by several weeks. Future work is in progress to determine whether and how expansion of eConsult utilization can further improve access to gynecologic care.
Ultrasound-Guided Polypectomy: Evaluation of A Novel Technique To Remove Endometrial Polyp In The Office [A295]
Authors: Sarkar Papri , Hochberg Lauri S.
Published: June 2022

INTRODUCTION:

Endometrial polyps are present in 13–50% in women with abnormal uterine bleeding (AUB). Hysteroscopy is the method of choice for diagnosis and treatment but has some limitations. Hence, we propose a novel technique that allows ultrasound-guided, office-based polypectomy. It avoids general anaesthesia, is inexpensive, and allows single point of care.

METHODS:

This is a prospective trial conducted at an academic hospital after IRB approval. Women with AUB had saline infusion sonogram (SIS) to delineate the polyp. Under ultrasound guidance, the universal grasping forceps (2.5 mm x 25 cm) was introduced through the cervix into the uterus to remove the polyp. It was an off-label use of the instrument. The goal of the study was to evaluate the patients' post-procedure pain and satisfaction score. The secondary outcomes were confirmation of complete removal of the polyp by assessing resolution of patients' symptoms and performing SIS at 3-month follow-up.

RESULTS:

There were 30 patients; 30% had premenopausal AUB, and 70% had post-menopausal bleeding. Mean age was 54.8±11 years, and mean BMI was 30.6±10. Average polyp volume was 1.26 cm3, and mean time taken for polypectomy was 11 minutes 50 seconds. The median pain and satisfaction scores were 5 and 10, respectively. Adequate pathology sample was obtained for all, and two returned as malignancy. For the 3-month follow-up, 16 patients returned. Among them, 13 (81%) had no evidence of polyps on SIS and 14 (87%) reported complete symptom resolution.

CONCLUSION:

This technique can be used safely and effectively to remove endometrial polyps in appropriately selected patient populations.
The Impact of COVID-19 on Pregnancy, and the Management of Infected Patients [A124]
Authors: Martens Mark G.
Published: June 2022

INTRODUCTION:

This seminar will focus on prevention of and management of patients with SARS-CoV-2 in pregnancy.

METHODS:

Federal (Centers for Disease Control and Prevention), state, and society (American College of Obstetricians and Gynecologists, Society for Maternal–Fetal Medicine) guidelines will be reviewed.

RESULTS:

The accuracy of coronavirus diagnosis is dependent on the specific test and the timing. Once correctly diagnosed, the impact of infection at various stages of pregnancy requires unique and specific management protocols, which are continually evolving as new data is reported. Innovative antepartum management strategies, including telemedicine, are emerging. Management protocols and treatment of COVID-19 in pregnancy require additional attention, and protocols for labor and delivery highlighting protection of both patients and the obstetric staff need to develop. New data on vertical transmission is also evolving.

CONCLUSION:

SARS-CoV-2 infection in pregnancy requires novel and specific treatment and management strategies which undergo continued updates and modifications as new data is presented. The seminar will first focus on establishing a correct diagnosis, and then, assessing and counseling the patient and her family of the impact of coronavirus infection on the pregnancy. Risk factors for adverse outcomes will be reviewed, including obesity, chronic medical conditions, and socioeconomic disparities. Antepartum management will be reviewed regarding the development of testing strategies for the patient, family, and staff, and protocols for safe office visits including telehealth. Intrapartum and postpartum management and treatment of infected and/or symptomatic patients will be reviewed, with specific attention to federal and society guidelines. All prevention (vaccines) and evolving treatment options and their safety in pregnancy will be discussed
COVID-19 Vaccine Hesitancy Among Reproductive-Aged Females [A129]
Authors: Gilani Sonia , Butler Leah , Shamshuddin Nabiha , Class Quetzal , Ganti Amitha
Published: June 2022

INTRODUCTION:

Initial COVID-19 vaccine trials excluded pregnant individuals, making eventual vaccine recommendations non-generalizable. After noninferiority was established, the Centers for Disease Control and Prevention, World Health Organization, and American College of Obstetricians and Gynecologists supported vaccination of this group. However, only 31% of pregnant patients accepted vaccination. This study aims to assess COVID-19 vaccine hesitancy in reproductive-aged females.

METHODS:

We developed a REDCap survey using a validated COVID-19 vaccine hesitancy survey tool. From August to November 2021, women aged 18–50 years were recruited from inpatient and outpatient obstetrics and gynecology services at the University of Illinois Hospital. We performed t tests and ANOVA statistics using SPSS.

RESULTS:

A total of 51 patients partially or fully completed the survey. The results revealed that Black individuals are more hesitant than Hispanic and White individuals (F
2,44=3.45, P<.50). Specifically, Black women differed in the belief that the COVID-19 vaccine is safe overall (F
2,44=5.62, P<0.01) and in pregnancy (F
2,46=4.95, P<0.01). Pregnant patients were less confident that the COVID-19 vaccine is safe overall (F
2,45=7.44, P<0.01) as well as in pregnancy (F
2,47=6.26, P<0.01) compared to those recently pregnant or not pregnant. Individuals who declined the flu vaccine were more likely to be vaccine hesitant (t
46=–4.49, P<.001). Participants’ age, occupation, and contraception status were not associated with vaccine hesitancy.

CONCLUSION:

Existing vaccine hesitancy highlights the need to study misconceptions regarding the safety of the COVID-19 vaccine.
Expedited Partner Therapy: A Quality Improvement Initiative to Boost Provider Prescription [A130]
Authors: Markowitz Melissa A. , Ackerman-Banks Christina , Gottlieb-Cohen Sara , Pathy Shefali R. , Sheth Sangini S.
Published: June 2022

INTRODUCTION:

High rates of chlamydia and/or gonorrhea (CT/GC) partner reinfection contribute to devastating sequelae, including pelvic inflammatory disease and infertility. While expedited partner therapy (EPT) is legal in 43 states and endorsed by the American College of Obstetricians and Gynecologists, rates of EPT utilization are highly variable. We designed a quality improvement (QI) initiative for implementation of EPT in an urban clinic providing care to a low-income patient population.

METHODS:

We performed an institutional review board‒approved pre–post study to evaluate our EPT QI initiative, which included education on EPT and development of electronic medical record (EMR) support tools. Cohorts included all women with CT/GC one year prior and one year after our initiative. Demographic and clinical characteristics were collected via EMR. Multivariate logistic regression assessed the association between the QI initiative and offering EPT.

RESULTS:

Of 287 patients with CT/GC, 155 were diagnosed pre-QI and 132 post-QI. There were no significant differences in demographic or clinical characteristics between the groups. EPT counseling increased significantly from 24.5% pre-QI to 37.8% post-QI (P=.015). Those offered EPT were more likely to be seen by a resident physician (OR, 3.44; 95% CI, 1.24–10.00; P=.019) and speak Spanish (OR, 3.14; 95% CI, 1.38–7.46; P=.007). Women with CT/GC post-QI were twice as likely to be counseled on EPT than their pre-QI counterparts, when adjusting for provider type and language (aOR, 2.02 (95% CI, 1.17–3.56).

CONCLUSION:

Our QI initiative significantly increased the rate of EPT counseling. Similar QI initiatives may be applied in other settings, such as adolescent clinics or urgent care, in order to decrease the rising rates of CT/GC.
Trends in Gestational Diabetes Mellitus by Race and Ethnicity Among Women With Advanced Maternal Age [A146]
Authors: Pawar Deepraj , Mester Nonda , Hersh Alyssa R. , Valent Amy , Boniface Emily
Published: June 2022

INTRODUCTION:

Advanced maternal age (AMA), defined as maternal age 35 years or older, is becoming more common, with simultaneously increasing adverse outcomes. We aim to determine if gestational diabetes mellitus (GDM) is becoming more common in AMA pregnancies, and if racial disparities exist.

METHODS:

This was a retrospective cohort study of singleton, non-anomalous deliveries with a gestational age ≥20 weeks and maternal age ≥35 in the United States from 2014 to 2018. Patients with chronic diabetes mellitus were excluded. Our analysis was stratified by maternal race/ethnicity, including non-Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian or Native Hawaiian or Pacific Islander (NHPI), non-Hispanic multiracial, and Hispanic. We performed multivariable logistic regression followed by calculation of adjusted predicted probabilities to estimate the proportion of deliveries effected by GDM. Confounders adjusted for include age, BMI, parity, cigarette use, educational attainment, and insurance type. All analyses were conducted using STATA 17.

RESULTS:

This study included 3,093,536 AMA deliveries. Non-Hispanic Asian and NHPI women had the highest probability of developing GDM, followed by Non-Hispanic AI/AN women. Non-Hispanic Black patients had the lowest rates of GDM. The predicted probability of developing GDM increased in all racial and ethnic groups between 2014 and 2018 but was most pronounced in Non-Hispanic Asian and NHPI patients, increasing from 19.0% to 21.0% over the four-year period.

CONCLUSION:

In the United States, GDM has increased among all groups in the AMA population from 2014 to 2018. However, the predicted probability of GDM still varies greatly by maternal race and ethnicity.
Trends in Cesarean Delivery by Race and Ethnicity Among Women With Advanced Maternal Age, 2014–2018 [A148]
Authors: Pawar Deepraj , Mester Nonda , Hersh Alyssa R. , Boniface Emily , Valent Amy
Published: June 2022

INTRODUCTION:

There has been an overall decrease of cesarean deliveries in the United States over recent years. We sought to determine if this trend was consistent in the advanced maternal age (AMA) population, and if there were disparities based on maternal race and ethnicity.

METHODS:

This was a retrospective cohort study including singleton, non-anomalous deliveries with a gestational age ≥20 weeks and maternal age ≥35 in the United States from 2014 to 2018. Our study included repeat cesarean delivery. Analyses were stratified by maternal race/ethnicity, including non- Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian or Native Hawaiian or Pacific Islander (NHPI), non-Hispanic multiracial, and Hispanic. We performed multivariable logistic regression followed by calculation of adjusted predicted probabilities to estimate the fraction of births cesarean delivery. Confounders assessed included diabetes status, prior cesarean delivery, age, parity, BMI, cigarette use, educational attainment, and insurance type.

RESULTS:

There were 3,094,296 births included in this study. Black women had the highest probability of cesarean delivery from 2014 to 2018. Non-Hispanic AI/AN women had the lowest probability. The predicted probability of cesarean delivery was lower in 2018 than 2014 for all maternal race and ethnicity groups. The largest decline was seen in Black women, decreasing from 45.5% to 43.8% from 2014 to 2018.

CONCLUSION:

Cesarean deliveries are decreasing among all pregnant women with AMA. However, there are disparities in this outcome when accounting for maternal race and ethnicity, with Black women most at risk.
Presenting Characteristics, Complications, and Outcomes of Pregnant Tourists Who Present to the Hospital in Hawaii [A152]
Authors: Malley Alyssa , Raidoo Shandhini , Loomis Alexander K. , Lee Men-Jean
Published: June 2022

INTRODUCTION:

Travel during pregnancy is increasingly popular, and literature describing possible complications is lacking. This study was conducted to determine characteristics, comorbidities, indications for seeking care, and outcomes of pregnant tourists who presented to care in Hawaii.

METHODS:

We conducted a chart review of pregnant tourists who presented to Kapiʻolani Medical Center for Women & Children in Honolulu, Hawaii between January 2018 and August 2020. Institutional review board approval was obtained. Demographics, details of the hospital course, and outcomes were recorded. Logistic regression and ANOVA were fit to test the influence of patient characteristics on admission and length of hospital stay, respectively.

RESULTS:

There were 301 pregnant tourists identified, with 40.2% patients in the first trimester, 43.5% in the second, and 16.3% in the third. We identified 11.6% of patients with chronic medical conditions and 19.9% of patients with pregnancy-related conditions. Most patients presented for pregnancy-related concerns. More advanced gestational age (P<.0001), pregnancy-related conditions (P<.01), and chronic medical conditions (P=.04) were associated with a significantly longer hospital stay. Thirty-four patients were admitted. Patients in their third trimester (P<.001) and patients with pregnancy-related (P<.01) or chronic (P=.01) conditions were significantly more likely to be admitted. Twenty-seven patients underwent delivery or procedure.

CONCLUSION:

Pregnant patients are traveling throughout pregnancy and many with known medical conditions. They seek care for a variety of reasons; some are admitted or undergo procedures. Increasing gestational age, chronic medical conditions, and pregnancy-related conditions are associated with increased length of hospital stay and likelihood of admission. Providers should be aware of the risks of travel to counsel patients appropriately.
Variations in Postpartum Opioid Prescribing Practices Among Obstetrician–Gynecologists [A153]
Authors: Ravikanti Nikhita , Okut Hayrettin , Keomany Jennifer , Ablah Elizabeth , Bradley Kent
Published: June 2022

INTRODUCTION:

Cesarean patients are commonly prescribed opioids when discharged from the hospital. This study aimed to determine if there were differences in prescribing practices based on the postoperative day opioid prescriptions were written, and before and after the publication of the most recent Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).

METHODS:

This retrospective chart review study included women who had a live birth via cesarean at a single institution from July 1, 2017, to February 28, 2021, and excluded those with chorioamnionitis or discharged after more than 4 days. Opioids were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were grouped based on date of delivery relative to the publication of ACOG Committee Opinion 742 (July 2018). Institutional review board approval was obtained for this study.

RESULTS:

Out of 411 patients, 93.9% (n=386) had opioids prescribed at discharge, 85.5% of whom (330/386) received a prescription written on the day of discharge. There was no difference in the quantity of MMEs in discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients delivering after the new ACOG Opinion (63.9%, n=263) received discharge prescriptions with fewer average MMEs (159.53±61.64) than those who delivered before the publication (36%, n=148) (187.35±53.42), chi-square (1, N=411)=17.71, P<.001.

CONCLUSION:

Patients delivering via cesarean after the published ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, but there was no difference between prescriptions written the day of versus before discharge.
Severe Maternal Morbidity in Deliveries Complicated by Preeclampsia Equalized by the Military Health Care System [A155]
Authors: Lundeberg Kathleen R. , Tindal Rachel R. , Grob Patrizia , Hamilton Jameaka , Gonzalez-Brown Veronica , Keyser Erin A.
Published: June 2022

INTRODUCTION:

In the United States, Black women die at 2.5 times the rate of White women and 3.5 times the rate of Hispanic women. These racial health care disparities have been largely attributed to access to health care and other social determinants of health. We hypothesize that the military health care system models universal health care access seen in other developed countries and should equalize these rates.

METHODS:

Delivery data from 41 military treatment facilities across the Department of Defense (Army, Air Force, and Navy), including over 36,000 deliveries from 2019 to 2020, were compiled in a convenience dataset through the National Perinatal Information Center. After aggregation, the parameters of percent of deliveries complicated by severe maternal morbidity (SMM) and percent of SMM secondary to preeclampsia with and without transfusion were calculated. Risk ratios were calculated by race for the resulting summary data. American Indian/Alaska Native patients were excluded due to a limited total number of deliveries, preventing statistical analyses.

RESULTS:

Overall, the risk of SMM was increased among Black women compared to White women. The risk of SMM related to preeclampsia showed no significant difference among races with or without transfusion. When other races were set as reference group, there was a significant difference for White women, suggesting a protective effect.

CONCLUSION:

While women of color still experience overall SMM at higher rates than their White counterparts, Tricare may have equalized the risk of SMM for deliveries complicated by preeclampsia.