bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Postpartum Medroxyprogesterone Problematic Bleeding [8R]
Authors: Thiyagarajan Dhanalakshmi , O'Shea Calliope , Mondheim Michael , Anasti James N.
Published: May 2019

INTRODUCTION:

Medroxyprogesterone acetate is a safe and effective immediate postpartum contraceptive (MPA-PP). However, the resultant irregular bleeding attributed to MPA-PP is problematic. Little is known as to the contributing factors that increase risk of MPA-PP bleeding. Thus we compared patients that complained of MPA-PP bleeding to those who did not.

METHODS:

We reviewed the charts of all women receiving MPA-PP and had at least 3 months follow-up during 16 month period at a suburban health network. Age, ethnicity, BMI, Breast feeding status, parity, pregnancy complications and delivery type were collected. All visit between 3 months and 12 months were reviewed for persistent bleeding complaints and continuation rates of MPA. This study was approved by IRB. Those with and without bleeding complaints were compared using chi squared or t-test as appropriate.

RESULTS:

Of the 204 MPA-PP patients studied during the first PP year, 99 switched to alternative contraception or discontinued all contraception, 58 had no MPA bleeding complaints and 47 complained of persistent bleeding. Thirty of the 47 (64%) patients with bleeding stopped MPA. MPA bleeding group did not differ by age, BMI, ethnicity, and pregnancy complications. Although MPA bleeding group had lower cesarean delivery (p=0.06), breast feeding rates (p=0.11), and parity (p=0.07), they did not reach statistical significance.

CONCLUSION:

Of those wishing to continue MPA-PP, 47/58 (63%) complained of persistent bleeding during the first PP year. Although initiation of MPA in the postpartum period is associated with higher rates of bleeding than in the non-postpartum period, risk factors remain elusive.
Reproductive Health Care Knowledge, Needs, and Access Among Transgender Men: A Mixed Methods Study [6R]
Authors: Fein Lydia A. , Zaw Catherine , Wong Adriana , Jhaveri Vasanti , Gerkowicz Sabrina Aleezah , Potter JoNell
Published: May 2019

INTRODUCTION:

Most transgender men retain their natal reproductive organs and genitalia. Approximately 70% of OB-GYN's report discomfort when providing care for this population. To ascertain the needs and experiences of transgender men who seek reproductive health care we conducted a mixed methods study among transgender men.

METHODS:

Self-identified transgender men participated in focus groups featuring questions about reproductive health care and completed a survey regarding reproductive goals. Descriptive statistical analysis was performed on survey data, and focus group data were transcribed and analyzed to identify emergent themes.

RESULTS:

Nine transgender men participated; mean age was 29, six were on hormone therapy. All had their uterus and ovaries in situ, and four reported recent vaginal receptive intercourse. Only two reported receiving fertility preservation information from a physician; five desired future children. Five reported current or past use of contraception, even after starting testosterone. Two reported history of unintended pregnancy and miscarriage. Themes identified through focus groups: reference to gynecologists as the “necessary evil”; sensing provider uncertainty about or avoidance of reproductive health topics, especially during the patients' reproductive transition'; systemic issues including insurance and financial barriers for gynecologic care and fertility preservation; and avoidance of gynecologic care due to dysphoria and lack of transgender-knowledgeable OB/GYN providers.

CONCLUSION:

These findings indicate that transgender men often retain their reproductive organs, use contraception, and desire childbearing, necessitating reproductive health care from OB/GYN providers. Strategies to increase providers awareness of these findings are needed so transgender men's access to and experiences of reproductive health are improved.
Patients With Mood Disorders Require Higher Doses of Buprenorphine for Management of Opiate Use Disorder [35Q]
Authors: Tonismae Tiffany R. , Lee McDowell Misty , Slaven James E. , Quinney Sara K. , Schubert Frank , Benjamin Tara D.
Published: May 2019

INTRODUCTION:

The purpose of this study is to compare differences in buprenorphine doses needed to treat Opiate Use Disorder (OUD) in patients with and without mood disorders.

METHODS:

This is a retrospective cohort study of pregnant women treated at Indiana University with OUD. IRB approval was obtained from Indiana University School of Medicine. Charts were obtained via prescription medication search. Patients were included if they had at least one outpatient visit with our center during pregnancy and delivered within the Indiana University Health system. Charts were reviewed for maternal demographics, medical history, prescription use, and delivery data.

RESULTS:

266 patients were treated and 171 patients had a mood disorder: 148 with depression, 130 with anxiety, and 19 with post-traumatic stress disorder (PTSD). Over 40% of the patients had a history of dual diagnoses. Patients with a history of depression or anxiety required a higher dose of buprenorphine during pregnancy (p=0.0217, p=0.0165) compared to those without a history of mood disorder. There was no significant difference in dose in those with PTSD versus those without mood disorder. In those with a diagnosis of mood disorder, there was no difference in buprenorphine dose between women on medication versus those not on medication for depression, anxiety, and PTSD.

CONCLUSION:

Patients with a mood disorder require higher doses of buprenorphine compared to patients without a mood disorder. Treatment of depression, anxiety or PTSD did not show a difference in buprenorphine dose versus no treatment when a mood disorder was diagnosed.
Differences in Outcomes by Mode of Operative Vaginal Delivery Among Nulliparous Women [21B]
Authors: Packer Claire , Pilliod Rachel , Gallagher Alexandra , Caughey Aaron B.
Published: May 2019

INTRODUCTION:

We sought to determine the differences in perinatal outcomes in deliveries with forceps compared to vacuum assisted delivery in nulliparous women.

METHODS:

A retrospective cohort study comparing the rate of perinatal outcomes among singleton, non-anomalous births in California to women who had forceps versus vacuum assisted deliveries between 2007 and 2011. Perinatal outcomes of interest included shoulder dystocia, brachial plexus injury (BPI), 3rd or 4th degree perineal laceration, cervical laceration, NICU admission, Apgar scores, facial nerve palsy, scalp injury, clavicular injury, and jaundice. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:

Of the nulliparous births in California, 4,028 had forceps deliveries and 53,781 had vacuum deliveries. Vacuum delivery was associated with an increased risk of both shoulder dystocia (Adjusted Odds Ratio [aOR] 1.5, 95% CI 1.16-1.93) and scalp injury (aOR 1.21, 95% CI 1.07-1.35), while forceps delivery was associated with an increased risk of adverse perinatal outcomes including 3rd or 4th degree perineal laceration (aOR 0.55, 95% CI 0.51-0.59), cervical laceration (aOR 0.55, 95% CI 0.22-0.51), and facial nerve palsy (aOR 0.30, 95% CI 0.21-1.59).

CONCLUSION:

Perinatal outcomes differ by method of operative vaginal delivery. It is interesting that vacuum deliveries have a higher rate of shoulder dystocia even when controlling for potential confounding factors. Forceps delivery, however, does have higher rates of perineal trauma. These findings can be used by clinicians to guide choices regarding mode of delivery.
Efficacy of Bremelanotide Across Hypoactive Sexual Desire Disorder Duration Subgroups [15M]
Authors: Simon James A. , Clayton Anita H. , Kingsberg Sheryl , Jordan Robert , Williams Laura , Krop Julie
Published: May 2019

INTRODUCTION:

Bremelanotide, an investigational new drug, demonstrated efficacy in premenopausal women with hypoactive sexual desire disorder (HSDD) in the RECONNECT studies. In this analysis, bremelanotide efficacy was investigated across HSDD duration subgroups.

METHODS:

RECONNECT comprised two replicate, phase 3, double-blind, randomized, placebo-controlled, IRB-approved studies. Subjects self-administered bremelanotide 1.75 mg or placebo using an autoinjector pen, on demand, for 24 weeks. Subjects were evaluated based on HSDD duration at baseline. Efficacy was assessed using RECONNECT co-primary endpoints: change from baseline to end-of-study (EOS) for Female Sexual Function Index-desire domain (FSFI-D) and Female Sexual Distress Scale-Desire/Arousal/Orgasm (FSDS-DAO) Item 13 scores.

RESULTS:

In the integrated population of RECONNECT (N=1202), differences in mean change in FSFI-D and FSDS-DAO Item 13 from baseline to EOS (bremelanotide-placebo) were 0.35 and -0.33, respectively (P<.0001 for both endpoints). Differences in mean FSFI-D changes from baseline to EOS for each duration quartile were 0.42 (6-18 months; N=174-177), 0.41 (>18-33 months; N=118-132), 0.28 (>33-60 months; N=158-167), and 0.33 (>60-360 months; N=131-144). Differences in mean FSDS-DAO Item 13 changes for each duration quartile were -0.46 (6-18 months), -0.43 (>18-33 months), -0.14 (>33-60 months), and -0.29 (>60-360 months). Significantly greater (P≤.0082) changes in FSFI-D were achieved with bremelanotide versus placebo in all HSDD duration quartiles. FSDS-DAO Item 13 was also significantly improved across duration quartiles (P≤.0295) except for the 33-60 months quartile (P=.2449).

CONCLUSION:

Bremelanotide demonstrated efficacy in premenopausal women regardless of HSDD duration. Bremelanotide significantly restored sexual desire across HSDD duration quartiles and showed improvements in decreasing distress.
The Long Term Safety and Efficacy of the FemTouch for the Treatment of Vulvovaginal Atrophy in Postmenopausal Women [20M]
Authors: Eder Scott Evan
Published: May 2019

INTRODUCTION:

Fractional CO2 lasers have been shown to provide improvement in vulvovaginal atrophy (VVA) in our previous study. (Eder, SE, Laser Therapy, 2018 March 31; 27(1):41-47) The aim of this extension study was to assess the long term safety and efficacy of a fractional CO2 laser system in treating VVA.

METHODS:

Twenty healthy post-menopausal women (mean age 60± 6.34 years) with VVA-related symptoms and previous fractional CO2 laser treatments (total of three at 4-week intervals) were enrolled after IRB approved consent obtained. Subjects were followed for 18 months after final treatment. At each visit, Vaginal Health Index Scores (VHIS) and VVA symptom severity was recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI).

RESULTS:

At 12 months following laser treatment the mean VHIS score was significantly improved (16.3 ± 4.5 vs. baseline 12.4 ± 4.0; p<0.05), and improved further at 15 and 18 months (16.9 ± 4.6 and 17.1 ± 4.6, respectively). Almost all VVA symptoms were significantly improved at 12-months. A further significant improvement in VVA symptoms was noted at 15 and 18 months following the third and final laser treatment. The FSFI score increased significantly at the 12 month follow up visit and remained significantly higher than baseline at the 18 months follow-up visit (25.8 ± 6.6 vs. baseline 1.69 ± 7.9; p<0.05).

CONCLUSION:

CO2 laser therapy for post-menopausal women can be considered a safe and effective therapeutic option providing long term relief of menopausal vulvovaginal symptoms.
Using a Shared Decision Making Tool to Clarify Patient Preference for Treatment Options of Menopausal Symptoms [21M]
Authors: Dayaratna Sandra , Powell Rhea , Gould Rebecca , Sifri Randa , Sherif Katherine , Myers Ronald
Published: May 2019

INTRODUCTION:

Decision counselling may prepare women for shared decision making about menopausal symptom treatment.

METHODS:

Women reporting menopausal vasomotor symptoms or genitourinary syndrome of menopause (GSM) were referred and consented. A nurse educator led a decision counselling session comprising review of an educational brochure and an online tool to clarify treatment preferences. Treatment options included non-hormone treatment vs. systemic hormones for vasomotor symptoms and non-hormone treatment vs. topical hormone treatment for GSM. Patients and their providers received a preference summary. Frequency of preferred treatments were calculated. An endpoint survey assessed participant perception of their preparation to discuss treatment options with their providers.

RESULTS:

A total 36 women with GSM (N=18) or vasomotor symptoms without a contraindication to systemic hormone therapy (N=18) completed a decision counseling session. Of these, 25 completed the endpoint survey. Among women with vasomotor symptoms, 6 (33%) preferred non-hormone treatment, 7 (39%) preferred hormone treatment, and 5 (28%) had an equal preference for these options. Among women with GSM, 6 (33%) preferred non-hormone treatment, 7 (39%) preferred topical hormone therapy, and 5 (28%) had an equal preference for these options. Ninety-six percent (24/25) felt the decision counseling session helped prepare them to discuss treatment options with their provider.

CONCLUSION:

After a decision counselling session, 72% percent of women with menopausal symptoms expressed a clear preference for a particular treatment and 96% felt more prepared to discuss treatment options with their provider. Decision counselling may add value to care of menopausal women. Further research should evaluate impact on the subsequent office visit.
Effect of Insurance Type on Patient Access to Outpatient Gynecologic Care [26M]
Authors: Zhang Jenny , Weerasooriya Nimali , Cagino Kristen , Griffin Todd
Published: May 2019

INTRODUCTION:

One purpose of the Affordable Care Act (ACA) was insurance reform and expanding Medicaid eligibility. While studies have shown access disparities in gynecological cancer surgery, limited data exists on access disparities in general gynecology. This study aims to conduct telephone surveys to evaluate (1) appointment success rates and (2) wait time disparities for gynecologic appointments in patients with Medicaid and Commercial insurance.

METHODS:

A prospective cross-sectional study using a telephone survey was conducted in October 2017. The cohort included all ACGME accredited OBGYN residency programs. Earliest appointment times were established for fictional patients with Medicaid then Commercial insurance. The primary outcome was wait time for new patient appointment in days. The secondary outcomes were differences in wait times by states that had more than three OBGYN residency programs and in states that participated in the ACA expansion.

RESULTS:

There were 188 ACGME accredited academic OBGYN residency programs that accepted both Medicaid and Commercial insurance (73.4% participation rate). Of these programs, 48.95% (n= 93) had a longer wait time for new patient visits with Medicaid insurance. Overall, there was significant difference (p< 0.0079) between the mean wait times for new patient visits for patients with Medicaid insurance (30.6 days) versus Commercial insurance (24.6 days).

CONCLUSION:

Our data suggest that Medicaid patients seeking gynecologic care experienced longer wait times and that expansion of ACA was not associated with an improvement in these wait times.
Utilization of Online Family History Collection and Hereditary Cancer Risk Assessment Tool [28M]
Authors: Gabitzsch Emily K. , Susswein Lisa R. , Klein Rachel T. , Metelski Deon , Fagbemi Adebanke F. , Solomon Benjamin D.
Published: May 2019

INTRODUCTION:

Collection and utilization of family history is necessary for hereditary cancer risk assessment but standardization is difficult in healthcare practices. The web-based, patient-entered MyGeneticsTree (MGT) can be administered outside of medical encounters, targeting follow-up on high-risk patients.

METHODS:

MGT was used in women's health offices between October 2015 and July 2018. Patients (users) were invited by providers directly, or found MGT through other means. MGT was accessed on personal computers, mobile devices, or in-office tablets.

RESULTS:

A total of 1,922 patients completed MGT; the overall completion rate was 85%. The average age was 45 (between 18 and 86) and 93% were female. The majority (87%) of patients were unaffected themselves, but reported a family history of cancer and/or genetic testing. Half (49%) of all patients met clinical guidelines for genetic testing in one of 5 hereditary cancer syndromes. Cancer family history was reported more in maternal (41%) than paternal (29%) relatives, and in first-degree compared to second- or third-degree relatives (85% to 13% or 2%, respectively). Excluding those with a known familial variant, 19.5% (375/1922) pursued multigene hereditary genetic testing, of whom 9% (n=34) were positive for a pathogenic variant.

CONCLUSION:

These results point to successful adoption of an online, patient-driven hereditary cancer risk assessment identifying patients appropriate for genetic testing. When administered to a patient population outside or within the office, MyGeneticsTree identified unaffected individuals with significant cancer family history. Planned enhancements include continued algorithm updates, optimized patient ease of use, and improved testing uptake for at-risk patients.
A Novel Counseling Tool: AMH as a Predictor of Oocyte Yield and Live Birth Rate (LBR) With Oocyte Cryopreservation (OC) [29M]
Authors: Maslow Bat-Sheva L. , Ramirez Leslie B. , Klein Joshua U.
Published: May 2019

INTRODUCTION:

Methods for counseling women regarding candidacy for OC are limited. This study aims to provide a novel evidence-based tool to interpret serum AMH as a predictor of oocyte yield and LBR in non-infertile women considering OC.

METHODS:

All OC cycles performed at Extend Fertility Medical Practice from 4/2016 through 8/2018 were included. The study was granted IRB exempt status. AMH levels were performed at an independent laboratory using Gen-II ELISA platform. Using published data, the number of oocytes needed for a 50% LBR were calculated per age group. ROC curves for each age group were used to select appropriate cutoffs based on accuracy and simplicity. Associations were made using X2.

RESULTS:

1385 cycles were included. Mean age at cycle start was 36.1+/-3.2. Median AMH 1.83 ng/mL [IQR 1.11-3.12]. Predicted 50% LBR was equivalent to 7 cryopreserved MII oocytes at age ≤34, 9 at 35-37, 11 at 38-40, 20 at ≥-41. ROC curve demonstrated good fit for AMH as a predictor of 50% LBR at each age group (AUC 0.80-0.86, P<.001-.016). Suggested AMH to achieve a predicted 50%LBR with 1 cycle of OC are as follows: ≤34=1.25 (P<.001, OR 4.54 CI 2.61-7.899)35-37=1.50 (P<.001, OR 5.23 CI 3.67-7.44)38-40=1.75 (P<.001 OR 7.97 CI 4.4-14.38)≥41=2.25 (P=.002 OR 1.01-1.60)

CONCLUSION:

Appropriate estimates of per cycle oocyte yield and predicted live birth rates based on age at cryopreservation are critical for enabling women to make informed decisions about their reproductive goals. These data provide a novel method with which to counsel women about their candidacy for OC.
Elagolix Improves Quality of Life Among Uterine Fibroids Patients With Heavy Menstrual Bleeding in Phase III Trials [31M]
Authors: Al-Hendy Ayman , Soliman Ahmed M. , Wang Hui , Coyne Karin , Carr Bruce R.
Published: May 2019

INTRODUCTION:

Uterine Fibroids (UF) are associated with impaired health-related quality of life (HRQL). The impact of elagolix, an oral gonadotrophin-releasing hormone antagonist, on the HRQL of women with heavy menstrual bleeding (HMB) associated with UF was evaluated.

METHODS:

Premenopausal women aged 18 to 51 with HMB (>80 mL/cycle menstrual blood loss) associated with UF were enrolled in two replicate 6-months phase III placebo-controlled randomized clinical trials (Elaris UF-1, Elaris UF-2). Women were randomized in 1:1:2 fashion to placebo, elagolix 300mg twice daily (BID) and elagolix 300mg BID in combination with 1mg estradiol (E2)/0.5 mg norethindrone acetate (NETA) once-daily add-back therapy (BID+E2/NETA). HRQL was measured using Uterine Fibroids Symptoms Severity and Health-Related Quality of life questionnaire (UFS-QOL) at baseline, months 3 and 6 of treatment. Changes from baseline in Symptom Severity (lower scores indicate lesser symptoms) and HRQL total scores (higher scores indicate better HRQL) were compared between elagolix arms and placebo using ANCOVA models controlling for baseline scores.

RESULTS:

In Elaris UF-1, 102, 104, 207 patients were randomized to placebo, elagolix BID and elagolix BID+E2/NETA, respectively. At month 6, mean reduction in Symptom Severity scores was significantly larger for elagolix BID and elagolix BID+E2/NETA compared to placebo (-48.3, -33.2, -10.3; respectively p<0.001). Mean increase in HRQL total score was significantly higher for elagolix BID and elagolix BID+E2/NETA compared to placebo (47.5, 38.0, 10.9; respectively p<0.001). Similar results were observed in Elaris UF-2.

CONCLUSION:

Elagolix + E2/NETA add-back reduces UF symptoms severity and improves HRQL among women with HMB associated with UF.
How Are We Doing? Documentation of Preconception and Contraceptive Counseling and LARC Use in Type I Diabetic Women [2N]
Authors: Disney Elizabeth , Gawron Lori , Sanders Jessica , Kaur Simranvir
Published: May 2019

INTRODUCTION:

To explore the frequency of preconception and contraceptive counseling and LARC use in type I diabetic women.

METHODS:

This retrospective cohort study identified women (16-49 years-old) with an ICD-9/ICD-10 code for type I diabetes and documented A1C level in a tertiary referral center between 1/1/2010-10/30/2017. We abstracted preconception or contraceptive counseling and LARC documentation within 1 year pre- and post-highest A1C. We identified provider type: primary care (PCP), endocrinology, obstetrics/gynecology (OB/GYN), and maternal fetal medicine (MFM). We defined advanced disease by micro- or macro-vascular complications or disease >20 years. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for age and race.

RESULTS:

We included 541 women. Median age was 30.7 (range 17-49), A1C was 9.1% (5%-20%), and median 4 visits (range 1-38) during the two-year span. Only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. MFMs most frequently documented preconception counseling (16%, P=0.01), while OB/GYNs most frequently documented contraceptive counseling (73%, P<0.01). LARC documentation was higher in MFM (26%) and OB/GYN (27%) visits compared to endocrinology (10%) and PCP (11%) visits (all P<0.01). Advanced disease resulted in less preconception counseling (3%, P=0.05), yet similar contraceptive counseling frequency and LARC use compared to non-advanced disease. Contraceptive counseling was highly associated with LARC use (aOR 9.87, 95% CI 5.09-19.12).

CONCLUSION:

Reproductive age type I diabetic women have high healthcare utilization, yet documentation of preconception and contraceptive counseling is sparse. Educating non-OB/GYN providers could avoid missed opportunities to improve pregnancy planning and outcomes.
Impact of Ryan Residency Training on Number of LARCs Inserted during Ob/Gyn Residency Training [5N]
Authors: Vetrici Mariana , Maples Jill , Evans Megan L. , Espey Eve , Ogburn Tony , Zite Nikki B.
Published: May 2019

INTRODUCTION:

Long-acting reversible contraception (LARC) is an important component of the contraceptive method mix; education and training in LARC provision is an integral skill for women's health care physicians. Performing IUD and contraceptive implant insertions is an Ob/Gyn residency requirement (Level 3 ACGME Milestone). This study determined the average number of LARC devices inserted by Ob/Gyn residents during their training and investigated the impact of Ryan Residency Training on the number of insertions.

METHODS:

In 2016, an electronic survey was distributed to Ob/Gyn residents just before the CREOG in-training examination; 4,322 respondents in US programs completed the survey and were included in the analysis. Residency program zip codes were reported by 4,203 respondents. Zip codes were used to create a “Ryan Training” (RT) categorical variable (with RT, without RT, can't be determined). Data were analyzed using Chi-square statistics.

RESULTS:

Among 3rd and 4th year residents, 6.9% had inserted <11 IUDs, 21.9% had inserted <11 contraceptive implants, and 28.9% had never inserted an IUD immediately post-partum (IPP) IUD. RT was significantly associated with IUD, implant, and IPP IUD insertions (P<.001). Including respondents from all years of residency, a higher percentage of those without RT inserted <11 IUDs (26.2% vs. 11.5%) and <11 implants (28.8% vs. 18.8%), compared to residents with RT. Additionally, 45.2% of residents without RT had never inserted an IPP IUD, compared to 14.3% with RT.

CONCLUSION:

Ob/Gyn residents who train at programs with RT gain broader experience inserting LARCs than those who train at programs without RT.
Initiating and Monitoring a Postpartum Contraceptive Program [8N]
Authors: Lacy Megan , Monaco Alexandra , Zite Nikki B.
Published: May 2019

INTRODUCTION:

The University of Tennessee in Knoxville is a pilot site for a statewide initiative to provide immediate postpartum long-acting reversible contraception (IPP LARC) access with a patient-centered focus. The pilot includes tracking prenatal contraceptive counseling (CC), postpartum (PP) contraceptive plan on arrival and discharge, and IPP LARC utilization.

METHODS:

Electronic medical record (EMR) was upgraded in January 2018 to allow for a PP contraception quality improvement project. On admission, data points were collected related to prenatal CC and intended plan for PP contraception. Actual PP contraception obtained was documented upon discharge.

RESULTS:

From January 15 through August 30, 2018, 1,968 women delivered, 936 (47.6%) reported prenatal CC; data were missing for 601 (30.5%). Of women who had prenatal CC, 534 (57.1%) obtained planned PP contraception, 153 (16.3%) changed their plan, and data were missing for 249 (26.6%). Women who reported prenatal CC, obtained intended PP contraception more than those without prenatal CC (57.1% vs 9.0%). A total of 216 women reported IPP LARC as their desired plan, data were missing for 62 (28.7%), and 24 (11.1%) of women faced various barriers obtaining IPP LARC or changed their plan. When IPP LARC was the intended plan, women with prenatal CC had more success obtaining IPP LARC than women without prenatal CC (55.1% vs 5.1%).

CONCLUSION:

Data suggest prenatal CC aids in the success women have in obtaining desired contraception and IPP LARC. EMR changes highlighted the importance of prenatal CC. To improve analysis in the future, documentation within EMR can be addressed.
Domestic Violence in Pregnancy-Related Death: A Novel Use of Coroner and Criminal Data in Clark County, Nevada [9N]
Authors: Paul Anthea , Mahesan Arnold
Published: May 2019

INTRODUCTION:

Existing studies in the literature analyze self-reported domestic violence in pregnant women which may be underestimated in this vulnerable population. Our study explores novel use of autopsy in combination with criminal data to understand domestic violence trends in unnatural deaths in pregnant women.

METHODS:

Retrospective review of women referred to the Clark County medical examiner from 2000-2015 was conducted. Pregnancy was confirmed by autopsy diagnosis, and criminal records were obtained from the Clark County District Attorney's Office. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.

RESULTS:

7215 women in total were referred to the Clark County medical examiner. 67 women were found to be pregnant at the time of autopsy. 55% of the women that were pregnant at the time of death were victims of pregnancy-related unnatural death (PRUD). 27% of women who were victims of PRUD filed charges of domestic violence against their partners versus 3% who were victims of natural death (p=0.02). Also, 71% (n=5) of women >30 years were victims of PRUD filed charges of domestic violence compared with 13% of women <30 years (n=3) (p=0.04). The most common manner of death among the PRUD group was suicide in 35% (n=13) and 32% (n=12) had a criminal record.

CONCLUSION:

Domestic violence is significantly more prevalent in PRUD than in those who die of natural death. Further, older victims of PRUD were significantly more likely to file charges for domestic violence. The causes underlying these trends are unclear and deserve further attention and study.
Efficacy and Acceptability of an Intimate Partner Violence Workshop for Third-Year Medical Students [10N]
Authors: Cha Sandolsam , Chia Stephanie , Pollack Staci
Published: May 2019

INTRODUCTION:

Approximately 1 in 4 women have been physically and/or sexually assaulted by a current or former partner. Despite this prevalence, Only a fifth of medical students report an extensive training in addressing intimate partner violence. The objective of this study was to assess the efficacy of a practical workshop built into the OB/GYN clerkship.

METHODS:

A 1 hour curriculum with a flipped-classroom method was developed, which incorporated role-play, video clips, and the use of safety card handouts. The workshop was incorporated into the didactics schedule during the third year medical student's OB/GYN clerkship. A survey with 5 sections (background, knowledge, opinion, personal experience, and acceptability) was sent to gather feedback.

RESULTS:

51 medical students responded to the survey. 49% of the respondents were female. 78% had a prior lecture in IPV. While 39% stated that they feel fairly well prepared to ask questions regarding IPV, only 19% felt similarly prepared to appropriately respond to positive disclosure. The average score on a 10 true/false knowledge assessment was 8. 7.8% have personally experienced IPV. 76% felt it was important to be trained in addressing IPV, 50% felt there was adequate time to cover important topics, and 60.8% would strongly recommend the curriculum to a colleague. Overall, 90% were satisfied or very satisfied with the curriculum.

CONCLUSION:

A practical workshop during an OB/GYN clerkship increased students' confidence in addressing IPV, and was well-received. A follow-up study is assessing whether this curriculum translates to an increase in the number of patients screened and referred to resources.
Increasing Underrepresented Minority Access to Healthcare Professions through Pipeline Programming [14N]
Authors: Iyamu Georgina , North Ware Jamie L. , Looney Kimberly , Aguinaga Maria del Pilar
Published: May 2019

INTRODUCTION:

The Robert Wood Johnson Foundation Center for Health Policy (RWJF-CHP) at Meharry Medical College (MMC) partnered with a local high school to create a pipeline program that trains minority students enrolled in the Community Health Academy (CHA). The program provided clinical training to successfully pass the certified clinical medical assistant (CCMA) exam that allows trained professionals to perform clinical duties and assist providers in the healthcare setting. It is expected that these students will enroll in an undergraduate institution affiliated with MMC and ultimately matriculate into one of MMC's Professional Schools.

METHODS:

Twenty-five students were selected from 100 applicants by the CHA committee to participate in the one year pilot study. Students submitted resumes, personal statements, and were interviewed. Parental consents were obtained. The RWJF-CHP implemented clinical and educational training which included Science Symposiums, Clinical Internships, Medical Simulation Training, and Tutoring by Meharry faculty, residents, and students.

RESULTS:

Prior to 2017, 25/25 took the CCMA exam and did not pass it. In 2018, 20/25 passed the exam on their first attempt. The current passage rate for students after implementation of this pilot pipeline program for one year was 80%.

CONCLUSION:

Through this pipeline opportunity, students learned clinical skills and earned a certification necessary to work in the medical field. This project demonstrated that the pipeline model is effective in increasing minorities in the healthcare field. Further implications are to expand the model to include other high schools in the Nashville area.
Medical Student Perceptions Regarding Students Performing Pelvic Examinations on Anesthetized Female Patients [20N]
Authors: Rice Elizabeth , White Chase , Myers John , Ko Janet , Jaspan David , Goldberg Jay
Published: May 2019

INTRODUCTION:

The purpose of this study was to determine perceptions of medical students regarding their peers performing pelvic examinations on anesthetized female patients.

METHODS:

A survey was distributed to medical students at multiple medical schools. Demographic data were collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared using Chi-squared test for independence and the Fisher's Exact Test.

RESULTS:

220 medical students completed the questionnaire. 77% of medical students believed permission should be obtained from patients before the performance of pelvic examinations by medical students on anesthetized patients. Only 30% of respondents believed prior consent was usually obtained. 46% believed patients would agree to have EUAs performed. 85% of medical students believed patients would be upset if they were made aware a pelvic examination by a medical student had been performed without their prior consent. 60% of medical students believed medical students should be allowed to examine anesthetized patients. 87% of medical students believed there was educational benefit. 53% would recommend to a female relative to allow a medical student to perform a pelvic EUA on them.

CONCLUSION:

Despite the perception of medical students that consent should be obtained before they perform pelvic examinations on anesthetized female patients, this does not usually occur. Almost 50% of medical students would not encourage their female relatives to consent to medical students performing pelvic examinations. There was no statistical difference between male and female medical students regarding perceptions of student pelvic examinations on anesthetized female patients.
MAMA's Risk Stratified, Prenatal Medical Home Model Reduces Preterm Birth for African Americans in LA [22N]
Authors: Scibetta Emily , Greenwell Lisa , Moini Moraya , Jackson Ashaki , Trang Cassandra , Saleeby Erin
Published: May 2019

INTRODUCTION:

MAMA'S Neighborhood (MAMA's) in LA County (LAC) organizes prenatal care into a medical home model of wrap-around services. African American (AA) women are 48% more likely to experience PTB than non-Hispanic whites and experience myriad social stressors; MAMA's was designed to support women experiencing such stressors to reduce PTB risk. MAMA's implemented risk assessments at intake for behavioral health, substance use, housing/food insecurity and medical risk; and stratified risk groups to direct levels of care management and services to address these risks.

METHODS:

This is a retrospective cohort study, using single site data from a national demonstration project, to compare PTB rates for women in LAC during two phases: Phase 1: January 2014-August 2015, MAMA's introduced a novel risk assessment for social stressors and Phase 2: September 2015-December 2016, implemented risk-stratified population health management and individualized care planning. Multiple births were excluded. Multivariate logistic regression was performed and controlled for: medical comorbidities, smoking, race/ethnicity, age and prior PTB.

RESULTS:

Phase 1 included 441 women, compared to 435 in Phase 2. PTB among AA women dropped from 18% in Phase 1 to 9% in Phase 2. Regression reveals PTB among AA women was reduced when compared to controls with an adjusted odds ratio of 0.21 (CI 0.062-0.708), p<0.02.

CONCLUSION:

MAMA's made a clinically and statistically significant impact on PTB for AA women, a critical step in addressing the health equity gap. MAMA's represents a promising value-based strategy leveraging multidisciplinary collaborative care with existing social services in the safety net to improve birth outcomes.
Maternity Leave Length Impact on Breastfeeding and Postpartum Depression [29N]
Authors: Shumbusho Diane I. , Keyser Erin A.
Published: May 2019

INTRODUCTION:

To determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members.

METHODS:

An IRB approved survey of nine questions was given to patients at the Brooke Army Medical Center Obstetrics and Gynecology clinic. Patients were offered voluntary participation if they had delivered a baby while on active duty in the preceding 20 years. The survey included questions about length of maternity leave, duration of breastfeeding, age at delivery, route of delivery, and whether the patient suffered from postpartum depression.

RESULTS:

A total of 214 surveys were collected. Fisher's exact test was used to compare rates of breastfeeding and postpartum depression between the two groups. 87% of service members initiated breastfeeding. Among women who had 6 weeks versus 12 weeks of maternity leave, 51.64% versus 56.96% breastfed up to 6 months, p=0.45. The overall rate of postpartum depression was 13.5%. Among women who had 6 weeks versus 12 weeks of maternity leave, 16.1% versus 9.5% reported postpartum depression, p=0.11.

CONCLUSION:

The ideal maternity leave duration is unknown. With the recent change in the Department of Defense maternity leave policy, we aimed to evaluate the impact this had on breastfeeding and postpartum depression rates. No statistical difference was seen when we compared rates of breastfeeding and postpartum depression in women who had 6 versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding and diminish postpartum depression.
Establishing New Diagnostic Criteria for Early Gestational Diabetes Screening [30N]
Authors: Loehr Frederick W. , Mackeen Awathif D. , Paglia Michael J. , Nordberg Cara
Published: May 2019

INTRODUCTION:

Cutoff values for the one-hour, 50-g glucose test (Glucola) in early pregnancy are based on data from studies at 24-28 weeks. A value of 200 mg/dL is often used to give a diagnosis of GDM without further testing. The aim of this study was to establish a lower cutoff for the early Glucola over which women should receive an immediate diagnosis of GDM.

METHODS:

In this IRB-approved retrospective cohort study, the electronic medical records in the Geisinger system were searched between 1/1/2010 and 12/31/2016 for all women who had completed a Glucola prior to 20 weeks and all subsequent indicated testing. Women with a result of 130-199 mg/dL on the early Glucola went on to complete a three-hour 100-g glucose tolerance test. Women who were not diagnosed with GDM on early screening underwent routine screening after 24 weeks. The risk of developing GDM for a given early Glucola result was analyzed to identify another, potentially lower level, above which women should receive an immediate diagnosis of GDM without further testing.

RESULTS:

There were 3040 women identified as having completed an early Glucola and 631 women had a result between 130 and 199 mg/dL. 125 women were diagnosed with GDM at some point in the pregnancy. Increasing values for the early Glucola trended towards higher positive predictive values as would be expected. However, the positive predictive value never surpassed 32.4%.

CONCLUSION:

A change in practice where a lower glucose level is used to diagnose GDM from the early Glucola is currently not supported.
Mode of Delivery Among Physicians Practicing at a Teaching Hospital, Northern Ethiopia [34N]
Authors: Teka Hale , Yeman Awol , Hasan Abida , Ahmed Sumeya , Abate Ermias
Published: May 2019

INTRODUCTION:

The Ethiopian national cesarean section rate is about 2%, but rates of cesarean delivery (CD) vary widely among population segments suggesting unequal access. Within this context, the aim of this study was to assess the mode of delivery among physicians employed at Ayder Comprehensive Specialized Hospital.

METHODS:

This is an IRB-approved cross-sectional study. All female physicians who are parous (n = 11) and all male physicians whose spouses are parous (n = 60) were interviewed to evaluate the mode of delivery among them, and assess indications for CD.

RESULTS:

The CD rate among physicians and their spouses was 46.5% (n=33). 9 out of 10 female obstetrician/gynecologists and male obstetrician/gynecologists' spouses delivered via CD. Of those who had their baby delivered via CD, 22 (67%) believe that the CD was not done for appropriate indications. Only 10 (30%) of these would try labor or allow their spouse to attempt vaginal trial of labor after prior CD. The driving factors for CD among parturient physicians were; lack of trust in the process of intrapartum fetal monitoring (which is used without pattern interpretation), “uncertainty” of outcome of vaginal delivery, fear of labor pain (due to absence of labor analgesia), and managing obstetricians' fear of blame by their colleagues.

CONCLUSION:

This study revealed a disparity in CD for women who are physicians or physicians' spouses Vs general population. More revealing are the reasons why they underwent CD. Rate of CD may be decreased by winning the confidence of parturients through instituting appropriate intrapartum fetal monitoring and labor analgesia protocols.
Mommy Meltdown: A Look at the Prevalence of Postpartum Depression and Attitudes Towards Treatment Guidance [35N]
Authors: House Talelia , Spiryda Lisa Beth
Published: May 2019

INTRODUCTION:

One in seven women are affected by perinatal depression. Black and Hispanic women are amongst those affected the most, which has been said be influenced by socioeconomic and emotional disadvantage. The goal of this study is to determine the prevalence of postpartum depression (PPD) and look at the attitudes of minority women toward depression and treatment considerations.

METHODS:

This study is a prospective survey that was completed at the six week postpartum In addition to the Edinburgh Postnatal Depression Scale. All 18 years old and older and less than 8 weeks postpartum were invited to complete the survey. The primary outcome of our study is prevalence and attitudes toward depression.

RESULTS:

Our preliminary results show that approximately 20% of our patient population suffer from postpartum depression based on EPDS scores (Median Score: 8; Range 0-25). 40% of our patients identified as Black. There was no difference in EPDS score when data stratified by race, mode of delivery, NICU stay and complications of pregnancy. Regardless of race, patients were also open to treatment for PPD and feel comfortable discussing the topic with their families.

CONCLUSION:

PPD was common among our patient regardless of race. Both black and white women were open to discussing depression with their families and willing to accept treatment. By identifying the prevalence of PPD and attitudes toward depression and treatment, we are hoping to shed light on the growing epidemic in minority patients and move toward eliminating health disparities in mental health in our moms and moms-to-be.
More Blood Transfusions for Rural Women Delivering Low Risk Infants in the United States [37N]
Authors: Hartenbach Ellen , Hsiang-Hui Daphne Kuo , Greene Madelyne , Shrider Emily , Antony Kathleen M. , Ehrenthal Deborah
Published: May 2019

INTRODUCTION:

Maternal morbidity and mortality is on the rise in the United States. We sought to assess outcomes for women who live in rural areas.

METHODS:

We used 2014-2015 geocoded birth records from the National Center for Health Statistics (NCHS) to examine the rural-urban differences in blood transfusion among nulliparous women delivering singleton, vertex pregnancies at term. We compared transfusion rates across maternal county of residence defined by the six NCHS geographic categories. We conducted multivariable logistic regressions controlling for maternal age, race/ethnicity, nativity, education, WIC participation, insurance, prenatal care, BMI, pre-existing diabetes and hypertension, hepatitis, tobacco use during pregnancy, mode of delivery, gestational age and birthweight. Data were obtained through a data use agreement; the study was declared exempt by our Institutional Review Board.

RESULTS:

Among 2,538,994 eligible births, transfusion rates increased across the geographic categories from more urban to rural: large metropolitan-center (2.0 per 1,000 live births), large metropolitan-fringe (2.5), medium metropolitan (2.5), small metropolitan (2.6), micropolitan (4.6), and non-core/rural area (5.3). After adjusting for covariates, the odds of transfusion was higher among women living in rural (adjusted odds ratio 2.70, 95% CI 2.44-2.98) and micropolitan (adjusted odds ratio 2.39, 95% CI 2.19-2.61) counties when compared to women living in large central metropolitan counties.

CONCLUSION:

Our results suggest that the odds of blood transfusion is higher for women living in rural and micropolitan counties than those living in more urban settings. This may indicate rural-urban disparities in maternity health care access and quality and warrants further investigation.
Usability of Virtual Reality for Anxiety Reduction During First Trimester Dilation & Curettage: A Qualitative Study [5A]
Authors: Woodson Ryan , Zhang Shiliang , Sridhar Aparna
Published: May 2019

INTRODUCTION:

Recent innovation in virtual reality (VR) has generated increased interest in its potential use as an innovative and non-invasive method for managing patient anxiety and subsequently decreasing acute pain. We assessed the ability of immersive VR and its impact on perceived anxiety and pain among women presenting for a first-trimester in office surgical abortion.

METHODS:

Using purposive sampling methods, we recruited 15 women presenting for a first trimester surgical abortion. Participants were given a commercially available VR device to wear during the procedure. In-depth interviews were conducted post-surgery with participants to understand their experience using the VR device and any impact it had on their perceived anxiety and pain. The interviews were recorded, transcribed, and analyzed using grounded theory via Dedoose.

RESULTS:

Fourteen out of fifteen participants stated the VR device lessened their anxiety during the procedure. Described as a “distraction,” the VR experience helped participants to “feel calm and less anxious” during and even after the procedure. Six participants removed the device at some point during the procedure due to reasons related to pain, nausea, and a desire of wanting to see the procedure. Nine out of fifteen participants reported the VR device helped with pain reduction during the procedure.

CONCLUSION:

The results of this feasibility study suggest the potential for VR use and its three-dimensional experiences can help reduce perceived anxiety and pain among women undergoing a first trimester surgical abortion. Future studies will use these findings to elucidate VR's potential effect on anxiety and pain with experimental studies.