bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Hepatitis C Screening in Kentucky: Does a Change in the Law Change Clinical Practice? [14A]
Authors: Winter Kathleen
Published: April 2020

INTRODUCTION:

Prevalence of hepatitis C virus (HCV) infection among pregnant women is highest in Kentucky. ACOG endorses a risk-based approach for prenatal HCV screening; however gaps in identification can occur. In 2018, Kentucky became the first state nationwide to legislatively mandate universal HCV screening for all pregnant women.

METHODS:

This retrospective study evaluates trends of prenatal HCV testing before and after a universal HCV screening requirement. Women with an ICD-9/ICD-10 code indicating delivery at UK Healthcare (UKHC) in 2016 through 2018 were identified; those with laboratory results for HBsAg in the 10 months prior to delivery were considered to have had prenatal care within UKHC and included in the study cohort. Electronic medical records were reviewed to identify maternal characteristics and anti-HCV test results.

RESULTS:

Among 5,616 women with deliveries, 3,869 (69%) had documentation of prenatal HBsAg testing and included in the study cohort. Of these, 48 (1.2%) had a diagnosis of HCV infection and an additional 716 (19%) had prenatal anti-HCV testing. Among women screened for HCV, 179 (25%) were anti-HCV positive. A total of 363 women in the cohort had a diagnosis indicating illicit drug use; 53 (15%) were neither tested for HCV nor had an existing HCV diagnosis. Prevalence of prenatal HCV screening increased significantly from 18% at baseline to 31% among women who delivered after the universal screening legislation became effective (P<.0001).

CONCLUSION:

A significant increase in HCV testing was observed following the universal HCV screening legislation, however testing uptake remained low. Efforts to improve implementation are warranted.
The State of HPV Vaccination in Rhode Island: Qualifying Outcomes of a School Entry Vaccine Mandate [17A]
Authors: Froehlich Allison , Anand Rajsavi , Sarkar Indra Neil , Chen Elizabeth
Published: April 2020

INTRODUCTION:

In 2015, RI became one of two states and Washington, DC to mandate HPV vaccination for school entry and RI's is the only mandate to include boys. Previous studies have described longitudinal trends in HPV vaccination rates in RI but no studies to date have evaluated factors predictive of vaccine series completion. The goal of this project was to identify factors predictive of up-to-date HPV vaccination status in RI and evaluate how factors change in the face of an implemented mandate.

METHODS:

Data were extracted from the National Immunization Survey-Teen for years 2012–2017 and then transformed and analyzed in Julia. Binomial logistic regression modeling was applied to evaluate predictive factors related to up-to-date vaccination status for RI teens surrounding implementation of the school mandate.

RESULTS:

In the pre-mandate period, maternal education level and income level were predictive (p less than 0.05) of up-to-date vaccine status for girls. In the post-mandate period, maternal education level and income level remained predictive in addition to patient-reported provider recommendation for girls (p less than 0.05). No factors in the pre- or post-mandate period were predictive of up-to-date status for boys.

CONCLUSION:

Parent-reported provider recommendation was predictive of up-to-date HPV vaccination status for girls in RI in the setting of a vaccine mandate. Qualifying significant predictors of HPV vaccine series completion and effectiveness of provider recommendation is important at the individual and policy level for implementing, evaluating, and improving the efficacy of an opt-in versus opt-out structure of HPV vaccination.
Women's Attitudes Toward Vaccination During Preconception Care [19A]
Authors: Foley Elise , Marsh Courtney , Lydic Michael , Ault Kevin
Published: April 2020

INTRODUCTION:

Infection with Rubella or Varicella during pregnancy can have potentially lethal consequences to the fetus. Increasingly pervasive anti-vaccine beliefs make it even more critical for providers to assess adherence to MMR and Varicella vaccination, particularly in women attempting pregnancy. The primary outcome of this study was prevalence of non-immune status to Rubella and Varicella. Secondary measures were obtained from those with a negative immunity titer: self-reported attitudes, self-reported incidence of follow-up, recency of vaccine counseling and knowledge of CDC vaccination recommendations.

METHODS:

University of Kansas Health System Advanced Reproductive Care clinic patients from January 2017 through June 2019 with negative Rubella or Varicella titer results were invited to anonymously participate in an IRB approved survey.

RESULTS:

1,767 patient records were reviewed. Non-immune status to Rubella and Varicella represented 7.2% (n=124) and 4.5% (n=79) of records, respectively. Surveys administered to all non-immune patients achieved a 32.5% (n=65) response rate. A minority of respondents did not receive the recommended vaccines following a negative titer, reportedly not wishing to further delay fertility treatment. Most respondents stated that they would be open to further vaccine education from their providers (67.7%).

CONCLUSION:

The prevalence of Rubella non-immunity in the study population fell within the recognized range for sufficient herd immunity (less than 13%). Our results indicate that women have a generally positive attitude toward vaccine education during pre-conception counseling. The risk/benefit analysis of postponing fertility treatment to achieve adequate levels of immunity should be a focused discussion with patients in the setting of advanced reproductive care.
HCG and FSH Levels During Early Pregnancy and Reproductive Aging [24A]
Authors: Zinaman Michael J. , Johnson Sarah , Warren Graham
Published: April 2020

INTRODUCTION:

hCG has high sensitivity and specificity for pregnancy, but low levels of hCG are known to be co-produced with FSH during reproductive aging.

METHODS:

Women were recruited preconception to collect daily urine samples from menses to 30 days after conception (if they became pregnant). Day of LH surge was determined for each conception cycle. Samples were also collected from not pregnant pre-, peri- and post- menopausal women. hCG, FSH and LH were measured by AutoDELFIA. A total of 6475 pregnancy samples and 395 non pregnancy samples were examined to create reference ranges.

RESULTS:

In not pregnant women, both hCG and FSH levels increased with age category. Women aged 20–39, generally had no hCG (maximal amount 0.6 mIU/ml), with maximal FSH of 25.5 mIU/ml. In women aged 40-maximal hCG was 4.8 mIU/ml hCG with 234 mIU/ml FSH, for women aged 50+, maximal level was 6.5 mIU/ml hCG and 297 mIU/ml FSH. In pregnancy, median post ovulation levels hCG levels were; 0 mIU/ml at 6–10 days, 61 mIU/ml at 11–15 days, 617 mIU/ml at 16–10 days, 3216 mIU/ml at 21–25 days and 9930 mIU/ml at 26–30 days. FSH declined from a median of 1.7 mIU/ml (maximum 18.3 mIU/ml) 6–10 days post ovulation to a maximal level of 0.1 mIU/ml 26–30 days post ovulation.

CONCLUSION:

FSH remains very low throughout early pregnancy, with hCG rising exponentially. Detectable levels of hCG were seen in some women of peri- and post- menopausal age, with FSH levels showing significant elevation. Therefore, to rule out pregnancy in a peri-menopausal woman with low hCG levels, FSH could be examined.
The Limitations of Middle Cerebral Artery Peak Systolic Velocity and the Need for Certification [38A]
Authors: Mayer Christopher , Rijhsinghani Asha , Parikh Raina
Published: April 2020

INTRODUCTION:

In fetuses at risk for anemia, middle cerebral artery-peak systolic velocity (MCA-PSV) may have a 12% false-positive rate. Guidelines suggest MCA-PSV is superior to amniocentesis for detection of anemia, provided the correct technique is used. We aim to describe the limitations of MCA-PSV in the diagnosis of fetal anemia and the need for MCA-PSV certification for tertiary care fetal centers.

METHODS:

This is a university based single-center retrospective study of 47 sensitized pregnancies suspected to have fetal anemia that underwent amniocentesis. Fetal anemia was suspected on elevated MCA-PSV >1.5 MoM. Amniotic fluid ΔOD450 was measured in all pregnancies. Fetuses with amniotic fluid ΔOD450 in zone 3 on Liley's chart, underwent cordocentesis for the assessment of fetal anemia. Intrauterine fetal transfusion (IUT) was performed in fetuses confirmed with anemia. Fetal anemia indicating IUT was defined as ≥5 SD below the mean for GA and Hematocrit ≤30%.

RESULTS:

Among sensitized pregnancies with elevated fetal MCA-PSV, 19 (40.4%) had elevated ΔOD450 measurements. Of these 19 fetuses, 15 (78.9%) required IUT. In 28/47 (59.6%) with normal ΔOD450, elevated MCA-PSV incorrectly predicted fetal anemia, increasing the amniocentesis related risks. This is much higher than the published false positive results of 12%.

CONCLUSION:

The decreased specificity of MCA-PSV for fetal anemia diagnoses may be associated with user variability. While MCA-PSV has clinical benefit for the initial workup, the additional amniocentesis confirmation reduced the need for cordocentesis. Amniocentesis also has risks and to further reduce the need for invasive diagnostic testing, we recommend a Certification for MCA-PSV Doppler sonography.
Contraceptive Use Among Women With a History of Physical or Sexual Violence [01B]
Authors: Foxx Alexandra , Thompson Ivana S.
Published: April 2020

INTRODUCTION:

Physical and sexual violence often begins in women's early reproductive years and can have longstanding impact on their lives and reproductive choices. While studies demonstrate decreased rates of contraception use in women experiencing abuse or intimate partner violence (IPV), none have examined the effect of interpersonal violence on the use of specific contraception methods.

METHODS:

Using ICD-9 and ICD-10 medical billing codes, we identified reproductive aged women who experienced physical or sexual violence in our academic OB/GYN practice from 2000 to 2019. We examined their outpatient medical records to determine their most recently used contraceptive method. The control group was comprised of randomly selected reproductive aged women without a history of violence who received outpatient care with our practice in the study period. IRB# 191005.

RESULTS:

The contraceptive methods used by women who experienced physical or sexual violence were significantly different from the contraceptive methods used by women without a history of violence (P<.01). Survivors of violence were more likely to use no method of contraception (26.6% vs 14.0%, P<.05) or women-controlled permanent contraceptive methods (21.8% vs 12.5%, P<.05). Women who had not experienced violence were more likely to use combined hormonal methods (41.2% vs 24.2%, P<.01) and vasectomy (0% vs 6.6%, P<.05).

CONCLUSION:

There are differences in the general utilization of contraception and specific contraceptive methods used by women who have survived violence as compared to peers who have not experienced violence. Knowledge of these differences may benefit the counseling, education, and provision of contraception to this unique population.
Barriers to Obstetric and Gynecologic Care for Women Who Use Wheelchairs [10B]
Authors: Carney Madeline H. , Holt Lauren , Kumar Ambuj , Duncanson Lauren , Woodard Laurie , Mckeon Bri Anne
Published: April 2020

INTRODUCTION:

Individuals with disabilities face significant barriers to healthcare and are at a higher risk of receiving inadequate care. Specifically, women with disabilities are more likely to be behind on routine screening examinations including Pap tests and screening mammography. This project aims to identify and explain the barriers that prevent female wheelchair users from obtaining standard gynecologic health care.

METHODS:

This IRB approved qualitative study was conducted to evaluate the barriers associated with seeking gynecologic health care among female wheelchair users. We recruited English-speaking female participants ages 18 and older who primarily used a wheelchair for mobility through flyer distribution and word of mouth. Interviews were conducted by a single investigator using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes.

RESULTS:

The thematic saturation was achieved with sixteen interviews. The most common barrier cited was lack of proper positioning on the exam table to perform a pelvic exam (n=13). Furthermore, another common theme was that women felt that their providers lacked knowledge and experience with women who use wheelchairs (n=13).

CONCLUSION:

There are many barriers to OB/GYN care for women who use wheelchairs. This study has identified how current knowledge, attitudes, practices, and existing infrastructure serve as barriers to gynecologic care. Interventions are needed to improve accessibility to care for women who use wheelchairs.
Does Fibroid Size and Bulk Affect Uterine Fibroid Symptom (UFS) Scores in Asian Compared to Caucasian Women? [13B]
Authors: Dhanani Zainub , Ramirez Norma Jimenez , Ghanouni Pejman , Chen Bertha
Published: April 2020

INTRODUCTION:

Uterine fibroids commonly cause pelvic symptoms, abnormal uterine bleeding, and urinary symptoms. According to past UFS data analysis, Asian women report significantly lower symptoms compared to Caucasians. Etiology of this difference has not been studied and may impact early detection and treatment for Asian women. Differences in fibroid burden, clinical risk factors and parity between Asians and Caucasians may correlate to the difference in UFS scores. We examined correlations between race and fibroid symptom severity using MRI and patient clinical data.

METHODS:

A retrospective cohort study (2013–2016) of Stanford Fibroid Clinic patients identified Caucasians (n=146) and Asians (n=123) with completed UFS surveys and pelvic MRIs. UFS scores and subscores, MRI data, clinical risk factors, and parity were correlated to race. Data were analyzed using Pearson's T-test and Chi squared analysis.

RESULTS:

Asians had significantly lower BMI values (P=5.31e-09) and were more likely nonsmokers (P=.003) vs Caucasians. Asians were less likely to report pain (P=.010), urinary frequency (P=.032) and urinary stress incontinence (P=.045). There was no significant difference in fibroid burden between groups (P=.618).

CONCLUSION:

Significant differences in BMI and smoking history may contribute to observed UFS score differences between Asian and Caucasian women, as both have been correlated to increased symptom severity of uterine fibroids in past studies. Conversely, fibroid burden and parity are not associated with the differential symptom experience. Further study of cultural and social factors, and biochemical and inflammatory markers between Asian and Caucasian women with uterine fibroids is necessary to interpret the observed symptom differences.
Effect of Elagolix on Menstrual Blood Loss in Women With Uterine Fibroids and Adenomyosis [15B]
Authors: Muneyyirci-Delale Ozgul , Bradley Linda D. , Kim Jin Hee , Wang Hui , Owens Charlotte , Simon James A.
Published: April 2020

INTRODUCTION:

Evaluate the efficacy of elagolix with add-back therapy on menstrual blood loss (MBL) and safety in women with uterine fibroids (UF), heavy menstrual bleeding (HMB) and adenomyosis.

METHODS:

Pooled data from two investigational, IRB approved, 6-month, randomized, double-blind, placebo-controlled phase 3 studies, Elaris UF-1 and UF-2, was used to conduct a subset analysis in premenopausal women (18–51 years) with HMB (>80mL MBL/cycle) associated with UF and baseline adenomyosis diagnosed by ultrasound and/or MRI. Primary endpoint was the proportion of women with <80mL MBL during the final month and ≥50% reduction in MBL from baseline to final month. Secondary and other efficacy endpoints included proportion of women who achieved amenorrhea or suppression of bleeding during the final month. MBL was assessed with alkaline hematin method. Adverse events (AEs) and bone mineral density (BMD) were monitored.

RESULTS:

Of 790 women treated, 126 (16%) had adenomyosis at baseline. Proportion of responders for the primary endpoint was significantly greater (P<.001) for elagolix+E2/NETA [76.8% (95% CI 65.84, 87.82)] compared to placebo [12.1% (95% CI 0.97, 23.15)]. Responder rate was significantly greater (P<.001) for elagolix+E2/NETA versus placebo for amenorrhea and suppression of bleeding. These results, along with AEs and mean change in lumbar BMD from baseline to month 6, were consistent with the all-subject group.

CONCLUSION:

In women with HMB associated with UF and co-existing adenomyosis at baseline, elagolix +E2/NETA significantly reduced MBL versus placebo similar to the all-subject group suggesting that elagolix is effective in reducing HMB in women with UF despite the presence of adenomyosis.
Effect of Prunes on Gastrointestinal Function After Benign Gynecological Surgery: A Randomized Control Trial [16B]
Authors: Rasouli Melody , Ozel Begum , Dancz Christina
Published: April 2020

INTRODUCTION:

To investigate the effect of postoperative prune consumption on time to first bowel movement after benign gynecologic surgery.

METHODS:

In this randomized controlled trial, women who had benign gynecologic surgery who gave informed consent were allocated to either postoperative prune consumption for 3 days or standard care. Inclusion criteria was women over 18 years of age. Exclusion criteria included malignancy, bowel surgery, prior laxative use and diabetes mellitus. The study's primary objective was time to first bowel movement (BM). Secondary objectives were pain associated with first bowel movement, stool consistency using Bristol stool scale, and patient satisfaction.

RESULTS:

77 subjects were randomized (38 to prunes and 39 to controls). Complete data was available for 65% of subjects. Seven women in the control group and none in the prune group reported no bowel movement in the study period of 72 hours (P<.05). There was no difference in groups with respect to satisfaction with surgery, pain with first BM, stool consistency, satisfaction with bowel regimen or need for additional laxative use. Subgroup analysis of those who reported actual use (>24 prunes over 3 days) showed that the prune group were more likely to report a BM in the study period (P=.014), had looser stool consistency (P=.056) and were discharged slightly earlier (POD1 vs POD 2, P=.057).

CONCLUSION:

The addition of prunes to the post op bowel regimen results in greater percentage of women having a bowel movement in the first 72 hours.
Factors Associated With Variation in Vaginal Hysterectomy Rates in an Integrated Health Care System [18B]
Authors: Kandahari Nazineen , Tucker Lue-Yen , Ojo Anthonia , Zaritsky Eve
Published: April 2020

INTRODUCTION:

Though ACOG endorses vaginal hysterectomy (VH) as the preferred surgical route for benign conditions, this has yet to be consistently translated into practice. We aimed to assess how much variation in VH rates are associated with patient characteristics and modifiable provider factors.

METHODS:

We conducted a retrospective cohort study of minimally invasive hysterectomies done for benign conditions at Kaiser Permanente Northern California from 2008 to 2018. We analyzed the proportion of surgical routes and outcomes, and the association between surgical route, patient characteristics, and provider characteristics using multivariable logistic regression.

RESULTS:

From 2008 to 2018, 44,379 hysterectomies were performed. The minimally invasive hysterectomy rates increased from 41.0% in 2008 to 97.0% in 2018 (P<.0001). VH rates varied from year to year but decreased overall from the highest rate of 27.5% in 2009 to 21.9% in 2018 (P<.0001). The rates by hospital ranged from 19.0% to 43.6%. VH rates were significantly lower than laparoscopic hysterectomy (LH) rates in patients who were obese and severely obese (P<.0001), were African American, or had uterine weights >500g (P<.0001). Differences by hospital persisted after controlling for uterine weight (P<.0001). Mean (±SD) surgery time was shorter for VH vs LH (2.2 (±1) vs 2.6 (±1.1) hours respectively, P<.0001). Mean (±SD) hospital stay decreased over time for VH from 37.8 (±21.5) to 7.7 (±11.5) hours (P<.0001). Operative and perioperative complications were low and comparable for all routes and years.

CONCLUSION:

There is large variation in VH rates by hospital after controlling for patient characteristics, demonstrating the need for evidence-based guidelines for route selection.
Heavy Menstrual Bleeding and Underlying Coagulopathy in an Adolescent Hematology Clinic [19B]
Authors: Mulvaney Kylie T. , Nelson Anita L. , Escovedo Michelle , Borzutzky Claudia
Published: April 2020

INTRODUCTION:

Current literature and guidelines suggest evaluation for underlying coagulopathy among adolescents who report heavy menstrual bleeding (HMB). Adolescent women with HMB are found to have higher prevalence of coagulopathy than the general population. Our study highlights the prevalence of hemostatic disorders among adolescents referred to a specialty adolescent hematology clinic for evaluation of HMB.

METHODS:

This study is a retrospective chart review of women <22 years seen in a joint Adolescent Medicine and Hematology clinic at Children's Hospital Los Angeles from January 1, 2015 to May 22, 2018. The primary inclusion factor was referral for anemia and reported HMB. Following IRB approval, data was collected on menstrual history and diagnosis of coagulopathy.

RESULTS:

Of 109 referred, 37 (34%) patients were found to have underlying coagulopathy; most commonly diagnosed was von Willebrand Disease (17.4%) then platelet dysfunction (15.6%); 1 patient was diagnosed with hereditary hemorrhagic telangiectasia. Not all patients presented with chronic HMB; 2 patients had histories of a single prolonged menstrual bleeding episode requiring hospitalization, 3 patients had anemia but normal menses, and 3 patients with anemia had prolonged menses but normal flow. The impact of severe HMB on health care utilization was notable; 47 had required prolonged ER stays in the past (43%); 27 required transfusion (25%).

CONCLUSION:

Our results showed 34% prevalence of underlying coagulopathy among adolescents referred for HMB, which mirrors existing literature. Our findings reiterate the importance of evaluating the source of HMB through formal testing; menstrual history may not be sufficient in the adolescent population.
How Does Labia Minora Labiaplasty Surgery Impact Patients' Perceptions of Their Genitals? [20B]
Authors: Hailparn Troy R.
Published: April 2020

INTRODUCTION:

Labia Minora Labiaplasty (LmL) surgery is sought after for comfort, function and appearance concerns but little is documented on how these surgeries affect women's perceptions of their genitals.

METHODS:

The impact of LmL on patients' perceptions of their genitals was evaluated using the Female Genital Self-Image Scale (FGSIS). Patients who underwent LmL were asked to fill out the FGSIS before and after surgery from August 2011 to May 2019. The Scores ranged from 7 to 28. The higher the score the more positive the perception. Pre- and Post-op scores were directly compared. Testimonials were collected.

RESULTS:

N=231 underwent LmL surgery and filled out the Pre-Op Questionnaires (Qs). The pre-op scores ranged from 7 to 26, mean score equaled 15.02 and the median pre-op score was 15. For N=217 who completed the Post-Op Qs, post-op scores ranged from 14 to 28 with mean post-op score of 25.45 and median score of 27. Twenty-one patients required a second procedure with higher FGSIS scores after the second procedure. The difference between the pre-op (CI 14.51, 15.52) and post-op (CI 25.02, 25.95) scores was strongly statistically significant (on the average 10 points higher) with a P-value=2.2 × 10−16.

CONCLUSION:

Labiaplasty surgery appears to have a positive impact on patients' perceptions of their genitalia using the FGSIS and testimonials. Labiaplasty surgery improves quality of life for women of all ages. The FGSIS can be a useful tool for practitioners to assess the success of LmL surgery.
Linzagolix for Endometriosis-Associated Pain: Lipid Changes After 52 Weeks of Treatment [25B]
Authors: Bestel Elke , Gotteland Jean-Pierre , Donnez Jacques , Taylor Robert N. , Garner Elizabeth I.
Published: April 2020

INTRODUCTION:

Linzagolix is a new, investigational, non-peptide, GnRH receptor antagonist being developed to treat endometriosis-associated pain (EAP). The EDELWEISS trial was a Phase 2b, double-blind, randomized, placebo-controlled, multicenter, dose-ranging trial in USA and Europe evaluating once daily oral doses of 50, 75, 100 and 200 mg for up to 52 weeks. Subjects randomized to placebo were crossed over to 100 mg after 12 weeks and those randomized to 200 mg were crossed over to 100 mg after 24 weeks.

METHODS:

IRB approval was obtained. Participants were women with surgically confirmed endometriosis and moderate to severe EAP. Changes in serum lipids were assessed up to 52 weeks.

RESULTS:

327 patients were randomized and treated. Mean age was 32 years and mean BMI was 26. There were small percentage increases in LDL-cholesterol (C), HDL-C, LDL-C/HDL-C ratio and triglycerides, which did not increase further at 24 and 52 weeks. Except for LDL-C/HDL-C ratio, the largest increases were observed in the linzagolix 200 mg dose group; at week 24 there was an approximately 8% increase in HDL-C, 10% increase in LDL-C and 24% increase in triglycerides. In all treatment groups, the percentage of women with LDL-C > 160 mg/dL or triglycerides > 200 mg/dL at 24 weeks less than 10% and overall the percentages were similar to baseline.

CONCLUSION:

Linzagolix doses of 75 to 200 mg taken once daily for 52 weeks resulted in small percentage increases in serum lipids after 12 weeks, which did not increase further after 52 weeks of treatment.
Malignant Testicular Germ Cell Tumor in Late Adolescent With Androgen Insensitivity Syndrome [26B]
Authors: Cruz Burgos Rosa I. , Rodriguez Gonzalez Zaskia M. , Bosch Ramirez Agnes M. , Mejias Jorge
Published: April 2020

INTRODUCTION:

Androgen receptor mutations located in the X chromosome may present as several clinical disorders. When total function of the androgen receptor is loss in a male, complete androgen insensitivity syndrome develops. A phenotypically normal appearing female develops without uterus, fallopian tubes, short vagina and bilateral intraperitoneal testes. Germ cell neoplasia may develop and the risk of developing malignant germ cell tumor is approximately a 5% that gradually increases after puberty. Although gonadectomy is the actual management, there is no consensus about the specific timing for gonadectomy or risk of developing malignant germ cell tumor by age.

METHODS:

IRB, Consent.

RESULTS:

15-year-old girl with primary amenorrhea, no relevant medical history and Tanner stage four for breast and pubic hair. Complete androgen insensitivity syndrome was diagnosed by means of transabdominal ultrasound, normal male testosterone levels and karyotype 46XY. Laparoscopic gonadectomy was performed at 18-year-old due to loss of follow up. Pathology with immunohistochemistry reported bilateral germ cell neoplasia in situ and unilateral seminoma.

CONCLUSION:

This case presents with an early development of a seminoma and appoints to reconsider an earlier post pubertal gonadectomy. A 30% risk of developing malignant germ cell tumor in late adulthood also supports the decision for an earlier gonadectomy. This case challenges the typical presentation of a female patient with complete androgen insensitivity syndrome, due to a clinical presentation with adequate tanner stage development. Considerations must be taken into account when dealing with a non-compliant patient, addressing the traditional timeline management to a more individualized clinical evaluation and prompt management.
Menstrual Hygiene Needs Among Women Receiving Substance Use Disorder Treatment [27B]
Authors: Keiser Victoria , Parlier-Ahmad Anna Beth , Martin Caitlin E.
Published: April 2020

INTRODUCTION:

Recent research has highlighted the high unmet menstrual hygiene product needs among low income women. The aim of this study was to evaluate the menstrual hygiene needs of women receiving treatment for substance use disorders (SUD).

METHODS:

Patients were recruited from an urban, outpatient SUD clinic to complete a voluntary, electronic, cross-sectional survey between July and September 2019. Menstrual hygiene questions were modeled from prior work (Kuhlmann et al., Obstetrics and Gynecology, February 2019) with author permission. Women were classified as having menstrual poverty if they reported needing menstrual hygiene products but not having the money to buy them in the past 12 months. Factors associated with menstrual poverty were assessed using χ2 tests. Exempted by VCU IRB.

RESULTS:

Eighty-six (94.5% response rate) women completed the survey, of whom 36 (41.9%) had a period in the past 12 months and were included in the study. Almost all (94.4%) were in treatment for opioid use disorder. Mean age was 34.69 (SD 7.433) years. Women were predominantly African American (50%), educated at a high school level (55.6%), unemployed (55.6%), and receiving public assistance (66.7%). Most (n=29; 80.6%) reported menstrual poverty. Menstrual poverty was not associated with heavy menstrual bleeding but was associated with food insecurity (P=.005). Many (n=23; 63.9%) stated they would like to receive hygiene products at the addiction clinic.

CONCLUSION:

Menstrual hygiene products are a necessity that women receiving addiction treatment lack. In the opioid crisis, providers should be aware of this disparity. Integration of reproductive/sexual health with addiction services should be prioritized.
Perioperative Blood Transfusions: Risk Factors for Patients Undergoing Hysterectomy for Benign Disease [29B]
Authors: Timmons Douglas , Grady Mary , Lederer Madeline , Ulker Ashley , Verna Ayita , Carugno Jose
Published: April 2020

INTRODUCTION:

Perioperative blood transfusion increases morbidity and increases significantly health care cost. Identifying risk factors for perioperative blood transfusion can help to minimize risks. Our objective was to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign indications.

METHODS:

We completed a retrospective chart review of patients who had undergone abdominal, laparoscopic, or vaginal hysterectomy. The following risk factors for blood transfusion were analyzed, 1. Route of Hysterectomy 2. Patient's BMI 3. Presence of adhesions 4. History of Cesarean Section 5. Uterine weight. Descriptive statistic was used to analyze the data.

RESULTS:

517 charts were reviewed. Forty-seven patients (9.09%) received perioperative blood transfusion. The route of hysterectomy was as follows: TAH: 34/263 (12.92%), TLH: 5/119 (4.2%), LAVH: 3/35 (8.57%), and VH: 5/100 (5.0%). Abdominal hysterectomy was a significant risk factor for receiving blood transfusions (P=.017). The patients who needed blood transfusion had larger BMI 33.01 vs 29.5 (P=.002), larger uterine weight 933.4 gm vs 542.5 gm (P=.002). There was no association between the presence of adhesions (P=.91) nor history of cesarean section (P=.89) with the need to receive blood transfusion. When analyzing only the patients who underwent TLH, pelvic adhesions was found as a risk factor for perioperative blood transfusion (P=.024).

CONCLUSION:

Blood transfusion is a frequent complication in patients undergoing hysterectomy for benign disease. Having a large uterus and obesity are risk factors for the need to receive blood transfusion. The presence of pelvic adhesion was risk factor for blood transfusion only in patients undergoing a laparoscopic approach.
Racial and Ethnic Disparities in Hysterectomies for Leiomyomas by Surgical Approach [31B]
Authors: Ko Jamie S. , Suh Christina H. , Huang Huang , Zhuo Haoran , Harmanli Oz , Zhang Yawei
Published: April 2020

INTRODUCTION:

Overall, minority women are at higher risk of complications after hysterectomy. This is partly explained by lower utilization of minimally invasive hysterectomy and higher prevalence of leiomyomas. Our objective was to evaluate the association between race/ethnicity and postoperative complications among patients undergoing abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH) specifically for leiomyomas.

METHODS:

Using the American College of Surgeons National Quality Improvement Program database 2014–2017, we identified 20,133 women who underwent non-emergent hysterectomy for leiomyomas. Using multivariate logistic regression, we estimated odds ratios (OR) and 95% confidence intervals controlling for age, body mass index, comorbidities, uterine weight, prior abdominal/pelvic surgeries, and concomitant surgical procedures. IRB approval was waived.

RESULTS:

Black women were more likely to experience complications for AH (aOR 1.54 [1.32–1.80]) and LH (aOR 1.38 [1.17–1.64]), but not for VH (aOR 1.44 [0.92–2.28]) compared to white women. Hispanic women were more likely to receive blood transfusions when undergoing AH (aOR 1.43 [1.07–1.91]) or LH (aOR 2.17 [1.37–3.45]), but their risk of total complications was not different from white women for any surgical approach, and they were less likely than their white counterparts to experience major complications when undergoing VH (aOR 0.27 [0.08–0.89]). Compared to white women, the mean length of stay is higher for black women undergoing AH or LH, and the mean total operation time is higher for all minority groups (including Asian/Other) regardless of surgical approach.

CONCLUSION:

Significant racial/ethnic disparities exist among women undergoing hysterectomy for leiomyomas via the abdominal and laparoscopic approaches but not vaginal.
Trend of Uterine Rupture and Different Approaches of Myomectomy [35B]
Authors: Badeghiesh Ahmad , Gil Yaron , Suarthana Eva , Mansour Fady , Volodarsky-Perel Alexander , Tulandi Togas
Published: April 2020

INTRODUCTION:

Uterine rupture is an uncommon typically occurring during pregnancy or labor. One of the risk factors in uterine rupture is previous myomectomy either by laparoscopy or laparotomy. Due to regulation of FDA on myoma morcellation, many gynecologists have returned to myomectomy by laparotomy. The purpose of the study was to evaluate this shift in surgical trends and the possible subsequent changes in number of uterine ruptures over the years.

METHODS:

Retrospective cohort study using the HCUP-NIS database. Our cohort consisted of women, aged 18 – 40 years, who underwent myomectomy by laparoscopy or laparotomy, and who suffered uterine rupture during pregnancy or labor between 2005 and 2014.

RESULTS:

Of a total 54,146 myomectomies, there were 237 uterine ruptures. The mean age of the patients was 31.8 years, they were mainly Caucasians, had private insurance and had high income. The myomectomy was performed mainly by laparotomy (97.7%); and 2.3% by laparoscopy. There was a decrease of total number of myomectomies performed annually, from 6646 in 2005 to 4589 in 2014. The numbers of uterine ruptures per 1,000 myomectomies were 4.2 after laparotomy and 10.6 after laparoscopic approach. Laparoscopic myomectomy increased the risk of uterine rupture by 2.3 fold [OR 2.3, 95% CI 1.2–4.2, P=.008] compared to open myomectomy after adjustment for sociodemographic and clinical characteristics.

CONCLUSION:

The myomectomies trend changed in recent years with a predominance of laparotomies over laparoscopies. Laparoscopic myomectomy increases the chance for uterine rupture with over 2 folds compared to open approach. More studies are needed to clarify this matter.
What Are Our Postoperative Hysterectomy Patients Sharing on Social Media? [37B]
Authors: Onyechi Elizabeth , Sharma Deepti , Mirtsching Drennen S. , Hoffman Mark
Published: April 2020

INTRODUCTION:

Millions of people use social media to share their experiences, including healthcare experiences. Data on what patients actually post is lacking. This study attempts to better understand the experience of patients, as well as examine who is posting on these platforms.

METHODS:

Two popular search terms were identified: #hysterectomyrecovery and #hysterectomypostop. The most recent Instagram, Twitter, and YouTube posts were reviewed. Authorship of the post was determined based on the bio of the poster and classified as patient, provider, advertisement, organization/institution, or unclassified. For patient posts, theses were further analyzed based on language/content of the post for tone: positive, neutral, or negative.

RESULTS:

Authorship of posts varied by platform. Identified Instagram posts were 64% by patients, 17% advertisements, 17% organization/institution, and 1% unclassified. 100% of Twitter posts originated from patients. YouTube posts were 47% patient and 47% healthcare provider. Tone of posts also varied by platform. 69% of Instagram posts were positive versus 15% negative. 83% of Twitter posts were positive versus 9% negative. 50% of YouTube posts were positive versus 43% negative.

CONCLUSION:

There are many posts about hysterectomy post-op and recovery on different platforms. Twitter and Instagram tend to have more patient-driven posts, whereas YouTube has equal patient and provider posts. Patients tend to have more positive tone related to hysterectomy experience on YouTube, Instagram, and Twitter, in increasing order. Prevailing wisdom suggests that social media draws negative attention to healthcare. Our study would suggest that while most of the posts on social media platforms were patient-driven, the majority were positive.
Outpatient Cervical Ripening With a Balloon Catheter: Systematic Review and Meta-analysis [38B]
Authors: Pierce-Williams Rebecca , Harper Lorie , Kuper Spencer , Sciscione Anthony , Berghella Vincenzo , Lesser Henry
Published: April 2020

INTRODUCTION:

To evaluate the difference in time on Labor and Delivery with outpatient versus inpatient cervical ripening with a balloon catheter in low-risk women.

METHODS:

This was a systematic review and meta-analysis including only randomized controlled trials (RCTs). Electronic databases (PubMed, Scopus, and Cochrane Central Register of Controlled Trials) were searched for eligible articles from inception to July 2019. Those not comparing balloon use in both arms of the RCT were excluded. The reference lists of identified articles were examined to identify additional studies.

RESULTS:

Four RCTs, including 418 women, met inclusion criteria. Only one RCT directly compared balloon only cervical ripening in the two arms. Two RCT protocols allowed for use of prostaglandins after the balloon if amniotomy was unacceptable or for Bishop score <6. In one RCT, oxytocin was administered to the inpatient arm. The mean difference in time on Labor and Delivery when comparing the outpatient to inpatient groups was -5.39 hours (95% confidence interval (CI) -7.14 to -3.64). Among three studies with available data, there was no difference in duration of oxytocin use (mean difference 1.17 hours, 95% CI -0.16 to 2.50). The outpatient group was significantly more likely to deliver vaginally than the inpatient group (Odds Ratio 2.1, 95% CI 1.31 to 3.37).

CONCLUSION:

Based on this analysis, outpatient cervical ripening with a balloon catheter in low-risk women is associated with a decreased amount of time spent on Labor and Delivery and increased rates of vaginal birth. This will likely translate into decreased hospital costs and improved patient outcomes.
Rethinking Meningitis in Pregnancy: Meningitis Presenting as Dysarthria and Otalgia at 28 Weeks Gestation [39B]
Authors: Palmieri Alicia J. , Giglio Alexandra
Published: April 2020

INTRODUCTION:

Bacterial meningitis is a rare, life-threatening disease with an incidence in the general population of 2.6–6 cases per 100,000 adults, and is even rarer in pregnancy. A study suggests that bacterial meningitis has an estimated mortality rate of >20% in adults.

METHODS:

A 27-year-old G1 at 28 weeks gestation presented with complaints of headache, fever, and difficulty speaking. Patient was reporting symptoms of otitis infection. On admission, patient's mental status declined, requiring intubation and sedation. Patient was febrile and had a leukocytosis. Lumbar puncture and blood cultures grew Streptococcus pneumonia. On admission, patient was started on broad spectrum antibiotics, which were switched to meropenem based on sensitivities. Secondary to CT evidence of increased intracranial pressure, an intracranial pressure catheter was placed. Fetal status was reassuring throughout hospitalization. Patient was intubated for 9 days before self-extubating. Patient showed clinical improvement and was discharged home after 16 days of inpatient treatment. Patient went on to deliver a full-term liveborn male neonate via normal spontaneous vaginal delivery.

CONCLUSION:

An observational study, showed that bacterial meningitis in pregnancy does not typically present with the typical clinical triad of fever, neck stiffness, and headache, but rather with headache (87%), altered mental status (73%), fever (60%), and signs of otitis infection (60%) [PMID 22925078]. These symptoms tend to be vague and difficult to decipher, but prompt diagnosis and treatment is crucial in maternal survival. This case report supports the most commonly associated symptoms found in patients with bacterial meningitis in pregnancy.
#BlackBreastsMatter: A Social Media Intervention Study to Increase Breastfeeding Among African-American Women [01C]
Authors: Oluloro Ann , Dauphin Cassy , Saad-Harfouche Frances , Deborah Erwin , Joseph Denagy
Published: April 2020

INTRODUCTION:

Breastfeeding reduces the risk of breast cancer. Disparities exist in breastfeeding with about 59% of African-American infants ever being breastfed versus 75% of white infants. One possible explanation is that African-American women may not be discussing benefits of breastfeeding. Thus, this pilot study explores the use of social media to engage pregnant African-American women in education about breastfeeding and to test its impact on breastfeeding outcomes.

METHODS:

This study was a randomized intervention enrolling eligible African-American women in Buffalo over 18 months into one of two private Facebook groups. The intervention arm received breastfeeding plus breast cancer risk-reduction messaging while the control arm received messaging about breastfeeding alone. A subset of the intervention and control arms failed to join the assigned Facebook group thus creating “true controls” for the study. Participants completed pre- and post-birth assessments.

RESULTS:

288 women (N=135 in intervention arm, N=153 in control arm) were randomized into the study. Pre-birth, 76.7% of true controls, 74.7% of breastfeeding-only, and 85.9% of the intervention-group were planning to breastfeed, but, respectively, only 24.6%, 34.6%, and 32.9% exclusively breastfeed post-birth. Breast cancer risk perceptions did not differ between pre-birth and post-birth for the intervention group. The percentage of controls who responded that their risk was “very low” or “somewhat low” significantly increased from 61.5% at pre-birth to 80.0% at post-birth.

CONCLUSION:

Exclusive breastfeeding is high among groups receiving social media messaging. Therefore, continued and improved efforts should be made to use social media to promote breastfeeding and its benefits.
A Quality Improvement Project for Care Transitions of Incarcerated Women [03C]
Authors: Davis Katherine M. , Tolleson-Rinehart Sue , Knittel Andrea K.
Published: April 2020

INTRODUCTION:

Currently incarcerated pregnant women face significant barriers when they seek health care services within prisons and jails, but little is known about transitions from state prison health care systems to outside hospitals.

METHODS:

With the goal of developing a policy to improve these transitions, we conducted in-depth interviews with key stakeholders at a state prison, university hospital, and local private hospital to identify the barriers and facilitators to care transitions for incarcerated pregnant women.

RESULTS:

Key themes emerging from the interviews were operational, including transfer of medical records, communication between systems, and education of providers, and structural, including care of marginalized populations and implicit biases.

CONCLUSION:

Policy changes to improve transitions of care may include the addition of a dedicated pregnancy care coordinator and a standardization of a clinician-to-clinician sign-out process. This work has the potential to motivate changes to the policies that govern care of incarcerated pregnant women, and stimulate the delivery of more effective and efficient health care to this population.
Association of FQHC Expansion With Birth Weight Outcomes by Race and Neighborhood Segregation [07C]
Authors: Debbink Michelle , McClurg Asha B.
Published: April 2020

INTRODUCTION:

Racial and spatial disparities in low birth weight (LBW) are well described. Neighborhood-level healthcare access may represent one pathway producing racial birthweight disparities. We assessed relationships between federally qualified health center (FQHC) expansion under the Affordable Care Act and LBW by race and segregation.

METHODS:

Retrospective cohort study of singleton births in Los Angeles County, 2009–2016. We geocoded births to Census Tract (CT) using vital records residential addresses. We calculated FQHC density by number of 10-mile driving radii around an FQHC that intersect a CT. We measured residential racial/economic segregation using Index of Concentration at Extremes (ICE). We used adjusted logistic regression models to estimate relationships between FQHC density and LBW by maternal race and segregation.

RESULTS:

A total of 967,491 births were included. LBW rates decreased over the study period, but racial disparities persisted. Women living in segregated neighborhoods (aOR 3.25; 95% CI 3.14–3.36), particularly black women (aOR 7.08; 95% CI 5.94 – 8.45), had greater odds of delivering a LBW infant. FQHC density increased by a median of 8 FQHC areas per CT (Mann-Kendall test-of-trend P<.001). The top-quartile CT for FQHC expansion was associated with decreased odds of LBW (aOR 0.67; 95% CI 0.65–0.68). Stratified by race and segregation, LBW odds decreased 37% (aOR 0.63; 95% CI 0.55–0.73) among black women and 56% (aOR 0.44; 95% CI 0.35–0.56) among black women in segregated neighborhoods.

CONCLUSION:

FQHC expansion in LA County decreased the odds of LBW for all women, particularly black women living in segregated neighborhoods.