bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the Frequency of Postpartum Depression in Marijuana Users With and Without a History of Depression [A226]
Authors: Richards Ria , Benedict Jason , Lynch Courtney , Schaffir Jonathan
Published: June 2022

INTRODUCTION:

Existing literature suggests an association between marijuana use in pregnancy and postpartum depression (PPD). We looked closer at this association by examining the role of depression history.

METHODS:

Institutional review board approval was attained. We conducted a retrospective cohort study of patients receiving perinatal care at an academic medical center between January 2017 and December 2019. Inclusion criteria included: delivery of a live-born infant at ≥24 weeks, no history of or current opioid dependence, and available Edinburgh Postnatal Depression Scale (EPDS). Marijuana use was self-reported. Screen positive for PPD was defined as scoring 10 or higher on the EPDS. Modified Poisson regression was used to calculate the relative risk (RR) of screening positive for depression.

RESULTS:

A total of 250 women were included in this analysis. Most were non-Hispanic Black (52%) or White (28%); 61 (24%) reported marijuana use during pregnancy; 102 (41%) had a history of depression and 148 (59%) did not; 39 (16%) screened positive for PPD. With a history of depression, the risk of PPD for those who reported marijuana use was 2.67 times (95% CI, 1.46–4.88) that of those who did not report use. Without a depression history, there was no statistically significant elevation in risk (RR, 1.81; 95% CI, 0.39–8.48). Multivariable analyses are ongoing to assess whether the finding is robust to adjustment for confounding.

CONCLUSION:

Those with a depression history who report using marijuana during pregnancy may have an increased risk of PPD compared to those who do not report use.
A Feasibility Study of Isolation of Circulating Fetal Trophoblast for Prenatal Aneuploidy Screening [A227]
Authors: Liu Zitao , Hou Shuang , Liu Lian
Published: June 2022

INTRODUCTION:

We are exploring the feasibility of isolating circulating fetal trophoblast (CFT) from maternal whole peripheral blood (MWPB) in the first trimester for prenatal aneuploidy screening (24 chromosomes) by a platform based on our in-house-developed enrichment technology.

METHODS:

The research was approved by institutional review board and consents were obtained. MWPB (5–7 mL) and chorionic villi were collected upon dilation and curettage (D&C) from seven patients with missed abortion (MAB; five from in vitro fertilization, one from intrauterine insemination, and one from natural conception). CFT was enriched by our in-house enrichment platform. We compared CFT with the chorionic villous trophoblast (CVT) and maternal white blood cell in their karyotype and DNA fingerprints, as well as the aneuploidy screening results from CFT, with conventional noninvasive prenatal testing (NIPT).

RESULTS:

The average gestational age upon D&C was 58.4±4.9 days of gestation. CFTs (3.4±1.7 cells/mL MWPB) were consistently enriched and successfully karyotyped. The karyotype and fingerprint between CFT and CVT were completely matched in all the cases. For the MAB from aneuploidy blastocyst transfer, the Preimplantation Genetic Testing for Aneuploidy result matched the karyotype of CFT and CVT. Sample identification was proved for the embryos created from autologous oocytes, but not from donor oocytes, by DNA fingerprints. The two cases of trisomy (47,XX+2 and 47,XX+4) detected by aneuploidy screening from CFT were not reported by conventional NIPT.

CONCLUSION:

The rare CFT could be successfully and efficiently isolated from MWPB in the first trimester by our enrichment platform, which makes prenatal aneuploidy screening feasible from<3 mL of MWPB in the first trimester.
Neighborhood Deprivation Index and Postpartum Depression: Association Varies by Race and Ethnicity [A244]
Authors: Onyewuenyi Ticara L. , Peterman Kelli , Tutwiler Ameisha , Weintraub Miranda Ritterman , Pettway Bria L. , Avalos Lyndsay A.
Published: June 2022

INTRODUCTION:

Little research has evaluated the influence of neighborhood deprivation index (NDI) on postpartum depression (PPD). This study evaluated the effects of NDI and race/ethnicity independently and jointly.

METHODS:

This is a retrospective cohort study of Kaiser Permanente Northern California members aged >15 years who delivered a live-born infant between October 7, 2012, and May 31, 2017. PPD was identified using depression diagnoses obtained the day after delivery through 12 months postpartum. NDI was categorized into quartiles; the top quartile represented the highest deprivation. Multivariable logistic regression was conducted to assess the association between NDI and PPD. We performed analyses stratified by race/ethnicity to assess for effect modification.

RESULTS:

Among 177,511 live births, 122,995 were to unique mothers; among those, 18,510 (12.5%) had PPD. PPD ranged from 20.8% in the lowest NDI quartile to 27.8% in the highest. Higher NDI was associated with greater odds of PPD (Q4, referent Q1: adjusted odds ratio [aOR], 1.16; 95% CI, 1.10–1.23). Associations between NDI and PPD varied by race/ethnicity. NDI was not associated with PPD among Hispanic women. Black women had the highest odds of PPD for all NDI quartiles (Q2: aOR, 1.50, 95% CI, 1.17–1.91; Q3: aOR, 1.64, 95% CI, 1.30–2.07; Q4: aOR, 1.78, 95% CI, 1.42–2.22; referent for all comparisons Q1).

CONCLUSION:

There were significant variations in PPD rates according to race and ethnicity that persisted regardless of NDI. Findings from this study suggest that while geographic targeting of mental health services may be informative, the role of systemic racism should be considered.
Fetal Abdominal Circumference and Risk of Neonatal Morbidity in Pregnancies Complicated by Diabetes [A246]
Authors: Lord Megan G. , Rasiah Stephen , Has Phinnara , Stoever Kara , Savitz David A. , Esposito Matthew A.
Published: June 2022

INTRODUCTION:

We aimed to characterize the relationship between fetal abdominal circumference and neonatal morbidity in pregnancies complicated by diabetes.

METHODS:

After institutional review board approval, patients with gestational diabetes (GDM) or preexisting diabetes type 1 or type 2 (T1DM, T2DM) who delivered a live, singleton, non-anomalous infant at a single center 2002–2013 were identified within a large, National Institutes of Health-funded database of detailed pregnancy and delivery information extracted by trained research nurses. Neonatal morbidity (NM) was defined as one or more of the following: 5-minute Apgar <7, arterial cord pH <7.0, sepsis, neonatal death, or need for respiratory support, chest compressions, phototherapy, exchange transfusion, or hypoglycemia treatment. Rates of morbidity were calculated for the following groups stratified by fetal abdominal circumference (AC) percentile for gestational age: below the 20th percentile, 20th–39th percentile, 40th–59th percentile, 60th–79th percentile, and 80th percentile or greater. Unadjusted relative risk (RR) of neonatal morbidity was calculated for each group, with AC 40th–59th percentile as the reference.

RESULTS:

A total of 721 eligible pregnancies were identified (643 GDM, 35 T1DM, 43 T2DM). Neonatal morbidity occurred in 261 (36%). The lowest rate of neonatal morbidity (22%) occurred in pregnancies with a fetal AC below the 20th percentile (RR, 0.55; 95% CI, 0.31–0.98). The highest rate of neonatal morbidity (42%) occurred in those with an AC at or above the 80th percentile, but this was not a statistically significant increase in risk compared to the reference group (RR, 1.05; 95% CI, 0.82–1.33).

CONCLUSION:

Among pregnancies complicated by diabetes, fetal abdominal circumference below the 20th percentile was associated with decreased risk of neonatal morbidity.
Pregnancy-Related Hypertension: Adherence to a New Type of Monitoring (PHANTOM) [A247]
Authors: Arkerson Brittany J. , Finneran Matthew , Harris Solita R. , McElwee Eliza R. , Demosthenes Lauren , Sawyer Renata
Published: June 2022

INTRODUCTION:

The majority of hypertension-related postpartum morbidity occurs in the early postpartum period. Due to this, current guidelines recommend that patients with hypertensive disorders of pregnancy present for a blood pressure check within 7–10 days postpartum. However, in-office assessment of blood pressure has a relatively low adherence rate, and remote monitoring may be a safe and feasible alternative.

METHODS:

This was an institutional review board‒approved prospective multi-site randomized controlled trial of postpartum patients diagnosed with a hypertensive disorder of pregnancy prior to discharge between April 2021 and August 2021. Patients were randomized to either an in-office blood pressure check or remote monitoring through a web-enabled smartphone platform. The primary outcome was the rate of blood pressure ascertainment within 10 days of discharge. Secondary outcomes include rates of initiation of anti-hypertensive medication, readmission, and additional office/triage visits for hypertension.

RESULTS:

A total of 197 patients were randomized (101 in-office, 96 remote). Patients with remote monitoring had higher rates of postpartum blood pressure ascertainment compared to in-office surveillance (92.7% versus 59.0%, P<.001). However, patients in the remote monitoring group had additional unscheduled hypertension-related visits in the office or triage (21.7% versus 8.2%, P=.008), but there was no difference in readmission rate (4.4% versus 5.1%, P=.807) or rate of initiation of antihypertensives after discharge (9.8% versus 7.1%, P=.499).

CONCLUSION:

Remote monitoring can increase postpartum blood pressure ascertainment within 10 days of discharge for patients with hypertensive disorders of pregnancy. Additional research is needed to develop safe protocols that promote cost-effective health care utilization.
Socioeconomic Status and Excessive Gestational Weight Gain Among Full-Term, Normal-BMI Parturients [A256]
Authors: Del Pozzo Jaclyn A. , Kouba Insaf , Blitz Matthew J. , Bracero Luis A.
Published: June 2022

INTRODUCTION:

The Institute of Medicine (IOM) recommends a weight gain of 25–35-pounds for pregnant patients with a body mass index (BMI) of 18.5–24.9. The purpose of this study is to assess socioeconomic and clinical factors that affect excessive gestational weight gain (eGWG) in women with normal prepregnancy BMI (pBMI).

METHODS:

Retrospective cohort study of term patients with normal BMI from seven hospitals within a large integrated health system between January 2018 and February 2020. eGWG was defined as >35 pounds for those with normal BMIs. Twin pregnancies and overweight and obese patients were excluded. Data collected included demographics, medical comorbidities, and ZIP codes, which were linked to neighborhood data from the U.S. Census Bureau’s American Community Survey. Patients with eGWG were compared to those without eGWG.

RESULTS:

A total of 23,691 patients were included: 13,940 (59%) met IOM guidelines and 9,751 (41%) had eGWG. When comparing patients with and without eGWG, significant differences were observed in race, preferred language, marital status, parity, pBMI, mood disorders, and neighborhood socioeconomic characteristics (educational attainment, households receiving supplemental income, single parent households, and owner-occupied housing). Patients who met IOM guidelines were less likely to have gestational diabetes (6% versus 3%). Maternal age, ethnicity, gestational age, medical comorbidities (chronic hypertension and diabetes mellitus), type of health insurance, and neighborhood characteristics (median annual household income, unemployment rate, mean persons per household) were not associated with eGWG.

CONCLUSION:

Neighborhood socioeconomic conditions contribute to eGWG and subsequent maternal and fetal complications.
Black Women With Low Numeracy Fare Worse in Diabetic Pregnancies [A257]
Authors: Jacobson Jennifer M. , Godecker Amy , Janik Jennifer , Eddy April , Adams Jacquelyn
Published: June 2022

INTRODUCTION:

Numeracy is the ability to understand and use numbers in daily life. Low diabetes (DM) numeracy is associated with poor knowledge of DM, lower perceived efficacy in managing DM, and worse glycemic control. Numeracy score (NS) is obtained using a validated diabetes screening tool assessing use of numbers in diabetes management.

METHODS:

Retrospective cohort study of 345 women with pregestational diabetes (preDM, n=166) or gestational diabetes (GDM, n=179) between January 1, 2018, and December 31, 2020. Patients were identified using our clinic diabetes database. Pregnancy data were obtained from a statewide QI database and medical records. Chi-square test was used for categorical variables and unpaired t test for continuous variables. For adjusted estimates, logistic regressions were used for binary outcomes and least squared regressions for continuous outcomes.

RESULTS:

No difference was observed between preDM and GDM groups in low NS (19.3% versus 20.1%, P=.846). Demographics were similar between groups, except for low NS by race (Asian 34.2%, Black-NH 58.1%, LatinX 20.0%, multiethnic 41.7%, and White-NH 10.4%, P<.01). When controlled for DM type, women with low and high NS had similar third-trimester hemoglobin A1c values (5.89% versus 5.68%, P=.059), except among Black women with low NS, who had significantly higher A1c in the third trimester (OR, 0.53; 95% CI, 0.28–0.81; P<.01).

CONCLUSION:

Low NS did not impact A1c values in the third trimester, except in Black women. Black women with low NS had worse glycemic control in the third trimester regardless of DM type. Additional studies are warranted to investigate the role of numeracy in glycemic control and develop interventions, particularly in Black women.
Decreasing Racial Disparity in Unexpected Complications of Term Newborns (Perinatal Core Measure 06) [A264]
Authors: Katz Chelsea , Hewlett Guy , Santangelo Alexander , Perry Robin
Published: June 2022

INTRODUCTION:

With a national push to decrease cesarean delivery rates, Perinatal Core Measure 06 (PC-06), which measures unexpected complications of term newborns, has become an important balancing metric. The purpose of this quality intervention was to lower PC-06 rates and mitigate racial disparity.

METHODS:

Quality metric review revealed an elevated baseline PC-06 rate of 4.29% (43/1002). The rate in White women was 2.15% (6/279), in African American women 5.42% (15/277), and in Hispanic women 5.44% (18/331). Non-White patients had a higher risk of PC-06 relative to White patients (odds ratio [OR], 2.52; 95% CI, 1.04–6.09). After in-depth review of all cases, management of abnormal fetal heart rate (FHR) tracing was identified as a contributing factor in a significant proportion of cases. Consequently, a multidisciplinary group developed the following quality interventions: 1. A note template to standardize real-time documentation of FHR interpretation; 2. Standardized process of timing and indications for documenting a FHR note; 3. Set time limits for observing category 2 FHR tracings. All clinical team members were educated regarding these quality interventions.

RESULTS:

The post-intervention PC-06 rate significantly declined from baseline to 2.26% (19/840, P=.020). The rate in White women declined to 1.53% (4/261, P=.75), in African American women to 3.13% (7/224, P=.277), and in Hispanic women to 1.57% (4/255, P=.026). Following the intervention, there is no longer a racial disparity at the 95% CI level (OR, 1.5; 95% CI, 0.47–4.75).

CONCLUSION:

Applying this standardized approach led to an improvement in outcomes for all patients and a narrowing of the racial disparity previously seen.
Association of 12-Month Contraceptive Supply Policy and Months of Contraception Prescribed by Obstetrician-Gynecologist Physicians [A01]
Authors: Fuerst Megan , Schrote Kaitlin , Garg Bharti , Rodriguez Maria
Published: June 2022

INTRODUCTION:

Seventeen US states have passed legislation requiring insurers to cover dispensation of a full 12-month supply of contraception prescribed at a single time. Such policies are linked to improved contraception continuation and reductions in unintended pregnancy. This study sought to determine if there was a difference in the months of oral contraception prescribed by physicians living in US states with a 12-month supply policy compared to physicians in states without a policy.

METHODS:

We conducted an exploratory descriptive study using a convenience sample of obstetrics and gynecology resident physicians (n=275) in the United States. Standard bivariate analyses were used to compare the difference between groups and describe the overall prescribing habits of physicians. The study was approved by the institutional review board at Oregon Health & Science University.

RESULTS:

Of the 275 respondents, 48% resided in a state with a policy requiring insurance coverage of a 12-month supply of contraception and 52% resided in states without such a policy. Few physicians in both groups (3.8% with a policy and 1.4% without a policy) routinely prescribed a 12-month supply of contraception. The mean coverage prescribed by providers in states with and without a policy was 2.81 and 2.07 months (P<.05).

CONCLUSION:

The majority of physicians were unaware of 12-month contraceptive supply policies and unable to correctly write a prescription for 12 months of contraception. Physician education may be needed to effectively implement 12-month contraceptive supply policies and meaningfully impact contraception access.
Contraceptive Congruence: A Novel Measure of Contraceptive Use that Acknowledges Pregnancy Ambivalence [A06]
Authors: Nelson Hallie , Weisman Carol S. , Lehman Erik , Chuang Cynthia H.
Published: June 2022

INTRODUCTION:

Aligned with the bias that highly effective long acting reversible contraception (LARC) should be first-line for all women not intending pregnancy, historic measures emphasized contraceptive effectiveness. We propose an alternative measure, contraceptive congruence, which acknowledges pregnancy ambivalence by describing whether a method is aligned with individual attitudes about getting pregnant, specifically how important it is to avoid pregnancy and how pleased/upset she would be if pregnant.

METHODS:

Among 984 women not intending pregnancy in the next year, contraceptive congruence was defined as a three-level variable describing whether a woman’s current contraceptive method was very congruent, somewhat congruent, or incongruent with her pregnancy attitudes. If a woman was ambivalent about pregnancy, she was very congruent at a lower tier of contraceptive efficacy than someone very upset and importantly avoiding pregnancy. Patient-level variables were examined using chi-square analysis for associations with contraceptive congruence.

RESULTS:

Contraceptive methods included LARCs (8%), hormonal methods (50%), barrier methods (30%), or no method (12%). Methods for 43% of women were very congruent, 39% somewhat congruent, and 18% incongruent with attitudes about becoming pregnant. Therefore, many women were using methods that were aligned with their pregnancy attitudes. Predictors of contraceptive congruence included age, marriage, non-Hispanic white ethnicity, full-time employment, and higher income.

CONCLUSION:

By including individual attitudes about getting pregnant, contraceptive congruence acknowledges pregnancy ambivalence, which is missing when categorizing contraceptive methods by strictly effectiveness alone. Future research and clinical care that acknowledge pregnancy ambivalence will more closely align with actual complex attitudes that affect individual contraceptive behavior.
Telehealth Follow-up After Medical Management for Early Pregnancy Loss [A07]
Authors: Chen Jessica , Nijim Sally , Flynn Anne N. , Sonalkar Sarita , Schreiber Courtney A. , Roe Andrea H.
Published: June 2022

INTRODUCTION:

Remote follow-up protocols after medical abortion (MAB) are evidence-based, but telehealth follow-up after medical management of early pregnancy loss (EPL) has not been investigated. In this study, we compare feasibility of remote follow-up for EPL to remote follow-up for MAB.

METHODS:

We conducted a retrospective cohort study of patients initiating medical management of EPL up to 12 weeks and 6 days and MAB up to 9 weeks and 6 days with mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally between April 1 and October 17, 2020. Patients were routinely scheduled for telehealth follow-up in 1 week and home urine pregnancy test in 4 weeks. Our primary outcome was feasibility of telehealth follow-up for EPL compared with MAB patients, defined by successful follow-up per clinical protocol. Exploratory outcomes included comparative effectiveness and safety.

RESULTS:

Ninety patients (40 EPL, 50 MAB) were eligible for inclusion. The median gestational age was 7 weeks and 3 days for patients with EPL and 7 weeks and 0 days for patients undergoing MAB. Of patients eligible for telehealth follow-up, 17/19 (89%) with EPL and 28/30 (93%) undergoing MAB successfully followed up per protocol (P=.63). Telehealth assessments were consistent with completed abortion in 13/17 (76%) patients with EPL and 24/28 (86%) patients undergoing MAB (P=.43). All (4/4) of EPL and 4/5 of MAB patients for whom a clinic visit was subsequently recommended completed this visit. Of these, 1/4 with EPL and 2/4 undergoing MAB required uterine aspiration. Among those with telehealth assessments consistent with completed abortion, neither group had documented complications within 30 days.

CONCLUSION:

Telehealth follow-up is a feasible alternative to in-person assessment after medical management of EPL.
Patient Perspectives on Web-Based Access to Contraceptive Options [A23]
Authors: Madan Upasana , Lee Danielle , Brandi Kristyn , Norin Jorden L.
Published: June 2022

INTRODUCTION:

Online-based applications have provided patients with an additional method of obtaining short-acting hormonal contraception and reduced barriers to contraceptive care. This study aims to assess patient perspectives on online methods of obtaining birth control and to explore barriers to obtaining contraception through traditional means.

METHODS:

We conducted a single-site cross-sectional survey study to assess the perspectives of reproductive-age females on web-based sources for contraception. Univariate analysis of raw data was performed and frequency distributions for survey items were determined. This study was approved by the institutional review board.

RESULTS:

We had 96 English-speaking, reproductive-age women recruited from the waiting room of an urban obstetrics and gynecology clinic. Of survey respondents, 34.4% knew that prescriptions for birth control are available online, while only 4.4% have ever obtained birth control online and 3.3% currently get their birth control through online methods. Top barriers to obtaining contraception via doctors’ offices included time off from work/school (49.4%), flexible appointment scheduling (33.8%), and finding childcare (27.3%). One-fourth of participants reported that they delayed getting birth control from a doctor’s office due to concerns related to COVID-19. Many (85.1%) would return for other obstetrics and gynecology care if they had access to contraception online. After learning about online methods of obtaining short acting contraceptives, 49.26% of respondents agreed or strongly agreed that they would use them instead of getting birth control from an office visit.

CONCLUSION:

Although patient knowledge and use of online contraceptive methods remain limited, patients are receptive to trying web-based contraceptive options, which may reduce barriers associated with traditional contraceptive care.
The Effects of the Etonogestrel Subdermal Implant on Weight Gain in Obese Women [A34]
Authors: Hatch Cherise , Young Amanda , Gray Celia M. , Paglia Michael J. , Howard Denise
Published: June 2022

INTRODUCTION:

To evaluate weight change after insertion of the etonogestrel subdermal implant (EI) in normal/underweight, overweight, and obese women.

METHODS:

This is a retrospective cohort study in a large health system which examined the weight changes in women using the EI from January 1, 2010–December 31, 2019. Data were obtained using the system’s electronic health records. Subjects were grouped by body mass index (BMI) class with weights (kg) obtained at regular intervals until removal. A test of trend analysis was completed to evaluate for significant weight changes as BMI class increased.

RESULTS:

The cohort included 3,497 women, of whom 34% were normal/underweight, 24% were overweight, and 42% were obese. The median time from insertion of the EI to removal was 1.7 years and there was no significant difference between time to removal for any BMI class. At the time of removal, there was no significant trend in weight change as BMI class increased. For the women who kept the EI for 3 years, the median weight change (interquartile range) per BMI class was: normal/underweight 3.2 kg (-0.5, 6.4), overweight 5.2 kg (-0.5, 9.3), class I obese 5.7 kg (0.2, 10.7), class II obese 9.1 kg (2.3, 13.6), and class III 5.0 kg (-2.3, 13.2).

CONCLUSION:

There was no trend in weight change after placement of the EI as BMI class increased. The greatest increase in weight occurred in the class II group at 3 years. This information will be useful in counseling obese women about the EI when discussing contraceptive options.
An Interactive Curriculum Increases Confidence in Identification and Management of Gynecologic Office Emergencies [A55]
Authors: Maciejko Laura , Cope Adela , Bell Shannon L. , Scheib Stacey A. , Galhotra Sheena , Green Isabel
Published: June 2022

INTRODUCTION:

Emergencies during gynecologic office procedures are uncommon. However, knowledge in management of these complications is essential as more gynecologic procedures move from the operating room to the office. Our goal was to develop an interactive curriculum to address a gap in residency training in the management of office-based procedural emergencies.

METHODS:

A curriculum including management of unanticipated bleeding, anaphylaxis, vasovagal response, and local anesthetic systemic toxicity (LAST) was developed and implemented using a combination of simulated patient sessions, a “choose-your-own-adventure” PowerPoint, and a mock oral board session. Pre and post intervention surveys queried participants’ confidence in recognition and management. The curriculum was delivered as in-person simulation sessions or virtual sessions due to COVID restrictions. Institutional review board (IRB) approval was obtained. Mean pre and post intervention scores were compared using paired t-test.

RESULTS:

Four accredited obstetrics and gynecology residency programs participated. Twenty-nine trainees completed the curriculum, and 24 submitted pre and post surveys (82.8% response rate). There was significant improvement in confidence scores for management of unanticipated bleeding (mean difference 0.96, P<.001), anaphylaxis (mean difference 1.7, P<.001), vasovagal response (mean difference 1.0, P<.001), and LAST (mean difference 2.5, P<.001). Additionally, significant improvement in confidence scores for identification of risk factors and signs/symptoms of vasovagal response (mean difference 0.96, P<.001, and 0.46, P=.005) and LAST (mean difference 2.3, P<.001, and 2.2, P<.001) was noted.

CONCLUSION:

Implementation of an office emergencies curriculum significantly increased confidence in identification and management of unanticipated bleeding, anaphylaxis, vasovagal response, and LAST. Future studies evaluating knowledge-based assessments of learners are needed.
Presentation to Publication: Analysis of Departmental Research Funding and Trainee Research Productivity [A61]
Authors: Ellett Tressa , Truong Tracy , Murtha Amy , Havrilesky Laura , Davidson Brittany
Published: June 2022

INTRODUCTION:

Conducting research is critical to the development of physician scientists; the authors’ obstetrics and gynecology department requires each resident to conduct an original research project that is then presented during an annual trainee Research Day (RD). A department research fund (DRF) was implemented in 2008 and a formal research curriculum subsequently implemented in effort to foster trainee academic success. This analysis explores associations between trainee DRF funding, peer-reviewed publication, and future National Institutes of Health (NIH) funding at a single academic institution over a 32-year period.

METHODS:

RD project titles and funding status were compiled from a single academic obstetrics and gynecology department from 1989-2020. Significant milestones were the DRF (2008) and implementation of a formal research curriculum (2017). Outcomes were peer-reviewed publication of the RD project within 5 years of RD presentation and subsequent NIH funding of the trainee. Chi-squared tests were used to investigate these relationships.

RESULTS:

Among 361 obstetrics and gynecology trainee (238 resident and 123 fellow) research projects presented at RD between 1989-2020, 169/361(46.8%) were peer-review published. Any funding of an RD project was associated with increased publication rate across the study period (85.9% versus 32%; P<.01). DRF-funded projects were also more likely to be published within 5 years (78.6% versus 57.7%; P=.03). DRF recipients were more likely to garner future NIH funding than non-recipients (37.9% versus 6.5%; P<.001).

CONCLUSION:

Trainee receipt of DRF funding is associated with both future NIH funding and trainee research publication. Program leaders may consider a formal research curriculum and a DRF to enhance the trainee research experience.
Tagged: The Use of Social Media in the Recruitment of Obstetrics and Gynecology Residents, Pre- and Post-pandemic [A62]
Authors: Haller Jasmine , Ghareeb Allen , Morales Pedro
Published: June 2022

INTRODUCTION:

As the residency application process adapts, social media may provide insight to the community behind a residency program. No studies have assessed applicant’s perception of the utility of social media as a tool during the pursuit for their match into obstetrics and gynecology residency.

METHODS:

Applicants who interviewed at a single academic institution during the 2019-2020 and 2020-2021 interview seasons completed an anonymous online survey. Responses were analyzed using chi-squared and Mann-Whitney statistical analysis.

RESULTS:

The survey response rate was 64.6% (n=45) of 65 applicants in 2019 and 80% (n=48) of 60 applicants in 2020 who interviewed at this institution. All applicants reported using some type of social media, with Facebook and Instagram being the most utilized. Social media was used to learn about residency programs significantly more in 2020 (P=.001). Applicants used social media significantly more to look up programs prior to applying/interviewing at that institution in 2020 (P=.000). Applicant perception of a program was felt to be significantly impacted by social media presence in 36% (n=15) of those surveyed in 2019, compared to 60% (n=29) in 2020 (P=.031). Significantly more applicants felt that a residency program social media presence was an important recruitment strategy in 2020 compared to 2019 (P=.006). The virtual match increased applicant uses of social media in the application process in 80% of respondents (n=38).

CONCLUSION:

Social media is a novel and essential tool for residency programs to showcase their culture. Our study highlights the utility of social media for resident applicant recruitment in the ever changing post-pandemic application milieu.
Resident Research Mentoring Teams: A Support Program to Increase Resident Research Productivity [A64]
Authors: Haas David , Haas Bachar M. , Haas Nicole M. , Shanks Anthony , Rojas Mirian Ramirez
Published: June 2022

INTRODUCTION:

Inspiring, supporting, and disseminating resident scholarly activity can be difficult for residency programs. In an effort to stimulate more resident and faculty engagement in the research process, we developed resident research mentoring teams (RRMT) alongside financial and resource support for resident scholarly activity (research) requirements. The RRMT involved 24 months of longitudinal curriculum of didactics and semi-annual formal meetings with a group of faculty and other team members with research expertise. The RRMT included biostatisticians, coordinators, regulatory experts, and database managers. The objective of this study was to determine if productivity from resident research increased after RRMT implementation.

METHODS:

We performed an analysis of rates of resident research projects presented at meetings and/or published before (8 total years) and after (4 years) implementation of the RRMT, with a 4-year washout during the RRMT implementation and revision. For presentations, we only included regional or national presentations outside of the local school environment.

RESULTS:

Overall, 43 (37.7%) of the 114 resident projects were published and 27 (23.7%) were presented at meetings. After implementation of the RRMT, resident projects were more likely to be published (55.0% vs. 28.4%, P=.005) and presented (40.0% vs. 14.9%, P=0.003). After implementation, resident projects were more likely to be either presented or published (67.5% vs. 36.5%, P=.002).

CONCLUSION:

Implementation of departmental support and mentoring programs such as the RRMT can increase the rate of resident research projects that are presented and published.
Pregnancy Remembrance Options and Patient-Perceived Impact on Coping Ability after Abortion [A67]
Authors: Oko Obinna C. , Schmidt Ashley , Creinin Mitchell D. , Wilson Susan , Hou Melody Y.
Published: June 2022

INTRODUCTION:

At our institution, we previously offered pregnancy remembrance options only to patients undergoing termination procedures for fetal anomalies, demise, or pregnancy complications, including footprints, ultrasound pictures, and religious blessings if desired. We sought to identify if all abortion patients desired similar options and the impact of offering the options on their abortion experience.

METHODS:

We created a questionnaire for patients to indicate their preferences for available pregnancy remembrance options. We included questions assessing their feelings about being offered these options and their perceived coping effect afterwards. We performed an institutional review board--exempt chart review February-July 2021 to evaluate responses. We compared these by indication using the Fisher exact test.

RESULTS:

Of 393 procedures performed during the 6-month study period, 244 (84%) patients completed the questionnaire, of which 58 (24%) terminated for fetal anomalies, demise, or pregnancy complications and 186 (76%) for other reasons. Most patients desired at least one remembrance option (41 [71%] and 134 [72%], respectively, P=1.0). About half in both groups (32 [55%] and 93 [50%], respectively, P=1.0) felt these options would provide a positive coping effect. The proportion of patients feeling upset about the questionnaire was low in both groups and not significantly different (12 of 58 [21%] vs 23 of 186 [12%], P=.13).

CONCLUSION:

Most patients, regardless of termination indication, desire a pregnancy remembrance option. Relatively few had negative feelings about being asked, with no significant differences by termination indication. Our findings support that providers should consider offering these options to all patients terminating their pregnancy, regardless of indication.
The Impact of Race on Discrepancies in Pain and Opioid Administration Following Hysterectomy [A90]
Authors: Saylor Leah , Mayborg Larry , Patel Nima R. , Vemula Ridhima , Devaiah C. Ganga , Crisp Catrina
Published: June 2022

INTRODUCTION:

More than 400,000 hysterectomies are performed annually. Gynecologic healthcare disparities in route of hysterectomy and surgical complications have been reported. There is, however, a paucity of information on postoperative pain scores and opioid administration. Therefore, the objective was to evaluate postoperative total morphine equivalents and pain scores for laparoscopic/robotic and vaginal hysterectomies among reported races.

METHODS:

This was an institutional review board (IRB)-approved retrospective study. Subjects underwent laparoscopic/robotic or vaginal hysterectomy from October 2018 to November 2020. Primary outcome was total postoperative morphine equivalents. Secondary outcomes included pain scores, operative time, estimated blood loss, time in recovery, and length of hospital stay.

RESULTS:

A total of 1,270 subjects were identified: 70.5% (n=895) underwent laparoscopic/robotic hysterectomy and 28.7% (n=364) underwent vaginal hysterectomy. Of all subjects, 78.2% (n=993) were Caucasian, 18% (n=228) African American, 1.1% (n=14) Asian, and 2.8% (n=35) other. African Americans undergoing hysterectomy were younger, 45.7 vs 50.4 (P<.001) and reported slightly higher pain scores 4.67 (3.1–6.0) vs. 4.13 (2.8–5.3) (P=<.001) compared to Caucasians. Mean total morphine equivalents was not different at 20.5 (11.6) vs. 20.3 (10.5) (P=.795). There was no difference in procedure length, time in recovery, or estimated blood loss. Although there was a difference in length of stay of 1.35 vs 1.5, the difference was less than 0.15 day.

CONCLUSION:

Most areas of interest demonstrated no difference between groups. Although a difference was noted in pain scores, the value is less than one and may have little clinical relevance. Further studies are warranted to help clarify this difference.
Ultrasound Appearance of the Endometrium Post Radio-Frequency Ablation [A103]
Authors: Carrel-Lammert Meredith , Parikh Shivani , Patel Nima R. , Devaiah C. Ganga , Crisp Catrina
Published: June 2022

INTRODUCTION:

Heavy and irregular menses affects 9-14% of gynecologic patients, and second-generation endometrial ablation is a treatment option when medications fail. Limited studies have been performed assessing the radiologic appearance of the endometrium post-ablation. Our study aims to describe the ultrasonographic appearance of the post-ablative endometrium to improve knowledge of its sonographic findings.

METHODS:

This was an institutional review board (IRB)-approved prospective study of patients who underwent second-generation endometrial ablation from 2016 to 2019. Patients had postoperative transvaginal ultrasounds at 2, 6, and 12 months. Ultrasound reports were analyzed for endometrial thickness, description of the endometrium and myometrium, presence of uterine fibroids, and uterine size. Statistical tests for repeated measures were utilized.

RESULTS:

There were 68 patients with an average age of 42 (standard deviation [SD] 6) and a body mass index of 32.5 (SD 8.1). Preoperatively the average endometrial thickness was 10mm, uterine length was 9.7cm, and 38.2% had leiomyoma. The average endometrial thickness decreased at each ultrasound: 8.4mm (SD 3.4), 7.2mm (SD 3.0), and 5.8mm (SD 2.5) at 2, 6, and 12 months, respectively. When comparing endometrial thickness postoperatively there was a significant difference at 2 and 12 months (P=.041) and at 6 and 12 months (P=.031). There was no change during the postoperative period in the presence of leiomyoma, hyperechoic endometrium, hypoechoic endometrium, heterogeneous endometrium, and cystic endometrium on the ultrasounds.

CONCLUSION:

After ablation with a second-generation device, the endometrial thickness on ultrasound decreases with time following surgery. Additional studies correlating these findings to clinical outcomes would be useful.
Effect of the Oral GnRH Antagonist Linzagolix on Uterine Fibroid-Related Severe Anemia [A105]
Authors: Stewart Elizabeth A. , Marsh Erica E. , Donnez Jacques , Al-Hendy Ayman , Humberstone Andrew , Garner Elizabeth
Published: June 2022

INTRODUCTION:

Iron-deficiency anemia is common in women with uterine fibroid (UF)-related heavy menstrual bleeding. Severe anemia is defined as hemoglobin (Hb) levels <10g/dL. The effect of linzagolix, an oral GnRH antagonist, on UF-related severe anemia was assessed in two Phase 3 trials.

METHODS:

PRIMROSE 1 and 2 are randomized, double-blind, placebo-controlled Phase 3 trials investigating the efficacy and safety of linzagolix 100 mg and 200 mg once daily, with or without hormonal add-back therapy (ABT) in the treatment of UF. Subjects were considered responders if an increase of ≥2g/dL from baseline was achieved. Patients with severe anemia were given iron supplements until they reached the Hb levels >12g/dL.

RESULTS:

In PRIMROSE 1, of 165 subjects with severe anemia, 57.9%, 61.5%, 82.1% and 65.2% of patients were responders at 24 weeks, in the respective treatment groups (100 mg, 100 mg+ABT, 200 mg and 200 mg+ABT), compared to 50% in the placebo group. In PRIMROSE 2, of 93 patients with severe anemia, 62.5%, 75%, 60% and 73.7%, respectively, were responders, compared to 46.2% for placebo. Given the small sample sizes, statistical significance was not reached. Improvements were maintained at week 52: in PRIMROSE 1, 69.2%, 62.5%, 81.3% and 75% of patients were responders in the respective treatment groups, compared to 40% in placebo, in PRIMROSE 2, 66.7%, 100%, 80%, 87% were responders, respectively.

CONCLUSION:

High and low doses of linzagolix improved Hb levels in patients with UF suffering from severe anemia.
Impact of Enhanced Recovery After Surgery Implementation and COVID-19 on Hysterectomy Outcomes at a Public Hospital [A113]
Authors: Cruz Daisy A. , Saad Christina A. , DeUgarte Daniel A. , Yazdany Tajnoos , Fleischman Ross J. , Rivera-Calonje Franchesca
Published: June 2022

INTRODUCTION:

Immediately prior to the COVID-19 pandemic, our public hospital implemented an enhanced recovery after surgery (ERAS) protocol. The purpose of this study was to evaluate ERAS outcomes for hysterectomy patients at our public hospital, given concerns about barriers to care in our underserved population.

METHODS:

A retrospective analysis was performed comparing outcomes (percent of outpatient cases, length of stay, perioperative opioids, percent of emergency department [ED] return) for hysterectomy patients for pre- and post-intervention periods (January to June in 2019 and 2021). Outcomes were compared using the Fisher exact test or t-test.

RESULTS:

A total of 192 preintervention and 120 post-intervention hysterectomy cases were analyzed. The majority of patients were Hispanic/Latinx in both groups (82% vs. 76%; P=.25). There was no significant change in the percentage of minimally-invasive procedures (71% vs 72%; P=1.0). The percentage of outpatient hysterectomies increased from 0% to 53% (P<.0001), and the mean length of stay (LOS) decreased from 1.6 days to 0.9 days (P<.0001). Peri-operative mean morphine milligram equivalents (MME) decreased from 78 to 54 (P≤.02). Mean post anesthesia care unit stay increased from 186 to 229 minutes (P<.01). There was no significant increase in returns to the ED <30 days (10% vs 13%; P=.36) or mean number of opioid pills prescribed (13 vs 13; P=.21).

CONCLUSION:

ERAS implementation for hysterectomy patients at a public hospital decreased LOS and peri-operative opioids without significantly increasing ED returns. The COVID-19 pandemic likely helped to expedite the adoption of outpatient management, which was feasible and safe in our underserved patient population.
Paraneoplastic Pityriasis Rubra Pilaris Preceding Leukemia
Authors: Vance Paul , Wyles Saranya , Alavi Afsaneh
Published: June 2022

Pityriasis rubra pilaris (PRP) is a rare, chronic papulosquamous disorder that presents with scaling plaques, palmoplantar keratoderma, and keratotic follicular papules. Typically, there are distinctive unaffected areas referred to as “islands of sparing.” Pityriasis rubra pilaris has been associated with various immunodeficient states and malignancies.

The authors conducted a literature review using MEDLINE, PubMed, and Google Scholar, documenting all known cases of PRP associated with malignancy; 15 cases were found in the literature. They also present the case of a 49-year-old White man who, prior to referral to dermatology, was seen in urgent care for widespread pruritic rash. Physical examination in the dermatology clinic revealed confluent, scaly erythematous papules coalescing into plaques with island of sparing involving the trunk and upper and lower extremities. Bilateral palms and soles showed hyperkeratosis with fissuring. He was diagnosed with PRP after punch biopsy and began a new course of topical corticosteroid therapy. Hematology was consulted because of abnormal complete blood count results, and he was subsequently diagnosed with chronic lymphoid leukemia.

Treatment of PRP is largely based on clinical experience and may involve corticosteroids, immunomodulators, or biologic therapy. The relationship between PRP and malignancy is unknown. Current theories postulate it may be driven by tumor production of functional peptides or antigen cross-reactivity between cancer cells and the skin. This is the second reported case of PRP as a manifestation of leukemia, and the first of chronic lymphoid leukemia. Although not yet understood, the documented relationship between PRP and malignancy prompts screening for cancer in all patients with new-onset PRP.
Virtual Reality Simulated Learning Environments: A Strategy to Teach Interprofessional Students About Social Determinants of Health
Authors: Buitron de la Vega Pablo , Dimitri Noelle , Araujo Brinkerhoff Cristina , Stern Aliza , Damus Karla , Miselis Heather , Garg Priya S. , Sarfaty Suzanne , Sprague Martinez Linda
Published: June 2022

Purpose

Physician assistants (PAs) and medical degree students (MDs) often lack training in addressing the social determinants of health (SDOH). Social work students (SWs), meanwhile, have extensive SDOH training; however, few medical professionals have opportunities to engage in interprofessional training with SWs. This study examined the feasibility, acceptability, and students’ perceptions of an interprofessional virtual reality (VR) simulated learning environment (SLE) for teaching health professions students about the SDOH.

Method

In January 2020, 15 students at Boston University School of Medicine attended web-based video conferences focused on SDOH, health equity, and team-based care. Subsequently, student dyads participated in a case-based learning activity using an immersive VR SLE to develop teamwork skills. Evaluation included a postsurvey and a focus group examining their experiences in the course to gauge feasibility and acceptability. Thematic analysis of open-ended survey responses from the postsurvey and focus group data was conducted.

Results

A total of 8 VR simulations were run. Findings indicated both MD and PA students learned patient engagement strategies from SW students, who enhanced their health care leadership capacity. Participants found the means of instruction acceptable, valued the hands-on VR interprofessional training, and expressed interest in learning more about the scope of one another’s roles and the community resources available to patients.

Conclusions

VR SLE is a feasible and acceptable means of instruction. It allowed students to connect across programmatic and geographic boundaries in a collaborative working environment mimicking the team approach to care they will use in their professional life. This experience illustrated for students the strengths a multidisciplinary team has to offer.
Time to Revisit Heart Failure Self-Care
Authors: Garland Rachel , Gagnon Marilou , Lewis Krystina B.
Published: June 2022

Self-care is a central concept in heart failure management and nursing practice. Yet, the uptake of heart failure self-care has been uncritical and detached from broader contexts. Therefore, heart failure self-care was explored using Rodger's evolutionary concept analysis approach to identify antecedents, attributes, and consequences with attention to context, time, application, and meaning. The analysis suggests that heart failure self-care tends to focus on individual behaviors to the detriment of social and structural determinants of health. It also shifts responsibility away from the health care system and onto the individual. Moving forward, a more robust conceptualization of heart failure self-care is needed or possibly, the development of a new concept that focuses beyond the self.