bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing Risk Factors for Obstetric Anal Sphincter Injury in the United States [A223]
Authors: Propst Katie A. , Bruckman David , Hickman Lisa C.
Published: June 2022

INTRODUCTION:

Due to the infrequency of obstetric anal sphincter injury (OASI), a clear understanding of risk factors beyond operative vaginal delivery and episiotomy is lacking. Given the significant short- and long-term impacts of OASI, a better understanding of risk factors is essential for prevention and accurate laceration identification.

METHODS:

The aim of this study is to evaluate risk factors for OASI at the time of vaginal birth. We utilized the Healthcare Cost and Utilization Project–National Inpatient Survey datasets of 2008–2017 to identify women undergoing singleton vaginal births aged 18–49 years. Multivariable logistic regression, survey weight-adjusted, was applied to determine factors associated with the primary outcome of OASI. Risk factors were defined as odds ratios.

RESULTS:

A total of 22,345,397 vaginal deliveries were identified. The rate of OASI significantly decreased from 3.37% in 2008 to 2.36% in 2017 (P<.001). The following risk factors were noted to be associated with OASI: maternal exhaustion (odds ratio [OR], 6.01; 95% CI, 5.84–6.18), fetopelvic disproportion (OR, 5.13; 95% CI, 4.02–6.56), long labor (OR, 4.80; 95% CI, 4.36–4.97), occiput posterior position (OR, 4.60; 95% CI, 4.34–4.88), operative vaginal delivery (OR, 4.33; 95% CI, 4.17–4.50), chorioamnionitis (OR, 2.31; 95% CI, 2.22–2.40), heart rate abnormalities (OR, 2.16; 95% CI, 2.12–2.21), fetal distress (OR, 2.01; 95% CI, 1.98–2.04), shoulder dystocia (OR, 1.64; 95% CI, 1.55–1.72), postterm pregnancy (OR, 1.64; 95% CI, 1.61–1.66), and induction of labor (OR, 1.43; 95% CI, 1.09–1.88). The following factors were protective against OASI: precipitous labor (OR, 0.43; 95% CI, 0.41–0.47) and obesity (OR, 0.62; 95% CI, 0.60–0.64).

CONCLUSION:

We recommend increased awareness of the identified risk factors for OASI. For women with these risk factors, we encourage the use of techniques to reduce OASI and thorough post-delivery perineal exams for proper laceration classification.
Improving the On-Time Administration of Antibiotics for Cesarean Delivery in African American and Latina Women [A233]
Authors: Mele Michele M. , Le Kyle , Hewlett Guy , Perry Robin
Published: June 2022

INTRODUCTION:

In 2020, we observed a spike in cesarean delivery (CD) postoperative infections. All aspects of our CD care were examined via chart review. The overall rate of on-time antibiotic administration (OTAA) was 89.2%; with a rate of 86.6% in African American women, 86.0% in Latina women, and 92.1% in White women. We established a combined departmental diversity, equity, and inclusivity quality goal for 2021 to improve the OTAA of antibiotic prophylaxis for CDs in African American and Latina women.

METHODS:

A multidisciplinary collaboration among obstetrics and gynecology, anesthesia, nursing, pharmacy, and information technology strategized to remove all obstacles to OTAA, defined as antibiotic administration within 60 minutes of incision. Emergent cases were excluded. Our action plan included: 1. adding antibiotic discussions in pre-CD huddle and labor and delivery morning report; 2. working with pharmacy to ensure all antibiotics are immediately available; 3. emphasizing antibiotic administration in pre-induction anesthesia time-out; and 4. ensuring best performance with ongoing team education. We performed a biweekly review of CD antibiotic reports to identify missed opportunities and remediate causes.

RESULTS:

From January 1 to September 30, 2021, there were 329 non-emergent CDs. After interventions, the overall OTAA rate increased from 89.2% to 92.7%. All subgroups also improved, African American from 86.6% to 89.9% (10 of 99), Latina from 86.0% to 94.8% (5 of 97), and White from 92.1% to 92.9% (7 of 98).

CONCLUSION:

Our structured multidisciplinary approach to improving OTAA both improved overall performance in antibiotic administration and mitigated the racial disparity originally seen.
Characteristics of Individuals Who Underwent Cesarean Delivery After Prolonged Labor [A245]
Authors: Chaiken Sarina , Phillips Jillian , Packer Claire , Garg Bharti , Caughey Aaron
Published: June 2022

INTRODUCTION:

We sought to determine factors associated with cesarean delivery among those with prolonged labor.

METHODS:

We utilized linked vital statistics-patient discharge data from California (2007–2011) and included singleton non-anomalous pregnancies with a diagnosis of prolonged labor. We examined the prevalence of CD in women with prolonged labor for varying subgroups and performed multivariable logistic regression to determine factors associated with CD in those with prolonged labor.

RESULTS:

Among those with a diagnosis of prolonged labor (N=41,130), 28.72% (11,811) underwent cesarean delivery. Compared with non-Hispanic White individuals, non-Hispanic Black patients had significantly lower odds of CD (aOR, 0.88; 95% CI, 0.78–0.99), while Hispanic (aOR, 1.29; 95% CI, 1.22–1.37) or Asian persons (aOR, 1.14; 95% CI, 1.07–1.23) had higher odds of CD. As compared to those with normal BMI, being underweight (BMI<18.5) had lower odds of CD (aOR, 0.81; 95% CI, 0.72–0.91), while overweight (BMI 25–29.9; aOR, 1.33; 95% CI, 1.26–1.41) or obese (BMI ≥30; aOR, 1.87; 95% CI, 1.76–2.00) patients had higher odds of CD. Those aged ≥35 years had higher odds of CD (aOR, 1.28; 95% CI, 1.20–1.35), and patients on public insurance had lower odds of CD (aOR, 0.91; 95% CI, 0.86–0.96).

CONCLUSION:

Our results indicate that sociodemographic factors, including race, BMI, and age, impact odds of CD among those with prolonged labor. It is known that bias can impact decision-making in the context of labor and delivery, further attention should be placed to understand and remedy the structural causes of bias that impact who undergoes CD with prolonged labor.
Thrombotic Thrombocytopenic Purpura and Pregnancy Outcomes: A Cohort Study [A258]
Authors: Tzur-Tseva Ayellet , Czuzoj-Shulman Nicholas , Abenhaim Haim A.
Published: June 2022

INTRODUCTION:

Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathy. Little is known of its impact on pregnancy. The aim was to evaluate the association between maternal TTP and pregnancy and neonatal outcomes.

METHODS:

A retrospective cohort study was conducted using the U.S. Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. A cohort of women who delivered between 1999 and 2015 was created. Then ICD-9 code 446.6 was used to identify women with a diagnosis of TTP, with the remaining women without a TTP diagnosis being the comparison group. Multivariate logistic regression estimated the effect of TTP on maternal and neonatal outcomes, while adjusting for maternal baseline variables.

RESULTS:

A total of 13,792,544 women delivered between 1999 and 2015, of whom 280 had a TTP diagnosis (2/100,000). Women with a TTP diagnosis, compared to those without, had more preexisting health conditions (diabetes, hypertension, and obesity). TTP was associated with several adverse outcomes: maternal death (odds ratio [OR], 215.50; 95% CI, 121.19–383.22), preeclampsia (OR, 18.63, 14.57–23.82), eclampsia (OR, 27.80; 95% CI, 13.08–59.11), placental abruption (OR, 5.20; 95% CI, 3.18–8.50), disseminated intravascular coagulation (OR, 139.11; 95% CI, 81.97–236.09), venous thromboembolism (OR, 10.69; 95% CI, 5.25–21.73), sepsis (OR, 118.42; 95% CI, 63.62–220.42), myocardial infarction (OR, 268.60; 95% CI, 84.30–855.81), postpartum hemorrhage (OR, 15.00; 95% CI, 11.66–19.29), requiring a blood transfusion (OR, 59.77; 95% CI, 46.54–76.76), and cesarean delivery (OR, 3.52; 95% CI, 2.74–4.53). Neonates born to women with a TTP diagnosis were at increased risk for preterm birth (OR, 3.40; 95% CI, 2.58–4.49), intrauterine growth restriction (OR, 2.73; 95% CI, 1.68–4.41), and stillbirth (OR, 9.41; 95% CI, 5.95–14.88).

CONCLUSION:

TTP increases the risk of adverse maternal and neonatal outcomes, including maternal and fetal death. Women with TTP in the past or present should be followed closely by a multidisciplinary team.
Progesterone for Prevention of Miscarriage and Preterm Birth in Women With First-Trimester Bleeding: PREEMPT Trial [A260]
Authors: Abenhaim Haim A. , Audibert Francois , Gagnon Robert , Girard Isabelle , Kellow Zina , Klam Stephanie
Published: June 2022

INTRODUCTION:

First-trimester bleeding is associated with miscarriage and preterm birth, for which progesterone has been suggested to improve outcomes. Our study objective was to evaluate the effect of progesterone treatment throughout pregnancy on preventing miscarriage and preterm birth in pregnancies with first trimester bleeding.

METHODS:

This was a multicenter, double-blind, placebo-controlled, randomized trial comparing 200 mg micronized progesterone, vaginally administered nightly from presentation to 34 weeks of gestation, with an identically appearing placebo. Subjects with vaginal bleeding and live intrauterine pregnancy <14 weeks of gestation were eligible. Multifetal gestations, cervical insufficiency, recurrent pregnancy loss, or bleeding unrelated to placentation were excluded. Primary outcome was occurrence of live term pregnancy. Secondary outcomes included adverse maternal/newborn events and time to miscarriage or birth. Chi-square analyses compared proportions and Mann-Whitney tests compared time-to-event outcomes.

RESULTS:

A total of 549 patients were randomized, of whom 16 withdrew or were lost to follow-up, leaving 264 patients in the progesterone group and 269 patients in the placebo group. Baseline characteristics were comparable in both groups. The number of patients having a live term birth among those in the progesterone group was 197 (74.6%), compared with 190 (70.6%) in the placebo group (P=.30). Compared to the placebo group, those in the progesterone group had comparable risks of abortion <20 weeks (38 (14.4%) versus 43 (16.0%), P=.94), preterm birth (27 [10.2%] versus 33 [12.3%], P=.46), and stillbirth (2 [0.9%] versus 3 [1.3%], P=.65). There were no differences in adverse maternal or newborn outcomes, or in time-to-event for miscarriage or birth between the groups.

CONCLUSION:

Progesterone prescribed throughout pregnancy is not effective in preventing miscarriage or prematurity in subjects presenting with first-trimester vaginal bleeding in context of a live intrauterine pregnancy.
COVID-19 Vaccine Acceptance in Pregnancy [A262]
Authors: Odedokun Temitope , Marquez Rafael , Thakkar Meera , Dinglas Cheryl , El Kady Dina
Published: June 2022

INTRODUCTION:

The purpose of the study is to evaluate the acceptance rate of the COVID-19 vaccine among pregnant women at our institution and determine whether there are factors including health disparities associated with acceptance or hesitance.

METHODS:

This is an IRB-exempt descriptive study. Anonymous surveys were administered and completed by 701 pregnant patients at Mount Sinai South Nassau’s affiliated Maternal Fetal Medicine office from February to May 2021. Descriptive statistics were calculated for the overall sample, as well as separately by group (acceptance versus declining/undecided about getting the COVID-19 vaccine). A result was considered statistically significant at the P<.05 level of significance.

RESULTS:

Of the 701 pregnant women who completed the survey, 96 patients accepted the vaccine. Pregnant women willing to get the flu vaccine and/or the Tdap vaccine in pregnancy were also more likely to obtain the COVID-19 vaccine (P=.0037 and P<.0001, respectively). Pregnant patients who had household members willing to receive the COVID-19 vaccine also more likely to obtain the vaccine for themselves (P<.0001). Interestingly, pregnant women who had an underlying respiratory illness in the pregnancy were less likely to accept the COVID-19 vaccine than those who had either other or no medical problems (P=.0279).

CONCLUSION:

There is a low rate of COVID-19 vaccine acceptance among pregnant women at only 13.69%. Efforts should be made to encourage the vaccine in this vulnerable population in order to protect them from the health risks of COVID-19 infection.
Labor Induction at 39 Weeks in Low-Risk Term Pregnancies and Risk of Perinatal Death [A263]
Authors: Abenhaim Haim A. , Czuzoj-Shulman Nicholas , Benjamin Alice , Spence Andrea
Published: June 2022

INTRODUCTION:

Induction of labor (IOL) at 39 weeks has been associated with decreased risk of cesarean delivery. The study objective was to evaluate the effect of IOL at 39 weeks on perinatal death in low-risk pregnancies.

METHODS:

We used the National Center for Health Statistics Linked Birth/Infant Deaths data from 2013 to 2017 to carry out a propensity score matched cohort study to test the influence of IOL at 39 weeks on risk of stillbirth and infant death. Low-risk singleton pregnancies with a live fetus at 39 weeks with no known congenital malformations who underwent an IOL were matched with comparable pregnancies that were not induced at 39 weeks and that delivered no later than 42 weeks.

RESULTS:

From >20 million births, 825,323 (4%) low-risk pregnancies that were induced at 39 weeks were propensity score matched (5:1 ratio) to a comparable group of pregnancies that were not induced at 39 weeks. Compared to pregnancies that were not induced at 39 weeks, IOL at 39 weeks was associated with increased risk of perinatal death (10.8 versus 5.8/10,000; OR, 3.83.5–4.2; P<.0001), which consisted of a decreased risk of stillbirth (0 versus 0.7/10,000) and an increased risk of infant death (10.8 versus 5.1/10,000; OR, 4.2; 95% CI, 3.8–4.6; P<.0001). Among live-born infants, the risk of sudden infant death syndrome was more common among pregnancies induced at 39 weeks (OR, 4.3; 95% CI, 3.6–5.2; P<.0001).

CONCLUSION:

IOL at 39 weeks in low-risk singleton pregnancies is associated with an increased risk of perinatal death. While this may not have a material effect on risk to an individual patient, adoption of widespread practices of inducing low-risk pregnancies at 39 weeks may lead to increases in perinatal deaths on a population level.
Examining the Association of Immediate Postpartum Long-Acting Reversible Contraception Payment Carve-outs and Postpartum LARC Use in Medicaid [A04]
Authors: Fuerst Megan , Moore Jennifer E. , Magnus Manya
Published: June 2022

INTRODUCTION:

Providing contraception in the postpartum period is essential to prevent unintended pregnancies and optimize birth spacing. The Medicaid program funds the majority of public family planning expenditures and pays for half of births in the United States. To improve postpartum contraception use, Medicaid stakeholders have focused on long-acting reversible contraception (LARC), which includes intrauterine devices and the contraceptive implants. A key platform for improving postpartum LARC access has been the adoption of carve-out policies that increase reimbursement for immediate postpartum LARC (IPP-LARC) services outside of the standard global maternity payment provided by Medicaid. IPP-LARC is LARC insertion that occurs after childbirth but prior to hospital discharge. IPP-LARC carve-out policies may increase postpartum LARC use among Medicaid enrolled individuals.

METHODS:

This study used the U.S. Centers for Disease Control Prevention Pregnancy Risk Assessment and Monitoring System dataset from 2016-2018 to explore the association between IPP-LARC carve-out policies and the use of postpartum LARC versus another form of hormonal and/or nonhormonal contraception. The study was approved by the institutional review board (IRB) at George Washington University.

RESULTS:

The study included 24,807 Medicaid enrolled postpartum individuals from 26 states. Results suggest that IPP-LARC policies are positively associated with LARC use over other forms of contraception and state Medicaid expansion status and postpartum visit attendance modify the association.

CONCLUSION:

The findings support the growing body of evidence that IPP-LARC carve-out policies and Medicaid expansion positively influence postpartum LARC use. Widespread adoption and implementation of such policies may be a key strategy to improve postpartum contraception access for Medicaid enrollees.
Characterization of Women Who Experienced Urinary Tract Infections in the Phase 3 AMPOWER Trial [A15]
Authors: Maximos Bassem , Dart Clint , Howard Brandon
Published: June 2022

INTRODUCTION:

Vaginal pH modulator (VPM; Phexxi) is a non-hormonal, on-demand, woman-controlled gel for the prevention of pregnancy. The objective of this post-hoc analysis was to characterize women who experienced urinary tract infections (UTIs) while receiving VPM in the AMPOWER trial.

METHODS:

AMPOWER was a phase 3, single-arm, multicenter (112 sites) study that evaluated the contraceptive efficacy/safety of VPM over 7 cycles of use in sexually active women 18-35 years old (NCT03243305; Thomas et al. Contraception 2020). Exclusion criteria included ≥3 UTIs in the past year or an active UTI at screening. In the post-hoc analysis, women who experienced an on-study UTI were assessed by demographic characteristics and by reports of product use and sexual intercourse.

RESULTS:

Of the 1339 women who administered at least one dose of VPM and were included in the safety population, 77 (5.7%) experienced an on-study UTI. Demographic characteristics of these women were as follows: mean age, 28.1 years; mean body mass index, 28.3 kg/m2; race, 75.3% White, 20.8% Black/African American, 3.9% other; ethnicity, 57.1% non-Hispanic/Latino, 42.9% Hispanic/Latino. In the cycles in which a UTI was diagnosed/reported, the mean number of all acts of intercourse was 3.4 (standard deviation [SD], 3.8) and the mean number of acts of intercourse with product use was 3.2 (SD, 3.7). By comparison, the mean number of product uses per cycle in the overall population was 4.24.

CONCLUSION:

Compared to the overall AMPOWER population, women who experienced on-study UTIs had similar baseline characteristics and slightly lower product use.
Understanding of Lactational Amenorrhea Among US Pregnant Women [A29]
Authors: Chen Melissa J. , Iwuagwu Caidon , Hoyt-Austin Adrienne E. , Fix Margaret , Kair Laura R. , Schwarz Eleanor Bimla
Published: June 2022

INTRODUCTION:

Lactational amenorrhea method (LAM) is a temporary postpartum contraceptive method that is typically more effective than use of condoms or birth control pills. However, this method may be underutilized due to incomplete knowledge.

METHODS:

To assess perceptions of the effectiveness of LAM compared to other postpartum contraceptives in 2021, we used social media to recruit US-born nulliparous pregnant women carrying a singleton pregnancy of 28+ weeks’ gestation. Participants were compensated a $20 gift card for completing an online survey. Institutional review board (IRB) approval was obtained.

RESULTS:

Of 152 respondents, 76% were college-educated, 90% wanted to breastfeed, and 7% indicated they planned to rely on LAM as their sole method of contraception in the first 6 months postpartum. However, less than half (48%) were aware that breastfeeding would delay the return of menses after the baby is born, and only 47% believed exclusive breastfeeding reduces the chance of pregnancy within 6 months of delivery. Only 9% (95% CI 5%-14%) knew breastfeeding prevents pregnancy when their infant is exclusively breastfed, while 27% (95% CI 20%-35%) knew breastfeeding only protects mothers from pregnancy until menstrual periods have returned. No respondents indicated that exclusive breastfeeding is typically more effective than condoms and only 2% (0%-6%) indicated that exclusive breastfeeding is typically more effective than birth control pills.

CONCLUSION:

Few US pregnant women are aware of LAM criteria or the effectiveness of LAM compared with other postpartum contraceptive options, suggesting that patients may be receiving incomplete counseling from their health care providers regarding their options for postpartum contraception.
Patterns and Determinants of Postpartum Long Acting Reversible Contraception Utilization and Sterilization Utilization in Michigan [A33]
Authors: Moniz Michelle , Peahl Alex F. , Zinsser Dawn , Kolenic Giselle , Stout Molly , Morgan Daniel
Published: June 2022

INTRODUCTION:

We aimed to evaluate patterns and determinants of utilization of postpartum long acting reversible contraception (LARC) and sterilization to guide future quality improvement interventions.

METHODS:

This institutional review board (IRB)-approved retrospective cohort analysis used administrative claims data from a statewide collaborative quality initiative to identify childbirth episodes from 1/2016-12/2019. Outcomes included LARC utilization and sterilization utilization by 60 days postpartum. Multivariable logistic regression using hospital fixed effects evaluated associations between outcomes and patient characteristics, including neighborhood social vulnerability index (a composite measure of socioeconomic status, household composition, minority status, and housing/transportation).

RESULTS:

The cohort included 140,380 delivery episodes among 130,174 women (44% publicly insured). By 60 days postpartum, adjusted hospital-specific rates of LARC utilization ranged from 0.5% to 20.4%; sterilization utilization ranged from 0.0% to 13.2%. In multivariable models, women living in neighborhoods with the highest quintile of socioeconomic vulnerability and racial/ethnic vulnerability were more likely to use LARC, as were those with younger age, chronic conditions, public insurance, and birth year later in the study period. Sterilization utilization was less likely among women in neighborhoods with highest socioeconomic and racial/ethnic vulnerability and more likely among women in neighborhoods with highest housing/transportation vulnerability, and those with older age, chronic conditions, public insurance, and later birth years.

CONCLUSION:

Wide variation in postpartum contraceptive use calls for quality improvement efforts in Michigan. Observed associations with social vulnerability identify the pressing need to understand how potential community factors (e.g., transportation, housing, racism) shape postpartum contraceptive decision-making and utilization.
Association Between Publicly-Funded Contraceptive Services and Abortion Rate in Texas [A39]
Authors: Madison Anita M. , Powers Daniel , Maslowsky Julie , Goyal Vinita
Published: June 2022

INTRODUCTION:

The Texas legislature cut its family planning budget in 2011 and restricted access to abortion in 2013. Our objective was to evaluate how the availability of contraceptive services correlated with a change in the abortion rate before and after these legislative changes.

METHODS:

We obtained 2010 and 2015 data on contraceptive provision (number of publicly-funded clinics and number of contraceptive clients served) from the Guttmacher Institute and county-level abortion data from Texas Department of State Health Services. We categorized counties by an abortion rate that increased or was less than (low decline) versus greater than or equal to (high decline) the decline seen nationally. We used the chi-square test, t-tests, and logistic regression to evaluate differences in contraceptive provision between high and low abortion decline counties, adjusting for county demographic and health care characteristics.

RESULTS:

The Texas abortion rate declined by 23% from 2010 to 2015. Statewide, the total number of publicly-funded family planning clinics increased by 11% and total number of contraceptive clients served decreased 4%. Compared to low decline counties (n=79), high decline counties (n=175) had a higher mean number of contraceptive clients served per 1000 women 18-44 years old (51.35 ± 124.26 vs. 81.85 ± 202.66, P<.05) and contraceptive clinics (0.82 ± 1.06 vs. 2.22 ± 5.57, P<.05) in 2015. Abortion decline did not differ by other county characteristics.

CONCLUSION:

Texas counties with higher abortion rate declines had more publicly-funded contraceptive clinics and served more contraceptive clients than counties with lower declines, demonstrating the importance of greater access to publicly-funded contraceptive services.
Professional Practice Trends of Minimally Invasive Gynecologic Surgeons Upon Graduation From U.S. Fellowships [A43]
Authors: Gupta Sonul , El-Farra Mohamed H. , Dasari Prathyusha , Kyeong Yena , Stuparich Mallory , Behbehan Sadikah
Published: June 2022

INTRODUCTION:

To investigate professional practice trends of minimally invasive gynecologic surgery (MIGS) fellows upon completion of training and assess if fellowship training site demographics match that of current practice.

METHODS:

Using the past five MIGS graduating classes, 172 graduates were included. Graduates’ names were searched for program location and post-graduate area of practice. Demographic information pertaining to fellowship city and practice city was obtained from the US Census. The Social vulnerability index (SVI) was used to measure socioeconomic status (SES), and Simpson’s diversity index was used for ethnic diversity. Independent chi-square tests compared graduates’ practice regions' demographics to their training sites'.

RESULTS:

Training and practice sites are located in large cities vs. midsize/small cities, and possess lower median household incomes (250,000) practice in large cities, and those who trained in smaller cities (69%) practice in smaller cities (P<.001). Most graduates (64.4%) who trained in higher median-income areas continue to practice there, and 69.3% of graduates who trained in low-income areas work in similar regions (P<.001). Most training and practice cities possess high-to-moderate SVI. Most graduates (66%) practice in moderately diverse areas and among those trained in highly diverse areas, and 55.8% continue to work there.

CONCLUSION:

MIGS graduates continue to practice in areas that are demographically similar to their training sites. Graduates tend to practice in larger cities and serve areas that possess moderate-to-high ethnic diversity and SVI, suggesting that diverse patients have access. Considering these trends, MIGS fellowship programs may have a larger responsibility to encourage practice in less-populated areas.
Eclampsia Management: Team Improvement Opportunities Identified in High-Fidelity Simulations [A48]
Authors: Crump Cade , Detlefs Sarah , Buttle Rae A. , Goffman Dena , Foley Michael R. , Deering Shad
Published: June 2022

INTRODUCTION:

Eclampsia is an uncommon obstetric emergency that can have significant consequences for both the mother and fetus. The objective of this qualitative study was to evaluate team performance with high-fidelity simulation and attempt to identify areas where additional training may be indicated for the treatment of eclampsia.

METHODS:

Participants at a national critical care obstetrics course received morning didactic sessions after which they were divided into teams and then participated in high-fidelity simulations of obstetric emergencies including a case of severe hypertension and eclampsia. Facilitators completed standardized checklist assessments of medical management for each group's performance. Critical actions were documented, and pre-defined significant errors, such as attempting intubation or performing a cesarean section during the eclamptic seizure, were also tracked. Data regarding performance was evaluated with descriptive statistics. This study was determined to be exempt by the hospital’s institutional review board (IRB).

RESULTS:

A total of 170 teams had complete data available for the eclampsia simulations conducted between 2014-2019. Almost a quarter of the teams (23.6%) did not do a good job in protecting the patient (turning to side/putting bedrails up) during the seizure and 14.2% did not administer magnesium sulfate correctly (dose/duration of infusion). In addition, 11.2% did not continue magnesium for prophylaxis after the seizure and 10.6% also attempted to intubate the patient during the 2-minute eclamptic seizure.

CONCLUSION:

There were multiple areas of suboptimal performance identified during high-fidelity eclampsia simulation of a large number of obstetric provider care teams. Future training efforts should be focused on these specific deficits in order to improve performance.
Maximizing the Number of Providers Using Medication-Assisted Treatment for Opioid Use in Pregnancy [A50]
Authors: Chithiwala Zahabiya , Waetjen L. Elaine , Mitchell Keyon R. , Hedriana Herman , Clark Shannon
Published: June 2022

INTRODUCTION:

To standardize and improve access to medication-assisted treatment (MAT) by X-waivered (XW) prescription and management of opioid use in pregnancy (OUP).

METHODS:

This quality improvement (QI) project standardized MAT training and management in two phases: 1) All faculty and resident physicians (FRPs) were invited to complete an 8-hour MAT training by a 4-hour group session followed by a 4-hour independent study. All FRPs were surveyed to assess completion and use of MAT. The goal was to increase MAT-trained providers from one to at least five. 2) OUP management algorithms were built and integrated into the prenatal clinic and labor and delivery protocols, and FRPs were educated on protocol use. Phase 1 was completed using the Plan-Do-Study-Act (PDSA) cycle. Phase 2 is currently ongoing.

RESULTS:

Sixty FRPs (78%) responded to the survey. Of the FRPs who responded, 25 completed the training. Eleven received XW and six (55%) FRPs successfully prescribed MAT for OUP. Additionally, a standardized treatment protocol was created and made available.

CONCLUSION:

With standardization, the numbers of FRPs using XW increased from one to 11 with 55% successfully prescribing MAT for OUP. Access to OUP care was improved with timely MAT prescription. With integration into residency orientation, we will increase the pool of XW-trained FRPs. Moving forward, all OUP care will follow the standard management algorithm.
The Psychological Impact of COVID-19 on Medical Students Interested in Obstetrics and Gynecology [A57]
Authors: Lin Jenny , Christophers Briana , Nieblas-Bedolla Edwin , Gordon-Elliott Janna S. , Holcomb Kevin , Frey Melissa K.
Published: June 2022

INTRODUCTION:

The COVID-19 pandemic has caused mental health distress among health care professionals. This study aimed to evaluate the psychological impact of COVID-19 on medical students interested in obstetrics and gynecology at medical schools in two early epicenters of COVID-19.

METHODS:

This study was approved by the Weill Cornell Medicine Institutional Review Board. An online questionnaire was distributed to allopathic medical students in Washington and New York. The survey assessed mental health from March to April 2020 via the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, and questions on self-rated mental health.

RESULTS:

Out of 1,139 students who completed the survey, 63 reported a plan to pursue residency training in obstetrics and gynecology. Forty-six (74%) reported an overall deterioration in mental health, 34 (59%) reported depressive symptoms, and 38 (65%) reported anxiety symptoms. Seventeen (28%) students met criteria for major depressive disorder and 16 (27%) for anxiety disorder. Twenty-three (37%) reported at least one close contact with symptoms or diagnosis of COVID-19 and 7 (11%) reported at least one close contact with COVID-19-related death. Commonly cited self-care tactics included staying in touch with friends/family (92%), entertainment (81%), and fitness (65%). When compared to the overall population of students, there were no significant differences in responses for students interested in obstetrics and gynecology.

CONCLUSION:

Students in this study experienced high levels of depressive and anxiety symptoms. Medical trainees are already at an increased risk for depression and anxiety relative to the general population, making it critical for medical schools to understand students’ perspectives and prioritize mental health.
Multidisciplinary Education: Piloting an Unconscious Bias-Maternal Mortality Curriculum in Obstetrics [A63]
Authors: Bey Amita , Garrison Etoi , Li Andria N. , Mosley Dominique , Nettles Arie L.
Published: June 2022

INTRODUCTION:

Racial and ethnic minority women are vulnerable to biases which can limit timely delivery and quality of care. Unconscious bias training (UCB) is recommended by the American College of Obstetricians and Gynecologists, the Council on Patient Safety, and the Tennessee Maternal Mortality Committee to potentially reduce provider bias and racial/ethnic health disparities.

METHODS:

We piloted a virtual 90-minute UCB-Maternal Mortality (MM) curriculum to empower obstetrics and gynecology providers to: (1) understand the science of unconscious bias, and (2) recognize racial/ethnic disparities in obstetrics. Utilizing didactic videos and small-group discussion, participants were expected to identify: (1) the role of bias in decision-making, and (2) equitable strategies to reduce disparate outcomes for women with preeclampsia. Pre- and-post-test surveys were used to assess knowledge regarding UCB-MM and intent to change current practices. Vanderbilt University Medical Center Institutional Review Board approval was obtained.

RESULTS:

Eleven workshops were conducted at four hospitals from May to July 2021. A total of 229 faculty/trainees, nurses, and staff attended workshops. Post-workshop survey respondents were significantly more likely to recognize a framework for mitigating bias (P=.0142). Ninety-seven percent of posttest respondents reported they will adopt/modify a strategy when communicating with patients from different cultures/backgrounds/languages after workshop completion. No significant differences in pre- and post-workshop knowledge regarding healthcare disparities in MM were identified. Protocol adherence, education, and patient follow-up were identified as strategies to reduce disparities during the management of preeclampsia.

CONCLUSION:

Further study is necessary to determine efficacy of the MM education delivered in the virtual curriculum. Additionally, follow-up surveys to assess impact on behavior and long-term knowledge retention are warranted.
Financial and Social Burdens Associated With Care at a Large Fetal Center [A69]
Authors: Gregory Emily , Abbasi Aleeza , Markham Kara B.
Published: June 2022

INTRODUCTION:

The Fetal Center (FC) at the University of Cincinnati Medical Center provides comprehensive care for pregnancies complicated by fetal anomalies and genetic abnormalities. Many diagnoses require families to relocate to receive care. To date, no study has assessed the financial and social burdens upon patients’ ability to comply with care recommendations.

METHODS:

An anonymous survey was sent via email to patients who received care at our FC from 2015-2021. The survey included questions regarding demographics, fetal diagnoses, and non-medical expenses related to care.

RESULTS:

Three of every five patients reported traveling >100 miles to our FC (58.3%, 95% CI 53.7-62.8), with one out of every five reporting travel of >300 miles (20%, 95% CI 16.5-23.9). Although one in four patients only attended one visit (27.4%, 95% CI 23.2-32.1), one-third traveled >10 times for care (33.6%, 95% CI 29.1-38.4). Also, 37.1% (95% CI 31.9-42.5) of patients received a recommendation to temporarily relocate nearer to our FC for continued prenatal, delivery, and neonatal care. Nearly half of patients reported significant non-medical expenditures exceeding $1000 (42.6%, 95% CI 37.7-47.6), with one in 10 reporting expenditures of >$5000 (8.6%, 95% CI 32-37.6). Overall, 38.2% (95% CI 33.5-43.1) reported moderate to severe financial burdens related to FC care.

CONCLUSION:

This study illuminates the socioeconomic burdens that care at a tertiary referral center imposes on families. Although regionalization of FC is associated with improved outcomes for certain fetal/neonatal conditions, the non-medical burden of this specialized care should be acknowledged so we can strive to provide equitable access to high-quality fetal care services to all in need.
Gender Differences of Endowed Professorship in Obstetrics and Gynecology Departments at Top Academic Institutions [A72]
Authors: Russell Colin B. , Burns Courtney , Griffith Kent , Johnson Timothy R. , Jagsi Reshma
Published: June 2022

INTRODUCTION:

Barriers to gender equality permeate academic medicine. A recent study demonstrated that women are less likely to hold endowed professorships in internal medicine from top schools. Given the resources and prestige that accompany endowed professorships, this designation can gauge diversity within medicine’s leaders. We assessed endowed professorships within obstetrics and gynecology departments at leading American medical schools.

METHODS:

Obstetrics and gynecology faculty lists were obtained from the top 25 academic institutions, as determined by 2020 National Institutes of Health (NIH) ranking. Data on faculty position, endowed professorship/chair, gender, graduate degrees held, graduation year, publication and citation numbers, H-index, and NIH funding as a principal investigator were collected from departments or publicly available sources (e.g., institutional websites, Scopus [Elsevier], NIH Reporter). Multivariable regression models were constructed to explain holding endowed professorships.

RESULTS:

Of the 680 total professors, 400 (58.8%) were women and 280 (41.2%) were men. From these groups, 64 (49.2%) women and 66 (50.8%) men held endowed professorships. On multivariable analysis, there were no significant differences between men and women in attainment of endowed professorships (P=.83). Faculty with non-MD doctorates (P=.006) and rank of associate professor (P<.001) were less likely to have endowed chairs. Those in the top two quartiles of number of publications (P<.001) and in the highest funding quartile (P=.004) were more likely to have endowed professorships. Endowed professorships were not significantly related to decade of graduation (P=.86).

CONCLUSION:

Despite previous findings of gender inequity among endowed professorships from internal medicine departments, obstetrics and gynecology departments at leading institutions show no significant role of gender at the level of endowed chairs.
Ob-gyn Wellness Overall and by Gender in a Large Integrated Health Care System During the Pandemic [A73]
Authors: Gregg Laurie C. , Cobb Jill Kacher , Stults Cheryl D. , Dillon Ellis , Deng Sien
Published: June 2022

INTRODUCTION:

Pre-pandemic research indicated that 35-45% of physicians had symptoms of burnout. We examined the wellness of obstetrician-gynecologist (ob-gyn) clinicians twice during the pandemic.

METHODS:

Surveys were distributed in the summer and fall of 2020 to clinicians at eight medical groups and 17 hospitals affiliated with Sutter Health across Northern California. Bivariate analyses (e.g., chi-square test for categorical variables) and multivariate logistic regression models were used to test for statistical significance.

RESULTS:

A total of 7,732 surveys were completed with 488 respondents from obstetrics and gynecology (393 women, 86 men, 5 missing gender). Burnout was more common among women than men (summer: 37.9% vs. 10%, P=.007; fall: 35.7% vs. 17.3%, P=.017). Fewer women than men believed their concerns would be acted upon (summer: 43.7% vs. 69.7%, P=.011: fall: 57.3% vs. 76.5%, P=.018). More women than men indicated that caregiving responsibilities impacted work (summer: 33.1% vs. 6.2%, P=.004; fall: 36.1% vs. 8.3%, P=.013). Compared to all specialties, a higher proportion of ob-gyn clinicians reported needing mental health support (summer: 19.4% vs. average 13.3%; fall 22.6% vs. average 14.6%). After adjusting for sex and age, ob-gyns still showed a higher odds of desire for mental health support than most other specialties.

CONCLUSION:

Women in obstetrics and gynecology experience more negative impacts with regards to wellness, feeling heard, and caregiving responsibilities when compared to their male colleagues. Compared to other specialties, more ob-gyn clinicians desired mental health support. Wellness efforts in our specialty should focus on addressing concerns, caregiving responsibilities, and mental health access.
Relugolix Combination Therapy Improves Uterine Fibroid Symptoms Independent of Fibroid Location [A77]
Authors: Venturella Roberta , Lukes Andrea S. , Stewart Elizabeth A. , Proehl Sarah , Zhao Xin , Al-Hendy Ayman
Published: June 2022

INTRODUCTION:

In the Phase 3, replicate, institutional review board-approved LIBERTY 1 and 2 studies, relugolix combination therapy (Relugolix CT; once daily relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) improved uterine fibroid (UF)-associated heavy menstrual bleeding (HMB), pain, and quality of life (QoL). We report the impact of location (submucosal, intramural, or subserosal) of the largest fibroid on treatment outcomes through 24 weeks.

METHODS:

Premenopausal women were randomized to relugolix combination therapy or placebo for 24 weeks. Location of the largest fibroid was investigator-defined using ultrasound; FIGO type 0/1 fibroids were excluded. Menstrual blood loss (MBL) volume was measured by alkaline hematin method (responders: MBL volume < 80mL and ≥50% reduction from baseline over last 35 days of treatment). Pain and other UF-associated symptoms were evaluated using the Numerical Rating Scale and UF-QoL Questionnaire (Symptom Severity) in this post-hoc analysis.

RESULTS:

In the relugolix combination therapy (N=253) and placebo (N=256) groups, the largest fibroid was categorized by location as subserous (N=50 and N=58), intramural (N=115 and N=130), submucosal (N=46 and N=43) or “other/unknown” (N=119 and N=106). Baseline characteristics, including MBL volume, pain and QoL scores, were similar between subgroups. In all fibroid subgroups, women randomized to relugolix combination therapy had comparable responder rates of 76.0%, 79.1%, 80.4%, and 65.6% at week 24 that were higher than with placebo: 24.1%, 16.2%, 14.0%, and 16.0% (all nominal P<.0001). Across all subgroups, women randomized to relugolix combination therapy experienced significant reductions in MBL volume, UF-associated pain and symptom severity versus placebo.

CONCLUSION:

Relugolix combination therapy improves HMB and other UF-associated symptoms independent of the location of the largest fibroid.
Real-world Effectiveness of Elagolix When Used in Combination With Hormonal Contraceptives [A79]
Authors: Levy Barbara , Fairbrothers David L. , McKenna Kelsey , Westhoff Carolyn , Cross Sarah , Frakes Eli
Published: June 2022

INTRODUCTION:

Real-world data on the use of elagolix, an oral gonadotropin-releasing hormone (GnRH) receptor antagonist, in combination with hormonal contraceptives (HC) is limited. This analysis evaluated endometriosis-associated pain in women treated with elagolix (150 mg once daily or 200 mg twice daily) in combination with HCs in routine clinical practice.

METHODS:

This retrospective chart review utilized Dorsata data available via their clinical and claims data network (Athena EMR and Surescripts). The primary outcome was the change in endometriosis pain in women receiving elagolix concomitantly with HCs (progesterone only oral contraceptives [POPs], long-acting reversible contraception [LARC], or estrogen containing combined oral contraceptives [COCs]) at the first follow-up visit vs baseline (elagolix initiation).

RESULTS:

Women (N=193) had a mean age of 28.5 years, and most (75.1%) had received previous endometriosis-related treatment. Overall, endometriosis pain was reported as better in 79.3% (n=153) of women who received elagolix concomitantly with HCs and specifically in 72.7% of women receiving COC (n=24), 79.2% of women receiving LARC (n=76), and 80.5% of women receiving POP (n=33). Documented discontinuations included anxiety/depression (n=4), mood changes (n=2), nausea (n=1), and other (n=2) or increased (n=2) pain. This study was limited geographically and by sample size.

CONCLUSION:

This analysis demonstrated that women taking elagolix for endometriosis-associated pain had improvement regardless of the HC used. Future studies are needed on the safety and efficacy of concomitant use of elagolix with specific hormonal contraceptives.
Brief Mindfulness Video to Reduce Pelvic Exam-Related Anxiety and Pain [A89]
Authors: Collins Marielle H. , Kho Kimberly A. , Evans Monty H. , Trombello Joseph M. , Carmody Thomas , Greer Tracy L.
Published: June 2022

INTRODUCTION:

Purpose: Pelvic examinations frequently cause anxiety and discomfort for women, which may lead to avoidance of medical appointments. This study evaluated the efficacy of a brief mindful movement video in reducing pelvic exam anxiety and pain.

METHODS:

Women (n=90) scheduled for pelvic examination were recruited at an outpatient gynecology clinic and randomized to mindfulness intervention (5-minute mindful movement video [n=44]) or control (educative materials [n=46]) groups. Upon arrival, women completed baseline measurements of anxiety and pain (visual analogue scale [VAS]). They then completed group specific activities and rated anxiety prior to pelvic exam. After exam, participants rated exam pain, post-exam anxiety, and completed questionnaires assessing intervention acceptability.

RESULTS:

Fifty-two percent of women who presented for pelvic examination reported clinically significant anxiety (i.e., VAS >34). Analysis of covariance controlling for baseline anxiety found clinically anxious individuals who received the intervention reported significantly lower anxiety before pelvic examination (P=<.001, partial η2=.232) and after (P=.006, partial η2=.165) compared to control. Analysis of covariance controlling for baseline pain found individuals who received the intervention rated pelvic examination as significantly less painful (P=< .01, partial η2=.075) compared to control. Intervention participants reported high interest, acceptability, and helpfulness of the mindful movement video.

CONCLUSION:

A 5-minute mindful movement video viewed prior to pelvic examination significantly lowered anxiety for individuals with clinically significant anxiety and reduced perceived painfulness of pelvic examination. This study demonstrates the ability to integrate a brief mindfulness intervention into the flow of a medical clinic and reduce pelvic exam anxiety and pain.
The Effect of the COVID-19 Pandemic on Access to Hysterectomy within One Hospital System [A101]
Authors: Chaoul Jessica , Sifri Yara , Nyein Ethan , Khalil Susan
Published: June 2022

INTRODUCTION:

This study seeks to study how the pandemic affected access to hysterectomy within one tertiary care hospital system, specifically evaluating racial breakdown.

METHODS:

This study is a retrospective observational study within one hospital system. Institutional review board (IRB) approval was exempt. All hysterectomy cases were compiled for 7 months before the COVID-19 pandemic, during the pandemic, and 7 months after. The records for each patient were accessed to find patient demographics.

RESULTS:

Of the 840 hysterectomies performed in 7 months prior to the pandemic, 37.66% were performed on patients identifying as “White,” 27.77% on “Black/African-American” patients, 20.26% on “Hispanic” patients, and 7.63% on “Asian American” patients. Of the 54 hysterectomies performed during the pause on elective surgeries, 50.00% were performed on patients identifying as “White,” 35.19% on “Black/African-American” patients, 7.41% on “Hispanic” patients, and 7.41% on “Asian American” patients. There was a significant 12.85% (P<.001, CI 5.36-20.35) decrease in cases performed on those identifying as “Hispanic” during the pandemic. Of the 860 hysterectomies performed in the 7 months after the pandemic, 40.93% were performed on those identifying as “White,” 29.07% on “African-American” patients, 14.88% on “Hispanic” patients, and 8.02% on “Asian-American” patients.

CONCLUSION:

The racial percentages did drastically change during the COVID-19 pandemic. The percentage of hysterectomy cases performed on those identifying as “White” increased 12.34%. The percentage of hysterectomies performed on those identifying as “Hispanic” decreased 12.85%. This shift in racial breakdown in hysterectomy cases performed before and during the pandemic may allow a glimpse into how hospitals prioritized certain gynecologic surgeries as “elective.”