bluuebunny/crossref_metadata_2025 huggingface dataset:
Timely Discharge: Oral Nifedipine is Superior to Labetalol for Postpartum BP Control in Patients with Preeclampsia [27R]
Authors: Beatty Catherine A. , Dangel Alissa
Published: April 2018

INTRODUCTION:

Postpartum BP is highest on days three to six postpartum, corresponding to the time when most women are preparing for hospital discharge. Elevated BP may delay hospital discharge. There is limited research guiding medication selection in postpartum patients with persistent hypertension in the setting of preeclampsia.

METHODS:

A retrospective study of consecutive patients at Tufts Medical Center from January 1, 2015 through December 31, 2015 with antepartum preeclampsia who were subsequently treated with oral medications for postpartum hypertension was performed. Time to achieve acceptable BP control (defined as sustained BP <160/110 mmHg requiring no further titration or additional medications) and discharge were compared between patients taking oral labetalol and nifedipine. Side effects and reevaluation for reported elevated BP were also evaluated.

RESULTS:

Patients started on oral nifedipine (n=11) had an average time from initiation of anti-hypertensive to acceptable BP control of 7.4 hours compared to 53.5 hours for patients started on labetalol (n=25) (P=0.013). No patients experienced side effects requiring a medication change. Three patients (3/25) in the labetalol group underwent reevaluation after discharge for poor BP control; no patients in the nifedipine group required reevaluation.

CONCLUSION:

Patients started on oral nifedipine in the postpartum period in the setting of preeclampsia achieved optimal BP control in a significantly shorter period of time than those started on labetalol, resulting in a significantly shorter hospital stay. Additional studies are needed to confirm these findings and determine whether nifedipine should be regarded as the preferred agent for postpartum hypertension in patients with preeclampsia.
Cost Effectiveness of Inpatient vs Outpatient Fetal Monitoring in Monochorionic-Monoamniotic Twin Gestations [30R]
Authors: Hickok Ruth A. , Walker Allison R. , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

To determine the cost-effectiveness of inpatient, continuous fetal monitoring versus outpatient management of monochorionic-monoamniotic (MCMA) twin gestations.

METHODS:

A decision-analytic model was created comparing continuous fetal monitoring versus outpatient daily nonstress test (NST) in a theoretical cohort of 250 MCMA pregnancies. The two arms were broken down based on gestational age beginning at 26 weeks gestation. All probabilities, utilities, and costs were derived from the literature. The primary outcome was the incremental cost per quality-adjusted life year (QALY). Rates of intrauterine fetal demise (IUFD), neonatal death, and cerebral palsy were also investigated. The cost-effectiveness threshold was set at $100,000 per QALY. Univariate and multivariate analyses were used to investigate model robustness.

RESULTS:

Inpatient continuous fetal monitoring results in improved neonatal outcomes and decreased cost. Compared to outpatient management, inpatient management would lead to 43 fewer cases of single IUFD, 7 fewer cases of double IUFD, 34 fewer neonatal deaths and 5 fewer neonates with cerebral palsy. Inpatient management improved effectiveness by 4.500 QALYs and saved $6.6 million (primary strategy improved outcomes). Inpatient management remained the dominant strategy as our estimated cost of per week was doubled to $8,325/week, and remained cost-effective up to five-times our estimated cost.

CONCLUSION:

Inpatient management is a cost-effective strategy for antenatal management of MCMA twin gestations that can reduce perinatal morbidity and mortality. Hospitalization of 5 patients would prevent an IUFD and 8 patients would prevent one neonatal death.
The Effect of Normotensive Antenatal Blood Pressure of Women with Chronic Hypertension on Neonatal Weight [31R]
Authors: Sander Sheigh , Goldkamp Jennifer , Vricella Laura , Rosenberg Henri
Published: April 2018

INTRODUCTION:

Our objective was to determine if birth weight of infants of women with chronic hypertension is affected by range of antepartum blood pressure.

METHODS:

A retrospective chart review of patients with chronic hypertension at a single tertiary care center was completed. The difference in birth weight between women with mean antenatal blood pressures in the systolic range of <140 mmHg verses >140mmHg was assessed. A second analysis to assess mean antenatal diastolic blood pressure of <90mmHg versus >90 mmHg was completed. Chi squared analysis was utilized, with a P-value of <.05 used to indicate statistical significance.

RESULTS:

Data from 148 women with a diagnosis of chronic hypertension was analyzed. This analysis included both those taking antihypertensive medications and those who were not medicated. There was a significant difference in birth weight in normotensive (<140mmHg systolic or <90 mmHg diastolic) versus hypertensive pregnancies, with normotensive women bearing larger children. Median birth weight for those who had normotensive systolic blood pressures was 3,005g versus 2,450g for those who had hypertensive average systolic blood pressures (P=.008). Median birth weight was 2,997.5g for those with normotensive diastolic pressure averages versus 1,857.5g who were hypertensive (P<.001).

CONCLUSION:

Women with chronic hypertension in pregnancy deliver larger babies when blood pressures are in the normotensive range during the antepartum period.
Predictors of False Negatives in Self-Report Screening for Prenatal Substance Use [34R]
Authors: Blake-Lamb Tiffany , Ondersma Steven , Chang Grace , Gilstad-Hayden Kathryn , Yonkers Kimberly
Published: April 2018

INTRODUCTION:

Substance use during pregnancy has known harmful effects for both the mother and fetus. Few substance use screening tools have been evaluated in pregnancy and only one has been validated against a biochemical assay. The current study sought to examine predictors of false negative screens using the most sensitive of five tested screeners.

METHODS:

In 2016-2017, women age 18 and over were recruited during prenatal care at three demographically diverse sites. Four existing substance use screeners with published evidence in pregnancy (SURP-P, CRAFFT, WIDUS, and 5Ps), plus the NIDA Quick Screen, were administered to pregnant women in counterbalanced order and followed by collection of urine that was tested for evidence of alcohol, tobacco, marijuana, opiates, cocaine, benzodiazepines, barbiturates, and amphetamines.

RESULTS:

Among 1,220 participating women, 397 (32.5%) had evidence of substance use per urine toxicology or self-report, with the SURP-P having the highest sensitivity (85%) but the lowest specificity (37%) for detecting use. Among women with evidence of substance use by urine toxicology or self-report, the odds of screening negative (false negative) on the SURP-P were higher for women with multiparity, lower educational attainment, Hispanic ethnicity, and those receiving public assistance.

CONCLUSION:

Substance use screening tools with relatively high detection rates during pregnancy may still miss use among clinically important groups of women. This is particularly true among multiparous and low-SES women who may have reason to under-report. Policies allowing safe disclosure to medical providers are desperately needed.
Prior Exam-Indicated Cerclage: Cervical Length Screening or History-Indicated Cerclage in the Next Pregnancy? [36R]
Authors: Roman Amanda , Saccone Gabriele , Pachtman Sarah , Cruz Yury , Rochelson Burton , Berghella Vincenzo
Published: April 2018

INTRODUCTION:

To evaluate pregnancy outcomes of women with prior physical exam indicated cerclage (PEIC), who in the subsequent pregnancy were either followed by transvaginal ultrasound cervical length (TVU CL) screening or received a planned history-indicated cerclage (HIC).

METHODS:

This was a multicenter cohort study of singleton gestations with prior PEIC. We evaluated two pregnancies in the study subjects: first pregnancy with PEIC for membranes visible or cervical dilatation ≥1.0 cm at speculum exam in asymptomatic women and the subsequent pregnancy in which women received either TVU CL screening with ultrasound-indicated cerclage (UIC) if CL shortened to ≤25mm or planned HIC. The primary outcome was incidence of preterm birth (PTB) <37weeks.

RESULTS:

Of 32 singletons with PEIC in a prior pregnancy who met the inclusion criteria, 8 (25%) were followed with TVU CL screening, while 24 (75%) received HIC. Of the 8 women in the TVU CL group, 7 (87.5%) underwent UIC for CL≤25mm. There was no significant difference between the two groups in the incidence of PTB <37 weeks (37.5% vs 29.2%; aOR 1.46, 95% CI 0.27 to 7.82) and in the secondary outcomes in the TVU CL screening versus the HIC groups, respectively.

CONCLUSION:

Women with prior PEIC have similar outcomes if they receive either TVU CL screening with UIC for CL ≤25mm or planned HIC in the subsequent pregnancy. 87.5% of the women in TVU CL screening require a repeat UIC in the subsequent pregnancy.
Association of Antepartum Blood Pressure and Angiogenic Profile in Women With Chronic Hypertension [3OP]
Authors: Minhas Ruby , Perdigao Joana , Nasim Rabab , Mueller Ariel , Young Danielle , Rana Sarosh
Published: April 2018

INTRODUCTION:

This pilot study explored the association between antenatal blood pressure (BP) and angiogenic biomarkers (sFlt and PlGF) at delivery among women with chronic hypertension (cHTN).

METHODS:

Blood samples were collected within 96 hours of delivery. Mean outpatient BP was stratified as controlled (cBP<140/90) or uncontrolled (uBP≥140/90). Angiogenic factors were measured on an automated platform. Descriptive statistics were assessed with Wilcoxon Rank Sum or chi-square tests, as appropriate. Logistic regression was employed to assess for adverse pregnancy outcomes.

RESULTS:

Of the 78 women enrolled, 58 (74.3%) were African American and 22 (28.2%) had uBP. There was no difference between cBP and uBP in age, race, ethnicity, BMI, smoking/substance abuse, parity, or previous preeclampsia (preE) diagnosis. A higher proportion cBP patients did not use a HTN agent (46.4% vs 13.6%, P=.01), although aspirin usage did not differ. Women with uBP had higher levels of sFlt1 and sFlt1/PlGF (sFlt: 4218.5 vs 3056.0 pg/mL, P=.046; sFlt/PlGF: 62.5 vs. 25.0, P=.04). A greater proportion of uBP vs. cBP patients had superimposed (SI) preE with severe features (preE-SF) (54.6% vs. 25.0%; P=.01), preterm delivery (40.9% vs. 10.7%; P=.002), and more admissions to rule out preE (77.3% vs. 30.4%; P=.0002). In the multivariable model, women with uBP had greater odds of preterm delivery (OR: 6.78; P=.01), SI preE (OR: 3.20; P=.03) and SI preE-SF (OR: 3.27; P=.04).

CONCLUSION:

Antepartum control of BP is associated with a favorable angiogenic profile at delivery and improved outcomes among women with cHTN. Larger studies are needed to confirm these findings.
Targeted Educational Interventions Increase Human Papillomavirus Vaccine Acceptability and Knowledge [7OP]
Authors: Cory Lori , Bogner Hillary , Burger Robert , Chu Christina , Ko Emily
Published: April 2018

INTRODUCTION:

We sought to determine if targeted educational interventions can increase human papillomavirus (HPV) vaccine acceptability and knowledge among young women.

METHODS:

A randomized controlled trial of 256 women aged 12 to 26 at a single institution was completed. Women were randomized to one of three study arms: control (n=85), educational handout (n=84) or educational video (n=87). All subjects completed a survey collecting data on demographics, HPV vaccine preferences and HPV vaccine knowledge following completion of their randomization assignment. Student t test and chi-square tests were applied.

RESULTS:

Baseline age, race, socioeconomic status and gynecologic history were similar between arms. Post intervention, those who watched the video had higher acceptability for vaccination (51.7%) than the handout (33.3%) or control arms (28.2%) (P<.01). Those in the video arm also had higher mean HPV vaccine knowledge scores than those in the handout and control arms, respectively, post-intervention (5.7 vs 5.0 vs 2.8, P<.01). Vaccine acceptors were more likely to try to obtain all vaccinations (91.5% vs 75.3%, P<.01) and to recommend HPV vaccination to acquaintances (92.8% vs 43.3%, P<.01) than decliners. Both the video and handout arms reported that the interventions helped them learn (97.7% vs 93.1%, P=.15), but the video arm was more likely to be helpful for deciding about vaccination (86.4% vs 70.5%, P<.01).

CONCLUSION:

Targeted educational interventions increase HPV vaccine acceptability and knowledge among young women. Future studies may determine if these interventions also increase rates of vaccine uptake and series completion.
Effect of Delayed Cord Clamping Above Versus Below the Perineum on Preterm Neonatal Hematocrit [13OP]
Authors: Schakett Cassandra , Khan Amir , Berens Pamela D.
Published: April 2018

INTRODUCTION:

The objective is to determine the difference in neonatal hematocrit when delayed cord clamping is performed above versus below the perineum.

METHODS:

Patients with anticipated preterm delivery between 30–36 6/7 weeks were randomized to 60 second delayed cord clamping either above or below the perineum after vaginal delivery. Primary outcome was difference in twenty-four hour neonatal hematocrit between groups. Secondary outcomes included Neonatal Intensive Care Unit (NICU) admissions, neonate's need for phototherapy or blood transfusion, one minute APGAR<4 and five minute APGAR<7.

RESULTS:

Of 103 patients consented to the study, 29 were ineligible prior to randomization and 13 did not complete to study. Sixty one patients completed the study (31 above and 30 below to perineum). There were no significant differences in maternal demographic characteristics or comorbidities. Mean gestational age was 35.5 (above) and 34.6 (below), P=.119. No statistical difference was found in neonatal hematocrit at 24-hours of life between the two groups; 51.5 above versus 52.6 below (P=.572). Correspondingly, none of the secondary outcomes were statistically different.

CONCLUSION:

When comparing delayed cord clamping above versus below the perineum in preterm deliveries greater than or equal to 30 weeks gestation, there is no difference in the neonatal hematocrit at 24 hrs of life or secondary neonatal outcomes. Delayed cord clamping can safely be performed above the perineum concomitant with skin to skin contact for vigorous preterm infants.
Nonspecific Tumor Markers in the Era of Value Based Medicine: Role of CA 19-9 in the Pelvic Mass Workup [18OP]
Authors: Underwood Jenny , Saeed Haleema , Chopra Vini , Hanna Rabbie
Published: April 2018

INTRODUCTION:

When encountering an obscure pelvic mass, the usual tumor markers, CA 125 and CEA, are obtained to evaluate for the presence of ovarian and colon cancer. Some physicians order a CA 19-9 level and we do not know if this has clinical importance to assist in the diagnosis. Does this test offer valuable information or does it add confusion and additional workup when found to be elevated? Studies have shown that CA 19-9 elevation is associated with a fat component, and mesodermal tissue derivative, that is present in many various cancers.

METHODS:

3,370 women were retrospectively identified using CPT codes for pelvic mass and CA 19-9. Initial analysis reviewed the subspecialty of the primary investigator using CA 19-9 in their initial workup, and its correlation to a gynecologic pathology. In the cases where an OBGYN was the primary investigator additional tumor markers, age, race, menopausal status, imaging, surgical interventions and final pathology were further analyzed.

RESULTS:

Out of 3,370 women 982 had abnormal CA 19-9. The subspecialties that utilized CA 19-9 the most in their initial work up was Hematology Oncology 29.6%, Gastrointestinal 16%, and Internal Medicine 15.7%. Of the 9% of cases that Gynecologist that ordered CA 19-9, it was noted that 56% additionally ordered ultrasound and CT, while 14% ordered US, CT and MRI at the time of initial workup. Further analysis revealed that in both postmenopausal and premenopausal women with normal CA 19-9, compared to abnormal CA19-9 showed no statistical significance in distinguishing benign versus malignant etiology.

CONCLUSION:

Majority of adnexal masses are benign, the main goal of diagnostic evaluation is to exclude malignancy. Value based medicine is implemented to help improve health care quality, and efficient utilization of health care resources. Based on this retrospective analysis the use of CA 19-9 in evaluation of a pelvic mass does not offer information that directly improves patient outcome, but rather correlates to the increased misuse of health care resources.
Long Acting Reversible Contraception Uptake and Presidential Election Survey [2F]
Authors: Scaramella Nicole M. , Mercier Rebecca
Published: April 2018

INTRODUCTION:

The Affordable Care Act's (ACA) contraception mandate expanded birth control coverage, making Long Acting Reversible Contraception (LARC) more accessible. Anecdotal reports suggest that concerns about loss of coverage following the November 2016 election would lead more women to seek LARC. We conducted a cross-sectional survey to investigate whether women choosing LARC cite politics as a motivation and if they support the ACA.

METHODS:

All women undergoing LARC insertion from June 2017 to July 2017 in an urban gynecology office were invited to participate. Non-English speakers were excluded. The survey queried demographics, motivation for selecting LARC and support for ACA. Descriptive statistics were used to summarize data and chi square tests were used to assess associations between views.

RESULTS:

97 women presented for LARC insertion and 84 completed the survey (86% response rate). 80% received IUDs and 20% received Nexplanon. 99% of devices were paid for by patient insurance. 38% stated recent political events influenced their decision to get LARC. 87% were in favor of the ACA and 86% supported the contraception mandate. Those who supported the ACA were significantly more likely to specifically support the contraception mandate (93% vs 40%, p <0.01). However, women who did not support the ACA were not more likely to support its repeal (25% vs 13%, p=0.38).

CONCLUSION:

A majority of the women seeking LARC support the ACA and for more than one third, the election affected their decision. Politics impacts patient choices and physicians may need to address the changing political climate to better serve their patients.
Screening and Counseling for Intimate Partner Violence in Pregnancy [23F]
Authors: Paruchuri Yasaswi , Rajendran Sneha , Chang Judy
Published: April 2018

INTRODUCTION:

An estimated 1.5 million experience physical or sexual violence from an intimate partner each year in the United States, however little data exists on how obstetric providers assess intimate partner violence (IPV), or on how IPV-affected women experience the discussions.

METHODS:

Patients who disclosed IPV on a computerized pre-visit survey or during an audio-recorded first obstetric visit were asked to return for qualitative semi-structured interviews during which they reviewed their recorded visit and provided their reflections regarding the IPV screening and counseling. Transcripts from these interviews were qualitatively coded for common themes.

RESULTS:

Of the 250 participants, 91 disclosed IPV either by computer survey or in-person during the recorded visit. Thirty-two women returned for semi-structured interviews. Interviews revealed women’s reasons not to disclose, positive and negative aspects about current approaches, and recommendations for providers. Reasons not to disclose included fears regarding confidentiality, stigma, and concern for involvement of child protective services. Positive attributes of current interviewing included expressions of care, direct questioning, telling patients they are not alone, and open body language. Negative attributes included asking about IPV in an insensitive manner. Recommendations for addressing IPV included being direct, nonjudgmental, and caring, and providing follow-up counseling after IPV disclosure. Women advised that post-disclosure discussions should include emotional support, strategies for emergency situations, housing resources, and self-defense resources.

CONCLUSION:

Understanding the experiences of pregnant IPV-affected women provides insight into specific approaches to use or avoid when addressing IPV. IPV training for obstetric care providers should include these strategies to improve IPV screening and counseling.
Risk of Neonatal Sepsis with Rescue Steroids in Preterm Premature Rupture of Membranes versus Intact Membranes [25F]
Authors: TenBrink Emily E. , Quain Angela , Daggy Joanne , Haas David Michael , Shanks Anthony
Published: April 2018

INTRODUCTION:

Currently there is insufficient evidence to make a recommendation for rescue steroids in women with preterm premature rupture of membranes (PPROM). Prior studies have suggested an increased risk of neonatal sepsis and studies investigating rescue steroids excluded these patients. The objective of our study was to compare the rate of neonatal sepsis after rescue steroids in women with PPROM compared to intact membranes.

METHODS:

We performed a retrospective cohort study of singleton gestations 23.0 to 34.0 weeks, who received rescue corticosteroids at our institution between January 2009 and October 2016. Patients were separated into three groups based on membrane status at the time of corticosteroid administration; Group 1 (intact at initial course/intact at rescue course), Group 2 (intact at initial course/PPROM at rescue course), and Group 3 (PPROM at initial course/PPROM at rescue course). The primary outcome, neonatal sepsis, was compared between the three groups. Patient characteristics and neonatal outcomes were analyzed with Fisher’s exact test and Anova.

RESULTS:

143 women were eligible. Neonatal sepsis occurred in 6.8% (7/103) of patients in Group 1, 21.1% (4/19) of patients in Group 2, and 23.8% (5/21) of patients in Group 3 (p 0.021). The relative risk of neonatal sepsis after a rescue course of steroids was 3.31 (95% CI= [1.32, 8.29]) for patients with PPROM (Group 2 and Group 3) compared to those with all intact membranes (Group 1).

CONCLUSION:

A rescue course of corticosteroids in PPROM was associated with an increased rate of neonatal sepsis. Larger studies are needed to further investigate this association.
Maternal Height and Perinatal Outcomes in a Trial of Labor After Cesarean [35F]
Authors: Skeith Ashley E. , Caughey Aaron B.
Published: April 2018

INTRODUCTION:

We sought to determine differences in perinatal outcomes associated with maternal height in the setting of a Trial of Labor After Cesarean (TOLAC).

METHODS:

We conducted a retrospective cohort study of 217,667 women with singleton, vertex, term gestations with a history of cesarean delivery attempting a TOLAC and examined rates of perinatal outcomes based on maternal height. Maternal height was divided in 2-inch increments and outcomes included successful vaginal birth after cesarean (VBAC), maternal transfusion, neonatal NICU admission, and Apgar less than 7 at 5 minutes. Chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:

Overall, we found that maternal height is positively correlated with VBAC success, while being inversely related to risk of poor perinatal outcomes. The overall odds ratio of successful VBAC as related to increasing maternal height is 1.06 (95% confidence interval [CI], 1.05-1.07), meaning that for every 2-inch increase in maternal height, there is a 6% increase in probability of success. Increasing maternal height decreases the risk of poor maternal outcomes, including transfusion (OR 0.96; 95%CI, 0.94-0.98), NICU admission (OR 0.98; 95%CI, 0.97-0.98), and Apgar <7 at 5 minutes (OR 0.98; 95%CI, 0.97-0.99).

CONCLUSION:

Though BMI has been a standard indicator of potential VBAC success, data related to maternal stature could be incorporated into prediction tools for VBAC probability.
The Final Design: Milli; Introducing the Only Patient Controlled Expanding Dilator [39F]
Authors: Krychman Michael , Juravic Mark
Published: April 2018

INTRODUCTION:

Dilators are poorly characterized in the scientific literature yet may recondition the brain body reconnection for anticipatory anxiety. Women report decreased compliance, burdensome regimes, and excessive time commitments as well as concern about stepwise abrupt transitioning between dilator sizes. Milli is a patient controlled electronically expanding dilator that rectify many of these dilemmas. The initial soft launch of 50 users of this novel dilator is reported here.

METHODS:

Fifty-seven patients purchased the device and they complete an initial and 3 months follow up anonymous survey.

RESULTS:

Seventy-seven percent were diagnosed with dyspareunia; 33% were suffering for greater than 5 years before seeking care. Twenty-five percent have not been sexually active for over 5 years. Most used the dilator 3 times a week. Fifty percent spent between 5 and 15 minutes using the dilator, in the bedroom (90%) and 44% using it before bedtime. Forty-three percent use dilators before intercourse, yet 64% do their exercises alone. No serious adverse events or device complications reported. All reported that the device was superior to conventional available dilators. Most reported that the device was easy to clean, comfortable, aesthetically pleasing and improve confidence.

CONCLUSION:

Milli is a patient controlled electronic dilator that increases by 1 mm at a time. Patients can self-control the device and slowly increase progress at her own pace towards specific goals. Initial pilot reports more gradual and rapid vaginal health recovery with less apprehension or anxiety. Larger long-term interventions, with a standardized dilation program with a larger population is planned.
IUDs After the Election: Politics Influencing the Bedroom [4G]
Authors: Abern Lauren , Kiely Kristen , DeGuzman Glen , Packard Adelaide , Maguire Karla
Published: April 2018

INTRODUCTION:

Reproductive health care remains highly politicized in the United States with the 2016 Presidential Election highlighting the debate over access to family planning. Our objective is to determine reasons for intrauterine device (IUD) choice, if the recent presidential election had any impact on contraceptive decision-making, and alternative methods if IUDs were not accessible.

METHODS:

Women 18 and older that presented for IUD insertion at an urban clinic were surveyed. They were asked about demographics, reasons for choosing an IUD, and what influenced this decision.

RESULTS:

100 surveys were completed. The mean age was 27.5 (SD 6.7, range 18-48). The majority (67%) described themselves as Caucasian, and had post-college education (50%). The most common reasons for choosing the IUD were because it was long-acting and effective (88%). 87% opted for a levonorgestrel and 13% a copper IUD. 55% of respondents said the recent presidential election did play a role in their decision. If IUD insurance coverage or cost was a factor, only 23% would pay out of pocket, and 44% would opt for oral contraceptive pills or ring. A significant number of women (23%) would choose much less effective methods including no contraception, condoms, and the rhythm method.

CONCLUSION:

Over half of women surveyed stated that the 2016 Presidential Election contributed to their decision to select an IUD. If an IUD was not an option due to cost, women would choose less effective methods, which could result in unintended pregnancy. This emphasizes the influence of politics in women’s health decision-making.
Do Patient Attitudes About the Intrauterine Device Differ Based on Race and Ethnicity? [6G]
Authors: Edwards Sara , Mercier Rebecca , Perriera Lisa
Published: April 2018

INTRODUCTION:

Differences in contraception usage by race have been documented, but studies evaluating patient attitudes toward intrauterine devices (IUDs) have not assessed racial differences. Since patient attitudes influence usage, we evaluated how attitudes toward IUDs differed based on patient race/ethnicity.

METHODS:

From June 13 to July 18, 2016, all women in an obstetrics & gynecology outpatient office of a large urban academic medical center were asked to participate in a 94 question survey. Women were excluded if they could not read English or were younger than 14 years of age. Surveys included questions about demographic characteristics and knowledge and opinions of IUDs. We performed exploratory bivariable analysis using t tests and chi square testing to determine which outcomes differed by participant race. For those appearing to differ significantly, we performed regression analysis to assess for confounding by other factors.

RESULTS:

Of 1,366 women approached, 521 completed the survey. Our sample was 46% White, 42% Black/African-American, 7% Asian, and 5% other. Questions assessing knowledge about IUDs did not differ significantly based on race, but black women were significantly more likely to perceive that they had less or insufficient knowledge about IUDs compared to white women (OR 1.91 CI 1.06 -3.46). Black women had a more negative opinion of IUD safety (OR 5.0, CI 2.35-10.66) and reliability (OR 5.5, CI 2.20-14.13) than white women.

CONCLUSION:

While knowledge about IUDs is similar between races, black women may have more negative opinions of IUDs, which should be taken into consideration when performing contraceptive counseling.
Colorado in the Crossroads: Opinions on Over-The-Counter Status of Progesterone-Only Contraceptives [16G]
Authors: Hartman Brittany , Secor-Turner Molly , Stamm Carol A. , Kalani Yazd Nazanin Kuseh , Borgelt Laura , Yi HeaMi
Published: April 2018

INTRODUCTION:

Long-Acting Reversible Contraception availability has reduced unintended pregnancy in Colorado, but 300,000 women are still in need of family planning services. In 2012, ACOG announced support for over-the-counter (OTC) oral contraceptives. Since that time, multiple legislative solutions have been proposed, but have been met with opposition for unclear reasons. The purpose of this study was to clarify stakeholder opinions on making progesterone-only pills (POPs) available OTC.

METHODS:

Individual qualitative interviews were conducted with 60 professionals recruited from five stakeholder groups: insurance industry (IC), religious leaders (RL), healthcare professionals (HP), health organization leadership (HO), and health policy (HL). These interviews solicited participants’ perspectives about making POPs available OTC in Colorado. Descriptive content analysis organized data into categories and themes.

RESULTS:

Most participants felt that Colorado is ready to endorse OTC POPs, and would support its implementation. HP and HO showed the largest support, encouraging women’s autonomy in their reproductive health decisions, and noting pharmacist support for this idea. HO showed the most opposition, citing patient cost concerns. RL and IC were conflicted, citing safety, education, and legislative wording concerns. Among all groups, political opposition and cost were perceived as the largest barriers against deregulation.

CONCLUSION:

The consensus among Colorado’s stakeholders is that the state is ready for OTC POPs. However, there was disagreement among groups as to the barriers to achieving that goal. Our research will help groups better understand each other’s interests so that we can come to a consensus on helping women in need in the state of Colorado.
Exit Survey of Women with HSDD Treated With Bremelanotide Demonstrated Meaningful Treatment Benefits [28G]
Authors: Koochaki Patricia , Revicki Dennis , Wilson Hilary , Pokrzywinski Robin , Jordan Robert , Lucas Johna
Published: April 2018

INTRODUCTION:

Bremelanotide, an investigational new drug, demonstrated clinically meaningful improvements in desire and decrease in distress in premenopausal women with hypoactive sexual desire disorder (HSDD) in the phase 3 RECONNECT studies. Here we present outcomes from exit surveys completed by a subset of subjects from RECONNECT, with a focus on the meaningfulness of treatment benefit.

METHODS:

Study subjects were randomized to self-administer bremelanotide (1.75 mg) or placebo subcutaneously via auto-injector pen as desired prior to sexual activity for 24 weeks. Upon study completion, 242 women participated in a quantitative exit survey.

RESULTS:

Among subjects who completed the survey, mean(SD) duration of HSDD was 55.2(48.1) months; symptoms at baseline included decreased sexual interest and desire, decreased arousal, changes in sexual satisfaction/orgasm, and physical changes in lubrication. Overall meaningful benefit as determined using the exit survey was seen in 58.8% of the bremelanotide group and 27.1% of the placebo group (p<0.0001). The bremelanotide group reported a meaningful increase in sexual desire and responsiveness to their partners initiating sexual activity (51.0% and 53.9%, respectively) compared to placebo (20.7% and 25.7%, respectively; p<0.0001 for both). Treatment with bremelanotide was associated with significant improvement in sexual satisfaction (56.9% vs 25.7%; p<0.0001), and meaningful improvements in mental (52.0% vs 25.7%; p<0.0001) and physical (64.7% vs 21.4%; p<0.0001) arousal. Overall, 62.4% of participants rated their experience with the device as excellent or very good.

CONCLUSION:

Women randomized to bremelanotide consistently reported meaningful treatment benefits compared to placebo, which reiterated the primary outcomes in the overall RECONNECT study population.
The Impact of Using Hysteroscopic Morcellation For Benign and Cancerous Endometrial Pathology: An Ex Vivo Study [31G]
Authors: Lincenberg Kimberly , Lindheim Steven , Kemner Emily , Maxwell Rose , Hood Daniel , Yaklic Jerome L.
Published: April 2018

INTRODUCTION:

Hysteroscopic morcellation is frequently used to resect endometrial pathology. We assessed the impact of hysteroscopic morcellation on histologic analysis and the accuracy on tissue diagnosis.

METHODS:

A prospective paired-comparison study was performed in consenting women undergoing hysterectomy for benign indications (n=13) or hyperplasia/cancer (n=10). After hysterectomy, a section of the endometrium was removed for ex vivo morcellation using the Hologic® MyoSure hysteroscopic tissue removal system. Morcellated specimens were then processed and compared by two blinded pathologists (Pa, Pb) to the original specimens’ final diagnoses at the end of patient recruitment. Chi square and Cohen’s kappa coefficient were used for analysis.

RESULTS:

Morcellated specimens were readable in 100% (23/23) by Pa and 91.3% (21/23) by Pb. Morcellated specimen diagnoses were concordant with final diagnoses in 86.9% (20/23, k=0.772, p<0.001) for Pa and 80.9% (17/21, k=0.559, p<0.001) for Pb. The majority of benign final diagnoses were concordant with morcellated specimen diagnoses: 100% (13/13, k=1, p=<0.001) for Pa and 90.9% (10/11, k=1, p=<0.001) for Pb. Each pathologist found 70% (7/10) concordance of morcellated specimen diagnoses with malignant final diagnoses (Pa k=0.559, p<0.003 and Pb k=0.394, p<0.014).

CONCLUSION:

The data supports that hysteroscopic morcellation does not adversely impact whether specimen is able to be interpreted by histologic analysis. However, 30% of malignant disease were under-diagnosed on morcellated specimens. Further research is warranted to confirm the findings. Our study emphasizes the importance of vigilance in securing an accurate diagnosis in patients with endometrial pathology as future patient management depends on it.
Elagolix Reduces Productivity Losses in Uterine Fibroids Patients With Heavy Menstrual Bleeding [33G]
Authors: Diamond Michael , Soliman Ahmed M. , Gao Jingjing , Owens Charlotte D.
Published: April 2018

INTRODUCTION:

This study assessed the impact of elagolix, an oral gonadotropin-releasing hormone antagonist, on workplace productivity in uterine fibroids (UF) patients with heavy menstrual bleeding (HMB).

METHODS:

M12-813 was a Phase IIb, randomized, double-blind, placebo-controlled trial with 6-month treatment period in premenopausal UF patients with HMB (>80 mL menstrual blood loss per month). M12-813 had two cohorts: elagolix 300mg twice daily (cohort 1) and elagolix 600mg once daily (cohort 2). Each cohort had four arms: placebo, elagolix alone, and two elagolix plus add-back arms (low dose [LDA]: estradiol [E2] 0.5mg/norethindrone acetate [NETA] 0.1mg and standard dose [SDA]: 1.0mg E2/0.5mg NETA). UF-related workplace productivity hours lost to absenteeism and presenteeism (reduced productivity while at work) were measured at baseline and month 6 using the health-related productivity questionnaire. Changes from baseline were compared between elagolix arms and placebo utilizing analysis of covariance.

RESULTS:

Cohort 1 included 204 women. At month 6, larger reductions in least-squared (LS) mean hours lost due to absenteeism were observed for elagolix 300mg BID, elagolix 300mg BID+LDA and elagolix 300mg BID+SDA (LS Means: -2.2, -2.6, and - 2.6 hours, respectively) compared to placebo (LS Means:-1.0 hours). P-values were <0.05 for both elagolix plus add-back arms. Reductions in LS mean hours lost due to presenteeism were greater for elagolix 300mg BID, elagolix 300mg BID+LDA and elagolix 300mg BID+SDA (LS Means: -6.8, -7.6, and -9.1 hours, respectively) than placebo (LS means: -2.9 hours); P-value was <0.01 in elagolix 300mg BID + SDA arm.

CONCLUSION:

Elagolix+ SDA reduces UF-related absenteeism and presenteeism.
Impact of Fetal Anomalies in Down Syndrome Terminations [5H]
Authors: Phillips Carolyn , Cui Yiwen , Fanucchi Hannah , Rijhsinghani Asha
Published: April 2018

INTRODUCTION:

To understand the impact of an anomalous Down syndrome fetus on a woman’s choice regarding her pregnancy options.

METHODS:

This retrospective study analyzed all women diagnosed with fetal Down syndrome by amniocentesis in the Fetal Diagnosis and Therapy Unit at The University of Iowa Hospital and Clinics between 1990 and 2006. Details of fetal findings on ultrasound examinations and subsequent decisions on pregnancy were collected. Sonographic fetal malformations were separated into structural abnormalities (limb asymmetry, facial anomalies) and major structural abnormalities (central nervous system, cardiac, gastrointestinal, genitourinary, or multiple system anomalies).

RESULTS:

249 patients were included in the study of which 86 (35.5%) had no fetal anomalies on ultrasound compared to 163 (62.5%) who did. Patients without sonographic evidence of fetal structural abnormalities had a significantly higher rate of pregnancy termination than those with fetal anomalies (89.5% vs 49.1%, p<0.0001). Moreover, for patients with fetal structural abnormalities, those with non-major fetal anomalies had a statistically higher proportion of termination that those with major anomalies (80.8% vs 43.1%, p=0.0004).

CONCLUSION:

A woman’s decision to terminate a pregnancy affected by Down syndrome may be more complex than a simple consideration of fetal anomalies, as patients in our study have higher rates of termination if they have no or non-major sonographic evidence of fetal anomalies.
Use of Tranexamic Acid to Prevent Postpartum Hemorrhage in Women Undergoing Cesarean Delivery: A Meta-Analysis [14H]
Authors: Vasichko Paula E. , Ireland Kayla E. , Boyd Angela R. , Acosta Ometeotl M. , Ramsey Patrick S.
Published: April 2018

INTRODUCTION:

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Multiple clinical trials evaluated tranexamic acid (TXA) for treatment and prevention of PPH, but there is currently insufficient evidence to support prophylactic use. Our objective was to conduct a systematic review and meta-analysis using available data from randomized clinical trials (RCT) that evaluated the efficacy of TXA prophylaxis during cesarean section.

METHODS:

A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 with relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCTs were abstracted and meta-analysis performed using the Mantel-Haenszel fixed effects model with test of heterogeneity.

RESULTS:

27 RCTs were identified for prophylactic use of TXA at cesarean section; which included 4728 women. Only a single study included women at high risk for PPH. Administration of TXA was significantly associated with reduction of mean estimated blood loss (EBL) (27 studies, n=4728, OR 0.45, 95% CI 0.41–0.50), PPH>1000 mL (6 studies, n= 1986, OR 0.27, 95% CI 0.18-0.43), use of blood transfusions (12 studies, n=2813, OR 0.33, 95% CI 0.20-0.54), and need for other medical interventions (9 studies, n=2577, OR 0.39, 95% CI 0.29-0.53). Only 4 cases of VTE in 4366 women were reported which occurred similarly in controls and TXA.

CONCLUSION:

In an overall low risk patient population, prophylactic TXA at cesarean section was effective in reducing mean EBL, PPH>1000, blood transfusions, and need for other medical interventions. Additional research is needed to elucidate optimal regimens to maximize efficacy and minimize risk.
Patient-Reported Breastfeeding Experience After Peripartum Hysterectomy [15H]
Authors: Keenan Karissa , Einerson Brett , Gibbins Karen J. , Silver Robert M. , Grover Bryan , Callaway Emily
Published: April 2018

INTRODUCTION:

Peripartum hysterectomy is associated with maternal morbidity, including blood transfusions and ICU admission. The impact of this morbidity on breastfeeding has not been documented. Our objective was to assess self-reported breastfeeding and overall satisfaction in women with peripartum hysterectomy.

METHODS:

Cohort study comparing women with peripartum hysterectomy to complicated cesarean section. Exposed women were those with hysterectomy due to placenta accreta or atony. Unexposed women were those with complicated cesarean (three or more prior cesareans or placenta previa) who did not have a hysterectomy. Women were enrolled at time of diagnosis or delivery. Details of the delivery hospitalization were abstracted. Breastfeeding surveys were sent to patients at twelve months or more postpartum. Proportions were analyzed with chi-square, Fisher exact, and t-tests.

RESULTS:

At 12 months postpartum, 69 (39%) of 178 women enrolled completed the follow-up questionnaire. Women with peripartum hysterectomy had higher rates of preterm birth, EBL > 1500cc, ICU admissions, blood transfusion, and NICU admissions compared to those with complicated cesarean section. Similar rates of breastfeeding were found at 6 months (64% vs 74%, P=.40) and 12 months (52% vs 60%, P=.55) postpartum as well as access to lactation consults (64% vs 60%, P=.72) between groups. Women who had a peripartum hysterectomy were less likely to be satisfied with their breastfeeding experience compared to women who had complicated cesarean section (48% vs 76%, P=.02).

CONCLUSION:

Women who undergo peripartum hysterectomy have higher rates of dissatisfaction with breastfeeding experience at 12 month postpartum compared to those with complicated cesarean sections.
Class III Obesity and Gestational Diabetes: The Role of Early Screening [20H]
Authors: DeTeresa Catherine A. , Ramus Ronald M.
Published: April 2018

INTRODUCTION:

Obesity is a risk factor for gestational diabetes mellitus (GDM), and current guidelines recommend early glucose screening for pregnant patients with class III obesity (BMI ≥40). This study was performed to evaluate the role of early screening on the diagnosis of GDM in a severely obese population.

METHODS:

This was a retrospective cohort study of women with class III obesity who delivered at our hospital in 2016. The incidence of GDM was examined, as well as timing of screening. Early screening was identified as a 1-hour 50 gram glucose tolerance test (GTT) administered prior to 20 weeks gestation, and late screening was classified as a 1-hour GTT administered ≥30 weeks. An abnormal 50 gram result then led to a 3 hour GTT to diagnose GDM.

RESULTS:

314 women with class III obesity delivered in 2016; 18 were found to have pregestational diabetes mellitus and 31 (10.5% of obese gravidas without pre-existing diabetes) were diagnosed with GDM. Out of the women diagnosed with GDM, 11 (35.5%) were diagnosed with early screening, 16 (51.6%) were diagnosed between weeks 20-29, and 4 (12.9%) were diagnosed at ≥30 weeks. Of the women who received early screening, 11 (73.3%) were diagnosed with GDM at that time and 4 (26.7%) were diagnosed later in pregnancy.

CONCLUSION:

Diabetes and GDM are linked with neonatal morbidity. Our overall incidence of GDM was 10.5% in this high risk group. However, early screening for GDM in women with class III obesity leads to earlier detection in about 35% of cases with greater opportunity to improve prenatal glycemic control.
Phase 3 Study Evaluating Brexanolone, a GABAA Receptor Modulator, in Moderate Postpartum Depression [25H]
Authors: Kanes Stephen , Colquhoun Helen , Riesenberg Robert , Rubinow David , Maximos Bassem , Meltzer-Brody Samantha
Published: April 2018

INTRODUCTION:

A double-blind, placebo-controlled Phase 2 study of brexanolone (USAN; formerly SAGE-547 Injection), a positive allosteric modulator of GABAA receptors, demonstrated rapid and durable improvements in postpartum depression (PPD). The current study (NCT 02942017) is one of two randomized, multi-center, double-blind, placebo-controlled Phase 3 studies that examined the efficacy and safety of brexanolone in women with PPD.

METHODS:

Approximately 100 women with moderate PPD (Hamilton Rating Scale for Depression [HAM-D] total score ≥20 and ≤25) were randomized 1:1 to a 60-hour infusion of blinded brexanolone (90 µg/kg/h) or placebo. The primary endpoint was the change from baseline in the mean HAM-D total score at Hour 60 following brexanolone compared with placebo. Durability of effect and safety were assessed through Day 30. Safety and tolerability were assessed by adverse events, vital signs, laboratory evaluations, electrocardiogram, and the Columbia Suicide Severity Rating Scale. Secondary efficacy endpoints included change from baseline in the Montgomery-Åsberg Depression Rating Scale, HAM-D response, HAM-D remission, and Clinical Global Impression-Improvement.

RESULTS:

This Phase 3 study will be completed in 2017. This presentation will be the first comprehensive reporting of primary and secondary endpoints. These data seek to validate and expand upon the Phase 2 results, which showed a rapid reduction in mean HAM-D score (Hour 60, brexanolone -21.0 vs. placebo -8.8, p=0.008) and durability through Day 30 (20.8 vs. -8.8, p=0.010).

CONCLUSION:

This study, along with a companion Phase 3 study with brexanolone in subjects with severe PPD, seeks to validate and expand upon the earlier Phase 2 data.