bluuebunny/crossref_metadata_2025 huggingface dataset:
Rates of Expedited Partner Therapy Prescribed by OB/GYN Residents at LA County Hospitals [15A]
Authors: Mitchell Evelyn , Nguyen Brian T. , Novatt Hilary , Hardley Macy T. , Chang Emily
Published: April 2020

INTRODUCTION:

The incidence of STIs, specifically gonorrhea, chlamydia, and trichomoniasis among Los Angeles County residents is on the rise. One possible explanation is inadequate treatment, especially of sexual partners. Expedited partner therapy (EPT) is a method of treating patients' partners without a separate healthcare visit, which has been shown to decrease persistent and/or recurrent infections. We report on quality improvement outcomes following interventions to help increase the rates of EPT provision.

METHODS:

Interventions included creating a protocol with the pharmacy, arranging for Cefixime to be on formulary, and conducting resident training sessions. Data collection was performed on all positive gonorrhea (GC), chlamydia (CT) and trichomoniasis lab results seen from January 1, 2017 to February 27, 2019 across all departments, inclusive of Ob/Gyn. EPT rates before and after interventions are presented.

RESULTS:

The rates of EPT prescriptions provided by OB/GYN providers for STI treatment increased following the interventions. EPT for GC/CT increased from 40% to 55% of cases; EPT for Trichomonas increased from 38% to 85%. Interestingly, patients were often counseled on the need for partner treatment, but were not given prescriptions. This study includes only female patients seen by Ob/Gyn providers, though the majority of results were detected in the emergency department by non Ob/Gyn providers.

CONCLUSION:

Following interventions aimed at establishing agreements with the pharmacy as well as increasing awareness among residents, the EPT rates of gonorrhea, chlamydia, and trichomoniasis did increase significantly. This may assist with decreasing the rate of STI reinfection among County hospitals and hospitals supported by medical trainees.
Secnidazole, an Approved Single Dose Drug for Bacterial Vaginosis, Does Not Cause Reproductive Toxicity in Animals [16A]
Authors: Pentikis Helen , Eder Scott , Kaufman Gregory , Chavoustie Steven
Published: April 2020

INTRODUCTION:

Single-dose oral secnidazole 2 g, has recently been approved in the US for treatment of bacterial vaginosis (BV) in adult women. BV is associated with an increased risk of several pathological gynecological conditions as well as major adverse outcomes during pregnancy, where it is associated with a two-fold increased risk of preterm birth and a six-fold increased risk of miscarriage. In order to inform patient labeling, reproductive toxicology studies have been conducted.

METHODS:

A complete reproductive toxicology program required for patient labeling was conducted. Rats and rabbits were fed varying doses of secnidazole, 0 to 1000 mg/kg/day and 0 to 100 mg/kg/day, respectively, leading up to and throughout gestation. Maternal examinations included clinical observations and survival, food consumption, and parturition. Data obtained from the first-generation (F1) pups included viability, body weight, neurobehavioral and reproductive function. Data including clinical signs, survival and body weights were also obtained for the second generation pups derived from F1 offspring. Adverse events associated secnidazole were measured.

RESULTS:

Secnidazole showed no reproductive toxicity in animal models. There was no effect on weight, growth, and food consumption for animals administered secnidazole, up to 300 mg/kg/day. There were no effects on survival, intrauterine growth, or external fetal morphology at any dose.

CONCLUSION:

There was no evidence of secnidazole toxicity in fertility and pre- and postnatal reproductive toxicology. In addition, there were no adverse developmental outcomes when secnidazole was administered orally to pregnant rats and rabbits during organogenesis at doses up to 4 times the clinical dose.
Association of Delayed Treatment of Chlamydia and Gonorrhea Infections in Pregnancy and Preterm Birth [18A]
Authors: Goggins Emily R. , Chamberlain Allison T. , Young Marisa R. , Jamieson Denise J. , Haddad Lisa B.
Published: April 2020

INTRODUCTION:

Treatment of chlamydia and gonorrhea in pregnancy decreases adverse health outcomes, including preterm birth. The impact of time to treatment on preterm birth is unknown.

METHODS:

Retrospective cohort study of women who delivered at a public hospital between July 2016 and June 2018. Polytomous logistic regression was used to examine associations between no infection, timely treatment (within one week), and delayed treatment (after one week) and preterm and very preterm birth. Multifetal gestations, cases diagnosed after 20 weeks, and subsequent deliveries from women who delivered multiple times in the study period were excluded.

RESULTS:

Among 2,967 women, 207 (7%) tested positive, 328 (11%) delivered preterm, and 62 (2%) delivered very preterm. The incidence of preterm birth was 11% for those with no infection, 14% for those treated within one week, and 14% for those treated after one week. The incidence of very preterm birth among these groups was 2%, 3.5%, and 7%. Compared to women without infection, delayed treatment was associated with a 3.5-fold increase in the odds of very preterm birth after adjusting for a priori confounders (95% CI 1.5–8.1). The risk of very preterm birth was similar for women with timely treatment and those with no infection. The risk of preterm birth was similar for women with timely treatment, delayed treatment, and no infection during pregnancy.

CONCLUSION:

Delays in treatment greater than one week were associated with very preterm birth, while timely treatment mitigated this risk. Timely treatment of these infections in pregnancy is imperative for reducing adverse health outcomes.
Association of Abnormal Placental Cord Insertion With Assisted Reproductive Technology [20A]
Authors: Leftwich Heidi K. , Chuahan Shaila V. , Hen Eden , Lueck Tyler , Leung Katherine , Yeh John
Published: April 2020

INTRODUCTION:

Abnormal placental cord insertion has been associated with an increase in preterm delivery, low birth weight, neonatal intensive care admissions and cesarean delivery. Assisted reproductive technology (ART) has been associated with some similar placenta-medicated pregnancy complications. We hypothesize an increase in abnormal placental cord insertion in pregnancies conceived using ART, thereby contributing to the increased association of adverse pregnancy outcomes.

METHODS:

We performed an IRB approved, retrospective chart review of 3728 singleton and twin placentas sent to pathology at the University of Massachusetts between January 2011-January 2016. Placental pathology reports were reviewed and evidence of abnormal placental cord insertion, either velamentous or marginal, were recorded. Chi-square test was used for categorical variables and student T-test for continuous. Logistic regression was used to control for potential confounders. P less than 0.05 was used for statistical significance.

RESULTS:

Of the 3728 pregnancies, 3615 were conceived via spontaneous conception, whereas 113 were conceived through ART. Women who conceived with ART were more likely to be married, of white race, older and have multiple gestations than those with spontaneous conception. ART pregnancies were over 2-fold more likely to have abnormal placental cord insertions (OR 2.1 [1.1–3.9], P=.03). After adjusting for confounding factors, statistical significance was no longer noted.

CONCLUSION:

Pregnancies conceived with ART were more likely to have abnormal placental cord insertion in our study. A larger sample size of women conceived using ART would be needed to fully understand the effect of ART on abnormal placental cord insertion beyond the confounding effect of multiple gestations.
LGBTQ+ Individuals' Perceptions of Reproductive Hormone Self-Collection Tests [26A]
Authors: Worthington Amber , Shirazi Talia , Abrams Mere , Burke Erin , Leahy Carly
Published: April 2020

INTRODUCTION:

LGBTQ+ individuals have faced persistent challenges accessing healthcare related to fertility. This can lead to a lack of reproductive and family planning knowledge. New applications of health technologies, specifically reproductive hormone self-collection tests, present a unique opportunity to overcome these issues. We examined LGBTQ+ individual's perceptions of reproductive hormone self-collection tests.

METHODS:

Participants (N=203 LGBTQ+), including cis lesbian (n=83) and transgender, nonbinary, or gender non-conforming (T/NB/GNC; n=120), completed an IRB-approved online survey in 2019.

RESULTS:

One-sample t-tests (with means compared to the scale midpoint) revealed that the participants believed reproductive hormone self-collection tests are useful, easy to use, and trustworthy (all P<.001); perceptions of risk did not differ from the midpoint (P=.88). A one-sample t-test also revealed that LGBTQ+ individuals felt more comfortable using a self-collection test (compared to a test at a doctor's office; P<.001). The majority (86%) believed that a reproductive hormone self-collection test would promote LGBTQ+ access to healthcare related to fertility. There were no differences between cis lesbian and T/NB/GNC participants.

CONCLUSION:

These results suggest that LGBTQ+ individuals believe reproductive hormone self-collection tests are useful, easy, and trustworthy and, further, believe that these self-collection tests would make LGBTQ+ individuals more comfortable testing their reproductive hormones and would increase access to healthcare. Increasing LGBTQ+ individuals' access to healthcare related to fertility is an important step in addressing sexual and gender minority health disparities and enabling LGBTQ+ individuals to achieve their reproductive and family planning goals.
Obese Women Undergoing in Vitro Fertilization Have Higher IL-6 and TNF-α Levels in Follicular Fluid [27A]
Authors: Kim Tana , Zhao Yulian , Enninga Elizabeth
Published: April 2020

INTRODUCTION:

Obesity is associated with lower pregnancy and live birth rates following in vitro fertilization (IVF). As the follicular fluid (FF) provides the microenvironment for the oocyte, immune dysregulation due to obesity related inflammation could disrupt the developing oocyte. The objective of this study was to compare differences in FF cytokines based on BMI in women undergoing IVF.

METHODS:

FF was collected from women undergoing IVF. Cytokines levels were measured from the FF using ELISA and compared based on BMI ≥35. Patient characteristics and cycle outcomes were compared between the groups. Wilcoxon rank sum and Fisher exact tests were used for continuous and categorical variables, respectively. Values are presented as medians.

RESULTS:

The analysis included 57 women with BMI <35 and 11 women with BMI ≥35. Women with BMI ≥35 had higher levels of IL-6 (129.23 vs 16.55 pg/mL, P=.019) and TNF-α (62.6 vs 9.54 pg/mL, P=.037) in the FF. Anti-müllerian hormone was lower with BMI ≥35 (2.0 vs 3.6 ng/mL, P=.049), but no other differences in patient characteristics were seen between the groups. There were no differences in stimulation duration (11 vs 11 days; P=.993), total gonadotropin (3075 vs 2475 units; P=.122), peak estradiol (2080 vs 1972 pg/mL, P=.521), mature oocytes (13 vs 12; P=.822), and oocyte maturity rate (82% vs 80%, P=.653) between the groups.

CONCLUSION:

Obese women undergoing IVF have higher levels of inflammatory cytokines IL-6 and TNF-α in the FF. These biochemical discrepancies may provide early insight into pathophysiologic differences in oocyte development in obese women undergoing IVF.
Patterns in the Management of Endometriosis Among Physicians: A Cross-Sectional Survey [28A]
Authors: Reddy Srinidhi , McLaughlin Jessica , Stansbury Nicholas , Knudtson Jennifer
Published: April 2020

INTRODUCTION:

Management of endometriosis is complex and varies among providers. This study investigates patterns in the management of endometriosis among Obstetrics and Gynecology physicians in the United States.

METHODS:

The Institutional Review Board reviewed and approved this study. A national online survey was sent to 5000 members of the American College of Obstetrics and Gynecology. It included 22 questions designed to assess the medical, surgical, and pain management of endometriosis. Variations in management were assessed using Fisher exact test and Mann-Whitney test.

RESULTS:

The adjusted response rate was 24.5%. The most common initial treatment for pelvic pain and suspected endometriosis was continuous combined oral contraceptives (COCs) (58%). When medical management fails, 52% of respondents opt for surgical management; 45% of respondents treat with excision while 42% treat with cautery ablation. Most indicated they offer postoperative hormone suppression, including continuous COCs (45%) or gonadotropin-releasing hormone agonists with add-back therapy (27%). The majority prescribe nonsteroidal anti-inflammatory drugs to treat endometriosis-related pain while a minority opt for alternative treatments such as opioids, acupuncture, and psychological support. 82% of physicians believe there is a need for women with endometriosis to have psychosocial care; however, only 15% routinely refer patients for psychological counseling. Importantly, 72% of respondents indicated they do not feel adequately trained to provide care for psychosocial aspects of endometriosis.

CONCLUSION:

The majority of responding providers are practicing evidence-based care for the treatment of endometriosis. Although most physicians recognize the need for a multidisciplinary approach to the treatment of endometriosis-related pain, only a minority recommend alternative treatments.
Presence of Human Herpesvirus 6 in Endometrial Samples of Women With Reproductive Failure [29A]
Authors: Doody Kaitlin , Knox Konstance
Published: April 2020

INTRODUCTION:

Human herpesviruses 6A and 6B (HHV-6) are members of the Herpesviridae family that includes cytomegalovirus and herpes simplex virus. Like other human herpesviruses, HHV-6 can persist unknowingly in a latent state. Recent studies have identified the presence of HHV-6 within the endometrial cells in 43% of women with unexplained infertility, but has not been seen in known fertile women. This study evaluates the association between presence of HHV-6 and different infertility subgroups including repeated implantation failure (RIF), recurrent pregnancy loss (RPL), and unexplained infertility.

METHODS:

A prospective cohort evaluation was performed on 201 women undergoing examination for unexplained infertility, RPL, or RIF. Data was collected from five infertility clinics from October 2017 to October 2019. Endometrial biopsies were collected from each patient and immunohistochemistry was performed to identify a late viral protein of HHV-6.

RESULTS:

A total of 75 of the 201 women met the criteria for RIF. The other 126 women were diagnosed with unexplained infertility or RPL. Of the 201 women, 75 women (37.3%) were positive and 126 were negative for HHV-6 viral antigen. In the 75 patients with RIF, 38 biopsies (51%) were positive for HHV-6. In the 126 women without RIF, 37 biopsies (29.3%) were positive for HHV-6.

CONCLUSION:

While previous studies have shown an association between HHV-6 and unexplained infertility, this cohort demonstrates the infection is likely associated with multiple causes of reproductive failure. The presence of HHV-6 in the endometrial cells of these patients supports further study of the pathogenesis of the infection.
Supporting Women in the Workforce: The Importance of Employer-Provided Supplemental Fertility Insurance Benefits [30A]
Authors: Worthington Amber , Shirazi Talia , Burke Erin
Published: April 2020

INTRODUCTION:

Age-related declines in natural fertility may pose a challenge to women who delay childbirth to pursue careers. Reproductive hormone testing may be critical for addressing workplace gender inequality by enabling women to pursue both professional and reproductive goals. Fertility treatments, when performed before significant fertility declines, can provide additional options. However, these procedures can be expensive and are not typically covered under employer-provided health insurance. We assessed U.S. women's beliefs about supplemental fertility insurance benefits.

METHODS:

Participants (N=327 women) completed an IRB-approved online survey in 2019. The data were analyzed with descriptive and chi-square analyses.

RESULTS:

Participants indicated that it is important to them to have insurance cover the cost of annual reproductive hormone testing (77.06%) and fertility treatments (78.28%). Further, they would choose an employer that provides insurance benefits for annual reproductive hormone testing (54.74%) and fertility treatments (59.32%) over one that does not. There were no differences by age, income, geographic region, health insurance, or fertility knowledge; however, infertile women were more likely than fertile women to choose an employer that provides insurance benefits for annual reproductive hormone testing (χ2=7.56*) and fertility treatments (χ2=7.99*). (note: * P<.05).

CONCLUSION:

Our results suggest that U.S. women believe supplemental fertility insurance benefits are important, and they would choose an employer based on the provisioning of these benefits. Employer-provided insurance that includes supplemental fertility insurance benefits may enable women to achieve both professional and reproductive goals, ultimately contributing to greater workplace gender equality.
Use of Corifollitropin Alfa in a Hispanic Cohort After Previously Failed Traditional Ovarian Stimulation Cycle [32A]
Authors: Colin Alinne , Barroso Gerardo , Avila Rosaura , Valdespin Carlos
Published: April 2020

INTRODUCTION:

The aim was to assess reproductive outcomes of corifollitropin alfa (CA) in the same cohort of patients who had before an Intracytoplasmic sperm injection cycle with a traditional controlled ovarian stimulation (COS) protocol using daily (rFSH/uhMG).

METHODS:

Retrospective cohort; forty couples included. Traditional COS received rFSH plus uHMG. Second cycle received 100 or 150 µg of CA, in both cycles patients had antagonist protocol and fresh embryo transfer.

RESULTS:

Mean age 34 ± 4.9 years. Compared traditional COS using (rFSH/uhMG) vs CA, there was a difference in peak of estradiol (mean±SD) (1984.9±1292 vs 1099±812 pg/mL, P<.05). No significant differences founded on: progesterone level (1.3±2 vs 1±2.4), endometrial thickness (9.3±1.8 vs 9.4±1.4), mean number of oocytes retrieved (7.1 ± 4.4 and 6.6 ± 5.4), metaphase II oocytes (MII) retrieved (49.8% vs 55.8%), fertilization rate (62.6% vs 67.4%) and number of embryos transferred (1.69 vs 1.61), for (rFSH/uhMG) and CA respectively. The number of blastomeres on day 3 of embryo culture was significantly different in favor of the CA cycle (6.4 ± 1.3 vs 5.5 ± 1.2, P<.05). Positive hCG per transfer was higher on the corifollitropin cycle (6.8% vs 41.38%, P<.05).

CONCLUSION:

This study allowed us to assess the effects of CA on the same cohort of patients; results suggest that the reproductive outcomes of patients treated with CA are similar, with the advantage of having a convenient one application and lower level of estradiol. More studies are needed to determine whether CA has an impact on embryo development in certain groups of patients.
Diagnosis of Late-Onset Gestational Diabetes in the Third Trimester [34A]
Authors: Choi Jennifer , Shultz Lori , Brazee Jennifer , Orr Enaujare
Published: April 2020

INTRODUCTION:

95% of obstetricians in the United States use the two-step approach to diagnose gestational diabetes. We hypothesized that women with normal results on routine screening in the second trimester may present with late-onset gestational diabetes. Therefore, we proposed offering women who have known complications of gestational diabetes, including LGA fetus(es) and/or polyhydramnios, screening in their third trimester.

METHODS:

The study was a retrospective case-control study. Women with third-trimester ultrasound findings of abdominal fetal circumference greater than the 95th percentile, an estimated fetal weight (EFW) greater than the 90th percentile, mild to moderate polyhydramnios (amniotic fluid index between 25–35 cm) on two different ultrasounds and/or severe polyhydramnios (amniotic fluid index greater than 35 cm) were offered the diagnostic 100-gram oral glucose tolerance test (3-hour OGTT). Data was analyzed with IBM SPSS.

RESULTS:

185 women met the ultrasound criteria for diagnostic evaluation. Among them, only 104 (56.2%) women completed both the two-step approach in their second trimester and the 3-hour OGTT in their third trimester. 27 of 104 (25.9%) who had normal screening results in their second trimester were diagnosed with late-onset gestational diabetes.

CONCLUSION:

Gestational diabetes has a significant impact on pregnancy. The study demonstrated that the two-step approach alone does not identify women with late-onset gestational diabetes. Therefore, we suggest implementation of additional screening in the third trimester. These changes may play a significant role in identifying women with late-onset gestational diabetes and decreasing fetal and maternal morbidity and mortality associated with the condition.
Unique Exposure to Ultrasound in Pre-clinical Undergraduate Medical Education [39A]
Authors: Rosen Zarah , Chan Doris , Kelly Rachel E. , Han Diane , Hollifield Lauren , Doyle Nora
Published: April 2020

INTRODUCTION:

Purpose: Descriptive case study of pre-clinical ultrasound education at the University of Nevada, Las Vegas School of Medicine.

BACKGROUND:

Point-of-Care Ultrasound (POCUS) is increasingly valued across medical disciplines. As benefits of ultrasound are recognized, so too is the need to integrate ultrasound into undergraduate medical education (UME). Early exposure contributes to ease of use during clinical rotations. Our objective is to describe integration of POCUS before clinical immersion and how efforts were perceived.

METHODS:

58 medical students participated in a hands-on training session before initiation of clerkship duties. A brief didactic introduction for ultrasound techniques began each session. Students were divided into duos and rotated through 6 stations designed to provide training in ultrasound of the abdomen, head/neck, and cardiac. Each station consisted of a clinical scenario, ultrasound machine, standardized patient/model, and instructor. Student feedback was collected via 6-point questionnaire at the end of the session.

RESULTS:

58/58 students completed the survey, positively evaluating clinical relevance and student satisfaction. 58/58 students answered “yes” that “the session met the stated learning objectives,” 57/58 answered “yes” that “the learning environment was conducive to my acquiring new skills.” Comments were entered in an optional field with the descriptors “great” and “helpful” trending throughout feedback, indicating high student satisfaction.

CONCLUSION:

UME is changing, with new challenges to preparing students for clinical years including the incorporation of POCUS. The overwhelmingly positive feedback for our session indicates integrating POCUS as an educational tool with hands-on ultrasound practice can provide engaging and applicable skills for medical students.
Hail Mary or Russian Roulette: Provider Knowledge and Attitudes Toward the Withdrawal Method of Contraception [02B]
Authors: Jones-Linares Brittany , Patel Jasmine , Nelson Anita L. , Nguyen Brian T.
Published: April 2020

INTRODUCTION:

Withdrawal is often perceived as an ineffective contraceptive method that is infrequently discussed by clinicians, despite frequent use and an efficacy level similar to condoms. It is also one of the few methods available to men. To address this discrepancy, we surveyed the knowledge and attitudes of women's healthcare providers about withdrawal.

METHODS:

In this IRB-approved, exempt study, surveys were distributed at four contraceptive health conferences across the United States. As part of a 16-item survey with open and close-ended questions, providers were asked about the effectiveness of withdrawal for pregnancy prevention and if and how they discussed withdrawal with their patients. Qualitative data were coded with 80% interrater reliability. Distribution frequencies and associations via chi-square tests are presented.

RESULTS:

Overall, 17.7% and 2% of respondents correctly identified typical and perfect use failure rates for withdrawal. Asked how they would respond if their patient reported withdrawal for contraception, half (55.3%) provided responses suggesting open-mindedness. Compared to other healthcare providers (such as physician assistants and nurses), physicians were more likely to endorse negative attitudes about using withdrawal (P<.01). Half (51.1%) of providers do not list withdrawal as a method choice on reproductive history intake forms; only one-third routinely ask about this method.

CONCLUSION:

Better education about withdrawal and its efficacy as a contraceptive method are needed for practitioners to recognize the importance of its inclusion in their counseling, as well as to provide their patients with the data needed to make informed contraceptive choices.
A Comparison of Sexual Reproductive Health Knowledge Between Transgender Men and Cisgender Women [04B]
Authors: Liu Ying X. , Joyner Andrea B. , McCool-Myers Megan
Published: April 2020

INTRODUCTION:

Gynecologic care for transgender (trans) men can be emotionally challenging due to the nature of the examinations. However, it remains important and recommended, especially in individuals who have not undergone gender-affirming surgery. There are currently no published studies assessing trans men's knowledge of sexual reproductive health (SRH) and gynecologic care. This study aimed to compare SRH knowledge and gynecologic care practices of trans men and cisgender women.

METHODS:

A cross-sectional survey composed of 41-questions that addressed demographics, SRH knowledge, and gynecologic care practices was administered online using Amazon Mechanical Turk. Inclusion criteria included female assigned at birth, 18 years or older and residing in the US. Data were analyzed descriptively using SPSS.

RESULTS:

To date, 520 participants (n=167 trans men, n=353 cisgender women) have completed the survey. Preliminary analyses revealed that trans men answered less than 50% of the twenty knowledge questions correctly (mean correct responses: 48.1% vs 62.9% for cisgender women), demonstrating significantly lower baseline SRH knowledge than cisgender women [95% CI 11.35–18.43, P<.001]. More trans men expressed interest in learning about the female reproductive system than cisgender women (68.9% vs 54.4%). Additionally, trans men reported more medical visits for SRH issues than cisgender women in the last 12 months (mean visits: 4.27 vs 3.03) and were more likely to discuss SRH concerns with providers other than gynecologists.

CONCLUSION:

Trans men seem to have limited SRH knowledge but are interested in learning more about their natal reproductive organs. Providers including gynecologist should assess for knowledge gaps and engage in appropriate counseling.
A Cross Sectional Analysis of Vaginal Myomectomies [05B]
Authors: Laibangyang Anya , Ghofranian Atoosa , Gabbur Nagaraj
Published: April 2020

INTRODUCTION:

Aborting uterine fibroids are common benign tumors of the uterus that may cause abnormal uterine bleeding and/or pelvic discomfort. Commonly these may be removed in the office or ER however, many cite heavy bleeding as a common complication and advocate that these types of myomas be removed in the OR. The purpose of this case series is to determine the demographics of aborting myomas and common complications.

METHODS:

A retrospective review of all patients from January 2018-June 2019 undergoing vaginal myomectomy at a large suburban hospital was conducted. The size and location of the leiomyomas were noted as well as any operative complications including blood loss.

RESULTS:

During this time frame, there was a total number 7739 Gyn cases done of all types. A total number of 10 patients had a vaginal myomectomy. The incidence of this type of case is 0.129%. The median blood loss was 25cc. Nine patients had a blood loss of less than 50cc. One patient with an 8cm fibroid had a 1250cc blood loss and required two units of packed red blood cells. The mean duration of the procedure was 35 minutes. The fibroid size measured via largest diameter ranged from 2 to 11 cm with a median of was 5 cm.

CONCLUSION:

In this case series, vaginal myomectomies appear to be a safe and effective method of uterine fibroid removal resulting in minimal blood loss. However it appears that for larger myomas, there should be a consideration for removal in the operating room.
An RCT of Bupivacaine Liposome Injectable Suspension for Supracervical Hysterectomies Postsurgical Analgesia [06B]
Authors: Son Mary Ann H. , Paiva Camila , Herzog David , Shamsnia Lily
Published: April 2020

INTRODUCTION:

To demonstrate utilization of intracervical block in reducing postoperative pain for minimally invasive supracervical hysterectomy.

METHODS:

This study is a randomized double blind placebo controlled study of women who underwent minimally invasive supracervical hysterectomy between October 2018 to April 2019. The severity of pain was assessed preoperatively in the holding area, PACU arrival, 12, 24, and 48 hours postoperatively using a numeric rating scale (NRS) at rest for pain with 0=no pain and 10=worst possible pain. Secondary endpoints were number of patients who required NSAIDS and acetaminophen and break through (additional) opioid analgesic medications at 24 and 48 hours.

RESULTS:

Of the 60 participants, half were randomized into the control and intervention groups. Immediate post-operative pain scores were 1 and 1.75 (P=.89) in the control and intervention groups respectively. Follow up pain scores were 3 and 3.5 (P=.85) at 12 hours, 3.5 and 5 (P=.22) at 24 hours, and 2.75 and 4 (P=.18) at 48 hours. Secondary outcomes demonstrated 13 and 15 patients used narcotics in the control and intervention groups respectively. Within the first 24 hours, 10 patients in the control and 14 patients in the intervention group used narcotics. Between 24 to 48 hours, 6 and 8 patients in the control and intervention groups used narcotics respectively.

CONCLUSION:

There was no statistically significant difference in pain scores in the immediately postoperative, 12, 24, and 48 hour time period between the intervention and control groups.
Angiotensin-Converting-Enzyme Inhibitors Protect Against Uterine Fibroids [08B]
Authors: Fischer Nicole M. , Nieuwenhuis Tim , Singh Bhuchitra , Segars James
Published: April 2020

INTRODUCTION:

Uterine leiomyomas are the most common benign pelvic tumor in women. Angiotensin-converting-enzyme inhibitors (ACEi) are a drug-class used for the treatment of hypertension and work by inhibiting the production of angiotensin, an enzyme that promotes blood vessel constriction and tumorigenesis. Angiotensin receptors are expressed in human uterine fibroids and blocking these receptors in animal models has been shown to inhibit leiomyoma cell proliferation. The aim of this population-based study is to examine the association between ACEi use and risk of uterine fibroids and fibroid-related symptoms.

METHODS:

This nested-case control study included women (n=5,563,980) aged 19–64 with a diagnosis of hypertension during 2010. Cases (n=1,390,995) with a uterine fibroid diagnosis were matched to controls (n=4,172,985) at a 1:3 ratio by age. A conditional logistic regression model was used to calculate odds ratios (OR) and confidence intervals (CI) correlating ACEi use with the risk of uterine fibroid development. An unconditional logistic regression was used to relate ACEi use with fibroid-related symptoms.

RESULTS:

The cohort with previous exposure to ACEi demonstrated a decreased risk of uterine fibroid development (OR 0.86, 95% CI 0.85–0.86) compared to those who were not exposed to ACEi. ACEi use was associated with lowered risk of experiencing fibroid-related symptoms like anemia (OR 0.88, 95% CI 0.88–0.89) and pelvic pain (OR 0.90, 95% CI 0.90–0.91).

CONCLUSION:

Angiotensin-converting-enzyme inhibitor use is associated with a reduced risk of the development of uterine fibroids and fibroid-related symptoms. Our findings demonstrate a potential novel therapy for uterine fibroids.
Awareness of Surgical Cost in Gynecology [09B]
Authors: Menzies Anya V. , Cochrane Elizabeth , Kim Sara , Dayton Samantha , Chappelle Joseph , Burke William
Published: April 2020

INTRODUCTION:

With the rising cost of healthcare in the United States, recent efforts have focused on reducing healthcare spending without compromising quality and outcomes. Studies have suggested that most surgeons are unaware of the costs related to surgery. The purpose of our study was to assess provider knowledge of the cost of surgical instruments and adjuncts used during gynecologic laparoscopy.

METHODS:

After IRB approval was obtained, an anonymous survey of practicing gynecologists, OR technologists, and OR nurses at Stony Brook University Hospital was conducted. We inquired about duration of training, formal education regarding cost, self-awareness of cost, and cost estimates for 37 commonly used disposable surgical instruments and items. Similarly to previously published studies assessing cost in other surgical specialties, we defined cost estimate accuracy as within 20% of the hospital cost.

RESULTS:

A total of 104 surveys were distributed, and 29 complete responses (28%) were received. Of the participants, 17 were attendings, 3 were fellows, 6 were residents, and 3 were OR techs and nurses. On average, participant estimates were within the defined accuracy range for only 13.5% items. There were no differences in accuracy when comparing educational level, years in practice, self-perceived awareness, history of formal cost education, or whether individuals factor in cost.

CONCLUSION:

Gynecologic surgeons and trainees have poor awareness regarding the cost of the items used during laparoscopic surgery. Providing further education regarding the cost of these items may aid surgeons in making more informed choices and help reduce healthcare costs.
Chlorhexidine Versus Iodine Vaginal Preparation Prior to Hysterectomy; A Randomized Controlled Trial [11B]
Authors: Hill Austin M. , Pauls Rachel N. , Basil Jack B. , Crisp Catrina C.
Published: April 2020

INTRODUCTION:

Currently we lack sufficient data for The American College of Obstetricians and Gynecologists to make recommendations regarding vaginal preparation solutions for hysterectomy. We designed a randomized controlled trial to compare the effectiveness of Chlorhexidine and Iodine.

METHODS:

Following Institutional Review Board approval, subjects undergoing hysterectomy via vaginal or endoscopic approach were randomized to 4% Chlorhexidine or 10% Iodine vaginal preparation. Vaginal cultures were obtained prior to preparation, then 30, 60 and 90 minutes thereafter. Primary outcome was the percent of samples with ≥5,000 bacteria (“positive culture”) at 90 minutes. Secondary outcomes included percent of samples ≥5,000 at 30 and 60 minutes, clearance of specific pathogens, postoperative complications, and surgical site infection rate.

RESULTS:

Eighty-five patients were randomized, average age 59.8 years (11.4) and median Charlson index score of 2 (0,6). Baseline percent ≥5,000 was no different (95.5% vs 100%; P=.495); 35.3% were positive for bacterial vaginosis. The Chlorhexidine group demonstrated a lower percentage of positive cultures at 90 minutes (47.6% vs 85.4%; P<.001), 30 minutes (27.3% vs 51.2%; P=.024) and 60 minutes (22.7% vs 70.7%; P<.001). Regarding specific pathogens, at 90 minutes, fewer subjects were positive for Staphylococcus in the Chlorhexidine group (5 vs 19; P=.035). There was no difference in the rate of urinary tract infection (15.9% vs 14.6%; P=.870), and no surgical site infections were documented.

CONCLUSION:

Chlorhexidine clears bacteria from the vagina more effectively and maintains a more aseptic surgical environment for 90 minutes. Gynecologic surgeons may consider switching to 4% Chlorhexidine from 10% Iodine for their vaginal preparation solution.
Clinical and Demographic Profile of Women With Endometriosis From Iberoamerica [12B]
Authors: Arroyo-Lluberas Nicolle , Rivera-Mudafort Estefania D. , Santos-Pinero Natasha B. , Hernandez Brian J. , Oliveras Jose A. , Flores Idhaliz
Published: April 2020

INTRODUCTION:

This study was conducted to determine for the first time the demographic and clinical profile of women with endometriosis of Hispanic/Latina background, a patient population not well represented in databases and cohort studies. In order to gather standardized, comparable data we used the Clinical Questionnaire developed by the Endometriosis Phenome project (EPhect) of the World Endometriosis Research Foundation (WERF).

METHODS:

A cross-sectional anonymous study was conducted using the Spanish translation of the questionnaire. A REDCap-based link was distributed via social media to women with endometriosis in collaboration with Patient Associations. Data was analyzed using SPSS.

RESULTS:

Women (1,296) from 22 countries of South America, Central America, the Caribbean, Spain and US participated. Patients reported on education (43.5% had a degree), race (49.8% were white), and work (78.5%). Mean age was 33.7 years old (y/o; range 15–66); at menarche was 12 y/o; at pain onset was 16.2 y/o. Many reported having regular menstrual cycles (70.4%), and profuse menstrual bleeding (47.9%). Most (78.9%) patients reported severe pelvic pain (mean VAS 7.7). Most (82.9%) reported dyspareunia (mean VAS 6.3). Mean number of children was 1.52; 40.3% reported infertility/abortion; only 27.6% sought infertility treatment. The mean length of infertility was 0.52 years (range 0.08–8 years). Quality of life was negatively impacted in household chores (64.8%), sleep (58.7%), and exercise/sports (56.4%).

CONCLUSION:

Hispanic/Latina women with endometriosis present with severe symptoms and substantial quality of life impact. The EPhect questionnaire is a valuable tool to capture data and allow comparisons across ethnicities and geographic regions.
Effect of Bremelanotide on Ambulatory Blood Pressure When Administered for Up to 16 Consecutive Days [14B]
Authors: White William , Faught Brooke , Viswanathan Prabhakar , Williams Laura , Krop Julie , Portman David
Published: April 2020

INTRODUCTION:

Bremelanotide is a melanocortin receptor agonist approved for the treatment of hypoactive sexual desire disorder. Bremelanotide 1.75 mg administered subcutaneously on-demand should not be administered more than once per 24 hours (maximum of 8 doses/month). We evaluated the impact of bremelanotide administered once-daily up to 16 consecutive days to determine if there was a cumulative effect on ambulatory blood pressure (ABP) and heart rate (HR) in premenopausal women.

METHODS:

In this IRB-approved study, 24-hour ABP and HR were assessed at baseline following a single-blind placebo injection, followed by an 8-day treatment period with 1.75 mg bremelanotide daily, and a subsequent 8-day double-blind, parallel-group, randomized (1:1 bremelanotide or placebo) withdrawal period.

RESULTS:

At baseline (n=142), mean age was 36 years, patients were 61% white, 34% black, and 24-hour mean BP was 109/70±8/6 mmHg. Demographics were balanced in the 127 women randomized at day 8. Maximal change from baseline in BP at 8 or 16 days was 3–4 mmHg 3 to 5 hours post-dose, decreasing to 1–2 mmHg by 12 hours post-dose with no cumulative effect. HR decreased by ≤1 beat/minute. The most common treatment-emergent adverse events were focal hyperpigmentation (38% of women during the first 8 days, with an additional 14% of women randomized to bremelanotide for days 9–16) and nausea (30%).

CONCLUSION:

No cumulative effects were observed on ABP or HR following daily dosing of bremelanotide for 8 or 16 days. BP returned to baseline after drug cessation. Data from the present study further support the safety of the recommended dosing.
Endometriosis Analysis: Current Healthcare Utilization and Costs in Women With Endometriosis [17B]
Authors: Williams Kristina , Paris Andy , Duch Dan , Kozma Chris , Bender Stephen
Published: April 2020

INTRODUCTION:

To develop a greater understanding of endometriosis patients' clinical characteristics, provider characteristics, and costs.

METHODS:

Longitudinal data from a 1/1/2010–9/30/2018 national commercial claims and encounters database, were examined. Person-specific (blinded) clinical utilization, expenditures, and enrollment were examined. There were 975 patients with a confirmed endometriosis diagnosis (e.g., laparoscopy, hysterectomy, oophorectomy). Data from 5 years prior to confirmed diagnosis and 1-year after were included.

RESULTS:

In 5 years prior to confirmed endometriosis diagnosis 93.7% of patients visited an Ob/Gyn; 79.3% family medicine; and 52.9% emergency medicine. More than half the patients (60.1%) visited an emergency room (mean 3.46 visits). Approximately 27% had visits to a chiropractic office (mean 17.94 visits over 5 years); 17.6% had physical therapy (mean 10.53 visits). Confirmed diagnosis averaged 984 days (2.7 years) from initial symptoms. Diagnoses for painful periods, heavy menses, infertility, and intercourse pain increased in the year before diagnosis. Oral contraceptive was the most common hormonal therapy. Gonadotropin use was 0.8% prior to diagnosis;12.4% in 6 months following; declined to 8.2% in the next 6 months. Average annual costs in years 5–2 prior to diagnosis were $4, 318; $6,791 year immediately prior to diagnosis; $17,230 in first 6 months post-diagnosis; and $6,129 in months 7–12 post-diagnosis.

CONCLUSION:

This analysis provides insight into patient clinical needs leading up to and following confirmed diagnosis of endometriosis. Understanding these characteristics may lead to more efficient healthcare utilization and lower costs.
Impact of Anesthesia on Estimated Blood Deficit With Dilation and Curettage for Early Pregnancy Loss [21B]
Authors: Conn Allison , Davis Beth R.
Published: April 2020

INTRODUCTION:

To evaluate the route of anesthesia [general endotracheal tube (GETA) inhalational agents versus total intravenous anesthesia (TIVA)] affects estimated blood loss (EBL) during dilation and curettage (D&C) for early pregnancy loss.

METHODS:

Women with early pregnancy loss that underwent D&C January 1, 2016 to May 31, 2017 had their medical records reviewed. Groups were compared that had GETA versus TIVA. The primary outcome was surgical EBL. To detect a 39% decrease in EBL, with a standard deviation of 200 ml at P<.05 with an 80% power, 70 women receiving each anesthetic agent were needed in each group.

RESULTS:

Of 140 charts evaluated (70 per cluster), no statistical differences were noted in sociodemographic variables between groups. Significantly greater EBL was noted in women receiving GETA (290 ml) versus TIVA (88 ml), P<.001. No differences were noted in operative room time or length of surgery. However length of anesthesia was less with TIVA (35 minutes) compared to GETA (39 minutes), P=.03. While no differences were noted in the proportion being given any type of uterotonic agent, only women receiving GETA received a blood transfusion (2.9%), returned to the operating room for bleeding (1.4%), or required hospital admission for 24 hour observation (4.3%).

CONCLUSION:

Women that require surgical intervention for early pregnancy loss, the use of GETA results in significantly greater blood loss compared to TIVA. Gynecologic providers should use TIVA as the preferred method of anesthesia for women undergoing surgical treatment for early pregnancy loss.
Outcomes of Endoscopic Cesarean Scar Defect Repair—A Retrospective Observational Study [22B]
Authors: Nezhat Camran , Vang Nataliya , Miranda-Silva Catarina , Tavakkolizadeh Shirin , Roman Robert
Published: April 2020

INTRODUCTION:

Cesarean scar defects may cause abnormal uterine bleeding, pelvic pain and infertility. We present our preliminary results after laparoscopic and/or hysteroscopic surgical repair.

METHODS:

We performed a retrospective review of clinical data and preliminary outcomes of patients with cesarean scar defect who underwent surgery at the Camran Nezhat Institute.

RESULTS:

We included a total of 27 women. Average age was 36 years, with an average BMI of 23.1 kg/m2. Most patients (74%) had 1 prior cesarean section, while 26% had 2 or more. The most common presenting symptom was pelvic pain (81%), followed by dysmenorrhea (70%), irregular vaginal bleeding (67%) and infertility (48%). Nearly half (44%) of the patients had a previous diagnosis of endometriosis. Prior to presenting to our center, 52% of patients with infertility had attempted IVF, and 30% attempted IUI. Defect repair was performed by a combined laparoscopic and hysteroscopic approach in 85% of patients, while 7% underwent hysteroscopic repair and 11% a hysterectomy. There were 2 postoperative complications, namely umbilical scar revision and umbilical cellulitis. A diagnosis of endometriosis was established by pathology in 67% of cases. Symptoms resolved in 33% of patients, improved in 44%, and persisted in 18%. In those who desired future fertility, the clinical pregnancy rate after repair was 47% (n=7), with five resulting in live births (33%) and two miscarriages (7%).

CONCLUSION:

Cesarean scar defect repair proved beneficial with improved symptoms in 77% of patients and restored fertility in 47%. Lower pregnancy rates may be related to the increased prevalence of endometriosis in this sample.
Informing Patient Selection for Elagolix Treatment of Heavy Menstrual Bleeding Associated With Fibroids [23B]
Authors: Al-Hendy Ayman , Simon James A. , Bradley Linda D. , Owens Charlotte , Wang Hui , Barnhart Kurt
Published: April 2020

INTRODUCTION:

Evaluate the efficacy of elagolix (300 mg BID) with add-back therapy (1 mg estradiol/0.5 mg norethindrone acetate [E2/NETA]) in various subgroups of women with heavy menstrual bleeding (HMB) associated with uterine fibroids (UF).

METHODS:

Data were pooled from two investigational, IRB approved, 6-month, phase 3 studies, Elaris UF-1 and UF-2, that evaluated premenopausal women (18–51 years) with HMB [>80 mL menstrual blood loss (MBL)/cycle; alkaline hematin methodology] and ultrasound-confirmed UF diagnosis. Subgroups analyzed include age, BMI, ethnicity, race, fibroid location based on FIGO classification, uterine and primary fibroid volume, and pregnancy history. Primary endpoint was the proportion of women with <80 mL MBL during the final month of treatment and ≥50% MBL reduction from BL to the final month of treatment. Secondary and other efficacy endpoints included mean change in MBL from baseline to final treatment month and amenorrhea. Adverse events (AEs) were monitored.

RESULTS:

In all subgroups of women who received elagolix+E2/NETA the proportion of responders to the primary endpoint, mean change in MBL from baseline to final treatment month, and proportion of women who achieved amenorrhea were statistically significant compared to placebo, consistent with the overall study population for the primary endpoint (72.2% vs 9.3%, P<.001), mean change in MBL (-172.5 mL vs -0.8 mL, P<.001), and amenorrhea (50.4% vs 4.5%, P<.001). Each subgroup AEs were consistent with the overall study population.

CONCLUSION:

Elagolix with add-back therapy was effective in reducing HMB associated with UF regardless of age, BMI, ethnicity, race, fibroid location based on FIGO classification, uterine and primary fibroid volume, and pregnancy history.