bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Uterine Size on the Failure Rate of NovaSure Radiofrequency Endometrial Ablation [11D]
Authors: Cantrell Laurel D. , Byck David , Bostwick Amelia
Published: May 2017

INTRODUCTION:

Utilization of NovaSure endometrial ablation has been shown to be successful in treating menorrhagia. Little data exists describing NovaSure ablation failure. The purpose of this research is to determine variables most predictive of failure with NovaSure endometrial ablation.

METHODS:

A retrospective case-control study included 224 women who received NovaSure ablation between 2003-2014 at Memorial University Medical Center. 112 of these patients were identified as failures receiving a subsequent hysterectomy and the other 112 women were identified as control patients without a need for subsequent hysterectomy. Patient charts were accessed and reviewed to determine uterine measurements and the preoperative status of each woman including pre-operative pain and prior bilateral tubal ligation. Using SPSS Statistical software, the data was analyzed.

RESULTS:

Mean uterine sound (p= 0.043) and mean cervical length (p= 0.049) were predictive of failure. Secondary analyses determined women with prior bilateral tubal ligation (p= 0.009) predicted failure with NovaSure ablation. Women who experienced preoperative pelvic pain trended toward failure requiring subsequent hysterectomy, but no statistically significant difference was noted (p= 0.073).

CONCLUSION:

Within the limitations of this study, a NovaSure ablation in women with a longer uterus and a longer cervix yields higher failure rates with subsequent hysterectomy. The data also supports the hypothesis that the presence of tubal sterilization is associated with increased risk of subsequent hysterectomy. Determining the significance of pre-operative pain will require further chart investigation. This study can help physicians better identify NovaSure ablation candidates that will be successful thereby improving cost efficacy.
Blood Loss During Voluntary Termination of Pregnancy: A Comparison of Anesthetics [12D]
Authors: Clare Camille A. , Shrestha Neela , Girshin Michael , Broumas Andre , Carmel Danielle , Inchiosa Mario A.
Published: May 2017

INTRODUCTION:

Over one million pregnancies each year will end in termination of pregnancy. There has not been a study in the United States to indicate a clear association between intraoperative blood loss and choice of anesthetics. The purpose of this study is to determine if there is a difference in intraoperative bleeding with inhalational versus non-inhalational anesthesia agents for patients undergoing suction dilatation and curettage for first trimester voluntary termination of pregnancy.

METHODS:

This is an institutional review board approved retrospective chart review of the electronic medical records of patients undergoing voluntary termination of pregnancy between 5 0/7 and 14 0/7 weeks of pregnancy from 2012 and 2014 at the Metropolitan Hospital Center. Comparison of blood loss and anesthetic technique was done using the Mann-Whitney U Test. Blood loss was estimated by the operating gynecology physician.

RESULTS:

The mean intraoperative blood loss for inhalational anesthetics is significantly higher than with non-inhalational agents (p=0.007). Age, body mass index (BMI), gestational age at voluntary termination of pregnancy, or number of methylergonovine doses was not statistically significant between the groups.

CONCLUSION:

The difference in blood loss between the two types of anesthetic techniques may not be clinically significant in a healthy reproductive-age woman. These findings may be important for patients with significant anemia or at an increased risk of bleeding, such as those with coagulopathies. Limitations of this study include its retrospective nature, as well as the method of blood loss measurement.
The Effect of Partial Bladder Filling on Post-Operative Time to Void in Minimally Invasive Gynecologic Procedures [13D]
Authors: Moawad Gaby , Abi khalil Elias , Gilmore Taylor , Marfori Cherie , Vargas Maria , Ebert Jenna
Published: May 2017

INTRODUCTION:

In urogynecologic procedures, backfilling the bladder with 300 cc has been shown to be a better predictor of successful post-operative bladder emptying than completely emptying the bladder at the end of surgery (1). The participants of this study were those undergoing GYN continence procedures, meaning they had some baseline urinary dysfunction. Our study attempts to see the effect on time to void in patients undergoing minimally invasive GYN procedures (laparoscopic or robotic hysterectomy or myomectomy) without baseline urinary dysfunction. The experimental group will have the bladder partially filled at 150cc and the control group will have the bladder completely emptied at the end of the procedure.

METHODS:

This is a double-blind randomized controlled trial. Sample calculations based on total time required to void after Foley catheter removal assuming an alpha level of 0.05 and beta of 0.8 indicate that 36 patients are needed in each group to determine a difference of 20 minutes in voiding time. Up to 38 patients will be enrolled to take into account a 5% dropout rate. Recruitment started on March 20,2016 with 32 patients recruited thus far.

RESULTS:

Preliminary comparisons between time to void in PACU and total PACU stay time between partially filled and empty bladder are as follows: 78-minute decrease in time needed to void in the PACU and 74-minute decrease in PACU stay time, respectively.

CONCLUSION:

This trial has potential to prove our hypothesis that partial bladder back-filling decreases time to void after minimally invasive benign gynecologic procedures, decreasing PACU length of stay and cost.
Pain and Sleep Around Hysterectomy: A Prospective Cohort Study [15D]
Authors: Levy Melanie , Meers Jessica , Stout-Aguilar Jacqueline , Kilic Gokhan , Borahay Mostafa , Nowakowski Sara
Published: May 2017

INTRODUCTION:

Hysterectomy is the most frequent non-pregnancy-related major surgery in reproductive-aged women. Proper pain management represents a critical peri-operative goal. Although the association of chronic pain and sleep disorders is well known, the relation between perioperative pain and sleep is less studied. This study tested the hypothesis pre-operative sleep pattern would predict post-hysterectomy pain perception.

METHODS:

A prospective cohort study of women undergoing hysterectomy for benign conditions. Institutional Review Board approval obtained. Measures included: PROMIS-PI 3a (pain intensity), total sleep time measured by wrist actigraphy and daily sleep diary, and time awake after sleep onset measured by actigraphy and sleep diary. Sleep diary and actigraphy sleep variables were averaged over 7 nights preceding and 7 nights following hysterectomy.

RESULTS:

Sixteen women (41±7.3 years old) participated in the study. Repeated measures ANOVA revealed a significant increase from pre- to post-hysterectomy in actigraphy total sleep time (402±43.7 vs. 481±85.8 min, p=.023), and diary time awake after sleep onset (28±11.4 vs. 58±17.7 min, p=.014). Pre-hysterectomy diary total sleep time was negatively correlated with post-hysterectomy pain intensity (r=-.92, p=.01). Pre-hysterectomy actigraphy time awake after sleep onset was positively correlated with post-hysterectomy pain intensity (r=.86, p=.008).

CONCLUSION:

Findings indicated that sleep duration and disturbance increased following hysterectomy. Shorter sleep duration and more disturbed sleep before hysterectomy were associated with greater perceived pain intensity following hysterectomy. These findings suggest that pre-operative sleep interventions could improve pain perception and recovery following hysterectomy.
Outcomes Associated With Transfusion at Time of Hysterectomy [16D]
Authors: Maredia Subhratha , Crisp Catrina , Devaiah Ganga , Blanton Kim , Schuler Kevin M.
Published: May 2017

INTRODUCTION:

Anemia is a common preoperative diagnosis in patients undergoing hysterectomy. In severe cases, perioperative blood transfusion may be necessary. This study describes perioperative risks associated with transfusion around the time of surgery.

METHODS:

This is a retrospective cohort study of women undergoing non-emergent hysterectomy between 2012-2014. The primary outcome was a comparison of complications in patients receiving transfusion and those that did not.

RESULTS:

Among 292 patients who underwent hysterectomy, 30 patients were transfused (10.3%). Factors associated with transfusion were preoperative anemia (10.6 gm/dL in patients requiring transfusion versus 13.0 gm/dL, P < .001), estimated blood loss (425mL vs 200mL, P < .001), and uterine weight (388g vs 100g, P < .001). Patients who received transfusion had a longer length of stay (4 days vs 2 days, P < .001), higher rates of readmission (23.3% vs. 3.4%, P < .001), increased rates of fascial dehiscence (10.0% vs 0.8%, P=.009), more frequent pelvic abscess development (6.7% vs 1.1%, P=.084), more often had venous thromboembolism (6.7% vs 0%, P=.01), and greater need for repeat surgery (13.3% vs 0.8%, P=.001).

CONCLUSION:

Preoperative anemia places patients undergoing hysterectomy at risk of needing blood transfusion. In this study, blood transfusion was associated with significant perioperative morbidity. Given these findings, aggressive preoperative management of anemia should be strongly considered.
Adverse Maternal Outcomes in Obese Women With Severe Preeclampsia [31C]
Authors: Teefey Christina P. , Durnwald Celeste P. , Srinivas Sindhu K. , Levine Lisa D.
Published: May 2017

INTRODUCTION:

Our objective was to evaluate the rate of adverse maternal outcomes in obese compared to non-obese women with severe preeclampsia (PEC-S).

METHODS:

A retrospective cohort study of women greater or equal to 34 weeks gestation that were diagnosed with PEC-S from 2011-2013 was performed. Obesity was defined as BMI greater or equal to 30 kg/m2. PEC-S was defined by current guidelines from the American College of Obstetricians and Gynecologists. The primary outcome was a composite defined as one or more than the following: liver or renal failure, thrombocytopenia, abruption, blood transfusion, pulmonary edema, DIC, stroke, eclampsia, ICU admission. Chi-square analyses and Fishers exact test were used for categorical variables. Multivariable logistic regression was used to calculate odds.

RESULTS:

193 women with PEC-S were included: 100 (51.8%) non-obese and 93 (48.2%) obese. Obese women were significantly less likely to have the composite outcome compared to non-obese women (9.7% vs. 21.0%, OR 0.40 [0.17-0.93], p=0.03). This decreased risk remained after adjusting for race, mode of delivery, and parity; aOR 0.38 [0.16-0.94], p=0.035. Within the composite outcome, obese women were less likely to have a blood transfusion (p=0.04) and had a non-significant lower risk of renal failure (p=0.13). Obese women were more likely to require IV antihypertensive medication (p=0.03) and to be discharged on oral antihypertensive medication (p=0.08) compared to non-obese women.

CONCLUSION:

Obese women with PEC-S have a lower risk of adverse maternal outcomes than non-obese women with PEC-S. This may reflect a different, less severe, phenotype for PEC-S in obese women compared to non-obese women and warrants further investigation.
Outcomes After Mini-Laparotomy for Tissue Extraction Following Laparoscopic Hysterectomy [19D]
Authors: Radtke Steven , Elkattah Rayan , DePasquale Stephen , Boren Todd , Mohling Shanti , Holcombe Jenny
Published: May 2017

INTRODUCTION:

Recognizing the importance of specimen integrity for patient care and pathologic evaluation, we aimed to determine if mini-laparotomy for tissue extraction of large specimens following laparoscopic hysterectomy would yield compromised outcomes when compared with vaginal extraction.

METHODS:

A retrospective analysis including all benign laparoscopic hysterectomies over a two year period was performed. Patients were separated into two groups depending on whether specimen was extracted vaginally or via mini-laparotomy. T-student and chi-square tests where used to assure both groups were homogenous to age, BMI, history of cesarean delivery and presence of diabetes or hypertension. Differences in complications, operating time, EBL and length of hospital stay between groups were determined. This was done via chi-square analysis. In the case of EBL and operating time, MANCOVA was employed to adjust for differences in specimen weight.

RESULTS:

A total of 225 patients were selected for analysis. There were no significant differences between vaginal extraction (n=157) and mini-laparotomy (n=68) groups in terms of age, BMI, previous cesarean deliveries, presence of diabetes or hypertension. No significant differences regarding presence of intraoperative (0.6% vs 1.5% p= 0.43) or postoperative complications (15.3% vs 7.4% p=0.10) were found. After controlling for specimen weight, there was no significant difference between groups with regard to operating time (143.66min vs 180.16min p=0.12), EBL (73.07ml vs 107.32ml p=0.80), or length of hospital stay (1248.71min vs 1512.21min p=0.98).

CONCLUSION:

Mini-laparotomy for tissue extraction is a safe approach and does not appear to add morbidity to minimally invasive hysterectomies, while conserving an intact specimen.
Preventing Ovarian Cancer: What Every Woman Should Know [20D]
Authors: Moore Imari , Anderson Lisa
Published: May 2017

INTRODUCTION:

The new paradigm of ovarian and pelvic serous carcinogenesis identifies the tubal fimbria as the origin of most ovarian cancer cases. With no effective screening modalities in place, women must have the opportunity to learn that the best means of reducing their risk is through prophylactic salpingectomy.

METHODS:

This was a prospective study to produce and test a patient-directed educational video with before-and-after knowledge questionnaires. The 4-minute video features a physician speaking about female reproductive anatomy, ovarian cancer, and the role of salpingectomy as a risk-reducing strategy. We recruited women attending the ambulatory OB/GYN clinics at our hospitals. We compared “before” and “after” responses with the McNemar’s test or the Cochran-Mantel-Haenszel method.

RESULTS:

We recruited 100 patients, one of which was excluded. Significant, positive results were obtained from all three questions that addressed the participant’s likelihood to consider salpingectomy after childbearing. For example, we asked “If you were to consider permanent sterilization now or in the future, would you prefer to have your tubes tied, or permanently removed?” Before the video, the ratio of “tied” to “removed” responses was 56/33; afterward, it was 14/81; p=0.001. In addition, patients were also significantly more likely to understand the role of salpingectomy after the video, and to report a better understanding of ovarian cancer overall. Significant learning was demonstrated by 13 out of 15 questions.

CONCLUSION:

This is an important learning tool, proven to work, which should be used and replicated so that all women know how to best reduce their risk of ovarian cancer.
Cost of Gynecologic Laparoscopy in Rural Western Kenya [21D]
Authors: Makin Jennifer , Ramanathan Aparna , Parkar Rafique , Burke Thomas , Eckardt Melody
Published: May 2017

INTRODUCTION:

Despite its advantages, laparoscopy is not yet routinely offered in rural low resource settings in Kenya due to high capital investment. With increased focus on globally accessible surgery, smaller hospitals must weigh costs versus demand. We describe the cost of laparoscopic surgery in rural Western Kenya through review of an initial launch effort in September 2016.

METHODS:

Practicality was assessed through a retrospective cost analysis. Prices of equipment previously purchased for laparotomy were excluded. Cost saving tactics were reported. Prices were obtained through local medical supply companies and hospital management.

RESULTS:

The cost of the laparoscopic tower was 62,924.46 USD. The cost of a basic set of thirteen re-useable instruments needed to perform gynecologic laparoscopy was 13,063.70 USD. The mean cost of pre-intra and post-operative care per patient was 135.84 USD. Given mean hospital charges of 495 USD per patient for pre-, intra- and post-operative care, we calculated it is necessary to perform 212 surgeries within a year to return a profit. Cost saving tactics included donated equipment and reuse of equipment with chemical sterilization.

CONCLUSION:

Literature published regarding the cost of laparoscopy is conflicted. Laparoscopy requires a large initial investment. We advocate for careful consideration of patient volume, available donations, local suppliers and technical assistance before launching laparoscopy in a rural setting within a developing nation.
Prevalence of Leiomyosarcoma Following Hysterectomy at a Single-Site Institution [22D]
Authors: Chao Lisa , Lum Deirdre
Published: May 2017

INTRODUCTION:

The U.S. Food and Drug Administration (FDA) issued a statement in April 2014 discouraging the use of power morcellation in women undergoing minimally invasive surgery for uterine fibroids, citing safety concerns regarding the potential dissemination of an occult uterine cancer. While it is estimated that between 1 in 400 and 1 in 1,000 women who undergo hysterectomy for presumed benign fibroids will be diagnosed with leiomyosarcoma (LMS), it is difficult to conclude the actual risk of an occult sarcoma. The purpose of this study was to determine the prevalence of LMS in patients that have undergone hysterectomy at Stanford University Medical Center, and to include all surgical approaches in this analysis.

METHODS:

Patients undergoing hysterectomy for benign and malignant gynecologic indications from January 2009 to December 2014 at Stanford University Medical Center were identified. The mode of hysterectomy along with relevant clinical and pathologic data were collected for this retrospective cohort study.

RESULTS:

A total of 909 hysterectomies were identified. The majority were performed by an abdominal route (69%), followed by laparoscopic (17%), robotic-assisted (13%), and vaginal (1%). Two patients were identified with leiomyosarcoma and two with occult sarcoma. Of the laparoscopic and robotic hysterectomies, morcellation was used in 26 patients. Of these, three patients had known endometrial carcinoma and contained morcellation was performed.

CONCLUSION:

The prevalence of leiomyosarcoma was 0.0022 in our population. As part of a multi-institution study, the long-term goal would be to understand prevalence rates in a larger population and develop risk-stratification to minimize risks of developing LMS.
Obstetrical Clostridium difficile Infection: A Retrospective Cohort Study [30D]
Authors: Ruiter-Ligeti Jacob , Vincent Sophie , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie
Published: May 2017

INTRODUCTION:

Clostridium difficile infections (CDIs) occurring in pregnancy and the peripartum period have been reported with increasing frequency. The aim of this study was to evaluate the risk factors and morbidity associated with obstetrical CDI.

METHODS:

We performed a retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The admission and delivery records of pregnant women were reviewed between 1999 and 2013. After adjusting for demographic data, the antenatal admission record and delivery outcomes of women with CDI in pregnancy were compared to pregnancies without CDI, using unconditional logistic regression.

RESULTS:

Of the total 12,592,178 births in our cohort, we identified 2757 admissions complicated by CDI. During the study period, the rate of antenatal admission for CDI doubled from 15 to 30 admissions per 100 000 deliveries per year (p < 0.001). Risk factors associated with CDI in pregnancy include: age over 35, multiple gestations, smoking, Crohn’s disease, ulcerative colitis, long-term antibiotic use, pneumonia, pyelonephritis, as well as cesarean or perineal wound infection. CDI in pregnancy was associated with a significant increase in maternal death (OR 56.82, 95% CI 35.83-90.10). Further, there was an increase in sepsis (OR 59.10, 95% CI 48.80-71.57), paralytic ileus (OR 33.08, 95% CI 27.51-39.78), venous thromboembolism (OR 8.14, 95% CI 6.52-10.16) and hospital stays greater than 2 weeks (OR 24.34, 95% CI 21.59-27.44).

CONCLUSION:

CDIs in pregnancy have increased over the last fifteen-years and are associated with significant maternal morbidity and increased mortality.
Cerclage for Management of Twin Pregnancies With Short Cervical Length: A Single-Center Retrospective Cohort Study [33D]
Authors: Behl Esha , Murphy June , Kazzi George , Abuzeid Mostafa
Published: May 2017

INTRODUCTION:

Cerclage for prevention of preterm birth (PTB) in twin pregnancies with short cervical length (CL) remains controversial. The study purpose was to compare perinatal outcomes of twin pregnancies with short CL managed with cerclage vs no cerclage.

METHODS:

Single-center retrospective cohort study of twin pregnancies with transvaginal ultrasound (TVUS) CL less than or equal to 25mm between 16 and 24 weeks gestation from 2010 to 2016. Monoamniotic, anomalous, or aneuploid fetuses, and pregnancies with indicated PTB were excluded. Primary outcomes were mean gestational age (GA) at delivery, interval from diagnosis to delivery, and birth weight. Secondary outcomes were incidence of PTB less than 28, 32, 34, and 37 weeks, cesarean section, low Apgar (less than 7), and NICU admission.

RESULTS:

Twenty-two women were included, twelve managed with cerclage and ten without. Mean GA at delivery was significantly higher, 32.8 ± 3.59 vs 29.3 ± 5.31 weeks (P=.0122); interval from diagnosis to delivery was significantly prolonged, 96.58 ± 23.36 vs 51.1 ± 27.71 days (P=.0001); and neonatal birth weight was significantly higher, 1990.58 ± 670.06 vs 1477.35 ± 796.90 (P=.0252) in the cerclage vs no cerclage group. Incidence of PTB less than 34 weeks GA was significantly less 33.33% vs 80% (P=.0027) and low Apgar was significantly lower 4.17% vs 30% (P=0.0353) in the cerclage vs no cerclage group.

CONCLUSION:

Cerclage placement in twin pregnancies with short CL was associated with higher mean GA at delivery, prolongation of pregnancy by 45 days, and decreased PTB less than 34 weeks GA compared to no cerclage.
Ondansetron Use During Pregnancy for Nausea and Vomiting and the Risk of Preterm Birth [34D]
Authors: Coonrod Dean V. , Lueth Amir J. , Sullivan Scott A. , Lam Garrett , Boggess Kim A. , Hickok Durlin E.
Published: May 2017

INTRODUCTION:

Nausea and Vomiting of Pregnancy (NVP) is a common condition affecting up to 80% of pregnant women. Risks of adverse pregnancy outcomes associated with anti-nausea medications have not been well studied. As one of the more common drugs administered for treatment of NVP, we investigated ondansetron use and risk of preterm delivery.

METHODS:

These data represent a secondary analysis of maternal pregnancy and fetal outcome characteristics from the prospective Proteomic Assessment of Preterm Risk (PAPR) study (2011-2013), where 5,501 pregnant women were enrolled between 17 and 28 weeks of gestation at 11 sites in the United States. Only women who consented to remain in the PAPR repository (n=3,563) were considered eligible and used in this analysis. Potential associations between exposed and unexposed women were investigated statistically by the use of Chi square and multivariate logistic regression.

RESULTS:

NVP was reported by 814 (23%) women consenting to remain in the repository. In these women ondansetron exposure prior to 290/7 weeks gestation occurred in 534 (66%) who were eligible for analysis. Women taking ondansetron experienced a PTB rate of 14.6% compared to 14.1% for those who did not (unadjusted OR 1.0 95% CI 0.1-1.4).

CONCLUSION:

The results of this study suggest that exposure to ondansetron was not associated with increased risk of PTB. However, the sample size in this study is relatively small and future studies should be performed in order to further investigate these findings.
Correlation of Blood Lactate Levels as a Predictor for Blood Transfusion in Postpartum Hemorrhage [14B]
Authors: Hoskins Iffath , Berg Robert
Published: May 2017

INTRODUCTION:

Postpartum hemorrhage is an obstetrical emergency which requires aggressive volume repletion. Serum lactate levels are used in the management of trauma patients because they reliably indicate tissue hypoperfusion.

METHODS:

A retrospective chart review was performed from June 01, 2013 through Sept 30, 2016 in patients undergoing an Obstetric Hemorrhage Team (OHT) alert, defined at our institution as a quantified blood loss of 900 cc after vaginal delivery and 1500 cc after Cesarean section. Stat venous lactate levels were correlated with hematocrit levels, vital signs (BP and pulse), urine output, crystalloid fluid resuscitation and blood transfusion.

RESULTS:

There were 1314 OHTs. Of these, 891 patients had venous lactate values. When the venous lactate level was “elevated”, i.e. 4.0 (range 3.4 to 6.6), 632 patients (71%), required at least one unit blood transfusion in addition to the usual resuscitative measures, (statistically significant). Of these, only 347 patients (39%) were hemodynamically unstable (BP less than 60/40 and/or pulse rate greater than 120 bpm); and only 276 (31%) demonstrated a 10 point hematocrit drop from the admission value. When venous lactate levels were “normal”, i.e. 2.0 (range 1.6 to 3.2), only 80 (9%) required blood transfusions.

CONCLUSION:

Venous lactate is a reliable indicator of tissue hypoperfusion in postpartum hemorrhage, and may help to identify patients who, regardless of hemodynamic status or hematocrit level, would most benefit from blood transfusion during the management of this condition.
The Effectiveness of Simulation Training in the Management of Eclampsia [2D]
Authors: Kolmogorova Ekaterina , Wright Danielle , Taneja Mansi , Marko Emily , Nieves Kelsey
Published: May 2017

INTRODUCTION:

Eclampsia is an obstetrical emergency of hypertensive disorders in pregnancy, which can lead to significant morbidity and mortality. The objective of this study was to demonstrate and quantify the effect of simulation training on knowledge, performance and confidence levels of providers in managing eclampsia.

METHODS:

A 3 month study was performed using 6 obstetrics and gynecology residents and a standardized simulation program with a high-fidelity manikin. Pre- and post-testing were performed using knowledge tests, validated performance checklists and confidence surveys. An interval performance assessment was conducted at three months to quantify retention of skills. Statistical analysis was performed using chi-squared analyses.

RESULTS:

Significant improvement was noted in all domains. Knowledge scores increased from 36.67% to 96.67% post simulation, p less than 0.0004. Performance assessment increased from 31.75% to 94.67%, p less than 000.1. Confidence levels demonstrated statistically significant improvements in all areas with the greatest in managing an eclamptic seizure, ordering eclampsia medications and managing magnesium sulfate toxicity, p less than 0.0001. Retention scores at 3 months indicated that performance remained strong at 91.67%, p less than 0.0001. Participant comments included the benefit of practicing this rare event in simulation which then occurred in real life the next day.

CONCLUSION:

Simulation-based training for eclampsia management improves knowledge, performance and confidence levels. Repeated simulation training demonstrates retention of learning. Simulation is a valuable tool in preparing physicians for managing eclampsia and maintaining knowledge and skills for when these rare emergencies occur in reality.
Transgender Men’s Experiences With and Perceptions of Gynecologic Care [10D]
Authors: Fein Lydia A. , Wong Adriana , Honorio David , Salgado Christopher J. , Medina Carlos A.
Published: May 2017

INTRODUCTION:

Transgender men who have female reproductive organs and genitalia are in particular need of gynecologic care. OB-GYNs report a lack of training and knowledge in transgender health. In a national survey, only 29% were comfortable caring for transgender men. Additionally, transgender men report barriers to health care including negative interactions with physicians. This study was undertaken to assess transgender men’s experiences with, ability to access, and understanding of gynecologic care.

METHODS:

IRB approval was obtained to create and distribute an anonymous web-based and paper survey to a convenience sample of transgender men. Responses are presented as categorical data.

RESULTS:

Thirty-seven transgender men completed the survey. The mean age of respondents was 28.8 years old (18-59). Twenty-nine (78%) were insured. Most have been to a gynecologist at least once (81%), but only 38% (14/37) attended annual visits. Seven (23%) reported mistreatment by a gynecologist, and 59% (22/37) reported avoiding or delaying gynecologic care due to gender identity concerns. Seventeen (46%) recognized sexually transmitted infection testing as extremely important, but only 38% considered annual gynecologic care extremely important, while 27% and 19% considered routine cancer screening and the pelvic examination as extremely important, respectively.

CONCLUSION:

While nearly half of transgender men consider screening for sexually transmitted infections as extremely important, only 38% would go annually for evaluation. This disparity may further support claims of mistreatment and consequential distress associated with medical care. Efforts are needed to improve care for transgender men through education and elimination of mistreatment.
Effects of Group Prenatal Care on Connection to Site of Care [27D]
Authors: Crimmins Sarah , Lubsky Julia , Fahey Jenifer
Published: May 2017

INTRODUCTION:

Centering Pregnancy, a form of group prenatal care, provides greater contact time and continuity of care with providers. We sought to determine if this approach impacts factors that serve as measures of affiliation with prenatal care site and prenatal care providers.

METHODS:

Retrospective case-control study at a single institution between 2012-2015. Individuals in group care were matched to controls in traditional care by gestational age at enrollment. Inclusion criteria included: greater than 17 years old and initiation of care at less than 16 weeks. Exclusion criteria included transfer to high-risk providers and miscarriage at less than 16 weeks gestation. Prenatal care, delivery, and postpartum information were collected on all participants. Outcomes of interest included: number of scheduled visits attended, institution at which delivery occurred, and attendance at postpartum visit.

RESULTS:

A total of 226 patients were included (124 cases and 101 controls). The gestational age at enrollment (9w5d v 10w3d) and gestational age at delivery (39w3d v 39w3d) did not differ between the groups. There was no significant difference between the percentages of prenatal care visits attended (80% vs 83.3%). Centering patients were significantly more likely to deliver at their home institution than controls (95.3% v 79.2%, p = 0.001). In addition, a significantly greater number of patients in group prenatal care attended a postpartum visit (81.1% v 68.3%, p = 0.03).

CONCLUSION:

Group prenatal care was associated with greater connection with home institution leading to increased number of individuals delivering at the home institution and attending a postpartum visit.
Evaluating Effect of New Secure Smartphone Texting Tool in Obstetrics [7K]
Authors: Feinberg Jacqueline , Shaw Sara , Kashyap Nitu , Campbell Katherine , Pettker Christian
Published: May 2017

INTRODUCTION:

As hospitals consider adopting HIPAA-compliant smartphone-based messaging, it is necessary to determine impact. Small studies found texting reliable and efficient, but insecure for patient information. Literature is sparse on new HIPAA-compliant texting, with no relevant studies in obstetrics. We evaluated a new HIPAA-compliant texting system (MH-Cure by Mobile Heartbeat) implemented in obstetrics at Yale-New Haven Hospital in 2016 for perceived effect on care and workflow.

METHODS:

Before implementation, surveyed residents and nurses on effects of current communication system (pagers with text receiving, service mobile phones, personal cellphones) on clinical workflow and patient care. Following roll-out (1-month), teams were again surveyed with same questions. Surveys used both 5-point Likert scale and open-ended questions. Results compared using Student t-tests.

RESULTS:

In both resident (n=18) and nursing (n=47) domains, new communication tool was perceived to improve efficiency (improving from no effect to moderately effective (Residents: p < .001, Nurses: p < .001)) and enhance patient care (improving from minor negative impact to minor positive impact (Residents: p < .001, Nurses: p < .001)). Qualitative results strongly favor two-way messaging (60% of respondents mentioned) and indicate quick adoption (89% of respondents using) with concerns regarding new system's impact and connectivity during emergencies (35% of respondents mentioned).

CONCLUSION:

New text-based communication tool does not demonstrate subjective workflow interruptions, and may improve efficiency and care. Despite significant shortcomings, even in first month of implementation a system can demonstrate impactful benefits. We recommend teams implementing new technologies for communication plan, test, and communicate strategies to avoid implementation flaws during emergencies.
Evaluating Ethnic Differences in the Labor Curve in Arabic Women: A Retrospective Cohort Study [8K]
Authors: Morgan Dorcas C. , Al-Kadhi Asmaa
Published: May 2017

INTRODUCTION:

Studies have described normal labor curves in nulliparous and multiparous women. Few studies have attempted to analyze data in regards to ethnicity. In this study we present the stages of labor of Arabic women in a community hospital labor and delivery unit.

METHODS:

We conducted a retrospective cohort study of term, singleton, vertex, laboring Arabic women from 9/2014-7/2016. Exclusion criteria: chorioamnionitis, multiple gestations, induction of labor, non-identifiable ethnicity, previous cesarean desired TOL, chromosomal abnormalities, IUFD and uterine surgery. Cervical dilatation was recorded from admission to delivery.

RESULTS:

354 patients were included. 34.5% were nulliparous with mean age 26.1± 4.7 years and neonatal birth weight of 3195.9±367.9 g. 38% had oxytocin. Mean cervical dilatation on admission was 4.2 ± 1.8 cm; the median time from 6-10 cm was 5.5 hours. The median length of second stage was 4.0 hours. 64.6% were multiparous with mean age 29.7 ± 5.1 years and neonatal birth weight of 3344.5 ± 406.3 g. 18.8% had oxytocin. The mean cervical dilatation was 4.7 ± 1.8 cm upon admission, and the median time from 6-10 cm was 3.7 hours. The median length of second stage was 2.1 hours.

CONCLUSION:

In historical comparison to Friedman's nulliparous, our nulliparous had a longer second stage and took our patient 5.8 h to dilate from 4-10 cm compare to 4 h and 5.3 h in Friedman's and Zheng's nulliparous respectively. Preliminary findings suggest standard management of labor may not apply in this population. Ethnic specific labor progression should be explored further.
Von Willebrand's Disease and Pregnancy: A Single Center Experience [10K]
Authors: Beck Stacy M. , Samuels Philip , Huang Ying , Kraut Eric , Wang Tzu-Fei
Published: May 2017

INTRODUCTION:

Von Willebrand's disease (VWD) is a common inherited bleeding disorder. Studies show increased risk of postpartum hemorrhage (PPH) in women with VWD. Guidelines recommend pre-delivery treatment when third trimester Von Willebrand factor (VWF) antigen (Ag) or activity levels are less than 50%, but practice remains variable regarding treatment threshold. Our aim was to evaluate peripartum management and outcomes of VWD patients including primary PPH and association between third trimester VWF levels and estimated blood loss (EBL) at delivery.

METHODS:

We performed a retrospective review to assess the management and pregnancy outcomes of women with VWD who gave birth at the Ohio State Wexner Medical Center between January 1, 2006 and April 30, 2016. We included singleton pregnancies with documented VWD and recorded third trimester VWF levels. We excluded women with an unclear diagnosis, lack of third trimester VWF levels, and women with other diagnoses or use of medications that increase risk of bleeding.

RESULTS:

There were 24 pregnancies from 20 women with median third trimester VWF Ag of 118. Seven of 20 patients with median VWF Ag of 54 received pre-delivery treatment, and their EBL was not significantly different from those who received no pre-delivery treatment (p=0.1). In our cohort, there were no primary PPH. There was no correlation between any third trimester levels and EBL, regardless of mode of delivery (p= 0.53, 0.63, 0.74 respectively).

CONCLUSION:

Our limited cohort showed good outcomes. Optimal peripartum management VWD remains unclear. Prospective studies of VWD in pregnancy are needed to elucidate optimal therapy.
Vasa Previa: Maternal and Early Neonatal Outcomes in the New Era of Obstetrical Care [13K]
Authors: Dunn Timothy , Nassr Ahmed A. , Moaddab Amirhossein , Eppes Catherine , Shamshirsaz Alireza A.
Published: May 2017

INTRODUCTION:

Report on one institution's experience with diagnosis, management, and outcomes in vasa previa cases.

METHODS:

Retrospective study of all pregnancies referred to two tertiary hospitals from 2010 to 2016 for suspicion or high risk for vasa previa. Medical records and imaging were reviewed by multiple authors to confirm diagnosis and assess outcomes.

RESULTS:

408 pregnant women were referred for evaluation of suspected vasa previa. 380 (93%) were not diagnosed with vasa previa after ultrasonography. Of the 28 confirmed cases, 20 (71%) and 8 (29%) were diagnosed as Type 1 and Type 2 vasa previa respectively. In 9 (32%) women, vasa previa resolved spontaneously after a mean 5.8 plus or minus 3.9 weeks. Unresolved cases were diagnosed on average at 25.9 plus or minus 5.2 weeks. Delivery occurred at 33.4 plus or minus 2.9 weeks on average. 13 (68%) neonates from unresolved vasa previa cases required NICU admission. Neonates had an average 5 minute Apgar score of 9. Only 1 fetus expired, but death was attributable to complications from a pericardial teratoma prior to delivery. One Type 2 case received antepartum laser obliteration of fetal vessels that successfully prolonged pregnancy. Average maternal blood loss was 860 plus or minus 56 cc with no ICU admissions or maternal deaths.

CONCLUSION:

In this large series, we display the continued improved maternal and neonatal outcomes in vasa previa. In equipped centers, physicians are able to successfully manage and deliver fetuses with careful antepartum attention. Furthermore, one case's treatment with laser ablation suggests a possible intervention in some presentations.
A Different Model of Care: High-Risk Obstetrical Services in a Rural Midwestern State [14K]
Authors: Jacobson Lisette , Farley Darren , Peterson Casey , Lu Kelsey , Collins Tracie
Published: May 2017

INTRODUCTION:

Rural obstetrical patients are more likely to experience adverse pregnancy and birth outcomes compared to their urban counterparts. Serving an underserved population in a Midwestern state, a rural hospital with 300 deliveries per year experienced a high rate of pregnancies complicated by gestational diabetes. The purpose of this study was to assess women's perceptions of obstetrical services in this area.

METHODS:

Through collaboration of the hospital, medical school, and a regional healthcare system, a rural maternal-fetal medicine (MFM) clinic was established. Once a month, a MFM physician and his staff travel by plane to see high-risk pregnant patients. Self-reported surveys were administered to these patients. Questions focused on quality of care, communication, patient adherence, support services, barriers to care, health status, and demographic characteristics. Data were collected between January and April, 2016. Descriptive analyses were conducted.

RESULTS:

Of the 31 distributed surveys, 26 pregnant women completed the survey. The majority of respondents were non-Hispanic white (44%) or Hispanic (40%), a high school graduate (31%), WIC enrolled (58%), and earned less than $25,000/year (54%). Women's average age was 29 with an average body mass index of 29.7 three months prior to pregnancy. Overall, women reported being satisfied with the quality of care, identified un/underinsurance as barriers to care, and expressed a need for additional support services.

CONCLUSION:

This study is a first step toward enhancing the quality of care provided to underserved, rural women with high-risk pregnancies. Follow-up studies are needed to improve the delivery of specialized rural healthcare services.
Does Obesity Increase the Complication Rate During Trial of Labor After Cesarean? [15K]
Authors: Mei Jenny Y. , Havard Alexandra , Mularz Amanda , Maykin Melanie , Valderramos Stephanie
Published: May 2017

INTRODUCTION:

Obesity has been shown to adversely affect success rates of trial and labor after cesarean (TOLAC), and has been associated with prolonged labor, increased cesarean rates, infection, and hemorrhage. We aimed to investigate the effect of obesity on risk of complications during TOLAC.

METHODS:

This is a retrospective cohort study of women electing for a TOLAC at a single institution from May 2007 to April 2016. Exclusion criteria included age < 18 years, fetal demise, lethal fetal anomalies, or incomplete medical records. Clinical data collected included maternal demographics and comorbidities, obstetric history, obstetric and perinatal outcomes, and BMI pre-pregnancy and at the time of delivery. Chi squared analysis was performed.

RESULTS:

614 patients met inclusion criteria. The overall TOLAC success rate was 72.31% (n=444) and average BMI at delivery was 30.7. Among women who were either obese prior to pregnancy (n=138), became obese during pregnancy (n=172), or were obese at time of delivery (n=311), there were no differences in augmentation rate, incidence of operative vaginal delivery, chorioamnionitis, postpartum hemorrhage, arrest of descent, or need for intrapartum magnesium. There was also no difference in composite maternal morbidity (P=.492). Moving up in obesity class during pregnancy was associated with an increased risk of augmentation of labor (47.8% no change vs 61.3% increase in class, P=.024).

CONCLUSION:

In contrast with prior studies, we found no adverse effects of obesity on maternal morbidity of TOLAC. An increase in weight class during pregnancy was associated with increased rate of augmentation.
Variation in Medicaid Managed Care Coverage Policies for Progesterone to Prevent Preterm Birth [18K]
Authors: Batra Priya , Hernandez Gray Ashley A. , Moore Jennifer E.
Published: May 2017

INTRODUCTION:

Preterm birth (PTB) is the leading cause of U.S. infant morbidity and mortality; Medicaid enrollees disproportionately experience preterm deliveries. Data suggest that progesterone – an evidence-based therapy for preventing PTB – is not provided to all eligible Medicaid beneficiaries. This study aimed to identify variation in progesterone coverage guidelines among state Medicaid Managed Care Organizations (MCOs).

METHODS:

Using a cross-sectional design, participation in a national web-based survey was offered to executives at 20 Medicaid MCOs between November 11, 2015 and January 15, 2016. The survey inquired about coverage guidelines for progesterone and associated interventions to prevent PTB. MCOs identified key barriers in providing progesterone. Descriptive analyses were performed.

RESULTS:

Analyses included data from 18 plans providing coverage in 31 of the 39 states with Medicaid MCOs (response rate 90%). Responding MCOs were diverse: 55.6% were multistate, 33.3% were nonprofit, and 31.2% covered more than 1,000,000 lives. Most respondents (87.5%) covered branded progesterone, and 81.3% covered the compounded progesterone (C17P). Prior authorization was not universal for branded progesterone (86.7%) or C17P (75.0%). MCO gestational age restrictions for initiating progesterone varied from 22 to 37 weeks of gestation, even within the same state. Barriers to providing progesterone included: cost, lack of provider knowledge of indications and coverage, and variation in billing procedures.

CONCLUSION:

Significant variation in Medicaid MCO policies regarding progesterone exists both between and within states. This non-standardized approach may be a significant barrier to accessing this evidence-based intervention to prevent PTB.
Factors Affecting Obstetric Patient Participation in Research [26K]
Authors: Monson Martha , Einerson Brett D. , Esplin Sean , Varner Michael
Published: May 2017

INTRODUCTION:

To assess factors that may contribute to obstetric patients' willingness to participate in clinical research.

METHODS:

Pilot study survey of obstetric patients greater than 17 years of age at a University and community tertiary care institution in the same community. A convenience sample of patients completed a Likert Scale survey about factors that may impact their willingness to participate in research. Survey questions were divided into 3 overarching categories (caregiver influence, altruism and convenience/personal-benefit). We report descriptive statistics and compared demographic characteristics in the groups willing to participate in research.

RESULTS:

171 consecutive patients agreed to the survey out of 177 patients approached. Patients report being positively influenced toward participation in research when considering provider enthusiasm for research as well as convenience/personal-benefit factors. College educated patients are more likely than non-college educated patients to respond positively to all question categories (P < .05). Married patients were more likely react positively to altruism and convenience/personal benefit factors (P < .05). Patients greater than 30 years old were more likely to cite convenience/personal benefit factors for influencing research participation (P < .05). Additionally, patients who have previously participated in research or who attend University-based practice are more likely to respond positively to questions appealing to altruism (P < .05).

CONCLUSION:

Caregiver influence, altruism, and convenience/perceived personal-benefit factors all impact obstetric patients' decision to participate in research. Demographics appear to influence a patient's response to matters of altruism and convenience. Clinical study recruitment efforts should focus on these factors to expand enrollment.