bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational Risk of Severe Fever With Thrombocytopenia Syndrome in Healthcare Workers
Authors: Yoo Jeong Rae , Choi Jae Hong , Kim Young Ree , Lee Keun Hwa , Heo Sang Taek
Published: May 2019

We identified a healthcare-associated infection of severe fever with thrombocytopenia syndrome (SFTS) virus (SFTSV), transmitted through direct blood contact with an index case. Following further epidemiological and clinical investigations, we identified SFTSV seropositivity in 2 healthcare workers and 2 family members, who were positive for anti-SFTSV immunoglobin G. It is important to prevent SFTSV transmission by early diagnosis of SFTS and universal precautions.
Biomechanics and Mechanism of Action of Indirect Lumbar Decompression and the Evolution of a Stand-alone Spinous Process Spacer
Authors: Falowski Steven M , Sayed Dawood , Deer Timothy R , Brescacin Dane , Liang Kevin
Published: May 2019

Objective

Objective Interspinous process spacers are used in the treatment of lumbar spinal stenosis by preventing extension at the implanted level and reducing claudication, which is a common symptom of lumbar spinal stenosis. This review assessed the current safety and performance of lumbar spinal stenosis treatments and the biomechanical effects of spinal position, range of motion, and the use of interspinous process spacers.

Method

Method EMBASE and PubMed were searched to find studies reporting on the safety and performance of nonsurgical treatment, including physical therapy and pharmacological treatment, and surgical treatment, including direct and indirect lumbar decompression treatment. Results were supplemented with manual searches to include studies reporting on the use of interspinous process spacers and the review of biomechanical testing performed on the Superion device.

Results

Results The effects of spinal position in extension and flexion have been shown to have an impact in the variation in dimensions of the spinal canal and foramina areas. Overall studies have shown that spinal positions from flexion to extension reduce the spinal canal and foramina dimensions and increase ligamentum flavum thickness. Biomechanical test data have shown that the Superion device resists extension and reduces angular movement at the implantation level and provides significant segmental stability.

Conclusions

Conclusions Superion interspinous lumbar decompression is a minimally invasive, low-risk procedure for the treatment of lumbar spinal stenosis, which has been shown to have a low safety profile by maintaining sagittal alignment, limiting the potential for device dislodgment or migration, and to preserve mobility and structural elements.
Prevalence of scabies in Sanma Province, Vanuatu
Authors: Callum Jack , McDiarmid Duin , Gao Yu , Armstrong Mark , Iavro Edna , Steer Andrew
Published: May 2019

Background

Scabies is a common, under-reported condition in the Pacific with acute and chronic complications. In this study we explored the prevalence of scabies in Sanma Province, Vanuatu.

Methods

We randomly selected 30 villages from nine government zones across three islands and examined residents present within these villages for scabies. Bivariate analysis and multilevel models were conducted to investigate associated demographic and household factors.

Results

Of 1879 participants examined, 563 had scabies (30%, 95% CI 27.9 to 32.1) with the highest prevalence in children aged 6–10 y (38.8%, 95% CI 33.9 to 44).

Conclusions

Scabies is a significant issue in Sanma with very high prevalence in children.
“Doesn’t That Feel Weird?”: How Physicians Reconcile Pregnancy and Parenthood With Abortion Provision [3G]
Authors: McLeod Corinne , Javlekar Ashwini , Flink-Bochacki Rachel
Published: May 2019

INTRODUCTION:

Support for abortion rights is portrayed as antithetical to family values. With shifting provider demographics, we explored the emotional and ideological effects of pregnancy and parenthood on abortion providers.

METHODS:

We conducted a web-based cross-sectional survey of U.S. abortion providers. We calculated descriptive statistics using Stata SE and utilized an inductive, iterative approach to code free-text responses and identify qualitative themes, organized using Atlas.ti. IRB approval was obtained.

RESULTS:

Of 321 respondents, 227 (70.7%) provided write-in responses, 176 (77.5%) of whom were parents. Qualitative analysis yielded a nested model for understanding the interplay of parenthood and abortion provision: 1) On a societal level, the false dichotomy between “pro-choice” and “pro-child” provokes tension, with providers often erroneously anticipating that parenting will increase the emotional challenges of their work. 2) At the patient level, shared reproductive experiences intensify empathy, often stimulating a stronger therapeutic bond (“A patient asked if I was a mom and when I said I was she said 'well then you understand'”). 3) On the level of pregnancy itself, the juxtaposition of contrasting fetal outcomes forces providers to confront how maternal motivation defines a pregnancy's meaning. 4) At the individual provider level, reconciling identities as both loving parents and reproductive advocates leads to increased passion and commitment to both roles.

CONCLUSION:

We demonstrate a multi-level framework to understand the effects of personal reproductive experiences on abortion providers. Acknowledging both the tension and gratification of these dual roles may humanize abortion providers and promote honesty and camaraderie in the family planning community.
Abnormal 1-Hour Glucose Screen Independently Predicts Fetal Macrosomia and Other Adverse Outcomes [19G]
Authors: Bennett Stevie N. , Sanchez-Ramos Luis , Mitta Melanie I. , Roeckner Jared T.
Published: May 2019

INTRODUCTION:

Gestational diabetes mellitus (GDM) is associated with adverse maternal and perinatal outcomes. Growing evidence suggests mild maternal hyperglycemia is also associated with poor outcomes. Our objective was to assess the association between an abnormal 1-hour 50-gram glucose challenge test (GCT) followed by a normal 3-hour 100-gram glucose tolerance test (GTT) on fetal macrosomia and other adverse outcomes.

METHODS:

Prospective and retrospective studies which the maternal and perinatal impact of an abnormal 50-gram 1-hour glucose challenge test (GCT) followed by a normal 3-hour, 100-g glucose tolerance test (study group) in comparison to patients with a normal GCT (comparison group) were identified using computerized databases. Data were extracted and quantitative analyses were performed.

RESULTS:

We identified 20 studies comprising 10,001 patients with a normal 3 hour GTT after an abnormal 1-hour GCT (study group) and 58,392 patients with a normal GCT. Patients in the study group had an increased risk of macrosomia (RR 1.71, CI 1.50-1.95), shoulder dystocia (RR 1.51, 95% CI 1.09-2.09), cesarean delivery (RR 1.27, 95% CI 1.19-1.36), and pre-eclampsia (RR 1.52, 95% CI 1.03-2.23). Neonatal birth weight was significantly increased in the study group. The predictive interval for macrosomia indicates that in 95% of future studies, the true effect will range from 1.15-2.5. NICU admission, low Apgar score, hypoglycemia, and respiratory morbidity were not significantly different between groups.

CONCLUSION:

Even in the absence of GDM, patients that fail the GCT test but have a normal GTT are at increased risk of maternal and neonatal morbidity including macrosomia and cesarean delivery.
Acute Fatty Liver of Pregnancy: The Challenging Obstetrical Emergency to Overcome [21G]
Authors: Siwatch Sujata , Singh Virendra , Suri Vanita , Jain Vanita , Kalra Jasvinder , Sikka Pooja
Published: May 2019

INTRODUCTION:

Acute fatty liver of pregnancy (AFLP) is a rare entity with high morbidity and mortality. We aim to review the 5 years data of patients with AFLP, presenting to a tertiary care hospital.

METHODS:

The Swansea criteria were used to diagnose AFLP. We collected data and analyzed it for demographic profile, clinical presentation, complications, obstetrical outcome and mortality.

RESULTS:

Twenty eight women attending the obstetrical emergency services were diagnosed with AFLP from 2014 to 2018. The mean age was 25.7+/- 4.1 years. Most women were multigravidas and the median gestational age was 35 weeks (range 31-40 weeks). Of the women who delivered, 19/28 (67%) had male fetuses. The commonest initial presenting symptoms included jaundice and vomiting. The average median Swansea score was 7 (range 6-9). The median duration of illness before admission was 4 days. Most women underwent a torment course of disease. There were fifteen deaths. The commonest causes of death were sepsis, acute kidney injury and multiorgan dysfunction. Other contributory factors of mortality were coagulopathy, liver failure, encephalopathy, acidosis, acute respiratory distress syndrome and pancreatitis. Hypertension was observed in half (14/28) of the patients. All patients required transfusion of blood products and ICU care. Nineteen women had vaginal delivery while seven underwent caesarean section. Hemorrhage was noted in 20 (71%) as postpartum bleeding, vaginal and abdominal hematomas and urinary tract bleed.

CONCLUSION:

AFLP is a rare obstetrical cause of acute liver failure with high maternal morbidity and mortality. Sepsis, acute kidney injury and hemorrhage are the important contributory causes of death.
Antibiotic Use During Obstetric Anal Sphincter Injury: a Quality Improvement Initiative [30G]
Authors: Kieserman-Shmokler Caroline Ann , Bugosh Meghan Donald , Fenner Dee E. , Swenson Carolyn Weaver
Published: May 2019

INTRODUCTION:

ACOG Practice Bulletin #165 recommends a single dose of broad-spectrum antibiotics be given at the time of obstetric anal sphincter injury (OASIS) repair. Our primary aim of this study is to assess antibiotic compliance at the time of OASIS repair after our institution launched a Quality Improvement (QI) initiative regarding best practices for OASIS management.

METHODS:

We conducted a retrospective chart review comparing the prevalence of antibiotic use with OASIS repair pre-initiative (1/1/2014-12/14/2017) and post-initiative (12/15/2017-9/23/2018). Best practice recommendations were presented during Grand Rounds and disseminated with posters and cards on L&D carts with recommended antibiotics and suture material. Cefazolin plus metronidazole or clindamycin plus gentamycin were the recommended antibiotics. Demographics, delivery characteristics, and postpartum complications were also compared between groups using Student t-test and Chi-square tests.

RESULTS:

Recommended antibiotic use increased from 0.27% (1/372) pre-initiative to 67.44% (58/86) post-initiative (P<.0001), and any antibiotic use increased from 3.49% (13/372) to 76.74% (66/86) (P<.0001). The rate of OASIS repaired in the OR increased from 3.5% to 18.6% (P<.0001). There were no differences in perineal wound complications (2.2% before versus 2.3% after, P>.99). Delivery characteristics including operative delivery, infant weight, length of second stage, and episiotomy were similar.

CONCLUSION:

After a QI initiative, antibiotic use at the time of OASIS repair significantly increased. This study demonstrates that a QI initiative targeted at wide spread dissemination of information to the OB/GYN department can lead to improved clinical care for our patients with OASIS.
Are Longer Periods of Latency After the Diagnosis of Preeclampsia Associated With Readmission? [31G]
Authors: Mussarat Naiha , Aziz Michael , Patterson Melinda Michelle , Duncan Jose R. , Meyer Norman L.
Published: May 2019

INTRODUCTION:

To determine if longer periods of latency after the diagnosis of preeclampsia with severe features is associated with postpartum readmission or complications.

METHODS:

This was a nested case control study of all patients with severe preeclampsia at an academic medical center from 2014 until 2017. The primary outcome was readmission within six weeks of discharge. The primary exposure was pregnancy latency after the diagnosis of preeclampsia with severe features until delivery. Secondary exposures were the differing severe features or complications of preeclampsia which the patients were diagnosed with during their antepartum admission. Controls were randomly selected from the patients who had been diagnosed with preeclampsia with severe features in a 2:1 ratio. Median latency, baseline characteristics, severe features, and complications of preeclampsia were compared between patients who were readmitted and those who were not.

RESULTS:

Of the 18,645 deliveries over this time period, 950 were complicated by preeclampsia with severe features. Of these deliveries, 39 were readmitted. The median gestational age on admission was 37 weeks and one day. Contrary to our hypothesis, readmission was more likely with shorter latencies (mean rank 65 vs 45, p<0.01). Pregestational diabetes was a risk factor for readmission (OR 3.2, p=0.04); Antepartum headache (OR 0.36, p=0.02), parenteral antihypertensives (OR .30, p<0.01), oral antihypertensives (OR 0.25, p<0.01), antepartum magnesium sulfate (OR 0.07, p<0.01) during the initial admission were protective.

CONCLUSION:

Analyzing the factors that contribute to readmission in preeclamptic patients allow us to be cognizant of factors that may lead to increased maternal morbidity and mortality.
Congenital Uterine Anomalies: Prevalence and Teratogen Exposure [33G]
Authors: Calhoun Byron , Schaible Burk , Seybold Dara , Frank Annie
Published: May 2019

INTRODUCTION:

Other than diethylstilbestrol, there are no strong risk factors known to cause congenital uterine anomalies (CUA). Discrepancies in defining and diagnosing uterine anomalies also create difficulties in discerning the prevalence of CUA. The study objective was to explore prevalence and risk factors of CUA in a cohort of women from an area with a history of chemical and teratogen exposure.

METHODS:

This was a retrospective observational study of obstetric patients with uterine ultrasounds from 1 January 2006 to 31 December 2016 at a tertiary care center. An Optimized Hot Spot analysis and Ripley's K- Function was constructed to ascertain any association with environmental exposures.

RESULTS:

The study population consisted of 46.4% of women having an ultrasound for an anatomy scan and 22.6% due to abdominal pain. The mean age was 26.1 years. The prevalence of a CUA was 0.9% (118/13040), which is below the reported national average of 3%. The most common were septate (46; 39.8%) and bicornuate (47; 39.0%). A Ripley's K - Function showed a normal observable relationship between Environmental Protection Agency (EPA) facilities and cases of congenital uterine anomalies. However, the Optimized Hot Spot Analysis located several statistical significant zip-codes of CUA in relation to zip-codes that include EPA chemical sites with possible watershed exposure.

CONCLUSION:

While the rate of CUA may be below the national prevalence, this may be due to the discrepancies in diagnostic classification. There was a statistically significant association of cases of CUA and zip-codes with EPA dump sites with possible teratogenic chemical exposure effect.
Effect of Service-Branch on Contraception Use and Childbirth Rates Among United States Military Recruits [6H]
Authors: Roberts Timothy , Smalley Joshua , Weir Larissa F. , Adelman William
Published: May 2019

INTRODUCTION:

Unintentional pregnancy is a common problem among US servicewomen, particularly junior enlisted, with negative effects on the mother, infant, and military readiness.

METHODS:

Secondary analysis of insurance records from 92,072 servicewomen, who attended basic training between 2013 and 2017, examining differences between service-branches in prescription contraception use after 6 months on active duty and childbirth in the first 24 months of active duty using Kaplan-Meier and Cox Regression Analyses. IRB approved.

RESULTS:

Rates of prescription contraception use after 6-months on active duty varied significantly between branches [Army (18.1%), Air Force (27.4%), Navy (37.6%), and Marines (26.5%); (P<.001)] as did the proportion of women on prescription contraception using longer-acting methods (Depot-medroxyprogesterone, Implant, or Intrauterine) [Army (15.2%), Air Force (17.5%), Navy (54.7%), and Marines (49.8%); P<.001)]. There were significant (P<.001) differences in the rate of childbirth in the first 24 months on active duty between all of the services except the Air Force and Navy (P=.057) [(Army: 11.1% (95% Confidence Interval 10.7-11.5), Air Force 6.0% (5.6-6.4), Navy 6.7% (6.3-7.1), and Marines 8.4% (7.8-9.0)). In multivariable analysis accounting for age and contraception use, there were significant (P<.001) differences between services in the risk of childbirth. For example, the Navy (Hazard Ratio 1.24 (95% Confidence Interval 1.13-1.35)), Marines (1.48 (1.33-1.65)), and Army (1.86 (1.71-2.01)) all had a higher risk than the Air Force.

CONCLUSION:

Despite access to an identical medical benefit, including free contraception, contraceptive use and pregnancy rates among junior enlisted vary significantly across services. Further study is needed to determine the etiology of these differences.
A Protocol to Evaluate Low Risk Pregnancies of Unknown Location Reduces Emergency Department Length of Stay [17H]
Authors: Parker Pamela Brooke , Mercier Rebecca
Published: May 2019

INTRODUCTION:

Women are frequently diagnosed with pregnancy of unknown location (PUL) in the emergency department (ED). These patients often receive a gynecology consult and then must be followed closely to finalize diagnosis. In 2017, our hospital implemented a protocol allowing low-risk patients diagnosed with PUL in the ED to have a telephone consult with gynecology rather than in-person evaluation. We investigated impact of this protocol on ED length of stay (LOS) for these patients.

METHODS:

Retrospective chart review of patients entered into the beta book from January 2017 to November 2017. All patients entered into the beta book after an ED visit were included, while those diagnosed outpatient were excluded. Primary outcome was ED LOS; secondary outcomes included provider adherence to the protocol and patients' completeness of follow up.

RESULTS:

120 subjects were included. LOS was significantly shorter in the telephone consult group (Median 270 min, IQR 223-346 min) than in the standard consult group (Median 345 min, IQR 276-434 min), P=.009. In-person gynecology consult was more likely when: a resident provided the initial evaluation (P=.017), patients presented with pain or nausea (P=.006), and ultrasound demonstrated free fluid (P=.007), adnexal mass (P=.001), or ectopic pregnancy (P<.001). Patient compliance with follow-up care was similar in both groups, and no adverse events were noted during study time frame.

CONCLUSION:

Patients with PUL not required to have an in-person gynecology consult have a significantly decreased ED LOS without compromising adherence to outpatient care. Such protocols may be safely adopted in tertiary care centers.
Cannabis for Treatment of Chronic Pelvic Pain: A Survey of Prevalence and Effectiveness [21H]
Authors: Johns Charity , Lachiewicz Mark
Published: May 2019

INTRODUCTION:

Chronic pelvic pain (CPP) is a prevalent but difficult entity to treat. Cannabis has been shown to significantly improve pain in several populations. There have been no studies on cannabis use among women with CPP. We aim to examine the prevalence of cannabis use in patients with CPP and hypothesize that CPP patients report an improvement in their pain symptoms with cannabis use.

METHODS:

Patients were identified via a medical record query of commonly used CPT codes for pelvic pain. Patients were contacted via phone then emailed an anonymous online survey. Setting: Tertiary care academic medical center.

RESULTS:

114 patients who screened positive for CPP over the phone were emailed; 89 responded for a response rate of 78.1%. The prevalence of current use was 16.9% (14/83). Nine of fourteen (64.3%) current users reported using cannabis for CPP while 8/24 (33.3%) of previous users reported using cannabis for CPP; all 17 (100%) reported that it was helpful. The users who reported using cannabis for CPP reported an average reduction in pain by 5.9 points (P<.0001) and those who did not report using cannabis for CPP also reported a reduction in pain by 2.9 points (P=.0012). 71/82 (86.6%) respondents would consider being in a clinical trial of medical cannabis to treat CPP.

CONCLUSION:

This study demonstrates that patients with CPP are self-treating with cannabis and finding this to be an effective intervention. Cannabis may serve as a future treatment option for females with CPP if found to be safe and effective. Clinical trials are needed.
Chronic Endometritis: A Prevalent Yet Poorly Understood Entity [23H]
Authors: Margulies Samantha Lee , Flores Valerie Alysse , Parkash Vinita , Pal Lubna
Published: May 2019

INTRODUCTION:

Chronic endometritis (CE) remains poorly understood by both pathologists and obstetrician/gynecologists (OB/GYNs). The purpose of this study was to: 1) assess uniformity in histological criteria utilized by pathologists for diagnosing CE, and 2) evaluate for clarity in OB/GYN provider understanding of the pathophysiology and patterns in management approaches to CE.

METHODS:

In a prospective observational study, members of national and international professional OB/GYN (including ACOG) and Pathology societies were surveyed utilizing two anonymous electronic surveys designed to respectively examine diagnostic criteria, pathophysiology, clinical implications and treatment.

RESULTS:

262 OB/GYNs and 336 pathologists responded. Inconsistencies in histological criteria utilized by pathologists for diagnosing CE, as well as lack of clarity in understanding the pathophysiology and management of CE were apparent. While respondents agreed on an infectious etiology, consensus on nature of infectious agent for CE was lacking (p < 0.001). Obvious discrepancies in understanding of clinical presentation and diagnostic methodology were apparent, and lack of consensus on treatment was noted, both in terms of whether to treat or not and on choice and duration of antimicrobial treatment. Differences in provider understanding of subject matter by experience and location were examined.

CONCLUSION:

Despite its prevalence, there are inconsistencies and deficiencies in practitioners' understanding of CE, which likely affects patient care. We propose consideration for establishment of a task force to examine the literature on CE to provide a standard of care for the diagnosis and management of this gynecologic condition.
Benefits and Challenges of Linking Electronic Medical Record and Claims Data for Perinatal Research [28H]
Authors: Stuebe Alison M. , Tucker Christine , Ferrari Renee , Verbiest Sarah , Pate Virginia , Jonsson-Funk Michele
Published: May 2019

INTRODUCTION:

To improve understanding of the postpartum health services received in the 90 days following delivery for mothers of medically fragile infants (MMFI) we linked electronic medical record (EMR) data to commercial insurance claims.

METHODS:

We conducted a retrospective cohort study of mothers delivering liveborn infants at North Carolina Women's Hospital between 7/1/2014 and 6/30/2016 (n=6849). We linked data from the UNC Health System Epic EMR to member encounters from a commercial insurance provider to measure prevalent conditions, health care utilization, and receipt of recommended services among MMFI compared with mothers of well babies. A list of mothers names with the payor on their delivery account (n=1687), birthdate, delivery date, procedure code for delivery, delivery location, subscriber ID, and billed provider was provided to an honest broker for matching.

RESULTS:

The honest broker identified members with enrollment and a childbirth-related procedure code during the study period (n=90,490) and applied context-based blocking and fuzzy matching on combinations of first and last name for a 97% match rate (n=1642). Having a finite time-period (a childbirth-related encounter date within 1-2 days of that mother's EMR delivery date) and adding anesthesia procedure codes contributed to a successful linkage. Changes in the mother's medical record number made it challenging to query EMR data on the same woman longitudinally.

CONCLUSION:

Linking claims to EMR data can elucidate women's health utilization in the early postpartum period by allowing ascertainment of encounters outside of the hospital. Additionally our findings have contributed to improved data quality initiatives in the hospital's EMR system.
Characteristics of Category II Tracings During Last Hour of Second Stage Labor in Predicting Fetal Acidosis [37H]
Authors: Hoskins Iffath Abbasi , Berg Robert E.
Published: May 2019

INTRODUCTION:

Intrapartum fetal heart rate (FHR) monitoring although sensitive, lacks specificity for predicting fetal acidosis. Category II tracings, within the last hour of labor, occur in >/=96% of uncomplicated, term, laboring patients. Most result in delivery of well oxygenated neonates. Neonatal acidosis occurs in <3% of term neonates and may result in neonatal encephalopathy. Currently, there is no standard approach to management of Category II tracings.

METHODS:

We retrospectively reviewed Category II tracings in singleton, uncomplicated, term patients, during the last hour prior to delivery, in women who delivered neonates with cord blood pH /=8 (Group 1) and pH ≥ 7.20, base excess.

RESULTS:

In Group 1 (n=414), 91% of tracings exhibited good/moderate variability, 17.5% demonstrated minimal/absent variability, 13% had accelerations (≥15 bpm, lasting ≥15 secs). In Group 2 (n = 913), 97% showed moderate/good variability, 9% minimal/absent variability, 92% demonstrated accelerations (P<0.05). Duration of second stage labor was comparable in both Groups, (Group 1 = 3.5 hours, Group 2 = 3.1 hours), as were rates of chorioamnionitis, Pitocin use. Apgar scores and rates of NICU interventions were also similar in the two Groups.

CONCLUSION:

Minimal/decreased variability and the absence of accelerations, in Category II tracings, reliably predict fetal acidosis. Thus, expedited delivery should be considered in this clinical setting.
Encouraging Obstetrics and Gynecology Residents to Deliver Cost-Conscious Care: A Randomised Controlled Trial [4I]
Authors: Rawji Fahrin , Edwards Allison , Yaskina Maryna , Ross Sue
Published: May 2019

INTRODUCTION:

Residents have a professional obligation to the stewardship of healthcare resources yet there is a paucity of research on how to improve their cost-awareness. Rising health care expenditure has highlighted a critical need to improve education in this competency. This study aims to test if an educational module can teach residents to make cost-conscious management plans and reduce health care spending.

METHODS:

All Canadian Obstetrics and Gynecology residents in 2017 were eligible for this randomised controlled trial. Institutional ethics board approval was obtained. The study was administered online via REDCap. Interested residents were enrolled, stratified by level of training and block randomised. Residents completed a survey to determine their management of four obstetrical scenarios. The intervention group reviewed an educational module on cost-effective ordering prior to completing the survey; the control group had the option to review it after. The primary outcome was mean total expenditure as calculated from the survey. Student t-test was used to compare the mean total expenditure between the two groups.

RESULTS:

85 residents were enrolled, 63 residents completed study requirements (30 intervention and 33 control). Mean total expenditure was $291.03 CAD (95% confidence interval [CI] 259.38-322.68) versus $192.98 CAD (95% CI 170.67-215.29) in the control and intervention groups respectively, corresponding to a 33.69% or $98.05 CAD (P=.0001) reduction in total expenditure.

CONCLUSION:

This educational module decreased expenditure by Canadian Obstetrics and Gynecology residents in the management of hypothetical obstetrical cases. This introduces a potential curriculum innovation to improve resident education in judicious use of healthcare resources.
Maternal Fetal Medicine Resources—Variations Across the Military Health Care System [14I]
Authors: Lutgendorf Monica Ann , Thagard Andrew Sloane , Foglia Lisa M. , Staat Barton C.
Published: May 2019

INTRODUCTION:

Maintaining high quality, efficient obstetric care is augmented by integration of maternal fetal medicine (MFM) resources to care for high risk pregnancies. Changes in the MFM workforce and staffing could affect pregnancy care in the Military Healthcare System (MHS). We sought to assess the current state of MFM resources within the MHS to identify variations and opportunities for improvement.

METHODS:

We identified military treatment facilities with MFM physicians in both the continental US and overseas. This was an IRB approved QI project. Sites were sent a data collection sheet for staffing information including MFM physicians, genetic counselors and ultrasound techs and delivery volume. MFM sites were also asked about residency & medical student training and research activities and presentations.

RESULTS:

We identified 11 centers with MFM physicians, 3 Navy sites, 4 Army sites, 3 combined sites and 1 Air Force site. Nine MFM sites responded to our request with a response rate of 82%. Centers with MFMs had delivery volumes of 800 to 3,000 deliveries per year, and were level 2-3 maternity hospitals. Number of deliveries per MFM ranged from 500 to 2,000, and encounters per MFM ranged from 1,400 to 3,000 per year. Of MFM centers, 4 (44%) had genetic counselors, while only 1 (11%) had genetic counselors outside the MFM division. Of the 5 sites with ongoing research, all but one had access to a research nurse.

CONCLUSION:

We noted a wide range of practice staffing and volume across the MHS. Future studies should evaluate the optimum staffing to maximize efficiency.
Obstetrician/Gynecologist Perception of Prescription Drug Monitoring Program Effectiveness [15I]
Authors: Goodin Amie , Brown Joshua , Freeman Patricia , Henry Stephen , Talbert Jeffery , Delcher Chris
Published: May 2019

INTRODUCTION:

Prescription drug monitoring programs (PDMPs) are primary prevention tools designed to reduce rising rates of substance use disorders (SUD) and sequelae such as neonatal abstinence syndrome. Evidence regarding OB/GYN perceptions of PDMPs, which may impact PDMP utilization, is unavailable. This study examines perceived PDMP effectiveness among OB/GYNs compared to primary care physicians (PCPs).

METHODS:

In the absence of national-level data, independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi square tests for each state.

RESULTS:

In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p≤0.01, all states). Florida: 64.1% OB/GYN vs. 83.7% PCP “agree positive impact”. Kentucky: 45.0% OB/GYN vs. 68.5% PCP “effective”. California: 73.2% OB/GYN vs. 86.4% PCP “useful”.

CONCLUSION:

These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs. These perceptions may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Outreach and guidelines to OB/GYNs regarding PDMP effectiveness as a SUD screening tool would be helpful. Further engagement of all prescribers, including OB/GYNs, is needed to inform future strategies, programs, policies and PDMP features to increase PDMP effectiveness.
Dilation and Evacuation of Thoracopagus Conjoined Twins per Vagina at 26 Weeks [20I]
Authors: Hern Warren M. , Landgren Benedict
Published: May 2019

INTRODUCTION:

Conjoined twins are an exceedingly rare obstetric occurrence with very poor neonatal outcomes. They are often delivered by low transverse or classical cesarean, even following induced or spontaneous fetal demise of a third-trimester fetus, due to perceived difficulty in achieving a vaginal delivery.

METHODS:

A 24-year-old with two prior full-term vaginal deliveries and a 26-week thoracopagus twin gestation presented desiring termination of pregnancy. The fetal prognosis was low chance of survival to separation surgery, with planned delivery by classical cesarean. Ultrasonography suggested adjacent or partly fused fetal hearts, with a possible shared pericardial sac. An uncomplicated induction of fetal demise was performed by intrafetal digoxin injection into the pericardium. A routine protocol was followed including a multiple laminaria treatment of the cervix followed by rupture of membranes, intrauterine placement of 400mcg of misoprostol and induction of labor by low dose oxytocin. This protocol resulted in ample cervical dilation and breech delivery of both twins to the umbilicus. Separation of the thoracopagus connection by sharp dissection facilitated disarticulation. Following intact delivery of the first twin, the second twin's calvarium was decompressed and delivered. Combined fetal weight was 1051 g, placental weight was 451 g, and measured blood loss was 250 cc.

CONCLUSION:

Late abortion techniques can avoid invasive surgeries, reduce risk and improve outcomes for complicated pregnancies presenting challenges for vaginal delivery. Such techniques involve a combination of surgical D&E techniques with induction and delivery.
HSDD, Flibanserin, and Eye Dynamics: A Double-Blind Randomized Placebo-Controlled Clinical Trial [24I]
Authors: Cacioppo Stephanie , Kaske Erika , Siewsrichol Wasuwat , Millheiser Leah
Published: May 2019

INTRODUCTION:

The Cacioppo neurofunctional model of hypoactive sexual desire disorder (HSDD) suggests an attentional visual deficit when looking at attractive stimuli, characterized by a deficit in orientation and disengagement. Little is known, however, about the effect of flibanserin on eye dynamics in women with HSDD.

METHODS:

A total of 24 premenopausal women who met DSM-IV TR criteria for HSDD were randomized to either flibanserin 100mg or placebo over an 8-week period (N=12, flibanserin, N=12 placebo; N=15 heterosexual; N=9 bisexual; mean age: 32.79 ± 9.17 years). Eye movements were recorded in our standard behavioral task i.e., the Desire Intention Task (DIT), in which individuals are instructed to indicate as rapidly and accurately as possible whether or not each visually presented stimulus (e.g., attractive persons of the opposite sex) is sexually desirable to them at the moment of the experiment. Participants then completed a series of self-reported questionnaires (e.g., demographics, level of sexual desire, well-being, anxiety and depression).

RESULTS:

Results showed an effect of flibanserin on the re-orientation of attention towards attractive stimuli. More precisely, a 2x2x2 repeated measures ANOVA with visit (baseline, 4 weeks) and visual attentional region of interest (face, torso) as within-subjects factors and treatment group (flibanserin, placebo) as a between-subjects factor revealed a significant interaction for duration of first fixation to the face (F(1,21)=5.046, P=.043, ηp2 = .187) and average stimulus duration of fixation from image onset to response (F(1.21)=4.411, P=.047, ηp2 = .167).

CONCLUSION:

These results suggest a positive effect of flibanserin, but not placebo, on eye movements during DIT.
Impact of High Body Mass Index on Perioperative Complications of Hysterectomies Using a National Registry Database [25I]
Authors: Ursillo Lauren , Fazzari Melissa , Ali Fahd , Pereira Musa Fernanda Baptista , Jimenez Edward , Chalas Eva
Published: May 2019

INTRODUCTION:

To evaluate the impact of high body mass index (BMI) on perioperative outcomes following hysterectomies reported to the National Surgical Quality Improvement Program (NSQIP).

METHODS:

Retrospective analysis of NSQIP database Participant Use Data File (PUF) from 2012 to 2016. Patient characteristics and perioperative complications were evaluated across BMI groups, combining normal and overweight (N/O) group, and utilizing standard definitions for class I, II and III obesity. ICD 9/10 and CPT codes were utilized. Patients were stratified into four groups based on benign vs. malignant diagnosis, and open vs. minimally invasive (MIS) procedure. Exclusion criteria were invalid CPT codes, BMI < 18, or missing data. Cochran-Armitage trend tests were used to examine linear trends in rates across increasing BMI category.

RESULTS:

Of 202,929 hysterectomies, 173,669 (85.6%) were eligible for analysis. Increases in obesity over time were noted with 50.5% classified as obese in 2016 vs. 46.5% in 2012 (p<0.001). For all procedures, as BMI category increased the rate of wound complication increased. In benign disease, overall complication rates also increased with BMI (MIS: 7.7% in normal BMI to 9.31% in class III, Open: 14% to 22.4%; p < 0.001). In open procedures, wound, sepsis, and readmission rates increased for obese patients, regardless of diagnosis (p < 0.001).

CONCLUSION:

Hysterectomy procedures for obese women were associated with increased perioperative complications. Obese patients had higher rates of wound complications regardless of surgical approach or diagnosis, and had higher rates of sepsis and readmission in open procedures regardless of diagnosis.
Comparison of Mobility and Pain With the Use of an Abdominal Binder Versus No Abdominal Binder Post Cesarean Delivery [27I]
Authors: Makarova Natasha , Tussey Christina , Erickson Laurie Paullette
Published: May 2019

INTRODUCTION:

Given our national epidemic with opioid use, clinicians look for non-pharmacologic options for postoperative pain control. The abdominal binder has been used in the postoperative period, but research has been inconclusive regarding the effectiveness for cesarean section patients. The purpose of this study was to compare use of an abdominal binder to no binder in women following cesarean delivery, specifically looking at pain and ambulation.

METHODS:

This was a randomized controlled trial at single academic medical center, between February and June 2018. Eighty-two post-cesarean section women were randomized to using an abdominal binder (binder arm) or not using a binder (control). Ambulation frequency, time from surgery, amount of pain medication taken, and pain scores before and after ambulation were recorded. Symptoms of distress were reported by a questionnaire 24 and 48 hours post-surgery. Patient demographics were assessed by electronic record review.

RESULTS:

Of the 82 patients, 48 were randomized to the binder arm. Controlling for parity, the binder group demonstrated less post-ambulation pain than control group (P=.001). Post-hoc general linear modeling was used to evaluate pain before and after ambulation and showed that women who wore a binder had less pain than women in the control group. There were differences in pain medications between groups. There were no statistical differences in the time to ambulation following surgery or in distress symptoms between groups. There were no statistically significant differences between demographics, except for parity.

CONCLUSION:

Abdominal binders may be associated with decreased postoperative, post-ambulation pain and can be used as a non-pharmacologic alternative.
Compliance With Repeat Antibiotic Dosing in Selected Cesarean Deliveries [29I]
Authors: Janssen Matthew , Stechna Sharon Beth , Ralston Steven J. , Sehdev Harish M.
Published: May 2019

INTRODUCTION:

Proper antibiotic administration reduces surgical site infection and perioperative morbidity. Recent data suggests these practices are not as established in obstetrics as other surgical specialties. We analyzed compliance with institutional guidelines for antibiotic administration in selected cesarean deliveries.

METHODS:

An institutional IRB approved retrospective analysis of cesarean deliveries over a 14-month time period with an estimated blood loss (EBL) of greater than 1,500 cc, operative times longer than four hours, or pre-delivery maternal weight greater than 120 kg were analyzed for antibiotic administration. Data was obtained from the electronic health record at multiple sites of an academic medical center. Antibiotic standards followed institutional guidelines. We evaluated the percentage of patients that received appropriate surgical prophylaxis.

RESULTS:

Six cesarean deliveries had an operative time of greater than four hours and all six received adequate antibiotic dosing. Fifty-seven patients with cesarean deliveries had an EBL greater than 1,500cc and 19 (33%) patients received an additional dose of antibiotics. Of 280 cesarean deliveries with pre-delivery maternal weight greater than 120 kg, 146 (52%) received adequate surgical prophylaxis.

CONCLUSION:

A significant number of patients did not receive repeat antibiotic dosing during cesarean delivery, when EBL was greater than 1500 cc or maternal weight was greater than 120 kg. We have implemented educational initiatives for obstetric and anesthesia providers as well as intraoperative check-points to improve communication. The goal is to continue along the plan-do-study-act method to achieve higher rates of antibiotic use and analyze effectiveness of our quality improvement strategy. We will study the effectiveness of our interventions over time.
Early Versus Late Amniotomy During Induction of Labor in Obese Gravida [37I]
Authors: Minor Kathleen , Leung Katherine , Allocco Elizabeth Rose , Knutson Karin Britta , Delpapa Ellen , Lauring Julianne
Published: May 2019

INTRODUCTION:

The purpose of this study is to compare early (≤4 cm) versus late (>4cm) amniotomy in obese women undergoing induction of labor and the effect on mode of delivery.

METHODS:

This is a secondary analysis of a retrospective cohort study that obtained IRB approval to investigate induction and augmentation of labor and BMI. Obese women undergoing induction of labor, with term, vertex, singleton pregnancies, with amniotomy as an intervention from 2012 to 2017 were included. Our primary outcome was mode of delivery. Secondary outcomes included length of labor, maximum dose of oxytocin required, adverse neonatal and maternal outcomes. Comparisons were made between those with early amniotomy at cervical exam ≤4 cm, and late amniotomy with cervical exam >4cm.

RESULTS:

The sub-analysis included 286 women. There was no difference in cesarean delivery rates between early and late amniotomy (21% vs. 12.7%, P=.075). Early amniotomy was associated with longer time from amniotomy to delivery (6.6 hours vs. 3.7 hours, P <.001). Early amniotomy was not associated with a statistically significant reduction in time to vaginal delivery, or vaginal delivery <24 hours from initiation of induction. Early amniotomy was associated with higher maximum dose of oxytocin. There was no statistically significant difference in hemorrhage, chorioamnionitis, NICU admissions or APGAR scores <7 at 1 minute.

CONCLUSION:

In an obese population, early amniotomy was not associated with an increase in cesarean delivery or increases in maternal or neonatal complications, but it did not appear to be associated with shorter labor course.
Changes in Narcotic Use after Initiation of an Advanced Surgical Recovery Program [4J]
Authors: Geisler John Patrick , Seeley Neil , Manahan Kelly J.
Published: May 2019

INTRODUCTION:

To determine the differences in opioid use (IV and total) in post-operative period and 90 days after surgery for patients undergoing radical complete debulking for ovarian cancer before and after initiation of an advanced surgical recovery program.

METHODS:

Medical records were examined for the last 50 patients before initiation of the program and for the first 75 patients after the initiation of the program undergoing radical complete debulking for ovarian cancer. Only patients not on narcotics before surgery were included. Opioid amounts were converted to morphine equivalents (ME). Demographics, opioid use and prolonged use of narcotics (>90 days after surgery) were also collected. IRB approval was either obtained or waived for the study.

RESULTS:

Mean pre-initiation IV (71.2 ME (95%CI 33.1-109.3)) and total (85.8 ME (95%CI 42.0-129.6)) opioid use was significantly higher before initiation of the program than after initiation: IV (4.2 ME (95%CI 1.0-7.9)) and total (21.9 ME (95%CI 15.5-28.3)). This correlates with a 94.1% decrease in IV narcotic use and 74.5% decrease in total narcotic use. At 90 days after surgery, the continued use of narcotics decreased from 6% to 1.3% (P <0.001) after initiation of the program. The mean age and BMI of the pre- (50.2 years (95%CI 47.5-52.0); 29.7 kg/m2 (95%CI 28.6-30.9) and post-initiation (51.5 years (95%CI 49.6-53.4); 31.1 kg/m2 (95% CI 30.2-31.9) were not significantly different.

CONCLUSION:

After initiation of an advanced surgical recovery program designed to decrease narcotic use, there were both significant decreases in post-operative opioid use and in chronic opioid use at 90 days.
Does Amitriptyline Work as Preemptive Analgesia in Abdominal Hysterectomies? [6J]
Authors: França Neto Antonio Henriques , Amorim Melania , Marinho Alexandre M.
Published: May 2019

INTRODUCTION:

Pain prevention is an important challenge for surgeons, since the painful sensation is a factor related to greater morbidity in the postoperative period. The introduction of preemptive analgesia appears to be an inexpensive, simple and effective alternative. The use of amitriptyline as a strategy for this type of analgesia has been proposed, but there are no studies associating this drug specifically with patients submitted to hysterectomy.

METHODS:

A randomized clinical trial was performed comparing 145 inpatients submitted to hysterectomy receiving 25 mg of amitriptyline (n=72) or placebo (n=73), six hours before the surgery. Pain was measured 6, 12, 24 and 48 hours after the procedure, using an algometer and visual pain scale (VPS). This study was approved by the local Institutional Review Board. All participants will be informed about the objectives of the project and only will be included if they agree to participate, signing the informed consent.

RESULTS:

There was no statistically significant difference between the groups amitriptyline and placebo. The pain measured using an algometer and VPS were extremely similar. Side effects and the other aspects tested were also similar.

CONCLUSION:

Amitriptyline appears not be effective as preemptive analgesia for patients submitted to abdominal hysterectomy. It's important to say that the patients in this study used multimodal analgesia, which is the routine in the hospital where they were operated. Further studies are necessary to shown if Amitriptyline can be effective in other types of surgery.