bluuebunny/crossref_metadata_2025 huggingface dataset:
Fertility Preservation in the Transgender and Nonbinary Population: A Survey Study [ID 2683653]
Authors: Hastings Charlotte , Damiano Ella A. , Pepin Renee
Published: May 2024

INTRODUCTION:

To date, there are little data discussing fertility preservation desires of transgender and nonbinary adults. This study seeks to examine the demographic characteristics of transgender and nonbinary adults interested in or who have pursued fertility preservation as well as assess the barriers these adults face when interested in fertility preservation.

METHODS:

An online survey was designed by a team of researchers at an academic medical center. It was assessed for readability by an expert in survey design and reviewed for relevance by members of the transgender and nonbinary communities. It was distributed to an international audience. Participants were 18+, English-speaking, identified as non-cisgender, and had interest or previous experience in completing fertility preservation. The survey was distributed online from November 2022 to May 2023. Results were analyzed using REDCap Stats & Charts software.

RESULTS:

In total, 102 participants initiated the survey. Fifty-three participants met inclusion criteria for analysis. The majority of participants identified either as transgender woman (43.3%; 23) or nonbinary (32.1%; 17), with 18.9% (10) identifying as transgender man. 17 (32.1%) participants had previously preserved eggs, sperm, or embryos, and 36 (67.9%) were interested in, but had not yet pursued, fertility preservation. Of participants who had completed preservation, 94.1% (16) were assigned male at birth. Of those interested in fertility preservation, 61.8% (21) were assigned female at birth. In terms of barriers to preservation, 63.8% (23) quoted cost as a barrier, despite 91.4% (32) having insurance.

CONCLUSION:

This survey demonstrates that transgender and nonbinary adults are both interested in and have pursued fertility preservation. In our study sample, only transgender women had been able to complete fertility preservation, which may be illustrative of the more arduous and costly process of preserving oocytes versus sperm. Our results demonstrate, as anticipated, cost continues to be the most common barrier to fertility preservation.
Maternal Contraception Education Increases the Use of Highly Effective Contraceptive Methods Postpartum [ID 2683527]
Authors: Wideman Lauren N. , Ehrlich Samantha , Rand Bethany , Young Megan Lacy , Maples Jill M. , Zite Nikki
Published: May 2024

INTRODUCTION:

Postpartum contraception planning is important for preventing short-interval pregnancies especially in populations at increased risk for adverse pregnancy and birth outcomes, such as those with gestational diabetes. This study evaluated the effect of antenatal contraception education on postpartum contraception plans and actual postpartum contraceptive use in patients with pregnancy hyperglycemia.

METHODS:

This pilot two-arm randomized controlled trial (Project Wellness, NCT04209348) assigned patients to receive contraception education (intervention, n=10) or standard-of-care (control, n=9). Postpartum contraceptive plans were assessed pre- and post-intervention. Contraceptive effectiveness was assessed pre- and post-intervention and 3 months postpartum. The primary outcome was a change in contraceptive plan from pre to post intervention (yes/no). The secondary outcome was contraceptive effectiveness; categorized as: 1) none, 2) least effective, 3) moderately effective, and 4) most effective methods. Fisher's exact test compared differences in contraceptive plans between groups and Mann–Whitney U test compared contraceptive effectiveness.

RESULTS:

Among participants in the contraception education group, 90% (n=9) changed their postpartum contraceptive plan after intervention, compared to 33.3% (n=3) in the control group (P=.02). Contraceptive effectiveness was significantly higher in the contraception education group immediately post-intervention (P=.045) and at 3 months postpartum (P=.030), compared to the control group.

CONCLUSION:

Structured education and planning for postpartum contraception may increase use of highly effective contraceptive methods in the early postpartum period to optimize family planning goals and decrease short interval births. Further research should evaluate satisfaction with contraception education and planning, and longer-term contraceptive use.
Risk Factors Associated With Being Lost to Follow-up Among Patients With Pregnancy of Unknown Location [ID 2683399]
Authors: Beshar Isabel , Doyle Alexis A. , Henkel Andrea , Padron Elisa , Liu Serena , Shorter Jade
Published: May 2024

INTRODUCTION:

Managing pregnancy of unknown location (PUL) is a logistical challenge for obstetrician–gynecologists. Close follow-up is a key component of management to reduce the risk of a ruptured ectopic pregnancy. We examined factors that may put patients at increased risk of being lost to follow-up.

METHODS:

We performed a case–control study of patients presenting to our emergency room with a positive pregnancy test and without previously confirmed intrauterine pregnancy in the first trimester between January 2020 and December 2022. Patients with newly diagnosed PUL were added to a secure list for follow-up (“beta book”). We compared patients who were lost to follow-up, which was defined as after three failed attempts at contact made multiple days apart, with those who were not. Chi-square and Fisher exact assessed demographic exposures putting patients at risk of being lost to follow-up.

RESULTS:

One hundred nineteen patients had PUL and were added to the beta book. Overall, 15 (12.6%) of patients were lost to follow-up (cases) compared to 104 (87.4%) of patients who were not (controls). No associations were found between sociodemographic variables and risk of being lost to follow-up, including age (P=.15), parity (P=.59), insurance type (P=.81), primary language (P=.77), race (P=.26), and ethnicity (P=.80). Finally, lost to follow-up rates were similar among women enrolled and not enrolled in the institution’s app-based medical communication system (P=.75).

CONCLUSION:

In a state in which pregnancy-related care is available regardless of immigration status, we found no demographic associations with risk of being lost to follow-up. As 12% of people in this study were still lost to follow-up, qualitative interviews may be useful to better understand factors not captured in a retrospective chart review to improve safe and equitable care.
Shortcomings of Current PCOS Care: Provider Bias and Provider–Patient Goal Misalignment [ID 2683466]
Authors: Zhang Alexander , McKenney Kathryn , Ross Kaitlin V. , Sehrt Madeleine N. , Ley Sara A. , Phimphasone-Brady Phoutdavone
Published: May 2024

INTRODUCTION:

Polycystic ovary syndrome (PCOS) affects 5–7 million people. Diagnosis is often only achieved after long delays and multiple opinions. We conducted focus groups to elucidate patient experience with diagnosis and treatment in PCOS.

METHODS:

We conducted semistructured virtual focus groups of individuals with diagnosed or suspected PCOS recruited from a university hospital obstetrics and gynecology clinic. Questions focused on experiences of bias in PCOS care and opportunities to improve care approaches. Rapid qualitative analysis of focus group transcripts was performed.

RESULTS:

Participants' (n=24) median age was 29 years. Three were non-White, eight Hispanic or Latino ethnicity, and one other than female gender. Provider bias influenced PCOS diagnosis: PCOS testing was delayed in those with smaller bodies, while symptoms of participants with larger bodies were attributed to body weight rather than to medical conditions. Provider recommendations were frequently misaligned with patients' needs and goals: Providers focused on weight loss when other approaches were requested, and fertility was centered, even for patients not desiring childbearing. Providers assumed and mistrusted patient reports of health behaviors: Larger body size was assumed to imply poor dietary habits and sedentary lifestyle. Participants frequently self-advocated to access testing, alternate treatments, and specialists. Conceptualizations of ideal PCOS care included centering patients' goals, access to specialists, and care coordination. Participants desired PCOS education, resources, and support for themselves and their communities.

CONCLUSION:

Provider bias and misalignment with patients' goals are common experiences in PCOS care. Centering patients’ goals, addressing weight bias, and creating additional PCOS educational and support resources are earnestly needed.
Characteristics Associated With Faster Human Chorionic Gonadotropin Resolution in C-Section Scar and Cervical Ectopic Pregnancies After Treatment With Double Balloon Catheter [ID 2683550]
Authors: Hedge Jaclynne , Kelly Jeannie , Dickison Shelby , Veade Ashley
Published: May 2024

INTRODUCTION:

C-section scar (CSP) and cervical (CXP) ectopic pregnancies are increasing in frequency and associated with significant maternal morbidity. Recently, double balloon catheter (DBC) has been shown as a successful treatment option, but data are limited regarding timing of human chorionic gonadotropin (hCG) resolution. We aimed to define characteristics associated with decreased time to hCG resolution.

METHODS:

This is a retrospective cohort study of CSPs and CXPs at a single tertiary center treated with DBC placement between 2018 and 2023. Institutional review board approval was obtained. The primary outcome was resolution of serum beta-hCG less than 5 within 30 days. Predictor variables included initial hCG levels, mean sac diameter, and DBC inflation volume. Multivariable logistic regression was used to adjust for gestational age and initial hCG.

RESULTS:

Thirty-three pregnancies were included; 13 (39%) had resolution of hCG in less than 30 days and 20 (61%) had resolution in greater than or equal to 30 days. Mean sac diameter less than 10 mm and initial hCG less than or equal to 25,000 were significantly associated with hCG resolution less than 30 days (77% versus 40%, aOR 7.18 [95% CI, 1.23–58.8] and 92% versus 60%, aOR 10.38 [95% CI, 1.39–239.98], respectively). There was no significant difference between lower balloon fill amount and hCG resolution.

CONCLUSION:

After treatment with DBC, most patients require greater than 30 days for hCG resolution. However, patients with mean sac diameter less than 10 mm and initial hCG less than or equal to 25,000 have higher odds of hCG resolution within 1 month, providing a framework for counseling of patients opting for this method.
Laparoscopic Management of Short-Interval Interstitial Pregnancy After Recent Tubal Ectopic: A Case Report [ID 2683561]
Authors: Bernstein Megan , Han Michelle
Published: May 2024

INTRODUCTION:

A 24-year-old G6P2032 presents with interstitial pregnancy 3 months after ipsilateral laparoscopic salpingectomy for ruptured tubal ectopic pregnancy. This case report demonstrates the management of short-interval interstitial pregnancy after recent ipsilateral laparoscopic salpingectomy.

METHODS:

The patient initially presented with a right-sided ruptured tubal ectopic pregnancy. Salpingectomy was performed to completely remove the fallopian tube and desiccate it at the cornua, leaving no residual visible tubal remnants. The patient presented with ipsilateral interstitial pregnancy 3 months later and initially underwent systemic methotrexate injection, which failed to resolve the pregnancy. She then underwent laparoscopic cornuostomy and dilation and curettage (D&C). Cornuostomy was performed with injection of dilute vasopressin around the gestational sac to help minimize blood loss followed by hydrodissection and sharp dissection to remove the pregnancy. The myometrium and serosa were closed in layers. There was attention to preserve uterine myometrial tissue integrity at the cornua. The patient did well postoperatively and was discharged on postoperative day 0 (POD0). Her β-hCG trended from 11,902 mIU/mL pre-surgery to 7,726 on POD0, and 289 at 1 week. Pathology showed fragments of chorionic villi, and the D&C showed decidualized secretory endometrium.

CONCLUSION:

Short-interval interstitial ectopic pregnancies after prior salpingectomy for tubal ectopic are extremely rare. We demonstrated successful management with a minimally invasive laparoscopic cornuostomy after failed methotrexate. Patients should be counseled carefully about the risks of short-interval pregnancy after tubal ectopic even after care is taken to remove all visible portions of the fallopian tube.
Effect of Updated Colposcopy Guidelines for Endocervical Curettage at Time of Colposcopy [ID 2683668]
Authors: Tindal Rachel , Cronin Anna , Winkler Stuart S. , Kim Ji Won
Published: May 2024

INTRODUCTION:

The American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines were updated in January 2023 to broaden the use of endocervical curettage (ECC) at the time of colposcopy. We aimed to determine how our practice at a single military institution aligned with the new recommendations.

METHODS:

After receiving approval from our institutional quality improvement (QI) office, a retrospective chart review was completed for all colposcopies performed at Brooke Army Medical Center from March 1, 2022 to December 31, 2022. Demographic and dysplasia history was extracted for each encounter. Cases were sorted into ASCCP-defined categories of ECC preferred, recommended, acceptable, omission acceptable, and unacceptable. The rate of endocervical curettage completion was compared across each category.

RESULTS:

Colposcopies were performed in 120 nonpregnant patients. ECC was performed in 95 cases (79%). Based on 2023 guidelines, ECC would be recommended for 57, preferred for 23, acceptable for 25, and omission acceptable for 15. The rates of ECC for recommended (84%) and preferred groups (82.5%) and omission acceptable group (73%) were not significantly different (P=NS).

CONCLUSION:

Prior to release of the 2023 ASCCP guidelines, ECC at our institution was commonly done in higher-risk groups. To mitigate overall health care burden and unindicated procedures, ECCs should be redistributed away from the omission acceptable groups towards the higher-risk groups. This would lead to an estimated 2.5% increase in overall ECC rate and a 20% increase in high-risk groups. A prospective evaluation of the implication of these guidelines is ongoing.
Complications Associated With Mifepristone Use for Dilation and Evacuation Abortion Procedures Between 22 and 24 Weeks of Gestation [ID 2683461]
Authors: Wergeles Maya , Scott Rachel , Lewandowska Maria , Lohr Patricia A. , Andreeva Andriana P.
Published: May 2024

INTRODUCTION:

One percent of abortions take place after 20 weeks of gestation in England and Wales. Overall rates of complications with second-trimester abortion are low, but they increase with gestational age. Dilation and evacuation (D&E) is the most common method of surgical abortion at this stage in pregnancy. The British Pregnancy Advisory Service (BPAS) provides nearly half of all abortions in England and Wales. In 2017, BPAS added mifepristone to their regimen of osmotic dilators for cervical ripening before D&E. This retrospective study analyzed the risk for complications associated with the use of mifepristone for cervical ripening.

METHODS:

The British Pregnancy Advisory Service provided data for D&E procedures that occurred between 22 and 23 6/7 weeks, between February 2012 and February 2017 (osmotic dilators only), and November 2017 to November 2022 (mifepristone and osmotic dilators). Using time as a proxy for mifepristone, the association between mifepristone use and D&E complications was established using multivariate logistic regression.

RESULTS:

There were 6,516 D&E procedures at BPAS during this time. Those who received mifepristone were more likely to experience any complication (odds ratio [OR] 2.40; 95% CI, 1.62, 3.54). They also had higher odds of bleeding (OR 3.08; 95% CI, 1.12, 8.48). Odds for cervical injury (OR 2.21; 95% CI, 0.84, 5.80) and infection (OR 1.89; 95% CI, 0.46, 7.69) were not different.

CONCLUSION:

The addition of mifepristone to osmotic dilators was associated with an increase in the odds of complications of D&E, without attenuating the risk of complications related to cervical dilation.
Thrombocytosis Is a Poor Prognostic Factor in Those Treated With Chemoradiation for Advanced Cervical Cancer [ID 2683596]
Authors: Lewis Karina , Geisler John P. , Manahan Kelly J.
Published: May 2024

INTRODUCTION:

Prior to the addition of chemotherapy to radiation, thrombocytosis was seen as a poor prognostic factor for women with advanced cervical cancer. The objective of this study was to see in the chemoradiation era whether thrombocytosis was still a prognostic factor.

METHODS:

An IRB-approved study was performed analyzing all patients with cervical cancer receiving primary chemoradiation (cisplatin) as therapy over a 10-year period. Minimum follow-up was 30 months. Records were examined for initial platelet count at diagnosis, stage, grade, histology, and survival. Only patients receiving chemoradiation with stage IIa–IVb cervical cancer were studied and included in the final analysis.

RESULTS:

Two hundred nine with cervical cancer were diagnosed with 173 treated with primary chemoradiation. The most common stage was IIIb (88; 50.9%). The mean platelet counts of those receiving chemoradiation were significantly higher (396k/mL; 95% CI, 376–416k) than those with lower-stage disease (313k/mL; 292–334k) (P<.001). Of the 173 patients, 42 (24.3%) had a platelet count >450k/mL and 24 (13.9%) had a platelet count >500k/mL. Patients who died of disease had significantly higher initial platelet counts (mean 433k/mL; 95% CI, 407–458k) than those who were alive at the completion of follow-up (mean 326k/mL; 95% CI, 303–350k). None of the patients with an initial platelet count greater than 500k/mL was alive at the time of follow-up.

CONCLUSION:

High platelet count at initial diagnosis is a poor prognostic factor in those with cervical cancer treated by primary chemoradiation.
Adherence to Nonantibiotic Prophylactic Regimens in Women With Recurrent Urinary Tract Infections [ID 2683400]
Authors: Ashmore Sarah , Geynisman-Tan Julia , Ehimiaghe Eseohi , Arteaga Rebecca , Sarkar Prottusha , Das Deepanjana
Published: May 2024

INTRODUCTION:

Nonantibiotic regimens such as methenamine hippurate, D-mannose, and vaginal estrogen are often recommended as first-line prevention for recurrent urinary tract infections (rUTIs). The objective of our study was to describe adherence rates in women prescribed nonantibiotic prophylaxis for rUTI and explore factors associated with adherence.

METHODS:

This was an IRB-approved retrospective cohort study comparing women adherent and nonadherent to prophylactic regimens. Adult women who sought care from a urogynecology clinic at a tertiary care center for rUTI or frequent UTI between January 2020 and December 2021 were included if they were prescribed a nonantibiotic prophylactic regimen. The medication adherence questionnaire (MAQ) was administered to all eligible patients. Adherence was defined by a score of 0. A score greater than 1 defined nonadherence.

RESULTS:

Eighty-six patients met inclusion criteria and completed the MAQ with 31 in the adherent and 55 in the nonadherent group. Mean age was 64.3 (+14.8) and 66.0 years (+14.4) in the adherent and nonadherent groups, respectively (P=.48). Vaginal estrogen was the most common prescribed regimen (80.6% adherent versus 90.1% nonadherent group; P=.15) followed by methenamine hippurate (38.7% adherent versus 21.8% nonadherent group; P=.08). 77.4% of adherent patients and 72.7% of nonadherent patients met criteria for rUTI as per American Urogynecologic Society best-practice statement. No demographic or clinical factors were associated with adherence to nonantibiotic prophylactic regimens.

CONCLUSION:

Nonantibiotic prophylactic rUTI regimens are commonly prescribed; however, adherence remains low at 36%. There were no predictors to help determine patient compliance. Clinicians should therefore inquire about adherence prior to escalating treatment.
Analyzing the Efficacy of Metronidazole as Additional Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy [ID 2683482]
Authors: Hoang Christine , Teigen Kari , Johnson Chrystia , Sampson Audrey , Marshall Caitlin , Sangha Roopina
Published: May 2024

INTRODUCTION:

The American College of Obstetricians and Gynecologists recommends cefazolin for antibiotic surgical prophylaxis for hysterectomy procedures. In 2018, hysterectomy surgical site infection (SSI) data at John Peter Smith Hospital demonstrated a higher proportion of anaerobic growth identified on cultures. The addition of metronidazole with cefazolin became surgical prophylaxis protocol at our institution. The purpose of the study is to compare rates of non-superficial SSI before and after the addition of metronidazole in hysterectomy procedures.

METHODS:

This was a retrospective cohort study of patients who underwent hysterectomy of any surgical approach from January 2015 to July 2023. The primary exposure of interest was administration of metronidazole with additional covariates including age, body mass index, diabetes, oncology status, and wound class. The association between metronidazole administration and non-superficial SSI was examined using a logistic regression model. Appropriate waiver was received from the institutional IRB.

RESULTS:

Two thousand five hundred thirty-four hysterectomies were included in our cohort. 1,207 (44%) cases had metronidazole administration, with 98% of those cases occurring after the antibiotic was incorporated into the protocol. Of the patients who did not receive metronidazole, 49 (3.7%) patients had a non-superficial SSI compared to 14 (1.2%) patients that had a non-superficial SSI with metronidazole administration. After adjusting for age and oncology status, patients who did not receive metronidazole had higher odds of having a SSI compared those who did (adjusted odds ratio [aOR]: 3.6; 95% CI: 1.97, 6.3; P≤.0001).

CONCLUSION:

The results demonstrate potential infection prevention benefit with metronidazole to patients undergoing hysterectomy, supporting the institutional prophylaxis protocol. The findings could have further implications across hospitals with similar patient populations.
Using the Electronic Medical Record to Correlate Patient–Provider Perspectives in the Care of Black Individuals With High-Risk Pregnancies [ID 2683496]
Authors: Nadkarni Siddhi , Falako Simileoluwa E. , Antwi Adwoa D. , Campbell Katherine H. , Adeyemo Oluwatosin
Published: May 2024

INTRODUCTION:

The electronic medical record (EMR) is a mainstay of medical documentation, although it is limited in its ability to fully capture patients' perspectives. This study aims to correlate patient and provider perspectives in the care of Black individuals with diabetes and/or hypertension in pregnancy to identify areas for quality improvement.

METHODS:

A mixed qualitative-retrospective study consisting of in-depth one-on-one interviews and EMR chart review was conducted from January 2021 to December 2022 for nine patients who self-identified as Black, were 6 weeks to 1 year postpartum with diagnoses of diabetes and/or hypertension during pregnancy or postpartum, and delivered at a tertiary hospital (IRB 2000028830). Interviews were virtual, lasted 55 minutes on average, and explored participants’ delivery and postpartum experiences. Chart notes were reviewed to correlate and compare participants' described experiences with documentation in the EMR. Themes were developed using inductive technique.

RESULTS:

Participants reported overall satisfaction with the care received, but four major themes were identified: 1) concerns with acknowledgement and management of pain, 2) perceived coercion and stereotyping with contraception counseling, 3) incomplete representation of positive and negative experiences in EMR documentation, and 4) balancing patient autonomy and professional responsibility to counsel. Although participants' described experiences were correlated to EMR documentation for some instances, documentation often lacked patient perspectives regarding their concerns and decision-making rationale. Additionally, participants did not always fully understand the rationale behind aspects of their care.

CONCLUSION:

Opportunities exist for improved patient–provider communication in the provision of obstetric care for minoritized populations with high-risk pregnancies.
Disparities in Child Protective Services Reporting Among Pregnant Patients With Positive Urine Drug Screening at Delivery Hospitalization [ID 2683555]
Authors: Lijewski Virginia A. , Cates Victoria , Hopkins Chase T. , Straub Heather
Published: May 2024

INTRODUCTION:

This study assesses predictors of Child Protective Services (CPS) reporting among patients with a positive urine drug screening (UDS) during delivery hospitalization.

METHODS:

Patients receiving prenatal care and delivering at any UCHealth location between 2015 and 2022 with a positive UDS at delivery were included. Patient demographics, medical history, UDS, infant toxicology, and CPS reporting were collected from medical records. T-tests or nonparametric equivalents for continuous variables and χ2 or Fisher's exact tests for categorical variables were used to compare patients with and without CPS reporting.

RESULTS:

We found 523 patients with a positive UDS during their delivery hospitalization, with CPS reporting for 71%. CPS reporting was more common in younger patients (26 versus 28 years; P<.01), patients with prior CPS involvement (15% versus 5%; P<.01), patients with an antenatal UDS positive for any substance (46% versus 29%; P<.01), and any positive neonatal toxicology (87% versus 58%; P<.01). Patients positive for cannabis (78% versus 57%; P<.01) or amphetamines (6% versus 1%; P=.03) were more likely to be reported to CPS, while patients positive for barbiturates (12% versus 1%; P<.01) and benzodiazepines (6% versus 2%; P<.01) were less likely. Hospitals located in large (>400k pop.) or small cities (<100k pop.) were less likely to be reported to CPS than mid-sized cities (>100–399k pop.) (66% and 65% versus 76%; P=.03).

CONCLUSION:

Differences in CPS reporting depended on the substance that tested positive, infant positivity, and delivery location. Future research should explore reasons for no CPS reporting among patients with a positive UDS during delivery hospitalization.
Assessing Adverse Neonatal Outcomes Associated With Intrapartum Narcotic Administration [ID 2683477]
Authors: Azar Michelle , Shukr Hassan , Bailey Beth A.
Published: May 2024

INTRODUCTION:

Approximately 83% of U.S. deliveries include pain control, with 67% incorporating epidural analgesia, and 16% utilizing narcotics. Research suggests intrapartum fentanyl predicts poor neonatal suckling, and thus impaired breastfeeding. Unclear are potential effects of other narcotics. We examined whether use of intrapartum narcotics increases risk of adverse neonatal outcomes.

METHODS:

Charts of patients admitted for delivery at a single academic institution were reviewed for drugs administered in the intrapartum period and neonatal outcomes. Institutional review board approval was obtained with a waiver of informed consent. Data were summarized using logistic regression, controlling for confounders.

RESULTS:

Of the 519 participants, 286 (55.1%) received at least one narcotic in the intrapartum period. Compared to the control group, those who received narcotics were significantly younger, had greater pregnancy weight gain, were less likely to deliver via cesarean section, were less likely to have had preeclampsia, had greater gestational age at delivery, and gave birth to babies that weighed more. Tylenol III predicted a three times higher adjusted risk of neonatal intensive care unit admission (odds ratio [OR] 3.03 [1.06–8.62]). Norco predicted greater than 2.5 times higher risk of 1-minute (OR 2.66 [1.26–5.60]) and 5-minute Apgar scores below 7 (OR 2.61 [1.08–6.31]), and requiring oxygen at birth (OR 2.68 [1.21–5.93]). Morphine predicted a three times higher risk of 5-minute Apgar scores below 7 (OR 3.00 [1.26–7.17]). When adjusting for receipt of epidural analgesia, epidural did not significantly increase risk of any study outcomes.

CONCLUSION:

Adverse neonatal outcomes were observed following intrapartum Norco, morphine, and Tylenol III, and were unrelated to use of epidural analgesia. Findings support growing evidence that intrapartum narcotics pose risk to neonates, and further research is needed to elucidate potential longer-term effects.
Predictive Factors of the Occurrence of Shoulder Dystocia in Diabetic Mothers [ID 2683495]
Authors: Alhousseini Ali , Sharif Nadiya , Polay Madison , Diab Maya , Fawaz Aya
Published: May 2024

INTRODUCTION:

Maternal diabetes is associated with shoulder dystocia that places the newborn and mother at high risk of morbidity and complications. In the diabetic population, obstetricians lack definitive predictive factors that may improve the counseling, preparation, and management before delivery. This study evaluates prenatal maternal and fetal factors that would predict shoulder dystocia prior to delivery in diabetic mothers.

METHODS:

This is a cross-sectional case–control study of 63 diabetic mothers with shoulder dystocia and 200 diabetic mothers without shoulder dystocia delivered at a single medical center between January 2013 and December 2021. Maternal and neonatal characteristics were obtained. Among the studied maternal characteristics were body mass index, height, weight, ethnicity, age, gestational age, medical comorbidities (including preeclampsia and essential hypertension), hemoglobin A1C, insulin administration, labor type, parity, and health insurance type (public versus private). Neonatal characteristics included weight, height, length, and head circumference. Statistical analysis was performed using univariate and multivariate logistic regression. A value of P<.05 was considered statistically significant.

RESULTS:

There was no statistical difference among most of the maternal and neonatal characteristics between the two groups using univariate and multivariate analysis. We did find a statistically significant association between the incidence of shoulder dystocia and lower maternal gravidity (P=.016), larger neonatal weight (P=.00001), smaller neonatal head circumference (P=.025), smaller head circumference/weight ratio (P=.00001), and smaller head circumference/length ratio (P=.00001).

CONCLUSION:

Our preliminary results indicate that most available maternal and neonatal characteristics were not able to predict perinatal injury. Our sample size and the complexity of etiologies behind neonatal injury are possible reasons behind our non-statistically significant results. Over the coming 2 months, based on the association between shoulder dystocia and neonatal weight and head circumference, we will evaluate third-trimester ultrasound head circumference/abdominal circumference ratio and the ability to predict shoulder dystocia with and without neonatal injury.
Artificial Intelligence-Powered Sentiment Analysis of Water Births on YouTube via ChatGPT [ID 2683505]
Authors: Fleming Erika G. , Chen Jamie , Collamore Katherine , Oladipo Antonia F.
Published: May 2024

INTRODUCTION:

YouTube is a popular platform for sharing information regarding experiences during pregnancy, including water births. Thus, it is beneficial for health care providers to be aware of the sentiment towards water birth in the most popular videos on the topic. ChatGPT, an artificial intelligence natural language processing tool was utilized to assess sentiments expressed by pregnant individuals and their loved ones through YouTube videos.

METHODS:

A YouTube search query on “water birth” was conducted. English transcripts from the top 100 “most viewed” videos were extracted and analyzed using ChatGPT, which categorized sentiments as positive, negative, neutral, or mixed. Chi-squared goodness-of-fit and independence tests were performed to assess significance of differences between groups.

RESULTS:

Of the 63 YouTube videos that met criteria, 52.4% were positive, 17.5% were mixed, 15.9% could not be assessed, 12.7% were neutral, and 1.6% were negative (P<.0001). Videos were uploaded from North America (84%), Australia (5%), Europe (5%), Asia (4%), Africa (1%), and South America (1%). When comparing North America to other regions, results are as follows: positive (54.7% versus 50% [P=.3173]), negative (8% versus 0% [P=.0032]), neutral (17.2% versus 16.7% [P=.6716]), and mixed (9.4% versus 8.3% [P=.2074]).

CONCLUSION:

As the trend of sharing labor and delivery experiences online gains traction, it is important to understand the sentiment surrounding water births on social media platforms such as YouTube. Over half of all sentiments on water birth were positive, whereas only a small amount were found to have a negative sentiment. While a majority of the most popular videos on water births are from North America, it is important to note that North American videos expressed more negative sentiment compared to other continents. Ongoing efforts should be undertaken to gain insights into the sentiments associated with nontraditional labor and delivery methods.
Estimated Incidence, Mortality, and Costs of Neonatal Herpes Simplex Virus Infections in the United States, 2019 [ID 2683519]
Authors: Pooser Matthew , Yuan Yan , Karki Saugat , O’Callaghan Kevin P. , Hufstetler Kaitlin , Kreisel Kristen
Published: May 2024

INTRODUCTION:

Neonatal herpes simplex virus (nHSV) infection is rare but can cause serious morbidity and mortality. This study assessed the incidence, mortality, and costs of nHSV infections in the United States in 2019.

METHODS:

Inpatient records of neonates aged 28 days or less at admission were examined using the 2019 Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationally representative sample of U.S. pediatric discharges. Neonatal herpes simplex virus cases were defined as those with ICD-10-CM codes for herpes simplex virus (B00.xx, A60.xx, or P35.2), and hospital stays greater than 5 days or resulting in death. Cases involving readmission or transfer from another hospital were excluded. Incidence, mortality, and costs were estimated by sociodemographic factors including race, U.S. region, primary payer, and median household income.

RESULTS:

In 2019, there were an estimated 561 nHSV cases in the United States (15.7 per 100,000 births), with a 4.6% mortality rate. Incidence rates were highest in neonates of Black race (27.3), in the South (21.3), with public insurance coverage (25.2), and born into a household with a median income less than $48,000 (24.5). The incidence rate of nHSV in preterm (41.8) was three times that of term neonates (13.0). The median hospital stay was 15 days with a median cost of $109,562.

CONCLUSION:

We found disparities in nHSV incidence, with infants in the South and born to Black birthing parents disproportionately affected. Higher incidence rates were also found in infants with public insurance coverage and lower household income. Prevention efforts and early detection are crucial to mitigate these disparities.
Maternal and Fetal Outcomes Among Pregnant Women With Endometriosis [ID 2683578]
Authors: Abdessamie Sara , Czuzoj-Shulman Nicholas , Abenhaim Haim A.
Published: May 2024

INTRODUCTION:

Endometriosis, a prevalent disorder affecting around 10% of reproductive-aged women, has been linked to obstetric complications during pregnancy. This study aims to evaluate endometriosis prevalence in pregnancy and its effect on maternal and newborn outcomes.

METHODS:

A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the United States between 1999 and 2019. Multivariate logistic regression analysis, controlling for diverse baseline maternal characteristics, was used to investigate pregnancy and newborn outcomes in births to women diagnosed with endometriosis as compared to those without.

RESULTS:

The cohort consisted of 16,911,497 births to women without endometriosis and 14,956 pregnant women diagnosed with endometriosis. Over the 20-year period, there was a significant upward trend in prevalence of endometriosis among births, rising from 34.9 to 160.6/100,000 births. Births to women with endometriosis exhibited distinctive demographic characteristics: being of advanced maternal age, predominantly of Caucasian ethnicity, belonging to higher income quartiles, obese, smokers, and having private insurance coverage. Births to women with endometriosis were at heightened risk of experiencing obstetric complications, including gestational diabetes, preeclampsia, preterm birth, and postpartum hemorrhage. Neonates born to mothers with endometriosis also demonstrated an elevated likelihood of growth restriction and congenital anomalies.

CONCLUSION:

The study highlights the evolving prevalence of endometriosis among pregnant women and establishes a strong connection between endometriosis and adverse maternal and newborn outcomes. These findings emphasize the importance of vigilant monitoring to enhance obstetrical and fetal outcomes in pregnant women with endometriosis.
Maternity Care Deserts and Postpartum Outcomes: Bridging the Gap in Maternal Health Care in Florida [ID 2683485]
Authors: Kendall Alexis
Published: May 2024

INTRODUCTION:

Over 2.2 million women of reproductive age live in areas, referred to as maternity care deserts (MCD), with inadequate access to postpartum care services. Furthermore, deaths occurring during the postpartum period account for over half of all pregnancy related deaths. This analysis serves to provide an overview of the intricate relationship between health care access and postpartum health while exploring the increased risk of delayed detection of postpartum complications and the association to increasing maternal mortality rates.

METHODS:

Data provided by the Area Health Resource File were used to identify counties in Florida that met the criteria of a designated MCD. Data collected on all pregnancy-related deaths verified by the Florida Department of Health (2020–2021) and geographic codes for MCD were used to identify significant associations.

RESULTS:

This study collected data from a total of 1,938 pregnancy related deaths. A significant increase in the number of postpartum related deaths was during that time (75%). More than a quarter were in MCD (26%). An association of postpartum related deaths with MCD showed an increase (22%). 1 in 10 women living in MCD reported to not receive a postpartum care visit, these counties were also noted to be more likely to have limited telehealth access (30%).

CONCLUSION:

Maternity care desert limitations to postpartum care reduce prevention efforts, increase risk for delayed complications to go undetected, and contribute to the maternal mortality rates. Potential solutions include policy revisions to expand telehealth access and efforts to increase the awareness of the importance of postpartum care.
The Development and Evaluation of the Mobile Obstetric Referral Emergency System (MORES) in Bong County, Liberia [ID 2683571]
Authors: Perosky Joseph , Edson Claire , Reynolds Christopher W. , Nyanplu Aloysius B. , Sieka Joseph M. , Lori Jody R.
Published: May 2024

INTRODUCTION:

Liberia and much of sub-Saharan Africa lacks a standard triage system for obstetric emergencies. Research conducted in low- and middle-income (LMICs) has shown that maternal mortality is directly related to inadequate triage systems. This study aimed to implement a novel mobile obstetric referral emergency system to improve obstetric triage in Liberia.

METHODS:

Ninety-seven midwives were recruited from 18 rural health facilities (RHFs) and two referral hospitals in Bong County, Liberia. The study utilized WhatsApp, an encrypted messaging platform, to enable communication between providers at RHFs and referral hospitals. Training sessions at RHFs on sending patient referral data including indication, age, gravidity/parity, gestational age, method of transportation, and delays were conducted. Midwives at referral hospitals were instructed to send messages confirming arrival and outcome.

RESULTS:

A total of 380 referral messages were sent, with significantly more referrals completing the referral process than not (60%). Both hypertension and hemorrhage accounted for 12% of referrals. Nonemergent obstetric causes accounted for 34%. Of women who arrived, 31% delivered via cesarean section. Significantly more women transported via ambulance arrived compared to self-transport or taxi. When money was identified as a barrier, only 45% of women arrived.

CONCLUSION:

This is the first study to introduce a real-time two-way mobile-phone obstetric triage platform for use in Liberia. Strengthening the obstetric triage system is critical to prevent delays in reaching care and improve obstetric outcomes. Addressing socioeconomic barriers is vital to increasing access to maternal health care. Future work includes country-wide scale-up in Liberia and assessment of the sustainability of the MORES intervention.
Implementation of Thromboelastography on the Labor and Delivery Floor for Postpartum Hemorrhage [ID 2683574]
Authors: Kumar Aarti , Noriega Dominique , Clay Carson E. , Taye Abigail , Roman Ashley , Limaye Meghana
Published: May 2024

INTRODUCTION:

Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Thromboelastography (TEG) is a rapid test that has been shown to improve outcomes in PPH by guiding resuscitation quickly and in a targeted manner. We incorporated TEG into our hemorrhage response protocol (HRP), a robust algorithm focused on facilitating immediate response to PPH, in a pilot study at our high-volume academic medical center. The objective of this quality improvement project was to evaluate the feasibility of incorporating TEG as part of our HRP.

METHODS:

We identified key HRP stakeholders and appointed team leads including obstetricians, anesthesiologists, nurses, and lab/blood bank staff and developed team-appropriate education including 30-minute teaching sessions, badge reference cards, and workflow posters. We then evaluated the TEG utilization rate over time.

RESULTS:

Thromboelastography was utilized in 4/9 (44%) PPHs during the first week after implementation, 4/7 (57%) the second week, and 28/28 (100%) during the following 4 weeks. After an HRT was called, the median time to order TEG was 4.0 minutes (interquartile range [IQR] 13), the median time to collect TEG was 8.5 minutes (IQR 11.8), and the median time for TEG to result was 7.0 minutes (IQR 7.7).

CONCLUSION:

We observed 100% uptake of TEG within 3 weeks of implementation, and rapid workflow completion (<10 minutes per step). The strengths of our implementation approach were its multidisciplinary nature, structuring the workflow into the electronic health record, and appointing team leads to facilitate buy-in. Future studies are needed to assess clinical implications and provider comfort with TEG.
Universal Screening for Syphilis at University of California, Davis, Labor and Delivery: A Response to National Trends [ID 2683426]
Authors: Shirazi Elizabeth
Published: May 2024

INTRODUCTION:

The number of congenital syphilis cases have been rapidly increasing in the United States despite prenatal screening. In Sacramento County, the rates of congenital syphilis are among the highest in the California. In response to the rapid rise in syphilis rates, there is universal syphilis screening on admission to University of California, Davis, labor and delivery.

METHODS:

Syphilis IgG was added to the admission order set for patients admitted to University of California, Davis, labor and delivery. To assess the effect of this intervention, charts were reviewed from the electronic medical record 6 months prior to and 6 months after the intervention was implemented.

RESULTS:

In the 6 months prior to implementing routine screening, there were nine individuals who screened positive for syphilis. Of those individuals, eight had scant or no prenatal care. Seven had a history of syphilis with prior treatment. Three required re-treatment based on follow-up titers. There were no false-positive screens. Four patients had concomitant sexually transmitted infection (STI) diagnoses, and seven had a history of or current drug use. Five had unstable housing. In comparison, after 6 months of routine syphilis screening, there were six individuals who screened positive for syphilis. Two had scant prenatal care. Three of the patients had history of syphilis and two required re-treatment based on follow-up titers. There were three false-positive screens. One patient had concomitant STI diagnosis. Two patients had unstable housing. The two groups had similar demographics in regard to age, gravidity, and parity.

CONCLUSION:

In the first 6 months of routine screening, there was no increase in identification of syphilis cases when compared to risk-based screening (P=0.17). This finding suggests that using a risk-based model (for example, screening individuals with scant to no prenatal care) is sufficient for identifying individuals in need of treatment.
Beyond Maternal Health: Examining the Effect of Birth Complications on Unmarried Fathers' Postpartum Well-Being [ID 2683609]
Authors: Chen Michael , Assibey-Mensah Vanessa , Olson-Chen Courtney
Published: May 2024

INTRODUCTION:

Birth complications (BCs) are known risk factors for maternal postpartum depression, but their effect on paternal postpartum depression (PPD), especially among unmarried fathers, remains understudied.

METHODS:

In this cross-sectional study, we analyzed data from The Future of Families and Child Wellbeing longitudinal birth cohort, focusing on unmarried fathers who were present at their child’s birth (n=1,484). Paternal PPD was assessed using a 12-item CES-D scale, dichotomized into depression present versus absent. Maternal medical records identified seven conditions constituting BC, including excessive bleeding, placental abruption, placenta previa, emergency c-section, seizure during delivery, cord prolapse, or fetal distress. Logistic regression models were estimated, adjusting for parents' demographics, self-reported health status, cohabitation, poverty, substance use, relationship quality, and prior fatherhood experience.

RESULTS:

Postpartum depression affected 132 fathers (9%), while BC occurred in 602 mothers (41%). In the unadjusted model, BC was associated with 42% increased odds of paternal PPD compared to uncomplicated births (95% CI, 1.00–2.04). In multivariable analysis, BC was significantly linked to paternal PPD (aOR 1.46; 95% CI, 1.00–2.12). Fathers in great/very good health had 37% lower paternal PPD odds than those in good/fair/poor health (95% CI, 0.43–0.96), while interparental conflict was linked to higher paternal PPD odds (aOR 2.38; 95% CI, 1.61–3.52).

CONCLUSION:

Our study found birth complications to be associated with increased odds of paternal postpartum depression. Further research is needed to explore how maternal birth experiences affect paternal well-being, particularly among unmarried fathers, and identify novel ways to incorporate fathers into perinatal support systems and interventions.