bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Quality of Care Amongst Gestational Diabetic Patients in Community Hospital [16N]
Authors: Ake-Uzoigwe Rukeme , Sanusi Ayodeji , Salafia Carolyn , Zhang Dongping , Akinnawonu Kolawole , Fuks Aleksandr
Published: May 2017

INTRODUCTION:

The objective of our study was to determine factors that affect the quality of care received by a gestational diabetic patient.

METHODS:

A retrospective cohort study of gestational diabetic patients' who delivered from January 2013 to December 2015. Patients were given quality scores based on predefined quality of care parameters. Patients were then categorized into high quality vs low quality care based on their quality score. Logistics regression analysis was used to determine the relationship between quality of care and variables of interest.

RESULTS:

Of 514 eligible patients, 468 (91%) had high quality care and 46 (9%) had low quality care. The predictors of High quality of care are: GDMA type: Medication vs Diet Control (OR: -5.74, p = < 0.001); Sex of Infant: Male vs Female (OR:- 0.74, p = 0.352); Age: 20-35 yrs vs less than 19 yrs (OR: 5.2, p= 0.062) and Greater than 35 yrs vs 19 yrs (OR: 5.2, p= 0.071).Gestational age at Diagnosis of GDM: 24 – 30 wks vs less than 24 weeks (OR:0.42, p= 0.16) and greater than 30 wks vs less than 24 wks (OR: 0.17, p = 0.001).Gestational age at initiation of prenatal care: greater than 24 wks vs less than 24 wks (OR: 0.46, p=0.023).

CONCLUSION:

Patients on medication control, who had an early diagnosis of gestational diabetes and who initiated prenatal care early were more likely to have high quality. Early initiation of prenatal care and prompt diagnosis of GDM is beneficial to improving quality prenatal care.
Preferences of Pregnant Women for Outcomes Related to Epilepsy and the Use of Antiepileptic Medications in Pregnancy [18N]
Authors: Wuebbolt Danielle , Nguyen Vanessa , Thomas Hannah , Bui Esther , Murphy Kellie , D'Souza Rohan
Published: May 2017

INTRODUCTION:

Women with epilepsy are at risk of higher seizure-frequency in pregnancy and fetal malformations from the use of antiepileptic drugs (AEDs). The trade-offs women are willing to make, to optimize pregnancy outcomes have not been determined. This study elicits preferences of pregnant women with and without epilepsy, for maternal and fetal health states related to epilepsy and the use of AEDs in pregnancy with a view to informing practice and research.

METHODS:

Cross-sectional study on pregnant women that had epilepsy or another chronic medical disorder requiring medications during pregnancy. Study participants were presented with seven vignettes related to epilepsy and the use of AEDs in pregnancy and asked to assign them values on a visual analogue scale, by the standard gamble and time trade-off methods. Utility values were presented on a scale of 0-100.

RESULTS:

52 pregnant women completed the interviews. The median age was 33 (29.5-35) years and the median gestational age was 30 weeks. The epileptic and non-epileptic groups had identical demographic characteristics. Utility values for combined maternal-fetal health states related to epilepsy and the use of AEDs was obtained by three methods, from women with and without epilepsy. There were no differences in utility values obtained between groups regardless of the method used.

CONCLUSION:

This study provides utility values for combined maternal-fetal health states related to epilepsy and the use of AEDs for use in decision analysis studies and suggests that these preferences could be obtained from pregnant women with any chronic medical disorder taking medications during pregnancy.
Impact of an Obstetrical Hospitalist Program on the Safety Events in a Midsized Obstetrical Unit [24N]
Authors: Morton Ashley , Decesare Julie , Bush Suzanne
Published: May 2017

INTRODUCTION:

As internal medicine hospitalist programs were developed to address issues in medicine such as a need to improve quality, improve efficiency and decrease healthcare cost, obstetrical (OB) hospitalist models were developed to address needs specific to obstetrics and gynecology (OB/GYN). Though there is an increase of OB hospitalist model utilization in the U.S., there is currently no published studies available that report outcomes following the implementation of OB hospitalist programs. Our objective was to compare outcomes measured by occurrence of safety events prior to and after implementation of an OB hospitalist program in a mid-sized obstetrical unit.

METHODS:

Our regional obstetrical referral hospital has approximately 3500 deliveries per year. Safety events are regularly monitored and evaluated. Our full-time OB hospitalist program was implemented in October 2014, with continuous coverage of the labor and delivery (L/D) floor. Safety events from the pre-implementation period, July 2012-September 2014, were compared to the post-implementation period, October 2014-June 2016.

RESULTS:

From July 2012 through September 2014, 11 safety events occurred on the L/D floor. From October 2014 through June 2016, post-implementation, there was zero safety events associated with L/D.

CONCLUSION:

Full-time OB hospitalists provided patients with immediate evaluation, early recognition of critical clinical events, and provided management in high stakes clinical situations. While it has been speculated that implementation of an OB hospitalist model would be associated with improved maternal and neonatal outcomes, our regional obstetrical referral hospital demonstrated a significant decrease and elimination of obstetrical safety events following the OB hospitalist program implementation.
Pregnancy Outcome in the Morbidly Obese: Black Versus White [37N]
Authors: Gennette Sarah , Guzman Angela , Peart Mishka , Carlan Steve , Mcwhorter Jeannie
Published: May 2017

INTRODUCTION:

Obesity during pregnancy is associated with multiple known maternal and perinatal risks and these risks increase with increasing degrees of obesity. Racial disparities in obstetric outcome are well documented. Whether these two risk factors together further increase the chances of a poor outcome have not been studied. The purpose of this study was to compare the obstetric outcome of singleton pregnancies in morbidly obese black versus morbidly obese white women.

METHODS:

Morbid obesity (MO) was defined as a BMI greater than 40 at the time of delivery. Race was self-identified and recorded on admission. This was a retrospective study of all deliveries at our hospital from 12/14/2009 to 10/1/2013, total singleton deliveries: N = 45,961. Grp 1= Black MO, N = 1,236. Grp 2= White MO, N = 1,384.

RESULTS:

Based on our data, the addition of black race to morbid obesity increases the chances of poor obstetric outcome in all important measured variables except Cesarean delivery, labor induction and macrosomia. NICU admission was higher (N= 128 v N=104), Cord pH lower (7.25 ± .08 v 7.26 ± .08) and birth weight lower (3103 ± 734 v 3383 ± 710 g) between Grp 1 and Grp 2, respectively, P less than .05.

CONCLUSION:

This study suggests that black MO pregnant women are at greater risk of poor obstetric outcome than white women possibly based on their race.
The Role of Residents in the Gynecologic Operating Room – What Do Patients Understand? [5O]
Authors: Cantor Arielle , Flood Cathy , Boutin Savanna , Regan Shauna , Ross Sue
Published: May 2017

INTRODUCTION:

Studies in emergency medicine show that patients believe it is important to know the training level of their doctor, but most do not understand the responsibilities of physicians-in-training. No research on this topic has been published in gynecology, even though gynecological surgeons have been sued by patients alleging they did not understand the role of residents in their surgery. The goal of this research was to explore what gynecological surgery patients understand about the role of resident doctors.

METHODS:

A questionnaire was distributed to female patients in pre-admission clinics awaiting gynecological surgery in Edmonton. Surveys included knowledge and opinion-based questions about resident duties. Anonymous responses were entered into a REDCap database. Descriptive statistics were used to characterize the results.

RESULTS:

Of 108 participants, 83% understood that residents had a higher level of training than medical students, yet 40% were unsure if residents were doctors. Almost half (43%) were uncertain if residents required supervision, including while operating (20%). The majority (92%) felt it was important to know their physician's level of training, yet only 63% reported actually knowing this information. Only half of participants would be comfortable with residents operating on them under supervision. A considerable number (56%) wanted to learn more about residents' roles.

CONCLUSION:

Patients do not fully understand the role of residents and many are uncomfortable with trainees operating on them under supervision. Considering the significant role of residents in patient care, educating patients is essential to improve their comfort and the overall consent process.
Gender Disparities in Small Group Verbal Participation Among 1st Year Medical Students [9O]
Authors: Peterson-Perry Sylvia , Bohnett Mary Clare , Rabinowitz Molly , Peterson Mariah
Published: May 2017

INTRODUCTION:

Gender disparities exist for female clinicians today, from limits on upward mobility to unequal pay and more. In non-medical education, it has been shown that in-class verbal participation correlates with academic success. Research is lacking on whether verbal participation disparities exist during preclinical medical education, and if they do, what the significance of this may be for female trainees and the educational climate.

METHODS:

This descriptive cohort study explores the extent to which gender disparities exist at the level of preclinical medical education, using the proxy metric of verbal participation in class. We aimed to (1) quantify any gender disparities in verbal participation in medical school small work groups, and (2) to examine whether factors such as facilitator gender or facilitation style impact female verbal participation. We collected covert observational data over a 4-week period during a 1st year basic science course. Ten small work group sessions were observed and unique verbal participation events were counted by gender. Facilitator gender, gender composition of group, and inclusionary comments by facilitator were also recorded.

RESULTS:

Descriptive statistics analysis revealed an imbalance in average verbal participation events between males and females of >2:1, even when adjusted for group composition and facilitator gender. At least one instance of inclusive facilitation per session increased female participation, but did not close this gap.

CONCLUSION:

Participation disparities exist. More research is needed to explore implications, as well as interventions by which gender equality can be promoted in the small work group microcosm and beyond.
Is 'Baby-Friendly' Actually 'Mommy-Friendly?' The Baby-Friendly Initiative and Effect on Patient Satisfaction [11O]
Authors: Ebinger Jessica , Castleberry Lauren , Cai Bo
Published: May 2017

INTRODUCTION:

The Baby-Friendly Hospital Initiative was launched by the World Health Organization in 1991 to encourage breastfeeding. Baby-Friendly USA has specific criteria for “Baby-Friendly” designation. No studies have been reported about patient satisfaction; few show increased breastfeeding rates.

METHODS:

Patients aged 16 years or older that were cared for and delivered by the resident service were provided anonymous surveys during postpartum visits during a 4-month study period.

RESULTS:

145 of 170 surveys qualified for analysis. 28% underwent Cesarean delivery (CD); 72% vaginal delivery. 28% responded “neutral or disagree” when asked if they could rest and recover in the hospital. Compared to patients delivering vaginally, post-operative patients were more likely to respond negatively when asked if they felt they could safely care for their infant (P < .05). 97% reported being informed of infant safe sleeping guidelines; 84% practiced safe sleeping. 103 (72%) planned exclusive breastfeeding with 50% switching to some formula feeding at discharge. 40 patients planned to formula feed prior to delivery; 3 (7.5%) switched to exclusive breastfeeding. Of formula users, 35.7% felt inadequately informed about formula feeding; 26% felt shamed regarding their decision.

CONCLUSION:

Baby-Friendly policies can impact patient well-being and potentially infant safety. Patients undergoing CD and those who formula feed may need additional support caring for newborns and education not addressed by Baby-Friendly. Though most patients planned to breastfeed, half switched to some formula feeding upon discharge. Many felt shamed regarding their decision or inadequately educated on formula feeding. This small study suggests additional research is needed.
Instrumental Vaginal Delivery in Abakaliki, South-East Nigeria. [17O]
Authors: Ozumba Benjamin , Ajah Leonard O. , Iyoke Chukwuemeka A. , Mamah Emmanuel J. , Asiegbu Obiorah G.
Published: May 2017

INTRODUCTION:

Instrumental vaginal delivery is used as an alternative to caesarean section especially in this environment with high aversion to caesarean section. This study aimed at determining the rate and perinatal outcome of instrumental vaginal deliveries in Abakaliki, South-East Nigeria.

METHODS:

This was a 5 year retrospective study in which case files of instrumental deliveries at Federal Teaching Hospital, Abakaliki from January 1,2011 to December 31,2015, were retrieved. The data on age, parity, booking status, type of instrumental delivery performed, Apgar scores of neonates delivered and complications were analyzed with SPSS software for Windows version 16.

RESULTS:

A total of 304 out of 11,649 deliveries were delivered with the aid of instrumental delivery. Therefore the instrumental delivery rate was 2.6%.The vacuum and forceps delivery rates within the study period were 2.6% (302/11649) and 0.02% (2/11,649) respectively. The perinatal mortality was 6.6% (20/304). There was an annual decreasing trend of instrumental delivery.

CONCLUSION:

The instrumental delivery rate especially forceps in Abakaliki is very low. This is worrisome in an environment with aversion to caesarean section. Therefore efforts should be geared towards training and retraining of doctors on this skill.
Effects of Amniotic Fluid Index on Perinatal Outcomes in Preterm Premature Rupture of Membranes [37O]
Authors: Ladella Subhashini , Leung Teresa , Cortez Cynthia
Published: May 2017

INTRODUCTION:

Amniotic fluid has antibacterial properties and a protective effect on the fetus. A decrease in amniotic fluid index (AFI) during pregnancy has been associated with increased risk for adverse perinatal outcomes. Prior studies have shown a low AFI of less than 5 cm to be associated with a shorter latency period, however, its association with increased risk of perinatal infection has been unclear. The purpose of this study is to determine if AFI levels in women with preterm premature rupture of membranes (PPROM) are associated with adverse perinatal outcomes.

METHODS:

A retrospective cross sectional study was performed at Community Regional Medical Center in Fresno, CA on women with diagnosis of PPROM between gestational ages of 23 to 34 weeks during 6/1/2014 to 6/1/2016. The primary predictor variable was AFI level less than 5 cm and greater than 5 cm in relationship to perinatal outcomes.

RESULTS:

A total of 117 PPROM cases were reviewed, 46 women had an AFI less than 5 cm and 71 women had an AFI greater than 5 cm. Length of stay in NICU was 42 days with AFI less than 5 cm versus 26.5 days with AFI greater than 5 cm (P < .013).

CONCLUSION:

AFI greater than 5 cm in PPROM is associated with decreased length of stay in the NICU. No significant difference was found between AFI levels and latency period. Further data is needed to increase the power of the study. Research is being done to investigate the association of AFI less than 5 cm with decreased latency period and increased adverse pregnancy outcomes.
Differences in Patient and Provider Views on Gestational Weight Gain and Exercise Counseling During Pregnancy [10E]
Authors: Delgado Arlin , Stark Lauren , Macri Charles J. , Schulkin Jay
Published: May 2017

INTRODUCTION:

Appropriate gestational weight gain (GWG) during pregnancy impacts the health of a mother and child long after birth, yet reports show only one third of women nationwide achieve this. Current literature documents a patient‒provider communication gap is associated with incorrect GWG. The purpose of this survey study was to assess provider and patient views on current office practices and suggested educational tools about GWG and exercise during pregnancy.

METHODS:

Providers and patients at a major urban OB/GYN clinic were recruited for a voluntary survey. Descriptive statistics of responses were run and compared.

RESULTS:

A total of 461 patient and 36 provider responses were analyzed. All providers reported discussing GWG with patients at least once; however, 76.1% of patients recalled any GWG discussion and even less recalled discussing personal GWG recommendations (53.4%). Providers and patients similarly recalled discussing exercise during pregnancy. Providers reported distributing pamphlets/brochures/flyers for GWG (60.0%) and local resources for exercise (43.8%) much more than patients reported receiving (30.6% and 6.5%, respectively). Patients perceived suggested educational tools much more useful than providers, the largest gaps among placing GWG and exercise informative posters in the exam and waiting rooms.

CONCLUSION:

The gap among patients and providers suggests current clinical practices should be improved to better healthcare. Patients may expect GWG and therefore are unaware of the negative health impacts, while providers are trained in these outcomes, thus explaining reported office differences. Future research should study if implementing tools, especially in exam and waiting rooms, would increase practice efficacy.
Prevalence of Abnormal Pap Smear in Women Undergoing Liver Transplantation [15E]
Authors: Threadcraft Marcus , Guha Paulami , Wells Ali , Dinh Tri , Nguyen Justin , Harnois Denise
Published: May 2017

INTRODUCTION:

Female patients being evaluated for liver transplantation (LT) routinely undergo a gynecologic exam including cervical cancer screening. The prevalence of cervical cytologic abnormalities in this high risk population is unknown. Our study determines prevalence of cervical cytologic abnormalities, HPV positive status, and risk factors for abnormal cervical screening for this population.

METHODS:

With Institutional review board approval, we reviewed 375 charts of women undergoing evaluation for LT from 2008‒2013 at Mayo Clinic Florida. We recorded demographics, Pap smear results, High risk HPV positive results, and co-morbid conditions. Univariate analysis was done to determine risk factors. We compared the result of the LT group to the general female population getting cervical cancer screening during the same time period.

RESULTS:

37 of 375 (9.86%) LT patients had abnormal Pap smear, compared to 1784 of 26118 (6.83%) of the general population patients (p < 0.01). Among LT patients with cervical cytologic abnormalities, 40.5% were ASCUS, HPV positive (64.8% for non-LT patients), 29.7% were LSIL (28.1% for non-LT patients), 5.4% were HSIL (6.7% for non-LT patients) and 24.3% were cytology negative with HPV positive (0.2% for non-LT patients, p < 0.05). Younger age and presence of hypertension were associated with higher risk of having an abnormal cervical cytology or positive HPV status among LT patients.

CONCLUSION:

Patients undergoing evaluation for LT have increased prevalence of abnormal cervical cytology, or a positive High risk HPV test. Gynecologic surveillance for this high risk population is recommended.
A Coordinated Cultural Shift Improves Breastfeeding Exclusivity in a Federally Qualified Health Center [16E]
Authors: Stechna Sharon , Miller Ralee , King LaShonda
Published: May 2017

INTRODUCTION:

Provider support for breastfeeding has been shown to have a positive impact on breastfeeding including initiation and continuation. This study attempts to determine if a coordinated cultural shift can influence breastfeeding rates among patients in a Federally Qualified Health Center (FQHC).

METHODS:

All staff at Eric B. Chandler Community Health Center, an FQHC located in an urban setting in New Jersey, were educated about the importance of breastfeeding and improved outcomes in breastfeeding mother-baby pairs. Additionally, key staff members were trained to assist with breastfeeding problems. Breastfeeding promotion was standardized within the obstetric program. A professional relationship with WIC was established. Data was collected and analyzed to determine if there was an impact on breastfeeding at the six-week postpartum visit comparing the six months prior to and six months after the cultural shift.

RESULTS:

Three hundred seventy-three women in the post intervention group were compared to 63 women in the baseline group. Exclusive breastfeeding at six weeks postpartum increased from 12/63 (19.1%) to 107/373 (28.7%), p less than 0.05. Combination feeding decreased from 31/63 (49.2%) to 159/373 (42.6%). Exclusive formula feeding remained unchanged 20/63 (31.7%) compared to 107/373 (28.7%). Mode of delivery had no influence on rates of breastfeeding.

CONCLUSION:

This study demonstrates that a coordinated cultural shift can increase the rate of breastfeeding exclusivity in a FQHC. Improvement in exclusivity, however, was a result of more breastfeeding women forgoing supplementation. There was no comparable increase in formula feeders choosing either combination feeding or exclusive breastfeeding.
The Effect of Ultrasound Findings on the Risk of Aneuploidy With a Positive Cell Free DNA Screen [17E]
Authors: Rich Gabrielle , Maher James , Kelly Randall , Kodeih Hanna , Schlabritz-Lutsevich Natalia
Published: May 2017

INTRODUCTION:

Cell free DNA (cfDNA) is the newest addition to prenatal screening. Its benefits include that it has a superior sensitivity and specificity and can be performed earlier in pregnancy. However, its use in a low risk population is controversial due to the lower prevalence of aneuploidy and the need for additional evaluation.

METHODS:

We performed a retrospective review of data from unexpected positive cfDNA with a normal ultrasound. We compared the karyotype information from this cohort with a high risk cohort where cfDNA was prompted by an abnormal ultrasound finding.

RESULTS:

48 cfDNA were performed for ultrasound anomaly. 14 of these were positive with a confirmed abnormal karyotype. There was a 29% risk of aneuploidy in this cohort. In 105 patients with a normal ultrasound, all had normal cfDNA and no post-natal abnormalities reported. 7 patients had positive cfDNA prior to ultrasound. All 7 cases had a normal ultrasound and a confirmed normal karyotype. Using Fishers exact test, the probability of an abnormal karyotype following a positive cfDNA was lower with a normal ultrasound. (p=0.0035). Phi coefficient for association = 0.39. (p=.0001).

CONCLUSION:

A positive cfDNA presents a challenge in counseling low risk patients. Best practice dictates invasive testing for confirmation of the cfDNA results. Our findings suggest that a normal ultrasound after a positive cfDNA is associated with a significantly reduced prevalence of aneuploidy. This information may be reassuring to women who decline invasive testing.
PodCare: Structured Individual Prenatal Care for the Academic Team [22E]
Authors: Damiano Ella A. , Gelb Daniel J. , George Karen , Foster Tina C. , Theiler Regan N.
Published: May 2017

INTRODUCTION:

Innovative models of prenatal care are needed to improve pregnancy outcomes in the U.S, while improving patient and family experience and lowering costs. We sought to improve upon the traditional prenatal model by structuring visits, coordinating care, and training residents within interprofessional teams.

METHODS:

Attending physicians, resident physicians, associate providers, and clinic staff were split into four “Pods”. Testing and counseling topics were assigned to appropriate visits to create a structured schedule based on gestational age. Weekly Pod meetings provided coordination of care. Data were abstracted retrospectively from Epic for all patients initiating prenatal care in the one year before and after initiation of the new model.

RESULTS:

370 of 1084 patients chose the physician-led group in 2014, compared to only 260 of 1064 in 2013 (P < 0.0005), when other care options included CNM and maternal-fetal medicine care. 113 more births were attributed to the Pods, with a total increase of only 48 prenatal visits. The median number of visits per pregnancy decreased, while quality remained excellent and unchanged by standard obstetric measures. Provider continuity with patients improved, and we observed a three-fold increase in the number of patients presenting for postpartum care. Generalist Ob/Gyn physicians also assumed care of more high risk patients under the model.

CONCLUSION:

The PodCare model is popular with patients, shows promise for improved value by decreasing visits while improving provider continuity and postpartum care, and by providing a robust experience in interprofessional education for residents. Future innovations may include incorporation of formal telehealth visits and biometric sensor data.
Improving Transfer of Patient Care Information Between OBGYNs and Pathology Department [23E]
Authors: Day Robert , Lambert Joelle , Lee Kimberly L.
Published: May 2017

INTRODUCTION:

The greatest number of medical errors occurs at the time of transfer of patient information. This performance improvement project seeks to improve patient safety by improving the communication between obstetricians/gynecologists and pathologists at single tertiary care facility. Ensuring no errors in the surgical pathology forms ensures that patients receive appropriate and timely pathologic evaluation.

METHODS:

A multidisciplinary team of clinicians and leaders from multiple departments developed educational materials for physician and staff handling pathological specimens, provided individual and group feedback and optimized pathology forms to decrease the amount of errors in communication as pathologic specimens change hands. The number of pathology form errors was identified at the end of every quarter from 2014 to 2016 at Kaiser Permanente Santa Clara.

RESULTS:

Prior to implementation of this project 11 errors were found in a single quarter. Following the implementation of this project, there was a 68% decrease in yearly pathology form errors. This included a steadily quarterly decline that contained 4 quarters without any errors. There was one outlier in the first quarter of 2015 which contained 6 errors.

CONCLUSION:

This project demonstrates that communication between different departments, educational training, directed feedback and optimization of pathology forms can decrease the amount of errors in transfer of patient care information, leading to improved patient care and safety.
Considering Closed Incision Negative Pressure Therapy for Obese Patients with Gynecologic Malignancies [31E]
Authors: Sims Travis , Palavalli Parsons Lavanya H. , Miller David S. , Lea Jayanthi , Carlson Matthew
Published: May 2017

INTRODUCTION:

In patients with major comorbidities undergoing complex gynecologic surgery, incision management is critical. This retrospective review examined factors associated with incisional complications in patients with multiple comorbidities who underwent laparotomy by the Division of Gynecologic Oncology at our institution.

METHODS:

A retrospective chart review was performed to identify patients who underwent laparotomy for either complex benign gynecologic procedures or gynecologic malignancies from 2013 to July 2016. Descriptive statistics were computed using Fishers Exact Test.

RESULTS:

217 patients were identified who underwent laparotomy; 144 had a gynecologic malignancy and 73 were benign. 42 had a negative pressure VAC system placed. 14 patients with postoperative wound complications were identified. Various risk factors, including body mass index (BMI), age, smoking, diabetes, coronary artery disease, hypertension, cancer, and blood transfusion were examined. Only obesity (BMI greater than 30) was significantly associated with wound complication (p = 0.02; OR 4.3; 95% CI 1.28-14.81). However, only 3 out of the 14 patients that had wound infections had a negative pressure VAC. The average BMI for patients with a negative pressure VAC that did not develop a wound complication was 37.6 plus or minus 9.5, however it was 46.8 plus or minus 11.6 (P less than 0.0001) for those that did.

CONCLUSION:

Obese patients have a higher risk for postsurgical wound complications. Negative pressure VAC therapy could be a preventative measure for obese patients with gynecologic malignancies undergoing laparotomy. Further study is warranted to determine whether closed incision negative pressure therapy reduces the rate of wound complications.
Accuracy of Robotic Cytoreduction Estimates for Ovarian Epithelial Malignancies [33E]
Authors: Geisler John , Manahan Kelly
Published: May 2017

INTRODUCTION:

Robotic surgery has become the standard for surgical treatment of early cervical and endometrial carcinomas. The purpose was to determine if robotic cytoreduction estimates are accurate.

METHODS:

All patients with stage IIIc or IV ovarian carcinoma who presented for second opinions after primary surgery was performed robotically were offered a laparotomy and attempt at complete cytoreduction within 6 weeks of initial surgery.

RESULTS:

Nineteen patients met the inclusion criteria. The median age was 51 years (mean 51.4, 95% CI 47.3-55.5). Thirteen patients were said to have no residual disease while 6 patients were declared optimally cytoreduced after robotic debulking. Significant differences in cytoreduction were found in 15 of 19 patients at time of laparotomy (P=0.028). All 13 (complete cytoreduction) patients were found to have residual disease with 9 of them having disease greater than >1 cm and four of them with disease < 1 cm. Of the six patients optimally robotically debulked, four had disease < 1 cm and two had gross disease >1 cm. In all 19, complete cytoreduction was attained. Fifteen patients had residual disease after robotic debulking in the upper abdomen (diaphragm, liver, infragastric omentum), thirteen had residual disease on bowel mesentery or surface, and nine had residual disease in the pelvis. The median hospital stay was 3 days (mean 3.53, 95% CI 3.02-4.04).

CONCLUSION:

It appears to be very difficult to accurately access the level of cytoreduction at time of robotic surgery. Open cytoreduction can achieve no visible or palpable residual disease after a robotic surgery.
Blood Gas Analysis Utility Predicting Multiple Organ Dysfunction Syndrome in Obstetric Patients [38E]
Authors: Eliana Montoya , Carrizosa Jorge , Castro Alejandro , Sanchez Alexander , Nino Reinaldo
Published: May 2017

INTRODUCTION:

Every day, 800 women die for pregnancy causes around the world, 99% of those in developing countries. The multiple organ dysfunction syndrome (MODS) occurs in 15% of patients in critical care, with a related mortality up to 80%. Some values of arterial blood gas (ABG) analysis has been proposed in few publications in obstetric patients and its relationship with bad outcomes.

METHODS:

The aim of this study was to describe blood gas thresholds as a risk to develop MODS in obstetric patients. A retrospective case-control study was conducted in four hospitals of Bogota, Colombia, between 2008 and 2014. Logistic regression analysis was conducted.

RESULTS:

We collected information form 277 cases and 558 controls, of them, 84.9% was pregnant and 15.1% in the puerperium. The mean age was 27.8 years old (SD 7.3), the main diagnosis were hypertensive disorders (52.4%), bleeding (12.2%) and sepsis (12.2%). 490 patients had at least one ABG test, pH, PO2, PCO2, lactate and base deficit were measured. A multivariate analysis was performed, with strata by every main diagnosis as mentioned before. Association with MODS was found in lactate higher than 1.2 mmol/L (OR 2.2 95%CI 1.5-3.4, p < 0.000) and pH less than 7.35 (OR 5.2 95%CI 2.6-10.6, p < 0.000) for patients with preeclampsia; for hemorrhage a base deficit 9 (OR 2.0 95%CI 1.2-3.3, p < 0.006) was founded. There was no association with sepsis founded.

CONCLUSION:

Patients with MODS and preeclampsia the better ABG predictors were lactate and pH values, and for patients with hemorrhage, base deficit was identified. Prospective studies are needed.
Impact on Decisional Quality With Implementation of a Shared Decision Aid for Contraceptive Choice [2F]
Authors: Sridhar Aparna , Lambrechts Sylvia , Kwan Lorna , Munnangi Meghana , Abutouk Mona , Saigal Christopher
Published: May 2017

INTRODUCTION:

The best contraceptive choice for a woman is one that takes into consideration their personal preferences and contraceptive needs. Shared decision aids have helped patients to identify the choice that likely best matches their needs.

METHODS:

A quality improvement project is being conducted at University of California Los Angeles. Patients were sent a web-based educational decision aid via an online patient portal prior to their appointment. We compared their decision quality, level of familiarity with various contraceptive options, satisfaction with decision, decisional conflict, shared decision making, health literacy and patient experience with a group of patients that did not receive the decision aid.

RESULTS:

A higher proportion of women that received the decision aid were interested in highly effective contraceptives such as intrauterine devices (20% versus 10%, p=0.0849) and a lower proportion were interested in less effective methods such as condoms (7% versus 23%, p=0.0055) compared to women not receiving the decision aid. Participants with low decisional quality (SURE=0-3) reported more decisional conflict than those with high decisional quality (SURE=4), regardless of whether or not they received the educational content (1.67 vs 1.23, p=0.0079; 1.88 vs 1.23, p=0.0002, respectively).

CONCLUSION:

Patient education aids offer patients information about contraceptive options, which may impact their contraceptive preferences. The quality improvement project is ongoing and we will collect more data to assess the effect of shared decision aid on the decisional quality and conflict. We plan to perform qualitative studies to further understand the factors affecting decisional quality.
Patient Preferences About Immediate Postpartum Long-Acting Reversible Contraception: A Qualitative Study [10F]
Authors: Soliman Ann , Dalton Vanessa , Moniz Michelle
Published: May 2017

INTRODUCTION:

To acquire in-depth understanding about patient preferences regarding the timing of long-acting reversible contraceptive (LARC) insertion after childbirth.

METHODS:

We conducted semi-structured interviews with pregnant women planning to use LARC postpartum (n=5). Participants watched a standardized video explaining LARC insertion timing options. Interviews were audio recorded, transcribed verbatim, and coded by two authors (AAS, MHM) using qualitative content analysis.

RESULTS:

Interviewees identified a variety of personal preferences for timing of LARC insertion. Cited reasons for preferring immediate postpartum insertion (n=3 women) included strong desire to prevent rapid repeat pregnancy, wanting to initiate contraception prior to being occupied with a new baby, and ability to address potential issues with their LARC device at the postpartum visit. Women (n=2) preferring outpatient insertion reported wanting to let the body recuperate after childbirth before initiating contraception and concern about expulsion and potential risks to breastfeeding with immediate insertion. Regardless of personal preferences for timing of insertion, all interviewees supported making immediate postpartum insertion available to women. Participants reported enthusiasm for discussing contraceptive options with any provider at any time during their prenatal care visits and expressed an affinity for receiving information via in-person conversations and visual formats (e.g. video, pamphlets) that could be shared with a partner.

CONCLUSION:

Our findings suggest that pregnant women have a range of preferences regarding timing of postpartum LARC insertion and support making immediate postpartum insertion available to women who desire it. Enhancing access to this service may align with women’s contraceptive preferences and enhance their ability to meet their reproductive goals.
Attitudes and Barriers to LARC Use in a Young Adult Population in Florida [11F]
Authors: Schickler Robyn , Holmstrom Shelly , Pargas Anaisy , Nandyala Arathi
Published: May 2017

INTRODUCTION:

In 2011, the unintended pregnancy rate decreased from 51% in 2008 to 45%. Of women using contraception, 7.2% were using a LARC in 2011-2013 as compared to 1.5% in 2002. Increasing LARC use decreases unintended pregnancies, however, data are lacking regarding barriers to the uptake of this contraception. The purpose of this study was to identify the barriers to adoption of LARC in a young adult population in Florida.

METHODS:

This project is a computer-based survey of females aged 18 to 30 at our institution’s satellite clinics. Survey questions address age, race, education level, insurance, income, obstetric and sexual history, and contraceptive use, knowledge about efficacy, safety, and misperceptions of intrauterine contraception.

RESULTS:

We found that 5.3% of the participants use an IUD and 57.9% use no method of contraception. One third of patients answered correctly about the failure rate of “typical use” of a LARC, and 40% of patients answered correctly the failure rate in “perfect use” of a LARC. About half of patients believed the IUD increases risk of pelvic inflammatory disease, and 40.9% believed that it causes infertility. Moreover, we found that patients are most influenced by their gynecologist regarding contraceptive options.

CONCLUSION:

Based on these findings, education is likely the main barrier to uptake of a LARC method. Gynecologists play a key role in providing contraceptive counseling and education to our patients, and should make this education part of every visit with our patients to provide them the most comprehensive care possible.
Oral Contraceptives. Is It Time for Over-the-Counter Access? [13F]
Authors: Fedorova Ekaterina , Feldman Scott
Published: May 2017

INTRODUCTION:

A prescription-only requirement to dispense oral contraceptive pills is a major contributor to a high percent of unintended pregnancies. It is hypothesized that removing a prescription-only requirement for oral contraceptives would decrease the rates of unintended pregnancies without adverse effects on patient health.

METHODS:

This review has been conducted based on the analysis of data collected across studies obtained from PubMed. Articles were excluded on the basis of content found in its abstracts and full text versions. Specifically, articles that studied attitudes or views of physicians, pharmacists and women in regards to over-the-counter and behind-the-counter availability of OCPs were included. Studies on safety that analyzed patients’ ability to self-screen for contraindications were also evaluated.

RESULTS:

Patients who receive oral contraceptive pills (OCPs) without a prescription have higher rates of compliance than those who receive drugs with a physician’s prescription. While drug safety remains of a concern, implementation of self-screening checklist can be utilized as a solution. Screening by pharmacists is needed during the initial phase of OCPs transition towards over-the-counter availability. Appropriate training must be provided to pharmacists to ensure consistent quality services provided to patients. Data has shown that patients would continue to receive regular gynecologic examinations regardless of how OCPs were obtained.

CONCLUSION:

Evidence from countries where OCPs are available over-the-counter or behind-the-counter provides examples of numerous benefits, favoring uninsured and low-income females. This paper concludes that making OCPs should be made available without a prescription and that it would decrease the rates of unintended pregnancies.
Knowledge, Attitudes, & Practice of Long-Acting Reversible Contraception Among Women Experiencing Homelessness [22F]
Authors: Douglass K. Marie , McKean Rachel , Van Dommelen Kaylee , Meshbane Karyn , Poquette Amelia , Curry Christine
Published: May 2017

INTRODUCTION:

Homeless women are a vulnerable patient population at increased risk for unintended pregnancy and face unique barriers to obtaining contraception. With failure rates of less than 1%, long-acting reversible contraceptives (LARC) have shown to be effective for reducing unplanned pregnancy rates. This study evaluates attitudes toward pregnancy and contraception among this demographic.

METHODS:

52 women at the Lotus House Shelter in Miami were surveyed using an adapted version of the validated “National Campaign to Prevent Teen & Unplanned Pregnancy.” We conducted a focus group with 14 women to better understand attitudes towards contraception.

RESULTS:

The majority of survey respondents had previously been pregnant, with 81% experiencing an unintended pregnancy in their lifetime. Nearly 60% wanted to delay future pregnancies for at least 3 years or avoid pregnancy entirely. 89% had received a sex education class, yet less than half covered the importance of contraception or available methods. Levels of LARC utilization were low (4%), and the survey revealed a deficit in knowledge accompanied by a desire to learn more and potentially utilize this contraceptive method. From the focus groups, themes relating to factors affecting contraceptive use and side effects were the most common.

CONCLUSION:

Participants demonstrated high rates of unintended pregnancy and desire to avoid pregnancy for an extended period of time. Women experiencing homelessness may be excellent candidates for LARC. This data will be used in the development of a contraception intervention to address the unique healthcare needs and potentially alleviate the burden of unintended pregnancy in this population.
Pregnancy After Periviable Birth: Making the Case for Postpartum and Interpregnancy Care [27F]
Authors: Vani Kavita , Wolfe Nancy M. , Facco Francesca , Himes Katherine
Published: May 2017

INTRODUCTION:

Women with a history of a periviable birth are at risk for recurrent preterm delivery. We sought to determine postpartum follow up rates, interpregnancy intervals (IPI) and uptake of 17OHPC in women with prior periviable preterm births.

METHODS:

We used data from the Magee Obstetrical Medical and Infant Database from 2008-2014 to identify women with a periviable birth of a singleton gestation due to spontaneous preterm labor or PPROM between 20 and 26 weeks gestation. Chart abstraction was performed for women who had a subsequent delivery at our institution by the end of 2015.

RESULTS:

Of the 361 spontaneous periviable births at our institution, 63 (17.4%) women had a subsequent delivery. The rates of recurrent preterm birth (less than 34 weeks) and recurrent periviable birth were 27% and 12.7% respectively. 42.9% of women had an IPI of less than 12 months and only 55.8% of women returned for a postpartum visit (PPV) after their periviable delivery. In the subsequent pregnancy, 20.6% of women did not receive 17OHPC, most commonly because of late presentation to care. Women who did not return for their PPV were less likely to receive 17OHPC in the next pregnancy (57.1% vs 94.1%, p=0.001).

CONCLUSION:

Non-compliance with the PPV and short IPI were common in women with a prior periviable delivery. Compliance with the PPV was associated with higher rates of 17OHPC administration in the next pregnancy. These data suggest that strategies should be developed to improve postpartum care and counseling regarding risk reduction for women with a periviable birth.
Pregnancy Patterns of Exercise and Physical Activity [35F]
Authors: Moore Iris , Johnson Amy , Mason Mikayla , O'Sullivan David
Published: May 2017

INTRODUCTION:

Despite the numerous health benefits and approved recommendations from the American College of Obstetricians and Gynecologists, a significant portion of women do not participate in exercise during pregnancy. The aim of this study was to examine exercise habits during pregnancy, the health effects and potential benefits on the mother and baby, and the levels of counseling mothers received from their healthcare professionals.

METHODS:

A questionnaire was distributed to women postpartum that queried if patients had discussed exercise with their obstetrical provider, exercise participation prior to and during pregnancy and potential barriers to exercise.

RESULTS:

A total of 101 patients were surveyed and 70.6% of patients who exercised in the first trimester continued to exercise in the third trimester. Of those who reported a lack of exercise in the first trimester (n=27), 44% (n=12) went on to exercise during the third trimester. There was a statistically significant difference in the average weight gained by the third trimester between women who exercised and those who did not (30.5 vs. 37.2 lbs., resp.; p=0.02). There was no difference in newborn birth weight. 69.1% (n=66) of women reported receiving exercise counseling from their healthcare provider. Women who received counseling reported a higher rate of compliance with exercise (77% vs. 51.7%, p= 0.028) vs. those who did not receive counseling.

CONCLUSION:

Women who exercise benefit from gaining less weight during pregnancy with no negative effects on newborn birth weight. Exercise counseling was associated with an increase in exercise compliance.
The Effects of RF Excited Fractional CO2 Laser on the Vaginal Canal in Treating Stress Urinary Incontinence [2G]
Authors: Patel Falguni
Published: May 2017

INTRODUCTION:

Stress Urinary Incontinence (SUI) affects 15 million American women. The causes of SUI include pregnancy, childbirth, obesity, menopause and chronic coughing. The current treatment options include Kegels, bio-feedback stimulation, bulking agents, pessary and surgical correction. Recently laser treatments have been reported as a treatment option.

METHODS:

Women suffering from SUI as evaluated by questionnaire, pelvic exam and urodynamic studies showing maximal urethral closure pressure (UCP) of less than 40 cm H2O, were enrolled in the study. Subjects received three fractional CO2 laser treatments four weeks apart. CO2 laser energy in deep mode at 50 mJ at 5% fractional density was delivered in the vaginal canal. The second pass of the laser was done at 1 and 11 o’clock. Subjects were then reevaluated at one month and three months post treatment, using a questionnaire for incontinence and a urodynamic evaluation to determine max UCP.

RESULTS:

Twenty women between the ages of 31 and 69 enrolled in the study, tolerated the treatments well. The subjects reported minimal to no treatment discomfort and no adverse events. At one month post treatment of the series, reported in 100% correction of SUI based on the questionnaire. The subset of subjects who completed three months post treatment underwent urodynamic reevaluation showed an increase in maximal UCP from 19 to 33 cm H2O pretreatment to 45-73 cm H2O.

CONCLUSION:

This study shows fractional CO2 laser is a safe and effective treatment and may be an option for the improvement of SUI which would have an impact on the quality of life.