bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational Modalities for Teaching Surgical Techniques for Obstetric Anal Sphincter Injuries: A Randomized Trial [09G]
Authors: Jackson Lindsey , Byrne John J. , Lupo Andrew , Florian-Rodriguez Maria , Wai Clifford , Balgobin Sunil 
Published: April 2020

INTRODUCTION:
Decreasing rates of obstetrical anal sphincter injuries (OASIS) has posed challenges for the clinical training of residents in repairing this highly morbid injury. The aim of this study is to compare an OASIS repair model to an educational video for resident education.

METHODS:
IRB Exemption was obtained. OB/GYN residents completed a baseline questionnaire and written knowledge test evaluating OASIS epidemiology, anatomy, complications, and surgical technique. In addition, they performed a baseline graded hands-on repair with a beef tongue model using a validated objective structured assessment of technical skills (OSATS). Subjects were randomized to either viewing an OASIS educational video (“video”) or attending a workshop using a synthetic anal sphincter trainer model (“model”). 6-10 weeks later, post-intervention knowledge and practical assessments were completed.

RESULTS:
53 residents (n=28 “video,” n=25 “model”) participated in the study. There were no pre-intervention differences in knowledge or skill scores between groups. Mean±SD knowledge and skill scores improved from baseline regardless of intervention (Model knowledge 6±2 vs 8±2, P=.01, skill 14±3 vs 18±1, P<.01; Video knowledge 6±1 vs 8±2, P=.03, skill -14±2 vs 16±1, P<.01). The “model” group had greater improvement in skill level than the “video” group (18±1 vs 16±1, P<.01). By training level, all but the PGY-4 class significantly improved (P<.05). 100% of residents in model group and 92% in video group believed the intervention to be very educational.

CONCLUSION:
Although both educational modalities improve OASIS knowledge and skills, the model is more effective at improving technical skills.
Effectiveness of ABOG’s Article-Based Questions on Diplomates’ Retention of Knowledge [10G]
Authors: Novak Amanda R. , Shivraj Pooja R. , Ramin Susan R. 
Published: April 2020

INTRODUCTION:
As part of continuing certification, the American Board of Obstetrics and Gynecology (ABOG) diplomates complete article-based assessments annually. Diplomates read articles, respond to article questions, and must score above a certain threshold to demonstrate competence in their understanding. There is a paucity of evidence that diplomates retain the information after reading articles. The study objective was to evaluate the effectiveness of the two question types (understanding and application) at measuring diplomates’ retention of knowledge over time.

METHODS:
A sample of 344 diplomates who chose selected articles between January-March 2019 volunteered for the study. Diplomates completed article questions in a business-as-usual setting (with article access) and were assessed again during summer 2019 (without article access). Each participant received 2 questions (one of each type) from 5 of the selected articles, for a total of 10 questions. The timed summer assessment was used as a proxy for retention. Diplomates’ scores, by item type, from each assessment setting were compared using a t-test to determine whether information was retained from the articles.

RESULTS:
The information assessed by application items was retained at a significantly higher rate (80.58%) than understanding items (60.75%), as demonstrated by mean scores on the assessment (P<.05).

CONCLUSION:
Application items yielded a higher knowledge retention rate. Understanding items ensure diplomates comprehend the article while application questions ensure diplomates can generalize and apply their understanding from the article. A combination of both item types for article-based assessments is necessary and this study demonstrates that diplomates retain the information they read from articles.
Evaluation of a Novel Pediatric & Adolescent Gynecology Sub-Internship for Medical Students [12G]
Authors: Solotke Michael T. , Crabtree Janice A. , Encandela John , Vash-Margita Alla 
Published: April 2020

INTRODUCTION:
Although Pediatric and Adolescent Gynecology (PAG) is an important and growing field, training opportunities are limited, especially at the medical school level. To address this gap, we developed a PAG sub-internship and elective course for medical students. Our course represents the fourth PAG sub-internship available in North American medical schools; by contrast, other available sub-internships include 113 in Maternal Fetal Medicine and 82 in Gynecologic Oncology.

METHODS:
Our four-week PAG sub-internship and two-week elective include a multi-pronged evaluation system with three components: a written test taken on the first and last day of the sub-internship, direct observation and evaluation of clinical skills using the Entrustable Professional Activities (EPAs) framework, and a 360-degree feedback system allowing students to provide anonymous feedback regarding the sub-internship.

RESULTS:
In the first year of our sub-internship, seven students applied and five students enrolled; in the second year, eight students have applied. Mean overall EPA entrustability scores were 2.3 and 3.7 on the first and final day of the sub-internship, respectively. Preliminary evaluation data showed a mean score of 5.0 (strongly agree) for the evaluation question “Were you satisfied with the clinical teaching in this elective/sub-internship?” Excerpts from the written feedback provided via anonymous evaluations included “This elective provided an excellent cross-section between pediatrics and gynecology.”

CONCLUSION:
We have developed, implemented, and evaluated a PAG sub-internship for medical students. We share our evaluation data to demonstrate the value of such training opportunities and help other institutions who wish to create a PAG sub-internship.
Follow Up of Newborns Exposed to Paclitaxel in Utero Evident by Metabolites in First Meconium Sample [28H]
Authors: Cardonick Elyce , Akoto Serwaa , Doan Mary , Xu Peining J. , Snyder Nathaniel , Broadrup Robert 
Published: April 2020

INTRODUCTION:
Paclitaxel is excluded from breast cancer treatment during pregnancy due to limited neonatal follow up. We confirmed fetal paclitaxel exposure by detection of chemotherapeutics in the first newborn meconium. Birth details and follow up of these newborns are reported.

METHODS:
Women receiving chemotherapy during pregnancy consented to submit their newborns’ initial meconium. Liquid chromatography-high resolution mass spectrometry screened for chemotherapeutics, while blinded to maternal treatment. Medical record review and questionnaires completed by obstetricians and pediatricians provided newborn details. The institutional review board approved of this study.

RESULTS:
Mean gestational age (GA) at first taxane was 27.0 +/- 5.8 weeks, following anthracycline based treatment for breast cancer. Paclitaxel and metabolites were identified in meconium of all exposed newborns. Birthweight was less than ten percent in three infants. Three congenital anomalies: hip dysplasia (breech presentation); mitral valve stenosis; Cleidocranial Dysostosis. Mean age at follow up 13.2.5 + 5.5 months, ranges from 6 to 25 months. Pediatricians report treatment for eczema, recurrent otitis media, iron deficiency anemia and sinusitis. One child, not initially born with growth restriction is less than ten percent for height and weight at 15 months of age. However, all children are meeting developmental milestones.

CONCLUSION:
Detection of taxane or metabolites was not significantly related to GA at first taxane, GA at delivery, number of taxane cycles, birthweight, or days between last taxane and birth. Despite in utero fetal exposure to taxane, all are meeting milestones at a median age of 19 months.
Site of Prenatal Care Impacts Aspirin Prophylaxis for Preeclampsia Prevention [29C]
Authors: Ragunanthan Nina , Lamb Jordan , Hauspurg Alisse , Beck Stacy 
Published: April 2020

INTRODUCTION:
Low-dose aspirin prophylaxis is recommended for preeclampsia prevention among high-risk women, but not all eligible women receive it. We investigated whether site of prenatal care impacts rates of aspirin prophylaxis among a cohort of women with chronic hypertension (cHTN).

METHODS:
This is a single institution, retrospective cohort study of women with cHTN who delivered between 2016–2018. Women with no prenatal care or care outside the hospital system were excluded (n=196). Medical records were reviewed to determine prenatal care site and to assess counseling and prescription of aspirin. Demographic and obstetric outcomes were compared by prenatal care site in univariate analysis. Multivariable logistic regression analysis was performed with adjustment for race, blood pressure and gestational age at first prenatal visit.

RESULTS:
We included 870 women. 126 (14.5%) had prenatal care in a hospital-based academic practice, 280 (32.2%) in a resident clinic, 303 (34.8%) in private practice, 76 (8.7%) in Maternal-Fetal Medicine (MFM) practice and 85 (9.8%) in a midwife or family practice. There were no differences in blood pressure or gestational age at first prenatal visit. Overall 64.6% of women were counseled or prescribed aspirin. Rates differed by prenatal care site (P<.001) ranging from 44.4% (academic practice) to 92.1% (MFM practice). Counseling rates were 70.4% in resident clinic, 58.1% in private practice, 72.9% in midwife/family practice. Differences in counseling persisted in multivariable models.

CONCLUSION:
In a cohort of women at high-risk for preeclampsia, aspirin counseling was not universal and rates varied by prenatal care site, which is an area for quality improvement.
A Novel Surgical Technique for Placenta Accreta Spectrum: Comparisons of Intra- and Post-operative Outcomes [01N]
Authors: Cojocaru Liviu , Shannon Allison , Desai Andrea , Goetzinger Katherine , Turan Ozhan 
Published: April 2020

INTRODUCTION:
A novel surgical technique to reduce blood loss during cesarean hysterectomy (Chyst) for placenta accreta spectrum disorder (PAS) was previously described (LC-VSS: hysterotomy using linear cutter and dissection of the bladder using vessel sealing system before clamping uterine arteries). We hypothesized that LC-VSS reduces intra- and post-operative complications.

METHODS:
After IRB approval, PAS cases from 2014 to 2019 were reviewed. Gravid hysterectomy, interval hysterectomy and focal resection were excluded. Data collected includes patient demographics, estimated blood loss (EBL), number of intra-operative blood products, massive transfusion, organ injuries and post-operative complications (intensive care unit (ICU) admission, re-laparotomy, hospital stay). Chyst without using LC-VSS was marked as control. Impact of LC-VSS was analyzed using univariate analysis. Predictors for transfusion of more than 4 packed red blood cells (PRBCs) were assessed using regression analysis including pathology (accreta-increta vs percreta), surgical technique and urgency.

RESULTS:
Of 59 cases, LC-VSS was used in 39 cases (66%). EBL was significantly lower in LC-VSS cases compared to controls (1200 vs 3330 ml, P=.0001) as well as the number of PRBCs and fresh frozen plasma transfused (0 vs. 4, P<.0001, and 0 vs 2, P=.0007, respectively). The number of massive transfusions was lower in LC-VSS cases (1 vs. 7, P=.002). Need for re-laparotomy was lower in LC-VSS patients (0 vs. 20%, P=.01). Median hospital stay was similar between groups. LC-VSS was the only predictor of blood transfusion less than 4 units of PRBCs (P=.004).

CONCLUSION:
Use of this novel surgical technique (LC-VSS) during Chyst for PAS improves intra- and post-operative outcomes.
Adherence to a Vaginal Breech Protocol and Success of Vaginal Breech Delivery [03N]
Authors: Marko Kathryn I. , Abbasi Annam , Halaseh Rami , Sparks Andrew , Madkour Amr 
Published: April 2020

INTRODUCTION:
At the George Washington University, we have established a Vaginal Breech Initiative (VBI) to increase access to, and training in, vaginal breech delivery as a component of a cesarean prevention strategy. The VBI is a collaborative team consisting of physicians and nurse midwives using strict antepartum and intrapartum guidelines to facilitate safe and successful vaginal breech delivery. The purpose of this study was to examine adherence to our protocol.

METHODS:
We performed a retrospective chart review of all women undergoing a breech trial of labor between 8/2011 and 6/2019. Our primary outcome measure was adherence to protocol. Women were considered adherent if they had an EFW 2500–3800 g, gestational age of 34–42 weeks, singleton pregnancy, frank or complete breech, and had appropriate breech counseling. Our secondary outcome was successful breech vaginal delivery and adverse maternal/fetal outcomes.

RESULTS:
Of all women undergoing a breech trial of labor (n=63), 47 adhered to our protocol (74.6%). Of those, 37/47 (78.7%) had a successful breech delivery. Of the patients who underwent a breech trial out-of-protocol (n=16), 12/16 (75%) had a successful breech delivery (P=.74). Overall, we had an 77.8% vaginal breech success rate. When in-protocol women were compared with those out-of-protocol, there were no statistically significant adverse maternal/fetal outcomes.

CONCLUSION:
While we adhered to our established protocol in 74.6% of women undergoing a breech trial of labor, we found this did not correlate to successful breech delivery. We will continue to examine our protocol and identify which components are most highly correlated with vaginal breech success and safety.
Timing of Delivery in Intrahepatic Cholestasis of Pregnancy With Total Bile Acids 40–99 µmol/L: A Decision Analysis [39N]
Authors: Frank Zoe C. , Nienow-Birch Mary N. , Lo Jamie , Shaffer Brian L. , Caughey Aaron B. 
Published: April 2020

INTRODUCTION:
Our study models the trade-off between preterm neonatal morbidity and stillbirth for women with intrahepatic cholestasis of pregnancy (ICP) with total bile acids (TBA) between 40 and 99 µmol/L in order to determine the optimal gestational age for delivery.

METHODS:
A decision analytic model was created to compare the outcomes of delivery at 33 through 40 weeks gestation in women with TBA between 40 and 99 µmol/L. Baseline morbidity and mortality risks were derived from the literature and adjusted where appropriate for peak TBA and administration of antenatal steroids. We assumed a population of 10,000 women with ICP and calculated total quality-adjusted life years (QALYs) for each strategy, taking into account both maternal and neonatal perspectives. Univariate sensitivity analysis was performed for all variables to test the robustness of the model.

RESULTS:
In women with TBA between 40 and 99 µmol/L, delivery at 39 weeks maximized QALYs, resulting in 700.6 more QALYs but 5.3 more stillbirths than delivery at 36 weeks. Sensitivity analysis demonstrated that delivery at 38 weeks became optimal when the relative risk of stillbirth given TBA between 40 and 99 µmol/L rose from a baseline of 1.00 to 4.91. Monte Carlo analysis demonstrated that when variation was incorporated into the model, delivery at 39 weeks was optimal 38% of the time and delivery at 38 weeks 25% of the time.

CONCLUSION:
In women with ICP with TBA between 40 and 99 µmol/L, delivery between 38 and 39 weeks may be optimal.
Obstetric and Cardiac Outcomes of Pregnant Women With Congenital Heart Disease by Functional Class [25N]
Authors: Steiner Jill , Lokken Erica , Buber Yonatan , Albright Catherine 
Published: April 2020

INTRODUCTION:
Women with adult congenital heart disease (ACHD) are at risk for adverse outcomes during pregnancy. There are limited data on type and extent of adverse outcomes given the small population size and lack of centralized health data.

METHODS:
We conducted a retrospective cohort study of women with ACHD who received obstetric care at the University of Washington between 2010 and 2018 using medical record review.

RESULTS:
We identified 169 women who contributed 232 pregnancies (mean age at first pregnancy 29±5.7 years; median number total pregnancies 2, range 1–13). Most women had moderate ACHD lesions (70%); 38% were ACHD functional class C/D, and 20% were WHO pregnancy class III/IV. There were 3 induced abortions related to maternal cardiac disease and 15 miscarriages; no maternal deaths. Of 212 continuing pregnancies, 18% were preterm birth <37 weeks, 45% were cesarean deliveries, 7% had intrauterine growth restriction, and 2% were small for gestational age. There were 2 neonatal deaths. 23% of women did not have concurrent ACHD care. Hospitalizations for cardiac reasons occurred for 22% of pregnancies. Women experienced arrhythmias with 12% of pregnancies, heart failure with 3%, and 1 woman had a stroke. Combined cardiac outcome varied by functional class (OR for class C/D 8.10, 95% CI 1.01–64.68) but not ACHD lesion or WHO risk. Key obstetric outcomes (preterm birth, cesarean delivery, IUGR) did not vary by ACHD predictors.

CONCLUSION:
Maternal and fetal health outcomes were generally favorable. Preterm delivery and hospitalization rates were high. ACHD functional class may predict adverse events.
Obstetric Outcomes in Pregnancies Complicated by Prior Renal Transplant or Chronic Kidney Disease [26N]
Authors: Morgan Jessica C. , DiGiovanni Laura M. , Della Torre Micaela 
Published: April 2020

INTRODUCTION:
Compare antepartum admissions and outcomes in pregnancies complicated by renal transplant (RT) versus chronic kidney disease (CKD).

METHODS:
Retrospective cohort study at University of Illinois at Chicago from 2010 to 2019. Electronic medical record queried for women age 18 to 51 with pregnancy, RT or CKD. SPSS used for statistical analysis. IRB approval was obtained.

RESULTS:
577 charts reviewed, 57 pregnancies complicated by RT or CKD. Of 33 women with RT, 20 had live births, 11 miscarried, 2 had elective terminations. Of 24 women with CKD, 14 had live births, 6 miscarried, 2 had ectopic pregnancies, 2 had elective terminations. Average time from RT to pregnancy was 7.45 years. Subjects with CKD had higher rates of preterm delivery and hypertensive disorders of pregnancy. No difference in rate of cesarean delivery (CD) between groups. Gestational age (GA) at delivery lower in women with CKD than RT, 31 vs 34 weeks. Rate of antepartum admission not statistically significant between groups. Subjects with RT admitted for obstetric complications compared to women with CKD admitted for worsening medical problems. Pregnancies 1 to 3 years posttransplant had lower rates of preeclampsia and CD, and later GA at delivery (36.3 vs 34.4 weeks) compared to those greater than 3 years posttransplant.

CONCLUSION:
Women with RT are not admitted antepartum at a higher rate than women with CKD and overall had better obstetrical outcomes. An area of further study is the ideal time between transplant and pregnancy, as we found improved obstetric outcomes in women with pregnancy closer to RT.
How Much Is Too Much? Intrapartum Interventions in a Term Singleton US Birth Cohort [19N]
Authors: Nethery Elizabeth , Painter Ian , Sitcov Kristin , Souter Vivienne 
Published: April 2020

INTRODUCTION:
Ideal rates of intrapartum interventions are unknown. Contemporary data from the US on the prevalence of these interventions is limited. The aim of this study was to evaluate rates of intervention in term singleton pregnancies.

METHODS:
This study uses a retrospective cohort of births at 17 hospitals in the Northwest US between 04/01/2017 and 03/31/2019. We report mode of delivery (cesarean with no labor/cesarean following labor/vaginal) and labor onset (spontaneous/induced). For spontaneous labors, we report rates of artificial rupture of the membranes (in those with intact membranes at admission), oxytocin augmentation, operative delivery, anesthesia (regional or general) and episiotomy. The proportion of pregnancies subject to none of these interventions was also evaluated.

RESULTS:
Of 47,770 singleton term pregnancies in this cohort, 8,485 (17.8%) had a cesarean without labor and 13,857 (29.0%) underwent induction of labor. Spontaneous labor occurred in 25,428 (53.2%) of all singleton term births. Interventions in spontaneous labor included: artificial rupture of the membranes in 63.9% (10,509/16,454) with intact membranes at admission, oxytocin augmentation in 9,227 (36.3%), cesarean birth in 2,594 (10.2%), operative vaginal birth in 1,250 (5.8%), anesthesia in 16,458 (64.7%) and episiotomy in 594 (2.3%). Only 4.6% (2,229) of all singleton term births followed spontaneous labor without any of the interventions evaluated.

CONCLUSION:
Intervention is common in this population and only 1 in 20 singleton term births occurred without any of the evaluated interventions. More research is needed into the effectiveness of obstetric interventions, particularly in spontaneous term labor.
Anticipation of Exclusive Formula Feeding Is a Risk Factor for Postpartum Depression [04O]
Authors: Smithson Sarah , Mirocha James , Horgan Rebecca , Graebe Robert , Massaro Robert , Accortt Eynav 
Published: April 2020

INTRODUCTION:
Breastfeeding may have protective effects against postpartum depression (PPD), although there is debate amongst the literature. We aimed to determine if prenatal intent to exclusively formula feed was a risk factor for higher PPD risk.

METHODS:
This is a secondary analysis of delivery data from a cohort study conducted between 8/2015–1/2016. Women were asked to report their feeding intention upon admission (prior to delivery). Women were then screened in the hospital for PPD risk using the Edinburgh Postnatal Depression Scale (EPDS), approximately 1–4 days post-delivery. Women who planned to breastfeed (either exclusively or in combination with formula) were analyzed separately from those who intended to exclusively formula feed. Fisher exact test was used to compare rates of PPD risk between groups (EPDS score ≥10 indicating moderate risk for PPD).

RESULTS:
A total of 2083 women had complete data for analysis. A total of 128 (6%) intended to formula feed only. Of these women, 4.48% screened at risk for PPD. This is significantly higher than the 1.85% at-risk rate in the group of women who anticipated they would breastfeed after delivery (P=.049). Of note, this relationship did not remain significant in multivariate analysis (including age and BMI).

CONCLUSION:
Exclusive formula feeding intention may be one of several important risk factors for moderate PPD risk. Therefore, feeding intention warrants inclusion in future PPD studies. Future studies may also investigate the association of postpartum feeding decisions with later PPD risk (e.g. 2–6 weeks).