bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Corifollitropin Alfa in a Hispanic Cohort After Previously Failed Traditional Ovarian Stimulation Cycle [32A]
Authors: Colin Alinne , Barroso Gerardo , Avila Rosaura , Valdespin Carlos 
Published: April 2020

INTRODUCTION:
The aim was to assess reproductive outcomes of corifollitropin alfa (CA) in the same cohort of patients who had before an Intracytoplasmic sperm injection cycle with a traditional controlled ovarian stimulation (COS) protocol using daily (rFSH/uhMG).

METHODS:
Retrospective cohort; forty couples included. Traditional COS received rFSH plus uHMG. Second cycle received 100 or 150 µg of CA, in both cycles patients had antagonist protocol and fresh embryo transfer.

RESULTS:
Mean age 34 ± 4.9 years. Compared traditional COS using (rFSH/uhMG) vs CA, there was a difference in peak of estradiol (mean±SD) (1984.9±1292 vs 1099±812 pg/mL, P<.05). No significant differences founded on: progesterone level (1.3±2 vs 1±2.4), endometrial thickness (9.3±1.8 vs 9.4±1.4), mean number of oocytes retrieved (7.1 ± 4.4 and 6.6 ± 5.4), metaphase II oocytes (MII) retrieved (49.8% vs 55.8%), fertilization rate (62.6% vs 67.4%) and number of embryos transferred (1.69 vs 1.61), for (rFSH/uhMG) and CA respectively. The number of blastomeres on day 3 of embryo culture was significantly different in favor of the CA cycle (6.4 ± 1.3 vs 5.5 ± 1.2, P<.05). Positive hCG per transfer was higher on the corifollitropin cycle (6.8% vs 41.38%, P<.05).

CONCLUSION:
This study allowed us to assess the effects of CA on the same cohort of patients; results suggest that the reproductive outcomes of patients treated with CA are similar, with the advantage of having a convenient one application and lower level of estradiol. More studies are needed to determine whether CA has an impact on embryo development in certain groups of patients.
Diagnosis of Late-Onset Gestational Diabetes in the Third Trimester [34A]
Authors: Choi Jennifer , Shultz Lori , Brazee Jennifer , Orr Enaujare 
Published: April 2020

INTRODUCTION:
95% of obstetricians in the United States use the two-step approach to diagnose gestational diabetes. We hypothesized that women with normal results on routine screening in the second trimester may present with late-onset gestational diabetes. Therefore, we proposed offering women who have known complications of gestational diabetes, including LGA fetus(es) and/or polyhydramnios, screening in their third trimester.

METHODS:
The study was a retrospective case-control study. Women with third-trimester ultrasound findings of abdominal fetal circumference greater than the 95th percentile, an estimated fetal weight (EFW) greater than the 90th percentile, mild to moderate polyhydramnios (amniotic fluid index between 25–35 cm) on two different ultrasounds and/or severe polyhydramnios (amniotic fluid index greater than 35 cm) were offered the diagnostic 100-gram oral glucose tolerance test (3-hour OGTT). Data was analyzed with IBM SPSS.

RESULTS:
185 women met the ultrasound criteria for diagnostic evaluation. Among them, only 104 (56.2%) women completed both the two-step approach in their second trimester and the 3-hour OGTT in their third trimester. 27 of 104 (25.9%) who had normal screening results in their second trimester were diagnosed with late-onset gestational diabetes.

CONCLUSION:
Gestational diabetes has a significant impact on pregnancy. The study demonstrated that the two-step approach alone does not identify women with late-onset gestational diabetes. Therefore, we suggest implementation of additional screening in the third trimester. These changes may play a significant role in identifying women with late-onset gestational diabetes and decreasing fetal and maternal morbidity and mortality associated with the condition.
Unique Exposure to Ultrasound in Pre-clinical Undergraduate Medical Education [39A]
Authors: Rosen Zarah , Chan Doris , Kelly Rachel E. , Han Diane , Hollifield Lauren , Doyle Nora 
Published: April 2020

INTRODUCTION:
Purpose: Descriptive case study of pre-clinical ultrasound education at the University of Nevada, Las Vegas School of Medicine.

BACKGROUND:
Point-of-Care Ultrasound (POCUS) is increasingly valued across medical disciplines. As benefits of ultrasound are recognized, so too is the need to integrate ultrasound into undergraduate medical education (UME). Early exposure contributes to ease of use during clinical rotations. Our objective is to describe integration of POCUS before clinical immersion and how efforts were perceived.

METHODS:
58 medical students participated in a hands-on training session before initiation of clerkship duties. A brief didactic introduction for ultrasound techniques began each session. Students were divided into duos and rotated through 6 stations designed to provide training in ultrasound of the abdomen, head/neck, and cardiac. Each station consisted of a clinical scenario, ultrasound machine, standardized patient/model, and instructor. Student feedback was collected via 6-point questionnaire at the end of the session.

RESULTS:
58/58 students completed the survey, positively evaluating clinical relevance and student satisfaction. 58/58 students answered “yes” that “the session met the stated learning objectives,” 57/58 answered “yes” that “the learning environment was conducive to my acquiring new skills.” Comments were entered in an optional field with the descriptors “great” and “helpful” trending throughout feedback, indicating high student satisfaction.

CONCLUSION:
UME is changing, with new challenges to preparing students for clinical years including the incorporation of POCUS. The overwhelmingly positive feedback for our session indicates integrating POCUS as an educational tool with hands-on ultrasound practice can provide engaging and applicable skills for medical students.
Hail Mary or Russian Roulette: Provider Knowledge and Attitudes Toward the Withdrawal Method of Contraception [02B]
Authors: Jones-Linares Brittany , Patel Jasmine , Nelson Anita L. , Nguyen Brian T. 
Published: April 2020

INTRODUCTION:
Withdrawal is often perceived as an ineffective contraceptive method that is infrequently discussed by clinicians, despite frequent use and an efficacy level similar to condoms. It is also one of the few methods available to men. To address this discrepancy, we surveyed the knowledge and attitudes of women's healthcare providers about withdrawal.

METHODS:
In this IRB-approved, exempt study, surveys were distributed at four contraceptive health conferences across the United States. As part of a 16-item survey with open and close-ended questions, providers were asked about the effectiveness of withdrawal for pregnancy prevention and if and how they discussed withdrawal with their patients. Qualitative data were coded with 80% interrater reliability. Distribution frequencies and associations via chi-square tests are presented.

RESULTS:
Overall, 17.7% and 2% of respondents correctly identified typical and perfect use failure rates for withdrawal. Asked how they would respond if their patient reported withdrawal for contraception, half (55.3%) provided responses suggesting open-mindedness. Compared to other healthcare providers (such as physician assistants and nurses), physicians were more likely to endorse negative attitudes about using withdrawal (P<.01). Half (51.1%) of providers do not list withdrawal as a method choice on reproductive history intake forms; only one-third routinely ask about this method.

CONCLUSION:
Better education about withdrawal and its efficacy as a contraceptive method are needed for practitioners to recognize the importance of its inclusion in their counseling, as well as to provide their patients with the data needed to make informed contraceptive choices.
A Comparison of Sexual Reproductive Health Knowledge Between Transgender Men and Cisgender Women [04B]
Authors: Liu Ying X. , Joyner Andrea B. , McCool-Myers Megan 
Published: April 2020

INTRODUCTION:
Gynecologic care for transgender (trans) men can be emotionally challenging due to the nature of the examinations. However, it remains important and recommended, especially in individuals who have not undergone gender-affirming surgery. There are currently no published studies assessing trans men's knowledge of sexual reproductive health (SRH) and gynecologic care. This study aimed to compare SRH knowledge and gynecologic care practices of trans men and cisgender women.

METHODS:
A cross-sectional survey composed of 41-questions that addressed demographics, SRH knowledge, and gynecologic care practices was administered online using Amazon Mechanical Turk. Inclusion criteria included female assigned at birth, 18 years or older and residing in the US. Data were analyzed descriptively using SPSS.

RESULTS:
To date, 520 participants (n=167 trans men, n=353 cisgender women) have completed the survey. Preliminary analyses revealed that trans men answered less than 50% of the twenty knowledge questions correctly (mean correct responses: 48.1% vs 62.9% for cisgender women), demonstrating significantly lower baseline SRH knowledge than cisgender women [95% CI 11.35–18.43, P<.001]. More trans men expressed interest in learning about the female reproductive system than cisgender women (68.9% vs 54.4%). Additionally, trans men reported more medical visits for SRH issues than cisgender women in the last 12 months (mean visits: 4.27 vs 3.03) and were more likely to discuss SRH concerns with providers other than gynecologists.

CONCLUSION:
Trans men seem to have limited SRH knowledge but are interested in learning more about their natal reproductive organs. Providers including gynecologist should assess for knowledge gaps and engage in appropriate counseling.
A Cross Sectional Analysis of Vaginal Myomectomies [05B]
Authors: Laibangyang Anya , Ghofranian Atoosa , Gabbur Nagaraj 
Published: April 2020

INTRODUCTION:
Aborting uterine fibroids are common benign tumors of the uterus that may cause abnormal uterine bleeding and/or pelvic discomfort. Commonly these may be removed in the office or ER however, many cite heavy bleeding as a common complication and advocate that these types of myomas be removed in the OR. The purpose of this case series is to determine the demographics of aborting myomas and common complications.

METHODS:
A retrospective review of all patients from January 2018-June 2019 undergoing vaginal myomectomy at a large suburban hospital was conducted. The size and location of the leiomyomas were noted as well as any operative complications including blood loss.

RESULTS:
During this time frame, there was a total number 7739 Gyn cases done of all types. A total number of 10 patients had a vaginal myomectomy. The incidence of this type of case is 0.129%. The median blood loss was 25cc. Nine patients had a blood loss of less than 50cc. One patient with an 8cm fibroid had a 1250cc blood loss and required two units of packed red blood cells. The mean duration of the procedure was 35 minutes. The fibroid size measured via largest diameter ranged from 2 to 11 cm with a median of was 5 cm.

CONCLUSION:
In this case series, vaginal myomectomies appear to be a safe and effective method of uterine fibroid removal resulting in minimal blood loss. However it appears that for larger myomas, there should be a consideration for removal in the operating room.
An RCT of Bupivacaine Liposome Injectable Suspension for Supracervical Hysterectomies Postsurgical Analgesia [06B]
Authors: Son Mary Ann H. , Paiva Camila , Herzog David , Shamsnia Lily 
Published: April 2020

INTRODUCTION:
To demonstrate utilization of intracervical block in reducing postoperative pain for minimally invasive supracervical hysterectomy.

METHODS:
This study is a randomized double blind placebo controlled study of women who underwent minimally invasive supracervical hysterectomy between October 2018 to April 2019. The severity of pain was assessed preoperatively in the holding area, PACU arrival, 12, 24, and 48 hours postoperatively using a numeric rating scale (NRS) at rest for pain with 0=no pain and 10=worst possible pain. Secondary endpoints were number of patients who required NSAIDS and acetaminophen and break through (additional) opioid analgesic medications at 24 and 48 hours.

RESULTS:
Of the 60 participants, half were randomized into the control and intervention groups. Immediate post-operative pain scores were 1 and 1.75 (P=.89) in the control and intervention groups respectively. Follow up pain scores were 3 and 3.5 (P=.85) at 12 hours, 3.5 and 5 (P=.22) at 24 hours, and 2.75 and 4 (P=.18) at 48 hours. Secondary outcomes demonstrated 13 and 15 patients used narcotics in the control and intervention groups respectively. Within the first 24 hours, 10 patients in the control and 14 patients in the intervention group used narcotics. Between 24 to 48 hours, 6 and 8 patients in the control and intervention groups used narcotics respectively.

CONCLUSION:
There was no statistically significant difference in pain scores in the immediately postoperative, 12, 24, and 48 hour time period between the intervention and control groups.
Angiotensin-Converting-Enzyme Inhibitors Protect Against Uterine Fibroids [08B]
Authors: Fischer Nicole M. , Nieuwenhuis Tim , Singh Bhuchitra , Segars James 
Published: April 2020

INTRODUCTION:
Uterine leiomyomas are the most common benign pelvic tumor in women. Angiotensin-converting-enzyme inhibitors (ACEi) are a drug-class used for the treatment of hypertension and work by inhibiting the production of angiotensin, an enzyme that promotes blood vessel constriction and tumorigenesis. Angiotensin receptors are expressed in human uterine fibroids and blocking these receptors in animal models has been shown to inhibit leiomyoma cell proliferation. The aim of this population-based study is to examine the association between ACEi use and risk of uterine fibroids and fibroid-related symptoms.

METHODS:
This nested-case control study included women (n=5,563,980) aged 19–64 with a diagnosis of hypertension during 2010. Cases (n=1,390,995) with a uterine fibroid diagnosis were matched to controls (n=4,172,985) at a 1:3 ratio by age. A conditional logistic regression model was used to calculate odds ratios (OR) and confidence intervals (CI) correlating ACEi use with the risk of uterine fibroid development. An unconditional logistic regression was used to relate ACEi use with fibroid-related symptoms.

RESULTS:
The cohort with previous exposure to ACEi demonstrated a decreased risk of uterine fibroid development (OR 0.86, 95% CI 0.85–0.86) compared to those who were not exposed to ACEi. ACEi use was associated with lowered risk of experiencing fibroid-related symptoms like anemia (OR 0.88, 95% CI 0.88–0.89) and pelvic pain (OR 0.90, 95% CI 0.90–0.91).

CONCLUSION:
Angiotensin-converting-enzyme inhibitor use is associated with a reduced risk of the development of uterine fibroids and fibroid-related symptoms. Our findings demonstrate a potential novel therapy for uterine fibroids.
Awareness of Surgical Cost in Gynecology [09B]
Authors: Menzies Anya V. , Cochrane Elizabeth , Kim Sara , Dayton Samantha , Chappelle Joseph , Burke William 
Published: April 2020

INTRODUCTION:
With the rising cost of healthcare in the United States, recent efforts have focused on reducing healthcare spending without compromising quality and outcomes. Studies have suggested that most surgeons are unaware of the costs related to surgery. The purpose of our study was to assess provider knowledge of the cost of surgical instruments and adjuncts used during gynecologic laparoscopy.

METHODS:
After IRB approval was obtained, an anonymous survey of practicing gynecologists, OR technologists, and OR nurses at Stony Brook University Hospital was conducted. We inquired about duration of training, formal education regarding cost, self-awareness of cost, and cost estimates for 37 commonly used disposable surgical instruments and items. Similarly to previously published studies assessing cost in other surgical specialties, we defined cost estimate accuracy as within 20% of the hospital cost.

RESULTS:
A total of 104 surveys were distributed, and 29 complete responses (28%) were received. Of the participants, 17 were attendings, 3 were fellows, 6 were residents, and 3 were OR techs and nurses. On average, participant estimates were within the defined accuracy range for only 13.5% items. There were no differences in accuracy when comparing educational level, years in practice, self-perceived awareness, history of formal cost education, or whether individuals factor in cost.

CONCLUSION:
Gynecologic surgeons and trainees have poor awareness regarding the cost of the items used during laparoscopic surgery. Providing further education regarding the cost of these items may aid surgeons in making more informed choices and help reduce healthcare costs.
Chlorhexidine Versus Iodine Vaginal Preparation Prior to Hysterectomy; A Randomized Controlled Trial [11B]
Authors: Hill Austin M. , Pauls Rachel N. , Basil Jack B. , Crisp Catrina C. 
Published: April 2020

INTRODUCTION:
Currently we lack sufficient data for The American College of Obstetricians and Gynecologists to make recommendations regarding vaginal preparation solutions for hysterectomy. We designed a randomized controlled trial to compare the effectiveness of Chlorhexidine and Iodine.

METHODS:
Following Institutional Review Board approval, subjects undergoing hysterectomy via vaginal or endoscopic approach were randomized to 4% Chlorhexidine or 10% Iodine vaginal preparation. Vaginal cultures were obtained prior to preparation, then 30, 60 and 90 minutes thereafter. Primary outcome was the percent of samples with ≥5,000 bacteria (“positive culture”) at 90 minutes. Secondary outcomes included percent of samples ≥5,000 at 30 and 60 minutes, clearance of specific pathogens, postoperative complications, and surgical site infection rate.

RESULTS:
Eighty-five patients were randomized, average age 59.8 years (11.4) and median Charlson index score of 2 (0,6). Baseline percent ≥5,000 was no different (95.5% vs 100%; P=.495); 35.3% were positive for bacterial vaginosis. The Chlorhexidine group demonstrated a lower percentage of positive cultures at 90 minutes (47.6% vs 85.4%; P<.001), 30 minutes (27.3% vs 51.2%; P=.024) and 60 minutes (22.7% vs 70.7%; P<.001). Regarding specific pathogens, at 90 minutes, fewer subjects were positive for Staphylococcus in the Chlorhexidine group (5 vs 19; P=.035). There was no difference in the rate of urinary tract infection (15.9% vs 14.6%; P=.870), and no surgical site infections were documented.

CONCLUSION:
Chlorhexidine clears bacteria from the vagina more effectively and maintains a more aseptic surgical environment for 90 minutes. Gynecologic surgeons may consider switching to 4% Chlorhexidine from 10% Iodine for their vaginal preparation solution.
Clinical and Demographic Profile of Women With Endometriosis From Iberoamerica [12B]
Authors: Arroyo-Lluberas Nicolle , Rivera-Mudafort Estefania D. , Santos-Pinero Natasha B. , Hernandez Brian J. , Oliveras Jose A. , Flores Idhaliz 
Published: April 2020

INTRODUCTION:
This study was conducted to determine for the first time the demographic and clinical profile of women with endometriosis of Hispanic/Latina background, a patient population not well represented in databases and cohort studies. In order to gather standardized, comparable data we used the Clinical Questionnaire developed by the Endometriosis Phenome project (EPhect) of the World Endometriosis Research Foundation (WERF).

METHODS:
A cross-sectional anonymous study was conducted using the Spanish translation of the questionnaire. A REDCap-based link was distributed via social media to women with endometriosis in collaboration with Patient Associations. Data was analyzed using SPSS.

RESULTS:
Women (1,296) from 22 countries of South America, Central America, the Caribbean, Spain and US participated. Patients reported on education (43.5% had a degree), race (49.8% were white), and work (78.5%). Mean age was 33.7 years old (y/o; range 15–66); at menarche was 12 y/o; at pain onset was 16.2 y/o. Many reported having regular menstrual cycles (70.4%), and profuse menstrual bleeding (47.9%). Most (78.9%) patients reported severe pelvic pain (mean VAS 7.7). Most (82.9%) reported dyspareunia (mean VAS 6.3). Mean number of children was 1.52; 40.3% reported infertility/abortion; only 27.6% sought infertility treatment. The mean length of infertility was 0.52 years (range 0.08–8 years). Quality of life was negatively impacted in household chores (64.8%), sleep (58.7%), and exercise/sports (56.4%).

CONCLUSION:
Hispanic/Latina women with endometriosis present with severe symptoms and substantial quality of life impact. The EPhect questionnaire is a valuable tool to capture data and allow comparisons across ethnicities and geographic regions.
Effect of Bremelanotide on Ambulatory Blood Pressure When Administered for Up to 16 Consecutive Days [14B]
Authors: White William , Faught Brooke , Viswanathan Prabhakar , Williams Laura , Krop Julie , Portman David 
Published: April 2020

INTRODUCTION:
Bremelanotide is a melanocortin receptor agonist approved for the treatment of hypoactive sexual desire disorder. Bremelanotide 1.75 mg administered subcutaneously on-demand should not be administered more than once per 24 hours (maximum of 8 doses/month). We evaluated the impact of bremelanotide administered once-daily up to 16 consecutive days to determine if there was a cumulative effect on ambulatory blood pressure (ABP) and heart rate (HR) in premenopausal women.

METHODS:
In this IRB-approved study, 24-hour ABP and HR were assessed at baseline following a single-blind placebo injection, followed by an 8-day treatment period with 1.75 mg bremelanotide daily, and a subsequent 8-day double-blind, parallel-group, randomized (1:1 bremelanotide or placebo) withdrawal period.

RESULTS:
At baseline (n=142), mean age was 36 years, patients were 61% white, 34% black, and 24-hour mean BP was 109/70±8/6 mmHg. Demographics were balanced in the 127 women randomized at day 8. Maximal change from baseline in BP at 8 or 16 days was 3–4 mmHg 3 to 5 hours post-dose, decreasing to 1–2 mmHg by 12 hours post-dose with no cumulative effect. HR decreased by ≤1 beat/minute. The most common treatment-emergent adverse events were focal hyperpigmentation (38% of women during the first 8 days, with an additional 14% of women randomized to bremelanotide for days 9–16) and nausea (30%).

CONCLUSION:
No cumulative effects were observed on ABP or HR following daily dosing of bremelanotide for 8 or 16 days. BP returned to baseline after drug cessation. Data from the present study further support the safety of the recommended dosing.