bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expedited Partner Therapy and Its Impact on Chlamydia and Gonorrhea Rates in LA County Hospitals [08A]
Authors: Chang Emily , Nguyen Brian T. , Mitchell Evelyn , Jeffrey Nicholas , Long Minica 
Published: April 2020

INTRODUCTION:
Rising rates of gonorrhea (GC) and chlamydia (CT) in Los Angeles County may be related to the inadequate notification/treatment of sexual partners, leading to cycles of treatment and reinfection. Expedited partner therapy (EPT) is a proposed solution that provides prescriptions/antibiotics directly to an affected patient's partner without a separate visit. EPT is approved in California for GC/CT treatment; however its distribution varies, warranting an examination of factors influencing partner notification and EPT distribution.

METHODS:
Institutional Review Board approval was obtained. Patients with positive GC/CT lab results from 1/2015 to 6/2017 were identified from LA County hospital electronic medical records. Documentation of the need to treat the patient's partner and/or EPT provision was identified, along with possible associated factors, e.g. the patient demographics, as well as the provider's specialty and training level. Descriptive statistics and bivariate comparisons identified correlations between receipt of EPT and possible factors.

RESULTS:
Of 319 GC/CT diagnoses, only 7.5% had EPT documented. More diagnoses occurred among female than male patients (63.6% vs. 36.4%) with males being less likely to be offered EPT (0.9% vs. 11.3%, P<.01). Patient age, race, and marital status were not associated with receiving EPT. Most diagnoses (60.2%) occurred in the emergency department, but those patients were least likely to receive EPT (3.7%, P<.01). Gynecologists were most likely to provide EPT (37.8%, P<.01).

CONCLUSION:
EPT was rarely offered to patients diagnosed with GC/CT, with provision least likely among male patients and in the emergency department setting. Gender-based and structural barriers may underlie low rates of EPT provision.
Limited Postpartum Versus 24-Hour Antibiotic Dosing Regimens Following Intrapartum Chorioamnionitis [11A]
Authors: Hood Keren , Ulfers Alexander , Mersch Michelle , Cuadra German , Stevenson Robert , Martingano Daniel 
Published: April 2020

INTRODUCTION:
The objective of this study was to determine if limited postpartum dosing versus (LPD) 24-hour dosing treatment regimens for endometritis prophylaxis following deliveries complicated by intrapartum chorioamnionitis (IC) provides greater effectiveness.

METHODS:
We conducted a prospective observational cohort study and followed all women receiving treatment for IC. All patients diagnosed with IC received IV gentamicin and IV ampicillin. Those who required a cesarean delivery additionally received IV clindamycin. Those in the LPD group received an additional dose of ampicillin (and clindamycin if cesarean delivery) while the 24-hour dosing group were continued on the scheduled antibiotics for 24 hours. Appropriate IRB approval was obtained. The primary outcome was treatment failure defined by persistent fever and fundal tenderness requiring continuation of antibiotics and ascribing a diagnosis of postpartum endometritis.

RESULTS:
The study included 206 patients, where 120 patients received 24-hour dosing of antibiotics postpartum and 86 received LPD. Baseline characteristics were not significantly different. Rates of endometritis were noted to be less in the 24-hour dosing group (15.8% versus 29.1%, P=.022) with a 46% decreased risk of developing endometritis (RR 0.54, 95% CI 0.3–0.99, P=.46). After adjusting for perceived confounders, this decreased risk was no longer statistically significant.

CONCLUSION:
In this prospective study, either dosing strategy appears to have equivalent efficacy of endometritis prophylaxis after adjusted analysis. Given the lack of superiority of either regimen, each dosing approach remains reasonable with the LTD favored to limit overuse of antibiotics and combat resistance.
Percutaneous Exposure Incidents in U.S. Obstetrics and Gynecology Residents [12A]
Authors: Garrett Alison 
Published: April 2020

INTRODUCTION:
To examine the self-reported incidence of percutaneous exposure incidents (PEIs) as well as injury reporting trends among U.S. Obstetrics and Gynecology residents.

METHODS:
IRB approval was obtained. This voluntary survey was distributed to all ACGME-accredited OB/GYN residency program leadership with instructions to forward to all residents in their programs. The online survey was IRB approved and open for responses from May-June 2019. Descriptive statistics were gathered, and variables were evaluated for significance by chi-square analysis.

RESULTS:
Among the 441 residents who responded, 355 (81%) reported ever experiencing a PEI. Sharps injuries were sustained by 321 (73%), and mucous membrane exposures (MMEs) were sustained by 255 (58%). By the final year of training, 96% of residents experienced at least one sharps injury, and 71% reported at least one MME. Most residents (258, 72%) did not reported an injury in the past. The most common reasons for not reporting included that the patient was perceived to be at low risk for infection (32%), the process was too cumbersome (24%), or the resident was too busy (12%).

CONCLUSION:
OBGYN residents experience a high rate of PEIs but infrequently report these injuries. Efforts to prevent PEIs are of utmost importance. Increased reporting of these injuries is needed to optimize post-exposure prophylaxis administration.
Rates of Expedited Partner Therapy Prescribed by OB/GYN Residents at LA County Hospitals [15A]
Authors: Mitchell Evelyn , Nguyen Brian T. , Novatt Hilary , Hardley Macy T. , Chang Emily 
Published: April 2020

INTRODUCTION:
The incidence of STIs, specifically gonorrhea, chlamydia, and trichomoniasis among Los Angeles County residents is on the rise. One possible explanation is inadequate treatment, especially of sexual partners. Expedited partner therapy (EPT) is a method of treating patients' partners without a separate healthcare visit, which has been shown to decrease persistent and/or recurrent infections. We report on quality improvement outcomes following interventions to help increase the rates of EPT provision.

METHODS:
Interventions included creating a protocol with the pharmacy, arranging for Cefixime to be on formulary, and conducting resident training sessions. Data collection was performed on all positive gonorrhea (GC), chlamydia (CT) and trichomoniasis lab results seen from January 1, 2017 to February 27, 2019 across all departments, inclusive of Ob/Gyn. EPT rates before and after interventions are presented.

RESULTS:
The rates of EPT prescriptions provided by OB/GYN providers for STI treatment increased following the interventions. EPT for GC/CT increased from 40% to 55% of cases; EPT for Trichomonas increased from 38% to 85%. Interestingly, patients were often counseled on the need for partner treatment, but were not given prescriptions. This study includes only female patients seen by Ob/Gyn providers, though the majority of results were detected in the emergency department by non Ob/Gyn providers.

CONCLUSION:
Following interventions aimed at establishing agreements with the pharmacy as well as increasing awareness among residents, the EPT rates of gonorrhea, chlamydia, and trichomoniasis did increase significantly. This may assist with decreasing the rate of STI reinfection among County hospitals and hospitals supported by medical trainees.
Secnidazole, an Approved Single Dose Drug for Bacterial Vaginosis, Does Not Cause Reproductive Toxicity in Animals [16A]
Authors: Pentikis Helen , Eder Scott , Kaufman Gregory , Chavoustie Steven 
Published: April 2020

INTRODUCTION:
Single-dose oral secnidazole 2 g, has recently been approved in the US for treatment of bacterial vaginosis (BV) in adult women. BV is associated with an increased risk of several pathological gynecological conditions as well as major adverse outcomes during pregnancy, where it is associated with a two-fold increased risk of preterm birth and a six-fold increased risk of miscarriage. In order to inform patient labeling, reproductive toxicology studies have been conducted.

METHODS:
A complete reproductive toxicology program required for patient labeling was conducted. Rats and rabbits were fed varying doses of secnidazole, 0 to 1000 mg/kg/day and 0 to 100 mg/kg/day, respectively, leading up to and throughout gestation. Maternal examinations included clinical observations and survival, food consumption, and parturition. Data obtained from the first-generation (F1) pups included viability, body weight, neurobehavioral and reproductive function. Data including clinical signs, survival and body weights were also obtained for the second generation pups derived from F1 offspring. Adverse events associated secnidazole were measured.

RESULTS:
Secnidazole showed no reproductive toxicity in animal models. There was no effect on weight, growth, and food consumption for animals administered secnidazole, up to 300 mg/kg/day. There were no effects on survival, intrauterine growth, or external fetal morphology at any dose.

CONCLUSION:
There was no evidence of secnidazole toxicity in fertility and pre- and postnatal reproductive toxicology. In addition, there were no adverse developmental outcomes when secnidazole was administered orally to pregnant rats and rabbits during organogenesis at doses up to 4 times the clinical dose.
Association of Delayed Treatment of Chlamydia and Gonorrhea Infections in Pregnancy and Preterm Birth [18A]
Authors: Goggins Emily R. , Chamberlain Allison T. , Young Marisa R. , Jamieson Denise J. , Haddad Lisa B. 
Published: April 2020

INTRODUCTION:
Treatment of chlamydia and gonorrhea in pregnancy decreases adverse health outcomes, including preterm birth. The impact of time to treatment on preterm birth is unknown.

METHODS:
Retrospective cohort study of women who delivered at a public hospital between July 2016 and June 2018. Polytomous logistic regression was used to examine associations between no infection, timely treatment (within one week), and delayed treatment (after one week) and preterm and very preterm birth. Multifetal gestations, cases diagnosed after 20 weeks, and subsequent deliveries from women who delivered multiple times in the study period were excluded.

RESULTS:
Among 2,967 women, 207 (7%) tested positive, 328 (11%) delivered preterm, and 62 (2%) delivered very preterm. The incidence of preterm birth was 11% for those with no infection, 14% for those treated within one week, and 14% for those treated after one week. The incidence of very preterm birth among these groups was 2%, 3.5%, and 7%. Compared to women without infection, delayed treatment was associated with a 3.5-fold increase in the odds of very preterm birth after adjusting for a priori confounders (95% CI 1.5–8.1). The risk of very preterm birth was similar for women with timely treatment and those with no infection. The risk of preterm birth was similar for women with timely treatment, delayed treatment, and no infection during pregnancy.

CONCLUSION:
Delays in treatment greater than one week were associated with very preterm birth, while timely treatment mitigated this risk. Timely treatment of these infections in pregnancy is imperative for reducing adverse health outcomes.
Association of Abnormal Placental Cord Insertion With Assisted Reproductive Technology [20A]
Authors: Leftwich Heidi K. , Chuahan Shaila V. , Hen Eden , Lueck Tyler , Leung Katherine , Yeh John 
Published: April 2020

INTRODUCTION:
Abnormal placental cord insertion has been associated with an increase in preterm delivery, low birth weight, neonatal intensive care admissions and cesarean delivery. Assisted reproductive technology (ART) has been associated with some similar placenta-medicated pregnancy complications. We hypothesize an increase in abnormal placental cord insertion in pregnancies conceived using ART, thereby contributing to the increased association of adverse pregnancy outcomes.

METHODS:
We performed an IRB approved, retrospective chart review of 3728 singleton and twin placentas sent to pathology at the University of Massachusetts between January 2011-January 2016. Placental pathology reports were reviewed and evidence of abnormal placental cord insertion, either velamentous or marginal, were recorded. Chi-square test was used for categorical variables and student T-test for continuous. Logistic regression was used to control for potential confounders. P less than 0.05 was used for statistical significance.

RESULTS:
Of the 3728 pregnancies, 3615 were conceived via spontaneous conception, whereas 113 were conceived through ART. Women who conceived with ART were more likely to be married, of white race, older and have multiple gestations than those with spontaneous conception. ART pregnancies were over 2-fold more likely to have abnormal placental cord insertions (OR 2.1 [1.1–3.9], P=.03). After adjusting for confounding factors, statistical significance was no longer noted.

CONCLUSION:
Pregnancies conceived with ART were more likely to have abnormal placental cord insertion in our study. A larger sample size of women conceived using ART would be needed to fully understand the effect of ART on abnormal placental cord insertion beyond the confounding effect of multiple gestations.
LGBTQ+ Individuals' Perceptions of Reproductive Hormone Self-Collection Tests [26A]
Authors: Worthington Amber , Shirazi Talia , Abrams Mere , Burke Erin , Leahy Carly 
Published: April 2020

INTRODUCTION:
LGBTQ+ individuals have faced persistent challenges accessing healthcare related to fertility. This can lead to a lack of reproductive and family planning knowledge. New applications of health technologies, specifically reproductive hormone self-collection tests, present a unique opportunity to overcome these issues. We examined LGBTQ+ individual's perceptions of reproductive hormone self-collection tests.

METHODS:
Participants (N=203 LGBTQ+), including cis lesbian (n=83) and transgender, nonbinary, or gender non-conforming (T/NB/GNC; n=120), completed an IRB-approved online survey in 2019.

RESULTS:
One-sample t-tests (with means compared to the scale midpoint) revealed that the participants believed reproductive hormone self-collection tests are useful, easy to use, and trustworthy (all P<.001); perceptions of risk did not differ from the midpoint (P=.88). A one-sample t-test also revealed that LGBTQ+ individuals felt more comfortable using a self-collection test (compared to a test at a doctor's office; P<.001). The majority (86%) believed that a reproductive hormone self-collection test would promote LGBTQ+ access to healthcare related to fertility. There were no differences between cis lesbian and T/NB/GNC participants.

CONCLUSION:
These results suggest that LGBTQ+ individuals believe reproductive hormone self-collection tests are useful, easy, and trustworthy and, further, believe that these self-collection tests would make LGBTQ+ individuals more comfortable testing their reproductive hormones and would increase access to healthcare. Increasing LGBTQ+ individuals' access to healthcare related to fertility is an important step in addressing sexual and gender minority health disparities and enabling LGBTQ+ individuals to achieve their reproductive and family planning goals.
Obese Women Undergoing in Vitro Fertilization Have Higher IL-6 and TNF-α Levels in Follicular Fluid [27A]
Authors: Kim Tana , Zhao Yulian , Enninga Elizabeth 
Published: April 2020

INTRODUCTION:
Obesity is associated with lower pregnancy and live birth rates following in vitro fertilization (IVF). As the follicular fluid (FF) provides the microenvironment for the oocyte, immune dysregulation due to obesity related inflammation could disrupt the developing oocyte. The objective of this study was to compare differences in FF cytokines based on BMI in women undergoing IVF.

METHODS:
FF was collected from women undergoing IVF. Cytokines levels were measured from the FF using ELISA and compared based on BMI ≥35. Patient characteristics and cycle outcomes were compared between the groups. Wilcoxon rank sum and Fisher exact tests were used for continuous and categorical variables, respectively. Values are presented as medians.

RESULTS:
The analysis included 57 women with BMI <35 and 11 women with BMI ≥35. Women with BMI ≥35 had higher levels of IL-6 (129.23 vs 16.55 pg/mL, P=.019) and TNF-α (62.6 vs 9.54 pg/mL, P=.037) in the FF. Anti-müllerian hormone was lower with BMI ≥35 (2.0 vs 3.6 ng/mL, P=.049), but no other differences in patient characteristics were seen between the groups. There were no differences in stimulation duration (11 vs 11 days; P=.993), total gonadotropin (3075 vs 2475 units; P=.122), peak estradiol (2080 vs 1972 pg/mL, P=.521), mature oocytes (13 vs 12; P=.822), and oocyte maturity rate (82% vs 80%, P=.653) between the groups.

CONCLUSION:
Obese women undergoing IVF have higher levels of inflammatory cytokines IL-6 and TNF-α in the FF. These biochemical discrepancies may provide early insight into pathophysiologic differences in oocyte development in obese women undergoing IVF.
Patterns in the Management of Endometriosis Among Physicians: A Cross-Sectional Survey [28A]
Authors: Reddy Srinidhi , McLaughlin Jessica , Stansbury Nicholas , Knudtson Jennifer 
Published: April 2020

INTRODUCTION:
Management of endometriosis is complex and varies among providers. This study investigates patterns in the management of endometriosis among Obstetrics and Gynecology physicians in the United States.

METHODS:
The Institutional Review Board reviewed and approved this study. A national online survey was sent to 5000 members of the American College of Obstetrics and Gynecology. It included 22 questions designed to assess the medical, surgical, and pain management of endometriosis. Variations in management were assessed using Fisher exact test and Mann-Whitney test.

RESULTS:
The adjusted response rate was 24.5%. The most common initial treatment for pelvic pain and suspected endometriosis was continuous combined oral contraceptives (COCs) (58%). When medical management fails, 52% of respondents opt for surgical management; 45% of respondents treat with excision while 42% treat with cautery ablation. Most indicated they offer postoperative hormone suppression, including continuous COCs (45%) or gonadotropin-releasing hormone agonists with add-back therapy (27%). The majority prescribe nonsteroidal anti-inflammatory drugs to treat endometriosis-related pain while a minority opt for alternative treatments such as opioids, acupuncture, and psychological support. 82% of physicians believe there is a need for women with endometriosis to have psychosocial care; however, only 15% routinely refer patients for psychological counseling. Importantly, 72% of respondents indicated they do not feel adequately trained to provide care for psychosocial aspects of endometriosis.

CONCLUSION:
The majority of responding providers are practicing evidence-based care for the treatment of endometriosis. Although most physicians recognize the need for a multidisciplinary approach to the treatment of endometriosis-related pain, only a minority recommend alternative treatments.
Presence of Human Herpesvirus 6 in Endometrial Samples of Women With Reproductive Failure [29A]
Authors: Doody Kaitlin , Knox Konstance 
Published: April 2020

INTRODUCTION:
Human herpesviruses 6A and 6B (HHV-6) are members of the Herpesviridae family that includes cytomegalovirus and herpes simplex virus. Like other human herpesviruses, HHV-6 can persist unknowingly in a latent state. Recent studies have identified the presence of HHV-6 within the endometrial cells in 43% of women with unexplained infertility, but has not been seen in known fertile women. This study evaluates the association between presence of HHV-6 and different infertility subgroups including repeated implantation failure (RIF), recurrent pregnancy loss (RPL), and unexplained infertility.

METHODS:
A prospective cohort evaluation was performed on 201 women undergoing examination for unexplained infertility, RPL, or RIF. Data was collected from five infertility clinics from October 2017 to October 2019. Endometrial biopsies were collected from each patient and immunohistochemistry was performed to identify a late viral protein of HHV-6.

RESULTS:
A total of 75 of the 201 women met the criteria for RIF. The other 126 women were diagnosed with unexplained infertility or RPL. Of the 201 women, 75 women (37.3%) were positive and 126 were negative for HHV-6 viral antigen. In the 75 patients with RIF, 38 biopsies (51%) were positive for HHV-6. In the 126 women without RIF, 37 biopsies (29.3%) were positive for HHV-6.

CONCLUSION:
While previous studies have shown an association between HHV-6 and unexplained infertility, this cohort demonstrates the infection is likely associated with multiple causes of reproductive failure. The presence of HHV-6 in the endometrial cells of these patients supports further study of the pathogenesis of the infection.
Supporting Women in the Workforce: The Importance of Employer-Provided Supplemental Fertility Insurance Benefits [30A]
Authors: Worthington Amber , Shirazi Talia , Burke Erin 
Published: April 2020

INTRODUCTION:
Age-related declines in natural fertility may pose a challenge to women who delay childbirth to pursue careers. Reproductive hormone testing may be critical for addressing workplace gender inequality by enabling women to pursue both professional and reproductive goals. Fertility treatments, when performed before significant fertility declines, can provide additional options. However, these procedures can be expensive and are not typically covered under employer-provided health insurance. We assessed U.S. women's beliefs about supplemental fertility insurance benefits.

METHODS:
Participants (N=327 women) completed an IRB-approved online survey in 2019. The data were analyzed with descriptive and chi-square analyses.

RESULTS:
Participants indicated that it is important to them to have insurance cover the cost of annual reproductive hormone testing (77.06%) and fertility treatments (78.28%). Further, they would choose an employer that provides insurance benefits for annual reproductive hormone testing (54.74%) and fertility treatments (59.32%) over one that does not. There were no differences by age, income, geographic region, health insurance, or fertility knowledge; however, infertile women were more likely than fertile women to choose an employer that provides insurance benefits for annual reproductive hormone testing (χ2=7.56*) and fertility treatments (χ2=7.99*). (note: * P<.05).

CONCLUSION:
Our results suggest that U.S. women believe supplemental fertility insurance benefits are important, and they would choose an employer based on the provisioning of these benefits. Employer-provided insurance that includes supplemental fertility insurance benefits may enable women to achieve both professional and reproductive goals, ultimately contributing to greater workplace gender equality.