bluuebunny/crossref_metadata_2025_split huggingface dataset:
Availability of Ulipristal Acetate and the Impact of a Brief Educational Intervention at Retail Pharmacies [07I]
Authors: Stamm Carol A. , Borgelt Laura M. , Ball Nina , Rupp Leanne , Weber Rachel , Arbet Jaron 
Published: April 2020

INTRODUCTION:
A Colorado study in 2014 determined levonorgestrel (LNG) emergency contraception (EC) to be completely accessible in 23% of pharmacies. No study has evaluated the availability of ulipristal acetate (UPA), which is a more effective form of EC, available by prescription in Denver. The goal was to assess availability of UPA EC, ability of pharmacy staff to answer questions about it, and determine if the American Society of Emergency Contraception (ASEC) educational tool was perceived as useful.

METHODS:
134 retail pharmacies within 10-mile radius of the state capitol were included: one-half were randomized to receive the ASEC handout. Three pharmacies subsequently merged. (N=131) All pharmacies received a standard mystery call two weeks after the intervention mailing. The pharmacies receiving the handout received additional calls one and 9 weeks after the original call, to assess handout usefulness and were asked about the intervention tool.

RESULTS:
UPA EC was reportedly available in only 24, or 18.3%, of pharmacies. 36.4% of pharmacy staff members counseled that there was no difference between UPA and LNG EC. Only 18.6% of pharmacy staff seemed aware of the higher efficacy of UPA. Few pharmacy staff recalled seeing the ASEC handout: 13/65 (20%) at one week and 3/65 (4.6%) at nine weeks. One site reported that the handout was posted.

CONCLUSION:
Although UPA is available by prescription (therefore covered under the Affordable Care Act) and has a higher efficacy than LNG EC, it is not readily available. A single educational intervention did not have lasting value to pharmacists.
Knowledge and Attitudes Towards LARCs Among Medicaid Recipients Desiring Surgical Sterilization [24I]
Authors: Leung Andrea , Loh Andrew , Ahmady Malalay , Haque Sidra , Pentlicky Sara , Gurney Elizabeth 
Published: April 2020

INTRODUCTION:
We sought to compare knowledge and attitudes about long-acting reversible contraceptives (LARC) among reproductive-age Medicaid recipients with satisfied parity who were not currently using LARC.

METHODS:
We conducted a cross-sectional survey using 18 true/false and Likert-items compiled from previously validated surveys assessing perceptions about LARC. We compared two groups: people seeking surgical sterilization and those who were not. Our primary outcome was the proportion of correct responses. Secondary outcomes were the proportion with negative LARC perceptions, and the proportion who would consider using LARC. 67 subjects were needed to detect a small-medium estimated effect size of Cohens f2=0.20, with 95% power and alpha=0.05.

RESULTS:
67 people participated: 43 desiring sterilization and 24 not. Subjects desiring sterilization were older (mean age 31.9 versus 28.4, P=.01), had higher gravidity (6 versus 3, P=.01) and parity (3 versus 2, P=.01). Subjects desiring sterilization had lower overall knowledge about LARC (62% correct responses versus 70%, P=.042) and more negative perceptions about LARC (54% versus 38%, P=.048). Fewer subjects desiring sterilization correctly identified LARC efficacy as equal to sterilization (32% versus 83%, P<.01), and fewer would consider using LARC (IUD: 23% versus 58%, P<.01; implant: 16% versus 46%, P<.01). A higher proportion of subjects desiring sterilization agreed with “I do not like the idea of putting an object in my body” (60% versus 29%, P=.014).

CONCLUSION:
Lower knowledge about LARC, particularly regarding efficacy, among people desiring sterilization underscores the need for comprehensive counseling. The higher proportion of negative perceptions towards LARC among people desiring sterilization warrant further study.
Sexual Satisfaction With the Vaginal pH Regulator: Results From the AMPOWER Clinical Trial [32I]
Authors: Thomas Michael A. , Culwell Kelly , Dart Clint , Howard Brandon 
Published: April 2020

INTRODUCTION:
The Vaginal pH Regulator (VPR™) is an investigational, non-hormonal, woman-controlled gel for prevention of pregnancy. Given the lubricating properties of VPR, the objective of the current analysis is to report on sexual satisfaction/function from AMPOWER.

METHODS:
AMPOWER was a phase 3, single-arm, open-label, IRB-approved trial in women aged 18-35 years and conducted at 112 U.S. sites (NCT03243305). Women were instructed to administer VPR intravaginally immediately before or up to 1 hour before each episode of vaginal intercourse. The primary endpoint was 7-cycle cumulative pregnancy rate. Sexual satisfaction/function was an exploratory endpoint and assessed via questionnaires administered at baseline (Study Visit 2, Cycle 0) and Study Visits 3 (Cycle 2), 4, and 5.

RESULTS:
Compared to their previous contraceptive method (N=1,330), more women reported positive impacts to their sex life with VPR (a little/a lot of improvement: with previous contraceptive in the 4 weeks prior to enrollment=16.9%; with VPR at Visit 3=44.5%) and in their ability to maintain lubrication during intercourse (no difficulty in maintaining lubrication: baseline=73.9%, Visit 3=82.5%). Women also reported improvements in sexual function measures, with the percentage reporting “none” at baseline vs Visit 3, respectively, as follows: vaginal dryness (59.8% vs 79.9%); lack of sexual desire/interest (61.9% vs 71.2%); vaginal tightness (58.5% vs 70.5%); pain during intercourse (70.5% vs 80.8%); anxiety about sexual performance (80.3% vs 85.4%); and inability to orgasm (60.8% vs 69.9%).

CONCLUSION:
In AMPOWER, women reported improvement in measures of sexual satisfaction/function after just 1 cycle of use with VPR compared to baseline.
The Maryland Contraceptive Equity Act (MCEA): Provider Awareness and Impact on Contraception Provision [35I]
Authors: Cheedalla Aneesha , Lee Jessica , Burke Anne E. 
Published: April 2020

INTRODUCTION:
The Maryland Contraceptive Equity Act (MCEA) took effect in January 2018, with the goal of reducing barriers to contraception among insured individuals. Key provisions allow 12-month supplies/prescriptions of short-acting contraception and remove prior-authorization requirements for long-acting reversible contraception (LARC). We sought to assess MCEA impact on contraceptive provision in Maryland.

METHODS:
From March-June 2019, we emailed an Institutional Review Board-approved survey to Obstetrics/Gynecology (OBG), Internal Medicine (IM), Pediatrics, and Family Medicine (FM) providers throughout Maryland. The 24-item survey queried provider’s prior awareness of the MCEA, changes to counseling, prescribing, and administrative practices based on the MCEA prior to the survey, likelihood of changes after MCEA awareness, changes in prior-authorization requirements for LARC, and MCEA impact on contraception access. Responses utilized a 5-point Likert scale (1: Very unlikely – 5: Very likely).

RESULTS:
The survey was sent to 1256 providers with 164 responses (13%): 67 OBG, 53 IM, 22 Pediatrics, 22 FM. One-hundred fourteen (70%) providers were unaware of the MCEA. The mean score of likelihood that the MCEA would change contraceptive counseling was 3.4/5 (SD 1.30), prescribing practices 3.5/5 (SD 1.29), and administrative practices 3.2/5 (SD 1.27). Of providers offering LARC, 22/42 (52%) reported fewer prior-authorization requirements since MCEA enactment. Fifty-eight percent of providers thought the MCEA very likely to increase access to LARC and 40% rated it very likely to increase access to short-acting contraceptives.

CONCLUSION:
Most contraceptive providers were not aware of MCEA provisions, but report that with increased awareness, their contraceptive counseling and prescribing practices are likely to change.
Intention Versus Uptake: LARC Among Postpartum Women in a Federally Qualified Health Clinic [17J]
Authors: Freeman Emily , Heiselman Cassandra , Bacak Stephen , Knebusch Madeleine , Cottrell Connie 
Published: April 2020

INTRODUCTION:
Access to full spectrum contraceptive methods, including long-acting reversible contraception (LARC), is critical for preventing unintended and short-interval pregnancy. Despite serving a population at high risk for unintended pregnancy, federal qualified heath centers (FQHC) often have limited access to LARC on-site and at associated hospitals that may impact contraceptive utilization. The goal of the study was to examine access and barriers to LARC uptake among women at a FQHC.

METHODS:
We conducted a retrospective chart review of all women seen for antenatal care at a single resident run FQHC from 2014 to 2017. Women age 18-40 and who delivered at the associated hospital were included. The FQHC offered intrauterine device (IUD) but did not offer contraceptive implant placement. The associated hospital did not provide immediate postpartum LARC during the study period.

RESULTS:
In our study, 560 women were identified. There was a 60.5% postpartum follow-up over the study period. 65% (n=364) had documentation of a confirmed postpartum contraception plan prior to delivery. Of women with a plan, 27% (n=100) expressed desire for postpartum LARC. Only 21% (n=21) of women who desired LARC actually received LARC within the first 6 months after delivery. All IUDs were received at the FQHC. No women received a contraceptive implant at an outside facility.

CONCLUSION:
Our data suggests that when LARC options are not readily available, postpartum uptake is poor regardless of intention. Therefore, strategies need to be developed to improve access to all LARC methods, including expanding immediate postpartum services and improving antepartum contraception counseling.
Maternal Fetal Medicine Physician Understanding, Attitudes, and Practice in Regards to New Abortion Legislation [18J]
Authors: Morgan Elizabeth A. , Miller Jill , Thompson Rachel , Jones Cresta W. 
Published: April 2020

INTRODUCTION:
Second trimester diagnosis of congenital anomalies and genetic disorders is often performed by Maternal Fetal Medicine (MFM) Physicians, who counsel on available options including termination of pregnancy (TOP). Recent abortion legislation, including implementation of gestational age limits, waiting periods, and mandatory counseling, can directly influence these conversations with patients. The Guttmacher Institute reports 58 such restrictions in the first half of 2019 alone. The purpose of this study was to understand how MFM Physicians perceive these legislative changes and whether they modify clinical practice in response.

METHODS:
We mailed an anonymous survey to all physician members of the Society of Maternal Fetal Medicine in January 2018 and again in April 2019. The survey included questions on physician demographics, knowledge of abortion legislative changes in the past five years, and impact on clinical practice.

RESULTS:
Of 2217 surveys mailed, 686 (30.3%) physicians responded. 33.2% of respondents reported changes to abortion provision legislation, 53.4% denied changes and 13.4% were unsure. In 30 of the 47 states represented, MFMs disagreed whether there were changes to legislation in their state. Of the 359 physicians reporting new legislation, 243 (67.7%) stated they changed clinical practice in response. Physicians also reported concerns with increasingly necessary out of state referrals, as well as rushed decision making and increasing financial burdens to low-income patients.

CONCLUSION:
There was significant variation in MFM Physician response regarding changes to abortion legislation. Many MFMs reported changes to legislation resulting in alterations of clinical practice and voiced concerns in regards to increasing patient burdens.
17-P for Women With Congenital Uterine Anomalies: Does it Impact Preterm Birth Risk? [01K]
Authors: Dotters-Katz Sarah K. , Schwartz Amanda R. 
Published: April 2020

INTRODUCTION:
The effectiveness of 17P in the prevention recurrent of preterm birth (PTB) among women with congenital uterine anomalies (CUA) is unknown. This study evaluate association between 17P and delivery gestational age among women with CUA and a previous spontaneous PTB.

METHODS:
This study is a retrospective cohort of women with CUA who delivered at 2 health systems from 2013-2019. Women with ≥1 prior spontaneous PTB carrying non-anomalous, singleton gestations were included. The primary outcome was delivery gestational age. Secondary outcomes included delivery <37 and <34 weeks. Women receiving 17P were compared to those who did not receive 17P using Wilcoxon rank sum, Fisher’s exact, and chi-square.

RESULTS:
Of the 48 women with prior PTB, 11 (22.9%) received 17P. Demographic, medical, and obstetric characteristics were similar between women who did and did not get 17P. The subtype of CUA was also similar by 17P status. The initial cervical length was more than 35mm in both groups and did not differ, nor did rates of PPROM (25% vs 12.5%, 0.63). The median delivery gestational age was similar between groups [37.7 (IQR 30.7-38.3) vs. 37.1 (IQR 31-38.4) weeks] for those who did and did not receive 17P, respectively. Rates of recurrent PTB 0.99) and 0.99) were also similar in those who did and did not receive 17P.

CONCLUSION:
In this cohort of women with prior PTB and CUA, recurrent PTB was common, and though 17P was used in fewer than 1 in 4 women, use of 17P did not appear to impact this risk.
Addressing the Epidemic: Screening for Substance Use in Pregnancy [04K]
Authors: Campbell Jolene L. , Cheese Callie , Muller Corinna 
Published: April 2020

INTRODUCTION:
The purpose of this project was to implement the use of an evidence-based model and validated screening tool for high-risk substance use in pregnancy. Substance use among pregnant women has quadrupled. Unidentified and untreated substance use can lead to poor maternal/ fetal outcomes and is currently the leading cause of maternal death in the U.S.

METHODS:
With IRB approval, 65 pregnant women were screened for substance use with a validated screening tool and provided brief intervention and/or referral to treatment as indicated. Data was collected over an 8-week period and analyzed using SPSS.

RESULTS:
Screening revealed that 61.4% of the women reported substance use (alcohol use, tobacco use, non-medical prescription drug use, or illicit drug use) in the past year. Continued substance use after knowledge of pregnancy was reported by 0% for alcohol use, 18.5% for tobacco use, 1.5% for non-medical prescription drug use, and 10.7% for illicit drug use. Screening indicated that 7.7% of the women had moderate to high-risk illicit drug use and all these women received a brief intervention and were referred for treatment. The project results were compared to the average substance use in pregnancy reported by local and recent literature data which included: 5.5-8.5% with alcohol use, 13.2-15.9% with tobacco use, and 6-7.7% with illicit drug/non-medical prescription drug use.

CONCLUSION:
This project confirms that substance use in pregnancy is an ongoing health issue and supports recommendations from the leaders in obstetrics and addiction medicine for universal substance use screening in all women of reproductive age.
The Impact of Mode of Delivery on Early Preterm Morbidity and Mortality [32K]
Authors: Zahedi-Spung Leilah D. , Raghuraman Nandini , Woolfolk Candice , Macones George , Cahill Alison 
Published: April 2020

INTRODUCTION:
Whether the mode of delivery for early preterm infants influences the risk of adverse outcomes is an ongoing topic of debate. This study aims to determine whether cesarean delivery is independently associated with improved early preterm neonatal morbidity or mortality.

METHODS:
This is a retrospective cohort study of preterm deliveries at 22.0–29.0 weeks gestation between 2010 and 2015, excluding multiple gestations, intrauterine fetal demise, and induction terminations. The primary outcome was a neonatal morbidity composite (apgar <5 at 5 min, prolonged ventilation >28 days, IVH, NEC, coagulopathy, discharged on home ventilator support, or discharged with enteric feeding tube). The secondary outcome was neonatal death. Outcomes were compared between patients who underwent cesarean vs vaginal delivery. Patients were first matched for ethnicity (black v. other). Propensity scores were estimated utilizing logistic regression models adjusting for small for gestational age, gestational at delivery, and nulliparity. IRB approval was granted through Washington University.

RESULTS:
Of the 273 (56.9%) early preterm deliveries, 125 (45.8%) were cesarean deliveries and 148 (54.2%) were vaginal deliveries. After matching, there were 115 patients in each group. In vertex fetuses, there was no significant difference in neonatal mortality within 24 hours (aOR 1.48 CI 0.56, 3.90) or within 28 days of delivery (aOR 0.71 CI 0.27, 1.90) by mode of delivery. There was no difference in composite neonatal morbidity.

CONCLUSION:
In this propensity score analysis, the risk of neonatal death or neonatal morbidity was not significantly improved among early preterm neonates delivered by cesarean versus vaginal delivery.
Use of Placental Growth Factor (PLGF) for Aneuploidy Screening in Pregnancy: A Systematic Review [38K]
Authors: Badeghiesh Ahmad , Volodarsky-Perel Alexander , Hemmings Robert , Gil Yaron , Balayla Jacques 
Published: April 2020

INTRODUCTION:
Placental growth factor (PLGF) is a protein of trophoblastic origin. Whether addition of PLGF to combined serum aneuploidy screening tests improves detection rates for trisomy 21 is controversial.

METHODS:
We performed a systematic review of the literature until August 2019. We performed a goodness of fit test and retrieved the coefficient of determinations (R2) before and after the introduction of PGLF, as a function of false positive rates. Receiver-operating characteristic curves are provided in order to illustrate findings.

RESULTS:
We identified a total of 51 studies, of which 8 met inclusion criteria. Three prospective and five case-control studies included a total of 834 aneuploidy cases and 105,904 euploid control pregnancies. Detection rates (DR) were proportional to false-positive rates (FPR) across all studies, and ranged from 59.0% to 95.3% without the use of PLGF and 61.0% to 96.3% with PLGF (FPR 1% to 5%). Goodness of fit regression analysis revealed a logarithmic distribution of DR with R2=0.109 in the no PLGF group and R2=0.06 in the PLGF group. These indicate a large variation between DR for a given FPR across studies. Our analysis demonstrates average improvements in DR of 3.3% for a 1% FPR, 1.7% for a 3% FPR, and 1.4% for a 5% FPR.

CONCLUSION:
Addition of PLGF to prenatal screening using serum analytes mildly improves trisomy 21 detection rates between 1.4 and 3.3% for FPR’s between 5% and 1%, respectively. Future studies should address the cost-benefit analysis of introducing PLGF for prenatal screening.
Bladder Rupture Following Both Successful and Failed Trial of Labor After Cesarean [02L]
Authors: Bennett Carrie , Newton Kathryn , Wilkins Catherine , Schleicher Maria 
Published: April 2020

INTRODUCTION:
The incidence of bladder injury during cesarean section is estimated to be 0.08 to 0.94%. In patients with previous cesarean delivery, rate of bladder injury after successful VBAC is 0.2% while unsuccessful TOLAC confers 1.1% risk. The average length of bladder injury is 4.2 cm.

METHODS:
Case presentation.

RESULTS:
The first patient is a 26 year-old gravida 3 para 2 presenting at 39w3d in spontaneous labor with history of 31 week emergent cesarean for breech presentation at complete dilation. Labor augmented with oxytocin and patient progressed to complete. Successful vacuum-assisted delivery performed for fetal bradycardia. Approximately 90 minutes after delivery, patient was noted to have copious amounts of fluid from the vagina upon retrograde bladder fill. Exploratory laparotomy demonstrated posterior bladder rupture from dome to neck and anterior cervicovaginal rupture causing cervical avulsion. The second patient is a 34 year-old gravida 2 para 1 presenting at 38w6d in spontaneous labor with history of cesarean for failed vacuum delivery. Patient progressed to complete by own mechanism but opted for cesarean after 1 hour of pushing. After an atraumatic delivery of infant, entirety of Foley catheter was noted within surgical field. Large cystotomy present from posterior aspect of dome distally through trigone and bladder neck concurrent with uterine rupture demonstrating vaginal extension.

CONCLUSION:
Successful VBAC does not preclude urologic injury. TOLAC counseling should be individualized based upon prior operative reports, with high indices of suspicion when hysterotomy may have been performed lower than anticipated. With early recognition of injury, favorable prognosis can be achieved.
Comparing Internal and External Severe Maternal Morbidity (SMM) Review in Illinois [06L]
Authors: Geller Stacie , Garland Caitlin , Horne Ashley , Locher Stephen 
Published: April 2020

INTRODUCTION:
A majority of states have implemented maternal mortality review committees, but Illinois is the only state to also implement facility-level, multidisciplinary review of SMM at all obstetric hospitals as recommended by the Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists.

METHODS:
Facility-level multidisciplinary SMM review was implemented in all perinatal networks in 2017 using a modified 2-factor scoring system recommended by CDC/ACOG (ICU admission and >4 units of packed red blood cells). A standing external, multidisciplinary SMM review committee was also established to review a subset of reviewed cases to improve the hospital review process and to compare external committee decisions to the internal review.

RESULTS:
The external committee found 34% of SMMs were potentially preventable compared to 16% across internal review. In external review, the most common factors contributing to SMM was medical decision making, however internal review found pre-existing conditions and pregnancy complications as leading preventable factors. The external committee found more provider (63% vs 16%) and system (41% vs 16%) opportunities to alter SMM than the internal committees (patient factors).

CONCLUSION:
This study is the first to present findings on statewide implementation of SMM review both within hospital and by external committee and compare parallel facility-level and state-level review. External review shows more preventability and more provider and system opportunities to prevent SMM compared to internal review. External review by a multidisciplinary committee provided more opportunities to identify strategies to alter outcomes, however both offer opportunities for quality improvement and population-based findings.