bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Elagolix on Menstrual Blood Loss in Women With Uterine Fibroids and Adenomyosis [15B]
Authors: Muneyyirci-Delale Ozgul , Bradley Linda D. , Kim Jin Hee , Wang Hui , Owens Charlotte , Simon James A. 
Published: April 2020

INTRODUCTION:
Evaluate the efficacy of elagolix with add-back therapy on menstrual blood loss (MBL) and safety in women with uterine fibroids (UF), heavy menstrual bleeding (HMB) and adenomyosis.

METHODS:
Pooled data from two investigational, IRB approved, 6-month, randomized, double-blind, placebo-controlled phase 3 studies, Elaris UF-1 and UF-2, was used to conduct a subset analysis in premenopausal women (18–51 years) with HMB (>80mL MBL/cycle) associated with UF and baseline adenomyosis diagnosed by ultrasound and/or MRI. Primary endpoint was the proportion of women with <80mL MBL during the final month and ≥50% reduction in MBL from baseline to final month. Secondary and other efficacy endpoints included proportion of women who achieved amenorrhea or suppression of bleeding during the final month. MBL was assessed with alkaline hematin method. Adverse events (AEs) and bone mineral density (BMD) were monitored.

RESULTS:
Of 790 women treated, 126 (16%) had adenomyosis at baseline. Proportion of responders for the primary endpoint was significantly greater (P<.001) for elagolix+E2/NETA [76.8% (95% CI 65.84, 87.82)] compared to placebo [12.1% (95% CI 0.97, 23.15)]. Responder rate was significantly greater (P<.001) for elagolix+E2/NETA versus placebo for amenorrhea and suppression of bleeding. These results, along with AEs and mean change in lumbar BMD from baseline to month 6, were consistent with the all-subject group.

CONCLUSION:
In women with HMB associated with UF and co-existing adenomyosis at baseline, elagolix +E2/NETA significantly reduced MBL versus placebo similar to the all-subject group suggesting that elagolix is effective in reducing HMB in women with UF despite the presence of adenomyosis.
Effect of Prunes on Gastrointestinal Function After Benign Gynecological Surgery: A Randomized Control Trial [16B]
Authors: Rasouli Melody , Ozel Begum , Dancz Christina 
Published: April 2020

INTRODUCTION:
To investigate the effect of postoperative prune consumption on time to first bowel movement after benign gynecologic surgery.

METHODS:
In this randomized controlled trial, women who had benign gynecologic surgery who gave informed consent were allocated to either postoperative prune consumption for 3 days or standard care. Inclusion criteria was women over 18 years of age. Exclusion criteria included malignancy, bowel surgery, prior laxative use and diabetes mellitus. The study's primary objective was time to first bowel movement (BM). Secondary objectives were pain associated with first bowel movement, stool consistency using Bristol stool scale, and patient satisfaction.

RESULTS:
77 subjects were randomized (38 to prunes and 39 to controls). Complete data was available for 65% of subjects. Seven women in the control group and none in the prune group reported no bowel movement in the study period of 72 hours (P<.05). There was no difference in groups with respect to satisfaction with surgery, pain with first BM, stool consistency, satisfaction with bowel regimen or need for additional laxative use. Subgroup analysis of those who reported actual use (>24 prunes over 3 days) showed that the prune group were more likely to report a BM in the study period (P=.014), had looser stool consistency (P=.056) and were discharged slightly earlier (POD1 vs POD 2, P=.057).

CONCLUSION:
The addition of prunes to the post op bowel regimen results in greater percentage of women having a bowel movement in the first 72 hours.
Factors Associated With Variation in Vaginal Hysterectomy Rates in an Integrated Health Care System [18B]
Authors: Kandahari Nazineen , Tucker Lue-Yen , Ojo Anthonia , Zaritsky Eve 
Published: April 2020

INTRODUCTION:
Though ACOG endorses vaginal hysterectomy (VH) as the preferred surgical route for benign conditions, this has yet to be consistently translated into practice. We aimed to assess how much variation in VH rates are associated with patient characteristics and modifiable provider factors.

METHODS:
We conducted a retrospective cohort study of minimally invasive hysterectomies done for benign conditions at Kaiser Permanente Northern California from 2008 to 2018. We analyzed the proportion of surgical routes and outcomes, and the association between surgical route, patient characteristics, and provider characteristics using multivariable logistic regression.

RESULTS:
From 2008 to 2018, 44,379 hysterectomies were performed. The minimally invasive hysterectomy rates increased from 41.0% in 2008 to 97.0% in 2018 (P<.0001). VH rates varied from year to year but decreased overall from the highest rate of 27.5% in 2009 to 21.9% in 2018 (P<.0001). The rates by hospital ranged from 19.0% to 43.6%. VH rates were significantly lower than laparoscopic hysterectomy (LH) rates in patients who were obese and severely obese (P<.0001), were African American, or had uterine weights >500g (P<.0001). Differences by hospital persisted after controlling for uterine weight (P<.0001). Mean (±SD) surgery time was shorter for VH vs LH (2.2 (±1) vs 2.6 (±1.1) hours respectively, P<.0001). Mean (±SD) hospital stay decreased over time for VH from 37.8 (±21.5) to 7.7 (±11.5) hours (P<.0001). Operative and perioperative complications were low and comparable for all routes and years.

CONCLUSION:
There is large variation in VH rates by hospital after controlling for patient characteristics, demonstrating the need for evidence-based guidelines for route selection.
Heavy Menstrual Bleeding and Underlying Coagulopathy in an Adolescent Hematology Clinic [19B]
Authors: Mulvaney Kylie T. , Nelson Anita L. , Escovedo Michelle , Borzutzky Claudia 
Published: April 2020

INTRODUCTION:
Current literature and guidelines suggest evaluation for underlying coagulopathy among adolescents who report heavy menstrual bleeding (HMB). Adolescent women with HMB are found to have higher prevalence of coagulopathy than the general population. Our study highlights the prevalence of hemostatic disorders among adolescents referred to a specialty adolescent hematology clinic for evaluation of HMB.

METHODS:
This study is a retrospective chart review of women <22 years seen in a joint Adolescent Medicine and Hematology clinic at Children's Hospital Los Angeles from January 1, 2015 to May 22, 2018. The primary inclusion factor was referral for anemia and reported HMB. Following IRB approval, data was collected on menstrual history and diagnosis of coagulopathy.

RESULTS:
Of 109 referred, 37 (34%) patients were found to have underlying coagulopathy; most commonly diagnosed was von Willebrand Disease (17.4%) then platelet dysfunction (15.6%); 1 patient was diagnosed with hereditary hemorrhagic telangiectasia. Not all patients presented with chronic HMB; 2 patients had histories of a single prolonged menstrual bleeding episode requiring hospitalization, 3 patients had anemia but normal menses, and 3 patients with anemia had prolonged menses but normal flow. The impact of severe HMB on health care utilization was notable; 47 had required prolonged ER stays in the past (43%); 27 required transfusion (25%).

CONCLUSION:
Our results showed 34% prevalence of underlying coagulopathy among adolescents referred for HMB, which mirrors existing literature. Our findings reiterate the importance of evaluating the source of HMB through formal testing; menstrual history may not be sufficient in the adolescent population.
How Does Labia Minora Labiaplasty Surgery Impact Patients' Perceptions of Their Genitals? [20B]
Authors: Hailparn Troy R. 
Published: April 2020

INTRODUCTION:
Labia Minora Labiaplasty (LmL) surgery is sought after for comfort, function and appearance concerns but little is documented on how these surgeries affect women's perceptions of their genitals.

METHODS:
The impact of LmL on patients' perceptions of their genitals was evaluated using the Female Genital Self-Image Scale (FGSIS). Patients who underwent LmL were asked to fill out the FGSIS before and after surgery from August 2011 to May 2019. The Scores ranged from 7 to 28. The higher the score the more positive the perception. Pre- and Post-op scores were directly compared. Testimonials were collected.

RESULTS:
N=231 underwent LmL surgery and filled out the Pre-Op Questionnaires (Qs). The pre-op scores ranged from 7 to 26, mean score equaled 15.02 and the median pre-op score was 15. For N=217 who completed the Post-Op Qs, post-op scores ranged from 14 to 28 with mean post-op score of 25.45 and median score of 27. Twenty-one patients required a second procedure with higher FGSIS scores after the second procedure. The difference between the pre-op (CI 14.51, 15.52) and post-op (CI 25.02, 25.95) scores was strongly statistically significant (on the average 10 points higher) with a P-value=2.2 × 10−16.

CONCLUSION:
Labiaplasty surgery appears to have a positive impact on patients' perceptions of their genitalia using the FGSIS and testimonials. Labiaplasty surgery improves quality of life for women of all ages. The FGSIS can be a useful tool for practitioners to assess the success of LmL surgery.
Linzagolix for Endometriosis-Associated Pain: Lipid Changes After 52 Weeks of Treatment [25B]
Authors: Bestel Elke , Gotteland Jean-Pierre , Donnez Jacques , Taylor Robert N. , Garner Elizabeth I. 
Published: April 2020

INTRODUCTION:
Linzagolix is a new, investigational, non-peptide, GnRH receptor antagonist being developed to treat endometriosis-associated pain (EAP). The EDELWEISS trial was a Phase 2b, double-blind, randomized, placebo-controlled, multicenter, dose-ranging trial in USA and Europe evaluating once daily oral doses of 50, 75, 100 and 200 mg for up to 52 weeks. Subjects randomized to placebo were crossed over to 100 mg after 12 weeks and those randomized to 200 mg were crossed over to 100 mg after 24 weeks.

METHODS:
IRB approval was obtained. Participants were women with surgically confirmed endometriosis and moderate to severe EAP. Changes in serum lipids were assessed up to 52 weeks.

RESULTS:
327 patients were randomized and treated. Mean age was 32 years and mean BMI was 26. There were small percentage increases in LDL-cholesterol (C), HDL-C, LDL-C/HDL-C ratio and triglycerides, which did not increase further at 24 and 52 weeks. Except for LDL-C/HDL-C ratio, the largest increases were observed in the linzagolix 200 mg dose group; at week 24 there was an approximately 8% increase in HDL-C, 10% increase in LDL-C and 24% increase in triglycerides. In all treatment groups, the percentage of women with LDL-C > 160 mg/dL or triglycerides > 200 mg/dL at 24 weeks less than 10% and overall the percentages were similar to baseline.

CONCLUSION:
Linzagolix doses of 75 to 200 mg taken once daily for 52 weeks resulted in small percentage increases in serum lipids after 12 weeks, which did not increase further after 52 weeks of treatment.
Malignant Testicular Germ Cell Tumor in Late Adolescent With Androgen Insensitivity Syndrome [26B]
Authors: Cruz Burgos Rosa I. , Rodriguez Gonzalez Zaskia M. , Bosch Ramirez Agnes M. , Mejias Jorge 
Published: April 2020

INTRODUCTION:
Androgen receptor mutations located in the X chromosome may present as several clinical disorders. When total function of the androgen receptor is loss in a male, complete androgen insensitivity syndrome develops. A phenotypically normal appearing female develops without uterus, fallopian tubes, short vagina and bilateral intraperitoneal testes. Germ cell neoplasia may develop and the risk of developing malignant germ cell tumor is approximately a 5% that gradually increases after puberty. Although gonadectomy is the actual management, there is no consensus about the specific timing for gonadectomy or risk of developing malignant germ cell tumor by age.

METHODS:
IRB, Consent.

RESULTS:
15-year-old girl with primary amenorrhea, no relevant medical history and Tanner stage four for breast and pubic hair. Complete androgen insensitivity syndrome was diagnosed by means of transabdominal ultrasound, normal male testosterone levels and karyotype 46XY. Laparoscopic gonadectomy was performed at 18-year-old due to loss of follow up. Pathology with immunohistochemistry reported bilateral germ cell neoplasia in situ and unilateral seminoma.

CONCLUSION:
This case presents with an early development of a seminoma and appoints to reconsider an earlier post pubertal gonadectomy. A 30% risk of developing malignant germ cell tumor in late adulthood also supports the decision for an earlier gonadectomy. This case challenges the typical presentation of a female patient with complete androgen insensitivity syndrome, due to a clinical presentation with adequate tanner stage development. Considerations must be taken into account when dealing with a non-compliant patient, addressing the traditional timeline management to a more individualized clinical evaluation and prompt management.
Menstrual Hygiene Needs Among Women Receiving Substance Use Disorder Treatment [27B]
Authors: Keiser Victoria , Parlier-Ahmad Anna Beth , Martin Caitlin E. 
Published: April 2020

INTRODUCTION:
Recent research has highlighted the high unmet menstrual hygiene product needs among low income women. The aim of this study was to evaluate the menstrual hygiene needs of women receiving treatment for substance use disorders (SUD).

METHODS:
Patients were recruited from an urban, outpatient SUD clinic to complete a voluntary, electronic, cross-sectional survey between July and September 2019. Menstrual hygiene questions were modeled from prior work (Kuhlmann et al., Obstetrics and Gynecology, February 2019) with author permission. Women were classified as having menstrual poverty if they reported needing menstrual hygiene products but not having the money to buy them in the past 12 months. Factors associated with menstrual poverty were assessed using χ2 tests. Exempted by VCU IRB.

RESULTS:
Eighty-six (94.5% response rate) women completed the survey, of whom 36 (41.9%) had a period in the past 12 months and were included in the study. Almost all (94.4%) were in treatment for opioid use disorder. Mean age was 34.69 (SD 7.433) years. Women were predominantly African American (50%), educated at a high school level (55.6%), unemployed (55.6%), and receiving public assistance (66.7%). Most (n=29; 80.6%) reported menstrual poverty. Menstrual poverty was not associated with heavy menstrual bleeding but was associated with food insecurity (P=.005). Many (n=23; 63.9%) stated they would like to receive hygiene products at the addiction clinic.

CONCLUSION:
Menstrual hygiene products are a necessity that women receiving addiction treatment lack. In the opioid crisis, providers should be aware of this disparity. Integration of reproductive/sexual health with addiction services should be prioritized.
Perioperative Blood Transfusions: Risk Factors for Patients Undergoing Hysterectomy for Benign Disease [29B]
Authors: Timmons Douglas , Grady Mary , Lederer Madeline , Ulker Ashley , Verna Ayita , Carugno Jose 
Published: April 2020

INTRODUCTION:
Perioperative blood transfusion increases morbidity and increases significantly health care cost. Identifying risk factors for perioperative blood transfusion can help to minimize risks. Our objective was to identify risk factors for perioperative blood transfusion in patients undergoing hysterectomy for benign indications.

METHODS:
We completed a retrospective chart review of patients who had undergone abdominal, laparoscopic, or vaginal hysterectomy. The following risk factors for blood transfusion were analyzed, 1. Route of Hysterectomy 2. Patient's BMI 3. Presence of adhesions 4. History of Cesarean Section 5. Uterine weight. Descriptive statistic was used to analyze the data.

RESULTS:
517 charts were reviewed. Forty-seven patients (9.09%) received perioperative blood transfusion. The route of hysterectomy was as follows: TAH: 34/263 (12.92%), TLH: 5/119 (4.2%), LAVH: 3/35 (8.57%), and VH: 5/100 (5.0%). Abdominal hysterectomy was a significant risk factor for receiving blood transfusions (P=.017). The patients who needed blood transfusion had larger BMI 33.01 vs 29.5 (P=.002), larger uterine weight 933.4 gm vs 542.5 gm (P=.002). There was no association between the presence of adhesions (P=.91) nor history of cesarean section (P=.89) with the need to receive blood transfusion. When analyzing only the patients who underwent TLH, pelvic adhesions was found as a risk factor for perioperative blood transfusion (P=.024).

CONCLUSION:
Blood transfusion is a frequent complication in patients undergoing hysterectomy for benign disease. Having a large uterus and obesity are risk factors for the need to receive blood transfusion. The presence of pelvic adhesion was risk factor for blood transfusion only in patients undergoing a laparoscopic approach.
Racial and Ethnic Disparities in Hysterectomies for Leiomyomas by Surgical Approach [31B]
Authors: Ko Jamie S. , Suh Christina H. , Huang Huang , Zhuo Haoran , Harmanli Oz , Zhang Yawei 
Published: April 2020

INTRODUCTION:
Overall, minority women are at higher risk of complications after hysterectomy. This is partly explained by lower utilization of minimally invasive hysterectomy and higher prevalence of leiomyomas. Our objective was to evaluate the association between race/ethnicity and postoperative complications among patients undergoing abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or vaginal hysterectomy (VH) specifically for leiomyomas.

METHODS:
Using the American College of Surgeons National Quality Improvement Program database 2014–2017, we identified 20,133 women who underwent non-emergent hysterectomy for leiomyomas. Using multivariate logistic regression, we estimated odds ratios (OR) and 95% confidence intervals controlling for age, body mass index, comorbidities, uterine weight, prior abdominal/pelvic surgeries, and concomitant surgical procedures. IRB approval was waived.

RESULTS:
Black women were more likely to experience complications for AH (aOR 1.54 [1.32–1.80]) and LH (aOR 1.38 [1.17–1.64]), but not for VH (aOR 1.44 [0.92–2.28]) compared to white women. Hispanic women were more likely to receive blood transfusions when undergoing AH (aOR 1.43 [1.07–1.91]) or LH (aOR 2.17 [1.37–3.45]), but their risk of total complications was not different from white women for any surgical approach, and they were less likely than their white counterparts to experience major complications when undergoing VH (aOR 0.27 [0.08–0.89]). Compared to white women, the mean length of stay is higher for black women undergoing AH or LH, and the mean total operation time is higher for all minority groups (including Asian/Other) regardless of surgical approach.

CONCLUSION:
Significant racial/ethnic disparities exist among women undergoing hysterectomy for leiomyomas via the abdominal and laparoscopic approaches but not vaginal.
Trend of Uterine Rupture and Different Approaches of Myomectomy [35B]
Authors: Badeghiesh Ahmad , Gil Yaron , Suarthana Eva , Mansour Fady , Volodarsky-Perel Alexander , Tulandi Togas 
Published: April 2020

INTRODUCTION:
Uterine rupture is an uncommon typically occurring during pregnancy or labor. One of the risk factors in uterine rupture is previous myomectomy either by laparoscopy or laparotomy. Due to regulation of FDA on myoma morcellation, many gynecologists have returned to myomectomy by laparotomy. The purpose of the study was to evaluate this shift in surgical trends and the possible subsequent changes in number of uterine ruptures over the years.

METHODS:
Retrospective cohort study using the HCUP-NIS database. Our cohort consisted of women, aged 18 – 40 years, who underwent myomectomy by laparoscopy or laparotomy, and who suffered uterine rupture during pregnancy or labor between 2005 and 2014.

RESULTS:
Of a total 54,146 myomectomies, there were 237 uterine ruptures. The mean age of the patients was 31.8 years, they were mainly Caucasians, had private insurance and had high income. The myomectomy was performed mainly by laparotomy (97.7%); and 2.3% by laparoscopy. There was a decrease of total number of myomectomies performed annually, from 6646 in 2005 to 4589 in 2014. The numbers of uterine ruptures per 1,000 myomectomies were 4.2 after laparotomy and 10.6 after laparoscopic approach. Laparoscopic myomectomy increased the risk of uterine rupture by 2.3 fold [OR 2.3, 95% CI 1.2–4.2, P=.008] compared to open myomectomy after adjustment for sociodemographic and clinical characteristics.

CONCLUSION:
The myomectomies trend changed in recent years with a predominance of laparotomies over laparoscopies. Laparoscopic myomectomy increases the chance for uterine rupture with over 2 folds compared to open approach. More studies are needed to clarify this matter.
What Are Our Postoperative Hysterectomy Patients Sharing on Social Media? [37B]
Authors: Onyechi Elizabeth , Sharma Deepti , Mirtsching Drennen S. , Hoffman Mark 
Published: April 2020

INTRODUCTION:
Millions of people use social media to share their experiences, including healthcare experiences. Data on what patients actually post is lacking. This study attempts to better understand the experience of patients, as well as examine who is posting on these platforms.

METHODS:
Two popular search terms were identified: #hysterectomyrecovery and #hysterectomypostop. The most recent Instagram, Twitter, and YouTube posts were reviewed. Authorship of the post was determined based on the bio of the poster and classified as patient, provider, advertisement, organization/institution, or unclassified. For patient posts, theses were further analyzed based on language/content of the post for tone: positive, neutral, or negative.

RESULTS:
Authorship of posts varied by platform. Identified Instagram posts were 64% by patients, 17% advertisements, 17% organization/institution, and 1% unclassified. 100% of Twitter posts originated from patients. YouTube posts were 47% patient and 47% healthcare provider. Tone of posts also varied by platform. 69% of Instagram posts were positive versus 15% negative. 83% of Twitter posts were positive versus 9% negative. 50% of YouTube posts were positive versus 43% negative.

CONCLUSION:
There are many posts about hysterectomy post-op and recovery on different platforms. Twitter and Instagram tend to have more patient-driven posts, whereas YouTube has equal patient and provider posts. Patients tend to have more positive tone related to hysterectomy experience on YouTube, Instagram, and Twitter, in increasing order. Prevailing wisdom suggests that social media draws negative attention to healthcare. Our study would suggest that while most of the posts on social media platforms were patient-driven, the majority were positive.