bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breastfeeding and HIV in the Era of Undetectable=Untransmittable: Research, Policy, and Lived Experiences [01A]
Authors: Martel Krista , Conley Jenna 
Published: April 2020

INTRODUCTION:
Evidence that maintaining undetectable HIV viral load eliminates risk of sexual transmission (Undetectable=Untransmittable or “U=U”) has shifted paradigms in HIV care, introducing the potential for safe and natural conception and decreasing stigma. In this setting, U.S. women living with HIV (WLHIV) are questioning the recommendation against breastfeeding, particularly given breastfeeding's known personal and health benefits for infants and women.

METHODS:
We perform scoping review of infant feeding for WLHIV, highlight available evidence on breastfeeding, provide international context, and present preliminary findings from healthcare provider and patient interviews and surveys.

RESULTS:
Research on breastfeeding with HIV predominantly occurs in low-resource settings, limiting applicability to U.S. populations. The World Health Organization guidelines recommend breastfeeding for WLHIV in low-resource settings due to improved infant outcomes. U.S. policy aims to minimize perinatal HIV transmission, without considering the potential health risks of avoiding breastfeeding for infants and women; however in 2018, US guidelines have incorporated harm reduction language to help clinicians support women who breastfeed despite current recommendations. WLHIV identify concerns of stigma, inequity, feelings of maternal inadequacy, and fears around HIV criminalization related to breastfeeding. Providers express need for more education and relevant research. Both groups indicate that evidence-based shared decision-making, rather than harm reduction, may be a more appropriate approach in the U=U era.

CONCLUSION:
Further medical research and ethical evaluation of the recommendation against breastfeeding for U.S. WLHIV is needed. Provider and patient education should be prioritized to promote informed decisions and observational research participation. We advocate for more nuanced policy and individualized recommendations.
Physician Survey Results: Clinical Practice Training Is Needed to Improve Ob/Gyn PrEP Adoption [02A]
Authors: Simoncini Gina M. , Koren David E. , D'Avanzo Paul A. , Diaz Quinones Juan J. , Brajuha Jesse , Bass Sarah B. 
Published: April 2020

INTRODUCTION:
Human immunodeficiency (HIV) disease prevention with pre-exposure prophylaxis (PrEP) is marred by disparities, especially among women and other high risk groups. PrEP prescribing adoption by primary care physicians including obstetrics and gynecology (Ob/Gyn) providers is crucial to improve HIV prevention.

METHODS:
We modified a previously validated PrEP provider survey and administered it online through REDCap to faculty and categorical residents in the Departments of Ob/Gyn and General Internal Medicine (GIM) of a large urban hospital. T-tests and chi-square tests were performed with an alpha significance value of 0.05.

RESULTS:
61 provider-surveys were completed (24 Ob/Gyn, 37 GIM). No statistically significant differences were observed by age or race, however there were a higher proportion of female-identified providers in Ob/Gyn (87.5%) compared to GIM (54.1%) (P=.01). The Ob/Gyn surveys demonstrated significant differences in the clinical processes for PrEP management. Surveys demonstrated perceived deficiencies in provider training/education (P=.006), clinical practice guidelines (P=.001), availability of resource access (such as PrEP guidelines/protocols) (P=.003), peers/colleagues who are knowledgeable about or supportive of PrEP provision within their practice (P=.008), and lab monitoring requirements (P=.019). GIM respondents were more likely to believe they knew enough about PrEP to feel comfortable prescribing it (P=.005), thought it was feasible to prescribe in GIM and OB/Gyn settings compared to HIV prevention/care clinics (P=.019) and to say they would be likely to prescribe PrEP in the next 6 months (P=.01).

CONCLUSION:
Overall, results indicate that improved clinical practice training and processes are necessary to increase PrEP adoption in OB/Gyn clinical settings.
Early Prediction of Sepsis: Cohort Study of Maternal Pyelonephritis [07A]
Authors: Kidd Jennifer M. J. , Gimovsky Martin 
Published: April 2020

INTRODUCTION:
Guidelines from the Society of Critical Care Medicine (SCCM) on maternal sepsis are limited. The Sepsis in Obstetrics Score has been proposed as a maternal specific sepsis score. This study attempts to identify sepsis before diagnosis using a modified form of this score. For consistent pathology across patients, a cohort of maternal pyelonephritis cases were used to capture sepsis cases.

METHODS:
An IRB approved retrospective cohort study included maternal admissions for pyelonephritis from 2016 to 2019. Exclusion criteria were absence of fetal tracing, alternative diagnosis on admission, or multiple gestation. Chart review included maternal demographics, obstetric history, insurance status, prenatal care access, cultures, and sepsis status. Sepsis score was calculated by presentation maternal vitals and fetal heart rate.

RESULTS:
The cohort included 72 patients diagnosed with pyelonephritis of which 22% had sepsis. The average cohort patient was black, insured, and reported prenatal care access. The sepsis group was younger, more nulliparous, and more likely to have positive urine cultures. Only 59% of positive urine cultures were E. coli. As expected the sepsis group had more positive blood cultures. However, the sepsis score did not identify sepsis status.

CONCLUSION:
This study is strengthened by a homogeneous cohort of singular disease pathology. However, the duration of pathology varied at presentation and could not be case matched potentially affecting the sepsis cohort. This study does not support the proposed sepsis scoring. The scoring could be improved by the addition of patient risk factors. Further study is needed to identify predictors of sepsis in the gravid patient.
Posaconazole as a Highly Efficacious Alternative for Treating Recurrent and Resistant Vulvovaginal Candidiasis [13A]
Authors: Tiran-Saucedo Jose , Garza Humberto , Godinez Jesus Alfonso , León Camacho Yvette Karina , Sepúlveda Argáez Ana Gabriela , Méndez Bertrand Jean-Carla 
Published: April 2020

INTRODUCTION:
Candidiasis is the second most common type of vaginal infection. Sometimes successful treatment due to underlying conditions, long standing disease, or even resistance emerging against antifungals, make it a real challenge. New alternative options are needed to help our patients heal faster and for longer periods of time.

METHODS:
We conducted a longitudinal descriptive study, in a private clinic setting IMIGO in Monterrey Mexico between January 2017 to October 2019, on 11 female patients with a diagnosis of recurrent and/or resistant vulvovaginal candidiasis between 23 to 59 years of age who after receiving multiple unsuccessful antifungal treatments, were treated with posaconazole as an alternative treatment option. Analysis of outcomes on recurrence of disease, disease free intervals, and number of treatment schedules needed for successful treatment of vulvovaginal candidiasis were evaluated.

RESULTS:
The 11 patients included in the study previously received multiples cycles of antifungals ranging from 1 to 7 (fluconazole, itraconazole, nystatin, terbinafine) with remission periods from 3 days to a maximum of 5 months. All patients were treated with posaconazole without need of a second cycle with remissions ranging from 6 months to 21 months.

CONCLUSION:
Posaconazole showed great results in patients with vulvovaginal candida resistant and recurrent infections with longer remission periods. This first 11 patients results show posaconazole to be considered as an antifungal of choice in this cases.
Prenatal Hepatitis C Screening in Kentucky: Does a Change in the Law Change Clinical Practice? [14A]
Authors: Winter Kathleen 
Published: April 2020

INTRODUCTION:
Prevalence of hepatitis C virus (HCV) infection among pregnant women is highest in Kentucky. ACOG endorses a risk-based approach for prenatal HCV screening; however gaps in identification can occur. In 2018, Kentucky became the first state nationwide to legislatively mandate universal HCV screening for all pregnant women.

METHODS:
This retrospective study evaluates trends of prenatal HCV testing before and after a universal HCV screening requirement. Women with an ICD-9/ICD-10 code indicating delivery at UK Healthcare (UKHC) in 2016 through 2018 were identified; those with laboratory results for HBsAg in the 10 months prior to delivery were considered to have had prenatal care within UKHC and included in the study cohort. Electronic medical records were reviewed to identify maternal characteristics and anti-HCV test results.

RESULTS:
Among 5,616 women with deliveries, 3,869 (69%) had documentation of prenatal HBsAg testing and included in the study cohort. Of these, 48 (1.2%) had a diagnosis of HCV infection and an additional 716 (19%) had prenatal anti-HCV testing. Among women screened for HCV, 179 (25%) were anti-HCV positive. A total of 363 women in the cohort had a diagnosis indicating illicit drug use; 53 (15%) were neither tested for HCV nor had an existing HCV diagnosis. Prevalence of prenatal HCV screening increased significantly from 18% at baseline to 31% among women who delivered after the universal screening legislation became effective (P<.0001).

CONCLUSION:
A significant increase in HCV testing was observed following the universal HCV screening legislation, however testing uptake remained low. Efforts to improve implementation are warranted.
The State of HPV Vaccination in Rhode Island: Qualifying Outcomes of a School Entry Vaccine Mandate [17A]
Authors: Froehlich Allison , Anand Rajsavi , Sarkar Indra Neil , Chen Elizabeth 
Published: April 2020

INTRODUCTION:
In 2015, RI became one of two states and Washington, DC to mandate HPV vaccination for school entry and RI's is the only mandate to include boys. Previous studies have described longitudinal trends in HPV vaccination rates in RI but no studies to date have evaluated factors predictive of vaccine series completion. The goal of this project was to identify factors predictive of up-to-date HPV vaccination status in RI and evaluate how factors change in the face of an implemented mandate.

METHODS:
Data were extracted from the National Immunization Survey-Teen for years 2012–2017 and then transformed and analyzed in Julia. Binomial logistic regression modeling was applied to evaluate predictive factors related to up-to-date vaccination status for RI teens surrounding implementation of the school mandate.

RESULTS:
In the pre-mandate period, maternal education level and income level were predictive (p less than 0.05) of up-to-date vaccine status for girls. In the post-mandate period, maternal education level and income level remained predictive in addition to patient-reported provider recommendation for girls (p less than 0.05). No factors in the pre- or post-mandate period were predictive of up-to-date status for boys.

CONCLUSION:
Parent-reported provider recommendation was predictive of up-to-date HPV vaccination status for girls in RI in the setting of a vaccine mandate. Qualifying significant predictors of HPV vaccine series completion and effectiveness of provider recommendation is important at the individual and policy level for implementing, evaluating, and improving the efficacy of an opt-in versus opt-out structure of HPV vaccination.
Women's Attitudes Toward Vaccination During Preconception Care [19A]
Authors: Foley Elise , Marsh Courtney , Lydic Michael , Ault Kevin 
Published: April 2020

INTRODUCTION:
Infection with Rubella or Varicella during pregnancy can have potentially lethal consequences to the fetus. Increasingly pervasive anti-vaccine beliefs make it even more critical for providers to assess adherence to MMR and Varicella vaccination, particularly in women attempting pregnancy. The primary outcome of this study was prevalence of non-immune status to Rubella and Varicella. Secondary measures were obtained from those with a negative immunity titer: self-reported attitudes, self-reported incidence of follow-up, recency of vaccine counseling and knowledge of CDC vaccination recommendations.

METHODS:
University of Kansas Health System Advanced Reproductive Care clinic patients from January 2017 through June 2019 with negative Rubella or Varicella titer results were invited to anonymously participate in an IRB approved survey.

RESULTS:
1,767 patient records were reviewed. Non-immune status to Rubella and Varicella represented 7.2% (n=124) and 4.5% (n=79) of records, respectively. Surveys administered to all non-immune patients achieved a 32.5% (n=65) response rate. A minority of respondents did not receive the recommended vaccines following a negative titer, reportedly not wishing to further delay fertility treatment. Most respondents stated that they would be open to further vaccine education from their providers (67.7%).

CONCLUSION:
The prevalence of Rubella non-immunity in the study population fell within the recognized range for sufficient herd immunity (less than 13%). Our results indicate that women have a generally positive attitude toward vaccine education during pre-conception counseling. The risk/benefit analysis of postponing fertility treatment to achieve adequate levels of immunity should be a focused discussion with patients in the setting of advanced reproductive care.
HCG and FSH Levels During Early Pregnancy and Reproductive Aging [24A]
Authors: Zinaman Michael J. , Johnson Sarah , Warren Graham 
Published: April 2020

INTRODUCTION:
hCG has high sensitivity and specificity for pregnancy, but low levels of hCG are known to be co-produced with FSH during reproductive aging.

METHODS:
Women were recruited preconception to collect daily urine samples from menses to 30 days after conception (if they became pregnant). Day of LH surge was determined for each conception cycle. Samples were also collected from not pregnant pre-, peri- and post- menopausal women. hCG, FSH and LH were measured by AutoDELFIA. A total of 6475 pregnancy samples and 395 non pregnancy samples were examined to create reference ranges.

RESULTS:
In not pregnant women, both hCG and FSH levels increased with age category. Women aged 20–39, generally had no hCG (maximal amount 0.6 mIU/ml), with maximal FSH of 25.5 mIU/ml. In women aged 40-maximal hCG was 4.8 mIU/ml hCG with 234 mIU/ml FSH, for women aged 50+, maximal level was 6.5 mIU/ml hCG and 297 mIU/ml FSH. In pregnancy, median post ovulation levels hCG levels were; 0 mIU/ml at 6–10 days, 61 mIU/ml at 11–15 days, 617 mIU/ml at 16–10 days, 3216 mIU/ml at 21–25 days and 9930 mIU/ml at 26–30 days. FSH declined from a median of 1.7 mIU/ml (maximum 18.3 mIU/ml) 6–10 days post ovulation to a maximal level of 0.1 mIU/ml 26–30 days post ovulation.

CONCLUSION:
FSH remains very low throughout early pregnancy, with hCG rising exponentially. Detectable levels of hCG were seen in some women of peri- and post- menopausal age, with FSH levels showing significant elevation. Therefore, to rule out pregnancy in a peri-menopausal woman with low hCG levels, FSH could be examined.
The Limitations of Middle Cerebral Artery Peak Systolic Velocity and the Need for Certification [38A]
Authors: Mayer Christopher , Rijhsinghani Asha , Parikh Raina 
Published: April 2020

INTRODUCTION:
In fetuses at risk for anemia, middle cerebral artery-peak systolic velocity (MCA-PSV) may have a 12% false-positive rate. Guidelines suggest MCA-PSV is superior to amniocentesis for detection of anemia, provided the correct technique is used. We aim to describe the limitations of MCA-PSV in the diagnosis of fetal anemia and the need for MCA-PSV certification for tertiary care fetal centers.

METHODS:
This is a university based single-center retrospective study of 47 sensitized pregnancies suspected to have fetal anemia that underwent amniocentesis. Fetal anemia was suspected on elevated MCA-PSV >1.5 MoM. Amniotic fluid ΔOD450 was measured in all pregnancies. Fetuses with amniotic fluid ΔOD450 in zone 3 on Liley's chart, underwent cordocentesis for the assessment of fetal anemia. Intrauterine fetal transfusion (IUT) was performed in fetuses confirmed with anemia. Fetal anemia indicating IUT was defined as ≥5 SD below the mean for GA and Hematocrit ≤30%.

RESULTS:
Among sensitized pregnancies with elevated fetal MCA-PSV, 19 (40.4%) had elevated ΔOD450 measurements. Of these 19 fetuses, 15 (78.9%) required IUT. In 28/47 (59.6%) with normal ΔOD450, elevated MCA-PSV incorrectly predicted fetal anemia, increasing the amniocentesis related risks. This is much higher than the published false positive results of 12%.

CONCLUSION:
The decreased specificity of MCA-PSV for fetal anemia diagnoses may be associated with user variability. While MCA-PSV has clinical benefit for the initial workup, the additional amniocentesis confirmation reduced the need for cordocentesis. Amniocentesis also has risks and to further reduce the need for invasive diagnostic testing, we recommend a Certification for MCA-PSV Doppler sonography.
Contraceptive Use Among Women With a History of Physical or Sexual Violence [01B]
Authors: Foxx Alexandra , Thompson Ivana S. 
Published: April 2020

INTRODUCTION:
Physical and sexual violence often begins in women's early reproductive years and can have longstanding impact on their lives and reproductive choices. While studies demonstrate decreased rates of contraception use in women experiencing abuse or intimate partner violence (IPV), none have examined the effect of interpersonal violence on the use of specific contraception methods.

METHODS:
Using ICD-9 and ICD-10 medical billing codes, we identified reproductive aged women who experienced physical or sexual violence in our academic OB/GYN practice from 2000 to 2019. We examined their outpatient medical records to determine their most recently used contraceptive method. The control group was comprised of randomly selected reproductive aged women without a history of violence who received outpatient care with our practice in the study period. IRB# 191005.

RESULTS:
The contraceptive methods used by women who experienced physical or sexual violence were significantly different from the contraceptive methods used by women without a history of violence (P<.01). Survivors of violence were more likely to use no method of contraception (26.6% vs 14.0%, P<.05) or women-controlled permanent contraceptive methods (21.8% vs 12.5%, P<.05). Women who had not experienced violence were more likely to use combined hormonal methods (41.2% vs 24.2%, P<.01) and vasectomy (0% vs 6.6%, P<.05).

CONCLUSION:
There are differences in the general utilization of contraception and specific contraceptive methods used by women who have survived violence as compared to peers who have not experienced violence. Knowledge of these differences may benefit the counseling, education, and provision of contraception to this unique population.
Barriers to Obstetric and Gynecologic Care for Women Who Use Wheelchairs [10B]
Authors: Carney Madeline H. , Holt Lauren , Kumar Ambuj , Duncanson Lauren , Woodard Laurie , Mckeon Bri Anne 
Published: April 2020

INTRODUCTION:
Individuals with disabilities face significant barriers to healthcare and are at a higher risk of receiving inadequate care. Specifically, women with disabilities are more likely to be behind on routine screening examinations including Pap tests and screening mammography. This project aims to identify and explain the barriers that prevent female wheelchair users from obtaining standard gynecologic health care.

METHODS:
This IRB approved qualitative study was conducted to evaluate the barriers associated with seeking gynecologic health care among female wheelchair users. We recruited English-speaking female participants ages 18 and older who primarily used a wheelchair for mobility through flyer distribution and word of mouth. Interviews were conducted by a single investigator using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes.

RESULTS:
The thematic saturation was achieved with sixteen interviews. The most common barrier cited was lack of proper positioning on the exam table to perform a pelvic exam (n=13). Furthermore, another common theme was that women felt that their providers lacked knowledge and experience with women who use wheelchairs (n=13).

CONCLUSION:
There are many barriers to OB/GYN care for women who use wheelchairs. This study has identified how current knowledge, attitudes, practices, and existing infrastructure serve as barriers to gynecologic care. Interventions are needed to improve accessibility to care for women who use wheelchairs.
Does Fibroid Size and Bulk Affect Uterine Fibroid Symptom (UFS) Scores in Asian Compared to Caucasian Women? [13B]
Authors: Dhanani Zainub , Ramirez Norma Jimenez , Ghanouni Pejman , Chen Bertha 
Published: April 2020

INTRODUCTION:
Uterine fibroids commonly cause pelvic symptoms, abnormal uterine bleeding, and urinary symptoms. According to past UFS data analysis, Asian women report significantly lower symptoms compared to Caucasians. Etiology of this difference has not been studied and may impact early detection and treatment for Asian women. Differences in fibroid burden, clinical risk factors and parity between Asians and Caucasians may correlate to the difference in UFS scores. We examined correlations between race and fibroid symptom severity using MRI and patient clinical data.

METHODS:
A retrospective cohort study (2013–2016) of Stanford Fibroid Clinic patients identified Caucasians (n=146) and Asians (n=123) with completed UFS surveys and pelvic MRIs. UFS scores and subscores, MRI data, clinical risk factors, and parity were correlated to race. Data were analyzed using Pearson's T-test and Chi squared analysis.

RESULTS:
Asians had significantly lower BMI values (P=5.31e-09) and were more likely nonsmokers (P=.003) vs Caucasians. Asians were less likely to report pain (P=.010), urinary frequency (P=.032) and urinary stress incontinence (P=.045). There was no significant difference in fibroid burden between groups (P=.618).

CONCLUSION:
Significant differences in BMI and smoking history may contribute to observed UFS score differences between Asian and Caucasian women, as both have been correlated to increased symptom severity of uterine fibroids in past studies. Conversely, fibroid burden and parity are not associated with the differential symptom experience. Further study of cultural and social factors, and biochemical and inflammatory markers between Asian and Caucasian women with uterine fibroids is necessary to interpret the observed symptom differences.