bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefits of Routine, Opt-Out Abortion and Family Planning Training: 20 Years of the Ryan Program [02J]
Authors: Steinauer Jody , Turk Jema , Koenemann Katheryn , Simonson Kristin , Landy Uta 
Published: April 2020

INTRODUCTION:
To describe the effects of routine, opt-out abortion and family planning training on clinical exposure to uterine evacuation skills and intentions to provide abortion post-residency.

METHODS:
Data from the first 20 years of the Ryan Residency Training Program in Abortion and Family Planning (RP) were analyzed. Post-rotation surveys assessed residents’ experiences with abortion and intentions to provide abortions post-residency. The 2019 residency program director survey assessed benefits of training from the educators’ perspective. This study is considered exempt by the University of California San Francisco IRB.

RESULTS:
A total of 3,197 residents completed post-rotation surveys, for an overall response rate of 80.1%. During the rotation, residents, including those who partially participated, gained significant exposure to all methods of first- and second-trimester termination, with an average of 7.4 medication abortions, 11.8 manual uterine aspirations, 15.6 electric uterine aspirations and 5.8 second-trimester dilation and evacuations (D&E). Residents reported feeling competent to do aspiration procedures independently up to an average of 12.8 weeks. Eighty-one percent of residents intend to do abortions for medical reasons after residency and sixty-one percent for all reasons. Ninety-six percent of directors reported increased clinical competence in abortion and contraception among all residents after the rotation, and 68% reported the RP training helped improve continuity of care for patients.

CONCLUSION:
Routine, opt-out training in abortion and family planning gives OB-GYN residents an opportunity to gain the clinical skills necessary to integrate abortion into their patient care after residency.
Clinical Outcomes of Intrauterine Devices Inserted After Peripartum Intrauterine Infection [06J]
Authors: Ye Peggy P. , Kyrillos Alexandra , Teng Stephanie , Fernandez Stephen 
Published: April 2020

INTRODUCTION:
Postpartum intrauterine device (IUD) insertion is contraindicated after intrauterine infection such as chorioamnionitis or endometritis, as this theoretically increases risk of pelvic inflammatory disease (PID). We conducted a retrospective study to evaluate PID risk associated with IUD placement after delivery complicated by intrauterine infection.

METHODS:
A retrospective cohort receiving an IUD off-label within 3 months of a delivery complicated by intrauterine infection (INF+IUD) was identified and propensity matched to two control cohorts: patients with intrauterine infection but no IUD (INF Only), and patients without infection but receiving an IUD (IUD Only). PID and other complications within 9 months post-delivery were assessed by chart review. IRB approval was obtained.

RESULTS:
Eighty patients in each cohort had similar demographics with the exceptions of higher age, gravidity, and parity in the IUD Only group. Documented follow up occurred for 79 (99%), 44 (55%), and 77 (96%) in the INF+IUD, INF Only, and IUD Only groups, respectively (P<.0001). PID developed in one patient each in the INF+IUD and IUD Only cohorts, which was not statistically significant (P=1). The INF+IUD cohort experienced more abnormal bleeding (12.1% vs 0% vs 3.9% in INF+IUD, INF Only, and IUD Only groups, respectively, P=.048), which was not significant after controlling for IUD type. Three patients in the INF Only cohort were pregnant within 9 months, compared to 0 in both IUD groups (P=.024).

CONCLUSION:
This retrospective review does not show an increased risk of PID in patients receiving an IUD after peripartum intrauterine infection. Larger studies are needed to confirm these findings.
Contraceptive Counseling in the Zika Era: Primary Care Providers’ Perspective [07J]
Authors: Kaiser Jennifer , Sanders Jessica , Simmons Rebecca , Gawron Lori M. , Turok David Keith 
Published: April 2020

INTRODUCTION:
The 2015 Zika virus (ZIKV) outbreak emphasized the imperative for contraceptive counseling for at-risk populations such as Latinx women. This study assessed primary care providers’ knowledge, perception of risk, and approach to contraceptive counseling in response to ZIKV.

METHODS:
We performed a sequential mixed-methods, cross-sectional study with a survey and semi-structured interview. From 06/2018 to 08/2018 we recruited primary care providers from a federally qualified health organization in the Salt Lake City area that provides preventive care to non-pregnant Latinx women of reproductive age. The survey assessed demographics, contraceptive and ZIKV knowledge, and CDC ZIKV guideline adherence. The Health Belief Model informed our interview guide on contraceptive and ZIKV counseling. We performed descriptive analyses on survey data and analyzed qualitative data for dominant themes.

RESULTS:
Twenty-two of 40 (57%) providers participated. Twelve (55%) are family medicine physicians, seven are physician assistants (32%), and three are nurse practitioners (14%); 53% are women, and 96% identify as white. On contraceptive and ZIKV knowledge questions, providers averaged 69% and 81% correct respectively. Sixty-five percent reported CDC ZIKV guideline adherence. Qualitative themes include conditional ZIKV risk, neonatal-related severity of ZIKV, specific cues to action for counseling about ZIKV and contraception, and omission of the ZIKV risk to non-pregnant women who may become pregnant.

CONCLUSION:
Primary care providers perceive the risk of ZIKV; however, their knowledge, guideline adherence, and perception of risk do not translate into ZIKV-aware counseling. Our results demonstrate the need for action plans that ensure practice changes in response to emerging infectious diseases.
Contraceptive Uptake After Obstetric Anal Sphincter Injuries (OASIS): A 5-Year Retrospective Review [08J]
Authors: Fields Ian , Knapper Allyson , Garg Bharti , Gregory W. Thomas 
Published: April 2020

INTRODUCTION:
OASIS is a complication of vaginal delivery. Although recurrence rates are low, women often feel apprehensive regarding subsequent births, with some wishing to delay future pregnancy. We aimed to evaluate contraceptive practices and interpregnancy interval of women who sustained OASIS.

METHODS:
We conducted a retrospective chart review of women who sustained OASIS from 2012–2017. We selected women who delivered during the same time period without OASIS as controls. We abstracted relevant demographic characteristics, delivery data, and documented postpartum contraceptive choice provided. We performed our analysis using independent two-sample t-test and chi-square test for unadjusted analyses and multivariable logistic regression for adjusted analyses, with alpha<0.05.

RESULTS:
We included 314 women with OASIS and 297 without as controls. Women who experienced OASIS were more likely to be nulliparous, have an assisted vaginal delivery, and experience a wound complication. There were similar rates of postpartum contraceptive uptake in both groups (82% vs 84%, P=.58). Greater than 50% of women in each cohort chose hormonal or long-acting contraceptives, with the majority choosing long-acting methods. Our multivariable regression showed no difference in method choice between groups. Of women with OASIS who had a subsequent delivery, 14% chose elective Cesarean section and the OASIS recurrence rate was 6%. Average interpregnancy interval was no different between cohorts (19.6 vs 20.7 months, P=.53).

CONCLUSION:
Although there were no significant differences in contraception uptake or type used in women who experienced OASIS, overall hormonal and long-acting contraception uptake was high. Experiencing OASIS does not appear to affect interpregnancy interval.
Differences in Postpartum Contraceptive Use in Patients Delivered by Academic Versus Private Hospitalists [09J]
Authors: Cuartas Karen , Corey Joey , Pineles Beth , Wagner Stephen 
Published: April 2020

INTRODUCTION:
Research has shown that women discharged postpartum without a contraception plan are significantly more likely to have a suboptimal interpregnancy interval. There is a lack of evidence examining the differences in postpartum contraception rates in patients treated by an academic hospitalist versus a private hospitalist.

METHODS:
A retrospective cohort study was completed examining women who delivered at a community hospital under the care of the hospitalist service surrounding a transition from a private to academic hospitalist service. Institutional Review Board approval was obtained. Records were collected for deliveries during six months in 2018. The primary outcome was postpartum women discharged without a contraceptive plan. Data was compared using a chi-square test. Relative risks with 95% confidence intervals were calculated.

RESULTS:
245 patients were delivered by a private physician and 447 patients were delivered by an academic physician. Patients delivered by an academic physician chose not to receive any contraception less often than patients delivered by a private physician (24% vs 32%: relative risk [RR] 0.67, 95% confidence interval [CI] [0.47-0.95]). Those delivered by an academic physician chose to receive long-acting reversible contraception more often than those delivered by a private physician (11% vs 1%: RR 9.48 [CI 2.92-30.79]). There was no difference in receiving a bilateral tubal ligation (1% vs 2%: RR 0.82 [CI 0.23-2.93]) or user-dependent contraception between the two groups (64% vs 65%: RR 0.96 [CI 0.69-1.33]).

CONCLUSION:
Postpartum patients receiving care from an academic laborist were more likely to have a contraception plan at discharge and to desire long-acting reversible contraception.
Effect of Delivery Room Postpartum Contraceptive Implant Insertion on Initiation of Breastfeeding [11J]
Authors: Shaw Kate A. , Lerma Klaira , Reyes Griselda , Gutow Hanna , Shaw Jonathan G. 
Published: April 2020

INTRODUCTION:
Initiation of postpartum contraception prior to hospital discharge has been limited by concerns about the impact of progestins on breastfeeding. Previous studies support initiation prior to hospital discharge. Insertion of the contraceptive implant in the delivery room is a convenient strategy to ensure desired contraceptive uptake prior to discharge. We designed a non-inferiority randomized controlled trial to determine if time to lactogenesis stage II (LTII; initiation of copious milk secretion) differs by timing of implant insertion.

METHODS:
We randomly assigned 95 pregnant people with intent to breastfeed, who desired the contraceptive implant to insertion 0-2-hours (delivery room) or 24-48-hours (delayed) post-delivery. We collected demographics and self-reported LTII using a validated tool.

RESULTS:
As-treated analysis included 71 participants (n=35 delivery room, n=36 delayed). Participants were similar between groups: mean age 25.5 years and median gestation over 39 weeks. The majority were admitted for labor induction (54%), used epidural anesthesia (87%) and had a vaginal delivery (81%) with no differences by group. Mean time to LTII did not differ significantly (delivery room: 64.97-hours, SD 25.1, delayed: 73.61-hours, SD 50.8; P=.37). Using an a priori margin of 12-hours, onset of LTII was non-inferior for delivery room insertion as compared to delayed insertion (mean difference -8.64-hours, 95% CI -27.69–10.42). Overall, the majority of participants achieved LTII before Day 4: 74.3% (n=26) delivery room and 72.2% (n=26) delayed, respectively (P=.84).

CONCLUSION:
Postpartum insertion of the contraceptive implant in the delivery room does not delay onset of lactogenesis and should be offered.
Physician Attitudes Toward Reproductive Justice: Results From an Institution-Wide Survey [21J]
Authors: Wautlet Cynthie , Schmuhl Nicholas B. , Higgins Jenny , Zukin Helen , Rice Laurel W. 
Published: April 2020

INTRODUCTION:
Reproductive justice (RJ) is a framework that promotes universal reproductive rights by addressing underlying economic, social, and political inequities. Although increasingly integrated into reproductive health specialties, broader physicians’ attitudes toward RJ have been unexamined – even though knowing and promoting RJ principles could improve patient care and public and social health.

METHODS:
Using mail and online recruitment methods, we surveyed clinical faculty at the largest academic medical center in one Midwestern state. On a five-point Likert-type scale (“strongly disagree” to “strongly agree”), physicians responded to five principles adapted directly from widely held RJ tenets.

RESULTS:
913 physicians representing 20 specialties responded (67% response rate). Majorities somewhat or strongly agreed that every woman has the right to parent or not parent a child if she chooses (89%); health systems should ensure that every woman has access to the full range of contraceptives (93%) and abortion (87%); health systems should ensure everyone achieves full autonomy over reproductive decisions (90%) and raises children in safe and healthy environments (96%). Given high reliability (Cronbach alpha=.85), we collapsed items into a bivariate outcome of support for all five principles vs any opposition. A majority (88%) supported all five principles. Chi-square tests of independence (P<.05) found that men, physicians over 40 years of age, religious physicians, and those who oppose legal abortion were less likely to support RJ principles.

CONCLUSION:
Physician support for RJ was high but not unanimous. We join the call to incorporate RJ principles into medical curricula and healthcare policy.
Postpartum LARC Among the Privately Insured—Use After Preterm and Term Births [23J]
Authors: Goldthwaite Lisa , Maric Ivana , Shaw Kate A. , Stevenson David K. , Shaw Gary 
Published: April 2020

INTRODUCTION:
Sub-optimal interpregnancy interval (IPI) and prior preterm delivery are risk factors for preterm birth. Provision of long acting reversible contraception (LARC) in the postpartum period may optimize IPI and thereby decrease the risk of a subsequent preterm birth. However, postpartum LARC uptake has not been investigated among those with a prior preterm delivery who are privately insured.

METHODS:
We used the national IBM MarketScan® Commercial Database to identify singleton deliveries from 2007-2016, spontaneous preterm birth, and follow up within 12 weeks postpartum. We compared LARC placement after preterm and term deliveries across years and by state.

RESULTS:
Among 3,132,107 singleton deliveries, 6.6% were preterm. Over the time period, postpartum LARC use more than doubled: 4.8% to 11.5% for intrauterine devices (IUDs), 0.1% to 2.3% for implants. In 2016, compared to term cohort, the preterm cohort was less likely to receive IUDs (10.1% vs 11.7%, P<.0001), as likely to receive implants (2.5% vs 2.3%, P=.15) and more likely to present for postpartum care (62% vs 56%, P<.0001). Placement of LARC prior to hospital discharge was exceedingly rare in both cohorts (preterm: 8 per 10,000 deliveries vs term: 7 per 10,000 deliveries, P=.05). State level analysis showed postpartum LARC use widely varied, by state (range 6%-32%).

CONCLUSION:
While postpartum LARC is increasing among the privately insured, exceedingly few receive LARC prior to hospital discharge. Postpartum follow-up is alarmingly low, highlighting the importance of inpatient LARC access. Variable state-level uptake and private reimbursement warrant ongoing surveillance and efforts to remove barriers to postpartum LARC for all.
Trends in Surgical Sterilization at an Academic Medical Center: Are We Being Opportunistic? [28J]
Authors: Barrows Emily , Truong Mireille , Johnson Molly , Siff Lauren 
Published: April 2020

INTRODUCTION:
In the age of evidence-based medicine, physicians are expected to adapt quickly to changing recommendations. The Society of Gynecologic Oncology (SGO) released a practice statement in November 2013 recommending providers consider performing salpingectomy concurrently with other pelvic surgeries for prevention of epithelial ovarian cancers. This study evaluates practice changes from tubal ligation to salpingectomy for surgical sterilization at an academic center following these recommendations.

METHODS:
This IRB approved, retrospective cohort study evaluated interval surgical sterilization procedures performed in an academic medical center between 1/1/2012 and 12/31/2018. Descriptive statistics compared rates of salpingectomy with tubal ligation before and after 1/1/2014, as well as annually. A multivariable regression model was fit to the data to adjust for potential confounding differences between populations.

RESULTS:
243 surgical sterilization procedures were performed during the study time period. Salpingectomy accounted for 0/64 (0%) prior to the recommendation release and 86/168 (51.19%) after the release, (P<.0001). Rate of salpingectomies increased annually: 3/31 (9.7%) in 2014, 9/35 (20.5%) in 2015, 16/32 (50.0%) in 2016, 22/23 (95.7%) in 2017, 36/38 (94.7%) in 2018, (P<.0001). Adjusting for potentially clinically relevant differences in the populations, the only other variable associated with type of sterilization was insurance, (P=.0279). Mean surgical duration was 8.5 minutes longer after the recommendation release, (P=.0019). There were no differences in blood loss, intraoperative or postoperative complications.

CONCLUSION:
Significant practice change in sterilization method from tubal ligation to salpingectomy occurred immediately following the SGO recommendations, however complete adoption of these recommendations (defined as 95% of procedures) took 4 years to achieve.
Uptake of Postpartum Long-Acting Reversible Contraception: The Impact of Timing and Practice Patterns [29J]
Authors: Corbin Kaitlin , Miller Hayley , Bates Paige , Lerma Klaira , Noon Brigit , Shaw Kate A. 
Published: April 2020

INTRODUCTION:
Uptake of long-acting reversible contraception (LARC) postpartum is impacted by differences in clinical practices, contraceptive counseling, postpartum follow-up and temporary Medicaid coverage. We sought to determine whether differences in inpatient provision influence uptake of preferred LARC by 8-weeks postpartum.

METHODS:
We performed an IRB approved, retrospective cohort study of all deliveries after 24 weeks gestation in two distinct practice groups at a single academic center in 2016: Practice A routinely offers initiation of intrauterine devices (IUDs) and contraceptive implants prior to hospital discharge; Practice B only routinely offers implants. We collected demographic information, documented postpartum contraception preference and LARC uptake by 8-weeks postpartum.

RESULTS:
We included all deliveries from Practice A (n=878) and Practice B (n=739). Patients from B were younger, Hispanic, publicly insured multiparas with a term, vaginal delivery. At discharge, more from B desired LARC (A: 27.2%, B: 39.2%; P<.001), but more from A desiring LARC initiated prior to discharge (A: 64.9%, B: 39.4%; P<.001). Postpartum follow-up was higher for B (A: 74.5%, B: 83.9%; P<.001), but by 8 weeks, uptake of desired IUD was higher for A (A: 72.9%, B: 51.6%, P<.001), with the majority placed inpatient for A (86.1% vs 10.6%; P<.001). Implant uptake by 8 weeks was similar (A: 86.3%, B: 90.4%; P=.41), with the majority placed inpatient (A: 72.5%, B: 69.2%; P<.001).

CONCLUSION:
Routine access to immediate postpartum IUD placement results in significantly increased uptake of desired IUD by 8-weeks postpartum, supporting provision of immediate postpartum LARC. Future efforts should focus on understanding if the option of immediate postpartum IUD placement influences contraceptive counseling, patient preferences and uptake.
Addressing Family and Genetic History in First Obstetric Visits [30J]
Authors: Walton Alexandra , Iyer Ankitha , Chang Judy 
Published: April 2020

INTRODUCTION:
The American College of Obstetrics and Gynecology states asking pregnant patients about family history (FHx) of genetic disease plays an important role in identifying and managing pregnancies with higher risk of genetic conditions. Few studies have assessed these conversations between pregnant patients and their obstetric care providers (OBS).

METHODS:
IRB approval was obtained to collect audio recordings and to transcribe conversations between pregnant patients and OBS during the first obstetric visit. A formulated codebook identified conversation segments containing FHx and genetic disorders and labeled the content of conversations. An independent coder reviewed transcripts to insure intercoder reliability, validity and accuracy. We identified communication patterns, categories, and themes.

RESULTS:
Of 152 transcripts, FHx was discussed in 93% of conversations. Genetic disorders most commonly mentioned were Down Syndrome (89%), Cystic Fibrosis (78%) and Sickle Cell Disease (75%). These were often discussed in the context of genetic screening tests. OBS asked patients to identify their ethnicity in 40% of visits. The father of the baby was present for 32% of visits, father’s ethnicity assessed in 51%, and father’s FHx discussed 48% of the time. Father’s presence at the visit was not associated with likelihood of OBS asking about their FHx. In 10% of visits OBS conveyed assumptions that if the patient did not recognize a disease, this represented a negative FHx for that disorder.

CONCLUSION:
While OBS assessed FHx in most first obstetric visits, communication approaches used in these assessments may not elicit complete information given that specific disorders and father’s FHx were not consistently discussed.
Maternal Outcomes Associated With Induction of Labor at 39 Weeks Compared With Expectant Management [34J]
Authors: Rossi Jordan , Contag Stephen , Burn Sabrina , Diaz Maria , Yao Ruofan 
Published: April 2020

INTRODUCTION:
To compare the risk of maternal complications associated with induction of labor (IOL) at 39 weeks gestation with that of expectant management (EM) beyond 39 weeks gestation.

METHODS:
This is a retrospective cohort analysis of singleton non-anomalous pregnancies in the United States between January 2015 and December 2017. Data was abstracted from the CDC National Center for Health Statistics from the Division of Vital Statistics. Analyses compared IOL at 39 weeks of gestation versus EM with delivery between 40 and 42 weeks of gestation. Maternal outcomes of interest included need for blood transfusion, development of chorioamnionitis, intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, and cesarean delivery (CD). Logistic-binomial regression analysis was performed to calculate the relative risk for the outcomes of interest, adjusting for confounding variables.

RESULTS:
There were 1,987,757 pregnancies included for analysis with 499,920 women in the IOL group. The risk of chorioamnionitis was 1.39% for IOL and 2.47% for EM (aRR: 0.58, 95% CI [0.56-0.59]). The risk of CD was 14.7% in the IOL group versus 14.8% in the EM group (aRR: 0.94, 95% CI [0.93-0.94]). Unplanned hysterectomy in the IOL group was 0.03% versus 0.02% in the EM group (aRR: 1.30, 95% CI [1.05-1.59]). There were no differences in risk of blood transfusion, ICU admission, and uterine rupture between the IOL and EM groups.

CONCLUSION:
Women who underwent IOL at 39 weeks had a lower risk of chorioamnionitis and CD compared to EM. However, there was a higher risk of unplanned hysterectomy with IOL at 39 weeks.