bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Intersection of Race and Class and the Use of Long Acting Reversible Contraception (LARC) a Quantitative Analysis [3A]
Authors: Alfred Kywanna , Holmes Katherine M. 
Published: May 2019

INTRODUCTION:
Long-acting reversible contraceptive agents (LARC), including IUD and implants are the most effective forms of reversible contraception. As such, they have gained attention from clinicians and public health organizations with their ability to decrease the rates of unintended pregnancy, abortion and teen births. Simultaneously, in the United States there has been a long history of reproductive coercion of marginalized groups. This study attempts to answer the key question: does the legacy of classism and racism affect patients' decisions to use LARC?

METHODS:
IRB Approval was obtained through the IRB at Wilson Hospital. Study population was a cross sectional group of women aged 18-50 registered at the UHS Wilson Primary Care Clinic as well as WIC participants in Broome County, Binghamton, NY. After informed consent was obtained, a structured qualitative interview was conducted with participants until theme saturation was reached. Questions included forms of birth control used, familiarity with and concerns about LARC. Demographic information, income levels and race were self-identified by study participants.

RESULTS:
Women of color and low-income women had the greatest number of concerns that use of a LARC contraceptive agent would harm them. The top two concerns were that the LARC would migrate or cause infertility. Patients would like their physician to talk to them about their fears.

CONCLUSION:
Counseling about birth control options should include an elicitation of patient fears: fear of harm and decreased reproductive autonomy are common and seem to be affecting decisions about LARC use.
Exploring How Targeted Regulations of Abortion Providers Affect Training and Practice Location [4A]
Authors: Gowda Tejasvi , O'Connor-Terry Carly , Lance Audrey , Chang Judy 
Published: May 2019

INTRODUCTION:
Targeted Regulations of Abortion Providers (TRAP laws) create variable abortion accessibility by state. We explored how TRAP laws affect where physicians choose to receive family planning training and practice.

METHODS:
We conducted semi-structured telephone interviews with 25 physicians who provide abortion care across the United States and asked them about their experiences providing care in the recent political climate. Using an iterative qualitative coding process, we detected themes around how political climate and state laws around abortion affected personal preference in location of family planning training and practice.

RESULTS:
State laws surrounding abortion provision often influenced where providers chose to receive family planning training and practice. Reasons for choosing to train in liberal areas with few TRAP laws include a higher patient load and more opportunity to gain procedural skills. Some providers chose to train in restrictive areas for experience in navigating state laws that limit abortion access. When choosing location of practice, those that chose a hostile environment cited a greater need for abortion providers in restrictive areas. Those who practice in liberal areas often had personal reasons, including safety concern for themselves and their families as well as a desire to work in an environment where state laws do not force providers into practicing substandard care.

CONCLUSION:
Understanding how state TRAP laws affect location of training and practice of abortion providers creates an opportunity to further analyze what training, supports, and resources can be provided to encourage physicians to practice in underserved areas with restrictive abortion policies.
Incidence and Risk Factors for Venous Thromboembolism During Cesarean Delivery Hospitalization [9A]
Authors: Mardock Alexandra L. , Sanaiha Yas , Rudasill Sarah E. , Rao Rashmi , Benharash Peyman , Cohen Joshua G. 
Published: May 2019

INTRODUCTION:
This study aimed to identify risk factors for venous thromboembolism (VTE) in women undergoing cesarean delivery in the United States.

METHODS:
The 2005-2015 Nationwide Inpatient Sample database was used to analyze VTE incidence during cesarean delivery hospitalization of women aged 12-55. Incidence, resource utilization, and risk factors were assessed using chi-square and logistic regression analyses.

RESULTS:
Of 14,071,941 cesarean delivery hospitalizations, 9,663 (0.07%) had VTE. Women experiencing VTE were more likely of Black race (19.6 vs 12.7%, P<.001) or insured by Medicaid (43.5 vs 40.8%, P=.018). Risk factors associated with VTE included puerperal infection (OR 7.88 [6.54-9.49], P<.001), thrombophilia (OR 6.93 [4.83-9.93], P<.001), cancer (OR 4.37 [1.75-10.95], P<.001), history of VTE (OR 3.63 [2.27-5.83], P <.001), disseminated intravascular coagulation (DIC) (OR 3.42 [2.33-5.02], P<.001), congestive heart failure (OR 3.33 [2.05-5.41], P<.001), need for blood transfusion (OR 3.21 [2.56-4.01], P<.001), and sickle cell disease (OR 3.05 [1.79-5.19], P<.001), among others. With multivariable analysis, Black race (OR 1.17 [0.98-1.38], P=.076) and Medicaid insurance (OR 1.04 [0.92-1.18], P=0.556) were not independently associated with VTE. VTE hospitalizations were associated with greater mortality (1.4 vs .01%, P<.001), adjusted cost ($25,706 vs $6,985, P<.001), and mean length of stay (10.2 vs 3.5 days, P<.001).

CONCLUSION:
Demographic disparities in VTE incidence exist among patients undergoing cesarean delivery. The strongest independent risk factors for VTE included infection, thrombophilia, cancer, history of VTE, DIC, and congestive heart failure, among others. Strategies to improve risk stratification and prophylactic anticoagulation decisions in at-risk populations are warranted.
BNP Levels as a Predictive Marker for Preterm Birth in Women With Hypertensive Disorders in Pregnancy [10A]
Authors: Duhon Ashley , Lai Monica , Heard Asha J. , Grant Joshua , Hagan Joseph , Stafford Irene A. 
Published: May 2019

INTRODUCTION:
Few tests are able to determine the risk of preterm birth (PTB) in women with hypertensive disorders in pregnancy. B-type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and volume expansion in these women. The primary purpose of this study is to evaluate BNP levels in pregnant women with hypertensive disorders as a predictor of medically indicated PTB.

METHODS:
Pregnant women who presented at Touro Infirmary, New Orleans, LA, between April 2015 and May 2017 for hypertension evaluation were eligible for enrollment. BNP values were collected prior to and at delivery. A BNP level of >100 was considered elevated. All obstetrical and neonatal outcomes were recorded. Fisher's test was used to compare the proportion of patients with elevated BNP levels for women with versus without indicated PTB and for women with versus without newborn requiring neonatal intensive care unit (NICU) stay. Neonatal weight and Apgar scores were compared using the Wilcoxon rank sum test.

RESULTS:
Of 52 women with hypertensive disorders as an indication for PTB, 34.6% had an elevated BNP, as compared to 12.5% of those with hypertensive disorders that delivered at term (p=0.004). Of 41 women whose newborn required NICU stay, 34.2% had an elevated BNP, as compared to 15.4% of those whose newborn did not require NICU stay (p=0.021). Neonatal weight and Apgar scores were not different (p>0.05) for those with elevated maternal BNP levels.

CONCLUSION:
BNP measurement may be helpful in determining which women with hypertensive disorders are at higher risk for medically indicated PTB.
Impact of an On-site Perinatal Mood Disorders Clinic in the Diagnosis and Management of Perinatal Depression [15A]
Authors: Roberson Dana , Roussos-Ross Dikea , Goodin Amie 
Published: May 2019

INTRODUCTION:
Perinatal mood disorders are a widespread complication of pregnancy and the postpartum period, with negative effects for mother and child if left untreated. This study assessed health outcomes of women seen in an onsite Perinatal Mood Disorder Clinic (PMDC) intended to improve access to timely evaluation and treatment.

METHODS:
A retrospective chart review was performed of 120 patients seen at the PMDC between March 1, 2017 and June 1, 2018. The primary outcome was participants' Edinburgh Postnatal Depression Scale (EPDS) score at final visit, where score >12 indicated postpartum depression. Two-tailed t-tests compared initial and final EPDS scores. A multivariable linear regression model with robust standard errors estimated the relationship between patient characteristics and final EPDS score for patients with greater than one score, controlling for initial score, mood disorder history, treatment type, and demographics.

RESULTS:
Mean final EPDS score (11.04) was lower than mean initial score (16.54; P<.001), among n=57 with greater than one score. There was a significant decrease between initial and final score for those receiving pharmacotherapy (P<.001) and those receiving combination pharmacotherapy/counseling (P<.01), but not those receiving counseling only (P=.137). Initial to final EPDS score decreased significantly for those in ongoing treatment at study period end (P<.01) and those referred back to primary physicians (P<.001), but not for those referred to psychiatry (P=.256) or lost to follow-up (P=.540).

CONCLUSION:
Women treated at the PMDC showed improved EPDS scores. Therefore, the PMDC may be filling a gap in access to timely care for perinatal mood disorders.
Percent Absent End-Diastolic Velocity and Risk of Donor Twin Demise in Twin-Twin Transfusion Syndrome [19A]
Authors: Purnell Margaret E. , Chon Andrew H. , Korst Lisa M. , Llanes Arlyn , Grubbs Brendan H. , Chmait Ramen H. 
Published: May 2019

INTRODUCTION:
We examined the association of percent absent end-diastolic velocity (%AEDV) in the umbilical artery with intrauterine fetal demise (IUFD) of the donor twin after laser surgery in patients with twin-twin transfusion syndrome (TTTS) Quintero stages III/IV. %AEDV was calculated as 100x the proportion of total cardiac cycle spent in AEDV.

METHODS:
Retrospective study of TTTS stage III/IV patients between 2006 and 2016. Donors were classified as having persistent AEDV (yes/no). In Part 1, we used multiple logistic regression analysis to test whether AEDV was associated with donor IUFD. We stratified these analyses by estimated fetal weight (EFW) discordance of ≥20% or <20%. In Part 2, we used similar models to test only those with AEDV to determine whether %AEDV was associated with IUFD. This was an IRB approved study.

RESULTS:
Of 344 stage III/IV TTTS cases, 153 (44.5%) donors had preoperative AEDV. In Part 1, we did not confirm an independent association between AEDV and donor IUFD. In Part 2, patients with AEDV who were discordant (N=129), had the following characteristics associated with donor IUFD: %AEDV (OR 1.04, 95% CI 1.01-1.08), %EFW discordance (OR 1.07, 95% CI 1.02-1.13), and presence of arterioarterial anastomoses (OR 5.15, 95% CI 2.06-12.89). In the non-discordant group (N=24), no association was found between %AEDV and donor IUFD.

CONCLUSION:
The presence of preoperative persistent AEDV was not an independent risk factor for donor IUFD in stage III/IV TTTS patients undergoing laser surgery. However, among donors with preoperative AEDV and EFW discordance ≥20%, %AEDV was positively associated with donor IUFD.
Insulin Requirements by Multiple Daily Injections Versus Pump in Women With Type 1 Diabetes Mellitus [22A]
Authors: Prior Alissa , Finneran Matthew M. , Smrz Stacy , Thung Stephen Francis. , Landon Mark B. , Gabbe Steven G. 
Published: May 2019

INTRODUCTION:
This study aimed to describe insulin dose changes throughout pregnancy by insulin delivery method.

METHODS:
This was a retrospective cohort study of patients with T1DM in pregnancy who delivered at a large academic tertiary medical center from 2012 to 2016. Prescribed bolus and basal insulin doses were extracted from the medical record at three time points: early (<20 weeks), mid (28-32 weeks), and at delivery. The primary outcome compared dose changes by insulin delivery method (multiple daily injections [MDI] vs. continuous infusion [CSII]). Secondary outcomes were percent change in bolus, basal and total insulin units per day (U/d). Backward stepwise logistic regression was used to identify risk factors for >50% increase in insulin dose prescribed.

RESULTS:
There were 110 women who met inclusion criteria with 48 (43.6%) using MDI and 62 (56.4%) using CSII. MDI users' total insulin doses were higher at all time points (early: 36.0 vs 29.1 U/d; p=.016, mid: 51.5 vs. 38.8 U/d; P=.01, late: 121.9 vs 78.0 U/d; P<.001). The MDI users' basal dose percent of total insulin increased from early to late pregnancy (40% [25-60%] vs 30% [10-40%]; p<.01), but percent bolus was similar between groups (p=.991). Risk factors for a total daily insulin dose increase greater than 50% included increasing weight gain (OR 1.07; CI 1.03-1.1), increasing maternal age (OR 1.2; CI 1.02-1.2), and MDI use (OR 5.8; CI 2.0-17.2).

CONCLUSION:
Women with T1DM using MDI for insulin delivery required higher basal and bolus insulin doses at each time point when compared to CSII.
A Comparative Study of the Impact of Chronic Pelvic Pain on Quality of Life in Women With and Without Endometriosis [34A]
Authors: Bhide Sayuli , Flyckt Rebecca , Yao Meng , Falcone Tommaso 
Published: May 2019

INTRODUCTION:
Few studies have examined the differing natural histories and quality of life in women with endometriosis-associated chronic pelvic pain (EACPP) versus other chronic pelvic pain (OCPP) in the years following surgery. In this study, we compared pain and quality of life scores in women with EACPP vs OCPP after surgery.

METHODS:
Women with CPP who had gynecologic surgery at the Cleveland Clinic between 2008 and 2010 with surgically confirmed endometriosis versus other CPP without endometriosis completed the EHP-30 and PROMIS validated quality of life questionnaires. Demographics and scores were compared between EACPP (N=84) versus OCPP (N=105) groups.

RESULTS:
Significant differences in racial demographics were seen between the two groups, with more African American patients in the OCPP group. The EACPP group had lower current disability than the OCPP group (3.6% vs 13.5%, P=.019). No significant difference was found in EHP-30 scores between groups. The PROMIS Global Health survey revealed no significant difference in Global Physical scores, however, the EACPP group had a lower mean Global Mental score compared to the OCPP group (12.5±3.4 vs 13.6±3.6, P=.057), a finding which approached significance. In exploratory regression models, higher age and higher Global Physical score were associated with lower EHP-30 scores (better health status) across all quality of life scales.

CONCLUSION:
Reported pain and quality of life are similar between women with EACPP vs OCPP. However, racial representation and disability status are different between groups. Furthermore, multivariable regression models indicated that higher age and physical health ratings may be associated with better quality of life.
Maternal Morbidity and BMI in Placenta Previa [15B]
Authors: Arditi Brittany , Purisch Stephanie Erin , Friedman Alexander Michael , Gyamfi-Bannerman Cynthia 
Published: May 2019

INTRODUCTION:
Placenta previa increases the risk of pregnancy complications, but how obesity modifies this risk is unknown. We sought to characterize how pre-pregnancy BMI is associated with maternal morbidity in the setting of placenta previa.

METHODS:
In this retrospective cohort study of women with placenta previa delivered by cesarean section, the primary exposure, BMI, was categorized as normal (18.5-25), overweight (25-30), or obese (>30). Women with BMI <18.5 or placenta accreta were excluded. The primary outcome, a composite including death, hysterectomy, blood transfusion, endometritis, surgical injury, arterial ligation, ileus, and ICU admission, among others, was compared by BMI.

RESULTS:
555 women were included. 306 (55%) were normal weight, 157 (28%) were overweight, and 92 (17%) were obese/morbidly obese. The primary outcome occurred in 21% of normal weight, 28% of overweight, and 30% of obese women (p=0.03). Increasing BMI was associated with blood transfusion (p=0.03), endometritis (p=0.04), uterine artery ligation (p=0.02), surgical injury (p=0.003), anesthetic complications (p=0.02), and increased length of hospitalization (p=0.02). In multivariable analysis adjusting for BMI, race, marital status, payor, diabetes, and number of cesarean sections, overweight women were more likely to require uterine artery ligation (adjusted OR 8.54, 95% CI 2.30-31.81).

CONCLUSION:
Increased pre-pregnancy BMI is associated with maternal morbidity among women with placenta previa. These findings can advise surgical planning and pre-delivery care for women with previa.
Creating Awareness of the Frequency of Cervical Exams in Patients With Term SROM [23B]
Authors: Lagon Elena , Pettit Kate Estelle , Dudley Donald J. , Chisholm Christian , Boyle Annelee 
Published: May 2019

INTRODUCTION:
Studies have associated the number of cervical exams performed during labor with deleterious outcomes. The study objective was to compare the number of exams performed in term laboring patients with spontaneous rupture of membranes (SROM) before and after instituting a recording system.

METHODS:
We conducted a retrospective cohort study of 106 term singleton pregnancies admitted with SROM at our institution. A board was installed in the physician workroom tallying the number of exams per patient. Data were collected for 3 months before and after the intervention. Primary outcomes were total exams and exams per hour after SROM. Secondary outcomes included rates of intrauterine infection (IUI) and maternal and neonatal length of stay (LOS). Composite rates of adverse maternal outcomes (IUI, hemorrhage, ICU admission) and neonatal outcomes (code, ICU admission, sepsis) were studied. Data pre- and post-intervention were compared using chi-square and Student's t-tests. Subgroup analyses by care team compared total exams and exams per hour ruptured within the pre- and post-intervention groups.

RESULTS:
Mean exams per hour ruptured and mean exams in patients with IUIs were significantly lower post-intervention. Mean exams per hour ruptured was significantly lower for midwife-followed versus physician-followed patients in both periods. The post-partum, maternal, and neonatal LOS, mean total exams, and risk of adverse maternal and neonatal outcomes did not significantly differ.

CONCLUSION:
Installation of a recording system reduced the number of exams in patients with IUIs and exams per hour ruptured. Clinicians may consider instituting similar policies to create awareness of the number of cervical exams during labor.
Diabetes in Pregnancy: Does Counseling Help? [26B]
Authors: Hartey Sara , Sherbeny Fatimah , Abramovici Dorel , Abramovici Adi Rosa 
Published: May 2019

INTRODUCTION:
Identify common themes of perceptions and fears relating to diabetes in pregnancy that may correlate with motivating factors or mental barriers to successful treatment. These factors are compared pre and post formalized education in order to assess the impact of individualized counseling among women with pregestational diabetes (PGDM) and gestational diabetes (GDM).

METHODS:
Subjects were diagnosed with PGD or GDM according to ACOG criteria. They were referred to our perinatal center for management. All gravidas received formal nutritional education focused on diet, lifestyle modification and treatment. After informed consent was obtained they were administered a IRB approved cross-sectional survey identifying measures of anxiety pre and post counseling. These responses were analyzed using Chi square test and JMP software.

RESULTS:
Population characteristics were comparable in the PGM and GDM groups, with the only difference being medical therapy in the beginning of the study. After counseling, GDM had a statistical decrease in anxiety of diagnosis (P<0.05), a decrease in anxiety regarding safety of medications (P<.05), and increased confidence in managing their diet (P<.05). Overall anxiety reduction was not seen in PDM however there was a trend towards significance when it came to reduction in anxiety of taking insulin (P=.07). The major motivating factor among both groups for adherence to their diet was preventing harm to the baby.

CONCLUSION:
Nutritional education can decrease anxiety and increase confidence in women diagnosed with GDM. Future studies may further show benefit of improved perinatal outcomes with formalized education.
Effect of Internal Iliac Arterial Balloon Occlusion on Estimated Blood Loss in Morbidly Adherent Placenta [29B]
Authors: Quist-Nelson Johanna Rachel , Crank Aislinn , Quist Arbor , Kim Christine , Richard Scott , Roman Amanda 
Published: May 2019

INTRODUCTION:
The role of prophylactic placement of internal iliac arterial balloon occlusion prior to cesarean hysterectomy for anticipated morbidly adherent placenta (MAP) is a subject of debate. We aimed to compare estimated blood loss (EBL) in patients with suspected MAP and received internal iliac balloon occlusion to those who did not.

METHODS:
This is a retrospective cohort of patients at a single tertiary center with suspected MAP between January 2007 and June 2018. The intervention group received internal iliac arterial occlusion balloon occlusion prior to cesarean hysterectomy while the control group did not. The primary outcome was EBL.

RESULTS:
There were 24 cases of suspected MAP. Balloon occlusion was placed in 17 (71%) cases, while 7 (29%) cases did not have balloon occlusion. Cases with balloon occlusion were more likely to have gynecology oncology (94.1% vs 42.9%, p=0.01) and more likely to receive cell saver (88.2% vs 42.9%, p=0.04). There was a non-significant trend towards lower EBL in women who received balloon occlusion (1200 [800, 2000] vs 3000 [1200, 3190], p=0.34). Transfusion outcomes did not differ between groups. Women who did have balloon occlusion were less likely to be admitted to the intensive care unit (ICU) after delivery (11.8% vs 57.1%, p=0.04). There were no complications observed from balloon occlusion. Neonatal outcomes did not differ between groups.

CONCLUSION:
There was a non-significant trend seen towards lower EBL in women with MAP and prophylactic internal iliac arterial balloon occlusion compared to those who did not.