bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analyzing Patient Experiences of Crisis Pregnancy Centers in Los Angeles County From Social Media [2A]
Authors: Chan Elaine , Korotkaya Yelena , Woodson Ryan , Sridhar Aparna 
Published: May 2019

INTRODUCTION:
Crisis Pregnancy Centers (CPCs) are non-profit organizations that claim provision of pregnancy counseling resources. As more patients utilize online reviews to select healthcare providers, we aimed to evaluate patient experiences of CPCs through analysis of social media, specifically Yelp.

METHODS:
We conducted a mixed method study. The quantitative part analyzed the star rating based on pregnancy intentions and political affiliations of reviewers. The qualitative component analyzed reviews using grounded theory via Dedoose.

RESULTS:
Using California Pro-life Council official website, 196 CPCs were identified, 26 based in LA county. 8 of these CPCs had established listings on Yelp. Positive and negative experiences were analyzed. Four themes emerged. Healthcare access: Those who wished to continue the pregnancy felt supported because of the services offered, staff attitudes and access to care (4.67/5 stars, 17 reviews). Those who intended to terminate the pregnancy felt pressured to change their decision and were given inaccurate information, if any information, about their options (1.62/5 stars, 11 reviews). Political affiliation: Those who identified as pro-choice rated CPC's negatively (1.29 stars, 10 reviews). Emotional outcome: Reviewers reported that the CPCs made them “feel guilty,” “uncomfortable,” and “disregarded” for entertaining any option other than pregnancy continuation or adoption. Deceptive advertising: Some CPCs advertised the term “abortion services” while not providing them.

CONCLUSION:
CPCs do not offer comprehensive women's healthcare. Social media sites can increase transparency about the services offered to women at CPCs.
Adjuvant 17-Hydroxyprogesterone Caproate in Ultrasound-Indicated Cerclage: A Systematic Review & Meta-Analysis [17A]
Authors: Lichter Katie , Graham Ernest M. , Eke Ahizechukwu C. 
Published: May 2019

INTRODUCTION:
To assess the additional benefits of 17-hydroxyprogesterone caproate (17-OHPC) therapy in preventing recurrent spontaneous preterm birth in women with an ultrasound-indicated cerclage.

METHODS:
Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published before September 2018. Keywords included “preterm birth,” “ultrasound-indicated cerclage,” “pregnancy” and “17-hydroxyprogesterone caproate.” The primary outcome was preterm birth at <35 weeks of gestation. Meta-analysis was performed using DerSimonian and Laird procedures. Risk of bias and quality assessment was performed using the ROBINS-I and GRADE tools respectively.

RESULTS:
Four studies met inclusion criteria and were included in the final analysis. Of the 332 women, 115 (34.6%) received ultrasound-indicated cerclage alone, and 217 (65.4%) received adjuvant 17-OHPC. The primary outcome, preterm birth <35 weeks of gestation, was present in 87/217 singleton pregnancies. Though there was a trend towards a reduced risk of preterm birth, the summary estimate of effect was not statistically significant when comparing cerclage alone to cerclage plus 17-OHPC at <35 weeks (RR: 0.95, 95% CI: 0.77-1.17). Similarly, we found no differences in preterm birth at <24 weeks (RR: 0.30, 95% CI: 0.06-1.60), <28 weeks (RR: 0.57, 95% CI: 0.13-2.53) and <32 weeks (RR: 0.99, 95% CI: 0.44-2.27) when comparing cerclage alone to cerclage plus 17-OHPC. There were no differences in fetal birth weight, intraventricular hemorrhage and necrotizing enterocolitis comparing cerclage alone to cerclage plus 17-OHPC.

CONCLUSION:
Intramuscular 17-OHPC in combination with ultrasound-indicated cerclage in women with prior preterm birth had no additional effect in reducing spontaneous recurrent preterm birth or improving perinatal outcomes.
Chronic Peripheral Inflammation and Perinatal Depression in High Risk Pregnancies [18A]
Authors: Onyewuenyi Ticara , Addo Jennifer , Le Nhung , Ghareeb Allen , Loret de Mola J. Ricardo , Braundmeier-Fleming Andrea 
Published: May 2019

INTRODUCTION:
Perinatal depression is one of the leading causes of maternal morbidity and mortality, with severe cases leading to suicide. An imbalance between immune tolerance and inflammatory mediators may cause peripartum women to become vulnerable to depression; however, little research has been done to explore this theory.

METHODS:
Patients considered high risk for preterm birth (PTB) were recruited from the Department of Ob/Gyn at SIU School of Medicine. Following exclusion for non-compliance and intrauterine fetal demise, 7 patients (4 term; 3 preterm) were assessed to date. Peripheral blood and depression questionnaires (QIDS) were collected at various timepoints during gestation (8-12 weeks, 20-24 weeks and 32-36 weeks). Lymphocyte buffy coats were extracted and flow cytometry analyses identified specific immune populations (nTregs, iTregs and Th17). Correlations between depression status and immune profiles were performed for each pregnancy outcome.

RESULTS:
With our limited patient dataset, no correlation between inflammatory immune profiles and depression status was noted. However, patients who subsequently delivered preterm did report more depressive events, throughout gestation, than patients who delivered at term. Finally, patients with an inflammatory immune profile during the first trimester maintained this status throughout gestation. Additionally, we aim to assess if a patient's microbial dynamics are associated with depression in this population.

CONCLUSION:
While the role of inflammation in depression has not been elucidated, little is known about how depression may alter the maternal-fetal immunological profile. Improving our understanding regarding the context of depression and its implications during the perinatal period will lead to better mother-infant attachment and improve health outcomes.
Resolving the Preterm Birth Phenotype Using Electronic Health Records and Genomic Biobanks [20A]
Authors: Abraham Abin , Bejan Cosmin Adrian , Edwards Digna , Capra John 
Published: May 2019

INTRODUCTION:
About 10% of annual births are preterm, and up to 34% of infant deaths are attributable to prematurity. Although preterm birth (PTB) is heritable, our understanding of the genetic basis of PTB remains limited. We hypothesize that characterizing comorbidities will yield insights into PTB genetics.

METHODS:
Using international classification of diseases (ICD9/10) codes, we identified 53,063 females with deliveries in Vanderbilt's electronic health records (EHRs). 298 codes were enriched for PTB by chi-squared test after multiple testing correction (P < 3.2*10^-5) and grouped using hierarchical clustering. To explore the genotype-phenotype relationships, a phenome wide association study (PheWAS) was conducted for single nucleotide polymorphisms (SNPs) associated with gestational age. These SNPs were also queried in the UK Biobank (UKBB) using GeneATLAS for phenotype associations.

RESULTS:
ICD9 codes enriched for PTB reproduced known (twin pregnancy, cervical insufficiency) and unexpected associations across multiple systems (hypertension, renal failure, sickle cell). PheWAS resulted in significant association with hematemesis (rs1735537, P=5.4*10^-7, OR=1.79) and schizophrenia (rs6556350, P=2.8*10^-6, OR=0.48). Attention deficit/hyperactive disorder (P=7.9*10^-6) was nominally significant. In the UKBB, height (rs3820282, P>1*10^-40), adiposity traits, and female reproductive tract disorders were significantly associated (P>1*10^-8) with gestational length.

CONCLUSION:
Using billing codes identified a large cohort of females with deliveries within the EHRs. ICD codes enriched for PTB captured several unexpected phenotypes that warrant further study. The PheWAS analysis suggests a shared genetic basis between several traits and gestational length. In particular, height is known to influence birth timing. SNP rs3820282 suggests a pleiotropic locus influence both traits.
Neonatal Outcomes in Single Agent vs. Combination Therapy in Management of Maternal Diabetes in Pregnancy [26A]
Authors: Scrivani Claire , Cortez Briana , Chisholm Christian , Boyle Annelee C. , Ferguson James E. , Dudley Donald J. 
Published: May 2019

INTRODUCTION:
To determine if there are decreased rates of neonatal hypoglycemia when type 2 diabetes mellitus (T2DM) is treated with combined insulin and oral hypoglycemic agent compared to insulin, oral hypoglycemic agent, or diet alone.

METHODS:
We performed an IRB approved, retrospective chart review of 357 women with a diagnosis of T2DM who delivered at our center from 1/2012 to 12/2017. Patients were managed by with diet alone, insulin alone, oral hypoglycemic agent alone, or combined insulin and oral hypoglycemic agent. Primary outcome was neonatal hypoglycemia, defined by the pediatric care providers in discharge diagnoses. Secondary outcomes included birth weight, NICU admission, neonatal death and composite neonatal outcome score (CNOS) that included respiratory failure, respiratory distress syndrome (RDS), death at delivery, ventilator use, admission to NICU, shoulder dystocia, and perinatal death.

RESULTS:
Of the 357 women included in the study, 11% who were treated with diet alone, 8.2% who were treated with insulin alone, 9.6% who were treated with oral agent alone and 8.7% who were treated with both insulin and oral agent delivered infants that were diagnosed with neonatal hypoglycemia (P=.90). Neonatal death was observed in 3.6% (4/112) of women treated with diet alone, whereas no neonatal death was observed in the other treatment groups (P=.04). There was no significant relationship between treatment type and the CNOS.

CONCLUSION:
Maternal use of combined insulin and oral hypoglycemic agent for T2DM in pregnancy did not improve, or worsen, neonatal hypoglycemia and other neonatal outcomes. However, neonatal death was more common in diet controlled diabetes.
Group Prenatal Care: A Promising Quality Measure in Ambulatory Obstetrics [28A]
Authors: Meadows Audra Roberston , Barrett Francesca , Manigat Charlee , Murphy Jennifer , Blanchfield Bonnie 
Published: May 2019

INTRODUCTION:
The group prenatal care (GPC) practice model has demonstrated success in achieving quality goals such as improved outcomes, care satisfaction and reduced costs. We sought to improve care quality among women receiving prenatal care in an urban, obstetrical residency training practice by implementing a GPC option.

METHODS:
We conducted a retrospective study comparing women in a GPC pilot cohort to a risk-based, matched cohort of women receiving individual prenatal care in the same practice from 2015 to 2018. Maternal and newborn outcomes and cost were assessed. Descriptive analysis was used to characterize the cohorts and bivariate analysis was used to compare outcomes and costs. Date were obtained from electronic medical records and hospital financial systems.

RESULTS:
Rates of cesarean delivery (17.9% vs 33%, p = 0.04) and neonatal intensive care unit (NICU) admissions (1.8% vs 17%, p = <0.01) were decreased among women in the GPC cohort compared to those in individual care. Reduced NICU admissions saved the Medicaid program approximately $256,216 or $37,027 per avoided admission.

CONCLUSION:
Few ambulatory quality metrics are defined in obstetrical care. GPC implemented in an urban, residency training practice setting improved outcomes and reduced costs compared to those in individual prenatal care. GPC is a promising model to improve quality among ambulatory obstetrics training practices.
Doing the Month: Traditional Asian Postpartum Practices at a Federally Qualified Health Center [31A]
Authors: Zheng Micha , Liu Stephanie , Kallen Michael , Nguyen Van Thuy , Kay Kerry , Ivey Susan 
Published: May 2019

INTRODUCTION:
“Doing the month” (DTM) is a traditional Asian month-long postpartum practice. Although there are varying levels of adherence, in its strictest form, women are not allowed to shower, leave the house, or brush their teeth.

METHODS:
A cross-sectional survey was developed in consultation with a psychometrician to determine the estimated prevalence of women who have participated in DTM. Female patients in a federally qualified health center's waiting room were surveyed in Cantonese, Mandarin, Vietnamese, and English. This study was approved by the UC Berkeley Institutional Review Board.

RESULTS:
One hundred fifty-four respondents participated; mean age was 40.1. Without prompting, 37.7% responded that they had heard of DTM. After an explanatory paragraph, 76.6% participants reported they had heard of DTM. Out of patients that have children, 60.7% “did the month” after giving birth. Likert-type scale questions showed that respondents believed DTM was stressful but enjoyable and helpful for recovery from childbirth.

CONCLUSION/IMPLICATIONS:
The majority of immigrant Asian women at this FQHC had heard of and participated in DTM. Asian immigrants are projected to become the largest foreign-born group in the U.S. by 2055. DTM is a common practice that providers should be aware of in order to promote postnatal health of both infant and mother. Drinking rice wine, recommended in DTM practices, could affect developing infants and may need to be addressed in breastfeeding patients. Being unable to shower or leave the house for a month may contribute to postpartum infections or depression. Obstetric residencies should include curriculum regarding this practice.
Evaluating the Quality and Reliability of Online Information on Social Fertility Preservation [38A]
Authors: Shao Yi-Hong , Spence Andrea , Tulandi Togas , Abenhaim Haim Arie 
Published: May 2019

INTRODUCTION:
Rising trends to postpone motherhood, has coincided with increasing infertility rates. Social fertility preservation offers the potential to overcome this age-related infertility and many women are turning to the Internet to seek medical information. The aim of our study was to evaluate online information on social fertility preservation.

METHODS:
We used five search terms, “egg freezing,” “fertility preservation,” “social egg freezing,” “social fertility preservation” and “oocyte cryopreservation,” to identify the most popular sites rated by Google. The information and quality were rated based on four categories: Silberg's accountability criteria, Abbott's aesthetic criteria, Flesch-Kincaid readability score and the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetrics and Gynecology of Canada (SOGC) guideline recommendations.

RESULTS:
We identified 21 most utilized websites. The average Silberg score was 6.57, with 85.7% of websites meeting the criteria for adequate accountability. Only one website (4.8%) did not meet the criteria for appropriate esthetic appeal. The average Flesch-Kincaid readability score was 11.39, equivalent to a Grade 11 reading level, which is significantly higher than the targeted reading level of the general population (Grade 8). 57% of websites contained less than half of the evidence-based recommendations provided in the CFAS and SOGC guideline recommendations.

CONCLUSION:
Online information on social fertility preservation is easily accessible and esthetically pleasing, but it is not easily readable and does not reflect evidence-based recommendations. In light of our findings, physicians must fill the knowledge gaps and adequately counsel their patients to optimize a woman's chance at a successful pregnancy.
Beyond Hormonal Impact: A Qualitative Analysis of the Intravaginal Ring (IVR) on Women's Sexual Experiences [1B]
Authors: Lu Connie F. , Vargas Sara E. , Guillen Melissa , Carbone Sofia , Ramirez Jaime , Guthrie Kate M. 
Published: May 2019

INTRODUCTION:
Current contraceptive literature includes limited studies focusing on the impact of contraceptive methods (exclusive of condom-only contraception) on women's sexual experiences. Many of these focus on hormonal effects of oral contraceptive pills (OCPs). Though important, women's experiences with contraception extend far beyond hormonal impacts. This study aims to add depth to the knowledge base by exploring the meaningful effects of intravaginal rings (IVR) on women's sexual experiences, highlighting the IVR as a device physically experienced by both the user and her sexual partner(s).

METHODS:
Twelve women, aged 18-45 years, used the IVR for 3-6 months, and completed daily phone surveys, monthly web surveys, and in-depth interviews regarding IVR use. This thematic content analysis of qualitative data explores how the IVR affects participants' sexual experiences.

RESULTS:
Sexual experiences with the IVR elicited a range of user reactions. Women reported impacts on their sexual experiences related to physical (e.g., feeling the IVR during sex), administrative (e.g., navigating IVR removal before sex), and relationship factors (e.g., partner's sexual comfort and pleasure). Women derived both positive and negative meaning from these experiences, which then altered and individualized their use and subsequent opinions of the IVR.

CONCLUSION:
The range of IVR impacts on women's sexual experiences shape their use and opinions of the product, leading to either increased motivation or poor adherence and discontinuation. Awareness of these individualized experiences can help providers better understand and guide their patients through effective IVR use. Research on user experiences across contraceptive methods is necessary to support women's sexual and reproductive health.
Immersive Virtual Reality Intervention for Anxiety Reduction During In-Office Dilation and Curettage [4B]
Authors: Zhang Shiliang , Woodson Ryan , Sridhar Aparna 
Published: May 2019

INTRODUCTION:
Progress in virtual reality (VR) has generated interest in using VR as a method for managing patient anxiety and subsequently decreasing pain. We assessed the practicality and effects of VR use among patients presenting for first-trimester surgical abortion at our academic center.

METHODS:
In this prospective pilot study, we consented women presenting for first trimester surgical abortion in office under local anesthesia. We enrolled a convenient sample of 30 participants (15 experimental and 15 control). Experimental participants were given a commercially available VR device to wear during the procedure. Anxiety scores using Modified Amsterdam Preoperative Anxiety and Information Survey (MAPAIS) and the Visual Analog Scale (VAS) were recorded before, during, and after the procedure in both groups.

RESULTS:
The two groups showed no significant differences in anxiety prior to procedure (P=0.29). On average the experimental group demonstrated lower anxiety during and after the procedure though results were not statistically significant in the pilot phase. Among participants in the experimental group, those who used the VR device for over 5 minutes (n=11) had statistically significant decrease in anxiety compared to those who used the device for a shorter period of time (n=4) (P=0.018).

CONCLUSION:
Our results suggest that VR can be used during in-office dilation and curettage and may have an impact on decreasing procedure-related anxiety. Based on our findings, we determine that a sampling size of 156 total participants would be sufficient for a target power of 0.80.
Current Residency Training: Increased Education Regarding the Care of Transgender and Gender Non-Binary Patients [8B]
Authors: Chiarappa Ashley , Francis Amanda , Zheng Julia , Bachmann Gloria A. 
Published: May 2019

INTRODUCTION:
An American College of Obstetricians and Gynecologists (ACOG) committee opinion in 2011 urged health insurance plans to cover transgender and gender non-binary (TGNB) affirming care and in 2017, another one reviewed medical guidelines that obstetrician-gynecologists should apply in addressing the needs of TGNB adolescents. Given this evolving clinical landscape, a difference in education regarding TGNB specific training, education and experience levels between Ob/Gyn residents and attendings was studied.

METHODS:
A twenty-one item survey was emailed to APGO program coordinators to distribute to their program directors and residents from February to April, 2018. This anonymous survey included demographics and TGNB perceptions, education and hands-on training.

RESULTS:
Of the 150 programs contacted, an unknown number of surveys was distributed. 200 surveys were email assessed, with 164 filled out. Providers included 2 PA/NP/APN (excluded from analysis), 49 attendings and 113 residents. Of the 126 physicians who cared for TGNB patients, 51 providers (44.73%) cared for five or more TGNB patients. Fifty-eight percent of residents and 79% of attendings reported inadequate/no formal TGNB training. One attending (2%) vs 11 residents (9.7%) reported 11 or more hours of TGNB education during medical school. Proportionally more attendings vs residents felt uncomfortable performing (33.33% vs 8.65%) and had performed fewer (14.28% vs 25.66%) gender affirmation hysterectomies/oophorectomies.

CONCLUSION:
These results suggest that attendings less contemporarily trained than current residents had less TGNB specific training and clinical experience. Additional educational endeavors for the entire health care team would be a positive asset to advancing TGNC healthcare.
Access to Antenatal Care and Hospital Delivery Among Haitian Migrant Mothers Within Batey Communities of La Romana [11B]
Authors: Ford Chandler , Batson Stephanie , Zucconi Rebecca , Brownell Elizabeth 
Published: May 2019

INTRODUCTION:
The batey communities in the sugarcane fields of La Romana, Dominican Republic house thousands of Haitian migrant families. Many of these bateyes lack electricity, potable water and reliable healthcare infrastructure. In 2015 the World Health Organization (WHO) reported a maternal mortality rate of 92/100,000 births in the Dominican Republic but rates within bateyes remain unspecified.

METHODS:
We evaluated barriers related to antenatal care and labor and delivery experience potentially associated with increased maternal mortality risk among Haitian migrant mothers living in bateyes. Under IRB approval qualitative interviews were conducted within 16 bateyes among 68 adult migrant mothers who experienced 1 live birth <3 years. Results were compared to the 2016 WHO recommendations.

RESULTS:
68% of women did not meet the recommended minimum of eight antenatal care contacts. 22% traveled more than two hours for a visit. Relative to WHO recommendations: 93% of women had their blood pressure taken, 88% had urine collected and 79% received at least one ultrasound during a visit. 47% did not initiate prenatal vitamin use until their second trimester. Reasons for this delay were attributed to cost and inconsistent provider access. The WHO recommends establishment of antenatal care by 10 weeks gestation, the average gestational age at first visit among batey mothers was 18 weeks. 91% gave birth in hospital, reflecting strong maternal preference attributable to perceived maternal safety.

CONCLUSION:
In accordance with WHO antenatal care recommendations, optimal care in the bateyes is not fully achieved and warrants further interventional studies assessing consistent provider contact during the first trimester.