bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing the Second Trimester Fetal Ultrasound in the Obese Gravida [37P]
Authors: Weatherborn Megan , Leftwich Heidi , McGuinness Bailey , Ogamba Maureen , Leung Katherine 
Published: April 2018

INTRODUCTION:
To identify the ideal time to perform the second trimester ultrasound for fetal assessment in the obese patient population we examined the relationship between scan completion rates and advancing gestational age.

METHODS:
This is a retrospective study at a single tertiary care center. Inclusion criteria were pregnant women with BMI ≥30 who had second trimester fetal ultrasound and delivery at our institution. Exclusion criteria were pregnancies without documented BMI, ultrasound not performed between 18 0/6 and 21 6/7 weeks, multiple gestations, or ultrasound performed for indication other than fetal anatomic assessment. Ultrasound reports were incomplete if they indicated suboptimal or non-visualization of any of 30 fetal anatomic structures. Chi square analysis was used to compare rates of completed surveys.

RESULTS:
2,138 records met study criteria. Using 18 weeks as a reference group, the odds of having a complete survey at each gestational age were calculated. At 19 weeks the OR was 1.35 [1.1-1.7, p = 0.001] and at 20 weeks OR 1.37 [1.05-1.8, p = 0.01]. At 21 weeks the difference was no longer statistically significant, OR 1.3 [0.95-1.9]. We found no difference in rates of completed surveys when comparing 19 to 20 weeks, OR 1.015 [0.76-1.34, p = 0.46].

CONCLUSION:
In obese gravidas, the odds of having a complete scan were greatest at 19 and 20 weeks gestational age. Therefore in this population it appears useful to wait until 19 weeks to perform the second trimester fetal ultrasound, but delaying the scan did not further increase the chance of a complete scan.
Factors Associated With Contraceptive Method Choice Among HIV+ Women: A Cross Sectional Study [38P]
Authors: Tote Katherine , Raziano Valerie , Haddad Lisa , Wall Kristin 
Published: April 2018

INTRODUCTION:
Effective contraceptive use is crucial for HIV-positive women to prevent unintended pregnancy. We aim to explore the factors influencing contraceptive method choice among HIV-positive women in the US.

METHODS:
HIV-positive women age 18-45 completed a cross-sectional survey and were eligible if they reported recent sexual activity and had not been sterilized. Chi-square tests and multivariable logistic regression were used to assess factors associated with Tier 1/2 efficacy methods (IUDs, implant, ring, pill, and Depo) within the past month compared to Tier 3 (condom, withdrawal) or no method use.

RESULTS:
Of 105 eligible participants, 31(26%) reported usage of efficacy Tier 1/2 methods. Significant factors associated with higher efficacy method use were younger age (unadjusted prevalence odds ratio per year, cPOR .86 95% CI .80-.91), age over 19 at time of HIV diagnosis (cPOR .28 95% CI .08-.57), higher recent CD4 count (>200 cells/µL, cPOR 2.5, 95% CI 1.1-6.0), HIV+ status during prior pregnancy (cPOR 6.3 95% CI 1.4-29.4), and belief that ‘it’s okay to take birth control that stops your period from coming’ (cPOR 2.8 95% CI 1.1-7.1). While knowledge did not differ significantly across efficacy tiers, the study population revealed a general lack of knowledge regarding contraceptive methods and a notable lack of self-efficacy regarding these choices.

CONCLUSION:
The women in this study who chose higher efficacy methods were clinically healthier. This may reflect more attention to care, patient compliance, or more time during HIV visits to address contraception. Improved knowledge about contraceptive methods is needed among HIV+ women.
Incidence and Characteristics of Cervical Cancer in Elderly Women [3Q]
Authors: Lababidi Suzanne , McQuerry Kristen J. , Duan Ran , Johnson Marian Symmes , Fredericks Tricia , Baldwin Lauren 
Published: April 2018

INTRODUCTION:
Cervical cancer screening guidelines currently recommend cessation of screening after the age of 65 in the absence of previous dysplasia. Patients over the age of 65 are still susceptible to the disease however. This project aims to describe the incidence of cervical cancer in elderly patients as well as characteristics of their disease.

METHODS:
The American College of Surgeons’ National Cancer Database was queried for cervical cancer patients aged 18-99. Variables collected included age, grade, stage, and histology of the disease. Multivariate regression and Cox proportional hazard models were performed to analyze association between the variables as well as survival data.

RESULTS:
A total of 18,015 patients were included in the analysis. Of the patients included, 21% were over the age of 65. Older age was associated with higher grade and stage of disease at time of diagnosis (P<.0001). Older patients were also noted to do more poorly, with an increased risk of death of 1.3% for every year older a patient was at time of diagnosis (95% CI 1.0%-1.64%).

CONCLUSION:
Cervical cancer is as much a disease of the elderly as it is a disease of the young. It is important for clinicians to remain vigilant when screening for the disease and to obtain a proper history, including previous history of dysplasia, when treating these patients. Older patients diagnosed with the disease have typically more advanced and more aggressive disease than their younger counterparts.
Salmonella Tuboovarian Abscess [4Q]
Authors: Chow Stephanie 
Published: April 2018

INTRODUCTION:
Salmonella is an extremely rare cause of tuboovarian abscesses.

METHODS:
Here we report a case of a 33 year old female found to have a ruptured tuboovarian abscess caused by Salmonella.

RESULTS:
After recent travel to South East Asia, our patient presented in septic shock after 1 week of fevers, diarrhea, and abdominal pain. Imaging showed an 11 x 8 cm bilobed cystic, thick-walled lesion in the right adnexa, concerning for a tuboovarian abscess. She underwent computed tomography (CT) guided drain placement resulting in 200 ml of viscous, chocolate-colored fluid aspirated. Despite antibiotics and a drain, she continued to have fevers to 103 F and developed an acute abdomen. Repeat CT revealed interval development of three new abdominal and pelvic abscesses measuring up to 13 cm in greatest dimension. She then underwent a diagnostic laparoscopy, pelvic washout, and ovarian cyst drainage. Both abscess drainage and intraabominal fluid collected from surgery grew out pan-sensitive Salmonella.

CONCLUSION:
Our patient likely had Salmonella enteritis with bacterial translocation to a right ovarian endometrioma, complicated by purulent peritonitis after cyst rupture following drain placement. Women with symptoms of pelvic inflammatory disease and gastroenteritis should be screened for enteric pathogens including Salmonella.
Incidence and Knowledge of Hypoactive Sexual Desire Disorder and Its Treatment: A Survey [6Q]
Authors: Phillips Nancy , Bachmann Gloria A. , Yeung Percy , Lu Chi-Wei 
Published: April 2018

INTRODUCTION:
HSDD has been recognized as a sexual disorder since 1950. Low sexual desire is self-reported by approximately 40% of women, with the true disorder present in about 14%. Despite this, studies consistently show women being hesitant to discuss sexual issues with their physicians. Women may feel low desire is a normal result of aging, or are unaware of possible treatment. Treatments for HSDD include identification and treatment of secondary causes, counseling or sex therapy, or most recently, flibanserin, FDA approved in 2015.

METHODS:
An IRB approved survey on HSDD was distributed to women aged 18 and over presenting to a general gynecology practice. The aim of the survey was to gather information on the incidence of decreased sexual desire, knowledge that HSDD was considered a medical diagnosis and assess if women were aware of treatment options.

RESULTS:
One hundred and thirty-three women participated in the survey. 29% reported decreased desire and 50% of these women reported distress, for a 14.5% incidence of HSDD. However, only 22% of respondents were aware that HSDD was a medical condition and only 12% were aware of an FDA approved medication for it.

CONCLUSION:
HSDD, by definition, causes marked personal or interpersonal distress. Yet women are not aware that this is a recognized medical condition. As even less women are aware that treatment options exist, even those who would consider discussing this with their physician may be hesitant to do so. Better education of both patients and physicians will help to better serve this unmet need.
Baseline Burden of Endometriosis-Associated Pain among Women in Two Phase 3 Elagolix Studies [10Q]
Authors: Leyland Nicholas , Surrey Eric , Soliman Ahmed M. , Eichner Samantha , Chen Kun , Snabes Michael 
Published: April 2018

INTRODUCTION:
Few data exist on the extent of symptoms in women with endometriosis. This analysis examined baseline pain burden among women with moderate to severe endometriosis pain in two phase 3 studies of elagolix (an oral, non-peptide GnRH antagonist) for the management of endometriosis-associated pain.

METHODS:
Elaris EM-I and Elaris EM-II were two double-blind, randomized, 6-month, placebo-controlled phase 3 studies evaluating two elagolix doses (150 mg once daily and 200 mg twice daily) in women with endometriosis-associated pain. This analysis included randomized women pooled across studies and treatment groups. Dysmenorrhea (DYS) and non-menstrual pelvic pain (NMPP) scores were recorded in a daily electronic-diary and characterized as ‘none’, ‘mild’, ‘moderate’, and ‘severe’, with definitions that incorporated daily functioning. Days with DYS or NMPP and severity of pain are summarized. Baseline was defined as the average of the last 35 days during the screening period.

RESULTS:
At baseline, the mean [SD] number of days women reported DYS and NMPP was 8.0 [3.0] days (97.6% of menstruating days) and 20.5 days [5.4] (90.3% of non-menstruating days), respectively (N=1686 for the combined studies). Enrolled women reported moderate/severe DYS and NMPP most days during the baseline phase (mean [SD]: DYS, 80.5% [21.2] of menstruating days; NMPP, 57% [29.0] of non-menstruating days).

CONCLUSION:
On average in these two phase 3 studies, women with endometriosis-associated pain experienced DYS or NMPP > 90% of days during the baseline phase and moderate/severe pain was reported for a majority of the days when pain was reported.
Obstetric and Gynecological Outcomes in Patients with STAT3-deficient Hyper IgE Syndrome [13Q]
Authors: Chepa-Lotrea Xenia , Urban Amanda , Bergerson Jenna , Weisman Hannah , Stratton Pamela , Freeman Alexandra 
Published: April 2018

INTRODUCTION:
Autosomal dominant Hyper IgE syndrome (AD-HIES) is a primary immunodeficiency due to STAT3 mutations, resulting in eczema, recurrent skin and pulmonary infections, and mucocutaneous candidiasis. Little is known of gynecologic-obstetric complications but with improved therapies, women are living longer making reproductive health more pertinent.

METHODS:
We prospectively interviewed and retrospectively reviewed medical records of adult women with AD-HIES evaluated at NIH between 2000-2017.

RESULTS:
Of 60 patients aged 19-66 years (mean 35), 45 women were interviewed, and chart reviews were performed on 15, of whom eight were deceased. 21/60 (35%) reported having regular cervical cytology testing with seven (33%) having abnormal squamous cells of unknown significance (ASCUS). Five women reported vulvar cysts/abscesses requiring drainage. Nine women had IUDs placed, in some to suppress menses-associated vulvar eczema/abscess flares; no infectious complications were reported. Over 30% of women chose not to conceive given underlying disease. Of 16 women with pregnancies, 15 women had 26 live births, 6/16 (38%) had miscarriages, and 3/16 (19%) experienced recurrent pregnancy loss. . Three women whose pulmonary symptoms worsened during pregnancy were diagnosed with progression of parenchymal lung disease post-partum. One woman experienced worsening of skin manifestations. Other reported postpartum complications included one incisional infection (after Caesarean) and one hemorrhage leading to hysterectomy.

CONCLUSION:
As women with AD-HIES are living longer, they elect to have children or prevent pregnancy; knowledge of their reproductive choices and complications can improve their care. While these women may choose to attempt pregnancy, the risk of recurrent pregnancy loss and worsening disease warrants discussion.
The Potential Cost-Effectiveness of Extended Genotyping in US Cervical Cancer Screening Paradigms [14Q]
Authors: Asjes Caitlin , Andrews Jeff 
Published: April 2018

INTRODUCTION:
A multitude of factors determine a women’s risk of cervical cancer and also determine the most cost-effective patient management. HPV extended genotyping (XGT) can support patient triage and management via individual risk stratification. It’s important to understand the potential clinical and economic impact of adding XGT into existing screening paradigms.

METHODS:
An Excel-based budget impact model was calibrated for the US population. Disease and genotype-specific prevalence was derived from the BD Onclarity Clinical Trial and published literature. The model compares: Cytology-based screening with ASCUS triage by HPV DNA testing and Co-testing. Each scenario compared a pooled HPV assay and one reporting high-risk genotypes individually. The model follows patients through one screening cycle and compares disease outcomes (CIN2+) and costs.

RESULTS:
The initial results demonstrate the use of XGT has the potential to increase cervical cancer and CIN2+ disease detection. While under certain scenarios there may be a minor increase in colposcopies performed, this analysis shows that by utilizing XGT up to 50% more high-risk genotypes would be referred to colposcopy, with more lower-risk genotypes being deferred to a 1 year follow-up. By this mechanism the model suggests that XGT will increase the colposcopy yield and decrease costs.

CONCLUSION:
Incorporating XGT into the existing screening paradigms could lead to improved patient outcomes and lower costs in the US. While this model only looked at the impact of the first screen, further research is recommended into the impact of XGT on persistence tracking and individualized patient management over time.
Enhanced Recovery Pathway for Minimally Invasive Hysterectomy: Outcomes of a Quality Improvement Initiative [15Q]
Authors: Bozzuto Laura , Mastroyannis Spyridon A. , Salva Catherine , Haggerty Ashley 
Published: April 2018

INTRODUCTION:
Enhanced recovery after surgery (ERAS) pathways have decreased postoperative pain and shortened hospital stays. This quality improvement project at a tertiary care academic medical center sought to implement an ERAS pathway for patients undergoing minimally invasive hysterectomy (MIH) for benign indications and evaluate perioperative outcomes.

METHODS:
Consecutive patients managed under an ERAS protocol (implemented June 1, 2016) undergoing MIH for benign indications from August 1-October 31, 2016 were compared to consecutive historical controls (August-October 2015). Demographic, operative, and clinical information was abstracted. Descriptive statistics and bivariate analyses were performed.

RESULTS:
There were 41 procedures performed by 15 surgeons pre-ERAS intervention and 47 performed by 18 surgeons post-ERAS implementation. There was no statistical difference between the groups by age, race, insurance status, ASA class, or BMI. After ERAS implementation, the percentage of patients discharged by noon increased (14.6 to 36.2%, P= .022) with a significant difference in length of stay (P=.029). The use of patient controlled analgesia (PCA) decreased from 51.2 to 10.6% (P<.001). Postoperative narcotic use decreased significantly with a reduction in intravenous oral morphine equivalents (OME) from a median of 5mg (SD 0-25mg) to 0mg (SD 0-4 mg) [P<.001] and in median total OME from 45mg (SD 25-128.5mg) to 24mg (SD 5-48mg) [P<.001]. There was no significant change in postoperative complications or readmissions.

CONCLUSION:
An ERAS pathway quality improvement initiative for benign MIH can be effectively implemented at a large academic center. Our quality improvement program resulted in improved postoperative recovery outcomes and a significant reduction in post-operative narcotic usage.
Congenital Cervical and Vaginal Malformations: Lessons from 42 cases Managed Clinically by a Common Protocol [28Q]
Authors: Pan Hongxin , Luo Guangnan 
Published: April 2018

INTRODUCTION:
To outline the anatomic variations and the clinical management of congenital cervical and vaginal malformations in a cohort of 42 patients in China.

METHODS:
From January 2008 to January 2017, a total of 42 patients with congenital cervical and vaginal malformations were treated in the department of Gynecology at the 3rd affiliated hospital of Shenzhen University (China). Clinical examinations, magnetic resonance imaging, hormonal profile and laparoscopy were collected. All surgical findings were carefully reviewed to determine the anatomic characteristics of the cervical and vaginal malformations.

RESULTS:
The mean age at the time of symptom onset was 12.8±1.9 years (range 9-17). The mean time from symptom onset to surgery was 3.4±0.9 years (range 0.1-14). Among the 38 patients, (90.5%) had pelvic endometriosis. Among the 38 patients with pelvic endometriosis, 20 patients had ovarian endometrial cysts. Endometriosis was staged as minimal-mild in 21 and as moderate-severe in 17. Of the 42 patients, 5 underwent hysterectomy during their first surgery and 37 received cervical reconstruction surgery. Among these 37 patients, 25 underwent Luohu III procedure (peritoneal vaginoplasty, trachelectomy and uterus-neovagina anastomosis), 12 underwent Luohu IV procedure (laparoscopic vaginal section and peritoneal vaginoplasty). Of the 37 patients with a preserved uterus, 2 attempted pregnancy up to day, and one woman achieved a successful pregnancy but experienced premature delivery.

CONCLUSION:
Our study found that cervical and vaginal malformations might be successfully treated by uterovaginal anastomosis under laparoscopy. With appropriate evaluation and individualized management, we believe that a successful treatment and pregnancy outcome might be achieved.
Postoperative Opioid Utilization Following Benign Gynecological Surgery [31Q]
Authors: Movilla Peter , Kokroko Jolene , Kotlyar Amalia , Rowen Tami 
Published: April 2018

INTRODUCTION:
There is increasing concern for opioid over-prescribing patterns, with nearly quadrupling of the number of opioid prescriptions in the United States since 1999. There are no guidelines for directing the opioid prescription patterns following benign gynecological surgery.

METHODS:
We are conducting a prospective study assessing postoperative pain prescriptions and medication usage via telephone survey.

RESULTS:
Our preliminary results show that 54 patients underwent a benign gynecological surgery at the University of California San Francisco from August to September 2017. 45 (83.3%) patient's received an opioid prescription. 15 (27.8%) were hysteroscopy procedures, 31 (57.4%) laparoscopy, 5 (9.3%) laparotomy, and 3 (5.6%) categorized as others. On average 41.7 morphine milligram equivalents (MME) of opioids were prescribed following hysteroscopy, 176.0 MME following laparoscopy, 260.0 MME following laparotomy, and 83.3 MME following others. 33 (61.1%) patients completed the telephone survey. On average 25.6 MME of opioids were not utilized by postoperative day seven following hysteroscopy, 116.6 MME following laparoscopy, 298.1 MME following laparotomy, and 29.1 MME following others. 26 patients completed the telephone survey and utilized opioids. 46.2% would keep excess opioids for future use. 23.1% would dispose of excess opioids.

CONCLUSION:
Opioid analgesics are a major component of current gynecological postoperative pain management. On average patients receive in excess an equivalent of 15.5 tablets of 5mg oxycodone following laparoscopic surgery not utilized by postoperative day seven. A majority of patients are keeping excess opioids for utilization outside of their intended purpose. Data collection is ongoing and estimate an additional 100 patients for the completed study.
Impact of BMI on Pelvic Inflammatory Disease [32Q]
Authors: Ashrafian Sogol , Uyar Denise 
Published: April 2018

INTRODUCTION:
Tubo-ovarian abscess (TOA) is a serious complication of pelvic inflammatory disease (PID) reported in 34% of patients. Obesity is a concern among women of all ages and has been shown to adversely affect healthcare outcomes. We compared PID infections in women with BMI > 30 and < 30 admitted for the treatment of PID to determine how obesity impacts PID.

METHODS:
A retrospective study was performed on patients admitted with PID (ages 18-40) between January 2010 and July 2017. Patients were stratified into BMI ≥30 vs. BMI <30. Data reviewed included diagnosis, past medical history, length of stay, readmissions and procedural interventions.

RESULTS:
72 patients met inclusion criteria. Thirty-eight patients had BMI > 30 and 34 patients had a BMI < 30. Women with a BMI > 30 had a higher incidence of TOA (65.8% v. 38.2%); greater number of procedures (50% v. 14.7%) and a greater length of hospital stay (6.9 ± 5.1 v. 4.0 ± 1.9). Patients with BMI > 30 were less likely to use tobacco (28.9% v. 41.2%), less likely to be readmitted (15% vs 50%) and more likely to be diabetic (26.3% v. 2.9%).

CONCLUSION:
BMI > 30 was associated with greater morbidity demonstrated by more severe PID infections with a greater incidence of TOAs, need for more invasive interventions and longer length of hospital stay. In women with BMI > 30, TOA was diagnosed twice as often than reported in the literature. Elevated BMI may be an additional risk factor to consider when treating women with PID.
Clarity for Improving Standardized Obstetrician-Neonatologist Neonatal Handoffs [33Q]
Authors: Dunnington Helen , Lake Natasha , Iniguez Suzanne , Baruah Isa 
Published: April 2018

INTRODUCTION:
There are currently no standardized methods of handoff between Labor & Delivery (L&D) and Neonatology teams for neonatology-attended deliveries. Communication breakdown occurs in approximately 70% of sentinel events resulting in perinatal mortality or permanent disability. Barriers to effective patient handoffs include confusion over role clarity, transferring unnecessary information, time constraints, and room volume. Standard communication in the delivery room could reduce communication variability and promote safer care. Our goal was to evaluate if standardized handoffs between the L&D and Neonatology teams in unplanned neonatology-attended cesarean deliveries would result in more complete and efficient transfer of critical patient information.

METHODS:
Members of the L&D and Neonatology teams were surveyed to determine critical areas of patient handoff in neonatology attended cesarean deliveries. Survey results were utilized to determine areas that required change for subsequent Plan-Do-Study-Act worksheets. Reliability of the process was assessed by Neonatology response respiratory therapists who submitted a separate observational survey.

RESULTS:
Over a 3 month period, 38 deliveries were assessed. The following transfer of critical information was identified: Obstetrician to Neonatologist - gestational age, single versus multiple gestation, presence of meconium, fetal heart rate abnormalities, fetal anomalies, and reason for the call. Whereas Neonatologist to Obstetrician - APGAR score, gender, birth weight, resuscitative measures, and disposition of infant. Both the L&D and Neonatology teams reported that a streamlined handoff process improved workflow and team satisfaction (15 and 16% positive increase, respectively).

CONCLUSION:
Standardization of handoffs and role identification improve communication of critical information between L&D and Neonatology teams.