bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Treatment of Hypothyroidism Among Pregnant Women: A Retrospective Analysis [13M]
Authors: Lage Maureen , Espaillat Ramon , Vora Jamie , Hepp Zsolt 
Published: April 2018

INTRODUCTION:
This study examined treatment patterns of hypothyroidism among pregnant women.

METHODS:
The Optum ClinformaticsTM DataMart retrospective claims database was used to identify women in 2014 who were age 18 to 49, were identified as having hypothyroidism, and had at least one recorded thyroid-stimulating hormone (TSH) laboratory value during their pregnancy (N=3,448). The study examines differences in characteristics between pregnant patients treated with levothyroxine (N=2,340) and untreated pregnant patients (N=1,108) as well as treatment target achievement based upon American Thyroid Association guidelines (2011).

RESULTS:
The average age was 32.76 years old (SD=4.80) with a median TSH value of 1.97 mIU/L (interquartile range 1.27 to 3.53). Compared to untreated pregnant women, treatment with levothyroxine was associated with significantly younger age (32.57 versus 33.14 years; P=0.0011), a lower Charlson Comorbidity Index (0.16 v 0.21; P=0.0086), and lower rates of comorbid type 2 diabetes (4.79% versus 6.77%; P=0.0164) and migraines (2.74% versus 4.06%; P=0.0376). Among women treated with levothyroxine, 52.61% had a last recorded TSH value consistent with ATA guidelines, 23.85% were under-treated, 1.03% were over-treated, and 22.52% did not have TSH monitored during their pregnancy.

CONCLUSION:
This study found significant differences in general health and comorbidities between pregnant women treated with levothyroxine and those untreated. These results suggest that a relatively large percentage of pregnant women are not being appropriately managed for their hypothyroidism.
Delivering Health Care to Refugee and Immigrant Women in Clarkston, GA: Opening a Women’s Clinic [28M]
Authors: Kaplan Jessica , DeSimone Mia , Phan Le Thien-Linh , Newman Sarah , Goedken Jennifer 
Published: April 2018

INTRODUCTION:
Refugee women are a vulnerable population who experience barriers accessing healthcare and disparities in health outcomes. Eighty-five women from the Clarkston Community Health Center (CCHC), a primary care clinic serving an uninsured refugee and immigrant population, were surveyed using a women’s health needs assessment. Eighty-four percent of reproductive aged women experienced unmet family planning needs, 46% of women over 40 years had never had a mammogram, and 29% of women over 21 years had never had a pap smear. While the survey didn’t specifically address sexually transmitted infections (STIs), 38/82 (46%) requested access to STI screening. Lack of knowledge and access to care were cited as common barriers.

METHODS:
Using the CCHC infrastructure, funding from Emory School of Medicine, and volunteer community providers, we opened a women’s clinic in January 2017. We have collected data on number of patients, presenting complaints, services provided, and referrals.

RESULTS:
As of September 2017, the clinic has served 230 women. Out of the 185 women offering reasons for attending clinic, 24% presented for contraception, 14% for STI testing or treatment, 10% for Pap smears, 3% for breast complaints, and the other 49% for specific gynecologic complaints. We have performed 80 pap smears, tested or treated 63 women for STI’s, and provided 33 women with contraception. We have referred 46 women for mammograms or other evaluation.

CONCLUSION:
The needs assessment was critical to the development of the clinic. However, it underestimated the STI related needs of the population. This may be important to others considering a similar undertaking.
Pregnancy Outcomes in Women with Rheumatoid Arthritis: A Retrospective Population-Based Cohort Study [7N]
Authors: Aljary Hissah , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie A. 
Published: April 2018

INTRODUCTION:
Rheumatoid arthritis (RA) is a chronic autoimmune, inflammatory disease that is more commonly found in women. Our objective is to assess if pregnancies in women with RA are at a higher risk of adverse maternal and neonatal outcomes.

METHODS:
We carried out a retrospective cohort study, using the US Healthcare Cost and Utilization Project National Inpatient Sample from 2004-2013. All births were identified and women were classified as having RA or not on the basis of ICD-9 coding. Logistic regression was used to evaluate the adjusted effect of RA on maternal and neonatal outcomes.

RESULTS:
Of the total 8,417,607 births in our cohort, 6,068 were among women with RA. There was a steady increase in RA in pregnancy from 47 to 100/100,000 over the 10-year study period. Compared with women without RA, women with RA were more likely to experience pre-eclampsia/eclampsia (OR 1.70, 95% CI 1.54-1.89), gestational diabetes (OR 1.13, 95% CI 1.02-1.24), PPROM (OR 1.78, 95% CI 1.66-1.91), placental abruption (OR 1.43, 95% CI 1.16-1.76), placenta previa (OR 1.37, 95% CI 1.05-1.78), and to deliver by cesarean section (OR 1.38, 95% CI 1.31-1.45). Congenital anomalies (OR 2.11, 95% CI 1.65-2.72), small for gestational age (OR 2.36, 95% CI 2.09-2.66) and preterm birth (OR 1.81, 95% CI 1.67-1.95) were more common in neonates of women with RA.

CONCLUSION:
RA in pregnancy is associated with greater likelihood of adverse maternal and neonatal outcomes. Women with RA should be made aware of these risks and be followed as a high risk pregnancy.
Interest and Attitudes Toward Global Health Training of Prospective Obstetrics and Gynecology Residents [4O]
Authors: Hoang Christine , Felini Martha , Nguyen Nguyen 
Published: April 2018

INTRODUCTION:
The benefits of global health training in clinical education have been well described in graduate medical education literature. Despite these benefits there is a lack of global health training offered by OBGYN residency programs nationally. The purpose of the study is to assess prospective OBGYN residents’ interests and attitudes toward such training and the results can potentially help develop an educational curriculum and clinical training opportunity.

METHODS:
A survey was developed to assess prospective residents’ views on global health training. Questions utilized a Likert scale response. Additional questions included demographics and prior global health experience. The anonymous, voluntary survey was distributed to our OBGYN residency applicants who interviewed in 2016-2017. Univariate and bivariate analysis was conducted. Fisher exact tests and two-sided p values were calculated to determine statistically significant differences.

RESULTS:
The response rate was 50/62. 76% were likely to participate in an offered elective. 94% agreed that residencies should offer voluntary electives. 64% expressed interest in incorporating global health into future practices. Scheduling conflicts were perceived as the greatest barrier to participation. Learning about public health systems and gaining procedural experience were the main interests. Over 50% had prior global health experience.

CONCLUSION:
Findings suggest that applicants to our OBGYN residency believe a global health elective should be offered in residency training and a majority would participate if given the opportunity. With the strong interest and positive attitudes toward a global health elective, steps can be taken to develop a curriculum and training opportunity.
Improving Resident Experience on a Gynecology Rotation by Implementing a Formal Curriculum and Feedback System [12O]
Authors: Wong Thalia , Rodriguez-Triana Valentina 
Published: April 2018

INTRODUCTION:
Surgical and inpatient gynecologic training is variable between obstetrics and gynecology residency programs. As a result, resident experiences may be impacted. We sought to determine if implementing a structured curriculum and feedback system for an inpatient gynecology rotation impacts resident learning and satisfaction.

METHODS:
Prior to implementing changes on an inpatient gynecology rotation at an academic hospital, a 13 question survey, including ratings from 1 to 5 and true-false responses, was administered to residents who had completed the rotation. The following academic year, the gynecology rotation was modified to include structured learning objectives, teaching conferences, anatomy wet lab simulations, and rotation feedback. The same survey was administered to residents who completed their rotation following the modifications. Wilcoxon sum rank test and chi squared analyses were used to compare responses between the two groups.

RESULTS:
From July 2015 to July 2017, 48 residents completed the gynecology rotation. A total of 47 residents responded to the survey, 24 (51%) completed the survey prior to the changes and 23 (49%) took the survey after. Following implementation of a structured curriculum and feedback system, residents rated their experience of the rotation overall significantly higher (P = 0.01) and found pre-operative teaching conferences more structured and valuable (P < 0.001). The post-intervention group also felt they received more benign surgical feedback (P = 0.004) and mid-rotation feedback (P = 0.002).

CONCLUSION:
A formalized curriculum that consists of clear goals and expectations, structured teaching time, formalized anatomy training, and regular feedback is an effective method of improving gynecology residents’ inpatient and surgical training experience.
A Multi-Modality Pelvic Anatomy Education Program for Ob/Gyn Residents [15O]
Authors: Suh Christina , Mulheron George , O'Brien Devon , Esguerra Cybill , Pradhan Archana , Balica Adrian 
Published: April 2018

INTRODUCTION:
Understanding pelvic anatomy is essential to training as an ob/gyn. In most residency programs, residents learn anatomy through self-guided reading and direct experiences in the operating room, which can be limited by time constraints and patient safety concerns. The purpose of our study was to develop and assess a novel pelvic anatomic education program for residents.

METHODS:
We utilized three different learning modalities: cadaveric dissection on unused cadavers from our medical school’s anatomy course, clay models of the pelvic floor, and didactic lectures. The cadaver dissection was presented in a “mock surgery” format. Learning objectives and relevant procedures were established for each year of training: abdominal wall anatomy and cesarean section for first years, pelvic spaces and abdominal hysterectomy for second years, presacral space and sacrocolpopexy for third years, and pelvic neuroanatomy for fourth years. Participants completed before and after multiple choice tests and a qualitative survey.

RESULTS:
16 residents from all 4 years of training were recruited to participate in the program. The average pre-test score was 45% and average post-test score was 50%, (p=0.22). The majority of participants strongly agreed that the program was interesting (67%), enhanced their understanding of pelvic anatomy (73%), and increased their confidence in the operating room (53%).

CONCLUSION:
Our multi-modality pelvic anatomy program improved residents’ anatomic knowledge (although this was not statistically significant) and was well received as a clinically applicable educational activity. The cadaveric lab mirrored the gynecological surgical curriculum of our residency and was cost efficient through collaboration with the anatomy department.
Uterine Sacculation of Di-Di Twin pregnancy [24O]
Authors: Sadek Seifeldin , Tendler Shlomo , Demirel Esra 
Published: April 2018

INTRODUCTION:
Uterine sacculation is a rare complication of pregnancy. It may cause substantial peri-partum morbidity including pain and rarely uterine rupture. It consists of a transitory out-pouching or sac-like structure developing from an abnormal forward or backward rotation of the uterine fundus.

METHODS:
A 36 year old female with past medical history significant for Crohn’s disease, total proctocolectomy, and resolved cervical prolapse who presented at 16 weeks gestation with severe pelvic pain and intermittent urinary retention. Physical exam and confirmatory MRI revealed the suspected diagnosis of uterine incarceration. Initially there was temporary improvement with exam under anesthesia and bimanual exam to dis-impact the uterus. Repeat attempts at bimanual exam had no success. Out of concern for thick pelvic adhesions inhibiting uterine mobility and the risk of uterine rupture the patient was taken for minimally invasive surgery.

RESULTS:
After a diagnostic laparoscopy, and thorough uterine manipulation using a single hand gel port the uterus was confirmed to not be truly incarcerated, rather to have a posterior uterine sacculation likely leading to the extreme pain. Post op course was complicated by prolonged and excessive pain symptoms. PMNR specialists were brought in to assist with management for the duration of this painful pregnancy and to assist with prevention of the unfortunate sequela of prolonged opiate use. The patient ultimately also sought out non-western modalities of pain management.

CONCLUSION:
Diagnosis of uterine sacculation can be difficult. Patients can present with symptoms mimicking incarceration, including severe pain and urinary retention. There is a reported minimal risk of uterine rupture.
Clinical Management of Unknown Group Beta Streptococcus Status [30O]
Authors: Ibarra Claudia J. , Murphy Robert E. , Sirajuddin Anwar , Blackwell Sean C. , Refuerzo Jerrie S. 
Published: April 2018

INTRODUCTION:
The objective of this study was to determine adherence to the Centers for Disease Control (CDC) guidelines for Group Beta Streptococcus (GBS) results available at the time of delivery.

METHODS:
A retrospective cohort review was conducted including women admitted for delivery who received prenatal care within the prior 6 weeks. Women were divided into groups including positive, negative and unknown GBS status. Source and effects of GBS status on adherence to CDC guidelines were collected.

RESULTS:
Of the 97 women who met study criteria, 20.6% (N=20) had unknown status, 26.8% (N=26) positive result and 52.6% (N=51) negative result. In 10% of women with unknown status, the result was available on electronic health record (EHR) with interface between outpatient with inpatient setting. The remaining 90% of cases did not have access to GBS results obtained in the prenatal setting. Adherence to CDC guidelines occurred in 45% (N=9) of these women in which antibiotics were administered only with known risk factors. Non-adherence occurred in 55% of cases such that 11 women received unnecessary antibiotic exposure even in the absence of risk factors. Moreover, when the GBS results were eventually available, 2 were negative.

CONCLUSION:
In our study, less than 50% of women with unknown GBS status received therapy in compliance with CDC recommendations. Efforts should be made to ensure EHR access to prenatally obtained GBS results and to educate health care providers regarding the potential harms of exposure of unindicated therapies.
Maternal and Fetal Outcomes in Pregnancies Affected by Aplastic Anemia: A Systematic Review [31O]
Authors: Idler Jay , Patek Kara , Patwardhan Sanjay 
Published: April 2018

INTRODUCTION:
Aplastic anemia is a rare and potentially fatal condition, affecting between 2 and 6/1,000,000 pregnancies in the United States. The primary objective of this review was to identify adverse maternal and fetal outcomes associated with aplastic anemia complicating pregnancy.

METHODS:
We conducted a systematic review of published literature to identify all observational and randomized studies evaluating pregnancy outcomes in women diagnosed with aplastic anemia. A combination of keywords was used to identify the maximum number of relevant citations in MEDLINE, EMBASE, CINAHL and the Cochrane Database.

RESULTS:
We identified 17 observational studies (70 women), which evaluated outcomes in pregnancies complicated by aplastic anemia. Overall, in 36 out of 70 (51.4%) cases at least one significant maternal complication was reported (Table 1). The most common maternal complications included antepartum and/or postpartum hemorrhage, which occurred in 11 (15.7%) cases, and postpartum relapse which developed in 13 (18.6%) cases. Three (4.3%) women experienced intracranial hemorrhage or thrombosis, while four (5.7%) women died within 1 year of pregnancy. Across these reported cases, pancytopenia was observed with a mean starting hemoglobin of 6.9g/dL, white blood cell count of 2.7x109/L and platelet count of 31x109/L. In 14 of 31 (45.2%) cases preterm birth ensued, with 20% of the women delivering prior to 34 weeks. Three cases of intrauterine fetal demise were also reported.

CONCLUSION:
This review demonstrates the significant adverse maternal and fetal outcomes in pregnancies complicated with aplastic anemia. The findings from this review may aid in counselling and managing obstetric patients suffering from this rare condition.
Use of Tranexamic Acid to Prevent Postpartum Hemorrhage in Women Undergoing Vaginal Delivery: A Meta-Analysis [36O]
Authors: Boyd Angela R. , Vasichko Paula E. , Ireland Kayla E. , Roman Tania , Acosta Ometeotl M. , Ramsey Patrick S. 
Published: April 2018

INTRODUCTION:
Randomized clinical trials (RCT) have evaluated the use of tranexamic acid (TXA) for treatment and prevention of postpartum hemorrhage (PPH), but there is currently insufficient evidence to support prophylactic use. Our objective was to conduct a systematic review and meta-analysis using available data from RCTs that evaluated the efficacy of prophylactic utilization of TXA at the time of vaginal delivery.

METHODS:
A systematic literature review was conducted using PUBMED and MEDLINE from 1966-2017 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCTs were abstracted and meta-analysis was conducted using the Mantel-Haenszel fixed effects model with test of heterogeneity.

RESULTS:
Three RCTs were identified for the prophylactic use of TXA at the time of vaginal delivery, for a total of 659 women. Compared to placebo, prophylactic administration of TXA significantly reduced mean blood loss (MBL) (659 women, odds ratio (OR) 0.54, 95% confidence interval (CI) 0.41-0.71), decreased incidence of MBL > 500 cc (two studies, 559 women, OR 0.48, 95% CI 0.26 to 0.88), decreased incidence of PPH > 1000 cc, (two studies, 559 women, OR 0.28, 95% CI 0.1 to 0.81), and decreased the use of additional medical interventions (three studies, 659 women, OR 0.27, 95% CI 0.13 to 0.57). No thromboembolic events were reported.

CONCLUSION:
Prophylactic administration of TXA following vaginal delivery decreases MBL, decreases the incidence of PPH and reduces the need for additional medical intervention. Additional research is needed to elucidate optimal regimens to maximize efficacy and minimize risk.
Opioid Remission in Pregnancy: Effects On Maternal and Fetal Outcomes [37O]
Authors: Seymour-Willey Alicia , Zhou Clarice , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
With the rising opioid epidemic, literature has explored the effect of maintenance therapies and detoxification in opioid-dependent pregnancy. However, the outcomes of pregnancy in the opioid remit population have not yet been ascertained. This study will examine the effect of remission on maternal and fetal outcomes of pregnancy compared to a general population.

METHODS:
A retrospective cohort study of 1,853,219 singleton gestations in California compared pregnancy outcomes of women with opioid remission to general population data. Maternal outcomes comprised cesarean deliveries, placental abruption, postpartum hemorrhage, and preeclampsia/eclampsia. Neonatal outcomes included preterm delivery (<37, <34, <32 weeks), intrauterine fetal demise, neonatal death (NND), respiratory distress syndrome, hypoglycemia, jaundice, asphyxia, neonatal seizures and neonatal abstinence syndrome (NAS). Hospital outcomes measured maternal and infant length of stay (LOS). Comparisons were performed using multivariate regression analyses, and Chi-square tests; a p-value of <0.05 was considered statistically significant.

RESULTS:
Opioid remission showed a statistically significant increase in NND, NAS, maternal/infant LOS, and infant hospitalization cost. Pregnancy outcomes of women in opioid remission showed a significantly greater likelihood of maternal sepsis (OR 6.24, 95% CI 1.54-25.26), placental abruption (OR 3.34, 95% CI 2.48-4.50), and neonatal seizures (OR 7.19, 95% CI 3.39-15.24). Mean hospitalization was $7,474 more for the neonate (p <0.001). Maternal LOS (2.71 versus 2.48 days, p<0.001) and neonate LOS (4.66 versus 2.50, p<0.001) were substantially increased.

CONCLUSION:
Remission has detrimental effects on pregnancy compared to a general population, and significantly increases NND, NAS and mother-baby dyad hospitals costs. For further analysis, a prospective trial is needed.
Exam Indicated Shirodkar Versus McDonald Cerclage: A Retrospective Review [38O]
Authors: Morgan Elizabeth A. , Gill Lisa , Hart Bethany , Tessier Katelyn , Morgan Elizabeth A. 
Published: April 2018

INTRODUCTION:
Cervical cerclage is an effective intervention for the prevention of preterm birth. The most commonly described techniques are McDonald and modified Shirodkar cerclage. Older literature suggests no evidence for preferential benefit between them, however more recently Shirodkar is favored as superior for history indicated placement. There are limited data comparing their use for exam indicated cerclages. We hypothesized that placement of an exam indicated Shirodkar cerclage would result in delivery at a later gestational age with a longer latency period compared to McDonald cerclage.

METHODS:
This is a retrospective cohort study. All exam-indicated cerclage procedures placed between April 1, 2011 and February 1, 2017 were collected from a single center. Exposure was defined as Shirodkar or McDonald cerclage. Primary outcome was gestational age at delivery, and secondary outcome was latency period to delivery. Continuous variables were compared with t-tests, categorical variables were compared with Chi-squared and Fisher’s exact tests. Results were adjusted for co-variants with linear regression.

RESULTS:
105 exam indicated cerclages, 82 McDonald and 23 Shirodkar were included. No significant difference existed between gravidity, race, BMI, chorioamnionitis, or membrane exposure. After adjustment for antibiotic and tocolytic use, Shirodkar cerclage was associated with later gestational age at delivery (36.5 weeks vs 32.3 weeks, p=.009), and longer latency (15.9 wks vs 12.3 wks, P = . 03) than McDonald cerclage.

CONCLUSION:
Placement of exam indicated Shirodkar cerclage results in longer latency and later gestational age at delivery. These findings are consistent with previously reported superior outcomes with the Shirodkar technique in history and ultrasound indicated cerclage.