bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long Acting Reversible Contraception Uptake and Presidential Election Survey [2F]
Authors: Scaramella Nicole M. , Mercier Rebecca 
Published: April 2018

INTRODUCTION:
The Affordable Care Act's (ACA) contraception mandate expanded birth control coverage, making Long Acting Reversible Contraception (LARC) more accessible. Anecdotal reports suggest that concerns about loss of coverage following the November 2016 election would lead more women to seek LARC. We conducted a cross-sectional survey to investigate whether women choosing LARC cite politics as a motivation and if they support the ACA.

METHODS:
All women undergoing LARC insertion from June 2017 to July 2017 in an urban gynecology office were invited to participate. Non-English speakers were excluded. The survey queried demographics, motivation for selecting LARC and support for ACA. Descriptive statistics were used to summarize data and chi square tests were used to assess associations between views.

RESULTS:
97 women presented for LARC insertion and 84 completed the survey (86% response rate). 80% received IUDs and 20% received Nexplanon. 99% of devices were paid for by patient insurance. 38% stated recent political events influenced their decision to get LARC. 87% were in favor of the ACA and 86% supported the contraception mandate. Those who supported the ACA were significantly more likely to specifically support the contraception mandate (93% vs 40%, p <0.01). However, women who did not support the ACA were not more likely to support its repeal (25% vs 13%, p=0.38).

CONCLUSION:
A majority of the women seeking LARC support the ACA and for more than one third, the election affected their decision. Politics impacts patient choices and physicians may need to address the changing political climate to better serve their patients.
Screening and Counseling for Intimate Partner Violence in Pregnancy [23F]
Authors: Paruchuri Yasaswi , Rajendran Sneha , Chang Judy 
Published: April 2018

INTRODUCTION:
An estimated 1.5 million experience physical or sexual violence from an intimate partner each year in the United States, however little data exists on how obstetric providers assess intimate partner violence (IPV), or on how IPV-affected women experience the discussions.

METHODS:
Patients who disclosed IPV on a computerized pre-visit survey or during an audio-recorded first obstetric visit were asked to return for qualitative semi-structured interviews during which they reviewed their recorded visit and provided their reflections regarding the IPV screening and counseling. Transcripts from these interviews were qualitatively coded for common themes.

RESULTS:
Of the 250 participants, 91 disclosed IPV either by computer survey or in-person during the recorded visit. Thirty-two women returned for semi-structured interviews. Interviews revealed women’s reasons not to disclose, positive and negative aspects about current approaches, and recommendations for providers. Reasons not to disclose included fears regarding confidentiality, stigma, and concern for involvement of child protective services. Positive attributes of current interviewing included expressions of care, direct questioning, telling patients they are not alone, and open body language. Negative attributes included asking about IPV in an insensitive manner. Recommendations for addressing IPV included being direct, nonjudgmental, and caring, and providing follow-up counseling after IPV disclosure. Women advised that post-disclosure discussions should include emotional support, strategies for emergency situations, housing resources, and self-defense resources.

CONCLUSION:
Understanding the experiences of pregnant IPV-affected women provides insight into specific approaches to use or avoid when addressing IPV. IPV training for obstetric care providers should include these strategies to improve IPV screening and counseling.
Risk of Neonatal Sepsis with Rescue Steroids in Preterm Premature Rupture of Membranes versus Intact Membranes [25F]
Authors: TenBrink Emily E. , Quain Angela , Daggy Joanne , Haas David Michael , Shanks Anthony 
Published: April 2018

INTRODUCTION:
Currently there is insufficient evidence to make a recommendation for rescue steroids in women with preterm premature rupture of membranes (PPROM). Prior studies have suggested an increased risk of neonatal sepsis and studies investigating rescue steroids excluded these patients. The objective of our study was to compare the rate of neonatal sepsis after rescue steroids in women with PPROM compared to intact membranes.

METHODS:
We performed a retrospective cohort study of singleton gestations 23.0 to 34.0 weeks, who received rescue corticosteroids at our institution between January 2009 and October 2016. Patients were separated into three groups based on membrane status at the time of corticosteroid administration; Group 1 (intact at initial course/intact at rescue course), Group 2 (intact at initial course/PPROM at rescue course), and Group 3 (PPROM at initial course/PPROM at rescue course). The primary outcome, neonatal sepsis, was compared between the three groups. Patient characteristics and neonatal outcomes were analyzed with Fisher’s exact test and Anova.

RESULTS:
143 women were eligible. Neonatal sepsis occurred in 6.8% (7/103) of patients in Group 1, 21.1% (4/19) of patients in Group 2, and 23.8% (5/21) of patients in Group 3 (p 0.021). The relative risk of neonatal sepsis after a rescue course of steroids was 3.31 (95% CI= [1.32, 8.29]) for patients with PPROM (Group 2 and Group 3) compared to those with all intact membranes (Group 1).

CONCLUSION:
A rescue course of corticosteroids in PPROM was associated with an increased rate of neonatal sepsis. Larger studies are needed to further investigate this association.
Maternal Height and Perinatal Outcomes in a Trial of Labor After Cesarean [35F]
Authors: Skeith Ashley E. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
We sought to determine differences in perinatal outcomes associated with maternal height in the setting of a Trial of Labor After Cesarean (TOLAC).

METHODS:
We conducted a retrospective cohort study of 217,667 women with singleton, vertex, term gestations with a history of cesarean delivery attempting a TOLAC and examined rates of perinatal outcomes based on maternal height. Maternal height was divided in 2-inch increments and outcomes included successful vaginal birth after cesarean (VBAC), maternal transfusion, neonatal NICU admission, and Apgar less than 7 at 5 minutes. Chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Overall, we found that maternal height is positively correlated with VBAC success, while being inversely related to risk of poor perinatal outcomes. The overall odds ratio of successful VBAC as related to increasing maternal height is 1.06 (95% confidence interval [CI], 1.05-1.07), meaning that for every 2-inch increase in maternal height, there is a 6% increase in probability of success. Increasing maternal height decreases the risk of poor maternal outcomes, including transfusion (OR 0.96; 95%CI, 0.94-0.98), NICU admission (OR 0.98; 95%CI, 0.97-0.98), and Apgar <7 at 5 minutes (OR 0.98; 95%CI, 0.97-0.99).

CONCLUSION:
Though BMI has been a standard indicator of potential VBAC success, data related to maternal stature could be incorporated into prediction tools for VBAC probability.
The Final Design: Milli; Introducing the Only Patient Controlled Expanding Dilator [39F]
Authors: Krychman Michael , Juravic Mark 
Published: April 2018

INTRODUCTION:
Dilators are poorly characterized in the scientific literature yet may recondition the brain body reconnection for anticipatory anxiety. Women report decreased compliance, burdensome regimes, and excessive time commitments as well as concern about stepwise abrupt transitioning between dilator sizes. Milli is a patient controlled electronically expanding dilator that rectify many of these dilemmas. The initial soft launch of 50 users of this novel dilator is reported here.

METHODS:
Fifty-seven patients purchased the device and they complete an initial and 3 months follow up anonymous survey.

RESULTS:
Seventy-seven percent were diagnosed with dyspareunia; 33% were suffering for greater than 5 years before seeking care. Twenty-five percent have not been sexually active for over 5 years. Most used the dilator 3 times a week. Fifty percent spent between 5 and 15 minutes using the dilator, in the bedroom (90%) and 44% using it before bedtime. Forty-three percent use dilators before intercourse, yet 64% do their exercises alone. No serious adverse events or device complications reported. All reported that the device was superior to conventional available dilators. Most reported that the device was easy to clean, comfortable, aesthetically pleasing and improve confidence.

CONCLUSION:
Milli is a patient controlled electronic dilator that increases by 1 mm at a time. Patients can self-control the device and slowly increase progress at her own pace towards specific goals. Initial pilot reports more gradual and rapid vaginal health recovery with less apprehension or anxiety. Larger long-term interventions, with a standardized dilation program with a larger population is planned.
IUDs After the Election: Politics Influencing the Bedroom [4G]
Authors: Abern Lauren , Kiely Kristen , DeGuzman Glen , Packard Adelaide , Maguire Karla 
Published: April 2018

INTRODUCTION:
Reproductive health care remains highly politicized in the United States with the 2016 Presidential Election highlighting the debate over access to family planning. Our objective is to determine reasons for intrauterine device (IUD) choice, if the recent presidential election had any impact on contraceptive decision-making, and alternative methods if IUDs were not accessible.

METHODS:
Women 18 and older that presented for IUD insertion at an urban clinic were surveyed. They were asked about demographics, reasons for choosing an IUD, and what influenced this decision.

RESULTS:
100 surveys were completed. The mean age was 27.5 (SD 6.7, range 18-48). The majority (67%) described themselves as Caucasian, and had post-college education (50%). The most common reasons for choosing the IUD were because it was long-acting and effective (88%). 87% opted for a levonorgestrel and 13% a copper IUD. 55% of respondents said the recent presidential election did play a role in their decision. If IUD insurance coverage or cost was a factor, only 23% would pay out of pocket, and 44% would opt for oral contraceptive pills or ring. A significant number of women (23%) would choose much less effective methods including no contraception, condoms, and the rhythm method.

CONCLUSION:
Over half of women surveyed stated that the 2016 Presidential Election contributed to their decision to select an IUD. If an IUD was not an option due to cost, women would choose less effective methods, which could result in unintended pregnancy. This emphasizes the influence of politics in women’s health decision-making.
Do Patient Attitudes About the Intrauterine Device Differ Based on Race and Ethnicity? [6G]
Authors: Edwards Sara , Mercier Rebecca , Perriera Lisa 
Published: April 2018

INTRODUCTION:
Differences in contraception usage by race have been documented, but studies evaluating patient attitudes toward intrauterine devices (IUDs) have not assessed racial differences. Since patient attitudes influence usage, we evaluated how attitudes toward IUDs differed based on patient race/ethnicity.

METHODS:
From June 13 to July 18, 2016, all women in an obstetrics & gynecology outpatient office of a large urban academic medical center were asked to participate in a 94 question survey. Women were excluded if they could not read English or were younger than 14 years of age. Surveys included questions about demographic characteristics and knowledge and opinions of IUDs. We performed exploratory bivariable analysis using t tests and chi square testing to determine which outcomes differed by participant race. For those appearing to differ significantly, we performed regression analysis to assess for confounding by other factors.

RESULTS:
Of 1,366 women approached, 521 completed the survey. Our sample was 46% White, 42% Black/African-American, 7% Asian, and 5% other. Questions assessing knowledge about IUDs did not differ significantly based on race, but black women were significantly more likely to perceive that they had less or insufficient knowledge about IUDs compared to white women (OR 1.91 CI 1.06 -3.46). Black women had a more negative opinion of IUD safety (OR 5.0, CI 2.35-10.66) and reliability (OR 5.5, CI 2.20-14.13) than white women.

CONCLUSION:
While knowledge about IUDs is similar between races, black women may have more negative opinions of IUDs, which should be taken into consideration when performing contraceptive counseling.
Colorado in the Crossroads: Opinions on Over-The-Counter Status of Progesterone-Only Contraceptives [16G]
Authors: Hartman Brittany , Secor-Turner Molly , Stamm Carol A. , Kalani Yazd Nazanin Kuseh , Borgelt Laura , Yi HeaMi 
Published: April 2018

INTRODUCTION:
Long-Acting Reversible Contraception availability has reduced unintended pregnancy in Colorado, but 300,000 women are still in need of family planning services. In 2012, ACOG announced support for over-the-counter (OTC) oral contraceptives. Since that time, multiple legislative solutions have been proposed, but have been met with opposition for unclear reasons. The purpose of this study was to clarify stakeholder opinions on making progesterone-only pills (POPs) available OTC.

METHODS:
Individual qualitative interviews were conducted with 60 professionals recruited from five stakeholder groups: insurance industry (IC), religious leaders (RL), healthcare professionals (HP), health organization leadership (HO), and health policy (HL). These interviews solicited participants’ perspectives about making POPs available OTC in Colorado. Descriptive content analysis organized data into categories and themes.

RESULTS:
Most participants felt that Colorado is ready to endorse OTC POPs, and would support its implementation. HP and HO showed the largest support, encouraging women’s autonomy in their reproductive health decisions, and noting pharmacist support for this idea. HO showed the most opposition, citing patient cost concerns. RL and IC were conflicted, citing safety, education, and legislative wording concerns. Among all groups, political opposition and cost were perceived as the largest barriers against deregulation.

CONCLUSION:
The consensus among Colorado’s stakeholders is that the state is ready for OTC POPs. However, there was disagreement among groups as to the barriers to achieving that goal. Our research will help groups better understand each other’s interests so that we can come to a consensus on helping women in need in the state of Colorado.
Exit Survey of Women with HSDD Treated With Bremelanotide Demonstrated Meaningful Treatment Benefits [28G]
Authors: Koochaki Patricia , Revicki Dennis , Wilson Hilary , Pokrzywinski Robin , Jordan Robert , Lucas Johna 
Published: April 2018

INTRODUCTION:
Bremelanotide, an investigational new drug, demonstrated clinically meaningful improvements in desire and decrease in distress in premenopausal women with hypoactive sexual desire disorder (HSDD) in the phase 3 RECONNECT studies. Here we present outcomes from exit surveys completed by a subset of subjects from RECONNECT, with a focus on the meaningfulness of treatment benefit.

METHODS:
Study subjects were randomized to self-administer bremelanotide (1.75 mg) or placebo subcutaneously via auto-injector pen as desired prior to sexual activity for 24 weeks. Upon study completion, 242 women participated in a quantitative exit survey.

RESULTS:
Among subjects who completed the survey, mean(SD) duration of HSDD was 55.2(48.1) months; symptoms at baseline included decreased sexual interest and desire, decreased arousal, changes in sexual satisfaction/orgasm, and physical changes in lubrication. Overall meaningful benefit as determined using the exit survey was seen in 58.8% of the bremelanotide group and 27.1% of the placebo group (p<0.0001). The bremelanotide group reported a meaningful increase in sexual desire and responsiveness to their partners initiating sexual activity (51.0% and 53.9%, respectively) compared to placebo (20.7% and 25.7%, respectively; p<0.0001 for both). Treatment with bremelanotide was associated with significant improvement in sexual satisfaction (56.9% vs 25.7%; p<0.0001), and meaningful improvements in mental (52.0% vs 25.7%; p<0.0001) and physical (64.7% vs 21.4%; p<0.0001) arousal. Overall, 62.4% of participants rated their experience with the device as excellent or very good.

CONCLUSION:
Women randomized to bremelanotide consistently reported meaningful treatment benefits compared to placebo, which reiterated the primary outcomes in the overall RECONNECT study population.
The Impact of Using Hysteroscopic Morcellation For Benign and Cancerous Endometrial Pathology: An Ex Vivo Study [31G]
Authors: Lincenberg Kimberly , Lindheim Steven , Kemner Emily , Maxwell Rose , Hood Daniel , Yaklic Jerome L. 
Published: April 2018

INTRODUCTION:
Hysteroscopic morcellation is frequently used to resect endometrial pathology. We assessed the impact of hysteroscopic morcellation on histologic analysis and the accuracy on tissue diagnosis.

METHODS:
A prospective paired-comparison study was performed in consenting women undergoing hysterectomy for benign indications (n=13) or hyperplasia/cancer (n=10). After hysterectomy, a section of the endometrium was removed for ex vivo morcellation using the Hologic® MyoSure hysteroscopic tissue removal system. Morcellated specimens were then processed and compared by two blinded pathologists (Pa, Pb) to the original specimens’ final diagnoses at the end of patient recruitment. Chi square and Cohen’s kappa coefficient were used for analysis.

RESULTS:
Morcellated specimens were readable in 100% (23/23) by Pa and 91.3% (21/23) by Pb. Morcellated specimen diagnoses were concordant with final diagnoses in 86.9% (20/23, k=0.772, p<0.001) for Pa and 80.9% (17/21, k=0.559, p<0.001) for Pb. The majority of benign final diagnoses were concordant with morcellated specimen diagnoses: 100% (13/13, k=1, p=<0.001) for Pa and 90.9% (10/11, k=1, p=<0.001) for Pb. Each pathologist found 70% (7/10) concordance of morcellated specimen diagnoses with malignant final diagnoses (Pa k=0.559, p<0.003 and Pb k=0.394, p<0.014).

CONCLUSION:
The data supports that hysteroscopic morcellation does not adversely impact whether specimen is able to be interpreted by histologic analysis. However, 30% of malignant disease were under-diagnosed on morcellated specimens. Further research is warranted to confirm the findings. Our study emphasizes the importance of vigilance in securing an accurate diagnosis in patients with endometrial pathology as future patient management depends on it.
Elagolix Reduces Productivity Losses in Uterine Fibroids Patients With Heavy Menstrual Bleeding [33G]
Authors: Diamond Michael , Soliman Ahmed M. , Gao Jingjing , Owens Charlotte D. 
Published: April 2018

INTRODUCTION:
This study assessed the impact of elagolix, an oral gonadotropin-releasing hormone antagonist, on workplace productivity in uterine fibroids (UF) patients with heavy menstrual bleeding (HMB).

METHODS:
M12-813 was a Phase IIb, randomized, double-blind, placebo-controlled trial with 6-month treatment period in premenopausal UF patients with HMB (>80 mL menstrual blood loss per month). M12-813 had two cohorts: elagolix 300mg twice daily (cohort 1) and elagolix 600mg once daily (cohort 2). Each cohort had four arms: placebo, elagolix alone, and two elagolix plus add-back arms (low dose [LDA]: estradiol [E2] 0.5mg/norethindrone acetate [NETA] 0.1mg and standard dose [SDA]: 1.0mg E2/0.5mg NETA). UF-related workplace productivity hours lost to absenteeism and presenteeism (reduced productivity while at work) were measured at baseline and month 6 using the health-related productivity questionnaire. Changes from baseline were compared between elagolix arms and placebo utilizing analysis of covariance.

RESULTS:
Cohort 1 included 204 women. At month 6, larger reductions in least-squared (LS) mean hours lost due to absenteeism were observed for elagolix 300mg BID, elagolix 300mg BID+LDA and elagolix 300mg BID+SDA (LS Means: -2.2, -2.6, and - 2.6 hours, respectively) compared to placebo (LS Means:-1.0 hours). P-values were <0.05 for both elagolix plus add-back arms. Reductions in LS mean hours lost due to presenteeism were greater for elagolix 300mg BID, elagolix 300mg BID+LDA and elagolix 300mg BID+SDA (LS Means: -6.8, -7.6, and -9.1 hours, respectively) than placebo (LS means: -2.9 hours); P-value was <0.01 in elagolix 300mg BID + SDA arm.

CONCLUSION:
Elagolix+ SDA reduces UF-related absenteeism and presenteeism.
Impact of Fetal Anomalies in Down Syndrome Terminations [5H]
Authors: Phillips Carolyn , Cui Yiwen , Fanucchi Hannah , Rijhsinghani Asha 
Published: April 2018

INTRODUCTION:
To understand the impact of an anomalous Down syndrome fetus on a woman’s choice regarding her pregnancy options.

METHODS:
This retrospective study analyzed all women diagnosed with fetal Down syndrome by amniocentesis in the Fetal Diagnosis and Therapy Unit at The University of Iowa Hospital and Clinics between 1990 and 2006. Details of fetal findings on ultrasound examinations and subsequent decisions on pregnancy were collected. Sonographic fetal malformations were separated into structural abnormalities (limb asymmetry, facial anomalies) and major structural abnormalities (central nervous system, cardiac, gastrointestinal, genitourinary, or multiple system anomalies).

RESULTS:
249 patients were included in the study of which 86 (35.5%) had no fetal anomalies on ultrasound compared to 163 (62.5%) who did. Patients without sonographic evidence of fetal structural abnormalities had a significantly higher rate of pregnancy termination than those with fetal anomalies (89.5% vs 49.1%, p<0.0001). Moreover, for patients with fetal structural abnormalities, those with non-major fetal anomalies had a statistically higher proportion of termination that those with major anomalies (80.8% vs 43.1%, p=0.0004).

CONCLUSION:
A woman’s decision to terminate a pregnancy affected by Down syndrome may be more complex than a simple consideration of fetal anomalies, as patients in our study have higher rates of termination if they have no or non-major sonographic evidence of fetal anomalies.