bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gynecologic Surgeons’ Perspectives on Risk Factors and Prophylaxis of Trocar Site Hernias: A National Survey [22Q]
Authors: Wells Ali , Germanos George , Salemi Jason , Mikhail Emad 
Published: April 2018

INTRODUCTION:
Although trocar site hernias (TSH) occur in only 1.5-1.8% of all laparoscopic procedures, TSHs can represent serious postoperative complications. The purpose of this study was to survey gynecologic surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) in order to elicit their experiences with TSHs, including fascial closure preferences.

METHODS:
After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based survey software. The survey link was sent to all members of SLS via email. Descriptive analyses included frequencies, percentages, and chi-square tests or Fisher’s exact tests for measures of association.

RESULTS:
Respondents included 242 gynecologic surgeons, 54.2 % of whom reported at least one patient developing a TSH within the past 10 years. The likelihood of having ≥1 patient with TSH increased with higher monthly surgical volume; 39.5% for low-volume surgeons (≤10 procedures/month) compared to 71.4% of high-volume surgeons (≥20 procedures/month) (p<0.01). Current use of fascial closure devices was more common among surgeons in an academic practice (60.3%) compared to those in private practice (39.6%, p <0.01). Among all respondents, 87.6%, 16.1%, and 2.5% close 10-12mm, 8mm, and 5mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported closing more than one port size.

CONCLUSION:
Increased surgical volume is directly proportional to TSH development. Port size remains one of the main risk factors for TSH development, with most respondents closing only 10-12 mm ports irrespective of surgical volume or practice setting.
Does Cost Influence the Choice of Disposable vs Reusable Instruments? Survey of Obstetrician/Gynecologists [24Q]
Authors: Yang Helen , Ross Sue , Capstick Valerie 
Published: April 2018

INTRODUCTION:
A “cost awareness” campaign was undertaken at the Lois Hole Hospital for Women from 2015 to 2016 to raise awareness about costs of disposable versus reusable instruments for laparoscopic procedures. We undertook a survey of obstetrician/gynecologists (Ob/Gyns) to find out if the campaign had affected their attitudes about choosing disposable versus cheaper reusable instruments.

METHODS:
In 2015 and 2017, all full-time university-associated Ob/Gyns were mailed a cover letter, questionnaire and coffee card ($5) with postage-paid return envelope. Responses (with unique ID) from Ob/Gyns who perform laparoscopic procedures were entered into a password-protected REDCap database on a secure server. Data analysis used REDCap summary descriptive statistics.

RESULTS:
34/47 eligible Ob/Gyns (72%) completed questionnaires before and after the intervention, with median 11.5 years in practice. The majority had undertaken MIS training, mainly during residency (78.4%) and conferences (73.0%). Before the intervention, the three most important qualities influencing their decision to use a particular instrument were safety (64.9%), effectiveness (54.1%) and personal experience (48.6%), and after the intervention were effectiveness (63.0%), safety (47.8%) and ease of use (47.8%). Device cost was ranked sixth (29.7%) before and fourth after (26.1%).

CONCLUSION:
Given the current economy, operative costs are constantly under review. Knowledge about Ob/Gyns’ attitudes provides information to design more effective awareness campaigns to encourage use of less costly instruments. To change practice, a campaign increasing Ob/Gyns’ exposure to cheaper but safe and effective instruments may help to increase uptake and potentially lead to cost reduction. Cost awareness alone is unlikely to change practice.
Can We Talk About Sex? Patient and Providers’ Comfort with the Sexual History [26Q]
Authors: Hart Casuarina , Ganz Eric , Brustman Lois 
Published: April 2018

INTRODUCTION:
Sexual histories are essential in evaluating and counseling patients. The evolution in sexual practices has not been incorporated into the modern sexual history. The aim of this study was to determine the types of sexual behaviors patients engage in, provider counseling, and patient comfort discussing sexual behaviors.

METHODS:
IRB-approved, voluntary, anonymous surveys were distributed at the Mt Sinai associated Obstetrics and Gynecology outpatient offices. These surveys used a Likert scale to evaluate sexual behaviors, if providers discussed certain behaviors, and patients’ comfort discussing their behaviors with providers.

RESULTS:
207 surveys were completed and analyzed. 90% of our patients participated in vaginal sex, 47% of patients participated in anal sex, 89% of patients received oral sex, and 85% performed oral sex. 39% of patients reported never using a condom. Patients are infrequently asked about sexual habits by providers. Only 50.7% of patients reported being asked about condom use. Over 80% of patients felt comfortable discussing sexual behaviors. The sexual behaviors that had a statistically significant age distribution were the use of sex toys and hook up apps.

CONCLUSION:
Our patients are sexually active in a variety of ways at or above the national average. More of our patient population is engaging in anal sex than the national average by 11%. Our patients are not being asked the basic sexual history. In general patients feel comfortable discussing sexual habits with providers. Age is not relevant when screening most sexual behaviors. This survey showcases a missed opportunity in screening and counseling patients.
Viable Umbilical Tissue Use in Laparoscopic Myomectomy: Study Design and Short-Term Post-Operative Outcomes [29Q]
Authors: Karon Magdalene 
Published: April 2018

INTRODUCTION:
Despite alternative methods such as embolization or leuprolide injections, myomectomy remains the “gold standard” for removing uterine fibroids, especially in younger women desiring pregnancy. Laparoscopic myomectomy offers a minimally invasive approach with the best chances for conception. However, post-operative adhesions and defects within the endometrial lining are still a risk. Thus, an ideal adjunct would promote endogenous regeneration of the tissue defect created by the surgery, minimize adhesions, and improve blood flow for future embryo implantation. We present for the first time use of viable, cryopreserved umbilical tissue (vCUT*, Stravix, Osiris Therapeutics, Inc.) in myomectomy. vCUT is ideal for prevention of adhesions and strengthening of the incised uterus due to its pro-regenerative, anti-fibrotic, angiogenic, and anti-inflammatory properties. vCUT contains all endogenous neonatal extracellular matrix proteins, growth factors, and tissue viable cells, including mesenchymal stem cells, in their native state.

METHODS:
Ten women underwent laparoscopic myomectomy. After fibroid removal the endometrium was closed with a monofilament suture, and vCUT was incorporated into the closure layer. Patients will be assessed at 3mo and 6mo post-op by 3D Doppler sonography for endometrial thickness and followed until time of conception and mandatory Cesarean delivery. At delivery, uterine anatomy and scarring will be assessed and, when possible, biopsies taken.

RESULTS:
Preliminary data show all patients are healing well with minimal pain, no complaints, and no abnormal bleeding. Data collection is on-going for 3mo (n=5) and 6mo (n=5) outcomes.

CONCLUSION:
Viable, cryopreserved umbilical tissue shows promise as a novel adjunct to support endometrial regeneration following laparoscopic myomectomy.
Ultrasound Prediction of Small-for-Gestational Age at Birth: The More, the Merrier? [39Q]
Authors: Beddow Meghan E. , Blue Nathan R. , Savabi Mariam , Katukuri Vivek R. , Fritts Cody , Chao Conrad R. 
Published: April 2018

INTRODUCTION:
Compare the ability of serial ultrasound (US) exams to predict small-for-gestational age (SGA) at birth compared to a single US exam at various gestational ages.

METHODS:
We reviewed deliveries at our institution from January 1, 2013 to March 31, 2017. We included well-dated, non-anomalous, singleton pregnancies with multiple estimated fetal weight (EFW) measurements before delivery. EFWs and percentiles were calculated using the Hadlock formulas. Fetal growth restriction (FGR) was defined as EFW <10th percentile, and SGA was defined as birth weight <10th percentile. We calculated the sensitivity, specificity, positive and negative predictive values for serial US exams to predict SGA at birth, as well as for a single US performed at either 24-276, 28-316, 32-356, or ≥36 weeks gestation.

RESULTS:
We included 1926 pregnancies (5609 total US exams, mean: 2.93 per patient). The rate of SGA at birth was 11.8% (n=228), and 14.2% (n= 274) had FGR on one or more US exams. The sensitivity of serial exams (48.2%, 95% confidence interval [CI] 41.6-54.9) to predict SGA was comparable to a single US performed at 32-356 weeks (50.3%, 95% CI 42.8-57.7) or ≥36 weeks (49.4%, 95% CI 38.5-60.4), whereas a single US at 24-276 or 28-316 weeks performed less well.

CONCLUSION:
To predict SGA at birth, the best sensitivity is achieved using either serial US exams or a single US performed beyond 32 weeks. If a single additional US is indicated to screen for FGR, it may be reasonable to delay this US until 32 weeks gestation.
Use of Enhanced Recovery after Surgery (ERAS) in Major Gynecologic Surgery [1R]
Authors: Owens Kristin , Stovall Dale W. 
Published: April 2018

INTRODUCTION:
The enhanced recovery after surgery protocol (ERAS) is a postoperative protocol which emphasizes quality of recovery over speed. Our study compared postoperative antiemetic and opioid use before and after implementation of the ERAS program at MDMC.

METHODS:
In this single-center, cohort study, we identified two groups of patients for comparison. The first group was women who underwent a major gynecologic surgical procedure 6 months prior to ERAS implementation and the second group were women who underwent their procedure in the six months after implementation. Major gynecologic procedures included TAH, TVH, myomectomy, and open staging procedures. Primary outcomes were post-op anti-emetic and opioid therapy. Secondary outcomes included intraoperative i.v. fluids and length of stay (LOS).

RESULTS:
A total of sixty subjects were included in the study, 29 in the pre-ERAS group and 31 in the post-ERAS group. The mean age of the study population was 49.5. There were no differences between groups in regards to post-operative anti-emetic use. A significantly greater proportion of subjects in the post-ERAS group, none of whom received PCA administration, received i.v. opioids on the ward, 25.8% (8/31) versus 6.9% (2/29), respectively (P < 0.05). The post-ERAS group also received significantly less intraoperative i.v. fluids, 1595.9 mL versus 1909.5 mL, respectively (P < 0.05). The LOS was less for the post-ERAS group, 2.0 days versus 2.5 days, but the difference was not significant.

CONCLUSION:
Implementation of ERAS for major gynecologic procedures at Methodist significantly reduced i.v. fluid use, but did not reduce the need for anti-emetic or opioid therapy.
Ilioinguinal/iliohypogastric Nerve Blocks as a Treatment for Pelvic Pain in a Gynecologic Population [4R]
Authors: Cooke Carly M. , Flaxman Teresa , Chen Innie , Singh Sukhbir S. 
Published: April 2018

INTRODUCTION:
Ilioinguinal/iliohypogastric nerve blocks (IINBs) are a simple, minimally invasive option for managing pain associated with ilioinguinal/iliohypogastric neuropathy (IIN). This study assessed the safety and efficacy of IINBs in women with IIN associated pelvic pain.

METHODS:
A retrospective chart review of patients who received IINBs at The Ottawa Hospital between January 1st, 2012 and July 13th, 2017 by a single physician was performed. Patient demographics, history, examination findings, and block data were extracted. Chi-square and Mann-Whitney U tests explored differences in patient characteristics between women with and without effective response to IINBs.

RESULTS:
Amongst 106 meeting inclusion criteria, 381 IINBs were performed. Most women had a history of chronic pain (n=97,90%), endometriosis (n=69,65%), and/or lower abdominal surgery (n=95,90%). On examination, 56 women (53%) had tenderness within the IIN distribution, 59(56%) had point tenderness, 20(19%) had a positive Carnett’s sign, 21(20%) had allodynia, and/or 7(7%) had hyperalgesia. Data regarding effectiveness was available for 301/381 blocks. Of these, the majority (n=227,75%) greatly improved pain, 11%(n=33) somewhat improved pain, 10%(n=31) had no effect, and 3%(n=10) worsened pain. Sixty women (57%) had at least one block which greatly improved pain. Five women (5%) reported complications which could be directly related to blocks. No significant differences in patient characteristics were observed between women with and without effective response to IINBs.

CONCLUSION:
Ilioinguinal/iliohypogastric nerve blocks may provide pain relief for women with complex pelvic pain and features of central sensitization with a low rate of adverse events. Future prospective studies on IINB safety and efficacy are warranted.
Awareness, Attitudes, Practices and Continuation of HPV Vaccines in Lebanon [7R]
Authors: Seoud Muhieddine , Jaafar Iman , Ghanem Rayan , Adra Abdallah 
Published: April 2018

INTRODUCTION:
HPV is a major cause of anogenital, oropharyngeal and penile cancers. Currently, there are three safe and effective HPV vaccines, however introducing them in the Middle East is slow for various social, cultural and religious reasons.

METHODS:
At the women health center of the AUBMC, HPV vaccination was offered to women and their daughters since 2007. We will present a retrospective review of a prospectively collected database on 563 Lebanese females who received these vaccines.

RESULTS:
From 2007 to 2017, a total of 563 females were HPV vaccinated. (379 (67%) had Gardasil and 183 (33%) had Cervarix; P=0.00). Their average age was 25.64±5.86(12.16-51.12). hundred 449 (87%) completed 3 doses and 67 (13%) took only 2 doses. The 3 doses completion was highest between 2007-2013 [329/449 (72%)] while the 2 doses completion was more common from 2013-2017 [47/57 (70%)]. 2/175 (1.13%) of those who received Gardasil had subsequent abnormal Pap smears (mostly LSIL) after an average of 33 months, while 5/91 (5.5%) of those who received Cervarix had abnormal Pap smears [ASCUS: 3/91 (3.3%); HSIL: 2/91 (2.2%,) after an average of 5 months and 1 month respectively]. The average abnormal cytology rates at AUBMC is 1.9-2.2% during that period of time.

CONCLUSION:
We report successful introduction and continuation of HPV vaccine into our private patient Middle-Eastern population. Longer follow-up is needed to assess the proper impact on genital warts, pre-cancerous genital lesions and genital and other cancers.
Physicians’ Perspective on Reproductive Health Education [9R]
Authors: Do Linh , Reddy Sireesha 
Published: April 2018

INTRODUCTION:
Reproductive health education (RHE) to adolescents is essential to decreasing teen pregnancy rates, increasing contraceptive use and overall knowledge of reproductive health. We are interested in learning physicians’ perspective on RH topics, what age is appropriate for the discussions and on parental presence during RHE discussions.

METHODS:
A 20-question survey with inclusion criteria, demographics, and subjective norm concerning 9 RHE topics such as puberty, period, STI, pregnancy, contraception, sex, HIV/AIDS, abortion, and gender identity and sexual orientation were inputted on RED CAP. An individualized link was emailed to 123 pediatric, Obstetrician & Gynecologist, and family physicians at Texas Tech University Health Center. 42 surveys completed.

RESULTS:
Physicians believe parents should be in the room during RHE discussions with a P<.05% with a 32% response rate. Significantly more Obstetrician & Gynecologist prefer to discuss contraceptive use with parental presence out of the 9 RHE topics for both male and female adolescents compared to pediatricians. Physician parental status does not affect their opinion on parental attendance during this conversation.

CONCLUSION:
OBGYN, pediatricians and family medicine doctors desire parent presence when discussing RHE topics. This may be for fear of what parents may think about certain topics. However, confidentiality is also a concern. Physicians need more counselling that parents and their adolescents desire confidentiality. Our previous survey showed that dependent on topic and age, confidentiality and sole discussions can be appropriate.
Necessity of Routine Post-Operative Day One Hemoglobin after Cesarean Section [17R]
Authors: Potocnik Elizabeth A. , Alford Catherine , Plante Brianne , Elliott John 
Published: April 2018

INTRODUCTION:
Cesarean section represents the most common surgery in the United States. The national cesarean section rate has increased in recent years and most recently was found to be 32.2%. Given the increased blood loss from a cesarean section compared to a vaginal delivery, it is routine practice at our institution to obtain a post-operative complete blood count (CBC) on the first day following all cesarean sections to evaluate for post-operative anemia. Despite this, studies have shown that the rate of blood transfusion following cesarean section is low.

METHODS:
A retrospective chart review of all patients who underwent a term, uncomplicated cesarean section in 2016 was undertaken.

RESULTS:
The cesarean section rate at Riverside Methodist Hospital for the year of 2016 was found to be comparable to the national average at 31%. The charts of 2,041 patients were reviewed, 587 did not meet inclusion criteria. Of the 1,439 patients included, 15 (1.0%, 95% CI 0.6-1.7) required blood transfusion. Eight of these patients experienced symptoms of anemia, four were asymptomatic but showed clinical signs of anemia, and three were asymptomatic without clinical signs. The average estimated blood loss recorded at the time of surgery was found to be 1017.9cc (468.1) for those who were transfused compared to 641.1cc (152.7) for those who did not undergo transfusion (P =.01).

CONCLUSION:
Given the low rate of blood transfusion following a routine, uncomplicated cesarean section, a routine post-operative CBC may not be necessary and the accrued cost of continuing this practice is significant.
Timing of Uterine Tamponade and Associated Morbidity in Patients with Stage 3 Postpartum Hemorrhage [20R]
Authors: Ernst Amanda , Vogel Rachel Isaksson , Bojan Katelyn , Erickson Alexandra , Das Kamalini 
Published: April 2018

INTRODUCTION:
Mortality from postpartum hemorrhage (PPH) is decreasing in the United States, however the incidence of PPH is actually increasing. Stage 3 PPH, or estimated blood loss greater than 1500 mL as defined by the California Maternal Quality Care Collaborative, often requires second-line intervention including uterine tamponade with Bakri balloon, dilation and curettage, uterine artery embolization, hemostatic sutures, compression sutures, or ultimately hysterectomy. Although guidelines exist for management of PPH, the timing and use of second-line therapies is less standardized and varies based on provider experience. We sought to determine whether timing of uterine tamponade, generally the first line treatment of ongoing PPH, is associated with morbidity among patients who experienced stage 3 blood loss.

METHODS:
This is a retrospective chart review of women with stage 3 PPH at a single academic institution. Patient demographics, delivery information, timing of second-line interventions and transfusion, and morbidity were abstracted from the electronic medical record. Morbidity included ICU admission, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, and endometritis.

RESULTS:
Between 2007 and 2015, 267 patients experienced a stage 3 PPH. Second-line therapies were used in 116 patients, with Bakri balloon being the most commonly used intervention. 28 patients had Bakri balloon placement within 30 minutes of PPH, compared to 19 patients who had placement after 30 minutes. Women who received a Bakri within 30 minutes of onset of PPH experienced lower composite morbidity.

CONCLUSION:
Placement of a Bakri balloon within 30 minutes of the onset of PPH may decrease morbidity in patients with stage 3 PPH.
Improving Obstetric Hemorrhage Morbidity and Mortality by a Checklist-based Management Protocol [26R]
Authors: Smith Rachael , Foley Michael , Hermann Catherine , Erickson Laurie , Mercer Laura 
Published: April 2018

INTRODUCTION:
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality in the US. Many obstetrical teams rely on clinical judgment when managing PPH, however critical care research has demonstrated that specific and uniform protocols result in better outcomes. This study analyzed the effect of implementation of a checklist-based management protocol for PPH.

METHODS:
A checklist was developed by a multidisciplinary team for the management of PPH that focused on timely diagnosis and systematic administration of uterotonics, invasive interventions, transfusions, and lab draws. A training video was used to introduce the protocol to nursing and physician staff. Following formal implementation, pre and post-protocol analyses were performed using nine matched months from 2015 and 2016. Outcome measures were surrogates for maternal morbidity.

RESULTS:
147 subjects met criteria in the pre-protocol group and 150 met criteria in the post-protocol group. Within the analysis of the first three matched months, there was a significant decrease in surgical interventions for PPH (p value 0.039) and a decreased length of stay for PPH following cesarean sections (p value 0.039). In the 9 month analysis, there was a significant decrease in severe PPH as defined by an EBL of >2L (p value 0.035).

CONCLUSION:
The implementation of a checklist based management protocol for PPH has shown a promising trend in improving maternal outcomes and healthcare delivery for obstetric hemorrhage. Specifically, significant improvement in severe PPH rates was demonstrated. Further multi-center research is needed to demonstrate consistent beneficial effects of such protocols.