bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Adjunctive Azithromycin Cesarean Bundle Decrease the Risk of Maternal and Neonatal Outcomes? [24H]
Authors: Johnson Christina , Dagum Camilla , Persad Malini D. , Herrera Kimberly M. , Buckley Ayisha , Garretto Diana J. 
Published: May 2019

INTRODUCTION:
The goal of preoperative antibiotics is to decrease and prevent postpartum infections. Recent evidence indicates that adding azithromycin (AZI) to Cefazolin as extended antibiotic coverage can decrease the risk of infectious co-morbidities for non-elective Cesarean Deliveries (nCD). November 2017 we started using AZI + cefazolin in nCD. The goal was to determine the institutional compliance to AZI administration.

METHODS:
An IRB approved retrospective cohort study over 4 months of patients undergoing nCD. ST (1st generation cephalosporin or, clindamycin and gentamycin for cephalosporin allergy). Patients in 2 groups: preEMR bundle (ST) and postEMR bundles (ST + AZI). Maternal and neonatal outcomes collected for 2 months preEMR bundle and 2 months postEMR bundles. Exclusion criteria: women undergoing elective CD, did not receive pre-operative antibiotics, AZI allergy. The primary outcome was overall compliance with AZI administration with the new EMR bundle. The composite outcome-maternal wound infection, endomyometritis, maternal morbidity, neonatal morbidity. Statistical analyses were performed with p value <0.05 significant.

RESULTS:
There were 100 patients meeting inclusion criteria in study time period. There were no differences in baseline demographics between groups. Only 56% of patients in the post EMR group received AZI in addition to ST. There were no significant differences in the composite outcome between groups.

CONCLUSION:
Adjunctive AZI at time of nCD does not appear to decrease the risk of maternal and neonatal outcomes; but it was only administered correctly in 56% of the eligible cases. The effect of AZI on outcomes may be improved with better adherence to the EMR bundle.
Barriers to Vaginal Progesterone in the Treatment of Incidental Short Cervix [27H]
Authors: Sutherland Monique B. , Garvey Sarah , Enakpene Christopher A. , DiGiovanni Laura M. , Della Torre Micaela 
Published: May 2019

INTRODUCTION:
Barriers in obtaining vaginal progesterone (VP) may adversely affect perinatal outcomes in women with short cervix. Aim of this study is to evaluate if delay in obtaining VP was associated with increased rate of sPTB.

METHODS:
Retrospective cohort study of singleton pregnancy with incidental short cervix (ISC) ≤20mm, prescribed VP and delivered at University of Illinois at Chicago, between June 2016 and June 2018. Rates of sPTB <37 weeks in women with delay in treatment were compared to women without delay. IRB approval was obtained.

RESULTS:
A total of 74 women with ISC were prescribed VP: 69(93%) received insurance approval. Of those 69, 8 (12%) received initial claim rejection, but subsequently received approval only for oral Prometrium to use vaginally. 15/74 (22%) women did not receive VP due to barriers or other causes. 29/47 (62%) who received VP timely, delivered preterm. 12 (20%) women encountered an insurance delay in obtaining VP ≥14 days, and 4 of those experienced sPTB. There was no significant difference in sPTD rate in women who began VP <14 days versus those ≥14 days, p=0.07. Those who experienced a delay compared to those with no VP at all, still had lower rate of sPTB 4/12 (33%) versus 11/15 (73%), respectively (p=0.038).

CONCLUSION:
Despite barriers, 93% of patients had access to VP treatment. Delay ≥14 days did not impact the rate of PTBs <37 weeks. Patients who received VP, despite delay, had a lower rate of PTBs than those who did not receive it at all.
Birth Plans: The Good, the Bad and the Ugly [29H]
Authors: Urbina Josephine P. , Christie Alexandra C. , Fumia Fred 
Published: May 2019

INTRODUCTION:
Birth plans became popular in the 1980s as a way to help patients identify what is important to them, to communicate their childbirth goals with their providers and ensure involvement in delivery decision making, which is an important component of childbirth satisfaction. For the provider, birth plans serve as an opportunity to inform patients about common obstetrical experiences which may occur during hospitalization. Despite the good intentions of having birth plans in place, there has been negative connotation associated with them. The purpose of this study was to examine current templates for birth plans available to women online and evaluate them for content based on various obstetrical subjects.

METHODS:
We examined the first fifty websites that appear under “birth plan” using a Google search. We analyzed birth plans for source, design and content.

RESULTS:
Fifty websites were examined and 27 birth plans met inclusion criteria. The content was grouped into 44 related topics. Twenty-five (93%) of the birth plans covered pain relief, fetal monitoring, cord clamping, breastfeeding and skin-to-skin contact. Nineteen (70%) of birth plans did not address discussion with providers. Seven (26%) had an area where discussion with a nurse or doctor could be documented.

CONCLUSION:
Documentation of communication between the patient and the provider was missing in the majority. There was no mechanism to provide feedback or discussion with the patient. Some of the birth plans advocated for practices that were not evidence-based. Ultimately, some gave unrealistic expectations to patients regarding the birth process.
Buprenorphine/Naloxone vs. Buprenorphine for Medication Assisted Therapy of Opioid Use Disorder in Pregnancy [32H]
Authors: Johnson Quinetta , O’Brien John M. , Hawk Greg , Qi Ya , Critchfield Agatha 
Published: May 2019

INTRODUCTION:
Historically methadone or buprenorphine mono-therapy have been the mainstays for opioid agonist pharmacotherapy. Less is known, however, regarding the use of buprenorphine/naloxone combination therapy in pregnancy as compared to buprenorphine mono-therapy.

METHODS:
The Perinatal Assistance and Treatment Home (PATHways) program is a multispecialty comprehensive substance abuse program for pregnant and early parenting women with Opioid Use Disorder (OUD). A retrospective case-control study for all women in the program from 2015-2018 was performed with cases selected as patients who were maintained on buprenorphine/naloxone compared to a control group treated with buprenorphine alone. Other PATHways enrollees treated with methadone or those not placed on maintenance treatment were excluded. Multivariable logistic regression adjusting for maternal age, gestational age at delivery, delivery mode, breastfeeding, and smoking was performed. All statistical analyses were performed using SAS 9.4. The Institutional Review Board at the University of Kentucky approved this study.

RESULTS:
Demographic characteristics were similar between groups, however those who were on buprenorphine/naloxone were more likely to be smokers. Birth outcomes, including gestational age at delivery, birthweight and Apgar's were similar between groups. The neonates exposed to combination therapy did not have a significant increase in neonatal opioid withdrawal syndrome, 45.7% versus 37.8% (P=.14); however, those treated with buprenorphine/naloxone had a decreased rate of NICU admission (39.1% versus 48.8%, P=.047). Among neonates admitted to the NICU, there was no difference in length of stay between the two groups.

CONCLUSION:
Neonatal outcomes appear favorable for women treated with buprenorphine/naloxone for OUD in pregnancy and this treatment strategy deserves additional study.
Case Report: Rare Hemoglobin Variant Causes Elevated A1c, False Diagnosis of Pre-gestational Diabetes in Pregnancy [33H]
Authors: Olp Robert J. , Carty Jenava , Schmiedecke Stacey Stevens , Pates Jason A. 
Published: May 2019

INTRODUCTION:
Hemoglobin variants result from missense mutations that lead to substitution of amino acids within globin proteins, altering the structure of the hemoglobin molecule. Hemoglobin A1c (HbA1c) is commonly used to diagnosis and assess control of diabetes mellitus and can be falsely affected by hemoglobinopathies, hyperbilirubinemia, and hypertriglyceridemia.

METHODS:
We present a case of an obese Caucasian 27 year-old Gravid 3 Para 0020 with early HbA1c of 10.0 percent at 9-weeks gestation. The patient was diagnosed with pre-gestational diabetes, and referred for nutrition counseling with initiation of four times daily home blood sugar monitoring notable for consistently normal fasting and postprandial values. Due to continued discordant results in HbA1c level with her glucometer log and random glucose testing, hemoglobin electrophoresis was performed at 22-weeks gestation with findings suggestive of Hemoglobin Wayne, a rare hemoglobin variant that is clinically silent. Hemoglobin Wayne results from a frameshift mutation within the alpha chain resulting in a net charge that is similar to HbA1c. This common charge manifests as similar retention times on cation-exchange high-performance liquid chromatography, leading to an overestimation of HbA1c concentration. Genetic sequencing was pursued and the patient completed appropriately timed routine screening for gestational diabetes with normal results.

CONCLUSION:
Our case, the first reported in a pregnant patient, should remind clinicians of the few conditions that can lead to misrepresentation of HbA1c levels. Remaining vigilant in clarifying such an atypical patient presentation will decrease the risk of mismanaging, particularly over-treating, patients believed to be high-risk for diabetes.
Cerclage Suture Type and Association With Gestational Age at Delivery [34H]
Authors: Love Heather R. , Afuape Nicole O. , Plevyak Michael , Rastegar Vida , Schoen Corina N. 
Published: May 2019

INTRODUCTION:
Cervical incompetence is associated with preterm delivery and poor obstetric outcomes. Placement of cervical cerclage may mitigate these risks but standard of care choice of suture material is not well established in the literature.

METHODS:
This retrospective cohort study at a single tertiary care center between 2001-2016 evaluated singleton pregnancies with cerclage placement. Women included had placement prior to 24 weeks, met appropriate indication for cerclage placement and delivered at our institution. Patients were excluded if pregnancy terminated or induced preterm for medical indication. Patients were grouped by cerclage indication and suture type (thick-braided suture, monofilament or tape). Primary outcome was gestational age at delivery time analyzed by type of suture material and cerclage indication. Secondary outcomes include vaginal delivery, 5 minute Apgar <7, birthweight, chorioamnionitis, preterm rupture of membranes and adverse neonatal outcomes.

RESULTS:
218 singleton pregnancies underwent transvaginal cerclage placement prior to 24 weeks. 117 were history-indicated, 64 were ultrasound-indicated. 37 received physical-exam indicated cerclage. There were no demographic differences between suture types used. No tape suture was used for physical exam indicated cerclage. There was no difference in gestational age at delivery for any suture types regardless of indication of cerclage. There were no differences in the secondary outcomes reported.

CONCLUSION:
Gestational age at delivery does not appear to be associated with choice of thick braided suture or monofilament at time of cerclage. Due to small number of tape used, limited conclusions can be drawn for that suture. Suture type may be left to surgeon discretion during cerclage placement.
Does Resident Bullying Affect Patient Care? [1I]
Authors: Nhundu Belinda Juliana , Kim Soorin , Desai Vrunda Bhavsar 
Published: May 2019

INTRODUCTION:
Workplace bullying has been demonstrated to affect mental health especially in high stress environments. Workplace bullying in healthcare has implications on physician mental health and patient care. Resident physicians are especially vulnerable, given the hierarchy of medicine. Our objective is to characterize the extent of bullying experienced by resident in Obstetrics and Gynecology and implications on patient care.

METHODS:
The Negative Acts Questionnaire-Revised (NAQ-R), a previously validated tool to assess was distributed to program coordinators at 13 residency programs in the American College of Obstetricians and Gynecologist (ACOG) District 1.

RESULTS:
Twenty-three percent of District one residents completed the survey. Most respondents were women (79.7%), interns (31.9%) and came from large residency programs (56.5%). Sixty-one percent of residents report having their clinical opinions ignored daily (7.1%), weekly (19%) and monthly (26.2%). Fourteen percent of residents cited having clinically valuable information withheld on a weekly (10%) basis. When asked if residents ever felt pressure to not report a near miss incident or critical patient error, 13% said yes. The most common sources of bullying came from attending physicians within the department (31.7%) co-residents (22.5%) and nursing staff (16.1%). Sixteen percent of patients reported considering quitting residency due to workplace bullying.

CONCLUSION:
Residents in Obstetrics and Gynecology commonly experience workplace bullying. Workplace bullying has detrimental effects to patient care due to withheld information and unreported near misses. Addressing the sources of bullying can improve patient care and reduce burnout of residents.
Pregnancy of Unknown Location in a Cohort of Patients Treated With Methotrexate [17I]
Authors: Shukr Ghadear , Zwain Omar , Kulkarni Sanjana , Eisenstein David 
Published: May 2019

INTRODUCTION:
To determine the prevalence of pregnancy of unknown location (PUL) in patients treated with Methotrexate (MTX) for nonsurgical diagnosis of ectopic pregnancy (EP). To determine the beta-hCG treatment outcomes.

METHODS:
IRB approved retrospective cohort study of patients who received MTX for treatment of EP over a 10-year period in an urban-based healthcare system. Wilcox test was used for statistical analysis.

RESULTS:
A total of 150 pregnancies were identified as treated with MTX over a 10-year period. Pregnancies were classified based on reviews of ultrasound as pregnancy of unknown location (PUL), ectopic pregnancy (EP), or Intrauterine pregnancy (IUP). 47 were classified as PUL, 101 EP, 2 IUP. Approximately 1/3 of patients treated with MTX were PULs. The average baseline beta-hCG was 2960 MIU/ML and the average B-hCG at treatment was 4188 MIU/ML for the entire cohort. Resolution of beta-hCG levels with one dose of MTX differed between pregnancy types with PULs prescribed MTX at a lower B-hCG level on day of treatment (56% vs 27% at beta-hCG of less than 1000 MIU/ML) compared to EP. Additionally, 61% of the entire cohort were treated with 2 data points or less. 38% of PUL were treated with 1 to 2 beta-hCG values and 82% PUL were treated at beta-hCG <2000 MIU/ML. Of the two IUPs, beta-hCG level at treatment was 6267 MIU/ML and 13353 MIU/ML.

CONCLUSION:
There may be an underappreciated risk of inadvertent administration of Methotrexate to patients with early IUP. A minimum of three beta-hCG assays over seven days in the diagnostic algorithm for EP would decrease treatment of PUL.
Differences in Length of Hospital Stay and Cost Associated With Hysterectomy Having a Uterus Greater Than 250 Grams [19I]
Authors: Brown Kelsei , Elsamadicy Emad A. , Le Chi , Lee Jaclyn , Mehta Sumit 
Published: May 2019

INTRODUCTION:
We sought to assess whether there is a difference in healthcare utilization costs associated with total laparoscopic hysterectomy (TLH) compared to total vaginal hysterectomy (TVH) with uterus size greater than 250 grams.

METHODS:
The medical records of 227 adult (18 years old) women undergoing an elective hysterectomy at a major academic medical center from 2010 to 2015 were reviewed. CPT codes used for removal of uterine size > 250 grams with TLH approach were [58572-58573] and for TVH approach [58290-58294]. Patient demographics, length of hospital stay (LOS) and total hospital cost were collected.

RESULTS:
Of the 227 patients, 119 (75.3%) patients underwent TLH and 39 (24.7%) underwent TVH with uterus > 250g (TLH: n=119 vs. TVH: n=39). There was a significant difference in Age, with the TVH cohort being older (TLH: 44.9±7.5 years vs. TVH: 50.4±7.5, P=.0002). The majority of patients were White for both cohorts (TLH: 63.0% vs. TVH: 59.0%, P=.651). There were no significant differences in insurance status between the cohorts, including Medicaid (P=0.889), Commercial/Private (P=.779), BlueCross/BlueShield (P=.717), and Medicare (P=.860). LOS was significantly different, with the TVH cohort having a longer LOS (TLH: 1.2±0.8 days vs. TVH: 1.6±0.7 days, P=.0096). However, the TLH cohort had a significantly greater mean hospital cost than the TVH cohort (TLH: $41,473.3±15,331.1 vs. TVH: $35,050.9±16,084.4, P=.0324).

CONCLUSION:
Our study suggests that there are significant differences in LOS and healthcare costs associated with hysterectomy approach with uterus greater than 250 grams. Further studies are necessary to better patient care and reduce overall healthcare costs.
Don't Forget the Clitoris: Two Cases of Anorgasmia Due to Clitoral Dysgenesis [21I]
Authors: Humes Jamie Christine , Hole Steven R. , Rodriguez Patricia J. , Keyser Erin A. , Baker Tieneka Mary 
Published: May 2019

INTRODUCTION:
Existing reports of clitoral dysgenesis are sparse. The few cases reported in the literature are associated with genetic syndromes or midline defects. Women with sexual dysfunction often present to their OB/GYN provider for evaluation. Historically treatment has centered around adjusting medications that can have a negative effect on sexual function, adding medications to enhance sexual function, and assistance with behavioral health or sex therapy. Structural abnormalities or dysgenesis of the clitoris have not previously been described as a causal factor of sexual dysfunction or anorgasmia.

METHODS:
Two patients, both in their mid-twenties, presented within six months of each other to a single facility with primary anorgasmia and lack of sexual arousal. Initial pelvic exams revealed normal appearing female genitalia. Upon subsequent workup, a more detailed exam of each patient confirmed a well-formed clitoral hood but concern for lack of clitoral gland with no sensory response. Magnetic resonance imaging (MRI) was performed which showed diminutive clitoral crura and bodies which did not converge into a glans.

CONCLUSION:
This report represents two occurrences of isolated clitoral dysgenesis and highlights a cause of primary orgasmic disorder not previously described. It is important that providers keep this diagnosis on the differential for female sexual dysfunction. An MRI should be considered during evaluation for anorgasmia to evaluate the clitoris especially if no sensory response following direct palpation of the clitoral hood.
Electromyographic Response of the Pelvic Floor Muscles in Female Sex Workers [23I]
Authors: Amorim Melania , Mariz Raiana , Macedo Lorena , França Neto Antonio Henriques , Vasconcelos Danilo , Katz Leila 
Published: May 2019

INTRODUCTION:
Sex workers are exposed to situations of vulnerability and may have intercourse many times a day. This intense, constant sexual activity may result in changes to the vagina, overburdening the perineum and other pelvic muscles. Various studies have evaluated PF muscle function in different groups of women.

METHODS:
A cross-sectional, observational study was conducted with 30 female sex workers aged 18-56 years. The study was approved by local IRB. All the women underwent electromyographic evaluation.

RESULTS:
A negative correlation was found between electromyographic activity of the pelvic floor muscles and age (r = -0.369; p=0.045), weight (r = -0.401; p=0.028), body mass index (r = -0.412; p=0.024) and number of pregnancies (r = -0.399; p=0.029). Electromyographic activity of the external pelvic floor muscles was greater in the women who worked longer hours compared to those working fewer hours/day (p<0.001). No statistically significant difference was found in relation to skin color, time working in the profession or number of partners per day.

CONCLUSION:
No correlation was found between the frequency and intensity of sexual activity and electromyographic activity of the pelvic floor muscles in this group of female sex workers; however, electromyographic activity of the external pelvic floor muscles was greater in the women who worked longer hours.
Clinically Significant Fetomaternal Hemorrhage: Incidence and Recurrence Rate [26I]
Authors: Boller Marie J. , Hung Yun-Yi , Varghese Reshma , Weintraub Miranda Ritterman , Moore Gaea S. , Schauer Galen M. 
Published: May 2019

INTRODUCTION:
Clinically significant fetomaternal hemorrhage (CS-FMH) occurs in 1/1000-1/5000 pregnancies and has an unknown risk of recurrence. We sought to establish recurrence rate by analyzing reproductive histories of patients with CS-FMH confirmed by flow cytometry in a large integrated health care system over a 10-year period (375,864 total births).

METHODS:
We conducted an IRB-approved retrospective case series of patients with a positive flow result (>0.1% fetal red cells in maternal circulation) from January 2008 through May 2018 within Kaiser Permanente Northern California (KPNC). For cases of CS-FMH we collected indication for testing, adverse outcomes, reproductive history and demographics.

RESULTS:
Of over 19,000 patients tested, 1105 had a positive flow result. Of these, 7.4% had a result > 1.0%, with 85.4% of these identified as CS-FMH. Of CS-FMH cases, 28.6% had a fetal demise, 71.4% had a symptomatic neonate, and 4.3% had a neonatal demise. 58.6% presented with decreased fetal movement. Excluding cases of fetal demise, 90.0% had an abnormal fetal heart rate tracing (14.0% sinusoidal). Autopsy supported CS-FMH in all but one case of demise. There were no predictive demographic characteristics for CS-FMH. There were no cases of recurrent CS-FMH. Collectively, affected patients had 126 additional pregnancies with 75 liveborns. At term, a flow result ≥4.0% had a positive predictive value (PPV) of 100% for CS-FMH. For preterm deliveries, a result ≥ 1.0% had a PPV of 100%.

CONCLUSION:
The incidence of CS-FMH in our diverse KPNC population is 0.19/1000. We did not find an increased risk of recurrence in future pregnancies.