bluuebunny/crossref_metadata_2025_split huggingface dataset:
Uterine Bioelectrical Activity in Pregnant Women With a Short Cervix in the Mid-Trimester [19O]
Authors: Marinescu Ponnila S. , Miller Lauren Anne , Young Roger C. , Hern Braxton , Pressman Eva K. , Seligman Neil Stuart 
Published: May 2019

INTRODUCTION:
Mechanisms of mid-trimester cervical shortening (<2.5cm) are unclear, and it is unknown if subclinical uterine activity plays a causative role. The purpose of this study is to characterize uterine bioelectrical activity by uEMG in women with a short cervix in the mid-trimester.

METHODS:
This is an observational cohort study of pregnant women at an urban academic medical center from November 2017 to June 2018. Women with short cervical length (CL) <2.5 cm were compared to women with normal CL (≥3 cm). Primary outcome was pattern of bioelectrical activity in both groups. Secondary outcomes were characteristics of identified signals. All subjects had a singleton pregnancy between 16w0d and 22w6d. Up to 4 proprietary uEMG electrode pads (PreTel, Inc., Chattanooga, TN), 4 commercially available ECG pads, a ground electrode, and a tocometer were placed on the lower abdomen. EMG recordings were obtained for 60 minutes using a Porti amplifier (TMSi, Oldenzaal, Netherlands) and analyzed between 0.15 and 1.2 Hz.

RESULTS:
Seven subjects were included, 4 with short CL and 3 with normal CL. Isolated spike and burst signals were identified during recordings. Spikes were observed in both groups, but burst-type signals were observed only in the short CL group. In women with short CL, 3 bursts in 4 subject hours of monitoring were appreciated.

CONCLUSION:
Burst-type signals in women with a short CL, while infrequent, are a novel finding. Our results need to be replicated in larger studies requiring prolonged subject monitoring (e.g., 10hr/patient). This would necessitate using wearable electrodes to allow for uninterrupted recording during daily activity.
Validation of Noninvasive Prenatal Testing for Fetal Aneuploidies and Microdeletions Down to 2% Fetal Fraction [20O]
Authors: Mito Yoshiko , McCafferty Jonathan , Calder Robert , Lu Xingwu , Gross Susan , Edelmann Lisa 
Published: May 2019

INTRODUCTION:
Noninvasive prenatal testing (NIPT) by massively parallel sequencing of cell-free DNA in maternal plasma detects fetal aneuploidies with high sensitivity and specificity. However, accurate detection of fetal aneuploidies in samples with low fetal fraction remains challenging.

METHODS:
We have developed an NIPT pipeline that utilizes a statistical model-based counting algorithm to (1) calculate the representation of genomic regions of interest; (2) estimate the fetal fraction; (3) assess the fetal sex by Y chromosome representation; (4) determine the risk of fetal aneuploidies and microdeletions. The training set was modeled using 2,813 euploid samples (1,673 male and 1,140 female fetuses). For intermediate result calls, assessment incorporated likelihood ratios. Sensitivities and specificities were dynamically calculated in relation to both sequencing read depth and fetal fraction to set reporting thresholds.

RESULTS:
This clinical pipeline tested with 2,253 samples including 98 known positive samples for aneuploidies of chromosomes 21, 18, 13, 16, 22, 15, X and Y as well as microdeletions of subchromosomal regions (22q11.2, 1p36, 15q11.2-q13, 4p16, 5p15, 11q23, and 8q24). Results were called with both sensitivity and specificity >99% for common aneuploidies. The observed normalized chromosome values closely fit the statistical model's estimation, indicating accurate aneuploidy calls down to 2% fetal fraction.

CONCLUSION:
In this study, we present a validation model for an NIPT pipeline utilizing a statistical model-based counting algorithm that can accurately detect the fetal aneuploidies and microdeletions down to low fetal fraction.
Opportunity for Cancer Prevention: 1 in 4 Unaffected Women Meet Hereditary Cancer Testing Criteria [26O]
Authors: Bucheit Leslie , Ready Kaylene , Brown Jonathan , Goldberg James D. 
Published: May 2019

INTRODUCTION:
Estimates show 5-10% of cancer is hereditary. OB/GYNs play an important part in identifying hereditary cancer syndromes (HCS) for women unaffected with cancer; however, the prevalence of HCS in this population is not well studied. This study describes the prevalence of HCS among unaffected female patients as measured by meeting National Comprehensive Cancer Network (NCCN) criteria for genetic testing for BRCA-related, Lynch, and/or polyposis syndromes.

METHODS:
A personalized link was sent to patients prior to their annual OB/GYN visit requesting that they report personal and family cancer history (PFHx) to a digital tool that aligns PFHx to NCCN genetic testing criteria for HCS. Responses were collected between 2/1/18 and 9/1/18; data were then de-identified and analyzed.

RESULTS:
Of 4226 possible patients, 2334 entered PFHx into the digital tool, 94% (n=2199) of whom were unaffected. 23% (n=506) of unaffected patients met NCCN criteria for HCS genetic testing including 82% for BRCA, 15% for Lynch syndrome, and 3% for polyposis syndromes; 6.5% met criteria for multiple syndromes. An additional 1.3% met criteria due to a reported familial mutation. Unaffected patients who reported PFHx averaged 42 years of age (range: 18 to 83) and 93% reported Caucasian (60%), Asian (16%), African-American (10%), or Ashkenazi Jewish (7%) ethnicity.

CONCLUSION:
Nearly 1 in 4 unaffected patients presenting for annual OB/GYN visits met NCCN genetic testing criteria for HCS. Many patients may benefit from OB/GYNs employing standardized ways to identify HCS.
Medroxyprogesterone Eliminates Abnormal Bleeding With a Levonorgestrel Intrauterine System (LNG-IUS) [4P]
Authors: Benor Ariel , Kulak David , Naroji Swetha Jaya 
Published: May 2019

INTRODUCTION:
Abnormal vaginal bleeding is a common side effect seen in the majority of patients in the first six months after LNG-IUS placement. Some women may desire its removal because of this effect. The objective of this study was to assess the ability of medroxyprogesterone (MP) to reduce this initial bleeding transition period.

METHODS:
We prescribed a tapering regimen of medroxyprogesterone (MP) overlapping the first 35 days with the LNG-IUS. Four women who desired amenorrhea adhered to this regimen: on day three of their menses, they began a 14-day course of MP 10 mg daily; on day four, the LNG-IUS was inserted; on day 17, the MP was reduced to 5 mg daily for ten days; on day 27, the MP was reduced to 2.5 mg daily for ten days. The women were given a diary to record their bleeding pattern.

RESULTS:
All four women (100%) became amenorrheic within seven days of LNG-IUS insertion and remained so for the duration of use with the LNG-IUS (>1 year). Three out of four (75%) recorded 3-5 days of spotting for the first 1-4 months with the LNG-IUS.

CONCLUSION:
Our tapering regimen of MP overlapping the first 35 days with an LNG-IUS is sufficient to eliminate the initial period of abnormal bleeding. Iatrogenic amenorrhea may alleviate many patients' feelings of anxiety as well as other menstrual symptoms, and this may affect a patient's decision to continue using the LNG-IUS. More research is required to validate this study.
Patterns of and Attitudes Towards Cannabis Use in Women's Health [7P]
Authors: Alton Katie , Han Leo , McCrimmon Sara , Darney Blair , Colwill Alyssa Covelli , Jensen Jeffrey T. 
Published: May 2019

INTRODUCTION:
Legal access to cannabis is increasing and its use to treat medical conditions has been shown to be effective and common. We sought to assess the use of and attitudes towards cannabis for treating gynecological conditions.

METHODS:
We utilized Amazon.com Inc.'s Mechanic Turk platform to administer a 21-question survey of US women. We present descriptive results of socio-demographic information, cannabis use for recreational and medicinal purposes, and attitudes about cannabis use for gynecologic conditions. We used bivariate statistics to test associations between past cannabis use and attitudes towards use for gynecologic conditions.

RESULTS:
We obtained responses from 1011 women from all 50 states. Respondents primarily identified as white (83%), with a median age of 37 (range 19-82). Sixty-four percent reported they had ever used a cannabis product. Among respondents who had used cannabis (n=648), 36% (n=232) reported using it to treat a specific medical condition; pain and depression/anxiety were the most common conditions. Of these women, 16% (38/232) reported cannabis use to treat a gynecologic condition; menstrual cramps was the most common condition. Of respondents reporting ever using cannabis, 49% (490/1011) stated they would consider using cannabis to treat pain associated with medical abortion, 47% (n=480/1011) would use for surgical abortion pain, and 48% would use for pain with IUD insertion (n=489/1011). Among respondents who have never used cannabis, 63% (n=229/362) would considering using cannabis to treat a gynecologic condition.

CONCLUSION:
Cannabis products are currently being used by women both recreationally and medically. Most women would consider using cannabis to treat gynecologic conditions.
Perspectives on Pharmacy Access to Hormonal Contraception Among Rural New Mexican Women (PHARM) [10P]
Authors: Thaxton Lauren D. , Sible Alexandra , Clark Elizabeth , Sussman Andrew , Espey Eve 
Published: May 2019

INTRODUCTION:
With the goal of expanding access to family planning, we interviewed rural New Mexican women to determine their perceptions of pharmacists' prescriptive authority and how it could impact contraceptive access in their communities.

METHODS:
Semi-structured telephone interviews were conducted with women recruited from four rural New Mexico communities. Researchers used interview guides to explain the new protocol; the guide covered topics including general attitudes, advantages, and disadvantages within their community.

RESULTS:
Between November 2017 and May 2018, 32 women were enrolled. Participants were young (56% between the ages of 18-29), gravid (52% with 3 or more prior pregnancies), employed (94%) and white (69%) Hispanic (84%). The majority used Medicaid as their primary insurer (57%). The majority of women were supportive of pharmacy access. Many expressed the desire for pharmacists to review side effects with them; most women did not think pharmacy access would reduce provider visits for preventive care. The main perceived benefit of pharmacy access was convenience: longer hours of operation, shorter wait times and no requirement for an appointment. Many did not support over the counter access to hormonal contraception due to concerns about side effects. Some concerns included lack of privacy, lack of individualized care and preference for a physician.

CONCLUSION:
Rural New Mexican women generally support pharmacy access to contraception. Operationalizing pharmacy access requires input from local community members to promote advantages and address concerns.
Tracking Obstetrical and Gynecological Experiences Using Mobile Devices [19P]
Authors: Jordan Sali , Marko Emily , McLeod Francine , Perez-Visona Sira 
Published: May 2019

INTRODUCTION:
Tracking clinical experiences is important toward progression of entrustable professional activities required by medical schools. The purpose of this study was to determine the effectiveness of using an innovative real-time mobile device tracker for medical student clinical experiences compared with the traditional tracking using a passport log.

METHODS:
A prospective single cohort observational study was performed using third year medical students in obstetrics and gynecology rotations. Participants downloaded the obstetrics and gynecology (OBG) tracker and recorded their clinical experiences; procedures, number, and degree of involvement. Results were compared with data from the passport log. Outcomes included data comparison from both tracking methods and end of clerkship student surveys. Internal review board exemption was obtained. Paired t-tests were used for data analysis.

RESULTS:
Thirty-six students participated in the study over 6 months. The OBG tracker recorded 269 entries, the passport recorded 187. The OBG tracker recorded higher numbers of procedures compared to the passport (procedure type, 56 OBG tracker, 8 passport, p<0.001; degree of involvement, 30 OBG tracker, 0 passport, p<0.001). OBG tracker also tabulated student involvement in cases; 40.2% vaginal deliveries, 41.2% delivered placentas, 62.0% coached patients, 50.9% inserted catheters, 35.8% sutured, 33.3% pelvic exam, 23.3% breast exams. Student surveys rated OBG tracker more useful than the passport (OBG tracker 1.29, passport 4.06, p<0.001).

CONCLUSION:
The use of a mobile device tracker for clinical experiences allowed for more meaningful real-time data of learners than the traditional passport logs. Tracking detailed experiences and degree of involvement is important to entrustment decisions in medical education.
Does Antepartum Vitamin D3 Supplementation Prevent Chorioamnionitis? [24P]
Authors: Persad Malini D. , Staszewski Cara , Khan Farzana , Perseleni Tatyana , Herrera Kimberly , Garretto Diana 
Published: May 2019

INTRODUCTION:
To determine the relationship between maternal Vitamin D status and the incidence of clinical chorioamnionitis and endometritis.

METHODS:
Nested case-control study performed 10/2016-5/2018 enrolled women from 12-16 weeks gestation. Women were excluded if taking Vitamin D3 supplements, had a malabsorption disorder, or carrying an anomalous fetus. Women were assigned to receive daily Vitamin D3 3000IU or no supplementation. Maternal demographics, baseline Vitamin D3 status, and pregnancy outcomes were collected. Clinical chorioamnionitis was defined as presence of elevated temperature of >39 C or 38 C occurring twice 30 minutes apart with fetal tachycardia, maternal tachycardia, purulent vaginal discharge or uterine tenderness. Endometritis was defined as elevated temperature and uterine tenderness in the postpartum period. Parametric and nonparametric statistics were performed. A p value of <0.05 was statistically significant.

RESULTS:
There were 210 women included, 103 in the Vitamin D3 supplementation group and 107 in the no supplementation group. There were no significant differences in baseline characteristics between the groups. The incidence of maternal infection was 4.8% (10/210). Women with Vitamin D deficiency had a significant higher risk for the development of chorioamnionitis (12.9 vs. 0%; OR 20.7; p=0.003). Women who were Vitamin D deficient, with or without supplementation, had an increased risk of chorioamnionitis (8.8 vs. 0%; OR 13.4; p=0.02). There was no association between Vitamin D3 status and endometritis.

CONCLUSION:
Women who are Vitamin D deficient, with or without antepartum Vitamin D supplementation, are at an increased risk for chorioamnionitis. Optimization of Vitamin D status may be considered in prevention of maternal infection.
Risk Factors of Subsequent Preeclampsia in Multiparous Women Among a Primarily African American Cohort [26P]
Authors: Rana Sarosh , Njoroge Scolastica , Minhas Ruby , Mueller Ariel 
Published: May 2019

INTRODUCTION:
Women with a history of preeclampsia (preE) have a higher risk of developing preE in subsequent pregnancies. However, the role of the inter-pregnancy interval on this association is unclear.

METHODS:
Data was collected from an ongoing study where women with hypertensive disorders of pregnancy (HDP) are enrolled and consented upon admission to the labor and delivery floor. From this dataset, we identified multigravid women with a prior diagnosis of preE and compared them to women with no prior history.

RESULTS:
The study included 375 women with HDP who were predominantly African American (74.4%). Of these, 245 were multigravida and 44 (18.0%) had a prior history of preE. Women with prior preE had earlier gestational age of delivery (36.1 vs 38.0 weeks), higher rates of preterm delivery (63.6% vs 31.8%), and a higher incidence of preE with severe features (sPE) (56.8% vs 29.8%) in the index pregnancy (p-values≤0.001) than those without. The median number of years between history of preE in previous pregnancy and current pregnancy was 6 years (range 1-19). Among patients with a prior history of PreE, preterm delivery in a prior pregnancy was identified as a risk factor in developing sPE in subsequent pregnancies (OR 9.00, 95% CI: 2.18-37.18, p=0.002); however, interpregnancy interval and number of previous pregnancies were not associated with severe preE (p-values>0.51).

CONCLUSION:
A number of factors were identified as risk factors for developing preeclampsia in subsequent pregnancy. These factors need to be considered as part of discussion when counselling these patients.
Risk of Readmission for Relapse Among Pregnant Women on Methadone With a Co-Occurring Psychiatric Diagnosis [27P]
Authors: Rosenthal Emily , Cruz Yury , Reyes Andres , Hand Dennis , Roman Amanda 
Published: May 2019

INTRODUCTION:
At our institution, methadone initiation for pregnant women with opioid use disorder (OUD) occurs in the inpatient setting. We sought to determine whether those who have a co-occurring psychiatric diagnosis are more likely to be readmitted for relapse than those who do not.

METHODS:
This is a retrospective cohort study of pregnant women with OUD at our institution from 2012-2017. The primary outcome was readmission for relapse during pregnancy. Women with a co-occurring psychiatric diagnosis were compared to those without.

RESULTS:
Readmission for relapse occurred in 59 patients (16%). A co-occurring psychiatric diagnosis was documented for 269 patients (71%). Of these, 190 patients were on a psychiatric medication (71%), and 124 patients (46%) received an inpatient psychiatric consultation. There was no significant difference in readmission for relapse between groups with and without a co-occurring psychiatric diagnosis (OR 1.13, 95% CI 0.62-2.12). Within the group with a co-occurring psychiatric diagnosis, there was no significant difference in readmission for relapse between those who were on psychiatric medication vs. not (20% vs 16%, OR 1.45, 95% CI 0.70-2.96). Women with a co-occurring psychiatric diagnosis who received an inpatient psychiatric consultation were significantly more likely to be readmitted for relapse than those who did not (26% vs 13%, OR 2.86, 95% CI 1.42-5.74).

CONCLUSION:
Pregnant women with OUD on methadone with a co-occurring psychiatric diagnosis are not more likely to be readmitted for relapse than those without. However, a co-occurring psychiatric disorder necessitating inpatient psychiatric consultation was associated with two-fold increased odds of readmission for relapse.
Seasonal Variation in the Incidence of Preeclampsia and Eclampsia in Kigali, Rwanda [28P]
Authors: Mutabazi Leon , Bazzett-Matabele Lisa , Small Maria Jacqueline , Ntasumbumuyange Diomede , Rulisa Stephen , Magriples Urania 
Published: May 2019

INTRODUCTION:
Hypertensive disorders complicate 5 to 10% of all pregnancies. The WHO estimates the incidence of preeclampsia (PEC) to be 7 times higher in developing countries (2.8%) than in developed countries. The aim of this study was to document the prevalence of preeclampsia (PEC) and eclampsia (EC) in Kigali, Rwanda and to determine whether seasonality at conception or delivery affects the rate

METHODS:
A combined retrospective and prospective study at 2 large teaching hospitals in Kigali, Rwanda was performed over a 2-year period. Data were collected through an admission questionnaire by trained midwives.

RESULTS:
Over a 2-year period, 19,746 deliveries were conducted and 454 cases of PEC/EC were identified for an overall prevalence of 2.3% (2.0% PEC; 0.3% EC). Most of the patients with PEC presented with severe features (62.3%). Half of the patients were admitted with blood pressure greater than 160/110 mmHg and 55.1% were admitted between 28 weeks to 36 weeks 6 days of gestation age. Women with PEC were more likely to have chronic hypertension than women with EC (10.9% vs 0%, p=0.05). Two thirds of patients presenting with PEC/EC were admitted during the rainy season (OR 1.36, p=0.002). Season at conception did not affect the prevalence of PEC/EC at admission. There was no difference in the severity of the disease based on seasonality.

CONCLUSION:
The overall prevalence of PEC/EC was 2.3%, with a higher prevalence in rainy season. Further studies need to examine whether this is affected by seasonal variation in other diseases such as malaria.
Super-Utilizers' of L&D Triage Do Not Have an Increased Postpartum EPDS [35P]
Authors: Cronin Sean , Style Michele , Goldberg Jay , Jaspan David 
Published: May 2019

INTRODUCTION:
Non-pregnant patients overutilizing emergency room resources have been reported to have higher rates of depression. Obstetrical "Super-utilization" has been previously defined as > 4 acute/unscheduled medical visits during pregnancy. We wished to determine if being a pregnant “Super-utilizer” could be a marker for postpartum depression.

METHODS:
A hospital obstetrical database was searched to determine the number of acute/unscheduled L&D triage visits for patients delivering during a three month time period. Patients with > 4 acute/unscheduled labor and delivery triage visits were considered “Super-utilizers.” Demographic and outcomes data were collected. An Edinburgh Postnatal Depression Score (EDPS) of ≥11 was considered a positive screen. Data were summarized, and groups were compared using chi-squared test for independence and Fisher's exact test.

RESULTS:
Of 750 delivered patients during a three month period, 56 (7.5%) pregnant triage “Super-utilizers” were identified. 3 (5.4%) of the 56 of “Super-utilizers” had an EPDS ≥11. Obstetrical non-“Super-utilizers” had similar rates of positive EPDS.

CONCLUSION:
Pregnant triage “Super-utilizers” were not statistically more likely to have an Edinburgh Postnatal Depression Score (EDPS) ï‚³ 11 than non-“Super-utilizers.”
The Effect of Decreased Opioid Prescribing After Routine Vaginal Delivery on Post Discharge Patient Encounters [37P]
Authors: Olsen Nina , Eagan Alexandra , Udayakumar Anu , Romutis Kristin , Martin Caitlin Eileen , Terplan Mishka 
Published: May 2019

INTRODUCTION:
In line with nationwide commitment to decrease opioid prescribing, our department instituted new guidelines to no longer routinely provide opioids at discharge following vaginal delivery. The purpose of this study was to measure the effect of this change on discharge opioid prescriptions and postpartum encounters.

METHODS:
This was a retrospective cohort study of patients who underwent vaginal delivery during two time periods: November 2016 to January 2017 before the guideline and November 2017 to January 2018 after its implementation. IRB approval was obtained. Exclusion criteria included substance use disorder history, age under 18 and having a contraindication for nonopioid analgesic use. The number of patients who were provided discharge opioid prescriptions or had an outpatient encounter related to pain within six weeks postpartum were compared using Student t-tests.

RESULTS:
A total of 1,188 patients delivered during the study periods, of those 810 met inclusion criteria. 405 patients delivered prior to the guideline and 405 after its implementation. The proportion of patients prescribed opioids decreased from 79.8% (n=323) to 7.2% (n=29) after the guideline (p<0.001). The number of patients who had a post-discharge outpatient encounter (either in the Emergency Department, clinic or via phone call) related to pain did not change (4% before and 6.7% after the guideline; p = 0.085). The majority of encounters were related to dysuria and pain around repaired lacerations.

CONCLUSION:
Substantially limiting opioid prescribing after vaginal delivery does not appear to increase the burden of outpatient patient encounters after discharge.