bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Ovarian Malignancy in Patients Undergoing Surgery for an Adnexal Mass at a High-Volume Cancer Center [36A]
Authors: Byrne Maureen E. , Spross Jennifer , Zivanovic Oliver , Gardner Ginger , Chi Dennis , Roche Kara Long 
Published: April 2018

INTRODUCTION:
To characterize a cohort of patients presenting to a high-volume cancer center with an adnexal mass (AM), reporting pathologic outcomes and risk of malignancy.

METHODS:
All new visits to the gynecology service were prospectively screened from July 1, 2015-5/31/2017. Patients with ovarian complaints were categorized prospectively and followed through treatment. AM was defined as a pelvic mass suspected to originate from the adnexa without apparent metastatic disease based on available clinical and radiographic studies. Clinicopathologic data were collected and analyzed.

RESULTS:
7690 new visits were screened and 2964 patients with an ovarian complaint were categorized: AM 35%, suspected advanced ovarian cancer (ovca) 28%, recurrent ovca 13%, hereditary ovca syndrome 14%, endocrine ablation 8%, other 2%. Of the 1046 with AM, 2% had evidence of metastatic disease on preoperative imaging, 40% were recommended observation, and 58% were managed surgically. For the 607 managed surgically, final pathology showed: benign 74%, non-ovarian malignancy 12%, ovca 8%, borderline tumor 5%, serous tubal intraepithelial carcinoma >1%, no pathology available >1%. Of the 51 patients diagnosed with ovca, median age was 57(27-79 years), median CA125 67 U/ml(9-353 U/ml), and median preoperative AM size was 9.8cm(2.6-21.4cm). Final histologic diagnosis was: epithelial ovca 40(78%), sex cord stromal tumor 5(9.8%), germ cell tumor 1(1.9%), other 5(9.8%). The most common epithelial histology was high grade serous 18(45%).

CONCLUSION:
In patients who underwent surgery for AM with no radiologic evidence of metastatic disease at a high-volume cancer center, risk of ovca was 8% with the majority of patients having benign disease.
Relationship between Sperm Vacuoles, Morphology, DNA Damage, Chromatin State, and Oxidative Stress [7B]
Authors: Tran Mai , Bilinski Melina , Lorenzi Daniela , Uriondo Heydy , Papier Sergio , Alvarez Sedó Cristian 
Published: April 2018

INTRODUCTION:
Some studies found that the presence of sperm nuclear vacuoles is positively correlated with DNA fragmentation. Our objectives are: 1) Evaluate the quantity and size of vacuoles and their association with morphology, DNA damage, and chromatin compaction in semen from men who underwent assisted reproductive treatments; and 2) Investigate the effect of oxidative stress on DNA fragmentation.

METHODS:
Semen samples from 75 men were analyzed and the number and size of vacuoles, DNA fragmentation, and chromatin compaction state were determined via MSOME, TUNEL, and acridine orange (AO) respectively. Furthermore, the level of vitality, DNA fragmentation, and chromatin compaction were evaluated prior to and after 4 hours of oxidative stress (H202).

RESULTS:
In the Kruger ≥4% population, spermatozoa with one or more vacuoles that covered >20% of the nuclear surface had more DNA fragmentation compared to those that covered less. Also, spermatozoa with 1 large or several vacuoles had a chromatin compaction state that was more susceptible to acid-induced DNA denaturation compared to those with other vacuoles pattern. In the Kruger<4% population, there is no difference in DNA fragmentation between spermatozoa with or without vacuoles. After 4 hours, H2O2 did not affect the spermatozoa vitality but did increased the DNA fragmentation.

CONCLUSION:
In patients with Kruger ≥14%, selecting a spermatozoon without vacuoles for ICSI may result in one with less DNA fragmentation. In patients with Kruger<4%, vacuoles should not be a factor in spermatozoon selection; time spent examining vacuoles may increase exposure to oxidative stress resulting in greater DNA damage.
Abnormal Glucose Tolerance and Pregnancy Outcomes in Women Without Diagnosis of Gestational Diabetes Mellitus [23C]
Authors: Enakpene Christopher A. , Jones Tiffany , Mastrogiannis Dimitrios , Della Torre Micaela , Knazze Lauren , DiGiovanni Laura 
Published: April 2018

INTRODUCTION:
Maternal hyperglycemia and untreated GDM lead to adverse perinatal outcomes. This study aims to determine whether abnormal 1-hour GCT alone or one elevated 3-hour GTT value are associated with adverse perinatal outcomes.

METHODS:
Retrospective cohort study of all pregnant women who had diabetic screening from January 2015 to December 2016 at the University of Illinois at Chicago (UIC. These singleton pregnancies were classified into 4 groups: normal 1-hour GCT, abnormal 1-hour GCT only, one elevated value on 3-hour GTT, and GDM. Baseline characteristics and pregnancy outcome of the four groups were compared. Chi square, one-way ANOVA and Student’s t-test were used.

RESULTS:
Of the 4658 deliveries during study the period, 497 women met inclusion criteria. There were 120 women with normal 1-hour GCT, 179 with abnormal 1-hour GCT only, 69 with one elevated value on 3-hour OGTT, and 129 diagnosed with GDM. The GDM patients were significantly older, heavier, gained more weight and delivered earlier (p-value: <0.001, 0.015, <0.001, and < 0.001 respectively). Mean birth weights were higher among patients with abnormal 1-hour GCT only and those with one abnormal value on 3-hours GTT but not statistically significant. A progressive trend was noted in primary cesarean delivery and NICU admission, and patients with GDM were most likely to have both, OR; 2.69 (95% CI: 1.21-5.96), and 2.0 (95% CI: 1.01-3.99) respectively.

CONCLUSION:
Our study shows that these screening results reflect a spectrum of glucose intolerance and these patients may require closer surveillance to improve pregnancy outcomes.
An Association Between Anemia and Postpartum Depression [35C]
Authors: Sutherland Shannon , O'Sullivan David , Mullins Jessica 
Published: April 2018

INTRODUCTION:
Anemia in pregnancy has been associated with increased rates of low birth weight, preterm delivery, and perinatal mortality in several previous studies. Despite these complications, few have investigated the impact of anemia on postpartum women. This postpartum period can be extremely difficult for mothers as 19% of United States women experience postpartum depression (PPD). It is therefore imperative to investigate anemia as a possible physiologic risk factor for PPD.

METHODS:
This retrospective cohort study was conducted by collecting hematocrit and demographic data from medical records of patients meeting all criteria. Patients included were women ≥16 years old who received postpartum care at Women’s Ambulatory Health Services in Hartford, Connecticut from January 2014 to January 2017. Those excluded were patients <16 years old, those on psychiatric medications, those with disease disrupting iron metabolism, tobacco users, patients receiving blood transfusions, or those experiencing neonatal mortality. Records were categorized into anemic and non-anemic. Percentage of Edinburgh Postnatal Depression Scale (EPDS) ≥11 vs <11 were compared using Chi square test.

RESULTS:
922 women fulfilled study requirements and completed the EPDS questionnaire. 9.2% of study patients screened positively for PPD (EPDS ≥11). 75.2% were anemic antenatally or immediately postpartum. The difference in PPD incidence for those anemic (10.8%) vs non-anemic (4.8%) was statistically different (P=.007). Anemic patients had an increased risk of screening positive for PPD (RR 2.25, 95% CI 1.22-4.16).

CONCLUSION:
Anemia during pregnancy or peripartum is associated with an increased incidence of PPD and thus should be further investigated as a potential risk factor for PPD.
Myomectomy: Factors Influencing Patient Decision-Making and Satisfaction [10D]
Authors: van der Does Louise , Kazi Nilofar , Baxi Rupen , Haworth Leah , Washington Kellie 
Published: April 2018

INTRODUCTION:
Myomectomy is a uterine-sparing treatment in women with symptomatic leiomyoma. We explored the decision-making process and overall postoperative satisfaction in patients who chose to undergo myomectomy.

METHODS:
Sequential mixed method design: retrospective chart review (n=1,380) of patients undergoing myomectomy at suburban hospital from 2011-2013, and postoperative mail survey of same population. Myomectomy routes: abdominal, laparoscopically-assisted abdominal (LAAM), conventional laparoscopic (CLM) & robotic-assisted (RAM). Myomectomy route was verified via corresponding survey identifiers. Survey response rate = 7.2%. Survey questions addressed preoperative education, patient decision-making process, complications, and patient satisfaction.

RESULTS:
Of 79 respondents: 18% abdominal, 48% LAAM, 16% CLM and 18% RAM. The top three reasons indicated for having a myomectomy was heavy periods (41.5%), fertility (26.8%) and painful periods (19.5%). 78.5% indicated the route of myomectomy mattered to them, yet 71.2% did not seek a second opinion. Primary reason for not seeking a second opinion was trust in their OBGYN (76.4%). 98% of respondents indicated they were satisfied with the “surgeon’s explanation of the surgical procedure,” yet 57.7% did not correctly identify their type of myomectomy. There was no significant difference in patient satisfaction with overall results of surgery across all myomectomy types. Postoperative care/follow-up was the only significant predictor of patient satisfaction (P <.05).

CONCLUSION:
Trust in the physician was the most significant factor in the patient decision-making process to undergo surgery, while postoperative follow-up care was most significant to overall patient satisfaction. This survey highlights the need for the OBGYN to recommend the most appropriate treatment option to their patients.
Prenatal Skills Pilot Study of Graduates from a Traditional Birth Attendant Training Program in Rural Guatemala [5M]
Authors: Hernandez Sasha , Oliveira Jessica , Cuc Juan Chumil , Shirazian Taraneh 
Published: April 2018

INTRODUCTION:
In developing countries the importance of training traditional birth attendants (TBAs) has been recognized. There is limited data on direct effect on clinical skills and referring capacities from training programs. This pilot study tests the efficacy of a WHO-adapted skills checklist in capturing prenatal skills and referrals in real time in rural Guatemala.

METHODS:
There have been three graduating classes from Saving Mothers TBA training program from 2014-2016 with a total of forty-eight participants. Seventeen graduates were recruited and consented. Four Saving Mothers medical volunteers observed 84 prenatal home-visits in 6 weeks and measured clinical skills in real time.

RESULTS:
92% of prenatal visits by TBAs from the first graduating class, who have had three years of training, were complete. TBAs with four to six months of prenatal skills training performed complete prenatal visits 26% of the time. 30 women were referred to a government clinic and/or hospital; one revealed fetal demise. In 90% of prenatal home visits blood pressure and pulse were correctly taken. Review of at least one of four signs requiring immediate refer to a hospital occurred at 67% of visits. Hand washing only occurred on 35% of total visits.

CONCLUSION:
This pilot testing of a WHO adapted skills checklist appropriately captured clinical skill and referral capabilities in our cohort of TBAs. Continued in-field training improves prenatal clinical skills and referring capacities. This WHO-adapted checklist will be subsequently used in a large-scale study to measure direct skill improvement before and after our training program.
Driving Time as a Structural Barrier to Quality Prenatal Care [21M]
Authors: Maldonado Lauren Y. , Fryer Kimberly , Tucker Christine , Stuebe Alison M. 
Published: April 2018

INTRODUCTION:
Timely prenatal care can significantly improve birth outcomes. To understand the impact of transportation on access to care, we investigated the effect of driving time on a patient’s likelihood of arriving late or no showing for prenatal appointments.

METHODS:
Retrospective cohort study of mothers receiving prenatal care and delivering at North Carolina Women's Hospital between 7/1/2014-6/30/2016. Demographic and outcome data were queried from the electronic medical record. Patients arriving more than 30 minutes late to appointments were classified as late arrivals. We used logistic regression to analyze the effect of driving time - calculated by ArcGIS software using geocoded addresses at time of delivery - on a patient’s arrival status while controlling for pregnancy (high vs. low risk, gravidity) and demographic (age, race/ethnicity, insurance status, partner status) characteristics. P values less than .05 were considered statistically significant.

RESULTS:
Among the 3,083 mothers included, most were publicly insured (62%) and partnered (50%), with an average gravidity of 3 (SD ±2). For every 10 additional minutes of drive time, women had a 1.05 (95% CI 1.02-1.08) adjusted odds of arriving late vs. on time to prenatal appointments. Mothers with higher gravidity, who are black (vs. white), and who are publicly (vs. privately) insured were significantly more likely to arrive late or no-show appointments. Partnered mothers (OR 0.75 95% CI 0.63-0.89) or high-risk pregnancies (OR 0.78 95% CI 0.67-0.90) are less likely to miss appointments.

CONCLUSION:
Longer driving time is one barrier that impedes timely prenatal care. Targeted approaches are needed to overcome these multi-faceted challenges.
Shirodkar Cerclage is More Effective than McDonald for the Prevention of Preterm Birth [36N]
Authors: Rodriguez Phillip Andres , Fylstra Donald , Newman Roger , Nino Julio Mateus 
Published: April 2018

INTRODUCTION:
Data on the efficacy of the McDonald (MD) and Shirodkar (SK) cervical cerclage to reduce preterm birth (PTB) is inconclusive. We aimed to compare the efficacy of these two surgical techniques in pregnancies with history and ultrasound-indicated cervical cerclage.

METHODS:
A retrospective cohort study of patients who underwent history or ultrasound-indicated cerclage between 2007 and 2014. PTB rates were compared among pregnancies with either a MD or SK cerclage. Kaplan-Meier Survival Analysis was performed to determine the latency between cerclage placement and delivery. Selected neonatal outcomes were compared between the two groups. Chi-square test and One-Way ANOVA on Ranks were used to analyze the data.

RESULTS:
Of 306 MD and 43 SK cerclages, 185 (60.5%) and 34 (79.1%) were history-indicated, and 121 (39.5%) and 9 (20.9%) were ultrasound-indicated, respectively. PTB < 32 weeks occurred in 100 (32.7%) and in 7 (16.3%) of MD and SK (p =.045). PTB < 37 weeks was higher in the MD than in the SK group (58.2% and 41.8%; p =.046). Latency was also different between the groups, (Figure; p =.002) with median latency of 17.7 weeks (95% confidence interval (CI); 16.9, 18.5) for the MD group and 23.0 weeks (95% CI; 22.0, 23.9) for the SK group. Neonatal respiratory distress syndrome was more common in the MD than in the SK group (45.2% versus 13.9%, p =.032).

CONCLUSION:
Shirodkar cerclage is associated with improved pregnancy prolongation, lower PTB rates, and better neonatal outcomes compared with McDonald cerclage. A randomized clinical trial to confirm our findings is justified.
Social Media Use, Beliefs, and Training Among Residents and Medical Students in Ob/Gyn [11O]
Authors: Stalcup Alane M. , Pak Arlene , Dotters-Katz Sarah , Gray Beverly 
Published: April 2018

INTRODUCTION:
To describe social media use, beliefs about appropriate use, and training from programs and institutions among residents in obstetrics and gynecology and students entering the profession.

METHODS:
A 28-question, anonymous, online survey was distributed throughout the country to current OB/GYN residents and 4th year Medical students who matched in the specialty.

RESULTS:
Most participants (96.5%) were between the ages of 25-34 and 86.8% were female. Social media usage included Facebook (90%), Instagram (55.2%), and Snapchat (32.4%). Only 5.5% report no use of social media. While the majority check their social media outlets at least once a day (66.9%), a majority post only 1-2 times per month (56.3%). Wide variation existed in beliefs about appropriate types of postings. 97% of respondents reported being tagged in a patient post. A majority of residents reported receiving social media training from their institutions (70%) or programs (56%), but most did not know whether a formal policy existed. Only 35% were aware of the ACOG Committee Opinion on social media, but only 8% had read it. Likewise, only 17% were aware of the relevant ACOG training video, and 5% had viewed it.

CONCLUSION:
Conclusion(s): Social media use and online patient contact is ubiquitous among residents and medical students, while awareness of formal policies is not common. A diversity of opinion around appropriateness of posts exists. Given potential issues with patient privacy protection and liability issues, training in social media use should become part of residency training.
Human Papillomavirus and Vaccine Knowledge Among Health Professional Students [19O]
Authors: Ruebsamen Rebecca , Savoni Jessica , Hosseini Parastou , Dong Fanglong , Nelson Anita L. 
Published: April 2018

INTRODUCTION:
Human Papillomavirus (HPV) is known to be associated with cancer, therefore, it is important that all health care team members are well educated about HPV screening and prevention. This study seeks to explore knowledge gaps among students in different health professional programs.

METHODS:
A 45-question survey was available on Google Forms from July 5 - September 1, 2017 for students in osteopathic medicine, nursing, physician assistant (PA), and pharmacy schools at Western University of Health Sciences (WesternU). Seventeen questions (yes/no answers) were used to assess knowledge of HPV. This study was approved by the Institutional Review Board at WesternU on an exempt basis.

RESULTS:
This report is based on 265 completed surveys. Two-thirds (65.2%) of respondents were women; 60.4% were age 25-29; and 81.5% were osteopathic medical students. The correct answer percentage ranged from 32.8% (when dual testing begins) to 93.6% (if vaccinated women still require Pap smears). Half (50.6%) correctly reported the recommended age for vaccination. Women were more likely to know this fact (55.2% vs. 41.3%, P=.031) and that HPV infection is usually asymptomatic (69.8% vs. 57.6%, P=.0476). Osteopathic medical students were more likely than PA students to know the HPV subtypes associated with carcinoma (65.7% vs. 42.9%, P=.003).

CONCLUSION:
There is a diverse deficit in HPV knowledge among health professional students from various programs. While post-graduate experiences may provide opportunities to close those gaps, it is important to recognize that more education is needed across programs regarding HPV testing and prevention.
Routine Use of Tranexamic Acid in Postpartum Hemorrhage: A Cost-Effectiveness Analysis [34O]
Authors: Howard Dagnie , Skeith Ashley E. , Lai Jasmine , D'Souza Rohan , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Postpartum hemorrhage (PPH) is a leading cause of pregnancy-related morbidity and mortality worldwide. Recent data has demonstrated that tranexamic acid (TXA), an antifibrinolytic agent, reduces death due to bleeding when used as a treatment for PPH. Our objective was to determine whether the routine use of TXA in the setting of PPH is cost-effective.

METHODS:
A decision analytic model was designed using TreeAge software in order to compare the outcomes and costs of TXA use in the treatment of PPH.

RESULTS:
Administration of TXA to a theoretical cohort of 100,000 women receiving usual care for PPH would prevent 403 maternal deaths due to hemorrhage and 457 laparotomies to control bleeding. This improvement in outcomes would result in an increase in 11,000 QALYs and a cost savings of $596 million. Furthermore, if TXA were administered early (within 3 hours) to the same theoretical cohort, 568 maternal deaths due to hemorrhage and 635 laparotomies would be prevented. This amounts to an increase in 16,000 QALYs and a cost savings of $842 million. Sensitivity analysis showed that the administration of TXA was the dominant strategy (lower costs, better outcomes) at all probabilities of maternal death due to hemorrhage. When the cost of TXA was varied, TXA use remained dominant up to a cost of $6,000 per administration and was cost-effective up to $16,555 (assumed cost = $50.40 per administration).

CONCLUSION:
Early administration of TXA is a cost-effective strategy for reducing maternal morbidity and mortality due to PPH.
Placental Thickness on Ultrasound and Neonatal Birthweight [35P]
Authors: Hamidi Odessa P. , Hameroff Avi , Kunselman Allen , Sinha Risha , Curtin William M. , Ural Serdar 
Published: April 2018

INTRODUCTION:
Our study aims to investigate the relationship between maximal placental thickness during routine anatomy scan and birthweight at delivery.

METHODS:
This retrospective descriptive study analyzed 200 term, singleton deliveries in 2016 at Penn State Hershey Medical Center. We measured maximal placental thickness in the sagittal plane from the ultrasound images of the placenta obtained at the 18-21 weeks fetal anatomy screen. The relationship between placental thickness and neonatal birthweight was assessed using Pearson's correlation coefficient (r) with 95% confidence interval (CI). Logistic regression was used to assess the association with secondary binary outcomes of NICU admission and poor APGAR scores. Two sample T-tests were used to assess for differences attributable to medical comorbidities (pre-gestational diabetes, gestational diabetes, chronic hypertension, gestational hypertension, preeclampsia and eclampsia).

RESULTS:
Placental thickness had a positive correlation with neonatal birthweight (r=0.18, 95% CI = (0.05, 0.32)). The mean placental thickness measured 34.2 ± 9.7mm. The strength of the correlation remained similar when adjusting for gestational age (r=0.20) or excluding medical comorbidities (r=0.19). Logistic regression analysis demonstrated no association between placental thickness and NICU admission, APGAR scores <7, or medical comorbidities.

CONCLUSION:
Our ongoing study demonstrated a positive correlation between sonographic placental thickness and birthweight. Future prospective studies are warranted in order to further investigate whether a clinically significant correlation exists while adjusting for more covariates. As an abnormally thick placenta may indicate implantation problems of placental disease, another area of future study is correlation with placental pathology and adverse pregnancy outcomes.