bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cryopreservation Promotes Sperm DNA Damage Through Oxidative Stress [38N]
Authors: Tran Mai , Uriondo Heydy , Nodar Florencia , Alvarez Sedó Cristian 
Published: April 2018

INTRODUCTION:
Sperm cryopreservation may be linked to DNA damage, possibly via oxidative stress. We compared the DNA damage, apoptosis levels, and oxidative stress in semen samples prior to and after slow cryopreservation and evaluated the relationship between these variables.

METHODS:
Semen samples from 60 men who underwent assisted reproductive technology (ART) (experimental group) and 20 normozoospermic sperm donors (control group) were analyzed. DNA fragmentation, apoptosis levels, and plasma membrane lipid peroxidation/oxidative stress were evaluated using TUNEL, Annexin V-FITC Apoptosis Kit, and BODIPY/8OH-DG respectively. These variables were evaluated prior to slow cryopreservation and after thawing. Apoptosis (Annexin V), DNA fragmentation (TUNEL), and oxidative stress (BODIPY and 8OHDG) values were also compared between the group of men who underwent ART and the sperm donor group.

RESULTS:
Annexin V, TUNEL, BODIPY, and 8OHDG values significantly increase after thawing (p<0.05). In the post-thawing group, the BODIPY and 8OHDG levels are significantly greater than the Annexin V level (p<0.05). Moreover, the sperm donor group had significantly lower Annexin V, TUNEL, and BODIPY and 8OHDG values than the group of men who underwent ART (p<0.05).

CONCLUSION:
After slow-freezing thawing, there are higher levels of apoptosis, DNA fragmentation, and oxidative stress in semen samples than prior to cryopreservation. The slow freezing-thawing process induces sperm DNA damage via oxidative stress more so than apoptosis. Semen samples from men who underwent ART are more susceptible to oxidative stress and cell death than normozoospermic sperm donors.
Who Publishes in the Green Journal? [3O]
Authors: Swaim Laurie S. , Davis Beth R. , Limmer Jane , Sangi-Haghpeykar Haleh , Thompson Chesney 
Published: April 2018

INTRODUCTION:
Specialists (formerly “generalists”) account for the largest percentage of faculty among medical school departments of obstetrics and gynecology (OBGYN) in the United States (US). First, second or last authorship in a peer-reviewed journal is required for promotion regardless of training. However, academic specialists lack research instruction obtained during subspecialty fellowships. We aim to compare the prevalence of specialist and subspecialist OBGYN and trainee first-authors of original research articles in the journal Obstetrics & Gynecology.

METHODS:
Articles published from 2014-2016 in Obstetrics & Gynecology were evaluated. First authors from US sites were classified as specialists, subspecialists or trainees from the institutional website at the time of publication. Original research articles were categorized as Randomized Controlled Trial (RCT), Cohort, Case-Control, Cross Sectional, or Meta-analysis/Systematic Review based on the description in the materials and methods. The Chi-square test was used to analyze categorical variables. P < .05 was considered significant

RESULTS:
From 2014 to 2016, 339 original research articles were identified. While 66% of first authors were subspecialist (225/339), no significant differences were noted in the portion of subspecialist versus generalist as first authors of RCT (8 vs 11%, P = .41), cohort trials (63 vs 60%, P = .64), or case-control studies (6 vs 4%, P = .44).

CONCLUSION:
Academic OBGYN’s who have completed or are in fellowship subspecialty training programs are more likely to be primary authors of original research than specialist and resident obstetrician-gynecologists. However, specialists are proportionally just as likely to publish original research articles as their subspecialist colleagues.
Assessing Knowledge of Cervical Cancer among Health Care Students in Mwanza, Tanzania [9O]
Authors: Patel Priya , Hari Anjali Y. , Bernstein Megan , Farfel Allison , Raman Kaavya 
Published: April 2018

INTRODUCTION:
In many Sub-Saharan African countries, cervical cancer remains the most prevalent cancer among women. The purpose of this study is to empirically characterize levels of knowledge in healthcare students in Mwanza, Tanzania with regards to transmission and risk factors for HPV infection, as well as treatment options and prevention of cervical cancer.

METHODS:
To assess educational needs and awareness, 185 health professions students were surveyed to measure knowledge of cervical cancer.

RESULTS:
3 out of 181 students identified all of the correct causes of cervical cancer and none of the incorrect causes. 11 students out of 181 identified all of the correct HPV prevention methods and none of the incorrect methods. None of the students were able to identify all correct responses without selecting any incorrect responses for cervical cancer risk factors, HPV transmission, or cervical cancer treatment options. Almost two-thirds of participants in this study reported being dissatisfied with their current level of cervical cancer knowledge, and the most common source of information indicated by students was the media, not school.

CONCLUSION:
Many policy changes are needed to curtail the high incidence and prevalence of cervical cancer in Tanzania. Low levels of demonstrated knowledge call for the implementation of additional HPV, cervical cancer prevention, and cervical cancer treatment educational lessons. These lessons may improve the knowledge base of the future healthcare workforce, who may in turn be more equipped to address the high rates of cervical cancer in Tanzania.
Pediatric Gynecology: Improving Ob/Gyn Resident Training by Using a Short Interactive Curriculum [13O]
Authors: Medina Yailis 
Published: April 2018

INTRODUCTION:
Ob/Gyn residency programs are not providing enough training time to pediatric gynecology education, and residents experience limited exposure in clinics. By graduation, most residents feel less than competent in managing pediatric evaluations. Multiple authors have published their concern and possible solutions to improve training during residency. Most interventions have been limited to independent study or simulations for technical skill development in pediatric pelvic examination. This study will integrate the individual solutions provided in the literature to develop a structured and interactive curriculum to achieve resident competence in all phases of the encounter.

METHODS:
A prospective pre-post cohort study to evaluate effects in knowledge, skills and attitudes (KAS) in 20 Ob/Gyn residents from University of Puerto Rico. The curriculum included 4 interactive, independent sessions of 60 minutes on bleeding patterns, pelvic pain, pelvic masses and vulvovaginal disease. Followed by a 120-minute workshop on examination, procedural and communication skills. To evaluate the areas, the data was collected in a pre and post tools for knowledge, skills and attitudes.

RESULTS:
Data was collected from 14 residents who completed the pre and post-tests. Descriptive statistics comparing all residents who responded pre and post-tests showed a 85% improvement in medical knowledge, 100% for procedural skills and 75% in attitudes.

CONCLUSION:
A short curriculum, with limited resources can be implemented in all interested programs. Providing more time and specific training in pediatric gynecology will improve KSA of Ob/Gyn residents leading to improvement in care for Ped/Gyn population. Study was limited by poor response of residents to web instruments.
Level of Nursing Experience and its Link to Cesarean Birth Rate [20O]
Authors: Adkins Christen B. , Dziadosz Margaret 
Published: April 2018

INTRODUCTION:
High cesarean birth rates are a concern both in the United States and around the world. There is limited research on the role of nursing care in contributing to cesarean births in patients who have the potential to deliver vaginally. Our study investigated an association between level of nursing experience and risk of cesarean birth by analyzing an existing data set.

METHODS:
We obtained a sample of women giving birth at a community hospital in New Jersey with approximately 6,000 births per year. Data were extracted from records of every eligible birth over a 2-month period, including experience of the nurse providing care, maternal and infant characteristics, obstetrical procedures, and type of birth. Pregnant patients were selected based on inclusion criteria: ages 18-40 years old, carrying singletons, at 37 weeks or more. Exclusion criteria included: prior uterine surgery, prior cesarean, and planned cesarean. After controlling for maternal age, race, body mass index, parity, infant weight, gestational age, type of rupture, and epidural analgesia, the association between cesarean birth and years of nursing experience was analyzed by a chi-square test. Total amount and maximum rates of Pitocin administered were compared with nurse experience by a Student t-test.

RESULTS:
Associations between nursing experience and cesarean section rate, total amount of Pitocin administered, and maximum Pitocin rate administered during labor were found with statistical significance (P<.05).

CONCLUSION:
Based on these results, this study concludes that more experienced nurses have higher cesarean section rates, and administer lower total amounts and lower maximum rates of Pitocin during labor.
When to Deliver Monochorionic Diamniotic Twins in the Setting of Preeclampsia [21O]
Authors: Walker Allison R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Monochorionic diamniotic (MCDA) twin pregnancies are at increased risk of preeclampsia (PET), intrauterine growth restriction (IUGR) and intrauterine fetal demise (IUFD). Our study compared outcomes of induction of labor (IOL) at 34 through 37 weeks to determine the most favorable gestational age for delivery in MCDA twin pregnancies complicated by mild PET.

METHODS:
A decision analytic model was created using TreeAgePro 2017 software to compare the outcomes of expectant management versus IOL at 34 to 37 weeks of gestational age. Outcomes examined included quality adjusted life years (QALYs), cases of advancement from mild to severe PET, maternal mortality, maternal stroke, IUGR, IUFD, cerebral palsy (CP) and neonatal mortality. Probabilities, utilities, and life expectancies were derived from the literature. Univariate analyses were used to investigate the impact of labor induction at various gestational ages.

RESULTS:
In a theoretical cohort of 10,000 MCDA pregnancies complicated by PET, IOL at 34 weeks resulted in the fewest cases of severe PET (0), maternal stroke (15), maternal mortality (4), IUFD (0), and IUGR (1,183). However, this strategy was also associated with the most cases of neonatal CP (91) and neonatal mortality (90). Neonatal CP and mortality were lowest in the 37 week IOL strategy group at 47 and 67, respectively. QALYs were highest (867,342) when IOL occurred at 36 weeks.

CONCLUSION:
MCDA twin pregnancies complicated by mild PET should be induced at 36 weeks. When compared to IOL at 37 weeks, this strategy reduces maternal and neonatal morbidity and mortality.
Vitamin C Supplementation and Risk for Preterm Premature Rupture of Membranes and Preterm Birth: A Meta-Analysis [23O]
Authors: Souryal Abigail , Galindo Megan , Roman Tania , Ireland Kayla E. , Ramsey Patrick S. , Boyd Angela R. 
Published: April 2018

INTRODUCTION:
Strong evidence has linked perturbations of vitamin C levels and collagen integrity with risk for preterm premature rupture of membranes (PPROM). We sought to evaluate the literature and perform a meta-analysis using available data from randomized clinical trials (RCT) which evaluated the use of vitamin C supplementation to prevent PPROM and preterm birth (PTB).

METHODS:
A systematic literature review was conducted using PUBMED and MEDLINE 1966-2017 using relevant search terms. Secondary citations from retrieved papers were also reviewed. Outcome data from RCT were abstracted and meta-analysis performed using Mantel-Haenszel fixed effects model with test of heterogeneity (Comprehensive Meta-Analysis - Version 2.2.064).

RESULTS:
Ten randomized placebo controlled trials, conducted 2004-2013, assessing Vitamin C supplementation and relationship to PPROM or PTB were identified. These studies included at total cohort of 14291 women who received vitamin C supplementation and 14307 women who received placebo. PPROM and/or PTB were the primary outcome in 4 of the 10 studies. The remainder of studies evaluated PPROM and/or PTB as a secondary outcome. Eight studies included data for PPROM<37 weeks and/or PTB<37 weeks. Five studies included data for PTB<34 weeks. Vitamin C was not associated with reduction in risk of PPROM<37 weeks (OR 1.05, CI 0.91-1.21, p=0.55), PTB<37 weeks (OR 1.02, CI 0.95-1.10, p=0.62) or PTB<34 weeks (OR 1.15, CI 0.97-1.36, p= 0.10).

CONCLUSION:
Vitamin C supplementation during pregnancy is not associated with prevention of PPROM or PTB.
Impact of ACOG Guideline Regarding Low Dose Aspirin for Prevention of Superimposed Preeclampsia [27O]
Authors: Banala Chaitra , Cruz Yury , Moreno Cindy , Schoen Corina , Berghella Vincenzo , Roman Amanda 
Published: April 2018

INTRODUCTION:
In July 2016, an American College of Obstetricians and Gynecologists (ACOG) guideline recommended that pregnant women with chronic hypertension (CHTN) be offered low dose aspirin to prevent superimposed preeclampsia (SIP). This study aimed to evaluate the incidence of SIP in women with CHTN before and after the ACOG guideline.

METHODS:
This retrospective cohort study included CHTN patients who delivered at Thomas Jefferson University Hospital from 1/2008 to 7/2017, excluding multiple gestations. The cohort was divided into 2 groups, before and after the ACOG recommendation. We offered daily 81 mg aspirin. The cohort was stratified by other risk factors for SIP, including history of preeclampsia and pre-gestational diabetes. The primary outcome was incidence of SIP. Secondary outcomes were incidence of SIP with severe features (SIPSF), small for gestational age, and preterm birth.

RESULTS:
We identified 715 pregnant CHTN patients, comprised of 80 post-ACOG and 635 pre-ACOG patients. The incidence of SIP in all women with CHTN was 20 (25%) vs 232 (37%), OR 0.43 (95% CI 0.26-0.73). SIP and SIPSF were significantly decreased in the subgroup of women with CHTN without other risk factors: 4/41 (10%) vs 106/355 (30%), OR 0.25 (95% CI 0.08-0.73); and 2/41 (5%) vs 65/355 (18%), OR 0.22 (95% CI 0.54-0.97), respectively. Maternal demographics and secondary outcomes were not significantly different.

CONCLUSION:
After the ACOG guideline, low dose aspirin decreased SIP by 57% in all women with CHTN. The benefit was higher in women with CHTN without other risk factors, with decreases of 75% in SIP and 78% in SIPSF.
Screening Rates, Elevated Risk, and Correlates of Postpartum Depression in an Obstetric Population [28O]
Authors: Long Molly M. , Morgan Franklin G. , Wilkes Charles A. , Fontanares Arlene J. , MacFarlane Beth , Cramer Robert J. 
Published: April 2018

INTRODUCTION:
Postpartum depression (PPD) affects approximately 1 in 9 women. However, screening rates for PPD are inconsistent and low among physicians. Physicians most often rely on clinical assessment to evaluate PPD but this method is often inaccurate or inconsistent in evaluating or diagnosing PPD. The current study had 3 objectives: 1) to assess overall screening rates of PPD; 2) to examine elevated PPD score rates; 3) to identify correlates of elevated PPD.

METHODS:
Archival data from an obstetrician/gynecology practice provided data for the current study. A total of 557 medical records were examined for the following: demographics, mental health history, PPD screening tools, elevated PPD screen recommendations and adherence. PPD screening frequency was assessed at 2 time points: intake appointment and 6-week post-delivery follow-up.

RESULTS:
The screening rates were relatively high at intake (335/557, 60.1%) and at 6-week follow-up (476/557, 85.5%). Elevated PPD score rates at intake were 18.2% (n = 61/335) and 13.0% (n = 62/476) at 6-week follow-up. The following bivariate correlates of elevated PPD risk were observed: history of depression, history of anxiety, younger age, Medicaid/Medicare health insurance, and single marital status. Full regression models will be presented at the conference.

CONCLUSION:
This research adds new knowledge regarding screening rates of PPD and elevated PPD screens, thereby enhancing quality of service provision for mothers. This study provides the basic science to inform an educational intervention addressing screening rates and correlates of PPD; such training may enhance provider knowledge, attitudes, and skills regarding PPD.
Prophylactic Uterotonic Use in Grandmultiparas Reduces Recurrent Postpartum Bleeding [32O]
Authors: Misal Meenal , Wong Melissa , Greene Naomi , Aghajanian Paola 
Published: April 2018

INTRODUCTION:
Grand multiparity is a risk factor for postpartum hemorrhage (PPH). We evaluated whether prophylactic uterotonics in grandmultiparas reduced the incidence of recurrent postpartum bleeding.

METHODS:
This retrospective cohort study of grandmultiparas who underwent vaginal delivery between January 2011 and December 2015 compared women who received postpartum prophylactic uterotonics (other than routinely given oxytocin) to women who did not. A uterotonic was deemed prophylactic if so recorded by the delivering physician or if given within 1 hour of delivery with no other indication documented. Physician re-evaluation of vaginal bleeding was chosen as the primary outcome as a proxy for clinically significant recurrent bleeding. A multivariable logistic model was used to compare rates of physician re-evaluation between groups receiving prophylactic uterotonics versus none.

RESULTS:
Of the 356 grandmultiparas, 53 (15%) received a prophylactic uterotonic. Women with 7-11 deliveries were more likely to receive prophylactic uterotonics than those with 4-6. Hispanic women were also more likely to receive prophylactic uterotonics. There were no other significant differences in demographic or obstetric factors. PPH rate was similar for both groups (6% vs. 6%, P=.79). However, the adjusted rate of physician re-evaluation was six-fold higher for women who did not receive prophylactic uterotonics (OR: 6.08 [95% CI 1.2 - 29.7] P=0.03). Of those who did not receive prophylactic uterotonics and required physician re-evaluation, 46% subsequently received an additional uterotonic.

CONCLUSION:
The rate of physician re-evaluation for recurrent postpartum bleeding was six-fold higher for grandmultiparas who did not receive prophylactic uterotonics post-delivery. Administration of prophylactic uterotonics may benefit this high-risk population.
Maternal Perception of Fetal Movements Near Term: The Problem of Maternal Compliance [33O]
Authors: Ghidini Alessandro , Newman Anne M. , Cacace Marietta , Han Sacha , Chongasing Kaci 
Published: April 2018

INTRODUCTION:
Women's compliance with counting of fetal movements (FM), a key issue for the success of such a screening test, has been poorly studied as non-compliant women have traditionally been excluded from studies on FM count.

METHODS:
Prospective cohort study of all women with risk factors for fetal death undergoing fetal testing via weekly modified biophysical profile started at 36 weeks. Excluded were multiple gestations, decreased fetal movements, delivery indicated at 37 weeks, severe maternal medical conditions or severe fetal anomalies. Risk of stillbirth in last month of pregnancy was explained and women were taught in a consistent way on FM count-to-10 with recording of time to the 10th movement. Log sheets were verified weekly at the time of fetal testing, when instructions on FM counts were reinforced by dedicated nurses.

RESULTS:
8% of candidate women declined FM count. Among women consenting to participate in the study, those compliant (52%) had similar maternal age, race, ethnicity, obesity, and indications for testing as those non-compliant, but were more frequently nulliparous (P<.001). Rates of induction of labor, mode of delivery, birth weights and Apgar scores were similar in the 2 groups. All neonates requiring NICU admission were from the non-compliant group (P=0.001).

CONCLUSION:
Compliance with FM count is low even among high risk women consenting to FM count and receiving specific and reinforced instructions by dedicated nurses. Non-compliant women tend to be multiparous and their babies have higher rates of NICU admission.
Placental Histopathologic Findings Associated with Antepartum Eclampsia [1P]
Authors: DuBois Molly , Ambia Anne M. , Wells C. Edward 
Published: April 2018

INTRODUCTION:
The aim of this study was to describe placental pathology among women with antepartum eclampsia.

METHODS:
This was a retrospective cohort study of placental pathology of women with antepartum eclampsia who delivered from May 2009 to December 2016 at Parkland Hospital. Placentas were processed using an institutionalized standardized examination. Placental pathology lesions were grouped into categories including inflammation (vasculitis, funisitis, amnionitis), vasculopathy (infarcts, atheroma), meconium exposure, placenta hypoplasia/hyperplasia, and no pathologic abnormality. Each placenta may have had numerous findings in different categories.

RESULTS:
There were 44 women with antepartum eclampsia at our institution during the study period. Of these, 31 women had placental pathology examined according to institutional protocol. These women were majority Hispanic (83%), primagravidas (65%), and the average age as 23 +/- 7 years. Eclampsia developed at an average gestational age of 36 +/-4 weeks. Sixteen women (52%) had cesarean deliveries, eight (26%) had vaginal deliveries, and seven (22%) had forcep-assisted vaginal deliveries. Overall, the finding of inflammatory lesions was observed in 61%, meconium staining in 55%, and vasculopathy in 42%. Placental hypoplasia was noted in 29% and hyperplasia in 19%. Only one placenta was found to have no histopathologic abnormality.

CONCLUSION:
In women with antepartum eclampsia, 97% of placentas examined revealed a histopathologic abnormality such as meconium exposure, vasculopathy, or inflammatory lesions. More than half were observed to have evidence of meconium exposure and 65% were noted to have more than one histopathologic finding.