bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perinatal Outcomes of Uncontrolled Pregestational Diabetics in California State [38H]
Authors: Thayer Sydney Marie , Owens Sarah N. , Skeith Ashley , Valent Amy , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
Our objective was to compare the maternal and neonatal outcomes of pregnancies complicated by controlled and uncontrolled pregestational diabetes in a large cohort in California state.

METHODS:
This is a retrospective cohort study of singleton gestations among women with diabetes between 2007 and 2011 using linked vital statistics and ICD-9 data. Chi-square tests were used to compare perinatal outcomes between patients with controlled and uncontrolled diabetes during pregnancy. Uncontrolled diabetes status was defined by the delivering clinician. Outcomes of interest included preeclampsia, gestational hypertension, congenital anomalies, preterm delivery, birthweight, neonatal death, shoulder dystocia, and adverse neonatal outcomes such as respiratory distress syndrome, jaundice and hypoglycemia. Multivariable logistic regression was used to estimate adjusted odds ratio (aOR), controlling for maternal age, education, parity, previous diagnosis of chronic hypertension, race, insurance status and tobacco use.

RESULTS:
In a cohort of 18,198 pregnant diabetic women consisting of 785 uncontrolled and 17,413 controlled, we found that women with uncontrolled diabetes have worse maternal and neonatal outcomes overall. Uncontrolled diabetic patients have significantly higher prevalence of preeclampsia, gestational hypertension, fetal anomalies, preterm deliveries, and neonatal death when compared with controlled diabetics. After controlling for confounders of interest, all relationships remained significant except for shoulder dystocia and stillbirth. A non-significant relationship was demonstrated between uncontrolled diabetes and neonatal hypoglycemia.

CONCLUSION:
Pregnancies complicated by uncontrolled diabetes have worse perinatal outcomes. Improving diabetic control in pregnant diabetic women is warranted to decrease risk of adverse maternal and neonatal outcomes.
Access and Barriers to Fertility Preservation for Women Prior to Gonadotoxic or Sterilizing Treatment [39H]
Authors: Anhut Jennifer L. , Barnard Emily P. , Steimer Sarah , Orwig Kyle E. , Valli-Pulaski Hanna 
Published: May 2019

INTRODUCTION:
Fertility preservation (FP) is a process through which individuals undergoing reproductive capacity-limiting treatments may retain the option to produce genetic offspring. It is important to understand referral patterns to access FP and barriers to pursuing procedures.

METHODS:
Institutional Review Board approval was obtained from the University of Pittsburgh. A survey was distributed to female patients or their guardians during initial consultation for FP to explore indications for FP, method of referral, and decision to pursue FP after counseling.

RESULTS:
Thirty-six respondents completed the survey; 19 were incomplete and excluded. The average age was 27 (range 7-40). Thirty-three (91.7%) patients were referred for FP consultation. Twenty-four (66.7%) had FP conversations initiated by a referring physician. Patients were pursuing treatment for brain (3, 8.3%), breast (10, 27.8%), hematological (10, 27.8%), gynecological (8, 22.2%), and other (5, 13.9%) disorders. Of these diagnoses, 80.6% were malignant. Thirty-two (88.9%) patients intended to pursue FP [ovarian tissue cryopreservation (10, 31.3%), oocyte cryopreservation (10, 31.3%), embryo cryopreservation (3, 9.4%), ovulation suppression with leuprolide acetate (1, 3.1%), or multiple therapies (8, 25%)]. Three (8.3%) declined FP; citing cost, concern about primary diagnosis, and unacceptable risk of morbidity associated with future pregnancy. Ultimately, 26 (81.3%) patients underwent an FP procedure.

CONCLUSION:
Females presenting for FP consultation were largely referred by a physician after malignant diagnoses; most planned to pursue treatment. Barriers to FP included cost and concern for health risk based on the primary diagnosis. Future directions include expanding the survey to referral centers to explore why patients decline FP.
Comparing Semen Parameters in Adolescents With Gender Dysphoria With Adolescents Undergoing Gonadotoxic Therapy [40H]
Authors: Dilday Elizabeth A. , Bukulmez Orhan , Saner Karla , Lopez Ximena , Jarin Jason 
Published: May 2019

INTRODUCTION:
Application of fertility preservation techniques has been expanded from adolescents with cancer undergoing gonadotoxic therapy to include transgender children and adolescents. This study aims to compare sperm parameters between young males with cancer and transgender patients undergoing hormonal transition at Dallas Children’s Medical Center and to characterize differences between sperm samples.

METHODS:
Records of male-to-female transgender adolescents and adolescent males with cancer undergoing sperm cryopreservation between March 2015 and September 2017 were reviewed. For transgender patients, cryopreserved sperm samples were obtained prior to hormonal transition. For adolescents with cancer, sperm was collected prior to treatment. Demographic data and sperm parameters (count, total count, motility, total motile) were collected. When available, hormone levels (luteinizing hormone, follicle-stimulating hormone, testosterone and estradiol) and Tanner stages were assessed. Data were compared using chi-square analysis and two-sample t-test.

RESULTS:
9 male-to-female transgender adolescents and 13 male cancer patients were included. Mean age at sperm cryopreservation was similar (15.2 vs 15.9, respectively) and mean documented Tanner stage was almost identical (4.55 vs 4.5). There were no statistically significant differences in height, weight and BMI. Mean semen volumes were significantly less for transgender patients as well as sperm counts (49.0 million/mL vs 56.2).

CONCLUSION:
Prior to hormone or gonadotoxic treatment, sperm parameters for both populations were less than expected for their age. Despite similar age and tanner stage, transgender adolescents have lower sperm parameters than their oncology counterparts do. Results support feasibility and practicality of sperm cryopreservation in both populations and open questions for research about factors affecting sperm quality.
Effect of Opioid Prescribing Education for Ob/Gyn Residents in a Safety-Net Hospital [3I]
Authors: Evans Casey , Yorkgitis Brian , Best Kelly , McCullough Deanna 
Published: May 2019

INTRODUCTION:
The U.S. opioid epidemic calls for urgent need to evaluate providers’ prescribing habits. The purpose of this study was to educate Ob/Gyn residents regarding opioid abuse, amounts typically used post-operatively, and strategies to decrease adverse outcomes. Our hypothesis is residents will prescribe fewer opiate doses for patients’ post-operative pain management following provider education.

METHODS:
Ob/Gyn residents at UF Health Jacksonville were given a pre-intervention survey to gauge opioid prescribing patterns and utilization of resources like Prescription Monitoring Programs (PMP) and Opioid Risk Tool (ORT). Residents then attended a didactic session reviewing rates of adverse outcomes from overprescribing, resources to reduce adverse outcomes, and amount of opioids considered appropriate post-operatively. Residents completed a post-intervention survey to re-evaluate prescribing patterns.

RESULTS:
13 residents completed both pre- and post-surveys. For cesarean delivery, 100% of residents prescribed at least 30 pills prior to education, but none prescribed more than 20 pills after intervention (p=<0.0001). Similar but less distinct shifts can be seen in laparoscopic hysterectomy (TLH) and use of pre-operative gabinoids. 54% prescribed 20 pills or more following TLH initially while only 7.7% prescribed more than 20 pills after education (p=0.0382). Pre-operative gabinoid usage consideration increased from 15.4% to 100% following intervention.

CONCLUSION:
Focused opioid education can greatly reduce the amount of opioids prescribed in a post-operative setting. This study highlights the impact educational curriculums can have on prescribing patterns by allowing providers to better understand the current epidemic as well as how to optimize stepwise multimodal analgesia to avoid over-prescribing opioids.
Evaluating the Bell Pepper Model for Teaching Operative Hysteroscopy [5I]
Authors: Seaman Sierra , Han Esther , Arora Chetna , Lee Minyi , Kim Jin Hee 
Published: May 2019

INTRODUCTION:
This study was performed to evaluate the effectiveness of an operative hysteroscopic simulation using a bell pepper model in improving skills and confidence in trainees performing resection of a polyp in a high fidelity virtual reality (VR) simulation with a loop electrode.

METHODS:
Ob/Gyn residents at a tertiary academic center completed a bell pepper exercise during which they assembled and practiced handling a resectoscope. They were asked to insert the resectoscope, visualize the inside of a bell pepper and resect portions of the flesh. A pre- and post-test assessment on a validated high-fidelity VR simulator was used to compare skill acquisition. Pre- and post-test questionnaires were used to compare confidence and perception of gained skills.

RESULTS:
Seventeen residents in post-graduate years 1 to 4 participated in the study. There was significant improvement in overall VR polypectomy score (P=.0008), economy of motion (P<0.0001), fluid handling (P=0.03), and safety (P=0.02). There was a decrease in total visualization scores (P=0.007). Overall change in performance did not differ significantly based on post-graduate year in training or hysteroscopic experience. Trainees had significantly improved confidence in performing hysteroscopic polypectomy (P=0.002) and myomectomy (P=0.01), and in using electrosurgical cut and coagulation functions (P=0.01).

CONCLUSION:
The bell pepper model improves operative hysteroscopy skills and confidence in trainees and can be used as a low-cost, easily reproducible training model. There are some deficiencies of the model with its inability to accurately simulate cervical and uterine anatomy and, particularly, the inability to simulate cervical entry, which can be difficult.
Impact of Multidisciplinary Ultrasound Education in a Low-Middle-Income Country [6I]
Authors: La Rosa Mauricio , Webb Camille , Marrs Caroline Carter , Hadley Emily Elizabeth , Cabada Miguel , Olson-Koutrouvelis Gayle 
Published: May 2019

INTRODUCTION:
The objective of our study is to evaluate the ultrasound knowledge before and after a hands-on workshop, designed to increase basic ultrasound knowledge among physicians and midwives from rural health centers in the Cusco region of Peru.

METHODS:
A basic three-day ultrasound curriculum tailored to specific needs was created by fellows. It included lectures, hands-on training. Thirty-three physicians and midwives attended the conference. A pretest was completed prior to starting the course. A posttest was given at the end of the course. The tests evaluated basic ultrasound knowledge, fetal biometry and anatomy, placenta and amniotic fluid, and hydatid cysts. The primary outcome was total test scores. Secondary outcomes included the scores in specific areas. Statistical analysis was performed using univariate analyses and a P<0.05 was considered statistically significant.

RESULTS:
Twenty-nine pretests and thirty-two posttests were completed. The mean percentage of correct answers in the pretest was 29.8% (IQR 21.1-31.6) and in the posttest was 77.1% (IQR 73.7-84.2), (p<0.0001) Participants showed significant improvement in scores in 13 out of the 19 questions included. The areas with most improvement were basic ultrasound knowledge and fetal biometry and anatomy. The percentages of correct answers on each area were: basic ultrasound knowledge: 25.6% vs. 78.6% (p<0.0001), fetal biometry and anatomy: 24.1% vs. 86.5% (p<0.0001), placenta and amniotic fluid: 35.3% vs. 60.2% (p<0.0001), and hydatic cyst: 50% vs. 78.1% (p<0.0001).

CONCLUSION:
A multidisciplinary 3-day ultrasound course tailored to identified needs of a Low-Middle-Income Country setting had a significant impact on the knowledge acquired by the participants.
Forceps-Assisted Vaginal Deliveries: What Is the Training Landscape of Current MFM Fellows? [7I]
Authors: Rose Kelsey , Afshar Yalda , Datkhaeva Ilina , Shih-Chi Han Christina 
Published: May 2019

INTRODUCTION:
The goal of this study is to determine the current landscape of forceps-assisted vaginal delivery (FAVD) training across the United States (U.S.) amongst MFM fellows.

METHODS:
An online survey was created on REDCap and sent to MFM Fellowship Program Directors for distribution to current MFM fellows in the U.S. Geographic regions were determined using Census Bureau-designated regions.

RESULTS:
The survey was completed by 106 MFM fellows (42% of U.S. fellows). Only 22.6% of fellows had performed >30 FAVDs, with 33% having performed ≤10 FAVDs. In comparison, 35.8% of fellows had performed more than 30 vacuum-assisted vaginal deliveries (VAVD). While 95.2% of fellows feel prepared to perform a VAVD independently, only 59.4% feel prepared to do FAVDs independently. Nonetheless, 53% of MFM fellows favor performing a FAVD. There is no significant difference in the percent of fellows by geographic region who have performed >30 FAVD (P=0.87). MFM fellows in the West are most likely to have performed >30 FAVD at 57.8%, compared to 42.3%, 35% and 11.4% in the Midwest, South and Northeast, respectively.

CONCLUSION:
MFM fellows are more confident with VAVD compared to FAVD. Despite lower confidence with FAVD, the majority of MFM fellows feel comfortable performing FAVDs independently. Region of training does not significantly affect one's training in FAVDs. A coordinated nationwide effort to increase exposure to and confidence for FAVDs should be considered.
Date Rape Drugs in Las Vegas: Detection After the Fact [11I]
Authors: Paul Anthea , Mahesan Arnold 
Published: May 2019

INTRODUCTION:
Date rape drugs (DRDs) are drugs which can be used to conduct drug-facilitated sexual assault. The three major drugs classified by the U.S Department of Health & Human Services misused for this purpose are Rohypnol (Flunitrazepam), Gamma hydroxybutyric acid (GHB) and Ketamine. Existing studies in the literature analyze self-reported incidents in women which likely underestimate the prevalence of this problem. Our study aimed to evaluate how frequently there was clinical or criminal suspicion of DRD use prior to autopsy evaluation in a group of deceased DRD positive women.

METHODS:
This study was a retrospective analysis of all female decedents aged 20-55 who tested positive for Flunitrazepam, GHB and Ketamine referred to the Clark County medical examiner from 2000-2015. Medical records, police report, and autopsy findings were reviewed. All decedents underwent standard toxicology screening from whole blood toxicology analysis. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.

RESULTS:
23 women referred to the Clark County medical examiner tested positive for DRDs. At autopsy 6 women were positive for Rohypnol, 15 for GHB, and 2 for ketamine. After clinical, autopsy and police report review, 74% of 17/23 women had no clinical suspicion of DRD involvement at the time of death. Specifically, 83% (n=5) women had no suspicion of flunitrazepam use prior to toxicology results.

CONCLUSION:
Only a small minority of cases raised suspicion of DRD use upon police or clinical assessment. DRD use may be more prevalent in society than previously thought posing a significant public health threat.
Delayed Uterine Inversion [16I]
Authors: Carney Casey , Boyd Bronwyn , Goldberg Jay 
Published: May 2019

INTRODUCTION:
Uterine inversion is a rare obstetric emergency that typically presents immediately following the third stage of labor with hemorrhage, shock, and possible maternal death if not promptly diagnosed and treated. We report a rare delayed postpartum uterine inversion.

METHODS:
28-year-old gravida 1 para 0 with an uncomplicated antenatal course and normal labor curve, delivered a full term infant via vacuum assisted vaginal delivery. The placenta was delivered spontaneously. Five weeks postpartum, the patient presented with ongoing vaginal bleeding. An erythematous friable mass filling her vagina. A pelvic ultrasound noted that the suspected pelvic hematoma measured 7.3 x 5.3 x 5.2 cm. The suspected hematoma was managed conservatively. Three months postpartum, due to acutely increasing vaginal bleeding, an exam under anesthesia was performed. Uterine inversion was diagnosed, with attempted uterine replacement unsuccessful. A total abdominal hysterectomy was then performed without postoperative complication.

CONCLUSION:
Delayed postpartum uterine inversion may present with persistent vaginal bleeding and an erythematous friable mass protruding through the cervix into the vagina. Given the risk of acute hemorrhage, uterine replacement should be attempted soon following the diagnosis of delayed postpartum uterine inversion, with hysterectomy if unsuccessful.
Comparison of Pregnancy Dating in Rural and Urban Rwanda and its Impact on Pregnancy Outcomes [28I]
Authors: Gashema Hertier , Small Maria Jacqueline , Kitessa Doee , Magriples Urania , Rulisa Stephen 
Published: May 2019

INTRODUCTION:
Optimal management of pregnancy and delivery is dependent upon dating. In low resource settings, pregnancies are predominantly dated by LMP. Little is known about dating methods and their impact on outcomes in different geographic areas in Rwanda. This study compared pregnancy dating and its impact on perinatal management and outcomes.

METHODS:
We performed a retrospective study at the largest teaching hospital (KUTH) and a rural district hospital (Kibogora) in Rwanda. All patients with antenatal care and delivery at the studied institution between March 1 and September 30, 2017 were included. Methods of pregnancy dating were: certain LMP, uncertain LMP and ultrasound before 20 weeks. If the clinician intervened and acted to medically to delay or expedite delivery, management was “active” and if they were managed expectantly it was defined as “passive”.

RESULTS:
We enrolled 239 patients from urban (57.3%) and rural (42.7%) settings. Among urban women, 91.2% were certain of their LMP and 58.8% of rural women reported certainty (p<0.001). US prior to 20 weeks was performed in 90.5% (urban) and 16.7% (rural) settings (p<0.001). At KUTH, LMP dating only was 0 v. 57.8% at Kibogora (p<0.001). All urban women (100%) were actively managed v. 3.9% of rural women. There was no difference in mode of delivery or maternal complications. There was no difference in APGARs, however, NICU admissions occurred in 5.8% of urban and 24.5% in the rural hospital (p<0.001).

CONCLUSION:
In this comparison of urban and rural hospitals, ultrasound prior to 20 weeks gestation significantly impacted maternal and neonatal outcomes.
Corticosteroids’ Effect on Neonatal Outcomes in Prelabor Rupture of Membranes During Late Preterm [31I]
Authors: Kidd Jennifer M. J. 
Published: May 2019

INTRODUCTION:
Recent recommendations from SMFM and ACOG now include administration of corticosteroids in the late preterm period to decrease complications of prematurity. This study attempts to understand if prelabor rupture of membranes during this time experience benefits and/or complications from corticosteroids.

METHODS:
This study was a retrospective IRB approved cohort study from 2015-2017. It included singleton liveborn pregnancies diagnosed with prelabor rupture of membranes from 34-36 weeks that had not received corticosteroids earlier in the pregnancy. The study excluded fetal anomalies, multiple gestations, prior uterine surgery, placenta previa, malpresentation, active genital herpes, and delivery outside the hospital. Chart review of maternal data included medical history, administration of corticosteroids, intrapartum complications, delivery information, and postpartum complications. Infant data included length of stay, neonatal hospital course, and readmission within 1 month after discharge.

RESULTS:
The administration and completion of corticosteroids course prior to delivery increased during the study. Mode of delivery between groups was not statistically significant. The length of stay for neonates decreased from 6.8 days to 5.1 days in 2017. The occurrence of hyperbilirubinemia and hypoglycemia decreased by half during the/or study period. Neonatal readmission rate was highest in 2015 secondary to cases of hyperbilirubinemia with no readmissions in 2017.

CONCLUSION:
This study provides support for administration of antenatal corticosteroids with prelabor rupture of membranes in the late preterm period. This study reviews potential secondary outcomes of decrease in length of stay, hyperbilirubinemia, and readmission for this population. These findings have clinical benefits to the neonates and decreased cost to the health system.
Does Adjunctive Azithromycin Treatment at the Time of Cesarean Delivery Improve Maternal and Neonatal Outcomes [32I]
Authors: Johnson Christina , Dagum Camilla , Persad Malini D. , Herrera Kimberly M. , Buckley Ayisha , Garretto Diana J. 
Published: May 2019

INTRODUCTION:
Postpartum (PP) infections are more common after Cesarean section (CS) compared to vaginal deliveries. Preoperative Cefazolin is commonly used, recent evidence indicates that adding azithromycin (AZI) as extended antibiotic coverage decreases the risk of infectious comorbidities for non-elective CS (nCS). Since 2017, our L&D used AZI + cefazolin in nCS. Goal was to determine if adding preoperative AZI lowers PP infections.

METHODS:
An IRB approved retrospective cohort study conducted. ST antibiotics (1st generation cephalosporin or clindamycin and gentamycin with allergy). Women placed in 2 groups: ST+AZI versus ST. Exclusion criteria: elective CD, no preoperative antibiotics, AZI allergy. The primary outcome: composite of maternal wound infection, endomyometritis, maternal morbidity, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, neonatal morbidity. Statistical analyses performed with p value <0.05 significant.

RESULTS:
100 women in study, 28 in the ST+AZI group and 72 in ST group. Women were more likely to be younger (29.2 vs 31.3 years, p 0.04), have rupture of membranes (78.6% vs 50%, p 0.03) in ST+AZI versus ST. The demographics, indication for delivery, gestational age at delivery, type of skin incision, closure, preparation were similar. There was no difference in the composite outcome between the ST and ST + AZI group (5.6% vs 10.6%, RR 1.3 [CI 0.7-2.5] p 0.55); the rate of NICU admission was nearly statistically significantly higher in ST group versus ST+AZI (36% vs 14.2%, RR 0.8 [CI 0.6-0.9] p value 0.05).

CONCLUSION:
Adjunctive AZI at time of CD does not appear to improve maternal and neonatal outcomes in our population.