bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cold Compress for Pain Associated With Intrauterine Device Insertion: A Randomized Controlled Trial [5G]
Authors: Hylton Jordan , Milton Sarah , Sima Adam 
Published: April 2018

INTRODUCTION:
Pain with intrauterine device (IUD) insertion is identified as a barrier to compliance with this highly effective long acting reversible contraceptive. Several studies have assessed the efficacy of interventions to alleviate patient discomfort associated with IUD insertion, but no interventions have been clearly shown to improve procedural pain. The aim of this study was to determine if use of a cold compress on the abdomen during intrauterine device insertion improves pain.

METHODS:
This study is a prospective, randomized controlled trial comparing cold compression to no intervention during IUD device insertion. Study participants were women who desired IUD placement at Virginia Commonwealth University OB/GYN clinics. Subjects were randomized to control (n=40) versus cold compress (n=47) and they completed a pre- and post-procedural visual acuity scale for pain. Additional data was collected regarding gravidity, parity, history of cervical procedures and socioeconomic status as well as history related to chronic pain.

RESULTS:
There was no difference in pre and post-insertional pain in those who received a cold compress versus the control during insertion of intrauterine device (3.6 versus 2.8, P=0.223). The insertional pain was rated at 4.5 and 4.7 for patients who received the cold compress and the control group, respectively (P=0.724).

CONCLUSION:
While a cold compress is a simple, inexpensive and safe method of pain control this study shows no improvement in insertional pain for intrauterine device placement.
Timing of LARC Insertion in Resident Physicians vs. Nurse Practitioners at an Urban Teaching Facility [11G]
Authors: Cortez Sarah , Runyan Aliye , Roberts LeAnne , Recanati Maurice , Dai Jing 
Published: April 2018

INTRODUCTION:
To examine the time interval between request and placement of long-acting reversible contraceptives (LARC) by residents vs. nurse practitioners at an urban teaching facility.

METHODS:
Retrospective electronic health record review of all patients who received LARC devices in 2016 at the University Health Center Ob/Gyn staff clinic in Detroit, MI. Data was analyzed using descriptive statistics and student’s t-test for comparison of means.

RESULTS:
Between January 1 and December 31, 2016, 311 patients received intrauterine devices (IUD) or subdermal implants (SDI). Of patients desiring LARC, 24% did not receive their contraceptive device same-day. Average interval between IUD request and placement, for those not receiving same-day contraception, was similar in nurse practitioner (1.2 months) vs. resident clinic (1.0 months). Average interval between SDI request and placement in nurse practitioner (1.3 months) vs. resident clinic (0.5 months) was statistically significant (95% CI, 0.4 to 1.2, p=0.0002). The only cited reason for interval delay of SDI placement was “no available trained provider”.

CONCLUSION:
The majority of patients at University Health Center did receive same-day LARC placement, however, many patients required multiple visits between expressed interest of LARC and placement of the contraceptive device. Interval timing, for IUD placement, did not differ in resident vs. nurse practitioner clinic; however interval timing of SDI placement was affected by a reduced number of available trained providers in the nurse practitioner group. ACOG recommends same-day LARC placement, therefore increasing SDI placement training or increasing the availability of SDI trained providers is an identified area of improvement for our clinics.
A Multi-Dimensional View of Contraception and Teen Pregnancy in Flint, MI [15G]
Authors: Drolet Anne , Smith Lauren , Sadler Richard 
Published: April 2018

INTRODUCTION:
USA has the highest rates of adolescent pregnancy of any industrialized country. These rates are disproportionally higher in both minority and low-income communities, as in Flint, MI, where the pregnancy rate (42.8 births per 1000 teens) is higher than the state average (31.6). This rate nearly doubles when examining African American teens (71.7). We aim to gain a better understanding of what factors may influence teen pregnancy. Examining the data geographically, we can also better understand spatial differences in this phenomenon.

METHODS:
We used CPT and ICD-9 codes to identify teen contraceptive use and pregnancy counseling, and linked this data with the patient’s ZIP code to model spatial variations in these behaviors. We also distributed a survey to Flint-area schools about their sex education. We then used geospatial analysis to determine which areas have higher risk for teen pregnancy, and compare this to the usage of contraception, sex education availability, amount of physician counseling, proximity to medical services, and other demographic spatial covariates

RESULTS:
We expect teen pregnancy to vary spatially with other socioeconomic factors, and are producing maps of the area showing co-occurrence of other factors (such as location of medical services and type of sex education available by school). From this data, we are computing statistical evidence to suggest which factors have the strongest links to teen pregnancy.

CONCLUSION:
Our results can be used as a model to help physicians understand what influences pregnancy rates for their teen patients and deliver spatially targeted interventions which best reflect local conditions and experiences.
Impact of Long-Acting Reversible Contraceptive Counseling on Postpartum Contraceptive Choice [17G]
Authors: Torre Bryna , Nokovic Jessica , Shelton James , Tsai Pai-Jong 
Published: April 2018

INTRODUCTION:
Approximately half of pregnancies occurring in the United States annually are unintended. Long-acting reversible contraceptives (LARCs) could help reduce unintended pregnancy, yet they are used by less than 3% of women in the United States. The objective of this study is to determine if prenatal contraceptive counseling for high-risk pregnant women will impact LARC choice postpartum.

METHODS:
A prospective cohort study was performed at the Perinatal Center of Women and Children’s Hospital of Buffalo. Patients who presented between ages 18 and 45 and within 34 weeks of gestation were recruited to participate in the study. Our intervention included two prenatal contraceptive counseling sessions. The patient’s choice of a LARC postpartum was compared to both their pre-counseling choice as well as to the choice of a control group who received standard prenatal counseling in the year prior to our intervention. Descriptive data and bivariate analysis were performed using SPSS. P-values less than or equal to .05 were considered significant.

RESULTS:
A total of 55 pregnant women were recruited. All women had co-morbid conditions, including chronic hypertension, diabetes, and venous thrombo-embolism. Counseling increased the intent for LARC from 27% pre-counseling to 42% post-counseling (P=.011). The intervention group also had higher postpartum LARC intent (42%) compared to control group who received standard counseling (20%) with P=.003.

CONCLUSION:
Our study suggests that instituting a prenatal contraceptive education program can improve LARC rates in high-risk pregnant women.
Contraception for Transgender Men: A Call to Action [18G]
Authors: Bonnington Adam , Obedin-Maliver Juno 
Published: April 2018

INTRODUCTION:
Contraceptive counseling is a cornerstone of most OBGYNs' practices and should extend to transgender patients. There are several reports of transgender men who become pregnant even when amenorrheic on testosterone, but discussing contraception with this population can be challenging given the lack of guidance available. Unmet contraceptive need can result in unplanned pregnancies and poorer pregnancy outcomes among cisgender women, but there are potential additional risks for transgender men. Given the paucity of contraceptive data for transgender men, providers find themselves needing guidance.

METHODS:
We conducted a review of available literature on contraception, pregnancy intention, and pregnancy capability for transgender men. We reviewed clinical medicine, psychology, social science, basic science, and public health literature. Using the Centers for Disease Control contraceptive efficacy model, we highlight key contraceptive considerations by method from provider and patient perspectives.

RESULTS:
Overall, we don’t anticipate that the risks associated with the various contraception methods differ significantly for transgender men, though more study is necessary. However, considerations of context and administration reflect transgender men’s unique needs. Bothersome side effects, need for frequent office visits, and role of pelvic exams, are just a few examples of factors that may differentially effect this population.

CONCLUSION:
Transgender individuals face pervasive discrimination, violence, and barriers to medical care. As OBGYNs, we are uniquely poised to care for this underserved population and provide solace and comprehensive care. By providing a safe and accepting space, we can use our knowledge to ensure intentional family planning and access to appropriate reproductive healthcare for these patients.
Use of Cycle Length Alone to Predict Ovulation, as Predicted by Apps, is Highly Inaccurate [19G]
Authors: Johnson Sarah , Marriott Lorrae , Zinaman Michael 
Published: April 2018

INTRODUCTION:
Women trying to conceive will often use methods to time intercourse. There are a plethora of free Apps available, claiming to be able to predict ovulation based on cycle length alone. This study sought to determine whether they could predict accurately.

METHODS:
This was an observational study of women >18 years old who were seeking to conceive (n=850). Volunteers collected daily urine samples for quantitative measurement of LH (AutoDELFIA), with day of ovulation determined as the day following LH surge. App determination of ovulation day for each cycle length was generated. Calendar based methods (rhythm, alternative rhythm, standard days and simple calendar method) were applied to determine accuracy.

RESULTS:
For each cycle length there was a wide spread of possible days of ovulation. For a 28 day cycle, day 16 was most common (21%), range 11-20. The most accurate calendar method was the rhythm method which gave 89% accuracy, providing an average fertile window of 11 days, whereas the simple calendar method provided a 2 day window, but only achieved 22% accuracy.

CONCLUSION:
The only way cycle length alone can be used to predict ovulation is by providing a very wide window of potential days, which is no better than the advice of frequent intercourse. Therefore Apps using cycle length alone are providing either inaccurate or imprecise information. If women wish to time intercourse to enhance their chance of pregnancy, they should use a true prospective method such as home ovulation tests.
Effect of Contraception Decisional Aid on Postpartum Contraceptive Choice: A Replicated Time Series Study [20G]
Authors: Sridhar Aparna , Kuperman Julie , Hulugalle Avanthi 
Published: April 2018

INTRODUCTION:
Contraception after birth is essential to the wellbeing of mothers as well as the health of their future children. The WHO recommends a two to three year inter-pregnancy interval. Decisional aids have helped to assist women with contraceptive decision-making. Our goal was to develop and test an electronic decisional aid to inform pregnant women about options for postpartum contraception.

METHODS:
We conducted a replicated interrupted time series study. A decisional aid was developed using attributes from Health Belief Model’s behavioral theory. It included detailed and interactive information about reversible and permanent contraceptives. We enrolled a total of 200 pregnant women between 24 to 36 weeks into either the intervention group (received decisional aid) or control group. The primary outcome was to compare contraceptive choice between two groups. The secondary outcome was to assess whether the patient received their contraceptive choice post delivery.

RESULTS:
Women did not differ in their demographics or contraceptive choice prior to delivery. Of the 200 participants, 56 decided to obtain very effective contraceptives such as intrauterine device and implant postpartum. This was similar across control and intervention groups (p= .697). Post-delivery, the majority of participants received birth control that was of similar or higher efficacy. Women in the intervention group however had less decisional conflict compared to those in control group (p < 0.05).

CONCLUSION:
The postpartum contraception decisional aid was successful in reducing decisional conflict. There was no significant difference in contraceptive choice or uptake between the intervention and control group.
Uptake of Immediate Postpartum LARC in Women at Risk of Loss to Follow Up [21G]
Authors: Bayer Chelsea , Paul Rachel , Braun Emma , Mullen Mary , Frisse Ann , Robbins Camaryn Chrisman 
Published: April 2018

INTRODUCTION:
Unintended pregnancies are associated with maternal depression, limited access to prenatal care, financial burden and in the case of short interval unintended pregnancies, increased risk of preterm delivery. Medicaid reimbursement for immediate postpartum LARC placement (immediate post-placental IUD insertion and implant insertion before discharge) lowers the risk of being lost to follow-up using no contraceptive method. The objective of this study was to investigate the uptake of immediate postpartum LARC among women lost to follow-up who are consequently at high risk for unintended pregnancy.

METHODS:
Women receiving Medicaid were prospectively recruited from a postpartum service of a large, urban hospital after immediate postpartum reimbursement took effect. Women completed a survey regarding their contraceptive choices, and additional information was gathered from the medical record. Lost to postpartum follow-up was defined as missing postpartum appointments or being unreachable via phone.

RESULTS:
65 women were classified as lost to postpartum follow-up. Of these, 24 were discharged with LARC in place, 23 without any form of contraception and 18 with a non-LARC contraceptive. 96% of women who had immediate postpartum LARC had been informed about the availability of immediate postpartum LARC during prenatal care or during labor compared to 56% of women who chose an alternate method.

CONCLUSION:
Immediate postpartum LARC ensures that women who are lost to follow-up after discharge may receive reliable, long acting contraception. Educating women during prenatal appointments and throughout the course of their labor about this option is associated with increased use of immediate postpartum LARC.
Endometrial Biopsies with Insufficient Tissue: Descriptive Analysis and Cancer Outcomes in Women aged 50 and Above [26G]
Authors: Chopra Vini , Sangha Roopina , Gadde Ramya , Alkhoory Wamidh 
Published: April 2018

INTRODUCTION:
Dilatation and curettage has remained the gold standard for evaluating postmenopausal bleeding. Office endometrial biopsy (EMB) is most times the first step in the investigation. Occasionally, however, the EMB results with insufficient tissue samples, which leads to additional interventions. We correlated EMB results with endometrial thickness and available follow up data to further investigate the presence of cancer.

METHODS:
We took a look at EMB done at our institution over a 12-month span that returned with insufficient tissue sample or scant tissue. For these patients, we also stratified a history of DM or HTN, BMI, and what subsequent procedure they had done afterward.

RESULTS:
We looked at 103 individuals who were 50+ years old with EMB that had insufficient tissue or scant tissue. We then looked at their follow up, specifically at following groups: no further invention, ultrasound, D&C or other surgical procedure. We found that 46 individuals (45%) had no further intervention, 9 women (9%) had a repeat biopsy within 3 months, 58 women (56%) had an ultrasound, 8 individuals (8%) underwent D&C, and 3 (3%) individuals opted for a hysterectomy. Out of these individuals, 1 individual who had a D&C done was diagnosed with endometrial adenocarcinoma. We found that the 58 individuals who had ultrasounds done, 43% of these individuals had an endometrial stripe that was >4mm. Of these 43% of individuals with an endometrial stripe over 4mm, only 4% had a diagnosis of cancer on after a hysteroscopy, D&C was done. This concludes that insufficient tissue samples on EMB rarely lead to serious endometrial pathology and despite endometrial thickness of >4mm on ultrasound done after this type of EMB, most individuals do not have any serious endometrial pathologies.

CONCLUSION:
Insufficient tissue samples on EMB rarely lead to serious endometrial pathology despite the comorbidities that increase the risk of endometrial carcinoma. Despite endometrial thickness of >4mm, most individuals did not have any serious endometrial pathologies.
Targeted Didactic Education to Increase Knowledge and Rate of Postpartum Placement of IUDs by Resident Physicians [3H]
Authors: Lagneaux Alex , Isley Michelle , Mclaughlin Eric , Hade Erinn 
Published: April 2018

INTRODUCTION:
The purpose of the study was to evaluate the effect of targeted didactic education on postpartum placement of intrauterine devices (IUDs) by resident physicians. We hypothesized that removal of barriers to immediate postpartum IUD placement through a targeted didactic education would increase knowledge and the rate of postpartum placement of IUDs by resident physicians.

METHODS:
A targeted didactic session on the proper placement, risks, and benefits of immediate postpartum IUDs was conducted at The Ohio State University for ObGyn residents. Residents completed surveys to assess changes in knowledge, confidence, and perception. The number of IUDs placed was collected 6 months before and after the didactic session. Scores were compared by the Wilcoxon rank sum test. Poisson regression models estimated the change in the rate of IUD placement.

RESULTS:
Twenty-eight residents completed the surveys. Significant increases in knowledge scores were found (0.93 points increase on average, P<.0001). 25% correctly answered all 6 questions before the session compared to 82% after. Significant increases in resident confidence were observed after the session (93% reporting being very or moderately confident after versus 72% prior, P=.0195). One hundred IUDs (5.2% of deliveries) were placed before the session with 108 (6.2%) placed after, suggesting limited evidence of an increase in the number of IUDs inserted after the didactic session (Rate ratio: 1.2, 95% CI 0.9-1.6).

CONCLUSION:
The study demonstrates targeted didactic education improves resident knowledge and confidence in postpartum placement of IUDs. As barriers are lifted through education, further research is needed to monitor an increase in placement rates.
Updating Fetal Foot Length to Gestational Age Reference Ranges: A Chart Review of Abortion Cases from 2012 to 2014 [4H]
Authors: Stevens Katelyn , Elia Jennifer L. , Kaneshiro Bliss , Salcedo Jennifer , Soon Reni , Tschann Mary 
Published: April 2018

INTRODUCTION:
Pathologists routinely use fetal foot length (FFL) to estimate the gestational ages (GA) of aborted fetuses. However, there is no standard formula. We aimed to develop an updated FFL-to-GA reference range from patient reported last menstrual period (LMP), ultrasound estimate, and best estimate for GA based on American College of Obstetricians and Gynecologists’ criteria in our patient population. After determining a reference range, we compared our measurements to those of previously published, commonly referenced FFL tables, which may not represent the ethnic diversity, or increasing BMI of current patient populations.

METHODS:
Retrospective chart review of 628 dilation and evacuation (D&E) clinical records and procedure pathology reports from October 2012 to December 2014 in Honolulu, HI.

RESULTS:
A linear relationship exists between FFL and GA in our population. Linear regression analysis of three pregnancy dating methods demonstrated that ultrasound derived dating provided the best-fit regression formula: FFL (mm) =496*(GA in days)-34.53 with an R2 value of .916. Patient race/ethnicity and BMI did not affect these equations in regression analysis. Our mean FFL differed from historically referenced ranges by .36-3.92mm, dependent on GA. Our FFL by GA was similar to ranges more recently endorsed by the National Abortion Federation despite differences in population racial and ethnic backgrounds.

CONCLUSION:
If post-abortion FFL measurement is utilized for GA estimation, then updated, modern ranges should be referenced to better reflect the diversity of abortion patients nationwide.
Utilization Patterns in Family-centered Cesarean Deliveries: A National Survey of Providers [16H]
Authors: Albert Arian L. , Spicer Alexandra B. , Greer Danielle M. , Kram Jessica J. F. , Forgie Marie M. 
Published: April 2018

INTRODUCTION:
Mothers undergoing cesarean delivery may experience later skin-to-skin contact, greater difficulty breastfeeding, and decreased satisfaction than mothers delivering vaginally. Mimicking a vaginal delivery, the family-centered cesarean section (FCS) allows a mother to watch the birth through a lowered or clear surgical drape and receive her baby immediately after delivery. We sought to document previously-unknown FCS utilization patterns through a nationwide survey.

METHODS:
Our survey targeted providers who deliver in US hospitals. Using a publicly-available sampling frame of 1,031 hospitals and a regionally-stratified two-stage random sampling design, we post-mailed invitations containing the web address of our anonymous 19-item online questionnaire to 2,324 providers at 250 hospitals. Patterns in awareness and use of FCS across provider, patient-population, and healthcare-setting characteristics were examined.

RESULTS:
Survey respondents (n=130) were geographically distributed and suggested broadly-dispersed awareness/use of FCS, with 87% (105/121) reporting awareness, 58% (65/121) reporting facility use, and 55% (64/116) reporting personal observation/performance. Overall, 81% (94/116) of providers recommended future use, 65% (34/52) in those who had not experienced FCS and 94% (60/64) in those who previously performed/observed FCS. In facilities having performed FCS, 60% (38/63) of providers reported that ≤20% of all cesarean sections were FCSs. In facilities without prior FCS use, 27% (15/56) of providers reported facility consideration of future use. Awareness and use of FCS also differed regionally and showed strong associations with provider demographics and credentials, patient socioeconomic characteristics, and facility size.

CONCLUSION:
Despite reporting moderate use of FCS, providers nationally suggest high levels of awareness and strong desire for future use.