bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Your Boss Do Your Pap?: Opinions on OB/GYN Residents Obtaining Personal Health Care From Program Faculty [9B]
Authors: Frost Andrea Nicole , Cook Ian , Hoffman Mark Richard 
Published: May 2019

INTRODUCTION:
Obstetrics & Gynecology residents and their partners often require care during residency. Many obtain care from program faculty, but little is known about opinions on this topic. The purpose of this study is to determine if Obstetrics & Gynecology residents' opinions differ from those of their program directors regarding whether a conflict of interest exists when residents obtain personal care from program faculty.

METHODS:
An anonymous survey with questions using a modified Likert scale from previously validated surveys was administered to program directors and residents from United States Obstetrics & Gynecology residency programs. SAS (9. 4) was used to analyze the data via chi-squared test. Significance was defined as p<0.05.

RESULTS:
Data was collected on 72 surveys from 57 residents and 15 program directors. Questions regarding conflict of interest showed no significant difference between groups with one exception: program directors were more concerned that care would cause embarrassment for residents (p=0.0401). Results also trended toward significance for multiple questions. Residents felt more concerned about the cost of outside care (p=0.0878) and about care not being fully documented in their records (p=0.0668). Program directors felt more concerned about information from residents' records being seen by others (p=0.0717) and residents feeling uncomfortable about disagreeing with advice from faculty (p=0.0913).

CONCLUSION:
While the majority of responses between groups were not found to be significantly different, the survey did show concern for conflicts of interest among both program directors and residents. Given the concern that conflicts of interest could exist, further investigation is warranted.
Actual vs Perceived Macronutrient Intake During Pregnancy: A Pilot Study [13B]
Authors: Marty Makenna , Heinig Meredith Jane 
Published: May 2019

INTRODUCTION:
Macronutrient intake during pregnancy has significant effects on maternal and infant health, yet pregnant women's ability to estimate adequacy of their intake is unknown. This study sought to gauge pregnant women's awareness of pregnancy macronutrient guidelines, and investigate if women's perception of adequate intake was a reliable marker for adherence to guidelines.

METHODS:
Pregnant women were recruited to participate in a survey and 24-hour recall. Surveys collected self-reported knowledge of guidelines and perception of guideline adherence. 24-hour recalls were analyzed to systematically assess dietary intake. Subjective opinions were compared to analyzed diets to determine if perception of adequately meeting guidelines equated to sufficient intake. This project was deemed Exempt by the UC Davis Institutional Review Board.

RESULTS:
Of the twenty-nine participants included in analysis, 51.7% reported being somewhat or more familiar with pregnancy macronutrient recommendations. Women were most likely to accurately estimate adherence to carbohydrate guidelines (65.5%), least likely to estimate adherence to water guidelines (51.7%), and equally likely to accurately estimate adherence to protein and fat guidelines (58.6% for each). The most common resources from which participants obtained pregnancy nutrition information were obstetrician/physician (75%), and the Internet (60%). Bivariate linear regression investigating relationships between accuracy of estimation and other variables (age, gravidity, education level, number of nutrition resources used) showed no significant associations.

CONCLUSION:
These results indicate that education for pregnant women of macronutrient intake guidelines can be improved, and a more reliable means for pregnant women to assess their own adherence to guidelines is needed.
Acute Decompensated Heart Failure Following Cesarean Delivery: A Case of Undiagnosed Rheumatic Heart Disease [14B]
Authors: Hmaidan Sarah , Benson Meagan , Hadley Emily , Gilmore Wyman 
Published: May 2019

INTRODUCTION:
Heart failure is a leading cause of maternal morbidity and mortality in the United States. It commonly occurs in the peripartum period—the last trimester and five months following delivery. It stems from multiple etiologies, most commonly peripartum cardiomyopathy and preexisting cardiac disease. The diagnosis of heart failure in the peripartum period is often delayed or misdiagnosed because its symptoms closely resemble those seen during normal pregnancy, pulmonary embolism, preeclampsia, and HELLP syndrome - including fatigue, shortness of breath and edema.

METHODS:
A 25-year-old G2P2 Burmese patient with no prior medical history presented five-days post cesarean delivery with chief complaint of shortness of breath, chest pressure, and palpitations. She was found to have tachypnea, tachycardia to the 140's, and hypoxemia with an oxygen saturation of 85%. Her EKG demonstrated atrial fibrillation with rapid ventricular response. Echocardiogram revealed findings consistent with undiagnosed Rheumatic Heart Disease (RHD) including bi-atrial enlargement, moderate mitral valve regurgitation, moderate tricuspid valve regurgitation, severe aortic valve regurgitation, moderate pulmonic valve regurgitation, and an LVEF of 55-60%.

CONCLUSION:
Diagnosis of RHD is rare in developed countries due to near eradication from improved efforts to administer antibiotic treatment. We hope our presentation sheds light on the burden of RHD that persists in developing nations and encourages providers to assess the possibility of this diagnosis in a subset of patients. Prompt diagnosis requires heightened awareness among multidisciplinary teams, a high degree of suspicion, and confirmation via echocardiographic studies. Treatment with targeted therapies can recover ventricular function in the majority of cases.
Antenatal Predictors of NICU Admission at a High-Risk Perinatal Center [16B]
Authors: Lane Monet , Dudley Donald J. , Cortez Briana , Boyle Annelee C. , Ferguson James E. 
Published: May 2019

INTRODUCTION:
The purpose of this study was to identify antenatal predictors of NICU admission at 34 weeks gestation and beyond at a high-risk perinatal center.

METHODS:
An IRB approved, quality improvement database was created containing clinical and sociodemographic data from 8,858 deliveries at 34+ weeks from January 2011 to May 2018. All data was obtained from the University of Virginia Clinical Data Repository. Relationships between NICU admission and potential antenatal predictors were stratified by gestational age (GA) and assessed using Pearson chi-square or logistic regression.

RESULTS:
Out of 8,858 births, 1,313 infants (14.8%) were admitted to the NICU with a mean length of stay of 13.2 days. Mean length of stay was longest for 35 week deliveries (15.5 days, 95% CI 12.48-16.3) and was shortest for 42 week deliveries (3.4 days, 95% CI 1.27-4.30). Most term NICU admissions occurred at 39 weeks (20.7%, P<.001). Of NICU admissions, 764 (58.2%) were male and 549 (41.2%) were female, yet gender was only associated with NICU admission at 39 weeks (P=.01). Cesarean delivery (P=0.00-0.02) and neonatal abstinence syndrome (P=.00-.01) were significantly correlated with NICU admission in all GA groups except 34 and 42 weeks. Risk factors associated with NICU admission varied by GA at delivery.

CONCLUSION:
NICU admission average length of stay exceeds usual maternal stays. Common obstetric complications were associated with NICU admission. Analysis of local data can guide quality improvement efforts to address risk factors for NICU admission. This could have future implications for development of programs that decrease identified risks and NICU admissions.
Arcuate Uterus as an Independent Risk Factor for Adverse Pregnancy Outcomes [17B]
Authors: Connolly Courtney T. , Hill Melissa B. , Klahr Rebecca A. , Zafman Kelly B. , Rebarber Andrei , Fox Nathan S. 
Published: May 2019

INTRODUCTION:
Mullerian anomalies are associated with adverse pregnancy outcomes. However, it is unclear if arcuate uterus, a milder abnormality, is also associated with adverse outcomes. The objective of our study is to estimate the association between arcuate uterus and adverse pregnancy outcomes using a similarly high risk control cohort.

METHODS:
Retrospective cohort study of women with an arcuate uterus cared for by a single maternal-fetal medicine practice from 2005 to 2018. We included all women with a singleton pregnancy and an arcuate uterus and randomly selected (3:1) patients with singleton pregnancies and no uterine anomalies from the same practice as controls. Baseline characteristics and pregnancy outcomes were compared. Chi-square test, Fisher's exact test, and Student's t-test were used, as appropriate. IRB approval was obtained.

RESULTS:
A total of 32 women with an arcuate uterus and 96 controls were included. There were no differences in baseline characteristics between the groups. Women with arcuate uterus had lower birthweights (2992+/-600 vs. 3238+/-560 g, p=0.037) and a higher likelihood of IUGR (25.0% vs. 9.4%, p=0.024), despite similar starting BMI and weight gain in pregnancy. There was a higher rate of malpresentation (21.9% vs. 5.2%, p=0.005), but not an overall increased risk of cesarean delivery.

CONCLUSION:
Having an arcuate uterus is significantly associated with lower birthweight and IUGR, as compared to high-risk controls. This suggests that arcuate uterus is itself a risk factor for poor fetal growth, as opposed to simply being a marker for a higher risk pregnancy.
Barriers to Completing Second-trimester Antenatal Screening: A Retrospective Cohort Study [19B]
Authors: Beshar Isabel , Henkel Andrea , Cahill Erica , Blumenfeld Yair Josh. , Shaw Kate 
Published: May 2019

INTRODUCTION:
This study identified barriers to completing the second-trimester antenatal screening ultrasound.

METHODS:
All women completing a Level II anatomy scan between Jan 1 2017 and Dec 31 2017 at one of the seven Lucile Packard Perinatal Diagnostic Center across Northern California were identified by an electronic query of the ClickView Ultrasound database. Maternal age, parity, insurance, distance traveled to clinic, gestational age (GA) at first scan, GA at follow-up scans, and type of anomaly were abstracted from the medical record.

RESULTS:
Our sample included 2000 women with screening ultrasounds between 16 and 24 weeks GA. The median GA at presentation for first ultrasound was 141 days (range 111-168 days) with 64.1% (n=1282) presenting after 20 0/7 weeks. 32.7% (n=654) of women were asked to return for an additional ultrasound as there were incomplete views. Of these 654 women, 17% (n=113) were lost to follow-up. Increased risk of being lost to follow-up was observed among women with public insurance when compared to those with private insurance (OR 1.44, CI 0.96, 2.17). There were also trends for women who were very close (<24 miles) or very far (>100 miles) having increased risk of being lost to follow-up.

CONCLUSION:
Nearly a third of women presenting for an anatomy scan were asked to return due to incomplete views on initial scan, with 17% of these women lost to follow-up. Should laws propose limits on abortion after 20-weeks, this study suggests a percentage of California women would not have important screening information from the anatomy scan.
Delivery Method of Neonates at 22 Weeks' Gestation: A Decision Analysis [25B]
Authors: Zhou Clarice G. , Sargent James Andrew , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
In women who desire resuscitation of a periviable neonate, a cesarean delivery is commonly used for the usual indications. The objective of this study was to examine the impact of mode of delivery of a 22-week neonate on current and future pregnancies.

METHODS:
Decision-analytic model was constructed using TreeAge software to compare outcomes of the delivery method at 22 gestational age in a theoretical cohort of 5,200 pregnant women. The interventions compared are cesarean delivery with a classical incision versus vaginal delivery in pregnancies where neonatal resuscitation efforts have been requested by the patient. The neonatal outcomes of the periviable birth and the clinical outcomes of the subsequent pregnancy were assessed along with the healthcare costs and quality-adjusted life years (QALYs). All probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY.

RESULTS:
Out of the 5,200 pregnancies, a classical cesarean would lead to 936 fewer neonatal mortalities. However, there would be 525 more children with neurodevelopmental disabilities. In subsequent pregnancies there would be 29 more previas, 15 more accretas, and 16 more hysterectomies. Overall, a vaginal delivery led to lower costs and higher QALYs when compared to a classical cesarean.

CONCLUSION:
For a 22 week periviable fetus, a vaginal delivery will lead to decreased clinical complications of placenta previa, placenta accreta, and hysterectomy in the subsequent pregnancy when compared with classical cesarean. This suggests that the risks of maternal complications of subsequent pregnancies should be addressed when discussing delivery plans of 22 gestational age pregnancies.
Does Daily Self-Weighing (DSW) Compared to Routine Care Impact Postpartum Weight Loss? [27B]
Authors: Lohr Ali , Hoppe Kara Kjersten. , Mei Chaoqun , Antony Kathleen M. 
Published: May 2019

INTRODUCTION:
Gestational weight gain not lost during the postpartum period contributes to obesity. eHealth technologies have demonstrated promise in promoting postpartum weight loss. In non-obstetric populations, DSW also demonstrates efficacy. This study examined the impact of remote patient monitoring (telehealth (TH)), inclusive of DSW on postpartum weight loss.

METHODS:
This was a secondary analysis of 428 postpartum women diagnosed with hypertensive-related disorders in pregnancy (HTN). In the parent non-randomized controlled trial, participants were allocated in a 1:1 concurrent manner to TH versus routine care. Participants in the TH arm received a tablet, a Bluetooth-enabled scale, and BP equipment to use daily. The amount of postpartum weight lost was compared, and the trend of postpartum weight loss was assessed among women completing DSW.

RESULTS:
Demographic variables were similar between groups except TH participants had more severe HTN disorders and were more likely to have undergone Cesarean. The mean weight loss from delivery to the 6-week postpartum visit for TH participants utilizing DSW was 22.72 (SD 10.5) pounds, while the control group lost an average of 22.83 (SD 11.4) pounds (p 0.92).

CONCLUSION:
In this study, weight loss among women with HTN discharged with TH utilizing DSW was not statistically different than women with HTN discharged with routine care. Prior studies examining DSW included healthy weight-related messages. This study suggests that DSW alone may be insufficient to promote postpartum weight loss in the immediate 6-week postpartum period.
Do Patients Undergoing Surgery on a Gynecologic Oncology Service Really Need a Routine Type and Screen? [38B]
Authors: Kirschen Gregory , Dayton Samantha , Pearl Michael Loran , Kirschen Gregory 
Published: May 2019

INTRODUCTION:
Preoperative bloodwork for patients undergoing gynecologic oncology surgery routinely includes a type and screen (T&S) due to potential need for blood products. However, it remains unclear whether a routine T&S is necessary.

METHODS:
We performed an IRB-approved retrospective chart review of 800 women who underwent surgery on the Gynecologic Oncology Service at Stony Brook University Hospital from 2009-2016. Data included patient demographics, pre-operative test results, surgical indication and procedure(s), and need for transfusion.

RESULTS:
88.9% of women had a T&S performed. Of these, 76.8% had just T&S performed, 15.3% were converted to T&C without transfusion, and 7.9% required transfusion. All those who underwent T&C or transfusion had an initial T&S. Those requiring transfusion were significantly older (59.1 vs. 55.2 years; p=0.048), more likely to undergo hysterectomy (64.9% vs. 41.0%; p=0.0004), undergo major (defined as entering the peritoneal cavity) vs. minor surgery (10.6% vs. 2.2%; p<0.0001), and had cancer or possible cancer indications vs. benign indications (8.84% vs. 4.92%; p=0.0367). After controlling for these significant factors, surgery type remained significantly associated with transfusion (p=0.0002).

CONCLUSION:
Our results indicate that routine type and screen for younger women undergoing minor surgery for benign indications is unwarranted. In our sample, only 1.72% of this targeted population (below median age women having minor surgery with benign indications) required a transfusion. With T&S and T&C costing roughly $100 and $400, respectively, per test, there is a potential for substantial cost savings with elimination of unnecessary routine preoperative type and screen.
Factors Associated With and Barriers to Receiving Inpatient Long-Acting, Reversible Contraception [1C]
Authors: McCarther Noria , Emily Pfeifer , Nguyen Jimmy , French Valerie , Ellerbeck Edward 
Published: May 2019

INTRODUCTION:
Factors associated with inpatient long-acting, reversible contraception (LARC) placement and potential barriers to inpatient LARC placement during the immediate postpartum period are largely unknown. The objective of this study was to determine factors associated with LARC placement and barriers to LARC placement during the post-partum hospitalization.

METHODS:
We identified 3072 deliveries at an urban, academic hospital between January 1, 2017 and July 31, 2018. We randomly selected 218 cases that received a LARC and 218 controls that did not receive a LARC. We excluded 68 patients <18 years of age or in a system requiring outpatient contraception planning. We look at bivariate relationships between patient characteristics and inpatient LARC placement. Chi-square tests and Fisher's Exact tests were used to assess statistical significance.

RESULTS:
Recipients of LARC were younger (mean age of 28 versus 29.5, p<0.01). Admission by Family Medicine providers (OR 0.10, 95% CI 0.02-0.45), lack of recorded prior contraception plan (OR 0.25, 95% CI 0.17-0.39), and delivery complications (OR 0.48, 95% CI 0.32-0.71) were associated with lower odds of receiving LARC placement. Single marital status was associated with higher odds of receiving LARC placement (OR 1.50, 95% CI 1.03-2.19).

CONCLUSION:
Findings suggest that provider specialty, which may be confounded by prior procedural training, and lack of prior contraception planning present significant barriers to immediate LARC placement.
Factors Associated With Hospital Non-Admission After Outpatient Hysterectomy [12C]
Authors: Ilizaliturri Ana K. , Burton Brittany N. , Frugoni Gina Reggiardo , Gabriel Rodney A. 
Published: May 2019

INTRODUCTION:
Outpatient hysterectomies have been increasing in the last two decades in an effort reduce cost and improve patient recovery. However, factors for non-admission have not been well documented. This study aims to identify demographic, preoperative, and intraoperative factors for non-admission after outpatient vaginal hysterectomy.

METHODS:
Outpatient vaginal hysterectomies from the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016 were included in this retrospective observational study. The primary outcome is hospital non-admission, defined as hospital stay <1 day. Multivariable logistic regression was done to determine independent association between factors and hospital non-admission.

RESULTS:
A total of 17,086 patients were included in the study with 15,697 (91.8%) experiencing hospital stay <1 day. The final multivariable logistic regression analysis demonstrates that the odds of hospital stay <1 day was significantly lower for Black or African American race (OR 0.69, 95% CI 0.57-0.84, P<.001), Hispanic ethnicity (OR 0.50, 95% CI 0.43-0.59, P<.001), age >80 (OR 0.34, 95% CI 0.21-0.55, P<.001), history of chronic obstructive pulmonary disease (OR 0.50, 95% CI 0.34-0.75, P<.001), preoperative diagnosis of anemia (OR 0.81, 95% CI 0.69-0.94, P=.006), and duration of surgery >118 minutes (OR 0.54, 95% CI 0.47-0.63, P<.001).

CONCLUSION:
This study suggests that patient characteristics, preoperative diagnoses, and intraoperative factors are associated with non-admission after outpatient vaginal hysterectomies. As the number of outpatient hysterectomies in the U.S increases, future studies may evaluate ways to address the effects of these factors in attempt to prevent unplanned admissions.
Estimated Prevalence of Human Papillomavirus Among Women in Nigeria: A Systematic Review and Meta-Analysis [14C]
Authors: Anoruo Onyemaechi , Bristow Claire , Klausner Jeffrey D. 
Published: May 2019

INTRODUCTION:
Human papillomavirus (HPV) remains the leading cause of cervical cancer worldwide. Overall HPV prevalence in Nigeria has been challenging to quantify given regional population heterogeneity and differences in diagnostic methodology.

METHODS:
We conducted a systematic review and meta-analysis of 17 studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols and guidelines. We also incorporated the Meta-Analysis of Observational Studies in Epidemiology Guidelines for Reporting. Each study summarized HPV prevalence in HIV-uninfected women residing in various regions of Nigeria at the time of the study. A random effects model was used to establish an estimated pooled HPV prevalence. We calculated median values with 95% confidence intervals.

RESULTS:
The estimated pooled prevalence of HPV in Nigeria was 32% (23-41%). HPV prevalence was 29% (20-39%) among studies that detected HPV by genotype. HPV prevalence among studies that used serologic detection was 38% (12-65%). When stratified by region, studies in northeast Nigeria reported the highest prevalence of 55% (49-61%) while a study in west Nigeria reported the lowest prevalence of 22% (14-30%). For meta-analysis stratified by detection method, the P value for heterogeneity testing was .52. Stratifying by location yielded a heterogeneity test P value of P<.001.

CONCLUSION:
HPV prevalence in Nigeria was high. Heterogeneity between study regions and differing HPV detection methods may both contribute to variation in estimates. Using pooled estimates may serve to inform future strategies for epidemiological surveillance and the future design of disease prevention initiatives.