bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can a Telephone Encounter Replace in Person Follow-up after IUD Insertion? [14G]
Authors: Chen Stephanie , MacIsaac Laura , Belkin Jori , Overbey Jessica , Pan Stephanie 
Published: April 2018

INTRODUCTION:
Limited research informs the recommendation for a 4 - 6 week follow-up surveillance visit after IUD insertion. We explored whether surveillance could occur over the phone instead of in-person without affecting continuation rates or adverse events.

METHODS:
Subjects were offered in-person or telephone follow-up 4 - 6 weeks after IUD insertion. All subjects were called at 6 months to assess if and why they had discontinued IUD use, or if they had any adverse events including expulsion, pregnancy, or pelvic infection. Subjects were also asked about string check attempts and success and their preferred method for IUD surveillance. Group demographics and outcome measures were compared using Chi-square, Fisher’s exact, T-test and Wilcoxon tests as appropriate.

RESULTS:
47 and 131 patients enrolled respectively in the in-person and telephone follow-up groups. Demographics and medical history were not significantly different between the groups. The majority of subjects were white, college educated, privately insured, and nulliparous. Of all subjects who completed the 6-month assessment, 138 (94%) reported still having their IUD in place, 8 had discontinued, and 1 had an expulsion. Subjects in the two groups had similar IUD continuation rates at 6 months (p=0.70). Unscheduled visits and ability to feel strings were similar between the groups.

CONCLUSION:
We observed similar 6-month continuation rates, no evidence of increased unscheduled visits, expulsions or adverse events in the telephone group compared to the in-person group. More subjects chose phone follow-up. The 4 - 6 week telephone follow-up was comparable to in-person IUD follow-up in our population.
Immediate Postpartum LARC Reimbursement Increases Uptake of Effective Contraception After Pregnancy [22G]
Authors: Paul Rachel , Bayer Chelsea , Braun Emma , Mullen Mary , Frisse Ann , Robbins Camaryn Chrisman 
Published: April 2018

INTRODUCTION:
Over one third of women have unfulfilled contraceptive needs during their first year postpartum, and women without health insurance are 30% less likely to use contraception. As states have begun to reimburse for immediate postpartum LARC placement (immediate post-placental IUD insertion and implant insertion before discharge), the objective of this study was to determine if LARC uptake increased in the Medicaid population after immediate postpartum reimbursement was instated.

METHODS:
Women receiving Medicaid were prospectively recruited from a postpartum service of a large, urban hospital before and after immediate postpartum reimbursement. They completed a survey regarding their contraceptive choices, and additional information was gathered from the medical record. A binary logistic regression was performed to determine if women receiving Medicaid were more likely to choose LARC as a contraceptive method after the policy took effect, adjusting for race, mode of delivery, and primiparity.

RESULTS:
178 women were included in the analysis (70 before reimbursement, 108 after reimbursement). Women were 2.5 times more likely to use LARC as postpartum birth control after immediate postpartum reimbursement was instated (95% CI: 1.26-4.79). Of the 49 women who chose LARC after immediate postpartum reimbursement, 42 (86%) received their method before hospital discharge.

CONCLUSION:
Immediate postpartum reimbursement resulted in women being more than twice as likely to choose LARC as their postpartum contraceptive method. Removing this barrier to cost and access is particularly important in a population vulnerable to unintended pregnancy and loss of healthcare coverage.
Effects of Human Papillomavirus–Related Disease on Patient Knowledge and Practices Regarding HPV Vaccination [32G]
Authors: Coleman Maame A. , Cohen Emily , Sangi-Haghpeykar Haleh 
Published: April 2018

INTRODUCTION:
To evaluate whether women with a history of an abnormal Pap test are more knowledgeable about Human Papillomavirus (HPV) and HPV vaccine, and more receptive to vaccinating their children against HPV.

METHODS:
Convenience sample of 100 women attending a community health clinic October 2016 to April 2017. Mann-Whitney U test was utilized to analyze ordinal variables. P < .05 was considered statistically significant.

RESULTS:
103 surveys were completed. Women had a median age of 38 years. The majority of women were White race (30%), Hispanic ethnicity (82%) with 59% being married, 61% having a high school education or greater and 55% reporting an annual household income of less than $25,000. Women with a history of an abnormal Pap test (n = 37) were more likely to have thought that HPV was the cause when compared to women with no such history (n = 57), 86% versus 49%, respectively P < .01. No differences were noted regarding the knowledge of the impact of HPV, awareness of the HPV vaccine, or the portion of women who vaccinated their children for the virus between women with a history of abnormal Pap test and those without.

CONCLUSION:
Women with a history of an abnormal Pap test are more aware that HPV was an etiology for this; however, no impact was noted on the rate of their children receiving the HPV vaccine. Obstetrician-Gynecologists should take advantage of this “teachable moment” to educate women of the benefits of HPV immunization for their children.
Racial/Ethnic Variations in Use of Alternative Treatment Before Hysterectomy for Benign Conditions [36G]
Authors: Nguyen Nancy T. , Ritterman Weintraub Miranda M.L. , Poceta Joanna , Salyer Chelsea , Merchant Maqdooda , Zaritsky Eve 
Published: April 2018

INTRODUCTION:
Hysterectomy rates for benign gynecologic conditions vary by race/ethnicity. We investigated racial/ethnic variations in rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications at Kaiser Permanente Northern California (KPNC), an integrated health care system.

METHODS:
We conducted a retrospective IRB-approved cohort study of 1,050 patients randomly selected from the 6,892 patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 at KPNC. Primary outcomes were use of treatments prior to hysterectomy. Demographic covariates included age and median household income. Clinical characteristics included comorbidities, benign gynecologic indication, type of hysterectomy and counseling status. Chi-square and Fisher exact tests were used for bivariate analyses and logistic regression for multivariable analyses.

RESULTS:
Of the 1,050 charts reviewed, 980 (93.3%) patients met inclusion criteria. Prior to a hysterectomy, 99.3% of patients were counseled regarding alternative treatments and 18.7% declined alternative treatment options. In bivariate analyses, there were racial/ethnic variations in the proportion of women who received alternative treatments. Among Asians, 70.5% received an alternative treatment compared to 77.8% for blacks, 84.4% for Hispanics and 82.2% for whites (p-value=0.0037). These variations did not persist in multivariate analyses, adjusting for demographic and clinical characteristics. Of the 18.7% who declined alternative treatment, the majority (41.9%) were white.

CONCLUSION:
The majority of patients were counseled about alternative treatments and 80% tried at least one prior to undergoing a hysterectomy. Unlike previous studies, there were no differences in receiving alternative treatments between whites, Asians, blacks and Hispanics within our integrated health system.
Vulvar Lichen Sclerosus in Gynecology and Dermatology Clinics: The Link between Treatment Compliance and Outcomes [37G]
Authors: Kohn Jaden R. , McClatchey Trissa M. , Chan Warren , Liang Cynthia S. , Dao Harry , Vyas Anuja 
Published: April 2018

INTRODUCTION:
To investigate the relationship between topical steroids, treatment compliance, and clinical outcomes in women with vulvar lichen sclerosus (VLS).

METHODS:
We performed a cross-sectional study of women with VLS seen at dermatology, general gynecology, and vulvovaginal gynecology clinics from 2012-2017. IRB approval was obtained. Analysis included descriptive statistics and panel data logistic regression.

RESULTS:
332 women attended 1525 visits (median 4 per patient, range 1-24 visits). 65% occurred in vulvovaginal gynecology clinic, 26% in general gynecology clinic, and 8% in dermatology clinic. Mean age was 61.7±11.8 years (range 23.1-90.0). 82% were non-Hispanic white. 31% had hypothyroidism and 22% were nulliparous. Patients reported perfect use of topical steroid at 66% of visits, imperfect use at 26%, and no use at 8%. Compared to no use, perfect use strongly predicted improvement in symptoms (OR 4.5, p<0.001) and physical exam (OR 6.9, p<0.001); imperfect use had lesser improvement in symptoms (OR 2.6, p=0.017) and physical exam (OR 4.2, p=0.004). Improvement was more likely with super-high potency steroid compared to low-potency (symptoms: OR 1.74, p=0.012; physical exam: OR 1.73, p=0.039). Sexual activity was documented at 93% of vulvovaginal gynecology visits, 29% of general gynecology visits, and 0% of dermatology visits. 42% of women were sexually inactive at intake due to pain; of these, 40% became sexually active during follow-up.

CONCLUSION:
Women with VLS are more likely to improve clinically with perfect use of topical steroid, though some improvement may occur with imperfect use. Sexual activity is often documented inconsistently, limiting follow up regarding quality of life.
Improving the Post-Placental Intrauterine Device Protocol to Reduce Patient Visits [2H]
Authors: Thornton Olivia , Purusothaman Vaishnavi , Dinesman Ilanna , Plastino Kristen 
Published: April 2018

INTRODUCTION:
Immediate post-partum intrauterine device (IUD) insertion is a safe and effective means of long-acting birth control. This project analyzes demographics, string visualization, and follow up of women who opted for post-partum IUD insertion and considers the need for follow up including ultrasound (TVS).

METHODS:
From March 2016 to March 2017, the Post-Placental IUD Insertion Protocol was used for immediate post-partum Mirena® and ParaGard® IUD insertion at University Hospital, San Antonio, Texas. Retrospective chart analysis was used to assess patient demographics, follow up rates, and expulsion rates.

RESULTS:
A total of 128 women received post-partum IUDs, 70 post-cesarean and 58 post-vaginal delivery. Patient age ranged from 16-43 (average = 26.76) and parity ranged from 1-10 (average = 3.1). Over 80% of the population was Hispanic. Per protocol, patients were scheduled for a string check follow up 7-14 days post insertion. Of the 89 patients who followed up, 27 were in the first three weeks of post-insertion. Over 88% (15/17) of the post-cesarean and 25% (2/8) of post-vaginal insertions did not have visible strings at the visit and 50% (44-89) eventually needed a TVS to confirm placement, 75% of which were post-cesarean. The expulsion rate was 9% (8/89) and 9 IUDs required removal per patient request or IUD not being at the uterine fundus.

CONCLUSION:
The Post-Placental IUD Insertion Protocol can be improved in efficiency and cost-effectiveness by reducing the number of post-partum visits to only one at six weeks as well as scheduling a pre-clinic TVS, especially for post-cesarean patients.
Knowledge, Attitudes, and Use of Family Planning in Rural Uganda: Comparing the Female and Male Perspectives [6H]
Authors: Deans Samantha J. , Dougherty Anne , Kayongo Alex , Mundaka John , Heil Sarah , Kalyesubula Robert 
Published: April 2018

INTRODUCTION:
Unintended pregnancy is a significant modifiable factor contributing to the high maternal mortality rate in Uganda. This study compares women and men’s knowledge of and attitudes toward family planning (FP) in rural Uganda to understand potential barriers to its use.

METHODS:
Data were collected from villagers through surveys in rural Nakaseke District, Uganda (N=362). Participants’ socio-demographics, indicators of unmet need, and knowledge/accessibility of FP services were queried and analyzed.

RESULTS:
183 women and 179 men (average age 32.5, range 15-71) participated. All women and 98% of men reported some knowledge of FP. Most women (62%) obtained FP information from health workers; most men (73%) obtained information via radio. 64% of women and 53% of men reported ever using FP; 40% of respondents reported current use. Of these, 35% of women involved their partners in their decision, compared to 23% of men. Of participants reporting barriers to FP (n=46), women cited partner opposition as the most common obstacle (23%), whereas men reported inability to access their chosen method (39%). Women and men identified common contraceptive side-effects, e.g. vaginal bleeding (47% vs 31%), but men were more likely to report myths, e.g. increased infertility (9% vs 1%).

CONCLUSION:
Men and women in rural Uganda reported limited access to FP as a significant barrier to use. For women, partner opposition contributed significantly to limiting access. Men relied on incomplete/inaccurate sources of information, furthering their reluctance to use FP. Our study demonstrates the importance of targeting education for men and women to increase acceptance/success of FP programs.
Resident Personal Contraceptive Use and LARC Practices in Residency Training [8H]
Authors: Kellogg Emily , Breeze Janis , Evans Megan L. 
Published: April 2018

INTRODUCTION:
In the United States, long acting reversible contraception (LARC) use has been steadily rising, and female physicians use LARC at a higher rate than the general population. Additionally, experience with LARC training and education can vary widely by program and region. The purpose of this study is to determine if choice of personal contraceptive use among OB-GYN residents varies with the number of LARCs placed during their training.

METHODS:
An electronic survey was distributed to all residents taking the annual OB-GYN resident in-training examination January 21st-23rd, 2016. The survey included questions about demographics, residency training experience, and personal contraceptive use. The survey was IRB-approved, voluntary, and anonymous. Experience with LARC was defined as the number of insertions performed during residency: 0, 1-10, 11-25, 26-50, >50.

RESULTS:
In total 4,316 residents completed the survey. Of these, 896 use oral contraceptive pills (OCPs), 88 use implants, and 1444 use intrauterine devices (IUDs) for contraception. All responses were included in this analysis. Overall, the highest proportion of residents using OCPs and implants inserted 1-10 IUDs (37.9%, 47.7%). Of residents who used an IUD, the highest proportion of residents inserted 11-25 IUDs (33.1%). Residents who inserted 26-50 IUDs during training were more likely to use an IUD (24.1%) than residents who used OCPs or implants (19.4%, 14.8%,). Of residents who use OCPs, implants, and IUDs, the highest proportion of residents placed 1-10 implants (43.9%, 36.4%, and 40.3%).

CONCLUSION:
Residents who use an IUD for contraception are more likely to have greater experience with insertion of these devices.
Racial Representation in United States and Australian Obstetric Research [13H]
Authors: Chern Ingrid , Yamasato Kelly , Lee Men-Jean 
Published: April 2018

INTRODUCTION:
To describe racial/ethnic composition in United States (US)/Australian obstetric research, represented by the Maternal-Fetal Medicine Units Network (MFMU) and Australian Research Centre for Health of Women and Babies (ARCH) trials.

METHODS:
MFMU studies were identified through PubMed and ARCH studies through their online publication listing from 2011 to 2016. Observational and randomized cohorts and primary and secondary data analyses were included. Studies with racial/ethnic-based enrollment were excluded. Racial composition was expressed as the mean racial percentages among studies (ie: studies weighted equally regardless of sample size). Racial percentages in MFMU studies were compared to US registered births (2015) and ARCH compared to Australian census ancestry data (2016).

RESULTS:
38 MFMU studies included 580,282 women. Racial/ethnic composition (% [SD]) included White 41.7 [12.3], Hispanic 28.1 [15.4], Black 26.2 [12.3], Asian 3.6 [2.3], and American Indian/Alaskan Native (AI/AN) 0.2 [0.02]. No studies reported Native Hawaiian/other Pacific Islanders (NHOPI) separately. Comparatively, registered US births (%) were White 75.7, Hispanic 28.1, Black 16.1, Asian/Pacific Islander 7.1, and AI/AN 1.1. 20 ARCH studies included 51,873 women. The most reported groups were White (76.5 [17.4]), Asian (15.2 [14.8]), and Aboriginal/Torres Strait Islander (13.9 [30.5]), compared to the estimated population of White 88.7, Asian 9.4, and Aboriginal/Torres Strait Islander 2.8. No studies reported Black race separately.

CONCLUSION:
There is diverse racial/ethnic representation in studies by MFMU and ARCH, with possible opportunities to increase enrollment, or the reporting of Asian, AI/AN, and NHOPI races in US studies and Black race in Australian studies.
Optimal Duration Of Urinary Catheterization After Cesarean Delivery [17H]
Authors: Taha Odette , Chappelle Joseph 
Published: April 2018

INTRODUCTION:
Indwelling urinary catheter placement is the standard of care in cesarean deliveries. Studies have evaluated utilizing one-time catheterization preoperatively but no studies have investigated the ideal length of catheterization. The primary outcome was to compare rates of urinary retention in women undergoing cesarean delivery who have had their urinary catheter removed at 24 vs 12 hrs.

METHODS:
We performed a quality assurance, non-inferiority study. A survey assessed discomfort due to the catheter, time to first ambulation, and overall satisfaction. Demographic, operative and postoperative data was collected including information on re-catheterization for retention, time to first void after catheterization, pain scores, time to first ambulation, and length of stay.

RESULTS:
125 women had their catheters removed at 24 hours and 155 at 12 hours. Women in the 12 hour group took 30 minutes longer to void for the first time (3.0±1.6 vs. 3.6±1.9, p=0.002). More women in the 24 hour group (37.2% vs. 21.5%, p=0.004) would have preferred an earlier removed. Two women in the 12 hours group had urinary retention vs. 0 in the 24 hour group (p=0.2).

CONCLUSION:
There was no difference in the time to first ambulation, dysuria, or overall patient satisfaction. Earlier removal is associated with a clinically non-significant increase in time to first void and less desire for earlier removal. This study demonstrated no difference in urinary retention but a larger study would be needed to rule-out a less dramatic increase. Urinary catheterization greater than 12 hours seems to infer no medical benefits for women undergoing cesarean delivery.
Prevalence of Post-Traumatic Stress Disorder after Vaginal Delivery and in Particular after Postpartum Hemorrhage [18H]
Authors: Woodley Nicole J. , Das Kamalini , Vogel Rachel Isaksson 
Published: April 2018

INTRODUCTION:
Post traumatic stress disorder (PTSD) involves intrusive thoughts, nightmares and flashbacks of traumatic events that interfere with daily activities. PTSD has been described most commonly after combat and assault, but is also described after medical intervention, particularly admission to the intensive care unit. The goal of this study was to assess prevalence of PTSD after vaginal delivery and compare women who did and did not experience postpartum hemorrhage (PPH).

METHODS:
Patients who had a singleton vaginal delivery who were English speaking and greater than 18 years old were identified between 1/1/2013 and 12/31/2014. Of these 4,738 patients, 339 had a PPH defined as an estimated blood loss greater than 500 ml. Surveys were sent to all PPH patients and 2000 of the non-PPH patients. Total response rate was 442, or 19.6%. The survey included questions regarding the delivery as well as the PCL-C, a validated PTSD questionnaire. Multivariate logistic regression models were used to compare those with clinically significant PTSD symptoms in those with and without PPH.

RESULTS:
Patients who experienced PPH were more likely to have fear of extra bleeding again (P<.0001) and fear of becoming pregnant again (P=.001). Those who had PPH were more than two times more likely to have a moderate or severe PCL-C score (OR 2.85).

CONCLUSION:
Understanding the prevalence of PTSD both after vaginal delivery and PPH will create awareness for providers to diagnose and treat these patients in the postpartum setting.
Differences in Obstetric and Neonatal Outcomes in Pregnancies Complicated by Type 1 and Type 2 Diabetes Mellitus [21H]
Authors: Ware Courtney A. , Finneran Matthew M. , Kiefer Miranda K. , Thung Stephen F. , Landon Mark B. , Gabbe Steven G. 
Published: April 2018

INTRODUCTION:
There are well-known baseline differences in medical comorbidities and disease related complications between patients with pregestational type 1 and type 2 diabetes, but limited research on the comparison in obstetric outcomes between these populations.

METHODS:
Retrospective cohort study of all pregnancies complicated by pregestational diabetes from 2012-2016. Patients were categorized by diabetes type and baseline demographics were compared between groups. A multivariate regression model was used to calculate adjusted odds ratios for obstetric and neonatal outcomes controlling for gestational age at delivery and late (>26 weeks) hemoglobin A1c.

RESULTS:
There were 464 patients who met inclusion criteria during the study period. Patients with type 2 diabetes were more likely to be of non-Hispanic white race (36.2% vs. 15.2%; p<.01), advanced maternal age (40.8% vs. 19.3%; p<.01), obese (81.7 vs. 46.2%; p<.01) and have preexisting hypertension (41.0% vs. 20.1%; p<.01). However, patients with type 1 diabetes had a longer duration of disease (White’s class C/D: 62.1% vs 19.5%; p<.01) and higher rates of end organ complications (White’s class R/F:19.3% vs 3.5%; p<.01). Adverse obstetric and neonatal outcomes were more common in type 1 diabetes including prematurity (aOR:1.8, CI:1.1-2.8), NICU admission (aOR:1.9, CI:1.1-3.2), and large for gestational age birth weight (aOR:2.5, CI:1.6-4.0). Whereas, patients with type 2 diabetes had a higher burden of spontaneous abortion (6.0% vs. 0.7%; p=0.01) and fetal demise (2.5% vs. 0%; p<.06).

CONCLUSION:
Despite lower rates of baseline medical co-morbidities, patients with type 1 diabetes have higher rates of preexisting diabetes complications and adverse perinatal outcomes independent of antenatal glycemic control.