bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self Screening as an Alternative Method of Cervical Screening [5D]
Authors: Manglardi Erin E. , Lendore Jessica , Balhotra Kimen , Fields Paul J. , Bahadoor-Yetman Avi , McGill Frances Mary 
Published: May 2019

INTRODUCTION:
The Papanicolaou smear, an accessible screening tool for cervical cancer worldwide is often underutilized. Caribbean cervical cancer incidence is higher than in developed countries. A self-sampling device created with the goal of increasing screening in developing regions. was evaluated in Grenada. Goals of this study included evaluating self screening for accuracy and comfort when compared to a standard Pap smear.

METHODS:
Following IRB approval we conducted a randomized controlled study involving 101 women in April 2017 at St. Georges University, Grenada. Informed consent was obtained. Two liquid based cervical specimens were obtained from each woman: one via physician collected specimen and one via SelfPap (i Self screen) device. Women were randomized as to which specimen was obtained first. Laboratory technicians were blinded to the sampling technique. The first sample from each woman was also tested for HPV (Human Papillomavirus). Participants completed a questionnaire assessing ease and comfort of self screening.

RESULTS:
Of 101 women, 90 (89%) reported the self screening device was easy to use; 79 (78%) reported mild discomfort, while 94 (93%) indicated they would recommend the it for future use. There was strong agreement in the adequacy and accuracy of the samples obtained by the self screening and physician obtained cervical cytology. (Gwet's AC1 = 0.906). HPV was detected in 49/101 samples, and genotyping was performed. Women with abnormal results were appropriately evaluated.

CONCLUSION:
Comparison of cytology results from both samples, our study deemed self screening as an accurate and acceptable alternative method to standard cervical sampling.
The Effect of Bariatric Surgery on Post-Operative Outcomes After Hysterectomy [6D]
Authors: Whitley Julia , Voltzke Kristin , Louie Michelle Yee 
Published: May 2019

INTRODUCTION:
Bariatric surgery is common and has been associated with an improvement in obesity-related medical co-morbidities. However, outcomes after hysterectomy for women who have had bariatric surgery is unknown. Our objective was to compare post-hysterectomy outcomes between patients who had bariatric surgery before hysterectomy and obese patients without prior bariatric surgery.

METHODS:
We performed an IRB-approved study of patients who had hysterectomy by any route between 1/2000 and 3/2018 at a large academic medical center. Patients with malignancy were excluded. Multivariable logistic regression was used for analysis.

RESULTS:
223 patients with bariatric surgery before hysterectomy were compared to 225 patients with body mass index (BMI) >40 kg/m2 and no previous bariatric surgery. The average BMI in the bariatric surgery group was 35 kg/m2, compared to 46 kg/m2 in the no bariatric surgery group. We observed a lower proportion of patients with diabetes, hypertension, and hyperlipidemia in the bariatric surgery group compared to the no bariatric surgery group. We found no significant difference in the odds of intraoperative (visceral injury, blood transfusion, conversion to laparotomy) or postoperative complications including major complications (transfusion, cuff dehiscence, surgical site complication, venous thromboembolism, bowel obstruction), minor complications, re-hospitalization, and re-operation within 30 days of hysterectomy, even after adjusting for confounding factors between groups.

CONCLUSION:
Despite a significantly higher BMI and higher proportion of obesity-related co-morbidities, there was no difference in the odds of intraoperative or postoperative complications after hysterectomy in morbidly obese women, compared to women with a history of bariatric surgery prior to hysterectomy.
Maternal HIV Diagnosis Timing and Use of Guideline-Based Antiretroviral Therapies on Infant Outcomes [8D]
Authors: Cohn Ellery , Lazenby Gweneth B. 
Published: May 2019

INTRODUCTION:
The primary aim was to evaluate differences in antiretroviral therapy (ART) use in pregnant women living with HIV (WLWH) according to timing of maternal HIV infection, including perinatal (PHIV). The secondary aim was to evaluate the effects of guideline-based maternal ART, including mono-, dual, and combination antiretrovirals (mARV, dARV, cART), on preterm delivery (PTD).

METHODS:
Data were obtained from the state Department of Health (SCDHEC) for WLWH delivering from 2004-2014. Perinatal outcomes were compared according to timing of maternal HIV diagnosis and maternal use of mARV, dARV, cART, and no ART. Bivariate outcomes were compared using Ï‡2 or Fischer's exact tests. Continuous variables were compared using Wilcoxon Rank Sum Tests or Kruskal-Wallis tests.

RESULTS:
663 WLWH delivered 885 infants. 26 (3%) of infants were born to PHIV WLWH, 683 (77%) to WLWH diagnosed before pregnancy, and 185 (21%) to WLWH diagnosed during pregnancy. PTD was less likely among PHIV-exposed infants (4% vs. 24% vs. 16%, P=0.006). PHIV mothers were more likely to use cART (88% vs. 65% vs. 54%, P=0.001). PTD rates were similar among infants exposed to any ART (mARV 21% vs. dARV 20% vs. cART 21%, P=0.93), while infants not exposed to ART had higher PTD rates (38% vs. 31%, P=0.02).

CONCLUSION:
PTD was not increased by maternal PHIV or ART exposure. HIV-exposed infants not exposed to ART had higher PTD rates. These findings support maternal cART use for improved infant outcomes and challenge previous reports of worsened perinatal outcomes among PHIV WLWH.
Prenatal Genetic Diagnostic Testing in the Era of Cell Free Fetal DNA For Aneuploidy Screening [10D]
Authors: Enakpene Christopher A. , Tan C. Danielle , Morgan Tamandra , Sutherland Monique B. , DiGiovanni Laura M. , Della Torre Micaela 
Published: May 2019

INTRODUCTION:
Prenatal screening for fetal aneuploidy has improved tremendously since the incorporation of cell-free DNA (cfDNA) in to the genetic screening armamentarium. Despite its improved detection rate of aneuploidy, this remains a screening tool and not designed to provide diagnostic information. This study aimed to assess whether initiation of cfDNA screening at the University of Illinois at Chicago (UIC) in January 2012 influenced the acceptance of prenatal diagnostic testing in at-risk women.

METHODS:
Retrospective study of two cohorts of women who received prenatal genetic counseling at UIC: pre-cfDNA era from January 2010 to December 2011 and cfDNA era from January 2012 to December 2016. Charts of eligible patients were reviewed; demographics, indications for genetic counseling and acceptance of diagnostic testing were analyzed. Statistical tests: Chi-square, Fisher exact test, Student t-test, bivariate and multivariate analysis were utilized.

RESULTS:
A total of 2371 women had genetic counseling at UIC from 2010 to 2016; 629 prior to cfDNA and 1741 after. There were 319 women who had diagnostic testing, 168 (26.7%) during pre-cfDNA era vs. 151 (8.7%) in the cfDNA era, RR 4.0 (95% CI 3.1-5.0), p<0.001. Multivariate analysis using Mantel-Haenszel test revealed that pregnant women prior to availability of cfDNA were more likely to pursue prenatal genetic diagnostic testing, and it remained statistically significant even after controlling for confounders, RR 1.20 (1.18-1.23), p<0.001.

CONCLUSION:
Advent of cfDNA as prenatal screening was associated with decreased utilization of diagnostic prenatal testing in women whose offspring were at risk of chromosomal abnormalities.
Rates of Neonatal Sepsis by Maternal Diabetes and Chronic Hypertension [12D]
Authors: Birch Mary Nienow , Frank Zoë , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
The purpose of this study is to characterize the rates of neonatal sepsis among infants born to mothers with diabetes mellitus, gestational diabetes, and chronic hypertension.

METHODS:
This is a retrospective cohort study of non-anomalous, singleton and twin deliveries in the US. We compared rates of sepsis among infants born to mothers with diabetes mellitus, gestational diabetes, and chronic hypertension to infants born to healthy mothers. Results were analyzed using Pearson Chi-Squared tests to control for maternal race, maternal age, insurance status, education level, diabetes, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age.

RESULTS:
Rates of neonatal sepsis were higher among infants born to mothers with diabetes mellitus and gestational diabetes than among infants born to mothers without diabetes (p<0.001). Diabetes mellitus yielded an odds ratio of 1.31 (95% CI 1.18-1.44) for neonatal sepsis. Gestational diabetes yielded an odds ratio of 1.17 (95% CI 1.12-1.22) for neonatal sepsis. Rates of neonatal sepsis were higher among infants born to mothers with chronic hypertension than among those born to healthy mothers (p<0.001). Chronic hypertension predicted neonatal sepsis with an odds ratio of 1.09 (95% CI 1.00-1.19).

CONCLUSION:
Infant rates of sepsis increase with maternal diabetes mellitus, gestational diabetes, and chronic hypertension. Maternal diabetes increases risk of neonatal sepsis independent of maternal race, maternal age, insurance status, education level, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age. Future research is needed to provide a causative explanation of the relationship between maternal diabetes, chronic hypertension, and neonatal sepsis.
Recumbent Versus Upright Positioning During Labor With an Epidural: A Cost-Effectiveness Analysis [13D]
Authors: Packer Claire , Hersh Alyssa R. , Greiner Karen S. , Gallagher Alexandra , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
A recent study, the BUMPES trial, found that recumbent positioning in labor for women with a low-dose epidural resulted in decreased time (minutes) of the second stage of labor and an increased number of spontaneous vaginal deliveries. We sought to examine the cost-effectiveness and outcomes associated with laboring upright versus recumbent position during the first delivery and its effect on the subsequent pregnancy.

METHODS:
We designed a cost-effectiveness model using TreeAge software comparing outcomes in women with a low-dose epidural who underwent labor in upright versus a recumbent position. We used a theoretical cohort of 1.1 million women. Outcomes included mode of delivery and maternal death in the index pregnancy, and mode of delivery, maternal death, uterine rupture and hysterectomy in the subsequent pregnancy. We measured cost and quality-adjusted life years (QALY) for both pregnancies. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY.

RESULTS:
We found that women using low-dose epidural anesthesia laboring in the recumbent position during her first labor resulted in fewer cesarean deliveries and reduced costs and improved QALYs for the first and subsequent deliveries. In our theoretical cohort, laboring in the recumbent position led to 38,190 fewer cesarean deliveries, 11 fewer maternal deaths, 66 fewer uterine ruptures, and 18 fewer hysterectomies, saving $165 million with 231,000 increased QALYs across both pregnancies (Table 1).

CONCLUSION:
Laboring in a recumbent position with a low-dose epidural is a no-cost intervention that leads to improved outcomes, decreased costs and increased QALYs during the first and second delivery.
Fetal Pressure Injury After Labor Augmentation With Foley Bulb Catheter: A Case Report [15D]
Authors: Kennedy Amantia , Vallely Jaxon , Kicklighter Stephen , Petri Nicholas 
Published: May 2019

INTRODUCTION:
Use of Foley bulb catheter is a common procedure for labor induction due to its efficacy and safety. In this report, we present the first case of fetal pressure injury as a result of labor augmentation with a Foley bulb catheter.

METHODS:
A 32-year-old primigravida at 35w0d gestation was admitted for induction of labor due to preterm premature rupture of membranes. Her pregnancy was significant for insulin controlled gestational diabetes. A Foley balloon was placed through the cervix, and inflated with 60cc of saline. 5 hours into the induction, the Foley balloon was noted to be behind the infant's neck, and was removed by deflating the balloon. The infant was delivered atraumatically via cesarean section hours later due to failure to progress. Initial exam was unremarkable aside from two dark macular areas at the base of the occiput and upper scapular area. At 32 hours of life there was significant subcutaneous swelling, central necrosis, and continued serous discharge. At this time, the lesion was determined to be an unstageable pressure injury.

CONCLUSION:
Intrauterine devices, including Foley bulb catheters, can provide external pressure to the fetus that can increase the risk of pressure injury development. In smaller fetuses, altered fetal descent and positioning can lead to this pressure being applied over surfaces that are more susceptible to pressure injury, such as the occiput. While this is the first reported case, the safety and standard practices of premature labor augmentation with a Foley bulb catheter should be further evaluated.
Risk Factors for the Development of Antepartum & Postpartum Depression in Patients Hospitalized During Pregnancy [16D]
Authors: Goodwin Alexandra I. , Welchman Caroline L. , Mead Julia , Hines Katherine Neuffer , Quinn Kristen H. 
Published: May 2019

INTRODUCTION:
Postpartum depression is a recognized public health issue that affects 1 in 9 women nationally. However, less is known about antepartum depression in women, especially those hospitalized during their pregnancies.

METHODS:
This is a prospective cohort study that analyzes how certain characteristics influence the likelihood of pregnant women to develop anxiety and depression during their hospitalizations and in the postpartum period. Patients completed the Edinburgh Postnatal Depression Scale (EPDS) on admission and six week follow-up and an additional questionnaire.

RESULTS:
Of 93 women, 33% had a positive EPDS on admission. For the 49 women with six week follow-up data, 20% had a positive EPDS. High EPDS on admission was not correlated with high EPDS on follow-up. Number of living children, and maternal cause for this admission were correlated with higher EPDS scores on admission, and spirituality, greater gestational age, and fetal cause for this admission were correlated with lower EPDS scores. At six week follow-up visits, NICU admission during this pregnancy and previous hospitalization in pregnancy were associated with higher EPDS, and number of days in the NICU during this pregnancy was associated with lower EPDS scores.

CONCLUSION:
There are many unmet needs for women during pregnancy and in in the postpartum period. It is therefore imperative that we include depression screening as a routine part of admission for high risk pregnancies. Additionally, by identifying certain factors that may prevent or predispose women to depression, we can better screen patients who may benefit from increased psychosocial support surrounding their pregnancy.
The Compliance of a Patient Safety Bundle for Management of Morbidly Adherent Placenta [21D]
Authors: Quist-Nelson Johanna Rachel , Crank Aislinn , Quist Arbor , Kim Christine , Richard Scott , Roman Amanda 
Published: May 2019

INTRODUCTION:
A recent expert review recommended the establishment of centers of excellence for care of patients with morbidly adherent placentas (MAP) as a primary method to improve outcomes. Our objective was to evaluate the compliance with a patient safety bundle for MAP by comparing pre and post-protocol time periods.

METHODS:
We performed a retrospective cohort study of singleton patients who had suspected or pathologically diagnosed MAP between January 2007 and June 2018. In June 2015 our tertiary center implemented a patient safety bundle for the management of MAP. This bundle involved a multidisciplinary approach, betamethasone administration, joint management by gynecologic oncology and maternal-fetal medicine intraoperatively after the placement of pre-operative internal iliac arterial occlusion balloon catheters by interventional radiology. The bundle also incorporated intraoperative blood salvage device. The primary outcome was incorporation of all 6 of the components of the bundle into a MAP cesarean hysterectomy: 1. Betamethasone 2. Gynecologic oncology 3. Preoperative balloon catheters 4. Blood salvage device in the operating room 5. Vertical skin incision 6. Fundal or high transverse hysterotomy.

RESULTS:
There were 41 cases of suspected and/or pathologically confirmed MAP during the study period. There were significantly more suspected MAP cases in the post protocol period (31.8% vs 89.5%, p<0.0001). Cesarean hysterectomy was performed for all patients. Compliance with of all components of the patient safety bundle was higher in the post-protocol group (4.5% vs 63.2%, p<0.0001).

CONCLUSION:
A patient safety bundle has improved compliance and standardized the execution of the multidisciplinary management of MAP.
Using the New Definition of Intraamniotic Infection: Is There Morbidity in the Women Left Out? [27D]
Authors: Smith Megan , Daifotis Helen , Denoble Anna Elisabeth , Dotters-Katz Sarah Kathleen 
Published: May 2019

INTRODUCTION:
Recently, The American College of Obstetricians and Gynecologists updated definitions for intraamniotic infection (IAI): maternal fever (greater than/equal to 38.0C) and 1 or more symptom (fetal tachycardia, maternal white blood cell count >15,000/mm3, purulent discharge). Treatment is no longer recommended for women with fever <39.0 and maternal tachycardia or fundal tenderness (prior chorioamnionitis criteria). Our study compares postpartum infectious morbidity among women meeting chorioamnionitis criteria to women with IAI.

METHODS:
Retrospective cohort of women delivering vaginally at a single academic center. Demographics, antepartum, and intrapartum characteristics of women who met diagnostic criteria for chorioamnionitis were compared to those meeting IAI criteria using bivariate statistics. The primary outcome was postpartum infectious morbidity (PIM): endometritis, perineal infection, sepsis, urinary tract infection (UTI), and pyelonephritis. Backward-stepwise elimination was used to estimate odds of primary outcome. This study obtained IRB approval.

RESULTS:
Of the 229 women who previously met chorioamnionitis criteria, 51 (22.3%) did not meet new IAI criteria. Women meeting previous criteria were younger (median age 25 vs 27, P=0.02), more likely to have gestational hypertension (16.0% vs 3.4%, P<0.01), and were less likely to have 3rd or 4th degree lacerations (2.0% vs 13.4%, P=0.02). PIM occurred in 16/229 (7.0%) women overall; 5 (9.8%) in previously included group, and 11 (6.2%) with IAI. No difference in antibiotic receipt was observed. After adjusting for confounders, there was no difference in odds of PIM (aOR 1.65, 95% CI 0.55-4.99).

CONCLUSION:
Among women who met previous criteria for chorioamnionitis, but not for IAI, postpartum infectious morbidity is about 10%, and may be higher among those not given antibiotics.
Referral Patterns for Gynecologic Oncology Consultation [29D]
Authors: Madeka Isheeta , Burnett Brian A. , Shalowitz David I. 
Published: May 2019

INTRODUCTION:
Women may experience worse outcomes from gynecologic cancers from delays in timely referral; however, care pathways for these patients are not well described. This study investigates the referral timeline of patients with suspected gynecologic cancers to identify opportunities for improved triage to subspecialist care.

METHODS:
50 consecutive patients seen at the Wake Forest Comprehensive Cancer Center for suspected malignancy or hyperplasia/dysplasia were identified. Clinical characteristics, demographics, number and sequence of providers seen for the patient's complaint, as well as time between evaluation, treatment, and referral were abstracted from the medical record. Descriptive statistics and logistic regression analyses were performed.

RESULTS:
Mean patient age was 58.5 years (SD=15.3). Mean distance traveled for care was 30 miles (SD=25). Disease sites included uterine corpus (n=27, 54%), ovary/fallopian tube/peritoneum (n=9, 18%), vulva (n=6, 12%), uterine cervix (n=5, 10%), and vagina (n=3, 6%). Referrals to gynecologic oncology were initiated by obstetrician-gynecologists (76%), family practitioners (12%), and emergency physicians (4%). 30% (N=15) of patients saw 2+ providers prior to gynecologic oncology referral. Mean interval between first evaluation and referral to gynecologic oncology was 39.3 days (SD=62.8). Mean interval between first evaluation and treatment was 75.9 days (SD=72.9).

CONCLUSION:
The >5 week interval between initial evaluation and referral to a gynecologic oncologist should be reduced through expeditious recognition of signs and symptoms concerning for malignancy. Additionally, education for non-obstetrician-gynecologists should target reducing the 30% of patients seen by multiple providers before gynecologic oncology evaluation. Factors associated with the highest risk for delays in care remain unclear.
Role of Cytochrome P450 Enzymes in the Maintenance of Breast Cancer Metastasized to the Bone [30D]
Authors: Chaudhari Sonal , Esteb Christopher , Chang Yu-Ting , Jones Richard 
Published: May 2019

INTRODUCTION:
Metastasis of cancer cells causes most cancer-related deaths, prompting interest in its molecular mechanisms. Cancer homeostasis depends on the tumor microenvironment. Interactions between malignant cells and surrounding stroma contribute to cancer processes, including carcinogenesis and resistance to therapy. For example, multiple myeloma and leukemia cells can be protected from systemic chemotherapy by stromal cytochrome P450 enzymes (CYPs) that are found in the bone marrow (BM). We hypothesized that stromal CYPs protect solid tumors metastases to the BM.

METHODS:
We used a conditioned media model to mimic tumor microenvironment, asking whether a human BM mesenchymal stroma cell line can affect growth of a breast adenocarcinoma metastatic cell line (MCF7).

RESULTS:
We first established that the IC50 of Doxorubicin of MCF7 cells is 50nM, a concentration which also preserved growth of stromal cells. We found that concomitant treatment of Doxorubicin and Clarithromycin (a CYP3A4 inhibitor) sensitized MCF7 cells in stromal conditioned media more than treatment with only Doxorubicin, while it had no such effect in stroma-free conditions. Preliminary results also show that the concomitant treatment of Doxorubicin and Clarithromycin rescued the sensitivity of MCF7 cell line to Doxorubicin in stromal conditioned media, while it had no rescue effect in stroma-free cultures.

CONCLUSION:
Our results suggest that breast carcinoma cells are relatively resistant to Doxorubicin in the presence of BM stroma and that this resistance can be overcome by Clarithromycin. Our in vitro data suggest that like its role in hematological malignancies, stroma in the BM microenvironment creates biochemical niches that protect metastases from systemic chemotherapy.