bluuebunny/crossref_metadata_2025_split huggingface dataset:
Congenital Syphilis Rates Correlate With Increased Maternal Syphilis Rates in a New Orleans Tertiary Care Center [30I]
Authors: Berra Alexandra , Roitsch Charles , Fontenot Virginia E. , Kopkin Rachel , Rodrigue Eliza Langford , Stafford Irene A. 
Published: May 2019

INTRODUCTION:
In recent years, the number of congenital syphilis (CS) cases in the United States increased from 8.4 to 11.6 cases per 100,000 live births. In 2017, Louisiana reported the highest rates of CS in the country. This study aims to determine provider management patterns for newborns at risk for CS.

METHODS:
All cases of maternal syphilis from 2013-2017 at Touro Infirmary in New Orleans, LA were identified using ICD-9 and ICD-10 codes. Women who were serofast were excluded. Seventy-three mother child pairs were identified with available records. Charts were reviewed for stage of syphilis, treatment regimen during pregnancy, interval from treatment to delivery and other variables. Newborn information including neonatal intensive care unit (NICU) admission, physical and radiologic exam findings, nontreponemal titers, treatment regimen and other outcomes were recorded. Variables were summarized using means with standard deviations and frequencies expressed as percentages.

RESULTS:
Of the 73 newborn charts reviewed, 8.96% (n=6) were found to be symptomatic, however only 83.3% of them were admitted to the NICU. Only 29.6% of infants were adequately treated with an extended penicillin regimen if the mother did not receive appropriate treatment. Furthermore, only 63.0% of newborns had a nontreponemal titer performed. Only twenty six percent (n=16) of asymptomatic newborns (n=61) considered low risk for CS received single dose penicillin.

CONCLUSION:
With the rising rates of both maternal and CS, strict adherence to the CDC guidelines for treatment of CS must be maintained. Attention to maternal treatment guidelines and vigilant follow up are necessary to ensure treatment success.
Does Mode of Terbutaline Administration Improve Success of External Cephalic Version? [34I]
Authors: Razavi Armin , Iftikhar Pulwasha , Chan-Akeley Rosalyn , Skupksi Daniel 
Published: May 2019

INTRODUCTION:
There is a high rate of cesarean delivery (CD) for breech presentation and external cephalic version (ECV) is a means to allow for vaginal delivery and thus reduce CD. Our primary objective was to compare the success rate of ECV with subcutaneous versus intravenous (IV) terbutaline.

METHODS:
This was a retrospective cohort of women with singleton fetuses ≥ 36 weeks of gestation undergoing ECV at our institution from May 2007-February 2018. Our protocol from 2007-2013 included a single dose of subcutaneous terbutaline (0.25 mg) followed by ECV. From March 2013 until February 2018, our protocol was a single dose of intravenous terbutaline (0.25 mg) prior to ECV attempt. Statistical analysis included Student t test, Mann-Whitney U, chi-squared and Fisher exact as appropriate. Logistic regression was used to determine which factors affected success.

RESULTS:
Of the 283 patients who underwent an attempted ECV, 111 received subcutaneous and 172 received IV terbutaline. The overall success rate was 65%. The success rate was 71% in the subcutaneous group vs 61.6% in the IV group (p=0.183). Lateral position of the fetal spine (p=0.02) and increasing AFI (p<0.005) were found to be predictive of success by logistic regression analysis. Maternal age, BMI, parity, placenta location, gestational age, head position, breech time and neonatal birth weight did not influence success.

CONCLUSION:
We did not find a difference in success rate of ECV when terbutaline was administered subcutaneously versus intravenously. We found that lateral fetal spine position and increasing AFI were independently associated with version success.
Early Versus Late Onset Preeclampsia: Maternal Characteristics and Severe Features [38I]
Authors: Beeraka Sridivya S. , Rincon Monica , Burwick Richard M. 
Published: May 2019

INTRODUCTION:
Early Onset and severe preeclampsia contribute disproportionately to adverse pregnancy outcomes. It remains unclear which maternal characteristics and severe features are associated with early-onset disease. Therefore, we sought to compare specific severe features of early-onset preeclampsia (EOP) vs late-onset preeclampsia (LOP).

METHODS:
Retrospective cohort study among subjects with a diagnosis of preeclampsia (PET) that delivered ≥23 weeks gestation at a single institution (October'13-April'18). Subjects were identified by ICD-9 and 10 codes, followed by chart review to confirm diagnostic accuracy and stratified into two groups by gestational age: 1) EOP <34 weeks; 2) LOP ≥34 weeks. Maternal characteristics and severe features of preeclampsia were abstracted from charts. Data was analyzed by Chi-squared and t-test, and multivariable logistic regression, with α±=.05.

RESULTS:
Among 10,833 deliveries, 781 (7.2%) had PET. Of these, 102 (13.1%) had EOP and 679 (86.9%) had LOP. The following maternal characteristics were significantly more common in EOP: Black race (P=.001), multiple gestation (P<.001), chronic hypertension (P<.001), and diabetes mellitus (P=.001). After multivariable logistic regression, these remained independent risk factors for EOP, with Black race having the strongest association (OR 4.9, CI 1.6-15.4, P=.007). Remarkably, all severe features were more common in EOP. After multivariable regression, the severe features most strongly associated with EOP were: severe systolic blood pressure, aspartate transaminase > 70 U/L, severe headache, and creatinine >1.1 mg/dl.

CONCLUSION:
EOP is characterized by specific maternal and clinical features. Black women have a nearly 5-fold increase in the odds of EOP warranting further attention.
Effect of Labor Analgesia on Fetal Heart Tracing in Term Pregnancies: Nitrous Oxide Versus Epidural [40I]
Authors: Earhart Kimberly Rhea , Cuff Ryan D. , Hebbar Latha , Goodier Christopher , Mateus Nino Julio Fernando 
Published: May 2019

INTRODUCTION:
The objective of this study is to determine whether the use of nitrous oxide (N2O) for analgesia is associated with fewer acute fetal heart rate (FHR) abnormalities than epidural analgesia.

METHODS:
This is a prospective cohort study of full-term singleton pregnancies in labor at the Medical University of South Carolina conducted after IRB approval. Women chose their method of analgesia. FHR tracings were compared pre and post analgesia between N2O and epidural groups. Independent investigators interpreted the fetal strips following the NICHD terminology. The primary outcome was acute changes in FHR tracing and the secondary outcomes include short-term maternal and neonatal outcomes.

RESULTS:
The cohort analysis included 68 patients including 19 women in the N2O group and 49 in the epidural group. There were no differences in baseline maternal demographics, parity, maternal BMI, or maternal medical comorbidities between the groups. Admission cervical dilation and membrane status (intact versus ruptured membranes) on admission were similar between the two groups. During the study period 29.4% of women using N2O and 57.4% of women using epidural for analgesia experienced negative acute changes in FHR (P=.04), defined as either a change from moderate or marked variability to minimal or absent, or from an overall Category I to a Category II or III FHR tracing. There were no differences in short-term maternal or neonatal outcomes.

CONCLUSION:
Based these findings, the use of N2O for analgesia during labor was associated with fewer acute FHR abnormalities than epidural analgesia and neither was associated with adverse short-term maternal or neonatal outcomes.
Technology-Driven Prenatal Screening Results Disclosure and Management [9J]
Authors: Arjunan Aishwarya , Ben-Shachar Rotem , Kostialik Jamie , Taber Katie Johansen , Denne Elizabeth , Haverty Carrie 
Published: May 2019

INTRODUCTION:
Non-invasive prenatal screening (NIPS) and expanded carrier screening (ECS) have widened the scope of information available to patients and providers alike, underscoring the importance of timely results delivery. We describe an automated system utilizing online education and tele-genetic counseling to aid women's health professionals in effectively delivering genetic testing results.

METHODS:
Providers are notified upon availability of results. For ECS results indicating a high reproductive risk, patients receive an automated email directing them to schedule a consultation with a laboratory-based genetic counselor. Screen-positive NIPS results are delivered to the ordering provider, who may request that a laboratory-based genetic counselor contact the patient. All other results can be viewed directly by the patient in an online portal with educational resources. Regardless of result type, patients can speak to a genetic counselor, either on-demand or by scheduling an appointment. This study was IRB exempt.

RESULTS:
Through December 2017, 278,318 ECS results and 67,122 NIPS results were issued via the system. Of these, 41,050 patients (15%) ECS patients and 4,673 (7%) NIPS patients elected genetic counseling, resulting in a total of 47,793 consultations. A number of patients electing genetic consultations received negative results (∼50% ECS, 95% NIPS). Patients frequently utilized on-demand services (32% ECS, 70% NIPS). Median consultation duration times were ten minutes and nine minutes for ECS and NIPS results, respectively.

CONCLUSION:
We describe a system that can provide large-scale prenatal genetic testing results delivery, education, and counseling congruent with clinical guidelines; imperative to quality care as uptake grows among the obstetric population.
Opioid Utilization Following Endometriosis Diagnosis: Retrospective Analysis of More Than 100,000 Women [17J]
Authors: Estes Stephanie Jean , Soliman Ahmed M. , Johns Beverly , Lamvu Georgine 
Published: May 2019

INTRODUCTION:
Endometriosis is a chronic gynecologic disorder associated with several pain symptoms. This research evaluated opioids utilization following endometriosis diagnosis.

METHODS:
Women aged 18 to 49 who had one inpatient or 2 outpatient claims with endometriosis ICD-9 or ICD-10 diagnosis codes (617.x or N80.x) between 2013 and 2016 were selected from Symphony Health Claims database. Study sample included women who were not diagnosed with cancer and had continuous medical and pharmacy plan eligibility (at least one pharmacy claim activity per quarter) in 12 months before and after their earliest recorded diagnosis for endometriosis (index date). Descriptive statistics were used to describe the following outcomes in the post-index period (12-months following index date): proportion of women receiving an opioid prescription, number of opioids prescriptions, days of opioids supply, prescriber specialty and opioid initiation and its relationship to receiving surgeries.

RESULTS:
Final analysis included 114,151 patients. Average age at index date was 36.7 (7.9) years. In the post-index period, 60.8% of patient received an opioid prescription. Among opioid users, mean number of opioids prescriptions received was 4.6 (6.7), average days of opioids supply was 64.1 (128.6) and the proportion of patients who received 90+ days of opioid supply were 18.1%. Top physician specialties prescribing opioids were Obstetrics/Gynecologists (27.6%), family practice (23.4%) and internal medicine (9.2%). Among opioids initiators (27%), 2.8% received 90+days of opioids supply and 75.7% had an endometriosis-related surgery in the post-index period.

CONCLUSION:
A significant proportion of women diagnosed with endometriosis used opioids following endometriosis diagnosis.
Transcervical Radiofrequency Ablation of Uterine Fibroids: US Experience From the SONATA Pivotal IDE Trial [22J]
Authors: Hudgens Joseph , Johns D. Alan , Lukes Andrea S. , Forstein David , Delvadia Dipak 
Published: May 2019

INTRODUCTION:
The SONATA Pivotal IDE Trial was a prospective trial in the United States (US) and Mexico of the safety and effectiveness of transcervical radiofrequency (RF) ablation for symptomatic uterine fibroids. This is a subanalysis of the US cohort (125 patients at 21 centers).

METHODS:
Transcervical RF ablation with the Sonata® System was performed on eligible patients with symptomatic fibroids. The 12-month co-primary endpoints were reduction in menstrual blood loss and freedom from surgical reintervention. Symptom severity, quality of life, satisfaction, safety and reductions in fibroid volume were also evaluated.

RESULTS:
125 patients were enrolled in the US cohort. Both co-primary endpoints were met: 65.3% of patients reported ≥50% reduction in menstrual bleeding and 99.2% of patients were free from surgical reintervention. 95% of patients reported reduced menstrual bleeding at 12 months. Significant mean improvements were realized in both symptom severity and health-related quality of life (33.8 points and 45.8 points, respectively; all P<.0001). Mean maximal fibroid volume reduction per patient was 63.8%. There were no device related adverse events. Mean length of stay was 2.5 hours and 50% of patients returned to normal activity within 1 day. Symptom improvement was noted by 97.4% of patients and 98.3% were satisfied, both at 12 months.

CONCLUSION:
Results for US patients in the SONATA Pivotal IDE Trial were identical to, or exceeded, those from the binational cohort. These results support the efficacy and safety of the Sonata System as a new treatment standard for women affected by symptomatic uterine fibroids.
5% Monolaurin Vaginal Gel for the Treatment of Bacterial Vaginosis: A Randomized, Placebo-Controlled Trial [23J]
Authors: Mancuso Abigail Catherine , Widdice Lea , Hughes Brenna L. , Stockdale Colleen K. , Bernstein David , Winokur Patricia 
Published: May 2019

INTRODUCTION:
Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge and standard medical treatment is associated with a high recurrence rate. Monolaurin has antimicrobial effects on vaginal pathogens without affecting lactobacilli sp. We assessed the effectiveness and safety of 5% Monolaurin vaginal gel for treatment of BV.

METHODS:
This multicenter, double-blinded, randomized trial compared 5% Monolaurin vaginal gel to vehicle placebo gel self-administered twice daily for three days. Healthy, non-pregnant, non-breastfeeding women ages 18 to 50 with BV diagnosed by Amsel criteria were enrolled and randomized 2 to 1 (Monolaurin to placebo). The Modified Intent To Treat (mITT) population had Nugent Scores ≥4. Clinical efficacy was defined as resolution of all four Amsel Criteria and therapeutic cure as Nugent Score ≤ 3. Solicited urogenital symptoms and adverse events were collected.

RESULTS:
109 women participated, with 73 randomized to treatment arm and 36 to placebo arm. Although lactobacilli sp. counts increased in the Monolaurin group compared to placebo (1.0x10^7 vs -5.2x10^6), there was no significant difference in achieving clinical cure (P=.42) or therapeutic cure (P=.99) with only 17% of the Monolaurin group and 25% of the placebo group achieving clinical cure, and only 3% of both groups achieving therapeutic cure (mITT population). There was no difference between groups in solicited urogenital symptoms (P=.24) and all were mild to moderate in nature. No serious adverse events were reported.

CONCLUSION:
Short course 5% Monolaurin was well tolerated but no more effective than placebo in curing BV; however, longer courses should be evaluated.
Potential HPV Vaccine Coverage According to Type Specific Papillomavirus Present in Open Population in Mexico [26J]
Authors: Tiran-Saucedo Jose , Garza Humberto , Leon Yvette , Godinez-Burgos Jesus Alfonso 
Published: May 2019

INTRODUCTION:
HPV genotyping is an essential tool for screening of patients with potential risk of developing cervical cancer. Information on the prevalence of genotypes of HPV in Mexico is still limited. The purpose of the study was to evaluate the usefulness of different vaccines against HPV by identifying the most prevalent serotypes in our population.

METHODS:
The study was conducted at the Mexican Institute of Infectious Diseases, Gynecology and Obstetrics in Monterrey, Mexico. The kits used were Innolippa HPV Genotyping Extra I and II, Linear Array HPV Genotyping Test, Seeplex HPV 18 ASE DPO and Abbot Real Time. Patients from 2008 to 2018, who requested an HPV test and patients with positive HPV infection were included.

RESULTS:
We included 816 samples, 524 positives for HPV infection. A total of 957 serotypes were isolated, of which 56.2% are high risk serotypes, 11.7% of probable high-risk, 28.5% low risk and only 3.55% could not be typed. The most prevalent high-risk serotypes were HPV-16 (8.78%), HPV-51 (8.67%), HPV-52 (7.84%), HPV-33 (7.75%), HPV-31 (5.54%). The most prevalent low risk serotype was HPV-6 (6.79%). The coverage of the different types of vaccine was determined according to the serotypes found.

CONCLUSION:
We found that of the first 6 most prevalent serotypes, 5 are high risk and 1 low risk, and of those 5 are included in the HPV9 vaccine, confirming a greater strategic benefit over the other vaccines available to reduce the risk of cancer caused by HPV in our country.
Results of Comprehensive Sexually Transmitted Disease Testing Utilizing an At-Home Kit Over One Year [27J]
Authors: Francis Marra Stankus , Ashley Kristin , Bruno Trudie 
Published: May 2019

INTRODUCTION:
This data set review examined rates of positive sexually transmitted disease (STD) results in women utilizing a consumer-initiated, self-collected STD kit over a twelve-month period.

METHODS:
De-identified data was obtained using SQL queries of EverlyWell's® database for women who took a Women's STD Panel Test from September 2017 through September 2018. A total of 1,003 tests were resulted from 951 unique women, 1 test was excluded for inadequate specimen, and 1,002 tests were analyzed in this study. Age range for this data set is 18 to 76.

RESULTS:
Overall, 21% of women received at least one positive STD result and 1.7% received more than one positive result. The most common STD resulted was Herpes Simplex Type 2 at 17% followed by Chlamydia trachomatis at 3.2%. The largest age group utilizing this platform for testing was 25 to 29 years, 23% of total tests taken. The highest proportion of positives within a single age group was found in 55 to 59 years, 54% of the total women in that group.

CONCLUSION:
In a single review of 1002 at-home STD panel test results, approximately 1 out of 5 women screened positive for at least one STD. At-home STD testing may allow women who would otherwise potentially be under-screened for a variety of reasons, such as age, to easily manage their sexual health testing. Self collected STD testing can easily be utilized by women of all ages to identify infections and seek care between routine gynecological visits.
Are OB/GYN Residents Receiving Adequate Training for Shoulder Dystocia? [29J]
Authors: Choi Jennifer , Mehta Shobha , Bell Theodore , Gherman Robert Brian 
Published: May 2019

INTRODUCTION:
Data are lacking to determine whether residents are competent to manage shoulder dystocia, as the ACGME does not track this condition. We sought to ascertain whether OB/GYN residents felt that they had received adequate training to independently handle shoulder dystocia.

METHODS:
A 25-question web-based survey was electronically disseminated to program directors of all accredited US OB/GYN residency programs. The survey was sent four times on a weekly basis. A Likert scale was used to query the residents with regards to clinical and didactic training experience. Survey monkey and IBM SPSS Statistics were used to analyze the responses.

RESULTS:
Nearly all (97%) of the 116 residents who responded had received formal lecture training and underwent simulation drills (87%), and most (89%) felt that they had received appropriate didactic training. 64% of residents had participated in < 10 total cases of shoulder dystocia. Only 51.7% and 48.3% agreed that they could currently independently perform delivery of the posterior fetal arm and fetal rotational maneuvers, respectively. Approximately half of residents (47%) responded that they had never independently managed a shoulder dystocia from start to finish. Slightly more than one third of residents strongly agreed that after completion of residency training they would feel comfortable independently managing a shoulder dystocia.

CONCLUSION:
Residency programs have incorporated simulation and didactic lectures into shoulder dystocia teaching. This does not appear to have translated into clinical competence in handling this obstetrical emergency.
Characterization of Mobile Applications for Patient Participation in Prenatal Care [33J]
Authors: Garchar Elizabeth , Quiner Trevor Elisha , Rayburn William 
Published: May 2019

INTRODUCTION:
There is great potential for obstetricians to educate and engage patients in using pregnancy-related mobile applications (apps). However, there is no standard method to evaluate the hundreds of applications currently available to identify accurate and complete apps for use prenatally.

METHODS:
We developed a method to systematically search and characterize the primary function of each pregnancy-related app from the Apple App Store. When present, the abilities of each app to allow data entry associated with specific monitoring tasks were listed. Consumer rating of each app, integration of social media, and cost were noted for each app.

RESULTS:
This search resulted in 915 patient-directed apps for use in pregnancy-of which one-third (321, 33.8%) had functions that permitted patient participation in prenatal care through monitoring specific tasks. These apps included the following monitoring functions: fetal movement (74, 8.1%), weight gain (208, 22.7%), contractions (95, 10.4%), diabetes (18, 2.0%), prenatal care (129, 14.1%), and blood pressure (28, 3.1%). Many apps (63, 6.9%) combined multiple monitoring functions with educational material which we characterized as “all-in-one” pregnancy apps.

CONCLUSION:
Obstetricians can use appropriately evaluated mobile apps to encourage patient participation in prenatal care through personalized, self-directed monitoring between prenatal visits. This allows for prospective information gathering and may aid in facilitating shared decision-making and individualized care. This report gives obstetricians an awareness of available apps and their functions, and provides a novel characterization framework for future evaluation of mobile apps. We intend to evaluate the “all-in-one” pregnancy to identify those best suited to introduce to patients.