bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer Panel Sequencing to Guide Personalized Therapy of Breast and Gynecologic Cancers [32A]
Authors: Li Shuyu , Gross Susan Joy , Donovan Michael , Sebra Robert , Housman Laura , Chen Rong 
Published: April 2018

INTRODUCTION:
Recent genomic studies have demonstrated significant heterogeneity in breast and gynecologic cancers, characterized by distinctive genomic profiles in individual patients that could affect treatment responses. The aim of this study was to determine what percentage of patients may have findings that are of potential clinical consequence.

METHODS:
We analyzed 56 tumor samples from 32 breast cancers and 24 gynecologic cancers (ovarian, uterine, cervical) using the Ion AmpliSeq Hotspot Panel v2 or the Oncomine Comprehensive Assay v2 to identify somatic mutations. We also generated copy number alteration and RNA-sequencing data to further characterize the tumors.

RESULTS:
TP53 was the most frequently mutated genes in this cohort, consistent with genomic sequencing studies by TCGA and ICGC. Mutations with therapeutic implications were identified in many cases. PI3-Kinase pathway is likely activated in 31% and 42% of the breast and gynecologic cancers respectively due to PIK3CA activating mutations, PTEN loss and/or TSC1 loss. We also observed EGFR exon-20 insertions in 3 breast tumor samples, representing a novel mechanism of activating the ERK pathway in breast cancers.

CONCLUSION:
Given that everolimus has been approved by the FDA for post-menopausal, advanced hormone-receptor positive, HER2-negative breast cancers, and in light of recent promising results from several clinical trials of PI3-Kinase pathway inhibitors in breast, ovarian, and uterine cancers, breast and gynecologic cancer panel sequencing in precision oncology holds promise for more directed therapies, clinical trial recruitment and future research.
Addressing Weight Management Among Endometrial Cancer Survivors [34A]
Authors: McKay Isabelle , Robinson William 
Published: April 2018

INTRODUCTION:
Gynecologists who practice in areas with a high burden of obesity are particularly affected by the challenge of weight management as a component of cancer survivorship. The primary goal of this study was to assess changes in the average BMI among survivors of endometrial adenocarcinoma at a high-volume cancer center in New Orleans, Louisiana. We aimed to determine the frequency of weight management interventions and discuss practical measures that gynecologists and oncologists can take to support their patients' attempts at weight loss.

METHODS:
Body Mass Index (BMI) data on 58 endometrial adenocarcinoma survivors seen between 2010 and 2016 was obtained from the Tulane Cancer Registry. BMI's at diagnosis, 6, 12, 24 and 36 months were tracked and compared. Medical records were reviewed for documentation of weight loss interventions and comorbidities, such as diabetes mellitus and hypertension.

RESULTS:
Average BMI at diagnosis or within 6 months of treatment was 39.3 (N: 58). Average BMI at 6, 12, 24, and 36 months was 40.5 (N: 27), 42.9 (N: 20), 41.57 (N: 16), and 39.9 (N: 9), respectively. 8.6% of survivors had chart documentation of weight loss intervention. One third of the women who attended a surveillance visit at 36 months received weight loss intervention. 36.2% and 43.1% of survivors had chart documentation of diabetes mellitus and hypertension, respectively.

CONCLUSION:
This data suggests profound under-utilization of weight management interventions among endometrial cancer survivors. A practical and time-efficient method to encourage these discussions is the use of obesity management tools available through the American Cancer Society and Society of Gynecologic Oncology.
Ovulation Induction for Infertility the Risk of Breast Cancer: A Population-Based Case-Control Study [11B]
Authors: Petrangelo Adriano , Czuzoj-Shulman Nicholas , Tulandi Togas , Azoulay Laurent , Abenhaim Haim Arie A 
Published: April 2018

INTRODUCTION:
There is a well-established interplay between reproductive hormone levels and breast cancer. Questions remain in regards to the potential ovulation-inducing fertility treatments, which elevate serum estrogen and progesterone to supraphysiologic levels the treatment period, to affect breast tumorigenesis.

METHODS:
A population-based case-control study using the Clinical Practice Research Datalink (CPRD) was performed. All cases of breast cancer occurring between 1995-2013 were matched with 10 age-matched controls. Cases and controls were assessed for exposure to clomiphene or in-vitro fertilization (IVF) via their clinical records. Odds ratios and 95% confidence intervals for each exposure were computed using multivariate logistic regression, adjusted for smoking, alcohol use, BMI, oral contraceptive use, hormone replacement therapy and oophorectomy.

RESULTS:
The study population consisted of 27,026 cases of breast cancer and their matched controls, with 1,717 subjects having a history of clomiphene exposure and 1,137 subjects having a history of IVF. Ever-exposure to clomiphene was significantly associated with breast cancer, OR 1.34 95% CI [1.26-1.44]. IVF-exposure was similarly associated with breast cancer, OR 1.52 95% CI [1.40-1.65]. The stratified analysis indicated clomiphene was associated with pre-menopausal cancers (OR 1.59 95% CI [1.47-1.73]) but not post-menopausal malignancies (OR 0.94 95% CI [0.83-1.06]). IVF was associated with both pre- and post-menopausal cancers.

CONCLUSION:
Ovulation induction with clomiphene citrate and gonadotropins increases the risk of breast cancer. Women should be advised of this elevated risk understanding the associated implications.
Does Obesity Affect the Frequency or Severity of Acute Placental Inflammation at Term? [18B]
Authors: Saeed Haleema , Jacques Suzanne , Qureshi Faisal 
Published: April 2018

INTRODUCTION:
Histologic acute placental inflammation, particularly low stage inflammation, is a frequent finding at term. Much of it is sterile inflammation, and its causes are poorly understood. Maternal obesity, a proinflammatory condition associated with adverse obstetrical outcomes, may affect the frequency, stage, or grade of histologic placental acute maternal inflammatory response (MIR) and fetal inflammatory response (FIR) at term.

METHODS:
Histologic acute MIR and FIR, including stage (location of inflammation) and grade (severity of inflammation), were evaluated according to standardized criteria and compared in singleton placentas from 205 obese (BMI>30kg/m2) and 204 non-obese mothers, all delivering at term with labor. Maternal medical records were reviewed.

RESULTS:
MIR was present in 54% of the obese compared to 56% of the non-obese group (p=NS), while FIR was present in 38% of the obese compared to 34% of the non-obese group (p=NS). FIR stage >1 was more frequent in the obese group (25% vs 3%, p<0.001); however, there was no significant difference in MIR stage. MIR grade >1 was more frequent in the obese group (13% vs 3%, p=0.005). FIR grade >1 was present in only 4 cases. Hypertension and diabetes were more frequent in the obese group, with no significant differences in other clinical features evaluated. The majority of mothers were African-American (80%).

CONCLUSION:
Histologic acute FIR stage >1 and MIR grade > 1 were more frequent in the obese group suggesting that obesity may affect placental inflammation and supporting a role for systemic inflammation in adverse obstetrical outcomes associated with obesity.
Signs of Poor Placental Perfusion In Placental Pathology in Stillbirth Fetuses [19B]
Authors: Leftwich Heidi , Nicasio Erica , Masiero Jessica , Novak Brittany , Leung Katherine , Vanguri Vijay 
Published: April 2018

INTRODUCTION:
Over 50% stillbirths have preceding growth restriction. Our objective was to determine whether placental changes commonly seen in fetal growth restriction are associated with placentas of stillbirth infants.

METHODS:
Secondary analysis of a retrospective chart review on singleton placentas January 2011-January 2016. Exclusion criteria were less than 24 weeks’ gestation, multiple gestations, known aneuploidy. Primary outcome was decreased placental weight. Secondary outcomes were infarcts, villitis, fibrin deposition, calcium deposition, villous hypermaturity, meconium staining, intervillous thrombus. Pathology reports, and demographics from the electronic medical records were reviewed. Chi square was used for categorical variables and logistic regression for adjusted analyses.

RESULTS:
3111 placental reports met inclusion/exclusion criteria. There were 78 stillbirths were noted in the study period, 71 (91%) with placenta evaluation. Nineteen (28%) of stillbirths were born SGA at birth. Placentas of stillbirths were more likely to have decreased placental weight (44% vs 20%), more than 2 (54% vs 26%) and 3 placental outcomes (28% vs 7%), p <0.01. Of the 67 with documented fetal weight at delivery, those placentas associated with small for gestational age (SGA) fetus were more likely to have decreased placental weight, infarcts, calcium deposition, and greater than 2 and 3 placental outcomes.

CONCLUSION:
Placentas from pregnancies with stillbirth have increased rates of placental pathology. Those stillbirths born SGA were more likely to have decreased placental weight, infarcts, calcium deposition and greater than 2 and 3 placental outcomes. These placental findings have been associated with poor placental perfusion and may represent cases of placental insufficiency prior to demise.
A Retrospective Study: Performing Opportunistic Salpingectomy at Time of Cesarean at a Community Residency Program [21B]
Authors: Marie Davenport Rachel , Multani Sukhpreet 
Published: April 2018

INTRODUCTION:
The American College of Obstetricians and Gynecologists (ACOG) supports discussing opportunistic salpingectomy at the time of pre-operative counseling period for benign gynecologic surgery. Cesarean section is the most common procedure an obstetrician-gynecologist performs in the United States; however, little data exists regarding performing opportunistic salpingectomies at the time of cesarean delivery. This retrospective study sought to evaluate the safety of performing an opportunistic salpingectomy at the time of cesarean section.

METHODS:
A total of 56 patients with singleton intrauterine pregnancy >37 weeks gestational age undergoing a scheduled cesarean at St. Vincent Women’s Hospital were identified from January 1, 2015 to August 1, 2017. Data was abstracted from electronic medical records. Estimated blood loss (EBL), length of operating room (OR) time, differences in hemoglobin pre and post-operatively, and return to operating room within 30 days were analyzed. Other data abstracted included age, body mass index, gravidity/parity, pregnancy complications (e.g., diabetes), training level of surgeon, and surgical technique.

RESULTS:
The average drop in hemoglobin was 1.25 g/dL. Average EBL was 745cc. The most common method was using a Ligasure device, followed by traditional clamp, cut, and tie. One patient required transfusion postoperatively for hemoglobin of 6.7 g/dL. Average OR time was 99.5 minutes. No patients returned to the OR for complications related to surgery.

CONCLUSION:
Performing bilateral salpingectomy at the time of cesarean section appears to be safe. Physicians performing cesarean sections should offer opportunistic salpingectomies to women at average-risk for developing ovarian cancer.
Enhanced Recovery after Surgery Implementation in a Cesarean Section Population in an Integrated Healthcare System [35B]
Authors: Lee Kimberly L. , Lee Derrick C. , Huang Mengfei , Hunt Eric J. , Hedderson Monique M. 
Published: April 2018

INTRODUCTION:
Enhanced Recovery After Surgery (ERAS) programs are evidence-based care pathways that focus on optimizing pain control, nutrition, fluids, and mobility. We evaluated implementation of a multi-faceted ERAS program among a cesarean section surgical population within Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system. We compared process measures before and after ERAS implementation at two pilot hospitals.

METHODS:
We evaluated changes in perioperative pain management (morphine equivalents and multimodal analgesics), mobility (early ambulation within 12 hours) and nutrition (early feeding within 12 hours), from pre-Implementation (March 2015-August 2015, n=1390 cesarean patients) to post-Implementation (March 2016-August 2016, n=1471 cesarean patients) of the multifaceted ERAS program. All urgent and elective cases were included. We quantified these metrics based on medication administration records, preoperative checklists, and/or nursing shift assessments recorded in the EMR.

RESULTS:
Process metrics among ERAS patients demonstrated significant changes between pre- and post-Implementation phases. The rate of early ambulation increased from 33% to 51% (p<0.001), early postoperative resumption of nutrition increased from 17% to 57% (p<0.001), and opioid consumption decreased significantly from 13.1 mg morphine equivalents to 7.7 mg (p<0.001), while the use of multimodal analgesics increased from 5% to 87% (p<0.001).

CONCLUSION:
ERAS program implementation successfully altered the process-of-care metrics for cesarean section surgical patients across two pilot hospitals. Further research is needed to determine the impact of ERAS implementation on complications and other outcomes following surgery among women undergoing cesarean sections.
A Qualitative Study of Pregnancy and Childbirth Experience for Women with a History of Sexual Trauma [37B]
Authors: O'Rourke-Suchoff Danielle , Sobel Lauren , Holland Erica , Resnick Kirsten , Perkins Rebecca , Bell Shannon L. 
Published: April 2018

INTRODUCTION:
Women with a sexual trauma history are more likely to perceive pregnancy and childbirth as traumatic. Our objective was to identify triggers that provoke anxiety or flashbacks for women with a sexual trauma history in order to design interventions to improve their labor and delivery experience.

METHODS:
Semi-structured qualitative interviews were conducted with 20 adult women who reported a sexual trauma history, and 10 without a sexual trauma history. All delivered since 2014. Interviews focused on antenatal, intrapartum, and immediate post-partum experiences.

RESULTS:
Triggers included language reflective of that used during a past sexual assault, the presence of unfamiliar providers, and cervical exams and vaginal repairs that were not adequately explained. Some women found regional anesthesia helpful, while others were triggered by a perceived lack of control. Women who disclosed their sexual trauma history to prenatal providers expected appropriate documentation so that subsequent providers were aware. Some participants desired elective cesarean section due to their sexual trauma history. Many described pregnancy, childbirth and breastfeeding as healing through the creation of positive connections to their bodies. They found advocates in family, trained birth support and medical staff. Our control group suggests that many of these findings are specific to women with a history of sexual trauma.

CONCLUSION:
Women with a sexual trauma history have unique priorities and needs during pregnancy and childbirth. Discussing medically safe delivery preferences during prenatal care, documenting sexual trauma history and clear communication during exams may improve labor and delivery experiences for this group of women.
Attitudes and Perceptions of Healthcare Providers Regarding the Safe Reduction of the Cesarean Section [7C]
Authors: Shah Ishani , Ogunyemi Dotun , Ronk Anne 
Published: April 2018

INTRODUCTION:
The American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) identified risk factors that increase the likelihood for a cesarean section (C/S). Analysis of these factors can aid in the safe reduction of the C/S rate within an institution.

METHODS:
Surveys comprised of clinical scenarios regarding the ACOG/SMFM C/S risk factors were sent to all providers within a hospital system. 250 surveys were analyzed using profession, experience, multiple hospital system exposure, and malpractice influence as outcome variables. Analysis was performed using Pearson correlation, Student's T-test, Chi-square Analysis, and Levene’s test.

RESULTS:
Baseline results showed that most C/S are done for category 2 fetal heart rate, about 40% of providers practice defensively, and that more providers are willing to speak up to a nurse, as compared to an attending. Significant findings showed that providers with a previous lawsuit are more likely to practice defensively (66.4% vs 47.8%, P-.002) and to speak up when they disagree with a care plan (80% vs 63%, P-.002). Nurses, as opposed to physicians, are more willing to wait during labor rather than support a C/S (91.6% vs 70%, P-.000), but are less likely to speak up (64.1% vs 79.6%, P-.006). More experienced providers are more likely to speak up (85.3% vs 57%, P-.000) and less likely to induce at 41 weeks (19.9% vs 31.5%, P-.021).

CONCLUSION:
These results suggest local risk factors that may be associated with increased C/S rates; this knowledge can be utilized to develop appropriate interventions to safely reduce the C/S rate.
Trends in Psychiatric Education Among Obstetrics and Gynecology Residency Programs: A Program Director Survey [9C]
Authors: Garbarino Abigail H. , Kohn Jaden R. , Coverdale John H. 
Published: April 2018

INTRODUCTION:
One-third of women in the U.S. receive primary care exclusively from Obstetrician/Gynecologists. Recent literature reveals gaps in recognition of common psychiatric issues by Ob/Gyns.

METHODS:
Program directors of 239 Ob/Gyn residencies received a 17-item anonymous questionnaire to assess the status of psychiatric education. Analysis included descriptive statistics, Student’s t-tests, and logistic regression.

RESULTS:
95 programs (40%) responded. 84% offered didactic instruction in psychiatric topics, of which 70% were taught by Ob/Gyn faculty. Few programs covered intimate partner violence (47%), non-obstetric depression (44%), anxiety (43%), medication management (31%), eating disorders (26%), human trafficking (20%), or PTSD (11%). 20% of programs offered an elective rotation.
The most common barriers to psychiatric training were lack of sufficient integration between Ob/Gyn and psychiatry (46%), ACGME surgical requirements (42%), and lack of sufficiently knowledgeable instructors (38%).
81% of program directors did not agree that their residents are fully equipped to identify psychiatric needs in patients; however, only 22% agreed with the addition of an ACGME milestone for mental health. Community programs and those who identified lack of integration as a barrier were more likely to agree with adding a milestone (p=0.003).

CONCLUSION:
Significant gaps exist in psychiatric education of Ob/Gyn residents, and most program directors perceive that residents are not equipped to identify patient psychiatric needs. The most common barrier to providing additional training was a lack of integration between Ob/Gyn and psychiatry; future efforts should be directed towards this. However, the addition of a new milestone would likely meet considerable resistance.
Gestational Age at Delivery in Preeclampsia with Severe Features Stratified by Race [20C]
Authors: Speranza Rosa , Greiner Karen Scrivner , Luck Marissa , Savitsky Leah , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
There are known racial disparities in preeclampsia, but there are limited data exploring the impact of race on gestational age at delivery for preeclampsia with severe features (PE-SF). We sought to describe rates of deliveries by week of gestation in PE-SF stratified by race.

METHODS:
This is a retrospective cohort study of singleton, non-anomalous deliveries from 2005-2008 using linked vital statistics and ICD-9 data. Women self-reported into racial categories of white, black, Hispanic/Latina, Asian/Pacific Islander, or other. We used chi-squared tests to compare outcomes by gestational age and multiple logistic regression to adjust for age, education, insurance status, chronic hypertension, diabetes, and birthweight.

RESULTS:
Of the 2,039,870 births in our cohort, 16,073 (0.79%) were from pregnancies complicated by PE-SF. Delivery rates for PE-SF were highest between 28-32 weeks gestation across all racial categories. Black women had the highest rate of delivery of any week in any race during the 31st week of gestation (12.5%, p<0.001). There was a decrease in rates of delivery in Asian/Pacific Islanders from 7.9% during the 28th week down to 3.3% in the 29th week (p<0.001). After the 37th week of gestation there was a decline in delivery rates across all racial categories and limited variation beyond that point.

CONCLUSION:
There are consistent trends in the rates of deliveries in PE-SF across racial groups when stratified by gestational age, likely reflecting the prevalence of diagnosis by gestational week. Black women have the highest rates of preterm birth and more research should be directed within this racial category.
A Change in Cervical Ripening Agents Leads to a Significant Reduction in Expenditure [33C]
Authors: Juusela Alexander , Nazir Munir , Gimovsky Martin Larry 
Published: April 2018

INTRODUCTION:
Each year approximately 3,000 deliveries occur at NBIMC labor and delivery. Of these deliveries, approximately 700 begin as inductions of labor. In June of 2016 the primary induction medication was switched from dinoprostone $428.53 per insert to misoprostol $1.85 per induction. The purpose of this project was to determine the outcomes in regard to inductions leading to vaginal birth versus cesarean delivery and estimated expenditures per cervical ripening medication.

METHODS:
IRB approval was obtained and then a retrospective chart review of all deliveries at NBIMC from January 1st 2016 until December 31st 2016 was performed with an analysis of successful vaginal deliveries for each induction medication versus failed inductions resulting in cesarean deliveries and the indications for cesarean delivery. The data was extrapolated to estimate the approximated savings from changing induction medication and a comparison for reasons for induction failure.

RESULTS:
There was a no significant difference between the two groups regarding delivery method (misoprostol cesarean delivery 29.72% versus dinoprostone cesarean delivery 35.51%, p-value 0.194). The dinoprostone 10mg vaginal insert was used a single time per induction of labor and cost approximately $428.53. Thus, the 245 inductions had an estimated cost of $104,989.85. In contrast, the misoprostol cervical ripening protocol consisted of misoprostol 25mcg PV for 3 doses followed by misoprostol 50mcg PO for 3 doses. This totaled 225mcg of misoprostol at a cost of $1.85. The total cervical ripening cost of 286 inductions is therefore estimated at $530.35. This is a stark contrast to the single dinoprostone insert costing $428.53. Extrapolating the data to approximately 700 inductions per year: the total cost for dinoprostone would be $299,971 versus misoprostol at $1,295, and the savings from switching to misoprostol would be $298,676.

CONCLUSION:
Changing the induction cervical ripening medication from dinoprostone to misoprostol has saved the department and NBIMC approximately $298,676 per year with a statistically significant similar successful induction rate. Our study has led to changing our institutions cervical ripening agent to a more cost effective agent with a similar delivery outcome.