bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Vitamin D Prophylaxis in Pregnancy Decrease the Risk of Adverse Neonatal Outcomes? [33N]
Authors: Persad Malini D. , Ly Victoria , Herrera Kimberly , Demishev Michael , Quirk J. Gerald , Garretto Diana 
Published: April 2018

INTRODUCTION:
Maternal vitamin D deficiency has been associated with adverse neonatal outcomes including preterm birth, immunosuppression, infection, low birth weight, neonatal seizures, asthma and fractures. We set out to determine if antepartum vitamin D prophylaxis decreases the risk of adverse neonatal outcomes.

METHODS:
A prospective cohort study was performed at a university hospital between October 2016 to July 2017. Included in the study were women with a confirmed intrauterine pregnancy, between 12-16 weeks gestation. Excluded from the study were women taking vitamin D supplements prior to enrollment, diagnosed with a malabsorption disorder, or carrying a fetus with a known anomaly. Women were assigned to receive vitamin D 3000IU daily or no supplement in addition to prenatal vitamins. Participants were routinely assessed for medication compliance. Neonatal factors were collected and compared between those who were compliant and those who were not. Adverse neonatal events were defined as preterm birth, Apgar score < 5 and 7 at 1 and 5 minutes respectively, NICU admission, or fetal death. Parametric and nonparametric statistics were used to compare groups.

RESULTS:
72 women were included in the study. There was no statistically significant difference in demographic characteristics between groups. Women receiving vitamin D delivered at a statistically significant greater gestational age, with no deliveries occurring prior to 34 weeks gestation. There was no difference in adverse neonatal events.

CONCLUSION:
Vitamin D prophylaxis in pregnancy may decrease the risk of preterm birth.
Behcet’s Disease and Pregnancy: Obstetrical and Neonatal Outcomes in a Cohort of 12 Million Births [34N]
Authors: Lee Seohyuk , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie A. 
Published: April 2018

INTRODUCTION:
Behcet’s disease (BD) is a rare inflammatory disorder for which limited and contradicting data exists in the context of pregnancy. This study aimed to estimate the prevalence of BD in pregnancy and to evaluate the associated maternal and fetal outcomes.

METHODS:
Using data collected by the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from the United States between 1999 and 2013, we performed a population-based retrospective cohort study consisting of deliveries that occurred during this time period. ICD-9 codes were used to identify deliveries underwent by women with and without BD. We calculated the prevalence of BD in pregnancy and conducted multivariate logistic regression to estimate the adjusted effects of BD on maternal and fetal outcomes.

RESULTS:
We found an overall prevalence of 1.14 cases per 100,000 births between 1999 and 2013, rising from 0.5 to 2.4 per 100,000 births over the 14-year study period. Women with BD demonstrated a more than two-fold greater chance of being admitted to a hospital during pregnancy (p<0.0001), and were more likely to be Caucasian, have private medical insurance, be of the third income quartile, and deliver at an urban teaching hospital. Women with BD were at increased risk for preterm labour (OR5.95, 95%CI1.47-24.12), and venous thromboembolism postpartum (OR15.22, 95%CI7.03-32.92), while their newborns were more likely to be born prematurely (OR1.73, 95%CI1.02-2.93).

CONCLUSION:
BD is associated with a greater risk for adverse maternal and fetal outcomes in pregnancy. Appropriate thromboprophylaxis during pregnancy should be considered given the increased risk for venous thromboembolism.
Preferences of Pregnant Women and Family Members for Maternal-fetal Health States: A Cross-Sectional Study [35N]
Authors: Adesanya Oluwabunmi , Andrejevic Katarina , Wuebbolt Danielle , D'Souza Rohan 
Published: April 2018

INTRODUCTION:
Our objective was to determine whether pregnant women and their family members choose differently when making medical decisions in pregnancy.

METHODS:
We conducted a cross-sectional study on pregnant women with chronic medical conditions and their family members involved in medical decision making, seen at Mount Sinai Hospital, Toronto. Participants were presented with seven vignettes related to the maternal and fetal outcomes related to the use of anticoagulants in pregnancy. Preferences values were obtained between 0-100 (zero representing death and 100 representing perfect health), using the visual analogue scale (VAS) and the standard gamble (SG).

RESULTS:
32 pregnant women, 31 family members, and 32 pairs completed the study. The median age for pregnant women and their family members was 32.5 and 35 years respectively. Most were in partnered relationships, Caucasian, of North American descent, educated, employed with combined annual incomes ≥100 000 Canadian Dollars and risk-averse. While preference values obtained from combined interviews by VAS showed no distinct pattern, those obtained by the SG were closer to those of the family member. . The health-state with the highest preference value was “mother ok, minor fetal malformation” while the lowest involved maternal blood clot with either a major fetal malformation or fetal loss.

CONCLUSION:
Preference values for maternal-fetal health-states obtained through shared interviews with pregnant women and their family members are closer to those of the family member than the pregnant woman. Reasons for these differences are being explored as part of a qualitative study.
Adverse Perinatal Outcomes in Mexican Women with Mild Gestational Diabetes Diagnosed by The IADSPG Criteria [39N]
Authors: Cerecedo-Ponce Carmen , Reyes Múñoz Enrique , Martínez Cruz Nayeli , Soriano Ortega Karla , Arce Sánchez Lidia , Ortega González Carlos 
Published: April 2018

INTRODUCTION:
Few studies had evaluated the risk of adverse perinatal outcomes among Mexican women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. The objective of this study is to evaluate the risk of adverse perinatal outcomes (APO) among Mexican women without treatment for mild GDM diagnosed by the IADPSG criteria

METHODS:
Historical cohort study. All participants had universal screening for GDM with a 75g 2h oral glucose tolerance test (OGTT). Group 1:Untreated mild GDM women with one abnormal glucose value during OGTT (fasting 92 and 94 mg/dL,1h <180 or 2h 153 and 154mg/dl) Group 2: Women with normal OGTT (fasting <92 mg/dL, 1h <180 mg/dL and 2h <153 mg/dl) matched by maternal age and pregestational body mass index (BMI). Any type of pregestational diabetes, multiple pregnancy or any other disease were excluded from this research

RESULTS:
We included 282 women per group. The glucose values during OGTT were significantly higher in group 1 in comparison to group 2, (P=0.0001). There were no differences between group 1 and 2, in the incidence of adverse perinatal outcomes as newborn large for gestational age (LGA), preeclampsia, cesarean, preterm birth and premature rupture of membranes. A sub-analysis showed that pregestational BMI >30 kg/m2 was related to higher incidence of LGA

CONCLUSION:
The risk of APO is similar among the Mexican women with mild GDM diagnosed by the IADSPG criteria to those non diabetic pregnant women
Teaching Medical Students About Abortion Through Problem-Based Learning [1O]
Authors: Pomerantz Tali , Patel Pradip , Miller Karen , Ziegler Craig , Hoffmann Jennifer , Bergin Ashlee 
Published: April 2018

INTRODUCTION:
Medical students have limited exposure to women’s reproductive health topics in their first two years of training. A problem-based learning (PBL) module was developed to introduce abortion to second year medical students at the University of Louisville School of Medicine. The study’s purpose was to evaluate students’ knowledge and perceptions of abortion before and after the module.

METHODS:
In February 2017, 159 medical students were divided into 16 small groups and received a case with a woman seeking abortion after diagnosis of Zika infection. Students discussed the case and developed learning objectives in the first session. Groups reconvened after one week to re-evaluate the case. One hundred twenty-seven students completed pre- and post-PBL surveys and 16 facilitators completed post-PBL surveys. Quantitative data were analyzed using SPSS Version 22.0, and qualitative data using Pandit’s version of Glaser and Strauss Grounded Theory.

RESULTS:
Students reported significantly increased knowledge about abortion after the PBL (58% felt informed or very informed after, 30% before. p<0.001). Paradoxically, students’ quiz scores decreased, with mean score dropping from 7.83 to 6.58 (p<0.001). Prevalent themes included professional obligation, patient autonomy, and moral/ethical objections to abortion.

CONCLUSION:
Students appreciated the opportunity to discuss abortion and evaluate the ethical and professional considerations surrounding abortion provision. However, comparison of pre- and post-PBL quiz scores suggest that some foundational content, such as procedural details and gestational limits, were not effectively taught in the PBL setting. Future studies are needed to determine whether didactic education, in addition to PBL, can effectively provide comprehensive abortion education.
Inability to Predict Successful Promotion within 9 Years of Appointment [2O]
Authors: Mastrobattista Joan , Ashton David , Aagaard Kjersti , Monga Manju 
Published: April 2018

INTRODUCTION:
Our objective was to determine factors that correlate with successful promotion from Assistant Professor to Associate Professor within 9 years of appointment.

METHODS:
Faculty demographic characteristics were abstracted from the de-identified faculty database of a large academic obstetrics and gynecology department and correlated with successful promotion from Assistant to Associate Professor within nine years of initial appointment. Fisher exact and t-test were used where appropriate, p<0.05 was considered significant.

RESULTS:
Information about 107 full-time clinical faculty was obtained. 79 faculty had initial appointment as Assistant Professor less than nine years ago and were excluded; data from 28 faculty was used for analysis. 21 were promoted within 9 years. Sex, age at initial appointment, sub-specialization, graduation from a US medical school, graduation from an academic residency, advanced degree prior to appointment, number of publications or funding prior to appointment, administrative or committee work or institution change as an Assistant Professor were not associated with likelihood of promotion within 9 years.

CONCLUSION:
Factors traditionally thought to be associated with timely promotion from Assistant to Associate Professor are not predictive of success in the 21st century.
Performance on the Obstetrics and Gynecology In-Training Examination After Implementation of a New Curriculum [7O]
Authors: Madison Shannon , Lo Nancy , Maxwell Rose , Galloway Michael , Massengill Jason 
Published: April 2018

INTRODUCTION:
The objective of this study is to determine the impact of a new academic curriculum on the Council on Resident Education in Obstetrics and Gynecology In-Training Examination (CREOG-ITE) scores in an American College of Graduate Medical Education (ACGME) accredited obstetrics and gynecology (OB/GYN) residency program.

METHODS:
This is a retrospective cohort analyzing the results of our scholastic preparation program. After scores from the January 2015 CREOG-ITE were released, all residents with a score one standard deviation below the mean, or <180, were placed into the experimental group and met with the same attending every month to discuss key learning objectives. They were compared to the control group of residents with a score >180 who had no additional formal education. Each resident served as her own matched paired internal control.

RESULTS:
Out of 18 possible residents, five were placed into the scholastic preparation program based on CREOG-ITE score <180; two were PGY1 (post-graduate year), two were PGY2 and one was PGY3. The mean improvement in CREOG-ITE score from 2015 to 2016 for the experimental group was 23.2 points (95% CI 12.4-40.5 with P<.001).

CONCLUSION:
The scholastic preparation program was associated with a substantial and statistically significant improvement in CREOG-ITE scores, even when accounting for PGY level. This demonstrates that improvement was not simply a by-product of inherent academic knowledge of a resident further along in training. Accountability to faculty members also played a large role in the program's success. This scholastic preparation program may serve as a model for improving OB/GYN resident education.
A Quality Improvement Project: Resident Engagement with the Medication Reconciliation Process [8O]
Authors: Clifford Caitlin , Bond Brian , Peterson Ashley 
Published: April 2018

INTRODUCTION:
Adverse drug events are injuries resulting from medication use and are associated with increased morbidity and mortality and higher costs. More than 40% of medication errors are believed to result from inadequate medication reconciliation (MR) during admissions and discharges. Historically, MR completion on patient admission to L&D at our institution is estimated to be 50%. Our aim was to evaluate Ob/Gyn resident understanding and compliance with the MR process prior to and following a resident didactics session.

METHODS:
During a didactics session, residents took a multiple choice quiz to evaluate their understanding of MR and then listened to a presentation detailing the process and its significance. MR completion rates for all resident admissions to L&D during the 14 days prior to and the 40 days following the session were calculated. Residents were then emailed individualized report cards detailing their progress. Finally, completion rates for the 26 days following the personalized feedback were calculated.

RESULTS:
Prior to the session, only 41% of residents could correctly identify an adverse drug event and their frequency of occurrence (85% response rate). Prior to the session, 64% of MRs were completed while 99% were completed in the following 40 days (p=0.02). Following personalized feedback, 100% of MRs were completed (p=0.01).

CONCLUSION:
Significant improvements in resident participation in quality measures can be achieved with focused peer interventions. Given that the Institute of Medicine estimates that the average hospitalized patient is subject to one medication error a day, such improvements in MR are likely to substantially improve patient care.
A Hands-On Approach to Hysteroscopy Training [16O]
Authors: Galhotra Sheena , Hammer Karissa , Tam Teresa , Fogg Louis 
Published: April 2018

INTRODUCTION:
Simulation training is an invaluable tool in learning, especially for surgical techniques. There is little research on hands-on hysteroscopic instruction and its effect on resident education. Our objective is to investigate a standardized curriculum for hysteroscopy to improve resident assembly times and familiarity with instrumentation.

METHODS:
A standardized hysteroscopy course was created per ACOG guidelines entailing a lecture and interactive session on hysteroscopy assembly and use. Knowledge improvement was measured by written test scores. Instrumentation proficiency was measured in assembly times and ability to identify parts of the hysteroscope detailed on a checklist. Pre and post lecture tests scores were compared. Three Chicago residency programs were included in the study from 2013 to 2017.

RESULTS:
Data points were assessed using a repeated measures analysis of variance. A statistically significant difference of 15.18% (N=42, p< 0.001) improvement between pre and post test scores was seen. This increase did not depend on PGY level (p= 0.188) but only exposure to curriculum. Assembly time decreased by 1.15 minutes (N= 38, p= 0.004). Checklist completion increased by 17.22% (N=38).

CONCLUSION:
The standardized curriculum made significant improvement in resident knowledge of hysteroscopy and familiarity with instrumentation. This was demonstrated by improved written test scores, assembly times and checklist completion in all years of training. The impact of such a hands-on learning course can be applied more widely to other residency programs to improve education in hysteroscopy.
First Trimester Fasting Plasma Glucose Screen in Advanced Maternal Age to Detect Pre-existing Glucose Intolerance [22O]
Authors: Waites Bethany T. , Walker Allison R. , Skeith Ashley E. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
Women of advanced maternal age (AMA) are at increased risk of diabetes in pregnancy. Screening for impaired fasting glucose in the first trimester can result in earlier diagnosis and treatment of pre-existing glucose intolerance. Our study examined the cost-effectiveness of first trimester fasting plasma glucose (FPG) screening in AMA women.

METHODS:
A decision analysis model was created using TreeAge2017 software to compare pregnancy outcomes between AMA women who undergo a first trimester FPG screen versus those who undergo second trimester screening alone. Outcomes examined included intrauterine fetal demise, preeclampsia, preterm delivery, neonatal death, cerebral palsy, cost, and quality adjusted life years (QALYs) of the mother and neonate. Probabilities, utilities, and costs were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY. Univariate analyses were used to investigate the impact of screening positivity.

RESULTS:
In a theoretical cohort of 10,000 AMA women, first trimester FPG screening was cost-saving, more effective and more cost-effective than traditional second trimester screening alone, with a cost-effectiveness ratio of $59.96 per QALY. Earlier detection resulted in lower incidence of preeclampsia and fewer preterm deliveries, intrauterine fetal demises, and neonatal deaths. Using a threshold of $100,000 per QALY, sensitivity analysis revealed that early screening was effective even when the cost of screening is increased 300-fold or the incremental cost of initiating diabetes treatment in the first trimester is increased 200-fold.

CONCLUSION:
First trimester FPG screening in advanced maternal age is cost-effective and allows for earlier diagnosis, treatment, and improved neonatal outcomes compared to second trimester screening alone.
Expired Group-B Streptococcus Cultures Among Women Delivering at or After 40 Weeks Gestation [26O]
Authors: Miller Amanda , Brustman Lois , Waldron Carolyn 
Published: April 2018

INTRODUCTION:
At term, 10 to 30% of pregnant women have vaginal or rectal colonization with Group-B Streptococcus (GBS). Fetal infection at delivery is associated with significant neurologic morbidity and mortality. The Centers for Disease Control recommends GBS collection between 35 and 37 weeks gestation; if taken within 5 weeks of delivery, GBS status at delivery has a positive predictive value (PPV) of 87 to 100%. However, PPV falls to 43% if the culture is taken 6 weeks or more before delivery. We hypothesize approximately one third of patients at our institution delivering past their estimated due date have expired GBS cultures, defined as greater than 35 days old.

METHODS:
A retrospective chart review from July 2015 to July 2016 included all women who delivered at or after 40 weeks gestation. Demographics, delivery information, GBS status, interval between culture and delivery, and neonatal data were collected. Patients were divided by week of gestational age at delivery, and rates of expired cultures compared by chi-square.

RESULTS:
1,393 patients were included; they delivered between 40 and 42 weeks gestation at Mount Sinai West. 660 (47%) had expired cultures at delivery. Of those delivering during week 40, 328/971 (34%) had expired cultures; during week 41, 296/385 (77%) had expired cultures; this difference in expiration rates was significant (P<.0001). Expiration rate was also significantly greater in week 42 than in week 41. No neonatal GBS infections occurred.

CONCLUSION:
Cultures should be repeated after 35 days, or initially collected at 37 weeks, to improve reliability.
Racial Disparities in Maternal and Neonatal Outcomes Among Pregnant Women with Bipolar Disorder [29O]
Authors: Toffey David E. , Chatroux Louisa R. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
We sought to determine the differences in pregnancy outcomes among white, black, Hispanic, Asian/Pacific Islander, Native American women with bipolar disorder.

METHODS:
A retrospective cohort of 3,344 women with bipolar disorder and singleton, non-anomalous gestations was used to examine maternal and neonatal outcomes, assessed according to race. Maternal outcomes included gestational diabetes (GDM), chorioamnionitis, postpartum hemorrhage (PPH), and preeclampsia/eclampsia (abbreviated “Any PET”). Neonatal outcomes included preterm birth (divided into <37, <34 and <32 weeks gestational age), respiratory distress syndrome (RDS), and jaundice. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Compared to white women, and after controlling for confounders, Asian/Pacific Islander women were more likely to develop GDM, and chorioamnionitis, and trended towards higher rates of PPH. Additionally, black women trended towards higher rates of PET. Compared to neonates of white women, neonates of black women were more likely to be delivered preterm before 37, 34, and 32 weeks gestational age, and had higher rates of RDS. Additionally, Asian/Pacific Islander neonates trended towards higher rates of jaundice.

CONCLUSION:
Pregnancies of non-white women with bipolar disorder are associated with higher rates of obstetric and neonatal complications than pregnancies of white women, with specific complications and rates varying across races. This data may suggest disparities exist in management of pregnant women with bipolar disorder across different races.
Using a Cadaveric Model to Map the Epigastric Artery [39O]
Authors: Han Michelle , Yu Steve , Peacock Warwick , Chang Grace 
Published: April 2018

INTRODUCTION:
Injury of the vessels of the anterior abdominal wall occurs in 0.2-2% of laparoscopic surgeries. The purpose of this study is to use surface landmarks on the abdominal wall of cadaver models to map out areas of safe trocar placement to avoid the inferior and superior epigastric arteries.

METHODS:
The inferior and superior epigastric arteries were dissected bilaterally in twenty formalin fixed cadavers. The rectus sheath was divided for adequate exposure of the entire length of the arteries from the pubic bone to the costal margin. Two reference points were defined. Point A was halfway between the umbilicus and the anterior superior iliac spine. Point B was 3cm below the costal margin on the midclavicular line (known as Palmer’s point on the left side). The distance from point A and point B to the inferior epigastric artery and superior epigastric artery, respectively, were measured bilaterally.

RESULTS:
Twenty formalin-fixed cadavers were dissected, for a total of forty epigastric arteries. Twelve female and eight male cadavers were included. The mean distance from point A to the inferior epigastric artery was 1.6 +/- 1.0 cm. The artery was always on or medial to point A. The mean distance from point B to the superior epigastric artery was 1.1 +/- 0.6 cm. The artery was always on or medial to point B.

CONCLUSION:
In trocar placement during laparoscopic surgery, staying lateral to a vertical line drawn from point A to point B is very likely to avoid the inferior and superior epigastric artery.