bluuebunny/crossref_metadata_2025_split huggingface dataset:
The TelAbortion Project: Delivering the Abortion Pill to your Doorstep by Telemedicine and Mail [5E]
Authors: Chong Erica , Raymond Elizabeth , Kaneshiro Bliss , Baldwin Maureen , Priegue Esther , Winikoff Beverly 
Published: April 2018

INTRODUCTION:
In the United States, many women struggle to obtain an abortion due to ever-increasing barriers to access. The TelAbortion Project provides medical abortion directly to women in their homes using telemedicine and mail, enabling them to receive services without going to a clinic. We will report data from the pilot phase of this project, which will be completed by October 2017.

METHODS:
TelAbortion was available in Hawaii, New York, Oregon, and Washington. Interested women contacted implementing sites and interacted with clinicians by videoconference. After obtaining screening tests at radiology and lab facilities close to them, eligible women were mailed packages containing mifepristone and misoprostol. Women took the medications at home, obtained follow-up tests and had another consultation with the clinician.

RESULTS:
Through August 2017, 105 women had a videoconference, 93 had received abortion drugs, and 60 had completed follow-up. Among women who took mifepristone and misoprostol, one had a surgical completion, and no serious adverse events were reported. All women reported being very satisfied or satisfied, and 59 of 60 would recommend this service to a friend. Convenience and privacy were commonly valued features.

CONCLUSION:
Direct-to-patient telemedicine abortion is feasible and can potentially increase access to abortion care in a safe and acceptable manner. Although telemedicine bans and other restrictions are on the rise, more than 60% of all abortions in the US are currently performed in states where this service would be legally feasible. Going forward, we plan to scale up this service to women in other states.
Wake Forest Preterm Birth Prevention Clinic: Is PTB a Modifiable Risk Factor with a Standardized Approach? [11E]
Authors: Quinn Kristen H. , Luper Allison , Mertz Heather , Denney Jeffrey M. 
Published: April 2018

INTRODUCTION:
Risk of recurrent spontaneous PTB is 15-30% and > 50% for women who have delivered ≥2 babies prior to 32 weeks. Women with inadequate access to care are at risk for PTB. We hypothesized standardized management in a designated prevention clinic would reduce risk of PTB in high risk women.

METHODS:
Retrospective cohort study evaluating pregnancies at risk for PTB. Women were managed with a standardized protocol of surveillance and medical/surgical interventions under care of a consistent team in a designated preterm birth prevention clinic. Patients’ recurrence risk of PTB was calculated adjusting for race, number of prior PTB, and gestational age of prior PTB. Calculated recurrence risk was compared to outcomes when followed in our clinic. Compliance with prenatal visits and reason for delivery were tracked. Univariate and multivariate analyses were used where appropriate.

RESULTS:
188 women with PTB history were enrolled and had complete data. Mean calculated recurrence risk of PTB was 42.6% (SD 25.9; 16-100). 87.3% were compliant with all scheduled appointments. Mean GA at delivery 36.3 weeks. Calculated risk score for PTB at enrollment was not predictive of PTB after care in our clinic (R=0.017). Enrollment in our prematurity clinic significantly reduced the risk of PTB from predicted (42.6% to 24.5%, p=0.0002, OR 0.44; 95% CI 0.28-0.68).

CONCLUSION:
Enrollment in our prematurity clinic significantly decreased the risk of PTB from predicted. In our high risk population only 8% delivered <32 weeks. Standardized evidenced-based intensive surveillance and appropriate medical/surgical interventions with consistent team can significantly reduce risk of PTB.
Characteristics and Outcomes Associated with Hepatic Infarction in Pregnancy [13E]
Authors: Gray Jordan , Fresquez Arianna , Ireland Kayla E. , Boyd Angela R. , Roman Tania , Ramsey Patrick S. 
Published: April 2018

INTRODUCTION:
Hepatic infarction is a rare pregnancy complication. We sought to review the literature to characterize risk factors, presentation, and outcomes associated with hepatic infarction in pregnancy.

METHODS:
We performed a systematic literature review using PUBMED and MEDLINE 1966-2017 with relevant search terms to identify reported cases of hepatic infarction in pregnancy. Maternal demographics, comorbidities, risk factors, presenting signs and symptoms, diagnostic tests, management, and outcomes were abstracted.

RESULTS:
We identified 45 cases (33 articles) of hepatic infarction in pregnancy. Average maternal age was 29 ± 5 years. Majority of cases occurred in nulliparous women (56%). Mean gestational age at presentation was 28 ± 8 weeks. The most common risk factors were preeclampsia/HELLP syndrome (67%) and antiphospholipid syndrome (53%). The most common presenting symptoms were abdominal pain (89%), elevated blood pressure (77%), nausea/vomiting (50%), and fever (34%). Abdominal pain was typically right upper quadrant (52%) or epigastric (39%). An upper abdominal ultrasound was performed in 50% of cases; however, 91% did not demonstrate hepatic infarction. Diagnosis was typically made with computerized tomography. Therapeutic anticoagulation and corticosteroids were the most common therapy used. Preterm birth occurred in 82% of cases and fetal demise was common (45%).

CONCLUSION:
Hepatic infarction is a rare complication of pregnancy that is associated with preeclampsia and antiphospholipid antibody syndrome and has a high rate of fetal demise. Additional imaging is required if initial ultrasound is normal and there is a concern for hepatic infarction.
National Trends for Reporting Opiate Use Disorder in Pregnancy and Available Treatment Resources [16E]
Authors: Oben Ayamo , Nelson Chelsea , Paraison Lauren , Vasichko Paula E. , Ramsey Patrick S. , Acosta Ometeotl M. 
Published: April 2018

INTRODUCTION:
Between 1999 and 2013, the prevalence of neonatal abstinence syndrome (NAS) in the United States increased almost 300%. Regional differences in the NAS prevalence highlight the need for comprehensive prevention strategies for opioid use disorder (OUD) in pregnancy. Our objective was to assess the presence of legislation requiring reporting of OUD in pregnancy, as well as available treatment resources.

METHODS:
We surveyed each state for existing laws or pending legislation requiring reporting of OUD in pregnancy by searching state government websites for keywords/phrases and contacted state officials directly to confirm the presence or absence of pertinent legislation. Information treatment resources offered and priority access to pregnant women was also collected.

RESULTS:
Fifteen states have active legislation for reporting OUD in pregnancy. Eighteen states treat OUD in pregnancy as child abuse. Twenty-five states provide priority access to pregnant women with OUD. The states not requiring reporting of OUD in pregnancy had a higher prevalence of NAS.

CONCLUSION:
Less than half of states have active legislation requiring OUD in pregnancy reporting. The rising prevalence and healthcare costs associated with NAS continue to confirm the need for legislation and comprehensive guidelines for opioid prescribing in each state, as well as the establishment of treatment resources for our pregnant patient population.
Nuchal Fold Thickness (NFT) in Male versus Female Fetus in Gender Discordant Twins [17E]
Authors: Soni Shelly , Rochelson Burton , Blitz Matthew J. , Vohra Nidhi , Pessel Caroline D. 
Published: April 2018

INTRODUCTION:
To evaluate second trimester nuchal fold thickness (NFT) in male versus female fetuses in gender-discordant dizygotic twin pregnancies.

METHODS:
Case control study of dizygotic twin pregnancies receiving second trimester fetal nuchal fold measurements identified from a search of ultrasound and cytogenetic databases. Structurally normal fetuses that delivered beyond 30 weeks of gestational age without known chromosomal aberrations were included. NFT was compared in male versus female fetuses using paired t-test.

RESULTS:
220 dizygotic twin pregnancies were included. Male fetuses had a higher mean NFT as compared to female fetuses in the entire cohort (3.7 mm in males versus 3.5 mm in females, p < 0.0001, 95% CI 0.3-0.1). Data was stratified based on gestational age. There was a gradual increase in NFT with an increase in gestational age. Male fetuses had a higher NFT through all the gestational ages.

CONCLUSION:
Male fetuses had a higher mean NFT as compared to female fetuses in gender-discordant dizygotic twin pregnancies.
Outcomes of Mothers and Children at Five Years After Cesarean Versus Vaginal Delivery [22E]
Authors: Ranjit Anju , Jiang Wei , Little Sarah , Witkop Catherine , Haider Adil , Robinson Julian 
Published: April 2018

INTRODUCTION:
The objective of this study was to determine whether outcomes of mothers and children at five years vary after cesarean versus vaginal delivery.

METHODS:
TRICARE (universal insurance coverage to all members of US Armed Services and their dependents) data was used to identify mother-infant pairs who delivered between 2007 and 2009 and had continuous enrollment for 5 years. Maternal complications (chronic pelvic pain, endometriosis, fistula, prolapse), and infant complications (asthma, acute respiratory illness (ARI) (>2/year), chronic respiratory illness (CRI), gastrointestinal allergies) within five years were compared between women delivered via cesarean as compared with those with a vaginal delivery using logistic regression adjusted for demographic, clinical and hospital characteristics.

RESULTS:
A total of 141,317 mother-infant pairs were identified:105,980 (74.9%) had a vaginal delivery and 35,337 (25.1%) had a cesarean delivery. Women with gestational diabetes (8.7%vs.4.9%) and pregnancy-related hypertension (17.3%vs.8.3%) were more likely to have had a cesarean delivery (p<0.001 for both). Mothers who had a cesarean delivery were more likely to have chronic pelvic pain (13.9%vs.4.6%, OR[CI]: 4.07[3.61-4.47]) and endometriosis (4.2%vs.2.9%, OR[CI]: 1.59[1.32-1.91]) within 5 years of delivery. Similarly, children born via a cesarean delivery were more likely to have asthma (OR[CI]:1.16[1.02-1.64]), ARI(OR[CI]: 1.19[1.13-1.37]) and CRI(OR[CI]: 1.16[1.04-1.29]) within 5 years of delivery.

CONCLUSION:
Cesarean delivery is associated an increased risk of maternal complications (chronic pain, endometriosis) and infant complications (asthma and acute/chronic respiratory illness) within the first 5 years of delivery. Such findings can inform decisions about mode of delivery, when cesarean delivery is not otherwise indicated.
The Effect of Hospitalization on Mood in Pregnancy [24E]
Authors: Hines Katherine N. , Mead Julia , Pelletier Carole-Anne , Hanson Shannon , Lovato James , Quinn Kristen H. 
Published: April 2018

INTRODUCTION:
Depression and stress in pregnancy have been linked with poor obstetrical outcomes. It is unknown whether hospitalization in pregnancy increases depression or stress. The goal of this study is to determine the effect of hospitalization and length of stay on depression and stress levels.

METHODS:
Prospective cohort study evaluating patients admitted to the High Risk Obstetrics Antepartum Service. Demographic data was collected. The Edinburgh Postnatal Depression Scale (EPDS) and Perceived Stress Scale (PSS-10) were administered on admission, weekly, and upon discharge. Primary outcome was to determine effects of hospitalization on levels of depression/stress; and evaluate effects of length of stay. Data were evaluated using the Wilcoxon signed rank sum test and linear regression as appropriate.

RESULTS:
Data on 40 women are included. Mean gestational age on admission was 27.2 (range: 6.6-36.1) weeks, mean length of stay was 16.3 (range: 2-37) days. No difference was observed between median admission and discharge EPDS scores; 10 (inter-quartile range (IQR) 5-13);8.5 (IQR 4.0-15.5) (P=.63). Similarly, no difference was observed between median admission and discharge PSS-10 scores; 19.5 (IQR 14.5-24.0); 17.0 (IQR 12.0-23.0) (P=.42). Length of stay did not significantly impact scores (PSS: P=.88, EPDS: P=.22). Half of our cohort demonstrated signs of clinical depression on admission. 20% (n=8) of patients indicated thoughts of self- harm during their hospitalization.

CONCLUSION:
While we found no effect of length of stay on our measures of stress and depression, our data highlight the significant psychological needs of hospitalized pregnant patients and demonstrate the prevalence of thoughts of self-harm and depression.
Tay-Sachs: An Ashkenazi Jewish Disease or Not? [26E]
Authors: Echeverri Natalia , Terhaar Catherine , Bardos Jonah D. , Longman Ryan 
Published: April 2018

INTRODUCTION:
Tay-Sachs disease (TSD) is an autosomal recessive disorder characterized by progressive neurodegeneration leading to total incapacitation and death by age four. Currently, carrier testing for TSD is recommended for the Ashkenazi Jewish (AJ) population. A joint ACOG/ACMG statement highlighted the increasingly multi-ethnic society as consideration for pan-ethnic carrier testing, and recent ACOG committee opinion states that pan-ethnic carrier testing is a reasonable strategy. This study assesses how many non-AJ Caucasian individuals screened positive for TSD when pan-ethnic carrier screening was implemented.

METHODS:
Retrospective database analysis of individuals that received expanded carrier testing utilizing a genotyping panel for nine pathologic variants of TSD (1278+TATC, IVS12+1G>C, IVS7+1G>A, IVS9+1G>A, p.G269S, p.R178H, p.R247W, P.R249W, del7.6kb). Expected number of positive carriers for TSD in AJ and Caucasian groups were calculated and compared to observed rates. Chi-square analysis was performed to assess for statistical significance (p < 0.01).

RESULTS:
A total of 71,829 individuals were tested for TSD. A higher than expected number of Caucasian individuals screened positive for TSD (110 observed vs 58.48 expected, p<0.001). The number of AJ individuals that screened positive was consistent with expected values (33 observed vs 31.14 expected, p<0.88).

CONCLUSION:
Caucasian carriers of TSD were more common than expected in this cohort. Pan-ethnic expanded carrier testing will increase the detection of carriers for TSD compared with current ethnicity based screening recommendations. Importantly, carriers of TSD, who would be missed by ethnicity based testing convention, will be identified allowing for more complete genetic counseling and family planning options for those who choose testing.
Factors Associated with Patient Satisfaction during Labor: A Quality Improvement Study [28E]
Authors: Menichini Daniela , Longo Monica , Chen Han-Yang , Viteri Molina Oscar A. , Blackwell Sean C. , Sibai Baha M. 
Published: April 2018

INTRODUCTION:
It is known that a positive birth experience is associated with an increased mother-child bond and maternal self-esteem. Thus, it is important to identify those factors playing a role with a positive birth experience. Our goal was to evaluate the association between patient satisfaction and maternal characteristics, management of labor and neonatal outcome using a patient satisfaction survey as a tool of health care quality.

METHODS:
A validated Labor and Delivery Satisfaction Index (LADSI) survey was administered to puerperal women on the first day post-partum, from November 2016 to January 2017. The primary outcome was patient satisfaction, defined as the total LADSI score. Maternal demographics, obstetrics characteristics and neonatal outcomes, relevant to maternal satisfaction, were collected. Univariate analysis, followed by a multivariate quantile regression analysis, were performed to examine the association between the study variables and LADSI score.

RESULTS:
Of the 312 women that participated in the study, 93% completed the survey. Our findings show that women managed by private providers are more satisfied than those managed by university providers (220, 201-226 vs 212, 196-223), p=0.017. Vaginal delivery is associated with a better birthing experience compared to cesarean section (220, 205-228 vs 210.5, 200-227, p=0.001). Patient satisfaction score is not associated with other demographics/obstetrics variables and neonatal outcomes. Multivariate quantile regression confirmed that private provider (βcoefficient=7.79, p=0.04) and vaginal delivery (βcoefficient=8.97, p=0.02) were significantly associated with a higher LADSI score.

CONCLUSION:
This study showed that women undergoing labor have a better birth experience when managed by a private provider and delivered vaginally.
Predictive Factors for the Development of Severe Hypocalcaemia during Surgery for Morbidly Adherent Placenta (MAP) [29E]
Authors: Erfani Hadi , Fox Karin A. , Shamshirsaz Amir , Hui Shiu-Ki , Shamshirsaz Alireza , Belfort Michael A. 
Published: April 2018

INTRODUCTION:
Acute severe hypocalcemia is a life-threatening complication of massive blood transfusion that requires prompt treatment. Our objective was to determine potential predictive factors for severe hypocalcaemia in patients undergoing cesarean hysterectomy for MAP.

METHODS:
Retrospective study of 123 patients with pathologically proven MAP (accreta, increta or percreta) who underwent cesarean hysterectomy in our center between January 2011 and February 2017. Cases: critically low (“panic level”) serum total Calcium (≤ 7mg/dL) and Controls: normal serum total Calcium (≥8.5). Regression and ROC analyses were performed.

RESULTS:
There 13 cases with critically low Calcium and 18 controls with normal Calcium levels. Baseline patient characteristics were not different. The median estimated blood loss (EBL), units of PRBC’s and volume of crystalloid (CT), were higher in the low Calcium group. 6/13 (46.2%) cases had received > 4 units of PRBC’s during surgery versus 2/18 (11.1%) controls (P = 0.04). ROC showed that EBL, units of PRBC’s and CT were useful in distinguishing patients who developed severe hypocalcaemia. Moreover, univariate regression analysis revealed that patients with EBL > 1500ml, those who received ≥4 units of PRBC’s [OR = 6.9 (1.1-42.8)] and those with CT ≥4L [OR = 16.7 (2.8-99.7)] were at increased risk of developing severe hypocalcaemia.

CONCLUSION:
Transfusion of ≥4 units PRBC’s and ≥4L crystalloid predict severe hypocalcaemia in MAP. These interventions are causally linked to EBL>1500ml. These data support the empiric replacement of calcium chloride after >4 units of PRBC’s or >4L of crystalloid are rapidly transfused during cesarean hysterectomy for MAP.
Factors Associated with Cesarean Delivery in Myelomeningocele Pregnancies [35E]
Authors: Rossi Robert , DeFranco Emily 
Published: April 2018

INTRODUCTION:
Myelomeningocele (MMC) complicates 1 in 2000 pregnancies in the United States. Mode of delivery for myelomeningocele (MMC) is controversial but there is limited data to support the benefit of cesarean delivery (CD). We sought to determine the rate of CD and characteristics associated with CD in MMC pregnancies.

METHODS:
Population-based retrospective cohort study of livebirths in Ohio (2006-2015). Frequency of CD, obtained from birth certificate data, was reported for women with a singleton, isolated MMC pregnancy. Obstetric characteristics were compared between women who underwent CD compared to vaginal delivery (VD).

RESULTS:
Of 1,409,231 live births in Ohio during the 10-year study period, 355 (0.02%) women had a singleton infant with MMC. Of these pregnancies, 70.7% (n=251/355) underwent a CD. While the rate of CD increased from 64.7 to 76.1% (p=0.02) in births after 2010 (2011-2015) compared to before (2006-2010), the rate of induction decreased (15.7 vs 8.5%, p=0.04). The CD rate for women delivering at an academic center was 83.8 vs 62.6% (p<0.001) compared to those who delivered at a community hospital. Factors associated with CD included delivery at an academic center (aOR 4.2, 95%CI 2.3-7.8) and delivery in the latter-half of the study period (aOR, 2.0, 95%CI 1.2-3.5).

CONCLUSION:
Approximately 7 in 10 women with MMC pregnancy delivered by cesarean. Delivery at an academic center was associated with a 4-fold increase in CD. Additionally, there was a temporal rise in CD rates across the 10-yr period correlating with decreased IOL suggesting a rise in planned CD by providers, particularly at academic centers.
An Evaluation of the Impact of Global Health Training Programs in Obstetrics and Gynecology Residency Programs [3M]
Authors: Trivedi Shivika , Haddad Lisa , Narvaez Jennifer , Walker Elizabeth , Jamieson Denise J. , Lathrop Eva 
Published: April 2018

INTRODUCTION:
Although the number of Global Health Training (GHT) programs in obstetrics and gynecology (OB/GYN) residencies has increased, few studies exist describing their programmatic work. We aimed to evaluate the contributions of GHT programs by assessing impact, reciprocity and whether global health goals were addressed.

METHODS:
This cross-sectional observational study identified all U.S. OB/GYN residencies with GHT programs and evaluated the publications resulting from them. Eligible articles included those published in 2009-2014 about work done in a GHT location by GHT faculty. All eligible articles were used to calculate an H-index for each institution as a proxy for impact. The inclusion of host authors on articles served as a proxy for reciprocity. Article content was assessed to evaluate whether programs addressed Millennium Development Goals (MDG).

RESULTS:
Among 245 OB/GYN residencies, 193 (80%) had GHT programs. Of these, 26 (14%) had faculty who had published articles meeting inclusion criteria and the H-indices per institution ranged from zero to 17. Of 698 articles reviewed, 95% of articles included one or more host country authors and 78% addressed at least one MDG, including 39% that addressed improving maternal health (MDG 5).

CONCLUSION:
Most OB/GYN residencies are offering GHT. The majority of programmatic work addresses MDG and thus is aligned with global health priorities. The impact and reciprocity of GHT programs varies across institutions. Residencies could benefit from internal analysis of their GHT programs to evaluate if knowledge gained is being disseminated, and to ensure equitable partnerships and the creation of sustainable, impactful initiatives.
Spring Into Wellness: An ACOG District VI Initiative [4M]
Authors: Barnard Emily , Zeal Carley , Mallen Adrianne , Hall Evelyn , Lyerly Kristin , Brincat Cynthia 
Published: April 2018

INTRODUCTION:
In the setting of physician shortages and increasing burnout, we sought to challenge the historically competing interests of wellness and residency. The aim of our project, Spring Into Wellness, was to foster well-being in our District while encouraging community and collaboration between residency programs.

METHODS:
Prior to initiating the project, we used the WHO-5 Well Being Index, a validated assessment tool measuring five aspects of wellness, to survey Junior Fellows in Training (JFs) from ACOG District VI. A JF Wellness committee planned weekly themes during April 2017, highlighting Nutritional, Emotional, Physical, and Community Wellness. Daily e-mails encouraged participation which was tracked using postings on social media (Facebook®). Funding for weekly winning residency programs was provided by Fellows in District VI.

RESULTS:
110 out of 466 eligible residents completed surveys (23.6%). More than half of the time JFs were “interested” in their work (76.4%) and “felt cheerful” (77.3%). However, less than half of the time 78.0% “woke up feeling fresh and rested” and 67.9% “felt active and vigorous.” 8 of 24 programs participated in wellness month, posting 72 entries on social media. Three winning programs received cash prizes. Social media posts declined from week one (23) to week four (0).

CONCLUSION:
A wellness initiative meets an obvious need in JF training programs. While our program met with initial enthusiasm, as the month progressed this waned. Our initiative is accessible and could translate to other Districts and residencies. Future improvements include transitioning to a condensed wellness week, a follow up survey, and encouraging faculty participation.