bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-Partum Contraception; Does Standardized Video Counseling Increase Long Acting Reversible Contraceptive Use [2R]
Authors: McGregor Ali , Hackney David , Ugwuegbu Obinna , Akesson Cydni , Perriera Lisa 
Published: May 2019

INTRODUCTION:
To assess if a standardized contraceptive counseling video increases selection of long acting reversible contraceptive (LARC) methods in the immediate postpartum period.

METHODS:
This randomized control trial assessed postpartum contraceptive choices of women receiving care at an urban clinic. On postpartum day 1, after consenting to participation, women were surveyed regarding contraceptive and breastfeeding plans, and were randomly assigned to watch a 10 minute standardized video about contraceptive options or to receive standard postpartum care. They completed a follow-up survey on postpartum day 2 to assess contraceptive choice. Chart review was completed 12 weeks postpartum to determine postpartum visit attendance and contraceptive method received. We estimated a sample size of 238 to have 90% power with an alpha of 0.05 to detect a 20% difference in LARC selection.

RESULTS:
We enrolled 127 women in the intervention group and 123 women in the control group with 38.1% and 33.3% choosing LARC methods respectively (P=0.58). There was also no significant difference in the percentage that returned for a postpartum visit (P=0.43), or that received a LARC method (P=1.0). The majority of women did not change their contraception choice between surveys 1 and 2, and 32.5% patients entered the study already wanting a LARC method.

CONCLUSION:
Watching a standardized contraceptive counseling video in the postpartum period did not increase the number of patients who chose a LARC method. Selection of contraceptive methods during antenatal care may have a higher impact on utilization of an effective method in this patient population.
Gabapentin as an Adjunct to Perioperative Pain Management for Surgical Abortion: A Randomized Controlled Trial [10S]
Authors: Hailstorks Tiffany , Cordes Sarah , Cwiak Carrie , Enriquez Christian , Moore Renee , Haddad Lisa 
Published: May 2019

INTRODUCTION:
The use of gabapentin in the setting of surgical abortion has never been evaluated; however, it is used successfully in similar surgical settings as an adjunct to pain management. We sought to evaluate the impact of Gabapentin on perioperative pain during first trimester abortion with local anesthesia.

METHODS:
We conducted a randomized double-blinded placebo-controlled trial of gabapentin 600 mg given 1-2 hours pre-operatively among subjects receiving a 1st trimester surgical abortion under paracervical block. The primary outcome was pain on a 100-mm visual analog scale (VAS) measured at 6 time points perioperatively. To assess changes in pain measures, an intention to treat (ITT) mixed effects model was fit with treatment group (Gabapentin vs. Control) as a between-subjects factor and time point as a within-subjects factor plus their interaction term. Using Fisher's exact tests, we examined any group differences in the percentage of patients who reported side effects post procedure.

RESULTS:
Among the 115 randomized, most subjects were Black/African American (69.6%), average age was 26 years (+/-5.6), and mean gestational age was 61.8 days. There were no significant changes in pain score preoperatively or intraoperatively. Subjects who received gabapentin had significantly lower levels of pain at 10 minutes postsurgery [mean difference (SE) = -13.0 (-5.1), p-value = 0.01] and 30 minutes postsurgery [-10.5 (-5.1), p=0.04] as compared to subjects who received placebo. Side effects were rare, of low severity, with no significant difference between groups.

CONCLUSION:
Post-operative pain scores were lower among subjects receiving Gabapentin preoperatively compared to placebo, thus improving recovery.
Trends in Gestational Weight Gain and Birth Weight in Pre-Existing Diabetic Women [13S]
Authors: Zhang-Rutledge Kathy , Kabacka Julia , Laurent Louise , Ramos Gladys A. 
Published: May 2019

INTRODUCTION:
Excessive gestational weight gain (GWG) has been linked to fetal overgrowth. Diabetes mellitus (T2DM) and obesity are known independent risk factors for abnormal fetal growth. The aim of this study is to evaluate the trend in GWG and the relationship between GWG and neonatal birthweights in women with and without T2DM.

METHODS:
This is a retrospective review of singleton gestations with T2DM who delivered at the University of California - San Diego (UCSD) from 2011 to 2017. The control population was all singleton gestations without T2DM at UCSD in 2016. Recommendations for GWG were based on Institute of Medicine (IOM) guidelines. The study was approved by the Institutional Review Board at UCSD. Statistics were performed using Pearson chi-square test.

RESULTS:
The study included 346 patients with T2DM and 1126 controls. Patients with T2DM and controls had similar rates of excessive GWG among the weight categories except in the overweight population, those with T2DM were less likely to have excessive GWG compared to controls (34.2% vs 59.1%, P=<.01). Compared to controls, those with T2DM who gained within and above the recommended GWG were more likely to have large for gestation (LGA) neonates [RR = 10.2, P<.01; RR = 4.3, P<.01, respectively]. The rate of LGA was highest in those with T2DM who gained at or above IOM guidelines.

CONCLUSION:
Patients with T2DM do not gain more weight during pregnancy when compared to normal controls, however they are more likely to have LGA neonates.
Ultrasound-Indicated Cerclage Placement in Early Preterm Birth Prevention in Women Without Prior Preterm Birth [15S]
Authors: Srinivasan Aarthi , Garneau Audrey , Love Paige Effie , Qi Ya , Critchfield Agatha 
Published: May 2019

INTRODUCTION:
To determine if cervical cerclage placement plus vaginal progesterone for short cervix decreased the risk for preterm birth in singleton gestations without prior spontaneous preterm birth.

METHODS:
This was a retrospective cohort study. Electronic charts of patients with singleton gestations with short cervix between 2007-2017 at the University of Kentucky were reviewed. Those without prior preterm birth with cervical length <25 mm between 16 0/7 and 23 6/7 weeks of gestation were eligible. All women received vaginal progesterone. A subgroup also undergoing cervical cerclage were compared to those on vaginal progesterone alone. Those receiving cerclage and progesterone at a cervical length <15 mm were also compared to the medication only group. The primary outcomes were mid-trimester and early preterm birth. Secondary outcomes included mean gestational age of delivery, birth weight, 1 and 5-minute APGARS.

RESULTS:
Out of the 55 eligible patients, 20 cases who underwent cerclage and vaginal progesterone were compared with 35 women who received vaginal progesterone alone. Rates of preterm birth <28 weeks (OR, 1.73, 95% CI 0.22-13.60) and <34 weeks (OR, 2.77, 95% CI, 0.40-18.74) were similar in both groups. No difference in the rates of preterm birth <28 weeks and <34 weeks of gestation in the sub-group with a cervix <15 mm was observed as well. Mean gestational age at delivery (36.2±4.9 weeks vs. 36.7±4.3, P=0.76), mean birth weights (2907±1198 grams vs. 2929±733 grams, P=0.94), 1-minute APGAR and 5-minute APGAR scores were also similar.

CONCLUSION:
Cervical cerclage placement in addition to vaginal progesterone does not appear to be beneficial for short cervix in low risk population in the prevention of spontaneous preterm birth.
Variation in Outcome Reporting in Studies on Obesity in Pregnancy—A Systematic Review [20S]
Authors: Dadouch Rachel , Faheim Mina , Susini Orsolina , Showell Marian , D'Souza Rohan D. 
Published: May 2019

INTRODUCTION:
Improving outcomes in women with obesity (BMI>30 kg/m2) in pregnancy is limited by the heterogeneous outcomes between clinical trials. This systematic review of antepartum and peripartum interventions/exposures aimed to determine outcomes and their definitions reported thus far, as a preliminary step towards the standardization of outcomes.

METHODS:
MEDLINE, Embase, CENTRAL and www.clinicalTrials.gov were searched for trials, secondary analyses and systematic reviews in English between 01 January 2000 and 20 November 2017. Grey literature and reference lists of included studies were searched. Title/abstracts and full-texts were screened in duplicate. The following data were extracted: study characteristics, primary, secondary maternal, fetal and neonatal outcomes (including composites), their definitions or measurements and outcome reporting quality (MOMENT criteria). The proportion of studies reporting each outcome, a primary outcome and variations in definitions and components of composite outcomes were determined.

RESULTS:
Of 4916 results screened, 218 full-texts were assessed and 70 included. 173 maternal/obstetric outcomes and 86 neonatal/fetal outcomes were reported. 49 of the 58 trials/registrations reported a primary outcome, 21 of which were not in a reproducible way. The most frequent maternal outcome was gestational weight gain (24 studies) with inconsistent definitions between studies. The most frequent fetal/neonatal outcome was birthweight (17 studies). There were three maternal composite outcomes, one fetal/neonatal and one combined. No maternal composite comprised the same components.

CONCLUSION:
The high number of outcomes prevents the reporting of relevant outcomes in all obesity in pregnancy studies. Further, inconsistencies and variations between outcome choices and definitions identified present challenges for study comparability and data aggregation.
Understanding Decision Making and Barriers to Fertility Preservation in Young Women With Cancer [21S]
Authors: Gadson Alexis K. , Lindsay Sarah F. , White Katharine O. , Woodhams Elisabeth J. 
Published: May 2019

INTRODUCTION:
Many women recognize a cancer diagnosis as a time to evaluate their desire for future fertility. While financial barriers to fertility preservation are well documented, other barriers are not often addressed. We sought to explore patients' experiences when considering fertility preservation options after cancer diagnosis and their perceived barriers to pursing those options.

METHODS:
We conducted twenty semi-structured interviews with female oncology patients ages 18-45 years who were stable on treatment or had completed therapy within the last 24 months at an urban northeast medical center. We analyzed data using direct content analysis using the Promoting Action on Research Implementation in Health Services (PARiHS) framework. We continued participant recruitment until we reached thematic saturation.

RESULTS:
Patients struggle to process complex, future-based decision-making when coping with a cancer diagnosis. Three subthemes emerged: 1) patients' personal biases and fears, rather than data, about pregnancy post-chemotherapy contribute notably to decision making; 2) patients perceive biases from their providers against fertility preservation; and 3) fertility desires are fluid, thus patients may regret not exploring fertility preservation options.

CONCLUSION:
Decision-making regarding fertility preservation in women with a cancer diagnosis is complex. Within the current model of care, patients may not be able to fully explore their fertility preservation options, particularly in the acute diagnosis setting. A shared-decision making approach, with their own obstetrician–gynecologist, may facilitate difficult decision-making. The general obstetrician-gynecologist may play a crucial role in helping patients to navigate their desires to engage in fertility preservation options after the specialist consult.
3-D Ultrasound is Accurate for Follicular Monitoring But Does Not Reduce Time to Perform [28S]
Authors: Sauerbrun May-Tal , Ghidei Luwam , Huber Warren J. , Wu Xiaotian , Alvero Ruben , Wang Shunping 
Published: May 2019

INTRODUCTION:
Objective: To assess time-savings and accuracy of 3-D versus 2-D ultrasound (US) for follicular monitoring during in vitro fertilization (IVF) cycles.

METHODS:
Patients undergoing IVF stimulation cycles at our fertility center from February 23rd to March 2nd 2018 had both 2-D and 3D US during each follicular monitoring appointment. During the 3-D US, SonoAVC software was utilized to automatically measure ovarian follicles in three dimensions. During the 2-D US, each follicle was measured in two dimensions and the mean was calculated. A Pearson's correlation test was used to compare the mean diameters of each follicle in 3d vs 2d. An equation to predict 2D mean follicular diameters from 3D data was developed using linear regression. A paired T-test was used to compare the time to perform each study.

RESULTS:
Eight ultrasounds evaluated 91 follicles with both 2D and 3D modalities. The correlation for the mean follicular diameter is 0.82 with p-value < 0.001 suggesting that the 3D and 2D follicular measurements are highly correlated. Using Linear regression we calculated a correction factor to convert 3D mean diameters (X) to 2D mean diameters (Y) and our equation is Y = 0.726X+3.987. The average time to perform the 3D and 2D study was 6.4 and 7.3 minutes respectively, which is not statistically different.

CONCLUSION:
3D follicular monitoring can substitute for 2D monitoring with consistency in terms of follicle measurements, however the shorter time to perform the study is not statistically significant. Additional studies are needed before recommending 3D Ultrasound/SonoAVC as a more efficient method.
Should ACOG Reconsider Their Criteria for the Early Diagnosis of Hypertension in Pregnancy? [32P]
Authors: Hussain Farrah N. , Grubman Olivia , Taylor Dyese , Chu Lam Melissa T. , Al-Ibraheemi Zainab Q. , Brustman Lois E. 
Published: May 2019

INTRODUCTION:
In 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for the evaluation of high blood pressure (BP). These lowered definitions for hypertension include: normal (<120/80 mmHg), elevated (120-129/<80 mmHg), stage 1 (130-139/80-89 mmHg), and stage 2 hypertension (≥140/90). Conversely, ACOG defines chronic hypertension as the presence of systolic BP≥140 mmHg or diastolic BP≥90 mmHg on 2 occasions before 20 weeks' gestation. There are limited data on the impact of hypertension as defined by the ACC/AHA in pregnancy. We aim to determine if there is a relationship between elevated or stage 1 hypertension in the first trimester and pregnancy-induced hypertensive disorders (PIH).

METHODS:
In this IRB approved retrospective cohort study, we examined singleton pregnancies, registered in the first trimester and diagnosed with PIH (gestational hypertension, preeclampsia +/- severe features, and HELLP) at an urban hospital between March and September 2018.

RESULTS:
110 patients were included: 61.8% of the study population had elevated (22.7%) or stage 1 (39.1%) hypertension. The mean age was greater in normotensive patients (p=0.03). Otherwise, demographics, gestational age (p=0.27), and timing of delivery (p=0.41) were similar between hypertension groups. Neither the incidence of PIH nor the specific PIH diagnosis were associated with hypertension status in the first trimester (p=0.08).

CONCLUSION:
Our data suggests no association between ACC/AHA hypertension status in the first trimester and PIH. However, over 60% of patients would be classified as early/stage I hypertension. Therefore, further evaluation of the incidence of ACC/AHA hypertension in patients with/without PIH and comparison to ACOG criteria is warranted.
Reducing Incomplete 3rd Trimester Labs: A Multi-Modal Approach [2Q]
Authors: Roeckner Jared T. 
Published: May 2019

INTRODUCTION:
The goal of 3rd trimester labs is to provide the optimal information to ensure a healthy mother and neonate. We estimated that 2% of patients at our institution were missing 3rd trimester labs prior to delivery. Our objective was to reduce the rate of missed 3rd trimester labs employing Best Practice Advisories (BPA) and other modalities in the inpatient and outpatient setting.

METHODS:
Inventions included (1) creation of an Epic-based Best Practice Advisory (BPA) in clinic and on admission to encourage providers to order the labs when missing, (2) changes to admission H&P to make the 3rd trimester labs more visible, (3) education of nursing and providers, and (4) an additional L&D Grease board column for 3rd trimester labs. These interventions were launched Feb 2018. An internal reporting system was used to report missing labs before and after the intervention. The rate of missing were compared before and after the intervention and feedback was elicited from the L&D team (nurses, midwives, residents, attendings).

RESULTS:
The average rate of missed labs was 2.8 per month prior the intervention. Rates of missed labs appear to have increased after the intervention (3.5 per month). It is unclear if increased awareness led to increased error reporting. Overall, the rate of missed 3rd trimester labs at our institution is 1.4% (28 misses/2066 deliveries).

CONCLUSION:
An approach that included EPIC-based BPA, provider and nurse education, and changes to note templates in the ambulatory and inpatient setting, resulted in no measurable improvement in the rates of missed 3rd trimester labs.
Evaluation of Smartphone Diabetes Tracking Applications for Use in Pregnancy Using the APPLICATIONS Scoring System [10K]
Authors: Quiner Trevor Elisha , Garchar Elizabeth , Perez-Yordan Jose Manuel , Rayburn William 
Published: May 2019

INTRODUCTION:
To systematically evaluate the quality and functionality of smartphone diabetes tracking applications for use in pregnancies complicated by diabetes.

METHODS:
We adapted the previously described APPLICATIONS scoring system (score 0-16) with the definition of comprehensiveness as the incorporation of: ability to record blood glucose, medication use, carbohydrates, and weight gain; provide reminders for checks and/or medication; identify abnormal glucose levels; and export the collected data in reports. The Apple App Store (iPhone/iPad) and the Google Play Store (Android phones/tablets) were both searched systematically with pertinent key words to identify smartphone applications for review by three independent reviewers.

RESULTS:
Initial searches revealed 408 smartphone applications. Non-English applications and those without diabetes tracking abilities were excluded as well as applications that were not available on both operating systems, all paid applications, and those requiring institutional affiliation or proprietary equipment--leaving eight pairs of applications for evaluation. No application received a perfect APPLICATIONS score. The mean score for each was 11.3 (SD 2.1). Only one application was found to have all seven functions on both operating systems. The desired functions were available in the following percentages: blood glucose tracking (100%); medication tracking (94%); carbohydrate tracking (81%); weight tracking (75%); data exporting (75%), ability to set reminders (56%); in-app recognition of high and low glucose levels (69%).

CONCLUSION:
This systematic review using the adapted APPLICATIONS scoring system identified many diabetes tracking smartphone applications most suitable for in pregnancies complicated by diabetes. There are many excellent apps but only one app that contained all desired functions.
Does the Use of Antenatal Corticosteroids Decrease Levels of Neonatal Hyperbilirubinemia in Preterm Infants? [15K]
Authors: Amorim Melania , Brandão Danielle , Meneses Jucille , Portela Nara , França Neto Antonio Henriques , Porto Ana Maria 
Published: May 2019

INTRODUCTION:
The use of prenatal corticosteroids for pregnant women between 34-36 6/7 weeks of pregnancy is recommended to reducing the morbidity of late preterm infants.

METHODS:
This is a secondary analysis of a randomized clinical trial conducted to determine the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks' gestation Trial registration Clinical Trials NCT00675246. This study was approved by IRB and all participants signed an informed consent term.

RESULTS:
Of 245 preterm infants, the number of newborns with gestational age 34, 35 and 36 was 30 (12.2%), 110 (45.1%), and 105 (42.7%), respectively. Jaundice occurred in 150 (62.5%) newborns and 70 among them required phototherapy during hospitalization. Late preterm infants exposed to corticosteroids started treatment with lifetime of 61.2± 33.6 h vs. 48.3± 25.3 h (p = 0.03) with similar levels of bilirubin (12.1± 3.2 mg/dL vs. 12.8± 3.7 mg/dL, p = 0.38) when compared to the control group. They required less treatment compared to the placebo group (n = 27 vs. n = 42, p = 0.025), and spent less days on phototherapy (1.7± 1.7 vs. 2.6± 2.2, p = 0.05).

CONCLUSION:
Late preterm infants exposed to prenatal corticosteroids had less need for phototherapy and shorter treatment. Also, they developed elevated level of bilirubin later. This result suggests that prenatal corticosteroids decrease the levels of hyperbilirubinemia in late preterm infants.
Haemophilus Influenzae Causing Lactational Mastitis and Sepsis During the Second Trimester of Pregnancy [23K]
Authors: Scribner Alicia Nicole , Houston Edward Joseph , McGowan Brett , Leonard Katherine 
Published: May 2019

INTRODUCTION:
Lactational mastitis is a common complaint in the post-partum period, most frequently occurring within the first three months after initiating breastfeeding. Mastitis is most often caused by Staphylococcus aureus, Streptococcus species, and Escherichia coli, typically managed in the outpatient setting with oral antibiotics. Rarely, mastitis can lead to severe infections requiring hospitalization.

METHODS:
Our patient is a 23 year-old G3P2002, breastfeeding female at 15-weeks' gestation, who presented to the emergency department with breast tenderness, erythema, hypotension, and tachycardia. Emergency room evaluation excluded common sources of infection and her clinical picture was consistent with mastitis. A breast ultrasound ruled out an abscess. She was admitted to the intensive care unit with sepsis and started Vancomycin and Zosyn with aggressive fluid management. The patient's breast milk culture was positive for Haemophilus influenza. Her clinical picture improved with treatment and she was discharged from the hospital after three days. Consent was obtained from the patient to write this case report.

CONCLUSION:
Herein, we present the first reported case of mastitis caused by H. Influenza. Our patient also developed mastitis while currently in her early second trimester of pregnancy, something not commonly seen. Early identification of sepsis and initiation of appropriate antibiotics were necessary for a positive outcome. Rapid recognition of sepsis, early initiation of broad-spectrum antibiotics, and aggressive fluid management are critical for survival of women with complications of this typically minor condition.