bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implicit Bias and Contraceptive Counseling [7N]
Authors: Rosenblum Jessica L. , Minkoff Howard , Joslin-Roher Sophie L. , Morrell Kathleen M. 
Published: May 2019

INTRODUCTION:
The unequal treatment of patients based on race/ethnicity is an ongoing problem in reproductive health. One possible reason for this is provider bias. While the relationship between explicit bias and providers' contraceptive recommendations has been studied, the relationship between those choices and provider's unconscious or implicit bias has not been examined. Our primary objective was to determine if implicit racial bias exists and if it correlates with providers' recommendations for their patients' contraceptive methods.

METHODS:
Practicing providers (attendings, residents, CNMs, PAs, etc.) who counsel on contraception participated in an IRB-approved computer-based survey at multiple hospitals in New York and at one national conference March 2018 to June 2018. The study included a demographic survey, clinical vignettes about contraception, and the racial Implicit Association Test - a validated tool designed by Project Implicit to assess implicit bias. Participants were randomized to clinical vignettes that described either White patients or Black patients.

RESULTS:
Three hundred forty-eight (348) providers participated in the study: 191 attendings, 120 residents, 23 CNMs, 10 PAs, and 4 NPs. Of those, 149 had vignettes with White patients and 199 had vignettes with Black patients. White participants showed a pro-White bias (p<0.001), while Black participants did not show racial bias in either direction (p=.986). White participants showing more pro-White bias were less likely to recommend sterilization for White patients (p=0.14).

CONCLUSION:
Implicit racial bias and contraceptive recommendations differed based on the provider's race. It is important for providers to understand their own implicit bias and how it may affect their contraceptive counseling.
Obesity and Nutritional Challenges Encountered by Survivors of Human Trafficking [11N]
Authors: George Joshua Sunny , Potter JoNell , Mathew Megan , Caralis Panagiota , Alhajji Lujain , Symes Stephen 
Published: May 2019

INTRODUCTION:
Human trafficking is a form of modern day slavery and an important public health issue globally. Survivors experience food insecurity and poor nutrition practices during their trafficking. They present with medical and psychiatric co-morbidities that compound their nutritional challenges. In Miami, survivors have access to comprehensive health care, provided through THRIVE- a multidisciplinary, trauma-informed medical-home clinic. THRIVE Clinic coordinates access to food and housing services as well as nutrition education for survivors.

METHODS:
A retrospective chart review was conducted to assess BMI at first visit, self-report exercise and dietary intake, and medical/psychiatric co-morbidities related to nutrition and diet. This review obtained IRB approval prior to data collection.

RESULTS:
Records were reviewed for 41 patients (35 women and 6 transwomen). All had a history of sex trafficking, labor trafficking, or both. Average BMI for women and transwomen were 26.7 and 33.1 respectively, with 42% of women and 50% of transwomen measuring as overweight/obese. All six transwomen were on hormone therapy. Related co-morbidities included chronic constipation, gastritis, depression, anxiety, anorexia nervosa, bulimia and PTSD. Approximately half of patients self-reported poor exercise and dietary habits.

CONCLUSION:
Our understanding of the long-term health and nutritional problems of human trafficking survivors is still developing. This review demonstrates survivors are living with obesity and other nutritional issues exacerbated by their past trauma experiences. Attention to nutritional needs during their recovery will provide a clearer understanding on how to address these co-morbidities. Attending to these complex physical and psychiatric morbidities is crucial to understanding the multiple challenges faced by survivors.
Social Support and Baby-Friendly Hospital Care: Improving Breastfeeding Rates Among African American Mothers [15N]
Authors: Ukoli Flora A.M. , Cheaves Mariah , McPherson Karmen Dionne , Ladson Gwinnett McGhee 
Published: May 2019

INTRODUCTION:
Women of high education and income status are more likely to breastfeed adequately in comparison with their less educated peers. African-American mothers continue to record the lowest breastfeeding rates compared to White and Hispanic mothers.

METHODS:
We recorded demographic information from 257 pregnant African-American women aged between 15 and 42 years recruited by flyers and word-of-mouth in a breastfeeding promotion intervention, and collected their infant feeding action at birth and at 3 months and 6 months postpartum. We computed their Baby-Friendly knowledge and exposure score using a 16-item survey, recorded their Supplemental Nutrition Assistance Program (SNAP) and Women, Infant, and Children (WIC) status. Rate comparisons was by Chi-Square test using Statistical Package for Social Sciences, SPSS Version 25.0.

RESULTS:
98 (38.1%) were nulliparous, 114 (44.4%) had one or two children, and 45 (17.5%) had >2 children. Of 164 interviewed within a week of delivery, 104 (63.4%) breastfed exclusively, 38 (23.2%) mix fed, and 22 (13.4%) did not breastfeed (NBF). Exclusive breastfeeding (EBF) rates at 3-months and 6-months were 32.8% and 17.1%, with NBF rates 30.5% and 44.4% respectively. Breastfeeding rates were higher for educated, older, and married mothers, but similar across work status. NBF rates at 3 months for mothers on SNAP, SNAP & WIC, WIC only, and Neither, were 47.1%, 50.0%, 16.0% and 15.2% respectively, P<.004. The rate for exclusive breastfeeding for WIC mothers with high vs low Baby-Friendly exposure score were 38.0% vs 0.0%, P<.006.

CONCLUSION:
Policies that combine Baby-Friendly principles and nutritional assistance for all mothers, particularly low-income working mothers, will improve breastfeeding rates dramatically.
L.E.A.D.E.R. Series: Resident Well-Being Woven Into the Clinical Curriculum [18N]
Authors: Reed Vicki Rae , Jhaveri StacieAntalis , Singh Katherine 
Published: May 2019

INTRODUCTION:
Across the field of medicine, there is a focus on physician well-being. We developed an innovative L.E.A.D.E.R. (Leadership, Equanimity, Acceptance, Diversity, Engagement and Resilience) series that focuses on each of these core qualities as part of our residents' training. Didactics, group activities and team based simulation are woven into our clinical curriculum.

METHODS:
Team Building Skills Sessions are a core of the LEADER series. Resident teams of varied PGY levels develop team names/slogans and worked together to perform surgical tasks. Seniors “chief” juniors through skills in an environment of collegial competition. Using iPads, standard post-activity simulation center surveys were completed by residents. Resident rated the experience 1) as a simulation, 2) the learning during the session, 3) the instructors and 4) the relevancy to practice on a scale of 0-9. Verbatim comments were request on the team based activities.

RESULTS:
In 2017, 21 of 24 captured participants completed the survey and 13 of 20 in 2018. Overall the mean score in 2017 was 8.3 and in 2018 it was 8.1. Verbatim comments included the positive impact on communication, "chiefing", team building, bonding and technical skills.

CONCLUSION:
Skill-based team building creates an environment of camaraderie and provides positive resident experiences. Faculty involvement in the sessions models collegiality. An example: during one simulation, our opening ceremony to our Resident Olympics involved themed music as our faculty carried I-phone torches into the simulation center full of residents. A focus on “teams” early in training, builds peer relationships that are the foundation of resilience.
Maternal Fetal Health Workshop in Cusco, Peru: Shifting From Assistance to Capacity Building [19N]
Authors: La Rosa Mauricio , Webb Camille , Hadley Emily Elizabeth , Marrs Caroline Carter , Olson-Koutrouvelis Gayle , Cabada Miguel 
Published: May 2019

INTRODUCTION:
Abroad medical volunteer work by United States citizens accounts for over one billion dollars in unpaid labor annually. The effectiveness of medical volunteerism in developing countries has been questioned. Changing the paradigm from assistance to capacity building might have a bigger and more permanent impact. The aim of our study is to evaluate a training intervention performed with Peruvian Ministry of Health personnel and determine its immediate impact.

METHODS:
This 2 day hands-on workshop was given by MFM and Infectious disease fellows, and focused on obstetric and neonatal emergencies. Midwifes and general physicians were invited to participate. Pre and post-workshop tests were conducted. The tests evaluated knowledge in management of pre-eclampsia, post-partum hemorrhage, ectopic pregnancy, maternal sepsis, and neonatal respiratory support. Total and topic specific mean scores in the pre and post-tests were compared using Chi square.

RESULTS:
A total of 47 healthcare professionals participated in the workshop and 38 answered both tests. Six were physicians, 6 registered nurses, and 35 midwifes. There was a significant improvement in the total score (12.9 vs 15.9, p<0.01) as well than in the areas of preeclampsia (1.5 vs 2.7 p<0.01), maternal sepsis (1.6 vs 2.4 p<0.01) and neonatal respiratory support (3.9 vs 4.4 p 0.05).

CONCLUSION:
Comparison of the pre and post-tests scores showed improvement in knowledge in general and in preeclampsia, maternal sepsis and neonatal respiratory support. The immediate effects of this intervention were positive. Further studies should be performed to evaluate the long term effects of these multidisciplinary workshops.
Location, Location, Location: Hospital Level Predictors of Length of Stay Following Cesarean Section [21N]
Authors: Peahl Alex Friedman , Kamdar Neil , Moniz Michelle , Dasmunshi Sudipta , Low Lisa Kane , Morgan Dan 
Published: May 2019

INTRODUCTION:
Length of stay (LOS) after cesarean delivery (CD) is poorly defined in different practice settings. We describe LOS in hospitals in a statewide obstetric collaborative, and evaluate for associations between LOS and hospital and patient characteristics.

METHODS:
Women who underwent CD in 2012-2016 for fetal malpresentation or prior CD were identified in an insurance claims database. LOS was defined as ≤2, 3, and ≥4 days. Multinomial logistic regression accounting for hospital clustering examined the influence of hospital and patient characteristics on post-surgical LOS.

RESULTS:
16,218 women at 66 hospitals met inclusion criteria. LOS was ≤2, 3, and ≥4 days for 40.1%, 43.1% and 16% of patients respectively. Women were more like to have a longer LOS at hospitals with 3600 deliveries/year compared to hospitals with <1200 (2 vs.3 days: >3600/year, RRR=2.34 p=0.005; 3 vs. 4 days: >3600/year RRR=2.28 p=0.001. LOS was longer for women with maternal comorbidities (2 vs. 3 days: RRR=2.11 p<0.001, 3 vs. 4 days: RRR=3.18 p>0.001), fetal comorbidities (3 vs. 4 days: RRR=5.91 p=0.035). LOS was also longer for women with severe maternal morbidity as defined by the NIH (2 vs. 3 days: RRR=2.23 p<0.001, 3 vs.4 days: RRR=3.74 p<0.001).

CONCLUSION:
LOS varies based on obstetric volume and comorbidities. Clarifying the relationship between patient and hospital level factors may inform guidelines for safe discharge after Cesarean.
Managing Women With Obesity in Pregnancy: Scope of Practice in the Wake of the Obesity Epidemic [23N]
Authors: Stafford Shawna M. , Demsky Ashley , Oster Richard , Steed Helen 
Published: May 2019

INTRODUCTION:
Obesity is a complex chronic disease affecting increasing numbers of reproductive aged women. Despite ongoing research efforts, many knowledge gaps remain when caring for women with obesity in pregnancy. Currently, there is no clearly defined, comprehensive standard of care for pregnant women with obesity. Consequently, obstetrical care providers have developed different approaches. In this study, we explored these approaches and how management of women with obesity differs from that of normal weight patients.

METHODS:
Qualitative concept maps were generated through individual in-depth mapping sessions with obstetricians (n=7) in Edmonton, Alberta, Canada. Concept maps were analyzed thematically and major themes and sub-themes used to inform survey development. Institutional ethics approval was obtained.

RESULTS:
Overall, seven dominant themes emerged from our thematic analysis: 1) Obstetricians define obesity differently; 2) Communication with patients with obesity should be “direct” and “honest”; 3) Understanding fetal wellbeing is more challenging in patients with obesity in both the pre-natal and intra-partum period; 4) Obstetricians recommend induction of labor for large for gestational age fetuses but not maternal obesity; 5) Women with obesity have abnormal labor; 6) Obstetricians expect more complications, alter their surgical approach, and adjust their threshold for Cesarean deliveries in patients with obesity; and 7) Education and knowledge translation about obesity in pregnancy is inadequate.

CONCLUSION:
Concept mapping provided insights into how present-day obstetrical care is affected by obesity. This information has led to the development of a quantitative survey for obstetricians that will more broadly assess practice patterns for the management of women with obesity in pregnancy.
Maternal and Neonatal Glycemic Response to Antenatal Corticosteroids [24N]
Authors: Fixler Joseph S. , Nickel Mara , DeFranco Emily A. 
Published: May 2019

INTRODUCTION:
The influence of the timing of antenatal corticosteroid (ANCS) administration on maternal and neonatal glycemic response remains poorly defined. We sought to describe the maternal and neonatal glycemic response to ANCS as it relates to timing of ANCS administration in early and late preterm deliveries.

METHODS:
We conducted a retrospective cohort study of deliveries from 2013-2017. Analysis was limited to those receiving ANCS within 1 week of delivery. We compared the mean maternal glucose on the first and second days after ANCS in early preterm deliveries (<34 weeks) to late preterm deliveries (34 to <37 weeks). Stratifying by delivery timing and interval from ANCS to delivery, we evaluated the rate of neonatal hypoglycemia in the 2 days after delivery.

RESULTS:
618 deliveries were included. 528 were early preterm deliveries; 90 were late preterm deliveries. No difference in mean maternal glucose was observed on the first or second day after ANCS between early and late preterm deliveries. A difference in rate of neonatal hypoglycemia was found based on interval from ANCS to delivery only in early preterm deliveries, with higher rates after receiving steroids 1 day (40.9%) or 2 days (38.6%) before delivery (p=0.008). Stratifying by interval from ANCS to delivery, no significant difference in neonatal hypoglycemia was found between early and late preterm deliveries.

CONCLUSION:
Neonatal hypoglycemia appears to be influenced by proximity of ANCS to delivery in early preterm deliveries. Targeted screening for hypoglycemia may be warranted in early preterm deliveries in which ANCS are administered 1 or 2 days before delivery.
Maternal Morbidity in Patients With Preeclampsia With Severe Features at Less Than 34 Weeks Gestation [25N]
Authors: Patel Krunal P. , Romagano Matthew P. , Apuzzio Joseph , Gittens Lisa Nadine , Williams Shauna F. 
Published: May 2019

INTRODUCTION:
Objective of this study is to review the maternal morbidity with expectant management compared to immediate delivery in patients with preeclampsia with severe features at less than 34 weeks.

METHODS:
This is a retrospective cohort study of all gravidas <34weeks gestation with preeclampsia with severe features who delivered at a tertiary care hospital from 1/1/2014 to 12/31/2017. Medical records were reviewed for maternal demographics, obstetric outcomes and maternal adverse events. Patients were grouped according to whether they were candidates for expectant management (Group 1: not candidates for expectant management; 2: candidate for expectant management and delivered immediately after steroid course; 3: expectant management). The composite outcome was occurrence of HELLP syndrome, abnormal LFTs, acute renal injury, eclampsia, and pulmonary edema, admission to ICU, stroke, cerebral complications, and abruption.

RESULTS:
83 patients were identified, 48 patients were not candidates for expectant management. Of the remaining 35 patients, 16 patients were delivered after steroid administration due to physician preference. 19 patients underwent expectant management and median time to delivery was 4 days from diagnosis. Composite morbidity occurred in 21 (44%) patients in group 1, 2 (12.5%) in group 2 and 3 (16%) in group 3. There were one case of each HELLP syndrome, acute renal injury, abruption, elevated LFTs and thrombocytopenia in group 3.

CONCLUSION:
Preeclampsia with severe features at less than 34weeks gestation is associated with significant maternal morbidity. Close surveillance and caution should be taken when managing patients expectantly.
Membrane Sweeping for Trial of Labor After Cesarean: A Systematic Review and Meta-analysis of RCTs [32N]
Authors: Hamidi Odessa Persia , Quist-Nelson Johanna Rachel , Xodo Serena , Berghella Vincenzo 
Published: May 2019

INTRODUCTION:
Our objective was to determine effects of membrane sweeping on promoting labor in patients undergoing a trial of labor after cesarean.

METHODS:
Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials using a combination of keywords related to “membrane sweeping,” “membrane stripping,” “vaginal birth after cesarean,” and “trial of labor after cesarean” from inception of databases until April 2018. We included all RCTs of pregnancies at 36 weeks or greater that evaluated pre-labor membrane sweeping in patients undergoing TOLAC. We excluded trials that did not include patients with a prior uterine scar, or that were studies of membrane sweeping during initiation of labor induction. The primary outcome was rate of spontaneous labor. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce relative risk (RR) with 95% confidence interval (CI).

RESULTS:
Two studies met inclusion criteria and were included in our meta-analysis (n=361). Membrane sweeping did not have an effect on onset of labor (RR 1.05, 95% CI 0.92 to 1.20). There was no significant difference for rate of spontaneous vaginal delivery (RR 1.06, 95% CI 0.84 to 1.34), operative vaginal delivery (RR 0.97, 95% CI 0.25 to 3.78) or cesarean delivery (RR 1.00, 95% CI 0.87 to 1.14).

CONCLUSION:
Membrane sweeping in patients planning a trial of labor after cesarean was not found to be effective promoting the onset of labor. This systematic review highlights the limited data addressing the utility of membrane sweeping for women with prior cesarean delivery.
Multidisciplinary Management of Morbidly Adherent Placenta Reduces Blood Loss [38N]
Authors: Podwika Sarah , Wang Connor , Zuber Matthew , Cortez Briana , Chisholm Christian , Dudley Donald J. 
Published: May 2019

INTRODUCTION:
We implemented a multidisciplinary team approach including prophylactic internal iliac artery (IIA) catheterization to manage patients at high risk of obstetric hemorrhage due to morbidly adherent placentation (MAP).

METHODS:
We performed an IRB approved, retrospective cohort study of patients (2000-2018) who underwent cesarean hysterectomy for suspected MAP. We compared outcomes before and after the implementation of a multidisciplinary treatment team approach with data from the electronic medical record.

RESULTS:
There were 12 cases of MAP prior to implementation of the multidisciplinary approach and 24 cases after. IIA catheters were placed preoperatively in 54% of the patients in the multidisciplinary team cohort. There were no differences between groups in mean maternal age (35.2 vs 31.7, P=.14), gravidity (4.4 vs 3.8, P=.51), parity (2.6 vs 1.9, P=.12), or number of prior cesareans (2.5 vs 1.8, P=.09). There were no differences in postoperative length of stay (9.7 vs 4.8 days, P=.09), 30-day readmission (8.3% vs 12.5%, P=.071), 5 minute Apgar <7 (P=.16) or birth weight (P=.88). We observed a significant difference in estimated blood loss (4,558 mL vs 2,215 mL, P=.02) and mean number of units of packed red blood cells transfused (12.75 vs 4.5, P=.03).

CONCLUSION:
The multidisciplinary approach, specifically the addition of IIA catheterization, results in reduced total blood loss and units of blood transfused. This intervention may be high yield at other centers.
Myomectomy Route and Adhesions at Subsequent Cesarean Delivery [39N]
Authors: Taggart Ashley A. , Carusi Daniela A. , Gargiulo Antonio R. , Srouji Serene S. 
Published: May 2019

INTRODUCTION:
To compare adhesions at cesarean delivery following open vs laparoscopic myomectomy.

METHODS:
In this retrospective cohort study, patients with an abdominal myomectomy were compared to those having conventional or robot-assisted laparoscopic myomectomy with regard to dense adhesions at the time of cesarean delivery. Logistic regression was used to control for potential confounders.

RESULTS:
141 patients met inclusion criteria: 65 with abdominal and 76 with laparoscopic myomectomies. Patients in the abdominal group were more likely to have an anterior (72% vs 49%, P < .01) or posterior (74% vs 58%, P=.05) vs fundal uterine incision, and had more endometrial entry (43% vs 22%, P < .01), more fibroids removed (median 7 vs 2, P < .01), and more preexisting dense adhesions (28% vs 11%, P < .01). Patients in the laparoscopic group were more likely to have been exposed to barbed suture (15% vs 2%, P < .01) and uncontained power morcellation (96% vs 11%, P < .01) with no difference in the use of adhesion barriers. The abdominal group developed significantly more dense adhesions (56% vs 12%, P < .01), even after controlling for surgical factors plus age, race, and obesity (OR 9.88, 95% CI 1.54-63.39). The abdominal myomectomy group experienced more vertical skin incisions or hysterotomies (17% vs 1% for both, P < .01) and longer incision to delivery times (median 12 vs 9 min, P < .01), but no difference in neonatal Apgar scores.

CONCLUSION:
Prior abdominal myomectomy confers more risk for dense adhesions at the time of cesarean delivery than laparoscopic procedures.