bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Quality Improvement Project—Standardizing Postpartum Discharge Instructions With an Educational Video [16G]
Authors: O'Dell Danyelle D. , West Sian , Hoffman Jennifer , Burke Lori M. 
Published: May 2019

INTRODUCTION:
The WHO estimates that, in the United States, 1,200 women experience perinatal events that prove fatal and 60,000 suffer complications that are near-fatal. Postpartum morbidity and mortality may be decreased by explicit patient education. At our institution, the maternal discharge education process was found to be variable. The objective of this project is to increase patient awareness of warning signs of postpartum complications by using a standardized discharge education video.

METHODS:
A patient survey was designed and administered to evaluate the effectiveness of the maternal discharge education procedures in our institution and the baseline results were reviewed by a team of physicians and nurses. A standardized discharge education video was created using information from ACOG and AWHONN. The video was made accessible on bedside tablet devices. All postpartum nurses were trained on the video content and how to operate the tablets. Survey responses following implementation of the video were compared with the baseline results.

RESULTS:
29 patient surveys were obtained prior to implementing the video. Patients reported that they did not understand “symptoms of losing too much blood” (48.2%) or when vaginal bleeding is “too heavy” (37.9%). Post-video surveys collected to date (n=6) reveals that 100% of patients report understanding the symptoms of “losing too much blood” and when vaginal bleeding is “too heavy.”

CONCLUSION:
The implementation of a standardized postpartum discharge education video has improved patients' knowledge regarding postpartum hemorrhage warning signs at our institution.
Effects of 17-α Hydroxyprogesterone Caproate on Recurrent Preterm Birth at an Inner City Hospital [17G]
Authors: Garcia Luis , Hudley Shakese Melina , Brown Judith 
Published: May 2019

INTRODUCTION:
Preterm birth is the major determinant of infant mortality in developed countries. Meis et al showed a substantial reduction in the rate of recurrent preterm when progesterone supplementation is used. However, our patient demographic is different from that studied. Therefore, the objective of our study is to evaluate the effect of 17α-Hydroxyprogesterone Caproate (17OHP-C) on the rate of preterm delivery in our specific patient population.

METHODS:
Institutional Review Board (IRB) committee approval was obtained for this study. Electronic medical records database from January 2015 to November 2017 were retrospectively analyzed. Inclusion criteria were preterm delivery and treatment with 17OHP-C between 16 and 36 weeks gestation. The primary outcome was preterm delivery. The secondary outcome was a neonatal composite score of adverse outcomes.

RESULTS:
Baseline demographics of the experimental group (n= 88) vs the control group (n= 259) were similar. There was no reduction in the rate of delivery before 37 weeks gestation with use of 17OHP-C (37.1 days in the experimental group vs 36.7 days in the control group, P=.466), before 35 weeks gestation (30.7 days in the experimental group vs 31.0 days in the control group, P=.845), and before 32 weeks gestation (26.0 days in the experimental group vs 28.8 in the control group, P=.130). There was no significant reduction in the neonatal composite score in infants born to mothers treated with 17OHP-C (injection group 9% vs control at 15.1%).

CONCLUSION:
17OHP-C did not result in a reduction in the rate of recurrent preterm delivery in our population.
An Induction Failed on a Whim? Or, WHIM Syndrome Resulting in a Failed Induction of Labor? [25G]
Authors: Zammarrelli William A. , Petersen Scott M. , Hickey Kimberly , Walton Robert B. 
Published: May 2019

INTRODUCTION:
The physiology of labor, specifically cervical dilation, likely depends on immunomodulation. Warts, Hypogammaglobulinemia, Infections, and Myelokathexis (WHIM) Syndrome, is a rare immunodeficiency syndrome with patients experiencing increased susceptibility to certain cancers, warts, and recurrent bacterial and viral infections secondary to both neutropenia and lymphopenia. Patients with immunodeficiency are more susceptible to both infection and Preterm Premature Rupture of Membranes. We report the first case of a pregnancy affected by WHIM Syndrome.

METHODS:
A 23-year-old woman, gravida 1, with a diagnosis of WHIM Syndrome was treated with filgrastim during the antenatal period with a goal absolute neutrophil count of >500. She underwent a primary low transverse cesarean section at 37 weeks and 2 days gestational age after a failed induction of labor for Oligohydramnios.

CONCLUSION:
A patient with WHIM Syndrome likely benefits from filgrastim treatment in the antenatal period. In addition, a patient with WHIM Syndrome undergoing an induction of labor has not been described in the literature. Understanding labor in this specific population may help to further elucidate the physiology and biochemistry of labor. Patients with WHIM syndrome may have an increased risk of failed induction of labor given a lack of neutrophil function, which is critical during cervical ripening.
An Uncommon Initial Presentation of Crohn’s Disease Complicating a Multi-gestation Pregnancy [26G]
Authors: Carney Alexandra C. , Wilson Karen 
Published: May 2019

INTRODUCTION:
Crohn's disease most commonly presents between the ages of 20 and 29. The incidence of a primary presentation of Crohn's disease occurring in pregnancy is about 4%. This inflammatory disease has systemic/extraintestinal manifestations making it highly relevant and potentially dangerous during pregnancy especially in a multifetal gestation. We present a case of an atypical primary presentation of Crohn's disease manifested as a rare complication of the disease in a multifetal gestation.

METHODS:
A 28 year old Gravida 5 Para 3 at 13 weeks gestation with a monochorionic, diamniotic twin gestation presented with lower abdominal pain and vomiting for two days. MRI revealed a dilated jejunum and terminal ileitis. Gastroenterology and General Surgery were consulted. The patient's symptoms improved with conservative management. On hospital day 6, fetal demise of the twin gestation occurred. Pathology of the placenta reported umbilical cord funisitis and focal placental infarct. She was readmitted 10 days later for similar abdominal pain. CT revealed a pelvic abscess. She underwent exploratory laparotomy with ileocecectomy secondary to perforation and fistulizing Crohn's disease.

CONCLUSION:
Initial presentation of inflammatory bowel disease in pregnancy is rare, and the fetal and maternal risks are exceedingly high; therefore, early identification and intervention is critical. Only 0.5% of abdominal abscesses requiring laparotomy are due to Crohn's disease and only between 10% and 30% of Crohn's patients develop an abscess in their lifetime. This case highlights the importance of maintaining a broad differential when managing a patient with abdominal pain in pregnancy, while potentially utilizing a multidisciplinary team approach.
An Unlikely Culprit of Paralysis in Pregnancy [27G]
Authors: Louise Lynes Maria Christine , North Ware Jamie L. , Looney Kimberly Rochelle , Aguinaga Maria del Pilar 
Published: May 2019

INTRODUCTION:
Todd paralysis (TP) is a rare postictal condition characterized by weakness following an epileptic seizure. TP includes both motor and non-motor entities including altered cognition, psychiatric symptoms, automatic behavior, and aphasia. The etiology is unknown. The reported duration of TP varies between half-an-hour to 36 hours.

METHODS:
A 33-year-old G6P5005 at 37 weeks with past medical history of epilepsy controlled with Levetiracetam, presented with right-sided weakness and elevated blood pressure following a generalized tonic-clonic seizure. Preeclampsia workup was performed and negative. Secondary to post-ictal paralysis Neurology was consulted with the conditional diagnosis of acute stroke. Motor examination showed paralysis on her right side. Cranial Magnetic Resonance Imaging revealed significant diffusion restriction in the territory of the left Middle Cerebral Artery involving the distal branches and watershed segments. After reviewing the clinical manifestations and neuroimaging findings, the diagnosis was established as TP and antiepileptic therapy was initiated. Routine electroencephalography showed slowed left frontal-parietal activity. Patient's weakness gradually improved with recovery to her premorbid status after 48 hours. The cranial Magnetic Resonance Angiography subsequently showed no significant stenosis or occlusion of the intracranial cerebral arteries.

CONCLUSION:
The nature, duration, and severity of TP are not related to the duration or severity of the seizures nor the presence of lesions or changes on electroencephalogram. Although stroke is the leading differential diagnosis in patients with neurologic deficits; in pregnancy, TP should be included in the differential if convulsive activity is coupled with paralysis. A misdiagnosis of stroke can lead to unnecessary and potential harmful interventions.
Anterior Placentation Without Previa in Patients With Prior Cesarean Section: What Is the Risk of Accreta? [29G]
Authors: Leovic Michael Phillip , Perlow Jordan Hugh 
Published: May 2019

INTRODUCTION:
In the absence of placenta previa, the risk of accreta is well documented (0: 0.03%, 1: 0.2%, 2: 0.1%, 3-4: 0.8%, >5: 4.7%) in the work of Silver et al. These frequently referenced risk metrics were derived from a cohort of patients delivered from 1999-2002 with a documented prevalence of accreta occurring in 1 in 2,625 deliveries. With the prevalence of accreta now approaching 1 in 533 deliveries, reevaluation of this risk is warranted.

METHODS:
A review of accreta cases presenting to a single, large, tertiary care center from 12/15/2011 to 08/22/2017 was performed. Records were reviewed and abstraction of data pertaining to demographics, obstetric history, placental location, delivery information, and tissue pathology was performed. For historical comparison, data from Silver et al was configured to reflect the risk of accreta in the absence of previa, stratified by number of prior cesareans. Data was summarized using SAS software, version 9.4.

RESULTS:
Of 169 AIP cases identified, there were 16 (9.5%) patients with prior cesarean delivery, anterior placentation, and no previa that had histologically-confirmed AIP. The risk of AIP after 1, 2, 3-4 and >5 prior cesarean deliveries was 50%, 75%, 77.8%, and 50%, respectively. No differences were observed comparing this risk to that of Silver et al (53.1%, 19.4%, 35.1%, 66.7%; p - 0.470).

CONCLUSION:
Our data suggests that absence of placenta previa should not be heavily relied upon for risk reduction when antenatal suspicion for AIP is raised based on other clinical variables.
Exploring Sociodemographic and Geospatial Variation in Human Papillomavirus Vaccination Uptake in Virginia [37G]
Authors: Staples Jeanine N. , Nelamangala Samhita , Morris Sean , Wells Kristen 
Published: May 2019

INTRODUCTION:
Despite strong CDC recommendations and a state school requirement, nearly half of all adolescents in Virginia have not completed the HPV vaccine series. Using ArcGIS software, we aimed to explore the relationship between provider density, socioeconomic status, and HPV vaccination uptake in the state of Virginia.

METHODS:
HPV vaccination rates among adolescents 11 to 17 years were retrieved at the zip-code level from the Virginia Immunization Information System. Choropleth maps of vaccination rates were produced. The ArcGIS Hot Spot Analysis tool identified spatial clusters of zip codes with high and low vaccination rates. Student t-test was used to compare provider density and various socioeconomic indicators between statistically significant clusters of higher (RR>1.0) or lower (RR<1.0) than expected vaccination rates.

RESULTS:
High series completion rates were noted in central Virginia and the eastern shore. Regions of northern Virginia, including Shenandoah and Page counties, had lower than expected initiation and completion rates. Clusters with significantly lower initiation rates had a lower number of primary care providers, were less educated, and had a lower median household income (MHI). Regions with significantly lower series completion rates had a higher MHI. While regions with lower rates of series completion for males had a higher concentration of providers and were more educated, there was no difference among these factors for female series completion.

CONCLUSION:
Regional socioeconomic indicators are significant predictors of HPV vaccination, but may have contrasting implications for series initiation and completion. These findings emphasize the utility of spatial analysis and GIS methodology for identifying cancer prevention disparities.
Deficiencies in Reproductive Health Counseling in Liver Transplant Patients [2H]
Authors: Ritchie Julia , Seidman Dominika , Srisengfa Yanin , Jacoby Vanessa L. , Perito Emily , Sarkar Monika 
Published: May 2019

INTRODUCTION:
Over 30% of female liver transplant patients are reproductive age. Fertility is quickly restored following transplant and unplanned pregnancy is common. Data on reproductive counseling in transplant patients are lacking.

METHODS:
Women ages 14-45 years who were listed, or with previous liver transplant (n=147) at an academic medical center were invited to complete an online survey in 2018. Questions explored contraception/pregnancy counseling, patient counseling preferences, and contraception use after transplant.

RESULTS:
Fifty (34%) women completed the survey, including 11 pre- and 39 post-transplant patients. Median age was 33 years; 76% were white, 20% Hispanic. Most (79%) reported reproductive counseling as “very important” to their post-transplant care, although 71% reported insufficient counseling received. Among pre-transplant women (n=11), 4 reported never discussing future pregnancy, 2 were advised never to conceive, and 3 were informed that pregnancy after transplant was impossible. During pre-transplant years only 14/38 (36%) received any counseling, of whom only 56% described counseling received as sufficient. While counseling after transplant was more common (74%), only 47% (18/38) of women reported contraception use in the first year post-transplant, including 22% using high failure methods including condoms, withdrawal, or rhythm. Women's reported preferences for counseling included discussion with transplant providers (92%), referral to women's health (67%), and handouts (31%).

CONCLUSION:
Reproductive counseling is inconsistent in liver transplant patients, despite patient interest, and the majority used no contraception. Given maternal and fetal risks of unplanned pregnancies, systems-based interventions that optimize women's preferred means of counseling should be implemented in this medically complex population.
Effect of Group Prenatal Care on Contraceptive Use at Twelve Weeks Postpartum [5H]
Authors: Olatunde Aishat , Paoletti Andrew , Hosein Safiyah , Pitcairn-Ramirez Alexis , Gurney Elizabeth Price 
Published: May 2019

INTRODUCTION:
We compared the prevalence of contraceptive use by 12 weeks postpartum among women who participated in group prenatal care (GPC) vs. traditional prenatal care (TPC) and investigated differences in contraceptive method choice by type of prenatal care.

METHODS:
We performed a retrospective review of patients who received GPC or TPC and followed up within 12 weeks of delivery, between January 1 and December 31, 2017, at our institution, after receiving IRB approval. Postpartum contraceptive methods were analyzed by effectiveness (Tier 1, long-acting reversible contraception and sterilization; Tier 2, hormonal methods; Tier 3, barrier and fertility awareness methods, withdrawal, spermicide; and no method) using Chi-square and multivariate logistic regression.

RESULTS:
122 participants in GPC and 121 in TPC were included. The prevalence of any contraceptive use by 12 weeks postpartum was 70.5% and 68.6% for GPC and TPC, respectively (P=.75). After controlling for demographic and clinical factors, there was no difference in Tier 1 versus other contraceptive use (aOR 0.92, 95% CI 0.81-1.07, P=.31). Participants in GPC were significantly more likely to select Tier 2 contraceptive methods (aOR 1.19, 95% CI 1.03-1.36, P=.02), and attendance at each additional GPC visit increased the odds of selecting a Tier 2 method (aOR 1.02, 95% CI 1.00-1.04, P=.03).

CONCLUSION:
There was no difference in the prevalence of contraceptive use at 12 weeks postpartum among women who received group compared to traditional prenatal care in this study. Participation in GPC was associated with increased use of Tier 2 contraceptive methods in a dose-dependent fashion, regardless of sociodemographics.
Examining Female Patients With Sickle Cell Disease Attitudes and Beliefs About Contraceptives [9H]
Authors: Kendra Piper , El Rassi Fuad , McLemore Morgan , Kottke Melissa Jo. 
Published: May 2019

INTRODUCTION:
Sickle cell disease (SCD) is an inherited hematological disorder. The U.S. Medial Eligibility Criteria for Contraceptive Use (MEC) highlights SCD as a condition that is associated with increased risk of adverse events during pregnancy. The MEC advises that the benefits of using hormonal contraceptives usually outweigh the risks for women with SCD and does not discourage the use of any specific contraceptives. However, use of highly effective contraceptives is low in this population.

METHODS:
African American females 18 and older with SCD were recruited from a sickle cell clinic in Atlanta, Georgia. We conducted semi-structured interviews to explore participants' beliefs and attitudes towards contraceptives. IRB approval was obtained.

RESULTS:
Seventeen women were interviewed. The women endorsed conflicting views of contraceptives. Positive perceptions about contraceptives included pregnancy prevention, relief of heavy menstrual bleeding and fewer sickle cell pain crises. Conversely, negative perceptions towards hormonal contraceptives included concerns about side effects and apprehension about using hormonal contraceptives while having SCD.

CONCLUSION:
Women with SCD have both positive perceptions about contraceptives as well as concerns about using them. Awareness and acknowledgement of this tension may help clinicians provide effective and supportive contraceptive counseling for people with SCD. Using a shared decision-making model and discussing an individual's concerns as well as the potential benefits for that person may result in increased uptake and improved contraceptive utilization.
OR Team Member Perceptions Regarding Medical Students Performing Pelvic Examinations on Anesthetized Female Patients [11H]
Authors: Rice Elizabeth , White Chase , Ko Janet , Myers John , Jaspan David , Goldberg Jay 
Published: May 2019

INTRODUCTION:
The purpose of this study was to determine perceptions regarding medical students performing pelvic examinations on anesthetized female patients.

METHODS:
An internet based survey was distributed to OB/GYNs, OR nurses/techs, anesthesiologists/CRNAs, and medical students at multiple hospitals. Demographic data were collected. Non-demographic answers were recorded on a 5-point scale. Characteristics between groups were statistically compared using Chi-squared test for independence and the Fisher's Exact Test.

RESULTS:
337 OR staff/students completed the questionnaire. 72% believed permission should be obtained from patients prior to EUAs by medical students. 30% of respondents believed prior consent was usually obtained. 50% believed patients would agree to have EUAs performed. 80% of respondents believed patients would be upset if made aware an EUA by a medical student had been performed without their prior consent. Medical students were less likely to believe performing EUAs had educational benefit. 57% would recommend to female relatives to allow a medical student to perform an EUA on them. Medical students were less likely to believe it was appropriate for a student to perform EUA, less likely to believe there was educational benefit, less likely to believe patients would consent, and more likely to believe patients would be upset if they learned an unconsented exam had occurred.

CONCLUSION:
Despite the perception OB/GYN OR team members on consenting prior to medical students performing pelvic examinations on anesthetized female patients, this does not usually occur. Almost 50% of medical students would not encourage their female relatives to consent to medical students performing such EUAs.
Laparoscopy in the Chronic Pelvic Pain Patient: Incidence and Outcomes of Subsequent Laparoscopies [20H]
Authors: Shukr Ghadear , Katiyar Urvashi , Cheng Monique , Eisenstein David 
Published: May 2019

INTRODUCTION:
Our aim is to determine the incidence of multiple laparoscopies for chronic pelvic pain over 10 years and to compare outcomes between patients who underwent single vs multiple laparoscopies.

METHODS:
An IRB approved retrospective case-control study of women at a tertiary medical center with a diagnosis of chronic pelvic pain that underwent one laparoscopy in comparison with those who underwent multiple laparoscopies in a 10-year period. Parametric, nonparametric and descriptive statistics were employed.

RESULTS:
678 controls with single laparoscopy and 114 cases with multiple laparoscopies were identified. 400 (59%) had medical management prior to initial laparoscopy in the control group and 82 (72%) in the cases. 559 had diagnostic and 119 had extirpative laparoscopies in the single laparoscopy group vs 91 diagnostic and 23 extirpative laparoscopies in the multiple laparoscopy group. Of the patients with persistent pain after initial laparoscopy, 56 underwent hysterectomy with 22 having pain resolution, 5 persistent, 4 improved and 15 unknown. The average number of subsequent laparoscopies in the multiple laparoscopy group was 2.27. 38 patients underwent hysterectomy with 18 having pain resolution, 4 persistent, 6 improved and 12 unknown. 25 patients were identified as having pathologic evidence of endometriosis in the single laparoscopy group vs 32 in the multiple laparoscopy group.

CONCLUSION:
This study reviews the outcomes of chronic pelvic pain in relation to laparoscopic management. It suggests that majority of patients undergo nonsurgical management prior to initial laparoscopy and that patients in the multiple laparoscopy group have a greater likelihood of undergoing subsequent hysterectomy with pain resolution.