bluuebunny/crossref_metadata_2025_split huggingface dataset:
Simulation-Based Curriculum is Effective in Teaching Principles of Vaginal Breech Delivery [35M]
Authors: Higgins Erin , Becker Les , Auguste Tamika 
Published: April 2018

INTRODUCTION:
Simulation has yet to be fully implemented into the curriculum in many obstetrics and gynecology residencies across the U.S. Reasons for resistance to implementation include cost, time requirements both of instructors and learners, and a paucity of data demonstrating the benefit of simulation with regards to skills training. Advocates of simulation in residency training note its value in teaching high-acuity, low-frequency events such as vaginal breech delivery.

METHODS:
We implemented a one year simulation curriculum incorporating obstetric and gynecologic skills training, standardized patient encounters, and teamwork training. Residents at all levels participated in the training sessions, which were a mandatory part of the educational curriculum. End-of-the-year evaluation was accomplished through the use of a two-hour practical exam in which residents performed skills at 13 different stations. Faculty evaluations of residents were collected for each station using an objective skills card that scored both clinical knowledge and procedural skills.

RESULTS:
We found that residents’ performance at the vaginal breech station improved consistently over 3 years of data collection. The junior cohort improved from 70.0% to 83.3% proficiency from PGY-1 to PGY-3, while a more senior cohort improved from 78.6% to 84.6% from PGY-2 to PGY-4. An third cohort that began the curriculum in the PGY-3 year improved from 90.4% to 91.6%.

CONCLUSION:
This pilot study demonstrates that a simulation-based educational curriculum is an effective method of teaching residents procedural skills and knowledge to improve competency in the area of vaginal breech deliveries.
Development of a Simulated Intra-Abdominal Model and Visual Analog Scale to Assess Visual Clarity of Laparoscopes [37M]
Authors: Palvia Vijay , Gonzalez Aaron Herrera , Richard Vigh , Anasti James 
Published: April 2018

INTRODUCTION:
Visual clarity (VC) is vital in performing laparoscopic surgery. However, few studies provide a direct assessment of laparoscopic VC or techniques to improve VC.

METHODS:
A box was constructed of ¼ inch acrylic glass with opaque insulation. An attached humidified source was heated to give a constant 81% humidity at 36 degrees Celsius. A 10 mm laparoscope was inserted and positioned 8 cm distal to a laminated white card containing black 12 pitch font. Four standard still images of varying visual clarity were captured and designated VC1, VC2, VC3, and VC4. A 10 cm visual analog scale (VAS) was used to rate VC scores. The 0 cm mark indicated total visual obstruction and the 10 cm mark indicated perfect visual clarity. The performance of the VAS was determined by having observers rate the still images. The observers were blinded to the VC rating and number of standard images used. Intra-observer and inter-observer differences were calculated.

RESULTS:
Standard images were assessed in random fashion 4 times by each of the 4 independent observers (64 total readings). Observed means were calculated (VC1, 9.2 ± 0.57 cm; VC2, 7.4 ± 0.65 cm; VC3, 4.4 ± 0.65 cm; VC4, 1.4 ± 0.52 cm). All values differed from each other (p < .001). Inter-observer differences were < 0.54 ± 0.37 cm and intra-observer differences were < 0.35 ± 0.13 cm.

CONCLUSION:
Our novel simulation model applied a visual analog scale that can serve as a tool to compare various techniques utilized for improving laparoscopic visual clarity.
Multiple Concurrent Malignancies Commonly Seen in Immunocompetent Human Immunodeficiency Virus-Infected Women [2N]
Authors: Davis Kelly , Kennedy Kathryn , Robinson William 
Published: April 2018

INTRODUCTION:
To determine optimal management strategies for HIV-infected women with HPV-associated invasive and in-situ malignancies. Also, to identify possible interactions between Highly Active Anti-Retroviral Therapy(HAART) and anti-malignancy therapy.

METHODS:
All HIV-infected women diagnosed with an HPV-associated malignancy between 2011-2016 were identified as part of an ongoing Quality-Improvement project. Data collected includes: demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, and compliance. The data was analyzed using standard statistical tests.

RESULTS:
17 HIV-infected women were identified with an HPV-related malignancy. The mean age was 39 years and all were African-American. Invasive malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Urethra/Bladder-2, Oropharyngeal-3. In-situ lesions included: Cervix-4, Vulva-3, Oropharyngeal-1. 4 subjects had 3 separate malignancies, and 2 others had 2 malignancies. Response to HAART and immunocompetence (as measured by CD4 and viral load) correlated strongly with survival. Compliance with HAART correlated strongly with response to anti-malignancy therapy. Compliance also correlated strongly with the use of patient advocate/navigators. Survival at 2 years was similar to that in the general population.

CONCLUSION:
Immunocompetent (high CD4/low viral load) HIV-infected women are at high risk for HPV-associated malignancy. Multiple concurrent cancers are common. However, response to anti-cancer therapy and survival are strongly correlated with immunocompetence, and in turn, compliance with HAART. Careful cancer surveillance should be emphasized, even in immunocompetent HIV-infected women. Once the diagnosis of malignancy has been made, the level of vigilance in screening for other malignancies should increase. The use of patient advocate/navigators influences compliance in these women, who face very complex therapeutic regimens.
Need for Increased Cervical Cancer Screening among HIV Positive African American Women [4N]
Authors: Rochon Hildred , Ranjit Anju , Jalloh Mohamed , Maxwell Celia 
Published: April 2018

INTRODUCTION:
BACKGROUND: Black females within the District of Columbia are disproportionately impacted by HIV compared to their non-black counterparts. Ensuring adequate screening for cervical dysplasia among this population is critical to mitigate the incidence of cervical cancer.

OBJECTIVE:
To determine the prevalence of cervical dysplasia among black women and other female patients at the Howard University Hospital(HUH) Center for Infectious Disease Research and Management(CIDMAR).

METHODS:
Data was extracted from HUH-CIDMAR electronic medical records for 464 HIV+ female patients (>17 years of age) from 1998 to 2017. Prevalence of cervical pathology was identified. Variations in abnormal cervical screening results were analyzed using Stata software version 13.0.

RESULTS:
A total of 464 women were included. The mean age was 27.9 years (SD =12.29 years). The majority of patients were African American (n=451, 97.2%) and infected by heterosexual contact (n=344, 74.14%). A total of 293 patients (63.15%) received Pap screenings. Pap screening records for 171 women (36.85%) were incomplete. Of the individuals screened, 146 (49.82%) were found to have a Pap smear abnormality (ASCUS: n=67(14.4%); LSIL CIN1:n=43(9.3%); HSIL CIN2:n=10(2.1 %); HSIL CIS: n=5(1.1%); invasive: n=4(0.8%); other abnormal Pap: n=34(7.3%)).Forty-three women (9.27%) received HPV screening and 24 (55.81%) tested positive for HPV.

CONCLUSION:
The presence of cervical screening abnormalities in a predominantly Black female HIV positive population demonstrates the importance of continued cervical cancer screening to mitigate cervical cancer progression.
Patterns of Fetal Growth in Obese Pregnant Women: an Observational Study [8N]
Authors: Barraza Jorge , Gei Alfredo , Bueno Juan L. , Garza Isabel 
Published: April 2018

INTRODUCTION:
The United States is witnessing an obesity epidemic. The maternal body mass index (BMI) and weight gain during pregnancy influence fetal growth. Little is known about fetal growth patterns (FGP) on obese women. The present study was performed to characterize FGPs among obese pregnant women (BMI>30) in a Maternal Fetal Medicine (MFM) practice.

METHODS:
Retrospective review of the ultrasound database of a private MFM practice in Houston. 43 obese patients with 3 or more ultrasounds and with completed pregnancies were included. Demographic, biometric and clinical data were obtained for mothers and neonates. Fetal growth was classified as normal, accelerated or decelerated. Chi square and Student-t test were performed as appropriate. Significance P<.05.

RESULTS:
The average patient was 33 yo (± 4.6) and had a BMI of 36.1 (± 6.3). The fetal growth was accelerated in 51.1%, normal in 46.5% and decelerated in 2.3%. The proportion of fetuses with an AC >95th p/GA increased from 18% at 32 weeks to 38% at 36 weeks. A significant difference (P<.0001) was observed in birth-weight between patients who had EFW accelerations and patients who didn’t (3.52 kg ± 0.47 vs 2.93 kg ± 0.62). An improvement of the fetal growth pattern (in EFW and/or AC) was observed in 31.8% of accelerated growth as a result of interventions (diet and activity) recommended to the mothers.

CONCLUSION:
Fetal growth is accelerated in over half of obese women followed with serial ultrasounds. The modification of FGP's suggests that an accelerated fetal growth might be responsive to medical interventions.
Toll-like Receptor 3-mediated Regulation of Drug Transporters in Primary Human Trophoblasts [9N]
Authors: Parrott Jessica , Mason Clifford 
Published: April 2018

INTRODUCTION:
Expression of efflux and influx transporters affects drug permeability across the placental barrier. Viral or bacterial challenges alter expression of several placental drug transporters in rodents, suggesting that infection and inflammatory pathways modulate their expression. However, the extent to which these pathways operate in humans are poorly understood. Placenta trophoblasts respond to infectious insults through expression of pattern recognition receptors including the well-characterized Toll-Like Receptors (TLR). The objective of this study was to determine role of TLR3, which recognizes viral RNA, on expression and function of quintessential drug transporters in primary human trophoblasts.

METHODS:
Primary human trophoblast cells were isolated from third trimester placenta and cultured for at least two days prior to treatment with Poly(I:C) (10 μg/ml). Activation of TLR3 signaling by Poly(I:C) was confirmed by measuring phosphorylation of NFkB and IRF3, and expression of pro-inflammatory cytokines. Gene and protein expression of drug transporters ABCB1 and ABCG2, and SLC29A1 and SLC29A2 were evaluated by qRT-PCR and Western blot analysis, respectively. Changes in drug transporter function was determined by measuring cellular accumulation of known substrates.

RESULTS:
Poly(I:C) increased NFkB and IRF3 phosphorylation in primary human trophoblast cells as early as 2hr after treatment and enhanced mRNA expression of TNF-alpha, IL6, and IL8 after 12hr of treatment. Poly(I:C) decreased mRNA and protein expression of drug transporters at 12hr and 48hr, respectively.

CONCLUSION:
Activation of TLR signaling pathways with Poly(I:C) decreases functional expression of drug transporters in primary human trophoblasts suggesting that viral infection may affect placental permeability by altering drug transporter expression.
Patterns of Exercise and Physical Activity in Pregnant Women [11N]
Authors: Moore Iris , Madraswalla Mehnaz , Mason Mikayla , O'Sullivan David , Johnson Amy 
Published: April 2018

INTRODUCTION:
In December 2015 ACOG released consensus guidelines recommending that pregnant women participate in a moderate intensity exercise for most or all days of the week. Despite the numerous health benefits, a significant percentage of women continue to avoid physical activity during their pregnancy. Deficiencies in knowledge about the risks and benefits may contribute to the decrease in exercise and overall physical inactivity.

METHODS:
Three hundred postpartum women were given a standardized questionnaire while at Hartford Hospital. The questionnaire gathered information on demographics, physical activity before and during pregnancy, and whether patients discussed exercise with their OB/GYN provider. Chi square tests were used to evaluate differences between those who exercised during pregnancy and those who didn’t.

RESULTS:
64% of patients discussed physical activity with their OB/GYN. Those who did, were more likely to consider exercise to be safe at least 2-3x/wk (75.8% (n=141) vs. 53.6% (n=53), p<0.001). Patients with prior athletic experience were more likely to report exercising at least once a week during the first trimester (55.6% (n=84) vs 36.2% (49), p=0.001) and 2nd trimester (54.6% (n=83) vs 39.1% (n=52), p=0.009).

CONCLUSION:
A majority of providers are discussing physical activity during pregnancy. However, a majority of pregnant women are not exercising enough. There was a correlation between exercise counseling and participation as well as appropriate perceptions about the safety of exercise in pregnancy. Patients with a prior history of participation in competitive athletics were more likely to exercise in pregnancy.
The Effect of Depression on Pregnant Patients with Gestational Diabetes: Maternal and Neonatal Outcomes [13N]
Authors: Chatroux Louisa R. , Shields Michelanne , DeJong Katherine , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
We sought to determine the differences in pregnancy outcomes seen in patients with major depressive disorder and gestational diabetes (GDM) in comparison to women with GDM and no diagnosis of depression.

METHODS:
A retrospective cohort study of 114,483 women with gestational diabetes with singleton, vertex, non-anomalous gestations was performed to assess maternal and neonatal outcomes in women with depression as compared to women without depression. Maternal outcomes included preeclampsia, placental abruption, cesarean delivery, postpartum hemorrhage (PPH) and endometritis. Neonatal outcomes included preterm, respiratory distress syndrome (RDS), jaundice, and neonatal death (NND). Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Women with GDM and depression had an increased risk of a range of complications of pregnancy when compared to women with GDM who did not have depression. It was associated with a statistically significant increase in preeclampsia (odds ratio [OR] 1.23), cesarean delivery (OR 1.10), PPH (OR 1.85), Preterm delivery (OR 1.25), and jaundice (OR 1.16).

CONCLUSION:
In women who have gestational diabetes, presence of major depressive disorder is associated with an increased risk of adverse maternal and neonatal outcomes in pregnancy. Whether this increased risk was due to other confounding factors, pharmacologic impact of treatment of depression, or from disease pathophysiology deserves future research. Further, how these risks can be mitigated through health care prior to and during pregnancy needs to be determined. Women should be counseled about these risks and managed accordingly during their pregnancies.
Trust in Physician and Health Agency Impact Postpartum Choices in Women with Gestational Diabetes [20N]
Authors: Spelke Bridget , Has Phinnara , Clark Melissa A. , Kanno Lindsey , Booker Tanya , Werner Erika 
Published: April 2018

INTRODUCTION:
Trust in physicians and health agency have been associated with adherence in primary care, but have not been evaluated in the postpartum setting. We assessed the role of these constructs in adherence to postpartum best-practices among women with gestational diabetes mellitus (GDM).

METHODS:
A prospective cohort of 300 women with GDM completed the validated Trust in Physician Scale (Cronbach alpha 0.81) during their postpartum hospitalization. Participants rated health agency with a 4-point Likert scale evaluating the statement, “I feel that I have little control over risks to my health”. Chart review determined postpartum visit attendance, glucose testing, and sustained breastfeeding. Contraceptive use was collected via telephone interview at 3 months postpartum. Trust and agency were compared with Kruskal-Wallis and Wilcoxon rank sum tests respectively. Confounders were accounted for in multivariable models.

RESULTS:
By 12 weeks postpartum, 83% of participants had attended postpartum visits, 61% of whom were breastfeeding, and 42% had completed postpartum glucose testing. Of 226 participants who completed telephone interviews, 66% reported using contraception. Trust did not differ by demographics or pregnancy outcome. Health agency differed by income and race/ethnicity. Trust and health agency were not associated with postpartum visit adherence, but greater trust was associated with postpartum glucose testing adherence (P<.01), and contraception use (P<.01). Increased health agency was associated with sustained breastfeeding (P<.01). This association persisted after adjusting for income and race/ethnicity.

CONCLUSION:
Strategies that foster trust between clinicians and patients may improve adherence with postpartum glucose testing and contraception use in women with GDM.
Does Buprenorphine Decrease the Risk of Neonatal Abstinence Syndrome in Mothers with Opioid use Disorder? [26N]
Authors: Ly Victoria , Persad Malini D. , Herrera Kimberly , Garry David , Garretto Diana 
Published: April 2018

INTRODUCTION:
The objective of this study is to determine if buprenorphine opioid maintenance therapy is associated with a decrease risk of neonatal abstinence syndrome in mothers with opioid use disorder.

METHODS:
A retrospective cohort study of pregnant women with opioid use disorder was performed at a tertiary care hospital from January 2016 to June 2016. Women were identified using the hospital's delivery logs. Women were categorized by opioid maintenance therapy type: buprenorphine or methadone. Maternal demographics, medical history, social history, maintenance therapy type, delivery characteristics and neonatal outcomes were collected from the electronic medical record. A composite adverse neonatal outcome score was created and defined as the presence of any of the following characteristics: preterm delivery, low birth weight <2500 g, Apgar score < 7 at 5 minutes, NICU admission, and neonatal abstinence syndrome. Parametric and nonparametric statistics were used to compared groups as appropriate. A p value of < .05 was considered statistically significant.

RESULTS:
Of 1,927 women who delivered, 37 women qualified for the study. There was no statistically significant difference in demographic characteristics between groups. Additionally, there were no statistically significant differences in neonatal outcomes, including neonatal abstinence syndrome, between women who received buprenorphine maintenance therapy compared to those who received methadone maintenance therapy.

CONCLUSION:
Buprenorphine has a comparable incidence of neonatal abstinence syndrome to methadone in the treatment of opioid use disorder in pregnancy. Providers can consider the use of either agent with treating women with this condition.
Do Psychiatric Medications Exacerbate Neonatal Withdrawal in Pregnant Women Using Opioid Maintenance Therapy? [27N]
Authors: Ly Victoria , Persad Malini D. , Herrera Kimberly , Garry David , Garretto Diana 
Published: April 2018

INTRODUCTION:
The objective is to determine if opioid maintenance therapy (OMT) in conjunction with psychiatric medications increases the risk of neonatal abstinence syndrome and adverse neonatal outcomes.

METHODS:
A retrospective cohort study of pregnant women with opioid use disorder was performed at a tertiary care hospital from January 2016 to June 2016. Women were identified from the hospital’s delivery logs. Included in the study were pregnant women on opioid maintenance therapy. Women were categorized by whether or not they simultaneously used psychiatric medication or if they did not. Maternal demographics, medical history, social history, maintenance therapy, delivery characteristics and neonatal outcomes were collected from the electronic medical record. A composite adverse neonatal outcome score was created and defined as the presence of any of the following: preterm delivery, birthweight <2500 grams, Apgar score < 7 at 5 minute, NICU admission, and neonatal abstinence syndrome. Data was compared between the two groups with the use of parametric and nonparametric statistics as appropriate. A p value of < 0.05 was considered statistically significant.

RESULTS:
Of 1,927 deliveries, 37 women qualified for the study. Compared to pregnant women who used opioid maintenance medications alone, pregnant women who used psychiatric medications were significantly more likely to be nulliparous and have a history of psychiatric disorder. There were no differences in adverse neonatal events, including neonatal abstinence syndrome.

CONCLUSION:
Using psychiatric medication in conjunction with opioid maintenance therapy has comparable incidence of neonatal abstinence syndrome to using opioid maintenance therapy alone.
Endometrial Calcifications: A Novel Sonographic Marker of Endometrial Injury [29N]
Authors: Starostanko Andrea , Ayers Jonathan , Keeton Kristie , Green Pooja 
Published: April 2018

INTRODUCTION:
Morbidly adherent placenta (MAP) has increased 10-fold in the last fifteen years and is associated with injury to the decidua basalis especially with placental implantation over a previous surgical scar. Transvaginal ultrasound (TVUS) can detect endometrial calcifications (EMC), which pathologically, indicate localized basalis injury. The purpose of this investigation is to determine if ultrasound evidence of EMC is seen more commonly in women with a history of cesarean delivery.

METHODS:
TVUS performed in non-pregnant women were reviewed for the presence of EMC. Women were stratified into 4 groups: 1) nulliparous; 2) one prior vaginal delivery; 3) one prior cesarean delivery (CD) with surgical incision above the internal os; and 4) one prior CD with surgical incision below the internal os.

RESULTS:
TVUS from 518 women were evaluated. EMC were noted in 4% of nulliparous women and 60% of women with one prior vaginal delivery. Sixty percent of patients with a prior CD had evidence of EMC within the surgical scar. Eighty-seven percent of women with a prior CD with a surgical incision below the internal os had localized EMC within the surgical scar.

CONCLUSION:
Parous women are more likely than nulliparous women to have EMC, likely from the placental implantation site. We propose that the combination of localized calcifications within a prior surgical scar, particularly when the incision is below the internal os (area of relatively decreased vascularity), synergistically predisposes patients to increased basalis injury and potentially MAP. This novel marker could be used to predict the risk of MAP in future pregnancies.