bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Performance of Endometrial Biopsy and Transvaginal Sonogram in Endometrial Polyp Diagnosis [12Q]
Authors: Doulaveris Georgios , Chen Alice , Christou Georgios , Escobar Pamela , Dar Pe'er , Rotenberg Ohad 
Published: May 2019

INTRODUCTION:
To assess and compare the performance of endometrial biopsy (EMB) and transvaginal ultrasound (TVS) in endometrial polyp detection in postmenopausal women.

METHODS:
Retrospective study of 1808 women, aged 55 and older, who underwent EMB between 1/1997 and 12/2008. Data was collected until 2015 for long term surveillance. We assessed EMB and TVS utilization and performance in diagnosis of endometrial polyps. A cutoff of ≥5 mm was used for “thickened endometrial echo (EE).”

RESULTS:
1808 women underwent EMB in the study period and 676/1808 (37.4%) had final diagnosis by surgery. 195/676 (28.8%) had polyp as final diagnosis and 98/195 (50.3%) cases had concurrent TVS assessment. In 23/195 (11.8%) EMB failed to obtain tissue compared to 1/98 (1.0%) of concurrent TVS that failed to visualize the EE adequately (p=0.001). Endometrial polyp histology was diagnosed in 17/195 (8.7%) of EMB and 12/98 (12.2%) of TVS. Thick EE was diagnosed in 84/98 (85.7%) of TVS. EMB had a sensitivity of 8.7%, specificity of 96.7%, NPV of 72.3% and PPV of 51.5% in diagnosis of polyps. TVS had a sensitivity of 12.2%, specificity of 92.9%, NPV of 64.8% and PPV of 50% in diagnosis of polyps. Thick EE seen in TVS had significantly higher sensitivity (85.7% vs 8.7%, p<0.0001) but lower specificity (28.2% vs 96.7%, p<0.0001) than EMB for polyp detection.

CONCLUSION:
Both EMB and TVS had similarly high specificity, but very low sensitivity for polyp diagnosis. The high sensitivity of TVS endometrial thickening may be essential in polyp detection.
Patterns of Magnesium Sulfate Administration in Women With Preeclampsia Without Severe Features [34C]
Authors: Wang Ann A. , Hsueh Jessica , Jensen Rachel , Fullerton Angelica F. , Miller Emily Stinnett 
Published: May 2019

INTRODUCTION:
In 2013, the American College of Obstetricians and Gynecologists (ACOG) guidelines changed to recommend magnesium “not be administered universally” for seizure prophylaxis in women with preeclampsia without severe features. We explored whether these guidelines were associated with a change in magnesium prescribing, and whether patient characteristics predicted ongoing magnesium use.

METHODS:
This retrospective cohort study included all women diagnosed with preeclampsia without severe features from 2013 to 2018 at a single academic center. Women were excluded if they received magnesium for fetal neuroprotection. Maternal data were abstracted from the electronic medical record. The primary outcome was initiation of magnesium. Non-parametric tests of trend, bivariable analyses, and multivariable analyses were performed to identify whether magnesium use was associated with time or maternal characteristics.

RESULTS:
Of the 338 patients who met inclusion criteria, 126 (37.3%) received magnesium. The proportion of patients given magnesium declined over time, from 73.8% in 2013 to 10.5% in 2018 (P<0.001). Women receiving magnesium were younger, were more likely to self-identify as a racial/ethnic minority, had higher peak blood pressures, and had higher preeclampsia laboratory values. Women diagnosed with chorioamnionitis were less likely to receive magnesium. After adjusting for confounders, maternal age, Hispanic ethnicity, and chorioamnionitis remained significantly associated with magnesium administration.

CONCLUSION:
Obstetricians adjusted prescribing behavior over time in accordance with the 2013 ACOG guidelines change. Providers were more likely to give magnesium to younger women and Hispanic women, and less likely to women with chorioamnionitis. These differences may be related to perceived risk of eclampsia and postpartum hemorrhage.
Seeking Help: Trends in Emergency Department Visits Among Women With Postpartum Mental Disorders [18D]
Authors: Batchelor Jourdin , Baker Regina , Giuliani Emma , Townsel Courtney , Marsh Erica 
Published: May 2019

INTRODUCTION:
Postpartum mental disorders (PPMD) are associated with adverse outcomes including impaired breastfeeding and maternal-child bonding. For many, the emergency department (ED) is a healthcare entry point, but factors surrounding these visits are unknown.

METHODS:
This was a retrospective cross-sectional analysis using the Nationwide Emergency Department Sample, (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) to assess national estimates of ED visits of women aged ≥years with a primary diagnosis of PPMD (ICD-9 codes 648.42 or 648.44) between 2006 and 2014. Variables included demographic and hospital characteristics. SAS 9.4 (Cary, NC) was used to perform all analyses.

RESULTS:
PPMD related ED visits remained stable between 2006 and 2014 (5,153 to 5,453 respectively). Approximately 2/3 of visits were by patients <30 years old. Total and mean ED charges per visit increased from $6.5 to 13.4 million and from $1,255 to 2,460 respectively (P<.0001). In 2014, the largest proportion of ED visits were in the South (37.5%) and in metropolitan areas (86.8%). Although 28.1% of visits were by women from the lowest zip code income quartile, over half of visits were funded by Medicaid (52.9%). Admission rates were approximately double those of age-matched women with all other primary diagnoses (29.7% vs 15.0%).

CONCLUSION:
Despite a stable number of visits, ED charges for PPMD increased from 2006 to 2014, indicating a growing economic and social burden. High admission rates represent an opportunity for optimization of outpatient screening and treatment. The high proportion of Medicaid funded visits suggest a policy opportunity for PPMD stakeholders.
The Effect of Antenatal Corticosteroids on Survival in Extreme Prematurity [22D]
Authors: Sivaram Mollie , Nguyen Julie , Barrett Jon FR. , Ladhani Noor Niyar N. 
Published: May 2019

INTRODUCTION:
The decision to administer antenatal corticosteroids (ACS) to women who in preterm labor prior to 25 weeks remains controversial. Recent studies suggest reduction in morbidity and mortality with administration of ACS prior to 25 weeks. Our primary objective was to evaluate the effect of ACS on survival in extreme prematurity. Our secondary objective was to assess the effect of ACS on morbidities such as respiratory distress syndrome (RDS), chronic lung disease (CLD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC).

METHODS:
A retrospective chart review was conducted on patients who delivered between gestational ages (GA) of 23-25 weeks at a large tertiary academic center between Jan 1st 2003 and Dec 31st 2017. Multiple gestation pregnancies, terminations, and patients who declined neonatal resuscitation were excluded. Logistic regression was used to assess the effect of ACS treatment on neonatal mortality and morbidity, while controlling for maternal age, GA, and maternal complications.

RESULTS:
A total of 407 singleton births met criteria, with 394 (96.8%) mothers receiving at least one dose of ACS and 13 (3.2%) receiving no ACS. Neonatal mortality was significantly lower for infants exposed to a full course of ACS (OR=0.30, 95% CI=0.09-0.99). Administration of ACS did not show any significant effect on morbidity, but did show a reduction in IVH (OR=0.63, 95% CI=0.15-2.64), increase odds of CLD (OR=1.51, 95% CI=0.43-5.30), and NEC (OR=1.14, 95% CI=0.22-5.93).

CONCLUSION:
Treatment with ACS for infants born at 23 to 25 weeks gestation was associated with a lower rate of neonatal mortality. No significant effect on morbidity was demonstrated.
The Home Team: How an Academic Practice Used Innovation Principles to Create a Novel Prenatal Model [24D]
Authors: Graseck Anna S. , Vasquez Peter J. , Power Maggie , Labora Amanda , Mahraj Katy 
Published: May 2019

INTRODUCTION:
The laborist model of obstetric care has benefits to patient safety and provider lifestyle, but requires a large group of providers to sustain. Our academic practice of 16 providers observed a disparity in patient satisfaction scores between obstetric and gynecologic patients, even for the same provider. Contextual inquiry attributed this finding to a lack of continuity for obstetric patients. Partnering with the Center for Healthcare Innovation, we designed and tested a novel team-based prenatal care model. Our hypothesis was that this would increase continuity and satisfaction for both patients and providers.

METHODS:
We utilized the “double diamond” methodology characterized by two rounds of divergent and convergent thinking. We first defined the problem by shadowing and interviewing stakeholders. Next, we prototyped, tested, and iterated multiple interventions, ultimately creating a team-based prenatal care model. Our pilot team consisted of two obstetricians and a nurse midwife who managed a panel of patients. We monitored the program with Press-Ganey data as well as a 5-question survey of patients and providers evaluating continuity and satisfaction.

RESULTS:
The “Home Team” enrolled 284 patients over 9 months. Both providers and patients in the pilot were more likely than non-participants to agree that they experienced continuity and rapport in prenatal care. Press-Ganey data (n=327) showed that pilot participants were more likely to recommend the practice (76.2% vs. 69.6%).

CONCLUSION:
Innovation principles provide an effective framework for problem-solving in healthcare. Using innovation techniques, our academic practice successfully piloted and implemented a team-based prenatal care model that improved patient and provider satisfaction.
Microbial Analysis of Peritoneal Fluid as a Screening Tool for Epithelial Ovarian Cancer [28D]
Authors: Gibson Kaitlin , Pratt Katelyn Nicole , Zhu Ruoqing , Cregger Melissa , Brard Laurent , Braundmeier-Fleming Andrea 
Published: May 2019

INTRODUCTION:
Epithelial ovarian cancer (OC) is typically diagnosed at advanced stages and accounts for more deaths than any other gynecological cancer. Early detection of OC may improve prognosis. Microbial profiling has identified various diseases and may be utilized to detect OC. We hypothesize that patients with OC have a unique microbial profile, which in conjunction with biomarkers Cancer Antigen-125 (CA-125) and Human Epididymis protein 4 (HE4), would enable a novel screening mechanism to effectively detect OC.

METHODS:
Inclusion: Consented patients ≥30 yrs presenting at SIU Gynecologic/Oncology for management of an adnexal mass or suspected OC. Exclusion: patients with a previous malignancy, pregnant/intending to conceive. CA-125/HE4 were analyzed in serum and peritoneal fluid (PF). Extracted DNA from PF was sequenced (V4 region of bacterial 16S rRNA gene), then identified using Greengenes database and clustered into operational taxonomical units (OTUs). Microbial profile associations with CA-125/HE4 in serum and PF were calculated utilizing machine learning models for biomarker discovery.

RESULTS:
CA-125 and HE4 levels were elevated in serum and PF from patients with OC. Patients with OC also exhibited microbial profile clustering. Machine learning models identified 37 microbial features correlative with OC. Overall, performance of biological features (age, BMI, serum [CA-125/HE4], PF [CA-125/HE4], OTUs [taxa]), indicated that serum [CA-125/HE4]+age/BMI had the highest (0.96) accuracy for OC detection. Interestingly, OTUs [family/genus level+age/BMI] (0.87) outperformed PF [CA-125/HE4+age/BMI] (0.78).

CONCLUSION:
Microbial feature analysis may improve OC screening modalities and warrants further investigations into the urogenital and/or gastrointestinal microbiome profiles to improve detection/survival rates for OC.
Perinatal Outcomes of Gestational Impaired Glucose Tolerance Without Diagnosis of Gestational Diabetes [21E]
Authors: Enakpene Christopher A. , Jones Tiffany N. , Della Torre Micaela , Knazze Lauren R. , Jin Ming , DiGiovanni Laura M. 
Published: May 2019

INTRODUCTION:
HAPO study showed continuous associations of maternal glucose levels with increased birth weight and cord C-peptide levels. This study aimed to compare perinatal outcomes of women with GIGT and those with normal 1-hour GCT.

METHODS:
Retrospective cohort study of pregnant women with GIGT and randomly selected women with normal 1-hour GCT at the University of Illinois at Chicago from January 2015 to April 2018. Primary outcome was LGA and secondary outcomes were preeclampsia, primary cesarean section, 3rd or 4th degree perineal lacerations, shoulder dystocia, NICU admission and composite neonatal outcomes. Chi square with Yates correlation, student-t test, and multiple regression analysis were used to compare the outcome variables.

RESULTS:
There were 615 subjects in the study; 366 had GIGT and 249 had normal 1-hour GCT. Mean age, maternal weight and BMI were significantly higher in the GIGT group. The primary outcome, LGA was significantly higher in the GIGT group, 27 (7.4%) versus 4 (1.6%), OR: 4.8 (1.7-14.0, p=.002). Birth weight was significantly higher in the GIGT group; 3278.7±571 versus 3099±546, p=.002 and it increased by 89 gm for every 1 mg/dL increase in 1-hour GCT, p=.013 in dose-response manner. After controlling for covariates, the likelihood of LGA was significantly greater in the GIGT group, OR: 5.1, (95% CI: 1.43-18.03, p=.012).

CONCLUSION:
GIGT is associated with increased likelihood of LGA and increased birth weight in a dose-response manner, but it did not significantly affect the overall perinatal outcomes.
Postpartum Care for Mothers of Preterm Infants Requiring Intensive Care: A Qualitative Study [26E]
Authors: Chen Melissa Joy , Kair Laura , Schwarz Eleanor Bimla , Creinin Mitchell D. , Chang Judy 
Published: May 2019

INTRODUCTION:
Postpartum care can be fragmented, especially among women with premature infants in the Neonatal Intensive Care Unit (NICU). We aimed to explore women's goals for and experiences with postpartum care.

METHODS:
We conducted a qualitative study using semi-structured interviews to ask women between 2 and 8 weeks after delivery of preterm infants in the NICU about their preferred topics of discussion at the postpartum visit and experiences with postpartum care. We analyzed transcripts using thematic analysis. IRB approval obtained.

RESULTS:
We enrolled 16 mothers who delivered between 25 and 34 weeks gestation (11 by Cesarean). At interview time (14-55 days postpartum), 4 women had attended a postpartum visit, 2 had missed their visit, and 10 had an upcoming appointment scheduled. Reasons for not attending a visit included distance of clinic from NICU, a desire to focus on their infant's health, and insurance changes. Participants identified several topics of importance for postpartum visits: assessing physical recovery after delivery (e.g., incision care, management of ongoing medical conditions), lactation support, and implications of preterm delivery for future pregnancies. One theme women described was feeling traumatized by the delivery or NICU experience and expressing concern about postpartum depression or anxiety. Participants suggested scheduling a visit soon after delivery (e.g., within 3 weeks postpartum) to assess mood.

CONCLUSION:
Women with premature infants requiring NICU hospitalization are at risk for delayed or inadequate postpartum care given concern for their infants' health. Arranging short-term follow-up after delivery allows clinicians to perform early assessments and offer anticipatory guidance for postpartum depression.
Should Endometrial Biopsy be Used for Diagnosing Polyps? [33E]
Authors: Bastow Brittney , Conageski Christine , Huguelet Patricia 
Published: May 2019

INTRODUCTION:
Abnormal uterine bleeding (AUB) accounts for more than 70% of visits to gynecologists. American College of Obstetricians and Gynecologists (ACOG) recommends endometrial sampling for women above age 45. This is done in clinic with an endometrial biopsy. One known limitation of the biopsy is limited sampling as only 4% of the cavity is sampled. Past studies demonstrate limitations in using endometrial biopsy to diagnose polyps, with biopsy missing 15/16 polyps. Our study sought to evaluate when the biopsy diagnoses a polyp. Is the specificity sufficient to proceed to the operating room, or are there other imaging or patient characteristics that can guide management?

METHODS:
This was a retrospective cohort study that identified patients with AUB who underwent endometrial biopsy and a confirmatory procedure of hysteroscopy or hysterectomy at the University of Colorado Hospital from 2005-2010. Patients were identified as having an endometrial biopsy, hysterectomy, or hysteroscopy with CPT codes, and ICD9 codes were used to eliminate women without AUB.

RESULTS:
A total of 216 charts were reviewed with mean age of 44 and BMI of 30.49 kg/m^2. The specificity of using endometrial biopsy to diagnose polyps was 87.2%, and we confirmed poor sensitivity at 30%. Vaginal ultrasound had a higher specificity at 94%. Logistic regression analyses will be utilized to identify patient factors, patient bleeding profile, and procedures to determine how best to triage patients for operative management of endometrial polyps.

CONCLUSION:
Endometrial biopsy should not be the only factor in determining a patient's need for operative management of AUB associated with polyps.
Concurrent Cervical and Vulvar Dysplasia and/or Cancer—High Likelihood in the Immunocompromised [38E]
Authors: Meinhardt Summer Sanford , Grubman Jessica , Nambiar Anjali , Lea Jayanthi 
Published: May 2019

INTRODUCTION:
Dysplastic lesions of the vulva and cervix have similar risk factors; however, the incidence of cervical dysplasia is 10 times that of vulvar dysplasia suggesting HPV induced transformation of the vulvar epithelium occurs less often than cervical epithelium. This implies there are novel factors required for the progression of vulvar dysplasia. The aim of this study was to evaluate clinicopathologic characteristics that predispose women to concurrent cervical and vulvar dysplasia and/or cancer.

METHODS:
We performed a retrospective review of 780 women from January 2010 to October 2013 with cervical intraepithelial neoplasia (CIN), adenocarcinoma in situ (AIS) and/or invasive cancer on excisional biopsy. Twenty-four developed concurrent vulvar dysplasia and/or cancer. Clinical variables were studied and SPSS software calculated the odds ratio (OR) for binary dependent variables.

RESULTS:
The rate of concurrent disease was 3%. Approximately 78% of patients with isolated cervical pathology were HPV+ compared to 100% of those with concurrent vulvar disease. There was no statistical difference in the use of tobacco, alcohol, illicit drugs or OCPs, hypertension, hyperlipidemia, diabetes or depression between study groups. Immunocompromised patients with: chronic steroid or immunosuppressant use, AIDS/HIV, a prior transplant, or non-gynecologic malignant processes revealed an OR 20.1521 (95% CI 11.3341-51.8172) and P value <0.0001 collectively. Those with HIV/AIDS had an OR 17.4458 (95% CI 8.7290-41.6923) and a P value <0.0001.

CONCLUSION:
Immunocompromised patients have a higher likelihood of developing concurrent cervical and vulvar dysplasia and/or cancer. This underscores the significance of a complete examination of the lower genital tract in the immunocompromised.
Where Does the Time Go? Understanding What Delays Emergent Gynecologic Surgical Management from the ED to the OR [4F]
Authors: Gray Derwin , Mehta-Lee Shilpi S. , Echevarria Ghislaine , Schweizer William E. 
Published: May 2019

INTRODUCTION:
Women who present to the emergency department (ED) for gynecologic issues at our institution undergo multiple evaluative steps. We sought to understand how these steps delay indicated operative management. Time spent at each stage of an ED visit for an acute surgical presentation was investigated as part of a quality improvement project for NYU Langone Health.

METHODS:
This retrospective, observational study quantifies time spent by patients at each evaluative stage from presentation to operating room incision time. We included females 18 years or older, presenting to the NYU Tisch Hospital ED with acute gynecologic complaints requiring surgery. Gynecology consult records from 9/1/16 to 8/29/17 were reviewed and surgical cases were identified. We defined five relevant time points for each patient: 1--initial presentation, 2--ED provider evaluation, 3--Gynecology consult, 4--time of imaging, and 5--surgical start time. We recorded time in hours, between the above evaluations.

RESULTS:
Of 1194 consults reviewed, 79 patients required urgent surgery for benign etiologies (eg, adnexal torsion, ruptured ectopic pregnancy or heavy vaginal bleeding). The median time spent from presentation to incision was 6.1 (IQR: 4.12-8.53) hours. The median time from presentation to finalization of imaging and from gynecology evaluation to incision were 0.78 (IQR: 0.35-1.4) and 3.3 (IQR: 1.6-5.4) hours, respectively.

CONCLUSION:
This information implies that throughout an evaluation for urgent gynecologic surgery, more than 50% of the time is spent after the decision has been made to operate. Further study of this time frame may ultimately improve bed utilization and reduce delays.
Does Resection of a Uterine Septum Improve Pregnancy Outcomes? [13F]
Authors: Connolly Courtney T. , Hill Melissa B. , Klahr Rebecca A. , Zafman Kelly B. , Rebarber Andrei , Fox Nathan S. 
Published: May 2019

INTRODUCTION:
It is unknown if uterine septum resection improves pregnancy outcomes beyond early pregnancy loss. Our objective was to compare pregnancy outcomes between women with a septum and those who had septum resection prior to pregnancy.

METHODS:
Retrospective cohort study of women with a uterine septum cared for by a large maternal-fetal medicine practice from 2005 to 2018. We identified all women with singleton pregnancies and a septum or history of septum resection. Baseline characteristics and pregnancy outcomes were compared. Nonparametric testing was used for analysis, and regression analysis was performed to control for differences in baseline characteristics. IRB approval was obtained.

RESULTS:
148 women were included, 40 with an intact septum and 108 who had a septum resected. Women with a resected septum were older (33.5 vs. 30.4 years, p=0.006) and more likely to have undergone IVF (25.0% vs. 2.5%, p=0.002). Pregnancy outcomes did not differ between the groups. Although there was a higher rate of cesarean delivery in the resected septum group (42.6% vs. 20.0%, p=0.013), this was not true among women who attempted vaginal delivery. The difference in cesarean rates also likely explains the differences in estimated blood loss. There was no difference in the likelihood of retained or morbidly adherent placenta.

CONCLUSION:
Resection of a uterine septum prior to pregnancy is not associated with improved pregnancy outcomes compared to women with a septum. Septum resection should only be considered for the indication of early pregnancy losses. Further studies in larger cohorts could examine septum size as a potential confounding variable.