bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Receiving an Opioid Prescription Refill After Vaginal Delivery [25R]
Authors: Sheng Jessica S. , Wernimont Sarah A. , Eyck Patrick Ten , Moreira Nina 
Published: May 2019

INTRODUCTION:
Opioids are not routinely prescribed at our institution for postpartum care after vaginal deliveries (VD). We sought to determine a model to predict need for opioid prescription refill after a VD.

METHODS:
This is an IRB-approved secondary analysis retrospective cohort study of all VD at a single tertiary care center from Dec 2014 to May 2015 and Dec 2015 to May 2016. Medical records were queried for demographic and clinical data. Multivariable logistic regression modeling was performed to determine the most relevant predictors for receiving an opioid prescription refill within 30 days of discharge. The performance of the prediction model was assessed by using the Akaike information criterion (AIC).

RESULTS:
Of the total 1100 VD patients included, 24 (2.2%) received an opioid prescription refill within 30 days of discharge. Factors included in the top model according to AIC were last pain score (OR 1.267, CI 1.01-1.60, P=.045) and age (OR 1.10, CI 1.00-1.21, P=.044). Predictors that were not included in the top model according to AIC were BMI, race, postpartum tubal ligation, gravidity, gestational age, tobacco use, psychiatric diagnoses and insurance.

CONCLUSION:
Last pain score is a significant modifiable predictor for patients requiring a refill for opioid pain medications after a VD. Better control of pain prior to discharge may help decrease the need for opioid refills within 30 days of discharge after a VD.
Treatment Practices of Pelvic Inflammatory Disease at Selected STD Clinics: STD Surveillance Network, 2015–2017 [16R]
Authors: LLata Eloisa , Braxton Jim , Trivedi Shivika , Pathela Preeti , Torrone Lizzi 
Published: May 2019

INTRODUCTION:
CDC recommends broad-spectrum antimicrobial therapy (ceftriaxone 250 mg and doxycycline 100 mg BID for 14 days) for women with mild to moderate acute pelvic inflammatory disease (PID). The addition of metronidazole, commonly used to treat bacterial vaginosis (BV) and trichomoniasis, can be considered. We assessed PID treatment practices in STD clinic settings.

METHODS:
We conducted a cross-sectional analysis of women diagnosed with PID from 2015-2017 in 26 U.S. STD clinics. For each PID episode, we reviewed treatment information within 14 days of the visit where PID was diagnosed, stratified by concomitant diagnosis of BV and/or trichomoniasis.

RESULTS:
A total of 1,032 PID episodes were identified over 3 years. Treatment was documented in 941 (91.2%) episodes. Of these 941 episodes, concomitant BV and/or trichomoniasis was identified in 40.0% (377/941) of episodes (31.9% BV only, 5.2% trichomoniasis only, and 3.0% both BV and trichomoniasis). CDC recommended therapy was documented for 66.7% of all PID episodes; an additional 25.7% received ceftriaxone with dosing for doxycycline <14 days. Metronidazole, in combination with PID treatment, was documented in 52.5% of episodes. Metronidazole was more frequently included in episodes associated with BV and/or trichomoniasis (72% [271/377]) compared to those without these diagnoses (39% [220/564]).

CONCLUSION:
Over 90% of patients diagnosed with PID in selected STD clinics were treated with the recommended ceftriaxone; however, over a quarter did not receive the recommended dose of doxycycline. Metronidazole was provided in about half of PID episodes and was more likely to be included with concurrent BV and/or trichomoniasis.
Effect of Needle Exchange Programs on Maternal HCV Prevalence [11R]
Authors: Brady Matthew , Rossi Robert M. , Warshak Carri 
Published: May 2019

INTRODUCTION:
To quantify the prevalence of maternal hepatitis C virus (HCV) before and after implementation of the needle exchange program (NEP) in Scioto county, Ohio.

METHODS:
Population-based retrospective cohort study of live births in Ohio (2006-2015). Rate of increase for maternal HCV was compared before (2006-2011) and after (2012-2015) implementation of an NEP (2011) in Portsmouth, Ohio (Scioto county). Trends in maternal HCV prevalence in neighboring counties both physically adjacent and regional (not physically adjacent) to Scioto were evaluated. Obstetric and neonatal outcomes were compared between Scioto post-NEP implementation (2012-2015) and regional counties. Multivariate regression estimated the association of obstetric and neonatal outcomes according to NEP status (Scioto vs regional counties).

RESULTS:
During the 10-year study period, there were 7,069 reported cases of maternal HCV at delivery among 1,463,506 (0.5%) live births in Ohio. The rate of maternal HCV increased 1017% (95% CI, 728 -1391) in Scioto between 2006-2011. After NEP implementation, the rate of increase from 2012-2015 was 12% (95% CI, -24 - 48%). Rate of increase in maternal HCV declined precipitously in bordering counties while regional, nonadjacent counties experienced substantial increases. After adjusting for confounders, delivery in Scioto (post-NEP implementation) was associated with decreased composite neonatal adverse events (NICU admission, low 5-min Apgar (<7), death, assisted ventilation, surfactant, and antibiotic administration), aRR 0.3 (95% CI 0.2-0.3) and maternal adverse events (ICU admission, transfusion, unplanned operation, hysterectomy, chorioamnionitis), aRR0.1 (95% CI 0.1-0.2) compared to regional counties.

CONCLUSION:
Our findings highlight a dramatic change in maternal HCV infection trajectory after NEP implementation in Scioto county, Ohio.
Resolution of Dermatitis After Laparoscopic Essure Coil Removal [7R]
Authors: Garneau Audrey , Hoffman Mark 
Published: May 2019

INTRODUCTION:
Systemic contact dermatitis due to nickel component of Essure is a rare complication.

METHODS:
We present a case of a 31 year old who developed a rash after Essure placement that resolved with complete removal of the coils. The patient had a history significant for Crohn's disease and multiple abdominal surgeries. To avoid another surgery, she elected for surgical sterilization with Essure. Approximately two months after placement of Essure, she developed diffuse itching and blistering with scarring. Over the course of two years, she was seen by numerous subspecialists for evaluation of the rash. Allergen testing by dermatology revealed a nickel allergy. The patient was then referred to gynecologic surgeons to discuss management. On exam, she was found to have ill-defined, erythematous patches, studded with red/brown crusted papules and superficial excoriation. The patient was counseled on her options and she preferred Essure removal. She underwent a hysteroscopy and laparoscopic bilateral salpingectomy with complete removal of the Essure coils. Complete removal was confirmed by identifying the gold tag at the proximal end of the coil after removal. Her skin lesions and itching began to improve immediately, and the lesions had almost completely resolved six weeks after surgery.

CONCLUSION:
Allergic contact dermatitis that resolves with Essure removal has been reported. This is the fifth case report of such a reaction. With allergic reactions like this, complete removal of the coils is essential, as leaving even a small piece of the coil could result in persistent symptoms.
Racial/Ethnic Variations in Trial of Labor After Cesarean in an Understudied Population [37Q]
Authors: Wong Jennifer W.H. , Pacheco Misty , Kaneakua-Pia Iolana , Chang Ann L. 
Published: May 2019

INTRODUCTION:
Increasing the vaginal birth after cesarean (VBAC) rate for appropriate candidates would help to decrease the high cesarean delivery rate in the United States. The purpose of this study is to examine racial/ethnic differences in trial of labor after cesarean (TOLAC) and VBAC rates in a largely Asian and Pacific Islander population.

METHODS:
Retrospective chart review was performed on all women with a term, singleton, live, cephalic fetus and with a history of 1 or 2 prior cesarean deliveries who delivered at a single institution in Honolulu, Hawaii between the years 2010 and 2016. Multiple logistic regression was performed to examine the likelihood of a successful VBAC for twelve different races/ethnicities.

RESULTS:
A total of 4,517 women met study criteria. Of the 37.8% that tried labor, 80.1% had a successful VBAC resulting in an overall 30.3% VBAC rate for the population studied. Native Hawaiians and other Pacific Islander (PI) groups (Marshallese, Micronesian, Other PI) (n=1,814) had the highest TOLAC rates (37.6-78.5%). Adjusted odds of successful VBAC was similar to White women in all groups except for Marshallese and Micronesian women (aOR 4.24, 95% CI 2.02-8.90 and aOR, 3.51, 95% CI 1.83-6.76).

CONCLUSION:
The high VBAC rate in the population studied was largely due to a high TOLAC rate. One's race/ethnicity should not deter a patient from attempting VBAC. Further research should be performed to see if these findings can be replicated.
Racial Disparities in Labor Induction Outcomes [36Q]
Authors: Teal Elizabeth Nicole , Lewkowitz Adam , Koser Sarah , Tran Carol , Gaw Stephanie 
Published: May 2019

INTRODUCTION:
Maternal morbidity is disproportionately high for non-white women in the US. This study aims to determine whether non-white race is associated with increased risk of maternal morbidity in the setting of induction of labor (IOL).

METHODS:
This retrospective cohort study included nulliparous women with non-anomalous, singleton, cephalic pregnancies who underwent IOL with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. Patients with undisclosed race were excluded. Primary outcome was cesarean delivery rate. Secondary outcomes were postpartum hemorrhage, transfusion, peripartum infection, and NICU admission. The data were analyzed using the Kruskal-Wallis test and multivariable logistic regression analysis.

RESULTS:
Of 769 patients, 230 (30%) underwent CD. Black and Asian/Pacific Islander race were associated with significantly higher odds of CD despite controlling for confounders (adjusted odds ratio [aOR], 2.5, 95% confidence interval [CI] 1.2 - 5 and aOR 1.7, CI 1.1 - 2.5 respectively). Furthermore, these groups had increased odds of hemorrhage (aOR 2.7, CI 1.4 - 5.2 and aOR 2.0, CI 1.3 -2.9 respectively). Black, Latina, and multirace/other were associated with increased odds of transfusion (aOR 3.8, CI 1.5-9.8; aOR 4.4, CI 2.0-9.8; aOR 2.9 CI 1.2 - 7.0; respectively). Latina and Asian/Pacific Islander race was associated with increased odds of infection (aOR 2.56, CI 1.40-4.71 and aOR 2.41, CI 1.46 - 3.97 respectively). There were no differences in neonatal outcomes.

CONCLUSION:
In this cohort, non-white race was independently associated with increased odds of CD, hemorrhage, transfusion, and peripartum infection. Further research is needed to examine why these disparities exist.
17-Hydroxyprogesterone Caproate and the Prevention of Preeclampsia [14G]
Authors: Greenbaum Ryley Lawrence , Cottrell Constance , Bacak Stephen , Paul Sarah Alexis 
Published: May 2019

INTRODUCTION:
Preeclampsia is a hypertensive disease caused by a dysfunction of the maternal and placental vasculature. Prior studies have shown that progesterone decreases inflammatory markers, mean arterial pressure and promotes vasodilation. Preeclampsia and preterm labor exhibit similar characteristics such as increased cytokines and inflammation. The goal of our study was to examine the association of 17-hydroxyprogesterone caproate and the development of preeclampsia.

METHODS:
We conducted a retrospective cohort study at a single high-risk obstetric center. All singleton pregnancies from January 1, 2016 through February 28, 2017 were identified. Patients with in multifetal gestations were excluded. Data were analyzed using Student t-test, chi-square test and logistic regression with significance set at P<.05.

RESULTS:
Our study included 1942 women, of which 96 women used 17-hydroxyprogesterone caproate. There was a significant difference in gravity (P<.001), parity (P .019) and gestational age at delivery (P<.001). There was no difference in the incidence of all forms of preeclampsia in patients exposed to 17-OH-P vs not exposed, P .640. No difference was found between preterm delivery secondary to preeclampsia with features and exposure to 17-OH-P, P .176.

CONCLUSION:
In our cohort, 17-hydroxyprogesterone caproate was not associated with a decrease in the incidence of preeclampsia or preterm delivery secondary to preeclampsia with features. Further studies are needed to determine if progesterone is a viable option for the prevention of preeclampsia.
Comparative Assessment of Serum Versus Menstrual Blood for Diagnostic Purposes [10C]
Authors: Naseri Sara , Lerma Klaira , Blumenthal Paul D. 
Published: May 2019

INTRODUCTION:
Blood testing remains an essential component of diagnosis for a wide range of disorders or for preventive assessments. Phlebotomists, laboratory infrastructure, storage, collection, and transport are required for current methods of blood collection. Menstrual blood has many of the same characteristics as circulating blood, but has not previously been assessed as a potential diagnostic resource. We investigated whether biomarkers derived from menstrual blood correlated with systemic blood and assessed whether menstrual blood could become a convenient alternative vehicle for diagnostic and health monitoring purposes.

METHODS:
This was a prospective observational study of healthy reproductive-aged women. We chose a panel of 16 common biomarkers and compared them between systemic and menstrual blood. IRB approval was obtained.

RESULTS:
Overall, the correlation was high, particularly for 13 biomarkers with no statistically significant differences between the mean menstrual and serum values. These include cholesterol (p for differences in means=0.89, R2 for correlation=0.89), cortisol (p=0.490, R2=0.68), creatinine (p=0.32, R2=0.94), hsCRP (p=0.89, R2=0.99), LDL (p=0.21, R2=0.84), LH (p=0.32, R2=0.5), or triglycerides (p=0.45, R2=0.89), HbA1c (p=0.54, R2=0.80), HDL (p=0.33, R2=0.77), Iron (p=0.93, R2=0.34), Total T3 (p=0.12, R2=0.02), Vitamin A (p=0.66, R2=0.97) and Vitamin D (p=0.48, R2=0.20). For one biomarker, FSH (p<0.001, R2=0.97), which was less directly comparable to systemic blood, a linear relationship was recognized suggesting that the correlation could be mathematically derived, and therefore diagnostic utility could remain.

CONCLUSION:
Based on our results, menstrual blood can reliably estimate levels of several biomarkers and may be a promising option for non-invasive collection of blood for diagnosis and health monitoring.
Is Ultrasound Evaluation of the Cervical Stroma After Ultrasound-Indicated Cerclage Useful to Predict Outcomes? [33S]
Authors: Jackson Araba A. , Seif Karl E. , Awosika Olubukunola , Alawneh Maysarah , Khoury Alfred , Gomez Luis M. 
Published: May 2019

INTRODUCTION:
We sought to assess if the evaluation of the cervical stroma before US-indicated cerclage placement contributes to the prediction of spontaneous preterm delivery (SPTD) <35 weeks.

METHODS:
Retrospective cohort study conducted at a single tertiary care institution. We collected information of women undergoing US-indicated cerclage from 2012 to 2017 who had transvaginal imaging of the cervix within 14 days before the procedure. We excluded cases of patients with other indications for cerclage, without cervical imaging before cerclage, Mullerian anomalies and multiple gestations. Measurement of the cervical length (CL) and stromal width of the posterior cervical lip were obtained. Our primary outcome was the rate of SPTD <35 weeks. Patients' consent and Institutional IRB approval were obtained.

RESULTS:
We analyzed outcomes of 110 patients who underwent US-indicated cerclage during the study period. The median gestational age at cerclage placement was 21 weeks. The median gestational age at delivery was 38 weeks. A total of 18/110 (19.8%) women delivered before 35 weeks. The median CL before cerclage for those who delivered <35 weeks was 13 mm compared to 17.4 mm for those delivering >35 weeks; P=0. 089. Meanwhile, the median cervical stroma in women delivering <35 weeks was 8.2 mm compared to 12.6 mm for those delivered >35 weeks; P=0.003 (after adjusting for confounders).

CONCLUSION:
Assessment of the cervical stroma is a useful predictor of SPTD <35 weeks in women who will undergo US-indicated cerclage. This technique is readily available and should be performed routinely in patients who will undergo US-indicated cerclage placement.
Saline-Air-HyCoSy Is Equivalent to the Modified HSG Following Hysteroscopic Sterilization [11M]
Authors: Wood Michelle , Luong Emerly , Yaklic Jerome , Maxwell Rose , Winter Thomas , Lindheim Steven 
Published: May 2019

INTRODUCTION:
Transvaginal ultrasound (TVU) is FDA approved for coil location (CL) only following hysteroscopic sterilization. We compared saline-air-hysterosalpingo-contrast-sonography (SA-HyCoSy) to modified HSG (mHSG) for confirmation of both CL and tubal occlusion (TO).

METHODS:
19 women underwent SA-HyCoSy and mHSG after random assignment to one followed by the other. Percent agreement and predictive values of SA-HyCoSy for CL and TO compared to mHSG by two interpreters were calculated along with inter-rater reliability. Differences in procedural time and pain score using a Likert 11-point pain scale were recorded.

RESULTS:
In total, 38 fallopian tubes were evaluated. For each interpreter, satisfactory CL was noted with mHSG in 97.4% and 100% compared to satisfactory-optimal CL with TVU in 100% for a PPV of 97.4% and 100%, respectively. TO on mHSG was noted in 97.3% of tubes compared with SA-HyCoSy in 97.3% and 94.6% for a PPV of 100% and NPV of 50% and 33%, respectively. SA-HyCoSy agreed with mHSG for both interpreters in 97.4% and 95.7% (kappa=0.67, P<.01). SA-HyCoSy changed CL in 50% and 44.7% (P-NS), being down-graded from optimal to satisfactory in 42.9% (9/21) and 36% (9/25) and upgraded to optimal in 58.8% (10/17) and 61.5% (8/13) (P-NS) for each, respectively. Procedural time (7.5 vs 9.4 min) and pain scores (2.3 vs 3.1) were similar for mHSG and SA-HyCoSy.

CONCLUSION:
There is a high degree of accuracy for TO with SA-HyCoSy, though CL was changed in nearly half of cases. While procedural time and pain were higher, avoidance of radiation with SA-HyCoSy may outweigh any drawbacks.
Segesterone Acetate/Ethinyl Estradiol 1-Year Contraceptive Vaginal System Safety Evaluation [12M]
Authors: Thomas Michael , Gemzell-Danielsson Kristina , Creinin Mitchell D. , Barnhart Kurt , Miranda Maria-Jose , Sitruk-Ware Regine 
Published: May 2019

INTRODUCTION:
A novel, 1-year contraceptive vaginal system (CVS) releasing a daily average of segesterone acetate (SA) 150 mcg and ethinyl estradiol (EE) 13 mcg has been developed. We evaluated clinical safety outcomes from nine studies conducted for product development.

METHODS:
We pooled data from four studies conducted with the final manufactured CVS, including a one-year, pharmacokinetic study; two 1-year duration, phase-3 trials; and a study extending treatment into a second year. The five other studies evaluated pilot SA/EE formulations. Safety was evaluated by adverse event (AE) reporting and three sub-studies of endometrial biopsies, vaginal microbiology, and liver proteins.

RESULTS:
The combined studies included 3052 women; 2308 (75.6%) women received the final manufactured CVS of whom, 999 (43.3%) completed 13 cycles. Treatment-related AEs most frequently reported included headache (n=601, 26%), nausea (n=420, 18%), vaginal discharge/vulvovaginal mycotic infection (n=242, 10%), and abdominal pain (n=225, 10%) However, <1.5% of women discontinued for each of these. Four (0.2%) women experienced venous thromboembolism (VTE), three of whom had other thrombosis risk factors (Factor V Leiden mutation [n=1]; BMI >29 kg/m2 [n=2]). Some participants (n=1107; 52.8%) reported at least 1 complete (24.5%) or partial (44.0%) expulsion during their use of the CVS; expulsions were most frequently reported in the initial cycle. Safety sub-studies revealed no unexpected safety signals.

CONCLUSION:
The 1-year SA/EE CVS has an acceptable safety profile, in line with other combination hormonal contraceptives. Similar prescribing precautions for combined hormonal contraceptives will apply and studies are warranted in obese women who are at higher VTE risk.
Cool Therapy to Reduce Menopausal Symptoms [18M]
Authors: Scheller Tracy F. , Abramson David 
Published: May 2019

INTRODUCTION:
Up to 80% of women going through menopause experience vasomotor symptoms. Some women are not medical candidates or personally choose not to start hormone replacement therapy. This study is a pilot study looking at a cooling bolero jacket as a non-hormonal option for hot flashes.

METHODS:
EHMC IRB Protocol E-16-661 with a patient informed consent. A study of 10 consecutive patients with significant menopausal symptoms wore a cooling bolero for one hour in the morning and one hour in the evening. The cooling bolero maintains a temperature of 15 degrees centigrade making it comfortable and easy for the patient to wear. Demographic data included BMI ranging from 20-32.9. Six patients spontaneously entered menopause while four had menopause either induced by surgery or other medical conditions. The patients tracked the number of hot flashes, menopausal symptoms, their severity and duration for six weeks. The first two weeks were used to create a baseline followed by four weeks of wearing the cooling bolero.

RESULTS:
The number of hot flashes decreased from 7.23/24 hours prior to wearing the bolero to 3.4/24 hours by week four. The number of symptoms decreased from 2.95 to 1.86 while the severity score decreased from 2.29 to 1.11. The duration of the hot flashes was significantly reduced.

CONCLUSION:
This study shows decreased hot flashes using cooling therapy targeting brown adipose tissue with a temperature controlled device.
Predictors of Frequency and Severity of Vasomotor Symptoms: Results from the REPLENISH Trial [19M]
Authors: Bitner Diana , Constantine Ginger , Graham Shelli , Bernick Brian , Mirkin Sebastian 
Published: May 2019

INTRODUCTION:
The objective of this analysis was to determine whether baseline characteristics can predict the frequency and severity of hot flushes (HF) in postmenopausal women.

METHODS:
REPLENISH was a phase 3, randomized, double-blind, placebo-controlled trial that evaluated the safety and efficacy of TX-001HR (17β-estradiol/progesterone oral capsule) in 767 postmenopausal women, who had ≥50 moderate to severe HF/week at baseline. Post hoc associations of baseline characteristics (age, race, BMI, smoking, time since last menstrual period [LMP], age at LMP, tubal ligation, parity, estradiol levels, and menopause-specific quality of life [MENQOL] total and vasomotor domain scores) with frequency and severity of hot flushes were evaluated.

RESULTS:
Baseline predictors for having ≥50 moderate to severe HF/week were BMI (P=.0299), MENQOL total score (P<.0001), and MENQOL Vasomotor domain score (P<.0001). For every unit increase in BMI, the odds of having ≥50 moderate to severe HF decreased by 12.6% while a one-point increase in MENQOL total and vasomotor scores increased the odds by 20.9% and 110.9%, respectively. Baseline predictors for HF severity were current smoking (P=.0042), and MENQOL overall (P<.0001) and vasomotor (P<.0001) scores. Multiple regression analyses showed that the MENQOL vasomotor score was the best predictor of severity (R2=0.1876; P<.0001), followed by MENQOL total score + smoking (R2=0.0325; P<.0001). Other baseline characteristics evaluated were not predictors of HF frequency and/or severity.

CONCLUSION:
In REPLENISH, baseline BMI, smoking, and MENQOL total and vasomotor scores were predictors for moderate to severe HF frequency and/or severity. These characteristics could potentially be used to predict women's HF frequency and severity at menopause.