bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management and Outcomes of Peptic Ulcer Disease in Pregnancy [37C]
Authors: Rosen Charlotte , Abenhaim Haim Arie , Mishkin Daniel , Czuzoj-Shulman Nicholas 
Published: May 2019

INTRODUCTION:
Given the altered physiology of pregnancy, gastroenterologists are often reluctant to perform endoscopic procedures in pregnant women. The purpose of our study was to compare management practices and outcomes among pregnant and non-pregnant women admitted to the hospital for peptic ulcer disease (PUD).

METHODS:
A retrospective matched cohort study was carried out using the Healthcare Cost and Utilization Project—National Inpatient Sample. All births that took place from 1999 to 2015 were identified and women were classified as having PUD on the basis of ICD-9 coding. Logistic regression analysis was used to evaluate the adjusted effect of PUD on variables and outcomes of interest.

RESULTS:
PUD was diagnosed in 2,535 pregnant women and 12,675 age-matched non-pregnant women during the 16-year study period. Compared with non-pregnant women, pregnant women were more likely to be Hispanic, less likely to be Caucasian and less likely to be smokers. As compared to non-pregnant women, pregnant women with PUD were less likely to undergo diagnostic or therapeutic esophagogastroduodenoscopies for this indication. Outcomes including fever, infection, sepsis, shock, transfusion and death were less likely to occur in pregnant women as compared to non-pregnant women and pregnant women also experienced shorter hospital stays.

CONCLUSION:
Pregnant women with PUD are less likely to undergo interventional diagnostic and therapeutic procedures than non-pregnant women with PUD. The reluctance to intervene in pregnancy does not appear to result in more adverse PUD-associated outcomes.
Patients Presenting After Sexual Assault: Population Characteristics and Rates of Follow up [1D]
Authors: Choi Jennie ES , Bechtel Kirsten , Pathy Shefali 
Published: May 2019

INTRODUCTION:
Survivors of sexual assault (SA) experience a range of physical and mental health consequences. Despite universal agreement that utilization of longitudinal follow-up decreases morbidity and mortality of survivors, studies demonstrate that only one-third of victims receive follow-up care directly related to their assault. This study aims to describe the patient population presenting after SA, characteristics of their acute care, and rates of follow-up within one year in an urban hospital setting.

METHODS:
A retrospective medical record review was conducted of patients presenting to emergency departments and primary care and women's outpatient clinics across two campuses of the Yale New Haven Health Systems from 01/2014-02/2017. Inclusion criteria were patients older than 12 years old with one of eleven ICD-10 codes associated with SA/abuse.

RESULTS:
There were 285 patients whose encounters met inclusion criteria. Mean patient age was 25.85 years (SD=11.98 y); 95% were female; 46% were White and 35% were Black. The overall rate of follow-up within one year after discharge was 34%, consistent with the reported national average. However, when analyzed by age, follow up rate for patients older than 18 years (42/197; 21%) was significantly lower than the rate for patients 13-18 years old (57/93; 61%) (Ï‡2=44.89; p<0.05).

CONCLUSION:
The rate of follow-up within one year after SA in patients is overall low, especially in women older than 18 years old. We suggest follow-up may be improved with implementation of a discharge protocol and consistent resources for patients seen in the ED for SA.
Early Discontinuation of Postpartum Long-Acting Reversible Contraception Among Women Living With HIV (WLWH) [7D]
Authors: Francis Elizabeth , Rucker Lindsay , Brzozowski Nicole Christine , Dempsey Angela , Lazenby Gweneth B. 
Published: May 2019

INTRODUCTION:
The objective of this study was to determine if WLWH were more likely than HIV negative women to remove postpartum (pp) LARC <12 months of placement (ED).

METHODS:
This is an IRB-approved, retrospective cohort study of women who had a LARC device (IUD or implant) placed <90 days pp and documentation of removal during the study period (1/1/09-2/14/18). Key variables were delivery date, LARC device, dates of placement and removal, age, parity, race/ethnicity, pregnancy characteristics and outcomes. Outcomes were compared using bivariate analysis. Logistic regression was used to evaluate factors associated with ED.

RESULTS:
794 women who had a LARC device placed <90 days pp were eligible for analysis: 50 WLWH and 744 HIV negative women. Most women selected IUDs (85%). Median time to insertion was 42 days (IQR 35-51 days). WLWH were more likely to use implants (52% vs 87%, P<0.0001) and were more likely to receive LARC <4 days pp (76% vs 17%, P<0.0001). WLWH were not more likely to have ED (38% vs 36%, P=.9). Placement of LARC <4 days pp was associated with ED [aOR 2.6, (95% CI 1.8-3.9)]. Women who bottle fed were less likely to have ED [aOR 0.6, (CI 0.4-0.8)].

CONCLUSION:
WLWH were more likely to receive LARC <4 days pp, but they were not more likely to have ED. WLWH were found to have a significantly lower pp IUD use compared to controls. Further investigation is needed to elucidate disparities in pp IUD use among WLWH.
Predictive Value of Fetal Abdominal Circumference in Diagnosing Large for Gestational Age Infants [9D]
Authors: Kopparam Rohini , Matthews Kathy , Khan Rana , Grossman Tracy B. , Gelber Shari Ellen 
Published: May 2019

INTRODUCTION:
Macrosomia is associated with adverse perinatal outcomes and has implications for mode of delivery. Research increasingly supports the use of fetal abdominal circumference (AC) as an additional measure to capture large for gestational age (LGA) infants. We evaluated the predictive value of sonographic fetal abdominal circumference (AC) measurement from 25-36 weeks' gestation for detection of LGA infants.

METHODS:
Retrospective chart review following IRB approval. LGA was defined as a newborn birth weight >90th percentile on the Fenton Growth Curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at various gestational age ranges (25-28, 29-32 and 33-36 weeks' gestation) for a Z-score >+1.88, corresponding to the 97th percentile, were calculated. Area under receiver operating characteristic curve (AUROCC) of AC Z-scores ranging from -3.00 to +3.00 was calculated.

RESULTS:
Ultrasounds of 4801 women with 5799 pregnancies were reviewed. Our study population had an LGA infant prevalence of 5.8%. An AC Z-score of +1.88 had a maximal sensitivity of 34.3%, specificity of 98.2%, and NPV of 96.2% for detecting LGA births at 29-32 weeks' gestation. The AUROCC at this time point was 0.88.

CONCLUSION:
Fetal AC <97th percentile in the third trimester has a very high specificity and negative predictive value in ruling out LGA newborns. These measures indicate that this modality can identify pregnancies that are not at high risk for fetal macrosomia and would not benefit from unnecessary cesarean delivery. High AUROCC demonstrates independent predictive potential of AC and supports its adjunct use with more traditional measurements.
Risk Factors for Neonatal Hypoglycemia Following Exposure to Antenatal Corticosteroids [14D]
Authors: Nickel Mara , Fixler Joseph S. , DeFranco Emily A. 
Published: May 2019

INTRODUCTION:
To quantify the influence of maternal and neonate characteristics on risk of neonatal hypoglycemia in pregnancies exposed to antenatal steroids (ANCS).

METHODS:
We performed a retrospective cohort study utilizing a 2013-2017 dataset created from electronic medical records (EPIC) of all mothers who delivered early (<34) and late preterm (34 to <37 weeks) at the University of Cincinnati, linked to neonatal data through 1 week postdelivery. Maternal and neonatal characteristics were compared between preterm neonates exposed to ANCS experiencing hypoglycemia and those with normal glycemic levels. Multivariate logistic regression estimated the relative risk of these factors on the risk of neonatal hypoglycemia following preterm ANCS.

RESULTS:
1,210 mother-neonate pairs were included. Hypoglycemia, defined as neonatal BG of <40 mg/dL in the first week of life, was present in 24.0% of early preterm births (PTBs) and 24.4% of late PTBs exposed to ANCS. The factor most strongly associated with neonatal hypoglycemia was maternal hyperglycemia (BG ≥180mg/dL) on the day of or day prior to delivery. This association was stronger in late PTBs (adjusted relative risk [adjRR] 4.49; 95% CI 1.50, 13.40) than early PTBs (adjRR 1.91; 95% CI 1.07, 3.41).

CONCLUSION:
The presence of maternal hyperglycemia proximate to time of delivery (0-1 days prior to birth) is the most predictive factor for neonatal hypoglycemia, with magnitude of risk higher in late preterm compared to early preterm neonates This information demonstrates the importance of maternal glycemic control near the time of delivery after exposure to ANCS.
Risk of Primary Cesarean Delivery: Role of Language Preference and Language-Concordant Labor Support [17D]
Authors: Schaefer Kimberly , Modest Anna M. , Chie Lucy , Connor Yamicia , Golen Toni , Molina Rose L. 
Published: May 2019

INTRODUCTION:
Increasing rates of cesarean deliveries (CD) in the US over recent decades have been associated with social factors such as race and migration status. This study aims to assess the effects of English language proficiency and language-concordant labor support on risk of primary CD at Beth Israel Deaconess Medical Center (BIDMC). Such labor support is offered uniquely at BIDMC-associated South Cove Community Health Center (SCCHC), which has a primarily Asian immigrant population with limited English proficiency (LEP).

METHODS:
We conducted a retrospective cohort study using BIDMC records of nulliparous, term, singleton, vertex (NTSV) deliveries from 2011-2016 with women over 18 years old. We used modified Poisson regression models with robust error variance to assess risk ratios for CD between English-speaking, LEP SCCHC, and LEP non-SCCHC groups, adjusting for age, education, race, insurance, and delivery year. This study received BIDMC IRB approval.

RESULTS:
Of the 11,599 women included, 89.8% (n=10,411) were English-speaking, 5.6% (n=654) were LEP at SCCHC, and 4.6% (n=534) were LEP at a non-SCCHC practice. Proportions of CD were 24.4% (n=2,537), 17.1% (n=112), and 22.1% (n=118), respectively. LEP women at SCCHC had 0.75 (95% CI 0.61-0.93) times the risk of CD compared with English-speaking women; the risk for CD was not significantly different between non-SCCHC LEP and English-speaking women (RR 0.89, 95% CI 0.75-1.05).

CONCLUSION:
Prenatal care provision at SCCHC for women with LEP was associated with a 25% decreased risk of CD, suggesting that language-concordant labor support can play a key role in limiting rates of NTSV cesarean deliveries.
Strong Start for Mothers and Newborns: Impact on OB Triage Visits [20D]
Authors: Wolfenden Emily , Manriquez Maria , Santiago Ricardo , Kang Paul 
Published: May 2019

INTRODUCTION:
The Strong Start for Mothers and Newborns Initiative was launched in 2012 as an effort to reduce preterm birth rates, improve birth outcomes, and reduce costs of medical care for those enrolled in Medicaid or CHIP1. The Strong Start program utilizes a maternity medical home model of care, which includes the services of an additional project manager, registered nurse care coordinator, and two community health workers, with the aim to provide enhanced prenatal and psychosocial services. Previous studies have shown that implementation of patient-centered medical home models of care among patients with chronic diseases have led to deceases in frequency of ED visits among these patients 2, 3. However, research is lacking regarding the effectiveness of implementation of a maternity medical home model of care on reduction of OB Triage visits.

METHODS:
IRB committee approval was obtained for this study. This retrospective chart review compared rates of OB Triage visits between two cohorts of women: Strong Start Maternity Medical Home participants (n=958) and non-Strong Start controls (n=1,223) within an urban county hospital network.

RESULTS:
Mean number of OB Triage visits among Strong Start participants was 0.78 (95% CI 0.70-0.86), compared to 0.58 (95% CI 0.52-0.64) among controls (P<0.001).

CONCLUSION:
Frequency of OB Triage visits was increased among Strong Start participants compared to controls. Further research is necessary to determine trends in OB Triage chief complaints, highlight modifiable factors that may allow a reduction in OB Triage visits, and determine the cost effectiveness of patient enrollment in a maternity medical home model of care.
The Efficacy of Intravenous Iron Sucrose in Treating Iron Deficiency Anemia of Pregnancy [23D]
Authors: Valdes Eduardo Ernesto , Gallo Danielle , Payero Elfy , Rezai Shadi , Henderson Cassandra 
Published: May 2019

INTRODUCTION:
Women diagnosed with iron deficiency anemia (IDA) in pregnancy are routinely treated with oral iron supplements, although side effects often prompt non-adherence. Parenteral administration of iron sucrose is reported to be a useful tool in the management of IDA in pregnancy. Inadequate iron stores during the prenatal period is often managed with transfusion of packed red blood cells (PRBCs). We have previously reported in a small sample that antenatal use of iron sucrose was associated with lower rates of PRBCs transfused during pregnancy. Our aim was to evaluate iron sucrose as a tool to treat IDA during pregnancy.

METHODS:
Searched PubMed and Google scholar using terms: pregnancy, iron sucrose and anemia for articles published between January 2017 and August 2018.

RESULTS:
813 RCTs and observational studies were identified. After applying exclusion criteria, 11 articles were selected for review. Between 14 and 36 weeks of gestation 2420 women between 14 and 36 weeks of gestation were studied. Antenatal infusion of parenteral iron sucrose was universally associated with increased concentration of hemoglobin and ferritin. While infusion site erythema was common, anaphylaxis was rare.

CONCLUSION:
Intravenous iron sucrose is an effective method of treating IDA in pregnant women with minimal side effects. These results, as well as our previous report associating intravenous iron sucrose with decreased PRBC transfusion, demonstrate the potential of this therapy to treat IDA and decrease rates of allogenic blood transfusion. We recommend additional studies be conducted to show the correlation between iron sucrose treatment and incidence of blood transfusion in pregnant women.
Upstream Obstetrics: Assessing the Prevalence of Food Insecurity in a High-Risk Obstetrics Population [26D]
Authors: Raghavan Deepika , Haugsdal Michael L. , Syrop Craig H. 
Published: May 2019

INTRODUCTION:
Food insecurity, a social determinant of health defined as limited availability of and access to adequate food, may heighten risks for poor pregnancy outcomes particularly if compounded by existing co-morbidities in high-risk pregnancies. The Upstream Obstetrical Clinic is a quality improvement project that seeks to address food insecurity in high-risk obstetrics patients. This study aims to identify the prevalence and impact of food insecurity among pregnant patients in the clinic population.

METHODS:
This project was deemed IRB-exempt by the HSRD. Validated survey questions regarding food insecurity were administered to high-risk obstetrics patients. Screen positive individuals were offered counseling by a team member to identify nutrition resources in the patient's residential area. Data collected were used to assess prevalence of social needs, correlation of social needs with co-morbidities, and effects on pregnancy outcomes.

RESULTS:
One hundred eighty-five women completed the survey, with 24% (44/185) screening positive. Diabetes was the most prevalent co-morbidity for screen positive patients (25/44, 57%). Twenty-two percent of screen positive, delivered patients were affected by diabetes (9/40). The prevalence of abnormal HgbA1C was 66% (6/9) among these patients. There was no difference in perinatal outcomes between patient subgroups.

CONCLUSION:
Twenty-four percent of all patients and 22% of diabetic patients identified as food insecure. Statistical differences could not be assessed due to limited sample size. Nevertheless, these results suggest that food insecurity may be associated with adverse health outcomes. As the Upstream Clinic population increases, the impact of food insecurity on obstetric and neonatal outcomes will continue to be assessed.
The Impact of Molecular Testing and Therapy for Gynecologic Cancers in Low Resource Environments [31D]
Authors: Berger Marisa C. , Sartor Rita A. , Le Anna H. , Mahlum Leigh S. , Robinson William R. 
Published: May 2019

INTRODUCTION:
Targeted cancer therapies based on tumor molecular analysis have grown exponentially in the last 5 years. Multiple gynecologic tumors can express markers that predict response to specific treatments. However not all insurance covers costly testing for every tumor marker, which can prevent un- or under-insured women from receiving optimal treatment. We worked with independent laboratories to provide free or cost-reduced testing. This study's aim is to demonstrate the impact of a universal molecular-based therapeutic program for gynecologic cancers in a low-resource environment.

METHODS:
Women with new gynecologic cancers presenting to an inner-city academic facility were identified between 1/1/18 and 6/30/18. Pedigree analysis and molecular testing of tumor specimens were done in all subjects. Data collected includes: demographics (including insurance status), tumor type and stage, and initial treatments.

RESULTS:
45 women with gynecologic cancer were identified. (Cervix-18, Ovary-7, Uterus-10, Vulva/vagina-10). 5/18 cervix cancers showed Combined Predictive Score >1.0; 3/10 uterine cancers showed mismatch repair (MMR) deficiencies; 3/10 vulva/vagina showed MMR deficiencies; and 2/7 ovarian cancers showed somatic BRCA mutations. In this 6-month period, 13/45 (29%) of gynecologic malignancies diagnosed had molecular markers associated with targeted therapies, and 7/13 (53%) patients with predictive molecular markers accepted a targeted therapy.

CONCLUSION:
Molecular analysis of cancer with therapy based on molecular markers is the gold standard for gynecologic cancers. 29% of the subjects had molecular markers associated with targeted therapies. While molecular testing and targeted therapies may be expensive, many laboratories and pharmaceutical companies are willing to work with patients with limited resources.
A Survey Assessment of Maternal Understanding of the Midtrimester Anatomy Scan [32D]
Authors: Buennemeyer Devin E. , Morgan Danielle , Terplan Mishka , Springel Edward H. 
Published: May 2019

INTRODUCTION:
Few studies have examined patients' understanding of prenatal ultrasounds (US). Our primary aim was to describe women's understanding of abnormalities detectable by midtrimester fetal anatomy scan. Our secondary aim was to determine if differences in the results varied with maternal demographics to identify subgroups who may benefit from additional counseling.

METHODS:
This was a cross-sectional survey of English-speaking patients presenting for a midtrimester fetal anatomy scan at a tertiary care teaching hospital. Patients were recruited prior to their US and if consent was obtained they completed a pre-US survey. The survey obtained demographic information and assessed knowledge of US detectable anatomic abnormalities by seven questions. Comparison between groups was performed by Wilcoxon rank sum test, Spearman rank correlation, and bivariate linear regression as appropriate.

RESULTS:
123 participants were recruited, 117 consented, and 116 completed surveys. A median of 43% [Interquartile Range 14-71%] of questions were answered correctly. Number of correct responses was found to correlate inversely with income <$50,000/year (P<0.0001), education less than Bachelor’s Degree (P<0.0001), age (P=0.001), and African American race (P<0.0001) in bivariate analyses.

CONCLUSION:
Patients with lower income, less education, younger age, and African American race have less knowledge about fetal anomalies detected via a midtrimester ultrasound. These data suggest that these women may benefit from additional counseling regarding the function of ultrasound as a medical test with the purpose of detecting fetal anomalies early in pregnancy.
Validation of Animal Model of Pelvic Radiation Induced Female Sexual Dysfunction and Cystitis [35D]
Authors: Burleson Lindsey K. , Powers Shelby A. , Odom Michael R. , Ellis Dillon A. , Jung Jae W. , Hannan Johanna L. 
Published: May 2019

INTRODUCTION:
Women receiving radiation therapy (RT) for cervical and endometrial cancers experience injury and fibrosis to surrounding healthy tissues leading to genitourinary dysfunction, specifically vaginal atrophy, dyspareunia and radiation cystitis.

METHODS:
Adult female Sprague-Dawley rats were separated into three groups (n=7-8/group): control, 4-week RT, and 9-week RT. RT rats received a single 20Gy dose of cervical x-ray irradiation. In vivo, pelvic nerve electric field stimulated (EFS) increases in vaginal blood flow were measured using a laser Doppler probe. Ex vivo tissue bath experiments assessed vaginal adrenergic and cholinergic contractions. Bladder cholinergic contractions were measured in the presence or absence of muscarinic inhibition. Internal and external urethral sphincter contractions to cholinergic agonists and caffeine were measured. EFS neurogenic contractions were evaluated in all tissues. Experiments were conducted in accordance with the East Carolina University Institutional Animal Care and Use Committee.

RESULTS:
Pelvic RT caused a decrease in vaginal blood flow and less cholinergic vaginal contraction 4-weeks post-RT. Following 9-weeks RT, vaginal blood flow normalized; however, adrenergic-mediated vaginal contraction remained elevated. In both RT groups, EFS neurogenic-mediated bladder contractions were reduced. No changes were observed in internal urethral sphincter contractility. In contrast, external urethral sphincter contractions to EFS and caffeine were elevated at 4 and 9-weeks post-RT.

CONCLUSION:
This pelvic RT model demonstrated impaired sexual arousal and increased vaginal contractility. Similar to previous RT studies, the bladder developed decreased neurogenic contractions; a symptom of radiation cystitis. Using our female pelvic RT model, we can begin to understand the pathophysiology of RT-induced sexual dysfunction and cystitis.