bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a Student-Run Clinic in a Non-Profit Substance Abuse Rehabilitation Facility for Women [32B]
Authors: Tran Cassandra , Ngo Lisa , Crowley Michelle , Tran Stacey , Robinson William R. 
Published: May 2019

INTRODUCTION:
Substance abuse is a growing problem among women, and is frequently accompanied by multiple gynecologic concerns. Residential substance abuse rehabilitation facilities offer an opportunity to address those concerns. The purpose of this report is to examine the impact of an all-volunteer, medical student-run clinic with faculty supervision within a non-profit, inner-city women's residential substance abuse rehabilitation facility.

METHODS:
625 clients were admitted, regardless of financial status, to a 70-bed residential substance abuse rehabilitation facility between 2016 and mid-2018. Data including Pap smears, Human Papillomavirus (HPV) infection, and sexually transmitted infection testing were analyzed.

RESULTS:
From January 2016 through August 2018, 175/625 (28.0%) clients accepted Pap testing. 52/175 (29.7%) had an abnormal result, defined as Trichomonas infection, HPV infection, or premalignant or malignant lesion. 240/625 (38.4%) clients accepted Gonorrhea/Chlamydia testing, and 6 were identified as having Gonorrhea or Chlamydia. In 2018 alone, Pap testing identified 7/44 (15.9%) clients as having premalignant or malignant lesions, including one case of squamous cell carcinoma. 9/24 (37.5%) had a high-risk HPV strain. 7/44 (15.9%) had Trichomonas. Clients also received counseling regarding personal health awareness and reduction of high-risk behaviors.

CONCLUSION:
The use of a student-run clinic to provide gynecologic services within a residential substance abuse rehabilitation facility has a major impact and is cost-efficient. Many clients have no other opportunity to obtain instruction on health awareness and high-risk behavior, as well as diagnosis and treatment of abnormal Pap smears and STIs. This model allows non-profit facilities to provide an otherwise unaffordable level of care.
Mapping the Cervical Cancer Care Cascade in Johannesburg, South Africa: Baseline Cohort Description [36B]
Authors: Oberlin Austin M. , Mulongo Masangu , Ramotshela Sibongile , Pasipamire Tafadzwa , Chibwesha Carla Joan 
Published: May 2019

INTRODUCTION:
Despite universal access to antiretroviral therapy (ART) in South Africa, the burden of cervical cancer and its precursors among HIV-infected women remains substantial.

METHODS:
Using electronic medical record data from our cervical cancer prevention program in Johannesburg, we conducted a retrospective analysis (IRB approval obtained) of HIV-infected women undergoing screening, colposcopy, and loop electrosurgical excision procedures (LEEP) for cervical intra-epithelia neoplasia (CIN). We report baseline characteristics of this high-risk cohort.

RESULTS:
Between January 2011 and June 2018, 2,801 HIV-infected women were included in the cohort. The median age was 42 years (interquartile range [IQR] 35-49). 2,649 (95%) women were receiving ART and the median CD4 count was 520 cells/uL (IQR 359-700). Our analysis database included 3,613 Pap smears, 556 diagnostic biopsies, and 153 LEEPs. More than half of the cytology results (54%) were abnormal, requiring follow-up. The risk of biopsy-confirmed disease was also high: 243/556 (44%) cases of CIN1 and 198/556 (36%) of CIN2/3. Among 153 LEEPs, there were 35 (23%) cases of CIN1 and 106 (69%) of CIN2/3. Of these, residual disease was reported in 65/91 (71%) cases, with one margin positive in 32/91 (35%) and both margins positive in 33/91 (36%). LEEP margin status was not associated with grade of CIN (P=.07).

CONCLUSION:
In this cohort of HIV-infected women living in urban South Africa, attrition between screening, diagnosis, and treatment was considerable. Additionally, the LEEP margins were positive in more than two-thirds of women, raising concern for treatment failure and subsequent progression to invasive cervical cancer.
Examination of Provider Assessed Patient Pain During Colposcopy: Implications for Care Provision [11C]
Authors: Grotheer Annette , Lee Jared , Franklin Kelsey , Gillespie Kendra , Carugno Jose 
Published: May 2019

INTRODUCTION:
The ubiquity of diagnostic cervical biopsy has resulted in subsequent reductions in morbidity and mortality secondary to cervical cancer. Minimizing psychological distress and procedural pain, known barriers to follow-up in patients with abnormal pap smears, remains an obstacle for optimization of care provision. However, few studies have quantified health care providers' (HCP) ability to anticipate patient pain.

METHODS:
Patients presenting to an academic gynecology practice for cervical biopsy with colposcopy completed surveys assessing demographics, anticipated biopsy pain, intra-biopsy pain, and other metrics. HCPs and their procedural assistants also estimated patient's perceived intra-procedural pain. Pain was quantified utilizing a visual-analog scale. Data analysis was performed using Spearman rank correlation, and coefficients were calculated. IRB committee approval was obtained.

RESULTS:
Eighty patients were enrolled and 62 underwent cervical biopsy. Patients with higher anticipated pain perceived greater intra-procedural pain (P=.024). Women reporting more painful periods anticipated and perceived more pain (P<.001, P=.058). HCP's perception of pain correlated with patients' perceived pain (P=.066), however, only PGY3 and PGY4 OB/GYN residents predicted patient's perceived intra-procedural pain with statistical significance (P=.014). PGY1 residents, PGY2 residents (P=.039) and male assistants (P=.037) anticipated lower pain ratings than were reported by patients.

CONCLUSION:
Providers were able to accurately estimate a patient's pain, particularly upper level resident physicians. Patient age, baseline anxiety, and history of dysmenorrhea were reliable predictors of procedural pain levels. Utilizing said predictors of patient pain may serve to optimize patient satisfaction and patient follow-up.
Exercise Amongst Women With Psychiatric Disorders and Substance Misuse During Pregnancy [16C]
Authors: Ahuja Chaarushi , Lipkind Heather , Gilstad-Hayden Kathryn , Yonkers Kimberly 
Published: May 2019

INTRODUCTION:
ACOG recommends 150 minutes/week of exercise to maintain fitness and reduce adverse outcomes. However, little is known about exercise habits of women with psychiatric disorders and substance misuse during pregnancy.

METHODS:
To examine associations of exercise with behavioral conditions and birth outcomes, we utilized data from a prospective pregnancy cohort study (n=2647). Participants may have had major depressive disorder (MDD) (n=220), anxiety disorders (n=375) and/or misused alcohol, marijuana, or illicit drugs (n=228), opioids (n=164), or nicotine (n=387). Self-reported, weekly exercise during the 1st trimester was categorized into 3 groups: none, 1-150 minutes, or ≥ 150 minutes. 1st trimester was a proxy because reported exercise is greatest during that time. The proportions of exercisers were compared between women with and without psychiatric disorders or substance misuse with chi-square tests. Logistic regression modeled the relationship between exercise, psychiatric disorders, substance use and birth outcomes (preterm labor, low birth weight).

RESULTS:
Overall, 44.7% of participants did not exercise and 24.2% met the weekly recommended goal (>150-minutes). Women with, compared to without MDD, were less likely to exercise (43.51% vs 58.64, p<0.01). This was similar for anxiety disorders (43.18% vs 54.40%, p<0.01), substance misuse (43.99% vs 53.07%, p=<0.01) and smoking (42.88% vs 55.81%, p<0.01) but not opioid use. Neither exercise nor its interaction with psychiatric conditions influenced the likelihood of adverse birth outcomes.

CONCLUSION:
Exercise, its relationship to psychiatric disorders, and impact on maternal health needs to be explored further. Focused efforts to encourage exercise may still prove beneficial for the mother.
Maternal Inflammation and Urogenital Microbial Profiling as Predictors of Preterm Birth [26C]
Authors: Idusuyi Brittany , Le Nhung , Gong Yuan Yuan , Ghareeb Allen , Loret de Mola J. Ricardo , Braundmeier-Fleming Andrea 
Published: May 2019

INTRODUCTION:
Preterm birth (PTB) is defined as delivery prior to 37 weeks gestation. Maternal immune dysregulation is thought to play a major role in the development of PTB. We hypothesize that systemic maternal inflammation during pregnancy alters the urogenital microbiome and decreases immune suppression by reducing circulating and placental regulatory T cells (Tregs), the immune cells primarily responsible for maternal immune suppression.

METHODS:
Patients considered high risk for PTB were recruited from the Department of Ob/Gyn at SIU School of Medicine. Following exclusion for non-compliance and intrauterine fetal demise, 18 term and 6 preterm deliveries were assessed (25% preterm rate). Peripheral blood and urine were collected at various timepoints during gestation (8-12 weeks, 20-24 weeks and 32-36 weeks), delivery and 6 weeks postpartum. Lymphocyte buffy coats were extracted and flow cytometry analyses identified specific immune populations. Urinary microbial analyses were performed by miSeq amplicon sequencing using the V4 region of the bacterial 16S rRNA gene.

RESULTS:
Higher levels of peripheral Treg populations, corresponding with immune tolerance for the fetal alloantigen, were found in patients with term deliveries. Reduced levels of peripheral Tregs were found in patients with subsequent preterm deliveries. This group also had a higher ratio of Th17/Treg cells, corresponding with increased inflammation, and altered urinary microbial profiles at each gestational timepoint.

CONCLUSION:
We found atypical shifts in immune and urinary microbial profiles from women with another PTB as compared to women with term deliveries. Our results demonstrate a potential novel screening modality for PTB utilizing the mother's immunological and urinary microbial profiles.
Maternal Perioperative Morbidity and Race in Women with Placenta Accreta [28C]
Authors: Arditi Brittany , Purisch Stephanie Erin , Friedman Alexander Michael , Gyamfi-Bannerman Cynthia 
Published: May 2019

INTRODUCTION:
Racial and ethnic disparities in obstetric outcomes are well documented in the literature, however the interaction between race and placenta accreta has not been investigated. We sought to determine whether race is associated with adverse maternal perioperative outcomes in this setting.

METHODS:
This retrospective cohort study was derived from an observational cohort of cesarean deliveries at US academic medical centers. Women with placenta accreta were included. Race and ethnicity were self-reported as African-American, Caucasian, and Hispanic. Other race and ethnicity groups were excluded. Outcomes including death, hysterectomy, uterine rupture, surgical injury, arterial ligation, and ICU admission were compared by race and ethnicity.

RESULTS:
182 women were included. 73 (40%) were Caucasian, 66 (36%) were African-American, and 43 (24%) were Hispanic. In regression analysis, the risk of severe morbidity (hysterectomy, uterine rupture, death) was significantly higher among Hispanic women as compared to their Caucasian counterparts (RR 2.8, 95%CI 1.1-6.9). African-American women were less likely to have a surgical injury than Caucasian or Hispanic women (4.6% vs 21.9% vs 16.3%, P=0.01). In adjusted analysis, African-American women remained at lower risk of surgical injury as compared to Caucasian women (adjusted OR 0.1, 95%CI 0.02-0.8). African-American women were also less likely to have hospital stays >4 days (adjusted OR 0.3, 95%CI 0.1-0.9).

CONCLUSION:
Hispanic women with placenta accreta have increased risk of severe perioperative morbidity. African-American women with placenta accreta are less likely to experience a surgical injury during cesarean delivery, and are less likely to have extended hospital stays.
Detection of Fetal Cardiac Anomalies Using Standard Sonography [32S]
Authors: Morgan Jamie L. , Byrne John J. , McIntire Donald D. , Twickler Diane M. , Dashe Jodi S. 
Published: May 2019

INTRODUCTION:
To investigate fetal cardiac anomaly detection during initial and follow-up standard sonography, and evaluate the association between visualization of cardiac anatomy and anomaly detection.

METHODS:
This was an IRB-approved retrospective cohort study of singleton pregnancies that received care at our hospital and subsequently delivered a live-born infant with ≥1 major cardiac anomaly between October 2011 and March 2018. We reviewed cardiac anomaly detection during the initial standard ultrasound performed at 18 to 21 6/7 weeks, and among those with anomalies not detected initially, during indicated follow-up ultrasound. Detection was analyzed according to the number of follow-up exams and visualization of the 4-chamber view and left and right ventricular outflow tracts. Statistical analyses were performed using Chi-squared and Mantel-Haenszel test for trend.

RESULTS:
105 low-risk pregnancies had fetuses with major cardiac anomalies. 63 (60%) were detected during the 18 to 21 6/7-week standard ultrasound, and 17 (16%) were detected during follow-up standard ultrasound, yielding 76% overall detection. The 42 infants (40%) not detected initially were more likely to have suboptimal cardiac anatomy visualization (71% vs 29%, p<0.001). Number of visualized cardiac views also correlated with likelihood of detection (p<0.001). Of pregnancies with undetected fetal cardiac anomalies in which follow-up ultrasound was performed, 62% (17/26) were subsequently detected with a significant decrease in the proportion of suboptimal cardiac views compared to the initial scan (82% vs 17%, p=0.001).

CONCLUSION:
In a low-risk population, standard ultrasonography identified over half of major cardiac malformations during initial screening examination, with follow-up examination identifying 40% of those initially missed.
Multigene Panel Testing of Patients With Uterine Carcinoma Reveals Actionable Variants in Non-Canonical Genes [25O]
Authors: Dae-Hoon Im Dwight , Yorczyk Arielle , Yang Shan , Michalski Scott , Nussbaum Robert , Esplin Edward 
Published: May 2019

INTRODUCTION:
Traditionally, targeted genetic testing for patients with carcinoma of the uterus (UC) has included the five Lynch syndrome (LS) genes and PTEN due to their association with UC. Now, other cancer genes actionable for treatment, prevention and early detection of malignancies can be included, at no additional cost. We report data on the diagnostic yield and clinical actionability in UC patients using a comprehensive genetic testing panel strategy.

METHODS:
With IRB approval, 6,582 consecutive patients with UC underwent hereditary cancer panel testing. Testing included up to 83 genes per the ordering clinicians' discretion. De-identified medical histories were obtained from requisition forms.

RESULTS:
A germline pathogenic or likely pathogenic (P/LP) variant was identified in 1,031 (15%) patients. Of these, 54% had a P/LP variant within a LS gene or PTEN while 39% had a P/LP variant in other cancer genes, including ATM, BRIP1, CHEK2, PALB2, and TP53 (excluding MUTYH heterozygotes). Of those with a P/LP variant 32% were eligible for clinical treatment trials, 52% qualified for FDA approved therapies, >90% had newfound NCCN guideline management recommendations, and cascade testing for at-risk family members.

CONCLUSION:
Hereditary multigene cancer panel testing identified many clinically actionable P/LP variants that would have been missed by traditional, targeted UC gene testing. Over 80% of patients with P/LP variants were potentially eligible for precision therapeutic intervention based in part on their germline test results. These data highlight the benefit of comprehensive panels for UC patients and the potential for cancer intervention, surveillance and family member cascade testing protocols.
Risk Factors for Stillbirth in an Inner-City Community Hospital [18C]
Authors: Posso Ramses G. , Gallo Danielle , Payero Elfy , Henderson Cassandra 
Published: May 2019

INTRODUCTION:
The stillbirth rate at Lincoln Medical and Mental Health Center (LMMHC) in the Bronx is 1/130, which is higher than the national average. Our aim was to compare the reported risk factors for term stillbirth with the identified antenatal risk factors for all cases of fetal demise that occurred after 39 weeks of gestation.

METHODS:
For this IRB approved quality improvement project, we reviewed data from all of the term fetal demise that occurred at LMMHC from 2013-2017. We categorized women based on the following characteristics which have been reported as risk factors for stillbirth: Hypertension, Diabetes, Obesity (BMI>30), and Advanced Maternal Age (>35).

RESULTS:
For births at LMMHC from 2013-2015, the relative risk (RR) of having a Stillbirth for a woman with Obesity was 3.2 (CI 95% 1.8-5.3, p<0.0001), RR for Diabetes was 3.5 (CI 95% 1.9-6.2, p<0.0001), RR for Hypertension was 3.1 (CI 95% 1.7-5.5, p<0.0001). For births from 2016-2017, the RR of a woman with Diabetes to have a Stillbirth was 3.8 (CI 95%, 1.8-7.9, p<0.0004), the RR for Hypertension was 3.5 (CI 95% 1.6-7.3, p<0.0010). We did not have the BMI data for this time period. We did not see an increased risk of stillbirth in patients with AMA.

CONCLUSION:
Considering the known risk factors of stillbirth and the potential benefits of delivery at 39 weeks gestation, induction can be considered to potentially decrease the risk of stillbirth. Physicians should utilize shared decision making with their patients who exhibit these risk factors.
Excision of Incidentally Discovered Bladder Leiomyoma During Repeat Cesarean Section: A Case Report [12K]
Authors: Eucalitto Patrick , Djordjevic Miroslav , Bryant Gwyneth 
Published: May 2019

INTRODUCTION:
Leiomyoma account for <0.5% of all bladder tumors. In women, the majority are identified during diagnostic work-up for symptoms such as urinary retention or frequency, recurrent UTI, dysuria or dyspareunia. Per our literature review, the surgical management of bladder leiomyoma has never been reported during cesarean section. Our case report describes the surgical management of an incidentally discovered 4 centimeter vesicoperitoneal leiomyoma during scheduled repeat cesarean section.

METHODS:
A 33-year-old G2P1001 at 39 weeks gestational age presented for scheduled repeat cesarean section. She had a known history of uterine fibroids with no symptoms suggestive of bladder involvement. After closing the hysterotomy, the pelvic anatomy was inspected. A firm 4 centimeter mass was discovered within the vesicoperitoneum along the right superior aspect of the bladder. Its appearance was consistent with other small leiomyoma noted on the uterus. The findings were discussed intraoperatively with the patient and informed consent was obtained to remove the bladder mass. The bladder was retrofilled with normal saline to rule out intramural involvement and to identify a safe plane for resection. Excision was achieved with 5 milliliters of additional blood loss.

CONCLUSION:
Our report highlights the surgical technique used to remove the mass. We include preoperative ultrasound images (inconclusive for the surgical diagnosis), intraoperative photographs, and postoperative histopathology. Our discussion emphasizes the importance of thorough pelvic anatomy inspection during cesarean section, particularly since the patient was 18 months status post primary cesarean section. Finally, we review the pathophysiology of leiomyoma and discusses management of leiomyoma in atypical locations.
First Trimester Uterine Incarceration Resolved With Conservative Management in a Multifetal Gestation [19K]
Authors: Carney Alexandra C. , Tobler Kyle James 
Published: May 2019

INTRODUCTION:
Gravid uterine incarceration has an incidence of 1 in 3,000 to 10,000 pregnancies. Presentation typically occurs between 14 and 16 weeks gestation. There has been only one previously reported case of uterine incarceration in a multifetal gestation. In symptomatic patients, treatment has included ultrasound-assisted manual reduction, colonoscopy-assisted insufflation, laparoscopy and laparotomy. We present a case of uterine incarceration of a twin gestation successfully resolved with bowel preparation and suppository pain control overnight followed by pessary placement requiring minimal ultrasound-assistance.

METHODS:
32 year old Gravida 5 Para 3 at 9 weeks gestation with a twin pregnancy by in vitro fertilization, presented with severe, intractable pelvic pain. Transvaginal ultrasound revealed a significantly retroverted incarcerated uterus. She was admitted for close observation and scheduled for manual reduction in the OR the next morning. Overnight, she received a bowel preparation and a Belladonna suppository for pain management. The following morning, the patient's pain had significantly improved. Ultrasound revealed substantial improvement and mobility of the uterus. Manual reduction required minimal force. A ring pessary was placed in the posterior cul-de-sac to maintain appropriate uterine position. The patient reported complete immediate resolution of pain following the procedure.

CONCLUSION:
Standard management for uterine incarceration has yet to be established; therefore, case reports are used when this rare complication occurs. Our case highlights that thorough bowel evacuation followed by pessary placement may be an effective first line treatment in symptomatic patients, thus avoiding surgical management. Additionally, anticholinergic effects of suppository pain control may contribute to uterine relaxation and self-reduction.
Joint Impact of Maternal Body Mass Index and Race on Macrosomia [31K]
Authors: Zhao Sifang Kathy , Velez Edwards Digna R. , Jones Sarah H. , Torstenson Eric , Hartmann Katherine Eubanks 
Published: May 2019

INTRODUCTION:
Macrosomia (birthweight > 4,000g) increases risk of birth complications and metabolic syndrome for the infant. Motivated by racial differences in prevalence of obesity and macrosomia, we examined the joint influence of maternal body mass index (BMI) and race on risk of macrosomia.

METHODS:
Right from the Start is a prospective pregnancy cohort that enrolled women from southeastern US (2000-2012). Maternal height and weight were measured around six weeks gestation. Race was self-reported during a first-trimester telephone interview. Infant birthweight was obtained from medical or vital records. The joint effect of maternal BMI and race was assessed using stratified logistic regression, adjusting for maternal age, income, and gestational age.

RESULTS:
Among 3,986 women, 506 (13%) gave birth to a macrosomic infant. Non-Hispanic blacks had lower risk of having a macrosomic infant compared to non-Hispanic whites (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.34, 0.71). This observation holds for non-Hispanic blacks regardless of BMI status (normal [18.5-24.9 kg/m2] OR 0.34, 95% CI 0.14-0.79; overweight [25.0-29.9 kg/m2] OR 0.34, 95% CI 0.16-0.70; obese [≥-30.0 kg/m2] OR 0.53, 95% CI 0.30-0.94). For non-Hispanic whites (OR 1.52, 95% CI 1.11-2.08) and Hispanics (OR 2.71, 95% CI 1.01-7.30), being obese is associated with higher risk of macrosomia compared to normal weight non-Hispanic whites.

CONCLUSION:
We observed increased risk for macrosomia among obese non-Hispanic whites and Hispanics, but not non-Hispanic blacks. Understanding the interplay between maternal BMI and race could guide personalized strategies for assessing maternal weight and risk of macrosomia to inform use of ultrasound to identify macrosomia.