bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alabama Early Detection Program Reveals High Rates of Cervical Dysplasia and Cancer in Young Women [37E]
Authors: Lee Tinker Nicholas , Grette Katherine Virginia , Huh Warner K. , Seetala Kumari , Norris Katherine , Pierce Jennifer Young 
Published: May 2019

INTRODUCTION:
The Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP) recently expanded to include coverage for women age 30-39 in an effort to decrease disparities related to cervical cancer. We sought to better understand the impact of inclusion of younger women on overall incidence of cervical intraepithelial neoplasia III or cancer (CIN3+).

METHODS:
A descriptive analysis of the database of women undergoing screening through the ABCCEDP was undertaken. We analyzed data from 2012 to 2016. Any Pap with atypical cells of undetermined significance (ASCUS) or positive for high-risk human papillomavirus (HRHPV) was considered abnormal. Incidence of CIN3+ was compared between the two groups (30-39 and 40-64).

RESULTS:
During a five-year period, a total of 24,530 pap tests and 1050 procedures were performed. Of these, 14.1% were performed on women in the younger cohort. An abnormal test was found in 15% of these and in 8% of women aged 40-64. Overall, 1 in 130 women were ultimately diagnosed with CIN3+, with a significantly higher incidence in younger women (1:57 vs 1:166, p<0.0001). Of the women who returned for follow-up, final diagnosis was CIN3+ in 1 of 6 women aged 30-39 and 1 of 8 women aged 40-64. In total, 32.5% of CIN3+ were diagnosed in the younger cohort of women despite only making up 14% of the total population of women screened.

CONCLUSION:
All states currently screening women under the National Breast and Cervical Cancer Early Detection Program should expand screening to a younger cohort of women.
PARP Inhibition Shows Anticancer Activity in Small Cell Carcinoma of the Ovary Hypercalcemic Type (SCCOHT) [40E]
Authors: Guo Ting , Li Bin , Xu Congjian 
Published: May 2019

INTRODUCTION:
Small cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare, aggressive ovarian cancer characterized by germline and somatic inactivation of SMARCA4. There is urgent need for effective targeted therapy for SCCOHT.

METHODS:
In silico screening of the Genomics of Drug Sensitivity in Cancer (GDSC) database that included drug sensitivity data of 265 compounds in 1,074 cancer cells were conducted. Drug sensitivity in ovarian cancer cells with SMARCA4 mutation was analyzed, and further in vitro and in vivo studies were performed using the compound. Animal use was approved by local institutional review board.

RESULTS:
Two PARP inhibitors (PARPi) and 1 AR inhibitor showed significant selectivity for the 3 ovarian cancer cell lines with SMARCA4 mutation and 2 of which were confirmed SCCOHT cell lines (OVK-18 and TOV-112D). BRCA1/2 or ATM status did not affect selectivity. We validated findings in another two SCCOHT cell lines (BIN-67 and COV434) showing significant inhibition of proliferation with PARPi whereas only trend for inhibition for AR blockade in contrast with OVCAR3 and SK-OV-3 ovarian cancer cell lines that did not harbor SMARCA4 mutation. AR blockade however enhanced effect of PARPi in SCCOHT cell lines. Similar effects of PARPi+/-AR blockade were also observed in apoptosis, epithelial-to-mesenchymal transition, migration and colony formation assays. PARPi and AR blockade inhibited BIN-67 xenograft tumor growth with no remarkable toxicity.

CONCLUSION:
PARPi plus AR blockade holds promise for SMARCA4-mutant SCCOHT in both in vitro and in vivo preclinical models. Further investigation for clinical translation is warranted.
Referrals to Abortion Care by Student Health Centers in Pennsylvania: A “Secret Caller” Study [1F]
Authors: Anand Priyanka , McAllister Arden , Schreiber Courtney A. , Sonalkar Sarita 
Published: May 2019

INTRODUCTION:
One in ten women between 20 and 24 years has an unintended pregnancy. For college students, student health centers play a vital role in providing reproductive health services, but their role in abortion referrals is unknown.

METHODS:
We conducted a “secret caller” study at 4-year colleges in Pennsylvania between June 2017 and April 2018. A female researcher posing as a student seeking abortion referral contacted student health centers using a structured script, once as a minor (under 18 years), and once as an adult (over 18). Calls were transcribed in real time. The primary outcome was “direct referral,” defined as a referral to an abortion provider; secondary outcomes were “no referral,” “indirect referral” (non-specific provider), and “inappropriate referral” (non-abortion provider). The study was approved by the University of Pennsylvania IRB.

RESULTS:
One hundred and fifteen institutions were contacted, resulting in 202 successful contacts. One hundred contacts (49.5%) resulted in a direct referral, which did not differ by caller age (P=0.48). Religious institutions were less likely than non-religious institutions to provide a direct referral to both minors (26.3% vs 59.4% P=0.001) and adults (36.6% vs 62.7% P=0.01). For adult callers, larger institutions (1,000+ students) as compared to smaller institutions were more likely to offer direct referral (63.0% vs. 20.0% P=0.003). Inappropriate referrals was the next most common outcome, in 68 (33.7%) contacts.

CONCLUSION:
Half of college health centers in Pennsylvania do not provide direct abortion referrals, and many provide inappropriate referrals. Religious institutions are less likely to provide direct abortion referrals, particularly for minors.
Narcotic Use in Endometriosis: A Nationwide Case-Control Study [6F]
Authors: Swailes Alexa , Cho Yonghee Kristina , Schaefer Eric , Deimling Timothy Allen 
Published: May 2019

INTRODUCTION:
Endometriosis affects up to 10% of reproductive-age women and is highly co-morbid with other chronic pain conditions. Clinical suspicion is high that narcotics may be used as a mainstay of treatment for many women with endometriosis or chronic pelvic pain. Very few data are available regarding rates of narcotic use in this population.

METHODS:
Data were obtained from a commercial insurance claims database from employee-sponsored health plans. 706,863 patients with endometriosis/chronic pelvic pain were identified as cases. 706,863 patients without endometriosis/CPP were identified as age- and state-matched controls. Rates of narcotic use were compared in the year prior to diagnosis and the two years subsequent to diagnosis. Use subsequent to diagnosis was further analyzed by stratification by use prior to diagnosis.

RESULTS:
Narcotic use was higher prior to diagnosis (31.3 vs 21.3%), subsequent to diagnosis (56.3 vs 34.5%), and at higher morphine-equivalent dosages in cases vs. controls. Patient with narcotic use prior to diagnosis were more prone to use after diagnosis (74.2 vs 57.1%). All p-values <0.001.

CONCLUSION:
In patients with endometriosis or chronic pelvic pain, the rates of narcotic use are high both before and after diagnosis. Rates increase substantially following diagnosis. Narcotics are associated with decreased functional status and quality of life. Alternative therapies should be exhausted prior to use of narcotics as a primary mode of analgesia in these patients.
Membrane Separation After Laser Treatment for Twin-Twin Transfusion Syndrome and Perinatal Outcomes [9F]
Authors: De Zoysa Madushka Y. , Chon Andrew H. , Korst Lisa , Llanes Arlyn , Chmait Ramen H. 
Published: May 2019

INTRODUCTION:
Postoperative membrane separation is a complication of selective laser photocoagulation of communicating vessels (SLPCV) for treatment of twin-twin transfusion syndrome (TTTS). This study aims to determine its association with preterm premature rupture of membranes (PPROM) and preterm delivery (PTD).

METHODS:
TTTS patients who underwent SLPCV from 2006 to 2017 were retrospectively studied. Patients with membrane separation documented on ultrasound on postoperative day (POD) 1 were stratified into greatest width of separation <1 cm (Group A) or ≥1 cm (Group B) and compared to patients without separation by the following outcomes: PPROM ≤21 postoperative days, PTD <28 gestational weeks, and PTD <32 gestational weeks.

RESULTS:
Of 651 patients with intact membranes on POD 1, 120 (18.4%) had membrane separation: Group A (N=91) and Group B (N=29). Bivariate analysis demonstrated a difference in the occurrence of PPROM â‰¤21 days: 4.9% in those without separation, 9.9% in Group A, and 31.0% in Group B (P<.0001). Multiple logistic regression analysis controlling for potential covariates of PPROM yielded associations with PPROM for Group B (OR 8.60, 95% CI 3.38-21.90, P<.0001) and Group A (OR 2.82, 95% CI 1.31-6.08, P=.0369) compared to those without membrane separation. In similar models, neither Group A nor B were associated with PTD <28 weeks, but Group B was associated with PTD <32 weeks (OR 2.37, 95% CI 1.09-5.19, P=0.0304).

CONCLUSION:
Postoperative membrane separation was associated with an increased risk of PPROM within 21 days. If membrane separation was ≥1 cm, there was also a higher risk of PTD <32 gestational weeks.
Electronic Medical Record Intervention to Improve Adherence to Prenatal Vaccination Recommendation [12F]
Authors: Greenfield Isabel , Wu Danny , Anderson Meredith , Postlethwaite Debbie , Zerbo Ousseny , Klein Nicola 
Published: May 2019

INTRODUCTION:
In 2013, the Advisory Committee on Immunization Practices (ACIP) changed its recommendation to administer prenatal Tetanus, Diphtheria, and acellular Pertussis (Tdap) vaccine to between 27 and 37 weeks gestation for optimal placental antibody transmission. In 2014, Kaiser Permanente Northern California (KPNC) instituted a “Best Practice Advisory” (BPA) within the Electronic Medical Record (EMR) to alert clinicians to give prenatal Tdap in this optimal window. We examined whether the BPA was associated with an increase in optimally-timed prenatal Tdap.

METHODS:
An IRB-approved retrospective cohort study of pregnancies resulting in live births after 20 weeks gestation at KPNC between 6/1/2011 and 5/31/2017 was conducted. We compared the proportions of Tdap received during pregnancy and during the optimal window: before the ACIP recommendation, after the recommendation but before the BPA, and after instituting the BPA. We evaluated demographic and clinical characteristics associated with receiving prenatal and optimally-timed Tdap using multivariable logistic regression models.

RESULTS:
166,705 pregnancies in 143,306 women were included. Throughout the study period, there was an increasing trend in receiving prenatal Tdap (31% to 89%, P<.0001). Receipt of optimally-timed Tdap increased from 91% before to 96% after the BPA (P<.0001). Younger, lower income, African American, and parous women were less likely to receive prenatal Tdap. After the BPA, women who were over age 40, African American, and lower income were less likely to receive optimally-timed Tdap.

CONCLUSION:
An EMR-based intervention targeting prenatal Tdap vaccination was associated with improved adherence to ACIP recommendations.
Blood Loss Measurement Technique That Predicts Decrease in Hemoglobin After Cesarean Delivery [17F]
Authors: Coviello Elizabeth Michelle , Chornock Rebecca Lynn , Fries Melissa H. , Cheney Megan Clair , Iqbal Sara Naeem 
Published: May 2019

INTRODUCTION:
To identify the blood loss technique that best predicts a decrease in hemoglobin (Hgb) >3 g/dL 24 hours after cesarean delivery (CD).

METHODS:
This was an IRB approved, retrospective review of women with singleton pregnancies who underwent cesarean delivery at >=34 weeks' gestation between July 1, 2017 and June 30, 2018. Women had blood loss measured by visually estimation (EBL), gravimetric estimation (QBL), Gauss Surgical's Triton (TBL) and a 24-hour postoperative complete blood count. The primary outcome was the optimal threshold for decrease in Hgb >3 g/dL by the area under the receiver-operating characteristic (ROC) curve (AUC) using blood loss estimation technique.

RESULTS:
Of the 446 women meeting inclusion criteria, 65 (15%) had a decrease in Hgb >3 g/dL. Women who had a decrease in Hgb >3 g/dL compared to women without a decreased in Hgb >3 g/dL were more likely to have increased gestational age, postoperative tachycardia (heart rate >100 beats per minute) at 12 and 24 hours post CD, postpartum hemorrhage by QBL and TBL and require blood product transfusion, (all P<0.05). None of the blood loss measurement techniques had a high AUC for predicting women with decrease in Hgb >3 g/dL (EBL 0.64 [95% CI 0.56-0.71], QBL 0.67 [95% CI 0.60-0.74] and TBL 0.70 [95% CI 0.63-0.77], P=0.13. All techniques had low sensitivity and high specificity for women with PPH and decrease in Hgb >3 g/dL.

CONCLUSION:
Blood loss at time of cesarean, measured by EBL, QBL or TBL, is a poor predictor for a decrease in Hgb by >3 g/dL.
Rates of Neonatal Sepsis by Maternal Race, Education, and Insurance [22F]
Authors: Birch Mary Nienow , Frank Zoë , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
Given the dearth of current data comparing sepsis rates among infants based on maternal demographics, clinicians have little with which to evaluate a neonate's chances of developing sepsis. This study aims to characterize the rates of sepsis stratified by maternal race, education level, and insurance status.

METHODS:
This is a retrospective cohort study of 9,676,773 non-anomalous, singleton and twin deliveries in the United States. We conducted a chi-squared analysis comparing rates of sepsis among infants stratified by maternal race, education level, and insurance status. Multivariate analysis controlled for maternal age, diabetes, chronic hypertension, preeclampsia, chorioamnionitis, postpartum hemorrhage, cesarean section, nulliparity, and gestational age.

RESULTS:
Within our cohort, rates of neonatal sepsis were significantly higher among infants born to women with Medicaid insurance than those born to women without Medicaid insurance (2.00% vs. 1.27%; p<0.001). Infants with mothers who had no college education exhibited higher rates of neonatal sepsis than infants with mothers who had some college education (1.84% vs. 1.35%; p<0.001). Additionally, multivariate analysis showed that non-Hispanic Black race and Hispanic race were predictive for neonatal sepsis (OR 1.22, 95% CI 1.16-1.29; OR 1.17, 95% CI 1.13-1.21).

CONCLUSION:
In our cohort, Hispanic and non-Hispanic Black mothers exhibited an increased risk of giving birth to an infant who developed neonatal sepsis. Rates of sepsis were also significantly higher among infants born to mothers with Medicaid and to mothers with no college education. This research highlights a need for further investigation into the association between sepsis rates and demographic factors.
Morbidly Adherent Placenta Among Women With Twin Gestation [24F]
Authors: Miller Hayley , Fox Karin , Carusi Daniela A. , Leonard Stephanie , Lyell Deirdre 
Published: May 2019

INTRODUCTION:
It is unknown whether women with twin gestations have greater risk for morbidly adherent placenta (MAP). We assessed whether MAP occurs more frequently among twin versus singleton gestations by using retained placenta with postpartum hemorrhage (PPH) in the absence of uterine atony as a surrogate marker for MAP.

METHODS:
All births in California during 2007-2012 were identified from birth certificate records linked to hospital discharge databases through the California Office of Statewide Health Planning and Development. Women were included if they had both ICD-9 codes for PPH (666.X) and retained placenta or membranes without hemorrhage (667.X), and singleton or twin gestations. Women diagnosed with uterine atony (666.X) or chorioamnionitis (654.8) were excluded. Chi-square and multivariable logistic regression analyses were used to estimate odds ratios.

RESULTS:
Among 3,047, 223 women who met inclusion/exclusion criteria, the diagnosis of MAP (n=30,037) was significantly more frequent among women with twin versus singleton gestations (1,642 (1.78% twins) vs. 28,395 (0.96% singletons), p=0.<0.001). Women with twins were older with more placenta previas and a higher rate of prior cesarean delivery. When controlling for maternal age, placenta previa, and prior cesarean delivery, twin gestation was associated with a 70% increase in the odds of MAP (aOR 1.70, 95% CI 1.62-1.79).

CONCLUSION:
Twin gestation appears independently to confer an increased risk for morbidly adherent placenta, when retained placenta with hemorrhage in the absence of uterine atony is used as a surrogate marker for this diagnosis. Clinicians should be aware of this increased risk when managing retained placenta after twin delivery.
Financial Analysis of Expectant Management of Preterm Premature Rupture of Membranes to Term in a Community Hospital [28F]
Authors: Warwar Rachel E. , Kuss Brittany N. , Elliott John O. , Guinness Jessica M. 
Published: May 2019

INTRODUCTION:
Recent studies have demonstrated a potential benefit of expectant management of preterm, premature rupture of membranes (PROM) during the “late preterm” period. Data from United States patient populations are lacking in this management option.

METHODS:
An IRB approved retrospective cohort study was conducted examining preterm PROM patients at or beyond 34 weeks identified from 12,598 patients on our labor and delivery service from April 2015 to April 2017. Hospital costs, neonatal infection and intensive care admissions were compared between those expectantly managed (n=67) and those induced or delivered at time of diagnosis (n=65).

RESULTS:
The cohorts were similar in terms of demographic and maternal characteristics. The expectantly managed patients were diagnosed with preterm PROM at an earlier gestational age (GA) and delivered, on average, 3.3 days (95% CI 1.3-5.3) later. There were no differences in GA at time of delivery, maternal postpartum or neonatal outcomes, specifically intensive care admissions and neonatal sepsis rates. Total hospital costs were significantly higher in those expectantly managed ($9,068 vs $5,901, P<0.001), with cost differences noted in lab, nursing and pharmacy (all P<0.001).

CONCLUSION:
We did not find benefits in terms of cost, maternal or neonatal outcomes in expectant management of preterm PROM after 34 weeks. Our data was limited by those expectantly managed gaining only 3 days latency prior to delivery. Areas of future research could include a similar cost analysis including gestational ages prior to 34 weeks where a longer latency phase between preterm PROM and delivery may be observed.
Association Between Liver Function Tests and Total Bile Acid Levels in Pregnant Women With Pruritus [29F]
Authors: Wang Tiffany , Iqbal Sara Naeem , Landy Helain J. , Smith Samuel , Huang Jim 
Published: May 2019

INTRODUCTION:
Intrahepatic cholestasis of pregnancy (ICP) is diagnosed based on pruritus in pregnancy and total bile acid (TBA) levels ≥10 µmoles/L. However, TBA levels can take several days to result, potentially delaying interventions. Elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels have been used in evaluating ICP when TBA levels are not available. The objective of this study was to examine the association between AST or ALT and TBA ≥10 µmoles/L in women with pruritus in pregnancy.

METHODS:
This was an IRB-approved multi-hospital retrospective cohort study of women with pruritus in pregnancy between 2009 and 2016. We examined maternal characteristics and laboratory values available at presentation. Variables were compared between women with TBA ≥10 µmoles/L vs TBA <10 µmoles/L. Multivariable regression models were performed to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for elevated AST or ALT, controlling for confounders.

RESULTS:
Of 287 women, 244 (85%) had an initial TBA ≥10 µmoles/L. Women with TBA ≥10 µmoles/L were more likely to have higher AST (P<0.01) and ALT (P<0.01). After adjusting for confounders, elevated ALT ≥50 units/L was associated with increased odds of TBA ≥10 µmoles/L (aOR 2.98, 95% CI 1.36-6.49). However, elevated AST ≥50 units/L was not significantly associated with TBA ≥10 µmoles/L (aOR 1.90, 95% CI 0.85-4.25).

CONCLUSION:
In women with pruritus in pregnancy, ALT ≥50 units/L was associated with initial TBA ≥10 µmoles/L. Elevated ALT may be useful in the diagnosis and management of suspected ICP when TBA levels are not immediately available.
Predicting Mode of Delivery After an Induction of Labor in Women With an Increased Body Mass Index [33F]
Authors: Demsky Ashley , Stafford Shawna M. , Birch Daniel , Sharma Arya , Schulz Jane Ann , Steed Helen 
Published: May 2019

INTRODUCTION:
There is a growing body of literature outlining the adverse consequences of excess body weight in pregnancy. In particular, this has demonstrated an increased rate of cesarean delivery. To date, there is no risk stratification tool to determine which women, with obesity and who are undergoing an induction of labor, are at the greatest risk of cesarean delivery. This study aims to validate the use of a modified Edmonton Obesity Staging System (EOSS) to predict mode of delivery amongst these women.

METHODS:
A prospective-cohort study was performed at two high obstetrical volume centers in Edmonton, Alberta. A total of 345 nulliparous women, undergoing an induction of labor at term, were recruited. Participating women provided a self-reported health survey and allowed for review of their medical records. The sample population included women with a body mass index (BMI) of ≥25.0 at first antenatal visit. The primary outcome is the rate of cesarean delivery.

RESULTS:
Overall, 345 women were recruited into this study with a participation rate of 93.7%. This included a sample group of 276 women, with an increased BMI, and a control group of 69 normal-weight women. Preliminary data analysis determined a cesarean delivery rate of 30.4% for the control group and 35.8%, 29.9%, 43.2%, and 90.5% for women assigned an EOSS Stage 0, 1, 2, and 3, respectively.

CONCLUSION:
A modified version of the EOSS may help stratify the risk of cesarean delivery in nulliparous women, with an increased BMI, who are undergoing an induction of labor.
ObGyn Physician Knowledge, Comfort, and Current Practices of Firearm Safety Counseling [35F]
Authors: Rubin Nicole , Morosky Christopher 
Published: May 2019

INTRODUCTION:
Homicide and suicide are two of the leading causes of maternal mortality in the United States, with firearms in the setting of intimate partner violence (IPV) responsible for the majority of these deaths. There is no published research evaluating ObGyn physicians' current practices related to firearm safety counseling.

METHODS:
We performed a pre- and post-test evaluation of ObGyn physicians following a one-hour educational intervention that reviewed maternal mortality due to gun violence, CT State Firearm Law, and best practices for safe storage and use of firearms. IRB approval was obtained through UCONN Health.

RESULTS:
A total of 78 ObGyn physicians (45 attendings, 30 residents, 3 fellows) completed the educational intervention. Of the study participants, 28.5% reported having had a patient that was killed by a firearm, with IPV accounting for 50% of these reported deaths. Only 13.5% of providers had previously received education related to firearm safety. Following the intervention, providers reported that in the setting of IPV they were more likely to change their practice knowing that there was a firearm in the home (P=.001). Additionally, the educational intervention increased provider comfort with firearm safety counseling (P<.001), knowledge of CT State Firearm Law (P<.001), and knowledge of safe storage and use of firearms (P<.001); which corresponded to the major barriers identified by providers in implementing firearm safety counseling.

CONCLUSION:
Our educational intervention increased ObGyn physician knowledge and comfort related to firearm safety counseling. Consideration should be given to incorporating education on firearm safety counseling into ObGyn graduate and continuing medical education.