bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sexual Violence Screening Practices Among Obstetricians and Gynecologists [21F]
Authors: Hicks-Courant Katherine , Baer Samantha , Lee Eung-Mi , Evans Megan L. 
Published: April 2018

INTRODUCTION:
In the United States, almost 1 in 5 women are affected by sexual assault and may face particular challenges when it comes to obstetric and gynecologic care. This study examines providers’ knowledge, comfort level, and barriers to screening patients for a history of sexual violence.

METHODS:
We conducted an anonymous computer-based survey which was sent to all physicians (n=46) in an Obstetrics and Gynecology department at a tertiary academic medical center.

RESULTS:
Our sample included 18 faculty members and 18 resident physicians for a response rate of 78%. The majority agree that it is important (97%) and that it is part of their role (81%) to screen patients for a history of sexual violence. While the majority agree that they feel comfortable screening patients for a history of sexual violence (69%), only 44% screen at least half of the time. The majority report feeling comfortable modifying their physical exam techniques to meet the needs of a patient with a history of sexual violence (61%), but do not know how to connect patients with timely, accurate resources (75%) and have not received formal training in screening patients (67%), responding to a disclosure of violence (67%), or modifying physical exam techniques (75%).

CONCLUSION:
Most providers agree that screening for a history of sexual violence is important and is part of their role as obstetricians or gynecologists. However, less than half screen patients regularly. Additional training and education could improve this discrepancy and improve care for patients with a history of sexual violence.
Childhood Abuse Increases Risk of Adverse Perinatal Outcomes [22F]
Authors: Johnson Quinetta , Bush Heather , Coker Ann 
Published: April 2018

INTRODUCTION:
Intimate partner violence (IPV) has been associated with numerous adverse perinatal outcomes. Little is known, however, regarding the impact of childhood abuse on subsequent adverse pregnancy outcomes among women never experiencing IPV.

METHODS:
Data from the University of Kentucky’s Women’s Health & You cohort were used to assess the association between women who experienced childhood sexual (CSA) and/or physical (CPA) abuse and the self-reported history of third trimester bleeding, postpartum depression, preterm labor, preeclampsia, and gestational diabetes. Multivariate logistic regression modeling was used to determine rate ratios (RR) for women who had never experienced IPV. Childhood abuse was categorized as experiencing both sexual and physical abuse, sexual abuse ‘alone’, and physical abuse ‘alone’; the comparison group were women never experiencing abuse.

RESULTS:
Among the 12,507 ever pregnant participants, 21% reported postpartum depression, 7.0% reported bleeding in their 3rd trimester, 12.3% disclosed preeclampsia, 16.0% reported preterm labor, and 8.2% had gestational diabetes. CSA and CPA alone were both statistically significantly (P<.05) associated with an increased risk of 3rd trimester bleeding, preterm labor, and postpartum depression. Those experiencing both CSA and CPA were at an increased risk of all five outcomes with the highest RR of 2.05 (95% CI 1.30-3.23) for 3rd trimester bleeding and 1.95 (95% CI 1.54-2.43) for postpartum depression.

CONCLUSION:
Childhood sexual and/or physical abuse were both associated with multiple adverse perinatal outcomes. Because both forms of abuse have adverse perinatal impact, screening for such abuse and tailoring a woman’s prenatal care may improve maternal and neonatal outcomes.
Association Between Timing of Epidural Placement and Obstetric Outcome with Reference to the Start of Active Labor [26F]
Authors: Braverman Alexis , Alban Juan , Dillard Morgan , Ghelani Seema , Hajnas Natalia , Haar Charlotte ter 
Published: April 2018

INTRODUCTION:
Previous research suggests that there is no association between timing of epidural placement and mode of delivery. However, with active labor now defined as beginning at six centimeters cervical dilation, we explored if timing of epidural placement before active labor was associated with higher rates of Cesarean section. Secondary outcomes included rate of operative vaginal delivery and length of the second stage.

METHODS:
We conducted a retrospective chart review of patients who delivered at an urban, academic hospital between June 2015 and May 2016. Primiparous women delivering live-born, singleton, full-term infants were included.

RESULTS:
Of 433 women, 284 (66%) had epidurals placed prior to six centimeters cervical dilation, while the remaining 149 (34%) women had epidurals placed after six centimeters. There was no difference in the rate of Cesarean section between those who had epidurals placed prior to (15.8%, N=45) and after (13.4% N=20) six centimeters, as well as no difference in the rate of operative vaginal delivery (4.2% vs. 3.3%, respectively), [Χ2(2, N=433) = 0.701 P=0.704]. Finally, there was no difference in the mean length of the second stage of labor (mean of 88 minutes vs 80 minutes), [F(1, 356) = 0.929, P=0.336].

CONCLUSION:
Placement of epidural prior to or after the onset of active labor did not differentiate mode of delivery or length of the second stage. With further study, providers may counsel patients to make decisions on timing of epidural based on maternal comfort without fear of increased risk of primary Cesarean section.
Distractions in the Obstetric Operating Room [27F]
Authors: Curcio Erin , Baum Jonathan , Sommer Brenna , Ricciardi Camille 
Published: April 2018

INTRODUCTION:
Distractions in the operating room are common. The frequency and impact of distractions during obstetric surgery is unknown. According to JACHO and HRO, distractions are an important cause of mistakes in medicine. Persoon et al reported distractions occurred at a rate of one event every 1.8 minutes during endo urological procedures at a teaching hospital in the Netherlands. Our goal was characterize the type and frequency of distractions in obstetric surgery at our institution.

METHODS:
Obstetric surgeries were observed at a community teaching hospital in suburban New Jersey. A researcher recorded all observed distractions during cesarean sections using a study design validated by Persoon et al. Distractions were categorized by severity, based on how distracting they were to the surgeons.

RESULTS:
23 operations were observed. Mean operating time was 47 ±16minutes (range 32-78 minutes). Average distractions per case was 57±16 (range 21-85). Potentially distracting events occurred every 54 ± 23 seconds (range 29-113). There were 3 distracting events that caused one of the surgeons to stop what they were doing to engage entirely with the distracting stimuli — twice for phone calls, and once for conversation related to another patient.

CONCLUSION:
Distractions appear to be twice as common in obstetric surgery versus the rate reported during endo urologic procedures. While no obvious adverse events were observed in this small study, the frequency, characterization and impact of distractions in obstetric surgery warrant further study.
How Do Hypertension in Pregnancy Practice Guidelines Change Hypertension Management in a Single Academic Center? [28F]
Authors: Weeks Corinne M. , Wiese Sarah , Ogamba Maureen , Kasper Rebecca E. , Leung Katherine , Leftwich Heidi 
Published: April 2018

INTRODUCTION:
In November 2013, the American College of Obstetricians and Gynecologists released the “Hypertension in Pregnancy” guidelines. Hypertensive disorders are a major source of perinatal morbidity and mortality. Our objective was to assess whether these guidelines affected hypertension management at our institution.

METHODS:
We performed a secondary analysis of a retrospective cohort study on postpartum hypertension from deliveries from 07/09 to 07/16. Inclusion criteria were the presence of a documented hypertensive disorder. Exclusion criteria were discharge home on antihypertensive medication. Study variables include: gestational age at time of induction, delivery method, antihypertensive treatment, maximum systolic/diastolic blood pressures < 24 and 24-72 hours postpartum, rates of attendance to blood pressure check and postpartum visit. Chi-square test was used for categorical variables and Student T-test was used for continuous variables. “Pre-Guidelines” (7/09-10/13) and “Post-Guidelines” (2/13-7/16) were chosen to allow for policy change within our institution.

RESULTS:
470 deliveries were pre-guidelines and 237 deliveries post-guidelines. There are increased rates post-guidelines of intrapartum IV antihypertensive treatment (9.8% vs 3.2%, P<.001) and increased attendance to a postpartum blood pressure check post-guidelines (24.1% vs 15.4%, P<.01). There was no difference in all other variables studied.

CONCLUSION:
Post-guidelines, our institution noted a statistically significant increase in IV intrapartum antihypertensive therapy and postpartum blood pressure checks within two weeks of delivery. There were no statistically significant differences in the time of induction, delivery method, or antihypertensive treatments despite these guideline changes. Further research needs to be done to study the implications of these guideline changes in respect to perinatal morbidity and mortality.
Excessive Gestational Weight Gain in Women With Positive Glucose Challenge Test is Associated with Adverse Outcomes [38F]
Authors: Kumar Dipti K. , Poe Amanda , Klapholz Henry , Dangel Alissa 
Published: April 2018

INTRODUCTION:
The Institute of Medicine (IOM) guidelines currently recommends targeting gestational weight gain (GWG) according to pre-pregnancy BMI. We compared the maternal and neonatal outcomes in women with a positive glucose challenge test (GCT) who gained weight in excess of the IOM guidelines to those who were adherent.

METHODS:
A retrospective single-center cohort study including all singleton, term (>37 weeks) pregnancies with a positive GCT (>140mg/dl) delivered between 2013-2016. Patients were classified as either ‘excess’ or ‘adherent’ based on IOM GWG recommendations. Primary outcome was the rate of macrosomia (>4,000g). Secondary outcomes included rates of cesarean delivery and neonatal hypoglycemia. Baseline variables were compared using t-test or chi-square test and combined in a multivariable logistic regression model.

RESULTS:
From 456 singleton-term pregnancies, 182 patients (40%) had ‘excess’ GWG. The excess cohort were younger, more likely to be African-American and have positive screening GCT with a negative diagnostic test (71% vs 58%,p<0.01). Excess cohort had greater rate of macrosomia (15% vs 5%,p<0.01), more likely to develop pre-eclampsia (10% vs 2%,p<0.01) and undergo cesarean delivery (40% vs 32%,p=0.10). The increased risk of macrosomia (OR-3.45, 95%CI 1.7-7.5) and pre-eclampsia (OR-4.8, 95%CI 1.8-15.4) remained when adjusting for age, ethnicity, and pre-pregnancy BMI. Rates of neonatal hypoglycemia were similar in both cohorts.

CONCLUSION:
Women with a positive GCT, regardless of the diagnosis of gestational diabetes, gaining weight in excess of IOM guidelines have increased risk of macrosomia and pre-eclampsia. Focused counseling regarding appropriate weight gain should be considered in all women with a positive GCT.
Twenty-Four Hour Mifepristone Combined With Vaginal Versus Buccal Misoprostol Prior to D&E [7G]
Authors: Casey Frances Elizabeth , Wegelin Jacob , Reeves Matthew 
Published: April 2018

INTRODUCTION:
The goal of this study was to evaluate oral mifepristone twenty-four hours prior to vaginal versus buccal misoprostol as cervical preparation prior to second-trimester dilation and evacuation (D&E).

METHODS:
Women desiring abortion between gestational ages 16 weeks 0 days and 20 weeks 6 days were randomized to 200-mg mifepristone 20-24 hours and 400-mcg vaginal or 400-mcg buccal misoprostol 1-2 hours prior to D&E. Primary outcome was intraoperative procedure time defined as time of initial cervical dilation assessment to speculum out. Secondary outcomes included initial Pratt dilator accepted without resistance and participant and provider perceptions. The study was powered to detect a 4-minute difference in procedure time with 36 participants in each arm.

RESULTS:
Of 72 women enrolled, 70 were randomized and completed the study. Age, BMI, gestational age (mean 18.7 weeks, SD 1.39), and parity did not significantly differ. Total procedure times were 9.4 and 10.6 minutes in the vaginal and buccal groups, respectively, with difference of 1.2 (95% CI -1.2, 3.8). Initial Pratt dilation was 49.6 and 45.6 Fr in the vaginal and buccal groups, respectively, with difference of 4 Fr (95% CI -9.0, 1.0). Participant and provider perceptions did not differ. All 70 procedures were completed without hemorrhage, cervical laceration, or other observed complications.

CONCLUSION:
Mifepristone 24 hours prior combined with vaginal or buccal misoprostol 2 hours prior is effective as cervical preparation for D&E at 16 weeks through 20 weeks 6 days.
Assessment of Contraceptive Need and Practice of Women in the Extended Postpartum Period in Addis Ababa, Ethiopia [8G]
Authors: Asires Hailegeorgis A. , Negash Shiferaw , Getiye Yemisrach 
Published: April 2018

INTRODUCTION:
Family planning is one of the most cost effective and high yield interventions to improve health outcomes in reproductive, maternal and child health. ACCESS-family planning defines the extended postpartum period as one full year post-birth. During this extended postpartum period, 95% of women in low- and middle-income countries want to avoid pregnancy within 2 years, but 70% are not using contraception. So this study is intended to identify the needs and practices of contraception among women in the extended postpartum period.

METHODS:
Institution based cross sectional study conducted using structured questionnaire, analysed with Epi-Info 7 and SPSS 21. Data categorized and summarized with descriptive statistics, bivariate and multivariate logistic regression model used to identify important determinants.

RESULTS:
A total of 833 mothers were interviewed. Mean age at their last delivery was 27.3 +/- 4.5 years. Median number of pregnancy was two with a minimum of one and maximum of seven. Regarding reproductive intention, 45.0% of mothers want to space the next pregnancy for more than 2 years. From 92.6% of mothers who wanted to use family planning, 70.9% use modern methods giving contraceptive prevalence rate of 65.7%. Less than half ever heard about lactational amenorrhea and less than 25% knew how to use it.

CONCLUSION:
Reproductive intention, resumption of menses and sexual intercourse, knowledge, discussion with partner, post-partum visit and counseling were associated with post-partum family planning practice. Government, policy makers and Health care providers should work on Improving the knowledge on long term family planning methods and lactational amenorrhea.
Nexplanon Procedure-Related Events: Final Results From the Nexplanon Observational Risk Assessment Study (NORA) [9G]
Authors: Reed Suzanne , Koro Carol , Heinemann Klaas , Westhoff Carolyn 
Published: April 2018

INTRODUCTION:
To characterize the frequency of insertion- and removal-related events among Nexplanon users in the US during standard clinical practice.

METHODS:
This large, prospective, non-interventional cohort study followed 7,369 new users of Nexplanon recruited by US health care professionals (HCPs) between December 2011 and March 2014. Questionnaires were completed by patients at 6-month intervals (beginning on the day of insertion and ending 6 months after implant removal) and by HCPs who inserted or removed the implant. Data analysis characterized the frequency of procedure-related events.

RESULTS:
During 7,369 insertions, HCPs reported 208 events involving 189 patients (2.6% of the study population). Difficulty removing the needle protection cap was the most common event (93 insertions). In total, 49 patients (0.7% of the study population) reported an event at insertion. The most common event was pins/needles/numbness in the arm/hand/fingers (17 patients; 2.3 per 1,000 insertions; 95% CI, 1.3-3.7), which was significantly more likely in repeat/consecutive implant users (10.1 per 1,000 insertions; 95% CI, 4.6-19.0) than first-ever implant users (1.2 per 1,000 insertions; 95% CI, 0.5-2.4). Follow-up data through April 2017 show that 345 patients reported 592 events in the implant arm: pins/needles/numbness (190), severe pain (160), altered strength (65) and other events (e.g. bruising) (100). Of 3,551 removal procedures, 48 (1.4%) involved challenge(s): encasement in fibrotic tissue (26), multiple removal attempts (9), local migration (4), deep implant (4) and other challenges (e.g. fragmented implants) (10). Final study results will be available at ACOG.

CONCLUSION:
Insertion- and removal-related events involving Nexplanon are rare.
Understanding Long-Acting Reversible Contraceptive Decision-Making in the Immediate Postpartum Period [10G]
Authors: DeWitt Jacob D. , Ahmad Niloufar , Hoffman Shelley M. , Tucker Edmonds Brownsyne 
Published: April 2018

INTRODUCTION:
To qualitatively assess factors influencing pregnant women’s desire for immediate postpartum long-acting reversible contraceptives (IPP LARCs), among women who change their minds about IPP LARC administration after delivery.

METHODS:
Data were derived from a larger cohort study evaluating the fulfillment of women’s requests for progesterone-containing LARCs in the form of the Medroxyprogesterone injection, Etonogestrel implant, or progestin intrauterine device in the immediate postpartum period. The subset of participants included in this qualitative analysis were those who changed their minds regarding contraceptive choice between the time of admission and the time of postpartum discharge. Specifically, women who changed their minds and opted out of a LARC were asked the following open-ended question: “how did you come to the original decision to use Depo/Nexplanon/Mirena?” Content analysis was used to classify participant responses.

RESULTS:
Twenty-eight patients who met the aforementioned criteria were approached. Many respondents described multiple influencing factors. The most commonly endorsed consideration was duration of effectiveness (32%). The second-largest grouping (28%) consisted of respondents whose decisions were based on desirable side-effect profiles, perceived safety, and/or ease of use associated with LARCs. Other responses indicated apprehension over non-LARC birth control methods or confidence in LARCs based on personal experience.

CONCLUSION:
Among the women surveyed, the dominant motivator to initially request IPP LARC was the duration of action for these types of contraception, followed by a collection of features beyond the measure of efficacy. These factors do not appear to differ substantially from those enumerated in the literature among women who have IPP LARC methods administered.
Implementing Quality Improvement Projects to Enhance Contraception and Abortion Care Training of Providers [12G]
Authors: Kassa Munir , Hailemariam Mengistu , Obermeyer Meghan , Baruda Kefelegn , Getachew Yonas , Dessie Asnakech 
Published: April 2018

INTRODUCTION:
In Ethiopia, most medical graduates and midlevel health professionals lack the necessary competencies required to provide contraception and abortion care services. Since 2014, the Center for International Reproductive Health Training (CIRHT) has partnered with 11 teaching hospitals across the country to improve the quality of the pre-service education. The program aimed to improve the pre-service training through curriculum development, expanding hands on training and fostering a team science approach to research. This article summarizes the interventions used and outcomes identified in improving utilization and quality of care of abortion and contraception services to support the quality of training.

METHODS:
CIRHT created standards for model contraception and abortion care service clinics, known locally as “Michu” clinics. Quality improvement (QI) committees including faculty, residents, and nurses were established at all partner institutions. To identify major gaps in the quality of care of contraception and abortion services, each QI committee conducted a baseline audit. Using IHI’s Model for Improvement, each site defined their goals and measures to assess progress and intervention projects were tested using Plan-Do-Study-Act cycles.

RESULTS:
Currently, there are eight functional Michu clinics where residents, interns, and nurses are involved in service provision. In addition, all 11 teaching hospitals are now providing comprehensive contraception and abortion care services. The utilization for immediate post-partum family planning has doubled while safe first and second trimester medication abortion has become accessible to clients.

CONCLUSION:
CIRHT will focus its support on ensuring these model clinics and QI projects become part of the institutional structure of each teaching hospital.
Insights From the National Emergency Department Sample: Pelvic Inflammatory Disease, 2010-2014 [23G]
Authors: Byrd Tierra , Baker Regina , Chibber Shani , Phang Laura , Schon Samantha , Marsh Erica E. 
Published: April 2018

INTRODUCTION:
Pelvic Inflammatory Disease (PID) is associated with long-term sequelae including infertility, ectopic pregnancy, and tubo-ovarian abscess. Although the emergency department (ED) is a common healthcare entry point, the extent of its utilization is unknown. Our objectives are to estimate utilization trends, determine economic burden and investigate factors affecting admission rates of women with PID presenting to EDs in the United States.

METHODS:
A retrospective analysis using the Nationwide Emergency Department Sample was used to assess ED visits of women ≥18 years old, between 2010 and 2014 with a primary diagnosis of PID, defined by the International Classification Diagnosis, 9th version. SAS 9.4 was used to perform chi-square and Z-tests. Admission rates were assessed by age, payer information, hospital characteristics and household income. Total charges were also analyzed.

RESULTS:
PID related ED visits decreased from 118,552 to 93,965 from 2010 to 2014 (-20.74%, P<.001). Total charges increased from $3,133.54 to $4,507.24 per visit from 2010 to 2014 (P<.0001); $1.926 billion total. In 2014, admission rates increased with age; 7.91%, 11.71%, 21.28%, 37.27% and 59.78% for women ages 18-24, 25-34, 35-44, 45-54 and 55+, respectively (P<.0001). Uninsured patients had the lowest admission rate (8.98% vs Medicaid 12.57%, private 20.99%, Medicare 27.21%, P<.0001). Admissions rates were nearly double for the highest income quartile compared to the lowest (23.41% vs 12.18%, P<.0001).

CONCLUSION:
Although the number of PID related ED visits decreased from 2010 to 2014, a significant economic burden still exists. Admission rate disparities are concerning for health inequities based on insurance status and household income.