bluuebunny/crossref_metadata_2025_split huggingface dataset:
Call the Midwife: Fortifying Collaborative Relationships through Simulation [18O]
Authors: Lee Mabel , Bazella Corinne 
Published: April 2018

INTRODUCTION:
Few studies have evaluated the impact of inter-professional education or simulation based programs in obstetric care; fewer have investigated inter-professional simulation. A study showed that inter-professional-simulation programs may be beneficial in undergraduate medical education, but it is unclear whether such training impacts the transition from undergraduate to graduate medical education, and if there is knowledge retention from simulations.

METHODS:
We developed a paging simulation, as part of our Ob/Gyn Bootcamp, for medical (n=6) and midwifery (n=5) students to assess the ACGME milestones and core competencies for inter-professional collaborative practice. Participants completed pre- and post-surveys using Likert scales to self-report changes in attitudes towards inter-professional collaboration and readiness for residency, and medical students again performed this survey 3 months into residency.

RESULTS:
Medical students felt more confident differentiating between emergent and non-emergent situations, more able to assess patients over the phone, more comfortable working with midwives, and reported increased knowledge of Ob/Gyn after the simulation (p<0.05). In the follow up survey in residency, participants reported a significant impact (mean 4.6) in their skills and confidence in these situations as a result of the simulation. Midwifery students had a more positive perception of working with medical students and physicians and felt less intimidated.

CONCLUSION:
Inter-professional simulation based activity increases a students’ confidence in evaluating clinical situations, knowledge in OB/Gyn, preparation for residency, and comfort in inter-professional collaboration. The positive impact continues as students transition into residency. Inter-professional-simulation based programs are beneficial to students and larger studies should be performed to ensure this positive impact.
Preeclampsia with Severe Features-Assessing the Impact of Headache and Visual Disturbances [25O]
Authors: Kia Farnaaz , Rincon Monica , Beeraka Sridivya Spurthi , Burwick Richard M. 
Published: April 2018

INTRODUCTION:
In pregnant women with hypertension, the presence of headache or visual symptoms may prompt early delivery due to concern for preeclampsia (PE) and eclampsia. We evaluated subjects with preeclampsia with severe features (PE-SF) to assess the impact of these symptoms on maternal and neonatal outcomes.

METHODS:
Retrospective cohort study of subjects with PE-SF, ≥23 weeks gestation at a single institution (October 2013-May 2017). Subjects were identified by ICD-9 and ICD-10 codes, with charts reviewed for diagnostic accuracy. Symptoms like headache and visual disturbances were determined by physician documentation. We compared outcomes in three groups: 1. No headache or visual disturbances; 2. Severe headache only; 3. Severe headache and visual disturbances. Significance determined by chi-square or t-test.

RESULTS:
Among 8,645 deliveries, 318 women (3.7%) delivered with PE-SF; 192 (60.4%) had no headache or visual disturbances, 68 (21.4%) severe headache only, and 39 (12.3%) both headache and visual disturbances. Maternal admission to the intensive care unit, pulmonary edema, kidney injury, or hemolysis, elevated liver enzymes, low platelet count syndrome, were no different between groups. However, those with both headache and visual disturbances had increased risk of eclampsia, p=0.016. Those with headache were delivered earlier (p<0.0001), more likely to have neonates born preterm (p=0.007) or admitted to the Neonatal Intensive Care Unit (NICU), p=0.02.

CONCLUSION:
We find that headache and visual disturbances contribute disproportionately to preterm delivery and NICU admission rates in PE-SF. However, the increased risk of eclampsia in this setting suggests that such action is justifiable.
Culture Change and Decreased Cesarean Rate Through Implementing C.A.L.M. [35O]
Authors: Wahl Geneva , Gallagher Kristen , Lombard Emily , Takhsh Eden 
Published: April 2018

INTRODUCTION:
In 2015, by putting the ACOG Consensus into practice, our institution was able to reduce our nulliparous, term, singleton, vertex (NTSV) cesarean rate by 5%. Our numbers then plateaued throughout 2016. In a continued effort to reduce the rate of cesarean sections amongst NTSV patients, we have instituted a multidisciplinary committee within our community hospital setting to help create a Consistent Approach to Labor Management (CALM). At the start of this project, our NTSV cesarean rate was 31.6%. Our benchmark goal was set at less than 24%.

METHODS:
The NTSV committee established four work groups with inspiration from the California Maternal Quality Care Collaborative (CMQCC) initiatives that included latent labor interventions, comfort measures for labor, second stage interventions, and ambulation in labor. Each work group focused on identifying variables that have an impact on the rates of cesarean section. An NTSV Fair was held to educate all staff and physicians. NTSV numbers were tracked and shared with all physicians in an unblinded, quarterly basis.

RESULTS:
Over an eight-month period we have been able to reduce our NTSV cesarean rate from 31.6% to 24.4%.

CONCLUSION:
The Consistent Approach to Labor Management (CALM) Project has helped us to nearly reach our benchmark goal for NTSV cesarean rates. Our NTSV committee will continue to educate our staff and physicians as we strive to change the overall culture towards supporting vaginal deliveries.
Nitrous Oxide in Labor: Predictors of Use and Conversion to Epidural Anesthesia [20P]
Authors: Brumley Jessica , Obican Sarah , Kendle Anthony , Louis Judette 
Published: April 2018

INTRODUCTION:
We evaluated factors associated with conversion from nitrous oxide (NO2) to epidural anesthesia in laboring women.

METHODS:
We conducted a retrospective cohort study including women who delivered at an academic tertiary center during 1/1/2015-6/30/2017. Women with planned Cesarean delivery or with multiple gestations were excluded. At this center, self-administered NO2, intravenous opioids and epidural anesthesia are routinely offered. Electronic databases and medical charts were reviewed. Characteristics of women were compared using χ2, students T-test and Mann Whitney U test and logistic regression. P < 0.05 was considered significant.

RESULTS:
Among 13,615 women admitted for trial of labor, 16.9% (n=2, 265) used NO2 for labor analgesia. NO2 use increased annually 16.2%, 16.8% and 18%, p=.02 from 2015-2017. Women who used NO2 were more likely to be Caucasian, nulliparous, commercially insured, and have induced labor. The NO2 group was more likely to have maternal comorbid conditions or fetal indication for delivery, and these factors were predictive of conversion to epidural anesthesia. Women using NO2 were less likely to have a subsequent epidural placement, undergo a Cesarean delivery or have a NICU admission. Women were more likely to convert from NO2 to epidural anesthesia if they were Black, of Middle Eastern descent, Hispanic, obese, or nulliparous. Labor induction and augmentation were not predictive of conversion to neuraxial anesthesia.

CONCLUSION:
Use of NO2 in this ethnically diverse cohort was not associated with morbidity. These predictors of residual need for epidural anesthesia can assist in counseling patients prior to delivery.
Initial Body Weight Gain as a Screening Tool to Adverse Pregnancy Outcome [23P]
Authors: Lozovyy Violetta , Magruder Jordan , King Jade , Singh Shailini 
Published: April 2018

INTRODUCTION:
Pregnancy weight gain is known to increase the risk of gestational diabetes and preeclampsia which can lead to preterm delivery. Inter-pregnancy weight retention worsens this risk. We have identified percent of initial body weight (IBW) gain that has relationship to maternal hyperglycemia and is lower than diagnostic of GDM criteria leading to adverse neonatal outcome.

METHODS:
227 mothers who had a delivery from June 2014 to July 2015 requiring entry into the neonatal hypoglycemia (NH) protocol for 24 hour monitoring after birth. Patients were excluded if collection of initial maternal weight was after 16 weeks GA as waiting any longer would be unreliable to approximate pre-gestational weight. Chi-square and t-tests were used to compare outcomes.

RESULTS:
Mothers with an initial BMI ≥25 who gained at least 15.3% ± 0.8% p=0.05 of their initial body weight throughout the pregnancy had normal GCT on initial screening. Additionally, there was a significant inverse correlation between weight gained during pregnancy and abnormal GCT.

CONCLUSION:
Early screening and intervention using 16±0.8% weight gain from initial maternal body weight could serve as a risk stratification tool along with glucose challenge (GCT) parameters. These women can be stratified early in the pregnancy course as having an increased risk for developing glucose intolerance and possibly neonatal hypoglycemia. Our findings suggest that overweight women are able to accommodate for greater changes in weight without affecting the GCT screening parameters, however not enough to prevent clinically significant neonatal hypoglycemia, therefore should be additionally subjected to glucose tolerance testing (GTT).
Fetal Gastric Area Ratio as a Predictor of Neonatal Abstinence Syndrome Treatment [26P]
Authors: Townsel Courtney , Stone Julie , DeBolt Chelsea , Ditommaso Nicole , Hussain Naveed , Campbell Winston 
Published: April 2018

INTRODUCTION:
Opioid use in pregnancy doubled between 1998 and 2011. Neonatal abstinence syndrome (NAS) occurs in newborns exposed to opioids in-utero. Opioids delay gastric emptying and inhibit gastric motility in adults, however, it is unknown if opioids affect the fetal gastrointestinal system. We assessed whether gastric size in opioid-exposed fetuses predicts NAS treatment.

METHODS:
We undertook a retrospective cohort study of maternal-neonatal dyads with chronic opioid use who delivered at our tertiary hospital January 2005 to April 2017. Primary outcome: treatment for NAS (3 consecutive Finnegan scores >8 or 3 scores >24 within 96 hours of life). Medical records were reviewed for maternal and neonatal demographics and fetal ultrasound images. Fetal gastric size was measured from abdominal circumference images using major and minor axis calculating an ellipse comparing this to the abdominal circumference to derive the gastric area ratio (GAR). Analysis was two-sided (alpha of 0.05) by t-test for continuous and chi square for categorical variables.

RESULTS:
We identified 49 maternal-neonatal dyads. NAS treatment occurred in 67% (n=33) of neonates. Neonatal length of stay was longer [26.9 (days) ± 13.7 vs 8.2 ± 7.7, p<0.001] and mean peak Finnegan scores were higher in infants treated for NAS (12 ± 3 vs 5 ± 3, p<0.001). GAR was not different between groups [2.91 ± 1.5 (treatment) vs 2.85 ± 1.6 (no treatment), p=0.90] and did not predict NAS treatment.

CONCLUSION:
Fetal GAR does not predict NAS treatment. More studies are needed to determine if an ultrasound marker predictive of NAS treatment exists.
The Utility of Transvaginal Cervical Length in Predicting Delivery Interval in Viable Outpatient Twin Pregnancies [27P]
Authors: Dubin Ariel , Lin Carol , Lyon Liisa 
Published: April 2018

INTRODUCTION:
Predicting preterm delivery in twin gestations helps identify women who may benefit from interventions such as antenatal corticosteroids within 7 days of delivery. Our aim was to quantify the performance of short cervical length (CL) (<25mm) in outpatient twin gestations to predict delivery within 7 days.

METHODS:
Outpatient transvaginal ultrasound reports for diamniotic twin gestations of 23w 0d to 28w 6sd were reviewed between January 2010-July 2014. Index CL was defined as the first CL less than 25mm. Primary outcome was the positive predictive value (PPV) of spontaneous delivery within 7 days of index CL. Secondary outcomes included PPV of index CL of 15mm and 10mm.

RESULTS:
Of the 411 included charts, 52 patients (12.6%) had a short cervix. There were no significant differences in major risk factors for preterm birth. Four women (1% of the total study population) delivered within 7 days of index CL; three of these had a short cervix while one had a normal CL. PPV of 25mm CL was 5.8% (95% CI 1.2-16.0); NPV 99.7% (95% CI 98.5- >99.9). The PPV of 15mm and 10mm CL were 9.1% (95% CI 1.1-29.2) and 20.0% (95% CI 7.5-55.6).

CONCLUSION:
In this retrospective observational study, CL of less than 25mm had a poor positive predictive value for delivery within 7 days. 25mm CL cutoff may not be useful to time interventions such as betamethasone administration or hospitalization. PPV increases with decreasing CL. Other tools can be considered in addition to CL measurement for intervention.
Amniotic Fluid Index Curves in the Obese Gravida: One Size Fits All? [36P]
Authors: Chishom Taylor , Stephens Angela , Raley Susanna , Street Linda , Browne Paul 
Published: April 2018

INTRODUCTION:
The purpose of this study was to evaluate whether amniotic fluid index (AFI) curves differed based on maternal body mass index (BMI) category.

METHODS:
This was a retrospective cohort study of 500 pregnant women receiving ultrasounds with AFI measurements. The study cohort was subdivided by maternal intake BMI into three groups: normal weight (18.5-24.9), overweight (25.0-29.9) and obese (>30). Demographic and outcome data were evaluated with chi square for dichotomous variables and ANOVA or Kruskal-Wallis on continuous variables as appropriate. Linear regression was used to evaluate AFI over gestation in each group and analysis of covariance was used to evaluate AFI over gestation between groups.

RESULTS:
There was no correlation between AFI and gestational age in each group (normal weight (R=.055), overweight (R=.161), obese (R=.018) or as an aggregate (R=.06)). However, there was a difference in AFI over gestation between groups (F (2,1740) = 9.96, P<.001). Both, pre-existing diabetes (P=.002) and chronic hypertension (P<.001), were more prevalent in obese gravida. Obese gravida were more likely to develop gestational diabetes (P<.001). Development of pregnancy hypertensive disorders did not vary between BMI groups (P=.145). Mean gestational age of delivery was similar between groups (P=.266); however, infant birth-weight increased with increasing maternal intake BMI (P=.040).

CONCLUSION:
In this cohort, there is a difference in AFI based on maternal BMI when accounting for gestational age. While the absolute difference in our cohort was small, this finding suggests we should evaluate this question on a larger scale and potentially re-visit a “one size fits all” approach to AFI.
CINE MRI During Spontaneous Cramps in Women with Menstrual Pain [7Q]
Authors: Kuhn Caroline , Hellman Kevin , Tu Frank 
Published: April 2018

INTRODUCTION:
Prior research has suggested that changes in the MR signal occur in the myometrial layer in women with dysmenorrhea. Since the mechanisms of dysmenorrhea are poorly understood, characterization of the relationship between MR signal changes and spontaneous pain report would be useful for developing a diagnostic tool.

METHODS:
This was an IRB-approved HIPAA-compliant prospective feasibility study during 2015-2017 on 16 women with dysmenorrhea and 10 healthy controls both on and off their menses while not taking analgesic medication. Continuous MRI was acquired using single HASTE sequence along with simultaneous reporting of pain severity with a squeeze bulb. The temporal relationships of signal changes were evaluated with Pearson correlations, image averaging, and statistical comparison to a random temporal distribution.

RESULTS:
Spontaneous progressive decreases in myometrial signal intensity were more frequently observed in women on their menses than in the same women off their menses or participants without dysmenorrhea (p’s < 0.01). Women without reductions in myometrial signal intensity on their menses either had a history of endometriosis or were not in pain. Episodes of cramping occurred either immediately before or 32-70s after myometrial signal change onset (p’s <0.05).

CONCLUSION:
The combination of early and delayed subjective pain report - relative to a decrease in T2 weighted signal intensity – provides new evidence supportive of a contribution of myometrial activity and impaired hemodynamics to menstrual pain. The proposed approach will allow future studies to evaluate effects of interventions for uterine pain disorders and test mechanistic hypotheses about the etiology of visceral pain.
Patient Satisfaction with Single-Port vs Multi-Port Minimally Invasive Hysterectomies [16Q]
Authors: Perlin Lauren , Fisher Jay 
Published: April 2018

INTRODUCTION:
Robotic surgery offers benefits such as shorter recovery time, shorter hospital stays, and decreased post-operative pain. Single-port robotic-assisted laparoscopy, which requires only a single incision, may offer further benefits.

METHODS:
Patient satisfaction was compared between those undergoing laparoscopic single-port vs multi-port hysterectomies. Patients received surveys on post-operative day 0 or 1, and at their two-week and six-week post-operative visits.

RESULTS:
Data analysis included survey responses from 29 patients of which 13 (44.8%) were in the single-port group and 16 (55.2%) were in the multi-port group. Patients who underwent single-port surgery had lower pain scores during their hospital stay (current pain 2/10 versus 5/10, P=.001, and maximum pain 5/10 versus 7/10, P=.008). They also had significantly lower estimated blood loss (65 mL versus 107 mL, P=.035) and shorter length of hospital stay (100% versus 87.5% discharged by POD#1, P=.01). Operative times did not differ between the two groups (176 minutes versus 171 minutes, P=.13). At two weeks and six weeks post-operatively, satisfaction scores were similar between the two groups with a trend towards improved satisfaction with incision appearance at six weeks (100% vs 61.5% completely satisfied, P=.13).

CONCLUSION:
Patients are more satisfied immediately after undergoing laparoscopic single-port hysterectomies as compared to multi-port hysterectomies. Patients experience significantly less pain while in the hospital. Additionally, estimated blood loss is decreased by 39% and patients are more likely to be discharged on the same day as their operation. The differences in satisfaction do not persist at patients’ two-week and six-week post-operative visits.
Is There a “July Effect” in Oncologic and Benign Gynecologic Surgery? [17Q]
Authors: Mastroyannis Spyridon A. , Buckingham Lindsey , Brensinger Colleen , Latif Nawar , Haggerty Ashley , Ko Emily 
Published: April 2018

INTRODUCTION:
The “July Effect” is a phenomenon previously described as increased complication rates during times of trainee transition. This study aimed to evaluate the effect of academic quarter on perioperative outcomes for gynecologic surgery patients.

METHODS:
Patients who underwent gynecologic surgery with trainee involvement were identified in the National Surgery Quality Improvement Program (NSQIP) database between July 1, 2006 and June 30, 2012. Benign and oncologic cases were collected. Academic quarters of the year were defined as Q1: Jul-Sep, Q2: Oct-Dec, Q3: Jan-Mar and Q4: Apr-Jun. Major complications included surgical site infection (SSI), myocardial infarction, pulmonary embolism, stroke, deep vein thrombosis (DVT), and re-intubation. Kruskal-Wallis and Chi square tests were performed. Two-sided alpha with p<0.05 was designated as significant.

RESULTS:
Of 104,012 gynecologic surgeries, 25,290 (21,086 benign; 4204 oncologic) had confirmed resident involvement. In benign cases, re-operation rate was highest in Q1 vs Q2-4 (1.8% vs 1.1-1.6%; P=0.043); length of stay (LOS) in days was also increased in Q1 (2.0 vs 1.6-1.8, p=0.0149). In Q3, higher rates of organ space SSI and emergent cases were observed: (1.0% vs 0.5-0.6%, P=0.0197 and 4.3% vs 3.4-3.9%, p=0.0321 respectively). For oncology patients, only LOS was increased for Q1 (4.8 vs 3.8-4.1, p<0.0001).

CONCLUSION:
In this national sample, first academic quarter was associated with increased LOS and re-operation, but not overall severe complication rate in benign gynecologic surgeries. In oncology, LOS was increased, but overall complications, re-operation and readmissions were not. The “July Effect” did not hold true for gynecologic surgery with trainee involvement.
Association Between Uterine Fibroid Findings on Pelvic MRI, Bleeding Symptoms, and Quality of Life [19Q]
Authors: Shaffer Robyn K. , Fast Angela M. , Vu Kim-Nhiem , Dobberfuhl Amy D. , Ghanouni Pejman , Chen Bertha 
Published: April 2018

INTRODUCTION:
Uterine fibroids are a common cause of abnormal uterine bleeding with diminished quality of life (QOL). Prior studies rely on sonography which can be inaccurate in evaluating fibroid size and location, especially in large fibroids. We sought to correlate uterine fibroid symptoms with fibroid characteristics using MRI imaging.

METHODS:
A retrospective chart review was conducted for patients seen at the Stanford Fibroid Clinic. Patient demographics, medical history and pelvic MRI data were collected on 60 patients with completed Uterine Fibroid Symptom (UFS) and Health Related-Quality of Life (HR-QOL) surveys. Primary outcomes included UFS and HR-QOL scaled scores and sub-scores.

RESULTS:
Patients with anemia had significantly worse UFS (mean 73.0 vs 43.4, P=.006) and HR-QOL scores (mean 34.6 vs 61.1, P=.006). Post-menopausal patients had significantly better HR-QOL scores (mean 74.5 vs 49.9, P=.034). The dominant fibroid volume was significantly smaller in women with worse UFS symptoms (UFS>75) (mean 99.5 vs 247.1 mL, P=.015) compared to women with few UFS symptoms (UFS<25). Worse symptoms tended to be seen when fibroids were located in the fundus vs body (mean UFS 58.5 vs 37.7, P=.059) or if fibroids were submucosal or intracavitary compared to intramural or subserosal (mean UFS 78.1 vs 46.9, P=.076).

CONCLUSION:
Abnormal uterine bleeding in conjunction with anemia contributed more significantly to symptom severity and QOL than fibroid size. UFS was inversely related to fibroid volume, suggesting fibroids that cause bleeding have a disproportionate impact on symptom severity independent of size.