bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rapidly Absorbing Polyglactin 910 Versus Poliglecaprone 25 for Laceration Repair: A Randomized Controlled Trial [38Q]
Authors: Morrell Lindsay Helene , Glass Clark Stephanie Marie , Morrell Christopher , Carroll Ashley Woodward 
Published: May 2019

INTRODUCTION:
To evaluate rates of pain and dyspareunia after first and second degree obstetric perineal laceration repair with rapidly absorbing polyglactin 910 compared to poliglecaprone 25.

METHODS:
This is an IRB approved randomized controlled trial comparing rapidly absorbing polyglactin 910 and poliglecaprone 25 for first and second degree obstetric perineal laceration repair. The study was conducted at a single academic medical center. Subjects were enrolled and randomized at time of delivery, prior to laceration repair. Telephone surveys were conducted during the postpartum period for primary and secondary outcomes. Subjects responded using a validated 10-point pain questionnaire to assess perineal pain at six weeks. The Female Sexual Function Index (FSFI-6) was used to elicit dyspareunia at twelve weeks. Fisher exact tests were used to perform analysis.

RESULTS:
335 women were enrolled and 276 were included in final analysis. Subjects were of similar BMI, age, gravidity, parity, and laceration type. Dyspareunia did not differ between suture types (3.49±1.47 v 3.60±1.40, P=.16). Sexual desire was significantly higher in those who received rapidly absorbing polyglactin 910 (2.51±1.04 v 2.87±1.11, P=.01). Perineal pain was not different between suture types and was minimal at six weeks postpartum.

CONCLUSION:
Dyspareunia and perineal pain are not significantly different when obstetric perineal lacerations are repaired with either rapidly absorbing polyglactin 910 or poliglecaprone 25, which supports surgeon preference. Sexual desire is higher in those receiving rapidly absorbing polyglactin 910, though additional studies are needed to further characterize this finding.
Postpartum Contraception at Bridgeport Hospital [1R]
Authors: Germain Ashley St. , Onda Saki , Laifer Julie Lauren , Presnick Carole 
Published: May 2019

INTRODUCTION:
ACOG supports immediate postpartum LARC provision as a means to reduce unintended and short interval pregnancies. Immediate postpartum contraception became routinely available at Bridgeport Hospital in 2016. The aim is to determine uptake, choice, and continued use of postpartum contraception at our institution.

METHODS:
Using an EPIC-generated list of all deliveries at Bridgeport Hospital for calendar years 2015 and 2017. Institutional IRB waiver was obtained. After sorting for only clinic service deliveries we performed a systematic chart review of each patient looking at demographic data, pregnancy and delivery information, contraceptive choice antepartum and postpartum, and pregnancies within one year of delivery. Data collection for 2017 in still ongoing.

RESULTS:
In 2015 and 2017, there were 326 and 202 Bridgeport Hospital OB/GYN Clinic deliveries, respectively. The demographic characteristics were similar for both cohorts. 92% in 2015 of patients had antepartum counseling on contraception compared to 97% in 2017. In 2015, 44% desired a LARC and 59% received one. Comparatively, in 2017, 53% desired a LARC and 92% received one. Over 80% of patients returned for a postpartum visit. Among patients who had their IUD or implant removed, 75% were for side effects. The percentage of short interval pregnancies in 2015 was 12% and 13% in 2017.

CONCLUSION:
LARCs were the most often requested contraception, and antepartum counseling has improved. Our hospital policy allowing immediate postpartum LARCs led to the majority of patients receiving their desired method. Whether this has led to a reduction in short interval pregnancies requires further investigation.
Examining the Validity of a Predictive Model for Vaginal Birth After Cesarean [22P]
Authors: Wong Jennifer W.H. , Yoshino Kurt D. , Kaneakua-Pia Iolana , Chang Ann L. 
Published: May 2019

INTRODUCTION:
The validated Maternal-Fetal-Medicine Units (MFMU) vaginal birth after cesarean (VBAC) calculator, while accurate for candidates with a high predicted success rate, is not as accurate for poor candidates. We examined the validity of the calculator in an understudied multiracial cohort with a high proportion of poor candidates.

METHODS:
This retrospective cohort study examined women with 1 or 2 prior cesarean deliveries who attempted VBAC at a single institution from 2010 to 2016. Subjects were placed into quartiles based on MFMU predicted success rates. For each quartile, actual and predicted success rates were compared. The calculated area under the receiver operating characteristic curve (AUC) was compared to the original AUC.

RESULTS:
1,604 women were included. Actual and predicted VBAC rates were similar in the lowest and highest quartile groups, 18.2% vs 21.2% (n=11) and 87.1% vs 88.5% (n=1090) respectively. In the 51-75% predicted success rate group, actual VBAC rate was higher than the predicted rate, 69.9% vs 65.5% (n=394), but statistical significance was not achieved (P-value=0.07). In the 26-50% predicted success rate group, actual success rate was significantly higher than the predicted rate 55.1% vs 39.6% (p=0.002). The AUC was lower than the MFMU model, 0.72 (95% CI 0.69-0.75) vs 0.77 (95% CI 0.76-0.78) (P-value=0.0003).

CONCLUSION:
The MFMU VBAC calculator's predicted success rates were comparable to actual success rates if the predicted success rate was greater than 50%. The calculator was inaccurately low for subjects with predicted success rates of 50% or less. Caution should be taken when using the calculator in this group.
Factors Associated With the Publication of Registered Randomized Controlled Trials in Obstetrics [18K]
Authors: Wagner Stephen , Chauhan Suneet P. , Gupta Megha 
Published: May 2019

INTRODUCTION:
In an effort to improve transparency, as part of the Food and Drug Amendment Act of 2007, Congress mandated that randomized clinical trials (RCTs) be registered on clinicaltrials.gov. The aim of this review was to identify factors associated with the publication of registered RCTs on obstetrical topics.

METHODS:
Study data was collected from the National Institutes of Health (NIH) database at clinicaltrials.gov. The database was queried by NIH recommended obstetrical terms for trials with a registered start date from 2009-2013. Self-reported descriptive data of the registered studies was abstracted. PubMed was interrogated for all self-identified completed projects for publication information by September 2018.

RESULTS:
Over the five-year study period, 412 obstetrical RCTs were registered and 266 (65%) were completed. Among the completed RCTs, 166 (62%) were published in a MEDLINE indexed journal. Compared to projects without publication, projects that resulted in publication had a larger sample size (median 179 vs 97.5 P<.005), and were more likely to be multicenter studies (P <.022). There was no difference in publication rates between United States-based or international studies (P<.56). Industry-funded projects were less likely to be published than those funded by the NIH (P<.017). Studies involving drug, device or procedure interventions were more likely to result in publication (P<.014).

CONCLUSION:
About 2 in 3 completed randomized control trials on obstetrical topics are published within five-years of being completed. Interventions may be necessary to increase the completion and publication rate of registered RCTs.
Group Prenatal Care for Pre-gestational Diabetes: A Feasibility Study for a Randomized Control Trial [22K]
Authors: Addae-Konadu Kateena Lovely , Stepanek Tricia , Hackney David , Ehrenberg Stacey 
Published: May 2019

INTRODUCTION:
Group prenatal care has been shown to improve clinical outcomes, increase patient satisfaction, and reduce healthcare cost in contrast to individual prenatal care for low risk pregnancies. However, this model has not been evaluated in the high risk pregnant population. This study evaluated the feasibility of a randomized control trial (RCT) to investigate the effectiveness of group prenatal care on neonatal outcomes in a population of pregnant women with pre-gestational diabetes.

METHODS:
A prospective cohort of 68 pre-gestational diabetic women receiving prenatal care at University Hospitals were randomly assigned to either individual or group prenatal care. Group care participants met bimonthly for an integrated educational curriculum designed to deliver both prenatal and diabetes care. Sessions included self-physical assessment, education, and group discussion. Neonatal outcomes including birth weight, gestational age at delivery, NICU admission and length of stay, hypoglycemia, and RDS were compared.

RESULTS:
No significant differences were observed between women assigned to group versus individual care for rates of NICU admission 39.2% compared to 41.3%, RDS 28.6% versus 27.6%, and rates of hypoglycemia 19.3% compared to 16.2%. Similarly, no significant differences were noted between group versus individual care for mean NICU stay 3.4 days compared to 2.9 days, median gestational age at delivery 37.0 wga (IQR =35-38) versus 36.5 wga (IQR= 35.5-38), and median birth weight 3.27kg (IQR= 2.87-3.64) compared to 3.32kg (IQR=2.9-3.74]).

CONCLUSION:
A RCT comparing group versus traditional prenatal care is feasible without increasing neonatal morbidity/mortality. A larger RCT is needed to better understand the benefits of group prenatal care for pre-gestational diabetes.
How Uncertain Are Patients in Regards to Invasive Prenatal Genetic Diagnostic Testing? [25K]
Authors: Milone Gina F. , Pastore Lisa , Davis Jay , Buckley Ayisha , Persad Malini D. , Herrera Kimberly M. 
Published: May 2019

INTRODUCTION:
The purpose of this project is to determine patients' decisional certainty regarding the use of invasive prenatal genetic diagnostic testing (PGDT).

METHODS:
Cross-sectional design, IRB-approved study. Voluntary, anonymous questionnaire (Q) assessing patient decision making process in regards to invasive (CVS and/or amniocentesis) PGDT. Q (paper and online options) were distributed from 2017-2018 to those undergoing genetic testing in a university academic practice. Questions (7 items on certainty, 5-point Likert scale) were structured to evaluate patient decisional certainty, and were partly adapted from published validated Q's. Exclusion criteria: English or Spanish illiterate. Means, variances (SD), and ranges were tabulated.

RESULTS:
50 female patients returned the study; 38 (76%) completed it entirely. Patients mean age was 31.76±6.07 years and 79% were Caucasian. 75% had equal PGDT decision making with their partner. Most were referred due to a positive carrier screen, or a positive cell free DNA result. 71% of patients had already made a decision at the time of the Q. Participants expressed high certainty of their decision to do PGDT (mean 3.18 on a 1=uncertain to 5=certain scale, SD 0.79). Non-white women appeared to have greater decisional certainty than white patients (3.54 (SD 0.6) v 3.08 (SD 0.8), respectively).

CONCLUSION:
Patients are very certain in their decision-making regarding PGNT; however this may be a reflection of when they completed the survey as most did so after deciding on PGDT.
Systemic Predictors of Non-Prescription Gender Affirming Hormone Use [32K]
Authors: Stroumsa Daphna , Crissman Halley P. , Dalton Vanessa Kathleen , Richardson Caroline R. 
Published: May 2019

INTRODUCTION:
Transgender people face multiple barriers to accessing needed healthcare. Use of nonprescription hormones for gender affirmation may pose significant health risks. We aim to assess systemic factors affecting nonprescription hormone use among transgender people.

METHODS:
We used data from the United States Transgender Survey, a large convenience sample of 27,000 transgender adults in the U.S., collected between August and September of 2015. Respondents who indicated that they were currently taking gender affirming hormones and were not on active military duty were included in the study (n =12,095). Weighted multivariable logistic regression and predictive margins were used to generate odds ratios.

RESULTS:
Of 12,095 people who were using gender affirming hormones and were not on active military duty, 9.36% (n=1,000) were receiving hormones from sources other than a licensed professional, and 19.71% (n=2,536) reported denial of hormone coverage by insurance. The odds of using nonprescription hormones was higher among transfeminine respondents (OR 5.08, 95% CI 3.44-7.51, P < 0.001), Asian and multiracial-identified respondents, those who were uninsured, who had negative experiences when accessing care (OR 1.58, 95% CI 1.06-2.36, P= 0.026), and those who were denied insurance coverage (OR 2.54, 95% CI 1.64-3.94, P<0.001).

CONCLUSION:
Barriers to accessing affirming care and to coverage of treatment were associated with increased risk of non-prescription hormone use. Future research is needed to explore potential interventions to decrease non-prescription use and its potential harms, such as coverage of hormone therapy, provider trainings, and harm-reduction strategies.
The Utility of Annual Pelvic Exams in Asymptomatic Women [33K]
Authors: Byron Rhiannon K. , Watkins Virginia Y. , Stiles Alexandra , Trieu Elissa , Truong Mireille D. 
Published: May 2019

INTRODUCTION:
The annual pelvic exam has been a part of women's preventative health care for decades, yet the ACP and ACOG's recommendations regarding its necessity are inconsistent. Currently, there are little data to support the value of annual exams in asymptomatic, non-pregnant individuals. This study was performed to determine the utility of the pelvic exam in this population.

METHODS:
This was a retrospective cohort study of patients seen for annual gynecologic exam at an urban academic hospital performed between June 2015 and 2016. Data collected included chief complaint, history, exam findings, work-up, diagnosis, and treatment. Descriptive statistics were calculated for demographic characteristics, and frequencies were calculated for findings of interest. Pearson chi-square analyses were conducted for comparisons.

RESULTS:
Of 1,118 annual pelvic exams, a significant difference was found between the number of abnormal exam findings in symptomatic women (41.4%) and in asymptomatic women (13.2%) (P<.0001). Within the asymptomatic population alone, the diagnostic sensitivity of the exam was 77.2% with specificity of 94.9%. The majority of false negatives were associated with abnormal Pap findings given otherwise normal exams. The exam was diagnostic in 20.1% of asymptomatic cases with greater than 13% requiring treatment based on its findings. The majority of the diagnoses, however, included cervical dysplasia, infection, and atrophy.

CONCLUSION:
In this study, the annual pelvic exam detected fewer abnormalities in asymptomatic patients than in those who presented with gynecologic symptoms. Its utility at the time of annual visit should be discussed with patients individually and may be unnecessary if a patient is asymptomatic.
Implementing Same-Day Discharge After Hysterectomy Within a Large, Multi-Hospital Healthcare System [1L]
Authors: Linkov Faina , Edwards Robert P. , Shalkar Adambekov , Harris John , Mansuria Suketu M. 
Published: May 2019

INTRODUCTION:
Same day discharge (SDD) for minimally invasive hysterectomies (MIH) often promises to save healthcare resources and improve satisfaction among patients and providers. Previous studies established the safety of SDD, however data are limited on how to effectively integrate SDD programs in heterogeneous healthcare systems consisting of tertiary care centers and smaller community hospitals. The goal of this work is to describe the implementation of a SDD process within UPMC--a large, multi-hospital health system in Pennsylvania.

METHODS:
Implementation of SDD was studied through stakeholder interviews including surgeons, nurses, and administrators. Participants were asked about the development and implementation of the SDD program including facilitator and barrier factors at 20 hospital of various sizes, with sub-specialists as well as general gynecologists. To determine the best course for integrating SDD, small multidisciplinary working groups were established with representatives from relevant departments. University of Pittsburgh IRB approved this work.

RESULTS:
System development of the program included formation of evidence based guidelines, development of protocols, hiring of a nurse concierge, quality checks, SDD pathway introduction into EMR, surgeon performance dashboards, incentives for following the pathway, etc. The program was piloted by a small group of surgeons, followed by integration within the wider UPMC community. Provider buy-in was encouraged through surgeon education and the use of outcomes data. SDD program resulted in considerable reduction in overnight stays associated with hysterectomies.

CONCLUSION:
It is safe and feasible to implementing a SDD program for MIH within a heterogeneous health care system through a multi-step process of providing processes, systems, and education.
Length of Hospital Stay and Costs Associated With Laparoscopic Versus Vaginal Hysterectomy: Study of 1,553 Patients [4L]
Authors: Elsamadicy Emad A. , Mehta Sumit , Le Chi , Brown Kelsei , Lee Jaclyn 
Published: May 2019

INTRODUCTION:
The aim of this study was to assess whether there was a difference in length of hospital stay (LOS) and total hospital costs associated with Total Laparoscopic Hysterectomy (TLH) versus Total Vaginal Hysterectomy (TVH) for benign indications.

METHODS:
Medical records of 1,553 adult women undergoing elective TLH or TVH at a major academic institution from 2010 to 2015 were reviewed. CPT codes used for TLH included [58570-58573] and for TVH included [58260-58263, 58270, 58290-58294]. Patient demographics, LOS and total hospital cost associated with hospitalization for hysterectomy were collected.

RESULTS:
Of the 1,553 patients, 988 (63.6%) underwent TLH and 565 (36.4%) underwent TVH (TLH: n=988 vs. TVH: n=565). There was significant differences in Age, with TVH cohort being older (TLH: 44.9±10.3 years vs. TVH: 53.1±13.1 years, P<.0001). The majority of patients were White, with greater proportion in TVH cohort (TLH: 77.9% vs. TVH: 86.0%, P<.0001). There were significant differences in insurance status, with TLH cohort having greater proportion of patients with Commercial/Private (31.7% vs. 23.4%, P=.0005), BlueCross/BlueShield (34.1% vs. 32.2%, P=0.446), Medicaid (14.8% vs. 11.0%, P=.034), and lesser proportion with Medicare (11.0% vs. 26.0%, P<.0001). LOS was significantly greater for TVH cohort (TLH: 1.15±0.89 days vs. TVH: 1.47±0.87 days, P<0.0001). However, TLH cohort had significantly greater mean hospital costs of approximately $10,000 compared to TVH cohort (TLH: $40,518±16,243 vs. TVH: $30,295±12,201, P<.0001).

CONCLUSION:
Our study suggests that there are significant differences in LOS and total hospital costs associated with TVH and TLH, respectively. Further studies are necessary to optimize surgical decision making for hysterectomy.
Management of Pyomyoma After Embolization of Large, Submucosal Fibroid With Emergent Vaginal Myomectomy [5L]
Authors: McKendrick Rebecca , Garneau Audrey , Hoffman Mark , Raissi Driss 
Published: May 2019

INTRODUCTION:
Pyomyoma is a rare complication after uterine fibroid embolization.

METHODS:
We present a case of a 27 year old nulligravid patient who underwent uterine fibroid embolization for symptomatic uterine fibroids and subsequently developed a pyomyoma. Patient consent was obtained for submission of case report.

RESULTS:
She had a complex medical and surgical history, including osteosarcoma as a child and two previous open myomectomies for large fibroids. The second myomectomy was complicated by a pulmonary embolization during her postoperative hospitalization. Another large, 10.6 cm posterior uterine fibroid with a submucosal component was found three years after her second myomectomy. She was counseled about alternatives to myomectomy and hysterectomy, and she elected for uterine fibroid embolization. Forty-one days after an uncomplicated procedure, she presented to the emergency room with a two day history of abdominal pain, fever, and vaginal discharge. She appeared ill and diaphoretic, with a heart rate in the 130's and a leukocytosis of 31 k/uL. Imaging at that time revealed a mass containing air concerning for pyomyoma with endomyometritis. Exam under anesthesia revealed a soft, gray mass, prolapsing from her dilated cervix. She was treated with transvaginal myomectomy and intravenous antibiotics. She did well postoperatively and four months later has not required additional treatment.

CONCLUSION:
Though definitive management of a pyomyoma is hysterectomy, our patient was successfully managed conservatively with vaginal myomectomy and intravenous antibiotics. Of the six reported pyomyomas after uterine fibroid embolization, hysterectomy was performed in four cases, laparoscopic drainage in one case, and one case did not report therapy.
Optimizing Clinical Status and Quality of Life With Iron Dextran in Gynecologic Patients With Iron Deficiency Anemia [8L]
Authors: Shukr Ghadear , Saeed Haleema , Girgis Marian , Basu Aparna , Kuriakose Phillip , Sangha Roopina 
Published: May 2019

INTRODUCTION:
To assess improvement in quality of life (QoL) in women with iron deficiency anemia secondary to chronic blood loss from benign gynecological conditions. To concurrently assess clinical improvement in hematologic indices.

METHODS:
An IRB approved prospective observational and survey study of women in an urban-based healthcare system with hemoglobin (Hgb) <12 g/dL who were poor candidates for oral iron supplementation. These women received iron dextran and Health-related quality of life (HRQOL) survey and had labs drawn at treatment, 30-days and 90-days post-infusion.

RESULTS:
Clinical improvement was assessed with Ferritin, Iron profile, Retic count, Hemoglobin and Hematocrit. The questionnaire assessed quality of life with two categories 1) physical health score and 2) mental health score. 23 patients completed the baseline questionnaire and labs. 13 patients completed the 30-day questionnaire, 7 of which completed the labs. Eight completed the survey and labs at 90-days. At baseline, average physical health T-score was 41, mental health T-score of 44, hgb 9.0 g/dL, ferritin 8.47 ng/mL, iron 35 µg/dL and TIBC of 481 mcg/dL. At 30 days, average physical health T-score was 43, mental health T-score of 45, hgb 11.6 g/dL, ferritin 162 ng/mL, iron 76 µg/dL and TIBC 285 mcg/dL. At 90-days, the average physical health T-score was 43, mental health T-score of 42, hgb 12.2 g/dL, ferritin 72 ng/mL, iron 76 µg/dL and TIBC 323 mcg/dL.

CONCLUSION:
Our study portrays the efficacy of iron dextran in improving hematologic indices without significant change in patient's QoL, including physical and mental health. Nonetheless, intravenous iron may be a good option for patients who are not candidates for oral iron supplementation.