bluuebunny/crossref_metadata_2025_split huggingface dataset:
DONALD F. RICHARDSON PRIZE PAPEREvaluating the Use of Handheld Point-Of-Care Ultrasound Testing for Gynecologic Pathology: A Pilot Study for Use in Low Resource Settings [07OP]
Authors: Toscano Marika , Szlachetka Kam , Whaley Natalie , Thornburg Loralei Lacina 
Published: May 2019

INTRODUCTION:
Point of care ultrasound (POC-US) is clinician-performed ultrasound at the bedside with direct interpretation. POC-US allows increased access in low resource settings (LRS). We investigated whether POC-US can identify and triage gynecologic (GYN) pathology in a LRS.

METHODS:
Validation of POCUS for GYN pathology performed in high resource setting as a prospective, blinded, cross-over study of 60 subjects. 20 subjects underwent POC-US with 3 test units (GE Vscan (US-V), Sonosite Iviz (US-I), Philips Lumify (US-L)) followed by reference diagnostic ultrasound (DxUS). Images scored blindly by two sonographers for quality and correlation; quantitative measurements compared. 40 subjects underwent POC-US with highest scoring device and reference DxUS. Concordance assessed by Cohen’s kappa and accuracy by Pearson’s and Bland-Altman plot. In a LRS, 20 subjects with GYN complaints underwent POC-US at a mobile clinic in North Haiti with intent to triage for referral.

RESULTS:
US-V was inferior in image quality and correlation. US-L and US-I were equivalent; US-L selected for further validation. No statistically significant differences in US-L measurements of endometrium, uterus, ovaries, adnexal pathology, or leiomyomata (P<0.02 for all) with excellent concordance (Kappa >0.7 for pathology). Sensitivity/specificity of detecting pathology 80-100%. In a LRS, POC-US was acceptable to providers/patients and utilized successfully to visualize GYN structures. No subjects were triaged for referral based on POC-US.

CONCLUSION:
Clinician-performed POC-US has high diagnostic accuracy, sensitivity/specificity for basic GYN anatomy and pathology. POC-US was an acceptable and feasible instrument in LRS, but future studies are needed to prove that POC-US improves GYN outcomes in LRS.
Evaluation of a Community-Based Intervention on Postpartum Contraceptive Utilization in Rural Nepal [12OP]
Authors: Wu Wan-Ju , Maru Sheela 
Published: May 2019

INTRODUCTION:
Unmet need for postpartum contraception in rural Nepal remains high. Strategies that integrate contraceptive counseling along the continuum of reproductive health care are more effective than isolated counseling sessions. One program is utilizing a system of Community Health Workers (CHWs) to provide integrated reproductive, maternal, newborn, and child health care. Structured contraceptive counseling is delivered at antenatal and postnatal home visits and data collected via a mobile phone application.

METHODS:
A mixed methods approach was used to evaluate the effect of the intervention on postpartum contraceptive uptake. We compared the odds of modern contraceptive uptake among recently postpartum women in the pre-intervention and intervention groups using multivariate logistic regression. Eleven individual interviews were conducted with staff and participants to understand the implementation process and mechanisms of behavior change.

RESULTS:
There were 445 postpartum women in the pre-intervention group and 510 in the intervention group. Modern contraceptive use increased from 29.4% pre-intervention to 46.1% in the intervention group. Women in the intervention group had twice the odds of using a modern contraceptive method as compared to the pre-intervention group (OR=2.05, P<.0001). Salient themes noted in the interviews include overall positive perceptions of the intervention and emphasis on the need to involve family members as they play a critical role in women's contraceptive decision-making.

CONCLUSION:
An integrated community-based structured contraceptive counseling intervention delivered by professionalized CHWs in the home in rural Nepal appears to be effective in increasing use of modern contraceptive methods. The intervention is being to scaled to other similar settings in Nepal.
Prevalence and Determinants of Maternal and Perinatal Outcome of Preeclampsia at a Teaching Hospital in Ethiopia [3T]
Authors: Yeman Awol , Zelelow Yibrah Berhe , Ahmed Sumeya , Teka Hale , Goba Gelila 
Published: May 2019

INTRODUCTION:
Preeclampsia is a common pregnancy disorder with potential adverse maternal and neonatal outcome. Ayder Referral Hospital (ARH), a tertiary hospital in northern Ethiopia where most preeclamptic patients are treated. This study aimed to assess the prevalence and determinants of maternal and perinatal outcome of preeclampsia at ARH.

METHODS:
Our study was a retrospective chart review of preeclamptic patients treated at ARH between September 1, 2016 and September 30, 2018. This study was approved by IRB.

RESULTS:
Over the study period, the total number of deliveries recorded was 8,502. There were 362 patients with preeclampsia. Most (77.3%) patients had preeclampsia with severity features. Poor maternal outcome was present in 40% of cases while 25% of cases had poor perinatal outcome. The top three poor maternal outcomes reported in this study were, eclampsia (6.6%), maternal death (2.8%), and renal failure (1.1%). Headache (AOR 32.26 95% CI 0.003-0.326 P=.004) and low hemoglobin value (AOR 3.44 95% CI 1.772-6.761 P=.005) were associated with poor maternal outcome. The poor perinatal outcomes were low APGAR score (18.8%), still births (5.8%), and early neonatal deaths (1.1%). Earlier gestational age at diagnosis (AOR 3.19 95% CI 1.762-5.766 P=.0001) was associated with poor perinatal outcome.

CONCLUSION:
Preeclampsia is a significant problem in Ethiopia. In a resource limited setting where tools are scarce, clinical profile should be taken into consideration for prediction of poor outcome. Owing to the association found in between maternal outcome and hemoglobin, further prospective research is required to identify if anemia was the cause or effect of preeclampsia.
Interpersonal Trauma: An Under-Recognized Risk Factor for Urinary Tract Dysfunction in Midlife and Older Women [16T]
Authors: Boyd Brittni , Gibson Carolyn , Van Den Eeden Stephen , McCaw Brigid , Subak Leslee , Huang Alison 
Published: May 2019

INTRODUCTION:
Interpersonal trauma has the potential to contribute to genitourinary dysfunction in women, but few studies have examined whether emotional, physical, or sexual abuse are associated with urinary tract symptoms.

METHODS:
We analyzed data from a multiethnic cohort of women aged 40-80 years enrolled in a large integrated healthcare system in California. Lifetime history of traumatic exposures, current post-traumatic stress disorder (PTSD) symptoms, and current urinary tract symptoms were assessed using structured-item questionnaires. Multivariable-adjusted logistic regression models examined associations between interpersonal trauma exposures and PTSD with: 1) any weekly incontinence, 2) weekly stress-type incontinence, 3) weekly urgency-type incontinence, and 4) nocturia ≥-2 times/night.

RESULTS:
Of the 1999 participants analyzed, 36% were Caucasian, 22% Black, 23% Latina, and 20% Asian. Twenty-seven percent reported at least one lifetime interpersonal trauma exposure and 22.5% reported clinically significant PTSD (PTSD Checklist-Civilian Version score ≥30). Overall, 45% reported any weekly incontinence, 23% weekly stress-type incontinence, 23% weekly urgency-type incontinence, and 35% nocturia. Women with a history of emotional abuse were more likely to report any weekly incontinence (OR=1.3, CI=1.0-1.7) and nocturia (OR=1.73, CI=1.36-2.19). Physical abuse was associated with nocturia (OR=1.35, CI=1.04-1.77) but not incontinence. PTSD was associated with any weekly incontinence (OR=1.46, CI=1.15-1.85), stress-type incontinence (OR=1.7, CI=1.3-2.2), urgency-type incontinence (OR=1.6, CI=1.2-2.1), and nocturia (OR=2.0, CI-1.6-2.5).

CONCLUSION:
Over 20% of women in this multiethnic, community-based cohort reported a history of interpersonal trauma and/or PTSD, which was associated with symptomatic urinary tract dysfunction. Findings highlight the need for trauma-informed care of midlife and older women with urinary symptoms.
The Effect of Video Education on Skin-to-Skin at the Time of Delivery [18T]
Authors: Caponero Catherine M. , Moussa Hind N. , Heh Victor 
Published: May 2019

INTRODUCTION:
Skin-to-skin contact (SSC) is significantly associated with breastfeeding which continues to be below national goals. With a lack of research on how to overcome barriers to SSC, this trial examined the effect of video education upon admission for delivery on intent to, and actual participation in SSC.

METHODS:
Randomized control trial (June 2017-October 2017) of educational intervention in women (N=240) 18 or older admitted in anticipation of normal spontaneous term delivery. Alternate patients were randomized at the time of admission into video (N=120) and no video (N=120) groups. Both groups received a brief survey about SSC. The video group watched a patient education DVD and completed a post survey about SSC. IRB approval and patient informed consent were obtained.

RESULTS:
During the pre-intervention survey, 89.2% (107/120) of those in the video group compared to 83.3% (100/120) of those in the no video group indicated that they planned to use SSC (p=0.396). After the video, 98.3% (118/120) planned to do SSC after delivery (p<0.001). However, only 59.8% (55/92) started SSC within 5 minutes of delivery in the video group and only 49.4% (42/85) started SSC within 5 minutes of delivery in the no video group (p=0.17).

CONCLUSION:
Video education at the time of admission prior to delivery alters the intention of patients and trends towards preforming SSC within five minutes of delivery. Despite the plans for SSC there was no significant difference in rates of utilization between the two groups. These findings support that obstacles, other than prenatal education, may affect early SSC.
The Glitz and Glamour Trial: Effects of Nail Polish Use on Post-Cesarean Wound Infections [20T]
Authors: van Staalduinen Brittany , Tricorico Gabrielle , Petrucci Samantha , Moretti Michael L. , Lakhi Nisha 
Published: May 2019

INTRODUCTION:
To determine the effect of fingernail polish on the rate of post-operative wound infection following Cesarean delivery.

METHODS:
This is a block-randomized trial where surgeons were assigned to wear or not wear nail polish for two week block-intervals. After each non-emergent Cesarean delivery nail characteristics were logged on a case-coded sheet. The primary outcome was wound site infection (superficial or deep) occurring within 6 weeks of cesarean delivery. A t-test and chi-squared or Fisher's exact were used with p < 0.05 considered significant.

RESULTS:
From August 1, 2017 - October 1, 2018, 632 cases met the inclusion criteria: 297 (47%) were randomized to the nail polish and 335 (53%) to the nail polish free arm. Mean age, 31.8 (15 - 52) vs. 31.7 years (16 - 47), p = 0.830 and gestational age at delivery, 38.6 (23.2 - 41.5) vs. 38.4 weeks (25.6 - 41.5), p = 0.125 were similar for the nail polish and nail polish free arms respectively. BMI was greater in the nail polish group, 29.3 (16.1 - 64.1) vs. 27.9 (16.5 - 49.4), p = 0.015, and more patients were obese 38.5% vs. 30.3%, p = 0.031. Other demographics including race and insurance status were similar. The rate of wound infection was lower in the nail polish group, although this difference was not significant (1.7% vs. 3.9%, p = 0.077).

CONCLUSION:
The rate of postoperative wound infection is not affected by the use of fingernail polish.
The Role of Surgical Attire in the Prevention of Postoperative Infections: A Before and After Study [24T]
Authors: Wajid Naji Abdul , Staudenmaier Emily K. , Kim-Vaghela Jessica Juhee , Sampino Anthony F. , Gurram Padmalatha 
Published: May 2019

INTRODUCTION:
Rates of postoperative infection (PI) related to cesarean delivery (CD) range from 2 to 7 percent. Traditional operating room attire consists of surgical cap, mask, and shoe cover. In August 2015, our institution adopted policy based on Association for Perioperative Registered Nurses (AORN) guidelines. Policy dictates use of surgical hood, laundered scrubs, beard cover, and disposable jacket before scrubbing. The objective of the study is to investigate the rate of PI in women undergoing CD before (Group 1) and after (Group 2) policy implementation.

METHODS:
A retrospective chart review was performed of women with term pregnancies who underwent elective CD for two years before (Group 1) and after (Group 2) new policy. Institutional Review Board approval was obtained. Inclusion criteria are as follows: hospital readmission, fever, positive wound culture, antibiotic treatment, cellulitis, endometritis, intra-abdominal abscess. Exclusion criteria included labor, ruptured membranes, intrapartum infection, and cerclage.

RESULTS:
The primary outcome measure was the rate of PI between the two groups. Group 1 consisted of 131 and Group 2 159 patients. Maternal characteristics and antepartum complications were similar between groups (p < 0.05). Mean gestational age at delivery was 38.96 weeks (Group 1) and 38.89 weeks (Group 2). Both groups had similar incidences of primary versus repeat CD. Rate of infection in group 1 was 4.5 percent vs 2.5 percent in group 2 (p > 0.05).

CONCLUSION:
The addition of surgical hood and jacket did not lead to a statistically significant decrease in postoperative infection. Further investigation may determine if the additional cost yields benefits.
Use of 17-Hydroxyprogesterone Caproate in Twin Gestations With a Prior Singleton Spontaneous Preterm Birth [30T]
Authors: Ward Andrew R. , Greenberg Victoria Rachel , Valcarcel Breanna , Al-Kouatly Huda Bachir , Berghella Vincenzo 
Published: May 2019

INTRODUCTION:
The purpose was to determine if weekly 17-hydroxyprogesterone caproate injections prevent preterm birth in women with a twin pregnancy and a history of a singleton spontaneous preterm birth.

METHODS:
Retrospective cohort study of women with twin gestation and prior singleton spontaneous PTB at two institutions between 2005 and 2016. Study group included women receiving 17P while the control group did not. Primary outcome was twin spontaneous PTB <34 weeks. Secondary outcome was composite neonatal morbidity: respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), neonatal intensive care nursery admission, and fetal or infant death prior to discharge. IRB approval was obtained.

RESULTS:
79 patients were included. 27 women received weekly 17P and 52 did not. There were no significant differences in maternal demographics (Table 1) or preterm birth (Table 2) aside from maternal age. Spontaneous PTB <34 weeks occurred in 16 study patients (59%) versus 24 (46%) controls (OR 1.69, 95% CI 0.68-4.54). There was no difference in the rate of spontaneous PTB <32 weeks (33% vs 31% [OR 1.12; 95% CI 0.42-3.06]), <28 weeks (18% vs 19% [OR 0.95, 95% CI 0.32-3.18]), and <24 weeks (11% vs 13% [OR 0.8, 95% CI 0.21-3.42]) between the study group and control group, respectively. Composite neonatal morbidity occurred in 20 pregnancies (74%) in the study group and 41 pregnancies (79%) in the control group (OR 0.76, 95% CI 0.27-2.12).

CONCLUSION:
Weekly 17P injections do not appear to prevent spontaneous preterm birth or neonatal complications in twin gestations with prior singleton spontaneous preterm birth.
Improving Nutrition and Exercise Counseling in the Outpatient Setting by Obstetrics and Gynecology Residents [33T]
Authors: Warehime Jenna , Dhanraj Dave 
Published: May 2019

INTRODUCTION:
Nutrition and exercise are large contributors to a patient's overall health. With the obesity epidemic in the United States, many of our patients have a body mass index above normal and could benefit from counseling in nutrition and exercise, potentially reducing their risks for many diseases over the course of their life. The purpose of this study is to determine if the availability of a food and exercise diary handout increases the frequency and comfort levels with which Obstetrics and Gynecology resident physicians counsel patients on nutrition and exercise.

METHODS:
This is an institutional review board approved prospective survey study. Residents were surveyed before and 6 months after a food and exercise diary handout was made available as a resource in the outpatient clinic, and the responses were analyzed.

RESULTS:
While our results did not show a statistically significant difference before and following the implication of the food/exercise diary handout, anecdotally there was an increase in frequency of comfort level for resident's counseling patients in both nutrition and exercise. On average three to four residents increased the frequency they counsel on these topics from rarely or occasionally to most of the time. The same increase was seen in the comfort level that residents had for discussing these topics with patients.

CONCLUSION:
Our results suggest that while a food and exercise diary handout may be helpful in increasing the frequency or comfort with which residents counsel patients, the availability of the resource alone is not sufficient to change residents' practice.
Association of Fetal Middle Cerebral Artery Doppler Indices in Different Positions and Adverse Perinatal Outcomes [40T]
Authors: McLaren Rodney Anthony , Kalgi Bharati , Ndubizu Chima , Haberman Shoshana 
Published: May 2019

INTRODUCTION:
Evidence has shown that “brain sparing” phenomenon can be replicated using maternal position as a physiological stress. Our study's objective is to ascertain if changes in Middle Cerebral Artery (MCA) Doppler pulsatility indices (PI) due to physiological stress caused by maternal position correlates with adverse perinatal outcomes in low risk and in high risk patients.

METHODS:
A prospective cohort study of singleton, nonanomalous pregnancies with chronic hypertension or pregestational diabetes, and low risk pregnancies between 18 and 36 weeks gestation. Pregnancies with Rh isoimmunizations, fetal growth restriction, maternal cardiac disease, smoking or drug use history were excluded. Fetal doppler velocimetry indices were obtained from the fetal MCA in maternal supine and left lateral decubitus position. ANOVA was used to compare demographics between cohorts and composite of adverse perinatal outcomes, which included fetal growth restriction, oligohydramnios and preeclampsia.

RESULTS:
The delta of MCA Doppler PI between the two maternal positions did not correlate with adverse perinatal outcome (p= 0.409). 89 patients were included. There were 34 (38.2%) women with adverse outcomes; 22 (64.7%) patients were from the low risk group and 12 (35.3%) patients were from the high risk group.

CONCLUSION:
Our preliminary study did not demonstrate correlation between delta fetal MCA Doppler indices and composite outcome. The limitation of this study was that it was not powered for the finding of high composite adverse outcome in the “low risk” group, which might suggest underlying unknown risks. More data is needed in order to address the significance of fetal MCA Doppler indices changes.
Why Women With Access to Health Care Undergo Elective Second Trimester Abortions: Identifying Risk Factors [8S]
Authors: Rounds Kacie , Silvestre Isabella , Wei Julia , Weintraub Miranda Ritterman , Goldsmith Crystal Marie 
Published: May 2019

INTRODUCTION:
Twelve percent of elective abortions are performed during the second trimester despite increased cost and morbidity. As health insurance is a major factor affecting abortion access nationally, we assessed risk factors associated with elective second trimester abortion among a well-insured population of women.

METHODS:
This IRB approved retrospective cohort study of women who obtained second trimester abortions at Kaiser Permanente Northern California (KPNC) between 2015 and 2016 used electronic medical records to identify the cohort and elective vs non-elective abortion indication, early (<16 weeks) vs late (≥16 weeks) second trimester abortion status, and demographic and clinical characteristics. Data were analyzed using descriptive and bivariate analyses.

RESULTS:
Of the 400 procedures randomly reviewed, 197 (49%) were performed in the second trimester, and of these, 95 (48%) were elective. Elective procedures were more likely to occur earlier in the second trimester (P<.0446). The mean age (standard deviation) of women undergoing an elective procedure was significantly younger at 26.5 (7.0) vs 33.5 years (5.7) (P<.0001). Women with a prior abortion were more likely to undergo an elective procedure (P<.0136). There were variations in elective status according to race/ethnicity (P<.0001); Black women were more likely to have an elective abortion. There were no differences in elective status according to gravidity, parity, history of irregular menses, or body mass index.

CONCLUSION:
Women who had a prior abortion, were younger, or Black were more likely to undergo elective termination. Further analyses are needed to identify factors independently linked to second trimester elective abortion in an insured population.
Using Quality Improvement to Increase the Awareness of Obesity Among Endometrial Cancer Patients [38R]
Authors: Shafa Anousheh , Torres Diogo , Bird Megan , Mundi Manpreet , Langstraat Carrie , Kumar Amanika 
Published: May 2019

INTRODUCTION:
Obesity is associated with endometrial cancer (EC); however, most patients are unaware of this association and the long-term consequences of their elevated body mass index (BMI). Our objectives were to increase both patient awareness of this association and referral rates to our weight loss clinic using quality improvement (QI) methodology.

METHODS:
A multidisciplinary team used QI methods to create a multi-pronged toolkit to improve obesity education in patients < 80 years old with a BMI ≥30 mg/kg2 and diagnosis of grade 1-2, stage I EC. Gynecologic oncology and bariatric surgery providers, endocrinologists, nutritionists, and psychologists collaboratively implemented the toolkit comprised of provider communication workshops, patient education resources, and dictation templates. A historic cohort from (July through December 2015) was compared to a post-intervention cohort (July through December 2017). Clinical characteristics, documented conversations, and referrals to the weight loss clinic were abstracted. Data for the two cohorts were compared using Chi-squared test, Fisher exact test, and Student t-test.

RESULTS:
The historic cohort had 54 patients and the post-intervention cohort had 53 patients. Clinical characteristics were balanced between groups. Conversations about obesity increased from 11.1% (6/54) to 79.2% (42/53) after toolkit implementation (P<.001). Referral rates to the weight loss clinic also increased from 3.7% (2/54) to 25.9% (14/53) (P<.005). No clinical characteristics, including age, BMI, or pre-operative diagnosis, were associated with documented conversations or referrals (P=1.0).

CONCLUSION:
A multidisciplinary quality improvement project can be used to increase discussion about obesity and referral to a weight loss clinic in patients with low-risk EC.