bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcervical Foley Bulb (TFB) and Risk of Subsequent Preterm Delivery [32O]
Authors: Fiest Kristen , Alexander Tamika , Wedoff Michael , Mastrogiannis Dimitrios 
Published: May 2017

INTRODUCTION:
To evaluate if the use of a transcervical Foley balloon (TFB) for induction of labor (IOL) increases the risk of preterm delivery in subsequent pregnancies.

METHODS:
This was a retrospective cohort study evaluating methods of induction and subsequent pregnancy outcomes.

RESULTS:
151 women were identified to have a term IOL followed by a subsequent pregnancy within a 10-year span meeting study's criteria. Patients were in the study group if a TFB was used alone or in combination with prostaglandins and/or oxytocin for IOL while the control group did not include TFB. Age, race, BMI (in first pregnancy and subsequent pregnancy), tobacco use, previous LEEP, previous D&C, indication for IOL, and birth weight (in first pregnancy and subsequent pregnancy) were all not significantly different between the groups. Bishop score was significantly higher in the control group (p=0.003). Mode of delivery for the initial pregnancy was significantly different between the two groups (p=0.019) with a higher rate of cesarean section in the study group. Mean gestational age at delivery of the subsequent pregnancy was 39 and 39.1 weeks for the control and study groups respectively (p=0.747).

CONCLUSION:
The use of TFB for IOL did not have an impact on gestational age of subsequent pregnancy when compared to other modes of induction. The cesarean section rate was higher in the TFB group in the initial pregnancy, which was likely related to the lower bishop score and increased difficulty of IOL which required the TFB in addition to the other methods to begin with.
Drugs and Death in Las Vegas: A Novel Use of Coroner Data to Create a Toxicology Surveillance System in Pregnant Women [33O]
Authors: Mahesan Arnold , Paul Anthea B. , Mahesan Andrew , Simms Lary 
Published: May 2017

INTRODUCTION:
Existing studies in the literature analyze self-reported use of substances or utilize prenatal laboratory testing to assess the prevalence of illicit substances in pregnant women. Our study explores a novel use of quantitative autopsy toxicology to understand trends and associations in maternal mortality.

METHODS:
This study was a retrospective review of pregnant women referred to the Clark County medical examiner from 2000-2015. Medical records were reviewed. These patients were all confirmed pregnant by autopsy diagnosis, and underwent whole blood toxicology analysis. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.

RESULTS:
67 women were included in the analysis. 40% had positive toxicology for any drug, and 28% were positive for illegal drugs. Methamphetamine was most prevalent (16%), followed by ethanol (15%). Individuals not receiving prenatal care had a significantly higher prevalence of illicit drugs 44% vs 7% (p=0.0121), ethanol 25% vs 3% (p=0.0437), and methamphetamine 30% vs 7% (p=0.0051). A positive marijuana result in those not receiving prenatal care, though increased, did not reach significance at 16% vs 7% (p=0.689). Some other trends were noted in the data. 30% (n=20) had documented mental illness. Further, the first trimester had the highest prevalence of illicit drugs and ethanol. Also, 39% (n=26) were victims of domestic violence with non-married women significantly more so than married women (p=0.0001).

CONCLUSION:
As Vital Statistics does not record routine toxicology in non-overdose cases, a toxicology surveillance system using Coroner data would provide important insights into the growing national problem of substance abuse in pregnancy.
Institution of a Postpartum Hemorrhage Bundle at an Academic Center Does Not Immediately Reduce Maternal Morbidity [36O]
Authors: Hamm Rebecca F. , Wang Eileen , O'Rourke Kathleen , Romanos April , Srinivas Sindhu 
Published: May 2017

INTRODUCTION:
Obstetric hemorrhage is a leading cause of morbidity and mortality. The Council for Patient Safety in Women's Health released a postpartum hemorrhage (PPH) bundle in 2015 designed to improve patient safety and reduce the use of blood products. We sought to assess whether institution of such a bundle could improve maternal morbidity in our population.

METHODS:
Pre-intervention data (PRE) data was collected on all deliveries at the Hospital of the University of Pennsylvania between 10/15/13 and 12/15/13. Deliveries were included if estimated blood loss (EBL), admission hemoglobin, and 12-hour postpartum hemoglobin were collected. A two-pronged, multidisciplinary educational and procedural intervention related to PPH, including institution of quantitative blood loss, was instituted from 3/2015 to 6/2015. Post-intervention data (POST) was collected on all deliveries from 10/20/2015 to 12/20/2015. Chi-square was used to compare proportions.

RESULTS:
592 of 626 (95%) PRE and 583 of 613 (95%) POST deliveries were included. The rates of PPH by EBL ≥1000 cc and by 3 g hemoglobin drop were not significantly different from PRE to POST (9.0% vs 12.2%, p=0.07 and 10.5% vs. 13.5%, p=0.10, respectively). There was no significant change in transfusion rate (3.4% vs. 5.1% p=0.13). Use of uterotonics was reduced from 9.8% to 6.3% from PRE to POST (p=0.03).

CONCLUSION:
While institution of a PPH bundle is designed to improve the morbidity of PPH, our data demonstrates that it cannot be expected to do so within 6 months of implementation. Further studies will need to assess the long term effects of such a resource intensive protocol.
Impact of Gestational Weight Gain on Trial of Labor After Cesarean Success [38O]
Authors: Havard Alexandra , Mei Jenny , Mularz Amanda , Maykin Melanie , Valderramos Stephanie 
Published: May 2017

INTRODUCTION:
Maternal obesity has been associated with decreased success of a trial of labor after cesarean delivery (TOLAC). We aimed to investigate the BMI and gestational weight changes on TOLAC success in a modern cohort.

METHODS:
This is a retrospective cohort study of women attempting TOLAC at a single institution from May 2007 to April 2016. Exclusion criteria included age less than 19 years, fetal demise, lethal fetal anomalies, or incomplete medical records. Clinical data collected included maternal demographics, comorbidities, obstetric history, obstetric complications and outcomes, and BMI prior to and throughout pregnancy. Chi squared analysis was used to detect differences between groups.

RESULTS:
614 patients met inclusion criteria. The overall TOLAC success rate was 72.31% (n=444) and average BMI at delivery was 30.7. Compared to normal weight women, we found no difference in success rates among women who were obese prior to pregnancy (73.2% vs 72.1%, P=.794), became obese during pregnancy (69.8% vs 73.3%, P=.379), or were obese at the time of delivery (71.1% vs 73.6%, P=.483). Appropriate weight gain during pregnancy (within Institute of Medicine recommendations) also did not impact TOLAC success (74.1% normal vs 71.4% excess P=.483). A post-hoc power analysis showed that we were powered to detect a 12.5% difference in TOLAC success rates.

CONCLUSION:
In contrast with prior studies, we found no difference in TOLAC success rates with maternal obesity or excess gestational weight gain. Our findings suggest that obesity may not have a negative impact on TOLAC success as previously reported.
Changing the Timing of the Postpartum Visit: Decreasing Short Interval Pregnancy Rates [39O]
Authors: Paredes Ingrid , Gonzalez Aaron Herrera , Row Kelsey , Shi Audrey , Anasti James 
Published: May 2017

INTRODUCTION:
Over 50% of pregnancies in the USA are unintended. Current contraception is very effective, if available and used correctly. We surmised the postpartum visit to be a key time to provide education and access to contraception. Thus we wanted to decrease our short interval pregnancy (less than 18 months, SIP) incidence as a simple measure of decreasing unintended pregnancies.

METHODS:
We retrospectively compared patients with SIP and those without with respect to age, race, parity, work status, attendance at postpartum visit (PPV), insurance status, breast feeding, and immediate postpartum medroxyprogesterone use. Modifiable risk factors would then be adjusted and the SIP incidence would be reassessed.

RESULTS:
We noted out of 991 deliveries that occurred from 5/2011 to 1/2013, 89 (8.9%) had an SIP. Only age (26.7 vs. 28.4 y, p=0.01) and PPV (40.9% vs. 67.4%, p=0.03) were significantly different in the SIP patients. Therefore, we changed our PPV timing from 6 weeks to 3 weeks in an effort to increase our PPV attendance. In the subsequent prospective time period from 1/2014 to 5/2016, we had 1021 births and 49 SIP births. Thus we had a decrease in our SIP from 8.9% to 4.8% (p=0.02) after changing the timing of our PPV. In addition, we increase our overall PPV attendance from 61% to 73% (p=0.04).

CONCLUSION:
Altering the timing of postpartum visit from 6 weeks to 3 weeks increased the frequency of attendance and may have decrease the unintended pregnancy rate.
Language Barriers Between Providers and Patients: Does It Equal to Patient Dissatisfaction? [2E]
Authors: Mustafa Nourhan , Rondeau Nancy , Mendez Melissa 
Published: May 2017

INTRODUCTION:
It is important for providers and patients to effectively communicate and understand each other. According to the U.S. Census, 21% of individuals reported speaking another language other than English at home, and out of this group 62% spoke Spanish. This study examined patient satisfaction secondary to patient-perceived language barriers in a predominately Hispanic Obstetrics and Gynecology clinical setting.

METHODS:
Data were collected using a 10 question self-administered survey at an academic institution clinic. Participants were Hispanic above the age of 18 who preferred to speak Spanish. Unadjusted and adjusted prevalence ratios (PR) for the dichotomous outcome of patient dissatisfaction with the care provided were estimated using log-binomial regression.

RESULTS:
A total of 420 surveys were collected. The mean age of the respondents was 37, and 30.6% had a high school diploma. Seventy two percent of the respondents reported being satisfied (32.8%) or very satisfied (40.0%) with their provider. The unadjusted PR for the outcome of patient dissatisfaction comparing patients who experienced a language barrier to those who did not experience a language barrier was 1.11 (95% CI: 0.63 ‒ 1.93, P=0.72). After controlling for the patient’s primary residence and educational level, the PR for patient dissatisfaction for the presence of a language barrier decreased to 1.02 (95% CI: 0.58 ‒ 1.78, P=0.95).

CONCLUSION:
Further studies are necessary to determine if additional provider training on Spanish provider-patient communication is necessary to improve the overall patient satisfaction for Spanish speaking patients visiting Ob/Gyn clinics.
Pain Perception After Office Hysteroscopy Alone vs. Hysteroscopy With Endometrial Biopsy [3E]
Authors: New Erika , Mikhail Emad , Sappenfield Elisabeth , Sarkar Papri , Plosker Shayne , Imudia Anthony 
Published: May 2017

INTRODUCTION:
Prior to performing office based gynecologic procedures, patients require appropriate preoperative counseling on anticipated pain. This study investigates the difference in patients’ pain perception when office hysteroscopy (OH) is performed alone compared with OH and concurrent endometrial biopsy (EMB).

METHODS:
A prospective study of patients presenting to USF for OH alone or OH with EMB between 10/2015 and 7/2016 was performed. Pre-procedure instructions were similar for all patients, and patients knew whether they were undergoing OH alone or OH with EMB. Patients described their pain perception using the visual analogue scale from 0-10 at the end of the procedure(s) and data was compared between groups using SPSS version 23.

RESULTS:
A total of 173 patients were enrolled in the study. Group 1 had OH alone (n=133) and group 2 had OH with EMB (n=40). Patients in group 1 were significantly younger than group 2 (36±6 vs 41±7, p-value less than 0.0001) but there was no significant difference in mean gravity or parity. Procedure indications included fibroids, endometrial polyps, fertility testing, and recurrent pregnancy loss. The median (range) global pain perception was 6 (0-10) vs 7 (0-10) between group 1 and 2 respectively, which was not significantly different (p=0.12). There was no difference in tenaculum use, uterine perforation or vasovagal reaction between the groups.

CONCLUSION:
Patient reported pain assessment was similar in women undergoing OH with or without endometrial biopsy. Similar preoperative instructions and preparation can be given to these patients.
Exploring the Patient Decision-Making Process in Choosing Route of Hysterectomy [5E]
Authors: van der Does Louise , Baxi Rupen P. , MacKoul Paul , Danilyants Natalya , Washington Kelly 
Published: May 2017

INTRODUCTION:
Laparoscopic hysterectomy offers clear benefits to patients when compared to abdominal (open) hysterectomy, yet a large percentage of women continue to undergo the latter procedure. The purpose of this study is to explore the patient decision-making process in choosing the route of hysterectomy.

METHODS:
A questionnaire survey was mailed to all patients (N=3,878) who underwent hysterectomy at a suburban community hospital between 2011-2013. Questions addressed preoperative education, patient involvement, and patient satisfaction. Quantitative data was summarized in contingency tables and analyzed using Pearson chi-square; qualitative data was analyzed using content analysis.

RESULTS:
The overall response rate was 10.3%. Nearly a third of respondents underwent open hysterectomy. Of those respondents, 48.2% indicated the route of hysterectomy “didn’t matter” to them and 13.7% “didn’t know about other surgical options,” compared to 14.8% and 8.5%, respectively of the laparoscopic group. Of the open group, nearly one third (31.7%) indicated their surgeon “did not talk about alternatives to open hysterectomy.” Compared to the laparoscopic group, open respondents were less likely to seek a second opinion, opting to have the surgery performed by their OB/GYN (44%), because “they trusted their OB/GYN” (76.6%). Only 1% of the open group performed on-line research regarding their surgical options. Of the open group, only 76% said they would recommend the same route of surgery, compared to 90.32% of the laparoscopic group.

CONCLUSION:
The outcomes of this study point to a need for improved preoperative patient education and patient involvement in the surgical informed consent process.
Factors Influencing Medication Adherence in High Risk Pregnant Patients [6E]
Authors: Mastrogiannis Dimitrios , Della Torre Micaela , DiGiovanni Laura , Wedoff Michael 
Published: May 2017

INTRODUCTION:
Pregnant patients’ non-adherence with prescription medications is a challenging problem. The purpose of this study was to investigate factors influencing medication adherence in our urban high risk obstetric clinic.

METHODS:
This is a prospective cross-sectional study performed February through June 2016 at the Maternal Fetal Medicine clinic at UIC. Participants were ≥24 weeks, English-speaking adults, and taking ≥1 prescription medication. After obtaining consent, study participants were surveyed by questionnaire. Answers were entered into 3 adherence scoring scales: Morisky 8 medication adherence score (MMAS-8), medication adherence reasons scale (MARS), and rapid estimate of adult literacy.

RESULTS:
A total of 69 patients completed the questionnaire; 60% had unplanned pregnancies, and 45% had health literacy < 8th grade level. Adherence scores were low in 42%, moderate in 38%, and high in 20% of participants. Pregnant women with low adherence score were significantly more likely to be on higher number of medications (p=0.044) and had trended towards missed prenatal visits (p=0.056). 31.9% had asthma, 52.2% had diabetes, 44.9% had hypertension, 11.6% had thyroid disorders, and 4.3% had seizure disorders. Patients with hypertension had higher non-adherence compared to all other categories (p=0.037), and more commonly used marijuana (p < 0.001). Being employed, having a smartphone, dependents, and partner did not affect adherence scores. Women reporting forgetfulness, carelessness, medication side-effects, stopping medication when symptom free, travel, inconvenience, and difficulty calculating dose had low adherence scores.

CONCLUSION:
Understanding the reasons for medication non-adherence in an urban high risk obstetric population may allow providers to tailor motivational interviewing to improve individual adherence.
Gestational Weight Gain in Diabetic Women: Do Supportive Text Messages Make a Difference? [7E]
Authors: Gupta Angela , Buchanan Christopher , Gavard Jeffrey , Hostetter Sarah , Miller Collin , Mostello Dorothea 
Published: May 2017

INTRODUCTION:
Weight gain during pregnancy can lead to adverse health outcomes. The purpose of this study was to examine the effect of different text message regimens on gestational weight gain in women with diabetes.

METHODS:
Data from a prospective, controlled trial of women with gestational or Type 2 diabetes mellitus were analyzed. Women were randomized to receive either general pregnancy supportive text messages (Text4Baby) or diabetes-specific text messages (Text4Diabetes). Women also received nutrition education to limit their weight gain to the Institute of Medicine (IOM) gestational weight gain guidelines based on pre-pregnancy BMI. Groups were compared on gestational weight gain from study entry to delivery using independent students t-test, Kolmogorov-Smirnov, chi-square, and Fisher Exact tests.

RESULTS:
The final analysis had 71 patients: Text4Baby (n=35) and Text4Diabetes (n=36). Most women were obese at study entry (87.5%). Demographics did not differ between groups. There was no difference in maternal weight at entry, duration of participation, or total maternal weight gain. More women receiving Text4Baby text messages exceeded IOM guidelines for weekly weight gain compared to women receiving Text4Diabetes text messages (57.7% vs. 48.1%). Of all overweight and obese women, 52.8% gained more weight than IOM guidelines, while only 32.1% gained less and 15.1% gained within IOM guidelines.

CONCLUSION:
While general pregnancy and diabetes-specific text message groups did not differ in weight gain during pregnancy, most women in both groups gained more than IOM guidelines recommend. Text message interventions for women with diabetes in pregnancy should address the importance of avoiding excessive weight gain during pregnancy.
An Exploration of Clinician's Personal Experience of Trauma and Its Impact on Screening Female Patients For Trauma [8E]
Authors: Cooper Conisha , Antoine Denis , Lee Amy S.D. , Irvin Nathan , Coleman Jenell 
Published: May 2017

INTRODUCTION:
Physical and sexual trauma can impact the health of patients, yet screening rates are low. Factors associated with screening are needed. We sought to determine whether clinician's personal experience of physical and sexual trauma was associated with screening their female patients for trauma.

METHODS:
We conducted an online survey of clinicians at a single academic institution. Self-reported screening of female patients was assessed using a 5-point Likert scale and scored 1 (never) to 5 (always). Separate validated tools were used to assess physical and sexual trauma. Descriptive and univariate statistics were performed.

RESULTS:
Among 134 participants, 83% were female, median was age 39.5 (interquartile range [IQR] 32-50). The majority were white (78.4%) and were nurses (53.7%). Disciplines included Ob/Gyn (32.3%), Emergency Medicine (27.1%), Psychiatry (27.8%) and Primary Care (12.8%). The median (IQR) screening score was 3.9 (3.3-4.3). Overall, 88.7% of clinicians reported personal experiences of sexual and/or physical trauma. There were no significant differences in screening scores between any trauma (3.9, [3.3-4.3]) vs no trauma (4.1 [3.5-4.4], P=.42). Greater number of years in practice was associated with higher screening scores (P=.03), but having a departmental policy was not (P=.63). Scores were significantly higher in Ob/Gyn (4.2 [3.7-4.4]) vs Emergency Medicine (3.56 [3.3-3.9], P=.007) and Primary Care (3.6 [3.1-3.8] P=.01). There were no differences between nurses and physicians (P=.50).

CONCLUSION:
Screening scores were high among our clinician cohort and a personal experience of trauma was not associated with screening. Successful strategies in Ob/Gyn should be further explored and disseminated to other specialties.
Analysis of Screening Women for Cervical Cancer Following an Excision for Cervical Intraepithelial Neoplasia [14E]
Authors: Talbot Ethan , Hunt Kimberly , Morosky Christopher 
Published: May 2017

INTRODUCTION:
This study assessed if the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests can be successfully applied to a group of women who were treated with an excisional procedure for cervical dysplasia.

METHODS:
This retrospective longitudinal study encompassed all patients at an academic medical center who underwent an excisional procedure for cervical intraepithelial neoplasia from 2001 to 2013. We performed a comparative model analysis by applying the 2012 updated management and screening guidelines to a patient population that had previously undergone traditional screening. Our primary outcomes were identification of dysplasia recurrence and over-screening. We also identified characteristics associated with an increased risk of dysplasia recurrence.

RESULTS:
A total of 493 subjects contributed 505 specimens and 2247 subsequent pap smears to the final study population. Eighteen subjects (3.65%) underwent an intervention for recurrence. Compared to traditional screening, the 2012 management guidelines identified less recurrence (100% vs. 97.0%, P=0.001), but greatly reduced over-screening (39.2% vs 8.5%, P

CONCLUSION:
Application of the 2012 updated consensus guidelines to patients who have undergone an excisional procedure for cervical dysplasia results in a marginal decrease in identification of dysplasia recurrence which is balanced by a significant decrease in over-screening.
Postpartum Cervical Cancer Screening Adequacy and Results: Comparison of Results 2-3 Versus 6-8 Weeks Postpartum [20E]
Authors: Carty Jenava , Batig Alison 
Published: May 2017

INTRODUCTION:
Postpartum follow up earlier than the traditional 6-8 week interval has been proposed as a means to enhance care provision to women after childbirth. Our study’s objective was to compare cervical cancer screening adequacy and results when screening was performed either 2-3 or 6-8 weeks postpartum.

METHODS:
The data for this study was obtained as part of a randomized controlled trial that recruited primiparous women who delivered at term with an expressed intent to breastfeed to postpartum appointment intervals of either 2-3 or 6-8 weeks following childbirth. When cervical cancer screening was performed, the results were reviewed for adequacy and findings. The results were compared for each group using chi-squared analysis; adequacy was compared using an odds ratio with 95% confidence interval.

RESULTS:
The rates of cytologic adequacy were comparable between the group (95.0 versus 100% in the 6-8 week group, p=0.21); the odds ratio for “unsatisfactory” cytology in the 2-3 week follow up group was 0.06 (95% CI < 0.01-41.8). The distribution of cytologic results was comparable between the group (p=0.09); no one in either group had a high-grade cytologic result or cervical cancer. When performed, the rates of positive and negative high-risk human papillomavirus results was comparable between the groups (p=0.92).

CONCLUSION:
Our study indicates that cervical cancer screening can be completed earlier during the postpartum period than traditionally accepted without compromising cytologic adequacy or results. This information may be useful in shaping future recommendations regarding the timing and medical services provided during the postpartum period.