bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Trauma-Associated Threatened Abortions Presenting to U.S. Emergency Departments From 2013 to 2015 [30C]
Authors: Bandzar Sean , Gupta Shabnam , Atallah Hany 
Published: May 2017

INTRODUCTION:
Threatened abortions are one of the most psychologically distressing and frequently occurring complications in the first trimester of pregnancy. Approximately 30% of threatened abortions result in spontaneous abortions. The objective of this study was to investigate the epidemiology of trauma-associated threatened abortions presenting to United States emergency departments (EDs) using nationally representative data.

METHODS:
A retrospective analysis of the National Electronic Injury Surveillance System (NEISS) database was conducted. The NEISS database is a national probability sample of over 60 US EDs. Inclusion criteria were pregnant women with vaginal bleeding from trauma seen in US EDs from calendar year 2013 to 2015. All injuries were stratified by age, gender, race and disposition.

RESULTS:
From calendar year 2013 to 2015, there were 1358 trauma-associated threatened abortions that presented to US EDs. The mean age was 27 years old. There were a higher percentage of threatened abortions in whites (43%) than in blacks (27%) and Hispanics (13%). Approximately 18% of races were not recorded. The majority of threatened abortions occurred after slipping down a set of stairs (48%). A high percentage of threatened abortions also occurred after slipping in restrooms at home (19%). The majority of patients were discharged home after being evaluated in the emergency department (76%). Approximately 12% of patients were admitted or observed at the hospital.

CONCLUSION:
Falls down stairs were the primary mechanism of injury for threatened abortions in this cohort. Further efforts are warranted to explore safety measures to prevent injuries and decrease the frequency of trauma-related threatened abortions.
Adverse Maternal and Perinatal Outcomes: A Comparison of United States- and Foreign-Born Women [32C]
Authors: Adegoke Tejumola , Pinder Leeya , Ndiwane Ndindam , Vragovic Olivera 
Published: May 2017

INTRODUCTION:
Despite significant socio-economic disadvantages, improved perinatal outcomes have been observed among foreign-born women relative to the native population in multiple countries. The current study aims to assess perinatal outcomes of United States (U.S.)- and foreign-born women in Boston, Massachusetts; and investigate how these differences are impacted by socio-demographic risk factors.

METHODS:
We analyzed singleton, index pregnancies (n=11,124) among women delivering at Boston Medical Center between January 2010 and December 2015. Outcomes included preterm birth, cesarean delivery, hypertensive disorders, abnormal glucose tolerance, premature rupture of membranes (PROM), fetal growth restriction, low birth weight at term (LBW, less than 2500g), neonatal intensive care unit (NICU) admission and intrauterine fetal demise (IUFD). Multivariate regression was used to control for maternal age, race, ethnicity, insurance coverage and tobacco use.

RESULTS:
Preterm birth, hypertensive disorders, PROM, LBW, NICU admission and fetal growth restriction were more common among U.S.-born women and their neonates (P less than .000). Foreign-born women were more likely to have abnormal glucose tolerance (P equals .008). Controlling for maternal characteristics eliminated the effect of maternal birthplace on fetal growth restriction (adjusted OR 0.98) and abnormal glucose tolerance (adjusted OR 1.06), but did not modify the effect on other study outcomes.

CONCLUSION:
U.S.-born women are at higher risk of adverse perinatal outcomes than foreign-born women. This increased risk persists for many outcomes even after controlling for confounders. As the immigrant population in the U.S. grows, understanding the social and physiologic determinants of these differences may guide targeted interventions critical for improving overall maternal and child health.
Antepartum Venous Thromboembolism Prophylaxis Dosing With Low Molecular Weight Heparin in Obese Population [34C]
Authors: Parrott Jessica , McCall Caitlyn , Udovich Mason , Holland Marium 
Published: May 2017

INTRODUCTION:
To determine adequacy of venous thromboembolism prophylaxis dosing with low-molecular-weight heparin (LMWH) in pregnant women based on anti-Xa concentrations, with focus on the obese population.

METHODS:
A retrospective cohort identified 50 subjects treated with prophylactic LMWH during pregnancy at the University of Kansas Medical Center between January 2012 and May 2016 were identified from the electronic medical record. Subjects were excluded if they did not deliver at our medical center, were not monitored with anti-Xa levels, or were receiving prophylaxis for proteinuria. The data abstracted from the chart included subject demographics, BMI, indication for pharmacologic thromboprophylaxis, LMWH dosing, anti-Xa levels, weight gain, and potential complications. Fischer exact test and ANOVA were used for statistical analysis.

RESULTS:
31 subjects were identified who were treated with an initial starting LMWH dose of 40mg daily. Of these, only 32.26% (10/31) had a prophylactic anti-Xa level (0.2-0.4). When stratified by BMI at treatment start, 58.82% (10/17) with BMI < 30.0 compared to 0% (0/14) subjects with BMI >30.0 reached a prophylactic anti-Xa level (p=0.0008). When stratified by gestational age at treatment start, 45% (9/20) in the first trimester, 33.33% (3/9) in the second trimester, and 0% (0/2) of subjects in the third trimester were at a prophylactic anti-Xa level on daily 40mg LMWH (p=0.24).

CONCLUSION:
Pregnant women with initial BMI >30.0 treated with daily 40mg LMWH are not likely to achieve a prophylactic anti-Xa level. BMI or weight-based dosing should be considered and patients should be monitored with anti-Xa levels during pregnancy.
Empathetic Yet Resistant: Accommodating Immigrant Women’s Preferences for Female Providers [36C]
Authors: Aubrey Christa L. , Mumtaz Zubia , Chari Radha , Mitchell Peter (BF) 
Published: May 2017

INTRODUCTION:
For women migrating from different religio-cultural environments, having a female obstetrical provider may be particularly important. While accommodating these requests can be seen as providing patient-centered care, the feasibility and ethical questions of gender discrimination and educational implications make it a contentious issue. The objective of this study was to gain obstetricians’ understanding of the importance, effect, and challenges to providing care when immigrant women prefer a female obstetrician.

METHODS:
A focused ethnography was conducted using purposive sampling of 20 obstetrical providers in Edmonton, Alberta, Canada. Data collection comprised of a single semi-structured interview with participants. Interviews were audio-recorded and transcribed verbatim. Data was managed by a qualitative data analysis software, and analyzed using thematic analysis.

RESULTS:
A total of 13 female and seven male physicians were interviewed. In line with patient-centered care, physicians recognized the validity, and empathized with immigrant women’s preference for female providers. However, they were resistant to accommodating these requests, stemming from concerns about the extent to which host communities should accommodate immigrant cultural requests, based on the ability of the health system to respond, discerning coercion-free patient decision-making, implications for training and quality of care, and fear of perpetuating and exacerbating gender inequalities in medicine.

CONCLUSION:
Physicians faced a dilemma trying to balance patient preferences with their own autonomy as a physician and a person. Identifying physician’s values and perspective will enhance understanding of the patient-physician relationship, ultimately progressing towards addressing this issue both philosophically and practically.
Barriers for Tdap Vaccination in Pregnancy [38C]
Authors: Ashby Mary , Roussos-Ross Dikea , Julie DeCesare Hanna Peterson , Vidrine Samantha , Floy Elizabeth 
Published: May 2017

INTRODUCTION:
The American College of Obstetricians and Gynecologists (the College) and the Centers for Disease Control and Prevention recommend the Tdap vaccination in the 3rd trimester of pregnancy in order to protect newborns from neonatal pertussis. The purpose of this study was to identify barriers to Tdap vaccination in pregnancy.

METHODS:
A multisite study was conducted at UF Health and Sacred Heart Hospitals in Florida. This study was performed in conjunction with the College's District XII Committee for Healthcare of Underserved Women. Admitted postpartum patients were offered a survey to complete on day of discharge.

RESULTS:
A total of 162 patients completed the survey. Forty-eight patients had private or government-sponsored insurance (TriCare, Medicare, VA) and 114 patients had Medicaid. Of private/gov-insured patients, 62.5% (30) received Tdap in the 3rd trimester compared to 21.9% (25) of patients with Medicaid. Of those who did not receive Tdap in the third trimester, 50% (6) of private/gov-insured patients cited education while 34% (21) of patients with Medicaid cited lack of access. Of patients who did not receive Tdap in the third trimester, 46.5% (53) of the Medicaid patients received it postpartum compared to 37.5% (18) of private/gov-insured patients.

CONCLUSION:
Patients with Medicaid insurance are less likely to receive the Tdap vaccine in the 3rd trimester than those with private or other government-sponsored insurances. In patients who did not receive Tdap, those with Medicaid cited lack of access as the primary reason they did not receive the vaccine while those with private/gov-insurance cited education-related reasons. Tdap vaccination rates in pregnancy could be increased by improving both education and access to patients.
Long-Term Skills Retention After Obstetric Simulation Training for Skilled-Birth Attendants in Rural Rwanda [9D]
Authors: Pimentel Veronica Maria , Rwab Denis , Gahima John , Rulisa Stephen , Bernstein Peter S. , Nathan Lisa 
Published: May 2017

INTRODUCTION:
The World Health Organization advocates for the presence of attendants at every birth skilled at managing normal pregnancies and obstetrical complications. We aimed to evaluate the long-term skills retention gained by skilled birth attendants (SBAs) who completed a spontaneous vaginal delivery (SVD) and postpartum hemorrhage (PPH) simulation-training program.

METHODS:
A pre-post intervention study was conducted with a convenience sample of SBAs in rural Rwanda. Two separate groups of SBAs underwent initial simulation training with pre- and immediate post-testing. Group A had training in February 2013. Group B had training in February 2014. Simulation drills to assess skill retention were conducted in September 2015 for both groups. Participants were scored on communication, evaluation, and management skills. Median scores were calculated and the Wilcoxon signed-rank sum test compared the pre-training, post-training, and retention scores.

RESULTS:
68% (13/19) of SBAs in Group A and 53% (8/15) SBAs in Group B were available for the skill-retention evaluation. There were no demographic, experiential, or educational differences between groups. After training, both groups showed immediate improvement in almost all the areas evaluated. At 2 years, Group A showed significant falls in their scores in three of the areas evaluated while group B at 1 year demonstrated a decline in only one of the areas evaluated.

CONCLUSION:
Simulation training is an effective method for acquisition of SVD and PPH skills in low resource settings. Most skills were retained 1 year after the initial training, but lost after 2 years, which suggests that training should be conducted on a yearly basis.
The Effect of Uterine Size on the Failure Rate of NovaSure Radiofrequency Endometrial Ablation [11D]
Authors: Cantrell Laurel D. , Byck David , Bostwick Amelia 
Published: May 2017

INTRODUCTION:
Utilization of NovaSure endometrial ablation has been shown to be successful in treating menorrhagia. Little data exists describing NovaSure ablation failure. The purpose of this research is to determine variables most predictive of failure with NovaSure endometrial ablation.

METHODS:
A retrospective case-control study included 224 women who received NovaSure ablation between 2003-2014 at Memorial University Medical Center. 112 of these patients were identified as failures receiving a subsequent hysterectomy and the other 112 women were identified as control patients without a need for subsequent hysterectomy. Patient charts were accessed and reviewed to determine uterine measurements and the preoperative status of each woman including pre-operative pain and prior bilateral tubal ligation. Using SPSS Statistical software, the data was analyzed.

RESULTS:
Mean uterine sound (p= 0.043) and mean cervical length (p= 0.049) were predictive of failure. Secondary analyses determined women with prior bilateral tubal ligation (p= 0.009) predicted failure with NovaSure ablation. Women who experienced preoperative pelvic pain trended toward failure requiring subsequent hysterectomy, but no statistically significant difference was noted (p= 0.073).

CONCLUSION:
Within the limitations of this study, a NovaSure ablation in women with a longer uterus and a longer cervix yields higher failure rates with subsequent hysterectomy. The data also supports the hypothesis that the presence of tubal sterilization is associated with increased risk of subsequent hysterectomy. Determining the significance of pre-operative pain will require further chart investigation. This study can help physicians better identify NovaSure ablation candidates that will be successful thereby improving cost efficacy.
Blood Loss During Voluntary Termination of Pregnancy: A Comparison of Anesthetics [12D]
Authors: Clare Camille A. , Shrestha Neela , Girshin Michael , Broumas Andre , Carmel Danielle , Inchiosa Mario A. 
Published: May 2017

INTRODUCTION:
Over one million pregnancies each year will end in termination of pregnancy. There has not been a study in the United States to indicate a clear association between intraoperative blood loss and choice of anesthetics. The purpose of this study is to determine if there is a difference in intraoperative bleeding with inhalational versus non-inhalational anesthesia agents for patients undergoing suction dilatation and curettage for first trimester voluntary termination of pregnancy.

METHODS:
This is an institutional review board approved retrospective chart review of the electronic medical records of patients undergoing voluntary termination of pregnancy between 5 0/7 and 14 0/7 weeks of pregnancy from 2012 and 2014 at the Metropolitan Hospital Center. Comparison of blood loss and anesthetic technique was done using the Mann-Whitney U Test. Blood loss was estimated by the operating gynecology physician.

RESULTS:
The mean intraoperative blood loss for inhalational anesthetics is significantly higher than with non-inhalational agents (p=0.007). Age, body mass index (BMI), gestational age at voluntary termination of pregnancy, or number of methylergonovine doses was not statistically significant between the groups.

CONCLUSION:
The difference in blood loss between the two types of anesthetic techniques may not be clinically significant in a healthy reproductive-age woman. These findings may be important for patients with significant anemia or at an increased risk of bleeding, such as those with coagulopathies. Limitations of this study include its retrospective nature, as well as the method of blood loss measurement.
The Effect of Partial Bladder Filling on Post-Operative Time to Void in Minimally Invasive Gynecologic Procedures [13D]
Authors: Moawad Gaby , Abi khalil Elias , Gilmore Taylor , Marfori Cherie , Vargas Maria , Ebert Jenna 
Published: May 2017

INTRODUCTION:
In urogynecologic procedures, backfilling the bladder with 300 cc has been shown to be a better predictor of successful post-operative bladder emptying than completely emptying the bladder at the end of surgery (1). The participants of this study were those undergoing GYN continence procedures, meaning they had some baseline urinary dysfunction. Our study attempts to see the effect on time to void in patients undergoing minimally invasive GYN procedures (laparoscopic or robotic hysterectomy or myomectomy) without baseline urinary dysfunction. The experimental group will have the bladder partially filled at 150cc and the control group will have the bladder completely emptied at the end of the procedure.

METHODS:
This is a double-blind randomized controlled trial. Sample calculations based on total time required to void after Foley catheter removal assuming an alpha level of 0.05 and beta of 0.8 indicate that 36 patients are needed in each group to determine a difference of 20 minutes in voiding time. Up to 38 patients will be enrolled to take into account a 5% dropout rate. Recruitment started on March 20,2016 with 32 patients recruited thus far.

RESULTS:
Preliminary comparisons between time to void in PACU and total PACU stay time between partially filled and empty bladder are as follows: 78-minute decrease in time needed to void in the PACU and 74-minute decrease in PACU stay time, respectively.

CONCLUSION:
This trial has potential to prove our hypothesis that partial bladder back-filling decreases time to void after minimally invasive benign gynecologic procedures, decreasing PACU length of stay and cost.
Pain and Sleep Around Hysterectomy: A Prospective Cohort Study [15D]
Authors: Levy Melanie , Meers Jessica , Stout-Aguilar Jacqueline , Kilic Gokhan , Borahay Mostafa , Nowakowski Sara 
Published: May 2017

INTRODUCTION:
Hysterectomy is the most frequent non-pregnancy-related major surgery in reproductive-aged women. Proper pain management represents a critical peri-operative goal. Although the association of chronic pain and sleep disorders is well known, the relation between perioperative pain and sleep is less studied. This study tested the hypothesis pre-operative sleep pattern would predict post-hysterectomy pain perception.

METHODS:
A prospective cohort study of women undergoing hysterectomy for benign conditions. Institutional Review Board approval obtained. Measures included: PROMIS-PI 3a (pain intensity), total sleep time measured by wrist actigraphy and daily sleep diary, and time awake after sleep onset measured by actigraphy and sleep diary. Sleep diary and actigraphy sleep variables were averaged over 7 nights preceding and 7 nights following hysterectomy.

RESULTS:
Sixteen women (41±7.3 years old) participated in the study. Repeated measures ANOVA revealed a significant increase from pre- to post-hysterectomy in actigraphy total sleep time (402±43.7 vs. 481±85.8 min, p=.023), and diary time awake after sleep onset (28±11.4 vs. 58±17.7 min, p=.014). Pre-hysterectomy diary total sleep time was negatively correlated with post-hysterectomy pain intensity (r=-.92, p=.01). Pre-hysterectomy actigraphy time awake after sleep onset was positively correlated with post-hysterectomy pain intensity (r=.86, p=.008).

CONCLUSION:
Findings indicated that sleep duration and disturbance increased following hysterectomy. Shorter sleep duration and more disturbed sleep before hysterectomy were associated with greater perceived pain intensity following hysterectomy. These findings suggest that pre-operative sleep interventions could improve pain perception and recovery following hysterectomy.
Outcomes Associated With Transfusion at Time of Hysterectomy [16D]
Authors: Maredia Subhratha , Crisp Catrina , Devaiah Ganga , Blanton Kim , Schuler Kevin M. 
Published: May 2017

INTRODUCTION:
Anemia is a common preoperative diagnosis in patients undergoing hysterectomy. In severe cases, perioperative blood transfusion may be necessary. This study describes perioperative risks associated with transfusion around the time of surgery.

METHODS:
This is a retrospective cohort study of women undergoing non-emergent hysterectomy between 2012-2014. The primary outcome was a comparison of complications in patients receiving transfusion and those that did not.

RESULTS:
Among 292 patients who underwent hysterectomy, 30 patients were transfused (10.3%). Factors associated with transfusion were preoperative anemia (10.6 gm/dL in patients requiring transfusion versus 13.0 gm/dL, P < .001), estimated blood loss (425mL vs 200mL, P < .001), and uterine weight (388g vs 100g, P < .001). Patients who received transfusion had a longer length of stay (4 days vs 2 days, P < .001), higher rates of readmission (23.3% vs. 3.4%, P < .001), increased rates of fascial dehiscence (10.0% vs 0.8%, P=.009), more frequent pelvic abscess development (6.7% vs 1.1%, P=.084), more often had venous thromboembolism (6.7% vs 0%, P=.01), and greater need for repeat surgery (13.3% vs 0.8%, P=.001).

CONCLUSION:
Preoperative anemia places patients undergoing hysterectomy at risk of needing blood transfusion. In this study, blood transfusion was associated with significant perioperative morbidity. Given these findings, aggressive preoperative management of anemia should be strongly considered.
Adverse Maternal Outcomes in Obese Women With Severe Preeclampsia [31C]
Authors: Teefey Christina P. , Durnwald Celeste P. , Srinivas Sindhu K. , Levine Lisa D. 
Published: May 2017

INTRODUCTION:
Our objective was to evaluate the rate of adverse maternal outcomes in obese compared to non-obese women with severe preeclampsia (PEC-S).

METHODS:
A retrospective cohort study of women greater or equal to 34 weeks gestation that were diagnosed with PEC-S from 2011-2013 was performed. Obesity was defined as BMI greater or equal to 30 kg/m2. PEC-S was defined by current guidelines from the American College of Obstetricians and Gynecologists. The primary outcome was a composite defined as one or more than the following: liver or renal failure, thrombocytopenia, abruption, blood transfusion, pulmonary edema, DIC, stroke, eclampsia, ICU admission. Chi-square analyses and Fishers exact test were used for categorical variables. Multivariable logistic regression was used to calculate odds.

RESULTS:
193 women with PEC-S were included: 100 (51.8%) non-obese and 93 (48.2%) obese. Obese women were significantly less likely to have the composite outcome compared to non-obese women (9.7% vs. 21.0%, OR 0.40 [0.17-0.93], p=0.03). This decreased risk remained after adjusting for race, mode of delivery, and parity; aOR 0.38 [0.16-0.94], p=0.035. Within the composite outcome, obese women were less likely to have a blood transfusion (p=0.04) and had a non-significant lower risk of renal failure (p=0.13). Obese women were more likely to require IV antihypertensive medication (p=0.03) and to be discharged on oral antihypertensive medication (p=0.08) compared to non-obese women.

CONCLUSION:
Obese women with PEC-S have a lower risk of adverse maternal outcomes than non-obese women with PEC-S. This may reflect a different, less severe, phenotype for PEC-S in obese women compared to non-obese women and warrants further investigation.