bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid Prescription and Patient Use Following Gynecologic Procedures [24D]
Authors: Griffith Kendall , Clark Nisse , Wright Kelly , Zuckerman Andrea , Ferzandi Tanaz 
Published: May 2017

INTRODUCTION:
Gynecologists play a significant role in post-operative opioid prescription. The aim of this study was to describe opioid distribution and patient use following gynecologic procedures, and to determine if physicians prescribe or patients use less opioids for minimally-invasive hysterectomy compared to abdominal hysterectomy (AH).

METHODS:
This study was composed of a physician survey on opioid prescribing practices following gynecologic procedures, and a retrospective patient survey on opioid consumption following hysterectomy.

RESULTS:
After AH, physicians prescribed a median of 30 tabs of oxycodone (5mg) (range 5-30, SD 6.1). After laparoscopic hysterectomy (LH) or vaginal hysterectomy (VH), physicians prescribed a median of 20 tabs of oxycodone (range 5-30, SD 6.0). Physicians prescribed significantly more opioids for AH compared to LH with a mean difference of 4.5 tabs (p=0.001). 40.0% of physicians prescribe narcotic after a hysteroscopy and 19.2% after a D&C. 56 patients consented to participate in the study when called. AH patients reported being prescribed a mean of 25.7 tabs and using a mean of 8.7 tabs (SD 10.9; 33.9% used). LH or VH patients reported being prescribed a mean of 24.2 tabs, and using a mean of 10.0 tabs (SD 12.2; 41.4% used). 16.1% used zero tabs, and 64.6% used less than half of the opioids prescribed.

CONCLUSION:
Most patients use less than half of prescribed opioids leaving the majority as surplus medication that is vulnerable to abuse. Future studies should prospectively assess opioid use following gynecologic procedures so that physicians can adapt to help curb the opioid epidemic.
Identification and Resection of Endometriosis Using Indocyanine Green [26D]
Authors: Hanna Mariam , McSorley Ashley , Tam Maria Teresa 
Published: May 2017

INTRODUCTION:
Endometriosis is a common cause of nonspecific pelvic symptoms, typically diagnosed through laparoscopic biopsies. An innovative technique utilizing indocyanine green (ICG), a dye that fluoresces in areas of increased vascularity such as endometriotic lesions, is used to diagnose normal-appearing, “clear” lesions of endometriosis. These lesions would have otherwise been missed by conventional laparoscopy.

METHODS:
A retrospective chart review and analysis included all patients on whom ICG was used from July 2014 to August 2016. Preoperative symptoms and postoperative localization of lesions were analyzed using the Fisher Exact test. Preoperative symptoms included abnormal uterine bleeding, pelvic pain, fibroids, and dyspareunia. Postoperative localization included lesions in the ovary, cul-de-sacs, vesicouterine peritoneum, pelvic peritoneum, uterosacral ligaments, and uterine serosa.

RESULTS:
Of 30 patients undergoing laparoscopic excision of endometriosis using ICG, twenty-one with positive fluorescence had endometriosis confirmed on pathology; eight with no ICG fluorescence had negative pathology results; and one patient had fluorescence with no identifiable endometriosis. This statistically indicates a positive predictive value of 95% with a sensitivity of 100%. The preoperative symptoms analyzed were not statistically significant for endometriosis, but clear lesions present in pelvic and vesicouterine peritoneum were statistically significant for endometriosis (p=0.001 and 0.01, respectively).

CONCLUSION:
Use of ICG fluorescence led to pathology-proven diagnosis in 29 of 30 patients. ICG is an inexpensive, non-toxic dye whose application could help change how endometriosis is diagnosed with minimal risk to patients. Future studies would benefit from larger patient recruitment by adding power to the analysis.
Obstetric Outcomes of Pregnancy Complicated by Marfan Syndrome: A Retrospective Cohort Study [28D]
Authors: Clennon Emily , Caughey Aaron B. , Teton Zoe , Shaffer Brian 
Published: May 2017

INTRODUCTION:
Marfan Syndrome (MS) effects 1/3,300 individuals in the US and confers significant potential for morbidity in pregnancy. Cardiovascular complications, namely aortic dissection, have been the primary focus of previous investigations of pregnancy in women with MS. This study aims to elucidate MS-associated obstetric complications.

METHODS:
This retrospective cohort study examined singleton, non-anomalous pregnancies recorded by the California Birth Registry from 2006-2010. Of collected pregnancies, 61 were complicated by MS as identified and defined by the registry. The remaining 2,039,809 pregnancies comprised the control group. Simple rates of 17 obstetric complications were compared between groups. Chi squared tests and multivariate regression were used for statistical analysis, with p < 0.05 as the cutoff for significance.

RESULTS:
Pregnancies complicated by MS were significantly more likely to result in preterm delivery (16.4%, p=0.04), neonates small for gestational age (13.5%, p=0.027), and neonatal hypoglycemia (3.3%, p=0.022). Postpartum hemorrhage was also more likely though not significantly (6.6%, p=0.079). MS was associated with significantly decreased likelihood of gestational diabetes (0.0%, p=0.043). Intrauterine fetal demise, neonatal death, deep vein thrombosis, and uterine rupture were absent in this cohort. Maternal length of stay was not significantly longer in pregnancies with MS.

CONCLUSION:
Our results indicate MS is associated with increased likelihoods of several obstetric complications and decreased likelihood of gestational diabetes. These findings are consistent with existing literature, though an association with neonatal hypoglycemia has not been described. Several other complications were notably absent despite being reported previously. Our findings strengthen limited literature on obstetric outcomes in pregnancy complicated by MS.
Academic and Community Partnerships: Telepsychiatry for Perinatal Depression in a Rural Setting [31D]
Authors: Acosta Tatiana , Meltzer-Brody Samantha , Tolleson-Rinehart Sue 
Published: May 2017

INTRODUCTION:
Perinatal depression is one of the most common complications of pregnancy, but limited access to mental health services in rural areas, especially those with underserved populations, prevents women from receiving appropriate care. Collaboration between academic institutions and safety net providers can bring effective mental health services to underserved communities through telepsychiatry. To date, telepsychiatry programs have proven successful in diverse populations, but few specific perinatal depression programs now exist. The present study examines the feasibility of collaboration among an academic institution, a federally qualified health center, and a local health department to implement a telepsychiatry program for pregnant women experiencing perinatal depression.

METHODS:
This study used literature review and in-depth structured interviews with members of the health care community who had experience as a provider or administrator in the delivery of perinatal care, mental health care, and/or telemedicine programs.

RESULTS:
Triangulation of data revealed that financial feasibility including physician reimbursement and cost of equipment and network, as well as provider/workforce capacity, are major barriers to implementation. The paucity of Spanish-speaking psychiatrists, and legal questions of licensing and credentialing are other barriers. Facilitators include any pre-existing relationships among these institutions and numerous opportunities for public and private grant funding.

CONCLUSION:
Existing partnerships between academic and community institutions provide a solid foundation from which to expand mental health services to rural communities. Despite partners’ marked willingness to collaborate, they must work to overcome financial, legal, and cultural barriers before we can expect a proliferation of perinatal telepsychiatry programs for underserved populations.
Case Report of Recurrent Sigmoid Volvulus in Pregnancy and Management Plan of the OB/GYN Hospitalist [35D]
Authors: Olds Scott-May , Wong Jennifer A. 
Published: May 2017

INTRODUCTION:
Sigmoid volvulus is a rare and dangerous surgical complication of pregnancy that has a maternal and fetal mortality rate of 6-12% and 20-26%, respectively. We present a case report of a 31 year old gravida 3 para 2002 female at 31 5/7 weeks who was diagnosed with a recurrent sigmoid volvulus and the management plan by the OB/GYN Hospitalist in coordination with General Surgery and Neonatology.

METHODS:
At 12 weeks gestation, the patient had an endoscopic decompression of a sigmoid volvulus. The patient then presented at 31 5/7 weeks with the triad of severe abdominal pain, distention, and obstipation consistent with recurrent sigmoid volvulus, as well as preterm contractions. Determining the timing of surgical intervention and delivery were essential for optimal maternal and neonatal outcome.

RESULTS:
Patient underwent supportive and betamethasone treatment for 48 hours. At this time, recurrence of severe abdominal pain and contractions resulted in urgent surgery. Cesarean section with B-lynch suture was performed to decrease uterine size in order to facilitate sigmoid volvulus evaluation and treatment by General Surgery.

CONCLUSION:
Mother and neonate were discharged home without significant sequelae. Worldwide literature review of volvulus in pregnancy including pathophysiology, clinical diagnosis, imaging guidelines, and surgical treatment will optimize the Laborist management of this rare third trimester complication.
Optimal Delivery Timing for Intrahepatic Cholestasis of Pregnancy (ICP) [36D]
Authors: Yu Xiaoqian , Chavan Niraj R. , McQuerry Kristen , Hansen Wendy 
Published: May 2017

INTRODUCTION:
While consensus exists regarding delivery timing for pregnancies affected by ICP, the differential impact of varying gestational age (GA) remains incompletely understood. This study evaluated the impact of GA at delivery in affecting maternal and neonatal outcomes in ICP.

METHODS:
We performed a retrospective cohort study of patients with ICP who were delivered at a tertiary teaching hospital from Jan 2008 to Dec 2015. The study cohort was divided into 3 groups: less than 37, at 37, greater than 37 weeks. We compared the maternal and neonatal outcomes using one way ANOVA and chi-squared / Fisher exact test for continuous and categorical data, respectively. Multivariable logistic regression analyses were performed to predict the likelihood of adverse perinatal outcomes while adjusting for sociodemographic, clinical and laboratory characteristics.

RESULTS:
Out of a total of 110 patients with ICP - 53 (48.19%) delivered at 37 weeks, with 28 (25.46%) and 29 (26.37%) patients delivered at less than 37 and greater than 37 weeks, respectively. Preterm delivery was significantly associated with higher bile acid levels, Hepatitis C, earlier diagnosis, lower Apgar scores, higher rates of hyperbilirubinemia, NICU admission, and length of NICU stay. Induction prior to 37 weeks resulted in higher cesarean rates, with vaginal delivery being higher for inductions ≥ 37 weeks.

CONCLUSION:
In our study, advanced ICP disease, often resulted in spontaneous preterm labor before a scheduled induction. Further prospective studies are warranted to characterize the influence of gestational age at delivery in modulating perinatal outcomes in ICP.
Optimal Management and Delivery Time for Intrahepatic Cholestasis of Pregnancy: Meta-analysis [37D]
Authors: Savasan Zeynep Alpay , Zeb Amna 
Published: May 2017

INTRODUCTION:
To determine the risk of adverse perinatal outcomes in patients with intrahepatic cholestasis of pregnancy (IHCP) with gestational age at delivery and treatment modalities.

METHODS:
A systematic search of MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials was performed. The inclusion criteria consisted of randomized controlled clinical trials (RCTs) consisting of ursodeoxycholic acid (UDCA) compared with other treatments like placebo, dexamethasone, cholestyramine and SMAe for IHCP.

RESULTS:
11 RCTs were eligible for analysis. Data was analyzed on 542 patients, of which 281 received UDCA and 261 received other treatments. Use of UDCA delayed gestational age at delivery by 6 days {SMD=0.59 (95% CI: 0.08-1.09); p < 0.001}. Risk for preterm delivery and NICU admission decreased in group treated with UDCA compared to other treatments {RR=0.52 (95% CI: 0.38-0.72); p < 0.001 and RR=0.53 (95% CI: 0.29-0.97); p=0.038}, respectively. Risk of adverse perinatal outcomes was decreased for delivery at 36 weeks {RR=0.59 (95% CI: 0.39-0.90); p=0.013} compared for delivery at 37 weeks. UDCA treatment decreased the risk of meconium staining and c-section with increased birth weight but these results did not show statistical significance.

CONCLUSION:
Treatment choice of IHCP should be UDCA and 36 weeks appeared to be the optimal time of delivery.​
Use of Interventions for Prevention of Serious Pregnancy Complications: Findings From a National Study in Ethiopia [15B]
Authors: Getachew Ashebir , Ricca Jim , Rawlins Barbara 
Published: May 2017

INTRODUCTION:
Reversing Ethiopia’s high maternal mortality ratio requires high access to interventions that address common causes of maternal deaths. We sought to determine levels of use of interventions and status of determinants of use that is needed by maternal health programmers.

METHODS:
We randomly selected 19 hospitals from a total list of hospitals in Ethiopia from which a total of 192 labors and 126 antenatal care counseling sessions were observed for use of interventions recommended by the World Health Organization regarding prevention of prolonged labor, postpartum hemorrhage, preeclampsia, & puerperal sepsis. Data on selected determinants of use were collected using key informant interviews & facility visits. Frequencies & means were computed using Excel software. Study was approved by Ethiopian Public Health Association & Johns Hopkins Bloomberg School of Public Health Ethical Review Boards.

RESULTS:
Only 41% of pregnant mothers were screened for preeclampsia; partograph & active management third stage of labor & infection prevention practices were used correctly in 13%, 28% & 85% of labors, respectively. Majority of providers have received in-service training on key interventions, availability of drugs was 85%. While national guideline is up to date, was not found in study health facilities.

CONCLUSION:
We found low use of interventions recommended for prevention of maternal complications. We recommend reviewing the quality of in-service training & availing national guidelines.
Obstetric Patient Self-Perception of Body Size and Obesity at First Prenatal Visit [2K]
Authors: Lutz Elizabeth A. , Street Kathleen , Simmons Kimberly , Furniss Anna 
Published: May 2017

INTRODUCTION:
The objective of this study is to evaluate (1) perceived body weight and body size of participants versus actual body weight and body size, and (2) participant application of recommended weight gain for themselves during pregnancy.

METHODS:
Potential study participants were identified at the initial prenatal visit and offered enrollment prior to triage. Thereafter a 13 question survey was completed with regard to perceived pre-pregnancy and current weight, body size, and knowledge of recommended weight gain for pregnancy. Subsequently actual participant height and weight were recorded and BMI was calculated.

RESULTS:
101 women completed the 13-question survey. Only six (13.6%) of the 44 participants classified as obese according to calculated BMI correctly identified themselves as obese; the majority (68%) classified themselves as overweight. This error in classification was statistically significant (p < 0.001) when compared to the non-obese population. 85 participants responded to questions regarding the estimation of recommended weight gain for their pregnancy. Calculated weight gain category was associated with inaccuracy regarding weight gain recommendations (p=0.02).

CONCLUSION:
Pregnant women who are obese may not recognize themselves as obese when asked to classify their body size. Compared to non-obese pregnant patients, obese pregnant patients are also more likely to over-estimate recommended weight gain for pregnancy.
Estimating Risk Factors for Cesarean Delivery in a Teenage Population [5K]
Authors: Oben Ayamo G. , Rodriguez Emma , Nkele Chika , Springer Lauren , Acosta Ometeotl 
Published: May 2017

INTRODUCTION:
Factors such as advanced age, increased body mass index, extremes of neonatal birth weight among others are predictors of delivery via cesarean section. However, some of these predictors may not applicable to a teenage population. As such, our objective was to identify modifiable predictors for prevention of the primary cesarean delivery, in a nulliparous teen population of a tertiary care center.

METHODS:
We performed a retrospective cohort chart review of all teenage deliveries (≤19 years old) at one institution over a 2-year period. The inclusion criteria were all singleton births from July 2014 to July 2016 among mothers at term who delivered via non-elective cesarean section. Exclusion criteria included fetal malpresentation, presentation to prenatal care at gestational age >20 weeks and pregnancies complicated by fetal anomalies.

RESULTS:
Of the 322 included deliveries, 14.6% delivered by non-elective C-section. The population was 90% Hispanic with a mean age of 17.7 years ± 1.31. Only neonatal birth weight was significantly associated with delivery via cesarean section in bivariate analysis and remained a predictor. Mothers of neonates with extremes of birth weights (< 2500, >4000 g) had higher odds of having a cesarean delivery, compared to neonates with normal birth weight (OR 4.7 95%CI 2.3 – 9.4 and OR 4.6 95% CI 1.1 – 19.4).

CONCLUSION:
Among adolescent nulliparous patients, birth weight of the neonate was found to be a risk factor that places the gravid teen at increased risk for cesarean delivery. Further research with a greater sample size over a 10-year period is under way.
Evaluating Severity of Postpartum Hemorrhage Retrospectively Based on Risk Factors [9K]
Authors: Amaya Stephanie , Mattox John , Tussey Christina , Kang Paul 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide. Currently, all patients receive oxytocin in the third stage of labor to prevent PPH. Several studies have identified risk factors for PPH secondary to uterine atony, but with little evidence to support additional prophylaxis for patients with these risk factors. Therefore, the objective of this study is to compare risk factors to determine which cause a more severe PPH.

METHODS:
Blood loss amount and risk factors were obtained from medical records of patients diagnosed with PPH between December 2011-to-December 2014 from Banner University Medical Center-Phoenix. Diagnosis was based on measured blood loss greater than 500 mL (vaginal delivery) or greater than 1000 mL (cesarean section (CS)). Only patients with uterine atony were studied.

RESULTS:
Among 366 patients, 254 and 112 delivered vaginally or CS, respectively. Using a multivariate linear regression, the estimated mean difference of blood loss during delivery demonstrated statistically significant increases with the following risk factors: fetal macrosomia (p=0.011), multiple gestation (p=0.043), parity (p=0.014), and prolonged labor (p=0.049). Patients who observed precipitous labor of less than 3 hours showed a statistically significant negative relationship of blood loss during delivery (beta= -225.7, p=-0.028).

CONCLUSION:
While these risk factors influence PPH occurrence, some may cause more severe PPH. Risk factors that cause over-distention of the uterus lead to a more severe form of hemorrhage compared to others such as use of oxytocin, chorioamnionitis, magnesium use, and preeclampsia. This provides evidence to support more aggressive prophylaxis in patients with these risk factors.
Evaluation of a Lateral Flow Assay Device for Detection of Urine Congophilia [11K]
Authors: Rood Kara M. , Davis Wendy , Locke Megan , Webster Shaylyn , Fowler Aubry , Buhimschi Irina A. 
Published: May 2017

INTRODUCTION:
In preeclampsia (PE), protein misfolding results in urinary protein aggregates with affinity for Congo-Red. Quantification of urine congophilia carries diagnostic and prognostic potential for PE. Transitioning this discovery to clinical practice requires converting research assays to standardized and technically reliable diagnostic tools. A newly developed rapid lateral flow chromatography assay (LFA) for urine congophilia addresses several limitations of the earlier generation assays. In this study we evaluated the agreement between the LFA device, the nitrocellulose Congo red Dot Test (CRD) Array and the paper-based CRD Simple Test.

METHODS:
71 urine samples were collected prospectively from women who were evaluated for PE. Fresh urine was applied to the LFA device (GestAssured™ test) and the CRD Simple Test. Results were scored using a chromatic visual aid. The CRD nitrocellulose array was run in the laboratory and the test result (% CRR, Congo Red Retention) was calculated using an automated protocol. A %CRR >15 was considered positive. Correlation and agreement among test results were recorded.

RESULTS:
The nitrocellulose %CRR values ranged from 0-89% with 40/71 measuring positive for urine congophilia (%CRR>15%). There was a significant difference in congophilia level between positive (%CRR: 60.4±3.0) and negative (%CRR: 4.8±0.7) specimens. The LFA device score correlated significantly with %CRR (0.865, P < 0.001) and CRD Simple Test Score (r=0.799, P < 0.001) with “excellent-level” agreement (kappa=0.86).

CONCLUSION:
The LFA test appears to be a reproducible, qualitative, diagnostic aid suitable for the clinic that detects PE-associated congophilia in urine, similarly to the CRD assays .
Venous Thromboembolism: Comparing Risk Assessment Tools for Postpartum Prophylaxis in a Teaching Hospital [12K]
Authors: Davis Brittany , Hadpawat-Lee Anita 
Published: May 2017

INTRODUCTION:
During the first 6 weeks postpartum, patients are 2.5 to 84 times more likely to have a venous thromboembolism (VTE). While risk is increased, the overall incidence of VTE is low, making the establishment of consistent VTE prophylaxis recommendations difficult. We identified population-specific risk factors and compared assessment tools and recommendations from the American College of Obstetricians and Gynecologists, American Academy of Chest Physicians, and Royal College of Obstetricians and Gynecologists. We also investigated adherence to our current VTE risk assessment tool and prophylaxis guidelines.

METHODS:
253 postpartum patients from our hospital were randomly selected and their charts reviewed to identify demographics, medical risk factors, hospital management, and postpartum complications.

RESULTS:
The most common risk factors in our population were a body mass index greater than or equal to 30 (59%) and Cesarean delivery (35%). Using the RCOG and ACCP guidelines, pharmacologic prophylaxis was recommended in 59% and 17% of patients, respectively. Appropriate utilization of our current VTE risk assessment tool yielded a recommendation for pharmacologic prophylaxis in 30% of patients. Our tool was only completed in 21-25% of patients and 6% of patients actually received pharmacologic prophylaxis.

CONCLUSION:
Significant variation in recommendations exist when applying published guidelines to our population. Our current assessment tool is underutilized and use of pharmacologic prophylaxis is lower than all available recommendations. Standardizing postpartum pharmacological prophylaxis guidelines may help decrease variations in practice and promote pharmacologic prophylaxis in patients at high risk of VTE, a leading cause of maternal morbidity and mortality.