bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Predictive Value of Myometrial to Endometrial Ratio in Type II Endometrial Cancer: A Case Series [16J]
Authors: Ahmed Rimsha , Estes Stephanie , Paroder Viktoriya , Frimer Marina , Kesterson Joshua , Phaeton Rebecca 
Published: May 2017

INTRODUCTION:
Endometrial cancer is the most common gynecologic malignancy in the U.S., classified by two histologic subtypes. Type II endometrial cancers are known to be non-estrogen dependent, poorly-differentiated, and with worse prognosis. Diagnostic imaging includes the use of transvaginal ultrasound (TVUS). Current guidelines don’t require further endometrial sampling if ultrasonography depicts an endometrial thickness of less than 4 mm. However, ultrasound alone could miss 4% of cancer diagnoses, since it often doesn’t correlate with histologic subtypes. This study aims to assess the ratio of myometrial to endometrial thickness obtained via TVUS in Type II endometrial cancer.

METHODS:
A chart review was performed at two academic centers, to identify all cases of Type II endometrial cancer from January 2009 to December 2014. Using pre-operative TVUS images, four distinct myometrial measurements were made in the longitudinal axis. The measurements were averaged and compared to thickness of the endometrium. Patients were excluded if myometrial or intracavitary lesions were noted.

RESULTS:
Out of a total of 103 cases of Type II endometrial cancer, 30 met inclusion criteria. Mean myometrial thickness ranged from 7.75 mm to 21.25 mm and endometrial thickness ranged from 2.4 mm to 37 mm. Thickness ratio of myometrium to endometrium ranged from 0.35 to 7.21, with an average ratio of 1.45.

CONCLUSION:
Type II histologic subtype of endometrial cancer presents with varying thicknesses of the uterine layers noted on TVUS. Significant variations in sonographic characteristics may result in delayed diagnoses compared to Type I endometrial cancers. Further research will be focused on directly comparing both histologic subtypes of endometrial cancer.
Provider Follow-up of Sexual Function in a Cohort of Pelvic Cancer Patients Treated With Radiation [20J]
Authors: Dutta Sonia , Garcia Bobby , Serna-Gallegos Tasha , Lane Felicia 
Published: May 2017

INTRODUCTION:
Survivorship and survival rates amongst women with pelvic cancers continues to improve. While enteritis and cystitis are known side effects of radiation, there is a lack of information regarding its effect on sexual dysfunction.

METHODS:
This was an IRB-approved study of females with a pelvic cancer who underwent radiation treatment between 2010-2015. Demographic and clinical variables, as well as radiation treatment specifics, vaginal dilator counseling and sexual function assessment, were collected through electronic medical record review. Logistic regressions were performed using SPSS Statistics software.

RESULTS:
In this convenience sample, records of 87 pelvic cancer patients were extensively reviewed (71 with gynecologic malignancy and 16 with colorectal cancer). The mean age of the cohort was 55.4 years, with mean parity of 2.6 and average BMI 27.79. Eighty five percent (74/87) of the cohort received external beam radiation and 41/87 (47%) had vaginal brachytherapy. Mean cumulative radiation dose was 63.5 gray. In this cohort, 38/87 (43.6%) had documentation of vaginal dilator counseling following treatment. This counseling was significantly associated with a prior urogynecologic diagnosis, vaginal brachytherapy and dosage of radiation. Sexual function was assessed in 20/87 patients (22.9%). Patient age, menopausal status, history of voiding complaints, use of vaginal dilators as well as post-radiation urogynecologic evaluation and vaginal estrogen use were significantly associated with sexual function evaluation by providers.

CONCLUSION:
Prevention of vaginal stenosis and assessment of sexual dysfunction following pelvic radiation is low. Increased counseling and treatment may improve our survivors’ quality of life.
The Impact of the Affordable Care Act on U.S. Maternal Mortality [21J]
Authors: Hope Shelley-Ann , Nunes Vanessa , Lambert Calvin , Miller Edward 
Published: May 2017

INTRODUCTION:
Between 2013-2014 the Maternal Mortality Rate in the United States was 21-22 per 100,000 - the worst among high-income countries. The World Health Organization attributes this in part to inadequate prenatal supervision. The Affordable Care Act (ACA) was fully implemented in 2014 and has provisions to increase access to health insurance and thus prenatal care. This study aims to determine any relationship between the 2014 implementation of the ACA on prenatal care attendance and maternal mortality.

METHODS:
State-level data from the Census Bureau and CDC was used to perform a multivariate logistic regression (ANOVA) on Percentage of Mothers Receiving Prenatal Care in First Trimester and Percentage of Uninsured Patients and their relationship to maternal mortality (MM) before and after the full implementation of the ACA nationwide.

RESULTS:
2014 data demonstrates a statistically significant relationship between MM and the percentage of uninsured patients with the ACA (r= 0.33, p=0.017) not found prior to the ACA implementation (2012: r=0.33, p=0.120) and (2013: r=0.17, p=.0214). A negative correlation between prenatal care in the first trimester with MM was statistically significant in 2012 (r=-0.402, p=0.011) and 2013 (r=-0.395, p=0.009) but this was increased in 2014 with ACA(r =-0.523, p = 0.0001).

CONCLUSION:
Preliminary analysis found a negative correlation between maternal mortality and percentage of prenatal care in the first trimester, this became increasingly statistically significant in 2014 with the ACA implementation. Similarly, a positive correlation was found between maternal mortality and percentage of uninsured patients by state that became statistically significant only after 2014 with the ACA implementation.
Hematologic Malignancy Recurrence in Female Reproductive Tract Seen on Routine Gynecologic Screening [25J]
Authors: Vyas Nina , Boitano Teresa , Battiwalla Minoo , Barrett John , Stratton Pamela 
Published: May 2017

INTRODUCTION:
Patients who undergo hematopoietic stem cell transplantation to treat hematologic malignancy are at risk of recurrent disease including myeloid sarcoma, an extramedullary collection of leukemic cells. Isolated extramedullary relapse after transplant in the form of a myeloid sarcoma is rare (< 1%). In women, the reproductive tract is often overlooked as a potential site of hematologic malignancy recurrence.

METHODS:
At our center, we assess women for symptoms of genital chronic graft-versus-host disease and conduct visual inspection of the lower reproductive tract, cervical cytology and human papillomavirus screening as part of post-transplant gynecology care. We present two cases of myeloid sarcoma occurring post-transplant isolated to the female reproductive tract and breast identified during routine gynecologic examination.

RESULTS:
The first case is a recurrence of mastocytosis manifesting as vaginal bleeding and cervical mass. The second is recurrent acute myeloid leukemia found in a large pelvic and bilateral breast granulocytic sarcoma.

CONCLUSION:
The sole manifestation of relapse of hematologic malignancy post-transplant may be a myeloid sarcoma in the reproductive tract or breast. Autopsies of women with acute myeloid leukemia show 36% and 40% involvement of the ovary and uterus, respectively — suggesting involvement of the female reproductive tract is more common than clinically suggested. Routine gynecologic care not only detects common post-transplant complications of human papillomavirus disease and genital graft-versus-host disease, but also is important to identify recurrent malignancy, potentially enabling earlier diagnosis and treatment.
Maternal Weight Retention Two Years After Delivery of a Baby: 2012 Los Angeles Mommy and Baby (LAMB) Follow Up Project [27J]
Authors: Sun Stacy , Chao Shin 
Published: May 2017

INTRODUCTION:
Postpartum weight retention can predict future weight gain and long-term obesity. This study identifies factors associated with weight retention two years after pregnancy.

METHODS:
We analyzed data from the 2012 LAMB Follow Up project. LAMB surveys Los Angeles mothers after a live birth. LAMB Follow Up re-interviews these same mothers shortly after the baby’s second birthday. A total of 3,488 mothers completed the 2012 Follow Up (63% response rate). Women with a subsequent pregnancy after the index baby were excluded leaving a final sample size of 2,049. Weight retention was defined as any weight gain between pre-pregnancy and 2 years postpartum. Logistic regression analyses were performed to identify differences in postpartum weight retention.

RESULTS:
Two-years after delivering a baby, women weighed an average of 7 pounds more than before pregnancy. After controlling for potential confounders, Latino mothers were 1.4 times more likely to have gained weight than whites (aOR=1.4, 95% CI=1.1-1.9); teens (< 20 years old) were 2.1 times more likely to have gained weight than non-teens (aOR=2.1, 95% CI=1.4-3.1); women who did not excise in the past month were 1.7 times more likely to have gained weight than those mothers who exercised 5 or more days/per week (aOR=1.74, 95% CI=1.19-2.6). There were no associations between weight gain and breastfeeding practice or perceived accessibility of healthy food.

CONCLUSION:
Postpartum weight retention was experienced differently among subgroups. Teens and Latino women had difficulty in returning to their pre-pregnancy weight compared to their older, non-Latino counterparts. Increased physical exercise was associated with improved weight loss.
Evaluating Transfer of Certolizumab Pegol and Polyethylene Glycol into Breast Milk [28J]
Authors: Thorp John , Clowse Megan , Förger Frauke , Hwang Caroline , Dolhain Radboud J.E.M. , Hale Thomas W. 
Published: May 2017

INTRODUCTION:
Breastfeeding women receiving anti-TNFs for chronic inflammatory disease face concerns surrounding their potential transfer into breast milk. CRADLE was the first sponsored study to evaluate certolizumab pegol (CZP) concentrations in breast milk and estimate CZP Average Daily Infant Dose.

METHODS:
CRADLE (NCT02154425) studied lactating mothers (≥6 weeks postpartum) receiving CZP. After ≥3 CZP doses, breast milk samples were collected across 1 dosing period (14 days for 200 mg Q2W; 28 days for 400 mg Q4W). Optimal analytical methods were developed to determine CZP and total polyethylene glycol (PEG) levels in breast milk.

RESULTS:
18 CZP-treated mothers were screened, and 17 entered the sampling period: 16 on 200 mg Q2W and 1 on 400 mg Q4W. 77/137 (56%) samples had no measurable CZP in breast milk. For 4/17 mothers, all samples were below LLQ. Estimated Average Daily Infant Dose was 0‒0.0104 mg/kg/day; median relative infant dose (RID): 0.125%. PEG was undetectable in 134/137 samples (3 had indeterminate results upon retesting). Infants of CZP-exposed mothers had a safety profile consisting of events occurring in unexposed infants of similar age.

CONCLUSION:
CZP was undetectable in 56% of breast milk samples. When detectable, CZP concentrations were < 3xLLQ (< 1% plasma concentration observed with therapeutic dose), indicating no/minimal CZP transfer from plasma to breast milk. RID was below 0.5% of maternal dose < 10% is considered unlikely to be of clinical concern. No transfer of PEG was observed. CZP absorption by infants via breast milk is unlikely, due to its low oral bioavailability and Fc-free structure. These findings are reassuring and support continuation of CZP treatment during breastfeeding.
Care-by-Parent as a Tool for Reduction in Neonatal Opioid Withdrawal Syndrome [37H]
Authors: Lawlor Megan , McQuerry Kristen , Chavan Niraj , Shook Lori , Critchfield Agatha 
Published: May 2017

INTRODUCTION:
Neonatal Opioid Withdrawal Syndrome (NOWS) is a significant public health problem. Care-By-Parent (CBP) is a model for mothers to room-in with their opioid-exposed infants during inpatient observation for postnatal development of NOWS. The purpose of this study is to determine if CBP is associated with a reduction in treatment-requiring NOWS.

METHODS:
We performed a retrospective, case control study of pregnant women enrolled in a combined prenatal and medication assisted treatment (MAT) program for opioid-dependent patients. Patients stable on MAT (as indicated by appropriate urine drug screen at Labor & Delivery admission) who participated in CBP were matched by gestational age, smoking and breastfeeding status with controls also stable in the combined prenatal/MAT program. Fisher Exact Test, ANOVA and logistic regression were performed. Primary outcome was diagnosis of treatment-requiring NOWS in neonates.

RESULTS:
Forty women met inclusion criteria (20 cases, 20 controls). There were no differences in age, gravidity, parity, birth weight, Apgar scores, or buprenorphine dose (P>.05). For the primary outcome, there was a statistically significant reduction in the rate of treatment requiring NOWS among cases vs controls (OR 0.08 95% CI 0.01-0.71). Significant difference was noted in patient time in program (cases vs controls, 19 vs 14 weeks, P=0.02) however, logistic regression demonstrated that the time in program did not affect the rate of NOWS (OR 0.99 95% CI 0.88-1.12).

CONCLUSION:
CBP significantly reduces the rate of treatment requiring NOWS. This approach decreases NICU admissions, increases maternal-child bonding and has the potential for alleviating maternal substance abuse patterns.
Epidemiological Surveillance of Teen Birth Rates in the United States 2006-2012 [19A]
Authors: Amin Raid , DeCesare Julie , Roussos-Ross Dikea 
Published: May 2017

INTRODUCTION:
To investigate the geographical variation in the average teen birth rates by county between 2006 and 2012 in the contiguous US.

METHODS:
SaTScan™, a software for disease surveillance and spatial cluster analysis was used to evaluate the spatial variation in teen birth rates and identify clusters with elevated relative risk. The analyses were first completed using unadjusted teen birth data. The data was then adjusted for percent poverty and percent high school diploma.

RESULTS:
The southern half of the US harbored most of the teen birth clusters in the unadjusted data set, and represented seven of the top ten cluster areas. When adjusting for poverty and high school diploma rate, the south still was the most represented geographical area, harboring four of the top ten clusters.

CONCLUSION:
Despite an overall national decline in the teen birth rate, clusters of elevated teen birth rates remain. These clusters are not random, and remain higher than expected when adjusted for poverty and education. This data set will provide a framework to focus targeted intervention implementation in order to reduce teen birth rates in this high risk population.
Can the Acting Intern Elective for 4th Year Students Teach and Assess APGO/CREOG Obstetric Competencies? [40C]
Authors: Garrison Etoi , Ruth Charles , Fambrough Jada , Mason Leilani , New Melinda , Goldberg Mack , Dewey Charlene M. 
Published: May 2017

INTRODUCTION:
The acting internship (AI) in Obstetrics provides 4th year medical students with progressive independence. Student learning is often self-directed and can be influenced by faculty teaching and patient volume. The purpose of this study is to determine if the AI elective enables students to manage an intern-level patient census and if the course is successful at teaching and assessing milestone level l APGO/CREOG preparation for residency competencies.

METHODS:
One AI student/month was enrolled during 4 consecutive months in the 2015-2016 academic year. The hospital database was retrospectively reviewed to identify all OB patient notes electronically linked to the AI students (n=4) and interns during the study period. All student notes (n=245) and formal assessments by faculty were reviewed.

RESULTS:
1485 patients were admitted during the 4 month study period. There were no statistically significant differences in the number of progress notes and vaginal deliveries attended by the AIs and interns (P>0.05). The AI students entered fewer discharge summaries, H&Ps, and patient care orders compared to the interns (P<0.05). Students were exposed to 6 of 10 APGO/CREOG procedural objectives and 8 of 12 APGO/CREOG knowledge objectives in OB. Limited objective information however, regarding student knowledge and procedural skills, could be obtained to support entry level mastery of these competencies.

CONCLUSION:
The traditional AI offered students sufficient procedural volume however documentation of OB knowledge and procedural competency was limited. Future studies will determine if the addition of formal curricula to teach APGO/CREOG entry level competencies improve knowledge and procedural skill.
Contraception Use in Reproductive-Age Women Taking Warfarin: A Retrospective Chart Review [40L]
Authors: Webster Carolyn , Morse Jessica E. , Bhatti Khadijah 
Published: May 2017

INTRODUCTION:
Reproductive-age women using oral anticoagulation have unique contraceptive and gynecologic needs due to teratogenic and bleeding risks.

METHODS:
This is a retrospective chart review of reproductive-age women taking warfarin in a university outpatient setting. Electronic medical record (EMR) query identified 18-44 year-old women who were prescribed warfarin and seen in a University of North Carolina primary care clinic during the 18-month study period. Outcome data were obtained by EMR query and chart review. The primary outcome was documented contraceptive method; secondary outcomes were gynecologic referral and method provision, adverse bleeding events, and unintended pregnancies. Primary analysis was descriptive; chi-square was employed for secondary analysis.

RESULTS:
Fifty-six women met inclusion criteria, yielding 65 separate patient-courses of warfarin. Contraceptive method was documented in 83%; the most common being intrauterine devices (30%) and abstinence (24%). Contraceptive method was documented in only 19% of initial primary care visits after warfarin initiation. For those without active gynecologic care, 38% (23/61) were referred to an obstetrician/gynecologist; 74% attended these consultations. Fourteen additional patients self-referred. Among women who attended general gynecologic consultation, 52% left with Tier 1 methods. Gynecologic consultation was associated with greater use of more effective contraception (p=0.002). Three adverse bleeding events and one unintended pregnancy were encountered.

CONCLUSION:
Many reproductive-age women taking warfarin are not using effective contraception, leaving them susceptible to complicated pregnancies. Gynecologic consultation is associated with greater use of effective contraception in this population. Providers should be cognizant of these unmet needs, and systems established to supply necessary contraceptive counseling and provision.
Outcome Comparison Between Obese and Nonobese Patients With Singleton Gestations Following Cerclage Placement [38F]
Authors: Rodriguez Phillip Andres , Patwardhan Sanjay , Ebeling Myla , Sullivan Scott , Vessa Blake 
Published: May 2017

INTRODUCTION:
Cervical cerclage is an established treatment in preventing preterm birth, however, there are little data regarding the effect of obesity on cerclage efficacy. The primary purpose of this study was to identify the effect of obesity on preterm birth prevention in patients undergoing cerclage placement.

METHODS:
A retrospective cohort study was performed at a single teaching institute and included all singleton pregnancies that underwent McDonald cerclage placement between 2006 and 2014. The study group consisted of patients with a body mass index (BMI) greater than or equal to 30 kg/m2 and was stratified into obesity classes based on World Health Organization (WHO) criteria. The control group consisted of patients with a BMI less than 30 kg/m2. Additional variables included maternal demographics, progesterone use, cerclage indication, and maternal co-morbidities (hypertension, smoking, history of preterm birth and diabetes).

RESULTS:
326 deliveries were included. There was a statistically significant latency between non-obese and class III obesity in reaching 30 weeks gestation (70% vs 55%, P = .0477). There was no difference in delivery less than 37 weeks and no difference in neonatal outcomes (Apgar scores, intubation, ICU admission, interventricular hemorrhage). There was a significant increase of chorioamnionitis in class III obesity (47% vs 14%, P < .005). A non-significant increase in the rate of preterm premature rupture of membranes (PPROM) with increasing BMI class was observed.

CONCLUSION:
In patient’s undergoing cerclage placement, class III obesity appears to increase the risk of earlier preterm birth as well as antenatal maternal complications (PPROM and chorioamnionitis) however this had no impact on neonatal outcomes.
A Targeted Postpartum CBC Protocol for Uncomplicated Vaginal Deliveries [40H]
Authors: Ton Jessica , Waitner Matthew , Sheth Sheetal 
Published: May 2017

INTRODUCTION:
Prior to our study, a complete blood count (CBC) was collected on all delivered patients on postpartum day one, regardless of risk factor or mode of delivery. While a routine CBC may detect asymptomatic anemia, this practice is costly and inconvenient to patients without significant benefit. We established a targeted postpartum CBC protocol, which exempts patients with uncomplicated vaginal deliveries from a routine CBC.

METHODS:
The protocol was instituted for 30 days. Patients who had uncomplicated vaginal deliveries had only a CBC collected on admission. Patients who met the following criteria had a routine CBC drawn on postpartum day one: cesarean delivery; operative vaginal delivery; postpartum hemorrhage (estimated blood loss. 500 mL for vaginal delivery); admission hematocrit, 35 g/dL; chorioamnionitis; and preeclampsia; signs or symptoms of anemia.

RESULTS:
In 30 days, our institution had 226 deliveries. Using the aforementioned criteria, 113 patients were exempt from a routine postpartum CBC, demonstrating a 50% reduction in postpartum blood draws. Those with a hematocrit between 30 and 35 on admission were started on iron empirically. Of patients who were exempt from a postpartum CBC, none experienced signs or symptoms requiring a CBC, and none required blood transfusion or iron therapy. At our institution a CBC costs $117. Estimated cost savings per month is approximately $13,000/month, or almost $160,000/year.

CONCLUSION:
A targeted postpartum CBC protocol is an effective quality improvement measure that benefits patients and significantly lowers cost without proven additional risk.