bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes After Mini-Laparotomy for Tissue Extraction Following Laparoscopic Hysterectomy [19D]
Authors: Radtke Steven , Elkattah Rayan , DePasquale Stephen , Boren Todd , Mohling Shanti , Holcombe Jenny 
Published: May 2017

INTRODUCTION:
Recognizing the importance of specimen integrity for patient care and pathologic evaluation, we aimed to determine if mini-laparotomy for tissue extraction of large specimens following laparoscopic hysterectomy would yield compromised outcomes when compared with vaginal extraction.

METHODS:
A retrospective analysis including all benign laparoscopic hysterectomies over a two year period was performed. Patients were separated into two groups depending on whether specimen was extracted vaginally or via mini-laparotomy. T-student and chi-square tests where used to assure both groups were homogenous to age, BMI, history of cesarean delivery and presence of diabetes or hypertension. Differences in complications, operating time, EBL and length of hospital stay between groups were determined. This was done via chi-square analysis. In the case of EBL and operating time, MANCOVA was employed to adjust for differences in specimen weight.

RESULTS:
A total of 225 patients were selected for analysis. There were no significant differences between vaginal extraction (n=157) and mini-laparotomy (n=68) groups in terms of age, BMI, previous cesarean deliveries, presence of diabetes or hypertension. No significant differences regarding presence of intraoperative (0.6% vs 1.5% p= 0.43) or postoperative complications (15.3% vs 7.4% p=0.10) were found. After controlling for specimen weight, there was no significant difference between groups with regard to operating time (143.66min vs 180.16min p=0.12), EBL (73.07ml vs 107.32ml p=0.80), or length of hospital stay (1248.71min vs 1512.21min p=0.98).

CONCLUSION:
Mini-laparotomy for tissue extraction is a safe approach and does not appear to add morbidity to minimally invasive hysterectomies, while conserving an intact specimen.
Preventing Ovarian Cancer: What Every Woman Should Know [20D]
Authors: Moore Imari , Anderson Lisa 
Published: May 2017

INTRODUCTION:
The new paradigm of ovarian and pelvic serous carcinogenesis identifies the tubal fimbria as the origin of most ovarian cancer cases. With no effective screening modalities in place, women must have the opportunity to learn that the best means of reducing their risk is through prophylactic salpingectomy.

METHODS:
This was a prospective study to produce and test a patient-directed educational video with before-and-after knowledge questionnaires. The 4-minute video features a physician speaking about female reproductive anatomy, ovarian cancer, and the role of salpingectomy as a risk-reducing strategy. We recruited women attending the ambulatory OB/GYN clinics at our hospitals. We compared “before” and “after” responses with the McNemar’s test or the Cochran-Mantel-Haenszel method.

RESULTS:
We recruited 100 patients, one of which was excluded. Significant, positive results were obtained from all three questions that addressed the participant’s likelihood to consider salpingectomy after childbearing. For example, we asked “If you were to consider permanent sterilization now or in the future, would you prefer to have your tubes tied, or permanently removed?” Before the video, the ratio of “tied” to “removed” responses was 56/33; afterward, it was 14/81; p=0.001. In addition, patients were also significantly more likely to understand the role of salpingectomy after the video, and to report a better understanding of ovarian cancer overall. Significant learning was demonstrated by 13 out of 15 questions.

CONCLUSION:
This is an important learning tool, proven to work, which should be used and replicated so that all women know how to best reduce their risk of ovarian cancer.
Cost of Gynecologic Laparoscopy in Rural Western Kenya [21D]
Authors: Makin Jennifer , Ramanathan Aparna , Parkar Rafique , Burke Thomas , Eckardt Melody 
Published: May 2017

INTRODUCTION:
Despite its advantages, laparoscopy is not yet routinely offered in rural low resource settings in Kenya due to high capital investment. With increased focus on globally accessible surgery, smaller hospitals must weigh costs versus demand. We describe the cost of laparoscopic surgery in rural Western Kenya through review of an initial launch effort in September 2016.

METHODS:
Practicality was assessed through a retrospective cost analysis. Prices of equipment previously purchased for laparotomy were excluded. Cost saving tactics were reported. Prices were obtained through local medical supply companies and hospital management.

RESULTS:
The cost of the laparoscopic tower was 62,924.46 USD. The cost of a basic set of thirteen re-useable instruments needed to perform gynecologic laparoscopy was 13,063.70 USD. The mean cost of pre-intra and post-operative care per patient was 135.84 USD. Given mean hospital charges of 495 USD per patient for pre-, intra- and post-operative care, we calculated it is necessary to perform 212 surgeries within a year to return a profit. Cost saving tactics included donated equipment and reuse of equipment with chemical sterilization.

CONCLUSION:
Literature published regarding the cost of laparoscopy is conflicted. Laparoscopy requires a large initial investment. We advocate for careful consideration of patient volume, available donations, local suppliers and technical assistance before launching laparoscopy in a rural setting within a developing nation.
Prevalence of Leiomyosarcoma Following Hysterectomy at a Single-Site Institution [22D]
Authors: Chao Lisa , Lum Deirdre 
Published: May 2017

INTRODUCTION:
The U.S. Food and Drug Administration (FDA) issued a statement in April 2014 discouraging the use of power morcellation in women undergoing minimally invasive surgery for uterine fibroids, citing safety concerns regarding the potential dissemination of an occult uterine cancer. While it is estimated that between 1 in 400 and 1 in 1,000 women who undergo hysterectomy for presumed benign fibroids will be diagnosed with leiomyosarcoma (LMS), it is difficult to conclude the actual risk of an occult sarcoma. The purpose of this study was to determine the prevalence of LMS in patients that have undergone hysterectomy at Stanford University Medical Center, and to include all surgical approaches in this analysis.

METHODS:
Patients undergoing hysterectomy for benign and malignant gynecologic indications from January 2009 to December 2014 at Stanford University Medical Center were identified. The mode of hysterectomy along with relevant clinical and pathologic data were collected for this retrospective cohort study.

RESULTS:
A total of 909 hysterectomies were identified. The majority were performed by an abdominal route (69%), followed by laparoscopic (17%), robotic-assisted (13%), and vaginal (1%). Two patients were identified with leiomyosarcoma and two with occult sarcoma. Of the laparoscopic and robotic hysterectomies, morcellation was used in 26 patients. Of these, three patients had known endometrial carcinoma and contained morcellation was performed.

CONCLUSION:
The prevalence of leiomyosarcoma was 0.0022 in our population. As part of a multi-institution study, the long-term goal would be to understand prevalence rates in a larger population and develop risk-stratification to minimize risks of developing LMS.
Obstetrical Clostridium difficile Infection: A Retrospective Cohort Study [30D]
Authors: Ruiter-Ligeti Jacob , Vincent Sophie , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie 
Published: May 2017

INTRODUCTION:

Clostridium difficile infections (CDIs) occurring in pregnancy and the peripartum period have been reported with increasing frequency. The aim of this study was to evaluate the risk factors and morbidity associated with obstetrical CDI.

METHODS:
We performed a retrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The admission and delivery records of pregnant women were reviewed between 1999 and 2013. After adjusting for demographic data, the antenatal admission record and delivery outcomes of women with CDI in pregnancy were compared to pregnancies without CDI, using unconditional logistic regression.

RESULTS:
Of the total 12,592,178 births in our cohort, we identified 2757 admissions complicated by CDI. During the study period, the rate of antenatal admission for CDI doubled from 15 to 30 admissions per 100 000 deliveries per year (p < 0.001). Risk factors associated with CDI in pregnancy include: age over 35, multiple gestations, smoking, Crohn’s disease, ulcerative colitis, long-term antibiotic use, pneumonia, pyelonephritis, as well as cesarean or perineal wound infection. CDI in pregnancy was associated with a significant increase in maternal death (OR 56.82, 95% CI 35.83-90.10). Further, there was an increase in sepsis (OR 59.10, 95% CI 48.80-71.57), paralytic ileus (OR 33.08, 95% CI 27.51-39.78), venous thromboembolism (OR 8.14, 95% CI 6.52-10.16) and hospital stays greater than 2 weeks (OR 24.34, 95% CI 21.59-27.44).

CONCLUSION:
CDIs in pregnancy have increased over the last fifteen-years and are associated with significant maternal morbidity and increased mortality.
Cerclage for Management of Twin Pregnancies With Short Cervical Length: A Single-Center Retrospective Cohort Study [33D]
Authors: Behl Esha , Murphy June , Kazzi George , Abuzeid Mostafa 
Published: May 2017

INTRODUCTION:
Cerclage for prevention of preterm birth (PTB) in twin pregnancies with short cervical length (CL) remains controversial. The study purpose was to compare perinatal outcomes of twin pregnancies with short CL managed with cerclage vs no cerclage.

METHODS:
Single-center retrospective cohort study of twin pregnancies with transvaginal ultrasound (TVUS) CL less than or equal to 25mm between 16 and 24 weeks gestation from 2010 to 2016. Monoamniotic, anomalous, or aneuploid fetuses, and pregnancies with indicated PTB were excluded. Primary outcomes were mean gestational age (GA) at delivery, interval from diagnosis to delivery, and birth weight. Secondary outcomes were incidence of PTB less than 28, 32, 34, and 37 weeks, cesarean section, low Apgar (less than 7), and NICU admission.

RESULTS:
Twenty-two women were included, twelve managed with cerclage and ten without. Mean GA at delivery was significantly higher, 32.8 ± 3.59 vs 29.3 ± 5.31 weeks (P=.0122); interval from diagnosis to delivery was significantly prolonged, 96.58 ± 23.36 vs 51.1 ± 27.71 days (P=.0001); and neonatal birth weight was significantly higher, 1990.58 ± 670.06 vs 1477.35 ± 796.90 (P=.0252) in the cerclage vs no cerclage group. Incidence of PTB less than 34 weeks GA was significantly less 33.33% vs 80% (P=.0027) and low Apgar was significantly lower 4.17% vs 30% (P=0.0353) in the cerclage vs no cerclage group.

CONCLUSION:
Cerclage placement in twin pregnancies with short CL was associated with higher mean GA at delivery, prolongation of pregnancy by 45 days, and decreased PTB less than 34 weeks GA compared to no cerclage.
Ondansetron Use During Pregnancy for Nausea and Vomiting and the Risk of Preterm Birth [34D]
Authors: Coonrod Dean V. , Lueth Amir J. , Sullivan Scott A. , Lam Garrett , Boggess Kim A. , Hickok Durlin E. 
Published: May 2017

INTRODUCTION:
Nausea and Vomiting of Pregnancy (NVP) is a common condition affecting up to 80% of pregnant women. Risks of adverse pregnancy outcomes associated with anti-nausea medications have not been well studied. As one of the more common drugs administered for treatment of NVP, we investigated ondansetron use and risk of preterm delivery.

METHODS:
These data represent a secondary analysis of maternal pregnancy and fetal outcome characteristics from the prospective Proteomic Assessment of Preterm Risk (PAPR) study (2011-2013), where 5,501 pregnant women were enrolled between 17 and 28 weeks of gestation at 11 sites in the United States. Only women who consented to remain in the PAPR repository (n=3,563) were considered eligible and used in this analysis. Potential associations between exposed and unexposed women were investigated statistically by the use of Chi square and multivariate logistic regression.

RESULTS:
NVP was reported by 814 (23%) women consenting to remain in the repository. In these women ondansetron exposure prior to 290/7 weeks gestation occurred in 534 (66%) who were eligible for analysis. Women taking ondansetron experienced a PTB rate of 14.6% compared to 14.1% for those who did not (unadjusted OR 1.0 95% CI 0.1-1.4).

CONCLUSION:
The results of this study suggest that exposure to ondansetron was not associated with increased risk of PTB. However, the sample size in this study is relatively small and future studies should be performed in order to further investigate these findings.
Correlation of Blood Lactate Levels as a Predictor for Blood Transfusion in Postpartum Hemorrhage [14B]
Authors: Hoskins Iffath , Berg Robert 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage is an obstetrical emergency which requires aggressive volume repletion. Serum lactate levels are used in the management of trauma patients because they reliably indicate tissue hypoperfusion.

METHODS:
A retrospective chart review was performed from June 01, 2013 through Sept 30, 2016 in patients undergoing an Obstetric Hemorrhage Team (OHT) alert, defined at our institution as a quantified blood loss of 900 cc after vaginal delivery and 1500 cc after Cesarean section. Stat venous lactate levels were correlated with hematocrit levels, vital signs (BP and pulse), urine output, crystalloid fluid resuscitation and blood transfusion.

RESULTS:
There were 1314 OHTs. Of these, 891 patients had venous lactate values. When the venous lactate level was “elevated”, i.e. 4.0 (range 3.4 to 6.6), 632 patients (71%), required at least one unit blood transfusion in addition to the usual resuscitative measures, (statistically significant). Of these, only 347 patients (39%) were hemodynamically unstable (BP less than 60/40 and/or pulse rate greater than 120 bpm); and only 276 (31%) demonstrated a 10 point hematocrit drop from the admission value. When venous lactate levels were “normal”, i.e. 2.0 (range 1.6 to 3.2), only 80 (9%) required blood transfusions.

CONCLUSION:
Venous lactate is a reliable indicator of tissue hypoperfusion in postpartum hemorrhage, and may help to identify patients who, regardless of hemodynamic status or hematocrit level, would most benefit from blood transfusion during the management of this condition.
The Effectiveness of Simulation Training in the Management of Eclampsia [2D]
Authors: Kolmogorova Ekaterina , Wright Danielle , Taneja Mansi , Marko Emily , Nieves Kelsey 
Published: May 2017

INTRODUCTION:
Eclampsia is an obstetrical emergency of hypertensive disorders in pregnancy, which can lead to significant morbidity and mortality. The objective of this study was to demonstrate and quantify the effect of simulation training on knowledge, performance and confidence levels of providers in managing eclampsia.

METHODS:
A 3 month study was performed using 6 obstetrics and gynecology residents and a standardized simulation program with a high-fidelity manikin. Pre- and post-testing were performed using knowledge tests, validated performance checklists and confidence surveys. An interval performance assessment was conducted at three months to quantify retention of skills. Statistical analysis was performed using chi-squared analyses.

RESULTS:
Significant improvement was noted in all domains. Knowledge scores increased from 36.67% to 96.67% post simulation, p less than 0.0004. Performance assessment increased from 31.75% to 94.67%, p less than 000.1. Confidence levels demonstrated statistically significant improvements in all areas with the greatest in managing an eclamptic seizure, ordering eclampsia medications and managing magnesium sulfate toxicity, p less than 0.0001. Retention scores at 3 months indicated that performance remained strong at 91.67%, p less than 0.0001. Participant comments included the benefit of practicing this rare event in simulation which then occurred in real life the next day.

CONCLUSION:
Simulation-based training for eclampsia management improves knowledge, performance and confidence levels. Repeated simulation training demonstrates retention of learning. Simulation is a valuable tool in preparing physicians for managing eclampsia and maintaining knowledge and skills for when these rare emergencies occur in reality.
Transgender Men’s Experiences With and Perceptions of Gynecologic Care [10D]
Authors: Fein Lydia A. , Wong Adriana , Honorio David , Salgado Christopher J. , Medina Carlos A. 
Published: May 2017

INTRODUCTION:
Transgender men who have female reproductive organs and genitalia are in particular need of gynecologic care. OB-GYNs report a lack of training and knowledge in transgender health. In a national survey, only 29% were comfortable caring for transgender men. Additionally, transgender men report barriers to health care including negative interactions with physicians. This study was undertaken to assess transgender men’s experiences with, ability to access, and understanding of gynecologic care.

METHODS:
IRB approval was obtained to create and distribute an anonymous web-based and paper survey to a convenience sample of transgender men. Responses are presented as categorical data.

RESULTS:
Thirty-seven transgender men completed the survey. The mean age of respondents was 28.8 years old (18-59). Twenty-nine (78%) were insured. Most have been to a gynecologist at least once (81%), but only 38% (14/37) attended annual visits. Seven (23%) reported mistreatment by a gynecologist, and 59% (22/37) reported avoiding or delaying gynecologic care due to gender identity concerns. Seventeen (46%) recognized sexually transmitted infection testing as extremely important, but only 38% considered annual gynecologic care extremely important, while 27% and 19% considered routine cancer screening and the pelvic examination as extremely important, respectively.

CONCLUSION:
While nearly half of transgender men consider screening for sexually transmitted infections as extremely important, only 38% would go annually for evaluation. This disparity may further support claims of mistreatment and consequential distress associated with medical care. Efforts are needed to improve care for transgender men through education and elimination of mistreatment.
Effects of Group Prenatal Care on Connection to Site of Care [27D]
Authors: Crimmins Sarah , Lubsky Julia , Fahey Jenifer 
Published: May 2017

INTRODUCTION:
Centering Pregnancy, a form of group prenatal care, provides greater contact time and continuity of care with providers. We sought to determine if this approach impacts factors that serve as measures of affiliation with prenatal care site and prenatal care providers.

METHODS:
Retrospective case-control study at a single institution between 2012-2015. Individuals in group care were matched to controls in traditional care by gestational age at enrollment. Inclusion criteria included: greater than 17 years old and initiation of care at less than 16 weeks. Exclusion criteria included transfer to high-risk providers and miscarriage at less than 16 weeks gestation. Prenatal care, delivery, and postpartum information were collected on all participants. Outcomes of interest included: number of scheduled visits attended, institution at which delivery occurred, and attendance at postpartum visit.

RESULTS:
A total of 226 patients were included (124 cases and 101 controls). The gestational age at enrollment (9w5d v 10w3d) and gestational age at delivery (39w3d v 39w3d) did not differ between the groups. There was no significant difference between the percentages of prenatal care visits attended (80% vs 83.3%). Centering patients were significantly more likely to deliver at their home institution than controls (95.3% v 79.2%, p = 0.001). In addition, a significantly greater number of patients in group prenatal care attended a postpartum visit (81.1% v 68.3%, p = 0.03).

CONCLUSION:
Group prenatal care was associated with greater connection with home institution leading to increased number of individuals delivering at the home institution and attending a postpartum visit.
Evaluating Effect of New Secure Smartphone Texting Tool in Obstetrics [7K]
Authors: Feinberg Jacqueline , Shaw Sara , Kashyap Nitu , Campbell Katherine , Pettker Christian 
Published: May 2017

INTRODUCTION:
As hospitals consider adopting HIPAA-compliant smartphone-based messaging, it is necessary to determine impact. Small studies found texting reliable and efficient, but insecure for patient information. Literature is sparse on new HIPAA-compliant texting, with no relevant studies in obstetrics. We evaluated a new HIPAA-compliant texting system (MH-Cure by Mobile Heartbeat) implemented in obstetrics at Yale-New Haven Hospital in 2016 for perceived effect on care and workflow.

METHODS:
Before implementation, surveyed residents and nurses on effects of current communication system (pagers with text receiving, service mobile phones, personal cellphones) on clinical workflow and patient care. Following roll-out (1-month), teams were again surveyed with same questions. Surveys used both 5-point Likert scale and open-ended questions. Results compared using Student t-tests.

RESULTS:
In both resident (n=18) and nursing (n=47) domains, new communication tool was perceived to improve efficiency (improving from no effect to moderately effective (Residents: p < .001, Nurses: p < .001)) and enhance patient care (improving from minor negative impact to minor positive impact (Residents: p < .001, Nurses: p < .001)). Qualitative results strongly favor two-way messaging (60% of respondents mentioned) and indicate quick adoption (89% of respondents using) with concerns regarding new system's impact and connectivity during emergencies (35% of respondents mentioned).

CONCLUSION:
New text-based communication tool does not demonstrate subjective workflow interruptions, and may improve efficiency and care. Despite significant shortcomings, even in first month of implementation a system can demonstrate impactful benefits. We recommend teams implementing new technologies for communication plan, test, and communicate strategies to avoid implementation flaws during emergencies.
Evaluating Ethnic Differences in the Labor Curve in Arabic Women: A Retrospective Cohort Study [8K]
Authors: Morgan Dorcas C. , Al-Kadhi Asmaa 
Published: May 2017

INTRODUCTION:
Studies have described normal labor curves in nulliparous and multiparous women. Few studies have attempted to analyze data in regards to ethnicity. In this study we present the stages of labor of Arabic women in a community hospital labor and delivery unit.

METHODS:
We conducted a retrospective cohort study of term, singleton, vertex, laboring Arabic women from 9/2014-7/2016. Exclusion criteria: chorioamnionitis, multiple gestations, induction of labor, non-identifiable ethnicity, previous cesarean desired TOL, chromosomal abnormalities, IUFD and uterine surgery. Cervical dilatation was recorded from admission to delivery.

RESULTS:
354 patients were included. 34.5% were nulliparous with mean age 26.1± 4.7 years and neonatal birth weight of 3195.9±367.9 g. 38% had oxytocin. Mean cervical dilatation on admission was 4.2 ± 1.8 cm; the median time from 6-10 cm was 5.5 hours. The median length of second stage was 4.0 hours. 64.6% were multiparous with mean age 29.7 ± 5.1 years and neonatal birth weight of 3344.5 ± 406.3 g. 18.8% had oxytocin. The mean cervical dilatation was 4.7 ± 1.8 cm upon admission, and the median time from 6-10 cm was 3.7 hours. The median length of second stage was 2.1 hours.

CONCLUSION:
In historical comparison to Friedman's nulliparous, our nulliparous had a longer second stage and took our patient 5.8 h to dilate from 4-10 cm compare to 4 h and 5.3 h in Friedman's and Zheng's nulliparous respectively. Preliminary findings suggest standard management of labor may not apply in this population. Ethnic specific labor progression should be explored further.