bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting Abortion Provision Among Obstetrics and Gynecology Residents: A National Survey [6A]
Authors: Hammoud Nadine , Marko Emily , Nieves Kelsey 
Published: May 2017

INTRODUCTION:
Elective abortion is a widely performed procedure in the United States. The number of physicians who perform abortions however has decreased due to diminishing availability of training. The purpose of this study is to identify the factors associated with residents’ attitudes about providing elective abortion and whether personal beliefs influence residents’ willingness to be trained and perform these procedures.

METHODS:
Anonymous surveys were sent out to all obstetrics and gynecology residents. The survey included demographic information and rated factors influencing their decision to perform abortion using a Likert scale. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). The factors associated with abortion provision were compared using chi square analysis.

RESULTS:
Of the 201 respondents (67% response rate), 83% planned to perform elective abortion. In a multivariable analysis; religion, age, gender, ethnicity and marital status were found to be not statistically significantly associated with plans to provide terminations. Residents’ attitude regarding providing abortion was dependent on the reasons for abortion with the most influential being “pregnancy has potential medical risks on the mother” (OR 8.2; 95% CI 6-14.3) followed by “fetus with congenital anomalies” (OR 6.7; 95% CI 3.7-11.6) and “gestational age” (OR 2.3; 95% CI 1.6-7.9). “Recent laws regarding abortion” and “maternal age” were the least influential factors.

CONCLUSION:
Providing elective abortions is an important element of women’s healthcare. In order to optimize integration of abortion training into residency programs it is important to identify resident attitudes and obstacles to providing elective abortions.
Factors Influencing Contraception Use in Rural Haiti Women: A Mixed-Methods Pilot Study [8A]
Authors: Reyes Jasmin , Tukiainen Erica , Partovi Susan , Sridhar Aparna 
Published: May 2017

INTRODUCTION:
Haiti has the highest maternal mortality rate in the western hemisphere, which can be potentially reduced via family planning utilization. However only 31% of married women are using modern methods of contraception. We conducted a mixed-methods pilot study in rural Mussotte to understand the factors influencing contraception use.

METHODS:
20 women were given a structured questionnaire followed by a semi-structured interview. The study was approved by local hospital administration. The data was transcribed with interpreters, audio recorded, exported into excel, and analyzed using grounded theory technique.

RESULTS:
Majority of the participants were married (85%). Median gravidity was 3 pregnancies. 90% were not planning to get pregnant in the next year. However, only half of them were currently using modern contraceptive method. All women had heard of at least one type of modern contraceptive method, the most common being condoms and Depo-Provera. 90% of participants obtained contraceptive knowledge from a healthcare provider. More than half of the participants believed that family planning use was not good for their health. 74% participants believed that family planning would harm future offspring. Analysis of qualitative responses generated three main themes: 1) Menstruation changes influencing contraception use; 2) Concern for negative effects (miscarriage, stillborn, poor development) on future offspring/pregnancy; and 3) Shared decision-making between partners without concealed contraceptive use.

CONCLUSION:
Healthcare providers must consider counseling women to dispel myths about negative effects on future pregnancies. Setting realistic expectations about menstruation changes and other side effects may change the contraception uptake and discontinuation rates.
The Availability of Long-Acting Reversible Contraception Through Los Angeles County FamilyPACT Clinics [14A]
Authors: Natavio Melissa Faith , Brown Niquelle , Blotky Elizabeth , Van Horn Christine , Waters Caitlin , Nelson Anita 
Published: May 2017

INTRODUCTION:
Family Planning, Access, Care and Treatment (FamilyPACT) is a Medicaid waiver program in California that provides all methods of contraception without charge to uninsured women and men with family incomes below 200% of the federal poverty level. The program requires that FamilyPACT clinics provide all methods on site or by referral. Extensive efforts with training and education have been made to encourage use of long-acting reversible contraception (LARC), but only 13% of women use an implant or IUD. This study was designed to assess the availability of LARC methods in Los Angeles County FamilyPACT clinics.

METHODS:
A list of all 855 Los Angeles County FamilyPACT clinics was obtained through the program’s website, from which a random sample of 400 clinics was generated. Young female researchers posing as potential patients called each clinic to ask a scripted series of questions about LARC availability in that practice.

RESULTS:
Of the 400 clinics selected, 340 responded to callers’ questions; 284 accepted FamilyPACT. Of these clinics, 61% did not offer any LARC method; 15% offered all currently available LARC; and 6% offered same-day LARC placement.

CONCLUSION:
The majority of FamilyPACT clinics surveyed did not offer any LARC and very few offered same-day LARC placement, despite FamilyPACT Program’s efforts to increase LARC use.
Spousal Concordance in Knowledge of Contraceptive Methods Among Married Couples in Rural Maharashtra, India [17A]
Authors: Mody Sheila , Saggurti Niranjan , Silverman Jay , Donta Balaiah , Raj Anita 
Published: May 2017

INTRODUCTION:
This study investigates spousal concordance in knowledge of contraceptive methods among married couples in rural Maharashtra, India.

METHODS:
Current analyses used baseline data from N=1081 young married couples (aged 18-30 years) who participated in a family planning evaluation trial (CHARM) conducted in Maharashtra, India. Baseline surveys conducted separately with husbands and wives assessed demographics, contraceptive knowledge and use. Cohen’s Kappas (K) were used to assess concordance in knowledge of contraceptive methods for husbands and wives; Kappa correlation coefficients were defined as Poor < 0.00, Slight 0.00-0.20, Fair 0.21-0.40, Moderate 0.41-0.60, Substantial 0.61-0.80, and Almost Perfect 0.81-1.00 for the total sample, and stratified by modern contraceptive users and non-users.

RESULTS:
For males and females, respectively, the most commonly recognized contraceptives (reported by >60%) were female sterilization (90% and 82%), pills (90% and 85%), and male condom (96% and 61%), with males having greater knowledge than females. Concordance in knowledge was slight for all contraceptive methods except male sterilization (kappa=.21) and IUD (kappa=.27). Concordance analyses stratified by contraceptive use found fair concordance in knowledge of male sterilization (kappa=.29), IUD (kappa=.28), and injectables (kappa=.21) among contraceptive users, but slight concordance in knowledge across all contraceptive methods for non-users.

CONCLUSION:
There is low concordance in contraceptive method knowledge among couples in this study, but concordance is stronger for contraceptive users suggesting that couples’ shared contraceptive knowledge may support better use.
Zika: Preconception & Perinatal Opportunities in Los Angeles County (LAC) [21A]
Authors: Ramos Adriana , Ramos Diana E. 
Published: May 2017

INTRODUCTION:
In Los Angeles County, there are over 3.8 million men and women of reproductive age. Forty-seven percent of pregnancies in LAC are unintended, and rates are disproportionately higher among African American (67%) and Hispanic (56%) women. Because the Zika virus can pass from a pregnant woman to her fetus and cause potential harm, awareness and prevention of the virus is an urgent public health priority. The CDC recommends that health departments increase “access to and use of effective contraception” as part of preparedness for areas with Aedes species mosquitoes. Our aim here is to review the use of the most effective contraceptive methods used in LAC women who have already had at least one child.

METHODS:
3,500 women with at least one child completed a self-administered questionnaire focusing on their preconception and perinatal experience.

RESULTS:
28% are not using any contraceptive method. Of those using a method (2,400): 38.1% used condoms, 15.6% used pills, 14.8% used withdrawal method, 15% used permanent sterilization (10% with tubal ligation and 5.0% with vasectomy), 14.5% used intrauterine devices (IUD), 6.8% used rhythm method, 6.1% used Depo-Provera, and 1.7% used vaginal rings.

CONCLUSION:
With almost half of LAC births being unplanned and over 59% using less effective contraceptive methods, educating providers to place the most effective methods (LARC- IUD and implant) and informing the public on the most effective contraceptive methods can decrease neonatal Zika complications by preventing unplanned pregnancies. LAC is undertaking these activities to decrease the number of neonatal Zika cases.
Hormonal Contraception and Therapy Use in Breast Cancer Survivors: Do Recurrence or Mortality Risks Increase? [23A]
Authors: O'Meara Sara M. , Greer Danielle M. , Kram Jessica J.F. , Tjoe Judy A. , Dorton Benjamin 
Published: May 2017

INTRODUCTION:
Breast cancer survivors are advised to avoid hormone use for contraception or peri-menopausal or post-menopausal symptoms. This study assessed the recurrence and mortality risks of contraceptive and non-contraceptive hormone use in breast cancer survivors.

METHODS:
We retrospectively studied women aged 18-55 years who were diagnosed with stage I-III breast cancer during 2006-2015 and entered remission. Multivariable extended proportional hazards models, supporting adjusted hazard ratio (HR), overall survival (OS), and locoregional and distant recurrence probability estimation, were used to examine the time-dependent effects of hormonal contraception (pill, patch, ring, subcutaneous device, injection, intrauterine device) and non-contraceptive hormonal therapies (e.g., menopausal symptoms), while adjusting for time-invariant patient, tumor, and treatment effects.

RESULTS:
Following diagnosis, 3,134 (91.2%) patients used no hormones, 171 (4.98%) used hormonal contraceptives, 129 (3.75%) used non-contraceptive hormones, and 3 (0.09%) used both. Models incorporating patients who used hormonal contraceptives versus no hormones revealed recurrence risk did not differ between groups (HR: 0.78, 95% confidence interval [CI]: 0.34-1.80). Mortality risk also did not differ (HR: 0.52, 95% CI: 0.13-2.15), with 5-year OS rates of 0.97 (95% CI: 0.90-0.99) and 0.95 (95% CI: 0.94-0.96), respectively. In models incorporating patients who used non-contraceptive hormones versus no hormones, recurrence risk was similar (HR: 1.52, 95% CI: 0.77-2.99) but hormone users incurred greater risk of death (HR: 2.95, 95% CI: 1.70-5.09).

CONCLUSION:
Breast cancer survivors who use hormonal contraceptives are not at increased risk of recurrence or mortality relative to women who do not use hormones. However, those who use non-contraceptive hormones demonstrate greater mortality risk.
Public Interest in Essure Tubal Occlusion [29A]
Authors: Schertz Katherine E. , Balica Adrian , Stadler Christian , Bachmann Gloria 
Published: May 2017

INTRODUCTION:
In 2015 the FDA conducted a review on Essure after a significant number of patient complaints were reported. Multiple sources were used to gather information on adverse reports including social media through “social listening” [1]. We aim to quantify the number of web searches related to Essure and to correlate these findings with FDA complaints.

METHODS:
We used Bing Adwords, a web search tool to quantify the monthly number of searches for 2015 until July 2016. Search terms included: Essure, Essure procedure, tubal occlusion, tubal ligation. We also quantified the number of FDA complaints during the same time.

RESULTS:
The average number of monthly searches on Essure or Essure procedure was 5,849 in 2015 and 4,824 in 2016 (18% decrease). In September 2015 and March of 2016 the number of searches increased to 7,760 and 7,260 searches, respectively. Similarly, the number of FDA reports decreased from an average of 500 per month in 2015 to 380 per month in 2016 (24% decrease) [2]. Tubal occlusion and tubal ligation searches remained in the same range for 2015-2016.

CONCLUSION:
There was a similar decreasing trend for both the number of Essure searches and the number of FDA reports in 2016, suggesting that public interest in Essure began to decline after 2015. Web searches spiked during the FDA review and update in September 2015 and March 2016. This trend was not observed for tubal occlusion searches, perhaps because the general population does not use this term. This method could be useful for population health interest research.
Prenatal Video-Based Contraceptive Counseling and Postpartum LARC Uptake: A Randomized Controlled Trial [32A]
Authors: Staley Allison , Slough Laurel , Charm Samantha , Rowe Carleen , Zerden Matthew , Morse Jessica E. 
Published: May 2017

INTRODUCTION:
Increasing access to long-acting reversible contraception (LARC) in the postpartum period can improve inter-pregnancy intervals and possibly prevent some of the associated infant and maternal morbidities. Videos are understudied as a tool to improve postpartum LARC use. Our primary goal is to evaluate if a validated, evidence-based, free counseling video during prenatal care increases postpartum LARC use.

METHODS:
We randomized women receiving prenatal care at an academic obstetric clinic to receive LARC FIRST video contraceptive counseling or routine prenatal care. All participants received information on free LARC methods in the postpartum period. The primary outcome was LARC placement by 12 weeks postpartum, with a secondary outcome of overall contraception use at 12 weeks postpartum. The primary outcome was analyzed using chi-square testing and logistic regression.

RESULTS:
Eighty-four participants were enrolled. To date, 80 have reached the 12 week postpartum period, of which 63 (78.75%) have completed all follow-up. Thirty were randomized to view the LARC FIRST video; 33 to routine prenatal care. LARC placement by 12 weeks postpartum was 14/30 (46.66%) versus 10/33 (30.30%), respectively. Any contraceptive method use at 12 weeks postpartum was reported by 28/30 (93.33%) and 25/33 (76.76%) participants in the LARC FIRST video versus routine prenatal care groups. We anticipate completing data collection on remaining participants by 10/17/2016.

CONCLUSION:
Video-based contraception counseling improved postpartum LARC rates with high levels of satisfaction. Widespread use of the LARC FIRST video has the potential to improve prenatal contraceptive counseling and reduce rapid, repeat unintended pregnancy.
Preliminary Baseline Findings of the CALM (Comfort, Assurance, Language Model) Approach [37A]
Authors: Ginde Savita , Stempinski-Metoyer Kelly , Bridge Rebecca , Abraham Angel , Patel Ashlesha 
Published: May 2017

INTRODUCTION:
Concerns about pain during IUC insertion are common among women and limit acceptability of IUCs. This study evaluates pain associated with IUC insertion prior to CALM intervention implementation (presence of a support person dedicated to patient comfort, enhanced assurance, scripted gentle language).

METHODS:
Women ages 18-53 seeking IUC insertion were recruited for participation at two clinic sites. There are 110 women in the control group receiving standard of care procedures. We calculated mean VAS Pain Scores from a Pain Sensitivity Questionnaire, 2 pre-insertion scales, 5 time points during the procedure and overall, and 2 post-procedure scales. We calculated t-tests for binary variables, ANOVA for categorical variables, and linear regression for continuous variables.

RESULTS:
Participants received 77 Mirena and 32 Paragard IUCs. VAS scores were M= 32.2mm for pain sensitivity, M= 48.0mm for pain expected, M=49.7mm for post procedure pain, M= 51.7mm for entire procedure pain, and M= 53.8mm for IUC insertion pain. There was a moderately significant difference in post procedure pain means between parous and nulliparous women (p-val = 0.05) and provider reported procedure difficulty (p-val=0.07). Pain sensitivity mean and pain level during period significantly predicted post procedure pain (p-val < 0.0001).

CONCLUSION:
Nulliparous women had a greater mean VAS pain score than parous women, and more difficult provider experience had a greater mean VAS pain score. There is a linear relationship between both period pain and pain sensitivity with post procedure pain. This may allow us to identify those most at risk for painful IUC insertion.
Are Baseline Elevations in Reactive Non-Stress Testing of Diabetic Mothers an Indicator of Fetal Compromise? [4B]
Authors: Alekseyeva Farzana , Gimovsky Martin , Nazir Munir , Koscica Karen 
Published: May 2017

INTRODUCTION:
To determine if baseline fetal tachycardia in reactive non-stress test (NST) is an indicator of fetal compromise in diabetic pregnancies.

METHODS:
Retrospective analysis of 145 diabetic mothers including gestational and pregestational diabetics from 2013-2016. Demographics included age, BMI, race, and gestational age. We reviewed the NST of patients >34 weeks of gestation and within 7 days of delivery. Baseline fetal heart rate (FHR) and the presence of 15x15mm accelerations were noted. Outcome measures included mode and indications for delivery.

RESULTS:
Of 145 diabetic patients, 55 patients had a baseline >150bpm. 47 of them had reactive tracings. Of those 47 patients, 35 underwent cesarean deliveries (C/S) (74.4%). Two patients with baseline tachycardia were diagnosed with IUFD on subsequent testing. 17 of 47 C/S performed were for non-reassuring tracing (36.17%). In comparison, 92 of 145 diabetic patients had baseline FHR < 150 bpm. 68 of 92 patients had reactive tracings. Of these 68 patients, 40 underwent C/S (58.82%), 8 were for non-reassuring fetal heart tracing (11.76%). The C/S rate for non-reassuring fetal heart tracing was significantly higher in the diabetics with elevated baseline FHR and reactive tracings in comparison to those with baseline FHR < 150bpm and reactive tracings, P < 0.05.

CONCLUSION:
The C/S rate secondary to non-reassuring fetal heart tracings was significantly higher in diabetics with elevated baseline FHR than those with baseline FHR < 150bpm even in the setting of a reactive tracing. This may be clinically relevant in antenatal testing of diabetic mothers as it implies that elevation in baseline heart rate may indicate fetal jeopardy.
Diagnostic Testing Uptake After High-Risk cffDNA Results for Sex Chromosome Aneuploidy [11B]
Authors: Suhag Anju , Robbins-Furman Patricia , Monga Manju , Hollier Lisa , Ramin Susan , Van den Veyver Ignatia B. 
Published: May 2017

INTRODUCTION:
The phenotype of sex chromosome aneuploidy (SCA) is typically mild, except in fetuses with cystic hygroma/hydrops. We hypothesize that because the phenotype of SCA is variable, the uptake of diagnostic testing after positive cffDNA screening varies between different SCA. Our study aim was to describe the uptake of diagnostic testing after a positive cffDNA screen for SCA.

METHODS:
A retrospective study of singleton gestations and abnormal cffDNA results for 45,X, 47,XXY or other SCA from 10/2012 to 3/2016. Any unreportable and other positive cffDNA results were excluded. Based on cffDNA results, 3 cohorts were defined: high-risk for 45,X, 47,XXY or other SCA. Diagnostic testing was offered to all study subjects. Primary outcome was uptake rate of diagnostic testing by abnormal cffDNA SCA results in 3 groups. P-value of < .05 was considered significant.

RESULTS:
109 women met inclusion criteria. Demographics were similar in the 3 groups. The overall uptake of diagnostic testing after abnormal cffDNA for SCA was 22.9%. It was higher in 45,X cohort (36.7%) compared to 47,XXY (14.3%); none of the patients in “other SCA” cohort accepted diagnostic testing (P=.0004). The false positive and confirmation rate of suspected chromosomal abnormality was similar in 45,X and 47,XXY group (P=.68).

CONCLUSION:
Only 23% of women with positive cffDNA for SCA proceed with diagnostic testing. Of all SCA, the uptake is noted to be highest for 45,X. The increased uptake in 45,X may be due to a higher likelihood of abnormal ultrasound findings such as cystic hygroma. Further analysis of this observation is indicated.
Use of Gestational Surrogates for Women With Marfan Syndrome: A Cost-effectiveness Analysis [16B]
Authors: Clennon Emily , Caughey Aaron B. , Teton Zoe , Shaffer Brian , Amato Paula 
Published: May 2017

INTRODUCTION:
The potential for morbidity in Marfan Syndrome (MS) increases substantially with pregnancy. Though reproductive decision-making among Marfan patients has been described, costs and effectiveness of their reproductive options have not. This study compares costs and outcomes of pregnancy carried by women with MS to pregnancy carried by gestational surrogates.

METHODS:
A decision-analytic model was built using TreeAge software that compared use of surrogates and pregnancy in women with MS. Outcomes assessed included maternal cardiovascular complication (CVC), intrauterine fetal demise (IUFD), preterm birth, small size for gestational age, and neonatal death. Probabilities and costs were derived from the literature. Utilities were discounted by 3% across the lifespan to generate quality-adjusted life years (QALYs). Univariate and multivariate sensitivity analyses were performed to evaluate robustness of the model.

RESULTS:
In a theoretical cohort of 10,000 women with MS, pregnancy would result in 590 maternal CVCs, 22 IUFDs, 1681 preterm births, and 171 neonatal deaths. Use of surrogates would prevent 92% of maternal CVCs, 94% of neonatal deaths, and all but one stillbirth. Cases of preterm birth are also significantly reduced. Surrogate use would save $786,389 per woman and gain 0.11 QALYs. Cost effectiveness is maintained with high surrogacy cost and low success rate.

CONCLUSION:
Surrogate use for women with MS is cost effective and significantly improves obstetric outcomes. Benefits are robust in the face of high surrogacy costs due to reduction in maternal CVC and preterm birth. These findings should be used to underscore the importance of broadening health care financing for medically-indicated assisted reproduction.