bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Pilot Testing of Theory Based Comic for Intrauterine Device Information [25A]
Authors: Sridhar Aparna , Brown Alice , Roque Karen 
Published: May 2017

INTRODUCTION:
A growing number of comics are being published on health-related topics. Comics use narrative communication. Translation of lived experiences into stories can be powerfully illustrated through comics.

METHODS:
The intrauterine device (IUD) comic was developed with theoretical concepts of health belief model and social cognitive theory. We tested the validity of the comic with women’s health experts. With IRB approval, the content of the comic was pilot tested among patients with a cross sectional survey. In addition to demographic information, questions in the survey had patients rate the comic on a scale of 1-5 (5= most favorable) about different aspects of the cartoon.

RESULTS:
30 women who underwent an IUD insertion at student health center (mean age 24) evaluated the comic. The comic was ‘really liked’ by women (mean score 4.66). The content of the comic scored high (>4.5/5) when evaluated by patients for color, images, overall look, layout, ease of understanding the material, clarity of words and satisfaction with information. Participants strongly agreed (>4.4/5) that the comic was successful in providing information about the types of IUDs, its effectiveness, mechanism of action, risks and benefits in addition to the placement details. They strongly believed that seeing this comic prior to IUD insertion would be helpful.

CONCLUSION:
Given the growing popularity of comics for health education, comics for contraception education have promising future to become sustainable educational tool. We are disseminating these comics as booklets, webpages and mobile applications. A quasi-experimental study is being conducted to evaluate its effect on IUD knowledge.
Describing Postpartum Contraceptive Counseling and Patient Satisfaction at a Large Urban Academic Medical Center [26A]
Authors: Jou Jessica , Findley Molly , McMahon Lauren , Kapedani Arisa , Levi Erika , Benfield Nerys 
Published: May 2017

INTRODUCTION:
Postpartum contraception is a powerful tool for reducing unintended pregnancy and optimizing birth spacing. In 2014 we initiated a comprehensive postpartum contraception counseling and provision program at our institution and subsequently evaluated the prevalence of counseling, satisfaction with counseling, and uptake of postpartum contraception.

METHODS:
During their postpartum hospitalization, women completed a survey assessing perinatal contraceptive counseling timing, locations, content, and satisfaction, along with demographic and labor characteristics, and subsequent contraceptive plans and uptake. A chart review confirmed medical and demographic data. Descriptive statistics were obtained and logistic regression was used to evaluate associations.

RESULTS:
Our 156 participants were primarily young, primiparous, non-white and had public insurance. 93% of women reported receiving contraceptive counseling: 82% antenatally, 69% intrapartum, and 61% postpartum. There was no difference in counseling prevalence by age, race, parity, preferred language, mode of delivery, or insurance type. 97% of patients reported high satisfaction with their contraceptive counseling. Most patients (60%) felt that counseling in antenatal care was optimal; 6% preferred intrapartum counseling. At discharge, 93% reported a plan for contraception use. 58% were discharged with a prescription for contraception, had an implant or IUD placed, or injection administered prior to discharge.

CONCLUSION:
We demonstrate that near universal contraceptive counseling is achievable in a diverse and socioeconomically disadvantaged population. This leads to a high uptake of postpartum contraception with high rates of satisfaction. Women have a preference for antenatal counseling but provision of counseling at multiple time-points allows for greater access to, and satisfaction with, counseling.
Provider Counseling and Women’s Family Planning Decisions in the Postpartum Period [30A]
Authors: Goulding Alison N. , Bauer Anna E. , Bryant Amy G. , Stuebe Alison M. 
Published: May 2017

INTRODUCTION:
Provider counseling may influence women’s family planning decisions.

METHODS:
We conducted an anonymous, Internet-based survey of adult women regarding multiple topics, including prenatal/postpartum care and family planning. Participants were included if they delivered a singleton infant within the last 3-9 months and breastfed at any time. We used multivariable logistic regression to quantify the association between quantity of provider counseling (indexed as number of family planning topics from 0-6 discussed by a healthcare provider) and women’s decisions regarding contraception and birth spacing.

RESULTS:
From January to May 2016, 3,010 women completed the survey and met inclusion criteria. Among this group, 2,684 (89.2%) were white and 2,166 (72.0%) completed at least a four-year college degree. 1,417 (47.1%) desired an inter-pregnancy interval (IPI) greater than two years, and 599 (19.9%) used long-acting reversible contraception (LARC) or sterilization. The majority of women (n=1,595, 53.0%) had received counseling on 3-6 family planning topics (defined as “more counseling” in regression models). Women who received more counseling were more likely to use LARC or sterilization (AOR 1.32, 95%CI 1.08-1.61) but were not more likely to desire an IPI greater than two years (AOR 0.97, 95%CI 0.81-1.15). Desired IPI modified the association between provider counseling and contraception (P=0.06 for interaction): Among those desiring an IPI greater than two years, more counseling was associated with more use of LARC or sterilization (AOR 1.56, 95%CI 1.22-2.01), but this was not observed among those desiring a shorter IPI.

CONCLUSION:
Contraceptive decisions depend on both provider counseling and patient goals.
Assessing Immediate Postpartum and Postabortion Contraception KAP Among Healthcare Professionals in Kigali [34A]
Authors: Aimable Muzungu Munyamboneza 
Published: May 2017

INTRODUCTION:
Immediate postpartum contraceptive administration is thought to be safe, effective reducing unintended pregnancies. Health staff have influence on women’s contraceptive behavior; and their knowledge and attitudes about contraception can affect women’s contraceptive behaviors. Data are lacking about the knowledge, attitude and practice of contraceptive methods among health personnel in Rwandan health facilities. The present study is designed to assess the healthcare staff awareness of immediate postabortion and postpartum contraception knowledge in Rwandan health facilities including referral hospitals and district hospitals.

METHODS:
A descriptive cross-sectional study, using anonymous questionnaire was conducted in Rwanda referral hospitals; and 3 DH, recruiting in 240 health personnel all working in maternity departments, for a period of 9 months from August, 2014 to April, 2015.

RESULTS:
194 out of 240 healthcare providers working in maternity participated in our study. Overall, they show good attitude towards immediate contraception. The provision of immediate contraception was largely seen in referral hospital compared to District hospitals. 76% of the providers in District hospitals have never prescribed an immediate contraception. The most cited reasons for nonprovision of immediate contraception include lack of sufficient knowledge, concerns about side effects and possibility that the immediate contraception may not work.

CONCLUSION:
Healthcare staff in Rwanda have gaps in their knowledge regarding immediate postabortion and postpartum contraception. Their knowledge about the indications for prescription of immediate postabortion and postpartum contraception, and its side effects was inadequate. The continuous educational efforts for health staff should focus more on the specific aspects of contraception and patients’ needs.
Immediate Postpartum Contraception in Adolescents: Intention, Retention, and Repeat Pregnancies [35A]
Authors: Cizek Stephanie , Postlethwaite Debbie , Alabaster Amy , Greenfield Isabel , Gupta Pratima 
Published: May 2017

INTRODUCTION:
Rapid repeat pregnancy (within 2 years) among young women poses serious health consequences. Long-acting reversible contraception (LARC) is safe and effective, and available to women immediately postpartum at our institution. Our primary aim was to compare the rapid repeat pregnancy rate for young women (aged 13-24 years) initiating LARC immediately postpartum versus initiating LARC within 8 weeks of delivery, and LARC versus other contraceptive methods.

METHODS:
A retrospective cohort study was conducted of 592 young women with a live birth from 2011-2013 within our healthcare system. Logistic regression models were used to determine the odds of rapid repeat pregnancy.

RESULTS:
Women using short-acting or no contraception had higher adjusted odds of rapid repeat pregnancy compared to those using LARC (aOR 2.9, 95% CI 1.5-6.0; and OR 3.2, 95% CI 1.6-7.0). Immediate postpartum LARC initiation had higher odds of rapid repeat pregnancy versus LARC initiation within 8 weeks (aOR 2.2, 95% CI 1.0-5.0). The LARC removal/expulsion rate within 2 years was 46% with immediate postpartum placement and 36% with 8 week placement. Women receiving immediate postpartum LARC were more likely to be under 18 years old, had higher gravidity, and received primarily subdermal implants.

CONCLUSION:
Overall, postpartum LARC use among young women resulted in decreased risk of rapid repeat pregnancy compared to short-acting or no contraception. However, because of early LARC removal and switching to short-acting or no method, young women initiating LARC immediately postpartum were more likely to experience a rapid repeat pregnancy than those initiating LARC around 6-8 weeks postpartum.
Using a Predictive Model of Summative, Stratified Variables to Assess Risk for Postpartum Hemorrhage [5B]
Authors: Colvin Zachary , Dabbous Firas , Sulo Suela , Fournogerakis Rachel , Asado Nahren , Iannucci Thomas 
Published: May 2017

INTRODUCTION:
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality. A previous study (Dilla et al) showed statistically different hemorrhage rates among groups rated low, medium, and high risk, but each group had low overall hemorrhage rates.

METHODS:
From 9/2012-5/2013, women who delivered at Advocate Lutheran General Hospital at gestational age greater than 20 weeks were included in this retrospective case control study. Risk factors present on admission and during labor were given score of 1, 2, or 3 based on existing literature and recommendation by an expert panel. Each patient was labeled low, moderate, or high risk based on total score at time of delivery. Definition of PPH was considered estimated blood loss greater or equal to 500 cc for vaginal delivery, greater or equal to 1000 cc for cesarean section, or if uterotonic medications beyond standard Pitocin protocol were administered.

RESULTS:
Of 1227 women, 115 (9.37%) experienced a PPH. The incidence of PPH in each risk group was: low (7%), moderate (22%), and high (31%). The proportion of the total hemorrhages occurring in each group was: low (64%), moderate (32%), and high (3%).

CONCLUSION:
This predictive model was better at predicting PPH than previous studies. Future studies with larger patient populations are needed to validate these findings. This type of model using a summation of all risk factors prior to delivery may represent an improved way to predict and thus prevent PPH.
Diagnostic Testing Uptake After High-Risk cffDNA Screening [6B]
Authors: Suhag Anju , Robbins-Furman Patricia , Hollier Lisa , Monga Manju , Ramin Susan , Van den Veyver Ignatia B 
Published: May 2017

INTRODUCTION:
Introduction of cffDNA screening has decreased the rate of diagnostic testing and serum screening. We hypothesized that the uptake of diagnostic testing after abnormal cffDNA depends on the type of chromosomal aneuploidy suspected. Our aim was to evaluate the uptake of diagnostic testing in women with abnormal cffDNA screening.

METHODS:
A retrospective study of singleton gestations and any abnormal cffDNA results between 10/1/2012 and 3/31/2016. We compared 3 cohorts based on high-risk cffDNA results for (1) trisomies 21, 18, 13, (2) sex chromosome aneuploidies (SCA) and (3) other (no call, unreportable). Diagnostic testing was offered to all study subjects. Primary outcome was uptake of diagnostic testing by abnormal cffDNA results. P-value < .05 was considered significant.

RESULTS:
443 women met inclusion criteria. Mean age, rate of AMA and abnormal ultrasound were higher in trisomy group compared to SCA and other category. Uptake of diagnostic testing after a positive cffDNA result in this cohort was 31.6%. Women at high-risk cffDNA for trisomies were more likely to undergo diagnostic testing compared to SCA or other category (P=.02). Similarly, women with high-risk cffDNA for trisomies were more likely to be confirmed with diagnostic testing compared to SCA and other category (P < .0001). Diagnostic testing results in the last group were more likely to be normal or discordant from screen result.

CONCLUSION:
Diagnostic testing uptake is low overall but is higher in women with cffDNA screening results indicating high-risk for trisomy compared to sex chromosome aneuploidies or other category. High-risk screens for trisomies are more likely to be confirmed.
Heart Failure Symptoms in Pregnancy Related to Cardiac Structure and Function by Echocardiography [8B]
Authors: Sharalaya Zarina , Chang Patricia , Caughey Melissa , Ivester Thomas , Hinderliter Alan 
Published: May 2017

INTRODUCTION:
Pregnancy is associated with physiologic changes causing alterations in cardiovascular hemodynamics, sometimes resulting heart failure (HF) symptoms which should be distinguished as physiologic or pathologic. We hypothesized that pregnant women with HF symptoms are more likely to have a difference in cardiac structure and function as determined by transthoracic echocardiogram (TTE).

METHODS:
237 pregnant women with no known cardiac history underwent TTE and questionnaires in the 3rd trimester and five months postpartum. HF symptoms were classified using modified Boston criteria (MBS), National Health and Nutrition Examination Survey (NHANES), and New York Heart Association (NYHA).

RESULTS:
48 patients (18%) had HF symptoms by MBS, 56 (24%) by NHANES, 148 (62%) had NYHA Class III/IV symptoms, and 24 patients (10%) met all 3 criteria. Self-reported symptoms including lack of energy, early satiety, and palpitations were correlated with higher HF scores on all scales (P

CONCLUSION:
The 3rd trimester brings subtle changes in cardiac structure and function that may be associated with HF symptoms. While some pregnant women meet HF criteria based on symptoms and have corresponding differences on TTE, it is reassuring that these changes resolve postpartum and likely reflect physiologic changes in pregnancy.
Highlights of Morcellation and Sarcoma Incidence in German Patients Admitted for Uterine Fibroid Surgery [12B]
Authors: Mettler Liselotte , Abdusattarova Khulkar 
Published: May 2017

INTRODUCTION:
To assess the incidence and frequency of unsuspected cases of uterine sarcomas among patients undergoing surgery for benign uterine fibroids in Germany.

METHODS:
This was a retrospective single-center study at a university hospital. The records of patients with uterine fibroids and uterine sarcoma from 2003 to 2015 were reviewed.

RESULTS:
A total of 2,275 patients were included. Preoperatively, 2,269 patients had presumed benign uterine fibroids, and 6 patients had suspected uterine sarcoma. Among the 2,269 patients who underwent surgery for presumed uterine fibroids, only one patient (0.044%, 95% CI: 0.001%-0.25%) histopathologically revealed endometrial stromal sarcoma (ESS) after laparoscopic subtotal hysterectomy (LSH) with morcellation(48 years old). Six patients were diagnosed with uterine sarcoma preoperatively and underwent a direct open conventional cancer treatment. Histopathological analyses confirmed four cases of uterine leiomyosarcoma (ULMS) mean age 73.7 ± 3.9, one high-grade undifferentiated uterine sarcoma (HGUS), and one embryonal rhabdomyosarcoma (ERMS). Altogether, seven of the 2,275 women (0.31%, 95% CI: 0.12%-0. 63%) were diagnosed with uterine sarcomas over this twelve-year period.

CONCLUSION:
The frequency of unsuspected uterine sarcoma was 1/2,269 (0.044%) among the women who underwent myomectomies and hysterectomies to treat presumed benign uterine fibroids. The total incidence of uterine sarcoma was 7/2,275 (0.31%) among the women who had presumed uterine fibroids or a suspected uterine sarcoma before undergoing the surgical procedures. Shall we continue with unprotected morcellation.
High-Risk Pregnancy Support Group: Formative Work Toward Development of a Group-Based Intervention [13B]
Authors: Louis-Jacques Adetola , Torres Jessica , Vamos Cheryl , Marhefka Stephanie , Cain Mary A. , Wilson Ronee E. 
Published: May 2017

INTRODUCTION:
Prolonged antepartum hospitalization can negatively affect psychological health of pregnant women. Study aims were: 1) Describe recurring themes regarding factors that impact women’s wellbeing during prolonged hospitalization in pregnancy; 2) Identify potential intervention characteristics that are desirable to women for improving their prolonged hospitalization experience.

METHODS:
In this convergent parallel mixed methods study, women who were experiencing or had previously experienced prolonged hospitalization during pregnancy, as well as key staff members (physicians, nurses, social workers, and lactation consultants) provided quantitative (survey) and qualitative (interview/focus group) data. Descriptive statistics, analyzed using SPSS 22, compared patient sociodemographic and preferred intervention characteristics. Qualitative data were analyzed with Applied Thematic Analysis.

RESULTS:
Patient respondents (N=57) were mostly white (77%), non-Hispanic (86%), married (65%) and insured (96.5%). Patients and staff (N=8) described challenges to women’s wellbeing related to: a) language/cultural barriers; b) social isolation in hospital; c) limited and/or ineffective information sharing between staff and patients; and d) anxiety and stress regarding concerns about hospitalization and competing demands at home. Narratives suggest strategies for improving women’s experiences—including interventions that involve family/friends, changes in information sharing and increased on-site services to facilitate an improved experience.

CONCLUSION:
Women who experience prolonged hospitalization during pregnancy experience many challenges that may lead to increased stress, anxiety, and depression. Facilitating opportunities for informational, appraisal, instrumental and emotional support may mitigate negative emotional impacts, reducing maternal stress and psychosocial dysfunction. This critical groundwork will inform further development and implementation of a theory- and evidence-based intervention.
Use of Gestational Surrogates for Women With Eisenmenger Syndrome: A Cost-effectiveness Analysis [17B]
Authors: Clennon Emily , Caughey Aaron B. , Pare Emmanuelle , Farwell Jennifer , Amato Paula 
Published: May 2017

INTRODUCTION:
Eisenmenger Syndrome (ES) is regarded as a contraindication to pregnancy, however, women with ES continue to desire and attempt pregnancy despite risks to their health. This study compares costs and outcomes of pregnancy in women with ES to use of gestational surrogates in their pregnancies.

METHODS:
A decision-analytic model was built using TreeAge software that compared use of surrogates and pregnancy in women with ES. Maternal death and neonatal outcomes (intrauterine fetal demise, preterm birth, cerebral palsy, and death) were assessed. Probabilities and costs were derived from the literature. Utilities were discounted by 3% across expected lifespan to generate quality-adjusted life years. Univariate and multivariate sensitivity analyses were performed to evaluate robustness of the model.

RESULTS:
In a theoretical cohort of 1,000 women with ES, pregnancy would result in 360 maternal deaths, 100 stillbirths, 477 preterm births, and 157 neonatal deaths. In these pregnancies, use of surrogates would prevent 99% and 98% of maternal and neonatal death, respectively, and significantly reduce cases and costs of preterm birth and cerebral palsy. Use of a surrogate would save $518,255 per woman and gain 6.77 QALYs. Cost effectiveness is maintained if surrogacy cost reaches $150,000 and the surrogate is impregnated only 30% of the time.

CONCLUSION:
Use of surrogate mothers for those with ES is cost effective and significantly improves obstetric outcomes. These benefits are robust in the face of high surrogacy costs due to reduction in maternal mortality and preterm birth. These findings underscore the importance of broadening health care financing for medically-indicated assisted reproduction.
How Malpractice Cases Can Drive Your Safety Agenda [18B]
Authors: Mann Susan , Greenberg Penny 
Published: May 2017

INTRODUCTION:
Malpractice data is a valuable tool to understand the complexities of alleged medical error. The Comparative Benchmark System (CBS) is a national database with over 350,000 medical professional liability (MPL) claims from more than 400 hospitals and 165,000 physicians across the country. Communication was identified as a factor in 30 percent of 23,658 medical malpractice cases filed between 2009-2013 in CBS, and 1,056 or 5 percent of these cases involved obstetrics.

METHODS:
Applying a Clinical Coding Taxonomy to MPL cases provides insight into specific factors driving patient harm and financial loss. Analysis of OB communication claims identified that communication failures occur among providers and/or between providers and patients, and failure types vary during throughout management of pregnancy, labor, and delivery.

RESULTS:
Identified communication failures: Antepartum -35 percent of cases involve communication failures (lab results): 63 percent are provider to provider; 57 percent are provider to patient. Intrapartum – 41 percent of cases involve communication failures in labor management and treatment of fetal distress (handoffs): 79 percent are provider to provider; 32 percent are provider to patient. Second stage or Delivery - 35 percent of cases involving the performance of the delivery involve communication issues (failure to escalate): 73 percent are provider to provider; 43 percent are provider to patient.

CONCLUSION:
Using malpractice claims to identify the need to improve the communication skills of providers can improve care and potentially reduce future malpractice claims.