bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Twin Pregnancies in Women Age 45 or Older [30R]
Authors: Gerber Rachel , Fields Jessica , Barberio Andrea , Bodenlos Kimberly , Fox Nathan 
Published: May 2017

INTRODUCTION:
Singleton pregnancies in well-selected women 45 and older undergoing assisted reproduction have a high likelihood of successful pregnancies with an increased risk of hypertensive disorders of pregnancy. Our objective was to investigate outcomes of twin gestations in women age 45 or older.

METHODS:
Historical cohort of 97 women age 45 or older with twin gestations cared for by 2 referral centers between 2005-2016. Analysis included baseline demographic and clinical characteristics. Pregnancy outcomes included gestational age at delivery, hypertensive disease in pregnancy, gestational diabetes, and IUGR. Univariate analysis of association between patient characteristics and outcomes were performed using student t-test and chi square.

RESULTS:
Mean maternal age at delivery was 47.7 +/- 2.0 with 99% undergoing IVF and 95.9% using donor egg. Patients have low baseline rates of hypertension (6.2%), obesity (8.0%) and pre-gestational diabetes (1%). 40.2% of women developed preeclampsia, 45.8% developed IUGR, 14.5% developed gestational diabetes, and 13.4% had an indicated preterm birth prior to 34 weeks. On univariate analysis, No baseline risk factors were associated with the development of preeclampsia or IUGR. Women of white race had a decreased risk of indicated preterm birth < 34 weeks (8.2% vs. 29.2%, p=0.009) and a decreased risk of gestational diabetes (9.6% vs. 30.4%, p=0.014).

CONCLUSION:
Twin pregnancy in women age 45 or older is associated with high rates of hypertensive disease in pregnancy and IUGR but overall outcomes are reassuring. Twin pregnancy should not be discouraged in well-selected, healthy women age 45 or older simply due to age alone.
Over a Half Million Noninvasive Prenatal Tests: A Clinical Laboratory Experience [31R]
Authors: Khanna Adity , Almasri Eyad , Boomer Theresa , Wardrop Jenna , McCullough Ron , Cacheris Phillip 
Published: May 2017

INTRODUCTION:
We describe the clinical laboratory experience with the MaterniT® 21 PLUS test, including autosomal/sex aneuploidies and select subchromosomal deletions.

METHODS:
Over 500,000 samples from pregnant patients were submitted for NIPT at our CLIA-certified, CAP-accredited, appropriately state-licensed clinical laboratories in Morrisville, NC and San Diego, CA using genome-wide sequencing. The test includes aneuploidies for chromosomes 13, 18, 21, X, Y and selected subchromosomal events. Statistical analysis of this large patient cohort was undertaken.

RESULTS:
The predominant indication for testing in this large cohort was advanced maternal age, followed by ultrasound findings and positive serum screening. Overall positivity rates were 1.25%, 0.40%, and 0.20% for trisomies of chromosomes 21, 18, and 13, respectively. More than 22,000 cases (∼4.2%) were multifetal pregnancies. In 2015 the average turnaround time was 5.4 calendar days, and the test had a total non-reportable rate, including quantity of DNA not sufficient and technical failures, of 1.75%. Estimated performance based on ad hoc clinical outcome showed that sensitivity and specificity met or exceeded the original clinical validation studies. Additionally, positive predictive values (PPV) of subchromosomal findings for all events ranged from 65.3% - 100%.

CONCLUSION:
MaterniT® 21 PLUS offers pregnant patients accurate and reliable information about fetal aneuploidy status. This laboratory developed test has demonstrated positivity rates for trisomy 21, 18 and 13 that mirror those found in large studies on populations that underwent invasive testing. The addition of subchromosomal events has been shown to perform well, with high PPVs. Operational performance met or exceeded performance from the original clinical validation studies.
Parent Concordance and Fathers' Persistence Through Pregnancy in a Prenatal Program Sample [32R]
Authors: Robinson Nuriya , Jackson Ashaki , Celaya Anna , Saleeby Erin 
Published: May 2017

INTRODUCTION:
Single parent households are common and their impact is greatest in underserved communities where racial and ethnic minorities primarily reside. Paternal parental involvement has been shown to improve a child's behavioral, social and mental health, while their absence fuels school dropout, incarceration, violence and drug involvement. This study describes a father's intention for involvement in the pregnancy and the baby's life across different couple types.

METHODS:
Data was collected from interviews with pregnant women enrolling in MAMAs, a prenatal care program at a Los Angeles County Health facility, from December 2013 to August 2016. During the intake visit, demographic information was collected, including maternal and paternal race/ethnicity, relationship status, as well as the expressed or assumed paternal intentions for involvement during pregnancy and in the baby's life. A Chi-Square test examined father's intentions to persist through the pregnancy and the child's life among couples of the same (concordant) and different (discordant) racial and ethnic backgrounds.

RESULTS:
Of the 3259 women interviewed, 87.2% (n=2841) stated the father of the baby intended to be involved during and after the pregnancy. In pregnancies with discordant parents (16.4%), the fathers were less likely to want to be involved than in pregnancies with concordant parents (Chi-Square =10.15, P=0.001).

CONCLUSION:
Intentions for paternal involvement during and after pregnancy differ significantly based on parental race and ethnic concordance. Children with discordant parents are at higher risk for absent fathers. Pregnant women with discordant partners may benefit from increased social support during prenatal care and throughout the child's life.
Patient Attitudes Toward Exercise During Pregnancy [34R]
Authors: Lott Melisa , Schulkin Jay , Power Michael , Mackeen A. Dhanya 
Published: May 2017

INTRODUCTION:
Maintaining a healthy lifestyle during pregnancy includes engaging in 30 minutes of moderate activity most days of the week. We sought to determine the attitudes of pregnant patients towards exercise and their access to counseling regarding safe exercise options.

METHODS:
From December 2015 to May 2016, women receiving prenatal care completed an anonymous survey that included questions about their exercise habits and their exposure to counseling regarding physical activity recommendations.

RESULTS:
One hundred eighty women completed the survey: 96.1% were Caucasian and 45.0% were obese. Most women (80.3%) planned to do low-impact cardiovascular exercise during pregnancy. The average number of days/week that patients exercised regularly during pregnancy were quantified: zero days (21.2%); 1-2 (47.5%); 3-4 (20.1%); 4-5 (6.1%) and 5+ (5.0%). Nineteen percent of patients reported they were not counseled regarding exercise in pregnancy; 32% of patients that did not exercise prior to pregnancy reported they did not receive counseling. Approximately 32% of patients who exercised and 12% of those who did not exercise pre-pregnancy expressed interest in meeting with a personal trainer for an exercise counseling session. Of women that expressed interest in a personal training session, 20% reported not receiving any exercise counseling.

CONCLUSION:
Twenty percent of pregnant women were not adequately counseled regarding exercise. Twelve percent of patients who did not exercise prior to pregnancy expressed interest in a personal training session. This illustrates a population of women that is interested in and would benefit from further efforts, encouragement and education regarding physical activity that may not otherwise exercise regularly.
The Shrek Test: A Proxy for the Smurf Test? [36Q]
Authors: Conger Jason , Olney Alexandra , Browne Paul , Street Linda M. 
Published: May 2017

INTRODUCTION:
Preterm premature rupture of membranes (PPROM) is a significant contributor to preterm birth. Amnio-dye test is diagnostic. Indigo carmine is typically used but is currently unavailable. Indocyanine green has been safely used in neonatal invasive studies and may be a viable alternative.

METHODS:
Case report. 19 year old G1 presented at 26 3/7 weeks gestation with an amniotic fluid index (AFI) of 5.6 cm with report of minimal vaginal discharge. The fetus had normal anatomy and an estimated weight of 813 grams (33rd percentile). She was hydrated with no change in AFI, and evaluated for PPROM with speculum exam negative for fluid pooling, nitrazine reaction, and ferning. The patient was counseled, confirmed to have no iodide allergies and an amniocentesis was performed instilling dilute indocyanine green without complication. PPROM was confirmed with vaginal leaking of green fluid. Continuous electronic fetal monitoring following the procedure was reassuring.

RESULTS:
The patient and fetus remained stable until preterm labor ensued with delivery 23 days post-procedure. A viable male infant was born via spontaneous vaginal delivery at 30 3/7 weeks gestation with Apgar scores of 6 and 9 at 1 and 5 minutes respectively. Umbilical cord arterial blood gas was normal. The infant was admitted to the NICU due to prematurity and did require intubation. At submission, the infant is 4 days of age and requiring minimal ventilatory support with no additional complications.

CONCLUSION:
Indocyanine green may be an acceptable dye when diagnosis of PPROM is inconclusive via non-invasive testing.
Prevalence of Zika Virus Cases in the State of Texas [37Q]
Authors: Sullivan Adriana , Ramsey Patrick S. , Adesomo Adebayo , Cuvillier James , Ireland Kayla , Page-Ramsey Sarah 
Published: May 2017

INTRODUCTION:
Zika virus is an emerging national health concern due to its potentially devastating effects on pregnancy. It is of particular concern in Texas because it shares a physical border with Mexico where Zika virus is endemic. Additionally, the Aedes mosquito vector capable of transmitting Zika virus can be found in Texas. Our objective was to determine the prevalence of Zika virus infection in Texas.

METHODS:
We accessed the Texas Department of State Health Services publicly available information on current Zika virus cases through the Texaszika.org website. The information was analyzed for trends and patterns in geographic location and mode of transmission.

RESULTS:
As of September 22nd 2016, one hundred and ninety-six cases of Zika virus have been identified in Texas. Two cases were transmitted via sexual transmission, but all remaining cases were acquired from travel to endemic countries. No locally acquired mosquito-borne cases have been identified. Cases are most prevalent in Harris county (fifty-five cases), Dallas county (thirty-five cases) and Tarrant county (twenty-one cases), all of which are in metropolitan areas with international airports. There are six cases in counties that share the physical border with Mexico. A significant association was found between Zika cases and factors including metropolitan counties (P < .0001), counties with an international airport (P < .0001) and increased birth rate (P < .0001).

CONCLUSION:
Zika virus is a concern in the state of Texas. Nearly all Zika cases have been acquired through travel to endemic countries. The largest number of cases appear to be associated with metropolitan areas containing international airports.
Mobile Phone-Based Perinatal Depression Screening: Feasibility and Acceptance [15R]
Authors: Silver Richard K. , Kim J. Jo , La Porte Laura , Zagorsky Benjamin , Desmarais Elyse , Gibbons Robert D. 
Published: May 2017

INTRODUCTION:
Routine depression screening can identify the 10-20% of perinatal women affected by depression. The American College of Obstetricians and Gynecologists recommends screening as a standard of care. However, competing clinical care priorities and lack of standardized protocols have been cited as barriers to universal perinatal depression screening. Delivering outpatient screening via mobile health technology is a promising strategy introduced to bypass these barriers, but feasibility and acceptance must first be evaluated.

METHODS:
This prospective cohort study enrolled 160 pregnant and postpartum women. Participants received a text message prompt to complete the perinatal-calibrated version of the Computerized Adaptive Test-Mental Health™ (CAT-MH™) via a secure portal. Feasibility was defined as the ability to complete CAT-MH™ without technical difficulties. Acceptability was determined by direct survey patient via SMS.

RESULTS:
Overall, 67.5% (108/160) of participants completed the CAT-MH™ via mobile phone, with 57.5% of these completing at the first prompt and 5% of additional participants completing after each of the first and second reminder prompts. CAT-MH™ completion rates did not vary by race, ethnicity or marital status. However, privately-insured women were nearly twice as likely (OR=1.98, CI = 1.03-3.81) to complete the mobile CAT-MH™ as their publicly-insured counterparts. Of 67 women who completed both the mobile CAT-MH™ and the satisfaction survey, 72% described the experience as easy.

CONCLUSION:
Perinatal depression screening via mobile phone using the CAT-MH™ is both feasible and acceptable among perinatal women. To assess barriers to mobile screening prior to recommendation for routine clinical use, stakeholder interviewing, particularly among low-income women, is warranted.
A Review of Hormone-Based Therapies in the Treatment of Adult Acne: Safety and Efficacy [2A]
Authors: Trivedi Megha , Murase Jenny , Anderson Anna 
Published: May 2017

INTRODUCTION:
Hormone-based therapies which include combined oral contraceptives and spironolactone have been considered effective alternatives to conventional therapies for adult onset acne which has a high rate of treatment failure. Our objective is to provide a concise and comprehensive overview of the types of hormone therapy available for acne treatment and comment on their efficacy and safety profiles for clinical practice.

METHODS:
A systematic search using the PubMed Database was conducted with the following search terms “contraceptives,” “hormone therapy,” “spirinolactone,” “flutamide,” and “acne treatment.” “Polycystic ovarian syndrome,” “endometriosis,” and “hidradenitis supparativa” were excluded. Filters included human studies published after Jan 1, 2000. 236 results were then manually filtered using a systematic approach to yield 39 relevant studies.

RESULTS:
It was found that OCP’s led to significant reductions in lesion counts across all lesion types compared to placebo. No consistent differences in efficacy between different combined OCPs were found. In terms of risk, OCP users had a three times increased odds of VTE versus non-users in a recent meta-analysis (95% CI 2.46-2.59). OCP’s conferred slightly higher risk of breast cancer but reduced risk of endometrial and ovarian cancer. Spironolactone was also shown to be an effective alternative with few side effects.

CONCLUSION:
Combined oral contraceptives and spironolactone as adjuvant and monotherapies are safe and effective in patients with adult-onset acne that is refractory to conventional treatments. However, appropriate clinical exam, screening, and individual risk assessment especially for VTE risk must be conducted in order to maximize benefits of therapy for each patient.
Abortion Stigma Resulting From State-Mandated Abortion Consent Language: A Randomized Controlled Trial [10A]
Authors: Sonalkar Sarita , Gurney Elizabeth P. , McAllister Arden , Schreiber Courtney 
Published: May 2017

INTRODUCTION:
State-mandated abortion counseling requirements may direct women toward continuing a pregnancy. We sought to pilot-test our hypothesis that state-mandated abortion counseling requirements in Pennsylvania increase individual-level stigma.

METHODS:
Women presenting for abortion were randomized to complete the validated Individual Level Abortion Stigma (ILAS) scale either before (unexposed) or after (exposed) hearing the mandatory Pennsylvania Abortion Control Act (PACA) consent language via video. A sample size of 46 (23 per group) allowed us to detect a one standard deviation difference in mean ILAS score.

RESULTS:
From November 2015 to April 2016, 46 participants completed the study. All characteristics but one were balanced among the groups: the unexposed group had a greater proportion of low-income participants. The median ILAS score among all participants was 0.85 [IQR 0.6, 1.4]. Compared to the unexposed group, the exposed group experienced a significantly lower median ILAS score (0.75 [IQR 0.5, 1.05] versus 1.25 [IQR 0.7, 1.9], p=0.016). However, when controlling for participant income category in a multivariate analysis, the effect of the PACA consent language on stigma scores was no longer statistically significant (p=0.068).

CONCLUSION:
In this randomized trial, stigma scores were lower among women who heard the state-mandated abortion consent script when compared with stigma scores among women who had not yet heard the script, but this effect was confounded by participants’ income category. State-mandated consent processes intended to dissuade women from having abortions do not appear to increase perceived stigma; however, the effect of socioeconomic status on abortion stigma deserves further study.
Four-Year Efficacy and Safety of the Liletta® Levonorgestrel Intrauterine System [11A]
Authors: Thomas Michael , Chen Beatrice A. , Keder Lisa M. , Kimble Thomas D. , Jensen Jeffrey T. , Creinin Mitchell D. 
Published: May 2017

INTRODUCTION:
Liletta is a levonorgestrel 52 mg contraceptive intrauterine system (IUS) currently approved for contraception for up to three years based on an ongoing multicenter trial evaluating the product for up to seven years of use. We evaluated four-year efficacy and safety data for Liletta.

METHODS:
Women aged 16-45 years were enrolled and followed in the clinical trial. Women aged 36-45 years received the IUS for safety evaluation only. We assessed four-year pregnancy rates (by Pearl Index and life-table analysis) and safety outcomes.

RESULTS:
Successful IUS placement occurred in 1,568 (98%) women aged 16-35 years and 146 (97%) women aged 36-45 years, including 1,011 (57.7%) nulliparous and 438 (25.1%) obese women. Among women 16-35 years at enrollment, eight pregnancies occurred including one following perforation and one following expulsion. Six (75%) pregnancies were ectopic. The eight pregnancies included three nulliparous women and one obese woman. The Pearl Index in the first year was .15 (95% CI .02-.55). Cumulative life-table pregnancy rates through years two, three and four were .49 (95% CI .22-1.09), .60 (95% CI .28-1.26) and .78 (95% CI .37, 1.60). Perforation following IUS placement occurred in two (0.1%) women; both were diagnosed within the first year. Expulsion was reported in 63 (3.7%) participants, most (50 [80.6%]) during the first year of use. Pelvic infection was diagnosed in 12 (.7%) women. Only 38 (2.2%) women discontinued due to bleeding complaints.

CONCLUSION:
Liletta is highly effective and safe over four years of use in nulliparous and parous women as well as non-obese and obese women.
Acceptance and Continuation of Immediate Postpartum LARC: Experiences From a Texas Hospital [12A]
Authors: Huff Cristina Wallace , Holcombe Sara , Duret-Uzodinma Jenny , Dillaway Chloe , Hopkins Kristine , Potter Joseph E. 
Published: May 2017

INTRODUCTION:
Lyndon Baines Johnson Hospital in Houston, Texas began offering immediate postpartum placement of long-acting reversible contraception (LARC) in June 2014. We aimed to assess patient demand for this service, along with continuation and satisfaction at 3 and 6 months after delivery.

METHODS:
We conducted a cohort study of 199 postpartum women who delivered at this hospital. Publicly insured women aged 18-44 who delivered a healthy singleton, and wanted to delay childbearing for 24 months were eligible. Interviews were conducted face-to-face following delivery and by telephone at 3 and 6 months. Women receiving LARC postpartum, were asked about their continued use and satisfaction.

RESULTS:
Twenty-four women (12%) had an IUD placed immediately following delivery, and 46 (23%) had an implant placed before discharge. Forty-two (21%) had a sterilization before discharge, and 15 (8%) received an injectable. Another 10 participants (5%) said they would have accepted immediate postpartum placement of LARC, but it was not placed. Among the 170 women for whom we had complete follow-up data through 6 months, 62 were using LARC at baseline. 59 were using LARC at 3 months and 6 months. Two implants and one IUD were removed, and one IUD expelled. Of women continuing on LARC, 68% were very satisfied, and 21% somewhat satisfied.

CONCLUSION:
Acceptance of immediate postpartum LARC among low-income, predominantly Hispanic women is high. Continuation and satisfaction were also high, indicating that the Texas Medicaid rule change permitting reimbursement for postpartum LARC that went into effect in January 2016 could be of great benefit.
Survey of OBGYN Residents to Assess Awareness and Use of the U.S. CDC Medical Eligibility Criteria for Contraceptive Use [15A]
Authors: Marchin Angela , Isley Michelle 
Published: May 2017

INTRODUCTION:
The CDC created the US Medical Eligibility Criteria (MEC) for Contraceptive Use in 2010 to serve as a tool for provider guidance when counseling patients with various medical conditions on safe use of contraception. Our study sought to assess US OB/GYN residents’ knowledge and use of this tool and how they choose to use it.

METHODS:
All US OBGYN residency program coordinators were emailed and asked to distribute a link to our online survey to their residents. Descriptive statistics and Fisher’s exact test were used to analyze the results.

RESULTS:
Ninety responses were obtained. Of the respondents, 91% were aware of the MEC, and 82% had used them. Of those who had used the MEC, 61% used the free smartphone app. Of those who did not use the MEC, most used UptoDate or asked a colleague to obtain contraception counseling information. There was no significant difference in use of the MEC among programs with and without Family Planning Fellowships or Ryan Programs.

CONCLUSION:
Most respondents were aware of and using the MEC, most often the downloadable smart-phone app. Due to a low response rate, additional assessment of resident use of the MEC is needed to fully understand how to improve OBGYN awareness and use of the MEC.