bluuebunny/crossref_metadata_2025_split huggingface dataset:
Living in a Neighborhood With Limited Access to Broadband Internet Is Associated With Adverse Pregnancy Outcomes [ID 2683563]
Authors: Stamilio David M. , Kline David , Sakowicz Allie , Miller-Fitzwater Anna , Jensen Elizabeth T. , Cochrane Anna C. 
Published: May 2024

INTRODUCTION:
The internet is an essential tool for ensuring health care access and delivery. We aimed to estimate the association between living in an area with limited broadband internet access and specific adverse pregnancy outcomes.

METHODS:
We performed an electronic health record-based retrospective cohort study of pregnant people who delivered at a referral medical center between September 1, 2019, and June 1, 2022. Primary outcomes were preterm birth, low birth weight (less than 2,500 g) and birth weight z-score for gestational age. Neighborhood internet access was defined as the proportion of residents with internet access in the pregnant person’s census tract of residence, based on the 2020 American Community Survey estimate and determined by geocoding. We used multivariable logistic or linear regression analysis to estimate the independent effect of internet access and computed adjusted odds ratios (aOR) or mean differences with 95% CIs for a 5-unit increase in the proportion with internet access for a given census tract.

RESULTS:
Among 5,190 pregnant people included, 885 (17.1%) had a preterm birth, 728 (14.0%) delivered a low-birth weight neonate, and 515 (9.9%) had a small-for-gestational age neonate. After adjusting for relevant confounders, increasing internet access was associated with reduced odds of preterm birth (aOR 0.97; 95% CI, 0.93–1.00; P=.048), reduced odds of low birth weight (aOR 0.95; 95% CI, 0.91–0.98), and increasing birth weight z-score (Beta 0.02; 95% CI, 0.01–0.03).

CONCLUSION:
Living in neighborhoods with better broadband internet coverage was associated with reduced odds of preterm birth, decreased odds of delivering a low-birth weight neonate, and increasing birth weight.
Comparison of Obstetrical Randomized Controlled Trials in the United States and Abroad [ID 2683467]
Authors: Koelker-Wolfe Ellery , Whelan Anna R. , Moody Rachel , Gupta Megha , Wagner Stephen 
Published: May 2024

INTRODUCTION:
Research priorities and governing regulations differ between the United States and other nations (non-United States). This study compared the characteristics of U.S. and non-U.S. obstetric randomized controlled trials (RCTs).

METHODS:
Original research articles published in seven journals (NEJM, JAMA, The Lancet, AJOG, AJOG-MFM, BJOG, and Obstetrics & Gynecology) from 2017 to 2022 were examined, and all RCTs with an obstetric focus were analyzed. Studies were categorized based on whether they were conducted in the United States.

RESULTS:
Of 238 RCTs in this study, 110 (46.2%) occurred in the United States. Compared to non-U.S. studies, U.S. RCTs were more likely to be published in obstetrics and gynecology journals (90.9% versus 73.4%; P=.001) and to be multicenter studies (59.4% versus 29.9%; P<.001). U.S. RCTs had a smaller median sample size (172 versus 335; P<.001) and a shorter median study length (19.9 versus 28.9 months; P=.026). U.S. RCTs were less likely to study the antepartum period (P<.001), to have a primary outcome examining the fetus/neonate (11.8% versus 37.8%; P<.001), and to study preventative interventions (51.6% versus 68.9%; P=.011). There was no difference in intervention type (drug, behavior, procedure, or device; P=.96) or whether the trial had a positive result (6.0% versus 3.7%; P=.52) between U.S. and non-U.S. studies.

CONCLUSION:
U.S. RCTs had smaller sample sizes and shorter study lengths, perhaps because of multicenter recruitment. Despite being potentially more generalizable, U.S. studies are less likely to be published in general medical journals. Further research is warranted to pursue this discrepancy as broad dissemination of information is important for improving maternal and fetal outcomes.
Management of Fetal Hemolytic Disease Due to Anti-Rh17 With the D−Phenotype [ID 2683500]
Authors: Saikaly Kayla , Orzechowski Kelly 
Published: May 2024

INTRODUCTION:
The rare blood D− haplotype produces multiple Rh antibodies against red blood cell antigens such as anti-Rh17 or anti-Hr0 antibodies if a patient is sensitized to Rh antigens.

METHODS:
This report discusses successful management of a pregnancy in a 28-year-old woman with high anti-Rh17 titers leading to hemolytic disease of the fetus (HDFN). The combination of a D− allele and the weak D 45 allele has not been reported previously, and it may be that the hybrid allele expresses D antigen epitopes such that the D antigen is not weakened. During the studied pregnancy, the patient received plasmapheresis and intravenous immunoglobulin (IVIG) infusions along with intrauterine transfusions (IUTs) when absolutely necessary. She underwent uncomplicated repeat cesarean delivery at 32 5/7 weeks of gestation resulting in a female infant weighing 2,020 g. Patient informed consent was obtained for this case report.

CONCLUSION:
This patient with the D−/D− blood phenotype leading to anti-Rh17 antibodies after her first pregnancy was managed successfully. Her baby with HDFN and several instances of hydrops fetalis, was successfully managed and treated. The patient’s blood donations for IUTs and maternal plasma exchange therapies promoted efficiency and favorable outcomes for the baby, but did put the mother in an anemic blood range.
The Association Between Maternal Body Mass Index and Spontaneous Preterm Birth Among Patients Prescribed Vaginal Progesterone for Short Cervix [ID 2683530]
Authors: Steelman Morgan , Park Jiwoo , Wang Kelly Z. , Warren Leslie , Fox Nathan , DeBolt Chelsea A. 
Published: May 2024

INTRODUCTION:
Vaginal progesterone decreases the risk of spontaneous preterm birth (sPTB) and adverse neonatal outcomes in patients with short cervix (cervical length [CL] <2.5 cm) between 16 and 24 weeks. Few studies have assessed the efficacy of this intervention in patients with obesity. We evaluate the association between maternal body mass index (BMI) and sPTB among patients prescribed vaginal progesterone for short cervix.

METHODS:
This was an IRB-approved retrospective cohort study of patients prescribed vaginal progesterone for short cervix at Mount Sinai Hospital. Exclusion criteria included prior PTB, cerclage, or progesterone treatment in prior pregnancy, and multifetal gestation. Logistic regression models assessed the association between BMI categories (BMI less than 25, BMI 25.0–29.9, BMI 30 or higher) and PTB less than 37 weeks, PTB less than 34 weeks, and neonatal intensive care unit (NICU) admission adjusting for nulliparity, CL at diagnosis, and insurance status.

RESULTS:
Of the 210 patients included, 86 had BMI of less than 25 (41%), 72 had BMI of 25.0–25.9 (34.4%), and 52 had BMI of 30 or higher (24.8%), and 79 experienced sPTB (37.6%). Although BMI was not associated with sPTB less than 37 weeks, the odds of sPTB at less than 34 weeks among individuals with BMI of 30 or higher was 3.03 times the odds for those with BMI of less than 25 (95% CI, 1.13–8.14). The odds of NICU admission among those with BMI of 30 or higher is 2.82 times the odds among those with BMI of less than 25 (95% CI, 1.23, 6.46).

CONCLUSION:
This study demonstrates obesity is associated with sPTB at less than 34 weeks and NICU admission among those prescribed vaginal progesterone for short cervix. Larger studies are needed to evaluate the effect of BMI on efficacy of vaginal progesterone.
Neurologic Complication Rates in Obstetric Patients With Chiari Malformation Based on Mode of Delivery [ID 2683669]
Authors: Feldmar Blake , Nosova Kristin , Howard Erin , Bauer Isabel L. , Kellerhals Sarah , Nakaji Peter 
Published: May 2024

INTRODUCTION:
Chiari malformation (CM) describes inferior displacement of hindbrain structures. Because of the theoretical effects of labor on cerebrospinal fluid dynamics, CM alone has historically been suggested as a sufficient indication for cesarean delivery because of concern for herniation. However, existing literature is limited and does not demonstrate increased adverse outcomes of vaginal delivery in this population. This novel work utilizes a national dataset to describe neurologic complication rates in CM parturients in relation to mode of delivery.

METHODS:
The 2016–2018 Nationwide Readmissions Datasets were queried for obstetric patients with and without documented CM. ICD-10 codes were used to identify parturients who experienced neurologic complications relevant to CM. Univariate and multivariate analyses were performed to assess associations between CM and mode of delivery.

RESULTS:
11,021,188 parturients were identified, including 1,210 with preexisting CM. The primary cesarean rate was 50.7% (n=479) in CM parturients compared to 20% (n=1,823,650) in the general population and CM independently predicted cesarean delivery (OR 3.8, CI, 3.1–4.7). There was no significant difference (P=.87) in the rate of herniation based on delivery method in CM parturients. The incidence of stroke, myelopathy, and hydrocephalus was zero regardless of delivery method.

CONCLUSION:
There is no significant difference in neurological complication rates in CM patients based on delivery method, yet CM patients are more than twice as likely to undergo cesarean delivery. Data suggest that vaginal delivery carries minimal risk to CM patients and should be considered during clinical decision making. Future studies should stratify risk based on type and severity of CM.
Assessing Patient Experiences With Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics [ID 2683581]
Authors: Bhuiyan Julia , Loder Charisse 
Published: May 2024

INTRODUCTION:
Ensuring patient satisfaction remains an important objective for obstetrics and gynecology care. To address a research gap in this field, we aimed to assess patient satisfaction with culturally competent and respectful care in our obstetrics and gynecology clinics after initiation of diversity, equity, and inclusion programming.

METHODS:
From September 2021 to February 2022, we surveyed outpatient ob-gyn visitors about their experiences, using a 21-item survey that assessed cultural competency, treatment discussions, clinic accommodations, and comfort during sensitive exams, using a Likert scale. Participants also self-reported demographic information.

RESULTS:
Out of 246 returned surveys, participants generally reported positive interactions with clinic staff and health care providers, feeling heard (91%), respected (95%), and having their cultural/spiritual beliefs considered in treatment (95%). Most felt respected and comfortable during sensitive exams (96%) and were satisfied with treatment discussions (84%). However, those with a high-school education (79%) were less likely than college or graduate degree holders (93%) to feel administrative staff listened to them and their families (P<.05). Experiences with culturally competent care varied by race/ethnicity. Black/African American participants were less likely to feel staff understood their cultural experiences (55% versus 67–88%; P<.05) and that they recognized differences within their racial/ethnic group (50% versus 82–88%; P<.01). Black/African American individuals reported the highest incidence of race-based unfair treatment (20% versus 0–2%; P<.01).

CONCLUSION:
Lower satisfaction among Black/African American participants indicates care can be improved. Enhanced education for clinical teams can foster respectful, inclusive, and culturally competent care. Future qualitative research can offer further insights into inclusive practices in obstetrics and gynecology care.
Bleeding Risk in Women on Anticoagulants While Undergoing Minor Gynecologic Procedures [ID 2683602]
Authors: Santoso Joseph , Nthiga Lynda I. 
Published: May 2024

INTRODUCTION:
The objective of this study was to determine the bleeding risk in women undergoing minor gynecologic procedures while concurrently taking various anticoagulants.

METHODS:
Patient charts from January 2008 to August 2013 were reviewed to identify patients who underwent minor procedures while taking anticoagulants. Bleeding complications were graded as none, mild, moderate, or severe. No-bleeding diagnoses were defined as a hemostatic biopsy site. Mild bleeding was classified as occasional spotting, requiring pressure for less than 5 minutes. Moderate bleeding required the use of suture for hemostasis. Severe bleeding complications required transfer to a tertiary center or blood transfusion.

RESULTS:
We reviewed 7,453 medical records yielding 269 minor procedures during which patients were concurrently taking anticoagulants. The mean age was 65 years (range, 30–96 years), with 148 African Americans and 121 Caucasian patients. Bleeding complications occurred in 14 patients: 13 mild and 1 moderate. Bleeding complications were not affected by age (P=.5576) or race (P=.1359) but were related to procedure type (P<.0001). Specifically, the loop electrosurgical excision procedure was the only procedure to result in a statistically significant mild complication rate (P=.0353). There was no association between the type of anticoagulant used (P=.6294) or medical diagnosis for anticoagulation (P=.7589) and bleeding risk.

CONCLUSION:
Minor gynecologic surgical procedures can safely be undertaken on women who are concurrently taking antiplatelet/anticoagulant medications.
“What I Wish I Knew”: Clinically Relevant Concerns Women Express on Social Media About Oocyte Cryopreservation [ID 2683486]
Authors: Moskalensky Liana , Hammi Mary C. , Nelson Anita L. , Fuchs Sebastien 
Published: May 2024

INTRODUCTION:
This is the first study to assess the clinically relevant understandings, beliefs, and concerns expressed about oocyte cryopreservation in spontaneous and unfiltered social media platforms as diverse as Reddit and TikTok.

METHODS:
We selected Reddit with its daily 56 million users to represent those aged 18–49 years and TikTok with its daily 1.6 billion users to represent those under 30 years. Search terms “Egg Freezing" and “Egg Freezing Support” as well as the subreddit thread “r/EggFreezing” were used on Reddit; search functions of “egg freezing” and “egg freezing journey” were used on TikTok. Exclusion criteria included having less than 10 relevant comments, non-U.S. account, embryo freezing, sponsored posts, and medical advice from non-patient medical professionals. Thematic saturation was achieved when 10 consecutive comments were reached with no new themes. Institutional review board approval was obtained, deemed as exempt.

RESULTS:
A total of 4,021 entries were evaluated, 355 were excluded, and 189 posts and 3,477 comments were included. Focusing on the 1,330 entries with clinically relevant themes, we found that the most common were “Recommended Age” (26%), “Out of Pocket Costs” (25%), “Side Effects” (18%), “What Can/Can’t I Do Before/During Egg Freezing” (18%), and “Number of Eggs Retrieved” (13%). Good examples addressing issues include “the hormonal roller coaster, the nightmare no one warns you about” and “I wish more doctors were more upfront about this.”

CONCLUSION:
Social media can be used to demonstrate educational gaps. In particular, physicians should be aware of unanswered questions women have about age and behaviors needed to maximize success in cryopreservation.
Virtual Interviews: The Format of the Future [ID 2683645]
Authors: White Joseph R. , Manorot Amanda , Lenze Nicholas , Benjamin William J. , Mihalic Angela , Marzano David 
Published: May 2024

INTRODUCTION:
Residency interviews have transitioned from an in-person to a virtual format during the COVID-19 pandemic. Virtual interviews have helped applicants reduce spending costs, time, and greenhouse gas emissions related to travel. This study aims to assess the preferences of obstetrics and gynecology applicants in continuing a virtual format for residency interviews.

METHODS:
The Texas STAR database was queried for obstetrics and gynecology applicants who responded to “I would be in favor of continuing virtual interviews going forward” on a 5-item Likert scale from 2021 to 2023. Descriptive statistics (chi-square and ANOVA) were used to evaluate trends in responses over time and associations with applicant characteristics.

RESULTS:
A total of 1,348 obstetrics and gynecology applicants responded to the survey, among whom 924 (68.5%) agreed or strongly agreed that they would favor continuation of virtual interviews. The percentage of applicants who favored virtual interviews significantly increased each year (55.1% in 2021, 68.7% in 2022, and 81.1% in 2023; P<.001). Applicants who reported higher total spending on the residency application process were more likely to favor virtual interviews (mean [SD]: $2,637 [2,243] versus $2,240 [1,550]; P=.001). There were no significant differences in sex, race, or geographic region in applicants who favored virtual interviews compared to those who did not favor or were undecided.

CONCLUSION:
The majority of obstetrics and gynecology applicants favor continuation of virtual interviews, and this trend has been increasing each year. There do not appear to be any sociodemographic differences between applicants who do and do not favor virtual interviews.
Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program
Authors: Jones Bayley A. , Richman Joshua , Rubyan Michael , Wood Lauren , Harsono Alfonsus Adrian H. , Oslock Wendelyn , English Nathan , Smith Burkely P. , Hollis Robert , Hearld Larry R. , Scarinci Isabel , Chu Daniel I. 
Published: May 2024

Objective:
This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.

Background:
ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.

Methods:
This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.

Results:
A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.

Conclusion:
Preoperative education is associated with adherence to ERP components and improved surgical outcomes.
Different Load-Induced Alterations in Intervertebral Discs Between Low Back Pain Patients and Controls
Authors: Torén Leif , Lagerstrand Kerstin , Waldenberg Christian , Brisby Helena , Hebelka Hanna 
Published: May 2024

Study Design.
Prospective cohort study.

Objective.
Investigate load-induced effects in lumbar intervertebral discs (IVDs) and differences between low back pain (LBP) patients and controls.

Summary of Background Data.
T2-map values, obtained from quantitative MRI sequences, reflect IVD tissue composition and integrity. Feasibility studies with T2-mapping indicate different load-induced effects in entire IVDs and posterior IVD parts between LBP patients and controls. Larger studies are required to confirm these findings and increase the understanding of specific characteristics distinguishing IVD changes in LBP patients compared with controls.

Materials and Methods.
Lumbar IVDs of 178 patients (mean age: 43.8 yr; range: 20–60 yr) with >3 months of LBP and 74 controls (mean age: 40.3 yr; range: 20–60 yr) were imaged with T2-map sequence in a 3T scanner in supine position without axial load, immediately followed by a repeated examination, using the same sequence, with axial load. On both examinations, mean T2-map values were obtained from entire IVDs and from central/posterior IVD parts on the three midsagittal slices in 855 patient IVDs and 366 control IVDs. Load-induced effect was compared with Fold-change ratio and adjusted for IVD-degeneration grade.

Results.
Loading induced an increase in T2-map values in both patients and controls. Excluding most extreme values, the ranges varied between -15% and +35% in patients and -11% and +36% in controls (first to 99th percentile). Compared with controls, the T2-map value increase in patients was 2% smaller in entire IVDs (Fold-change: 0.98, P=0.031), and for central and posterior IVD parts 3% (Fold-change: 0.98, P=0.005), respectively, 2% (Fold-change: 0.9, P=0.015) smaller.

Conclusions.
This quantitative study confirmed diverse load-induced behaviors between LBP patients and controls, suggesting deviant biomechanical characteristics between IVDs in patients and controls not only attributed to the global grade of degeneration. These findings are an important step in the continuous work of identifying specific IVD phenotypes for LBP patients.

Level of Evidence.
Level II.