bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors Associated With Being Lost to Follow-up Among Patients With Pregnancy of Unknown Location [ID 2683399]
Authors: Beshar Isabel , Doyle Alexis A. , Henkel Andrea , Padron Elisa , Liu Serena , Shorter Jade 
Published: May 2024

INTRODUCTION:
Managing pregnancy of unknown location (PUL) is a logistical challenge for obstetrician–gynecologists. Close follow-up is a key component of management to reduce the risk of a ruptured ectopic pregnancy. We examined factors that may put patients at increased risk of being lost to follow-up.

METHODS:
We performed a case–control study of patients presenting to our emergency room with a positive pregnancy test and without previously confirmed intrauterine pregnancy in the first trimester between January 2020 and December 2022. Patients with newly diagnosed PUL were added to a secure list for follow-up (“beta book”). We compared patients who were lost to follow-up, which was defined as after three failed attempts at contact made multiple days apart, with those who were not. Chi-square and Fisher exact assessed demographic exposures putting patients at risk of being lost to follow-up.

RESULTS:
One hundred nineteen patients had PUL and were added to the beta book. Overall, 15 (12.6%) of patients were lost to follow-up (cases) compared to 104 (87.4%) of patients who were not (controls). No associations were found between sociodemographic variables and risk of being lost to follow-up, including age (P=.15), parity (P=.59), insurance type (P=.81), primary language (P=.77), race (P=.26), and ethnicity (P=.80). Finally, lost to follow-up rates were similar among women enrolled and not enrolled in the institution’s app-based medical communication system (P=.75).

CONCLUSION:
In a state in which pregnancy-related care is available regardless of immigration status, we found no demographic associations with risk of being lost to follow-up. As 12% of people in this study were still lost to follow-up, qualitative interviews may be useful to better understand factors not captured in a retrospective chart review to improve safe and equitable care.
Shortcomings of Current PCOS Care: Provider Bias and Provider–Patient Goal Misalignment [ID 2683466]
Authors: Zhang Alexander , McKenney Kathryn , Ross Kaitlin V. , Sehrt Madeleine N. , Ley Sara A. , Phimphasone-Brady Phoutdavone 
Published: May 2024

INTRODUCTION:
Polycystic ovary syndrome (PCOS) affects 5–7 million people. Diagnosis is often only achieved after long delays and multiple opinions. We conducted focus groups to elucidate patient experience with diagnosis and treatment in PCOS.

METHODS:
We conducted semistructured virtual focus groups of individuals with diagnosed or suspected PCOS recruited from a university hospital obstetrics and gynecology clinic. Questions focused on experiences of bias in PCOS care and opportunities to improve care approaches. Rapid qualitative analysis of focus group transcripts was performed.

RESULTS:
Participants' (n=24) median age was 29 years. Three were non-White, eight Hispanic or Latino ethnicity, and one other than female gender. Provider bias influenced PCOS diagnosis: PCOS testing was delayed in those with smaller bodies, while symptoms of participants with larger bodies were attributed to body weight rather than to medical conditions. Provider recommendations were frequently misaligned with patients' needs and goals: Providers focused on weight loss when other approaches were requested, and fertility was centered, even for patients not desiring childbearing. Providers assumed and mistrusted patient reports of health behaviors: Larger body size was assumed to imply poor dietary habits and sedentary lifestyle. Participants frequently self-advocated to access testing, alternate treatments, and specialists. Conceptualizations of ideal PCOS care included centering patients' goals, access to specialists, and care coordination. Participants desired PCOS education, resources, and support for themselves and their communities.

CONCLUSION:
Provider bias and misalignment with patients' goals are common experiences in PCOS care. Centering patients’ goals, addressing weight bias, and creating additional PCOS educational and support resources are earnestly needed.
Characteristics Associated With Faster Human Chorionic Gonadotropin Resolution in C-Section Scar and Cervical Ectopic Pregnancies After Treatment With Double Balloon Catheter [ID 2683550]
Authors: Hedge Jaclynne , Kelly Jeannie , Dickison Shelby , Veade Ashley 
Published: May 2024

INTRODUCTION:
C-section scar (CSP) and cervical (CXP) ectopic pregnancies are increasing in frequency and associated with significant maternal morbidity. Recently, double balloon catheter (DBC) has been shown as a successful treatment option, but data are limited regarding timing of human chorionic gonadotropin (hCG) resolution. We aimed to define characteristics associated with decreased time to hCG resolution.

METHODS:
This is a retrospective cohort study of CSPs and CXPs at a single tertiary center treated with DBC placement between 2018 and 2023. Institutional review board approval was obtained. The primary outcome was resolution of serum beta-hCG less than 5 within 30 days. Predictor variables included initial hCG levels, mean sac diameter, and DBC inflation volume. Multivariable logistic regression was used to adjust for gestational age and initial hCG.

RESULTS:
Thirty-three pregnancies were included; 13 (39%) had resolution of hCG in less than 30 days and 20 (61%) had resolution in greater than or equal to 30 days. Mean sac diameter less than 10 mm and initial hCG less than or equal to 25,000 were significantly associated with hCG resolution less than 30 days (77% versus 40%, aOR 7.18 [95% CI, 1.23–58.8] and 92% versus 60%, aOR 10.38 [95% CI, 1.39–239.98], respectively). There was no significant difference between lower balloon fill amount and hCG resolution.

CONCLUSION:
After treatment with DBC, most patients require greater than 30 days for hCG resolution. However, patients with mean sac diameter less than 10 mm and initial hCG less than or equal to 25,000 have higher odds of hCG resolution within 1 month, providing a framework for counseling of patients opting for this method.
Laparoscopic Management of Short-Interval Interstitial Pregnancy After Recent Tubal Ectopic: A Case Report [ID 2683561]
Authors: Bernstein Megan , Han Michelle 
Published: May 2024

INTRODUCTION:
A 24-year-old G6P2032 presents with interstitial pregnancy 3 months after ipsilateral laparoscopic salpingectomy for ruptured tubal ectopic pregnancy. This case report demonstrates the management of short-interval interstitial pregnancy after recent ipsilateral laparoscopic salpingectomy.

METHODS:
The patient initially presented with a right-sided ruptured tubal ectopic pregnancy. Salpingectomy was performed to completely remove the fallopian tube and desiccate it at the cornua, leaving no residual visible tubal remnants. The patient presented with ipsilateral interstitial pregnancy 3 months later and initially underwent systemic methotrexate injection, which failed to resolve the pregnancy. She then underwent laparoscopic cornuostomy and dilation and curettage (D&C). Cornuostomy was performed with injection of dilute vasopressin around the gestational sac to help minimize blood loss followed by hydrodissection and sharp dissection to remove the pregnancy. The myometrium and serosa were closed in layers. There was attention to preserve uterine myometrial tissue integrity at the cornua. The patient did well postoperatively and was discharged on postoperative day 0 (POD0). Her β-hCG trended from 11,902 mIU/mL pre-surgery to 7,726 on POD0, and 289 at 1 week. Pathology showed fragments of chorionic villi, and the D&C showed decidualized secretory endometrium.

CONCLUSION:
Short-interval interstitial ectopic pregnancies after prior salpingectomy for tubal ectopic are extremely rare. We demonstrated successful management with a minimally invasive laparoscopic cornuostomy after failed methotrexate. Patients should be counseled carefully about the risks of short-interval pregnancy after tubal ectopic even after care is taken to remove all visible portions of the fallopian tube.
Effect of Updated Colposcopy Guidelines for Endocervical Curettage at Time of Colposcopy [ID 2683668]
Authors: Tindal Rachel , Cronin Anna , Winkler Stuart S. , Kim Ji Won 
Published: May 2024

INTRODUCTION:
The American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines were updated in January 2023 to broaden the use of endocervical curettage (ECC) at the time of colposcopy. We aimed to determine how our practice at a single military institution aligned with the new recommendations.

METHODS:
After receiving approval from our institutional quality improvement (QI) office, a retrospective chart review was completed for all colposcopies performed at Brooke Army Medical Center from March 1, 2022 to December 31, 2022. Demographic and dysplasia history was extracted for each encounter. Cases were sorted into ASCCP-defined categories of ECC preferred, recommended, acceptable, omission acceptable, and unacceptable. The rate of endocervical curettage completion was compared across each category.

RESULTS:
Colposcopies were performed in 120 nonpregnant patients. ECC was performed in 95 cases (79%). Based on 2023 guidelines, ECC would be recommended for 57, preferred for 23, acceptable for 25, and omission acceptable for 15. The rates of ECC for recommended (84%) and preferred groups (82.5%) and omission acceptable group (73%) were not significantly different (P=NS).

CONCLUSION:
Prior to release of the 2023 ASCCP guidelines, ECC at our institution was commonly done in higher-risk groups. To mitigate overall health care burden and unindicated procedures, ECCs should be redistributed away from the omission acceptable groups towards the higher-risk groups. This would lead to an estimated 2.5% increase in overall ECC rate and a 20% increase in high-risk groups. A prospective evaluation of the implication of these guidelines is ongoing.
Complications Associated With Mifepristone Use for Dilation and Evacuation Abortion Procedures Between 22 and 24 Weeks of Gestation [ID 2683461]
Authors: Wergeles Maya , Scott Rachel , Lewandowska Maria , Lohr Patricia A. , Andreeva Andriana P. 
Published: May 2024

INTRODUCTION:
One percent of abortions take place after 20 weeks of gestation in England and Wales. Overall rates of complications with second-trimester abortion are low, but they increase with gestational age. Dilation and evacuation (D&E) is the most common method of surgical abortion at this stage in pregnancy. The British Pregnancy Advisory Service (BPAS) provides nearly half of all abortions in England and Wales. In 2017, BPAS added mifepristone to their regimen of osmotic dilators for cervical ripening before D&E. This retrospective study analyzed the risk for complications associated with the use of mifepristone for cervical ripening.

METHODS:
The British Pregnancy Advisory Service provided data for D&E procedures that occurred between 22 and 23 6/7 weeks, between February 2012 and February 2017 (osmotic dilators only), and November 2017 to November 2022 (mifepristone and osmotic dilators). Using time as a proxy for mifepristone, the association between mifepristone use and D&E complications was established using multivariate logistic regression.

RESULTS:
There were 6,516 D&E procedures at BPAS during this time. Those who received mifepristone were more likely to experience any complication (odds ratio [OR] 2.40; 95% CI, 1.62, 3.54). They also had higher odds of bleeding (OR 3.08; 95% CI, 1.12, 8.48). Odds for cervical injury (OR 2.21; 95% CI, 0.84, 5.80) and infection (OR 1.89; 95% CI, 0.46, 7.69) were not different.

CONCLUSION:
The addition of mifepristone to osmotic dilators was associated with an increase in the odds of complications of D&E, without attenuating the risk of complications related to cervical dilation.
Thrombocytosis Is a Poor Prognostic Factor in Those Treated With Chemoradiation for Advanced Cervical Cancer [ID 2683596]
Authors: Lewis Karina , Geisler John P. , Manahan Kelly J. 
Published: May 2024

INTRODUCTION:
Prior to the addition of chemotherapy to radiation, thrombocytosis was seen as a poor prognostic factor for women with advanced cervical cancer. The objective of this study was to see in the chemoradiation era whether thrombocytosis was still a prognostic factor.

METHODS:
An IRB-approved study was performed analyzing all patients with cervical cancer receiving primary chemoradiation (cisplatin) as therapy over a 10-year period. Minimum follow-up was 30 months. Records were examined for initial platelet count at diagnosis, stage, grade, histology, and survival. Only patients receiving chemoradiation with stage IIa–IVb cervical cancer were studied and included in the final analysis.

RESULTS:
Two hundred nine with cervical cancer were diagnosed with 173 treated with primary chemoradiation. The most common stage was IIIb (88; 50.9%). The mean platelet counts of those receiving chemoradiation were significantly higher (396k/mL; 95% CI, 376–416k) than those with lower-stage disease (313k/mL; 292–334k) (P<.001). Of the 173 patients, 42 (24.3%) had a platelet count >450k/mL and 24 (13.9%) had a platelet count >500k/mL. Patients who died of disease had significantly higher initial platelet counts (mean 433k/mL; 95% CI, 407–458k) than those who were alive at the completion of follow-up (mean 326k/mL; 95% CI, 303–350k). None of the patients with an initial platelet count greater than 500k/mL was alive at the time of follow-up.

CONCLUSION:
High platelet count at initial diagnosis is a poor prognostic factor in those with cervical cancer treated by primary chemoradiation.
Adherence to Nonantibiotic Prophylactic Regimens in Women With Recurrent Urinary Tract Infections [ID 2683400]
Authors: Ashmore Sarah , Geynisman-Tan Julia , Ehimiaghe Eseohi , Arteaga Rebecca , Sarkar Prottusha , Das Deepanjana 
Published: May 2024

INTRODUCTION:
Nonantibiotic regimens such as methenamine hippurate, D-mannose, and vaginal estrogen are often recommended as first-line prevention for recurrent urinary tract infections (rUTIs). The objective of our study was to describe adherence rates in women prescribed nonantibiotic prophylaxis for rUTI and explore factors associated with adherence.

METHODS:
This was an IRB-approved retrospective cohort study comparing women adherent and nonadherent to prophylactic regimens. Adult women who sought care from a urogynecology clinic at a tertiary care center for rUTI or frequent UTI between January 2020 and December 2021 were included if they were prescribed a nonantibiotic prophylactic regimen. The medication adherence questionnaire (MAQ) was administered to all eligible patients. Adherence was defined by a score of 0. A score greater than 1 defined nonadherence.

RESULTS:
Eighty-six patients met inclusion criteria and completed the MAQ with 31 in the adherent and 55 in the nonadherent group. Mean age was 64.3 (+14.8) and 66.0 years (+14.4) in the adherent and nonadherent groups, respectively (P=.48). Vaginal estrogen was the most common prescribed regimen (80.6% adherent versus 90.1% nonadherent group; P=.15) followed by methenamine hippurate (38.7% adherent versus 21.8% nonadherent group; P=.08). 77.4% of adherent patients and 72.7% of nonadherent patients met criteria for rUTI as per American Urogynecologic Society best-practice statement. No demographic or clinical factors were associated with adherence to nonantibiotic prophylactic regimens.

CONCLUSION:
Nonantibiotic prophylactic rUTI regimens are commonly prescribed; however, adherence remains low at 36%. There were no predictors to help determine patient compliance. Clinicians should therefore inquire about adherence prior to escalating treatment.
Analyzing the Efficacy of Metronidazole as Additional Surgical Site Infection Prophylaxis in Patients Undergoing Hysterectomy [ID 2683482]
Authors: Hoang Christine , Teigen Kari , Johnson Chrystia , Sampson Audrey , Marshall Caitlin , Sangha Roopina 
Published: May 2024

INTRODUCTION:
The American College of Obstetricians and Gynecologists recommends cefazolin for antibiotic surgical prophylaxis for hysterectomy procedures. In 2018, hysterectomy surgical site infection (SSI) data at John Peter Smith Hospital demonstrated a higher proportion of anaerobic growth identified on cultures. The addition of metronidazole with cefazolin became surgical prophylaxis protocol at our institution. The purpose of the study is to compare rates of non-superficial SSI before and after the addition of metronidazole in hysterectomy procedures.

METHODS:
This was a retrospective cohort study of patients who underwent hysterectomy of any surgical approach from January 2015 to July 2023. The primary exposure of interest was administration of metronidazole with additional covariates including age, body mass index, diabetes, oncology status, and wound class. The association between metronidazole administration and non-superficial SSI was examined using a logistic regression model. Appropriate waiver was received from the institutional IRB.

RESULTS:
Two thousand five hundred thirty-four hysterectomies were included in our cohort. 1,207 (44%) cases had metronidazole administration, with 98% of those cases occurring after the antibiotic was incorporated into the protocol. Of the patients who did not receive metronidazole, 49 (3.7%) patients had a non-superficial SSI compared to 14 (1.2%) patients that had a non-superficial SSI with metronidazole administration. After adjusting for age and oncology status, patients who did not receive metronidazole had higher odds of having a SSI compared those who did (adjusted odds ratio [aOR]: 3.6; 95% CI: 1.97, 6.3; P≤.0001).

CONCLUSION:
The results demonstrate potential infection prevention benefit with metronidazole to patients undergoing hysterectomy, supporting the institutional prophylaxis protocol. The findings could have further implications across hospitals with similar patient populations.
Using the Electronic Medical Record to Correlate Patient–Provider Perspectives in the Care of Black Individuals With High-Risk Pregnancies [ID 2683496]
Authors: Nadkarni Siddhi , Falako Simileoluwa E. , Antwi Adwoa D. , Campbell Katherine H. , Adeyemo Oluwatosin 
Published: May 2024

INTRODUCTION:
The electronic medical record (EMR) is a mainstay of medical documentation, although it is limited in its ability to fully capture patients' perspectives. This study aims to correlate patient and provider perspectives in the care of Black individuals with diabetes and/or hypertension in pregnancy to identify areas for quality improvement.

METHODS:
A mixed qualitative-retrospective study consisting of in-depth one-on-one interviews and EMR chart review was conducted from January 2021 to December 2022 for nine patients who self-identified as Black, were 6 weeks to 1 year postpartum with diagnoses of diabetes and/or hypertension during pregnancy or postpartum, and delivered at a tertiary hospital (IRB 2000028830). Interviews were virtual, lasted 55 minutes on average, and explored participants’ delivery and postpartum experiences. Chart notes were reviewed to correlate and compare participants' described experiences with documentation in the EMR. Themes were developed using inductive technique.

RESULTS:
Participants reported overall satisfaction with the care received, but four major themes were identified: 1) concerns with acknowledgement and management of pain, 2) perceived coercion and stereotyping with contraception counseling, 3) incomplete representation of positive and negative experiences in EMR documentation, and 4) balancing patient autonomy and professional responsibility to counsel. Although participants' described experiences were correlated to EMR documentation for some instances, documentation often lacked patient perspectives regarding their concerns and decision-making rationale. Additionally, participants did not always fully understand the rationale behind aspects of their care.

CONCLUSION:
Opportunities exist for improved patient–provider communication in the provision of obstetric care for minoritized populations with high-risk pregnancies.
Disparities in Child Protective Services Reporting Among Pregnant Patients With Positive Urine Drug Screening at Delivery Hospitalization [ID 2683555]
Authors: Lijewski Virginia A. , Cates Victoria , Hopkins Chase T. , Straub Heather 
Published: May 2024

INTRODUCTION:
This study assesses predictors of Child Protective Services (CPS) reporting among patients with a positive urine drug screening (UDS) during delivery hospitalization.

METHODS:
Patients receiving prenatal care and delivering at any UCHealth location between 2015 and 2022 with a positive UDS at delivery were included. Patient demographics, medical history, UDS, infant toxicology, and CPS reporting were collected from medical records. T-tests or nonparametric equivalents for continuous variables and χ2 or Fisher's exact tests for categorical variables were used to compare patients with and without CPS reporting.

RESULTS:
We found 523 patients with a positive UDS during their delivery hospitalization, with CPS reporting for 71%. CPS reporting was more common in younger patients (26 versus 28 years; P<.01), patients with prior CPS involvement (15% versus 5%; P<.01), patients with an antenatal UDS positive for any substance (46% versus 29%; P<.01), and any positive neonatal toxicology (87% versus 58%; P<.01). Patients positive for cannabis (78% versus 57%; P<.01) or amphetamines (6% versus 1%; P=.03) were more likely to be reported to CPS, while patients positive for barbiturates (12% versus 1%; P<.01) and benzodiazepines (6% versus 2%; P<.01) were less likely. Hospitals located in large (>400k pop.) or small cities (<100k pop.) were less likely to be reported to CPS than mid-sized cities (>100–399k pop.) (66% and 65% versus 76%; P=.03).

CONCLUSION:
Differences in CPS reporting depended on the substance that tested positive, infant positivity, and delivery location. Future research should explore reasons for no CPS reporting among patients with a positive UDS during delivery hospitalization.