bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Dobbs on the Obstetrics and Gynecology Workforce [ID 2683443]
Authors: Arora Kavita S. , Sabbath Erika L. , Buchbinder Mara , McKetchnie Samantha M. 
Published: May 2024

INTRODUCTION:
After the Dobbs v. Jackson decision in June 2022, 17 U.S. states have functionally banned abortion. Little research has focused on consequences of these bans for obstetrician–gynecologists in affected states, for whom medically necessary care provision may now carry serious personal and professional consequences. The objective of the Study of Ob-Gyns in Post-Roe America (SOPRA) was to characterize how abortion bans affect obstetrician–gynecologists and identify institution-level practices to support obstetrician–gynecologists in abortion-restrictive policy climates.

METHODS:
This was a cross-sectional qualitative study of 54 obstetrician–gynecologists from 13 of 14 states that had banned abortion as of March 2023. Data included semistructured interviews conducted from March to August 2023, which were thematically coded and analyzed. Institutional review board approval was obtained.

RESULTS:
We identified three major domains in which laws affected obstetrician–gynecologists: 1) clinical effects (waiting to provide necessary care until patients became sicker or institutional permission to treat was obtained; inability to counsel on pregnancy options; inability to provide or refer for appropriate care; patient relationships); 2) professional effects (conflicts with colleagues; documentation; fears and perceived consequences of law violation; practicing below the standard of care; moral distress and moral injury; job satisfaction; intention to leave the state); and 3) personal effects (health and well-being). Institutional practices—both helpful and harmful—modified the laws' effects on physicians.

CONCLUSION:
Findings reveal pervasive effects of state abortion bans on obstetrician–gynecologists, with implications for workforce sustainability, physician health, and patient outcomes. Institutional practices to support and protect obstetrician–gynecologists in restrictive policy environments may help mitigate laws’ effects on attrition and physician well-being.
24-Hour Compared With 48-Hour β-hCG Follow-up for Patients With Pregnancy of Unknown Location [ID 2683407]
Authors: Watkins Jayla , Flynn Anne N. , Seng Panhaneath , Ponzini Matthew D. 
Published: May 2024

INTRODUCTION:
Patients who are followed with a pregnancy of unknown location (PUL) are generally advised to return for repeat β-hCG level after 48 hours. This study compares the time to final diagnosis for patients who had repeat β-hCG levels 24 versus 48 hours after diagnosis of PUL.

METHODS:
This was a retrospective cohort study of patients diagnosed with PUL who were recommended to return at 24 versus 48 hours at a single site from 2021 to 2022. We reviewed charts for time to final diagnosis, demographic characteristics, pregnancy history, β-hCG levels, interventions, and whether the patient was lost to follow-up. We compared the time to final diagnosis using Kaplan–Meier curves and log-rank tests between the two cohorts.

RESULTS:
Over the two-year time period, 61 patients were eligible for inclusion, 18 of whom followed up at 24 hours and 43 of whom followed up at 48 hours. Most patients completed the recommended follow-up (94.4% 24-hour versus 83.7% 48-hour). The median time to final diagnosis was 2 days (interquartile range [IQR] 1–5 days) for the 24-hour cohort compared to 6 days (IQR 3–13) for the 48-hour cohort (P=.03). None of the 24-hour group was lost to follow-up compared to 11.6% (n=5) in the 48-hour group.

CONCLUSION:
We found the time to final diagnosis was shorter in the 24-hour group compared to the 48-hour group. Clinicians may consider 24-hour follow-up for patients at higher risk for ectopic pregnancy or to expedite the time to a final diagnosis.
“Disheartened and Powerless”: How Abortion Providers Discuss Moral Distress Under Dobbs [ID 2683590]
Authors: Wascher Jocelyn , Howard Dana , Tomu Taylor , Bornstein Marta , Norris Alison H. , Rivlin Katherine 
Published: May 2024

INTRODUCTION:
Moral distress occurs when providers feel powerless to provide ethical health care. We analyzed how abortion providers discuss moral distress since the Dobbs decision.

METHODS:
In 2023, we distributed an IRB exempt survey measuring moral distress to U.S. abortion providers through professional listservs. Surveys included an optional open-ended section where participants reflected on their experience of moral distress. Using thematic analysis, we compared open-ended responses between providers practicing in states protective and restrictive to abortion. Open-ended responses were deidentified, so we categorized “protective” and “restrictive” based on the written description of practice environment.

RESULTS:
Of 253 practitioners who completed the survey, 57% practiced in “protective” states and 43% practiced in “restrictive” states (using Guttmacher's classifications). Of these, 164 (64%) completed the optional, deidentified, open-ended section. Providers who indicated practicing in restrictive environments experienced moral distress arising from being forced to turn patients away or provide substandard care, the instability and ambiguity of abortion laws, and feeling powerless to use the specialized skills central to their identities as providers. Providers who indicated practicing in protective environments experienced moral distress arising from witnessing burdens placed on patients seeking care and the substandard care out-of-state patients received, a lack of resources to accommodate increased clinical volume, and encountering restrictive institutional policies despite the protections afforded by permissive state policy.

CONCLUSION:
Restrictions on abortion care can harm providers through their experiences of moral distress. Moral distress can lead to provider burnout and attrition, which exponentiates provider shortages and can ultimately lead to poor patient outcomes.
Loss to Follow-up in Fertility-Sparing Management of Endometrial Cancer and Pre-cancer [ID 2683403]
Authors: Hartup Lindsay A. , Yauger Belinda , Schenken Claire M. , Kohler Kelsey R. 
Published: May 2024

INTRODUCTION:
Follow-up is essential with conservatively managed endometrial cancer (EC) and endometrial intraepithelial neoplasia (EIN) due to high risk of recurrence. There are little published data regarding follow-up in this population. The purpose of this study was to assess possible factors associated with loss to follow-up.

METHODS:
This was an IRB-approved retrospective chart review (protocol HSC20220315EX). Patients aged 18–45 with a history of EIN or early EC who elected fertility-sparing management and achieved pathologic response were included. Demographic and clinical data were collected and compared across patients who followed up and did not follow up.

RESULTS:
Eighty-six patients met inclusion criteria, of which 40 were lost to follow-up. 52% of patients with EIN and 25% of patients with EC were lost to follow-up (P=.12). 43% of patients with private insurance were lost to follow-up, compared to 63% with Medicaid (P=.45) and 67% without insurance (P=.40). There was no difference in follow-up based on age (P=.24), race (P=.47), body mass index (P=.90), or parity (P>.99), nor was there a difference based on fertility consultation (P=.83), assisted reproductive technology utilization (P>.99), or achievement of pregnancy (P>.99).

CONCLUSION:
Although no statistical differences were found, trends towards difference in follow-up based on diagnosis and insurance warrant further investigation. Barriers to care also may be more individual than systemic in nature. A future survey study of patients lost to follow-up may provide additional insight.
Reducing Endometrial Cancer Disparities to Advance Health Equity (REACH Study) [ID 2683434]
Authors: Suh-Burgmann Betty , Nau Claudia , Finertie Holly , Eng Sarah 
Published: May 2024

INTRODUCTION:
Racial disparities in endometrial cancer survival have been increasing over the past 10 years. While Black women are diagnosed more often with aggressive histologic subtypes, studies have found tumor characteristics only partially account for their lower rates of survival. The degree to which system factors such as insurance and access to subspecialty care contribute to disparate survival outcomes is unclear.

METHODS:
This was a retrospective cohort study of individuals diagnosed with endometrial cancer from 2005 to 2021 within a large integrated health care system with high levels of access to gynecologic oncologists. Data were extracted from tumor registry and electronic databases. Multivariable logistic regression was used to evaluate associations between 1- and 5-year survival rates and race.

RESULTS:
Among 11,249 women, 61.9% identified as White, 15.1% Asian, 7.8% Black, 13.6% Hispanic, and 0.6% mixed or unknown race, with 46.5% having public insurance through Medicare or Medi-Cal. In preliminary analysis, Black women had lower survival compared to White women at 1 year (87.4% versus 92.3%) and 5 years (67% versus 78.7%) (OR 0.57; 95% CI, 0.46–0.71; P<.001). However, when adjusted for histology and stage, survival differences between Black and White women at both 1 year (OR 0.83; 95% CI, 0.65–1.07; P=.15) and 5 years (OR 0.92; 95% CI, 0.73–1.15; P=.45) were no longer significant.

CONCLUSION:
Among a diverse group of insured individuals receiving care within an integrated health care system, tumor characteristics largely accounted for racial disparities in survival. These findings suggest that disparities in survival not explained by tumor characteristics can be addressed by closing gaps in insurance coverage and access to care.
Age-Related Increase in Live-Birth Rates of First Frozen Thaw Embryo Compared With First Fresh Transfer in Initial Assisted Reproductive Technology Cycles Without Preimplantation Genetic Testing [ID 2683417]
Authors: Wang Sarah , Seifer David B. 
Published: May 2024

INTRODUCTION:
Compare live-birth outcomes stratified by age between primary frozen (FET) and fresh transfers in initial autologous assisted reproductive technology (ART) cycles without preimplantation genetic testing (PGT).

METHODS:
This was a retrospective cohort study of autologous first ART cycles without PGT comparing success rates of primary embryo transfer (frozen thaw versus fresh) from the 2014–2020 SARTCORS database. We compared live-birth rate (LBR) stratified by age and cumulative live-birth rate (CLBR) for first FET versus first fresh cycles in first ART cycle. Primary transfer (FET or fresh) was the first transfer for an index retrieval. LBR was number of live births from first embryo transfer associated with first retrieval. CLBR was defined as at least one live birth from all linked embryo transfers within 1 year from initial retrieval. Multivariate logistic regression (MLR) determined association between live-birth outcomes and method of transfer.

RESULTS:
228,171 first ART cycles resulted in primary embryo transfer. 62,100 initial FETs and 166,071 fresh transfers were compared. LBR was 48.3% for initial FETs versus 39.8% for initial fresh transfers (P<.001). CLBR was 71.8% for initial FETs versus 59.2% for initial fresh transfers (P<.001). MLR demonstrated that initial FETs had a greater chance of live birth across all age groups, with adjusted odds ratio of live birth incrementally increasing with advancing age groups.

CONCLUSION:
Overall, LBR and CLBR were greater for first FET than fresh transfers with incremental increases in odds of live birth with advancing age, suggesting the presence of a more favorable age-related change in endometrial receptivity present in frozen–thawed cycles.
U.S. Gestational Carrier Embryo Transfer Trends, 2014–2020 [ID 2683526]
Authors: Traub Ariana M. , Shandley Lisa M. , Boulet Sheree L. , Hipp Heather S. , Kawwass Jennifer Fay 
Published: May 2024

INTRODUCTION:
Multiple embryo transfers (METs) are common among gestational carriers (GCs) despite increased obstetric risks of multiple gestations and strong recommendations from American Society for Reproductive Medicine (ASRM) for single-embryo transfers. This study assessed GC embryo transfer trends from 2014–2020 to evaluate compliance with national guidelines.

METHODS:
This retrospective, population-based cohort study used data from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. All cycles from 2014 to 2020 involving an embryo transfer to a GC were analyzed. The number of GC embryo transfers, use of preimplantation genetic testing (PGT), and outcome (singleton versus multiple gestation) were assessed. Poisson and linear regression models evaluated trends in number and proportion of cycles over time. Institutional review board approval was obtained.

RESULTS:
Of the 40,177 GC transfer cycles from 2014 to 2020, 11,081 (27.6%) involved transfer of two or more embryos. Both the number (n=2,001 in 2014; n=814 in 2020) and proportion of METs (56.6% of all transfers in 2014; 11.8% in 2020) (P<.05 for both) decreased. The use of PGT among MET GC cycles increased from 23.9% in 2014 to 61.4% in 2020. Among live births, there was a 71.0% reduction in the proportion of multiple gestations from 2014 (25.5%) to 2020 (7.4%) (P<.05). Among double-embryo transfers, the majority were performed at the blastocyst stage with an increase from 2014 (76.7%) to 2020 (88.1%) (P<.05).

CONCLUSION:
With increased use of PGT and extended blastocyst culture, MET and subsequent multiple gestation pregnancies have decreased amongst U.S. GCs. These trends suggest increased compliance with ASRM national guidelines.
Evaluating the TRH Test: Prolactin Cutoff Level on the Prevalence of Reactive Hyperprolactinemia Among PCOS Women [ID 2683598]
Authors: Vargas Sofía B. , Ugarte Fernanda Villa , Ortuzar Antonia , Soto Hugo , Jose del Rio María , Vigil Pilar 
Published: May 2024

INTRODUCTION:
The prolactin cutoff value is currently under discussion, although accepted values range between 15 and 25 ng/mL. The thyrotropin-releasing hormone (TRH) test is a validated methodology for the study of reactive hyperprolactinemia, but there is no consensus for which group of patients it should be used, especially in those women diagnosed with polycystic ovary syndrome (PCOS). The objective of this study was to classify the prolactin values obtained from the TRH test in women of reproductive age but previously diagnosed with PCOS, according to ranges: group A: PRL, less than 15 ng/mL; group B: PRL, 15–20 ng/mL; and group C: PRL, 20–25 ng/mL.

METHODS:
Three hundred seventy-eight women between 12 and 40 years old, previously diagnosed with PCOS according to Rotterdam criteria, and without a diagnosis of hyperprolactinemia or use of antipsychotics were considered. An initial prolactin measurement was performed, the TRH test was performed after 15 and 30 minutes, and the resulting values were classified in groups A, B, and C, respectively.

RESULTS:
The number of patients obtained was 266. Group A (n=199) had 34.17% (68) of patients with an altered TRH test, whereas in group B (n=42) 47.62% (20) had an abnormality in the test. Finally, in group C (n=25), 28.00% (7) showed an altered TRH test.

CONCLUSION:
Group B is the one with the highest prevalence of reactive hyperprolactinemia compared to groups A and C. It is concluded that the application of the TRH test is suggested in those patients with PCOS with prolactin ranges between 15 and 20 ng/mL.
The Effect of Body Mass Index on the Risk of Postoperative Complications After Myomectomy [ID 2683654]
Authors: Meyer Raanan , Hamilton Kacey M. , Schneyer Rebecca , Truong Mireille , Wright Kelly , Siedhoff Matthew T. 
Published: May 2024

INTRODUCTION:
We aimed to evaluate the association of body mass index (BMI) and short-term postoperative complications after myomectomy.

METHODS:
Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, we analyzed major and minor complications according to BMI for patients who underwent myomectomy between 2012 and 2020.

RESULTS:
A total of 29,305 cases were included. Postoperative complications occurred in 11.5% of cases (n=3,374), ranging from 10.2% among underweight patients to 15.9% among patients with obesity class 3 (P<.001). In multivariable regression analysis, overweight patients experienced fewer postoperative complications (adjusted odds ratio [aOR] 95% CI, 0.89 [0.80–0.99]), both minor (aOR 95% CI, 0.89 [0.80–0.99]), and major (aOR 95% CI, 0.75 [0.58–0.98]), compared to patients with normal BMI. Patients with obesity class 1 also experienced fewer major complications compared to normal weight (aOR 95% CI, 0.61 [0.45–0.84]). Patients with obesity class 3 experienced more complications (aOR 95% CI, 1.21 [1.05–1.38]), both minor (aOR 95% CI, 1.17 [1.02–1.34]) and major (aOR 95% CI, 1.17 [1.02–1.35]), compared to the other BMI classes combined. When examining abdominal myomectomies only, compared to normal weight, overweight patients experienced fewer minor complications, and obesity class 1 patients had fewer major complications. Complications did not differ based on BMI when restricting the cohort to minimally invasive or vaginal myomectomies only.

CONCLUSION:
Class 3 obese patients are at increased odds for experiencing complications after myomectomy, whereas being overweight or slightly obese appears to be protective. These differences based on BMI are largely driven by complications experienced following abdominal, rather than minimally invasive, myomectomy.
Risk Factors and Racial Disparities of Maternal and Neonatal Morbidity at Premier Health Maternity Facilities [ID 2683422]
Authors: Whitehead Katie , McKenna David 
Published: May 2024

INTRODUCTION:
Nationally, racial disparities in obstetrical outcomes have proven to be contributing to the high maternal morbidity and mortality rates in the United States when compared to other developed nations. To best approach the inequalities in our community, we sought to determine whether and where obstetrical outcomes were being disproportionately affected by the race of the patient.

METHODS:
We conducted a retrospective chart review of patients delivering singleton pregnancies at 37 weeks of gestation or greater from January 2019 to July 2021. Using the patient’s self-identified race, regression modeling was used to identify disparities in obstetrical outcomes. A composite of maternal outcomes consisting of third/fourth-degree lacerations, blood transfusion, febrile morbidity, and ICU admission was used to compare morbidities. Neonatal composite morbidity consisted of respiratory distress, sepsis, need for resuscitation, and neonatal intensive care unit (NICU) admission. This study was approved by the Wright State University IRB (protocol number: 07272).

RESULTS:
There were 13,689 births during the study period. Significantly more non-Caucasian patients experienced cesarean sections than Caucasian patients (30.3% versus 28.5%; P <.01) and on average had a higher maternal composite score (0.5 versus 0.03; P <.01). Black or African American babies were more likely to qualify as small for gestational age, be admitted to the NICU, and have a higher composite score than Caucasian babies (P<.01).

CONCLUSION:
Within our community, obstetrical and neonatal outcomes were experienced at significantly different rates by different race groups. Next steps include creating standardized protocols to decrease the opportunity for implicit bias to adversely affect patient care.
External Validation of the fullPIERS Risk Prediction Model in a U.S. Cohort of Women With Preeclampsia [ID 2683408]
Authors: Long Danielle , Flicker Kari , Vishnia Maya , Wright Madeleine , Francis Matilda , Kawakita Tetsuya 
Published: May 2024

INTRODUCTION:
Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and adverse pregnancy outcomes. The fullPIERS model was developed to predict severe adverse maternal outcomes within 48 hours of admission in patients with preeclampsia. This model has not been validated in the U.S. cohort. We sought to examine whether the fullPIERS model was predictive in the U.S. cohort.

METHODS:
This was a retrospective study of patients with preeclampsia who delivered at 23 weeks or greater from January 1, 2010, to December 31, 2020. Our primary outcome was a composite of maternal mortality or other serious complications of preeclampsia that occurred within 48 hours of admission. Using the prediction model that considers gestational age at admission, chest pain or dyspnea, serum creatinine, platelet, aspartate transaminase, and oxygen saturation, we calculated the probability of the composite outcome. We assessed performance using the area under the curve (AUC) of the receiver operating characteristic curve. Hosmer–Lemeshow test was used to assess the goodness-of-fit.

RESULTS:
Of 1,552 patients with preeclampsia, 77 (5.0%) had the composite outcome within 48 hours. The fullPIERS model had an AUC of 0.73 (95% CI, 0.66–0.80). However, the Hosmer–Lemeshow test showed poor calibration with a value of P<.001. The calibration plot showed the model underestimated when the predicted probability was less than 10% and overestimated when the predicted probability was over 28%.

CONCLUSION:
The fullPIERS model had good AUC in the U.S. cohort of patients with preeclampsia but poor calibration. The fullPIERS model may not be clinically useful in the United States.
Maternal and Neonatal Characteristics Associated With Failed Induction of Labor in Diabetic Mothers [ID 2683497]
Authors: Alhousseini Ali , Abdel-Gadir Deena , Hashmi Nabiha , Diab Maya , Ramseyer Abigail 
Published: May 2024

INTRODUCTION:
Uncontrolled diabetes is a risk factor for cesarean delivery. Identifying and stratifying associated risk factors for failed induction of labor (IOL) may improve counseling and intrapartum care. This study aims at determining maternal and fetal factors that would predict the occurrence of failed IOL in diabetic mothers.

METHODS:
This is a retrospective study of 2,172 diabetic mothers who underwent IOL at a single university medical center between January 2013 and December 2021. Maternal and neonatal characteristics were obtained. Among the studied maternal characteristics were ethnicity, age, gestational age, medical comorbidities (including preeclampsia and essential hypertension), insulin administration, parity, and health insurance type (public versus private). Statistical analysis was performed using univariate and multivariate logistic regression. A value of P<.05 was considered statistically significant.

RESULTS:
Our preliminary analysis showed that 567 out of 2,172 (26.1%) diabetic mothers failed IOL and delivered via cesarean pathway. Failed IOL was associated with nulliparity (P=.0001), preexisting diabetes (compared to gestational diabetes) (P=.001), control of diabetes by insulin (P=.001), maternal essential hypertension (P=.001), preeclampsia (P=.001), polyhydramnios (P=.001), prenatal diagnosis of fetal growth restriction (P=.008), and placental abnormalities (P=.027). Neonatal weight, large for gestational age, head circumference, and height were not statistically associated with failed induction of labor (all values of P>.05). Failed IOL was associated with admission to neonatal intensive care unit (P=.001), hyperbilirubinemia (P=.001), lower APGAR score at 1 minute (P=.033), longer stay in the hospital (0.001). Failed IOL was not associated with lower APGAR score at 5 minutes, lower umbilical cord pH value, neonatal readmission or maternal ethnicity (all values of P>.05).

CONCLUSION:
Failed IOL among diabetic mothers is associated with significant maternal and neonatal adverse outcomes. Our continued data analysis aims at assessing the role of optimal glucose control and other maternal factors in improving maternal and neonatal outcomes.