bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluorescent Imaging Using Indocyanine Green for Intraoperative Detection of Endometriosis [ID 2683620]
Authors: Ward Megan , Tam Maria Teresa , Mabini Christopher-Armand Z. 
Published: May 2024

INTRODUCTION:
Endometriosis is characterized by the presence of endometrial-like tissue outside of the uterus. Definitive diagnosis is made by laparoscopic visualization with confirmatory histopathologic biopsy. In some cases, lesions can be ambiguous or difficult to visualize with traditional white light (WL)-illuminated laparoscopy. The study objective is to evaluate whether the use of indocyanine green (ICG) aids in identification and removal of clear or ambiguous endometriosis lesions, not visualized under traditional WL imaging.

METHODS:
This is a retrospective chart review of patients with symptoms suspicious for endometriosis where ICG is used during laparoscopy to assist in identification of suspected endometriosis lesions. Data collection includes patient demographics, medical history, surgical history, preoperative symptoms, and localization of lesions. Data will be collected from hospital electronic health record system and from a private practice.

RESULTS:
In total, 211 suspected lesions were excised, of which 115 had histologically proven endometriosis. 196 lesions were detected using ICG and 112 were confirmed to be endometriosis. These results were statistically significant (P=.024) with a sensitivity of 97.4% and a negative predictive value of 80%, demonstrating that ICG can significantly improve the intraoperative detection of endometriosis lesions. Research is ongoing with more data being collected. Our goal is that the additional data will further strengthen the power of our study.

CONCLUSION:
Our study shows that ICG fluorescence significantly improves the intraoperative detection and resection of ambiguous or clear endometriosis lesions and improves histopathologic diagnosis when compared to WL imaging. Indocyanine green has the potential to increase the detection of endometriosis and improve patient outcomes.
Is Resectoscopic Hysteroscopy a Dying Art? Creation of an Educational Instructional Video [ID 2683474]
Authors: Purmalek Monica , Fielden Aaron , Ramirez Christina I. 
Published: May 2024

INTRODUCTION:
Resectoscopic hysteroscopy is a valuable surgical technique for addressing intrauterine pathology. Within our institution, most operative hysteroscopies are performed using newer non-resectoscopic systems, potentially creating a gap in resident surgical education. We developed a novel instructional video demonstrating the components and capabilities of the resectoscopic hysteroscope. Our aim is to assess whether the instructional video increased surgeon comfort using the resectoscopic hysteroscope.

METHODS:
A pilot cohort study was performed with gynecologic surgery and obstetrics (GS&O) residents and staff physicians at Brooke Army Medical Center. Participants were provided access to the resectoscope surgical set throughout the study, completed a baseline survey assessing surgeon comfort, and then repeated the survey after watching the instructional video. The survey used a 5-point Likert scale with 1) very uncomfortable, 3) neutral, and 5) very comfortable.

RESULTS:
Of the 20 participants, 85% lacked formal resectoscope training and 45% had no prior resectoscope experience. Prior experience was limited: 55% used it less than five times and 64% had no use in the last year. At baseline, few were comfortable with setup (15%) and troubleshooting (5%). The instructional video significantly increased surgeon comfort with resectoscope setup (P<.001) and troubleshooting (P<.001). Surgeon comfort supervising a resident doubled after the instructional video (33–66%). All participants felt the video was helpful and would recommend it to others (100%; P<.01). Finally, 80% of participants would like more formal training opportunities for other surgical devices.

CONCLUSION:
This survey demonstrated a gap in surgical experience and comfort using the resectoscope at our institution. The novel instructional resectoscope video improved GS&O resident and staff comfort with setting up and troubleshooting the resectoscope. Staff comfort with supervising a resident using the resectoscope also increased. Future directions include expanding study population to include operating room staff and assessing post-intervention resectoscope utilization rates.
Postoperative Telemedicine Use: Satisfaction and Safety After Benign Gynecologic Surgery: A Randomized Controlled Trial [ID 2683391]
Authors: Norris Vanessa A. , Provost Holly , Smith Chloe , Willard Allison , Knowling Joselyn S. 
Published: May 2024

INTRODUCTION:
Telemedicine for postoperative care can be appropriate after minimally invasive surgery, but few studies have examined this option in gynecologic surgery. The objective of this randomized controlled trial was to determine whether virtual, compared to in-person postoperative care, after minimally invasive gynecologic procedures would increase patient satisfaction without negative safety concerns.

METHODS:
Patients were randomized to a telemedicine or in-person visit 2 weeks postoperatively. Eligible participants included women undergoing elective, minimally invasive gynecologic surgery. All participants completed the PSQ-18 form with addendum questions at their 6-week postoperative visit. Chart review was performed to assess frequency of postoperative adverse events. The Wilcoxon rank sum and Fisher exact test were used.

RESULTS:
Of 51 participants enrolled, 29 were randomized to standard (in-person) visits versus 22 randomized to intervention (telehealth). There was no statistical difference in the overall satisfaction with the postoperative care received between the intervention and the standard groups (93.8% agree or strongly agree versus 95.7%; P=1). There was no increase in postoperative complications in the intervention arm of the study, with an overall complication rate of 12.5% in all cases.

CONCLUSION:
It is reasonable to use telemedicine as an option for postoperative care based on shared decision-making with appropriate patients. A virtual postoperative visit is a safe option for patients who may not be able to travel to the office. Future study is ongoing to confirm statistical significance.
Patterns in Female Permanent Contraception After the Dobbs v. Jackson Ruling [ID 2683406]
Authors: Lulseged Bethlehem , Rockwell Tori , Wang Karen C. , Sufrin Carolyn , Stone Rebecca , Frost Anja S. 
Published: May 2024

INTRODUCTION:
On June 24, 2022, the Supreme Court reversed the constitutional right to abortion in Dobbs v. Jackson. We aimed to explore changes in interval female permanent contraception procedures before and after the Dobbs ruling.

METHODS:
We performed a retrospective chart review of interval female permanent contraception procedures at a large academic center between June 24, 2019, and May 25, 2023, using relevant CPT codes. Procedure counts pre- and post-ruling were compared. Chi-squared and difference-in-mean-proportions tests were used to explore differences across periods by patient characteristics. Institutional review board approval was waived for this study.

RESULTS:
There were 913 procedures performed during the observation period: 611 in the 3 years pre-ruling (June 24, 2019 to June 23, 2022) and 302 in the 11 months post-ruling (June 24, 2022 to May 25, 2023). There was a 49.5% increase in procedures between the pre-ruling and post-ruling timeframes. A higher proportion of patients who identify as White underwent procedures post-ruling compared to non-White counterparts (P<.001). Chi-squared testing indicated a relationship between insurance status and post-ruling procedures (P<.001). The largest proportion of patients who had procedures post-ruling were privately insured. Patients who had procedures post-ruling had lower gravidity compared to those who had procedures pre-ruling (P<.001).

CONCLUSION:
There was a significant increase in interval female permanent contraception procedures post-Dobbs ruling with significant differences found by race, insurance, and gravidity—notably, in a state without restrictive contraception or abortion legislation. As state abortion and contraception laws evolve, both state and national trends in female permanent contraception should be monitored.
Development and Potential Implementation of Endometrial Cancer Screening in a Poor-Prognosis Endemic Cancer Community [ID 2683642]
Authors: Chavez Thomas , Eiran Ekta , Matthews Roland P. , Leonis Regina , Giuseppe Del Priore 
Published: May 2024

INTRODUCTION:
Endometrial cancer incidence and mortality both are increasing in the United States. Certain patient populations are disproportionately affected by this disease. Currently, there is no recommendation from any professional society to screen high-risk patients for premalignancy or cancer. Our patient population is composed of predominantly Black women, a group that experiences worse endometrial cancer outcomes than other demographics. A risk assessment nomogram may be able to be developed using data from this unique patient population that can identify women at high risk of developing endometrial disease.

METHODS:
Endometrial pathology specimens collected at a large safety-net hospital between the years of 2013 and 2022 were analyzed. A retrospective chart review was performed on this data, looking for the patient characteristics of race, age, body mass index (BMI), parity, hemoglobin A1C level, and tamoxifen use history at the time of specimen collection. Odds ratios were calculated for those variables individually as well as collectively to determine whether they could be used to predict risk of endometrial disease in a woman with some of all those characteristics.

RESULTS:
The odds ratios for age, BMI, and parity were statistically significant between benign and abnormal pathologic specimens. The area under the receiver operating characteristic curve was 0.76 when combining age, BMI, and parity.

CONCLUSION:
Our data suggest that at-risk patients can be reliably identified using simple characteristics. Strengths of our study include a unique patient population and large database. Future directions include refinement of the model and prospective application in the clinical setting.
Trends in Overactive Bladder Prescriptions From 2020 to 2022: A Single Institution Review [ID 2683593]
Authors: Ashmore Sarah , Sarkar Prottusha , Brown Oluwateniola 
Published: May 2024

INTRODUCTION:
Anticholinergic (AC) and beta-3 agonist (B3) medications are the mainstay of pharmacotherapy to treat overactive bladder (OAB). Recent clinical guidelines recommend cautious use of ACs in elderly patients as ACs are associated with cognitive side effects. The primary objective of this study was to examine OAB prescribing patterns from 2020 to 2022.

METHODS:
This is an IRB-approved retrospective study at a single academic center between January 2020 and December 2022. Women aged at least 18 years, diagnosed with OAB, and newly prescribed ACs or B3s were included. Overactive bladder diagnosis was identified using ICD-9 and -10 codes and the electronic medical record queried for new OAB medication prescriptions in our system. Patient demographics and clinician specialty were abstracted from the medical record. Group comparisons were conducted using Student's t-test, and χ2, Fisher's exact tests were used as appropriate.

RESULTS:
Five thousand six hundred forty-eight women were prescribed an AC or B3 between 2020 and 2022. Anticholinergic medications were more commonly prescribed, comprising 58.3% of OAB prescriptions compared to B3s (41.7%). Beta-3 agonist prescriptions increased by 127% over the study period. In contrast, AC prescribing remained stable. Women prescribed B3 agonists were more likely to be older (P<.001). There were significant differences in OAB prescription trends by prescriber specialty (P<.001). Urogynecologists were the leading prescribers of B3s (38.3%), whereas primary care clinicians prescribed the most ACs (57.9%).

CONCLUSION:
Beta-3 agonist prescriptions increased while AC prescriptions were relatively unchanged from 2020 to 2022. Despite growing concern regarding AC risks, our study shows that ACs are still prescribed at high volume.
How Did the Recent Infant Formula Shortage Affect Breastfeeding Rates in Northeast New York [ID 2683397]
Authors: Gojayev Anar , Gifford Jamie , Zelig Craig M. 
Published: May 2024

INTRODUCTION:
To determine the effect of the recent infant formula shortage on breastfeeding rates in the northeast New York area.

METHODS:
This was a retrospective analysis of the Northeast New York (NENY) Regional Birth Registry database from January 2021 to June 2022. Breastfeeding rates of patients in the first 6 months of 2022 were compared to those from 2021. Maternal demographics, obstetrical history, breastfeeding, and delivery information were collected. We wanted to determine whether the recent infant formula shortage in the United States affected the breastfeeding rates. Statistical analyses were performed using STATA software (Stata/SE 12.1). A P value of <.05 was considered statistically significant. This study was approved by the IRB at Albany Medical Center. We controlled for maternal marital status, education level, ethnicity, and employment status during pregnancy in our statistical analysis.

RESULTS:
We identified 19,610 patients in the NENY database from January 2021 to June 2022. 170 (0.87%) were excluded from our study due to breastfeeding data not being available. The exclusive breastfeeding rate increased from 55.97% to 57.25%. However, this was not statistically significant (P<.104). The formula-only rates essentially stayed the same, 17.94% versus 17.54%. The rates of the infants who were supplemented with formula had a nonsignificant decrease from 25.23% to 24.33% (P<.185). We did a secondary analysis in which the data were excluded for those infants who were admitted to the neonatal intensive care unit and the differences were even smaller with an overall P value of 0.949.

CONCLUSION:
Although the recent infant formula shortage in the United States led to a slight increase in exclusive breastfeeding rates and decrease in formula feeding in a first 6 months of 2022, none of these were statistically significant. These differences were not statistically significant even after controlling for demographic factors such as marital status, race, and education level and BMI.
Gestational Weight Gain Is Not Associated With Risk of Fetal Acidosis in Scheduled Cesarean Deliveries [ID 2683603]
Authors: Dubois Bethany , Sarker Minhazur , Bianco Angela , DeBolt Chelsea A. 
Published: May 2024

INTRODUCTION:
Obesity is associated with fetal acidosis at time of scheduled cesarean delivery (CD). Although excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes, it is not known whether GWG is associated with fetal acidosis at time of scheduled CD.

METHODS:
This was an IRB-approved retrospective cohort study of term, singleton, non-anomalous deliveries by scheduled cesarean under neuraxial anesthesia at Mount Sinai Hospital from 2013 to 2019. Gestational weight gain was the difference between pre-pregnancy or first-trimester weight and delivery weight. Gestational weight gain appropriateness was defined by Institute of Medicine recommendations: insufficient, appropriate, excessive. Primary outcome was fetal acidosis defined as umbilical arterial pH less than 7.1. Demographics were compared using chi-squared analysis and the association between GWG and fetal acidosis was evaluated with multivariable logistic regression.

RESULTS:
Of 2,435 individuals included, 1,046 (43%) had excessive, 749 (31%) had appropriate, and 640 (26%) had insufficient GWG. Incidence of fetal acidosis was 0.8%, 1.7%, and 1.9% among populations with insufficient, appropriate, and excessive GWG, respectively (P=.2). Across groups, rates of insurance status, history of cesarean delivery, and anesthesia type were similar. Compared to appropriate GWG, the excessive GWG group had higher rates of early pregnancy obesity (P=.001). After adjusting for early pregnancy weight, age, cesarean history, insurance type, and anesthesia type, excessive GWG was not associated with increased odds of fetal acidosis (adjusted odds ratio [aOR] 1.01 [0.49, 2.14]).

CONCLUSION:
Neither excessive nor insufficient GWG are associated with increased risk for fetal acidosis in term, scheduled CD. Association between obesity and fetal acidosis are likely unrelated to GWG.
Prediction of Expected Fetal Weight From Fetal Limb Soft Tissue Measurements [ID 2683393]
Authors: Kim II Dong 
Published: May 2024

INTRODUCTION:
This study was to investigate a combination of new formulas that predict birth weight in full-term pregnancy by measuring the thickness of the humerus soft tissue and femur soft tissue in fetuses using three-dimensional (3D) ultrasound.

METHODS:
There were a total of 110 mothers and newborns who were hospitalized with selective cesarean section, induced delivery, or natural delivery between April 2019 and August 2021. We retrospectively investigated fetal biometric parameters (BPD, HC, AC, FL, partial arm volume [Avol], and partial thigh volume [Tvol]), as measured by 4D View 9.0 and GE Healthcare Ultrasound while the mother was admitted to the delivery ward before delivery. The study was approved by the ethics board of the National Medical Center (NMC-2022-03-026).

RESULTS:
Among the several combinations that showed the expected weight, the weight predicted by AC/BPD/Tvol gave the strongest correlation (0.780) with the actual weight of the newborn, with an error rate of 6.4%. In boys, among the several combinations indicating the predicted body weight, AC/Avol/BPD had the highest correlation coefficient with the actual body weight (0.791), with an error rate of 5.0%. In girls, among several combinations, AC/Tvol/BPD had the highest correlation coefficient with actual body weight (0.878), with an error rate of 5.3%.

CONCLUSION:
The fetal weight predicted using Tvol and Avol measured using 3D ultrasound as parameters had a lower error rate for birth weight than the predicted weight measured by conventional 2D ultrasound. The parameters highly correlated with birth weight; however, differences were seen between the sexes.
Decreased Sonographic Head Circumference Is Found in Buprenorphine-Exposed Fetuses [ID 2683396]
Authors: Benton Brooke , Condra Alex , Lewis Nicole , Olsen Martin 
Published: May 2024

INTRODUCTION:
Neonates diagnosed with neonatal opioid withdrawal syndrome (NOWS) have decreased head circumference compared to non-exposed newborns. This is the first study to evaluate fetal head circumference over time in a group of fetuses with intrauterine buprenorphine exposure.

METHODS:
Fetal anatomic surveys are commonly performed at around 20 weeks of gestation. Patients treated with medication-assisted therapy (MAT) for opioid use disorder commonly receive estimated fetal weight scans at around 32 weeks of gestation due to the risk of intrauterine growth restriction. Retrospective review of ultrasound reports for three groups of patients were performed. Group 1 (75 patients) was low-dose MAT; group 2 (73 patients) was traditional higher-dose MAT. Group 3 (104 patients) was a control group. The IRB approval was 1220.9e-ETSU, entitled “Effect of Maternal Buprenorphine on Fetal Head Circumference.”

RESULTS:
At the time of the approximately 20-week scan, no statistical difference was found between the groups. At the approximately 32-week growth scan, however, a comparison of the two buprenorphine groups together versus control group showed a statistically significant difference (P=.018) in head circumference. Although the low-dose group had larger head circumferences than the higher-dose group in the 32-week scan, the difference was not significant.

CONCLUSION:
Previous studies have shown decreased head circumference in newborns in association with maternal MAT. This is the first study to provide ultrasound confirmation of decreased head circumference in fetuses exposed to buprenorphine. Effects are pronounced in the third trimester; the possibility exists that interventions during pregnancy might preserve fetal brain volume. Further research is needed.
Intravenous Iron Supplementation in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683469]
Authors: Pfeiffer Alixandria F. , Chang Nathalie H. , Cheng CeCe , Byrne John J. , Doyle Nora M. 
Published: May 2024

INTRODUCTION:
Intravenous (IV) iron supplementation for patients with iron deficiency anemia in pregnancy has been shown to improve hemoglobin (Hb) levels in the peripartum period and ultimately lead to a decrease in severe maternal morbidity (SMM), specifically blood transfusion. The objective of this study was to analyze the effects of IV iron supplementation on maternal pre-delivery Hb levels after the implementation of an institution-based protocol focused on maternal red blood cell transfusion reduction.

METHODS:
We performed a retrospective review of patients who received IVFe supplementation after the implementation of a maternal transfusion reduction bundle at our Level IV maternal care center in 2020. We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023), along with rates of postpartum blood transfusion. Patients were excluded if they received an antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software.

RESULTS:
Two hundred ninety-five patients met inclusion criteria; most patients were Hispanic (71.9%), had Medicaid (51.9%), and underwent a vaginal delivery (76.9%). Mean gestational age at time of infusion was 34.2 weeks (95% CI, 33.7–34.7) The average Hb pre-infusion and pre-delivery were 8.9 (95% CI, 8.8–9.0) and 10.6 (95% CI, 10.4–10.8), respectively. The change in maternal Hb at time of delivery increased by 2 points (P<.0001). Only two patients received a blood transfusion postpartum.

CONCLUSION:
Implementation of a standardized antenatal IV iron infusion protocol can improve maternal pre-delivery Hb levels and reduce morbidity associated with blood transfusion.
Intravenous Iron Supplementation Timing in Pregnancy: A Quality Improvement Project on Maternal Transfusion Reduction [ID 2683470]
Authors: Pfeiffer Alixandria F. , Chang Nathalie H. , Zarudskaya Oxana M. , Boyd Angela R. , Doyle Nora M. 
Published: May 2024

INTRODUCTION:
Intravenous iron supplementation (IVFe) for pregnant patients with iron deficiency anemia improves hemoglobin (Hb) levels in the peripartum period. Optimal timing of this therapy, however, is unknown. We analyzed the effects of IVFe as part of an institution-based protocol on maternal Hb levels, stratifying by gestational age (GA).

METHODS:
We reviewed changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by gestational age (<34 or ≥34 weeks) at time of IVFe. We excluded patients with known antepartum blood transfusion. Maternal demographics, ferritin and Hg levels were compared between the two groups using GraphPad Prism software.

RESULTS:
Of 295 patients who met inclusion criteria, maternal age, body mass index, nulliparity, and ferritin levels were similar in both groups. Mean GA for the cohorts at time of IV iron transfusion were 29.6 ± 4.9 weeks (early third trimester) and 36.6 ± 2.4 weeks (late third trimester), respectively (P<.0001). Higher delta Hb (2.5 g/dL at <34 weeks versus 1.3 g/dL at ≥34 weeks) and improved mean pre-delivery Hb were seen when IV iron was given in the early third trimester (P<.0001).

CONCLUSION:
Early third-trimester IVFe improves maternal pre-delivery Hb levels and may reduce significant maternal morbidity hemorrhage complications.