bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Vulvar Aphthous (Lipschütz) Ulcer After COVID-19 Vaccine: Two Cases [ID: 1337743]
Authors: Fassett Karena , Combs Shanna 
Published: May 2023

INTRODUCTION:
Vulvar aphthous ulcers are uncommon, non-sexually transmitted genital lesions that typically arise in adolescents and young women after viral infection. The pathogenesis of this condition is poorly understood but is thought to arise from an immune-mediated process. More recently, there have been several reports of vulvar aphthosis after COVID-19 infection, and to date, we have identified five case reports describing the development of this condition within days of receiving one of the existing U.S. Food and Drug Administration-approved mRNA COVID-19 vaccines.

METHODS:
We present the cases of two adolescents, aged 13 and 16 years, who both developed acute genital aphthous ulcers within days of their second Pfizer-BioNTech COVID-19 vaccinations with no other apparent triggers.

CONCLUSION:
These two cases represent a growing number of patients who have developed acute genital ulceration (AGU) in close temporal proximity to COVID-19 vaccination, which represents a potential novel etiology for this uncommon condition. If vaccination is indeed a trigger for AGU, this may support an immune-mediated pathogenesis, although future studies are needed to explore this further. The continued publication of high-quality case reports describing AGU will allow us to gather enough data to make statistical inferences and to raise awareness for this condition, which is underrecognized and often misdiagnosed by providers.
Does Weaning of Buprenorphine in Pregnancy (in Outpatient Setting) Improve Neonatal and Maternal Outcome? [ID: 1369357]
Authors: Shah Darshan , Chroust Alyson , Olsen Martin 
Published: May 2023

INTRODUCTION:
Treatment of opioid use disorder (OUD) in pregnancy is challenging. There are reports of successful weaning in OUD in pregnancy, even though professional bodies maintain the recommendation of nonweaning during pregnancy.

METHODS:
It was a prospective, nonintervention study after the local IRB's approval. We have a university group of obstetrician providers who will wean buprenorphine during pregnancy after contracting with pregnant women while providing counseling and social services. Many women choose to wean, while many continue not to wean and get their obstetric care at university but their substance use disorder care at other medical-assisted treatment centers. Women in the weaning group consented at the prenatal clinic, while the nonweaning group consented to the study at the hospital when they presented for the delivery. Women were given questionnaires in the postpartum period for the Edinburg Postnatal Depression Scale (EPDS), and the Perceived Stress Scale (PSS). Demographics for mothers and neonates were extracted from medical records.

RESULTS:
There were 34 pregnant women in the weaning group, with 13 women in the nonweaning group. Polysubstance use and low-birth-weight infant were excluded from neonatal outcome measures for the length of neonatal stay in hospital analysis for obvious reasons. The mean buprenorphine dose in the weaning group was significantly lower (1.9 versus 11.7 [mean] with P<.0001 [T test]). Also, the length of neonatal stay was significantly lower (4.9 versus 7.2, P<.05) and a trend towards higher birth weight (3,137 versus 3,018 g) and decreasing morphine requirement (62 versus 249 doses) in weaning group. PSS and EPDS scores did not show statistically significant differences with lower scores in the weaning group.

CONCLUSION:
Our results show that weaning of buprenorphine in OUD women during pregnancy in an outpatient setting is possible and improves outcomes for neonates and mothers.
Uterine and Ovarian Histopathology in Transmasculine and Nonbinary Patients on Testosterone Compared to Cisgender Control Patients [ID: 1381367]
Authors: Toland Maris , Bentz Jessica , Bonasia Kyra , Damiano Ella , DelBaugh Regina , Gerjevic Kristen 
Published: May 2023

INTRODUCTION:
Hormonal treatment is a critical aspect of health care for transgender and nonbinary patients, but scientific literature describing ovarian and uterine histopathology in the setting of testosterone therapy remains limited and conflicted.

METHODS:
After IRB approval and patient consent, uterine and ovarian histopathology was prospectively evaluated in 22 gender-diverse patients on testosterone compared with 21 premenopausal cisgender controls not on hormones undergoing hysterectomy.

RESULTS:
Average duration of testosterone administration was 54.9 months. Average age was 30 years in the testosterone group and 40.6 years in the control group. Average body mass index was 28 kg/m2 in the testosterone group and 31 kg/m2 in the control group. 18 (82%) patients in the testosterone group had inactive/atrophic endometria, compared with 2 (10%) in the control group. 4 (18%) patients in the testosterone group had proliferative endometria, compared to 10 (48%) in the control group. No patients on testosterone had secretory endometrium, compared to 6 (29%) in the control group. Leiomyoma were noted for 5 (23%) in the testosterone group and 4 (19%) in the control group. Adenomyosis was present in 1 (5%) in the testosterone group, compared to 5 (24%) in the control group. Low rates of preoperative cervical dysplasia were reported in both groups. All cervical and fallopian tube specimens in both groups were benign.

CONCLUSION:
Compared to a cisgender control group, patients on long-term testosterone therapy were more likely to have inactive/atrophic endometrium. Increasing our knowledge of the effects of testosterone has implications for preoperative surgical assessment and surveillance for patients not undergoing surgery.
Association of the Cervicovaginal Microbiome With Contraceptive Methods in Hispanic Women Living in Puerto Rico [ID: 1376364]
Authors: Oliveras-Alsina Nicole , Navarrete-Cortés Marilís , Romaguera Josefina , Tosado-Rodríguez Eduardo 
Published: May 2023

INTRODUCTION:
Recent studies have demonstrated an association linking the cervicovaginal microbiome with susceptibility to infectious diseases and overall cervical health. We aimed to evaluate the effect of contraceptive methods used by Hispanic females living in Puerto Rico on their cervical microbiome.

METHODS:
An analysis of 85 women, aged 21–45, grouped by the contraceptive method used at time of sampling, was performed. The methods included birth control pills, intrauterine devices (IUDs), injectable progesterone, male condoms, and female sterilization. The control group did not use any contraception. Swabs collected from the posterior fornix underwent DNA extraction and sequencing of the 16S rRNA gene, being characterized for microbial diversity, and taxonomic composition. IRB approval was obtained.

RESULTS:
Women using male condoms or sterilization had the highest microbiome richness, and those using IUDs and female sterilization had the highest microbiome diversity. Birth control pills and male condoms had the least effect on the microbiota as participants had a dominance of Lactobacillus. Injectable progesterone and IUDs use were associated with increased levels of Gardnerella. The IUDs group has a noticeable presence of Clostridium when compared to other groups. The female sterilization group is copious in Atopobium and Streptococcus. The injectable progesterone group has an elevated abundance of Megasphaera.

CONCLUSION:
Preliminary analyses indicate that contraceptive methods may affect the cervicovaginal microbiome, injectable progesterone and IUDs being the methods most associated with vaginal dysbiosis. These findings allow information about the microbiome of Hispanic women living in Puerto Rico to guide further investigations that could contribute to better gynecologic care.
Levonorgestrel Emergency Contraception Availability in Louisiana Independent and Chain Pharmacies Post-Dobbs v Jackson Women’s Health Organization [ID: 1376654]
Authors: Shu Sharon , Bergeron Lauren , Juracek Kali , Sisk Charles , Williams Frank 
Published: May 2023

INTRODUCTION:
Following recent legal changes, there is increased confusion regarding availability of medications for reproductive health, including emergency contraception (EC). We aimed to quantify over-the-counter (OTC) access to levonorgestrel EC in three metropolitan Louisiana parishes (counties) among chain and independent pharmacies.

METHODS:
This cross-sectional study took place during August and September 2022. Secret shoppers surveyed all retail pharmacies in Jefferson, Orleans, and Terrebonne parishes. Pharmacies were classified as independent or chain based on affiliation with supermarket or drug store chains. Odds ratios (ORs) with 95% CIs were used to compare availability of OTC EC.

RESULTS:
Among 212 retail pharmacies, 55% (n=117) were large chain pharmacies and 45% were independent stores. Only 67% (n=141) had EC in stock. Chain pharmacies were more likely to offer EC than independent pharmacies (92% versus 35%, OR 22.6, 95% CI [10.1, 50.2]). Independent pharmacies were more likely to keep OTC EC behind the counter (91% versus 11%, OR 80.0, 95% CI [21.2, 302.5]), require identification (45% versus 4%, OR 21.7, 95% CI [6.5, 72.7]), and carry no EC less than $50 (24% versus 2%, OR 17.0, 95% CI [3.4, 84.8]). Among pharmacies without EC available, no chain pharmacies described recent changes in EC stock, while 5 out of 28 (18%) respondent independent pharmacies attributed loss of EC stock to recent legislation.

CONCLUSION:
Independent pharmacies were less likely to carry OTC EC and more likely to enforce multiple barriers to purchase. Recent legislation has disproportionately further reduced EC availability at these pharmacies.
Assessing the Effect of Telemedicine Implementation on Patient Satisfaction With and Adherence to Gynecologic Appointments [ID: 1344973]
Authors: Junn Sue , Desai Andrea , Hurvitz Julie , Lahti Elizabeth 
Published: May 2023

INTRODUCTION:
The COVID-19 pandemic led to a rapid increase in telemedicine visits to ensure delivery of essential health services while minimizing infection exposure. While there have been studies related to telemedicine in other specialties, there is a paucity of data assessing the effect of telemedicine visits in gynecology. The purpose of this study is to evaluate whether and how implementation of telemedicine affects patient adherence to and satisfaction with scheduled gynecologic appointments.

METHODS:
A retrospective review of 1,170 patients who participated in gynecologic telemedicine visits and 5,303 patients who participated in in-person gynecologic visits between March 1, 2020, and December 1, 2021, was performed to evaluate demographic information, chief complaint, and visit attendance. A cross-sectional survey of 1,248 patients who participated in gynecologic telemedicine visits between these dates was also performed to evaluate perceptions of satisfaction, access, quality and safety, and convenience of telemedicine. Institutional review board exempt protocol HP-00099093.

RESULTS:
The average no-show rate for gynecologic telemedicine visits was 2% compared to 22% for in-person gynecologic visits (P<.001). 33/1,249 patients responded to the survey. Sixty-nine percent (23/33) of survey respondents were satisfied with telemedicine visits.

CONCLUSION:
This study supports the continued incorporation of telemedicine into standard gynecologic practice to increase patient adherence with visits. Our gynecologic telemedicine no-show rates are significantly lower than patients’ overall no-show rates for in-person visits. These outcomes may be associated with patients’ satisfaction with telemedicine visits because of their being convenient, time saving, and less disruptive to their day.
Relugolix Combination Therapy in Women With Uterine Fibroids and Adenomyosis: LIBERTY 1 and 2 Trials [ID: 1345355]
Authors: Catherino William , Al-Hendy Ayman , Munro Malcolm , Proehl Sarah , Wu Rui , Zaim Souhil 
Published: May 2023

INTRODUCTION:
Adenomyosis and uterine fibroids (UFs) may coexist in women with heavy menstrual bleeding (HMB). Relugolix combination therapy (Relugolix-CT: relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) is approved in the United States to treat HMB associated with UFs and moderate-to-severe pain associated with endometriosis. A post-hoc analysis of the pivotal, 24-week LIBERTY 1 and 2 studies evaluated the efficacy of Relugolix-CT versus placebo in the subgroup with ultrasound evidence of adenomyosis.

METHODS:
Baseline ultrasound images from women enrolled in the replicate, IRB-approved LIBERTY studies were evaluated for adenomyosis using predefined criteria. Primary endpoint: proportion of study completers with baseline adenomyosis who were HMB responders, defined as 50% or higher reduction in menstrual blood loss (MBL) volume from baseline and less than 80-mL MBL over the last 35 days. Pooled LIBERTY 1 and 2 results are presented.

RESULTS:
Of women who completed the LIBERTY studies, 111/610 (18.2%) had ultrasound evidence of adenomyosis at study entry. The prevalence of adenomyosis was similar between treatment groups (18.3% and 14.0% for Relugolix-CT and placebo, respectively). In this subgroup, 83.8% of women treated with Relugolix-CT were HMB responders versus 27.6% of women who received placebo; responders in the overall population were 72.3% and 16.8%, respectively. Additionally, 64.9% of women in this subgroup who received Relugolix-CT were amenorrheic over the last 35 days of treatment, versus 6.9% of women treated with placebo.

CONCLUSION:
Relugolix-CT effectively reduced HMB in women with UFs and adenomyosis through 24 weeks. Efficacy in this subgroup of women was generally similar to the overall study population.
Effect of Clinical Setting on Prevalence of Pregnancy of Unknown Location: A Retrospective Cohort Study [ID: 1377630]
Authors: Javlekar Ashwini , Flink-Bochacki Rachel , Piatelli Alissa , Vinner Amanda 
Published: May 2023

INTRODUCTION:
Pregnancy of unknown location (PUL) is the diagnosis of a positive pregnancy test without ultrasonographic confirmation of pregnancy location. Using varying diagnostic criteria, studies from the 1980s to early 2000s estimated the prevalence of PUL diagnoses at 8–31%. With advances in ultrasound technology and increasing use of early ultrasound, we aimed to determine current prevalence of PUL and differences by clinical setting.

METHODS:
With IRB approval, we conducted a retrospective cohort study of all initial pregnancy ultrasounds less than 14 weeks performed at a single academic medical center from January 1, 2018, to December 31, 2019. Ultrasounds occurred in the outpatient perinatal ultrasound suite or inpatient radiology suite via the emergency department. We compared diagnoses by setting via chi-square tests and logistic regression using Stata SE.

RESULTS:
Of 1,775 ultrasounds, only 81 (4.6%) were PULs, while 308 (17.4%) were intrauterine pregnancies of uncertain viability (IPUV). Both types of uncertain pregnancy diagnosis were more common in the emergency department than the outpatient obstetrics and gynecology setting (PUL: 8.3% versus 2.0%, P<.001; IPUV: 23.8% versus 12.9%, P<.001). Patients with symptoms of cramping or vaginal bleeding were more likely to have uncertain diagnoses (33.1% versus 16.8%, P<.001); however, presence of symptoms was not independently associated with uncertain diagnosis after controlling for setting.

CONCLUSION:
Diagnoses of PUL have declined, largely replaced by diagnoses of IPUV. Differences in diagnosis prevalence unexplained by patient symptoms support existing evidence of disparate early pregnancy experiences between the outpatient and emergency settings. As over one-fifth of patients will have an uncertain pregnancy diagnosis on initial ultrasound, safe, efficient, and patient-centered follow-up protocols are crucial.
Disparities and Patterns of Pain Management, Pharmacologic Therapies, and Surgical Treatments for Leiomyomas in the 2017–2019 National Survey of Family Growth [ID: 1380252]
Authors: Rennie Christopher , Andelija Sanela , Prol Barbara 
Published: May 2023

INTRODUCTION:
Leiomyomas affect most women throughout their lifetime with an incidence of roughly 80%. Approximately 30% of these women develop symptomology that warrants intervention. With such a large prevalence, it is important to highlight patterns in treatment modalities to guide effective management for all women with this condition.

METHODS:
We utilized weighted survey results from the Centers for Disease Control and Prevention’s 2017–2019 National Survey of Family Growth. After isolating data to those who reported a leiomyoma diagnosis, we performed a test of equal proportions (P<.05) among the nine listed therapies compared to the following socioeconomic factors: race, age, education, and insurance status.

RESULTS:
The incidence of leiomyomas was 7.3% (449/6,141). Hispanic women and those with state-sponsored or uninsured status were more likely to report receiving none of the listed treatments (P=.05 and .02). Women who marked “Other” were most likely to seek alternative medicine (P=.03). Hysterectomy was most likely for Black, White, and 40- to 49-year-old women (P=.02 and P<.001). Nonhysterectomy procedures were most seen with government-sponsored health care, private insurance, and women with graduate degrees (P<.001 and P=.02). Pharmacologically, White women were more likely to receive progesterone-releasing intrauterine devices (P=.02), women 19–29 were more likely to use hormonal medicine (P<.001), and those with government insurance were more likely to receive narcotics (P=.006).

CONCLUSION:
All socioeconomic factors held significant inconsistencies in the utilization of various leiomyoma treatments. As this condition will affect most women, this analysis highlights the need for future standardization to ensure optimal treatment implementation and patient outcomes.
Emergency Department Readmission for Early Pregnancy Concerns Among Patients Who Speak Spanish [ID: 1366721]
Authors: Taper Gabrielle , Alvarez Miriam , Thaxton Lauren , Tristan Sigrid 
Published: May 2023

INTRODUCTION:
The purpose of this study was to compare readmission rates for early pregnancy concerns in the emergency department (ED) among patients that speak English versus Spanish as their primary language.

METHODS:
From January 1, 2020 to June 1, 2021, we conducted a chart review to identify pregnant patients presenting to the ED using ICD-10 codes for pregnancy and first-trimester diagnoses (n=383). Charts were excluded if pregnancy was beyond 13 weeks or an ultrasound-confirmed ectopic pregnancy. Readmission was a separate ED encounter during the first trimester of that same pregnancy. Preventable readmission was one that could have been prevented if the patient had received correct counseling, diagnosis, or management at the index admission. Our primary outcome was frequency of ED readmission among English versus Spanish speakers. This protocol was approved for IRB exemption by the University of Texas.

RESULTS:
Threatened abortion was the most common diagnosis among both groups. Readmissions were more frequent among Spanish speakers (40% versus 26% [P=.01]). Preventable readmissions were more common among Spanish speakers (31% versus 25%). The majority of preventable readmissions (81%) among Spanish speakers could have been prevented if correct management was offered, compared to 25% in English speakers (P=.03).

CONCLUSION:
Spanish and English speakers present with similar types of early pregnancy concerns, but Spanish speakers are not offered management of early pregnancy concerns at the same frequency. Standardization of care for early pregnancy concerns in the ED may help reduce language-based disparities in quality and equity of care.
Black Race and Racism Affect Likelihood of Undergoing Surgery After Referral to a Minimally Invasive Gynecologic Surgeon [ID: 1377814]
Authors: DeGaia Ayana , Louie Michelle , McClurg Asha , Silverstein Gina 
Published: May 2023

INTRODUCTION:
Significant racial and ethnic disparities persist in access and outcomes for patients with benign gynecologic disorders. The role of sociodemographic factors in surgical delays after referral to a minimally invasive gynecologic surgery (MIGS) specialist is unknown.

METHODS:
A retrospective cohort study of patients who completed a MIGS consultation at a single, large academic hospital between March 2015 and July 2016 (n=1,110) was performed. Logistic regression was used to assess effect of age, self-reported race and ethnicity, primary language, and insurance type on likelihood of surgical intervention within 12 months of consultation.

RESULTS:
Of patients undergoing surgery, the average wait time after consultation was 86 days (SD 69). Black patients had 2.6 times the odds of having surgery within 12 months of consultation (odds ratio [OR] 2.6, 95% CI 1.96–3.47) compared to White patients. Patients with Medicare had lower odds of completing surgery (OR 0.4, 95% CI 0.21–0.72) compared to those with other insurance or no insurance. Age, ethnicity, and primary language were not found to be correlated with surgical intervention.

CONCLUSION:
Race was found to be independently associated with likelihood of surgical intervention. Black patients in our study had more than twice the odds of having surgery compared to White patients, irrespective of age, ethnicity, primary language, or insurance. This may be due to more advanced disease at time of presentation secondary to care delays as well as surgeon bias in more readily pursuing surgery for Black patients, both of which stem from racism.
Difference in Time to Delivery Between Dilation and Evacuation (D&E) Versus Induction of Labor for Medical Indications [ID: 1380391]
Authors: Navarrete Emily , Goldsmith Crystal , Guzik Claudia , Stephens Joncel , Wei Julia , Wei Julia , Weintraub Miranda 
Published: May 2023

INTRODUCTION:
Pregnancy termination may be the safest management option among pregnancies with medical conditions that arise during the second trimester and are associated with elevated risk of maternal morbidity and mortality. Termination can be done by dilation and evacuation (D&E) or induction. Each method carries different risk and benefit profiles; however, variations in time to delivery have not been established. We assess the difference in time from diagnosis to delivery between D&E and induction for medically indicated second-trimester terminations.

METHODS:
Electronic medical records of 85 adult patients who underwent a D&E and 19 who underwent an induction between July 1, 2020, and December 31, 2020, within Kaiser Permanente Northern California were retrospectively surveyed for patient demographics and clinical characteristics, including indication for and method of termination, time of diagnosis and delivery, cervical preparation method, and perioperative complications.

RESULTS:
Patient demographic and clinical characteristics were similar across groups. The median time from diagnosis to delivery was 74 hours (interquartile range [IQR]: 18–141 hours) in the D&E cohort and 9 hours (IQR: 4–45 hours) in the induction cohort (P<.01). In the induction cohort, there were 21.1% (n=4) complications versus 4.7% (n=4) in the D&E cohort (P=.04). In the induction group, 10.5% (n=2) of patients required an additional procedure to complete the termination.

CONCLUSION:
The median time from diagnosis to delivery was 65 hours shorter in the induction group compared to D&E. This difference may be deemed clinically significant for patients who weigh time to delivery in their decision-making.