bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of the New Diagnostic Criteria of Fetal Growth Restriction on Obstetric and Neonatal Outcomes [ID: 1376466]
Authors: Ibirogba Eniola , Romero Vivian , Tsimis Michael , Wizner Casey 
Published: May 2023

INTRODUCTION:
The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification.

METHODS:
This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study.

RESULTS:
Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05).

CONCLUSION:
The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.
Effect of Fetal Surgery on Maternal Mental Health [ID: 1376946]
Authors: Larish Alyssa , Betcher Hannah , Liseth Olivia , Moore Katherine , Schenone Mauro , Weng Jessica 
Published: May 2023

INTRODUCTION:
Perinatal mental illness imparts a significant health burden. A multitude of factors are hypothesized to increase the incidence of perinatal mood and anxiety disorders (PMADs) in the fetal surgical population, including uncertain fetal prognosis and the inherent risks of surgery and preterm delivery. We sought to determine the disease course of PMADs in the fetal surgery population.

METHODS:
A retrospective chart review was conducted of fetal surgery patients from 2017 to 2021 at a tertiary care center. Demographics, surgical, obstetric, and psychiatric diagnoses were recorded. Standard descriptive analyses were performed.

RESULTS:
One hundred nineteen eligible patients were identified. Fetal surgery was performed at a median gestational age of 23.0 (range 16.0–34.0) weeks. Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. 26.8% (32/119) had preexisting mood disorders, with 59.3% (19/32) and 53.1% (17/32) on a baseline medication for depression or anxiety, respectively, prior to surgery. 26.4% (23/87) of patients without a history of anxiety or depression had a new diagnosis of PMAD. Two patients experienced suicidal ideation. 6.7% (8/119) and 10.1% (12/119) initiated a new psychiatric medication during or post-pregnancy, respectively. 19.8% (21/113) received a therapy referral. Among patients with baseline anxiety or depression, 62.5% (20/32) experienced an exacerbation postpartum with 25.0% (8/32) referred for therapy, and 34.3% (11/32) changing dose or medication for anxiety and 37.5% (12/32) for depression.

CONCLUSION:
Among patients undergoing fetal surgery, a high incidence of PMAD was identified. Most patients with prepregnancy anxiety or depression experienced an exacerbation postpartum. Further research into effective supportive interventions is warranted.
Where Is Communication Breaking Down? Narrative Tensions in Obesity-in-Pregnancy Clinical Encounters [ID: 1377560]
Authors: Dadouch Rachel , D'Souza Rohan , Kingdom John , Maxwell Cynthia , Parsons Janet , Windrim Rory 
Published: May 2023

INTRODUCTION:
Health care professionals (HCPs) often view obesity in pregnancy as a condition associated with numerous adverse clinical outcomes and procedural difficulties. In contrast, patients characterize their challenges encountered because of stigma, their desire for a normal pregnancy, and may feel weight is overemphasized. The study's objective was to explore stories of patients and HCPs in tandem, in order to understand communication challenges within obesity-in-pregnancy clinical encounters.

METHODS:
Employing narrative inquiry, we conducted in-depth interviews with 16 patients and 19 HCPs. Stigma theory informed our research approach. Dialogical narrative analysis of interview transcripts was conducted.

RESULTS:
We identified five narrative tensions that contributed to communication challenges during clinical encounters. The first three tensions related to contrasting views on obesity: 1) obesity as a detriment to health versus acceptance of obesity; 2) a result of personal choice versus a result of uncontrollable circumstances; and 3) a regular pregnancy versus a high-risk diagnosis. Two further tensions related to characterizations of communication within the clinical encounter: 4) typical and problem-free versus a tremendously difficult clinical encounter; and 5) talking openly about obesity versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity and being a “good” HCP/patient influenced these tensions.

CONCLUSION:
This study identified five narrative tensions and revealed specific areas where communication in the obesity-in-pregnancy clinical encounter is vulnerable to breaking down, accounting for the complexities in this interactive space. These findings can inform clinical practice and education and may be applicable to other clinical contexts.
Outcomes in Gestational Diabetes Stratified by Treatment With Oral Agents Only, Insulin Transition From Oral Agents, and Insulin Only [ID: 1378229]
Authors: Griffith Taylor , DeFranco Emily , Edwards Kayla , Masters Heather 
Published: May 2023

INTRODUCTION:
Patients with gestational diabetes (GDM) requiring insulin after inadequate glycemic control on oral agents have increased rates of fetal macrosomia and neonatal intensive care unit admission compared to patients with insulin-only treatment. Our objective was to stratify additional GDM outcomes by treatment type.

METHODS:
Single-center retrospective cohort study of 617 patients with GDM, 2011–2018, excluding pre- and diet-controlled GDM. We stratified by treatment: oral agents (referent), transition to insulin from oral agents, and insulin only. Generalized linear modeling adjusted for group differences and biologically plausible covariates.

RESULTS:
Most patients were treated with oral agents only (74.5%), 7.1% changed to insulin, and 19.7% insulin only. Patients on oral agents only were more likely to be Black, Asian, or Hispanic/Latina race and ethnicity, non-English-speaking, lower body mass index (BMI), and later diagnosis. Insulin addition was significantly associated with increased hyperglycemia admissions and gestational weight gain (GWG), after adjusting for BMI, treatment initiation gestational age (GA), race and ethnicity, language, and insurance. Insulin transition was also significantly associated with increased cesarean delivery (CD) rate, after adjusting for age, delivery GA, parity, BMI, chronic hypertension, race and ethnicity, and insurance. To examine abdominal circumference (AC90) and estimated fetal weight (EFW90) above the 90th percentile, we adjusted for age, weight gain, parity, and race and ethnicity. Insulin use after oral agents increased risk of AC90, while insulin only decreased risk of EFW90.

CONCLUSION:
Oral agent failure was associated with excess GWG, admission for hyperglycemia, CD rate, and AC90. Insulin-only treatment was associated with decreased risk of EFW90, perhaps indicating identification of patients likely to fail oral agents could improve outcomes.
Accuracy of Endometrial Biopsy in Diagnosing Endometrial Polyps [ID: 1343431]
Authors: King Nathan , Goldfeld Ester , Mansuria Suketu , Wang Li 
Published: May 2023

INTRODUCTION:
Endometrial polyps are commonly reported on endometrial biopsies, but accuracy remains uncertain. The purpose of this study was to determine the positive predictive value (PPV) of endometrial polyp findings on endometrial biopsy.

METHODS:
In this retrospective cohort study, we screened 1,403 patients with endometrial biopsies that indicated presence of endometrial polyp between 2010 and 2020. Patients with concurrent endometrial cancer were excluded. Of the remaining patients, 546 had a subsequent gold-standard (GS) procedure (440 with hysteroscopy and 106 with hysterectomy) and were enrolled. Pathology results of GS procedures were analyzed for confirmation of endometrial polyp, and hysteroscopy operative reports were reviewed to determine intraoperative polyp visualization.

RESULTS:
Of the 546 patients whose endometrial biopsy reported endometrial polyp, 391 had endometrial polyp confirmed on GS pathology for a PPV of 71.6% (95% CI 67.6–75.4). Of the 440 patients who had hysteroscopy, 351 had endometrial polyp on pathology for a PPV of 79.8% (95% CI 75.7–83.4). Only 292 of the 440 hysteroscopy patients, however, had a polyp visualized by the surgeon, for a PPV of 66.4% (95% CI 61.7–70.8) when based on operative findings. Patients with a polyp on GS pathology were more likely to be postmenopausal (P=.001), have obesity (body mass index >30) (P=<.001), diabetes (P=.015), and hypertension (P=.037). There was no difference based on patient race (P=.182), hormonal therapy use (P=.295), or tamoxifen use (P=.127). Patients with thicker endometrial linings on ultrasound were more likely to have a polyp on GS pathology (P=.002), but uterine cavity length did not affect the PPV (P=.415).

CONCLUSION:
Endometrial biopsy correctly predicted the diagnosis of endometrial polyp in 72% of cases based on subsequent GS procedures, with the remaining 28% being false positives. Endometrial biopsy was more likely to accurately diagnose endometrial polyps in patients who were postmenopausal, had certain comorbid conditions, and had thicker endometrial linings.
Determinants of Patient No-Shows in a Multisite Urogynecology Clinic [ID: 1376316]
Authors: Miranne Jeannine , Courtepatte Alexa , Minassian Vatche , Schatzman-Bone Stephanie 
Published: May 2023

INTRODUCTION:
The objective of this study was to describe sociodemographic and clinical characteristics of patients who “no-show” urogynecology appointments and identify risk factors for “no-show” appointments.

METHODS:
We conducted an IRB-approved prospective chart review study of women aged 18 years or older scheduled for a urogynecology appointment at four outpatient clinical sites associated with an urban academic tertiary care referral center over 4 months. Patients were included in the no-show group if they did not show up for their appointment or cancelled their appointment the same day. For a comparison group, the patient immediately prior to or after the one who “no-showed” with the same visit type was included. Logistic regression was used to identify risk factors for “no-show” appointments.

RESULTS:
Four hundred twenty-six women were included, 213 in both the no-show and show groups. Women who “no-showed” were younger (median age 60 [interquartile range (IQR) 47–72] versus 69 [IQR 59–78], P<.001). More women in the no-show group were Hispanic (24.4% versus 13.1%) and non-Hispanic Black (7.51% versus 3.76%, P=.0093), had Medicaid (17.4% versus 6.57%, P=.0006), no-showed a previous appointment (24.9% versus 11.7% P=.0005), had to wait longer for an appointment (median 39 days [IQR 23.5–55.5] versus 30.5 days [IQR 12.8–47.0], P=.002), and made appointments for urinary incontinence (44.1% versus 26.8%, P=.0002). On multivariate logistic regression, women with Medicaid had significantly higher odds of “no-showing” their appointment (adjusted odds ratio, 2.11 [1.04–4.48], P=.0440).

CONCLUSION:
Women with Medicaid are particularly likely to “no-show” urogynecology appointments. Further research is needed to identify and address potential barriers this group faces when accessing care.
Improving Care After Sexual Assault: A Needs Assessment for a Standardized, Patient-Centered Educational Resource [ID: 1377465]
Authors: Lepore Christina , Bechtel Kirsten , Choi Jennie E. S. , Gawel Marcie , Griggs Susan , Pathy Shefali 
Published: May 2023

INTRODUCTION:
Prompt medical and psychiatric follow-up improves outcomes among survivors of sexual assault (SSAs). The American College of Obstetricians and Gynecologists recommends clinical and psychological follow-up within 1–2 weeks, yet only one-third receive such care within 1 year. In the setting of acute trauma, SSAs are unlikely to retain much information and discharge paperwork should be provided, including follow-up resources and patient education. Lack of standardization may result in wide variation of these handouts and negatively affect follow-up rates.

METHODS:
A retrospective chart review of discharge paperwork was performed of SSA patients presenting to a tertiary care emergency department from May to October 2022. Per World Health Organization guidelines for sexual assault (SA) follow-up, the elements evaluated included 1) acute SA treatment (human immunodeficiency virus, sexually transmitted infection, and pregnancy prophylaxis), 2) clinical and psychological follow-up resources, and 3) community resources for SSA. Institutional review board approval was obtained.

RESULTS:
A total of 39 SA handouts were evaluated. Only two-thirds (27/39) contained instructions regarding post-SA medications, 82% (32/39) included medical follow-up information, a quarter (10/39) included mental health resources, and one-third (13/39) included community resources.

CONCLUSION:
Timely follow-up after SA reduces patient morbidity. This initial needs assessment demonstrated a wide variation in completeness of discharge paperwork for SSA. As a result, a standardized handout was created, including a timeline of acute and long-term follow-up objectives and a comprehensive list of patient resources, which was incorporated into the electronic medical record system. This model can empower SSA to obtain follow-up care, improve outcomes, and address potential disparities in care.
Bridging Gaps in Access for Youth: Youth Feedback on a Novel Sexual and Reproductive Health Digital Platform [ID: 1377818]
Authors: Sao Saumya , Coleman Jenell , Wang Runzhi 
Published: May 2023

INTRODUCTION:
Youth bear a disproportionate burden of sexually transmitted infections (STIs) in the United States. Youth face barriers to STI testing, such as fear of breaches in confidentiality, lack of transportation, and anticipated stigma. Also, youth struggle with knowing when and where to get tested because of a lack of education about sexual and reproductive health (SRH). We sought to obtain feedback from youth about a digital health platform designed to address these barriers.

METHODS:
The Health Belief Model was used to develop a prototype digital health platform that offered interactive SRH education, free STI testing and safe sex products, and an anonymous ask column. Five focus group discussions (IRB approved) were conducted, each lasting 45–60 minutes with five to six youth living in a high-prevalence STI region of Baltimore, Maryland. Thematic analysis was performed.

RESULTS:
Twenty-eight youth (aged 14–19) participated. Three domains emerged: 1) the need for a reliable source of SRH information, 2) approval of the digital health platform, and 3) suggestions for improvement. Youth expressed concerns about the reliability of SRH information they receive from school, peers, and media. Participants preferred to access SRH resources on their phones or other small electronic devices as opposed to laptops or computer screens that may feel more exposed. Additionally, participants desired to access this information for free as that removes barriers of parental approval and financial support.

CONCLUSION:
Overall, youth viewed the digital health platform as an acceptable tool for sexual and reproductive health care education. The platform met their preferences of being free, accessible, and reliable.
Updated Causes of Primary Amenorrhea [ID: 1381195]
Authors: Fowler Kylie , Josephson Rebecca , O'Flynn O'Brien Kate , Pitera Rosabella 
Published: May 2023

INTRODUCTION:
Pubertal progression within a normal cadence is an important marker of natal female health. Data regarding causes of primary amenorrhea in a United States' adolescent population have not been published since 1981. We hypothesize that hyperandrogenism/polycystic ovarian syndrome (PCOS) is an increasingly common cause of primary amenorrhea.

METHODS:
A retrospective chart review was performed to identify patients with primary amenorrhea. A total of 1,785 charts were identified, of which 1,052 charts have been reviewed. Patients with hyperandrogenism/PCOS were classified by meeting any recommended diagnostic criteria for PCOS in adolescents or an elevated total or free testosterone based on Tanner staging with all other conditions ruled out. Other diagnoses for primary amenorrhea were classified per the American Society for Reproductive Medicine guidelines.

RESULTS:
Of the 1,052 charts reviewed so far, 263 patients met criteria for primary amenorrhea. Causes in order of prevalence were as follows: 85 hyperandrogenism/PCOS (32.3%), 71 hypothalamic hypogonadism (27%), 36 physiologic delay (13.7%), 19 primary hypogonadism (7.2%), 15 other endocrine causes (5.7%), 8 pituitary (3%), and 4 anatomic (1.5%). Twenty-five (9.5%) patients were unable to be classified. Of the 71 patients with hypothalamic hypogonadism, 27 (38%) had relative energy deficiency in sport (RED-S) making it the most common diagnosis of patients in this categorization.

CONCLUSION:
Polycystic ovarian syndrome/hyperandrogenism and RED-S are among the top three causes of primary amenorrhea. Proposed reasons for the shift in causes of primary amenorrhea over time include increasing obesity rates and metabolic syndrome in adolescents on one hand as well as increasing access to high-level athletics on the other.
Implementing a Virtual Collaborative Behavioral Health Care Program in an Obstetrics and Gynecology Practice [ID: 1376661]
Authors: Moon Khatiya , Alvarado George , Hy Jonathan , McNally Stephanie 
Published: May 2023

INTRODUCTION:
More women require behavioral health services than exist psychiatrists to treat them. In order to meet this need, the collaborative care model (CoCM) was proposed in the 1990s to extend the reach of behavioral health services. Relatively little is known about the applicability of the CoCM to obstetrics. We instituted a virtual collaborative behavioral health care program in an obstetrics and gynecology practice in our health system.

METHODS:
This was an IRB-approved retrospective chart review of a collaborative care program using the model initially proposed in the IMPACT study. Patients presenting to an obstetrics and gynecology office were assessed for depression using validated tools (PHQ-9). Women who screened positive were referred to a behavioral health care manager (BHCM) embedded in the practice. The BHCM conducted a behavioral health assessment, provided short-term psychotherapy, coordinated referral to a higher level of care if necessary, maintained a registry of patients, and worked with a supervising psychiatrist who provided medication recommendations. Our primary outcomes were the incidence of screenings completed, the number of contacts with the BHCM, and the number of cases that underwent review by a psychiatrist.

RESULTS:
Between February 2020 and February 2022, 166 women were enrolled in the CoCM out of 213 referred by the obstetrician–gynecologist (78% enrollment rate); participants were enrolled for an average of 177 days. Ninety participants (n=166, 54%) had at least one PHQ-9 completed and 81 participants (n=166, 49%) had at least one GAD-7 completed. One hundred six (n=166, 64%) patients had therapy for an average of five visits. One hundred four (n=166, 63%) participants participated in care coordination. Thirty-four (n=166, 20%) cases were reviewed by a psychiatrist.

CONCLUSION:
Our results indicate the high utilization of collaborative care services in this context, and moderate feasibility with only half of enrolled participants receiving validated assessments. Future studies should examine effectiveness and the components of the model that are most beneficial.
Patient's Perception of Access to Reproductive Health and Family Planning During the COVID-19 Pandemic Quarantine Period [ID: 1372575]
Authors: Caplin Arielle , Eisner Isabel , Foster Hannah , Gutta Sravanthi 
Published: May 2023

INTRODUCTION:
The objective of this study was to assess patient perception of access to reproductive health and family planning care during the COVID-19 pandemic quarantine period, at which time routine annual visits were deferred.

METHODS:
Patients aged 18–44 seen at Temple University Hospital for an annual gynecology visit from March 2018 to December 2020 were identified. Pregnant patients, those with a history of permanent sterilization (bilateral tubal ligation, hysterectomy), women who were not heterosexually active, prisoners, non-English or non-Spanish speakers, and those with intellectual disability were excluded. Using a random number generator, 99 eligible patients were randomly selected from this population. Eligible patients were contacted via telephone and verbally consented. If agreeable, these patients were administered a 20-question survey.

RESULTS:
Of 99 patients selected, 27 (27.3%) responded to the telephone survey. 0% of responders felt that they faced barriers to contraceptive care during the quarantine period. Survey responders and nonresponders had no significant differences in age (P=.26), race (P=.50), insurance type (P=.15), gravida (P=.78), parity (P=.10), and number of induced abortions (P=.51). However, nonresponders were significantly more likely to have no-showed a gynecology appointment in 2020 (P<.05).

CONCLUSION:
This study found that patients at Temple University Hospital did not perceive barriers to accessing contraceptive care during the COVID-19 quarantine period. Additionally, the majority of patients felt that contraceptive care was an important reason to have an in-person visit.