bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidisciplinary High-Risk Obstetrical Simulation Improves Periviability Counseling [ID: 1366577]
Authors: Burn Sabrina , Clark Lou , Cross Sarah , Rolfes Julie Johnson , Miller Joseph 
Published: May 2023

INTRODUCTION:
The objective of this study was to determine the feasibility and effectiveness of multidisciplinary simulation in the development of skills required for high-risk periviability counseling.

METHODS:
Trainees were recruited from the University of Minnesota to participate in a faculty-observed standardized high-risk periviability patient simulation. The simulation was unique in that multiple specialties collaborated in the evaluation, counseling, and management of their patient. Trainees completed presimulation and postsimulation knowledge and comfort self-assessment surveys to evaluate skill improvement and merit of the study. Evaluations were also performed by faculty and simulated patients. An IRB waiver was obtained.

RESULTS:
Of the 18 participants, there were 6 neonatal intensive care unit fellows, 2 maternal–fetal medicine fellows, and 10 senior ob-gyn residents. Presimulation and postsimulation Likert surveys with scale 1–5, showed improvement in the ability of trainees to elicit patient values and tailor their conversations (pre-mean 2.84, SD 0.67; post-mean 3.39, SD 0.59), use patient-centered language (pre-mean 3.37, SD 0.74; post-mean 3.89, SD 0.57), ally with patients (pre-mean 3.37, SD 0.93; post-mean 3.94, SD 0.52), provide difficult medical information (pre-mean 3.32, SD 1.03; post-mean 3.67, SD 0.58), discuss medical uncertainty (pre-mean 3.11, SD 0.79; post-mean 3.50, SD 0.60), and understand their own implicit biases (pre-mean 3.26, SD 0.71; post-mean 3.50, SD 0.60). Trainees also reported an increased use of hopeful language that did not focus on statistical outcomes (pre-mean 3.00, SD 0.65; post-mean 3.33, SD 0.47) and discussion of multiple management options, including comfort cares (pre-mean 2.05, SD 1.05; post-mean 2.94, SD 0.85). The post surveys also reflected that trainees felt the simulation was useful, provided a safe environment to practice counseling (mean 4.83, SD 0.37), and better prepared them for future high-risk obstetrical scenarios (mean 4.83, SD 0.37).

CONCLUSION:
Multidisciplinary high-risk obstetrical simulation offers a unique opportunity for trainees to receive structured training and improve their ability to collaboratively counsel in rare high-risk obstetrical scenarios.
Utility of Ferritin at Registration as a Screen for Development of Anemia in Third Trimester [ID: 1362276]
Authors: Crary Isabelle , Koski Chloe , Rijhsinghani Asha 
Published: May 2023

INTRODUCTION:
The objective of this study was to assess the utility of screening ferritin (<20 weeks of gestation) in pregnant patients on hemoglobin (Hgb) and hematocrit (Hct) later in gestation.

METHODS:
Pregnant patients who received nondiagnostic ferritin labs at less than 20 weeks of gestation from 2019 to 2021 were retrospectively identified. Patients were excluded if ferritin testing was conducted for diagnostic purposes or if the patient had a history of anemia. Labs at the time of registration, 28 weeks of gestation, and at delivery were analyzed. Anemia was defined as Hgb less than 11 g/dL. This study was approved by the University of Washington IRB, and patient consent was waived.

RESULTS:
Forty-four patients underwent routine ferritin screening at registration, with ferritin levels ranging from 10 to 136 ng/mL (average 52.5 ng/mL). Average Hgb/Hct at registration were 12.6 g/dL and 37.3%, respectively. At 28 weeks of gestation, Hgb/Hct were obtained on 42 patients, of whom 9 patients were diagnosed with anemia. Patients diagnosed with anemia had a screening ferritin level of 33.6 ng/mL, and nonanemic patients had a ferritin level of 57.4 ng/mL (P=.1). When a cutoff of 50 ng/mL was studied to compare patients with “low” versus “normal” ferritin, ferritin less than or equal to 50 ng/mL had significantly lower Hgb levels at 28 weeks compared to those with ferritin greater than 50 ng/mL (P=.013). On labor and delivery (L&D), Hgb/Hct was obtained on 44 patients, and 14 were diagnosed with anemia. Anemic patients on L&D had significantly lower screening ferritin compared to nonanemic, 31.9 and 62.2 ng/mL, respectively (P=.016).

CONCLUSION:
Ferritin screening in early pregnancy may help predict lower Hgb in later gestation. Using a higher ferritin cutoff of 50 ng/mL in early pregnancy for identifying patients at risk for anemia in the third trimester may be warranted. Larger prospective studies are needed to evaluate further the utility of ferritin screening.
Risk Factors for Discharge Against Medical Advice at Antepartum Hospitalizations [ID: 1373372]
Authors: Guo Pengfei , Campbell Katherine , Grechukhina Olga , Lee Emily , Xu Xiao 
Published: May 2023

INTRODUCTION:
Antepartum obstetrical admissions are often unplanned. Despite counseling, some patients may choose to be discharged against medical advice (DAMA). This study examined patterns of DAMA at antepartum hospitalizations and associated patient characteristics.

METHODS:
Using 2019 National Inpatient Sample (NIS) data, we identified pregnant patients aged 12–50 years with antepartum admissions. The primary outcome was DAMA determined based on patients' discharge disposition status. Patients' sociodemographic and clinical characteristics were measured based on hospital discharge records and diagnosis/procedure codes. Characteristics of DAMA and non-DAMA patients were compared using chi-square tests and multivariable logistic regression, while accounting for NIS complex sample design to generate nationally representative estimates.

RESULTS:
Among 214,935 patients in the sample, 8,495 (4.0%) were DAMA. The risk of DAMA was significantly higher among Black than White patients (5.4% versus 3.8%, P<.001, adjusted odds ratio [OR] 1.25, 95% CI 1.09–1.43), Medicaid than privately insured patients (5.4% versus 1.7%, P<.001, adjusted OR 2.49, 95% CI 2.12–2.93), and patients with (versus without) obstetrical/comorbid conditions, such as substance use disorders (11.3% versus 2.7%, P<.001, adjusted OR 3.30, 95% CI 2.76–3.96), prior preterm birth (8.1% versus 3.9%, P<.001, adjusted OR 2.04, CI 1.44–2.89), hypertensive disorders of pregnancy (5.4% versus 3.8%, P<.001, adjusted OR 1.70, 95% CI 1.43–2.03), and chronic hypertension (6.2% versus 3.8%, P<.001, adjusted OR 1.51, 95% CI 1.28–1.79).

CONCLUSION:
Patients who are DAMA in the antepartum period have certain sociodemographic and clinical characteristics that may place them at higher risk of adverse obstetrical outcomes. Risk-stratified, targeted patient support during admission may be beneficial.
Stay Home, Stay Connected: Providing Supplemental Education and Psychosocial Support for Pregnant People [ID: 1375777]
Authors: Gates Brittany , Aaron Bryan , Kilbane Emma , Maben-Feaster Rosalyn , Peahl Alex , Stukenberg Zoe 
Published: May 2023

INTRODUCTION:
The traditional medical model of prenatal care may miss opportunities for anticipatory guidance and psychosocial support for pregnant people. We describe Stay Home, Stay Connected (SHSC), a virtual, service-learning, pregnancy support group that supplements routine prenatal care.

METHODS:
Stay Home, Stay Connected was implemented during the acute COVID-19 pandemic and updated in January 2022 in keeping with relaxation of COVID-19 restrictions. The program consists of monthly small-group sessions with 8–10 pregnant people at similar gestational age, led by an obstetric provider (eg, physician, midwife) and medical, midwifery, and social work students. Recorded group classes on mental health and wellness are available on-demand. In our IRB-exempt assessment of SHSC patients from January 2022 to October 2022, we obtained consent and collected surveys at enrollment and after sessions to assess participants' reasons for joining and overall satisfaction.

RESULTS:
Since program updates, 80 patients have participated in 5 small groups, led by 4 providers and 8 students. Of the 80 patients registered for SHSC, 65 (81%) completed the enrollment survey. The top reasons for joining SHSC were desire for extra support, more information about pregnancy, and connection with other patients. The majority of participants who completed satisfaction surveys, reported sessions were helpful to their learning (32/34, 94%) and feeling supported (25/26, 96%). All participants surveyed reported they would recommend SHSC to other pregnant patients.

CONCLUSION:
A virtual service-learning pregnancy support group remains feasible and acceptable for participants after the acute COVID-19 pandemic. We are continuing to expand and develop SHSC to fulfill unmet needs in pregnancy.
Effect of Maternal Depressive Symptoms on Prenatal Care Utilization and Milestones [ID: 1376259]
Authors: Jang Minyoung , Esguerra Cybill , Olson Sarah , Voegtline Kristin 
Published: May 2023

INTRODUCTION:
Depression is a common complication of pregnancy, but research is limited regarding its effect antepartum. This study assessed the relationship between maternal depressive symptoms and prenatal care utilization.

METHODS:
This retrospective cohort includes pregnant women who completed first- or second-trimester depression screening using the Edinburgh Postnatal Depression Scale (EPDS) between 2020 and 2021. Patient and pregnancy-related characteristics were compared between women who screened positive versus negative for depression. Multivariate logistic regression models were used to estimate odds of completing prenatal care milestones. The IRB approved a consent waiver.

RESULTS:
Of 718 women who completed the EPDS in early pregnancy, 85 (12%) screened positive for depression. A greater proportion of these women were younger (P=.034), unpartnered (P=.005), publicly insured (P=.013), had a history of substance use (P<.0001) or prior psychiatric diagnosis (P<.0001), and started prenatal care later (P=.002) than those who screened negative. Although there were no significant differences in total routine prenatal care visits (P=.123), the adjusted odds of completing third-trimester milestones including glucose tolerance testing (odds ratio [OR] [95% CI] 0.596 [0.364–0.975]) and group B streptococcus testing (OR [95% CI] 0.559 [0.330–0.947]) were lower among women who screened positive for depression. In addition, higher EPDS scores were positively correlated with number of labor and delivery triage visits (r=0.103, P=.006).

CONCLUSION:
Women who screen positive for depression during pregnancy are a socially vulnerable group at risk of starting prenatal care late, missing major milestones, and overusing nonroutine medical services. Early mental health screening and intervention in pregnancy may help improve prenatal outcomes.
Maternal and Neonatal Outcomes in Pregnancies With Adenomyosis [ID: 1375447]
Authors: Hguig Soukaina , Abenhaim Haim Arie , Czuzoj-Shulman Nicholas 
Published: May 2023

INTRODUCTION:
Adenomyosis is a common gynecologic disease involving the uterus with effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes.

METHODS:
Using the Healthcare Cost and Utilization Project–National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.0, with the remaining pregnancies being the reference group. Multivariate logistic regression models, adjusting for baseline maternal demographics, were used to determine the effect of adenomyosis on pregnancy outcomes. In light of the diagnosis bias inherent in births by cesarean delivery, adjustment for mode of delivery was performed on all outcome analyses.

RESULTS:
Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases per 100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (odds ratio 1.67, 95% CI 1.17–2.39), preterm delivery (1.36, 1.16–1.59), preterm premature rupture of membranes (1.31, 1.07–1.61), postpartum hemorrhage (2.65, 2.14–3.27), postpartum transfusion (2.20, 1.62–2.99), disseminated intravascular coagulation (9.31, 4.15–20.92), sepsis (2.67, 1.60–4.45), congenital anomalies (1.95, 1.34–2.84), and intrauterine fetal demise (1.98, 1.02–3.84).

CONCLUSION:
Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. Pregnancies in patients with adenomyosis should be considered at higher risk and may benefit from delivering in centers capable of managing postpartum hemorrhage.
Maternal and Neonatal Outcomes of Pregnancies With Periviable and Previable Preterm Premature Rupture of Membranes [ID: 1380561]
Authors: Browning Danielle , Fandozzi Eva , Megli Christina , Sasaki Alexandria 
Published: May 2023

INTRODUCTION:
Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks).

METHODS:
A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study.

RESULTS:
27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P=.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) (P=.047).

CONCLUSION:
Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.
Assessing Interest in Peer Doula-Facilitated Empathy and Self-Compassion Training Among Women With History of Early Pregnancy Loss (AIDES for EPL) [ID: 1344944]
Authors: Conroy Carmen , Jain Tanya , Mody Sheila 
Published: May 2023

INTRODUCTION:
Limited data exist regarding the type of support patients need when experiencing early pregnancy loss (EPL). The objective of this study is to explore how patients emotionally cope with EPL and to assess whether there is interest in a peer EPL doula program with a self-compassion component.

METHODS:
We conducted semistructured interviews with 21 patients who had experienced EPL in the past 2 years. We evaluated the kinds of support that patients felt were most helpful, interest in a possible peer EPL doula intervention, and concerns or suggestions for the creation of such a program. Content analysis was utilized to process the data and identify themes.

RESULTS:
52.38% (n=11) of interviewees reported expectant management of their EPL, 23.81% (n=5) reported medication management, and 23.81% (n=5) reported undergoing a dilation-and-curettage procedure. Participants represented various races and ethnicities, income brackets, and insurance statuses. We identified five themes: 1) therapy and in-person support groups are helpful when experiencing EPL, but are sometimes inaccessible; 2) social media support groups are initially advantageous for creating a sense of solidarity, but in the long term can be triggering; 3) support from a peer who has also experienced EPL is valuable; 4) developing self-compassion is important in emotionally coping with EPL; and 5) there is a demand for emotional and informational support after EPL.

CONCLUSION:
Given the unique types of support participants identified in this study, a peer EPL doula could feasibly provide the emotional and informational support patients desire when experiencing an EPL.
Obtaining Consent for Educational Pelvic Exams Under Anesthesia: Patient Perspectives [ID: 1337224]
Authors: Konrad Beatrice , Grimm Barry 
Published: May 2023

INTRODUCTION:
Historically, procedural education on pelvic exams has included students performing them on anesthetized gynecologic surgical patients—oftentimes, without the patient's explicit consent. What constitutes acceptable consent in this situation? We surveyed patients on minimally acceptable methods of obtaining verbal consent for a medical student to perform a pelvic exam while a patient is under general anesthesia (EUA).

METHODS:
Our study population was Vanderbilt University Medical Center gynecology outpatients 18+ who had no history of gynecologic surgery under anesthesia nor planned surgery of this kind in the future. Patients were screened for eligibility via chart and then approached at clinic. If they agreed to participate, they received a secure REDCap survey to submit an anonymous response.

RESULTS:
Overall, 31 patients received surveys and 21 responses were collected (response rate 67%). Results demonstrated patients are willing to participate in educational exams and consider informed consent via verbal discussion to be critically important. Among these respondents there was consensus the surgeon is the ideal person to lead discussion. A resident was acceptable, but a medical student alone was considered unacceptable by significant portion of respondents (38.1%). Free text responses indicated chaperoning or supervision of a medical student was of great importance, both during consent process and exam. Respondents indicated multiple time points (before and day of surgery) and locations (office and in hospital) were ideal, but day of surgery was acceptable. Finally, there was consensus language used to describe the exam should be specific and detailed; generalizations or omissions were considered unacceptable, not just unideal.

CONCLUSION:
Responses suggest informed consent discussion before pelvic EUA with student and supervising educator present is highly important to these participants and should be as detailed and specific as possible. Additionally, these results agree with prior evidence that this discussion would not likely cause patients to decline to participate in EUAs.
Fertility Knowledge and Educational Experiences of Graduating Medical Students: A Multi-Institution Survey [ID: 1363003]
Authors: Hunt Kelby , Blakemore Jennifer , Dauer Laura Chamorro , Faubion Laura , Marshall Ariela , Melikian Ryan 
Published: May 2023

INTRODUCTION:
There is a paucity of data regarding medical students' knowledge and education in fertility and reproductive life planning (RLP). Our goal was to assess fertility knowledge and educational experiences of graduating medical students to determine knowledge gaps and goals for future educational interventions.

METHODS:
Institutional review board-waived, online cross-sectional questionnaire was disseminated to graduating medical students at five participating institutions.

RESULTS:
The survey was distributed to 815 graduating medical students, and 117 (14.4%) completed the survey. Twenty-three (22%) overestimated the age of most precipitous fertility decline and 50 (52%) overestimated the chance of getting pregnant for a 40-year-old couple. One-third of students (30, 32%) incorrectly believe that physicians have equivalent infertility rates to the general population. Students were less cognizant of male fertility issues, incorrectly believing there was no negative effect on male fertility by age (43, 42%), certain sexual lubricants (73, 72%), and gonorrhea or chlamydia infections (45, 44%). Seventy-five (81%) report less than 5 hours of fertility-related education in medical school. Only 30 (32%) are satisfied or very satisfied with the fertility and family-building education they received. In an open-response survey question, students expressed interest in more education on transgender and cancer patient care, fertility preservation, assisted reproductive technologies, and RLP for medical professionals.

CONCLUSION:
This study identified deficits in medical student knowledge regarding fertility and RLP. This poses an opportunity for medical training programs to improve the amount and content of fertility-related education, both for their students' personal RLP and their ability to provide accurate, effective counseling for their patients.
Assessing Fertility Awareness in Female Medical Students, Trainees, and Attending Physicians [ID: 1374645]
Authors: Doxsey Martha , Faschan Kristin , Reyes Lilia 
Published: May 2023

INTRODUCTION:
The incidence of female physician infertility is greater in comparison to the general public. In this study, we utilized a validated instrument to assess fertility and infertility knowledge among biologically female medical students, trainees, and attending physicians.

METHODS:
The validated Fertility & Infertility Treatment Knowledge Score (FIT-KS) instrument was distributed from April 2022 to July 2022 to biologically female medical students, trainees, and attending physicians. Demographics were obtained to assess for differences between groups via contingency table analysis. The IRB found this study exempt.

RESULTS:
Participants answered 20 of the 29-item FIT-KS instrument correctly. Nine items had a less than 50% correct response rate, four pertained to fertility knowledge, and five pertained to infertility treatment knowledge. Most participants (81.4%) correctly identified the years of peak fertility, but 44.8% overestimated the fecundity of a 30-year-old woman and 36.9% underestimated the chance of miscarriage in peak reproductive years. Most participants (76.6%) underestimated in vitro fertilization (IVF) success for a woman under 35 year old and overestimated IVF success for a woman over 44 year old (56.0%). Obstetrics and gynecology performed significantly better on the FIT-KS instrument overall in comparison with other specialties. No differences in performance were present based on participant age, parity, or position.

CONCLUSION:
Female medical students and physicians recognize that fecundity decreases with age but overestimate successful pregnancy rates with increasing age. In concordance with low knowledge surrounding infertility treatment success, medical trainees are underequipped to make informed family planning decisions while in medical training.