bluuebunny/crossref_metadata_2025_split huggingface dataset:
Providing Mifepristone and Misoprostol in Emergency Departments During the COVID-19 Pandemic [A08]
Authors: Bleck Roselle R. , Gurney Elizabeth P. 
Published: June 2022

INTRODUCTION:
Compared to misoprostol alone, medical management of early pregnancy loss (EPL) with mifepristone and misoprostol has a 25% higher success rate, reduces subsequent uterine aspiration, and is cost-effective. During the COVID-19 pandemic, we began providing mifepristone and misoprostol for EPL in our urban emergency departments (EDs), aiming to increase access to essential services and to minimize repeated health care visits. We sought to describe the safety and efficacy of this novel practice.

METHODS:
With institutional review board approval, we retrospectively reviewed the charts of all patients receiving mifepristone and misoprostol for first trimester pregnancy management in our EDs between April 2020 and March 2021 (n=33). Effective treatment was defined as pregnancy resolution after a single treatment with mifepristone and misoprostol. Safety outcomes included need for additional management, emergent surgical interventions, and blood transfusion. Descriptive statistics and univariate analysis were performed.

RESULTS:
The prevalence of effective treatment was 70% (n=23). Among the 10 subjects (30%) requiring additional management, interventions were: one additional dose of misoprostol (n=4), uterine aspiration (n=4), methotrexate (n=1), and uterine artery embolization (n=1). Three interventions (30%) were emergent, and two of these patients also required transfusion. Demographic characteristics were not associated with effective treatment nor with safety outcomes. Twenty-eight subjects (84%) participated in follow-up, 17 via telemedicine and 11 in person.

CONCLUSION:
Providing mifepristone and misoprostol for EPL in the ED may be an effective method to increase health care access. Further research is needed to determine whether this population is truly at increased risk for serious complications.
The Impact of the COVID-19 Pandemic on Postpartum LARC: A Retrospective Cohort Study [A20]
Authors: Jensen Rachel , Habib Alyssar , Lenus Sasha , Lee Jessica K. 
Published: June 2022

INTRODUCTION:
At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in long-acting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake.

METHODS:
In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race.

RESULTS:
We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28).

CONCLUSION:
Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.
Secret Shopper Study Evaluating Long Acting Reversible Contraception Access Barriers in Rural Michigan [A22]
Authors: Lozier Ann , Ling Vivian , Keer Emma , Dalton Vanessa , Owens Lauren , Moniz Michelle 
Published: June 2022

INTRODUCTION:
Rural communities are disproportionately affected by unintended pregnancy and access barriers to long-acting reversible contraception (LARC). It is unknown whether differences in patient payer type affect LARC access in rural communities. We evaluated rural access to LARC and same-day insertion, using the Upper Peninsula of Michigan (UP) as a case study for rural access.

METHODS:
Using a secret shopper study design, we administered a screening telephone survey to UP women’s health clinics, excluding those not accepting new patients or not offering LARC. Between September 15 and October 29, 2021, we re-contacted eligible clinics using a telephone script simulating an adult patient with either commercial or Medicaid insurance seeking LARC insertion. Key outcomes were differences in access to LARC and same-day insertion by payer type and LARC access by county, ascertained by merging LARC access findings with 2010 census data.

RESULTS:
Of 19 eligible clinics, 16 (84.2%) offered LARC to simulated patients, with all 16 offering LARC to both commercial insurance and Medicaid enrollees. Same-day LARC insertion was available at 7 of 19 clinics (36.8%) for commercially insured enrollees and 4 of 19 clinics (21.1%) for Medicaid enrollees. Of 15 counties in the UP, five have zero clinics that currently offer LARC insertion to new patients, representing 12,677 women of childbearing age (24.9% of this population in the UP).

CONCLUSION:
LARC access is limited in Michigan’s UP and may be particularly challenging for Medicaid patients given less opportunity for same-day LARC placement.
Impact of Immediate Postpartum Long Acting Reversible Contraception on Short Interval Pregnancy Rates [A27]
Authors: Hess Amanda K. , Quiñones Joanne N. , Flicker Amanda B. 
Published: June 2022

INTRODUCTION:
To evaluate the impact of immediate postpartum long acting reversible contraception (LARC) at our institution, we compared short interval pregnancy (SIP) rates between women who received immediate postpartum LARC with those who did not.

METHODS:
Institutional review board (IRB) approval was obtained for a single center retrospective cohort study of women >/= 18 years old with government insurance who delivered between 7/1/2019-3/31/2020. SIP was defined as <12 months from live birth to conception of a subsequent pregnancy. Women who underwent cesarean hysterectomy or postpartum sterilization were excluded from analysis.

RESULTS:
A total of 1,220 women were identified. Of these, 150 (12.3%) received LARC prior to discharge: 56 received a levonorgestrel intrauterine device (IUD) (37.3%), 20 received a copper IUD (13.3%), 74 received an etonogestrel implant (49.3%). A higher proportion of women who received a LARC were ages 18-21 (26.7%), compared with the non-LARC group (14.1%, P<.001). SIP rate in the LARC group was 4.0% (n=6) vs. 14.5% (n=155) in the non-LARC group (P<.001). Excluding women who declined or deferred contraception until the postpartum visit, women choosing contraceptive methods other than immediate postpartum LARC also had a higher rate of SIP (12.6%) when compared with the LARC group (4.0%, P=0.003). After adjustment for potential confounders including nulliparity, young maternal age, and married status, SIP was lower with immediate postpartum LARC [AOR 0.27 (95% CI 0.18, 0.64), P=.003] and higher by married status [AOR 1.89 (95% CI 1.26, 2.84), P=.002].

CONCLUSION:
Implementation of an immediate postpartum LARC program decreased SIP rates. Improved counseling about the impact of immediate LARC placement for family planning is encouraged.
Contraceptive Use After Removal or Expulsion of Malpositioned and Nonmalpositioned Intrauterine Devices [A37]
Authors: Frisse Ann , Louik Jay , Kachwala Isha , Vorawandthanachai Thammatat , Avila Karina , Benfield Nerys 
Published: June 2022

INTRODUCTION:
The effect of intrauterine device (IUD) malposition on subsequent contraceptive choice is not well characterized. We aimed to evaluate contraceptive choice after removal or expulsion of IUDs identified as malpositioned or non-malpositioned on ultrasound imaging.

METHODS:
We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected via medical record review. Descriptive statistics were reported for contraceptive choice after removal or expulsion of malpositioned and non-malpositioned IUDs. Institutional review board (IRB) approval was obtained for this study.

RESULTS:
Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9 years old respectively, P=.02). Contraceptive use after IUD expulsion or removal was available for 677 participants. Of the participants who had their non-malpositioned IUDs removed or expulsed, 29.4% used no contraceptive method compared to 19.4% of participants with malpositioned IUDs. The contraceptive implant or another IUD was used by 2.7% and 22.2% of participants after removal or expulsion of a non-malpositioned IUD, whereas these methods were used by 5.2% and 25.9% of participants who initially had a malpositioned IUD.

CONCLUSION:
Individuals with malpositioned IUDs had higher contraceptive use and higher use of long-acting reversible contraceptive methods after IUD removal or expulsion compared to those with non-malpositioned IUDs. This difference could be due to a difference in pregnancy desires which was not captured with this study design.
Effect of Intrauterine Device Malposition on Pregnancy Occurrence [A38]
Authors: Frisse Ann , Louik Jay , Kachwala Isha , Felix Nicole , Avila Karina , Benfield Nerys 
Published: June 2022

INTRODUCTION:
We aimed to compare pregnancy occurrence within 12 months of ultrasound evaluation of intrauterine device (IUD) position.

METHODS:
We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Data was collected through medical record review. The Fisher exact test was used to compare groups. Institutional review board (IRB) approval was obtained.

RESULTS:
Of 1,759 ultrasound reports with an IUD present, 436 described malpositioned IUDs. Baseline characteristics between participants with malpositioned and non-malpositioned IUDs did not differ aside from age (30.7 and 31.9, P=.02). Pregnancy status was available for 323 participants with malpositioned IUDs and 1007 participants with non-malpositioned IUDs. Compared to participants with non-malpositioned IUDS, those with malpositioned IUDs were more likely to be pregnant within 12 months of their initial ultrasound (10% and 5%, P=.002). Of the participants whose initial ultrasound showed a malpositioned IUD, 33 experienced a pregnancy: three with IUD in situ, 26 after IUD removal, and three after IUD expulsion. Of participants whose initial ultrasound showed a non-malpositioned IUD, 51 experienced a pregnancy: five with IUD in situ, 35 after IUD removal, and four after IUD expulsion. No significant difference was seen in pregnancy occurrence between groups for those with IUD in situ, after IUD expulsion, or after IUD removal.

CONCLUSION:
Participants with malpositioned IUDs were more likely to experience pregnancy within 12 months of initial ultrasound. However, this was not due to increased risk of pregnancy with an IUD in situ.
Exploring Contraception Attitudes, Beliefs, and Practices Among Refugee Women [A41]
Authors: Pfeil Sarah , Crouthamel Bonnie , Chalmiers Morgen A. , Ghebrendrias Selemawit , Kully Gennifer , Mody Sheila 
Published: June 2022

INTRODUCTION:
In order to improve patient care and education efforts, there is a need to have more insight into the attitudes, beliefs, and practices regarding contraception among refugee women.

METHODS:
We conducted a qualitative study among refugee women in California. All participants provided informed consent. The focus groups included questions about general women’s health, prior experiences with health care professionals in the United States, and attitudes towards, as well as experience with, birth spacing and contraception. In addition, we asked refugee women to evaluate the appropriateness of MyPATH, a web-based reproductive goals decision-support tool.

RESULTS:
Sixty-two refugee participated in focus groups. Participants ranged from 20-50 years and came from Congo, Somalia, Sudan, Eritrea, Ethiopia, Kenya, Uganda, Iraq, and Syria. Limiting family size while in the United States was more important than in participants’ home countries given economic burdens and lack of family support. Side effects, misconceptions that contraception contributes to cancer and infertility, and impact on menses were major concerns with utilizing contraception. Many participants desired in-person female interpreters for reproductive health visits. Participants were receptive to the web-based reproductive goals decision support tool MyPATH, but preferred being able to ask questions in person during low technology reproductive-health education sessions at community centers.

CONCLUSION:
The refugee women in this study were interested in using contraceptives to limit family size due to economic strain. Participants reported concerns about side effects that impacted their current contraception use. The women preferred contraceptive education in their community centers.
The Effect of an Educational Intervention on Obstetrics and Gynecology Residents’ Postpartum Depression Knowledge [A45]
Authors: Haslam Melissa D. , Cruz Amy , Baweja Ritika 
Published: June 2022

INTRODUCTION:
Up to 15% of women experience postpartum depression (PPD), and maternal suicide is a leading cause of maternal mortality. Obstetrician-gynecologists (ob-gyns) are intimately involved in postpartum care of women and are in a position to help diagnose and manage PPD. Council on Resident Education in Obstetrics and Gynecology (CREOG) learning objectives include goals for residents to diagnose and perform initial management of postpartum complications such as PPD. The objective of this study was to assess if a psychiatry educational intervention (pre-recorded didactic lecture and facilitated discussion) would improve ob-gyn residents’ knowledge and comfort level in diagnosing and managing PPD.

METHODS:
We performed an educational intervention study including ob-gyn residents at an academic training program. A pre-lecture survey/test was sent to residents. A prerecorded psychiatric didactic session was sent to residents. Participants were instructed to complete the post-lecture survey/test. A facilitated discussion via Zoom at which time presubmitted questions were reviewed and discussed with a psychiatrist was performed. A postdiscussion survey was then sent out.

RESULTS:
Before the intervention, 32% of residents agreed/strongly agreed that they felt comfortable diagnosing PPD; after the intervention, this increased to 81% of residents. Before the intervention, 25% of residents agreed/strongly agreed that they felt comfortable treating PPD; after the lecture/discussion this increased to 69% of residents. The difference in pre and post test scores was significantly improved (POST-PRE difference of 2.6 with a 95% CI of 1.8-3.5, P<.0001).

CONCLUSION:
This study helps show the importance of interdisciplinary didactics and interactive learning sessions which can help improve ob-gyn residents’ knowledge and comfort level in diagnosing/managing PPD in patients.
Effect of Pelvic Floor Education and Physical Therapy Referral on Postpartum Patient Satisfaction [A46]
Authors: Wallace Erika , Griffin Alexis , Redhunt Allyson M. , Heiden Erica , Sokol Nicole , Liff Ingrid 
Published: June 2022

INTRODUCTION:
Postpartum pelvic floor dysfunction (PFD) is associated with reduced quality of life; however, patient education regarding PFD is limited. The purpose of this study was to evaluate impact of PFD education and pelvic floor physical therapy (PFPT) referral on patient satisfaction with postpartum care.

METHODS:
This randomized controlled trial included 160 postpartum patients recruited during their delivery admission between November 2020 and June 2021. Patients were randomized to receive postpartum PFD education materials and PFPT referral (n=80) or to receive standard postpartum teaching (n=80). The Client Satisfaction Questionnaire (CSQ-8) was used to assess patient satisfaction at 12 weeks postpartum.

RESULTS:
In total, 131 (81.87%) participants completed the questionnaire. The groups were well matched in terms of demographics, comorbidities, and delivery type. In total, 60 of 131 (45.8%) reported PFD symptoms. Overall satisfaction did not differ between groups (27.43 vs. 28.31 out of 32, P=.28). Significantly more patients in the intervention group felt that they received enough PFD education and support (47.1% vs. 27.0%, P=.017). Of those who read the educational materials (48 of 68, 70.6%), 89.6% found them helpful, and 100% thought all patients should receive PFD education. Most common obstacles to attending PFPT included lack of interest, time commitment, and childcare.

CONCLUSION:
Our study demonstrates that while providing PFD education and PFPT referral does not lead to increased patient satisfaction, patients do find these resources helpful. Postpartum PFD is prevalent; however, few patients attend PFPT despite referrals. We identify specific barriers to attending PFPT which are targets for future studies on patient satisfaction.
A Validated Needs Assessment to Inform a Simulation-Based Maternal Cardiac Arrest Resuscitation Curriculum [A47]
Authors: Kavanagh Laurie D. , Shields Andrea , Battistelli Jacqueline , Thomson Brook , Nielsen Peter 
Published: June 2022

INTRODUCTION:
Maternal cardiac arrest (MCA) is a clinically challenging event, yet there are currently no standardized training courses to train providers to prevent, identify, and treat MCA. We conducted a needs assessment of the target learner populations to inform a simulation-based curriculum.

METHODS:
The authors sent a modified, validated personnel, infrastructure, procedures, equipment, and supplies (PIPES) tool to target learners of a proposed simulation-based curriculum in MCA resuscitation. The tool assessed the target learners’ clinical and procedural confidence with cardiopulmonary resuscitation (CPR) skills during an MCA.

RESULTS:
A total of 191 in-hospital and 124 pre-hospital practitioners completed the survey. Most respondents had 20+ years of experience and were diverse in geographic and specialty representation. Most respondents were familiar with the 2015 American Heart Association (AHA) resuscitation guidelines for cardiac arrest in pregnancy and had performed CPR on a pregnant or postpartum patient. Less than half of respondents were comfortable leading a maternal code. Of 21 clinical scenarios, in-hospital respondents were least confident managing amniotic fluid embolism, anesthetic complication, drug overdose, pneumothorax, post-arrest care, and ventricular tachycardia. Of 16 procedural skills assessed, prehospital providers reported the least confidence in performing left uterine displacement. Participants in both populations lacked the most confidence in placing a chest tube and a central line during pregnancy.

CONCLUSION:
Despite an awareness of existing guidelines and personal experience responding to MCA, respondents lacked confidence in many clinical and procedural skills used during a maternal code. This needs assessment will help inform the learning objectives of a standardized simulation-based curriculum on MCA.
A National Survey of Obstetrics and Gynecology Emergency Training and Deficits in Office Emergency Preparation [A53]
Authors: Maciejko Laura , Cope Adela , Mara Kristin , Bell Shannon L. , Green Isabel 
Published: June 2022

INTRODUCTION:
While rare, emergencies encountered during office procedures have the potential for significant morbidity if the team is caught unprepared. The aim of this study was to evaluate current availability of and needs for training in office emergencies in residency programs in the United States.

METHODS:
This was a cross-sectional survey of residents from accredited obstetrics and gynecology residency programs. Identified programs were those with representation in the American College of Obstetricians and Gynecologists Simulation Working Group (ACOG SWG). A multi-item instrument was developed, designed, and edited by representatives of the ACOG SWG for accuracy and content validity. Participants were asked to rate their level of agreement with statements on importance of training in the recognition and management of obstetrics and gynecology emergencies and their confidence in management of those emergencies. Specific emergencies encountered in the office, gynecologic surgery, and obstetrics were queried.

RESULTS:
Six programs participated for a total of 116 residents and a response rate of 62% (116/188). Most residents agreed office emergency (97.5%) and obstetric emergency training (94.8%) were important in residency training. While 65.5% were confident in managing a vasovagal episode in the office, 0.9% were confident in managing lidocaine toxicity. In contrast, the majority of residents felt confident in obstetric emergency management across all listed emergencies (hemorrhage, cord prolapse, shoulder dystocia, eclampsia).

CONCLUSION:
While rated as important to residency training, significant gaps exist within resident preparation for identification and management of office-based emergencies, providing an opportunity for curriculum development and education.
The Effects of the United States Medical Licensing Examination STEP 1 Pass/Fail Scoring Change for Obstetrics and Gynecology Residency Applicants [A58]
Authors: Girling Isabel C. , Burge Kaitlin G. , Haynes William , Patel Om U. , Yadav Ishant , Williams Audra R. 
Published: June 2022

INTRODUCTION:
The National Board of Medical Examiners (NBME) recently approved the transition of the United States Medical Licensing Examination (USMLE) STEP 1 exam from a three-digit numeric scoring to a pass/fail format, effective January 26, 2022. The change will ideally result in a more holistic review of residency applicants, but the realized impacts remain to be seen. We aimed to examine the implications of the scoring change on future obstetrics and gynecology residency applicants.

METHODS:
Surveys were distributed to obstetrics and gynecology residency program directors (PD) for all 291 Accreditation Council for Graduate Medical Education-accredited residency programs. The survey assessed their viewpoints about the STEP 1 exam and asked respondents to rank the importance of variables used in assessment of potential applicants before and after the change to pass/fail. The survey was approved by the University of Alabama at Birmingham Institutional Review Board.

RESULTS:
We received 70 responses (response rate=24.0%). While most (60%) PDs believe that STEP 1 scores do not accurately predict a resident’s clinical performance, the majority (68.6%) disagreed that students will be better prepared clinically following the change to pass/fail. Clerkship grades were ranked as the most important variable in evaluating applicants both before and after the transition to pass/fail. Number of abstracts/presentations/publications and volunteer experiences saw the greatest increases in rank of importance with pass/fail as opposed to before.

CONCLUSION:
Despite the shortcomings of the STEP 1 exam in predicting clinical performance and the opportunity for more holistic review, obstetrics and gynecology PDs are skeptical of a transition to pass/fail scoring. The change will necessitate that alternative variables play a greater role in evaluation of residency applicants.