bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Postpartum Hemorrhage Outcomes With Team-Based Simulation of Operating Room Transfers [A339]
Authors: Levit Elizabeth , Marko Emily K. 
Published: June 2022

INTRODUCTION:
Postpartum hemorrhage is an obstetric emergency where time and team preparedness are of critical importance. The study objective was to determine the effectiveness of team simulations on transferring patients with severe postpartum hemorrhage for operating room (OR) procedures to improve patient outcomes.

METHODS:
A prospective pre/post simulation study design was used to assess effectiveness of labor/delivery and OR personnel in the transfer and preparedness for patients with postpartum hemorrhage requiring operative management. An existing multidisciplinary simulation course was expanded to transfer of the manikin to the OR to improve team communication and preparedness. Institutional review board Exempt status was obtained. Outcomes were measured using participant knowledge tests and safety culture surveys, as well as team performance assessments and time. Clinical outcomes were tracked during the study period.

RESULTS:
Seventy-eight multidisciplinary personnel composing 13 teams participated in the two-year study. Pre/post participant improvement occurred in knowledge (pre 68.75%, post 92.65%, P< .0001), confidence (pre 2.05, post 1.43, P=.0005) and team performance (pre 72.5%, post 85.42%, P<.0001). Protocols for postpartum hemorrhage were adjusted because of team debriefings, resulting in improved efficiency and reduced time to transfer. During the study period patient transfusions and intensive care admissions decreased by over 50%.

CONCLUSION:
Simulation training significantly improved team performance during postpartum hemorrhages requiring OR procedures. Timely transfer and preparedness are essential during severe postpartum hemorrhage and may have contributed to the improved patient outcomes observed during the study period.
Uterocervical Angle as a Screening Tool to Predict Preterm Birth [A341]
Authors: Armstrong Lacey , Allen Joa , Woodham Padmashree 
Published: June 2022

INTRODUCTION:
The objective of this study was to determine if a larger uterocervical angle measurement at the time of second trimester transvaginal ultrasound is a predictor of preterm birth in a predominantly African American population. The study took place in Macon, Georgia at Perinatal Associates associated with The Medical Center, Atrium Health Navicent and Mercer University School of Medicine.

METHODS:
This institutional review board‒approved retrospective cohort study included women with singleton gestations who had transvaginal ultrasounds performed at Perinatal Associates in Macon, Georgia for cervical length screening between 16 0/7 weeks – 23 6/7 weeks from July 1, 2015-June 30, 2016 and delivered at Atrium Health Navicent. The images were reviewed and the uterocervical angles were measured.

RESULTS:
A total of 230 women were included in this study. The rate of spontaneous preterm birth in this cohort was 12.2%; for delivery, 95 degrees and >105 degrees had no association with spontaneous preterm birth < 37 weeks. Cervical length < 25 mm was significantly associated with spontaneous preterm birth.

CONCLUSION:
A uterocervical angle of >95 and >105 degrees detected during the second trimester transvaginal ultrasound was not associated with an increased risk for spontaneous preterm birth. Cervical length was a better predictor of preterm birth in this cohort. Our data indicates that uterocervical angle is not a useful tool in predicting preterm birth in a predominantly African American population and that traditional measurement of cervical length is a better screening tool.
Sensitivity of Broadened Definition of Fetal Growth Restriction in Predicting Adverse Neonatal Outcomes [A342]
Authors: Allen Stephanie M. , Contag Stephen A. , Rubin Nathan T. , Engel Melissa S. 
Published: June 2022

INTRODUCTION:
In 2020 the Society for Maternal-Fetal Medicine suggested broadening the fetal growth restriction (FGR) definition to include fetuses with isolated abdominal circumference (AC) less than 10th percentile. The purpose of this study was to determine if including these fetuses improves prediction of severe neonatal morbidity and mortality.

METHODS:
This is a retrospective analysis of births over the past 10 years within a hospital system affiliated with the University of Minnesota. A pregnancy was included if prenatal ultrasound data were available after 24 weeks gestation. Excluded were non-singletons and fetuses with diagnosis of structural or genetic abnormalities that could affect biometry measurements. Fetuses were categorized as FGR based on the prior definition (estimated fetal weight [EFW] less than 10th percentile) and on the proposed definition of EFW or AC less than 10th percentile. Institutional review board approval was obtained from the University of Minnesota (ID 00011238).

RESULTS:
A total of 26,526 births met inclusion criteria. The mean gestational age at birth was 39 weeks (SD 0.2). The rate of severe morbidity (e.g., severe acidosis, hypoxic ischemic encephalopathy, and sepsis) and mortality for those with EFW less than 10th percentile was 9.3% (odds ratio [OR] 3.6, P<.001) and 2.8% (OR 26.1, P<.001), respectively. For those with EFW or AC less than 10th percentile, rates were 6% (OR 2.3, P<.001) and 1.5% (OR 15.0, P<.001), respectively.

CONCLUSION:
Broadening the definition unsurprisingly increased the frequency of FGR, but frequency of adverse outcomes was lower. Thus, this analysis does not support the addition of isolated AC less than 10th percentile to the FGR definition.
Provider Counseling Regarding Postmenopausal Bleeding [A297]
Authors: Wise Meredith , Schefter Alexandra M. , Bharucha Kharmen , Brill Joshua , Tessier Katelyn M. , Terrell Carrie A. 
Published: June 2022

INTRODUCTION:
The aim of this study was to determine the rate of anticipatory counseling regarding postmenopausal bleeding (PMB) provided by obstetrician–gynecologists (ob-gyns) and primary care providers (PCPs). We also sought to determine whether counseling is associated with an increased likelihood of presenting for evaluation of PMB.

METHODS:
This survey study was administered at the University of Minnesota's research building at the Minnesota State Fair 2021. Eligible participants were aged 18 and older and female sex assigned at birth. Self-reported menopausal participants answered questions about their healthcare providers (PCP, ob-gyn, or both), when they were last seen, and whether they had been counseled about PMB. They were then questioned about when they would present to a provider for PMB.

RESULTS:
A total of 129 post-menopausal survey participants were included in the analysis. Of these participants, 46.5% (60 participants) reported that their provider counseled them about PMB. There was almost a significant difference between type of provider seen and rate of counseling, with the highest rate occurring in those who had seen both a PCP and an ob-gyn provider in the last 5 years (P=.052). A total of 61% of participants (79 participants) reported they would tell their doctor if they had PMB after just one episode. There were no differences in likelihood of telling a doctor about PMB between participants who had received counseling and those who had not.

CONCLUSION:
This study demonstrates a low rate of provider counseling regarding PMB. The relatively low likelihood of presenting for evaluation of an episode of PMB highlights the need for improved patient education regarding this symptom.
Disparities in Outcomes Following Ovarian Cancer: An Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database (1998-2016) [A313]
Authors: Akinyemi Oluwasegun A. , Lipscombe Christina A. , Nasef Kindha Elleissy , Aaron Sabrina , Ranjit Anju 
Published: June 2022

INTRODUCTION:
Ovarian cancer is the most lethal cancer among women in the United States. However, there are significant racial disparities in the timely diagnosis and treatment of ovarian cancers. It remains unknown if race is an independent predictor of adverse outcomes following treatment of ovarian cancer. The aim of this study is to determine if race is an independent predictor of adverse outcomes following diagnosis of primary ovarian cancer.

METHODS:
We utilized the Surveillance, Epidemiology, and End Results (SEER) 18 Registry to extract all patients with a primary diagnosis of ovarian cancer from 1998 to 2016. Our primary outcomes of interest were differences in mortality and survival (in months) among African American and White women. Propensity score matching was used to match the groups according to age, treatment modalities (surgery/irradiation/chemotherapy), laterality, and stage of cancer at presentation.

RESULTS:
We compared 6,801 African American and 27,204 White patients with primary ovarian cancer. Prior to propensity score matching, African American women had a higher mortality rate (56.7% vs. 53.5%; P<.001) and a lower survival rate (40.1 vs. 48.9 months; P<.001). Following propensity score matching, there was no difference in the mortality rate between the two groups (56.7% vs. 55.7%; P=.13). However, African American patients had significantly lower survival rates (40.1 vs. 49.6 months; P<.001).

CONCLUSION:
Racial disparities in survival following treatment for ovarian cancer persist despite adjusting for age, stage of cancer, and treatment modalities. Further research is warranted to explore patient and systemic factors such as appropriate level of care and follow up after treatment that might account for these differences.
Association Between External Cephalic Version and Body Mass Index For Nonvertex Presentation [A266]
Authors: Prewitt Kristin , Hersh Alyssa R. , Fennimore Nicole , Bullard Kimberley , Boniface Emily , Valent Amy 
Published: June 2022

INTRODUCTION:
External cephalic versions (ECVs) are critical to preventing the primary cesarean section. We sought to assess the association between indication for ECV and pre-pregnancy BMI. We defined indicated for ECV by those who either had a non-cephalic presentation at delivery or had undergone ECV during pregnancy.

METHODS:
We conducted a retrospective cohort study using 2014–2018 National Vital Statistics Birth Data. Inclusion criteria were singleton, non-anomalous, >36 weeks gestation deliveries without prior cesarean. Those with missing data for BMI, delivery presentation, or ECV performed were excluded. We assessed rates of ECVs performed based on pre-pregnancy BMI categories (underweight, normal, overweight, and obese). Chi-square and multivariable logistic regression were performed for statistical analyses. We adjusted for age, race, ethnicity, and parity as confounders. All analyses were conducted using STATA version 17.

RESULTS:
Of the 549,422 patients included, 8.0% underwent an ECV. When assessed by BMI category, 7.6% in the underweight category, 8.6% in the normal category, 7.9% in the overweight category, and 7.2% in the obese category underwent indicated ECV. After adjusting for confounders, compared to normal weight patients, the odds of undergoing indicated ECV were 0.89 (0.84–0.94) for underweight patients, 0.91 (0.89–0.93) for overweight patients, and 0.81 (0.79–0.83) for obese patients.

CONCLUSION:
We found that the majority of patients eligible for ECV did not undergo ECV. The rates of attempted ECV are lower for patients with abnormal BMI. Future studies should assess the differences in rates of ECV by BMI and harms of primary cesarean section in these patients.
Evaluating the Importance of Immediate Postpartum Depression Screening [A269]
Authors: Zafman Kelly , Riegel Melissa , Wu Jessica , Leitner Kirstin , Srinivas Sindhu 
Published: June 2022

INTRODUCTION:
Postpartum depression (PPD) is costly for women, families, and the health care system. Early identification is critical. We sought to evaluate PPD screening at delivery discharge and compare ongoing rates of positive screening among women at risk of PPD.

METHODS:
In September 2020, we implemented universal Edinburgh Postpartum Depression Scale (EPDS) screening postpartum (PP) prior to discharge. A score of 9–12 and>12 was moderate and high risk for PPD, respectively. All who scored≥9 met with social workers and were referred for outpatient resources. From September to December 2020, women who scored≥9 were contacted for re-screening at 1–3 weeks PP and at 6-weeks PP visit.

RESULTS:
A total of 1,256 women underwent immediate PPD screening. Of those, 165 (13.1%) scored ≥9, with 63 (5.0%) of these scoring >12. Two percent (n=24) indicated thoughts of self-harm. Over 50% (n=80) had no prior history of mental illness. Among women who scored≥9 immediately PP and were reached for re-screening, 58 of 111 (52.5%) scored ≥9 within 3 weeks and 48 of 93 (51.6%) scored ≥9 at their PP visit. Among women who scored>12 immediately PP, 32 of 42 (76.2%) scored ≥9 at 3 weeks and 24 of 31 (77.4%) scored ≥9 at their PP visit. Only 41 (24.8%) had initiated therapy by their PP visit.

CONCLUSION:
Immediate PP EPDS screening is feasible and captures women at risk of PPD. More than half of women who had an elevated score immediately PP continued to score high at their PP visit. Timely screening and access to mental health services is critical and should be integrated into PP care.
Does Insurance Status Effect the Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rate? [A276]
Authors: Sigdel Manisha , Jiang Judy , Seidor Samantha , Benito Carlos W. 
Published: June 2022

INTRODUCTION:
Per the CDC, nulliparous, term, singleton, vertex (NTSV) cesarean delivery (CD) rates are between 21% and 33% in the United States, and the current initiative is to decrease the NTSV CD rate to 24.7% by 2030. At Saint Peters University Hospital in New Brunswick, NJ, the NTSV CD rate was 29.3% in 2020.

METHODS:
This is a retrospective cohort study of NTSV patients who delivered between 1/1/2020 and 12/31/20. Data were obtained from Paragon Electronic Medical Record. The insurance status of each patient was obtained and codified as private insurance (PI) versus HMO, Medicaid, or no insurance/self-pay (NI) coverage. The mode of delivery and insurance type were recorded. NI patients are delivered by hospital-employed physicians present in the labor and delivery department, which is staffed 24 hours a day. Significance was set at P<.05.

RESULTS:
A total of 1,421 NTSV patients were delivered in 2020, with 1,004 delivering vaginally and 417 delivering via CD. There were 1,047 patients with private insurance, with an NTSV CD rate of 31% (325 of 1,047). There were 374 patients with NI, with an NTSV CD rate of 24.6% (92 of 374). There was a significant difference between the two CD rates (P<.0196).

CONCLUSION:
Patients with NI had a statistically lower CD rate (24.6% vs. 31.0%) as compared to those with PI. This may partly be due to the availability of hospital faculty physicians present in the hospital 24/7. The effect of individual practice patterns impacting the private NTSV CD rate cannot be ruled out. The majority of the private physicians are not present in labor and delivery 24 hours a day.
Tracheal Intubation in Term Infants—Trends, Risk Factors, and Outcomes: A Population-Based Study [A281]
Authors: Debay Anthony , Beltempo Marc , Czuzoj-Shulman Nicholas , Abenhaim Haim A. 
Published: June 2022

INTRODUCTION:
Tracheal intubation (TI) is associated with hypoxia and an increase in intracranial pressure, potentially leading to brain injury. We aimed to estimate trends, risk factors, and outcomes among term neonates undergoing TI, using a large population-based database.

METHODS:
This is a retrospective cohort study of 2,122,245 births using the Healthcare Cost and Utilization Project/Nationwide Inpatient Sample from 2015 to 2018. Term infants having undergone TI were identified using ICD-10 codes. Infants with congenital anomalies were excluded. Multivariate logistic regression models were used to evaluate outcomes while adjusting for confounders.

RESULTS:
Rate of death was 4.4% among the 13,205 infants who had TI, and 0.04% among the 2,109,040 infants who did not have TI. Infants undergoing TI in urban teaching hospitals had higher odds of death compared to infants in rural hospitals (OR 1.77, 95% CI 1.17–2.69). Infants who had TI and died had higher odds of intraventricular hemorrhage (IVH; OR 5.28, 95% CI 4.08–6.83), hypoxic-ischemic encephalopathy (HIE; OR 2.34, 95% CI 1.86–2.94), and sepsis (OR 1.50, 95% CI 1.23–1.83); pulmonary hemorrhage (PH) was the greatest predictor of death (OR 7.34, 95% CI 5.17–10.42). Among infants who had TI and survived, odds of IVH (OR 76.24, 95% CI 67.33–86.32), HIE (OR 291.86, 95% CI 263.26–323.56), sepsis (OR 28.76, 95% CI 27.39–30.31), and PH (OR 542.01, 95% CI 384.73–763.58) were higher compared to controls.

CONCLUSION:
Term infants undergoing TI have higher mortality rates compared to controls; TI survivors have an increased risk of neurological sequelae. Non-invasive respiratory support and postnatal neuroprotective interventions should be optimized in term infants.
Assessing Clinical Outcomes of Uncomplicated Cystitis Treatment via Asynchronous Telemedicine [A121]
Authors: Martinez Melina , Newman Jesse , Dai Jiaxin , Nguyen Hoa , Jacobson Mary T. 
Published: June 2022

INTRODUCTION:
Asynchronous telemedicine provides affordable, convenient, and accessible care for patients. An increase in telemedicine visits during the COVID-19 pandemic highlights the importance of assessing clinical outcomes in telemedicine. To our knowledge, this is the first study to examine treatment outcomes of cystitis in women via a telemedicine platform.

METHODS:
The objective of this retrospective study was to assess clinical outcomes and the appropriateness of treatment for uncomplicated cystitis in female patients utilizing an asynchronous telemedicine platform. Electronic medical records were retrospectively reviewed to collect data from patients seen via a direct-to-consumer telemedicine platform in the United States between June 2020 and August 2021. IDSA guidelines were used to determine the appropriateness of treatment. Reported adverse events were also gathered to assess safety.

RESULTS:
Data from 1,799 patients were included, with an average age of 29 (range, 18–84) years. Of these, 91% (1,646) of patients received IDSA guideline-recommended treatment, with 97% (1,747) experiencing symptom resolution and 3% (52) returning within seven days of their initial visit for additional concerns. The referral rate for additional in-person care or labs was 2% (43). In total, 1% (18) of patients experienced an adverse event.

CONCLUSION:
Patients utilizing an asynchronous telemedicine platform for the treatment of uncomplicated cystitis experienced high rates of symptom resolution and low rates of referral. Additionally, s prescribed guideline-concordant care. These findings support asynchronous telemedicine as a safe and effective option for the treatment of uncomplicated cystitis.
Racial and Ethnic Disparities in Menopausal Hormone Therapy Acceptance [A134]
Authors: Pershad Anita , Morris Joshua , Khanna Pallavi 
Published: June 2022

INTRODUCTION:
There is a paucity of data on race and ethnicity in hormone therapy (HT) acceptance in previous menopause treatment studies. Our primary objective was to examine differences in HT acceptance between self-reported race and ethnic groups. Our secondary objective was to assess patient comorbidities and trends in reported symptom frequency at presentation in a menopause-focused care clinic.

METHODS:
Retrospective medical record review of patients presenting to a single menopause clinic from July 2018 to July 2021 at a tertiary level, urban, academic center in the Midsouth. Statistical tests included t test and odds ratios, with P values <.05 considered significant.

RESULTS:
A total of 113 patients presented with menopausal symptoms and were included; 58 (52%) were Black, 47 (42%) were White, and 8 (6%) declined to answer. Of 42 women with vasomotor symptoms, 23 (55%) accepted lifestyle modification therapy and 19 (45%) accepted HT. Of 34 women with vaginal dryness, only 5 (15%) accepted vaginal HT, while 29 (85%) accepted moisturizers/lubricants. A total of 20 patients were excluded from eligibility for systemic HT due to medical comorbidities. Of 37 women eligible for systemic HT, 18 (49%) of White women accepted HT, compared to only 9 (24%) of Black women. This difference was statistically significant (P=.01). Black women were 24% less likely to accept HT for menopausal symptom management (OR, 0.24; 95% CI, 0.09–0.64).

CONCLUSION:
Our pilot study suggests racial disparity in acceptance of HT among perimenopausal and postmenopausal women. This can inform clinicians about patient factors affecting treatment choice for menopausal symptoms and opportunities to explore racial differences in quality of care.
Assessment of In-Hospital Pain Control After Childbirth and Its Correlation With Anxiety in the Postpartum Period [A150]
Authors: Olson Clara , Poehlmann John , Stowe Zachary , Antony Kathleen M. 
Published: June 2022

INTRODUCTION:
The relationship between pain and anxiety in medical and surgical contexts is established; less is known about this relationship in obstetric populations. This study evaluated whether there is an association between postpartum pain and anxiety.

METHODS:
In this institutional review board‒approved survey-based prospective cohort study, the General Anxiety Disorder-7 (GAD-7) and American Pain Society-Patient Outcome Questionnaire (APS-POQ) were completed the day of postpartum discharge. The association between moderate-to-severe anxiety and measures of pain control were assessed.

RESULTS:
A total of 64 subjects completed discharge surveys. Parturients with moderate-to-severe scores (≥10) on the GAD-7 also had more maximum pain scores (0–10 scale) in the severe range (≥7) in the first (P=.049) and second (P=.010) 24-hour periods after delivery and were more likely to have spent a higher percentage of their time in severe pain within these time frames (P=0.007 and P=0.010, respectively). Similar relationships were observed when classifying anxiety as no anxiety (GAD-7 score <5), mild anxiety (GAD-7 score 5–9), moderate anxiety (GAD-7 score 10–14), and severe anxiety (GAD-7 score ≥15). Parturients with preexisting anxiety did not have higher rates of perceived inadequate pain control. Parturients whose infants had health concerns did not have higher rates of anxiety.

CONCLUSION:
Postpartum pain levels were associated with higher levels of anxiety in the immediate postpartum period. Consideration of the relationship between pain control and anxiety may help optimize patients’ postpartum experience.