bluuebunny/crossref_metadata_2025_split huggingface dataset:
Five-Year Real-World Audit Data for Adjunctive Spectroscopic Colposcopy [A293]
Authors: Brady Jullien 
Published: June 2022

INTRODUCTION:
Spectroscopic colposcopy is National Institute for Health and Care Excellence–recommended in the United Kingdom for its increased detection rate of high-grade cervical intraepithelial neoplasia (CIN) compared to traditional colposcopy. The author's institution adopted the technology in 2015, and it is used as the sole method of colposcopy. Over 1,500 examinations have been conducted.

METHODS:
This is a 5-year retrospective audit of practice, using the U.K.-mandated colposcopy data set where applicable to review change in detection rate of high-grade CIN in a low-grade referral population following introduction of the technology. Biopsies suitable for histology analysis (standard 90%).LEEPS removed a single specimen (standard 80%)LEEPS meeting the depth of excision requirements (standard minimum depth of 7 mm in 95%)Rate of change of colposcopy opinion following presentation of adjunctive map.

RESULTS:
The high-grade CIN detection rate reflects and improves upon the published data. It confirms a significant improvement following introduction of the technology of 30–70%. The U.K. standards were exceeded in biopsies suitable for histology analysis (actual, 99%; standard, 90%). LEEPS removed a single specimen (actual, 96%; standard, 80%), meeting the depth of excision requirements (actual, 96%; standard minimum depth of 7 mm in 95%). Rate of change of colposcopy opinion following presentation of the map was 5%.

CONCLUSION:
These real-world data confirm an improvement in the detection of high-grade CIN following the introduction of spectroscopic colposcopy technology. Coloscopy procedures performed when using the technology exceed the requirements of the U.K.-mandated standards. Spectroscopic colposcopy should be considered by all physicians performing colposcopy.
Heavy Menstrual Bleeding Treatment With a Levonorgestrel 52-mg IUS [A116]
Authors: Creinin Mitchell D. , Barnhart Kurt , Gawron Lori M. , Eisenberg David , Mabey R. Garn , Jensen Jeffrey T. 
Published: June 2022

INTRODUCTION:
Prior levonorgestrel 52-mg intrauterine system (IUS) studies for heavy menstrual bleeding (HMB) limited body mass index (BMI) and included only parous women. We evaluated outcomes in a population without BMI or parity restrictions.

METHODS:
We performed an institutional review board‒approved, Phase 3 study of Liletta for HMB. Participants had up to three screening cycles with collection of study-specific sanitary products for alkaline hematin blood loss measurement. We enrolled those with two menses ≥80 mL (values averaged for baseline blood loss) and placed the IUS. Participants collected sanitary products used during months 3 and 6 post-placement for blood loss measurement if any bleeding occurred. We evaluated median absolute change in blood loss in participants with at least one follow-up assessment and compared BMI and parity outcomes using Wilcoxon rank sum tests.

RESULTS:
Of the 105 enrolled participants, 68 (65%) were White, 25 (24%) were Black, 47 (45%) were obese (BMI ≥30), and 29 (28%) were nulliparous. Baseline mean blood loss ranged from 73 mL to 520 mL (median, 143 mL; interquartile range [IQR], 112–196 mL), with median 3-month (n=86) and 6-month (n=81) values of 9.5 mL (IQR, 2.5–22.9 mL) and 3.8 mL (IQR, 0–10.1 mL), respectively. The median percentage decreases per participant were 93% (IQR, 82–98%) and 97% (IQR, 90–100%), respectively. At six months, median decreases in non-obese (n=46) and obese (n=35) participants did not differ (97% [IQR, 90–100%] and 97% [IQR, 89–100%], respectively; P=.73) with similar findings for nulliparous (n=25) and parous (n=56) participants (97% [IQR, 92–99%] and 97.5% [IQR, 89–100%], respectively; P=.74). Discontinuations included 4 (4%) expulsions, 6 (6%) removals for bleeding/cramping, and 12 (11%) participant choice/lost to follow-up/consent withdrawal.

CONCLUSION:
Levonorgestrel 52-mg IUS reduces blood loss more than 90% for most users with HMB regardless of BMI and parity.
Uptake of Influenza, Tdap, and COVID-19 Vaccines in Pregnancy [A126]
Authors: Agasse Eva , Rodriguez Gabriella , Vilarino Valerie , Galli Johnny , Duthely Lunthita M. , Potter JoNell 
Published: June 2022

INTRODUCTION:
Immunization plays an essential role in protecting the mother and child dyad from serious illnesses. Despite current recommendations from the American College of Obstetricians and Gynecologist, Advisory Committee on Immunization Practices, and Centers for Disease Control and Prevention, vaccination rates in the U.S. are significantly below 100%. The aim of this study is to assess uptake of influenza, Tdap, and COVID-19 vaccination in pregnancy among a culturally diverse population in South Florida.

METHODS:
An institutional review board‒approved cross-sectional survey was administered among inpatient postpartum persons between July and September 2021. The 359 enrolled participants completed a survey assessing basic demographics and vaccination history. Chi-square tests, set at a significance level of P<.05, compared uptake of each vaccine by ethnicity and U.S.-born status.

RESULTS:
Of the 359 participants, 67.7% self-identified as White, 67.4% reported Hispanic ethnicity, and 68.5% were non-U.S.-born. Compared to the 2019–2020 national average, Tdap vaccine uptake in this cohort was higher (74.7% versus 56.6%) and influenza vaccine uptake was lower (45.1% versus 61.2%). COVID-19 vaccine uptake during the study period mirrored the national average (18.1% versus 18.9%). Generally, there was higher vaccination uptake among Hispanics and non-U.S.-born individuals. However, a significant difference was only observed for uptake in influenza vaccine between U.S.-born and non-U.S.-born persons (chi-square=11.54, P=.0007).

CONCLUSION:
The suboptimal rates of influenza, Tdap, and COVID-19 vaccination seen in this cohort demonstrate the necessity for interventions to improve education about the safety and effectiveness of vaccination in pregnancy. Furthermore, increased efforts to maximize availability and access to vaccines during prenatal care are also needed. Together, these strategies may increase vaccine uptake in pregnancy, especially across diverse populations.
Uterine Prolapse in Pregnancy: National Trends, Risk Factors, and Obstetric Outcomes [A141]
Authors: Paterson David S. , Badeghiesh Ahmad , Baghlaf Haitham , Debay Anthony , Alturki Faisal , Dahan Michael H. 
Published: June 2022

INTRODUCTION:
The uterus can prolapse acutely during pregnancy. We report national trends, characteristics, and obstetric outcomes of women with uterine prolapse (UP).

METHODS:
Retrospective cohort study using the HCUP-NIS database. Our study cohort included women admitted for delivery between 2004 and 2014 inclusively and had a diagnosis of UP. Multivariate logistic regression analyses compared obstetric outcomes among pregnancies complicated by UP versus those without, while adjusting for confounding variables.

RESULTS:
Among the 9,096,788 deliveries during our study period, 713 received a diagnosis of UP. The incidence of UP increased over time (P≤0.0001). Women with UP were likelier to be older, multigravida, smokers, have endometriosis, or fibroids (P≤0.002, all). They were less likely to have had a previous cesarean delivery (CD) (P<.0001), or multiple gestation (P=.03). Women with UP had lower odds of pregnancy-induced hypertension (aOR, 0.38; 95% CI, 0.25–0.58), preeclampsia (aOR, 0.27; 95% CI, 0.13–0.57), operative vaginal delivery (aOR, 0.41; 95% CI, 0.26–0.64), and CD (aOR, 0.30; 95% CI, 0.23–0.39). They had higher odds of having a spontaneous vaginal delivery (aOR, 3.46; 95% CI, 2.73–4.39), para-delivery hysterectomy (aOR, 21.5; 95% CI, 11.78–29.25), postpartum hemorrhage (aOR, 2.12; 95% CI, 1.56–2.87), wound complications (aOR, 2.72; 95% CI, 1.22–6.09), blood transfusion (aOR, 2.39; 95% CI, 1.43–3.10) or birth of neonates with major congenital abnormalities (aOR, 2.48; 95% CI, 1.18–5.22).

CONCLUSION:
Women with UP are at higher risk of obstetric complications and neonatal morbidity. These findings elucidate risk factors that may improve prenatal counseling, perinatal surgical management, and clinical practice and policy guidelines.
Patterns in Preconception Expanded Carrier Screening: Race, Wealth, and Marriage [A142]
Authors: Spiegel Strauss Tirtza N. , Schneider Emily , Boniferro Emily , Johnson Anna , Brockhoff Erika , Brustman Lois 
Published: June 2022

INTRODUCTION:
Genetic carrier screening is ideally performed before pregnancy to provide patients with a full range of reproductive options. In 2018, our academic medical center began offering expanded carrier screening (ECS), which was universally reimbursed. The aim of this study was to compare the demographics of women who obtained ECS preconception to women who obtained ECS during pregnancy.

METHODS:
This was a descriptive retrospective cohort study. From 2018 to 2021, ECS was ordered by genetic counselors, residents, fellows, and attendings. Demographics were reviewed to evaluate age, race, ethnicity, insurance payer, marital status, and language spoken by patient. Chi-square tests were performed as appropriate.

RESULTS:
During our study, 98 women underwent ECS preconception and 1,090 women obtained ECS during pregnancy. The majority of patients obtaining preconception ECS were White (58%), non-Hispanic (84.7%), married (66.3%), English-speaking (86.7%), and had commercial insurance (77.6%). Ordering providers were predominantly genetic counselors (89%). White women were more likely than Black women to obtain ECS preconception (P<.0001), as were women with commercial insurance compared to those with public insurance (P<.0001). There was a nonsignificant trend toward married women being more likely to obtain ECS preconception than unmarried women (P=.06).

CONCLUSION:
Our data suggests race and insurance payer were different in patients who obtained ECS preconception compared to those who obtained ECS during pregnancy. In order to provide complete reproductive autonomy, it is important that ECS be offered to all women of reproductive age prior to pregnancy. Future directions include assessing patient comprehension of ECS, and access to screening and care.
Mode of Delivery of Stillbirths in the United States 2014–2018 [A145]
Authors: Pearson Hattie , Schumaker Brianna , Berman Susan 
Published: June 2022

INTRODUCTION:
In recent years there has been a movement to decrease the cesarean delivery rate. In cases of stillbirths, the American College of Obstetricians and Gynecologists (ACOG) recommends cesarean delivery only in unusual cases. This study examines the most recent data for rates of cesarean delivery in women with intrauterine fetal demises.

METHODS:
Fetal deaths from 2014 to 2018 were analyzed from the Center for Disease Control’s National Vital Statistics Report. Institutional review board approval was waived. We examined the overall rates of cesarean delivery as well as the rates in several subpopulations. We used a Cox proportional-hazard model to adjust for contributing factors and determine risk factors for cesarean delivery.

RESULTS:
From 2014 to 2018, 16.1% of all fetal deaths in the United States were delivered by cesarean. In gestations over 28 weeks, 32% of stillbirths were delivered by cesarean. Multiple gestations and history of cesarean delivery were most strongly associated with risk of cesarean delivery. Preexisting maternal conditions, pregnancy, and delivery complications increased the risk of cesarean delivery.

CONCLUSION:
Despite ACOG's recommendation to reserve cesarean delivery of stillbirths for exceptional cases, cesarean delivery remains a commonly performed procedure in this population. We found a small increase in the overall rate of cesarean delivery compared to prior studies. When examining data for gestations over 28 weeks, the rate of cesarean delivery approached that of live births. Our study identified several factors associated with cesarean delivery of stillbirths that can help obstetricians understand indications for surgical delivery and prevent unnecessary interventions.
Maternal Race and Clinical Vigilance in Obstetric Hemorrhage Management [A147]
Authors: Wang Michelle J. , Alexander Megan , Srivastava Akanksha , Tummala Swetha P. , Comfort Ashley , Yarrington Christina 
Published: June 2022

INTRODUCTION:
Non-White maternal race has been associated with an increased risk for severe morbidity from obstetric hemorrhage (OBH). In the present study, we investigate the hypothesis that such disparities could be secondary to delay in the administration of standard third stage oxytocin or decreased use of additional hemorrhage interventions for pregnant patients of color compared to White patients.

METHODS:
We performed a retrospective cohort of all deliveries from 2018 to 2019 at our institution. The two groups compared were 1) Hispanic White or non-White race (HW/NWR) pregnant people and 2) non-Hispanic White (NHW) pregnant people. The primary outcome was time from delivery to first dose of postpartum oxytocin; secondary outcome was the frequency of additional hemorrhage interventions. Groups were compared using t test and chi-square or Fisher’s exact tests.

RESULTS:
Of 3,832 patients who delivered a live infant between January 1, 2018, and December 31, 2019, with self-identified race and ethnicity recorded in their patient record, 644 patients identified as NHW and 3,188 patients identified as HW/NWR. There was no difference in time to first dose of postpartum oxytocin (P=.51). There was also no difference in frequency of administration of any individual uterotonics, tranexamic acid, transfusion, uterine artery embolization, or hemorrhage-related surgical techniques.

CONCLUSION:
There was no delay in the administration of postpartum oxytocin when comparing non-White and Hispanic White patients to non-Hispanic White patients. Additional research is needed to continue to explore systemic causes of and solutions for racial disparities in obstetric hemorrhage.
Preconception Immunosuppression Regimens and Perinatal Outcomes in Renal Transplant Recipients [A158]
Authors: Mulhall Joseph C. , Nguyen Lynsa , Pham Amelie , Langone Anthony , Thompson Jennifer L. 
Published: June 2022

INTRODUCTION:
Renal transplant recipients are frequently transitioned to new immunosuppression regimens (ISR) in anticipation of pregnancy to reduce teratogenic risks. The consequent effects on perinatal outcomes and renal allograft condition are not known. We evaluated the risks of transitioning to a new ISR in the preconception period on perinatal outcomes and allograft condition in renal transplant recipients.

METHODS:
Institutional review board approval was obtained for the study. A retrospective cohort study at a single tertiary-care center included all pregnancies with a history of renal transplant between January 1995 and 2021. Patients who did not have a pregnancy following their transplant or who were still pregnant at the time of data analysis were excluded. Study groups included patients who transitioned to a new ISR prior to pregnancy versus patients who continued on their established ISR.

RESULTS:
Of 93 pregnancies identified, 27 patients, with a total of 30 pregnancies, met inclusion criteria. Preconception ISR transition occurred in 13 pregnancies (48.1%). There were no significant differences in maternal characteristics between groups. Preconception ISR transition was associated with a significantly later gestational age at delivery (36.0 versus 30.9, P=.02) and a non-statistically-significant higher live birth rate (84.6% versus 52.9%, P=.07). Overall, maternal and fetal composite adverse outcomes and acute renal injury in pregnancy did not differ between groups.

CONCLUSION:
Transitioning patients to a new ISR in the preconception period did not significantly affect perinatal outcomes or allograft condition in pregnancy; however, women may deliver at a later gestational age. Additional studies are needed to further investigate this association.
Reconsidering Absolute Diagnostic Thresholds in Intrahepatic Cholestasis of Pregnancy [A159]
Authors: Tamzali Ines , Pirics Michael L. , Burwick Richard M. 
Published: June 2022

INTRODUCTION:
Practice guidelines utilize absolute bile acid levels to diagnose intrahepatic cholestasis of pregnancy (ICP) or to determine its severity, but the normal reference range varies by laboratory. We sought to evaluate variation in total bile acid assays by laboratory, testing method, and fasting state.

METHODS:
Using a search engine, we compiled a list of laboratories located within North America, the United Kingdom, and Australia. We obtained laboratory-specific information on bile acid assays, including testing method, reference range, and fasting requirements. Reference ranges were evaluated in relation to ICP severity thresholds (40 or 100 micromoles/L).

RESULTS:
We identified seven laboratories with total bile acid assays: four in the U.S., one in Canada, one in the U.K., and one in Australia. Three labs also offered a fractionated assay (ARUP, Lab Corp, Quest). Depending on the test employed, the upper limit of normal for total bile acids ranged from 6.8 to 19.0 micromoles/L. Assay methods included chromatography/mass spectrometry, quantitative enzymatic, and spectrophotometry. Fasting was preferred or required in 10 of 11 assays—either overnight, 8 hours, 12–14 hours, or duration unspecified. Utilizing ICP severity thresholds, a total bile acid level greater than 40 micromoles/L or 100 micromoles/L was 2–6 times or 5–15 times the upper limit of normal, respectively, depending on the assay used.

CONCLUSION:
Multiple bile acid assays are available, but the normal reference range varies due to assay methodology and fasting recommendations. Thus, caution is warranted if a definitive bile acid is utilized to define disease severity or perinatal risk.
Prenatal Phenotype in Nonimmune Hydrops Fetalis [A160]
Authors: Makhamreh Mona M. , Rice Stephanie , Critchlow Elizabeth , Araji Sarah , Berger Seth , Al-Kouatly Huda B. 
Published: June 2022

INTRODUCTION:
Nonimmune hydrops fetalis (NIHF) is defined by fluid accumulation in ≥2 fetal compartments without alloimmunization. Structural anomalies on prenatal imaging should be assessed for genetic diagnosis. Our goal was to describe the prenatal phenotype of a NIHF cohort based on prenatal imaging, also determine the significance of prenatal imaging in the genetic workup.

METHODS:
The Hydrops-Yielding Diagnostic Results of Prenatal Sequencing (HYDROPS) study is an ongoing prospective series of NIHF with negative standard workup. Trio exome sequencing (ES) was performed and prenatal records were reviewed. The primary outcome was identifying major organ system abnormalities in NIHF. The secondary outcome was comparing major organ system abnormalities in NIHF in cases diagnosed or possibly diagnosed by ES to cases that remained undiagnosed.

RESULTS:
In 30 cases, major organ system abnormalities were: musculoskeletal (MSK) 9 (30%); central nervous system (CNS) 7 (23%); cardiac 6 (20%); and renal 2 (6.7%). Among 16 cases with major organ system abnormality on prenatal imaging, 15 (93.7%) were diagnosed or possibly diagnosed by ES, while 1 (6.3%) was undiagnosed. Of 14 cases with no major organ abnormalities, 6 (42.9%) were diagnosed or possibly diagnosed by ES while 8 (57.1%) were undiagnosed. The presence of major organ abnormalities in NIHF increased the diagnostic yield of ES. (P=.004).

CONCLUSION:
The most common major organ system abnormalities on prenatal imaging in NIHF were MSK, CNS and cardiac. Most NIHF cases with congenital abnormalities on prenatal imaging yielded a diagnostic or possibly diagnostic result on ES. Comprehensive prenatal phenotyping increases the diagnostic yield in NIHF.
Low Mortality and High Severe Maternal Morbidity in Pregnancy Among People With Sickle Cell Disease [A174]
Authors: Early Macy , Eke Ahizechukwu , Lanzkron Sophie , Pecker Lydia 
Published: June 2022

INTRODUCTION:
Pregnancy in people with sickle cell disease (SCD), who are predominantly Black, is high-risk. This study’s purpose is to update risk estimates of severe pregnancy outcomes in SCD and define the excess risk attributable to SCD.

METHODS:
We analyzed pregnancy-related admissions in the 2012–2018 National Inpatient Sample (NIS) and compared rates of the Center for Disease Control and Prevention’s Severe Maternal Morbidity (SMM) Index in SCD to the general unaffected population (GP) and the unaffected Black population (UB). The composite SMM excluded transfusion and vaso-occlusive crisis. Multivariate logistic regression was used to calculate odds ratios and excess risk fractions, controlling for age, multiple gestation, socioeconomic variables, and hospital characteristics.

RESULTS:
There were 8,121,002 pregnancy-related admissions, 6,610 among people with SCD (87% Black). There were few maternal deaths in SCD pregnancies (<10). SCD pregnancies were over three times as likely to experience SMM than GP or UB pregnancies (GP: OR 4.63, 95% CI 4.16–5.16, P<.001; UB: OR 3.33, 95% CI 2.97–3.75, P<.001). SCD pregnancies had higher odds of hysterectomy (GP: OR 2.24, P=.002; UB: OR 1.68, P=.09), sepsis (GP: OR 6.72, P<.001; UB: OR 5.54, P<.001), venous thromboembolism (GP: OR 9.89, P<.001; UB: OR 6.24, P<.001), and cerebrovascular event (GP: OR 13.94, P<.001; UB: OR 10.90, P<.001). In SCD pregnancies, excess risk for composite SMM was attributable to SCD status (70%; 95% CI, 67–73%), Black race (31%; 95% CI, 30–32%), and public insurance (14%; 95% CI, 14–15%).

CONCLUSION:
Contemporary data identifies SMM-, race-, and insurance-based disparities in SCD pregnancies, highlighting the need for disease-specific, pharmacotherapeutic interventions during pregnancy, and requires further prospective validation.
Rates of Attempted and Successful Trial of Labor After Cesarean Delivery by Race at a University Medical Center [A175]
Authors: Martin Angela , Leslie Dunmire , Wolff Sharon F. , Voth Cassandra , Mendez Rosa , DiTeresi Rachel 
Published: June 2022

INTRODUCTION:
It is important that the counseling that patients receive regarding trial of labor after cesarean delivery (TOLAC) is data-driven and devoid of racial bias. Vaginal birth after cesarean delivery (VBAC) “calculators” are commonly used by providers, but many are based on older research studies and use race in their calculations, with patients of Hispanic and African American descent having lower rates of predicted success when controlling for other confounders.

METHODS:
This retrospective study included patients with a history of one or two prior cesarean deliveries and a current singleton, non-anomalous, term pregnancy. We compared rates of attempted TOLAC among various races. Among those who underwent a TOLAC, we compared rates of successful VBAC among patients of various races at the University of Kansas Medical Center (KUMC), a large tertiary-care center.

RESULTS:
A total of 791 patient charts were analyzed and showed no difference in attempted TOLAC rates among Black, Hispanic, Asian, and patients of “other” race compared to White patients after adjusting for BMI, number of previous cesarean deliveries, history of vaginal birth, and gestational age at delivery. Among patients who had a TOLAC, the likelihood of successful VBAC also did not show significant variation by race after adjusting for potential confounding variables.

CONCLUSION:
This data shows that there is no difference in rate of attempted or successful TOLAC based on race at a large tertiary-care center. These results further highlight the importance of eliminating racial bias in TOLAC counseling.