bluuebunny/crossref_metadata_2025_split huggingface dataset:
Labor Induction at 39 Weeks in Low-Risk Term Pregnancies and Risk of Perinatal Death [A263]
Authors: Abenhaim Haim A. , Czuzoj-Shulman Nicholas , Benjamin Alice , Spence Andrea 
Published: June 2022

INTRODUCTION:
Induction of labor (IOL) at 39 weeks has been associated with decreased risk of cesarean delivery. The study objective was to evaluate the effect of IOL at 39 weeks on perinatal death in low-risk pregnancies.

METHODS:
We used the National Center for Health Statistics Linked Birth/Infant Deaths data from 2013 to 2017 to carry out a propensity score matched cohort study to test the influence of IOL at 39 weeks on risk of stillbirth and infant death. Low-risk singleton pregnancies with a live fetus at 39 weeks with no known congenital malformations who underwent an IOL were matched with comparable pregnancies that were not induced at 39 weeks and that delivered no later than 42 weeks.

RESULTS:
From >20 million births, 825,323 (4%) low-risk pregnancies that were induced at 39 weeks were propensity score matched (5:1 ratio) to a comparable group of pregnancies that were not induced at 39 weeks. Compared to pregnancies that were not induced at 39 weeks, IOL at 39 weeks was associated with increased risk of perinatal death (10.8 versus 5.8/10,000; OR, 3.83.5–4.2; P<.0001), which consisted of a decreased risk of stillbirth (0 versus 0.7/10,000) and an increased risk of infant death (10.8 versus 5.1/10,000; OR, 4.2; 95% CI, 3.8–4.6; P<.0001). Among live-born infants, the risk of sudden infant death syndrome was more common among pregnancies induced at 39 weeks (OR, 4.3; 95% CI, 3.6–5.2; P<.0001).

CONCLUSION:
IOL at 39 weeks in low-risk singleton pregnancies is associated with an increased risk of perinatal death. While this may not have a material effect on risk to an individual patient, adoption of widespread practices of inducing low-risk pregnancies at 39 weeks may lead to increases in perinatal deaths on a population level.
Examining the Association of Immediate Postpartum Long-Acting Reversible Contraception Payment Carve-outs and Postpartum LARC Use in Medicaid [A04]
Authors: Fuerst Megan , Moore Jennifer E. , Magnus Manya 
Published: June 2022

INTRODUCTION:
Providing contraception in the postpartum period is essential to prevent unintended pregnancies and optimize birth spacing. The Medicaid program funds the majority of public family planning expenditures and pays for half of births in the United States. To improve postpartum contraception use, Medicaid stakeholders have focused on long-acting reversible contraception (LARC), which includes intrauterine devices and the contraceptive implants. A key platform for improving postpartum LARC access has been the adoption of carve-out policies that increase reimbursement for immediate postpartum LARC (IPP-LARC) services outside of the standard global maternity payment provided by Medicaid. IPP-LARC is LARC insertion that occurs after childbirth but prior to hospital discharge. IPP-LARC carve-out policies may increase postpartum LARC use among Medicaid enrolled individuals.

METHODS:
This study used the U.S. Centers for Disease Control Prevention Pregnancy Risk Assessment and Monitoring System dataset from 2016-2018 to explore the association between IPP-LARC carve-out policies and the use of postpartum LARC versus another form of hormonal and/or nonhormonal contraception. The study was approved by the institutional review board (IRB) at George Washington University.

RESULTS:
The study included 24,807 Medicaid enrolled postpartum individuals from 26 states. Results suggest that IPP-LARC policies are positively associated with LARC use over other forms of contraception and state Medicaid expansion status and postpartum visit attendance modify the association.

CONCLUSION:
The findings support the growing body of evidence that IPP-LARC carve-out policies and Medicaid expansion positively influence postpartum LARC use. Widespread adoption and implementation of such policies may be a key strategy to improve postpartum contraception access for Medicaid enrollees.
Characterization of Women Who Experienced Urinary Tract Infections in the Phase 3 AMPOWER Trial [A15]
Authors: Maximos Bassem , Dart Clint , Howard Brandon 
Published: June 2022

INTRODUCTION:
Vaginal pH modulator (VPM; Phexxi) is a non-hormonal, on-demand, woman-controlled gel for the prevention of pregnancy. The objective of this post-hoc analysis was to characterize women who experienced urinary tract infections (UTIs) while receiving VPM in the AMPOWER trial.

METHODS:
AMPOWER was a phase 3, single-arm, multicenter (112 sites) study that evaluated the contraceptive efficacy/safety of VPM over 7 cycles of use in sexually active women 18-35 years old (NCT03243305; Thomas et al. Contraception 2020). Exclusion criteria included ≥3 UTIs in the past year or an active UTI at screening. In the post-hoc analysis, women who experienced an on-study UTI were assessed by demographic characteristics and by reports of product use and sexual intercourse.

RESULTS:
Of the 1339 women who administered at least one dose of VPM and were included in the safety population, 77 (5.7%) experienced an on-study UTI. Demographic characteristics of these women were as follows: mean age, 28.1 years; mean body mass index, 28.3 kg/m2; race, 75.3% White, 20.8% Black/African American, 3.9% other; ethnicity, 57.1% non-Hispanic/Latino, 42.9% Hispanic/Latino. In the cycles in which a UTI was diagnosed/reported, the mean number of all acts of intercourse was 3.4 (standard deviation [SD], 3.8) and the mean number of acts of intercourse with product use was 3.2 (SD, 3.7). By comparison, the mean number of product uses per cycle in the overall population was 4.24.

CONCLUSION:
Compared to the overall AMPOWER population, women who experienced on-study UTIs had similar baseline characteristics and slightly lower product use.
Understanding of Lactational Amenorrhea Among US Pregnant Women [A29]
Authors: Chen Melissa J. , Iwuagwu Caidon , Hoyt-Austin Adrienne E. , Fix Margaret , Kair Laura R. , Schwarz Eleanor Bimla 
Published: June 2022

INTRODUCTION:
Lactational amenorrhea method (LAM) is a temporary postpartum contraceptive method that is typically more effective than use of condoms or birth control pills. However, this method may be underutilized due to incomplete knowledge.

METHODS:
To assess perceptions of the effectiveness of LAM compared to other postpartum contraceptives in 2021, we used social media to recruit US-born nulliparous pregnant women carrying a singleton pregnancy of 28+ weeks’ gestation. Participants were compensated a $20 gift card for completing an online survey. Institutional review board (IRB) approval was obtained.

RESULTS:
Of 152 respondents, 76% were college-educated, 90% wanted to breastfeed, and 7% indicated they planned to rely on LAM as their sole method of contraception in the first 6 months postpartum. However, less than half (48%) were aware that breastfeeding would delay the return of menses after the baby is born, and only 47% believed exclusive breastfeeding reduces the chance of pregnancy within 6 months of delivery. Only 9% (95% CI 5%-14%) knew breastfeeding prevents pregnancy when their infant is exclusively breastfed, while 27% (95% CI 20%-35%) knew breastfeeding only protects mothers from pregnancy until menstrual periods have returned. No respondents indicated that exclusive breastfeeding is typically more effective than condoms and only 2% (0%-6%) indicated that exclusive breastfeeding is typically more effective than birth control pills.

CONCLUSION:
Few US pregnant women are aware of LAM criteria or the effectiveness of LAM compared with other postpartum contraceptive options, suggesting that patients may be receiving incomplete counseling from their health care providers regarding their options for postpartum contraception.
Patterns and Determinants of Postpartum Long Acting Reversible Contraception Utilization and Sterilization Utilization in Michigan [A33]
Authors: Moniz Michelle , Peahl Alex F. , Zinsser Dawn , Kolenic Giselle , Stout Molly , Morgan Daniel 
Published: June 2022

INTRODUCTION:
We aimed to evaluate patterns and determinants of utilization of postpartum long acting reversible contraception (LARC) and sterilization to guide future quality improvement interventions.

METHODS:
This institutional review board (IRB)-approved retrospective cohort analysis used administrative claims data from a statewide collaborative quality initiative to identify childbirth episodes from 1/2016-12/2019. Outcomes included LARC utilization and sterilization utilization by 60 days postpartum. Multivariable logistic regression using hospital fixed effects evaluated associations between outcomes and patient characteristics, including neighborhood social vulnerability index (a composite measure of socioeconomic status, household composition, minority status, and housing/transportation).

RESULTS:
The cohort included 140,380 delivery episodes among 130,174 women (44% publicly insured). By 60 days postpartum, adjusted hospital-specific rates of LARC utilization ranged from 0.5% to 20.4%; sterilization utilization ranged from 0.0% to 13.2%. In multivariable models, women living in neighborhoods with the highest quintile of socioeconomic vulnerability and racial/ethnic vulnerability were more likely to use LARC, as were those with younger age, chronic conditions, public insurance, and birth year later in the study period. Sterilization utilization was less likely among women in neighborhoods with highest socioeconomic and racial/ethnic vulnerability and more likely among women in neighborhoods with highest housing/transportation vulnerability, and those with older age, chronic conditions, public insurance, and later birth years.

CONCLUSION:
Wide variation in postpartum contraceptive use calls for quality improvement efforts in Michigan. Observed associations with social vulnerability identify the pressing need to understand how potential community factors (e.g., transportation, housing, racism) shape postpartum contraceptive decision-making and utilization.
Association Between Publicly-Funded Contraceptive Services and Abortion Rate in Texas [A39]
Authors: Madison Anita M. , Powers Daniel , Maslowsky Julie , Goyal Vinita 
Published: June 2022

INTRODUCTION:
The Texas legislature cut its family planning budget in 2011 and restricted access to abortion in 2013. Our objective was to evaluate how the availability of contraceptive services correlated with a change in the abortion rate before and after these legislative changes.

METHODS:
We obtained 2010 and 2015 data on contraceptive provision (number of publicly-funded clinics and number of contraceptive clients served) from the Guttmacher Institute and county-level abortion data from Texas Department of State Health Services. We categorized counties by an abortion rate that increased or was less than (low decline) versus greater than or equal to (high decline) the decline seen nationally. We used the chi-square test, t-tests, and logistic regression to evaluate differences in contraceptive provision between high and low abortion decline counties, adjusting for county demographic and health care characteristics.

RESULTS:
The Texas abortion rate declined by 23% from 2010 to 2015. Statewide, the total number of publicly-funded family planning clinics increased by 11% and total number of contraceptive clients served decreased 4%. Compared to low decline counties (n=79), high decline counties (n=175) had a higher mean number of contraceptive clients served per 1000 women 18-44 years old (51.35 ± 124.26 vs. 81.85 ± 202.66, P<.05) and contraceptive clinics (0.82 ± 1.06 vs. 2.22 ± 5.57, P<.05) in 2015. Abortion decline did not differ by other county characteristics.

CONCLUSION:
Texas counties with higher abortion rate declines had more publicly-funded contraceptive clinics and served more contraceptive clients than counties with lower declines, demonstrating the importance of greater access to publicly-funded contraceptive services.
Professional Practice Trends of Minimally Invasive Gynecologic Surgeons Upon Graduation From U.S. Fellowships [A43]
Authors: Gupta Sonul , El-Farra Mohamed H. , Dasari Prathyusha , Kyeong Yena , Stuparich Mallory , Behbehan Sadikah 
Published: June 2022

INTRODUCTION:
To investigate professional practice trends of minimally invasive gynecologic surgery (MIGS) fellows upon completion of training and assess if fellowship training site demographics match that of current practice.

METHODS:
Using the past five MIGS graduating classes, 172 graduates were included. Graduates’ names were searched for program location and post-graduate area of practice. Demographic information pertaining to fellowship city and practice city was obtained from the US Census. The Social vulnerability index (SVI) was used to measure socioeconomic status (SES), and Simpson’s diversity index was used for ethnic diversity. Independent chi-square tests compared graduates’ practice regions' demographics to their training sites'.

RESULTS:
Training and practice sites are located in large cities vs. midsize/small cities, and possess lower median household incomes (250,000) practice in large cities, and those who trained in smaller cities (69%) practice in smaller cities (P<.001). Most graduates (64.4%) who trained in higher median-income areas continue to practice there, and 69.3% of graduates who trained in low-income areas work in similar regions (P<.001). Most training and practice cities possess high-to-moderate SVI. Most graduates (66%) practice in moderately diverse areas and among those trained in highly diverse areas, and 55.8% continue to work there.

CONCLUSION:
MIGS graduates continue to practice in areas that are demographically similar to their training sites. Graduates tend to practice in larger cities and serve areas that possess moderate-to-high ethnic diversity and SVI, suggesting that diverse patients have access. Considering these trends, MIGS fellowship programs may have a larger responsibility to encourage practice in less-populated areas.
Eclampsia Management: Team Improvement Opportunities Identified in High-Fidelity Simulations [A48]
Authors: Crump Cade , Detlefs Sarah , Buttle Rae A. , Goffman Dena , Foley Michael R. , Deering Shad 
Published: June 2022

INTRODUCTION:
Eclampsia is an uncommon obstetric emergency that can have significant consequences for both the mother and fetus. The objective of this qualitative study was to evaluate team performance with high-fidelity simulation and attempt to identify areas where additional training may be indicated for the treatment of eclampsia.

METHODS:
Participants at a national critical care obstetrics course received morning didactic sessions after which they were divided into teams and then participated in high-fidelity simulations of obstetric emergencies including a case of severe hypertension and eclampsia. Facilitators completed standardized checklist assessments of medical management for each group's performance. Critical actions were documented, and pre-defined significant errors, such as attempting intubation or performing a cesarean section during the eclamptic seizure, were also tracked. Data regarding performance was evaluated with descriptive statistics. This study was determined to be exempt by the hospital’s institutional review board (IRB).

RESULTS:
A total of 170 teams had complete data available for the eclampsia simulations conducted between 2014-2019. Almost a quarter of the teams (23.6%) did not do a good job in protecting the patient (turning to side/putting bedrails up) during the seizure and 14.2% did not administer magnesium sulfate correctly (dose/duration of infusion). In addition, 11.2% did not continue magnesium for prophylaxis after the seizure and 10.6% also attempted to intubate the patient during the 2-minute eclamptic seizure.

CONCLUSION:
There were multiple areas of suboptimal performance identified during high-fidelity eclampsia simulation of a large number of obstetric provider care teams. Future training efforts should be focused on these specific deficits in order to improve performance.
Maximizing the Number of Providers Using Medication-Assisted Treatment for Opioid Use in Pregnancy [A50]
Authors: Chithiwala Zahabiya , Waetjen L. Elaine , Mitchell Keyon R. , Hedriana Herman , Clark Shannon 
Published: June 2022

INTRODUCTION:
To standardize and improve access to medication-assisted treatment (MAT) by X-waivered (XW) prescription and management of opioid use in pregnancy (OUP).

METHODS:
This quality improvement (QI) project standardized MAT training and management in two phases: 1) All faculty and resident physicians (FRPs) were invited to complete an 8-hour MAT training by a 4-hour group session followed by a 4-hour independent study. All FRPs were surveyed to assess completion and use of MAT. The goal was to increase MAT-trained providers from one to at least five. 2) OUP management algorithms were built and integrated into the prenatal clinic and labor and delivery protocols, and FRPs were educated on protocol use. Phase 1 was completed using the Plan-Do-Study-Act (PDSA) cycle. Phase 2 is currently ongoing.

RESULTS:
Sixty FRPs (78%) responded to the survey. Of the FRPs who responded, 25 completed the training. Eleven received XW and six (55%) FRPs successfully prescribed MAT for OUP. Additionally, a standardized treatment protocol was created and made available.

CONCLUSION:
With standardization, the numbers of FRPs using XW increased from one to 11 with 55% successfully prescribing MAT for OUP. Access to OUP care was improved with timely MAT prescription. With integration into residency orientation, we will increase the pool of XW-trained FRPs. Moving forward, all OUP care will follow the standard management algorithm.
The Psychological Impact of COVID-19 on Medical Students Interested in Obstetrics and Gynecology [A57]
Authors: Lin Jenny , Christophers Briana , Nieblas-Bedolla Edwin , Gordon-Elliott Janna S. , Holcomb Kevin , Frey Melissa K. 
Published: June 2022

INTRODUCTION:
The COVID-19 pandemic has caused mental health distress among health care professionals. This study aimed to evaluate the psychological impact of COVID-19 on medical students interested in obstetrics and gynecology at medical schools in two early epicenters of COVID-19.

METHODS:
This study was approved by the Weill Cornell Medicine Institutional Review Board. An online questionnaire was distributed to allopathic medical students in Washington and New York. The survey assessed mental health from March to April 2020 via the Patient Health Questionnaire, Generalized Anxiety Disorder Questionnaire, and questions on self-rated mental health.

RESULTS:
Out of 1,139 students who completed the survey, 63 reported a plan to pursue residency training in obstetrics and gynecology. Forty-six (74%) reported an overall deterioration in mental health, 34 (59%) reported depressive symptoms, and 38 (65%) reported anxiety symptoms. Seventeen (28%) students met criteria for major depressive disorder and 16 (27%) for anxiety disorder. Twenty-three (37%) reported at least one close contact with symptoms or diagnosis of COVID-19 and 7 (11%) reported at least one close contact with COVID-19-related death. Commonly cited self-care tactics included staying in touch with friends/family (92%), entertainment (81%), and fitness (65%). When compared to the overall population of students, there were no significant differences in responses for students interested in obstetrics and gynecology.

CONCLUSION:
Students in this study experienced high levels of depressive and anxiety symptoms. Medical trainees are already at an increased risk for depression and anxiety relative to the general population, making it critical for medical schools to understand students’ perspectives and prioritize mental health.
Multidisciplinary Education: Piloting an Unconscious Bias-Maternal Mortality Curriculum in Obstetrics [A63]
Authors: Bey Amita , Garrison Etoi , Li Andria N. , Mosley Dominique , Nettles Arie L. 
Published: June 2022

INTRODUCTION:
Racial and ethnic minority women are vulnerable to biases which can limit timely delivery and quality of care. Unconscious bias training (UCB) is recommended by the American College of Obstetricians and Gynecologists, the Council on Patient Safety, and the Tennessee Maternal Mortality Committee to potentially reduce provider bias and racial/ethnic health disparities.

METHODS:
We piloted a virtual 90-minute UCB-Maternal Mortality (MM) curriculum to empower obstetrics and gynecology providers to: (1) understand the science of unconscious bias, and (2) recognize racial/ethnic disparities in obstetrics. Utilizing didactic videos and small-group discussion, participants were expected to identify: (1) the role of bias in decision-making, and (2) equitable strategies to reduce disparate outcomes for women with preeclampsia. Pre- and-post-test surveys were used to assess knowledge regarding UCB-MM and intent to change current practices. Vanderbilt University Medical Center Institutional Review Board approval was obtained.

RESULTS:
Eleven workshops were conducted at four hospitals from May to July 2021. A total of 229 faculty/trainees, nurses, and staff attended workshops. Post-workshop survey respondents were significantly more likely to recognize a framework for mitigating bias (P=.0142). Ninety-seven percent of posttest respondents reported they will adopt/modify a strategy when communicating with patients from different cultures/backgrounds/languages after workshop completion. No significant differences in pre- and post-workshop knowledge regarding healthcare disparities in MM were identified. Protocol adherence, education, and patient follow-up were identified as strategies to reduce disparities during the management of preeclampsia.

CONCLUSION:
Further study is necessary to determine efficacy of the MM education delivered in the virtual curriculum. Additionally, follow-up surveys to assess impact on behavior and long-term knowledge retention are warranted.
Financial and Social Burdens Associated With Care at a Large Fetal Center [A69]
Authors: Gregory Emily , Abbasi Aleeza , Markham Kara B. 
Published: June 2022

INTRODUCTION:
The Fetal Center (FC) at the University of Cincinnati Medical Center provides comprehensive care for pregnancies complicated by fetal anomalies and genetic abnormalities. Many diagnoses require families to relocate to receive care. To date, no study has assessed the financial and social burdens upon patients’ ability to comply with care recommendations.

METHODS:
An anonymous survey was sent via email to patients who received care at our FC from 2015-2021. The survey included questions regarding demographics, fetal diagnoses, and non-medical expenses related to care.

RESULTS:
Three of every five patients reported traveling >100 miles to our FC (58.3%, 95% CI 53.7-62.8), with one out of every five reporting travel of >300 miles (20%, 95% CI 16.5-23.9). Although one in four patients only attended one visit (27.4%, 95% CI 23.2-32.1), one-third traveled >10 times for care (33.6%, 95% CI 29.1-38.4). Also, 37.1% (95% CI 31.9-42.5) of patients received a recommendation to temporarily relocate nearer to our FC for continued prenatal, delivery, and neonatal care. Nearly half of patients reported significant non-medical expenditures exceeding $1000 (42.6%, 95% CI 37.7-47.6), with one in 10 reporting expenditures of >$5000 (8.6%, 95% CI 32-37.6). Overall, 38.2% (95% CI 33.5-43.1) reported moderate to severe financial burdens related to FC care.

CONCLUSION:
This study illuminates the socioeconomic burdens that care at a tertiary referral center imposes on families. Although regionalization of FC is associated with improved outcomes for certain fetal/neonatal conditions, the non-medical burden of this specialized care should be acknowledged so we can strive to provide equitable access to high-quality fetal care services to all in need.