bluuebunny/crossref_metadata_2025_split huggingface dataset:
Satisfaction With Levonorgestrel-Releasing Intrauterine System 12 in North American Women: Findings From the Real-World Kyleena Satisfaction Study [A14]
Authors: Hauck Brian , Baisden Kristie W. , Frenz Ann-Kathrin , Aqua Keith 
Published: June 2022

INTRODUCTION:
The real-world Kyleena Satisfaction Study (KYSS) confirmed clinical findings that the levonorgestrel-releasing intrauterine system (LNG-IUS) 12 (Kyleena) is associated with high satisfaction and continuation rates. We report results from North American KYSS participants.

METHODS:
This observational, multinational, multicenter, single-arm cohort study was conducted from 2017 to 2018. All centers obtained institutional review board approval. Women who independently elected to use LNG-IUS 12 were enrolled. KYSS assessed LNG-IUS 12 satisfaction, continuation, and safety.

RESULTS:
LNG-IUS 12 was successfully placed in 99/99 Canadian and 99/100 US women. Clinicians rated placement “easy” in 88 (89%) Canadian and 90 (90%) US women. Sixty-seven (67) (68%) Canadian and 72 (72%) US women rated placement pain as none/mild. For Canadian women, mean age was 24.2±7.0 years and 87/99 (88%) were nulliparous, compared with 26.4±7.3 years and 71/99 (72%) for US women. Motivations for choosing LNG-IUS 12 were most commonly “no need for a contraceptive routine” (31/99 [31%] Canadian and 49/99 [50%] US women) and “high contraceptive reliability” (34/99 [34%] and 23/99 [23%], respectively). At 12 months/premature discontinuation, 69/75 (92%) Canadian and 83/89 (93%) US women reported being very/somewhat satisfied with LNG-IUS 12; 49/74 (66%) Canadian and 64/80 (80%) US women were satisfied with their menstrual bleeding profile. The 12-month continuation rate was 74% (73/99) for Canadian and 82% (82/100) for US women. Most discontinuations were due to loss to follow-up (16/99 [16%] and 7/100 [7%], respectively) or treatment-emergent adverse events (10/99 [10%] and 8/100 [8%], respectively).

CONCLUSION:
Results from North American KYSS participants demonstrate high satisfaction and continuation including among young and nulliparous women.
Effects of the COVID-19 Pandemic on Contraceptive Access at Planned Parenthood of Illinois [A16]
Authors: Young Danielle , Schumm L. Philip , McHugh Ashley , Whitaker Amy K. , Stulberg Debra 
Published: June 2022

INTRODUCTION:
Prior to the COVID-19 pandemic, Planned Parenthood of Illinois (PPIL) provided in-clinic contraceptive services to over 10,000 patients/year. At pandemic onset, PPIL rapidly consolidated services to six health centers and launched telehealth. This study aims to understand the disruptions of the pandemic on contraceptive access and to understand the impact of telehealth as measured by changes in time to appointment and method mix.

METHODS:
Retrospective contraceptive service delivery data were analyzed before (March 2019–March 2020) and during (March–October 2020) the pandemic. Time to appointment was defined as days from date appointment was made to originally scheduled appointment date. Method mix was dichotomized as pill/patch/ring or long-acting reversible contraception (LARC). Other methods were excluded. Descriptive and comparative statistics were generated. Institutional review board approval was received from the University of Chicago.

RESULTS:
Before the pandemic, median (IQR) time to in-clinic appointment was 5 (2-9) days compared to 11 (5-15) days during the pandemic. Median time to telehealth appointment was 4 (2-8) days. During the pandemic, 6,615 patients received contraceptive services, 1,701 through telehealth and 4,914 in-clinic, with 91.9% choosing pill/patch/ring or LARC methods. When dichotomized, method mix slightly changed with 57.0% of patients, pre-pandemic, choosing pill/patch/ring methods compared to 54.9% patients during the pandemic (P=.006). During the pandemic, 41.4% of pill/patch/ring visits were through telehealth and 58.6% through in-clinic visit.

CONCLUSION:
Telehealth appointments were available sooner than in-clinic visits and uptake of telehealth visits for patients obtaining pill/patch/ring was substantial. The small change in method mix is likely not clinically significant.
Postmarketing Safety of a Levonorgestrel/Ethinyl Estradiol Contraceptive Transdermal Delivery System [A24]
Authors: Kroll Robin , Chiodo Joseph , Previtera Michelle , Korner Paul , Kaunitz Andrew M. , Teixeira Beata 
Published: June 2022

INTRODUCTION:
TWIRLA is a low-dose contraceptive transdermal delivery system of 120 µg/day levonorgestrel and 30 µg/day ethinyl estradiol (LNG/EE TDS) used in a 28-day cycle. It was approved by the US Food and Drug Administration in February 2020 as a method of contraception for use in women of reproductive potential with a body mass index (BMI) <30 kg/m2. The phase 3 SECURE study showed an acceptable safety profile for the LNG/EE TDS in a clinical trial setting. This assessment provides an update of LNG/EE TDS safety based on real-world postmarketing adverse event reporting.

METHODS:
Data collected from LNG/EE TDS standard postmarketing reporting during December 2020 through September 2021 were assessed and describe serious adverse events (SAEs) to date, including venous thromboembolism (VTE, an event of special interest), and the number of patients who received replacements in a patch-replacement program.

RESULTS:
Approximately 14,600 prescriptions for the LNG/EE TDS were dispensed during this postmarketing period, with additional patches dispensed as samples. No VTEs were reported. Two SAEs (one case each of suicidal ideation and loss of consciousness) were reported; based on spontaneous reporting, no new safety issues were identified. Reports of TDS adhesion issues were rare; only 11 individuals received a replacement over the 10-month period.

CONCLUSION:
In this assessment of real-world usage of the LNG/EE TDS, SAEs and TDS replacements were infrequent and no VTEs were reported. These findings are consistent with the safety profile reported in the SECURE study, where four patients with VTEs were identified, all in women with a BMI >30 kg/m2.
Clinical Outcomes of Incidental, Postplacental Intrauterine Device Placement in the Setting of Chorioamnionitis [A26]
Authors: Bayard Katherine E. , Fabricant Sonya , White Jessica D. , Gordon Brian , Nguyen Brian T. 
Published: June 2022

INTRODUCTION:
This case-control study reviews complications and contraceptive outcomes following incidental, immediate post-placental intrauterine device (IUD) placement in the setting of chorioamnionitis (CDC contraindication category 4), versus waiting to receive an interval IUD per standard guidelines.

METHODS:
We conducted an institutional review board (IRB)-compliant retrospective chart review of individuals delivering an infant and desiring an IUD for postpartum contraception in the setting of chorioamnionitis (2015-2020). We collected demographics, histopathologic confirmation of chorioamnionitis, timing of IUD placement, duration of use, short term outcomes/complications (e.g., worsening infection), and long-term outcomes/complications (e.g., IUD retention, IUD expulsion, pelvic inflammatory disease). Data were compared between individuals receiving post-placental IUDs and those waiting to receive outpatient, interval IUDs. We conducted phone interviews to validate and follow-up on medical record data.

RESULTS:
Fifty-five individuals with chorioamnionitis desired an IUD for postpartum contraception (mean age: 27 years, gestational age at delivery: 39 weeks); 25% provided phone interviews. Nearly half (45%) of clinician-diagnosed chorioamnionitis was confirmed on histopathology. Among IUD recipients (22 post-placental, 10 interval), four re-presented with five complaints (one vaginal discharge, three pelvic pain, one IUD malposition). Incidence of re-presentation did not differ by timing (P=.77) or presence (P=.91) of IUD. Individuals who received a post-placental IUD were significantly more likely (P<.01) to have their IUD in place at 12 months than those intending to receive a post-partum interval IUD.

CONCLUSION:
No severe complications occurred among individuals receiving a post-placental IUD in the setting of chorioamnionitis. Recipients of immediate versus interval IUDs were more likely to have an IUD at 1 year follow-up.
Awareness of the Maternal Health Benefits of Lactation Among US Pregnant Women [A30]
Authors: Iwuagwu Caidon , Chen Melissa J. , Hoyt-Austin Adrienne E. , Kair Laura R. , Fix Margaret , Schwarz Eleanor Bimla 
Published: June 2022

INTRODUCTION:
Rates of breastfeeding in the US remain suboptimal. Public health campaigns encouraging breastfeeding have focused on health benefits for infants, despite over 60 years of data demonstrating breastfeeding reduces maternal risk of breast cancer with more recent data indicating breastfeeding lowers maternal risk of ovarian cancer, diabetes, hypertension and heart disease.

METHODS:
To assess awareness of the effects of lactation on maternal health, we used social media to recruit a prospective cohort of US-born nulliparous women carrying a singleton pregnancy of 28+ weeks’ gestation in 2021. Participants were compensated a $20 gift card for completing an online survey. Institutional review board (IRB) approval was obtained.

RESULTS:
Of 152 respondents, a family history of breast cancer (9%), diabetes (23%), hypertension (26%), and heart disease (9%) was reported by some; fewer (5%) were diagnosed with gestational diabetes or a hypertensive disorder of pregnancy (2%), and 76% were college educated. Most respondents were aware that breastfeeding benefits infant health; 23% strongly (and 42% somewhat) felt that breastfed babies are healthier than formula fed babies. Most (91%) believed breastfeeding will save their family money. Most strongly (67%) or somewhat (23%) agreed that breastfeeding their baby was important. However, fewer than half were aware that breastfeeding lowers maternal risk of breast cancer (47%), ovarian cancer (32%), diabetes (25%), and hypertension or heart disease (28%).

CONCLUSION:
Few US pregnant women are aware of the maternal health benefits of breastfeeding. Counseling pregnant women about the beneficial effects of lactation on maternal, in addition to infant, health may help increase breastfeeding rates.
Operationalizing the Hyde Amendment at Federally Funded Health Care Centers [A40]
Authors: Glaser Katherine , Karlin Jennifer , Schwarz Eleanor Bimla 
Published: June 2022

INTRODUCTION:
The Hyde Amendment restricts federal funding for abortion in the US. Currently, federal funding for abortion is only allowed in cases of rape, incest, or a threat to the woman’s life.

METHODS:
To understand how clinicians in federally funded settings care for patients who qualify for abortion permitted by the Hyde Amendment, we conducted semi-structured interviews with 17 clinicians [obstetrician-gynecologists (n=12), family physicians (n=2), and certified nurse midwives (n=3)] practicing in four states, including some that provide state funding for abortion (n=3).

RESULTS:
Most respondents stated there was no way they knew of to operationalize federally funded abortion care in their clinical setting in cases of rape, incest, or a threat to the woman’s life. Most clinicians described having referred patients to freestanding abortion clinics with the expectation that the patient would pay out of pocket or receive state-funded abortion care, despite the theoretical commitment to federal funding for such services; as one clinician stated, “…[we’re] kind of compounding trauma, you know, when you’re saying, ‘Okay, you have to go really far to receive the abortion…’.” Only one clinician described working at a federally funded health center that had a policy in place that allowed prompt delivery of permitted abortion care when needed.

CONCLUSION:
Even in cases of rape, incest, or a threat to the woman’s life, few patients are able to access federal funding for abortion services in settings without state funding for abortion. Efforts are needed to ensure equitable access to compassionate and timely care for these vulnerable patients.
The Impact of X-Waiver Training Within Obstetrics and Gynecology Residency Programs on Improving Access to Medication-Assisted Treatment in Pregnancy [A51]
Authors: Frazier La-Tisha , Fields Reagen , Tuller Molly , Eskridge Jessica , Miller Edward E. 
Published: June 2022

INTRODUCTION:
The opioid epidemic is a crisis within the country, with 136 Americans dying daily from opioid overdose. One of the hardest hit areas is the Appalachian region. Despite medication-assisted treatment (MAT) with methadone or buprenorphine being considered standard of care, studies find that pregnant women in this region face significant barriers to receiving this lifesaving treatment from both insurers and providers. While the number of providers in the country with X-waivers has increased dramatically, the availability of providers willing to prescribe in pregnancy is disproportionate to the severity of the epidemic.

METHODS:
We surveyed 91 obstetrics and gynecology residency programs within Appalachian states to assess if X-waiver training was a part of their residency training. We then collected the geographic locations of program graduates from 2016 to 2021 to assess the impact that this training could have provided to the region.

RESULTS:
Despite working in regions disproportionately impacted by the opioid epidemic, the majority of obstetrics and gynecology residency programs do not provide X-waiver training to their residents. Many residents who train in residency programs located in the Appalachian regions work/have worked in the region after graduation. Our results will be displayed graphically along with mapping illustrations.

CONCLUSION:
Residents of the Appalachian region face barriers accessing adequate health care. This disparity is more prevalent among pregnant women. Coordinated efforts by obstetrics and gynecology residency programs to allow access to X-waiver licensure among residents in training could make a significant impact by improving access to MAT among pregnant women and lead to improved maternal and fetal outcomes.
An Implementation Project to Expand Access to Teledoulas for Abortion Patients [A52]
Authors: Shapiro Marit Pearlman , Termulo Kara , McAllaster Sara , Raidoo Shandhini 
Published: June 2022

INTRODUCTION:
The purpose of this study was to describe the implementation and results of a patient outreach project to offer teledoula services to patients choosing medication abortion in Hawai’i during the COVID-19 pandemic.

METHODS:
We trained medical student volunteers at John A. Burns School of Medicine (JABSOM) as abortion teledoulas to remotely provide emotional support, education, pain management, and self-advocacy. We offered teledoula services to pregnant patients presenting for medication abortion either in person or via telemedicine appointment at a university-based, outpatient family planning clinic. The teledoulas were notified by the abortion provider when a patient was interested in the service and the assigned teledoula contacted the patient by phone or text message. We conducted initial training and outreach in February 2021 and recorded completed pairings of teledoulas and patients through July 2021. Institutional review board (IRB) committee approval was waived for the study.

RESULTS:
Of the 15 medical students who attended the teledoula training, 12 (80%) were interested in participating. Of the interested medical students, 100% successfully paired with patients for support. Of the 194 patients who had a medication abortion in the 5 months that this service was offered, 37 (19.1%) were interested in participating in the program and all were contacted by a teledoula via text message. Thirty-three (89%) patients responded to the text message and successfully connected with a teledoula for support during their medication abortion.

CONCLUSION:
A teledoula service staffed by medical student volunteers can be successfully implemented and provide remote support for patients choosing medication abortion during the COVID-19 pandemic.
Experiences of Inappropriate, Disrespectful, or Coercive Health Care: A Study of University Women [A71]
Authors: Hess Andrea , Loder Charisse , Kalpakjian Claire , Munro-Kramer Michelle L. , Ernst Susan 
Published: June 2022

INTRODUCTION:
A number of prominent cases involving sexual misconduct among university-affiliated physicians reveal the need to assess inappropriate, disrespectful, or coercive (IDC) health care experienced by university students.

METHODS:
We surveyed students at one public university to gather information about their positive and negative experiences while receiving health care. Survey items included questions about respect for the participant’s identity (race, gender, sexual identity) and whether IDC occurred during health care provision. Items queried about experiences with sensitive exams or exams involving the breast, genitals, or rectum.

RESULTS:
Survey respondents (n=2495) had a mean age of 23 years, identified as female or trans-male, and had experienced at least five relevant health care interactions (76%). Most respondents reported that their needs were accommodated (99%) and their provider made sure they understood their care (98%). However, respondents felt judged about sexual behavior (52%), experienced sexist comments (42%), reported unwanted attention (29%) or advances (23%), and experienced personal calls (1%) from their provider. During sensitive exams, respondents reported that they waited too long while undressed (26%) and were not provided a gown or drape (5%). Alarmingly, respondents reported that sensitive exams were performed without gloves (2%) and experienced inappropriate touch (1%). Finally, 62% stated that they did not know how to report a concern about a provider.

CONCLUSION:
University students are vulnerable to IDC health care experiences and lack comfort with reporting concerns. These negative experiences reveal the need to improve health professional education, including robust training in cultural safety, professionalism, and trauma-informed care, and to create transparent reporting mechanisms.
Trends in Surgeon Subspecialty and Surgical Indications for Vaginal Hysterectomy [A75]
Authors: Hong Christopher X. , Kim Edward K. , White Joseph , Harvie Heidi 
Published: June 2022

INTRODUCTION:
Although the American College of Obstetricians and Gynecologists recommends vaginal hysterectomy (VH) as the preferred approach for benign hysterectomy whenever feasible, the number of VH performed is declining in the US. Our objective was to describe trends in gynecologic surgeon subspecialty and surgical indications for patients who underwent vaginal hysterectomy between 2015-2019.

METHODS:
Institutional review board approval was waived for this study of patients who underwent VH for benign indications between 2015-2019 in the American College of Surgeons’ National Surgical Quality Improvement Program database. Patients were identified using current procedural terminology (CPT) codes. To analyze trends over time, two cohorts were compared: VH surgeries between 2015-2017 versus 2018-2019.

RESULTS:
Of 122,457 benign hysterectomies captured, 18,262 (14.9%) were VH. The proportion of VH decreased from 15.8% during 2015-2017 to 14.0% during 2018-2019 (P 05 for all).

CONCLUSION:
Trends in surgeon subspecialty and surgical indications for vaginal hysterectomy are important to consider in addressing the shift away from VH, as they may have implications for patient outcomes and surgical education.
Management of Cesarean Scar Ectopic Pregnancies at an Academic Referral Center [A82]
Authors: Wu Brenda T. , Feld Zoe M. , Creinin Mitchell D. 
Published: June 2022

INTRODUCTION:
Cesarean scar ectopic pregnancies (CS-EP) represent less than 1% of ectopic pregnancies and are associated with significant morbidity when undiagnosed. Currently, no standard of care exists for optimal management.

METHODS:
We reviewed our de-identified family planning clinical database for patients seen by our subspecialty service for CS-EP from 7/2017-6/2021 as a quality assurance project. We extracted referral date, final diagnosis, management, and outcome information.

RESULTS:
Of 47 patients referred for suspected CS-EPs, 16 (34%) had a confirmed diagnosis with eight less than and eight greater than 50 days gestation (range 39-58 days). Most (n=40[85%]) referrals occurred in the last 2 years of the 4-year study period. We treated all eight patients less than 50 days primarily with suction aspiration under ultrasound guidance with no complications and estimated blood loss (EBL) of 17±11mL. The eight patients greater than 50 days included six managed with primary aspiration, of which four were uncomplicated, one required intrauterine Foley balloon (EBL 200 mL), and one had uterine perforation and exploratory laparotomy (EBL 250 mL). Two patients primarily received systemic methotrexate with aspiration after significant hCG decline, one uncomplicated and one requiring intrauterine Foley balloon (EBL 250mL). One patient (57 days) had attempted intrauterine double-catheter balloon for primary treatment with immediate hemorrhage requiring uterine artery embolization followed by an uncomplicated suction aspiration.

CONCLUSION:
Patients with confirmed CS-EPs at less than 50 days gestation can be primarily treated with suction aspiration with low risk for significant adverse outcomes. CS-EPs of greater than 50 days gestation are more likely to have complicated outcomes.
Effect of Age on Gynecologic Patients’ Use of Social Media for Women’s Health Information [A84]
Authors: Avis Emily , Sundaram Padmaja , Flink-Bochacki Rachel , Bringley Johanna 
Published: June 2022

INTRODUCTION:
Over the last decade, social media platforms have become a major source of health information. We aimed to determine prevalence of social media usage for women’s health information, timing of usage, and perceived benefit among general gynecologic patients.

METHODS:
We performed a cross-sectional study of patients presenting to one US academic gynecology clinic, distributing an anonymous 15-question survey over a 3-week period in spring 2021. The Albany Medical Center Institutional Review Board determined this study to be exempt. We calculated descriptive statistics and used chi-square testing to compare patients of reproductive age (< 50 years) and non-reproductive age (≥50 years).

RESULTS:
Of 377 who completed the survey (91.3% response rate), 259 (68.7%) were reproductive aged and 333 (88.3%) used social media. Most respondents use social media to learn about women’s health (57.0%), believe women’s health information should be available on social media (92.4%), and find social media helpful in making health decisions (58.5%), without differences by age group. Older patients are more likely than their reproductive-aged counterparts to actively search for women’s health information rather than passively finding it on a feed (52.2% vs. 36.8%, P=.024), to use social media for health information specifically around doctor’s visits (52.8% vs. 28.6%, P<.001), and to only trust health information from medical professionals rather than non-medical individuals (85.5% vs. 71.6%, P=.015).

CONCLUSION:
Social media is ubiquitous, with different usage patterns by patient age. Understanding how different groups find and determine trustworthiness of health information on social media can facilitate creation of accessible, medically accurate, and patient-friendly content.