bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreasing Racial Disparity in Unexpected Complications of Term Newborns (Perinatal Core Measure 06) [A264]
Authors: Katz Chelsea , Hewlett Guy , Santangelo Alexander , Perry Robin 
Published: June 2022

INTRODUCTION:
With a national push to decrease cesarean delivery rates, Perinatal Core Measure 06 (PC-06), which measures unexpected complications of term newborns, has become an important balancing metric. The purpose of this quality intervention was to lower PC-06 rates and mitigate racial disparity.

METHODS:
Quality metric review revealed an elevated baseline PC-06 rate of 4.29% (43/1002). The rate in White women was 2.15% (6/279), in African American women 5.42% (15/277), and in Hispanic women 5.44% (18/331). Non-White patients had a higher risk of PC-06 relative to White patients (odds ratio [OR], 2.52; 95% CI, 1.04–6.09). After in-depth review of all cases, management of abnormal fetal heart rate (FHR) tracing was identified as a contributing factor in a significant proportion of cases. Consequently, a multidisciplinary group developed the following quality interventions: 1. A note template to standardize real-time documentation of FHR interpretation; 2. Standardized process of timing and indications for documenting a FHR note; 3. Set time limits for observing category 2 FHR tracings. All clinical team members were educated regarding these quality interventions.

RESULTS:
The post-intervention PC-06 rate significantly declined from baseline to 2.26% (19/840, P=.020). The rate in White women declined to 1.53% (4/261, P=.75), in African American women to 3.13% (7/224, P=.277), and in Hispanic women to 1.57% (4/255, P=.026). Following the intervention, there is no longer a racial disparity at the 95% CI level (OR, 1.5; 95% CI, 0.47–4.75).

CONCLUSION:
Applying this standardized approach led to an improvement in outcomes for all patients and a narrowing of the racial disparity previously seen.
Association of 12-Month Contraceptive Supply Policy and Months of Contraception Prescribed by Obstetrician-Gynecologist Physicians [A01]
Authors: Fuerst Megan , Schrote Kaitlin , Garg Bharti , Rodriguez Maria 
Published: June 2022

INTRODUCTION:
Seventeen US states have passed legislation requiring insurers to cover dispensation of a full 12-month supply of contraception prescribed at a single time. Such policies are linked to improved contraception continuation and reductions in unintended pregnancy. This study sought to determine if there was a difference in the months of oral contraception prescribed by physicians living in US states with a 12-month supply policy compared to physicians in states without a policy.

METHODS:
We conducted an exploratory descriptive study using a convenience sample of obstetrics and gynecology resident physicians (n=275) in the United States. Standard bivariate analyses were used to compare the difference between groups and describe the overall prescribing habits of physicians. The study was approved by the institutional review board at Oregon Health & Science University.

RESULTS:
Of the 275 respondents, 48% resided in a state with a policy requiring insurance coverage of a 12-month supply of contraception and 52% resided in states without such a policy. Few physicians in both groups (3.8% with a policy and 1.4% without a policy) routinely prescribed a 12-month supply of contraception. The mean coverage prescribed by providers in states with and without a policy was 2.81 and 2.07 months (P<.05).

CONCLUSION:
The majority of physicians were unaware of 12-month contraceptive supply policies and unable to correctly write a prescription for 12 months of contraception. Physician education may be needed to effectively implement 12-month contraceptive supply policies and meaningfully impact contraception access.
Contraceptive Congruence: A Novel Measure of Contraceptive Use that Acknowledges Pregnancy Ambivalence [A06]
Authors: Nelson Hallie , Weisman Carol S. , Lehman Erik , Chuang Cynthia H. 
Published: June 2022

INTRODUCTION:
Aligned with the bias that highly effective long acting reversible contraception (LARC) should be first-line for all women not intending pregnancy, historic measures emphasized contraceptive effectiveness. We propose an alternative measure, contraceptive congruence, which acknowledges pregnancy ambivalence by describing whether a method is aligned with individual attitudes about getting pregnant, specifically how important it is to avoid pregnancy and how pleased/upset she would be if pregnant.

METHODS:
Among 984 women not intending pregnancy in the next year, contraceptive congruence was defined as a three-level variable describing whether a woman’s current contraceptive method was very congruent, somewhat congruent, or incongruent with her pregnancy attitudes. If a woman was ambivalent about pregnancy, she was very congruent at a lower tier of contraceptive efficacy than someone very upset and importantly avoiding pregnancy. Patient-level variables were examined using chi-square analysis for associations with contraceptive congruence.

RESULTS:
Contraceptive methods included LARCs (8%), hormonal methods (50%), barrier methods (30%), or no method (12%). Methods for 43% of women were very congruent, 39% somewhat congruent, and 18% incongruent with attitudes about becoming pregnant. Therefore, many women were using methods that were aligned with their pregnancy attitudes. Predictors of contraceptive congruence included age, marriage, non-Hispanic white ethnicity, full-time employment, and higher income.

CONCLUSION:
By including individual attitudes about getting pregnant, contraceptive congruence acknowledges pregnancy ambivalence, which is missing when categorizing contraceptive methods by strictly effectiveness alone. Future research and clinical care that acknowledge pregnancy ambivalence will more closely align with actual complex attitudes that affect individual contraceptive behavior.
Telehealth Follow-up After Medical Management for Early Pregnancy Loss [A07]
Authors: Chen Jessica , Nijim Sally , Flynn Anne N. , Sonalkar Sarita , Schreiber Courtney A. , Roe Andrea H. 
Published: June 2022

INTRODUCTION:
Remote follow-up protocols after medical abortion (MAB) are evidence-based, but telehealth follow-up after medical management of early pregnancy loss (EPL) has not been investigated. In this study, we compare feasibility of remote follow-up for EPL to remote follow-up for MAB.

METHODS:
We conducted a retrospective cohort study of patients initiating medical management of EPL up to 12 weeks and 6 days and MAB up to 9 weeks and 6 days with mifepristone 200 mg orally followed by misoprostol 800 mcg vaginally between April 1 and October 17, 2020. Patients were routinely scheduled for telehealth follow-up in 1 week and home urine pregnancy test in 4 weeks. Our primary outcome was feasibility of telehealth follow-up for EPL compared with MAB patients, defined by successful follow-up per clinical protocol. Exploratory outcomes included comparative effectiveness and safety.

RESULTS:
Ninety patients (40 EPL, 50 MAB) were eligible for inclusion. The median gestational age was 7 weeks and 3 days for patients with EPL and 7 weeks and 0 days for patients undergoing MAB. Of patients eligible for telehealth follow-up, 17/19 (89%) with EPL and 28/30 (93%) undergoing MAB successfully followed up per protocol (P=.63). Telehealth assessments were consistent with completed abortion in 13/17 (76%) patients with EPL and 24/28 (86%) patients undergoing MAB (P=.43). All (4/4) of EPL and 4/5 of MAB patients for whom a clinic visit was subsequently recommended completed this visit. Of these, 1/4 with EPL and 2/4 undergoing MAB required uterine aspiration. Among those with telehealth assessments consistent with completed abortion, neither group had documented complications within 30 days.

CONCLUSION:
Telehealth follow-up is a feasible alternative to in-person assessment after medical management of EPL.
Patient Perspectives on Web-Based Access to Contraceptive Options [A23]
Authors: Madan Upasana , Lee Danielle , Brandi Kristyn , Norin Jorden L. 
Published: June 2022

INTRODUCTION:
Online-based applications have provided patients with an additional method of obtaining short-acting hormonal contraception and reduced barriers to contraceptive care. This study aims to assess patient perspectives on online methods of obtaining birth control and to explore barriers to obtaining contraception through traditional means.

METHODS:
We conducted a single-site cross-sectional survey study to assess the perspectives of reproductive-age females on web-based sources for contraception. Univariate analysis of raw data was performed and frequency distributions for survey items were determined. This study was approved by the institutional review board.

RESULTS:
We had 96 English-speaking, reproductive-age women recruited from the waiting room of an urban obstetrics and gynecology clinic. Of survey respondents, 34.4% knew that prescriptions for birth control are available online, while only 4.4% have ever obtained birth control online and 3.3% currently get their birth control through online methods. Top barriers to obtaining contraception via doctors’ offices included time off from work/school (49.4%), flexible appointment scheduling (33.8%), and finding childcare (27.3%). One-fourth of participants reported that they delayed getting birth control from a doctor’s office due to concerns related to COVID-19. Many (85.1%) would return for other obstetrics and gynecology care if they had access to contraception online. After learning about online methods of obtaining short acting contraceptives, 49.26% of respondents agreed or strongly agreed that they would use them instead of getting birth control from an office visit.

CONCLUSION:
Although patient knowledge and use of online contraceptive methods remain limited, patients are receptive to trying web-based contraceptive options, which may reduce barriers associated with traditional contraceptive care.
The Effects of the Etonogestrel Subdermal Implant on Weight Gain in Obese Women [A34]
Authors: Hatch Cherise , Young Amanda , Gray Celia M. , Paglia Michael J. , Howard Denise 
Published: June 2022

INTRODUCTION:
To evaluate weight change after insertion of the etonogestrel subdermal implant (EI) in normal/underweight, overweight, and obese women.

METHODS:
This is a retrospective cohort study in a large health system which examined the weight changes in women using the EI from January 1, 2010–December 31, 2019. Data were obtained using the system’s electronic health records. Subjects were grouped by body mass index (BMI) class with weights (kg) obtained at regular intervals until removal. A test of trend analysis was completed to evaluate for significant weight changes as BMI class increased.

RESULTS:
The cohort included 3,497 women, of whom 34% were normal/underweight, 24% were overweight, and 42% were obese. The median time from insertion of the EI to removal was 1.7 years and there was no significant difference between time to removal for any BMI class. At the time of removal, there was no significant trend in weight change as BMI class increased. For the women who kept the EI for 3 years, the median weight change (interquartile range) per BMI class was: normal/underweight 3.2 kg (-0.5, 6.4), overweight 5.2 kg (-0.5, 9.3), class I obese 5.7 kg (0.2, 10.7), class II obese 9.1 kg (2.3, 13.6), and class III 5.0 kg (-2.3, 13.2).

CONCLUSION:
There was no trend in weight change after placement of the EI as BMI class increased. The greatest increase in weight occurred in the class II group at 3 years. This information will be useful in counseling obese women about the EI when discussing contraceptive options.
An Interactive Curriculum Increases Confidence in Identification and Management of Gynecologic Office Emergencies [A55]
Authors: Maciejko Laura , Cope Adela , Bell Shannon L. , Scheib Stacey A. , Galhotra Sheena , Green Isabel 
Published: June 2022

INTRODUCTION:
Emergencies during gynecologic office procedures are uncommon. However, knowledge in management of these complications is essential as more gynecologic procedures move from the operating room to the office. Our goal was to develop an interactive curriculum to address a gap in residency training in the management of office-based procedural emergencies.

METHODS:
A curriculum including management of unanticipated bleeding, anaphylaxis, vasovagal response, and local anesthetic systemic toxicity (LAST) was developed and implemented using a combination of simulated patient sessions, a “choose-your-own-adventure” PowerPoint, and a mock oral board session. Pre and post intervention surveys queried participants’ confidence in recognition and management. The curriculum was delivered as in-person simulation sessions or virtual sessions due to COVID restrictions. Institutional review board (IRB) approval was obtained. Mean pre and post intervention scores were compared using paired t-test.

RESULTS:
Four accredited obstetrics and gynecology residency programs participated. Twenty-nine trainees completed the curriculum, and 24 submitted pre and post surveys (82.8% response rate). There was significant improvement in confidence scores for management of unanticipated bleeding (mean difference 0.96, P<.001), anaphylaxis (mean difference 1.7, P<.001), vasovagal response (mean difference 1.0, P<.001), and LAST (mean difference 2.5, P<.001). Additionally, significant improvement in confidence scores for identification of risk factors and signs/symptoms of vasovagal response (mean difference 0.96, P<.001, and 0.46, P=.005) and LAST (mean difference 2.3, P<.001, and 2.2, P<.001) was noted.

CONCLUSION:
Implementation of an office emergencies curriculum significantly increased confidence in identification and management of unanticipated bleeding, anaphylaxis, vasovagal response, and LAST. Future studies evaluating knowledge-based assessments of learners are needed.
Presentation to Publication: Analysis of Departmental Research Funding and Trainee Research Productivity [A61]
Authors: Ellett Tressa , Truong Tracy , Murtha Amy , Havrilesky Laura , Davidson Brittany 
Published: June 2022

INTRODUCTION:
Conducting research is critical to the development of physician scientists; the authors’ obstetrics and gynecology department requires each resident to conduct an original research project that is then presented during an annual trainee Research Day (RD). A department research fund (DRF) was implemented in 2008 and a formal research curriculum subsequently implemented in effort to foster trainee academic success. This analysis explores associations between trainee DRF funding, peer-reviewed publication, and future National Institutes of Health (NIH) funding at a single academic institution over a 32-year period.

METHODS:
RD project titles and funding status were compiled from a single academic obstetrics and gynecology department from 1989-2020. Significant milestones were the DRF (2008) and implementation of a formal research curriculum (2017). Outcomes were peer-reviewed publication of the RD project within 5 years of RD presentation and subsequent NIH funding of the trainee. Chi-squared tests were used to investigate these relationships.

RESULTS:
Among 361 obstetrics and gynecology trainee (238 resident and 123 fellow) research projects presented at RD between 1989-2020, 169/361(46.8%) were peer-review published. Any funding of an RD project was associated with increased publication rate across the study period (85.9% versus 32%; P<.01). DRF-funded projects were also more likely to be published within 5 years (78.6% versus 57.7%; P=.03). DRF recipients were more likely to garner future NIH funding than non-recipients (37.9% versus 6.5%; P<.001).

CONCLUSION:
Trainee receipt of DRF funding is associated with both future NIH funding and trainee research publication. Program leaders may consider a formal research curriculum and a DRF to enhance the trainee research experience.
Tagged: The Use of Social Media in the Recruitment of Obstetrics and Gynecology Residents, Pre- and Post-pandemic [A62]
Authors: Haller Jasmine , Ghareeb Allen , Morales Pedro 
Published: June 2022

INTRODUCTION:
As the residency application process adapts, social media may provide insight to the community behind a residency program. No studies have assessed applicant’s perception of the utility of social media as a tool during the pursuit for their match into obstetrics and gynecology residency.

METHODS:
Applicants who interviewed at a single academic institution during the 2019-2020 and 2020-2021 interview seasons completed an anonymous online survey. Responses were analyzed using chi-squared and Mann-Whitney statistical analysis.

RESULTS:
The survey response rate was 64.6% (n=45) of 65 applicants in 2019 and 80% (n=48) of 60 applicants in 2020 who interviewed at this institution. All applicants reported using some type of social media, with Facebook and Instagram being the most utilized. Social media was used to learn about residency programs significantly more in 2020 (P=.001). Applicants used social media significantly more to look up programs prior to applying/interviewing at that institution in 2020 (P=.000). Applicant perception of a program was felt to be significantly impacted by social media presence in 36% (n=15) of those surveyed in 2019, compared to 60% (n=29) in 2020 (P=.031). Significantly more applicants felt that a residency program social media presence was an important recruitment strategy in 2020 compared to 2019 (P=.006). The virtual match increased applicant uses of social media in the application process in 80% of respondents (n=38).

CONCLUSION:
Social media is a novel and essential tool for residency programs to showcase their culture. Our study highlights the utility of social media for resident applicant recruitment in the ever changing post-pandemic application milieu.
Resident Research Mentoring Teams: A Support Program to Increase Resident Research Productivity [A64]
Authors: Haas David , Haas Bachar M. , Haas Nicole M. , Shanks Anthony , Rojas Mirian Ramirez 
Published: June 2022

INTRODUCTION:
Inspiring, supporting, and disseminating resident scholarly activity can be difficult for residency programs. In an effort to stimulate more resident and faculty engagement in the research process, we developed resident research mentoring teams (RRMT) alongside financial and resource support for resident scholarly activity (research) requirements. The RRMT involved 24 months of longitudinal curriculum of didactics and semi-annual formal meetings with a group of faculty and other team members with research expertise. The RRMT included biostatisticians, coordinators, regulatory experts, and database managers. The objective of this study was to determine if productivity from resident research increased after RRMT implementation.

METHODS:
We performed an analysis of rates of resident research projects presented at meetings and/or published before (8 total years) and after (4 years) implementation of the RRMT, with a 4-year washout during the RRMT implementation and revision. For presentations, we only included regional or national presentations outside of the local school environment.

RESULTS:
Overall, 43 (37.7%) of the 114 resident projects were published and 27 (23.7%) were presented at meetings. After implementation of the RRMT, resident projects were more likely to be published (55.0% vs. 28.4%, P=.005) and presented (40.0% vs. 14.9%, P=0.003). After implementation, resident projects were more likely to be either presented or published (67.5% vs. 36.5%, P=.002).

CONCLUSION:
Implementation of departmental support and mentoring programs such as the RRMT can increase the rate of resident research projects that are presented and published.
Pregnancy Remembrance Options and Patient-Perceived Impact on Coping Ability after Abortion [A67]
Authors: Oko Obinna C. , Schmidt Ashley , Creinin Mitchell D. , Wilson Susan , Hou Melody Y. 
Published: June 2022

INTRODUCTION:
At our institution, we previously offered pregnancy remembrance options only to patients undergoing termination procedures for fetal anomalies, demise, or pregnancy complications, including footprints, ultrasound pictures, and religious blessings if desired. We sought to identify if all abortion patients desired similar options and the impact of offering the options on their abortion experience.

METHODS:
We created a questionnaire for patients to indicate their preferences for available pregnancy remembrance options. We included questions assessing their feelings about being offered these options and their perceived coping effect afterwards. We performed an institutional review board--exempt chart review February-July 2021 to evaluate responses. We compared these by indication using the Fisher exact test.

RESULTS:
Of 393 procedures performed during the 6-month study period, 244 (84%) patients completed the questionnaire, of which 58 (24%) terminated for fetal anomalies, demise, or pregnancy complications and 186 (76%) for other reasons. Most patients desired at least one remembrance option (41 [71%] and 134 [72%], respectively, P=1.0). About half in both groups (32 [55%] and 93 [50%], respectively, P=1.0) felt these options would provide a positive coping effect. The proportion of patients feeling upset about the questionnaire was low in both groups and not significantly different (12 of 58 [21%] vs 23 of 186 [12%], P=.13).

CONCLUSION:
Most patients, regardless of termination indication, desire a pregnancy remembrance option. Relatively few had negative feelings about being asked, with no significant differences by termination indication. Our findings support that providers should consider offering these options to all patients terminating their pregnancy, regardless of indication.
The Impact of Race on Discrepancies in Pain and Opioid Administration Following Hysterectomy [A90]
Authors: Saylor Leah , Mayborg Larry , Patel Nima R. , Vemula Ridhima , Devaiah C. Ganga , Crisp Catrina 
Published: June 2022

INTRODUCTION:
More than 400,000 hysterectomies are performed annually. Gynecologic healthcare disparities in route of hysterectomy and surgical complications have been reported. There is, however, a paucity of information on postoperative pain scores and opioid administration. Therefore, the objective was to evaluate postoperative total morphine equivalents and pain scores for laparoscopic/robotic and vaginal hysterectomies among reported races.

METHODS:
This was an institutional review board (IRB)-approved retrospective study. Subjects underwent laparoscopic/robotic or vaginal hysterectomy from October 2018 to November 2020. Primary outcome was total postoperative morphine equivalents. Secondary outcomes included pain scores, operative time, estimated blood loss, time in recovery, and length of hospital stay.

RESULTS:
A total of 1,270 subjects were identified: 70.5% (n=895) underwent laparoscopic/robotic hysterectomy and 28.7% (n=364) underwent vaginal hysterectomy. Of all subjects, 78.2% (n=993) were Caucasian, 18% (n=228) African American, 1.1% (n=14) Asian, and 2.8% (n=35) other. African Americans undergoing hysterectomy were younger, 45.7 vs 50.4 (P<.001) and reported slightly higher pain scores 4.67 (3.1–6.0) vs. 4.13 (2.8–5.3) (P=<.001) compared to Caucasians. Mean total morphine equivalents was not different at 20.5 (11.6) vs. 20.3 (10.5) (P=.795). There was no difference in procedure length, time in recovery, or estimated blood loss. Although there was a difference in length of stay of 1.35 vs 1.5, the difference was less than 0.15 day.

CONCLUSION:
Most areas of interest demonstrated no difference between groups. Although a difference was noted in pain scores, the value is less than one and may have little clinical relevance. Further studies are warranted to help clarify this difference.