bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-Guided Polypectomy: Evaluation of A Novel Technique To Remove Endometrial Polyp In The Office [A295]
Authors: Sarkar Papri , Hochberg Lauri S. 
Published: June 2022

INTRODUCTION:
Endometrial polyps are present in 13–50% in women with abnormal uterine bleeding (AUB). Hysteroscopy is the method of choice for diagnosis and treatment but has some limitations. Hence, we propose a novel technique that allows ultrasound-guided, office-based polypectomy. It avoids general anaesthesia, is inexpensive, and allows single point of care.

METHODS:
This is a prospective trial conducted at an academic hospital after IRB approval. Women with AUB had saline infusion sonogram (SIS) to delineate the polyp. Under ultrasound guidance, the universal grasping forceps (2.5 mm x 25 cm) was introduced through the cervix into the uterus to remove the polyp. It was an off-label use of the instrument. The goal of the study was to evaluate the patients' post-procedure pain and satisfaction score. The secondary outcomes were confirmation of complete removal of the polyp by assessing resolution of patients' symptoms and performing SIS at 3-month follow-up.

RESULTS:
There were 30 patients; 30% had premenopausal AUB, and 70% had post-menopausal bleeding. Mean age was 54.8±11 years, and mean BMI was 30.6±10. Average polyp volume was 1.26 cm3, and mean time taken for polypectomy was 11 minutes 50 seconds. The median pain and satisfaction scores were 5 and 10, respectively. Adequate pathology sample was obtained for all, and two returned as malignancy. For the 3-month follow-up, 16 patients returned. Among them, 13 (81%) had no evidence of polyps on SIS and 14 (87%) reported complete symptom resolution.

CONCLUSION:
This technique can be used safely and effectively to remove endometrial polyps in appropriately selected patient populations.
The Impact of COVID-19 on Pregnancy, and the Management of Infected Patients [A124]
Authors: Martens Mark G. 
Published: June 2022

INTRODUCTION:
This seminar will focus on prevention of and management of patients with SARS-CoV-2 in pregnancy.

METHODS:
Federal (Centers for Disease Control and Prevention), state, and society (American College of Obstetricians and Gynecologists, Society for Maternal–Fetal Medicine) guidelines will be reviewed.

RESULTS:
The accuracy of coronavirus diagnosis is dependent on the specific test and the timing. Once correctly diagnosed, the impact of infection at various stages of pregnancy requires unique and specific management protocols, which are continually evolving as new data is reported. Innovative antepartum management strategies, including telemedicine, are emerging. Management protocols and treatment of COVID-19 in pregnancy require additional attention, and protocols for labor and delivery highlighting protection of both patients and the obstetric staff need to develop. New data on vertical transmission is also evolving.

CONCLUSION:
SARS-CoV-2 infection in pregnancy requires novel and specific treatment and management strategies which undergo continued updates and modifications as new data is presented. The seminar will first focus on establishing a correct diagnosis, and then, assessing and counseling the patient and her family of the impact of coronavirus infection on the pregnancy. Risk factors for adverse outcomes will be reviewed, including obesity, chronic medical conditions, and socioeconomic disparities. Antepartum management will be reviewed regarding the development of testing strategies for the patient, family, and staff, and protocols for safe office visits including telehealth. Intrapartum and postpartum management and treatment of infected and/or symptomatic patients will be reviewed, with specific attention to federal and society guidelines. All prevention (vaccines) and evolving treatment options and their safety in pregnancy will be discussed
COVID-19 Vaccine Hesitancy Among Reproductive-Aged Females [A129]
Authors: Gilani Sonia , Butler Leah , Shamshuddin Nabiha , Class Quetzal , Ganti Amitha 
Published: June 2022

INTRODUCTION:
Initial COVID-19 vaccine trials excluded pregnant individuals, making eventual vaccine recommendations non-generalizable. After noninferiority was established, the Centers for Disease Control and Prevention, World Health Organization, and American College of Obstetricians and Gynecologists supported vaccination of this group. However, only 31% of pregnant patients accepted vaccination. This study aims to assess COVID-19 vaccine hesitancy in reproductive-aged females.

METHODS:
We developed a REDCap survey using a validated COVID-19 vaccine hesitancy survey tool. From August to November 2021, women aged 18–50 years were recruited from inpatient and outpatient obstetrics and gynecology services at the University of Illinois Hospital. We performed t tests and ANOVA statistics using SPSS.

RESULTS:
A total of 51 patients partially or fully completed the survey. The results revealed that Black individuals are more hesitant than Hispanic and White individuals (F
2,44=3.45, P<.50). Specifically, Black women differed in the belief that the COVID-19 vaccine is safe overall (F
2,44=5.62, P<0.01) and in pregnancy (F
2,46=4.95, P<0.01). Pregnant patients were less confident that the COVID-19 vaccine is safe overall (F
2,45=7.44, P<0.01) as well as in pregnancy (F
2,47=6.26, P<0.01) compared to those recently pregnant or not pregnant. Individuals who declined the flu vaccine were more likely to be vaccine hesitant (t
46=–4.49, P<.001). Participants’ age, occupation, and contraception status were not associated with vaccine hesitancy.

CONCLUSION:
Existing vaccine hesitancy highlights the need to study misconceptions regarding the safety of the COVID-19 vaccine.
Expedited Partner Therapy: A Quality Improvement Initiative to Boost Provider Prescription [A130]
Authors: Markowitz Melissa A. , Ackerman-Banks Christina , Gottlieb-Cohen Sara , Pathy Shefali R. , Sheth Sangini S. 
Published: June 2022

INTRODUCTION:
High rates of chlamydia and/or gonorrhea (CT/GC) partner reinfection contribute to devastating sequelae, including pelvic inflammatory disease and infertility. While expedited partner therapy (EPT) is legal in 43 states and endorsed by the American College of Obstetricians and Gynecologists, rates of EPT utilization are highly variable. We designed a quality improvement (QI) initiative for implementation of EPT in an urban clinic providing care to a low-income patient population.

METHODS:
We performed an institutional review board‒approved pre–post study to evaluate our EPT QI initiative, which included education on EPT and development of electronic medical record (EMR) support tools. Cohorts included all women with CT/GC one year prior and one year after our initiative. Demographic and clinical characteristics were collected via EMR. Multivariate logistic regression assessed the association between the QI initiative and offering EPT.

RESULTS:
Of 287 patients with CT/GC, 155 were diagnosed pre-QI and 132 post-QI. There were no significant differences in demographic or clinical characteristics between the groups. EPT counseling increased significantly from 24.5% pre-QI to 37.8% post-QI (P=.015). Those offered EPT were more likely to be seen by a resident physician (OR, 3.44; 95% CI, 1.24–10.00; P=.019) and speak Spanish (OR, 3.14; 95% CI, 1.38–7.46; P=.007). Women with CT/GC post-QI were twice as likely to be counseled on EPT than their pre-QI counterparts, when adjusting for provider type and language (aOR, 2.02 (95% CI, 1.17–3.56).

CONCLUSION:
Our QI initiative significantly increased the rate of EPT counseling. Similar QI initiatives may be applied in other settings, such as adolescent clinics or urgent care, in order to decrease the rising rates of CT/GC.
Trends in Gestational Diabetes Mellitus by Race and Ethnicity Among Women With Advanced Maternal Age [A146]
Authors: Pawar Deepraj , Mester Nonda , Hersh Alyssa R. , Valent Amy , Boniface Emily 
Published: June 2022

INTRODUCTION:
Advanced maternal age (AMA), defined as maternal age 35 years or older, is becoming more common, with simultaneously increasing adverse outcomes. We aim to determine if gestational diabetes mellitus (GDM) is becoming more common in AMA pregnancies, and if racial disparities exist.

METHODS:
This was a retrospective cohort study of singleton, non-anomalous deliveries with a gestational age ≥20 weeks and maternal age ≥35 in the United States from 2014 to 2018. Patients with chronic diabetes mellitus were excluded. Our analysis was stratified by maternal race/ethnicity, including non-Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian or Native Hawaiian or Pacific Islander (NHPI), non-Hispanic multiracial, and Hispanic. We performed multivariable logistic regression followed by calculation of adjusted predicted probabilities to estimate the proportion of deliveries effected by GDM. Confounders adjusted for include age, BMI, parity, cigarette use, educational attainment, and insurance type. All analyses were conducted using STATA 17.

RESULTS:
This study included 3,093,536 AMA deliveries. Non-Hispanic Asian and NHPI women had the highest probability of developing GDM, followed by Non-Hispanic AI/AN women. Non-Hispanic Black patients had the lowest rates of GDM. The predicted probability of developing GDM increased in all racial and ethnic groups between 2014 and 2018 but was most pronounced in Non-Hispanic Asian and NHPI patients, increasing from 19.0% to 21.0% over the four-year period.

CONCLUSION:
In the United States, GDM has increased among all groups in the AMA population from 2014 to 2018. However, the predicted probability of GDM still varies greatly by maternal race and ethnicity.
Trends in Cesarean Delivery by Race and Ethnicity Among Women With Advanced Maternal Age, 2014–2018 [A148]
Authors: Pawar Deepraj , Mester Nonda , Hersh Alyssa R. , Boniface Emily , Valent Amy 
Published: June 2022

INTRODUCTION:
There has been an overall decrease of cesarean deliveries in the United States over recent years. We sought to determine if this trend was consistent in the advanced maternal age (AMA) population, and if there were disparities based on maternal race and ethnicity.

METHODS:
This was a retrospective cohort study including singleton, non-anomalous deliveries with a gestational age ≥20 weeks and maternal age ≥35 in the United States from 2014 to 2018. Our study included repeat cesarean delivery. Analyses were stratified by maternal race/ethnicity, including non- Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian or Native Hawaiian or Pacific Islander (NHPI), non-Hispanic multiracial, and Hispanic. We performed multivariable logistic regression followed by calculation of adjusted predicted probabilities to estimate the fraction of births cesarean delivery. Confounders assessed included diabetes status, prior cesarean delivery, age, parity, BMI, cigarette use, educational attainment, and insurance type.

RESULTS:
There were 3,094,296 births included in this study. Black women had the highest probability of cesarean delivery from 2014 to 2018. Non-Hispanic AI/AN women had the lowest probability. The predicted probability of cesarean delivery was lower in 2018 than 2014 for all maternal race and ethnicity groups. The largest decline was seen in Black women, decreasing from 45.5% to 43.8% from 2014 to 2018.

CONCLUSION:
Cesarean deliveries are decreasing among all pregnant women with AMA. However, there are disparities in this outcome when accounting for maternal race and ethnicity, with Black women most at risk.
Presenting Characteristics, Complications, and Outcomes of Pregnant Tourists Who Present to the Hospital in Hawaii [A152]
Authors: Malley Alyssa , Raidoo Shandhini , Loomis Alexander K. , Lee Men-Jean 
Published: June 2022

INTRODUCTION:
Travel during pregnancy is increasingly popular, and literature describing possible complications is lacking. This study was conducted to determine characteristics, comorbidities, indications for seeking care, and outcomes of pregnant tourists who presented to care in Hawaii.

METHODS:
We conducted a chart review of pregnant tourists who presented to Kapiʻolani Medical Center for Women & Children in Honolulu, Hawaii between January 2018 and August 2020. Institutional review board approval was obtained. Demographics, details of the hospital course, and outcomes were recorded. Logistic regression and ANOVA were fit to test the influence of patient characteristics on admission and length of hospital stay, respectively.

RESULTS:
There were 301 pregnant tourists identified, with 40.2% patients in the first trimester, 43.5% in the second, and 16.3% in the third. We identified 11.6% of patients with chronic medical conditions and 19.9% of patients with pregnancy-related conditions. Most patients presented for pregnancy-related concerns. More advanced gestational age (P<.0001), pregnancy-related conditions (P<.01), and chronic medical conditions (P=.04) were associated with a significantly longer hospital stay. Thirty-four patients were admitted. Patients in their third trimester (P<.001) and patients with pregnancy-related (P<.01) or chronic (P=.01) conditions were significantly more likely to be admitted. Twenty-seven patients underwent delivery or procedure.

CONCLUSION:
Pregnant patients are traveling throughout pregnancy and many with known medical conditions. They seek care for a variety of reasons; some are admitted or undergo procedures. Increasing gestational age, chronic medical conditions, and pregnancy-related conditions are associated with increased length of hospital stay and likelihood of admission. Providers should be aware of the risks of travel to counsel patients appropriately.
Variations in Postpartum Opioid Prescribing Practices Among Obstetrician–Gynecologists [A153]
Authors: Ravikanti Nikhita , Okut Hayrettin , Keomany Jennifer , Ablah Elizabeth , Bradley Kent 
Published: June 2022

INTRODUCTION:
Cesarean patients are commonly prescribed opioids when discharged from the hospital. This study aimed to determine if there were differences in prescribing practices based on the postoperative day opioid prescriptions were written, and before and after the publication of the most recent Committee Opinion from the American College of Obstetricians and Gynecologists (ACOG).

METHODS:
This retrospective chart review study included women who had a live birth via cesarean at a single institution from July 1, 2017, to February 28, 2021, and excluded those with chorioamnionitis or discharged after more than 4 days. Opioids were converted to oral morphine milligram equivalents (MME) for comparison, and total MME was calculated for each prescription. Patients were grouped based on date of delivery relative to the publication of ACOG Committee Opinion 742 (July 2018). Institutional review board approval was obtained for this study.

RESULTS:
Out of 411 patients, 93.9% (n=386) had opioids prescribed at discharge, 85.5% of whom (330/386) received a prescription written on the day of discharge. There was no difference in the quantity of MMEs in discharge prescriptions between those written on the day of discharge and those written on a prior day. Patients delivering after the new ACOG Opinion (63.9%, n=263) received discharge prescriptions with fewer average MMEs (159.53±61.64) than those who delivered before the publication (36%, n=148) (187.35±53.42), chi-square (1, N=411)=17.71, P<.001.

CONCLUSION:
Patients delivering via cesarean after the published ACOG Committee Opinion 742 received discharge prescriptions with fewer MMEs, but there was no difference between prescriptions written the day of versus before discharge.
Severe Maternal Morbidity in Deliveries Complicated by Preeclampsia Equalized by the Military Health Care System [A155]
Authors: Lundeberg Kathleen R. , Tindal Rachel R. , Grob Patrizia , Hamilton Jameaka , Gonzalez-Brown Veronica , Keyser Erin A. 
Published: June 2022

INTRODUCTION:
In the United States, Black women die at 2.5 times the rate of White women and 3.5 times the rate of Hispanic women. These racial health care disparities have been largely attributed to access to health care and other social determinants of health. We hypothesize that the military health care system models universal health care access seen in other developed countries and should equalize these rates.

METHODS:
Delivery data from 41 military treatment facilities across the Department of Defense (Army, Air Force, and Navy), including over 36,000 deliveries from 2019 to 2020, were compiled in a convenience dataset through the National Perinatal Information Center. After aggregation, the parameters of percent of deliveries complicated by severe maternal morbidity (SMM) and percent of SMM secondary to preeclampsia with and without transfusion were calculated. Risk ratios were calculated by race for the resulting summary data. American Indian/Alaska Native patients were excluded due to a limited total number of deliveries, preventing statistical analyses.

RESULTS:
Overall, the risk of SMM was increased among Black women compared to White women. The risk of SMM related to preeclampsia showed no significant difference among races with or without transfusion. When other races were set as reference group, there was a significant difference for White women, suggesting a protective effect.

CONCLUSION:
While women of color still experience overall SMM at higher rates than their White counterparts, Tricare may have equalized the risk of SMM for deliveries complicated by preeclampsia.
Is Mask Ventilation an Acceptable Alternative to Endotracheal Intubation for Pregnant Women Undergoing ECT? [A162]
Authors: Jhaveri Vasanti , Martinez Ramon , Trippensee Arvin , Roussos-Ross Dikea (Kay) , Brennan Meghan , Wendling Adam 
Published: June 2022

INTRODUCTION:
Electroconvulsive therapy (ECT) is an evidence-based treatment for severe depression and bipolar disorder in pregnancy. ECT involves induction of general anesthesia with muscle relaxation requiring positive-pressure ventilation. Airway manipulation may lead to complications such as vocal cord injury, aspiration, inability to ventilate, and death. Appropriate airway management for ECT in pregnant patients is unknown. The purpose of this study was to determine if there are differences in incidence of airway complications (AWC) in subjects who underwent mask ventilation (MV) versus endotracheal intubation (ETI).

METHODS:
This was a retrospective case-control study conducted from June 1, 2011, to June 30, 2020, of all adult pregnant patients who underwent anesthesia for ECT. Each ECT treatment on a pregnant patient was matched with two ECT treatments in nonpregnant control patients. Charts were queried for airway management (MV versus ETI), gestational age, and AWCs. Each ECT procedure was considered an independent airway event.

RESULTS:
A total of 13 nonpregnant and 11 pregnant patients met inclusion criteria and received 154 and 76 ECT treatments, respectively. Of the 76 ECT treatments in pregnant patients, 12 occurred in the first trimester, 44 in the second trimester, and 20 in the third trimester. In pregnant patients, airway management consisted of MV in 57 of the 76 treatments: 12 in the first trimester, 33 in the second trimester, and eight in the third trimester. No airway complications were experienced in pregnant or nonpregnant patients.

CONCLUSION:
There were no airway complications observed in pregnant patients undergoing either MV or ETI regardless of gestational age. Our data supports consideration of less invasive airway management during ECT of pregnant patients.
Provider Attitudes and Practice Patterns for Periviable Birth Management [A166]
Authors: George Joshua S. , Swor Katie , Fernandes Nithi , Tremonti Nadia , Gonik Bernard 
Published: June 2022

INTRODUCTION:
Periviable birth (PV) is a clinical situation marked by prognostic uncertainty and high maternal and neonatal morbidity and mortality. The objective of this study was to examine obstetric care professional practice patterns in managing PV as a basis for a multidisciplinary exchange.

METHODS:
A cross-sectional survey was administered between February and April 2021 to obstetric (OB) and neonatal (NEO) providers. The survey consisted of nine vignettes with binary questions assessing intrapartum interventions (IPI), resuscitation (RESUS), cesarean delivery (CD), and lethality. Responses were analyzed using a 5-point Likert scale and Fisher's exact test.

RESULTS:
Respondents (N=59) rated their confidence in counseling on IPI and neonatal outcomes as 3.11±1.14 and 3.05±1.11, respectively. A total of 79% would offer IPI at earlier gestational ages (GA) than guidelines suggest, with no difference between groups (76% OB versus 100% NEO; P=.19). At 22 weeks GA, 90% would offer RESUS and 52.5% would offer CD. When confronted with RESUS against maternal wishes at 24 weeks, 57% OB and 50% NEO opined this was an obligation with signs of life at birth (P=.72). In vignettes involving presumed lethality, 92% would want NEO at delivery, 85% would offer RESUS if requested, and 50% would offer CD.

CONCLUSION:
At a center commonly confronted with PV, providers were more likely to offer IPI and RESUS and less likely to offer CD at lower GA. Similar attitudes were observed between OB and NEO providers. The survey identified dichotomous themes involving lethality and patient/provider autonomy. This exercise established ongoing educational efforts to improve patient counseling and provider confidence in decision making.
Does Peripartum Miscalculation of Estimated Fetal Weight Increase Maternal or Fetal Complications? [A181]
Authors: Bharucha Jinai , Rimsza Rebecca , Raghuraman Nandini , Bligard Katherine H. 
Published: June 2022

INTRODUCTION:
An estimated fetal weight (EFW) is frequently determined near the time of delivery. We investigated whether discrepancy between EFW and birth weight was associated with increased rates of maternal or neonatal complications.

METHODS:
We performed a secondary analysis of an institutional review board‒approved retrospective cohort study including all women delivering non-anomalous, term singletons via scheduled cesarean delivery from 2004 to 2014. EFW was determined by Leopold maneuvers or recent ultrasound. An accurate EFW was defined as within 20% of BW, while an inaccurate EFW was an EFW >20% or <20% of BW. Neonatal and maternal outcomes were compared based on accuracy of EFW. Neonatal outcomes included Apgar<7, death, hypoxic ischemic encephalopathy, therapeutic hypothermia, intubation, respiratory distress, and seizures. Maternal outcomes included postpartum hemorrhage, transfusion, wound infection, and venous thromboembolism. Multivariable logistic regression was used to adjust for confounders.

RESULTS:
The EFW was inaccurate in 223/1,697 (13.1%) cases. Increasing maternal BMI and abnormal birth weight were associated with inaccurate EFW. The EFW overestimated birth weight in 72/167 (43.0%) of SGA neonates and underestimated birth weight in 47/238 (19.7%) of LGA neonates. Risk of postpartum hemorrhage was two-fold higher when EFW was inaccurate (aOR, 2.09; 95% CI, 1.02–4.31). All other surgical and neonatal outcomes were similar between groups.

CONCLUSION:
Inaccurate estimation of birth weight is more common in LGA and SGA neonates. Increased postpartum hemorrhage, but no other adverse outcomes, were seen when birth weight was inaccurately estimated. Future research should investigate the impact EFW–birth weight discordance has on outcomes after labor.