bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Noninvasive Hemoglobin Testing Be Used to Detect Postpartum Anemia? [A253]
Authors: Mills Kienna , Malhotra Radhika , Lett Christine , Karreman Erwin 
Published: June 2022

INTRODUCTION:
Noninvasive hemoglobin analyzers measure hemoglobin percutaneously and offer the benefit of a one-time spot check without phlebotomy. The objective of this study was to determine the validity of noninvasive hemoglobin testing for detection of postpartum anemia (hemoglobin <10 g/dL).

METHODS:
A convenience sample of 584 women aged 18 and over were recruited on postpartum day 1 following a singleton delivery. Two noninvasive hemoglobin monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value.

RESULTS:
Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland-Altman plots determined a positive bias of 2.4 (±1.2) g/dL with the Pronto and 2.2 (±1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for Pronto and 16% for Rad-67. Adjusting for the fixed positive bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%.

CONCLUSION:
A consistent overestimation of hemoglobin by the noninvasive monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed positive bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.
Trends in Co-Use Among Pregnant People Admitted for Treatment of Opioid Use Disorder [A255]
Authors: Schmidt Christina N. , Seidman Dominika 
Published: June 2022

INTRODUCTION:
Co-use of opioids with other substances in pregnancy increases the risk of adverse perinatal outcomes and complicates substance use treatment. The objective of this analysis was to estimate trends in co-use among pregnant people presenting for opioid use treatment in the U.S.

METHODS:
Using the Treatment Episode Dataset, an administrative database including admissions to federally funded substance use treatment centers, we extracted substance use and demographic data on pregnant people presenting for opioid use treatment between 2000 and 2017 (N=98,444). We performed Joinpoint regression to describe trends in co-use of methamphetamines, benzodiazepines, cocaine, marijuana, and alcohol, stratified by geographic region.

RESULTS:
A total of 61% of pregnant people presenting for opioid use treatment reported co-use of another substance. Nationally, the average annual percent change (AAPC) in opioid admissions with methamphetamine (AAPC: 13.7%; 95% CI, 8.6–19.0%) and benzodiazepine co-use (AAPC: 6.7%; 95% CI, 4.5–9.0%) increased, while admissions with cocaine co-use (AAPC: –5.7%; 95% CI, –7.8% to –3.5%) decreased. Co-use of alcohol (AAPC: –3.5%; 95% CI, –5.5% to 1.4%) and marijuana (AAPC: 2.9%; 95% CI, –0.4% to 6.4%) remained stable. The increasing proportion of admissions with methamphetamine co-use was driven by trends in the West (AAPC: 10.7%; 95% CI, 4.5–17.2%), where admissions for methamphetamine co-use surpassed those for opioid use alone, and co-use with other substances.

CONCLUSION:
Co-use of opioids with methamphetamines increased among pregnant people presenting for substance use treatment between 2000 and 2017. Tailored programming is needed to meet the complex needs of pregnant people with co-use, in order to improve substance use treatment and prenatal services for this growing population.
Medical Students' Knowledge of and Attitudes Towards Oocyte Cryopreservation [A10]
Authors: Santana E'lysse A. , Jeffe Donna B. , Omurtag Kenan , Martin Caitlin E. 
Published: June 2022

INTRODUCTION:
Physicians initiate childbearing at older ages and are more concerned about fertility than non-medical professionals. This study aims to assess medical students’ knowledge and attitudes towards fertility and oocyte cryopreservation (OC).

METHODS:
After institutional review board approval, an anonymous survey was administered to second-year students at Washington University School of Medicine in St. Louis assessing knowledge and attitudes towards fertility decline and OC. Descriptive statistics were performed using SPSS v28.

RESULTS:
Of 104 students, 77 (74.0%) participated. The mean (standard deviation, SD) age of participants was 24.0 (SD 1.6) years, with 62.3% female. Approximately half were in committed relationships or married. Over three-quarters were interested in having children; the average age students planned to start childbearing was 30.9 (SD 2.3) years. Over 80% of participants reported delaying childbearing for career or education reasons, and 89.1% responded with “Yes” or “Maybe” when asked if they or their partner would consider OC. Seventy-eight percent of students reported financial concerns as a barrier to OC. The average knowledge score was 42.0% (2.1/5). Most agreed that insurance companies should cover OC (89.1%) and that coverage may play a role in future training decisions (56.8%). Most agreed that education on OC should be included in education for medical students (97.2%) and postgraduate trainees (98.6%).

CONCLUSION:
Almost 90% of surveyed students would consider elective OC, but report finances as a barrier. These findings suggest that insurance coverage for OC is desired and may influence training decisions. Low knowledge scores indicate the need for better education regarding OC and fertility decline.
Immediate Postpartum Hormonal Contraceptives and Their Association With Postpartum Depression [A12]
Authors: Prasad Shailly , Frid Gabriela , Roig Jacqueline , Lunde Britt , Molenaar Nina M. 
Published: June 2022

INTRODUCTION:
The purpose of this study is to determine the association between immediate postpartum hormonal contraceptives and postpartum depression (PPD) as represented by the Edinburgh Postpartum Depression Score (EPDS). Immediate postpartum contraception, including long-acting reversible contraception (LARC) placement, is convenient, effective, and becoming more accessible given ongoing reimbursement changes. Some hormonal contraceptives have been suggested to cause mood changes outside of the peripartum period. However, they have not been fully studied in the postpartum period, and postpartum depression is a significant cause of morbidity post-delivery.

METHODS:
A retrospective cohort study was performed on patients presenting for their postpartum visit from January 1, 2016 through June 30, 2019 at a hospital-based outpatient clinic. Patients were divided into three study arms (1) hormonal contraceptive (2) non-hormonal contraceptive, and (3) no contraceptive. The primary outcome, EPDS score, was collected at the postpartum visit (4-10 weeks after delivery). Multivariate analysis was performed to control for confounders including multiparity, history of mood disorders and psychiatric medications, and neonatal outcomes.

RESULTS:
A total of 1,041 patients were included in the analysis. The rate of immediate postpartum hormonal contraceptive use was 14.6%. There was no difference in the mean or median EPDS across the three study groups. There was not enough evidence to conclude that the rate of EPDS>12 or EPDS as a continuous variable was significantly different between the groups.

CONCLUSION:
Patients who received hormonal contraceptives were neither at increased risk nor decreased risk for postpartum depression.
Vomiting and Risk of Intubation Related to Preoperative Doxycycline Use for Dilation and Evacuation [A17]
Authors: Weiss Madeleine E. , Potter Laura A. , Kamboj Rabia , Ponzini Matthew D. , Wilson Machelle D. , Hou Melody Y. 
Published: June 2022

INTRODUCTION:
Oral doxycycline is a common prophylactic antibiotic for second trimester dilation and evacuation (D&E) procedures, but recent research reports associated vomiting rates of 25.2-28.3%. Since deep sedation with natural airway is the preferred anesthetic route for D&E, doxycycline-associated vomiting may increase need for general endotracheal tube anesthesia (GETA) to avoid aspiration. We aimed to describe the rate of vomiting from oral doxycycline given the night before D&E, proportions of anesthesia routes, and anesthetic complications.

METHODS:
We conducted a retrospective chart review of patients presenting for second trimester D&E (14-0/7 to 23-6/7 weeks gestation) at our institution 7/1/2019-6/30/2020, identified by billing records. Our institutional review board deemed this study exempt. We recorded vomiting within 30 minutes of ingestion, anesthetic route, and complications. We tested for associations using chi-square analyses for categorical variables and Wilcoxon-rank sum for non-normal numeric variables.

RESULTS:
We reviewed 702 charts, of which 465 (66%) met inclusion criteria and 425 (61%) took doxycycline as prescribed. Thirty-one (31, 7.3%) vomited within 30 minutes of ingestion. Nulliparity and younger age were significantly associated with emesis (P<.001 and P=.03, respectively), but gestational age (P=.36), BMI (P=.94), and gastrointestinal issues (P>.99) were not. All 10 GETA events (2.4%) occurred in patients without emesis. Anesthetic complications (n=5, 1.2%) were rare and observed only in those without emesis.

CONCLUSION:
Our vomiting rates are lower than those previously published. We found no association between doxycycline-associated vomiting and either need for GETA or anesthetic complications.
Surveys of California Family Physicians and LA County Pharmacists: Pill Prescribing and Dispensing Practices [A18]
Authors: Munnangi Meghana , Matlack Abigail , Gedestad Ilish , Nelson Anita L. 
Published: June 2022

INTRODUCTION:
Providing women with 13 cycles of oral contraceptives at once (a one-year supply) reduces unintended pregnancy and abortion rates. Family Planning, Access, Care, and Treatment (PACT) is a state-licensed Medicaid family planning program that is legally required to pay for 13 cycles at once if the physician orders them. Physician prescribing and pharmacy dispensing practices are key components to maximizing contraceptive efficacy.

METHODS:
In a two-part institutional review board-approved study, we conducted an online survey of California family physicians about their pill prescribing practices. We also sampled a substantial proportion of pharmacies in Los Angeles County using a secret shopper survey to determine if staff would dispense 13 cycles as the physician ordered and if they would not, how many they would dispense and why.

RESULTS:
Fifty-one family physicians completed the survey; 22 (43.1%) provided care to women on Family PACT. Eighteen of these 22 physicians reported their prescribing practices; only 5.6% prescribed 13 cycles at once. We attempted to contact 582 representative pharmacies but only successfully contacted 432. Of these, 3.2% of pharmacies stated they would dispense 13 cycles at one time, 47% stated they could not dispense 13 cycles at one time, and 49.7% required that women come in to determine prescription and insurance eligibility.

CONCLUSION:
With only 5.6% of physicians and 3.2% of pharmacies stating they would prescribe or dispense 13 cycles, women on Family PACT insurance face a substantial barrier to accessing the legally allowed amount of oral contraceptives, placing them at a higher risk for unintended pregnancies and abortions.
Validation of Chloe SED, a Low-Cost, Reusable Syringe Extension Device for the Provision of Paracervical Analgesia [A21]
Authors: Ramanathan Aparna , Gwer Stephen , Imbamba Javan L. , Odenyo Stella , Omoto Jackton , Bailey Robert C. 
Published: June 2022

INTRODUCTION:
Women in Kenya and other low- and middle-income countries often do not receive analgesia during manual vacuum aspiration (MVA). This pilot study evaluated the efficacy of a novel, ultra-low-cost syringe extension device (Chloe-SED) developed by this research team for provision of paracervical block (PCB) during MVA.

METHODS:
A randomized, single-blinded non-inferiority trial of 61 patients was conducted at two facilities in Kisumu between September 2019 and January 2021 comparing PCB administered with Chloe-SED to a standard spinal needle. The primary outcome was non-inferiority of pain score during uterine evacuation within a non-inferiority margin of 2 points on an 11-point visual assessment scale. Secondary outcomes included non-inferiority of pain score at 4 other time points, patient satisfaction, and provider feedback on Chloe-SED. Institutional review board approval was obtained and written consent was obtained from all participants.

RESULTS:
Chloe-SED showed non-inferiority of the primary outcome with mean pain score during evacuation of 3.9 (3.2-4.7) compared with spinal needle at 4.1 (3.5-4.7). Non-inferiority was shown at all time points. In one patient the syringe and device were incompatible. In one case, breakage of the finger-pad of the device after completion of PCB was noted with no injury to patient or provider. Most patients and providers expressed desire for continued use of the device to administer PCB for MVA.

CONCLUSION:
The Chloe SED device appears effective and desirable for administration of PCB during MVA. Further study and development of Chloe SED will allow humane pain control during MVA in regions worldwide where this previously was not possible.
The Effect of Immediate Postpartum Implant Use on Breastfeeding or Breast Milk Supply [A28]
Authors: Fleurant Erin , O'Sullivan David , Hazel Kathleen , Crim Mary Marshall , Kuhnly Joan , Johnson Amy 
Published: June 2022

INTRODUCTION:
Lactogenesis is triggered by withdrawal of circulating progesterone after birth, thus leading to theoretical concern that progesterone-containing contraception may decrease breast milk production. While current studies show no adverse effects of implant placement on milk supply, there has not yet been a study to evaluate the effects with immediate postpartum implant use.

METHODS:
We performed a prospective cohort study from June 2019 through April 2021. Inclusion criteria were breastfeeding females ages 18 years and older. Exclusion criteria were use of other hormonal contraception, contraindications to breastfeeding, or inability to breastfeed due to neonatal circumstances. Participants were enrolled prior to discharge and assigned to an implant (progesterone-containing contraceptive) or control group. Follow-up data were collected at the 6-week visit or via telephone. Statistics included Student’s t-test and chi square, and were performed using an alpha level of 0.05.

RESULTS:
A total of 151 participants were enrolled. There was no significant difference between breastfeeding rates at 6 weeks postpartum (implant 65.0% vs control 70.5%, P=.537). Cohorts differed in marital status (P<.001) and age (P=.017), with implant users more likely to be younger and single.

CONCLUSION:
Interim analysis indicates that immediate implant use does not have a significant effect on postpartum breastfeeding rates. Due to interruptions during a global pandemic, the study did not reach goal participation of implant users to adequately power the primary outcome. Despite younger age, potential lack of partner support, and a trend toward first-time mothers, immediate postpartum implant use did not appear to affect breastfeeding rates.
“There’s only one use for it”: Stigma as a Barrier to Mifepristone Use for Early Pregnancy Loss [A31]
Authors: Mokashi Mugdha , Boulineaux Christina M. , Janiak Elizabeth , Boozer Margaret , Neill Sara 
Published: June 2022

INTRODUCTION:
Mifepristone combined with misoprostol has superior efficacy for early pregnancy loss (EPL) treatment compared to misoprostol alone. Mifepristone access is restricted by the U.S. Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy program, and its use may be further limited by logistical and interpersonal barriers due to its association with abortion, especially in states with restrictive policies. Understanding barriers to incorporation of mifepristone in EPL care is key for developing interventions to improve care quality.

METHODS:
We conducted semi-structured interviews with 19 obstetrician-gynecologists in Alabama who manage EPL. Interviews explored participants’ knowledge of and experience with mifepristone use for EPL and abortion, along with barriers to and facilitators of clinical mifepristone use. Interviews were coded by multiple study staff using inductive and deductive thematic coding. This study was deemed exempt by the Harvard Medical School Institutional Review Board.

RESULTS:
Nearly all interviewees identified abortion-related stigma as a barrier to mifepristone use. Interviewees often attributed stigma to a lack of knowledge about the clinical use of mifepristone for EPL. Stigmatization of mifepristone due to its association with abortion was related to religious and politic objections. Many also described stigma associated with misoprostol use. Although providers believed mifepristone use for abortion would not be accepted in their practice, most felt that mifepristone could be successfully used for EPL after practice-wide education on its use.

CONCLUSION:
Mifepristone is strongly associated with abortion stigma, which is a barrier to its use for EPL. Interventions to increase clinical knowledge of mifepristone use and decrease stigma are needed to optimize EPL care.
Risk Factors for IUD Malposition [A36]
Authors: Frisse Ann , Louik Jay , Kachwala Isha , Wu Haotian , Avila Karina , Benfield Nerys 
Published: June 2022

INTRODUCTION:
We aimed to identify the risk factors for intrauterine device (IUD) malposition and to develop a model to predict who is at risk for IUD malposition.

METHODS:
We performed a retrospective cohort study of IUD users with ultrasounds performed between July 2014 to July 2017 within a large, urban, academic medical system. Our primary outcome was IUD malposition. The Fisher’s exact test and Wilcoxon rank sum test were used. We used logistic regression, least absolute shrinkage and selection operator (LASSO), and elastic net models to predict the likelihood of having a malpositioned IUD. Institutional review board (IRB) approval was obtained for this study.

RESULTS:
Of 1,759 ultrasound reports with an IUD present, 436 described a malpositioned IUD. Compared to participants with non-malpositioned IUDs, participants with malpositioned IUDs were more likely to be younger (30.7 and 31.9 years old, P=.02), have fibroids (21.6% and 15.9%, P<.01), and have abnormal uterine bleeding (AUB) (19.7% and 14.9%, P=.02). There were no differences between groups in gravidity, parity, uterine surgeries, number of cesarean deliveries, IUD type, or timing of IUD placement relative to abortion or delivery. Reports describing malpositioned IUDs were more likely to have been authored by radiologists than gynecologists (85.1% and 13.5%, P<.01). LASSO model, elastic net model, and logistic regression were unable to identify a meaningfully predictive model for IUD malposition

CONCLUSION:
Fibroids and AUB are associated with IUD malposition. No other risk factors were statistically or clinically significant. No linear combination of factors meaningfully predicted risk of IUD malposition. Radiologists were more likely to author reports describing malpositioned IUDs.
Online Education Improves Clinicians’ Knowledge and Competence Related to Advances in Cervical Cancer Screening [A44]
Authors: Thorpe Sara , Bahra Sukhbir 
Published: June 2022

INTRODUCTION:
Women who test positive on primary screening tests for human papillomavirus (HPV) infection are triaged with Pap to determine whether a colposcopy is needed. The diagnostic variability of Paps may lead to missed diagnosis. Clinicians would benefit from education that will provide expert guidance on best-practice triage strategies for women who test HPV-positive.

METHODS:
The educational initiative consisted of an online video-based continuing medical education (CME) discussion among three experts, with synchronized slides. Intervention included pre/post study assessment, and McNemar tests (P< .05 level) determined statistical significance. Learners who improved (answered ≥1 questions correctly pre-education than post) were identified. Data are reported from 1/11/2021-10/17/2021.

RESULTS:
The analysis set consisted of obstetrician-gynecologists (ob-gyns) (n=1,086) and primary care providers (PCPs) (n=296). Pre- vs. post-education decisions demonstrated significant improvement (P<.001) in knowledge and competence related to the following for HPV positive women (pre% vs. post%): Knowledge regarding the limitations of traditional cytology methods: 20% of ob-gyns improved (36% pre, 48% post, P<.001); 21% of PCPs improved (28% pre, 41% post, P<.001). Knowledge regarding newer methodologies to triage women with abnormal screening results: 41% of ob-gyns improved (31% pre, 67% post, P<.001); 33% of PCPs improved (24% pre, 49%,P<.001). Competence related to follow-up care: 21% of ob-gyns (16% pre, 30% post, P<.001); 11% of PCPs improved (18% pre, 24% post; P<.05).

CONCLUSION:
The intervention demonstrates improvements and highlights the role of online video-based CME discussion in improving knowledge and competence related to clinicians’ ability to triage women who are HPV positive or have an abnormal Pap test. Additional gaps were identified for future education.
Linguistic Differences in Letters of Recommendation for Maternal Fetal Medicine Fellowship Applicants [A49]
Authors: Rosenthal Elise , Tappy Erryn , Pan Evelyn T. , Brown L. Steven , Wang Angela , Florian-Rodriguez Maria 
Published: June 2022

INTRODUCTION:
Multiple medical specialties have previously reported on gender bias in letters of recommendation (LORs). We aimed to determine if linguistic differences exist in LORs for male and female applicants to a maternal fetal medicine (MFM) fellowship at an academic institution.

METHODS:
This was an institutional review board (IRB)-approved retrospective single-site cohort study conducted from 2019-2021. Data collected included applicant’s age, race, self-reported gender, geographic region of residency, Step 1 and 2 scores, scholarly and volunteer activities, and number of LORs. The Linguistic Inquiry and Word Count (LIWC) software, a validated text analysis program, was used to characterize LORs’ linguistic content. Multivariable analysis was used to compare letter characteristics to applicant demographics.

RESULTS:
A total of 212 applications were reviewed, including 808 LORs. Women comprised 76.9% of applicants and men 23.1%. Most applicants identified as non-Hispanic White (52.8%). Men were more likely to be international medical graduates (20% vs. 6%, P=<.01), and women reported more volunteer activities (7.1 ± 5.1 vs. 5.5 ± 4.3, P=.04). There were no significant differences in Step scores, number of research projects, or number of LORs. Multivariable analysis controlling for applicant race, Step 1 score, and gender of the letter writer revealed that letters written for males contained significantly more references to the word category cognitive processes (7.4 ± 0.2 vs. 7.1 ± 0.1, P=.046), specifically in reference to the subcategories of certainty and differentiation.

CONCLUSION:
We identified linguistic differences in LORs written for MFM applicants, suggesting potential bias in the style of writing for male and female physicians applying to this field.