bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pelvic Pain Disorders and Associated Acceptability of Office Hysteroscopy [A288]
Authors: Brant Amanda C. , Echetebu Nneanata , Mara Kristin , Laughlin-Tommaso Shannon , Hopkins M. , Green Isabel 
Published: June 2022

INTRODUCTION:
Despite the benefits, convenience, and acceptability of office hysteroscopy (OH), 20% of patients find OH unacceptable. In this study we defined acceptability as willingness to undergo office hysteroscopy in the future and investigated whether patients with co-existing pelvic pain disorders were more likely to find OH unacceptable.

METHODS:
Patients who underwent OH from 12/2016 to 6/2018 were included. Patients were asked to rate acceptability at the time of their procedure. Retrospective chart review was used to identify patients with pelvic pain disorders defined as chronic pelvic pain (CPP), dysmenorrhea, vulvodynia, dyspareunia, or high tone pelvic floor dysfunction (PFD). Patients rating OH as acceptable (Likert scale 4–5) were compared to those rating it as unacceptable (Likert scale 1–2). Comparisons between groups were made using a t-test or Wilcoxon rank sum test for continuous data, and a Chi-square test for categorical data. This study was determined to be exempt from the requirement for IRB approval (IRB #20–009387).

RESULTS:
Compared to patients in the “acceptable” group (n=929), patients who rated OH as “unacceptable” (n=55) reported higher during and post-procedure pain scores and lower satisfaction rates (P<.001). Prior diagnosis of PFD (P<.001) and dyspareunia (P=.003) were both associated with finding OH unacceptable. Dysmenorrhea, CPP, and vulvodynia were associated with unacceptability but did not achieve significance.

CONCLUSION:
A preexisting diagnosis of a pelvic pain disorder, specifically PFD and dyspareunia, was associated with unacceptability of OH. Implementing triage criteria for patients to pursue hysteroscopy with sedation or anesthesia could help improve patient satisfaction and warrants additional study.
Prenatal Visit Vitals: Comparison Between Virtual And Traditional Visits [A294]
Authors: DeWitt Jason 
Published: June 2022

INTRODUCTION:
Prenatal visits via a virtual platform are increasingly offered to patients. Previous studies have shown favorable acceptance by patients. The COVID-19 pandemic dramatically accelerated adoption of this new technology. This study was designed to compare documentation of maternal blood pressure and weight between virtual visits and traditional face-to-face visits.

METHODS:
The study is a retrospective comparison of documentation of blood pressure and maternal weight between virtual and traditional face-to-face prenatal visits between January 2019 and June 2021. IRB exemption was obtained. The electronic medical record of a large midwest U.S. health system was utilized to identify prenatal visit encounters for all patients at all gestations. The visits were grouped into virtual visits and face-to-face visits. Data analytics were used to compare documentation of maternal weight, systolic blood pressure, and diastolic blood pressure for both subgroups. Data were further broken down by month to show comparison over time. Comparison was also made by gestational age.

RESULTS:
A total of 108,428 prenatal visits were identified. Of these, 7,004 (6.5%) were virtual visits. Appropriate documentation of blood pressure was absent in 3% of face-to-face visits and 46% of virtual visits. For the maternal weight, data were missing for 3% of face-to-face visits and 66% of virtual visits.

CONCLUSION:
Studies validating the safety of virtual prenatal visits are lacking. This analysis identifies obstacles that need to be overcome to improve the safety of virtual care.
Single-Dose Oral Secnidazole for Treatment of Trichomoniasis in Women With BV Co-infection [A119]
Authors: Muzny Christina A. , Kaufman Gregory , Sematczyn Anna , Pandey Brajesh , Chavoustie Steven E. 
Published: June 2022

INTRODUCTION:
Bacterial vaginosis (BV) and trichomoniasis are the most common causes of vaginitis. Both infections are associated with increased risk for HIV/STIs and adverse reproductive health outcomes. Coexistence of BV pathogens and Trichomoniasis vaginalis is common, with co-infection rates of 60–80%. In this secondary analysis of clinical trial data of single-dose oral secnidazole (SEC) for the treatment of women with trichomoniasis, we review a subset of women with both trichomoniasis and BV.

METHODS:
In an institutional review board‒approved study, women with clinically diagnosed trichomoniasis were randomized to SEC 2 g oral granules or placebo at baseline (Visit 1). At Visit 2 (days 6–12), patients were evaluated for test-of-cure by T. vaginalis culture and were provided the opposite treatment. The primary endpoint was microbiological cure (negative culture for T. vaginalis) at the TOC visit. BV was clinically diagnosed at both visits using Amsel’s criteria.

RESULTS:
Overall, 147 women were enrolled; the modified intent-to-treat (mITT) population included 131 randomized patients. Cure rates were 92.2% and 1.5% for SEC and placebo (P<.001). The per-protocol population included 119 patients. Cure rates were 94.9% and 1.7% for SEC and placebo, respectively. In the mITT subgroup of women with BV based on at least three Amsel criteria (n=79), cure rates for trichomoniasis were 97.67% (42/43) for SEC and 0/36 for placebo.

CONCLUSION:
Single-dose oral SEC was highly effective in treating trichomoniasis in women with BV co-infection. Co-infection is common and appropriate treatment for both infections is critical. SEC is the only FDA-approved single-dose treatment for BV in women and trichomoniasis in women and men.
Oral Ibrexafungerp Outcomes in Subjects With Refractory Vulvovaginal Candidiasis From an Open-Label Study (FURI) [A122]
Authors: Goje Oluwatosin , King Thomas , Angulo David , Azie Nkechi 
Published: June 2022

INTRODUCTION:
Ibrexafungerp, a novel one-day oral triterpenoid antifungal, was recently approved for the treatment of vulvovaginal candidiasis (VVC). Ibrexafungerp is a fungicidal with broad activity against Candida species, including fluconazole-resistant strains. We present data from an open-label Phase 3 study (FURI), which enrolled patients with refractory VVC utilizing a 3-day dose ibrexafungerp regimen.

METHODS:
FURI VVC subjects were included if they had proven or probable severe VVC, with evidence of treatment failure, intolerance, or toxicity to a currently approved standard-of-care antifungal treatment. Subjects with VVC received ibrexafungerp monotherapy given as oral doses of 375 mg twice daily every three days for a total of three dosing days (Day 1, Day 4, and Day 7). Global Response or Clinical Improvement, defined as complete or partial resolution of signs and symptoms with total vaginal signs and symptoms composite score<1, without need for additional antifungal, was measured at Day 17.

RESULTS:
There were 14 VVC patients enrolled in FURI from 2019 to 2021. All patients had previously failed other therapies, including fluconazole, and were referred to an infectious disease specialist at a tertiary-care setting. Global response measured at Day 17 indicated that 12 patients (85.7%) had clinical improvement, one patient had partial improvement and one patient was deemed indeterminate. Adverse events for ibrexafungerp were predominantly gastrointestinal, with mild-to-moderate diarrhea, nausea, and abdominal pain.

CONCLUSION:
These results demonstrate the therapeutic potential of a 3-day dose of oral ibrexafungerp for the treatment of patients with VVC who have failed other treatments.
Effects of the COVID-19 Pandemic on Tdap (Tetanus, Diphtheria, Pertussis) Vaccination During Prenatal Care [A123]
Authors: Smith Alicia , Paoletti Andrew , Jaspan David , Goldberg Jay 
Published: June 2022

INTRODUCTION:
It is recommended to administer the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. We evaluated whether the COVID-19 pandemic affected Tdap vaccination during periods when (1) many prenatal visits were via telemedicine and (2) patients might be vaccine wary due to COVID-19 vaccination misinformation.

METHODS:
This was a retrospective observational study using data queried from the Einstein Healthcare Network electronic medical record. The study included patients who delivered between 2019 and 2021 and their Tdap vaccination status during prenatal care. Chi-square tests compared vaccination rates between patients delivering at different times.

RESULTS:
Of the pre-pandemic pregnancy control group (n=1,408), 60% received Tdap vaccination. In the second quarter of 2020, when many prenatal visits were done via telemedicine, patients (n=688) were 1.3 times more likely to not receive Tdap vaccination (54%; P=.0033). During the second quarter of 2021, when there was much misinformation regarding COVID-19 vaccination, even with all prenatal visits being in person, patients (n=363) were 1.3 times more likely to not have received the Tdap vaccination (54%; P=.028). True percentages of Tdap vaccination were higher than those reported above due to 16% of patients who received either prenatal care elsewhere or no prenatal care, for whom no vaccination data was available.

CONCLUSION:
Compared to pre-COVID-19 pandemic, pregnant patients were less likely (OR, 1.3) to have consented to and received the Tdap vaccination during periods when (1) many prenatal visits were via telemedicine and (2) patients might be vaccine wary due to COVID-19 vaccination misinformation.
Increased Perinatal Morbidity and Mortality Among Asian American and Pacific Islander Women in the Military Health System [A149]
Authors: Grob Patrizia , Tindal Rachel R. , Hamilton Jameaka , Gonzalez-Brown Veronica , Keyser Erin A. , Lundeberg Kathleen R. 
Published: June 2022

INTRODUCTION:
Rates of maternal morbidity and mortality experienced by women in the United States have been shown to vary significantly by race, most commonly attributed to differences in access to health care and socioeconomic status. Recent data shows that Asian Pacific Islander (API) have highest rate of maternal morbidity, despite having higher socioeconomic status. In the military, women of all races are granted equal access to health care, irrespective of socioeconomic class. We hypothesized that within the military there would be no racial disparities in maternal outcome due to universal health care.

METHODS:
A retrospective cohort study included data from National Perinatal Information Center report from participating military treatment facilities from April 2019 to March 2020, totaling 36,861 deliveries. We compared racial differences in percentages in each of the following three categories: postpartum hemorrhage (PPH) and severe maternal morbidity (SMM) among women with postpartum hemorrhage including and excluding transfusion.

RESULTS:
MTFs included in the data showed an increased rate of PPH (RR, 1.73; 95% CI, 1.45–2.07), SMM including transfusion (RR, 1.22; 95% CI, 0.93–1.61), and SMM excluding transfusion (RR, 1.97; 95% CI, 1.02–3.8) in API women when compared to women of Black and White race.

CONCLUSION:
Even with equal access to health care in the military, API women experience increased rates of adverse maternal outcomes when compared to Black or White women. This highlights the need to continue to include API as a separate race for data collection and calls for further research into possible causes of this health care disparity.
Risk for Cesarean Delivery by Severity of Hypertension in Women of Advanced Maternal Age [A151]
Authors: Smithson Sarah , Rincon Monica , Burwick Richard M. 
Published: June 2022

INTRODUCTION:
Advanced maternal age (AMA) is associated with increased risk for hypertensive disorders of pregnancies (HDP) as well as cesarean delivery (CD). We sought to determine if severity of HDP increases CD risk among AMA women.

METHODS:
Cohort study of women with HDP, delivering at a single institution from 2013 to 2018. Participants were divided into four groups: chronic hypertension (CHTN), gestational hypertension (GHTN), preeclampsia (PE) without severe features, and PE with severe features. The CD rate was compared between AMA and non-AMA women, stratified by HDP group. Differences were evaluated by chi-square test or t test, and logistic regression was utilized to adjust for confounders, with significance at P<.05. This study was institutional review board‒approved.

RESULTS:
We identified 1,625 women with HDP, of whom 450 (28%) were AMA. CD rate was highest in PE with severe features compared to all other groups (P<.001). In AMA women, the CD rate also varied significantly by HDP, with the highest CD rate in PE with severe features compared to all other groups (P=.008). AMA was associated with increased odds of CD (OR, 1.6; 95% CI, 1.3–2.0; P<.001), and this association remained significant after adjustment for race-ethnicity, BMI, gestational age, parity, diabetes, and prior preeclampsia (aOR, 1.7; 95% CI, 1.0–2.7; P=.03).

CONCLUSION:
CD rates vary by severity of HDP and are significantly higher among AMA women with HDP compared to non-AMA women. This data may impact delivery counseling for AMA women, especially those with PE with severe features.
Clinical Application of a Previously Validated Pregnancy-Specific Screening Tool for Sleep Apnea [A165]
Authors: Bajaj Sakshi , Rice Alexandra L. , Jones Nathan , Jacobson Natalie , Bazalakova Mihaela , Antony Kathleen M. 
Published: June 2022

INTRODUCTION:
The purpose of this project was to determine the positive predictive value of existing obstructive sleep apnea (OSA) screening tools in clinical use and to explore the development of a new questionnaire for the screening of OSA during pregnancy.

METHODS:
Pregnant women as part of routine clinical practice were administered questionnaires from Facco’s four-variable OSA screening tool, STOP-BANG, and the Epworth Sleepiness Scale. Those who screened positive were referred for diagnostic OSA testing, typically with a type III home monitoring device, in routine use at the sleep clinic. Here we analyzed the screening responses used by those who completed diagnostic testing to determine the positive predictive value of the existing tools. We also sought to develop a new questionnaire for OSA screening during pregnancy. The project was approved by the institutional review board at UnityPoint Health-Meriter (Meriter IRB# 2019-014).

RESULTS:
A total of 159 women completed diagnostic OSA testing and were included in this analysis. The positive predictive value of Facco’s four-variable sleep screening tool was 74%, STOP-BANG was 75%, and the Epworth Sleepiness Scale was 69.8%. Our sample size was insufficient to create a new screening tool.

CONCLUSION:
Here we validated Facco’s four-variable tool for screening of OSA in pregnancy. While we were not able to generate a new screening tool for screening of OSA during pregnancy, both STOP-BANG and Facco’s four-variable tool had positive predictive values over 70% in our population, which was characterized by high BMI and advanced maternal age.
Inter-observer and Intra-observer Reliability for NICE 2017 Interpretation Guidelines for Cardiotopography [A167]
Authors: Ghuman Navdeep Kaur , Singhmor Priya , Singh Pratibha , Kathuria Priyanka , Sharma Charu 
Published: June 2022

INTRODUCTION:
The goal to standardize the interpretations of cardiotopography (CTG) graphs by various guidelines has met with a low degree of agreement between the observer and poor reproducibility.

METHODS:
The study was commenced following approval of the Institutional Research Committee & Institutional Ethics Committee (AIIMS/IEC/2019-20/824). Intrapartum CTG traces from 165 consecutive women were independently interpreted by six clinicians (three consultants and three residents in training) twice. Inter-observer and intra-observer agreement were calculated by SPSS software version 26 by calculating Fleiss's kappa and Cohen’s kappa coefficient, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of CTG for neonatal metabolic acidosis were computed.

RESULTS:
Among all CTG parameters, observed agreement for baseline was substantial (k=0.678) but the congruence for variability was only slightly above chance (k=0.196). Observers had moderate inter-observer reliability for the presence of decelerations among themselves (k=0.595). The intra-observer agreement was greatly influenced by the experience of observers (k for classifying CTG category was 0.552 for the senior consultant versus 0.473 for the junior resident). For detecting moderate metabolic acidosis (pH≤7.10), CTG had sensitivity 75%, specificity 77.78%, positive predictive value 14.6%, and negative predictive value 98.39%.

CONCLUSION:
The findings emphasize the role of training to improve inter-observer reliability. The higher degree of non-congruence in certain CTG parameters like variability and type of decelerations may perhaps point to the need for further objectivity in defining these parameters. CTG is a good screening tool in a high-risk population and owing to its high negative predictive value provides reassurance to patients and clinicians for fetal wellbeing.
Impact of Insurance Status on Outcomes in Patients With Placenta Accreta Spectrum [A173]
Authors: Hussein Nada , Rigaud Rachelle A. , Edwards Sara , Harrison Rachel , Holmgren Calla 
Published: June 2022

INTRODUCTION:
Placenta accreta spectrum (PAS) leads to significant maternal morbidity and mortality. We hypothesized that women with public insurance diagnosed with PAS have increased complications compared to those with private insurance.

METHODS:
This was a retrospective cohort study drawn from the Healthcare Utilization Project–National Inpatient Sample database from across the U.S. between January and December 2018. Inclusion criteria were those with an antepartum diagnosis of PAS, and we compared those with private to those with public insurance. The primary outcome was a composite of surgical complications, including organ/vascular injury or need for repair, ileus or bowel obstruction, IR intervention, or pelvic hematoma. The secondary outcomes were each individual component of the composite. Groups were compared via t tests, chi-square, and logistic regression analyses.

RESULTS:
A total of 1,401 women were eligible for analysis; of these, 709 had public insurance. Women with public insurance were more likely to be Black or Hispanic, of lower socioeconomic status, obese, tobacco users, and be diagnosed with placenta percreta (all P<.05). Those with public insurance had higher rates of the primary composite outcome of any surgical complication (17.0% versus 12.5%, P=.040). However, multivariable logistic regression showed no statistically significant difference in the composite of surgical complications (aOR, 1.19; 95% CI, 0.77–1.84) when adjusted for race, obesity, tobacco use, prior cesarean deliveries, and income, although women with public insurance were 2.5 times more likely to have an ileus or small bowel obstruction (aOR, 2.52; 95% CI, 1.05–6.05).

CONCLUSION:
In this cohort of women with PAS, insurance status was associated with higher rates of ileus or bowel obstruction.
Postpartum Readmission Rates for Hypertensive Disorders of Pregnancy During the COVID-19 Pandemic [A179]
Authors: Griffin Myah , Black Mara , Deeb Jessica , Hoskins Iffath A. 
Published: June 2022

INTRODUCTION:
To compare the postpartum (PP) readmission rates of patients with hypertensive disorders of pregnancy (HDP) before and after implementation of an early discharge policy due to the COVID-19 pandemic.

METHODS:
This is a retrospective, quality improvement study of patients with HDP who delivered and were readmitted at NYU Langone Health from March 1, 2019, to February 29, 2020 (Pre) and from April 1, 2020, to March 31, 2021 (Post). The primary outcome was comparison of PP readmission rates between groups. Data were analyzed using ANOVA, Fisher’s exact test, and chi-square test, with significance defined as P<.05.

RESULTS:
There was no statistical difference in readmission rates for PP HDP after implementation of an early discharge policy (19 readmissions of 1,851 deliveries with HDP [1.03%] versus 23 readmissions of 1,847 deliveries with HDP [1.25%]; P=.53). Demographics in each group were similar, as were mean times to readmission (6.4±5.4 days versus 6.4±5.4 days; P=.88) and mean readmission lengths of stay (3.0±1.04 days versus 3.3±1.2 days; P=.45). There was one ICU readmission in the post-group versus none in the pre-group (P=.45). There were no maternal deaths.

CONCLUSION:
These findings support reducing postpartum lengths of stay without increasing readmissions for HDP. The reduction of postpartum length of stay was accompanied by the continuation of a home blood pressure monitoring and introduction of outpatient HDP management guidelines. Further investigation into best practices to support early discharge is warranted.
Training Emergency Department Residents in the Management of Postpartum Hemorrhage: Comparison of Two Approaches [A183]
Authors: Casper Scott , Ray Jessica M. , Galerneau France , Evans Leigh , Slade Martin , Pal Lubna 
Published: June 2022

INTRODUCTION:
Postpartum hemorrhage (PPH) is a major contributor to maternal mortality, accounting for 15% of all maternal deaths in the United States. Mortality and morbidity from PPH can be prevented with recognition and rapid intervention. The emergency department (ED) is the first place where women with postpartum hemorrhage present, particularly in areas where obstetric care is limited. Maternity care deserts are defined as counties without a hospital offering obstetric care and no obstetric providers. A total of 34.9% of the counties in the United Sates qualify as maternity care deserts, accounting for 146,451 births. It is critical that ED physicians be trained in the management of PPH.

METHODS:
The study design is a blinded randomized control trial. Thirty ED residents from Yale New Haven Hospital enrolled completed a pre-intervention survey assessing their baseline knowledge and confidence in managing PPH. Residents received a lecture on the management of PPH. Participants were then randomized into a group that received no further intervention and a group that participated in a simulation and debriefing. One week later, the residents’ clinical skills were evaluated in a simulation and repeated the survey. Clinical skills evaluation and survey test scores of the two groups were compared using t test. Covariates were analyzed by linear regression.

RESULTS:
All participants improved their knowledge and confidence regardless of the method used. Simulation did not appear to confer additional benefit.

CONCLUSION:
This study demonstrated that through delivery of a curriculum, we can improve the confidence and the knowledge of ED residents in the management of PPH.