Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000929876.54020.ad
Aurora M. Phillips, R. Flink-bochacki, Sofia Rachad
INTRODUCTION: Miscarriage is common, and treatment modalities overlap with those used for induced abortion. In places where abortion is heavily regulated, clinicians managing miscarriages may cautiously rely on the strictest criteria to differentiate early pregnancy loss from potentially viable pregnancy and may not offer certain treatments commonly associated with abortion. METHODS: From November 2021 to January 2022, we conducted a cross-sectional study of all 296 U.S. obstetrics and gynecology residency programs, surveying each about their institution’s miscarriage practices. We compared miscarriage care by program characteristics, institutional abortion restrictions, and state legislative policies. RESULTS: Of 149 programs who responded (50.3% response rate), 74 (49.7%) reported strict reliance on conservative imaging criteria before offering any intervention for suspected early pregnancy loss, despite patient-centered society recommendations, while the remaining 75 (50.3%) reported incorporation of imaging guidelines with other factors. After controlling for other factors, institutional abortion restrictions were the only independent predictor of strict reliance on imaging guidelines (odds ratio 12.3, 95% CI 3.2–47.9). Mifepristone was used less at programs in states with hostile abortion legislation (32% versus 75%, P<.001) or with institutional abortion restrictions (25% versus 86%, P<.001). Similarly, office-based aspiration was lower in hostile states (48% versus 68%, P=.014) and with institutional abortion restrictions (40% versus 81%, P<.001). CONCLUSION: Academic institutions with restricted access to induced abortion are less likely to holistically incorporate clinical evidence and patient priorities in determining when to intervene for miscarriage and are less likely to offer the full range of treatment options. With abortion bans proliferating nationwide, evidence-based education and patient-centered care for miscarriage may also be imperiled.
前言:流产是常见的，治疗方式与那些用于人工流产重叠。在堕胎受到严格管制的地方，处理流产的临床医生可能会谨慎地依赖最严格的标准来区分早期妊娠丢失和潜在的存活妊娠，并且可能不会提供通常与流产相关的某些治疗。方法:从2021年11月到2022年1月，我们对所有296个美国妇产科住院医师项目进行了横断面研究，调查了每个机构的流产实践。我们比较了流产护理的项目特点、机构堕胎限制和州立法政策。结果:在149个有应答的项目中(50.3%应答率)，74个(49.7%)报告严格依赖保守的影像学标准，而不考虑以患者为中心的社会建议，而其余75个(50.3%)报告了影像学指南与其他因素的结合。在控制其他因素后，机构流产限制是严格依赖成像指南的唯一独立预测因子(优势比12.3,95% CI 3.2-47.9)。米非司酮在堕胎立法不友好的州(32%对75%，P<.001)或机构堕胎限制(25%对86%，P<.001)的项目中使用较少。同样，在敌对国家，以办公室为基础的妊娠率较低(48%对68%，P= 0.014)，在机构堕胎限制中(40%对81%，P< 0.001)。结论:限制人工流产的学术机构在决定何时干预流产时不太可能全面纳入临床证据和患者优先事项，也不太可能提供全方位的治疗选择。随着堕胎禁令在全国范围内的扩散，以证据为基础的教育和以病人为中心的流产护理也可能受到危害。
{"title":"The Association Between Abortion Restrictions and Patient-Centered Miscarriage Care: A Cross-Sectional Study of U.S. Obstetrics and Gynecology Residency Programs [ID: 1377546]","authors":"Aurora M. Phillips, R. Flink-bochacki, Sofia Rachad","doi":"10.1097/01.AOG.0000929876.54020.ad","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929876.54020.ad","url":null,"abstract":"INTRODUCTION: Miscarriage is common, and treatment modalities overlap with those used for induced abortion. In places where abortion is heavily regulated, clinicians managing miscarriages may cautiously rely on the strictest criteria to differentiate early pregnancy loss from potentially viable pregnancy and may not offer certain treatments commonly associated with abortion. METHODS: From November 2021 to January 2022, we conducted a cross-sectional study of all 296 U.S. obstetrics and gynecology residency programs, surveying each about their institution’s miscarriage practices. We compared miscarriage care by program characteristics, institutional abortion restrictions, and state legislative policies. RESULTS: Of 149 programs who responded (50.3% response rate), 74 (49.7%) reported strict reliance on conservative imaging criteria before offering any intervention for suspected early pregnancy loss, despite patient-centered society recommendations, while the remaining 75 (50.3%) reported incorporation of imaging guidelines with other factors. After controlling for other factors, institutional abortion restrictions were the only independent predictor of strict reliance on imaging guidelines (odds ratio 12.3, 95% CI 3.2–47.9). Mifepristone was used less at programs in states with hostile abortion legislation (32% versus 75%, P<.001) or with institutional abortion restrictions (25% versus 86%, P<.001). Similarly, office-based aspiration was lower in hostile states (48% versus 68%, P=.014) and with institutional abortion restrictions (40% versus 81%, P<.001). CONCLUSION: Academic institutions with restricted access to induced abortion are less likely to holistically incorporate clinical evidence and patient priorities in determining when to intervene for miscarriage and are less likely to offer the full range of treatment options. With abortion bans proliferating nationwide, evidence-based education and patient-centered care for miscarriage may also be imperiled.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81587783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000931260.84787.fb
J. Simon, S. Jewell, Moming Li, J. Ng, B. Pinsky
INTRODUCTION: Patients with heavy menstrual bleeding (HMB) associated with uterine fibroids (UFs) have significantly improved menstrual blood loss (MBL) when taking elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) versus placebo. However, data on the effect of ELA+AB on nonbleeding symptoms are limited. METHODS: This post hoc analysis from the duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated the Patients Global Impression of Change (PGIC). Patients rated symptom change for menstrual bleeding (MB) and nonbleeding symptoms on a 7-point scale from “very much improved” (1) to “very much worse” (7). RESULTS: By 6 months, scores for the PGIC-MB and the domains of “abdominal or pelvic pain,” “abdominal or pelvic pressure,” “abdominal or pelvic cramping,” “back pain,” and “abdominal bloating” were significantly better (P<.001 for all; no adjustment for multiple comparisons were made) in the ELA+AB versus placebo groups, regardless of patient age (<40 years, 40 to <45 years, ≥45 years), baseline MBL (less than median [187.0 mL], greater than or equal to median), International Federation of Gynecology and Obstetrics (FIGO) classification (0–3, 4, 5–8), or baseline uterine volume (less than median [356.5 cm3], greater than or equal to median). Patients receiving ELA+AB reported PGIC domain scores that consistently exceeded “minimally improved” (≤3) and often reached or exceeded “much improved” (≤2) by 6 months. CONCLUSION: ELA+AB provides better bleeding and nonbleeding symptom improvement versus placebo for patients with HMB associated with UFs, regardless of subpopulation investigated. In all populations, PGIC-MB and domain scores consistently reached or exceeded “much improved” by 6 months with ELA+AB.
{"title":"Elagolix Plus Add-Back Consistently Improves Uterine Fibroids-Associated Bleeding and Nonbleeding Symptoms Across Subpopulations [ID: 1368059]","authors":"J. Simon, S. Jewell, Moming Li, J. Ng, B. Pinsky","doi":"10.1097/01.aog.0000931260.84787.fb","DOIUrl":"https://doi.org/10.1097/01.aog.0000931260.84787.fb","url":null,"abstract":"INTRODUCTION: Patients with heavy menstrual bleeding (HMB) associated with uterine fibroids (UFs) have significantly improved menstrual blood loss (MBL) when taking elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) versus placebo. However, data on the effect of ELA+AB on nonbleeding symptoms are limited. METHODS: This post hoc analysis from the duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated the Patients Global Impression of Change (PGIC). Patients rated symptom change for menstrual bleeding (MB) and nonbleeding symptoms on a 7-point scale from “very much improved” (1) to “very much worse” (7). RESULTS: By 6 months, scores for the PGIC-MB and the domains of “abdominal or pelvic pain,” “abdominal or pelvic pressure,” “abdominal or pelvic cramping,” “back pain,” and “abdominal bloating” were significantly better (P<.001 for all; no adjustment for multiple comparisons were made) in the ELA+AB versus placebo groups, regardless of patient age (<40 years, 40 to <45 years, ≥45 years), baseline MBL (less than median [187.0 mL], greater than or equal to median), International Federation of Gynecology and Obstetrics (FIGO) classification (0–3, 4, 5–8), or baseline uterine volume (less than median [356.5 cm3], greater than or equal to median). Patients receiving ELA+AB reported PGIC domain scores that consistently exceeded “minimally improved” (≤3) and often reached or exceeded “much improved” (≤2) by 6 months. CONCLUSION: ELA+AB provides better bleeding and nonbleeding symptom improvement versus placebo for patients with HMB associated with UFs, regardless of subpopulation investigated. In all populations, PGIC-MB and domain scores consistently reached or exceeded “much improved” by 6 months with ELA+AB.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83926786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000931000.56844.2d
C. Russell, T. Beyuo, E. Lawrence, S. Oppong, R. Owusu-Antwi
INTRODUCTION: Despite maternal and perinatal mortality disproportionately occurring in low- and middle-income countries, there are limited data on the emotional toll these losses have on obstetric providers. In a series of focus groups discussions (FGDs), this study delves into the experiences of physicians and midwives in Ghana after maternal and perinatal losses. METHODS: Participants were obstetrician/gynecologists and midwives at the two largest tertiary hospitals in Ghana. Five FGDs were conducted by a trained facilitator, using a semi-structured guide. Questions explored experiences after patient deaths and perspectives on supportive interventions for providers. FGDs were audio-recorded and transcribed verbatim. Using an iteratively developed codebook, transcripts were thematically analyzed with NVivo. Written informed consent and IRB approvals were obtained. RESULTS: Twenty obstetricians and 32 midwives participated in five FGDs in Accra and Kumasi, Ghana. Most providers (84%) had completed training, and almost half (46%) had been in practice for above 10 years. Three major themes emerged: 1) pervasive stigma about seeking mental health services, especially from psychiatrists, rooted in cultural norms; 2) skepticism about departmental and peer confidentiality if providers seek support after poor outcomes; 3) profound sense of blame, both from self and peers, that resulted in poor mortality audit attendance and effects on workplace performance. Despite numerous barriers, providers expressed a strong need for improved departmental and institutional support systems. CONCLUSION: This study uncovers key barriers for providers to access mental health care and support after experiencing maternal and perinatal mortalities. Findings should inform interventions to better support struggling providers.
{"title":"Stigma, Confidentiality, and Blame: Qualitative Focus Groups of Ghanaian Obstetric Providers After Maternal and Perinatal Losses [ID: 1377293]","authors":"C. Russell, T. Beyuo, E. Lawrence, S. Oppong, R. Owusu-Antwi","doi":"10.1097/01.aog.0000931000.56844.2d","DOIUrl":"https://doi.org/10.1097/01.aog.0000931000.56844.2d","url":null,"abstract":"INTRODUCTION: Despite maternal and perinatal mortality disproportionately occurring in low- and middle-income countries, there are limited data on the emotional toll these losses have on obstetric providers. In a series of focus groups discussions (FGDs), this study delves into the experiences of physicians and midwives in Ghana after maternal and perinatal losses. METHODS: Participants were obstetrician/gynecologists and midwives at the two largest tertiary hospitals in Ghana. Five FGDs were conducted by a trained facilitator, using a semi-structured guide. Questions explored experiences after patient deaths and perspectives on supportive interventions for providers. FGDs were audio-recorded and transcribed verbatim. Using an iteratively developed codebook, transcripts were thematically analyzed with NVivo. Written informed consent and IRB approvals were obtained. RESULTS: Twenty obstetricians and 32 midwives participated in five FGDs in Accra and Kumasi, Ghana. Most providers (84%) had completed training, and almost half (46%) had been in practice for above 10 years. Three major themes emerged: 1) pervasive stigma about seeking mental health services, especially from psychiatrists, rooted in cultural norms; 2) skepticism about departmental and peer confidentiality if providers seek support after poor outcomes; 3) profound sense of blame, both from self and peers, that resulted in poor mortality audit attendance and effects on workplace performance. Despite numerous barriers, providers expressed a strong need for improved departmental and institutional support systems. CONCLUSION: This study uncovers key barriers for providers to access mental health care and support after experiencing maternal and perinatal mortalities. Findings should inform interventions to better support struggling providers.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81107471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930512.24906.d7
A. Kostolias, Zia Husnain, Jane A. James, Adolphia Lauture, Maximiliano Mayrink, J. Pérez
INTRODUCTION: Mount Sinai Medical Center (MSMC) in Miami Beach, Florida, is home to a diverse and international obstetric population. In 2017, the state of Florida had a cesarean delivery (CD) rate for nulliparous, term, singleton, vertex (NTSV) of 31.1%, the highest in the nation. Mount Sinai Medical Center had a NTSV CD rate of 38.3%. The national rate of NTSV CD in 2017 was 26%. Mount Sinai Medical Center joined PROVIDE (Promoting Primary Vaginal Deliveries), a statewide initiative by the Florida Perinatal Quality Collaborative with the goal of improving maternal and newborn outcomes by applying evidence-based interventions and reducing NTSV CD rates. METHODS: The implementation of an obstetrics and gynecology residency program and monthly grand rounds contributed to an effort of evidence-based medicine. The interventions implemented were nurse education of labor positioning from Bundle Births and Spinning Babies, nursing recognition as “Vaginal Queen of the Month,” Bishop score documentation added to H&P, obstetric physicians assigned “Badge Buddies” next to their hospital ID cards disclosing their personal NTSV CD rate, and a pre-cesarean checklist for labor dystocia or failed induction. RESULTS: After 2 years of multifaceted interventions, MSMC had decreased its cesarean delivery rate for NTSV patients from 38.3% in 2017 to 27.7% in 2019. The average rate in Florida overall was 29.7% in 2019 and the national rate of CD in NTSV patients was 25.6% in 2019 (data source: FPQC Perinatal Indicator System). CONCLUSION: With continued interventions, we hypothesize that we will meet the healthy people 2030 target CD for NTSV rate of 23.6% as the initiative enters its sustainability phase.
{"title":"Reduction of Cesarean Delivery Rates in South Florida: The MSMC Experience [ID: 1370319]","authors":"A. Kostolias, Zia Husnain, Jane A. James, Adolphia Lauture, Maximiliano Mayrink, J. Pérez","doi":"10.1097/01.aog.0000930512.24906.d7","DOIUrl":"https://doi.org/10.1097/01.aog.0000930512.24906.d7","url":null,"abstract":"INTRODUCTION: Mount Sinai Medical Center (MSMC) in Miami Beach, Florida, is home to a diverse and international obstetric population. In 2017, the state of Florida had a cesarean delivery (CD) rate for nulliparous, term, singleton, vertex (NTSV) of 31.1%, the highest in the nation. Mount Sinai Medical Center had a NTSV CD rate of 38.3%. The national rate of NTSV CD in 2017 was 26%. Mount Sinai Medical Center joined PROVIDE (Promoting Primary Vaginal Deliveries), a statewide initiative by the Florida Perinatal Quality Collaborative with the goal of improving maternal and newborn outcomes by applying evidence-based interventions and reducing NTSV CD rates. METHODS: The implementation of an obstetrics and gynecology residency program and monthly grand rounds contributed to an effort of evidence-based medicine. The interventions implemented were nurse education of labor positioning from Bundle Births and Spinning Babies, nursing recognition as “Vaginal Queen of the Month,” Bishop score documentation added to H&P, obstetric physicians assigned “Badge Buddies” next to their hospital ID cards disclosing their personal NTSV CD rate, and a pre-cesarean checklist for labor dystocia or failed induction. RESULTS: After 2 years of multifaceted interventions, MSMC had decreased its cesarean delivery rate for NTSV patients from 38.3% in 2017 to 27.7% in 2019. The average rate in Florida overall was 29.7% in 2019 and the national rate of CD in NTSV patients was 25.6% in 2019 (data source: FPQC Perinatal Indicator System). CONCLUSION: With continued interventions, we hypothesize that we will meet the healthy people 2030 target CD for NTSV rate of 23.6% as the initiative enters its sustainability phase.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89616862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000929704.34094.4a
Savannah Groves, A. Hsu
INTRODUCTION: Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine. METHODS: This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683). RESULTS: In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331). CONCLUSION: In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.
{"title":"Intrauterine Insemination (IUI) Pregnancy Rates After COVID-19 Vaccination [ID: 1376042]","authors":"Savannah Groves, A. Hsu","doi":"10.1097/01.aog.0000929704.34094.4a","DOIUrl":"https://doi.org/10.1097/01.aog.0000929704.34094.4a","url":null,"abstract":"INTRODUCTION: Public concern over the potential negative effect of COVID-19 vaccines on fertility has persisted, as confidence in COVID-19 vaccines remains low, especially in certain Midwestern populations. We evaluated the success of intrauterine inseminations (IUIs) in achieving pregnancy in women who self-report receiving at least one dose of the vaccine against SARS-CoV-2, compared with women who self-report declining the vaccine. METHODS: This is a retrospective cohort study of 109 IUI procedures in women receiving fertility treatment at the University of Missouri Reproductive Endocrinology and Infertility clinic from October 2021 through September 2022. Participants were grouped based on self-reported COVID-19 vaccination status, prior to their IUI. The primary outcome was pregnancy after IUI, as verified by a serum pregnancy test. This study was performed under University of Missouri IRB approval (IRB #MU2062683). RESULTS: In comparing women self-reporting COVID-19 vaccination versus nonvaccination, no statistical differences were found for positive serum pregnancy tests after IUI (17.3% among vaccinated; 21.7% among nonvaccinated). Although these IUI success rates are higher than the national average, there was no significant difference in pregnancy rates (P=.6331). CONCLUSION: In this limited sample, self-reported COVID-19 vaccination status does not appear to have a significant negative effect on the ability to conceive a pregnancy with IUI. Further prospective studies should evaluate the effect of male partner or sperm donor vaccination, the number and type of COVID-19 vaccines received, pregnancy outcomes, and confounders. This study may help address the ongoing questions of whether the COVID-19 vaccines have a significant negative effect on fertility and pregnancy outcomes.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90073005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930236.89093.3c
Roxana Richardson, Lisa P. Kessler, L. Patchen, D. Perry, Caitlin Schille Jensen, A. Thomas
INTRODUCTION: Health-harming legal needs (HHLNs), social determinants of health that have a legal remedy, are drivers of poor health outcomes for Black women and children. HHLNs include inadequate access to safe housing, employment accommodations, and income supports. A medical–legal partnership (MLP) adds an attorney to the health care team to address patients’ HHLNs in a variety of health care settings. The Perinatal LAW Project (P-LAW), an MLP between the Georgetown University Health Justice Alliance and MedStar Washington Hospital Center Women’s & Infants’ Services, addresses perinatal patients’ HHLNs in an obstetrics and gynecology practice. METHODS: Perinatal LAW Project attorneys record client and case data in a legal case management system. The research team analyzed data for the first 18 months of the program (March 2021 to September 2022). RESULTS: One hundred thirty-one patients were referred for legal assistance, primarily by social workers and health navigators. Most patients were in their second and third trimesters. The majority of patients were Black or African American, aged 20–34, and lived under 200% FPL. The most common legal issues were in the areas of employment (parental leave, discrimination), housing (conditions, eviction), public benefits (food stamps, disability benefits), and family law (child support, domestic violence). The P-LAW addressed 150 legal issues and served 117 patients. CONCLUSION: Medical–legal partnership is a novel approach to addressing maternal health disparities. In our experience, legal services have a high utilization rate and patients often have more than one legal need. Future efforts to measure patient outcomes, including reduced maternal stress and medical appointment attendance, will build the evidence base for MLP in the perinatal context.
{"title":"Integrating Lawyers into the Perinatal Health Care Team: Initial Findings From an Innovative Medical–Legal Partnership [ID: 1377957]","authors":"Roxana Richardson, Lisa P. Kessler, L. Patchen, D. Perry, Caitlin Schille Jensen, A. Thomas","doi":"10.1097/01.aog.0000930236.89093.3c","DOIUrl":"https://doi.org/10.1097/01.aog.0000930236.89093.3c","url":null,"abstract":"INTRODUCTION: Health-harming legal needs (HHLNs), social determinants of health that have a legal remedy, are drivers of poor health outcomes for Black women and children. HHLNs include inadequate access to safe housing, employment accommodations, and income supports. A medical–legal partnership (MLP) adds an attorney to the health care team to address patients’ HHLNs in a variety of health care settings. The Perinatal LAW Project (P-LAW), an MLP between the Georgetown University Health Justice Alliance and MedStar Washington Hospital Center Women’s & Infants’ Services, addresses perinatal patients’ HHLNs in an obstetrics and gynecology practice. METHODS: Perinatal LAW Project attorneys record client and case data in a legal case management system. The research team analyzed data for the first 18 months of the program (March 2021 to September 2022). RESULTS: One hundred thirty-one patients were referred for legal assistance, primarily by social workers and health navigators. Most patients were in their second and third trimesters. The majority of patients were Black or African American, aged 20–34, and lived under 200% FPL. The most common legal issues were in the areas of employment (parental leave, discrimination), housing (conditions, eviction), public benefits (food stamps, disability benefits), and family law (child support, domestic violence). The P-LAW addressed 150 legal issues and served 117 patients. CONCLUSION: Medical–legal partnership is a novel approach to addressing maternal health disparities. In our experience, legal services have a high utilization rate and patients often have more than one legal need. Future efforts to measure patient outcomes, including reduced maternal stress and medical appointment attendance, will build the evidence base for MLP in the perinatal context.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83353823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000931196.59419.50
Jamie Mcilvaine, J. Foncham, A. Francis, E. Kayaalp
INTRODUCTION: YouTube has emerged as a common resource used by ob-gyn residents to learn procedural skills. There has not been any research conducted that examines the relationship between video characteristics and the quality and accuracy of ob-gyn procedural videos. The purpose of this study was to assess whether YouTube video metrics, including number of likes, views, channel subscribers, geographic location, and organizational affiliations, can be used to gauge the quality and accuracy of ob-gyn procedural videos. METHODS: Using American College of Obstetricians and Gynecologists (ACOG) surgical curriculum topics, we conducted a search query into YouTube and sorted by relevance. Screening criteria were used to exclude videos. We then recorded video characteristics and scored the videos using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) video assessment tool for quality. Additionally, we scored videos for accuracy by comparing them to the ACOG Surgical Curriculum in Obstetrics and Gynecology (SCOG) checklist. RESULTS: Of the 306 videos analyzed, number of likes, views, channel subscribers, and geographic location were not of high quality with LAP-VEGaS scores less than 11. The number of likes, views, and channel subscribers were not significantly associated with LAP-VEGaS or SCOG accuracy. There was a significant difference in LAP-VEGaS score and SCOG accuracy with international health care organization/specialty society with P values of .004 and .001, respectively. CONCLUSION: Of the characteristics studied, number of likes, views, and channel subscribers, and geographic location did not have a statistically significant difference in accuracy of educational value. Only association with international health care organizations/specialty societies was significantly associated with an increased LAP-VEGaS, indicating increased quality of video and increased percent accuracy by ACOG standards.
{"title":"Are There Video Characteristics That Improve the Accuracy and Quality of Ob-Gyn Procedural Videos? [ID: 1376966]","authors":"Jamie Mcilvaine, J. Foncham, A. Francis, E. Kayaalp","doi":"10.1097/01.AOG.0000931196.59419.50","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931196.59419.50","url":null,"abstract":"INTRODUCTION: YouTube has emerged as a common resource used by ob-gyn residents to learn procedural skills. There has not been any research conducted that examines the relationship between video characteristics and the quality and accuracy of ob-gyn procedural videos. The purpose of this study was to assess whether YouTube video metrics, including number of likes, views, channel subscribers, geographic location, and organizational affiliations, can be used to gauge the quality and accuracy of ob-gyn procedural videos. METHODS: Using American College of Obstetricians and Gynecologists (ACOG) surgical curriculum topics, we conducted a search query into YouTube and sorted by relevance. Screening criteria were used to exclude videos. We then recorded video characteristics and scored the videos using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) video assessment tool for quality. Additionally, we scored videos for accuracy by comparing them to the ACOG Surgical Curriculum in Obstetrics and Gynecology (SCOG) checklist. RESULTS: Of the 306 videos analyzed, number of likes, views, channel subscribers, and geographic location were not of high quality with LAP-VEGaS scores less than 11. The number of likes, views, and channel subscribers were not significantly associated with LAP-VEGaS or SCOG accuracy. There was a significant difference in LAP-VEGaS score and SCOG accuracy with international health care organization/specialty society with P values of .004 and .001, respectively. CONCLUSION: Of the characteristics studied, number of likes, views, and channel subscribers, and geographic location did not have a statistically significant difference in accuracy of educational value. Only association with international health care organizations/specialty societies was significantly associated with an increased LAP-VEGaS, indicating increased quality of video and increased percent accuracy by ACOG standards.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91127983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930996.24850.1a
Hayley Rogovin, H. Arem, T. Auguste, Christine Laccay, L. Patchen, Angela Thomas
INTRODUCTION: The District of Columbia has one of the highest maternal mortality rates in the United States. It is estimated that clinical factors account for 20% of health outcomes; the remaining 80% are attributable to other factors including social determinants of health (SDOH). This quality improvement project aims to examine the effectiveness of utilizing screening tools to identify social risk factors during the perinatal period. METHODS: We conducted a retrospective analysis of birthing individuals who completed our SDOH screening tool between April 1, 2021, and March 31, 2022. There were 1,106 birthing individuals screened. Social determinants of health were divided into seven risk categories: food insecurity, housing conditions, transportation, safety, legal, finance, and social support. Occurrences of each risk category were analyzed and compared for those who screened at both the pregnancy and postpartum stages. RESULTS: Of the 1,106 patients screened, 72% of the patients screened positive by reporting at least one social risk factor. Of those who screened positive, 81% requested general support. The primary needs identified were transportation (42%) and housing conditions (27%). Of 216 patients who were seen during pregnancy and postpartum, 24% had a decrease in the number of positive social risk categories from pregnancy to postpartum; 24% had the same; and 52% had an increase. There was a decrease in the number of patients with housing conditions; transportation needs increased. CONCLUSION: A majority of our perinatal patients report at least one social risk factor. The next step is to strengthen our ability to respond to resource needs identified by routine screening.
{"title":"Early Indicators That Universal Screening for Social Risk Factors Is Essential in the Perinatal Period [ID: 1381099]","authors":"Hayley Rogovin, H. Arem, T. Auguste, Christine Laccay, L. Patchen, Angela Thomas","doi":"10.1097/01.aog.0000930996.24850.1a","DOIUrl":"https://doi.org/10.1097/01.aog.0000930996.24850.1a","url":null,"abstract":"INTRODUCTION: The District of Columbia has one of the highest maternal mortality rates in the United States. It is estimated that clinical factors account for 20% of health outcomes; the remaining 80% are attributable to other factors including social determinants of health (SDOH). This quality improvement project aims to examine the effectiveness of utilizing screening tools to identify social risk factors during the perinatal period. METHODS: We conducted a retrospective analysis of birthing individuals who completed our SDOH screening tool between April 1, 2021, and March 31, 2022. There were 1,106 birthing individuals screened. Social determinants of health were divided into seven risk categories: food insecurity, housing conditions, transportation, safety, legal, finance, and social support. Occurrences of each risk category were analyzed and compared for those who screened at both the pregnancy and postpartum stages. RESULTS: Of the 1,106 patients screened, 72% of the patients screened positive by reporting at least one social risk factor. Of those who screened positive, 81% requested general support. The primary needs identified were transportation (42%) and housing conditions (27%). Of 216 patients who were seen during pregnancy and postpartum, 24% had a decrease in the number of positive social risk categories from pregnancy to postpartum; 24% had the same; and 52% had an increase. There was a decrease in the number of patients with housing conditions; transportation needs increased. CONCLUSION: A majority of our perinatal patients report at least one social risk factor. The next step is to strengthen our ability to respond to resource needs identified by routine screening.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91132499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.AOG.0000931088.65427.7d
S. Hull, Tami Alade, Patricia Moriarty, R. Scott, Hannah Sinks, Jennifer Zack
INTRODUCTION: Black cisgender women bear a disproportionate burden of the U.S. human immunodeficiency virus (HIV) epidemic, compared to women of other racial groups. Preexposure prophylaxis (PrEP) is a highly effective prevention tool. Evidence indicates that Black women are interested in initiating PrEP, but low utilization persists in this population. Historical mistreatment of women of color and the resulting distrust erect barriers to open communication and shared decision-making with health care providers. METHODS: Using an IRB-approved questionnaire, we surveyed 186 consenting adults (83% Black, 9% White, 3% American Indian/Alaskan Native, 4% Other), who were PrEP eligible, HIV seronegative, cisgender women, recruited from family planning and obstetrics and gynecology specialty clinics in Washington, DC. We tested the interaction of patient racial identification and group-based medical mistrust on intentions to use PrEP, as mediated by intentions to discuss PrEP with a health care provider during the imminent clinical interaction. RESULTS: Results indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months (index −0.3093, SE 0.1886, 95% CI [–0.7455,–0.0122]) and 12 months (index −0.3248, SE 0.1987, 95% CI [–0.7827,–0.0040]) through anticipated discussion with a provider. CONCLUSION: When distrust is low, Black women had stronger intentions to utilize PrEP (relative to women of other racial groups). This was explained by stronger intentions to discuss PrEP with the provider during the clinical visit. This relationship was nonsignificant at moderate and high levels of distrust. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity.
{"title":"The Association Between Medical Distrust and the Intention to Initiate Preexposure Prophylaxis (PrEP) in HIV-Seronegative Cisgender Women of Color Within the DC Area [ID: 1377701]","authors":"S. Hull, Tami Alade, Patricia Moriarty, R. Scott, Hannah Sinks, Jennifer Zack","doi":"10.1097/01.AOG.0000931088.65427.7d","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931088.65427.7d","url":null,"abstract":"INTRODUCTION: Black cisgender women bear a disproportionate burden of the U.S. human immunodeficiency virus (HIV) epidemic, compared to women of other racial groups. Preexposure prophylaxis (PrEP) is a highly effective prevention tool. Evidence indicates that Black women are interested in initiating PrEP, but low utilization persists in this population. Historical mistreatment of women of color and the resulting distrust erect barriers to open communication and shared decision-making with health care providers. METHODS: Using an IRB-approved questionnaire, we surveyed 186 consenting adults (83% Black, 9% White, 3% American Indian/Alaskan Native, 4% Other), who were PrEP eligible, HIV seronegative, cisgender women, recruited from family planning and obstetrics and gynecology specialty clinics in Washington, DC. We tested the interaction of patient racial identification and group-based medical mistrust on intentions to use PrEP, as mediated by intentions to discuss PrEP with a health care provider during the imminent clinical interaction. RESULTS: Results indicate significant moderated mediation of the interaction between race and distrust on intention to initiate PrEP at 3 months (index −0.3093, SE 0.1886, 95% CI [–0.7455,–0.0122]) and 12 months (index −0.3248, SE 0.1987, 95% CI [–0.7827,–0.0040]) through anticipated discussion with a provider. CONCLUSION: When distrust is low, Black women had stronger intentions to utilize PrEP (relative to women of other racial groups). This was explained by stronger intentions to discuss PrEP with the provider during the clinical visit. This relationship was nonsignificant at moderate and high levels of distrust. These results underscore the critical importance of provider-initiated discussion of PrEP with women to improve health equity.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78824021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930872.37320.85
Sabrina C Burn, Lou Clark, Sarah Cross, Julie Johnson Rolfes, Joseph M. Miller
INTRODUCTION: The objective of this study was to determine the feasibility and effectiveness of multidisciplinary simulation in the development of skills required for high-risk periviability counseling. METHODS: Trainees were recruited from the University of Minnesota to participate in a faculty-observed standardized high-risk periviability patient simulation. The simulation was unique in that multiple specialties collaborated in the evaluation, counseling, and management of their patient. Trainees completed presimulation and postsimulation knowledge and comfort self-assessment surveys to evaluate skill improvement and merit of the study. Evaluations were also performed by faculty and simulated patients. An IRB waiver was obtained. RESULTS: Of the 18 participants, there were 6 neonatal intensive care unit fellows, 2 maternal–fetal medicine fellows, and 10 senior ob-gyn residents. Presimulation and postsimulation Likert surveys with scale 1–5, showed improvement in the ability of trainees to elicit patient values and tailor their conversations (pre-mean 2.84, SD 0.67; post-mean 3.39, SD 0.59), use patient-centered language (pre-mean 3.37, SD 0.74; post-mean 3.89, SD 0.57), ally with patients (pre-mean 3.37, SD 0.93; post-mean 3.94, SD 0.52), provide difficult medical information (pre-mean 3.32, SD 1.03; post-mean 3.67, SD 0.58), discuss medical uncertainty (pre-mean 3.11, SD 0.79; post-mean 3.50, SD 0.60), and understand their own implicit biases (pre-mean 3.26, SD 0.71; post-mean 3.50, SD 0.60). Trainees also reported an increased use of hopeful language that did not focus on statistical outcomes (pre-mean 3.00, SD 0.65; post-mean 3.33, SD 0.47) and discussion of multiple management options, including comfort cares (pre-mean 2.05, SD 1.05; post-mean 2.94, SD 0.85). The post surveys also reflected that trainees felt the simulation was useful, provided a safe environment to practice counseling (mean 4.83, SD 0.37), and better prepared them for future high-risk obstetrical scenarios (mean 4.83, SD 0.37). CONCLUSION: Multidisciplinary high-risk obstetrical simulation offers a unique opportunity for trainees to receive structured training and improve their ability to collaboratively counsel in rare high-risk obstetrical scenarios.
{"title":"Multidisciplinary High-Risk Obstetrical Simulation Improves Periviability Counseling [ID: 1366577]","authors":"Sabrina C Burn, Lou Clark, Sarah Cross, Julie Johnson Rolfes, Joseph M. Miller","doi":"10.1097/01.aog.0000930872.37320.85","DOIUrl":"https://doi.org/10.1097/01.aog.0000930872.37320.85","url":null,"abstract":"INTRODUCTION: The objective of this study was to determine the feasibility and effectiveness of multidisciplinary simulation in the development of skills required for high-risk periviability counseling. METHODS: Trainees were recruited from the University of Minnesota to participate in a faculty-observed standardized high-risk periviability patient simulation. The simulation was unique in that multiple specialties collaborated in the evaluation, counseling, and management of their patient. Trainees completed presimulation and postsimulation knowledge and comfort self-assessment surveys to evaluate skill improvement and merit of the study. Evaluations were also performed by faculty and simulated patients. An IRB waiver was obtained. RESULTS: Of the 18 participants, there were 6 neonatal intensive care unit fellows, 2 maternal–fetal medicine fellows, and 10 senior ob-gyn residents. Presimulation and postsimulation Likert surveys with scale 1–5, showed improvement in the ability of trainees to elicit patient values and tailor their conversations (pre-mean 2.84, SD 0.67; post-mean 3.39, SD 0.59), use patient-centered language (pre-mean 3.37, SD 0.74; post-mean 3.89, SD 0.57), ally with patients (pre-mean 3.37, SD 0.93; post-mean 3.94, SD 0.52), provide difficult medical information (pre-mean 3.32, SD 1.03; post-mean 3.67, SD 0.58), discuss medical uncertainty (pre-mean 3.11, SD 0.79; post-mean 3.50, SD 0.60), and understand their own implicit biases (pre-mean 3.26, SD 0.71; post-mean 3.50, SD 0.60). Trainees also reported an increased use of hopeful language that did not focus on statistical outcomes (pre-mean 3.00, SD 0.65; post-mean 3.33, SD 0.47) and discussion of multiple management options, including comfort cares (pre-mean 2.05, SD 1.05; post-mean 2.94, SD 0.85). The post surveys also reflected that trainees felt the simulation was useful, provided a safe environment to practice counseling (mean 4.83, SD 0.37), and better prepared them for future high-risk obstetrical scenarios (mean 4.83, SD 0.37). CONCLUSION: Multidisciplinary high-risk obstetrical simulation offers a unique opportunity for trainees to receive structured training and improve their ability to collaboratively counsel in rare high-risk obstetrical scenarios.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79468128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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