Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000931148.27353.d4
Etoi A. Garrison, Amita K. Bey, E. Jiménez, Andria Li, A. Nettles
INTRODUCTION: Birthing people with limited English proficiency (LEP) often face systemic limitations to care and are at increased risk for disparate birth outcomes due to barriers in patient–provider communication. Patients with LEP are particularly vulnerable to biases and microaggressions that can limit timely health care delivery and the quality of services received. We developed a multidisciplinary curriculum to educate providers about 1) unconscious bias (UCB), 2) barriers to equitable health care delivery for patients with LEP, and 3) use of trained interpreter services to promote patient–provider communication. METHODS: We developed a 60-minute workshop for physicians/midwives/nurses (n=75). Surveys were used to assess change in knowledge. Results were evaluated by descriptive statistics, t tests for significance, and thematic analysis. Institutional review board approval was obtained. RESULTS: Approximately 75 participants attended the workshop. Thirty-three percent of pre-workshop survey respondents (13/39) had not received cultural competency training within the last 3 years. Approximately 1 in 5 (22%) pre-workshop respondents were unaware of their hospital's interpreter services policy. After a brief didactic presentation, participants identified common microaggressions and barriers to care for patients with LEP. They also developed 15 unique strategies to promote communication via use of trained interpreters when the patient/family initially opt for ad hoc interpretation instead. At workshop completion, 97.1% of participants reported that they will adopt or modify an existing strategy when communicating with LEP patients and families. CONCLUSION: Post-workshop survey results suggest that continuing education can be used to address UCB for patients with LEP and promote use of interpreter services to improve patient–provider communication.
{"title":"Results of a Multidisciplinary Workshop to Reduce Bias and Improve Health Equity for Patients With Limited English Proficiency [ID: 1375774]","authors":"Etoi A. Garrison, Amita K. Bey, E. Jiménez, Andria Li, A. Nettles","doi":"10.1097/01.aog.0000931148.27353.d4","DOIUrl":"https://doi.org/10.1097/01.aog.0000931148.27353.d4","url":null,"abstract":"INTRODUCTION: Birthing people with limited English proficiency (LEP) often face systemic limitations to care and are at increased risk for disparate birth outcomes due to barriers in patient–provider communication. Patients with LEP are particularly vulnerable to biases and microaggressions that can limit timely health care delivery and the quality of services received. We developed a multidisciplinary curriculum to educate providers about 1) unconscious bias (UCB), 2) barriers to equitable health care delivery for patients with LEP, and 3) use of trained interpreter services to promote patient–provider communication. METHODS: We developed a 60-minute workshop for physicians/midwives/nurses (n=75). Surveys were used to assess change in knowledge. Results were evaluated by descriptive statistics, t tests for significance, and thematic analysis. Institutional review board approval was obtained. RESULTS: Approximately 75 participants attended the workshop. Thirty-three percent of pre-workshop survey respondents (13/39) had not received cultural competency training within the last 3 years. Approximately 1 in 5 (22%) pre-workshop respondents were unaware of their hospital's interpreter services policy. After a brief didactic presentation, participants identified common microaggressions and barriers to care for patients with LEP. They also developed 15 unique strategies to promote communication via use of trained interpreters when the patient/family initially opt for ad hoc interpretation instead. At workshop completion, 97.1% of participants reported that they will adopt or modify an existing strategy when communicating with LEP patients and families. CONCLUSION: Post-workshop survey results suggest that continuing education can be used to address UCB for patients with LEP and promote use of interpreter services to improve patient–provider communication.","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":"82637298","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.0000930216.47847.c4
Ria Joglekar, J. Applequist, A. Louis-Jacques, R. Powis, Roneé E. Wilson
INTRODUCTION: This study, part of a larger qualitative project, spurred significant participant feedback related to BIPOC (Black, Indigenous, people of color) clients’ needs for support from racially similar doulas. As such, this study analyzed the data to investigate how doulas navigate client perceptions of race. METHODS: Seven in-depth interviews and six focus groups were conducted with doulas serving in Florida (n=31). Transcripts were coded post-inter-coder agreement using an inductive approach to thematic analysis. Participant consent and IRB approval were obtained. RESULTS: 1) White doulas reported Black doulas advising them to refrain from taking on Black, Brown, non-English speaking clients and instead to refer when possible. Some participants explained tendency for implicit bias and discrimination when White doulas try to step into the perspective of clients of color, specifically Black women, despite good intent in trying to support a community facing health disparities. 2) A few doulas referred to White doulas reaching out to non-White clients as a savior/virtue signaling act, while others countered that White doulas can use their racial status for advocacy in medical settings. CONCLUSION: Doulas shared a desire to work with underserved families and discussed that issues surrounding race must first be acknowledged in order to create safer spaces for open communication surrounding maternal health, thereby mitigating disparities. It is important to note that our study relied on convenience sampling, utilizing predominantly White doulas, limiting our data on Black doula experiences and their perceptions on the role of race in the doula–client relationship. Future directions must include diversification of participants and speaking directly with Black doulas.
{"title":"Understanding the Role of Race in Doula Communities: Florida Doulas’ Perceptions of Maternal Health Disparities [ID: 1377606]","authors":"Ria Joglekar, J. Applequist, A. Louis-Jacques, R. Powis, Roneé E. Wilson","doi":"10.1097/01.AOG.0000930216.47847.c4","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930216.47847.c4","url":null,"abstract":"INTRODUCTION: This study, part of a larger qualitative project, spurred significant participant feedback related to BIPOC (Black, Indigenous, people of color) clients’ needs for support from racially similar doulas. As such, this study analyzed the data to investigate how doulas navigate client perceptions of race. METHODS: Seven in-depth interviews and six focus groups were conducted with doulas serving in Florida (n=31). Transcripts were coded post-inter-coder agreement using an inductive approach to thematic analysis. Participant consent and IRB approval were obtained. RESULTS: 1) White doulas reported Black doulas advising them to refrain from taking on Black, Brown, non-English speaking clients and instead to refer when possible. Some participants explained tendency for implicit bias and discrimination when White doulas try to step into the perspective of clients of color, specifically Black women, despite good intent in trying to support a community facing health disparities. 2) A few doulas referred to White doulas reaching out to non-White clients as a savior/virtue signaling act, while others countered that White doulas can use their racial status for advocacy in medical settings. CONCLUSION: Doulas shared a desire to work with underserved families and discussed that issues surrounding race must first be acknowledged in order to create safer spaces for open communication surrounding maternal health, thereby mitigating disparities. It is important to note that our study relied on convenience sampling, utilizing predominantly White doulas, limiting our data on Black doula experiences and their perceptions on the role of race in the doula–client relationship. Future directions must include diversification of participants and speaking directly with Black doulas.","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":"86633613","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.0000930588.16136.3f
K. Deligiannidis, Amy Bullock, M. Kotecha, Sigui Li, B. Maximos, Theresa Vera
INTRODUCTION: Postpartum depression (PPD) is a serious perinatal complication. SKYLARK (phase 3, randomized, double-blind, placebo-controlled trial [NCT04442503]) evaluated zuranolone, an investigational, neuroactive steroid positive allosteric modulator of both synaptic and extrasynaptic GABA(A) receptors, in adult patients with PPD. The primary endpoint, change from baseline (CFB) in HAMD-17 total score at day 15, was met. Zuranolone was generally well tolerated. The HAMD-17 can be divided into subscales that group specific items from the HAMD-17 scale that measure different aspects of depression presentation. Here, we present HAMD-17 subscale data from SKYLARK. METHODS: Patients aged 18–45 years with severe PPD (HAMD 17 total score ≥26) were randomized 1:1 to oral, once-daily zuranolone 50 mg or placebo for 14 days. The secondary endpoint was day 15 CFB in HAMD-17 subscale (Core Depression, Anxiety, Bech-6, Maier) scores. Subscales were analyzed separately by a mixed-effects model for repeated measures. Institutional review board approval was obtained. RESULTS: One hundred ninety-five patients (zuranolone, 98; placebo, 97) were randomized, received study drug, and had valid baseline and one or more post-baseline efficacy assessments. At day 15, patients receiving a 14-day treatment course of zuranolone showed nominally significant improvements across all HAMD-17 subscales versus placebo (least squares mean [SE] CFB treatment difference: Core Depression, −5.9 [2.4], P=.0151; Anxiety, −5.7 [2.3], P=.0123; Bech-6, −8.6 [3.0], P=.0040; Maier, −7.6 [2.6], P=.0041). Improvement in all subscales was observed starting at day 3. CONCLUSION: In SKYLARK, zuranolone was associated with rapid improvement in depressive and anxiety symptoms in patients with PPD across multiple domains, supporting its development as a potential oral, rapid-acting treatment option for PPD.
{"title":"Improvement in HAMD-17 Subscale Scores With 14-Day Treatment Course of Zuranolone in Postpartum Depression: Results From the SKYLARK Study [ID: 1372313]","authors":"K. Deligiannidis, Amy Bullock, M. Kotecha, Sigui Li, B. Maximos, Theresa Vera","doi":"10.1097/01.aog.0000930588.16136.3f","DOIUrl":"https://doi.org/10.1097/01.aog.0000930588.16136.3f","url":null,"abstract":"INTRODUCTION: Postpartum depression (PPD) is a serious perinatal complication. SKYLARK (phase 3, randomized, double-blind, placebo-controlled trial [NCT04442503]) evaluated zuranolone, an investigational, neuroactive steroid positive allosteric modulator of both synaptic and extrasynaptic GABA(A) receptors, in adult patients with PPD. The primary endpoint, change from baseline (CFB) in HAMD-17 total score at day 15, was met. Zuranolone was generally well tolerated. The HAMD-17 can be divided into subscales that group specific items from the HAMD-17 scale that measure different aspects of depression presentation. Here, we present HAMD-17 subscale data from SKYLARK. METHODS: Patients aged 18–45 years with severe PPD (HAMD 17 total score ≥26) were randomized 1:1 to oral, once-daily zuranolone 50 mg or placebo for 14 days. The secondary endpoint was day 15 CFB in HAMD-17 subscale (Core Depression, Anxiety, Bech-6, Maier) scores. Subscales were analyzed separately by a mixed-effects model for repeated measures. Institutional review board approval was obtained. RESULTS: One hundred ninety-five patients (zuranolone, 98; placebo, 97) were randomized, received study drug, and had valid baseline and one or more post-baseline efficacy assessments. At day 15, patients receiving a 14-day treatment course of zuranolone showed nominally significant improvements across all HAMD-17 subscales versus placebo (least squares mean [SE] CFB treatment difference: Core Depression, −5.9 [2.4], P=.0151; Anxiety, −5.7 [2.3], P=.0123; Bech-6, −8.6 [3.0], P=.0040; Maier, −7.6 [2.6], P=.0041). Improvement in all subscales was observed starting at day 3. CONCLUSION: In SKYLARK, zuranolone was associated with rapid improvement in depressive and anxiety symptoms in patients with PPD across multiple domains, supporting its development as a potential oral, rapid-acting treatment option for PPD.","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":"83457541","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.0000931048.06184.77
A. Larish, Hannah K. Betcher, O. Liseth, K. Moore, M. Schenone, Jessica Weng
INTRODUCTION: Perinatal mental illness imparts a significant health burden. A multitude of factors are hypothesized to increase the incidence of perinatal mood and anxiety disorders (PMADs) in the fetal surgical population, including uncertain fetal prognosis and the inherent risks of surgery and preterm delivery. We sought to determine the disease course of PMADs in the fetal surgery population. METHODS: A retrospective chart review was conducted of fetal surgery patients from 2017 to 2021 at a tertiary care center. Demographics, surgical, obstetric, and psychiatric diagnoses were recorded. Standard descriptive analyses were performed. RESULTS: One hundred nineteen eligible patients were identified. Fetal surgery was performed at a median gestational age of 23.0 (range 16.0–34.0) weeks. Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. 26.8% (32/119) had preexisting mood disorders, with 59.3% (19/32) and 53.1% (17/32) on a baseline medication for depression or anxiety, respectively, prior to surgery. 26.4% (23/87) of patients without a history of anxiety or depression had a new diagnosis of PMAD. Two patients experienced suicidal ideation. 6.7% (8/119) and 10.1% (12/119) initiated a new psychiatric medication during or post-pregnancy, respectively. 19.8% (21/113) received a therapy referral. Among patients with baseline anxiety or depression, 62.5% (20/32) experienced an exacerbation postpartum with 25.0% (8/32) referred for therapy, and 34.3% (11/32) changing dose or medication for anxiety and 37.5% (12/32) for depression. CONCLUSION: Among patients undergoing fetal surgery, a high incidence of PMAD was identified. Most patients with prepregnancy anxiety or depression experienced an exacerbation postpartum. Further research into effective supportive interventions is warranted.
{"title":"Effect of Fetal Surgery on Maternal Mental Health [ID: 1376946]","authors":"A. Larish, Hannah K. Betcher, O. Liseth, K. Moore, M. Schenone, Jessica Weng","doi":"10.1097/01.aog.0000931048.06184.77","DOIUrl":"https://doi.org/10.1097/01.aog.0000931048.06184.77","url":null,"abstract":"INTRODUCTION: Perinatal mental illness imparts a significant health burden. A multitude of factors are hypothesized to increase the incidence of perinatal mood and anxiety disorders (PMADs) in the fetal surgical population, including uncertain fetal prognosis and the inherent risks of surgery and preterm delivery. We sought to determine the disease course of PMADs in the fetal surgery population. METHODS: A retrospective chart review was conducted of fetal surgery patients from 2017 to 2021 at a tertiary care center. Demographics, surgical, obstetric, and psychiatric diagnoses were recorded. Standard descriptive analyses were performed. RESULTS: One hundred nineteen eligible patients were identified. Fetal surgery was performed at a median gestational age of 23.0 (range 16.0–34.0) weeks. Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. 26.8% (32/119) had preexisting mood disorders, with 59.3% (19/32) and 53.1% (17/32) on a baseline medication for depression or anxiety, respectively, prior to surgery. 26.4% (23/87) of patients without a history of anxiety or depression had a new diagnosis of PMAD. Two patients experienced suicidal ideation. 6.7% (8/119) and 10.1% (12/119) initiated a new psychiatric medication during or post-pregnancy, respectively. 19.8% (21/113) received a therapy referral. Among patients with baseline anxiety or depression, 62.5% (20/32) experienced an exacerbation postpartum with 25.0% (8/32) referred for therapy, and 34.3% (11/32) changing dose or medication for anxiety and 37.5% (12/32) for depression. CONCLUSION: Among patients undergoing fetal surgery, a high incidence of PMAD was identified. Most patients with prepregnancy anxiety or depression experienced an exacerbation postpartum. Further research into effective supportive interventions is warranted.","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":"87401049","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.0000931244.57313.88
R. Linfield, Lindsay Marty, O. Myrick
INTRODUCTION: As part of a quality improvement initiative at a high-volume, outpatient obstetric center, a preintervention performance metric was obtained that determined physician adherence to providing the Edinburgh Postnatal Depression Screen (EPDS), which identifies patients with perinatal mood and anxiety disorders. METHODS: This was a retrospective chart review conducted over a 6-month period at the outpatient offices of an academic faculty group practice in a large, urban area. Provider adherence to EPDS screening and documentation was identified as per the standard office protocol—at both 24–28 weeks of gestation and 6–8 weeks postpartum. Patient population was limited to those who presented to their postpartum visit at the designated offices from January 2021 to June 2021 and received antenatal care through this same location. RESULTS: Four hundred forty-five patients met the inclusion criteria for receiving both antenatal and postpartum care within the selected time frame. Antenatally, only 55% of patients received a properly scored EPDS, 12% of patients were screened but the scores were not documented, and 33% of encounters did not include depression screening. Postpartum, only 60% of patients received a properly scored EPDS, 16% of patients were screened but the scores were not documented, and 24% of postpartum encounters did not include depression screening. CONCLUSION: This study emphasizes the need for increased physician education and targeted changes to workflow with respect to prioritizing depression screens for patients in antenatal and postpartum periods. Further trends will highlight the need for targeted education interventions or specific patient populations that require more attention to ensure screening is performed.
{"title":"Provider Adherence to Edinburgh Postnatal Depression Screening [ID: 1375752]","authors":"R. Linfield, Lindsay Marty, O. Myrick","doi":"10.1097/01.aog.0000931244.57313.88","DOIUrl":"https://doi.org/10.1097/01.aog.0000931244.57313.88","url":null,"abstract":"INTRODUCTION: As part of a quality improvement initiative at a high-volume, outpatient obstetric center, a preintervention performance metric was obtained that determined physician adherence to providing the Edinburgh Postnatal Depression Screen (EPDS), which identifies patients with perinatal mood and anxiety disorders. METHODS: This was a retrospective chart review conducted over a 6-month period at the outpatient offices of an academic faculty group practice in a large, urban area. Provider adherence to EPDS screening and documentation was identified as per the standard office protocol—at both 24–28 weeks of gestation and 6–8 weeks postpartum. Patient population was limited to those who presented to their postpartum visit at the designated offices from January 2021 to June 2021 and received antenatal care through this same location. RESULTS: Four hundred forty-five patients met the inclusion criteria for receiving both antenatal and postpartum care within the selected time frame. Antenatally, only 55% of patients received a properly scored EPDS, 12% of patients were screened but the scores were not documented, and 33% of encounters did not include depression screening. Postpartum, only 60% of patients received a properly scored EPDS, 16% of patients were screened but the scores were not documented, and 24% of postpartum encounters did not include depression screening. CONCLUSION: This study emphasizes the need for increased physician education and targeted changes to workflow with respect to prioritizing depression screens for patients in antenatal and postpartum periods. Further trends will highlight the need for targeted education interventions or specific patient populations that require more attention to ensure screening is performed.","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":"87434558","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.0000929796.86272.2e
R. Young, Priyal P. Fadadu, I. Green, Catherine Yang
INTRODUCTION: Studies have investigated risk factors for intrauterine device (IUD) malposition, but there is a paucity of data regarding patients’ contraceptive decisions after experiencing a malpositioned IUD. Therefore, we sought to investigate continued long-acting reversible contraception (LARC) usage after management of a malpositioned IUD. METHODS: After IRB approval, a retrospective cohort study was conducted, which included 541 patients who underwent IUD insertion at one institution with subsequent pelvic imaging. One hundred six had a malpositioned IUD and were age-matched to controls. Chart and imaging reports were abstracted. Long-acting reversible contraception retention was documented through 24 months from index imaging. RESULTS: Most patients had a levonorgestrel IUD (90.9%) for the indication of contraception alone (54.1%). The imaging indication of abnormal uterine bleeding (AUB) was most likely to be associated with malposition (odds ratio [OR] 1.67 [1.03–2.71], P=.038), as well as a copper IUD type (OR 5.31 [2.14–13.18], P<.001). Most patients with a malpositioned IUD did not have an IUD replaced after removal (57.8%). Of those who abandoned IUD therapy, only six chose to initiate an alternative LARC. Malposition was not an independent risk factor for LARC abandonment between the two groups over the 24 months of follow-up. Risk factors for abandonment over the follow-up period included AUB, copper IUD use, younger age, and shorter duration of use before undergoing imaging. CONCLUSION: Most patients with a malpositioned IUD did not have IUD replacement and abandoned all LARC therapy. These are important preliminary findings regarding LARC abandonment associated with IUD malposition that will help shape further studies as well as clinical counseling.
{"title":"Long-Acting Reversible Contraception Continuation After Management of a Malpositioned Intrauterine Device [ID: 1376021]","authors":"R. Young, Priyal P. Fadadu, I. Green, Catherine Yang","doi":"10.1097/01.aog.0000929796.86272.2e","DOIUrl":"https://doi.org/10.1097/01.aog.0000929796.86272.2e","url":null,"abstract":"INTRODUCTION: Studies have investigated risk factors for intrauterine device (IUD) malposition, but there is a paucity of data regarding patients’ contraceptive decisions after experiencing a malpositioned IUD. Therefore, we sought to investigate continued long-acting reversible contraception (LARC) usage after management of a malpositioned IUD. METHODS: After IRB approval, a retrospective cohort study was conducted, which included 541 patients who underwent IUD insertion at one institution with subsequent pelvic imaging. One hundred six had a malpositioned IUD and were age-matched to controls. Chart and imaging reports were abstracted. Long-acting reversible contraception retention was documented through 24 months from index imaging. RESULTS: Most patients had a levonorgestrel IUD (90.9%) for the indication of contraception alone (54.1%). The imaging indication of abnormal uterine bleeding (AUB) was most likely to be associated with malposition (odds ratio [OR] 1.67 [1.03–2.71], P=.038), as well as a copper IUD type (OR 5.31 [2.14–13.18], P<.001). Most patients with a malpositioned IUD did not have an IUD replaced after removal (57.8%). Of those who abandoned IUD therapy, only six chose to initiate an alternative LARC. Malposition was not an independent risk factor for LARC abandonment between the two groups over the 24 months of follow-up. Risk factors for abandonment over the follow-up period included AUB, copper IUD use, younger age, and shorter duration of use before undergoing imaging. CONCLUSION: Most patients with a malpositioned IUD did not have IUD replacement and abandoned all LARC therapy. These are important preliminary findings regarding LARC abandonment associated with IUD malposition that will help shape further studies as well as clinical counseling.","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":"88165473","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.0000929920.04007.7b
P. Blustein, K. Dillon, E. Pereira, J. Villella, S. Werner
INTRODUCTION: Type 2 endometrial cancer (T2EC) accounts for 38.7% of all endometrial cancers but is responsible for 74.6% of endometrial cancer deaths. This is potentially due to advanced stage at time of diagnosis. We examine whether social determinants of health are predictors associated with T2EC diagnosed at an advanced stage. METHODS: Retrospective analysis of T2EC cases was performed from May 1, 2015, to March 31, 2022, at one academic site. The primary outcome was advanced stage at time of surgical diagnosis, defined as FIGO stages 3 or 4. Patient age, ethnicity, race (White versus non-White), obesity, and diabetes were evaluated. Multivariate logistic regression model was used to investigate predictors associated with increased risk of advanced-stage disease (ASD), with two-sided P value of <.05 considered significant. RESULTS: A total of 72 patients with T2EC were identified. Thirty-eight (52.7%) cases had early-stage disease and 34 (47.3%) cases had ASD at diagnosis. Ethnicity was the only predictor significantly associated with the primary outcome. Hispanic or Latina ethnicity was associated with 5 times higher odds (odds ratio 5.1, 95% CI 1.2–21.6, P=.028) of ASD at diagnosis, compared to non-Hispanic or Latina. CONCLUSION: Our results show that Hispanic or Latina ethnicity was significantly associated with advanced stage at diagnosis. Non-White race, obesity, diabetes, and age at surgery were not found to be predictors significantly associated with the primary outcome. This could be due to sample size limitations. To facilitate health equity, there is continued need for investigation into the effect of social determinants of health on ASD for T2EC.
2型子宫内膜癌(T2EC)占所有子宫内膜癌的38.7%，但占子宫内膜癌死亡人数的74.6%。这可能是由于诊断时处于晚期。我们研究健康的社会决定因素是否与晚期诊断的T2EC相关。方法:回顾性分析2015年5月1日至2022年3月31日在一个学术站点的T2EC病例。主要终点为手术诊断时的晚期，定义为FIGO 3期或4期。评估患者的年龄、种族、种族(白人与非白人)、肥胖和糖尿病。采用多因素logistic回归模型探讨与晚期疾病(ASD)风险增加相关的预测因素，双侧P值<。0.05认为显著。结果:共发现72例T2EC患者。38例(52.7%)诊断为早期疾病，34例(47.3%)诊断为ASD。种族是唯一与主要结果显著相关的预测因子。与非西班牙裔或拉丁裔相比，西班牙裔或拉丁裔在诊断时与ASD的比值(比值比5.1,95% CI 1.2-21.6, P= 0.028)高出5倍。结论:我们的研究结果显示，西班牙裔或拉丁裔与晚期诊断有显著相关性。非白人种族、肥胖、糖尿病和手术年龄未被发现是与主要结果显著相关的预测因素。这可能是由于样本量的限制。为了促进健康公平，继续需要调查健康的社会决定因素对2型ec的ASD的影响。
{"title":"Effect of Social Determinants of Health on Advanced Stage Type 2 Endometrial Cancer at Time of Diagnosis [ID: 1376689]","authors":"P. Blustein, K. Dillon, E. Pereira, J. Villella, S. Werner","doi":"10.1097/01.aog.0000929920.04007.7b","DOIUrl":"https://doi.org/10.1097/01.aog.0000929920.04007.7b","url":null,"abstract":"INTRODUCTION: Type 2 endometrial cancer (T2EC) accounts for 38.7% of all endometrial cancers but is responsible for 74.6% of endometrial cancer deaths. This is potentially due to advanced stage at time of diagnosis. We examine whether social determinants of health are predictors associated with T2EC diagnosed at an advanced stage. METHODS: Retrospective analysis of T2EC cases was performed from May 1, 2015, to March 31, 2022, at one academic site. The primary outcome was advanced stage at time of surgical diagnosis, defined as FIGO stages 3 or 4. Patient age, ethnicity, race (White versus non-White), obesity, and diabetes were evaluated. Multivariate logistic regression model was used to investigate predictors associated with increased risk of advanced-stage disease (ASD), with two-sided P value of <.05 considered significant. RESULTS: A total of 72 patients with T2EC were identified. Thirty-eight (52.7%) cases had early-stage disease and 34 (47.3%) cases had ASD at diagnosis. Ethnicity was the only predictor significantly associated with the primary outcome. Hispanic or Latina ethnicity was associated with 5 times higher odds (odds ratio 5.1, 95% CI 1.2–21.6, P=.028) of ASD at diagnosis, compared to non-Hispanic or Latina. CONCLUSION: Our results show that Hispanic or Latina ethnicity was significantly associated with advanced stage at diagnosis. Non-White race, obesity, diabetes, and age at surgery were not found to be predictors significantly associated with the primary outcome. This could be due to sample size limitations. To facilitate health equity, there is continued need for investigation into the effect of social determinants of health on ASD for T2EC.","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":"82018125","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.0000930988.66530.d4
A. Moustafa, S. Araji, Natalie Clericuzio, D. Frieson, L. Hendon
INTRODUCTION: Triploidy is a chromosomal abnormality that occurs in 1–3% of all conceptions and often results in early spontaneous miscarriage. It is exceedingly rare for a triploid fetus to survive to birth. Neonates usually die within hours to days after delivery. After the Dobbs v Jackson Women's Health Organization ruling in July 2022, access to abortion is becoming increasingly limited, and therefore providers should consider the adverse maternal health outcomes that can be associated with triploidy. METHODS: In this case series, we describe three cases of confirmed fetal triploidy that we encountered in our center within 1 year (2021–2022). All three cases were referred to us after House Bill 1259 was passed on July 1, 2020, in Mississippi banning termination of pregnancy based on race, sex, or genetic abnormality. RESULTS: Our first case is a 21-year-old patient referred at 19 weeks 2 days for abnormal second-trimester serum screen. Ultrasound showed an enlarged multicystic placenta and multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 21 week 5 days, patient was diagnosed with superimposed preeclampsia with severe features. Patient underwent medical termination of pregnancy. The second case is a 25-year-old referred at 30 weeks 0 days for concerns of fetal anomalies. Ultrasound confirmed multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was diagnosed with preeclampsia and pulmonary edema and was delivered at 30 weeks 1 day. The neonate passed away at 22 days of life. Our third case is a 20-year-old referred at 24 weeks 0 days for abnormal aneuploidy screening. Ultrasound showed a major cardiac defect and severe fetal growth restriction. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 29 weeks 0 days, intrauterine fetal demise was diagnosed. Patient was diagnosed with peripartum depression. CONCLUSION: Women with pregnancies affected by fetal triploidy are at risk of developing preeclampsia. Restricting access to abortion will lead to increased maternal morbidity and mortality rates.
简介:三倍体是一种染色体异常，发生在所有怀孕的1-3%，经常导致早期自然流产。三倍体胎儿存活到出生是极其罕见的。新生儿通常在分娩后数小时至数天内死亡。在2022年7月Dobbs v Jackson妇女健康组织裁决之后，堕胎的机会变得越来越有限，因此提供者应该考虑与三倍体相关的不良孕产妇健康结果。方法:在这个病例系列中，我们描述了我们在1年内(2021-2022年)在我们中心遇到的3例确诊的胎儿三倍体。2020年7月1日，众议院1259号法案在密西西比州通过，禁止基于种族、性别或基因异常终止妊娠，这三起案件都被提交给我们。结果:我们的第一例病例是一名21岁的患者，在19周2天因妊娠中期血清筛查异常而被转诊。超声显示多囊胎盘增大及多胎畸形。羊膜穿刺术显示69,xxy核型。病人得到了周到的治疗。在第21周5天，患者被诊断为伴有严重特征的叠加性子痫前期。病人接受了药物终止妊娠。第二个病例是一名25岁的妇女，在30周0天时因担心胎儿异常而转诊。超声证实多胎畸形。羊膜穿刺术显示69,xxy核型。患者被诊断为先兆子痫和肺水肿，于30周1天分娩。这名新生儿在出生22天后就去世了。我们的第三个病例是一名20岁的患者，在24周0天进行异常非整倍体筛查。超声显示严重的心脏缺陷和严重的胎儿生长受限。羊膜穿刺术显示69,xxy核型。病人得到了周到的治疗。29周0天诊断宫内胎儿死亡。患者被诊断为围产期抑郁症。结论:受胎儿三倍体影响的妊娠妇女有发生先兆子痫的危险。限制堕胎将导致产妇发病率和死亡率上升。
{"title":"The Natural History of Fetal Triploidy in an Era of Limited Abortion Access: A Case Series [ID: 1380133]","authors":"A. Moustafa, S. Araji, Natalie Clericuzio, D. Frieson, L. Hendon","doi":"10.1097/01.aog.0000930988.66530.d4","DOIUrl":"https://doi.org/10.1097/01.aog.0000930988.66530.d4","url":null,"abstract":"INTRODUCTION: Triploidy is a chromosomal abnormality that occurs in 1–3% of all conceptions and often results in early spontaneous miscarriage. It is exceedingly rare for a triploid fetus to survive to birth. Neonates usually die within hours to days after delivery. After the Dobbs v Jackson Women's Health Organization ruling in July 2022, access to abortion is becoming increasingly limited, and therefore providers should consider the adverse maternal health outcomes that can be associated with triploidy. METHODS: In this case series, we describe three cases of confirmed fetal triploidy that we encountered in our center within 1 year (2021–2022). All three cases were referred to us after House Bill 1259 was passed on July 1, 2020, in Mississippi banning termination of pregnancy based on race, sex, or genetic abnormality. RESULTS: Our first case is a 21-year-old patient referred at 19 weeks 2 days for abnormal second-trimester serum screen. Ultrasound showed an enlarged multicystic placenta and multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 21 week 5 days, patient was diagnosed with superimposed preeclampsia with severe features. Patient underwent medical termination of pregnancy. The second case is a 25-year-old referred at 30 weeks 0 days for concerns of fetal anomalies. Ultrasound confirmed multiple fetal anomalies. Amniocentesis showed a 69,XXY karyotype. Patient was diagnosed with preeclampsia and pulmonary edema and was delivered at 30 weeks 1 day. The neonate passed away at 22 days of life. Our third case is a 20-year-old referred at 24 weeks 0 days for abnormal aneuploidy screening. Ultrasound showed a major cardiac defect and severe fetal growth restriction. Amniocentesis showed a 69,XXY karyotype. Patient was managed expectantly. At 29 weeks 0 days, intrauterine fetal demise was diagnosed. Patient was diagnosed with peripartum depression. CONCLUSION: Women with pregnancies affected by fetal triploidy are at risk of developing preeclampsia. Restricting access to abortion will lead to increased maternal morbidity and mortality rates.","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":"90753726","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.0000931064.63997.6b
Danielle Browning, E. Fandozzi, Christina J. Megli, Alexandria Sasaki
INTRODUCTION: Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks). METHODS: A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study. RESULTS: 27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P=.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) (P=.047). CONCLUSION: Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.
{"title":"Maternal and Neonatal Outcomes of Pregnancies With Periviable and Previable Preterm Premature Rupture of Membranes [ID: 1380561]","authors":"Danielle Browning, E. Fandozzi, Christina J. Megli, Alexandria Sasaki","doi":"10.1097/01.aog.0000931064.63997.6b","DOIUrl":"https://doi.org/10.1097/01.aog.0000931064.63997.6b","url":null,"abstract":"INTRODUCTION: Preterm premature rupture of membranes (PPROM) accounts for one-third of preterm deliveries and is associated with significant perinatal morbidity. Neonatal resuscitation has been extended to earlier gestational ages, including for patients with PPROM, but maternal and neonatal outcomes are not well characterized. Our objective is to compare outcomes after PPROM diagnosis prior to viability (23 weeks 0 days) or in the periviable period (23–25 weeks). METHODS: A retrospective cohort of 101 pregnancies and 112 neonates from July 2015 to May 2018 were identified by maternal ICD-9/10 codes for PPROM. Exclusion criteria include PPROM greater than 24 weeks 6 days and neonatal congenital anomalies. Detailed chart review was performed. Patients were stratified by gestational age (GA) at PPROM and groups were compared according to GA. Chi-square test was used for dichotomous variables and t test for continuous variables. Institutional review board approval was obtained for this study. RESULTS: 27.9% of patients who elected for expectant management delivered after viability (23 weeks 0 days or later). Neonatal death was greater after delivery from pregnancies with previable PPROM in comparison to periviable PPROM with similar gestational age at birth, P=.005. The composite adverse neonatal outcomes occurred in 100% of neonates born after previable PPROM. Maternal outcomes were elevated with both previable and periviable PPROM who elected for expectant management (52.4% versus 35.3%, NS). The maternal morbidity rate after termination of pregnancy was significantly less (26.9%) (P=.047). CONCLUSION: Previable PPROM is associated with higher neonatal death rates, despite similar GA at delivery in comparison to periviable PPROM. Maternal morbidity is high with both previable and periviable PPROM.","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":"91087972","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.0000931164.75993.7d
Emily Lee, Xiomara Brioso Rubio, Yifan Chang, J. Crabtree, Jia Jennifer Ding, Shefali R Pathy
INTRODUCTION: Point-of-care ultrasonography (POCUS) is increasingly used in medicine and is widely integrated into training. While obstetric (OB) ultrasound (US) is prevalent, its formal use and curriculum is often overlooked in POCUS training. METHODS: We performed a prospective comparative study of medical students who underwent formal obstetrics POCUS training and simulation. Students participated in a pre- and post-knowledge assessment of basic (presentation, placentation, fluid) and advanced (biometry and basic anatomy) knowledge. Scores were compared via Wilcoxon signed-ranks test. In addition to formal didactics, students participated in hands-on simulation training. The simulation provided one-on-one biometry training with a high-fidelity CIRS model 065-20 fetal model. Participants were evaluated on their ability to perform a complete fetal biometry. RESULTS: There were 58 participants in formal POCUS simulation training. Prior to training, only 29.7% were comfortable with a basic OB US and 8.1% were comfortable with performing biometry. Afterwards, 83.8% and 78.4% were comfortable performing basic and biometry US. Students had significantly higher basic OB US knowledge comparing before (Mdn=50.0) to after training (Mdn=83.3) (Z=5.27, P<.01). Similarly, there was a significant increase in advanced OB US knowledge comparing before (Mdn=56.3) to after (Mdn=100.0) (Z=4.99, P<.01). All participants were able to complete biometry measurements on the CIRS model. 91.9% of participants recommended this training to others. CONCLUSION: Obstetric ultrasound provides invaluable opportunity for learners to gain POCUS skills. Formal training and simulation significantly improves learning knowledge, confidence, and practical OB POCUS skills that can be used during clinical care.
{"title":"Integrating Obstetric Point-of-Care-Ultrasonography (POCUS) Simulation Curriculum [ID: 1363619]","authors":"Emily Lee, Xiomara Brioso Rubio, Yifan Chang, J. Crabtree, Jia Jennifer Ding, Shefali R Pathy","doi":"10.1097/01.aog.0000931164.75993.7d","DOIUrl":"https://doi.org/10.1097/01.aog.0000931164.75993.7d","url":null,"abstract":"INTRODUCTION: Point-of-care ultrasonography (POCUS) is increasingly used in medicine and is widely integrated into training. While obstetric (OB) ultrasound (US) is prevalent, its formal use and curriculum is often overlooked in POCUS training. METHODS: We performed a prospective comparative study of medical students who underwent formal obstetrics POCUS training and simulation. Students participated in a pre- and post-knowledge assessment of basic (presentation, placentation, fluid) and advanced (biometry and basic anatomy) knowledge. Scores were compared via Wilcoxon signed-ranks test. In addition to formal didactics, students participated in hands-on simulation training. The simulation provided one-on-one biometry training with a high-fidelity CIRS model 065-20 fetal model. Participants were evaluated on their ability to perform a complete fetal biometry. RESULTS: There were 58 participants in formal POCUS simulation training. Prior to training, only 29.7% were comfortable with a basic OB US and 8.1% were comfortable with performing biometry. Afterwards, 83.8% and 78.4% were comfortable performing basic and biometry US. Students had significantly higher basic OB US knowledge comparing before (Mdn=50.0) to after training (Mdn=83.3) (Z=5.27, P<.01). Similarly, there was a significant increase in advanced OB US knowledge comparing before (Mdn=56.3) to after (Mdn=100.0) (Z=4.99, P<.01). All participants were able to complete biometry measurements on the CIRS model. 91.9% of participants recommended this training to others. CONCLUSION: Obstetric ultrasound provides invaluable opportunity for learners to gain POCUS skills. Formal training and simulation significantly improves learning knowledge, confidence, and practical OB POCUS skills that can be used during clinical care.","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":"91050975","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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