Pub Date : 2023-05-01DOI: 10.1097/01.aog.0000930032.98040.29
Thomas Hale, Yu Bagger, Teresa Baker, Carina Holmqvist, Daniel Jonker, Lorien Urban
INTRODUCTION: Antenatal corticosteroids (ACS) are recommended for pregnant persons at risk for imminent preterm delivery within 7 days. Many diagnosed with threatened preterm labor (tPTL) are given ACS but do not deliver until term. The objective of this study was to analyze characteristics of those seen for tPTL who receive ACS to better understand clinical decision-making. METHODS: This retrospective cohort study consisted of patients seen in triage at an urban hospital caring for underserved patients in 2021 for tPTL during pregnancy. Demographic variables (maternal age, race and ethnicity, prior preterm delivery) and obstetric variables (cervical dilation, effacement, membrane rupture, tocolytic administration) were evaluated against the primary outcome of ACS administration. RESULTS: Two hundred ninety pregnant people with 372 unique encounters for tPTL were identified. The mean gestational age at presentation was 33.5 weeks. 107 patients in 111 encounters received ACS, which was associated with lower body mass index (BMI), greater cervical dilation and effacement, membrane rupture, and more frequent contractions (all P<.01). Logistic regression, limited to first encounter in triage, found that BMI (odds ratio 0.91, 95% CI 0.87–0.95), cervical dilation 2 cm or greater (2.49, 1.12–5.35), and cervical effacement 50% or higher (4.80, 2.25–10.24) were significantly associated with patients receiving ACS. Forty-four percent of those receiving ACS delivered within 7 days, compared to 11% of those who did not receive ACS (P<.001). CONCLUSION: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, although most patients receiving ACS did not deliver within 7 days. These findings will contribute to developing a clinical decision model for administering ACS.
简介:产前皮质类固醇(ACS)建议孕妇在7天内有即将早产的风险。许多诊断为先兆早产(tPTL)的人给予ACS，但直到足月才分娩。本研究的目的是分析接受ACS的tPTL患者的特征，以更好地了解临床决策。方法:这项回顾性队列研究包括2021年在一家城市医院就诊的孕期tPTL患者。人口统计学变量(产妇年龄、种族和民族、早产史)和产科变量(宫颈扩张、宫颈脱落、膜破裂、抗早产药)对照ACS给药的主要结局进行评估。结果:确定了290名孕妇的372例tPTL独特遭遇。分娩时平均胎龄为33.5周。111例患者中有107例患者接受了ACS治疗，ACS患者的身体质量指数(BMI)较低，宫颈扩张和消退较大，膜破裂，宫缩更频繁(P< 0.01)。Logistic回归，仅限于初次就诊的分诊，发现BMI(优势比0.91,95% CI 0.87-0.95)、宫颈扩张2 cm或更大(2.49,1.12-5.35)和宫颈消退50%或更高(4.80,2.25-10.24)与ACS患者显著相关。接受ACS治疗的患者在7天内分娩的比例为44%，而未接受ACS治疗的患者为11% (P< 0.001)。结论:较大的宫颈扩张和消退以及较低的BMI与ACS治疗相关，尽管大多数接受ACS的患者在7天内没有分娩。这些发现将有助于开发ACS管理的临床决策模型。
{"title":"Analysis of Factors Contributing to Antenatal Corticosteroid Administration in Threatened Preterm Labor [ID: 1375840]","authors":"Thomas Hale, Yu Bagger, Teresa Baker, Carina Holmqvist, Daniel Jonker, Lorien Urban","doi":"10.1097/01.aog.0000930032.98040.29","DOIUrl":"https://doi.org/10.1097/01.aog.0000930032.98040.29","url":null,"abstract":"INTRODUCTION: Antenatal corticosteroids (ACS) are recommended for pregnant persons at risk for imminent preterm delivery within 7 days. Many diagnosed with threatened preterm labor (tPTL) are given ACS but do not deliver until term. The objective of this study was to analyze characteristics of those seen for tPTL who receive ACS to better understand clinical decision-making. METHODS: This retrospective cohort study consisted of patients seen in triage at an urban hospital caring for underserved patients in 2021 for tPTL during pregnancy. Demographic variables (maternal age, race and ethnicity, prior preterm delivery) and obstetric variables (cervical dilation, effacement, membrane rupture, tocolytic administration) were evaluated against the primary outcome of ACS administration. RESULTS: Two hundred ninety pregnant people with 372 unique encounters for tPTL were identified. The mean gestational age at presentation was 33.5 weeks. 107 patients in 111 encounters received ACS, which was associated with lower body mass index (BMI), greater cervical dilation and effacement, membrane rupture, and more frequent contractions (all P<.01). Logistic regression, limited to first encounter in triage, found that BMI (odds ratio 0.91, 95% CI 0.87–0.95), cervical dilation 2 cm or greater (2.49, 1.12–5.35), and cervical effacement 50% or higher (4.80, 2.25–10.24) were significantly associated with patients receiving ACS. Forty-four percent of those receiving ACS delivered within 7 days, compared to 11% of those who did not receive ACS (P<.001). CONCLUSION: Greater cervical dilation and effacement and a lower BMI were associated with ACS administration, although most patients receiving ACS did not deliver within 7 days. These findings will contribute to developing a clinical decision model for administering ACS.","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":"89865386","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.0000931028.63331.7d
Lauren Lester, A. Boerrigter, J. Gavard, D. Mostello, J. Sakach
INTRODUCTION: The objective was to determine whether providing individualized text messages regarding diabetes management improved compliance with care and pregnancy outcomes. METHODS: Institutional review board committee approval was obtained for the study. Pregnant women with type 2 (T2) and gestational diabetes (GDM) were randomized into two groups. The “contact-control” group was enrolled in the Text4baby program, which provides nonpersonalized educational text messages throughout pregnancy. The intervention group (Text4diabetes) received individualized text messages regarding upcoming appointments, current insulin regimen, and encouragement to keep and submit glucose logs for review. The primary outcome is compliance (data not yet analyzed). This analysis assesses neonatal outcomes, including perinatal loss (>24 weeks), delivery gestational age (GA), arterial cord pH less than 7.1, 5-minute Apgar less than 7, large-for-gestational-age (LGA) status, need for glucose supplementation, intubation, and surfactant administration. RESULTS: One hundred forty-four women with T2 or GDM were randomized. Both groups had similar numbers of women with T2 diabetes (33% and 31%) and history of GDM in prior pregnancy (21% and 19%). The Text4diabetes group had fewer deliveries less than 35 weeks, fewer LGA infants, and fewer surfactant administrations. A composite of adverse neonatal outcomes, including LGA status, delivery less than 35 weeks GA, arterial cord pH less than 7.1, and need for surfactant administration, showed fewer adverse outcomes in the Text4diabetes group. No findings, however, reached statistical significance. CONCLUSION: Text messages aimed at improving compliance with diabetes care in pregnancy did not significantly affect neonatal outcomes. Correlation with compliance results is needed to see whether improved compliance improved neonatal outcomes.
{"title":"Neonatal Outcomes Associated With Personalized Text Messages for Diabetes Self-Management in Pregnancy [ID: 1373396]","authors":"Lauren Lester, A. Boerrigter, J. Gavard, D. Mostello, J. Sakach","doi":"10.1097/01.AOG.0000931028.63331.7d","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931028.63331.7d","url":null,"abstract":"INTRODUCTION: The objective was to determine whether providing individualized text messages regarding diabetes management improved compliance with care and pregnancy outcomes. METHODS: Institutional review board committee approval was obtained for the study. Pregnant women with type 2 (T2) and gestational diabetes (GDM) were randomized into two groups. The “contact-control” group was enrolled in the Text4baby program, which provides nonpersonalized educational text messages throughout pregnancy. The intervention group (Text4diabetes) received individualized text messages regarding upcoming appointments, current insulin regimen, and encouragement to keep and submit glucose logs for review. The primary outcome is compliance (data not yet analyzed). This analysis assesses neonatal outcomes, including perinatal loss (>24 weeks), delivery gestational age (GA), arterial cord pH less than 7.1, 5-minute Apgar less than 7, large-for-gestational-age (LGA) status, need for glucose supplementation, intubation, and surfactant administration. RESULTS: One hundred forty-four women with T2 or GDM were randomized. Both groups had similar numbers of women with T2 diabetes (33% and 31%) and history of GDM in prior pregnancy (21% and 19%). The Text4diabetes group had fewer deliveries less than 35 weeks, fewer LGA infants, and fewer surfactant administrations. A composite of adverse neonatal outcomes, including LGA status, delivery less than 35 weeks GA, arterial cord pH less than 7.1, and need for surfactant administration, showed fewer adverse outcomes in the Text4diabetes group. No findings, however, reached statistical significance. CONCLUSION: Text messages aimed at improving compliance with diabetes care in pregnancy did not significantly affect neonatal outcomes. Correlation with compliance results is needed to see whether improved compliance improved neonatal 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":"89043797","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.0000929728.96591.2f
H. McLaren, B. Farley
INTRODUCTION: The human papillomavirus (HPV) vaccine is an important component of comprehensive sexual and reproductive health care and has the potential to completely eradicate cervical cancer. However, many women make it to adulthood without receiving a single vaccine. The abortion visit is an important health care access point for high-risk, unvaccinated individuals. METHODS: Patients (N=20) were recruited from the waiting room at a Chicago Planned Parenthood. Phase 1 included participants completing a 29-question assessment on HPV knowledge, HPV testing, and HPV vaccination. Phase 2 consisted of a randomized control trial of English-speaking patients, aged 18–26, presenting for a medication abortion (N=50). Primary outcome was uptake of vaccine; secondary was HPV knowledge via the same knowledge assessment tool used in phase 1. Patients were randomized to the interventional video or “usual care.” All patients were offered an HPV vaccine during medication abortion counseling. RESULTS: Knowledge scores significantly improved from preintervention (0.68 [±0.06]) to postintervention (0.77±0.05) (P=.03). Patients from the video intervention group demonstrated higher vaccine uptake (16%) compared to the “usual-care” group (0%) (P=.04). HPV knowledge assessment was significantly different between arms, with usual-care patients scoring 60% versus video intervention patients at 72%. CONCLUSION: There was significant improvement in knowledge assessment scores and vaccine uptake among the video intervention group. Video education is an effective tool in increasing HPV knowledge and uptake.
{"title":"The HPV at the Abortion Visit: The Utility of Video Education [ID: 1377357]","authors":"H. McLaren, B. Farley","doi":"10.1097/01.AOG.0000929728.96591.2f","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929728.96591.2f","url":null,"abstract":"INTRODUCTION: The human papillomavirus (HPV) vaccine is an important component of comprehensive sexual and reproductive health care and has the potential to completely eradicate cervical cancer. However, many women make it to adulthood without receiving a single vaccine. The abortion visit is an important health care access point for high-risk, unvaccinated individuals. METHODS: Patients (N=20) were recruited from the waiting room at a Chicago Planned Parenthood. Phase 1 included participants completing a 29-question assessment on HPV knowledge, HPV testing, and HPV vaccination. Phase 2 consisted of a randomized control trial of English-speaking patients, aged 18–26, presenting for a medication abortion (N=50). Primary outcome was uptake of vaccine; secondary was HPV knowledge via the same knowledge assessment tool used in phase 1. Patients were randomized to the interventional video or “usual care.” All patients were offered an HPV vaccine during medication abortion counseling. RESULTS: Knowledge scores significantly improved from preintervention (0.68 [±0.06]) to postintervention (0.77±0.05) (P=.03). Patients from the video intervention group demonstrated higher vaccine uptake (16%) compared to the “usual-care” group (0%) (P=.04). HPV knowledge assessment was significantly different between arms, with usual-care patients scoring 60% versus video intervention patients at 72%. CONCLUSION: There was significant improvement in knowledge assessment scores and vaccine uptake among the video intervention group. Video education is an effective tool in increasing HPV knowledge and uptake.","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":"88080751","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.0000930220.31045.74
Jaclyn M. Phillips, Francis M. Hacker, Lara S Lemon, H. Simhan, Jayanthi Simhan, Uma Simhan
INTRODUCTION: Anemia on admission for delivery is a significant contributor to peripartum transfusion. Risk of maternal morbidity including transfusion has been linked to neighborhood deprivation. We sought to explore the relationship between a composite measure of neighborhood-level deprivation and frequency and severity of anemia on admission for delivery. METHODS: We performed an IRB-approved retrospective cohort analysis of delivery admissions in a single health care network from 2015 to 2020. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Anemia was defined as hemoglobin less than 11.0 mg/dL and severe anemia less than 9.0 mg/dL. Multivariable binomial regression models assessed the relationship between ADI and anemia. RESULTS: Eighty-five thousand five hundred fifty-three delivery admissions were included. A monotonic linear positive relationship was observed between ADI and anemia. Individuals who reside in the most disadvantaged neighborhoods (ADI>95) had 2.2 times the odds (95% CI 2.1–2.3) of anemia on admission for delivery. For example, individuals who live in a less disadvantaged neighborhood (ADI of 5) had a 11% predicted probability of anemia compared to 23% in individuals who lived in a more disadvantaged neighborhood (ADI of 95). Individuals who lived in the most disadvantaged neighborhoods had a higher rate of severe anemia (1% versus 3%, P<.001). CONCLUSION: Anemia is more likely and more severe in individuals living in disadvantaged neighborhoods. Neighborhood-level interventions could be used to target populations at high risk for anemia and potentially affect maternal outcomes.
{"title":"Socioeconomic Disadvantage Is Associated With Risk and Severity of Anemia [ID: 1377641]","authors":"Jaclyn M. Phillips, Francis M. Hacker, Lara S Lemon, H. Simhan, Jayanthi Simhan, Uma Simhan","doi":"10.1097/01.AOG.0000930220.31045.74","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930220.31045.74","url":null,"abstract":"INTRODUCTION: Anemia on admission for delivery is a significant contributor to peripartum transfusion. Risk of maternal morbidity including transfusion has been linked to neighborhood deprivation. We sought to explore the relationship between a composite measure of neighborhood-level deprivation and frequency and severity of anemia on admission for delivery. METHODS: We performed an IRB-approved retrospective cohort analysis of delivery admissions in a single health care network from 2015 to 2020. Area deprivation index (ADI) was used to represent neighborhood socioeconomic disadvantage and is a composite index of neighborhood that spans income, education, household characteristics, and housing. The index ranges from 1 to 100 with higher values indicating higher disadvantage. Anemia was defined as hemoglobin less than 11.0 mg/dL and severe anemia less than 9.0 mg/dL. Multivariable binomial regression models assessed the relationship between ADI and anemia. RESULTS: Eighty-five thousand five hundred fifty-three delivery admissions were included. A monotonic linear positive relationship was observed between ADI and anemia. Individuals who reside in the most disadvantaged neighborhoods (ADI>95) had 2.2 times the odds (95% CI 2.1–2.3) of anemia on admission for delivery. For example, individuals who live in a less disadvantaged neighborhood (ADI of 5) had a 11% predicted probability of anemia compared to 23% in individuals who lived in a more disadvantaged neighborhood (ADI of 95). Individuals who lived in the most disadvantaged neighborhoods had a higher rate of severe anemia (1% versus 3%, P<.001). CONCLUSION: Anemia is more likely and more severe in individuals living in disadvantaged neighborhoods. Neighborhood-level interventions could be used to target populations at high risk for anemia and potentially affect maternal 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":"88863566","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.0000931232.83495.32
A. Traub, Bryan Aaron, J. Kawwass, L. King, Kellen Mermin-Bunnell, Kelly Wang
INTRODUCTION: The United States is experiencing a physician shortage, particularly in rural and lower socioeconomic status regions. The Dobbs v Jackson Women's Health decision puts individual state health care access at the forefront of future physician's decisions on where to train and practice medicine. This study assesses how access to abortion care is changing where medical students choose to apply to residency. METHODS: This study surveyed third- and fourth-year U.S. medical students applying into U.S. residency programs from August 6, 2022, to October 22, 2022. Participants were selected via convenience sampling through social media and direct outreach to U.S. medical school admissions offices, medical student class presidents, and medical student organizations. 494 complete responses were analyzed. RESULTS: The majority (77.0%) of respondents across all medical specialties reported that access to abortion care, or lack thereof, affects the location of residency programs to which they apply. Over half (58.1%) of respondents said they are unlikely to apply to a residency program located in a state with abortion restrictions. The sample represented students applying to many specialties, with obstetrics and gynecology applicants comprising 21.6% of the sample. CONCLUSION: This study found that the majority of third- and fourth-year medical students' residency choices, across all specialties, are influenced by state abortion laws. Future physicians are choosing where to attend residency based on state abortion policies, indicating that access to abortion care is changing the landscape of medical practice, and has the potential to shift the geographical makeup of health care.
{"title":"The Dobbs Decision and Its Geographical Effect on Future Physician Training [ID: 1380882]","authors":"A. Traub, Bryan Aaron, J. Kawwass, L. King, Kellen Mermin-Bunnell, Kelly Wang","doi":"10.1097/01.aog.0000931232.83495.32","DOIUrl":"https://doi.org/10.1097/01.aog.0000931232.83495.32","url":null,"abstract":"INTRODUCTION: The United States is experiencing a physician shortage, particularly in rural and lower socioeconomic status regions. The Dobbs v Jackson Women's Health decision puts individual state health care access at the forefront of future physician's decisions on where to train and practice medicine. This study assesses how access to abortion care is changing where medical students choose to apply to residency. METHODS: This study surveyed third- and fourth-year U.S. medical students applying into U.S. residency programs from August 6, 2022, to October 22, 2022. Participants were selected via convenience sampling through social media and direct outreach to U.S. medical school admissions offices, medical student class presidents, and medical student organizations. 494 complete responses were analyzed. RESULTS: The majority (77.0%) of respondents across all medical specialties reported that access to abortion care, or lack thereof, affects the location of residency programs to which they apply. Over half (58.1%) of respondents said they are unlikely to apply to a residency program located in a state with abortion restrictions. The sample represented students applying to many specialties, with obstetrics and gynecology applicants comprising 21.6% of the sample. CONCLUSION: This study found that the majority of third- and fourth-year medical students' residency choices, across all specialties, are influenced by state abortion laws. Future physicians are choosing where to attend residency based on state abortion policies, indicating that access to abortion care is changing the landscape of medical practice, and has the potential to shift the geographical makeup of health 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":"83602713","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.0000929828.39591.cb
A. Mastronardi, J. Maples, Z. Shelton, M. Young, N. Zite
INTRODUCTION: Preliminary research indicates prenatal and postpartum care decreased during the COVID-19 pandemic. Models also indicate increases in unintended pregnancies after 2020. The goal of this study was to assess whether immediate postpartum long-acting reversible contraception (IPP LARC) insertions and desire for IPP LARC increased during COVID-19 among patients insured under TennCare Medicaid (TennCare or CoverKids) with access to coverage for this type of contraception. METHODS: Deliveries in patients insured under TennCare Medicaid Programs (n=6,922) in one East Tennessee hospital were assessed before and during the COVID-19 pandemic (January 2019 to May 2020 and June 2020 to December 2021, respectively). Data from electronic health records were securely collected in Excel and analyzed using SPSS software. Comparisons were made using chi-square tests. RESULTS: During COVID, increased uptake of IPP LARC was statistically significant: 18.0% (CI 16.9–19.1%) before the COVID-19 pandemic and 22.0% (CI 20.6–23.3%) during (P<.001). In addition, desire for IPP LARC increased significantly among patients: 20.0% (CI 19.1–21.3%) before COVID-19 and 22.3% (CI 21.0–23.7%) during COVID-19 (P=.016). Significant increases in desire for IPP LARC during the pandemic occurred among adolescent patients (<20 years of age) (P=.003), those living HRSA-defined nonrural areas (P=.024), non-Hispanic women (P=.036), and White women (P=.027). CONCLUSION: IPP LARC is a highly effective, convenient contraception option for women, especially during times with possible increased limitations in accessing postpartum care. Perhaps because of shelter-at-home orders, limitations in “nonessential” health care being practiced, or personal preferences and desires during the pandemic, IPP LARC was more highly utilized and desired by those wishing to avoid unintended pregnancy after the pandemic began.
{"title":"Increasing Contraception Options Immediately After Birth: Did Immediate Postpartum Long-Acting Reversible Contraception (IPP LARC) Utilization Increase During the COVID-19 Pandemic? [ID: 1377847]","authors":"A. Mastronardi, J. Maples, Z. Shelton, M. Young, N. Zite","doi":"10.1097/01.aog.0000929828.39591.cb","DOIUrl":"https://doi.org/10.1097/01.aog.0000929828.39591.cb","url":null,"abstract":"INTRODUCTION: Preliminary research indicates prenatal and postpartum care decreased during the COVID-19 pandemic. Models also indicate increases in unintended pregnancies after 2020. The goal of this study was to assess whether immediate postpartum long-acting reversible contraception (IPP LARC) insertions and desire for IPP LARC increased during COVID-19 among patients insured under TennCare Medicaid (TennCare or CoverKids) with access to coverage for this type of contraception. METHODS: Deliveries in patients insured under TennCare Medicaid Programs (n=6,922) in one East Tennessee hospital were assessed before and during the COVID-19 pandemic (January 2019 to May 2020 and June 2020 to December 2021, respectively). Data from electronic health records were securely collected in Excel and analyzed using SPSS software. Comparisons were made using chi-square tests. RESULTS: During COVID, increased uptake of IPP LARC was statistically significant: 18.0% (CI 16.9–19.1%) before the COVID-19 pandemic and 22.0% (CI 20.6–23.3%) during (P<.001). In addition, desire for IPP LARC increased significantly among patients: 20.0% (CI 19.1–21.3%) before COVID-19 and 22.3% (CI 21.0–23.7%) during COVID-19 (P=.016). Significant increases in desire for IPP LARC during the pandemic occurred among adolescent patients (<20 years of age) (P=.003), those living HRSA-defined nonrural areas (P=.024), non-Hispanic women (P=.036), and White women (P=.027). CONCLUSION: IPP LARC is a highly effective, convenient contraception option for women, especially during times with possible increased limitations in accessing postpartum care. Perhaps because of shelter-at-home orders, limitations in “nonessential” health care being practiced, or personal preferences and desires during the pandemic, IPP LARC was more highly utilized and desired by those wishing to avoid unintended pregnancy after the pandemic began.","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":"76122757","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.0000929860.18306.99
S. Jewell, B. Pinsky, W. Schlaff, M. Snabes, Liz Uribe
INTRODUCTION: Women with uterine fibroids (UFs) often experience heavy menstrual bleeding (HMB) and anemia. We report improvement in hemoglobin (Hgb) levels over time with elagolix (ELA) with estradiol 1 mg/norethindrone acetate 0.5 mg once-daily add-back (AB) therapy in women with UF-associated HMB. METHODS: This post hoc analysis from duplicate, IRB-approved, randomized, double-blind, placebo (PBO)-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated ELA 300 mg twice daily plus AB versus PBO in women with UF-associated HMB. Hgb concentration (in grams/deciliter) was assessed monthly; no adjustment for multiple comparisons were made. All patients received ELA+AB in the pivotal and extension periods. Patients with baseline Hgb>10.5 g/dL but ≤12 g/dL were classified as “HgbLow” and Hgb≤10.5 g/dL as “Hgb≤10.5.” RESULTS: Baseline demographics were balanced between treatment groups. Overall, by month 1 of treatment, patients receiving ELA+AB (n=395) showed significant improvement in mean change in Hgb compared with PBO (n=196, P=.001). At month 6, 58.8% (HgbLow) and 35.7% (Hgb≤10.5) of patients reached Hgb>12 g/dL with ELA+AB versus 27.7% and 7.2% with PBO, respectively. Improvements in Hgb levels were sustained through 12 months (HgbLow, 59.6%; Hgb≤10.5, 46.3%). During the extension period, 49.3% of patients in the Hgb≤10.5 group treated with ELA+AB reached Hgb>12 g/dL at 9 months of treatment, with responses sustained through 12 months (ELA+AB/ELA+AB, 46.3%). 71.9% of patients in the HgbLow group reached Hgb>12 g/dL by 9 months, with responses sustained through 12 months (ELA+AB/ELA+AB, 59.6%). CONCLUSION: ELA+AB results in rapid, sustained improvement in Hgb levels in women with UF-HMB, regardless of starting Hgb levels.
{"title":"Elagolix Improves Low Hemoglobin in Women With Uterine Fibroid-Associated Heavy Menstrual Bleeding: Post Hoc Analysis of Elaris UF-1 and UF-2 [ID: 1368055]","authors":"S. Jewell, B. Pinsky, W. Schlaff, M. Snabes, Liz Uribe","doi":"10.1097/01.aog.0000929860.18306.99","DOIUrl":"https://doi.org/10.1097/01.aog.0000929860.18306.99","url":null,"abstract":"INTRODUCTION: Women with uterine fibroids (UFs) often experience heavy menstrual bleeding (HMB) and anemia. We report improvement in hemoglobin (Hgb) levels over time with elagolix (ELA) with estradiol 1 mg/norethindrone acetate 0.5 mg once-daily add-back (AB) therapy in women with UF-associated HMB. METHODS: This post hoc analysis from duplicate, IRB-approved, randomized, double-blind, placebo (PBO)-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated ELA 300 mg twice daily plus AB versus PBO in women with UF-associated HMB. Hgb concentration (in grams/deciliter) was assessed monthly; no adjustment for multiple comparisons were made. All patients received ELA+AB in the pivotal and extension periods. Patients with baseline Hgb>10.5 g/dL but ≤12 g/dL were classified as “HgbLow” and Hgb≤10.5 g/dL as “Hgb≤10.5.” RESULTS: Baseline demographics were balanced between treatment groups. Overall, by month 1 of treatment, patients receiving ELA+AB (n=395) showed significant improvement in mean change in Hgb compared with PBO (n=196, P=.001). At month 6, 58.8% (HgbLow) and 35.7% (Hgb≤10.5) of patients reached Hgb>12 g/dL with ELA+AB versus 27.7% and 7.2% with PBO, respectively. Improvements in Hgb levels were sustained through 12 months (HgbLow, 59.6%; Hgb≤10.5, 46.3%). During the extension period, 49.3% of patients in the Hgb≤10.5 group treated with ELA+AB reached Hgb>12 g/dL at 9 months of treatment, with responses sustained through 12 months (ELA+AB/ELA+AB, 46.3%). 71.9% of patients in the HgbLow group reached Hgb>12 g/dL by 9 months, with responses sustained through 12 months (ELA+AB/ELA+AB, 59.6%). CONCLUSION: ELA+AB results in rapid, sustained improvement in Hgb levels in women with UF-HMB, regardless of starting Hgb levels.","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":"80038298","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.0000930144.01488.9e
R. Harrison, Blake Neuburg, A. Palatnik
INTRODUCTION: Patients with gestational diabetes mellitus (GDM) are at increased risk for lifelong type 2 diabetes mellitus (T2DM). We sought to identify whether a 1-hour 50-g glucose result of 200 mg/dL or greater increased likelihood of T2DM among individuals with GDM. METHODS: This was a retrospective cohort study at a single tertiary care site from 2011 to 2019. Participants were included if diagnosed and treated for GDM during pregnancy, at least 18 years of age, and had singleton pregnancy. Exclusion criteria were significant fetal anomalies or incomplete records. Participants with values of 200 mg/dL or greater were then grouped and compared to participants with a value less than 200 mg/dL. Primary outcome was diagnosis of T2DM within 5 or less years of pregnancy. T tests, χ2, Fisher’s exact, and logistic regression were utilized for statistical analyses. RESULTS: Seven hundred eight participants met inclusion criteria. Among these, 100 (14.1%) had a value of 200 mg/dL or greater on the 1-hour 50-g glucose test. Groups were similar, with the exception that those with a very elevated 1-hour glucose result were more likely to be publicly insured (32.0% versus 17.1%, P=.009), identify as non-Hispanic Black (19% versus 14.6%, P=.036), and likely to be married (28.0% versus 25.8%, P=.039). Of the 708 participants, 31 (31.0%) were found to have T2DM among those with 1 hour of 200 mg/dL or greater versus 93 (15.3%) of those with lower 1-hour glucose results (P<.001). After controlling for confounders, T2DM remained independently associated with 1-hour glucose of 200 mg/dL or greater (adjusted odds ratio 2.14, 95% CI 1.22–3.74). CONCLUSION: Elevated screening results (≥200 mg/dL) on the 1-hour 50-g glucose test predicts an increased likelihood for T2DM.
{"title":"Likelihood of Subsequent Type 2 Diabetes Diagnosis Among Patients Diagnosed With Gestational Diabetes and a 50-Gram 1-Hour Glucose Test Value of 200 mg/dL or Greater [ID: 1379006]","authors":"R. Harrison, Blake Neuburg, A. Palatnik","doi":"10.1097/01.aog.0000930144.01488.9e","DOIUrl":"https://doi.org/10.1097/01.aog.0000930144.01488.9e","url":null,"abstract":"INTRODUCTION: Patients with gestational diabetes mellitus (GDM) are at increased risk for lifelong type 2 diabetes mellitus (T2DM). We sought to identify whether a 1-hour 50-g glucose result of 200 mg/dL or greater increased likelihood of T2DM among individuals with GDM. METHODS: This was a retrospective cohort study at a single tertiary care site from 2011 to 2019. Participants were included if diagnosed and treated for GDM during pregnancy, at least 18 years of age, and had singleton pregnancy. Exclusion criteria were significant fetal anomalies or incomplete records. Participants with values of 200 mg/dL or greater were then grouped and compared to participants with a value less than 200 mg/dL. Primary outcome was diagnosis of T2DM within 5 or less years of pregnancy. T tests, χ2, Fisher’s exact, and logistic regression were utilized for statistical analyses. RESULTS: Seven hundred eight participants met inclusion criteria. Among these, 100 (14.1%) had a value of 200 mg/dL or greater on the 1-hour 50-g glucose test. Groups were similar, with the exception that those with a very elevated 1-hour glucose result were more likely to be publicly insured (32.0% versus 17.1%, P=.009), identify as non-Hispanic Black (19% versus 14.6%, P=.036), and likely to be married (28.0% versus 25.8%, P=.039). Of the 708 participants, 31 (31.0%) were found to have T2DM among those with 1 hour of 200 mg/dL or greater versus 93 (15.3%) of those with lower 1-hour glucose results (P<.001). After controlling for confounders, T2DM remained independently associated with 1-hour glucose of 200 mg/dL or greater (adjusted odds ratio 2.14, 95% CI 1.22–3.74). CONCLUSION: Elevated screening results (≥200 mg/dL) on the 1-hour 50-g glucose test predicts an increased likelihood for T2DM.","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":"80106337","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.0000930624.77303.72
Radhika Viswanathan, Saba H. Berhie, Sarah Little, Ellen W. Seely, Louise E. Wilkins-Haug
INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research has led to the creation of clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this project is to understand the perspective of patients readmitted for postpartum hypertension. METHODS: Institutional review board committee approval was obtained for the study. This was a qualitative study with data generated through semistructured interviews. Patients readmitted with postpartum HDP at an urban academic medical center were approached and consented for a single interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n=9). Two coders coded all interviews using NVivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus. Researchers identified themes through grounded theory and were reflexive in their thematic generation. RESULTS: Five themes were generated through the grounded theory analysis: Every pregnancy is different, symptoms of preeclampsia are easily dismissed or often not taken seriously, miscommunication regarding medical changes can hinder patient care, readmission logistics are not baby-friendly, and patient well-being improved when conversations acknowledged the struggles of readmission. CONCLUSION: A qualitative research process revealed patient-identified gaps in care that may have led to readmission for HDP. The specific recommendations that emerge from these themes include: addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.
{"title":"Postpartum Readmission for Hypertension: The Patient Experience [ID: 1377602]","authors":"Radhika Viswanathan, Saba H. Berhie, Sarah Little, Ellen W. Seely, Louise E. Wilkins-Haug","doi":"10.1097/01.aog.0000930624.77303.72","DOIUrl":"https://doi.org/10.1097/01.aog.0000930624.77303.72","url":null,"abstract":"INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research has led to the creation of clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this project is to understand the perspective of patients readmitted for postpartum hypertension. METHODS: Institutional review board committee approval was obtained for the study. This was a qualitative study with data generated through semistructured interviews. Patients readmitted with postpartum HDP at an urban academic medical center were approached and consented for a single interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n=9). Two coders coded all interviews using NVivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus. Researchers identified themes through grounded theory and were reflexive in their thematic generation. RESULTS: Five themes were generated through the grounded theory analysis: Every pregnancy is different, symptoms of preeclampsia are easily dismissed or often not taken seriously, miscommunication regarding medical changes can hinder patient care, readmission logistics are not baby-friendly, and patient well-being improved when conversations acknowledged the struggles of readmission. CONCLUSION: A qualitative research process revealed patient-identified gaps in care that may have led to readmission for HDP. The specific recommendations that emerge from these themes include: addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.","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":"77060899","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.0000930876.55935.ee
Olivia Grubman, F. Hussain, Mackenzie A. Mitchell, T. Owens, T. Strauss
INTRODUCTION: There are no universal guidelines for transvaginal ultrasound (TVUS) at time of anatomy scan. TVUS can provide valuable information on placental location and cervical length (CL). As a quality assurance initiative, universal TVUS (UTVUS) protocol was started. The aim of this study was to evaluate differences in diagnoses and interventions in the 6 months prior to UTVUS protocol to 6 months after implementation. METHODS: This was an institutional review board-approved retrospective cohort study performed on singleton gestations from February 2021 to January 2022. The pre-group underwent TVUS for history of preterm birth, if the cervix appeared short or if the placenta appeared low lying on transabdominal scan. In the post-group, all patients underwent TVUS. RESULTS: Of the 1,197 patients, 148 underwent TVUS in the pre-group and 1,049 received UTVUS in the post-group. A greater proportion of patients had short CL identified in the post-group compared to the pre-group (2.2% versus 0.9%, P<.01). Additionally, CL was shorter in the post-group compared to the pre-group (median 1.6 versus 2.2 cm, P=.03). A greater proportion of patients in the post-group received vaginal progesterone (3.1% versus 0.7%, P<.01) and cerclage (2.3% versus 0.7%, P<.01) compared to those in the pre-group, and had a later gestational age at cerclage placement (median 17 weeks 2 days versus 13 weeks 6 days, P=.04). Patients in the pre-group had a higher rate of prior preterm birth (P<.01), delivered at an earlier gestational age (P<.01), and were more likely to have neonatal intensive care unit admission compared to patients in the post-group (P=.02). The overall preterm birth rate in both time periods was not significantly different (11.4% versus 11.2%, P=.82). CONCLUSION: UTVUS identifies shorter CL, which leads to increased use of vaginal progesterone and cerclage as compared to abdominal ultrasound with targeted TVUS. UTVUS may lead to increased intervention. However, the cost-effectiveness and clinical significance need to be further evaluated.
{"title":"Universal Transvaginal Ultrasounds: Does It Really Make a Difference? [ID: 1369458]","authors":"Olivia Grubman, F. Hussain, Mackenzie A. Mitchell, T. Owens, T. Strauss","doi":"10.1097/01.aog.0000930876.55935.ee","DOIUrl":"https://doi.org/10.1097/01.aog.0000930876.55935.ee","url":null,"abstract":"INTRODUCTION: There are no universal guidelines for transvaginal ultrasound (TVUS) at time of anatomy scan. TVUS can provide valuable information on placental location and cervical length (CL). As a quality assurance initiative, universal TVUS (UTVUS) protocol was started. The aim of this study was to evaluate differences in diagnoses and interventions in the 6 months prior to UTVUS protocol to 6 months after implementation. METHODS: This was an institutional review board-approved retrospective cohort study performed on singleton gestations from February 2021 to January 2022. The pre-group underwent TVUS for history of preterm birth, if the cervix appeared short or if the placenta appeared low lying on transabdominal scan. In the post-group, all patients underwent TVUS. RESULTS: Of the 1,197 patients, 148 underwent TVUS in the pre-group and 1,049 received UTVUS in the post-group. A greater proportion of patients had short CL identified in the post-group compared to the pre-group (2.2% versus 0.9%, P<.01). Additionally, CL was shorter in the post-group compared to the pre-group (median 1.6 versus 2.2 cm, P=.03). A greater proportion of patients in the post-group received vaginal progesterone (3.1% versus 0.7%, P<.01) and cerclage (2.3% versus 0.7%, P<.01) compared to those in the pre-group, and had a later gestational age at cerclage placement (median 17 weeks 2 days versus 13 weeks 6 days, P=.04). Patients in the pre-group had a higher rate of prior preterm birth (P<.01), delivered at an earlier gestational age (P<.01), and were more likely to have neonatal intensive care unit admission compared to patients in the post-group (P=.02). The overall preterm birth rate in both time periods was not significantly different (11.4% versus 11.2%, P=.82). CONCLUSION: UTVUS identifies shorter CL, which leads to increased use of vaginal progesterone and cerclage as compared to abdominal ultrasound with targeted TVUS. UTVUS may lead to increased intervention. However, the cost-effectiveness and clinical significance need to be further evaluated.","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":"84820313","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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