Obstetrics & Gynecology最新文献_第9页

Utility of Ferritin at Registration as a Screen for Development of Anemia in Third Trimester [ID: 1362276] 铁蛋白在妊娠晚期贫血筛查中的应用[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.aog.0000930920.33049.bb

Isabelle Crary, Chloe Koski, Asha Rijhsinghani

{"title":"Utility of Ferritin at Registration as a Screen for Development of Anemia in Third Trimester [ID: 1362276]","authors":"Isabelle Crary, Chloe Koski, Asha Rijhsinghani","doi":"10.1097/01.aog.0000930920.33049.bb","DOIUrl":"https://doi.org/10.1097/01.aog.0000930920.33049.bb","url":null,"abstract":"INTRODUCTION: The objective of this study was to assess the utility of screening ferritin (<20 weeks of gestation) in pregnant patients on hemoglobin (Hgb) and hematocrit (Hct) later in gestation. METHODS: Pregnant patients who received nondiagnostic ferritin labs at less than 20 weeks of gestation from 2019 to 2021 were retrospectively identified. Patients were excluded if ferritin testing was conducted for diagnostic purposes or if the patient had a history of anemia. Labs at the time of registration, 28 weeks of gestation, and at delivery were analyzed. Anemia was defined as Hgb less than 11 g/dL. This study was approved by the University of Washington IRB, and patient consent was waived. RESULTS: Forty-four patients underwent routine ferritin screening at registration, with ferritin levels ranging from 10 to 136 ng/mL (average 52.5 ng/mL). Average Hgb/Hct at registration were 12.6 g/dL and 37.3%, respectively. At 28 weeks of gestation, Hgb/Hct were obtained on 42 patients, of whom 9 patients were diagnosed with anemia. Patients diagnosed with anemia had a screening ferritin level of 33.6 ng/mL, and nonanemic patients had a ferritin level of 57.4 ng/mL ( P =.1). When a cutoff of 50 ng/mL was studied to compare patients with “low” versus “normal” ferritin, ferritin less than or equal to 50 ng/mL had significantly lower Hgb levels at 28 weeks compared to those with ferritin greater than 50 ng/mL ( P =.013). On labor and delivery (L&D), Hgb/Hct was obtained on 44 patients, and 14 were diagnosed with anemia. Anemic patients on L&D had significantly lower screening ferritin compared to nonanemic, 31.9 and 62.2 ng/mL, respectively ( P =.016). CONCLUSION: Ferritin screening in early pregnancy may help predict lower Hgb in later gestation. Using a higher ferritin cutoff of 50 ng/mL in early pregnancy for identifying patients at risk for anemia in the third trimester may be warranted. Larger prospective studies are needed to evaluate further the utility of ferritin screening.","PeriodicalId":19405,"journal":{"name":"Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135096034","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}

引用次数: 0

The Effect of Advanced Maternal Age on Adverse Outcomes Among Forceps-Assisted Vaginal Deliveries [ID: 1355950] 高龄产妇对产钳辅助阴道分娩不良结局的影响[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.aog.0000930448.60219.0b

Elizabeth Cochrane, Angela Bianco, Chelsea DeBolt, Tahera Doctor, Sarah Roger, Kelly Wang

{"title":"The Effect of Advanced Maternal Age on Adverse Outcomes Among Forceps-Assisted Vaginal Deliveries [ID: 1355950]","authors":"Elizabeth Cochrane, Angela Bianco, Chelsea DeBolt, Tahera Doctor, Sarah Roger, Kelly Wang","doi":"10.1097/01.aog.0000930448.60219.0b","DOIUrl":"https://doi.org/10.1097/01.aog.0000930448.60219.0b","url":null,"abstract":"INTRODUCTION: Delivery rates among patients of advanced maternal age (AMA) are increasing. Prior studies have shown that AMA is associated with increased pregnancy risks and adverse outcomes. This study’s objective was to evaluate whether AMA is associated with an increase in obstetric anal sphincter injury (OASIS) rates among patients who undergo forceps-assisted vaginal deliveries (FAVDs). METHODS: This was an IRB-approved, retrospective cohort study of singleton gestations with FAVD at a single institution between 2017 and 2021. Primary outcome was rate of OASIS among patients with and without AMA. Secondary outcomes included quantitative blood loss (QBL), neonatal composite of subgaleal and cephalohematoma (adverse neonatal composite), and neonatal intensive care unit (NICU) admission. Quantitative blood loss was assessed using Mann-Whitney U test. Remaining outcomes were assessed using multivariate logistic regression models while adjusting for provider clustering and confounding patient characteristics including episiotomy and birth weight. RESULTS: Nine hundred eighty-three records were included, 704 non-AMA and 279 AMA. Patients of AMA were more likely to be Caucasian and were less likely to be Hispanic, nulliparous, experience spontaneous labor, and undergo episiotomy. Patients of AMA did not demonstrate increased odds of OASIS compared to non-AMA patients (odds ratio [OR] 1.21 [0.78, 1.89]). When age was assessed continuously, there was no association between increasing age and rates of OASIS (OR 1.02 [0.98, 1.06]). There was no statistically significant difference in QBL among the two groups (357.0 versus 350.0 cc, P =.20), NICU admission or adverse neonatal composite. CONCLUSION: Advanced maternal age does not appear to be a risk factor for OASIS or other adverse outcomes in patients undergoing FAVD.","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":"135096233","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}

引用次数: 0

Evaluation of a Youth-Led Intervention to Improve Adolescent Sexual and Reproductive Health Knowledge, Efficacy, and Autonomy [ID: 1377919] 青少年主导干预提高青少年性健康和生殖健康知识、有效性和自主性的评估[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.aog.0000931092.06067.d0

Saumya S. Sao, J. Coleman, Lillee Izadi, Runzhi Wang, R. Yu

{"title":"Evaluation of a Youth-Led Intervention to Improve Adolescent Sexual and Reproductive Health Knowledge, Efficacy, and Autonomy [ID: 1377919]","authors":"Saumya S. Sao, J. Coleman, Lillee Izadi, Runzhi Wang, R. Yu","doi":"10.1097/01.aog.0000931092.06067.d0","DOIUrl":"https://doi.org/10.1097/01.aog.0000931092.06067.d0","url":null,"abstract":"INTRODUCTION: Youth bear a disproportionate burden of sexually transmitted infections (STIs) and unintended pregnancy. Knowledge about sexual and reproductive health (SRH) is low among this population, and youth face numerous barriers to care. We sought to develop and assess a youth-led intervention to increase youth SRH knowledge, self-efficacy, and autonomy, which are key indicators in developing positive sexual health behaviors and skills to feel confident in accessing health services. METHODS: Nine interactive, youth-led, 2-hour sessions were held virtually or in-person over 9 months. Session topics included human immunodeficiency virus and STIs, contraception, reproductive anatomy, menstrual health, healthy relationships, sexual decision-making, sexual violence, substance use, goal setting, gender identity and sexuality, and navigating health care services as an adolescent. Monetary compensation and transportation were provided. Sexual and reproductive health knowledge, self-efficacy, and autonomy were assessed using validated scales via an electronic questionnaire before and after implementing the intervention (IRB approved). Paired t tests were used to assess intervention effect. RESULTS: Thirty-seven participants with a mean age of 15.8 years (SD 1.13) were enrolled. All lived in the greater Baltimore area, and the majority self-identified as female. 52% were Black/African American, 28% Asian/Asian American, 12% White, and 8% Hispanic/Latino. Average attendance across sessions was 88%. Participants showed improvement in SRH knowledge (P=.02), advocacy and self-efficacy (P<.001), and personal safety and autonomy (P<.01). They reported increased comfort using trusted sites to procure SRH information (P<.01). CONCLUSION: A youth-led SRH intervention effectively increased SRH knowledge, self-efficacy, and autonomy. Further work should be done to explore the effects and expansion of peer-to-peer SRH education.","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":"88725172","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}

引用次数: 0

Timing of Fetal Growth Restriction Development in Patients With Preeclampsia [ID: 1363469] 子痫前期胎儿生长发育受限的时机研究[ID: 1363469]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.AOG.0000931016.50292.eb

Matilda Francis, T. Kawakita, Juliana Martins

{"title":"Timing of Fetal Growth Restriction Development in Patients With Preeclampsia [ID: 1363469]","authors":"Matilda Francis, T. Kawakita, Juliana Martins","doi":"10.1097/01.AOG.0000931016.50292.eb","DOIUrl":"https://doi.org/10.1097/01.AOG.0000931016.50292.eb","url":null,"abstract":"INTRODUCTION: Preeclampsia (PEC) and fetal growth restriction (FGR) share common pathophysiology of placental insufficiency. In pregnancies complicated by PEC, the incidence of FGR increases significantly. We sought to examine the timing of FGR development in patients with PEC. METHODS: This was a retrospective cohort study of patients with PEC and singleton pregnancy who delivered at 23 weeks or greater. Patients who had been diagnosed with FGR prior to PEC diagnosis, those who were diagnosed with FGR at the same time as PEC, and those who delivered immediately after PEC diagnosis were excluded. Demographics were compared between patients with FGR and those without FGR. We plotted Kaplan-Meier curves for the interval from the diagnosis of PEC to the development of FGR. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) for FGR. Our IRB approved this analysis. RESULTS: Of 392 patients with PEC, 31 (7.9%) developed FGR. Compared to patients who did not develop FGR, patients who developed FGR were more likely to have early-onset PEC and lower maternal weight and were less likely to have gestational diabetes (P<.05). The incidence rate of FGR increased by 11.6% each week from the PEC diagnosis. Compared to patients with late-onset PEC, those with early-onset PEC had a significantly higher cumulative incidence of FGR (P<.01). The Cox proportional hazards model showed that early-onset PEC was associated with FGR (adjusted HR 4.12, 95% CI 1.19–14.33) compared to late-onset PEC. CONCLUSION: Patients with early-onset PEC had a significantly higher incidence of FGR compared to those with late-onset PEC. There was a high cumulative incidence rate of FGR in patients with early-onset PEC. Patients with PEC should be followed by serial fetal growth ultrasound.","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":"86077952","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}

引用次数: 0

A Rare Case of Biparental Placental Mesenchymal Dysplasia: A Case Report and Literature Review [ID: 1336615] 双代胎盘间充质发育不良1例报告并文献复习[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.AOG.0000930060.19431.a8

Francisco Ruiloba Portilla, Megan Barragan Wolff, Montserrat Cuevas, Salvador Jiménez Chaidez, Yolotzin Valdespino Vázquez, Ximena Alexandra van Tienhoven

{"title":"A Rare Case of Biparental Placental Mesenchymal Dysplasia: A Case Report and Literature Review [ID: 1336615]","authors":"Francisco Ruiloba Portilla, Megan Barragan Wolff, Montserrat Cuevas, Salvador Jiménez Chaidez, Yolotzin Valdespino Vázquez, Ximena Alexandra van Tienhoven","doi":"10.1097/01.AOG.0000930060.19431.a8","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930060.19431.a8","url":null,"abstract":"INTRODUCTION: Placental mesenchymal dysplasia (PMD) is a rare placental anomaly associated with high perinatal mortality; it is predominantly seen in female fetuses and very few cases have been reported. The evaluation of first- and second-trimester products of conception is of the utmost importance when assessing molar pathologies such as complete hydatidiform moles, partial hydatidiform moles, and nonmolar samples. METHODS: We report a monochorionic 46XX,69XXY pregnancy with placental mesenchymal dysplasia (PMD) with possible androgenetic biparental mosaicism etiology (Instituto Nacional de Perinatología Isidro Espinosa de los Reyes approval number P-270-18). RESULTS: The patient is a 28-year-old gravida 2, para 1, female with no notable past medical history. She had a previous pregnancy resulting in an uncomplicated abdominal delivery at 39 weeks of gestation 5 years prior. The patient was transferred to our health center at 24.2 weeks of gestation with a molar component because of USG data consistent with a probable hepatic tumor, perimembranous ventricular septal defect, and probable PMD. Ultrasound at 24.3 weeks of gestation demonstrated a single intrauterine pregnancy with one-third of the placenta appearing normal, the second third showing irregular cystic masses, and the remaining third with larger cysts. Placental mesenchymal dysplasia was diagnosed retrospectively based on data from the gross, histologic, and genetic components. CONCLUSION: To our knowledge, this is the first reported case of PMD with a 46XX,69XXY karyotype. A radical and cautious approach to PMD cases is needed because of the lack of sufficient data and reports.","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":"85117352","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}

引用次数: 0

Racial Differences in Severe Maternal Morbidity Exist for Tricare Beneficiaries [ID: 1377133] Tricare受益人严重产妇发病率的种族差异[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.AOG.0000930252.58330.98

E. Lyon, Veronica M Gonzalez-Brown, E. Keyser, Katherine Porter, R. Tindal

{"title":"Racial Differences in Severe Maternal Morbidity Exist for Tricare Beneficiaries [ID: 1377133]","authors":"E. Lyon, Veronica M Gonzalez-Brown, E. Keyser, Katherine Porter, R. Tindal","doi":"10.1097/01.AOG.0000930252.58330.98","DOIUrl":"https://doi.org/10.1097/01.AOG.0000930252.58330.98","url":null,"abstract":"INTRODUCTION: Maternal morbidity and mortality rates in the United States have increased in the last two decades with a disproportionate effect on women of color. Military Tricare coverage models universal health care access; however, in studies looking at births in military treatment facilities, disparities still exist for women of color. This study analyzes maternal delivery outcomes for all women with Tricare coverage including deliveries in the civilian sector. METHODS: Data from 6.2 million births in the Centers for Disease Control and Prevention WONDER Linked Birth/Infant Death Records for 2017–2019 were analyzed for all-cause morbidity (transfusions, perineal lacerations, uterine rupture, unplanned hysterectomy, and intensive care unit admissions), severe maternal morbidity (SMM) (excludes lacerations), and SMM excluding transfusion. Risk ratios were calculated comparing overall maternal morbidity rates between Tricare, Medicaid, self-pay, and private insurance. In addition, risk ratios were calculated between insurance types stratified by race. RESULTS: Compared to private insurance, Tricare insurance had significantly reduced risk of all-cause maternal morbidity. Compared to White women, Black women with Tricare and all other insurances had a decreased risk of all-cause morbidity, but a significantly increased risk of SMM and SMM without transfusion. Asian women had significant increased risk of all-cause, SMM and SMM without transfusion. There was no significant difference in the risk of morbidity for women of color with Tricare insurance compared to women of color with Medicaid, private, or self-pay insurance. CONCLUSION: The risk of severe maternal morbidity remains elevated for women of color despite access to Tricare health insurance.","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":"89361879","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}

引用次数: 20

Disparities and Patterns of Pain Management, Pharmacologic Therapies, and Surgical Treatments for Leiomyomas in the 2017–2019 National Survey of Family Growth [ID: 1380252] 2017-2019年全国家庭生长调查中平滑肌瘤疼痛管理、药物治疗和手术治疗的差异和模式[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.aog.0000929888.98115.b5

C. Rennie, Sanela Andelija, Barbara Prol

{"title":"Disparities and Patterns of Pain Management, Pharmacologic Therapies, and Surgical Treatments for Leiomyomas in the 2017–2019 National Survey of Family Growth [ID: 1380252]","authors":"C. Rennie, Sanela Andelija, Barbara Prol","doi":"10.1097/01.aog.0000929888.98115.b5","DOIUrl":"https://doi.org/10.1097/01.aog.0000929888.98115.b5","url":null,"abstract":"INTRODUCTION: Leiomyomas affect most women throughout their lifetime with an incidence of roughly 80%. Approximately 30% of these women develop symptomology that warrants intervention. With such a large prevalence, it is important to highlight patterns in treatment modalities to guide effective management for all women with this condition. METHODS: We utilized weighted survey results from the Centers for Disease Control and Prevention’s 2017–2019 National Survey of Family Growth. After isolating data to those who reported a leiomyoma diagnosis, we performed a test of equal proportions (P<.05) among the nine listed therapies compared to the following socioeconomic factors: race, age, education, and insurance status. RESULTS: The incidence of leiomyomas was 7.3% (449/6,141). Hispanic women and those with state-sponsored or uninsured status were more likely to report receiving none of the listed treatments (P=.05 and .02). Women who marked “Other” were most likely to seek alternative medicine (P=.03). Hysterectomy was most likely for Black, White, and 40- to 49-year-old women (P=.02 and P<.001). Nonhysterectomy procedures were most seen with government-sponsored health care, private insurance, and women with graduate degrees (P<.001 and P=.02). Pharmacologically, White women were more likely to receive progesterone-releasing intrauterine devices (P=.02), women 19–29 were more likely to use hormonal medicine (P<.001), and those with government insurance were more likely to receive narcotics (P=.006). CONCLUSION: All socioeconomic factors held significant inconsistencies in the utilization of various leiomyoma treatments. As this condition will affect most women, this analysis highlights the need for future standardization to ensure optimal treatment implementation and patient 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":"87248096","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}

引用次数: 0

Early Treatment of Gestational Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials [ID: 1377137] 妊娠期糖尿病和前驱糖尿病的早期治疗:随机临床试验的系统回顾和meta分析[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.aog.0000930124.76180.1e

K. Hessami, Lorie M. Harper, A. Shamshirsaz, E. Werner

{"title":"Early Treatment of Gestational Diabetes Mellitus and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials [ID: 1377137]","authors":"K. Hessami, Lorie M. Harper, A. Shamshirsaz, E. Werner","doi":"10.1097/01.aog.0000930124.76180.1e","DOIUrl":"https://doi.org/10.1097/01.aog.0000930124.76180.1e","url":null,"abstract":"INTRODUCTION: This meta-analysis aims to determine whether early treatment of hyperglycemia in gestational diabetes mellitus (GDM) and prediabetic pregnancies improve perinatal outcomes. METHODS: PubMed/Medline, EMBASE, ClinicalTrials.gov and Web of Science were systematically searched up to June 30, 2022. Randomized clinical trials (RCTs) of early treatment for gestational diabetes mellitus (International Association of the Diabetes and Pregnancy Study Groups [IADPSG] or Carpenter and Coustan [C&C] criteria) and prediabetes (HbA1c 5.7–6.4%) before 20 weeks of gestation were considered eligible. Random-effects model meta-analysis was used to pool the odds ratios (OR) and/or mean differences (MD) with 95% CI. Furthermore, subgroup analysis was performed stratifying by indication for intervention (GDM versus prediabetic). RESULTS: Seven RCTs including 2,757 pregnant individuals, of whom 647 had positive screening before 20 weeks of gestation, were included. Of 647 individuals, 346 were allocated to early treatment and 301 to the routine treatment. There was no significant difference in terms of gestational age at delivery (MD –0.21 [95% CI: −0.44, 0.02], P=.089), rate of cesarean delivery (OR 0.93 [95% CI: 0.64, 1.34], P=.394), hypertensive disorder of pregnancy (OR 1.19 [95% CI: 0.59, 2.39], P=.341), any diabetic medication use (OR 1.31 [95% CI: 0.89, 1.93], P=.177), and neonatal hypoglycemia (OR 1.02 [95% CI: 0.50, 2.08], P=.952). However, there was a decreased risk of macrosomia (OR 0.42 [95% CI: 0.19, 0.92], P=.031) and increased need for insulin use (OR 2.23 [95% CI: 1.30, 3.84], P=.004) for early treatment group. After separate analyses on GDM and prediabetics as distinct groups, the risk of macrosomia was not decreased for GDM and prediabetic subgroups after early treatment. CONCLUSION: Treatment in early pregnancy for GDM or prediabetes does not appear to improve the maternal or 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":"84413357","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}

引用次数: 0

Barriers to HPV Vaccination in Women at a Federally Qualified Health Center [ID: 1377846] 联邦合格医疗中心妇女接种HPV疫苗的障碍[ID: 1377846]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.aog.0000931136.85731.b0

Sophie Blakey-Cheung, Kristen Demertzis, Q. Zeeshan

{"title":"Barriers to HPV Vaccination in Women at a Federally Qualified Health Center [ID: 1377846]","authors":"Sophie Blakey-Cheung, Kristen Demertzis, Q. Zeeshan","doi":"10.1097/01.aog.0000931136.85731.b0","DOIUrl":"https://doi.org/10.1097/01.aog.0000931136.85731.b0","url":null,"abstract":"INTRODUCTION: Human papillomavirus (HPV) vaccination significantly decreases the rate of HPV-related diseases; however, vaccine uptake is limited in the United States. New York State set a goal of 80% HPV vaccination by 2023. First-dose rates at our Federally Qualified Health Center (FQHC) in 2021 were 68% in girls aged 13–19 years and 31% in women aged 20–29 years. Little research surrounding barriers to HPV vaccination in adults exists. METHODS: An anonymized survey was distributed to providers at a network of FQHCs using REDCap. Question domains included provider demographics, provider attitudes, and practices. Questions were subdivided by patient age group. Descriptive statistics were analyzed. RESULTS: Our response rate was 15%. Respondent specialties included family practice (49%), women's health (27%), pediatrics (13%), and internal medicine (11%). Frequency of vaccine recommendation decreased as patient age increased. Most common barriers for vaccination included previous vaccination, parental or patient objection, and lack of time for counseling. Additional barriers in the 19–45 age group included concerns about efficacy and cost. Common reasons for patient refusal included objection to vaccination, feeling low risk for infection, lack of knowledge, and side effect concerns. CONCLUSION: The expansion of HPV vaccination eligibility to include women aged 27–45 in 2018 provided an opportunity to protect more patients against HPV-related diseases. Patient and provider knowledge about HPV risk and vaccine efficacy can limit the implementation. Significant barriers for vaccine administration included the lack of provider engagement, knowledge about the vaccine, and time for counseling. This study underscores the need for provider and patient education about the benefits of HPV vaccination, especially in the 19–45 age group.","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":"85312025","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}

引用次数: 0

Emergency Department Readmission for Early Pregnancy Concerns Among Patients Who Speak Spanish [ID: 1366721] 会说西班牙语的早期妊娠患者的再入院问题[j]

Obstetrics & Gynecology Pub Date : 2023-05-01 DOI: 10.1097/01.AOG.0000929904.21738.96

Gabrielle Taper, M. Álvarez, L. Thaxton, S. Tristan

{"title":"Emergency Department Readmission for Early Pregnancy Concerns Among Patients Who Speak Spanish [ID: 1366721]","authors":"Gabrielle Taper, M. Álvarez, L. Thaxton, S. Tristan","doi":"10.1097/01.AOG.0000929904.21738.96","DOIUrl":"https://doi.org/10.1097/01.AOG.0000929904.21738.96","url":null,"abstract":"INTRODUCTION: The purpose of this study was to compare readmission rates for early pregnancy concerns in the emergency department (ED) among patients that speak English versus Spanish as their primary language. METHODS: From January 1, 2020 to June 1, 2021, we conducted a chart review to identify pregnant patients presenting to the ED using ICD-10 codes for pregnancy and first-trimester diagnoses (n=383). Charts were excluded if pregnancy was beyond 13 weeks or an ultrasound-confirmed ectopic pregnancy. Readmission was a separate ED encounter during the first trimester of that same pregnancy. Preventable readmission was one that could have been prevented if the patient had received correct counseling, diagnosis, or management at the index admission. Our primary outcome was frequency of ED readmission among English versus Spanish speakers. This protocol was approved for IRB exemption by the University of Texas. RESULTS: Threatened abortion was the most common diagnosis among both groups. Readmissions were more frequent among Spanish speakers (40% versus 26% [P=.01]). Preventable readmissions were more common among Spanish speakers (31% versus 25%). The majority of preventable readmissions (81%) among Spanish speakers could have been prevented if correct management was offered, compared to 25% in English speakers (P=.03). CONCLUSION: Spanish and English speakers present with similar types of early pregnancy concerns, but Spanish speakers are not offered management of early pregnancy concerns at the same frequency. Standardization of care for early pregnancy concerns in the ED may help reduce language-based disparities in quality and equity of 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":"86293106","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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