Obstetrics and Gynecology
Unknown authors
Abstract
A National Analysis of Fetal Delivery in Pregnant Trauma Patients Presenting after Motor Vehicle Collision Michelle Hough, MD, Jeffry T Nahmias, MD, MHPE, FACS, Jeffrey W Santos, MD, Lourdes Y Swentek, MD, FACS, Robert Bristow, MD, FACS, Jennifer Butler, MD, Areg Grigorian, MD University of California Irvine Medical Center, Orange, CA Introduction: The majority of pregnant trauma patients (PTPs) present after motor vehicle collision (MVC). The national rate and risk factors for fetal delivery (FD) during the index hospitalization for PTPs are unknown. We sought to investigate the national rate of FD in PTPs presenting after MVC, hypothesizing a higher risk of FD among those with severe injuries or elevated shock index (SI). Methods: The 2017-2020 TQIP was queried for PTPs presenting after MVC. PTPs undergoing FD were compared to patients without FD. Elevated SI was defined as ≥1. Severe injury was defined by abbreviated injury scale ≥3. Bivariate and multivariable logistic regression analyses were performed. Results: From 1,183 PTPs, 95 (8.0%) underwent FD. The median time to FD was 115 minutes. The FD group had higher rates of lung (27.4% vs. 12.2%, p<0.001) and spleen (18.9% vs. 5.5%, p<0.001) injury, and elevated SI (22.1% vs. 9.8%, p<0.001). FD patients also had higher rates of complications (9.5% vs. 2.1%, p<0.001) and death (4.2% vs. 1.1%, p=0.012). Independently associated risk factors for FD included severe head (OR 2.65, CI 1.14-6.17, p=0.023) or abdominal (OR 2.07, CI 1.08-3.97, p=0.028) injuries and elevated SI (OR 2.17 CI 1.25-3.79, p=0.006). Conclusion: The national rate of FD among PTPs presenting after MVC is 8% with most occurring within the first two hours of arrival. Severe head and abdominal injuries are risk factors for FD. Obstetricians should be readily available for PTPs of viable age presenting with an elevated SI or with severe head or abdominal trauma (Table). Table 1. - Multivariable Logistic Regression Analysis Evaluating Risk of Fetal Delivery among PTPs after MVC Characteristic Odds Ratio 95% CI p-value Elevated SI ≥1 2.172 1.245 - 3.790 0.006 High risk MVC 1.123 0.596 - 2.114 0.720 Severe Injury Head 2.656 1.143 - 6.174 0.023 Abdomen 2.071 1.081 - 3.967 0.028 Thorax 1.239 0.441 - 3.484 0.684 Lower extremity 0.941 0.254 - 3.490 0.927 Improving Minority Clinical Trial Enrollment in Gynecologic Oncology Patients Through the Implementation of a Formalized Screening Process Teresa K Boitano, MD, Zachary Gentry, MD, Charles A Leath III, MD, FACS, John M Straughn, MD, Rebecca C Arend, MD The University of Alabama at Birmingham, Birmingham, AL Introduction: The goal of this study was to evaluate the impact of a formalized screening process on racial disparities associated with surgical and chemotherapy-based clinical trial enrollment at a tertiary academic center. Methods: This is a retrospective review of patients with gynecologic malignancy who were screened between 8/2018 and 2/2022 to be enrolled in clinical trials at our institution. Our institution initiated a formalized screening process 11/2019 where all patients are evaluated and approached by a dedicated research nurse for clinical trial enrollment. All patients with a primary or recurrent gynecologic cancer who qualified for a clinical trial, including surgical or chemotherapy-based, were included in the study. Results: 411 women met inclusion criteria for the study with 187 in the control group (pre-initiation of the screening process) and 224 in the research nurse group (RNG). Most patients were White (68.0%) or Black (27.3%). Of the women approached, 28 (15%) were consented for a clinical trial in the control group which increased to 82 (36.9%) in the RNG (p=0.01). Clinical trial enrollment increased by over 200% in women of minority races (p=0.01). Patients were more likely to enroll if they had recurrent disease versus primary disease (p<0.001). In the RNG group, the most common reason for patients declining a clinical trial were desire to receive treatment locally (22%). Conclusion: By using a dedicated research nurse and formalized screening process, clinical trial enrollment of minority women tripled. Patients were more likely to enroll if they had recurrent disease compared to primary disease. e-Posters Readmission Risk of Nonoperative Management of Surgical Diseases in Pregnancy Marcelo Paiva, MPP, Anastasia C Tillman, MD, Tareq Kheirbek, MD, ScM, FACS Brown University, Providence, RI Introduction: Non-obstetric surgical diseases in pregnant patients present a decisional dilemma due to anatomical limitations or concerns for unfavorable outcomes of surgical interventions. We aimed to evaluate rates of readmissions following non-obstetric surgery in pregnancy. Methods: We analyzed the Nationwide Readmission Database (1/2018-10/2018) to compare 30-day readmission rates (READMIT) in pregnant patients who did or did not undergo surgery for acute biliary disease, acute appendicitis, or hernia (SURG vs No SURG). Secondary outcome was fetal loss. Logistic regression was performed to estimate the odds of READMIT adjusting for demographic, trimester, and hospital characteristics. Results: Our cohort included 16,801 patients (94.7% biliary, 4.3% appendicitis, 1% hernia). Only 8.9% underwent surgery with variability among diseases (4.9% biliary, 86% appendicitis, 48.3%, hernia repair, p=0.0001). Patients were more likely to undergo surgery in the second trimester (68.8% vs 54.6% in first and 3% in third trimesters). Overall, READMIT rate was 2.3% and was lower in SURG (0.6% vs 2.5%, p=0.0001). Almost all readmissions were in nonoperative management of biliary disease (2.5% vs 1%, p=0.009). SURG had lower adjusted odds of READMIT (OR: 0.16, 95%CI: 0.08 - 0.36). There was no difference in adjusted odds of fetal loss between groups (OR: 1.45, 95%CI: 0.70 - 3.03) Conclusion: Rates of surgical interventions for common surgical diseases in pregnancy are varied. Surgery appears to be safe and is associated with a lower 30-day readmission rate. Operative management should be strongly considered in pregnancy. The Effect of Number of Neoadjuvant Chemotherapy Cycles on Pathologic Complete Response at Time of Interval Cytoreductive Surgery in Epithelial Ovarian Cancer Patients Zachary Gentry, MD, MBA, Mckenzie Foxall, BA, Alexander Harrelson, BA, Jaclyn Wall, MD, Rebecca C Arend, MD The University of Alabama at Birmingham, Birmingham, AL Introduction: In epithelial ovarian cancer (EOC), no residual disease at time of interval cytoreductive surgery is critical for survival outcomes. Currently, there are no algorithms available to decide the number of neoadjuvant chemotherapy (NACT) cycles. We sought to determine the effect of NACT cycles on pathologic complete response (PCR) at time of surgery and to identify potential variables for a screening algorithm. Methods: This was a retrospective cohort of patients with newly diagnosed EOC at one institution between 11/2019-6/2022. We abstracted baseline characteristics, NACT regimen, pathologic response, and other cancer-related data. Data analysis included Chi squared, student’s t-test, and Wilcoxon ranked-sum tests. Results: Of 188 patients included, 152 received 3-4 NACT cycles; 36 patients received >4. Baseline characteristics were similar. Of those receiving 3-4 cycles, 10 (6.6%) had PCR at time of surgery; 142 (93.4%) did not. Of patients who received >4 cycles, 3 (8.3%) had PCR; 33 (91.7%) did not. Rate of PCR was not different between groups (p=0.709). Conclusion: In our cohort, number of NACT cycles was not associated with increased likelihood of PCR at time of surgery, thus more NACT cycles may not improve rates of PCR. Due to sample heterogeneity and the retrospective nature of the study, we did not identify any variables that could be used in a screening algorithm. Further research is needed to determine factors that may affect the likelihood of PCR. We are working to model factors that may help determine the most effective NACT regimen for surgical optimization and patient tolerability. Trends in Obstetrics and Gynecology Education Research: A Fifteen-Year Analysis of Educational Publications Ali Michelotti, BS, Niva Shrestha, BS, Nicholas Stansbury, MD, Sarah M Page-ramsey, MD University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX; University of Texas Health San Antonio, San Antonio, TX Introduction: As the specialty of obstetrics and gynecology (OB/GYN) expands, so does the demand for high-quality educational research to direct training. The aim of this study was to determine the prevalence, content, and quality of OB/GYN educational publications over time. Methods: A systematic review was performed to identify OB/GYN educational publications from 2007-2021. Two reviewers were used with 88% data agreeability. Journal, author, and publication characteristics were collected. Categories included curriculum, assessment, simulation, career development, program development, case outcomes, trainee perceptions, diversity, social media, and wellness/burnout. Interactivity data and Medical Education Research Study Quality Instrument (MERSQI) scores were collected. Univariate analysis and linear regressions were performed for statistical analysis. Results: Ninety-three publications were identified in 36 journals with median impact factor of 2.9 (1.9-6.8), comprising 0.12% (IQR 0.03-0.17) of publications. Obstetrics & Gynecology published the highest number of articles (19%), while the Journal of Surgical Education had the greatest proportion amongst their total publications (0.38%). Simulation studies were most common (34%), followed by curriculum (24%) and assessment (18%). Simulations had the most citations (14(2-6); p<0.001). Wellness/burnout had the most captures (50(33-67); p<0.001). Abstracts presented at conferences (28%) were more likely to be published in higher impact journals (p<0.001). The median MERQSI score was 11 (10-12.5), with 59% considered “adequate” quality. Educational publications increased over time (R2=0.86; p<0.001). Conclusion: Despite the need for educational research, publications remain sparse, though increasing over time. Promotion of high-quality educational research is essential to continue advancing medical education in students, residents, and fellows in OB/GYN.