Faculty Bibliography

INTRODUCTION/BACKGROUND:Puberty is a key transition point in adolescents' lives that plays a foundational role in shaping health behaviors and outcomes across one's life course. This period holds significant potential to empower adolescents and support autonomy in health and well-being, but limited puberty education curricula exist for early adolescents (age 8-14), and those that do exist vary in content. There is a paucity of evaluations of puberty competencies and limited consensus on what competencies should be measured to assess effectiveness or even how to measure these competencies. OBJECTIVE:The objective of this scoping review is to systematically map and characterize the outcomes, domains, and instruments used to evaluate puberty education curricula for early adolescents aged 8-14 years. In accordance with PRISMA-ScR and JBI scoping review guidance, this review does not synthesize effect sizes or assess intervention efficacy, but maps the breadth of evidence to identify conceptual gaps and inform future framework development. METHODS:The review protocol is registered with the Open Science Framework (OSF). We will search PubMed, CINAHL, PsycInfo, ERIC, Education Source, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, and OpenAlex for relevant sources. Two reviewers will independently screen and extract studies that meet inclusion criteria using our data extraction tool. EXPECTED OUTPUTS/UNASSIGNED:Findings from the scoping review will be synthesized to create an overarching framework that can guide approaches to the development and evaluation of puberty curricula targeted to early adolescents. Focus group discussions with adolescents, parents, and school representatives will be conducted to assess the applicability and appropriateness of identified competencies and evaluation measures prior to broader dissemination. Insights from this scoping review will ultimately be used to inform the implementation and evaluation of puberty education.

OBJECTIVES/OBJECTIVE:Inequities in race, ethnicity and socioeconomic status have been well documented in postpartum hemorrhage (PPH) and hemorrhage-associated morbidity. However, little is known about the impact of language barriers on maternal outcomes in PPH. Our study aim was to investigate language-based inequities in maternal outcomes among gravidas with PPH. METHODS:This is a retrospective cohort of patients with PPH who delivered at an urban academic institution between January 2020 and December 2022. Maternal language is categorized as English primary language (EPL) or non-English primary language (NEPL). PPH is defined as a quantitative blood loss (QBL) greater than 1000 mL within 24 h of delivery. QBL is a calculated measurement of peripartum and postpartum blood loss. Primary outcome is transfusion of packed red blood cells (pRBC). Secondary outcomes include transfusion of 4 + units of pRBC, disseminated intravascular coagulation (DIC) and admission to intensive care unit (ICU). Multivariable logistic regression was used to estimate the association of primary language with maternal outcomes. RESULTS:1723 patients with PPH were included: 1314 (76.3%) with EPL and 409 (23.7%) with NEPL. English-speaking and non-English speaking patients had similar QBL rates (1530.2 ± 634.2 vs 1496.0 ± 668.1, p = 0.3). However, transfusion rates were lower in those with NEPL, when compared to EPL (28.2% vs 22.9%, p = 0.039). After adjusting for age, race/ethnicity, nulliparity, body mass index, pre-eclampsia and pre-delivery anemia, gravidas with NEPL were less likely to be transfused compared with EPL (aOR 0.7, 95% CI 1.012-1.806, p = 0.04). Rates of DIC, ICU admission and transfusion of 4 + units of pRBC were similar between groups. CONCLUSIONS FOR PRACTICE: Despite a similar postpartum blood loss, patients with NEPL had lower rates of blood transfusion in PPH compared to patients with EPL. Further research is needed in health literacy and language proficiency that may impede access to transfusion in patients with PPH.

OBJECTIVE:Low placentation is associated with increased risk of postpartum hemorrhage (PPH). There is a paucity of data on the association between second trimester low placentation that later resolves, and PPH. Our objective was to investigate the association of resolved low placentation and other prenatal ultrasound markers, and PPH with delivery. STUDY DESIGN/METHODS:This was a retrospective matched case-control (1:1) study of full term, singleton pregnancies complicated by PPH who delivered vaginally at our academic center between 2018-2022. All patients received a transvaginal ultrasound in the second and third trimester. PPH was defined as quantitative blood loss (QBL) >1L within 24 hours of delivery. Primary exposure variable was second-trimester low placentation (defined as previa or low-lying placenta within 10mm from internal os) that resolved before labor. Additional exposure variables included uterine leiomyoma, first-trimester subchorionic hematoma, second-trimester cervical length< 25mm, and third-trimester polyhydramnios or large for gestational age (LGA) fetus. Chi-square test and unpaired student t-test were used to compare categorical and continuous variables, respectively. Multivariable logistic regression analysis was performed to adjust for confounders. RESULTS:We compared 400 gravidas with PPH to 400 without. Gravidas were matched by age, parity, gestational age and mode of vaginal delivery. PPH occurred more often in cases with resolved previa versus controls (12 % vs 4.6 %, p < 0.01). On multivariate analysis, those with resolved previa were 2.58 times more likely to have PPH, compared to controls (aOR 2.58, 95% CI 1.49 - 4.81, p < 0.001). PPH rates were also increased in those with leiomyoma (aOR 3.50, 95% CI 1.59 - 7.72, p = 0.002). Rates of subchorionic hematoma, short cervical length, polyhydramnios and LGA fetus were similar between groups. CONCLUSION/CONCLUSIONS:Low placentation on second-trimester ultrasound is associated with an increased risk of PPH, even when it appears to resolve in the third trimester. Routine assessment of placentation in the second trimester should be considered to improve prediction and management of PPH.

BACKGROUND:Hypertension is a leading cause of adverse pregnancy outcomes. These outcomes disproportionately affect Black individuals. Reproductive life planning that includes patient-centered contraception counseling could mitigate the impact of unintended pregnancy. OBJECTIVE:The primary objective of the study is to compare contraception counseling and use between hypertensive and nonhypertensive individuals at risk for unintended pregnancy. Our secondary objectives are the following: (1) to evaluate the effect of race on the probability of counseling and the use of contraception, and (2) to evaluate the methods used by individuals with hypertension. METHODS:Data from the 2015-2017 and 2017-2019 National Survey of Family Growth Female Respondent Files were used to analyze whether individuals who reported being informed of having high blood pressure within the previous 12 months received counseling about contraception or received a contraceptive method. Covariates considered in the analysis included age, race, parity, educational attainment, body mass index, smoking, diabetes, and experience with social determinants of health. The social determinants of health covariate was based on reported experiences within 5 social determinants of health domains: food security, housing stability, financial security, transportation access, and childcare needs. Linear probability models were used to estimate the adjusted probability of receiving counseling and the use of a contraceptive. Using difference-in-difference analyses, we compared the change in counseling and use between hypertensive and nonhypertensive respondents by race, relative to White respondents. RESULTS:Of the 8625 participants analyzed, 771 (9%) were hypertensive. Contraception counseling was received by 26.2% (95% confidence interval, 20.4-31.9) of hypertensive individuals and 20.7% (95% confidence interval, 19.3-22.2) of nonhypertensive individuals. Contraception use was reported by 39.8% (95% confidence interval, 33.2-46.5) of hypertensive and 35.3% (95% confidence interval, 33.3-37.2) of nonhypertensive individuals. The linear probability model adjusting for age, parity, education attainment, body mass index, smoking, diabetes, and social determinants of health indicated that hypertensive individuals were 8 percentage points (95% confidence interval, 3-18 percentage points) more likely to receive counseling and 9 percentage points (95% confidence interval, 3-16 percentage points) more likely to use contraception. Hypertensive Black individuals did not receive more counseling or use more contraceptives compared with nonhypertensive Black individuals. The difference in counseling when hypertension was present was 13 percentage points lower than the difference observed for White respondents when hypertension was present (P=.01). The most frequently used contraceptive method among hypertensive individuals was combined oral contraceptive pills (54.0%; 95% confidence interval, 44.3%-63.5%). CONCLUSION/CONCLUSIONS:Despite the higher likelihood of receiving contraception counseling and using contraception among hypertensive individuals at risk for unintended pregnancy, two-thirds of this population did not receive contraception counseling, and <40% used any contraceptive method. Furthermore, unlike White individuals, Black individuals with hypertension did not receive more contraception care than nonhypertensive Black individuals. Of all those who used contraception, half relied on a method classified as Centers for Disease Control and Prevention Medical Eligibility Criteria Category 3. These findings highlight a substantial unmet need for safe and accessible contraception options for hypertensive individuals at risk for unintended pregnancy, emphasizing the importance of targeted interventions to improve contraceptive care and counseling in this population.

INTRODUCTION/UNASSIGNED:The aim of this study was to describe the sexual and reproductive goals of female adolescents with human immunodeficiency virus (HIV) in an urban cohort and decipher if they vary depending on the mode of HIV acquisition. METHODS/UNASSIGNED:We conducted in-depth qualitative interviews with 25 Black and/or Hispanic/Latinx female adolescents living with HIV (14 perinatally, 11 behaviourally acquired) aged 17-25 years who have access to care and antiretroviral therapy at an urban public hospitals (NYC, NY). Interviews were transcribed, coded and analysed using thematic analysis. RESULTS/UNASSIGNED:Interviews demonstrated that access to antiretroviral therapy and HIV disclosure to a sexual partner were critical aspects of sexual health for the majority of participants. Persons with perinatal HIV defined motherhood as a source of self-validation and were confident that antiretroviral therapy prevents HIV transmission. Persons with behaviourally acquired HIV viewed their status as an insurmountable barrier that will prevent them from attaining sexual intimacy with a partner and expressed persistent concerns about HIV transmission during pregnancy despite reassurance from medical providers. CONCLUSION/UNASSIGNED:Sexual and reproductive perspectives of adolescents/young women living with HIV are multifactorial, highly stigmatized, and likely influenced by the mode of HIV acquisition. This population may benefit from patient-centred care models, including sexual health counselling that addresses sexual agency, intimacy, parenting and transmission risk reduction.

INTRODUCTION AND IMPORTANCE/UNASSIGNED:Cecal bascule is a rare form of a cecal volvulus characterized by an anterior and superiorly displaced cecum in turn causing compression of the ascending colon that can result in a large bowel obstruction. We report a case of cecal bascule in a newly postpartum patient, with emphasis on clinical presentation, radiologic findings and treatment. CASE PRESENTATION/METHODS:A 37-year-old female who underwent an uncomplicated c-section and bilateral salpingectomy developed severe abdominal pain, vomiting, and peritonitis 12 h after surgery. A computerized tomography of the abdomen and pelvis revealed a dilated and superiorly displaced cecum. The diagnosis of cecal bascule was confirmed intraoperatively and a right hemicolectomy was performed. The patient recovered appropriately and was discharged on postoperative day six. DISCUSSION/CONCLUSIONS:Cecal bascule is the rarest form of cecal volvulus. In the context of obstetrics and gynecology, it has mostly been mentioned perioperatively after cesarean, but was also reported in an antepartum patient. It usually occurs in patients with redundant or mobile cecum, which is a result of incomplete fixation of the cecum to the retroperitoneum during embryogenesis. Other risk factors include recent surgery, previous abdominal surgery, ileus, chronic constipation, and distal colonic obstruction. An association has also been shown with pregnancy or the postpartum abdomen and is hypothesized to be due to mass effect. CONCLUSION/CONCLUSIONS:Cecal bascule is a serious entity requiring a high index of suspicion and warranting greater awareness in the post-natal patient. Clinical diagnosis, prompt imaging, and surgery are important to avoid bowel ischemia and perforation.