Faculty Bibliography

INTRODUCTION/UNASSIGNED:There is uncertainty about the benefits of cerclage in patients with transvaginal cervical length (TVCL) ≤10 mm and no prior spontaneous preterm birth. Our aim was to assess whether cervical cerclage in these patients was associated with prolonged pregnancy latency. METHODS/UNASSIGNED:This was an observational study of asymptomatic singleton pregnancies without a history of spontaneous preterm birth with extremely short cervix (TVCL ≤10 mm) in the second trimester. Exposure and outcome data were extracted manually from medical charts by obstetric providers, with all outcomes occurring prior to study initiation. All patients were prescribed vaginal progesterone and those with a cervical dilation >1.5 cm were excluded. The primary outcome was time interval from diagnosis to delivery (or 37 weeks' gestation, whichever occurred first). Secondary outcomes included gestational age at delivery, mode of delivery, and neonatal outcomes. We adjusted for parity and used log-binomial regression to estimate the relative risk for categorical variables and linear regression to estimate mean differences for continuous variables. RESULTS/UNASSIGNED:There were 247 patients with TVCL ≤10 mm during anatomy scan. After exclusions, 87 remained, of which 55 (63.2%) received cervical cerclage. At the time of diagnosis, the mean cervical length was 5.8 mm (cerclage group) versus 7.4mm (no cerclage group, difference: -1.6, 95% CI -0.6, -2.6) and the gestational age was 21.0 weeks (cerclage group) versus 22.1 weeks (no cerclage group, -1.1, 95% CI -1.8, -0.3). Mean pregnancy latency was longer in the cerclage group compared to the no cerclage group (13.4 vs 11.1 weeks, 2.2, 95% CI -0.3, 4.9), though there was a high level of uncertainty in the estimate. Term delivery occurred 30% more often in the cerclage group compared to the no cerclage group (RR 1.31, 95% CI 0.96, 1.79). CONCLUSION/UNASSIGNED:In our cohort, patients with extremely short cervix who received a cerclage had longer pregnancy latency than those who did not receive cerclage and more patients achieved term gestation, suggesting a potential benefit of cerclage in this population. However, given the high level of uncertainty of our estimates, additional research is needed to investigate these findings.

BACKGROUND:Preterm birth (PTB, < 37 weeks of gestation) is the leading cause of child mortality in the United States (U.S.) and worldwide, and has substantial short- and long-term health consequences for mothers and infants. Each year, > 350,000 infants in the U.S. are born preterm, and rates continue to rise in parallel with maternal risk factors such as hypertension, diabetes, anemia, asthma, and mental health conditions. Evidence-based interventions exist for many of these conditions and are associated with improved pregnancy outcomes, including low-dose aspirin for preeclampsia prevention in individuals with chronic hypertension or pregestational diabetes, inhalers for asthma, iron for anemia, and therapy or medication for mental health disorders, but fewer than half of eligible individuals receive them, reflecting persistent gaps in use. To address this, we developed the PTB Actionable Risk Index (PTB-ARIx), which leverages factors with known evidence-based interventions to identify individuals who are pregnant and are at increased risk for PTB. This study evaluates performance of the PTB-ARIx throughout pregnancy with respect to risk determination and characterization of actionable risk factors, including their combined contributions to PTB. METHODS:A retrospective cohort study was conducted using linked data for 1.9 million singleton live births in California in 2016-2020, divided into training and testing sets. Poisson regression estimated associations between 18 candidate risk factors for PTB with evidence-based interventions spanning clinical, behavioral, and social risks, including preeclampsia risk composites (≥ 1 high-risk or ≥ 2 moderate-risk factors based on U.S. Preventive Services Task Force (USPSTF) criteria), maternal conditions (e.g., gestational hypertension, asthma), substance use, and social adversity. Beta coefficients were combined to construct the PTB-ARIx, evaluated by per-unit associations with PTB and by area under the receiver operating characteristic curve (AUC) overall, by early (< 32 weeks), late (32-36 weeks), spontaneous, and medically-indicated PTB, and by PTB co-occurring with preeclampsia. FINDINGS/RESULTS:All risk factors were found to be associated with increased PTB risk. Having ≥ 1 high-risk or ≥ 2 moderate-risk factors for preeclampsia (based on composites) was most strongly related to PTB (relative risk (RR) 6.73, 95% confidence interval (CI) 6.57, 6.89). Each unit increase in PTB-ARIx was associated with > 60% higher PTB risk (RRs 1.66-1.72) across training and testing samples, with consistent findings across PTB and race/ethnicity-insurance subgroups. Model performance was modest for late PTB (AUC ≈ 0.63), stronger for early PTB (0.69-0.72), and especially high for early PTB with preeclampsia (AUCs up to 0.97). Over 70% of individuals with PTB-ARIx scores ≥ 3.00 experienced PTB or another adverse outcome such as low birth weight (< 2,500 grams). CONCLUSIONS:The PTB-ARIx is a well-performing metric for identifying individuals at increased risk for PTB and other adverse pregnancy outcomes. By centering on modifiable risks, the PTB-ARIx combines risk identification with opportunities for intervention. Demonstrating strong performance across subgroups, including for early PTB and PTB with preeclampsia, the PTB-ARIx provides a potential pathway to improve patient-provider communication and uptake of equitable, evidence-based care. Further validation, including integration with treatment data, is needed to confirm its potential to reduce PTB risk and rates.

OBJECTIVES/OBJECTIVE:This study evaluates how access to abortion training influenced OBGYN residents who selected residency programs before and after the Dobbs decision. STUDY DESIGN/METHODS:Current OBGYN residents completed a survey in January 2024 as part of their annual in-training exam. Residents rated the importance of abortion training and compared access to abortion training to other factors (e.g., residency culture and happiness, geographic location) when selecting and ranking programs. We computed the percentage of residents reporting abortion training as important and a top factor when ranking programs. We used chi-squared test to compare differences between cohorts. RESULTS:Of the 6,134 residents surveyed, 3,182 consented to participation and had complete responses (52%). Overall, 2,281 (72%) considered abortion training important when choosing programs and 2,179 (69%) when ranking programs; 1,105 (71%) of post-Dobbs and 1,074 (66%) of pre-Dobbs residents considered abortion training important when ranking programs (p<0.01). Access to abortion training was a top three factor for 741 (23%) respondents when ranking programs. More post-Dobbs (392, 25%) than pre-Dobbs residents (349, 21%) considered access to abortion training as a top factor when ranking programs (p=0.01). CONCLUSIONS:Applicants weigh a variety of factors when selecting programs and may match to abortion restricted environments - this includes the 23% who considered abortion training a top factor. Future work should continue to focus on the impact of the Dobbs decision on residency program selection and the ability of all residents to develop abortion-care skills. IMPLICATIONS/CONCLUSIONS:Abortion training is an important consideration in residency program selection and essential for patient care. Without prioritization of abortion education, programs risk losing viable candidates and graduating residents without essential skills.

BACKGROUND/UNASSIGNED:. those who proceeded directly to mTESE. METHODS/UNASSIGNED:A retrospective cohort study of 73 male patients with NOA or cryptozoospermia severe enough to qualify for mTESE at NYU Langone Fertility Center between 2018 and 2024. Patients were categorized based on their initial intervention: ESSM-first group (n=45), in which ESSM was attempted prior to surgical retrieval, and an mTESE-first group (n=28), in which patients proceeded directly to surgery. The primary outcome was overall sperm identification rate per patient. Secondary outcomes included sperm retrieval success from mTESE after failed ESSM, and among patient proceeding to in vitro fertilization (IVF) with ICSI, fertilization rate, blastocyst formation rate, euploid rate, and live birth rate. RESULTS/UNASSIGNED:. 46%, P=0.66). CONCLUSIONS/UNASSIGNED:In men with NOA or cryptozoospermia eligible for surgical sperm retrieval, an ESSM-first strategy was associated with higher overall sperm identification rates while preserving comparable reproductive outcomes among those proceeding to IVF with ICSI. These findings support consideration of ESSM as an initial, non-invasive strategy prior to mTESE in appropriately selected patients.

BACKGROUND/UNASSIGNED:Placenta accreta spectrum (PAS) is a leading cause of obstetric morbidity and peripartum hysterectomy. Rising cesarean delivery rates, advanced maternal age, and assisted reproductive technologies have increased its incidence. Early, standardized diagnosis is essential for multidisciplinary planning and improved outcomes, yet formal screening guidelines are lacking. OBJECTIVE/UNASSIGNED:To raise awareness of the importance of antenatal screening for PAS, summarize key clinical and imaging risk factors, and propose a standardized mid-trimester ultrasound protocol for high-risk patients. METHODS/UNASSIGNED:An expert panel convened under the Pan-American Society for the Placenta Accreta Spectrum (PAS2) reviewed available evidence, risk stratification models, and prior consensus statements to develop practical recommendations for PAS screening. RESULTS/UNASSIGNED:PAS risk rises with the number of prior cesarean deliveries, especially in the setting of concurrent placenta previa or anterior low-lying placenta. Combined transabdominal and transvaginal ultrasound using grayscale and low-flow color Doppler (<10 cm/s) best identifies characteristic markers such as loss of the clear zone, myometrial thinning, bladder-wall interruption, placental bulge, uterovesical hypervascularity, lacunae, and bridging vessels. Standardized imaging protocols and structured reporting improve detection and facilitate referral to specialized centers. CONCLUSIONS/UNASSIGNED:All patients with placenta previa or low-lying placenta and prior cesarean delivery should undergo targeted PAS screening at the time of anatomic survey. Early, systematic assessment and referral improve safety and outcomes.

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.

OBJECTIVE:To determine the association between molecular classification and response in patients with endometrial intra-epithelial neoplasia or endometrial cancer treated with a levonorgestrel intra-uterine device. METHODS:Eligible patients were treated with a levonorgestrel intra-uterine device for endometrial intra-epithelial neoplasia or endometrial cancer for at least 6 months. Immunohistochemistry for MLH1, MSH2, MSH6, PMS2, and p53 was performed. Specimens were categorized using a modified Proactive Molecular Risk Classifier for Endometrial Cancer algorithm as deficient mismatch repair, p53 abnormal, or p53 wild-type. A subset underwent single-gene POLE sequencing. Best response was recorded as pathologic complete response, partial response, stable disease, or progressive disease. Kruskal-Wallis tests and Fisher exact tests were used for statistical analysis. RESULTS:There were 143 patients, including 83 with endometrial intra-epithelial neoplasia and 60 with endometrial cancer. Fertility preservation was desired in 35.7%, 53.8% had significant medical co-morbidities precluding hysterectomy, and 10.5% had levonorgestrel intra-uterine device placement for other indications, including patient preference, placement during the coronavirus disease 2019 pandemic, and logistical considerations for other cancer diagnoses. Molecular characterization showed 90.9% p53 wild-type, 7.0% deficient mismatch repair, and 2.1% p53 abnormal. Only 4.4% of specimens with sequencing had a POLE mutation (2 of 45). The overall response rate was 86.7% (endometrial cancer: complete response 38.3%, partial response 36.7%; endometrial intra-epithelial neoplasia: complete response 67.5%, partial response 27.7%). In patients with endometrial cancer, the response rate was 75% (45 of 60), varying by molecular sub-group: 50% in the p53 abnormal group (1 of 2) and 50% in the deficient mismatch repair group (5 of 10). Only 1 patient with endometrial intra-epithelial neoplasia had p53 abnormal expression; the remaining patients had intact MMR expression and p53 wild-type. CONCLUSIONS:The complete response to levonorgestrel intra-uterine device therapy was lower than expected for endometrial intra-epithelial neoplasia. Response rates varied by molecular classification, with worse outcomes observed in deficient mismatch repair and p53 abnormal sub-types. Although limited by sample size, these findings suggest that levonorgestrel intra-uterine device therapy may not be sufficient for all molecular sub-groups.

IMPORTANCE/UNASSIGNED:Current pregnancy surveillance efforts in the US face substantial challenges in providing timely and accurate data on prenatal care use. Electronic health record (EHR) networks have the potential to enhance existing surveillance systems by providing near real-time, clinically documented data. OBJECTIVE/UNASSIGNED:To assess whether EHR network data could be used to define valid and reliable surveillance metrics of prenatal care use. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This longitudinal cohort study included US adults (age ≥18 years) who received prenatal care and delivered a live birth from January 1, 2023, to December 31, 2024, at a facility that used the Epic Cosmos EHR network. EXPOSURE/UNASSIGNED:Live birth at a facility that used the selected EHR network. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Prenatal care use was calculated as the proportions of patients who initiated care by the 13th week of pregnancy (early care) and who received adequate or better prenatal care (adequate care). Raking weights were applied to adjust the EHR sample to match the marginal distributions for US residents with live births by age, race and ethnicity, insurance, pregnancy risk factors, and geographic region. Electronic health records-based metrics were externally validated against published natality data estimates from National Center for Health Statistics (NCHS) using the two 1-sided test of equivalence. Patterns by demographics, state, and year were examined. RESULTS/UNASSIGNED:In total, 1 963 496 patients (mean [SD] age, 29.5 [5.7] years; 100% women) had a live birth and evidence of prenatal care at a facility using the selected EHR network during the study period. Compared with all US birthing people (n = 7 224 951), patients who gave birth at a facility using the selected EHR network had lower Medicaid coverage (40.5% vs 21.1%) and a higher prevalence of pregnancy risk factors (eg, prior preterm birth: 4.0% vs 8.8%). After weighting to the national population, EHR-based estimates of early care were consistently lower than those from NCHS data (68.0% [95% CI, 67.9%-68.2%] vs 76.1% [95% CI, 76.1%-76.1%]). However, adequacy estimates were equivalent to NCHS-based estimates (76.0% [95% CI, 75.9%-76.2%] vs 75.2% [95% CI, 75.1%-75.2%]; P < .001 at 0.01 equivalence bound), aligned with expected demographic patterns, and were stable across place and time. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this cohort study, EHR network data reliably informed surveillance of prenatal care adequacy after adjusting for nonrepresentativeness of the patient population. These findings suggest that near real-time availability of EHR data has the potential to improve the timeliness of population-level pregnancy surveillance to better inform policy, public health, and clinical efforts aimed at enhancing prenatal care access and use among individuals receiving inadequate care.

BACKGROUND/UNASSIGNED:Due to the COVID-19 pandemic, in 2020 the medical community modified residency and fellowship interview processes to a virtual-only format. The 2023 application cycle marked the first year that any gynecologic oncology fellowship interviews returned to an in-person format with two programs conducting in-person interviews. OBJECTIVE/UNASSIGNED:This study evaluated the perspectives of gynecologic oncology fellowship applicants on in-person and virtual interview formats to inform programs' decision-making around future interview cycles. METHODS/UNASSIGNED:Applicant lists from three gynecologic oncology fellowship programs were compiled from the 2023 application cycle. An anonymous survey regarding applicant perspectives on the interview process was electronically distributed. RESULTS/UNASSIGNED:There was a 56% (47/86) response rate. Applicants applied to a median of 50 programs (IQR 42-60), accepted 24 interviews (IQR 20-32), declined 4 interviews (IQR 2-9), and attended 24 interviews (IQR 17-24). Thirty (64%) applicants attended at least one in-person interview. Among the 30 applicants who experienced both interview formats, in-person interviews resulted in a better understanding of the program's geography, culture, and hospital facilities (p < 0.0001). Applicants who attended in-person interviews were more satisfied with their interview experience, found it easier to interpret body language, and were better able to connect with other applicants and form personal connections with interviewers (p < 0.0001). Of applicants who experienced both formats, 53% preferred in-person format. CONCLUSION/UNASSIGNED:Applicants who participated in both interview formats reported higher satisfaction and connected better with other applicants and interviewers with in-person interviews; however, there was only a slight (53%) preference for in-person format.

This study analyzed the association between self-perceived bullying and self-reported toothache among Brazilian students and evaluated the moderating role of school-based health actions, including participation in the School Health Program, oral health promotion, and bullying prevention. A cross-sectional study was conducted using data from the 2019 National School-based Health Survey, including 53,711 students aged 13-17 years. The outcome was self-reported toothache and the main exposure was self-perceived bullying. Moderating variables included school participation in the School Health Program, oral health promotion actions, and bullying prevention actions. Poisson regression models with robust variance were fitted, with standard errors adjusted for clustering by school. Overall, 23.6% of students reported toothache and 13.7% reported bullying. Moderation analyses showed no evidence that school health actions influenced the association between bullying and toothache. For bullying once or ≥2 times, prevalence ratios were: School Health Program participation (PR_once = 0.92, 95%CI 0.77-1.09; PR_ ≥ 2 = 1.07, 95%CI 0.81-1.41), bullying prevention (PR_once = 0.98, 95%CI 0.76-1.25; PR_ ≥ 2 = 0.82, 95%CI 0.72-1.09), and oral health promotion (PR_once = 1.13, 95%CI 0.96-1.33; PR_ ≥ 2 = 1.19, 95%CI 0.94-1.52). These findings indicate that school-based health actions alone may be insufficient to mitigate the impact of bullying on adolescents' oral health.