Counseling Women Research Articles

Early infant diagnosis of HIV infection: a mixed-method study of uptake and challenges at primary health centers in Lagos State, Nigeria

IntroductionNigeria has a low uptake of early infant diagnosis (EID) of HIV despite its high pediatric HIV infection rate. Efforts to increase the EID of HIV have been limited by many factors. This research assessed EID uptake and challenges service providers experienced in providing routine care for HIV-exposed infants.MethodsThis is a mixed-method study at primary health centers (PHCs) in Lagos state, Nigeria. The quantitative component of the research was a review of the PMTCT Infant Follow-up Register at a purposive sample of 22 PHCs of Lagos State. The number of HIV-exposed infants (HEIs) returned for a dried blood sample (DBS) collection, date of collection, and the infant’s EID results for one year preceding the study were captured on Research Electronic Data Capture (RedCap). In-depth interviews were conducted with service providers purposively selected per participating PHC. Electronic transcripts were analyzed using MAXQDA 2020 (VERBI Software, 2019).ResultsTwenty-two Lagos State primary health centers participated in the research. Fifteen PHCs (68.2%) had PMTCT HIV counseling and Infant follow-up registers. Documentation of DBS sample collection was observed in 12 (54.6%) PHCs. Both DBS sample collection and EID results documentation were observed in only nine (40.9%) PHCs. In-depth interviews revealed both maternal and health systems’ challenges to EID. The denial of HIV status was the only maternal factor reported as a barrier against the use of EID services. Health systems challenges include unavailability of EID services, uncertainty regarding whether EID is performed in a facility, referral to secondary health facilities for EID services (leading to losses to follow-up), and delay in getting results of EID. Task-shifting of DBS collection by nurses was suggested as means to increase access to EID services.ConclusionsThere is a need to expand EID services and address women’s denial of HIV infection. Counseling women and linkage to available services are emphasized. Re-training of health workers on DBS collection and proper documentation of EID services were noted as key to improving the implementation of early infant diagnosis of HIV in the state.

Anesthesia and postpartum pain management for placenta accreta spectrum: The healthcare provider perspective.

To explore the management and experiences of healthcare providers around anesthetic care in placenta accreta spectrum (PAS). This descriptive survey study was carried out over a 6-week period between January and March 2023. Healthcare providers, both anesthesiologists and those involved in operative care for women with PAS, were invited to participate. Questions invited both quantitative and qualitative responses. Qualitative responses were analyzed using content analysis. In all, 171 healthcare providers responded to the survey, the majority of whom were working in tertiary PAS referral centers (153; 89%) and 116 (70%) had more than 10 years of clinical experience. There was variation in the preferred primary mode of anesthesia for PAS cases; 69 (42%) used neuraxial only, but 58 (35%) used a combined approach of neuraxial and general anesthesia, with only 12 (8%) preferring general anesthesia. Ninety-nine (61%) were offering a routine antenatal anesthesia consultation. Content analysis of qualitative data identified three main themes, which were "variation in approach to primary mode of anesthesia", "perspectives of patient preferences", and "importance of multidisciplinary team care". These findings led to the development of a decision aid provided as part of this paper, which may assist clinicians in counseling women on their options for care to come to an informed decision. Approach to anesthesia for PAS varied between healthcare providers. The final decision for anesthesia should take into consideration the clinical care needs as well as the preferences of the patient.

EFFICACY AND SAFETY OF INTRA CAESAREAN IUCD

The objective of this study was to evaluate the effectiveness and complications of post-partum intrauterine contraceptive device (PPIUCD) insertion during cesarean delivery. The study was conducted at Nishtar Medical Hospital from June to December 2022. A total of 150 women were included in the study. In the first phase, medical eligibility for the intervention was assessed, while in the second phase, WHO Medical Eligibility Criteria were evaluated. The IUCD was manually inserted after delivery with its string towards the cervix. The patients were followed up at 2 and 6 months. After 6 months, 9 (6%) cases reported abdominal pain, 22 (15%) had menorrhagia, and 23 (15.3%) had missed threads with the IUCD in place. None of the patients reported pregnancy or perforation of the uterus. After 6 months, 133 (88.6%) patients continued to use this method of contraception, while 9(6%) were lost to follow-up, 4 (2.6%) had the device removed due to complications, and 4 (2.6%) had spontaneous expulsion. The study concluded that PPIUCD is a safe and effective long-term contraceptive method. Clinicians should evaluate patients' eligibility for PPIUCD and counsel women on adopting this method.

ASO Visual Abstract:A Randomized Trial Comparing the Effectiveness of Pre-test Genetic Counseling Using an Artificial Intelligence Automated Chatbot and Traditional In-person Genetic Counseling in Women Newly Diagnosed with Breast Cancer.

ASO Visual Abstract:A Randomized Trial Comparing the Effectiveness of Pre-test Genetic Counseling Using an Artificial Intelligence Automated Chatbot and Traditional In-person Genetic Counseling in Women Newly Diagnosed with Breast Cancer.

Empowerment of Premenopausal women regarding knowledge on Cardiac Health in selected Self Help Women Groups Mangalore

Heart disease is the number one cause of death among women. Although 450000 women die annually from it, this fact is unknown to many women. Because heart disease is frequently preventable, increasing awareness of personal risk and preventative measures is a key element of healthcare for women. Nurse clinicians can evaluate, educate, and counsel women regarding their risk for this pervasive disease and promote behaviour changes that will decrease that risk. The present investigation was aimed to evaluate the effectiveness of empowerment programme on cardiac health among the premenopausal women’s and to find out an association between pre-test knowledge scores with selected demographic variables among premenopausal women. The research design used in the study was pre–experimental one group pre-test post-test and non-probability convenient sampling technique was used to draw sample. The data was collected from 100 premenopausal women using the structured knowledge questionnaire. Empowerment programme was conducted and post-test was administered after 7days using the same structured knowledge questionnaire to find out the effectiveness of empowerment programme. The results revealed that the overall mean percentage knowledge score in the pre-test and post-test were 35.70% and 61.22% respectively. Enhancement mean percentage knowledge score was found to be 25.52%. The statistical paired ‘t’ test (t= 47.74) indicates that enhancement in the mean percentage knowledge score was found to be significant at 0.05 level for all the aspects under study. The association found to be significant between pre-test knowledge scores & selected socio demographic variables such as age, educational status, occupation, history of diabetes mellitus and information about cardiac disease at 0.05 levels (P< 0.05). There is no significant association between pre-test knowledge score and demographical variable such as religion, income, marital status and family history of cardiac disease.

Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy: a systematic review

BackgroundPregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG).MethodsA systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480.ResultsA total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason.ConclusionOur systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.

Factors influencing uptake of the COVID-19 vaccination among pregnant women in Australia: A cross-sectional survey.

Mounting evidence shows the risk of COVID-19 on perinatal outcomes, as well as the safety and efficacy of vaccination during pregnancy. However, little is known about vaccine uptake among pregnant women in Australia, including women who are culturally and linguistically diverse (CALD), and about sources of information pregnant women use when making decisions about vaccines. We aimed to determine the proportion of pregnant women who had been vaccinated and to identify factors associated with vaccine uptake or decline during pregnancy. A cross-sectional, anonymous, online survey was conducted from October 2021 to January 2022 in two metropolitan hospitals in New South Wales, Australia. Of 914 pregnant women, 406 (44%) did not speak English at home. Overall, 101 (11%) received a vaccine prepregnancy and 699 (76%) during pregnancy. In the nonvaccinated cohort, 87 (76%) declined vaccination during pregnancy. The uptake was more than 87% among women during pregnancy who received information from government or health professional websites but 37% when received from personal blogs. The main reasons for vaccine uptake were (1) hearing that COVID-19 affects pregnant women, (2) being concerned about the COVID-19 outbreak, and (3) receiving vaccine recommendation from a general practitioner. In a multivariable logistic regression, three main factors associated with declining or feeling unsure about vaccination were (1) concerns about the safety of the COVID-19 vaccine, (2) lack of trust and being unsatisfied with the information received about COVID-19 vaccination during pregnancy, and (3) doubting the importance of COVID-19 vaccine. Clinicians play a critical role in counseling women to alleviate vaccine fear, support vaccine acceptance, and direct women to use reliable information sources, such as government and professional healthcare organizations, for information about vaccines.

Empowering Women in Counseling by Dismantling Internalized Sexism: The Feminist-Multicultural Orientation and Social Justice Competencies

Women are exposed to multiple stressors that derive from various forms of violence and social injustice, most notably sexism. Sexism is an ideological system that maintains and reinforces gender injustice, which manifests at institutional, interactional, and individual levels. Among the various iterations of structural sexism, internalized sexism encourages women to retain and reproduce sexist messages unconsciously, leading to such adverse mental health outcomes as increased feelings of inferiority and self-doubt. With this background, the current article provides a review of literature on internalized sexism among women, as well as its impact on women’s mental health. In so doing, we posit the Feminist-Multicultural Orientation and Social Justice Competencies (F-MCOSJ) as a model for mental health counselors tending to women clients. This model includes feminist multicultural orientation, awareness, knowledge, skills, and actions. A case example is provided to demonstrate how the F-MCOSJ can be applied to address internalized sexism in counseling.

The Impact of Breast-Conserving Surgery Re-excision on Patient-Reported Outcomes Using the BREAST-Q.

Approximately 14% of women undergoing breast-conserving surgery (BCS) require re-excision to achieve negative margins following the Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) margin guidelines, which may influence patient-reported outcomes (PROs). Few studies have assessed the impact of re-excision on PROs following BCS. Women with stage 0-III breast cancer undergoing BCS who completed a BREAST-Q PRO measure from 2010 to 2016 were identified from a prospective database. Baseline characteristics were compared between women who underwent one BCS and those who underwent ≥ 1 re-excision surgery for positive margins (R-BCS). Linear mixed models were used to analyze associations between number of excisions and BREAST-Q scores over time. Of 2543 eligible women, 1979 (78%) had one BCS and 564 (22%) had R-BCS. Younger age, lower BMI, surgery pre-SSO Invasive Guidelines issuance, ductal carcinoma in situ (DCIS), multifocal disease, radiation therapy receipt, and endocrine therapy omission were more common in the R-BCS group. Breast satisfaction and sexual well-being were lower in the R-BCS group 2years postoperatively. There were no differences in psychosocial well-being between groups over 5 years. On multivariable analysis, re-excision was associated with lower breast satisfaction and sexual well-being (p= 0.007 and p= 0.049, respectively), but there was no difference in psychosocial well-being (p= 0.250). Women with R-BCS had lower breast satisfaction and sexual well-being 2 years postoperatively, but this difference did not remain long term. Psychosocial well-being in women who underwent one BCS were largely comparable over time to the R-BCS group. These findings may help in counseling women who are concerned about satisfaction and quality-of-life outcomes with BCS if re-excision is necessary.

Evaluating interventions to increase the uptake of NCCN genetic counseling recommendations.

10599 Background: Genetic counseling for hereditary breast cancer remains underutilized despite increased access. The lack of identification and/or referral of high-risk women for genetic counseling is the major contributor to the poor uptake. A cancer risk assessment program (CRA) utilizing NCCN guidelines was implemented in our breast imaging department to identify women at increased risk for breast cancer. We analyzed the impact of informing all women who get a screening mammogram of their genetic mutation risk and the effect of nurse navigation on increasing the subsequent uptake of genetic counseling. Methods: To assess the effectiveness of these interventions, data from July 2021 to January 2022 was extracted from the EMR and grouped into cohorts based on nurse navigation contact and the completion of genetic counseling. A chi-squared analysis was performed to determine the significance of the results. Results: A total of 22,915 patients participated in the CRA program during the study period. 2,671 (11.7%) patients qualified for genetic counseling based on NCCN guidelines. 414 (15.5%) of these patients completed a genetic counseling appointment. 298 of these patients received genetic testing (72%) and 18 (4.3%) had a pathogenic mutation found. The nurse navigator was able to reach 1,288 (48%) of the 2,671 patients (Cohort A). Of these patients, 324 (25.2%) completed genetic counseling appointments compared to 90 of the 1,383 (6.5%) patients who were not contacted by the nurse navigator (Cohort B). Statistical analysis determined there was a significant difference in uptake of genetic counseling between Cohort A and Cohort B (p<.0001). Conclusions: The implementation of the CRA program at the breast imaging center uncovered many patients who qualified for genetic counseling and testing based on NCCN guidelines. Genetic counseling uptake is significantly increased in patients who are reached by a Nurse Navigator. These interventions allowed for the discovery of unsuspected deleterious genetic mutations which require more aggressive screening to allow for the early detection of breast cancer and better overall prognosis. [Table: see text]

Effect of sexual counseling on sexual function and sexual quality of life for women undergoing open heart surgery: a pilot randomized controlled trial.

Sexual counseling can improve or may have benefit to patients' sexual function after open heart surgery. The study aims to determine the effect of sexual counseling on sexual function and quality of sexual life with the PLISSIT model (ie, permission, limited information, specific suggestions, intensive therapy) for women undergoing open heart surgery. The study was a pilot randomized controlled trial. Seventy women who planned open heart surgery were randomly divided into the control group or the sexual counseling group between November 2020 and November 2021. In addition to routine care, sexual counseling with the PLISSIT model was given to women in the sexual counseling group for 12weeks after the operation. During the research, 6 PLISSIT sessions were conducted. Women in the control group received routine postoperative care, which included hospital-provided postoperative home care practices (medication, nutrition, physical activity). Data were obtained with an information form, the Beck Depression Inventory, the Female Sexual Function Index, and the Sexual Quality of Life Questionnaire-Female. The women in the sexual counseling and control groups were similar in terms of sociodemographic, obstetric, gynecologic, general health, current heart disease, and sexual function data (P > .05). After sexual counseling with the PLISSIT model, scores on the Female Sexual Function Index and Sexual Quality of Life Questionnaire-Female significantly increased in the sexual counseling group while Beck Depression Inventory scores decreased (P < .05). Comparisons were made within and between groups. Sexual counseling with the PLISSIT model is a useful and effective model for health professionals to improve the sexual function and sexual quality of life of women's who will undergo open heart surgery. The limitations of the study were as follows: only 1 assessment after the intervention ended, no short- or long-term follow-up, and a small sample size. Other limitations include the absence of controls for therapeutic context or positive expectations in the experimental group. Sexual counseling with the PLISSIT model after open heart surgery increased the sexual function and sexual quality of life of women while reducing the symptoms of depression.

Perspectives on Counseling Women of Reproductive Age About Emergency Preparedness by Primary Health Care Providers: DocStyles, United States, 2021 [ID: 1364512

INTRODUCTION: Pregnant, postpartum, and lactating women (PPLW) face unique challenges during disasters that may be mitigated by emergency preparedness. Health care providers have opportunities to counsel this population on emergency preparedness, but the extent of counseling has not been reported. Our objective is to report health care provider attitudes and practices related to counseling women of reproductive age (WRA), including PPLW, on emergency preparedness. METHODS: DocStyles, a web-based panel survey of a convenience sample of primary health care providers in the United States, was conducted from March 17 to May 17, 2021. Family practitioners, internists, obstetrician–gynecologists, nurse practitioners, and physician assistants were asked about importance of emergency preparedness counseling, confidence level of counseling, frequency of counseling, barriers to providing counseling, and preferred resources to support counseling among their WRA and PPLW patients. We calculated frequencies of provider attitudes and practices using R, version 4.0.3. RESULTS: Among 1,503 respondents, family practitioners (33%), internists (34%), obstetrician–gynecologists (17%), nurse practitioners (8%), and physician assistants (8%), 88% thought that emergency preparedness for keeping reproductive-aged patients safe, and counseling patients of reproductive age about emergency preparedness were both important. However, 45% of respondents were not confident in WRA emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of preparedness knowledge (34%) as barriers. Most respondents (79%) stated they would use educational materials, especially fact sheets or brochures and patient text alerts. CONCLUSION: Emergency preparedness resources combined with training may improve health care provider confidence in counseling WRA and PPLW.

Pelvic organ prolapse after hysterectomy: A 10-year national follow-up study.

Hysterectomy may have an effect on the pelvic floor. Here, we evaluated the rates and risks for pelvic organ prolapse (POP) surgeries and visits among women with a history of hysterectomy for benign indication excluding POP. In this retrospective cohort study 3582 women who underwent hysterectomy in 2006 were followed until the end of 2016. The cohort was linked to the Finnish Care Register to catch any prolapse-related diagnoses and operation codes following the hysterectomy. Different hysterectomy approaches were compared according to the risk for a prolapse, including abdominal, laparoscopic, laparoscopic-assisted vaginal and vaginal. The main outcomes were POP surgery and outpatient visit for POP, and Cox regression was used to identify risk factors (hazard ratios [HR]). During the follow-up, 58 women (1.6%) underwent a POP operation, of which a posterior repair was the most common (n=39, 1.1%). Outpatient visits for POP symptoms occurred in 92 (2.6%) women of which posterior wall prolapses (n=58, 1.6%) were the most common. History of laparoscopic-assisted vaginal hysterectomy were associated with risk for POP operation (HR 3.0, p =0.02), vaginal vault prolapse operation (HR 4.3, p=0.01) and POP visits (HR 2.2, p < 0.01) as compared to the approach of abdominal hysterectomy. History of vaginal deliveries and concomitant stress urinary continence operation were associated with the risk for a POP operation (HR 4.4 and 11.9) and POP visits (HR 3.9 and 7.2). Risk for POP operations and outpatient visits for POP symptoms in hysterectomized women without a preceding POP seems to be small at least 10 years after hysterectomy. History of LAVH, vaginal deliveries and concomitant stress urinary incontinence operations increased the risk for POP operations after hysterectomy. These data can be utilized in counseling women considering hysterectomy for benign indication.

Abstract 1183: Mutation type and location in breast cancer susceptibility genes are associated with differential risk in the general population

Abstract Two recent studies have defined population-based risk of breast cancer (BC) due to pathogenic variants (PVs) in well-established BC susceptibility genes. Prior studies in high-risk BC cohorts identified variable BC risks based on the position and type of mutation in BRCA1 and BRCA2, and based on the type of mutation in ATM, CHEK2, and PALB2. Whether this variability holds true in the general population has not been evaluated. To determine the BC risks associated with mutations of different types and in different locations in BC susceptibility genes in the general population, we carried out case-control analyses of 32247 cases and 32544 controls in the CARRIERS study, including 12 US population-based studies, and case-control analyses, subset to mutation carriers. We used age-adjusted logistic regression to estimate odds ratios (OR), relative OR (rOR), and 95% confidence intervals (CI) for PVs in BRCA1, BRCA2, ATM, CHEK2, and PALB2. ORs were estimated using the full population of mutation carriers and noncarriers while rORs were estimated within subsets of individual gene mutation carriers. We identified 273 BRCA1, 421 BRCA2, 253 ATM, 351 CHEK2, and 148 PALB2 in women with BC and 35 BRCA1, 84 BRCA2, 139 ATM, 139 CHEK2, and 38 PALB2 variant carriers in those without BC. For BRCA1, we did not find differences in risk by mutation type or location. However, variants leading to nonsense mediated decay (NMD) predicted to have re-initiation at p.M128 had a non-statistical 3-fold higher risk for BC compared to those leading to NMD without re-initiation (rOR 3.1, 0.99-13.52, p = 0.0826). BRCA2 loss of function (LoF) mutations in exons 1-10 had a higher BC risk compared to LoF mutations in the exon 11 (rOR 2.7, 1.1-7.9, p=0.048) ovarian cancer cluster region (OCCR). We did not detect any differences in risk by mutation type or location in ATM, CHEK2, or PALB2. CHEK2 missense variants p.I157T (rOR 0.5, 0.4-0.7, p &amp;lt;0.001) and p.T476M (rOR 0.5, 0.3 - 0.8, p=0.005) were associated with lower BC risk relative to CHEK2 c.1100delC (OR 2.5, 2.0-3.3, p&amp;lt;0.001). The CHEK2 c.444+1G&amp;gt;A splicing variant was associated with highest BC risk among common CHEK2 variants (OR 4.2, 1.9-10.5, p&amp;lt;0.001), but was not statistically significantly different from c.1100delC (rOR 1.7, 0.8-4.3, p=0.230). In summary, we identified a higher BC risk for LoF variants in BRCA2, lower risk for CHEK2 missense mutations, and non-statistical higher risk for NMD/re-initiation BRCA1 variants and CHEK2 c.444+1G&amp;gt;A in this population-based study. Despite the large numbers included in the overall CARRIERS study, the number of PV carriers was relatively small, which may have limited the detection of associations. Nonetheless, we were able to detect genotype-risk associations that have implications for counseling women about their BC risk, and certainly for the development of individualized risks. Citation Format: Mwangala P. Akamandisa, Nicholas Boddicker, Chunling Hu, Siddhartha Yadav, Jeffrey N. Weitzel, Peter Kraft, Susan M. Domchek, Fergus J. Couch, Katherine L. Nathanson, for the CARRIERS Consortium . Mutation type and location in breast cancer susceptibility genes are associated with differential risk in the general population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1183.

Acute coronary syndromes in pregnancy: a literature review

Key content Maternal mortality from cardiovascular disease has not improved in almost 20 years; this contrasts to significant sustained improvement in cardiovascular outcomes in the nonpregnant population, particularly regarding acute coronary syndrome (ACS). Many of the women who died in recent MBRRACE‐UK reports presented with cardiac symptoms and signs, but this was not always recognised upon clinical review. The incidence of ACS is increasing alongside advancing maternal age, with an accompanying increased prevalence of typical and pregnancy‐specific cardiac risk factors. Early involvement of senior clinicians and a multidisciplinary approach is crucial for improving maternal outcomes. Counselling women on long term prognosis and implications for future pregnancy is vital. Learning objectives To be aware of the latest data for ACS in pregnancy, including the changing trends in prevalence of this condition and the suggested reasoning behind this. To understand the various presentations of ACS in pregnancy and its differential diagnosis. To understand the possible investigation and management of ACS in pregnancy in a multidisciplinary setting.

Does induction of labor at 41 weeks (early, mid or late) improve birth outcomes in low‐risk pregnancy? A nationwide propensity score‐matched study

This study aimed to assess whether induction of labor at 41 weeks of gestation improved perinatal outcomes in a low-risk pregnancy compared with expectant management. Registry-based national cohort study in The Netherlands. The study population comprised 239 971 low-risk singleton pregnancies from 2010 to 2019, with birth occurring from 41+0 to 42+0 weeks. We used propensity score matching to compare induction of labor in three 2-day groups to expectant management, and further conducted separate analyses by parity. The main outcome measures were stillbirth, perinatal mortality, 5-min Apgar <4 and <7, neonatal intensive care unit (NICU) admissions ≥24 h, and emergency cesarean section rate. Compared with expectant management, induction of labor at 41+0 to 41+1 weeks resulted in reduced stillbirths (adjusted odds ratio [aOR] 0.15, 95% confidence interval [CI] 0.05-0.51) in both nulliparous and multiparous women. Induction of labor increased 5-min Apgar score <7 (aOR 1.30, 95% CI 1.09-1.55) and NICU admissions ≥24 h (aOR 2.12, 95% CI 1.53-2.92), particularly in nulliparous women, and increased the cesarean section rate (aOR 1.42, 95% CI 1.34-1.51). At 41+2-41+3 weeks, induction of labor reduced perinatal mortality (aOR 0.13, 95% CI 0.04-0.43) in both nulliparous and multiparous women. The rate of 5-min Apgar score <7 was increased (aOR 1.26, 95% CI 1.06-1.50), reaching significance in multiparous women. The cesarean section rate increased (aOR 1.57, 95% CI 1.48-1.67) in both nulliparous and multiparous women. Induction of labor at 41+4 to 41+5 weeks reduced stillbirths (aOR 0.30, 95% CI 0.10-0.93). Induction of labor increased rates of 5-min Apgar score <4 (aOR 1.61, 95% CI 1.01-2.56) and NICU admissions ≥24 h (aOR 1.52, 95% CI 1.08-2.13) in nulliparous women. Cesarean section rate was increased (aOR 1.47, 95% CI 1.38-1.57) in nulliparous and multiparous women. At 41+2 to 41+3 weeks, induction of labor reduced perinatal mortality, and in all 2-day groups at 41 weeks, it reduced stillbirths, compared with expectant management. Low 5-min Apgar score (<7 and <4) and NICU admissions ≥24 h occurred more often with induction of labor, especially in nulliparous women. Induction of labor in all 2-day groups coincided with elevated cesarean section rates in nulliparous and multiparous women. These findings pertaining to the choice of induction of labor vs expectant management should be discussed when counseling women at 41 weeks of gestation.

Counseling women of reproductive age about emergency preparedness – Provider attitudes and practices

We report healthcare provider attitudes and practices on emergency preparedness counseling for women of reproductive age (WRA), including pregnant, postpartum, and lactating women (PPLW), for disasters and weather emergencies. DocStyles is a web-based panel survey of primary healthcare providers in the United States. During March 17–May 17, 2021, obstetricians-gynecologists, family practitioners, internists, nurse practitioners, and physician assistants were asked about the importance of emergency preparedness counseling, level of confidence, frequency, barriers to providing counseling, and preferred resources to support counseling among WRA and PPLW. We calculated frequencies of provider attitudes and practices, and prevalence ratios with 95% CIs for questions with binary responses. Among 1503 respondents (family practitioners (33%), internists (34%), obstetrician-gynecologists (17%), nurse practitioners (8%), and physician assistants (8%)), 77% thought emergency preparedness was important, and 88% thought counseling was necessary for patient health and safety. However, 45% of respondents did not feel confident providing emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of knowledge (34%) as barriers to providing counseling. Most respondents (79%) stated they would use emergency preparedness educational materials for WRA, and 60% said they were willing to take an emergency preparedness training. Healthcare providers have opportunities to provide emergency preparedness counseling; however, many have not, noting lack of time and knowledge as barriers. Emergency preparedness resources combined with training may improve healthcare provider confidence and increase delivery of emergency preparedness counseling.

Clinical outcomes after total excision of transobturator tape inserted for treatment of stress urinary incontinence.

Midurethral tapes (MUTs) were the most common surgical treatment for stress urinary incontinence (SUI) between 2008 and 2017. Transobturator tapes were introduced as a novel way to insert MUTs. Some women have experienced life-changing complications, and opt to undergo a total excision of transobturator tape (TETOT). There is a paucity in evidence about the outcomes of TETOT, which is a complex operation. This study aims to report clinical outcomes of all women who underwent TETOT in a specialist mesh center. All women between 2017 and 2022 who underwent TETOT in one mesh center were reviewed. Background demographics and preoperative symptoms were recorded retrospectively. Outcome data were collected usingpatient global impression of improvement (PGI-I) scales via telephone review and analyzed using SPSS 25. Forty-five women underwent telephone review in May 2022, on average 27.9 months (range: 3-60) after TETOT. Mean age was 55 and body mass index (BMI): 30; 82% were postmenopausal, 20% were smokers, and 73.3% had recurrent SUI before excision. Indications for excision were infection (4%), vaginal exposure (24%), urethral perforation (9%), and chronic pain not associated with other complications (60%). Two women with recurrent SUI opted for a concomitant fascial sling; both reported a PGI of "very much improved" regarding SUI postoperatively. Only 12 women (26.5%) did not have SUI before excision; of these 9 (75%) reported new SUI postoperatively. Pain improved for 57.8%, but worsened for 24.4%. Although not statistically significant (p = 0.055), more women who underwent TETOT for pain alone reported worsening pain than those with pain with an additional complication (37% vs. 5.55%). Overall, 62.2% women felt "better" after their excision, 17.8% felt "worse." After TETOT, 62% of women felt better. Improvement in pain was reported by 58%-those with chronic pain without another complication reported improvement in pain less frequently (48% vs. 72%) and worsening pain more frequently (37% vs. 6%). Existing SUI worsened in 65% of women and 75% developed new SUI. There appears to be discordance between reporting global improvement with worsening of commonly measured clinical outcomes. Outcome data are important for counseling women about the risks and benefits of TETOT. Women and clinicians may have different attitudes to the possible benefits of TETOT, as evidenced by women reporting feeling better despite continuing pain or SUI. Conventional outcome measures do not adequately capture all outcomes that are important to patients.

Pregnancy outcomes after stoma surgery for inflammatory bowel disease: results of a multicentre retrospective audit

Background: Active inflammatory bowel disease (IBD) and IBD surgery can have a negative impact on ability to conceive a pregnancy many patients with stomas are concerned about pregnancy. Aim: This study aimed to describe IBD-related, stoma-related, obstetric and neonatal outcomes in pregnancies of women who had stomas formed for IBD prior to the reported pregnancies. Methods: A multicentre retrospective audit used routine records from 15 UK hospitals on women with IBD and pregnancy after stoma formation since 2014. Results: In one miscarriage, one stillbirth and 80 live births, delivery occurred in 58 cases by caesarean section (CS), of which 44 were elective and 14 emergency. The 73% CS rate compares to a national rate of 29.1%. There was a high rate of serious stoma complications at 24%, although most were managed conservatively. Conclusions: Guidance and patient information should be updated to facilitate early conversations with obstetric teams and counsel women about increased risk of planned CS after IBD surgery with a stoma.

Factors that influence the management recommendations breast surgeons provide to women with pathogenic variants in moderate penetrance breast cancer susceptibility genes.

Pathogenic variants in moderate penetrance breast cancer susceptibility genes, such as ATM and CHEK2, confer a two- to five-fold increased lifetime risk for breast cancer. The National Comprehensive Cancer Network has guidelines for breast surgeons to utilize when counseling women with pathogenic variants in these genes; however, previous studies indicate that other factors impact breast surgeons' recommendations to patients. This study investigated factors influencing management recommendations presented by breast surgeons to women with pathogenic variants in moderate penetrance breast cancer susceptibility genes. Focus groups and interviews were conducted with breast surgeons practicing in Ohio, Kentucky, and Indiana. A total of 15 breast surgeons from eight different hospitals participated in five focus groups and three individual interviews. Participants discussed factors they consider when making management recommendations for risk reduction in women with pathogenic variants in moderate penetrance breast cancer susceptibility genes. Participants provided risk management recommendations for given scenarios. Patient motivation/opinion, family history, patient current health status, patient personal preference, and patient anxiety level were among the most common factors mentioned. It appeared that how these factors are valued and applied in practice varies. There was no consensus among breast surgeons on which risk-reducing management options they would recommend in each scenario. There are many factors breast surgeons take into consideration when making recommendations for this patient population. This information could inform future research on decision making around treatment for individuals with pathogenic variants in moderate penetrance breast cancer susceptibility genes.