Objective To investigate whether coronavirus disease 2019 (COVID-19) is associated with adverse perinatal outcomes in a large national dataset and to examine rates of adverse outcomes during the pandemic compared to pre-pandemic period. Methods This observational cohort study included 683,905 patients, between the ages of 12-50, hospitalized for childbirth and abortion between January 1, 2019 and May 31, 2021. During the pre-pandemic period, 271,444 women were hospitalized for childbirth. During the pandemic, 308,532 women were hospitalized for childbirth and 2,708 had COVID-19. Associations between COVID-19 and in-hospital adverse perinatal outcomes were examined using propensity score-adjusted logistic regression. Results Compared to women without COVID-19, women with COVID-19 were more likely to experience both early and late preterm birth (aOR 1.38 [95% CI 1.1-1.7], aOR 1.62 [95% CI 1.3-1.7], respectively), preeclampsia (aOR 1.2 [95% CI 1.0-1.4]), disseminated intravascular coagulopathy (DIC) (aOR 1.57 [95% CI 1.1-2.2]), pulmonary edema (aOR 2.7 [95% CI 1.1- 6.3]), and need for mechanical ventilation (aOR 8.1 [95% CI 3.8-17.3]). There was no significant difference in the prevalence of stillbirth among women with (n= 16 / 2,708) and without (n= 174 / 39,562) COVID-19, p=0.257. There were no differences in adverse outcomes among women who delivered during the pandemic versus pre-pandemic period. Combined in-hospital mortality was significantly higher for women with COVID-19 (147 [95% CI 3.0 -292] vs 2.5 [95% CI 0-7.5] deaths per 100,000 women). Women diagnosed with COVID-19 within 30 days prior to hospitalization were more likely to experience early preterm birth, placental abruption, and mechanical ventilation, compared to women diagnosed with COVID-19 > 30 days prior to hospitalization for childbirth (4.0% vs. 2.4% for early preterm birth, aOR 1.7 [95% CI 1.1-2.7]; 2.2% vs. 1.2% for placental abruption, aOR 1.86 [95% CI 1.0 - 3.4]); 0.9% vs. 0.1% for mechanical ventilation, aOR 13.7 [95% CI 1.8-107.2])). Conclusion Women with COVID-19 had a higher prevalence of adverse perinatal outcomes and increased in-hospital mortality, with highest risk occurring when diagnosis was within 30 days of hospitalization, raising the possibility of a high-risk period.
Introduction Female sexual dysfunction (FSD) is a broad term that encompasses personal distress from various aspects of intercourse including desire, arousal, orgasm, or pain. Various studies report a high prevalence of 10-20% in women, FSD screening rates are low in the United States. Objectives The objectives of this study are to determine if provider type or provider level of training affect rate of FSD screening at annual well-woman visits, and to compare rates of FSD screening compared to other screening including depression, cervical cancer, and breast cancer. Methods We performed a retrospective cohort study chart review of patients from our outpatient gynecology office who underwent a well-woman annual visit. Women were eligible if at least 18 years of age, new patients, sexually active now or in the past, were seen by a provider in our gynecology department (attending, resident, midwife, or nurse practitioner), and used English as a primary language. Charts were identified within the gynecology department between 11/1/2017 and 1/31/2020 by looking up visits with CPT codes 99385, 99386, and 99387, as well as GC modifiers to identify resident-level providers. The attending-level physician, nurse practitioner, and certified nursing midwife visits were matched to resident-level visits by CPT code and similar date of service. The primary outcome is comparative rates of FSD screening by resident-level providers versus attending-level providers. Secondary outcomes including comparative rates of FSD screening amongst other provider types, and comparison of FSD screening versus depression, cervical cancer, and breast cancer screening. Outcomes will be analyzed using Chi-square testing (if more than 5 patients are screened for FSD from each provider-type) or Fisher’s exact test (if no more than 5 patients are screened for FSD from any provider-type). Multivariable logistic regression modeling will be used to identified any associations between patient or provider demographics that may affect screening rates (patient age, race, insurance type, sex of provider, etc.) Results We have approximately 400 total charts identified for review, which is ongoing and approximately 20% complete. We anticipate reporting results and conclusions after completion of chart review. Conclusions We have approximately 400 total charts identified for review, which is ongoing and approximately 20% complete. We anticipate reporting results and conclusions after completion of chart review. Disclosure No.
Background Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates. Aim This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations. Methods Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates. Outcomes Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer. Results FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures. Clinical Implications There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates. Strengths and Limitations This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases. Conclusion Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women’s health.
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