Practice Variation in Antenatal Steroid Administration for Anticipated Late Preterm Birth: A Physician Survey.

OBJECTIVE: The objective of this study was to measure knowledge and practice variation in late preterm steroid use. STUDY DESIGN: Electronic survey of American College of Obstetricians and Gynecologists (ACOG) members about data supporting the ACOG/Society for Maternal-Fetal Medicine (SMFM) recommendations and practice when caring for women with anticipated late preterm birth (PTB), 340/7 to 366/7 weeks. RESULTS: Of 352 administered surveys, we obtained 193 completed responses (55%); 82.5% were generalist obstetrician-gynecologists (OB/GYNs), and 42% cared for women with anticipated late PTB at least weekly. Most believed that late preterm steroids provided benefit by reducing respiratory distress syndrome (93%), transient tachypnea of the newborn (83%), and neonatal intensive care unit admission (82%). More than half administered late preterm steroids to women with multiple gestations (73%), and pregestational diabetes (55-80%) depending on glycemic control. OB/GYNs administered steroids to insulin-dependent and poorly controlled diabetics more often than MFMs (75 vs. 46% and 59 vs. 37% respectively, p < 0.05 for both). While providers believed there was increased maternal hyperglycemia (88%) and neonatal hypoglycemia (59%), 88% believed neonatal respiratory benefits outweighed these risks. Respondents agreed research is needed to determine who are appropriate candidates (77%) and how to minimize adverse outcomes (82%). CONCLUSION: Most providers are administering late preterm steroids to all women, even those populations who have been excluded from previous trials. Despite widespread use, providers believe more research is needed to optimize management.

Role of Physician Gender in the Modern Practice of Obstetrics and Gynecology: Do Obstetrician-Gynecologists Perceive Discrimination from their Sex?

OBJECTIVES: It is unclear whether obstetrician-gynecologists (OBGYNs) experience gender discrimination as a result of patient and organizational gender preferences. Our objective was to evaluate whether the gender preference for OBGYNs resulted in perceptions of discrimination by the physician while simultaneously assessing their patients' views for choosing their OBGYN. METHODS: A survey assessed whether OBGYNs' perceptions of patients and employers' preferences for gender in selecting an OBGYN affected their clinical practice and resulted in feelings of discrimination. Providers' patients simultaneously completed a survey to explore the role of gender in the selection of their OBGYN. The Mann-Whitney U test was used for comparisons. A P < 0.05 was considered statistically significant. RESULTS: Thirty-four physicians (97% response rate) and 803 patients (81% response rate) completed the survey. The majority of male physicians agreed that their gender negatively affects their patient practice volume (60%), whereas no female physicians agreed with this statement (0%, P < 0.01). Female physicians were more likely to agree (46%) that they are discriminated against because of gender in terms of salary as compared with male physicians (20%, P = 0.049), however. Although more women who see a female OBGYN (compared with those who see a male OBGYN) perceive that their physician's gender is important to them (62% versus 20%, P < 0.01), the most frequent reason all women chose their OBGYN is the "rating" of the physician. CONCLUSIONS: Female and male OBGYNs perceive bias because of their gender; however, the former is because of compensation and the latter is because of patient preferences. The majority of women choose their OBGYN based on the physician's rating and not on the physician's sex, however.

United States' Obstetrician/Gynecologists' Readiness to Care for Women Affected by Female Genital Cutting.

Background: Female genital cutting (FGC) is a form of gender-based violence with obstetrical and gynecological complications that require recognition and care. Data suggest that United States' physicians are not prepared to care for those who have been affected by this practice. This study evaluated the knowledge and practices of United States' obstetricians and gynecologists to care for patients who have undergone FGC. Materials and Methods: This was a cross-sectional confidential survey distributed electronically to a sample of clinically active members of the American College of Obstetricians and Gynecologists. The survey consisted of questions characterizing care of patients who had undergone FGC and barriers to optimal support. Results: Five hundred forty-eight participants representing a wide range of years in practice, geographical locations, subspecializations, and patient demographics participated. Sixty-six percent of participants had cared for patients who had undergone FGC. Participants' description of their patient population racial/ethnic composition did not correlate with likelihood of treating this patient population. Forty percent of participants reported some form of education about FGC, more often among women, younger physicians, and those in practice for fewer years. Thirty-one percent of participants were comfortable counseling about and 20% were comfortable performing deinfibulation; these percentages were higher among those who had received education or had recently cared for an affected patient. Participants reported insufficient training as the largest barrier to providing care to women. Conclusions: While most physicians in this national cohort had cared for women who had undergone cutting, a minority had any form of education. However, prior education correlated with indicators of improved care. Physicians require additional guidance in treating this important and growing patient population.

Integrating evolution into medical education for women's health care practitioners.

Evolution is a fundamental principle in biology; however, it has been neglected in medical education. We argue that an evolutionary perspective is especially important for women's health care providers, as selection will act strongly on reproductive parameters, and the biological costs of female reproduction are generally more resource expensive than for men (e.g. due to gestation and lactation) with greater effects on health and wellbeing. An evolutionary perspective is needed to understand antibiotic resistance, disease and health risks associated with mismatches between our evolved adaptations and current conditions, the importance of the microbiome and the maternal role in how infants acquire and develop their early-life microbiome (vaginal birth, lactation), and the importance of breastmilk as a biochemical signal from mothers to their babies. We present data that obstetrician-gynecologists' views regarding the inclusion of evolution within their training is generally positive, but many barriers are perceived. Requiring coursework in evolutionary biology with an emphasis on evolutionary medicine prior to enrollment in medical school may be a solution.

Obstetrician-gynecologists' practices and attitudes on substance use screening during pregnancy.

OBJECTIVE: To describe obstetrician-gynecologists' practices and attitudes related to substance use screening in pregnant patients. STUDY DESIGN: A 2017 cross-sectional survey assessed US obstetrician-gynecologists' (n = 462; response rate = 34%) practices (substance use screening frequency and methods) and attitudes (practice priority of screening, confidence in treating, and responsibility statements). Chi-squared tests and adjusted modified Poisson regression were used to estimate associations between practices and attitudes. RESULTS: Of 353 respondents with screening information, 79% frequently screen for substance use and 11% used a validated instrument. Confidence was the highest for treating pregnant patients using tobacco (81%). Respondents whose practices make it a high priority to screen for all substances were 1.2 times as likely to frequently screen as their counterparts (95% CI: 1.1-1.3). CONCLUSIONS: Four out of five obstetricians-gynecologists reported a high frequency of substance use screening in pregnant patients. Findings highlight the importance of increasing priority of substance use screening by obstetrician-gynecologists.

Obstetrician-gynecologists' practice patterns related to opioid use during pregnancy and postpartum-United States, 2017.

OBJECTIVE: To describe obstetrician-gynecologists' practices and attitudes related to opioid use among pregnant and postpartum women. STUDY DESIGN: A 2017 cross-sectional survey assessed U.S. obstetrician-gynecologists' (N = 462; response rate = 34%) practices (management) and attitudes (knowledge, preparedness, confidence, barriers, and resources needed) related to opioid use among pregnant and postpartum women. Modified Poisson regression determined adjusted prevalence ratios (aPR) for advising medication-assisted therapy (MAT) for pregnant women with opioid use disorder (OUD) by knowledge, confidence, and preparedness. RESULTS: Of respondents, 33% always or usually advised MAT to pregnant women with OUD. Confidence in treating pregnant women who use opioids (aPR: 1.3, 95% CI: 1.0-1.8) and knowledge that substance use services were covered under the Affordable Care Act (aPR: 1.4, 95% CI: 1.1-1.8) were associated with advising MAT. CONCLUSION: Evidence suggests that efforts are needed to enhance physician confidence to manage pregnant and postpartum patients who use opioids, which may increase optimal care of this patient population.

Obstetricians' knowledge and practices regarding the management of preeclampsia.

Background: Preeclampsia affects over 4% of pregnancies in the United States. Management of preeclampsia is dependent on the severity of the condition and can range from expectant management to early delivery and inpatient observation. After publication of the hypertension in Pregnancy Task Force guidelines in 2013, little is known about their implementation and acceptance by practicing obstetricians and maternal-fetal medicine (MFM) specialists.Objective: To evaluate Obstetricians' knowledge and practices regarding the management of preeclampsia.Methods: A prospective survey was administered to ob-gyns at three different hospital systems in the Northeastern United States to assess practices regarding preeclampsia management and prevention.Results: A total of 87 out of 130 providers completed and returned a questionnaire (66.9% response rate). Providers with a subspecialty in MFM made up 44.3% of the sample. 90.7% of respondents agreed that preeclampsia is a common diagnosis in their practice, while 85% agreed that aspirin is useful for reducing a patient's risk of preeclampsia. 68.8% of providers reported not administering magnesium sulfate in labor to reduce seizure risk in patients with preeclampsia without severe features. Only 5.8% of providers reported using a preeclampsia prediction algorithm, all of whom were MFMs. Providers who specialized in MFM were more likely to prescribe aspirin for preeclampsia prevention in patients with chronic hypertension (26, 74.3% vs. 17, 39.5%, p = .002). MFM specialists were also more likely to counsel patients with abnormal biomarkers on the risk of preeclampsia (23, 69.7% vs. 15, 35.7%, p = .005).Conclusion: Efforts to inform practicing ob-gyns about the best practices for preeclampsia management and prevention have been largely successful, though there are still discrepancies between current recommendations and practice. Differences between general OBGYNs and MFM specialists were also significant with regards to practice. Given the acknowledgement of how common diagnoses of preeclampsia are in respondents' practices, better education and distribution of guidelines on management of preeclampsia is needed.

Benefits and Barriers to Teaching Medical Students in an Ob-Gyn Clinic.

INTRODUCTION: As the US health-care system has evolved over the past decade, access to obstetric care in rural communities has declined, and there has been a challenge in retaining obstetrics and gynecology (OB-GYN) providers to train the next generation of physicians. The current pilot study sought to identify the factors that influence faculty who train medical students within the field of OB-GYN with the hope of influencing recruitment and retention of providers for the future. METHODS: Clinical OB-GYN faculty within the University of Washington School of Medicine regional medical education program were surveyed about practice patterns and beliefs regarding medical student training as part of a pilot study on provider recruitment and retention. RESULTS: Fifty-seven eligible respondents completed the survey. Most (88.9%) reported their hospitals encourage student participation in patient care. Students in their practices participate in many aspects of patient care, including conducting exams (96.2%) and participating in the operating room (94.3%). The majority found the rewarding aspects of teaching medical students to be intellectual stimulation (90.9%), continuing the tradition of medical teaching (87.5%), and the intrinsic satisfaction of teaching (83.6%). Challenging aspects of teaching included reduced reimbursement (40%) and the student/workload (63.6%). DISCUSSION: Medical student education continues to rely on a generation's medical professionals to impart their knowledge to the next. We hope that with a better understanding of the benefits of participation and minimization of the challenges, we can perpetuate this tradition despite the uncertainty in our health-care system.

Screening for History of Childhood Abuse: Beliefs, Practice Patterns, and Barriers Among Obstetrician-Gynecologists.

BACKGROUND: A history of childhood abuse is strongly linked to adult health problems. Obstetrician-gynecologists will undoubtedly treat abuse survivors during their careers, and a number of patient presenting problems may be related to a history of childhood abuse (e.g., chronic pelvic pain, sexual dysfunction, mental health disorders, obesity, and chronic diseases). Knowledge of abuse history may assist with treatment planning and the delivery of trauma-informed care. The current study sought to explore obstetrician-gynecologists' training, knowledge, beliefs, practice patterns, and barriers around screening for history of childhood abuse in their adult patients. METHODS: Eight hundred Fellows and Junior Fellows of the American College of Obstetricians and Gynecologists were sent an electronic survey; 332 viewed recruitment emails. Data were analyzed with SPSS 24.0, including descriptive statistics, χ2, and t tests. RESULTS: One-hundred forty-five physicians completed the survey. The majority of responding providers believe that assessment of abuse history is important and relevant to patient care, yet few reported screening regularly. Most did not have formal training in screening for childhood abuse or its effects, although those who completed their training more recently were more likely to report training in these areas, as well as more likely to screen regularly. The majority of respondents noted they were not confident to screen. Barriers to screening were identified. CONCLUSIONS: Greater education and training about screening for childhood abuse history and the effects of childhood abuse are needed. The integration of mental health providers into practice is one method that may increase screening rates.

New Partner Recruitment to Rural Versus Urban Ob-Gyn Practices: A Survey of Practicing Ob-Gyns.

PURPOSE: The purpose of this pilot study was to investigate the recruitment efforts of practicing obstetrics and gynecology (ob-gyns) from rural and urban practices. METHOD: The authors surveyed practicing ob-gyns from 5 states in the Pacific Northwest in 2016 about their background, practice setting, practice profile, partner recruitment, and retention. RESULTS: Seventy-three patients completed the study (53.2% response rate). Thirty-seven percent of respondents work in an urban practice and 43% have a rural practice, with the remainder in a suburban setting. A majority of the respondents attempted to recruit a new partner in the past 5 years. Respondents were most interested in experience and diversity in new recruits. Urban respondents, however, were more interested in hiring those with specialized skills (χ2 = 7.842, P = .02) than rural providers who were more interested in partners familiar with their community (χ2= 7.153, P = .03). Reasons most often cited to leave their practice were reimbursement, limited social/marital options, and workload, other than rural providers who more often also cited lack of access to specialty care (χ2= 13.256, P = .001). Rural providers were more likely to cite marital and family status as an advantage to recruitment, whereas urban and suburban providers were more often neutral. CONCLUSIONS: Reduced access to care has led to significant health disparities for women living in rural communities. Understanding which providers are most likely to be successful in these settings might help preserve access as our health-care systems evolves.