- Email: [email protected]
29: Pregnant patient knowledge, behavior, and attitude regarding perinatal oral health
IDSOG Abstracts
ajog.org (RPR) and another was co-infected with hepatitis C virus. The remaining 17 patients had no other co-infections. CONCLUSIONS: Chagas disease is an emerging infection in nonendemic regions, such as the United States, secondary to emigration from endemic areas including Central and South America. In our pregnant population we found a prevalence of 0.04% or approximately 1 in 2500 patients. Future work will focus on which patient populations may benefit from a routine screening program. As the rate of mother-to-child transmission is significant, screening of highrisk women in pregnancy would allow both maternal and neonatal treatment with a subsequent reduction in morbidity and mortality. LEARNING OBJECTIVE: Learners will be able to describe the types and rates of Chagas disease transmission. Learners will be able to identify patients who are at risk of Chagas disease based on geographic location. Learners will be able to identify appropriate screening and treatment strategies for Chagas disease in pregnancy.
28 Chronic cervicitis: presenting features and responses to therapy J. Polk, S. Mattson, P. Nyirjesy Department of Obstetrics and Gynecology at Drexel University College of Medicine, Philadelphia, PA
OBJECTIVES: Chronic non-gonococcal non-chlamydial (NGNC) cervicitis is a condition of frequently unknown etiology. Data about treatment options are lacking. Our goal was to review a single center’s experience in evaluating and treating women with chronic NGNC cervicitis. METHODS: All patient encounters with the ICD-9 diagnostic code for cervicitis between April 1, 2008 and March 1, 2014 were evaluated. Cases were defined as women with the two of the following three diagnostic criteria: mucopurulent discharge noted by (1) patient or (2) practitioner and (3) cervical bleeding upon gentle probing with a cotton swab. All women had either current or recent nucleic acid amplification testing (NAAT) negative for N. gonorrheae, C. trachomatis and T. vaginalis. Data regarding patient’s background characteristics, symptoms, physical and laboratory findings, treatment and treatment outcomes were analyzed. Cure was defined as complete resolution of patient symptoms and signs. RESULTS: 58 women were identified. The mean age was 31 (SD-8.6) years, 35% were Caucasian, and 35% were nulliparous. The mean duration of symptoms was 70.6 months (SD-25.5). Approximately half had PCR testing for genital mycoplasmas, with no cases positive for Mycoplasma genitalium. All 58 patients received one of three antibiotic treatments (azithromycin, doxycycline, or moxifloxacin). The cure rate after initial treatment was 62% overall, with cures of 64% for those receiving azithromycin (n¼36), 71% for doxycycline (n¼14) and 37.5% for moxifloxacin (n¼8). 19 (33%) patients required one or more additional treatments with a total of 11 different regimens. Treatments included additional antibiotics (n¼9), hormonal treatments (n¼8), vaginal hydrocortisone (n¼6), silver nitrate (n¼4), cryotherapy (n¼1) and loop excision electrosurgical procedure (n¼2). Cure rates for each of these approaches were 43% with antibiotics (6/14), 50% with hormone treatment (3/6), 0% with hydrocortisone (0/6), 100% with silver nitrate (4/4), 0% with cryotherapy (0/1), and 100% with LEEP (2/2). Of the initial 58 women, 91.3% were eventually cured, 1.7% were not, and 7% were lost to follow-up. CONCLUSIONS: NGNC cervicitis is a condition which can cause chronic unremitting symptoms. Most patients will respond to antibiotics, although other treatments including surgery may be necessary to affect a cure. Given the small number of affected
women, multicenter studies will be necessary for randomized controlled treatment studies. LEARNING OBJECTIVE: Learners will be able to identify strategies to identify and treat NGNC cervicitis.
29 Pregnant patient knowledge, behavior, and attitude regarding perinatal oral health E. Wilson1, M. Mayberry2, B. Gonik1 1
Wayne State University School of Medicine, Detroit, MI, 2University of Detroit Mercy School of Dentistry, Detroit, MI
OBJECTIVES: Perinatal oral health is a critical component to obstetric practice, with significant implications for maternal, fetal and infant health. Adverse obstetric outcomes are thought to be mediated by infectious and inflammatory pathophysiologic mechanisms. Recent data demonstrate that obstetric health care providers do a poor job proactively incorporating this facet of prenatal care into their practices. We sought to better define patient understandings in this regard, as part of a needs assessment process. METHODS: As a part of a quality improvement program in an urban teaching health care setting, an anonymous 13 question survey was distributed at clinic appointments, examining patient knowledge, behavior and attitude concerning their oral health. Descriptive statistics were tabulated. RESULTS: A total of 110 surveys were completed over a 2 month time period in 2015. The majority of respondents (86%) had Medicaidbased health insurance with only 14% not having dental insurance coverage. Most (58%) reported having a dentist, although the majority (52%) last received dental care greater than 1 year ago. Some subjects recognized that bleeding (54%) or swollen (20%) gums could be a normal finding in pregnancy. However, 23% did not identify this association, and others thought that toothache (22%), decay (20%) and tooth loss (6%) are normally seen in pregnancy. Regarding adverse outcomes, only 6%, 10% and 11% recognized miscarriage, preterm birth and growth restriction, respectively, as potential consequences of poor oral health in pregnancy. Most (87%) saw teeth cleaning as safe in pregnancy, but few thought any other interventions were acceptable. Few (13%) understood how to protect their teeth in association with morning sickness, and many (42%) added harm. Concerning issues related to vertical transmission of Streptococcus mutans and childhood caries, most patients (63%) were unaware of this relationship and therefore few recognized preventable risk factors. CONCLUSIONS: Despite having access to dental care, most pregnant women have a poor understanding of the importance of perinatal oral health, for both themselves and their children. These misconceptions can lead to deterioration in oral health, adverse pregnancy outcomes and childhood caries. These data highlight an opportunity for patient education that can improve the health status of this patient population. LEARNING OBJECTIVE: 1. Better assess the knowledge, attitude, and behavior of their obstetric patients with regard to oral health in pregnancy; 2. Create a platform for patient education in this regard; 3. Develop an office based quality assessment program, using the described needs assessment data.
31 A rare case of pyoderma gangrenosum and the effects of pathergy in a postpartum patient
P. Simmons1, A. Artis1, M. Dwiggins1, T. Gross2, S. LoCoco2, J. Farrell2
1 University of Illinois College of Medicine-Peoria, Peoria IL, 2OSF St. Francis Medical Center, Peoria, IL
DECEMBER 2015 American Journal of Obstetrics & Gynecology
907
ajog.org (RPR) and another was co-infected with hepatitis C virus. The remaining 17 patients had no other co-infections. CONCLUSIONS: Chagas disease is an emerging infection in nonendemic regions, such as the United States, secondary to emigration from endemic areas including Central and South America. In our pregnant population we found a prevalence of 0.04% or approximately 1 in 2500 patients. Future work will focus on which patient populations may benefit from a routine screening program. As the rate of mother-to-child transmission is significant, screening of highrisk women in pregnancy would allow both maternal and neonatal treatment with a subsequent reduction in morbidity and mortality. LEARNING OBJECTIVE: Learners will be able to describe the types and rates of Chagas disease transmission. Learners will be able to identify patients who are at risk of Chagas disease based on geographic location. Learners will be able to identify appropriate screening and treatment strategies for Chagas disease in pregnancy.
28 Chronic cervicitis: presenting features and responses to therapy J. Polk, S. Mattson, P. Nyirjesy Department of Obstetrics and Gynecology at Drexel University College of Medicine, Philadelphia, PA
OBJECTIVES: Chronic non-gonococcal non-chlamydial (NGNC) cervicitis is a condition of frequently unknown etiology. Data about treatment options are lacking. Our goal was to review a single center’s experience in evaluating and treating women with chronic NGNC cervicitis. METHODS: All patient encounters with the ICD-9 diagnostic code for cervicitis between April 1, 2008 and March 1, 2014 were evaluated. Cases were defined as women with the two of the following three diagnostic criteria: mucopurulent discharge noted by (1) patient or (2) practitioner and (3) cervical bleeding upon gentle probing with a cotton swab. All women had either current or recent nucleic acid amplification testing (NAAT) negative for N. gonorrheae, C. trachomatis and T. vaginalis. Data regarding patient’s background characteristics, symptoms, physical and laboratory findings, treatment and treatment outcomes were analyzed. Cure was defined as complete resolution of patient symptoms and signs. RESULTS: 58 women were identified. The mean age was 31 (SD-8.6) years, 35% were Caucasian, and 35% were nulliparous. The mean duration of symptoms was 70.6 months (SD-25.5). Approximately half had PCR testing for genital mycoplasmas, with no cases positive for Mycoplasma genitalium. All 58 patients received one of three antibiotic treatments (azithromycin, doxycycline, or moxifloxacin). The cure rate after initial treatment was 62% overall, with cures of 64% for those receiving azithromycin (n¼36), 71% for doxycycline (n¼14) and 37.5% for moxifloxacin (n¼8). 19 (33%) patients required one or more additional treatments with a total of 11 different regimens. Treatments included additional antibiotics (n¼9), hormonal treatments (n¼8), vaginal hydrocortisone (n¼6), silver nitrate (n¼4), cryotherapy (n¼1) and loop excision electrosurgical procedure (n¼2). Cure rates for each of these approaches were 43% with antibiotics (6/14), 50% with hormone treatment (3/6), 0% with hydrocortisone (0/6), 100% with silver nitrate (4/4), 0% with cryotherapy (0/1), and 100% with LEEP (2/2). Of the initial 58 women, 91.3% were eventually cured, 1.7% were not, and 7% were lost to follow-up. CONCLUSIONS: NGNC cervicitis is a condition which can cause chronic unremitting symptoms. Most patients will respond to antibiotics, although other treatments including surgery may be necessary to affect a cure. Given the small number of affected
women, multicenter studies will be necessary for randomized controlled treatment studies. LEARNING OBJECTIVE: Learners will be able to identify strategies to identify and treat NGNC cervicitis.
29 Pregnant patient knowledge, behavior, and attitude regarding perinatal oral health E. Wilson1, M. Mayberry2, B. Gonik1 1
Wayne State University School of Medicine, Detroit, MI, 2University of Detroit Mercy School of Dentistry, Detroit, MI
OBJECTIVES: Perinatal oral health is a critical component to obstetric practice, with significant implications for maternal, fetal and infant health. Adverse obstetric outcomes are thought to be mediated by infectious and inflammatory pathophysiologic mechanisms. Recent data demonstrate that obstetric health care providers do a poor job proactively incorporating this facet of prenatal care into their practices. We sought to better define patient understandings in this regard, as part of a needs assessment process. METHODS: As a part of a quality improvement program in an urban teaching health care setting, an anonymous 13 question survey was distributed at clinic appointments, examining patient knowledge, behavior and attitude concerning their oral health. Descriptive statistics were tabulated. RESULTS: A total of 110 surveys were completed over a 2 month time period in 2015. The majority of respondents (86%) had Medicaidbased health insurance with only 14% not having dental insurance coverage. Most (58%) reported having a dentist, although the majority (52%) last received dental care greater than 1 year ago. Some subjects recognized that bleeding (54%) or swollen (20%) gums could be a normal finding in pregnancy. However, 23% did not identify this association, and others thought that toothache (22%), decay (20%) and tooth loss (6%) are normally seen in pregnancy. Regarding adverse outcomes, only 6%, 10% and 11% recognized miscarriage, preterm birth and growth restriction, respectively, as potential consequences of poor oral health in pregnancy. Most (87%) saw teeth cleaning as safe in pregnancy, but few thought any other interventions were acceptable. Few (13%) understood how to protect their teeth in association with morning sickness, and many (42%) added harm. Concerning issues related to vertical transmission of Streptococcus mutans and childhood caries, most patients (63%) were unaware of this relationship and therefore few recognized preventable risk factors. CONCLUSIONS: Despite having access to dental care, most pregnant women have a poor understanding of the importance of perinatal oral health, for both themselves and their children. These misconceptions can lead to deterioration in oral health, adverse pregnancy outcomes and childhood caries. These data highlight an opportunity for patient education that can improve the health status of this patient population. LEARNING OBJECTIVE: 1. Better assess the knowledge, attitude, and behavior of their obstetric patients with regard to oral health in pregnancy; 2. Create a platform for patient education in this regard; 3. Develop an office based quality assessment program, using the described needs assessment data.
31 A rare case of pyoderma gangrenosum and the effects of pathergy in a postpartum patient
P. Simmons1, A. Artis1, M. Dwiggins1, T. Gross2, S. LoCoco2, J. Farrell2
1 University of Illinois College of Medicine-Peoria, Peoria IL, 2OSF St. Francis Medical Center, Peoria, IL
DECEMBER 2015 American Journal of Obstetrics & Gynecology
907