Christine L. Curry

Barriers to Immediate Post-placental Intrauterine Devices among Attending Level Educators.

OBJECTIVE To determine whether barriers to immediate post-placental intrauterine device (PPIUD) placement exist at the provider level. STUDY DESIGN Obstetrics providers at seven academic teaching hospitals in Massachusetts were asked to complete an electronic survey regarding their knowledge, experience, and opinions about immediate PPIUDs. RESULTS Eighty-two providers, including obstetricians, family medicine physicians, and midwives, completed the survey. Thirty-five (42.7%) reported experience placing an immediate PPIUD with the majority of them having placed three to five PPIUDs. Of participants who had never placed a PPIUD, the reason cited most frequently was inadequate training. Fewer than one-half (43.4%) correctly identified the PPIUD expulsion rate, whereas 75.9% knew the correct expulsion rate for interval IUD placement. The majority of providers responded that PPIUDs are acceptable in certain clinical scenarios. CONCLUSIONS Overall, knowledge and experience with PPIUD placement is relatively low. As increasing numbers of states amend Medicaid policy to include reimbursement for immediate postpartum IUDs, additional education and training opportunities are needed.

Knowledge and perceptions of Zika virus among reproductive‐aged women after public announcement of local mosquito‐borne transmission

This study was conducted to ascertain the knowledge and perceptions of the Zika virus among reproductive‐aged women living in the first affected area of the United States with local mosquito‐borne transmission.

Zika virus testing and outcomes during pregnancy, Florida, USA, 2016

Zika virus infection during pregnancy can lead to congenital Zika syndrome. Implementation of screening programs and interpretation of test results can be particularly challenging during ongoing local mosquitoborne transmission. We conducted a retrospective chart review of 2,327 pregnant women screened for Zika virus in Miami–Dade County, Florida, USA, during 2016. Of these, 86 had laboratory evidence of Zika virus infection; we describe 2 infants with probable congenital Zika syndrome. Delays in receipt of laboratory test results (median 42 days) occurred during the first month of local transmission. Odds of screening positive for Zika virus were higher for women without health insurance or who did not speak English. Our findings indicate the increase in screening for Zika virus can overwhelm hospital and public health systems, resulting in delayed receipt of results of screening and confirmatory tests and the potential to miss cases or delay diagnoses.

First Locally Acquired Congenital Zika Syndrome Case in the United States: Neonatal Clinical Manifestations

In the spring of 2017, a full-term infant with microcephaly was delivered in South Florida. During first trimester, the mother presented with fever, nausea, and vomiting. She reported no foreign travel for herself or her partner. The infants neurologic, ophthalmologic, neuroradiologic, and audiologic findings were highly suggestive of congenital Zika syndrome (CZS), confirmed by IgM antibodies and plaque reduction neutralization test. New observations, including peripheral temporal retinal avascularity and peripapillary retinal nerve fiber layer thinning, are presented from this first known case of non-travel-associated CZS in the United States. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e93-e98.].

Zika Virus and the Non-Microcephalic Fetus: Why We Should Still Worry

&NA; Zika virus is a mosquito‐transmitted flavivirus and was first linked to congenital microcephaly caused by a large outbreak in northeastern Brazil. Although the Zika virus epidemic is now in decline, pregnancies in large parts of the Americas remain at risk because of ongoing transmission and the potential for new outbreaks. This review presents why Zika virus is still a complex and worrisome public health problem with an expanding spectrum of birth defects and how Zika virus and related viruses evade the immune response to injure the fetus. Recent reports indicate that the spectrum of fetal brain and other anomalies associated with Zika virus exposure is broader and more complex than microcephaly alone and includes subtle fetal brain and ocular injuries; thus, the ability to prenatally diagnose fetal injury associated with Zika virus infection remains limited. New studies indicate that Zika virus imparts disproportionate effects on fetal growth with an unusual femur‐sparing profile, potentially providing a new approach to identify viral injury to the fetus. Studies to determine the limitations of prenatal and postnatal testing for detection of Zika virus–associated birth defects and long‐term neurocognitive deficits are needed to better guide women with a possible infectious exposure. It is also imperative that we investigate why the Zika virus is so adept at infecting the placenta and the fetal brain to better predict other viruses with similar capabilities that may give rise to new epidemics. The efficiency with which the Zika virus evades the early immune response to enable infection of the mother, placenta, and fetus is likely critical for understanding why the infection may either be fulminant or limited. Furthermore, studies suggest that several emerging and related viruses may also cause birth defects, including West Nile virus, which is endemic in many parts of the United States. With mosquito‐borne diseases increasing worldwide, there remains an urgent need to better understand the pathogenesis of the Zika virus and related viruses to protect pregnancies and child health.

Perceptions of Community Risk and Travel During Pregnancy in an Area of Zika Transmission

Introduction Between June 2016 and August 2016, the first cases of the Zika transmission were reported in Miami, FL, US. Since then, travel advisories have been issued by the Centers for Disease Control and Prevention (CDC) to avoid travel to Florida. Women that are of childbearing age or pregnant are the populations most vulnerable to Zika infection because birth defects can occur in infants born to infected mothers. Till date, there are no studies assessing the perception of the community risk of Zika in pregnant women residing in an affected region such as Miami. Methods A cross-sectional design was utilized for this study. The survey included questions assessing community risk and travel perceptions. Surveys were distributed in the antenatal clinics at the University of Miami Hospital and the Jackson Memorial Hospital. Results A total of 85 women were surveyed between January 27, 2016 and March 3, 2017. Of the surveyed women, 92.6 percent believed Zika is an important issue in their community, 85.9 percent reported a change in behavior because of Zika, 26.9 percent believed they can get Zika at their location, and 13.9 percent considered moving away from Florida because of Zika. Conclusion Despite the majority of women believing Zika is an important issue in their community, only one-fourth believed they could get Zika in Miami. Efforts to educate pregnant women in affected areas about preventive measures against the Zika infection should be undertaken. Further studies comparing the perceptions of community risks and travel behaviors in other affected areas are warranted.

Enhancing Reproductive Health Through Medical Education and Advocacy [1H]

INTRODUCTION: Despite the Association of Professors of Gynecology and Obstetrics recommendation to include reproductive health in medical education curricula, a recent literature review revealed reproductive health education is lacking in medical schools nationwide. In response to these findings, we created a Reproductive Health Advocacy (RHA) team whose purpose is two-fold: to educate medical students on reproductive health, and to train students to serve as advocates for patients in need of reproductive health counseling and services. METHODS: Second-year medical students were recruited to the RHA program via email. Thirteen students completed the two-day training on contraception, pregnancy options, patient counseling, abortion laws and finances. Pre and post surveys were administered to assess student knowledge and attitudes toward reproductive health. RESULTS: All respondents were female (average age=24.3). Pre- and post-test findings respectively revealed 77% vs 23% (P=.0003) of participants incorrectly identified methods of long acting reversible contraception (LARC); 84.62% vs 8% (P=.0003) misidentified emergency contraceptive methods; 46% vs 100% (P=.0498) strongly agreed abortion is a safe procedure; and 8.33% vs 66.67% (P=.0498) strongly believed abortion access is problematic. After training, advocates expressed enhanced awareness of reproductive healthcare barriers and available resources. CONCLUSION: Our program enhances reproductive health education through improvements of clinical knowledge, attitudes and confidence in counseling patients on reproductive health. Since launching the program in July 2015 and receiving IRB approval at Jackson Memorial Hospital and the University of Miami Hospital in August 2015, we have trained 13 RHAs who have helped 6 women access reproductive healthcare services.