A228 GASTROENTEROLOGISTS DIFFER IN THEIR PREFERRED MODE OF DELIVERY FOR PREGNANT WOMEN WITH ILEAL ANAL-POUCH ANASTOMOSIS
Bibliographic record
Abstract
Ileal pouch-anal anastomosis (IPAA) is common among individuals with medically-refractory ulcerative colitis and familial adenomatous polyposis syndrome and is often performed during patients’ reproductive years. Female infertility is common after IPAA but is decreased with laparoscopic procedures. Clinical practice guidelines recommend caesarean(C-) section but are based on little evidence. Determine recommendations given to pregnant women with IPAA by their gastroenterologist with regard to mode of delivery. Canadian gastroenterologists (GIs) were surveyed through the Canadian Association of Gastroenterology in May 2014. The questionnaire included demographic and clinical practice characteristics, and queried GIs on recommendations made to women with IPAA using a clinical vignette. We assessed physician characteristics associated with providing recommendations using a Fisher’s exact test (categorical variables) and Wilcoxon rank-sum test (duration of clinical practice). 57 gastroenterologists responded and had practiced for a median of 9 years (IQR 15). Two-thirds (38/56; 68%) of GIs practiced in an academic centre. Most GIs regularly (29/54; 54%) or sometimes (14/54; 20%) recommended a mode of delivery to women with IPAA of childbearing age. Physicians with ≥200 IBD patients in their practice and ≥10 patients with an IPAA were more likely to provide recommendations (p<0.05 for both; Table). Among gastroenterologists providing recommendations, 14/40 (35%) would recommend a trial of labour with a low threshold for C-section; 5/40 (13%), elective C-section; and 4/40 (10%), spontaneous vaginal delivery. The remaining physicians would defer to another specialty or patient preference. While the majority of gastroenterologists recommend a specific mode of delivery to their female patients of childbearing age with an IPAA, their recommendations are heterogeneous. This differs from the clinical practice guidelines on IBD in pregnancy, which recommend C-section in women with IPAA. Additional research is needed to identify the safest mode of delivery for these women and to assess uptake of these guidelines. Characteristics of GIs recommending a mode of delivery to women with IPAA *p<0.05 CAG, CCC, CIHR
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".