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Obstetrics and Gynecology

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https://read.qxmd.com/read/30870304/etonogestrel-subdermal-implant-associated-regression-of-endometrial-intraepithelial-neoplasia
#1
Sunnie Wong, Amber Naresh
BACKGROUND: Endometrial intraepithelial neoplasia is a precursor lesion to endometrial adenocarcinoma. Total hysterectomy is the preferred management, but systemic or locally acting progestin therapies are acceptable alternatives. The use of the etonogestrel subdermal implant for treatment of endometrial intraepithelial neoplasia has not been studied. CASE: A 36-year-old woman, G2P2002, with obesity presented with abnormal uterine bleeding. Her endometrial specimen demonstrated endometrial intraepithelial neoplasia...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870303/the-backstory-behind-burnout-in-obstetrics-and-gynecology
#2
Abigail Ford Winkel
No abstract text is available yet for this article.
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870302/multimodal-stepwise-approach-to-reducing-in-hospital-opioid-use-after-cesarean-delivery-a-quality-improvement-initiative
#3
Alisha M Smith, Paul Young, Colleen C Blosser, Aaron T Poole
OBJECTIVE: To evaluate the association of a standardized, structured approach to in-hospital postcesarean delivery pain management with maternal opioid use after cesarean delivery. METHODS: We conducted a retrospective cohort study of women who underwent cesarean delivery before and after a quality improvement intervention at a single tertiary care center. A multidisciplinary task force revised electronic order sets for all patients who underwent cesarean delivery with neuraxial anesthesia...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870301/the-unexpected-power-of-presence
#4
Bettina Paek
No abstract text is available yet for this article.
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870300/wound-complication-rates-after-vulvar-excisions-for-premalignant-lesions
#5
Mary M Mullen, Emily C Merfeld, Marguerite L Palisoul, L Stewart Massad, Candice Woolfolk, Matthew A Powell, David G Mutch, Premal H Thaker, Andrea R Hagemann, Lindsay M Kuroki
OBJECTIVE: To assess the rate of wound complications and evaluate the effectiveness of antibiotic prophylaxis in vulvar wide local excision procedures. METHODS: We performed a single-institution, retrospective cohort study of women undergoing vulvar surgery for premalignant lesions between January 2007 and January 2017. The primary outcome was a composite wound complication rate that included breakdown or infection within 8 weeks postoperatively. Data were analyzed using Fisher exact or χ test, Student t-test, and Poisson regression...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870299/perioperative-antibiotic-use-and-associated-infectious-outcomes-at-the-time-of-myomectomy
#6
Annie J Kim, Nisse V Clark, L Joya Jansen, Mobolaji O Ajao, Jon I Einarsson, Xiangmei Gu, Sarah L Cohen
OBJECTIVE: To report the frequency of perioperative antibiotic use at time of myomectomy and associated risk of infectious outcomes. METHODS: We conducted a retrospective cohort study including all women who underwent any route of myomectomy from 2009 to 2016 at two academic hospitals in Boston, Massachusetts. Cases involving chromopertubation or conversion to hysterectomy were excluded from further analysis. Medical records were queried for the use or nonuse of perioperative antibiotics, as well as baseline patient factors and perioperative outcomes...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870298/like-mother-like-daughter
#7
Megan E Bunnell
No abstract text is available yet for this article.
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870297/educating-obstetrics-and-gynecology-residents-on-transgender-patients-a-survey-of-program-directors
#8
Kavita Vinekar, Shannon K Rush, Seine Chiang, Melissa A Schiff
OBJECTIVE: To describe education on transgender health provided by obstetrics and gynecology residency programs and to identify the facilitators and barriers to providing this training. METHODS: We conducted a cross-sectional survey to evaluate transgender health education in residency among a representative sample of 100 of the 236 obstetrics and gynecology residency programs listed in the 2015 Electronic Residency Application Service catalogue. We compared programs that did and did not offer transgender education on demographics, presence and type of transgender education offered, and reasons for and barriers to offering transgender health education using χ or Fisher's exact testing...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870296/three-dimensional-printed-uterine-model-for-surgical-planning-of-a-cesarean-delivery-complicated-by-multiple-myomas
#9
Amy Mackey, Joshua I Ng, Jason Core, Linh Nguyen, Devon Cross, Philip Lim, Courtney Woodfield, Robert Pugliese, Bon Ku
BACKGROUND: Uterine myomas encountered at cesarean delivery increase the complexity and risk of the procedure. Preoperative planning of such deliveries may help optimize patient outcomes. The application of three-dimensional printing technology is rapidly expanding in many surgical specialties. We created a three-dimensional-printed model from the magnetic resonance images (MRIs) of a gravid uterus with multiple myomas for surgical planning of cesarean delivery. INSTRUMENT: A three-dimensional-printed uterine model from MRIs of a pregnant patient with multiple uterine myomas as a tool for planning cesarean delivery...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870295/race-research-and-women-s-health-best-practice-guidelines-for-investigators
#10
Luwam Ghidei, Anne Murray, Janet Singer
Medicine has a complex history of mishandling the concept of race. This is a crucial time for the field of obstetrics and gynecology to address racial and ethnic disparities. In this commentary, we address misconceptions about race, show how race can be misused in research and clinical care, and suggest new standards to guide authors as they conduct research on disparities and race.
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870294/neonatal-and-maternal-morbidity-among-low-risk-nulliparous-women-at-39-41-weeks-of-gestation
#11
Han-Yang Chen, William A Grobman, Sean C Blackwell, Suneet P Chauhan
OBJECTIVE: To use a large national database to compare composite maternal or neonatal morbidity among low-risk, full-term women. METHODS: This cohort study, using the U.S. vital statistics datasets (2011-2015), evaluated low-risk nulliparous women with nonanomalous singleton gestations who labored at 39, 40, or 41 weeks of gestation (as reported in completed weeks of gestation; eg, 39 weeks include 39 0/7 to 39 6/7 weeks). The primary outcome, composite neonatal morbidity, included any of the following: Apgar score below 5 at 5 minutes, assisted ventilation longer than 6 hours, seizure, or mortality...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870293/change-in-second-trimester-abortion-after-implementation-of-a-restrictive-state-law
#12
Kari White, Sarah E Baum, Kristine Hopkins, Joseph E Potter, Daniel Grossman
OBJECTIVE: To assess whether indicators of limited access to services explained changes in rates of second-trimester abortion after implementation of a restrictive abortion law in Texas. METHODS: We used cross-sectional vital statistics data on abortions performed in Texas before (November 1, 2011-October 31, 2012) and after (November 1, 2013-October 31, 2014) implementation of Texas' abortion law. We conducted monthly mystery client calls for information about abortion facility closures and appointment wait times to calculate distance from women's county of residence to the nearest open Texas facility, the number of open abortion facilities in women's region of residence (facility network size), and days until the next consultation visit...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870292/preventing-surgical-site-infection-approaching-zero-tolerance
#13
David E Soper
No abstract text is available yet for this article.
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870291/furosemide-use-and-time-to-confirmation-of-ureteral-patency-during-intraoperative-cystoscopy-a-randomized-controlled-trial
#14
Simon Patton, Jean Paul Tanner, Isabel Prieto, Elisha Jackson, Kristie Greene, Renee Bassaly, Allison M Wyman
OBJECTIVE: To investigate the effect of intravenous administration of furosemide on the time to confirmation for ureteral patency during intraoperative cystoscopy. METHODS: In a double-blind randomized controlled trial, intravenous administration of furosemide 10 mg was compared with placebo (normal saline) to investigate the effect of furosemide on the time to confirmation for ureteral patency during intraoperative cystoscopy. The primary outcome was time to confirmation of ureteral patency...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870290/comparing-force-of-stream-with-a-standard-fill-voiding-trial-after-surgical-repair-of-apical-prolapse-a-randomized-controlled-trial
#15
Marjorie L Pilkinton, Kathryn S Williams, Cristina P Sison, Dara F Shalom, Harvey A Winkler
OBJECTIVE: To estimate whether the urinary force of stream method is noninferior to a standard fill voiding trial for rate of catheterization within 6 weeks after apical prolapse surgery in those discharged without a catheter. METHODS: A noninferiority randomized controlled trial was conducted in postoperative women comparing force of stream with standard fill voiding trials after vaginal, abdominal, or laparoscopic-robotic apical pelvic organ prolapse (POP) surgery...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870289/an-alternate-approach-to-using-candy-cane-stirrups-in-vaginal-surgery
#16
Eddie H M Sze
BACKGROUND: Candy cane stirrups are widely used for vaginal surgery because they provide sufficient operating space. When placed in the standard perpendicular alignment, however, these stirrups cause excessive flexion, abduction, and external rotation of the thigh, which may injure the femoral, lateral femoral cutaneous, sciatic, and common peroneal nerves. TECHNIQUE: We corrected this deficiency by positioning the stirrups parallel to the operating table, just above and tilting slightly toward its lower break...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870288/safety-assessment-of-a-large-scale-improvement-collaborative-to-reduce-nulliparous-cesarean-delivery-rates
#17
Elliott K Main, Shen-Chih Chang, Valerie Cape, Christa Sakowski, Holly Smith, Julie Vasher
OBJECTIVE: To evaluate maternal and neonatal safety measures in a large-scale quality improvement program associated with reductions in nulliparous, term, singleton, vertex cesarean delivery rates. METHODS: This is a cross-sectional study of the 2015-2017 California Maternal Quality Care Collaborative (CMQCC) statewide collaborative to support vaginal birth and reduce primary cesarean delivery. Hospitals with nulliparous, term, singleton, vertex cesarean delivery rates greater than 23...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870287/incorporating-precesarean-vaginal-preparation-into-standard-of-care-for-obstetrics
#18
Cassandra R Duffy, Mary E DʼAlton, Yiping W Han, Robert L Goldenberg, Cynthia Gyamfi-Bannerman
Postoperative infections remain a serious concern after cesarean delivery, the most common major surgical procedure in the United States. Multiple strategies have been proposed to combat this problem, including the addition of azithromycin to the standard preoperative antibiotic prophylaxis. However, as obstetricians, we have failed to uniformly adopt precesarean vaginal preparation despite convincing evidence from randomized controlled trials that this technique reduces postoperative rates of endometritis by more than 50%...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870286/u-s-food-and-drug-administration-approved-poly-adp-ribose-polymerase-inhibitor-maintenance-therapy-for-recurrent-ovarian-cancer-a-cost-effectiveness-analysis
#19
Joseph A Dottino, Haley A Moss, Karen H Lu, Angeles A Secord, Laura J Havrilesky
OBJECTIVE: We sought to determine whether use of a poly (ADP-ribose) polymerase inhibitor is cost effective for maintenance treatment of platinum-sensitive recurrent ovarian cancer. METHODS: A decision analysis model compared four maintenance strategies: 1) observation, 2) BRCA germline mutation testing and selective treatment of carriers (gBRCA only), 3) BRCA germline and tumor homologous recombination deficiency testing and selective treatment of either BRCA carriers or those with tumor HRD (gBRCA and HRD only), and 4) treat all with niraparib to progression (treat all)...
March 11, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30870285/connect-the-dots-april-2019
#20
Lauren M Little, Sebastian Z Ramos, Heather Link, Nancy C Chescheir
No abstract text is available yet for this article.
March 11, 2019: Obstetrics and Gynecology
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