Obstetrics and Gynecology

Jessica M Page, Tyler Bardsley, Vanessa Thorsten, Amanda A Allshouse, Michael W Varner, Michelle P Debbink, Donald J Dudley, George R Saade, Robert L Goldenberg, Barbara Stoll, Carol J Hogue, Radek Bukowski, Deborah Conway, Uma M Reddy, Robert M Silver
OBJECTIVE: To better characterize infection-related stillbirth in terms of pathogenesis and microbiology. METHODS: We conducted a secondary analysis of 512 stillbirths in a prospective, multisite, geographically, racially and ethnically diverse, population-based study of stillbirth in the United States. Cases underwent evaluation that included maternal interview, chart abstraction, biospecimen collection, fetal autopsy, and placental pathology. Recommended evaluations included syphilis and parvovirus serology...
November 4, 2019: Obstetrics and Gynecology
J Jay Boniface, Julja Burchard, George R Saade
The need to reduce the rate of preterm delivery and the recent emergence of technologies that measure hundreds of biological analytes (eg, genomics, transcriptomics, metabolomics, proteomics; collectively referred to as "omics approaches") have led to proliferation of potential diagnostic biomarkers. On review of the literature, a concern must be raised regarding experimental design and data analysis reporting. Specifically, inaccurate performance has often been reported after selective exclusion of patients around the definition boundary of preterm birth...
November 4, 2019: Obstetrics and Gynecology
Jasmine D Johnson, Ifeyinwa V Asiodu, Christine P McKenzie, Christine Tucker, Kristin P Tully, Katherine Bryant, Sarah Verbiest, Alison M Stuebe
OBJECTIVE: To evaluate whether the frequency of pain assessment and treatment differed by patient race and ethnicity for women after cesarean birth. METHODS: We performed a retrospective cohort study of all women who underwent cesarean birth resulting in a liveborn neonate at a single institution between July 1, 2014, and June 30, 2016. Pain scores documented and medications administered after delivery were grouped into 0-24 and 25-48 hours postpartum time periods...
November 4, 2019: Obstetrics and Gynecology
Nevert Badreldin, William A Grobman, Lynn M Yee
OBJECTIVE: To evaluate racial and ethnic differences in women's postpartum pain scores, inpatient opioid administration, and discharge opioid prescriptions. METHODS: We conducted a retrospective cohort study of all deliveries at a single high-volume tertiary care center from December 1, 2015, through November 30, 2016. Women were included if they self-identified as non-Hispanic white, non-Hispanic black, or Hispanic; were at least 18 years of age; and did not have documented allergies to nonsteroidal antiinflammatory drugs or morphine...
November 4, 2019: Obstetrics and Gynecology
Hannah J Cooper, Martha Iwamoto, Maura Lash, Erin E Conners, Marc Paladini, Sally Slavinski, Anne D Fine, Joseph Kennedy, Dominique Heinke, Andrea Ciaranello, George R Seage, Ellen H Lee
OBJECTIVE: To evaluate whether antenatal Zika virus infection is associated with risk of having a small-for-gestational-age (SGA) neonate, risk of preterm birth, and lower mean birth weight of term neonates. METHODS: For this retrospective observational study, we linked birth record data for women who delivered liveborn singleton neonates in New York City in 2016 to data for pregnant women with Zika virus infection reported to the New York City Health Department...
November 4, 2019: Obstetrics and Gynecology
Sarp Aksel, Louise Ross Wannamaker, Henry Tal Lesser, Nancy C Chescheir
No abstract text is available yet for this article.
November 4, 2019: Obstetrics and Gynecology
Brian T Bateman, Brendan Carvalho
No abstract text is available yet for this article.
November 4, 2019: Obstetrics and Gynecology
John Buek
This month we focus on current research in validation and simulation training. Dr. Buek discusses four recent publications, which are concluded with a "bottom line" that is the take-home message. A complete reference for each can be found on Box 1 on this page along with direct links to the abstracts.
November 4, 2019: Obstetrics and Gynecology
Julie My Van Nguyen, Allan Covens
No abstract text is available yet for this article.
November 4, 2019: Obstetrics and Gynecology
Huma Farid
No abstract text is available yet for this article.
November 4, 2019: Obstetrics and Gynecology
Tresa M Lombardi, Bruce S Kahn, Lily J Tsai, Jill M Waalen, Nicole Wachi
OBJECTIVE: To compare pain after robotic-assisted laparoscopic hysterectomy when giving preoperative oral compared with intravenous acetaminophen. METHODS: This double-blind randomized trial included women undergoing robotic-assisted laparoscopic hysterectomy for benign indications. Participants received either acetaminophen 1 g orally then normal saline 100 mL intravenously before surgery, or a placebo orally then acetaminophen 1 g intravenously. The primary outcome measured was difference in pain between the groups 2 hours postoperatively...
November 4, 2019: Obstetrics and Gynecology
Jane Morris, Mustafa Ascha, Barbara Wilkinson, Emily Verbus, Mary Montague, Brian M Mercer, Kavita Shah Arora
OBJECTIVE: To evaluate whether women with Medicaid are less likely than their privately insured counterparts to receive a desired sterilization procedure at the time of cesarean delivery. METHODS: This is a secondary analysis of a single-center retrospective cohort examining 8,654 postpartum women from 2012 to 2014, of whom 2,205 (25.5%) underwent cesarean delivery. Insurance was analyzed as Medicaid compared with private insurance. The primary outcome was sterilization at the time of cesarean delivery...
November 4, 2019: Obstetrics and Gynecology
Jing Hao, Dina Hassen, Qiang Hao, Jove Graham, Michael J Paglia, Jason Brown, Matthew Cooper, Victoria Schlieder, Susan R Snyder
OBJECTIVE: To provide U.S. case-based preeclampsia health care cost estimates for mothers and infants from a U.S. payer perspective, with comparisons with both uncomplicated and hypertensive pregnancies. METHODS: Electronic health record and billing data from a large regional integrated health care system in Pennsylvania were used to identify mother-singleton infant pairs with deliveries between 2010 and 2015. Data on clinical care and costs using actual payment amounts were compiled from 20 weeks of gestation to 6 weeks postdelivery for mothers and birth to 12 months for infants...
November 4, 2019: Obstetrics and Gynecology
Carolyn A Miller, Andrea H Roe, Arden McAllister, Zachary F Meisel, Nathanael Koelper, Courtney A Schreiber
OBJECTIVE: To quantitatively and qualitatively describe the patient experience for clinically stable patients presenting with miscarriage to the emergency department (ED) or ambulatory clinics. METHODS: We present a subanalysis of a mixed-methods study from 2016 on factors that influence miscarriage treatment decision-making among clinically stable patients. Fifty-four patients were evaluated based on location of miscarriage care (ED or ambulatory-only), and novel parameters were assessed including timeline (days) from presentation to miscarriage resolution, number of health system interactions, and number of specialty-based provider care teams seen...
November 4, 2019: Obstetrics and Gynecology
Maya M Hammoud, Kayte Spector-Bagdady, Meg O╩╝Reilly, Carol Major, Laura Baecher-Lind
The pelvic examination is a critical tool for the diagnosis of women's health conditions and remains an important skill necessary for students to master before becoming physicians. Recently, concerns regarding student involvement in pelvic examinations-specifically those performed while a woman is under anesthesia-have been raised in the scientific, professional, and lay literature. These concerns have led to calls to limit or halt the performance of pelvic examinations by students while a woman is under anesthesia...
November 4, 2019: Obstetrics and Gynecology
Angela B Lu, Benjamin Lazarus, Daniel L Rolnik, Kirsten R Palmer
BACKGROUND: Untreated microangiopathic hemolytic anemia in pregnancy is associated with adverse maternal and perinatal outcomes. Accurate diagnosis is challenging owing to nonspecific clinical features and pathologic findings. Timely initiation of appropriate management is essential to optimize maternal and perinatal outcomes. CASE: A 26-year-old primiparous woman presented at 20 weeks of gestation with new-onset microangiopathic hemolytic anemia on a background of poorly controlled type 1 diabetes...
November 4, 2019: Obstetrics and Gynecology
Hannah L Cundall, Sally E MacPhedran, Kavita Shah Arora
We provide an overview of the issue of specific consent for pelvic examinations under anesthesia performed by medical students. Arguments that have historically been made against requiring consent for such examinations are reviewed and refuted. The implications of requiring consent for examinations under anesthesia are discussed as they relate to patient autonomy, medical student education, and society at large. Finally, we outline a solution and offer sample language that balances the interests of patients, learners, and society...
November 4, 2019: Obstetrics and Gynecology
Pleun Beelen, Imke M A Reinders, Wessel F W Scheepers, Malou C Herman, Peggy M A J Geomini, Sander M J van Kuijk, Marlies Y Bongers
OBJECTIVE: To provide an overview of prognostic factors predicting failure of second-generation endometrial ablation. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Library, and were systematically searched from 1988 until February 2019. The search was conducted without language restrictions using the following search terms: "endometrial ablation," "prognosis," "predict," "long term," "late onset," "outcome...
November 4, 2019: Obstetrics and Gynecology
Michele K Saums, Caroline C King, Jenna C Adams, Anandi N Sheth, Martina L Badell, Marisa Young, Lynn M Yee, Ellen G Chadwick, Denise J Jamieson, Lisa B Haddad
OBJECTIVE: To compare the incidence of hypertensive disorders of pregnancy among women living with human immunodeficiency virus (HIV) on combination antiretroviral therapy (ART) to women without HIV, and to evaluate the association of hypertensive disorders of pregnancy with ART regimens or timing of ART initiation. METHODS: We conducted a retrospective cohort study among two overlapping pregnancy cohorts using preexisting databases at a single tertiary care hospital: all pregnant women who delivered during years 2016-2018 (cohort 1) and all women living with HIV who delivered during years 2011-2018 (cohort 2)...
November 4, 2019: Obstetrics and Gynecology
Halei Wong, Denicia Dwarica, Lieschen Quiroz
BACKGROUND: The occurrence of retained surgical instruments in vaginal surgery, although low, carries unique complications. Appropriate imaging to find retained surgical instruments allows for timely diagnosis and retrieval of the vaginal foreign body. CASE: The patient is a 33-year-old woman with recurrent cervical cancer who was undergoing radiation therapy. During interstitial implantation, a reverse cutting needle was broken into the anterior vaginal wall. Three-dimensional endoluminal ultrasonography allowed for timely retrieval with minimal surgical exploration in the operating room...
November 4, 2019: Obstetrics and Gynecology
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