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Obstetrics and Gynecology

Sarah C Haight, Nancy Byatt, Tiffany A Moore Simas, Cheryl L Robbins, Jean Y Ko
OBJECTIVE: To describe national, state-specific, and sociodemographic trends in diagnoses of depressive disorders recorded during delivery hospitalizations. METHODS: Data were analyzed from the National Inpatient Sample (2000-2015) and 31 publicly available State Inpatient Databases (2000-2015) of the Healthcare Cost and Utilization Project. Delivery hospitalizations were identified by using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes for obstetric delivery...
May 9, 2019: Obstetrics and Gynecology
Ronald Sancetta, Hiba Khanzada, Ricardo Leante
BACKGROUND: Shoulder dystocia is a potential complication of vaginal delivery that increases the chances of injury to the neonate and the mother. The incidence of dystocia can be up to 3%, and sudden presentation and the lack of reliable predictors make shoulder dystocia a challenge for obstetricians. TECHNIQUE: The shoulder shrug technique involves shrugging the posterior shoulder and rotating the head-shoulder unit 180 degrees to resolve the shoulder dystocia...
May 9, 2019: Obstetrics and Gynecology
Elinore F McCance-Katz, Jerome Adams
No abstract text is available yet for this article.
May 9, 2019: Obstetrics and Gynecology
Heather Link, Katherine W McHugh, Ryan D Cuff, Nancy C Chescheir
No abstract text is available yet for this article.
May 9, 2019: Obstetrics and Gynecology
Nancy C Chescheir
No abstract text is available yet for this article.
May 9, 2019: Obstetrics and Gynecology
Kaitlyn Huegel Mayer, April L McGill
BACKGROUND: Refeeding syndrome is a rare constellation of electrolyte abnormalities after reintroduction of glucose during an adaptive state of starvation and malnutrition, resulting in fluid shifts, end-organ damage, and, potentially, death. We present a case of fetal death in a patient with hyperemesis gravidarum complicated by refeeding syndrome. CASE: A 32-year-old obese, multigravid patient was admitted at 16 weeks of gestation with hyperemesis gravidarum and laboratory abnormalities concerning for refeeding syndrome after consuming a sugar-rich beverage...
May 9, 2019: Obstetrics and Gynecology
Gautam G Rao
No abstract text is available yet for this article.
May 9, 2019: Obstetrics and Gynecology
Abimbola O Famuyide
This month we focus on current research in hysterectomy for benign gynecologic disorders. Dr. Famuyide 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 abstracts.
May 9, 2019: Obstetrics and Gynecology
Brian Gordon, Tucker Fischbeck, Russell Salamo, Stuart Schroff
BACKGROUND: Myomatous erythrocytosis syndrome, a form of secondary polycythemia associated with uterine leiomyomas, increases the risk of thrombosis and traditionally has been treated with hysterectomy. CASE: The patient is a 68-year-old woman with 7-year history of polycythemia initially thought to be secondary to a gastrointestinal stromal tumor that persisted after resection. A subsequent search for an alternative etiology led to the discovery of an 11.2-cm submucosal leiomyoma and likelihood of myomatous erythrocytosis syndrome...
May 9, 2019: Obstetrics and Gynecology
Maureen S Hamel, Lindsey M Kanno, Phinnara Has, Michael J Beninati, Dwight J Rouse, Erika F Werner
OBJECTIVE: To assess the effect of tight compared with liberalized intrapartum maternal glucose management on neonatal hypoglycemia risk in pregnancies complicated by gestational diabetes mellitus (GDM). METHODS: This was a randomized controlled trial of women with singleton gestations and GDM attempting vaginal delivery. After written informed consent, women were randomly allocated to one of two intrapartum maternal glucose management protocols: tight control (glucose measurements hourly and treatment for maternal glucose levels lower than 60 mg/dL or greater than 100 mg/dL) or liberalized control (glucose measurements every 4 hours and treatment for maternal glucose levels lower than 60 mg/dL or greater than 120 mg/dL)...
May 9, 2019: Obstetrics and Gynecology
Sarah M Temkin
No abstract text is available yet for this article.
May 9, 2019: Obstetrics and Gynecology
Erin A Brennand, Hude Quan
OBJECTIVE: To estimate rates of revision surgery after insertion of mesh midurethral slings and explore whether physician specialty, annual operative volume, or hospital type are associated with this outcome. METHODS: A population-based retrospective cohort of women undergoing midurethral sling procedures over a 13-year interval (2004-2017) in Alberta, Canada was created using administrative health data. The primary outcome was subsequent surgery for revision of midurethral sling, defined by a composite of surgical procedures...
May 9, 2019: Obstetrics and Gynecology
Jennifer Wong, Andrea Langford, David L Howard
BACKGROUND: Genital ulcers that are not the result of sexually transmitted infections (STIs) are uncommon, and case reports predominantly feature pubertal girls. CASE: A 38-year-old monogamous, nulliparous woman acutely developed painful vaginal ulcers 7 days after babysitting a child who was subsequently diagnosed with hand, foot, and mouth disease. The patient developed nonspecific systemic symptoms followed by painful and rapidly expanding genital ulcers. Laboratory test results for herpes, syphilis, human immunodeficiency virus, gonorrhea, chlamydia, and Epstein-Barr virus were all negative...
May 9, 2019: Obstetrics and Gynecology
Alina Tvina, Ryan Spellecy, Anna Palatnik
Peer review is the major method used by the scientific community to evaluate manuscripts and decide what is suitable for publication. However, this process in its current design is not bulletproof and is prone to reviewer and editorial bias. Its lack of objectivity and transparency raise concerns that manuscripts might be judged based on interests irrelevant to the content itself and not on merit alone. This commentary reviews some of the most common biases that could potentially affect objective evaluation of a manuscript and proposes alternatives to the current single-blind peer review process that is being used by most scientific journals, including Obstetrics & Gynecology...
May 9, 2019: Obstetrics and Gynecology
Jason D Wright, Yongmei Huang, Alexander Melamed, Ana I Tergas, Caryn M St Clair, June Y Hou, Fady Khoury-Collado, Cande V Ananth, Alfred I Neugut, Dawn L Hershman
OBJECTIVE: To assess the potential effects of implementing minimum hospital volume standards for ovarian cancer on survival and access to care. METHODS: We used the National Cancer Database to identify hospitals treating women with ovarian cancer from 2005 to 2015. We estimated the number of patients treated by each hospital during the prior year. Multivariable models were used to estimate the ratio of observed/expected 60-day, and 1-, 2- and 5-year mortalities...
May 9, 2019: Obstetrics and Gynecology
Leah Yieh, Dmitry Dukhovny, Clarice G Zhou, Ladawna Gievers, Aaron B Caughey
OBJECTIVE: To evaluate the cost effectiveness of three different approaches to the care of neonates born at 22 weeks of gestation: universal resuscitation, selective resuscitation, or no resuscitation. METHODS: We constructed a decision-analytic model using TreeAge to compare the outcomes of death and survival with and without neurodevelopmental impairment in a theoretical cohort of 5,176 neonates (an estimate of the annual number of deliveries that occur in the 22nd week of gestation in the United States)...
May 9, 2019: Obstetrics and Gynecology
Morgen S Doty, Han-Yang Chen, Baha M Sibai, Suneet P Chauhan
OBJECTIVE: To evaluate whether, at 37-39 weeks of gestation, delivery of a neonate with a birth weight that is 90% or greater for gestational age but less than 4,000 g is associated with increased composite maternal and neonatal morbidity. METHODS: This retrospective cohort study used U.S. Vital Statistics datasets for the years 2011-2013. Inclusion criteria were singleton pregnancies delivered at 37-39 weeks of gestation after labor in which the neonates were nonanomalous, and either appropriate for gestational age or large for gestational age (LGA) neonates with birth weights of less than 4,000 g (our threshold for macrosomia)...
May 9, 2019: Obstetrics and Gynecology
Maria I Rodriguez, Alyssa Hersh, Lorinda B Anderson, Daniel M Hartung, Alison B Edelman
OBJECTIVE: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception. METHODS: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted...
May 9, 2019: Obstetrics and Gynecology
Lorinda Anderson, Daniel M Hartung, Luke Middleton, Maria I Rodriguez
OBJECTIVE: To describe early utilization of pharmacist prescription of contraception in Oregon's Medicaid program. METHODS: Using Oregon Medicaid claims data, we conducted a retrospective analysis and quantified overall and monthly trends in pharmacist-prescribed contraceptives from January 1, 2016, to December 31, 2017. Our population was restricted to patients obtaining a new prescription for oral and transdermal methods and who had continuous Medicaid coverage during the study period...
May 9, 2019: Obstetrics and Gynecology
Elizabeth S Rubin, Neha A Deshpande, Peter J Vasquez, Susan Kellogg Spadt
In the United States, more than half of all women have used a vibrator, nearly one third of women have used a dildo, and more than three quarters of women who have sex with women have used a vibrator. Sexual devices can be used by patients with decreased libido, anorgasmia, conditions inhibiting vaginal penetration, partner erectile dysfunction, and motor or sensory disabilities. Basic knowledge of sexual devices can help obstetrician-gynecologists counsel patients about device safety, sharing, cleaning, disinfection, and material selection...
May 9, 2019: Obstetrics and Gynecology
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