Obstetrics and Gynecology

Robert E Bristow, Jenny Chang, Carolina Villanueva, Argyrios Ziogas, Veronica M Vieira
OBJECTIVE: To validate the observed/expected ratio for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care, and to identify patient characteristics associated with disparities in access to high-performing hospitals. METHODS: This was a retrospective population-based study of stage I-IV invasive epithelial ovarian cancer reported to the California Cancer Registry between 1996 and 2014. A fit logistic regression model, which was risk-adjusted for patient and disease characteristics, was used to calculate the observed/expected ratio for each hospital, stratified by hospital annual case volume...
February 9, 2020: Obstetrics and Gynecology
Annam Abbasi, Julie Watters, Tesia Kim, Nancy C Chescheir
No abstract text is available yet for this article.
February 9, 2020: Obstetrics and Gynecology
William M Callaghan
No abstract text is available yet for this article.
February 9, 2020: Obstetrics and Gynecology
William W Andrews, Alan Thevenet N Tita
No abstract text is available yet for this article.
February 9, 2020: Obstetrics and Gynecology
Elizabeth A Howell, Natalia N Egorova, Teresa Janevic, Michael Brodman, Amy Balbierz, Jennifer Zeitlin, Paul L Hebert
OBJECTIVE: To examine within-hospital racial and ethnic disparities in severe maternal morbidity rates and determine whether they are associated with differences in types of medical insurance. METHODS: We conducted a population-based, cross-sectional study using linked 2010-2014 New York City discharge and birth certificate data sets (N=591,455 deliveries) to examine within-hospital black-white, Latina-white, and Medicaid-commercially insured differences in severe maternal morbidity...
February 9, 2020: Obstetrics and Gynecology
Emily C Cleveland Manchanda, Lara D Vogel, Dara Kass, Shada A Rouhani
Breastfeeding has demonstrable benefits for children and their mothers; however, breastfeeding can be particularly difficult for women who return to the workplace in the months after a child's birth. The challenge of continuing to provide breast milk to an infant after a mother returns to work is evident in the day-to-day lives of health professionals who choose to do so and is reflected in the literature, which shows a marked reduction in breastfeeding rates corresponding to a woman's return to work. These barriers are even more apparent when travel is required for professional obligations or advancement, such as to attend or present at national conferences or to take standardized examinations at test centers...
February 9, 2020: Obstetrics and Gynecology
Logan K Williams, Jeremy M Weber, Carl Pieper, Amelia Lorenzo, Haley Moss, Laura J Havrilesky
OBJECTIVE: To compare pain control during vulvar biopsy after either application of 5% lidocaine-prilocaine cream or injection of 1% lidocaine. METHODS: In a single-site randomized trial, patients who needed vulvar biopsy on a non-hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine-prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned...
February 9, 2020: Obstetrics and Gynecology
Ida Bergman, Marie Westergren Söderberg, Marion Ek
OBJECTIVE: To evaluate outcomes after pelvic floor muscle therapy, as compared with perineorrhaphy and distal posterior colporrhaphy, in the treatment of women with a poorly healed second-degree obstetric injury diagnosed at least 6 months postpartum. METHODS: We performed a single center, open-label, randomized controlled trial. After informed consent, patients with a poorly healed second-degree perineal tear at minimum 6 months postpartum were randomized to either surgery or physical therapy...
February 9, 2020: Obstetrics and Gynecology
Katy B Kozhimannil, Julia D Interrante, Alena N Tofte, Lindsay K Admon
OBJECTIVE: To describe delivery-related severe maternal morbidity and mortality among indigenous women compared with non-Hispanic white (white) women, distinguishing rural and urban residents. METHODS: We used 2012-2015 maternal hospital discharge data from the National Inpatient Sample to conduct a pooled, cross-sectional analysis of indigenous and white patients who gave birth. We used weighted multivariable logistic regression and predictive population margins to measure health conditions and severe maternal morbidity and mortality (identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes) among indigenous and white patients, to test for differences across both groups, and to test for differences between rural and urban residents within each racial category...
February 9, 2020: Obstetrics and Gynecology
Alicia E Hersey, Patricia Giglio, Habibe Kurt, Gofran Tarabulsi, Kenneth K Chen
BACKGROUND: Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma affecting pregnancy. These tumors may be aggressive and rapidly growing in pregnancy. Management is based on the balance of risks and benefits to both the pregnant patient and the fetus. CASE: We present a case of diffuse large B-cell lymphoma diagnosed in the third trimester of pregnancy. The patient underwent labor induction at 34 weeks of gestation, started a standard chemotherapy protocol postpartum, and breastfed following a timed lactation protocol...
February 9, 2020: Obstetrics and Gynecology
Lauren K MacAfee, Roxanne F Harfmann, Lindsay M Cannon, Giselle Kolenic, Yasamin Kusunoki, Mishka Terplan, Vanessa K Dalton
OBJECTIVE: To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired. METHODS: We conducted a cross-sectional study of female patients aged 18-50 years who accessed opioid use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. Computer-assisted self-interviews were completed using online survey management software to assess prior substance use and use disorder treatment, sexual and reproductive health history, and sexual and reproductive health services received in the previous 12 months through a treatment program, and desire for and barriers to sexual and reproductive health services within substance use disorder treatment...
February 9, 2020: Obstetrics and Gynecology
Anne M Stachowicz, James L Whiteside
Since a variety of procoagulant products, collectively called hemostatic agents, became available to surgeons in the mid-20th century, their use has increased across multiple specialties, including gynecology. Congruent with past research on the causes of regional variation in the practice of medicine, available evidence suggests that a central predictor for use of these products is physician preference rather than documented clinical necessity. Use of these products adds risks and avoidable cost. This article seeks to highlight specific gynecologic circumstances in which evidence and surgical judgment supports hemostatic agent use and other settings in which use should be reconsidered...
February 9, 2020: Obstetrics and Gynecology
Ashish Premkumar, Michelle P Debbink, Robert M Silver, David M Haas, Hyagriv N Simhan, Deborah A Wing, Samuel Parry, Brian M Mercer, Jay Iams, Uma M Reddy, George Saade, William A Grobman
OBJECTIVE: To evaluate the relationship between acculturation and adverse pregnancy outcomes, and whether these relationships differ across racial or ethnic groups. METHODS: This is a planned secondary analysis of the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study of 10,038 pregnant women at eight academic health care centers in the United States. Nulliparous pregnant women with singleton gestations were recruited between 6 0/7 and 13 6/7 weeks of gestation from October 2010-September 2013...
February 9, 2020: Obstetrics and Gynecology
Gregory M Gressel, John R Potts, Sandolsam Cha, Fidel A Valea, Erika Banks
OBJECTIVE: To characterize trends in self-reported numbers and routes of hysterectomy for obstetrics and gynecology residents using the Accreditation Council for Graduate Medical Education (ACGME) case log database. METHODS: Hysterectomy case log data for obstetrics and gynecology residents completing training between 2002-2003 and 2017-2018 were abstracted from the ACGME database. Total numbers of hysterectomies and modes of approach (abdominal, laparoscopic, and vaginal) were compared using bivariate statistics, and trends over time were analyzed using simple linear regression...
February 9, 2020: Obstetrics and Gynecology
Stephanie M Glass Clark, Qi Huang, Adam P Sima, Lauren N Siff
OBJECTIVE: To evaluate the effects of four different surgical interventions for stress urinary incontinence (SUI) on 2-year postoperative sexual function. METHODS: This is a combined secondary analysis of SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) and TOMUS (Trial of Mid-Urethral Slings). Women in the original trials were randomized to receive surgical treatment for SUI with an autologous fascial sling or Burch colposuspension (SISTEr), or a retropubic or transobturator midurethral sling (TOMUS)...
February 9, 2020: Obstetrics and Gynecology
Kyan Lynch
No abstract text is available yet for this article.
February 9, 2020: Obstetrics and Gynecology
Robert M Rossi, Christopher Wolfe, Richard Brokamp, Jennifer M McAllister, Scott Wexelblatt, Carri R Warshak, Eric S Hall
OBJECTIVE: To quantify the reported prevalence and trend of maternal hepatitis C virus (HCV) infection in the United States (2009-2017) and identify maternal characteristics and obstetric outcomes associated with HCV infection during pregnancy. METHODS: We conducted a population-based retrospective cohort study of all live births in the United States for the period 2009 through 2017 using National Center for Health Statistics birth records. We estimated reported prevalence and trends over this time period for the United States...
February 9, 2020: Obstetrics and Gynecology
Federica Bellussi, Gaia Poʼ, Alessandra Livi, Gabriele Saccone, Valentino De Vivo, Emily A Oliver, Vincenzo Berghella
OBJECTIVE: To assess the association of fetal movement counting with perinatal mortality. DATA SOURCES: Electronic databases (ie, MEDLINE,, ScienceDirect, the Cochrane Library at the CENTRAL Register of Controlled Trials) were searched from inception until May 2019. Search terms used were: "fetal movement," "fetal movement counting," "fetal kick counting," "stillbirth," "fetal demise," "fetal mortality," and "perinatal death...
February 9, 2020: Obstetrics and Gynecology
Matthew E Spotnitz, Karthik Natarajan, Patrick B Ryan, Carolyn L Westhoff
OBJECTIVE: To evaluate the relative risk of cervical neoplasms among copper intrauterine device (Cu IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) users. METHODS: We performed a retrospective cohort analysis of 10,674 patients who received IUDs at Columbia University Medical Center. Our data were transformed to a common data model and are part of the Observational Health Data Sciences and Informatics network. The cohort patients and outcomes were identified by a combination of procedure codes, condition codes, and medication exposures in billing and claims data...
February 9, 2020: Obstetrics and Gynecology
Emily Z Barney, Christina D Pedro, Brock H Gamez, Matthew E Fuller, Jennifer E Dominguez, Ashraf S Habib
OBJECTIVE: To evaluate the efficacy of wound infusion with ropivacaine plus ketorolac compared with placebo for post-cesarean delivery analgesia in women who received a multimodal analgesic regimen including intrathecal morphine. METHODS: In a randomized double-blind study, women undergoing scheduled cesarean delivery under spinal or combined spinal epidural anesthesia were randomized to wound infusion with ropivacaine 0.2% plus ketorolac, or saline placebo using an elastometric pump for 48 hours...
February 9, 2020: Obstetrics and Gynecology
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