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Obstetrics and Gynecology

Mackenzie N Naert, Alberto Muniz Rodriguez, Hanaa Khadraoui, Mariam Naqvi, Nathan S Fox
OBJECTIVE: To assess the association of first-trimester subchorionic hematomas with pregnancy outcomes after 20 weeks of gestation in women with singleton pregnancies. METHODS: We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All patients underwent routine first-trimester ultrasound examinations. We compared rates of adverse pregnancy outcomes at more than 20 weeks of gestation in women with and without a subchorionic hematoma on the initial ultrasound examination, excluding women with pregnancy loss before 20 weeks of gestation...
September 10, 2019: Obstetrics and Gynecology
Steven B Cherry, Michelle Vasko
BACKGROUND: Medical adhesive-related skin injury is often caused by improper technique in removing surgical dressings and may lead to pain, infection, delayed healing, and litigation. It is rare for obstetrics and gynecology residents and staff to receive any training regarding the proper technique for removing surgical dressings. TECHNIQUE: The proper technique for the removal of adhesive dressings is discussed, minimizing patient discomfort and lessening the risk of skin injury...
September 10, 2019: Obstetrics and Gynecology
Rebecca Luckett, Neo Mogowa, Howard J Li, Adrienne Erlinger, Michele R Hacker, Katharine Esselen, Sarah Feldman, Roger Shapiro, Chelsea Morroni, Doreen Ramogola-Masire
OBJECTIVE: To evaluate the performance of cervical cancer screening algorithms for women living with human immunodeficiency virus (HIV), using primary high-risk human papillomavirus (HPV) testing followed by cytology, visual inspection with acetic acid, or colposcopy. METHODS: We conducted a prospective cohort study of women living with HIV in Botswana. All participants underwent high-risk HPV testing. Participants with positive high-risk HPV test results underwent cytology, visual inspection with acetic acid, colposcopy, and biopsy...
September 10, 2019: Obstetrics and Gynecology
Alisse Hauspurg, Lara S Lemon, Beth A Quinn, Anna Binstock, Jacob Larkin, Richard H Beigi, Andrew R Watson, Hyagriv N Simhan
OBJECTIVE: To evaluate the feasibility, acceptability, and compliance of a remote blood pressure monitoring protocol implemented as a quality improvement measure at the hospital level for management of hypertension in postpartum women after hospital discharge. METHODS: This is an ongoing quality improvement project that included women admitted to the postpartum unit of a single tertiary care hospital. We designed nursing call center-driven blood pressure management and treatment algorithms, which were initiated after hospital discharge until 6 weeks postpartum...
September 10, 2019: Obstetrics and Gynecology
Adam K Lewkowitz, Joshua I Rosenbloom, Matt Keller, Julia D López, George A Macones, Margaret A Olsen, Alison G Cahill
OBJECTIVE: To estimate whether severe maternal morbidity is associated with increased risk of psychiatric illness in the year after delivery hospital discharge. METHODS: This retrospective cohort study used International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes within Florida's Healthcare Cost and Utilization Project's databases. The first liveborn singleton delivery from 2005 to 2015 was included; women with ICD-9-CM codes for psychiatric illness or substance use disorder during pregnancy were excluded...
September 10, 2019: Obstetrics and Gynecology
Roxanne Hastie, Fiona C Brownfoot, Catherine A Cluver, Susan P Walker, Susanne Hesselman, Stephen Tong, Lina Bergman
OBJECTIVE: To estimate the predictive value of signs and symptoms that occur before onset of eclampsia among pregnant women. DATA SOURCES: Electronic databases, including MEDLINE, EMBASE, Cochrane, and were searched from inception to 2018. Search terms included eclampsia, predict, likelihood ratio, predictive value, and risk. METHODS OF STUDY SELECTION: Abstracts and later full texts were selected for review if a diagnosis of eclampsia was made, a comparator arm included (women without a diagnosis of eclampsia), and predictors of imminent eclampsia reported...
September 10, 2019: Obstetrics and Gynecology
Vivek K Gupta, Jacquelyn H Adams, Timothy Heiser, J Igor Iruretagoyena, Kara K Hoppe, Kathleen M Antony
OBJECTIVE: To evaluate the association of the duration of the detailed fetal anatomic ultrasound examination with maternal body mass. METHODS: This was a retrospective chart review of patients presenting to our clinic for detailed fetal anatomic examinations between January 1, 2010, and June 30, 2017. After excluding multifetal pregnancies and other examinations expected to have a longer duration, a total of 6,522 examinations were performed between 18 0/7 and 22 0/7 weeks of gestation...
September 10, 2019: Obstetrics and Gynecology
William D Winkelman, Anna M Modest, Monica L Richardson
OBJECTIVE: To assess the effects of the U.S. Food and Drug Administration (FDA) safety communication and the reclassification of transvaginal mesh to a class III device on national trends in the treatment of apical prolapse. METHODS: A retrospective cohort study of surgical cases from 2008 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program was conducted. Patients were included if they underwent apical prolapse repair, as identified by Current Procedural Terminology codes...
September 10, 2019: Obstetrics and Gynecology
Maria Andrikopoulou, Yongmei Huang, Cassandra R Duffy, Conrad N Stern-Ascher, Jason D Wright, Dena Goffman, Mary E DʼAlton, Alexander M Friedman
OBJECTIVE: To analyze trends in unindicated antibiotic use during vaginal delivery hospitalization. METHODS: This study used an administrative database to analyze antibiotic use during delivery hospitalizations from January 2006 to March 2015. Women were classified by mode of delivery and whether they had an evidence-based indication for antibiotics. Indications for antibiotics included preterm prelabor rupture of membranes (PROM), cesarean delivery, group B streptococcus (GBS) colonization, chorioamnionitis, endometritis, urinary tract infections, and other infections...
September 10, 2019: Obstetrics and Gynecology
Annmarie L Vilkins, Michael Sahara, Sara R Till, Christina Ceci, Ryan Howard, Kendall C Griffith, Jennifer F Waljee, Courtney S Lim, Bethany D Skinner, Daniel J Clauw, Chad M Brummett, Sawsan As-Sanie
OBJECTIVE: To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy. METHODS: We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain management. They were then educated on the department's guidelines regarding the maximum number of tablets recommended per prescription and the mean number of opioid tablets used by a similar cohort of patients in a previously published study at our institution...
September 10, 2019: Obstetrics and Gynecology
Melissa Merideth, Deborah Tamura, Divya Angra, Sikandar G Khan, Joyln Ferrell, Alisa M Goldstein, John J DiGiovanna, Kenneth H Kraemer
OBJECTIVE: To assess the age at menarche and menopause of women with xeroderma pigmentosum, a DNA repair disease with premature aging, in a longitudinal natural history study. METHODS: We conducted a natural history study that reviewed medical records for gynecologic and reproductive health of all female patients with xeroderma pigmentosum aged older than 9 years examined at the National Institutes of Health (NIH). We performed gynecologic and laboratory examinations on a subset of the patients...
September 10, 2019: Obstetrics and Gynecology
David A Becker, Jeff M Szychowski, Spencer G Kuper, Victoria C Jauk, Michelle J Wang, Lorie M Harper
OBJECTIVE: To analyze the labor curves of nulliparous and multiparous women between 23.0 and 34.0 weeks of gestation who underwent induction of labor and achieved vaginal delivery. METHODS: This is a retrospective cohort study of all live singletons delivered vaginally after medically indicated induction of labor between 23.0 and 34.0 weeks of gestation from 2011 through 2014 at our institution. We excluded those with one or no cervical examinations available during labor...
September 10, 2019: Obstetrics and Gynecology
Ramkumar Menon, Brandie D Taylor
OBJECTIVE: To examine inflammatory mediators in three fetomaternal biological compartments to inform theory related to the fetal and maternal inflammatory contributions to parturition at term and preterm. METHODS: We conducted a cross-sectional study of amniotic fluid, cord blood, and maternal plasma from women with singleton pregnancies. Women had one of four conditions: term labor (n=11), term not in labor (n=13), spontaneous preterm birth with intact membranes (preterm birth; n=13), or preterm prelabor rupture of membranes (PROM; n=8)...
September 10, 2019: Obstetrics and Gynecology
Helen Kang Morgan, Scott C Graziano, LaTasha B Craig, Elise N Everett, David A Forstein, Brittany S Hampton, Laura Hopkins, Margaret L McKenzie, Archana Pradhan, Celeste Royce, Shireen Madani-Sims, Christopher M Morosky
OBJECTIVE: To monitor demographics and factors associated with quality of life among obstetrics and gynecology clerkship directors. A secondary goal was to compare current demographics and survey responses to a 1994 survey of clerkship directors. METHODS: A 36-item electronic survey was developed and distributed to the 182 U.S. clerkship directors with active memberships with the Association of Professors of Gynecology and Obstetrics. Items queried respondents on demographics, attitudes about being a clerkship director, quality of life, and burnout...
September 10, 2019: Obstetrics and Gynecology
Erin Seifert Lavelle, Pakeeza Alam, Melanie Meister, Maria Florian-Rodriguez, Cara Elmer-Lyon, Joseph Kowalski, Charelle Carter-Brooks, Donna Mazloomdost, Halina Zyczynski, Jerry Lowder, Robert Gutman, Gary Sutkin
OBJECTIVE: To estimate whether nitrofurantoin prophylaxis decreases the incidence of culture-documented urinary tract infection for women with catheter-managed urinary retention after pelvic reconstructive surgery. METHODS: This double-blind, placebo-controlled, randomized trial was conducted at five academic institutions. Women with urinary retention after surgery for prolapse or incontinence were randomized to oral nitrofurantoin 100 mg daily during indwelling or clean intermittent self-catheterization...
September 10, 2019: Obstetrics and Gynecology
Katie L Westerfield, Amit K Bhavsar, Samantha Green
BACKGROUND: Aspiration is a known risk of obstetric anesthesia; however; it has not been previously described outside of active labor or the setting of anesthesia. CASE: We present the case of a 31-year-old patient with a twin gestation at 33 weeks of gestation, not in labor, with clinically silent aspiration leading to aspiration pneumonitis and respiratory collapse requiring endotracheal intubation and transport to a pulmonary critical care service. After 4 days, she was extubated and eventually underwent a cesarean delivery at 37 weeks of gestation with no long-term pulmonary sequelae...
September 10, 2019: Obstetrics and Gynecology
Camran Nezhat, Nataliya Vang, Pedro P Tanaka, Ceana Nezhat
The pathophysiology of endometriosis-associated pain involves inflammatory and hormonal alterations and changes in brain signaling pathways. Although medical treatment can provide temporary relief, most patients can achieve long-term sustained pain relief when it is combined with surgical intervention. Owing to its complexity, there is an ongoing debate about how to optimally manage endometriosis-associated pain. We believe optimal management for this condition requires: 1) possible egg preservation in affected young patients with and without endometriomas; 2) preoperative medical suppression to inhibit ovulation and to avoid removal of functional cysts that might look like endometriomas; and 3) postoperative hormonal suppression to decrease recurrence, but this treatment should be modified according to disease severity, symptoms, and fertility goals...
September 10, 2019: Obstetrics and Gynecology
Aaron Lazorwitz, Christina L Aquilante, Eva Dindinger, Margaret Harrison, Jeanelle Sheeder, Stephanie Teal
OBJECTIVE: To estimate whether serum etonogestrel concentrations influence bleeding patterns and related side effects in contraceptive implant users. METHODS: We conducted a prospective cross-sectional study with healthy, reproductive-aged women using etonogestrel implants for 12-36 months. Participants completed a brief questionnaire to assess their current bleeding pattern and any experience of abnormal bleeding with the implant. We then measured serum etonogestrel concentrations...
September 10, 2019: Obstetrics and Gynecology
Ashley Aluko, Emily Seidler, Alan Penzias
BACKGROUND: Genetic carrier screening of individuals with a history of hematopoietic stem cell (HSC) transplant is not always straightforward. CASE: We present the case of a couple who underwent prepregnancy genetic screening before fertility treatment. The genetics laboratory flagged the male partner's blood sample because there was a discrepancy between the sex of the patient and the sex chromosome markers, ultimately leading to the discovery of a prior HSC transplant...
September 10, 2019: Obstetrics and Gynecology
Zachary P Reilly, Timothee F Fruhauf, Stephen J Martin
Reversal of gender-discriminatory insurance coverage policies has led to a substantial increase in access to gender-affirming surgical care in the United States over the past 20 years. Although the evidence supports the safety, feasibility, and medical necessity of gender-affirming hysterectomy and oophorectomy, there are currently no evidence-based guidelines to define optimal care surrounding many aspects of these surgeries. This commentary reviews the evidence supporting the safety, feasibility, and route of hysterectomy and oophorectomy for transgender men, the benefits and risks of oophorectomy in cisgender women and their extrapolation to transgender men, and the effects of testosterone supplementation in transgender men with and without ovaries...
September 10, 2019: Obstetrics and Gynecology
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