Obstetrics and Gynecology

Sonja A Rasmussen, Denise J Jamieson
As the world confronts coronavirus disease 2019 (COVID-19), an illness caused by yet another emerging pathogen (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]), obstetric care providers are asking what this means for pregnant women. The global spread has been swift, and many key questions remain. The case-fatality rate for persons cared for in the United States and whether asymptomatic persons transmit the virus are examples of questions that need to be answered to inform public health control measures...
March 19, 2020: Obstetrics and Gynecology
Megan R Sax, Zoran Pavlovic, Alan H DeCherney
With improvement in cancer therapies, there has been an increasing emphasis on survivorship, including options for fertility preservation. Fertility preservation is the process of either protecting or saving gametes or reproductive tissues for potential future procreation. Methods and outcomes of fertility preservation have similarly been rapidly advancing. Before initiation of gonadotoxic therapy, health care providers must consider future fertility of patients and provide options for fertility preservation...
March 10, 2020: Obstetrics and Gynecology
Emily R Goggins, Allison T Chamberlain, Tesia G Kim, Marisa R Young, Denise J Jamieson, Lisa B Haddad
OBJECTIVE: To describe factors associated with not being tested for Chlamydia trachomatis and Neisseria gonorrhea infection during pregnancy and for testing positive and to describe patterns of treatment and tests of reinfection. METHODS: We conducted a retrospective cohort study of women who delivered at an urban teaching hospital from July 1, 2016 to June 30, 2018. Women with at least one prenatal care or triage visit were included. The index delivery was included for women with multiple deliveries...
March 10, 2020: Obstetrics and Gynecology
Margaret L Dow, Erica Bove, Helen K Morgan, Mark B Woodland, Abigail F Winkel
Resident well-being is a significant issue affecting our future physicians' abilities to fulfill their potential in training and practice. In the 2017 Council on Resident Education in Obstetrics and Gynecology National Wellness Survey, residents identified many challenges to wellness and had the opportunity to provide free-text responses about these issues. Secondary analysis of these responses revealed clusters of symptoms associated with mood disorders, including high rates of reported anxiety and depression symptoms, and even suicidality...
March 10, 2020: Obstetrics and Gynecology
Kopalasuntharam Muhunthan, Sandrasegarampillai Balakumar, Thiyahini S Navaratnaraja, Sundaralingam Premakrishna, Sabaratnam Arulkumaran
OBJECTIVE: To evaluate the pharmacokinetics of tranexamic acid after oral administration to postpartum women. METHODS: We conducted a single-center pharmacokinetic study at Teaching Hospital-Jaffna, Sri Lanka, on 12 healthy postpartum women who delivered vaginally. After oral administration of 2 g of immediate-release tranexamic acid 1 hour after delivery, pharmacokinetic parameters were measured on plasma samples at 0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, 6, 8, 10, and 12 hours...
March 10, 2020: Obstetrics and Gynecology
L Lewis Wall
Over the past 40 years, American medicine has become corporatized. Medical care has become permeated by a business philosophy whose primary concern is increasing shareholder value rather than providing optimal care for patients. Patient-physician relationships have eroded as the health care system has turned its attention toward electronic medical records (rather than face-to-face interactions with patients), toward quantifiable ("billable") metrics, and toward calculating the relative value units delivered by various health care "providers...
March 10, 2020: Obstetrics and Gynecology
Emily Delpero
No abstract text is available yet for this article.
March 10, 2020: Obstetrics and Gynecology
David K Turok, Anita L Nelson, Clint Dart, Courtney A Schreiber, Kevin Peters, Mary Jo Schreifels, Bob Katz
OBJECTIVE: To assess in parous and nulliparous women, the efficacy, safety, and tolerability of a new, low-dose copper (175 mm) intrauterine contraceptive with a flexible nitinol frame provided in a preloaded applicator. METHODS: Institutional review boards at 12 U.S. sites approved this commercially funded project. Patients met standard inclusion and exclusion criteria for a copper-based intrauterine device (IUD), generally consistent with the Centers for Disease Control and Prevention's U...
March 10, 2020: Obstetrics and Gynecology
Sarah C Lassey, Sarah E Little, Michael Saadeh, Nicole Patton, Michaela K Farber, Brian T Bateman, Julian N Robinson
OBJECTIVE: A cephalic elevation device is an inflatable device that elevates the fetal head. We sought to evaluate whether such a device reduces time to delivery after hysterotomy and lowers morbidity in cesarean deliveries during the second stage of labor. METHODS: We conducted a double-blind randomized controlled trial among nulliparous, term women aged 18-50 years with vertex singleton pregnancies. Women were eligible if they were to undergo cesarean delivery in the second stage of labor...
March 10, 2020: Obstetrics and Gynecology
Sammy Saab, Ravina Kullar, Prabhu Gounder
Hepatitis C virus (HCV) infection affects 170 million people worldwide, with at least 5% of individuals with HCV progressing to life-threatening complications, including hepatocellular carcinoma, within 20 years from acute infection. The World Health Organization has called for viral hepatitis elimination as a major public health threat by 2030. The recent development and availability of direct-acting antiviral drugs have been a game-changer in the HCV-treatment paradigm-response exceeds 90%, with minimal adverse events...
March 10, 2020: Obstetrics and Gynecology
Julia R Steinberg, Eowna Young Harrison, Michel Boudreaux
OBJECTIVE: To examine whether depression, intimate partner violence, and other psychosocial stressors were independently associated with effectiveness level of postpartum contraception among women who recently had an unintended birth. METHODS: We analyzed cross-sectional data from PRAMS (the Pregnancy Risk Assessment Monitoring System) to identify women who had an unintended birth between 2012 and 2015. The effectiveness level of the contraceptive method was coded into one of five categories based on the postpartum contraceptive method that women were using: none, less effective (withdrawal, rhythm, condoms, or other barrier), moderately effective (pill, patch, ring, or shot), long-acting reversible contraception (LARC; intrauterine devices or implants), and sterilization (female or male sterilization)...
March 10, 2020: Obstetrics and Gynecology
Jennifer J Schmitt, Mary V Baker, John A Occhino, Michaela E McGree, Amy L Weaver, Jamie N Bakkum-Gamez, Sean C Dowdy, Kalyan S Pasupathy, John B Gebhart
OBJECTIVE: To evaluate the rate of vaginal hysterectomy and outcomes after initiation of a prospective decision-tree algorithm to determine the optimal surgical route of hysterectomy. METHODS: A prospective algorithm to determine optimal route of hysterectomy was developed, which uses the following factors: history of laparotomy, uterine size, and vaginal access. The algorithm was implemented at our institution from November 24, 2015, to December 31, 2017, for patients requiring hysterectomy for benign indications...
March 10, 2020: Obstetrics and Gynecology
Marvin Williams, Emily Zantow, Mark Turrentine
OBJECTIVE: To evaluate whether group B streptococci (GBS) screening using the 2010 guideline (screening at 35 0/7-37 6/7 weeks of gestation) compared with the 2019 guideline (screening at 36 0/7-37 6/7 weeks of gestation with re-screening of women with GBS-negative results 5 weeks later) was more cost effective. METHODS: We constructed a decision-analysis model to compare the outcome of GBS early-onset disease in a hypothetical cohort of 3,614,049 women at 35 0/7 weeks of gestation or greater (the number of live births in 2017 excluding births based on population frequency from 23 to 34 weeks of gestation, women with GBS bacteriuria during the current pregnancy, and those with a history of a previous neonate with GBS disease)...
March 10, 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
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
Aude Girault, Camille Bonnet, François Goffinet, Béatrice Blondel, Camille Le Ray
OBJECTIVE: To evaluate whether the decrease in the frequency of oxytocin administration and artificial rupture of membranes observed between the 2010 and 2016 French Perinatal Surveys was associated with a change in the frequency of cesarean delivery or cesarean delivery indications among women who entered labor spontaneously. METHODS: This cross-sectional study included women who participated in the 2010 and 2016 French National surveys who had singleton pregnancies and who gave birth at at least 37 weeks of gestation after spontaneous labor to a liveborn neonate in cephalic presentation...
February 9, 2020: Obstetrics and Gynecology
Annam Abbasi, Courtney Marie Bisson, Nandi Chihombori-Quao, Nancy C Chescheir
No abstract text is available yet for this article.
February 6, 2020: Obstetrics and Gynecology
Elizabeth A Thom
No abstract text is available yet for this article.
February 6, 2020: Obstetrics and Gynecology
Shelun Tsai, Kathryn Shaia, Julia T Woodward, Michael Y Sun, Suheil J Muasher
The first child carried by a surrogate after in vitro fertilization in the United States was born in 1985. Since then, the number of such births has steadily grown. According to the Centers for Disease Control and Prevention, the number of gestational carrier cycles increased from 727 in 1999 to 3,432 in 2013, encompassing more than 18,000 children born over this period. Surrogacy offers an alternative to adoption. However, it also disrupts traditional notions of parentage and gestation and complicates the role of obstetrician-gynecologists (ob-gyns) in helping their patients navigate difficult ethical issues...
February 6, 2020: Obstetrics and Gynecology
Ellen M Hartenbach, Hsiang-Hui Daphne Kuo, Madelyne Z Greene, Emily A Shrider, Kathleen M Antony, Deborah B Ehrenthal
OBJECTIVE: To evaluate the peripartum transfusion rates for rural women compared with urban women in the United States. METHODS: In this population-based retrospective cohort study, geocoded birth records from 2014 to 2016 from the National Center for Health Statistics were used to examine the rural-urban differences in blood transfusion among nulliparous women delivering singleton, vertex pregnancies at term. We compared transfusion rates across the counties on a continuum from urban to rural...
February 6, 2020: Obstetrics and Gynecology
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