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Obstetrics and Gynecology

April D Adams, Rebecca S Benner, Thomas W Riggs, Nancy C Chescheir
OBJECTIVE: To evaluate observational research manuscripts submitted to Obstetrics & Gynecology to determine the level of adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and highlight specific areas that could be improved. METHODS: A scoring system based on the STROBE checklist was developed and validated for consistency by volunteer medical students or doctors. Using this scoring system, we performed a cross-sectional analysis on 198 observational research manuscripts submitted to Obstetrics & Gynecology from 2008 to 2016...
July 10, 2018: Obstetrics and Gynecology
Mehrsa Jalalizadeh, Jonia Alshiek, Giulio A Santoro, Andrzej Pawel Wieczorek, S Abbas Shobeiri
OBJECTIVE: To review our 6-year experience (2009-2015) in teaching three-dimensional pelvic floor ultrasonography workshops that utilized pelvic floor phantoms in the setting of an Objective Structured Assessment of Technical Skills methodology. METHODS: Four-hour Objective Structured Assessment of Technical Skills workshops were given at several society meetings and involved a didactic session, a hands-on session using the pelvic floor phantoms, and a computer station session reviewing pelvic floor pathologies...
July 10, 2018: Obstetrics and Gynecology
Valerie A Flores, Nina S Stachenfeld, Hugh S Taylor
BACKGROUND: Endometriosis is a gynecologic disorder affecting 6-10% of reproductive-aged women. First-line therapies are progestin-based regimens; however, failure rates are high, often requiring alternative hormonal agents, each with unfavorable side effects. Bazedoxifene with conjugated estrogens is approved for treatment of menopausal symptoms, and use in animal studies has demonstrated regression of endometriotic lesions. As such, it represents a potential treatment option for endometriosis...
July 10, 2018: Obstetrics and Gynecology
Malik Elharram, Natalie Dayan, Amanpreet Kaur, Tara Landry, Louise Pilote
OBJECTIVE: To systematically review and summarize studies investigating an association between a history of preeclampsia and cognitive function later in life. DATA SOURCES: Studies published before August 2017 were identified without any language restriction or study design limits through electronic searches of 10 main databases including MEDLINE and METHODS OF STUDY SELECTION: We considered all observational studies that included preeclampsia as a clearly defined prespecified risk factor and that examined a cognition-related outcome measure including validated cognitive tests, magnetic resonance brain imaging, or a clinical diagnosis of dementia...
July 10, 2018: Obstetrics and Gynecology
Luis D Pacheco, M James Lozada, George R Saade, Gary D V Hankins
Damage-control surgery (abdominopelvic packing followed by a period of medical stabilization in the intensive care unit) is a life-saving intervention usually reserved for critically injured patients who may not survive an attempt to achieve hemostasis and complete repair of the damage in the operating room. Most obstetricians have little or no experience in this area, although the use of damage-control surgery in selected cases may be life-saving. This approach should be considered when arterial bleeding has been controlled and persistent bleeding is deemed to be secondary to coagulopathy that is refractory to blood product replacement, particularly in the presence of hypothermia, acidosis, and vasopressor requirement...
July 10, 2018: Obstetrics and Gynecology
Samantha E Parker, Carla Van Bennekom, Marlene Anderka, Allen A Mitchell
OBJECTIVE: To use data from two large studies of birth defects to describe time trends in ondansetron use for the treatment of first-trimester nausea and vomiting of pregnancy and to investigate associations, either previously reported or undescribed, between first-trimester ondansetron use and major birth defects. METHODS: We used data from two case-control studies, the National Birth Defects Prevention Study (1997-2011) and the Slone Birth Defects Study (1997-2014)...
July 10, 2018: Obstetrics and Gynecology
Mauricio La Rosa, Victoria Jauk, George Saade, Kim Boggess, Sherri Longo, Erin A S Clark, Sean Esplin, Kirsten Cleary, Ronald Wapner, Kellett Letson, Michelle Y Owens, Sean Blackwell, Jeff M Szychowski, William W Andrews, Alan T Tita
OBJECTIVE: To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor. METHODS: This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria...
July 10, 2018: Obstetrics and Gynecology
Daniel L Rolnik, Yuanqi Yong, Timothy J Lee, Cheryl Tse, Andrew C McLennan, Fabricio da Silva Costa
OBJECTIVE: To assess the influence of body mass index (BMI) on fetal fraction increase with gestational age and on the rates of test failure. METHODS: We performed a cross-sectional study of consecutive singleton pregnancies in which cell-free DNA screening for fetal aneuploidies was performed from 10 weeks of gestation, between May 2013 and January 2018, at two fetal medicine clinics in Australia using one of two different platforms. Maternal characteristics, fetal fraction, and failure after a first attempt ("no-call") and after resampling ("test failure") were recorded...
July 10, 2018: Obstetrics and Gynecology
Yen-Yi Juo, Usah Khrucharoen, Yas Sanaiha, Young-Ji Seo, Erik Dutson, Peyman Benharash
OBJECTIVE: To evaluate the cumulative hospitalization cost differences between routine cholecystectomy and an observational approach during index hospitalization for pregnant patients. METHODS: A retrospective cohort study of 1,245 pregnant women with biliary pancreatitis across the United States between 2010 and 2014 was performed using the Nationwide Readmissions Database. Cumulative costs and complications were compared between patients with and without cholecystectomy during both initial and subsequent hospitalizations...
July 10, 2018: Obstetrics and Gynecology
Géraldine Giraudet, Chrystèle Rubod, Pierre Collinet, Michel Cosson
BACKGROUND: Opportunistic salpingectomy at the time of hysterectomy is currently recommended to reduce the lifetime risk of ovarian cancer. The vaginal route is least invasive, but surgeons sometimes may choose to perform this procedure laparoscopically or robotically when anticipating adnexal surgery as a result of limited visibility. TECHNIQUE: We describe a surgical technique to make salpingectomy by the vaginal route easier and more feasible. Posterior rotation of the uterus provides excellent access to the tube, which can easily be removed before separation of the adnexa...
July 10, 2018: Obstetrics and Gynecology
Bethany M Mulla, Olivia H Chang, Anna M Modest, Michele R Hacker, Karen F Marchand, Karen E O'Brien
OBJECTIVE: To evaluate the effectiveness of an educational video explaining aneuploidy testing. METHODS: This was a randomized controlled trial of women with singleton pregnancies having aneuploidy testing at less than 14 weeks of gestation from September 2016 to March 2017 at our prenatal ultrasound center. We developed an educational video on aneuploidy testing. Participants, stratified by age younger than or 35 years or older at estimated delivery date, were randomized to either view or not view the video before their ultrasonogram...
July 10, 2018: Obstetrics and Gynecology
Natalie C Stentz, Laura G Cooney, Mary D Sammel, Divya K Shah
OBJECTIVE: To compare surgical approach, operative time, and perioperative morbidity after myomectomy by patient race. METHODS: In this retrospective cohort study, data were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database on 8,438 women undergoing myomectomy between January 1, 2012, and December 31, 2015. Myoma burden and approach to myomectomy were determined based on Current Procedural Terminology coding...
July 10, 2018: Obstetrics and Gynecology
Larissa A Meyer, Javier Lasala, Maria D Iniesta, Alpa M Nick, Mark F Munsell, Qiuling Shi, Xin Shelley Wang, Katherine E Cain, Karen H Lu, Pedro T Ramirez
OBJECTIVE: To investigate the effect of an enhanced recovery after surgery (ERAS) program on perioperative outcomes with an emphasis on opioid consumption and patient-reported outcomes in the immediate and extended postoperative periods. METHODS: We initiated our ERAS program as part of a quality improvement initiative in November 2014. We compared clinical outcomes among a cohort of 607 women undergoing open gynecologic surgery before or after implementation of ERAS...
July 10, 2018: Obstetrics and Gynecology
Ava Ferguson Bryan, Julie Chor
OBJECTIVE: To understand factors contributing to women's level of preparedness for their first pelvic examination. METHODS: We conducted semistructured interviews with young women, aged 18-24 years, who had undergone at least one pelvic examination. This analysis explored 1) gynecologic and health care experience before the first pelvic examination, 2) preprocedure expectations and concerns, and 3) preprocedure knowledge about the examination. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented...
July 10, 2018: Obstetrics and Gynecology
J Eric Jelovsek, Kevin Chagin, Emily S Lukacz, Tracy L Nolen, Jonathan P Shepherd, Matthew D Barber, Vivian Sung, Linda Brubaker, Peggy A Norton, David D Rahn, Ariana L Smith, Alicia Ballard, Peter Jeppson, Susan F Meikle, Michael W Kattan
OBJECTIVE: To develop statistical models predicting recurrent pelvic organ prolapse, surgical complications, and change in health status 12 months after apical prolapse surgery. METHODS: Logistic regression models were developed using a combined cohort from three randomized trials and two prospective cohort studies from 1,301 participants enrolled in surgical studies conducted by the Pelvic Floor Disorders Network. Composite recurrent prolapse was defined as prolapse beyond the hymen; the presence of bothersome bulge symptoms; or prolapse reoperation or retreatment within 12 months after surgery...
July 10, 2018: Obstetrics and Gynecology
C Emi Bretschneider, David Sheyn, Sangeeta T Mahajan, Cecile A Ferrando
OBJECTIVE: To evaluate the incidence and trends of 30-day outcomes after concurrent surgeries for gynecologic cancer and pelvic floor disorders. METHODS: Using the American College of Surgeons National Quality Improvement Program database, patients who underwent surgery for gynecologic cancer with and without pelvic floor reconstruction were identified between the years 2013 and 2016. Propensity score matching was performed to ameliorate selection. Student t test and Mann-Whitney tests were used to compare continuous variables between two groups where appropriate...
July 10, 2018: Obstetrics and Gynecology
Moeun Son, Archana Roy, William A Grobman, Emily S Miller
OBJECTIVE: To examine whether, with fetal malpresentation at term, perinatal morbidity and mortality differ between women who undergo an external cephalic version (ECV) attempt and those who do not and are expectantly managed. METHODS: We conducted a retrospective cohort study of women with nonanomalous singleton gestations in nonvertex presentation delivering at a tertiary care institution from 2006 to 2016. Women undergoing an ECV attempt at 37 weeks of gestation or greater were compared with those with nonvertex fetuses who did not undergo an ECV attempt and delivered at 37 weeks of gestation or greater...
July 10, 2018: Obstetrics and Gynecology
Malavika Prabhu, Elizabeth M Garry, Sonia Hernandez-Diaz, Sarah C MacDonald, Krista F Huybrechts, Brian T Bateman
OBJECTIVE: To describe nationwide patterns in outpatient opioid dispensing after vaginal delivery. METHODS: Using the Truven Health Analytics MarketScan database, we performed a large, nationwide retrospective cohort study of commercially insured beneficiaries who underwent vaginal delivery between 2003 and 2015 and who were opioid-naive for 12 weeks before the delivery admission. We assessed the proportion of women dispensed an oral opioid within 1 week of discharge, the associated median oral morphine milligram equivalent dose dispensed, and the frequency of opioid refills during the 6 weeks after discharge...
July 10, 2018: Obstetrics and Gynecology
Deborah J Wexler, Camille E Powe, Linda A Barbour, Thomas Buchanan, Donald R Coustan, Rosa Corcoy, Peter Damm, Fidelma Dunne, Denice S Feig, Assiamira Ferrara, Lorie M Harper, Mark B Landon, Sara J Meltzer, Boyd E Metzger, Hilary Roeder, Janet A Rowan, David A Sacks, David Simmons, Jason G Umans, Patrick M Catalano
The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop on research gaps in gestational diabetes mellitus (GDM) with a focus on 1) early pregnancy diagnosis and treatment and 2) pharmacologic treatment strategies. This article summarizes the proceedings of the workshop. In early pregnancy, the appropriate diagnostic criteria for the diagnosis of GDM remain poorly defined, and an effect of early diagnosis and treatment on the risk of adverse outcomes has not been demonstrated...
July 10, 2018: Obstetrics and Gynecology
Davida M Schiff, Timothy Nielsen, Mishka Terplan, Malena Hood, Dana Bernson, Hafsatou Diop, Monica Bharel, Timothy E Wilens, Marc LaRochelle, Alexander Y Walley, Thomas Land
OBJECTIVE: To estimate fatal and nonfatal opioid overdose events in pregnant and postpartum women in Massachusetts, comparing rates in individuals receiving and not receiving pharmacotherapy for opioid use disorder (OUD). METHODS: We conducted a population-based retrospective cohort study using linked administrative and vital statistics databases in Massachusetts to identify women with evidence of OUD who delivered a liveborn neonate in 2012-2014. We described maternal sociodemographic, medical, and substance use characteristics, computed rates of opioid overdose events in the year before and after delivery, and compared overdose rates by receipt of pharmacotherapy with methadone or buprenorphine in the prenatal and postpartum periods...
July 10, 2018: Obstetrics and Gynecology
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