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Obstetrics and Gynecology

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Female and male sterilization are both safe and effective methods of permanent contraception used by more than 220 million couples worldwide (1). Approximately 600,000 tubal occlusions and 200,000 vasectomies are performed in the United States annually (2-4). For women seeking permanent contraception, sterilization obviates the need for user-dependent contraception throughout their reproductive years and provides an excellent alternative for those with medical contraindications to reversible methods. The purpose of this document is to review the evidence for the safety and effectiveness of female sterilization in comparison with male sterilization and other forms of contraception...
January 9, 2019: Obstetrics and Gynecology
Laura M Glaser, Magdy P Milad
Bowel and bladder injuries are relatively rare, but there can be serious complications of both open and minimally invasive gynecologic procedures. As with most surgical complications, timely recognition is key in minimizing serious patient morbidity and mortality. Diagnosis of such injuries requires careful attention to surgical entry and dissection techniques and employment of adjuvant diagnostic modalities. Repair of bowel and bladder may be performed robotically, laparoscopically, or using laparotomy. Repair of these injuries requires knowledge of anatomic layers and suture materials and testing to ensure that intact and safe repair has been achieved...
January 8, 2019: Obstetrics and Gynecology
Allie Regens, Sumit Mehta, Kirsten Jorgensen, Nancy C Chescheir
No abstract text is available yet for this article.
January 8, 2019: Obstetrics and Gynecology
Inga T Winkler
No abstract text is available yet for this article.
January 8, 2019: Obstetrics and Gynecology
Tetsuya Kawakita, Sara N Iqbal, Helain J Landy, Jim C Huang, Melissa Fries
OBJECTIVE: To examine the association of a resident-driven quality initiative with cesarean delivery surgical site infections. METHODS: This was a quasi-experimental, preintervention and postintervention study of women undergoing cesarean delivery at 23 weeks of gestation or greater between January 2015 and June 2018 at a single tertiary care center. We implemented a resident-driven, evidence-based surgical bundle, excluding women who underwent emergency cesarean or had chorioamnionitis...
January 8, 2019: Obstetrics and Gynecology
Recia Frenn
No abstract text is available yet for this article.
January 8, 2019: Obstetrics and Gynecology
Keith A Hansen
This month we focus on current research in ovulation induction. Dr. Hansen discusses five 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.
January 8, 2019: Obstetrics and Gynecology
Besher Tolaymat, Michaella M Reif
No abstract text is available yet for this article.
January 8, 2019: Obstetrics and Gynecology
Barbara S Levy, Debra L Ness, Steven E Weinberger
In policy and law, regulation of abortion is frequently treated differently from other health services. The safety of abortion is similar to that of other types of office- and clinic-based procedures, and facility requirements should be based on assuring high-quality, safe performance of all such procedures. False concerns for patient safety are being used as a justification for promoting regulations that specifically target abortion. The Project on Facility Guidelines for the Safe Performance of Primary Care and Gynecology Procedures in Offices and Clinics was undertaken by clinicians, consumers, and representatives from accrediting bodies to review the available evidence and guidelines that inform safe delivery of outpatient care...
January 8, 2019: Obstetrics and Gynecology
Jialin Mao, Maryam Guiahi, Scott Chudnoff, Peter Schlegel, Samantha Pfeifer, Art Sedrakyan
OBJECTIVE: To evaluate 7-year outcomes after hysteroscopic and laparoscopic sterilizations, including subsequent tubal interventions and hysterectomies. METHODS: This observational cohort study included women undergoing hysteroscopic and laparoscopic sterilizations in outpatient and ambulatory surgical settings in New York State during 2005-2016. We examined subsequent procedures (tubal ligation or resection, and hysterectomy not related to uterine leiomyomas or gynecologic tumors) after the index procedures...
January 8, 2019: Obstetrics and Gynecology
Malavika Prabhu, Sarah Dolisca, Rachel Wood, Kaitlyn James, Brian T Bateman, William H Barth, Blair J Wylie
OBJECTIVE: To identify characteristics associated with high inpatient daily opioid consumption after cesarean delivery. METHODS: This is a retrospective cohort study of all cesarean deliveries performed under neuraxial anesthesia with neuraxial morphine, at a single institution from January 1, 2015, to December 31, 2015. Women with preoperative opioid use disorder or chronic opioid use were excluded. Sociodemographic data, medical comorbidities, use of anxiolytics or antidepressants, smoking history, nonopioid substance use, intrapartum and cesarean delivery characteristics, and opioid consumption data (converted to morphine milligram equivalents) were abstracted...
January 8, 2019: Obstetrics and Gynecology
Michael L Stitely, Keryn Harlow, Elliot MacKenzie
OBJECTIVE: To evaluate whether oral riboflavin is more effective than placebo as a marker of ureteric patency at cystoscopy. METHODS: Patients scheduled for gynecologic surgery where cystoscopy was a planned component of the procedure were randomized to receive riboflavin 400 mg or placebo orally the night before surgery. During cystoscopy, the operating surgeon visualized ureteric jets and video recorded the cystoscopy portion of the procedure. The primary outcome was to determine whether orally administered riboflavin produced stronger yellow color of urine seen on cystoscopy than placebo on a 3-point scale...
January 8, 2019: Obstetrics and Gynecology
Katelin Sisler, Alex Knutson, Mary McLennan
BACKGROUND: Primary small cell neuroendocrine carcinoma of the urinary tract is a very rare cancer, accounting for fewer than 0.5% of urinary tract tumors. These are aggressive neoplasms with high rates of metastases. Urethral diverticula can be found in up to 6% of women. CASE: A 31-year-old woman presented with a clear vaginal discharge and an anterior vaginal wall mass that was thought to be a recurrent cyst. After surgical dissection, she was noted to have a urethral diverticulum with a solid nodule at the base...
January 8, 2019: Obstetrics and Gynecology
Anne Sebert Kuhlmann, Eleanor Peters Bergquist, Djenie Danjoint, L Lewis Wall
OBJECTIVE: To assess the menstrual hygiene needs of low-income women in St. Louis, Missouri. METHODS: Using an exploratory, cross-sectional design, women 18 years of age and older were recruited from a purposive sample of 10 not-for-profit community organizations that serve low-income women in St. Louis. From July 2017 to March 2018, 183 interviewer-administered surveys and three focus group discussions were conducted. Surveys and focus groups identified where and how women access menstrual hygiene products and what they do when they cannot afford to buy them...
January 8, 2019: Obstetrics and Gynecology
Shontreal Cooper, Nayo S Williams
A 38-year-old woman, gravida 3 para 2, with a history of two prior vaginal deliveries, at 18 weeks of gestation is diagnosed with fetal anencephaly. The patient asks: "May I undergo a scheduled primary cesarean delivery to optimize my baby's chance of survival?"
January 8, 2019: Obstetrics and Gynecology
Erika F Werner, Megan E Romano, Dwight J Rouse, Grecio Sandoval, Cynthia Gyamfi-Bannerman, Sean C Blackwell, Alan T N Tita, Uma M Reddy, Lucky Jain, George R Saade, Jay D Iams, Erin A S Clark, John M Thorp, Edward K Chien, Alan M Peaceman, Geeta K Swamy, Mary E Norton, Brian M Casey, Steve N Caritis, Jorge E Tolosa, Yoram Sorokin
OBJECTIVE: To assess neonatal respiratory morbidity in pregnancies with and without gestational diabetes mellitus (GDM) at imminent risk of late preterm delivery in a modern U.S. cohort. METHODS: Secondary analysis of a randomized placebo-controlled trial in which women with singleton pregnancies at high risk for delivery between 34 0/7 and 36 5/7 weeks of gestation were allocated to betamethasone or placebo. The primary outcome for the trial and this secondary analysis was a composite outcome of neonatal respiratory morbidity in the first 72 hours of life...
January 8, 2019: Obstetrics and Gynecology
Abriana Tasillo, Golnaz Eftekhari Yazdi, Shayla Nolen, Sarah Schillie, Claudia Vellozzi, Rachel Epstein, Liisa Randall, Joshua A Salomon, Benjamin P Linas
OBJECTIVE: To estimate the clinical effects and cost-effectiveness of universal prenatal hepatitis C screening, and to calculate potential life expectancy, quality of life, and health care costs associated with universal prenatal hepatitis C screening and linkage to treatment. METHODS: Using a stochastic individual-level microsimulation model, we simulated the lifetimes of 250 million pregnant women matched at baseline with the U.S. childbearing population on age, injection drug use behaviors, and hepatitis C virus (HCV) infection status...
January 8, 2019: Obstetrics and Gynecology
Angela Stephens, Khilen Patel, Janet Davis, Sharad Ghamande
BACKGROUND: Cesarean scar dehiscence is rare in pregnancy. When it occurs late in pregnancy, management typically involves delivery of the fetus with concurrent uterine repair. However, consensus regarding management earlier in gestation is lacking. CASE: A 30-year-old African American woman, gravida 5 para 2113, presented with cesarean scar dehiscence confirmed by magnetic resonance imaging at 20 weeks of gestation. She desired pregnancy continuation and underwent repair of the dehiscence at 23 weeks of gestation using bovine pericardial graft...
January 8, 2019: Obstetrics and Gynecology
Shokoufeh Dianat, Edith Fox, Katherine A Ahrens, Ushma D Upadhyay, Vera M Zlidar, Maria F Gallo, Reva L Stidd, Susan Moskosky, Christine Dehlendorf
OBJECTIVE: Counseling about potential side effects and health benefits of contraceptive methods could facilitate continued method use and method satisfaction, yet no evidence-based compilation of side effects and benefits exists to aid such counseling. Among contraceptive methods in the United States, depot medroxyprogesterone acetate (DMPA) injectables have the highest discontinuation rates, and most discontinuation is attributable to side effects. This review examines the side effects and health benefits of DMPA to inform counseling...
January 8, 2019: Obstetrics and Gynecology
Erin E Burke, Safedin Beqaj, Nataki C Douglas, Robert Luo
BACKGROUND: Minimally invasive fingerstick sampling allows testing of reproductive hormone levels at home, providing women with increased access to tests that can screen for conditions such as polycystic ovarian syndrome, primary ovarian insufficiency, and pituitary and thyroid dysfunction. METHOD: We present a measurement procedure comparison study of matched venipuncture and fingerstick samples from 130 women aged 18-40 years, tested on menstrual cycle day 3. Samples were measured for anti-müllerian hormone, estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), testosterone, thyroid-stimulating hormone (TSH), and free thyroxine (T4) levels...
January 8, 2019: Obstetrics and Gynecology
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