Proceedings in Obstetrics and Gynecology
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A literature review on vaginal dilator use
Full text linkDilator stretching is often a frequent part of treatment for multiple disorders involving the pelvic floor muscles and it is unknown what the time and duration of dilator use is until patient goals are achieved. This paper looks at studies involving patient use of vaginal dilators with the diagnoses of vaginismus, dyspareunia, and pelvic pain to begin to answer the question. It was determined the recommendations given to UIHC physical therapy patients with these diagnoses change to increase the daily time and frequency of dilator usage
Kelly K. Ward, MD
Full text linkClinical Associate Professor of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology. Medical Director, Labor and Delivery Unit and Mother-Baby Care, Department of Obstetrics and Gynecology. Associate Residency Director, Department of Obstetrics and Gynecolog
A pilot evaluation of social needs among gynecologic oncology patients in inpatient versus outpatient settings
Full text linkThe WHO defines social determinants of health (SDoH) as the conditions in which we are born, grow, work, and live as well as other large systems that positively or negatively affect our health. Many healthcare systems currently lack the resources and strategies required to accurately assess and address SDoH. Action must be taken because studies have found that chronic diseases, including cancer, are affected by SDoH. The aim of this study is to identify the incidence of social needs in an inpatient gynecologic oncology population and its relation to patient demographics and clinical diagnostic data to guide and inform future intervention. Patients agreeing to participate in the study completed a needs assessment survey during their inpatient stay at the hospital between November 2020 to March 2021. The survey contained seven questions, six of which were questions screening for social needs including food and housing security, transportation means, financial stability, health literacy, and social support. Responses were considered positive if any degree of need was reported. Demographic and cancer diagnosis data were then collected and included zip code, race, cancer stage and age at diagnosis, treatment history, and number of hospital admissions and length of stay over the past 12 months. The most substantial reported needs across all gynecologic malignancies were social support (65%), health literacy (37%), and financial need (22%). Less need was reported in the categories of food (11%), housing (7%), and transportation (4%). SDoH have been studied in the outpatient gynecologic population and the needs seen in this study are similar to the needs of that population. However, there are likely different challenges and frequencies of unmet need in the different types of gynecologic cancers that may affect the stage at which their cancer is diagnosed as well as the number of hospital admissions related to their cancer care
Factors Influencing high adolescent pregnancy rate in Riobamba, Ecuador
Full text linkThe country of Ecuador has the highest rate of adolescent pregnancy in Latin America and the Caribbean. Risk factors associated with this pregnancy rate need to be explored to effectively implement educational youth programs.1 Early sexual initiation, poor reproductive health knowledge, and disruption of family structure are hypothesized to be major risk factors of adolescent (<20 years) motherhood (AMH) in Riobamba, Ecuador.2 We conducted a case-control study with case being women <20 years of age during first pregnancy and control being women ≥20 years of age during first pregnancy. Controls were not matched. The study took place in June/July of 2021 in five public governmental primary health clinics within Riobamba, Ecuador with the primary goal of determining risk factors associated with AMH. Age responses were used to designate group status. Risk factors were analyzed using Welch’s two-sample t-tests and Fisher’s Exact tests. 198 participants were analyzed: 99 who had AMH and 99 who had non-AMH. Adolescent mothers were significantly younger during first sexual encounter than adult mothers. Adolescent mothers were also more likely to lack reproductive health knowledge and have a disruption in family structure. While our study was able to broadly explore the risk factors for AMH, the underlying causes of these risk factors, such as societal pressures, need to be examined further. Early education about sexual health and use of contraception should be an initial goal of Riobamba’s programs to reduce AMH
Prevalence of maternal complications and neonatal outcomes at a Midwest academic health center
Full text linkIntroduction: The University of Iowa Hospitals and Clinics (UIHC) serves as the main referral center for Iowa and has seen increased delivery volumes following many hospital closures across the state. Maternal characteristics are also shifting as pre-pregnancy obesity of reproductive-age women is increasing nationally and in Iowa; average maternal age at first delivery has also increased over time. The aim of the current study was to characterize the outcomes of the delivering population at UIHC over a one-year period to better understand the population we serve, as well as compare our population to state and national delivering populations. Methods: This study is a secondary analysis of a pre-existing prospectively gathered database related to COVID-19 in pregnancy. The current study included all pregnant patients who delivered or underwent procedures for a spontaneous or induced second-trimester abortion on the labor and delivery unit at UIHC between May 1, 2020, and April 30, 2021. Demographic and clinical data including maternal characteristics, delivery information, maternal complications, and neonatal outcomes were obtained from the electronic medical record and double entered in a Research Electronic Data Capture (REDCap) database. Continuous and categorical variables were summarized using medians and ranges. Results: The median maternal age among the 2497 delivering patients was 30 (IQR 26, 33). The median pre-delivery body mass index (BMI) was 32 (IQR 28, 37), which included 439 patients (17.6%) with BMI >40 at time of delivery. 1769 (70.8%) patients listed White as their self-defined race and 2275 (91.0%) listed English as their preferred language. 23% had hypertensive disease of pregnancy. The patients delivered a total of 2603 neonates, with 907 (34.8%) born by cesarean section. 18.7% of deliveries were preterm and 16.6% of neonates had low birth weight. Discussion: The delivering population at UIHC has a high rate of obesity and preeclampsia, both of which place patients at higher risk for other obstetric complications. The cesarean section rate was significantly higher than the national rate of 31.8% (p=0.0017). Understanding common complications in our changing population will better equip providers to care for these patients; providing these data also creates a resource for other researchers
Cotyledonoid dissecting leiomyoma in pregnancy: a case report
Full text linkCotyledonoid dissecting leiomyoma (CDL) is a rare variant of uterine leiomyoma characterized by intramural dissection within the uterine corpus and a distinctive gross appearance resembling the cotyledons of the placenta. Despite their alarming, sarcomatous appearance both macroscopically and radiographically, these tumors are typically associated with bland histologic findings. Approximately 70 cases of CDL have been described in the literature. This case represents the second described case of CDL in pregnancy, the first in which a pregnancy was carried to term. A 28-year-old primigravid was incidentally found to have a massive, exophytic growth of the uterus on ultrasound with concomitant 14-week intrauterine pregnancy. The pregnancy was monitored with serial growth ultrasounds. She was delivered at 37 weeks via Cesarean section. After being lost to follow-up, the patient presented 2.5 years later with worsening abdominal fullness and persistent uterine mass
Holly Bolger, DO
Full text linkClinical Associate Professor of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology
Postpartum contraception counseling and uptake in an uninsured population
Full text linkObjective: Assess postpartum contraceptive preferences and use before and after implementation of interventions to improve contraceptive counseling at a free clinic for uninsured pregnant patients. Methods: This was a pre- and post-intervention observational study in Iowa City, Iowa, that included patients from February 2019 – December 2021. Multilingual educational charts and an electronic medical record (EMR) template reminder to prompt antenatal contraceptive discussion were implemented in April 2021. Results: There were 117 pre-intervention patients and 33 post-intervention. Prior to the intervention, 30% of patients had no documentation of contraceptive counseling; afterward, 3% had no documentation (p=.001). Thirty-three percent of patients obtained highly or moderately effective contraception prior to the interventions and 52% did after (p=.068). Conclusions: Multi-lingual educational handouts and an EMR template reminder were associated with increased postpartum contraceptive counseling; contraceptive use also generally increased with the interventions. Increasing access to contraceptive education may increase contraceptive autonomy in underserved populations
Michael L. Haugsdal, MD
Full text linkMichael L. Haugsdal, MDAssistant Medical Clerkship Director, Obstetrics and GynecologyUniversity of Iowa Carver College of Medicine, Iowa City, Iow