Proceedings in Obstetrics and Gynecology
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Introducing e-consents in a clinical setting
Full text linkPreeclampsia (PE) is a multiorgan hypertensive-disorder in pregnancy that causes significant maternal-fetal mortality and morbidity. The diagnostics and therapeutics for PE are limited due to its unclear etiology. Using the UI Maternal Fetal Tissue Bank, our lab has demonstrated that copeptin is robustly predictive of PE. To investigate copeptin further, we developed the Rule Out Pre-Eclampsia Study (ROPE). The ROPE study recruits women admitted to Labor and Delivery for evaluation of PE. Women are admitted for PE evaluation at all hours. Research team members are not available at all times to obtain consent which limits recruitment. Our project aimed to develop an electronic informed consent (e-IC) that is compliant with the Federal Regulation for Human Research Protection and is easy to use and readily understood by study participants. After obtaining IRB approval, simulated patients were given an iPad on which to read and evaluate the e-IC using a validated questionnaire, the Quality of Informed Consent (QuIC). Based on the QuIC, the e-IC was modified and re-tested. Participants demonstrated good comprehension of the e-IC as evidence by QuIC scores ranging from 61 to 96. Based on our results, the e-IC is an effective and efficient method for the Informed Consent process
The impact of great leadership
Full text linkThe mentorship I’ve enjoyed from some UIHC Ob-Gyn faculty has influenced not only my decision to enter this field, but also shaped the way I will practice in the future and given me reason to teach and mentor others. Finding faculty who really pushed me to be not just a better student but a more engaged health care provider, teacher, citizen and leader has cemented my career trajectory. I hope it will lead to richer experiences for the others that I work with along the way. Beyond what I have experienced in other departments, Ob-Gyn faculty at UIHC are doing the after-hours work of inspiring the next generation of women’s health providers. The value of this is incalculable, indescribable, and irreplaceable
A predictive model for serous epithelial ovarian cancer chemo-response using clinical characteristics
Full text linkOne of the prognostic factors most highly associated with ovarian cancer survival is response to initial chemotherapy. Current prediction models of chemo-response built with comprehensive molecular datasets, like The Cancer Genome Atlas (TCGA), could be improved by including clinical and outcomes data designed to study response to treatment. The objective of this study was to create a prediction model of ovarian cancer chemo-response using clinical-pathological features, and to compare its performance with a similar TCGA clinical model
Evaluating the association of physical activity and weight gain in pregnancy
Full text linkPrevious research has shown that physical activity in pregnancy decreases the risk of poor pregnancy outcomes including development of gestational hypertension, pre-eclampsia, gestational diabetes, and the need for unplanned cesarean section. Research has also shown that excessive weight gain in pregnancy increases the risk of poor pregnancy outcomes. Tracking accurate physical activity in pregnancy is difficult using patient-reported data, however with commercially available and accurate physical activity monitors, objective data is more readily available. Our study is a feasibility study using objective data to track physical activity and weight gain in pregnancy
Superficial versus deep lymph node dissection in early stage vulvar carcinoma
Full text linkOur primary objective was to evaluate the difference in overall survival, recurrence rate, and post-operative morbidity related to superficial versus deep inguinal lymphadenectomy in squamous cell carcinoma of the vulva
Colleen K. Stockdale, MD, MS
Full text linkDr. Colleen K. Stockdale is a Clinical Professor of General Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics. She received a BS in Nursing from Eastern Washington University, Post Baccalaureate Pre-Med at the University of Pennsylvania, MD from the Medical College of Pennsylvania, MS in Epidemiology from the University of Iowa, and completed a residency in Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics. She has served as the Program Director for the Medical Student Clerkship and is now the Associate Residency Program Director. She is the Director of the Colposcopy Clinic and the Vulvar Vaginal Disease Clinic. Dr. Stockdale worked in private practice in Washington State before returning to the University of Iowa Hospitals and Clinics. At Iowa, she is involved in research as well as caring for patients and mentoring learners at all levels
Adnexal torsion in a patient with Müllerian agenesis undergoing ovarian stimulation: a case report
Full text linkBackground: As assisted reproductive technologies become increasingly available to patients, more women with Müllerian agenesis may undergo ovarian stimulation and oocyte retrieval to have genetically-related offspring. The risk of ovarian torsion is increased in patients utilizing assisted reproductive technologies compared to patients who do not undergo these treatments.Case: A 25-year-old G0 with Mayer-Rokitansky-Kuster-Hauser syndrome presented to the emergency room two days after oocyte retrieval with an acute abdomen. During laparoscopy, she was found to have torsion of her left ovary.Summary and Conclusion: As more young women with Müllerian agenesis present for fertility treatment, this anatomically unique patient cohort may be at an especially high risk for ovarian torsion. Physicians should recognize this risk and counsel their patients on this risk when discussing fertility options in patients with Müllerian agenesis
Single incision laparo-endoscopic surgery (SILS) is comparable with robotic surgery at a tertiary care center for the management of gynecologic oncology patients
Full text linkA shift toward minimally invasive surgical techniques has been implemented in the surgical management of gynecologic oncology patients. Over the course of 18 months, we have established a single incision laparo-endoscopic surgery program (SILS), and incorporated it in the management of our patients. We sought to assess the operative and postoperative outcomes of these patients in relation to patients who underwent robotic surgery during that same time period at our institution
Static urine osmolality with elevated first trimester urine copeptin in human preeclampsia
Full text linkWe have previously shown that maternal plasma copeptin (CPP), as a marker of vasopressin, is highly predictive of preeclampsia (PE) in the first trimester and remains elevated throughout pregnancy. Furthermore, in maternal urine samples we demonstrated that CPP was also significantly elevated in the first trimester in women who later developed PE. Because a urine dipstick test could be easily used in the clinic, we sought to validate this finding in a new and expanded cohort of samples and to determine whether these changes persist throughout pregnancy. In addition, to begin to address the mechanism for this difference, we also assessed urine osmolality to further probe renal function
Project to decrease medical student refusal in the Obstetric and Gynecology Clinic at the University of Iowa
Full text linkPurpose: To describe the frequency at which students are refused from patient care, and to evaluate the impact of interventions designed to reduce medical student refusal.Background: Medical student refusal from patient care is perceived to be a common problem during the Ob-Gyn clerkship at the University of Iowa. Review of the literature shows that medical student refusal is common in a variety of clerkships1-4. Few studies have evaluated interventions to reduce the rate of refusal.Methods: Beginning in 2016, surveys measuring medical students’ perception of refusal were administered upon completion of the Ob-Gyn clerkship. Interventions to reduce refusal of medical student participation were implemented and/or modified with each subsequent clerkship block starting in 2017.Results: Over the 2017 calendar year, 86% (85% among females and 88% among males) of students reported being refused from patient interaction in any clerkship because they are a medical student, 88% reported being refused in their Ob-Gyn clerkship because they are a medical student, and 85% percent of male students reported being refused in their Ob-Gyn clerkship because of their gender. The data show no clear correlations with refusal and gender nor with the interventions put in place. Multiple qualitative responses describe patient discomfort with the presence of male students.Discussion: The data suggest that exclusion from patient care in the Ob-Gyn clerkship occurs for the majority of medical students queried. Further, gender based exclusion may be a related problem. So far, the data have not shown a clear improvement following interventions. Possible explanations are explored and future interventions are discussed