Proceedings in Obstetrics and Gynecology
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Review of outside pathology prior to treatment of cervical intraepithelial neoplasia: a cost analysis
Get PDFObjectives: Academic institutions routinely require in-house review of pathology prior to treatment. However, it is unclear if pathology review is beneficial for the management of patients referred for cervical intraepithelial neoplasia (CIN). This study aims to determine if review of outside pathology for CIN at an academic medical center resulted in a change in the treatment plan and the associated cost for pathology review.Methods: A retrospective chart review of patients referred for treatment of CIN, including review of outside cytology and histology was performed from January 1 to December 31, 2007 after obtaining IRB approval. Data was analyzed to determine whether pathology diagnosis was changed from the outside facility interpretation; classified as minor if there was no change in clinical management and major if there was a change in treatment as a result of the internal review. Demographic and pathology information was collected from electronic medical records. Billing information was collected from the finance department. Data were analyzed using descriptive statistics.Results: Seventy-eight patients were identified of which 54 had outside pathology slides available for pathology review. Eleven had a minor change in the pathology diagnosis (20%). None of the changes in pathology diagnosis resulted in a change in treatment plan (major). The total pathology review charge was 272. Nine of the cases were charged twice to reflect the opinion of two separate pathologists (internal consultation). Of the 54 patients, 23 (43%) had state supported insurance, 24 (44%) had private insurance, and 7 (13%) were self-pay. A total of $12,969.29 was not covered/paid (88% of all charges) and thus absorbed by the institution.Conclusion: Mandatory review of outside pathology is a common practice. However, it may not be beneficial in all clinical situations. While this pathology review for CIN resulted in minor changes for 20% of patients referred to our academic/tertiary institution, it did not affect any treatment recommendations. Pathology review did increase the cost burden to the institution and the patient
Small cell carcinoma of the cervix: a retrospective analysis of characteristics important in outcomes
Get PDFTo assess clinical characteristics and treatment modalities in patients with small cell carcinoma of the cervix and the effect this has on overall (OS) and recurrence free survival (RFS)
Fast versus slow tenaculum placement during office transcervical procedures
Get PDFTo evaluate if slow tenaculum placement at the time of office transcervical procedures was less painful for patients than fast tenaculum placement
Management of pregnancy in patients with exstrophy-epispadias sequence: a case series and literature review
Get PDFExstrophy-epispadias sequence is an uncommon diagnosis in which surgical reconstruction has increased quality of life for these patients. As they are entering the reproductive phase of their life, consideration must be made for management of their pregnancies in the context of their genitourinary reconstruction. There have been few case reports of patients with cloacal exstrophy conceiving; therefore, information to guide management of their pregnancies is limited. Here we describe a patient with Omphalocele-Exstrophy-Imperforate Anus-Spinal defects (OEIS) and a patient with a history of bladder exstrophy both with spontaneous pregnancy managed by a multidisciplinary approach and primary cesarean delivery
A rare case of lethal campomelic dysplasia
Get PDFCampomelic dysplasia is a rare and mostly lethal congenital malformation. It is known as an autosomal dominant disorder due to mutations in SOX9, a member of the SOX (SRY-related HMG box) gene family. Here we report a case of a 26 years old primigravida married for 3 years with a history of consanguinity. She was impregnated by intracytoplasmic sperm injection (ICSI) due to male factor infertility. This mostly lethal skeletal anomaly was diagnosed by detailed ultrasonography in the late second trimester. She underwent an induction of labor termination due to intrauterine fetal demise
First trimester elevation in circulating endothelin-1 and arterial stiffness are predictive of late pregnancy preeclampsia
Get PDFPreeclampsia (PE) is characterized by late pregnancy hypertension and proteinuria. PE causes significant morbidity for the maternal-fetal unit. Circulating endothelin-1 (ET-1), a potent vasoconstrictor, is elevated at the time of diagnosis of human PE. In addition, women with PE demonstrate arterial stiffness as early as the end of the first trimester. However, it is unknown if arterial stiffness is associated with a first trimester elevation in ET-1 and post-delivery placental ET-1. We hypothesized that 1) first trimester plasma ET-1 is elevated and is associated with arterial stiffness in women who develop PE; 2) first trimester ET-1 is predictive of PE; and 3) placental ET-1 is increased in PE. To address these questions, we performed a nested case-control study in women at risk for P
Identifying risk factors for preeclampsia in subsequent pregnancies in women with a history of preeclampsia
Get PDFPreeclampsia (PE) is a prevalent hypertensive disorder of pregnancy that causes significant maternal-fetal mortality. It has been reported that 60% of maternal mortality can be prevented. Studies have demonstrated that nursing has the ability to influence the mortality rates by providing proactive and competent care. Part of proactive, competent care is to identify those women at the highest risk for PE. Multiple studies have identified a history of PE as a significant risk factor for PE in future gestations. We conducted a nested case control study with our Rule Out Pre-Eclampsia (ROPE) cohort to identify comorbidities most likely to lead to recurrent PE
Pregnancy predictors in the fresh cycle using dual trigger protocol
Get PDFDual trigger protocol using a combination of GnRH agonist and hCG for final oocyte maturation has been shown to minimize ovarian hyperstimulation syndrome (OHSS) risk without compromising fresh embryo transfer outcomes. Therefore, we sought to determine if any cycle characteristics were associated with predictive of pregnancy outcomes in fresh cycles that utilized this protocol for in-vitro fertilization
Betamethasone: a novel therapeutic intervention for preeclampsia
Get PDFThe early pathogenesis of preeclampsia (PE) involves a systemic inflammatory immune response. Recent data demonstrate that increased circulating arginine vasopressin (AVP) in humans is predictive of PE and that infusion of AVP in mouse dams phenocopies the pregnancy-specific cardiovascular and immune alterations observed in human PE. Specifically, AVP suppresses anti-inflammatory cytokines and cells. Betamethasone (BMTZ), commonly given to women at risk for preterm birth, is both an AVP and immune response modulator. We hypothesize that early treatment with BMTZ will prevent the development of AVP-induced PE
Let’s talk about sex history: impact of a communication curriculum on medical student performance and perceived competency
Get PDFIntroduction: Communication in general, but especially regarding difficult topics such as sexual health is inadequately addressed in undergraduate medical education. Students often feel they are poorly trained in this area due to a lack of opportunities to practice taking sexual history. Thus, a communication curriculum was implemented to address this gap, including formal small group practice sessions on taking a sexual history during the Obstetrics and Gynecology (OB/GYN) clerkship.Aim: Determine whether medical students who completed a sexual history communication curriculum performed better during a formal standardized patient based assessment (PBA) at the conclusion of the OB/GYN clerkship than historical control medical students, and assess medical student perception about taking a sexual history.Methods: Retrospective study comparing 3 specific PBA standardized patient rating questions and 5 questions gathering medical student feedback at a single academic institution. All (n=71) medical students between January and June 2011 were queried at the conclusion of their OB/GYN clerkship prior to implementation of the sexual history curriculum in July 2011 with responses compared to all subsequent (n=432) medical students through June 2014.Main Outcome Measures: Cochran-Mantel-Haenszel was used to compare scores by clerkship year and block with p<0.05 significant.Results: There was no change in medical student PBA performance or medical student perception regarding ability to take a sexual history following implementation of the sexual history communication curriculum. However, in response to “what other instruction or experiences could the clerkship provide to help you gain competency,” the theme was more practical experience.Conclusion: Learners require different formats to promote and enhance learning which may not have been measured with the outcomes chosen for this study. This may be best achieved by implementation of a formal curriculum including explicit supplementation to incorporate additional experience with sexual history taking