Proceedings in Obstetrics and Gynecology
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Marygrace Elson, MD, MME
Get PDFDr. Marygrace Elson is a Clinical Professor of General Obstetrics and Gynecology at the University of Iowa Hospital and Clinics. She received a BA from the University of Illinois, an MD from the University of Illinois College of Medicine and completed a residency in Obstetrics and Gynecology at the University of Wisconsin Hospitals and Clinics. She received an MME from the University of Iowa Carver College of Medicine. Dr. Elson worked as a private practitioner in California and Illinois, before joining the University of Iowa Hospitals and Clinics to serve as a clinical physician and on the medical faculty. She specializes in working with and teaching others through medical education. She stays busy with her family as well
University of Iowa Hospitals and Clinics Obstetrics and Gynecology Residency: Vital for Iowa Women
Get PDFI knew right away when I came to the University of Iowa Hospitals and Clinics for my residency interview that it was where I wanted to complete my training; and now that I am done with residency and continuing on in fellowship, I’ve never had one regret about choosing to come to Iowa. Iowa is a unique place – it is a nationally recognized program with faculty that are leaders in their fields, yet it is also a close-knit program where the trainees are treated with respect. The ObGyn residents receive well-rounded training and fortunately, many find that after 4 years in Iowa, they want to stay
A case of uterine gangrene after termination of second trimester pregnancy complicated by chorioamnionitis
Get PDFUterine gangrene is a rare event during pregnancy. Here, we report the case of a 22-year-old patient pregnant in her second trimester presenting with premature rupture of membranes and a low-lying placenta. Hysterotomy was done to evacuate the pregnancy. The procedure was complicated by hemorrhage so bilateral uterine arteries and the left internal iliac artery were ligated to control the bleeding. She continued to run a fever in spite of antibiotics and on the 11th postoperative day, the patient developed signs of septicemia. Abdominal re-exploration was done revealing a gangrenous uterus with signs of peritonitis. Subtotal hysterectomy was done. The patient was discharged from the hospital in good health on the 10th post repeat laparotomy day
A review of medical and surgical techniques for overcoming cervical stenosis
Get PDFCervical stenosis is anomalous narrowing or obstruction of any part or the entirety of the cervical canal. It may be congenital or acquired as the result of aging, nulliparity, use of progestins, curettage, cervical surgery or any combination of these factors. Cervical stenosis is challenging to gynecologists in that it presents an additional complication to the completion of procedures that require examination of or passage through the cervical canal. Limited literature on overcoming cervical stenosis recommends both medical therapy using laminaria or misoprostol (with additional estrogen therapy in postmenopausal patients) and surgical therapy using a variety of tools including hysteroscope, grasping forceps, scissors, bipolar electrode, hysteroscopic morcellator, resectoscope, LEEP and incision. We present an exemplar case where use of medical therapy might have eliminated the need for or at least reduced the risk of the surgical therapy that the patient actually received. We recommend that gynecologists become familiar with the variety of methods currently in use for resolving cervical stenosis so that they may best advise patients that need such treatment and that medical therapy be attempted before surgical therapy is applied whenever possible
Peripartum cardiomyopathy with a history of doxorubicin therapy: case report & review of literature
Get PDFBackground: Peripartum cardiomyopathy and doxorubicin-induced cardiomyopathy are well described conditions but there is little description in the literature of both occurring together.Case: A 29 year old G1P0 with a remote history of childhood chondroblastic osteosarcoma treated with high-dose doxorubicin therapy who developed minimally symptomatic cardiomyopathy during her pregnancy with ejection fraction reaching as low as 20-30%. She delivered via primary low-transverse cesarean section at 37 weeks complicated by uterine atony with an unremarkable recovery. Cardiomyopathy was treated with metoprolol and enalapril and she achieved ejection fraction of 44% at one year follow-up with complete return to baseline activity.Discussion: We present a woman with a history of doxorubicin therapy who developed peripartum cardiomyopathy and recovered symptomatically after one year. Although treatment of peripartum cardiomyopathy regardless of etiology is well-defined, there are few reports and no standard guidelines for special considerations in pregnant women with a history of doxorubicin therapy, a topic that may warrant further investigation
Effect of endometrial thickness on live birth rates in fresh and frozen embryo transfers in women under 38 years of age
Get PDFMany IVF clinics use endometrial thickness as a predictive factor for IVF outcomes, as research has shown a positive association between endometrial thickness and favorable IVF outcomes. A thickness of 6-8 mm is often used as a cut-off in for the decision of whether or not to transfer an embryo in both fresh and frozen cycles. However, prior studies investigating the relationship between a thin endometrium and IVF outcomes have overwhelmingly been performed in fresh cleavage stage embryo transfers. Given the recent trend toward the transfer of frozen blastocyst transfers, we aimed to determine whether endometrial thickness predicts live birth in both fresh and frozen blastocyst stage single embryo transfers
Postpartum LARC use in low-risk women in CenteringPregnancy® versus traditional certified nurse midwife prenatal care
Get PDFContraception satisfaction and utilization is linked to pre-use clinical counseling. Group prenatal care may offer increased opportunity for education on postpartum contraception options. This study evaluated postpartum long acting reversible contraception (LARC) rates in women who attend CenteringPregnancy® group prenatal (CP) care versus individual prenatal care with Certified Nurse Midwives (CNM)
Recovery from cesarean delivery at UIHC: a comparison to Enhanced Recovery Protocols
Get PDFEnhanced Recovery After Surgery programs (ERAS) have been used by some specialties for years, and are now becoming popular for gynecologic and obstetrics surgeries. ERAS programs consist of evidence-based interventions during a patient’s hospital stay that are intended to promote early return to activities such as eating, ambulation, and voiding and to manage pain. These programs reduce the risk of complications post-operatively and shorten a patient’s hospital stay. The University of Iowa Hospitals and Clinics (UIHC) is developing an ERAS protocol for cesarean deliveries. Our goal was to determine how current practices and outcomes for cesarean deliveries at UIHC compare to established ERAS programs. We also sought to identify which patients would be appropriate candidates for an ERAS protocol at UIHC
Vasopressin, depression, pain & preeclampsia
Get PDFPreeclampsia (PreE) is a prevalent hypertensive disorder of pregnancy leading to a death every minute worldwide. Predictive and preventative challenges in PreE stems from its unclear early-pregnancy etiology. Arginine vasopressin (AVP) secretion, as measured by copeptin, activates the stress response system and is a novel, early pregnancy predictor of PreE. In addition, elevated AVP is associated with stress, depression and pain. Our Precision Healthcare goal is to understand how AVP-associated changes in depression and pain affect the phenotype of PreE to develop preventative and therapeutic modalities against it. We hypothesize that in humans, antecedent depression and pain affects early pregnancy AVP secretion/copeptin which will be differentially predictive of PreE. To address this hypothesis we aim to 1) determine the association of maternal plasma copeptin and measures of depression and pain throughout human gestation and 2) determine how depression and pain through gestation affects an early pregnancy copeptin based prediction model of preeclampsia
Pregnancy outcome according to body mass index in primigravidas: a prospective cohort study
Get PDFObjective: The study aims to evaluate the association between Body Mass Index (BMI), gestational weight gain (GWG) and adverse obstetric outcomes among primigravidas.Material and methods: This was a prospective cohort study conducted at a tertiary University Hospital between June 2015 and May 2017. The study included 480 primigravidas, with singleton pregnancies, who were divided into three groups: women with a healthy weight (BMI: 18.5–24.9 kg/m2) overweight (BMI: 25 – 29.9 kg/m2) and obese (BMI ≥ 30 kg/m2). The primary outcome of the study was the rate of GWG in the participants. Secondary outcomes included the rate of gestational diabetes mellitus (GDM), gestational hypertension, pre-eclampsia, preterm labor (PTL), postdate pregnancy, fetal macrosomia and the rate of birth by cesarean (CB).Results: There were no significant differences between groups regarding the socio-demographic criteria. The rate of GWG was significantly higher in obese women versus average weight women (11.4±1.73 vs. 10.49±1.09, p=0.0001). There was an increased incidence of GDM (p=0.008), gestational hypertension (p=0.001), pre-eclampsia (p=0.0001), PTL (p=0.002), postdate (p=0.0001) and macrosomia (p=0.0001) in women who were obese compared with women with a healthy weight. Additionally, there was an increased incidence of CB with increasing body mass (p=0.0001)Conclusions: Higher BMI in primigravidas is associated with increased GWG and with adverse pregnancy outcomes such as GDM, gestational hypertension, pre-eclampsia, PTL, postdate, fetal macrosomia and cesarean birth