Proceedings in Obstetrics and Gynecology
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Pregnancy Predictors of Health
Full text linkPregnancy Predictors of Health, University of Iowa Obstetrics and Gynecology Postgraduate Virtual Conference, November 5, 2021Poster Presentation
Amenorrhea and pituitary human chorionic gonadotrophin production in a 38-year-old presenting as pregnancy of unknown location: case report and review of literature
Full text linkBackground: Amenorrhea and extraplacental production of serum human chorionic gonadotropin (hCG), particularly in young women, can mimic a pregnancy of unknown location. Elevated serum hCG in the absence of pregnancy can pose a diagnostic dilemma and has led to potentially harmful and unwarranted interventions including chemotherapeutic agents like methotrexate or have led to delay in necessary medical interventions in women. We report a case to demonstrate that amenorrhea and extraplacental human chorionic gonadotropin (hCG) production in young women can mimic a pregnancy of unknown location. Furthermore, we performed a critical review of literature on pituitary hCG production. Case: A 38-year-old woman with a diagnosis of Silver-Russell syndrome, a unicornuate uterus, history of right oophorectomy for a benign serous cystadenoma and a desire for pregnancy presenting with a provisional diagnosis of pregnancy of unknown location.After performing a thorough review of history, physical examination, ultrasound exams, and a review of hormone analysis [including hCG, Tumor markers, Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Anti-Mullerian Hormone (AMH), Estradiol (E2) levels], we confirmed the diagnosis of premature ovarian insufficiency and pituitary hCG production. Conclusions: In women, serum levels of hCG may increase with age, and are not always an indicator of pregnancy. Therefore, it is imperative to interpret false-positive test results and rule out the extraplacental production of hCG. This will help prevent unnecessary surgical procedures and treatment, including chemotherapy
New Technologies in Obstetrics and Gynecology: Poster Presentations
No full textNew Technologies in Obstetrics and Gynecology, University of Iowa Obstetrics and Gynecology Postgraduate Conference, Hyatt Regency Coralville, Coralville, IA. November 4, 2022Poster Presentation
How did the COVID-19 Pandemic impact self-reported cancer screening rates in 12 Midwestern states?
Full text linkObjective: In the early months of the COVID-19 pandemic, the U.S. healthcare system reallocated resources to emergency response and mitigation. This reallocation impacted essential healthcare services, including cancer screenings. Methods: To examine how the pandemic impacted cancer screenings at the population-level, this study analyzes 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the change in the proportion of eligible adults reporting a recent cancer screen (mammogram, pap smear, colon/sigmoidoscopy, blood stool test). All analyses accounted for response rates and sampling weights, then explored differences by gender and rurality across 12 Midwestern states. Results: We found that the proportion of adult women completing a mammogram declined across all states (-0.9% to -18.1%). The change in colon/sigmoidoscopies, pap smears, and blood stool tests were mixed, ranging from a 9.7% decline in pap smears to a 7.1% increase in blood stool tests. Declines varied considerably between states and within states by gender or metro/urban/rural status. Conclusions: The COVID-19 pandemic led to delayed breast, cervical, and colorectal cancer detection services. Policymakers should aim to advance cancer control efforts by implementing targeted screening initiatives
Look before you LEEP: patient reported pain with IV sedation vs local analgesia
Full text linkObjective: Examine the effectiveness of IV sedation in addition local analgesia compared to local analgesia alone for LEEP pain management. Methods: This quality improvement project surveyed 89 patients who underwent a LEEP procedure: 26 in the local only group and 63 in the IV + local group. Patients completed a visual analog scale and pain survey immediately following their LEEP. Results: The local analgesia + IV sedation group reported a lower average pain score compared to the local analgesia only group (2.4 ± 2.2 v 3.6 ± 2.7). However, this was not statistically significant, p 0.47. Patients found it was helpful to know what to expect prior to the LEEP and utilized various means of pain relief in addition to the primary treatments assessed. Conclusions: There is a need for high quality trials to determine best practices of pain management
COVID-19 expands food insecurity disparities among rural, high-risk obstetrics patients
Full text linkObjective: To compare rural and urban food insecurity in a high-risk obstetrics population prior to and during the COVID-19 pandemic. Methods: Utilizing convenience sampling of high-risk obstetrics patients, validated survey questions assessed self-reported food insecurity from March - October 2019 (pre-COVID-19) and March - October 2020 (COVID-19). Chi-squared analysis compared food insecurity between these two periods and among patients living in rural vs. urban counties.Results: A total of 1089 (pre-COVID-19) and 1246 (COVID-19) screenings were completed. Compared to 2019, the prevalence of food insecurity in 2020 was significantly higher from March-June only (7.8% pre-COVID-19 vs. 11.4 % COVID-19, p=0.04). Despite pre-COVID-19 similarity, rural patients reported significantly higher food insecurity prevalence during COVID-19 than urban counterparts (12.9% rural vs. 8.2% urban, p<0.01). Conclusions: The COVID-19 pandemic was associated with a disproportionate effect on food insecurity among rural patients with high-risk pregnancies. Rural health systems and agencies should explore proactive screening and intervention efforts to mitigate the adverse, downstream health effects of food insecurity
Serum concentration of matrix metalloproteinase-1 in patients with preterm labor compared to gestational age matched controls
Full text linkDuctal-cutaneous fistula secondary to recurrent Bartholin’s cysts: a case report
Full text linkBackground: Disorders of the Bartholin’s duct and gland, including cyst and abscess formation, account for 2% of gynecologic visits annually. An uncommon complication of a Bartholin’s duct or gland abscess is fistula formation. Literature has described cases of recto-Bartholin’s and recto-vaginal fistulas. Case: We present a case of fistula development between the perineum and the Bartholin’s duct and gland. The patient was successfully managed with fistulectomy and Bartholin’s gland excision. Conclusion: Though fistula formation is a rare complication of Bartholin’s duct and gland pathology, investigation is warranted. A ductal-cutaneous fistula is possible in the setting of recurrent cysts located beyond the vaginal introitus. The best method of prevention is appropriate execution of a marsupialization. Complete removal of the fistulous tract and Bartholin’s duct and/or gland can result in resolution of symptoms
New Technologies in Obstetrics and Gynecology: Presentations
No full textNew Technologies in Obstetrics and Gynecology, University of Iowa Obstetrics and Gynecology Postgraduate Conference, Hyatt Regency Coralville, Coralville, IA. November 4, 2022 Presentation