Proceedings in Obstetrics and Gynecology
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Association between recurrent bacterial vaginosis and Helicobacter pylori infection: a case report
Get PDFBackground: Nearly one in three women in the United States are affected by bacterial vaginosis at some point in their life, with more than fifty percent experiencing recurrent symptoms within 12 months.Case: A 36 year old G9P2072 with 1 year history of recurrent bacterial vaginosis despite repeated treatments with local and systemic metronidazole, metronidazole suppression, and probiotic therapy had relief of bacterial vaginosis following triple antibiotic therapy for Helicobacter pylori. She remains asymptomatic for both bacterial vaginosis and Helicobacter pylori at 6 month follow up.Discussion: We present a woman with recurrent bacterial vaginosis who had sudden relief of her symptoms following treatment for Helicobacter pylori. While association should not be construed as causation, similar pathogenesis may warrant investigation of H pylori as a potential cause of the complex change in the vaginal flora leading to bacterial vaginosis
The Power of a Team
Get PDFIn this creative writing piece, Dr. Racek shows how being a part of a team informs much of her life
Adherence to the updated guidelines for the prevention of perinatal Group B streptococcal disease
Get PDFIn 2010, the Centers for Disease Control and Prevention updated the Guidelines for the Prevention of Perinatal Group B Streptococcal (GBS) Disease. Previous studies of adherence to GBS guidelines have focused on the treatment of carriers of GBS. Our objective was to determine whether there was any difference in adherence to the guidelines for screening and treatment of women who delivered at our institution between the beginning of 2011 and the end of 2011 as the revised guidelines were published in November 2010. Our secondary outcome was to determine whether any differences in adherence occurred between prenatal provider types (OB/Gyn, Certified Nurse Midwives, and Family Practice)
Vaginal cancer in patient presenting with advanced pelvic organ prolapse: case report and literature review
Get PDFBackground: Vaginal cancer presenting concurrently with stage 4 uterovaginal prolapse is a rare occurrence, representing less than 1% of all gynecologic malignancies.Case: We review the case of an 82-year-old woman who presented for care of prolapse. Examination demonstrated complete uterovaginal prolapse and a vaginal ulcer, later confirmed to be vaginal cancer.Conclusion: The management of these complicated patients is limited by a lack of data available to guide treatment. This case and the literature review highlight the need for a multi-disciplinary approach to treatment and a high level of clinical suspicion for diagnosis of these very challenging cases
Colpotomy in total laparoscopic hysterectomy without using an energy source: a new approach
Get PDFStructured Abstract :At present, energy source is used, either monopolar current or harmonic scalpel in total laparoscopic hysterectomy for colpotomy. This is associated with lateral thermal damage to adjacent organs. The risk of scar dehiscence is high as compared to abdominal hysterectomyThe objective of the new technique is to reduce these complications.The colpotomy is done by blade and scissors through the vaginal tube and not by any energy source.The cut edge is sharp making it easy to pick full thickness. Colpotomy is quicker than by using energy source, there are no toxic fumes thus visibility is not affected. Cardinal ligaments are tied to edge of vaginal angle, as is done in abdominal hysterectomy.Key words: colpotomy, energy source, laparoscopic hysterectomy, ureteral injur
Division of Gynecologic Oncology
Get PDFThe Division of Gynecologic Oncology at the University of Iowa provides comprehensive care for women with gynecologic malignancies. The Gynecologic Oncology Division is part of the Holden Comprehensive Cancer Center with clinical services located on the third floor of the Pomerantz Family Pavilion within the Women’s Health Clinic in the Department of Obstetrics and Gynecology. Our clinicians are highly experienced in robotic, laparoscopic, and open surgical procedures and base their approach on individual considerations for each case. As a long standing full member of the Gynecologic Oncology Group and a Phase I institution we actively participate in clinical trial enrollment, which includes in-depth knowledge of the design and implementation of clinical trials research. Additionally we have a strong basic science and translational research component
Does observed vs expected lung head ratio correlate with neonatal survival in infants with congenital diaphragmatic hernias?
Get PDFTo investigate whether observed vs expected (O/E) lung–to–head ratio (LHR) correlates with neonatal survival in infants with congenital diaphragmatic hernia (CDH). Secondary goal was to correlate O/E LHR with Oxygenation index (OI) in the first 12 hours of life
Mapping change in medical student attitudes regarding lesbian, gay and bisexual healthcare
Get PDFDespite significant social advances among lesbian, gay, bisexual, and transgender (LGBT) individuals, healthcare disparities remain prevalent. Medical education represents a prime opportunity for addressing this need. Thus, we undertook this study to explore second year medical students’ attitudes regarding equal access to healthcare services including erectile dysfunction medication, family planning medications and technology, and partner health insurance coverage.Nearly 1500 allopathic medical students were surveyed from 2006 to 2014 during their second pre-clinical training year. While attitudes regarding care between LGB patients and heterosexual patients were often similar, there was a significant change in favor of providing insurance coverage for in-vitro and assisted reproduction services for lesbian women (increasing from 70% of students in favor in 2008 to 87% of students in 2013). Similarly, the proportion of students in favor of providing health insurance coverage for prescription drugs to same sex partners significantly increased from 2009 to 2013. Additionally, students noted healthcare providers should be required to provide equal access to care for all patients regardless of marital status or sexual practices (96% agreement in 2006 and 98.6% agreement in 2014).Even with this significant increase in medical student approval of certain healthcare services for LGB patients, continuing to integrate LGBT healthcare topics into medical education curriculum remains critically important
The unexpected presence of a huge cystic hygroma with thanatophoric dysplasia type I: a case report
Get PDFIntroduction: The presence of a thin-walled, multicystic structure posterior to the fetal head and neck with an intact vertebral column is known as a cystic hygroma. Thanatophoric dysplasia is the most lethal skeletal dysplasia. Thanatophoric dysplasia (TD) is an autosomal dominant disorder with two phenotypes. TD type I is characterized by a normal shaped skull with bowed femurs and micromelia, while TD type II is characterized by straight femurs with a clover-leaf deformity of the skull and micromelia. We report here a case of thanatophoric dysplasia type I associated with cystic hygroma, this association needs further evaluation.Case history: A 30 year old woman was referred at 26 weeks of gestation because of marked polyhydramnios. Ultrasonographic examination of the fetus revealed a narrow chest, protuberant abdomen, short curved femur, normal shaped skull with accidentally cystic hygroma were present. No other anomalies were detected. We explained to the patient the nature and severity of the anomaly and the patient preferred the termination of pregnancy. Induction of abortion was done successfully.Conclusion: This case report has highlighted the association between cystic hygroma and thanatophoric dysplasia type I. To our knowledge, this is the first report in the literature reporting the association of cystic hygroma and thanatophoric dysplasia type I. We believe that this case is useful for obstetricians and pediatricians. We also highly recommend the genetic evaluation of the fetus and parents
Outcomes of ovulation induction-intrauterine insemination in lean, overweight, and obese women with polycystic ovary syndrome
Get PDFObjective: To compare pregnancy rates between lean, overweight, and obese women with polycystic ovary syndrome (PCOS) undergoing ovulation induction-intrauterine insemination (OI-IUI).Design: Retrospective cohort studySetting: Academic training programPatient(s): All women with PCOS undergoing OI-IUI from January 2000 to November 2013.Interventions: Ovulation induction-intrauterine insemination with oral (oral OI-IUI) or combined oral and injectable (combined OI-IUI) agents.Main Outcome Measures: Clinical pregnancy rates (CPR) per IUI were compared in 198 women undergoing oral OI-IUI and combined OI-IUI. Multivariate logistic regression was used to calculate the odds of clinical pregnancy while adjusting for potential confounders. Results were expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI), using lean women as the referent population.Results: In lean PCOS patients undergoing combined OI-IUI, the unadjusted CPR was 52%; CPR was comparatively lower in overweight (22%), obese (27%) and morbidly obese (21%) women for all cycles. Adjusting for age and duration of infertility, the odds of clinical pregnancy after combined OI-IUI was significantly diminished in overweight (OR=0.27 CI=0.12-0.63), obese (OR=0.41, CI=0.20-0.83) and morbidly obese women (OR=0.33 CI=0.14-0.78) as compared to the lean PCOS referent. A similar but non-significant trend was identified in women undergoing oral OI-IUI.Conclusion: Lean women with PCOS have a higher CPR after combined OI-IUI as compared to their overweight, obese, and morbidly obese counterparts. Patients with a lean PCOS phenotype may preferentially benefit from this treatment approach