Proceedings in Obstetrics and Gynecology
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The effects of obesity with pregnancy termination: a literature review
Get PDFObesity has become a major health problem in the United States as well as globally which may affect the safety of pregnancy termination. Thus, a literature review was conducted to determine the available evidence regarding the effects of obesity with pregnancy termination to assist with patient care and counseling. The available evidence is limited by small numbers and descriptive study design. While pregnancy termination upon obese women may impart additional technical challenges, experienced providers complete procedures upon obese women without statistically significant differences in procedure or patient outcomes compared to normal weight women for first trimester gestations. Pharmacological abortion may be a more practical option in some very obese women
An undiagnosed case of placenta percreta presenting as a massive hemoperitoneum in obstetric emergency
Get PDFPlacenta accreta and placenta percreta are rare causes of serious obstetric hemorrhage. Here we report an undiagnosed case of placenta percreta presenting to the emergency department with shock in the third trimester of pregnancy. Emergency laparotomy with caesarean hysterectomy and blood transfusion are the key steps in successful management
Maternal demographic and clinical variables do not predict intrauterine contraception placement: Evidence for postplacental intrauterine contraception placement
Get PDFObjective: Determine if specific demographic and clinical variables are associated with intra-uterine contraception (IUC) placement by eight weeks postpartum.Methods: This retrospective cohort study included all patients who delivered at Dartmouth-Hitchcock Medical Center (DHMC) (July-December 2008) who identified IUC as their preferred postpartum contraceptive method. Medical records of patients identified from the birth log were reviewed for preferred contraception, demographics, medical, obstetric, and social histories, as well as payer status. Chi-squared analysis was performed for categorical variables, and Mann-Whitney U test was used for continuous variables. Nonparametric continuous variables were categorized for regression modeling.Results: 224 (34%) patients who delivered identified IUC as their preferred method of postpartum contraception. Of these, 94 (49.7%) women had an IUC placed by 8 weeks postpartum. In univariate analyses comparing those who received an IUC versus those patients who did not, only mean interdelivery interval in months (39.7 vs. 35.5, p=0.027) and mean gravidity (2.3 vs. 2.8, p=0.036) were statistically significant. In multivariate regression modeling, no variables were significantly associated with IUC placement.Conclusions: While statically significant interdelivery interval and gravidity are not likely to be clinically significant. Multivariate modeling failed to identify a model associated with IUC placement suggesting that postpartum IUC placement is not well predicted by patient variables. Lack of identifying factors may support offering postplacental IUC placement to all patients who indicate IUC as their preferred contraceptive method
Vulvar contact dermatitis
Get PDFContact dermatitis is a common problem in the world of dermatology as well as women’s health, where vulvar irritation is a frequent complaint among women. It occurs following exposure to exogenous irritants (irritant contact dermatitis) or allergens (allergic contact dermatitis), and can present in acute, subacute, or chronic forms. While vulvar pruritus and pain can be seen in a number of different conditions, contact dermatitis is one of the most common causes encountered in clinical practice, and its effects on patient quality of life can be dramatic. With a thorough history and a complete physical exam, this prevalent condition can be diagnosed and addressed. Treatment is aimed at identifying and eliminating the underlying cause, restoring the damaged epithelial barrier, and calming the inflammation. Although numerous options are available for addressing the itch and pain, the only true ”cure” for contact dermatitis is to avoid the responsible exposures
Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation
Get PDFBackground: Vulvovaginal irritation is a common gynecologic complaint. A number of factors may lead to a trial of therapy without undertaking a physical exam or diagnostic testing.Case Report: A 45 year-old woman presented to our colposcopy clinic for evaluation of an abnormal Papanicolaou (Pap) test. She reported a one month history of vulvovaginal irritation, for which Premarin vaginal cream had been empirically prescribed. Examination of the external genitalia showed ulcers and erythema of the labia minora. Speculum exam was deferred because of the patient’s discomfort. Wet mount microscopy from a vaginal swab revealed evidence of Trichomonas vaginalis, bacterial vaginosis (BV), and yeast. A swab of the ulcers was sent for herpes simplex virus (HSV) polymerase chain reaction (PCR); this confirmed HSV-2. Treatment was initiated for each of these conditions, and the patient returned for colposcopy 21 days later.Conclusion: This case illustrates the importance of the physical exam when evaluating a complaint of vulvovaginal irritation. In many cases, the cause(s) of vulvovaginal irritation can be identified based on physical exam findings and in-office testing with wet mount microscopy, vaginal pH, and the amine “whiff” test. In some cases, additional testing may be required to establish or confirm a diagnosis. Accurate diagnosis is essential not only to initiate appropriate therapy, but also to prevent the transmission of sexually transmitted infections. In some cases, this may decrease the delay in diagnosing vulvar gynecologic malignancies
Vulvar pruritus secondary to hemochromatosis
Get PDFBackground: While acute pruritus is often attributable to yeast vulvovaginitis, chronic pruritus can present as the result different conditions including manifestation of a systemic disorder.Case: A 27-year-old woman presented with a 3 year history of vulvar pruritus, burning, and dyspareunia consistent with contact dermatitis. She failed to improve despite treatment prompting evaluation for an underlying systemic disorder, such as iron deficiency anemia. Interestingly, elevated iron levels were identified leading to the diagnosis of hemochromatosis. Following treatment and near normalization of her serum iron levels, the patient’s vulvar symptoms improved.Conclusion: Vulvar pruritus is a symptom and not a disease. Thus it is important to search for the cause keeping in mind that dermatologic complaints such as pruritus can be the first manifestation of a systemic process
A phase II evaluation of gefitinib in the treatment of persistent or recurrent endometrial cancer: A Gynecologic Oncology Group study*
Get PDFA phase II trial was performed to evaluate the efficacy and safety of gefitinib in patients with persistent/recurrent endometrial cancer
Isolated torsion of the fallopıan tube in a postmenopausal woman; a rare entity
Get PDFIsolated torsion of the fallopian tube is an uncommon cause of acute lower abdominal pain. The lack of pathognomonic symptoms, clinical findings on physical examination, and specific imaging or laboratory characteristics makes this entity difficult to diagnose preoperatively, which can cause surgical intervention to be postponed. We report a case of isolated torsion of the right fallopian tube in a 58-year-old woman with a history of sexually transmitted infection. In most reported cases, there is no vascular flow on Doppler imaging modalities. We also detected high impedance of vascular flow around the cyst wall. Imaging modalities could not provide a definitive diagnosis. Tubal torsion was diagnosed upon laparotomy
The effects of preeclampsia on signaling to hematopoietic progenitor cells
Get PDFBackground: The role of the microenvironment is important in cell differentiation. The effect of placental disease on the growth and differentiation and hematopoietic stem cells has not been well-studied.Methods: Enzyme linked immunoassay was used to measure erythropoietin and osteopontin in plasma from umbilical cord blood of children born to normotensive and preeclamptic women. Additionally, CD34+ cells were isolated from umbilical cord blood and grown in complete methylcellulose media. Colony types were identified and enumerated.Results: Differences in the concentration of erythropoietin in the cord blood between the controls and the preeclamptics approached significance (P = 0.067) using a Mann-Whitney U test. In the plasma of cord blood from children born to normotensive women, the median erythropoietin was 0.186 mIU/mL compared to 1.986 mIU/mL in children of preeclamptic women. We did not find any significant differences in the number and types of colonies; however, there was a trend toward increased BFU-E in the preeclamptic samples. Furthermore, this trend for increased BFU-E colonies was also seen from CD34+ cells isolated from umbilical cord blood of severe preeclamptics compared to mild.Conclusion: Our preliminary studies suggest that abnormalities in the placenta, such as those found when the mother experiences preeclampsia, may affect the ability of hematopoietic stem cells to grow and differentiate
ACOG Iowa Section Report, November 2013
Get PDFThe Iowa Section of (ACOG), The American College/Congress of Obstetricians and Gynecologists, the strengths of our membership are education, research, political advocacy and service to women including internationally