Proceedings in Obstetrics and Gynecology
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Sarah A. Shaffer, DO, MME
Full text linkSarah A. Shaffer, DO, MME.University of Iowa Hospitals and Clinics. Clinical Associate Professor of Obstetrics and Gynecology-General Obstetrics and GynecologyDepartment of Obstetrics and Gynecology Clerkship Director - Obstetrics & Gynecology. University of Iowa Carver College of Medicine, Iowa City, Iow
The Challenge of Maternal Mortality
Full text linkThe Challenge of Maternal Mortality, University of Iowa Obstetrics and Gynecology Postgraduate Virtual Conference, November 20, 2020.Poster presentations
The impact of adding fetal MRI to sonographically diagnosed intrauterine ventriculomegaly: a prospective cohort study
Full text linkObjective: Intrauterine fetal ventriculomegaly (IVM) is one of the most commonly detected fetal anomalies. Prenatal diagnosis in IVM is considered a challenge with a significant impact on management. The current study aims to evaluate the added value of performing fetal MRI to sonographically diagnosed IVM.Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between January 2017 and March 2019. We included pregnant women with a single fetus sonographically diagnosed IVM (symmetrical or asymmetrical). First, a basic obstetric sonographic examination was done, followed by a detailed (2D/3D) fetal CNS anomaly scan for the detection of other associated anomalies. A fetal MRI brain scan was performed for all cases.Results: Sixty women were included in the study. Of the 60 fetuses with IVM, additional findings were seen on MRI in 14 cases (23%), and most of these findings were identified in fetuses with severe IVM (about 50%). No additional abnormalities were identified in fetuses of less than 24 weeks gestation. Callosal and septum pellucidum lesions (29%), along with posterior fossa abnormalities (28%) and cortical malformations (21%) accounted for the most common additional significant fetal MRI findings. Fetal MRI sensitivity, specificity, and positive and negative predictive values in correlation with those of prenatal ultrasound turned out to be notably higher, approaching nearly 100 %.Conclusions: Fetal MRI for sonographically diagnosed moderate or severe IVM is recommended to guide clinical management
Thin endometrial lining during frozen embryo cycles: a case-control study of risk factors and natural history
Full text linkObjective: To identify predictors of thin endometrial lining in the first frozen embryo transfer cycles and to characterize the natural history of this condition over subsequent cycles.Design: Retrospective case-control studyConclusions: This study shows that prognosis after a diagnosis of thin endometrial lining is favorable. Lower weight and thinner fresh cycle lining are predictors of thin endometrial lining in FET cycles. Most importantly, women with a diagnosis of thin endometrial lining have similar live birth rates as those with adequate endometrial lining, although their time to achieve live birth is slightly longer
Efficacy and safety of Elagolix in the treatment of endometriosis associated pain: a systematic review and network meta-analysis
Full text linkBackground: Endometriosis commonly presents with dysmenorrhea, non-menstrual pelvic pain, and infertility. Elagolix is an oral, short-acting, gonadotropin-releasing hormone antagonist acting through complete estrogen suppression.Objective: To evaluate the evidence from published randomized controlled trials (RCTs) about the efficacy and safety of Elagolix in the treatment of endometriosis associated pain.Search strategy: Electronic databases containing articles published between January 2000 and February 2020 were searched using the MeSH terms (Elagolix OR gonadotropin-releasing hormone antagonist OR GnRH antagonist OR antigonadotropin) AND (endometriosis) AND (pelvic pain).Selection criteria: All RCTs assessing the efficacy of Elagolix in the treatment of pain associated with endometriosis were considered for this network meta-analysis, where five studies were deemed eligible for this review. Data collection and analysis: The mean difference (MD) and confidence intervals (95% CI) for continuous outcomes including analgesic use, dysmenorrhea, non-menstrual pelvic pain, and quality of life were calculated. Main results: Elagolix 250 mg reduced dysmenorrhea significantly, as compared to placebo, (MD = -0.41, 95% CI [-0.7, -0.13]) at 12 weeks, while Elagolix 200 mg reduced dysmenorrhea significantly (MD= -1.2, 95% CI [-1.9, -0.57]) compared to placebo after 24 weeks of treatment.Conclusions: Elagolix 200 mg seems to be an effective drug with fewer side effects when used to reduce dysmenorrhea and non-menstrual pelvic pain after 24 weeks of treatment in patients with endometriosis
Quantitative blood loss: a validation study
Full text linkObjective: To determine if quantitative blood loss would correlate to predicted blood loss based on change in blood concentration of hemoglobin.
Conclusion: The correlation between calculated blood using modified Brecher’s formula showed poor overall correlation to quantitative blood loss. There was a higher correlation at blood loss greater than 1500 cc which is where estimated blood loss has been shown to be most poor. Possible reasons for this poor correlation include maternal factors influencing hemoglobin levels, gestational age, error in blood loss calculation, inaccuracy of Brecher’s formula in pregnancy
Maternal inflammatory bowel disease, racial diversity and adverse birth outcomes
Full text linkBackground: Inflammatory bowel disease (IBD) is a term used to describe two conditions, Crohn’s disease and ulcerative colitis (UC), that currently have no definite cure. The incidence of IBD worldwide has increased, frequently affecting women during their reproductive years.Objectives: This study examines the association of Crohn's disease and ulcerative colitis (UC) with adverse pregnancy outcomes and looks at the interactions of race/ethnicity on these associations.Study Design: We examined hospital birth records in the National Inpatient Sample (NIS) data sets in 2011 and 2012. We identified maternal demographics and clinical characteristics using international classification of disease-9 codes. Chi-square and Fisher exact tests were used to examine associations and logistic regression models were used to control for confounders.Results: Crohn's disease is associated with small for gestational age, aOR 1.70(CI:1.53-1.89,p<0.001) but not premature delivery, whereas UC was associated with prematurity, aOR 1.5(CI:1.36-1.66,p<0.001) to a greater extent than with SGA. Analyses by race/ethnicity showed Crohn’s disease to be associated with SGA among newborns of all racial groups, but most evident among African Americans, aOR 2.55(CI:2.06-3.15,p<.001). Crohn’s disease was associated with prematurity only in Caucasian women, aOR 1.21(CI:1.10-1.34,p<.001). UC was associated with SGA newborns only in Hispanic mothers, aOR 3.40(CI:2.24-5.15,p<0.001), and with premature delivery only among Caucasian mothers, aOR 1.60(CI:1.42-1.80,p<.001).Conclusion: Both Crohn's disease and ulcerative colitis are associated with prematurity and small for gestational age in a way that is significantly affected by maternal race. Qualitative studies are needed to understand mechanisms for these associations and the role of race/ethnicity
Factors associated with long-term pessary use
Full text linkVaginal pessary is a well-established pelvic organ prolapse (POP) treatment, but little evidence about long-term use is available. Our aim was to report the duration of use and investigate predictors of long-term pessary use for POP. We hypothesized that younger, healthier women and women who experienced complications would have shorter duration of use
Unique health needs and characteristics of homeless women in Iowa City, Iowa
Full text linkContext: Homeless individuals have comparatively poorer health, however few gender specific assessments exist.Purpose: This cross-sectional survey of homeless individuals assesses gender-specific health needs.Procedure: 68 Homeless adults were surveyed at a shelter from March to April, 2015 in Iowa City, IA. Descriptive statistics were computed to compare gender-subgroup responses.Main Findings: The study population was predominately male (45, 67.2%), white (37, 54.4%), and averaged 42.35 years old (range 21-74). Males were more likely to be veterans (13, 28.9% vs. 1, 4.5%, p=0.025). Women were more likely to have dependents (9, 47.4% vs. 1, 4%, p=0.001) and access to dental coverage (16, 80% vs. 12, 30.8%, p=0.001). Similar rates of chronic disease, primary care access, and unmet health needs were noted.Conclusions: Homeless women and men have unique needs and would benefit from gender-specific health interventions. Resources for child-care may be important for women who are homeless, while dental health care may be particularly beneficial for men
Persistent vaginal granulation tissue of a large size on the episiotomy scar
Full text linkAlthough persistent granulation tissue continues to be a well-recognized complication of wound healing, the incidence of episiotomy scar granulation tissue is unknown, and reports are rare. Herein, we present a case of multiple hypertrophied and polypoidal granulation tissue of a large size at the site of episiotomy scar treated with surgical excision and the recovery was uneventful with excellent results