Proceedings in Obstetrics and Gynecology
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Division of Urogynecology and Reconstructive Pelvic Surgery
Get PDFThe Division of Urogynecology and Reconstructive Pelvic Surgery at the University of Iowa includes two fellowship-trained physicians, Drs. Catherine Bradley and Ali Luck, and a nurse practitioner, Diane Elas, ARNP. Seven UIHC Urogynecology clinic sessions are available weekly for the outpatient evaluation and management of female pelvic floor disorders, including urinary incontinence, pelvic organ prolapse, and other urinary and defecatory disorders. Outpatient diagnostic testing is available, including urodynamic tests and cystourethroscopy. We offer a wide spectrum of clinical care for pelvic floor disorders, including nonsurgical (e.g. pessaries and behavioral therapies) and surgical therapies. Clinic-based procedures (such as transurethral bulking injections and intra-detrusor botulinum toxin injections) are offered, as well as outpatient and inpatient surgeries. Special clinical intiatives include our minimally-invasive surgery program for urinary incontinence and prolapse, including outpatient slings and robotic hysterectomy and sacrocolpopexy. Also, Dr. Luck offers neurostimulation therapies for overactive bladder, including peripheral and sacral nerve stimulation procedures
Ovarian hyperstimulation syndrome and development of pulmonary embolism in pregnancy: case report
Get PDFOvarian hyperstimulation syndrome caused by assisted reproductive technology can lead to pulmonary embolism, a rare but serious side effect
Teaching about sexual minorities: an Iowa experience
Get PDFDespite greater social acceptance of sexual minorities and growing national support for equal medical care, disparities in healthcare access persist. Medical school curricula allot limited time to sexuality education and students’ perceptions. Combining the topics of sexual response and sexual minority healthcare may perpetuate the misconception that lesbianism and transgender identity are deviations from normal sexual functioning. We comment on teaching about sexual minority healthcare at our medical school and argue for a review of medical educator preparation and existing curricula
Defining genetic intra-tumor heterogeneity: a chronological annotation of mutational pathways
Get PDFTumor heterogeneity is believed to be important in tumor progression and its response to therapies. However, despite numerous mutations being reported in human tumors, genetic intra-tumor heterogeneity remains poorly defined. We have developed a novel strategy to provide a chronological annotation of mutational events in a tumor. We used an endometrial tumor from a patient and transplanted it into athymic mice to create many tumor xenografts. While the patient tumor xenografts were initially responsive to raloxifene treatment, xenografts created with cancer cell clones isolated from the same patient tumor showed dramatic differences in response to raloxifene, indicating existence of intra-tumor heterogeneity with some subpopulations inherently resistant to the drug. A 250K single nucleotide polymorphism (SNP) array from Affymetrix was used to profile genotype changes on 3 xenografts and 10 single cells from another 10 xenografts. We found 797 SNP sites containing loss of heterozygosity (LOH) common to all these specimens, indicating that genetic mutations in these regions may contain the earliest genetic events in the original patient tumor. Based upon the genotype information from the 10 single cancer cells, we developed a phylogenetic tree using neighbor-joining method. We showed that there are at least 3 distinct subpopulations in the patient tumor. Additionally, the phylogenetic tree was used to determine the order of genetic events, thus providing a chronological annotation to genetic mutations. Our approach represents an important analytic strategy for defining genetic intra-tumor heterogeneity and providing chronological annotations to the genetic landscape revealed by future whole genome sequencing in tumors
A rare case of a ruptured ovarian pregnancy
Get PDFOvarian pregnancy is a rare type of extrauterine pregnancy accounting for 1 to 3% of all extrauterine pregnancies. We report a rare case of a ruptured ovarian pregnancy. A 22 year old, gravida 2 para 1 living 1 was admitted with amenorrhea of 4 weeks and 6 days with chief complaints of severe acute lower abdomen pain. Urine pregnancy test was positive. Ultrasonogram pelvis revealed left sided ruptured adnexal mass with moderated hemoperitoneum. Laparotomy was performed and a diagnosis of ruptured ovarian pregnancy was made. Biopsy of the mass was taken which confirmed the diagnosis. Although ovarian pregnancy is rare, in any case of a ruptured ectopic pregnancy where the tubes are found to be normal on laparotomy, an ovarian pregnancy must be ruled out. Early detection and prompt diagnosis can preserve the future fertility of the woman
Risk of Early & Late Obstetric Complications in Women with IVF- Conceived Pregnancies and Polycystic Ovary Syndrome (PCOS)
Get PDFThere is conflicting evidence on the association between PCOS and early and late obstetric complications. It is unclear if the reported risks are independent of BMI, preexisting hypertension and diabetes. We performed a retrospective chart review to examine the risk of early and late obstetrical complications after IVF in women with PCOS (n=130) compared to controls (n=130). The miscarriage rate was 17.7% in PCOS women and 15.4% in controls. PCOS was not associated with miscarriage independent of age and BMI. The prevalence of gestational DM (GDM) was similar in both groups (12% PCOS versus 11% controls). BMI was independently associated with GDM (p=0.01). Risk of both preeclampsia and PIH was 10% in PCOS and 5% in controls, but not statistically significant. Preexisting HTN showed a significant association with preeclampsia (