Proceedings in Obstetrics and Gynecology
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Diagnosis of uterine torsion during cesarean section: a case series
Full text linkPartial rotation of the uterus up to 45 degrees is a common physiological finding during pregnancy whereas uterine torsion is pathologic and defined as rotation greater than 45 degrees. Torsion of up to 720 degrees has been reported; with most cases occurring between 90 degrees and 180 degrees. While uterine torsion in pregnancy requires emergent intervention, the incidence is unknown. Most cases of uterine torsion are diagnosed intra-operatively at emergent cesarean section following non-specific clinical presentation, such as fetal heart rate decelerations or bradycardia, severe abdominal pain, hypotension, or vaginal bleeding. In this case series, we report on two cases of one woman with gravid uterine levorotation of 180 degrees and another with gravid uterine dextrorotation of 180 degrees
Planned use of long acting reversible postpartum contraception in low-risk women in CenteringPregnancy® group versus individual physician prenatal care
Full text linkIntroduction: Education on effective contraceptive methods is necessary during the prenatal period to help women achieve optimal birth spacing. This study identified rates of long-acting reversible contraception (LARC) uptake in women who attended CenteringPregnancy® (CP) group prenatal care versus individual physician care (IP).Methods: Charts for low-risk women who participated in group CP or IP prenatal care between March 2012 and May 2016 were reviewed. Charts of IP subjects were randomly selected in each year to achieve a CP:IP ratio of at least 1:3. The primary outcome was rate of LARC use at discharge and within 8 weeks postpartum. Pearson chi-squared test and Wilcoxon rank-sum tests were performed, and a p-value <0.05 was considered significant.Results: 129 women participated in CP care and 412 in IP care. CP women were more likely nulliparous (91, or 70.5% vs 212, or 51.5%, p=0.0001) and more likely to attend at least 15 prenatal visits (54, or 41.9% vs 62, or 15.1%, p<0.0001). LARC use rates at discharge and at the postpartum visit were similar (36, or 27.9% vs 89, or 21.6%, p=0.142; 39, or 32.2% vs 110, or 29.4%, p=0.557). Rates of women using effective contraception (LARC and other hormonal options, including oral contraceptives and Depo Provera) at discharge and at the postpartum visit were similar (59, or 45.7% vs 206, or 50.0%, p=0.177; 72, or 59.5% vs 229, or 61.2%, p=0.157). IUD use was greater than subdermal implant use in both groups (31, or 24.0% vs 5, or 3.9%; 72, or 17.5% vs 17, or 4.1%; p=0.081). Rates of routine postpartum visit attendance at 6-8 weeks postpartum were similar and high in both groups (121, or 93.8% vs 374, or 90.8%; adjusted p-value=0.164).Conclusion: Although CP subjects had more prenatal visits and spent more time with providers, there was no difference on uptake of LARC or effective contraception at discharge or at the postpartum visit when compared to IP subjects
Disparities in healthcare: a focus on Native American Women’s health and the system that is failing them
Full text linkWomen’s health care has always been a hotbed for public attention. The upcoming presidential election and new state-level laws targeting reproductive rights have only brought these issues into greater prominence. While reproductive rights are an important topic on their own, we also need to talk about a subset of the greater issue that is often swept under the rug, to talk about women’s healthcare disparities on Native American reservations. Unless you live close to a reservation, you may have never thought to consider that a disparity even exists. Yet, as a female tribal member who has lived on the reservation most of my life, this issue is of paramount concern ethically, socially and morally
Mesenteric lymphatic malformation mimicking an adnexal source in a teenager
Full text linkMesenteric lymphatic malformations are rare benign tumors that are usually found in children and very rarely are they found in the abdomen. We present a rare case in which a mesenteric lymphatic malformation mimics an adnexal source. This is an important contribution to obstetrics and gynecology literature to show the importance of keeping this rare diagnosis on the differential, as well as the value of multi-disciplinary care
The effect of music on pain perception in women scheduled for elective cesarean section: a systematic review and meta-analysis
Full text linkObjective: To study the effect of music on pain perception in women scheduled for elective cesarean section (CS)Search Strategy: We used the following keywords (“music” or “music therapy” and any of the following: cesarean section OR cesarean delivery OR CS OR cesarean OR Caesarean OR "post-op*)Selection Criteria: We included all studies satisfying the following criteria: (1) Population: pregnant women scheduled for cesarean section. (2) Intervention: the addition of any type of music to routine care compared with routine care alone. (3) Study design: randomized controlled trials (RCTs). We excluded the following: (1) non-randomized trials, (2) in vitro and animal studies, (3) studies in languages other than English, and (4) studies whose data were unreliable for extraction and analysis.Data Collection and Analysis: Data extraction was independently performed using a standardized form. In case of discrepancies, a consensus was reached after the involvement of the senior investigator. Then, data were extracted from assessed articles and entered RevMan software for meta-analysis.Main Results: Pooled data significantly favored the music group over the non-music one in terms of pain and anxiety scores (p<0.001). Heart rate, systolic and diastolic blood pressure did not differ significantly between both groups.Conclusion: Music can be used during, before, and after cesarean section to reduce associated pain and anxiety
Dual trigger protocol is an effective IVF strategy in both normal and high responders without compromising pregnancy outcomes
Full text linkTo compare pregnancy outcomes between normal versus high responders after dual trigger of final oocyte maturation with gonadotropin-releasing hormone (GnRH) agonist and human chorionic gonadotropin (hCG) in fresh in-vitro fertilization (IVF) cycles, where ovarian stimulation was achieved by a flexible GnRH antagonist protocol
Multimodal perioperative pain protocol for gynecologic oncology laparotomy is associated with reduced hospital length of stay and improved patient pain scores
Full text linkThe primary objective was to evaluate the impact of a multimodal perioperative pain regimen on length of hospital stay for patients undergoing laparotomy with a gynecologic oncologist
Effects after use of laser therapy for vulvovaginal atrophy in a patient with lichen sclerosus: a case report
Full text linkObjective: Use of laser therapy has most recently been introduced as a non-invasive option for the treatment of genitourinary syndrome of menopause (GSM). Recent literature has shown promise in providing benefit for patients with symptoms of vulvovaginal atrophy (VVA) and stress urinary incontinence with minimal adverse effects. Despite this, the United States Food and Drug Administration has not cleared laser therapy for these specific indications given the lack of sufficient evidence to support safety and efficacy.A case is presented of a patient with GSM in the setting of lichen sclerosus who was referred to a tertiary vulvovaginal disease clinic after worsening of symptoms after three laser therapy treatments. Patient data is protected by the Health Insurance Portability and Accountability Act of 1996.The case presented demonstrates initial worsening of symptoms after treatment with laser therapy, with initial exam findings showing atrophic vaginitis, marked introital narrowing, partial phimosis of the clitoral hood, and fusion of the labia minor and majora. The patient ultimately had complete resolution of post-laser therapy symptoms by one year after initial presentation. The case findings and follow-up are presented.Conclusions: Despite case series and studies in the literature showing promise of the use of laser therapy for GSM and urinary incontinence, laser therapy is not currently FDA-approved for these indications. Large scale, long-term prospective randomized controlled data is necessary to provide data on the safety, efficacy, indications, and appropriate candidates for laser therapy
Efficacy and safety of misoprostol for intrauterine device insertion in women with no previous vaginal delivery: a systematic review and meta-analysis of randomized controlled trials
Full text linkIntroduction: The efficacy of misoprostol use for cervical priming before intrauterine device insertion (IUD) is controversial. This review aims to evaluate the evidence from published randomized controlled trials about the efficacy and safety of misoprostol before IUD insertion for pain relief in women with no previous vaginal delivery.Materials and methods: We searched the following electronic databases: Web of Science, Cochrane CENTRAL, SCOPUS, and PubMed for relevant studies using the following Mesh terms: (misoprostol) AND (intrauterine device OR IUD). The primary outcome was the mean pain score during insertion. Secondary outcomes included the ease of insertion score, the rate of successful IUD insertion, the rate of IUD insertion failure, and the adverse effects.Results: Ten randomized controlled trials (RCTs) (misoprostol: n=698 and placebo: n=689) were pooled in the analysis. The overall Standardized Mean Difference (SMD) of pain score did not favor either of the two groups (SMD= -0.09, 95%CI [-0.50, 0.33], p=0.007). Pooled results were highly heterogeneous (I2=93%, P<0.001). The total MD of the ease of insertion score favored the misoprostol group (MD= -1.36, 95% CI [-2.20, -0.52], p =0.002). The overall risk ratio (RR) of the number of failed insertions showed that misoprostol is associated with less IUD insertion failures compared to placebo (RR=0.55, 95% CI [0.38, 0.81], p=0.002). Finally, the overall risk showed that misoprostol is associated with more shivering, diarrhea and pelvic pain.Conclusions: Misoprostol facilitates IUD insertion in women with no previous vaginal delivery, and is associated with 50% less chance for IUD insertion failure despite inducing mild adverse effect
Scurvy presenting as vulvar folliculitis, a case report and review of the literature
Full text linkThis case examines clinical features and care of a patient with scurvy presenting with vulvar folliculitis