Proceedings in Obstetrics and Gynecology
Not a member yet
462 research outputs found
Sort by
Successful non-surgical management of acute, uncomplicated appendicitis in pregnancy: A case report
Full text linkAcute appendicitis during pregnancy is one of the most common non-obstetric indications for surgery during pregnancy. Prompt surgical intervention for appendicitis is considered the standard of care. However, data on the utility of surgical management of uncomplicated cases of appendicitis is inconclusive and effectiveness of non-surgical management is currently understudied. We present a case that provides evidence for successful, antibiotic management of uncomplicated appendicitis as a means to reduce the burden of surgical complications on the pregnant population. This article also offers a critical analysis of current standard of care and assesses feasibility of nonsurgical management of acute, uncomplicated appendicitis in pregnancy for well-selected patients
Ultrasonographic evaluation of fetal lung histogram versus lamellar body count in the prediction of fetal lung maturity
Full text linkObjective: The current study aims to compare the ultrasonographic evaluation of fetal lung Gray-level histogram width (GLHW) ratio with an amniotic fluid lamellar body count (LBC) in the prediction of fetal lung maturity.Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between May 1, 2017 and March 31, 2018. The study included pregnant women with a single fetus at ≥37 weeks of gestation scheduled for delivery by elective cesarean section (CS). Ultrasound evaluation was performed for assessment of the fetal lung to liver GLHW ratio to predict lung maturity. Lamellar body count was determined from an amniotic fluid sample obtained via amniotomy during CS. The lamellar body count for this sample was measured using a hematology analyzer. These data were further compared to Apgar scores at 1 and 5 minutes after delivery to assess the condition of the newborn immediately after birth, the degree of respiratory distress syndrome (RDS) and the need for resuscitation.Results: One hundred twenty women and their neonates were included in the study. There was a statistically significant decrease in the levels of both GLHW and LBC among those neonates that showed distressed respiration after Apgar testing as compared with those who did not show similar distress, with p-value <0.001. The Receiver Operating Characteristic Curve (ROC) for LBC levels in the prediction of respiratory distress shows the best cutoff point for LBC was found at ≤20214/μL with a sensitivity of 100.0%, specificity of 75.47% and area under the curve (AUC) of 88.4%. The ROC curve for GLWH levels in the prediction of respiratory distress shows the best cutoff point for GLWH was found at ≤0.93 with sensitivity of 100.0%, specificity of 84.91% and AUC of 97.1%.Conclusions: Ultrasonographic evaluation of GLHW of the fetal lung and liver is a non-invasive, inexpensive and time-efficient test for prediction of fetal lung maturity that has higher sensitivity and specificity
A case of rheumatic heart disease diagnosed in the third trimester
Full text linkMigration from areas with a high incidence of rheumatic heart disease has led to an increase in pregnancy complicated by rheumatic heart disease in high-income countries. We present a case of rheumatic heart disease diagnosed in a 33-year-old G2P0010 French-speaking Congolese woman at 32 weeks gestation. She was initially hospitalized with respiratory syncytial virus (RSV) bronchiolitis at 24 weeks gestation and established care in our clinic. Mitral valve stenosis was identified at 32 weeks gestation after she presented with severe edema and was hospitalized for acute on chronic heart failure complicated by urosepsis and cellulitis. She was managed in the cardiovascular intensive care unit with a subsequent emergent cesarean delivery at 33 weeks gestation for nonreassuring fetal status. Postoperatively, pulmonary artery pressures were 40 mm Hg and left ventricular ejection fraction was 35%. Her condition stabilized and she was discharged home with outpatient cardiology management on postoperative day 10 with baby in the NICU. This case illustrates the importance of a high threshold of suspicion for women at risk for complications of heart disease in pregnancy. A triad of cardiovascular risk screening, patient education and multidisciplinary team planning with maternal-fetal medicine, cardiology, and anesthesiology has been shown to optimize outcomes in women with known cardiovascular disease
Health care disparities: moving the needle
Full text linkAs an obstetrician, I am acutely aware of the United States maternal mortality rate, which is frighteningly worse than any other developed country. Even more alarming is the fact that the rate for black and native women in the USA is 3-4 times higher, regardless of socioeconomic status and education level. In Iowa, our maternal mortality figures are no better than the rest of the nation overall and may be slightly worse for black and native women. How can this be, when Iowa enjoys a reputation for quality health care
Investigation of the relationship between gestational week and sexuality
Full text linkBackground: The aim of the study was to twofold: to provide sociological data comparing sexuality both before and during pregnancy for women in developing countries as well as to look for differences in correlation between elements of sexuality and gestational age. Its intention is to help improve communication between physicians and patients in and from countries where social mores and traditions make such conversations difficult and uncommon.Methods: Participants in the study included 1026 pregnant women at different gestational ages that presented to an Antenatal Outpatient Clinic in Istanbul, Turkey between April 2017 and November 2017. The participants were given a questionnaire composed of 20 questions, 17 of which were multiple-choice. The pregnant women were asked to mark the most appropriate option for them. The questionnaire began by collecting demographic information. Participants were asked to provide their current gestational week, age, weight and height. In another question, they were asked about their gravidity, parity, abortions, cesarean sections and curettage as well as about the presence of any dyspareunia. Questions about libido were evaluated on a 12-point scale based on the Turkish Libido Scoring System.Results: The frequency of sexual intercourse, orgasm and masturbation as well as the gender of the partner initiating sexual intercourse were compared before and during pregnancy. Differences across gestational age (first, second and third trimester) were also considered where relevant. Notably, the frequency of sexual intercourse and orgasm decrease significantly during pregnancy; however, trends related to masturbation and gender of the partner did not change in any meaningful way.Conclusion: The frequency of sexual intercourse and related activities were determined to decrease significantly as gestational age increased. Sexual intercourse was determined to be mostly initiated by the male partner before and during pregnancy and this rate was found to mildly increase during pregnancy and the difference was determined to be statistically significant
Programmed Death Ligand-1 (PD-L1) expression is up-regulated and related to the pattern of invasion in FIGO Stage I vulvar squamous cell carcinomas
Full text linkThe immune checkpoint protein programmed death ligand-1 (PD-L1) is expressed in different types of cancer and is a potential prognostic factor as well as therapeutic target.This study evaluated PD-L1 expression in the neoplastic progression of vulvar epithelia with respect to the pattern of infiltration in FIGO stages I keratinizing squamous cell carcinomas (SCC). Normal squamous vulvar epithelia (n=20), usual type vulvar intraepithelial neoplasia (uVIN, n=23), differentiated VIN (dVIN, n=21) and FIGO stage I SCC (n=35) were immunostained for PD-L1. In SCC a cohesive growth with well-delineated borders was considered as pushing, dissociative growth in small groups or single cells was defined as diffuse pattern of infiltration. Immunostaining was done with a monoclonal anti PD-L1 antibody (clone SP263, Ventana) and scored to determine up-regulation and overexpression (score 0/1+, 0-5% immunoreactive cells; score 2+, >5 to 50% immunoreactive cells; score 3+, >50% immunoreactive cells). PD-L1 immunoexpression was comparable in normal epithelia and VINs (score 0/1+, n=59; score 2+, n=5, in VINs only; score 3+, n=0), was significantly increased (P<0.0001) in SCC (score 0/1+, n=13; score 2+, n=16; score 3+, n=6), and was related to a diffuse pattern of infiltration (P<0.0001). Staining was accentuated at the invasive margins of SCC frequently. PD-L1 expression is up-regulated in the neoplastic cells of vulvar low stage SCC, related to the development of an invasive phenotype reflecting the initiation of cancer immunoediting, and to an aggressive diffuse type of stromal invasion
Rachel A. Maassen, MD, MBA
Full text linkRachel A. Maassen, MD, MBAClinical Associate Professor of Obstetrics and Gynecology - General Obstetrics and Gynecology.Medical Director for Clinical Risk Management for Carver College of Medicine, the University of Iowa Physicians Group, and University of Iowa Hospitals and Clinics Director, Division of General Obstetrics and Gynecology
Efficacy of oral celecoxib and hyoscine butyl-bromide versus placebo during copper intrauterine device placement in women delivered only by elective cesarean section: a randomized controlled study
Full text linkObjective: To compare the efficacy and tolerability of celecoxib to hyoscine butyl bromide (HBB) and placebo in reducing pain scores during placement of copper intrauterine devices (IUD) in parous women who have undergone elective cesarean section and who have had no previous vaginal deliveries. Methods: We conducted a randomized, double-blind, placebo-controlled trial at a tertiary University hospital from April 2018 to September 2018. The study included women who had never delivered vaginally and who desired copper IUD insertion. We randomized the study participants in a 1:1:1 ratio to celecoxib, HBB or placebo groups. They took the tablets orally two hours before IUD insertion. The study outcomes were the self-reported pain measurements, using a 10-cm Visual Analogue Scale (VAS), taken during tenaculum placement, sound insertion, IUD insertion and five minutes post-insertion, as well as an ease of insertion score. Results: The study included 105 women (n=35 in each group). The baseline characteristics were similar among all groups. The mean pain score in the celecoxib group was lower during IUD insertion than placebo (1.97 vs 4.34, p<0.001). Moreover, the ease of insertion score was significantly better with celecoxib [1.56 vs. 3.03, p< 0.001] than with placebo. Similarly, Women in the HBB group were more likely to report lower pain scores during IUD insertion (2.91 vs 4.34, p<0.001) and lower ease of insertion score [1.43 vs. 3.03, p< 0.001].Conclusions: The use of celecoxib and HBB may both reduce the pain associated with copper IUD insertion among women with no previous vaginal delivery. However, celecoxib is better tolerated with fewer side effect
Obstetric care among refugee populations: reinforcing cultural humility in residency training—preliminary report
Full text linkThe burden of increasing obstetric morbidity and mortality in the United States disproportionately impacts certain populations more than others, one such group being refugees. Poor obstetric outcomes among refugee communities historically have been attributed to delayed initiation of prenatal care, failure to detect co-morbidities, as well as higher rates of Cesarean sections (C-sections), stillbirths, pre-term births, and low birth weight infants in comparison to host-country mothers. Therefore, understanding the contextual nuances that play a role in these poor outcomes among refugee populations is very important
Placental pouch closure: a novel, safe and effective surgical procedure for conservative management of placenta accreta
Full text linkBackground: Placenta accreta spectrum (PAS) has become a global problem secondary to the high rate of cesarean delivery (CD). The current study presents an effective surgical procedure (placental pouch closure) for uterine preservation in patients with PAS.Methods: We applied this procedure in sixty cases at a tertiary university hospital between September 2017 and January 2019. We included women who were diagnosed as PAS based on preoperative ultrasound and Doppler evaluation, and who had the desire for uterine preservation.Results: The procedure was successful in almost all cases; the uterus was conserved 98.33 % of participants, with no associated severe maternal morbidities or mortality. In all cases, no additional surgical procedures were needed. The mean blood loss was 1263 ml, and the mean number of units of blood required for transfusion was 2.31 units.Conclusion: Identifying and meticulously closing the placental pouch is a novel surgical procedure for conservative management of PAS. In well-selected cases with the availability of facilities and expertise, the technique could have a place as a safe and effective surgical technique in women presenting with placenta accreta who desire uterine preservation.Trial registration number: NCT03241849. Registered on August 8, 201