Proceedings in Obstetrics and Gynecology
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New directions in medical student clerkship evaluations
Full text linkPurpose: To compare the number of requested medical student evaluations with mean evaluation scores and final clerkship grades.Background: The University of Iowa Obstetrics & Gynecology (OBGYN) clerkship requires six evaluations for each student: two assigned and four requested by the student. Many students request more evaluations than required, contributing to a backlog that slows the grading process.Methods: Medical student evaluations from 2014 to 2016 were analyzed. Three groups were created based on the number of evaluations an individual student received. Group 1 received 3-4 evaluations (73), Group 2 received 5-6 evaluations (240) and Group 3 received 7-16 evaluations (222). A paired T-test compared mean evaluation scores and a chi-square test was used to compare mean shelf exam scores and percentages of pass, near honors, and honors grades.Results: A total of 535 independent students and their evaluations were reviewed for the study. The difference in mean evaluation scores for groups 1 and 2 and groups 2 and 3 were statistically significant (p 0.05). Similarly, the differences in rates of pass, near honors, and honors grades between groups were not statistically significant (p > 0.05).Discussion: Increased number of requested evaluations did not translate to differences in rates of pass, near honors, and honors grades for medical students on their OBGYN clerkship, indicating that decreasing the mandatory evaluations per student would not be detrimental to student outcomes and would potentially expedite the grading process
Noelle C. Bowdler, MD
Full text linkDr. Noelle C. Bowdler is a Clinical Professor in the Generalist Division of Obstetrics and Gynecology at the University of Iowa Hospitals and Clinics. She received a BA from Michigan State University, East Lansing, Michigan. She completed her MD at the University of Michigan, Ann Arbor, Michigan. She completed an Obstetrics and Gynecology Residency at the University of Michigan Affiliated Hospitals. Dr. Bowdler sees patients in the Gynecology Clinic. She received the 2019 Excellence in Quality Award from the University of Iowa Physicians. This award is given to in recognition of outstanding quality of care provided to patients. Recipients will have demonstrated excellence in reportable measures of quality, benchmarked patient outcomes, or improvements in internally measured outcome
Clinical usefulness of the IUD post insertion ultrasound in symptomatic and asymptomatic patients
Full text linkThe aim of this retrospective chart review study was to evaluate the clinical usefulness of an ultrasound performed at the intrauterine device (IUD) post insertion visit in an otherwise asymptomatic patient. The data demonstrated that 18% of asymptomatic patients required an IUD removal based on an IUD post insertion ultrasound 4-8 weeks after insertion. This study does support the routine use of performing an ultrasound at the IUD post insertion visit in an otherwise asymptomatic patient
Quantitative Blood Loss (QBL) at every delivery: a quality improvement initiative utilizing Electronic Medical Record tools
Full text linkMaternal hemorrhage is a major cause of maternal morbidity and mortality in the United States and efforts are in place to eliminate preventable harm. Accurate assessment of blood lost around the time of birth is essential for timely recognition and intervention. As part of the Alliance for Innovation on Maternal Health (AIM) Obstetrical Hemorrhage Patient Safety Bundle at our institution a quantitative blood loss (QBL) calculator was created within the electronic medical record. This process allows for real-time tracking of cumulative blood loss measurements and is built with triggers to alert the care team when criteria for various hemorrhage stages are achieved along with suggested interventions and assessments. The consistency of implementation and efficacy of the QBL calculator was evaluated by following both utilization of the calculator flowsheet as well as tracking of rates of erroneous QBL values, defined by negative values and cesarean deliveries with QBL2019, 14 months after implementation and post three system-based improvements. By the end of this implementation review the calculator was in use consistently at all cesarean deliveries with improved confidence in the process by providers
Atypical hemolytic uremic syndrome in the postpartum period: a case series
Full text linkBackground: Atypical hemolytic uremic syndrome (aHUS) may present in either the antepartum or postpartum period and is often indistinguishable from other pregnancy-associated diseases. Timely recognition and appropriate treatment can greatly reduce maternal morbidity and mortality.Cases: This case series describes two cases of aHUS in the post-partum period, the difficulty in distinguishing the diagnosis, and the implementation of appropriate treatment with eculizumab, a terminal complement inhibitor.Conclusion: As a terminal complement inhibitor, eculizumab, has been shown to significantly improve clinical and long term renal outcomes, early diagnosis of aHUS is increasingly important. These two cases of aHUS demonstrate the path of accurate diagnosis and timely initiation of therapy to maximize the possibility of patient recovery
Vestibular Schwannoma growth during pregnancy: case report of neurofibromatosis type 2 in pregnancy
Full text linkBackground: Acoustic neuromas are a common sequela of neurofibromatosis type 2 and have been shown to grow at an increased rate during pregnancy.Case: 21-year-old female, gravida 1 para 0, with history of neurofibromatosis type 2 presented for prenatal care following new onset seizures and progressive deafness. She was found to have bilateral slow-growing acoustic neuromas. Over the course of her pregnancy, her acoustic neuroma began growing and she became completely deaf. She underwent surgical decompression during her pregnancy and had a late preterm vaginal delivery due to preeclampsia with severe features. She subsequently had further operative and medical treatment of her neuromas.Conclusion: Acoustic neuromas during pregnancy are exceedingly rare, but can be managed successfully with an interdisciplinary team approach tailored to the patients’ specific clinical presentation
Bilateral serous tubal intraepithelial carcinoma associated with high-grade serous carcinoma of the peritoneum: evidence for transcoelomic tumor spread by extended lymph node evaluation
Full text linkSerous tubal intraepithelial carcinoma (STIC) is now considered a putative precursor lesion of most extrauterine high-grade serous carcinomas (HGSC). It is frequently reported in high-risk women and women with advanced-stage serous carcinoma. This case study reports a serous high-grade carcinoma (HGSC) consisting of a bilateral STIC with a focus of stromal invasion in the left tube, and a peritoneal HGSC. The grossly normal-appearing tubes including the fimbriated ends were sectioned following the SEE-FIM protocol. In both tubes, tumor aggregates were exfoliated extensively to the tubal lumens. The neoplastic epithelia in any location were diffusely positive for p53 in strong nuclear patterns. Pelvic lymph nodes were negative for tumor on serial sections and keratin 7 immunohistochemistry, and there was no evidence of lymphatic vessel involvement. The lack of any evidence of lymphovascular invasion and regional lymph node metastases supports the interpretation of intraluminal and transcoelomic spread, and may be taken as evidence of dissemination of tubal neoplastic cells by exfoliation in this case. The biology of transcoelomic spread is reviewed in this manuscript
Successful management of a supralevator intraperitoneal puerperal hematoma with angiographic embolization
Full text linkPuerperal hematomas are rare, yet often life threatening, complications following vaginal deliveries. The etiology remains broad; however, early recognition is vital in preventing postpartum hemorrhage and maternal death. Our case illustrates treatment of a supralevator hematoma with angiographic embolization following a spontaneous vaginal delivery in a young woman. Her labor course was complicated by persistent occiput posterior presentation that failed spontaneous and manual rotation
Frequency of preconception education for teenage patients with diabetes attending an academic Pediatric Endocrinology Clinic
Full text linkPurpose: Diabetes mellitus (DM) in pregnancy produces adverse outcomes with significant human and economic costs. Potential lifetime cost savings of preventative preconception counseling for women with diabetes may reach $4.3 billion (U.S.). Preconception education has been shown in prior research to improve knowledge of reproductive risks in an adolescent diabetic population and to improve future health outcomes. This study assessed the current extent of preconception DM-related reproductive risk education at a tertiary academic medical center to better inform the opportunity for a systematic quality improvement intervention.Methods: We reviewed the electronic medical records (EMR) of females (N=70), ages 16-19, seen in the Pediatric Endocrinology clinic (2013-2016) and diagnosed with type 1 DM, type 2 DM, or insulin resistance. Any reproductive risks education documentation by providers, nursing or educators within Pediatric Endocrinology, or within consults to Nutrition or Obstetrics and Gynecology was reviewed and characterized.Results: According to EMR documentation, patient education for nonreproductive medical needs and complications of DM were consistently present in this population: 96% of patients received general diabetes education with at least 4/8 components. However, documented education regarding DM reproductive risks occurred for only 18% of the same patients while contraceptive use discussion occurred for 20%.Conclusion: The potential benefits of preconception education may include achieving recommended glucose control preceding and during pregnancy with fewer downstream maternal and fetal adverse outcomes. Although limited by the single site, retrospective design and the unknown rate of reproductive education documentation failure, our findings reveal a performance gap of potential downstream medical significance. Recognizing this deficiency provides an opportunity for a population-based intervention to create improved health outcomes
Quality and safety considerations in breast cancer screening
Full text linkBreast cancer is a leading cause of premature mortality among United States women. Early detection has been shown to reduce breast cancer morbidity, mortality and cost of treatment. The relative safety of breast cancer screening has been viewed in terms of benefits and harms. The quality and safety of breast cancer screening depends on both technical and human factors. Focusing on quality and safety considerations, we review two imaging modalities recommended for primary breast cancer screening: mammography and magnetic resonance imaging, and the use of ultrasound (US) for supplemental breast cancer screening