Current Opinion in Obstetrics & Gynecology, Dec 1, 2015
This article reviews the incidence, pathophysiology, risk factors, diagnosis, and management of a... more This article reviews the incidence, pathophysiology, risk factors, diagnosis, and management of amniotic fluid embolism (AFE). AFE is a leading cause of maternal morbidity and mortality despite an incidence of approximately 7 to 8 per 100 000 births. Recent reevaluation of AFE suggests that the presence of fetal tissue in maternal circulation alone is not sufficient to cause the clinical syndrome, but rather an individual's response to this fetal tissue. The 'anaphylactoid reaction' associated with AFE shares many clinical and metabolic aspects of septic shock. Acute dyspnea followed by cardiovascular collapse, coagulopathy, and neurological symptoms, such as coma and seizures may all be associated with the clinical AFE syndrome. Specific biochemical markers have been described, but are of limited clinical value because of the rapid progression of the disease process. Treatment is based on an interdisciplinary approach that consists of a combination of prompt, aggressive hemodynamic resuscitation, provision of end-organ support, correction of hemostatic disorders, and delivery. Although AFE cannot be prevented, early diagnosis and intervention may lead to better outcomes for both the mother and the fetus. Clinical suspicion, traditional laboratory data, or intravascular cellular debris (demonstrated only in 50% of patients) are insufficient to make a definitive diagnosis of AFE. An evolving array of novel biomarkers may help differentiate AFE from other conditions, but none of them currently provide sufficient 'early warning' ability to make real-time impact on diagnosis and/or treatment of AFE.
Journal of Minimally Invasive Gynecology, Nov 1, 2017
(FRED), warm saline (WS), chlorhexidine gluconate (CHG) solution, and manual glove warming (GLOV)... more (FRED), warm saline (WS), chlorhexidine gluconate (CHG) solution, and manual glove warming (GLOV). Measurements and Main Results: Three observers rated the visual clarity with each LDT using a visual analog scale (0 = no clarity, 100 = perfect clarity). Each LDT was repeated four times in a blinded randomized fashion. This provided 12 observations per LDT for each laparoscope (5 mm and 10 mm). All values reported as mean ± standard deviation: Control (26 ± 10), GLOV (32 ± 21), FRED (49 ± 24), WS (79 ± 8) and CHG (78 ± 7). LDTs were significantly different (ANOVA, p < .001). Post hoc pairwise comparisons revealed that all LDTs except for GLOV were better than controls. WS and CHG clarity were the highest, but similar. WS and CHG clarity were better than FRED. The results were similar for the 5 and 10 mm laparoscopes. Conclusion: Our study is the first randomized controlled trial that compares efficacy of different laparoscopic lens defogging techniques. Warm
Journal of Minimally Invasive Gynecology, Nov 1, 2016
All results reported as p-values; Group 3 had significantly higher abnormal chromosomes detected,... more All results reported as p-values; Group 3 had significantly higher abnormal chromosomes detected, lower maternal contamination and higher overall fetal chromosome detection rates. Conclusion: Obtaining fetal genetics can be useful when planning for a future successful pregnancy. Maternal contamination occurred at a higher rate when all products of conception were evacuated with curettage despite use of diagnostic hysteroscopy to identify intracavitary products of conception. The addition of operative hysteroscopy to biopsy the gestational sac, chorionic villi and/or fetus significantly decreased the risk of maternal contamination and increased the detection of fetal chromosomes for genetic analysis without increasing the risk of surgical complications.
Instrumented placental removal is reported in 15% or more of women having second-trimester termin... more Instrumented placental removal is reported in 15% or more of women having second-trimester termination of pregnancy by induction. Decreasing interventions for placental removal simplifies the termination process. METHODS: This is a retrospective cohort study to evaluate the outcome of two simultaneous cohorts undergoing induction abortion; one cohort was enrolled in another study, and the other received routine care. Both groups received feticidal intraamniotic digoxin 1.5 g the day before induction. On admission, all women received misoprostol 400 g vaginally. Subsequent doses of 200 g every 6 hours were given buccally or vaginally. Spontaneous placental expulsion was allowed. Instrumented placental removal was defined as treatment that required speculum placement. RESULTS: From November 2003 to August 2005, 150 women had induction abortions. Buccal misoprostol was used by 32 of 64 women in the study group; vaginal misoprostol was used for all other women. The mean gestational age was 19.9 weeks. The median abortion time for both groups was 13.5 hours. Eleven women (7.33%, 95% confidence interval 3.12-11.47) had instrumental removal in a treatment room. The most common reason for removal was that the woman was otherwise awaiting discharge. None were removed for bleeding. Fetal extractions were performed on 3 women for bleeding before delivery. If included in analysis, the instrumented removal rate is 9.33% (95% confidence interval 4.68-13.99). CONCLUSION: The combination of digoxin 24 hours before induction, misoprostol, and expectant management of placental delivery results in a low rate of instrumentation in second-trimester induction termination.
Objective: To assess the effect of using abdominal binders on pain, distress, and postpartum hemo... more Objective: To assess the effect of using abdominal binders on pain, distress, and postpartum hemorrhage after cesarean delivery. Methods: The present prospective randomized controlled trial enrolled patients undergoing non-emergency cesarean deliveries in Gonbad-e Kavus, Golestan Province, Iran, between January 22 and October 23, 2015. Patients were randomized in a 1:1 ratio by blocks of four or six to a control group or to use an abdominal binder after delivery; all patients received routine care. The primary outcomes were visual analog scale-assessed pain, symptom distress scale (SDS)-assessed distress, and hemoglobin and hematocrit levels. Participants and researchers were masked to treatment This article is protected by copyright. All rights reserved. assignments until after cesarean delivery, and data analysis was unmasked; intentionto-treat analyses were performed. Results: There were 89 patients enrolled in each group, with no differences in baseline pain scores, SDS scores, and hemoglobin and hematocrit levels between the groups (all P>0.05). Pain and SDS scores were lower in the binder group at all post-baseline time points compared with the control group (all P<0.001). Hemoglobin and hematocrit levels were higher among patients who received binders 36 hours after baseline (both P<0.001). There was one patient who experienced hemorrhage in the binders group and one patient requested removal of their binder. Conclusions: Patients who received abdominal binders reported less pain, lower SDS scores, and higher hemoglobin and hematocrit levels following cesarean delivery.
INTRODUCTION: Medroxyprogesterone acetate is a safe and effective immediate postpartum contracept... more INTRODUCTION: Medroxyprogesterone acetate is a safe and effective immediate postpartum contraceptive (MPA-PP). However, the resultant irregular bleeding attributed to MPA-PP is problematic. Little is known as to the contributing factors that increase risk of MPA-PP bleeding. Thus we compared patients that complained of MPA-PP bleeding to those who did not. METHODS: We reviewed the charts of all women receiving MPA-PP and had at least 3 months follow-up during 16 month period at a suburban health network. Age, ethnicity, BMI, Breast feeding status, parity, pregnancy complications and delivery type were collected. All visit between 3 months and 12 months were reviewed for persistent bleeding complaints and continuation rates of MPA. This study was approved by IRB. Those with and without bleeding complaints were compared using chi squared or t-test as appropriate. RESULTS: Of the 204 MPA-PP patients studied during the first PP year, 99 switched to alternative contraception or discontin...
INTRODUCTION: Wound complications in obese patients can use considerable resources in their care.... more INTRODUCTION: Wound complications in obese patients can use considerable resources in their care. Although closure of the subcutaneous layers has shown to help, these problems still occur. We hypothesized that the addition of subdermal closure using a delayed-absorbable suture to standard wound-closure techniques in obese patients might further reduce wound problems. METHODS: A chart review of laparotomies with midline vertical skin incision performed for gynecologic disorders during the previous 3 years was conducted. In addition to demographic data, data on wound separation, use of antibiotics, readmission for wound care, referral to the wound care center, and use of wound vacuum dressings were abstracted. Separate &khgr;2 or Fisher exact tests were used as appropriate. RESULTS: We identified 106 patients; 36 received standard closure plus subdermal closure using a delayed-absorbable suture (case group) and 70 received standard closure (control group). Body mass index (calculated as weight (kg)/[height (m)]2), age, and comorbidities were similar among the groups. Wound separation was noted in 10 patients (four in the case group, six in the control group). Antibiotics were used in one patient (in the control group). Three patients were referred to the wound care center (one in the case group, two in the control group) and three patients were readmitted to the hospital for wound care (all from the control group). Wound vacuum dressings were used in two patients (both in the control group). No difference in postoperative visits was noted between groups. CONCLUSION: A tendency toward fewer wound complications was seen in the group receiving subdermal closure using a delayed-absorbable suture. Owing to the rarity of these complications and the exploratory nature of our study, no statistical significance was noted for the variables studied between groups. A larger prospective clinical trial is needed.
INTRODUCTION: About 20% of women who undergo endometrial ablation subsequently undergo hysterecto... more INTRODUCTION: About 20% of women who undergo endometrial ablation subsequently undergo hysterectomy. Thus, the identification of factors that increase the risk of endometrial ablation failures would be valuable in counseling patients. Through limited chart reviews, a few factors have been identified. We searched for additional risk factors by an intense abstraction of the medical record. METHODS: A review was conducted on patients who underwent hysterectomy for failed endometrial ablation. In addition, a review of randomly selected cases of successful endometrial ablation for the same period was performed. Body mass index (BMI, calculated as weight (kg)/[height (m)]2), post–endometrial ablation weight gain, gravity, parity, cesarean delivery, comorbidities, smoking, gynecologic surgery, hysteroscopy or dilation and curettage (D&C) at the time of endometrial ablation, uterine sound length, and preoperative endometrial biopsy result were compared in separate univariate analyses. To correct for multiple measurements, all comparisons were considered significantly different if P<.002. RESULTS: During a 10-year period, endometrial ablation was performed in 785 patients, with 202 undergoing subsequent hysterectomy; 271 patients of the remaining 583 were used as a control group. All of the following were significant risk factors: smoking, multiparty, history of cesarean delivery, previous gynecologic surgery, larger uterine sound length, and lack of hysteroscopy or D&C at the time of endometrial ablation. The following factors did not appear significant: BMI, post–endometrial ablation weight gain, and preoperative endometrial biopsy pathology. Of note, 62% of patients had adenomyosis on uterine pathology. CONCLUSION: From our detailed chart review, we have identified several previously unrecognized factors that increase the risk of endometrial ablation failure. Further study of these factors may help in the counseling of patients regarding treatment options for their abnormal uterine bleeding.
Tweets most frequently focused on news (27.3%), EC access (27.3%) and humor (25.6%). Compared to ... more Tweets most frequently focused on news (27.3%), EC access (27.3%) and humor (25.6%). Compared to males, females mentioned birth control (OR=9.18; p=.002) and EC side effects (OR=2; 5.10; p=0.024) more often than expected. Tweets with a humorous tone (31%) were shared most often, followed by those disclosing personal or vicarious experience (29%). Newsrelated EC tweets had 2.27 times lower odds of being shared compared with other tweets (pb.001). Tweets had greater odds of being sent on the weekend if they mentioned a personal or vicarious experience (OR=1.91, pb.001), sought advice (OR=1.94, p =.01) or expressed humor (OR=1.56; pb.001). Similar patterns were identified for tweets sent around St. Patrick's Day discussing a personal or vicarious experience (OR= 1.59, p =.001), seeking advice (OR= 2.45, p=.001) and expressing humor (OR=1.47; p=.005). Conclusions: Study findings offer timely and practical suggestions for reproductive health professionals wanting to communicate about EC via Twitter.
INTRODUCTION: The red blood cell distribution width is a measure of the variation of red blood ce... more INTRODUCTION: The red blood cell distribution width is a measure of the variation of red blood cell volume. Recently, elevated levels have been associated with several disease processes such as heart disease and septic shock outcomes. Some have attributed this increase in red blood cell distribution width as a result of occult inflammation. In normal pregnancies red blood cell distribution width increases during the last 4 weeks before delivery. We therefore hypothesized that as a result of inflammation, preterm patients would have higher red blood cell distribution width compared with term women in a control group. MATERIAL AND METHODS: In a retrospective case–control study, we compared 150 randomly selected patients who spontaneously delivered before 37 weeks of gestation with 150 patients who delivered at term during the last 10 years at our hospital. Red blood cell distribution width, hemoglobin, hematocrit, and white blood cell count were compared at the day of admission and day of delivery. We excluded individuals with known infection, inflammatory diseases, and hematologic disorders. RESULTS: Ages were similar in each of the groups (preterm 25±4.9 years, term 26.1±6.1 years). The average gestational was 33.1±4.6 weeks in the preterm group and 39.1±1.9 weeks in term. Red blood cell distribution width did not differ between the groups (preterm 13.7±0.98, term 14.2±1.9). Subanalysis of preterm patients with premature preterm rupture of membranes (n=52) or gestational age less than 35 weeks (n=72) did not result in a significant difference when compared with women in a control group. CONCLUSION: To our knowledge, this is the first study to look at red blood cell distribution width in preterm patients. Red blood cell distribution width does not appear to be a significant marker for preterm delivery at this time.
Female Pelvic Medicine & Reconstructive Surgery, 2022
Objective The objective of this study is to evaluate factors associated with obstetric anal sphin... more Objective The objective of this study is to evaluate factors associated with obstetric anal sphincter injury and identify modifiable risks. Methods A retrospective case-control study was performed in women who gave birth at our institution between May 2008 and December 2012. Patients who had a third- or fourth-degree lacerations were compared with those who did not. Parity, stretch marks, age, body mass index, tobacco use, fetal weight, operative delivery, labor, and second stage duration were compared between groups. Multivariate direct logistic regression was conducted on all patients who had complete data to calculate the adjusted odds ratio. Results We identified 299 patients with third- or fourth-degree lacerations and 8,459 patients without third- or fourth-degree lacerations during the time frame. Duration of second stage between 1 hour and 2 hours (P < 0.0001), duration of second stage greater than 2 hours (P < 0.0001), midline or unknown type episiotomy (P < 0.0001...
CONCLUSION: Our data show that a simulation training program including a targeted education sessi... more CONCLUSION: Our data show that a simulation training program including a targeted education session in vacuum assisted-deliveries improves obstetrician technical skills.
Current Opinion in Obstetrics & Gynecology, Dec 1, 2015
This article reviews the incidence, pathophysiology, risk factors, diagnosis, and management of a... more This article reviews the incidence, pathophysiology, risk factors, diagnosis, and management of amniotic fluid embolism (AFE). AFE is a leading cause of maternal morbidity and mortality despite an incidence of approximately 7 to 8 per 100 000 births. Recent reevaluation of AFE suggests that the presence of fetal tissue in maternal circulation alone is not sufficient to cause the clinical syndrome, but rather an individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s response to this fetal tissue. The &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;anaphylactoid reaction&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; associated with AFE shares many clinical and metabolic aspects of septic shock. Acute dyspnea followed by cardiovascular collapse, coagulopathy, and neurological symptoms, such as coma and seizures may all be associated with the clinical AFE syndrome. Specific biochemical markers have been described, but are of limited clinical value because of the rapid progression of the disease process. Treatment is based on an interdisciplinary approach that consists of a combination of prompt, aggressive hemodynamic resuscitation, provision of end-organ support, correction of hemostatic disorders, and delivery. Although AFE cannot be prevented, early diagnosis and intervention may lead to better outcomes for both the mother and the fetus. Clinical suspicion, traditional laboratory data, or intravascular cellular debris (demonstrated only in 50% of patients) are insufficient to make a definitive diagnosis of AFE. An evolving array of novel biomarkers may help differentiate AFE from other conditions, but none of them currently provide sufficient &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;early warning&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ability to make real-time impact on diagnosis and/or treatment of AFE.
Journal of Minimally Invasive Gynecology, Nov 1, 2017
(FRED), warm saline (WS), chlorhexidine gluconate (CHG) solution, and manual glove warming (GLOV)... more (FRED), warm saline (WS), chlorhexidine gluconate (CHG) solution, and manual glove warming (GLOV). Measurements and Main Results: Three observers rated the visual clarity with each LDT using a visual analog scale (0 = no clarity, 100 = perfect clarity). Each LDT was repeated four times in a blinded randomized fashion. This provided 12 observations per LDT for each laparoscope (5 mm and 10 mm). All values reported as mean ± standard deviation: Control (26 ± 10), GLOV (32 ± 21), FRED (49 ± 24), WS (79 ± 8) and CHG (78 ± 7). LDTs were significantly different (ANOVA, p < .001). Post hoc pairwise comparisons revealed that all LDTs except for GLOV were better than controls. WS and CHG clarity were the highest, but similar. WS and CHG clarity were better than FRED. The results were similar for the 5 and 10 mm laparoscopes. Conclusion: Our study is the first randomized controlled trial that compares efficacy of different laparoscopic lens defogging techniques. Warm
Journal of Minimally Invasive Gynecology, Nov 1, 2016
All results reported as p-values; Group 3 had significantly higher abnormal chromosomes detected,... more All results reported as p-values; Group 3 had significantly higher abnormal chromosomes detected, lower maternal contamination and higher overall fetal chromosome detection rates. Conclusion: Obtaining fetal genetics can be useful when planning for a future successful pregnancy. Maternal contamination occurred at a higher rate when all products of conception were evacuated with curettage despite use of diagnostic hysteroscopy to identify intracavitary products of conception. The addition of operative hysteroscopy to biopsy the gestational sac, chorionic villi and/or fetus significantly decreased the risk of maternal contamination and increased the detection of fetal chromosomes for genetic analysis without increasing the risk of surgical complications.
Instrumented placental removal is reported in 15% or more of women having second-trimester termin... more Instrumented placental removal is reported in 15% or more of women having second-trimester termination of pregnancy by induction. Decreasing interventions for placental removal simplifies the termination process. METHODS: This is a retrospective cohort study to evaluate the outcome of two simultaneous cohorts undergoing induction abortion; one cohort was enrolled in another study, and the other received routine care. Both groups received feticidal intraamniotic digoxin 1.5 g the day before induction. On admission, all women received misoprostol 400 g vaginally. Subsequent doses of 200 g every 6 hours were given buccally or vaginally. Spontaneous placental expulsion was allowed. Instrumented placental removal was defined as treatment that required speculum placement. RESULTS: From November 2003 to August 2005, 150 women had induction abortions. Buccal misoprostol was used by 32 of 64 women in the study group; vaginal misoprostol was used for all other women. The mean gestational age was 19.9 weeks. The median abortion time for both groups was 13.5 hours. Eleven women (7.33%, 95% confidence interval 3.12-11.47) had instrumental removal in a treatment room. The most common reason for removal was that the woman was otherwise awaiting discharge. None were removed for bleeding. Fetal extractions were performed on 3 women for bleeding before delivery. If included in analysis, the instrumented removal rate is 9.33% (95% confidence interval 4.68-13.99). CONCLUSION: The combination of digoxin 24 hours before induction, misoprostol, and expectant management of placental delivery results in a low rate of instrumentation in second-trimester induction termination.
Objective: To assess the effect of using abdominal binders on pain, distress, and postpartum hemo... more Objective: To assess the effect of using abdominal binders on pain, distress, and postpartum hemorrhage after cesarean delivery. Methods: The present prospective randomized controlled trial enrolled patients undergoing non-emergency cesarean deliveries in Gonbad-e Kavus, Golestan Province, Iran, between January 22 and October 23, 2015. Patients were randomized in a 1:1 ratio by blocks of four or six to a control group or to use an abdominal binder after delivery; all patients received routine care. The primary outcomes were visual analog scale-assessed pain, symptom distress scale (SDS)-assessed distress, and hemoglobin and hematocrit levels. Participants and researchers were masked to treatment This article is protected by copyright. All rights reserved. assignments until after cesarean delivery, and data analysis was unmasked; intentionto-treat analyses were performed. Results: There were 89 patients enrolled in each group, with no differences in baseline pain scores, SDS scores, and hemoglobin and hematocrit levels between the groups (all P>0.05). Pain and SDS scores were lower in the binder group at all post-baseline time points compared with the control group (all P<0.001). Hemoglobin and hematocrit levels were higher among patients who received binders 36 hours after baseline (both P<0.001). There was one patient who experienced hemorrhage in the binders group and one patient requested removal of their binder. Conclusions: Patients who received abdominal binders reported less pain, lower SDS scores, and higher hemoglobin and hematocrit levels following cesarean delivery.
INTRODUCTION: Medroxyprogesterone acetate is a safe and effective immediate postpartum contracept... more INTRODUCTION: Medroxyprogesterone acetate is a safe and effective immediate postpartum contraceptive (MPA-PP). However, the resultant irregular bleeding attributed to MPA-PP is problematic. Little is known as to the contributing factors that increase risk of MPA-PP bleeding. Thus we compared patients that complained of MPA-PP bleeding to those who did not. METHODS: We reviewed the charts of all women receiving MPA-PP and had at least 3 months follow-up during 16 month period at a suburban health network. Age, ethnicity, BMI, Breast feeding status, parity, pregnancy complications and delivery type were collected. All visit between 3 months and 12 months were reviewed for persistent bleeding complaints and continuation rates of MPA. This study was approved by IRB. Those with and without bleeding complaints were compared using chi squared or t-test as appropriate. RESULTS: Of the 204 MPA-PP patients studied during the first PP year, 99 switched to alternative contraception or discontin...
INTRODUCTION: Wound complications in obese patients can use considerable resources in their care.... more INTRODUCTION: Wound complications in obese patients can use considerable resources in their care. Although closure of the subcutaneous layers has shown to help, these problems still occur. We hypothesized that the addition of subdermal closure using a delayed-absorbable suture to standard wound-closure techniques in obese patients might further reduce wound problems. METHODS: A chart review of laparotomies with midline vertical skin incision performed for gynecologic disorders during the previous 3 years was conducted. In addition to demographic data, data on wound separation, use of antibiotics, readmission for wound care, referral to the wound care center, and use of wound vacuum dressings were abstracted. Separate &khgr;2 or Fisher exact tests were used as appropriate. RESULTS: We identified 106 patients; 36 received standard closure plus subdermal closure using a delayed-absorbable suture (case group) and 70 received standard closure (control group). Body mass index (calculated as weight (kg)/[height (m)]2), age, and comorbidities were similar among the groups. Wound separation was noted in 10 patients (four in the case group, six in the control group). Antibiotics were used in one patient (in the control group). Three patients were referred to the wound care center (one in the case group, two in the control group) and three patients were readmitted to the hospital for wound care (all from the control group). Wound vacuum dressings were used in two patients (both in the control group). No difference in postoperative visits was noted between groups. CONCLUSION: A tendency toward fewer wound complications was seen in the group receiving subdermal closure using a delayed-absorbable suture. Owing to the rarity of these complications and the exploratory nature of our study, no statistical significance was noted for the variables studied between groups. A larger prospective clinical trial is needed.
INTRODUCTION: About 20% of women who undergo endometrial ablation subsequently undergo hysterecto... more INTRODUCTION: About 20% of women who undergo endometrial ablation subsequently undergo hysterectomy. Thus, the identification of factors that increase the risk of endometrial ablation failures would be valuable in counseling patients. Through limited chart reviews, a few factors have been identified. We searched for additional risk factors by an intense abstraction of the medical record. METHODS: A review was conducted on patients who underwent hysterectomy for failed endometrial ablation. In addition, a review of randomly selected cases of successful endometrial ablation for the same period was performed. Body mass index (BMI, calculated as weight (kg)/[height (m)]2), post–endometrial ablation weight gain, gravity, parity, cesarean delivery, comorbidities, smoking, gynecologic surgery, hysteroscopy or dilation and curettage (D&C) at the time of endometrial ablation, uterine sound length, and preoperative endometrial biopsy result were compared in separate univariate analyses. To correct for multiple measurements, all comparisons were considered significantly different if P<.002. RESULTS: During a 10-year period, endometrial ablation was performed in 785 patients, with 202 undergoing subsequent hysterectomy; 271 patients of the remaining 583 were used as a control group. All of the following were significant risk factors: smoking, multiparty, history of cesarean delivery, previous gynecologic surgery, larger uterine sound length, and lack of hysteroscopy or D&C at the time of endometrial ablation. The following factors did not appear significant: BMI, post–endometrial ablation weight gain, and preoperative endometrial biopsy pathology. Of note, 62% of patients had adenomyosis on uterine pathology. CONCLUSION: From our detailed chart review, we have identified several previously unrecognized factors that increase the risk of endometrial ablation failure. Further study of these factors may help in the counseling of patients regarding treatment options for their abnormal uterine bleeding.
Tweets most frequently focused on news (27.3%), EC access (27.3%) and humor (25.6%). Compared to ... more Tweets most frequently focused on news (27.3%), EC access (27.3%) and humor (25.6%). Compared to males, females mentioned birth control (OR=9.18; p=.002) and EC side effects (OR=2; 5.10; p=0.024) more often than expected. Tweets with a humorous tone (31%) were shared most often, followed by those disclosing personal or vicarious experience (29%). Newsrelated EC tweets had 2.27 times lower odds of being shared compared with other tweets (pb.001). Tweets had greater odds of being sent on the weekend if they mentioned a personal or vicarious experience (OR=1.91, pb.001), sought advice (OR=1.94, p =.01) or expressed humor (OR=1.56; pb.001). Similar patterns were identified for tweets sent around St. Patrick's Day discussing a personal or vicarious experience (OR= 1.59, p =.001), seeking advice (OR= 2.45, p=.001) and expressing humor (OR=1.47; p=.005). Conclusions: Study findings offer timely and practical suggestions for reproductive health professionals wanting to communicate about EC via Twitter.
INTRODUCTION: The red blood cell distribution width is a measure of the variation of red blood ce... more INTRODUCTION: The red blood cell distribution width is a measure of the variation of red blood cell volume. Recently, elevated levels have been associated with several disease processes such as heart disease and septic shock outcomes. Some have attributed this increase in red blood cell distribution width as a result of occult inflammation. In normal pregnancies red blood cell distribution width increases during the last 4 weeks before delivery. We therefore hypothesized that as a result of inflammation, preterm patients would have higher red blood cell distribution width compared with term women in a control group. MATERIAL AND METHODS: In a retrospective case–control study, we compared 150 randomly selected patients who spontaneously delivered before 37 weeks of gestation with 150 patients who delivered at term during the last 10 years at our hospital. Red blood cell distribution width, hemoglobin, hematocrit, and white blood cell count were compared at the day of admission and day of delivery. We excluded individuals with known infection, inflammatory diseases, and hematologic disorders. RESULTS: Ages were similar in each of the groups (preterm 25±4.9 years, term 26.1±6.1 years). The average gestational was 33.1±4.6 weeks in the preterm group and 39.1±1.9 weeks in term. Red blood cell distribution width did not differ between the groups (preterm 13.7±0.98, term 14.2±1.9). Subanalysis of preterm patients with premature preterm rupture of membranes (n=52) or gestational age less than 35 weeks (n=72) did not result in a significant difference when compared with women in a control group. CONCLUSION: To our knowledge, this is the first study to look at red blood cell distribution width in preterm patients. Red blood cell distribution width does not appear to be a significant marker for preterm delivery at this time.
Female Pelvic Medicine & Reconstructive Surgery, 2022
Objective The objective of this study is to evaluate factors associated with obstetric anal sphin... more Objective The objective of this study is to evaluate factors associated with obstetric anal sphincter injury and identify modifiable risks. Methods A retrospective case-control study was performed in women who gave birth at our institution between May 2008 and December 2012. Patients who had a third- or fourth-degree lacerations were compared with those who did not. Parity, stretch marks, age, body mass index, tobacco use, fetal weight, operative delivery, labor, and second stage duration were compared between groups. Multivariate direct logistic regression was conducted on all patients who had complete data to calculate the adjusted odds ratio. Results We identified 299 patients with third- or fourth-degree lacerations and 8,459 patients without third- or fourth-degree lacerations during the time frame. Duration of second stage between 1 hour and 2 hours (P < 0.0001), duration of second stage greater than 2 hours (P < 0.0001), midline or unknown type episiotomy (P < 0.0001...
CONCLUSION: Our data show that a simulation training program including a targeted education sessi... more CONCLUSION: Our data show that a simulation training program including a targeted education session in vacuum assisted-deliveries improves obstetrician technical skills.
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