Pub Date : 2024-05-01DOI: 10.1016/j.xagr.2024.100340
Eleza Valente DO , Morgan Zueger DO , Daniel Donato MD
Myomatous erythrocytosis syndrome is a rare phenomenon of secondary polycythemia evolving from uterine leiomyoma. Although the underlying pathology is still unknown, patients have an increased risk of venous thrombosis. A 44-year-old GO (gravida zero) presented with an incidental finding of secondary polycythemia, and a diagnosis of myomatous erythrocytosis syndrome was made because of her large uterine fibroids. She was placed on therapeutic anticoagulation after developing pulmonary embolisms and a dural sinus venous thrombosis. Subsequently, she underwent uterine artery embolization, which resulted in a substantial decrease in her erythropoietin (8.1 mU/mL) along with hemoglobin (15.1 g/dL) and hematocrit (4 5g/dL). Myomatous erythrocytosis syndrome can cause venous thrombosis, leading to neurologic complications. In patients with increased risk for surgery, uterine artery embolization is an effective option for treatment.
子宫肌瘤性红细胞增多症综合征是一种罕见的由子宫肌瘤演变而来的继发性多血症现象。虽然潜在的病理机制尚不清楚,但患者静脉血栓形成的风险会增加。一名 44 岁的 GO 患者(孕酮为 0)偶然发现继发性多血症,因其子宫肌瘤较大,被诊断为肌瘤性红细胞增多症综合征。在出现肺栓塞和硬膜窦静脉血栓后,她接受了抗凝治疗。随后,她接受了子宫动脉栓塞术,这导致她的促红细胞生成素(8.1 mU/mL)、血红蛋白(15.1 g/dL)和血细胞比容(4.5 g/dL)大幅下降。肌红细胞增多症综合征可引起静脉血栓,导致神经系统并发症。对于手术风险增加的患者,子宫动脉栓塞是一种有效的治疗方法。
{"title":"A rare case of venous sinus thrombosis and pulmonary embolisms secondary to myomatous erythrocytosis syndrome","authors":"Eleza Valente DO , Morgan Zueger DO , Daniel Donato MD","doi":"10.1016/j.xagr.2024.100340","DOIUrl":"10.1016/j.xagr.2024.100340","url":null,"abstract":"<div><p>Myomatous erythrocytosis syndrome is a rare phenomenon of secondary polycythemia evolving from uterine leiomyoma. Although the underlying pathology is still unknown, patients have an increased risk of venous thrombosis. A 44-year-old GO (gravida zero) presented with an incidental finding of secondary polycythemia, and a diagnosis of myomatous erythrocytosis syndrome was made because of her large uterine fibroids. She was placed on therapeutic anticoagulation after developing pulmonary embolisms and a dural sinus venous thrombosis. Subsequently, she underwent uterine artery embolization, which resulted in a substantial decrease in her erythropoietin (8.1 mU/mL) along with hemoglobin (15.1 g/dL) and hematocrit (4 5g/dL). Myomatous erythrocytosis syndrome can cause venous thrombosis, leading to neurologic complications. In patients with increased risk for surgery, uterine artery embolization is an effective option for treatment.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000340/pdfft?md5=33ce4d5781f3876e66a03bc801a2b9ee&pid=1-s2.0-S2666577824000340-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.xagr.2024.100355
Greg J. Marchand MD, FACS, FICS, FACOG , Hollie Ulibarri BS , Amanda Arroyo BS , Madison Blanco BS , Daniela Gonzalez Herrera BS , Brooke Hamilton BS , Kate Ruffley BS , Ali Azadi MD, FACOG, FPMRS
Objective
As the second most common surgery performed on women in the United States, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications.
Data sources
We searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1, 2023.
Study eligibility criteria
We included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (mL), operation time (min), length of hospital stay (d), Visual Analogue Scale pain score at Day 1, intraoperative complications, and postoperative complications.
Study appraisal and synthesis methods
We analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool.
Results
We found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=−44.70 [−99.97, 10.57]; P=.11). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=−0.16 [−1.62, 1.30]; P=.83). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain score after 1 day, intraoperative complications, and postoperative complications.
Conclusion
vNOTES seems to be associated with a nonsignificant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.
{"title":"Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery hysterectomy versus vaginal hysterectomy for benign indications","authors":"Greg J. Marchand MD, FACS, FICS, FACOG , Hollie Ulibarri BS , Amanda Arroyo BS , Madison Blanco BS , Daniela Gonzalez Herrera BS , Brooke Hamilton BS , Kate Ruffley BS , Ali Azadi MD, FACOG, FPMRS","doi":"10.1016/j.xagr.2024.100355","DOIUrl":"10.1016/j.xagr.2024.100355","url":null,"abstract":"<div><h3>Objective</h3><p>As the second most common surgery performed on women in the United States, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications.</p></div><div><h3>Data sources</h3><p>We searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1, 2023.</p></div><div><h3>Study eligibility criteria</h3><p>We included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (mL), operation time (min), length of hospital stay (d), Visual Analogue Scale pain score at Day 1, intraoperative complications, and postoperative complications.</p></div><div><h3>Study appraisal and synthesis methods</h3><p>We analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool.</p></div><div><h3>Results</h3><p>We found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=−44.70 [−99.97, 10.57]; <em>P</em>=.11). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=−0.16 [−1.62, 1.30]; <em>P</em>=.83). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain score after 1 day, intraoperative complications, and postoperative complications.</p></div><div><h3>Conclusion</h3><p>vNOTES seems to be associated with a nonsignificant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000492/pdfft?md5=cf7c03d25a26f726059121737c1a7fe5&pid=1-s2.0-S2666577824000492-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141027491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.xagr.2024.100353
Xiaotong Dong MD , Shengrui Zhao MM , Peng Liu MM , Qian Yu MD , Lei Yan MD
We reported 5 patients with unilateral or bilateral tubal discontinuity between the ampulla and fimbria, occasionally detected through laparoscopy combined with hysteroscopy at the Reproductive Hospital Affiliated with Shandong University from 2017 to 2023. Three cases were observed to have this malformation on the left fallopian tube, 1 case on the right side, and 1 case bilaterally. None of these cases were combined with urological malformations. After surgery, there was 1 instance of postoperative delivery, 1 ongoing pregnancy, and 3 not yet conceived. The congenital ampulla and fimbria interruption of the fallopian tube may be independent of other significant deformities of reproductive or renal tracts. However, it can lead to hydrosalpinx and primary or secondary infertility. Surgical management options, such as salpingostomy, salpingectomy, and tubal ligation, have shown the potential to improve pregnancy outcomes.
{"title":"Congenital interruption between the ampulla and fimbria of the fallopian tube: case report","authors":"Xiaotong Dong MD , Shengrui Zhao MM , Peng Liu MM , Qian Yu MD , Lei Yan MD","doi":"10.1016/j.xagr.2024.100353","DOIUrl":"10.1016/j.xagr.2024.100353","url":null,"abstract":"<div><p>We reported 5 patients with unilateral or bilateral tubal discontinuity between the ampulla and fimbria, occasionally detected through laparoscopy combined with hysteroscopy at the Reproductive Hospital Affiliated with Shandong University from 2017 to 2023. Three cases were observed to have this malformation on the left fallopian tube, 1 case on the right side, and 1 case bilaterally. None of these cases were combined with urological malformations. After surgery, there was 1 instance of postoperative delivery, 1 ongoing pregnancy, and 3 not yet conceived. The congenital ampulla and fimbria interruption of the fallopian tube may be independent of other significant deformities of reproductive or renal tracts. However, it can lead to hydrosalpinx and primary or secondary infertility. Surgical management options, such as salpingostomy, salpingectomy, and tubal ligation, have shown the potential to improve pregnancy outcomes.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000479/pdfft?md5=0cb0aa25760a7886ec6accf2e2230977&pid=1-s2.0-S2666577824000479-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141052177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cesarean delivery rates are increasing globally, raising concerns about associated complications such as isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior cesarean delivery scar.
OBJECTIVE
This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a history of cesarean delivery.
STUDY DESIGN
This cross-sectional study evaluated 297 women with prior cesarean delivery using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for cesarean delivery were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele.
RESULTS
Isthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported in 21.1% of participants, pelvic pain by 4.1% of participants, and both by 4.1% of participants. Compared to women without isthmocele, those with isthmocele were older (35.9 vs 31.6 years), had higher body mass index (26.8 vs 25.5 kg/m2), gravidity (1.8 vs 1.3), and parity (1.7 vs 1.2). Repeat cesarean delivery was more common (30.4% vs 12.6%) and elective cesarean delivery less common (33.5% vs 67.9%) among those with isthmocele.
CONCLUSION
Over half of the women with history of cesarean delivery had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.
{"title":"Investigating the risk factors for isthmocele development after cesarean delivery","authors":"Masoud Saadat Fakhr MD , Mahya Mozafari MD , Kiana Rezvanfar MD , Zahra Amini MD , Koosha Amiri MD , Reza Shah Hosseini MD , Hengame Sarnaz MD , Poorya Gholami MD , Zohreh Lavasani MD","doi":"10.1016/j.xagr.2023.100299","DOIUrl":"10.1016/j.xagr.2023.100299","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Cesarean delivery rates are increasing globally, raising concerns about associated complications such as isthmocele. Isthmoceles are pouch-like defects in the anterior uterine wall at the site of a prior cesarean delivery scar.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to determine isthmocele prevalence, associated symptoms, and risk factors among women with a history of cesarean delivery.</p></div><div><h3>STUDY DESIGN</h3><p>This cross-sectional study evaluated 297 women with prior cesarean delivery using transvaginal ultrasound to screen for isthmocele. Data on demographics, pregnancy details, comorbidities, and indications for cesarean delivery were collected. Isthmocele was defined sonographically as any niche or defect at the hysterotomy site. Descriptive and comparative analyses identified factors associated with isthmocele.</p></div><div><h3>RESULTS</h3><p>Isthmocele prevalence was 65.3% (n=194). Abnormal vaginal bleeding was reported in 21.1% of participants, pelvic pain by 4.1% of participants, and both by 4.1% of participants. Compared to women without isthmocele, those with isthmocele were older (35.9 vs 31.6 years), had higher body mass index (26.8 vs 25.5 kg/m<sup>2</sup>), gravidity (1.8 vs 1.3), and parity (1.7 vs 1.2). Repeat cesarean delivery was more common (30.4% vs 12.6%) and elective cesarean delivery less common (33.5% vs 67.9%) among those with isthmocele.</p></div><div><h3>CONCLUSION</h3><p>Over half of the women with history of cesarean delivery had an isthmocele. Abnormal bleeding was common. Advanced maternal age, obesity, repeat procedures, and certain comorbidities appear to increase risk. Further research on prevention and treatment is warranted given the high prevalence.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577823001417/pdfft?md5=80e5235a11e8795072c4c928c992199d&pid=1-s2.0-S2666577823001417-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139024962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.xagr.2024.100339
Vo Anh Vinh Trang MD , Thao-Ngan Nguyen Pham MD , Bao Huy Le MD , Thien Tan Tri Tai Truyen MD , Hoang Kim Tu Trinh MD, PhD , Kieu-Minh Le MSc , Huu Doan Pham MD , Ngoc Minh Tam Nguyen MD , Quoc Kha Tran , Phuc Cam Hoang Nguyen MD, PhD , Vinh Hung Tran MD, PhD
Spontaneous idiopathic vulvar edema during the second trimester is a rare condition. The approach to managing this condition involves relieving symptoms, identifying underlying causes, and implementing appropriate treatment. Managing such cases during pregnancy is challenging because of concerns for potential adverse fetal outcomes. Conservative management expects the condition to be relieved spontaneously postpartum, whereas invasive treatment offers a more rapid resolution. Treatment choices are controversial because each method has its pros and cons and influences the delivery process to a certain extent. Surgical drainage becomes a viable option when patients are not responsive to medications. We report a case of spontaneous massive vulvar edema in a 22-year-old primigravida in her 23rd week of pregnancy. After ruling out other notable causes of vulvar edema, we decided to intervene using an invasive procedure because she complained of progressive symptoms and discomfort. Subsequently, the edema subsided postprocedure, and the patient experienced successful labor with no complications. This report aims to alert clinicians that drainage attempts should be considered in pregnant patients with worsening symptoms.
{"title":"When intervention becomes imperative: a case report of spontaneous vulvar edema during pregnancy","authors":"Vo Anh Vinh Trang MD , Thao-Ngan Nguyen Pham MD , Bao Huy Le MD , Thien Tan Tri Tai Truyen MD , Hoang Kim Tu Trinh MD, PhD , Kieu-Minh Le MSc , Huu Doan Pham MD , Ngoc Minh Tam Nguyen MD , Quoc Kha Tran , Phuc Cam Hoang Nguyen MD, PhD , Vinh Hung Tran MD, PhD","doi":"10.1016/j.xagr.2024.100339","DOIUrl":"10.1016/j.xagr.2024.100339","url":null,"abstract":"<div><p>Spontaneous idiopathic vulvar edema during the second trimester is a rare condition. The approach to managing this condition involves relieving symptoms, identifying underlying causes, and implementing appropriate treatment. Managing such cases during pregnancy is challenging because of concerns for potential adverse fetal outcomes. Conservative management expects the condition to be relieved spontaneously postpartum, whereas invasive treatment offers a more rapid resolution. Treatment choices are controversial because each method has its pros and cons and influences the delivery process to a certain extent. Surgical drainage becomes a viable option when patients are not responsive to medications. We report a case of spontaneous massive vulvar edema in a 22-year-old primigravida in her 23rd week of pregnancy. After ruling out other notable causes of vulvar edema, we decided to intervene using an invasive procedure because she complained of progressive symptoms and discomfort. Subsequently, the edema subsided postprocedure, and the patient experienced successful labor with no complications. This report aims to alert clinicians that drainage attempts should be considered in pregnant patients with worsening symptoms.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000339/pdfft?md5=287db7c847c3651849d31b536361b49e&pid=1-s2.0-S2666577824000339-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.xagr.2024.100351
Erin C. Nacev MD, MPH , Ann C. Martinez Acevedo MPH , Menolly Kaufman PhD, MPH , Megan F. Fuerst MD, MPH , Jacquelyn M. Knapp MD , Maria I. Rodriguez MD, MPH
BACKGROUND
Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.
OBJECTIVE
We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.
STUDY DESIGN
We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.
RESULTS
Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; P<.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059–1.059], P<.001). We found a significant interaction between maternal race and rurality (P<.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188–1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843–1.252]).
CONCLUSION
We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection
{"title":"Differences between rural and urban residence in the detection and treatment of perinatal mood and anxiety disorders","authors":"Erin C. Nacev MD, MPH , Ann C. Martinez Acevedo MPH , Menolly Kaufman PhD, MPH , Megan F. Fuerst MD, MPH , Jacquelyn M. Knapp MD , Maria I. Rodriguez MD, MPH","doi":"10.1016/j.xagr.2024.100351","DOIUrl":"10.1016/j.xagr.2024.100351","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Perinatal mood and anxiety disorders are common, serious complications of pregnancy. Disparities exist by race and income in the prevalence and treatment of these conditions, and overall treatment rates remain low. Outside of pregnancy, a small body of literature suggests that rural residency may contribute to higher rates of depression for those who identify as women. However, among more diverse populations, evidence suggests urban residency may be associated with higher rates of depression among women of color. It is not known whether these trends hold for mood and anxiety disorders during pregnancy and postpartum.</p></div><div><h3>OBJECTIVE</h3><p>We examined differences in the detection and treatment of perinatal mood and anxiety disorders by rural and urban residents and assessed if the observed differences varied by maternal race or ethnicity.</p></div><div><h3>STUDY DESIGN</h3><p>We conducted a cross-sectional study using linked Medicaid claims and birth certificate records from Oregon and South Carolina from 2016 to 2020. We identified perinatal mood and anxiety disorder diagnoses during the perinatal period (pregnancy and within 60 days postpartum) using International Classification of Disease 10th edition codes and enumerated receipt of pharmacotherapy and psychotherapy treatment using Medicaid claims. We used logistic regression models controlling for relevant clinical and sociodemographic characteristics to estimate associations between rural residence and mood disorder detection and treatment.</p></div><div><h3>RESULTS</h3><p>Among the 185,809 births in our sample, 27% of births (n=50,820) were to people who lived in rural areas and 73% (n=134,989) to those in urban areas. The prevalence of any perinatal mood and anxiety disorders diagnosis was higher for urban residents (19.5%) than for rural residents (18.0%; <em>P</em><.001). Overall treatment rates were low among people with a perinatal mood and anxiety disorder (42% [n=14,789]). In our adjusted models, those living in urban areas had higher odds of a perinatal mood and anxiety disorder diagnosis (adjusted odds ratio, 1.059 [95% confidence interval, 1.059–1.059], <em>P</em><.001). We found a significant interaction between maternal race and rurality (<em>P</em><.001). When we stratified by race, we found that among those who identified as Black, the odds of a perinatal mood and anxiety disorder diagnosis were increased for urban residents (odds ratio, 1.188 [95% confidence interval, 1.188–1.188]), whereas among those who identified as White, there were no such increased odds (odds ratio, 1.027 [95% confidence interval, 0.843–1.252]).</p></div><div><h3>CONCLUSION</h3><p>We saw small but meaningful differences between rural and urban residents in perinatal mood and anxiety disorder diagnosis rates. We detected an interaction between race and rural vs urban maternal residence that impacted the observed differences. By elucidating the intersection","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000455/pdfft?md5=a5e936d8c8d02c15a291c55c40428394&pid=1-s2.0-S2666577824000455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140783836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.xagr.2024.100354
Amanda Morgan MD, Myanna Cook BA, Megan Christman DO, Nicole Scott MD, Anthony Shanks MD, MS, MEd
{"title":"Association of Professors of Gynecology and Obstetrics Preparation for Residency Knowledge Assessment scores are more closely associated with first postgraduate year Council on Resident Education in Obstetrics and Gynecology scores than United States Medical Licensing Examination Steps 1 and 2","authors":"Amanda Morgan MD, Myanna Cook BA, Megan Christman DO, Nicole Scott MD, Anthony Shanks MD, MS, MEd","doi":"10.1016/j.xagr.2024.100354","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100354","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000480/pdfft?md5=4afd7aff3bfca71ccfd714a9ab69b2c0&pid=1-s2.0-S2666577824000480-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140909772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.
OBJECTIVE
This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.
STUDY DESIGN
This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography score.
RESULTS
The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and −removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia.
CONCLUSION
The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia
{"title":"The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor","authors":"Ayumu Ito MD, PhD , Eijiro Hayata MD, PhD , Hikari Kotaki MD , Makiko Shimabukuro MD , Mayumi Takano MD, PhD , Sumito Nagasaki MD, PhD , Masahiko Nakata MD, PhD","doi":"10.1016/j.xagr.2024.100343","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100343","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.</p></div><div><h3>STUDY DESIGN</h3><p>This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography score.</p></div><div><h3>RESULTS</h3><p>The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–decision of emergency cesarean delivery and −removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring–removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia.</p></div><div><h3>CONCLUSION</h3><p>The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia ","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000376/pdfft?md5=72893d346015d23ba308693a0e360317&pid=1-s2.0-S2666577824000376-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-03DOI: 10.1016/j.xagr.2024.100352
Ellen Kupka MD, James M. Roberts MD, Zaleha A. Mahdy MD, FRCOG, Carlos Escudero MD, PhD, Lina Bergman MD, PhD, Leandro De Oliveira MD, PhD, Global Pregnancy Collaboration
Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women's adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.
{"title":"Aspirin for preeclampsia prevention in low- and middle-income countries: mind the gaps","authors":"Ellen Kupka MD, James M. Roberts MD, Zaleha A. Mahdy MD, FRCOG, Carlos Escudero MD, PhD, Lina Bergman MD, PhD, Leandro De Oliveira MD, PhD, Global Pregnancy Collaboration","doi":"10.1016/j.xagr.2024.100352","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100352","url":null,"abstract":"<div><p>Preeclampsia is a syndrome that continues to be a major contributor to maternal and neonatal mortality, especially in low-income countries. Low-dose aspirin reduces the risk of preeclampsia, but the mechanism is still unknown. Risk factors to identify women at risk of preeclampsia are based on clinical characteristics. Women identified as high-risk would benefit from aspirin treatment initiated, preferably at the end of the first trimester. Current efforts have largely focused on developing screening algorithms that incorporate clinical risk factors, maternal biomarkers, and uterine artery Doppler evaluated in the first trimester. However, most studies on preeclampsia are conducted in high-income settings, raising uncertainties about whether the information gained can be totally applied in low-resource settings. In low- and middle-income countries, lack of adequate antenatal care and late commencement of antenatal care visits pose significant challenges for both screening for preeclampsia and initiating aspirin treatment. Furthermore, the preventive effect of first-trimester screening based on algorithms and subsequent aspirin treatment is primarily seen for preterm preeclampsia, and reviews indicate minimal or no impact on reducing the risk of term preeclampsia. The lack of evidence regarding the effectiveness of aspirin in preventing term preeclampsia is a crucial concern, as 75% of women will develop this subtype of the syndrome. Regarding adverse outcomes, low-dose aspirin has been linked to a possible higher risk of postpartum hemorrhage, a condition as deadly as preeclampsia in many low- and middle-income countries. The increased risk of postpartum hemorrhage among women in low-income settings should be taken into consideration when discussing which pregnant women would benefit from the use of aspirin and the ideal aspirin dosage for preventing preeclampsia. In addition, women's adherence to aspirin during pregnancy is crucial for determining its effectiveness and complications, an aspect often overlooked in trials. In this review, we analyze the knowledge gaps that must be addressed to safely increase low-dose aspirin use in low- and middle-income countries, and we propose directions for future research.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000467/pdfft?md5=e89a27dae02e0d8f80abed3c8c59fce2&pid=1-s2.0-S2666577824000467-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140638345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sub-Saharan Africa bears the burden of 70% of maternal deaths worldwide, of which ∼10% are attributable to hypertensive disorders of pregnancy, primarily complications of preeclampsia. In other global settings, outcomes of pregnancies affected by preeclampsia are improved with timely and effective medical care.
OBJECTIVE
This study aimed to explore the perspectives of local health care professionals on how preeclampsia care is currently delivered in the study setting and what challenges they experience in providing prompt and safe care. We identified specific objectives of exploring stakeholder perceptions of (1) recognizing preeclampsia and (2) timely intervention when preeclampsia is diagnosed. We also explored the wider system factors (eg, cultural, financial, and logistic challenges) that health care professionals perceived as affecting their ability to deliver optimal preeclampsia care.
STUDY DESIGN
Individual semistructured interviews were conducted with health care professionals and stakeholders. The findings were analyzed using thematic analysis.
RESULTS
Thirty-three participants contributed to the study, including doctors and midwives with varying degrees of clinical experience and external stakeholders. The following 5 key themes emerged: delayed patient presentation, recognizing the unwell patient with preeclampsia, the challenges of the existing triage system, stakeholder disconnect, and ways of learning from each other. Health care professionals referenced an important psychosocial perspective associated with preeclampsia in the study setting, which may influence the likelihood of seeking care through traditional healers rather than hospital-based routes.
CONCLUSION
We identify the key barriers to improving maternal and neonatal outcomes of preeclampsia, described at both the institutional level and within the wider setting. The study provides invaluable contextual information that suggests that a systems-based approach to health care quality improvement may be effective in reducing rates of maternal and neonatal morbidity and mortality.
{"title":"Implementation challenges in preeclampsia care: perspectives from health care professionals in urban Uganda","authors":"Imelda Namagembe MD , Babu Karavadra BSc Hons, MBBS, PhD , Lawrence Kazibwe MBChB, MMed , Joseph Rujumba PhD , Noah Kiwanuka MBChB, MPH, PhD , Brandon Smith BSc Hons, PhD , Josaphat Byamugisha PhD , Ashley Moffett MB/BChir, PhD , Tom Bashford MBBS, MBiochem, PhD, MRCP, FRCA , Annettee Nakimuli MD, PhD , Catherine E. Aiken MB/BChir, MA, PhD, MRCOG, MRCP","doi":"10.1016/j.xagr.2024.100348","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100348","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Sub-Saharan Africa bears the burden of 70% of maternal deaths worldwide, of which ∼10% are attributable to hypertensive disorders of pregnancy, primarily complications of preeclampsia. In other global settings, outcomes of pregnancies affected by preeclampsia are improved with timely and effective medical care.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to explore the perspectives of local health care professionals on how preeclampsia care is currently delivered in the study setting and what challenges they experience in providing prompt and safe care. We identified specific objectives of exploring stakeholder perceptions of (1) recognizing preeclampsia and (2) timely intervention when preeclampsia is diagnosed. We also explored the wider system factors (eg, cultural, financial, and logistic challenges) that health care professionals perceived as affecting their ability to deliver optimal preeclampsia care.</p></div><div><h3>STUDY DESIGN</h3><p>Individual semistructured interviews were conducted with health care professionals and stakeholders. The findings were analyzed using thematic analysis.</p></div><div><h3>RESULTS</h3><p>Thirty-three participants contributed to the study, including doctors and midwives with varying degrees of clinical experience and external stakeholders. The following 5 key themes emerged: delayed patient presentation, recognizing the unwell patient with preeclampsia, the challenges of the existing triage system, stakeholder disconnect, and ways of learning from each other. Health care professionals referenced an important psychosocial perspective associated with preeclampsia in the study setting, which may influence the likelihood of seeking care through traditional healers rather than hospital-based routes.</p></div><div><h3>CONCLUSION</h3><p>We identify the key barriers to improving maternal and neonatal outcomes of preeclampsia, described at both the institutional level and within the wider setting. The study provides invaluable contextual information that suggests that a systems-based approach to health care quality improvement may be effective in reducing rates of maternal and neonatal morbidity and mortality.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400042X/pdfft?md5=7b11cd7cad1c9931a15000c51a5b1c29&pid=1-s2.0-S266657782400042X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140631769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}