Pub Date : 2024-08-13DOI: 10.1016/j.ajog.2024.07.047
Yang Cao, Dan Wang, Honghui Shi, Tao Wang
The Sturmdorf type sutures are traditionally used for obtaining hemostasis after a cold knife conization. In this article and accompanying video, we provided a simplified modification of the Sturmdorf suture to further reduce the risk of postoperative bleeding and cervical stenosis. Our modified Sturmdorf suture is essentially a large horizontal figure-of-eight suture, with simultaneous small bites on the mucosa of the anterior and posterior lips drawing the cervical mucosa to cover the denuded cervical stump. The advantages of this modification are: (1) The surgery is simple, accomplished with only one suture; (2) excellent hemostasis is achieved by incorporating the cervical branch of the descending rami of the uterine artery lateral to the cervix in the suture loop; (3) the single-suture technique provides more appropriate tension on the cervix when tying the knot and pulls the cervical mucosa towards the cervical canal from six symmetrical directions, evenly distributed tension helps restore the preferable cylindrical shape of the cervical stump; and (4) the intersection point of the figure-of-eight suture is located in the cervical canal, where the tissue undergoes minimal deformation when the suture loop is tightened, therefore stenosis of the uterine cervix is rare.
{"title":"A simplified modification of the Sturmdorf suture.","authors":"Yang Cao, Dan Wang, Honghui Shi, Tao Wang","doi":"10.1016/j.ajog.2024.07.047","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.07.047","url":null,"abstract":"<p><p>The Sturmdorf type sutures are traditionally used for obtaining hemostasis after a cold knife conization. In this article and accompanying video, we provided a simplified modification of the Sturmdorf suture to further reduce the risk of postoperative bleeding and cervical stenosis. Our modified Sturmdorf suture is essentially a large horizontal figure-of-eight suture, with simultaneous small bites on the mucosa of the anterior and posterior lips drawing the cervical mucosa to cover the denuded cervical stump. The advantages of this modification are: (1) The surgery is simple, accomplished with only one suture; (2) excellent hemostasis is achieved by incorporating the cervical branch of the descending rami of the uterine artery lateral to the cervix in the suture loop; (3) the single-suture technique provides more appropriate tension on the cervix when tying the knot and pulls the cervical mucosa towards the cervical canal from six symmetrical directions, evenly distributed tension helps restore the preferable cylindrical shape of the cervical stump; and (4) the intersection point of the figure-of-eight suture is located in the cervical canal, where the tissue undergoes minimal deformation when the suture loop is tightened, therefore stenosis of the uterine cervix is rare.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-12DOI: 10.1016/j.ajog.2024.08.006
Małgorzata Starzec-Proserpio, Helena Frawley, Kari Bø, Mélanie Morin
Objective: To evaluate the effectiveness of non-pharmacological, conservative therapies for women with chronic pelvic pain (CPP).
Data sources: A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023.
Study eligibility criteria: Randomized controlled trials (RCTs) comparing a non-pharmacological, conservative therapy to inert (e.g., placebo, usual care) or non-conservative (e.g., surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (e.g., electrophysical agents, manual stretching).
Study appraisal and synthesis methods: All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using post-intervention scores for data that included similar interventions and outcomes. Standardized mean differences (SMD) were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the PEDro scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.
Results: Of 5776 retrieved studies, 38 RCTs including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or non-conservative treatments in both the short (SMD -1.69, 95% CI -2.54,-0.85; high certainty) and intermediate-terms (SMD -1.82, 95% CI -3.13, -0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (SMD -0.18, 95% CI -0.56, 0.20; moderate certainty) and a slight difference in sexual function (SMD -0.28, 95% CI -0.52,-0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (SMD 1.08, 95% CI -1.38, 3.54, non-statistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence.
Conclusions: This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with CPP with a high certainty of evidence.
目的:评估非药物保守疗法对慢性盆腔疼痛妇女的疗效:评估非药物保守疗法对慢性盆腔疼痛(CPP)妇女的疗效:于 2023 年 1 月对电子数据库(Amed、CINAHL、PsycINFO、SportDiscuss、Medline、PubMed、Embase 和 Cochrane Central Register of Controlled Trials)进行了系统检索,并于 2023 年 12 月进行了更新:研究资格标准:纳入比较非药物保守疗法与惰性疗法(如安慰剂、常规护理)或非保守疗法(如手术、药物)的随机对照试验(RCT)。本综述所关注的保守疗法包括:多模式物理疗法、以心理治疗为主的方法、针灸和其他基于组织的单一疗法(如电物理药剂、徒手拉伸):对所有研究数据进行汇总,并对纳入的研究进行分析。分析了对疼痛、性功能指标、心理和生理功能、健康相关生活质量、症状严重程度/烦扰、盆底肌肉功能和形态、感知改善和不良事件的影响。对于包含类似干预措施和结果的数据,采用干预后评分进行了元分析(随机效应模型)。计算了标准化平均差异(SMD)。对未能纳入荟萃分析的研究结果进行了叙述性总结。证据质量采用 PEDro 量表进行评估,证据的确定性采用建议、评估、发展和评价分级(GRADE)标准:在检索到的 5776 项研究中,共纳入了 38 项 RCT,包括 2168 名女性(平均年龄为 35.1±8.6)。元分析显示,与惰性或非保守疗法相比,多模式物理疗法在短期(SMD -1.69, 95% CI -2.54,-0.85; 高度确定性)和中期(SMD -1.82, 95% CI -3.13, -0.52;中度确定性),而以心理治疗为主的方法导致疼痛强度无差异(SMD -0.18,95% CI -0.56,0.20;中度确定性),性功能略有差异(SMD -0.28,95% CI -0.52,-0.04;中度确定性)。针灸对疼痛强度影响的荟萃分析(SMD 1.08,95% CI -1.38, 3.54,无统计学意义,结果有利于对照治疗)的证据水平排除了任何确定性声明。有限的几项试验调查了基于单个组织的单一疗法,提供的证据有限:该系统综述和荟萃分析表明,多模式物理疗法对患有 CPP 的妇女有效,证据的确定性较高。
{"title":"Effectiveness of non-pharmacological conservative therapies for chronic pelvic pain in women: a systematic review and meta-analysis.","authors":"Małgorzata Starzec-Proserpio, Helena Frawley, Kari Bø, Mélanie Morin","doi":"10.1016/j.ajog.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.08.006","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of non-pharmacological, conservative therapies for women with chronic pelvic pain (CPP).</p><p><strong>Data sources: </strong>A systematic search of electronic databases (Amed, CINAHL, PsycINFO, SportDiscuss, Medline, PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed in January 2023, and updated in December 2023.</p><p><strong>Study eligibility criteria: </strong>Randomized controlled trials (RCTs) comparing a non-pharmacological, conservative therapy to inert (e.g., placebo, usual care) or non-conservative (e.g., surgical, pharmacological) treatment were included. Conservative therapies of interest to this review were: multimodal physical therapy, predominantly psychological approaches, acupuncture, and other tissue-based monotherapies (e.g., electrophysical agents, manual stretching).</p><p><strong>Study appraisal and synthesis methods: </strong>All study data were aggregated, and analyses of the included studies were performed. Effects on pain; sexual measures; psychological and physical function; health-related quality of life; symptom severity/bother; pelvic floor muscle function and morphometry; perceived improvement; and adverse events were analyzed. Meta-analyses (random effects model) were conducted using post-intervention scores for data that included similar interventions and outcomes. Standardized mean differences (SMD) were calculated. A narrative summary of findings that could not be included in the meta-analysis is provided. The quality of the evidence was assessed with the PEDro scale and the certainty of evidence with Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.</p><p><strong>Results: </strong>Of 5776 retrieved studies, 38 RCTs including 2168 women (mean age 35.1±8.6) were included. Meta-analyses revealed that multimodal physical therapy resulted in lower pain intensity compared to inert or non-conservative treatments in both the short (SMD -1.69, 95% CI -2.54,-0.85; high certainty) and intermediate-terms (SMD -1.82, 95% CI -3.13, -0.52; moderate certainty), while predominantly psychological approaches resulted in no difference in pain intensity (SMD -0.18, 95% CI -0.56, 0.20; moderate certainty) and a slight difference in sexual function (SMD -0.28, 95% CI -0.52,-0.04; moderate certainty). The level of evidence regarding the meta-analysis of the effects of acupuncture on pain intensity (SMD 1.08, 95% CI -1.38, 3.54, non-statistically significant results in favor of control treatment) precluded any statement of certainty. A limited number of trials investigated individual tissue-based monotherapies, providing a restricted body of evidence.</p><p><strong>Conclusions: </strong>This systematic review with meta-analysis revealed that multimodal physical therapy is effective in women with CPP with a high certainty of evidence.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1016/j.ajog.2024.08.005
Sarosh Rana, Luke P Burns
{"title":"Real-world evidence for the utility of serum soluble fms-like tyrosine kinase 1/placental growth factor testing.","authors":"Sarosh Rana, Luke P Burns","doi":"10.1016/j.ajog.2024.08.005","DOIUrl":"10.1016/j.ajog.2024.08.005","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.ajog.2024.08.001
Gabriela M Weigel, George N Baison, Linda Mihalov, Tariro Mupombwa
Background: The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are a cause for clinical concern.
Objective: This study aimed to estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women and to evaluate risk factors associated with their presence.
Study design: This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women who underwent a hysterectomy for uterovaginal prolapse. Patients were excluded if they underwent a hysterectomy for other indications, including postmenopausal bleeding. Following chart review, eligible patients who received care at a single site in Washington state from 2009 to 2018 were included. The primary outcome was the presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression.
Results: Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13±10 mm and 1.4±1.5 mm, respectively. Most cases (78%) had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); 1 had endometrial carcinoma and 1 had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and those without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis. A multivariate logistic regression showed that the presence of polyps was independently associated with a high body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P=.02) and use of menopausal hormone therapy (odds ratio, 1.67; 95% confidence interval, 1.02-2.72; P=.04).
Conclusion: Asymptomatic postmenopausal women who underwent hysterectomy for uterovaginal prolapse exhibited a high prevalence of endometrial polyps. Those who used menopausal hormone therapy and who had a high body mass index were at a higher risk for developing endometrial polyps. Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.
{"title":"Prevalence of and risk factors for endometrial polyps among asymptomatic postmenopausal women with uterovaginal prolapse.","authors":"Gabriela M Weigel, George N Baison, Linda Mihalov, Tariro Mupombwa","doi":"10.1016/j.ajog.2024.08.001","DOIUrl":"10.1016/j.ajog.2024.08.001","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are a cause for clinical concern.</p><p><strong>Objective: </strong>This study aimed to estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women and to evaluate risk factors associated with their presence.</p><p><strong>Study design: </strong>This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women who underwent a hysterectomy for uterovaginal prolapse. Patients were excluded if they underwent a hysterectomy for other indications, including postmenopausal bleeding. Following chart review, eligible patients who received care at a single site in Washington state from 2009 to 2018 were included. The primary outcome was the presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression.</p><p><strong>Results: </strong>Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13±10 mm and 1.4±1.5 mm, respectively. Most cases (78%) had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); 1 had endometrial carcinoma and 1 had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and those without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis. A multivariate logistic regression showed that the presence of polyps was independently associated with a high body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P=.02) and use of menopausal hormone therapy (odds ratio, 1.67; 95% confidence interval, 1.02-2.72; P=.04).</p><p><strong>Conclusion: </strong>Asymptomatic postmenopausal women who underwent hysterectomy for uterovaginal prolapse exhibited a high prevalence of endometrial polyps. Those who used menopausal hormone therapy and who had a high body mass index were at a higher risk for developing endometrial polyps. Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Performance comparison of 4 short methods for urine-protein estimation versus the standard 24-hour method for diagnosis of proteinuria: a prospective observational study.","authors":"Manal Massalha, Efrat Yanai, Mysalon Mahajna, Gali Garmi, Noah Zafran, Raed Salim","doi":"10.1016/j.ajog.2024.07.046","DOIUrl":"10.1016/j.ajog.2024.07.046","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1016/j.ajog.2024.08.002
Herbert Valensise, Gian Paolo Novelli, Barbara Vasapollo
{"title":"Restricted physical activity and maternal rest improve fetal growth: should we look for the reason in the cardiovascular modifications?","authors":"Herbert Valensise, Gian Paolo Novelli, Barbara Vasapollo","doi":"10.1016/j.ajog.2024.08.002","DOIUrl":"10.1016/j.ajog.2024.08.002","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1016/j.ajog.2024.08.003
Greggory R DeVore, Bardo Polanco, Wesley Lee, Jeffrey Brian Fowlkes, Emma E Peek, Manesha Putra, John C Hobbins
{"title":"Restricted physical activity and maternal rest improve fetal growth.","authors":"Greggory R DeVore, Bardo Polanco, Wesley Lee, Jeffrey Brian Fowlkes, Emma E Peek, Manesha Putra, John C Hobbins","doi":"10.1016/j.ajog.2024.08.003","DOIUrl":"10.1016/j.ajog.2024.08.003","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Given the limitations in perioperative management strategies available at freestanding abortion clinics, abortion providers must commonly discern which patients are too complicated for procedural abortions at their center and must be referred for a hospital-based abortion. The need to transition from freestanding clinics to hospital-based abortion care can lead to delays in completing an abortion and significant social, economic, and psychological repercussions for the pregnant individual. One significant clinical problem that exemplifies the issue of who can be safely taken care of at a freestanding abortion clinic is when the placenta accreta spectrum is suspected. Placenta accreta spectrum is one of the major contributors to maternal morbidity and mortality in the United States, requiring coordinated multidisciplinary management to ensure the safest outcome for the pregnant individual. In this Clinical Opinion, we review the literature focused on identifying individuals at risk for placenta accreta spectrum >14+0 weeks gestation, delineate an algorithm to improve the frequency of timely referrals to hospital-based abortion providers, and propose next steps for future training goals and research on placenta accreta spectrum in the second trimester between complex family planning and maternal-fetal medicine subspecialists.
{"title":"Placenta accreta spectrum in the second trimester: a clinical conundrum in procedural abortion care.","authors":"Ashish Premkumar, Bridget Huysman, CeCe Cheng, Brett D Einerson, Ghazaleh Moayedi","doi":"10.1016/j.ajog.2024.07.045","DOIUrl":"10.1016/j.ajog.2024.07.045","url":null,"abstract":"<p><p>Given the limitations in perioperative management strategies available at freestanding abortion clinics, abortion providers must commonly discern which patients are too complicated for procedural abortions at their center and must be referred for a hospital-based abortion. The need to transition from freestanding clinics to hospital-based abortion care can lead to delays in completing an abortion and significant social, economic, and psychological repercussions for the pregnant individual. One significant clinical problem that exemplifies the issue of who can be safely taken care of at a freestanding abortion clinic is when the placenta accreta spectrum is suspected. Placenta accreta spectrum is one of the major contributors to maternal morbidity and mortality in the United States, requiring coordinated multidisciplinary management to ensure the safest outcome for the pregnant individual. In this Clinical Opinion, we review the literature focused on identifying individuals at risk for placenta accreta spectrum >14+0 weeks gestation, delineate an algorithm to improve the frequency of timely referrals to hospital-based abortion providers, and propose next steps for future training goals and research on placenta accreta spectrum in the second trimester between complex family planning and maternal-fetal medicine subspecialists.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1016/j.ajog.2024.07.043
Rachel Collings, Christian Potter, Val Gebski, Monika Janda, Andreas Obermair
<p><strong>Background: </strong>Obstetrics and gynecology surgery is becoming increasingly complex because of an aging population with increasing rates of medical comorbidities and obesity. Complications are therefore common, and not only impact the patient but can also cause distress to the obstetrics and gynecology surgeon as a "second victim."</p><p><strong>Objective: </strong>This study aimed to describe and quantify the range of effects of complications on obstetrics and gynecology surgeons, and assess sociodemographic, clinician, and practice factors associated with such impact.</p><p><strong>Study design: </strong>A cross-sectional survey was developed on the basis of interviews with obstetrics and gynecology surgeons and a review of the literature. The survey assessed obstetrics and gynecology surgeons' demographic, clinical, and practice characteristics; estimated the number of complications per year and the impact of complications on distress, physical and mental health, sleep, and relationships; and explored strategies that obstetrics and gynecology surgeons used to cope with complications. Univariate logistic regression analyses were used to determine the association between obstetrics and gynecology surgeons' characteristics and complication consequences.</p><p><strong>Results: </strong>Overall, of 727 survey respondents, 431 (61%) were female, 384 (55%) were aged ≥50 years, almost half had worked as obstetrics and gynecology surgeons for ≥15 years (329 [45%]), and 527 (73%) reported completing <10 surgical procedures per week. Most (568 [78%]) reported <3 surgical complications per year, and most (472 [66%]) thought this was similar or less frequent compared with their colleagues. Complications caused most stress when they resulted in poor patient outcomes (653 [90%]), had severe patient consequences (630 [87%]), or were a result of surgeon error (627 [86%]). Complications impacted most obstetrics and gynecology surgeons' well-being and sleep. A greater proportion of those aged <50 years reported that their mental well-being (32 [10%]; P=.002) and sleep (130 [42%]; P=.03) were affected when a complication occurred. Female participants were also more likely to report that their physical health (14 [3%]; P≤.001), mental health (39 [9%]; P=.01), and sleep (183 [43%]; P≤.001) were affected. Current trainees (11 [10%]) and surgeons with <15 years of experience (25 [9%]) were more likely to experience mental well-being consequences compared with surgeons with ≥15 years of experience (12 [4%]; P=.01). Female participants reported less willingness to interact with colleagues when complications occurred (323 [75%]; P=.006), and surgeons with <15 years of training were less likely to report comfort in talking (221 [74%]; P=.03) and interacting with others (212 [74%]; P=.02).</p><p><strong>Conclusion: </strong>The vast majority of obstetrics and gynecology surgeons experience a major impact on their health and well-being when one of their pati
{"title":"The impact of surgical complications on obstetricians' and gynecologists' well-being and coping mechanisms as second victims.","authors":"Rachel Collings, Christian Potter, Val Gebski, Monika Janda, Andreas Obermair","doi":"10.1016/j.ajog.2024.07.043","DOIUrl":"10.1016/j.ajog.2024.07.043","url":null,"abstract":"<p><strong>Background: </strong>Obstetrics and gynecology surgery is becoming increasingly complex because of an aging population with increasing rates of medical comorbidities and obesity. Complications are therefore common, and not only impact the patient but can also cause distress to the obstetrics and gynecology surgeon as a \"second victim.\"</p><p><strong>Objective: </strong>This study aimed to describe and quantify the range of effects of complications on obstetrics and gynecology surgeons, and assess sociodemographic, clinician, and practice factors associated with such impact.</p><p><strong>Study design: </strong>A cross-sectional survey was developed on the basis of interviews with obstetrics and gynecology surgeons and a review of the literature. The survey assessed obstetrics and gynecology surgeons' demographic, clinical, and practice characteristics; estimated the number of complications per year and the impact of complications on distress, physical and mental health, sleep, and relationships; and explored strategies that obstetrics and gynecology surgeons used to cope with complications. Univariate logistic regression analyses were used to determine the association between obstetrics and gynecology surgeons' characteristics and complication consequences.</p><p><strong>Results: </strong>Overall, of 727 survey respondents, 431 (61%) were female, 384 (55%) were aged ≥50 years, almost half had worked as obstetrics and gynecology surgeons for ≥15 years (329 [45%]), and 527 (73%) reported completing <10 surgical procedures per week. Most (568 [78%]) reported <3 surgical complications per year, and most (472 [66%]) thought this was similar or less frequent compared with their colleagues. Complications caused most stress when they resulted in poor patient outcomes (653 [90%]), had severe patient consequences (630 [87%]), or were a result of surgeon error (627 [86%]). Complications impacted most obstetrics and gynecology surgeons' well-being and sleep. A greater proportion of those aged <50 years reported that their mental well-being (32 [10%]; P=.002) and sleep (130 [42%]; P=.03) were affected when a complication occurred. Female participants were also more likely to report that their physical health (14 [3%]; P≤.001), mental health (39 [9%]; P=.01), and sleep (183 [43%]; P≤.001) were affected. Current trainees (11 [10%]) and surgeons with <15 years of experience (25 [9%]) were more likely to experience mental well-being consequences compared with surgeons with ≥15 years of experience (12 [4%]; P=.01). Female participants reported less willingness to interact with colleagues when complications occurred (323 [75%]; P=.006), and surgeons with <15 years of training were less likely to report comfort in talking (221 [74%]; P=.03) and interacting with others (212 [74%]; P=.02).</p><p><strong>Conclusion: </strong>The vast majority of obstetrics and gynecology surgeons experience a major impact on their health and well-being when one of their pati","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141900644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}