The July effect represents the month when interns begin residency and residents advance with increased responsibility. This has not been well studied in Obstetrics and Gynecology residencies and no study has been conducted evaluating obstetric outcomes. The purpose of this study was to evaluate the July effect on obstetric outcomes. Women who delivered between July and September (quarter 1) were compared to those delivering between April and June (quarter 4). Methods: This retrospective cohort study compared outcomes of deliveries between quarter 1 and quarter 4 from 2017 to 2020. Outcomes evaluated were postpartum length of stay (LOS), postpartum readmission, wound complication, wound infection, blood transfusion, estimated blood loss, 3rd and 4th degree lacerations, 5 min APGAR scores, and cesarean delivery rates. Results: There were 3693 deliveries in quarter 1 and 3107 deliveries in quarter 4. There was a higher incidence Of wound infection during the April-June period (N = 21; 0.68%) compared to July-September (N = 10; 0.27%; p = 0.0135). Although LOS for both periods were the same, the average postpartum LOS during July-September was slightly longer than April-June (1.7 days; SD = 1.1 vs 1.6 days; SD = 1.2; p = 0.0026). All other pregnancy outcomes were similar between the two groups. Conclusion: Overall, the July effect is minimal on obstetric complications. However, LOS between July and September may differ because all residents are less experienced in quarter 1. Wound infection rates were higher in April-June, perhaps because new PGY-1s went from assisting to primary on cesarean surgeries starting in the 4th quarter of the year.

Importance: Spontaneous perinatal rupture of a uterine vessel is a rare occurrence that may lead to severe hemorrhage and requires prompt identification and management.Objective: The aim of this study was to examine the etiologies, locations, diagnostic tools, treatment options, and risks in subsequent pregnancies when spontaneous rupture of a uterine vessel occurs in pregnancy.Evidence Acquisition: A literature search was performed by university research librarians using the PubMed, CINAHL, and Web of Science search engines. Identified were 78 cases of perinatal spontaneous uterine vessel rupture and formed the basis for this review.Results: Increased uterine blood flow during pregnancy may alter the integrity of pelvic vessels leading to increased risk of spontaneous rupture. The uterine artery is the most common site of vessel rupture; the second most common site is the uterine-ovarian plexus. The most common presentation is abdominal or pelvic pain, maternal vital sign abnormalities, and an absence of vaginal bleeding. Exploratory laparotomy and embolization (interventional radiology) have been reported as management options.Conclusions: Spontaneous rupture of uterine vessels is a rare but potentially life-threatening complication of pregnancy that should be included in the differential diagnosis of pregnant patients presenting with an acute abdomen.Relevance: Our aim is to increase the awareness of spontaneous vessel rupture during pregnancy to improve detection, management, and perinatal outcomes.Target Audience: Obstetrician-gynecologists, radiologists, family medicine physicians Learning Objectives: After completing this CME activity, participants should be better able to describe spontaneous uterine vessel rupture; identify its risk factors and presenting symptoms; and explain preferred diagnostic imaging modalities, management options, and possible complications in future pregnancies.All authors, faculty, and staff have no relevant financial relationships with any ineligible organizations regarding this educational activity.

Highlights Sertoli-Leydig cell tumor and gynandroblastoma are rare ovarian sex cord-stromal tumors that warrant germline DICER1 testing. DICER1 mutations are associated with an increased risk of various benign and malignant tumors especially during childhood. Childhood genetic testing is controversial but provides earlier screening and diagnosis in DICER1 mutation patients.

Purpose of reviewDespite efforts to minimize patient barriers to equitable care, health disparities persist in gynecology. This paper seeks to highlight racial and ethnic disparities in gynecologic care as represented by recent literature. Recent findingsDisparities exist among many areas including preventive screenings, vaccination rates, contraception use, infertility, and oncologic care. These can be identified at the patient, physician, and institutional levels.

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Background Retained products of conception and placenta accreta spectrum are causes of postpartum hemorrhage. Placenta accreta spectrum is frequently managed with cesarean hysterectomy, but conservative approaches are emerging. We present a case of delayed postpartum hemorrhage secondary to a retained placenta increta. Case A 29-year-old G3P2 presented with heavy vaginal bleeding 20 days postoperatively following an uncomplicated classical cesarean delivery at 27 5/7 weeks' gestation for preterm labor in the setting of a vasa previa. On workup, imaging showed retained products of conception and concern for placenta accreta. A hypervascular area in the lower uterine segment was identified at the time of postpartum laparotomy. Total abdominal hysterectomy was performed due to postpartum hemorrhage and clinical suspicion for placenta accreta spectrum disorder. Pathology confirmed a placenta increta. Conclusion Diagnosis of placenta accreta spectrum in the remote postpartum period is uncommon but should be a considered etiology in delayed postpartum hemorrhage. Careful inspection and documentation of the placenta implantation site should occur in cesarean sections because placenta accreta spectrum disorders can remain unnoticed during delivery.

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