INTRODUCTION:The utility and accuracy of hysterosalpingogram in a community hospital setting were evaluated for accuracy in predicting uterine cavity pathology.METHODS: A retrospective chart review was performed for all hysteroscopic procedures that had a hysterosalpingogram performed between August 1, 2012, and August 25, 2014, at a single community hospital in an inner-city setting. Hysterosalpingogram reports by a radiologist were reviewed, and hysteroscopy operative reports were reviewed that were performed by a reproductive endocrinologist. RESULTS:A total of 60 patients were identified. Average age was 31.3 years (median 34 years). Findings correlated for tubal diagnosis in 88.4% of patients. However, for uterine cavity defects, the accuracy was lowest for the finding of uterine septum on hysteroscopy; hysterosalpingogram reported normal findings on all six patients encountered in this series. High sensitivity and correlation were found for findings of intrauterine adhesions (95%), submucosal myomas, and endometrial polyps (90%). The findings for submucosal myomas and endometrial polyps were confirmed with final pathology.CONCLUSION: Hysterosalpingogram has a low sensitivity for finding of uterine septum in this setting. Further studies are needed for correlation with clinical impression by a reproductive endocrinologist.INTRODUCTION: Reproductive health care providers need recommendations on applications (apps) for patient use, particularly apps for menstrual cycle and fertility tracking, because these apps are frequently downloaded by women and can be used by clinicians when evaluating menstrual problems. METHODS: We searched PubMed and OVID MEDLINE for literature on women's reproductive health apps and searched the Apple iTunes store for menstrual cycle and fertility tracking apps. We recorded price, user rating, functionality, and whether an app was developed or recommended by medical experts. RESULTS:We identified six articles, all published since 2012, that discuss apps for patient use regarding women's reproductive health; none focused specifically on menstrual cycle or fertility tracking. The apps search identified 94 unique apps for menstrual cycle tracking, priced from free to $16.99. Sixteen (17%) free apps also had paid versions. User ratings ranged from 1.5-4.5 of 5 stars. App functionality included the ability to create a password (43%), tailor for irregular cycles (23%), back up or restore data (22%), select a pregnancy mode (20%), export or e-mail data (10%), or connect to social media (7%).
fetal heart tones. At the time of delivery, a dusky umbilical cord suggestive of thrombosis was noted. Placental pathology revealed 40% occlusion of umbilical vein and chorangiosis. Chorangiosis is a vascular change of the placenta involving terminal chorionic villi, proposed to result from longstanding, low-grade hypoxia in placental tissue. It has been associated with diabetes, intrauterine growth restriction (IUGR), and hypertensive conditions. Clinical significance has not been studied extensively but case reports suggest correlation with increased fetal morbidity and mortality. METHODS:We identified 56 cases of "chorangiosis" on placental pathology at Henry Ford Hospital from 2010-2015. We reviewed factors such as: maternal age, BMI, smoking status, maternal health conditions, antenatal fetal issues, gestational age, mode of delivery and fetal outcome. RESULTS:Average age was 27.6 years; 20% of advanced maternal age. 16% of cases associated with hypertensive disorders, 11% with diabetes, 11% with IUGR and 45% associated with maternal obesity. 30% associated with current or former smokers. One resulted in neonatal death, 1 intrauterine fetal demise and 18% of deliveries were pre-term. 52% of deliveries were by cesarean section, with the most noted indication being abnormal fetal heart tones.CONCLUSION: Chorangiosis may contribute to increased rates of cesarean section due to abnormal fetal heart tones from longstanding hypoxia coupled with the stress of labor. Further studies are needed to characterize the association of chorangiosis with subsequent infant health outcomes.
preintervention and 18.2% postintervention). For patients presenting for annual examinations, 22.7% reported being asked about intimate partner violence (28.6% preintervention compared with 12.5% postintervention). For patients reporting current or past intimate partner violence, 30.8% were presenting for their annual examination, 53.8% for a problem visit, and 46.2% of patients with intimate partner violence were screened during their visit. Most patients prefer a conversation with the nurse or their health care provider when discussing intimate partner violence and 60% of patients reporting intimate partner violence found the intervention (the wheel posters) helpful. CONCLUSION:The prevalence of intimate partner violence in our resident gynecology clinic is similar to national rates. Most patients presenting for annual examinations report they were not asked about intimate partner violence. More than 50% of patients who were experiencing or had experienced intimate partner violence in the past presented for problem visits when screening may not routinely occur. Goals for our practice will be to improve intimate partner violence screening at annual examinations and broaden screening to all visits to help the majority of patients connect to needed services.OBJECTIVE AND BACKGROUND: Intimate partner violence is prevalent in Latin America and is a leading cause of death for women. A 2004 Demographic Health Survey study showed that 24% of ever-partnered women in the Dominican Republic experienced physical violence in their lifetime. Our objective is to understand the beliefs surrounding intimate partner violence among community health workers (cooperadoras) in the Dominican Republic who serve 110 distinct rural communities.METHODS: Five focus groups were conducted, totaling 35 cooperadoras, representing nine regions in the Dominican Republic. Ten open-ended questions were asked regarding domestic violence within their communities, including knowledge of, attitudes toward, understanding of causes and resources, and the relationship between health care and affected women.RESULTS: Five common themes emerged from these focus groups. Cooperadores consistently believed intimate partner violence was a social issue, not a medical issue. They often stated that women were at fault and felt that conflict between partners was the result of poor communication. They agreed that intimate partner violence was prevalent and that death was frequently an outcome. There also was a lack of understanding of appropriate resources for affected women.CONCLUSION AND IMPLICATION: Cooperadores in the Dominican Republic could be a potential resource for women affected by intimate partner violence but currently do not view themselves as such, because they have limited knowledge of the issue and how to address it. Future public health outreach includes discussions with community members regarding intimate partner violence, educaticng health care workers to advocate for women, and appropriate referral of women to resources.OBJECTIVE: To evaluate a...
from 2013 to 2014. The educational program consisted of a pretest, a lecture on hysteroscopy followed by a posttest and skills laboratories. It was piloted to 28 obstetrics and gynecology residents from two different training programs. A single faculty member assessed all residents using a standardized hysteroscopy checklist. Residents were evaluated based on: identification of hysteroscopic device components, proper hysteroscopic device assembly, performance, and time completion of assigned tasks. A linear mixed-effects model assessed differences in pre-educational to posteducational training test scores within and between residency levels. The mixed-effects model accounts for two repeated measurements per participant. Analysis of variance was used to compare hysteroscopy assembly time between residency levels.MEASUREMENTS AND MAIN RESULTS: Examination scores showed that overall knowledge generally increased with residency year. All residents improved significantly from pretest (mean 65.8) to posttest scores (mean 83.0; P,.001). There were no significant differences between the residency levels with respect to the change in pretest to posttest scores. Most improvement was seen among postgraduate year 3 residents with an average score improvement of 24.4. Hysteroscopy assembly time improved with residency year. There were no statistically significant differences between the residency levels with respect to hysteroscopy assembly time. Assembly time was quickest among senior residents compared with junior residents with postgraduate year 1s being slowest.CONCLUSION: This comprehensive program improved the residents' procedural knowledge and enhanced skill development in hysteroscopic techniques. Establishing an educational program provided a useful, practical, and effective training tool for teaching hysteroscopy.
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