The obesity epidemic has touched all aspects of obstetric care, including the practice of cesarean delivery. Obesity is an independent risk factor for cesarean delivery, and the increased prevalence of obesity has contributed to the overall rise in primary cesarean delivery seen over the past few decades. Because of the frequent existence of co-morbidities such as hypertension and diabetes, obesity is a plausible contributor to rising maternal mortality. In addition, obese women who undergo both primary and repeat cesarean delivery have a higher chance to develop surgical and post-operative complications, including wound infection and thromboembolic events. Surgical complications increase steadily with increasing maternal weight. In this chapter, we will review the incidence and contributing factors that lead to cesarean delivery in obese patients, peri-operative complications, and strategies to reduce these risks in obese women undergoing cesarean delivery.
Academic healthcare workforce diversity is important in addressing health disparities. Our goal was to evaluate trends and associations in faculty diversity of United States (US) medical schools over a five-year period. MethodsWe analyzed the Association of American Medical Colleges (AAMC) Faculty Roster data of 151 US medical schools from 2014-2018. Outcome faculty variables were female gender, underrepresented in medicine (UiM), age, and professorial representation. Predictor variables included geographical distributions, and institutional characteristics. Statistical analysis included Jonckheere-Terpstra test, ANOVA, and regression analysis. ResultsFemale faculty increased from 37.6% to 40.4% (p<0.001), senior faculty (age >60 years) from 22.6% to 25.9% (p=0.001) while UiM faculty stayed relatively flat from 9.74% to 10.08% (p=0.773). UiM [adjusted odds ratio (aOR) = 0.39, p=0.015], and female faculty (aOR=0.3, p=0.001) had independently significantly decreased associations with professorial representation, while senior faculty had increased associations (aOR=3.82, p<0.001). Significant independent differences occurred in female, UiM, and professorial faculty distributions within US regions; Hispanic faculty were highest in Southwest (6.57%) and lowest in Midwest region (1.59%), while African-American faculty were highest in Southeast (8.15%) but lowest in the West (3.12%). UiM faculty had significantly independent decreased associations with MD/PhD degree (aOR=0.30, p=0.004) and higher US ranking institutions (aOR=0.45, p=0.009). ConclusionsFrom 2014 to 2018, female faculty increased modestly while the UiM faculty trend remained flat. Female and UiM faculty were less represented at the professor level. UiM faculty were less represented in higher-ranking institutions. Geographic location is associated with faculty diversity.
Objective To determine if outpatient cervical ripening with daily misoprostol can reduce admission to delivery time in women with low-risk pregnancies at 39 or more weeks of gestation. Study design This is a retrospective cohort study of a convenience sample of low-risk pregnancies that underwent elective outpatient cervical ripening compared to matched controls for parity (nulliparous vs. parous) and gestational age. Time from admission to delivery, induction agents, presence of tachysystole, mode of delivery, length of hospitalization, neonatal intensive care unit (NICU) admission, and low Apgar scores were compared. Results Fifty-six patients who underwent outpatient cervical ripening with daily dosing of misoprostol were compared to 56 patients matched for parity and gestational weeks who underwent inpatient cervical ripening/induction of labor with misoprostol. We found the time from admission to delivery in the outpatient cervical ripening cohort was significantly lesser than the inpatient cohort (17.5 ± 11.5 hours outpatient vs. 26.6 ± 15.6 hours inpatient, P=0.001). More patients (N=18, 32%) were able to deliver within 12 hours of admission in the outpatient induction group compared to the inpatient group (N=8, 11%, P=0.010). There were no differences in frequency of cesarean delivery, uterine tachysystole with or without fetal heart rate changes, NICU admission, low Apgar scores, or low umbilical artery pH values between the two groups. Conclusion Outpatient cervical ripening with misoprostol may be a feasible alternative to inpatient cervical ripening in low-risk pregnancies, may help improve patient experience, and reduce the operational burden that elective induction confers upon labor and delivery units.
Objective To assess patient pain and satisfaction and time to delivery following transcervical Foley catheter balloon inflation to 10, 30, or 70 mL with simultaneous administration of oxytocin. Methods We performed a randomized prospective study with 30 or 70 mL transcervical Foley balloon catheters in combination with oxytocin during labor induction at term. A 10 mL group was included as a sham control group. Time to delivery was measured, and a patient questionnaire was administered at the time the catheter was expelled to determine patient pain and satisfaction. Results In 120 enrolled patients, there was a non-significant trend toward reduced time to delivery in the large Foley balloon group (10 mL: 30:45 ± 38:53, 30 mL: 26:41 ± 20:53, and 70 mL 22:40 ± 15:35, hh:mm, P = 0.412). The pain score at the time the balloon was expelled was significantly higher in the 70 ml group compared to the 10 ml and 30 ml groups (P = 0.004 and P = 0.034, respectively). We found no other differences in patient satisfaction or pain scores at the time of placement of the Foley catheter for the three groups. Conclusion Small gains in time to delivery should be balanced against patient experiences, and expectations of pain during the ripening process should be addressed at the time of Foley insertion.
Colorectal cancer during pregnancy is rare. Because of a pattern of delay in childbearing and because colorectal cancer is now diagnosed more often in young adults, the incidence is expected to rise. Diagnosis during pregnancy is challenging as many of the symptoms mimic common pregnancy symptoms. Colonoscopy is the gold standard for diagnosis, but pregnancy is a relative contraindication to colonoscopy. Once diagnosed, pregnant women often have more advanced disease. Due to its rarity, treatment is often based on case reports and limited studies. A multidisciplinary team is important in the optimization of treatment. We present a case of a 29-year-old African-American primigravid with chronic gastrointestinal symptoms diagnosed with colorectal adenocarcinoma at 17 weeks of gestation. She delayed surgical intervention for several weeks due to fear of miscarriage, and ultimately underwent exploratory laparotomy with hemicolectomy and colostomy placement at 20 weeks. Abdominal ultrasound and magnetic resonance imaging revealed non-specific hepatic lesions concerning for metastatic disease, but the patient refused biopsy due to concern for radiation harm to the fetus. Chemotherapy was considered, but postponed until the postpartum period, for fear of fetal harm. Computed tomography imaging after delivery noted an increased number of hepatic lesions, representing progression of her disease. She received two rounds of chemotherapy in the postpartum period, but remained non-compliant with treatment recommendations and ultimately was lost to follow-up. This case presents a delayed diagnosis of colorectal cancer in pregnancy, as well as delayed treatment due to concerns for fetal harm with current therapies. It emphasizes the diagnostic challenges and the complexity and ethical issues involved when a pregnant patient faces a lifethreatening terminal illness. This case adds to the growing body of literature on colorectal cancer in pregnancy and highlights the importance of clinical suspicion, informed patient centered decision making, and tailored treatment goals.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.