Diabetes is the most common metabolic dysfunction in pregnancy. The objective of this study was to assess the effectiveness of diabetes knowledge using various educational interventions, including Web-based, traditional in-person class, and a combination of Web-based and in-person education. A quasi-experimental nonequivalent control group pre/posttest design was utilized to assess diabetes and nutrition-related knowledge. There was no statistical difference found among the 3 interventions regarding the mean difference in pretest and posttest scores (P > .05). However, there was a statistically significant mean change in pretest and posttest scores for each intervention group (P < .05), indicating an improvement in nutrition knowledge in each group.
HighlightsManagement of cervical leiomyosarcoma in pregnancy requires a multidisciplinary approach.Ovarian preservation is preferred in young patients with early stage cervical leiomyosarcoma.Routine lymphadenectomy in patients with early stage cervical leiomyosarcoma is not useful.
Importance Surrogacy allows for parenthood when it is otherwise impossible or exceedingly difficult; however, the risks of surrogate pregnancy for the gestational surrogate and the fetus are not well defined. Objective The aim of this study was to review the literature to examine the prevalence and requirements of surrogate pregnancy and maternal and perinatal outcomes. Evidence Acquisition A CINAHL and 2 PubMed searches were undertaken using the terms “surrogate mothers” OR “(surrogate or surrogacy)” AND “(mothers OR pregnancy OR pregnant).” The second search used these terms and pregnancy outcomes. The search was limited to the English language, but the years searched were unlimited. Results The search identified 153 articles, 36 of which are the basis for this review. The number of surrogate pregnancies is increasing in the United States. Fetal risks associated with surrogacy include low birth weight, increased risk of multiple gestation, and preterm birth. Maternal complications associated with surrogate pregnancy include hypertensive disorders of pregnancy, postpartum hemorrhage, and gestational diabetes. Conclusions and Relevance Surrogacy is a route to parenting that is not without risk to the surrogate or the fetus, and surrogate pregnancy is increasing in frequency in the United States. Target Audience Obstetricians and gynecologists, family physician. Learning Objectives After completing this activity, the learner should be better able to identify candidates for surrogacy; describe the effects of obesity on surrogacy; and explain the maternal and perinatal complications associated with surrogate pregnancy.
Importance Uterine torsion is an uncommon but life-threatening clinical situation that requires a high index of suspicion for diagnosis. Objective The aim of this study was to review literature and determine the etiology, presentation, diagnosis, and management of uterine torsion in the gravid and nongravid patients. Evidence Acquisition A literature search was undertaken by our research librarian using the search engines PubMed and CINAHL. The search terms used were “uterine torsion” OR (uterus and torsion). The search was limited to the English language, but the years searched were unlimited. Results The search identified 177 articles, 91 of which are the basis for this review. There have been 41 cases or gravid uterine torsion, their characteristics, and symptoms published since 2006. Torsion is rare in nongravid patients, but can still occur. Conclusion and Relevance Uterine torsion is rare, can affect all ages, and can have significant implications for women. Prompt recognition allows for timely intervention and can mitigate harm. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to diagnose uterine torsion in the gravid and nongravid uteri and identify causative factors if present; ascertain differences in uterine torsion presentation in gravid and nongravid patients; identify severity of symptoms from asymptomatic to acute; and implement a treatment plan based on the reduction of morbidity and mortality while considering fertility preservation.
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.
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