Cervical evaluation in pregnancy: proper measurement, evaluation, and management.

Preterm birth is the leading cause of perinatal morbidity and mortality in developed nations. The heterogeneous causes of spontaneous preterm birth make prediction and prevention difficult. The primary importance of transvaginal cervical sonography and cervicovaginal fetal fibronectin lies in their high negative predictive values in assessing risk for preterm birth. Cervical length may be useful in identifying women who are candidates for cervical cerclage or progesterone therapy for preterm birth prevention. Together, cervical length and fibronectin can be used in the triaging of women symptomatic for preterm labor

Workplace Violence in Health Care--It\u27s Not Part of the Job .

IMPORTANCE: While health care workers comprise just 13% of the US workforce, they experience 60% of all workplace assaults. This violence is the second leading cause of fatal occupational injury. Women comprise 45% of the US labor force but 80% of health care workers, the highest proportion of females in any industry. OBJECTIVE: The purpose was to describe the prevalence, forms, and consequences of health care workplace violence (WPV). The role and components of prevention programs for avoiding or mitigating violence are discussed, including opportunities for participation by obstetrician-gynecologists. EVIDENCE ACQUISITION: A search of PubMed from 1990 to February 1, 2016, identified relevant manuscripts. Additional studies were found by reviewing the manuscripts\u27 references. Government Web sites were visited for relevant data, publications, and resources. RESULTS: Health care WPV continues to rise despite an overall decrease in US WPV. While workers are most likely to be assaulted by clients or patients, they are most frequently bullied and threatened by coworkers. All incidents are markedly underreported in the absence of physical injury or lost work time. Sequelae include physical and psychological trauma, adverse patient outcomes, and perceived lower quality of care. CONCLUSIONS: The human, societal, and economic costs of health care WPV are enormous and unacceptable. Comprehensive prevention, planning, and intervention offer the best means of mitigating risks. As women\u27s health physicians and health care workers, obstetrician-gynecologists should be encouraged to participate in such efforts

Biophysical and biochemical screening for the risk of preterm labor: an update.

The heterogeneous causes of spontaneous preterm birth make prediction and prevention difficult. Recently developed biochemical and biophysical tests add significantly to clinicians\u27 ability to evaluate and treat women at risk for spontaneous preterm birth. The primary importance of transvaginal cervical sonography and cervicovaginal fetal fibronectin lies in the high negative predictive values of the tests for preterm delivery risk. Cervical length may be useful in identifying women who are candidates for cervical cerclage or progesterone therapy for preterm birth prevention. Together, cervical length and fibronectin can be used in the triaging of women symptomatic for preterm labor

Promoting preconception, pregnancy, and postpartum care following bariatric surgery: a best practice planning toolkit for patients and their physicians.

Most bariatric procedures are performed in reproductive-aged women. Managing sequelae of postoperative anatomic and physiologic changes can be complex, particularly in women. Standardizing preconception, pregnancy, and postpartum management may limit practice variation and improve pore. We therefore provide a clinical toolkit consisting of physician checklists and corresponding written patient educational material to achieve these goals

Preparing a research presentation: a guide for investigators.

Many obstetrics and gynecology residencies require trainees to complete a research project as a graduation requirement. These projects may be submitted for publication in a peer-review journal or presentation at a professional meeting. Although written instructions are available for novice authors, few references target research abstract submission and presentation. This paper provides investigators with the advice to successfully negotiate this process

Transient Idiopathic Polyhydramnios: Maternal and Perinatal Outcomes: Maternal and Perinatal Outcomes

OBJECTIVES: To compare maternal and perinatal outcomes in pregnancies with transient and persistent idiopathic polyhydramnios to those with normal amniotic fluid volume. METHODS: This retrospective cohort study included subjects delivering a singleton pregnancy between January 1, 2015, and June 30, 2020, with sonography ≥26 weeks\u27 gestation demonstrating transient or persistent idiopathic polyhydramnios (amniotic fluid index [AFI] ≥24.0 cm) or normal AFI (referent group). The primary maternal outcome was a composite of spontaneous preterm delivery \u3c37 \u3eweeks, cesarean delivery for malpresentation, abnormal labor progress, or nonreassuring fetal status, operative vaginal delivery, hemorrhage requiring transfusion, and umbilical cord prolapse. The primary perinatal outcome was a composite of birthweight \u3e4500 g, fetal or neonatal death, 5-minute Apgar score 24 hours. RESULTS: Patients with transient polyhydramnios (n = 259) exhibited maternal outcomes similar to those of the referent group (n = 435) but had significantly increased odds for the primary perinatal outcome (odds ratio [OR] 1.70, 95% confidence interval [CI] 1.15-2.53; P = .008) and for birthweight ≥4500 g (OR 8.70, 95% CI 1.89-40.0; P = .005). Persistent polyhydramnios (n = 176) was significantly associated with both the primary maternal (OR 1.93, 95% CI 1.27-2.95, P = .002) and primary perinatal outcome (OR 2.15, 95% CI 1.40-3.30; P \u3c .001), and individually with cesarean delivery for abnormal labor (OR 3.22, 95% CI 1.55-6.68; P = .002) and birthweight ≥4500 g (OR 8.97, 95% CI 1.84-43.6; P = .007). CONCLUSIONS: Transient idiopathic polyhydramnios does not impact maternal outcomes but is associated with increased odds of newborn birthweight \u3e4500 g. Persistent polyhydramnios is associated with both adverse maternal and perinatal outcomes

U.S. acute care hospital shootings, 2012-2016: A content analysis study.

BACKGROUND: Healthcare workers experience a disproportionately high frequency of workplace assaults. Incidents involving firearms are of particular concern. OBJECTIVE: To provide detailed characterizations of recent hospital shootings to better inform prevention and mitigation strategies. METHODS: Quantitative content analysis of reports involving hospital shootings resulting in casualties derived from web searches for each year from 2012-2016. Data were abstracted independently by two investigators, with differences resolved by consensus. Data were compared between subgroups by chi-square test, Fisher\u27s exact test, or Kruskal-Wallis test, as appropriate. RESULTS: Eighty-eight shootings occurred in 86 hospitals resulting in 121 firearms-related casualties, including 54 victims and 67 perpetrators. Case fatality rates were 55.6% (n = 30) and 70.1% (n = 47), respectively. The most frequent sites involved were the emergency department, (n = 27, 30.3%), patient room (n = 19, 21.3%), and parking lot (n = 13, 14.6%). Grudge (n = 17, 19.3%), suicide (n = 14, 15.9%), and mental instability (n = 13, 14.8%) were the most common explanations for these shootings. Four inadvertent discharges occurred and were more likely to involve a female perpetrator (p = 0.03). Shootings were most frequent during summer (p = 0.03) and winter (p = 0.04). CONCLUSIONS: Out study findings on location and seasonal patterns can guide the development or improvement of prevention and mitigations strategies for hospital shootings

First trimester transabdominal chorionic villus sampling--does the needle matter?

PURPOSE: To compare first-trimester transabdominal chorionic villus samples (TA-CVS) when obtained by 20-gauge amniocentesis versus lancet needles. METHODS: This is a retrospective study of all women with viable singleton pregnancies undergoing TA-CVS from 01/01/2009 to 03/31/2011. All CVS were performed by a single operator using a freehand technique and amniocentesis needles from 01/01/2009 to 08/31/2010 and lancet needles from 09/01/2010 to 03/31/2011. All samples were processed by the same laboratory. RESULTS: There were no differences between groups regarding maternal age, weight, gestational age at CVS, indication for CVS, uterine position, or placental location. Lancet needles were associated with significantly larger samples (median 18 [range 3-40] versus 7 [range 1-33] mg, p \u3c 0.0001), more successful in situ hybridization (96% versus 74.2%, p = 0.03), and faster result reporting (median 7 [range 5-12] versus 9 [range 6-26] days, p = 0.002). CONCLUSIONS: Needle type may be clinically important when selecting 20-gauge TA-CVS needles

Clinical pitfalls in misoprostol-based medical management of first-trimester induced and presumed spontaneous abortion.

When administered inappropriately, first-trimester misoprostol management of induced or spontaneous abortion can result in loss or damage of a continuing pregnancy. Despite these serious consequences, such misoprostol exposures continue to occur. Unfortunately, contributing factors and preventive measures receive little attention. We describe the cases of 4 women in whom misoprostol was inappropriately administered during management of induced and presumed spontaneous abortion. In each case, careful adherence to published clinical guidance could have avoided the exposures

The chorionic bump: etiologic insights from two pathologic pregnancies.

The clinical significance and etiology of the chorionic bump remain unclear. We describe two pregnancies characterized by chorionic bumps, which subsequently were diagnosed with a complete mole and trisomy 18, respectively. We hypothesize that placental pathology, including edema and hydropic villi, may contribute to or cause the sonographic finding of some chorionic bumps. An association between chorionic bumps and aneuploidy awaits future study. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:452-454, 2016