Furosemide for Postpartum Management of Hypertensive Disorders: A Randomized Controlled Study

Loop diuretics have been investigated for managing postpartum hypertensive disorders, but there is currently insufficient clinical evidence pointing to any single agent. This study aims to compare blood pressure (BP) outcomes for patients with gestational hypertensive disorders receiving labetalol alone versus labetalol + furosemide during postpartum hospital stay. The primary aim was to learn if loop diuretic incorporation in conjunction with labetalol could lower the need for additional anti-hypertensive agents.https://corescholar.libraries.wright.edu/urop_celebration/1147/thumbnail.jp

Obstetrics Emergency Labor and Delivery Case Simulations with Normal Vaginal Delivery Demonstration: A Hands-on Simulation for Clerkship Students

Introduction: Simulation is rarely used for medical student education in the field of obstetrics. This method is an effective model of learning for topics that are encountered in clinical situations and for topics that pose significant risk to patients when an untrained individual is involved. Methods: A 2-hour obstetric delivery simulation session was developed and incorporated into the third-year obstetrics and gynecology clerkship rotation at Wright State University Boonshoft School of Medicine. Medical students completed self-guided content reviews with resources provided prior to the session. During the session, each medical student conducted a normal vaginal delivery and one of the emergent cases (umbilical cord prolapse, pre-eclampsia/eclampsia, shoulder dystocia, and postpartum hemorrhage). During each case the Resident facilitator followed a script which included asking questions using gamification strategies to promote a low-stress learning environment. Critical action checklists were used to ensure students gained a strong understanding of topics. Simulation sessions were conducted both remotely and in-person. The simulation experience was evaluated using surveys and quizzes completed prior to and after participating in the simulation session. Results: Students reported that the simulation experience increased their comfort with emergent obstetric situations, increased their medical knowledge, and was beneficial to their education. Discussion: Simulation is an untapped learning method in obstetrics. We developed simulations for obstetric events to provide medical students with hands-on exposure to important obstetric experiences. This simulation session provides the framework for other medical schools to incorporate these obstetric simulations into their clerkship curriculum

Vulvodynia, A Step-wise Therapeutic Prospective Cohort Study

Vulvodynia is characterised by the presence of vulval allodynia (pain evoked by non-painful stimuli) and vulval dysaesthesias (burning, soreness, rawness, stinging and irritation). We assessed a protocol for the evaluation and management of vulvodynia. The protocol was based on the most recent evidence available. We began a simple evaluation and proceeded to an aggressive one. From the cohort of 74 patients, 69 patients (93.2%) were adherent to the protocol. A total of 25 patients (36.3%) improved after antibiotic therapy: 14 patients (20.4%) had a positive fungal culture and 11 patients (15.9%) had a positive bacterial culture; none with a positive viral culture. Eight patients (11.6%) improved with dietary modification. Ten patients (14.5%) benefitted from tricyclic medications; 13 patients (18.8%) improved after gabapentin therapy; 13 patients (18.8%) did not show improvement of their condition. Some 56 patients (81.2%) manifested an improvement of their symptoms, which allowed them to achieve painless sexual intercourse

Vulvar Problems in Elderly Women: Don\u27t Assume That Menopause Is the Culprit

Like many other parts of the body, the vulva is affected by cessation of estrogen after menopause. Vulvar pruritus and irritation are common findings with normal aging, but they may also be signs of infection, inflammation, or other skin conditions. Misdiagnosis results in incorrect treatment, a dissatisfied patient and, often, referral to a gynecology clinic. In this article, two instructors in the field describe acute and chronic vulvar disorders and summarize how to identify and treat them

Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial disease with a high prevalence. This condition affects Caucasians, African Americans, Africans and Hispanic women, particularly those sexually active at child-bearing age. The etiology of this condition is complex and remains elusive. An accurate diagnosis requires a comprehensive history, physical examination and targeted diagnostic tests. Although many treatment options have been utilized, a rational therapeutic strategy is still under research. Psychological counseling and group support should be considered in all cases

Vulvar Problems in Elderly Women: Don\u27t Assume That Menopause Is the Culprit

Like many other parts of the body, the vulva is affected by cessation of estrogen after menopause. Vulvar pruritus and irritation are common findings with normal aging, but they may also be signs of infection, inflammation, or other skin conditions. Misdiagnosis results in incorrect treatment, a dissatisfied patient and, often, referral to a gynecology clinic. In this article, two instructors in the field describe acute and chronic vulvar disorders and summarize how to identify and treat them

Vulvodynia

Vulvodynia or vulvar pain syndrome is a chronic, heterogeneous, and multifactorial disease with a high prevalence. This condition affects Caucasians, African Americans, Africans and Hispanic women, particularly those sexually active at child-bearing age. The etiology of this condition is complex and remains elusive. An accurate diagnosis requires a comprehensive history, physical examination and targeted diagnostic tests. Although many treatment options have been utilized, a rational therapeutic strategy is still under research. Psychological counseling and group support should be considered in all cases

Reducing Emergency Births by Modification in Oxytocin Utilization

Background: The purpose of our study was to explore the correlation between the amount of oxytocin use and emergency vacuum, forceps, cesarean births and neonatal intensive care unit (NICU) response to fetal distress. In 2004, we restricted the criteria for oxytocin utilization for labor induction and augmentation. Methods: This retrospective study was carried out at a large private university tertiary care hospital- affiliated, and included data from the years 2005 to 2007. We utilized hospital data from vital statistics, labor and delivery, central pharmacy and NICU. Information obtained included maternal characteristics, annual birth data, indication and numbers of emergency vacuum, forceps and cesarean births, oxytocin utilization, and number of NICU responses to fetal distress. Results: The total number of deliveries during the studied period equaled14,184. The oxytocin utilization showed a reduction from 93.3% to 78.9%. The number of patients who did not receive oxytocin during labor increased from 6.7% to 21.1%. The correlation between the reduction of oxytocin utilization with the reduction of emergency cesarean births (10.9% to 5.07%), vacuum briths (9.1% to 8.5%), and forceps birth (4% to 2.3%) including NICU responses to fetal distress (P = 0.0001) revealed a significant statistical difference. The overall cesarean section rate did not indicate a significant increase 29.4% to 29.8% (P = 0.14) nor did the patient’s characteristics differ. Conclusion: In our population, reducing oxytocin appears to strongly correlate with a reduction in the number of emergency vacuum, forceps, cesarean births and NICU responses to fetal distress