Left-sided gastroschisis: A case report and review of the literature

The fetus of a 29 year old G2P1 was diagnosed on routine prenatal ultrasound in the early second trimester with gastroschisis. Classically, gastroschisis is a right-sided periumbilical abdominal wall defect. Our case is highly unusual because the gastroschisis defect was on the left. None of the current theories of the embryogenesis of right sided gastroschisis adequately explain how the defect can arise on the left. Associated congenital anomalies are rare in gastroschisis but our patient had a left talipes deformity, digital anomalies of the right hand and persistent left superior vena cava. Also, our patient had severe problems with gastrointestinal motility and a protracted surgical course. A review of the literature suggests that this case represents the 26th reported case of left-gastroschisis

Remote gestational weight gain monitoring in a large low-risk US population

Background: Over the past decade there have been rapid advancements in telemedicine and mobile health technology (mHealth) and rapid increases in adoption of these technologies among OB-GYN providers. Mobile technology is routinely used in the general adult population to simplify monitoring of food intake and weight. Studies have demonstrated that weight loss achieved via remote monitoring, through use of wi-fi scales and web applications, is similar to weight loss achieved with in-person support. These technologies also increase flexibility for subjects and providers. However, there has been limited large-scale research to evaluate the use of these technologies to improve adherence to weight-gain recommendations during pregnancy. Objectives: To evaluate gestational weight gain tracking in a large low-risk obstetrical population using remote patient monitoring and a mobile phone app. Methods: Self-reported age, height, estimated due date, and weight data were extracted from low-risk, singleton pregnancies entered from 50,769 participants who were enrolled in the phone app between 1 January 2016 and 1 March 2020. After data cleaning, 15,468 participants were included the final analysis. Linear regression and Spearman\u27s correlation were used to examine the relationships between total weight gain, rate of weight gain, body mass index (BMI), postpartum weight loss, and app engagement. Results: The average weight gain in the first, second, and third trimester were 0.09 ± 1.8 kg, 4.2 ± 3.3 kg, and 3.9 ± 3.9 kg, respectively. The average rate of weight gain per week for the second and third trimesters were 0.5 ± 0.4 kg/wk and 0.6 ± 0.8 kg/wk, respectively. Participants with higher initial BMI had slower rate of weight gain than those with lower initial BMI (= -0.24, = -0.05, for second and third trimester, respectively). Overall, 21.4% of participants met the Institutes of Medicine (IOM) recommendation for total weight gain during pregnancy. Patients who were highly engaged with the mobile app had increased adherence to the IOM guidelines (29.8% vs. 9.4%, \u3c 0.001). A larger proportion of highly engaged patients adhered to the IOM guidelines for rate of weight gain in the second and third trimester, compared to the lowest engaged patients (12.7% vs. 6.8%, \u3c 0.001). On average, participants lost 8.8 ± 3.3 kg over an average of 8.1 ± 4.6 weeks in the immediate postpartum period. This weight loss was positively associated with engagement ( = 0.3, \u3c 0.001). Comments: Engagement with the mobile app was associated with increased adherence to the IOM gestational weight gain guidelines and with increased postpartum weight loss. Use of remote patient monitoring in conjunction with mHealth technology may be a strategy to improve adherence to IOM guidelines

An update to tranexamic acid trends during the peripartum period in the United States, 2019 to 2021

BACKGROUND: Results from the 2017 World Maternal Antifibrinolytic trial found that patients who received tranexamic acid during delivery had significantly lower rates of death and hysterectomy. Several months after the World Maternal Antifibrinolytic trial publication, American College of Obstetricians and Gynecologists endorsed the consideration of tranexamic acid usage when traditional uterotonics fail during postpartum hemorrhage. Since then, tranexamic acid usage has become more mainstream for the treatment of postpartum hemorrhage. OBJECTIVE: This study aimed to evaluate tranexamic acid trends in obstetrics both temporally and geographically within the United States. Additional outcomes included patient demographics and perinatal outcomes. STUDY DESIGN: This retrospective cohort study included 19 hospitals divided into East, Central, and West geographic regions within the Universal Health Services, Incorporated network. Rates of tranexamic acid use were compared from July 2019 through June 2021. Patient demographics and perinatal outcomes were analyzed for tranexamic acid recipients. RESULTS: During the two-year study period, 3.2% (1580/50,150) of patients received tranexamic acid during delivery. The western region of the United States demonstrated increased tranexamic acid use over the 2-year study period. Recipients of tranexamic acid were more likely to have a history of postpartum hemorrhage (P\u3c.0001), chronic hypertension (P\u3c.0001), preeclampsia (P\u3c.0001), and/or diabetes (P=.004). Patients who received tranexamic acid did not have an increased likelihood of venous thromboembolism in comparison with those who did not receive tranexamic acid (8 [0.5%] vs 226 [0.5%]; P=.77). Of those who received tranexamic acid, 53.2% (840/1580) had an estimated blood loss \u3c1000 mL. CONCLUSION: Nationally, a higher percentage of patients received tranexamic acid without a postpartum hemorrhage diagnosis compared with previous studies, and the western region of the United States had an overall increased use of tranexamic acid during delivery compared with previous years. There was no increased risk of venous thromboembolism in those who received tranexamic acid, regardless of postpartum hemorrhage diagnosis

Adverse perinatal outcomes in a large United States birth cohort during the COVID-19 pandemic

BACKGROUND: The impact of coronavirus disease 2019 (COVID-19) on adverse perinatal outcomes remains unclear. OBJECTIVE: This study aimed to investigate whether COVID-19 is associated with adverse perinatal outcomes in a large national dataset and to examine the rates of adverse outcomes during the pandemic compared with the rates of adverse outcomes during the prepandemic period. STUDY DESIGN: This observational cohort study included 683,905 patients, between the ages of 12 and 50, hospitalized for childbirth and abortion between January 1, 2019, and May 31, 2021. During the prepandemic period, 271,444 women were hospitalized for childbirth. During the pandemic, 308,532 women were hospitalized for childbirth, and 2708 women had COVID-19. The associations between COVID-19 and inhospital adverse perinatal outcomes were examined using propensity score-adjusted logistic regression. RESULTS: Women with COVID-19 were more likely to experience both early and late preterm birth (adjusted odds ratios, 1.38 [95% confidence interval, 1.1-1.7] and 1.62 [95% confidence interval, 1.3-1.7], respectively), preeclampsia (adjusted odds ratio, 1.2 [95% confidence interval, 1.0-1.4]), disseminated intravascular coagulopathy (adjusted odds ratio, 1.57 [95% confidence interval, 1.1-2.2]), pulmonary edema (adjusted odds ratio, 2.7 [95% confidence interval, 1.1-6.3]), and need for mechanical ventilation (adjusted odds ratio, 8.1 [95% confidence interval, 3.8-17.3]) than women without COVID-19. There was no significant difference in the prevalence of stillbirth among women with COVID-19 (16/2708) and women without COVID-19 (174/39,562) (P=.257). There was no difference in adverse outcomes among women who delivered during the pandemic vs prepandemic period. Combined inhospital mortality was significantly higher for women with COVID-19 (147 [95% confidence interval, 3.0-292.0] vs 2.5 [95% confidence interval, 0.0-7.5] deaths per 100,000 women). Women diagnosed with COVID-19 within 30 days before hospitalization were more likely to experience early preterm birth, placental abruption, and mechanical ventilation than women diagnosed with COVID-19 \u3e30 days before hospitalization for childbirth (4.0% vs 2.4% for early preterm birth [adjusted odds ratio, 1.7; 95% confidence interval, 1.1-2.7]; 2.2% vs 1.2% for placental abruption [adjusted odds ratio, 1.86; 95% confidence interval, 1.0-3.4]; and 0.9% vs 0.1% for mechanical ventilation [adjusted odds ratio, 13.7; 95% confidence interval, 1.8-107.2]). CONCLUSION: Women with COVID-19 had a higher prevalence of adverse perinatal outcomes and increased in-hospital mortality, with the highest risk occurring when the diagnosis was within 30 days of hospitalization, raising the possibility of a high-risk period

Away Rotations in Obstetrics and Gynecology: A Survey of Program Directors

OBJECTIVE: To evaluate residency program director views on the purpose and value of an away rotation for students applying to a residency application in Obstetrics and Gynecology (OBGYN). DESIGN, SETTING, AND PARTICIPANTS: The Council on Resident Education in Obstetrics and Gynecology administered a 28-question survey to current U.S. program directors in OBGYN in 2022. Program directors were asked if they offered away rotations to visiting medical students and if so, what the purpose the rotation played in their application process and whether rotating students were automatically offered a residency interview. Program characteristics such as program size, geographic location, and program type (university, community, or military based) were ascertained. A test of proportions was utilized to understand the relationship between program description and survey responses. RESULTS: Seventy-nine percent (224/285) of OBGYN PDs responded to the survey and consented to participation. Programs were representative of the types of training program, size of programs, and geographic location. Of respondents, 77.2% (173/224) of PDs indicated that away rotations were offered at their institution, but only 26.6% (46/173) of residency PDs assessed prospective candidates for away electives. The opportunity to provide students an audition for a residency position was the most common reason to offer an elective. Only 34.7% (60/173) of OBGYN PDs guaranteed an interview to students who completed away electives at their institution. The majority (118/173, 68.2%) of PDs indicated less than 25% of their current residents had completed an away rotation with their program. CONCLUSIONS: Many residency programs offered away electives to prospective applicants, but the majority did not personally assess applicants for competitiveness or guarantee interviews to students completing electives. To increase transparency in the application process, programs should publicize the purpose of away rotations and provide information on the number of interviews granted to students who complete away rotations

Analysis of sociodemographic factors affecting ambulatory surgical center discharge patterns for endometrial cancer hysterectomies

STUDY OBJECTIVE: Investigateoutcomes for patients undergoing minimally invasive hysterectomies (MIH) performed for endometrial cancer at ambulatory surgery centers (ASC). DESIGN: Our study aims to explore the feasibility and discharge outcomes for MIHs for endometrial cancer in an ASC setting by utilizing same-day discharge data. SETTING: The prevalence of MIH for endometrial cancer between 2016-2019 was estimated from the Nationwide Ambulatory Surgery Sample (NASS). PATIENTS: Patient who underwent MIHs for endometrial cancer at an ASC were included. INTERVENTIONS: N/A MEASUREMENTS: Weighted estimates of prevalence and association between discharge status and sociodemographic factors were explored. Same-day discharge was defined as discharge on day of surgery, and delayed discharge was defined as discharge after day of surgery. MAIN RESULTS: An estimated 95,041 MIH for endometrial cancer were performed at ASCs between 2016-2019. 91.9% (n= 87,372) resulted in same-day discharge, 1.2% (n=1,121) had delayed discharge, and 6.9% (n=6,548) had missing discharge information. 78.7% procedures (n=68,812) were performed at public hospitals. The proportion of delayed discharges were lower in private, not-for profit ASCs (0.8%, p=0.03) compared to public hospitals. Patients who had delayed discharges on average were older (69.7 vs. 62.4 years, p\u3c.001), more likely to have co-morbid conditions including diabetes (aOR 1.48, 95% CI 1.25-1.75); overweight or obese BMIs (aOR 1.18, 95% CI 1.01-1.39), and more likely to have public insurance (aOR 1.78, 95% CI 1.40-2.25). CONCLUSION: MIHs for endometrial cancer are feasible in an ASC. Optimal candidates for receipt of MIHs for endometrial cancer at an ASC are patients who are younger, have less comorbidities, lower BMI, and private insurance