Obstetrics and Gynecology Commons^™

Reducing Postoperative Opioids After Minimally Invasive Hysterectomy With Enhanced Recovery, Kevin D. White, Shirin Azadi, Amanda Pauley, Dr. Brenda L Mitchell,, Nadim Bou Zgheib

Marshall Journal of Medicine

I

Introduction:

We evaluated the efficacy of various strategies utilized for the control of postoperative pain after minimally invasive hysterectomy. The primary enhanced recovery after surgery (ERAS) protocol of interest utilized premedication (acetaminophen, celecoxib and pregabalin), then intraoperative subcutaneous liposomal bupivacaine followed by scheduled oral acetaminophen and ibuprofen postoperatively. Patients also had tramadol and oxycodone as needed for moderate or severe breakthrough pain, respectively.

Materials and Methods:

We conducted a retrospective cohort study that included all patients who underwent minimally invasive hysterectomy (total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy) for both benign and oncologic indications over a 2-year period. We ...

Failure Of Effective Contraception In Opioid Addicted Mothers: A Disparity In Planned And Actual Usage, Robert C. Bowers, Makenzie Hatfield Kresch, Amy Roy, Danielle Lancaster, Jennie L. Yoost

Marshall Journal of Medicine

The ongoing opioid epidemic in West Virginia has given rise to a unique population of opioid-addicted obstetric patients. Appropriate education, counseling, and implementation of contraception is of extreme importance among this high risk patient population. This study was a retrospective chart review aimed at evaluating contraception choice and initiation rates among patients enrolled in a maternal buprenorphine maintenance program compared to non-opioid addicted patients. Rates of planned contraception initiation were compared between the two groups. Rates of actual contraception initiation were also compared. Contraceptive choices were then placed into one of three tiers based on efficacy, and rates of initiation ...

Patient Perceptions Of Planned Organ Removal During Hysterectomy, Zeinab Kassem, Chad M. Coleman, Andrew S. Bossick, Wan-Ting Su, Roopina Sangha, Ganesa Wegienka

Journal of Patient-Centered Research and Reviews

Purpose: Previous reports indicate many women may not have a firm grasp on likely outcomes of different hysterectomy procedures. This study aimed to assess women’s self-reported expectations of how they think their anatomy will change after hysterectomy.

Methods: Women scheduled for hysterectomy at a tertiary care hospital, for non-oncological reasons, reported their planned procedure type and the organs they understood would be removed 2 weeks prior to surgery. Patient reports and electronic medical records were reviewed, and kappa statistics (κ) were calculated to assess agreement for all women and within subgroups.

Results: Most of the 456 study participants (mean ...

The Influence Of Obstetrician And Gynecologists' Avoidance Behaviors On Maternal Morbidities, Nakisha Rene'e Boulware

Walden Dissertations and Doctoral Studies

The prevalence of maternal morbidities continues to increase in U.S. women of lower socioeconomic status and non-Hispanic Black women despite the efforts of health care practitioners to reduce the disparities. Two decades of research has shown that physicians avoid patients based on insurance and socioeconomic status or their malpractice history. Reducing maternal illness and complications is one of the federal government's top 10 maternal health indicators in the Healthy People 2020 initiative. The purpose of this study was to evaluate the influence of malpractice allegations on patients at high-risk for maternal morbidity. Supported by the theoretical foundation of ...

Management Of The Third Stage Of Labor In Second-Trimester Deliveries: How Long Is Too Long?, Jessica J F Kram

Jessica Kram, MPH

No abstract provided.

Introducing E-Consents In A Clinical Setting, Jesse Weiss, Donna A. Santillan, Kellie Thomas, Heather Davis, Mark K. Santillan, Debra Sue Brandt

Proceedings in Obstetrics and Gynecology

Preeclampsia (PE) is a multiorgan hypertensive-disorder in pregnancy that causes significant maternal-fetal mortality and morbidity. The diagnostics and therapeutics for PE are limited due to its unclear etiology. Using the UI Maternal Fetal Tissue Bank, our lab has demonstrated that copeptin is robustly predictive of PE. To investigate copeptin further, we developed the Rule Out Pre-Eclampsia Study (ROPE). The ROPE study recruits women admitted to Labor and Delivery for evaluation of PE. Women are admitted for PE evaluation at all hours. Research team members are not available at all times to obtain consent which limits recruitment. Our project aimed to ...

Betamethasone: A Novel Therapeutic Intervention For Preeclampsia, Sabrina M. Scroggins, Donna A. Santillan, Jeremy A. Sandgren, Gary L. Pierce, Curt D. Sigmund, Justin L. Grobe, Mark K. Santillan

Proceedings in Obstetrics and Gynecology

The early pathogenesis of preeclampsia (PE) involves a systemic inflammatory immune response. Recent data demonstrate that increased circulating arginine vasopressin (AVP) in humans is predictive of PE and that infusion of AVP in mouse dams phenocopies the pregnancy-specific cardiovascular and immune alterations observed in human PE. Specifically, AVP suppresses anti-inflammatory cytokines and cells. Betamethasone (BMTZ), commonly given to women at risk for preterm birth, is both an AVP and immune response modulator. We hypothesize that early treatment with BMTZ will prevent the development of AVP-induced PE.

Static Urine Osmolality With Elevated First Trimester Urine Copeptin In Human Preeclampsia, Donna A. Santillan, Sabrina M. Scroggins, Alyssa T. Ray, Shao Y. Zhang, Curt D. Sigmund, Gary L. Pierce, Justin L. Grobe, Mark K. Santillan

Proceedings in Obstetrics and Gynecology

We have previously shown that maternal plasma copeptin (CPP), as a marker of vasopressin, is highly predictive of preeclampsia (PE) in the first trimester and remains elevated throughout pregnancy. Furthermore, in maternal urine samples we demonstrated that CPP was also significantly elevated in the first trimester in women who later developed PE. Because a urine dipstick test could be easily used in the clinic, we sought to validate this finding in a new and expanded cohort of samples and to determine whether these changes persist throughout pregnancy. In addition, to begin to address the mechanism for this difference, we also ...

Good News About Women & Hpv By Alexander Mortakis Md, Phd, Colleen Stockdale

Proceedings in Obstetrics and Gynecology

Dr. Mortakis is recognized internationally as an expert in HPV infections and lower genital tract diseases. ‘Good News About Women & HPV’ was written to provide an accurate and informational resource for his many patients who are concerned about HPV infections and their health. This book is a practical, hands-on approach for women as well as their partners. In addition to well organized chapters (starting with definitions and an introduction to the HPV virus), he poses and answers over 300 questions. The format is straight forward and presents information using both medical terms and lay definitions to assist the reader in ...

Developing A Program For Residents To Support Training In Research, Donna Santillan, Michaela Wiltgen, Marygrace Elson, Mark K. Santillan

POG In Press

Physicians are expected to be life-long learners and to assimilate and evaluate new knowledge gained from research. Many residencies also require completion of a scholarly project during their residency. However, the majority of residency training is dedicated to enhancing clinical knowledge base and skills. Often, residents are not provided with a structured learning experience and support system for research.

Vestibular Schwannoma Growth During Pregnancy: Case Report Of Neurofibromatosis Type 2 In Pregnancy, Sraavya S. Akella, Jordan N. Mattson, Nina N. Moreira Md

POG In Press

Background: Acoustic neuromas are a common sequela of neurofibromatosis type 2 and have been shown to grow at an increased rate during pregnancy.

Case: 21-year-old female, gravida 1 para 0, with history of neurofibromatosis type 2 presented for prenatal care following new onset seizures and progressive deafness. She was found to have bilateral slow-growing acoustic neuromas. Over the course of her pregnancy, her acoustic neuroma began growing and she became completely deaf. She underwent surgical decompression during her pregnancy and had a late preterm vaginal delivery due to preeclampsia with severe features. She subsequently had further operative and medical treatment ...

Identifying Risk Factors For Preeclampsia In Subsequent Pregnancies In Women With A History Of Preeclampsia, Michaela Wiltgen, Donna A. Santillan, Kellie Thomas, Adam Fitzsimmons, Lindsay Krotz, Heather Davis, Laura Jacobus, Mark K. Santillan, Debra S. Brandt

Proceedings in Obstetrics and Gynecology

Preeclampsia (PE) is a prevalent hypertensive disorder of pregnancy that causes significant maternal-fetal mortality. It has been reported that 60% of maternal mortality can be prevented. Studies have demonstrated that nursing has the ability to influence the mortality rates by providing proactive and competent care. Part of proactive, competent care is to identify those women at the highest risk for PE. Multiple studies have identified a history of PE as a significant risk factor for PE in future gestations. We conducted a nested case control study with our Rule Out Pre-Eclampsia (ROPE) cohort to identify comorbidities most likely to lead ...

Regulatory Dendritic Cell Treatment Prevents The Development Of Vasopressin-Induced Preeclampsia, Sabrina M. Scroggins, Donna A. Santillan, Jeremy A. Sandgren, Gary L. Pierce, Curt D. Sigmund, Justin L. Grobe, Mark K. Santillan

Proceedings in Obstetrics and Gynecology

The concept that persistent feto-placental intolerance is important in the pathogenesis of preeclampsia (PE) has been demonstrated by our lab and others. Arginine vasopressin (AVP) infusion during pregnancy induces cardiovascular, renal, and immune alterations in mice consistent with human PE. These findings identify AVP as a potential contributor to poor fetal tolerance and the development of PE. In addition to their conventional immuno-stimulatory role, dendritic cells (DCs) also play a vital role in immune tolerance. In contrast to conventional DCs, regulatory DCs (DCregs) express low levels of co-stimulatory markers, produce anti-inflammatory cytokines, induce T regulatory cells, and promote tolerance. In ...

Multimodal Perioperative Pain Protocol For Gynecologic Oncology Laparotomy Reduces Length Of Hospital Stay, Jordan N. Mattson, Mackenzie Thayer, Sarah L. Mott, Yasmin A. Lyons, Henry D. Reyes, Megan E. Mcdonald, Abbey J. Hardy-Fairbanks, Emily K. Hill

Proceedings in Obstetrics and Gynecology

Our primary objective was to evaluate the impact of a multimodal perioperative pain regimen on length of hospital stay for patients undergoing laparotomy with a gynecologic oncologist.

Impact Of An Entrustable Professional Activities-Based Assessment System, Megan Lord, Amanda B. Murchison, Alaina Lawrence, Isaiah Johnson

Proceedings in Obstetrics and Gynecology

Background: Beginning in 2014, all Accreditation Counsel of Graduate Medical Education (ACGME) accredited residency programs were required to move to a Milestones-based system for biannual resident assessment. The resident assessment system for the Virginia Tech-Carilion Obstetrics and Gynecology (OB/GYN) residency program was re-designed to meet this requirement in July, 2014. The ACGME Milestones based assessment tool was identified on multiple faculty surveys as an area for improvement. To address this issue, an entrustable professional activities (EPA) based assessment system was designed and implemented for assessment of all OB/GYN rotations.

Objective: To evaluate the impact of an EPA based ...

Small Cell Carcinoma Of The Cervix: A Retrospective Analysis Of Characteristics Important In Outcomes, Jordan N. Mattson, Sarah L. Mott, Yasmin A. Lyons, Jean-Marie Stephan, Michael J. Goodheart

Proceedings in Obstetrics and Gynecology

To assess clinical characteristics and treatment modalities in patients with small cell carcinoma of the cervix and the effect this has on overall (OS) and recurrence free survival (RFS).

Superficial Versus Deep Lymph Node Dissection In Early Stage Vulvar Carcinoma, Jordan N. Mattson, Jenna Emerson, Amita Kulkarni, Amelia Underwood, Grace Sun, Sarah L. Mott, Katina Robison, Emily K. Hill

Proceedings in Obstetrics and Gynecology

Our primary objective was to evaluate the difference in overall survival, recurrence rate, and post-operative morbidity related to superficial versus deep inguinal lymphadenectomy in squamous cell carcinoma of the vulva.

Bilateral Serous Tubal Intraepithelial Carcinoma Associated With High-Grade Serous Carcinoma Of The Peritoneum: Evidence For Transcoelomic Tumor Spread By Extended Lymph Node Evaluation, Hermann Brustmann

POG In Press

Serous tubal intraepithelial carcinoma (STIC) is now considered a putative precursor lesion of most extrauterine high-grade serous carcinomas (HGSC). It is frequently reported in high-risk women and women with advanced-stage serous carcinoma. This case study reports a serous high-grade carcinoma (HGSC) consisting of a bilateral STIC with a focus of stromal invasion in the left tube, and a peritoneal HGSC. The grossly normal-appearing tubes including the fimbriated ends were sectioned following the SEE-FIM protocol. In both tubes, tumor aggregates were exfoliated extensively to the tubal lumens. The neoplastic epithelia in any location were diffusely positive for p53 in strong nuclear ...

First Trimester Elevation In Circulating Endothelin-1 And Arterial Stiffness Are Predictive Of Late Pregnancy Preeclampsia, Alexandria M. Betz, Gary L. Pierce, Donna A. Santillan, Eric J. Devor, Sabrina M. Scroggins, Debra S. Brandt, Amy K. Stroud, Kellie M. Thomas, Seth W. Holwerda, Allison O’Deen, Lyndsey E. Dubose, Justin L. Grobe, Curt D. Sigmund, Mark K. Santillan

Proceedings in Obstetrics and Gynecology

Preeclampsia (PE) is characterized by late pregnancy hypertension and proteinuria. PE causes significant morbidity for the maternal-fetal unit. Circulating endothelin-1 (ET-1), a potent vasoconstrictor, is elevated at the time of diagnosis of human PE. In addition, women with PE demonstrate arterial stiffness as early as the end of the first trimester. However, it is unknown if arterial stiffness is associated with a first trimester elevation in ET-1 and post-delivery placental ET-1. We hypothesized that 1) first trimester plasma ET-1 is elevated and is associated with arterial stiffness in women who develop PE; 2) first trimester ET-1 is predictive of PE ...

Postpartum Larc Use In Low-Risk Women In Centeringpregnancy® Versus Traditional Certified Nurse Midwife Prenatal Care, Tara Hoff, Petra Hahn, Deepti Sharma, Abbey J. Hardy-Fairbanks, Colleen K. Stockdale

Proceedings in Obstetrics and Gynecology

Contraception satisfaction and utilization is linked to pre-use clinical counseling. Group prenatal care may offer increased opportunity for education on postpartum contraception options. This study evaluated postpartum long acting reversible contraception (LARC) rates in women who attend CenteringPregnancy® group prenatal (CP) care versus individual prenatal care with Certified Nurse Midwives (CNM).