Limited Uptake of Planned Intrauterine Devices During the Postpartum Period.

OBJECTIVES: The primary objective of this study was to determine the percentage of women with a documented plan for postpartum intrauterine device (IUD) insertion who had a device inserted within 8 weeks of delivery. The secondary objective was to determine factors associated with successful initiation of postpartum IUDs as planned. METHODS: We conducted a retrospective chart review of women who had at least one prenatal visit and delivered a viable pregnancy at our academic medical center. Methods of planned and established postpartum contraceptive methods were recorded, as well as demographic information and documented reasons for failure to initiate planned intrauterine contraception. RESULTS: A total of 110 women planned postpartum IUD placement. Of these women, 84 (76%) presented for at least one postpartum appointment. Only 22.6% (95% confidence interval 13.7-31.5) of those presenting for postpartum follow-up underwent IUD placement within 8 weeks of delivery. Women planning postpartum IUD insertion were just as likely as women with no planned postpartum contraceptive method to fail to establish contraception within 8 weeks (P = 0.55). CONCLUSIONS: Failure to establish planned postpartum intrauterine contraception occurs frequently, even in a setting with a high rate of postpartum follow-up.

Loss of consciousness and seizure during normobaric hypoxia training.

Loss of consciousness is a symptom with a broad differential diagnosis. Distinguishing between syncope and seizure in a patient with a history of loss of consciousness can be equally difficult as their presentation can be very similar. We present the case of a naval electronic countermeasures officer who experienced a loss of consciousness while undergoing hypoxia training with the reduced oxygen breathing device (ROBD). During the episode the patient experienced tonic-clonic contractions with subsequent vertebral fractures, resulting in a prolonged grounding period. The patient's work-up focused on ruling out inherent cardiac and neurologic etiologies. After extensive examination and consultation with neurology, the patient was diagnosed with hypoxia-induced seizure, but was not felt to have an underlying seizure disorder. After reviewing his case, the Naval Aerospace Medical Institute felt that this incident represented a physiologic event and not a medical condition inherent to the aviator. It was, therefore, determined that this episode was not considered disqualifying and did not require a waiver for return to duties involving flight. Our discussion details the appropriate work-up for loss of consciousness, examines possible physiologic explanations for this event, and describes aeromedical considerations. The authors include the patient's physiology instructor, one, of the primary witnesses for the event, and the patient's flight surgeon, who was extensively involved in his care.

Uterine leiomyomatosis with intracaval and intracardiac extension.

► Intravenous leiomyomatosis is histologically benign, but biologically aggressive. ► No diagnostic tools reliably distinguish it from leiomyosarcoma prior to surgery. ► Complete resection is curative, but antiestrogens can stabilize disease.

Malignant mixed ovarian germ cell tumor with embryonal component.

BACKGROUND: Malignant germ cell tumors of the ovary are relatively rare, making up less than 10% of all ovarian cancers. However, although they represent only a small fraction of ovarian cancers overall, they frequently affect adolescent women of reproductive age, making fertility sparing treatment of paramount importance. Malignant germ cell tumors are subdivided into dysgerminoma and nondygerminomatous tumors. The most common types of nondysgerminomatous tumors are yolk sac and immature teratoma. Mixed germ cell tumors with embryonal carcinoma, nongestational choriocarcinoma, and polyembryoma are less common. Embryonal carcinomas, though rare, are one of the most malignant cancers arising in the ovary. CASE: A 19-year-old female with abdominal pain and massive ascites was found to have a malignant mixed ovarian germ cell tumor with a large embryonal component which was treated via surgical resection and chemotherapy. CONCLUSIONS: Malignant germ cell tumors frequently affect adolescent women of reproductive age. Management of these tumors requires consideration of fertility sparing surgical techniques and chemotherapy management. Using these techniques, the vast majority of patients will maintain their ovarian function and the ability to bear children after their recovery.