Assessment of bowel function in the peripartum period.

PURPOSE: Obstetric patients frequently experience changes in bowel function, throughout pregnancy and into the postpartum period. Little is known regarding the timing and consistency of bowel movements immediately postpartum. The primary aim of this study was to characterize the timing and consistency of the first bowel movement after obstetric delivery in a racially diverse population at an academic medical center. METHODS: Patients were approached on the day of delivery. Patients received a data collection survey to record the date and consistency of their first bowel movement. Consistency was assessed using the Bristol Stool Form Scale. RESULTS: One hundred and sixty-nine patients were enrolled and 101 completed surveys were returned, for a response rate of 59%. The average number of days to first bowel movement was 1.55 versus 3.38 (p < 0.01), for vaginal delivery and cesarean section, respectively. Univariate analysis revealed cesarean delivery (+1.79 days, p < 0.01) and breastfeeding (-0.64 days, p = 0.01) as independent factors affecting the timing of the first bowel movement. CONCLUSIONS: Both route of delivery and breastfeeding status may affect timing and consistency of the first bowel movement after obstetric delivery.

Assessing current trends in resident hysterectomy training.

OBJECTIVES: : Our survey assessed the current trends in hysterectomy experience in US obstetrics and gynecology (OG) residency programs and residents' and program directors' perceptions of robotic surgery's effect on surgical training. METHODS: : An online survey was e-mailed to program directors and graduating residents of 42 US OG programs. RESULTS: A total of 21 program directors and 35 graduating residents responded. There was no significant difference between the number of hysterectomies residents and program directors thought should be performed. Only 38.1% of program directors and 27.8% of residents reported graduating residents as being "completely prepared" to perform a vaginal hysterectomy compared with 76.2% and 58.3% for abdominal, 28.6% and 22.2% for laparoscopic, and 0% and 2.8% for robotic hysterectomies. Only 12.1% of graduating residents and 17.7% of program directors reported residents sitting at the console "often" or "always" during robotic surgery. Only 34.3% of residents plan to perform robotic hysterectomy after graduation. Both residents (77.2%) and program directors (71.5%) reported that robotic surgery is having a negative impact on residents' training nationally. CONCLUSIONS: : Graduating residents report adequate numbers of vaginal and abdominal hysterectomies. Both residents and program directors report that graduating residents are not prepared to perform all types of hysterectomies. Both residents and program directors express concern that robotic surgery is negatively impacting surgical training. Further efforts are needed to ensure that residents are graduating with surgical proficiency in these basic gynecologic procedures.