Uterine diverticulum.

BACKGROUND: Uterine diverticula complicating pregnancy rarely are reported and should be differentiated from sacculation of pregnancy and other pelvic masses. CASE: A primigravida presented for a routine second-trimester anatomical survey ultrasound examination at 22 weeks of gestation. She initially was thought to have a bicornuate, bicolic uterus with bulging membranes. However, on examination, one normal-appearing cervix was found, and no membranes were visible. Magnetic resonance imaging demonstrated a posterolateral uterine diverticulum. At 31 weeks of gestation, she had premature rupture of membranes and onset of labor. Delivery by cesarean was performed, and the presence of a uterine diverticulum was confirmed. CONCLUSION: Uterine diverticula are rare anomalies in the pregnant uterus and should be considered in the differential diagnosis of a fluid-filled pelvic mass. With close observation, successful pregnancy outcome can be achieved.

They Should Say "I Don't": Norms About Midpregnancy Marriage and Job Loss.

This study examined effects of local economic conditions on individuals' attitudes toward midpregnancy marriages using an experimental vignette method. Adults (N = 460) were each shown two vignettes about a hypothetical couple expecting a baby; within each vignette pair, vignettes randomly varied as to whether the couple lived in a community that had recently experienced job losses or had stable employment. Respondents indicated if the couple should and will get married before the baby's birth. Results showed that worse local economic conditions led people to believe that marriage would be less common. Among more socio-economically disadvantaged respondents, if the hypothetical couple lived in a community with job loss, fewer respondents also thought that the couple should marry. In contrast, among more socioeconomically advantaged respondents, slightly more respondents thought that the couple should marry. When economic conditions worsen, low-socioeconomic-status individuals may believe that financial prerequisites for marriage become harder to meet.

Abortion training in United States obstetrics and gynecology residency programs.

OBJECTIVE: To identify characteristics of programs which provide training in abortion, to calculate the number of procedures done during training, and to compare the availability of abortion training in 2004 with that of prior national surveys. METHODS: An investigator-designed questionnaire about abortion training in obstetrics and gynecology residency programs was mailed to all U.S. residency directors. Collected data included program information, abortion training, and numbers of residents trained. Data were analyzed to estimate differences in abortion training by region, program size, and type of training offered. RESULTS: Of the 252 questionnaires mailed, 185 (73%) were returned. Of the 185, 94 (51%) program directors reported routine instruction in elective abortion, 72 (39%) optional training, and 19 (10%) no training. Large programs and programs located in the Northeast and West Coast were significantly more likely to offer routine training in terminations (P < .01). In the programs offering routine training, more than 50% of residents received instruction in termination practices. Of those practices, the most common were first-trimester surgical abortion (85% of programs), followed by medical abortion (59%), second-trimester induction (51% of programs), and dilation and extraction (36%). As compared with those in programs with optional training, residents in programs with routine training were significantly more likely to receive instruction in all modalities of abortion provision and performed proportionally more first- and second-trimester terminations (P < .01). CONCLUSION: Routine training in elective abortion resulted in greater exposure to abortion practices and greater experience in more complicated abortion techniques during residency.

Abortion training in Canadian obstetrics and gynecology residency programs.

OBJECTIVE: To study abortion training in Canadian obstetrics and gynecology (ob-gyn) residency programs. METHODS: An anonymous questionnaire was sent to all postgraduate year (PGY)-4 and PGY-5 ob-gyn residents (n=130) and residency program directors (n=16) in Canada. The questionnaires inquired about demographic information, details of abortion training, resident participation in training, and intention to provide abortions after residency. RESULTS: Ninety-two of 130 residents (71%) and 15 of 16 program directors (94%) responded. Abortion training is considered routine in approximately half of programs and elective in half. The majority of residents (71%) participated in abortion training, and half plan to do elective abortions after residency. More than half of residents felt competent after training to perform first-trimester aspiration and second-trimester inductions but did not feel competent in first-trimester medical abortions or dilation and evacuation (D&E). Residents were more likely to participate in training if the program arranged the training for residents (P=.04) and were more likely to intend to provide abortions if the training was considered routine (P=.02), while controlling for all significant demographic and training variables. CONCLUSION: Most Canadian ob-gyn programs offer some training in elective abortion, but only half include it routinely in training, and the minority of residents feels competent in D&E and medical abortion. Integrated abortion training was associated with greater resident participation in training and increased likelihood of intention to provide abortions after residency.

Future abortion provision among US graduating obstetrics and gynecology residents, 2004.

BACKGROUND: This study was conducted to identify characteristics associated with US obstetric and gynecology graduating residents' intention to provide pregnancy termination services in their clinical practice. STUDY DESIGN: In this cross-sectional study, we surveyed all 1148 fourth-year residents in obstetrics and gynecology graduating from US training programs in 2004. RESULTS: Of 494 respondents, 187 (39%) planned to perform elective abortions after residency. In multivariable analysis controlling for various factors, the following were independently associated with plans to perform pregnancy termination in the future: pre-residency intentions to provide pregnancy termination [odds ratio (OR), 10; 95% confidence interval (CI), 5.3-18.9; p<.001], performing more than 50 first-trimester abortions during residency (OR, 5.1; 95% CI, 1.3-19.6; p=.02) and plans to enter academic practice (OR, 2.5; 95% CI 1.1-6.2; p=.04). CONCLUSIONS: Intentions before residency to provide pregnancy termination services was the strongest predictor of future abortion provision.