The Effect of a Targeted Educational Activity on Obstetrics and Gynecology Resident In-Training Examination Scores.

The objective of this study was to compare the examination scores before and after implementation of a study program based on high yield topics on the Council of Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. This prospective cohort study compared scores from academic years 2012 to 2014 of University of Hawai'i obstetrics and gynecology residents who participated in a directed study program based on selected high yield topics from the CREOG Test Item Summary Booklet. Topics were considered high yield if more than 75% of the program residents answered the topic questions incorrectly during the immediately preceding CREOG In-Training Examination administration. Residents were assigned topics to research and present at monthly teaching sessions. The presentations were made accessible in a wiki website. The intervention was initiated in 2012 and discontinued in 2013. The primary outcome was the difference among CREOG In-Training Examination scores before the study program, during the study program, and after the study program was discontinued. Only scores of residents who sat for all three exams were included. Eleven residents were present during the duration of the study period and sat for all three CREOG examinations. During the year of the educational activity, paired individual resident CREOG exams scores increased significantly from the 2012 CREOG administration (mean = 194.7) to the 2013 CREOG administration (mean = 208.2). These findings demonstrate that the CREOG Test Item Summary Booklet and the wiki platform can be used to effectively direct educational efforts resulting in improvements in CREOG examination performance.

Cesarean delivery times and adhesion severity associated with prior placement of a sodium hyaluronate-carboxycellulose barrier.

OBJECTIVE: To evaluate the association between the prior use of a sodium hyaluronate-carboxycellulose adhesion barrier and the incision-to-delivery time and adhesion scores at first repeat cesarean delivery. METHODS: In this cohort study, intraoperative data were prospectively collected at the time of the study participants' first repeat cesarean delivery. Subsequent retrospective chart review of each patient's primary cesarean operative note was then performed to determine whether hyaluronate-carboxycellulose barrier film had been used. The primary outcome was incision-to-delivery time. Secondary outcomes were adhesion grade and blood loss. RESULTS: A total of 97 patients were analyzed; 71 did not have hyaluronate-carboxycellulose barrier film used during their primary cesarean and 26 did. Mean ± standard deviation incision-to-delivery time was 9.5 ± 4.3 minutes in the no hyaluronate-carboxycellulose barrier film group and 10.6 ± 5.8 minutes in the hyaluronate-carboxycellulose barrier film group (P=.8). Average blood loss was 564 ± 255 mL and 563 ± 246 mL, respectively (P=.4). There was no difference between the mean fascia adhesion scores (1.45 compared with 1.31 Z -1.06, P=.29) and mean intraperitoneal adhesion scores (1.11 compared with 0.92 Z -1.09, P=.27). Our sample size yielded a power of 91% to detect a 5-minute difference in delivery times and 99% for a 1-point difference in adhesion scores. CONCLUSION: Our study showed no difference in the delivery time, blood loss, or adhesion scores at first repeat cesarean delivery between women who had hyaluronate-carboxycellulose barrier film placed at the time of their primary cesarean delivery and those who did not. LEVEL OF EVIDENCE: : II.

Amniotic fluid arborization in the diagnosis of previable preterm premature rupture of membranes.

OBJECTIVE: To determine the accuracy of using amniotic fluid arborization to diagnose preterm premature rupture of membranes (PPROM) in the second trimester using specimens collected from the vaginal pool. STUDY DESIGN: Women presenting for pregnancy termination between 14 and 22 weeks' gestation were enrolled. At the time of termination, amniotic fluid samples were collected directly from the amniotic sac and from the vaginal pool, air dried and examined for arborization. RESULTS: Arborization was detected in 51/59 (86.4%) samples collected from the amniotic sac and 41/59 (69.5%) samples collected from the vaginal pool. The sensitivity and specificity in detecting arborization in fluid collected by swabbing the vagina was 0.69 and 0.98, respectively (positive predictive value 0.98%, negative predictive value 0.76). CONCLUSION: While the presence of arborization in samples collected from the vaginal pool is predictive of PPROM in the second trimester, the absence of arborization should not rule out the diagnosis if there is strong clinical suspicion.

Transvaginal ovarian cystectomy for adnexal torsion during pregnancy.

Ovarian torsion requiring surgical intervention in pregnancy is rare. Herein is reported a case of ovarian torsion that was managed by transvaginal ovarian cystectomy in a 27 week gravid patient.

Cesarean scar dehiscence associated with intrauterine balloon tamponade placement after a second trimester dilation and evacuation.

While surgical abortion is a safe procedure, the most common complication is excessive bleeding. Methods to conservatively manage hemorrhage are gaining popularity. The authors present a case of a Cesarean scar rupture that occurred after an intrauterine balloon tamponade was placed to treat postabortion bleeding.

Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device.

The intrauterine device (IUD), primarily in the form of the copper IUD, is used by more than 150 million women around the world, making it the most widely used reversible method of contraception. With a remarkably low failure rate of less than 1 per 100 women in the first year of use, the Copper T-380A is in the top tier of contraceptives in terms of efficacy. Risks of utilization include perforation and an increased risk of infection in the first 20 days following insertion. Overall, the number of adverse events is low, making the Copper T-380A a very safe contraceptive method. The most common reasons for the discontinuation of this method are menstrual bleeding and dysmenorrhea. However, cumulative discontinuation rates of Copper T-380A are lower than that have been reported for other methods, indicating that the Copper T-380A is highly acceptable to women. After 5 years, approximately 50% of all women, who have a Copper T-380A inserted, will continue to use this highly effective contraceptive method.

Problem based learning and academic performance in residency.

BACKGROUND: In the Problem Based Learning (PBL) curriculum, knowledge is acquired by solving medical cases. Because of this quality, it has been hypothesized that residents trained in a PBL curriculum during medical school will be better equipped to succeed during residency. The purpose of this study was to compare the academic performance of obstetrics and gynecology residents who were trained using a PBL curriculum during medical school with those who were trained in a traditional curriculum. METHODS: A retrospective analysis was performed on residents at the University of Hawai'i Obstetrics and Gynecology Residency Program between 1997 and 2007. Scores on standardized tests were compared between residents who attended a PBL medical school (PBL group) and residents who attended a traditional medical school (non-PBL group) using a t-test analysis. United States MedicalLicensing Examination (USMLE) Step 1, USMLE Step2, and the Council on Resident Education in Obstetrics and Gynecology (CREOG) examination scores for all four years of residency were compared between the two groups. RESULTS: Thirty-five students had complete data. There were no significant differences between the mean scores in PBL group versus the non-PBL group for the Step 1 (205.7 vs. 202.0, p = 0.491), CREOG PGY1 (197.8 vs. 195.7, p = 0.711), CREOG PGY2 (202.7 vs. 198.1, p = 0.394), CREOG PGY3 (197.3 vs. 201.1, p = 0.545), and CREOG PGY4 (202.4 vs. 198.8, p = 0.531). However, there was a significant difference between the mean scores of the two study groups for the USMLE Step 2 (215.1 vs.202.1, p = 0.046). CONCLUSIONS: Although PBL students performed significantly better on the USMLE Step 2, the academic performance of obstetrics and gynecology residents who attended a PBL medical school and those who attended a traditional medical school was similar.

Impact of paracervical block on postabortion pain in patients undergoing abortion under general anesthesia.

BACKGROUND: Paracervical block is used as a way to decrease postoperative pain in patients having abortions under general anesthesia. To date, no studies have evaluated the efficacy of this practice. STUDY DESIGN: Patients were recruited from a university-based family planning clinic. Seventy-two patients seeking abortion under general anesthesia were enrolled into the single-blinded study. Thirty-nine patients were randomized to receive a paracervical block, and 33 were randomized to no local anesthesia. The patients completed a demographic survey and visual analog pain scales for pain prior to and at several time points after the procedure. Data regarding the need for additional pain medications postoperatively were recorded. Analysis of variance single factor and two-sample one-sided t test were used in data analysis. RESULTS: Experimental and control groups were similar in all measured demographic characteristics. They were also similar in gestational age, number of laminaria required, preoperative dilation, operative time, estimated blood loss and reported complications. Postoperative pain was not significantly affected by placement of a paracervical block prior to abortion under general anesthesia. The need for postoperative pain medication during recovery was similar between groups. CONCLUSION: This study does not support the hypothesized benefit of local anesthesia prior to surgical abortion under general anesthesia to reduce postoperative pain.