SUGAR: spotting undiagnosed glucose abnormal results--a new protocol to increase postpartum testing among women with gestational diabetes mellitus.

OBJECTIVE: Over 70% of women with gestational diabetes mellitus (GDM) will develop diabetes mellitus (DM), but only 30% follow through with the recommended postpartum oral glucose tolerance testing (OGTT). HbA1c is approved to diagnose DM, and combined with a fasting plasma glucose it can identify 93% of patients with dysglycemia. We tested the hypothesis that a single blood draw to assess for dysglycemia at the postpartum visit could improve testing rates compared with those required to obtain an OGTT at an outside laboratory. STUDY DESIGN: Prospective cohort study of all women with GDM who delivered between July 2010 and December 2011. When insurance status required testing at an outside laboratory an OGTT was ordered, when insurance allowed testing at our center a random sugar and HbA1c were drawn at the postpartum visit (SUGAR Protocol). RESULTS: Of the 40 women, 36 attended a postpartum visit. In the SUGAR arm, 19 of 19 (100%) were tested versus 9 of 17 (53%) in the OGTT arm; relative risk of testing was 1.9 (95% confidence interval, 1.2-3.0). 36% were glucose intolerant. CONCLUSION: This pilot study found that an in-office testing model doubled the rate of postpartum testing in this clinic population, and was reasonably sensitive at detecting dysglycemia.

How do patients use email to communicate with their doctor?

OBJECTIVE: To evaluate unsolicited email sent from patients to a general obstetrician-gynecologist. STUDY DESIGN: A retrospective review was performed of 60 unsolicited emails sent to an obstetrician-gynecologist. Time sent, content, and physician response were evaluated. RESULTS: Most emails were sent during office hours. Fifty-four percent of the emails had content related to gynecologic issues. Twenty-seven percent of the emails had content related to obstetrical concerns. Nineteen percent of emails were nonclinical in nature. Fourteen percent of emails required a follow-up phone call. Twenty-nine percent of emails necessitated an office visit. CONCLUSION: Patients did not use email for emergency communication. The participating physician was pleased with the ease of responding to patients, especially while away from the office.

Letters of recommendation: an analysis for evidence of Accreditation Council for Graduate Medical Education core competencies.

OBJECTIVE: To determine if letters of recommendation contain content pertinent to the Accreditation Council for Graduate Medical Education (ACGME) outcome project core competencies and to quantify the content. STUDY DESIGN: Letters of recommendation for candidates accepted into the obstetric/gynecologic residency program at Jersey Shore University Medical Center since 1998 were reviewed by the authors. Letters were evaluated for structure and sentence content. Each sentence was characterized as pertaining to any of the ACGME core competencies or other content. Descriptive statistical analysis was performed. RESULTS: Seventy letters of recommendation were reviewed. Sixty-five (93%) of the letters had at least one sentence related to a competency. Other content made up the bulk of each letter. None of the letters contained negative information. CONCLUSION: Letters of recommendations for candidates to our residency program addressed core competencies; however, the information was not abundant. (J Re-

Verification of publications, presentations and posters by applicants to a residency in obstetrics and gynecology.

OBJECTIVE: To determine if the publications, presentations and posters reported by applicants to the obstetrics and gynecology residency program at Jersey Shore University Medical Center could be verified in electronic databases. STUDY DESIGN: We conducted a retrospective review of all applications for obstetrics and gynecology residency positions at Jersey Shore University Medical Center in 2006. A systematic search using electronic databases was performed on the information reported in the application. RESULTS: There were 111 applicants (45%), who reported a total of 490 items. Of these, 119 (24.3%) were confirmed, 359 (73.3%) could not be confirmed, and 12 (2.4%) were misrepresented. CONCLUSION: The majority of publications, presentations and posters reported by applicants to the obstetrics and gynecology residency program could not be verified in electronic databases.

Yoga in Pregnancy: An Examination of Maternal and Fetal Responses to 26 Yoga Postures.

OBJECTIVE: To examine the acute maternal and fetal effects of yoga postures and suspected contraindicated postures in a prospective cohort of healthy pregnant women in the third trimester. METHODS: This was a prospective study that evaluated pregnant women between 35 0/7 and 37 6/7 weeks of gestation in a one-on-one yoga session. A baseline nonstress test, vital signs, and pulse oximetry were performed. Participants then assumed 26 yoga postures. Vital signs, pulse oximetry, tocometry, and continuous fetal heart rate monitoring were obtained in each posture. Postsession nonstress test, vital signs, and pulse oximetry were obtained. Participants were contacted 24 hours postsession. RESULTS: Twenty-five healthy pregnant women were evaluated. Ten reported regular yoga practice, eight were familiar with yoga, and seven had no yoga experience. Yoga groups were similar in age, race, body mass index, gestational age, and parity. Presession and postsession nonstress tests were reactive. Presession and postsession data showed no change in maternal heart rate, temperature, pulse oximetry, or fetal heart rate. During the 26 yoga postures, vital signs, pulse oximetry, and uterine tocometry remained normal in all women and in all postures. The fetal heart rate across all 26 postures was normal. There were no falls or injuries during the total cumulative 650 poses. No participants reported decreased fetal movement, contractions, leakage of fluid, or vaginal bleeding in the 24-hour follow-up. CONCLUSION: All 26 yoga postures were well-tolerated with no acute adverse maternal physiologic or fetal heart rate changes. LEVEL OF EVIDENCE: III.

Clinical and patient estimation of fetal weight vs. ultrasound estimation.

OBJECTIVE: To compare clinical and patient estimation of fetal weight to ultrasound estimation. STUDY DESIGN: Prospective study of clinical, patient and ultrasound estimation of fetal weight at term. RESULTS: A total of 200 pregnant women participated. There was no statistically significant difference between clinical and sonographic estimates of fetal weight: of the estimates, 64.0% were within 10% of the actual birth weight vs. 62.5% (P > .2). There was no statistically significant difference between patient and sonographic estimates of fetal weight: of the estimates, 53.5% were within 10% of the actual birth weight vs. 62.5%, respectively (P < .1). Senior resident clinical and sonographic estimates of fetal weight were superior to junior resident estimates: 75.2% of clinical estimates were within 10% of the actual birth weight vs. 59.2% (P < .03), and 73.1% of sonographic estimates were within 10% of the actual birth weight vs. 58.3% (P < .05). Nulliparous and multiparous patients were equally accurate in estimating fetal weight: 48.1% of estimates were within 10% of birth weight vs. 57.4% (P > .2). CONCLUSION: Sonographic estimation of fetal weight offers no advantage over clinical or patient estimation of fetal weight at term. Senior resident clinical and sonographic estimates are superior to junior resident estimates. Parity has no effect on patient accuracy in estimating fetal weight.

Pregnancy following Radical Resection of Solid Pseudopapillary Tumor of the Pancreas.

Solid pseudopapillary tumor of the pancreas is a rare tumor seen in predominately young women and carries a low malignant potential. We discuss a patient, who presented to our high risk clinic, with a clinical history of solid pseudopapillary tumor of the pancreas, predating her pregnancy. The patient had undergone previous surgery and imaging which had excluded recurrence of disease; however, increased attention was paid to the patient during her pregnancy secondary to elevated hormonal levels of progesterone, which any residual disease would have a heightened sensitivity to. In cases of pregnant patients with a history of pancreatic tumors, a multidisciplinary approach with maternal fetal medicine, medicine, and general surgery is appropriate and can result in a healthy mother and healthy term infant.

Idiopathic granulomatous mastitis with erythema nodosum simulating breast abscess in pregnancy: A case report.

Granulomatous mastitis is a rare benign inflammatory condition of the breast and is known to be associated with pregnancy. A 25-year-old Hispanic G2P1 at 17 weeks gestation presented to the emergency department with findings consistent of a breast abscess. The abscess failed to resolve with incision and drainage followed by multiple courses of antibiotic therapy. A biopsy was then obtained and yielded a diagnosis of granulomatous lobulitis. The patient was treated with steroids and her symptoms resolved. Granulomatous lobulitis may present with characteristics of various clinical entities including neoplasm or, as in this case, abscess. Clinicians should consider a diagnosis of granulomatous mastitis in cases of recalcitrant breast abscess.