Uterine Lipoleiomyoma Presenting With Pelvic Pain in a Post-Menopausal Woman.

Uterine leiomyomas (fibroids) are the most common tumor of the reproductive system in women between menarche and menopause. Uterine lipoleiomyomas are a rare variant of leiomyoma, consisting of smooth muscle cells admixed with adipocytes. Herein is the case of a 70-year-old female who presented with acute pelvic pain and a palpable pelvic mass. A computed tomography scan of her abdomen and pelvis demonstrated a large, circumscribed, fat and soft tissue density, uterine mass suggestive of a lipoleiomyoma. Histopathology examination of the resected specimen after total abdominal hysterectomy confirmed a mature lipoleiomyoma.

The effect of distraction on the quality of patient handoff: a randomized study.

OBJECTIVE: The number of patient handoffs has increased in recent years. In addition, technology has advanced in the medical field, leading to most providers carrying smartphones at work. Little is known about the effect of mobile devices and quality of patient handoffs. The objective of this study was to determine whether distraction affects the quality of sign-out among obstetrical providers. DESIGN: A randomized, prospective study was conducted. SETTING: Hospital. PARTICIPANTS INTERVENTION: Obstetrical providers listened to a recorded sign-out vignette. Provider groups either were or were not exposed to a distraction while listening to the vignette. All providers had been told that they would be participating in a trial of two methods of sign-out, although in actuality they were all assigned to a single method. In the distraction arm, the participants were exposed to a 'distracting event' (a phone ring, which was answered by the proctor and followed by a brief conversation) that occurred midway through the vignette. MAIN OUTCOME MEASURE: Providers answered a 14-question survey testing recall of facts included in the vignette. The results of each group were analyzed using Fisher's exact test and Student's t-test. RESULTS: Eighty-eight providers were randomized, 44 in the distraction group and 44 in the non-distracted group. The average scores on the survey were similar between groups (11.0 and 10.8, P = 0.57). In addition, the average scores for questions that occurred after the distraction did not differ between the distracted and non-distracted groups (6.4 vs 6.2, P = 0.42). CONCLUSIONS: We observed that a phone ring and brief response did not affect the obstetrical providers' recall of details of a standardized sign-out. More studies are warranted to determine if more frequent or longer distractions would change results.

Pregnancy outcomes among women with American College of Cardiology- American Heart Association defined hypertension.

OBJECTIVE: To compare the rate of adverse pregnancy outcomes of women with hypertension defined by the ACC-AHA guidelines, women with hypertension defined by ACOG guidelines, and normotensive women. METHODS: A historical cohort study of women with singleton, nonanomalous pregnancies who presented before 20 weeks for their first prenatal visit between 1 January 2014 and 31 January 2016 with (a) hypertension defined by ACC-AHA (systolic blood pressure 130 mmHg and/or diastolic blood pressure of 80 mmHg documented), (b) hypertension defined by ACOG (systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg documented) and (c) women documented to be normotensive. Primary outcomes were preeclampsia and small for gestational age. Fisher's exact test was used to compare demographics and risk factors between the groups. Multivariable logistic regression analysis was used to predict the association of preeclampsia within the groups adjusting for additional risk factors. RESULTS: A total of 252 women were included. Of these, 92 (36.5%) had hypertension by ACC-AHA, 34 (13.5%) by ACOG and 126 (50%) were normotensive. Sixty percent of women with the ACOG definition developed preeclampsia compared to 45.1% of women with the ACC-AHA definition and 17.1% in the control group (p < .001). The rate of preeclampsia among women with hypertension by ACC-AHA criteria was not significantly different from the rate among women with hypertension by ACOG criteria (p = .288). Differences in small for gestational age among the groups were not significant (ACOG: 20%, ACC-AHA: 11.1%, normotensive: 9.8%, p = .423). CONCLUSION: Women with hypertension defined by ACC-AHA have a rate of developing preeclampsia that is similar to that of women with hypertension defined by ACOG.