Family medicine physician identification of obstetric lacerations: a US national survey.

INTRODUCTION AND HYPOTHESIS: We evaluated family medicine obstetric providers' identification and categorization of vaginal delivery lacerations in the USA. We hypothesized that there would be inaccuracy in family medicine physicians' identification of vaginal delivery injuries, similar to our previous studies of midwives and obstetricians (OBs). METHODS: We included clinically active physicians who attended deliveries within 2 years and evaluated their identification and categorization of delivery lacerations using descriptive text and visual images. We asked about their education on this topic and how they document lacerations in the labor and delivery record. RESULTS: We analyzed 250 completed responses (70% of opened surveys). Fifty-five percent of respondents characterized their obstetric laceration training as "good" or "excellent" and half previously had education on obstetric lacerations. The median accuracy overall for the classification and identification of perineal lacerations was 78% (IQR 56-91%). Respondents frequently mischaracterized nonperineal lacerations. Few respondents (36%) reported using the third-degree injury subclassification system. In adjusted analysis, the highest scoring respondents were board certified in family medicine, with fewer years in practice, and a higher obstetric volume. CONCLUSIONS: Obstetric laceration diagnoses may be inaccurate, which could influence perinatal quality and patient outcomes. We found gaps in knowledge similar to previous reports on midwives and obstetricians in the USA. These data suggest a need for increased education and training on obstetric injuries, perhaps especially for physicians with less obstetric activity. Improved categorization and identification of vaginal delivery trauma can impact management and improve women's postpartum care and long-term pelvic floor outcomes.

Tyrosine partners coordinate DNA nicking by the Salmonella typhimurium plasmid pCU1 relaxase enzyme.

Conjugative plasmid transfer results in the spread of antibiotic resistance genes and virulence factors between bacterial cells. Plasmid transfer is dependent upon the DNA nicking activity of a plasmid-encoded relaxase enzyme. Tyrosine residues within the relaxase cleave the DNA plasmid nic site in a highly sequence-specific manner. The conjugative resistance plasmid pCU1 encodes a relaxase with four tyrosine residues surrounding its active site (Y18,19,26,27). We use activity assays to demonstrate that the pCU1 relaxase preferentially uses Y26 or a combination of Y18 + 19 to nick DNA at wild type levels, and that an adjacent aspartic acid deprotonates these tyrosines to activate them for attack. Our findings illustrate the unique modifications that the pCU1 relaxase has introduced into the traditional relaxase-mediated DNA nicking mechanism.