Maternal anthropometric measurements and correlation to maternal and fetal outcomes in late pregnancy.

BACKGROUND: Body mass index does not distinguish between lean and fat body mass; therefore, its utility defining body composition is limited in pregnancy. Anthropometric measurements may better represent variation in body composition among women who are overweight or obese. We sought to examine body fat composition using maternal anthropometric measurements in late pregnancy and correlate with mode of delivery. METHODS: A prospective study of pregnant patients who were overweight (body mass index: 25-29.9 kg/m2) or obese (body mass index ⩾ 30 kg/m2) with singleton pregnancies who underwent anthropometric measurements between 27 weeks, 0 days to 34 weeks, 6 days gestation. Maternal skinfold thicknesses from eight sites were used to estimate body fat mass. Correlation of skinfold thickness, anthroprometric measurements, and estimated body fat percentage on mode of delivery were analyzed with p < .05 as significant. RESULTS: A total of 41 women with overweight (34.1%) or obese (65.9%) body habitus were included. Mean age was 29.9 years, and the majority (43.9%) were Black and 31.7% identified Hispanic/Latinx. The average gestational age at recruitment was 30 weeks, 2 days and 38 weeks, 6 days at delivery. A greater weight at recruitment (94.2 vs 81.8 kg, p = .023), waist circumference (47.1 vs 43.5 inches, p = .010), Huston-Presley body fat percentage (36.4% vs 31.8%, p = .030), triceps skinfold thickness (20.1 vs 15.7 mm, p = .030), biceps skinfold thickness (18.6 vs 15.0 mm, p = .042), and skinfold thickness, as well as sum of skinfold sites (83.3 vs 68.8 mm, p = .049) were associated with cesarean delivery compared to vaginal delivery on univariate analysis. CONCLUSION: Third-trimester anthropometric measurements may help predict increased risk for c-section in women with obesity. Further research may elucidate utility in nutritional counseling and delivery planning.

Exploring barriers to abortion access: Medical students' intentions, attitudes and exposure to abortion.

OBJECTIVE: To describe medical student attitudes and exposure to abortion and pregnancy options counseling and influences of that experience on the provision of these services in their future practice. STUDY DESIGN: A survey was conducted of 3rd and 4th year medical students in 2019 at an US medical school in the Northeast. RESULTS: One hundred and sixty-two students participated in the survey (response rate = 46 %, 162/353). Only 27 % reported receiving at least one educational lecture on abortion during medical school. Fifty-eight percent reported clinical exposure to surgical abortion. About 2/3 reported being somewhat likely to provide abortions in the future, despite most identifying as "pro-choice." There was significant association between clinical exposure to surgical abortion and desire to include abortion in future practice (P = 0.03). The most common objections to performing future abortions were personal values, religious objection, and lack of training/experience. Most respondents did not feel comfortable providing counseling for abortion or adoption. Combined, only 14.4 % reported that they would be at least somewhat likely to apply to obstetrics-gynecology or family medicine residency programs, including programs with opportunities for such training. CONCLUSIONS: Earlier work has shown that medical student intentions to provide abortions prior to residency are better predictors of future abortion provision than during residency. Thus, medical school is a critical time for exposure to abortion and pregnancy options counseling. Such exposure and medical student attitudes are areas of research that should be further studied to contribute to the expansion and normalization of these services.

Implementation and Assessment of a Novel Telehealth Education Curriculum for Undergraduate Medical Students.

INTRODUCTION: Despite its healthcare advantages and expanded use during the COVID-19 pandemic, telehealth is not included in many medical school curricula. METHODS: In this prospective mixed methods study (n=52), we created a novel Telehealth Education Curriculum (TEC) for the third year Obstetrics and Gynecology (Ob/Gyn) rotation at New York Medical College during COVID-19. The TEC included supervised telehealth patient encounters via video conference [and a virtual Objective Structured Clinical Encounter (vOSCE)] designed to simulate a telehealth encounter (Zoom Video Communications, Inc.). We measured student perceptions of the TEC via two 4-point Likert surveys, which included free response questions, administered via SurveyMonkey between April and June 2020. Participation was voluntary and responses were de-identified. We computed means and response distributions across survey questions using SPSS; IBM version 19. RESULTS: The response rate was 92% for both the Telehealth (33/36) and vOSCE (48/52) surveys. Seventy-six percent (25/33) strongly or moderately agreed that telehealth and in-person patient encounters have similar educational value. Eighty-three percent (40/48) strongly or moderately agreed the vOSCE provided a valuable patient interaction. Ninety-seven percent (32/33) strongly or moderately agreed the telehealth encounters should continue during COVID-19 restrictions versus 82% (27/33) agreeing they should be incorporated into the curriculumpost COVID-19. CONCLUSION: Almost all students responded that the TEC should continue during COVID-19 and most agreed it should be incorporated into the Ob/Gyn clerkship permanently, after COVID-19. We found vOSCEs to be an effective method for teaching telehealth to medical students. Key challenges identified by students included adjusting to a virtual format, lack of body language, and communicating empathy virtually. Positive takeaways included practice with telemedicine and an opportunity for continued clinical education during COVID-19.

The Status of Medical Student Education in Pregnancy Options Counseling: a Review.

BACKGROUND: The Association of Professors of Gynecology and Obstetrics (APGO) has acknowledged the importance of pregnancy options counseling by listing it as a "shows how" skill for all undergraduate medical students. Unfortunately, there is no standard curriculum utilized to teach medical students pregnancy options counseling or to assess skill sustainability over time. OBJECTIVES: To review and summarize the literature on pregnancy options counseling in undergraduate medical education. METHODS: We performed a structured literature review searching Google Scholar, PubMed, and EMBASE for articles between 2000 and February 2020. Inclusion criteria were English language studies of M. D. and D.O. programs in North America with a discussion of pregnancy options counseling as it relates to medical student education. RESULTS: There is a small but growing body of literature on pregnancy options counseling in medical student education. The common themes across the 17 papers reviewed include the status of pregnancy options counseling in undergraduate medical education, barriers to teaching options counseling, the timing of education, utilization of the options counseling Objective Structured Clinical Examination (OSCE), learner challenges, and novel strategies for implementing education in options counseling and subsequent learning outcomes. CONCLUSIONS: There is no standardized pregnancy options counseling curriculum in undergraduate medical education (UME). The landscape in which this important skill is being taught is one of random, insufficient, and uncoordinated curricular interventions. This is the only review on this subject, making it a unique summary on pregnancy options counseling in UME.

Pitfalls and challenges in managing neuroendocrine carcinoma of gynecological origin: A case series and brief review.

Due to gynecologic tract (gNET) rarity, gynecologists may not have a strong index of suspicion for which to diagnose these tumors ultimately causing misdiagnoses and potential mismanagement. Gynecologists should be wary of diagnostic pitfalls.