The efficacy of laparoscopic surgical treatment of ovarian remnant and ovarian retention syndromes.

STUDY OBJECTIVE: To evaluate the degree of pain relief provided by laparoscopic surgical treatment of ovarian remnant and ovarian retention syndromes. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: Academic hospital and affiliated outpatient offices. PATIENTS: A total of 54 patients from 2004 to 2008 who underwent surgical treatment for suspected ovarian remnant syndrome or ovarian retention syndrome. INTERVENTIONS: Oophorectomy. MEASUREMENTS AND MAIN RESULTS: Preoperative and postoperative pain scores were recorded from patients who underwent surgical treatment for either ovarian remnant or ovarian retention syndrome. Data regarding comorbid diagnoses that would contribute to chronic abdominopelvic pain, previous surgical history, surgical complications, and pathology to confirm the preoperative diagnosis were also collected. Pathology confirmed that ovarian tissue was removed in 52 of the 54 patients. Forty percent and 41% of patients with ovarian remnant and ovarian retention, respectively, achieved a 50% reduction of their average pain levels; 50% and 56%, respectively, achieved a 30% reduction in average pain levels. There was not a statistically significant difference in postoperative pain relief between the 2 groups. Cases with ovarian remnant syndrome had more prior surgical procedures (4.8 vs 3.6, p = .049) and were more likely to have a surgical complication (25% vs 3%, p = .03) than cases with ovarian retention syndrome. Patients with a 30% or greater decrease in their pain levels postoperatively were likely to have fewer other diagnoses associated with chronic pain (1.4 ± 1.1 vs 2.1 ± 0.9, p = .009). CONCLUSION: Surgical treatment for ovarian remnant or ovarian retention syndrome is effective but is most effective in patients with no other pain-related diagnoses. Thus, it is important to thoroughly evaluate women with ovarian remnant or ovarian retention syndrome for other pelvic pain-related disorders. In almost all cases, surgery can be done laparoscopically in patients with these syndromes.

Management of hyponatraemia in pre-eclampsia with severe features.

Pre-eclampsia is a common pregnancy complication with many associated maternal and fetal risks, yet its pathophysiology remains poorly understood. Hyponatraemia is a rarely described finding in pre-eclampsia that has been associated with both maternal and fetal complications and medically indicated delivery. We present a case of hyponatraemia in a patient admitted for induction of labour for gestational hypertension, which developed into pre-eclampsia with severe features requiring magnesium sulfate therapy for seizure prophylaxis. The patient's hyponatraemia resolved with delivery, fluid restriction and serial sodium monitoring. Adjustment to the components of the patient's magnesium sulfate infusion was made to reduce free water intake and avoid further exacerbation of her hyponatraemia. While there is currently no recommendation to routinely monitor sodium levels in hypertensive disorders of pregnancy, careful consideration of this potential finding in cases of pre-eclampsia should be given due to the overlap between symptoms of hyponatraemia and cerebral symptoms of pre-eclampsia.

Management of Bilateral Ectopic Pregnancies after Ovulation Induction Using Unilateral Salpingectomy and Methotrexate for the Remaining Ectopic with Subsequent Intrauterine Pregnancy.

Bilateral ectopic pregnancy is a rare phenomenon which is found with increased frequency when using assisted reproductive technology (ART). This diagnosis is most often made incidentally and intraoperatively, as ultrasound and serial ß-hCG trends have shown poor efficacy for accurate diagnosis. Management of bilateral ectopic pregnancies is most commonly reported using bilateral surgical removal of the ectopic pregnancy (salpingostomy and/or salpingectomy). We present a case of an ART patient with incidentally found bilateral tubal ectopic pregnancies, where multiple management strategies including medical and surgical techniques were used concurrently which resulted in a subsequent spontaneous intrauterine pregnancy. While the standard of care is difficult to establish, we recommend individualizing management decisions based on the patient's reproductive goals and overall risk profile.

Testing the Feasibility of Remote Patient Monitoring in Prenatal Care Using a Mobile App and Connected Devices: A Prospective Observational Trial.

BACKGROUND: Excessive weight gain and elevated blood pressure are significant risk factors for adverse pregnancy outcomes such as gestational diabetes, premature birth, and preeclampsia. More effective strategies to facilitate adherence to gestational weight gain goals and monitor blood pressure may have a positive health benefit for pregnant women and their babies. The impact of utilizing a remote patient monitoring system to monitor blood pressure and weight gain as a component of prenatal care has not been previously assessed. OBJECTIVE: The objective of this study is to determine the feasibility of monitoring patients remotely in prenatal care using a mobile phone app and connected digital devices. METHODS: In this prospective observational study, 8 women with low risk pregnancy in the first trimester were recruited at an urban academic medical center. Participants received a mobile phone app with a connected digital weight scale and blood pressure cuff for at-home data collection for the duration of pregnancy. At-home data was assessed for abnormal values of blood pressure or weight to generate clinical alerts to the patient and provider. As measures of the feasibility of the system, participants were studied for engagement with the app, accuracy of remote data, efficacy of alert system, and patient satisfaction. RESULTS: Patient engagement with the mobile app averaged 5.5 times per week over the 6-month study period. Weight data collection and blood pressure data collection averaged 1.5 times and 1.1 times per week, respectively. At-home measurements of weight and blood pressure were highly accurate compared to in-office measurements. Automatic clinical alerts identified two episodes of abnormal weight gain with no false triggers. Patients demonstrated high satisfaction with the system. CONCLUSIONS: In this pilot study, we demonstrated that a system using a mobile phone app coupled to remote monitoring devices is feasible for prenatal care.

Objective Structured Assessment of Technical Skills to Teach and Study Retention of Fourth-Degree Laceration Repair Skills.

BACKGROUND: Fourth-degree perineal lacerations are a serious but infrequent complication of childbirth. OBJECTIVE: We studied the long-term effect of an educational workshop on the knowledge and ability of obstetrics and gynecology residents to repair fourth-degree lacerations. METHODS: We assessed obstetrics and gynecology residents' baseline knowledge and skill of fourth-degree laceration repair by using a written examination and the Objective Structured Assessment of Technical Skills (OSATS). After the educational intervention (a lecture, a demonstrational video, and practice on a model), residents completed a written and OSATS posttest. Six months later, residents took the same posttests to determine their level of retention. Another group of residents who had not attended the workshop also took the tests at the 6-month mark and served as a control group. RESULTS: A total of 17 residents were in the intervention group and 11 residents in the control group. The pretest written examination mean was 6.1/10 and the OSATS mean was 10.9/18. After the workshop, the written mean increased to 9.1/10 and the OSATS to 16.6/18. This improvement was statistically significant (P < .01). Compared to the pretest, the 6-month follow-up scores had a statistically significant increase (written mean, 8.0/10, P < .01, and OSATS mean 15.5/18, P < .01). CONCLUSIONS: Residents improved on the written examination and OSATS after the educational workshop and maintained this improvement for 6 months. This intervention may prepare graduating residents for repairing future fourth-degree lacerations they may not have encountered during training.