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A Survey of Menopause Care Among US Women
Sandy Rose Truong,
Jennifer Wolff,
Teresa Keenan,
Victoria Gelfeld,
G. Oscar Anderson,
Patricia David,
Wen Shen
Issue:
Volume 7, Issue 2, March 2019
Pages:
31-35
Received:
7 January 2019
Accepted:
25 February 2019
Published:
18 April 2019
Abstract: Objective: Nearly one-third of American women are postmenopausal and at risk for menopausal symptoms such as hot flashes, mood disorders, and vulvovaginal atrophy. Primary healthcare providers in addition to gynecologists need to be ready to address these concerns. One area of controversy has been the role of menopausal hormone therapy (MHT) in the treatment of symptoms. This study sought to determine how often women seek care for menopause, their satisfaction with care, and their use of MHT. Methods: An online survey was administered to 1,509 women age 40-89. Descriptive statistics were performed. Results: 81% have experienced symptoms but only 50% of women have discussed menopause with a provider and 31% do not receive information about menopause from any sources. Among those who say they need treatment, only 15% have pursued but not received it. Of those who have discussed it with their provider, 25% with symptoms were not offered treatment and 11% said their provider was not sympathetic. However, 97% said that their provider was comfortable and 97% knowledgeable. Regarding treatment, 62% reported that providers discussed MHT, 36% reported that providers recommended it, but only 6% of women are using it. Conclusions: It is encouraging that the vast majority of women who have pursued treatment are satisfied with their care. However, a quarter of women who sought treatment were not offered treatment and half of the women surveyed had never been counselled on menopause. Steps should be taken to encourage provider-initiated discussion of menopause.
Abstract: Objective: Nearly one-third of American women are postmenopausal and at risk for menopausal symptoms such as hot flashes, mood disorders, and vulvovaginal atrophy. Primary healthcare providers in addition to gynecologists need to be ready to address these concerns. One area of controversy has been the role of menopausal hormone therapy (MHT) in the...
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Conservative Management, Follow-up and Perinatal Outcomes After Gestational Trophoblastic Disease with Coexistent Normal Fetus: Case Report
Herrera-Ortiz Alejandra,
Barrita-Domínguez Isela Juliana,
Morales-Domínguez Liliana,
Rojas-Camacho Francisco Miguel
Issue:
Volume 7, Issue 2, March 2019
Pages:
36-40
Received:
23 January 2019
Accepted:
30 March 2019
Published:
22 April 2019
Abstract: Background: Gestational trophoblastic disease (GTD) is the consequence of a genetic alteration that happens during fecundation. Is the term used to describe malignant lesions that originates in the chorionic villi an extra villous trophoblast. Molar pregnancies can be subdivided into complete (CM) and partial moles (PM) based on genetic and histopathological features. Case report: 23-year old patient, who presents an ultrasound which revealed a singleton pregnancy with no fetal structural abnormalities, and fetal biometry consistent with gestational age (16w + 6d). There was a placenta with focal areas of enlargement associated with numerous lucent cyst, and normal amniotic fluid, compatible with partial molar pregnancy in association with a normal fetus. After risks of subsequent fetal and maternal complications were explained to the patient and her family, it was elected to continue with her pregnancy; patient went under cesarean delivery at 31w 3d because low amniotic fluid levels (oligohydramnios) and abnormal fetal well-being tests.
Abstract: Background: Gestational trophoblastic disease (GTD) is the consequence of a genetic alteration that happens during fecundation. Is the term used to describe malignant lesions that originates in the chorionic villi an extra villous trophoblast. Molar pregnancies can be subdivided into complete (CM) and partial moles (PM) based on genetic and histopa...
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Utility of Frozen Section in the Evaluation of Borderline Ovarian Tumors: A Single Institution Experience
Marilyn Huang,
Matthew Schlumbrecht,
Tegan Hunter,
Mehrdad Nadji,
Andre Pinto
Issue:
Volume 7, Issue 2, March 2019
Pages:
41-45
Received:
3 March 2019
Accepted:
9 April 2019
Published:
6 May 2019
Abstract: Background: Borderline ovarian tumors (BOTs) account for a 10-15% subset of all primary ovarian epithelial neoplasms. Preoperative imaging and serologic markers are often inconclusive at distinguishing between benign, pre-malignant, and malignant ovarian tumor. Limitations at time of frozen section (FS) are relatively well known, and misinterpretation may occur potentially leading to over- and under-treatment. We evaluated all cases of BOTs submitted for FS in our institution to determine the accuracy of intraoperative diagnosis when compared with the final pathology, and possibly identify features that may guide surgical staging decision-making. Methods: We identified all intraoperative diagnoses of BOTs from our institution in a 12-year period. Clinical and pathologic data were abstracted. Intraoperative pathology diagnosis was compared to final pathologic diagnosis. Statistical analysis was performed using chi-square and logistic regression. Results: There were 80 cases included for analyses, of which 39 (48.8%) were serous borderline tumor (SBT), 18 (22.5%) mucinous borderline tumors (MBT), 1 (1.2%) endometrioid borderline tumor, and 22 (27.5%) at least borderline tumor (of various histologies). There were 13 cases with a discrepancy between FS and final diagnosis. In patients with a discrepancy where final pathology demonstrated carcinoma, 4/11 (36.3%) were not staged or had incomplete staging. Subsequently, 3/4 (75%) underwent a re-operation for staging purposes. In patients with discrepant pathology, discrepancy was more common 8/37 (21.6%) among non-gynecologic pathologists compared to 5/43 (11.6%) among gynecologic pathologists, but not statistically significant (p=0.23). When “at least borderline” tumor was diagnosed at FS, 10/22 (45%) had invasive malignancies on final pathology compared to diagnosis of BOT “only” on FS; on which 1/58 (1.7%) had invasive carcinoma. The cases with histologic diagnosis of BOT “only” were associated with significantly reduced discrepancy (OR 0.04 [95% CI 0.01-0.18], p< 0.001). Conclusion: In conclusion, use of intraoperative evaluation for ovarian tumors is a useful diagnostic tool but has its limitations. In intraoperative cases where pathologists call “at least borderline”, strong consideration for surgical staging should be contemplated with re-evaluation of preoperative testing. Moreover, when possible, direct communication between surgeon and pathologist at time of FS diagnosis of BOT may be valuable.
Abstract: Background: Borderline ovarian tumors (BOTs) account for a 10-15% subset of all primary ovarian epithelial neoplasms. Preoperative imaging and serologic markers are often inconclusive at distinguishing between benign, pre-malignant, and malignant ovarian tumor. Limitations at time of frozen section (FS) are relatively well known, and misinterpretat...
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Pemphigoid Gestationis in a 15 Year Old Pregnant Patient, A Case Report and Literature Review
Emile Dabaj,
Jana Abdo,
Stephanie Yacoub,
Rawad Halimeh,
Zarouhie Bedoyan,
Joe Khalifeh
Issue:
Volume 7, Issue 2, March 2019
Pages:
46-50
Received:
5 February 2019
Accepted:
25 March 2019
Published:
8 May 2019
Abstract: Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of pemphigoid gestationis is made histopathologically on biopsies, based on the presence of sub-epidermal vesicles, as well as direct visualization of linear deposition of C3 at the basement membrane zone by using immunofluorescence staining on those biopsies. The mainstay treatment of the disease remains corticosteroids. Prompt recognition and provision of the appropriate management allow a reduction in both maternal morbidity as well as fetal adverse perinatal outcomes. Pathologic skin dermatoses and diseases of pregnancy are rare and have different presentations, treatment and prognoses. This literature review includes an up to date comparison on the presentation, diagnosis and treatment of dermatoses in pregnancy, in order to help with the discrimination. A case of pemphigoid gestationis in a 15 year old woman is described. This is the youngest reported age of presentation of pemphigoid gestationis, raising the question of whether maternal age is a factor that can affect the course and the severity of the disease.
Abstract: Pemphigoid gestationis, previously known as herpes gestationis, is a rare autoimmune bullous disease that manifests in pregnancy. Upon presentation, patients complain of intense pruritis, urticarial plaques, vesicles and bullae that primarily affect the peri-umbilical area before spreading to involve the rest of the body. The accurate diagnosis of ...
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Misplaced (''Missing'') Intrauterine Contraceptive Device Among Clients at a Rural Tertiary Hospital in South Western Nigeria
Adeniyi Augustine Adebayo,
Adebisi Timothy Olumide,
Okere Raymond Akujuobi,
Adebara Idowu Oluseyi,
Bakare Adewumi,
Adeyemo Olabisi Timoty,
Busari Adesola Olusegun,
Achebe Chijioke Cosmas,
Amerijoye Adewale
Issue:
Volume 7, Issue 2, March 2019
Pages:
51-55
Received:
5 March 2019
Accepted:
26 April 2019
Published:
20 May 2019
Abstract: Background: Misplacement is one of the complications reported with intrauterine contraceptive devices (IUCDs) as a form of contraception. Objective: To study the methods of diagnosis and the mode of management of misplaced IUCDs at the Federal Teaching Hospital, Ido-Ekiti. Methods: This was a retrospective review of records of all clients who presented with complaints of missing IUCD over a 5 year period, from 1st January 2011 to 31st December 2015. Results: A total of 527 clients were seen at the family planning unit within the period under review. Three hundred and one (301) clients used IUCD, giving a prevalence of 57.1% of total contraceptive use. Of these, 12 IUCDs were reported misplaced, giving the incidence of misplaced IUCDs as 4%. The peak age of the clients reporting misplaced IUCD was 31-40 years. IUCDs insertion during puerperium was seen in 33.4% while most (41.6%) had their IUCD insertion more than 12 months following last childbirth. When considering IUCD insertion in relation to abortion and menses, most (50%) had insertion during menstrual period, 25% had insertion just before the onset of the next menses, postabortal insertion was seen in 16.7% while one (8.3%) could not ascertained the event that preceded the insertion of IUCD. Inability to feel the thread was the commonest presenting complaint in 6 (50%). Most of the clients with misplaced IUCD had the device inserted at the primary health centre (41.6%) and private hospitals (33.4%). Pelvic examination with uterine sound and abdominal ultrasound were the diagnostic methods commonly used. Most clients (83.3%) missed their IUCDs within the first twelve months of use. Retrieval hook was used for removal in 91.7% of the cases. One (8.3%) had exploratory laparotomy to recover the missing IUCD. Conclusion: Intrauterine devices should be inserted after proper case selection by properly trained medical personnel in both primary and tertiary centres in order to reduce reported cases of missing IUCDs.
Abstract: Background: Misplacement is one of the complications reported with intrauterine contraceptive devices (IUCDs) as a form of contraception. Objective: To study the methods of diagnosis and the mode of management of misplaced IUCDs at the Federal Teaching Hospital, Ido-Ekiti. Methods: This was a retrospective review of records of all clients who prese...
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Caesarean in Case of Scar Uterus: Indications and Maternal and Neonatal Prognosis at the University Hospital of Brazzaville (Republic of Congo)
Itoua Clautaire,
Iloki Itoba Imongui Sandra,
Buambo Gauthier Régis Jostin,
Potokoue Mpia Samantha Nuelly,
Mokoko Jules César,
Ngakengni Nelie Yvette,
Eouani Max Levy Eméry,
Iloki Léon Hervé
Issue:
Volume 7, Issue 2, March 2019
Pages:
56-59
Received:
21 March 2019
Accepted:
25 April 2019
Published:
20 May 2019
Abstract: Objective: Caesarean section in case of cicatricial uterus generates a real epidemiological and prognostic obstetric problem. It is a real concern for the obstetrician with regard to all the factors that can influence the maternal and perinatal prognosis. The aim of this study is to analyze indications for caesarean section in cases of uterine scarring and to establish maternal and neonatal pronotics at the University Hospital of Brazzaville. Methods: A cross-sectional analytical study conducted from January 1, 2015 to June 30, 2017 at the University Hospital of Brazzaville in Congo, comparing 150 deliveries by caesarean to 300 by vaginal route. Results: one hundred and fifty cesarized were recorded among 1212 women giving birth with scar uterus (12.3%). They were different from vaginal deliveries with uterine scarring in age (31 vs 28 years, p <0.05) and mostly referred (70% vs 20.7%, p <0.05). Caesareans were performed more urgently (52.7%) than prophylactically (47.3%). The risk of being caesarized was higher in the case of multiple scar (OR = 9.8 [4.5-21.1]), less than 16 months (OR = 10.2 [2.2-47.6]), and without evidence of strength in connection with a previous vaginal delivery (OR = 4.5 [1.7-11.8]). Emergency caesarean were dominated by acute fetal asphyxia (OR = 7.3 [3.6-14.5]) and dynamic dystocia (OR = 13.3 [10.1-26.6]). Maternal morbidity in cesarized patients was related to parietal suppuration (14, 9.3%) and was associated with a low risk of endometritis (3.4% vs 12%, OR = 0.2 [0.1-0.6], p <0.05). Newborns born to caesarean mothers were more resuscitated (17.2% vs 4%, OR = 4.9 [2.4-10.2], p <0.05), transferred to neonatology (19.8% vs 7.6%, OR = 2.9 [1.6-5.3 p <0.05) and died in the neonatal period (2.6% vs 0.3%, OR = 8.1 [1.2-52], p <0.05]. Conclusion: Caesarean section indications for cicatricial uterus are dominated by obstetric emergencies involving maternal and neonatal prognosis.
Abstract: Objective: Caesarean section in case of cicatricial uterus generates a real epidemiological and prognostic obstetric problem. It is a real concern for the obstetrician with regard to all the factors that can influence the maternal and perinatal prognosis. The aim of this study is to analyze indications for caesarean section in cases of uterine scar...
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