In Brief BACKGROUND: Uterine cervical arteriovenous malformation is a rare cause of vaginal bleeding. CASE: A 32-year-old multigravida presented with severe vaginal bleeding originating in the cervix, which resulted in a hypovolemic shock. Attempts to control the bleeding included hysterectomy, pelvic arterial embolization, and upper vaginectomy. Each proved unsuccessful. Histopathologic examination revealed an arteriovenous malformation. Despite local packing, suturing of the vault area, and brachytherapy to the vaginal vault, bleeding persisted. Treatment with GnRH agonist and tranexamic acid stopped the bleeding. CONCLUSION: Severe vaginal bleeding can be the result of cervical arteriovenous malformation, and GnRH agonist may be used for treatment. Cervical arteriovenous malformation is difficult to diagnose and treat and may be life-threatening.
Abnormal gestational weight gain (GWG) has been associated with adverse outcomes for mothers and their offspring.To compare the achievement of recommended GWG and lifestyle factors in women with high-risk versus normal-risk pregnancies.Pregnant women hospitalized in a gynecological and obstetrics department and pregnant women who arrived at a community clinic for a routine checkup were interviewed and completed questionnaires relating to weight gain and lifestyle factors (e.g., smoking, diet, exercise). Recommended GWG was defined by the American Congress of Obstetricians and Gynecologists (ACOG).GWG higher than ACOG recommendations was reported by 52/92 women (57%) with normal pregnancies and by 43/86 (50%) with high-risk pregnancies. On univariate analysis, characteristics associated with greater GWG were: current or past smoking, age > 40 years, pre-gestational body mass index (BMI) > 25 kg/m2, low fruit intake, and high snack intake. High-risk pregnancies were associated with pre-gestational BMI > 25 kg/m2 (48% vs. 27%, P = 0.012), consumption of vitamins (84% vs. 63%, P = 0.001), avoidance of certain foods (54% vs. 21%, P = 0.015), receiving professional nutritionist consultation (65% vs. 11%, P = 0.001), and less physical activity (9% vs. 24%, P = 0.01).A minority of pregnant women met the recommended GWG. No difference was noted between normal and high-risk pregnancies. High-risk population tended to have a less healthy lifestyle. Counseling to follow a healthy, balanced diet should be recommended, regardless of pregnancy risk, with particular attention to women at high risk of extra weight gain.
In Brief Objectives: Evaluate the efficacy of a multicenter, multidisciplinary surgical curriculum (Kenton et al, Am J Obstet Gynecol. 2006;195:1789–1793) that was designed to teach basic pelvic anatomy and surgical skills to junior residents in Urology and Gynecology. Methods: The Clinical Anatomy and Surgical Skills Training program was developed for junior residents in urology and gynecology at 3 academic medical centers in Chicago. The course consisted of five 3-hour sessions. Each session was composed of didactics and a hands-on laboratory. A written test comprised of 2 sections, anatomy and surgical knowledge, was given before and after the course. Pre- and posttest scores were compared using the paired t test. A 0.05 significance level was used for all statistical tests. Results: Twenty-eight residents completed the program (15 first-year residents [PGY-1] and 13 second-year residents [PGY-2]). At completion of the program, residents showed a 71% and 60% improvement in both anatomy and surgical skills knowledge, respectively (38 vs. 65, P < 0.001 and 50 vs. 80, P < 0.0001, respectively). The PGY-2 residents had significantly higher baseline scores than the PGY-1 residents in both anatomy (48 ± 14 vs. 28 ± 10, P < 0.001) and surgical skills test scores (59 ± 9 vs. 42 ± 9, P < 0.001). However, there were no significant differences in the posttest scores of the PGY-2 residents compared with the PGY-1 residents in either anatomy or surgical skills. Conclusion: Our multidisciplinary Clinical Anatomy and Surgical Skills Training program improved urology and gynecology residents’ knowledge of anatomy and basic surgical skills, demonstrating that knowledge essential for the development of a competent resident can be taught outside of the operating room. The Clinical Anatomy and Surgical Skills Training workshop for senior residents in obstetrics/gynecology and urology is based upon a format utilizing cadaveric and bench models with didactic lectures to teach advanced gynecological and urological procedures and pertinent clinical anatomy.
We evaluated the effect of in vitro fertilization (IVF) on sexual function in men, particularly for erectile dysfunction.A prospective case-control study at a tertiary medical center. The study group comprised men of infertile couples that required IVF to conceive. The control group comprised men of couples who conceived spontaneously. The effects of IVF on sexual and erectile function were assessed based on the International Index of Erectile Function (IIEF-15) and the Self-Esteem and Relationship (SEAR) questionnaires. Participants were followed up to 1 year postpartum.Compared to the control group (378), for the IVF group (356), mean IIEF-15 scores were significantly lower: prior to pregnancy (31.7±4.5 vs 64.4±7.2, p <0.0001), at mid-pregnancy (37.3±5.1 vs 66.4±5.5, p <0.0001) and up to one year postpartum (42.3±4.9 vs 68.6±4.3, p <0.0001). Compared to the control group, in the IVF group, mean SEAR scores were significantly lower at these 3 respective time points (29.9±6.3 vs 66.5±8.3; 34.1±5.8 vs 66.9±7.2; and 40.9±6.7 vs 67.3±5.6; p <0.0001). At the 3 time points, for the IVF compared to the control group, the median monthly sexual intercourse rate was lower; and both the use of phosphodiesterase-5 inhibitor and psychologist/sexologist care were higher.The prevalence of erectile dysfunction among men participating in IVF in order to conceive is significantly higher compared to couples that conceived spontaneously, thus leading to an extremely high rate of phosphodiesterase-5 inhibitor use.
Objectives: Midurethral sling Placement for stress urinary incontinence (SUI) repair has a profound effect on both anatomical and physiologic properties of the anterior vaginal wall. The current study compared vaginal elasticity, mobility, and strength, using vaginal tactile imaging (VTI) changes before and after midurethral sling placement for treating SUI. Materials and Methods: This prospective cohort study included women undergoing midurethral sling placement to treat their SUI. Vaginal elasticity, levator ani muscle tone, and contraction strength were measured prior to treatment and 6 months following surgery, using VTI measurements. In addition, participants were asked to fill Female Sexual Function and Urinary Distress–6 questionnaires, among others, for sexual-function assessment. Results: A total of 23 women, with proven SUI, participated in the study. Their mean age was 51.2 ± 10.6 years and mean body mass index was 28.3 ± 5.5 kg/m2. There was a parallel, statistically significant increase in vaginal elasticity from 1.02 ± 0.47 to 1.44 ± 1.05 (p < 0.05), and FSFI scores from 21.49 ± 1.86 to 29.5 ± 1.16 (p < 0.0001). Furthermore, statistically significant increases in vaginal muscle tone and contraction strength developed from 2.97 ± 1.66 to 3.45 ± 1.47 (p < 0.05) and from 0.98 ± 0.6 to 1.36 ± 0.67 (p < 0.05), respectively. The increase in elasticity was moderately correlated with muscle-contraction strength (σ: 0.625; p < 0.0001) and vaginal tone in the anterior vaginal walls (σ: 0.702; p < 0.0001). Conclusions: SUI repair with midurethral-sling placement appears to increase vaginal elasticity, muscle tone, and contraction strength, and improves sexual function and urinary distress symptoms significantly. (J GYNECOL SURG 38:226)
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