Effect of Serial Pregnancies on Physical Fitness.

Introduction: Pregnancy has a profound impact on physical fitness, and delivery does not allow for rapid return to peak performance levels as physiologic changes can persist for greater than 1 year postpartum. Multiple studies across all military services have documented decrements in physical performance with pregnancy among women. The purpose of this study was to determine the impact of serial pregnancies on physical fitness and body composition in a cohort of Army women.

Pre-Pregnancy Physical Fitness, Body Mass Index and Gestational Weight Gain as Risk Factors for Cesarean Delivery: A Study of Active Duty Women.

Introduction: The World Health Organization considers the optimal rate of delivery by Cesarean among healthy nulliparous women to be <15%. In 2020, the rate of primary Cesarean delivery (CD) in the US among nulliparous women with singleton, vertex pregnancies was 26%. An enhanced understanding of factors associated with women undergoing CD may assist in reducing this rate.

The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: A cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence.

Introduction: Pregnancy profoundly affects cardiovascular and musculoskeletal performance requiring up to 12 months for recovery in healthy individuals.

Objective: To assess the effects of extending postpartum convalescence from 6 to 12 weeks on the physical fitness of Active Duty (AD) soldiers as measured by the Army Physical Fitness Test (APFT) and Body Mass Index (BMI).

Methods: We conducted a retrospective study of AD soldiers who delivered their singleton pregnancy of ≥ 32weeks gestation at a tertiary medical center.

Does symptom severity predict response to low-dose onabotulinumtoxinA for the treatment of urgency urinary incontinence?

Objective: Intradetrusor onabotulinumtoxinA is a third-line treatment for urgency urinary incontinence (UUI) which is customarily reserved for severe disease. We sought to determine if symptom severity predicts the proportional response to onabotulinumtoxinA and whether low-dose injection may be an appropriate treatment for mild-moderate symptoms.

Study Design: This prospective cohort study compared patients with urgency urinary incontinence who were recruited from the Urogynecology Clinic with mild-moderate (2-9 episodes/3-day diary) and severe UUI (>9 episodes/3-day diary) symptoms.

Bangladesh Fistula Mission Partnership: Leveraging Assets from the United States Agency for International Development and the Department of Defense to Address a Health Care Crisis in a Developing Nation.

Introduction: Obstetric fistulae are a leading scourge for women in developing countries resulting, in severe individual suffering and devastating socio-economic repercussions for her family and community. The underlying causes of obstetric fistula stem from multiple factors to include poor nutrition, early marriage, insufficient education and inferior social status of women as well as substandard medical care. The US Agency for International Development (USAID) has invested more than $100 million globally since 2004 to address these factors as well as support women suffering with fistulae.

Does Mid-Urethral Sling Surgery in the Treatment of Stress Urinary Incontinence Affect Weight Changes in Women? A Retrospective Cohort Study Using Internal Controls.

Objective: Stress urinary incontinence (SUI) is a common disorder among women. This is particularly bothersome to physically active women, such as those who serve in the Armed Forces. With the documented success of the midurethral sling (MUS) in the treatment of SUI, more women are electing to undergo surgical treatment.

Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy.

Introduction And Hypothesis: Urinary tract infections (UTIs) are the most common complication following hysterectomy and mid-urethral sling procedures (MUS). As a MUS is often placed at the time of hysterectomy, we sought to determine if the addition of an MUS procedure significantly increases the risk of UTI in the first 30 days following hysterectomy.

Methods: This retrospective cohort study utilizes the National Surgical Quality Improvement Program (NSQIP) data bank for the years 2006-2012.

The incidence of early and recurrent urinary tract infections after midurethral sling operations.

Objective: To define the incidence of early and recurrent urinary tract infections (RUTIs) in the 12-month postoperative period following midurethral sling (MUS) operations and evaluate for risk factors.

Methods: This retrospective chart review compiled all urine analyses and urine culture results within 12 months of MUS surgery on all patients in the years 2006-2012 for which data were available. All coincident risk factors were tabulated.

Comparison of urodynamic volume measurements using room and body temperature saline: a double-blinded randomized crossover study design.

Introduction: Urodynamic studies, routinely performed in women with lower urinary tract symptoms, have a large impact on clinical decision making. Unfortunately, these studies are insensitive in reproducing idiopathic detrusor overactivity (IDO). We set out to examine whether serial cystometry with different distending fluid temperatures could better reproduce symptoms.

Inflammatory cytokine and matrix metalloproteinase expression induced by collagen-coated and uncoated polypropylene meshes in a rat model.

Objective: The objective of the study was to compare the influence of collagen-coated vs uncoated polypropylene meshes on the expression of genes critical for wound healing.

Study Design: In 54 rats, abdominal wall defects were created, repaired by polypropylene sutures, and covered by an overlay of coated polypropylene (n = 20), uncoated polypropylene (n = 18), or no mesh (n = 16). Explants were harvested 7 or 90 days after repair and divided for histological, immunohistochemical, and messenger ribonucleic acid (mRNA) analyses.

Influence of mesh materials on the expression of mediators involved in wound healing.

The use of synthetic mesh for ventral hernia repair is widely accepted, but mesh-induced inflammatory responses may lead to postoperative complications. Molecular mechanisms that direct the extent of the foreign body reaction to implanted materials are poorly understood. This study compares the influence of three macroporous meshes on the expression of genes critical for wound healing and extracellular matrix remodeling in a rat model.

Utility of ultrasound in the combat theater: experiences of a gynecologist during Operation Iraqi Freedom/Operation Enduring Freedom.

Objective: The purpose of this study was to evaluate the utility of ultrasound in a combat theater.

Methods: A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 237 required pelvic ultrasound.

Sexually transmitted diseases in Operation Iraqi Freedom/Operation Enduring Freedom.

Objective: To identify the incidence of sexually transmitted diseases (STDs) in a female active duty population deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom was the objective of this study.

Methods: Retrospective chart review was completed on all soldiers seeking outpatient gynecologic care at Camp Doha, Kuwait, from September 2003 through March 2004. Descriptive statistical analysis was performed on data from all patients identified as having an STD.

Pelvic pain presenting in a combat environment.

Objective: The objective was to identify the incidence of pain disorders in the deployed female active duty population in support of Operation Iraqi Freedom.

Methods: Retrospective chart review was completed on all patients who were seen for gynecologic services at Camp Doha, Kuwait, from September 2003 through March 2004. One thousand seven hundred thirty-seven patients were identified.

Chronic urinary retention and pelvic floor hypertonicity after surgery for endometriosis: a case series.

Objective: The purpose of this study was to evaluate 4 cases of chronic urinary retention and pelvic floor muscle spasms after surgery for endometriosis.

Study Design: These patients underwent a complete history, physical exam, and diagnostic work- up. The results were analyzed with regards to type and extent of inciting surgery, diagnostic findings, postoperative recovery, and treatment success.

Acute dysuria among female soldiers.

Objective: To assess behavior patterns among active duty female soldiers presenting to military care facilities for acute dysuria.

Methods: A self-administered questionnaire was developed. One hundred twelve female soldiers presenting with acute dysuria and one hundred twenty-six presenting for other reasons were surveyed.

Arcus tendineus fascia pelvis: a further understanding.

Objective: The study was undertaken to further define the anatomy of the arcus tendineus fascia pelvis (ATFP).

Study Design: Thirty cadavers were dissected to find the average length, SD, and range of the ATFP. Comparisons were made to height and pelvis type.