Hormone Therapy: Menopausal Hormone Therapy.

The marked decrease in estrogen levels in menopausal women can cause bothersome symptoms that affect daily life. More than 75% of women experience menopausal symptoms, which can include vaginal dryness, itching, discharge, dyspareunia, mood changes, hot flushes, and night sweats. Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms.

Diagnosing and managing adrenal crisis in pregnancy: A case report.

Background: The diagnosis of adrenal insufficiency in pregnancy is relatively rare. Further, making this diagnosis can be challenging as many of the symptoms overlap with normal symptoms of pregnancy. Given the potential for severe maternal and fetal morbidity and mortality, early recognition and prompt comprehensive treatment are critical.

Speed Mentoring: An Effective & Efficient Path to Development of Mentor Relationships in a Military Obstetrics & Gynecology Residency.

Introduction: With a deficit of effective military residency mentorships, a paucity of research on successful mentorship programs, and growing reports on innovative mentoring programs, we developed a "Speed Mentoring" event for the National Capital Consortium OBGYN Residency.

Materials And Methods: The development, implementation, and follow-up responses through participant surveys were designed as an institutional review board (IRB)-approved evidence-based quality improvement project at our institution. Our event coordinated mentorship opportunities between residents and faculty from a wide range of specialties, leadership roles, and research experiences.

The Safety of Low-Dose Aspirin on the Mode of Delivery: Secondary Analysis of the Effect of Aspirin in Gestation and Reproduction Randomized Controlled Trial.

Objective: This study aimed to examine whether prenatal low-dose aspirin (LDA) therapy affects risk of cesarean versus vaginal delivery.

Study Design: This study is a secondary analysis of the randomized clinical effects of aspirin in gestation and reproduction (EAGeR) trial. Women received 81-mg daily aspirin or placebo from preconception to 36 weeks of gestation.

Donor oocyte recipients do not benefit from preimplantation genetic testing for aneuploidy to improve pregnancy outcomes.

Study Question: Do donor oocyte recipients benefit from preimplantation genetic testing for aneuploidy (PGT-A)?

Summary Answer: PGT-A did not improve the likelihood of live birth for recipients of vitrified donor oocytes, but it did avoid embryo transfer in cycles with no euploid embryos.

What Is Known Already: Relative to slow freeze, oocyte vitrification has led to increased live birth from cryopreserved oocytes and has led to widespread use of this technology in donor egg IVF programs. However, oocyte cryopreservation has the potential to disrupt the meiotic spindle leading to abnormal segregation of chromosome during meiosis II and ultimately increased aneuploidy in resultant embryos.

Creation and Evaluation of a Cesarean Section Simulator Training Program for Novice Obstetric Surgeons.

Background: We evaluated a novel simulation-based cesarean section training program to teach critical techniques for cesarean section and hemorrhage management.  Methods: This was a prospective educational intervention. After Institutional Review Board approval, we recruited Obstetrics and Gynecology, Family Medicine, and General Surgery residents at three hospitals.

Recalled maternal lifestyle behaviors associated with anti-müllerian hormone of adult female offspring.

Anti-müllerian hormone (AMH) is an established marker of ovarian reserve that decreases with age. Though the pool of ovarian follicles is established during fetal development, impacts of in utero exposures on AMH are uncertain. Thus, we sought to evaluate associations of in utero exposures with AMH of adult daughters with a prospective cohort study of adult daughters at university medical centers.

Obstetric simulation for a pandemic.

Objective: In the middle of the COVID-19 pandemic, guidelines and recommendations are rapidly evolving. Providers strive to provide safe high-quality care for their patients in the already high-risk specialty of Obstetrics while also considering the risk that this virus adds to their patients and themselves. From other pandemics, evidence exists that simulation is the most effective way to prepare teams, build understanding and confidence, and increase patient and provider safety.

Is transferring a lower-quality embryo with a good-quality blastocyst detrimental to the likelihood of live birth?

Objective: To determine if transferring a lower-quality embryo with a good-quality blastocyst is detrimental, given that evidence suggests that embryos can signal the endometrium and that embryo quality may affect negatively endometrial receptivity.

Design: Retrospective cohort study.

Setting: In vitro fertilization center.

Maternal risk factors and neonatal outcomes in placental abruption among patients with equal access to health care.

Introduction: Placental abruption complicates 1% of pregnancies, and is associated with significant morbidity and mortality. The objective was to examine risk factors and outcomes in pregnancies complicated by abruption in a health care system with equal access to care.

Methods: This was a retrospective cohort study of all deliveries at Walter Reed National Military Medical Center (WRNMMC) between 1 January 2014 and 1 June 2017.

An alternative to cesarean: a description of external cephalic version in noncephalic presenting twin.

External cephalic version (ECV) is utilized in breech presenting singleton gestations but ECV of the noncephalic presenting twin has been considered technically unfeasible. We have successfully performed ECVs of the noncephalic presenting twin. Our objective is to describe our experience with this technique.

Intravesicular Onabotulinumtoxin A Hemorrhage on Rivaroxaban.

Overactive bladder (OAB) is urgency, with or without urgency incontinence. For OAB, an injection of onabotulinumtoxin A (BOTOX®) can be a low-risk outpatient procedure. We present a patient on a novel anticoagulant that experienced excessive bleeding after this procedure.

Visual Estimation of Force Applied During Simulated Deliveries Complicated by Shoulder Dystocia.

 Shoulder dystocia occurs when the fetal head delivers, but the shoulder is lodged behind the pubic symphysis. Training for these emergency deliveries is not optimized, and litigation can occur around a shoulder dystocia delivery.  Evaluate the ability of an outside observer to visually estimate the amount of traction applied to the fetal head during simulated deliveries complicated by shoulder dystocia.

Risk Assessment and Treatment Guide for Obstetric Thromboprophylaxis: Comprehensive Review of Current Guidelines.

Objective: Currently, there are numerous recommendations and often conflicting guidance provided for venous thromboembolism (VTE) prophylaxis in pregnancy. Our objective was to create a one-page risk assessment and treatment guide based on a review of the most recent and evidence-based publications on this subject to simplify the approach and allow all obstetric patients to be properly assessed for risk of VTE and treated if indicated.

Study Design: We identified studies by completing a PubMed and MEDLINE search from January of 1980 through March 2017 with articles utilizing a specific combination of the selected general keywords (thrombophilia, pregnancy, VTE, prophylaxis, hypercoagulability, antepartum, postpartum, risk, etc.

Postpartum Management After Obstetric Anal Sphincter Injuries.

A 26-year-old woman, gravida 1 para 1, experiences a severe perineal laceration that extends through the rectal mucosa after a vaginal delivery. She asks you, "What can be done to optimize my recovery?"

Congenital Megaureter Presenting in an Adult as a Vaginal Wall Cyst.

Background: Vaginal cysts are a common finding. The differential diagnosis includes epidermal inclusion, Bartholin gland, Gartner duct, and Skene gland cysts and Müllerian anomalies. Rarely, leiomyomas, cancers, or ectopic ureters or megaureters are found.