Brief report: Influence of mandatory contraceptive education emphasizing long-acting reversible methods on continuation rates among military recruits.

Objectives: Determine if the replacement of patient-initiated, individual contraceptive education with mandatory group contraceptive education, during US Navy basic training, was associated with decreased LARC continuation.

Study Design: Secondary analysis of administrative billing data from female military recruits who began basic training between September 2012 and February 2020.

Results: Servicewomen who started LARC method during rather than after basic training had higher continuation rates.

Selection, Initiation, Continuation, and Efficacy of Reversible Contraception Among Enlisted U.S. Service Women in Their First Term of Service From 2012 to 2020.

Background: Pregnancy is the second most common cause of limited duty days among active duty service members in the U.S. Military.

Mandatory HPV Vaccination; Opportunity to Save Lives, Improve Readiness and Cut Costs.

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the U.S. military and accounts for more healthcare visits than the next two most common STIs combined.

Differences in Rate of Gestational Diabetes Between Active Duty and Non-active Duty Beneficiaries at a Military Treatment Facility.

Introduction: Gestational diabetes mellitus (GDM) affects approximately 1-14% of all pregnancies in the United States and has significant maternal and neonatal consequences. Developing GDM can increase a patient's risk of developing overt diabetes in the future which may impact a soldier's readiness. The purpose of this study is to compare the incidence of GDM in active duty females compared with civilian dependents.

Extending Peer Support Across the Military Health System to Decrease Clinician Burnout.

Introduction: Clinician burnout is widespread throughout medicine, affecting professionalism, communication, and increases the risk of medical errors, thus impacting safe quality patient care. Previous studies have shown Peer Support Programs (PSPs) promote workforce wellness by supporting clinicians during times of heightened stress and vulnerability. Although these programs have been implemented in large institutions, they have not been used in military hospitals, which have high staff turnover and added stressors of deployments.

Influence of military contraceptive policy changes on contraception use and childbirth rates among new recruits.

Background: Unplanned pregnancy is a common problem among United States servicewomen. Variation among service branches in contraceptive education and access during initial training is associated with differences in contraceptive use and childbirth rates despite access to a uniform health benefit including no-cost reproductive healthcare and contraception. However, it is unclear whether changes in branch-specific contraceptive policies can influence reproductive outcomes among junior enlisted women in that service branch.

Development of In-situ Simulation Lab for Training Gynecology Residents in Basic Laparoscopic and Hysteroscopic Operative Skills.

Introduction: Mounting evidence suggests that practice on simulators leads to improved operative skills and patient safety. With restrictions on resident work hours resulting in less exposure to procedures, simulation is the key to developing operative skills during residency and beyond. Residency programs struggle with implementing a simulation program due to timing and availability of residents.

Contraceptive use and childbirth rates by service branch during the first 24 months on active duty in the United States military from 2013 to 2018: a retrospective cohort analysis.

Objective: To measure the association of military branch-specific contraceptive education and access policy during basic training with contraceptive use and childbirth among new recruits.

Study Design: Secondary analysis of insurance records from 92,072 active duty servicewomen who started basic training between 2013 and 2017.

Results: Exposure to reproductive health education and access to contraception during basic training differ by military branch.

Measuring Community Prevalence of Trichomonas vaginalis Infection to Guide Local Screening Practices: A Process Improvement Project.

The Centers for Disease Control and Prevention suggests screening for Trichomonas vaginalis infection might be considered in high-prevalence populations. High asymptomatic infection rates and poor sensitivity of clinical diagnosis make it difficult to estimate local prevalence. Testing of ThinPrep samples can provide an estimate of local Trichomonas vaginalis infection rates and guide screening practices.

Postpartum contraception: initiation and effectiveness in a large universal healthcare system.

Background: Repeat pregnancies after a short interpregnancy interval are common and are associated with negative maternal and infant health outcomes. Few studies have examined the relative effectiveness of postpartum contraceptive choices.

Objective: We aimed to determine the initiation trends and relative effectiveness of postpartum contraceptive methods, with typical use, on prevention of short delivery intervals (≤27 months) among women with access to universal healthcare, including coverage that entails no co-payments and allows unlimited contraceptive method switching.

Chorioamniotic Membrane Separation Found on Routine Testing in an Otherwise Asymptomatic Woman With Late Preterm Twin Gestation.

Background: Chorioamniotic membrane separation (CMS) is a rare finding that is commonly preceded by invasive fetal procedures. The presence of CMS can also be associated with uncommon maternal or fetal conditions as well as preterm delivery, amniotic band syndrome, umbilical cord complications, and fetal and neonatal death. It is classified as a high-risk antepartum condition due to the significant fetal morbidity and mortality that may ensue.

Complete fetal transection after a motor vehicle collision.

Background: Motor vehicle collisions are the leading cause of fetal death related to maternal trauma, with rupture of the gravid uterus being one potential grave outcome.

Case: We present a case of a woman at 22 weeks of gestation who presented to the emergency department after a "high-speed" motor vehicle collision. On initial presentation, she was hemodynamically stable, and the examination was significant for midabdominal transverse ecchymosis from seatbelt trauma.

Postoperative activity restrictions: any evidence?

Objective: Because of a widespread but untested belief that increased intra-abdominal pressure contributes to pelvic floor disorders, physicians commonly restrict various activities postoperatively. Our aim was to describe intra-abdominal pressures during common physical activities.

Methods: Thirty women of wide age and weight ranges who were not undergoing treatment for pelvic floor disorders performed 3 repetitions of various activities while intra-abdominal pressures (baseline and maximal) were approximated via microtip rectal catheters.