The Certification Process Driving Patient Safety.

In 2016, the American Board of Medical Specialties (ABMS) and the National Patient Safety Foundation issued a joint call encouraging each ABMS member board to integrate patient safety principles and activities into their initial and continuous certification processes. This article describes how the American Board of Obstetrics and Gynecology integrates various aspects of patient safety principles into its initial and continuous certification processes. The authors first describe how they assess patient safety within their initial certification processes.

Variation in Use of Prophylactic Antibiotics in Gynecologic Procedures Before and After an Educational Intervention.

Objectives: Guidelines for use of prophylactic antibiotics in gynecologic procedures are outlined by the American Congress of Obstetricians and Gynecologists. There remains, however, a high rate of unindicated administration of antibiotics for surgeries. A retrospective study performed at our institution in 2012-2013 demonstrated that unindicated prophylactic antibiotics were administered over half the time.

Anatomic relation between single-incision slings and the obturator vessels.

The risk of arterial vascular injury within the retropubic space is a potentially life-threatening complication associated with mid-urethral sling placement for the treatment of female stress urinary incontinence. To determine the relationship between the major blood vessels and a single incision sling, these slings were placed in 12 fresh female cadavers. Following the insertion of each sling, the retropubic space was dissected and sling placement was observed relative to the obturator neurovascular bundle bilaterally.

Perineal body length and perineal lacerations during delivery in primigravid patients.

This study assessed the relation between perineal body length and the risk of perineal laceration extending into the anal sphincter during vaginal delivery in primigravid patients at an institution with a low utilization of episiotomy. This was a prospective study of primigravid patients in active labor. Primigravid women with singleton pregnancies who were in the first stage of labor at 37 weeks gestation or greater were recruited, and the admitting physician measured the length of the perineal body.

Inappropriate use of antibiotics in patients undergoing gynecologic surgery.

We retrospectively examined prophylactic antibiotic use and documentation of wound classification in patients having gynecologic surgery at a tertiary hospital. Of the 326 cases reviewed, 175 (54%) received prophylactic antibiotics when not indicated according to guidelines of the American College of Obstetricians and Gynecologists. Antibiotic administration varied significantly ( < 0.

Incidence of Bladder Injury During Retropubic Midurethral Sling Placement After Prior Burch Colpopexy.

Objectives: To elucidate if prior Burch changes the risk of bladder injury or rates of voiding dysfunction and continence in the immediate postoperative period when undergoing retropubic midurethral sling (MUS) placement.

Methods: In this retrospective case control, charts were selected by Current Procedural Terminology codes for MUS placement. Women undergoing retropubic MUS placement with history of Burch urethropexy were considered.

Iatrogenic Bladder Diverticulum 11 Years After Sacrospinous Ligament Fixation for Apical Prolapse.

Introduction: In this case, we describe a bladder diverticulum due to apical vaginal suspension to the sacrospinous ligament presenting 11 years after surgery. This case report explores her signs and symptoms, diagnostic work-up, surgical intervention, and postoperative course.

Case Description: A 71-year-old G2P2 presented with symptoms of urinary urgency.

Randomized trial of cesarean vs vaginal delivery for effects on the pelvic floor in squirrel monkeys.

Background: Vaginal delivery is a risk factor in pelvic floor disorders. We previously described changes in the pelvic floor associated with pregnancy and parturition in the squirrel monkey, a species with a humanlike pattern of spontaneous age- and parity-associated pelvic organ prolapse.

Objective: The potential to prevent or diminish these changes with scheduled cesarean delivery (CD) has not been evaluated.

Can laparoscopic cholecystectomy be performed with a positive margin at medicaid reimbursement rates?

Background: The Affordable Care Act provides health care coverage to an increasing segment of the population at Medicaid reimbursement rates. Health care systems currently offset lower Medicaid reimbursement through higher payers. The ability to "cost shift" will be diminished as the Medicaid population increases.

Lack of preoperative predictors of the immediate return of postoperative bladder emptying after uterosacral ligament suspension.

Objectives: To determine whether preoperative postvoid residual volume (PVR), pelvic organ prolapse quantification (POPQ) stage, patient characteristics, or concurrent operations are predictors of immediate postoperative bladder emptying after uterosacral ligament suspension (USLS).

Methods: A review of patients undergoing USLS in 2008 and 2009 was performed. The factors analyzed included patient age, body mass index, parity, preoperative PVR, POPQ stage, concurrent anterior repair, posterior repair, hysterectomy and/or sling procedures, and postoperative voiding trial status.

Recognition and management of nerve entrapment pain after uterosacral ligament suspension.

Objective: To estimate the incidence, risk factors, and characteristics of neuropathic pain related to nerve entrapment after uterosacral ligament suspension.

Method: A review of patients who underwent uterosacral ligament suspension from January 2007 to August 2011 was performed. Patients with neuropathic pain attributable to nerve entrapment from uterosacral ligament suspensory suture placement were identified.

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.

A novel transvaginal approach to correct recurrent apical prolapse after failed sacral colpopexy: case series.

Introduction And Hypothesis: The objective of the study was to describe the transvaginal approach utilizing the existing sacral colpopexy (SC) graft for recurrent apical prolapse following failed SC.

Methods: Twenty-two patients with recurrent vaginal vault prolapse following a prior SC were treated between January 2000 and December 2009. Twelve patients had a standard uterosacral ligament cuff suspension (USLS) performed.

Incidence and risk factors of postoperative urinary tract infection after uterosacral ligament suspension.

Introduction And Hypothesis: We assessed the incidence of and risk factors for developing urinary tract infection (UTI) after uterosacral ligament suspension (USLS).

Methods: Retrospective analysis of patients undergoing USLS in 2008-2009 was performed. Postoperative UTI was defined as a positive urine culture within 1 month following surgery.

Risk factors for late postpartum preeclampsia.

Objective: To determine the risk factors for late postpartum preeclampsia.

Study Design: This was a retrospective case control study of women readmitted in the postpartum period (>48 hours and <4 weeks) with preeclampsia. Inclusion criteria were readmission with confirmed preeclampsia.

Patterns of care for cervical cancer patients treated in the U.S. military health care system.

Objective: To determine whether women diagnosed with cervical cancer within the U.S. Department of Defense (DOD) Military Health Care System received treatment within standard guidelines and whether survival was influenced by implementation of these guidelines.

Grading of squamous dysplasia in endocervical curettage specimens: The case for conservative management of mild endocervical dysplasia.

Objective: To determine if the severity of dysplasia in a loop electrical excision procedure (LEEP) specimen is different for women with a preoperative endocervical curettage (ECC) positive for mild dysplasia.

Study Design: Records from a colposcopy clinic for a 5-year period were reviewed. The subjects were divided into 3 groups: group I, ECC positive for mild dysplasia; group II, mild ectocervical dysplasia; and group III, ECC positive for dysplasia not identified as mild.

Long-term impact of the women's health initiative on HRT.

Objective: To evaluate the long-term trends in the HRT following the results of the WHI, which were made public in July 2002.

Study Design: An observational cohort study was performed from prescription data of estrogen containing products ordered from Tripler Army Medical Center between July 1999 and July 2005. We used automated pharmacy data to identify all estrogen products dispensed to active duty soldiers, dependent wives, and retirees during the study period.

A randomized double-blind placebo-controlled phase II trial of the cyclooxygenase-2 inhibitor Celecoxib in the treatment of cervical dysplasia.

Objectives: The objective of the study was to evaluate the efficacy of daily Celecoxib in the regression of moderate and severe cervical dysplasia, when compared to placebo.

Materials And Methods: Women, over the age of 18, with the histologic diagnosis of moderate or severe cervical dysplasia were enrolled in this IRB approved study. Women were randomized to receive either Celecoxib 200 mg twice a day or placebo.

Far forward gynecologic care of the female soldier.

Objective: To evaluate the value, unit cost and medical effectiveness of providing specialized obstetric and gynecologic care far forward, at echelon III, the combat support hospital (CSH), in the operating theater of Afghanistan during Operation Enduring Freedom (OEF), rotation 5.

Study Design: Between April 2004 and September 2004, records were reviewed from the outpatient gynecology clinic at Bagram Air Field (BAF), in Afghanistan, through an approved protocol request. Cohort analysis was performed on all gynecologic patients.

Pelvic organ prolapse and urinary incontinence in nulliparous women at the United States Military Academy.

The objective of this study was to evaluate both baseline pelvic support and incontinence in relation to physical activity in nulliparous college women. Participants were examined using the pelvic organ prolapse and quantification system (POP-Q) and completed a questionnaire. Women with stage 0 prolapse and any other stage were compared.

Treatment of metastatic gestational choriocarcinoma with oral methotrexate in a combat environment.

Background: Gestational trophoblastic neoplasia (GTN) is a rare neoplastic complication of pregnancy. This disease can be successfully treated with parenteral intravenous or intramuscular chemotherapy. We present a case of metastatic gestational choriocarcinoma following a term pregnancy that was treated successfully with oral methotrexate therapy.