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The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand. [ABSTRACT FROM AUTHOR]

The article discusses training given to medical students in a women's health clerkship which focused on ways in which doctors can help women of all ages in improving their nutrition. According to the article, the training revolved around weight rated issues which are faced by women in various times of their lives. The learning objectives which were involved with the program are mentioned, including teaching medical students to conduct nutrition assessments on their patients. The author states that the intervention skills taught to medical students focused on four aspects of a woman's health including weight, activity, variety and excess.

A letter to the editor is presented in response to the article "Elective primary cesarean delivery," by H. Minkoff and F. A. Chervenak in the March 6, 2003 issue.

Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and Its content may not be copied or emailed to multiple sites or posted to a listserv without the Copyright holder's express written permission. [Extracted from the article]

OBJECTIVE: To describe the use of peripheral nerve blocks in a case series of pregnant women with migraine. METHODS: A retrospective chart review of all pregnant patients treated with peripheral nerve blocks for migraine over a 5-year period was performed. Injections targeted greater occipital, auriculotemporal, supraorbital, and supratrochlear nerves using local anesthetics. RESULTS: Peripheral nerve blocks were performed 27 times in 13 pregnant women either in a single (n=6) or multiple (n=7) injection series. Mean patient age was 28 years and gestational age was 23.5 weeks, and all women had migraine, including 38.5% who had chronic migraine. Peripheral nerve blocks were performed for status migrainosus (51.8%) or short-term prophylaxis of frequent headache attacks (48.1%). Before peripheral nerve blocks were performed, oral medications failed for all patients and intravenous medications failed for most. In patients with status migrainosus, average pain reduction was 4.0 (±2.6 standard deviation) (P<001) immediately postprocedure and 4.0 (±4.4 standard deviation) (P=.007) 24 hours postprocedure in comparison to preprocedure pain. For patients receiving peripheral nerve blocks for short-term prophylaxis, immediate mean pain score reduction was 3.0 (±2.1 standard deviation). No patients had any serious immediate, procedurally related adverse events, and the two patients who had no acute pain reduction ultimately developed preeclampsia and had postpartum headache resolution. CONCLUSION: Peripheral nerve blocks for treatment- refractory migraine may be an effective therapeutic option in pregnancy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Strongyloides stercoralis is a common human parasite worldwide and has been associated with severe infection in immunosuppressed patients. High mortality rates have accompanied this severe disseminated infection. There is a scarcity of literature surrounding severe Strongyloides infection in pregnancy. CASE: A 30-year-old primigravid Haitian woman at 25 weeks of gestation presented with acute abdominal pain and an abnormal fetal heart tracing. Mild anemia and eosinophilia were laboratory abnormalities on admission. She received corticosteroids for the fetus and subsequently developed septic shock. Sputum and stool were positive for S stercoralis larvae. Hyperinfection was diagnosed, stillbirth occurred, and the patient died. CONCLUSION: A more global awareness and education surrounding helminth infection during pregnancy may improve response, reduce delay in diagnosis, and potentially improve outcome. [ABSTRACT FROM AUTHOR]

We evaluated sex-related differences in symptoms and risk factors for mortality in 4798 patients hospitalized with coronavirus disease 2019 in New York City. When adjusted for age and comorbidities, being male was an independent predictor of death with mortality significantly higher than females, even with low severe acute respiratory syndrome coronavirus 2 viral load at admission. [ABSTRACT FROM AUTHOR]

Objective To describe labor and delivery outcomes in pregnant patients presenting to the hospital setting with an acute severe migraine headache attack earlier in the same gestation. Methods We retrospectively reviewed pregnancy and delivery records from a database of consecutive inpatient neurology consultations for acute headache in pregnant women over a 5 year period. Results We identified 86 pregnant women with acute migraine. The mean age was 29.3 (±6.4) years. Nearly half had migraine with aura (35/86 [40.7%]), 12.8% (12/86) had chronic migraine, and 31.4% (27/86) presented in status migrainosus. Complication rates included 54.7%([41/75], 95% CI 29.87, 52.13) for at least one adverse outcome, 28.0% ([21/75], 95% CI 11.78, 30.22) for preterm delivery, 21.3% ([16/75], 95% CI 7.7, 24.3) for preeclampsia, 30.6% ([23/75] 95% CI 13.48, 32.52) for cesarean delivery, and 18.7% ([14/75] 95% CI 6.15, 21.85) for low birthweight. Conclusions Pregnant women seeking treatment for acute migraine headache experienced a higher rate of preterm delivery, preeclampsia, and low birthweight but a lower rate of cesarean delivery than the local and general populations. More than half (54.7% [41/75] 95% CI 29.87, 52.13) of the study patients experienced some type of adverse birth outcome, suggesting that pregnancies in migraine patients presenting to an acute care setting may benefit from more intense surveillance. [ABSTRACT FROM AUTHOR]

Objective: Case report of a young woman with a rare vulvar malignancy who received treatment with a personalized multidisciplinary approach to balance management of her malignancy without compromising survival with her desire for future pregnancy. Design: Case report. Setting: University hospital. Patient(s): A 33-year-old woman, gravida 2, para 1-0-1-1, who had a diagnosis of synovial cell sarcoma of the vulva and who desired future fertility. Intervention(s): At multiple steps, treatment was planned to try to maximize fertility preservation without potentially affecting initial treatment, which included a radical hemivulvectomy with bilateral lymph node dissection, brachytherapy with interstitial needles (20 Gy), and external beam radiation therapy (50 Gy). Main Outcome Measure(s): Treatment and eradication of the malignancy and achievement of a successful subsequent pregnancy and live birth. Result(s): The patient had no evidence of disease for 2 years after treatment. During that time she received preconception counseling by both a perinatologist and a reproductive endocrinologist. She conceived with the use of ultrasound monitoring to time intercourse specifically with ovulation from the contralateral ovary and had an uncomplicated pregnancy with a term delivery. Conclusion(s): By using several disciplines and subspecialists, this patient received personalized treatment for a rare cancer, focused at curing her cancer and optimizing her future fertility. [Copyright &y& Elsevier]