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Pregnant women were queried to determine if racial and ethnic disparities exist in prenatal care by assessing their satisfaction in private and clinic practices. An anonymous survey was distributed in both English and Spanish and focused on demographics, satisfaction and cultural sensitivity. A total of 273 surveys were collected. Demographics of clinic patients (Hispanic 62%, Black 26.4%, and Caucasian 5%) varied significantly (P<0.001) from private patients (Caucasian 62.5%, Black 14.1%, and Hispanic 18.8%). Significant differences were noted between clinic and private patients' in their country of birth, education, income, insurance, employment status, home ownership, and planned pregnancies. Patients reported that their prenatal care was influenced by race (27% clinic vs 5% private, P <0.001) and language (24.9% clinic vs 4.9% private, P=0.004). Race and language were more likely to influence clinic patients' perceptions of the prenatal care received as compared to those seeking care in private practices. [ABSTRACT FROM AUTHOR]

Objective: We sought to study the frequency, and reasons that third-year medical students on an ObGyn clerkship are denied the opportunity to be involved in patient care. Methods: Students from four hospitals affiliated with the University of Connecticut Medical School completed an anonymous postclerkship survey. Results: Among the 157 students studied (66 males and 91 females), 51% (n=80) were denied the opportunity to participate in a gynecologic examination and 47% (n=73) were denied the opportunity for routine ObGyn care by patients. Among these students, 55% (n=44) and 38% (n=28) stated that being male was the reason they were excluded from gynecologic and routine care, respectively. Of the 80 students who were denied involvement in a gynecologic examination, 81% (n=65) were denied involvement by clinic patients. Of the 44 males who stated they were denied the opportunity to be involved in a gynecologic examination due to their gender, 89% (n=39) were refused by clinic patients. Compared with female students, male students are statistically more likely to be denied the opportunity to be involved in gynecologic examinations (RR= 1.69 [1.24-2.29]), especially by clinic patients (RR= 2.07 [1.41-3.03]). Conclusion: A significant number of students were denied the opportunity to be involved in ObGyn care experiences. More frequently male students were denied involvement in care, with a higher incidence among clinic patients. We hypothesize that being denied involvement provides a negative perception of the ObGyn specialty, especially to male students, possibly affecting their decision to choose ObGyn training. Précis: A significant number of medical students, particularly males, were denied involvement in patient care, primarily by clinic patients, during the ObGyn clerkships. [ABSTRACT FROM AUTHOR]

Introduction/Hypothesis: To identify factors that influence nulliparous women to choose cesarean delivery on maternal request (CDMR). Methods: Nulliparous women at ≥ 34 weeks completed a 76-item survey about concerns during labor, delivery and postpartum. Results: Mean age of the 294 respondents was 28.4 years (± 6.13 years SD) and mean gestational age was 35.4 weeks (± 2.8 weeks). Sixteen patients (5.4%) would request CDMR if offered. Women who would request CDMR were more likely to plan breastfeeding (OR 5.1, P=0.02), have a mother who delivered by C-section (OR 5.1, P=0.01), and be concerned about the number of family members present (OR 1.75, P=0.002). Pelvic muscle damage, urinary incontinence, fecal incontinence, or need for prolapse surgery were not cited by any patient as her top concern. Conclusions: Few women in our sample desire CDMR. Concern for pelvic-floor problems was low. [ABSTRACT FROM AUTHOR]

Recently, applications for subspecialty fellowship positions in obstetrics and gynecology have increased dramatically. A survey completed by fellows in Maternal-Fetal Medicine (MFM), Reproductive Endocrinology (REI), Gynecologic Oncology (Gyn Onc), and Urogynecology (Urogyn) training programs in the United States between January and March 2006 was aimed at determining why this trend was occuring. Of 449 fellows in 2006, 192 (42.8%) responded. The two most influential factors in all four subspecialties were interest and lifestyle (P <.001). Although these factors were similar throughout all subspecialties, variations exist in how fellows rated each factor by subspecialty. An overwhelming majority (99%) of fellows were either "very satisfied" or "satisfied" with their decisions to pursue fellowship training. The majority of fellows believe that when compared to a generalist Obstetrician/Gynecologist (OB/GYN) they will have a reduced workload, decreased liability, and a higher salary. The recent increase in the number of fellowship applicants is most likely due to a complex interplay of multiple factors. [ABSTRACT FROM AUTHOR]

Objective: We investigated the observed and expected Down syndrome livebirths in the US from 1989 to 2001. Study design: Using birth certificate data, we recorded maternal age-specific live births from 1989 to 2001, and stratified them by women 15 to 34 and 35 to 49 years old. We estimated Down syndrome live births from 1989 to 2001, assuming no terminations. We recorded Down syndrome live births by year from 1989 to 2001. Results: Despite an expected 1.32-fold increase in Down syndrome live birth rates from 1989 to 2001, Down syndrome live births actually declined. In 1989, the rate of Down syndrome cases was 15% lower than expected, decreasing to 51% by 1998. Women 15 to 34 had 45% fewer affected pregnancies in 2001, while women 35 to 49 had 53% fewer in 2001. We estimated that Down syndrome live births decreased from 3962 in 1989 to 3654 in 2001. Conclusion: Down syndrome live births declined in the US despite an expected increase caused by delayed or extended childbearing. [ABSTRACT FROM AUTHOR]

Lists medically oriented letters to the 'Journal of the American Medical Association.' Possible causal relationship between measles-mumps-rubella (MMR) vaccinations and autism; Thyroid disease and primary pulmonary hypertension; Causes of traumatic death during pregnancy; Interobserver agreement about cervical cytologic and histologic diagnosis; Ultrasound markers of fetal down syndrome.