Search

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.06.076 Byline: Marlene M. Corton (a), Don D. McIntire (a), Clifford Y. Wai (a), Frank W. Ling (b), George D. Wendel (a) Abstract: This study was undertaken to assess the impact of interactive, computer-based versus conventional, paper-based format in student, resident, and fellow learning and retention of anatomy knowledge. Author Affiliation: (a) Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX (b) Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN Article History: Received 21 February 2006; Revised 23 May 2006; Accepted 27 June 2006 Article Note: (footnote) Support provided by a grant from The Association of Professors of Gynecology and Obstetrics and continued support from the University of Texas Southwestern Medical Center Obstetrics and Gynecology Department in the development of this project. Reprints not available from the authors.

Randomized longitudinal cohort design is used to assess the impact of interactive, computer-based versus conventional, paper-based format in student, resident and fellow learning and retention of pelvic anatomy knowledge. The results have shown that improvement and retention of anatomy knowledge was not very different when comparing a new CD-ROM interactive approach with a traditional paper-based method.

Oral methotrexate can be used to treat ectopic pregnancy if patients object to intramuscular injections, according to a study of 22 patients. Ectopic pregnancy occurs when the fertilized embryo implants in the Fallopian tubes instead of the uterus.

A single intramuscular dose of methotrexate appears to be successful in treating an ectopic pregnancy. An ectopic pregnancy occurs when the fertilized egg implants in the Fallopian tubes rather than the uterus. Researchers gave a single intramuscular injection of methotrexate to 315 women with an unruptured ectopic pregnancy. The treatment was repeated if their blood levels of human chorionic gonadotropin did not decrease. This treatment was effective in 93% of the women.

Third-year obstetrics residents who score two standard deviations below average on a national standardized test may need additional instruction. The Committee on In-Training Examinations for Residents in Obstetrics and Gynecology Task Force on Standard-Based Scoring asked 28 faculty members to evaluate the 1991 examination. Faculty members considered which items on the exam a hypothetical marginal third-year resident would and would not be able to answer. University faculty members agreed with community hospital faculty on a cutoff score of 58%, which happens to be two standard deviations below the average score. Actual performance should be considered along with knowledge before residents are told to receive additional instruction.

Practicing gynecologists attending a surgical seminar in laparoscopic procedures could not pass a test in basic laparoscopic sterilization given to residents at the University of Tennessee Medical School. Registrants at the seminar were asked to take the test given to residents on completion of an educational program covering basic techniques and complications of laparoscopy and laparoscopic sterilization. Of the 155 questionnaires distributed, 72 were returned. No gynecologist achieved the 85% correct score that was required of the residents before performing laparoscopic surgery. However, practicing gynecologists familiar with one technique may not be familiar with others, nor is it clear that the information covered in the test is clinically relevant. Neither is there consensus on what constitutes essential basic knowledge to safely performing laparoscopic surgery.

Outpatient hysterectomy appears to be feasible among selected patients. The records of 133 women who underwent outpatient vaginal and laparoscopy-assisted vaginal hysterectomy were reviewed. Women had to be younger than age 65, healthy, and with uterine and pelvic size adequate for vaginal hysterectomy. They had to have help at home and a telephone. They were released after recovery if they could walk, tolerate clear liquids, and had not lost abnormal amounts of blood. They were sent home with oral pain medication and suppositories to relieve vomiting. The surgeon called on the subsequent two days and a home health nurse paid a visit. Nine percent of the women were admitted to the hospital because of complications during the surgery or recovery period, or for nausea or pain control. Another 3.8% required readmission for infection or bleeding. A 13% hospital admission rate is high compared with other types of outpatient surgery but was deemed acceptable.

A gonadotropin-releasing hormone (GnRH) agonist may be a good treatment for patients with uterine fibroids before surgery. Uterine fibroids, also called leiomyomas, are benign tumors of the smooth muscle of the uterus. Patients with symptomatic leiomyoma who are treated with a GnRH agonist before hysterectomy may be able to have a vaginal rather than an abdominal hysterectomy, and may experience less bleeding during surgery and a shorter hospital stay and convalescence. Patients with a pretreatment uterine size of 14 to 18 weeks' gestation were treated effectively with leuprolide acetate, a GnRH agonist. Patients with a pretreatment uterine size of more than 18 weeks' gestation did not experience the same benefits as did the 14 to 18 week-size group. Pretreatment with leuprolide acetate of the 14 to 18 weeks' gestation size shrank the uterus to a 14 week or less gestation size, which enabled surgeons to perform a hysterectomy through the vagina if the uterus was mobile upon examination. Patients who underwent vaginal hysterectomies were discharged as outpatients, which shortened their hospital stays much more than those who had abdominal hysterectomies.

A single dose of methotrexate was a successful treatment for unruptured ectopic pregnancy in 113 out of 120 patients studied. Four patients required a second dose of methotrexate to resolve the pregnancy and seven eventually needed surgery. An ectopic pregnancy is one that is implanted outside the uterus. The rupture of an ectopic pregnancy can be life threatening. Patients with ectopic pregnancies were first diagnosed through blood tests. They then had ultrasounds to locate the pregnancy and to ensure that it had not ruptured. Curettage, or the removal of tissue from the uterus for microscopic examination, was done if indicated to rule out a viable uterine pregnancy. Patients were eligible for drug therapy if the ectopic pregnancy was smaller than or equal to 3.5 centimeters. Resolution of the pregnancy took approximately 35.5 days. Of the 49 patients who later desired pregnancy, 39 became pregnant.

Leiomyomas are benign (noncancerous) tumors that grow in smooth muscle tissue. When leiomyomas occur in the uterus, a hysterectomy (removal of the uterus) is performed to remove these tumors. The uterus can be removed through an incision made in the abdomen (abdominal hysterectomy) or by an incision made in the vagina (vaginal hysterectomy). Abdominal hysterectomies require a longer period of hospitalization, more blood transfusions, and give rise to more complications than vaginal hysterectomies. However, vaginal hysterectomies are difficult to perform if the uterus is large, and when leiomyomas grow in the uterus they increase the size of the uterus. Previous studies have reported that treatment with a drug that mimics the effect of gonadotropin-releasing hormone, such as leuprolide, can reduce the size of the uterus within eight weeks. A study was performed to determine if treatment with leuprolide would reduce the size of the uterus of women with leiomyomas, thereby making vaginal hysterectomy possible. Twenty-five women with leiomyomas were treated with leuprolide for two months, and 25 patients who were not treated were included for comparison. Treatment with leuprolide reduced the size of the uterus by 33 percent, and made it possible for 76 percent of the treated women to have vaginal hysterectomies. Only 16 percent of the women who were not treated were able to have vaginal hysterectomies. Those who received drug treatment spent an average of four days in the hospital, while those who were not treated spent an average of five days in the hospital. It is concluded that two months of treatment with leuprolide may allow patients with leiomyomas to be candidates for vaginal hysterectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ectopic pregnancies are pregnancies in which the embryo implants in an area outside the uterus. Most ectopic pregnancies occur in the fallopian tubes, which lead from the ovaries to the uterus. These abnormal pregnancies must be terminated because they pose a serious threat to the mother's health. Microsurgical techniques are now performed in an effort to maintain tubal integrity for future fertility. However, it has been estimated that even with microsurgical techniques, only 68 percent of the patients will become pregnant and only 56 percent will have embryos implant inside of the uterus. A new treatment for ectopic pregnancies involves injecting the embryonic sac with the chemotherapeutic drug, methotrexate. The subsequent reproductive functioning of 57 women with unruptured tubal pregnancies who were treated with methotrexate and citrovorum factor is reported. It took an average of 26 days (0 to 157 days) for the women to begin menstruating again. Follow-up information was available for 44 patients. Of the 23 patients who had a hysterosalpingogram, a method of assessing the patency of the fallopian tubes by injecting a contrast material, 19 women had a functioning tube. During the follow-up period, 11 pregnancies were achieved in the 14 women desiring pregnancy (78.6 percent). The pregnancy implanted inside the uterus in 10 women (90.9 percent) and outside the uterus in one (9.1 percent) woman. It took an average of 2.3 months to achieve pregnancy. It is concluded that methotrexate treatment for ectopic pregnancy did not alter the return of menstruation or the functioning of the fallopian tube. Although pregnancy rates were similar to those following conventional surgical methods of treating ectopic pregnancy, the risks and cost of a surgical operation are eliminated with the methotrexate method. (Consumer Summary produced by Reliance Medical Information, Inc.)