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The measurement of human chorionic gonadotropin (hCG) levels in different body fluids is a commonly utilized tool in obstetrics and gynecology, as well as other fields. It is often one of the first steps in the medical workup of female patients, and the results and interpretation of this test can have significant downstream ramifications. It is essential to understand the uses and limitations of hCG as a testing and therapeutic measure to appropriately evaluate, counsel, and treat patients.The purpose of this article is to review the current literature on hCG, including its origins, structure, pharmacokinetics, metabolism, and utility in testing and medical treatment.Original research articles, review articles, and guidelines on hCG use were reviewed.While the primary function of hCG is to maintain early pregnancy, testing for hCG demonstrates that this molecule is implicated in a multitude of different processes where results of testing may lead to incorrect conclusions regarding pregnancy status. This could affect patients in a myriad of settings and have profound emotional and financial consequences. In addition, hCG testing may be revealing of alternative pathology, such as malignancy. It is imperative to understand the nuances of the physiology of hCG and testing methods to effectively use and interpret this test for appropriate patient management.

Ovarian cancer is the second most common gynecologic malignancy, but the most deadly female reproductive cancer in the United States. Epithelial ovarian cancer makes up approximately 90% of all cases and is responsible for more than 90% of ovarian cancer deaths. Elective salpingectomy has been shown to reduce ovarian cancer risk when performed at the time of a benign hysterectomy. Data regarding the risks and benefits of opportunistic bilateral salpingectomy performed at the time of cesarean delivery are limited.We aim to review the current evidence regarding safety and benefits of opportunistic bilateral salpingectomy at the time of cesarean delivery compared with bilateral tubal ligation.Original research articles, review articles, and guidelines on contraception were reviewed.Opportunistic bilateral salpingectomy at the time of cesarean delivery is feasible and safe. Operative time may be increased up to 15 minutes for salpingectomy performed by suture ligation compared with standard tubal ligation. Women with a history of 3 or more cesarean deliveries are more likely to require an alternative procedure. It is important to counsel women that although opportunistic bilateral salpingectomy may significantly decrease the risk of ovarian cancer, it does not eliminate the risk entirely.

Objective: To date, there is limited information about medical student duty hours, shelf scores, and overall clerkship performance in Obstetrics and Gynecology. As a result, we were curious to know whether spending more time in the clinical environment translated to an improved learning experience or, in contrast, translated to decreased study time and worse overall clerkship performance. Study Design: A retrospective cohort analysis was performed at a single academic medical center of all medical students on the Obstetrics and Gynecology clerkship from August 2018 to June 2019. Recorded student duty hours were tabulated per day and per week, by student. National Board of Medical Examiners (NBME) Subject Exam (Shelf) equated percentile scores for the quarter of year were used. Results: Our statistical analysis showed that working long hours did not translate to higher or lower shelf score, or higher overall clerkship grade. However, working longer hours in the last two weeks of the clerkship was associated with high shelf score. Conclusion: Longer medical student duty hours did not correlate to higher shelf scores or overall clerkship grades. Future multi-center studies are necessary to evaluate the importance of medical student duty hours and continue optimizing the educational experience of the OB/GYN clerkship.

Objective: To characterize rates of maternal morbidity associated with early (2 units were considered severe maternal morbidity(SMM). Simple statistics used to compare characteristics among patients experiencing any morbidity and those not. Poisson regression used to assess relative risks. Results: Of 260 patients included, 77(29.6%) experienced maternal morbidity and 16(6.2%) experienced SMM. PPH(n=46, 17.7%) was the most common morbidity, though 15(5.8%) patients were readmitted, 16(6.2%) needed a blood transfusion, and 14(5.4%) had AKI. Patients who experienced maternal morbidity were more likely to be advanced maternal age, have pre-existing diabetes, have multiparity, and deliver non-vaginally (all p

The scientific benefits of breastfeeding for the parent and baby are clear, but the goal is often simplified to "breast is best." Patients' decisions to breastfeed are more nuanced than this approach implies, and it is essential for providers to understand other factors that contribute to this complex decision.We reviewed the current literature of the health benefits of breastfeeding, local and global breastfeeding trends and current disparities, and the historical, political, and social factors that influence a patient's decision to breastfeed.Original research articles, review articles, and guidelines on breastfeeding were reviewed.Rates of breastfeeding have increased in the United States and globally after public health interventions, but significant disparities persist. Numerous factors influence a patient's decision to breastfeed including the medical benefits, formula marketing campaigns, historical connections to slavery and oppression, limited societal support for working parents, mental or physical health concerns, previous sexual abuse or trauma, gender identity, and others.Understanding both the medical importance of breastfeeding and the various other factors that influence a patient's decision or ability to breastfeed is essential for counseling patients before delivery. Providers have a responsibility to navigate this complex conversation with patients to empower them to make an informed decision that works for them.

For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks.In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM).Original research articles, review articles, and guidelines on management of late PPROM.Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis.We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.

Hypertensive complications of pregnancy comprise 16% of maternal deaths in developed countries and 7.4% of deaths in the United States. Rates of preeclampsia increased 25% from 1987 to 2004, and rates of severe preeclampsia have increased 6.7-fold between 1980 and 2003.The aim of this study was to review current and available evidence for common clinical questions regarding the management of hypertensive disorders of pregnancy.Original research articles, review articles, and guidelines on hypertension in pregnancy were reviewed.Severe gestational hypertension should be managed as preeclampsia with severe features. Serum uric acid levels can be useful in predicting development of superimposed preeclampsia for women with chronic hypertension. When presenting with preeclampsia with severe features before 34 weeks, expectant management should be considered only when both maternal and fetal conditions are stable. In the setting of hypertensive disorders of pregnancy, oral antihypertensive medications should be initiated when systolic blood pressure is greater than 160 mm Hg or when diastolic blood pressure is greater than 110 mm Hg, with the most ideal agents being labetalol or nifedipine. Furthermore, although risk of preeclampsia recurrence in future pregnancy is low, women with a history of preeclampsia should be managed with 81 mg aspirin daily for preeclampsia prevention.Despite the frequency with which hypertensive disorders of pregnancy are encountered clinically, situations arise frequently with limited evidence to guide providers in their management. An urgent need exists to better understand this disease to optimize outcomes for impacted patients.

Maternal obesity is associated with delayed lactogenesis and shorter duration of breastfeeding compared to patients with a normal BMI.We investigated the impact of excessive gestational weight gain, defined as greater than the Institute of Medicine guidelines (9.1 kg), on the initiation and duration of breastfeeding in patients with class III obesity.Retrospective cohort of patients with body mass index ≥40 in first trimester, delivering a singleton term infant at a tertiary care center between July 2013 and December 2017. Primary outcome was exclusive breastfeeding at discharge and at postpartum visit. Secondary outcomes included any breastfeeding at discharge and postpartum visit, and cessation of breastfeeding by the postpartum visit. Descriptive statistics were used to compare those whose gestational weight gain exceeded (eIOM) versus met (mIOM) Institute of Medicine guidelines. Regression models were performed to adjust for baseline confounding factors.Of 294 women included, 117(39.8%) were in the eIOM group. These women were more likely to be primigravida, have a higher delivery BMI, greater delivery blood loss, and have a neonate admitted to the intensive care unit. Exclusive breastfeeding at discharge was not different between eIOM and mIOM (66.7% vs 70.9%,Among women with class III obesity, excessive gestational weight gain did not impact the rate of exclusive breastfeeding at discharge or postpartum visit.

We sought to evaluate and describe the maternal and obstetric morbidity associated with Listeria infection in pregnancy. Retrospective cohort of pregnant women using the 2007-2018 National Inpatient Sample. Pregnant women with discharge diagnosis codes consistent with Listeria infection were identified. Outcomes of deliveries complicated by Listeria infection were compared to those of delivery without this infection. The primary outcome was a composite of severe maternal morbidity. Secondary outcomes included components of the composite, maternal length of stay, mode of delivery, stillbirth, and preterm delivery. We identified 134 maternity associated hospitalizations for Listeria (weighted national estimate 666), of which 72 (weighted national estimate of 358) were delivery admissions. Delivery admissions complicated by Listeria resulted in higher rates of severe maternal morbidity than those without, (30.9% vs. 1.6%, pppppp < 0.001) and stillbirth (13.5% vs. 0.7%, ppp

Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population.The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy.Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed.Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits.The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.

Introduction The differential diagnosis for abnormal uterine bleeding (AUB) among reproductive-age women is broad and includes common and life-threatening conditions. Recognition and accurate diagnosis of AUB are important but can be challenging for medical students. We developed a standardized patient (SP) encounter for medical students during their OB/GYN clerkship. Methods We implemented two SP encounters, on AUB and dyspareunia, that included a postencounter note and SP evaluations. Here, we describe the implementation of the SP encounter on AUB. Students received formative feedback on their interpersonal and history-taking skills, differential diagnosis, and management plan from the SP as well as OB/GYN residents and faculty. Student cumulative feedback was obtained mid-clerkship and following the clerkship. Summary statistics and qualitative data for students’ experiences are reported. Results SP cases were implemented at the Duke University School of Medicine with 101 second-year medical students who completed the encounter from September 2018 to July 2019. Regarding the AUB case, SPs identified students as adequate history takers, with a mean evaluation score of 3.45 (SD = 0.15) out of 5. Most students (94%) correctly identified at least one diagnosis and provided evidence. Endometrial cancer/hyperplasia (63%) and uterine leiomyoma (60%) were most likely to be identified. Regarding both SP encounters, of the 82 students (81%) completing the end-of-clerkship survey, 57% indicated that the experience enhanced their overall learning at least adequately well or better. Discussion The AUB case provided students with the opportunity to exercise their diagnostic and management skills.