Cassing Hammond

Human cervicovaginal mucus contains an activity that hinders HIV-1 movement

Cervical and vaginal epithelia are primary barriers against HIV type I (HIV-1) entry during male-to-female transmission. Cervical mucus (CM) is produced by the endocervix and forms a layer locally as well as in the vaginal compartment in the form of cervicovaginal mucus (CVM). To study the potential barrier function of each mucus type during HIV-1 transmission, we quantified HIV-1 mobility in CM and CVM ex vivo using fluorescent microscopy. Virions and 200-nm PEGylated beads were digitally tracked and mean-squared displacement was calculated. The mobility of beads increased significantly in CVM compared with CM, consistent with the known decreased mucin concentration of CVM. Unexpectedly, HIV-1 diffusion was significantly hindered in the same CVM samples in which bead diffusion was unhindered. Inhibition of virus transport was envelope-independent. Our results reveal a previously unknown activity in CVM that is capable of impeding HIV-1 mobility to enhance mucosal barrier function.

Pain control for intrauterine device insertion: a randomized trial of 1% lidocaine paracervical block

BACKGROUND This study was conducted to investigate the effects of a 1% lidocaine paracervical block on perceived patient pain during intrauterine device (IUD) insertion. STUDY DESIGN We randomized 50 women undergoing IUD insertion to receive either a 10-mL 1% lidocaine paracervical block or no local anesthetic before IUD insertion. Women marked their pain on a 100-mm visual analogue scale (VAS) (0 mm = no pain, 100 mm = worst pain possible) at various points of the procedure (speculum insertion, tenaculum placement, paracervical block administration, IUD insertion and 5 min postprocedure). RESULTS Twenty-six women received the paracervical block before IUD insertion, and 24 received no local anesthesia. Groups were similar in age, parity, ethnicity, education and complications. Women who received the paracervical block reported a median VAS score of 24.0 mm with IUD insertion, and women who did not receive local anesthetic reported a median VAS score of 62.0 mm with IUD insertion; p=.09. CONCLUSION Compared with no anesthetic, a 1% lidocaine paracervical block did not result in a statistically significant decrease in perceived pain with IUD insertion.

Recent advances in second-trimester abortion: an evidence-based review.

The proportion of US abortions performed in the second trimester has varied little since 1992. Although 30 years of cumulative data corroborate the safety of dilation and evacuation (D&E), the most commonly used method of second-trimester abortion in the United States, both D&E and alternative induction regimens continue to evolve such that the traditional safety gap between medical and surgical regimens has narrowed. Providers now have options that allow them to either expedite D&E by diminishing the cervical-ripening period or reduce induction abortion intervals during medical induction.

Pregnancy Outcomes of Women With Physical Disabilities: A Matched Cohort Study

To document pregnancy outcomes of women with moderate‐to‐severe physical disabilities and to evaluate maternal and fetal outcomes compared with those of nondisabled 1:1 matched controls within the same hospital system.

The Impact of Hormonal Contraception on Disease-related Cyclical Symptoms in Women with Inflammatory Bowel Diseases.

Background:Women with inflammatory bowel diseases (IBD) commonly report an increase in their IBD symptoms related to their menstrual cycle. Hormonal contraceptives are safe for women with IBD and frequently used for reproductive planning, but data are lacking on their effect on IBD-related symptoms. Methods:We completed a cross-sectional phone survey of 129 women (31% response rate), aged 18 to 45 years, with IBD in an academic practice between March and November 2013. An electronic database query identified eligible women, and we sent an opt-out letter before contact. Questions included demographics, medical and reproductive history, and current/previous contraceptive use. Women were asked if/how their menses affected IBD-related symptoms and if/how their contraceptive affected symptoms. We calculated descriptive statistics and made comparisons by Crohns disease versus ulcerative colitis on Stata V11. Results:Participants were predominately white (85%) and college educated (97%), with a mean age of 34.2 (SD 6.2, range 19–45) years. Sixty percent had Crohns disease, and 30% had IBD-related surgery previously. Half of the participants were parous, and 57% desired future pregnancy. Of the participants, 88% reported current or past hormonal contraceptive use and 60% noted cyclical IBD symptoms. Symptomatic improvement in cyclical IBD symptoms was reported by 19% of estrogen-based contraceptive users and 47% of levonorgestrel intrauterine device users. Only 5% of all hormonal method users reported symptomatic worsening. Conclusions:In a subset of women with IBD, 20% of hormonal contraception users reported improved cyclical menstrual-related IBD symptoms. Health care providers should consider potential noncontraceptive benefits of hormonal contraception in women with cyclical IBD symptoms.

Contraceptive Method Selection by Women with Inflammatory Bowel Diseases: A Cross-sectional Survey

OBJECTIVE Women with inflammatory bowel diseases (IBDs) utilize contraception at a lower rate than the general population. We sought to identify factors associated with contraceptive use and selection of more effective methods in IBD patients at risk for unintended pregnancy. STUDY DESIGN An online survey was distributed to women with IBD in January 2013. Contraceptive methods were categorized by effectiveness and associations with use explored by demographics, disease characteristics and reproductive goals. RESULTS A total of 162 respondents were analyzed: 62% had Crohns disease and 38% ulcerative colitis. Mean age was 31 (range 20-45), 97% identified as White, and 53% were nulliparas. Seventy-four percent were currently using IBD medications. A quarter of participants (23%) used no contraception, 17% used highly effective methods, 41% used short-term hormonal methods, and 19% chose barrier/behavioral methods. Prior IBD-related surgery, biologic therapy use and low education attainment were associated with no contraception use. Of contraceptive users, age, parity, insurance status, IBD surgery and prior immunomodulator use were associated with highly effective method selection. CONCLUSIONS A quarter of women with IBD at risk for pregnancy in this study population reported no contraceptive method use. Higher levels of IBD activity influence contraceptive use and method selection, which could guide future patient and provider educational interventions. IMPLICATIONS Pregnancy planning is important for women with inflammatory bowel diseases to avoid adverse outcomes in a disease-poor state. Use of contraception assists in avoidance of unintended pregnancy. IBD characteristics are targets for educational interventions to improve uptake of highly effective contraceptive methods.

Team-based learning: a novel approach to medical student education in family planning

BACKGROUND Medical schools are increasingly using team-based learning (TBL). We compared medical student satisfaction and understanding of key concepts in family planning following TBL and traditional lectures. STUDY DESIGN During the OB/GYN clinical rotation orientation, third year medical students completed a pretest in family planning. Students in the odd-numbered clerkships participated in TBL, and students in the even-numbered clerkships participated in lectures. Both groups of students completed a posttest and satisfaction survey. RESULTS A total of 130 students participated in this study. Sixty-nine students were in the TBL group, and 61 students were in the lecture group. The TBL group reported higher scores when asked if the learning style was a valuable experience (p=.045), helped them learn the course material (p=.01) and improved problem-solving skills (p=.04). Both groups gained significant amount of knowledge (p<.001) as calculated by the Students paired t test. The change in scores was not significantly different between the groups (p=.73), as calculated using the Students unpaired t test. CONCLUSION As a learning strategy for family planning, TBL resulted in high student satisfaction. This is the first study to evaluate this innovative teaching style for medical student education in family planning.

Contraception Is a Fundamental Primary Care Service

The Affordable Care Act (ACA) requires health care plans after August 1, 2012, to cover preventive health services recommended by the Institute of Medicine and endorsed by the Department of Health and Human Services. Covered services promote development of a health care system that sustains health rather than merely treats illness. Many services, such as cervical cancer screening, sexually transmitted infection (STI) screening, and contraceptive services, promote the health and well-being of women.1 Some religious organizations and private employers, however, have demanded exemption from providing contraception, arguing that it violates their religious beliefs. We believe that allowing such an exception is at odds with evidence-based preventive care, inconsistent with actual patterns of contraceptive use among women who are religious, and a sectarian incursion into private health care decisions that is without parallel in the US health care system.

Perinatal pathologic examination of nonintact, second-trimester fetal demise specimens: The value of standardization

CONTEXT Management of second-trimester intrauterine fetal demise via dilation and evacuation results in nonintact specimens for pathologic examination. Surgical pathology examination is often mandated; however, evidence on expected findings and specimen evaluation guidelines are lacking. OBJECTIVES To assess pathologic findings of nonintact, second-trimester fetal demise specimens, through comparison of anatomic abnormalities identified on standardized perinatal examination to individualized general pathology examinations. DESIGN Single institution, retrospective chart review of 14- to 24-week gestational size fetal demise cases was conducted from May 2006 to October 2010. Suspected abnormalities, chromosomal and pathologic diagnoses were collected. A general surgical pathology examination occurred between May 2006 and October 2008, while a perinatal pathologist examined specimens between October 2008 and October 2010. Statistical analysis consisted of t tests and χ(2) tests by Stata/SE 12.1. RESULTS One hundred eighteen specimens were included and mean gestational size was 16.0 weeks (standard deviation, 1.6 weeks). Perinatal pathologic evaluation diagnosed significantly more abnormalities than did general pathologic examination (77.3% [34 of 44] versus 9.5% [7 of 75], P < .001). Forty-eight abnormalities were identified: 77.0% (n = 37) were placental and 23.0% (n = 11) were fetal. Chromosomal analysis was done on 73.7% (n = 87 of 118) with 12.6% (n = 11 of 87) showing abnormalities. Among aneuploid specimens, the perinatal pathologist confirmed abnormalities in 66.7% (n = 4 of 6) of cases while general pathologists confirmed abnormalities in 0% (n = 0 of 5) (P = .02). CONCLUSIONS Systematic surgical pathology examination of nonintact, second-trimester fetal demise specimens yields increased information on fetal or placental abnormalities, which may be clinically useful. Institutions with high-risk obstetrical practices and dilation and evacuation providers should consider integrating a standardized perinatal checklist into educational and practice guidelines.

Postpartum glucose tolerance in women with gestational diabetes using levonorgestrel intrauterine contraception.

OBJECTIVE Postpartum contraception is critical in women with gestational diabetes mellitus (GDM). We evaluated the effect of the levonorgestrel intrauterine system (LNG-IUS) on glucose tolerance in postpartum women with GDM. STUDY DESIGN The study is a descriptive analysis of 12-month glucose tolerance in women with recent GDM who used the LNG-IUS, the copper IUD or postpartum sterilization. RESULTS Twelve months postpartum, 3 of 13 LNG-IUS users (23.1%) and 1 of 6 nonhormonal contraceptive users (16.6%) had prediabetes. No woman developed overt diabetes. CONCLUSIONS This study is the first and only to measure the metabolic effects of the LNG-IUS women with GDM. Larger trials are necessary. IMPLICATIONS Use of levonorgestrel intrauterine contraception does not appear to negatively affect glucose tolerance in postpartum women with a history of gestational diabetes. Additional appropriately powered clinical studies are needed to confirm these results.