Comparison of obstetrician-gynecologists and family physicians regarding weight-related attitudes,communication, and bias

ObjectivesTo assess physician perceptions regarding weight-related communication, quality of care, and bias in obstetrics-gynecology (OBGYN) and family physician (FP) practices.MethodsA cross-sectional survey study based on a convenient sampling of OBGYN and FP was conducted. Physicians completed a 40-question survey assessing perceived obesity management and weight bias in caring for female patients with body mass index ≥25 kg/m².ResultsReponses from 51 physicians (25 OBGYN and 26 FP) were received. There was no difference between specialties in satisfaction with care or level of confidence in treating patients with obesity. However, OBGYNs reported more negative perceptions of patients with obesity (mean score 19.2 ± 3.3 vs. 15.0 ± 4.0, p < 0.001) and greater weight bias (11.8 ± 2.0 vs. 9.7 ± 2.5, p < 0.01) compared to FPs. OBGYNs were also more likely to expect less favorable treatment outcomes (13.3 ± 2.5 vs. 15.5 ± 2.8. p < 0.01). Physicians between 31?50 years old displayed a significantly higher perception of weight bias in their profession when compared to the reference 21?30 year olds, and for each unit increase in self-reported BMI there was a 0.18 average increase in the composite score for perceived weight bias.ConclusionsOBGYN physicians reported significantly higher levels of weight bias than FP physicians, indicating a need for improved education in OBGYN training.Clinical trial registrationN/A.     

Comparison of sonohysterography and hysteroscopy: lessons learned and avoiding pitfalls

We compared ultrasound images of the uterine cavity obtained by sonohysterography (SHG) with those of hysteroscopy in an attempt to avoid inaccurate interpretations. Women referred for abnormal bleeding or infertility underwent SHG before treatment. Those with an abnormal study underwent hysteroscopy for confirmation and treatment. Abnormal SHG studies are frequent, with false positive images including blood clots, mucus plugs, and shearing of normal endometrium relatively common. Uterine pathology generally seen on SHG, including anomalies, polyps, and myomas, is consistent with that seen at hysteroscopy. Performing intraoperative SHG concomitantly with hysteroscopy adds value due to SHG's three-dimensional images to confirm depth of pathology and false negative hysteroscopy findings.     

Echosight patton coaxial catheter-guided hysteroscopy

Two women requiring assisted reproduction had cervical stenosis on diagnostic evaluation. Office hysteroscopy was performed with paracervical block supplemented with mild intravenous sedation. When cervical pathology precluded placement of a diagnostic hysteroscopy, an Echosight Patton coaxial catheter with an outer echogenic sheath (5.7F) and inner 0.018-inch diameter guidewire with coude tip was introduced transcervically. Intraoperative transvaginal ultrasound was performed to ensure proper placement into the uterine cavity. When the uterine cavity was identified, cervical pathology was corrected with a VersaPoint electrosurgical electrode with bipolar coagulation through an operative hysteroscope. Concomitant diagnostic laparoscopy was not necessary. Echosight Patton coaxial catheter-guided ultrasound is a reassuring method to confirm hysteroscopic placement.     

Cornual gestation: a systematic literature review and two case reports of a novel treatment regimen

STUDY OBJECTIVE: To introduce a novel tubal-sparing regimen for the treatment of nonruptured cornual pregnancies. DESIGN: Case report and systematic review of the literature. SETTING: Tertiary Care University setting. PATIENTS: Two patients referred for care in our subspecialty clinic. INTERVENTIONS: Laparoscopic surgery, dilation and evacuation, and postoperative methotrexate injection. Systematic review of the literature. MEASUREMENTS AND MAIN RESULTS: Both medical and surgical treatments for cornual gestation exist; however, each is not without its shortcomings. Medical treatment is associated with failure rates that may result in uterine rupture and catastrophic hemorrhage. Surgical treatment that involves hysterectomy causes a loss of future childbearing capability. Surgical treatment that involves resection of the involved cornual region is associated with decreased fertility rates and increased rates of uterine rupture in future pregnancies. Our treatment regimen is safe and effective and conserves future fertility. CONCLUSION: A cornual gestation is one of the most hazardous types of ectopic gestation. The diagnosis and treatment of such a pregnancy is challenging and constitutes an urgent medical situation. We herein introduce a novel regimen for the treatment of nonruptured cornual pregnancies. The existing treatment regimens are also systematically reviewed.