Faculty Bibliography

OBJECTIVE:The aim of the study was to review the management of endometrial hyperplasia in a woman undergoing liver transplantation for alcoholic cirrhosis. METHODS:This is a case presentation on a postmenopausal woman with a tissue diagnosis of endometrial intraepithelial neoplasia managed with a levonorgestrel intrauterine device, before and after liver transplantation. Full written informed consent was obtained from the patient to present her case. RESULTS:The patient experienced resolution of her endometrial intraepithelial neoplasia with conversion to atrophic endometrium after management with levonorgestrel intrauterine device. CONCLUSIONS:A large percentage of women with cirrhosis experience abnormal uterine bleeding, which may be due to the coagulopathy that accompanies liver disease, or endometrial hyperplasia or carcinoma. Although hysterectomy is the criterion standard of treatment for atypical endometrial hyperplasia in a postmenopausal woman, patients with cirrhosis severe enough to require transplant are usually poor surgical candidates. Multiple studies have shown success with conservative management of atypical hyperplasia. There is a paucity of literature on managing patients undergoing transplant with abnormal uterine bleeding and it is therefore important to highlight conservative management options for this patient population.

OBJECTIVES/OBJECTIVE:To compare the expulsion rate at 6months after post-placental insertion by intrauterine device type. STUDY DESIGN/METHODS:This prospective cohort included participants with a post-placental intrauterine device inserted after vaginal or cesarean delivery, aged 18-45 and≥24weeks gestation. Study enrollment took place after IUD selection and insertion. Participants returned for a postpartum visit and received a short message service survey regarding intrauterine device expulsion, removal, vaginal bleeding and breastfeeding weekly from weeks 0 to 5 and on weeks 12 and 24 postpartum. Multivariable logistic regression examined 6-month expulsion rate by intrauterine device type. adjusting for variables that differed between the groups at baseline and in the bivariate analyses. RESULTS:Of 114 participants, 75 (65.8%) chose a levonorgestrel 52 mg intrauterine device and 39 (34.2%) chose a copper intrauterine device; 58 (50.9%) had a vaginal delivery and 56 (49.1%) had a cesarean delivery. Groups were similar except that copper intrauterine device users had a higher median parity (3 vs. 2, p=.03) and a higher proportion of senior residents compared to junior residents had performed insertion (46.2% vs. 22.7%, p=.02). The expulsion rate at 6-months was similar between the levonorgestrel and copper groups (26.7% and 20.5%, respectively; p=.38). Multivariable logistic regression also demonstrated that the odds of expulsion did not differ by intrauterine device type (aOR 0.98, 95% CI 0.22-4.48). CONCLUSION/CONCLUSIONS:The expulsion rate at 6-months after post-placental insertion did not differ between the levonorgestrel and copper intrauterine device type. IMPLICATIONS/CONCLUSIONS:Prior studies demonstrate a wide range of expulsion after post-placental insertion and recent data suggest a higher expulsion rate for the levonorgestrel compared to the copper intrauterine device. However, many studies did not control for patient level factors or delivery route. We found that when controlling for these confounding variables, the expulsion rate at 6-months postpartum did not differ by intrauterine device type.

OBJECTIVE: We sought to assess knowledge and adherence to the revised US Preventive Services Task Force breast cancer screening guidelines among gynecologic care providers. STUDY DESIGN: This was a cross-sectional descriptive study based on a survey conducted among gynecologic care providers. RESULTS: Forty providers completed the survey (80%). In response to the statement "The current recommended age to initiate breast cancer screening is ... .," 48.7% of providers responded in accordance with revised guidelines. For the statement "Women between the age of 50 and 74 years old are recommended to have screening mammography," 46.2% of respondents answered in accordance. In response to the statement "The United States Preventative Services Task Force recommends teaching breast self-examination," 71.8% of providers responded in accordance. A total of 37 respondents (92.5%) stated that they were aware of the revised guidelines, but 17 (42.4%) stated that they were applicable to their patient population. CONCLUSION: Knowledge of the revised guidelines appeared to be relatively low in our provider sample.