Faculty Bibliography

Perinatal mood and anxiety disorders (PMADs) are one of the most common complications in the peripartum period. The Council for Resident Education in Obstetrics and Gynecology (CREOG) includes diagnosis and management of PMADs as educational objectives, but no formal curriculum for trainees exists. Consequently, providers often struggle to identify and treat these disorders. We aimed to assess the effects of a pilot lecture series on obstetrics and gynecology (OBGYN) residents' knowledge and comfort in the diagnosis and management of PMADs. As part of an educational cross-sectional study, a Qualtrics survey was distributed to OBGYN residents at a single center in New York City. Residents were exposed to a 10-h virtual lecture series on perinatal mental health, and a follow-up survey was distributed. Initially, few residents were familiar with screening tools (45%), and few felt comfortable providing resources (5-45%), diagnosing (0-55%), and managing (0-30%) patients with the PMADs presented. After the pilot, improvement was seen in residents' familiarity with screening tools (86%), and their comfort in providing resources (11-67%) and diagnosing (11-78%) PMADs. However, comfort in management did not improve (0-22%). The majority of trainees (75%) found the virtual setting appropriate. There is a deficit in OBGYN residents' knowledge and comfort regarding diagnosis and discussion of PMADs that can be improved with a focused lecture series, though a greater emphasis on treatment is needed. The majority of OBGYN learners found the virtual setting conducive to learning this material. Their preferences should guide the development of a formal, national curriculum.

Objective: Gynecology residents have self-reported deficits in preparation for surgical practice, particularly in robotic training. The primary source of surgical training is active participation in an operating room, which can be documented in a resident's case log. Educators and trainees may assume an institution's case volume reflects residents' participation, but there is no standard way to hold attending physicians accountable for surgical education, case-by-case. This study examined the percent of major gynecologic cases that allowed active trainee participation over 3 months at a major academic medical center. Materials and Methods: A baseline assessment of obstetrics/gynecology residents' participation in gynecologic surgical cases was conducted over 3 months at a large, urban academic medical center. All open and robotic gynecologic cases were recorded by the residency education team. Trainees were asked to document if a resident was present in a surgical case and that resident's level of participation in the procedure. Results: Of 324 open and robotic gynecologic surgeries, 74% were covered by residents. Of the 240 cases in which residents participated, 71% could be entered into clinical case logs, and 29% permitted minimal to no active participation. Thus, residents were only able to log active participation in 53% of all open and robotic gynecologic cases in the 3-month timeframe. Conclusions: Operative case volume at an academic medical center does not necessarily reflect resident participation and surgical training experience; there is a need to incorporate surgical-teaching skills into faculty-development programs and to emphasize the importance of active participation, case by case, in residency training further. (J GYNECOL SURG 20XX:000)

Perinatal mood and anxiety disorders (PMADs) are one of the most common complications in the peripartum period. The Council for Resident Education in Obstetrics and Gynecology (CREOG) includes diagnosis and management of PMADs as educational objectives, but no formal curriculum for trainees exists. Consequently, providers often struggle to identify and treat these disorders. We aimed to assess the effects of a pilot lecture series on obstetrics and gynecology (OBGYN) residents"™ knowledge and comfort in the diagnosis and management of PMADs. As part of an educational cross-sectional study, a Qualtrics survey was distributed to OBGYN residents at a single center in New York City. Residents were exposed to a 10-h virtual lecture series on perinatal mental health, and a follow-up survey was distributed. Initially, few residents were familiar with screening tools (45%), and few felt comfortable providing resources (5"“45%), diagnosing (0"“55%), and managing (0"“30%) patients with the PMADs presented. After the pilot, improvement was seen in residents"™ familiarity with screening tools (86%), and their comfort in providing resources (11"“67%) and diagnosing (11"“78%) PMADs. However, comfort in management did not improve (0"“22%). The majority of trainees (75%) found the virtual setting appropriate. There is a deficit in OBGYN residents"™ knowledge and comfort regarding diagnosis and discussion of PMADs that can be improved with a focused lecture series, though a greater emphasis on treatment is needed. The majority of OBGYN learners found the virtual setting conducive to learning this material. Their preferences should guide the development of a formal, national curriculum.

In this unique time of technological advancement in medicine and the culture of public discourse that surrounds it, trainees in obstetrics and gynecology require more intensive education in medical ethics to appropriately guide patient decision-making and to become more responsible voices in such an ethically complex field.

OBJECTIVE:To measure the effect of prophylactic antibiotics given at time of previable prelabor rupture of membranes (PROM) on latency. METHODS:Single center, retrospective cohort study of singleton pregnancies with previable (<23 0/7weeks) PROM. Antibiotics were given at clinician discretion. The primary outcome was latency, defined as duration of time between previable PROM and delivery. Secondary outcomes included delivery at ≥ 23weeks, infant survival, and maternal morbidity. Bivariate analysis compared maternal covariates between women who did and did not receive antibiotics. Antibiotic effect on latency was modeled using a Cox proportional hazards ratio. RESULTS:213 women with previable PROM were identified; 77 (36%) remained pregnant and thus were included in this analysis. Forty (52%) of 77 received antibiotics. Compared to women who did not receive antibiotics, those who did had PROM at a later median (IQR) estimated gestational age, EGA, (22.2weeks [20.7, 22.5] vs. 19.3weeks [18, 20.7], p < 0.01). Median (IQR) latency was not different between women who did and did not receive antibiotics (2.2 [0.7, 3.9] vs. 1.5 [0.5, 4.6] weeks, p = 0.49). More infants survived to discharge among women who received antibiotics compared to those who did not [17(43%) vs. 3(8%), p < 0.01]. When adjusted for EGA at PROM, antibiotics were associated with longer latency (HR 0.57 [95% CI 0.33, 0.97], p = 0.01). Antibiotic use was not associated with differences in maternal morbidity. CONCLUSION/CONCLUSIONS:After adjusting for EGA at PROM, antibiotic receipt was associated with longer latency. Larger prospective studies are needed to define the utility of prophylactic antibiotics in previable PROM.

OBJECTIVE:This study aims to determine if antibiotics given for latency to women with twins and previable preterm premature rupture of membranes (PPROM) affect the duration from membrane rupture to delivery. METHODS:A retrospective cohort study of twin pregnancies at a single center from 2000 to 2015 with previable (14 (0/7)-22 (6/7) weeks) PPROM was conducted. Women who were not candidates for expectant management or who elected for immediate delivery were excluded. Pregnancy complications, delivery data, and neonatal outcomes were compared between women who did and did not receive latency antibiotics. The primary outcome was latency. RESULTS:Of 52 eligible women, 30 (64%) elected expectant management; 17 women received antibiotics and 13 did not. No demographic differences existed between the groups. The median gestational age of rupture was 20 and 20.3 weeks in the antibiotic group and no antibiotic group, respectively. Median latency was 0.8 and 2.4 weeks in the antibiotic and no antibiotic groups correspondingly (p = 0.21). Overall, 58.8 and 23.1% of women who did and didn't receive antibiotics developed chorioamnionitis (p = 0.07). Perinatal mortality and maternal complication rates were high, though not different between the groups. CONCLUSION/CONCLUSIONS:Currently, even though in singletons with previable PPROM there is a recommendation to consider administrating antibiotics, in the setting of twins, no evidence exists to support this.