Faculty Bibliography

Main purposes of the study/UNASSIGNED:To report an example of how concurrent von Willebrand disease type IIB disease and severe preeclampsia can be safely managed to and to review the current literature to evaluate management approaches that have proven safe and effective. The basic procedures used/UNASSIGNED:Report of case with a review of literature. Conclusions/UNASSIGNED:Through regular von Willebrand factor and platelet replacement during the prenatal period, immediately pre-delivery, and as needed intraoperatively and postoperatively, women with von Willebrand disease type IIB can safely undergo both normal spontaneous vaginal deliveries and caesarean deliveries, even with concurrent disorders like preeclampsia. Further studies with larger sample size are required to solidify management concepts in this disease concurrent with pregnancy.

Background:Although not incorporated into current cervical cancer screening guidelines, racial differences are known to persist in both occurrence of and outcomes related to cervical cancer. Objective:To compare the differences in progression and regression of precancerous lesions of the uterine cervix on cervical cytologic analysis among women of different races who adhered to cervical cancer screening recommendations and follow-up. Methods:Retrospective cohort study comparing differences in precancerous lesion diagnoses for patients receiving adequate evaluation according to the American Society for Colposcopy and Cervical Pathology guidelines. The authors fit Markov multistate models to estimate self-reported race-specific expected wait times and hazard ratios for each possible regression and progression and compared a race model with an intercept-only model using a likelihood ratio test. Results:The sample included 5472 women receiving a Papanicolaou test between January 2006 and September 2016, contributing a total of 24,316 person-years of follow-up. Of 21 hazard ratios tested for significance, the following 4 hazard ratios (95% CIs) were statistically significant: atypical squamous cells of undetermined significance (ASC-US) progression to low-grade squamous intraepithelial lesion (LSIL) for Hispanic patients (0.72; 95% CI, 0.54-0.96); LSIL regression to ASC-US for Hispanic patients (1.55; 95% CI, 1.04-2.31), LSIL regression to ASC-US for Asian patients (1.91; 95% CI, 1.08-3.36), and high-grade squamous intraepithelial lesion regression to LSIL for black patients (0.39; 95% CI, 0.16-0.96). There is an observed trend that all racial groups other than white had a slower rate of progression from ASC-US to LSIL, with Hispanics having demonstrated the slowest rate from ASC-US to LSIL. Hispanics also demonstrated the fastest rate from LSIL to HSIL when compared with all other race categories. In regressions, blacks had the slowest rate of regression from HSIL to LSIL, and Asians had the fastest rate from LSIL to ASC-US. The Hispanic group demonstrated the fastest expected progression (17.6 months; 95% CI, 11.5-25.5), as well as the fastest regression (27.6 months; 95% CI, 21.5-35.6), and the black group has the slowest expected times for both progression (28.1 months; 95% CI, 14.6-47.2) and regression (49 months; 95% CI, 29.1-86.2). The number of visits (1 vs ≥2) in the study was differentially distributed both by race (P=.033) and by last diagnosis (P<.001). Conclusion:Variations in precancerous lesions of the uterine cervix are not uniform across races.

Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside of the endometrial cavity. The majority of ectopic pregnancies encountered in clinical practice are located within the fallopian tube. Abdominal pregnancies represent 1% of all ectopic pregnancies. Primary omental pregnancy, in which the extrauterine site of implantation is the greater omentum, is the least common form of abdominal pregnancy. The rarity of an ectopic pregnancy in the omentum and the absence of clinical symptoms often delays diagnosis and proper identification before rupture. The authors describe the case of a 23-year-old woman who had hemoperitoneum from a ruptured omental ectopic pregnancy that mimicked adnexal implantation. Her omental pregnancy was diagnosed through intraoperative exploration and osteopathic structural examination findings.

BACKGROUND: Ectopic pregnancies occur when the implantation of a fertilized ovum occurs outside the endometrial cavity. Such pregnancies occur in approximately 1.5% to 2.0% of all pregnancies and cause 6% of maternal deaths. OBJECTIVES: To evaluate osteopathic structural examination (OSE) findings in patients with ectopic pregnancies of uncommon locations and to establish the utility of these findings in the diagnosis of these ectopic pregnancies. METHODS: In this prospective case series, a focused OSE was performed on each patient with an ectopic pregnancy at her initial presentation after the patient history but before other diagnostic or laboratory tests were performed and surgical treatment was initiated. Chapman reflex points (CRPs) were evaluated pre- and postoperatively. For comparison, patients who had otherwise normal first pregnancies, underwent elective postpartum bilateral tubal ligation, or had simple ovarian cysts were also included and received OSEs. RESULTS: Seven cases with ectopic pregnancies outside the fallopian tube were included. Two primary ovarian pregnancies and 1 heterotopic pregnancy (uterine and ovarian) had somatic dysfunction at the T10-T11 spinal levels and CRPs posterior for the ovary, 1 primary omental pregnancy with somatic dysfunction at the T9-T12 spinal levels and CRPs anterior and posterior for the ileum and jejunum, and 1 tubal pregnancy with somatic dysfunction at the T10-L1 spinal levels and CRPs anterior and posterior for the fallopian tube. Two cornual ectopic pregnancies were not associated with unique findings. These somatic dysfunctions and CRP findings appear to be distinct from those of comparison cases, including first pregnancies at any trimester, simple ovarian cysts, and elective bilateral tubal ligation. CONCLUSION: The OSE findings demonstrated in these cases aided in the final diagnosis and thus can potentially prove helpful in cases of ovarian, tubal, and omental pregnancies to provide clues to abnormal ectopic pregnancy locations where diagnostic imaging results are insufficient or equivocal. Osteopathic structural examinations may allow osteopathic physicians to better prepare for treatment approaches, including surgery.

Pregnancy-related rupture of an arterial aneurysm is an unusual occurrence associated with increased risk of morbidity and mortality. Various pregnancy-related physiologic changes appear to make pregnancy a high-risk situation for rupture of either preexisting arterial aneurysms or those that develop throughout the course of pregnancy. Splenic artery aneurysms are the most common (60%), followed by hepatic (20%), superior mesenteric (5.9%), celiac (4%), ovarian, uterine, and renal (<2%) artery. Even rarer are aneurysms involving the internal iliac artery and its branches, to which there is only one published case report. In this report, we present a case of a 34-year-old pregnant gravida1 para0 who, following a normal vaginal delivery, had a severe rupture of the right internal pudendal artery and subsequently developed a massive hematoma which ultimately required embolization treatment.