Cauda equina syndrome with surgical intervention in pregnancy during the periviable period.

INTRODUCTION: Cauda equina syndrome (CES) following lumbar disc herniation is exceedingly rare in pregnancy and there is limited literature outlining management of CES in pregnancy. There is further limited data addressing the management of periviable pregnancies complicated by CES. CASE PRESENTATION: A 38-year-old female at 22 weeks gestation presented with worsening lower back pain radiating to the right posterior lower extremity. She was initially managed with conservative therapy, but re-presented with worsening neurologic symptoms, including fasciculations and perineal numbness. Magnetic resonance imaging showed a large herniated disc at L4-5, and given concern for CES, she underwent emergent decompression surgery, which was complicated by a superficial wound dehiscence. She ultimately carried her pregnancy to term and had a cesarean delivery. The patient's residual neurologic symptoms continued to improve with physical therapy throughout the postpartum period. DISCUSSION: Cauda equina syndrome is a rare spinal condition with potentially devastating outcomes if not managed promptly. Diagnosis and management of CES in pregnancy is the same as in non-pregnant patients, however, standardization of patient positioning for surgery, surgical approach, anesthetic use, and fetal considerations is lacking. A multidisciplinary approach is critical, especially at periviable gestational ages of pregnancy. Our case and review of the literature demonstrates that patients in the second trimester can be managed surgically with prone positioning, intermittent fetal monitoring, and continued management of the pregnancy remains unchanged. Given the rarity of these cases, there is a need for a consensus on management and continued care in pregnant patients with CES.

Surgical management of an incarcerated uterus in a gynecological patient: A case report.

Uterine incarceration is most often described as occurring in pregnancies. Presenting with severe pelvic pain, urinary retention, and in some cases spontaneous abortion, this complication often arises at 12-15 weeks of gestational age. Although usually considered an obstetrical complication, uterine incarceration can occur in nongravid females. This case report presents a gynecological patient with acute urinary retention secondary to uterine incarceration. The patient chose surgical management, and surgery provided immediate symptomatic relief. Our case highlights an uncommon etiology of acute urinary retention and demonstrates the importance of considering the diagnosis of uterine incarceration in nongravid as well as gravid females.

Reading Level of Online Patient Education Materials From Major Obstetrics and Gynecology Societies.

OBJECTIVE: To assess whether the readability of online patient education materials provided by eight nationally recognized obstetrics and gynecology societies is in accordance with the recommended 6th-grade reading level outlined by the American Medical Association, National Institute of Health, and United States Department of Health and Human Services. METHODS: An analysis of 410 online patient education materials from the American Association of Gynecologic Laparoscopists, the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, the American Urogynecologic Society, the Association of Reproductive Health Professionals, the Society of Gynecologic Oncology, the Society for Maternal-Fetal Medicine, and Voices for Pelvic Floor Disorders was completed, and the readability scores using the Flesch-Kincaid Grade Level, Flesch Reading Ease, Gunning Fog Scale, and Simple Measure of Gobbledygook readability scales were calculated. These scales are used to assess print and web-based written material across a wide range of medical specialties and are endorsed by the National Institutes of Health. All four scales are computer-based assessments of readability that consider word count, number of syllables, and length of sentences when calculating a score that corresponds to grade level. RESULTS: Majority of the patient education materials across all eight obstetrics and gynecology societies had readability scores above the recommended 6th-grade reading level. The average reading level for the 69 obstetrics-related articles ranged from 9th to 12th grade. The mean grade level for the 341 gynecology articles had a similar range across the four readability scales. CONCLUSION: Online patient education materials provided by major obstetrics and gynecology societies do not currently adhere to recommended readability guidelines. Continued efforts to provide accessible and informative patient education materials is recommended to help improve health literacy for women.