Posttraumatic stress disorder and pregnancy health: preliminary update and implications.

Posttraumatic stress disorder (PTSD) is pervasive among women of childbearing age. The cascade of behavioral health and neuroendocrine changes commonly associated with PTSD may adversely affect perinatal health. The authors examined the relationship between PTSD and perinatal health in a sample of 101 women seeking prenatal care on the island of Oahu, Hawaii. Trauma, PTSD, and psychological and behavioral health were assessed during prenatal care. Pregnancy health, labor and delivery information, and birth outcomes were abstracted from medical records post-partum. Findings suggest that women with PTSD entering pregnancy are at increased risk for engaging in high-risk health behaviors, such as smoking, alcohol consumption, substance use, poor prenatal care, and excessive weight gain. Authors discuss clinical and research implications.

Mental health during pregnancy: a study comparing Asian, Caucasian and Native Hawaiian women.

OBJECTIVE: This study examines perinatal mental health issues, ethnic differences, and comorbidity among pregnant women in Hawaii. METHODS: Eighty-four participants were recruited from women, ages 18-35, seeking prenatal care on Oahu. They were interviewed at their initial prenatal visit about substance use, depression, and anxiety. RESULTS: Sixty-one percent of women screened positive for at least one mental health issue. Thirteen percent of all pregnant women reported drinking during pregnancy with 5% reporting problem drinking, 15% reported smoking cigarettes on a regular basis, 5% of pregnant women had probable depression, and 13% of pregnant women had probable anxiety. Significant ethnic differences were found in cigarette smoking, with the highest rate among Native Hawaiian women (35%). Native Hawaiian women were also more likely to binge drink. CONCLUSION: Given the high rates of potential mental health issues in our sample, our findings highlight the importance of screening and treatment for mental health issues early in pregnancy in Hawaii.

Obstetrics and gynecology medical student outcomes: longitudinal multispecialty clerkship versus traditional block rotations.

OBJECTIVE: To evaluate outcomes of students in a longitudinal clerkship. STUDY DESIGN: Clerkship grades, written examination scores, and clinical evaluations were compared between students participating in a longitudinal clerkship and students in block rotations. The percent of students pursuing an obstetrics and gynecology residency from each group was evaluated. RESULTS: There was no difference in clerkship grade (3.3 versus 3.5, P = .158). Longitudinal and block students received similar clinical evaluations with no significant difference in any category. The average written examination score was lower for students in the longitudinal clerkship (76.9% versus 80.0%, P = .008). A higher percent of students in the longitudinal program chose an obstetrics and gynecology residency, 12.5% versus 6.17% (odds ratio = 2.17, 95% confidence interval 0.57-6.89, P = .18). CONCLUSIONS: Longitudinally trained students received similar clinical evaluations to their colleagues but may need assistance in acquiring the knowledge needed for the written examination. This program should be examined closely for factors influencing a higher percent of students to pursue a residency in obstetrics and gynecology.

Pelvic examination teaching: linking medical student professionalism and clinical competence.

The Professional Patient teaching program is an essential part of assuring competency in the performance of the pelvic examination and professional behaviors. Through a series of integrated teaching sessions from the first year reproductive anatomy laboratory, the second year basic clinical pelvic examination teaching program, to the third year teaching program, students perform at an enhanced level of clinical competency and professional behavior. A Professional Patient commented: "We create a safe environment where medical students not only learn the clinical portion of the exam, but also focus on the patient as the primary source of information on patient comfort. Students receive immediate feedback from us and have ample opportunity to ask questions about aspects of the clinical pelvic examination or doctor/patient communication skills. We guide them, teach them, and help them prepare for examinations with other patients who will not be as open or in tune with their bodies as we are."

Implementation and evaluation of a training program to improve resident teaching skills.

OBJECTIVE: This study was undertaken to develop, implement, and evaluate a program designed to improve residents' teaching skills. STUDY DESIGN: A training program to improve the teaching skills of obstetrics and gynecology residents was developed and implemented. All residents completed a survey of their teaching skills, participated in the program, and then completed a follow-up survey. The surveys were compared using the Wilcoxon signed rank test. Medical students also completed surveys about participating residents' teaching skills either before or after the intervention. RESULTS: The training program was well received by the residents. Resident self-rating scores significantly improved (P<.05) in a number of areas, such as ability to teach physical examination skills, and explaining topics in a clear and concise manner. Interestingly, student ratings of resident teaching skills did not improve. CONCLUSION: Although the training program improved resident self-ratings of teaching skills, this was not reflected in student ratings of resident teaching skills. Possible explanations for this difference will be explored.

Local anesthetic reduces the pain of colposcopic biopsies: a randomized trial.

OBJECTIVE: This study was undertaken to determine whether administration of local anesthetic reduces pain associated with colposcopically directed cervical biopsies. STUDY DESIGN: Fifty-six patients undergoing colposcopically directed cervical biopsies were randomly selected prospectively to receive a 1% lidocaine injection or no injection before the biopsy procedure. Pain was assessed by using a 10-cm visual analog scale at various points during the procedure. Data were analyzed with the Student t test. RESULTS: Injection of lidocaine resulted in a reduction in pain scores for cervical biopsies (4.004 to 1.166, P: <.001), endocervical curettage (5.757 to 3.900, P =.0018), and overall procedure scores (4.911 to 3.145, P =.0013). CONCLUSION: This pilot study demonstrates that injection of local anesthetic at the site of colposcopically direct cervical biopsies decreases the pain perceived by patients.