Diagnosis and treatment of women with radiologic findings suspicious for uterine arteriovenous malformations.

This study investigated the clinical outcomes for patients with pelvic ultrasound findings suspicious for uterine arteriovenous malformations (AVMs) at a single institution. We reviewed the electronic medical record to identify women with pelvic ultrasound reports read as possible uterine AVM, and used medical records to determine clinical outcomes. Among the 39 women with ultrasounds suspicious for AVM, 14 had subsequent MRIs, 10 had additional ultrasounds, and 10 underwent pelvic angiography. Five of the 39 women were ultimately diagnosed with AVMs. Of the 34 women who did not have an AVM, 12 were diagnosed with retained products of conception. Women may be receiving overtreatment for possible uterine AVMs; careful clinical consideration is warranted as the most common clinical diagnosis for women with radiologic findings suspicious of uterine AVM is retained products of conception.Impact statementWhat is already known on the subject: An acquired uterine arteriovenous malformation (AVM) is an abnormal arterio-venous connection in the myometrium that may cause life-threatening haemorrhage. Over the past decade, it has been noted that the characteristic ultrasound findings of uterine AVM may represent other causes of uterine hypervascularity including retained products of conception.What the results of this study add: As there is no consensus on the management of highly vascular myometrial lesions suspicious for uterine AVMs, this study reports our institution's experience with pelvic ultrasound findings suspicious for uterine AVMs. We found that further diagnostic workup, including MRI and angiography were common, but that the most frequent final diagnosis was retained products of conception.What the implications are of these findings for future clinical practice: This study contributes to the growing body of work noting spectrum of conditions with similar vascular ultrasound findings, and suggests that at least in this sample, women may be receiving overtreatment for these presumed uterine AVMs. Close collaboration among gynaecologists and radiologists is needed to interpret the significance of these radiographic images and to determine the appropriate intervention, as women with radiologic findings suspicious of uterine AVM will frequently have retained products of conception.

The labor and birth experience of women with opioid use disorder: A qualitative study.

OBJECTIVE: This study describes the experience of pregnancy and childbirth from the perspective of women with opioid use disorder. METHODS: This qualitative study analyzed semi-structured interviews about the prenatal care and birth experience of nine women with opioid use disorder as a sub-analysis of a qualitative study of women with a history of sexual trauma. Transcripts were analyzed using inductive content analysis. RESULTS: Analysis revealed unique interactions with the healthcare system specific to pregnant women with opioid use disorder. Participants identified pregnancy as a reason to enter and maintain recovery and an increased availability of resources when pregnant. Yet during labor and birth, concerns regarding pain control, child protective services involvement and provider stigma led to negative interactions with the healthcare system. CONCLUSION: Pregnant woman with opioid use disorder face unique challenges when seeking care. The perspectives of women with a history of opioid use disorder can inform creation of a harm reduction, non-stigmatizing model of prenatal, labor and birth, and postpartum care.

Pregnancy and Childbirth After Sexual Trauma: Patient Perspectives and Care Preferences.

OBJECTIVE: To explore the pregnancy and childbirth experiences and preferences of women with a history of sexual trauma in order to identify trauma-informed care practices that health care providers may use to improve obstetric care. METHODS: We conducted a qualitative study consisting of semistructured interviews with women who either self-identified as having a history of sexual trauma or did not. Participants were recruited from a tertiary care ambulatory clinic and had at least one birth experience within the past 3 years. Interviews were audio-recorded and transcribed verbatim. Grounded theory was used to derive themes using the participants' own words. RESULTS: From 2015 to 2017, we interviewed 20 women with a history of sexual trauma and 10 without. Women with a history of sexual trauma desired clear communication about their history between prenatal care providers and the labor and delivery team. In the intrapartum period, they desired control over who was present in the labor room at the time of cervical examinations and for health care providers to avoid language that served as a stressing reminder of prior sexual trauma. They wanted control over the exposure of their bodies during labor and to be asked about their preference for a male health care provider. In the postpartum period, some women with a history of sexual trauma found breastfeeding healing and empowering. CONCLUSION: Women with a history of sexual trauma have clear needs, preferences, and recommendations for obstetric care providers regarding disclosure, cervical examinations, health care provider language, body exposure, and male health care providers. They offer insight into unique breastfeeding challenges and benefits.

Exploring maternal attitudes towards adolescent contraception: implications for use of LARC.

Introduction Maternal attitudes have been shown to impact adolescent girls' sexual decision making and attitudes towards contraception. Given the potential for maternal influence on adolescent contraceptive use, we undertook an exploratory study of mothers' perceptions of the maternal role in adolescent contraceptive decision making, and maternal perceptions of long acting reversible contraceptives (LARC) for adolescent girls. Materials and methods We utilized a mixed methods study design. Acceptability of contraceptive methods and attitudes towards adolescent contraceptive use were assessed using a paper survey of 162 mothers of girls aged 11-19 years in Cleveland, Ohio, USA. Seven survey participants completed subsequent semi-structured interviews, which were analyzed using grounded theory methodology. Results Pills, condoms and injections were most frequently selected as acceptable by 55.4%, 55.4%, and 51.6% of women, respectively. One or more LARC methods were selected by 16.6% of the women. Of those (94.4%) agreed or strongly agreed that, "It is expected of me to make sure that my daughter knows about birth control methods." Important themes that emerged during interviews were the responsibility mothers felt to help their daughters navigate contraception options, appreciation of the effectiveness of LARC methods and concerns about the use of those methods by teenagers due to the invasiveness. Conclusion Our data suggest that mothers want to be involved and support adolescent decision making about contraceptives. We also found that mothers viewed LARC as less acceptable than other forms of birth control for adolescents and have specific concerns about LARC. These results suggest directions for future work to better characterize the impact of maternal attitudes on adolescent LARC use.

Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars:: A Cross-sectional Study.

INTRODUCTION: Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them. METHODS: Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014. RESULTS: Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only. CONCLUSIONS: These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.