Association between maternal cigarette smoking cessation and risk of preterm birth in Western New York.

BACKGROUND: Although many studies suggested the benefit of smoking cessation among pregnant women in reducing the risk of preterm birth (PTB), the timing of the effect of the cessation remains inconclusive. OBJECTIVES: To examine the association of trimester-specific smoking cessation behaviours with PTB risk. METHODS: We included 199,453 live births in Western New York between 2004 and 2018. Based on self-reported cigarette smoking during preconception and in each trimester, we created six mutually exclusive groups: non-smokers, quitters in each trimester, those who smoked throughout pregnancy, and inconsistent smokers. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression to examine the association between smoking cessation and PTB. Effect modification by illegal drug use, maternal age, race and ethnicity and pre-pregnancy body mass index (BMI) was investigated multiplicatively by ratio of relative risk and additively by relative excess risk due to interaction (RERI). RESULTS: Overall, 6.7% of women had a PTB; 14.1% smoked throughout pregnancy and 3.4%, 1.8% and 0.8% reported quitting smoking during the first, second and third trimesters, respectively. Compared to non-smokers, third-trimester cessation (RR 1.20, 95% CI 1.01, 1.43) and smoking throughout pregnancy (RR 1.27, 95% CI 1.21, 1.33) were associated with a higher PTB risk, while quitting smoking during the first or second trimester, or inconsistent smoking was not associated with PTB. A positive additive interaction was identified for maternal age and late smoking cessation or smoking throughout pregnancy on PTB risk (RERI 0.17, 95% CI 0.00, 0.36), and a negative interaction was observed for pre-pregnancy BMI ≥30 kg/m2 (ratio of relative risk 0.70, 95% CI 0.63, 0.78; RERI -0.42, 95% CI -0.56, -0.30). CONCLUSION: Compared to non-smokers, smoking throughout pregnancy and third-trimester smoking cessation are associated with an increased risk of PTB, while quitting before the third trimester may not increase PTB risk.

Postpartum contraception usage in immigrants compared with non-immigrants in Buffalo, NY.

OBJECTIVES: The purpose of this study was to compare rates of postpartum contraception use in immigrant populations in Buffalo, NY compared with non-immigrant populations. The study also explores rates of specific birth control selection amongst those who did choose to employ postpartum contraception. STUDY DESIGN: A retrospective chart review was conducted comparing the rate of postpartum contraceptive use in 132 immigrant individuals with that of 134 non-immigrant individuals, as measured by the documented intent or refusal to initiate any contraceptive method within the first three months postpartum. Patients were from clinics affiliated with the Women and Children's Hospital of Buffalo (WCHOB) who delivered during the years 2015-2016. The immigrant patients were chosen from the top ten immigrant countries of origin who delivered at WCHOB at the time. RESULTS: After controlling for factors of maternal age, gestational age at time of delivery, and gravidity and parity, the immigrant group was more likely to decline postpartum contraception in the first three months postpartum compared with the non-immigrant group (25.8% vs 6.7%, p < 0.001). Immigrants were more likely to select a barrier method (p = 0.036) and decided to employ contraception more remotely from delivery when compared with non-immigrant individuals (p < 0.001). Amongst the immigrant cohort, there was no statistically significant difference in methods chosen based on broad geographic areas of origin. CONCLUSIONS: Immigrant obstetric populations in Buffalo are less likely to employ postpartum contraception compared with non-immigrant populations. The factors influencing this are multifactorial; however, this information can inform care for both immigrant and non-immigrant patients.

Primary endometrial squamous cell carcinoma with synchronous early stage Fallopian adenocarcinoma: A case report and review of diagnostic and treatment considerations.

Background: Primary endometrial squamous cell carcinoma (PESCC) remains a rare sub-type of endometrial cancer. This case is especially unique due to the incidental finding of early stage Fallopian adenocarcinoma. This report adds to the literature of this rare condition and discuss it's etiology, clinical course, and treatment regimen.Case: 65 year old postmenopausal female presented with postmenopausal bleeding. Dilation and curettage revealed endometrial highly atypical squamous epithelial proliferation. Staging procedure showed FIGO stage IB squamous cell carcinoma of the endometrium, without evidence of cervical involvement. A small focus of incidental poorly differentiated FIGO stage IA adenocarcinoma of the left Fallopian tube was discovered. She underwent six cycles of Paclitaxel and Cisplatin, and has remained disease free for two years. Conclusion: Primary endometrial squamous cell carcinoma is poorly understood entity. Early diagnosis is critical due to the strong correlation between initial stage and survival. Biopsy of the cervix and endometrium should be considered in cases of abnormal uterine sampling. The case presented is a prototypical example of PESCC, both in presentation, pathology, and course. It is especially unique due to synchronous high grade Fallopian adenocarcinoma.

Renal Hilum Injury with Veress Needle.

Introduction: Since the advent of laparoscopy, the ideal first-port entry technique has not yet been determined. Use of the Veress needle at Palmer's point, although safe in practice under skilled physicians, is not without risk of complications. Case Description: A female patient with prior abdominal surgeries underwent a laparoscopic surgery for a nonmalignant indication. Intraoperative complications included hemodynamic instability and gross hematuria. The patient was ultimately stabilized, and imaging after the case revealed a hematoma formation around the left kidney with evidence of renal hilar injury. Discussion: The laparoscopic surgeon must be aware that blind Veress needle entry has inherent risk for injury of retroperitoneal structures including the renal system. Particularly if hemodynamic instability is noted after abdominal entry at any site, physicians should have a low threshold for investigation, including by laparotomy if necessary.