Recurrent Peri-Clitoral Abscess with Positive Actinomyces turicensis Culture.

A peri-clitoral abscess is a condition that is seldom encountered in practice and is found scarcely in the literature. The cause of spontaneous peri-clitoral abscess not associated with female circumcision/genital mutilation is generally unknown. Additionally, there have been no case reports of positive Actinomyces culture at the time of drainage of a peri-clitoral abscess. This case outlines a 42-year-old female with a spontaneous peri-clitoral abscess. The abscess was initially treated with incision and drainage (I&D) and antibiotics, but it later reoccurred necessitating a second I&D with bedside marsupialization and antibiotics targeted at Actinomyces, which grew on the culture after primary I&D.

Obtaining buy-in for immediate postpartum long-acting reversible contraception programs in Texas hospitals: A qualitative study.

OBJECTIVE: To understand the specific ways in which champions lead efforts to obtain and sustain buy-in for immediate postpartum long-acting reversible contraception (LARC) programs. METHODS: We conducted a qualitative study with 60 semistructured interviews at 3 teaching hospitals in Texas with physicians, nurses, administrators and other staff who participated in the implementation of immediate postpartum LARC. Physicians self-identified as champions and identified other champion physicians and administrators. Two researchers analyzed and coded interview transcripts for content and themes. RESULTS: We found that champions draw on institutional knowledge and relationships to build awareness and support for immediate postpartum LARC implementation. To obtain buy-in, champions needed to demonstrate financial sustainability, engage key stakeholders from multiple departments, and obtain nurse buy-in. Champions also created buy-in by communicating goals for the service that focused on expanding reproductive autonomy, improving maternal health, and improving access to postpartum contraception. Some staff, especially nurses, identified reasons for the program that run counter to reproductive justice principles: reducing birth rates, poverty, and/or unplanned pregnancy among young women and high-parity women. Respondents at 2 hospitals noted that not all women had equitable access to immediate postpartum LARC. CONCLUSION: Physician and non-physician champions must secure long-term support across multiple hospital departments to successfully implement an immediate postpartum LARC program. For programs to equitably serve all women in need of postpartum contraceptive care, champions and other program leaders need to implement strategies to address access issues. They should also explicitly focus on reproductive justice principles during program introduction and training. IMPLICATIONS: Successfully implementing immediate postpartum long-acting reversible contraception programs requires champions with institutional networking connections, administrative and nursing support, and clearly communicated goals. Champions need to address access issues and focus on reproductive justice principles during program introduction and training to equitably serve all women in need of postpartum contraceptive care.

Patients' Experiences with an Immediate Postpartum Long-Acting Reversible Contraception Program.

INTRODUCTION: We compared the characteristics of postpartum women who recalled being offered or not offered intrauterine devices and implants and who obtained placement of these long-acting reversible contraceptive (LARC) devices at a county hospital before discharge. We assessed satisfaction and continuation among those who obtained LARC methods. METHODS: We interviewed 199 patients who delivered at a Texas hospital and tested for differences in who recalled being offered/not offered immediate postpartum LARC. We provide descriptive statistics on when offered and satisfaction, and assess continuation using Kaplan-Meier survival curves. RESULTS: There were 103 of 199 women (51.8%) who recalled providers offering them immediate postpartum LARC; English-speaking relative to Spanish-speaking Hispanic women had higher odds of recounting being offered immediate postpartum LARC (adjusted odds ratio [OR], 3.88; 95% confidence interval [CI], 1.33-11.23), as did women with two children versus one child (OR, 3.64; 95% CI, 1.13-11.67). Compared with women 18-24 years of age who wanted more children, women 30-34 years of age who wanted more children had lower odds (OR, 0.14; 95% CI, 0.03-0.59), as did sterilized women 18 to 44 (OR, 0.02; 95% CI, 0.00-0.10). Seventy-four women (37% of all and 72% of those who recalled being offered) received immediate postpartum LARC. Sixty percent of those who received immediate postpartum LARC recalled that they were first offered it during prenatal care. Satisfaction was high but decreased between 3 and 6 months postpartum, mainly owing to negative side effects. Continuation at 24 months postpartum was 76.9% (CI, 71.7%-81.4%), with no difference between intrauterine device and implant use. CONCLUSIONS: Language barriers may have hindered equal access to immediate postpartum LARC for Spanish-speaking patients; younger patients were more likely to recall being offered immediate postpartum LARC, possibly owing to providers' implicit biases or greater demand for LARC versus sterilization. Using formal interpretation services and patient-centered decision making may improve patient access to the contraception methods most aligned with their values and preferences.

Placenta Percreta in First Trimester after Multiple Rounds of Failed Medical Management for a Missed Abortion.

BACKGROUND: The detection of a morbidly adherent placenta (MAP) in the first trimester is rare. Risk factors such as multiparity, advanced maternal age, prior cesarean delivery, prior myomectomy, placenta previa, or previous uterine evacuation place patients at a higher risk for having abnormal placental implantation. If these patients have a first trimester missed abortion and fail medical management, it is important that providers have a heightened suspicion for a MAP. CASE: A 24-year-old G4P3003 with 3 prior cesarean deliveries underwent multiple rounds of failed medical management for a missed abortion. She had a dilation and curettage that was complicated by a significant hemorrhage and ultimately required an urgent hysterectomy. CONCLUSION: When patients fail medical management for a missed abortion, providers need to assess the patient's risk factors for a MAP. If risk factors are present, a series of specific evaluations should be triggered to rule out a MAP and help further guide management. Early diagnosis of a MAP allows providers to coordinate a multidisciplinary treatment approach and thoroughly counsel patients. Ensuring adequate resources and personnel at a tertiary hospital is essential to provide the highest quality of care and improve outcomes.