Women's Selection of Mode of Birth for their Breech Presentation.

OBJECTIVE: Many studies since the Term Breech Trial have demonstrated the safety of vaginal breech birth (VBB), and today it is an option for breech presentation at term. However, women with breech presentation often face a difficult decision regarding mode of birth, especially when planned cesarean was the standard of care in the not-so-distant past. We aim to clarify the decision-making process and barriers women face when making this decision. METHODS: Between January and April 2016, women who delivered with breech presentation were approached during their postpartum hospital stay to obtain consent for the study. The follow-up, semi-structured interview probed the woman's acquisition of knowledge and supports and barriers to her choices leading up to delivery. The responses were recorded and transcribed for analysis, and themes were identified for reporting. RESULTS: Of the 95 women who completed the interview, 21 preferred VBB but only 1 had a VBB. Most unplanned cesarean deliveries were performed for obstetrical indications, but 5 women expressed a lack of support for VBB or did not recall being provided options. Themes were identified with respect to the influences the women experienced, including passive external, provider-based, evidence-based, and internal. CONCLUSION: Despite the availability of options for breech pregnancy, the majority of women continue to have planned cesarean deliveries. The retrospective process reveals that women did not fully understand the eligibility criteria for VBB and all available options (including external cephalic version). Shared decision-making and continuity of care should remain a priority during the counselling process and delivery of care.

Retained Shotgun Pellets in the Vulva: Case Report.

BACKGROUND: Vulvar trauma is relatively uncommon and typically occurs in accidental or sports-related injuries. There is limited literature for management of penetrating trauma to the vulva. CASE: A 38-year-old G9, P9 woman presented to the gynaecology service for assessment of vulvar injury after a gunshot wound to the right lateral thigh. She underwent initial stabilization and operative management by the Trauma and Plastic Surgery services for predominantly soft-tissue injuries. Multiple gunshot pellets were found embedded in the right labia majora and medial thigh. On assessment, surgical removal was deemed necessary on the basis of symptoms and potential for functional impairment. CONCLUSION: We present the first reported case on the management of vulvar injury secondary to penetrating trauma. The principles of non-obstetrical vulvar trauma management are discussed.

Patterns of performance in students with frequent low stakes team based learning assessments: Do students change behavior?

Team-based learning offers an active learning strategy that provides a structure for measurement of learning and feedback to the students. Aggregating these results provides a longitudinal pattern of student performance. In this study, we analyzed results from a sequence of assessments related to TBL IRAT and GRAT assessments and traditional quizzes in a second-year musculoskeletal course in an undergraduate medical education program to determine if there are any measurable patterns, or performance trends, that students demonstrate in the course. Analyzing results from four academic years, we found evidence supporting there is predictability in student's future week's performance based on past performances across teaching modalities. We hypothesize that students are moderating their own effort regarding weekly low-stake assessments in prioritizing their academic efforts. The results from this study highlight the role of self-efficacy in medical education and suggest a new area of research for assessment of student performance patterns. Future studies could investigate whether these performance patterns are replicated in other assessment modalities and whether the same pattern holds for high-stakes assessments.