Design and Evaluation of a Low-Cost Speculum Examination Training Model.

INTRODUCTION: Learning how to perform a speculum examination is a key component of the medical student curriculum, yet there is a paucity of data on the validity of available speculum examination models. This purpose of this study is to design, evaluate, and improve a low-cost speculum examination model. METHODS: A speculum examination training model was created using low-cost or recycled materials from other simulators. A total of 54 medical students, residents, and faculty in the obstetrics and gynecology department of a single academic institution performed speculum examinations on the model. Each participant completed a survey to provide qualitative and quantitative data. Using this feedback from participants, adjustments were made to the model and a similar survey was repeated with a total of 35 medical students and residents. RESULTS: The first iteration of the model was viewed positively by most participants. Eighty-three percent gave the model either a very realistic or realistic rating. Ninety-four percent thought the model was a very useful or useful teaching device. There were few significant differences in quantitative data based on experience level. Qualitative feedback yielded generally positive remarks with areas for improvement. The second iteration of the model was successful in differentiating between novice and skilled participants: residents were significantly better at identifying cervical position compared with students. Eighty-nine percent of participants thought the model was very useful or useful, whereas 49% thought the model was very realistic or realistic. DISCUSSION: The first iteration of the model demonstrated realism and usefulness; however, it lacked construct validity. Participant feedback yielded several helpful suggestions to improve the model. The second and final iteration of the model differentiated between novice and skilled participants at the cost of realism. This low-cost model is a useful tool to aid in teaching the speculum examination. Further development and study of the model could lead to a valid tool to evaluate speculum examination skills.

Accuracy of clinically estimated fetal weight in pregnancies complicated by diabetes mellitus and obesity.

OBJECTIVE: To determine the accuracy of clinically estimated fetal weight (CEFW) in patients with gestational diabetes (GDM), pregestational diabetes (DM), and obesity. STUDY DESIGN: This is a retrospective analysis of Consortium of Safe Labor data. Subjects were classified into six groups: DM, DM and obese, GDM, GDM and obese, nondiabetic obese, and controls. The mean difference between birth weight (BW) and CEFW, the percent of accurate CEFW (defined as < 10% difference), and the sensitivity for identifying BW > 4,000 g and > 4,500 g were calculated for each group. RESULTS: The accuracy of CEFW in our population was 54.3 to 64.4% and was significantly lower in patients with DM and obesity and patients with obesity but not diabetes. When CEFW was analyzed in the >4,000-g and > 4,500-g groups, its accuracy was 20 to 51% and 14 to 40%, respectively. CEFW overestimated BW more commonly in GDM, obese GDM, and obese groups. The sensitivity of CEFW for diagnosing BW > 4,000 g or > 4,500 g was 19.6% and 9.6%, respectively, and it improved in pregnancies complicated by diabetes. CONCLUSION: CEFW is a poor predictor of macrosomia in pregnancies complicated by obesity and diabetes.

Fetal fibronectin for evaluation of preterm labor in the setting of cervical cerclage.

OBJECTIVE: To evaluate the efficacy of fetal fibronectin (fFN) testing in cervical cerclage patients presenting with acute signs or symptoms of preterm labor. METHODS: A total of 71 fFN tests were performed in 48 women between 23 and 34 weeks' gestation who presented at two institutions at risk for imminent delivery with cerclage in situ. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value for delivery within 2 weeks of fFN testing were 100, 77, 28 and 100%, respectively. For delivery before 34 weeks sensitivity, specificity, positive predictive value, and negative predictive value were 91, 78, 56 and 97%, respectively. The relative risk of delivery <34 weeks with positive fFN was 16.7 (P < 0.001). CONCLUSIONS: For patients with cervical cerclage, fFN testing is a valid diagnostic tool in the evaluation of preterm labor.

Perioperative complications of history-indicated and ultrasound-indicated cervical cerclage.

OBJECTIVE: To evaluate perioperative complications of history- and ultrasound-indicated cerclage. METHODS: We performed a retrospective observational study of a cohort of patients who underwent history- (n = 198) or ultrasound-indicated (n = 89) cerclage procedures. We evaluated the rates of perioperative complications based on indication for cerclage. The χ(2) was used for categorical variables and Student t test for continuous data. RESULTS: One patient (0.35%) had an intraoperative complication (unsuccessful regional anesthesia) and 1 patient (0.35%) had a postoperative complication (contractions and bleeding 2 weeks after cerclage placement, delivered a nonviable infant). Peripartum complications included chorioamnionitis (6.2%), preterm premature rupture of membranes (11%), preterm delivery (20%), and delivery before 32 weeks' gestational age (8%), and they were similar in the history-indicated and ultrasound-indicated groups. CONCLUSION: History- and ultrasound-indicated cerclages are associated with a 0.6%; 95% confidence interval, -0.26 to 1.66 risk of perioperative complications. There was no difference in perioperative complications or outcome between the 2 groups.

A comparison of virus isolation, immunohistochemistry, fetal serology, and reverse-transcription polymerase chain reaction assay for the identification of porcine reproductive and respiratory syndrome virus transplacental infection in the fetus.

Virus isolation (VI), immunohistochemistry (IHC), fetal serology, and reverse-transcription polymerase chain reaction assay (RT-PCR) were performed on samples from 107 fetuses comprising 10 litters taken from sows experimentally infected with porcine reproductive and respiratory syndrome virus (PRRSV). In addition to comparing the relative sensitivity and specificity of each test, RT-PCR was evaluated with respect to the relative suitability of thoracic fluids and tissues as samples, the effects of autolysis, and the effects of pooling of fetal specimens. VI, IHC, and fetal serology identified PRRSV infection in 48.6%, 23.4%, and 14.9% of 107 fetuses, respectively, and identified at least 1 infected fetus in 10, 10, and 5 of 10 litters, respectively. In utero death with autolysis reduced the test efficacy of all 3 methods. Fetal thoracic fluid and tissues were equally suitable for RT-PCR detection of PRRSV. Pooling fetal tissues or fluids from VI-positive animals with comparable material from negative controls had no detrimental effect on RT-PCR results when evaluated at dilutions of 1:1, 1:2, 1:4, and 1:8. The results of RT-PCR testing were positive in 100%, 94.4%, and 83.3% of VI-positive specimens allowed to autolyze at 4, 21, or 37 C, respectively, for 24, 48, and 96 hours. Compared with the other testing modalities, RT-PCR appeared to be impacted the least by the adverse effects of autolysis.