Pelvic Girdle Pain in Pregnancy: A Review.

Importance: Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies. Objective: The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain. Evidence Acquisition: Electronic databases (PubMed and Embase) were searched from 1980 to 2021 with the only limitation being that the articles were in English. Studies were selected that examined associations between pelvic pain/pelvic girdle pain and pregnancy. Results: There were 343 articles identified. After reviewing the abstracts, 88 were used in this review. Pelvic girdle pain is a common condition of pregnancy, affecting a reported 20% of pregnant women. The pathophysiology is poorly understood and likely multifactorial, involving both hormonal and biomechanical changes that occur during pregnancy. Several risk factors have been identified. This diagnosis is most commonly made based on symptoms related to pelvic pain during pregnancy. Treatment should be multimodal, including pelvic girdle support, stabilizing exercises, analgesia, and potentially complementary therapies. The effects on future pregnancies are uncertain, although some limited information suggests an increased risk of recurrent PGP in subsequent pregnancies. Conclusions: Pelvic girdle pain in pregnancy is a common condition that is often overlooked as a normal part of pregnancy but has a significant impact on quality of life during, after, and in subsequent pregnancies. Multimodal therapies are available and are largely low cost and noninvasive. Relevance: Our aim is to increase the awareness of pelvic girdle pain in pregnancy as a common but often underdiagnosed and undertreated condition.

Hyperparathyroidism in Pregnancy: A Review of the Literature.

IMPORTANCE: Maternal hyperparathyroidism can be associated with significant maternal and fetal morbidity and fetal mortality. Because the maternal symptoms are typically nonspecific, the disorder may not be recognized leading to adverse pregnancy outcomes. OBJECTIVE: The aim of this study was to review the literature on the etiology/prevalence, pathophysiology, diagnosis, management (medical and surgical), and the maternal/neonatal complications associated with pregnancies complicated by hyperparathyroidism. EVIDENCE ACQUISITION: A literature search was undertaken by our university librarian using the search engines PubMed and Web of Science. Search terms used included "hyperparathyroidism" AND "pregnancy" OR "pregnancy complications" OR "maternal." The number of years searched was not limited, but the abstracts had to be in English. RESULTS: There were 309 abstracts identified, 164 of which are the basis of this review. This includes 137 articles of the 269 individual case reports in the literature since the first case report in 1947. The articles and case reports reviewed the etiology, risk factors, diagnosis, management, complications, and maternal/fetal outcomes of pregnancies complicated by hyperparathyroidism. CONCLUSIONS AND RELEVANCE: Undiagnosed maternal hyperparathyroidism can result in critical maternal and fetal outcomes during pregnancy. This review highlights what is currently known about hyperparathyroidism during pregnancy to increase the awareness of this serious pregnancy disorder.

Umbilical Cord Prolapse: A Review of the Literature.

IMPORTANCE: Umbilical cord prolapse is a rare occurrence and is a life-threatening emergency for the fetus. These events are unpredictable and unpreventable. Umbilical cord prolapse requires swift diagnosis and management for optimal outcome. OBJECTIVE: The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of this rare but potentially life-threatening event. EVIDENCE ACQUISITION: A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. RESULTS: There were 200 articles identified, with 53 being the basis of review. Multiple risk factors for a umbilical cord prolapse have been suggested including fetal malpresentation or abnormal lie, prematurity, multifetal gestation, and polyhydramnios. The diagnosis is largely made by examination and found after rupture of membranes, and most often, examination is prompted by fetal heart rate decelerations. The management of umbilical cord prolapse is expedited delivery; however, there are rare specific scenarios in which immediate delivery is not possible and efforts should be made to relieve cord compression. CONCLUSIONS: Rapid identification of an umbilical cord prolapse facilitates management and increases likelihood of an optimal outcome. The management is an expedited delivery with efforts to relieve cord compression until delivery can be achieved. RELEVANCE: Umbilical cord prolapse is a rare but a life-threatening obstetrical emergency.

Telemedicine and Distance Learning for Obstetrician/Gynecologist Provider Education.

Tele-education is the use of communications technologies to distribute knowledge from one health care provider to another when distance separates providers. At the University of Arkansas for Medical Sciences, tele-education has been used for more than two decades to educate and support rural obstetrician/gynecologists throughout the state. Tele-education at University of Arkansas for Medical Sciences incorporates numerous interactive videoconferences and other digital portals and platforms. Continued provider education through tele-education increases access to quality care and evidenced-based practices for rural populations and is an effective strategy in the battle against health care disparities.

A hands-on resident umbilical cord blood educational curriculum compared to online education of post-residency obstetricians: comparison of the volume of collected cord blood units.

BACKGROUND: Umbilical cord blood unit (CBU) volume is a predictor of its later clinical utility. Many studies suggest the need to increase the volume of CBU collected, but most obstetrical providers receive no formal collection training. STUDY DESIGN AND METHODS: We designed and implemented an educational curriculum for obstetrics residents aimed at improving collection methods and increasing CBU volumes (CBUV). Residents were required to attend grand rounds and interactive didactic sessions on CBU collection followed by work with a simulated collection kit and then performed training collections under observation by a trained collector. Residents completed a self-assessment after each collection and received immediate personal feedback. Outside providers (non-UAMS physicians) received written instructional materials with the collection kits and had access to online training materials. They received feedback regarding their collection via standard mail. CBU donated to Cord Blood Bank of Arkansas for public use from 2014-2016 were analyzed. CBUV from residents were compared to those from outside providers. RESULTS: After adjusting for maternal age and race, infant gender, gestational age, and birth weight, the least-squared mean CBUV was 92.1 mL for UAMS collections and 65.5 mL for outside provider collections. The improved CBUV of UAMS providers is statistically significant (p < 0.0001). CONCLUSION: Our educational intervention was successful, and we believe that it can be replicated in other obstetrical residency programs. Cord blood collection education involving hands-on training with a model and immediate feedback improves CBUV, decreases kit waste, increases likelihood of CBU storage, and, therefore, inventory for transplantation.

Maternal-Fetal Physiology, Intrapartum Care, Postpartum Care: A Team-Based Learning Module for Normal Obstetrics.

Introduction: Team-based learning (TBL) is an active learning strategy used at the University of Arkansas for Medical Sciences in both the preclinical and clinical years of medical school. The Department of Obstetrics and Gynecology (OB/GYN) uses TBLs during a 6-week clinical clerkship. This TBL is the first in a series of six and was designed to teach the topic of normal obstetrics to third-year medical students. Methods: Prior to the TBL, students were provided with learning objectives and a list of advance preparation resources. These resources included a reading assignment from the student textbook, as well as optional online videos and optional online interactive quizzes. The students then came to class and completed an individual readiness assurance test (iRAT) and a group readiness assurance test (gRAT). The majority of in-class time was spent working through complex application exercises in the form of case vignettes. The TBLs were facilitated by a faculty member in the OB/GYN department. Results: Since its initiation in June 2018, 93 students have participated in this TBL activity. The mean score on the iRAT was 88.9%, and the mean score on the gRAT was 98.8%. Ninety-eight percent of students reported that they were satisfied with this learning activity. Discussion: This TBL was well received by students and unique in that it utilized a variety of types of advance preparation resources. With few other published OB/GYN TBLs available, we believe that this module could be a valuable resource for OB/GYN clerkships.