American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jul 2018
Randomized Controlled TrialCervical pessary to reduce preterm birth <34 weeks of gestation after an episode of preterm labor and a short cervix: a randomized controlled trial.
To date, no intervention has proved effective in reducing the spontaneous preterm birth rate in singleton pregnancies following an episode of threatened preterm labor and short cervix remaining. ⋯ Pessary use did not significantly lower the spontaneous preterm birth rate <34 weeks in women with a short cervix remaining after a threatened preterm labor episode but did significantly reduce the spontaneous preterm birth rate <37 weeks, threatened preterm labor recurrence, and the preterm premature rupture of membranes rate.
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Am. J. Obstet. Gynecol. · Jul 2018
Characteristics associated with prolonged length of stay after hysterectomy for benign gynecologic conditions.
Length of stay after surgery has become an important quality measure for many common surgical procedures and is now also tied to reimbursement. Currently, little is known about the perioperative factors that contribute to prolonged hospital length of stay in women who undergo hysterectomy for benign conditions. ⋯ The most important perioperative factors that contributed to prolonged length of stay for hysterectomy were, in large part, not modifiable and suggest that targeted interventions to reduce length of stay will be challenging.
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Am. J. Obstet. Gynecol. · Jul 2018
Identification of experimental bladder sensitivity among dysmenorrhea sufferers.
Dysmenorrhea is a common risk factor for chronic pain conditions including bladder pain syndrome. Few studies have formally evaluated asymptomatic bladder pain sensitivity in dysmenorrhea, and whether this largely reflects excess pelvic symptom reporting due to comorbid psychological dysfunction. ⋯ Women experiencing moderate-to-severe dysmenorrhea also harbor a higher pain response to naturally evoked bladder distension. Noninvasive bladder provocation needs to be tested further longitudinally in those with dysmenorrhea to characterize the course of visceral sensitivity and determine if it may help predict individuals at risk for developing subsequent pain in the bladder or elsewhere.
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Am. J. Obstet. Gynecol. · Jul 2018
The impact of cost sharing on women's use of annual examinations and effective contraception.
We sought to describe the relationship between the elimination of out-of-pocket costs and women's use of preventive care office visits and long-acting reversible contraception after accounting for baseline levels of cost sharing. ⋯ Out-of-pocket costs were low prior to the Affordable Care Act. Eliminating costs was associated with increases in preventive service use among those with high levels of cost, but effect sizes were low, suggesting that cost is only 1 barrier. Failing to recognize that cost sharing was already low could cause us to falsely conclude that the elimination of cost sharing was ineffective.
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Am. J. Obstet. Gynecol. · Jul 2018
Abdominal skeletal muscle activity precedes spontaneous menstrual cramping pain in primary dysmenorrhea.
Dysmenorrhea is a pervasive pain condition that affects 20-50% of reproductive-aged women. Distension of a visceral organ, such as the uterus, could elicit a visceromotor reflex, resulting in involuntary skeletal muscle activity and referred pain. Although referred abdominal pain mechanisms can contribute to visceral pain, the role of abdominal muscle activity has not yet been investigated within the context of menstrual pain. ⋯ Abdominal muscle activity may contribute to cramping pain in primary dysmenorrhea but is resolvable with naproxen. Dysmenorrheic patients without cramp-associated abdominal muscle activity exhibit widespread pain sensitivity (lower pressure pain thresholds) and are more likely to also have a chronic pain diagnosis, suggesting their cramps are linked to changes in central pain processes. This preliminary study suggests new tools to phenotype menstrual pain and supports the hypothesis that multiple distinct mechanisms may contribute to dysmenorrhea.