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Hartup LA, Schenken CM, Kohler KR, Yauger BJ. Fertility After Endometrial Intraepithelial Neoplasia and Early Endometrial Cancer: Ovulation Induction May Shorten Time to Conception. Reprod Sci 2024:10.1007/s43032-023-01441-3. [PMID: 38172334 DOI: 10.1007/s43032-023-01441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
The purpose of this study was to determine whether utilization of assisted reproductive technology following clearance of endometrial intraepithelial neoplasia (EIN) or early endometrial cancer (EC) shortens time to conception (TTC) and reduces recurrence. Patients aged 18 to 45 with EIN or early EC who achieved pathologic response following progesterone treatment were identified via retrospective chart review. Study groups included patients who pursued ovulation induction (OI), in vitro fertilization (IVF), and spontaneous pregnancy. Primary outcomes were TTC and recurrence rate. Three hundred forty-six charts were reviewed, with 86 patients meeting inclusion criteria and 53 attempting pregnancy. Of those 53 patients, 11 became pregnant and seven had a live birth. Median times to pregnancy were 183 days for IVF, 54 days for OI, and 347 days for spontaneous conception (p < 0.05). No differences were seen in recurrence or progression based on attempted pregnancy method, nor with duration of fertility treatment. Forty-two of 86 patients (49%) were lost to follow-up. For patients with a history of treated EIN or EC, OI may decrease TTC. Larger prospective studies are needed to definitively answer this question. Although no differences in recurrence or progression were identified, the significant loss to follow-up rate in this study is concerning and warrants further investigation.
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Affiliation(s)
- Lindsay A Hartup
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA.
| | - Claire M Schenken
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, USA
| | - Kelsey R Kohler
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | - Belinda J Yauger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
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Hartup LA, Kostroun KE, Yauger BJ. Delayed diagnosis of a non-communicating right uterine horn: A case report and literature review. Case Rep Womens Health 2023; 39:e00535. [PMID: 37637006 PMCID: PMC10457418 DOI: 10.1016/j.crwh.2023.e00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Background Accurate diagnosis of a müllerian anomaly is essential for appropriate management and prevention of complications. However, diagnosis is often missed or delayed. Case This is a case of a nulliparous woman with a müllerian anomaly diagnosed at the age of 36 despite prior evaluation with ultrasound and laparoscopy. Magnetic resonance imaging (MRI) suggested a unicornuate uterus with a right non-communicating rudimentary horn. Hysteroscopy and chromopertubation confirmed the diagnosis. The rudimentary horn was resected laparoscopically using bipolar energy. Conclusion An undiagnosed müllerian anomaly should be considered in the setting of persistent dysmenorrhea. Three-dimensional ultrasound or MRI should be used judiciously in patients with refractory dysmenorrhea or when ultrasound raises concern for a müllerian anomaly.
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Affiliation(s)
- Lindsay A. Hartup
- Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, San Antonio, TX, United States of America
| | - Katherine E. Kostroun
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, San Antonio, TX, United States of America
| | - Belinda J. Yauger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, San Antonio, TX, United States of America
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Kluckman ML, Schwope RB, Provagna AJ, Yauger BJ, Ramirez CI. The double corpus luteum: A novel sonographic sign of heterotopic pregnancy. J Clin Ultrasound 2021; 49:617-621. [PMID: 33761132 DOI: 10.1002/jcu.23006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/26/2021] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
Heterotopic pregnancy is a rare and highly morbid condition with simultaneous intrauterine and extra-uterine pregnancies. The early diagnosis of heterotopic pregnancy is difficult, owing to rarity of the condition and nonspecific clinical and laboratory findings. This case report introduces the "double corpus luteum" sign, a new sonographic and magnetic resonance imaging sign which is easily detectable and should raise the index of suspicion for heterotopic pregnancy. We present a surgically confirmed spontaneous heterotopic and angular pregnancy in a young woman without risk factors or assisted reproductive therapy to illustrate the utility of this novel sign.
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Affiliation(s)
- Matthew L Kluckman
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Ryan B Schwope
- Department of Radiology, Brooke Army Medical Center, San Antonio, Texas, USA
- Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA
| | - Alyssa J Provagna
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Belinda J Yauger
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
| | - Christina I Ramirez
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, Texas, USA
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Pilgrim J, Healy M, Yauger BJ, Torrealday S, Csokmay J, Hill M. Assisted Reproductive Technology and the Reproductive Endocrinology and Infertility Specialist in the U.S. Military. Semin Reprod Med 2019; 36:323-326. [PMID: 31003247 DOI: 10.1055/s-0039-1681084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The U.S. military mirrors the U.S. population given the diverse ethnic and cultural backgrounds of the service members. Active-duty military members, veterans, and Department of Defense beneficiaries can be negatively impacted by infertility.
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Affiliation(s)
- Justin Pilgrim
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Mae Healy
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Saioa Torrealday
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - John Csokmay
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Micah Hill
- Walter Reed National Military Medical Center, Bethesda, Maryland
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Healy MW, Yauger BJ, James AN, Jezior JR, Parker P, Dean RC. Seminal vesicle sperm aspiration from wounded warriors. Fertil Steril 2016; 106:579-83. [PMID: 27341990 DOI: 10.1016/j.fertnstert.2016.05.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/10/2016] [Accepted: 05/31/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether seminal vesicle sperm aspiration (SVSA) is an option for wounded warriors with severe genital and testicular injuries, with the goal of cryopreservation to use in future assisted reproductive technology (ART) cycles. DESIGN Retrospective case series. SETTING Tertiary care military hospital. PATIENT(S) Six wounded warriors. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Seminal vesicle fluid analysis after harvest, after thaw analysis, fertilization rates, pregnancy rates (PRs), live birth. RESULT(S) Six patients with lower extremity, pelvic, and genital injuries from dismounted improvised explosive devices underwent SVSA within 5-12 days of the initial injury. Sperm retrieved were analyzed (volume, 0.4-1.8 mL; concentration, 40-2,200 K; motility, 0-5%), washed, and cryopreserved. Two patients underwent IVF/intracytoplasmic sperm injection (ICSI) cycles using their samples. In one couple, fertilization rate was 38%. One grade V embryo was transferred with a negative pregnancy test. The second couple underwent two cycles. In their first cycle, fertilization rate was 44%, with one blastocyst transferred and a negative pregnancy test. In the second cycle, fertilization rate was 47%. Two blastocysts were cryopreserved due to ovarian hyperstimulation syndrome (OHSS) concerns. One blastocyst was later transferred in a frozen cycle resulting in a live birth. CONCLUSION(S) The SVSA is a reasonable option to retrieve sperm in wounded warriors or trauma patients with extensive genital injuries.
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Affiliation(s)
- Mae Wu Healy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | - Belinda J Yauger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Aidita N James
- A.R.T. Institute of Washington Inc., Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James R Jezior
- Division of Andrology, Department of Urology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Patrick Parker
- Division of Andrology, Department of Urology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Robert C Dean
- Division of Andrology, Department of Urology, Walter Reed National Military Medical Center, Bethesda, Maryland
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Royster GD, Krishnamoorthy K, Csokmay JM, Yauger BJ, Chason RJ, DeCherney AH, Wolff EF, Hill MJ. Are intracytoplasmic sperm injection and high serum estradiol compounding risk factors for adverse obstetric outcomes in assisted reproductive technology? Fertil Steril 2016; 106:363-370.e3. [PMID: 27172401 DOI: 10.1016/j.fertnstert.2016.04.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/08/2016] [Accepted: 04/13/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate whether intracytoplasmic sperm injection (ICSI) use and E2 on the final day of assisted reproductive technology (ART) stimulation are associated with adverse obstetric complications related to placentation. DESIGN Retrospective cohort study. SETTING Large private ART practice. PATIENT(S) A total of 383 women who underwent ART resulting in a singleton live birth. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Adverse placental outcomes composed of placenta accreta, placental abruption, placenta previa, intrauterine growth restriction, preeclampsia, gestational hypertension, and small for gestational age infants. RESULT(S) Patients with adverse placental outcomes had higher peak serum E2 levels and were three times more likely to have used ICSI. Adverse placental outcomes were associated with increasing E2 (odds ratio 1.36, 95% confidence interval 1.13-1.65) and ICSI (odds ratio 3.86, 95% confidence interval 1.61-9.27). Adverse outcomes increased when E2 was >3,000 pg/mL and continued to increase in a linear fashion until E2 was >5,000 pg/mL. The association of ICSI with adverse outcomes was independent of male factor infertility. Interaction testing suggested the adverse effect of E2 was primarily seen in ICSI cycles, but not in conventional IVF cycles. Estradiol >5,000 pg/mL was associated with adverse placental events in 36% of all ART cycles and 52% of ICSI cycles. CONCLUSION(S) ICSI and elevated E2 on the day of hCG trigger were associated with adverse obstetric outcomes related to placentation. The finding of a potential interaction of E2 and ICSI with adverse placental events is novel and warrants further investigation.
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Affiliation(s)
- Greene Donald Royster
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Walter Reed National Military Medical Center, Bethesda, Maryland; Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| | - Kavitha Krishnamoorthy
- Department of Obstetrics and Gynecology, University of Miami Jackson Health System, Miami, Florida
| | - John M Csokmay
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Belinda J Yauger
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rebecca J Chason
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Alan H DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Erin F Wolff
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Micah J Hill
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Walter Reed National Military Medical Center, Bethesda, Maryland
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Patounakis G, Ozcan MC, Chason RJ, Norian JM, Payson M, DeCherney AH, Yauger BJ. Impact of a prior cesarean delivery on embryo transfer: a prospective study. Fertil Steril 2016; 106:311-6. [PMID: 27087400 DOI: 10.1016/j.fertnstert.2016.03.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine whether a history of prior cesarean delivery (CD) makes ET more difficult and impacts pregnancy outcomes. DESIGN Prospective cohort study. SETTING Tertiary care military facility. PATIENT(S) One hundred ninety-four patients with previous delivery undergoing IVF/intracytoplasmic sperm injection (ICSI)-ET. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Live birth (primary), positive hCG, clinical pregnancy, and time to perform ET. RESULT(S) There was no statistically significant difference between patients with a history of only vaginal deliveries versus those with a history of CD for live birth (39% vs. 32%), positive hCG (56% vs. 53%), or clinical pregnancy (49% vs. 41%). Embryo transfers took longer in the history of CD group (157 vs. 187 seconds) and were more likely to have mucus (27% vs. 45%) or blood (8% vs. 21%) on the catheter. CONCLUSION(S) Embryo transfers performed on patients with a prior CD took 30 seconds longer. They were also more likely to have blood or mucus on the catheter. Despite the apparently more difficult transfers, pregnancy outcomes were not different between the two groups.
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Affiliation(s)
- George Patounakis
- National Institutes of Health/National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Meghan C Ozcan
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Rebecca J Chason
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Mark Payson
- Dominion Fertility, Arlington, Virginia; Inova Fairfax Hospital Women's Center, Falls Church, Virginia
| | - Alan H DeCherney
- National Institutes of Health/National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Belinda J Yauger
- Walter Reed National Military Medical Center, Bethesda, Maryland.
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Wolfe HL, Healy MW, Yauger BJ, Csokmay JM. Cobblestone fallopian tubes on hysterosalpingogram followed by bilateral tubal abscesses and sepsis. Am J Obstet Gynecol 2016; 214:544.e1-544.e2. [PMID: 26854399 DOI: 10.1016/j.ajog.2016.01.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/13/2016] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
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Stegmann BJ, Goldman KN, Moon KS, Yauger BJ, Payson MD, Segars JH. Reply of the Authors. Fertil Steril 2011. [DOI: 10.1016/j.fertnstert.2011.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yauger BJ, Feinberg EC, Levens ED, Gustofson RL, Larsen FW, DeCherney AH. Pre-cycle saline infusion sonography minimizes assisted reproductive technologies cycle cancellation due to endometrial polyps. Fertil Steril 2008; 90:1324-6. [DOI: 10.1016/j.fertnstert.2007.09.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2007] [Revised: 09/21/2007] [Accepted: 09/21/2007] [Indexed: 11/25/2022]
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Levens ED, Whitcomb BW, Hennessy S, James AN, Yauger BJ, Larsen FW. Blastocyst development rate impacts outcome in cryopreserved blastocyst transfer cycles. Fertil Steril 2008; 90:2138-43. [PMID: 18178191 DOI: 10.1016/j.fertnstert.2007.10.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 10/24/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess cycle outcome among day 5 and day 6 cryopreserved frozen-thawed blastocyst embryo transfers (FBET). DESIGN Retrospective cohort study. SETTING Military-based assisted reproduction technology (ART) center. PATIENT(S) One hundred seventy-two nondonor, programmed cryopreserved embryo cycles. INTERVENTION(S) Fully expanded blastocysts on day 5 were cryopreserved on day 5, and those achieving this state on day 6 were cryopreserved on day 6. Leuprolide acetate was given for ovulation inhibition, and endometrial supplementation was by oral and vaginal estradiol. Progesterone in oil was administered, and blastocyst transfer occurred in the morning of the sixth day of progesterone. MAIN OUTCOME MEASURE(S) Implantation, pregnancy, and live-birth rates. RESULT(S) Fresh and frozen cycle characteristics were similar between groups. Day-5 FBET had statistically significantly higher implantation rates (32.2% vs. 19.2%), which remained significant even when adjusting for covariates (odds ratio: 1.91; 95% confidence interval, 1.00, 3.67). Live-birth rates trended toward improvement after adjusting for covariates (odds ratio: 1.18; 95% confidence interval, 0.61, 2.30). CONCLUSION(S) Cryopreserved day-5 blastocysts have higher implantation rates and trend toward improved pregnancy outcomes compared with cryopreserved day-6 blastocysts. This suggests that embryo development rate may, in part, predict implantation and subsequent FBET outcomes, although embryos not achieving the blastocyst stage until day 6 still demonstrate acceptable outcomes.
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Affiliation(s)
- Eric D Levens
- Walter Reed Army Medical Center ART Program, Washington, DC, USA.
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Abstract
OBJECTIVE To determine the extent of nonadherence and impediments to care in a military colposcopy and loop excision electrocautery procedure (LEEP) clinic. MATERIALS AND METHODS The nonadherence rate for colposcopy and LEEP appointments was determined for a 6-month period at Walter Reed Army Medical Center. Nonadherence was defined as failure to keep an appointment or cancellation within 24 hours of the scheduled time. A nurse coordinator telephoned all nonadherent women. Women who agreed to participate were administered a structured survey to elicit their reasons for default from their appointments. RESULT Sixty-one (15%) of 405 women were nonadherent. Of the 61 nonadherent women, 55 (90%) agreed to participate, 4 (7%) were unable to be contacted, and 2 (3%) declined participation. The average age of participants was 30 years. Beneficiary status of the 55 women was as follows: dependent, 27 (49%); active duty, 25 (45%); retired, 2 (4%); and veteran, 1 (2%). The most common reasons for default overall for 55 women were onset of menses (15 [27%]), unplanned family or personal event (9 [16%]), forgetting (8 [15%]), and work conflict (7 [13%]). Leading reasons for 25 active duty women included work conflict (7 [28%]) and menses (6 [24%]). Leading reasons for 27 dependent women included menses (9 [33%]), unplanned family or personal event (6 [22%]), and forgetting (5 [19%]). CONCLUSIONS Despite unrestricted access to care in the military clinic, the default rate was similar to rates reported for civilian clinics. Previsit interventions likely to improve compliance include sending informational packets to patients, better attention to scheduling around the time of expected menses, and initiating an appointment reminder system. To decrease the high percentage of nonadherence attributable to work conflicts for active duty women, supervisors need to be better informed about both medical and deployment implications of an unevaluated abnormal Pap smear.
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Affiliation(s)
- Belinda J Yauger
- Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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Yauger BJ, Dunlow SG, Lockrow EG. Laparoscopic appendectomy: a series of cases utilizing laparosonic coagulating shears as compared to endo-GIA and endoshears. J Reprod Med 2005; 50:231-4. [PMID: 15916204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To report a series of laparoscopic appendectomies utilizing laparosonic coagulating shears (LCS) (harmonic scalpel). STUDY DESIGN We conducted a retrospective chart underwent laparoscopic appendectomy at Walter Reed Army Medical Center between January 1, 1996, and December 31, 2001. Procedures were included if only 1 instrument was utilized for transection of the appendix: endoshears, endo-GIA (Tyco U.S. Surgical, Norwalk, Connecticut) or LCS. Procedures on ruptured appendixes and emergency procedures were excluded. Outcome variables of interest included operative time, estimated blood loss, length of hospital stay and complications. RESULTS Mean estimated blood loss, mean operative times and hospital stay were consistent with those of other techniques of laparoscopic appendectomy. LCS was used more frequently for appendectomy performed at the time of another procedure than were endo-GIA and endoshears. There were no complications in the harmonic scalpel laparoscopic appendectomy series. CONCLUSION This series demonstrates that laparoscopic appendectomy with LCS has low morbidity and is as efficacious as other methods of laparoscopic appendectomy.
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Affiliation(s)
- Belinda J Yauger
- Uniformed Services Residency in Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC, USA
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