Introduction: While the gold standard for evaluation of maternal urinary protein is a 24-hr urine collection, spot urine protein/creatinine ratio has been instituted as an alternative for quantification proteinuria. Though it seems intuitive to obtain a catheterized urine sample on patients with ruptured amniotic membranes, it is a common practice to forgo this step under the argument that there is no data to show its necessity. Data on the effect of amniotomy, spontaneous or artificial, on the accuracy of the protein/creatinine ratio are scant. The present study was designed to address this issue and objectively compare protein/creatinine ratio values on samples obtained from the same patient before and after amniotomy. Methods: We conducted a prospective non-interventional study. Women presenting in active labor or for labor induction with intact amnion were enrolled. Separate random catch urines for the protein/creatinine ratio were obtained prior to and immediately after spontaneous or assisted amniotomy. The urine samples were analyzed in the hospital chemistry department, and the results were compared. Results: Of the 137 patients consented, 63 had pre- and post-amniotomy protein/creatinine ratios collected. The mean age was 28.5±5.6 y, Gravidity 2.7±1.6, Gestational age 39.2±1.8 wks, and BMI 31.6±6.4 kg/m 2 . Comorbidities included gestational diabetes (5/63, 7.9%), chronic hypertension (3/63, 4.7%), and pre-eclampsia (5/63, 7.9%). Post-amniotomy protein/creatinine ratio was significantly higher than pre-amniotomy ratio (1.3±2.5 vs 0.34±0.83, p <0.001). In addition, the number of patients with protein/creatinine ratio greater than 0.3 was higher post-amniotomy than pre-amniotomy (41/63 vs 14/63, p <0.001). Conclusion: Amniotomy results in a false elevation of the protein/creatinine ratio in term patients. Urine samples should be obtained by catheterization in the setting of ruptured membranes to reduce falsely elevated results. Although the same can be assumed for other gestational ages, further studies including this population need to be conducted.

INTRODUCTION: Endometrial polyps (EMPolyp) are a common cause of abnormal uterine bleeding (AUB). For over 30 years endometrial biopsy (EMB) has been an important tool in the work up of AUB. Occasionally the pathologic sample obtained from an EMB may note a "possible" EMPolyp. However, hysteroscopy is considered the "gold standard" for diagnosis of EMPolyps. Our study attempts to look at existence of an EMPolyp when suggested by EMB. METHODS:We reviewed all EMBs send to our pathology lab during the last full year (2014). All EMBs read as "endometrial polyp" or "suggestive of endometrial polyp" were analyzed. Demographic data and medical histories were obtained on these patients. Pre-EMB ultrasounds (US) and post EMB hysteroscopy operative notes, if available, were reviewed.RESULTS: An EMB suggestive for polyps was noted in 102 of 1,380 (7.4%) procedures done for AUB. The mean age was 47.3610.5 years and BMI 30.668.7 kg/m 2 . Diabetes was noted in 14/102 (13.7%) and hypertension in 36/102 (35.3%). In the 32 patients that underwent follow-up hysteroscopy, polyps were noted in 24. Thus EMB correctly identify the polyps in 75% of cases. Of the 23 Pre-biopsy US all but one correctly predicted the presence or absence of EMPolyp. CONCLUSION: An EMB finding suggestive of EMPolyp appears to overcall their existence. Even non-saline infusion sonography appears to be a better predicator than EMB in diagnosing the presence or absence of an EMPolyp.INTRODUCTION: With cervical cancer highly prevalent across Honduras, this study assessed obstacles to screening among adult women living in Tegucigalpa and surrounding villages. It was hypothesized that major barriers to cervical cancer screening and follow-up are due to lack of adequate transportation and/or education. METHODS:During a VCOM medical mission trip in April 2015, a convenience sample of 73 adult women completed a pre-validated survey, adapted from Sullivan, 2010, at the James Moody Adams Baxter Clinic. Statistical analyses assessed the association between cervical cancer screening rates and common barriers reported in the survey. RESULTS: Overall, 90.4% of participants reported previously having a PAP smear with over half (61.7%) receiving the test every year. While not statistically significant, those who received PAP smears less frequently than every year (30.6%) also reported no means of transportation. Women who reported receiving results of their PAP smear (85.1%) also had transportation (45.6%). Of the women who did not receive their results, most did not have transportation (55.6%). While not statistically significant, most of the women who reported receiving treatment for an abnormal test also had transportation (75%). Of the women who have never received a PAP smear, 33% reported not knowing the PAP was important.CONCLUSION: Within the restraints of the study, it appears transportation was the largest barrier to cervical cancer screening and follow-up. Future research into the use of organized group women's health visits and implementing further preventative ...

INTRODUCTION: Visual clarity (VC) is vital in performing laparoscopic surgery. However, few studies provide a direct assessment of laparoscopic VC or techniques to improve VC. METHODS: A box was constructed of ¼ inch acrylic glass with opaque insulation. An attached humidified source was heated to give a constant 81% humidity at 36 degrees Celsius. A 10 mm laparoscope was inserted and positioned 8 cm distal to a laminated white card containing black 12 pitch font. Four standard still images of varying visual clarity were captured and designated VC1, VC2, VC3, and VC4. A 10 cm visual analog scale (VAS) was used to rate VC scores. The 0 cm mark indicated total visual obstruction and the 10 cm mark indicated perfect visual clarity. The performance of the VAS was determined by having observers rate the still images. The observers were blinded to the VC rating and number of standard images used. Intra-observer and inter-observer differences were calculated. RESULTS: Standard images were assessed in random fashion 4 times by each of the 4 independent observers (64 total readings). Observed means were calculated (VC1, 9.2 ± 0.57 cm; VC2, 7.4 ± 0.65 cm; VC3, 4.4 ± 0.65 cm; VC4, 1.4 ± 0.52 cm). All values differed from each other (p < .001). Inter-observer differences were < 0.54 ± 0.37 cm and intra-observer differences were < 0.35 ± 0.13 cm. CONCLUSION: Our novel simulation model applied a visual analog scale that can serve as a tool to compare various techniques utilized for improving laparoscopic visual clarity.

INTRODUCTION: Oral anticoagulation in reproductive age women is not uncommon. Some studies have reported increased incidence of abnormal uterine bleeding and heavy menstrual bleeding in those receiving anticoagulation. However, studies comparing the effect of different oral anticoagulants on hemoglobin levels on menstruating women are lacking. METHODS: We retrospectively reviewed charts of reproductive age women on oral direct activated Factor X inhibitors (FXaI), vitamin K antagonist (vKa), or aspirin (ASA). Demographics and indication for anticoagulation were recorded. Hemoglobin before and 6 to 12 months after initiation of oral anticoagulation were recorded. Pre and post treatment hemoglobin values were compared using paired t-test for each individual anticoagulant and ANOVA was employed to compare initial Hemoglobin levels and pre and post treatment Hemoglobin differences. RESULTS: FXaI, vKa, ASA groups included 91, 73 and 68 patients, respectively. They did not differ in mean age (44.2 ± 6.2 yrs) or BMI (32.5 ± 8.1 kg/m2). Indications for FXaI were Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE) (64/91), Atrial fibrillation (Afib) (8/91) or antiphospholipid syndrome(7/91). vKa was used for DVT/PE (28/73), stroke (12/73), or Afib (10/73). ASA indications included stroke (27/68), DVT/PE (11/68), or Factor V Leiden (10/68). Post treatment Hemoglobin values were less than 2% lower than pretreatment Hemoglobin levels in all groups. This was not clinically or statistically significant. Differences in Hemoglobin were similar between groups. CONCLUSION: There was no clinically significant decrease in Hemoglobin levels in menstruating women receiving oral anticoagulants at 6 to 12 months post initiation of oral anticoagulation.

INTRODUCTION: Over 50% of pregnancies in the USA are unintended. Current contraception is very effective, if available and used correctly. We surmised the postpartum visit to be a key time to provide education and access to contraception. Thus we wanted to decrease our short interval pregnancy (less than 18 months, SIP) incidence as a simple measure of decreasing unintended pregnancies. METHODS: We retrospectively compared patients with SIP and those without with respect to age, race, parity, work status, attendance at postpartum visit (PPV), insurance status, breast feeding, and immediate postpartum medroxyprogesterone use. Modifiable risk factors would then be adjusted and the SIP incidence would be reassessed. RESULTS: We noted out of 991 deliveries that occurred from 5/2011 to 1/2013, 89 (8.9%) had an SIP. Only age (26.7 vs. 28.4 y, p=0.01) and PPV (40.9% vs. 67.4%, p=0.03) were significantly different in the SIP patients. Therefore, we changed our PPV timing from 6 weeks to 3 weeks in an effort to increase our PPV attendance. In the subsequent prospective time period from 1/2014 to 5/2016, we had 1021 births and 49 SIP births. Thus we had a decrease in our SIP from 8.9% to 4.8% (p=0.02) after changing the timing of our PPV. In addition, we increase our overall PPV attendance from 61% to 73% (p=0.04). CONCLUSION: Altering the timing of postpartum visit from 6 weeks to 3 weeks increased the frequency of attendance and may have decrease the unintended pregnancy rate.