Objective The aim of the study was to determine whether forced cough during colposcopy-guided cervical biopsy affected pain and anxiety levels. Materials and Methods The study was conducted at the University Hospital (Newark, NJ) Ambulatory Care Center from December 2016 to June 2018 and evaluated 110 patients at the time of a colposcopy-guided cervical biopsy. Study patients were randomized to either cough or no cough group during the biopsy procedure. Pain level was assessed using a visual analog pain scale before, during, and immediately after a colposcopy-guided cervical biopsy. Study patients also completed a standardized anxiety survey before and after the procedure. T tests, Pearson χ2, or Cochran-Mantel-Haenszel were used to compare baseline characteristics between the cough and no cough groups. Multivariate linear regression analysis was used to identify potential confounders and then compare pain levels across both groups. Results There was no statistically significant difference in pain scores between the cough and no cough group when analyzed for each demographic variable even when confounders were accounted for. The anxiety scores for both study groups before and after the procedure were similar and not significantly reduced. Conclusions We observed a trend that cough reduced pain associated with the colposcopy-guided cervical biopsy but did not reach statistical significance. A similar outcome was observed in anxiety level, where anxiety was reduced in the cough group but was not statistically significant as compared with the no cough group. Further studies are necessary to assess various modalities in reducing pain and anxiety associated with colposcopy-guided cervical biopsy.

A pitfall to avoid is classifying these benign lesions as malignant based on atypical histopathology.

No abstract

was diagnosed in 21.3% of pregnancies, with 35% (6/17) of those diagnosed occurring in the third trimester. Six fetal demises (IUFD) were identified, with half occurring in non-anomalous fetuses and 30% occurring after 30 weeks gestation (Table 2). CONCLUSION: Among pregnancies complicated by T21, the rates of structural anomalies, FGR, and IUFD are high. The diagnosis of these conditions occurs frequently in the third trimester. Surprisingly, US surveillance, i.e. growth US or antenatal testing, is only done in a minority of T21 pregnancies. Consideration for US surveillance in the third trimester, with subsequent antenatal testing as indicated by the results of that US, is warranted, in pregnancies complicated by T21.

OBJECTIVE: Obesity has been shown to lower vaginal birth after cesarean section(VBAC) success rates. Repeat cesarean delivery(CD) and failed trial of labor after cesarean(TOLAC) both increase risk to the obese gravida. Our objective was to examine the delivery outcomes of obese patients undergoing TOLAC. STUDY DESIGN: This was a retrospective cohort of women who attempted TOLAC at an urban, academic hospital between 1/1/2015 and 12/31/2016. Exclusion criteria were EGA < 24 weeks, fetal chromosomal anomalies, IUFD and contraindication for vaginal delivery. Patients were identified by departmental statistics and medical records were reviewed. The VBAC rate for obese women was compared to that of nonobese women, based on BMI at delivery. RESULTS: 191 women met the inclusion criteria and 131(68.6%) were obese. Mean BMI for the cohort was 32.8 with a range of 19.4-67 kg/m2. Hypertension was higher in the obese group(16% vs 5%, p¼0.04). Age, parity, and initial cervical dilation were similar in the two groups. In the nonobese group, 82% had a successful VBAC compared with 74% in the obese group(p ¼ 0.28). In the obese group, 37% were admitted for induction of labor (IOL), similar to the nonobese group (32%, p¼0.62). 83(63%) of the obese group had no previous SVD or VBAC. The CD rate for this subset was 36%. 5minute Apgar < 7, postpartum fever, endometritis and chorioamnionitis rates were similar. Rates of VBAC in patients with class 1 and 2 obesity did not differ from the nonobese group. 55% of patients with class 3 obesity delivered by VBAC, lower than the nonobese group. 4 patients had an admission weight >300 lbs, and all underwent repeat CD. CONCLUSION: Obese patients in this cohort had a high rate of successful VBAC, similar to the nonobese group. Obesity should not be a contraindication to TOLAC, even when there is no history of a prior SVD or VBAC. It may be reasonable to set maternal weight >300 lb as a "cut-off " for attempting TOLAC given that all patients delivered by CD, but given the small number of patients above this weight, this warrants further study.