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BackgroundWith an increasing number of reproductive-aged women undergoing renal transplantation coupled with improved fertility post-transplantation, more women are becoming pregnant with a kidney transplant in place. This leads to increased risk of perinatal complications such as pre-eclampsia, gestational diabetes, preterm delivery and Cesarean section. Given that kidney transplants are often placed extra-peritoneally in the iliac fossa, there is also a risk of damage to the transplanted kidney at the time of Cesarean section.Case presentationWe present a case of shearing-force injury to a transplanted kidney at the time of repeat Cesarean section due to adherence of the organ to the overlying fascia. This is the first known case of an injury by this mechanism.ConclusionPre-operative planning with organ mapping and incision planning is imperative, with consideration for a vertical midline incision to avoid direct or shearing forces on the transplant kidney. Preoperative collaboration with the Transplant Surgery team is also important so they are available in case of emergency or need for intraoperative consultation.

ObjectivesThis study aimed to evaluate the prevalence of obstetric and gynecologic (Ob/Gyn) hospitalists and determine if an association exists between the presence of Ob/Gyn hospitalists and severe maternal morbidity (SMM).MethodsThis observational study included data from hospitals listed in the USA TODAY’s 2019 article titled, “Deadly deliveries: Childbirth complication rates at maternity hospitals.” Telephone and email surveys of staff in these hospitals identified the presence or absence of continuous providers in the hospital 24 hours, 7 days a week (24/7 coverage) and the types of providers who are employed, then compared these responses with the SMM cited by USA TODAY.ResultsEight hundred ten hospitals were contacted, with participation from 614 labor and delivery units for a response rate of 75.8%. Fifty-seven percent of units were staffed with 24/7 coverage, with 46% of hospitals’ coverage primarily provided by an Ob/Gyn hospitalist and 54% primarily by a nonhospitalist OB/Gyn provider. The SMM and presence of 24/7 coverage increased with the level of neonatal care and delivery volume. Of hospitals with 24/7 coverage, those that primarily used Ob/Gyn hospitalists had a lower SMM for all mothers (1.7 versus 2.0, P = 0.014) and for low-income mothers (1.9 versus 2.30, P = 0.007) than those who primarily used nonhospitalist OB/Gyn providers.ConclusionsSevere maternal morbidity increases with delivery volume, level of neonatal care, and 24/7 coverage. Of hospitals with 24/7 coverage, units that staff with Ob/Gyn hospitalists have lower levels of SMM than those that use nonhospitalist Ob/Gyn providers.

Background: By 2014, there were more than 1,700 Obstetrician Gynecologic (OB/GYN) hospitalists working at more than 243 hospitals in the United States, representing approximately 10% of hospitals offering maternity care. There is a paucity of data assessing the impact of the hospitalist care model on house staff education and delivery of patient care. Objective: The goal of this study is to assess parameters surrounding the educational experience of OB/GYN residents while being supervised on Labor and Delivery by attendings from each of the Department's Divisions.Methods: A Likert scale survey was developed and distributed to determine residents' perceptions of 4 quality metrics (quality of patient care, teaching, professional relationships, and resident autonomy) amongst department provider groups: Generalists, Hospitalists, Family Planning, Maternal-Fetal-Medicine, and Gynecology Oncology. STATA MP 10 was used to analyze data. As a function of attending provider group, questions were analyzed individually using Fisher Exact test. Questions were grouped by quality metric and analyzed using the Student t test. P-value <0.05 was considered statistically significant.Results: A 100% response rate (N = 28) yielded three statistically significant metrics for the Hospitalist group: 'quality of patient care' 20.5 ± 0.94 (p=0.003), 'teaching' 26.6 ± 0.89 (p<0.001), and 'professional relationships' 25.7 ± 1.5 (p<0.001). The Hospitalist providers scored significantly higher in resident teaching, mean score 26.6 ± 0.89 (p<0.008). Conclusion:These results help demonstrate the positive impact the OB/GYN hospitalist role has on house staff experiences and its potential in academic medicine.