General Obstetrician-gynecologists Research Articles

Genetic Predisposition for Gynecologic Cancers.

Hereditary cancer syndromes (HCS) are responsible for up to 10% of all cancers. At present, the majority of cancer susceptibility testing is initiated after a cancer diagnosis. There exists a significant opportunity for primary care providers including general obstetrician-gynecologists to engage in hereditary cancer risk assessment through adequate family history evaluation, initiation of genetic testing, and following the recommendations of national organizations. Identifying hereditary cancer genes may prompt primary prevention efforts such as enhanced screening, prevention, or personalized care strategies. We will review the literature regarding the approach and assessment of the most common gynecologic HCS.

Access to general obstetrics and gynecology care among Medicaid beneficiaries and the privately insured: a nationwide mystery caller study in the USA.

The mean wait time for new patient appointments has been growing across specialties, including obstetrics and gynecology, in recent years. This study aimed to assess the impact of insurance type (Medicaid versus commercial insurance) on new patient appointment wait times in general obstetrics and gynecology practices. A cross-sectional study used covert mystery calls to general obstetrician gynecologists. Physicians were selected from the American College of Obstetricians and Gynecologists directory and stratified by districts to ensure nationwide representation. Wait times for new patient appointments were collected and analyzed. Regardless of insurance type, the mean wait time for all obstetrician gynecologists was 29.9 business days. Medicaid patients experienced a marginally longer wait time of 4.8% (Ratio: 1.048). While no statistically significant difference in wait times based on insurance type was observed (P=0.39), the data revealed other impactful factors. Younger physicians and those in university-based practices had longer wait times. The gender of the physician also influenced wait times, with female physicians having a mean wait time of 34.7 days compared to 22.7 days for male physicians (P=0.03). Additionally, geographical variations were noted, with physicians in American College of Obstetricians and Gynecologists District I (Atlantic Provinces, CT, ME, MA, NH, RI, VT) having the longest mean wait times and those in District III (DE, NJ, PA) the shortest. While the type of insurance did not significantly influence the wait times for general obstetrics and gynecology appointments, physician demographic and geographic factors did.

Awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation: a cross-sectional survey

BackgroundThe demand for fertility preservation has increased substantially over the past decade as more women wish to delay childbearing and with improved survival outcomes of various medical conditions. This study evaluated the awareness and perceptions of Filipino obstetrician-gynecologists on fertility preservation.MethodsA cross-sectional survey was conducted among diplomates and fellows of the Philippine Obstetrical and Gynecological Society from September to December 2021. A self-administered questionnaire with 24 items was distributed online. Univariate descriptive statistics were reported as means for continuous variables and frequencies with percentage for categorical variables. Differences in responses were tested using the chi-square test.ResultsA total of 215 respondents completed the survey. Majority of the respondents were female, general obstetrician-gynecologists practicing in the National Capital Region. There was an overall positive perception of fertility preservation, with 98.60% agreeing that discussions about childbearing intentions should be initiated. Most participants (98.60%) were aware of fertility preservation but had varying levels of awareness of the different techniques. Fifty-nine percent of the respondents were unaware of regulations on fertility preservation. Setting up dedicated centers for fertility preservation and offering it as a public service were viewed as necessary by the respondents.ConclusionsThis study underscored the need to increase awareness of fertility preservation techniques among Filipino obstetrician-gynecologists. Meeting the need for comprehensive guidelines and centers is essential to promote fertility preservation in the country. Efficient referral systems and multidisciplinary approaches should be established for holistic care.

Physician's Knowledge and Practices Surrounding Low-Dose Aspirin for Preeclampsia Risk Reduction.

Preeclampsia is a leading cause of pregnancy-related deaths. Up to 60% of maternal deaths associated with preeclampsia may be prevented. Clinical trials have shown that low-dose aspirin reduces preeclampsia up to 30% among women at increased risk. Since 2014, multiple professional societies and the U.S. Preventive Services Task Force have released guidelines on the use of low-dose aspirin to reduce the risk of preeclampsia. We aimed to evaluate physician's knowledge and practices surrounding low-dose aspirin for preeclampsia risk reduction. We distributed an anonymous electronic survey to licensed physicians in the Rio Grande Valley of Texas who provide prenatal care, including general obstetrician-gynecologists, maternal fetal medicine subspecialists, and family medicine physicians. The survey consisted of 20 items assessing demographics, provider practices, and knowledge on the use of low-dose aspirin for preeclampsia risk reduction. We received 48 surveys with a response rate of 55%. More than 90% of physicians reported recommending low-dose aspirin for preeclampsia risk reduction, of which 98% correctly identified the dose. Of the physicians recommending aspirin, 83% initiate dosing between 12 and 16 weeks, but only 52% continue it until the day of delivery. Nearly 80% of respondents identified that one high-risk factor for preeclampsia is an indication for prophylaxis, but only 56% identified that two or more moderate risk factors should prompt aspirin recommendation. Despite clear professional guidelines, physicians demonstrated gaps in knowledge and differences in practices. Enhancing screening tools to assess patient's risk of developing preeclampsia and tailored medical education on moderate risk factors are needed to identify patients who may benefit from this intervention. Increasing the use of aspirin in patients at risk is critical given the benefits of low-dose aspirin in the reduction of poor maternal and neonatal outcomes related to preeclampsia. · Low-dose aspirin reduces preeclampsia in patients up to 30%.. · Physicians have gaps in knowledge despite guidelines.. · Following guidelines reduces poor outcomes associated with preeclampsia..

8341 Implementation of Robotic Surgery in a Rural Setting: Impact on Need for Assistant Surgeon and Route of Hysterectomy

<h3>Study Objective</h3> Robot-assisted hysterectomy allows the surgeon improved visualization, range of motion, and ergonomics which in some cases may obviate the need for an assistant surgeon. In rural hospitals where physician shortages remain a major barrier to care, reducing the number of surgeons necessary to perform hysterectomy would be of significant consequence. We sought to evaluate the impact of robotic surgery on the need for an assistant surgeon at time of hysterectomy at a rural community hospital. <h3>Design</h3> We performed a retrospective chart review of hysterectomies performed at a rural community hospital by general gynecologists, focusing on the 12-month period prior to, and the 12-month period 2 years following, implementation of a robotic surgical program. We chose 2 years to allow for gradual surgeon adoption of robotic technology. Our primary outcome was need for an assistant surgeon at time of hysterectomy. Our secondary outcome was route of hysterectomy. Billing records were cross-referenced against the medical record, and statistical analyses performed. <h3>Setting</h3> A rural community hospital in northcentral Pennsylvania. <h3>Patients or Participants</h3> Patients undergoing hysterectomy by general obstetrician-gynecologists. <h3>Interventions</h3> All modes of hysterectomy (abdominal, laparoscopic, robotic, and vaginal). <h3>Measurements and Main Results</h3> Following implementation of a robotic surgical program we observed a statistically significant decrease in the presence of an assistant surgeon at the time of hysterectomy from 86.7% to 29.7% (p<0.05). The percentage of hysterectomies performed by minimally-invasive technique (laparoscopic, robotic, and vaginal) versus open technique (total abdominal) increased from 67.0% to 87.4% following implementation of a robotic surgical program (p<0.05). <h3>Conclusion</h3> Access to robotic surgical technology reduced the need for an assistant surgeon at time of hysterectomy and increased the rate of minimally-invasive hysterectomy performed. These findings are of particular relevance to rural hospitals facing physician shortages.

OBGYN practice patterns regarding combination therapy for prevention of preterm birth: A national survey

ObjectiveOur objective was to examine if US obstetrician-gynecologists (OBGYNs) practice outside of evidenced-based guidelines and use a combination of interventions to prevent spontaneous preterm birth (sPTB). Study designAn electronic survey was distributed to members of the Pregnancy-Related Care Research Network (PRCRN), and also to members of the Society of Maternal-Fetal Medicine (SMFM). The survey consisted of questions regarding physician demographics, and the use of interventions to prevent sPTB in women with 1) a prior sPTB, 2) an incidental short cervix (no prior sPTB), and 3) a history of cervical insufficiency. ResultsThe PRCRN response rate was 58.6% (283/483) with an additional 143 responses from SMFM members. Among PRCRN responders, 82.7% were general OBGYNs and 17.3% were Maternal-Fetal Medicine subspecialists. Respondents were from all geographic regions of the country; most practiced in a group private practice (42.6%) or academic institution (31.4%). In women with prior sPTB, 45.2% of respondents would consider combination therapy, most commonly weekly intramuscular progesterone (IM-P) and serial cervical length (CL) measurements. If the patient then develops a short cervix, 33.7% would consider adding an ultrasound-indicated cerclage. In women with an incidental short cervix, 66.8% of respondents were likely to recommend single therapy with daily vaginal progesterone (VP). If a patient developed an incidentally dilated cervix, 40.8% of PRCRN respondents would recommend dual therapy, most commonly cerclage + VP, whereas 64.3% of SMFM respondents were likely to continue with VP only. In women with a history of cervical insufficiency, 47% of PRCRN respondents indicated they would consider a combination of IM-P, history-indicated cerclage and serial CL measurements. ConclusionAlthough not currently supported by evidence-based medicine, combination therapy is commonly being used by U.S. OBGYNs to prevent sPTB in women with risk factors such as prior sPTB, short or dilated cervix or more than one of these risks.

Commentary on Provider Adherence to Surgical Guidelines for Risk Reducing Salpingo-Oophorectomy

BRCA mutation carriers have a significantly increased lifetime risk of ovarian cancer compared to the general population. Risk-Reducing Salpingo-Oophorectomy (RRSO) is the primary evidence-based treatment to decrease that risk. The National Comprehensive Care Network (NCCN) and American College of Obstetricians and Gynecologists (ACOG) endorse a set of surgical guidelines to be completed at the time of RRSO. In the study “Provider Adherence to Surgical Guidelines for Risk Reducing Salpingo-oophorectomy”, we found that only two-thirds of all surgical providers were fully adherent to these guidelines. Gynecologic oncologists were more likely to follow surgical guidelines compared to general Obstetrician Gynecologists, and more likely to diagnose occult neoplasia despite similar patient populations. Here we discuss the reason for the surgical protocol, the clinical implications of noncompliance, and practical ways that providers can ensure full adherence to the protocol.

Provider-based initiation and management of pharmacologic therapy for gestational diabetes mellitus

Objective After failure of diet and exercise prescribed for gestational diabetes mellitus (GDM), pharmacotherapy initiation is recommended. The objective of this study was to examine the association between provider type and timing of pharmacotherapy initiation. Methods This was a retrospective cohort study of women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy) delivering in a tertiary care center between 2009 and 2019. Variables including maternal demographics, GDM characteristics, and provider type (general obstetrician/gynecologists (OBGYN), maternal–fetal medicine (MFM), or endocrinology) were assessed. The percent of abnormal glucose values at pharmacotherapy initiation was compared among provider types via univariable and multivariable analyses. Results A total of 428 women were included in the analysis. Eighteen percent were managed by MFM, 54% by general OBGYN, and 28% by endocrinology. Insulin was prescribed in 45.8% of women. In univariable analysis, the percent of abnormal glucose values was higher in women managed by MFMs, compared with general OBGYN and endocrinology (58.0%±25.1, 50.0%±23.1, and 50.3%±26.8, respectively, p = .041). Women started on insulin as first-line pharmacotherapy were more likely to be managed by endocrinology (p < .001). After adjusting for confounding variables, provider type was not significantly associated with percent of abnormal glucose values at pharmacotherapy initiation, but endocrinology was more likely to initiate insulin (aOR = 9.33, 95% CI 4.27–20.39). Conclusions Provider type was not associated with percent of elevated glucose values at the time of pharmacotherapy initiation for A2GDM, but it was associated with insulin usage as first-line pharmacotherapy.

Physician's opinions regarding salpingectomy as a risk-reducing procedure for ovarian cancer

Objective: Bilateral salpingectomy (BS) at the time of sterilization and hysterectomy has been proposed as a method to decrease the incidence of ovarian cancer. Recent studies have shown BS to be an equivalent procedure to bilateral tubal ligation (BTL) in terms of complication rate and a more efficacious procedure in terms of sterilization. The purpose of this study was to assess current practices in offering BS and to gather opinions regarding barriers preventing general obstetrician gynecologists from offering BS to their patients.

Knowledge of Endometrial Cancer Risk Factors in a General Gynecologic Population

Abstract Objectives To determine knowledge regarding endometrial cancer (EC) risk factors in a general gynecologic patient population. Study design A questionnaire survey regarding health behaviors and knowledge of risk factors of EC was administered to patients presenting for routine gynecologic care at two general gynecologic practices affiliated with a tertiary-care center between August and October 2014. Patient demographics, lifestyle information, and knowledge regarding EC risk factors were assessed. Data were analyzed using univariable and bivariable analyses, Χ2 tests, Fischer's exact tests, and t-tests. Results 231 women responded. Median age was 56 years old (IQR 25–64), and 87% were Caucasian. Median BMI was 24.9 (IQR 22.3–29.2). 24.7% were overweight and 24.3% obese. The majority (69.4%) of patients received a college or graduate degree. Over half of the women (52.1%) did not know that obesity was associated with increased risk of EC. When dichotomized based on obese vs non obese, there was no difference in patients' knowledge of the association between obesity and EC (47% vs 48%, respectively, p = .93). 91% of all respondents reported that their gynecologist or primary care physician had never discussed the risks of EC with them. Conclusions Regardless of education level, age or obesity status, the majority of women did not know the common risks of EC. Increased efforts towards educating women regarding obesity and other risk factors of EC are necessary in order to reduce the rising incidence of EC, a predominantly obesity-driven disease. Interventions must include general obstetrician-gynecologists and primary care providers.

Impact of a High-Volume Gynecologic Surgeon Preceptor on Benign Laparoscopic Hysterectomy

Objective: To compare operative times and surgical outcomes of women undergoing benign laparoscopic hysterectomy by general obstetrician–gynecologists (OB-GYNs) alone with those performed by general OB-GYNs in conjunction with a high-volume minimally invasive gynecologic surgeon preceptor. Design: This is a retrospective cohort study. (Canadian Task Force Classification II-2). Materials and Methods: A surgical preceptoring program for low-volume OB-GYNs was implemented in 2011 at an academic-affiliated community hospital. All women undergoing laparoscopic hysterectomy for benign disease between 2011 and 2013 are included. Results: A total of 391 laparoscopic hysterectomies were performed: 179 by low-volume OB-GYNs alone and 212 with the assistance of a preceptor. Laparoscopic hysterectomies performed with a preceptor had shorter operative times (128.4 vs. 105.4 minutes, p < 0.01). After adjusting for differences between groups, those performed in conjunction with a preceptor were 42 minutes faster. The group receiving surgery in conjunction with a preceptor had decreased rates of composite organ injury (6% vs. 1%, p < 0.01), ureteral injury (3% vs. 0%, p = 0.02), and conversion to open approach (5% vs. 0%, p < 0.01). The estimated blood loss was also significantly lower (163 vs. 134 mL, p = 0.03) and there were fewer intraoperative consultations (6% vs. 0.5%, p < 0.01) in the preceptor group. There was no difference in postoperative rates of blood transfusion, readmission, or reoperation. Conclusion: Women undergoing laparoscopic hysterectomy in conjunction with a high-volume minimally invasive gynecologic surgeon preceptor have improved outcomes, including shorter operative time, lower rate of organ injury and conversion to laparotomy fewer intraoperative consultations, and lower estimated blood loss than women undergoing laparoscopic hysterectomy by general OB-GYNs alone. (J GYNECOL SURG 36:115)

Knowledge of endometrial cancer risk factors in a general gynecologic population

ObjectivesTo determine knowledge regarding endometrial cancer (EC) risk factors in a general gynecologic patient population. Study designA questionnaire survey regarding health behaviors and knowledge of risk factors of EC was administered to patients presenting for routine gynecologic care at two general gynecologic practices affiliated with a tertiary-care center between August and October 2014. Patient demographics, lifestyle information, and knowledge regarding EC risk factors were assessed. Data were analyzed using univariable and bivariable analyses, Χ2 tests, Fischer's exact tests, and t-tests. Results231 women responded. Median age was 56 years old (IQR 25–64), and 87% were Caucasian. Median BMI was 24.9 (IQR 22.3–29.2). 24.7% were overweight and 24.3% obese. The majority (69.4%) of patients received a college or graduate degree. Over half of the women (52.1%) did not know that obesity was associated with increased risk of EC. When dichotomized based on obese vs non obese, there was no difference in patients' knowledge of the association between obesity and EC (47% vs 48%, respectively, p = .93). 91% of all respondents reported that their gynecologist or primary care physician had never discussed the risks of EC with them. ConclusionsRegardless of education level, age or obesity status, the majority of women did not know the common risks of EC. Increased efforts towards educating women regarding obesity and other risk factors of EC are necessary in order to reduce the rising incidence of EC, a predominantly obesity-driven disease. Interventions must include general obstetrician-gynecologists and primary care providers.

Premenstrual dysphoric disorders in women of Russian Federation and risk factors for their development. Epidemiological study of1,326 women

The epidemiology of premenstrual dysphoric disorders (PMDD) and the risk factors for PMDD in women of the Russian Federation are still not fully resolved. Objective: to assess the prevalence of PMDD among women in the Russian Federation and to identify risk factors for PMDD. Materials and methods. An anonymous questioning using the questionnaire was carried out by 1326 women of the reproductive period of different regions of the Russian Federation: Moscow (880), Ural (150), Rostov (146) and Novosibirsk (150) regions. Inclusion criteria were: age of 15-45 years, regular menstrual cycle of 25-35 days, lack of psychiatric diagnoses in history. The results. It was found that 15.6 % of Russian women meet the criteria for PMDD. The primary age of the first appearance of PMDD symptoms is 15-19 years. The statistically significant risks of developing PMDD are ages 15-24 years, education at a higher education institution, lack of regular sexual life, history of neurocirculatory dystonia, complication of heredity in neuropsychiatric diseases and premenstrual syndrome, painful periods and complications in childbirth or abortion. Conclusions: the high prevalence of PMDD (15.6 %) in young women of the reproductive period, the presence of psychosocial and biological risk factors for PMDD requires the development of a modified tool for the early diagnosis of PMDD for general practitioners, obstetrician gynecologists, and psychiatrists.

ACOG Committee Opinion No. 740: Gynecologic Care for Adolescents and Young Women With Eating Disorders.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines eating disorders as a "persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning." The correct diagnosis of and distinction between eating disorders are important because the course, prognosis, and treatment may be vastly different. Although the age at peak incidence can vary depending on the eating disorder, these disorders commonly arise during adolescence. Adult and adolescent females with eating disorders may present with gynecologic concerns or symptoms, including irregular menses, amenorrhea, pelvic pain, atrophic vaginitis, and breast atrophy. Although formal diagnosis and treatment of eating disorders in adolescents are complex and outside the scope of practice for most general obstetrician-gynecologists, it is important that health care providers be comfortable with recognizing and screening at-risk patients. Recognizing risk factors for eating disorders can help to identify patients who should be further evaluated. Simply asking the patient how she feels about her weight, what she is eating, how much she is eating, and how much she is exercising can help identify at-risk patients. A physical examination and laboratory tests are valuable in the diagnosis of an eating disorder. Because eating disorders are complex and affect psychologic and physical health, a multidisciplinary approach is imperative. Although obstetrician-gynecologists are not expected to treat eating disorders, they should be familiar with the criteria that warrant immediate hospitalization for medical stabilization.

ACOG Committee Opinion No. 740 Summary: Gynecologic Care for Adolescents and Young Women With Eating Disorders.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, defines eating disorders as a "persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning." The correct diagnosis of and distinction between eating disorders are important because the course, prognosis, and treatment may be vastly different. Although the age at peak incidence can vary depending on the eating disorder, these disorders commonly arise during adolescence. Adult and adolescent females with eating disorders may present with gynecologic concerns or symptoms, including irregular menses, amenorrhea, pelvic pain, atrophic vaginitis, and breast atrophy. Although formal diagnosis and treatment of eating disorders in adolescents are complex and outside the scope of practice for most general obstetrician-gynecologists, it is important that health care providers be comfortable with recognizing and screening at-risk patients. Recognizing risk factors for eating disorders can help to identify patients who should be further evaluated. Simply asking the patient how she feels about her weight, what she is eating, how much she is eating, and how much she is exercising can help identify at-risk patients. A physical examination and laboratory tests are valuable in the diagnosis of an eating disorder. Because eating disorders are complex and affect psychologic and physical health, a multidisciplinary approach is imperative. Although obstetrician-gynecologists are not expected to treat eating disorders, they should be familiar with the criteria that warrant immediate hospitalization for medical stabilization.

Ovulation Induction for the General Gynecologist.

The practice of ovulation induction often falls to the reproductive endocrinology and infertility specialist. However, attitudes toward the evaluation and treatment of infertility has shifted among general obstetrician-gynecologists (OB-GYN). This review discusses the underlying scientific basis of anovulation and clinical guidelines regarding the use of different medications for the purpose of promoting follicular recruitment and ovulation for the general OB-GYN.

Gestational Trophoblastic Disease Electronic Consults: What Do Patients and Physicians Want to Know?

Given the rarity of gestational trophoblastic disease (GTD), specialized regional and national centers for GTD have been established. These centers serve at least 3 purposes: to improve care for women with GTD, to enhance research though collaboration, and to educate other clinicians. This study was undertaken to understand the potential GTD knowledge gap by examining both patient and physician inquiries received at a specialized GTD center. All electronic consults received by specialists at our center between March 2016 and March 2017 were analyzed. Information collected included source of inquiry, reason for the consult, type of GTD, and the advice provided. Descriptive statistics were used to analyze the major trends. We analyzed 102 electronic consults. Physicians sent 49 (48%) and patients sent 53 (52%) consults. Most e-consults were sent by physicians and patients within the United States; however, 11% of the consults were directed from international locations. Among physicians, gynecologic oncologists (65%) were the most common specialty to consult our institution followed by medical oncologists (18%) and obstetrician gynecologists (16%).Most questions from gynecologic (62%) and medical oncologists (77%) concerned treatment regimens. This was contrasted by general obstetrician gynecologists who more commonly asked about human chorionic gonadotropin monitoring (62%). Difficulty with appropriate Federation of Gynecology and Obstetrics staging and World Health Organization risk score assignment were common themes. Most of the confusion centered on the use of chest computed tomography rather than plain chest x-ray for the assessment of lung metastases. Unlike physicians, patient e-consults were most concerned with the duration of human chorionic gonadotropin monitoring (51%) and timing of future conceptions. Both physicians and patients in the United States and abroad frequently use electronic consults to improve their knowledge about GTD management and follow-up. Although the type of inquires varied, they highlight fundamental gaps in understanding and potential opportunities for formal education.

930: Relocations of Maternal-Fetal Medicine specialists in the United States, 2007-2016

To examine recent trends in the relocation of maternal-fetal medicine (MFM) specialists in the United States. This longitudinal descriptive study analyzed county and state level migration patterns of MFM specialists in active practice between the earliest reference point (2007) and most recently (2016). A physician's practice location in a year was compared with the prior year. Physician demographic characteristics came from three data resources (Association of American Medical Colleges data warehouse, American Medical Association Physician Masterfile, and American Community Survey). Comparisons were made between MFMs who either moved or not. A multivariable logistic regression model was used to model factors associated with migration for the entire period An average of 7.6% (5.5% to 10.9%) of the 1,126 practicing MFMs moved per year or 25.3% during the 10 years. Most who relocated moved once or twice during the 10 years, with approximately half (52.9%) remaining within their state. The odds of relocating were higher if the MFM was less than under 40 years old as compared to 60 and over (OR = 2.16, 95% CI: 1.38 - 3.40). There were no differences between males and females (OR = 1.07; 95% CI: 0.83 - 1.37) or rural vs urban locations (OR = 0.93; 95% CI: 0.35 - 2.47). Relocation was primarily in urban counties (96%). Net gains were most common in Texas, Maryland, and Florida, and net losses were most in New York, Illinois, and New Jersey. Approximately one in four MFM specialists in active practice relocated at least once in the last 10 years to counties that were predominantly urban. This finding is less than that reported for general obstetrician-gynecologists. Observing this trend will contribute to a better understanding about the national distribution of MFM physicians.

Discrepancies in the female pelvic medicine and reconstructive surgeon workforce.

It is unclear whether the current distribution of surgeons practicing female pelvic medicine and reconstructive surgery in the United States is adequate to meet the needs of a growing and aging population. We assessed the geographic distribution of female pelvic surgeons as represented by members of the American Urogynecologic Society (AUGS) throughout the United States at the county, state, and American Congress of Obstetricians and Gynecologists district levels. County-level data from the AUGS, American Congress of Obstetricians and Gynecologists, and the United States Census were analyzed in this observational study. State and national patterns of female pelvic surgeon density were mapped graphically using ArcGIS software and 2010 US Census demographic data. In 2013, the 1058 AUGS practicing physicians represented 0.13% of the total physician workforce. There were 6.7 AUGS members available for every 1 million women and 20 AUGS members for every 1 million postreproductive-aged women in the United States. The density of female pelvic surgeons was highest in metropolitan areas. Overall, 88% of the counties in the United States lacked female pelvic surgeons. Nationwide, there was a mean of 1 AUGS member for every 31 practicing general obstetrician-gynecologists. These findings have implications for training, recruiting, and retaining female pelvic surgeons. The uneven distribution of female pelvic surgeons throughout the United States is likely to worsen as graduating female pelvic medicine and reconstructive surgery fellows continue to cluster in urban areas.

Colpocleisis: a safe, minimally invasive option for pelvic organ prolapse.

This study aimed to describe the morbidity and mortality associated with colpocleisis and factors associated with improved outcomes. We used University HealthSystem Consortium database, which included inpatient data from US hospitals. We included all women who underwent colpocleisis from 2002 to 2012. Centers were categorized geographically and by annual case volume. Cases were grouped by age and provider specialty. Outcome and readmission data from participating hospitals were compared between groups by analysis of variance and Tukey statistics. Average length of stay (LOS), intensive care unit (ICU) admission rate, complication rate, mortality rate, and readmission rate were calculated for each hospital and compared. Colpocleisis procedures (4776) were performed at 145 US medical centers. Forty-three percent of procedures were done on women older than 80 years, 52% on women 60 to 79 years, 3% on women 40 to 59 years, and 0.9% on women 20 to 39 years. Overall, rates of complications, ICU admission, and mortality were low with average rates of 6.82%, 2.80%, and 0.15%, respectively. High-volume centers had lower ICU admission and complications rates as well as a shorter LOS. Younger women had higher ICU admission and complication rates as well longer LOS. Stratification by provider specialty demonstrated higher ICU admission rates among cases performed by urologists as compared to cases performed by urogynecologists and general obstetrician-gynecologists. Complication rates were also higher among obstetrician-gynecologists and urologists as compared to urogynecologists. Length of stay was significantly longer when colpocleisis was performed by urologists rather than a urogynecologists. Colpocleisis is a safe minimally invasive procedure and outcomes are influenced by provider specialty and hospital volume.