Health care bills within medical genetic makeup: an event regarding decentralization in the southern part of Brazil.

Objective The goal of this study was to evaluate differences in levator ani hematoma formation within 3 days of delivery between adult women after their first vaginal delivery and adult women who have had multiple vaginal deliveries. Methods This was a cross-sectional study at a single institution from 2013 to 2015 using a high-resolution endovaginal ultrasound transducer to identify postvaginal delivery hematoma formation. Logistic regression was used to examine the association between hematoma formation and vaginal parity while considering potential confounders including induction, vaginal operative delivery, vaginal birth after cesarean, fetal weight, fetal head circumference, race and ethnicity, body mass index, age at delivery, gestational age, and length of second-stage labor. Results Ninety women (46 vaginal-primiparous; 44 vaginal-multiparous) were included in this study. After adjusting for oxytocin use, length of second-stage labor, and body mass index, the odds of pelvic floor hematoma of 1000 mm or greater were 2.93 (95% confidence interval, 0.78-10.91) times greater in women after their first vaginal delivery compared with women with a history of multiple vaginal deliveries. The adjusted odds of pelvic floor hematoma of 1500 mm or greater were 6.02 (95% confidence interval, 1.09-33.24) times greater in vaginal-primiparous compared with vaginal-multiparous women. Conclusions Although the prevalence of pelvic floor hematoma was higher in vaginal-primiparous women than vaginal-multiparous women after vaginal delivery, hematomas were present in both groups. Future prospective studies are needed to evaluate the additive effect of multiple vaginal deliveries on the pelvic floor.Objective To evaluate differences in standardized scores and surgical confidence in the completion of a standardized total laparoscopic hysterectomy and bilateral salpingo-oophorectomy (TLH-BSO) among obstetrician-gynecologists (ob-gyns) with different levels of training, and to assess a TLH-BSO model for validity. Methods We conducted a prospective cohort study of 68 participants within four categories of ob-gyns 1) graduating or recently graduated residents (n=18), 2) minimally invasive gynecologic surgery graduating or recently graduated fellows (n=16), 3) specialists in general obstetrics and gynecology (n=15), and 4) fellowship-trained minimally invasive gynecologic surgery subspecialists (n=19) who completed a TLH-BSO simulation. Participants completed presimulation questionnaires assessing laparoscopic confidence. Participants performed a video-recorded TLH-BSO and contained specimen removal on a standardized 250-g biological model in a simulated operating room and completed a postsimulation questionnants were slowest in almost all categories. Conclusion When performing a TLH-BSO of a standardized 250-g uterus on a simulation model, fellowship-trained minimally invasive gynecologic surgery subspecialists achieved higher OSATS in all areas and completed all components faster. Similar performances were noted between residents, fellows, and specialists in obstetrics and gynecology in practice an average of 19.7 years. Funding source Support from Applied Medical, Medtronic, CooperSurgical, and Karl Storz in the form of in-kind equipment was obtained through unrestricted educational grants.Objective To compare hospitalization costs of pregnancies managed by elective induction of labor to those with spontaneous labor in a large cohort of pregnant women. Methods We conducted a retrospective cohort study of women with singleton, nonanomalous births in California from 2007 to 2011. We excluded women with placenta previa, breech presentation, prior cesarean delivery, planned cesarean delivery, medically indicated induction of labor, gestational age less than 37 weeks or at or greater than 41 weeks, and stillbirths. We adjusted hospital charges using a cost-to-charge ratio and costs included hospitalization costs for admission for delivery only. We estimated the difference in costs between elective induction of labor (resulting in a vaginal or cesarean delivery) and spontaneous labor for both women and neonates, stratified by mode of delivery, parity, gestational age at delivery and geographic location. We conducted analyses using Kruskal-Wallis equality-of-populations rank tests with a significance affecting or even improving outcomes could help curb costs associated with induction of labor.Objective To evaluate whether women living in areas deemed food deserts had higher rates of pregnancy morbidity, specifically preeclampsia, gestational hypertension, gestational diabetes, prelabor rupture of membranes, preterm labor, than women who did not live in food deserts at the time of their pregnancy and delivery. Methods This was a retrospective observational study in which we reviewed electronic medical records of all patients who delivered at Loyola University Medical Center in Maywood, Illinois in 2014. The Economic Research Service of the U.S. Department of Agriculture publishes the Food Access Research Atlas, which presents a spatial overview of food access indicators for low-income and other Census tracts using different measures of supermarket accessibility. A spatial join between the Food Access Research Atlas and patient coordinates was performed to identify patient point locations and determine whether each patient was located within or outside of a food desert. Results Data for 1,003 deliveries at Loyola University Medical Center in 2014 were provided by the Loyola University Chicago Clinical Research Database. Two deliveries were excluded owing to inability to map address coordinates; thus 1,001 deliveries were analyzed. Of the 1,001 patients, 195 (19.5%) women were designated to food deserts. GSK3787 Multivariable analysis was done by adjusting for age, race, and medical insurance class. Having at least one morbid condition was the only variable that demonstrated a significant association with the food desert in multivariable analyses (47.2% vs 35.6%) (odds ratio [OR] 1.62, 95% CI 1.18-2.22) (adjusted OR 1.64, 95% CI 1.18-2.29). Conclusion The odds of having at least one of the studied morbid conditions in pregnancy were greater for patients living in a food desert. As there is an association of morbidity in pregnancy with living in a food desert, intervention trials to improve the built food environment or mitigate the effect otherwise are needed.GSK3787