laparoscopies in the single laparoscopy group vs 91 diagnostic and 23 RESULTS: Chart review yielded 217 cases.
Number of included VH
extirpative laparoscopies in the multiple laparoscopy group. Of the
patients with persistent pain after initial laparoscopy, 56 underwent
hysterectomy with 22 having pain resolution, 5 persistent, 4 improved
and 15 unknown. The average number of subsequent laparoscopies in
the multiple laparoscopy group was 2.27. 38 patients underwent
hysterectomy with 18 having pain resolution, 4 persistent, 6 improved
and 12 unknown. 25 patients were identified as having pathologic
evidence of endometriosis in the single laparoscopy group vs 32 in the
multiple laparoscopy group.
CONCLUSION: This study reviews the outcomes of chronic pelvic
pain in relation to laparoscopic management. It suggests that majority of
patients undergo nonsurgical management prior to initial laparoscopy
and that patients in the multiple laparoscopy group have a greater
likelihood of undergoing subsequent hysterectomy with pain resolution.
Financial Disclosure: David Eisenstein disclosed the following—Abbvie:
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Speaker/Honoraria includes speakers bureau, symposia, and expert witness.
The other authors did not report any potential conflicts of interest.
Cannabis for Treatment of Chronic Pelvic Pain: A
Survey of Prevalence and Effectiveness [21H]
Charity Johns, MD
Peachtree Women’s Clinic, Atlanta, GA
Mark Lachiewicz, MD
INTRODUCTION: Chronic pelvic pain (CPP) is a prevalent but
difficult entity to treat. Cannabis has been shown to significantly improve
pain in several populations. There have been no studies on cannabis use
among women with CPP. We aim to examine the prevalence of cannabis
use in patients with CPP and hypothesize that CPP patients report an
improvement in their pain symptoms with cannabis use.
METHODS: Patients were identified via a medical record query of
commonly used CPT codes for pelvic pain. Patients were contacted via
phone then emailed an anonymous online survey. Setting: Tertiary
care academic medical center.
RESULTS: 114 patients who screened positive for CPP over the
phone were emailed; 89 responded for a response rate of 78.1%. The
prevalence of current use was 16.9% (14/83). Nine of fourteen (64.3%)
current users reported using cannabis for CPP while 8/24 (33.3%) of
previous users reported using cannabis for CPP; all 17 (100%) reported
that it was helpful. The users who reported using cannabis for CPP
reported an average reduction in pain by 5.9 points (P,.0001) and
those who did not report using cannabis for CPP also reported a reduc-
tion in pain by 2.9 points (P5.0012). 71/82 (86.6%) respondents would
consider being in a clinical trial of medical cannabis to treat CPP.
CONCLUSION: This study demonstrates that patients with CPP are
self-treating with cannabis and finding this to be an effective intervention.
Cannabis may serve as a future treatment option for females with CPP if
found to be safe and effective. Clinical trials are needed.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Cervical Elongation Among Patients Undergoing
Vaginal Hysterectomy for Prolapse Versus Other
Benign Indications [22H]
Aldene Olia Elio Zeno, MD
Harbor-UCLA Medical Center, Torrance, CA
Yoko Takashima, MD, Sara Ghayouri, MD, and Tajnoos Yazdany, MD
INTRODUCTION: Surgeons have cited anterior colpotomy as
a barrier to performing vaginal hysterectomy (VH); cervical elongation
(CE) may make this difficult. This study aims to understand CE and its
significance among patients undergoing VH for pelvic organ prolapse
(POP) versus those undergoing VH for other benign indications.
METHODS: VH from 2015-2017 were identified through CPT codes.
Study variables were obtained from operating room and pathology
reports. CE was identified according to four definitions reported in
three different studies. Twenty-three patients per study arm were
estimated to be necessary to detect a statistically significant difference
in CL .33.8mm between VH patients with versus without POP.
90S SATURDAY POSTERS © 2019 by the American College of Obstetricians
and Gynecologists. Published by Wolters Kluwer Health, Inc.
Unauthorized reproduction of this article is prohibited.
cases was 128. There were 51 VH for POP, and 77 VH for other
indications. CE prevalence was higher among patients undergoing VH
for POP based on uterine corpus to cervical length ratio (UC:CL) .
0.79 (25.5% versus 15.6%) and CL . 33.8mm (66.7% versus 51.9%).
Other CE parameters demonstrated no statistically significant differ-
ence between groups. In regression analysis, postmenopausal status
was not associated with CL . 3.38 (OR 0.138, 95% CI 0.02-0.941);
and VH not for POP were more likely to have longer-than-average
operating time (mean5210).
CONCLUSION: CE was more prevalent in patients undergoing VH
for POP compared to those having VH for other indications. CE was
not associated with perioperative outcomes. These results refute
existing literature regarding CE, particularly that CE may not be of
consequence with regards to clinical outcomes during and after VH.
Financial Disclosure: The authors did not report any potential conflicts of
interest.
Chronic Endometritis: A Prevalent Yet Poorly
Understood Entity [23H]
Samantha Lee Margulies
Yale Medicine, Department of Obstetrics, Gynecology &
Reproductive Medicine, New Haven, CT
Valerie Alysse Flores, Vinita Parkash, MBBS, and Lubna Pal, MBBS
INTRODUCTION: Chronic endometritis (CE) remains poorly
understood by both pathologists and obstetrician/gynecologists (OB/
GYNs). The purpose of this study was to: 1) assess uniformity in
histological criteria utilized by pathologists for diagnosing CE, and 2)
evaluate for clarity in OB/GYN provider understanding of the
pathophysiology and patterns in management approaches to CE.
METHODS: In a prospective observational study, members of
national and international professional OB/GYN (including ACOG)
and Pathology societies were surveyed utilizing two anonymous
electronic surveys designed to respectively examine diagnostic criteria,
pathophysiology, clinical implications and treatment.
RESULTS: 262 OB/GYNs and 336 pathologists responded. Inconsisten-
cies in histological criteria utilized by pathologists for diagnosing CE, as well
as lack of clarity in understanding the pathophysiology and management of
CE were apparent. While respondents agreed on an infectious etiology,
consensus on nature of infectious agent for CE was lacking (p , 0.001).
Obvious discrepancies in understanding of clinical presentation and diag-
nostic methodology were apparent, and lack of consensus on treatment was
noted, both in terms of whether to treat or not and on choice and duration
of antimicrobial treatment. Differences in provider understanding of subject
matter by experience and location were examined.
CONCLUSION: Despite its prevalence, there are inconsistencies and
deficiencies in practitioners’ understanding of CE, which likely affects
patient care. We propose consideration for establishment of a task
force to examine the literature on CE to provide a standard of care
for the diagnosis and management of this gynecologic condition.
Financial Disclosure: Lubna Pal disclosed the following—Abbot: Consultant/
Advisory Board, Speaker/Honoraria includes speakers bureau, symposia, and
expert witness; AMAG: Consultant/Advisory Board, Speaker/Honoraria in-
cludes speakers bureau, symposia, and expert witness; GLG: Consultant/Advi-
sory Board, Speaker/Honoraria includes speakers bureau, symposia, and expert
witness; Natera: Consultant/Advisory Board. The other authors did not report
any potential conflicts of interest.
OBSTETRICS
Does Adjunctive Azithromycin Cesarean Bundle
Decrease the Risk of Maternal and Neonatal
Outcomes? [24H]
Christina Johnson, MD
Stony Brook University Hospital, Stony Brook, NY
Camilla Dagum, BS, Malini D. Persad, MD, MPH,
Kimberly M. Herrera, MD, Ayisha Buckley, MD, and Diana J. Garretto, MD
INTRODUCTION: The goal of preoperative antibiotics is to
decrease and prevent postpartum infections. Recent evidence indicates
OBSTETRICS & GYNECOLOGY