A 42 year-old woman presents in the outpatient obstetrics and gynecology clinic with severe, uncontrolled pelvic pain, painful bowel movements, and constipation. The patient has a history of stage IV endometriosis and had conceived via in-vitro fertilization (IVF). The patient now desires definitive therapy; she has completed childbearing and she had unsuccessful medical management of her symptoms with oral contraceptives and a progestin IUD. Recent ultrasound revealed a large endometrioma in the right ovary. Colonoscopy results indicated deep endometriosis of the sigmoid colon.
Stephanie Estes, M.D., of Penn State Hershey Obstetrics and Gynecology says, “In complex cases like this, a minimally invasive surgical procedure using robotic technology in a single operation offers the best odds for success, both procedurally and with a good recovery. A gynecologic surgeon would begin with a hysterectomy, and then a colorectal surgeon would resect the affected portion of sigmoid colon en bloc, to complete the procedure.” Estes continues, “With the robotic surgical tools we use, there is definitely better dexterity and enhanced 3D visualization of tissue and organs, compared to an open abdominal approach. This minimally invasive approach is really key for complex cases with widespread pathology, to avoid injury to delicate surrounding tissues.” Continue reading
Most pregnant women receive one-on-one prenatal care from their OB provider, but a group-care model has shown increasing promise and is becoming more widely available. Danielle Hazard, M.D., of Penn State Hershey Obstetrics and Gynecology, explains: “We offer a group prenatal care program called Centering Pregnancy. This model integrates three important components of care: health assessment, education, and support. During the group sessions, ten to twelve pregnant patients, all due around the same time, participate in a facilitated discussion focused on health-promoting behaviors, complete their standard physical health assessments, and develop a support network with other group members. The group discussions provide a dynamic environment for learning and sharing that is impossible to create in a one-on-one encounter.”
The group-centered care approach, developed by midwife and nurse, Sharon Schindler Rising in the 1990s, is currently supported by the nonprofit Centering Healthcare Institute (CHI), which trains physicians to implement standardized group-based prenatal care programs throughout the United States (centeringhealthcare.org).
Initiated at Penn State Hershey in 2009, the Centering Pregnancy program gained CHI site approval in 2011, and is among only six sites in Pennsylvania. Continue reading
If you’ve ever sat through a journal club meeting where the article headlines were just re-hashed, you’re not alone. Over time, journal clubs tend to get stale. Pitfalls, like choosing from a limited range of topics, and having only two or three people who are consistently willing to rotate leading discussions, are common.
Yet the need for clinicians to stay abreast of research, technical advancements, and controversial professional issues is a constant which can’t be fulfilled by attending annual meetings.
William C. Dodson, M.D., of Penn State Hershey Obstetrics and Gynecology, has taken on the challenge of making journal clubs a key part of ongoing, meaningful medical education worldwide. In 2009, as part of Dodson’s longtime leadership role with Obstetrics and Gynecology (i.e. the Green Journal), he and Cathy Spong, M.D., from the National Institutes of Health (NIH), began to create a monthly journal club feature aimed at enhancing the journal club experience (journals.lww.com/greenjournal). “Each month, for two articles from the current issue, we develop facilitator questions intended to lead club members to critically weigh the most salient points of each manuscript. It’s like providing a study guide for club facilitators, so even if they aren’t experts on a given topic or technique, they can lead discussion.” Continue reading
John T. Repke, M.D., F.A.C.O.G.
Greetings from Penn State Hershey! I am pleased to share with you the first issue of the OB/GYN Medical Report from the Department of Obstetrics and Gynecology of the Penn State College of Medicine and Penn State Milton S. Hershey Medical Center.
We recognize the importance of collaboration among our peer physicians, and regularly work with other academic medical schools to propel our field forward through new research discoveries, better patient care, and educating new physicians. Our hope is that this publication helps inform physicians like yourself of some of this important work, and that you find it to be a valuable resource.
In the coming year, this publication will feature Penn State Hershey clinicians and researchers who are helping to raise current standards of patient care and shape the future of OB/GYN practice. Our department features five divisions – General OB/GYN, Maternal-Fetal Medicine (MFM), Reproductive Endocrinology and Infertility (REI), Gynecologic Oncology, and Urogynecology/ Minimally Invasive Gynecologic Surgery. Continue reading