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ng to the clinic (16% in McAllen and 15% in Fort Worth vs. 9% in San Antonio, p less then 0.001). Experiencing barriers to clinic access was associated with having considered medication self-management (OR=2.2, 95% CI 1.7-3.0) and with seeking or trying any method of self-management before attending the clinic (OR=1.9, 95% CI 1.3-2.7). Difficulty affording the cost of in-clinic care was the most commonly cited reason for having considering medication self-management before attending the clinic. Reasons for interest in medication self-management as an alternative to clinic care included both access barriers and preferences for the privacy and comfort of home. CONCLUSIONS Considering or attempting self-managed abortion may be part of the pathway to seeking in-clinic care, particularly among those experiencing access barriers. However, considerable interest in medication self-management as an alternative to the clinic also suggests demand for more autonomous abortion care options. Obstetric anal sphincter injuries represent the minority of obstetric lacerations, but can have a significant long-term impact on urinary and fecal continence, as well as pelvic organ support. Accurate diagnosis of lacerations, appropriate repair, and close follow-up are essential to healthy healing and to improve outcomes for women. Ethyl 3-Aminobenzoate research buy The infrequency of these injuries has resulted in a lack of familiarity with laceration repair and postpartum care of this population at all levels of practice. As such, continuing education strategies aimed at simulation, increased clinical exposure to anal sphincter injuries, and evidence-based repair techniques are important for mitigating the deficits in the current obstetric environment. Ensuring that patients have access to timely multidisciplinary postpartum care and education on the laceration incurred is essential to promote healthy healing and optimize pelvic floor outcomes. OBJECTIVES To provide updated and more detailed pooled IUD expulsion rates and expulsion risk estimates among women with postpartum IUD placement by timing of insertion, delivery type, and IUD type to inform current IUD insertion practices in the United States. DATA SOURCES We searched PubMed, Cochrane Library, and ClinicalTrials.gov through June 2019. STUDY ELIGIBILITY CRITERIA We included all studies, of any study design, that examined postpartum placement of Copper T380A (copper) or Levonorgestrel (LNG)-containing IUDs that reported counts of expulsion. STUDY APPRAISAL AND SYNTHESIS METHODS We evaluated IUD expulsion among women receiving postpartum IUDs in the 'immediate' (within 10 minutes), 'early inpatient' (greater than 10 minutes to less than 72 hours), 'early outpatient' (72 hours to less than 4 weeks) and interval (4 weeks or greater) time periods after delivery. We assessed study quality using the U.S. Preventive Services Task Force evidence grading system. We calculated pooled absolute rates of p95% CI, 2.56-10.85, respectively). Among immediate postpartum placements, risk of expulsion was greater for placement after vaginal compared with cesarean deliveries (aRR, 4.57; 95% CI, 3.49-5.99). Among immediate placements at the time of vaginal delivery, LNG-IUDs were associated with a greater risk of expulsion compared with copper IUDs (aRR, 1.90; 95% CI, 1.36-2.65). CONCLUSION While IUD expulsion rates vary by timing of placement, type, and mode of delivery, IUD insertion can take place at any time. Understanding the risk of IUD expulsion at each time period will enable women to make an informed choice about when to initiate an IUD in the postpartum period based on her own goals and preferences. BACKGROUND Differences in receipt of guideline-concordant treatment might underlie well-established racial disparities in endometrial cancer mortality. OBJECTIVE Using the National Cancer Database, we assessed the hypothesis that among women with endometrioid endometrial cancer, racial/ethnic minority women would have lower odds of receiving guideline-concordant treatment than White women. In addition, we hypothesized that lack of guideline-concordant treatment was linked with worse survival. STUDY DESIGN We defined receipt of guideline-concordant treatment using the National Comprehensive Cancer Network guidelines. Multivariable logistic regression models were used to compute odds ratios and 95% confidence intervals for associations between race and guideline-concordant treatment. We used multivariable Cox proportional hazards regression models to estimate hazards ratios and 95% confidence intervals for relationships between guideline-concordant treatment and overall survival in the overall study population overall study population (hazard ratio=1.12, 95% confidence interval=1.08-1.15), but was not significantly associated with overall survival among non-Hispanic Black (hazard ratio=1.09, 95% confidence interval=0.98-1.21), Hispanic (hazard ratio=0.92, 95% confidence interval=0.78-1.09), or Asian/Pacific Islander (hazard ratio=0.90, 95% confidence interval=0.70-1.16) women. CONCLUSIONS Non-Hispanic Black and Hispanic women were less likely than non-Hispanic White women to receive GCT, while Asian/Pacific Islander women more commonly received treatment in line with guidelines. Further, in the overall study population, overall survival was worse among those not receiving guideline-concordant treatment, although low power may have impacted the race-stratified models. Future studies should evaluate reasons underlying disparate endometrial cancer treatment. BACKGROUND Chronic hypertension (CH) complicates around 3% of all pregnancies and is associated with an increased risk for pregnancy complications such as superimposed preeclampsia, fetal growth restriction, preterm delivery, and stillbirth, reaching a rate of complications up to 25-28%. OBJECTIVES We performed an echocardiographic study, to evaluate pre-pregnancy cardiac geometry and function, and the hemodynamic features of treated CH patients searching for a possible correlation with the development of feto-maternal complications and with pre-pregnancy therapy. STUDY DESIGN This was a prospective observational cohort study of 192 consecutive CH treated patients (Calcium Channel Blockers [CCB], ACE-inhibitors/Angiotensin Receptor Blockers [ACEI/ARB], ß-blockers, α1-adrenoceptor antagonists and/or diuretics). Patients were submitted to echocardiography before pregnancy, assessing left ventricular morphology and function, cardiac output (CO) and Total Vascular Resistance (TVR). Pre-pregnancy therapy was noted, patients were shifted to alpha methyldopa right before pregnancy, and followed until delivery noting major early (1498 (sensitivity 87.
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