Browsing by Author "Moshesh, Malana"

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    Factors associated with low-lying intrauterine devices: a cross-sectional ultrasound study in a cohort of African-American women.
    (Contraception, 2018-07) Moshesh, Malana; Saldana, Tina; Deans, Elizabeth; Cooper, Tracy; Baird, Donna

    Objective

    The object of this study is to examine factors and symptoms associated with low-lying IUDs as defined by ultrasound.

    Study design

    This is a cross-sectional sub-study of participants in the Study of Environment, Life-style, and Fibroids (SELF). SELF participants had screening ultrasounds for fibroids at study enrollment; those with an IUD in place are included in this sub-study. Low-lying IUDs were identified and localized. Logistic regression was used to identify factors and symptoms associated with low-lying IUDs.

    Results

    Among 168 women with IUDs at ultrasound, 28 (17%) had a low-lying IUD. Having a low-lying IUD was associated with low education level (≤high school: aOR 3.1 95% CI 1.14-8.55) and with increased BMI (p=.002). Women with a low-lying IUD were more likely to report a "big problem" with dysmenorrhea (the highest option of the Likert scale) as compared to women with a normally-positioned IUD (OR 3.2 95% CI 1.07-9.54).

    Conclusion

    Our study found that women with a low-lying IUD are more likely to be of lower education and higher BMI, and to report more dysmenorrhea.

    Implications

    Women who are obese may benefit from additional counseling and closer follow-up after IUD placement. Future research is warranted to investigate IUD placement and possible IUD migration among women who are obese.
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    Intraobserver variability in fibroid size measurements: estimated effects on assessing fibroid growth.
    (Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2014-07) Moshesh, Malana; Peddada, Shyamal D; Cooper, Tracy; Baird, Donna
    To evaluate intraobserver variability of fibroid sonographic measurements and apply this factor to fibroid growth assessment.Study participants were African American women aged 23 to 34 years who had never had a diagnosis of uterine fibroids. All participants underwent transvaginal sonography to screen for the presence of previously undiagnosed fibroids (≥0.5 cm in diameter). The diameters of up to 6 fibroids were measured in 3 perpendicular planes at 3 separate times during the examinations by experienced sonographers. Intraobserver variability as measured by the coefficient of variation (CV) for fibroid diameter and volume was calculated for each fibroid, and factors associated with the CV were assessed by regression models. The impact of variability on growth assessment was determined.Ninety-six of 300 women screened were found to have at least 1 fibroid, yielding a total of 174 fibroids for this analysis. The mean CV for the 3 measurements of fibroid maximum diameter was 5.9%. The mean CV for fibroid volume was 12.7%. Fibroid size contributed significantly to intraobserver variability (P = .04), with greater variability for smaller fibroids. Fibroid type (submucosal, intramural, or subserosal) was not important. Fibroids from the same woman tended to have similar measurement variability when assessed for volume but not for maximum diameter. Calculations showed that when following up fibroids, as much as a 20% increase in diameter could be due to measurement error, not "true growth."A small fibroid must have a greater change in size than a large fibroid to conclude that it is growing, but even for small fibroids an increase in diameter of greater than 20% is likely to indicate true growth, not measurement variability.