Ob/Gyn News
The use of laparoscopic surgery in pregnancy
Laparoscopic surgery in pregnant women has become increasingly more common since the 1990s; however, the safety of laparoscopy in this population has been widely debated, particularly in emergent and urgent situations. A retrospective chart review of all pregnant women following a nonobstetric abdominal operation at a University hospital between 1993 and 2007. Perioperative morbidity and mortality for the mother and fetus were evaluated. Cholecystectomy and appendectomy were performed in both groups with salpingectomy/ovarian cystectomy only in the laparoscopic group. No maternal deaths occurred, while fetal loss occurred in 3 cases within 7 days of the operation and in 1 case 7 weeks postoperatively. This and other perinatal complications occurred in 36.7% of the laparoscopic group and 41.7% of the open group. Overall, Laparoscopic appendectomy and cholecystectomy appear to be as safe as the respective open procedures in pregnant patients; however, this population in particular remains at risk for perinatal complications regardless of the method of abdominal access.
IUD Reduces Heavy Menstrual Flow
This article compared the efficacy and safety of the levonorgestrel-releasing intrauterine system and oral medroxyprogesterone acetate in the treatment of idiopathic heavy menstrual bleeding. At the end of the study, the absolute reduction in median menstrual blood loss was significantly greater in the levonorgestrel-releasing intrauterine system group (−128.8 mL, range −393.6 to +1242.2 mL) than in the medroxyprogesterone acetate arm (−17.8 mL, range −271.5 to +78.6 mL, P < .001), and the proportion of women with successful treatment was significantly higher for the levonorgestrel-releasing intrauterine system (84.8%) than for medroxyprogesterone acetate (22.2%, P < .001). This study showed that in women with idiopathic heavy menstrual bleeding, the levonorgestrel-releasing intrauterine system reduces menstrual blood loss more effectively and has a higher likelihood of treatment success than oral medroxyprogesterone acetate.
Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids
This study compared the clinical outcomes and health related quality of life (HRQOL) 5 years after uterine artery embolization (UAE) or hysterectomy in the treatment of menorrhagia caused by uterine fibroids. Patients were assigned randomly to UAE (n = 88) or hysterectomy (n = 89). Five years after treatment 23 of 81 UAE patients (28.4%) had undergone a hysterectomy because of insufficient improvement of complaints (24.7% after successful UAE). HRQOL measures improved significantly and remained stable until the 5-year follow-up evaluation, with no differences between the groups. UAE had a positive effect both on urinary and defecation function. UAE is a well-established alternative to hysterectomy about which patients should be counseled.
IUD works for emergency birth control: study
A copper intrauterine device was 100 percent effective at emergency contraception in a study of almost 2000 Chinese women who had the device implanted up to 5 days after unprotected sex.
Gestational sac volume in missed abortion and anembryonic pregnancy compared to normal pregnancy
This article compared gestational sac (GS) volume (GSV) between normal pregnancies and missed abortions and anembryonic pregnancies and to determine at what gestational age differences in GS volume become evident.
GSV was significantly larger in normal pregnancies than in missed or anembryonic abortion: 27.51 ± 25.25 cm3 and 8.04 ± 10.54 cm3, respectively (p < 0.001). When stratified by weeks, statistically significant differences were found beginning at 7 weeks, while GSV measurements were not significantly different between the normal and abnormal pregnancies from 6 to 6+6 weeks.
Critical analysis of risk factors and outcome of placenta previa
This article investigated risk factors and pregnancy outcome of patients with placenta previa. Placenta previa was significantly associated with adverse outcomes such as peripartum hysterectomy (5.3 vs. 0.04%; P < 0.001), previous episode of second trimester bleeding (3.9 vs. 0.05%; P < 0.001), blood transfusion (21.9 vs. 1.2%; P < 0.001), maternal sepsis (0.4 vs. 0.02%; P < 0.001), vasa previa (0.5 vs. 0.1%; P < 0.001), malpresentation (19.8 vs. 5.4%; P < 0.001), postpartum hemorrhage (1.4 vs. 0.5%; P = 0.001) and placenta accreta (3.0 vs. 1.3%; P < 0.001). Placenta previa was significantly associated with adverse perinatal outcomes such as higher rates of perinatal mortality (6.6 vs. 1.3%; P < 0.001), an Apgar score <7 after 1 and 5 min (25.3 vs. 5.9%; P < 0.001, and 7.1 vs. 2.6%, P < 0.001, respectively), congenital malformations (11.5 vs. 5.1%; P < 0.001) and intrauterine growth restriction. Infertility treatments, prior cesarean section, and advanced maternal age are independent risk factors for placenta previa. An increase in the incidence of these risk factors probably contributes to a rise in the number of pregnancies complicated with placenta previa and its association with adverse maternal and perinatal outcomes. Careful surveillance of these risk factors is recommended with timely delivery in order to reduce the associated complications.
Postoperative Outcomes Associated with Topical Skin Adhesives among Women Having Hysterectomies
Multiple options are available for closure of hysterectomy incisions. This study compared postoperative clinical and economic outcomes using topical skin adhesive (2-octyl cyanoacrylate; OCA) vs. conventional skin closure in women undergoing total abdominal hysterectomy. It was found that 2-octyl cyanoacrylate appears to be a safe and cost-effective alternative to topical sutures for patients having total abdominal hysterectomy. There were less favorable outcomes in groups receiving staples.
Ultrasound cervical length measurement for prediction of delivery before 32 weeks in women with emergency cerclage for cervical insufficiency
This article assessed the accuracy of ultrasound cervical length for predicting delivery before 32 weeks among women with a threatened second trimester fetal loss treated by emergency cervical cerclage, and to compare it with prediction based on clinically-assessed cervical dilation.
It found that
ultrasound cervical length measurement does not predict early preterm birth better than clinically-assessed cervical dilation in women with an emergency cerclage.
No Pap smears for women under 21: guidelines
Pap smears in women under 21 do more harm than good, new guidelines from the American College of Obstetricians and Gynecologists (ACOG) say.In most cases such tests reveal only human papillomavirus (HPV) infections, which rarely lead to cervical cancer in women under 21, said Dr. Mark Einstein of the Albert Einstein College of Medicine (no relation) in the Bronx, New York.
Comparison of local metronidazole and a local antiseptic in the treatment of bacterial vaginosis
Bacterial vaginosis (BV) is characterized by a mixed flora of pathogenic anaerobic bacteria and associated with risks of pathologic conditions. In the present study, therapy with a local antiseptic spray (octenidine hydrochloride/phenoxyethanol, OHP) for 7 or 14 days is compared against the standard local therapy of BV (metronidazole) in a Serbian patient population.Overall it found that Octenidine hydrochloride/phenoxyethanol spray was as effective as the standard therapy with metronidazole. Patients stated that OHP was more comfortable, easier to apply, and side effects were lesser.
Valproic Acid Monotherapy in Pregnancy and Major Congenital Malformations
The use of valproic acid in the first trimester of pregnancy is associated with an increased risk of spina bifida, but data on the risks of other congenital malformations are limited. This study out of NEJM combined data from eight published cohort studies (1565 pregnancies in which the women were exposed to valproic acid, among which 118 major malformations were observed) and identified 14 malformations that were significantly more common among the offspring of women who had received valproic acid during the first trimester. We then assessed the associations between use of valproic acid during the first trimester and these 14 malformations by performing a case–control study with the use of the European Surveillance of Congenital Anomalies (EUROCAT) antiepileptic-study database, which is derived from population-based congenital-anomaly registries. As compared with no use of an antiepileptic drug during the first trimester (control group 1), use of valproic acid monotherapy was associated with significantly increased risks for 6 of the 14 malformations under consideration.
A decrease in maternal plasma concentrations of sVEGFR-2 precedes the clinical diagnosis of preeclampsia
An article in this months American Journal of Obstetrics and Gynecology sought to examine if maternal plasma concentrations of soluble vascular endothelial growth factor receptor (sVEGFR)-2 change prior to the diagnosis of preeclampsia. Through a longitudinal study of normal pregnant women (n = 160) and patients with preeclampsia (n = 40) this study found that mothers destined to develop preeclampsia have lower plasma sVEGFR-2 concentrations than those who will have a normal pregnancy.
Comparison of adnexal torsion between pregnant and nonpregnant women
An article in this months American Journal of Obstetrics and Gynecology sought to compare clinical manifestations, treatment, and pregnancy outcome of adnexal torsion in pregnant and nonpregnant women through a retrospective case-control study in the Departments of Gynecology at 2 tertiary centers between 1999-2008. Forty-one pregnant and 77 nonpregnant women with surgically proved adnexal torsion were assessed. Recurrence rate of torsion was 19.5% in pregnant women and 9.1% in control subjects; 73% of pregnant women conceived through assisted reproductive technologies. Doppler blood flow was falsely normal in 61% of pregnant women and in 45% of nonpregnant women. This study shows that presentation of adnexal torsion is similar in pregnant and nonpregnant women. Past assisted reproductive technology is an important risk factor in pregnancy. Doppler blood flow has a high false-negative rate and should not outweigh clinical suspicion. Although pregnancy outcome is favorable, the high rate of recurrence raises the issue of surgical fixation at the first episode.
Waiting to Clamp the Umbilical Cord May Be Better for Babies
Pregnant women may want to consider asking their doctors to hold off on clamping the umbilical cord for a few minutes after the baby is born, a new study suggests. Clamping the cord in the seconds after birth cuts off the blood flow from mom to baby. While not necessarily harmful, the common practice in delivery rooms potentially robs newborns of those last precious minutes of cord blood, the researchers said, and cord blood contains stem cells that have regenerative properties and can grow into different types of cells. Research suggests there may be some benefits to getting that extra blood from mom right after birth, said senior study author Dr. Paul Sanberg, director of the University of South Florida's Center of Excellence for Aging and Brain Repair.
Irregular menstrual periods tied to heart disease
Women with a history of irregular menstrual periods may have a higher risk of developing heart disease than do other women, a new study suggests.The study, which followed more than 23,000 Dutch women for a decade, found that those who said they'd typically had irregular periods in the past were 28 percent more likely than women who reported regular monthly periods to develop heart disease.
Rectally administered misoprostol versus intravenous oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss
A study out of the International Journal of Gynecology compared the efficacy of rectally administered misoprostol with intravenous oxytocin infusion in preventing uterine atony and blood loss during cesarean delivery. A total of 96 and 94 women were analyzed in the misoprostol and oxytocin groups, respectively. Intraoperative and postoperative blood loss was significantly lower in the misoprostol group than in the oxytocin group. Rectal misoprostol appears to be an effective alternative to intravenous oxytocin in preventing blood loss for routine use during cesarean delivery.
Osteopathic care may ease late-pregnancy back pain
NEW YORK (Reuters Health) - Gentle manipulation from an osteopathic doctor may relieve late-pregnancy back pain that frequently hinders bending, lifting, or walking, findings from a small study hint. The study, in the American Journal of Obstetrics and Gynecology, included 144 otherwise healthy pregnant women, about 24 years old on average, with moderate levels of back pain and related movement difficulties during late pregnancy.
African-American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy
A study out of the Journal of the American College of Cardiology assessed whether African-American women are at increased risk of having peripartum cardiomyopathy. Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions. A case-control study was performed and showed African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non–African Americans. Other significant univariate risk factors were hypertension and having had >2 previous pregnancies. African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable and stratified analyses. Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women.
Cervical length predicts spontaneous preterm birth in asymptomatic twin pregnancies
A study out of the American College of Obestrics and Gynecology sought to evaluate the change in cervical length (CL) as a predictor of preterm birth in asymptomatic twin pregnancies.121 twin pregnancies were evaluated with CL testing between 18-24 weeks who had a follow-up CL 2-6 weeks after the initial CL.A total of 19 patients had their CL decrease by ≥20% (shortened CL group) and 102 patients' CL decreased by less, or not at all (stable CL group). The shortened CL group had a significantly higher rate of spontaneous preterm birth <28 weeks, <30 weeks, <32 weeks, and <34 weeks.In twin pregnancies, a CL that decreases by 20% over 2 measurements is a significant predictor of very preterm birth, even in the setting of a normal CL. Serial CL measurements should be considered in twin pregnancies, starting <24 weeks.
Teen pregnancy, abortion rates rise
The teen pregnancy rate in the USA rose 3% in 2006, the first increase in more than a decade, according to data out today. The data also show higher rates of births and abortions among girls 15-19. The numbers, calculated by the Guttmacher Institute, a non-profit group that studies reproductive and sexual health, show a clear reversal from the downward trend that began in the 1990s.
