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Current events in Obstetrics & Gynecology, updates on new web site features and links to other web sites of interest to ObGyns.
Saturday, April 19, 2014

Grimsby et al. Autologous buccal mucosa graft augmentation for foreshortened vagina

Why should you read about this topic?

Vaginal stenosis and foreshortening and congenital vaginal agenesis are some of the most difficult surgical problems we face.  Innovations in plastic and reconstructive vaginal surgery are welcome

What were the authors trying to do?

Describe a new application of buccal mucosa graft: treatment of foreshortened vagina

Who participated and in what setting?

60 year old woman with vaginal foreshortening 15 years after radical hysterectomy and radiation for endometrial cancer

What was the study design?

Case report

What were the main outcome measures?

Pain-free sexual intercourse

What were the results?

Success

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: innovative technique that leaves no donor site scars and uses a hairless graft. Weaknesses: limited surface area of donor site; limited follow-up

What does the study contribute for your practice?

Another option for vaginal reconstruction.


Saturday, April 12, 2014

Edwards, et al.  Carboxymethylcellulose adhesion barrier placement at primary cesarean delivery and outcomes at repeat cesarean delivery

Why should you read about this topic?

When you’re using a device this expensive you should know what your patient is getting for the money.

What were the authors trying to do?

Assess the benefit of carboxymethylcellulose adhesion barrier placed at primary cesarean delivery by observing important clinical outcomes at repeat cesarean delivery

Who participated and in what setting?

Women (N=517) undergoing primary cesarean delivery (transverse skin and uterine incisions) and first repeat cesarean delivery between 2008 and 2011 at the Banner Health System in Arizona

What was the study design?

Retrospective cohort comparing women who received the adhesion barrier to women who did not

What were the main outcome measures?

Incision to delivery time at repeat cesarean

What were the results?

Times to delivery were not different between groups. Surgical complications were not different between groups but the study was not powered to adequately settle that issue.

What is the most interesting image in the paper?

Table 4

What were the study strengths and weaknesses?

Strengths: large sample size.  Weaknesses:  retrospective chart review; potential confounding by delivery hospital; not powered for surgical complications.

What does the study contribute for your practice?

So far, there is no demonstrated clinically significant benefit to using Seprafilm at cesarean delivery.


Saturday, March 29, 2014

Conner, et al.  Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis

Why should you read about this topic?

Because the question never seems to go away: is LEEP associated with preterm birth?

What were the authors trying to do?

Determine whether LEEP is associated with preterm birth and if so, whether it is attributable to the condition or the treatment

Who participated and in what setting?

Studies (N=19) of pregnant women who had LEEP for dysplasia (N=6,589) compared with no treatment in women (N=1,415,015) with or without dysplasia

What was the study design?

Meta-analysis of observational studies

What were the main outcome measures?

Rates of preterm births

What were the results?

LEEP was associated with an increased rate of preterm birth (RR 1.65) compared with women with no or unknown history of dysplasia.  However, there was no increased rate of preterm birth compared with women with a history of dysplasia but no LEEP.

What is the most interesting image in the paper?

Figure 3

What were the study strengths and weaknesses?

Strengths: clear criteria for study quality assessment (selection bias, outcome independence, and data source quality); two types of unexposed comparison groups (dysplasia, no dysplasia). Weaknesses: unrealistically low rate of preterm birth in the exposed (8.8%) and unexposed (5.1%) groups; some of the included studies were outdated.

What does the study contribute for your practice?

Maybe it’s not the treatment but the condition that conveys the increased risk of preterm birth.  Push the HPV vaccine


Saturday, March 22, 2014

Smith et al. Hysteroscopic morcellation compared with electrical resection of endometrial polyps: a randomized controlled trial

Why should you read about this topic?

Because anytime you can move a procedure from the OR to the office everyone benefits.

What were the authors trying to do?

To compare office hysteroscopic morcellation with electrosurgical resection of endometrial polyps in duration of surgery, pain, and acceptability

Who participated and in what setting?

Women (N=121) with endometrial polyps planning hysteroscopic surgery at two teaching hospitals in the UK between 2012 and 2013

What was the study design?

Multicenter, single-masked randomized controlled trial of hysteroscopic morcellation or electrosurgical resection

What were the main outcome measures?

Time to completion

What were the results?

Median time to completion was about 5½ minutes for morcellation compared with almost twice that duration for electrosurgical resection.  Complete removal was more likely with morcellation and pain scores were lower in comparison with electrosurgical resection.

What is the most interesting image in the paper?

Video

What were the study strengths and weaknesses?

Strengths: randomized controlled trial; thoughtful stratification for polyp location. Weaknesses: no estimate of percent eligibility within the pool of women needing surgical treatment of endometrial polyps; no comparative cost analysis

What does the study contribute for your practice?

Office hysteroscopic morcellation is quicker and less painful than electrical resection of endometrial polyps


Saturday, March 15, 2014

Kim et al. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births

Why should you read about this topic?

Parsing the contributions of maternal factors related to LGA opens the doors to informative research into interventions

What were the authors trying to do?

Estimate the proportion of LGA (>90%ile) babies associated with maternal prepregnancy BMI>25, gestational weight gain (IOM, 2009), and GDM

Who participated and in what setting?

Live, singleton deliveries (N=660,038) at 37-41 weeks in FL between 2004 and 2008

What was the study design?

Retrospective, population-based analysis of birth certificates linked with Florida’s Hospital Inpatient Discharge Database

What were the main outcome measures?

LGA

What were the results?

LGA prevalence increased with increasing BMI, excessive weight gain, and GDM for all racial or ethnic groups.  Excessive weight gain contributed the highest population attributable proportion across all racial or ethnic groups, ranging from 33.3% to 37.7%

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: population-based; systematic adjustment for confounding. Weaknesses: birth certificate and administrative databases

What does the study contribute for your practice?

Excessive weight gain during pregnancy relates to a higher proportion of LGA babies than GDM or prepregnancy overweight and obesity

About the Author

William C. Dodson, MD
William C. Dodson, MD, is Professor of Obstetrics and Gynecology and Director of the Division of Reproductive Endocrinology and Infertility at Penn State College of Medicine. He completed his fellowship in reproductive endocrinology at Duke University. His research and clinical areas of focus include treatment of infertility, especially ovulation induction. He was previously on the Editorial Board of Obstetrics & Gynecology and has served as the Consultant Web Editor for Obstetrics & Gynecology since 2008.