Skip Navigation LinksHome > Blogs > blO+G
blO+G
Current events in Obstetrics & Gynecology, updates on new web site features and links to other web sites of interest to ObGyns.
Saturday, November 15, 2014

Gyamfi-Bannerman and Ananth. Trends in spontaneous and indicated preterm delivery among singleton gestations in the United States, 2005-2012

Why should you read about this topic?

The preterm delivery rate in the US is too high.  The more we know about its trends the better we will be able to direct research to reduce the rate.

What were the authors trying to do?

To determine whether the recent decline in preterm delivery rate was due to a decrease in spontaneous or indicated preterm delivery across all races and ethnicities.

Who participated and in what setting?

Women with singleton deliveries (N=19,984,436) in the US between 2005 and 2012

What was the study design?

Population-based cross-sectional retrospective analysis of the2003 revision birth certificate data

What were the main outcome measures?

Preterm delivery (24-36 weeks) rates—overall, spontaneous, and indicated

What were the results?

Both spontaneous preterm delivery and indicated preterm delivery rates declined (spontaneous—15.4%; indicated—12.9%) similarly across all race/ethnicity groups.  The largest relative decline occurred in the early preterm delivery rate (24-31 weeks).

What is the most interesting image in the paper?

Figure 3

What were the study strengths and weaknesses?

Strengths: population-based; huge sample size. Weaknesses: birth certificate data; significant potential for misclassification of indicated/spontaneous preterm delivery.

What does the study contribute for your practice?

Progress in reducing preterm delivery is being made across all fronts, probably due to a collection of factors including protocols for elective delivery and progesterone therapy.


Saturday, November 08, 2014

Nyirjesy. Management of persistent vaginitis

Why should you read about this topic?

No matter what your patient population is—young, old, pregnant—you’re going to be faced with persistent vaginitis at one point or another

What were the authors trying to do?

Provide a framework for evaluating and treating persistent vaginitis.

What was the study design?

Expert review

What were the results?

Key diagnostic tests are pH, amine test, saline/10% KOH microscopy, and yeast culture with speciation.

What is the most interesting image in the paper?

Table 1

What does the study contribute for your practice?

Systematic evaluation and testing are critical to effective treatment of persistent vaginitis


Saturday, November 01, 2014

Brumbaugh et al. Neonatal survival after prolonged preterm rupture of membranes before 24 weeks of gestation.

Why should you read about this topic?

Counseling a woman with PROM prior to 24 weeks requires some estimate of probability of survival

What were the authors trying to do?

Update estimates of survival after prolonged PROM before 24 weeks

Who participated and in what setting?

Infants (N=58) born following prolonged (>1 week) PROM before 24 weeks were matched 2:1 with infants whose membranes ruptured <24 hours prior to delivery at the University of Iowa between 2002 and 2011.

What was the study design?

Retrospective cohort chart review with case-control analysis of the secondary outcomes

What were the main outcome measures?

Survival to discharge

What were the results?

90% survival of infants with prolonged PROM before 24 weeks.  Prolonged ROM was associated with a higher rate of pulmonary hypoplasia, pulmonary hypertension, and pulmonary air leak.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: respectable number of neonates in the sample; contemporary matching for gestational age at birth.  Weaknesses: underpowered for predictors of survival; single center study limits generalizability

What does the study contribute for your practice?

If you can keep the pregnancy going  1 week after ROM prior to 24 weeks, 90% survival rates can be achieved with antenatal corticosteroids, surfactant, and inhaled nitric oxide


Saturday, October 25, 2014

Wishall et al. Postablation risk factors for pain and subsequent hysterectomy

Why should you read about this topic?

Do you have any patients with heavy menstrual bleeding and a history of dysmenorrhea, cesarean delivery, or tubal ligation?  If so, you need to read this.

What were the authors trying to do?

Identify factors associated with pain and hysterectomy following endometrial ablation

Who participated and in what setting?

Women (N=270) over 18 years of age who had endometrial ablation (mostly thermal balloon and bipolar radiofrequency) between 2006 and 2013 at Drexel University and the University of Pennsylvania

What was the study design?

Retrospective cohort (chart review)

What were the main outcome measures?

New or worsening pain lasting at least 2 months following the postop visit.  Secondary outcome was hysterectomy.

What were the results?

23% of women developed new or worsening pain and 19% had a hysterectomy.  Factors associated with increased odds of pain were a history of dysmenorrhea, prior tubal ligation, and non-white race.  Women were more likely to have a hysterectomy if they had a cesarean delivery or uterine abnormalities on imaging.  They were less likely to have a hysterectomy if the ablation was done in the operating room rather than the office.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: large sample size. Weaknesses: retrospective chart review; more than 25% of eligible patients not evaluated due to missing information or loss to follow-up

What does the study contribute for your practice?

In treatment of heavy menstrual bleeding, endometrial ablation is an alternative but not always a replacement for hysterectomy


Saturday, October 18, 2014

Cantu et al. Predicting fetal acidemia using umbilical venous cord gas parameters

Why should you read about this topic?

Cord blood gas when you really need it—sometimes all you have is a venous sample.  This article can help with interpretation

What were the authors trying to do?

Assess the value of venous cord blood gases for predicting arterial cord blood gases and fetal acidemia

Who participated and in what setting?

All singleton newborns (N=11,455) with paired arterial and venous cord blood gas samples born at UAB between 2006 and 2012

What was the study design?

Retrospective cohort study

What were the main outcome measures?

Fetal acidemia defined as arterial cord pH<7.0 or arterial cord base deficit>12 mmol/L

What were the results?

Venous cord blood pH and base deficit were highly predictive of acidemia.  Cutoffs for a 5% probability of acidemia were a venous cord blood pH of 7.17 and a venous cord base deficit of 8.2 mmol/L.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: large number of arterial-venous pairs; stringent criteria for validating sampling. Weaknesses: large proportion of missing data; thresholds not validated in an independent sample

What does the study contribute for your practice?

When you don’t have an arterial cord blood gas, a venous sample is the next best thing for estimating fetal acidemia

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.