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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, August 29, 2015

Ducarme et al. Maternal and neonatal morbidity after attempted operative vaginal delivery according to fetal head station

Why should you read about this topic?

To get updated data on morbidity with contemporary operative vaginal delivery

What were the authors trying to do?

Compare rates of severe short-term maternal and neonatal morbidity between midpelvic and low pelvic operative vaginal delivery attempts

Who participated and in what setting?

Women (N=2138) with live singleton term fetuses in vertex presentation undergoing attempted operative vaginal delivery at a tertiary care university hospital between 2008 and 2013

What was the study design?

Prospective observational cohort

What were the main outcome measures?

Composite severe maternal and severe neonatal morbidity

What were the results?

There was no significant difference in severe maternal (8.3% overall) or neonatal (11.1%) morbidity between attempted midpelvic and low pelvic operative vaginal delivery.  Use of forceps was associated with severe maternal morbidity compared with vacuum (aOR 3.55).  Propensity score matching confirmed the multivariate analysis.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths:  propensity score matching; prospective study. Weaknesses: single center data

What does the study contribute for your practice?

Compared with attempted low forceps delivery, midpelvic operative vaginal delivery is not associated with greater risk for maternal or neonatal severe short-term morbidity


Saturday, August 22, 2015

Ashwal et al. Characteristics and management of ovarian torsion in premenarchal compared with postmenarchal patients

Why should you read about this topic?

When you’re covering the emergency room ovarian torsion shows up—a lot—on the differential diagnosis list

What were the authors trying to do?

Compare characteristics of premenarchal with postmenarchal patients having surgically proven ovarian torsion

Who participated and in what setting?

Females (premenarchal [N=41] and postmenarchal [N=208]) with surgically verified ovarian torsion at the Rabin Medical Center in Israel between 1997 and 2013

What was the study design?

Retrospective cohort

What were the main outcome measures?

Surgically verified torsion

What were the results?

Premenarchal girls had a longer duration of symptoms prior to presentation (24h v. 8h) and longer interval from hospital admission to surgery (9.5h v. 4.6h) compared with postmenarchal women.  During surgery, a black-bluish ovary was more commonly seen in premenarchal girls.

What is the most interesting image in the paper?

Video

What were the study strengths and weaknesses?

Strengths: large cohort, including premenarchal patients. Weaknesses: retrospective chart review; unstated criteria for torsion

What does the study contribute for your practice?

Ovarian torsion in premenarchal girls has a longer duration of symptoms and increased rate of fever and pelvic mass at presentation compared with postmenarchal women.


Saturday, August 15, 2015

Cress et al. Characteristics of long-term survivors of epithelial ovarian cancer

 

Why should you read about this topic?

To accurately portray prognosis for your patients diagnosed with epithelial ovarian cancer

What were the authors trying to do?

Identify characteristics associated with long-term survival in women with epithelial ovarian cancer

Who participated and in what setting?

All California residents diagnosed with epithelial ovarian cancer between 1994 and 2001 tracked in the California Cancer Registry through 2011 (N=11,541)

What was the study design?

Retrospective, cross-sectional, descriptive analysis

What were the main outcome measures?

Length of survival after the diagnosis of cancer

What were the results?

Long-term survival (>10 years) was associated with younger age, early stage, low-grade, and non-serous histology.  Almost 1/3 survived more than 10 years.

What is the most interesting image in the paper?

Table 3

What were the study strengths and weaknesses?

Strengths:  large cohort, long follow-up. Weaknesses:  missing data, particularly for tumor grade; no pathology review

What does the study contribute for your practice?

Nearly one-third of ovarian cancer patients will be long-term survivors


Saturday, August 08, 2015

Jackson et al.  My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it

Why should you read about this topic?

How many times has someone asked you for a note for work accommodations?

What were the authors trying to do?

Inform providers of consequences of work accommodations notes and provide a resource for defining accommodations and crafting effective communications about them.

What was the study design?

Current commentary by authors from UCSF, including the Hastings College of the Law

What were the results?

Providers need to be certain that requested workplace accommodations are truly necessary because if the changes recommended keep the patient from doing the essential functions of her job she could be fired.  Things to consider: 1) is the restriction necessary; 2) can the restriction be delayed; 3) will the restriction interfere with doing the essential function of the job; 4) can accommodations be introduced gradually; 5) what type of accommodation is necessary; 6) would leave be better than accommodation.

What is the most interesting image in the paper?

Appendix 3

What does the study contribute for your practice?

Think carefully about what you put in a work accommodations note—you may cost your patient her job.


Saturday, August 01, 2015

Biggs et al. California family planning health care providers’ challenges to the same-day long-acting reversible contraception provision

Why should you read about this topic?

To learn how to reduce the number of office visits before LARC can be provided

What were the authors trying to do?

Determine the proportion of times LARC was provided with only one visit and the reasons why more than one visit was required

Who participated and in what setting?

California Family PACT practice sites (N=636) in 2011

What was the study design?

Survey

What were the main outcome measures?

Whether a practice site offered same-day insertion of an IUD or contraceptive implant

What were the results?

Of those with onsite provision, 59% required at least two visits to insert an IUD and 47% required two visits to place an insert.  The major reasons for requiring more than one visit were screening, clinic flow, and scheduling.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: large number of diverse practice sites surveyed. Weaknesses: unvalidated survey; no evaluation of actual practice; no analysis of characteristics of non-respondents.

What does the study contribute for your practice?

The easiest way to increase the proportion of same-day LARC insertions seems to be not waiting for STI tests in asymptomatic women.

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.