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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, May 23, 2015

Wright et al. Trends in relative survival for ovarian cancer from 1975 to 2011

Why should you read about this topic?

Are we making progress in treatment of ovarian cancer?

What were the authors trying to do?

To explore trends in survival of women with ovarian cancer relative to those without ovarian cancer

Who participated and in what setting?

White or black women (N=49,932) from one of 9 regional registries diagnosed with ovarian cancer between 1975 and 2011 and entered into the SEER database

What was the study design?

Retrospective cohort

What were the main outcome measures?

Time from diagnosis of ovarian cancer to death from any cause

What were the results?

Relative survival (the ratio of observed survival of women with ovarian cancer to expected survival of a comparable group in the general population) for stage I improved for those diagnosed in 2006 compared with those diagnosed in 1975.  Similarly, women with stage III-IV tumors diagnosed in 2006 had a 7% lower risk of death from ovarian cancer compared with women diagnosed in 2000, and 51% lower risk of death from ovarian cancer compared with women diagnosed in 1975.

What is the most interesting image in the paper?

Figure 1

What were the study strengths and weaknesses?

Strengths:   large study sample; population based. Weaknesses:  insufficient number of women with stage II cancer to test for interactions; changing staging over the period of observation

What does the study contribute for your practice?

Relative survival has improved for women with all stages of ovarian cancer between 1975 and 2011


Saturday, May 16, 2015

Wilkins-Haug et al. Recognition by women’s health care providers of long-term cardiovascular disease risk after preeclampsia

Why should you read about this topic?

The women you are delivering today will be needing your help with preventive care and health maintenance for years to come

What were the authors trying to do?

To assess providers’ knowledge of pregnancy history as a risk factor for cardiovascular disease and general knowledge about cardiovascular disease risk

Who participated and in what setting?

Internal medicine and obstetric and gynecologic care providers (N=265) at Brigham and Women’s between 2012 and 2013.

What was the study design?

Anonymous electronic survey

What were the main outcome measures?

Correct responses to hypothetical cases

What were the results?

Although groups of providers were comparable for knowledge of general cardiovascular risk factors, ob/gyns more often requested a pregnancy history and, more specifically, preeclampsia history but internal medicine providers were more knowledgeable about appropriate follow-up tests for women with increased pregnancy-related risk factors.  Most providers did not recognize the importance of a history of fetal growth restriction.

What is the most interesting image in the paper?

Table 5

What were the study strengths and weaknesses?

Strengths: case-based vignette style questions.  Weaknesses: poor response rate; unvalidated survey; self-report of practice performance

What does the study contribute for your practice?

Pregnancy history foreshadows medical problems later in life.  Ask about pregnancy.


Saturday, April 25, 2015

Lyndon et al. Transforming communication and safety culture in intrapartum care: a multi-organization blueprint

Why should you read about this topic?

Acknowledging that problems with safety and clinical performance arising from poor communication are rampant is just the first step.  Fixing the problems requires a blueprint.

What were the authors trying to do?

Participating on behalf of the American College of Nurse-Midwives, ACOG, Association of Women’s Health, Obstetric and Neonatal Nurses, and the SMFM, the authors studied safety issues in labor and delivery teams and listed approaches for improving communication and teamwork.

What was the study design?

Consensus development using two collaborative research studies as a springboard.

What were the results?

Multi-tiered approaches for improving communication, including descriptions of actions that can be taken by women and their families, clinicians, team leaders, administrators, health care organizations, and professional organizations.

What is the most interesting image in the paper?

Table 1

What does the study contribute for your practice?

Organizational commitment and executive leadership are essential to empowering women, clinicians, and family to act about safety concerns


Saturday, April 18, 2015

Coughlin et al. Obstetric and neonatal outcomes after antipsychotic medication exposure in pregnancy

Why should you read about this topic?

With more and more people using antipsychotic medications for bipolar disorder, schizophrenia, and unipolar depression, it is essential to understand the association between the use of these medications and pregnancy outcomes.

What were the authors trying to do?

Assess the association between the use of antipsychotic medication during pregnancy and adverse obstetric and neonatal outcomes.

Who participated and in what setting?

Women enrolled in 13 cohort studies, including 6,289 antipsychotic-exposed and 1,618,039 unexposed pregnancies.

What was the study design?

Systematic review and meta-analysis

What were the main outcome measures?

Congenital malformations, fetal demise, gestational age, and birth weight

What were the results?

Antipsychotic exposure was associated with an increased risk of major malformations, preterm delivery, termination of pregnancy, and SGA births.  There was no difference in risk of major malformations comparing typical with atypical antipsychotics.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: Sound methodology; large sample size.  Weaknesses: limited adjustment for potential confounding variables; large degree of heterogeneity of effect for some outcomes; limited evaluation of publication bias

What does the study contribute for your practice?

Women taking antipsychotic medication during pregnancy are at increased risk for adverse birth outcomes


Saturday, April 11, 2015

Eschenbach. Treating spontaneous and induced septic abortions

Why should you read about this topic?

Septic abortions can be deadly, even in the US.

What was the author trying to do?

Review the diagnosis and treatment of septic abortions

What was the study design?

Clinical expert series selective review

What is the most interesting image in the paper?

Box 1

What does the study contribute for your practice?

There are four key elements of management of septic abortion: prompt recognition, bacterial cultures, IV fluids and antibiotics, and prompt uterine evacuation

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.