Obstetrics & Gynecology

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.
Sunday, February 28, 2016

Hofler et al. Comparison of women in department leadership in obstetrics and gynecology with other specialties

Why should you read about this topic?

Workplace limitations for any segment of our workforce ultimately diminish all of us.

What were the authors trying to do?

Compare the representation of women in obstetrics and gynecology departmental leadership to other clinical specialties

Who participated and in what setting?

Academic departments (N=950) of anesthesiology, diagnostic radiology, general surgery, internal medicine, neurology, obstetrics and gynecology, pathology, pediatrics and psychiatry in the US in 2013

What was the study design?

Cross-sectional observational

What were the main outcome measures?

Gender of department-based leaders

What were the results?

Although pediatrics and obstetrics and gynecology had the highest proportion of department leaders, women were underrepresented (a ratio of the proportion of leaders who are women to the proportion of residents in 1990 who were women) among chairs for all specialties and for division directors for all specialties except anesthesiology and diagnostic radiology. Women were overrepresented as residency program directors in general surgery, anesthesiology, obstetrics and gynecology, and pediatrics.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: innovative representation ratio. Weaknesses: missing data ranged from 5.1-21.4%; assumption about proportional entry into academic positions may not be valid

What does the study contribute for your practice?

Our specialty is lagging behind others in promoting women to positions of leadership in academic departments


Saturday, February 13, 2016

Wright et al. Trends in periodic surveillance testing for early-stage uterine cancer survivors

Why should you read about this topic?

While early detection of asymptomatic recurrence of endometrial cancer is highly desired, it must be done cost-effectively

What were the authors trying to do?

Evaluate the use of periodic surveillance testing for early-stage endometrial cancer survivors

Who participated and in what setting?

Women (N=17,638) at least 65 years old with stage I-II endometrioid endometrial cancer treated from 1992-2011 and registered in the SEER-Medicare database.

What was the study design?

Population-based retrospective cohort

What were the main outcome measures?

Use of vaginal cytology and imaging

What were the results?

Over the span of years observed the use of chest radiography decreased while chest CT, abdominopelvic CT, and PET scans increased.  Vaginal cytology increased to a peak of 72.3% in 2007 but has declined a little since then.

What is the most interesting image in the paper?

Figure 3

What were the study strengths and weaknesses?

Strengths: population based.  Weaknesses: no evaluation of indications for vaginal cytology or imaging.

What does the study contribute for your practice?

The use of more costly imaging techniques for early stage endometrial cancer has increased despite a lack of evidence supporting its utility.


Saturday, January 30, 2016

Raymond et al. Effect of immediate compared with delayed insertion of etonogestrel implants on medical abortion efficacy and repeat pregnancy: a randomized controlled trial

Why should you read about this topic?

Increased efficiency of LARC initiation will yield fewer unplanned pregnancies

What were the authors trying to do?

Evaluate the effect of insertion of etonogestrel implants on medical abortion success and early repeat pregnancy

Who participated and in what setting?

Women (N=476) undergoing first trimester medical abortion and desiring etonogestrel implant contraception at various centers in the US and Mexico between 2013 and 2014

What was the study design?

Randomized trial of insertion of implants with mifepristone administration or after the abortion

What were the main outcome measures?

Abortion outcome, pregnancies, and contraception use

What were the results?

There was no difference in the rate of abortion failure between groups.  Although the subsequent pregnancy rate was not different between groups more women who had immediate insertion were satisfied with their group assignment than women with delayed insertion.

What is the most interesting image in the paper?

Table 3

What were the study strengths and weaknesses?

Strengths: randomized trial. Weaknesses: no standardized protocol for follow-up; no criteria to diagnose complete abortion; passive approach to post-procedure contraception; questionably generalizable.

What does the study contribute for your practice?

Immediate insertion of an etonogestrel implant will not impede medical abortion in the first trimester


Tuesday, January 19, 2016

Donders et al. Maternal immunization with an investigational trivalent Group B streptococcal vaccine: a randomized controlled trial

Why should you read about this topic?

Same concept as Tdap: immunization of the mother yields better health for the infant

What were the authors trying to do?

Evaluate the safety and immunogenicity of a trivalent vaccine for Group B strep in pregnant women and their newborn children

Who participated and in what setting?

Pregnant women (N=86) 18-40 years of age at 24-35 weeks gestation between 2011 and 2013 at multiple sites in Belgium and Canada

What was the study design?

Observer-masked, randomized placebo controlled Phase 2 trial

What were the main outcome measures?

Placental antibody transfer rates at birth

What were the results?

Placental transfer ratios were 66-79%.  Three months after birth infant antibody concentrations were 22-25% of birth levels.  Serum levels of antibodies were greater for those with pre-existing detectable levels.  Rates of adverse events were not different between groups.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: observer-masked, randomized trial.  Weaknesses:  surrogate endpoint for Group B strep prevention

What does the study contribute for your practice?

Immunization of the mother with this trivalent Group B strep vaccine leads to persistence of antibodies for the first three months of the infant’s life.


Saturday, January 2, 2016

Lin et al. Ovarian cancer treatment and survival trends among women over 65 in the United States, 1995-2008

Why should you read about this topic?

Your patients are living longer.  Those with ovarian cancer will look to you for guidance for treatment decisions.

What were the authors trying to do?

Assess trends for treatment and survival for older women with advanced ovarian cancer

Who participated and in what setting?

Women (N=7938) >65 years of age with Stage III-IV epithelial ovarian cancer registered in SEER between 1995 and 2008 and linked to Medicare claims

What was the study design?

Retrospective cohort

What were the main outcome measures?

Overall survival

What were the results?

Optimal treatment yielded the longest median survival (39 months) with a trend for improvement over the past decade.  Those who received chemotherapy alone survived longer (14.4 months) than those who had surgery alone (2.2 months) or no treatment (1.7 months).  The proportion of women who received optimal treatment declined over the past 10 years. 

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: established, validated data base; adjusted for co-morbidities. Weaknesses: no pathology confirmation; per protocol analysis

What does the study contribute for your practice?

Older women with advanced ovarian cancer survive longer with optimal therapy.  When optimal therapy is not used, survival is longer with chemotherapy alone compared with surgical therapy alone.

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.