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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, January 24, 2015

Mor et al. Alpha-fetoprotein as a tool to distinguish amniotic fluid from urine, vaginal discharge, and semen

Why should you read about this topic?

It’s not always easy to detect PROM

What were the authors trying to do?

Show that AFP can be used to distinguish amniotic fluid from semen, urine, and vaginal discharge in perineal pads

Who participated and in what setting?

Pregnant women (N=79) > 34 weeks at Maimonides Medical Center and men (N=17) undergoing infertility evaluation in 2014

What was the study design?

Prospective cohort

What were the main outcome measures?

AFP concentrations in body fluids

What were the results?

AFP concentrations were much higher in amniotic fluid than in urine, semen, or vaginal discharge.  AFP concentrations extracted from sanitary pads instilled with the same body fluids showed similar relative concentrations.  Amniotic fluid can be distinguished from vaginal discharge with a high level of sensitivity and specificity by measuring AFP concentrations in sanitary pads.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths:  the analyte is inexpensive to measure. Weaknesses: most testing was done with artificial, contrived specimens.

What does the study contribute for your practice?

AFP concentrations may be helpful in distinguishing amniotic fluid from other body fluids


Saturday, January 17, 2015

Gordon et al. Sleep position, fetal growth restriction, and late pregnancy stillbirth: The Sydney Stillbirth Study

Why should you read about this topic?

Every year well over 2 million babies are stillborn

What were the authors trying to do?

Identify potentially modifiable risk factors for late pregnancy stillbirth

Who participated and in what setting?

Pregnant women (cases, N=103; controls, N=192) >32 weeks in maternity hospitals in Sydney between 2006 and 2011.

What was the study design?

Population-based case-control interview and questionnaires

What were the main outcome measures?

Stillbirth

What were the results?

Potentially modifiable factors associated with stillbirth included supine sleeping (aOR 6.26), suspected fetal growth restriction (aOR 5.5), not be in paid work (aOR 2.9), and no education beyond high school (aOR 1.9). The population attributable risk for reported supine sleeping was 9.9%.

What is the most interesting image in the paper?

Table 3

What were the study strengths and weaknesses?

Strengths: a priori specified exposures; contemporaneous controls; population based. Weaknesses: recall bias

What does the study contribute for your practice?

“Back to sleep” may be best for infants but not necessarily expectant moms


Saturday, January 10, 2015

Kinney et al. Increased cervical cancer risk associated with screening at longer intervals

Why should you read about this topic?

Haven’t you seen the reluctance of your patients to have Pap smears at longer intervals?

What were the authors trying to do?

Assess the difference in risk of cervical cancer with 2012 ACS/ACOG guidelines compared with co-testing every 3 years or annual cytology

Who participated and in what setting?

Current commentary

What was the study design?

Selective review

What were the main outcome measures?

Incidence of cervical cancer; mortality rate for cervical cancer

What were the results?

The incidence of cervical cancer is 2x greater using the 2012 guidelines compared with co-testing every 3 years.  Adopting the 2012 guidelines yields an incremental risk of 1/369 women developing cervical cancer and 1/1639 women dying of cervical cancer.

What does the study contribute for your practice?

Adopting the 2012 guidelines may yield more cases of cervical cancer but the harms of more frequent testing remain to be determined.


Saturday, January 03, 2015

Boxer et al. Use of granulocyte colony-stimulating factor during pregnancy in women with chronic neutropenia

What were the authors trying to do?

Summarize the maternal and fetal outcomes of G-CSF administration to pregnant women with chronic neutropenia

Who participated and in what setting?

Women (N=107) with congenital, cyclic, idiopathic, or autoimmune neutropenia enrolled in the Severe Chronic Neutropenia International Registry after 1994

What was the study design?

Retrospective, self-reported recall survey

What were the main outcome measures?

Spontaneous abortions, preterm delivery, and perinatal and neonatal infections

What were the results?

There were no observed differences between groups defined by the use of G-CSF for maternal complications (including infection, preterm delivery, and spontaneous abortions) or fetal or neonatal complications.

What is the most interesting image in the paper?

Table 4

What were the study strengths and weaknesses?

Strengths: single best source of information for this rare condition.  Weaknesses: outcomes by recall; sample size was underpowered for significant adverse events

What does the study contribute for your practice?

Although this study was limited by small numbers of participants and pregnancies, there appears to be no greater risk for adverse pregnancy outcomes in pregnancies exposed to G-CSF in women with chronic neutropenia


Saturday, December 27, 2014

Win et al. Family history and risk of endometrial cancer: a systematic review and meta-analysis

Why should you read about this topic?

Endometrial cancer is the most common gynecologic cancer in developed countries.

What were the authors trying to do?

Estimate the risk of endometrial cancer for women with a family history of cancer.

Who participated and in what setting?

Cases (N=37,381) and controls in 16 previously published case-control or cohort studies

What was the study design?

Systematic review and meta-analysis

What were the main outcome measures?

Relative risk for endometrial cancer

What were the results?

Relative risk for endometrial cancer in women with a first degree relative with endometrial cancer was 1.82 (95% CI 1.65, 1.98).  Relative risk for endometrial cancer with a first degree relative with colorectal cancer was 1.17 (95% CI 1.03, 1.31).  Women with a first degree relative with breast, ovarian, and cervical cancer had no increased risk.

What is the most interesting image in the paper?

Figure 3

What were the study strengths and weaknesses?

Strengths:  stratified analyses and linear meta-regression modeling showed that the risk estimates are robust.  Weaknesses: most of the studies used unverified diagnoses of cancer in relatives; exposure limited to first-degree relatives.

What does the study contribute for your practice?

Women with a first-degree relative with endometrial or colorectal cancer have an increased risk of endometrial cancer

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.