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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, 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


Saturday, April 04, 2015

Metz et al. Validation of vaginal birth after cesarean delivery prediction model in women with two prior cesareans

Why should you read about this topic?

Some women with two prior cesareans want to consider TOLAC

What were the authors trying to do?

To estimate the value of the MFMU VBAC prediction model for women with two prior cesarean deliveries

Who participated and in what setting?

Women (N=369) attempting TOLAC with a term singleton cephalic-presenting fetus and two prior cesarean deliveries in 1999-2003

What was the study design?

Secondary analysis of the MFMU Cesarean Registry

What were the main outcome measures?

Vaginal birth

What were the results?

Women with a successful TOLAC had a higher probability of success predicted by the model than women with unsuccessful TOLAC.  The model prediction corresponded to the observed TOLAC success rate at predicted levels >30%.

What is the most interesting image in the paper?

Figure 2

What were the study strengths and weaknesses?

Strengths: model derived from independent cohort. Weaknesses: model derived from practice prevailing in 1999-2003; missing data for BMI; study sample did not include all women eligible for TOLAC

What does the study contribute for your practice?

The current model for estimating the likelihood of vaginal birth after cesarean can be used for women with two prior cesarean deliveries


Saturday, March 28, 2015

Friedman et al. Evaluation of third-degree and fourth-degree laceration rates as quality indicators

Why should you read about this topic?

Quality indicators drive reimbursement.  We should advocate for the use of quality indicators that actually reflect quality care.

What were the authors trying to do?

Examine the patterns and predictors of third- and fourth-degree laceration in women undergoing vaginal delivery

Who participated and in what setting?

Women (N=7,096,056) 18-49 years old with vaginal delivery between 1998 and 2010 reported in the Nationwide Inpatient Sample

What was the study design?

Retrospective population-based cohort study

What were the main outcome measures?

Third- and fourth degree lacerations

What were the results?

Rate of third-degree laceration was 3.3%; rate of fourth-degree laceration was 1.1%.  Risk factors for fourth-degree lacerations were shoulder dystocia and operative vaginal deliveries.  There was limited between-hospital variation in laceration rates.

What is the most interesting image in the paper?

Table 3

What were the study strengths and weaknesses?

Strength:  huge, population-based sample size. Weakness: administrative database.

What does the study contribute for your practice?

Given the limited variation in hospital laceration rates and the likely use of cesarean delivery to reduce the operative vaginal delivery rate in order to reduce the laceration rate, it doesn’t make sense to use third- and fourth-degree laceration rates as quality indicators.


Sunday, March 15, 2015

Bristow et al. Sociodemographic disparities in advanced ovarian cancer survival and adherence to treatment guidelines.

Why should you read about this topic?

Health disparities are pervasive.  We cannot develop solutions until we better understand the causes.

What were the authors trying to do?

To determine whether race, ethnicity, and socioeconomic status are associated with cancer-specific survival after adjusting for adherence to treatment guidelines.

Who participated and in what setting?

Women (N=10,296) at least 66 years old with stage IIIC/IV epithelial ovarian cancer registered in the Surveillance Epidemiology and End Results-Medicare database from 1992 to 2009.

What was the study design?

Retrospective, population-based observational cohort

What were the main outcome measures?

Cancer-specific survival

What were the results?

Black race and low socioeconomic status were associated with non-guideline care.  After multivariable survival analysis with propensity score matching, deviation from treatment guidelines was associated with comparable risks of ovarian cancer mortality across race/ethnicity and socioeconomic status.  

What is the most interesting image in the paper?

Table 4

What were the study strengths and weaknesses?

Strengths:  large sample size; propensity score matching;   Weaknesses: sample restricted to Medicare patients (>66 years old); use of claims data to identify comorbidity

What does the study contribute for your practice?

Adherence to treatment guidelines for advanced stage ovarian cancer is associated with equivalent disease-specific survival rates across race/ethnicity and socioeconomic status.

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.