Obstetrics & Gynecology

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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 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.


Saturday, December 26, 2015

Van’t Hooft et al. A core outcome set for evaluation of interventions to prevent preterm birth

Why should you read about this topic?

Consistency of reporting outcomes should yield more readable and relevant research

What were the authors trying to do?

To develop a consensus on a set of outcomes relevant to clinical research, systematic reviews, and guidelines on prevention of preterm birth

Who participated and in what setting?

Members (N=228) of 5 stakeholder groups (parents, midwives, obstetricians, neonatologists, and researchers) from middle and high income countries

What was the study design?

Two-stage web-based Delphi survey and a face-to-face meeting to develop consensus on a set of outcomes.

What were the main outcome measures?

9-point Likert scale of importance

What were the results?

Consensus was achieved on 4 maternal outcomes (maternal mortality, maternal infection or inflammation, prelabor rupture of membranes, and harm to mother from intervention).  Consensus was also achieved with 9 neonatal outcomes (gestational age at birth, perinatal mortality, birth weight, early neurodevelopmental morbidity, late neurodevelopmental morbidity, gastrointestinal morbidity, infection, respiratory morbidity and harm to offspring from intervention.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths:  objective approach to identifying a set of core outcomes.  Weaknesses: unclear plan for implementation

What does the study contribute for your practice?

A core outcomes set for prevention of preterm birth will enable comparison and combination of data from clinical trials


Saturday, December 19, 2015

Feldman et al. Gestational diabetes screening: the International Association of the Diabetes and Pregnancy Study Groups compared with Carpenter-Coustan Screening

Why should you read about this topic?

To see the latest round of the GDM diagnosis debate

What were the authors trying to do?

To show whether adopting the IADPSG testing is associated with better maternal, perinatal, or neonatal outcomes compared with Carpenter-Coustan testing

Who participated and in what setting?

Women with singleton pregnancies (N=6066) managed from the first trimester at the Kaiser Baldwin Park Medical Center between 2010 and 2013.  The study was powered to detect a 2% difference in rate of LGA babies

What was the study design?

Retrospective cohort with groups defined by management before and after adoption of IADPSG criteria in November, 2011

What were the main outcome measures?

LGA neonate

What were the results?

GDM prevalence was 17% with Carpenter-Coustan and 27% with IADPSG.  Although there was no difference in LGA rates between groups, the primary cesarean delivery rate was higher in the IADPSG group.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: large number of patients with uniform management; Weaknesses: LGA not clearly defined; sequential rather than simultaneous cohorts

What does the study contribute for your practice?

Incorporating the IADPSG criteria into your practice will increase the number of GDM patients but will not reduce rates of cesarean delivery or LGA babies

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.