Ob/Gyn News
No Pap smears for women under 21: guidelines
Pap smears in women under 21 do more harm than good, new guidelines from the American College of Obstetricians and Gynecologists (ACOG) say.In most cases such tests reveal only human papillomavirus (HPV) infections, which rarely lead to cervical cancer in women under 21, said Dr. Mark Einstein of the Albert Einstein College of Medicine (no relation) in the Bronx, New York.
Comparison of local metronidazole and a local antiseptic in the treatment of bacterial vaginosis
Bacterial vaginosis (BV) is characterized by a mixed flora of pathogenic anaerobic bacteria and associated with risks of pathologic conditions. In the present study, therapy with a local antiseptic spray (octenidine hydrochloride/phenoxyethanol, OHP) for 7 or 14 days is compared against the standard local therapy of BV (metronidazole) in a Serbian patient population.Overall it found that Octenidine hydrochloride/phenoxyethanol spray was as effective as the standard therapy with metronidazole. Patients stated that OHP was more comfortable, easier to apply, and side effects were lesser.
Valproic Acid Monotherapy in Pregnancy and Major Congenital Malformations
The use of valproic acid in the first trimester of pregnancy is associated with an increased risk of spina bifida, but data on the risks of other congenital malformations are limited. This study out of NEJM combined data from eight published cohort studies (1565 pregnancies in which the women were exposed to valproic acid, among which 118 major malformations were observed) and identified 14 malformations that were significantly more common among the offspring of women who had received valproic acid during the first trimester. We then assessed the associations between use of valproic acid during the first trimester and these 14 malformations by performing a case–control study with the use of the European Surveillance of Congenital Anomalies (EUROCAT) antiepileptic-study database, which is derived from population-based congenital-anomaly registries. As compared with no use of an antiepileptic drug during the first trimester (control group 1), use of valproic acid monotherapy was associated with significantly increased risks for 6 of the 14 malformations under consideration.
A decrease in maternal plasma concentrations of sVEGFR-2 precedes the clinical diagnosis of preeclampsia
An article in this months American Journal of Obstetrics and Gynecology sought to examine if maternal plasma concentrations of soluble vascular endothelial growth factor receptor (sVEGFR)-2 change prior to the diagnosis of preeclampsia. Through a longitudinal study of normal pregnant women (n = 160) and patients with preeclampsia (n = 40) this study found that mothers destined to develop preeclampsia have lower plasma sVEGFR-2 concentrations than those who will have a normal pregnancy.
Comparison of adnexal torsion between pregnant and nonpregnant women
An article in this months American Journal of Obstetrics and Gynecology sought to compare clinical manifestations, treatment, and pregnancy outcome of adnexal torsion in pregnant and nonpregnant women through a retrospective case-control study in the Departments of Gynecology at 2 tertiary centers between 1999-2008. Forty-one pregnant and 77 nonpregnant women with surgically proved adnexal torsion were assessed. Recurrence rate of torsion was 19.5% in pregnant women and 9.1% in control subjects; 73% of pregnant women conceived through assisted reproductive technologies. Doppler blood flow was falsely normal in 61% of pregnant women and in 45% of nonpregnant women. This study shows that presentation of adnexal torsion is similar in pregnant and nonpregnant women. Past assisted reproductive technology is an important risk factor in pregnancy. Doppler blood flow has a high false-negative rate and should not outweigh clinical suspicion. Although pregnancy outcome is favorable, the high rate of recurrence raises the issue of surgical fixation at the first episode.
Waiting to Clamp the Umbilical Cord May Be Better for Babies
Pregnant women may want to consider asking their doctors to hold off on clamping the umbilical cord for a few minutes after the baby is born, a new study suggests. Clamping the cord in the seconds after birth cuts off the blood flow from mom to baby. While not necessarily harmful, the common practice in delivery rooms potentially robs newborns of those last precious minutes of cord blood, the researchers said, and cord blood contains stem cells that have regenerative properties and can grow into different types of cells. Research suggests there may be some benefits to getting that extra blood from mom right after birth, said senior study author Dr. Paul Sanberg, director of the University of South Florida's Center of Excellence for Aging and Brain Repair.
Irregular menstrual periods tied to heart disease
Women with a history of irregular menstrual periods may have a higher risk of developing heart disease than do other women, a new study suggests.The study, which followed more than 23,000 Dutch women for a decade, found that those who said they'd typically had irregular periods in the past were 28 percent more likely than women who reported regular monthly periods to develop heart disease.
Rectally administered misoprostol versus intravenous oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss
A study out of the International Journal of Gynecology compared the efficacy of rectally administered misoprostol with intravenous oxytocin infusion in preventing uterine atony and blood loss during cesarean delivery. A total of 96 and 94 women were analyzed in the misoprostol and oxytocin groups, respectively. Intraoperative and postoperative blood loss was significantly lower in the misoprostol group than in the oxytocin group. Rectal misoprostol appears to be an effective alternative to intravenous oxytocin in preventing blood loss for routine use during cesarean delivery.
Osteopathic care may ease late-pregnancy back pain
NEW YORK (Reuters Health) - Gentle manipulation from an osteopathic doctor may relieve late-pregnancy back pain that frequently hinders bending, lifting, or walking, findings from a small study hint. The study, in the American Journal of Obstetrics and Gynecology, included 144 otherwise healthy pregnant women, about 24 years old on average, with moderate levels of back pain and related movement difficulties during late pregnancy.
African-American Women Have a Higher Risk for Developing Peripartum Cardiomyopathy
A study out of the Journal of the American College of Cardiology assessed whether African-American women are at increased risk of having peripartum cardiomyopathy. Peripartum cardiomyopathy is a heart disease of unknown cause that affects young women, often with devastating consequences. The frequency of peripartum cardiomyopathy varies markedly between African and non-African regions. A case-control study was performed and showed African-American women had a 15.7-fold higher relative risk of peripartum cardiomyopathy than non–African Americans. Other significant univariate risk factors were hypertension and having had >2 previous pregnancies. African-American ethnicity remained a significant risk factor for peripartum cardiomyopathy when other risk factors were considered in multivariable and stratified analyses. Although the frequency of peripartum cardiomyopathy (185 of 100,000 deliveries) at this center was higher than in previous U.S. reports, it was comparable to the frequency in countries with more women of African descent (100 to 980 of 100,000). Analysis of other U.S. studies confirmed that the frequency of peripartum cardiomyopathy was significantly higher among African-American women.
Cervical length predicts spontaneous preterm birth in asymptomatic twin pregnancies
A study out of the American College of Obestrics and Gynecology sought to evaluate the change in cervical length (CL) as a predictor of preterm birth in asymptomatic twin pregnancies.121 twin pregnancies were evaluated with CL testing between 18-24 weeks who had a follow-up CL 2-6 weeks after the initial CL.A total of 19 patients had their CL decrease by ≥20% (shortened CL group) and 102 patients' CL decreased by less, or not at all (stable CL group). The shortened CL group had a significantly higher rate of spontaneous preterm birth <28 weeks, <30 weeks, <32 weeks, and <34 weeks.In twin pregnancies, a CL that decreases by 20% over 2 measurements is a significant predictor of very preterm birth, even in the setting of a normal CL. Serial CL measurements should be considered in twin pregnancies, starting <24 weeks.
Teen pregnancy, abortion rates rise
The teen pregnancy rate in the USA rose 3% in 2006, the first increase in more than a decade, according to data out today. The data also show higher rates of births and abortions among girls 15-19. The numbers, calculated by the Guttmacher Institute, a non-profit group that studies reproductive and sexual health, show a clear reversal from the downward trend that began in the 1990s.
