OB/GYN Clinical Alert
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When Is the Ideal Time in the Menstrual Cycle for IUD Insertion?
In this retrospective cohort study, women using the levonorgestrel intrauterine device for noncontraceptive indications had higher expulsion rates (38% vs. 17%, P = 0.03) when insertion occurred on day 1 to day 8 of the menstrual cycle compared to after day 8.
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The Association Between SSRIs and Congenital Anomalies
In this synthesis involving 15 meta-analytic studies, four studies demonstrated an association between paroxetine use during pregnancy and increased risk of major congenital anomalies (relative risk [RR], 1.18 [95% confidence interval (CI), 1.05, 1.32] to 1.29 [95% CI, 1.11-1.49]). For all selective serotonin reuptake inhibitors (SSRIs), the RR for major anomalies (1.10 [95% CI, 1.03, 1.16] to 1.27 [95% CI, 1.09, 1.47]) and cardiac defects (1.06 [95% CI, 0.94, 1.18] to 1.36 [95% CI, 0.61, 3.04]) were increased. This meta-analysis suggests an increased risk of cardiac and major anomalies with SSRI use, but the results should be interpreted with caution, since all included studies were meta-analyses of retrospective cohort studies.
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Management of Heavy Menstrual Bleeding: Levonorgestrel-Releasing Intrauterine System vs. Endometrial Ablation
In this multicenter, randomized, noninferiority trial among patients aged 34 years and older with heavy menstrual bleeding, the levonorgestrel-releasing intrauterine system did not meet the noninferiority threshold when compared to endometrial ablation for mean blood loss at 24 months following intervention. Both interventions did lead to large decreases in blood loss and comparable satisfaction and quality-of-life scores.
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Is a Vacuum-Induced Device Effective for Control of Postpartum Hemorrhage?
In this multicenter study across 12 centers in the United States, a vacuum-induced intrauterine device successfully treated 94% of participants who experienced a postpartum hemorrhage with a median time of three minutes to control of bleeding.
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Anticholinergic Use for Three Months or More Increases Dementia Risk
There is a significant increase in dementia risk associated with the use of anticholinergic medications for three months or longer.
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Does Maternal BMI Influence the Success of Trial of Labor After Cesarean?
In this retrospective cohort study between May 2007 and April 2016, women undergoing a trial of labor after cesarean (TOLAC) were analyzed to determine if pre-pregnancy or delivery obesity status made an impact on TOLAC success. Overall, maternal body mass index did not have a significant effect on TOLAC success rates.
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Tranexamic Acid for the Prevention of Obstetric Hemorrhage
In this prospective, cohort, pharmacokinetic-pharmacodynamic (PKPD) dose-finding study by Ahmadzia and colleagues, 30 pregnant women (10 women in each study arm) received 5 mg/kg, 10 mg/kg, or 15 mg/kg doses of tranexamic acid for the prevention of postpartum hemorrhage. Advanced PKPD modeling demonstrated that 600 mg of tranexamic acid was the optimal dose to use in the prevention of postpartum hemorrhage.
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HIV Management During Pregnancy
Human immunodeficiency virus (HIV) infection during pregnancy carries a significant burden to healthcare systems, and continues to be of significant public health concern.
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The Cost-Effectiveness of HPV Vaccination for Adults Aged 30 to 45 Years
This study evaluated the cost-effectiveness of extending the upper age limit of human papillomavirus (HPV) vaccination to age 30 to 45 years using two independent HPV microsimulation models and found that vaccinating in this age group was not cost-effective.
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Are Modern Intrauterine Devices Associated with Infertility?
In this prospective cohort study of 461 women, there was no association between intrauterine device use and time to conception (hazard ratio, 1.25; 95% confidence interval, 0.99-1.58). However, past Mycoplasma genitalium infection was found to be associated with longer times to conception and lower conception rates by 12 months (68% vs. 80%, P = 0.02).