OB/GYN Clinical Alert
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Disease Severity and Perinatal Outcomes of Pregnant Patients with COVID-19
In this observational cohort study of patients with singleton gestation and positive coronavirus test, patients with severe or critical disease were at risk for perinatal complications compared to those who were asymptomatic. Patients classified with mild or moderate disease were not shown to have an increased risk compared to asymptomatic positive patients.
Standard-Dose vs. High-Dose Oxytocin for Labor Augmentation
In this randomized clinical trial of standard-dose vs. high-dose oxytocin regimens for labor augmentation among 1,003 nulliparous women, the primary outcome (cesarean delivery) was similar between the two groups. However, secondary outcomes were lower, labor duration was shorter, and umbilical artery acidemia occurred less frequently.
BSO at Benign Hysterectomy: What Should We Be Recommending?
In this population-based retrospective cohort study, among 44,549 adult women undergoing hysterectomy in Ontario, Canada, there was marked variation between surgeons in bilateral salpingo-oophorectomy (BSO) rates after controlling for patient age and other factors. Approximately 41% of patients had no indication for the bilateral salpingo-oophorectomy in their records.
Mifepristone as an Adjunct to Misoprostol for Pregnancy Termination
In this prospective, double-blind, randomized, placebo-controlled trial, pretreatment with 200 mg of mifepristone 24 to 48 hours before labor induction using misoprostol significantly reduced time to delivery among demised fetuses between 14 and 28 weeks of gestation. Maternal complications were equivalent in both groups.
Evaluation of an Inpatient Postpartum Human Papillomavirus Immunization Program
In this cohort study, results from two years of an inpatient postpartum HPV vaccination program are presented. Overall, their results show an increased rate of immunization (hazard ratio of 2.51) and an increased proportion of women completing the vaccination series (35.8% of those receiving an inpatient dose completed the series compared to 9.3% of those who did not get the inpatient dose).
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.
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.
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.
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.
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.