OB/GYN Clinical Alert
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Perinatal Mental Health During the COVID-19 Pandemic: The Role of the OB/GYN
The obstetrical effect of COVID-19 has received attention worldwide. However, data examining the psychological effect on women in the perinatal period still are emerging. Although there is little doubt that COVID-19 has increased depression and anxiety in many demographic groups, a small amount of existing literature begins to give us some insight into the incidence, risk factors, and protective factors for mental illness in perinatal women during the COVID-19 pandemic.
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HPV Vaccination Reduces the Risk of Invasive Cervical Cancer
In this retrospective cohort study of women in Sweden, receipt of human papillomavirus vaccination prior to age 17 years was associated with an 88% decrease in cervical cancer, and vaccination at ages 17 to 30 years was associated with a 53% decrease in cervical cancer.
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Female Caregivers May Delay Seeking Care for Pelvic Floor Disorders
One-third of patients presenting for urogynecologic subspecialty care are caregivers. Of these, women caring for an adult are more likely to delay seeking care for pelvic floor disorders.
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Does Epidural Analgesia for Labor and Delivery Pain Relief Cause Autism?
In this retrospective cohort study of 147,895 singleton births, epidural anesthesia was used in 74.2% of cases and the hazard ratio for the subsequent diagnosis of autism spectrum disorders was 1.37 (95% confidence interval, 1.23-1.53).
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Understanding the Utility of Hemoglobin A1c in Diagnosing Gestational Diabetes in Early Pregnancy
In this retrospective cohort study of 243 pregnant women who had combined hemoglobin A1c (HbA1c) and a two-step oral glucose tolerance testing at less than 21 weeks of gestation, median values of HbA1c were higher in women with gestational diabetes compared to nondiabetics (5.8% compared to 5.3%; P < 0.001). The predictive probability of using HbA1c in diagnosing diabetes in early pregnancy was high compared to two-step testing (area under the curve, 0.8), with an optimal diagnostic threshold of 5.6%. Although a HbA1c level of > 6.5% is diagnostic of early gestational diabetes, a lower diagnostic threshold might be justified during pregnancy.
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Outpatient Foley Catheter for Induction of Labor in Nulliparous Women
In this randomized controlled trial among nulliparous patients with low Bishop scores, outpatient placement of a Foley catheter the day prior to scheduled admission, when compared to inpatient placement, showed a decreased mean time from admission to delivery.
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Maternal Sepsis: Risk Factors that Could Lead to Postpartum Readmission
In this analysis of California deliveries between 2008 and 2011, risk factors for maternal readmission for sepsis were found to include preterm birth, hemorrhage, obesity, and a primary cesarean delivery.
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Prenatal Care Visits During COVID-19
In this nested case-control study in the Boston area, there was no association between testing positive for COVID-19 during pregnancy or on admission to labor and delivery and the number of in-person prenatal care visits.
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Application of Acetic Acid to Identify Lesions During Colposcopy
In this prospective study, one minute of acetic acid application was found to be sufficient to identify the most severe colposcopic lesion in 96.7% of subjects.
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Outcomes in Pregnant Women Treated with Anti-Tumor Necrosis Factor-Alpha Biologic Therapy
In this population-based cohort study of 1,027 infants born to women treated with anti-TNF-α biologic therapy, there was an increased prevalence of preterm birth (adjusted odds ratio [aOR], 1.61; 95% confidence interval [CI], 1.29-2.02), cesarean delivery (aOR, 1.57; 95% CI, 1.35-1.82), and small for gestational age neonates (aOR, 1.36; 95% CI, 0.96-1.92) when treatment with anti-TNF was compared to non-biologic systemic treatment. Since disease processes varied greatly in these pregnant women, it was difficult to rule out confounding by disease severity (confounding by indication).