OB/GYN Clinical Alert
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Estrogens Used in Hormonal Therapy
To practice as a consultant in reproductive medicine, clinicians require a strong background in hormonal therapy. In this feature, we will review the role of steroidal estrogens used in contraceptive and hormone therapy.
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Perioperative Antibiotics in Gynecologic Surgery: The Case for Myomectomy
The authors of a retrospective cohort study suggest that perioperative antibiotics reduce the risk of surgical site infection in women undergoing myomectomy.
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Does Hormone Therapy Increase the Risk of Alzheimer’s Disease?
A large Finnish case-control study suggests that postmenopausal hormone therapy results in a 9-17% increase in the risk of Alzheimer’s disease. However, the small effect size, and likely confounding of use effect, does not provide strong evidence for a causal relationship.
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Multimodal Stepwise Post-Cesarean Pain Control Reduces Opioid Use
These investigators found that the routine use of acetaminophen alone rather than a combination acetaminophen-opioid significantly reduced overall and daily opioid use. In addition, there was no worse effect on overall pain score or length of stay.
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Thank You, John Hobbins; Welcome Camille Hoffman
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Should All Pregnant Women Be Screened for Hepatitis C?
In this cost-effectiveness analysis using Markov modeling, investigators found that universal antenatal screening for hepatitis C was cost-effective, with a mean incremental cost-effectiveness ratio of approximately $3,000 per quality-adjusted life years gained compared to risk-based screening.
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Staged Preeclampsia Screening in Early Pregnancy
The use of 150 mg of daily aspirin from 11 to 14 weeks through 36 weeks of gestation reduces the rate of early preeclampsia (PE) in approximately 90% of at-risk pregnancies. In addition, aspirin also provides the benefit of reducing the risk of PE < 37 weeks by about 60% and the length of NICU stay by about 70%, primarily by reducing the number of neonates delivered before 32 weeks. What constitutes a high-risk patient and what quantifies patient-specific risks before PE develops remain to be answered.
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The Changing Face of Labor Management
Throught the years, clinicians' understanding of the conduct of labor has undergone periodic re-evaluation. In the 1950s, cesarean delivery was a major operation. Today, the procedures are shorter, accompanied by less surgical fanfare, and associated with fewer days in the hospital. Nevertheless, as the only other option to vaginal delivery, the operation, performed in 35% of cases for failure to progress, still should be considered “major” considering its potential for maternal complications.
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Update on Treatments for Vulvovaginal Atrophy
Vulvovaginal atrophy, now known as the genitourinary syndrome of menopause (GSM), occurs with the decline of estrogen in the menopausal period. As with many clinical conditions, the spectrum of GSM requires the clinician to consider the effect on the patient’s quality of life. Although many symptoms are pacified effectively with situational lubricants and regular moisturizers, local estrogen is a safe, effective, and affordable way to treat the vulvovaginal changes of menopause.
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Infertility Therapy Leads to Increased Risk of Severe Maternal Morbidity
Women undergoing infertility treatment, particularly in vitro fertilization, are at higher risk of severe maternal morbidity, but the overall risk remains low.