American College of Obstetricians and Gynecologists, April 30 - May 4, 2011Last Updated: May 09, 2011.
The annual clinical meeting of the American College of Obstetricians and Gynecologists was held from April 30 to May 4 in Washington, D.C., and attracted approximately 4,500 participants from around the world. The conference highlighted recent advances in the prevention, detection, and treatment of conditions impacting women, with presentations focusing on fibroids, pregnancy, overall health and well-being, pelvic pain, breast and ovarian cancers, hormone imbalance, and psychological issues.
Bruce D. Rodgers, M.D., of the State University of New York -- University at Buffalo, and colleagues found that two popular estimation equations (Modification of Diet in Renal Disease [MDRD] and Cockcroft-Gault Equation [CG]) could not be used to accurately estimate renal function during pregnancy in patients at risk for renal impairment.
"Renal function is directly measured by the glomerular filtration rate, but this can only be measured directly in a research laboratory, or by utilizing radioisotopes in the clinical setting. The former is not practical in the clinical setting, and the latter is contraindicated during pregnancy," Rodgers said.
Therefore, the investigators aimed to assess the accuracy of the two estimation equations to estimate creatinine clearance in pregnant women at risk for renal impairment.
"The results showed that the CG equation lacked in both accuracy and precision during pregnancy. The MDRD equation was found to be only modestly accurate during pregnancy, and lacked in precision. The inadequacy of both estimation equations was even more evident in obese pregnant women," Rodgers said.
In a multicenter, double-blind, placebo-controlled, parallel-group study, David F. Archer, M.D., of the Eastern Virginia Medical School in Norfolk, and colleagues found that treatment of heavy menstrual bleeding (HMB) with tranexamic acid (TA) reduced large stains and sanitary product use.
The investigators randomized 294 women with HMB in a ratio of 2:2:1 to receive TA 1.95 g/day or 3.9 g/day, or placebo for up to five days per menstrual period for three cycles.
The investigators found that 71 of 111 women who received TA at a dose of 3.9 g/day (64.0 percent), and 70 of 114 who received a dose of 1.95 g/day of TA (61.4 percent), experienced a reduction in large stains compared with 35 of 67 in the placebo group (52.2 percent). Compared to women who received placebo, those in both TA groups experienced a significant reduction in the number of sanitary products used.
"Reductions in large stains and sanitary products used were apparent in women with HMB treated with TA compared with placebo. TA was well tolerated in this study," the authors write.
In another study, Kaylen M. Silverberg, M.D., and Brandon K. Howard, Ph.D., of the Texas Fertility Center in Austin, found that a progesterone vaginal ring (PGN VR) was effective for luteal phase supplementation in in vitro fertilization (IVF), independent of duration or diagnosis of infertility.
The investigators randomized 1,297 women to a novel, weekly PGN VR or daily 8 percent progesterone vaginal gel (90 mg/day). They found that clinical pregnancy rates were within nationally reported ranges for both treatment groups, independent of duration or diagnosis of infertility.
"The PGN VR is effective for luteal phase supplementation in IVF regardless of duration or diagnosis of infertility," the authors write.
Julie Chor, M.D., M.P.H., of the John H. Stroger Jr. Hospital of Cook County in Chicago, and colleagues found that modifiable and non-modifiable risk factors affect the impact of cardiac disease on women's fertility plans.
"The goal of our study was to interview women with cardiovascular disease (chronic hypertension or peripartum cardiomyopathy) in order to evaluate factors affecting these women's ability to either avoid unplanned pregnancy or plan pregnancy safely. We interviewed 10 women with peripartum cardiomyopathy and 20 women with chronic hypertension," Chor said.
The investigators found that women collectively described a spectrum regarding the degree to which they considered their cardiovascular disease when thinking about their reproductive health, including future fertility, contraceptive use, and pregnancy termination, as well as the degree to which they considered the impact of reproductive health on their cardiovascular disease.
"The impact of cardiovascular disease on women's future fertility planning is affected by non-modifiable factors (the context of diagnosis and reproductive health experiences) and modifiable factors (the setting of contraceptive care and conceptualization of risk). These factors must be addressed in order to optimize the reproductive trajectory of women with cardiovascular disease towards avoiding unplanned pregnancies or planning pregnancy safely," Chor said.
In another study, Adam J. Wolfberg, M.D., M.P.H., of Tufts Medical Center in Boston, and colleagues developed a reliable, validated survey instrument using focus groups and pilot testing to identify factors that most influence the attitudes of obstetrician/gynecologists (Ob-Gyns) about practicing in the current medico-legal environment. The investigators surveyed a sample of 10,000 Ob-Gyns practicing in the United States.
Of 733 physicians in general Ob-Gyn practice or maternal-fetal medicine with complete data available, the investigators found that 75 percent had been named in a liability lawsuit and 31 percent had an ongoing claim. The data revealed that medical liability caused physicians to experience an overall diminished quality of life (30 percent), lower job satisfaction (37 percent), and feelings of anxiety or depression (33 percent). In addition, 82 percent of physicians reported that medical liability caused some stress or a great deal of stress in their lives, with 66 percent stating medical malpractice negatively impacted their personal financial status. As a result, practitioners reported that medical liability caused them to be more diligent in providing patient care (50 percent).
"The impact of medical liability is more than financial, and affects the quality of life of practicing physicians, and influences the care they provide to their patients," the authors write.
Beth Lewis, M.D., M.P.H., of the Saint Peters University Hospital in New Brunswick, N.J., and colleagues performed a retrospective chart review of 64 consecutive clinic patients and 41 private patients for six months to compare total pregnancy weight gain between clinic and private patients with gestational diabetes.
The investigators found no significant difference in the average weight gain in pounds between the clinic and private patients. The average weight gain for Caucasian, Asian-Indian, Hispanic, African/African-American, Far East Asian, and Middle Eastern patients was also not significantly different.
"There was no significant difference in total pregnancy weight gain between clinic and private patients. In addition, ethnicity/race and education level had no impact on weight gain," the authors write.
To evaluate the association between cigarette smoking and postpartum depression, Diana Cheng, M.D., and Lee Hurt, M.P.H., of the Maryland Department of Health and Mental Hygiene in Baltimore, evaluated data from a stratified random sample of 8,074 Maryland mothers who delivered in 2004 to 2008 and completed the Pregnancy Risk Assessment Monitoring System survey two to nine months postpartum. The investigators found that depression was reported by 13 percent of non-smokers, 22 percent of smokers who smoked 10 or fewer cigarettes/day, and 29 percent who smoked more than 10 cigarettes/day. The investigators also found that depression was more common among heavier smokers who did not graduate high school (46 percent) and non-Hispanic black mothers (38 percent).
"Postpartum depression was a significant comorbid condition among new mothers who smoked," the authors write. "Screening and treatment of depression should be considered in all smoking cessation programs that target new mothers."
In a retrospective case-control study, Magdi M. Hanafi, M.D., of Gynecology & Fertility Specialists in Atlanta, found that robotic assisted laparoscopic myomectomy (RALM) was associated with shorter hospital stays, less blood loss, and increased operative time compared with abdominal myomectomy (AM). The investigators evaluated 122 patients with symptomatic leiomyomata who underwent either RALM or AM.
The investigators found that operating time was longer with RALM (mean, 205.43 min) compared to AM (mean, 161.65 min). However, RALM was associated with less blood loss (mean, 110.19 ml versus 176.11 ml) and shorter hospital stays (mean, 1.08 versus 2.35 days).
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