Obstetrical & Gynecological Survey最新文献

{"title":"Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation","authors":"Abigail Davenport, Yi Li, Emily Melvin, Arthur Arcaz, Lucie Lefbom, Cheryl B. Iglesia, Alexis A. Dieter","doi":"10.1097/ogx.0000000000001201","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001201","url":null,"abstract":"ABSTRACT Common issues after pelvic reconstructive surgery are incomplete bladder emptying and urinary retention, often resulting in placement of an indwelling transurethral Foley catheter, which then remains until a patient returns to the office. Catheterization is significantly distressing for women undergoing these procedures and burdensome due to travel to the office during the postoperative period. In addition, in-office voiding trials add to the workload of health care professionals and staff. A potential alternative is at-home self-discontinuation of the Foley catheter. This study's primary aim was the comparison of the rates of health care utilization (calls, messages, office visits, and emergency department [ED] visits) and postoperative complications within 30 days of surgery among patients with voiding trials on the day of surgery, versus those with Foley placement and void trials on postoperative day 1. Secondary objectives included identifying risk factors for unsuccessful voiding trials and exploring any complications associated with catheter self-discontinuation. This study was designed as a prospective observational cohort study at 1 academic institution and included outpatient women undergoing outpatient urogynecologic or minimally invasive gynecological surgery for benign indications between August 2021 and January 2022. Qualifying patients included cisgendered English-speaking women of at least 18 years of age who exhibited postoperative urinary retention on the day of surgery. Excluded were patients with any preoperative degree of urinary retention (defined as any observation of a postvoid residual more than 200 mL), known upper motor neuron disease, and patients undergoing surgeries with concomitant extra pelvic procedures or minor procedures not requiring a postoperative voiding trial. Based on the exploratory nature of this study, primarily for determining safety and feasibility, the convenience sample size of 50 was set, and patients were recruited at the time of their unsuccessful voiding trials on the day of surgery. On the day of surgery, medical staff performed voiding trials in the postoperative anesthesia care unit, backfilling the bladder with 200 mL of sterile fluid. The void trial was successful if this was followed by a patient void of at least 150–200 mL, otherwise the voiding trial was marked as unsuccessful. Unsuccessful trials resulted in the insertion of an indwelling Foley catheter, followed by verbal and written instruction for performing a home-based, patient-led catheter self-discontinuation at 6:00 am on postoperative day 1. Instructions for catheter removal included pictures and written information. After removal, if the patient failed to void 150 mL within 6 hours, they were instructed to return to the office for additional care. Perioperative data collected from charts included age, parity, body mass index, self-reported race, surgical location, smoking status, periprocedural antibiotics, operative i","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cesarean Delivery Trends Among Patients at Low Risk for Cesarean Delivery in the US, 2000–2019","authors":"Anna M. Frappaolo, Teresa C. Logue, Dena Goffman, Lisa M. Nathan, Jean-Ju Sheen, Maria Andrikopoulou, Timothy Wen, Mary E. D'Alton, Alexander M. Friedman","doi":"10.1097/01.ogx.0000979652.08372.3b","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979652.08372.3b","url":null,"abstract":"ABSTRACT Cesarean delivery is a method of improving outcomes for both mothers and neonates when there are medical complications to vaginal delivery. When used unnecessarily, however, it causes increased risks for adverse outcomes as a major surgery. Limited data and investigations have prevented some previous analyses of trends in cesarean deliveries, especially when classifying them as necessary or unnecessary. This study was designed to determine temporal trends in cesarean deliveries among low-risk patients over a 20-year period and to analyze trends in specific cesarean delivery indications. This study was designed as a repeated cross-sectional analysis among patients at low risk for cesarean delivery. The authors utilized the National Inpatient Sample data set, and then patients with conditions previously associated with an increased risk of cesarean delivery (eg, obesity) were excluded. Primary outcomes included temporal trends in the number of cesarean deliveries, as well as trends related to diagnoses of nonreassuring fetal status, labor arrest, or obstructed labor (including disproportion). Between 2000 and 2019, 40,517,867 eligible low-risk deliveries were identified. Of these, 4,885,716 were cesarean deliveries. The overall rate of cesarean delivery increased between 2000 and 2009 (from 9.7% to 13.9%) and then decreased between 2012 and 2019 (from 13% to 11.1%). The average annual percentage change (AAPC) from 2000 to 2005 was 6.4% (95% confidence interval [CI], 5.2%–7.6%), with a plateau from 2005 to 2009 (AAPC, 1.2%; 95% CI, −1.2% to 3.7%) and then a decrease from 2009 to 2019 (AAPC, −2.2%; 95% CI, −2.7% to −1.8%). Deliveries associated with the diagnosis of nonreassuring fetal status increased between 2000 and 2019 (AAPC, 2.1%; 95% CI, 1.7%–2.5%); those associated with labor arrest peaked in 2009 at 4.8% and then decreased to 2.7% in 2019 (AAPC 2009–2019, −5.6%; 95% CI, −6.6% to −4.6%). In contrast, cesarean deliveries due to obstructed labor continuously decreased from 2000 to 2019 (AAPC, −8.6%; 95% CI, −10.0% to −7.1%). After accounting for demographic and hospital characteristics, analysis showed that patients were at increased risk of cesarean delivery if they were between 35 and 39 years of age compared with the younger group of 25 to 29 years (adjusted odds ratio [aOR], 1.27; 95% CI, 1.25–1.28), if they delivered at a hospital in the South versus the Northeast (aOR, 1.11; 95% CI, 1.07–1.15), and if they were non-Hispanic Black versus non-Hispanic White (aOR, 1.23; 95% CI, 1.20–1.25). Overall trends showed increasing rates of cesarean delivery in the first 10 years of the study, but then decreasing rates for the final 10 years. Rates associated with diagnoses of nonreassuring fetal status increased over the study period, and those associated with labor arrest or obstruction decreased. The increase of cesarean delivery due to nonreassuring fetal status when compared with the overall trend of decreasing cesarean deliveries indica","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sacrospinous Fixation and Vaginal Uterosacral Suspension-Evaluation in Uterine Preservation Surgery","authors":"Katherine L. Woodburn, Angela S. Yuan, Michele Torosis, Kasey Roberts, Cecile A. Ferrando, Robert E. Gutman","doi":"10.1097/ogx.0000000000001200","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001200","url":null,"abstract":"ABSTRACT Although hysterectomy is traditionally performed at the time of pelvic organ prolapse repair for apical prolapse, women are increasingly interested in uterine preservation during pelvic organ prolapse surgical management. Approximately 36% to 60% of women indicate interest in uterine preservation, assuming equal efficacy. This has led to more uterus-preserving prolapse repairs (hysteropexy) being performed. After the removal of mesh products from the US market in 2019, transvaginal native tissue techniques are commonly used for hysteropexy. This study aimed to compare 6-week and 1-year anatomical failure rates between vaginal uterosacral ligament hysteropexy and sacrospinous ligament hysteropexy. Secondary outcomes included retreatment for prolapse, symptoms of recurrent prolapse, and perioperative adverse event rates in these 2 groups. This was a multicenter retrospective cohort study of patients undergoing vaginal uterosacral hysteropexy (USHP) or sacrospinous hysteropexy (SSHP) with a urogynecologist between January 1, 2015 and December 31, 2019. The pool of patient data was extrapolated from 4 geographically unique urban locations. Patient identification took place via querying the respective electronic medical records for the current procedural terminology codes of extraperitoneal colpopexy (57,282, SSHP) and intraperitoneal colpopexy (57,283, USHP). These operative reports underwent review in order to confirm that each patient had a uterus at time of surgery, underwent either USHP or SSHP, and did not undergo concurrent hysterectomy. Exclusion criteria included patients undergoing different types of uterine-preserving procedures or patients with less than 6 weeks of follow-up. The study included 147 patients undergoing SSHP and 114 having USHP over 5 years at the 4 clinical sites. The study population included mostly nonsmoking (179, 68.6%), White (224, 85.5%) patients with no history of pelvic surgery (142, 54.4%), and a mean Charleston Comorbidity Index score of 2. Overall, USHP patients exhibited a higher likelihood to undergo concurrent anterior repair, posterior repair, and incontinence procedures. The follow-up rate was 95% at 6 postoperative weeks with 4 anatomic failures. Not all patients had formal prolapse quantitation examinations recorded. However, only 32% (83/261) of patients were available for follow-up at 1 year after surgery when 10 patients met criteria for anatomic failure. Notably, although there was no statistically significant difference between failure rates for SSHP and USHP at either time point, there were roughly 3 times as many failures for USHP compared with SSHP, despite the SSHP representing a larger portion of the total cohort. At 1 year, however, 26 patients had undergone retreatment for prolapse, with 12 undergoing hysterectomy (11 due to prolapse, 1 due to colorectal cancer debulking). Of those undergoing hysterectomy, 10 were from the SSHP cohort, whereas 1 was from the USHP cohort. The 1 year ana","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Vault Infiltration With Bupivacaine for Postoperative Pain Control After Total Laparoscopic Hysterectomy: A Randomized Control Trial","authors":"Kallol Kumar Roy, Poojitha Kalyani Kanikaram, Nilanchali Singh, Vimi Riwari, Rinchen Zangmo, Jyoti Meena, Anamika Das, Deepika Kashyap, Archana Minz","doi":"10.1097/ogx.0000000000001194","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001194","url":null,"abstract":"ABSTRACT A viable alternative to total abdominal hysterectomy is total laparoscopic hysterectomy (TLH), which offers abdominal route advantages for women in need of total hysterectomy for benign diseases. Fewer complications, faster recovery, and less pain are ensured by laparoscopy, although this method is not entirely devoid of pain. Reports from various authors indicate that up to 80% of laparoscopic surgery patients require opioid analgesia, which could increase hospital-stay duration and delay mobilization/recovery. Because of these statistics, opioid analgesic usages ought to be minimized, for the aforementioned reasons and also to prevent additional adverse effects. This study was performed to evaluate efficacy of reducing postoperative pain by infiltration of bupivacaine, a long-acting anesthetic agent, into the vaginal vault after TLH. This study was a randomized control trial designed as a 2-arm double-blinded study conducted at a North-Indian Apical Center in the Department of Obstetrics and Gynecology. After written informed consent from all patients, computer-generated randomization software placed them in 1 of 2 groups: group 1, the intervention group (received the infiltration of bupivacaine in the vaginal vault following TLH), or group 2 (the control group). The inclusion criteria were a uterine size of ≤12 weeks' pregnancy and patients requiring TLH with or without bilateral salpingo-oophorectomy for uterine size and benign conditions. Exclusion criteria were contraindication to any medication used by the study, presence of malignancy, history of multiple surgeries, and history of inflammatory disease. Postoperative pain outcome measured in both groups at 1, 3, 6, 12, and 24 hours via a visual analog score was the primary outcome. The secondary outcome was the need for rescue analgesia. A complete profile of each patient was created, using eligibility criteria, body mass index, and demographic profile, and a complete gynecological and physical examination was performed, along with preoperative investigations for fitness to general anesthesia. Per standard protocol, general anesthesia was administered for all surgeries. After vault closure, a fine-tipped aspiration needle was used to administer 10 mL of bupivacaine, which was infiltrated laparoscopically at 2 different locations, approximately 2–4 cm apart. The control group omitted this step. In the first 24 hours after operation, pain was treated using 1 g intravenous paracetamol every 6 hours. For the next 5 days, patients were given nonsteroidal anti-inflammatory drugs (diclofenac) 3 times daily for 5 days. Participants scaled their pain using the visual analog scale (VAS) score at the 1, 2, 6, 12, and 24 hours intervals postsurgery. Scores greater than 4 initiated the distribution of tramadol 50 mg intramuscular. Also recorded were the uterine weight, the operative time, complications, and the amount of operative bleeding. Group 1 patients exhibited VAS scores of less than 4 ","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Predictive Value of Prenatal Cell-Free DNA Testing for Rare Autosomal Trisomies: A Systematic Review and Meta-analysis","authors":"Melissa L. Acreman, Sofia Bussolaro, Yvette C. Raymond, Ilaria Fantasia, Daniel L. Rolnik, Fabricio Da Silva Costa","doi":"10.1097/01.ogx.0000979668.10711.82","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979668.10711.82","url":null,"abstract":"ABSTRACT Noninvasive prenatal testing has been a reliable method for prenatal screening for the common autosomal trisomies for the last decade. It has been analyzed in many prospective studies for accuracy in screening for the most common trisomies—13, 18, and 21—and the technology has continued to progress. With high accuracy for common trisomies, advances are attempting to expand noninvasive prenatal testing for identifying rare autosomal trisomies, such as trisomies 7, 15, 16, and 22; sex chromosome aneuploidies; and segmental copy number variants. Although cell-free DNA (cfDNA) technology is now available to screen for these abnormalities, accuracy and detection rates have not been well studied. This systematic review analyzes and reports the diagnostic accuracy of cfDNA screening for the rare autosomal trisomies. This review included case series with 10 or more cases that reported on the accuracy of cfDNA in reporting rare autosomal trisomies that were confirmed by diagnostic results or postnatal genetic testing; the final review included 31 studies. Methodological analysis found the risk of bias to be high in most studies, with only 5 rated as high quality and low risk in all domains. All studies included in the final analyses were published between 2017 and 2022, and study populations ranged from 14 to 153,575 patients. Indications for screening and characteristics of the patients varied from study to study, with 12 studies in high-risk women, 10 studies in the general obstetric population, and 9 studies without inclusion of underlying risk factors and indications. Whole-genome sequencing was used in all studies as testing methodology. Testing timing varied and was performed anywhere from gestational week 8 to week 39. In the 3 studies that analyzed sensitivity and specificity of cfDNA testing, sensitivity ranged from 87.2% to 100%, and specificity ranged from 90.7% to 99.9%. In all 3 of these studies, there were significant limitations that led authors to acknowledge the difficulty of drawing clear conclusions about sensitivity and specificity from their data. Meta-analysis performed for positive predictive value (PPV) provided a pooled estimate of 11.46% (95% confidence interval [CI], 7.80%–15.65%). Sensitivity analysis including only studies at low risk of bias gave a PPV of 9.13% (95% CI, 2.49%–18.76%). Analysis was performed again with groups divided into high or low background risk, with a slightly higher PPV in the higher background risk group, but no significant difference between these groups ( P = 0.595). Statistical heterogeneity was not explained by year of publication or baseline risk of participants but could be largely explained by rate of diagnostic follow-up. Studies with a follow-up rate of less than 50% showed a PPV of 23.69% (95% CI, 9.21%–41.94%), whereas studies with a follow-up rate greater than 50% reported a PPV of 8.80% (95% CI, 6.08%–11.90%). Based on the results of this systematic review and meta-analysis, it is","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Cerclage: A Comprehensive Review of Major Guidelines","authors":"Sonia Giouleka, Eirini Boureka, Ioannis Tsakiridis, Antonios Siargkas, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/ogx.0000000000001182","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001182","url":null,"abstract":"Importance Cervical cerclage (CC) represents one of the few effective measures currently available for the prevention of preterm delivery caused by cervical insufficiency, thus contributing in the reduction of neonatal morbidity and mortality rates. Objective The aim of this study was to review and compare the most recently published major guidelines on the indications, contraindications, techniques, and timing of placing and removal of CC. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the International Federation of Gynecology and Obstetrics (FIGO) on CC was carried out. Results There is a consensus among the reviewed guidelines regarding the recommended techniques, the indications for rescue CC, the contraindications, as well as the optimal timing of CC placement and removal. All medical societies also agree that ultrasound-indicated CC is justified in women with history of prior spontaneous PTD or mid-trimester miscarriage and a short cervical length detected on ultrasound. In addition, after CC, serial sonographic measurement of the cervical length, bed rest, and routine use of antibiotics, tocolysis, and progesterone are unanimously discouraged. In case of established preterm labor, CC should be removed, according to ACOG, RCOG, and SOGC. Furthermore, RCOG and SOGC agree on the prerequisites that should be met before attempting CC. These 2 guidelines along with FIGO recommend history-indicated CC for women with 3 or more previous preterm deliveries and/or second trimester pregnancy miscarriages, whereas the ACOG suggests the use of CC in singleton pregnancies with 1 or more previous second trimester miscarriages related to painless cervical dilation or prior CC due to painless cervical dilation in the second trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue CC remains a matter of debate. Conclusions Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm delivery in women considered as high-risk for these common pregnancy complications. The development of universal international practice protocols for the placement of CC seems of paramount importance and will hopefully improve the outcomes of such pregnancies. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be able to identify the indications and contraindications of cervical cerclage; evaluate the prerequisites before cervical cerclage placement; and explain the strategies for perioperative and postoperative care after cervical cerclage placement.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azithromycin to Prevent Sepsis of Death in Women Planning a Vaginal Birth","authors":"A.T.N. Tita, W.A. Carlo, E.M. McClure, M. Mwenechanya, E. Chomba, J.J. Hemingway-Foday, A. Kavi, M.C. Metgud, S. S. Goudar, R. Derman, A. Lokangaka, A. Tshefu, M. Bauserman, C. Bose, P. Shivkumar, M. Waikar, A. Patel, P.L. Hibberd, P. Nyongesa, F. Esamai, O.A. Ekhaguere, S. Bucher, S. Jessani, S.S. Tikmani, S. Saleem, R. L. Goldenberg, S.M. Billah, R. Lennox, R. Haque, W. Petri, L. Figueroa, M. Mazariegos, N.F. Krebs, J.L. Moore, T.L. Nolen, M. Koso-Thomas","doi":"10.1097/ogx.0000000000001199","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001199","url":null,"abstract":"ABSTRACT A high proportion of peripartum maternal deaths are caused by infection and sepsis, and this proportion continues to rise. In addition, neonatal sepsis is the third most common cause of neonatal death; the 2 conditions are connected in that maternal infection causes an increased risk of neonatal sepsis. Recent studies have shown azithromycin to be effective in reducing instances of maternal infection after an unplanned cesarean delivery, but its effectiveness for infections related to vaginal delivery has not yet been examined. This study, A-PLUS (Azithromycin Prevention in Labor Use Study), was designed to investigate the effectiveness of azithromycin in women planning a vaginal delivery. This study was conducted as a multicountry, double-blind, placebo-controlled, randomized trial over 8 sites in 7 countries. Primary outcomes included maternal sepsis or death within 6 weeks of delivery, as well as stillbirth, neonatal death, or sepsis within 4 weeks of delivery. Secondary maternal outcomes included related components, such as specific infections of chorioamnionitis, endometritis, perineal wound infection, abdominal or pelvic abscess, mastitis or breast abscess, pneumonia, or pyelonephritis, as well as therapeutic use of antibiotics, duration of hospital stay, readmission, admission to a special care unit, and unscheduled health care visits. Secondary outcomes relating to neonates included similar components, specific infection, the duration of hospital stay, readmission, admission to a special care unit, unscheduled health care visits, and safety outcomes (adverse events related to medication). Final analysis included 29,278 women, with 14,590 women (and 14,687 neonates or stillbirths) in the azithromycin group and 14,688 women (and 14,782 neonates or stillbirths) in the placebo group. Maternal sepsis or death was observed in 227 patients in the azithromycin group and 344 patients in the placebo group (adjusted relative risk, 0.67; 95% confidence interval [CI], 0.56–0.79; P < 0.001). Sepsis was the case in 219 in the azithromycin group and 339 in the placebo group (relative risk, 0.65; 95% CI, 0.55–0.77), and death from sepsis was rare. For neonates, stillbirth, death, or sepsis was observed in 1540 in the azithromycin group and 1526 in the placebo group (relative risk, 1.02; 95% CI, 0.95–1.09), with sepsis accounting for 1433 and 1407 cases in the azithromycin and placebo groups, respectively. Both the outcomes of stillbirth and neonatal death were relatively uncommon. Maternal adverse effects experienced from the medication were not significantly different between groups, and the azithromycin group had noticeably reduced risk of endometritis, wound infections, and several others when compared with the placebo group. These results indicate that azithromycin is consistently effective in lowering the risk of infection and sepsis in mothers and infants during vaginal delivery. The number treated to prevent 1 case of maternal death or sep","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death A Randomized Clinical Trial","authors":"Anna Roca, Bully Camara, Joel D. Bognini, Usman N. Nakakana, Athasana M. Somé, Nathalie Beloum, Toussaint Rouamba, Fatoumata Sillah, Madikoi Danso, Joquina C. Jones, Shashu Graves, Isatou Jagne, Pauline Getanda, Saffiatou Darboe, Marc C. Tahita, Ebrahim Ndure, Hien S. Franck, Sawadogo Y. Edmond, Bai L. Dondeh, Wilfried G. J. Nassa, Zakaria Garba, Abdoulie Bojang, Yusupha Nije, Christian Bottomley, Halidou Tinto, Umberto D'Alessandro","doi":"10.1097/01.ogx.0000979648.94036.ac","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979648.94036.ac","url":null,"abstract":"ABSTRACT Sepsis is a leading cause of neonatal mortality, and rates have not decreased in recent years despite medical advances. Azithromycin has been shown in previous research to be effective in reducing infection and sepsis; in particular, a recent study showed that administration of the drug during labor reduced gram-positive bacteria over the next 4 weeks, along with reduced disease in mothers and newborns. This study was designed to assess the effectiveness of azithromycin administered during labor in reducing instances of neonatal sepsis and mortality. The primary outcome for this study was neonatal sepsis or death within the first 28 days of life. Deaths that were identifiably due to severe birth asphyxia, low birth weight, and severe congenital malformations were excluded. Secondary outcomes included neonatal sepsis, neonatal mortality, culture-confirmed sepsis, fever, skin infections, bacterially confirmed skin infections, conjunctivitis, umbilical infection/omphalitis, malaria, prescribed antibiotics, and hospitalization. Secondary outcomes for parents included postpartum sepsis, bacterially confirmed postpartum sepsis, mastitis, malaria, puerperal fever, prescribed antibiotics, hospitalization, and mortality. The final analysis included 11,625 parents and 11,783 neonates; baseline characteristics between the azithromycin and placebo groups were not significantly different. Of the total sample, 225 instances of neonatal sepsis or death occurred. The incidence of either mortality or sepsis was similar between groups (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.80–1.38; P = 0.70), as well as the individual outcomes of mortality (OR, 1.05; 95% CI, 0.70–1.60; P = 0.80) and sepsis (OR, 1.02; 95% CI, 0.74–1.40; P = 0.92). Incidence of neonatal skin infections ( P < 0.001), bacterially confirmed skin infections ( P = 0.003), and need for antibiotics ( P < 0.001) were all significantly reduced in the azithromycin group. Azithromycin reduced instances of both mastitis ( P = 0.04) and puerperal fever ( P = 0.04), but there were no other significant differences between groups. These results indicate no effect of azithromycin on neonatal sepsis or mortality. There were reductions in some instances of infection in both parents and newborns, specifically newborn skin infections, but there was no effect on the primary outcome. These results are in contrast to the previous proof-of-concept trial that showed azithromycin to reduce the amount of gram-positive bacteria carried by mothers and infants. Recent studies from different countries have found some conflicting results in longer-term outcomes, but the differing time periods limit comparison of results. This study was limited by underestimation of incidence of infections due to follow-up design, as well as slight differences between the 2 countries involved in the study. Overall, the results of this analysis do not support a change in clinical practice to introduce azithromycin to prevent","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of the Endometrial Thickness on the Live Birth Rate: Insights From 959 Single Euploid Frozen Embryo Transfers Without a Cutoff For Thickness","authors":"Baris Ata, Alberto Linan, Erkan Kalafat, Francisco Ruíz, Laura Melado, Asina Bayram, Ibrahim Elkhatib, Barbara Lawrenz, Human M. Fatemi","doi":"10.1097/01.ogx.0000979684.30759.bd","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979684.30759.bd","url":null,"abstract":"ABSTRACT Although numerous studies have examined whether endometrial thickness (ET) independently affects the live birth rate (LBR) after an embryo transfer, contradictory conclusions have resulted in an unclear answer. It has been hypothesized that a thin endometrium decreases implantation rates possibly due to elevated oxygen concentration from spiral arteries; however, this mechanism has not been unequivocally demonstrated. This retrospective analysis aimed to investigate whether ET independently affects the LBR after a frozen embryo transfer cycle. All patients who underwent a single euploid blastocyst transfer between March 2017 and March 2020 at a single-assisted reproductive technology clinic were included. Live birth was defined as the delivery of a live fetus after 22 weeks of gestation. Programmed cycle (PC) or natural cycle (NC) for endometrial preparation was conducted at physician’s and patient’s discretion. The presence of a linear relationship between ET and LBR was assessed by conditional density plots (CDPs), and receiver operating characteristics (ROC) curve analyses were used to identify whether a threshold of the ET existed to predict the occurrence of live birth. The CDPs were analyzed for an optimal range of the ET that could be associated with a higher LBR, and the distribution of cycle characteristics and embryo quality in that range were compared with cycles outside of that range to identify confounders. Logistic regression models were constructed separately for the PC and NC. A total of 959 single euploid FETs were included in this analysis, of which 33% (n = 315) were NC and 67% (n = 644) were PC with an overall LBR of 47.1% (452/959). No linear relationship between the ET and LBR or threshold below which the LBR decreased perceivably was identified. In addition, ROC analysis did not suggest a predictive value of the ET for occurrence of live birth based on endometrial preparation or in the overall cohort. Similarly, logistic regression analyses showed no independent effect of the ET on LBR. The results of this study suggest that there is no linear relationship between the ET and LBR or a clinically significant cutoff for ET below which the LBR decreases in FET cycles. Significantly, the common practice of canceling embryo transfers when the ET is <7 mm is not supported by these data.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CME PROGRAM EXAM AND ANSWER SHEET","authors":"","doi":"10.1097/ogx.0000000000001178","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001178","url":null,"abstract":"","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136172440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}