Conversations in Obstetrics and Gynecology

Polycystic Ovarian Syndrome (PCOS) is common, affecting 5 to 15% of women of reproductive age. PCOS can have reproductive, metabolic and psychological implications across the lifespan. This month on COG we talk with Prof Adam Balen about the international evidenced based guideline released in 2018 on the the diagnosis and management of PCOS. Then in journal club we discuss 4 articles: Costello, M. F., et al. "Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility." (2019): hoy021. Smithson, David S., Tannys DR Vause, and Anthony P. Cheung. "No. 362-ovulation induction in polycystic ovary syndrome." Journal of Obstetrics and Gynaecology Canada 40.7 (2018): 978-987. Torres, Pedro J., et al. "Gut microbial diversity in women with polycystic ovary syndrome correlates with hyperandrogenism." The Journal of Clinical Endocrinology & Metabolism 103.4 (2018): 1502-1511. Varanasi, L. Chitra, et al. "Polycystic ovarian syndrome: prevalence and impact on the wellbeing of Australian women aged 16–29 years." Australian and New Zealand Journal of Obstetrics and Gynaecology 58.2 (2018): 222-233. Related papers from the International group: Teede, Helena J., et al. "Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome." Human Reproduction 33.9 (2018): 1602-1618.

Do you ERAS?  You should! ERAS protocols have resulted in shorter length of hospital stay reduced complications, readmissions and costs. This month on COG we talk to  Dr Amanika Kumar, a Gynaecological Oncologist from the Mayo Clinic about Enhanced Recovery After Surgery. Then we check out three articles in journal club along the ERAS theme.   Nensi A, Coll-Black M, Leyland N, Sobel ML. Implementation of a Same-Day Discharge Protocol Following Total Laparoscopic Hysterectomy. Journal of Obstetrics and Gynaecology Canada. 2018 Jan 1;40(1):29-35. Meyer LA, Lasala J, Iniesta MD, Nick AM, Munsell MF, Shi Q, Wang XS, Cain KE, Lu KH, Ramirez PT. Effect of an Enhanced Recovery After Surgery Program on Opioid Use and Patient-Reported Outcomes. Obstetrics & Gynecology. 2018 Aug 1;132(2):281-90. Keil DS, Schiff LD, Carey ET, Moulder JK, Goetzinger AM, Patidar SM, Hance LM, Kolarczyk LM, Isaak RS, Strassle PD, Schoenherr JW. Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery. Anesthesia and analgesia. 2018 Apr.   Also here’s the link to a new publication on recommendations for ERAS in CS… Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L. Guidelines for intraoperative care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. American journal of obstetrics and gynecology. 2018 Aug 15. #COG #COG11 #ERAS #FOAMEd #MayoClinic  

Can we close the orgasm gap? Recent US data suggests that only 65% of heterosexual women usually orgasm during sex, compared with 95% of heterosexual men. In the same study 88% of lesbian women reported usual orgasm during sex. Dr Debra Wickman’s work focuses on helping women achieve great sex. This month on COG we talk about how to ask the difficult questions, and what interventions might help.   Then on journal club, we discuss 2 recent papers. Szell N, Komisaruk B, Goldstein SW, Qu XH, Shaw M, Goldstein I. A meta-analysis detailing overall sexual function and orgasmic function in women undergoing midurethral sling surgery for stress incontinence. Sexual medicine. 2017 Jun 1;5(2):e84-93. McDonald E, Woolhouse H, Brown SJ. Sexual pleasure and emotional satisfaction in the first 18 months after childbirth. Midwifery. 2017 Dec 1;55:60-6.

Persistent pelvic pain is common, affecting 15-25% of women. Women experiencing persistent pelvic pain often experience a delay in diagnosis and may also experience associated negative psychological, behavioural, cognitive and sexual consequences sometime worsened because of this delay. Check out this excellent presentation  “Persistent Pelvic Pain - The Big Picture - Dr Susan Evans” from Pelvic Pain Foundation on Vimeo.   https://vimeo.com/163056418. Treating women with persistent pain can be complex - but there is hope!  This month on COG we talk to Dr Sawsan As-Sanie about the evolving science around chronic pelvic pain, and optimal  techniques for diagnosis and management. Then journal club explores 3 offerings from the latest literature.   In journal club we discuss 3 articles: Allaire, Catherine, et al. "Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort." American journal of obstetrics and gynecology 218.1 (2018): 114-e1. As-Sanie, Sawsan, et al. "Opioid prescribing patterns, patient use, and postoperative pain after hysterectomy for benign indications." Obstetrics & Gynecology 130.6 (2017): 1261-1268. Saxena, Rahul, et al. "Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain." International journal of yoga 10.1 (2017): 9.    

COG#8 - Evidence Research underpins advancements in women’s health around the world. This month we talk to Nancy Chescheir, the Editor in Chief of ‘Obstetrics and Gynecology’ aka the Green Journal about her work to improve women’s health globally.  The articles referenced during the discussion include: Arya R. Postpartum venous thromboembolism prophylaxis: harm versus benefit. BJOG: An International Journal of Obstetrics & Gynaecology. 2018 Feb 23. Skeith AE, Niu B, Valent AM, Tuuli MG, Caughey AB. Adding Azithromycin to Cephalosporin for Cesarean Delivery Infection Prophylaxis: A Cost-Effectiveness Analysis. Obstetrics & Gynecology. 2017 Dec 1;130(6):1279-84

51% of Australian women have had an unplanned pregnancy. This month on COG we talk about contraception. The World Health Organisation estimates that if every couple used contraception perfectly every single time they had sex, there would still be six million unplanned pregnancies each year worldwide.  First up we talk to Dr Catrina Melville, an Obstetrician and Gynecologist who specialises in sexual health.  Then we chat with Dr Ander Faber-Swenson about the current evidence around salpingectomy as a sterilisation procedure and prevention of ovarian cancer.  The articles he references are here: Dilley, Sarah E., J. Michael Straughn Jr, and Charles A. Leath III. "The Evolution of and Evidence for Opportunistic Salpingectomy." Obstetrics & Gynecology 130.4 (2017): 814-824. Falconer, Henrik, et al. "Ovarian cancer risk after salpingectomy: a nationwide population-based study." Journal of the National Cancer Institute 107.2 (2015): dju410.   In journal club we discuss 4 articles: Iversen, Lisa, et al. "Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study." American Journal of Obstetrics & Gynecology 216.6 (2017): 580-e1. Lathrop, Eva, et al. "The Zika Contraception Access Network: a feasibility programme to increase access to contraception in Puerto Rico during the 2016–17 Zika virus outbreak." The Lancet Public Health (2018). Eggebroten, Jennifer L., Jessica N. Sanders, and David K. Turok. "Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis." American Journal of Obstetrics & Gynecology 217.1 (2017): 51-e1. Roberts, Timothy A., and Shana Hansen. "Association of Hormonal Contraception with depression in the postpartum period." Contraception 96.6 (2017): 446-452.

Mental health problems affect up to 20% of women around the time of pregnancy and birth. This month we talk to Dr Jo Black, a perinatal psychiatrist from Devon in the UK and an associate director of the NHS’ National Perinatal Mental Health Strategy. We discuss some findings from the Australian Institute of Health and Wellbeing’s latest maternal mortality report: Australian Institute of Health and Welfare 2017. Maternal deaths in Australia 2012–2014. Cat. no. PER 92. Canberra: AIHW.   In journal club we discuss 3 articles: Hewitt, Belinda, Lyndall Strazdins, and Bill Martin. "The benefits of paid maternity leave for mothers' post-partum health and wellbeing: Evidence from an Australian evaluation." Social Science & Medicine 182 (2017): 97-105.   Gressier, Florence, et al. "Risk factors for suicide attempt in pregnancy and the post-partum period in women with serious mental illnesses." Journal of psychiatric research 84 (2017): 284-291.   Yildiz, Pelin Dikmen, Susan Ayers, and Louise Phillips. "The prevalence of posttraumatic stress disorder in pregnancy and after birth: a systematic review and meta-analysis." Journal of affective disorders 208 (2017): 634-645.  

How many Caesareans is too many? This month we talk to Professor Aaron B Caughey about the Caesarean epidemic. Aaron is the Chair of Obstetrics and Gynecology and Associate Dean for Women’s Health Research and Policy at Oregon Health and Science University in Portland, Oregon. He was the lead author on the statement published by the American College of Obstetricians and Gynecologists and Society for Maternal–Fetal Medicine about the safe reduction of the primary caesarean delivery.  Caughey, Aaron B., et al. "Safe prevention of the primary cesarean delivery." American journal of obstetrics and gynecology 210.3 (2014): 179-193. Then in journal club we discuss three articles: O'Donovan, Charles, and James O'Donovan. "Why do women request an elective cesarean delivery for non‐medical reasons? A systematic review of the qualitative literature." Birth (2017). Muraca, Giulia M., et al. "Perinatal and maternal morbidity and mortality among term singletons following midcavity operative vaginal delivery versus caesarean delivery." BJOG: An International Journal of Obstetrics & Gynaecology (2017). Nelson, Karin B., Thomas P. Sartwelle, and Dwight J. Rouse. "Electronic fetal monitoring, cerebral palsy, and caesarean section: assumptions versus evidence." Obstetrical & Gynecological Survey 72.4 (2017): 207-209.

In October’s conversation in Obstetrics and Gynecology we chat with Professor Ian Hammond, a Gynaecologic Oncologist from Perth about the renewed cervical screening program in Australia.  With implementation of the guidelines commencing in December 2017, it's a great time to brush up on the evidence behind the new recommendations.  Journal club looks at three articles along the same theme.    Small, William, et al. "Cervical cancer: A global health crisis." Cancer (2017).   Velentzis, L. S., et al. "How will transitioning from cytology to HPV testing change the balance between the benefits and harms of cervical cancer screening? Estimates of the impact on cervical cancer, treatment rates and adverse obstetric outcomes in Australia, a high vaccination coverage country." International journal of cancer (2017).   Berman, Tara A., and John T. Schiller. "Human papillomavirus in cervical cancer and oropharyngeal cancer: One cause, two diseases." Cancer (2017).  

In September’s conversation in Obstetrics and Gynecology we talk to Dr Scott White, a maternal fetal medicine specialist from Perth about the Western Australian Prevention of Preterm Birth Initiative. Ted and Rachael discuss cervical length screening in low and high risk populations. Then we have a quick chat with Dr Anders Faber-Swensson, a general O&G about the evidence around fetal fibronectin.    Peaceman, Alan M., et al. "Fetal fibronectin as a predictor of preterm birth in patients with symptoms: a multicenter trial." American journal of obstetrics and gynecology 177.1 (1997): 13-18.   Berghella, Vincenzo, and Gabriele Saccone. "Fetal fibronectin testing for prevention of preterm birth in singleton pregnancies with threatened preterm labor: a systematic review and metaanalysis of randomized controlled trials." American journal of obstetrics and gynecology 215.4 (2016): 431-438.   Berghella V, Hayes E, Visintine J, Baxter JK. Fetal fibronectin testing for reducing the risk of preterm birth. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006843. DOI: 10.1002/14651858.CD006843.pub2   Journal club discusses 3 articles related to preterm birth: Newnham, John P., et al. "Reducing preterm birth by a statewide multifaceted program: an implementation study." American journal of obstetrics and gynecology 216.5 (2017): 434-442.   Liu, Can, et al. "Prenatal parental depression and preterm birth: a national cohort study." BJOG: An International Journal of Obstetrics & Gynaecology 123.12 (2016): 1973-1982.   Norman, Jane Elizabeth, et al. "Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial." The Lancet 387.10033 (2016): 2106-2116.