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Preview: Clinical Obstetrics and Gynecology

Clinical Obstetrics and Gynecology


Post-breastfeeding tissue remodeling explained by new research


A ground-breaking study into the changes that occur in a woman’s breast, from growing into one that provides milk for a new-born, and then back to its normal state, has discovered that milk-producing cells are, in effect, cannibalised by other cells following the period of breastfeeding. The human body can usually cope with the limited amount of detritus created from normal cellular lifecycles through the deployment of immune cells to remove the material. But just how it manages to eradicate the large amounts of dead or redundant mammary cells, and left over milk, following breastfeeding without triggering inflammation due to the quantities of immune cells which would be needed, wasn’t fully known. During the lactation process, women produce vast quantities of milk for their babies - up to nearly a litre per day. To do this breasts change dramatically during pregnancy, developing the tissue so that cells can make lots of milk. But when weaning finishes, the breasts need to be remodelled so that they can return to a non-pregnant form.

Research shows efficacy of steroid use in late preterm delivery


Current recommendations are for all women who go into labor prior to 34 weeks gestation to be given antenatal corticosteroids (betamethasone) to help mature the baby’s lungs. However, many babies born in the late preterm period - between 34 and 36 weeks gestation - require respiratory support at birth. A recently completed study asked the question, “Would neonates born at these later gestational ages also benefit from antenatal corticosteroids?” The answer is “yes” and is detailed in “Antenatal Betamethasone for Women at Risk for Late Preterm Delivery,” a study from the Eunice Kennedy Shriver National Institute of Child and Human Development Maternal Fetal Medicine Units Network (MFMU) with co-sponsorship from the National Heart, Lung and Blood Institute. The research was recently published in the New England Journal of Medicine. Dwight Rouse, MD, of the Division of Maternal-Fetal Medicine at Women & Infants Hospital of Rhode Island, a Care New England hospital, a professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, and the Brown/Women & Infants principal investigator for the MFMU, said, “For many years, obstetric and pediatric providers have known that steroids administered in preterm labor help speed the development of the preterm baby’s lungs at 34 weeks gestation or earlier. This new research has shown that these same steroids when given to women who are at risk for late preterm delivery can significantly reduce the rate of neonatal respiratory complications.”

Salt intake appears to have little impact on bone health in menopausal women


A low-salt diet does not necessarily translate to stronger bones in postmenopausal women, physician-scientists report. “When we started the study, we thought we were going to be telling everyone again that a low-salt diet is good for your bones,” said Dr. Laura D. Carbone, chief of the Section of Rheumatology at the Medical College of Georgia at Augusta University. “Instead our message is low-sodium intake by itself is not likely to be beneficial to your bones. We definitely don’t want to go further than that and say high sodium is good for them,” said Carbone, corresponding author of the study in the Journal of Clinical Endocrinology & Metabolism.

Taming hot flashes without hormones: What works, what doesn’t


Some three-quarters of North American women have menopausal hot flashes, but many cannot use hormones for medical reasons or choose not to. Numerous products and techniques are promoted for hot flashes, but do they work, and are they safe? To answer these questions, a North American Menopause Society (NAMS) panel of experts weighed the evidence and made recommendations in a position statement, “Nonhormonal management of menopause-associated vasomotor symptoms,” published online today in the Society’s journal, Menopause. From 50 to 80 percent of women approaching menopause try nonhormonal therapies for hot flashes. Many don’t really work, and sticking with those therapies can just prolong the misery. With little guidance on what does work, many women just experiment with products or suffer. “Many women try one thing after another, and it is months before they stumble upon something that truly works for them,” said Janet S. Carpenter, PhD, RN, FAAN. US surveys show just how uncertain women are about these therapies, with one survey demonstrating that nearly half feel confused about their options for managing menopause symptoms and another showing that 75% don’t feel fully informed about herbal products. But with this careful, critical look at all the available studies, healthcare providers can confidently advise women on how to handle hot flashes without hormones.

24-hour OBs, midwives lead to less C-sections


Privately insured pregnant women are less likely to have C-sections when their regular care includes midwives and 24-hour obstetrician coverage, according to a study by researchers at UC San Francisco and Marin General Hospital. The study published online in Obstetrics & Gynecology, on Sept. 8, compared the number of C-sections among women with private insurance, before and after an overhaul of staff practices at Marin General Hospital. Prior to April 2011, private patients at this community hospital in Northern California were managed under a conventional model, in which labor and delivery care was provided by a private physician or covering partner. In that model, the physician took calls at home or in the office and generally managed labor remotely, the authors wrote.

Hysterectomy can be safely combined with cosmetic surgery for ‘hanging abdomen’


For women undergoing hysterectomy, removal of “hanging” abdominal fat and skin—a cosmetic procedure called panniculectomy - can be performed at the same surgery without increasing the risk of complications, reports a study in the September issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). “This is among the best evidence to date regarding 30-day risk profiles, and the data suggests that the complication rates are comparable for patients undergoing combined hysterectomy and panniculectomy versus hysterectomy alone,” comments lead author Dr. Antonio Jorge Forte. “In other words, patients may elect to benefit from the convenience of multiple procedures in a single stage associated with the peace of mind of documented safety.” The research was performed at Yale School of Medicine; Dr. Forte is now at the Mayo Clinic, Jacksonville, Fla. No Increase in Complications When Adding Panniculectomy to Hysterectomy Hysterectomy, or removal of the uterus, is among the most common surgical procedures. With the US epidemic of obesity, many women scheduled for hysterectomy are also obese. Dr. Forte explains, “When the obesity is so pronounced that the patient develops a pannus, or ‘hanging abdomen,’ she may become interested in getting rid of the hanging abdominal skin/fat in addition to the original removal of uterus.”

Women undergoing fertility treatment can succeed with fewer hormones


Since the early days of fertility treatment, women undergoing IVF treatment have had to place a hormonal gel in their vagina on a daily basis for at least 14 days after embryo transfer. The hormone is necessary to increase the chances of pregnancy, but it may also cause some side effects in the form of irritation and leaky discharge. However, the results of a new scientific study suggest that women will be able to avoid this kind of discomfort in the future. “Fertility treatment is a physical and mental challenge for childless couples. The daily treatment with hormonal gel after embryo transfer is the part of the treatment which many women find very unpleasant,” says Peter Humaidan, professor at Aarhus University, Denmark, and the fertility clinic at Skive Regional Hospital, Denmark.

Data mining DNA for polycystic ovary syndrome genes


Polycystic ovary syndrome (PCOS) has been passed down in many families for generations - causing reproductive and metabolic health problems for millions of women around the world. Yet, its cause remains unknown despite more than 80 years of research since the disorder was first described in 1935. A new Northwestern Medicine genome-wide association study of PCOS - the first of its kind to focus on women of European ancestry - has provided important new insights into the underlying biology of the disorder. Using the DNA of thousands of women and genotyping nearly 700,000 genetic markers from each individual, an international team led by investigators from Northwestern Medicine have identified two new genetic susceptibility regions that appear to be unique to European women with PCOS, as well as one region also present in Chinese women with PCOS.

The global cost of unsafe abortion


Seven million women a year in the developing world are treated in healthcare facilities for complications following unsafe abortion, finds a study published today (19 August) in BJOG: An International Journal of Obstetrics & Gynaecology (BJOG). Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. Unsafe abortion accounts for 8 - 15% of maternal deaths and remains one of the leading causes of maternal mortality worldwide.[1] However, these figures do not take into account the number of women who are surviving but need hospital treatment. This study, conducted by the Guttmacher Institute in the US, used data from official health statistics and scientific studies from 26 countries in the developing world to calculate the number of women attending hospital for treatment following an unsafe abortion. Data were adjusted to take into account women receiving treatment in the private sector and to exclude those who needed treatment after miscarriage.

C-sections could influence babies’ ability to focus


Being delivered through a caesarean section influences at least one form of babies’ ability to concentrate. It slows their spatial attention, which plays a role in how well they are able to prioritize and focus on a particular area or object that is of interest. These are the findings of Scott Adler and Audrey Wong-Kee-You of York University in Canada, published in Springer’s journal Attention, Perception, & Psychophysics. Very early birth factors such as birth weight and a mother’s age impact the development of a child. However, very little is known about how the actual birth event influences a baby’s cognitive and brain development. Adler and Wong Kee-You’s study is therefore important as it is the first on birth experiences to compare the spatial attention of babies delivered vaginally to those born through caesarean sections. Such research is noteworthy in light of the steadily increasing number of babies delivered through such c-sections. The study shows that the type of birth experience influences one form of infants’ attention, and possibly any cognitive process that relies on spatial attention. It consisted of two experiments involving different groups of three-month-old infants. Their eye movement was monitored, as an indication of what caught the babies’ attention. Eyes cannot move to where someone’s attention is not directed. Therefore, disruptions or changes in the mechanisms involved in attention would manifest in subsequent eye movement.