OBG Management

I understand that you as an ObGyn do not have the time or bandwidth to “vet” the available mobile apps for your practice. However, that does not mean you need to forgo using apps that could make your clinical life a little easier if possible. In this continuation of my “APP review” series, I focus on drug reference apps, which generally include the names of drugs, their indications, dosages, pharmacology, drug-drug interactions, contraindications, cost, and identifying characteristics.¹ Drug reference apps, along with medical calculator and disease diagnosis apps, are reported as most useful by health care professionals and medical or nursing students.¹ Drug reference apps are particularly popular among residents and medical students as the apps allow for rapid decision making.²

I have selected 2 drug reference apps—Epocrates and Medscape—to report here as both of these apps are free and are the only apps that appear in independent comprehensive studies.^1,3 I particularly like Epocrates’ pill identification function for those patients who have forgotten the name of the medication they use but have the actual pill with them. I find Medscape’s additional information on diseases, conditions, and medical procedures especially useful for the times I have forgotten the condition that the medication is indicated for.

The recommended apps are listed in the TABLE alphabetically and are detailed with a shortened version of the APPLICATIONS scoring system, APPLI (app comprehensiveness, price, platform, literature use, and important special features).⁴ Visit the OBG Management website to download the apps featured.

Watch for my next column in which I will recommend, according to APPLI, the top apps for patients to use to track their menstrual cycles.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

I understand that you as an ObGyn do not have the time or bandwidth to “vet” the available mobile apps for your practice. However, that does not mean you need to forgo using apps that could make your clinical life a little easier if possible. In this continuation of my “APP review” series, I focus on drug reference apps, which generally include the names of drugs, their indications, dosages, pharmacology, drug-drug interactions, contraindications, cost, and identifying characteristics.¹ Drug reference apps, along with medical calculator and disease diagnosis apps, are reported as most useful by health care professionals and medical or nursing students.¹ Drug reference apps are particularly popular among residents and medical students as the apps allow for rapid decision making.²

I have selected 2 drug reference apps—Epocrates and Medscape—to report here as both of these apps are free and are the only apps that appear in independent comprehensive studies.^1,3 I particularly like Epocrates’ pill identification function for those patients who have forgotten the name of the medication they use but have the actual pill with them. I find Medscape’s additional information on diseases, conditions, and medical procedures especially useful for the times I have forgotten the condition that the medication is indicated for.

The recommended apps are listed in the TABLE alphabetically and are detailed with a shortened version of the APPLICATIONS scoring system, APPLI (app comprehensiveness, price, platform, literature use, and important special features).⁴ Visit the OBG Management website to download the apps featured.

Watch for my next column in which I will recommend, according to APPLI, the top apps for patients to use to track their menstrual cycles.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

I understand that you as an ObGyn do not have the time or bandwidth to “vet” the available mobile apps for your practice. However, that does not mean you need to forgo using apps that could make your clinical life a little easier if possible. In this continuation of my “APP review” series, I focus on drug reference apps, which generally include the names of drugs, their indications, dosages, pharmacology, drug-drug interactions, contraindications, cost, and identifying characteristics.¹ Drug reference apps, along with medical calculator and disease diagnosis apps, are reported as most useful by health care professionals and medical or nursing students.¹ Drug reference apps are particularly popular among residents and medical students as the apps allow for rapid decision making.²

I have selected 2 drug reference apps—Epocrates and Medscape—to report here as both of these apps are free and are the only apps that appear in independent comprehensive studies.^1,3 I particularly like Epocrates’ pill identification function for those patients who have forgotten the name of the medication they use but have the actual pill with them. I find Medscape’s additional information on diseases, conditions, and medical procedures especially useful for the times I have forgotten the condition that the medication is indicated for.

The recommended apps are listed in the TABLE alphabetically and are detailed with a shortened version of the APPLICATIONS scoring system, APPLI (app comprehensiveness, price, platform, literature use, and important special features).⁴ Visit the OBG Management website to download the apps featured.

Watch for my next column in which I will recommend, according to APPLI, the top apps for patients to use to track their menstrual cycles.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“TRUST: How to build a support net for ObGyns affected by a medical error”

PATRICE M. WEISS, MD (JANUARY 2017)

Support for ObGyn versus “evidence” for attorney

While every clinician recognizes the need to support the practi- tioner involved in a significant medical error, I found it puzzling that Dr. Weiss’ article did not mention our constant after-the-event associate, the personal injury attorney. How are we to provide the needed relief for the practitioner’s emotional distress without handing ammunition to the plaintiff’s lawyer?

E. Darryl Barnes, MD
Mechanicsville, Virginia

Experienced being the second victim

As Dr. Weiss states in her article, patients and their families, the first victims, are not the only ones affected by medical errors. I was involved in a medication error on a labor and delivery unit more than 20 years ago, and I was the second victim. There were also countless others. You are correct when you state that physicians, and others in medicine, do not support colleagues who have experienced a medical error. I agree with Dr. Wu’s observation that lack of empathy by peers is distressing. Symptoms of depression, burnout, decreased quality of life, and feelings of distress, guilt, and shame can occur in the second victim. I hope more people will get on board to use The Joint Commission toolkit to assist health care organizations in developing a second-victim program.

Carol Permiceo, RN
Long Island, New York

Dr. Weiss responds

I thank Dr. Barnes for his comments. The purpose of this article was mainly to assist people in establishing institutional support systems for providers when medical errors occur. Often we are not aware of litigation until some time well after the event. The TRUST second-victim support program and other programs are for immediate first aid for the provider and the team. Concerning the plaintiff’s ammunition, please remember that the purpose of these support systems, whether immediate or ongoing, is to discuss the emotional impact of the case on the provider, not the clinical details of the case.

I appreciate Ms. Permiceo sharing her story. As you probably have figured out, my interest in this area stems from my own experiences with medical errors (one in particular) and unanticipated outcomes. I hope by talking about it and validating our feelings (we are only human, after all) others will suffer less and come forward.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“TRUST: How to build a support net for ObGyns affected by a medical error”

PATRICE M. WEISS, MD (JANUARY 2017)

Support for ObGyn versus “evidence” for attorney

While every clinician recognizes the need to support the practi- tioner involved in a significant medical error, I found it puzzling that Dr. Weiss’ article did not mention our constant after-the-event associate, the personal injury attorney. How are we to provide the needed relief for the practitioner’s emotional distress without handing ammunition to the plaintiff’s lawyer?

E. Darryl Barnes, MD
Mechanicsville, Virginia

Experienced being the second victim

As Dr. Weiss states in her article, patients and their families, the first victims, are not the only ones affected by medical errors. I was involved in a medication error on a labor and delivery unit more than 20 years ago, and I was the second victim. There were also countless others. You are correct when you state that physicians, and others in medicine, do not support colleagues who have experienced a medical error. I agree with Dr. Wu’s observation that lack of empathy by peers is distressing. Symptoms of depression, burnout, decreased quality of life, and feelings of distress, guilt, and shame can occur in the second victim. I hope more people will get on board to use The Joint Commission toolkit to assist health care organizations in developing a second-victim program.

Carol Permiceo, RN
Long Island, New York

Dr. Weiss responds

I thank Dr. Barnes for his comments. The purpose of this article was mainly to assist people in establishing institutional support systems for providers when medical errors occur. Often we are not aware of litigation until some time well after the event. The TRUST second-victim support program and other programs are for immediate first aid for the provider and the team. Concerning the plaintiff’s ammunition, please remember that the purpose of these support systems, whether immediate or ongoing, is to discuss the emotional impact of the case on the provider, not the clinical details of the case.

I appreciate Ms. Permiceo sharing her story. As you probably have figured out, my interest in this area stems from my own experiences with medical errors (one in particular) and unanticipated outcomes. I hope by talking about it and validating our feelings (we are only human, after all) others will suffer less and come forward.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“TRUST: How to build a support net for ObGyns affected by a medical error”

PATRICE M. WEISS, MD (JANUARY 2017)

Support for ObGyn versus “evidence” for attorney

While every clinician recognizes the need to support the practi- tioner involved in a significant medical error, I found it puzzling that Dr. Weiss’ article did not mention our constant after-the-event associate, the personal injury attorney. How are we to provide the needed relief for the practitioner’s emotional distress without handing ammunition to the plaintiff’s lawyer?

E. Darryl Barnes, MD
Mechanicsville, Virginia

Experienced being the second victim

As Dr. Weiss states in her article, patients and their families, the first victims, are not the only ones affected by medical errors. I was involved in a medication error on a labor and delivery unit more than 20 years ago, and I was the second victim. There were also countless others. You are correct when you state that physicians, and others in medicine, do not support colleagues who have experienced a medical error. I agree with Dr. Wu’s observation that lack of empathy by peers is distressing. Symptoms of depression, burnout, decreased quality of life, and feelings of distress, guilt, and shame can occur in the second victim. I hope more people will get on board to use The Joint Commission toolkit to assist health care organizations in developing a second-victim program.

Carol Permiceo, RN
Long Island, New York

Dr. Weiss responds

I thank Dr. Barnes for his comments. The purpose of this article was mainly to assist people in establishing institutional support systems for providers when medical errors occur. Often we are not aware of litigation until some time well after the event. The TRUST second-victim support program and other programs are for immediate first aid for the provider and the team. Concerning the plaintiff’s ammunition, please remember that the purpose of these support systems, whether immediate or ongoing, is to discuss the emotional impact of the case on the provider, not the clinical details of the case.

I appreciate Ms. Permiceo sharing her story. As you probably have figured out, my interest in this area stems from my own experiences with medical errors (one in particular) and unanticipated outcomes. I hope by talking about it and validating our feelings (we are only human, after all) others will suffer less and come forward.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“MANAGEMENT OF WOUND COMPLICATIONS FOLLOWING OBSTETRIC ANAL SPHINCTER INJURY (OASIS)”

ROBERT L. BARBIERI, MD, AND JEANNINE M. MIRANNE, MD, MS (EDITORIAL; DECEMBER 2016)

Delivering clinician should be seated

Indeed, obstetric anal sphincter injuries (OASIS),¹ with their short- and long-term consequences, merit clinical attention, as spotlighted in Dr. Barbieri and Dr. Miranne’s article. An issue not discussed is the position of the obstetrician.

In our practice, we sit down to perform a vaginal delivery, as taught by Soranus of Ephesus.² We strive to be at the bedside sooner than when the nurse calls “she is crowning.” This allows communication with the woman, attending nurse, and support person(s), as well as for a brief review of recent estimated fetal weight, length of the second stage, position of the presenting part, degree of flexion, presence of caput, and other last-minute details. Sitting down in front of the outlet permits uninterrupted visual evaluation of the distention of the soft perineal tissues. All traditional maneuvers are performed comfortably from the sitting position: the vertex is controlled by hands-on, and a quick reach with the nonpredominant hand searches for a loop of cord or a small part procidentia to resolve it. The patient is coached either for the next bearing-down effort or to not push to allow for gradual, controlled delivery of the fetal shoulder girdle. We avoid use of the fetal head for traction and move to facilitate “shrugging” with reduction of the bisacromial to facilitate delivery.

In our experience, the sitting position is ideal to observe uninterruptedly the tension of the perineal body during vertex and shoulders delivery, without having to flex and rotate our back and neck in repeatedly nonergonomic positions.

If an obstetrician of above-average height stands for the delivery, the obstetric bed should be elevated to fit her or his reach. Should shoulder dystocia occur, an assistant will stand on a chair and hover over the maternal abdomen to provide suprapubic pressure (indeed, an indelible memory for any parturient and her family). From the sitting position, exploration of the birth canal and repair of any injury, if necessary, can be conducted without technical impediments.

These simple steps have provided our patients and ourselves with clinical and professional satisfaction with minimal OASIS events as shown by others.³ Ironically, if we successfully avoid perineal injuries, our young trainees may require simulation training to learn this tedious repair procedure. In our geographic practice area, a new “collaborative” expects the frequency of episiotomy to be less than 4.6%. Third- and 4th-degree spontaneous or procedure-related perineal injuries still are used to measure quality of care despite demonstrated reasons for this parameter to be a noncredible metric.

Federico G. Mariona, MD
Dearborn, Michigan

Dr. Barbieri responds

I agree with Dr. Mariona that in some cases the fetal head delivers without causing a 3rd- or 4th-degree laceration, but then the delivery of the posterior shoulder causes a severe perineal injury. Dr. Mariona’s clinical pearl is that the delivering clinician should be seated, carefully observe the delivery of the shoulders, and facilitate fetal shrugging by gently reducing the bisacromial diameter as the posterior shoulder transitions over the perineal body.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“MANAGEMENT OF WOUND COMPLICATIONS FOLLOWING OBSTETRIC ANAL SPHINCTER INJURY (OASIS)”

ROBERT L. BARBIERI, MD, AND JEANNINE M. MIRANNE, MD, MS (EDITORIAL; DECEMBER 2016)

Delivering clinician should be seated

Indeed, obstetric anal sphincter injuries (OASIS),¹ with their short- and long-term consequences, merit clinical attention, as spotlighted in Dr. Barbieri and Dr. Miranne’s article. An issue not discussed is the position of the obstetrician.

In our practice, we sit down to perform a vaginal delivery, as taught by Soranus of Ephesus.² We strive to be at the bedside sooner than when the nurse calls “she is crowning.” This allows communication with the woman, attending nurse, and support person(s), as well as for a brief review of recent estimated fetal weight, length of the second stage, position of the presenting part, degree of flexion, presence of caput, and other last-minute details. Sitting down in front of the outlet permits uninterrupted visual evaluation of the distention of the soft perineal tissues. All traditional maneuvers are performed comfortably from the sitting position: the vertex is controlled by hands-on, and a quick reach with the nonpredominant hand searches for a loop of cord or a small part procidentia to resolve it. The patient is coached either for the next bearing-down effort or to not push to allow for gradual, controlled delivery of the fetal shoulder girdle. We avoid use of the fetal head for traction and move to facilitate “shrugging” with reduction of the bisacromial to facilitate delivery.

In our experience, the sitting position is ideal to observe uninterruptedly the tension of the perineal body during vertex and shoulders delivery, without having to flex and rotate our back and neck in repeatedly nonergonomic positions.

If an obstetrician of above-average height stands for the delivery, the obstetric bed should be elevated to fit her or his reach. Should shoulder dystocia occur, an assistant will stand on a chair and hover over the maternal abdomen to provide suprapubic pressure (indeed, an indelible memory for any parturient and her family). From the sitting position, exploration of the birth canal and repair of any injury, if necessary, can be conducted without technical impediments.

These simple steps have provided our patients and ourselves with clinical and professional satisfaction with minimal OASIS events as shown by others.³ Ironically, if we successfully avoid perineal injuries, our young trainees may require simulation training to learn this tedious repair procedure. In our geographic practice area, a new “collaborative” expects the frequency of episiotomy to be less than 4.6%. Third- and 4th-degree spontaneous or procedure-related perineal injuries still are used to measure quality of care despite demonstrated reasons for this parameter to be a noncredible metric.

Federico G. Mariona, MD
Dearborn, Michigan

Dr. Barbieri responds

I agree with Dr. Mariona that in some cases the fetal head delivers without causing a 3rd- or 4th-degree laceration, but then the delivery of the posterior shoulder causes a severe perineal injury. Dr. Mariona’s clinical pearl is that the delivering clinician should be seated, carefully observe the delivery of the shoulders, and facilitate fetal shrugging by gently reducing the bisacromial diameter as the posterior shoulder transitions over the perineal body.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“MANAGEMENT OF WOUND COMPLICATIONS FOLLOWING OBSTETRIC ANAL SPHINCTER INJURY (OASIS)”

ROBERT L. BARBIERI, MD, AND JEANNINE M. MIRANNE, MD, MS (EDITORIAL; DECEMBER 2016)

Delivering clinician should be seated

Indeed, obstetric anal sphincter injuries (OASIS),¹ with their short- and long-term consequences, merit clinical attention, as spotlighted in Dr. Barbieri and Dr. Miranne’s article. An issue not discussed is the position of the obstetrician.

In our practice, we sit down to perform a vaginal delivery, as taught by Soranus of Ephesus.² We strive to be at the bedside sooner than when the nurse calls “she is crowning.” This allows communication with the woman, attending nurse, and support person(s), as well as for a brief review of recent estimated fetal weight, length of the second stage, position of the presenting part, degree of flexion, presence of caput, and other last-minute details. Sitting down in front of the outlet permits uninterrupted visual evaluation of the distention of the soft perineal tissues. All traditional maneuvers are performed comfortably from the sitting position: the vertex is controlled by hands-on, and a quick reach with the nonpredominant hand searches for a loop of cord or a small part procidentia to resolve it. The patient is coached either for the next bearing-down effort or to not push to allow for gradual, controlled delivery of the fetal shoulder girdle. We avoid use of the fetal head for traction and move to facilitate “shrugging” with reduction of the bisacromial to facilitate delivery.

In our experience, the sitting position is ideal to observe uninterruptedly the tension of the perineal body during vertex and shoulders delivery, without having to flex and rotate our back and neck in repeatedly nonergonomic positions.

If an obstetrician of above-average height stands for the delivery, the obstetric bed should be elevated to fit her or his reach. Should shoulder dystocia occur, an assistant will stand on a chair and hover over the maternal abdomen to provide suprapubic pressure (indeed, an indelible memory for any parturient and her family). From the sitting position, exploration of the birth canal and repair of any injury, if necessary, can be conducted without technical impediments.

These simple steps have provided our patients and ourselves with clinical and professional satisfaction with minimal OASIS events as shown by others.³ Ironically, if we successfully avoid perineal injuries, our young trainees may require simulation training to learn this tedious repair procedure. In our geographic practice area, a new “collaborative” expects the frequency of episiotomy to be less than 4.6%. Third- and 4th-degree spontaneous or procedure-related perineal injuries still are used to measure quality of care despite demonstrated reasons for this parameter to be a noncredible metric.

Federico G. Mariona, MD
Dearborn, Michigan

Dr. Barbieri responds

I agree with Dr. Mariona that in some cases the fetal head delivers without causing a 3rd- or 4th-degree laceration, but then the delivery of the posterior shoulder causes a severe perineal injury. Dr. Mariona’s clinical pearl is that the delivering clinician should be seated, carefully observe the delivery of the shoulders, and facilitate fetal shrugging by gently reducing the bisacromial diameter as the posterior shoulder transitions over the perineal body.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“SHOULDER DYSTOCIA: TAKING THE FEAR OUT OF MANAGEMENT”

JOHN T. REPKE, MD, AND RONALD T. BURKMAN, MD (WEB EXCLUSIVE; APRIL 2016)

Montgomery maneuver for shoulder dystocia

In managing shoulder dystocia, my maneuver is to use my elbow to maximize mechanical advantage when applying suprapubic pressure to push the trapped shoulder down. It works well and is more efficient than having a nurse standing off to the side.

J.S. Montgomery, MD
Cypress, Texas

Dr. Barbieri responds

I thank Dr. Montgomery for sharing his maneuver for dislodging the trapped anterior shoulder by using his elbow to apply suprapubic pressure. There is vast knowledge and experience in our clinical community, and sharing insights is helpful to all our readers.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“SHOULDER DYSTOCIA: TAKING THE FEAR OUT OF MANAGEMENT”

JOHN T. REPKE, MD, AND RONALD T. BURKMAN, MD (WEB EXCLUSIVE; APRIL 2016)

Montgomery maneuver for shoulder dystocia

In managing shoulder dystocia, my maneuver is to use my elbow to maximize mechanical advantage when applying suprapubic pressure to push the trapped shoulder down. It works well and is more efficient than having a nurse standing off to the side.

J.S. Montgomery, MD
Cypress, Texas

Dr. Barbieri responds

I thank Dr. Montgomery for sharing his maneuver for dislodging the trapped anterior shoulder by using his elbow to apply suprapubic pressure. There is vast knowledge and experience in our clinical community, and sharing insights is helpful to all our readers.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“SHOULDER DYSTOCIA: TAKING THE FEAR OUT OF MANAGEMENT”

JOHN T. REPKE, MD, AND RONALD T. BURKMAN, MD (WEB EXCLUSIVE; APRIL 2016)

Montgomery maneuver for shoulder dystocia

In managing shoulder dystocia, my maneuver is to use my elbow to maximize mechanical advantage when applying suprapubic pressure to push the trapped shoulder down. It works well and is more efficient than having a nurse standing off to the side.

J.S. Montgomery, MD
Cypress, Texas

Dr. Barbieri responds

I thank Dr. Montgomery for sharing his maneuver for dislodging the trapped anterior shoulder by using his elbow to apply suprapubic pressure. There is vast knowledge and experience in our clinical community, and sharing insights is helpful to all our readers.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“LONG-ACTING REVERSIBLE CONTRACEPTIVES AND ACNE IN ADOLESCENTS”

ROBERT L. BARBIERI, MD, AND ANDREA H. ROE, MD (EDITORIAL; JANUARY 2017)

Manage acne with spironolactone for women on LARC

Dr. Barbieri’s editorial with Dr. Roe addressed the very important theme of proactively talking about acne before a patient starts long-acting reversible contraception (LARC), especially when switching from a birth control pill that had controlled the acne to a levonorgestrel intrauterine device (LNG-IUD). It missed the mark, however, in not mentioning a very important presenting feature of adolescent polycystic ovary syndrome (PCOS)—cystic acne. I highly recommend obtaining baseline testosterone levels and using spironolactone, 50 to 200 mg daily, to treat acne while on LARC, especially an LNG-IUD. I learned this trick a few years ago from a Canadian endocrinologist.

John Lewis, MD

Waterbury, Connecticut

Dr. Barbieri responds

I thank Dr. Lewis for the important clinical pearl to use spironolactone to prevent and treat acne when inserting a progestin-releasing LARC in an adolescent or young woman. Spironolactone blocks testosterone action in the pilosebaceous unit, thereby decreasing sebum production and reducing acne activity. I frequently use spironolactone in my practice, especially for women with PCOS who have hirsutism and acne (see my editorial on page 8 of this issue). However, authors of a recent systematic review reported that there is minimal evidence from clinical trials to support the use of spironolactone to treat acne vulgaris.¹

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“LONG-ACTING REVERSIBLE CONTRACEPTIVES AND ACNE IN ADOLESCENTS”

ROBERT L. BARBIERI, MD, AND ANDREA H. ROE, MD (EDITORIAL; JANUARY 2017)

Manage acne with spironolactone for women on LARC

Dr. Barbieri’s editorial with Dr. Roe addressed the very important theme of proactively talking about acne before a patient starts long-acting reversible contraception (LARC), especially when switching from a birth control pill that had controlled the acne to a levonorgestrel intrauterine device (LNG-IUD). It missed the mark, however, in not mentioning a very important presenting feature of adolescent polycystic ovary syndrome (PCOS)—cystic acne. I highly recommend obtaining baseline testosterone levels and using spironolactone, 50 to 200 mg daily, to treat acne while on LARC, especially an LNG-IUD. I learned this trick a few years ago from a Canadian endocrinologist.

John Lewis, MD

Waterbury, Connecticut

Dr. Barbieri responds

I thank Dr. Lewis for the important clinical pearl to use spironolactone to prevent and treat acne when inserting a progestin-releasing LARC in an adolescent or young woman. Spironolactone blocks testosterone action in the pilosebaceous unit, thereby decreasing sebum production and reducing acne activity. I frequently use spironolactone in my practice, especially for women with PCOS who have hirsutism and acne (see my editorial on page 8 of this issue). However, authors of a recent systematic review reported that there is minimal evidence from clinical trials to support the use of spironolactone to treat acne vulgaris.¹

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

“LONG-ACTING REVERSIBLE CONTRACEPTIVES AND ACNE IN ADOLESCENTS”

ROBERT L. BARBIERI, MD, AND ANDREA H. ROE, MD (EDITORIAL; JANUARY 2017)

Manage acne with spironolactone for women on LARC

Dr. Barbieri’s editorial with Dr. Roe addressed the very important theme of proactively talking about acne before a patient starts long-acting reversible contraception (LARC), especially when switching from a birth control pill that had controlled the acne to a levonorgestrel intrauterine device (LNG-IUD). It missed the mark, however, in not mentioning a very important presenting feature of adolescent polycystic ovary syndrome (PCOS)—cystic acne. I highly recommend obtaining baseline testosterone levels and using spironolactone, 50 to 200 mg daily, to treat acne while on LARC, especially an LNG-IUD. I learned this trick a few years ago from a Canadian endocrinologist.

John Lewis, MD

Waterbury, Connecticut

Dr. Barbieri responds

I thank Dr. Lewis for the important clinical pearl to use spironolactone to prevent and treat acne when inserting a progestin-releasing LARC in an adolescent or young woman. Spironolactone blocks testosterone action in the pilosebaceous unit, thereby decreasing sebum production and reducing acne activity. I frequently use spironolactone in my practice, especially for women with PCOS who have hirsutism and acne (see my editorial on page 8 of this issue). However, authors of a recent systematic review reported that there is minimal evidence from clinical trials to support the use of spironolactone to treat acne vulgaris.¹

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Forceful use of forceps, infant dies: $10.2M verdict

A woman in her mid-20s went to the hospital in labor. After several hours, fetal heart-rate (FHR) monitor results became nonreassuring. The ObGyn and the nurse in charge disagreed on the interpretation of the FHR monitor strips. The nurse went to her supervisor, who confronted the ObGyn 2 hours later, saying that fetal distress was a serious concern and necessitated the cessation of oxytocin. The ObGyn disagreed and ordered another nurse to increase the oxytocin dose.

Three hours later, when the FHR monitoring strips showed severe distress, the ObGyn decided to undertake an operative vaginal delivery. During a 17-minute period, the ObGyn unsuccessfully used forceps 3 times. On the second attempt, a cracking noise was heard. Then a cesarean delivery was ordered; the baby was born limp, lifeless, and unresponsive. She was found to have hypoxic ischemic encephalopathy, was removed from life support, and died.

PARENTS’ CLAIM:

Oxytocin should not have been continued when the baby was clearly in distress. The supervising nurse should have contacted her supervisor and continued up the chain of command until the ObGyn was forced to stop the oxytocin.

Physicians are prohibited from using their leg muscles when applying forceps; gentle action is critical. During one attempt, the ObGyn had his leg on the bed to increase the force with which he pulled on the forceps. The ObGyn’s reckless use of forceps caused a skull fracture to depress into the brain. The ObGyn also tried to turn the baby using forceps, which is outside the standard of care because of the risk of rotational injury. A mother’s pushing rarely causes such severe damage to the baby.

DEFENDANTS’ DEFENSE:

There was no negligence. The hypoxia was due to a hemorrhage. Natural forces of a long delivery caused the skull injury.

VERDICT:

A $10,200,575 Texas verdict was returned.

After long labor, baby has CP: $8.4M settlement

Early on March 20, a 30-year-old woman who weighed 300 lbs was admitted for delivery at 40 weeks’ gestation. Labor was induced with oxytocin. Within 30 minutes, FHR monitoring showed that the baby’s baseline began to climb, accelerations ceased, and late decelerations commenced. The oxytocin dose was steadily increased throughout the day. A nurse decided that the baby was not tolerating the contractions and discontinued oxytocin. The attending ObGyn ordered oxytocin be restarted after giving the baby a chance to recover. The mother requested a cesarean delivery, but the ObGyn refused, saying that he was concerned with the risk due to her excessive weight and prior heart surgery. When his shift ended, his partner took over.

On March 21, a nurse reported that the FHR had climbed to 160 bpm although labor had not progressed. The ObGyn ordered terbutaline to slow contractions but he did not examine the mother. An hour after terbutaline administration, the FHR showed a deceleration. An emergency cesarean delivery was performed. The baby, born severely depressed, was resuscitated. Magnetic resonance imaging performed at 23 days of life showed that the child had a hypoxic ischemic injury. She has cerebral palsy and is nonambulatory with significant cognitive deficits.

PARENTS’ CLAIM:

The care provided by 2 ObGyns, nursing staff, and hospital was negligent. A cesarean delivery should have been performed on March 20 when the nurse identified fetal distress. The nurses should have been more assertive in recommending cesarean delivery. The injury occurred 30 minutes prior to delivery and could have been prevented by an earlier cesarean delivery.

DEFENDANTS’ DEFENSE:

FHR strips on March 20 were not as nonreassuring as claimed and did not warrant cesarean delivery, which was performed when needed.

VERDICT:

An $8.4 million Wisconsin settlement was reached by mediation.

Eclamptic seizure, twins stillborn: $4.25M

A 29-year-old woman pregnant with twins had an eclamptic seizure at 33 4/7 weeks’ gestation. The babies were stillborn.

PARENTS’ CLAIM:

The ObGyn failed to properly treat the patient’s preeclampsia for more than 11 weeks. The seizure caused hypovolemic shock, tachycardia, and massive hemorrhaging and required an emergency hysterectomy and bilateral salpingo-oophorectomy. The patient has no children and has been rendered unable to conceive. She sought to apportion 60% of the settlement proceeds to her distress claim and 20% each to wrongful-death and survival claims. She also sought to bar the twins’ biological father from sharing in the recovery due to abandonment.

HOSPITAL'S DEFENSE:

The case was settled during the trial.

VERDICT:

The mother agreed to receive 65% of the wrongful-death and survival funds, with 35% going to the father. A Pennsylvania settlement of $4.25 million was reached.

Brachial plexus injury: $4.8M verdict

A woman gave birth with assistance from a midwife. During delivery, shoulder dystocia was encountered. The baby has a permanent brachial plexus injury.

PARENTS’ CLAIM:

The midwife mismanaged shoulder dystocia by applying excessive traction to the baby’s head. The ObGyn in charge of the mother’s care did not provide adequate supervision.

DEFENDANTS’ DEFENSE:

The hospital settled prior to trial. The midwife and ObGyn denied negligence during delivery and contended that the child’s injury occurred as a result of the natural forces of labor.

VERDICT:

The jury found the midwife 60% negligent and the ObGyn 40% negligent. A $4.82 million Florida verdict was returned.

What caused infant's death?

During prenatal care, a woman underwent weekly nonstress tests due to excessive amniotic fluid until the level returned to normal. Near the end of her pregnancy, the patient noticed a decrease in fetal movement and called her ObGyn group. She was told to perform a fetal kick count and go to the emergency department (ED) if the count was abnormal, but she fell asleep. In the morning, she presented to the ObGyns’ office and was sent to the hospital for emergency cesarean delivery, which was performed 2.5 hrs after her arrival. The infant was born in distress and died 8 hours later.

PARENTS’ CLAIM:

The ObGyns should have continued weekly tests even after the amniotic fluid level returned to normal. She should have been sent to the ED when she initially reported decreased fetal movement. Cesarean delivery should have been performed immediately upon her arrival at the hospital.

PHYSICIAN’S DEFENSE:

Further prenatal testing for amniotic fluid levels was unwarranted. Telephone advice to count fetal kicks was appropriate. The delay in performing a cesarean delivery was beyond the ObGyns’ control. The outcome would have been the same regardless of their actions.

VERDICT:

A Michigan defense verdict was returned.

Perineal laceration during vaginal delivery

During vaginal delivery, a 27-year-old woman suffered a 4th-degree perineal laceration. She developed a retrovaginal fistula and has permanent fecal incontinence.

PARENTS’ CLAIM:

The ObGyn’s care was negligent. She failed to perform a rectal examination to assess the severity of the perineal laceration. The laceration was improperly repaired, and, as a result, the patient developed a retrovaginal fistula that persisted for 6 months until it was surgically repaired. A divot in her anal canal causes fecal incontinence.

PHYSICIAN’S DEFENSE:

The ObGyn contended she correctly diagnosed and repaired a 3rd-degree laceration. The wound later broke down for unknown reasons.

VERDICT:

An Arizona defense verdict was returned.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Forceful use of forceps, infant dies: $10.2M verdict

A woman in her mid-20s went to the hospital in labor. After several hours, fetal heart-rate (FHR) monitor results became nonreassuring. The ObGyn and the nurse in charge disagreed on the interpretation of the FHR monitor strips. The nurse went to her supervisor, who confronted the ObGyn 2 hours later, saying that fetal distress was a serious concern and necessitated the cessation of oxytocin. The ObGyn disagreed and ordered another nurse to increase the oxytocin dose.

Three hours later, when the FHR monitoring strips showed severe distress, the ObGyn decided to undertake an operative vaginal delivery. During a 17-minute period, the ObGyn unsuccessfully used forceps 3 times. On the second attempt, a cracking noise was heard. Then a cesarean delivery was ordered; the baby was born limp, lifeless, and unresponsive. She was found to have hypoxic ischemic encephalopathy, was removed from life support, and died.

PARENTS’ CLAIM:

Oxytocin should not have been continued when the baby was clearly in distress. The supervising nurse should have contacted her supervisor and continued up the chain of command until the ObGyn was forced to stop the oxytocin.

Physicians are prohibited from using their leg muscles when applying forceps; gentle action is critical. During one attempt, the ObGyn had his leg on the bed to increase the force with which he pulled on the forceps. The ObGyn’s reckless use of forceps caused a skull fracture to depress into the brain. The ObGyn also tried to turn the baby using forceps, which is outside the standard of care because of the risk of rotational injury. A mother’s pushing rarely causes such severe damage to the baby.

DEFENDANTS’ DEFENSE:

There was no negligence. The hypoxia was due to a hemorrhage. Natural forces of a long delivery caused the skull injury.

VERDICT:

A $10,200,575 Texas verdict was returned.

After long labor, baby has CP: $8.4M settlement

Early on March 20, a 30-year-old woman who weighed 300 lbs was admitted for delivery at 40 weeks’ gestation. Labor was induced with oxytocin. Within 30 minutes, FHR monitoring showed that the baby’s baseline began to climb, accelerations ceased, and late decelerations commenced. The oxytocin dose was steadily increased throughout the day. A nurse decided that the baby was not tolerating the contractions and discontinued oxytocin. The attending ObGyn ordered oxytocin be restarted after giving the baby a chance to recover. The mother requested a cesarean delivery, but the ObGyn refused, saying that he was concerned with the risk due to her excessive weight and prior heart surgery. When his shift ended, his partner took over.

On March 21, a nurse reported that the FHR had climbed to 160 bpm although labor had not progressed. The ObGyn ordered terbutaline to slow contractions but he did not examine the mother. An hour after terbutaline administration, the FHR showed a deceleration. An emergency cesarean delivery was performed. The baby, born severely depressed, was resuscitated. Magnetic resonance imaging performed at 23 days of life showed that the child had a hypoxic ischemic injury. She has cerebral palsy and is nonambulatory with significant cognitive deficits.

PARENTS’ CLAIM:

The care provided by 2 ObGyns, nursing staff, and hospital was negligent. A cesarean delivery should have been performed on March 20 when the nurse identified fetal distress. The nurses should have been more assertive in recommending cesarean delivery. The injury occurred 30 minutes prior to delivery and could have been prevented by an earlier cesarean delivery.

DEFENDANTS’ DEFENSE:

FHR strips on March 20 were not as nonreassuring as claimed and did not warrant cesarean delivery, which was performed when needed.

VERDICT:

An $8.4 million Wisconsin settlement was reached by mediation.

Eclamptic seizure, twins stillborn: $4.25M

A 29-year-old woman pregnant with twins had an eclamptic seizure at 33 4/7 weeks’ gestation. The babies were stillborn.

PARENTS’ CLAIM:

The ObGyn failed to properly treat the patient’s preeclampsia for more than 11 weeks. The seizure caused hypovolemic shock, tachycardia, and massive hemorrhaging and required an emergency hysterectomy and bilateral salpingo-oophorectomy. The patient has no children and has been rendered unable to conceive. She sought to apportion 60% of the settlement proceeds to her distress claim and 20% each to wrongful-death and survival claims. She also sought to bar the twins’ biological father from sharing in the recovery due to abandonment.

HOSPITAL'S DEFENSE:

The case was settled during the trial.

VERDICT:

The mother agreed to receive 65% of the wrongful-death and survival funds, with 35% going to the father. A Pennsylvania settlement of $4.25 million was reached.

Brachial plexus injury: $4.8M verdict

A woman gave birth with assistance from a midwife. During delivery, shoulder dystocia was encountered. The baby has a permanent brachial plexus injury.

PARENTS’ CLAIM:

The midwife mismanaged shoulder dystocia by applying excessive traction to the baby’s head. The ObGyn in charge of the mother’s care did not provide adequate supervision.

DEFENDANTS’ DEFENSE:

The hospital settled prior to trial. The midwife and ObGyn denied negligence during delivery and contended that the child’s injury occurred as a result of the natural forces of labor.

VERDICT:

The jury found the midwife 60% negligent and the ObGyn 40% negligent. A $4.82 million Florida verdict was returned.

What caused infant's death?

During prenatal care, a woman underwent weekly nonstress tests due to excessive amniotic fluid until the level returned to normal. Near the end of her pregnancy, the patient noticed a decrease in fetal movement and called her ObGyn group. She was told to perform a fetal kick count and go to the emergency department (ED) if the count was abnormal, but she fell asleep. In the morning, she presented to the ObGyns’ office and was sent to the hospital for emergency cesarean delivery, which was performed 2.5 hrs after her arrival. The infant was born in distress and died 8 hours later.

PARENTS’ CLAIM:

The ObGyns should have continued weekly tests even after the amniotic fluid level returned to normal. She should have been sent to the ED when she initially reported decreased fetal movement. Cesarean delivery should have been performed immediately upon her arrival at the hospital.

PHYSICIAN’S DEFENSE:

Further prenatal testing for amniotic fluid levels was unwarranted. Telephone advice to count fetal kicks was appropriate. The delay in performing a cesarean delivery was beyond the ObGyns’ control. The outcome would have been the same regardless of their actions.

VERDICT:

A Michigan defense verdict was returned.

Perineal laceration during vaginal delivery

During vaginal delivery, a 27-year-old woman suffered a 4th-degree perineal laceration. She developed a retrovaginal fistula and has permanent fecal incontinence.

PARENTS’ CLAIM:

The ObGyn’s care was negligent. She failed to perform a rectal examination to assess the severity of the perineal laceration. The laceration was improperly repaired, and, as a result, the patient developed a retrovaginal fistula that persisted for 6 months until it was surgically repaired. A divot in her anal canal causes fecal incontinence.

PHYSICIAN’S DEFENSE:

The ObGyn contended she correctly diagnosed and repaired a 3rd-degree laceration. The wound later broke down for unknown reasons.

VERDICT:

An Arizona defense verdict was returned.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

Forceful use of forceps, infant dies: $10.2M verdict

A woman in her mid-20s went to the hospital in labor. After several hours, fetal heart-rate (FHR) monitor results became nonreassuring. The ObGyn and the nurse in charge disagreed on the interpretation of the FHR monitor strips. The nurse went to her supervisor, who confronted the ObGyn 2 hours later, saying that fetal distress was a serious concern and necessitated the cessation of oxytocin. The ObGyn disagreed and ordered another nurse to increase the oxytocin dose.

Three hours later, when the FHR monitoring strips showed severe distress, the ObGyn decided to undertake an operative vaginal delivery. During a 17-minute period, the ObGyn unsuccessfully used forceps 3 times. On the second attempt, a cracking noise was heard. Then a cesarean delivery was ordered; the baby was born limp, lifeless, and unresponsive. She was found to have hypoxic ischemic encephalopathy, was removed from life support, and died.

PARENTS’ CLAIM:

Oxytocin should not have been continued when the baby was clearly in distress. The supervising nurse should have contacted her supervisor and continued up the chain of command until the ObGyn was forced to stop the oxytocin.

Physicians are prohibited from using their leg muscles when applying forceps; gentle action is critical. During one attempt, the ObGyn had his leg on the bed to increase the force with which he pulled on the forceps. The ObGyn’s reckless use of forceps caused a skull fracture to depress into the brain. The ObGyn also tried to turn the baby using forceps, which is outside the standard of care because of the risk of rotational injury. A mother’s pushing rarely causes such severe damage to the baby.

DEFENDANTS’ DEFENSE:

There was no negligence. The hypoxia was due to a hemorrhage. Natural forces of a long delivery caused the skull injury.

VERDICT:

A $10,200,575 Texas verdict was returned.

After long labor, baby has CP: $8.4M settlement

Early on March 20, a 30-year-old woman who weighed 300 lbs was admitted for delivery at 40 weeks’ gestation. Labor was induced with oxytocin. Within 30 minutes, FHR monitoring showed that the baby’s baseline began to climb, accelerations ceased, and late decelerations commenced. The oxytocin dose was steadily increased throughout the day. A nurse decided that the baby was not tolerating the contractions and discontinued oxytocin. The attending ObGyn ordered oxytocin be restarted after giving the baby a chance to recover. The mother requested a cesarean delivery, but the ObGyn refused, saying that he was concerned with the risk due to her excessive weight and prior heart surgery. When his shift ended, his partner took over.

On March 21, a nurse reported that the FHR had climbed to 160 bpm although labor had not progressed. The ObGyn ordered terbutaline to slow contractions but he did not examine the mother. An hour after terbutaline administration, the FHR showed a deceleration. An emergency cesarean delivery was performed. The baby, born severely depressed, was resuscitated. Magnetic resonance imaging performed at 23 days of life showed that the child had a hypoxic ischemic injury. She has cerebral palsy and is nonambulatory with significant cognitive deficits.

PARENTS’ CLAIM:

The care provided by 2 ObGyns, nursing staff, and hospital was negligent. A cesarean delivery should have been performed on March 20 when the nurse identified fetal distress. The nurses should have been more assertive in recommending cesarean delivery. The injury occurred 30 minutes prior to delivery and could have been prevented by an earlier cesarean delivery.

DEFENDANTS’ DEFENSE:

FHR strips on March 20 were not as nonreassuring as claimed and did not warrant cesarean delivery, which was performed when needed.

VERDICT:

An $8.4 million Wisconsin settlement was reached by mediation.

Eclamptic seizure, twins stillborn: $4.25M

A 29-year-old woman pregnant with twins had an eclamptic seizure at 33 4/7 weeks’ gestation. The babies were stillborn.

PARENTS’ CLAIM:

The ObGyn failed to properly treat the patient’s preeclampsia for more than 11 weeks. The seizure caused hypovolemic shock, tachycardia, and massive hemorrhaging and required an emergency hysterectomy and bilateral salpingo-oophorectomy. The patient has no children and has been rendered unable to conceive. She sought to apportion 60% of the settlement proceeds to her distress claim and 20% each to wrongful-death and survival claims. She also sought to bar the twins’ biological father from sharing in the recovery due to abandonment.

HOSPITAL'S DEFENSE:

The case was settled during the trial.

VERDICT:

The mother agreed to receive 65% of the wrongful-death and survival funds, with 35% going to the father. A Pennsylvania settlement of $4.25 million was reached.

Brachial plexus injury: $4.8M verdict

A woman gave birth with assistance from a midwife. During delivery, shoulder dystocia was encountered. The baby has a permanent brachial plexus injury.

PARENTS’ CLAIM:

The midwife mismanaged shoulder dystocia by applying excessive traction to the baby’s head. The ObGyn in charge of the mother’s care did not provide adequate supervision.

DEFENDANTS’ DEFENSE:

The hospital settled prior to trial. The midwife and ObGyn denied negligence during delivery and contended that the child’s injury occurred as a result of the natural forces of labor.

VERDICT:

The jury found the midwife 60% negligent and the ObGyn 40% negligent. A $4.82 million Florida verdict was returned.

What caused infant's death?

During prenatal care, a woman underwent weekly nonstress tests due to excessive amniotic fluid until the level returned to normal. Near the end of her pregnancy, the patient noticed a decrease in fetal movement and called her ObGyn group. She was told to perform a fetal kick count and go to the emergency department (ED) if the count was abnormal, but she fell asleep. In the morning, she presented to the ObGyns’ office and was sent to the hospital for emergency cesarean delivery, which was performed 2.5 hrs after her arrival. The infant was born in distress and died 8 hours later.

PARENTS’ CLAIM:

The ObGyns should have continued weekly tests even after the amniotic fluid level returned to normal. She should have been sent to the ED when she initially reported decreased fetal movement. Cesarean delivery should have been performed immediately upon her arrival at the hospital.

PHYSICIAN’S DEFENSE:

Further prenatal testing for amniotic fluid levels was unwarranted. Telephone advice to count fetal kicks was appropriate. The delay in performing a cesarean delivery was beyond the ObGyns’ control. The outcome would have been the same regardless of their actions.

VERDICT:

A Michigan defense verdict was returned.

Perineal laceration during vaginal delivery

During vaginal delivery, a 27-year-old woman suffered a 4th-degree perineal laceration. She developed a retrovaginal fistula and has permanent fecal incontinence.

PARENTS’ CLAIM:

The ObGyn’s care was negligent. She failed to perform a rectal examination to assess the severity of the perineal laceration. The laceration was improperly repaired, and, as a result, the patient developed a retrovaginal fistula that persisted for 6 months until it was surgically repaired. A divot in her anal canal causes fecal incontinence.

PHYSICIAN’S DEFENSE:

The ObGyn contended she correctly diagnosed and repaired a 3rd-degree laceration. The wound later broke down for unknown reasons.

VERDICT:

An Arizona defense verdict was returned.

These cases were selected by the editors of OBG Management from Medical Malpractice Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (www.verdictslaska.com). The information available to the editors about the cases presented here is sometimes incomplete. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation and are meant to illustrate nationwide variation in jury verdicts and awards.

Share your thoughts! Send your Letter to the Editor to rbarbieri@frontlinemedcom.com. Please include your name and the city and state in which you practice.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

3/28/17. DAY 3 AT SGS

Exciting presentations continue, society groups provide updates

The team from Mayo Clinic was still riding high this morning after winning last night’s armadillo race, which was part of the Texas hoedown fundraiser for SHARE.

The seventh scientific session started with a nice presentation by Cara Grimes, MD, entitled, “Evaluating ureteral patency in the post-indigo carmine era: a randomized controlled trial.” Several quality presentations followed before Ike Rahn, MD, updated the society on the work of the Fellows Pelvic Research Network, a group currently celebrating its 10th anniversary.

Drs. Star Hampton and Peter Jeppson then took the stage to share the progress of the SGS Pelvic Anatomy Group as they undertake the daunting task of a systematic review of anatomic terms used in the medical literature.

Leadership transition

Surely the moment that SGS President Vivian Sung, MD, had been waiting for all week was the passing of the gavel to incoming president John Gebhart, MD. On acceptance of his role as the incoming president, Dr. Gebhart’s remarks focused on the honor of serving in that role, and he stated that Dr. Sung, in her usual fashion, set the bar for performance very high.

After the midmorning break, where attendants usually say their temporary goodbyes to friends and mentors, old and new, the eighth and final scientific session began.

Come to next year’s meeting!

If you consider yourself a gynecologic surgeon (and if you’re reading this you probably do), please consider adding attendance at the next SGS meeting to your list of “things to do” in 2018. This family-friendly meeting is filled with opportunities for surgical teaching, learning, rest, relaxation, networking, and reconnecting. Most of all, it is a place where mentoring relationships begin and are nurtured, recognized, and appreciated.

See you in Orlando!

3/28/17. DAY 2 AT SGS

Morning highlights: Prize-winning paper, presidential address

Scholarly activity continued this morning at the Society of Gynecologic Surgeons Annual Scientific meeting at the La Cantera Resort in San Antonio, Texas.  After early morning reviews and coffee with good friends, the scientific program began with a comparison of barbed and nonbarbed sutures, after which Eric Jelovsek, MD, presented the prize-winning paper for the Pelvic Floor Disorders Network, “A Randomized Trial of Uterosacral Ligament Suspension or Sacrospinous Ligament Fixation for Apical Pelvic Organ Prolapse: Five-year Outcomes.”

The highlight of the morning was almost certainly the presidential address in which Dr. Vivian Sung shared with the audience the recipe for the “secret sauce” that makes SGS a special organization:

1. Be everyday leaders and mentors. Do the little things to teach, coach, and encourage others in the field.
2. Maintain a safe environment. Allow others to be brave, be creative, and make mistakes. It will make them more effective.
3. Consider the “WHY.” Focus on why SGS exists and continue to strive for that mission.

Stimulating scientific sessions

After the fifth scientific session, where we learned that prophylactic salpingectomy at the time of vaginal hysterectomy not only is feasible but also cost-effective, participants were treated to the TeLinde Lecture. Dr. Richard Reznick, Dean of Health Sciences and Professor in the Department of Surgery at Queen’s University in Kingston, Ontario, shared exciting and intriguing data regarding competency-based learning in surgical training. The lecture, entitled “Great Expectations: The Promise of Competency-based Education,” sparked questions and conversation that could have gone on for hours. Alas, program director Rob Gutman, MD, kept the program on track and, after a brief break for lunch, the sixth scientific session was underway.

In the sixth session, Dr. Gutman moderated a lively panel discussion that set out to answer the question, “How can we increase the percentage and quality of minimally invasive hysterectomy for benign disease among low/intermediate volume gynecologic surgeons?” Panelists shared thoughts and information—from organizations and institutions around the country—outlining the data on current hysterectomy rates, trends in policymaking, learning through simulation, incremental quality improvement planning, and surgical pathways.

Afternoon fun and a Texas hoedown

The scientific meeting was then adjourned, making way for the SGS business meeting and then an afternoon of well-deserved fun in the Texas sun. 

Evening events included an old-fashioned Texas hoedown—a time for two-stepping, armadillo racing, and camaraderie to raise money for SHARE.  My money’s on the armadillo from the University of New Mexico!

3/27/17. DAY 1 AT SGS

Debate, postgrad courses, videos galore

The Annual Scientific Meeting of the Society of Gynecologic Surgeons, held in San Antonio, Texas, opened to an energetic crowd when SGS President, Vivan Sung, MD, welcomed participants from 10 countries before introducing the society’s 10 newest members. The first scientific session then quickly got underway with oral presentations and videos covering a variety of topics.

Janet Bickel, MS, a national leader in mentorship and faculty development, reinforced the meeting’s theme with her keynote lecture, “Hard Work and Talent Aren’t Enough: Mentoring and Finding Mentors across Career Stages.” She shared with attendees the keys to mentoring women and minorities before outlining the characteristics associated with both effective mentors and mentees. It turns out that many of her key points had been on display just a day earlier during the postgraduate courses in which physicians from around the country were coached by experts on surgical complications, pelvic anatomy and computer modeling, surgical teaching, and enhanced surgical recovery.

After a brief break for lunch at the beautiful La Cantera Resort, attendees returned for a lively debate between Kim Kenton, MD and Geoff Cundiff, MD entitled “Should we separate the O from the G in Obstetrics and Gynecology?” Dee Fenner, MD acted as moderator and referee as both sides passionately shared their convincing arguments. In the end, both parties agreed that this century-old debate would continue as we constantly evaluate the best approach to caring for the female patient.

Promises of popcorn brought attendees back to the meeting hall for the afternoon videofest where 13 videos were presented on a variety of surgical topics.

Specialists learn from each other

Meanwhile, the Fellows Pelvic Research Network had the pleasure a special lecture and Q&A session with Linda Brubaker, MD. Among the many pearls of wisdom she shared was an evergreen piece of advice, “Enthusiasm is good. Focus is better.” The fellows then turned their focus to the review of current projects and evaluation of proposals for new research.

Eight academic roundtables hosted by experts from across the country provided an opportunity for attendees to discuss best practices in various areas of pelvic surgery including bladder pain syndrome, chronic pelvic pain, transgender care, billing and coding, social media, and more.

The day ended with a delightful awards ceremony in which Dr. Sung recognized outstanding scholarly and service activity in the gynecologic surgery community. Notably, Dr. Peter Jeppson was presented with the 2017 Distinguished Service Award. Members then joined meeting sponsors and staff in the exhibit hall for an evening reception—a fitting ending to a phenomenal first day.

Click for more…

For more details about the scientific presentations and to read abstracts of presentations, videos, and posters, see the March 2017 supplemental issue of the American Journal of Obstetrics and Gynecology.

For an up-to-the minute report of the week’s events, follow the #SGS2017 hashtag on Twitter. Be sure to follow @obgmanagement, @gynsurg, and @stuboo as well.

A) Endometrial polyp INCORRECT
Endometrial polyps on ultrasonography appear as focal echogenic (hyperechoic) masses or as nonspecific endometrial thickening.¹ Color Doppler often demonstrates a vascular stalk, which is a nonspecific finding that also can be seen in submucosal fibroids and endometrial cancer.² On sonohysterography (SHG), endometrial polyps typically appear as well-defined echogenic/hyperechoic polypoid lesions (tissue appearance similar to that of normal endometrium) protruding into the endometrial canal but still preserving the endometrial−myometrial interface.^2,3

B) Submucosal fibroid CORRECT
Submucosal fibroids on ultrasonography appear as heterogeneous hypoechoic lesions distorting the endometrial cavity.¹ In contrast to endometrial polyps, which involve the endometrium only, submucosal (intracavitary) fibroids originate in the myometrium, as clarified in Figures 3A & B. SHG demonstrates a broad-based mixed hypoechoic/isoechoic lesion protruding into the endometrial canal but preserving the echogenic endometrium, distinguishing myometrial from endometrial lesions. Submucosal fibroids often distort the endometrial myometrial interface and demonstrate acoustic shadowing.^2,3

C) Endometrial carcinoma INCORRECT
Endometrial carcinoma on SHG appears as an irregular inhomogeneous lobulated vascular mass distorting the endometrial−myometrial interface.³ Additionally, irregular frond-like projections can be seen extending from the mass into the endometrial cavity, which are distended with echogenic fluid.²

D) Endometrial hyperplasia INCORRECT
On ultrasonography, endometrial hyperplasia has a nonspecific appearance, often presenting as diffuse smooth endometrial thickening.¹ SHG typically demonstrates diffuse thickening of the echogenic endometrial stripe without a focal lesion and, when a focal lesion is present, can mimic a broad-based endometrial polyp.^2,3

A) Endometrial polyp INCORRECT
Endometrial polyps on ultrasonography appear as focal echogenic (hyperechoic) masses or as nonspecific endometrial thickening.¹ Color Doppler often demonstrates a vascular stalk, which is a nonspecific finding that also can be seen in submucosal fibroids and endometrial cancer.² On sonohysterography (SHG), endometrial polyps typically appear as well-defined echogenic/hyperechoic polypoid lesions (tissue appearance similar to that of normal endometrium) protruding into the endometrial canal but still preserving the endometrial−myometrial interface.^2,3

B) Submucosal fibroid CORRECT
Submucosal fibroids on ultrasonography appear as heterogeneous hypoechoic lesions distorting the endometrial cavity.¹ In contrast to endometrial polyps, which involve the endometrium only, submucosal (intracavitary) fibroids originate in the myometrium, as clarified in Figures 3A & B. SHG demonstrates a broad-based mixed hypoechoic/isoechoic lesion protruding into the endometrial canal but preserving the echogenic endometrium, distinguishing myometrial from endometrial lesions. Submucosal fibroids often distort the endometrial myometrial interface and demonstrate acoustic shadowing.^2,3

C) Endometrial carcinoma INCORRECT
Endometrial carcinoma on SHG appears as an irregular inhomogeneous lobulated vascular mass distorting the endometrial−myometrial interface.³ Additionally, irregular frond-like projections can be seen extending from the mass into the endometrial cavity, which are distended with echogenic fluid.²

D) Endometrial hyperplasia INCORRECT
On ultrasonography, endometrial hyperplasia has a nonspecific appearance, often presenting as diffuse smooth endometrial thickening.¹ SHG typically demonstrates diffuse thickening of the echogenic endometrial stripe without a focal lesion and, when a focal lesion is present, can mimic a broad-based endometrial polyp.^2,3

A) Endometrial polyp INCORRECT
Endometrial polyps on ultrasonography appear as focal echogenic (hyperechoic) masses or as nonspecific endometrial thickening.¹ Color Doppler often demonstrates a vascular stalk, which is a nonspecific finding that also can be seen in submucosal fibroids and endometrial cancer.² On sonohysterography (SHG), endometrial polyps typically appear as well-defined echogenic/hyperechoic polypoid lesions (tissue appearance similar to that of normal endometrium) protruding into the endometrial canal but still preserving the endometrial−myometrial interface.^2,3

B) Submucosal fibroid CORRECT
Submucosal fibroids on ultrasonography appear as heterogeneous hypoechoic lesions distorting the endometrial cavity.¹ In contrast to endometrial polyps, which involve the endometrium only, submucosal (intracavitary) fibroids originate in the myometrium, as clarified in Figures 3A & B. SHG demonstrates a broad-based mixed hypoechoic/isoechoic lesion protruding into the endometrial canal but preserving the echogenic endometrium, distinguishing myometrial from endometrial lesions. Submucosal fibroids often distort the endometrial myometrial interface and demonstrate acoustic shadowing.^2,3

C) Endometrial carcinoma INCORRECT
Endometrial carcinoma on SHG appears as an irregular inhomogeneous lobulated vascular mass distorting the endometrial−myometrial interface.³ Additionally, irregular frond-like projections can be seen extending from the mass into the endometrial cavity, which are distended with echogenic fluid.²

D) Endometrial hyperplasia INCORRECT
On ultrasonography, endometrial hyperplasia has a nonspecific appearance, often presenting as diffuse smooth endometrial thickening.¹ SHG typically demonstrates diffuse thickening of the echogenic endometrial stripe without a focal lesion and, when a focal lesion is present, can mimic a broad-based endometrial polyp.^2,3

cfDNA screening failures occur in 1% to 12% of samples, a rate that has an inverse relationship to gestational age. Recent studies have shown an increased risk for screening failures among obese women. To determine the optimal gestational age for cfDNA testing among obese women, Mary C. Livergood, MD, and colleagues at the Mercy Hospital in St. Louis, Missouri, performed a retrospective cohort study of those undergoing cfDNA testing at one center from 2011 through 2016. Study results recently were published online in the American Journal of Obstetrics and Gynecology.¹

Details of the study

Adjusted odds ratios (aORs) with 95% confidence interval (CI) for a cfDNA screening failure (referred to as a “no call” in the study) were determined for each body mass index (BMI) weight class (TABLE). Each BMI weight class also was compared with the aOR of normal-weight women (BMI <25.0 kg/m²). The predicted probability of a no call was determined for each week of gestational age for normal weight and obese women and the results were compared.¹

Among the 2,385 patients meeting inclusion criteria, 4.4% (n = 105) received a no call. Compared with normal weight women, the aOR of no call increased as weight increased from overweight (aOR, 2.31 [95% CI, 1.21–4.42]) to obesity class III (aOR, 8.55 [95% CI, 4.16–17.56]).¹

At 21 weeks’ gestation, a cut-point was identified for obesity class II/III women (ie, there was no longer a significant difference in the probability of no call when compared with normal-weight women). From 8 to 16 weeks’ gestation, there was a 4.5% reduction in the probability of a no call for obesity class II/III women (aOR, 14.9; 95% CI, 8.95–20.78 and aOR, 10.4; 95% CI, 7.20–13.61; P_trend<.01).¹

Although the authors conclude that a cut-point of 21 weeks’ gestation allowed for optimal sampling of cfDNA in obese women, they also acknowledge that this cut-point limits a woman’s reproductive choices. However, they say that delaying cfDNA testing in obese women is a reasonable strategy to reduce the probability of screening failure.¹

cfDNA screening failures occur in 1% to 12% of samples, a rate that has an inverse relationship to gestational age. Recent studies have shown an increased risk for screening failures among obese women. To determine the optimal gestational age for cfDNA testing among obese women, Mary C. Livergood, MD, and colleagues at the Mercy Hospital in St. Louis, Missouri, performed a retrospective cohort study of those undergoing cfDNA testing at one center from 2011 through 2016. Study results recently were published online in the American Journal of Obstetrics and Gynecology.¹

Details of the study

Adjusted odds ratios (aORs) with 95% confidence interval (CI) for a cfDNA screening failure (referred to as a “no call” in the study) were determined for each body mass index (BMI) weight class (TABLE). Each BMI weight class also was compared with the aOR of normal-weight women (BMI <25.0 kg/m²). The predicted probability of a no call was determined for each week of gestational age for normal weight and obese women and the results were compared.¹

Among the 2,385 patients meeting inclusion criteria, 4.4% (n = 105) received a no call. Compared with normal weight women, the aOR of no call increased as weight increased from overweight (aOR, 2.31 [95% CI, 1.21–4.42]) to obesity class III (aOR, 8.55 [95% CI, 4.16–17.56]).¹

At 21 weeks’ gestation, a cut-point was identified for obesity class II/III women (ie, there was no longer a significant difference in the probability of no call when compared with normal-weight women). From 8 to 16 weeks’ gestation, there was a 4.5% reduction in the probability of a no call for obesity class II/III women (aOR, 14.9; 95% CI, 8.95–20.78 and aOR, 10.4; 95% CI, 7.20–13.61; P_trend<.01).¹

Although the authors conclude that a cut-point of 21 weeks’ gestation allowed for optimal sampling of cfDNA in obese women, they also acknowledge that this cut-point limits a woman’s reproductive choices. However, they say that delaying cfDNA testing in obese women is a reasonable strategy to reduce the probability of screening failure.¹

cfDNA screening failures occur in 1% to 12% of samples, a rate that has an inverse relationship to gestational age. Recent studies have shown an increased risk for screening failures among obese women. To determine the optimal gestational age for cfDNA testing among obese women, Mary C. Livergood, MD, and colleagues at the Mercy Hospital in St. Louis, Missouri, performed a retrospective cohort study of those undergoing cfDNA testing at one center from 2011 through 2016. Study results recently were published online in the American Journal of Obstetrics and Gynecology.¹

Details of the study

Adjusted odds ratios (aORs) with 95% confidence interval (CI) for a cfDNA screening failure (referred to as a “no call” in the study) were determined for each body mass index (BMI) weight class (TABLE). Each BMI weight class also was compared with the aOR of normal-weight women (BMI <25.0 kg/m²). The predicted probability of a no call was determined for each week of gestational age for normal weight and obese women and the results were compared.¹

Among the 2,385 patients meeting inclusion criteria, 4.4% (n = 105) received a no call. Compared with normal weight women, the aOR of no call increased as weight increased from overweight (aOR, 2.31 [95% CI, 1.21–4.42]) to obesity class III (aOR, 8.55 [95% CI, 4.16–17.56]).¹

At 21 weeks’ gestation, a cut-point was identified for obesity class II/III women (ie, there was no longer a significant difference in the probability of no call when compared with normal-weight women). From 8 to 16 weeks’ gestation, there was a 4.5% reduction in the probability of a no call for obesity class II/III women (aOR, 14.9; 95% CI, 8.95–20.78 and aOR, 10.4; 95% CI, 7.20–13.61; P_trend<.01).¹

Although the authors conclude that a cut-point of 21 weeks’ gestation allowed for optimal sampling of cfDNA in obese women, they also acknowledge that this cut-point limits a woman’s reproductive choices. However, they say that delaying cfDNA testing in obese women is a reasonable strategy to reduce the probability of screening failure.¹