The latest medical research on Obstetrics And Gynecology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about obstetrics and gynecology gathered by our medical AI research bot.
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Reduction in preterm birth rates during and after the COVID-19 lockdown in Queensland Australia.Australian and New Zealand Journal
Preventative strategies for preterm birth are lacking. Recent evidence proposed COVID-19 lockdowns may have contributed to changes in preterm birth.
To determine the prevalence of preterm birth and birth outcomes during and after the COVID-19 lockdown at the Sunshine Coast University Hospital and the overall state of Queensland, Australia.
Retrospective cohort analysis of all births in Queensland including the Sunshine Coast University Hospital, during two epochs, April 1-May 31, 2020 (lockdown) and June 1-July 31, 2020 (post-lockdown), compared to antecedent calendar-matched periods in 2018-2019. Prevalence of preterm birth, stillbirth, and late terminations were examined.
There were 64 989 births in Queensland from April to July 2018-2020. At the Sunshine Coast University Hospital, there was a significantly higher chance of birth at term during both lockdown (odds ratio (OR) 1.81, 95% CI 1.17, 2.79; P = 0.007) and post-lockdown (OR 2.01, 95% CI 1.27, 3.18; P = 0.003). At the same centre, prevalence of preterm birth was 5.5% (30/547) during lockdown, compared to 9.1% (100/1095) in previous years, a 40.0% relative reduction (P = 0.016). At this centre during lockdown, emergency caesareans concurrently decreased (P < 0.01) and instrumental vaginal births increased (P < 0.01). In Queensland overall, there was a nonsignificant decrease in the prevalence of preterm birth during lockdown.
There is a link between lockdown and a reduction in the prevalence of preterm birth on the Sunshine Coast. The cause is speculative at present, although increased influenza vaccination rates, decreased transmission of infections, and improved air quality may have been favourable in reducing preterm birth. Further research is needed to determine a causal link.
Birth outcomes by type of attendance at antenatal education: An observational study.Australian and New Zealand Journal
Antenatal education aims to prepare expectant parents for pregnancy, birth, and parenthood. Studies have reported antenatal education teaching breathing and relaxation methods for pain relief, termed psychoprophylaxis, is associated with reduction in caesarean section rates compared with general birth and parenting classes. Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended.
A cross-sectional antenatal survey of nulliparous women ≥28 weeks gestation with a singleton pregnancy was conducted in two maternity hospitals in Sydney, Australia in 2018. Women were asked what type of antenatal education they attended and sent a follow-up survey post-birth. Hospital birth data were also obtained. Education was classified into four groups: psychoprophylaxis, birth and parenting, other, or none.
Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03; 95% CI 0.93-4.43).
Women who attended psychoprophylaxis couple-based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes.
The stability investigation of variable viscosity control in the human-robot interaction.Int J Med
For many co-manipulative applications, variable damping is a valuable feature provided by robots. One approach is implementing a high viscosity at low velocities and a low viscosity at high velocities. This, however, is proven to have the possibility to alter human natural motion performance.
We show that the distortion is caused by the viscosity drop resulting in robot's resistance to motion. To address this, a method for stably achieving the desired behavior is presented. It involves leveraging a first-order linear filter to slow the viscosity variation down.
The proposition is supported by a theoretical analysis using a robotic model. Meanwhile, the user performance in human-robot experiments gets significantly improved, showing the practical efficiency in real applications.
This paper discusses the variable viscosity control in the context of co-manipulation. An instability problem and its solution were theoretically shown and experimentally evidenced through human-robot experiments. This article is protected by copyright. All rights reserved.
A novel virtual cutting method for deformable objects using high-order elements combined with mesh optimization.Int J Med
Virtual cutting of deformable objects plays an important role in many applications, especially in digital medicine, such as soft tissue cutting in virtual surgery training system.
We developed a novel virtual cutting algorithm, combined with mesh optimization. A new local mesh processing method is used to control the number and quality of the elements created during the cutting process. At the same time, high-order tetrahedral elements are used to fit the cutting surface and reduce the mesh size.
In this paper, single cut, multiple cut and intersecting cut are performed on the mesh model, combined with a force feedback device, and the result obtained is that the visual feedback is higher than 30Hz, and the tactile feedback is 800∼1000Hz.
Experimental results show that the method proposed in this paper can effectively eliminate low-quality elements and control the mesh size, thereby ensuring real-time simulation. This article is protected by copyright. All rights reserved.
Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022.Breastfeed Med
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impa...
Time Trends in Unilateral and Bilateral Oophorectomy in a Geographically Defined American Population.Obstetrics and Gynecology
To evaluate trends in the incidence of premenopausal unilateral and bilateral oophorectomy between 1950 and 2018.
The Rochester Epidemiology Project medical records-linkage system was used to identify all women aged 18-49 years who were residents of Olmsted County, Minnesota, and underwent unilateral or bilateral oophorectomy before spontaneous menopause between January 1, 1950, and December 31, 2018. Population denominators were derived from the U.S. Decennial Censuses for the years 1950-2010, and intercensal year population denominators were linearly interpolated. For 2011-2018, the annual population denominators were obtained from the U.S. Census projections. Where appropriate, overall incidence rates were age-adjusted to the total U.S. female population from the 2010 Census.
There were 5,154 oophorectomies in Olmsted County across the 69-year period between 1950 and 2018, and 2.9% showed malignant disease on pathology. A total of 2,092 (40.6%) women underwent unilateral oophorectomy, and 3,062 (59.4%) women underwent bilateral oophorectomy. More than half (n=1,750, 57.2%) of the bilateral oophorectomies occurred between 1990 and 2009. Until 1975-1979, the incidence of unilateral oophorectomy was mostly higher than bilateral oophorectomy. From 1980-1984 until 2000-2004, the incidence of bilateral oophorectomy more than doubled and the incidence of unilateral oophorectomy declined. After 2005, both procedures declined and converged to a similar incidence in 2015-2018. The decline in premenopausal bilateral oophorectomy over the past 14 years (2005-2018) was most pronounced for women who underwent oophorectomy concurrently with hysterectomy or did not have any ovarian indication.
The incidence rates of unilateral and bilateral oophorectomy have varied greatly across the 69-year period of this study. In the past 14 years, the incidence of premenopausal unilateral and bilateral oophorectomy has decreased. These trends reflect the effects of the initial 2005-2006 publications and the subsequent expanding body of evidence against the practice of oophorectomy for noncancer indications.
A Revised Markov Model Evaluating Oophorectomy at the Time of Hysterectomy for Benign Indication: Age 65 Years Revisited.Obstetrics and Gynecology
To perform an updated Markov modeling to assess the optimal age for bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign indication.
We performed a literature review that assessed hazard ratios (HRs) for mortality by disease, age, hysterectomy with or without BSO, and estrogen therapy use. Base mortality rates were derived from national vital statistics data. A Markov model from reported HRs predicted the proportion of the population staying alive to age 80 years by 1-year and 5-year age groups at time of surgery, from age 45 to 55 years. Those younger than age 50 years were modeled as either taking postoperative estrogen or not; those 50 and older were modeled as not receiving estrogen. Computations were performed with R 3.5.1, using Bayesian integration for HR uncertainty.
Performing salpingo-oophorectomy before age 50 years for those not taking estrogen yields a lower survival proportion to age 80 years than hysterectomy alone before age 50 years (52.8% [Bayesian CI 40.7-59.7] vs 63.5% [Bayesian CI 62.2-64.9]). At or after age 50 years, there were similar proportions of those living to age 80 years with hysterectomy alone (66.4%, Bayesian CI 65.0-67.6) compared with concurrent salpingo-oophorectomy (66.9%, Bayesian CI 64.4-69.0). Importantly, those taking estrogen when salpingo-oophorectomy was performed before age 50 years had similar proportions of cardiovascular disease, stroke, and people living to age 80 years as those undergoing hysterectomy alone or those undergoing hysterectomy and salpingo-oophorectomy at age 50 years and older.
This updated Markov model argues for the consideration of concurrent salpingo-oophorectomy for patients who are undergoing hysterectomy at age 50 and older and suggests that initiating estrogen in those who need salpingo-oophorectomy before age 50 years mitigates increased mortality risk.
Association of an Obstetric Surgical Closing Protocol With Infection After Cesarean Delivery.Obstetrics and Gynecology
To examine surgical site infection rates before and after the addition of a closing protocol to an existing surgical site infection risk-reduction bundle used during cesarean delivery.
We conducted a single-center retrospective cohort study to review the association of a closing protocol with rates of surgical site infection after cesarean delivery. The closing protocol included fresh surgical instruments and physician and scrub nurse glove change before fascia closure. Surgical site infections were defined using Centers for Disease Control and Prevention criteria. Eligible patients underwent cesarean delivery at our institution from July 1, 2013, through December 31, 2015 (n=1,708; preimplementation group), or from June 1, 2016, through April 30, 2018 (n=1,228; postimplementation group).
The surgical site infection rate was 2.3% preimplementation and 2.7% postimplementation (difference 0.4%, 95% CI -1.6 to 0.7%]. The mean [SD] duration of the surgical procedure was longer postimplementation (59.6 [23.7] vs 55.6 [21.5] minutes; P<.001).
Addition of a closing tray and glove change to our existing surgical site infection risk-reduction bundle was not associated with a reduction in the frequency of postcesarean surgical site infection but was associated with longer operating times.
Use of Estrogen Therapy After Surgical Menopause in Women Who Are Premenopausal.Obstetrics and Gynecology
To examine the use of estrogen therapy (ET) and patterns of follow-up evaluation for sequelae of estrogen deprivation among women who were premenopausal who underwent bilateral salpingo-oophorectomy (BSO) for benign gynecologic diseases.
The IBM Watson Health MarketScan Research Databases were used to identify women between age 18 and 50 years who underwent BSO from 2008 to 2019. Estrogen therapy was defined as any prescription of estrogen filled from 6 weeks before BSO to 36 months after BSO. Patterns of follow-up testing including bone mineral density and lipid testing were examined.
We identified a total of 61,980 women who underwent BSO for benign indications. Overall, 64.5% (95% CI 64.1-64.9%) of women received ET. The rate of ET use within 36 months of surgery declined from a peak of 69.5% in 2008 to 58.2% in 2016. The median duration of continuous ET was 5.3 months. Estrogen therapy use declined with increasing age. The cumulative rate of ET use at 36 months after surgery was 79.1% (95% CI 76.9-81.1) in those aged 18-29 years, 75.9% (95% CI 74.5-77.3%) in those aged 30-34 years, 70.2% (95% CI 69.1-71.2%) in those aged 35-39 years, 66.1% (95% CI 65.3-66.9%) in those aged 40-44 years, and 60.0% (95% CI 59.4-60.6%) in those aged 45-50 years. In a multivariable model, women who underwent surgery more recently and those with medical comorbidities were less likely to receive ET, whereas younger women, those with Medicaid insurance, those outside of the northeast, and those who underwent concurrent hysterectomy were more likely to receive ET.
Estrogen therapy use in women who are premenopausal who underwent BSO for benign gynecologic diseases has declined substantially over the past decade.
Method of Hormonal Contraception and Protective Effects Against Ectopic Pregnancy.Obstetrics and Gynecology
To estimate the incidence rates for ectopic pregnancy by contraceptive method in a cohort of women using hormonal contraception in Sweden between 2005 and 2016.
Women aged 15-49 years with a filled prescription for a hormonal contraceptive in the Swedish Prescribed Drug Register between 2005 and 2016 were included. For each woman, all exposed woman-years were allocated to treatment episodes depending on the method of contraception. Treatment time started on the day the prescription was filled and ended on the first day of the end of supply, new eligible dispensing, pregnancy-related diagnosis and its associated estimated last menstrual period, or removal procedure. Ectopic pregnancy was defined as having at least two records of International Classification of Diseases, Tenth Revision code O00-, including O00.0, O00.1, O00.2, O00.8, O00.9, within 30 days or one episode of O00- and one surgical procedure for ectopic pregnancy (NOMESCO Classification of Surgical Procedures code LBA, LBC, LBD, LBE, LBW). Incidence rates per 1,000 woman-years and 95% CIs were calculated for each method of contraception.
The study included 1,663,242 women and 1,915 events of ectopic pregnancy. The incidence rate (95% CI) for ectopic pregnancy per method of hormonal contraception was estimated: 13.5-mg levonorgestrel (LNG) hormonal intrauterine device (IUD), 2.76 (2.26-3.35) per 1,000 woman-years; 52-mg LNG hormonal IUD, 0.30 (0.28-0.33) per 1,000 woman-years; combined oral contraception, 0.20 (0.19-0.22) per 1,000 woman-years; progestogen implants, 0.31 (0.26-0.37) per 1,000 woman-years; oral medium-dose progestogen (desogestrel 75 mg), 0.24 per 1,000 woman-years, (0.21-0.27); and oral low-dose progestogen (norethisterone 0.35 mg and lynestrenol 0.5 mg), 0.81 (0.70-0.93) per 1,000 woman-years.
Hormonal contraception lowers the risk of ectopic pregnancy markedly. The incidence rate of ectopic pregnancy among women using a low-dose hormonal IUD (13.5 mg LNG) was substantially higher than that in women using other types of hormonal contraception. This study provides real-world evidence to inform best clinical practice for women-centered contraceptive counseling.
Mifepristone and Misoprostol for Undesired Pregnancy of Unknown Location.Obstetrics and Gynecology
To compare immediate initiation with delayed initiation of medication abortion among patients with an undesired pregnancy of unknown location.
This retrospective cohort study used electronic medical record data from the Planned Parenthood League of Massachusetts (2014-2019) for patients who requested medication abortion with a last menstrual period (LMP) of 42 days or less and pregnancy of unknown location (no gestational sac) on initial ultrasonogram. Clinicians could initiate medication abortion with mifepristone followed by misoprostol while simultaneously excluding ectopic pregnancy with serial serum human chorionic gonadotropin (hCG) testing (same-day-start group) or establish a diagnosis with serial hCG tests and repeat ultrasonogram before initiating treatment (delay-for-diagnosis group). We compared primary safety outcomes (time to diagnosis of pregnancy location [rule out ectopic], emergency department visits, adverse events, and nonadherence with follow-up) between groups. We also reported secondary efficacy outcomes: time to complete abortion, successful medication abortion (no uterine aspiration), and ongoing pregnancy.
Of 5,619 medication abortion visits for patients with an LMP of 42 days or less, 452 patients had pregnancy of unknown location (8.0%). Three patients underwent immediate uterine aspiration, 55 had same-day start, and 394 had delay for diagnosis. Thirty-one patients (7.9%), all in the delay-for-diagnosis group, were treated for ectopic pregnancy, including four that were ruptured. Among patients with no major ectopic pregnancy risk factors (n=432), same-day start had shorter time to diagnosis (median 5.0 days vs 9.0 days; P=.005), with no significant difference in emergency department visits (adjusted odds ratio [aOR] 0.90, 95% CI 0.43-1.88) or nonadherence with follow-up (aOR 0.92, 95% CI 0.39-2.15). Among patients who proceeded with abortion (n=270), same-day start had shorter time to complete abortion (median 5.0 days vs 19.0 days; P<.001). Of those who had medication abortion with known outcome (n=170), the rate of successful medication abortion was lower (85.4% vs 96.7%; P=.013) and the rate of ongoing pregnancy was higher (10.4% vs 2.5%; P=.041) among patients in the same-day-start group.
In patients with undesired pregnancy of unknown location, immediate initiation of medication abortion is associated with more rapid exclusion of ectopic pregnancy and pregnancy termination but lower abortion efficacy.
Association of Pharmacist Prescription of Contraception With Breaks in Coverage.Obstetrics and Gynecology
To assess whether pharmacist prescription of combined hormonal contraception is associated with 12-month contraceptive continuation rates or breaks in contraceptive coverage.
We conducted a retrospective cohort study of all short-acting, hormonal contraceptive users (pill, patch, ring, injectable) in Oregon's All Payer All Claims database from January 1, 2016, to December 31, 2018. We captured contraceptive use using diagnosis and National Drug Classification codes. We used logistic regression to measure the association between prescription by a pharmacist and 12-month contraceptive continuation rates and breaks in contraceptive coverage. Model covariates included age, rurality, and payer.
Our study sample consisted of 172,325 contraceptive users, of whom 1,512 (0.9%) received their prescriptions from a pharmacist. Pharmacists were significantly more likely than clinicians to prescribe to women between the ages of 25 and 34 years (50.5% vs 36.9%, P<.05), in urban settings (88.4% vs 81.7%, P<.05), and with commercial insurance (89.2% vs 59.5%, P<.05). We found that the rate of 12 months contraceptive continuation was higher among the population receiving a pharmacist prescription (34.3% vs 21.0%, P<.01). In an adjusted model, the odds of contraceptive continuation at 12 months were 61.0% higher for individuals with any pharmacist prescription (adjusted odds ratio [aOR] 1.61, 95% CI 1.44-1.79) compared with those with clinician prescriptions. Over 6 months, most contraceptive users in both groups experienced a break in coverage, defined as a gap of 1-29 days between prescriptions (61.6% vs 61.9%, P=.89). Breaks in contraceptive use were not significantly associated with prescriber type (aOR 1.03, 95% CI 0.90-1.18).
Compared with clinician prescriptions, pharmacist prescription of contraception is associated with increased odds of 12-month contraceptive continuation rates. However, the frequency of breaks in contraceptive coverage was similar among pharmacist and clinic-based prescribers.