News from ACOG 2018: Aspirin cuts down the risk of superimposed preeclampsia in women with chronic hypertension

Keeping up with the American College of Obstetricians and Gynecologists (ACOG) 2016 practice guideline of supplementing low-dose aspirin to pregnant women with chronic hypertension was associated with a 57% decrease in superimposed preeclampsia.

Investigators at Thomas Jefferson University presented the results of this retrospective study in a poster presentation at the ACOG 2018 annual meeting (April 27–30, 2018, Austin, Texas).

The study participants included 715 women with chronic hypertension carrying singleton pregnancy, who delivered at Thomas Jefferson University Hospital between January 2008 to July 2017.

The women were divided into 2 groups based on whether they delivered before and after ACOG recommendations. The pre-ACOG group included 635 women while the post-ACOG group had 80 women.

The cohort was further stratified based on additional risk factor for the development of superimposed preeclampsia (SIP) like a previous history of preeclampsia or pregestational diabetes. The primary outcome of interest was the development of preeclampsia, while the secondary outcomes studied were the incidence of SIP with severe features (SIPSF), small for gestational age, and preterm birth was also studied.

The incidence of SIP was dramatically reduced by 57% in women with chronic HT who received low dose aspirin (OR 0.43 (95% CI 0.26-0.73).

Women who had no other risk factor for the development of SIP, the incidence of SIP and SIP with severe features decreased by 75% and 77% respectively.

The incidence of secondary outcomes did not show any significant changes. Aspirin showed the highest benefits in women with chronic hypertension who did not have any additional risk factor for preeclampsia.

Hence the authors concluded that this study showed that ACOG guidelines have a significant positive impact on bringing down the incidence of superimposed preeclampsia in patients with chronic hypertension.

Abstract

ACOG Practice Advisory on Low-Dose Aspirin and Prevention of Preeclampsia

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News from ACOG: Skills Demonstration Video for the Localization and Removal of Non-Palpable Contraceptive Implants

This year’s film festival at the at American College of Obstetricians and Gynecologists (ACOG) 2018 annual meeting at Austin, Texas offered more audience-friendly format with three 1-hour sessions with 30 minutes break in between the first 2 sessions.

The organizers reviewed 96 videos this year, and while videos about minimally invasive surgical techniques are very popular, they were outnumbered by patient education and anatomic videos.

This popular video about how to localize and remove a non-palpable contraceptive implant earned a spot among the top 3 videos.

This video was developed by Jhpiego, an international, non-profit health organization affiliated with The Johns Hopkins University for clinicians who provide implant services to be able to locate and perform a difficult removal of a deeply placed implant as well as sonographers and other healthcare providers who participate in localizing deep implants.  

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News from ACOG 2018: First trimester bleeding linked to increased risk of retained placenta

Women who have a history of first-trimester hemorrhage face 8 times the increased risk of undergoing D&C for removal of the retained placenta as compared to women with a history of bleeding reports the result of a study presented at American College of Obstetricians and Gynecologists (ACOG) 2018 annual meeting at Austin, Texas.

This abstract also won the first prize among the oral award winners at the conference.

These women also have a higher incidence of postpartum hemorrhage and require blood transfusions more frequently says Marissa Le Gallee, of Jewish General Hospital in Montreal, and colleagues who conducted the research.

This case-control study was conducted over a period of four years (2012-2016) at a tertiary care center in Montréal, Canada. Subchorionic hemorrhage was identified by the patient's obstetric history on as an anechoic structure visualized on ultrasound.

The authors recruited 68 cases who had post vaginal delivery D&C for retained placenta and matched them to 330 controls who delivered on the same day but did not have D&C after going through the medical records.

The demographics of cases and controls were similar, except women requiring a D&C for placental removal were slightly older than controls. The incidence of retained placenta requiring D&C was 3/1000 deliveries.

There were 11 women with a history of the first trimester bleeding who underwent post-partum D&C as compared with only two controls without a D&C (adjusted OR 35.00, 95% CI 6.96-175.69, P=0.0002).

This association strongly existed even after adjusting for confounders (OR 7.70, CI 1.-37.5).

A significant number of women who had undergone D&C lost blood greater than 500ml and needed manual removal as well as blood transfusions compared with patients with no D&C.

Dr. Le Gallee hypothesized that Subchorionic bleed leads to adhesion of portions of the placenta that necessitates D&C at birth. It is also associated with placental abruptions and preterm births.

The authors concluded that women with a history of the first-trimester bleed should be watched carefully watched for other potential pregnancy and peripartum complications.

Abstract

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News from ACOG 2018: Unexplained infertility may be an indicator of decreased ovarian reserve even in young women

Despite advances in diagnostic modalities in the infertile couples, the cause of infertility remains largely unexplained in 25% to 30% of couples. The treatment in these couples remains largely empirical.

The result of a small study presented at the ACOG 2018 by, Dr. Andrea Starostanko MD and Dr. Jonathan Ayers MD from Saint Joseph Mercy Hospital Department of Obstetrics and Gynecology, Ann Arbor, MI suggests that even in young women with unexplained infertility (UI) ovarian reserve should be evaluated as part of initial work up.

Institute for Reproductive Health

They looked at data from 343 nulligravid couples (18-34 years) who were unable to conceive after unprotected coitus for a period of 12 months. The couples underwent tubal patency test, ovulation study and anatomic status by mid-cycle TVUS, comprehensive semen analysis, and assessment of Decreased Ovarian Reserve (DOR) with serum Anti-Mullerian Hormone (AMH).

A cause of infertility was found in 142/343 (41%) couples with anovulation in 30%, anatomic abnormality in 9% and male factor in 6%.  In 201/343 (59%) of couples, no probable cause could be identified.

In these couples with UI, 118/201 women had serum AMH levels below the 95 percentile of age-appropriate value and in nearly 25% of women below the age of 35(53/201), the values were < 1.5.

The researchers concluded that: 

All women with UI should be investigated for ovarian reserve during the initial workup, irrespective of their age

Women who are diagnosed with DOR should seek consultation with a specialist for further treatment options

DOR may also be a harbinger of premature menopause and associated cardiovascular complications  

Abstract

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ACOG annual meeting kicks off today in Austin, Texas

The American College of Obstetricians and Gynecologists (ACOG) 2018 Annual Meeting kicks off today at Austin, Texas. This year's meeting is going to highlight the medical and surgical innovations in healthcare, with an emphasis on those that are practice-ready.

The meeting begins at 8 A.M. on April 27, 2018, with ACOG President Haywood L. Brown, MD, calling the meeting to order and providing a review of our profession and his presidential year. This will be followed by new Trifecta Clinical Seminars in which three experts will voice their opinions on the same topic at the same time and a roundtable conference thereafter on “The New Postpartum Visit: Beginning of Lifelong Health.”

Postpartum care has been a focus during Dr. Brown’s presidency. The “Redefining the Postpartum Visit” task force and the Committee on Obstetric Practice are expected to release a revised “Optimizing Postpartum Care” Committee Opinion in the coming weeks, which will propose a new postpartum care paradigm. The task force confronts two areas: Redesigning the postpartum visit and researching and highlighting the impact of pregnancy complications such as high blood pressure (preeclampsia) on long-term health

There will not be a dearth of educational and hands-on opportunities throughout the conference said Sandra Carson, MD, vice president of education for the ACOG and lead organizer of the meeting.

ACOG innovation Rodeo is a new event at the conference this year. Keeping in line with the ACOG’s well-earned reputation for producing original, entertaining, and engaging educational programming, the Rodeo features educational games, learning labs, digital activations, networking opportunities, and two virtual reality stations focusing on pre-operative, surgery, and postoperative components for vaginal hysterectomy. It will be open Thursday through Sunday.

Mobile apps will also be a major attraction during this event. Katherine Chen, MD, from the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai in New York City will deliver the John I Brewer Memorial Lecture, entitled Smart Phones, Tablets, and Phablets: Delivering Apps for the OB/GYN.

Aaron Caughey, MD, PhD, chair of the Department of Obstetrics and Gynecology and associate dean for Women's Health Research and Policy at the Oregon Health & Science University School of Medicine in Portland will present the initial results of the ARRIVE trial (NCT01990612), which refute the claim that induction of labor leads to higher cesarean section rates.

This year meeting also sees an increase in the number of flipped classrooms sessions, in which attendees receive educational materials about the topic prior to the meeting to review on their own before the session. During the live session, the focus is on discussions and collaborative work instead of lectures.

Looking forward to some interesting research and digital innovations in the field of obstetrics.

2018 ACOG ANNUAL MEETING PREVIEW