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

When and How to Induce Labor in Nulliparous Women-- News from ACOG Annual Clinical and Scientific Meeting 2016.

Induction of labor is a major component of obstetrics practice with nearly one third of multiparous women   and 43 percent of nulliparous women undergoing induction.

Mary Catherine Tolcher, MD, MS, assistant professor of obstetrics, Mayo Clinic Rochester said “Induction of labor is likely to become more common with increasing maternal age, hypertensive disorders and obesity,” at Saturday afternoon Clinical Seminar at the conference.

The leading indications for induction of labor at the Mayo Clinic are late-term pregnancy, fetal indications, PROM, gestational hypertension and diabetes.

She further added that benefits of induced labor are clear, Induced labor avoids maternal and fetal risks of continuing pregnancy, avoids risks of late-term pregnancy, allows the timing of labor to be controlled in cases where delivery in a particular facility is appropriate and may be an alternative to cesarean delivery.

The risks are equally clear too, which means prolonged hospitalization before delivery, increased likelihood of more intrusive interventions, increased risk of postpartum hemorrhage and increased likelihood of cesarean delivery.

Answering the key question of whether induction increases the risks of cesarean section she said that it is like a lot of other things in medicine, and depends on your comparison group. 

Results based on retrospective cohort data show the following conclusions.

Depending upon studies the odds ratio for undergoing a cesarean delivery was somewhere between 1.9 and 3.5 when comparing spontaneous labor and induction. 

But compared to expectant management, induction does not seem to be associated with an increased risk of cesarean delivery. 

The first randomized control trial of induction vs expectant (ARRIVE TRIAL) management is currently recruiting participants and will be completing the data collection at the end of 2016.

Since the inception of induction of labor, many methods have been in use like mechanical ripening by Foleys catheter, pharmacological use of prostaglandins and oxytocin. These are either used alone or in combination with or without amniotomy.    

According to Dr. Tolcher, clinical trials have shown all of them to be effective. Cervical ripening is definitely more effective than oxytocin alone, while prostaglandins and Foleys catheter seems to have the same outcome.  Recent data reported at annual meeting of Society for Maternal-Fetal Medicine in 2016, concluded that time to delivery is shortened by using combination methods than using each of the method alone with no increase in cesarean section rates.

Amniotomy is also effective in augmenting the labor, but when early amniotomy (Cervix < 5 cm dilated) was compared to late amniotomy (Cervix > 5 cm dilated), the latter seemed more appropriate. Early amniotomy does results in shorter labor time but it comes with higher incidences of chorioamnionitis and increased fetal cord compression.

Dr. Tolcher also said that Mayo clinic has its own protocols for induction and the cases scheduled for induction in the coming week are reviewed in a staff meeting on Friday and Labor and Delivery nurse also has a significant say to put a stop to non-indicated cases.

Current indication for inductions include advanced maternal age, cholestasis, diabetes, fetal issues, hypertensive disorders, obesity, preterm premature rupture of membranes, prolonged pregnancy, prior stillbirth and unstable presentation. Depending on the indication, the pregnancy must be in week 37 and later.

Cervical ripening is the initial step, followed by oxytocin as needed and amniotomy at the discretion of physician. A failed induction is 24 hours of oxytocin or 18 hours of oxytocin plus rupture of membranes.

Before the decision for induction is taken, the physician should have a very good discussion with patient about the procedure, the expected time to delivery and slightly higher odds of having a cesarean delivery.

References:

http://www.acogdailynews.com/when-and-how-to-induce-labor-in-nulliparous-women/

http://www.acog.org/Womens-Health/Labor-Induction