A year in review: Best of 2017

We are already round the corner to 2018, here are the top 10 most read articles from 2017.

News from ACOG 2017: Changing gloves before abdominal closure brings down the rate of wound infection by almost 50% in Cesarean Section

Results of a randomized controlled trial presented at the ACOG 2017 showed that changing the outer gloves before closing the abdomen decreases the wound complication of infection, cellulitis and dehiscence.

https://obgynupdated.blogspot.com/2017/05/news-from-acog-2017-changing-gloves.html

Clinical review: Updates on Cesarean Section

Here is a roundup of the latest research on Cesarean Section.

https://obgynupdated.blogspot.com/2017/08/clinical-review-updates-on-cesarean.html

The American Heart Association updates BP guidelines in 14 years: now 130 is the new 140

The American Heart Association (AHA)  and The American College of Cardiology (ACC) has changed the definition of hypertension for the first time in 14 years, moving the number from the old standard of 140/90 to the newly revised 130/80.

According to the new definition, 130 to 139 mm Hg systolic and or 80 to 89 mm Hg will be labelled as stage 1 hypertension.

https://obgynupdated.blogspot.com/2017/11/the-american-heart-association-updates.html

First US baby born after uterine transplant delivered in Texas

The first birth as a result of a uterine transplant in the United States took place on Friday in Texas at the Baylor University Medical Center in Dallas. The women had undergone a live donor transplant and have received her uterus from Taylor Siler, 36, a registered nurse in the Dallas area.

https://obgynupdated.blogspot.com/2017/12/first-us-baby-born-after-uterine.html

New use of old drug: Sildenafil Citrate (Viagra) improves amniotic fluid index in oligohydramnios.

Sildenafil Citrate (Viagra) improves amniotic fluid index in pregnancies complicated by oligohydramnios according to a new study published ahead of print on March 6,2017 in Journal of Obstetrics and Gynecology.

https://obgynupdated.blogspot.com/2017/03/new-use-of-old-drug-sildenafil-citrate.html

WHO updates its guidance on Tranexamic Acid for the Treatment of Postpartum Hemorrhage

WHO has recently updated their guidelines for use of Tranexamic acid for treatment of Postpartum Hemorrhage: TXA should now be included in the treatment regimen for PPH along with other drugs, irrespective of the cause of hemorrhage.  

https://obgynupdated.blogspot.com/2017/11/who-updates-its-guidance-on-tranexamic.html

CDC releases ‘long awaited’ guidelines for preventing surgical site infections.

The Center for Disease Control released its much-awaited update to its 1999 guidelines for the prevention of surgical site infections (SSIs). The guidelines were published online May 3, 2017 in JAMA.

https://obgynupdated.blogspot.com/2017/05/cdc-releases-long-awaited-guidelines.html

Finally, an oral drug found effective in treatment of Uterine Fibroids following successful phase-3 trial

Relugolix successfully reduced heavy menstrual blood loss among Japanese women in a Multicenter, Randomized, Double-Blind, Parallel-Group, Phase 3 Study to Evaluate the Efficacy and Safety of Oral relugolix 40 mg as compared with injectable leuprolide in the Treatment of Uterine Fibroids.

https://obgynupdated.blogspot.com/2017/10/finally-oral-drug-found-effective-in.html

Now ‘Switch’ the way you suture: Reinventing suturing technique with the new device

Mellon Medical, a Dutch MedTech developer has reinvented suturing by developing a device which enables the surgeon to suture with only one hand, the other hand remaining free to use as needed. The product is named Switch®, a single use precision instrument that allows the surgeon to suture tubular structures or skin with twice the speed of conventional suturing.

https://obgynupdated.blogspot.com/2017/10/now-switch-way-you-suture-reinventing.html

A simple, novel solution to identify and protect ureter during surgery

AllotropeMedical, a Houston based medical startup has devised StimSite, a novel, hand-held, single use device that precisely identifies ureter during surgery; thus, eliminating the need for ureteral stenting.

https://obgynupdated.blogspot.com/2017/12/a-simple-novel-solution-to-identify-and.html

An inexpensive intervention reduces maternal mortality due to Post-partum hemorrhage.

An inexpensive intervention like Tranexamic acid (TXA) has the potential to significantly reduce maternal death due to Post-Partum hemorrhage(PPH) when used in timely manner, report the results of large randomized control trial.

The WOMAN (World Maternal Antifibrinolytic) Trial results along with an accompanying editorial were published online April 26, 2017 in Lancet.

Primary Post-partum hemorrhage is responsible for about 100 000 deaths every year primarily in developing countries and in low resource settings.

Before the WOMAN trial, tranexamic acid was shown to be effective in surgical blood loss and trauma cases but a review of literature failed to document any research in use of tranexamic acid in postpartum hemorrhage. Interestingly, the drug was originally developed for controlling hemorrhage in obstetrics and gynecology.

Further, WHO guideline in 2012 recommended “tranexamic acid should be used for the treatment of post-partum hemorrhage when uterotonics fail to control the bleeding or when the bleeding is thought to be due to trauma,” but the results were extrapolated from surgery or trauma cases.

Comprising of 20,060 patients with a clinical diagnosis of PPH during normal or cesarean delivery, the WOMAN trial spanned across 193 hospitals in 21 countries.

All patients received normal obstetric care and were randomized to receive 1 g tranexamic acid or placebo by slow intravenous injection. If bleeding persisted after 30 minutes or restarted after once controlled within 24 hours, a dose of TXA was repeated.  

Trial results were evaluated in terms of number of deaths from all causes or hysterectomy within 42 days of drug administration. Deaths due to bleeding was also looked at as main secondary outcome.

The results showed that treatment with TXA reduces the chances of death due to bleeding by almost 20% as compared to placebo (risk ratio [RR], 0.81; P = .045). The effect was maximum when TXA was used within 3 hours of delivery (RR, 0.69; P = .008).

When the drug was used after 3 hours, there was no significant reduction in risk of death due to bleeding (RR, 1.07; P = .70).

The risk of death due to hysterectomy and all causes or hysterectomy including pulmonary embolism, organ failure, sepsis, and eclampsia were similar between the study and control group.

TXA did not increase the risk of thromboembolic events as compared to placebo.

An accompanying editorial writes that “Hemorrhage accounts for 18% of these deaths, and is a particularly important cause of maternal mortality in Africa and Asia. Discovering new ways to prevent maternal death, especially from bleeding, therefore continues to be a high priority, and WOMAN trial is an important milestone in that quest.”

The authors recognize that most deaths due to PPH occur in developing or low resource setting countries, where administering IV TXA may not be feasible.  So, studies investigating alternate routes of TXA administration should be planned.

The trial also supported the WHO recommendation of inclusion of tranexamic acid in treatment guidelines for primary postpartum hemorrhage but with a caveat that it should be given as soon as possible.

Full text of the article can be accessed here.

Full text of the editorial can be accessed here.

                                          Woman Trial: Tranexamic acid for the treatment of PPH