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New research highlights that low levels of placental growth factor during mid-pregnancy screening can effectively predict early preterm birth, offering a potential tool to enhance maternal and infant health outcomes.

Early preterm birth risk linked to low PlGF levels during pregnancy screening

A large population-based study found that first-trimester tetracycline exposure does not elevate the risk of major congenital malformations, though specific risks for nervous system and eye anomalies warrant further research.

Major congenital malformations not linked to first trimester tetracycline use

A study found that Obstetric Life Support education significantly improves health care providers' readiness and outcomes in maternal cardiac arrest management, advocating for broader implementation.

Improved maternal cardiac arrest management reported from Obstetric Life Support training

A study reveals no significant difference in 6-month intrauterine device use between placements within 48 hours or 2 to 4 weeks after a second-trimester abortion, though earlier placement carries a higher expulsion risk.

IUD placement within 48 hours nonsuperior vs 2 to 4 weeks after abortion

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Spotlight

A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

STIs

Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Authors

JARED ROBINS, MD, is executive director of the American Society for Reproductive Medicine (ASRM). Prior to joining ASRM, he was a practicing reproductive endocrinologist working in both academic and private settings.

As we were going to press with the July issue, the United States Supreme Court overturned Roe v Wade, eliminating the constitutional right to an abortion, and leaving the question of abortion rights to the states.

Not just abortion: How the demise of Roe v Wade may impact fertility care

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

Postpartum hemorrage

In a recent interview with Contemporary OB/GYN, Kameelah Phillips, MD, a board-certified obstetrician and gynecologist, founder of Calla Women’s Health and Organon Health Partner, discusses the crisis related to postpartum hemorrhage (PPH) and how doctors may treat this condition in their patients. 

PPH is a leading cause of maternal morbidity and mortality, particularly in the United States, where maternal health outcomes have fallen behind those of other developed nations. Phillips attributed the ongoing challenges with PPH to factors such as difficulty in accurately quantifying blood loss, lack of uniform progress in managing PPH, and a disproportionate impact on women in low-resource settings with limited access to health services.

Phillips highlighted the increased risks for women residing in maternity care deserts, defined as often rural regions where obstetrical care is sparse or unavailable. Approximately 2 million women in the United States live in these areas, which lack critical maternal health care services and screenings, increasing their vulnerability to complications such as PPH, preterm birth, and other severe maternal health issues.

According to Phillips, the current standard of care for PPH involves using uterotonic medications to slow bleeding. If these do not suffice, a balloon tamponade is often employed, or in some cases, surgical procedures to block blood flow to the uterus. However, she noted that guidance from leading organizations may vary, and medical training and protocols differ, resulting in inconsistent approaches to managing PPH.

For more effective PPH treatment, Phillips emphasized the importance of timely intervention. In her own practice, she has implemented the JADA system, a device designed to manage abnormal postpartum bleeding by using low-level vacuum technology to encourage natural uterine contraction. Clinical studies on the JADA system have shown a median control time for bleeding of only 3 minutes, with minimal adverse events.

Phillips concluded by stressing the need for preparation and communication with patients before delivery to optimize maternal health and ensure that both health care providers and patients are equipped to handle potential complications such as PPH.

Learn why postpartum hemorrhage remains a critical maternal health issue in the United States and discover effective treatment approaches and preventative strategies shared by expert ob-gyn Kameelah Phillips, MD.

Clinical

Understanding and managing postpartum hemorrhage: Insights from Kameelah Phillips, MD

These are 3D ultrasound images of a 14-week fetus. What is your diagnosis?

occipital meningocele and umbilical hernia

DailyDx: 3D Images of a 14-week fetus

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

This middle-aged woman has severe dysmenorrhea and pelvic discomfort. Ultrasound images of the uterus are shown. What is your diagnosis?

Daily Dx: Dysmenorrhea and Pelvic Discomfort

Recreational cannabis legalization in California was linked to increased rates of cannabis use during 

 among women—particularly in jurisdictions in the state that allowed adult-use retailer businesses to open.

The findings from the population-based time-series study highlights a potential public health worth addressing proactively in obstetrician / gynecology clinics in states where recreational cannabis may potentially become legalized going forward.

A team of investigators from the University of California, San Francisco—led by Kelly C. Young-Wolff, PhD, MPH, from the division of research at Kaiser Permanente Northern California—sought any correlations between recreational cannabis legalization and prenatal cannabis use rates via self-report and urine toxicology testing. They additionally wanted to observe any more distinct correlations prenatal cannabis use and local policies banning or allowing cannabis retail.

Their setting was California, where cannabis was legalized in November 2016. The team observed that the prevalence of self-reported cannabis use has more than doubled in the US since 2002.

“Pregnant individuals report using cannabis to treat mental health and physical symptoms, and some view cannabis as a potentially safer option than prescription medications,” investigators wrote. “However, prenatal cannabis use is associated with an increased risk of adverse neonatal outcomes and maternal pregnancy outcomes and may also be associated with offspring neurodevelopment. National medical organizations recommend that clinicians screen for prenatal cannabis use, educate patients about potential risks, and recommend abstinence during pregnancy.”

Their time-series analysis of the real-world population used data from pregnancies to occur at Kaiser Permanente Northern California. The data included screen results from universal pregnancy cannabis use tests—both self-report and toxicology—between January 2012 – December 2019.

Young-Wolff and colleagues examined California’s legalization and the implementation of legal sales in 2018 with a 1-month lag. They additionally assessed local policies for or against medical retailers prior to recreational use legalization, and adult-use retailers, post-recreational use legalization.

Prenatal cannabis use was based on screening at entrance of prenatal care (8 – 10 weeks’ gestation) and were defined by either positive urine toxicology and self-report, lone toxicology, or lone-report.

The team’s data included 300,993 pregnancies from 236,327 individuals over the time period. Patients were primarily White (37.7%), then Hispanic (26.0%) or Asian (25.9%). Median age was 3.03 years old.

Prenatal cannabis use rose from 4.5% in January 2012 to 7.1% in January 2018. At the time of recreational cannabis use legalization in California, there was no change use rates among early-pregnancy women. In the first month after recreational cannabis implementation, the rate of prenatal cannabis use increased to 8.6% in February 2018—indicating a level change increased risk of 10% (RR, 1.10; 95% CI, 1.04 – 1.16). The team observed no difference in prenatal cannabis use based on toxicology test self-report.

Based on local policies, investigators observed that post-recreational cannabis legalization increase in use was only observed in jurisdictions that which allowed adult-use cannabis retailers (RR, 1.21; 95% CI, 1.10 – 1.33).

In prior research, another team of US investigators observed that public health interventions including warning sign policies do not seem to deter the rate of women who use cannabis during pregnancy.

In reviewing the findings, Young-Wolff and colleagues concluded that the implementation of legalized recreational cannabis in California was linked to an increase in early pregnancy cannabis use.

“Longer-term studies are needed to understand whether trends persist or change further

over time,” the team wrote. “As legalization spreads across the US, it will be important to test whether local policies that prohibit or limit adult-use retailers moderate changes in prenatal cannabis use associated with state-level legalization.”

California Courts. Proposition 64: Legalizes Marijuana. Accessed October 30, 2024. Available from: https://www.courts.ca.gov/prop64.htm#:~:text=Effective%20November%209%2C%202016%2C%20Proposition,sealing%20of%20prior%2C%20eligible%20marijuana%2D

Krewson C. Impact of warning signs on cannabis use during pregnancy. 

. Published June 21, 2023. https://www.contemporaryobgyn.net/view/impact-of-warning-signs-on-cannabis-use-during-pregnancy

A population-based time-series analysis California before, during and after legalization show a rising trend in women using cannabis while pregnancy especially when the state has legalized the drug.

Jared Robins, MD

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