The Leadership Report: The Best Ob/Gyn Research from 2013

From new treatments for menopausal symptoms and targeted therapies for gynecological cancers, to myriad discoveries that will improve obstetrical care, 2013 was another important year in ob/gyn research. Here, the leaders of five major ob/gyn societies reflect on the most exciting research from the past year. 

(Want more? Check out their picks for the most hotly anticipated research of 2014 here.)

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“In 2013, research pertaining to targeted therapies for the treatment of gynecologic cancers has been very important. We have seen studies report the effectiveness of poly(ADP ribose) polymerase (PARP) inhibitors, pazaponib (a tyrosine kinase inhibitor), and cedaranib (a vascular endothelial growth factor [VEGF]) inhibitors in the treatment of ovarian cancer. Also, the addition of the targeted therapy bevacizumab to standard chemotherapy was associated with a survival benefit when used in women with cervical cancer and in women with ovarian cancer. Trials of other targeted agents for endometrial cancer are nearing completion as well.

“It is very exciting to see the efficacy of these new biologic agents. And for our patients, these agents often are associated with less toxicity because they selectively target abnormal pathways in the cancer cell.”

- Barbara A. Goff, MD, President, Society of Gynecologic Oncology

[[{"type":"media","view_mode":"media_crop","fid":"23568","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_7313187273684","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1891","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"line-height: 1.538em; float: left; margin: 0px;","title":" ","typeof":"foaf:Image"}}]]“The past year brought forth 3 studies of significance. The first is the research from the Microbiome Project as it relates to the vagina, or the vaginal microbiome. For example, recent findings have helped us better understand how variations in vaginal microbiota can affect menopause status and vulvovaginal atrophy.

“The second is that the risks of hormone therapy are acceptably low for women experiencing symptoms at the time of menopause, as clarified in a summary paper from the WHI. 

“And third, research supports the use of 3 new treatment options for menopausal symptoms: ospemifene was approved for dyspareunia, or painful sexual intercourse; low-dose paroxetine (7.5 mg) was found to be well-tolerated and effective for vasomotor symptoms; and bazedoxifene/conjugated estrogens (BZA/CE) was approved for moderate-to-severe vasomotor symptoms and the prevention of postmenopausal osteoporosis.

- Margery Gass, MD, NCMP, Executive Director, The North American Menopause Society

[[{"type":"media","view_mode":"media_crop","fid":"23569","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_1536189296748","media_crop_h":"128","media_crop_image_style":"-1","media_crop_instance":"1894","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"340","media_crop_x":"1","media_crop_y":"97","style":"line-height: 1.538em; float: left; margin-left: 0px; margin-right: 0px;","title":" ","typeof":"foaf:Image"}}]]Several leaders from the Society for Maternal-Fetal Medicine (SMFM) weighed in when OBGYN.net asked about the most important research from the past year.

“The ACOG guideline on hypertension in pregnancy will completely change the criteria for diagnosis and treatment of the condition in pregnancy, including preeclampsia. Although this new guideline isn’t based on primary research, I expect it will change the face of care. A second study has not gotten its wings yet but speaks against planned cesarean deliveries for twin pregnancies."

- Brian Mercer, MD, Immediate Past President, Society for Maternal-Fetal Medicine

“Several studies come to mind. Results from the PLUTO study have afforded us a better understanding of the role of vesicoamniotic shunting for the treatment of fetal lower urinary tract obstruction. Also, the ProTwin study has shown that prophylactic use of a cervical pessary in twin pregnancies does not reduce the risk of poor perinatal outcomes.

"The CORONIS study found that there is no ideal surgical technique for cesarean sections, at least when looking at short-term effects. In addition, the APOSTEL-II Study Group provided more information about the utility of maintenance tocolysis with nifedipine in patients with threatened preterm labor. The conclusion was that use of nifedipine may have some benefits, but it cannot be recommended for maintenance tocolysis.

"Lastly, some good first steps were made in understanding how risk adjustment models can be used in obstetrics for meaningful comparisons of obstetrical outcomes between institutions.”

- George R. Saade, MD, Past President, Society for Maternal-Fetal Medicine

“From a practice perspective, the biggest change was the implementation of noninvasive prenatal testing through fetal DNA in maternal blood for high-risk pregnancies in most of our practices. The second biggest change was probably the start of universal cervical length screening. Neither of these existed in 2012.”

- Vincenzo Berghella, MD, President, Society of Maternal-Fetal Medicine

[[{"type":"media","view_mode":"media_crop","fid":"23570","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_7813573211897","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1895","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"line-height: 1.538em; margin: 0px; float: left;","title":" ","typeof":"foaf:Image"}}]]“Three studies from 2013 stand out. The first was a 17-year follow-up study of women who received the tension-free vaginal tape (TVT) procedure for female stress urinary incontinence. The study findings confirmed that the TVT midurethral sling, a procedure now performed in over 3 million women worldwide, is safe and effective. Another finding of significance was that surgery is a more effective treatment than physiotherapy for stress incontinence. Lastly, a randomized trial failed to show benefit of postpartum pelvic floor exercises reducing the prevalence of urinary incontinence.”

- Charlie Nager, MD, President, American Urogynecologic Society

[[{"type":"media","view_mode":"media_crop","fid":"23571","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_254584304057","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1896","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"line-height: 1.538em; float: left; margin-left: 0px; margin-right: 0px;","title":" ","typeof":"foaf:Image"}}]]“There were several interesting reports this year. One finding came from the lab of John Eppig, PhD, of the Jackson Laboratory in Maine, where it was determined that there actually isbidirectional communication between oocytes and ovarian follicular cells that contains the oocyte in a molecular state. It’s a basic finding but has profound implications.

“Another paper that was very, very interesting came from Aaron Hsueh, PhD.” The study looked at women with primary ovarian insufficiency, where they disrupted the hippo-signaling pathway in the ovaries by mincing them up and treating them with a drug that stimulates the Akt signaling pathway. The fragments were transplanted back into the women and, in one case, they retrieved mature eggs and had a successful live birth from IVF. “The problem with the study is that they did not have any controls in the humans. So we don’t know if it was cutting up the ovaries, or incubating with Akt stimulator that prompted the result.

“The third study assessed the long-term cancer risks of IVF. This large study looked at hazard ratios for various cancers in women being evaluated and treated for infertility. The incidences of cancer were evaluated, and researchers found no significant relationships between IVF exposure and the risk of breast, endometrial, or ovarian cancers. There was no association or increase in hazard ratios. And in the case of cervical cancer, the risk of cancer was reduced. These results should be very reassuring to women who are undergoing infertility procedures.”

- Andrew La Barbera, PhD, Scientific Director, American Society for Reproductive Medicine