Updates and resources from ACOG and SASGOG

Christine Isaacs, MD, professor of Obstetrics and Gynecology at Virginia Commonwealth University and Interim Chair in Richmond; and William M. Leininger, MD, from the Naval Medical Center in San Diego and assistant professor, Uniformed Services University in Bethesda, Maryland, discussed women’s health clinical updates, practical guidelines, and patient management tools, as well as educational resources to facilitate practice-based learning, in their session, “Our annual booster shot: clinical updates from ACOG-SASGOG at the 2022 American College of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting in San Diego, California.

One of the first studies looked at in this session was the predictions of the vaginal birth after cesarean delivery (VBAC) calculator, with the aim to develop an accurate tool to predict VBAC, without inclusion of race and ethnicity. Results of this study showed that VBAC was more likely for women who were taller and had a prior vaginal birth; it was less likely for women who were older, were of heavier weight, had a prior cesarean delivery for arrest of dilation or descent, or had a history of chronic hypertension on meds.

The presenters then shared results from a systematic review of oral antihypertensives for non-severe pregnancy hypertension. The aims of this review included prevention of proteinuria/preeclampsia, fetal/newborn death, preterm birth, and NICU admission using these medications. Results from the meta-analysis of randomized trials of anti-hypertensives showed that all medications reduced the risks of severe hypertension by 30% to 70%, with the medication labetalol statistically better at decreasing proteinuria/pre-eclampsia and fetal/newborn death.

Additional updates included, among others:
--management of nonpalpable radiopaque contraceptive implant, which is FDA-approved for up to 3 years

--negative patient descriptors in electronic health records (results showing that Black patients had 2.54 times the odds of having a negative descriptor as White patients)

--a review of low-dose misoprostol for induction of labor, which proved that low-dose oral misoprostol to induce labor led to fewer cesarean deliveries, and oral dosing caused less hyperstimulation with fetal heart rate changes vs vaginal dosing

--a look at clothing, electrical devices, and surgical site infection, with evidence supporting glove change before abdominal cavity closure if visible soilage from bowel or intra-abdominal contents; no evidence showing covered arms during skin antisepsis decreases surgical site infections (SSIs); a lack of evidence for disinfection of electronic devices to prevent SSIs or clinician infection; and a lack of evidence between attire practices and SSI’s.

--notes from a systemic review between NSAIDs and perioperative bleeding (the meta-analysis showed no difference in NSAIDs vs non-NSAIDs in hematoma, return to the operating room for bleeding, or blood transfusion, with the conclusion being that NSAIDS should be encouraged as an adjunct or replacement for opioids, SASand safely adopted as part of a multimodal analgesic strategy in the postoperative period.

At the conclusion of the session, the presenters offered a number of resources for self-education including ACOG notifications (https://www.acog.org/myacog/communication-preferences ), Society for Maternal-Fetal Medicine updates(https://www.smfm.org/publications); and the CDC “Health Matters for Women” newsletter (https://www.cdc.gov/women/newsletter/index.htm)

Reference

Isaacs C, Leininger WM.Our annual booster shot: clinical updates from ACOG-SASGOG. 2022 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting. May 7, 2022. San Diego, California.