 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

Jeanette Carpenter, MD, MSCI, maternal-fetal medicine specialist at Pediatrix Medical Group, based out of Salt Lake City, Utah, discussed a recently published study regarding pregnant COVID-19 patients who also had disseminated intravascular coagulation (DIC). DIC is a serious condition that can cause the depletion of blood clotting factors and lead to hemorrhage among other complications.

Videos

Jeanette Carpenter, MD, MSCI, maternal-fetal medicine specialist at Pediatrix Medical Group, discussed a recently published study regarding pregnant COVID-19  patients who also had disseminated intravascular coagulation (DIC). 

Disseminated intravascular coagulation among pregnant patients with COVID-19

You can reach her a lcarr@mjhlifesciences.com.

Cancer survivors face heightened risk of bone fractures

An analysis of data from the Cancer Prevention Study-II suggests cancer survivors had a more than doubling in risk of frailty-related bone fractures than their counterparts without cancer.

HBsAg-positive status, excessive gestational weight gain risk factors for gestational diabetes mellitus

HBsAg-positive women with adequate gestational weight again among pre-pregnancy normal-weight women had a higher risk of gestational diabetes mellitus than HBs-Ag-negative women.

Many cases of new-onset postpartum hypertension go unnoticed for weeks

An analysis of deliveries occurring at the Boston Medical Center from 2016-2018 is providing clinicians with new insights into the risk of new-onset postpartum hypertension.

AAGL has officially begun: What to expect at this year's 51st Global Congress on MIGS

An inside look at our exclusive coverage at this year's 51st Global Congress on MIGS from the American Association of Gynecologic Laparoscopists (AAGL). 

Articles

A look at what's coming to Contemporary OB/GYN this week.

This week on Contemporary OB/GYN: November 28 to December 2

Survivors of cancer, particularly those diagnosed or who had received chemotherapy within the past 5 years, were at an increased risk of 

 compared to their counterparts without cancer, according to new research from the American Cancer Society.

An analysis of data from more than 90,000 participants from the Cancer Prevention Study-II Nutrition cohort and Medicare claims data from 1997-2017, results of the study indicated cancer survivors who were diagnosed 1 to less than 5 years earlier with advanced stage cancer had a more than doubling in risk of fractures compared to their counterparts without a history of cancer, but part of this risk was mediated by increased physical activity.

“These findings are important as the number of cancer survivors living in the United States is projected to rise to 26.1 million by 2040. Research like this seeks ways for cancer survivors to have a better quality of life after their diagnosis,” said lead investigator Erika Rees-Punia, PhD, MPH, a senior principal scientist in behavioral and epidemiology research at the American Cancer Society, 

. “Fractures of the pelvis and vertebrae are more than just broken bones – they are serious and costly.”

As the population ages and the number of cancer survivors continues to grow, concern over the long-term prognosis of cancer survivors, including risk of fracture, has grown as well. Recognizing this concern, Rees-Punia and a team of colleagues from the American Cancer Society sought to further examine the topic to provide clinicians with guidance on fracture prevention in this patient population. With this in mind, investigators designed the current study as an analysis of data from the Cancer Prevention Study II (CPS-II).A prospective study assessing cancer mortality launched by the American Cancer Society in 1982, CPS-II contained a subset of participants who were invited to join a nutrition cohort within the study in 1992. This nutrition cohort completed a survey in 1992 and biennial questionnaires beginning in 1997. From the cohort, 92,431 participants were identified for inclusion in the current study. This cohort had a mean age of 69.4 (SD, 6.0) years, 56% were female, 97.9% were White, and 14% (n=12,943) experienced a frailty-related bone fracture.

For the purpose of analysis, multivariable Cox proportional hazards regression was used to assess risk of pelvic, radial, vertebral, and total frailty-related fractures, which were considered the primary outcomes of interest for the investigators’ analysis. Investigators pointed out their analysis included data recorded from 1999-2017, with analyses occurring from July 15, 2021-May 3, 2022. Investigators also pointed out cancer history, some since diagnosis, and stage at cancer diagnosis served as the exposures of interest for their analyses.

Upon analysis, results indicated cancer survivors who were diagnosed 1 to less than 5 years earlier with advanced sage cancer had a more than doubling in fracture risk compared to those without a history of cancer (HR, 2.11 [95% CI, 1.75-2.58]). Further analysis suggested the increased risk in cancer survivors with recent advanced staff cancer compared to their counterparts without cancer was mostly driven by increased risk of vertebral (HR, 2.46 [95% CI, 1.93-3.13]) and pelvic (HR, 2.46 [95% CI, 1.84-3.29]) fractures.

Compared to those who did not receive chemotherapy, survivors who received chemotherapy were more likely to experience a frailty-related bone fracture. Investigators noted this association was stronger within 5 years of diagnosis than it was more than 5 years after diagnosis (HR, 1.22 [95% CI, 0.99-1.51]). Additionally, investigators highlighted that the risk of fracture was lower among those who were physically active survivors 5 years or more removed from diagnosis, but this did not reach statistical significance (HR, 0.76 [95% CI, 0.54-1.07]). Investigators also highlighted the finding that current smoking was significantly associated with higher risk of fracture (HR, 2.27 [95% CI, 1.51-3.33]).

“We hope our findings will inform clinical guidance on fracture prevention, which could incorporate physical activity with exercise cancer professionals and smoking cessation programs, to improve quality of life after a cancer diagnosis,” Rees-Punia added.

Fracture Risk Among Older Cancer Survivors Compared With Older Adults Without a History of Cancer

This article originally appeared on Endocrinology Network®.

The volume of fat mass, as analyzed by a Principal Component Analysis (PCA), was shown to negatively modulate the severity of fibromyalgia syndrome (FMS), according to a study published in Reumatología Clínica.1 Investigators urge clinicians to evaluate body composition as part of the basic clinical approach for the treatment of this patient population.

“Since at least part of the pathogenesis of FM appears to be influenced by impaired regulation of pain modulating cytokines,both centrally and peripherally, the hypothesis that body composition can modulate the symptomatic context of fibromyalgia syndrome is perfectly plausible, although the results coming from studies devoted to the topic are contradictory,” investigators stated.

In this observational, quantitative, cross-sectional study, the association between type of body composition and FMS was evaluated using 43 women with clinically diagnosed FMS, per the American College of Rheumatology (ACR) 2010 criteria.

Clinical outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), Symptom Severity Scale (SSS), and the Widespread Pain Index (WPI). Anthropometric data was categorized into PCA-

. Patients were also classified into high and low categories for each clinical indicator, which were used in the binomial logistic regression (BLR) models. Inclusion criteria included female sex, aged 18 years or older, with a clinical diagnosis of fibromyalgia (FM). Patients were selected through the Rheumatology outpatient clinic at the Yucatán Peninsula’s High Specialties Regional Hospital.

The median age of patients was 52.7 (± 11.3 years) years and had an average disease duration of 53.6 ± 54 months. Most patients were currently receiving some form of medication, including nonsteroidal anti-inflammatory drugs (NSAIDs) (65%, n = 30), opioids (28%, n = 13), and benzodiazepines or antidepressants (62%, n = 27, combined). Nearly all patients were classified as overweight or obese (90.7%), and most had 1 or more comorbidity (62.7%).

A positive correlation was shown between PCA-

 and both WPI (r = 0.326, P = .043) and FIQ (r = 0.325, 

 = .044). There was a negative correlation between PCA-

 was a significant predictor of high WPI (OR = 2.477, 

 was an inversely significant predictor of high SSS (OR = 0.303, 

“Our results strongly suggest that hyper-adiposity states may negatively modulate the clinical severity in FM,” investigators concluded. “Thus, body composition appraisal must be part of the global assessment of FM patients, with mandatory nutritional counseling, and special emphasis in the diet, from which patients can see benefits ranging from reduced anxiety symptoms, mood disturbance, and even disappointment with body image.”

This article originally appeared on Rheumatology Network®.

Álvarez-Nemegyei J, Pacheco-Pantoja EL, Olán-Centeno LJ, Angulo-Ramírez A, Rodríguez-Magaña FE, Aranda-Muiña JF. Association between fibromyalgia syndrome clinical severity and body composition. A principal component analysis. 

. 2022;18(9):538-545. doi:10.1016/j.reumae.2021.09.008

The association between type of body composition and fibromyalgia was evaluated using 43 women with clinically diagnosed fibromyalgia.

Volume of fat mass negatively impacts severity of fibromyalgia

Bacterial vaginosis during pregnancy may heighten risk of preterm birth, pregnancy loss

Bacterial vaginosis during pregnancy may lead to increased risks for preterm birth, preterm delivery, and spontaneous abortion, according to new research in the Archives of Gynecology and Obstetrics.

The Challenges of Diagnosing Recurrent Vulvovaginal Candidiasis

Michael L. Krychman, MD, and Jack D. Sobel, MD, review diagnostic criteria of diagnosis of RVVC and the impact of misdiagnosis.

Dextromethorphan ineffective adjuvant option for medication abortion pain management

Dextromethorphan was not a successful adjunctive pain management option for medication abortion, according to research results published in 

Five minutes of a doctor’s time could cost patients $50

Cleveland Clinic begins charging for doctors’ time spent responding to some electronic messages.

Pap Talk S4E10: 2023 women's health outlook

In this episode of Pap Talk, Alison Cowan, MD, discusses her predictions for women's health trends in 2023.

In case you missed it: November 21 to November 25

A look at more than 8300 deliveries with a pregnancy length of at least 20 weeks, the study identified being aged 35 years or older, delivery via cesarean, or being a current or former cigarette smoker as risk factors for new-onset postpartum hypertension and produced evidence suggesting more than 1-in-10 with no prior history went on to develop hypertension in the year following delivery.

“The findings of our study have implications for postpartum care, particularly among women without a history of high blood pressure,” said lead study author Samantha Parker, PhD, an assistant professor of epidemiology at Boston University School of Public Health, in 

a statement from the American Heart Association

. “We were surprised at the number of cases captured more than six weeks after delivery, a period that falls well outside of routine postpartum follow-up. Monitoring during this period could mitigate severe postpartum and long-term cardiovascular complications.”

With a renewed emphasis on cardio-obstetrics in recent years, research efforts have begun to further explore associations of hypertensive disorders of pregnancy with negative cardiovascular outcomes. However, fewer research endeavors have examined incidence and risk factors of new-onset postpartum hypertension, also known as de novo postpartum hypertension (dn-PPHTN) using contemporary data. With this in mind, Parker, along with colleagues Ayodele Ajayi, MBBS, MPH, and Christina Yarrington, MD, of Boston University, designed a retrospective medical record-based cohort study of deliveries occurring at the Boston Medical Center, a large, central, urban safety-net hospital.

Limiting their analyses to pregnancies among adult patients of at least 20 weeks in length from 2016-2018, investigators identified 3925 deliveries for potential inclusion in their analyses. Further restricting this population to those without chronic hypertension or hypertensive disorders of pregnancy, investigators identified 2465 patients without a history of hypertension for inclusion. Using this cohort, investigators planned to assess for dn-PPHTN within 1 year of delivery, which was defined as 2 separate blood pressure reading with a systolic blood pressure at or exceeding 140 mmHg and a diastolic blood pressure at or exceeding 90 mmHg at least 48 hours after delivery. Secondary outcomes of interest included risk factors individually and in combination as well as timing of diagnosis and occurrence of severe dn-PPHTN, a systolic blood pressure at or exceeding 160 mmHg and a diastolic blood pressure at or exceeding 110 mmHg.

Among the 2465 patients included in the study, 12.1% (n=298) developed dn-PPHTN during the first year following delivery. Among this group of patients, 17.1% (n=51) developed severe dn-PPHTN. An analysis of patient characteristics among those who developed dn-PPHTN compared to those who did not were more likely to be 35 years or older (36.2% vs 22.8%), delivered via cesarean, or be current or former smoker, with patients with all of these characteristics at a 29% risk of developing dn-PPHTN. Investigators noted this increase in risk was even more apparent in non-Hispanic Black patients (36%). Investigators pointed out 22% cases were diagnosed 6 weeks or more postpartum.

“Understanding the relationship between pregnancy and hypertension is particularly important in addressing inequities in maternal cardiovascular disease and death for people of color,” Parker added.

De Novo Postpartum Hypertension: Incidence and Risk Factors at a Safety-Net Hospital

This article originally appeared on Practical Cardiology®.

For a medical device start-up to be successful, it needs a talented team, decisive implementation, and adequate funding. Without resources for prototype development, patent filing, regulatory work, and more, the best ideas will die on the vine because running out of funds is a common reason for failure.

In an exclusive interview, Nash Moawad, MD, MS, FACOG, FACS, discussed the recent implementation of the Essentials of Minimally Invasive Gynecologic Surgery (EMIGS) training program, which helps physicians provide the best care and ensure optimal safety for their patients.

Past traumas may worsen menopausal symptoms and wellbeing at midlife

Research in Menopause connects history of physical/sexual abuse, financial instability with worse menopausal symptoms and overall wellbeing at midlife.

Study: COVID-19 reduced contraceptive access

In a recent study, it was found that access to contraceptive services declined during the COVID-19 pandemic.

Phase 3 data show oral oteseconazole successful for treating vulvovaginal candidiasis and infections

The medication also performed comparably to vulvovaginal candidiasis (VVC) standard-of-care fluconazole for treating acute VVC infection.

 Air pollution associated with adverse birth outcomes

Prenatal exposure to industrial air pollutants increases risk of adverse birth outcomes in infants.

COVID-19 vaccine associated with increased menstrual cycle length

In a recent study, participants who had received a COVID-19 vaccine saw an average increase in menstrual cycle length of less than 1 day.

Endometrial ablation in the office setting

Breaking down barriers through patient selection, new devices, and the latest techniques.

Bowel injury after operative hysteroscopy

Delayed response to surgical complications leads to adverse outcomes.

Revisit this month's issue of Contemporary OB/GYN®. 

November issue recap: Vol 67 No 11

A specific imbalance of 2 placental proteins may indicate women at risk of developing preeclampsia with severe features (sPE), according to research published in 

“We discovered that a blood test measuring the ratio between two proteins involved in blood vessel development in the placenta could identify which of the women would develop preterm preeclampsia with severe features,” said study co-senior author Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center. “This test was significantly better than all the standard-of-care markers for preeclampsia with severe features. It predicted with over 90% accuracy whether the patient would develop preeclampsia with severe features or not, while the usual markers were accurate less than 75% of the time.”

Investigators evaluated a total of 1014 pregnant women across 18 US centers. They prospectively measured the ratio of serum soluble tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) in pregnant women hospitalized between 23 and 35 weeks gestation. The study’s primary outcome was predicting sPE, and secondary outcomes included predicting adverse outcomes within 2 weeks.

They ultimately included 299 women in the derivation cohort and 715 in the validation cohort. For the derivation group, the median sFlt-1 to PlGF ratio was 200 ((interquartile range, 53 to 458) among women who developed sPE compared with 6 (interquartile range, 3 to 26) in those who did not (P<0.001). The discriminatory ratio of ≥40 was then tested in the validation cohort and yielded a 65% positive (95% confidence interval [CI], 59 to 71) and a 96% negative (95% CI, 93 to 98) predictive value for the primary outcome.

In women with hypertensive disorders of pregnancy between 23 and 35 weeks gestation, investigators concluded that the measurement of serum sFlt-1 to PlGF provided stratification of the risk of progressing to sPE within the upcoming 2 weeks.

Circulating Angiogenic Factor Levels in Hypertensive Disorders of Pregnancy | NEJM Evidence. NEJM Evidence. Published November 9, 2022. Accessed November 28, 2022. https://evidence.nejm.org/doi/full/10.1056/EVIDoa2200161

Testing the ratio between 2 placental proteins may be an early predictor of women at risk of developing preeclampsia with severe features. 

Placental protein imbalance may predict preeclampsia risk

 surface antigen are at an increased risk of gestational diabetes mellitus, according to new research.

A team, led by Wanchang Yin, Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University, identified the association between gestational weight gain (GWG) and gestational diabetes mellitus in HBsAg-positive women to provide management advice on gestational weight gain.

Pregnant women with chronic HBV infections have a higher risk of developing gestational diabetes mellitus.

In the retrospective cohort, the investigators examined 39,539 pregnant women who gave birth at the Third Affiliated Hospital of Guangzhou Medical University in China.

The patients were split up into a group of HBsAG-negative (n = 36,500) and HBsAg-positive (n = 3039) groups. The investigators used univariate and multivariable logistic regression analyses to explore the link between gestational weight gain and gestational diabetes mellitus in maternal carrier women with HBV.

The results show being HBsAg-positive and excessive gestational weight gain are independent risk factors for gestational diabetes mellitus, while excessive gestational weight gain was linked to a higher risk of gestational diabetes mellitus in HBsAg-positive women.

However, HBsAg-positive women with adequate gestational weight again among pre-pregnancy normal-weight women had a higher risk of gestational diabetes mellitus than HBs-Ag-negative women.Moreover, HBsAg-positive women with inadequate gestational weight gain had a lower risk of gestational diabetes mellitus.

“The optimal GWG ranges for pre-pregnancy normal-weight HBsAg-positive pregnancies might be lower than the United States Institute of Medicine recommendations,” the authors wrote. “HBsAg-positive women should strictly control GWG to reduce the risk of GDM.”

Earlier this year, investigators have identified at least 2 new risk factors for liver-related mortality in patients with 

A team, led by Nobuhiro Hattori, Department of Internal Medicine, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, identified the risk factors linked to liver-related and non-liver-related mortality in patients with HCV following sustained virologic response to direct-acting antiviral agents.

In the retrospective, single-center cohort, the investigators examined 330 patients with HCV cured by DAAs. There was a median follow-up of 3.38 years. Each patient was administered IFN-free DAA treatment between September 2014 and January 2021 at the St. Marianna University Hospital. In addition, the patients with a history of hepatocellular carcinoma (HCC) did not have active HCC at the time of initiation of their final DAA therapy.

The results show a cumulative liver-related or non-liver-related mortality rate of 0.00 or 1.29% at year 1, compared to 2.87 or 3.60% at year 3 and 5.10 or 9.46% at year 5.

For liver-related deaths, 90% (n = 9) were from liver cancer, while the most common cause of non-liver-related deaths was malignancy.

After conducting a multivariate analysis using the Cox proportional hazard model, the investigators found diabetes mellitus (HR, 13.1; 95% CI, 2.81–61.3) and a history of hepatocellular carcinoma (HR, 12.8; 95% CI, 2.76–59.2), independently predicted liver-related death. There were no variables linked to non-liver-related death.

Reducing the risk of gestational diabetes mellitus in chronic hepatitis B virus carriers via more strict control of gestational weight gain

International Journal of Gynecology & Obstetrics


This article originally appeared on HCP Live®.

Sarah Crafton, MD, gynecologic oncologist at Allegheny Health Network in Pittsburgh, Pennsylvania, details how sentinel lymph node mapping can help identify the stage of uterine cancers and lead to better patient care.

Sarah Crafton, MD, details how sentinel lymph node mapping can help identify the stage of uterine cancers and lead to better patient care.