The WHC is a response to the recent creation of a pregnancy think tank and years of fighting for equality.

The Womxn's Health Collaborative with Dr. Michal Elovitz 

 and get additional information about the WHC 

Podcasts

Senior Editor Angie DeRosa interviews Dr. Michal Elovitz, executive director of the recently formed Womxn’s Health Collaborative (WHC), a group whose mission is to empower women from diverse backgrounds to succeed and become leaders in science and health in the field of women’s health.

S2E5: The Womxn's Health Collaborative with Dr. Michal Elovitz

"Vaginal Dilators 101: Basic suggestions for the health care professional,"

 which will be published in the November issue of 

Poll

This week's poll focuses on vaginal dilation for treatment of various sexual concerns. 

Do you recommend vaginal dilation to patients?

Most fetal anomalies are not determined prenatally. Fluid buildup in fetuses, known as nonimmune Hydrops fetalis (NIHF), is no exception and can often be lethal. 

used exome sequencing to analyze 127 fetuses with unexplained cases of NIHF and identified a gene variant in approximately one-third of the cases.

Researchers evaluated a series of 127 consecutive unexplained cases of NIHF that were defined by the presence of the following conditions: fetal ascites, pleural or pericardial effusions, skin edema, cystic hygroma, increased nuchal translucency, or a combination of these conditions.

In 29% of the cases (37), researchers identified diagnostic genetic variants, including those for disorders affecting the RAS-MAPK cell-signaling pathway (known as RASopathies) (30% of the genetic diagnosis); inborn errors of metabolism and musculoskeletal disorders (11% each); lymphatic, neurodevelopmental, cardiovascular, and hematologic disorders (8% each); and others.

Overall, 68% of cases (25 of 37) with diagnostic variants were autosomal dominant, of which 12% were inherited and 88% were de novo. Ten of 37 (27%) were autosomal recessive, of which 95% were inherited and 5% were de novo. One was inherited X-linked recessive, and 1 was of uncertain inheritance.

Additionally, researchers identified potentially diagnostic variants in 12 additional cases.

Ob/gyns know that NIHF is often fatal and has several genetic causes. Exome sequencing is a rapid DNA sequencing technique that may be used to provide more in-depth information than current genetic testing methods.

The researchers were funded by the National Institutes of Health (NIH). Lead investigator Teresa Sparks, MD, of the University of California, San Francisco, is supported by a Women’s Reproductive Health Research grant from NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development. Additional support was provided by the National Human Genome Research Institute.

Sparks T, Lianoglou B, Adami R, et al. Exome Sequencing for Prenatal Diagnosis in Nonimmune Hydrops Fetalis. 

. Published online October 7, 2020. doi: 10.1056/NEJMoa2023643

Science Update: DNA sequencing technique helpful for identifying genetic causes of fetal fluid buildup, NIH-funded study suggests. News release. National Institute of Child Health and Human Development. October 9, 2020.

Articles

A new study in The New England Journal of Medicine used exome sequencing to analyze 127 fetuses with unexplained cases of nonimmune Hydrops fetalis.

DNA sequencing technique may help prenatally detect NIHF 

To address this knowledge gap, a team of researchers investigated clinical outcomes of people with inherited metabolic diseases that had been identified via newborn screening programs. The study, published in 

 analyzed 306 people between 1999 and 2016 who were followed for a median time of 6.2 years.

The research team ultimately found that individuals with phenylketonuria, as well as those with a lifelong risk of metabolic decomposition, had favorable long-term outcomes. They also found that a high newborn screening process quality was a necessity for this positive result.

“Although the risk for metabolic decompensation was disease-specific and NBS could not prevent decompensations in every individual at risk (n = 49), the majority did not develop permanent disease-specific signs (75.9%), showed normal development (95.6%) and normal cognitive outcome (87.7%; mean IQ: 100.4), and mostly attended regular kindergarten (95.2%) and primary school (95.2%),” the authors wrote.

Newborn screening, according to the research team, is a highly successful element of secondary prevention for inherited metabolic diseases. They noted, however, that these screenings may not be successful in completely preventing clinical presentation in all individuals.

For further detail of this prospective multicenter observational study, visit 

Despite the fact that extended newborn screenings have been used for more than 20 years, the impact of such screenings on long-term clinical outcomes among individuals who had inherited metabolic diseases is still relatively unknown. 

The impact of extended newborn screening programs on inherited metabolic diseases

VIew the slideshow below to learn about the data and statistics that surround pregnancy and infant loss in the United States in recognition of Pregnancy and Infant Loss Awareness Month.

October: Pregnancy and Infant Loss Awareness Month

Slideshows

Each year, approximately 24,000 babies are stillborn in the U.S, and as many as half of all pregnancies may end in miscarriage. 

October is Pregnancy and Infant Loss Awareness Month

, there are a number of hot topics that we will be posting throughout the week including:

The Womxn's Health Collaborative with Dr. Michel Elovitz

Infectious complications after massive blood loss from gynecologic laparotomy

and a slideshow of statistics to recognize Pregnancy and Infant Loss Awareness Month. 

Get a snapshot of what's coming up this week.

This week on Contemporary OB/GYN

“What’s important to me is that people stand up,” Dr. Elovitz says in the interview. “What’s important to me is that people join us. It is a core group of women and now with hundreds of other women supporting it.”

What prompted the formation of this group was the creation of the 

Burroughs Wellcome Fund Pregnancy Think Tank 

as part of the fund’s effort to advance human health in the decade ahead, with pregnancy as a key window to discovery, according to the fund and a 

American Journal of Obstetrics & Gynecology

. A working group was formed, but Dr. Elovitz and company were dismayed at the make-up of the group. For purporting to support diversity, the make-up of the group was anything but diverse, they said.

Dr. Elovitz, Elizabeth A. Bonney, MD, MPH, and Indira U. Mysorekar, PhD, 

 and asserted their position: The think tank was made up of personally and professionally affiliated white scientists (16 of 17), 13 of 17 men, and included only one practicing obstetrician. Burroughs Wellcome Fund offered its own response, which can be found 

 reached out to Burroughs Wellcome Fund, whose President and CEO Louis Muglia, MD, provided a written response.

“This ‘think tank’ was a one-time event created to bring in researchers from outside of reproductive sciences to help add new and diverse perspectives with a basic science focus,” he said. “Our intentions were not to exclude anyone, but the meeting was limited in size with usually a single person per discipline. As we have conveyed, we will be more intentional in prioritizing greater diversity of individuals as well as disciplines as we convene future efforts. Burroughs Wellcome Fund as an organization is committed to this core element of all we do moving forward.

“I applaud Dr. Elovitz and her leadership team in creating the Womxn’s Health Collaborative,” Dr. Muglia said. “This initiative highlights the need to maintain attention to all aspects of diversity, and we would welcome the opportunity to help support this collaborative. We share the same goals.”

 and hashtag #WomxnsHealthCollaborative; or visit its website at ​

 Editor in Chief Catherine Y. Spong’s column “

Addressing inequalities in women’s health research

Videos

The WHC is a response to the recent creation of a pregnancy think tank and years of fighting for equality. 

The Womxn's Health Collaborative with Dr. Michal Elovitz

The final sample for the study comprised 711 patients undergoing gynecologic laparotomy at Health Sciences Hospital in Winnipeg, Canada, between January 2012 and December 2016.

The group exposed to MIBL (n = 298) were patients with either > 1L of blood loss operatively, < 40 g/L drop in hemoglobin by postoperative Day 1, or perioperative blood transfusion.

The group not exposed to MIBL (n = 413) did not meet the criteria for MIBL.

The primary outcome was one or more postoperative infectious complications, defined as a positive wound swab culture, a positive urine culture or systemic inflammatory response syndrome (SIRS).

SIRS is considered as having two or more of the following conditions simultaneously, at any point during the postoperative stay: temperature > 38⁰C; heart rate > 90 beats per minute; respiratory rate > 20 breaths per minute or a PaCO2 < 32 torr; or a leukocyte count > 12,000 or < 4,000 cells/mm3 with > 10% bands.

Composite postoperative febrile morbidity occurred in 48% of surgeries with MIBL (n = 144 of 289) compared with only 12% of surgeries without MIBL (n= 51 of 413) (

After adjusting for age, body mass index (BMI), diabetes, immunosuppression, type of procedure and incision type

 and bowel complications, MIBL was revealed to be robustly and independently associated with infectious outcomes: adjusted odds ratio 7.04; 95% confidence interval: 4.62 to 10.74 (

A prior study from the group found the prevalence of MIBL during gynecologic laparotomy was 14% and the frequency of postoperative infectious complications in those with MIBL was 26%.

“The predisposition to infection secondary to massive intraoperative blood loss has many proposed mechanisms including diminished delivery of oxygen to end organs resulting in end-organ dysfunction, diminished delivery of oxygen to the wound, dilution effects of fluid and blood loss on antibiotics given prophylactically and diminished delivery of essential factors and cells involved in wound healing and repair,” wrote the authors.

Blood transfusions administered to manage MIBL may also have immunosuppressive effects postoperatively, secondary to diminished number and function of natural killer and cytotoxic T cells.

The researchers noted that at their institution, it is standard procedure to administer preoperative antimicrobial prophylaxis for gynecologic laparotomies, with the first choice being 1 to 2 g of cefazolin, 15 to 30 minutes before the skin incision.

The most common surgery performed for the current study was total abdominal hysterectomy, comprising 71.1% (n= 212) of the surgeries with MIBL and 75.5% (n = 312) of the selected surgeries without MIBL.

Preoperative antibiotics were given in over 99% of cases in both groups.

Patients that had surgeries with MIBL had lower BMI, lengthier surgery, and a higher frequency of vascular injury, bowel injury, surgical complications, and surgical drains left in situ postoperatively compared with surgeries without MIBL.

“Further prospective research is needed in order to identify interventions that might mitigate the increased risk for postoperative infection associated with MIBL,” the authors concluded.

Poliquin V, Singh P, Leylek M, et al. The risk of post-operative infectious complications following massive intraoperative blood loss during gynecologic laparotomy: retrospective cohort study. 

. Published online August 26, 2020. doi:org/10.1016/j.jogc.2020.07.013

Massive intraoperative blood loss (MIBL) is strongly and independently linked to postoperative febrile morbidity following gynecologic laparotomy, according to a retrospective cohort study in the Journal of Obstetrics and Gynaecology Canada (JOGC).

Data on COVID-19 during pregnancy, as reported by the CDC, in collaboration with state, local, and territorial health departments and external partners.

The data below is a reflection of data collected weekly by the Centers for Disease Control and Prevention (CDC). The cases reported are only confirmed cases with laboratory evidence of SARS-CoV-2 infection.

Here’s the latest data, updated on October 16:

Pregnant women with COVID-19, United States:

Data is updated weekly based on data collected by the Centers for Disease Control and Prevention (CDC). The cases reported are only confirmed cases with laboratory evidence of SARS-CoV-2 infection. CDC’s case numbers are validated through a confirmation process with each jurisdiction.

Currently, there are 56 U.S.-affiliated jurisdictions reporting cases of COVID-19, including 50 states, District of Columbia, Guam, New York City, the Northern Marina Islands, Puerto Rico, and the U.S. Virgin Islands.

 and additional information from the CDC’s 

COVID-19 Pregnancy Data in the United States: October 16 Update

Hormonal contraception for women with hypertension

Although hypertension is a modifiable risk factor for cardiovascular disease (CVD), certain hormonal contraceptives increase the risk of stroke and myocardial infarction in women with the disorder.

Effect on endometriosis recurrence with postoperative hormonal suppression

“As surgeons, our primary goal is to make patients feel better and we often accomplish this by surgically treating endometriosis,” said co-author Ally Murji, MD, MPH, an associate professor of ob/gyn at the University of Toronto and Mount Sinai Hospital in Toronto, Canada.

Placental DNA may predict pregnancy complications

New research suggests that placental DNA may have potential as a biomarker for adverse pregnancy outcomes (APOs).

Our weekly update of COVID-19 Pregnancy Data, collected by the Centers for Disease Control and Prevention (CDC), totals 26,364 cases, 45 deaths, and 6,011 hospitalizations. 

It was a very busy week for the Contemporary OB/GYN team. 

This week on Contemporary OB/GYN

The Womxn's Health Collaborative with Dr. Michal Elovitz

Infectious complications after massive blood loss from gynecologic laparotomy

COVID-19 Pregnancy Data in the United States: October 16 Update

What you missed this week on Contemporary OB/GYN