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A recent study shows that adding metronidazole to cefazolin significantly lowers the risk of surgical site infections in gynecologic cancer surgeries, enhancing patient outcomes.

Study reports reduced SSI odds after gynecologic surgery from metronidazole and cefazolin

In a recent study, very preterm birth rates were reduced during COVID-19 lockdown periods vs prepandemic periods.

COVID-19 restrictions linked to reduced preterm birth rates

In a recent study, reported rates on emergency department utilization for hypertensive disorders of pregnancy and the postpartum period were higher in 2020 than 2006, with rates especially high among non-Hispanic Black, Hispanic, and Asian patients.

Increase in ED visits for hypertensive disorders from 2006 to 2020 reported

New research shows fezolinetant significantly reduces the frequency and severity of hot flashes in Hispanic women, offering a safer alternative to hormone replacement therapy.

Safety and efficacy of fezolinetant proven in Hispanic women

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

1rem

Authors

Some research shows the previous guideline may have led to the under-treatment of patients with chronic pain.

CDC’s proposed opioid prescribing guideline: Does it fall short on drug testing?

In a recent interview ObGyn.net conducted for 

 on comprehensive care and cancer screenings at well-woman visits, the topic of stethoscopes came up. Ilene S. Gewirtz, MD, the interviewee, mentioned that she still carries a stethoscope and listens to her patients' heart and lungs at well-woman visits. She also said that she believes she's in the minority regarding this practice. We want to know if she's right.

POLL: Many women consider their OB/GYN their primary care provider. But like your primary care counterpart, do you carry a stethoscope?

Do OB/GYNs Carry Stethoscopes?

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

Women's Health

Susan LePlae Miller, founder of Pieces of I, discussed her personal and professional journey in advocating for improved health care communication and empowerment, particularly in women's health and breast cancer. 

Miller has been working in the field of women’s health for over 4 and a half years, with a focus on educating women to take charge of their health. This involves encouraging them to have better, more informed conversations with their healthcare providers.

One of the main themes in the discussion was the importance of patients becoming active participants in their own health care journey. Miller emphasized the need for women, particularly those going through menopause or dealing with breast cancer, to educate themselves about their health conditions and symptoms. Through her work with the platform 

, she aims to help women gain knowledge and confidence to take action in their health care by working collaboratively with their doctors. By learning more about their health, women can make informed decisions not only for themselves but also for their loved ones.

Additionally, Miller noted the significance of preparation before medical appointments. She suggested writing down symptoms and questions in advance, and if possible, submitting them to doctors ahead of time through patient portals. This ensures that important concerns are addressed, especially considering how busy doctors can be. The relationship between a patient and doctor should be viewed as a partnership, with the patient actively advocating for their health and the doctor serving as part of the health care team.

Another key point raised is the need for self-advocacy in monitoring health conditions. Miller compared managing one’s health to managing financial health, such as with a 401k or IRA. Just as individuals must manage their financial investments, they should also stay on top of their health metrics. If test results such as cholesterol levels are off, patients should not wait for doctors to notice but take proactive steps to discuss these issues. However, she advised balancing self-advocacy with giving doctors grace and understanding for their workload.

Ultimately, Miller advocated for ownership of one’s health, urging women not to let shame or stigma prevent them from living fully. She concluded by emphasizing the importance of living in the present and taking responsibility for personal health.

Learn how self-advocacy, preparation, and collaboration with doctors can help women gain control over their health and live more fully, free from stigma and shame.

Clinical

Empowering women to take charge of their health

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?

The US Food and Drug Administration (FDA) has issued a warning regarding the risk of fezolinetant (Veozah) to cause rare, serious liver injuries to patients.

 associated with menopause last May, the Astellas Pharma therapy was the first neurokinin 3 receptor antagonist to receive approval for this indication from the FDA. Its approval was supported by clinical efficacy and safety data accrued in the SKYLIGHT trial program, wherein the once-daily, 45 mg pill was assessed in 3000-plus participants for the treatment of VMS.

At the time of its approval, the FDA issued label warning regarding the risk of elevated hepatic transaminase in patients treated with fezolinetant; the agency advised that eligible patients receive a blood work test to assess for liver damage prior to initiating the therapy, followed by routine bloodwork every 3 months for the 9 months of the regimen.

The FDA additionally discouraged the use of fezolinetant in combination with CYP1A2 inhibitors, as well as in patients with cirrhosis, severe renal damage, or end-stage kidney disease.

Now, this week, the FDA published a Drug Safety Communication stating fezeolinetant’s prescribing information label has been updated to address the risk of liver injury on the basis of post-marketing data showing elevated liver blood test values and signs of liver injury in a patient taking the medication for approximately 40 days.

“We also added new recommendations for patients and health care professionals about increasing the frequency of liver blood testing, adding monthly testing for the next 2 months after starting Veozah, and then at months 3, 6, and 9 of treatment as already recommended,” the FDA wrote. “The updated prescribing information also instructs patients to stop the medicine immediately and contact the health care professional who prescribed the medicine if signs and symptoms of liver injury occur.”

Key among the symptoms reported in the patient were abnormal liver enzymes and bilirubin levels, as well as visible signs of liver injury including fatigue, nausea, itching, yellowed eyes and skin, light-colored stool and dark urine. The FDA confirmed the symptoms gradually receded and blood test values improved once the fezolinetant regimen was stopped.

A number of individual demographic and clinical factors may impact one’s risk of liver injury due to fezolinetant, the FDA wrote; as such, the agency cannot determine the likelihood of one experiencing these adverse events due to the therapy. They advised that patients communicate with their prescribing clinicians regarding the benefit – risk profile of fezolinetant. Clinicians are reminded to report adverse events associated with the drug to the FDA’s MedWatch program.

Astellas Pharma has responded to the FDA's warning, stating, "We are committed to ensuring the hepatic laboratory testing protocol in the VEOZAH US prescribing information identifies patients at risk for or experiencing symptoms of potential drug-induced liver injury as early as possible and therefore have added 2 additional timepoints for hepatic tests to the label, testing for an additional liver value, as well as guidance on when to seek medical attention and when to discontinue VEOZAH." See sidebar for the company's full statement. 

US Food & Drug Administration. FDA adds warning about rare occurrence of serious liver injury with use of Veozah (fezolinetant) for hot flashes due to menopause. FDA Drug Safety Communication. Published September 12, 2024. Accessed September 13, 2024. https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due?utm_medium=email&utm_source=govdelivery

Petronelli M. FDA approves fezolinetant for vasomotor symptoms. 

. Published May 12, 2023. https://www.contemporaryobgyn.net/view/fda-approves-fezolinetant-for-vasomotor-symptoms

The FDA upped the recommended rate of liver blood tests for patients initiating fezolinetant on the basis of a post-marketing case report involving serious liver injury.

FDA updates warning for liver injury due to fezolinetant

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

occipital meningocele and umbilical hernia

Jack Kain

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