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A recent analysis highlights the heightened risk of adverse pregnancy outcomes, including preterm delivery and cesarean sections, among women with uterine fibroids.

Uterine fibroids linked to increased risks of pregnancy complications

A new study underscores the critical need for gynecologists and mental health professionals to collaborate in managing anxiety, depression, and sexual dysfunction in women with endometriosis, driven by chronic pain and related comorbidities.

Addressing mental health risks in endometriosis patients

In a recent study, patients of all age categories were less likely to conceive if they had low antimüllerian hormone levels, highlighting its potential in reproductive counseling.

Low antimüllerian hormone levels linked to reduced odds of conception

A recent review established guidelines for prenatal diagnosis and care of vasa previa, outlining its definition, screening and diagnosis, management, and timing of delivery in asymptomatic patients.

Expert consensus sheds light on diagnosis and management of vasa previa

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

STIs

Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

1rem

Authors

A teenager’s day-to-day behavior can vary greatly. Here are some tips for understanding and navigating this challenging time.

Helping  parents cope with adolescent behavior

The US Preventive Services Task Force (USPSTF) has issued a draft recommendation for 

 screening aimed at enhancing early detection while minimizing unnecessary interventions. This update highlights that human papillomavirus (HPV) screening gives women ages 30 to 65 years the best balance of benefits and harms, and introduces self-collection of HPV samples as an effective alternative.

: Continue screening every 3 years using the Pap test.

: Opt for screening every 5 years with an HPV test. Other effective alternatives include:

Women over age 65 with a history of normal screening results.

Women who have had a total hysterectomy for non-cancer reasons.

For the first time, the USPSTF endorses self-collected HPV samples, an innovation expected to increase accessibility, particularly for underserved populations. According to Task Force member Esa Davis, MD, MPH, "Women who would be more comfortable collecting their HPV test sample themselves can now do so. We hope that this new, effective option helps even more women get screened regularly."

The recommendation underscores the importance of regular screenings in reducing cervical cancer rates. Nearly all cases of cervical cancer are caused by HPV, a sexually transmitted infection. “The latest science shows that screening for cervical cancer with an HPV test is the optimal approach for women who are 30 to 65 years old,” stated John Wong, MD, MACP, vice chair of the Task Force. He also noted, "Pap tests continue to be the best option for women in their 20s."

Additionally, Wanda Nicholson, MD, MPH, MBA, chair of the Task Force, emphasized, “Most cases of cervical cancer are in women who have not been regularly screened or appropriately treated after an abnormal test result. That’s why it’s so important that women get screened regularly, so cancer can be prevented or caught early when it’s treatable.”

The guidelines apply broadly to all individuals assigned female at birth but exclude those at higher risk due to conditions like HIV or a history of cervical cancer.

The draft recommendation is open for public comment through January 13, 2025. For details and submissions, visit 

US Preventive Services Task Force. US Preventive Services Task Force Issues Draft Recommendation Statement on Screening for Cervical Cancer. USPSTF Bulletin. December 10, 2024. Accessed December 10, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/cervical-cancer-screening-draft-rec-bulletin_0.pdf

The USPSTF has issued a draft recommendation on cervical cancer screening, find out what physicians need to know.

Clinical

USPSTF proposes updates to cervical cancer screening guidelines

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?

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

While the use of thromboprophylaxis during gynecologic cancer procedures increases bleeding risk, this may be outweighed by the reduced risk of venous thromboembolism (VTE), according to a study published in the 

American Journal of Obstetrics & Gynecology.

Complications of gynecologic cancer surgeries include VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), and major bleeding that may lead to transfusion, reintervention, or death. Data has indicated reduced VTE risk but increased bleeding risk when using pharmacologic thromboprophylaxis during these procedures.

It is vital to understand baseline risks of VTE and bleeding to quantify the trade-off between reduced VTE risk and increased VTE risk from thromboprophylaxis.

 However, multiple factors influence baseline VTE risk in patients.

Investigators conducted a study to estimate procedure-specific risks of VTE and major bleeding during gynecologic cancer surgeries. Observational studies performing a gynecologic cancer procedure in at least 50 adults were included in the analysis.

Additional eligibility criteria included reporting the exact procedure and an absolute risk for at least 1 outcome of interest. These outcomes included fatal PE, symptomatic PE, symptomatic VTE, symptomatic DVT, fatal bleeding, bleeding causing transfusion, bleeding needing intervention, and postoperative hemoglobin under 70 g/L.

Studies published between January 1, 2000, and November 25, 2020, were identified through comprehensive searches of the MEDLINE, Embase, Web of Science, and Google Scholar databases. Randomized trials evaluating the impact of prophylaxis on VTE and bleeding risks were identified through separate searches.

Title, abstract, and full-text screening were performed by 2 trained screeners, with at least 1 being a gynecologic surgeon during full-text screening. During the first phase of data extraction, data related to procedure characteristics was extracted. During the second phase, patient characteristics and outcome data was extracted.

Symptomatic VTE incidence and major bleeding at day 28 after surgery were reported as primary outcomes. Bleeding was categorized based on requiring reintervention, leading to transfusion, or leading to postoperative hemoglobin under 70 g/L.

VTE categories included symptomatic PE, symptomatic DVT, and both in the same patient. Risks were stratified by procedure and by approach.

There were 188 studies encompassing 398,167 patients and 37 gynecologic cancer surgeries included in the final analysis. Patients were aged a median 62 years when receiving total hysterectomy, 48 years for radical hysterectomy, 31 years for trachelectomy, 61 years for ovarian cancer surgery, and 55 years for pelvic exenteration.

In the studies reporting thromboprophylaxis use, laparoscopic total hysterectomy and pelvic exenteration had the longest duration of use, both with a median of 21 days. The shortest duration was reported for ovarian cancer surgery and open radical hysterectomy with lymphadenectomy, both with a median of 8 days.

Risks of VTE, bleeding requiring intervention, bleeding causing transfusion, and bleeding leading to hemoglobin below 70 g/L were established for 37, 29, 34, and 2 procedures, respectively. For VTE, the median risk was under 1% in 13 procedures, 1% to 2% in 11, and over 2% in 13.

Bleeding requiring reintervention had a median risk under 1% in 22 procedures and 1% to 2% in 24. Bleeding causing transfusion had median risk under 2% in 15 procedures, 2% to 4% in 5, and over 4% in 14.

The lowest median VTE risk of 0.1% was reported for cervical conization, while the highest of 11.1% was reported for open pelvic exenteration. For bleeding requiring intervention, the lowest median risk was under 0.1% for interval surgery for ovarian cancer and the highest was 1.3% for laparoscopic radical hysterectomy with lymphadenectomy.

For bleeding leading to transfusion, the lowest median risk of 0.9% was reported for robotic radical hysterectomy with lymphadenectomy while the highest of 32.9% was reported for open primary surgery for ovarian cancer.

The risk of symptomatic VTE was 2.9% for ovarian cancer surgery when performed minimally invasively vs 7.2% in an open approach. In comparison, open surgery for ovarian cancer had a 1.2% risk of bleeding requiring intervention. A minimally invasive approach was linked to a 3.2% risk of bleeding requiring transfusion vs 11.9% for the open approach.

These results indicated varying risks of VTE and bleeding across procedures. While evidence indicated more benefit than harm from VTE prevention, investigators noted the decision to use thromboprophylaxis should depend on individual risk prediction.

Lavikainen LI, Guyatt GH, Luomaranta AL, et al. Risk of thrombosis and bleeding in gynecologic cancer surgery: systematic review and meta-analysis. 

American Journal of Obstetrics & Gynecology. 

2024;230(4):403-416. doi:10.1016/j.ajog.2023.10.006

Marcucci M, Etxeandia-Ikobaltzeta I, Yang S, et al. Benefits and harms of direct oral anticoagulation and low molecular weight heparin for thromboprophylaxis in patients undergoing non-cardiac surgery: systematic review and network meta-analysis of randomised trials. 

 2022;376:e066785. doi:10.1136/bmj-2021-066785

A comprehensive analysis shows the benefits of thromboprophylaxis often outweigh the bleeding risks during gynecologic cancer procedures, though patient-specific risk factors are crucial for decision-making.

Balancing VTE and bleeding risks in gynecologic cancer surgeries

Simple hysterectomy is not inferior to radical hysterectomy in regards to pelvic recurrence within 3 years, and also leads to reduced risks of urinary incontinence and retention, according to a recent study published in the 

An invasive cervical cancer diagnosis was reported in over 600,000 individuals worldwide in 2020.

 This condition is often treated through radical hysterectomy, but data has indicated no significant differences in survival rate from this procedure vs simple hysterectomy in stage IA cervical cancer.

Reduced odds of parametrial infiltration have also been reported from less radical surgery, indicating it as a potentially safer option in certain populations. However, current data comes from studies that vary in quality, highlighting a need for further research.

To compare the safety of simple hysterectomy with radical hysterectomy in low-risk early-stage cervical cancer patients, investigators conducted a phase 3, international, randomized trial. Participants were randomized 1:1 to receive either simple or radical hysterectomy.

Eligibility criteria included having squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix stage IA2 or IB1 tumors, limited cervical stromal invasion depth, and a histologic-grade tumor. Patients with other histologic subtypes, lesions over 2 cm, or evidence of metastatic disease were excluded from the analysis.

Type 2 radical hysterectomy involved removal of the uterus cervix, one-third of parametria, 2 cm of the uterosacral ligaments, and upper 1 to 2 cm of the vagina. During simple hysterectomy, the uterus with the cervix was removed without adjacent parametria. Complete removal of the cervix was ensured through a maximum 0.5 cm removal of the vaginal cuff.

An open vs minimally invasive surgical approach was determined through surgeon decision. Pelvic lymph-node dissection was performed in all procedures.

Cancer recurrence in the pelvic area within 3 years was reported as the primary outcome. This was based on disease presence below the pelvic brim and inferior to the L4 to L5 vertebral level.

Secondary outcomes included sentinel-node detection, parametrial involvement, disease at margins of surgically removed tissues, and pelvic-node involvement. Assessments were performed 4 to 6 weeks after surgery and at 3 months, then at 3-month intervals during week 1, 4-month intervals during year 2, 6-month intervals during year 3, and 12-month intervals until death or end of follow-up.

There were 700 participants included in the final analysis, 91.7% of whom had stage IB1 disease, 61.7% squamous histologic type, and 59.2% grade 1 or 2 disease. Similar baseline characteristics were reported between groups.

The odds of abdominal surgery were reduced in simple hysterectomy patients vs radical hysterectomy patients, at 16.9% vs 28.8%, respectively. However, laparoscopic surgery was more likely in these patients, at 55.6% vs 44.2%, respectively. Similar rates of robotic surgery were reported, at 24.3% vs 25.3%, respectively.

Loop electrosurgical excision procedure or conization occurred in 80.2% of patients. Residual disease in the hysterectomy specimen was reported in 40% of these patients who received simple hysterectomy vs 37% who received radical hysterectomy.

Of patients receiving simple hysterectomy, 37.3% underwent sentinel lymph-node mapping, vs 38.2% receiving radical hysterectomy. The procedure was successful in 61.9% vs 63.4% of these patients, respectively.

There were 11 pelvic recurrences reported in the simple hysterectomy group vs 10 in the radical hysterectomy group. These incidences were identified during median follow-up periods of 4.5 and 4.6 years, respectively, Incidence rates were 2.52% and 2.17%, respectively, indicating a difference of 0.35%.

Pelvic recurrence was found in 3.2% of simple hysterectomy patients receiving minimally invasive surgery vs 3.5% receiving open surgery. For radical hysterectomy, these rates were 2.9% and 3%, respectively.

Intraoperative surgical complications were reported in 7.1% of the simple hysterectomy group vs 6.4% of the radical hysterectomy group. Bladder injuries occurred in 0.9% and 2.6%, respectively, and ureteral injuries in 0.9% and 1.5%, respectively.

These results indicated noninferiority from simple hysterectomy vs radical hysterectomy in low-risk cervical cancer patients. Investigators noted that alongside noninferiority toward recurrence at 3 years, simple hysterectomy also led to reduced urologic complications.

Plante M, Kwon JS, Ferguson S, et al. Simple versus radical hysterectomy in women with low-risk cervical cancer. 

. 2024;390(9):819-829. doi:10.1056/NEJMoa2308900

Cancer stat facts: Cervical cancer. National Cancer Institute. Accessed December 9, 2024. 

https://seer.cancer.gov/statfacts/html/cervix.html

A phase 3 trial found simple hysterectomy is noninferior to radical hysterectomy in preventing pelvic recurrence within 3 years while reducing urologic complications in low-risk, early-stage cervical cancer patients.

Michael S. Jellinek, MD

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