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Enter the Laborist

Louis Weinstein, MD, Professor and Chair of Obstetrics at Thomas Jefferson University in Philadelphia, wants to transform obstetrics. Just as overworked and frustrated internists gave rise to the hospitalist in the 1990s, Dr. Weinstein sees overworked and frustrated obstetricians evolving into laborists.

Analysis of preterm delivery (PTD) patterns among Mormon women in Utah and surrounding states indicates that genetics play a leading role in preterm delivery. If the genetic link holds, obstetricians can expect to see even higher rates of PTD in future years.

Dyspareunia is a significant problem in postmenopausal women. A recent study at George Washington University found that up to 92% of sexually active women reported moderate or severe symptoms. Forty percent of women cited dyspareunia as their most bothersome problem associated with vaginal atrophy. A recent Phase III trial showed that lasofoxifene can significantly improve the symptoms of dyspareunia as well as increase bone mineral density (BMD) in postmenopausal women.

Many middle-aged women are getting more Pap tests than they need. Women aged 45 to 60 are typically advised to get an annual Pap test, noted George Sawaya, MD, Associate Professor of Obstetrics, Gynecology, and Reproductive Science at the University of California San Francisco. But in a paper presented yesterday, Dr. Sawaya concluded that women with a history of three or more normal Paps should only be screened once every 3 years.

The identification of abnormal growth in triplet fetuses has been difficult because there have been no standards for comparison. A study at Tufts-New England Medical Center in Boston has produced curves for growth as measured by estimated fetal weight, abdominal circumference, biparietal diameter, head circumference, and femur length. All measurements were conducted sonographically.

Do even half of your patients keep their appointments for annual gynecologic exams? Compliance with annual checkups is so poor that most ob/gyns would have to answer "no." Boris Petrikovsky, MD, PhD, and a research team at Nassau University Medical Center in East Meadow, NY, found that simply inviting women to visit their physician can boost compliance rates by nearly a third.

Healthy women who have had a prior cesarean delivery can safely delivery vaginally. That is the conclusion of a 14-year retrospective study at the John H. Stroger Jr. Hospital of Cook County, IL.

The day begins at 7:45 am with a repeat showing of prize-winning films from the ACOG Film Festival (concludes at 8:45 am) and the 7th scientific session. Karen Lu, MD, presents the John I. Brewer Memorial Lecture, "Update in Ovarian Cancer Screening and Prevention."The annual Presidential Inauguration and Convocation runs from 9:00 to 10:30, featuring the installation of Michael Mennuti, MD, as ACOG's 56th President.The exhibit hall and the final poster session are both open from 10:30 am to 2:30 pm. The final day of postgraduate courses begins at 10:45, with session 2 running through 12:15 pm.

Tuesday is Go Red for Heart Health Day, sponsored in part by the American Heart Association. Heart disease is the number one killer of women over the age of 25, but fewer than half of all women know they are more likely to die of cardiovascular disease than from any other cause. All attendees are urged to wear red on Tuesday in support of heart health. The day begins at 8:30 am with the 4th Scientific Session. Charles Hammond, MD, and Peter Schwartz, MD, present the Irvin M. Cushner Memorial Lecture on "Ethical Issues Related to Expert Testimony," which ends at 9:45 am.ACOG's live telesurgery session begins at the same time and runs until 11:30 am. This course is limited to professional attendees and has limited seating. Admission is by ticket only.

The ACM got off to a strong start at 8:30 am with the opening ceremony and first scientific session, better known as the President's Program. This year's program focuses on Sex, Power, and Politics. Malcolm Potts, MB, BChir, PhD, FRCOG, leads off with the Samuel A. Cosgrove Memorial Lecture, asking the provocative question "Why Can't a Man Be More Like a Woman? The Behavioral Background of Ob-Gyn Practice."

The American College of Obstetricians and Gynecologists brings its Annual Clinical Meeting back to San Francisco's Moscone Convention Center for 2005. The City by the Bay has long been one of ACOGs's most popular venues, said president Vivian Dickerson, MD, in her official welcome message on the College's Web site. The 2005 clinical meeting is no exception.

An expert examines the evidence for the effectiveness of a wide array of drugs and surgical approaches used to treat, and overtreat, heavy menstrual bleeding.

Some women appear to have a gradual, yet premature, decline in ovarian function that is distinct from ovarian failure. In the author's experience, there is hope for successful pregnancy in these cases, with quick and correct diagnosis and the right treatment.

We can do a better job of screening and testing sexually active teens and young adults for STIs. Keeping up with the latest evidence can help you decide when to test, whom to test, and which of a wide array of office- and lab-based tests to choose.

My first two editorials on venous thromboembolism (VTE) suggested ways to reduce risk in women taking estrogen-containing hormones and undergoing gynecologic surgery, respectively. This editorial explores strategies for avoiding it in pregnancy.

Each year CPT introduces new codes and makes revisions to existingcodes to better reflect current medical practices. CPT 2005 is nodifferent. This month, we'll look at changes in coding for vaginalcolpopexy. The 2005 CPT codes reflect the expansion and improvementof surgical techniques in the area of female reconstructive surgery

Although there have been no clinical trials to conclusively establish a cause-and-effect relationship between ovulation induction with clomiphene citrate or gonadotropins and cancer, evidence derived from prospective and cohort studies suggests the following:

A fetus is more likely to have chromosomal instability, expressed as an increase in structural chromosomal abnormalities and chromosomal lesions, when a woman smokes 10 or more cigarettes a day for at least 10 years and continues to smoke during pregnancy. And that danger is not influenced by maternal age.

Women with BRCA1 and BRCA2 mutations are not only at greater risk for invasive breast cancer (IBC); the latest research suggests these mutations also increase the threat of ductal carcinoma in situ (DCIS), according to a case-control study conducted in Connecticut.

The risks of neonatal convulsions and neonatal withdrawal syndrome seem to increase when a pregnant women uses selective serotonin reuptake inhibitors (SSRIs), with paroxetine being the worst offender, according to cases reported by 72 countries to the World Health Organization's Collaborating Centre for International Drug Monitoring in Uppsala, Sweden.

Pregnant asthmatics who use inhaled steroids don't increase their risk of pregnancy-induced hypertension or preeclampsia, according to a recent nested case-control study from Canada.

Adjuvant treatment with cyclophosphamide, methotrexate, and fluorouracil (CMF) in women with operable breast cancer at risk of relapse halves that threat and reduces the risk of death with minimal long-term sequelae.