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Women with low levels of pregnancy-associated plasma protein A (PAPP-A) during the first 10 weeks of pregnancy are forty times more likely to have a stillbirth later in pregnancy, according to a multicenter, prospective cohort study conducted in Scotland.

Imagine practicing gynecology and performing the most challenging surgeries day and night without worrying about malpractice suits, managed-care pre-authorization, or CPT and ICD-9 codes. Wouldn't it be wonderful to have no concerns about being paid and patients who are grateful for care even when the outcome isn't perfect? That would never happen in this country but it's a scenario experienced by health-care professionals affiliated with PRN Relief International. These dedicated individuals minister to some of the planet's most needy-and grateful-patients. I was fortunate to be able to serve with them recently in Jamaica and it's an experience I'll never forget.

As described in the first half of this roundtable (see Contemporary OB/GYN, November 2004), the professional liability insurance crisis has had a broad and pernicious impact on the country's obstetrician/ gynecologists. As they conclude the discussion, the panelists move from reflecting on how the crisis came about to speculating about the prospects for reforming--or even completely replacing--the current tort system.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.

An estradiol dose of 14 ?g reduces bone turnover and preserves bone mineral density (BMD) in postmenopausal women, say results of a randomized trial presented at the 15th Annual Meeting of the North American Menopause Society. The once-a-week regimen also does not stimulate the endometrium or increase vaginal bleeding.

A study extending experience with raloxifene to 8 years shows no adverse impact on gynecologic health with longer-term use. Results of the Continuing Outcomes Relevant to EVISTA (CORE) trial build on and support previous findings from the 4-year Multiple Outcomes of Raloxifene Evaluation (MORE) trial.

Vaginal hysterectomy is about four times more likely to fail in women with a narrow pubic arch than in others, according to a prospective cohort study of 75 women.

In women who carry BRCA1 or BRCA2 mutations, MRI is more sensitive for detecting breast cancers than mammography, ultrasound, or clinical breast exam (CBE) alone, but whether this translates into reduced mortality is still unknown. This is according to the results of a surveillance study involving 236 Canadian women between the ages of 25 and 65.

Lasofoxifene is the first selective estrogen receptor modulator (SERM) to help vaginal atrophy, says a multicenter trial presented at the 15th Annual Meeting of the North American Menopause Society (NAMS). Investigators found the drug reduced dryness with few side effects.

Celiac disease-once believed to be rare-actually affects up to 1% of the US population. So underdiagnosed is the problem that the National Institutes of Health convened a consensus panel, which recently announced recommendations for appropriate diagnosis and management of the disease.

The sensitivity and specificity of screening mammography is lower in women taking hormone replacement therapy (HRT), those who have had breast surgery, and those who are thin, according to results from a sample of women from the Million Women Study.

While many hoped that ductal lavage might provide a means for detecting breast cancer sooner in women at high risk for the disease, a recent study finds that the method isn't as useful as we had hoped.

When neurologic injury occurs despite following all the right medical procedures, a no-fault compensation system may be the best way to handle the situation.

Many women have sexual dysfunction, and effective treatments are available for some conditions. Routinely discussing sexual function with your patients, and their partners, is important because dysfunction truly is a couples issue.

In June 2000, I arrived a few minutes late to the American College of Obstetricians and Gynecologists' headquarters for a meeting of the Committee on Obstetric Practice. As Chair, I was used to dealing with political hot potatoes, but that day, I was handed a real sizzler. Earlier that morning, then ACOG president, Benjamin Harer, MD, speaking for himself and not the College, had seemingly endorsed "elective" cesarean deliveries (CD) in an interview with Diane Sawyer on "Good Morning America." After watching an excerpt of the interview in which Dr. Harer debated a non-physician advocate of home VBACs attended by midwives, I was struck by the logic of his arguments and his grace under fire. Yet it fell to my committee to restate ACOG's official position against such surgeries, which we did in a press release

"Misinformation about toxoplasmosis is widespread," according to Patrick Duff, MD, Department of Obstetrics and Gynecology at the University of Florida.

Your patient has a twin gestation at almost 29 weeks and one of the fetuses has IUGR. How should you proceed?

Last month, I reviewed the factors that have driven the dramatic increase in cesarean delivery (CD) rates over the past several years. This month, I'll review the potential impact of this trend on a "typical" obstetric service. While both staff and physical capacity will be taxed by increased CD rates, I believe that patient safety may also be threatened as a result of the incremental demand on limited obstetrical operating room (OR) availability. I offer several strategies to manage the coming chaos.