Still searching for the Holy Grail

For over 25 years, obstetricians have been searching for the definitive tool that will ultimately improve perinatal outcomes and lower the cesarean section rate. Unfortunately, while there have been several promising technologies, none has significantly reduced the rate of cerebral palsy due to intrapartum fetal hypoxia. The search nevertheless continues and no one is suggesting we give up on this important goal. With that in mind, in this issue of Contemporary OB/GYN, Dr. Lawrence Devoe discusses fetal ECG waveform analysis as an adjuvant to electronic fetal monitoring. Preliminary data from randomized clinical trials using the STAN system suggest that this technology may reduce operative delivery rates, neonatal metabolic acidosis, and hypoxic-ischemic encephalopathy.

Of course, high-risk obstetrics is not the only specialty affected by changing technology. Changes in malpractice rates, surgical reimbursements, personal time management, and improved patient care have encouraged many gynecologists to move high-tech operative procedures from the hospital OR to the office. Endometrial ablation and office tubal sterilization have led the way for global reimbursement for office-based procedures that provides physicians with the financial incentive to offer these procedures in the office instead of taking up valuable time in the operating room. Patient satisfaction rates are extremely positive for these office-based procedures. Dr. Jim Presthus reviews the current state of office-based gynecologic procedures and makes a strong case for incorporating these techniques in your practice.

As gynecologic surgeons, we are trained to treat common conditions first with medication followed by surgery if the medication fails. Too often, we neglect to consider alternative approaches for which we have little experience or no exposure. Drs. Diwadkar and Rosenblatt point out that overactive bladder affects up to 17% of women and can significantly affect quality of life. They provide an excellent review of the evidence on the effectiveness of alternative approaches to this condition including hypnosis, weight loss and nutrition, nerve stimulation, acupuncture, and biofeedback.