FAQ’s on What’s New
1. What is the present evidence based role of “Tranexamic acid for management of postpartum hemorrhage” (May 2017)
Tranexamic acid, an antifibrinolytic drug, reduces bleeding in surgical and trauma patients. In a pragmatic randomized trial involving over 20,000 women with postpartum hemorrhage in over 20 countries (the World Maternal Antifibrinolytic Randomized Trial [WOMAN]), tranexamic acid, compared with placebo, reduced the relative risk of death due to bleeding by 20 to 30 percent, reduced the incidence of laparotomy to control bleeding, and was not associated with an increase in adverse effects.
2. What is the present evidence based role of “Computerized interpretation and alerts for intrapartum fetal monitoring not beneficial” (April 2017)
Two randomized trials (FM-ALERT and INFANT )have evaluated the use of continuous intrapartum fetal monitoring with computerized interpretation and real-time alerts versus usual care (continuous intrapartum fetal monitoring with clinician interpretation). In both trials, use of the intervention did not improve any maternal or neonatal outcome. In the larger INFANT trial, which included over 47,000 pregnancies at or near term, developmental assessment at age two years was similar for both groups .Thus, a change in the standard clinical approach to intrapartum fetal heart rate monitoring is unwarranted.
3. What is the present evidence based role of “Sensitivity of measuring short cervix on TVS and fetal fibronectin for prediction of preterm birth “(March 2017)
Cervical length is measured sonographically in the midtrimester because a short cervix is predictive of preterm birth, and the risk may be reduced by administration of progesterone. A new large prospective study reported the sensitivity for preterm birth among nulliparous women with singleton gestations and cervical length ≤25 mm was 8 percent at 16 to 22 weeks of gestation and 23 percent at 22 to 30 weeks.
The study also confirmed that midtrimester measurement of fetal fibronectin in asymptomatic nulliparous women performs poorly for prediction of preterm birth.
We continue to obtain a cervical length measurement in nulliparous women during ultrasound examinations at 18 to 24 weeks of gestation and treat those with a short cervix with vaginal progesterone.
4. What is the present evidence on “Pregnancy outcomes with HPV vaccination” (March 2017)
Human papillomavirus (HPV) vaccination during pregnancy is not recommended, but mounting evidence suggests that it is safe. In a large cohort study from Denmark, the risks of spontaneous abortion, major birth defects, preterm birth, and low birth weight were comparable among women who received quadrivalent HPV vaccine during pregnancy (mostly during the first trimester) and matched controls who did not Women who inadvertently receive HPV vaccine during pregnancy can be reassured that it does not increase their risk of adverse pregnancy or fetal outcomes.
5. What is the present evidence based role of “Delayed cord clamping “(January 2017)
Delaying umbilical cord clamping for at least 30 to 60 seconds after birth in both term and preterm vigorous infants is the recommendation of an updated committee opinion by the American College of Obstetricians and Gynecologists (ACOG). Previously, ACOG had recommended individualizing the timing of cord clamping in term infants.
6. What is the present evidence on “Risk of birth defects with Zika virus infection during pregnancy” (January 2017)
The risk of birth defects resulting from in utero exposure to Zika virus was 10 and 42 percent in two recent reports .The most common fetal/newborn findings in these reports were abnormal brain imaging, microcephaly, small size for gestational age, and abnormal neurologic examination.
7. What is the present evidence on “IUD use does not impact human papillomavirus infection” (March 2017)
A reduction in cervical cancer rates among intrauterine device (IUD) users has been observed and attributed to favorable effects of the device on human papillomavirus (HPV) clearance. However, a prospective cohort study that controlled for sexual and behavioral confounders reported no difference in HPV acquisition or clearance among women and girls with or without an IUD .Thus, IUD use does not appear to impact HPV infection.
8. What is the present evidence based role of “.Vaginal prasterone [DHEA] for dyspareunia in postmenopausal women” (November 2016)
In November 2016, the US Food and Drug Administration approved the use of prasterone (also known as dehydroepiandrosterone [DHEA]) for treatment of dyspareunia in women with vulvovaginal atrophy (VVA) due to menopause .In an earlier randomized trial of women with VVA and moderate to severe dyspareunia, 12 weeks of daily intravaginal DHEA resulted in improved scores for pain during sexual activity and other key domains of female sexual function (desire, arousal, lubrication, orgasm, satisfaction) compared with placebo.
9. What is the present evidence on “Safety of transvaginal mesh for stress urinary incontinence “(February 2017)
Although relatively high complication rates have been reported when transvaginal mesh is used in pelvic organ prolapse surgery, this is not the case for female stress urinary incontinence (SUI) surgery. In a large cohort study comparing outcomes of mesh with non-mesh SUI procedures, the risk of immediate complications was approximately 50 percent lower in mesh-based procedures, with similar five-year efficacy and complication rates .Transvaginal mesh continues to be the preferred surgical treatment for women with SUI.
10. GYNECOLOGIC ONCOLOGY
(1) What is the present evidence on “Sentinel lymph node biopsy in endometrial cancer” (May 2017)
Sentinel lymph node biopsy for staging endometrial carcinoma is increasingly performed instead of selective or extended nodal dissection. In the largest multicenter prospective study of the procedure in over 300 women with clinical stage I endometrial carcinoma, successful mapping of at least one sentinel lymph node was achieved in 86 percent and the sensitivity of the sentinel lymph node was 97 percent.
(2) What is the present evidence on “Laparoscopic interval debulking after neoadjuvant chemotherapy for ovarian cancer “(May 2017)
Women with stage IIIC or IV ovarian cancer and unresectable disease may be candidates for neoadjuvant chemotherapy (NACT) followed by interval debulking, typically performed with laparotomy. Results of a large retrospective study suggest that laparoscopy could be a minimally invasive option for such debulking. Compared with laparotomy, laparoscopy was associated with similar three-year overall survival rates (47.5 versus 52.6 percent), similar suboptimal debulking rates (20.0 versus 22.6 percent), a shorter hospital stay by one day, and similar 30-day readmission rates.
(3) What is the present evidence on “Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer “(March 2017)
US Food and Drug Administration (FDA) has approved niraparib for the maintenance treatment of patients with relapsed ovarian cancer who are not candidates for bevacizumab and who are in a complete or partial response to platinum-based chemotherapy.
10. UROGYNECOLOGY
What is the present evidence on “Safety of transvaginal mesh for stress urinary incontinence” (February 2017)
Although relatively high complication rates have been reported when transvaginal mesh is used in pelvic organ prolapse surgery, this is not the case for female stress urinary incontinence (SUI) surgery. In a large cohort study comparing outcomes of mesh with non-mesh SUI procedures, the risk of immediate complications was approximately 50 percent lower in mesh-based procedures, with similar five-year efficacy and complication rates .Transvaginal mesh continues to be the preferred surgical treatment for women with SUI.