American College of Obstetricians and Gynecologists, May 14-17
The annual meeting of the American College of Obstetricians and Gynecologists (ACOG) was held from May 14 to 17 in Washington, D.C., and attracted more than 3,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in obstetrics and gynecology. The conference highlighted recent advances in the prevention, detection, and treatment of conditions impacting women, with presentations focusing on the advancement of health care services for women worldwide.
In one study, Amir Mor, M.D., Ph.D., of the Maimonides Medical Center in New York City, and colleagues used a novel approach to measure alpha-fetoprotein (AFP) in vaginal blood and compare it to the AFP levels in maternal serum.
"During a miscarriage, fetal tissue (mixed with blood) is expelled out of the uterus. However, the expelled fetal tissue is not easily visible. Furthermore, the physical exam and ultrasonographic findings are inconclusive and the clinician may not be able to differentiate between a normal and a failing pregnancy," Mor said. "In such a case, a follow-up visit within two to seven days is needed in order to reach a diagnosis. The uncertainty throughout the days that precede the follow-up visit is of concern to both the doctor and the patient."
Since fetal tissue contains very high levels of AFP, the investigators used it as a marker in their novel approach.
"In cases in which vaginal blood AFP concentration is significantly higher than AFP in maternal blood, the diagnosis of a failing pregnancy can be reached. This test can be done bedside during the initial visit and the results can be obtained within several minutes," Mor said. "With this new approach we can reach a final diagnosis during the initial visit, and therefore, avoid the need for follow-up visits as well as the anxiety caused by the uncertainty. This approach has the ability to change the way we assess and manage cases of first-trimester bleeding."
In another study, Emmie Strassberg, D.O., of the Geisinger Health System in Danville, Pa., and colleagues aimed to identify barriers to vaccine acceptance.
"What we discovered was that patients tend to have a better attitude towards tetanus, diphtheria, and acellular pertussis vaccine (Tdap) vaccination in pregnancy than influenza vaccination. We also discovered that giving a patient educational materials is a good predictor of vaccine acceptance for influenza vaccine, while just recommending the vaccine was a good predictor of Tdap vaccination acceptance," Strassberg said. "I think in further studies it would be good to see if this panned out in a larger patient population. For now, from this information, I know that if I'm recommending influenza vaccine to my patient, I may give them a pamphlet about the vaccine and pregnancy to help them make their decision. I will also discuss both vaccines as recommended by ACOG and the U.S. Centers for Disease Control and Prevention for all my patients in pregnancy."
Mark A. Clapp, M.D., of Brigham and Women's Hospital in Boston, and colleagues, evaluated trends in postpartum readmission rates in the United States.
The investigators found that postpartum readmission rates increased between 2004 and 2011, from 1.72 to 2.16 percent. Factors tied to readmission included being publicly insured, black ethnicity, having comorbid conditions, and having had a cesarean delivery. Infection, hypertension, and psychiatric illness were the key reasons for postpartum readmission.
"Understanding the risk factors, etiologies, and cause-specific timing for postpartum readmissions may aid in the development of new quality metrics in obstetrics and targeted strategies to curb the rising rate of postpartum readmissions in the United States," the authors write.