A recording of this presentation is available HERE.
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Thanks to Dr. Hannah Watson, our interim Maternity Care Director at the Santa Rosa Family Medicine Residency, for an excellent talk on 2024-2025 OB Updates. She covered five studies recently published, which suggested some practice changes in the care of OB/Gyn patients. I love looking at recent literature to either reinforce our current practice or to update in real time what we do clinically.
She also toured us through some beautiful wildflowers!
Here are my take home pearls:
1) VTE prophylaxis in patients after c-section (while hospitalized) may not change outcomes.
In this retrospective cohort study of patients who received VTE ppx vs. those who didn't, 0.31% vs 0.08% (not statistically significant) developed VTE; 6.7% vs. 1.7% were readmitted, 3% vs 1% wound complications.
Bruno AM, Sandoval GJ, et al Postpartum pharmacologic thromboprophylaxis and complications in a US cohort. Am J Obstet Gynecol. 2024 Jul;231(1):128.e1-128.e11. doi: 10.1016/j.ajog.2023.11.013. Epub 2024 Feb 12. PMID: 38346912; PMCID: PMC11194157.
2) While antepartum betamethasone (for fetal lung maturity) has excellent evidence prior to 34 weeks EGS, in patients who deliver at 34-36 weeks, the positive impact of maternal steroids varies based on gestational age AND mode of delivery (LTCS vs. vaginal).
In this secondary analysis of the 2017 Antenatal Later Preterm Steroids (ALPS) Trial, 7ounger gestational age and surgical delivery confer greater benefit of steroids. Of note, GDM patients were excluded from the ALPS trial.
Clapp MA, Li S, Cohen JL, Gyamfi-Bannerman C, et al Betamethasone Exposure and Neonatal Respiratory Morbidity Among Late Preterm Births by Planned Mode of Delivery and Gestational Age. Obstet Gynecol. 2024 Dec 1;144(6):747-754. doi 10.1097/AOG.0000000000005756. Epub 2024 Oct 10. PMID: 39388700.
3) Pregnant patient with GDM may benefit with improved glucose control from split dosing their long acting (i.e. glargine) insulin when using over 20-30 units per day. Also injecting prandial insulin 20-30 minutes BEFORE eating improves glycemic control.
Valent AM, Barbour LA. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstet Gynecol. 2024 Nov 1;144(5):633-647. doi: 10.1097/AOG.0000000000005640. Epub 2024 Jun 13. PMID: 38870526.
4) Concurrent partner treatment (oral metronidazole and topical clindamycin) for patients with bacterial vaginosis (BV) reduces risk of recurrence of BV by 50% at 12 weeks.
Recurrence rates of BV were still high: 63% at 12 weeks in the control group (no partner treatment) and 35% in the partner treatment group.
https://www.nejm.org/doi/full/10.1056/NEJMoa2405404
5) The Jada (aspiration system) demonstrates equivalent outcomes to the Bakri (balloon system) for post partum hemorrhage management.
Of note, Dr. Watson says that both she and patients generally prefer the Jada system, which generally stays in for one hour; whereas the Bakri requires traction for up to 12 hours. Evidence shows either system is better the sooner it is placed.
Shields, Laurence E. MD; Klein, Catherine MSN, RN et al Effectiveness of the Intrauterine Balloon Tamponade Compared With an Intrauterine, Vacuum-Induced, Hemorrhage-Control Device for Postpartum Hemorrhage. Obstetrics & Gynecology 145(1):p 65-71, January 2025. | DOI: 10.1097/AOG.0000000000005770
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