A recording of this presentation is available HERE.
(late entry)
Many thanks to Drs. Allison Bacon and Erin Lund for an excellent review of important practice-changing literature from the fields of OB and Gyn in 2025. It's obviously important for us to keep track of practice-changing advances, but the task can be overwhelming and burdensome, particularly if it's an area you are not using on a daily basis.
Dr. Bacon started us off with 3 practice-changing OB papers:
1) Quality-Improvement (QI) Strategies for the Safe Prevention of Preterm Birth, ACOG Committee Statement 17, May 2025
Key take homes:
- current US NTSVD (normal term spontaneous vaginal delivery) rate is 25.6% but ranges 18.5-84.6%, and the WHO goal is 23.6%>> the variability represents opportunity for improvement through local QI projects
- in fact the CMQCC initiative in California reduced rates from 26% to 22.8% (from 2014 to 2019)
- suggested strategies to improve vaginal delivery:
- local policies and procedures to support vaginal birth
- labor support huddles
- team trainings for interpretation of fetal heart rate monitoring
- unit based policies for oxytocin and management of labor dystocia
2) FIGO good practice recommendations on preconception care: A strategy to prevent preterm birth, Int'l Journal of Gynecology/Obs 2025
- preterm delivery is responsible for most neonatal and infant deaths
- many risk factors for preterm birth can be targeted outside of pregnancy
- baby-centered assessment as a part of preconception care
- examples risk factors and interventions
- teen pregnancies>> preconception counseling
- optimize screening/treatment of chronic conditions (e.g. hypertension, DM, thyroid)
- mental health>> screen for mental health and eating disorders
- infectious disease>> HPV vaccination, screen for STIs, preserve oral health
- nurtitional status>> discuss BMI, dx/tx iron-deficiency
3) Air Pollution Linked to Risk of Spontaneous Preterm Birth, Celeste Krewson, 2025, Contemporary Ob/gyn
- talk to patients about PM2.5 as mechanism for for social drivers of health, use of air filters?
- solutions driven by housing, community, city planning
Dr. Lund presented the second half on the important gyn literature:
1) ACOG Clinical Consensus #9: Pain Management for in-Office uterine and cervical procedures
- healthcare professionals tend to underestimate the pain people with uterus may feel during a procedure, providers may deem pain management not needed and therefore not offer to patients
- despite discrepancy between level of pain between patients and providers, patients still do report high degree of satisfaction with in-office gyn procedures
- higher pre-procedural anxiety and anticipated pain are
- associated with higher pain scores
- THEREFORE options for pain management should be offered to all patients for in-office procedures
- IUD: topical anesthetic is more effective over placebo or misoprostol
- lidocaine spray>> lidocaine injection (?2017 RCT)
- no evidence to support pre-procedure NSAID, though may help for post-procedure pain
- use of ultrasound has been shown to decrease pain of IUD insertion
- EMB: 10% lidocaine spray (3 puffs before), naproxen 30 minutes prior reduced pain in one study, performing EMB with full bladder may reduce pain
- Uterine aspiration: paracervical block, NSAIDs pre-procedure (for post-procedure pain), oral benzos do not reduce pain but do reduce anxiety
- Colpo: topical/intracervical lidocaine recommended for biopsies and LEEP
- Trauma-informed care: universal trauma precautions, given patients control over procedure, ask permission to begin/continue procedure, careful with words used (e.g. not bed, table)
2) Management of Recurrent Bacterial Vaginosis, ACOG Clinical Practice Guideline Update 12/2025
- Recurrence is common! 66% of patients experience recurrence of BV within 12 months of initial diagnosis
- Recent RCT comparing partner therapy for recurrent BV (treating partner with oral and topical) showed marked decrease in recurrence (35% vs. 65% at 12 weeks), absolute risk was BIG -2.6 recurrences per person per year
- Increasing evidence that BV should be considered an STI: predominantly occurring in sexually active populations, associated with new/multiple sexual partners, there is microbiological evidence that sexual partners exchange bacteria
- Ideal people to partner treat: monogamous male/female partners (shared decision making for other scenarios)
- Coverage may vary-- CA extended partner therapy applies to STIs (GC/CT), MAY be applied to BV (pharmacy dependent)
- Note clindamycin gel can weaken latex condoms
- Also note, recent evidence based guidelines say it's okay to drink alcohol and take metronidazole!!
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