2 Minute Medicine ® - Obstetrics & Gynecology

1. Efficacy: There was no significant difference in death or cerebral palsy at 2 years between those who received magnesium sulfate at 30-34 weeks’ gestation compared to the placebo group; albeit the study had limited power to detect minimally important differences. 2. Safety: Adverse effects (nausea, vomiting, flushing, dry mouth, dizziness, blurred vision) were greater in the pregnant individuals who received magnesium, but there were no serious cardiovascular or respiratory effects from the magnesium infusion...

1. In this randomized controlled trial, a maternally administered vaccine for infant group B streptococcus (GBS) demonstrated a reduced risk of invasive GBS. 2. There was no significant difference in number of adverse events seen in patients who received the vaccine. Evidence Rating Level: 1 (Excellent) Study Rundown: GBS can cause sepsis and meningitis in newborns, with the primary risk factor being exposure to maternal rectovaginal group B streptococcal colonization during delivery. Often, pregnant women receive intrapartum antibiotic prophylaxis if they test positive for the GBS screen...

1. In an underserved community, providing free iron-containing prenatal vitamins improved hematocrit, reduced the prevalence of anemia, and reduced the need for postpartum blood transfusions.  Evidence rating level: 2 (Good) Maternal anemia during pregnancy is associated with a greater need for postpartum blood transfusions, intrauterine growth restriction, and perinatal mortality. Researchers aimed to determine whether providing free iron supplements to an underserved patient population during prenatal visits would improve hematologic indices and reduce the need for postpartum blood transfusions...

1. In this cross-sectional study, the odds of infertility in participants with a diet in the highest inflammatory index (DII) quartile were significantly higher than those in the lowest quartile (anti-inflammatory diet). 2. Furthermore, the prevalence of infertility was highest in participants with light daily physical activity compared to those with intense daily physical activity. Evidence Rating Level: 2 (Good) Infertility is a growing issue affecting 10-15% of women worldwide. Recent studies have looked at modifiable factors in treating infertility...

1. The offspring of individuals consuming a Mediterranean diet or engaging in a mindfulness-based stress reduction program during pregnancy had better neurodevelopmental outcomes in certain domains at age 24 months compared to the control group.  Evidence Rating Level: 3 (Average) Study Rundown: Prior studies have demonstrated that maternal high-fat diets, obesity, and psychological stress are associated with adverse fetal neurodevelopment. Researchers aimed to determine whether lifestyle interventions, specifically a consuming Mediterranean diet or engaging in mindfulness-based stress reduction (MBSR), can improve offspring neurodevelopment...

1. Compared to those consuming below the maximum tolerable daily intake of the mycotoxin deoxynivalenol, those consuming above this threshold were at a greater risk of giving birth to small-for gestational age infants.  Evidence rating level: 1 (Excellent) Deoxynivalenol (DON) is a mycotoxin found in certain agricultural products, such as wheat and corn. It has been found to cause fetal growth retardation in animals, but its effects have not previously been studied in humans. Researchers aimed to assess the effect of DON consumption on fetal growth...

1. For postpartum pain management, there is no overall increased risk of persistent opioid use in patients prescribed oxycodone versus codeine upon hospital discharge. 2. For patients with vaginal deliveries, there is an increased risk of persistent opioid use for oxycodone compared to codeine. 3. For patients with C-section deliveries, there is a slightly decreased risk of persistent opioid use for oxycodone compared to codeine. Evidence Rating Level: 2 (Good) Study Rundown: There has been a recent shift away from codeine and towards other opioids for management of pain immediately postpartum...

1. The prevalence of Hepatitis C infection during pregnancy increased between 1998 and 2018, coinciding with the opioid epidemic.  2. Individuals of White race, lower socioeconomic status, and a history of substance use were more likely to be infected with Hepatitis C during pregnancy.  3. Hepatitis C Infection was associated with a greater risk of gestational hypertension, cesarean delivery, preterm labour, poor fetal growth, and fetal distress . Evidence Rating Level: 2 (Good) Study Rundown: Hepatitis C virus (HCV) is the most prevalent chronic bloodborne infection in the United States...

1. For women with infertility on assisted reproductive technologies (ART), higher preconception adherence to dietary patterns for prevention of chronic disease were associated with lower probability of pregnancy loss, but no difference for clinical pregnancy or live birth.  Evidence Rating Level: 2 (Good) The prevalence of infertility has been increasing over time, turning attention towards research into the use of assisted reproductive technologies (ART). Several studies have demonstrated associations between maternal dietary patterns and probability of pregnancy or live birth from using ART, including the Mediterranean diet...

1. This population-based cohort study is the first to establish an evidence-based recommendation of delivery at 39 weeks for females with pregnancies conceived via infertility treatments and assisted reproductive technology (ART).  Evidence Rating Level: 2 (Good) The proportion of females between the ages of 15 to 49 receiving infertility therapies has risen over recent years. Assisted reproductive technology (ART) more specifically, although useful, is also associated with the risk for low birth weight, perinatal mortality, and stillbirth...

1. Important components of the endocannabinoid system (ECS) were isolated in the developing human fetal testis, implying that the development of this organ could be impacted by cannabinoid consumption.  2. Early testis exposure to phytocannabinoids directly and negatively impacted male gonadal development and physiology ex vivo.  Evidence Rating Level: 1 (Excellent) Study Rundown:  Cannabis is the most commonly consumed recreational drug by women in pregnancy, and the presence of THC (Δ9-trans-tetrahydrocannabinol) and cannabidiol (CBD) in the fetal blood and/or meconium suggest that this substance crosses the placenta...

1. In a population-based study based in Southern California, the risk of autism spectrum disorder (ASD) in children was increased with exposure to labour epidural analgesia (LEA), independent of exposure to oxytocin. 2. There was no significant association between risk of ASD and exposure to oxytocin in labour, independently of exposure to LEA. Evidence Rating Level: 2 (Good) While some population-based studies have reported an association between labour epidural analgesia (LEA) and risk of children with autism spectrum disorder (ASD), the results overall from these studies have been inconsistent...

1. In this randomized controlled trial, the E-MOTIVE bundle, consisting of early detection and treatment of postpartum hemorrhage, was associated with a lower risk of complications than usual care.  2. The E-MOTIVE treatment bundle also resulted in higher detection rates of postpartum hemorrhage and treatment adherence compared to usual care. Evidence Rating Level: 1 (Excellent) Study Rundown: The adoption of the World Health Organization (WHO) recommendations for the prevention and treatment of postpartum hemorrhage is poor...

1. Live birth rate between the low-molecular-weight heparin and standard care group was comparable. 2. The most common inherited thrombophilia were heterozygous Factor V Leiden followed by heterozygous Prothrombin G20210A mutations. Evidence Rating Level: 1 (Excellent) Study Rundown: Thrombophilia is a leading cause of recurrent miscarriage around the world. Although anticoagulant therapy may reduce the number of miscarriages and adverse pregnancy outcomes, the recommendation for low molecular weight heparin (LMWH) has been most studied in patients with antiphospholipid syndrome...

1. In this randomized controlled trial, the Eat, Sleep, Console approach resulted in a significantly shortened time to medical readiness for discharge in neonates with opioid withdrawal syndrome.  2. There was no significant difference between usual care and the Eat, Sleep, Console approach in the incidence of adverse outcomes.  Evidence Rating Level: 1 (Excellent) Study Rundown: Neonatal opioid withdrawal syndrome results from exposure to opioids in utero. Clinical signs can include seizures, irritability, and gastrointestinal issues...

1. In this systematic review and meta-analysis, physical activity improved the reproductive outcomes of women with polycystic ovarian syndrome (PCOS), whether used alone or in combination with other interventions. 2. In addition, physical activity was associated with improvements in psychological factors in women with PCOS. Evidence Rating Level: 1 (Excellent) Issues with fertility are common and distressing for women diagnosed with polycystic ovarian syndrome (PCOS). Physical activity is often recommended to PCOS patients to maintain a healthy body weight and improve insulin sensitivity...

1. In this randomized controlled trial, patients with adenomyosis that received mifepristone were found to have decreased adenomyosis-associated dysmenorrhea intensity at 12 weeks.  Evidence Rating Level : 1 (Excellent) Adenomyosis, characterized by the presence of ectopic endometrial glands and stroma in the myometrium, is diagnosed in approximately 20% of reproductive-aged people with a uterus. Mifepristone, a selective progesterone receptor modulator found to have applications for endometriosis and uterine fibroids, has shown promise in preclinical and small sample studies as a potential therapy for adenomyosis...

1. In this randomized controlled trial, the treatment of gestational diabetes before 20 weeks’ gestation was associated with a lower risk of adverse neonatal outcomes compared to no treatment.  2. There was no significant difference between treatment and no treatment with respect to maternal hypertension or neonatal lean body mass. Evidence Rating Level: 1 (Excellent) Study Rundown: Gestational diabetes occurs when the human body is unable to make sufficient amounts of insulin, resulting in high blood glucose levels...

1. Elective induction of labour at 39 weeks gestation compared to expectant management was associated with reduced likelihood of 3 rd and 4 th degree perineal injury, operative vaginal birth, macrosomia, and low APGAR score at 5 minutes. 2. For multiparous women, elective induction was associated with a reduced likelihood of emergency Cesarean section. 3. For nulliparous women, elective induction was associated with an increased likelihood of shoulder dystocia. Evidence Rating Level: 2 (Good) Study Rundown: Elective induction of labour refers to induction without a medical indication...

1. In this systematic review, most studies found that pregnant women and new mothers who received telemedicine interventions showed a significant improvement in many mental health outcomes. 2. However, these interventions did not demonstrate a significant improvement in symptoms of anxiety. Evidence Rating Level: 1 (Excellent) Affective disorders during pregnancy may have deleterious consequences, not only for the mother, but also for the fetus, making treatment imperative. Telemedicine may offer a solution due to its ease of access, especially for those who may have difficulties with transportation...