2 Minute Medicine ® - Obstetrics & Gynecology

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...

1. Offspring of mothers with alopecia areata had a significantly higher risk of autoimmune, inflammatory, atopic, thyroid, ad psychiatric disorders. 2. Clinicians and mothers with AA should be aware of potential offspring health risks and comorbidities. Evidence Rating Level: 2 (Good) Study Rundown: Alopecia areata (AA) is a chronic autoimmune dermatological condition that results in nonscarring hair loss. Although the exact mechanism is not clear, AA is thought to be related to immune dysregulation affecting hair follicles...

1. Although anemia prevalence at 36 weeks was slightly lower in the ferric carboxymaltose group compared to standard-of-care, statistical significance was not achieved. 2. Adverse events between both groups were comparable; there were no changes in birth weight. Evidence Rating Level: 1 (Excellent) Study Rundown: Anemia affects more than one-third of all pregnancies in Africa. Although oral iron supplementation is recommended during pregnancy, patient adherence and uptake may be unsatisfactory. Ferric carboxymaltose is an intravenous iron formulation that can be administered in a single dose as an alternative, however, current evidence regarding its effectiveness is limited...

1. The prevalence of uterine fibroids was found to be greater among reproductive-age participants of Black/ African American or Asian-Chinese descent compared to white participants. Evidence Rating Level : 2 (Good) Uterine fibroids are associated with significant morbidity, including heavy menstrual bleeding, pelvic pain, subfertility, and early pregnancy loss. The prevalence of uterine fibroids based on patient demographics, including ethnicity and age, has not previously been well defined. Researchers collected data from the University of California San Francisco Ovarian Aging Study, an ongoing longitudinal cohort study, to collect data on 996 females between 25 and 45 years of age...

1. The 3-year incidence of breast cancer in the study group was 8.9% compared to 9.2% in the control group 2. At 3 years follow-up, the distant recurrence in the study group was 4.5% compared to 5.8% in the control group Evidence Rating Level : 1 (Excellent) Study Rundown: The preservation of fertility and the desire to pursue pregnancy is a concern for patients diagnosed with breast cancer, which is the most common cancer found in women 40 years old or younger. This study investigated the effect of a temporary interruption of endocrine therapy treatment of endocrine-responsive breast cancer in young women who desired pregnancy...

1. In this longitudinal cohort study, individual-level factors such as age >35, more than high school education, English language proficiency, being married, White race, smaller family size, and higher income were associated with lower odds of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 2. State-level factors such as higher earned income tax credit rates were associated with lower rates of WIC participation, while other factors such as higher gross domestic product (GDP) per capita, unemployment rates, and Medicaid caseloads, were associated with higher participation rates...

1. In a multinational retrospective cohort study, preterm birth was associated with an increased risk of atrial fibrillation (AF). 2. Neonatal factors such as being small for gestational age were associated with increased AF risk before age 18 years and being large for gestational age was associated with AF at all age groups studied. Evidence Rating Level : 2 (Good) Study Rundown: Neonatal factors such as restricted (small for gestational age; SGA) or excess (large for gestational age; LGA) fetal growth have been linked to increased risk of cardiovascular diseases...

1. In this population-based cohort study, c ompared to women without bilateral salpingo -oophorectomy (BSO), women with BSO had a higher overall risk of developing cancer . 2. Notably, women in the BSO group had a higher 10-year mortality than those without BSO. Evidence Rating Level: 1 (Excellent) Study Rundown: BSO during benign hysterectomy has been shown to decrease the risk of ovarian cancer. Thus, women at high risk for this type of cancer will have a substantial survival benefit from undergoing BSO...

1. In this randomized controlled trial, respiratory syncytial virus prefusion F protein−based vaccine (RSVpreF) administered during pregnancy prevented severe RSV respiratory tract illness in infants. 2. When administered during pregnancy, there were no safety concerns identified with the RSVpreF vaccine . Evidence Rating Level: 1 (Excellent) Study Rundown:   RSV is a common cause of acute lower respiratory tract illness and a leading cause of death in infants younger than six months of age, particularly in low- and middle-income countries...

1. In a case-control study based in Sweden, females born by C-section had greater odds of developing early-onset colorectal cancer (CRC), compared to females born by vaginal delivery. 2. No association was found between males born by C-section and early-onset CRC. Evidence Rating Level: 3 (Average) In the USA and Europe, there have been reports of increasing incidence of colorectal cancer (CRC) in patients less than 50 years old. Risk factors such as obesity, diabetes, and metabolic syndrome, have been identified for early-onset CRC...

1. In this randomized controlled trial, prophylactic administration of tranexamic acid during cesarean section did not lead to a lower risk of composite maternal death or blood transfusion as compared to placebo. 2. There was no difference in the need for surgical or radiologic intervention by seven days postpartum between the treatment and placebo groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Postpartum hemorrhage is associated with significant maternal death worldwide. In this study, the primary outcome of a composite score for maternal death and blood transfusion was observed at similar rates in patients undergoing cesarean section in those receiving tranexamic group as compared to placebo...