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American College of Obstetricians and Gynecologists, April 30-May 2

a doctor mesures patient\'s blood pressure

The annual meeting of the American College of Obstetricians and Gynecologists was held virtually this year from April 30 to May 2 and attracted 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, Eran Bornstein, M.D., of Northwell Health in New York City, and colleagues found a significant association between neonatal birth weight and the likelihood of a successful external cephalic version (ECV).

The authors analyzed the U.S. Centers for Disease Control and Prevention Natality live birth database between 2016 and 2018. Data on all singleton, term, and live births with a birth weight of 2,500 to 5,000 g and an ECV attempt were included in the analyses (controlled for several potential confounders). Of the 11,150,527 live births in 2016 to 2018, 26,255 women who underwent an ECV attempt met the inclusion criteria. The researchers found that high birth weight was associated with higher ECV success rates (69 percent success rate in the 4,500- to 5,000-g group with 2.1 odds for success). Low birth weight was associated with lower ECV success rates (47 percent success rate in the 2,500- to 3,000-g group with 0.8 odds for success).

"This information is contrary to prior concerns that ECV is less likely to be successful with larger fetuses and may be used by providers while counseling patients regarding ECV," Bornstein said.

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In another study, Kaitlyn Mayer, M.D., of the Virginia Commonwealth University Medical Center in Richmond, and colleagues found a statistically significant decrease in time from induction to delivery with combination therapy of mifepristone and misoprostol compared to misoprostol alone for patients with late pregnancy loss.

The authors performed a systematic review to assess the efficacy of mifepristone with misoprostol compared to misoprostol alone for induction of labor due to intrauterine fetal demise in the third trimester of pregnancy. The researchers found that mifepristone administered prior to misoprostol for patients choosing medical management of pregnancy loss in the third trimester shortened induction-to-delivery intervals.

"Mifepristone is heavily regulated by the U.S. Food and Drug Administration Risk Evaluation and Mitigation Strategy (REMS) and Elements to Assure Safe Use (ETASU) restrictions. Organizations such as the American College of Obstetricians and Gynecologists have advocated for the removal of the REMS and ETASU requirements to increase access to this important medication," Mayer said. "Our study supports increased access to mifepristone to increase the efficacy of induction of labor for late pregnancy loss, which has important implications on clinical practice by decreasing time from induction to delivery for these patients who are already experiencing a heartbreaking and traumatic diagnosis."

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Karampreet Kaur, an M.D. candidate, and Soha S. Patel, M.D., of the Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues found that obstetrical patients and providers believed telehealth was a safe modality that improved access to obstetric care during the COVID-19 pandemic.

The authors developed separate patient and provider surveys based on prior validated obstetric telehealth surveys with additional questions specifically about the COVID-19 pandemic. Surveys were self-administered electronically via REDCap. Participation in this study was optional, and responses were anonymous for both patients and providers. One hundred sixty-seven obstetrical patients filled out the survey between June 2020 and April 2021, and 72 obstetrical providers filled out the survey between June 2020 and August 2020.

The researchers found that 75 percent of patients strongly agreed or agreed that they personally felt safer using telehealth during the COVID-19 pandemic. More than 95 percent of providers strongly agreed or agreed that telehealth was safer than in-clinic appointments for themselves, colleagues, and obstetrical patients during the COVID-19 pandemic.

"Obstetrical patients and providers were satisfied with telehealth as a modality for prenatal care and believe it should be expanded beyond the COVID-19 pandemic," Kaur said. "Telehealth options should be considered for delivery of prenatal care independent of the COVID-19 pandemic. Expansion of obstetric telehealth provides an opportunity to improve access to care, especially for patients whose geography, work schedule, and access to transportation make it difficult for them to travel for much needed prenatal appointments."

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Physician's Briefing