16 Dec 2011
Women with polycystic ovary syndrome (PCOS) are more likely to suffer adverse pregnancy and birth outcomes, a population-based cohort study from Sweden suggests. The researchers identified women with singleton pregnancies who gave birth between 1995 and 2007, using the Swedish medical birth register. Using linkage to another national database, they established that, in this cohort, 3,787 births were to women with diagnosed PCOS and 1,191,336 were to women without the disease. Data on maternal and fetal pregnancy outcomes were collected. Comments Dr Chris Barclay: 'We know that women with PCOS are more likely to be overweight and are at greater future risk of diabetes and cardiovascular disease. The results of this study suggest that they are also more likely to have high-risk pregnancies. There are two observations I would like to make on this study. First, the numbers of women with diagnosed PCOS here were small, and this may have obscured the magnitude of its adverse effects on pregnancy. Second, nowhere in the paper were the significance of hyperinsulinism or the metabolic syndrome discussed which considering they are common and relevant characteristics of PCOS was baffling.'
16 Dec 2011
Failure rates are significantly higher following hysteroscopic sterilisation (HS), in a theatre or office setting, compared with laparoscopic sterilisation (LS), a study has found. A research group from Pittsburgh reviewed the literature and collated a number of studies from which data were extracted and analysed. All studies had to have a minimum of 50 subjects with follow-up for at least 12 months. No absolute figures were presented, only percentages. Figures for successful sterilisation at the first attempt were: 99%, 86% and 85% for LS, HS in theatre and HS in the office setting at three months and 99%, 88% and 87% respectively six months post-procedure. The respective figures at 12 months were 99%, 95% and 94%. However, the method by which some patients were eventually successfully sterilised was different from the method they chose initially. Although, some women elected to have a second HS attempt, 7.0% of patients who had had HS in theatre and 5.3% of those who had had HS in an office setting went on to have a laparoscopic procedure. Overall, 5% of patients declined any further sterilisation attempts. When best and worst case data were compared the difference in success rates at 12 months showed LS to outperform HS by 0.4-10%.
22 Nov 2011
Uptake of IUD insertion is greater when it is offered immediately after termination than when insertion is delayed for four to six weeks. Expulsion and bleeding were no higher in the early insertion group a study has found. Dr Chris Barclay reviews the paper, commenting, 'The care of women undergoing termination of pregnancy is incomplete unless a plan for future contraception is addressed. The copper IUD is a reasonable option; it has a low failure rate and requires no further action from the woman for it to be effective. The authors conclude that immediate insertion of a copper IUD after medical termination should be offered routinely to women. The suggestion from this paper is that diligent and proactive attention to post-termination contraception is beneficial although the trend for six-month continuation rates was lower for early IUD insertion. Careful follow-up checking for expulsion is also advisable.'
20 Oct 2011
A prospective population-based case control study from New Zealand suggests that maternal sleep practices may increase stillbirth rates, but the risk was still low. The absolute risk for late stillbirth among women who fell asleep in the left lateral position was 1.96/1,000 births compared with 3.93/1,000 for those who did not.
22 Jun 2011
Combined oral contraceptives containing drospirenone appear to carry a three-fold higher risk of non-fatal idiopathic venous thromboembolism (VTE) than those containing levonorgestrel, although the overall risk is still low. The study used data from the UK General Practice Research Database (GPRD) that gathers information from a large number of general practices and more than three million people in the UK, including demographic data, information about prescribed drugs, diagnoses, hospital admissions and deaths.
25 May 2011
Loop excisions <10 mm for CIN do not raise the risk of recurrence in women aged 35 and under with high-grade disease, a study has found. A total of 1,558 women with high-grade CIN undergoing loop excision of the cervix, over a six-year period, were studied. 'The upshot is that smaller loop excisions in potentially fertile women appear safe.'
25 May 2011
A single visit protocol based on serum progesterone measurements appears to be a safe and effective approach for triaging and managing women with pregnancy of unknown location (PUL). A total of 6,201 women with suspected early pregnancy complications attended King's College Hospital, London over the 15-month study period. There were 676 (10.9%) with PUL, defined as a positive pregnancy test but with no evidence of a gestation sac in utero or ectopic on ultrasound scanning. Of these 252 were found to have a progesterone level <10 nmol/L. All but one of these women were treated as outpatients and were not invited for further investigation.
20 Apr 2011
A low-glycaemic load (GL) diet in overweight or obese women did not affect the birthweight or body fat of their babies when compared with a low-fat diet. However, women in the former group had smaller increases in triglycerides and total cholesterol and a greater decrease in C-reactive protein (CRP) than those in the latter. Infant head circumference and duration of pregnancy were also greater in this group. 'Rising rates of overweight and obesity within society in general are increasingly being mirrored in women during pregnancy. Current dietary advice does not seem to be achieving significant improvements and not surprisingly alternative dietary interventions are under scrutiny. Preterm and early-term births contribute significantly to perinatal morbidity and head circumference is directly related to brain volume and possibly later IQ. Drawing firm conclusions from pilot studies is difficult. Although a low-GL diet was associated with a more favourable maternal biochemistry profile and with better birth statistics, the number of subjects in the study was small. Larger studies are needed to evaluate whether a low-GL diet does improve maternal and infant outcomes.'
20 Apr 2011
The Clinical Effectiveness Unit of the Faculty of Sexual and Reproductive Healthcare currently advises that larger women need not take a higher dose of the progestogen-only contraceptive pill (POP) for effective contraceptive cover. However, a case report in the Faculty's journal casts doubt on this advice. Dr Chris Barclay reviews the paper and comments: 'I drew two conclusions from this interesting paper. First heavier women, >60-70 kg, using POP contraception, should be included in the decision about dosage. Second, that evidence-based medicine does not address every facet of day-to-day medical practice. Deploying clinical wisdom as the authors did here is, in my view, to be commended.'
21 Feb 2011
An observational study from Canada has shown that a decline in the use of HRT over the past decade was followed by a reduction in the incidence of breast cancer. Data on HRT prescriptions dispensed for women aged 50-69, during the years 2001-2006, was collated from a national registry. Information about current HRT use was obtained by telephone from a sample of 1,200 women in this age group already enrolled in the National Population Health Survey. Subjects were asked ‘in the past month, did you take hormones for menopause or ageing symptoms?' Those who answered affirmatively were asked about the type of formulation used. 'It would seem logical that prolonging a woman's exposure to sex hormones would increase risk (breast cancer is slightly more common in women with early menarch and late menopause). However, the data are observations of association only, and are not controlled for other risk factors for breast cancer such as parity and alcohol intake. The absolute risk of breast cancer to an individual user of HRT is small (and smaller still in oestrogen-only formulation users). The potential benefits need to be weighed up against the risks for each individual patient.'
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