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  • June 27, 2017 3:04 PM | Ashley Monson (Administrator)

    Southern Ob/Gyn is pleased to announce our collaboration with APAOG, the national organization for Physician Assistants in Ob/Gyn. We are pleased to welcome them to the 2017 Annual Meeting and into membership in our society.

    July 12 –15, 2017

    Biltmore Estate
    Asheville, NC

    Download attendee brochure here. 

    More information on Southern Obstetric & Gynecologic Seminar can be found at: www.southernobgynseminar.org


  • June 26, 2017 9:57 AM | Ashley Monson (Administrator)

    Unclear if HPV testing prevented more cervical cancer

    • by Judy George, Contributing Writer, MedPage TodayJune 22, 2017

    Action Points

    Human papillomavirus (HPV) tests resulted in faster and more complete diagnosis of precancerous lesions than Pap smears alone, but also led to more biopsies and surgical treatment of low-grade lesions, according to a new analysis of the New Mexico HPV Pap Registry published in JAMA Oncology.

    HPV screening led to a nonsignificant 15.8% increase in detecting overall cervical intraepithelial neoplasia grade 3 or worse (CIN3+) lesions, and did so much more quickly than Pap smears alone, in a median time of 103 versus 393 days. It also detected significantly more of the less severe CIN1 and CIN2 lesions, and resulted in 55.8% more biopsies and a 20% higher rate of loop electrosurgical excision procedures (LEEP).

    "This study is the first comprehensive evaluation to date of the influence of HPV testing on the long-term outcome associated with ASC-US (atypical squamous cells of undetermined significance) cytology," wrote Cosette Wheeler, PhD, of the University of New Mexico Health Sciences Center in Albuquerque, and colleagues.

    The Wheeler group analyzed the clinical records of 457,317 women whose average age was 39.8 (±12.5 years) from New Mexico's population-based cervical screening register from 2008 to 2012, linking Pap smears and HPV tests to pathology reports.

    The primary objective was to study 5-year outcomes after a Pap smear, with versus without HPV testing. Of the 457,317 women, 20,677 (4.5%) had an abnormal Pap smear result, and 16,648 of the 20,677 -- 80.5% -- had HPV testing.

    Over 5 years, HPV screening detected CIN3+ lesions (adenocarcinoma in situ or cancer) in 2.49% of women, compared to a 2.15% detection rate in women who did not have HPV testing (RR 1.16, 95% CI, 0.92-1.45, P=0.23). HPV triage made a difference detecting high-grade lesions especially during the first year of follow-up, when the detection rate was 1.49% versus 0.93% (RR 1.60, 95% CI, 1.14-2.24, P=0.004).

    By year 5, however, the relative risk dropped and the absolute difference decreased from 0.56% to 0.34%, indicating that most CIN3+ lesions were persistent.

    Among those tested for HPV, virtually all CIN2 and CIN3+ disease occurred in HPV-positive women. The RRs for this group always were above 10, except CIN3+ in women ages 50 to 64, where it was 7.64.

    HPV screening also detected CIN1 lesions in 11.6% of women, compared to a 6.5% detection rate in women who were not screened for HPV (RR 1.76, 95% CI 1.56-2.00, P<0.001). This increase was similar across age groups (P=0.32). Among those tested for HPV, CIN1 lesions were much more common in women who were HPV-positive (24.3% versus 2.7% after 5 years; RR 9.11, 95% CI, 8.01-10.36, P<0.001), and was detected in a median time of 61 versus 582 days (P<0.001).

    "This study shows that knowing a woman's HPV status can help determine her likelihood of needing additional procedures and prioritize immediate treatment and medical resources to the women who need them most," said Jack Cuzick, PhD, director of the Wolfson Institute of Preventive Medicine at Queen Mary University of London, who was part of the research team.

    In an accompanying editorial, Chris Meijer, MD, PhD, and Peter Snijders, PhD, of the pathology department at VU University Medical Center in Amsterdam, pointed out that although HPV triage is effective at detecting cervical disease in a shorter time, it comes at the cost of more biopsies and LEEPs.

    It's unclear whether HPV testing prevented more cervical cancer or whether the reduced time balances the risks of overtreatment, they noted. Among young women especially, an HPV-positive test may stem from a transient HPV infection, and CIN1 and a subset of CIN2 lesions often regress spontaneously without progressing to cervical cancer. CIN3 lesions -- the most advanced cervical cancer precursors -- may persist for more than 2 decades before cervical cancer eventually develops.

    "The HPV triage strategy [used in this study] detects more CIN1 and CIN2 than the algorithm without HPV testing and at present triggers considerable overtreatment of many women of reproductive age who will never develop cervical cancer," they wrote. "These unnecessary treatments are associated with a significant cervical morbidity, including preterm birth, perinatal mortality, and low birth weight."

    Other triage tests also should be considered, they wrote, adding that the latest host gene methylation assays perform well against other options and should have a low cancer risk for test-negative women.

    Because this was an observational study, HPV testing was not randomized in this research. It is possible women not tested for HPV had a different disease risk, or their clinicians used a different follow-up strategy after Pap smears. Clinics in rural areas were less likely to use HPV testing, the researchers noted, and even in urban areas, public health clinics and some federally-qualified health centers had almost no HPV testing during the study period.

    This study was funded by a grant from the Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium, which is funded by the U.S. National Cancer Institute.

    Wheeler reported relationships with the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, GSK, Merck, and Roche Molecular Systems. Dr. Cuzick disclosed relationships with Abbott, Becton Dickinson, Cepheid, Merck, Hologic, OncoHealth, Qiagen, and Trovagene. The research team reported no other relationships.

    Meijer and Snijders are minority shareholders of Self-Screen B.V., a spin-off company of VU University Medical Center with patents on human papillomavirus testing and methylation markers for cervical screening. They also disclosed relationships with GSK, Qiagen, Sanofi Pasteur-MSD/Merck, Roche Diagnostics, Menarini, Seegene, Abbott, Genticel, Crucell B.V., Diassay B.V., and Delphi Biosciences.

    • Reviewed by F. Perry Wilson, MD, MSCEAssistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner


  • June 26, 2017 7:51 AM | Ashley Monson (Administrator)

    Women who receive human papillomavirus (HPV) testing, in addition to a pap smear, receive a faster, more complete diagnosis of possible cervical precancer, according to a study of over 450,000 women by Queen Mary University of London (QMUL) and the University of New Mexico (UNM) Comprehensive Cancer Center.

    HPV is a virus that can cause cervical, vaginal, penile and anal cancers. More than 520,000 cases of cervical cancer are diagnosed worldwide each year, causing around 266,000 deaths. A common screening procedure for cervical cancer is the Pap smear, which tests for the presence of precancerous or cancerous cells on the cervix.

    The study, published in JAMA Oncology, used data from the New Mexico HPV Pap Registry in the United States. It is the first comprehensive evaluation of HPV testing on the long-term outcomes of women who had received a borderline abnormal Pap test result.

    A total of 457,317 women were included in the study. Of these, 20,677 women (4.5 percent) received a borderline abnormal result through a Pap smear and were followed in the study for five years. Some of the women with borderline abnormal Pap smear results had an HPV test.

    HPV testing led to a 15.8 percent overall increase in the detection of cervical precancers and time to detection was much shorter (a median of 103 days versus 393 days).

    Virtually all cervical pre-cancers were detected in women who tested positive for HPV, suggesting HPV testing to be a good additional screening method after the Pap smear. Colposcopy, which is a medical examination of the cervix, could then be focused on women who would need it most: those with a positive HPV test.

    At the same time, however, HPV testing of women resulted in 56 percent more biopsies and a 20 percent increase in surgical treatment procedures performed. Most of the additional biopsies were for low grade lesions which could have regressed, indicating some overtreatment due to HPV testing.

    Professor Jack Cuzick from QMUL said: "This study shows that knowing a woman's HPV status can help determine her likelihood of needing additional procedures, and prioritise immediate treatment and medical resources to the women who need them most."

    Professor Cosette Wheeler from the UNM Comprehensive Cancer Center said: "The benefits of HPV testing outweigh the harms observed but it's important to understand and quantify the harms as well."

    The authors warn that, as this was an observational study, the use of HPV testing was not randomised. So, it is also possible that there could be socioeconomic or other relevant differences among health care facilities that have not been measured.

    Explore further: Screening, HPV vaccine can prevent cervical cancer: FDA

    More information: JAMA Oncology (2017). DOI: 10.1001/jamaoncol.2017.1040 

    Journal reference: JAMA Oncology search and more info website

    Provided by: Queen Mary, University of London search and more info


    Read more at: https://medicalxpress.com/news/2017-06-hpv-earlier-treatment-cervical-pre-cancer.html#jCp


  • June 21, 2017 8:53 AM | Ashley Monson (Administrator)

    APAOG members may view recorded webinars at anytime. Please check out our latest addition, Menopause, Where are we now? presented by Elyse Watkins, PA-C. 

    Click here to view the webinar library. *Must be logged in to view webinar library. 

  • June 20, 2017 11:02 AM | Ashley Monson (Administrator)

    APAOG Members Elyse, Audrey, and Christina featured in latest AAPA E-blast for article in JAAPA.

    Caring for a patient with first-trimester bleeding

    Watkins, Elyse J. DHSc, PA-C; Hellams, Audrey; Saldanha, Christina

    Journal of the American Academy of Physician Assistants: June 2017 - Volume 30 - Issue 6 - p 15–20
    doi: 10.1097/01.JAA.0000516341.64222.81
    CME: Women&apos;s Health


  • June 19, 2017 7:48 AM | Ashley Monson (Administrator)

    Published: Thursday 15 June 2017

    A minimally invasive treatment can help restore fertility in women with uterine fibroids, according to a new study published online in the journal Radiology.

    Uterine fibroids, abnormal masses of fiber and muscle tissue in the wall of the uterus, are considered one of the most common causes of infertility and complications related to pregnancy. Previous research has found that one out of every four women with fibroids has problems related to fertility. The standard treatment option for such women is myomectomy, or surgical removal of the fibroids.

    However, myomectomy is not always possible or effective and can result in major complications including hysterectomy, according to study co-author João Martins Pisco, M.D., Ph.D., from the Department of Interventional Radiology at Saint Louis Hospital in Lisbon, Portugal.

    Uterine fibroid embolization (UFE) is a less invasive option that involves injection of an embolic agent, typically made up of very small beads, into the uterine arteries to block the blood supply to the uterus and fibroids. As the fibroids die and begin to shrink, the uterus fully recovers. UFE can be performed in patients with a prior myomectomy or in vitro fertilization (IVF).

    Despite its less invasive nature, UFE has yet to be fully embraced in the medical community as a fertility-preserving treatment for women with symptomatic fibroids due to concerns that the procedure may cause inadequate blood flow to the endometrium, or lining of the uterus, and the ovaries.

    For the new study, Dr. Pisco and colleagues assessed pregnancy rates in 359 women with uterine fibroids who were unable to conceive and who underwent either conventional or partial UFE. In conventional UFE, all uterine artery branches are embolized. However, the partial procedure requires treatment of only the small vessels to the fibroids, leaving the corresponding larger vessels unaffected. Partial UFE may help reduce the risks of infertility associated with conventional UFE.

    After an average follow-up of almost six years, 149 of the 359 women, or 41.5 percent, had become pregnant one or more times, and 131 gave birth to a total of 150 babies. It was the first pregnancy for more than 85 percent of the women who gave birth.

    The procedures had a clinical success rate of approximately 79 percent for fibroid-related symptoms. Complication rates were 14.6 percent for partial UFE and 23.1 percent for conventional UFE. The procedure was repeated in 28 patients whose fibroids had not been fully treated, as shown by MRI, and 11 of those patients subsequently got pregnant.

    "Our findings show that UFE is a fertility-restoring procedure in women with uterine fibroids who wish to conceive, and pregnancy following UFE appears to be safe with low morbidity," Dr. Pisco said. "Women who had been unable to conceive had normal pregnancies after UFE and similar complication rates as the general population in spite of being in a high-risk group."

    Dr. Pisco suggested that UFE may become the first-line treatment for women with fibroids who wish to conceive, particularly for those with numerous or very large fibroids. Such patients have a fibroid recurrence rate of more than 60 percent after myomectomy, making UFE an important option.

    The researchers are continuing the treatments and compiling data. Since the time of writing, there were 12 additional pregnancies.

    "In our study there are now almost 200 newborns following UFE," Dr. Pisco said. "Our next step will be a randomized study comparing the results of partial and conventional UFE."

    Article: Spontaneous Pregnancy with a Live Birth after Conventional and Partial Uterine Fibroid Embolization, João M. Pisco et al., Radiology, doi: 10.1148/radiol.2017161495, published online 13 June 2017.


  • June 14, 2017 10:08 AM | Ashley Monson (Administrator)

    a pregnant woman holding a glass of wine

    Medical News Today

    Even low levels of alcohol during pregnancy may alter the facial development of offspring.

    A new study affirms that there is no safe level of alcohol consumption during pregnancy, after finding that even the occasional drink can affect a baby's facial development.

    Researchers from Belgium and Australia assessed the drinking habits of more than 400 women during pregnancy and mapped the facial features of their offspring at the age of 1 year.

    The team found that prenatal alcohol exposure - even at low levels - subtly influenced the formation of facial features in the womb, including the nose, chin, and eyes.

    Study co-leader Evi Muggli, of the Murdoch Children's Research Institute in Australia, and colleagues recently reported their results in JAMA Pediatrics.

    The Centers for Disease Control and Prevention (CDC) state that there is no safe amount of alcohol to drink during pregnancy, nor is there a safe time to drink alcohol while pregnant.

    However, a 2015 study from the CDC found that around 1 in 10 expectant mothers in the United States report having consumed alcohol within the past 30 days.

    Alcohol consumption during pregnancy can cause a number of physical and developmental problems for offspring, including low birthweight, learning disabilities, small head size, intellectual disabilities, and problems with vision or hearing. These conditions fall under the umbrella of fetal alcohol spectrum disorder (FASD).

    It is also known that prenatal alcohol exposure can influence a child's facial development, though the level of alcohol intake that causes such an effect has been unclear.

    For their study, Muggli and colleagues set out to investigate how different levels of prenatal alcohol exposure affect facial development.


  • June 14, 2017 10:05 AM | Ashley Monson (Administrator)

    Duke University researchers have developed a handheld device for cervical cancer screening that produces high-quality images on a smartphone or laptop, part of an initiative to make screenings more accessible, easier to conduct and less costly than studies using expensive traditional equipment.

    Read more.

  • June 14, 2017 9:31 AM | Ashley Monson (Administrator)

    06/08/2017

    June 8, 2017 – The U.S. Preventive Services Task Force posted today a draft research plan on screening for syphilis infection in pregnant women. The draft research plan is available for review and public comment from June 8, 2017 through July 5, 2017. To review the draft research plan and submit comments, go to http://www.uspreventiveservicestaskforce.org/Page/Name/us-preventive-services-task-force-opportunities-for-public-comment.

     


  • June 14, 2017 7:59 AM | Ashley Monson (Administrator)

    By 

    HealthDay Reporter

    TUESDAY, June 6, 2017 (HealthDay News) -- Gaining too much or too little weight during pregnancy can harm both baby and mom, researchers say.

    In a review of more than 1.3 million pregnancies, investigators found that 47 percent of women gained too much weight. And, 23 percent did not gain enough weight to meet recommended levels.

    "Healthy recommended pregnancy weight gain depends on a mother's starting weight, with women with a higher weight recommended to gain less in pregnancy," said lead researcher Dr. Helena Teede.

    "Regardless of a mother's starting weight, unhealthy weight gain in pregnancy is now very common and carries significant health risks for mothers and babies," said Teede, a professor of women's health at Monash University in Melbourne, Australia.

    Weight gain below the recommended amount was associated with a higher risk of having a small baby and preterm delivery, the researchers found.

    On the other hand, packing on more weight than recommended was tied to a greater risk of a having a larger and heavier infant (a condition called fetal macrosomia) and a cesarean delivery.

    Around the world, prevalence of obesity and excess weight gain in pregnancy are increasing. And, about 4 out of 10 U.S. women are obese, according to background notes in the study.

    For the study, Teede and her American and international colleagues reviewed 23 previously published studies from developed countries around the world. This type of study is called a meta-analysis, in which researchers pool data from divergent studies to tease out common trends.

    Specifically, the researchers looked at how much weight women gained during pregnancy and whether it met the weight gain recommended by the U.S. Institute of Medicine.

    Institute of Medicine guidelines recommend that underweight women gain from 28 to 40 pounds during pregnancy. Normal-weight women should gain between 25 and 35 pounds. Overweight women should add just 15 to 25 pounds. And obese women should limit weight gain to 11 to 20 pounds.

    The report was published June 6 in the Journal of the American Medical Association.

    Teede said that doctors need to monitor weight gain in pregnancy and to help women eat healthier and stay mobile and active.

    "Women need to be aware of what their individual recommended healthy pregnancy weight gain is and note that the old stories of confinement or resting throughout pregnancy and eating for two are not healthy for mothers or their babies," she said.

    Other specialists agreed.

    "Pregnancy is not a time for 'eating for two,' but a great time to eat healthfully and exercise," said Dr. Aaron Caughey, chair of obstetrics and gynecology at Oregon Health and Science University.

    Efforts to help women with diet and exercise have only demonstrated small benefits at best, said Caughey, who wrote an editorial accompanying the study.

    "We may need newer ideas about how to counsel and incentivize pregnant women to achieve better outcomes," he said.

    Another specialist said it's best to get to a healthy weight before pregnancy.

    "Doctors need to help patients to optimize their weight before they become pregnant," said Dr. Jill Rabin of Northwell Health in New Hyde Park, N.Y.

    "If you take care of yourself before you are pregnant, you are going to have a healthier baby," said Rabin, who is co-chief of ambulatory care in Northwell's women's health programs.

    More information

    For more about weight gain during pregnancy, visit the March of Dimes.

    SOURCES: Helena Teede, M.B.B.S., Ph.D., professor, Monash University, Melbourne, Australia; Aaron Caughey, M.D., Ph.D., professor and chair, department of obstetrics and gynecology, Oregon Health and Science University, Portland; Jill Rabin, M.D., co-chief, ambulatory care, Women's Health Programs, PCAP Services, Northwell Health, New Hyde Park, N.Y.; June 6, 2017, Journal of the American Medical Association

    Last Updated: 


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