Heidi Splete

WASHINGTON — Retroperitoneal dissection and uterine artery occlusion offer a successful approach to laparoscopic hysterectomy in morbidly obese patients, Dr. Jessica M. Vaught and her associates reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The option to perform a laparoscopic hysterectomy can spare morbidly obese women the potential morbidity associated with an abdominal procedure, the investigators wrote.

Dr. Vaught and her colleagues at George Washington University Medical Center in Annapolis, Md., reviewed 186 laparoscopic hysterectomies performed by the same surgeon at a teaching hospital. Of these, 84 patients qualified as morbidly obese, with a body mass index ranging from 35 to 58 kg/m

Overall, the average operating time was 98 minutes, with an average estimated blood loss of 230 mL. Uterine weight ranged from 41 to 2,032 g, with an average of 426 g.

Complications included blood transfusions required by two patients, readmission for a pelvic hematoma in one patient, and an intestinal obstruction in one patient that required a 3-day hospital stay. The average hospital stay was 1.2 days.

None of the patients experienced vascular, bowel, or lower urinary tract injuries. More than half (55%) of the patients had undergone prior abdominal surgery, and nine had a laparoscopic pelvic node dissection concurrently with the hysterectomy.

WASHINGTON — Retroperitoneal dissection and uterine artery occlusion offer a successful approach to laparoscopic hysterectomy in morbidly obese patients, Dr. Jessica M. Vaught and her associates reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The option to perform a laparoscopic hysterectomy can spare morbidly obese women the potential morbidity associated with an abdominal procedure, the investigators wrote.

Dr. Vaught and her colleagues at George Washington University Medical Center in Annapolis, Md., reviewed 186 laparoscopic hysterectomies performed by the same surgeon at a teaching hospital. Of these, 84 patients qualified as morbidly obese, with a body mass index ranging from 35 to 58 kg/m

Overall, the average operating time was 98 minutes, with an average estimated blood loss of 230 mL. Uterine weight ranged from 41 to 2,032 g, with an average of 426 g.

Complications included blood transfusions required by two patients, readmission for a pelvic hematoma in one patient, and an intestinal obstruction in one patient that required a 3-day hospital stay. The average hospital stay was 1.2 days.

None of the patients experienced vascular, bowel, or lower urinary tract injuries. More than half (55%) of the patients had undergone prior abdominal surgery, and nine had a laparoscopic pelvic node dissection concurrently with the hysterectomy.

WASHINGTON — Retroperitoneal dissection and uterine artery occlusion offer a successful approach to laparoscopic hysterectomy in morbidly obese patients, Dr. Jessica M. Vaught and her associates reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The option to perform a laparoscopic hysterectomy can spare morbidly obese women the potential morbidity associated with an abdominal procedure, the investigators wrote.

Dr. Vaught and her colleagues at George Washington University Medical Center in Annapolis, Md., reviewed 186 laparoscopic hysterectomies performed by the same surgeon at a teaching hospital. Of these, 84 patients qualified as morbidly obese, with a body mass index ranging from 35 to 58 kg/m

Overall, the average operating time was 98 minutes, with an average estimated blood loss of 230 mL. Uterine weight ranged from 41 to 2,032 g, with an average of 426 g.

Complications included blood transfusions required by two patients, readmission for a pelvic hematoma in one patient, and an intestinal obstruction in one patient that required a 3-day hospital stay. The average hospital stay was 1.2 days.

None of the patients experienced vascular, bowel, or lower urinary tract injuries. More than half (55%) of the patients had undergone prior abdominal surgery, and nine had a laparoscopic pelvic node dissection concurrently with the hysterectomy.

WASHINGTON — Elevated levels of the Bcl-2 protein in urine were associated with 92% of ovarian cancers in a pilot study of 95 women, Patricia Kruk, Ph.D., said at the annual meeting of the American Association for Cancer Research.

“Ovarian cancer has the highest mortality rate among gynecologic malignancies,” said Dr. Kruk. “It is usually detected in the very late stages, because we don't have very good detection systems and the women are generally asymptomatic.”

The average amount of Bcl-2 in the urine of 36 women with ovarian cancer was more than 2 ng/mL, which was significantly greater—at least 10 times greater in most cases—than Bcl-2 levels in the urine of 21 healthy women and 38 women with benign gynecologic disease.

Urinary levels of Bcl-2 decreased up to 100% after patients had debulking surgery, noted Dr. Kruk, who heads a cancer research team at the University of South Florida in Tampa. The Bcl-2 levels remained low during the course of chemotherapy, but increased significantly among patients whose disease recurred.

In contrast, urine samples from the healthy women showed almost no measurable Bcl-2. “All the women had normal renal function, so Bcl-2 was not suggestive of renal dysfunction,” Dr. Kruk noted. Urinary levels of Bcl-2 were not related to tumor size, but increased levels of Bcl-2 were correlated with increased tumor stage and grade. In addition, only 65% of the patients with serious carcinomas were diagnosed using the standard method of blood test results for the tumor marker CA125. “We are cautiously optimistic and excited about our results,” said Dr. Kruk.

WASHINGTON — Elevated levels of the Bcl-2 protein in urine were associated with 92% of ovarian cancers in a pilot study of 95 women, Patricia Kruk, Ph.D., said at the annual meeting of the American Association for Cancer Research.

“Ovarian cancer has the highest mortality rate among gynecologic malignancies,” said Dr. Kruk. “It is usually detected in the very late stages, because we don't have very good detection systems and the women are generally asymptomatic.”

The average amount of Bcl-2 in the urine of 36 women with ovarian cancer was more than 2 ng/mL, which was significantly greater—at least 10 times greater in most cases—than Bcl-2 levels in the urine of 21 healthy women and 38 women with benign gynecologic disease.

Urinary levels of Bcl-2 decreased up to 100% after patients had debulking surgery, noted Dr. Kruk, who heads a cancer research team at the University of South Florida in Tampa. The Bcl-2 levels remained low during the course of chemotherapy, but increased significantly among patients whose disease recurred.

In contrast, urine samples from the healthy women showed almost no measurable Bcl-2. “All the women had normal renal function, so Bcl-2 was not suggestive of renal dysfunction,” Dr. Kruk noted. Urinary levels of Bcl-2 were not related to tumor size, but increased levels of Bcl-2 were correlated with increased tumor stage and grade. In addition, only 65% of the patients with serious carcinomas were diagnosed using the standard method of blood test results for the tumor marker CA125. “We are cautiously optimistic and excited about our results,” said Dr. Kruk.

WASHINGTON — Elevated levels of the Bcl-2 protein in urine were associated with 92% of ovarian cancers in a pilot study of 95 women, Patricia Kruk, Ph.D., said at the annual meeting of the American Association for Cancer Research.

“Ovarian cancer has the highest mortality rate among gynecologic malignancies,” said Dr. Kruk. “It is usually detected in the very late stages, because we don't have very good detection systems and the women are generally asymptomatic.”

The average amount of Bcl-2 in the urine of 36 women with ovarian cancer was more than 2 ng/mL, which was significantly greater—at least 10 times greater in most cases—than Bcl-2 levels in the urine of 21 healthy women and 38 women with benign gynecologic disease.

Urinary levels of Bcl-2 decreased up to 100% after patients had debulking surgery, noted Dr. Kruk, who heads a cancer research team at the University of South Florida in Tampa. The Bcl-2 levels remained low during the course of chemotherapy, but increased significantly among patients whose disease recurred.

In contrast, urine samples from the healthy women showed almost no measurable Bcl-2. “All the women had normal renal function, so Bcl-2 was not suggestive of renal dysfunction,” Dr. Kruk noted. Urinary levels of Bcl-2 were not related to tumor size, but increased levels of Bcl-2 were correlated with increased tumor stage and grade. In addition, only 65% of the patients with serious carcinomas were diagnosed using the standard method of blood test results for the tumor marker CA125. “We are cautiously optimistic and excited about our results,” said Dr. Kruk.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 37.7% of the twice-daily frovatriptan group, compared with 51.3% of the once-daily group and 67.1% of the placebo group. The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Overall, moderate to severe headaches were reported by 25.3%, 32.3%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups; the incidence of functional impairment was 13.6%, 24.1%, and 35.4% in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups, respectively.

The overall symptoms of functional impairment—including light and sound sensitivity, nausea, and vomiting—were significantly reduced in women who took frovatriptan, and each of these symptoms individually were significantly reduced among patients in the twice-daily frovatriptan group, compared with the placebo group.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 37.7% of the twice-daily frovatriptan group, compared with 51.3% of the once-daily group and 67.1% of the placebo group. The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Overall, moderate to severe headaches were reported by 25.3%, 32.3%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups; the incidence of functional impairment was 13.6%, 24.1%, and 35.4% in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups, respectively.

The overall symptoms of functional impairment—including light and sound sensitivity, nausea, and vomiting—were significantly reduced in women who took frovatriptan, and each of these symptoms individually were significantly reduced among patients in the twice-daily frovatriptan group, compared with the placebo group.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 37.7% of the twice-daily frovatriptan group, compared with 51.3% of the once-daily group and 67.1% of the placebo group. The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Overall, moderate to severe headaches were reported by 25.3%, 32.3%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups; the incidence of functional impairment was 13.6%, 24.1%, and 35.4% in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups, respectively.

The overall symptoms of functional impairment—including light and sound sensitivity, nausea, and vomiting—were significantly reduced in women who took frovatriptan, and each of these symptoms individually were significantly reduced among patients in the twice-daily frovatriptan group, compared with the placebo group.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups.

WASHINGTON — Seasonale Lo, the 91-day extended-regimen low-dose oral contraceptive, was effective and well tolerated compared with a 28-day low-dose oral contraceptive, after both 1 year and 3 years of use.

The Seasonale Lo data from a randomized, multicenter study were presented in two posters at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Andrew M. Kaunitz of the University of Florida Health Science Center in Jacksonville, Fla., monitored women aged 18–35 years who could potentially become pregnant. After 1 year, the overall cumulative failure rate of Seasonale Lo was 2.23% among 463 patients, compared with a 2.83% failure rate among 231 patients who took a traditional 28-day oral contraceptive (Levlite).

Compliance rates were high—98.1% in the Seasonale Lo group and 96.5% in the Levlite group. Among compliant patients, the Seasonale Lo failure rate was only 0.65%, compared with 4.14% among compliant Levlite patients. Although more Seasonale patients reported unscheduled bleeding days than the Levlite patients (6.1% vs. 3.3%), the number of scheduled bleeding or spotting days per cycle was approximately the same in both groups.

Breakthrough bleeding episodes were reported more frequently by the Seasonale Lo group than the Levlite group (13.8% vs. 1.3%), but the incidence of other adverse events was similar between the two groups. For example, headaches, the most common adverse event, were reported by 22% of the Seasonale Lo group and 21% of the Levlite group.

Each Seasonale Lo pill includes 0.02 mg of ethinyl estradiol and 0.1 mg of levonorgestrel. The regimen includes 84 days of active pills followed by 7 days of placebo pills. Dr. Kaunitz serves as a consultant to Barr Pharmaceuticals, the manufacturer of Seasonale, which also supported the study.

Seasonale continued to be safe and well tolerated in a subset of 161 women who participated in a 2-year extension of the study, reported Dr. David Portman of the Columbus Center for Women's Health Research in Columbus, Ohio.

Notably, the median number of unscheduled bleeding or spotting days decreased over the course of the study, from 2 days during the first cycle to 0 days by the eighth cycle. Patient exposure to the drug included 937 complete 91-day cycles. Patients reported their pill-taking, bleeding, and spotting data in electronic diaries, and they underwent clinical evaluation during quarterly visits. The overall discontinuation rates were similar to those for Seasonale Lo and Levlite in the original study, which were about 44% and 32%, respectively.

Dr. Portman serves on the speakers' bureau of Barr Pharmaceuticals.

WASHINGTON — Seasonale Lo, the 91-day extended-regimen low-dose oral contraceptive, was effective and well tolerated compared with a 28-day low-dose oral contraceptive, after both 1 year and 3 years of use.

The Seasonale Lo data from a randomized, multicenter study were presented in two posters at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Andrew M. Kaunitz of the University of Florida Health Science Center in Jacksonville, Fla., monitored women aged 18–35 years who could potentially become pregnant. After 1 year, the overall cumulative failure rate of Seasonale Lo was 2.23% among 463 patients, compared with a 2.83% failure rate among 231 patients who took a traditional 28-day oral contraceptive (Levlite).

Compliance rates were high—98.1% in the Seasonale Lo group and 96.5% in the Levlite group. Among compliant patients, the Seasonale Lo failure rate was only 0.65%, compared with 4.14% among compliant Levlite patients. Although more Seasonale patients reported unscheduled bleeding days than the Levlite patients (6.1% vs. 3.3%), the number of scheduled bleeding or spotting days per cycle was approximately the same in both groups.

Breakthrough bleeding episodes were reported more frequently by the Seasonale Lo group than the Levlite group (13.8% vs. 1.3%), but the incidence of other adverse events was similar between the two groups. For example, headaches, the most common adverse event, were reported by 22% of the Seasonale Lo group and 21% of the Levlite group.

Each Seasonale Lo pill includes 0.02 mg of ethinyl estradiol and 0.1 mg of levonorgestrel. The regimen includes 84 days of active pills followed by 7 days of placebo pills. Dr. Kaunitz serves as a consultant to Barr Pharmaceuticals, the manufacturer of Seasonale, which also supported the study.

Seasonale continued to be safe and well tolerated in a subset of 161 women who participated in a 2-year extension of the study, reported Dr. David Portman of the Columbus Center for Women's Health Research in Columbus, Ohio.

Notably, the median number of unscheduled bleeding or spotting days decreased over the course of the study, from 2 days during the first cycle to 0 days by the eighth cycle. Patient exposure to the drug included 937 complete 91-day cycles. Patients reported their pill-taking, bleeding, and spotting data in electronic diaries, and they underwent clinical evaluation during quarterly visits. The overall discontinuation rates were similar to those for Seasonale Lo and Levlite in the original study, which were about 44% and 32%, respectively.

Dr. Portman serves on the speakers' bureau of Barr Pharmaceuticals.

WASHINGTON — Seasonale Lo, the 91-day extended-regimen low-dose oral contraceptive, was effective and well tolerated compared with a 28-day low-dose oral contraceptive, after both 1 year and 3 years of use.

The Seasonale Lo data from a randomized, multicenter study were presented in two posters at the annual meeting of the American College of Obstetricians and Gynecologists.

Dr. Andrew M. Kaunitz of the University of Florida Health Science Center in Jacksonville, Fla., monitored women aged 18–35 years who could potentially become pregnant. After 1 year, the overall cumulative failure rate of Seasonale Lo was 2.23% among 463 patients, compared with a 2.83% failure rate among 231 patients who took a traditional 28-day oral contraceptive (Levlite).

Compliance rates were high—98.1% in the Seasonale Lo group and 96.5% in the Levlite group. Among compliant patients, the Seasonale Lo failure rate was only 0.65%, compared with 4.14% among compliant Levlite patients. Although more Seasonale patients reported unscheduled bleeding days than the Levlite patients (6.1% vs. 3.3%), the number of scheduled bleeding or spotting days per cycle was approximately the same in both groups.

Breakthrough bleeding episodes were reported more frequently by the Seasonale Lo group than the Levlite group (13.8% vs. 1.3%), but the incidence of other adverse events was similar between the two groups. For example, headaches, the most common adverse event, were reported by 22% of the Seasonale Lo group and 21% of the Levlite group.

Each Seasonale Lo pill includes 0.02 mg of ethinyl estradiol and 0.1 mg of levonorgestrel. The regimen includes 84 days of active pills followed by 7 days of placebo pills. Dr. Kaunitz serves as a consultant to Barr Pharmaceuticals, the manufacturer of Seasonale, which also supported the study.

Seasonale continued to be safe and well tolerated in a subset of 161 women who participated in a 2-year extension of the study, reported Dr. David Portman of the Columbus Center for Women's Health Research in Columbus, Ohio.

Notably, the median number of unscheduled bleeding or spotting days decreased over the course of the study, from 2 days during the first cycle to 0 days by the eighth cycle. Patient exposure to the drug included 937 complete 91-day cycles. Patients reported their pill-taking, bleeding, and spotting data in electronic diaries, and they underwent clinical evaluation during quarterly visits. The overall discontinuation rates were similar to those for Seasonale Lo and Levlite in the original study, which were about 44% and 32%, respectively.

Dr. Portman serves on the speakers' bureau of Barr Pharmaceuticals.

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjustment for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively. The study did not analyze the specific outcomes that prompted the NICU transfers.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

An analysis of a larger sample while controlling for confounding variables is needed to confirm the study's validity, the investigators wrote.

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjustment for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively. The study did not analyze the specific outcomes that prompted the NICU transfers.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

An analysis of a larger sample while controlling for confounding variables is needed to confirm the study's validity, the investigators wrote.

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjustment for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively. The study did not analyze the specific outcomes that prompted the NICU transfers.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

An analysis of a larger sample while controlling for confounding variables is needed to confirm the study's validity, the investigators wrote.

WASHINGTON — Often, the best episiotomy may be no episiotomy, Dr. Lily A. Arya noted at the annual meeting of the American College of Obstetricians and Gynecologists.

That said, episiotomies are needed in some cases, and sometimes wound dehiscence requires additional repair, said Dr. Arya, a urogynecologist at the University of Pennsylvania Medical Center in Philadelphia.

The need for episiotomies remains a subject for debate. Dr. Arya cited a recent study that compared routine episiotomy, selective episiotomy, and no episiotomy, and found no significant difference in the incidence of minor lacerations or fecal incontinence (Acta Obstet. Gynecol. Scand. 2004;83:364–8).

“Sometimes, if you let nature take its course you will only end up with minor lacerations,” Dr. Arya said, although she added that she favors selective episiotomies. The surgeon's challenge lies in trying to deduce whether significant tearing might occur.

Mediolateral episiotomy has several advantages over median episiotomy if the surgeon decides to proceed, Dr. Arya said. Although the midline episiotomy involves less bleeding, pain, and dyspareunia, the median technique tends to cause more fecal incontinence and a greater risk of anal sphincter injury.

Mediolateral episiotomy, on the other hand, will not prevent tears, but it will not cause tearing, either.

The traditional strategy in dehiscence cases has been to reopen the wound and perform a secondary repair in 3–4 months.

However, the wound can be debrided and repaired almost immediately if there is no infection. “Infection from an episiotomy is extremely rare,” Dr. Arya noted. If infection is present, the wound can be debrided on an outpatient basis until all necrotic material is gone and pink, granulating tissue is achieved, and a repair can usually be performed within a week.

Closures for episiotomy dehiscence are similar to those for perineal tears, but Dr. Arya recommends incorporating some tissue from the sides of the wound to close with two layers. The repair will bring the transverse perineal muscles together.

“Make sure you don't leave gaps in the submucosa; that is what will cause a fistula,” she noted.

To minimize the patient's postoperative discomfort, Dr. Arya recommends stool softeners for 6 weeks, antibiotics for the first 48 hours, and a low-residue diet for the first 72 hours to postpone bowel movements and prevent the patient from becoming constipated.

Fecal incontinence remains a significant problem in women, and the majority of cases stem from obstetric trauma, said Dr. Najia N. Mahmoud, a colorectal surgeon at the University of Pennsylvania, Philadelphia.

Many women who present with fecal incontinence have managed for long periods of time by employing a range of coping strategies. Their tricks include avoiding travel, reducing food intake and exercise, wearing dark clothing and multiple absorbent products, and only visiting places with readily accessible bathrooms. Dr. Mahmoud's strategy for evaluating fecal incontinence starts with an examination of the patient.

“A lot of what you learn about the patient's incontinence comes from the physical exam,” she said. Unless the physical exam is confusing in some way, anal manometry and pudendal nerve testing do not add much to the diagnosis. “I don't think these are necessary for people with obvious signs of fecal incontinence.” However, endoanal ultrasound allows for an anatomic description of the injury and helps with surgical planning for patients who are good surgical candidates. Incontinence to solid stool constitutes the most common indication for surgery.

Biofeedback with a trained physical therapist can be helpful both pre- and postoperatively for patients with mild or moderate fecal incontinence (incontinence to gas or urgency), as well as for patients who aren't immediate candidates for surgery, she said.

In addition, Dr. Mahmoud said that she makes an effort to modify the patient's diet. “It's imperative that you investigate the underlying causes of diarrhea and modify the bowel movements,” she said. In many cases, the incontinence will resolve once diarrhea is under control.

Most people don't consume as much fiber as they think they do, so Dr. Mahmoud prescribes a daily dose of fiber wafers with 6 ounces of water for incontinent patients or those with soft or loose bowel movements. The consistent fiber consumption seems to result in a better-formed stool and improved continence, and provides a good adjuvant therapy to either conservative strategies like biofeedback or surgical solutions such as sphincter reconstruction.

Surgery is rarely necessary for patients with incontinence to liquid stool and flatulence, she emphasized.

An overlapping sphincteroplasty is an appropriate surgical plan for patients with sphincter defects who are consistently incontinent to solid stool. The technique is generally successful; data from a 2000 study of 40 patients showed an 81% success rate immediately following surgery, and a 51% success rate after 40 months.

To optimize outcomes, be sure to address patient expectations, and remind them that the return to normal muscle and sphincter function is slow, and can take up to 3 months. Kegel exercises can help strengthen the muscles during recovery, she said. Infection rates are low—less than 8%-in overlapping sphincteroplasty patients, but the presence of infection increases the failure rate.

The most significant factor in a successful sphincter repair is its durability, and constipation must be prevented to preserve the intactness of the repair in the immediate postoperative period.

“Constipation is the enemy of a sphincter repair in the first week or two,” Dr. Mahmoud said. She uses a combination of treatments including milk of magnesia, fiber, and stool softeners, and mineral oil, to help steer patients through recovery.

WASHINGTON — Often, the best episiotomy may be no episiotomy, Dr. Lily A. Arya noted at the annual meeting of the American College of Obstetricians and Gynecologists.

That said, episiotomies are needed in some cases, and sometimes wound dehiscence requires additional repair, said Dr. Arya, a urogynecologist at the University of Pennsylvania Medical Center in Philadelphia.

The need for episiotomies remains a subject for debate. Dr. Arya cited a recent study that compared routine episiotomy, selective episiotomy, and no episiotomy, and found no significant difference in the incidence of minor lacerations or fecal incontinence (Acta Obstet. Gynecol. Scand. 2004;83:364–8).

“Sometimes, if you let nature take its course you will only end up with minor lacerations,” Dr. Arya said, although she added that she favors selective episiotomies. The surgeon's challenge lies in trying to deduce whether significant tearing might occur.

Mediolateral episiotomy has several advantages over median episiotomy if the surgeon decides to proceed, Dr. Arya said. Although the midline episiotomy involves less bleeding, pain, and dyspareunia, the median technique tends to cause more fecal incontinence and a greater risk of anal sphincter injury.

Mediolateral episiotomy, on the other hand, will not prevent tears, but it will not cause tearing, either.

The traditional strategy in dehiscence cases has been to reopen the wound and perform a secondary repair in 3–4 months.

However, the wound can be debrided and repaired almost immediately if there is no infection. “Infection from an episiotomy is extremely rare,” Dr. Arya noted. If infection is present, the wound can be debrided on an outpatient basis until all necrotic material is gone and pink, granulating tissue is achieved, and a repair can usually be performed within a week.

Closures for episiotomy dehiscence are similar to those for perineal tears, but Dr. Arya recommends incorporating some tissue from the sides of the wound to close with two layers. The repair will bring the transverse perineal muscles together.

“Make sure you don't leave gaps in the submucosa; that is what will cause a fistula,” she noted.

To minimize the patient's postoperative discomfort, Dr. Arya recommends stool softeners for 6 weeks, antibiotics for the first 48 hours, and a low-residue diet for the first 72 hours to postpone bowel movements and prevent the patient from becoming constipated.

Fecal incontinence remains a significant problem in women, and the majority of cases stem from obstetric trauma, said Dr. Najia N. Mahmoud, a colorectal surgeon at the University of Pennsylvania, Philadelphia.

Many women who present with fecal incontinence have managed for long periods of time by employing a range of coping strategies. Their tricks include avoiding travel, reducing food intake and exercise, wearing dark clothing and multiple absorbent products, and only visiting places with readily accessible bathrooms. Dr. Mahmoud's strategy for evaluating fecal incontinence starts with an examination of the patient.

“A lot of what you learn about the patient's incontinence comes from the physical exam,” she said. Unless the physical exam is confusing in some way, anal manometry and pudendal nerve testing do not add much to the diagnosis. “I don't think these are necessary for people with obvious signs of fecal incontinence.” However, endoanal ultrasound allows for an anatomic description of the injury and helps with surgical planning for patients who are good surgical candidates. Incontinence to solid stool constitutes the most common indication for surgery.

Biofeedback with a trained physical therapist can be helpful both pre- and postoperatively for patients with mild or moderate fecal incontinence (incontinence to gas or urgency), as well as for patients who aren't immediate candidates for surgery, she said.

In addition, Dr. Mahmoud said that she makes an effort to modify the patient's diet. “It's imperative that you investigate the underlying causes of diarrhea and modify the bowel movements,” she said. In many cases, the incontinence will resolve once diarrhea is under control.

Most people don't consume as much fiber as they think they do, so Dr. Mahmoud prescribes a daily dose of fiber wafers with 6 ounces of water for incontinent patients or those with soft or loose bowel movements. The consistent fiber consumption seems to result in a better-formed stool and improved continence, and provides a good adjuvant therapy to either conservative strategies like biofeedback or surgical solutions such as sphincter reconstruction.

Surgery is rarely necessary for patients with incontinence to liquid stool and flatulence, she emphasized.

An overlapping sphincteroplasty is an appropriate surgical plan for patients with sphincter defects who are consistently incontinent to solid stool. The technique is generally successful; data from a 2000 study of 40 patients showed an 81% success rate immediately following surgery, and a 51% success rate after 40 months.

To optimize outcomes, be sure to address patient expectations, and remind them that the return to normal muscle and sphincter function is slow, and can take up to 3 months. Kegel exercises can help strengthen the muscles during recovery, she said. Infection rates are low—less than 8%-in overlapping sphincteroplasty patients, but the presence of infection increases the failure rate.

The most significant factor in a successful sphincter repair is its durability, and constipation must be prevented to preserve the intactness of the repair in the immediate postoperative period.

“Constipation is the enemy of a sphincter repair in the first week or two,” Dr. Mahmoud said. She uses a combination of treatments including milk of magnesia, fiber, and stool softeners, and mineral oil, to help steer patients through recovery.

WASHINGTON — Often, the best episiotomy may be no episiotomy, Dr. Lily A. Arya noted at the annual meeting of the American College of Obstetricians and Gynecologists.

That said, episiotomies are needed in some cases, and sometimes wound dehiscence requires additional repair, said Dr. Arya, a urogynecologist at the University of Pennsylvania Medical Center in Philadelphia.

The need for episiotomies remains a subject for debate. Dr. Arya cited a recent study that compared routine episiotomy, selective episiotomy, and no episiotomy, and found no significant difference in the incidence of minor lacerations or fecal incontinence (Acta Obstet. Gynecol. Scand. 2004;83:364–8).

“Sometimes, if you let nature take its course you will only end up with minor lacerations,” Dr. Arya said, although she added that she favors selective episiotomies. The surgeon's challenge lies in trying to deduce whether significant tearing might occur.

Mediolateral episiotomy has several advantages over median episiotomy if the surgeon decides to proceed, Dr. Arya said. Although the midline episiotomy involves less bleeding, pain, and dyspareunia, the median technique tends to cause more fecal incontinence and a greater risk of anal sphincter injury.

Mediolateral episiotomy, on the other hand, will not prevent tears, but it will not cause tearing, either.

The traditional strategy in dehiscence cases has been to reopen the wound and perform a secondary repair in 3–4 months.

However, the wound can be debrided and repaired almost immediately if there is no infection. “Infection from an episiotomy is extremely rare,” Dr. Arya noted. If infection is present, the wound can be debrided on an outpatient basis until all necrotic material is gone and pink, granulating tissue is achieved, and a repair can usually be performed within a week.

Closures for episiotomy dehiscence are similar to those for perineal tears, but Dr. Arya recommends incorporating some tissue from the sides of the wound to close with two layers. The repair will bring the transverse perineal muscles together.

“Make sure you don't leave gaps in the submucosa; that is what will cause a fistula,” she noted.

To minimize the patient's postoperative discomfort, Dr. Arya recommends stool softeners for 6 weeks, antibiotics for the first 48 hours, and a low-residue diet for the first 72 hours to postpone bowel movements and prevent the patient from becoming constipated.

Fecal incontinence remains a significant problem in women, and the majority of cases stem from obstetric trauma, said Dr. Najia N. Mahmoud, a colorectal surgeon at the University of Pennsylvania, Philadelphia.

Many women who present with fecal incontinence have managed for long periods of time by employing a range of coping strategies. Their tricks include avoiding travel, reducing food intake and exercise, wearing dark clothing and multiple absorbent products, and only visiting places with readily accessible bathrooms. Dr. Mahmoud's strategy for evaluating fecal incontinence starts with an examination of the patient.

“A lot of what you learn about the patient's incontinence comes from the physical exam,” she said. Unless the physical exam is confusing in some way, anal manometry and pudendal nerve testing do not add much to the diagnosis. “I don't think these are necessary for people with obvious signs of fecal incontinence.” However, endoanal ultrasound allows for an anatomic description of the injury and helps with surgical planning for patients who are good surgical candidates. Incontinence to solid stool constitutes the most common indication for surgery.

Biofeedback with a trained physical therapist can be helpful both pre- and postoperatively for patients with mild or moderate fecal incontinence (incontinence to gas or urgency), as well as for patients who aren't immediate candidates for surgery, she said.

In addition, Dr. Mahmoud said that she makes an effort to modify the patient's diet. “It's imperative that you investigate the underlying causes of diarrhea and modify the bowel movements,” she said. In many cases, the incontinence will resolve once diarrhea is under control.

Most people don't consume as much fiber as they think they do, so Dr. Mahmoud prescribes a daily dose of fiber wafers with 6 ounces of water for incontinent patients or those with soft or loose bowel movements. The consistent fiber consumption seems to result in a better-formed stool and improved continence, and provides a good adjuvant therapy to either conservative strategies like biofeedback or surgical solutions such as sphincter reconstruction.

Surgery is rarely necessary for patients with incontinence to liquid stool and flatulence, she emphasized.

An overlapping sphincteroplasty is an appropriate surgical plan for patients with sphincter defects who are consistently incontinent to solid stool. The technique is generally successful; data from a 2000 study of 40 patients showed an 81% success rate immediately following surgery, and a 51% success rate after 40 months.

To optimize outcomes, be sure to address patient expectations, and remind them that the return to normal muscle and sphincter function is slow, and can take up to 3 months. Kegel exercises can help strengthen the muscles during recovery, she said. Infection rates are low—less than 8%-in overlapping sphincteroplasty patients, but the presence of infection increases the failure rate.

The most significant factor in a successful sphincter repair is its durability, and constipation must be prevented to preserve the intactness of the repair in the immediate postoperative period.

“Constipation is the enemy of a sphincter repair in the first week or two,” Dr. Mahmoud said. She uses a combination of treatments including milk of magnesia, fiber, and stool softeners, and mineral oil, to help steer patients through recovery.

WASHINGTON — Data from 597 cesarean sections suggest that smoking may slow wound healing, Dr. Cecilia Avila reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Both smoking and chorioamnionitis were significantly associated with wound complications in 20 cases of infection and 10 cases of hematoma that were identified in a case-control review of patients who had cesarean sections during a 7-year period.

Overall, wound complications were about three times more likely in smokers, wrote Dr. Avila of Stony Brook (N.Y.) University Hospital.

About 47% of the patients with wound complications were smokers, compared with 28% of the patients without wound complications.

In addition, chorioamnionitis was about five times more common in patients with wound complications, compared with patients without wound complications (28% vs. 7%).

The independent associations between smoking and wound complications and between chorioamnionitis and wound complications remained significant in a logistic regression analysis, the investigators noted.

Younger maternal age, premature membrane rupture, primary cesarean delivery, and earlier gestational age showed trends toward an association with wound complications, but these associations did not reach statistical significance. No associations were found between wound complications and several other clinical variables including body mass index, diabetes, and substance use.

WASHINGTON — Data from 597 cesarean sections suggest that smoking may slow wound healing, Dr. Cecilia Avila reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Both smoking and chorioamnionitis were significantly associated with wound complications in 20 cases of infection and 10 cases of hematoma that were identified in a case-control review of patients who had cesarean sections during a 7-year period.

Overall, wound complications were about three times more likely in smokers, wrote Dr. Avila of Stony Brook (N.Y.) University Hospital.

About 47% of the patients with wound complications were smokers, compared with 28% of the patients without wound complications.

In addition, chorioamnionitis was about five times more common in patients with wound complications, compared with patients without wound complications (28% vs. 7%).

The independent associations between smoking and wound complications and between chorioamnionitis and wound complications remained significant in a logistic regression analysis, the investigators noted.

Younger maternal age, premature membrane rupture, primary cesarean delivery, and earlier gestational age showed trends toward an association with wound complications, but these associations did not reach statistical significance. No associations were found between wound complications and several other clinical variables including body mass index, diabetes, and substance use.

WASHINGTON — Data from 597 cesarean sections suggest that smoking may slow wound healing, Dr. Cecilia Avila reported in a poster presented at the annual meeting of the American College of Obstetricians and Gynecologists.

Both smoking and chorioamnionitis were significantly associated with wound complications in 20 cases of infection and 10 cases of hematoma that were identified in a case-control review of patients who had cesarean sections during a 7-year period.

Overall, wound complications were about three times more likely in smokers, wrote Dr. Avila of Stony Brook (N.Y.) University Hospital.

About 47% of the patients with wound complications were smokers, compared with 28% of the patients without wound complications.

In addition, chorioamnionitis was about five times more common in patients with wound complications, compared with patients without wound complications (28% vs. 7%).

The independent associations between smoking and wound complications and between chorioamnionitis and wound complications remained significant in a logistic regression analysis, the investigators noted.

Younger maternal age, premature membrane rupture, primary cesarean delivery, and earlier gestational age showed trends toward an association with wound complications, but these associations did not reach statistical significance. No associations were found between wound complications and several other clinical variables including body mass index, diabetes, and substance use.

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjusting for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjusting for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

WASHINGTON — Either too much or too little weight gain during pregnancy could increase the risk of neonatal intensive care unit admission and peripartum complications, according to data presented at the annual meeting of the American College of Obstetricians and Gynecologists.

The highest quintiles of maternal weight gain during pregnancy were significantly associated with rates of NICU admission in a study of 2,784 singleton pregnancies, Dr. Teresa Tam and her colleagues, of Saint Joseph Hospital, Chicago, reported in a poster.

After adjusting for age, delivery method, and prepregnancy weight, among other factors, the medium weight gain quintiles— 22–29 pounds and 30–35 pounds—were associated with the lowest NICU transfer rates of 3.3% and 2.6%, respectively.

A second poster by Dr. Devendra A. Patel of Weill Cornell Medical College, New York, and colleagues found that heavier women had almost twice the rate of maternal and fetal complications as women of normal weight.

Dr. Patel found no fetal complications and 11 peripartum complications among 68 women whose BMI was less than 30 kg/m

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Women who took 2.5 mg of frovatriptan either once or twice daily for 6 days at the time of menstruation had significantly fewer—and less severe—menstrual migraines, compared with women who took a placebo, reported Dr. Marie Pinizzotto and her colleagues at Endo Pharmaceuticals.

The women on either regimen of frovatriptan also reported significantly fewer headaches in general and less functional impairment compared with the placebo group. Data from the randomized, double-blind, three-way crossover study were presented in a poster at the annual meeting of the American College of Obstetricians and Gynecologists. The study was sponsored by Vernalis Development Ltd., and Endo Pharmaceuticals Inc.

Frovatriptan has been approved by the Food and Drug Administration for the acute treatment of migraines, both with and without aura, in adults, but it has not been approved for the prophylactic prevention of migraines. The manufacturers are seeking an additional indication for the prophylactic treatment of menstrual migraines.

The patients were randomized to receive each of the two treatment regimens or a placebo over the course of three different 6-day periods from 2 days before to 4 days after the onset of menstruation.

The incidence of pure menstrual migraines, defined as migraines that occurred during the time period from 2 days before to 3 days after the onset of menstruation, was significantly lower in both frovatriptan groups, compared with placebo. These distinctive headaches occurred in 38% of the twice-daily frovatriptan group, compared with 51% of the once-daily group and 67% of the placebo group.

The intent-to-treat analysis included 179 women aged 18 years and older with at least a 1-year history of menstrually-related migraines. The mean age was 37 years, and 82% were white. On average, the study participants had a history of migraines greater than 10 years, and the average number of migraine attacks was one per month during the year prior to the study.

Moderate to severe headaches were reported by 25%, 32%, and 46% of women in the twice-daily frovatriptan, once-daily frovatriptan, and placebo groups. The incidence of functional impairment was 14%, 24%, and 35%, respectively.

Adverse events included headache, nausea, dizziness, and nasopharyngitis, and the incidence of these events was similar between the two groups, with the exception of upper respiratory tract infections, which were significantly more common in the patients treated with twice-daily frovatriptan.

WASHINGTON — Only 9% of 276 physicians surveyed use standardized screening measures to assess patients for postpartum depression, reported Randy Fingerhut, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that as many as 50% of all cases of postpartum depression remain undetected by physicians, wrote Dr. Fingerhut and his colleagues at La Salle University in Philadelphia.

The study included 95 obstetricians and 181 pediatricians based in Pennsylvania.

Overall, 77% of obstetricians reported screening patients for postpartum depression prenatally, and 93% screened postnatally. By contrast, only 47% of pediatricians reported assessing mothers for postpartum depression.

The physicians completed the Postpartum Depression Survey, which asks true/false questions about postpartum depression, and the Postpartum Screening and Assessment Questionnaire, which includes questions about physician procedures for handling cases of postpartum depression.

A slight majority (58%) of the physicians estimated that 0%–10% of their patients experienced postpartum depression, which is lower than the 10%–20% shown in previous studies. This discrepancy may be attributable to the infrequent use of a standard screening method, the investigators noted. The physicians reported a range of interventions, including medication and psychotherapy, and most believed that medication was superior to psychotherapy for postpartum depression.

Although only 11% of the physicians considered themselves to be “extremely knowledgeable” about postpartum depression, 87% said they were interested in learning more about the condition.

WASHINGTON — Only 9% of 276 physicians surveyed use standardized screening measures to assess patients for postpartum depression, reported Randy Fingerhut, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that as many as 50% of all cases of postpartum depression remain undetected by physicians, wrote Dr. Fingerhut and his colleagues at La Salle University in Philadelphia.

The study included 95 obstetricians and 181 pediatricians based in Pennsylvania.

Overall, 77% of obstetricians reported screening patients for postpartum depression prenatally, and 93% screened postnatally. By contrast, only 47% of pediatricians reported assessing mothers for postpartum depression.

The physicians completed the Postpartum Depression Survey, which asks true/false questions about postpartum depression, and the Postpartum Screening and Assessment Questionnaire, which includes questions about physician procedures for handling cases of postpartum depression.

A slight majority (58%) of the physicians estimated that 0%–10% of their patients experienced postpartum depression, which is lower than the 10%–20% shown in previous studies. This discrepancy may be attributable to the infrequent use of a standard screening method, the investigators noted. The physicians reported a range of interventions, including medication and psychotherapy, and most believed that medication was superior to psychotherapy for postpartum depression.

Although only 11% of the physicians considered themselves to be “extremely knowledgeable” about postpartum depression, 87% said they were interested in learning more about the condition.

WASHINGTON — Only 9% of 276 physicians surveyed use standardized screening measures to assess patients for postpartum depression, reported Randy Fingerhut, Ph.D., in a poster presented at the annual meeting of the Association for Behavioral and Cognitive Therapies.

Previous studies have shown that as many as 50% of all cases of postpartum depression remain undetected by physicians, wrote Dr. Fingerhut and his colleagues at La Salle University in Philadelphia.

The study included 95 obstetricians and 181 pediatricians based in Pennsylvania.

Overall, 77% of obstetricians reported screening patients for postpartum depression prenatally, and 93% screened postnatally. By contrast, only 47% of pediatricians reported assessing mothers for postpartum depression.

The physicians completed the Postpartum Depression Survey, which asks true/false questions about postpartum depression, and the Postpartum Screening and Assessment Questionnaire, which includes questions about physician procedures for handling cases of postpartum depression.

A slight majority (58%) of the physicians estimated that 0%–10% of their patients experienced postpartum depression, which is lower than the 10%–20% shown in previous studies. This discrepancy may be attributable to the infrequent use of a standard screening method, the investigators noted. The physicians reported a range of interventions, including medication and psychotherapy, and most believed that medication was superior to psychotherapy for postpartum depression.

Although only 11% of the physicians considered themselves to be “extremely knowledgeable” about postpartum depression, 87% said they were interested in learning more about the condition.