ACOG 2011

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – A longitudinal study of patients with previously diagnosed endometrial polyps found that about 75% of the polyps either decreased in size or remained the same size, while about one-quarter increased with up to 3.5 years of follow-up, leading the authors to suggest that the practice of automatic treatment of benign-appearing endometrial polyps should be re-evaluated.

"The current practice is to treat endometrial polyps that are found, especially if the patient is undergoing fertility procedures or is postmenopausal. This study shows that routine treatment of endometrial polyps may not always be necessary. Polyps should be triaged based on their appearance, size, patient’s age, and whether there is increased blood flow in the polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study included 300 consecutive patients aged 22-78 years who underwent sonohysterography from January to July of 2010. All patients were diagnosed with polyps from 1 to 43 months previously, and none had an intervention for the polyps.

Results showed that 34% of the polyps decreased in size (41 resolved [14%], and 61 [20%] decreased more than 1 mm); 41.7% had no significant change from time of diagnosis, and 24.3% showed an increase in size (16% showed an increase of more than 1 mm, and 8% had an increase of greater than or equal to 50%). Independent t-tests showed that the change in polyp size was significantly associated with menopausal status and blood flow, but failed to find an association between increased size and polyp location and abnormal uterine bleeding. Univariate linear regression found no association between change in polyp size and patient age, time between scans, and endometrial thickness.

Dr. Hartman said in an interview: "In common practice, polyps found in a postmenopausal woman that cause bleeding and polyps with increased vascularity should be treated. Treatment of all polyps without these features should be re-evaluated." He noted that his impression is that smaller polyps and those in women of reproductive age may not require treatment and may instead be monitored.

Dr. Hartman said he had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment’s success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) "may be an especially important treatment choice for women at high surgical risk," the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the annual meeting of the American College of Obstetricians and Gynecologists.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m² or greater; 25% had BMI of 35 or greater. Treatment failure was defined as removal of LNG-IUS for continued menorrhagia, need for additional treatment, or expulsion. Continued menorrhagia was uncommon in all BMI groups, but it was most common in women with BMI greater than 34 kg/m², compared with those in all BMI groups (6.9% vs. 3.3%).

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are larger uterus, persistent unopposed estrogen endometrial stimulation, or poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the department of obstetrics and gynecology at the university and one of the study authors said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

One of the limitations of the study was that it was observational and "that cannot assess details about decision-making. It is possible that providers are more likely to recommend surgical treatment for obese women than [for] normal weight women," Dr. Dalton said.

"Additional analysis is ongoing to further characterize predictors of treatment failure," she added.

Ms. Fairchild and Dr. Dalton said that they had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment’s success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) "may be an especially important treatment choice for women at high surgical risk," the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the annual meeting of the American College of Obstetricians and Gynecologists.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m² or greater; 25% had BMI of 35 or greater. Treatment failure was defined as removal of LNG-IUS for continued menorrhagia, need for additional treatment, or expulsion. Continued menorrhagia was uncommon in all BMI groups, but it was most common in women with BMI greater than 34 kg/m², compared with those in all BMI groups (6.9% vs. 3.3%).

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are larger uterus, persistent unopposed estrogen endometrial stimulation, or poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the department of obstetrics and gynecology at the university and one of the study authors said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

One of the limitations of the study was that it was observational and "that cannot assess details about decision-making. It is possible that providers are more likely to recommend surgical treatment for obese women than [for] normal weight women," Dr. Dalton said.

"Additional analysis is ongoing to further characterize predictors of treatment failure," she added.

Ms. Fairchild and Dr. Dalton said that they had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment’s success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) "may be an especially important treatment choice for women at high surgical risk," the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the annual meeting of the American College of Obstetricians and Gynecologists.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m² or greater; 25% had BMI of 35 or greater. Treatment failure was defined as removal of LNG-IUS for continued menorrhagia, need for additional treatment, or expulsion. Continued menorrhagia was uncommon in all BMI groups, but it was most common in women with BMI greater than 34 kg/m², compared with those in all BMI groups (6.9% vs. 3.3%).

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are larger uterus, persistent unopposed estrogen endometrial stimulation, or poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the department of obstetrics and gynecology at the university and one of the study authors said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

One of the limitations of the study was that it was observational and "that cannot assess details about decision-making. It is possible that providers are more likely to recommend surgical treatment for obese women than [for] normal weight women," Dr. Dalton said.

"Additional analysis is ongoing to further characterize predictors of treatment failure," she added.

Ms. Fairchild and Dr. Dalton said that they had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment’s success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) "may be an especially important treatment choice for women at high surgical risk," the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the annual meeting of the American College of Obstetricians and Gynecologists.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m² or greater; 25% had BMI of 35 or greater. Treatment failure was defined as removal of LNG-IUS for continued menorrhagia, need for additional treatment, or expulsion. Continued menorrhagia was uncommon in all BMI groups, but it was most common in women with BMI greater than 34 kg/m², compared with those in all BMI groups (6.9% vs. 3.3%).

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are larger uterus, persistent unopposed estrogen endometrial stimulation, or poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the department of obstetrics and gynecology at the university and one of the study authors said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

One of the limitations of the study was that it was observational and "that cannot assess details about decision-making. It is possible that providers are more likely to recommend surgical treatment for obese women than [for] normal weight women," Dr. Dalton said.

"Additional analysis is ongoing to further characterize predictors of treatment failure," she added.

Ms. Fairchild and Dr. Dalton said that they had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment’s success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) "may be an especially important treatment choice for women at high surgical risk," the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the annual meeting of the American College of Obstetricians and Gynecologists.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m² or greater; 25% had BMI of 35 or greater. Treatment failure was defined as removal of LNG-IUS for continued menorrhagia, need for additional treatment, or expulsion. Continued menorrhagia was uncommon in all BMI groups, but it was most common in women with BMI greater than 34 kg/m², compared with those in all BMI groups (6.9% vs. 3.3%).

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are larger uterus, persistent unopposed estrogen endometrial stimulation, or poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the department of obstetrics and gynecology at the university and one of the study authors said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

One of the limitations of the study was that it was observational and "that cannot assess details about decision-making. It is possible that providers are more likely to recommend surgical treatment for obese women than [for] normal weight women," Dr. Dalton said.

"Additional analysis is ongoing to further characterize predictors of treatment failure," she added.

Ms. Fairchild and Dr. Dalton said that they had no relevant financial disclosures.

WASHINGTON – In very obese women, treatment of menorrhagia with levonorgestrel intrauterine system may be slightly less effective, but the treatment’s success rate justifies its use, according to a study conducted by researchers at the University of Michigan.

In addition, levonorgestrel intrauterine system (LNG-IUS) "may be an especially important treatment choice for women at high surgical risk," the authors reported.

Although studies have shown the effectiveness of LNG-IUS in treatment of menorrhagia, most have not considered the role of body mass index (BMI), said Ms. Paige C. Fairchild, a medical student at the university who presented the study at the annual meeting of the American College of Obstetricians and Gynecologists.

The team conducted a retrospective chart review of 398 women with menorrhagia who were treated with LNG-IUS between 1999 and 2009 within the University of Michigan Health System, Ann Arbor. Nearly 50% had BMI of 30 kg/m² or greater; 25% had BMI of 35 or greater. Treatment failure was defined as removal of LNG-IUS for continued menorrhagia, need for additional treatment, or expulsion. Continued menorrhagia was uncommon in all BMI groups, but it was most common in women with BMI greater than 34 kg/m², compared with those in all BMI groups (6.9% vs. 3.3%).

Also, removal of LNG-IUS because of continued menorrhagia was more common among women who had BMI greater than 34, compared with those in all BMI groups (6.9% vs. 4.1%).

The odds of surgery within 2 years of LNG-IUS removal also was higher in obese patients (2.6 times), compared with other groups.

Some factors that might contribute to the reduced effectiveness of LNG-IUS in obese women are larger uterus, persistent unopposed estrogen endometrial stimulation, or poor placement/difficulty in achieving fundal placement, Dr. Vanessa Dalton of the department of obstetrics and gynecology at the university and one of the study authors said in an interview.

Despite the findings, the authors concluded that the high continuation rates of LNG-IUS and low surgery rates indicate that the treatment is still a good option for women with a high BMI.

One of the limitations of the study was that it was observational and "that cannot assess details about decision-making. It is possible that providers are more likely to recommend surgical treatment for obese women than [for] normal weight women," Dr. Dalton said.

"Additional analysis is ongoing to further characterize predictors of treatment failure," she added.

Ms. Fairchild and Dr. Dalton said that they had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

"We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, Canada, said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists. "The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps."

Dr. Hartman explained in an interview: "Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries."

In a study of women aged 45-95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. "In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps," Dr. Hartman stated.

Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

"We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, Canada, said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists. "The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps."

Dr. Hartman explained in an interview: "Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries."

In a study of women aged 45-95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. "In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps," Dr. Hartman stated.

Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

"We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, Canada, said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists. "The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps."

Dr. Hartman explained in an interview: "Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries."

In a study of women aged 45-95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. "In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps," Dr. Hartman stated.

Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

"We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, Canada, said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists. "The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps."

Dr. Hartman explained in an interview: "Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries."

In a study of women aged 45-95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. "In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps," Dr. Hartman stated.

Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

"We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, Canada, said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists. "The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps."

Dr. Hartman explained in an interview: "Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries."

In a study of women aged 45-95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. "In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps," Dr. Hartman stated.

Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – A small but important percentage of postmenopausal women not taking hormone replacement therapy have an endometrial lining that is suspicious for polyps, according to a prospective study of 1,500 consecutive asymptomatic women.

"We found no suspicion of polyps in the vast majority of asymptomatic postmenopausal women not taking HRT [hormone replacement therapy]; but we did find a suspicion of polyps in 6.7% of all patients. The appearance of a nonhomogeneous endometrial lining on ultrasound increased our suspicion of polyp," Dr. Michael Hartman of Memorial University of Newfoundland, St. John’s, Canada, said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists. "The number of women with suspicion of polyps was higher than expected and indicates there are a large number of asymptomatic postmenopausal women with endometrial polyps."

Dr. Hartman explained in an interview: "Any woman can develop polyps, whether or not she is on exogenous hormones. Estrogen can affect the lining of the uterus after menopause since it is produced in fat cells and not just the ovaries."

In a study of women aged 45-95 years (mean age, 62.7 years) who underwent transvaginal ultrasound from January to August 2010, 77.1% had an endometrial thickness of less than or equal to 4 mm, and 92% had an endometrial thickness of less than 5 mm. Polyps were suspected in 101 (6.7%) of these patients based on the ultrasound appearance of the endometrial lining.

Independent t-tests of age and endometrial thickening were performed, comparing the patients with a normal appearing endometrium with those whose endometrial thickening was suspicious for polyps. A significant difference was observed between the groups, with older age and mean endometrial thickness having a significant association with suspicion of polyps. Polyps were significantly more likely to be found in older patients, with a mean age of 67.7 years, than in younger patients (mean age of 62 years). Patients with a lining suspicious for polyps had a thicker endometrium (mean of 8.02 mm) than did patients who did not have a lining suspicious for a polyp (mean of 3.40 mm).

These findings do not support routine ultrasound screening of older asymptomatic women. "In fact, I would say that the finding of polyps in 6.7% of women does not necessarily signal the presence of cancerous or precancerous growths. Further clinical investigation is required to determine the natural history of these polyps," Dr. Hartman stated.

Dr. Hartman said that he had no relevant financial disclosures.

WASHINGTON – It appears that only one postpartum visit is necessary for IUD placement, according to Dr. David R. Kattan.

A common protocol for placement of an IUD includes two postpartum visits: one for testing for STDs and a second to place the IUD, with the goal of preventing the development of pelvic inflammatory disease (PID). A retrospective study found that the rates of STDs were below 1% in women who requested an IUD, and that positivity for STDs in the postpartum period did not predict the development of pelvic inflammatory disease.

"Eliminating one of the two postpartum visits promises to increase the rate of IUD placement in women who seek a reliable contraceptive method post partum," said Dr. Kattan of the University of Colorado at Denver.

"Two postpartum visits for IUD insertion are unnecessary. Adopt what the American College of Obstetricians and Gynecologists already supports, which is a single-visit protocol for postpartum IUD insertion," he emphasized.

For women with no health insurance and little financial means, the postpartum visit may be the last time they see a doctor before proceeding with a second pregnancy. An IUD is an effective means of preventing unwanted pregnancy, yet many women who request an IUD fail to have one placed. Factors implicated in the failure to have an IUD placed include being counseled against using one, getting pregnant before having an IUD placed, and being lost to follow-up, Dr. Kattan explained.

Dr. Kattan and his colleagues hypothesized in their poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists that conflating testing for Chlamydia trachomatis and Neisseria gonorrhoeae with immediate IUD placement at one visit can improve the success rate of having an IUD implanted without increasing the rate of PID.

The study included 1,417 women receiving an IUD in the year 2008 at Denver Health Medical Center; of these, 629 (44%) met the inclusion criterion of having given birth within the previous 3 months. The average age was 25.3 years, and the average parity was 2.3.

At the preinsertion screening visit, five (0.8%) tested positive for chlamydia and one (0.16%) tested positive for gonorrhea. None of these six women developed PID. Three women did develop PID, and none of them tested positive for either of these organisms during pregnancy, the postpartum period, or at the time of PID diagnosis. None of these three women required hospitalization or removal of their IUD.

"Based on these data showing that a separate screening visit was unnecessary, practice at Denver Health Medical Center and the University of Colorado has changed. Residents at both sites are now taught one-visit IUD placement protocol," Dr. Kattan said. "One of the side benefits of adopting this protocol is the availability of a clinic appointment that would have otherwise been used for a second IUD placement visit. In a busy resident clinic, this means that women seeking gynecology care can be seen more quickly because an unnecessary clinic visit has been eliminated. One of the aims of my study is to reinforce a single-visit practice as the standard of care at other programs across the [United States]. Despite ACOG’s recommendations, practice is still sometimes slow to change."

Dr. Kattan said he had no relevant financial disclosures.

WASHINGTON – It appears that only one postpartum visit is necessary for IUD placement, according to Dr. David R. Kattan.

A common protocol for placement of an IUD includes two postpartum visits: one for testing for STDs and a second to place the IUD, with the goal of preventing the development of pelvic inflammatory disease (PID). A retrospective study found that the rates of STDs were below 1% in women who requested an IUD, and that positivity for STDs in the postpartum period did not predict the development of pelvic inflammatory disease.

"Eliminating one of the two postpartum visits promises to increase the rate of IUD placement in women who seek a reliable contraceptive method post partum," said Dr. Kattan of the University of Colorado at Denver.

"Two postpartum visits for IUD insertion are unnecessary. Adopt what the American College of Obstetricians and Gynecologists already supports, which is a single-visit protocol for postpartum IUD insertion," he emphasized.

For women with no health insurance and little financial means, the postpartum visit may be the last time they see a doctor before proceeding with a second pregnancy. An IUD is an effective means of preventing unwanted pregnancy, yet many women who request an IUD fail to have one placed. Factors implicated in the failure to have an IUD placed include being counseled against using one, getting pregnant before having an IUD placed, and being lost to follow-up, Dr. Kattan explained.

Dr. Kattan and his colleagues hypothesized in their poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists that conflating testing for Chlamydia trachomatis and Neisseria gonorrhoeae with immediate IUD placement at one visit can improve the success rate of having an IUD implanted without increasing the rate of PID.

The study included 1,417 women receiving an IUD in the year 2008 at Denver Health Medical Center; of these, 629 (44%) met the inclusion criterion of having given birth within the previous 3 months. The average age was 25.3 years, and the average parity was 2.3.

At the preinsertion screening visit, five (0.8%) tested positive for chlamydia and one (0.16%) tested positive for gonorrhea. None of these six women developed PID. Three women did develop PID, and none of them tested positive for either of these organisms during pregnancy, the postpartum period, or at the time of PID diagnosis. None of these three women required hospitalization or removal of their IUD.

"Based on these data showing that a separate screening visit was unnecessary, practice at Denver Health Medical Center and the University of Colorado has changed. Residents at both sites are now taught one-visit IUD placement protocol," Dr. Kattan said. "One of the side benefits of adopting this protocol is the availability of a clinic appointment that would have otherwise been used for a second IUD placement visit. In a busy resident clinic, this means that women seeking gynecology care can be seen more quickly because an unnecessary clinic visit has been eliminated. One of the aims of my study is to reinforce a single-visit practice as the standard of care at other programs across the [United States]. Despite ACOG’s recommendations, practice is still sometimes slow to change."

Dr. Kattan said he had no relevant financial disclosures.

WASHINGTON – It appears that only one postpartum visit is necessary for IUD placement, according to Dr. David R. Kattan.

A common protocol for placement of an IUD includes two postpartum visits: one for testing for STDs and a second to place the IUD, with the goal of preventing the development of pelvic inflammatory disease (PID). A retrospective study found that the rates of STDs were below 1% in women who requested an IUD, and that positivity for STDs in the postpartum period did not predict the development of pelvic inflammatory disease.

"Eliminating one of the two postpartum visits promises to increase the rate of IUD placement in women who seek a reliable contraceptive method post partum," said Dr. Kattan of the University of Colorado at Denver.

"Two postpartum visits for IUD insertion are unnecessary. Adopt what the American College of Obstetricians and Gynecologists already supports, which is a single-visit protocol for postpartum IUD insertion," he emphasized.

For women with no health insurance and little financial means, the postpartum visit may be the last time they see a doctor before proceeding with a second pregnancy. An IUD is an effective means of preventing unwanted pregnancy, yet many women who request an IUD fail to have one placed. Factors implicated in the failure to have an IUD placed include being counseled against using one, getting pregnant before having an IUD placed, and being lost to follow-up, Dr. Kattan explained.

Dr. Kattan and his colleagues hypothesized in their poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists that conflating testing for Chlamydia trachomatis and Neisseria gonorrhoeae with immediate IUD placement at one visit can improve the success rate of having an IUD implanted without increasing the rate of PID.

The study included 1,417 women receiving an IUD in the year 2008 at Denver Health Medical Center; of these, 629 (44%) met the inclusion criterion of having given birth within the previous 3 months. The average age was 25.3 years, and the average parity was 2.3.

At the preinsertion screening visit, five (0.8%) tested positive for chlamydia and one (0.16%) tested positive for gonorrhea. None of these six women developed PID. Three women did develop PID, and none of them tested positive for either of these organisms during pregnancy, the postpartum period, or at the time of PID diagnosis. None of these three women required hospitalization or removal of their IUD.

"Based on these data showing that a separate screening visit was unnecessary, practice at Denver Health Medical Center and the University of Colorado has changed. Residents at both sites are now taught one-visit IUD placement protocol," Dr. Kattan said. "One of the side benefits of adopting this protocol is the availability of a clinic appointment that would have otherwise been used for a second IUD placement visit. In a busy resident clinic, this means that women seeking gynecology care can be seen more quickly because an unnecessary clinic visit has been eliminated. One of the aims of my study is to reinforce a single-visit practice as the standard of care at other programs across the [United States]. Despite ACOG’s recommendations, practice is still sometimes slow to change."

Dr. Kattan said he had no relevant financial disclosures.

WASHINGTON – Bundling criteria for elective induction would result in better outcomes and reduced costs if favorable cervix were added as a criterion, according to the results of a prospective trial.

"Among women achieving elective induction bundle criteria, favorable cervix is associated with significantly better outcomes and costs," said Tiffany Kenny, R.N., of Summa Health System in Akron, Ohio. "It’s not a novel finding that outcomes are better when the cervix is favorable. However, this study indicates that the current bundle is missing this key component and does not adequately guarantee cost or quality."

The elective induction bundle includes four criteria: a gestational age of at least 39 weeks, a normal fetal status at the start, pelvic exam documented prior to the start, and recognition and management of uterine tachysystole.

The investigators included all women at one institution who had delivered from October 2009 to October 2010 and had an elective induction. Data were collected prospectively for all 180 women, and all underwent quality bundling, which included a bundle audit, related education, and peer review, Ms. Kenny said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study patients were divided into two groups – those achieving bundle criteria and those who did not. Those who achieved bundling criteria were then grouped by favorable cervix on admission. A favorable cervix was defined as a Bishop score greater than 6, determined by hospital admission exam by a physician or certified nurse midwife before the start of the induction.

At the end of the study period, a control group (prebundling) was retrospectively abstracted using the same methods, and included all women who had delivered from January 2005 to December 2007 and met the inclusion criteria.

Among the prebundling control group of 473 women, none achieved bundling. Of the 180 women included in the study group, 96% achieved bundling.

The two primary end points were cesarean delivery rate and rates of special or intensive care required. The cesarean delivery rate was 21% for women in the prebundling group and 12% with bundling, a significant difference. Women in the study group also had significantly less maternal blood loss and shorter lengths of stay. However, there were no differences in the rates of special or intensive care required – around 5.5%.

"Those who achieved bundle criteria did not always have favorable outcomes," Ms. Kenny said. "When bundle achievers were grouped by Bishop score, those with a poor Bishop score had higher rates of cesarean, more neonates to special care, longer lengths of labor, and higher rates of cesarean for dystocia and poor fetal heart rate pattern."

Among women in the study group, those with a Bishop score greater than 6 – considered a favorable cervix – had a 4% cesarean rate, compared with 19% for women who had a Bishop score of 6 or less, which was a significant difference. In addition, women with a Bishop score greater than 6 were significantly less likely to have a neonate requiring special or intensive care – 1% vs. 10% for women with a Bishop score of 6 or less.

In addition, "bundle achiever dyads with a poor Bishop score were significantly more costly than those with a Bishop score greater than 6, particularly if delivered vaginally."

Among vaginal delivery dyads, the net loss was $341 for those with a Bishop score greater than 6 vs. a net loss of $1,706 for those with a Bishop score of 6 or less. Likewise, among cesarean delivery dyads, the net loss was $2,166 for those with a Bishop score greater than 6 vs. a net loss of $6,342 for those with a Bishop score of 6 or less.

"Overall, the study cohort totaled a net income loss of over $270,000 for the hospital," said Ms. Kenny. "Elective induction was identified as the top drain to our department. The financial concerns of elective inductions will further intensify with health care reform, as reimbursement will soon be based on quality and cost – transitioning from fee-for-service to value-based care."

"Our findings also suggest that education and peer review interventions are not sufficient. Hard stops at the point of scheduling may be required," she said.

The investigators reported that they had no relevant financial disclosures.

WASHINGTON – Bundling criteria for elective induction would result in better outcomes and reduced costs if favorable cervix were added as a criterion, according to the results of a prospective trial.

"Among women achieving elective induction bundle criteria, favorable cervix is associated with significantly better outcomes and costs," said Tiffany Kenny, R.N., of Summa Health System in Akron, Ohio. "It’s not a novel finding that outcomes are better when the cervix is favorable. However, this study indicates that the current bundle is missing this key component and does not adequately guarantee cost or quality."

The elective induction bundle includes four criteria: a gestational age of at least 39 weeks, a normal fetal status at the start, pelvic exam documented prior to the start, and recognition and management of uterine tachysystole.

The investigators included all women at one institution who had delivered from October 2009 to October 2010 and had an elective induction. Data were collected prospectively for all 180 women, and all underwent quality bundling, which included a bundle audit, related education, and peer review, Ms. Kenny said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study patients were divided into two groups – those achieving bundle criteria and those who did not. Those who achieved bundling criteria were then grouped by favorable cervix on admission. A favorable cervix was defined as a Bishop score greater than 6, determined by hospital admission exam by a physician or certified nurse midwife before the start of the induction.

At the end of the study period, a control group (prebundling) was retrospectively abstracted using the same methods, and included all women who had delivered from January 2005 to December 2007 and met the inclusion criteria.

Among the prebundling control group of 473 women, none achieved bundling. Of the 180 women included in the study group, 96% achieved bundling.

The two primary end points were cesarean delivery rate and rates of special or intensive care required. The cesarean delivery rate was 21% for women in the prebundling group and 12% with bundling, a significant difference. Women in the study group also had significantly less maternal blood loss and shorter lengths of stay. However, there were no differences in the rates of special or intensive care required – around 5.5%.

"Those who achieved bundle criteria did not always have favorable outcomes," Ms. Kenny said. "When bundle achievers were grouped by Bishop score, those with a poor Bishop score had higher rates of cesarean, more neonates to special care, longer lengths of labor, and higher rates of cesarean for dystocia and poor fetal heart rate pattern."

Among women in the study group, those with a Bishop score greater than 6 – considered a favorable cervix – had a 4% cesarean rate, compared with 19% for women who had a Bishop score of 6 or less, which was a significant difference. In addition, women with a Bishop score greater than 6 were significantly less likely to have a neonate requiring special or intensive care – 1% vs. 10% for women with a Bishop score of 6 or less.

In addition, "bundle achiever dyads with a poor Bishop score were significantly more costly than those with a Bishop score greater than 6, particularly if delivered vaginally."

Among vaginal delivery dyads, the net loss was $341 for those with a Bishop score greater than 6 vs. a net loss of $1,706 for those with a Bishop score of 6 or less. Likewise, among cesarean delivery dyads, the net loss was $2,166 for those with a Bishop score greater than 6 vs. a net loss of $6,342 for those with a Bishop score of 6 or less.

"Overall, the study cohort totaled a net income loss of over $270,000 for the hospital," said Ms. Kenny. "Elective induction was identified as the top drain to our department. The financial concerns of elective inductions will further intensify with health care reform, as reimbursement will soon be based on quality and cost – transitioning from fee-for-service to value-based care."

"Our findings also suggest that education and peer review interventions are not sufficient. Hard stops at the point of scheduling may be required," she said.

The investigators reported that they had no relevant financial disclosures.

WASHINGTON – Bundling criteria for elective induction would result in better outcomes and reduced costs if favorable cervix were added as a criterion, according to the results of a prospective trial.

"Among women achieving elective induction bundle criteria, favorable cervix is associated with significantly better outcomes and costs," said Tiffany Kenny, R.N., of Summa Health System in Akron, Ohio. "It’s not a novel finding that outcomes are better when the cervix is favorable. However, this study indicates that the current bundle is missing this key component and does not adequately guarantee cost or quality."

The elective induction bundle includes four criteria: a gestational age of at least 39 weeks, a normal fetal status at the start, pelvic exam documented prior to the start, and recognition and management of uterine tachysystole.

The investigators included all women at one institution who had delivered from October 2009 to October 2010 and had an elective induction. Data were collected prospectively for all 180 women, and all underwent quality bundling, which included a bundle audit, related education, and peer review, Ms. Kenny said at the annual meeting of the American College of Obstetricians and Gynecologists.

The study patients were divided into two groups – those achieving bundle criteria and those who did not. Those who achieved bundling criteria were then grouped by favorable cervix on admission. A favorable cervix was defined as a Bishop score greater than 6, determined by hospital admission exam by a physician or certified nurse midwife before the start of the induction.

At the end of the study period, a control group (prebundling) was retrospectively abstracted using the same methods, and included all women who had delivered from January 2005 to December 2007 and met the inclusion criteria.

Among the prebundling control group of 473 women, none achieved bundling. Of the 180 women included in the study group, 96% achieved bundling.

The two primary end points were cesarean delivery rate and rates of special or intensive care required. The cesarean delivery rate was 21% for women in the prebundling group and 12% with bundling, a significant difference. Women in the study group also had significantly less maternal blood loss and shorter lengths of stay. However, there were no differences in the rates of special or intensive care required – around 5.5%.

"Those who achieved bundle criteria did not always have favorable outcomes," Ms. Kenny said. "When bundle achievers were grouped by Bishop score, those with a poor Bishop score had higher rates of cesarean, more neonates to special care, longer lengths of labor, and higher rates of cesarean for dystocia and poor fetal heart rate pattern."

Among women in the study group, those with a Bishop score greater than 6 – considered a favorable cervix – had a 4% cesarean rate, compared with 19% for women who had a Bishop score of 6 or less, which was a significant difference. In addition, women with a Bishop score greater than 6 were significantly less likely to have a neonate requiring special or intensive care – 1% vs. 10% for women with a Bishop score of 6 or less.

In addition, "bundle achiever dyads with a poor Bishop score were significantly more costly than those with a Bishop score greater than 6, particularly if delivered vaginally."

Among vaginal delivery dyads, the net loss was $341 for those with a Bishop score greater than 6 vs. a net loss of $1,706 for those with a Bishop score of 6 or less. Likewise, among cesarean delivery dyads, the net loss was $2,166 for those with a Bishop score greater than 6 vs. a net loss of $6,342 for those with a Bishop score of 6 or less.

"Overall, the study cohort totaled a net income loss of over $270,000 for the hospital," said Ms. Kenny. "Elective induction was identified as the top drain to our department. The financial concerns of elective inductions will further intensify with health care reform, as reimbursement will soon be based on quality and cost – transitioning from fee-for-service to value-based care."

"Our findings also suggest that education and peer review interventions are not sufficient. Hard stops at the point of scheduling may be required," she said.

The investigators reported that they had no relevant financial disclosures.

WASHINGTON  – The initiation of 17P after the recommended 16-21 weeks’ gestation period appears to be beneficial, whereas stopping the drug early may increase a patient’s risk of spontaneous preterm delivery, according to a study of more than 700 women on Medicaid.

There were no significant differences in rates of recurrent spontaneous preterm birth (SPTB) at less than 37, 35, or 32 weeks’ gestation, regardless of whether 17P was started before or after 21 weeks’ gestation. "However, if you look at outcomes of those patients who discontinued early, there is statistically significant difference in each gestational age band in those patients who completed the therapy vs. those who discontinued early," Dr. Brad Lucas said at the annual meeting of the American College of Obstetricians and Gynecologists.

Level I evidence suggests that 17P – a form of progesterone called 17 alphahydroxyprogesterone caproate – is effective in preventing recurrent preterm birth in patients with a prior history of spontaneous preterm delivery. In fact, ACOG recommends progesterone supplementation for the prevention of recurrent preterm birth in patients with current singleton gestation and a prior history of SPTD at less than 37 weeks’ gestation (ACOG Committee Opinion No. 419, 2008). However, compliance issues and social barriers to treatment with 17P are common in the Medicaid population, noted Dr. Lucas, an ob.gyn. employed at Centene Corp., a health management and services company that provides health plans in 11 states.

The Food and Drug Administration approved Makena (a noncompounded form of 17P) earlier this year for the prevention of recurrent preterm birth in women with singleton pregnancies. Makena is marketed by Ther-Rx, a subsidiary of Missouri-based KV Pharmaceutical Co. However, Makenas high price is raising physicians’ ire.

A compounded form of 17P was used in this study.

The investigators performed a retrospective study of data that was prospectively collected between July 2004 and May 2010. They included women with a current singleton pregnancy and a history of one or more prior SPTB (20 to less than 37 weeks’ gestation). These women could have no current or planned cerclage.

"We use the treatment guidelines that are commonly associated with those in the Meis study," he said (N. Engl. J. Med. 2003;348:2379-85). Weekly 17P injections (250 mg on days 6-9) were initiated starting at 16 weeks up to 21 weeks’ gestation. The injections were discontinued at 36 weeks or at preterm delivery.

A total of 790 women with prior SPTB received care through a managed Medicaid health plan. These women were enrolled in a 17P home-administration program for the prevention of recurrent preterm birth, in which a nurse administered a weekly IM injection of compounded 17P (250 mg) to women in their homes. Written and verbal education was also provided by the perinatal nurse. Intensive case management was provided. Patients had round-the-clock telephone access to nurses, who could answer questions or concerns.

The primary outcome in this study was adherence to treatment guidelines (initiation of treatment at 16 to less than 21 weeks vs. initiation at 21 weeks or more). Patients also had to complete the recommended treatment – continuation until within 10 days of 36 weeks’ gestation or until preterm delivery.

The average maternal age was 28 years. Only a small percentage of the patients were teens (3.5%) or were older than 34 years (6%). Interestingly, 36% had had more than one prior preterm delivery.

In terms of adherence to the guidelines, the average gestational age at the start of 17P injections was 21 weeks. More than half of the women (59%) started treatment at 16-21 weeks’ gestation. The average number of injections received was 13. Only seven women refused treatment after the first injection. Most women (89%) received all expected injections.

The average gestational age at delivery was 37 weeks. In all, 28% of women had SPTB prior to 37 weeks, 12% had SPTB prior to 35 weeks, and 6% had SPTB prior to 32 weeks. More than a third of women (36%) had cesarean delivery. Some 15% of infants required care in neonatal ICUs or special-care nurseries. Perinatal loss was less than 1%. Overall, 35% of women delivered before 37 weeks’ gestation and 65% delivered at 37 weeks’ gestation or later.

In terms of early discontinuation of 17P, 38% of mothers who discontinued 17P use early had SPTB at less than 37 weeks’ gestation, compared with only 26% of women who did not discontinue 17P. Likewise, 23% of mothers who discontinued 17P use early had SPTB at less than 35 weeks, compared with only 10% of women who did not discontinue; 12% of mothers who discontinued 17P use early had SPTB at less than 32 weeks, compared with only 4% of women who did not discontinue. All of the differences were significant.

"Early discontinuation of 17P increases a patient’s risk for recurrent spontaneous preterm delivery," said Dr. Lucas.

Dr. Lucas is an employee of Centene Corp. His coauthor, Dr. Gary J. Stanziano, is an employee of Alere, which provides home medical services. However, no funding was received from either company for the completion of this study.

WASHINGTON  – The initiation of 17P after the recommended 16-21 weeks’ gestation period appears to be beneficial, whereas stopping the drug early may increase a patient’s risk of spontaneous preterm delivery, according to a study of more than 700 women on Medicaid.

There were no significant differences in rates of recurrent spontaneous preterm birth (SPTB) at less than 37, 35, or 32 weeks’ gestation, regardless of whether 17P was started before or after 21 weeks’ gestation. "However, if you look at outcomes of those patients who discontinued early, there is statistically significant difference in each gestational age band in those patients who completed the therapy vs. those who discontinued early," Dr. Brad Lucas said at the annual meeting of the American College of Obstetricians and Gynecologists.

Level I evidence suggests that 17P – a form of progesterone called 17 alphahydroxyprogesterone caproate – is effective in preventing recurrent preterm birth in patients with a prior history of spontaneous preterm delivery. In fact, ACOG recommends progesterone supplementation for the prevention of recurrent preterm birth in patients with current singleton gestation and a prior history of SPTD at less than 37 weeks’ gestation (ACOG Committee Opinion No. 419, 2008). However, compliance issues and social barriers to treatment with 17P are common in the Medicaid population, noted Dr. Lucas, an ob.gyn. employed at Centene Corp., a health management and services company that provides health plans in 11 states.

The Food and Drug Administration approved Makena (a noncompounded form of 17P) earlier this year for the prevention of recurrent preterm birth in women with singleton pregnancies. Makena is marketed by Ther-Rx, a subsidiary of Missouri-based KV Pharmaceutical Co. However, Makenas high price is raising physicians’ ire.

A compounded form of 17P was used in this study.

The investigators performed a retrospective study of data that was prospectively collected between July 2004 and May 2010. They included women with a current singleton pregnancy and a history of one or more prior SPTB (20 to less than 37 weeks’ gestation). These women could have no current or planned cerclage.

"We use the treatment guidelines that are commonly associated with those in the Meis study," he said (N. Engl. J. Med. 2003;348:2379-85). Weekly 17P injections (250 mg on days 6-9) were initiated starting at 16 weeks up to 21 weeks’ gestation. The injections were discontinued at 36 weeks or at preterm delivery.

A total of 790 women with prior SPTB received care through a managed Medicaid health plan. These women were enrolled in a 17P home-administration program for the prevention of recurrent preterm birth, in which a nurse administered a weekly IM injection of compounded 17P (250 mg) to women in their homes. Written and verbal education was also provided by the perinatal nurse. Intensive case management was provided. Patients had round-the-clock telephone access to nurses, who could answer questions or concerns.

The primary outcome in this study was adherence to treatment guidelines (initiation of treatment at 16 to less than 21 weeks vs. initiation at 21 weeks or more). Patients also had to complete the recommended treatment – continuation until within 10 days of 36 weeks’ gestation or until preterm delivery.

The average maternal age was 28 years. Only a small percentage of the patients were teens (3.5%) or were older than 34 years (6%). Interestingly, 36% had had more than one prior preterm delivery.

In terms of adherence to the guidelines, the average gestational age at the start of 17P injections was 21 weeks. More than half of the women (59%) started treatment at 16-21 weeks’ gestation. The average number of injections received was 13. Only seven women refused treatment after the first injection. Most women (89%) received all expected injections.

The average gestational age at delivery was 37 weeks. In all, 28% of women had SPTB prior to 37 weeks, 12% had SPTB prior to 35 weeks, and 6% had SPTB prior to 32 weeks. More than a third of women (36%) had cesarean delivery. Some 15% of infants required care in neonatal ICUs or special-care nurseries. Perinatal loss was less than 1%. Overall, 35% of women delivered before 37 weeks’ gestation and 65% delivered at 37 weeks’ gestation or later.

In terms of early discontinuation of 17P, 38% of mothers who discontinued 17P use early had SPTB at less than 37 weeks’ gestation, compared with only 26% of women who did not discontinue 17P. Likewise, 23% of mothers who discontinued 17P use early had SPTB at less than 35 weeks, compared with only 10% of women who did not discontinue; 12% of mothers who discontinued 17P use early had SPTB at less than 32 weeks, compared with only 4% of women who did not discontinue. All of the differences were significant.

"Early discontinuation of 17P increases a patient’s risk for recurrent spontaneous preterm delivery," said Dr. Lucas.

Dr. Lucas is an employee of Centene Corp. His coauthor, Dr. Gary J. Stanziano, is an employee of Alere, which provides home medical services. However, no funding was received from either company for the completion of this study.

WASHINGTON  – The initiation of 17P after the recommended 16-21 weeks’ gestation period appears to be beneficial, whereas stopping the drug early may increase a patient’s risk of spontaneous preterm delivery, according to a study of more than 700 women on Medicaid.

There were no significant differences in rates of recurrent spontaneous preterm birth (SPTB) at less than 37, 35, or 32 weeks’ gestation, regardless of whether 17P was started before or after 21 weeks’ gestation. "However, if you look at outcomes of those patients who discontinued early, there is statistically significant difference in each gestational age band in those patients who completed the therapy vs. those who discontinued early," Dr. Brad Lucas said at the annual meeting of the American College of Obstetricians and Gynecologists.

Level I evidence suggests that 17P – a form of progesterone called 17 alphahydroxyprogesterone caproate – is effective in preventing recurrent preterm birth in patients with a prior history of spontaneous preterm delivery. In fact, ACOG recommends progesterone supplementation for the prevention of recurrent preterm birth in patients with current singleton gestation and a prior history of SPTD at less than 37 weeks’ gestation (ACOG Committee Opinion No. 419, 2008). However, compliance issues and social barriers to treatment with 17P are common in the Medicaid population, noted Dr. Lucas, an ob.gyn. employed at Centene Corp., a health management and services company that provides health plans in 11 states.

The Food and Drug Administration approved Makena (a noncompounded form of 17P) earlier this year for the prevention of recurrent preterm birth in women with singleton pregnancies. Makena is marketed by Ther-Rx, a subsidiary of Missouri-based KV Pharmaceutical Co. However, Makenas high price is raising physicians’ ire.

A compounded form of 17P was used in this study.

The investigators performed a retrospective study of data that was prospectively collected between July 2004 and May 2010. They included women with a current singleton pregnancy and a history of one or more prior SPTB (20 to less than 37 weeks’ gestation). These women could have no current or planned cerclage.

"We use the treatment guidelines that are commonly associated with those in the Meis study," he said (N. Engl. J. Med. 2003;348:2379-85). Weekly 17P injections (250 mg on days 6-9) were initiated starting at 16 weeks up to 21 weeks’ gestation. The injections were discontinued at 36 weeks or at preterm delivery.

A total of 790 women with prior SPTB received care through a managed Medicaid health plan. These women were enrolled in a 17P home-administration program for the prevention of recurrent preterm birth, in which a nurse administered a weekly IM injection of compounded 17P (250 mg) to women in their homes. Written and verbal education was also provided by the perinatal nurse. Intensive case management was provided. Patients had round-the-clock telephone access to nurses, who could answer questions or concerns.

The primary outcome in this study was adherence to treatment guidelines (initiation of treatment at 16 to less than 21 weeks vs. initiation at 21 weeks or more). Patients also had to complete the recommended treatment – continuation until within 10 days of 36 weeks’ gestation or until preterm delivery.

The average maternal age was 28 years. Only a small percentage of the patients were teens (3.5%) or were older than 34 years (6%). Interestingly, 36% had had more than one prior preterm delivery.

In terms of adherence to the guidelines, the average gestational age at the start of 17P injections was 21 weeks. More than half of the women (59%) started treatment at 16-21 weeks’ gestation. The average number of injections received was 13. Only seven women refused treatment after the first injection. Most women (89%) received all expected injections.

The average gestational age at delivery was 37 weeks. In all, 28% of women had SPTB prior to 37 weeks, 12% had SPTB prior to 35 weeks, and 6% had SPTB prior to 32 weeks. More than a third of women (36%) had cesarean delivery. Some 15% of infants required care in neonatal ICUs or special-care nurseries. Perinatal loss was less than 1%. Overall, 35% of women delivered before 37 weeks’ gestation and 65% delivered at 37 weeks’ gestation or later.

In terms of early discontinuation of 17P, 38% of mothers who discontinued 17P use early had SPTB at less than 37 weeks’ gestation, compared with only 26% of women who did not discontinue 17P. Likewise, 23% of mothers who discontinued 17P use early had SPTB at less than 35 weeks, compared with only 10% of women who did not discontinue; 12% of mothers who discontinued 17P use early had SPTB at less than 32 weeks, compared with only 4% of women who did not discontinue. All of the differences were significant.

"Early discontinuation of 17P increases a patient’s risk for recurrent spontaneous preterm delivery," said Dr. Lucas.

Dr. Lucas is an employee of Centene Corp. His coauthor, Dr. Gary J. Stanziano, is an employee of Alere, which provides home medical services. However, no funding was received from either company for the completion of this study.

WASHINGTON – Modified panniculectomy at the time of cesarean section may be a useful adjunct for decreasing postoperative morbidity in morbidly obese patients, based on results of a small case series.

"We found that women who underwent panniculectomy at the time of cesarean section were less likely to have significant wound complications than controls that did not undergo panniculectomy," Dr. Pedro Miranda-Seijo said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

He and his coinvestigators conducted a chart review during 2004 that included 30 morbidly obese patients who underwent incidental panniculectomy during cesarean section and a control group of 29 morbidly obese women who underwent a cesarean section without a panniculectomy. The definition of morbidly obese was a body mass index (BMI) of greater than 42 kg/m².

"The decision to perform a panniculectomy was made originally by me before starting surgery, at which time I would obtain informed consent," Dr. Miranda-Seijo said in an interview.

"After I’d done the first 10 or 15 cases, the residents and other attending began trying to schedule elective cases on morbidly obese patients on days that I would be available; often I would see these patients during their antepartum visit and discuss the procedure with them," said Dr. Miranda-Seijo, who is an obstetrician at Denver Health and Hospitals. "I am the only attending that does these procedures; [patients] understand that if they come in labor and I’m not available, they would not be getting a panniculectomy."

Also "when a morbidly obese patient who is in labor needs a cesarean section, if I’m available, I often get called to do it," he said. "If the indication is urgent but not emergent – say failure to descend or secondary arrest of dilation – and I will be available in a few hours, the case is often held for me to do when I arrive," he said.

Notably, the women in this series who underwent panniculectomy had significantly greater BMIs – a mean of 54 vs. 49 kg/m² for the control group.

Of the 30 women who underwent modified panniculectomy at the time of cesarean section, there was one operative site infection that required readmission. In contrast, in the control group there were seven late wound complications and three readmissions. The difference in late wound complications was significant.

There was a nonsignificant difference in operative time, with a mean of 66 minutes with a panniculectomy compared with 63 minutes for cesarean section alone. Panniculectomy did not significantly increase blood loss.

"The extra time needed to infiltrate the skin, remove the pannus, and [close] the large incision is offset by the greater speed achieved in accessing the uterus, delivering the baby, and closing the uterus and fascia, due to better exposure and easier access," Dr. Miranda-Seijo noted.

Several questions were raised by the study: Does the removal of so much adipose tissue have an effect on glucose tolerance, and could this procedure be used by patients as a starting point to initiate healthier lifestyle changes? Additional research will be needed to provide answers, he said.

Dr. Miranda-Seijo reported that he had no relevant financial disclosures.

WASHINGTON – Modified panniculectomy at the time of cesarean section may be a useful adjunct for decreasing postoperative morbidity in morbidly obese patients, based on results of a small case series.

"We found that women who underwent panniculectomy at the time of cesarean section were less likely to have significant wound complications than controls that did not undergo panniculectomy," Dr. Pedro Miranda-Seijo said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

He and his coinvestigators conducted a chart review during 2004 that included 30 morbidly obese patients who underwent incidental panniculectomy during cesarean section and a control group of 29 morbidly obese women who underwent a cesarean section without a panniculectomy. The definition of morbidly obese was a body mass index (BMI) of greater than 42 kg/m².

"The decision to perform a panniculectomy was made originally by me before starting surgery, at which time I would obtain informed consent," Dr. Miranda-Seijo said in an interview.

"After I’d done the first 10 or 15 cases, the residents and other attending began trying to schedule elective cases on morbidly obese patients on days that I would be available; often I would see these patients during their antepartum visit and discuss the procedure with them," said Dr. Miranda-Seijo, who is an obstetrician at Denver Health and Hospitals. "I am the only attending that does these procedures; [patients] understand that if they come in labor and I’m not available, they would not be getting a panniculectomy."

Also "when a morbidly obese patient who is in labor needs a cesarean section, if I’m available, I often get called to do it," he said. "If the indication is urgent but not emergent – say failure to descend or secondary arrest of dilation – and I will be available in a few hours, the case is often held for me to do when I arrive," he said.

Notably, the women in this series who underwent panniculectomy had significantly greater BMIs – a mean of 54 vs. 49 kg/m² for the control group.

Of the 30 women who underwent modified panniculectomy at the time of cesarean section, there was one operative site infection that required readmission. In contrast, in the control group there were seven late wound complications and three readmissions. The difference in late wound complications was significant.

There was a nonsignificant difference in operative time, with a mean of 66 minutes with a panniculectomy compared with 63 minutes for cesarean section alone. Panniculectomy did not significantly increase blood loss.

"The extra time needed to infiltrate the skin, remove the pannus, and [close] the large incision is offset by the greater speed achieved in accessing the uterus, delivering the baby, and closing the uterus and fascia, due to better exposure and easier access," Dr. Miranda-Seijo noted.

Several questions were raised by the study: Does the removal of so much adipose tissue have an effect on glucose tolerance, and could this procedure be used by patients as a starting point to initiate healthier lifestyle changes? Additional research will be needed to provide answers, he said.

Dr. Miranda-Seijo reported that he had no relevant financial disclosures.

WASHINGTON – Modified panniculectomy at the time of cesarean section may be a useful adjunct for decreasing postoperative morbidity in morbidly obese patients, based on results of a small case series.

"We found that women who underwent panniculectomy at the time of cesarean section were less likely to have significant wound complications than controls that did not undergo panniculectomy," Dr. Pedro Miranda-Seijo said in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.

He and his coinvestigators conducted a chart review during 2004 that included 30 morbidly obese patients who underwent incidental panniculectomy during cesarean section and a control group of 29 morbidly obese women who underwent a cesarean section without a panniculectomy. The definition of morbidly obese was a body mass index (BMI) of greater than 42 kg/m².

"The decision to perform a panniculectomy was made originally by me before starting surgery, at which time I would obtain informed consent," Dr. Miranda-Seijo said in an interview.

"After I’d done the first 10 or 15 cases, the residents and other attending began trying to schedule elective cases on morbidly obese patients on days that I would be available; often I would see these patients during their antepartum visit and discuss the procedure with them," said Dr. Miranda-Seijo, who is an obstetrician at Denver Health and Hospitals. "I am the only attending that does these procedures; [patients] understand that if they come in labor and I’m not available, they would not be getting a panniculectomy."

Also "when a morbidly obese patient who is in labor needs a cesarean section, if I’m available, I often get called to do it," he said. "If the indication is urgent but not emergent – say failure to descend or secondary arrest of dilation – and I will be available in a few hours, the case is often held for me to do when I arrive," he said.

Notably, the women in this series who underwent panniculectomy had significantly greater BMIs – a mean of 54 vs. 49 kg/m² for the control group.

Of the 30 women who underwent modified panniculectomy at the time of cesarean section, there was one operative site infection that required readmission. In contrast, in the control group there were seven late wound complications and three readmissions. The difference in late wound complications was significant.

There was a nonsignificant difference in operative time, with a mean of 66 minutes with a panniculectomy compared with 63 minutes for cesarean section alone. Panniculectomy did not significantly increase blood loss.

"The extra time needed to infiltrate the skin, remove the pannus, and [close] the large incision is offset by the greater speed achieved in accessing the uterus, delivering the baby, and closing the uterus and fascia, due to better exposure and easier access," Dr. Miranda-Seijo noted.

Several questions were raised by the study: Does the removal of so much adipose tissue have an effect on glucose tolerance, and could this procedure be used by patients as a starting point to initiate healthier lifestyle changes? Additional research will be needed to provide answers, he said.

Dr. Miranda-Seijo reported that he had no relevant financial disclosures.