ACOG 2014

CHICAGO – Suture closure of the skin incision after cesarean delivery was associated with significantly improved patient satisfaction, compared with staple closure, according to findings in a prospective, randomized, multicenter study of 746 women.

Suture closure also was associated with improved patient and physician assessments of cosmesis, compared with staple closure, Dr. Jonah Fleisher reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The median interquartile range of overall "satisfaction with method of closure" scores on the validated Patient and Observer Scar Assessment Scale (POSAS) differed significantly for 299 suture patients and 307 staple patients for whom the data were available (scores of 10 vs. 9, respectively), as did median "satisfaction with appearance of skin incision" scores (also 10 vs. 9, respectively), said Dr. Fleisher of Geisinger Health System, Danville, Pa.

Courtesy Dr. Jonah Fleisher

The cosmetic-specific question was included to help adjust for the multifactorial nature of the overall satisfaction score, which could be affected by the patient’s degree of pain, healing time, need for extra office visits, and frequency of complications, among other factors.

The two measures correlated positively, and both subjective and objective components of the POSAS favored suture closure, he noted.

Study participants were women undergoing cesarean delivery via low-transverse skin incisions at any of three participating centers. After fascia closure, the women were allocated to either the suture (type was surgeon’s choice) or metal staple closure group. Staples were removed between postoperative days 4 and 10.

About 1.3 million cesarean deliveries are performed each year in the United States, Dr. Fleisher said.

"Those scars that are formed as a result are very important to patients, both as far as cosmetic and general satisfaction ... and it turns out they are important to obstetricians, too," he added, noting that data to guide decision making are lacking.

In the current study, the differences between the suture and staple groups were significant, but patients in both groups had high rates of satisfaction.

"Given these considerations, I would suggest that we ought to incorporate wound complications rates into the decision of which method to use," he said.

An article that addresses the wound complication rates in this study is currently in press and scheduled for publication in the American Journal of Obstetrics & Gynecology in June. The data show a 57% lower complication rate with suture closure vs. staple closure, Dr. Fleisher said.

"The bottom line is, for all these reasons, we have moved to recommending suture closure in all transverse C-sections," he said.

As for whether the findings apply to other types of surgical operations, such as abdominal hysterectomy, Dr. Fleisher said there are many changes in pregnancy, including immunologic changes, that don’t necessarily apply to nonobstetric situations.

"There is some literature in the general surgery area about this, and some literature in gynecologic surgery, but given the immunologic changes – I think we’re seeing that even the adhesion data is not necessarily the same in those two contexts. ... I wouldn’t want to generalize from this to nonobstetric indications," he said.

This study was supported by Ethicon. Dr. Fleisher reported having no disclosures.

CHICAGO – Suture closure of the skin incision after cesarean delivery was associated with significantly improved patient satisfaction, compared with staple closure, according to findings in a prospective, randomized, multicenter study of 746 women.

Suture closure also was associated with improved patient and physician assessments of cosmesis, compared with staple closure, Dr. Jonah Fleisher reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The median interquartile range of overall "satisfaction with method of closure" scores on the validated Patient and Observer Scar Assessment Scale (POSAS) differed significantly for 299 suture patients and 307 staple patients for whom the data were available (scores of 10 vs. 9, respectively), as did median "satisfaction with appearance of skin incision" scores (also 10 vs. 9, respectively), said Dr. Fleisher of Geisinger Health System, Danville, Pa.

Courtesy Dr. Jonah Fleisher

The cosmetic-specific question was included to help adjust for the multifactorial nature of the overall satisfaction score, which could be affected by the patient’s degree of pain, healing time, need for extra office visits, and frequency of complications, among other factors.

The two measures correlated positively, and both subjective and objective components of the POSAS favored suture closure, he noted.

Study participants were women undergoing cesarean delivery via low-transverse skin incisions at any of three participating centers. After fascia closure, the women were allocated to either the suture (type was surgeon’s choice) or metal staple closure group. Staples were removed between postoperative days 4 and 10.

About 1.3 million cesarean deliveries are performed each year in the United States, Dr. Fleisher said.

"Those scars that are formed as a result are very important to patients, both as far as cosmetic and general satisfaction ... and it turns out they are important to obstetricians, too," he added, noting that data to guide decision making are lacking.

In the current study, the differences between the suture and staple groups were significant, but patients in both groups had high rates of satisfaction.

"Given these considerations, I would suggest that we ought to incorporate wound complications rates into the decision of which method to use," he said.

An article that addresses the wound complication rates in this study is currently in press and scheduled for publication in the American Journal of Obstetrics & Gynecology in June. The data show a 57% lower complication rate with suture closure vs. staple closure, Dr. Fleisher said.

"The bottom line is, for all these reasons, we have moved to recommending suture closure in all transverse C-sections," he said.

As for whether the findings apply to other types of surgical operations, such as abdominal hysterectomy, Dr. Fleisher said there are many changes in pregnancy, including immunologic changes, that don’t necessarily apply to nonobstetric situations.

"There is some literature in the general surgery area about this, and some literature in gynecologic surgery, but given the immunologic changes – I think we’re seeing that even the adhesion data is not necessarily the same in those two contexts. ... I wouldn’t want to generalize from this to nonobstetric indications," he said.

This study was supported by Ethicon. Dr. Fleisher reported having no disclosures.

CHICAGO – Suture closure of the skin incision after cesarean delivery was associated with significantly improved patient satisfaction, compared with staple closure, according to findings in a prospective, randomized, multicenter study of 746 women.

Suture closure also was associated with improved patient and physician assessments of cosmesis, compared with staple closure, Dr. Jonah Fleisher reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The median interquartile range of overall "satisfaction with method of closure" scores on the validated Patient and Observer Scar Assessment Scale (POSAS) differed significantly for 299 suture patients and 307 staple patients for whom the data were available (scores of 10 vs. 9, respectively), as did median "satisfaction with appearance of skin incision" scores (also 10 vs. 9, respectively), said Dr. Fleisher of Geisinger Health System, Danville, Pa.

Courtesy Dr. Jonah Fleisher

The cosmetic-specific question was included to help adjust for the multifactorial nature of the overall satisfaction score, which could be affected by the patient’s degree of pain, healing time, need for extra office visits, and frequency of complications, among other factors.

The two measures correlated positively, and both subjective and objective components of the POSAS favored suture closure, he noted.

Study participants were women undergoing cesarean delivery via low-transverse skin incisions at any of three participating centers. After fascia closure, the women were allocated to either the suture (type was surgeon’s choice) or metal staple closure group. Staples were removed between postoperative days 4 and 10.

About 1.3 million cesarean deliveries are performed each year in the United States, Dr. Fleisher said.

"Those scars that are formed as a result are very important to patients, both as far as cosmetic and general satisfaction ... and it turns out they are important to obstetricians, too," he added, noting that data to guide decision making are lacking.

In the current study, the differences between the suture and staple groups were significant, but patients in both groups had high rates of satisfaction.

"Given these considerations, I would suggest that we ought to incorporate wound complications rates into the decision of which method to use," he said.

An article that addresses the wound complication rates in this study is currently in press and scheduled for publication in the American Journal of Obstetrics & Gynecology in June. The data show a 57% lower complication rate with suture closure vs. staple closure, Dr. Fleisher said.

"The bottom line is, for all these reasons, we have moved to recommending suture closure in all transverse C-sections," he said.

As for whether the findings apply to other types of surgical operations, such as abdominal hysterectomy, Dr. Fleisher said there are many changes in pregnancy, including immunologic changes, that don’t necessarily apply to nonobstetric situations.

"There is some literature in the general surgery area about this, and some literature in gynecologic surgery, but given the immunologic changes – I think we’re seeing that even the adhesion data is not necessarily the same in those two contexts. ... I wouldn’t want to generalize from this to nonobstetric indications," he said.

This study was supported by Ethicon. Dr. Fleisher reported having no disclosures.

CHICAGO – The use of a sodium hyaluronate–carboxycellulose adhesion barrier during primary cesarean delivery was not associated with decreased delivery time or improved adhesion scores during a first repeat cesarean delivery in a cohort study involving 97 women.

The incision to delivery time among 71 women who did not receive sodium hyaluronate–carboxycellulose (HA-CC) barrier film during their primary cesarean delivery was 9.5 minutes, compared with 10.6 minutes in 26 women who did receive HA-CC barrier film, Dr. Maria Gaspar-Oishi of the University of Hawaii, Honolulu, reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Average blood loss and adhesion scores also were similar in the two groups. Blood loss was 564 mL and 563 mL, in the groups, respectively; mean fascia adhesion scores were 1.45 and 1.31; and mean intraperitoneal adhesion scores were 1.11 and 0.92, said Dr. Gaspar-Oishi, whose paper received a Donald F. Richardson Memorial Prize Paper award as one of the best papers by a junior fellow at the meeting.

Patients included in the combined prospective/retrospective cohort study were women who gave birth at a single center. Intraoperative data were collected prospectively at the time of first repeat cesarean delivery, and a retrospective chart study was performed for each subject to determine whether HA-CC barrier film was used during the primary cesarean delivery. The two study groups were similar with respect to age, body mass index, parity, and gestational age.

HA-CC barrier film is commonly used in gynecologic and other surgeries in an effort to reduce the risk of postoperative adhesions, which can result in significant morbidity – including pain, infertility, and bowel obstruction, Dr. Gaspar-Oishi said.

Data with respect to the use of HA-CC barrier film for cesarean delivery, however, are limited. In fact, this is the first prospective study to show that barrier film use does not improve delivery time or adhesion severity in subsequent cesarean deliveries, she noted.

The findings support a recent commentary in Obstetrics & Gynecology, which stated that the routine use of HA-CC barrier film is ill advised because of a lack of evidence regarding clinical benefit, she noted.

Although limited by the fact that about 80% of the women in the study were Asian American (an accurate reflection of the population served by the study hospital), the findings are nonetheless important, because an estimated 90% of all primary cesarean deliveries will result in a repeat cesarean delivery, and because HA-CC barrier film use can be costly, she said.

Additional study in a more diverse population is needed to allow for more generalized conclusions, she noted.

Dr. Gaspar-Oishi reported having no relevant financial disclosures.

CHICAGO – The use of a sodium hyaluronate–carboxycellulose adhesion barrier during primary cesarean delivery was not associated with decreased delivery time or improved adhesion scores during a first repeat cesarean delivery in a cohort study involving 97 women.

The incision to delivery time among 71 women who did not receive sodium hyaluronate–carboxycellulose (HA-CC) barrier film during their primary cesarean delivery was 9.5 minutes, compared with 10.6 minutes in 26 women who did receive HA-CC barrier film, Dr. Maria Gaspar-Oishi of the University of Hawaii, Honolulu, reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Average blood loss and adhesion scores also were similar in the two groups. Blood loss was 564 mL and 563 mL, in the groups, respectively; mean fascia adhesion scores were 1.45 and 1.31; and mean intraperitoneal adhesion scores were 1.11 and 0.92, said Dr. Gaspar-Oishi, whose paper received a Donald F. Richardson Memorial Prize Paper award as one of the best papers by a junior fellow at the meeting.

Patients included in the combined prospective/retrospective cohort study were women who gave birth at a single center. Intraoperative data were collected prospectively at the time of first repeat cesarean delivery, and a retrospective chart study was performed for each subject to determine whether HA-CC barrier film was used during the primary cesarean delivery. The two study groups were similar with respect to age, body mass index, parity, and gestational age.

HA-CC barrier film is commonly used in gynecologic and other surgeries in an effort to reduce the risk of postoperative adhesions, which can result in significant morbidity – including pain, infertility, and bowel obstruction, Dr. Gaspar-Oishi said.

Data with respect to the use of HA-CC barrier film for cesarean delivery, however, are limited. In fact, this is the first prospective study to show that barrier film use does not improve delivery time or adhesion severity in subsequent cesarean deliveries, she noted.

The findings support a recent commentary in Obstetrics & Gynecology, which stated that the routine use of HA-CC barrier film is ill advised because of a lack of evidence regarding clinical benefit, she noted.

Although limited by the fact that about 80% of the women in the study were Asian American (an accurate reflection of the population served by the study hospital), the findings are nonetheless important, because an estimated 90% of all primary cesarean deliveries will result in a repeat cesarean delivery, and because HA-CC barrier film use can be costly, she said.

Additional study in a more diverse population is needed to allow for more generalized conclusions, she noted.

Dr. Gaspar-Oishi reported having no relevant financial disclosures.

CHICAGO – The use of a sodium hyaluronate–carboxycellulose adhesion barrier during primary cesarean delivery was not associated with decreased delivery time or improved adhesion scores during a first repeat cesarean delivery in a cohort study involving 97 women.

The incision to delivery time among 71 women who did not receive sodium hyaluronate–carboxycellulose (HA-CC) barrier film during their primary cesarean delivery was 9.5 minutes, compared with 10.6 minutes in 26 women who did receive HA-CC barrier film, Dr. Maria Gaspar-Oishi of the University of Hawaii, Honolulu, reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Average blood loss and adhesion scores also were similar in the two groups. Blood loss was 564 mL and 563 mL, in the groups, respectively; mean fascia adhesion scores were 1.45 and 1.31; and mean intraperitoneal adhesion scores were 1.11 and 0.92, said Dr. Gaspar-Oishi, whose paper received a Donald F. Richardson Memorial Prize Paper award as one of the best papers by a junior fellow at the meeting.

Patients included in the combined prospective/retrospective cohort study were women who gave birth at a single center. Intraoperative data were collected prospectively at the time of first repeat cesarean delivery, and a retrospective chart study was performed for each subject to determine whether HA-CC barrier film was used during the primary cesarean delivery. The two study groups were similar with respect to age, body mass index, parity, and gestational age.

HA-CC barrier film is commonly used in gynecologic and other surgeries in an effort to reduce the risk of postoperative adhesions, which can result in significant morbidity – including pain, infertility, and bowel obstruction, Dr. Gaspar-Oishi said.

Data with respect to the use of HA-CC barrier film for cesarean delivery, however, are limited. In fact, this is the first prospective study to show that barrier film use does not improve delivery time or adhesion severity in subsequent cesarean deliveries, she noted.

The findings support a recent commentary in Obstetrics & Gynecology, which stated that the routine use of HA-CC barrier film is ill advised because of a lack of evidence regarding clinical benefit, she noted.

Although limited by the fact that about 80% of the women in the study were Asian American (an accurate reflection of the population served by the study hospital), the findings are nonetheless important, because an estimated 90% of all primary cesarean deliveries will result in a repeat cesarean delivery, and because HA-CC barrier film use can be costly, she said.

Additional study in a more diverse population is needed to allow for more generalized conclusions, she noted.

Dr. Gaspar-Oishi reported having no relevant financial disclosures.

CHICAGO – The 3,200 U. S. hospitals that offer obstetric care are being urged to reduce maternal morbidity and mortality by joining the National Partnership for Maternal Safety. The initial aim of the collaborative is to implement priority bundles for the three most common preventable causes of maternal death and severe morbidity: obstetric hemorrhage, severe hypertension in pregnancy, and peripartum venous thromboembolism.

Efforts by Dr. Elliott Main to turn maternal mortality reviews into quality improvement materials for preeclampsia and hemorrhage were instrumental in the efforts. In this exclusive video, Dr. Main, medical director of the California Maternal Quality Care Collaborative and chair of obstetrics and gynecology at California Pacific Medical Center in San Francisco, discusses how those efforts are beginning to take root nationally with Dr. Mary Elizabeth D’Alton, chair of obstetrics and gynecology at Columbia University, New York, and Dr. Sarah J. Kilpatrick, chair of obstetrics and gynecology at Cedars-Sinai, Los Angeles.

Dr. Main interviewed Dr. D’Alton and Dr. Kilpatrick at the 2014 ACOG annual clinical meeting after they presented the Edith Louise Potter Memorial Lecture titled "Maternal Morbidity and Mortality in the U.S.: Time to Wake Up and Take the Lead."

CHICAGO – The 3,200 U. S. hospitals that offer obstetric care are being urged to reduce maternal morbidity and mortality by joining the National Partnership for Maternal Safety. The initial aim of the collaborative is to implement priority bundles for the three most common preventable causes of maternal death and severe morbidity: obstetric hemorrhage, severe hypertension in pregnancy, and peripartum venous thromboembolism.

Efforts by Dr. Elliott Main to turn maternal mortality reviews into quality improvement materials for preeclampsia and hemorrhage were instrumental in the efforts. In this exclusive video, Dr. Main, medical director of the California Maternal Quality Care Collaborative and chair of obstetrics and gynecology at California Pacific Medical Center in San Francisco, discusses how those efforts are beginning to take root nationally with Dr. Mary Elizabeth D’Alton, chair of obstetrics and gynecology at Columbia University, New York, and Dr. Sarah J. Kilpatrick, chair of obstetrics and gynecology at Cedars-Sinai, Los Angeles.

Dr. Main interviewed Dr. D’Alton and Dr. Kilpatrick at the 2014 ACOG annual clinical meeting after they presented the Edith Louise Potter Memorial Lecture titled "Maternal Morbidity and Mortality in the U.S.: Time to Wake Up and Take the Lead."

CHICAGO – The 3,200 U. S. hospitals that offer obstetric care are being urged to reduce maternal morbidity and mortality by joining the National Partnership for Maternal Safety. The initial aim of the collaborative is to implement priority bundles for the three most common preventable causes of maternal death and severe morbidity: obstetric hemorrhage, severe hypertension in pregnancy, and peripartum venous thromboembolism.

Efforts by Dr. Elliott Main to turn maternal mortality reviews into quality improvement materials for preeclampsia and hemorrhage were instrumental in the efforts. In this exclusive video, Dr. Main, medical director of the California Maternal Quality Care Collaborative and chair of obstetrics and gynecology at California Pacific Medical Center in San Francisco, discusses how those efforts are beginning to take root nationally with Dr. Mary Elizabeth D’Alton, chair of obstetrics and gynecology at Columbia University, New York, and Dr. Sarah J. Kilpatrick, chair of obstetrics and gynecology at Cedars-Sinai, Los Angeles.

Dr. Main interviewed Dr. D’Alton and Dr. Kilpatrick at the 2014 ACOG annual clinical meeting after they presented the Edith Louise Potter Memorial Lecture titled "Maternal Morbidity and Mortality in the U.S.: Time to Wake Up and Take the Lead."

CHICAGO – Transvaginal ultrasound measures of cervical length at 16-22 weeks gestation can identify patients who have a short cervix and are at risk of preterm birth, allowing selection of patients for vaginal progesterone therapy.

At the annual meeting of the American Congress of Obstetricians and Gynecologists, Dr. Eric Strand, director of the division of general obstetrics and gynecology at Washington University, St. Louis, interviews Dr. George Andrew Macones, the Mitchell and Elaine Yanow Professor and chair of the department of obstetrics and gynecology at Washington University, about these findings and how clinicians can get free training in performing transvaginal screening to determine cervical length. Dr. Macones presented the March of Dimes Annual Lecture entitled "Preventing Preterm Birth: Recent Progress and Future Directions."

CHICAGO – Transvaginal ultrasound measures of cervical length at 16-22 weeks gestation can identify patients who have a short cervix and are at risk of preterm birth, allowing selection of patients for vaginal progesterone therapy.

At the annual meeting of the American Congress of Obstetricians and Gynecologists, Dr. Eric Strand, director of the division of general obstetrics and gynecology at Washington University, St. Louis, interviews Dr. George Andrew Macones, the Mitchell and Elaine Yanow Professor and chair of the department of obstetrics and gynecology at Washington University, about these findings and how clinicians can get free training in performing transvaginal screening to determine cervical length. Dr. Macones presented the March of Dimes Annual Lecture entitled "Preventing Preterm Birth: Recent Progress and Future Directions."

CHICAGO – Transvaginal ultrasound measures of cervical length at 16-22 weeks gestation can identify patients who have a short cervix and are at risk of preterm birth, allowing selection of patients for vaginal progesterone therapy.

At the annual meeting of the American Congress of Obstetricians and Gynecologists, Dr. Eric Strand, director of the division of general obstetrics and gynecology at Washington University, St. Louis, interviews Dr. George Andrew Macones, the Mitchell and Elaine Yanow Professor and chair of the department of obstetrics and gynecology at Washington University, about these findings and how clinicians can get free training in performing transvaginal screening to determine cervical length. Dr. Macones presented the March of Dimes Annual Lecture entitled "Preventing Preterm Birth: Recent Progress and Future Directions."

CHICAGO – The presence of scar tissue may protect against synthetic mesh erosion following vaginal prolapse repair, according to findings from a retrospective case-control study.

The findings provide further support for the existing American College of Obstetricians and Gynecologists recommendation that vaginal mesh repair should be reserved for women with recurrent prolapse, and may be helpful for preoperative counseling in these patients, according to Dr. Nicholas Kongoasa of Saint Peter’s University Hospital, New Brunswick, N.J.

"Women are four times less likely to have mesh erosion if they have previously undergone prolapse repair, and that mesh should be reserved for those who fail primary repair," Dr. Kongoasa said in an interview.

Dr. Kongoasa was unable to make his presentation at the scheduled session at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Patients in the study included all those who underwent mesh-augmented pelvic floor repair between June 1, 2008, and Dec. 31, 2011. All surgeries were performed by a single surgeon using polypropylene mesh. Of 810 mesh-augmented pelvic floor repair surgeries, 688 involved no prior vaginal prolapse surgery and 142 were in patients with a prior vaginal prolapse repair.

The two groups did not differ with respect to mean operating time, intraoperative complications, postoperative complications, hospital stay, or prolapse recurrence. Also, they were similar in terms of demographics and pelvic organ prolapse quantification staging with the exception of prior hysterectomy in the prior surgery group.

During follow-ups of 1-4.5 years, mesh erosion occurred in 10.6% of those with no prior vaginal prolapse surgery, and in 2.8% of those with prior vaginal prolapse surgery (odds ratio, 4.1).

Among those with mesh erosion, no differences were seen between those with and without prior surgery with respect to time to diagnosis or location and size of erosion.

"The large number of cases and the high odds ratio warrant that this subject be further investigated by future prospective studies," he said.

The study was limited by its retrospective nature and the fact that some patients who experienced complications may have sought care elsewhere.

As for why previous surgery may protect against mesh erosion, "my personal theory is that there is generally less blood supply to the previously operated area, and this may lead to less inflammation and reaction to the foreign body," he said.

Dr. Kongoasa reported having no disclosures.

CHICAGO – The presence of scar tissue may protect against synthetic mesh erosion following vaginal prolapse repair, according to findings from a retrospective case-control study.

The findings provide further support for the existing American College of Obstetricians and Gynecologists recommendation that vaginal mesh repair should be reserved for women with recurrent prolapse, and may be helpful for preoperative counseling in these patients, according to Dr. Nicholas Kongoasa of Saint Peter’s University Hospital, New Brunswick, N.J.

"Women are four times less likely to have mesh erosion if they have previously undergone prolapse repair, and that mesh should be reserved for those who fail primary repair," Dr. Kongoasa said in an interview.

Dr. Kongoasa was unable to make his presentation at the scheduled session at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Patients in the study included all those who underwent mesh-augmented pelvic floor repair between June 1, 2008, and Dec. 31, 2011. All surgeries were performed by a single surgeon using polypropylene mesh. Of 810 mesh-augmented pelvic floor repair surgeries, 688 involved no prior vaginal prolapse surgery and 142 were in patients with a prior vaginal prolapse repair.

The two groups did not differ with respect to mean operating time, intraoperative complications, postoperative complications, hospital stay, or prolapse recurrence. Also, they were similar in terms of demographics and pelvic organ prolapse quantification staging with the exception of prior hysterectomy in the prior surgery group.

During follow-ups of 1-4.5 years, mesh erosion occurred in 10.6% of those with no prior vaginal prolapse surgery, and in 2.8% of those with prior vaginal prolapse surgery (odds ratio, 4.1).

Among those with mesh erosion, no differences were seen between those with and without prior surgery with respect to time to diagnosis or location and size of erosion.

"The large number of cases and the high odds ratio warrant that this subject be further investigated by future prospective studies," he said.

The study was limited by its retrospective nature and the fact that some patients who experienced complications may have sought care elsewhere.

As for why previous surgery may protect against mesh erosion, "my personal theory is that there is generally less blood supply to the previously operated area, and this may lead to less inflammation and reaction to the foreign body," he said.

Dr. Kongoasa reported having no disclosures.

CHICAGO – The presence of scar tissue may protect against synthetic mesh erosion following vaginal prolapse repair, according to findings from a retrospective case-control study.

The findings provide further support for the existing American College of Obstetricians and Gynecologists recommendation that vaginal mesh repair should be reserved for women with recurrent prolapse, and may be helpful for preoperative counseling in these patients, according to Dr. Nicholas Kongoasa of Saint Peter’s University Hospital, New Brunswick, N.J.

"Women are four times less likely to have mesh erosion if they have previously undergone prolapse repair, and that mesh should be reserved for those who fail primary repair," Dr. Kongoasa said in an interview.

Dr. Kongoasa was unable to make his presentation at the scheduled session at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Patients in the study included all those who underwent mesh-augmented pelvic floor repair between June 1, 2008, and Dec. 31, 2011. All surgeries were performed by a single surgeon using polypropylene mesh. Of 810 mesh-augmented pelvic floor repair surgeries, 688 involved no prior vaginal prolapse surgery and 142 were in patients with a prior vaginal prolapse repair.

The two groups did not differ with respect to mean operating time, intraoperative complications, postoperative complications, hospital stay, or prolapse recurrence. Also, they were similar in terms of demographics and pelvic organ prolapse quantification staging with the exception of prior hysterectomy in the prior surgery group.

During follow-ups of 1-4.5 years, mesh erosion occurred in 10.6% of those with no prior vaginal prolapse surgery, and in 2.8% of those with prior vaginal prolapse surgery (odds ratio, 4.1).

Among those with mesh erosion, no differences were seen between those with and without prior surgery with respect to time to diagnosis or location and size of erosion.

"The large number of cases and the high odds ratio warrant that this subject be further investigated by future prospective studies," he said.

The study was limited by its retrospective nature and the fact that some patients who experienced complications may have sought care elsewhere.

As for why previous surgery may protect against mesh erosion, "my personal theory is that there is generally less blood supply to the previously operated area, and this may lead to less inflammation and reaction to the foreign body," he said.

Dr. Kongoasa reported having no disclosures.

CHICAGO – The placental alpha-microglobulin-1 test is superior from a cost-benefit perspective to the combined traditional diagnostic test of pooling, nitrazine, and ferning for screening in the setting of questionable preterm premature rupture of membranes, Dr. Nelson C. Echebiri reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The PAMG-1 also should be used if the traditional test result is equivocal or inconclusive, he said.

The cost of PAMG-1 is about $85, compared with $14 for the traditional diagnostic test. Because of the added expense, testing all patients who present with possible preterm premature rupture of membranes (PROM) and those whose diagnosis is obvious would be counterproductive, Dr. Echebiri said.

The PAMG-1 test is easy to use and has been shown in multiple studies to have high sensitivity and specificity for detecting PAMG-1 – a marker for amniotic fluid. Dr. Echebiri said he felt the test would be a good noninvasive alternative to the invasive standard test of indigo carmine dye injection into the amniotic cavity.

For the study, a decision analysis was constructed to estimate the cost benefit of the PAMG-1 test as compared with the traditional test with respect to preterm delivery costs, which average $47,000. The analysis was based on the setting of potential preterm PROM at 34 weeks to less than 37 weeks of gestation as applied to 1,000 theoretical patients, 1,000 times each. Cost estimates reflected 2013 dollars.

When used according to the decision analysis, the estimated annual net benefit with the noninvasive placental alpha-microglobulin-1 (PAMG-1) test was $12,215/person tested, compared with $4,737/person tested using the traditional test. The PAMG-1 test was cost-beneficial in cases in which the probability of preterm PROM was less than 42% (net savings of $5,000-$32,000 per person tested vs. $5,000-$9,000 per person with the traditional test.

The PAMG-1 test was not associated with any savings in cases with 44% or greater probability of preterm PROM, said Dr. Echebiri of the University of Buffalo, N.Y., whose paper received a Donald F. Richardson Memorial Prize Paper Award as one of the best papers by a junior fellow at the meeting.

Dr. Echebiri reported having no disclosures.

CHICAGO – The placental alpha-microglobulin-1 test is superior from a cost-benefit perspective to the combined traditional diagnostic test of pooling, nitrazine, and ferning for screening in the setting of questionable preterm premature rupture of membranes, Dr. Nelson C. Echebiri reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The PAMG-1 also should be used if the traditional test result is equivocal or inconclusive, he said.

The cost of PAMG-1 is about $85, compared with $14 for the traditional diagnostic test. Because of the added expense, testing all patients who present with possible preterm premature rupture of membranes (PROM) and those whose diagnosis is obvious would be counterproductive, Dr. Echebiri said.

The PAMG-1 test is easy to use and has been shown in multiple studies to have high sensitivity and specificity for detecting PAMG-1 – a marker for amniotic fluid. Dr. Echebiri said he felt the test would be a good noninvasive alternative to the invasive standard test of indigo carmine dye injection into the amniotic cavity.

For the study, a decision analysis was constructed to estimate the cost benefit of the PAMG-1 test as compared with the traditional test with respect to preterm delivery costs, which average $47,000. The analysis was based on the setting of potential preterm PROM at 34 weeks to less than 37 weeks of gestation as applied to 1,000 theoretical patients, 1,000 times each. Cost estimates reflected 2013 dollars.

When used according to the decision analysis, the estimated annual net benefit with the noninvasive placental alpha-microglobulin-1 (PAMG-1) test was $12,215/person tested, compared with $4,737/person tested using the traditional test. The PAMG-1 test was cost-beneficial in cases in which the probability of preterm PROM was less than 42% (net savings of $5,000-$32,000 per person tested vs. $5,000-$9,000 per person with the traditional test.

The PAMG-1 test was not associated with any savings in cases with 44% or greater probability of preterm PROM, said Dr. Echebiri of the University of Buffalo, N.Y., whose paper received a Donald F. Richardson Memorial Prize Paper Award as one of the best papers by a junior fellow at the meeting.

Dr. Echebiri reported having no disclosures.

CHICAGO – The placental alpha-microglobulin-1 test is superior from a cost-benefit perspective to the combined traditional diagnostic test of pooling, nitrazine, and ferning for screening in the setting of questionable preterm premature rupture of membranes, Dr. Nelson C. Echebiri reported at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The PAMG-1 also should be used if the traditional test result is equivocal or inconclusive, he said.

The cost of PAMG-1 is about $85, compared with $14 for the traditional diagnostic test. Because of the added expense, testing all patients who present with possible preterm premature rupture of membranes (PROM) and those whose diagnosis is obvious would be counterproductive, Dr. Echebiri said.

The PAMG-1 test is easy to use and has been shown in multiple studies to have high sensitivity and specificity for detecting PAMG-1 – a marker for amniotic fluid. Dr. Echebiri said he felt the test would be a good noninvasive alternative to the invasive standard test of indigo carmine dye injection into the amniotic cavity.

For the study, a decision analysis was constructed to estimate the cost benefit of the PAMG-1 test as compared with the traditional test with respect to preterm delivery costs, which average $47,000. The analysis was based on the setting of potential preterm PROM at 34 weeks to less than 37 weeks of gestation as applied to 1,000 theoretical patients, 1,000 times each. Cost estimates reflected 2013 dollars.

When used according to the decision analysis, the estimated annual net benefit with the noninvasive placental alpha-microglobulin-1 (PAMG-1) test was $12,215/person tested, compared with $4,737/person tested using the traditional test. The PAMG-1 test was cost-beneficial in cases in which the probability of preterm PROM was less than 42% (net savings of $5,000-$32,000 per person tested vs. $5,000-$9,000 per person with the traditional test.

The PAMG-1 test was not associated with any savings in cases with 44% or greater probability of preterm PROM, said Dr. Echebiri of the University of Buffalo, N.Y., whose paper received a Donald F. Richardson Memorial Prize Paper Award as one of the best papers by a junior fellow at the meeting.

Dr. Echebiri reported having no disclosures.

CHICAGO – Dr. Laurie J. McKenzie, who is a member of the ACOG Committee on the Scientific Program and the medical faculties of the University of Texas and Baylor College of Medicine, Houston, interviews Dr. Michael M. Frumovitz of the University of Texas MD Anderson Cancer Center, Houston, the presenter of the John I. Brewer Memorial Lecture on cervical cancer screening.

During a video interview at the annual meeting of the American Congress of Obstetricians and Gynecologists, they discuss reductions in cervical dysplasia that have already been seen with HPV vaccination in Australia and note the barriers to HPV vaccination in the United States. Dr. Frumovitz predicts that HPV testing will ultimately replace Pap smears for primary screening in most cases and discusses the potential for high-resolution microendoscopy to change how cervical lesions are diagnosed and treated.

CHICAGO – Dr. Laurie J. McKenzie, who is a member of the ACOG Committee on the Scientific Program and the medical faculties of the University of Texas and Baylor College of Medicine, Houston, interviews Dr. Michael M. Frumovitz of the University of Texas MD Anderson Cancer Center, Houston, the presenter of the John I. Brewer Memorial Lecture on cervical cancer screening.

During a video interview at the annual meeting of the American Congress of Obstetricians and Gynecologists, they discuss reductions in cervical dysplasia that have already been seen with HPV vaccination in Australia and note the barriers to HPV vaccination in the United States. Dr. Frumovitz predicts that HPV testing will ultimately replace Pap smears for primary screening in most cases and discusses the potential for high-resolution microendoscopy to change how cervical lesions are diagnosed and treated.

CHICAGO – Dr. Laurie J. McKenzie, who is a member of the ACOG Committee on the Scientific Program and the medical faculties of the University of Texas and Baylor College of Medicine, Houston, interviews Dr. Michael M. Frumovitz of the University of Texas MD Anderson Cancer Center, Houston, the presenter of the John I. Brewer Memorial Lecture on cervical cancer screening.

During a video interview at the annual meeting of the American Congress of Obstetricians and Gynecologists, they discuss reductions in cervical dysplasia that have already been seen with HPV vaccination in Australia and note the barriers to HPV vaccination in the United States. Dr. Frumovitz predicts that HPV testing will ultimately replace Pap smears for primary screening in most cases and discusses the potential for high-resolution microendoscopy to change how cervical lesions are diagnosed and treated.

CHICAGO – Dr. Rosanne M. Kho discussed patient selection for vaginal approaches in an interview with Dr. Daniel M. Breitkopf of the Mayo Clinic in Rochester, Minn., at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Dr. Kho of the Mayo Clinic in Phoenix noted that there are only a few contraindications to the vaginal approach and emphasized the importance of incorporating lessons from robotic and minimally invasive surgery into vaginal hysterectomy. Dr. Kho warned of an impending health care crisis as a result of inadequate training in vaginal approaches.

[email protected]

On Twitter @maryjodales

CHICAGO – Dr. Rosanne M. Kho discussed patient selection for vaginal approaches in an interview with Dr. Daniel M. Breitkopf of the Mayo Clinic in Rochester, Minn., at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Dr. Kho of the Mayo Clinic in Phoenix noted that there are only a few contraindications to the vaginal approach and emphasized the importance of incorporating lessons from robotic and minimally invasive surgery into vaginal hysterectomy. Dr. Kho warned of an impending health care crisis as a result of inadequate training in vaginal approaches.

[email protected]

On Twitter @maryjodales

CHICAGO – Dr. Rosanne M. Kho discussed patient selection for vaginal approaches in an interview with Dr. Daniel M. Breitkopf of the Mayo Clinic in Rochester, Minn., at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Dr. Kho of the Mayo Clinic in Phoenix noted that there are only a few contraindications to the vaginal approach and emphasized the importance of incorporating lessons from robotic and minimally invasive surgery into vaginal hysterectomy. Dr. Kho warned of an impending health care crisis as a result of inadequate training in vaginal approaches.

[email protected]

On Twitter @maryjodales

CHICAGO – From advances in long-acting reversible contraception (LARC) to emergency contraception, Dr. Eve Espey and Dr. Tony Ogburn of the University of New Mexico, Albuquerque, give you a quick update of their clinical seminar session at the annual meeting of the American Congress of Obstetricians and Gynecologists. Watch their video highlights for the latest updates on contraceptive techniques and their recommendations on resources for selecting patient-centered contraception for "every woman, every time."

[email protected]

On Twitter @maryjodales

CHICAGO – From advances in long-acting reversible contraception (LARC) to emergency contraception, Dr. Eve Espey and Dr. Tony Ogburn of the University of New Mexico, Albuquerque, give you a quick update of their clinical seminar session at the annual meeting of the American Congress of Obstetricians and Gynecologists. Watch their video highlights for the latest updates on contraceptive techniques and their recommendations on resources for selecting patient-centered contraception for "every woman, every time."

[email protected]

On Twitter @maryjodales

CHICAGO – From advances in long-acting reversible contraception (LARC) to emergency contraception, Dr. Eve Espey and Dr. Tony Ogburn of the University of New Mexico, Albuquerque, give you a quick update of their clinical seminar session at the annual meeting of the American Congress of Obstetricians and Gynecologists. Watch their video highlights for the latest updates on contraceptive techniques and their recommendations on resources for selecting patient-centered contraception for "every woman, every time."

[email protected]

On Twitter @maryjodales

CHICAGO – "Every Woman, Every Time," Dr. Jeanne A. Conry’s presidential theme, was front and center at the President’s Program at the annual meeting the American Congress of Obstetricians and Gynecologists. In this exclusive video interview, Dr. Conry spoke with Dr. Lesley Regan about her presentation on basic rights to health care and Dr. Mark Hanson about the role of obstetrician-gynecologists in preventive health initiatives to reduce noncommunicable diseases. Prof. Regan leads global women’s health efforts for the Royal College of Obstetricians & Gynaecologists in London and chairs the Committee for Sexual and Reproductive Rights for the International Federation of Gynecology and Obstetrics.

Prof. Hanson, director of the academic unit of human development and health at the University of Southhampton in the United Kingdom, has focused his work on new ways to reduce disease processes and improve health by championing preventive interventions during preconception, throughout pregnancy, and in infancy and childhood.

The program also included Dr. Tyrone Hayes, professor of biology at the University of California, Berkeley, whose research findings on the impact of environmental chemicals on health demonstrate why industry must bear the burden of proof for safety before products are introduced.

CHICAGO – "Every Woman, Every Time," Dr. Jeanne A. Conry’s presidential theme, was front and center at the President’s Program at the annual meeting the American Congress of Obstetricians and Gynecologists. In this exclusive video interview, Dr. Conry spoke with Dr. Lesley Regan about her presentation on basic rights to health care and Dr. Mark Hanson about the role of obstetrician-gynecologists in preventive health initiatives to reduce noncommunicable diseases. Prof. Regan leads global women’s health efforts for the Royal College of Obstetricians & Gynaecologists in London and chairs the Committee for Sexual and Reproductive Rights for the International Federation of Gynecology and Obstetrics.

Prof. Hanson, director of the academic unit of human development and health at the University of Southhampton in the United Kingdom, has focused his work on new ways to reduce disease processes and improve health by championing preventive interventions during preconception, throughout pregnancy, and in infancy and childhood.

The program also included Dr. Tyrone Hayes, professor of biology at the University of California, Berkeley, whose research findings on the impact of environmental chemicals on health demonstrate why industry must bear the burden of proof for safety before products are introduced.

CHICAGO – "Every Woman, Every Time," Dr. Jeanne A. Conry’s presidential theme, was front and center at the President’s Program at the annual meeting the American Congress of Obstetricians and Gynecologists. In this exclusive video interview, Dr. Conry spoke with Dr. Lesley Regan about her presentation on basic rights to health care and Dr. Mark Hanson about the role of obstetrician-gynecologists in preventive health initiatives to reduce noncommunicable diseases. Prof. Regan leads global women’s health efforts for the Royal College of Obstetricians & Gynaecologists in London and chairs the Committee for Sexual and Reproductive Rights for the International Federation of Gynecology and Obstetrics.

Prof. Hanson, director of the academic unit of human development and health at the University of Southhampton in the United Kingdom, has focused his work on new ways to reduce disease processes and improve health by championing preventive interventions during preconception, throughout pregnancy, and in infancy and childhood.

The program also included Dr. Tyrone Hayes, professor of biology at the University of California, Berkeley, whose research findings on the impact of environmental chemicals on health demonstrate why industry must bear the burden of proof for safety before products are introduced.