OBG Management

RELIZEN: NONHORMONAL TX FOR HOT FLASHES
RELIZEN^® is a patented, nonhormonal therapy for the relief of hot flashes associated with menopause from JDS Therapeutics.New to the United States, Relizen has been used by women and physicians in Europe for more than 15 years, according to the manufacturer, and has clinical efficacy data established in a placebo-controlled trial published in Climacteric. The active ingredient is a non-estrogenic, purified Swedish pollen extract that has pollen allergens removed. The daily dose is 2 pills/day.
FOR MORE INFORMATION, VISIT www.relizen.com

RISK ASSESSMENT FOR SPORADIC BREAST CA
BREVAGenplus, from Phenogen Sciences, Inc, assesses clinical risk factors (Gail score) and genetic markers (SNP profile) to determine 5-year and lifetime risks of developing sporadic (nonhereditary) breast cancer. The test is for Caucasian, Hispanic, and African-American women, aged 35 years and older, who have not had breast cancer but have one or more risk factors for developing breast cancer.
FOR MORE INFORMATION, VISIT http://phenogensciences.com

3 NEW DEVICE LENGTHS FOR DISSECTION
Covidien has added 13-cm, 26-cm, and 48-cm lengths to its Sonicision^tm Cordless Ultrasonic Dissection Device portfolio. Covidien reports that Sonicision offers surgeons faster dissection with increased mobility without having to manage electrical cords. Single-use and reusable components available.
FOR MORE INFORMATION, VISIT www.covidien.com

ROBOTICS SIMULATOR
Simbionix has launched RobotiX Mentor, a comprehensive educational tool for surgeons of all levels to practice the skills required to perform robotic surgery. By using basic task modules and cross-specialty clinical procedure simulations, surgeons can experience partial or entire robotic procedures.
FOR MORE INFORMATION, VISIT www.simbionix.com

NATURAL PRODUCTS FOR PREGNANCY
Fairhaven Health’s PregnancyPlus Line includes Prenatal Vitamins, Omega-3, and Cal-Mag (calcium, magnesium, and vitamin D3) natural supplements. Fairhaven Health claims that the Belly Rest Pregnancy Pillow provides back-pain relief during sleep. All products are BPA-free, with no artificial flavors, colors, or preservatives.
FOR MORE INFORMATION, VISIT www.fairhavenhealth.com

OPTIMIZE OFFICE WORKFLOW
Comtron offers Medgen EHR, a customized electronic health record (EHR) system. Comtron claims the Medgen EHR system is easily adaptable and is cost-effective by offering increased efficiency, decreased overhead, and improved patient care.
FOR MORE INFORMATION, VISIT www.medgenehr.com

VISUALIZATION ENHANCEMENT TOOLS
Karl Storz launched the Image1^® SPIES^tm visualization enhancement modular system for endoscopic surgery. SPIES, an acronym for Storz Professional Image Enhancement System, has three components: video software, a modular camera control unit, and a graphic user interface. Karl Storz reports that the modular design allows customization to individual needs. The combined camera heads and visualization tools offer homogenous illumination and contrast enhancement.
FOR MORE INFORMATION, VISIT www.karlstorz.com

NONINVASIVE PRENATAL GENETIC BLOOD TEST
Synapse Diagnostics offers Materni T21 PLUS, a test for specific chromosomal conditions in a fetus that are associated with birth defects. Conducted on blood drawn from the mother as early as 10 weeks’ gestation, the test uses genomic sequencing. Synapse Diagnostics claims that this is the only test that not only detects abnormalities like Down syndrome but also reveals defects called “microdeletions” caused by a missing gene that are otherwise difficult to discover early in pregnancy.
FOR MORE INFORMATION, VISIT www.synapsediagnostics.com

NEW ULTRASOUND SYSTEM
Samsung Electronics America, Inc. has introduced the UGEO WS80A ultrasound system for ObGyn applications. Key features: 21.5"-wide LED monitor with touch panel, 5D technologies, FRV^tm (Feto Realistic View) with 3D visualization, and piezoelectric crystal design for high resolution. Samsung reports that the UGEO WS80A has improved gray scale and color with a more precise signal, speckle reduction, and edge and contrast enhancement.
FOR MORE INFORMATION, VISIT www.samsung.com/healthcare

SEAL & CUT TECHNOLOGY
Aesculap has expanded its line of Caiman 5 Seal and Cut Technology to include 24-cm and 44-cm lengths of vessel sealing devices in addition to its original 36-cm device. Aesculap claims that the extended jaw design provides uniform pressure distribution across a variety of tissue thicknesses. These bipolar electrosurgical RF energy instruments are intended for open and laparoscopic surgery.
FOR MORE INFORMATION, VISIT www.caimansurgery.com

DETECTING RUPTURED MEMBRANES
ROM Plus^®is a rapid qualitative test for in vitro detection of amniotic proteins in vaginal secretions of pregnant women for possible diagnosis of premature rupture of membranes (PROM). ROM Plus uses a monoclonal/polyclonal antibody approach to detect two amniotic proteins, AFP and PP12. Accurate and prompt diagnosis of PROM helps decrease or avoid serious complications for mother and fetus.
FOR MORE INFORMATION, VISIT www.clinicalinnovations.com

RELIZEN: NONHORMONAL TX FOR HOT FLASHES
RELIZEN^® is a patented, nonhormonal therapy for the relief of hot flashes associated with menopause from JDS Therapeutics.New to the United States, Relizen has been used by women and physicians in Europe for more than 15 years, according to the manufacturer, and has clinical efficacy data established in a placebo-controlled trial published in Climacteric. The active ingredient is a non-estrogenic, purified Swedish pollen extract that has pollen allergens removed. The daily dose is 2 pills/day.
FOR MORE INFORMATION, VISIT www.relizen.com

RISK ASSESSMENT FOR SPORADIC BREAST CA
BREVAGenplus, from Phenogen Sciences, Inc, assesses clinical risk factors (Gail score) and genetic markers (SNP profile) to determine 5-year and lifetime risks of developing sporadic (nonhereditary) breast cancer. The test is for Caucasian, Hispanic, and African-American women, aged 35 years and older, who have not had breast cancer but have one or more risk factors for developing breast cancer.
FOR MORE INFORMATION, VISIT http://phenogensciences.com

3 NEW DEVICE LENGTHS FOR DISSECTION
Covidien has added 13-cm, 26-cm, and 48-cm lengths to its Sonicision^tm Cordless Ultrasonic Dissection Device portfolio. Covidien reports that Sonicision offers surgeons faster dissection with increased mobility without having to manage electrical cords. Single-use and reusable components available.
FOR MORE INFORMATION, VISIT www.covidien.com

ROBOTICS SIMULATOR
Simbionix has launched RobotiX Mentor, a comprehensive educational tool for surgeons of all levels to practice the skills required to perform robotic surgery. By using basic task modules and cross-specialty clinical procedure simulations, surgeons can experience partial or entire robotic procedures.
FOR MORE INFORMATION, VISIT www.simbionix.com

NATURAL PRODUCTS FOR PREGNANCY
Fairhaven Health’s PregnancyPlus Line includes Prenatal Vitamins, Omega-3, and Cal-Mag (calcium, magnesium, and vitamin D3) natural supplements. Fairhaven Health claims that the Belly Rest Pregnancy Pillow provides back-pain relief during sleep. All products are BPA-free, with no artificial flavors, colors, or preservatives.
FOR MORE INFORMATION, VISIT www.fairhavenhealth.com

OPTIMIZE OFFICE WORKFLOW
Comtron offers Medgen EHR, a customized electronic health record (EHR) system. Comtron claims the Medgen EHR system is easily adaptable and is cost-effective by offering increased efficiency, decreased overhead, and improved patient care.
FOR MORE INFORMATION, VISIT www.medgenehr.com

VISUALIZATION ENHANCEMENT TOOLS
Karl Storz launched the Image1^® SPIES^tm visualization enhancement modular system for endoscopic surgery. SPIES, an acronym for Storz Professional Image Enhancement System, has three components: video software, a modular camera control unit, and a graphic user interface. Karl Storz reports that the modular design allows customization to individual needs. The combined camera heads and visualization tools offer homogenous illumination and contrast enhancement.
FOR MORE INFORMATION, VISIT www.karlstorz.com

NONINVASIVE PRENATAL GENETIC BLOOD TEST
Synapse Diagnostics offers Materni T21 PLUS, a test for specific chromosomal conditions in a fetus that are associated with birth defects. Conducted on blood drawn from the mother as early as 10 weeks’ gestation, the test uses genomic sequencing. Synapse Diagnostics claims that this is the only test that not only detects abnormalities like Down syndrome but also reveals defects called “microdeletions” caused by a missing gene that are otherwise difficult to discover early in pregnancy.
FOR MORE INFORMATION, VISIT www.synapsediagnostics.com

NEW ULTRASOUND SYSTEM
Samsung Electronics America, Inc. has introduced the UGEO WS80A ultrasound system for ObGyn applications. Key features: 21.5"-wide LED monitor with touch panel, 5D technologies, FRV^tm (Feto Realistic View) with 3D visualization, and piezoelectric crystal design for high resolution. Samsung reports that the UGEO WS80A has improved gray scale and color with a more precise signal, speckle reduction, and edge and contrast enhancement.
FOR MORE INFORMATION, VISIT www.samsung.com/healthcare

SEAL & CUT TECHNOLOGY
Aesculap has expanded its line of Caiman 5 Seal and Cut Technology to include 24-cm and 44-cm lengths of vessel sealing devices in addition to its original 36-cm device. Aesculap claims that the extended jaw design provides uniform pressure distribution across a variety of tissue thicknesses. These bipolar electrosurgical RF energy instruments are intended for open and laparoscopic surgery.
FOR MORE INFORMATION, VISIT www.caimansurgery.com

DETECTING RUPTURED MEMBRANES
ROM Plus^®is a rapid qualitative test for in vitro detection of amniotic proteins in vaginal secretions of pregnant women for possible diagnosis of premature rupture of membranes (PROM). ROM Plus uses a monoclonal/polyclonal antibody approach to detect two amniotic proteins, AFP and PP12. Accurate and prompt diagnosis of PROM helps decrease or avoid serious complications for mother and fetus.
FOR MORE INFORMATION, VISIT www.clinicalinnovations.com

RELIZEN: NONHORMONAL TX FOR HOT FLASHES
RELIZEN^® is a patented, nonhormonal therapy for the relief of hot flashes associated with menopause from JDS Therapeutics.New to the United States, Relizen has been used by women and physicians in Europe for more than 15 years, according to the manufacturer, and has clinical efficacy data established in a placebo-controlled trial published in Climacteric. The active ingredient is a non-estrogenic, purified Swedish pollen extract that has pollen allergens removed. The daily dose is 2 pills/day.
FOR MORE INFORMATION, VISIT www.relizen.com

RISK ASSESSMENT FOR SPORADIC BREAST CA
BREVAGenplus, from Phenogen Sciences, Inc, assesses clinical risk factors (Gail score) and genetic markers (SNP profile) to determine 5-year and lifetime risks of developing sporadic (nonhereditary) breast cancer. The test is for Caucasian, Hispanic, and African-American women, aged 35 years and older, who have not had breast cancer but have one or more risk factors for developing breast cancer.
FOR MORE INFORMATION, VISIT http://phenogensciences.com

3 NEW DEVICE LENGTHS FOR DISSECTION
Covidien has added 13-cm, 26-cm, and 48-cm lengths to its Sonicision^tm Cordless Ultrasonic Dissection Device portfolio. Covidien reports that Sonicision offers surgeons faster dissection with increased mobility without having to manage electrical cords. Single-use and reusable components available.
FOR MORE INFORMATION, VISIT www.covidien.com

ROBOTICS SIMULATOR
Simbionix has launched RobotiX Mentor, a comprehensive educational tool for surgeons of all levels to practice the skills required to perform robotic surgery. By using basic task modules and cross-specialty clinical procedure simulations, surgeons can experience partial or entire robotic procedures.
FOR MORE INFORMATION, VISIT www.simbionix.com

NATURAL PRODUCTS FOR PREGNANCY
Fairhaven Health’s PregnancyPlus Line includes Prenatal Vitamins, Omega-3, and Cal-Mag (calcium, magnesium, and vitamin D3) natural supplements. Fairhaven Health claims that the Belly Rest Pregnancy Pillow provides back-pain relief during sleep. All products are BPA-free, with no artificial flavors, colors, or preservatives.
FOR MORE INFORMATION, VISIT www.fairhavenhealth.com

OPTIMIZE OFFICE WORKFLOW
Comtron offers Medgen EHR, a customized electronic health record (EHR) system. Comtron claims the Medgen EHR system is easily adaptable and is cost-effective by offering increased efficiency, decreased overhead, and improved patient care.
FOR MORE INFORMATION, VISIT www.medgenehr.com

VISUALIZATION ENHANCEMENT TOOLS
Karl Storz launched the Image1^® SPIES^tm visualization enhancement modular system for endoscopic surgery. SPIES, an acronym for Storz Professional Image Enhancement System, has three components: video software, a modular camera control unit, and a graphic user interface. Karl Storz reports that the modular design allows customization to individual needs. The combined camera heads and visualization tools offer homogenous illumination and contrast enhancement.
FOR MORE INFORMATION, VISIT www.karlstorz.com

NONINVASIVE PRENATAL GENETIC BLOOD TEST
Synapse Diagnostics offers Materni T21 PLUS, a test for specific chromosomal conditions in a fetus that are associated with birth defects. Conducted on blood drawn from the mother as early as 10 weeks’ gestation, the test uses genomic sequencing. Synapse Diagnostics claims that this is the only test that not only detects abnormalities like Down syndrome but also reveals defects called “microdeletions” caused by a missing gene that are otherwise difficult to discover early in pregnancy.
FOR MORE INFORMATION, VISIT www.synapsediagnostics.com

NEW ULTRASOUND SYSTEM
Samsung Electronics America, Inc. has introduced the UGEO WS80A ultrasound system for ObGyn applications. Key features: 21.5"-wide LED monitor with touch panel, 5D technologies, FRV^tm (Feto Realistic View) with 3D visualization, and piezoelectric crystal design for high resolution. Samsung reports that the UGEO WS80A has improved gray scale and color with a more precise signal, speckle reduction, and edge and contrast enhancement.
FOR MORE INFORMATION, VISIT www.samsung.com/healthcare

SEAL & CUT TECHNOLOGY
Aesculap has expanded its line of Caiman 5 Seal and Cut Technology to include 24-cm and 44-cm lengths of vessel sealing devices in addition to its original 36-cm device. Aesculap claims that the extended jaw design provides uniform pressure distribution across a variety of tissue thicknesses. These bipolar electrosurgical RF energy instruments are intended for open and laparoscopic surgery.
FOR MORE INFORMATION, VISIT www.caimansurgery.com

DETECTING RUPTURED MEMBRANES
ROM Plus^®is a rapid qualitative test for in vitro detection of amniotic proteins in vaginal secretions of pregnant women for possible diagnosis of premature rupture of membranes (PROM). ROM Plus uses a monoclonal/polyclonal antibody approach to detect two amniotic proteins, AFP and PP12. Accurate and prompt diagnosis of PROM helps decrease or avoid serious complications for mother and fetus.
FOR MORE INFORMATION, VISIT www.clinicalinnovations.com

A new mobile app for iPhone and iPad enables both clinicians and patients to make decisions about menopausal therapies for moderate to severe hot flashes, night sweats, and/or genitourinary symptoms. The app also aids in assessing the patient’s risk of cardiovascular disease, breast cancer, and fracture.

The MenoPro app, developed in association with the North American Menopause Society (NAMS), is available free of charge from Apple. The app is designed to aid in the assessment and management of bothersome menopausal symptoms in women aged 45 and older.

Designed for both clinician and patient
A novel feature of the app is its two modes—one for the clinician and another for the patient. The clinician mode enables risk assessment and decision-making to determine whether hormonal therapy might be indicated and to determine the formulation and dosage of the therapy selected. It also features assessment of the patient’s 10-year risk of cardiovascular disease, her risk of breast cancer using the Gail model, and her fracture risk using the FRAX tool. When hormonal therapies are not appropriate, the app steers the clinician to nonhormonal options.

The patient can make use of the app to learn about her different treatment options, including lifestyle modifications. The app guides her through a self-assessment to gauge how far along she is in the menopausal transition, the severity of her symptoms, and her interest in hormonal or nonhormonal therapy. The app begins by recommending lifestyle changes and behavioral factors that can reduce menopausal symptoms. After a 3-month trial of these modifications, the patient is prompted to visit her health-care provider if further relief is needed.

Only FDA-approved drugs are recommended
“The app is completely up to date in terms of information about the newest medications that have been approved by the US Food and Drug Administration,” says JoAnn E. Manson, MD, DrPH, current chair of the NAMS Scientific Program and a past president of NAMS. Dr. Manson is Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston. She also is Professor of Medicine and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School.

“The app focuses on FDA-approved medications, including off-label use of medications that may be commonly prescribed in practice to treat hot flashes, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs),” she says.

“I think another big advantage is that very often clinicians who are managing patients during the menopausal transition or in early menopause may not be thinking that much about cardiovascular risk or even know how to evaluate it or make use of a 10-year risk score. So the app really helps them to become very familiar with the evaluation of cardiovascular risk, breast cancer risk, and fracture risk, and provides them with the resources to make use of the information.”

An algorithm is available within the app
The app is based on an algorithm that can be accessed within the app by choosing the “About” button. Another feature: the clinician can email a summary of the patient’s assessment directly to her, along with links to resources on a variety of relevant topics.

“In the future, there is a plan to have the app available for other mobile phones and tablet devices in addition to the iPhone and iPad,” says Dr. Manson. “We also hope to have it incorporated into electronic health records, where it could be used for clinical decision-making within the record.”

The app is not intended to replace clinical judgment, she adds. “I think clinicians are really familiar with the concept that, when you’re using an app, clinical judgment remains paramount. The app is not going to replace the clinician’s own discernment of what is going on with the patient.”

For detailed information, see an article on the app in the journal Menopause, available at http://www.menopause.org/docs/default-source/professional/our-new-paper.pdf

Share your thoughts on this article! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

A new mobile app for iPhone and iPad enables both clinicians and patients to make decisions about menopausal therapies for moderate to severe hot flashes, night sweats, and/or genitourinary symptoms. The app also aids in assessing the patient’s risk of cardiovascular disease, breast cancer, and fracture.

The MenoPro app, developed in association with the North American Menopause Society (NAMS), is available free of charge from Apple. The app is designed to aid in the assessment and management of bothersome menopausal symptoms in women aged 45 and older.

Designed for both clinician and patient
A novel feature of the app is its two modes—one for the clinician and another for the patient. The clinician mode enables risk assessment and decision-making to determine whether hormonal therapy might be indicated and to determine the formulation and dosage of the therapy selected. It also features assessment of the patient’s 10-year risk of cardiovascular disease, her risk of breast cancer using the Gail model, and her fracture risk using the FRAX tool. When hormonal therapies are not appropriate, the app steers the clinician to nonhormonal options.

The patient can make use of the app to learn about her different treatment options, including lifestyle modifications. The app guides her through a self-assessment to gauge how far along she is in the menopausal transition, the severity of her symptoms, and her interest in hormonal or nonhormonal therapy. The app begins by recommending lifestyle changes and behavioral factors that can reduce menopausal symptoms. After a 3-month trial of these modifications, the patient is prompted to visit her health-care provider if further relief is needed.

Only FDA-approved drugs are recommended
“The app is completely up to date in terms of information about the newest medications that have been approved by the US Food and Drug Administration,” says JoAnn E. Manson, MD, DrPH, current chair of the NAMS Scientific Program and a past president of NAMS. Dr. Manson is Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston. She also is Professor of Medicine and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School.

“The app focuses on FDA-approved medications, including off-label use of medications that may be commonly prescribed in practice to treat hot flashes, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs),” she says.

“I think another big advantage is that very often clinicians who are managing patients during the menopausal transition or in early menopause may not be thinking that much about cardiovascular risk or even know how to evaluate it or make use of a 10-year risk score. So the app really helps them to become very familiar with the evaluation of cardiovascular risk, breast cancer risk, and fracture risk, and provides them with the resources to make use of the information.”

An algorithm is available within the app
The app is based on an algorithm that can be accessed within the app by choosing the “About” button. Another feature: the clinician can email a summary of the patient’s assessment directly to her, along with links to resources on a variety of relevant topics.

“In the future, there is a plan to have the app available for other mobile phones and tablet devices in addition to the iPhone and iPad,” says Dr. Manson. “We also hope to have it incorporated into electronic health records, where it could be used for clinical decision-making within the record.”

The app is not intended to replace clinical judgment, she adds. “I think clinicians are really familiar with the concept that, when you’re using an app, clinical judgment remains paramount. The app is not going to replace the clinician’s own discernment of what is going on with the patient.”

For detailed information, see an article on the app in the journal Menopause, available at http://www.menopause.org/docs/default-source/professional/our-new-paper.pdf

Share your thoughts on this article! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

A new mobile app for iPhone and iPad enables both clinicians and patients to make decisions about menopausal therapies for moderate to severe hot flashes, night sweats, and/or genitourinary symptoms. The app also aids in assessing the patient’s risk of cardiovascular disease, breast cancer, and fracture.

The MenoPro app, developed in association with the North American Menopause Society (NAMS), is available free of charge from Apple. The app is designed to aid in the assessment and management of bothersome menopausal symptoms in women aged 45 and older.

Designed for both clinician and patient
A novel feature of the app is its two modes—one for the clinician and another for the patient. The clinician mode enables risk assessment and decision-making to determine whether hormonal therapy might be indicated and to determine the formulation and dosage of the therapy selected. It also features assessment of the patient’s 10-year risk of cardiovascular disease, her risk of breast cancer using the Gail model, and her fracture risk using the FRAX tool. When hormonal therapies are not appropriate, the app steers the clinician to nonhormonal options.

The patient can make use of the app to learn about her different treatment options, including lifestyle modifications. The app guides her through a self-assessment to gauge how far along she is in the menopausal transition, the severity of her symptoms, and her interest in hormonal or nonhormonal therapy. The app begins by recommending lifestyle changes and behavioral factors that can reduce menopausal symptoms. After a 3-month trial of these modifications, the patient is prompted to visit her health-care provider if further relief is needed.

Only FDA-approved drugs are recommended
“The app is completely up to date in terms of information about the newest medications that have been approved by the US Food and Drug Administration,” says JoAnn E. Manson, MD, DrPH, current chair of the NAMS Scientific Program and a past president of NAMS. Dr. Manson is Chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston. She also is Professor of Medicine and the Michael and Lee Bell Professor of Women’s Health at Harvard Medical School.

“The app focuses on FDA-approved medications, including off-label use of medications that may be commonly prescribed in practice to treat hot flashes, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs),” she says.

“I think another big advantage is that very often clinicians who are managing patients during the menopausal transition or in early menopause may not be thinking that much about cardiovascular risk or even know how to evaluate it or make use of a 10-year risk score. So the app really helps them to become very familiar with the evaluation of cardiovascular risk, breast cancer risk, and fracture risk, and provides them with the resources to make use of the information.”

An algorithm is available within the app
The app is based on an algorithm that can be accessed within the app by choosing the “About” button. Another feature: the clinician can email a summary of the patient’s assessment directly to her, along with links to resources on a variety of relevant topics.

“In the future, there is a plan to have the app available for other mobile phones and tablet devices in addition to the iPhone and iPad,” says Dr. Manson. “We also hope to have it incorporated into electronic health records, where it could be used for clinical decision-making within the record.”

The app is not intended to replace clinical judgment, she adds. “I think clinicians are really familiar with the concept that, when you’re using an app, clinical judgment remains paramount. The app is not going to replace the clinician’s own discernment of what is going on with the patient.”

For detailed information, see an article on the app in the journal Menopause, available at http://www.menopause.org/docs/default-source/professional/our-new-paper.pdf

Share your thoughts on this article! Send your Letter to the Editor to [email protected]. Please include your name and the city and state in which you practice.

As Ebola virus spreads from West Africa, it has become apparent that ObGyns in the United States may need to evaluate patients who have been exposed to the disease. The Centers for Disease Control and Prevention (CDC) has a dedicated Web site for Ebola that outlines signs and symptoms, transmission, risk of exposure, diagnosis and treatment options, and clinical guidance for health-care workers.¹

What are the symptoms of Ebola?
If a woman from West Africa presents with a fever, the CDC advises that she be asked specifically about recent travel to affected areas (currently Liberia, Sierra Leone, Guinea, and Nigeria). Clinical signs and symptoms of Ebola include a fever of 38.6°C [101.5°F] or higher with additional symptoms¹:

• severe headache
• muscle pain
• weakness
• vomiting
• diarrhea
• abdominal (stomach) pain
• unexplained hemorrhage.

Symptoms may appear from 2–21 days after exposure to Ebola. If a person with early symptoms of Ebola has had contact with the blood or body fluids of a person sick with Ebola, objects contaminated with the blood or body fluids of a person sick with Ebola, or with Ebola-infected animals, the patient should be isolated and public health professionals immediately notified, says the CDC. Blood samples from the patient should be tested to confirm infection (visit the CDC’s Ebola Web site for a list of diagnostic tests).¹

More women than men infected
In a recently published perspective from the CDC on what ObGyns should be aware of regarding Ebola, Jamieson and colleagues reported that, according to UNICEF data, in this current outbreak more women than men are infected.² They say this is most likely because women in West Africa are the primary caregivers for sick relatives, as well as make up the majority of health-care providers and birth attendants.

Pregnancy and Ebola
Based on limited, historic data from other Ebola outbreaks in Africa, there is no evidence suggesting that pregnant women are more susceptible to Ebola, although say Jamieson and colleagues, there is limited evidence suggesting that pregnant women are more at risk for severe illness and death from Ebola.² It also appears that pregnant women with Ebola are at increased risk for spontaneous abortion and pregnancy-related hemorrhage. In 1996 in Kikwit, Democratic Republic of the Congo, pregnant women were more likely than the overall patient population with Ebola to have hemorrhagic complications, specifically vaginal and uterine bleeding associated with abortion or delivery. Children born to mothers with Ebola have not survived, though the cause of death has not been identified specifically.²

Breastfeeding and Ebola
The CDC has issued recommendations for breastfeeding or infant feeding by women with suspected or confirmed exposure to Ebola. Two key points are made³:

• Mothers with probable or confirmed Ebola virus disease should not have close contact with their infants when safe alternatives to breastfeeding and infant care exist
• Where resources are limited, non−breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.

CDC recommends that decisions about how to best feed an infant whose mother has probable or confirmed Ebola be made on a case-by-case basis, balancing nutritional needs with the risk of contracting the disease. There is not enough evidence to suggest when it is safe to resume breastfeeding after a mother’s recovery, unless her breast milk can be shown to be Ebola-free.³

Protecting health-care personnel
The CDC Ebola Web site¹ provides specific protocols designed to keep health-care workers safe. These include detailed guidelines for evaluating returned travelers, instructions for specimen collection, transport, testing, submission, use of protective equipment, and isolation procedures.

Share your thoughts on this news! Send your Letter to the Editor to [email protected]. Please include your name, and the city and state in which you practice

As Ebola virus spreads from West Africa, it has become apparent that ObGyns in the United States may need to evaluate patients who have been exposed to the disease. The Centers for Disease Control and Prevention (CDC) has a dedicated Web site for Ebola that outlines signs and symptoms, transmission, risk of exposure, diagnosis and treatment options, and clinical guidance for health-care workers.¹

What are the symptoms of Ebola?
If a woman from West Africa presents with a fever, the CDC advises that she be asked specifically about recent travel to affected areas (currently Liberia, Sierra Leone, Guinea, and Nigeria). Clinical signs and symptoms of Ebola include a fever of 38.6°C [101.5°F] or higher with additional symptoms¹:

• severe headache
• muscle pain
• weakness
• vomiting
• diarrhea
• abdominal (stomach) pain
• unexplained hemorrhage.

Symptoms may appear from 2–21 days after exposure to Ebola. If a person with early symptoms of Ebola has had contact with the blood or body fluids of a person sick with Ebola, objects contaminated with the blood or body fluids of a person sick with Ebola, or with Ebola-infected animals, the patient should be isolated and public health professionals immediately notified, says the CDC. Blood samples from the patient should be tested to confirm infection (visit the CDC’s Ebola Web site for a list of diagnostic tests).¹

More women than men infected
In a recently published perspective from the CDC on what ObGyns should be aware of regarding Ebola, Jamieson and colleagues reported that, according to UNICEF data, in this current outbreak more women than men are infected.² They say this is most likely because women in West Africa are the primary caregivers for sick relatives, as well as make up the majority of health-care providers and birth attendants.

Pregnancy and Ebola
Based on limited, historic data from other Ebola outbreaks in Africa, there is no evidence suggesting that pregnant women are more susceptible to Ebola, although say Jamieson and colleagues, there is limited evidence suggesting that pregnant women are more at risk for severe illness and death from Ebola.² It also appears that pregnant women with Ebola are at increased risk for spontaneous abortion and pregnancy-related hemorrhage. In 1996 in Kikwit, Democratic Republic of the Congo, pregnant women were more likely than the overall patient population with Ebola to have hemorrhagic complications, specifically vaginal and uterine bleeding associated with abortion or delivery. Children born to mothers with Ebola have not survived, though the cause of death has not been identified specifically.²

Breastfeeding and Ebola
The CDC has issued recommendations for breastfeeding or infant feeding by women with suspected or confirmed exposure to Ebola. Two key points are made³:

• Mothers with probable or confirmed Ebola virus disease should not have close contact with their infants when safe alternatives to breastfeeding and infant care exist
• Where resources are limited, non−breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.

CDC recommends that decisions about how to best feed an infant whose mother has probable or confirmed Ebola be made on a case-by-case basis, balancing nutritional needs with the risk of contracting the disease. There is not enough evidence to suggest when it is safe to resume breastfeeding after a mother’s recovery, unless her breast milk can be shown to be Ebola-free.³

Protecting health-care personnel
The CDC Ebola Web site¹ provides specific protocols designed to keep health-care workers safe. These include detailed guidelines for evaluating returned travelers, instructions for specimen collection, transport, testing, submission, use of protective equipment, and isolation procedures.

Share your thoughts on this news! Send your Letter to the Editor to [email protected]. Please include your name, and the city and state in which you practice

As Ebola virus spreads from West Africa, it has become apparent that ObGyns in the United States may need to evaluate patients who have been exposed to the disease. The Centers for Disease Control and Prevention (CDC) has a dedicated Web site for Ebola that outlines signs and symptoms, transmission, risk of exposure, diagnosis and treatment options, and clinical guidance for health-care workers.¹

What are the symptoms of Ebola?
If a woman from West Africa presents with a fever, the CDC advises that she be asked specifically about recent travel to affected areas (currently Liberia, Sierra Leone, Guinea, and Nigeria). Clinical signs and symptoms of Ebola include a fever of 38.6°C [101.5°F] or higher with additional symptoms¹:

• severe headache
• muscle pain
• weakness
• vomiting
• diarrhea
• abdominal (stomach) pain
• unexplained hemorrhage.

Symptoms may appear from 2–21 days after exposure to Ebola. If a person with early symptoms of Ebola has had contact with the blood or body fluids of a person sick with Ebola, objects contaminated with the blood or body fluids of a person sick with Ebola, or with Ebola-infected animals, the patient should be isolated and public health professionals immediately notified, says the CDC. Blood samples from the patient should be tested to confirm infection (visit the CDC’s Ebola Web site for a list of diagnostic tests).¹

More women than men infected
In a recently published perspective from the CDC on what ObGyns should be aware of regarding Ebola, Jamieson and colleagues reported that, according to UNICEF data, in this current outbreak more women than men are infected.² They say this is most likely because women in West Africa are the primary caregivers for sick relatives, as well as make up the majority of health-care providers and birth attendants.

Pregnancy and Ebola
Based on limited, historic data from other Ebola outbreaks in Africa, there is no evidence suggesting that pregnant women are more susceptible to Ebola, although say Jamieson and colleagues, there is limited evidence suggesting that pregnant women are more at risk for severe illness and death from Ebola.² It also appears that pregnant women with Ebola are at increased risk for spontaneous abortion and pregnancy-related hemorrhage. In 1996 in Kikwit, Democratic Republic of the Congo, pregnant women were more likely than the overall patient population with Ebola to have hemorrhagic complications, specifically vaginal and uterine bleeding associated with abortion or delivery. Children born to mothers with Ebola have not survived, though the cause of death has not been identified specifically.²

Breastfeeding and Ebola
The CDC has issued recommendations for breastfeeding or infant feeding by women with suspected or confirmed exposure to Ebola. Two key points are made³:

• Mothers with probable or confirmed Ebola virus disease should not have close contact with their infants when safe alternatives to breastfeeding and infant care exist
• Where resources are limited, non−breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.

CDC recommends that decisions about how to best feed an infant whose mother has probable or confirmed Ebola be made on a case-by-case basis, balancing nutritional needs with the risk of contracting the disease. There is not enough evidence to suggest when it is safe to resume breastfeeding after a mother’s recovery, unless her breast milk can be shown to be Ebola-free.³

Protecting health-care personnel
The CDC Ebola Web site¹ provides specific protocols designed to keep health-care workers safe. These include detailed guidelines for evaluating returned travelers, instructions for specimen collection, transport, testing, submission, use of protective equipment, and isolation procedures.

Share your thoughts on this news! Send your Letter to the Editor to [email protected]. Please include your name, and the city and state in which you practice

Should a baby that presents breech at term be delivered vaginally or by cesarean delivery? In October 2000, results of the Term Breech Trial (TBT), the largest randomized controlled trial to investigate the effect of delivery mode for term breech deliveries on neonatal and maternal outcomes, essentially answered this question, showing that planned cesarean delivery was safer than planned vaginal delivery (with combined perinatal morbidity and mortality scores of 5% vs 16%, respectively).¹ These study results affected national guidelines for choosing delivery mode in the Netherlands as well as other countries around the world.

What has been the impact on mode of delivery and neonatal outcome in the Netherlands since the TBT’s publication? Furthermore, are there antepartum parameters that can distinguish which women are at high risk versus low risk for adverse neonatal outcomes when presenting breech at delivery? Vlemmix and colleagues sought to answer these questions, using retrospective data from the Netherlands Perinatal Registry (PRN) from 1999 through 2007.¹

Perinatal death decreased over time—but only for women electing cesarean
During the study period, approximately 4% of all births were breech. The researchers studied 58,320 women with term breech delivery, using the PRN. They noted an increase in the elective cesarean delivery (ECD) rate for these women, from 24% before October 2000 to 60% after December 2000, and as a consequence, found that overall perinatal mortality decreased from 1.3% to 0.7% (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.28–0.93).¹

However, among the women who underwent planned vaginal delivery, the overall perinatal mortality remained stable (1.7% vs 1.6%; OR, 0.96; 95% CI, 0.52–1.76). “Despite the lower percentage of women opting for or offered a vaginal delivery, and despite a higher emergency cesarean rate during vaginal breech birth, neonatal outcome within the planned vaginal birth group did not improve,” state the authors.¹

Putting the results in absolute numbers
The investigators say that the 40% of Dutch women with breech presentation at term who still attempt vaginal birth do so without improved neonatal outcome; these deliveries generate a 10-fold higher fetal mortality rate compared with ECD. Further, no subgroup of women, when evaluating parity, onset of labor, type of breech presentation, and birthweight, could be identified with a low risk of poor neonatal outcome during planned vaginal delivery compared with ECD.¹

Since the TBT, 1,692 more combined elective and emergency cesarean deliveries were performed annually, leading to five less neonatal deaths per year (number needed to treat, 338). If all women who still undergo planned vaginal birth receive ECD, 6,490 more ECDs would be performed, with 10 less neonatal deaths, 116 less neonates with low Apgar score, and 20 less neonates with birth trauma per year, according to the researchers.¹ 

They suggest that clinicians use the results of this study when counseling women with a term breech presentation on mode of delivery. “To properly inform patients, a combination of risk presentation (absolute risks, relative risks and figures) is necessary to enable individual informed decision making.”¹

Share your thoughts on this news! Send your Letter to the Editor to [email protected]. Please include your name, and the city and state in which you practice.

Should a baby that presents breech at term be delivered vaginally or by cesarean delivery? In October 2000, results of the Term Breech Trial (TBT), the largest randomized controlled trial to investigate the effect of delivery mode for term breech deliveries on neonatal and maternal outcomes, essentially answered this question, showing that planned cesarean delivery was safer than planned vaginal delivery (with combined perinatal morbidity and mortality scores of 5% vs 16%, respectively).¹ These study results affected national guidelines for choosing delivery mode in the Netherlands as well as other countries around the world.

What has been the impact on mode of delivery and neonatal outcome in the Netherlands since the TBT’s publication? Furthermore, are there antepartum parameters that can distinguish which women are at high risk versus low risk for adverse neonatal outcomes when presenting breech at delivery? Vlemmix and colleagues sought to answer these questions, using retrospective data from the Netherlands Perinatal Registry (PRN) from 1999 through 2007.¹

Perinatal death decreased over time—but only for women electing cesarean
During the study period, approximately 4% of all births were breech. The researchers studied 58,320 women with term breech delivery, using the PRN. They noted an increase in the elective cesarean delivery (ECD) rate for these women, from 24% before October 2000 to 60% after December 2000, and as a consequence, found that overall perinatal mortality decreased from 1.3% to 0.7% (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.28–0.93).¹

However, among the women who underwent planned vaginal delivery, the overall perinatal mortality remained stable (1.7% vs 1.6%; OR, 0.96; 95% CI, 0.52–1.76). “Despite the lower percentage of women opting for or offered a vaginal delivery, and despite a higher emergency cesarean rate during vaginal breech birth, neonatal outcome within the planned vaginal birth group did not improve,” state the authors.¹

Putting the results in absolute numbers
The investigators say that the 40% of Dutch women with breech presentation at term who still attempt vaginal birth do so without improved neonatal outcome; these deliveries generate a 10-fold higher fetal mortality rate compared with ECD. Further, no subgroup of women, when evaluating parity, onset of labor, type of breech presentation, and birthweight, could be identified with a low risk of poor neonatal outcome during planned vaginal delivery compared with ECD.¹

Since the TBT, 1,692 more combined elective and emergency cesarean deliveries were performed annually, leading to five less neonatal deaths per year (number needed to treat, 338). If all women who still undergo planned vaginal birth receive ECD, 6,490 more ECDs would be performed, with 10 less neonatal deaths, 116 less neonates with low Apgar score, and 20 less neonates with birth trauma per year, according to the researchers.¹ 

They suggest that clinicians use the results of this study when counseling women with a term breech presentation on mode of delivery. “To properly inform patients, a combination of risk presentation (absolute risks, relative risks and figures) is necessary to enable individual informed decision making.”¹

Share your thoughts on this news! Send your Letter to the Editor to [email protected]. Please include your name, and the city and state in which you practice.

Should a baby that presents breech at term be delivered vaginally or by cesarean delivery? In October 2000, results of the Term Breech Trial (TBT), the largest randomized controlled trial to investigate the effect of delivery mode for term breech deliveries on neonatal and maternal outcomes, essentially answered this question, showing that planned cesarean delivery was safer than planned vaginal delivery (with combined perinatal morbidity and mortality scores of 5% vs 16%, respectively).¹ These study results affected national guidelines for choosing delivery mode in the Netherlands as well as other countries around the world.

What has been the impact on mode of delivery and neonatal outcome in the Netherlands since the TBT’s publication? Furthermore, are there antepartum parameters that can distinguish which women are at high risk versus low risk for adverse neonatal outcomes when presenting breech at delivery? Vlemmix and colleagues sought to answer these questions, using retrospective data from the Netherlands Perinatal Registry (PRN) from 1999 through 2007.¹

Perinatal death decreased over time—but only for women electing cesarean
During the study period, approximately 4% of all births were breech. The researchers studied 58,320 women with term breech delivery, using the PRN. They noted an increase in the elective cesarean delivery (ECD) rate for these women, from 24% before October 2000 to 60% after December 2000, and as a consequence, found that overall perinatal mortality decreased from 1.3% to 0.7% (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.28–0.93).¹

However, among the women who underwent planned vaginal delivery, the overall perinatal mortality remained stable (1.7% vs 1.6%; OR, 0.96; 95% CI, 0.52–1.76). “Despite the lower percentage of women opting for or offered a vaginal delivery, and despite a higher emergency cesarean rate during vaginal breech birth, neonatal outcome within the planned vaginal birth group did not improve,” state the authors.¹

Putting the results in absolute numbers
The investigators say that the 40% of Dutch women with breech presentation at term who still attempt vaginal birth do so without improved neonatal outcome; these deliveries generate a 10-fold higher fetal mortality rate compared with ECD. Further, no subgroup of women, when evaluating parity, onset of labor, type of breech presentation, and birthweight, could be identified with a low risk of poor neonatal outcome during planned vaginal delivery compared with ECD.¹

Since the TBT, 1,692 more combined elective and emergency cesarean deliveries were performed annually, leading to five less neonatal deaths per year (number needed to treat, 338). If all women who still undergo planned vaginal birth receive ECD, 6,490 more ECDs would be performed, with 10 less neonatal deaths, 116 less neonates with low Apgar score, and 20 less neonates with birth trauma per year, according to the researchers.¹ 

They suggest that clinicians use the results of this study when counseling women with a term breech presentation on mode of delivery. “To properly inform patients, a combination of risk presentation (absolute risks, relative risks and figures) is necessary to enable individual informed decision making.”¹

Share your thoughts on this news! Send your Letter to the Editor to [email protected]. Please include your name, and the city and state in which you practice.