Conversations in Obstetrics and Gynecology Unknown

Polycystic Ovarian Syndrome (PCOS) is common, affecting 5 to 15% of women of reproductive age. PCOS can have reproductive, metabolic and psychological implications across the lifespan. This month on COG we talk with Prof Adam Balen about the international evidenced based guideline released in 2018 on the the diagnosis and management of PCOS.
Then in journal club we discuss 4 articles:
Costello, M. F., et al. "Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility." (2019): hoy021.
Smithson, David S., Tannys DR Vause, and Anthony P. Cheung. "No. 362-ovulation induction in polycystic ovary syndrome." Journal of Obstetrics and Gynaecology Canada 40.7 (2018): 978-987.
Torres, Pedro J., et al. "Gut microbial diversity in women with polycystic ovary syndrome correlates with hyperandrogenism." The Journal of Clinical Endocrinology & Metabolism 103.4 (2018): 1502-1511.
Varanasi, L. Chitra, et al. "Polycystic ovarian syndrome: prevalence and impact on the wellbeing of Australian women aged 16–29 years." Australian and New Zealand Journal of Obstetrics and Gynaecology 58.2 (2018): 222-233.
Related papers from the International group:
Teede, Helena J., et al. "Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome." Human Reproduction 33.9 (2018): 1602-1618.

Do you ERAS?  You should! ERAS protocols have resulted in shorter length of hospital stay reduced complications, readmissions and costs. This month on COG we talk to  Dr Amanika Kumar, a Gynaecological Oncologist from the Mayo Clinic about Enhanced Recovery After Surgery. Then we check out three articles in journal club along the ERAS theme.
 
Nensi A, Coll-Black M, Leyland N, Sobel ML. Implementation of a Same-Day Discharge Protocol Following Total Laparoscopic Hysterectomy. Journal of Obstetrics and Gynaecology Canada. 2018 Jan 1;40(1):29-35.
Meyer LA, Lasala J, Iniesta MD, Nick AM, Munsell MF, Shi Q, Wang XS, Cain KE, Lu KH, Ramirez PT. Effect of an Enhanced Recovery After Surgery Program on Opioid Use and Patient-Reported Outcomes. Obstetrics & Gynecology. 2018 Aug 1;132(2):281-90.
Keil DS, Schiff LD, Carey ET, Moulder JK, Goetzinger AM, Patidar SM, Hance LM, Kolarczyk LM, Isaak RS, Strassle PD, Schoenherr JW. Predictors of Admission After the Implementation of an Enhanced Recovery After Surgery Pathway for Minimally Invasive Gynecologic Surgery. Anesthesia and analgesia. 2018 Apr.
 
Also here’s the link to a new publication on recommendations for ERAS in CS…
Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, Pettersson K, Fawcett WJ, Shalabi MM, Metcalfe A, Gramlich L. Guidelines for intraoperative care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. American journal of obstetrics and gynecology. 2018 Aug 15.
#COG #COG11 #ERAS #FOAMEd #MayoClinic
 

Can we close the orgasm gap? Recent US data suggests that only 65% of heterosexual women usually orgasm during sex, compared with 95% of heterosexual men. In the same study 88% of lesbian women reported usual orgasm during sex. Dr Debra Wickman’s work focuses on helping women achieve great sex. This month on COG we talk about how to ask the difficult questions, and what interventions might help.
 
Then on journal club, we discuss 2 recent papers.
Szell N, Komisaruk B, Goldstein SW, Qu XH, Shaw M, Goldstein I. A meta-analysis detailing overall sexual function and orgasmic function in women undergoing midurethral sling surgery for stress incontinence. Sexual medicine. 2017 Jun 1;5(2):e84-93.
McDonald E, Woolhouse H, Brown SJ. Sexual pleasure and emotional satisfaction in the first 18 months after childbirth. Midwifery. 2017 Dec 1;55:60-6.

Persistent pelvic pain is common, affecting 15-25% of women. Women experiencing persistent pelvic pain often experience a delay in diagnosis and may also experience associated negative psychological, behavioural, cognitive and sexual consequences sometime worsened because of this delay. Check out this excellent presentation  “Persistent Pelvic Pain - The Big Picture - Dr Susan Evans” from Pelvic Pain Foundation on Vimeo.   https://vimeo.com/163056418. Treating women with persistent pain can be complex - but there is hope! 
This month on COG we talk to Dr Sawsan As-Sanie about the evolving science around chronic pelvic pain, and optimal  techniques for diagnosis and management. Then journal club explores 3 offerings from the latest literature.
 
In journal club we discuss 3 articles:
Allaire, Catherine, et al. "Chronic pelvic pain in an interdisciplinary setting: 1-year prospective cohort." American journal of obstetrics and gynecology 218.1 (2018): 114-e1.
As-Sanie, Sawsan, et al. "Opioid prescribing patterns, patient use, and postoperative pain after hysterectomy for benign indications." Obstetrics & Gynecology 130.6 (2017): 1261-1268.
Saxena, Rahul, et al. "Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain." International journal of yoga 10.1 (2017): 9.
 
 

COG#8 - Evidence
Research underpins advancements in women’s health around the world. This month we talk to Nancy Chescheir, the Editor in Chief of ‘Obstetrics and Gynecology’ aka the Green Journal about her work to improve women’s health globally. 
The articles referenced during the discussion include:
Arya R. Postpartum venous thromboembolism prophylaxis: harm versus benefit. BJOG: An International Journal of Obstetrics & Gynaecology. 2018 Feb 23.
Skeith AE, Niu B, Valent AM, Tuuli MG, Caughey AB. Adding Azithromycin to Cephalosporin for Cesarean Delivery Infection Prophylaxis: A Cost-Effectiveness Analysis. Obstetrics & Gynecology. 2017 Dec 1;130(6):1279-84

51% of Australian women have had an unplanned pregnancy. This month on COG we talk about contraception. The World Health Organisation estimates that if every couple used contraception perfectly every single time they had sex, there would still be six million unplanned pregnancies each year worldwide. 
First up we talk to Dr Catrina Melville, an Obstetrician and Gynecologist who specialises in sexual health.  Then we chat with Dr Ander Faber-Swenson about the current evidence around salpingectomy as a sterilisation procedure and prevention of ovarian cancer. 
The articles he references are here:
Dilley, Sarah E., J. Michael Straughn Jr, and Charles A. Leath III. "The Evolution of and Evidence for Opportunistic Salpingectomy." Obstetrics & Gynecology 130.4 (2017): 814-824.
Falconer, Henrik, et al. "Ovarian cancer risk after salpingectomy: a nationwide population-based study." Journal of the National Cancer Institute 107.2 (2015): dju410.
 
In journal club we discuss 4 articles:
Iversen, Lisa, et al. "Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study." American Journal of Obstetrics & Gynecology 216.6 (2017): 580-e1.
Lathrop, Eva, et al. "The Zika Contraception Access Network: a feasibility programme to increase access to contraception in Puerto Rico during the 2016–17 Zika virus outbreak." The Lancet Public Health (2018).
Eggebroten, Jennifer L., Jessica N. Sanders, and David K. Turok. "Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis." American Journal of Obstetrics & Gynecology 217.1 (2017): 51-e1.
Roberts, Timothy A., and Shana Hansen. "Association of Hormonal Contraception with depression in the postpartum period." Contraception 96.6 (2017): 446-452.