Dr.Awesome

It may be Safer to Delay Cutting the Cord

Press Release: Feb.17, 2019 

Gainesville Fl., February 21, 2019 (swampstrattcomm-sp.19.tumblr.com)- This week’s topics in MDedge, mostly focused on politics that will affect the health care field, as well as research conducted recently that observe how some procedures are beneficial to patients in the obstetrics department, and how some may actually increase the risks of diseases and complications. One of these procedures is umbilical cord milking. In recent years umbilical cord milking has gained accreditation due to its health benefits pertaining to premature infants. Contrary to the traditional delayed cord clamping (DCC) method – cutting the umbilical cord after at least one minute- the umbilical cord milking process consist of squeezing the umbilical cord gently to allow contents inside to facilitate into the infant’s abdomen, thereby increasing blood flow and nutrients (Cord Milking). Though this method does come with numerous benefits, new research has discovered that it may also increase some of the risks, most specifically: intraventricular hemorrhage (IVH).  

Dr. Varner of the University of Utah urges clinics and centers to refrain from umbilical cord milking infants that are 23-27 weeks’ gestation. “…These very premature babies have more pulmonary vasoconstriction, which shunts more blood toward the brain. This results in fluctuations in flow in an immature brain with fragile germinal matrices and perhaps further compromised by chorioamnionitis inflammation, resulting in IVH,” Dr. Varner (MDedge).  In simpler terms, an overload caused by milking and excess fluid can risk brain damage and severe conditions. 

A Premature Infants Receiving Milking or Delayed Cord Clamping (PREMOD2) trial was conducted at eleven locations in the United States and Europe; however, the data safety monitoring board discontinued it after concluding that milking was not superior to DCC, and did in fact increase the chance of having IVH. The trial included 474 premature infants who were separated by gestational age: 23-27 weeks and 28-31 weeks, and randomly underwent the umbilical cord milking process or DCC.  Twenty of the infants who underwent the milking process had severe IVH; in comparison to five of the infants who had IVH and underwent the delayed clamping process. The number of deaths were similar between the cord milking and cord clamping groups, and were more so indicated by the gestational groups rather than the umbilical process (MDedge). 

While the data indicates that gestational age is a primary factor in the severity and chance of having IVH and death, it also concludes that umbilical milking is correlated to higher risks of IVH compared to delayed clamping, and is nearly equal in its benefits. Therefore, one can conclude that the traditional route may actually be the safer one, despite the gaining popularity of milking. 

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News. 

Marijuana May Not be the go to Anecdote for New Moms

Press Release Published February 8, 2018

Gainesville, Fl., February 8, 2019 (swampstrattcomm-sp.19.tumblr.com)- The topics in this week’s MDedge included the financial and economic part of the medical field, a Supreme Court abortion case, and new drug approvals. One drug that has recently been receiving good press for its medical benefits despite preconceived notions, is marijuana. While the legalization of marijuana is on the rise due to its wide-range of benefits and lack of imminent harm, new research suggests that marijuana is not for everyone, and that it could especially cause harm to pregnant mothers and their unborn children. The rate of pregnant women age 18 to 44 using marijuana is increasing, and social media headlines that advocate for using marijuana for nausea and morning sickness contributes to this rise. Although marijuana’s legalization gives the impression that it is benign, the American Academy of Pediatrics (AAP) is urging women who are pregnant and or breastfeeding to refrain from using it due to the possible long-term effects on the mother and child.

“We do not have good safety data on prenatal exposure to marijuana. Based on the limited data that do exist, as pediatricians, we believe there is cause to be concerned about how the drug will impact the long-term development of children,” Sheryl A. Ryan, MD. Despite limited research, a study was conducted by the AAP that showed that exposure to cannabinoid can increase the permeability of pharmacological agents and recreational substances through the placenta. This is the case for delta-9-tetrahydrocannabinol (THC), a substance in marijuana that can potentially cross the placental barrier and enter into fetal blood (MDedge). Although some may argue that using marijuana in small doses has no effect, several studies show that using it in any portion-small or large, puts the mother at risk for anemia, and the fetus at risk for a low birth weight and neonatal intensive care unit (NICU) use. Other possible effects include impaired mental development, deficits in function, hyperactivity, symptoms of depression, and a higher chance of substance abuse. 

Another study was conducted by Kerri Bertrand at the University of California that looked into concentrations of cannabinoid in breastmilk. From 2014 to 2017 researchers analyzed 54 samples of breastmilk donated by fifty women who used marijuana. Out of the 54 samples, 34 of them contained delta-9-THC six days after using marijuana. While ten other samples contained substances that were also cannabidiol (MDedge). 

Although the imminent effects of marijuana on pregnant or breastfeeding women as well as their children is uncertain due to it only currently being legalized, researchers and doctors alike are discovering that this docile drug will inevitably have very harmful long-term effects. 

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News.

Minimally Invasive Surgeries May Not Be as Beneficial as Assumed

Press Release: January 25, 2019

Gainesville, Fl., January 25, 2019 (swampstrattcomm-sp.19.tumblr.com)- In this week’s MDedge, the topics included new legislation in medicine, price inflations for new and already existing drugs and medication, and new procedural methods in medicine, such as robotic assistance. One of these procedural methods that has been gaining increasing attraction in recent years is minimally invasive surgeries (MIS). MIS is a process that uses small tools for insertion during procedures; and consequently, smaller cuts or incisions, which is perhaps why it is usually the preferred choice for not only patients but for doctors as well. This is especially the case for surgeons in the field of obstetrics and gynecology (Colorado Women’s Health). Today, most hysterectomies and tubal ligations, amongst other procedures are performed by surgeons using MIS technology and robotic surgery such as laparoscopy and hysteroscopy, as opposed to the more traditional open surgery (Med UNC). While MIS undoubtedly has its benefits due to the smaller incisions, smaller scars, and faster recovery rate, a study suggests that the traditional approach of open surgery, specifically for cervical cancer, may be more beneficial.  

Two new studies were published in the New England Journal of Medicine in November of 2018, and another was presented at the American Society of Clinical Oncology (ASCO). Both argued that compared to open surgeries, those who underwent the MIS surgery had a greater probability of the disease reappearing and an overall reduced survival rate for stages IA-IB of cervical cancer. From 2008 to 2017 the Laparoscopic Approach to Cervical Cancer (LAAC) conducted a study comparing the MIS approach to the open surgery approach on 631 patients. The study found that 4.5 years after the MIS procedure, 86% of the patients were still disease free, compared to a 96% disease-free survival for those who did the open surgery.  Furthermore, there were 22 deaths in the MIS group and three deaths in the open surgery group. Another study was conducted by the National Cancer Database that included 2,641 women and focused more on the death rates. From a total of 164 deaths, 94 of those were of MIS patients, while 70 were of open surgery patients (Abandon MIS?). Essentially, mortality rates were higher for those who underwent MIS, and those patients therefore had a shorter overall survival rate. “While we recognize that open surgery is associated with increased morbidity, we do argue that, with the almost-universal implementation of Enhanced Recovery Pathways (ERP) in gynecologic oncology, the disparities between the two groups will be minimized and likely are much smaller than that reported in historical literature,” Mary Mullen, MD.

Although these two studies along with several others depreciates MIS in comparison to open surgery, there are also studies that insinuate the opposite effect, and show research of patients that benefited more from MIS and had fewer drawbacks. Ultimately, more research would need to be conducted in order to adequately compare the two and conclude that it may be a defining factor, but it also may be a case-to-case basis that is dependent on the patient and his or her diagnosis. 

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News

Radioactive Implants may be a New Tool in Reducing Health Disparities for Black Women

PRESS RELEASE: MARCH 29, 2019

Gainesville, Fl., March 29, 2019 (swampstrattcomm-sp.19.tumblr.com)- The recent topics in this week’s MDedge focused on FDA updates and regulations for particular medications, comparisons to mothers who received certain treatments to those that did not, and observations on post cesarean patients and varying types of cancers specified to women. One in particular, being cervical cancer. A study conducted by researchers at John Hopkins University found that black women in the United States are dying from cervical cancer 77% higher than previously conceived, and at twice the rate as white women (John Hopkins). Despite this daunting statistic, a form of treatment is believed to not only reduce the death rate but ultimately this health disparity as well: brachytherapy. Brachytherapy is a type of radiation therapy for cancer that involves the insertion of radioactive material - via a device such as a tube or cylinder - inside a person’s body, more specifically, the part of the body where the cancer cells are located. It treats the affected area by essentially destroying the cancerous cells (Mayo Clinic).  

Brachytherapy Insertion 

Due to this procedure, researchers like Dr. Stephanie Alimena of Brigham and Women’s Hospital, believe that allowing more access to brachytherapy for black patients with locally advanced cervical cancer, may decrease the racial disparities when pertaining to the survival rate. “We know that use of a brachytherapy boost is associated with improved patient outcomes, including improved cancer-specific and overall survival. We also know that African-American women have one of the highest incidences of cervical cancer in the United States and also have worse mortality from cervical cancer” Dr. Alimena, (MDedge). Although this is the case, studies have shown that minority women are less likely to receive brachytherapy compared to white women which may contribute to the higher death rates. From 2004 to 2014, Dr. Alimena studied the interaction between race, radiation, and survival.

Dr. Alimena, and other researches assessed 15,411 women with cervical cancer whose mean age was 54 years old, and with 58% receiving brachytherapy, and 19% being African American. There were significant survival differences based on those who received brachytherapy compared to those who did not. African American patients who did not receive brachytherapy had a significantly higher risk of death than non-black patients. However, among those who did receive brachytherapy, the risk of death for black and non-black patients were similar (MDedge). 

From this study, one can infer the significant impact access to brachytherapy can have on patients and perhaps even society pertaining to the health care field and eliminating disparities. This is only one hypothesis for the exponentially higher death rates of cervical cancer among black women, however, the research shows that it is a very notable one. 

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News. 

Corticosteroids are Safe for Children 

Press Release: March 8, 2019

Gainesville Fl., March 15, 2019 (swampstrattcomm-sp.19.tumblr.com) – The recent articles in MDedge consisted of features on the increasing maternal morbidity, and studies on patients’ experiences during pregnancy with diagnosis of medical conditions such as multiple sclerosis. It also included articles on how patients could improve outcomes, and limit possible pregnancy risks. The articles however, mostly focused on the latest news on FDA approved drugs and medications after positive findings in patients with varying conditions. These medications not only affected the mother positively, but the infant as well. One such circumstance was with prenatal betamethasone. Preterm birth can cause an array of medical conditions and defects, however, due to drugs such as the corticosteroid betamethasone, a mother can delay the delivery in order for the infant to continue to develop properly (Healthline). 

A new study has found that administering prenatal corticosteroids to pre-term pregnant women does not put the infant at risk to neurocognitive conditions six to eight years later, regardless of possible fetal growth restriction. Despite this however, there was some apprehension concerning the possible long-term effects of multiple steroid doses on an infant. Several animal studies conducted suggested that administering steroids could harm the immune system, neurological development, and growth (Healthline), which led researchers and health professionals to believe that injecting steroids could cause fetal growth restriction and severe neurological conditions (MDedge). However, a study by the Australian Collaborative Trial of Repeat Doses of Corticosteroids (ACTORDS) proved that the benefits of corticosteroids and lack of adverse effects out weighted possible fetal growth restriction. “Physicians should use repeated doses of antenatal corticosteroids when indicated before preterm birth, regardless of fetal growth restriction, in view of the associated neonatal benefits and absence of later adverse effects,” the authors concluded (MDedge). 

The study included 1,146 fetuses and 982 pregnant women who were less than 32 weeks’ gestation, and were at risk of preterm birth for at least seven days. The women were randomly assigned to receive betamethasone or a saline placebo weekly. A follow-up was conducted when the children were six to eight years old, where they received several exams, including a neurological and physical exam. Fetal growth restriction (FGR) occurred in 28% of children who received betamethasone and 25% who received the placebo. Those with FGR had a greater risk of death, moderate to severe disability, and motor impairment than those without FGR regardless of treatment group. Infants with FGR had an increased benefit from continuous antenatal corticosteroid therapy; however, there is concern with whether repeated antenatal corticosteroid therapy could risk ADHD (MDedge). 

Various studies like this one have proved that corticosteroids, more specifically betamethasone, are in fact safe for children, and do not cause harmful effects later on in life. Although more research still needs to be conducted about the effects of continuous corticosteroid injections, it is safe to say that the benefits of these steroids for preterm infants out weight the possible drawbacks.

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News.

It May be Safer to Delay Cutting the Cord

Press Release: Feb.17, 2019

Gainesville Fl., February 21, 2019 (swampstrattcomm-sp.19.tumblr.com)- This week’s topics in MDedge mostly focused on politics that will affect the health care field, as well as research conducted recently that observe how some procedures are beneficial to patients in the obstetrics department, and how some may actually increase the risks of diseases and complications. One of these procedures is umbilical cord milking. In recent years umbilical cord milking has gained accreditation and acclaim due to its health benefits pertaining to premature infants. Contrary to the traditional delayed cord clamping (DCC) method – cutting the umbilical cord after at least one minute- the umbilical cord milking process consist of squeezing the umbilical cord gently to allow contents inside to facilitate into the infant’s abdomen, thereby increasing blood flow and nutrients (Cord Milking). Though this method does come with numerous benefits, new research has discovered that it may also increase some of the risks; most specifically: intraventricular hemorrhage (IVH).  

Dr. Varner of the University of Utah urges clinics and centers to refrain from umbilical cord milking infants that are 23-27 weeks’ gestation. “…These very premature babies have more pulmonary vasoconstriction, which shunts more blood toward the brain. This results in fluctuations in flow in an immature brain with fragile germinal matrices and perhaps further compromised by chorioamnionitis inflammation, resulting in IVH,” Dr. Varner (MDedge).   In simpler terms, an overload caused by milking and excess fluid can risk brain damage and sever conditions.

A Premature Infants Receiving Milking or Delayed Cord Clamping (PREMOD2) trial was conducted at eleven locations in the United States and Europe; however, the data safety monitoring board discontinued it after concluding that milking was not superior to DCC, and did in fact increase the chance of having IVH. The trial included 474 premature infants who were separated by gestational age: 23-27 weeks and 28-31 weeks, and randomly underwent the umbilical cord milking process or DCC.  Twenty of the infants who underwent the milking process had severe IVH; in comparison to five of the infants who had IVH and underwent the delayed clamping process. The number of deaths were similar between the cord milking and cord clamping groups, and were more so indicated by the gestational groups rather than the umbilical process (MDedge).

While the data indicates that gestational age is a primary factor in the severity and chance of having IVH and death, it also concludes that umbilical milking is correlated to higher risks of IHV compared to delayed clamping, and is nearly equal in its benefits. Therefore, one can conclude that the traditional route may actually be the safer one as well, despite the gaining popularity of milking.

MDedge: ObGyn is a trade journal that includes various articles on cutting edge and relevant news in the medical field of obstetrics and gynecology. Its news is delivered by experts in the field, and includes clinical reviews and recent research. It also includes content offered from the publications of OBG MANAGEMENT and Ob.Gyn.News.

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