OB/GYN Clinical Alert – February 1, 2021
February 1, 2021
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The Utility of Nuchal Translucency Screening in the Era of Cell-Free Fetal DNA Testing
In this retrospective cohort study of 1,901 pregnant women between 11 weeks and 13 weeks six days of gestation who had a nuchal translucency (NT) screening for fetal aneuploidies and demonstrated NT measurements > 95th percentile, 47% of fetuses (894/1,901) had an NT between the 95th and 99th percentile and 53% (1,007/1,901) had an NT ≥ the 99th percentile. In addition, of the 43% of fetuses (814/1,901) with at least one abnormality (structural or genetic), 34% (279/814) would have been missed in the first trimester if only cell-free deoxyribonucleic acid was used for prenatal genetic screening.
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Are We Prescribing Enough Emergency Contraception?
In this national sample of obstetrician-gynecologists, the majority (84%) reported offering at least one form of emergency contraception, with 80% offering the levonorgestrel pill, 18% offering ulipristal acetate, and 29% offering the copper intrauterine device.
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Reducing Opioid Prescriptions Following Gynecologic Surgery
With sufficient institutional buy-in, appropriate patient education, and staff adherence to standardized postoperative prescribing practices, patients undergoing abdominal gynecologic surgery can leave the hospital safely and recover with low doses of opioid medications, or no opioid prescription at all.
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What Is the Optimal Mode of Delivery of the Second Twin?
In this randomized clinical trial, 343 pregnant women with twin gestations were randomized to planned cesarean delivery and planned vaginal delivery groups (208 patients vs. 135 patients, respectively) between October 2013 and March 2015. The cesarean delivery rate in the planned vaginal delivery arm was 49% compared to the cesarean rate of 99% in the planned cesarean delivery arm. If all criteria for vaginal delivery are met, it would be reasonable and appropriate to offer women with diamniotic twin gestations planned vaginal delivery between 34 0/7 to 37 6/7 weeks of gestation.