Browse OB/GYN Clinical Alert Articles by Topic

Ketamine Use in the Prevention of Postpartum Depression Is Premature

A double-blinded, randomized clinical trial of 134 low-risk pregnant women in Iran undergoing scheduled cesarean deliveries was conducted to address if a single dose of ketamine during anesthesia induction has a role in the prevention of postpartum depression. The authors reported that depression scores using the Edinburgh Postnatal Depression Scale at two and four weeks after the cesarean delivery were significantly lower in the ketamine group vs. the control group.

Is Black Race Associated with Major Depression Following Early Pregnancy Loss?

Reporting symptoms of having major depression one month after treatment for early pregnancy loss was about twice as common among Black women compared to non-Black women.

Disease Severity and Perinatal Outcomes of Pregnant Patients with COVID-19

In this observational cohort study of patients with singleton gestation and positive coronavirus test, patients with severe or critical disease were at risk for perinatal complications compared to those who were asymptomatic. Patients classified with mild or moderate disease were not shown to have an increased risk compared to asymptomatic positive patients.

Standard-Dose vs. High-Dose Oxytocin for Labor Augmentation

In this randomized clinical trial of standard-dose vs. high-dose oxytocin regimens for labor augmentation among 1,003 nulliparous women, the primary outcome (cesarean delivery) was similar between the two groups. However, secondary outcomes were lower, labor duration was shorter, and umbilical artery acidemia occurred less frequently.

BSO at Benign Hysterectomy: What Should We Be Recommending?

In this population-based retrospective cohort study, among 44,549 adult women undergoing hysterectomy in Ontario, Canada, there was marked variation between surgeons in bilateral salpingo-oophorectomy (BSO) rates after controlling for patient age and other factors. Approximately 41% of patients had no indication for the bilateral salpingo-oophorectomy in their records.

Mifepristone as an Adjunct to Misoprostol for Pregnancy Termination

In this prospective, double-blind, randomized, placebo-controlled trial, pretreatment with 200 mg of mifepristone 24 to 48 hours before labor induction using misoprostol significantly reduced time to delivery among demised fetuses between 14 and 28 weeks of gestation. Maternal complications were equivalent in both groups.

Evaluation of an Inpatient Postpartum Human Papillomavirus Immunization Program

In this cohort study, results from two years of an inpatient postpartum HPV vaccination program are presented. Overall, their results show an increased rate of immunization (hazard ratio of 2.51) and an increased proportion of women completing the vaccination series (35.8% of those receiving an inpatient dose completed the series compared to 9.3% of those who did not get the inpatient dose).

When Is the Ideal Time in the Menstrual Cycle for IUD Insertion?

In this retrospective cohort study, women using the levonorgestrel intrauterine device for noncontraceptive indications had higher expulsion rates (38% vs. 17%, P = 0.03) when insertion occurred on day 1 to day 8 of the menstrual cycle compared to after day 8.

The Association Between SSRIs and Congenital Anomalies

In this synthesis involving 15 meta-analytic studies, four studies demonstrated an association between paroxetine use during pregnancy and increased risk of major congenital anomalies (relative risk [RR], 1.18 [95% confidence interval (CI), 1.05, 1.32] to 1.29 [95% CI, 1.11-1.49]). For all selective serotonin reuptake inhibitors (SSRIs), the RR for major anomalies (1.10 [95% CI, 1.03, 1.16] to 1.27 [95% CI, 1.09, 1.47]) and cardiac defects (1.06 [95% CI, 0.94, 1.18] to 1.36 [95% CI, 0.61, 3.04]) were increased. This meta-analysis suggests an increased risk of cardiac and major anomalies with SSRI use, but the results should be interpreted with caution, since all included studies were meta-analyses of retrospective cohort studies.

Management of Heavy Menstrual Bleeding: Levonorgestrel-Releasing Intrauterine System vs. Endometrial Ablation

In this multicenter, randomized, noninferiority trial among patients aged 34 years and older with heavy menstrual bleeding, the levonorgestrel-releasing intrauterine system did not meet the noninferiority threshold when compared to endometrial ablation for mean blood loss at 24 months following intervention. Both interventions did lead to large decreases in blood loss and comparable satisfaction and quality-of-life scores.