Mollie Elliot

Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial.

OBJECTIVE: To estimate whether an organized, consistent program of dietary and lifestyle counseling prevents excessive weight gain in pregnancy. METHODS: This randomized controlled trial assigned women to receive either an organized, consistent program of intensive dietary and lifestyle counseling or routine prenatal care. The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine (IOM) guidelines. Secondary outcomes included mode of delivery, rate of operative vaginal delivery, neonatal weight, and the incidence of preeclampsia, gestational diabetes mellitus (GDM), vaginal/perineal lacerations, and shoulder dystocia. RESULTS: A total of 100 women were randomized to the study (lifestyle counseling 57, routine prenatal care 43). Baseline demographic characteristics were similar between the study groups. The lifestyle counseling group gained significantly less weight than did the routine prenatal care group (28.7±12.5 lb compared with 35.6±15.5 lb, P=.01). The routine prenatal care group had significantly more cesarean deliveries due to “failure to progress” (routine prenatal care 58.3% compared with lifestyle counseling 25.0%, P=.02). Across groups, patients who were not adherent to the IOM guidelines had significantly heavier neonates (adherent 3,203.2±427.2 g compared with not adherent 3,517.4±572.4 g, P<.01). Nulliparous women gained significantly more weight than did parous women (36.5±14.5 lb compared with 27.7±12.7 lb, P<.01). The most predictive factor of IOM adherence was having a normal prepregnancy body mass index. No statistically significant differences were noted between the groups in adherence to IOM guidelines, rate of cesarean delivery, preeclampsia, GDM, operative vaginal delivery, or vaginal lacerations. CONCLUSION: An organized, consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00792480 LEVEL OF EVIDENCE: I

Cervical wet mount as a negative predictor for gonococci- and Chlamydia trachomatis-induced cervicitis in a gravid population.

OBJECTIVE The purpose of this study was to determine whether a wet mount preparation of endocervical secretions from obstetric patients can accurately rule out the presence of gonococci and Chlamydia trachomatis. STUDY DESIGN Gravid patients were screened for gonococci and C trachomatis with a deoxyribonucleic acid probe and a wet mount preparation of endocervical secretions. The number of polymorphonuclear lymphocytes was counted and averaged per x400 high-power field. A count of <10 polymorphonuclear lymphocytes per high-power field was defined as predicting the absence of gonococci- and C trachomatis -induced cervicitis. A chi(2) analysis was used to compare the wet mount results to the deoxyribonucleic acid probe. RESULTS Between January and March 1998, 341 patients were enrolled in the study. Wet mount results showed 32% (108/341) of patients had <10 polymorphonuclear lymphocytes per high-power field. The incidence of infection with gonococci and C trachomatis in this population, as determined by deoxyribonucleic acid probe, was 10 of 341 (2.9%) and 30 of 340 (8.8%), respectively. The sensitivity values for gonococci and C trachomatis were 90% and 87%, respectively. The negative predictive value of the wet mount for gonococci-induced cervicitis was 99%, and that for C trachomatis -induced cervicitis was 96%. CONCLUSION In this population the wet mount accurately predicted the absence of gonococci- and C trachomatis -induced cervicitis. Use of this screening protocol in gravid patients has the potential to reduce the cost of screening for these 2 diseases.

Molecular evaluation of proliferative-phase endometrium may provide insight about the underlying causes of infertility in women with endometriosis.

PurposeTo determine if endometrial gene expression is different in women with endometriosis-related infertility and fertile women.MethodsProspective study of mid-follicular phase endometrium in 47 subjects in two phases: microarray study of 10 infertile women with endometriosis and five fertile controls, and a quantitative real-time PCR (qRT-PCR) study of 27 infertile women with endometriosis and 15 fertile controls. Gene expression was determined by DNA microarray, and qRT-PCR used for 12 “promising” genes based on the microarray analysis.ResultsCompared to fertile controls, women with stage I–II endometriosis had 23, and women with stage III–IV had 35 genes that were significantly up- or down-regulated by microarray. However, using qRT-PCR, only chemokine ligand (CXCL) 13 was significantly down-regulated and somatostatin was significantly up-regulated with early endometriosis, and only CXCL 14 was significantly down-regulated with advanced endometriosis compared to fertile controls.ConclusionsOur findings indicate that the pattern of gene expression in proliferative-phase endometrium is different when comparing tissue from patients with endometriosis versus fertile controls. Recognition of these endometrial alterations could be helpful to diagnose and stage endometriosis, and may provide insight to explain why conception rates are low in women with endometriosis.

Sexual absorption of vaginal progesterone: a randomized control trial.

Objective. To determine if sexual intercourse reduces absorption of vaginal progesterone gel in women and to determine if progesterone is absorbed by the male during intercourse. Study Design. Prospective, randomized, cross over, controlled study of 20 reproductive-aged women and their male sexual partners randomized to receive vaginal progesterone gel (Crinone 8% gel, Actavis Inc., USA) or placebo cream. Serum progesterone for both male and female partners were measured 10 hours after intercourse. One week later, subjects were crossed over to receive the opposite formulation. In the third week, women used progesterone gel at night and abstained from intercourse. Results. Serum progesterone was significantly reduced with vaginal progesterone gel + intercourse compared with vaginal progesterone gel + abstinence (P = 0.0075). Men absorbed significant progesterone during intercourse with a female partner using vaginal progesterone gel compared to placebo (P = 0.0008). Conclusion(s). Vaginal progesterone gel is reduced in women after intercourse which may decrease drug efficacy during luteal phase support. Because men absorb low levels of progesterone during intercourse, exposure could cause adverse effects such as decreased libido. This study is registered under Clinical Trial number NCT01959464.

Operative Complications Diagnosed by CT Scan in Minimally Invasive Hysterectomy Patients [24E]

INTRODUCTION: The indications for CT scan to evaluate complications of minimally invasive surgery have not been well established. The objective of this study was to identify patient characteristics and clinical findings that correlated with postoperative complications diagnosed on CT scan. METHODS: A retrospective cohort study was conducted with patients who underwent laparoscopic or robotic hysterectomy, from 2011 to 2013, and had a CT scan to evaluate postoperative complications. Patient characteristics and clinical findings were analyzed for association with 1) a CT being ordered 2) abnormal CT findings. RESULTS: 784 patients underwent minimally invasive hysterectomy. 74 (9.4%) had a CT scan. Patients who underwent CT scan were demographically similar to those who did not except for a lower BMI (P=.025) and a trend toward younger age (P=.543). Chronic pain and history of prior abdominal surgery were associated with the CT scan group. There were no significant differences between patients with abnormal versus normal CT scan. In the CT scan group, subgroup analysis of CT findings (primary abnormal, incidental abnormal, normal) demonstrated a significant difference in WBC count (P=.017). CONCLUSION: Patients with smaller BMI, chronic pain, and history of abdominal surgery were more likely to undergo CT scan for workup of postoperative complication, but not more likely to have abnormalities on CT scan. There were no associations between patient characteristics or indications for CT and abnormal CTs. A larger study with more CT scans and abnormal findings may show associations not found in this study.

Antenatal sexually transmitted infection screening in private and indigent clinics in a community hospital system

OBJECTIVE To determine whether clinics that serve indigent patients demonstrate equal compliance with sexually transmitted infection testing guidelines when compared with private clinics. STUDY DESIGN One hundred eighty-three women were divided into cohorts based on whether they received prenatal care at a private or indigent clinic. Timing of required antenatal sexually transmitted infection screening was collected for 8 tests and compliance scores were calculated. Primary outcome was average compliance score compared between clinic types. Secondary outcomes included disease-specific compliance and percent of perfect compliance at different office types. RESULTS Compliance was found to be different between clinic types (P = .023). Indigent clinics had the same median with slightly higher inner-quartile range than private clinics (7 [7-8], 7 [7-7]). Indigent clinics had higher mean compliance scores (7.1 vs 6.9) and a greater percentage of patients demonstrating perfect compliance (42% vs 14%, P < .001). CONCLUSION Clinics serving indigent patient populations had a higher compliance with required testing compared to private clinics. HIV testing in the third trimester remains the greatest need for improvement for all practice types.