Sharon Worcester

ORLANDO – Specially trained dogs accurately detected specific prostate cancer volatile organic compounds in urine samples from patients with varying stages of disease and risk levels in a controlled study.

One dog was able to distinguish 320 urine samples taken from prostate cancer patients from 357 control samples with 100% sensitivity, 97.8% specificity, and 98.9% accuracy. A second dog performed with 98.6% sensitivity, 95.9% specificity, and 97.3% accuracy, Dr. Gianluigi Taverna of Humanitas Research Hospital, Milan, reported at the annual meeting of the American Urological Association.

The combined performance of the dogs – German shepherds trained by a dedicated research team using hundreds of urine samples over several months – resulted in 98.1% accuracy, 99.2% sensitivity, and 97.1% specificity.

Samples used in the study were from prostate cancer patients with cancer raging from very low risk disease to metastatic disease, and controls were a heterogeneous cohort of healthy subjects or patients affected by nonneoplastic diseases or nonprostatic tumors.

An evaluation of the wrongly detected cases showed that there were no differences in the specimens with respect to epidemiological, clinical, or histopathological characteristics, Dr. Taverna said.

Interest in the analysis of volatile organic compounds (VOCs) in urine is increasing, as this is considered a promising approach to cancer detection, and based on the findings of the current study it appears that a rigorously trained canine olfactory system can recognize prostate cancer VOCs, and thus represents a "real clinical opportunity" to reduce unnecessary biopsies and identify patients at high risk for prostate cancer, he concluded.

Dr. Brian Stork of West Shore Urology, Muskegon, Michigan, who moderated a press briefing where the findings were presented, said that the data highlight the potential value of VOCs in urine as a means for cancer detection.

"The possibility of using dogs in identifying cancer is something most would never have considered possible a decade or two ago. It’s an interesting concept that ‘man’s best friend’ could help save your life," he said in press statement.

It has been long known, however, that dogs have a highly sensitive olfactory system, with roughly 200 million olfactory cells in their noses, compared with about 5 million for humans, and interest in tapping their potential in medicine has been on the rise. Research has shown that dogs are capable of detecting epileptic seizure onset, and breast and lung malignancies through the detection of VOCs. In 2010, a small study of 33 patients suggested that dogs could detect prostate cancer VOCs in urine; the current study, in a much larger cohort, confirms those findings.

Dr. Taverna reported having no disclosures.

ORLANDO – Specially trained dogs accurately detected specific prostate cancer volatile organic compounds in urine samples from patients with varying stages of disease and risk levels in a controlled study.

One dog was able to distinguish 320 urine samples taken from prostate cancer patients from 357 control samples with 100% sensitivity, 97.8% specificity, and 98.9% accuracy. A second dog performed with 98.6% sensitivity, 95.9% specificity, and 97.3% accuracy, Dr. Gianluigi Taverna of Humanitas Research Hospital, Milan, reported at the annual meeting of the American Urological Association.

The combined performance of the dogs – German shepherds trained by a dedicated research team using hundreds of urine samples over several months – resulted in 98.1% accuracy, 99.2% sensitivity, and 97.1% specificity.

Samples used in the study were from prostate cancer patients with cancer raging from very low risk disease to metastatic disease, and controls were a heterogeneous cohort of healthy subjects or patients affected by nonneoplastic diseases or nonprostatic tumors.

An evaluation of the wrongly detected cases showed that there were no differences in the specimens with respect to epidemiological, clinical, or histopathological characteristics, Dr. Taverna said.

Interest in the analysis of volatile organic compounds (VOCs) in urine is increasing, as this is considered a promising approach to cancer detection, and based on the findings of the current study it appears that a rigorously trained canine olfactory system can recognize prostate cancer VOCs, and thus represents a "real clinical opportunity" to reduce unnecessary biopsies and identify patients at high risk for prostate cancer, he concluded.

Dr. Brian Stork of West Shore Urology, Muskegon, Michigan, who moderated a press briefing where the findings were presented, said that the data highlight the potential value of VOCs in urine as a means for cancer detection.

"The possibility of using dogs in identifying cancer is something most would never have considered possible a decade or two ago. It’s an interesting concept that ‘man’s best friend’ could help save your life," he said in press statement.

It has been long known, however, that dogs have a highly sensitive olfactory system, with roughly 200 million olfactory cells in their noses, compared with about 5 million for humans, and interest in tapping their potential in medicine has been on the rise. Research has shown that dogs are capable of detecting epileptic seizure onset, and breast and lung malignancies through the detection of VOCs. In 2010, a small study of 33 patients suggested that dogs could detect prostate cancer VOCs in urine; the current study, in a much larger cohort, confirms those findings.

Dr. Taverna reported having no disclosures.

ORLANDO – Specially trained dogs accurately detected specific prostate cancer volatile organic compounds in urine samples from patients with varying stages of disease and risk levels in a controlled study.

One dog was able to distinguish 320 urine samples taken from prostate cancer patients from 357 control samples with 100% sensitivity, 97.8% specificity, and 98.9% accuracy. A second dog performed with 98.6% sensitivity, 95.9% specificity, and 97.3% accuracy, Dr. Gianluigi Taverna of Humanitas Research Hospital, Milan, reported at the annual meeting of the American Urological Association.

The combined performance of the dogs – German shepherds trained by a dedicated research team using hundreds of urine samples over several months – resulted in 98.1% accuracy, 99.2% sensitivity, and 97.1% specificity.

Samples used in the study were from prostate cancer patients with cancer raging from very low risk disease to metastatic disease, and controls were a heterogeneous cohort of healthy subjects or patients affected by nonneoplastic diseases or nonprostatic tumors.

An evaluation of the wrongly detected cases showed that there were no differences in the specimens with respect to epidemiological, clinical, or histopathological characteristics, Dr. Taverna said.

Interest in the analysis of volatile organic compounds (VOCs) in urine is increasing, as this is considered a promising approach to cancer detection, and based on the findings of the current study it appears that a rigorously trained canine olfactory system can recognize prostate cancer VOCs, and thus represents a "real clinical opportunity" to reduce unnecessary biopsies and identify patients at high risk for prostate cancer, he concluded.

Dr. Brian Stork of West Shore Urology, Muskegon, Michigan, who moderated a press briefing where the findings were presented, said that the data highlight the potential value of VOCs in urine as a means for cancer detection.

"The possibility of using dogs in identifying cancer is something most would never have considered possible a decade or two ago. It’s an interesting concept that ‘man’s best friend’ could help save your life," he said in press statement.

It has been long known, however, that dogs have a highly sensitive olfactory system, with roughly 200 million olfactory cells in their noses, compared with about 5 million for humans, and interest in tapping their potential in medicine has been on the rise. Research has shown that dogs are capable of detecting epileptic seizure onset, and breast and lung malignancies through the detection of VOCs. In 2010, a small study of 33 patients suggested that dogs could detect prostate cancer VOCs in urine; the current study, in a much larger cohort, confirms those findings.

Dr. Taverna reported having no disclosures.

Treating pneumonia with azithromycin is linked to lower risk of death but a slightly higher risk of myocardial infarction in older patients, according to a large retrospective cohort study.

Although azithromycin is recommended in combination with macrolides for the first-line treatment of patients hospitalized with pneumonia, recent research suggests it is associated with an increased risk of cardiovascular events. However, the current findings suggest that while it is associated with a slight increase in MI risk (number needed to harm equals 144), it is not associated with "any cardiac event," cardiac arrhythmia, or heart failure, and that the reduction in 90-day mortality risk (number needed to treat of 21) is large enough to provide an overall net benefit.

Dr. Eric M. Mortensen of the Veterans Affairs North Texas Health Care system, Dallas, and his colleagues reported their findings in the June 4 issue of JAMA.

In the current study, 20 in 31,863 patients aged 65 years and older who were exposed to azithromycin were significantly lower than in an equal number of propensity-matched controls who were not exposed (17.4% vs. 22.3%; odds ratio, 0.73).

The risk of myocardial infarction, however, was significantly increased in the azithromycin group (5.1% vs. 4.4%; OR, 1.17), investigators reported.

Azithromycin use was defined as patients’ receipt of at least one dose of azithromycin during the first 48 hours after admission.

Study subjects were older adults with a mean age of 77.8 years in the national Department of Veterans Affairs administrative database who were hospitalized with pneumonia between 2002 and 2012 (JAMA 2014 June 4 [doi:10.1001/jama.2014.4304]). Most patients (98%) were male.

The study had a relatively small number of female subjects and relied "upon ICD-9 diagnosis of cardiovascular events rather than clinical information, which particularly may affect the diagnosis of heart failure,"h the authors said. However, they said, treating physicians were likely to have believed the patients in the study indeed had pneumonia and did not show any bias toward azithromycin.

This study was supported by a grant from the National Institute of Nursing Research. Dr. Mortensen reported having no disclosures. Other researchers reported receiving grants from industry sources.

Treating pneumonia with azithromycin is linked to lower risk of death but a slightly higher risk of myocardial infarction in older patients, according to a large retrospective cohort study.

Although azithromycin is recommended in combination with macrolides for the first-line treatment of patients hospitalized with pneumonia, recent research suggests it is associated with an increased risk of cardiovascular events. However, the current findings suggest that while it is associated with a slight increase in MI risk (number needed to harm equals 144), it is not associated with "any cardiac event," cardiac arrhythmia, or heart failure, and that the reduction in 90-day mortality risk (number needed to treat of 21) is large enough to provide an overall net benefit.

Dr. Eric M. Mortensen of the Veterans Affairs North Texas Health Care system, Dallas, and his colleagues reported their findings in the June 4 issue of JAMA.

In the current study, 20 in 31,863 patients aged 65 years and older who were exposed to azithromycin were significantly lower than in an equal number of propensity-matched controls who were not exposed (17.4% vs. 22.3%; odds ratio, 0.73).

The risk of myocardial infarction, however, was significantly increased in the azithromycin group (5.1% vs. 4.4%; OR, 1.17), investigators reported.

Azithromycin use was defined as patients’ receipt of at least one dose of azithromycin during the first 48 hours after admission.

Study subjects were older adults with a mean age of 77.8 years in the national Department of Veterans Affairs administrative database who were hospitalized with pneumonia between 2002 and 2012 (JAMA 2014 June 4 [doi:10.1001/jama.2014.4304]). Most patients (98%) were male.

The study had a relatively small number of female subjects and relied "upon ICD-9 diagnosis of cardiovascular events rather than clinical information, which particularly may affect the diagnosis of heart failure,"h the authors said. However, they said, treating physicians were likely to have believed the patients in the study indeed had pneumonia and did not show any bias toward azithromycin.

This study was supported by a grant from the National Institute of Nursing Research. Dr. Mortensen reported having no disclosures. Other researchers reported receiving grants from industry sources.

Treating pneumonia with azithromycin is linked to lower risk of death but a slightly higher risk of myocardial infarction in older patients, according to a large retrospective cohort study.

Although azithromycin is recommended in combination with macrolides for the first-line treatment of patients hospitalized with pneumonia, recent research suggests it is associated with an increased risk of cardiovascular events. However, the current findings suggest that while it is associated with a slight increase in MI risk (number needed to harm equals 144), it is not associated with "any cardiac event," cardiac arrhythmia, or heart failure, and that the reduction in 90-day mortality risk (number needed to treat of 21) is large enough to provide an overall net benefit.

Dr. Eric M. Mortensen of the Veterans Affairs North Texas Health Care system, Dallas, and his colleagues reported their findings in the June 4 issue of JAMA.

In the current study, 20 in 31,863 patients aged 65 years and older who were exposed to azithromycin were significantly lower than in an equal number of propensity-matched controls who were not exposed (17.4% vs. 22.3%; odds ratio, 0.73).

The risk of myocardial infarction, however, was significantly increased in the azithromycin group (5.1% vs. 4.4%; OR, 1.17), investigators reported.

Azithromycin use was defined as patients’ receipt of at least one dose of azithromycin during the first 48 hours after admission.

Study subjects were older adults with a mean age of 77.8 years in the national Department of Veterans Affairs administrative database who were hospitalized with pneumonia between 2002 and 2012 (JAMA 2014 June 4 [doi:10.1001/jama.2014.4304]). Most patients (98%) were male.

The study had a relatively small number of female subjects and relied "upon ICD-9 diagnosis of cardiovascular events rather than clinical information, which particularly may affect the diagnosis of heart failure,"h the authors said. However, they said, treating physicians were likely to have believed the patients in the study indeed had pneumonia and did not show any bias toward azithromycin.

This study was supported by a grant from the National Institute of Nursing Research. Dr. Mortensen reported having no disclosures. Other researchers reported receiving grants from industry sources.

Prophylactic implantable cardioverter-defibrillator use was associated with improved 3-year survival in Medicare beneficiaries with heart failure and a left ventricular ejection fraction of 30%-35% and in those with LVEF less than 30%, compared with no prophylactic ICD use in comparable patients in a retrospective cohort study.

All-cause mortality at 3 years in 408 patients with LVEF of 30% -35% who received a prophylactic ICD was 51.4%, compared with 55% in 408 matched controls without an ICD (hazard ratio, 0.83). The all-cause mortality rates at 3 years in 1,088 patients with LVEF of less than 30% was 45% in those with a prophylactic ICD vs. 57.6% in 1,088 matched controls without an ICD (HR, 0.72), Dr. Sana M. Al-Khatib of Duke University, Durham, N.C., and her colleagues reported in the June 4 issue of JAMA.

Study subjects were Medicare beneficiaries in the National Cardiovascular Data Registry ICD registry during 2006-2007, and similar patients in the Get With the Guidelines-Heart Failure database during 2005-2009 (JAMA 2014;311:2209-15).

Prior studies of prophylactic ICD use have included only a minority of patients with LVEF of 30%-35%; the current findings demonstrate a "clearly significant" benefit in this population and support guideline recommendations calling for prophylactic ICD use in eligible patients with an LVEF of 35% or less, the investigators concluded.

This study was funded by a National Heart, Lung, and Blood Institute grant. Dr. Al-Khatib reported having no disclosures. Detailed disclosures for several of the other study authors are available with the full text of the article at jama.com.

Prophylactic implantable cardioverter-defibrillator use was associated with improved 3-year survival in Medicare beneficiaries with heart failure and a left ventricular ejection fraction of 30%-35% and in those with LVEF less than 30%, compared with no prophylactic ICD use in comparable patients in a retrospective cohort study.

All-cause mortality at 3 years in 408 patients with LVEF of 30% -35% who received a prophylactic ICD was 51.4%, compared with 55% in 408 matched controls without an ICD (hazard ratio, 0.83). The all-cause mortality rates at 3 years in 1,088 patients with LVEF of less than 30% was 45% in those with a prophylactic ICD vs. 57.6% in 1,088 matched controls without an ICD (HR, 0.72), Dr. Sana M. Al-Khatib of Duke University, Durham, N.C., and her colleagues reported in the June 4 issue of JAMA.

Study subjects were Medicare beneficiaries in the National Cardiovascular Data Registry ICD registry during 2006-2007, and similar patients in the Get With the Guidelines-Heart Failure database during 2005-2009 (JAMA 2014;311:2209-15).

Prior studies of prophylactic ICD use have included only a minority of patients with LVEF of 30%-35%; the current findings demonstrate a "clearly significant" benefit in this population and support guideline recommendations calling for prophylactic ICD use in eligible patients with an LVEF of 35% or less, the investigators concluded.

This study was funded by a National Heart, Lung, and Blood Institute grant. Dr. Al-Khatib reported having no disclosures. Detailed disclosures for several of the other study authors are available with the full text of the article at jama.com.

Prophylactic implantable cardioverter-defibrillator use was associated with improved 3-year survival in Medicare beneficiaries with heart failure and a left ventricular ejection fraction of 30%-35% and in those with LVEF less than 30%, compared with no prophylactic ICD use in comparable patients in a retrospective cohort study.

All-cause mortality at 3 years in 408 patients with LVEF of 30% -35% who received a prophylactic ICD was 51.4%, compared with 55% in 408 matched controls without an ICD (hazard ratio, 0.83). The all-cause mortality rates at 3 years in 1,088 patients with LVEF of less than 30% was 45% in those with a prophylactic ICD vs. 57.6% in 1,088 matched controls without an ICD (HR, 0.72), Dr. Sana M. Al-Khatib of Duke University, Durham, N.C., and her colleagues reported in the June 4 issue of JAMA.

Study subjects were Medicare beneficiaries in the National Cardiovascular Data Registry ICD registry during 2006-2007, and similar patients in the Get With the Guidelines-Heart Failure database during 2005-2009 (JAMA 2014;311:2209-15).

Prior studies of prophylactic ICD use have included only a minority of patients with LVEF of 30%-35%; the current findings demonstrate a "clearly significant" benefit in this population and support guideline recommendations calling for prophylactic ICD use in eligible patients with an LVEF of 35% or less, the investigators concluded.

This study was funded by a National Heart, Lung, and Blood Institute grant. Dr. Al-Khatib reported having no disclosures. Detailed disclosures for several of the other study authors are available with the full text of the article at jama.com.

CHICAGO – Women who have multiple children early in life are at increased risk for obesity early in adulthood, according to an analysis of National Health and Nutrition Examination Survey data.

The findings, from pooled 2001-2010 NHANES data, suggest that young multiparous women are a critical target group for obesity reduction efforts, Dr. Michelle H. Moniz of the University of Michigan, Ann Arbor, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The 4,979 women included in the study were aged 20-50 years at the time they were surveyed, and had a body mass index between 16.5 and 70 kg/m². They were not currently or recently pregnant.

After adjustment for race, ethnicity, income, and NHANES study wave, multiparous women aged 20-25 years were almost twice as likely as nulligravid women in that age group to be obese (odds ratio, 1.91). No significant differences were seen for other age groups or for primiparous vs. nulligravid women in any of the age groups, Dr. Moniz found.

Although limited by an inability to account for the effect of breast-feeding due to significant missing data and restriction on sample size, as well as by factors associated with its cross-sectional design – such as an inability to determine whether childbearing occurred before the onset of obesity – the study nevertheless highlights the importance of addressing the issue of obesity in young women, according to Dr. Moniz.

"Obesity affects more than a third of women in the United States and is a profound, persistent threat to health throughout the life course," she wrote, noting that studies have shown that once obesity is established, it is difficult to reverse.

Furthermore, childbearing increases the risk of obesity in women, and may be a particularly important risk factor in young mothers due to their increased risk of poverty, lower educational attainment, and endocrine parameters associated with physiologic growth during adolescence.

"Preventing unplanned pregnancies in adolescent and young adult women may be an important strategy to help reduce obesity prevalence and duration of exposure to obesity in women," Dr. Moniz concluded

Dr. Moniz reported having no relevant financial disclosures.

CHICAGO – Women who have multiple children early in life are at increased risk for obesity early in adulthood, according to an analysis of National Health and Nutrition Examination Survey data.

The findings, from pooled 2001-2010 NHANES data, suggest that young multiparous women are a critical target group for obesity reduction efforts, Dr. Michelle H. Moniz of the University of Michigan, Ann Arbor, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The 4,979 women included in the study were aged 20-50 years at the time they were surveyed, and had a body mass index between 16.5 and 70 kg/m². They were not currently or recently pregnant.

After adjustment for race, ethnicity, income, and NHANES study wave, multiparous women aged 20-25 years were almost twice as likely as nulligravid women in that age group to be obese (odds ratio, 1.91). No significant differences were seen for other age groups or for primiparous vs. nulligravid women in any of the age groups, Dr. Moniz found.

Although limited by an inability to account for the effect of breast-feeding due to significant missing data and restriction on sample size, as well as by factors associated with its cross-sectional design – such as an inability to determine whether childbearing occurred before the onset of obesity – the study nevertheless highlights the importance of addressing the issue of obesity in young women, according to Dr. Moniz.

"Obesity affects more than a third of women in the United States and is a profound, persistent threat to health throughout the life course," she wrote, noting that studies have shown that once obesity is established, it is difficult to reverse.

Furthermore, childbearing increases the risk of obesity in women, and may be a particularly important risk factor in young mothers due to their increased risk of poverty, lower educational attainment, and endocrine parameters associated with physiologic growth during adolescence.

"Preventing unplanned pregnancies in adolescent and young adult women may be an important strategy to help reduce obesity prevalence and duration of exposure to obesity in women," Dr. Moniz concluded

Dr. Moniz reported having no relevant financial disclosures.

CHICAGO – Women who have multiple children early in life are at increased risk for obesity early in adulthood, according to an analysis of National Health and Nutrition Examination Survey data.

The findings, from pooled 2001-2010 NHANES data, suggest that young multiparous women are a critical target group for obesity reduction efforts, Dr. Michelle H. Moniz of the University of Michigan, Ann Arbor, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

The 4,979 women included in the study were aged 20-50 years at the time they were surveyed, and had a body mass index between 16.5 and 70 kg/m². They were not currently or recently pregnant.

After adjustment for race, ethnicity, income, and NHANES study wave, multiparous women aged 20-25 years were almost twice as likely as nulligravid women in that age group to be obese (odds ratio, 1.91). No significant differences were seen for other age groups or for primiparous vs. nulligravid women in any of the age groups, Dr. Moniz found.

Although limited by an inability to account for the effect of breast-feeding due to significant missing data and restriction on sample size, as well as by factors associated with its cross-sectional design – such as an inability to determine whether childbearing occurred before the onset of obesity – the study nevertheless highlights the importance of addressing the issue of obesity in young women, according to Dr. Moniz.

"Obesity affects more than a third of women in the United States and is a profound, persistent threat to health throughout the life course," she wrote, noting that studies have shown that once obesity is established, it is difficult to reverse.

Furthermore, childbearing increases the risk of obesity in women, and may be a particularly important risk factor in young mothers due to their increased risk of poverty, lower educational attainment, and endocrine parameters associated with physiologic growth during adolescence.

"Preventing unplanned pregnancies in adolescent and young adult women may be an important strategy to help reduce obesity prevalence and duration of exposure to obesity in women," Dr. Moniz concluded

Dr. Moniz reported having no relevant financial disclosures.

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

CHICAGO – Same-day intrauterine device placement is safe and effective, and should be considered for women seeking contraception, according to findings from two separate studies.

In one study, 272 women aged 15-44 years who visited an inner-city clinic for pregnancy testing or emergency contraception between Aug. 22, 2011, and May 30, 2013, were offered same-day copper IUD placement if they did not report unprotected intercourse within 8-14 days prior to the visit, and if they had no evidence of cervicitis on examination.

At 3 months’ follow-up, the rate of pelvic inflammatory disease (PID) was not significantly higher in 28 women who received the same-day IUD placement than in 17 who received an IUD within 3 months, Nan A. Wang of the University of Pittsburgh Medical Center reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

Based on a chart review, 6.1% of those with same-day IUD placement and none of those with later placement reported a PID diagnosis, and 12.1% vs. 0% reported an STI diagnosis. Electronic medical record data showed that 6.5% of patients with same-day placement and 5.0% of patients without same-day placement had a PID diagnosis, and 48.4% and 37.5%, respectively, had pelvic pain.

Survey data at the initial visit and at 3 months’ follow-up showed that 50% vs. 43.8% of patients in the groups, respectively, had pelvic pain, and 57.1% and 52.9% were using condoms.

Furthermore, 88% of those who received same-day IUD placement reported ongoing IUD use at 3 months, and only 3% reported unintended pregnancy at 3 months, compared with 15% of patients who received ulipristal acetate pills and 9% who received levonorgestrel pills, Ms. Wang noted.

"Same-day IUD placement was not associated with higher rates of PID within 3 months, compared to women who did not receive same-day IUD placement," Ms. Wang wrote, adding that the absolute risk of PID following IUD placement in women who reported recent unprotected sex was less than 4%.

Same-day placement also did not reduce condom use, compared with other prescription contraceptives, and although pelvic pain was more common in those with same-day placement, it is not always a sign of infection, she wrote, concluding that concern for asymptomatic STI should not delay IUD placement, even among high-risk women.

In a separate study, Dr. Margaret Markham also found evidence favoring same-day IUD placement.

In 720 patients who presented for IUD placement and who were subject to a "two-visit protocol" for IUD insertion, with testing for gonorrhea and chlamydia at the first visit, the incidence of gonorrhea was 0.56% and the incidence of chlamydia was 2.5%, but only 69.74% of patients returned for the second visit for IUD placement, according to a chart review.

Those who tested positive for gonorrhea or chlamydia were less likely to return (odds ratio, 4.68), and the rate of pregnancy was significantly higher in those who did not return (32.4% vs. 1.9%), Dr. Markham of Baylor College of Medicine, Houston, reported in a poster at the meeting.

Women included in the study were predominantly Hispanic, multiparous, and married, with a low historical rate of STIs. The rate of follow-up for IUD placement was consistent with rates of 30%-71% reported in prior studies involving a two-visit protocol.

"Current ‘two-visit’ protocols should be amended to allow for immediate placement of IUDs in similar populations to prevent delay in contraceptive service and unintended pregnancy," Dr. Markham concluded.

Ms. Wang and Dr. Markham reported having no disclosures.

CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.

Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).

The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m², 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists

Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.

Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.

Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.

Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.

Dr. Mikhail reported having no relevant financial disclosures.

CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.

Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).

The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m², 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists

Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.

Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.

Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.

Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.

Dr. Mikhail reported having no relevant financial disclosures.

CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.

Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).

The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m², 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists

Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.

Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.

Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.

Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.

Dr. Mikhail reported having no relevant financial disclosures.

CHICAGO – Obesity was not associated with an increase in the risk of preterm birth among women with cerclage in a retrospective cohort study.

The rate of preterm births before 34 weeks’ gestation was similar in 103 nonobese women with cerclage and 93 obese women with cerclage (37.9% and 31.2%, respectively; odds ratio, 1.35) in a 2009-2011 study of patients, Dr. Lorene A. Temming and her colleagues reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In fact, there were no differences in the rate of preterm births between the two groups at any of the other time points evaluated, including 24, 28, 32, and 37 weeks’ gestation, and there also was no difference in the rate of term births between the groups, according to Dr. Temming of Carolinas Medical Center, Charlotte, N.C., and her associates.

The nonobese patients had a body mass index less than 30 kg/m², and the obese patients had a BMI of 30 or greater. The women all had singleton gestation, she noted.

The results of prior studies that investigated the effect of obesity on cerclage efficacy have conflicted. A secondary analysis of a large randomized trial of cerclage for short cervix showed no effect of obesity, but a smaller study showed that obesity was associated with increased risk of preterm birth prior to 35 weeks.

"Obesity increases risks of preeclampsia, gestational diabetes, and cesarean delivery, and is associated with increased operative morbidity with cesarean delivery. The role of obesity in preterm birth is less clear," Dr. Temming and her associates wrote.

Furthermore, although cerclage has been shown in multiple randomized, controlled trials and in a recent meta-analysis to reduce preterm birth in women with short cervical length, the effect of obesity on the efficacy of cerclage has also been unclear, they noted.

The current findings, which are derived from the second-largest data set available in the literature (although Dr. Temming listed sample size as a limiting factor in the study), are consistent with those from the larger of two prior studies, and suggest that obesity does not worsen outcomes in the setting of cerclage, she and her coauthors concluded.

Dr. Temming reported having no relevant financial disclosures.

CHICAGO – Obesity was not associated with an increase in the risk of preterm birth among women with cerclage in a retrospective cohort study.

The rate of preterm births before 34 weeks’ gestation was similar in 103 nonobese women with cerclage and 93 obese women with cerclage (37.9% and 31.2%, respectively; odds ratio, 1.35) in a 2009-2011 study of patients, Dr. Lorene A. Temming and her colleagues reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In fact, there were no differences in the rate of preterm births between the two groups at any of the other time points evaluated, including 24, 28, 32, and 37 weeks’ gestation, and there also was no difference in the rate of term births between the groups, according to Dr. Temming of Carolinas Medical Center, Charlotte, N.C., and her associates.

The nonobese patients had a body mass index less than 30 kg/m², and the obese patients had a BMI of 30 or greater. The women all had singleton gestation, she noted.

The results of prior studies that investigated the effect of obesity on cerclage efficacy have conflicted. A secondary analysis of a large randomized trial of cerclage for short cervix showed no effect of obesity, but a smaller study showed that obesity was associated with increased risk of preterm birth prior to 35 weeks.

"Obesity increases risks of preeclampsia, gestational diabetes, and cesarean delivery, and is associated with increased operative morbidity with cesarean delivery. The role of obesity in preterm birth is less clear," Dr. Temming and her associates wrote.

Furthermore, although cerclage has been shown in multiple randomized, controlled trials and in a recent meta-analysis to reduce preterm birth in women with short cervical length, the effect of obesity on the efficacy of cerclage has also been unclear, they noted.

The current findings, which are derived from the second-largest data set available in the literature (although Dr. Temming listed sample size as a limiting factor in the study), are consistent with those from the larger of two prior studies, and suggest that obesity does not worsen outcomes in the setting of cerclage, she and her coauthors concluded.

Dr. Temming reported having no relevant financial disclosures.

CHICAGO – Obesity was not associated with an increase in the risk of preterm birth among women with cerclage in a retrospective cohort study.

The rate of preterm births before 34 weeks’ gestation was similar in 103 nonobese women with cerclage and 93 obese women with cerclage (37.9% and 31.2%, respectively; odds ratio, 1.35) in a 2009-2011 study of patients, Dr. Lorene A. Temming and her colleagues reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In fact, there were no differences in the rate of preterm births between the two groups at any of the other time points evaluated, including 24, 28, 32, and 37 weeks’ gestation, and there also was no difference in the rate of term births between the groups, according to Dr. Temming of Carolinas Medical Center, Charlotte, N.C., and her associates.

The nonobese patients had a body mass index less than 30 kg/m², and the obese patients had a BMI of 30 or greater. The women all had singleton gestation, she noted.

The results of prior studies that investigated the effect of obesity on cerclage efficacy have conflicted. A secondary analysis of a large randomized trial of cerclage for short cervix showed no effect of obesity, but a smaller study showed that obesity was associated with increased risk of preterm birth prior to 35 weeks.

"Obesity increases risks of preeclampsia, gestational diabetes, and cesarean delivery, and is associated with increased operative morbidity with cesarean delivery. The role of obesity in preterm birth is less clear," Dr. Temming and her associates wrote.

Furthermore, although cerclage has been shown in multiple randomized, controlled trials and in a recent meta-analysis to reduce preterm birth in women with short cervical length, the effect of obesity on the efficacy of cerclage has also been unclear, they noted.

The current findings, which are derived from the second-largest data set available in the literature (although Dr. Temming listed sample size as a limiting factor in the study), are consistent with those from the larger of two prior studies, and suggest that obesity does not worsen outcomes in the setting of cerclage, she and her coauthors concluded.

Dr. Temming reported having no relevant financial disclosures.

CHICAGO – Many women who undergo a loop electrosurgical excision procedure for advanced cervical dysplasia are not screened for HIV and other sexually transmitted diseases, according to findings from a records review.

"While younger women were more likely to have been screened for HIV and other STIs than older women in this cohort, all women presenting for LEEP should be counseled and offered screening if indicated," investigators reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists. Ob.gyn. providers should not assume that screening is routinely offered in the primary care setting, they added.

Of 95 women who underwent LEEP at a large, urban university clinic between January 2010 and December 2012, 52 (55%) had no screening for HIV, syphilis, chlamydia, or gonorrhea within 12 months of the procedure or between their most recent Pap smear and the LEEP procedure, and 43 had at least one STI screening, Nicholas O. Jeffrey, a medical student at Florida State University, Tallahassee, and his associates reported.

Older women were less likely than younger women in this cohort to be screened; the mean age of women with no documented STI or HIV screening test was 43 years, compared with 33 years among those who were screened, Mr. Jeffrey found.

Those with no testing had at least two visits within the year prior to their LEEP procedure, they noted.

"Ob.gyn. providers have a unique opportunity to recommend and offer HIV and STI screening to women seeking treatment for abnormal cervical cytology, because these women often have more than one [gynecologic] visit during treatment," they wrote.

Based on these findings, the opportunity is often missed.

HIV and STI screening are important public health interventions because the incidence of HIV and STIs continues to rise, particularly among minority women in urban areas. In fact, the U.S. Preventive Services Task Force recommends HIV screening for those who have not been tested or who are at increased risk of HIV or other STIs.

Most invasive and preinvasive lesions of the cervix and vagina are caused by human papillomavirus types 16 and 18, and because HPV is transmitted through sexual contact, screening for other STIs is warranted in women who present with HPV infection.

Furthermore, having an STI increases the risk of acquiring HIV infection, Mr. Jeffrey and his colleagues noted, adding that as detection of HPV-related diseases advances, the number of women accessing the health care system for treatment will likely increase.

Mr. Jeffrey reported having no disclosures.

CHICAGO – Many women who undergo a loop electrosurgical excision procedure for advanced cervical dysplasia are not screened for HIV and other sexually transmitted diseases, according to findings from a records review.

"While younger women were more likely to have been screened for HIV and other STIs than older women in this cohort, all women presenting for LEEP should be counseled and offered screening if indicated," investigators reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists. Ob.gyn. providers should not assume that screening is routinely offered in the primary care setting, they added.

Of 95 women who underwent LEEP at a large, urban university clinic between January 2010 and December 2012, 52 (55%) had no screening for HIV, syphilis, chlamydia, or gonorrhea within 12 months of the procedure or between their most recent Pap smear and the LEEP procedure, and 43 had at least one STI screening, Nicholas O. Jeffrey, a medical student at Florida State University, Tallahassee, and his associates reported.

Older women were less likely than younger women in this cohort to be screened; the mean age of women with no documented STI or HIV screening test was 43 years, compared with 33 years among those who were screened, Mr. Jeffrey found.

Those with no testing had at least two visits within the year prior to their LEEP procedure, they noted.

"Ob.gyn. providers have a unique opportunity to recommend and offer HIV and STI screening to women seeking treatment for abnormal cervical cytology, because these women often have more than one [gynecologic] visit during treatment," they wrote.

Based on these findings, the opportunity is often missed.

HIV and STI screening are important public health interventions because the incidence of HIV and STIs continues to rise, particularly among minority women in urban areas. In fact, the U.S. Preventive Services Task Force recommends HIV screening for those who have not been tested or who are at increased risk of HIV or other STIs.

Most invasive and preinvasive lesions of the cervix and vagina are caused by human papillomavirus types 16 and 18, and because HPV is transmitted through sexual contact, screening for other STIs is warranted in women who present with HPV infection.

Furthermore, having an STI increases the risk of acquiring HIV infection, Mr. Jeffrey and his colleagues noted, adding that as detection of HPV-related diseases advances, the number of women accessing the health care system for treatment will likely increase.

Mr. Jeffrey reported having no disclosures.

CHICAGO – Many women who undergo a loop electrosurgical excision procedure for advanced cervical dysplasia are not screened for HIV and other sexually transmitted diseases, according to findings from a records review.

"While younger women were more likely to have been screened for HIV and other STIs than older women in this cohort, all women presenting for LEEP should be counseled and offered screening if indicated," investigators reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists. Ob.gyn. providers should not assume that screening is routinely offered in the primary care setting, they added.

Of 95 women who underwent LEEP at a large, urban university clinic between January 2010 and December 2012, 52 (55%) had no screening for HIV, syphilis, chlamydia, or gonorrhea within 12 months of the procedure or between their most recent Pap smear and the LEEP procedure, and 43 had at least one STI screening, Nicholas O. Jeffrey, a medical student at Florida State University, Tallahassee, and his associates reported.

Older women were less likely than younger women in this cohort to be screened; the mean age of women with no documented STI or HIV screening test was 43 years, compared with 33 years among those who were screened, Mr. Jeffrey found.

Those with no testing had at least two visits within the year prior to their LEEP procedure, they noted.

"Ob.gyn. providers have a unique opportunity to recommend and offer HIV and STI screening to women seeking treatment for abnormal cervical cytology, because these women often have more than one [gynecologic] visit during treatment," they wrote.

Based on these findings, the opportunity is often missed.

HIV and STI screening are important public health interventions because the incidence of HIV and STIs continues to rise, particularly among minority women in urban areas. In fact, the U.S. Preventive Services Task Force recommends HIV screening for those who have not been tested or who are at increased risk of HIV or other STIs.

Most invasive and preinvasive lesions of the cervix and vagina are caused by human papillomavirus types 16 and 18, and because HPV is transmitted through sexual contact, screening for other STIs is warranted in women who present with HPV infection.

Furthermore, having an STI increases the risk of acquiring HIV infection, Mr. Jeffrey and his colleagues noted, adding that as detection of HPV-related diseases advances, the number of women accessing the health care system for treatment will likely increase.

Mr. Jeffrey reported having no disclosures.

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

CHICAGO – Induction of labor is reasonable in cases involving fetal growth restriction, as most patients who are induced deliver vaginally rather than by cesarean section, according to findings from a retrospective cohort study.

Of 134 patients who underwent induction of labor for fetal growth restriction (FGR), 81% delivered vaginally, Dr. Kari Horowitz reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists.

In those who delivered by C-section, the indication was nonreassuring fetal heart rate in 88% of cases, according to Dr. Horowitz, of the University of Connecticut, Farmington.

The cesarean delivery rates were highest in cases involving nulliparity, prematurity, hypertension, oligohydramnios, and use of prostaglandins. Logistic regression analysis showed that only prematurity was significantly associated with cesarean delivery (odds ratio, 3.81).

The findings are based on a chart review of all patients with singleton pregnancy, a non-anomalous fetus, and suspected FGR (estimated fetal weight and/or fetal abdominal circumference less than the 10th percentile, or no interval growth) who delivered between January 2008 and December 2012. Patients were excluded from the study if there was multiple gestation; fetal anomalies or aneuploidy; malpresentation; a history of prior cesarean delivery; or other contraindications to vaginal delivery.

Although FGR is associated with neonatal risks, including intrauterine demise, neonatal morbidity and mortality, and postnatal morbidity, it is not considered an indication for cesarean delivery. Affected fetuses, however, may be at risk for nonreassuring fetal heart rate tracing and fetal distress due to uteroplacental insufficiency. Delivery at 38 to 39 6/7 weeks is recommended in cases of isolated FGR, and delivery before 38 weeks is recommended in cases with additional risk factors for adverse outcomes.

"Prior studies have found increased risk of cesarean delivery in FGR neonates undergoing induction of labor as compared to spontaneous labor, and no difference in rates of cesarean delivery or adverse outcomes in patients undergoing induction of labor versus expectant management. Term FGR fetuses have been found to have significantly higher rates of cesarean delivery for nonreassuring fetal heart rate tracing," Dr. Horowitz noted.

"It is recommended that these patients undergo a trial of labor," Dr. Horowitz concluded, noting that preterm patients should be counseled about the increased risk of cesarean delivery for nonreassuring fetal heart tracing.

Dr. Horowitz reported having no disclosures.

Some studies have suggested that overweight and obese patients have a survival advantage following stroke, but no evidence of this "obesity paradox" was found in an analysis of registry data.

Of 71,617 patients in the Danish Stroke Register, 7,878 (11%) died within a month of the index stroke, with 5,512 of the deaths (70%) attributable to the stroke. The largest proportion of deaths (39%) were among normal-weight patients, while 9.7% were underweight, 34.5% were overweight, and 16.8% were obese. The hazard ratios for stroke mortality for overweight and obese patients, compared with normal weight patients, were 0.96 and 1.0, respectively, Christian Dehlendorff, Ph.D., of the Danish Cancer Society Research Center, Copenhagen, and associates reported online June 2 in JAMA Neurology.

Of note, BMI was inversely related to average age of stroke onset, the investigators found (JAMA Neurol. 2014 June 2 [doi:10.1001/jamaneurol.2014.1017]).

The findings suggest that the "obesity paradox" identified in some earlier studies was an artifact related to selection bias, and that overweight and obese individuals with stroke should continue to aim for normal weight, the investigators concluded.

This study was funded by Jascha Foundation. The authors reported having no disclosures.

Some studies have suggested that overweight and obese patients have a survival advantage following stroke, but no evidence of this "obesity paradox" was found in an analysis of registry data.

Of 71,617 patients in the Danish Stroke Register, 7,878 (11%) died within a month of the index stroke, with 5,512 of the deaths (70%) attributable to the stroke. The largest proportion of deaths (39%) were among normal-weight patients, while 9.7% were underweight, 34.5% were overweight, and 16.8% were obese. The hazard ratios for stroke mortality for overweight and obese patients, compared with normal weight patients, were 0.96 and 1.0, respectively, Christian Dehlendorff, Ph.D., of the Danish Cancer Society Research Center, Copenhagen, and associates reported online June 2 in JAMA Neurology.

Of note, BMI was inversely related to average age of stroke onset, the investigators found (JAMA Neurol. 2014 June 2 [doi:10.1001/jamaneurol.2014.1017]).

The findings suggest that the "obesity paradox" identified in some earlier studies was an artifact related to selection bias, and that overweight and obese individuals with stroke should continue to aim for normal weight, the investigators concluded.

This study was funded by Jascha Foundation. The authors reported having no disclosures.

Some studies have suggested that overweight and obese patients have a survival advantage following stroke, but no evidence of this "obesity paradox" was found in an analysis of registry data.

Of 71,617 patients in the Danish Stroke Register, 7,878 (11%) died within a month of the index stroke, with 5,512 of the deaths (70%) attributable to the stroke. The largest proportion of deaths (39%) were among normal-weight patients, while 9.7% were underweight, 34.5% were overweight, and 16.8% were obese. The hazard ratios for stroke mortality for overweight and obese patients, compared with normal weight patients, were 0.96 and 1.0, respectively, Christian Dehlendorff, Ph.D., of the Danish Cancer Society Research Center, Copenhagen, and associates reported online June 2 in JAMA Neurology.

Of note, BMI was inversely related to average age of stroke onset, the investigators found (JAMA Neurol. 2014 June 2 [doi:10.1001/jamaneurol.2014.1017]).

The findings suggest that the "obesity paradox" identified in some earlier studies was an artifact related to selection bias, and that overweight and obese individuals with stroke should continue to aim for normal weight, the investigators concluded.

This study was funded by Jascha Foundation. The authors reported having no disclosures.