The following represent additions to UpToDate since the last version that were considered by the authors and editors to be of particular interest. The new material described below represents a small subset of the updating that has been performed, since approximately 40 percent of the topic reviews are updated during each four month cycle.
OBSTETRICS
Diagnosis of diabetes in pregnancy — The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommended a change in the terminology and diagnosis of diabetes in pregnancy [1]. The new approach, which has not yet been endorsed by the American Diabetes Association or the American College of Obstetricians and Gynecologists, is shown in the algorithm (algorithm 1). (See "Screening and diagnosis of diabetes mellitus during pregnancy", section on 'Proposed new terminology'.)
Influenza vaccine — Influenza vaccination with inactivated vaccine is recommended for pregnant women, regardless of the stage of pregnancy. Starting with the 2010 influenza season in the southern hemisphere and the 2010-2011 season in the northern hemisphere, a trivalent influenza vaccine will be available and will include antigens from both the 2009 pandemic H1N1 influenza virus and seasonal influenza viruses [2]. (See "Seasonal influenza vaccination in adults" and "Immunization of pregnant women", section on 'Influenza'.)
Acetaminophen for fever in pregnancy — The National Birth Defects Prevention Study observed that among women with infection-related fever, use of acetaminophen was associated with a statistically significant reduction in neural tube defects, as well as cleft lip/palate and gastroschisis [3]. These data support the safety of acetaminophen for relief of fever and pain; however, the reduction in birth defects should be confirmed in other studies before acetaminophen is recommended to febrile women for this purpose. (See "Genetic and environmental causes of birth defects", section on 'Fever/hyperthermia'.)
Clinical manifestations of uterine rupture — A study that evaluated the association between epidural dosing and the risk of uterine rupture in women who attempt a trial of labor after a cesarean delivery (TOLAC) observed that frequent dosing was a marker of women who experience uterine rupture [4]. This suggests that rupture-related pain is perceived, but often attributed to normal labor rather than a pathological process. There should be heightened clinical suspicion for uterine rupture in women who require frequent epidural dosing during TOLAC. (See "Trial of labor after cesarean delivery", section on 'Uterine rupture'.)
OFFICE GYNECOLOGY
HE4 levels associated with endometriomas — Like CA 125, human epididymal secretory protein E4 (HE4) is a promising biomarker for ovarian cancer. In contrast to CA 125, HE4 levels do not appear to be elevated in women with endometriosis, and thus can be useful to rule out ovarian cancer in patients with endometriosis and a pelvic mass suspected to be an endometrioma [5]. (See "Pathogenesis, clinical features, and diagnosis of endometriosis", section on 'Human epididymal secretory protein E4 (HE4)', and (see "Overview of the evaluation and management of adnexal masses", section on 'Human epididymis protein 4').
New CDC medical eligibility tables for contraceptive use — The United States Centers for Disease Control (CDC) modified the World Health Organization (WHO) tables for medical eligibility criteria for contraceptive use [6]. Selected WHO recommendations were adapted for US clinicians and patients, the number of medical conditions was expanded and recommendations added, and contraceptive methods not available in the US were removed. These changes are described in the table (table 1). (See "Overview of contraception", section on 'CDC modifications to WHO tables'.)
REPRODUCTIVE ENDOCRINOLOGY
Treatment of recurrent pregnancy loss — A large randomized trial found that neither aspirin alone nor aspirin plus heparin improved the live-birth rate of women with unexplained recurrent pregnancy loss (RPL) [7]. In this trial, 364 women with unexplained RPL after a thorough evaluation were randomly assigned to receive daily aspirin (80 mg), aspirin plus nadroparin (2850 international units), or placebo during pregnancy. The live-birth rates for combination therapy, aspirin alone, and placebo were not significantly different: 69, 62, and 67 percent, respectively. (See "Management of couples with recurrent pregnancy loss", section on 'Aspirin with or without heparin'.)
GYNECOLOGIC ONCOLOGY
Paraaortic lymph node dissection in endometrial cancer — Paraaortic lymph node dissection (LND) appears to be associated with a survival benefit in women with intermediate or high-risk endometrial cancer. A retrospective cohort study of women with endometrial cancer who underwent LND reported that eight-year disease-specific survival rates were significantly higher for women with intermediate or high-risk disease who underwent combined pelvic and paraaortic LND group compared with those who had pelvic LND alone, but there was no significant difference in women with low-risk disease [8]. (See "Endometrial cancer: Pretreatment evaluation, staging, and posttreatment surveillance", section on 'Assessment of paraaortic nodes'.)
Predicting optimal cytoreduction in ovarian cancer — A high preoperative CA 125 level has been associated with a lower likelihood of optimal cytoreduction. A meta-analysis of 15 studies found that CA 125 ≥500 U/mL has sensitivity and specificity for optimal cytoreduction of 69 and 63 percent, respectively [9].
Multiple conization procedures increase risk of preterm delivery — The risk of preterm delivery may increase in women with cervical intraepithelial neoplasia who undergo more than one cervical conization. A population-based retrospective study reported that, compared to women with one prior conization, the risk of preterm delivery increased three-fold in women with two prior conizations [10]. (See "Cervical intraepithelial neoplasia: Reproductive effects of treatment", section on Number of procedure.)
GYNECOLOGIC SURGERY
Endometrial preparation for endometrial ablation — Women undergoing microwave endometrial ablation may be able to schedule the procedure according to their menstrual cycle, as an alternative to hormonal endometrial preparation. A randomized trial found that women in whom the procedure was performed after menses had no significant differences in rates of amenorrhea or hysterectomy at five-year follow-up compared with those who were pretreated with danazol or goserelin [11]. (See "An overview of endometrial ablation", section on 'Endometrial preparation'.)
Sterilization does not impact sexual function — Sexual function appears to be unchanged or improved in women following sterilization. In a large prospective study of women who underwent interval tubal sterilization, almost all women reported no change in, or increased, sexual desire or pleasure [12]. (See "Surgical sterilization of women", section on 'Other long-term issues'.)
UROGYNECOLOGY
Transobturator versus retropubic midurethral slings — The optimal surgical route (transobturator or retropubic) for midurethral sling surgery in women with stress urinary incontinence is uncertain. The largest randomized trial to-date, in which women were assigned to undergo either a transobturator or retropubic sling procedure, was unable to prove that the newer retropubic procedure had equivalent efficacy to the older transobturator procedure [13]. (See "Stress urinary incontinence in women: Choosing a primary surgical procedure", section on 'Transobturator versus retropubic midurethral slings'.)
Pessary use versus pelvic floor muscle training — A large randomized trial of women with stress urinary incontinence found that those treated with a continence pessary had a significantly lower rate of resolution of incontinence symptoms and treatment satisfaction during the first few months of therapy than those treated with pelvic floor muscle training; however, outcomes were similar with long-term use of either strategy [14]. (See "Vaginal pessary treatment of prolapse and incontinence", section on 'Treatment of urinary incontinence trials'.)
Botulinum toxin for overactive bladder syndrome — Detrusor injection of botulinum toxin (BoNT) has been investigated for treatment of overactive bladder syndrome that is refractory to other therapy. The effect of BoNT is transient, and a prospective cohort study of patients who were treated with BoNT-A (onabotulinumtoxinA, Botox®) reported that the average time between injections was 8 to 12 months [15]. (See "Use of botulinum toxin for treatment of non-neurogenic lower urinary tract dysfunction", section on 'Dosage and duration of action'.)
REFERENCES
- International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33:676.
- World Health Organization. Recommended viruses for influenza vaccines for use in the 2010-2011 northern hemisphere influenza season. Available at www.who.int/csr/disease/influenza/recommendations2010_11north/en/index.html (Accessed May 10, 2010).
- Feldkamp, ML, Meyer, RE, Krikov, S, Botto, LD. Acetaminophen use in pregnancy and risk of birth defects: findings from the National Birth Defects Prevention Study. Obstet Gynecol 2010; 115:109.
- Cahill, AG, Odibo, AO, Allsworth, JE, Macones, GA. Frequent epidural dosing as a marker for impending uterine rupture in patients who attempt vaginal birth after cesarean delivery. Am J Obstet Gynecol 2010; 202:355.
- Bordin, L, Fiore, C, Dona, G, et al. Evaluation of erythrocyte band 3 phosphotyrosine level, glutathione content, CA-125, and human epididymal secretory protein E4 as combined parameters in endometriosis. Fertil Steril 2010; :.
- U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 — Adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition. Available at www.cdc.gov/mmwr/preview/mmwrhtml/rr59e0528a1.htm (Accessed May 28, 2010).
- Kaandorp, SP, Goddijn, M, van der, Post JA, et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N Engl J Med 2010; 362:1586.
- Todo, Y, Kato, H, Kaneuchi, M, et al. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 2010; 375:1165.
- Kang, S, Kim, TJ, Nam, BH, et al. Preoperative serum CA-125 levels and risk of suboptimal cytoreduction in ovarian cancer: a meta-analysis. J Surg Oncol 2010; 101:13.
- Ortoft, G, Henriksen, T, Hansen, E, Petersen, L. After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy. BJOG 2010; 117:258.
- Sambrook, AM, Jack, SA, Cooper, KG. Outpatient microwave endometrial ablation: 5-year follow-up of a randomised controlled trial without endometrial preparation versus standard day surgery with endometrial preparation. BJOG 2010; 117:493.
- Smith, A, Lyons, A, Ferris, Jet al. Are sexual problems more common in women who have had a tubal ligation? A population-based study of Australian women. BJOG 2010; 117:463.
- Richter, HE, Albo, ME, Zyczynski, HM, et al. Retropubic versus transobturator midurethral slings for stress incontinence. N Engl J Med 2010; 362:2066.
- Richter, HE, Burgio, KL, Brubaker, L, et al. Continence pessary compared with behavioral therapy or combined therapy for stress incontinence: a randomized controlled trial. Obstet Gynecol 2010; 115:609.
- Sahai, A, Dowson, C, Khan, MS, Dasgupta, P. Repeated injections of botulinum toxin-A for idiopathic detrusor overactivity. Urology 2010; 75:552.
