1. Probiotics as adjunct therapy for vulvovaginal candidiasis
- Probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women: A systematic review and meta-analysis of randomized controlled trials in American Journal of Obstetrics & Gynecology
Vulvovaginal candidiasis (VVC), commonly known as vaginal yeast infection, is a common cause of vaginal discomfort and itching, and can significantly affect quality of life. While azole antifungal medications are the first-line treatment, patients with recurrent VVC who use these medications long-term may eventually develop drug resistance. Accordingly, there is increased interest in alternative and/or adjunctive treatment options for management of VVC. In this systematic review and meta-analysis of 14 randomized controlled trials investigating the use of probiotics in relation to traditional antifungal agents, the authors concluded that combination therapy with both antifungals and probiotics provided significantly higher short-term cures, clinical cures, and 6 month recurrence rates for VVC, and decreased 3-month rates of recurrent VVC; no longer-term effects were noted. Antifungals outperformed probiotics alone for short-term cure, while probiotics alone showed some benefit for recurrent VVC at 6 months compared with placebo. The authors call for additional studies, but conclude that combination therapy with antifungals and probiotics has the potential to enhance VVC cure rates, as well as the duration of cure for recurrent VVC.
2. ACOG guidance on unexplained elevated hCG
- ACOG Clinical Consensus No. 11: Management of Positive Human Chorionic Gonadotropin Test Results in Nonpregnant Patients Without Gynecologic Malignancy in Obstetrics & Gynecology
Human chorionic gonadotropin (HCG) is a hormone produced after implantation, and is most commonly seen in pregnancy, gestational trophoblastic neoplasm, or certain germ cell tumors. However, there are rare scenarios in which a patient may have an elevated HCG even when when pregnancy and gynecologic malignancy have been excluded. In this new Clinical Consensus published by the American College of Obstetricians and Gynecologists, the authors outline an structured approach to elevated HCG in these individuals. The Clinical Consensus describes some of the most common reasons for these elevated HCG results, including antibody production, kidney failure, and a rare familial syndrome. It provides a framework that can guide healthcare professionals, with possible next steps of comparing urine and serum HCG results, repeating testing with a different assay, or tracking the patient’s follicle-stimulating hormone. Providers can also consider non-gynecologic malignancies, which can occasionally cause HCG to be elevated, but should followed only after an initial, less invasive evaluation. This Consensus is a useful clinical reference for a scenario that can otherwise prompt unnecessary intervention.
3. Paracervical blocks reduce pain during IUD placement
- A double-blind, triple-arm randomized controlled trial of 1% lidocaine paracervical block for intrauterine device (IUD) insertion in Contraception
IUDs are highly effective forms of long-acting contraception, and can be safely used by almost all patients. However, concern about pain during placement remains a meaningful barrier to IUD uptake. In this randomized controlled trial, researchers compared pain scores among patients receiving a lidocaine paracervical block, a normal saline block, or a capped-needle control. Patients who received paracervical blocks with lidocaine, including nulliparous patients, reported lower pain scores at key steps in IUD placement (tenaculum placement, sounding, and IUD placement). Pain during block placement itself was minimal, and patient satisfaction was significantly higher among those who received a lidocaine block. This data can be used to support routinely offering paracervical blocks for outpatient IUD placement.
4. Lidocaine spray does not significantly reduce IUD insertion pain
- The role of lidocaine spray in reducing pain during intrauterine device insertion in BMC Womens Health
Interest is high in identifying safe and effective modalities of pain control for outpatient IUD placements. In this double-blind randomized controlled trial, the authors recruited nearly 300 patients to determine whether lidocaine spray improved pain scores during IUD placement. In their analysis, the authors found that lidocaine spray did not significantly change pain scores during IUD placement in relation to a placebo spray. While the authors acknowledge that preferences between individual patients may vary around preferred pain control modalities, these findings suggest lidocaine spray alone is unlikely to meaningfully improve insertion pain for most patients.
5. Social media exposure linked to higher anticipated IUD pain
- Anxiety and pain from office intrauterine device insertion: relationship to prior social media use in Contraception
Patient expectations about IUD insertion are increasingly shaped by social media. In this prospective longitudinal study of 133 patients presenting for IUD placement, participants were queried about their social media use and specifically asked about content related to IUDs. Overall social media use was high, a median of 1-3 hours daily, and 80% of patients reported seeing content about IUDs; most of this content (67%) was negative. Exposure to negative content was associated with higher anticipated pain and anxiety scores. The authors emphasize the importance of proactively addressing online narratives, setting realistic expectations, and discussing evidence-based pain management strategies before insertion.
6. Menstrual blood HPV testing shows high sensitivity
Infection with human papilloma virus (HPV) is common, and a small percentage of patients with HPV infection will develop cervical dysplasia or cervical cancer. Testing for HPV infection is an important component for cervical cancer screening, either on its own or alongside cervical cytology, but patients may not have access to a provider who can provide such screening or avoid pelvic exams involved in testing. In this cross sectional population based study, the authors studied samples from more than 3,000 patients to determine whether menstrual blood could accurately detect HPV infection. The sensitivity of such testing was high, nearly 95% for CIN2+ detection, and comparable with clinician-collected HPV testing at 92%. While specificity of menstrual blood testing was slightly lower than clinician-collected testing, both methods had similar negative and positive predictive values. These findings suggest a promising new approach to HPV testing and screening, and may expand screening to populations not well-served by existing screening options.
7. ACOG Committee Statement on care for immigrants
- Advocating for Safe and Equitable Obstetric and Gynecologic Care for Immigrants in Obstetrics & Gynecology
Increasingly anti-immigrant rhetoric and government policy has created an environment of danger, fear, and isolation for the millions of immigrants who live and work around the United States. This toxic climate has been shown to increase the rates of numerous health disorders along with adverse perinatal outcomes and mistrust of healthcare professionals. This ACOG Committee Statement affirms the organization’s support for reproductive justice and its stance against policies and activities that result in coercion, family separation, or infringement of human rights. The statement also provides policy context, institutional recommendations, a glossary of key terms, and a list of legal and advocacy resources. For clinicians seeking guidance on creating safe, welcoming care environments for all patients, including immigrants, this document provides both useful background and resources and actionable resources.
8. Telemedicine medication abortion comparable to in-person care
- Comparing Efficacy of Medication Abortion by Health Care Modality at a California Health System in Obstetrics & Gynecology
The majority of abortions in the United States are now provided using medication, which has been shown to be safe and effective through 11 weeks of gestation. Studies already support the use of telehealth services for abortion provision, but there is less available evidence that directly compares the efficacy of telemedicine vs in-person medication abortion. In this cohort study of 576 patients receiving medication abortion via telemedicine or in-person care, efficacy (defined as effective medication abortion without needing a procedure for six weeks after mifepristone administration) and follow-up attendance were comparable between groups, with telemedicine patients demonstrating slightly higher follow-up rates. Serious adverse events were so rare that it wasn’t possible to make a comparison. Even more importantly, there were no missed ongoing pregnancies or missed ectopic pregnancies detected in this cohort. These findings reinforce existing evidence that telehealth medication abortion is a safe and effective model of care.
9. Intrauterine synechiae after D&C are rare
- Incidence and Risk Factors for Intrauterine Synechiae in Women With Previous Dilation and Curettage in Obstetrics & Gynecology
Intrauterine synechiae, also called Asherman’s Syndrome, are adhesions within the uterine lining that can lead to infertility and menstrual irregularities. The exact incidence of intrauterine synechiae is unknown, and, depending on the subspecialty and diagnostic criteria, definitions and risk factors vary widely. The lack of clear information about this diagnosis is anxiety-producing for patients, and can complicated counseling and management of induced abortion, miscarriage, and other kinds of early pregnancy care. In this large retrospective cohort of more than 58,000 patients undergoing dilation and curettage (D&C) between 2010 and 2020, fewer than 1% (0.8%) were diagnosed with intrauterine synechiae. Risk of intrauterine synechiae formation was higher among patients with pelvic inflammatory disease, uterine artery embolization, and multiple prior D&Cs. In contrast with prior evidence, sharp curettage was not associated with adhesion formation. This large cohort study adds to what is known about intrauterine synechiae, and further highlights a need for large-scale prospective studies on this topic.
10. Tranexamic acid does not improve implant-related bleeding
- Treatment of unfavorable bleeding patterns in contraceptive implant users with tranexamic acid: randomized clinical trial in American Journal of Obstetrics & Gynecology
Irregular bleeding remains the leading reason for contraceptive implant discontinuation. Tranexamic acid, or TXA, is an anti-fibrinolytic medication that has been well-established as a treatment for obstetric hemorrhage and heavy menstrual bleeding. Limited evidence has suggested that TXA, which supports the formation of blood clots, might help with menstrual irregularities associated with contraceptive use, but prior to this study, there was no data on TXA and Nexplanon. This randomized controlled trial compared a five-day regimen of TXA to placebo for the treatment of menstrual irregularities in Nexplanon users. The study found that TXA did not reduce bleeding days, nor did it create a longer interval without bleeding. The authors suggest that this lack of improvement may be due to Nexplanon’s thinning endometrial effect and creation of unstable blood vessels, which do not rely on fibrinogen for repair. Additional research is needed to identify effective management strategies for bothersome bleeding in implant users.