2022: A year in review

The article offers a look at the advances in obstetrics and gynecology in 2022 along with some impactful articles that were important to women's health care providers. It includes an article on addressing physician burnout published in the January 2021 issue, another on a study on the treatment for mild chronic hypertension in pregnancy, and another study which evaluated whether the addition of lenvatinib and pembrolizumab improved outcome in women with recurrent advanced endometrial cancer.

Neuraxial Anesthesia during the COVID-19 Pandemic: Report from a Large Academic Medical Center.

OBJECTIVE: Three primary neuraxial techniques reduce labor pain: epidural, dural puncture epidural (DPE), and combined spinal-epidural (CSE). This study aims to determine whether neuraxial analgesia techniques changed after the onset of the coronavirus disease 2019 (COVID-19) pandemic. Given that a dural puncture confirms neuraxial placement, we hypothesized that DPE was more frequent in women with concerns for COVID-19. STUDY DESIGN: A single-center retrospective cohort study comparing neuraxial analgesia techniques for labor and delivery pain management before and after the onset of the COVID-19 pandemic and in patients with and without SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) at a maternity hospital in Dallas, Texas, with a large delivery service. Statistical analyses included the Chi-square test for categorical and Kruskal-Wallis test for nonparametric ordinal comparisons. The Cochran-Mantel-Haenszel test was used to assess the association between neuraxial technique and accidental dural puncture or postdural puncture headache. RESULTS: Of 10,971 patients who received neuraxial analgesia for labor, 5,528 were delivered in 2019 and 5,443 in 2020. Epidural analgesia was the most common neuraxial technique for labor pain in 2019 and 2020. There was no difference in the frequency of neuraxial analgesia techniques or the rates of accidental dural puncture or postdural puncture headaches comparing all deliveries in 2019 to 2020. Despite a significant increase in DPEs relative to epidurals in the SARS-CoV-2-positive group compared with the SARS-CoV-2-negative group in 2020, there was no significant difference in postdural puncture headaches or accidental dural punctures. CONCLUSION: The advantages of a DPE, specifically the ability to confirm epidural placement using a small gauge spinal needle, likely led to an increase in the placement of this neuraxial in SARS-CoV-2-positive patients. There was no effect on the frequency of postdural puncture headaches or accidental dural punctures within the same period. KEY POINTS: · Epidural analgesia was the most common neuraxial technique for labor pain management.. · Dural puncture epidural placements increased in SARS-CoV-2-positive patients.. · Rates of postdural puncture headaches and accidental dural puncture after neuraxial placement did not change..

2022: A year in review

The article offers a look at the advances in obstetrics and gynecology in 2022 along with some impactful articles that were important to women's health care providers. It includes an article on addressing physician burnout published in the January 2021 issue, another on a study on the treatment for mild chronic hypertension in pregnancy, and another study which evaluated whether the addition of lenvatinib and pembrolizumab improved outcome in women with recurrent advanced endometrial cancer.

Leadership in the new reality

The article addresses the issue of leadership in the post-COVID-19-pandemic climate. Topics discussed include differences in leadership styles before and after the pandemic, reasons why employees leave their jobs without another one to replace it, and the need for leaders to be decisive, communicate clearly, and leverage the crisis to create opportunities.

Vaccination: Protecting our most vulnerable

The author reflects on the need to protect the most vulnerable members of society, particularly pregnant women and children, against infectious diseases like COVID-19. Topics include the low number of vaccinated pregnant women against COVID-19, influenza, tetanus, diphtheria and pertussis, as well as the need to address the political issues on COVID-19 vaccination in the U.S.

Addressing the health care system strain

The author offers observation on the impact of hospitalization from Covid-19 on the health care system in the U.S. Topics discussed include impact of nurse shortages on the obstetrics and gynecology (ob-gyn) field, actions taken by the American Hospital Association (AHA) to address nurse shortages, and growth of U.S. health care expenditures in 2019.

Contemporary OB/GYN®: A YEAR IN REVIEW

The author discusses the accomplishment of the journal in addressing prevalent topics for its readers and offering information on trending topics that can guide physicians. Among the top topics for 2021 are breastfeeding and alcohol, diet and pregnancy and gestational diabetes. She also mentions the issue of COVID-19 vaccination for pregnant women. She cites new features implemented to the publication to provide practical content to its readers.

Policies, politics, and medicine -- hard to mix

The author discusses how government policies and laws are adversely affecting the medical sector's efforts to achieve expert medical care. Topics include the low COVID-19 vaccination rate among pregnant women in the U.S. despite the solid Centers for Disease Control and Prevention (CDC) data on vaccine safety, and the collaborative care strategy to reduce maternal morbidity and mortality.

Breastfeeding and alcohol: Do they mix?

An editorial is presented in which the author discusses the risks of drinking alcohol while breastfeeding. The author reports the increased frequency of alcohol consumption in women during the COVID-19 pandemic. Particular focus is also given to varied cultural practices regarding alcohol consumption during pregnancy and during breastfeeding.

Steps to optimize maternal health

The author reflects on the strategies to optimize maternal health and some conditions that could be avoided by optimizing maternal health like maternal anemia. Topics include the safety of COVID-19 vaccination for pregnant and lactating women, the role of intravenous (IV) iron in iron deficiency anemia in pregnancy, and the conditions linked to maternal anemia like fetal growth restriction and preterm birth.

Smoldering

The author offers insights into the prevalence of burnout among female physicians in obstetrics and gynecology during the COVID-19 pandemic in the U.S. Topics mentioned include the contributors to physician burnout including the emphasis on remote learning and limited child care, the warning signs according to the American College of Obstetricians and Gynecologists including irritability and lapses in confidentiality, and the solutions including the need of practicing mindfulness.

Comparison Between In-Person and Audio-Only Virtual Prenatal Visits and Perinatal Outcomes.

Importance: Ensuring access to prenatal care services in the US is challenging, and implementation of telehealth options was limited before the COVID-19 pandemic, especially in vulnerable populations, given the regulatory requirements for video visit technology. Objective: To explore the association of audio-only virtual prenatal care with perinatal outcomes. Design, Setting, and Participants: This cohort study compared perinatal outcomes of women who delivered between May 1 and October 31, 2019 (n = 6559), and received in-person prenatal visits only with those who delivered between May 1 and October 31, 2020 (n = 6048), when audio-only virtual visits were integrated into prenatal care during the COVID-19 pandemic, as feasible based on pregnancy complications. Parkland Health and Hospital System in Dallas, Texas, provides care to the vulnerable obstetric population of the county via a high-volume prenatal clinic system and public maternity hospital. All deliveries of infants weighing more than 500 g, whether live or stillborn, were included. Exposures: Prenatal care incorporating audio-only prenatal care visits. Main Outcomes and Measures: The primary outcome was a composite of placental abruption, stillbirth, neonatal intensive care unit admission in a full-term (≥37 weeks) infant, and umbilical cord blood pH less than 7.0. Visit data, maternal characteristics, and other perinatal outcomes were also examined. Results: The mean (SD) age of the 6559 women who delivered in 2019 was 27.8 (6.4) years, and the age of the 6048 women who delivered in 2020 was 27.7 (6.5) years (P = .38). Of women delivering in 2020, 1090 (18.0%) were non-Hispanic Black compared with 1067 (16.3%) in 2019 (P = .04). In the 2020 cohort, 4067 women (67.2%) attended at least 1 and 1216 women (20.1%) attended at least 3 audio-only virtual prenatal visits. Women who delivered in 2020 attended a greater mean (SD) number of prenatal visits compared with women who delivered in 2019 (9.8 [3.4] vs 9.4 [3.8] visits; P < .001). In the 2020 cohort, 173 women (2.9%) experienced the composite outcome, which was not significantly different than the 195 women (3.0%) in 2019 (P = .71). In addition, the rate of the composite outcome did not differ substantially when examined according to the number of audio-only virtual visits attended. Conclusions and Relevance: Implementation of audio-only virtual prenatal visits was not associated with changes in perinatal outcomes and increased prenatal visit attendance in a vulnerable population during the COVID-19 pandemic when used in a risk-appropriate model.