Recent Research Publications- May 2022
Larry J. Copeland, MD, American Journal of Obstetrics & Gynecology Editor.
Bradley CS, Romero R.
Am J Obstet Gynecol. 2022 May;226(5):603-604
Natural history of postoperative neuropathies in gynecologic surgery.
Chen E,
Int Urogynecol J. 2022 Apr 6. doi: 10.1007/s00192-022-05183-9. Epub ahead of print.
Introduction and hypothesis: Neuropathy following pelvic surgery is an uncommon but important complication. The current literature about the natural history and treatment of these neuropathies is limited. We aim to describe the characteristics, treatments and natural history of postoperative neuropathy following benign gynecologic surgery.
Methods: This retrospective case series included patients who underwent benign gynecologic surgery for ≥ 60 min in lithotomy. Patients with preexisting neurologic disease were excluded. Patient demographics, identification of postoperative neuropathy and details regarding evaluation and treatment were obtained from the medical record. Neuropathies were characterized by anatomic location and nerve/dermatome distribution. Duration of symptoms was classified as < 1 week, 1 week to 3 months or > 3 months with neuropathy symptoms grouped as resolved, persistent but improved or persistent. Data were analyzed with appropriate descriptive statistics, Pearson correlation and chi-square test.
Results: The study included 2449 patients who had undergone benign gynecologic surgery, with 78 (3.2%) patients identified as having postoperative neuropathy. Most patients with neuropathies demonstrated either complete resolution [59 (75.6%)] or persistent but improved [13 (16.7%)] symptoms. Twenty-eight (35.9%) had symptoms of ≥ 3 months. Most neuropathies were sensory only [63 (80.8%)], and the most frequently documented nerve distribution was femoral [23 (29.5%)]. Evaluation and treatment of neuropathy most commonly included physical therapy consult [17 (21.8%)] and neurology consult [8 (10.3%)].
Conclusions: The incidence of postoperative neuropathy in this large, benign gynecologic surgery population was 3.2%. Most neuropathies are sensory only and self-limited. While physical therapy was the most common treatment, most patients received no specific intervention.
Jacobs E, Summers K, Sparks A, Mejia R.
JAMA Netw Open. 2022 Apr 1;5(4):e228625
Trends and Outcomes for Preimplantation Genetic Testing in the United States, 2014-2018.
Hipp HS, Crawford S, Boulet S, Toner J, Kawwass JF.
JAMA. 2022 Apr 5;327(13):1288-1290.
This study uses US national surveillance data to describe preimplantation genetic testing trends and outcomes between 2014 and 2018.
Early Diagnostics of Vulvar Intraepithelial Neoplasia.
Kesić V, Vieira-Baptista P,
Cancers (Basel). 2022 Apr 4;14(7):1822.
The spectrum of vulvar lesions ranges from infective and benign dermatologic conditions to vulvar precancer and invasive cancer. Distinction based on the characteristics of vulvar lesions is often not indicative of histology. Vulvoscopy is a useful tool in the examination of vulvar pathology. It is more complex than just colposcopic examination and presumes naked eye examination accompanied by magnification, when needed. Magnification can be achieved using a magnifying glass or a colposcope and may aid the evaluation when a premalignant or malignant lesion is suspected. It is a useful tool to establish the best location for biopsies, to plan excision, and to evaluate the entire lower genital system. Combining features of vulvar lesions can help prediction of its histological nature. Clinically, there are two distinct premalignant types of vulvar intraepithelial neoplasia: HPV-related VIN, more common in young women, multifocal and multicentric; VIN associated with vulvar dermatoses, more common in older women and usually unicentric. For definite diagnosis, a biopsy is required. In practice, the decision to perform a biopsy is often delayed due to a lack of symptoms at the early stages of the neoplastic disease. Clinical evaluation of all VIN lesions should be conducted very carefully, because an underlying early invasive squamous cancer may be present.
Look before you LEEP: patient reported pain with IV sedation vs local analgesia.
Frahm AJ,
Proc Obstet Gynecol. 2022;11(1): Article 8 [ 6 p.].
Objective: Examine the effectiveness of IV sedation in addition local analgesia compared to local analgesia alone for LEEP pain management.
Methods: This quality improvement project surveyed 89 patients who underwent a LEEP procedure: 26 in the local only group and 63 in the IV + local group. Patients completed a visual analog scale and pain survey immediately following their LEEP.
Results: The local analgesia + IV sedation group reported a lower average pain score compared to the local analgesia only group (2.4 ± 2.2 v 3.6 ± 2.7). However, this was not statistically significant, p 0.47. Patients found it was helpful to know what to expect prior to the LEEP and utilized various means of pain relief in addition to the primary treatments assessed.
Conclusions: There is a need for high quality trials to determine best practices of pain management.