Aneuploidy Risk Assessed
Women who have had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.
The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.
The study reviewed fetal karyotype analyses from 46,939 women seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco at the University of California, San Francisco.
According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.
Because the review found an escalating rate with each additional known pregnancy loss, the study needs to be replicated to see if this holds true for younger women, Dr. Bianco said in an interview.
Essure Safe for at Least 5 Years
Hysteroscopic sterilization with Essure microinserts appears safe and effective for at least 5 years after the procedure, according to a poster presented by John F. Kerin, M.D., at the annual meeting of the American College of Obstetricians and Gynecologists.
Dr. Kerin of Flinders Medical Centre, Adelaide, Australia, and his colleagues from the Selective Tubal Occlusion Procedure 2000 Investigators Group followed 643 women for up to 5 years after they underwent the procedure. All women had received bilateral placements of Essure microinserts as part of phase II or phase III clinical trials sponsored by Conceptus Inc., the device's manufacturer.
Not a single pregnancy occurred in 29,357 woman-months of follow-up, Dr. Kerin reported. The age-adjusted cumulative bayesian effectiveness rate at 5 years was 99.74%.
Patient tolerance, comfort, and satisfaction were measured at seven or eight visits during the follow-up period. At all visits, 99% of women rated their tolerance of Essure as “good” or “excellent,” 99% rated their comfort as “good” or “excellent,” and 97% rated their satisfaction as “satisfied” or “very satisfied.” No women reported persistent pain or bleeding.
NuvaRing Has Low Expulsion Rate
In a year's experience with the NuvaRing contraceptive, only 2.3% of women had an expulsion of the device, according to the pooled results of four large, phase III clinical trials, Marc Kaptein, M.D., and Edio Zampaglione, M.D., reported in a poster presentation at the annual meeting of the American College of Obstetricians and Gynecologists.
In a retrospective analysis of 3,333 women and 33,462 cycles, expulsion occurred in only 0.5% of cycles, according to the investigators, who were from Organon International Inc., Roseland, N.J. Organon is the manufacturer of NuvaRing.
The proportion of cycles with expulsions decreased over time, an effect the investigators attributed to users' increasing experience with the NuvaRing. During the first three cycles, 1.7% of women experienced an expulsion. The studies followed the women for 13 cycles. During the 11th, 12th, and 13th cycles, only 0.2% of women experienced expulsions.
Surgery for Brachial Plexus Injuries
Surgery is the best option for treatment in children with global brachial plexus birth palsies, according to one study.
Final shoulder function in 36 infants with such injuries who underwent surgery was fair in 22% of patients, satisfactory in 50%, good in 22%, and excellent in 6%. Final shoulder function was poor in 100% of 12 control patients who did not undergo surgery, Patricia DiTaranto, M.D., said at the annual meeting of the American Association for Hand Surgery.
Hand function in the surgery patients was fair in 19%, satisfactory in 58%, good in 17%, and excellent in 6%. Hand function in controls was poor in 25% and fair in 75%, said Dr. DiTaranto of Miami Children's Hospital.
Function was assessed with the Gilbert-Raimondi system, she noted. The children studied were born at a single institution over a 4-year period and were followed for at least 2.5 years. All had global brachial plexus injuries at birth, and the clinical findings persisted at 6-month follow-up.
The goal of the surgical reconstruction of the brachial plexus was to recover shoulder stability and hand function, she said.