Tag Archives: ACOG

A seemingly surprising increase in incidence of Endometrial Cancer

The ACOG 2017 saw several interesting results come out. One surprising result, presented at an oral presentation, appears to be a presentation about the increase in the incidence of Endometrial Cancer.

It appears that Endometrial Cancer rates were stable from 1999 to 2002, but then, since 2006 to 2014, the rates appear to have increased by 10%.

The authors were curious, as you and I might be, so they examined EC incidence through the Surveillance, Epidemiology, and End Result Program database from 1975 through 2014.

Factors affecting Endometrial Cancer

It appears that FDA approved hormonal therapies have dropped in number, and therefore the use of non FDA approved combinations of estrogen and estrogen+progesterone, which may not be enough to stop endometrial cancer.

Obesity, which has been increasing consistently, already a known risk factor, might be aggravated.

Study Limitations

The study, as stated by the authors themselves, is clearly not a randomized clinical trial, but an ecological study. Therefore, it is not sufficient to draw conclusions and yet, the findings, especially the coincidence of the use of non-approved hormonal therapy and the increase in endometrial cancer as well as factors such as obesity is quite interesting, and this should be flushed out further, perhaps with targeted studies. Women, in particular should be aware of risk factors and seek medical help in advance.

References

  1. A report on the study: http://www.mdedge.com/clinicalendocrinologynews/article/137805/gynecologic-cancer/endometrial-cancer-rates-increased?channel=247&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  2. The ACOG summary of the study: http://journals.lww.com/greenjournal/Abstract/2017/05001/Increased_Incidence_of_Endometrial_Cancer.19.aspx
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/beach-woman-sunrise-silhouette-40192/

Some shocking revelations on violence and trauma during pregnancy!

The American College of Obstetrics and Gynecologists (ACOG) has its annual meeting this week, and how I wish I could be there! Maybe next year. Meanwhile, some shocking new findings are being presented at the meeting!

The results are from researchers at the Perelman School of Medicine at the University of Pennsylvania, who analyze a statewide analysis, for pregnancy related hospital trauma cases over a decade, for the State of Pennsylvania.

Please read the key findings in the link below. You may also refer to the proceedings poster.

A Couple of Shockers

The data itself is shocking, about 1 in 12 women have trauma during pregnancy, that may be due to accidents or assaults. This is also the leading non-obstetric  reason for death among pregnant women. There are the usual caveats about how pregnancy complicates everything. But, I found a couple of things really shocking! Here is one from Neha Deshpande MD, the clinical resident, who is also the lead author of the study:

“Despite the severity of the issue, little is known about how trauma actually impacts pregnant women since accidental and incidental causes of death are excluded in many statewide and national maternal mortality reviews. The striking results of our study suggest that widespread screening for violence and trauma during pregnancy may provide an opportunity to identify women at risk for death during pregnancy.”

  1. The “little is known” gave me pause and I had to re-read it twice! And, apparently not much screening of trauma and pregnancy occurs!
  2. The second thing that shocks me is that “accidental and incidental causes of death” are excluded from many state and national maternity mortality reviews! Well, there is something in need of fixing! If we don’t even do a good job of counting the causes and cases carefully, how would we proactively fight pregnancy related trauma?

Other Findings

  1. Some of the other findings were disturbing as well. The study found that injuries in pregnant women were fewer than in women who weren’t, but even with the reduced severity, pregnant women were nearly twice as likely to die! Clearly, resource availability and planning have to be increased to give immediate special care and attention to pregnant women.
  2. The next one, mental health, ignored for long, seems to be particularly troublesome when it comes to pregnant women. Nearly 1 in 5 pregnant women reported some form of psychiatric illness. What little attention has been provided to pregnancy related mental health issues, usually focuses (not that it should be reduced) on postpartum depression. Well, it appears, this attention should be increased and should span the entire pregnancy timeline!
  3. In more disturbing news, minority and uninsured women were reported be significantly more likely to experience assault. It is already reported through many channels that minority women and uninsured women have the most problems, and this makes things worse. Given the recent proposed changes to healthcare laws in the US, and the debate surrounding affordable care, and access to care, these findings are the most disturbing and alarming!

The Future?

Results from a single state, spanning a decade are commendable, as much as their findings give much cause for concern. But, what of the future? I think alongside making more resources available, and creating more awareness, a few changes are in order:

  1. Change how pregnancy related morbidity and mortality data are collected, specifically to highlight accidents and violence.
  2. As I mentioned before, make maternal mental health a central issue through the pregnancy cycle. Is there any reason to believe (and this is in no way in defense of) that both parents face mental health issues during pregnancy, and perhaps, sometimes, violence is a result? This might be important to know.
  3. Do pregnant women know how to approach for help when abused? Where to go? What treatment options are available?
  4. How would this data about pregnancy look like, if collected and analyzed globally?

This study, from U.Penn is truly an eye opener, but if anything, it tells us not enough is being done.

Reference:

  1. The MedicalXpress Article: https://medicalxpress.com/news/2017-05-pregnancy-linked-higher-death-traumatic.html
  2. Image courtesy, Pexels: https://www.pexels.com/photo/motherhood-parenthood-pregnancny-mother-59894/