Contemporary OB/GYN week in review: Worsening maternal care, general anesthesia, and more

In an interview with Contemporary OB/GYN, Mark Neuman, MD, discussed findings from a meta-analysis evaluating neonatal outcomes associated with general anesthesia compared with neuraxial anesthesia—spinal or epidural—during cesarean delivery.

Neonates exposed to general anesthesia had modestly higher rates of requiring respiratory support, but the researchers found no significant differences in NICU admission rates. Neuman emphasized, however, that many included studies were small, dated, or conducted outside the United States, limiting the ability to assess rare outcomes such as neonatal death or longer-term developmental effects. As a result, he stressed the need for more contemporary, US-based research that evaluates both immediate and long-term child health outcomes after anesthetic exposure.

A recent randomized clinical trial led by Gary Elkins, PhD, professor at Baylor University, examined the effectiveness of self-administered clinical hypnosis in reducing hot flashes among postmenopausal women and breast cancer survivors.

Participants were assigned to either a 6-week self-hypnosis program or a sham hypnosis control that matched the intervention in session number and contact time. By the end of the 6-week period, women using self-hypnosis experienced an average 53% reduction in hot flashes.

Notably, this improvement continued even after the intervention ended. At 3 months, reductions exceeded 60% overall, with breast cancer survivors achieving approximately a 64% decline. These findings underscore the durability of benefits as women continued independently practicing self-hypnosis after the study period.

In a recent interview with Contemporary OB/GYN, Katherine Perslev, doctoral student affiliated with Herlev Hospital, discussed new evidence regarding the risk of wound complications following vaginal delivery and the potential benefits of prophylactic antibiotics for women with second-degree perineal tears or episiotomies.

Perslev described outcomes from a randomized controlled trial of 442 women who received either prophylactic oral antibiotics or placebo after episiotomy or second-degree tears. Although a broad definition of wound complications showed a nonsignificant overall reduction, clinically relevant complications dropped from 17% in the placebo group to 9% in the antibiotic group, which was a statistically significant reduction.

Women who received antibiotics also reported better subjective health, needed fewer additional antibiotic prescriptions, and required fewer extra follow-up visits. Importantly, no increase in side effects was observed between the groups.

Researchers from Penn State and other locations have identified increased proportions of women seeking permanent contraception following the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision ending the federal constitutional right to abortion in June 2022, publishing their findings in Contraception.

These increases included a 51% rise in tubal ligation procedures among women attending 1 of 4 academic medical centers. Access to reproductive health options was commonly cited as a reason for seeking permanent contraception, with 47% of patients in New York and Pennsylvania having their decision influenced by the current political climate.

“The Dobbs decision was an inflection point that made people think about their future plans,” said Sarah Horvath, MD, MSHP, study co-author and associate professor at Penn State. “More than anything, we saw that the Dobbs decision impacted the timing for people seeking tubal ligations more than it influenced the actual decision to have the procedure.”

Click here for the full article.