Monday, September 8, 2014

NEJM articles and musings on changes

Interesting article in this week's NEJM regarding the ethics of testing of procedures. A lot of what we do in OB/GYN is procedures - surgeries, office procedures. And a fair amount of what folks do is based on shoddy science and cool tools (I'm looking at you, DaVinci).

But science is linked to asking the how and why questions. And we change practices if we can be shown (some people may need to be beaten about the head with the evidence). Episiotomy rates have plummeted - I was a resident when these studies were coming out and most attendings drastically decreased that procedure fairly quickly. Early term inductions as well - my first practice they wanted to deliver everyone by 38ish weeks. Vaginal mesh is now rare...thank goodness. Digging it out of the vagina is a hot, unpleasant mess. I'm happy to say I was an early disadopter of the various meshes.

Sterilization methods may be revolutionized as well if some of the newest data from Canada holds up, but it'll be another decade before we can see a reduction in ovarian cancer because of changing the method of tubal ligation. Plus, some new data from Essure is showing long-term, it's not as effective as we need it to be.

Guess I'll always have something new to learn.


AtYourCervix said...

wait, hold up -- what's this about ovarian cancer and tubal ligation? Do you have a journal article or link to info?

Kate said...

There is evidence that salpingectomy may decrease ovarian cancer risk. The last time I reviewed the literature this evidence was strongest for BRCA mutation carriers. Most of the evidence I've seen comes from the University of Britisg Columbia. A quick google search for salpingectomy and ovarian cancer revealed an ACOG Comittee opinion from last month (jan 2015 which I haven't yet read (but now will thanks to you!) but I would assume it's references section would be an easy place to start in terms of reviewing the literature.