OG Update for April
Hey everyone,
Today’s collection includes:
A review of meconium-stained liquor
AI in medicine
IVF embryo selection: time-based vs standard
Advice for supporting sexual wellbeing in older patients
Placenta accreta spectrum disorder
TikTok docs, DAMA situations, & HIE antecedents
Cheers for now,
Danny
Expert review: Meconium-stained amniotic fluid
Green-stained amniotic fluid, often referred to as meconium-stained amniotic fluid (MSAF), has been considered an obstetrical hazard for centuries. It has become increasingly clear that not all green-stained fluid is attributable to meconium and that not all meconium is green. This article reviews the composition of meconium, the clinical significance of MSAF and its implications for obstetric care, and the pathophysiology of meconium aspiration syndrome (MAS).
Artificial Intelligence and Machine Learning in Clinical Medicine, 2023
This NEJM editorial asserts that AI and machine learning have significantly enhanced the quality of care in medicine and will continue to do so in the future. Drawing parallels with the impact of computerised radiographic imaging, it predicts a transformative role for these technologies in the medical field. Instead of rendering health professionals obsolete, AI and machine learning will empower them to perform their tasks more effectively while also allowing more time for essential human interactions that make medicine a rewarding profession.
Clinical outcomes of uninterrupted embryo culture with or without time-lapse-based embryo selection versus interrupted standard culture (SelecTIMO)
Since the first IVF birth in 1978, the technique's adoption has steadily increased, resulting in over 10 million children being born worldwide. Improved cryopreservation techniques and blastocyst culture have significantly enhanced IVF pregnancy rates since the 2010s. Despite numerous add-ons being introduced to boost pregnancy and live birth rates, most have not been tested in adequately designed trials. Time-lapse technology, one such add-on, uses built-in cameras to document embryo development in uninterrupted culture conditions, enabling analysis by embryologists or AI. Although time-lapse technology seems promising, well-designed, large, randomised trials are lacking. Kieslinger and colleagues conducted a randomised trial to evaluate time-lapse-based embryo selection and uninterrupted culture conditions. They found no significant difference in cumulative ongoing pregnancy rates or live birth rates compared to routine methods. The study emphasises the importance of conducting randomised controlled trials before introducing innovations into routine clinical practice in reproductive medicine. Future studies should critically evaluate the cost-effectiveness of such add-ons.
How to support the sexual wellbeing of older patients
This article offers some pointers for how to support the sexual wellbeing of older patients, with a focus on clinical consultation. Barriers to discussing sexual well-being in consultations with older adults include person-related, consultation-related, and health system-related factors. Sexual wellbeing is often assigned a lower priority by patients with multiple health concerns and by healthcare professionals who may view it as a luxury rather than a necessity. Taboo and stigma, particularly in certain communities, can also hinder open discussions. Consultations may involve a ‘dance of shame’ where both parties hesitate to raise the subject of sex due to fear of embarrassment or sexualising the consultation. The language used in medical training often focuses on sex-specific dysfunction rather than wellbeing, leading to a deficit in skills for discussing sensitive topics.
A planned caesarean hysterectomy for placenta accreta spectrum at 35 weeks of gestation: antenatal identification and a multidisciplinary approach to manage an increasing condition
Sadly, this week in Queensland we heard in the news of a Queensland woman who died from a ruptured uterus, reportedly due to undiagnosed placenta accreta spectrum disorder. This condition is increasing in frequency, and the current issue of Lancet journal includes a case study introduced here.
A case study of a 37-year-old woman, who was 35 weeks into a singleton pregnancy, was admitted for a planned caesarean hysterectomy. Previously, she had two children, both delivered by caesarean section; this was her third pregnancy. She had no other notable medical history.
At 20 weeks’ gestation, an ultrasound scan had shown a low-lying anterior placenta. At 32 weeks, a repeat ultrasound scan showed placenta praevia with heterogeneity of the placental tissue—some lacunae were seen. Additionally, a placental bulge was identified anteriorly, with deficient overlying myometrium: findings suggestive of placenta accreta spectrum (PAS). See below for images and the article for more.
Also here is a useful descriptive commentary that is still relevant from 2013, outlining some surgical tips for hysterectomy in this situation.
And in this link, a brief review I wrote about this condition, a description of one of our recent cases and the operative approach we take for caesarean hysterectomy, including a 7-minute surgical video.
Finally…