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ACOG committee member shares top takeaways from annual meeting

Jared Robins

Treatment for heavy menstrual bleeding, the future of genetics in gynecology and intrapartum care were some of the highlights at the recent American College of Obstetricians and Gynecologists’ annual clinical and scientific meeting, a member said.

“A huge focus of this meeting was for nonsurgical approaches for the treatment of fibroids and heavy menstrual bleeding,” Jared Robins, MD, a member of the ACOG Scientific Committee who reviewed the meeting’s abstracts told Healio Family Medicine.

“In the past, if a woman experienced heavy menstrual bleeding or fibroid tumors, she could no longer bear children. But we’re seeing now that we can treat these conditions with noninvasive, nonsurgical approaches. That’s a huge change for our field.”

“Hopefully the FDA will approve the marketing of elagolix as treatment for heavy menstrual bleeding,” Robins said.

Some of the elagolix presentations at ACOG included:

• Women who received 300 mg of elagolix two times a day or 300 mg of elagolix and a combination of norethindrone acetate and estradiol daily for 6 months had lower absenteeism and presenteeism linked to uterine fibroids vs. those who took placebo for the same period of time.
• Women who took 300 mg of elagolix two times a day or 600 mg of elagolix daily and with add-back therapy of varying amounts of estradiol and norethindrone acetate had norethindrone acetate for 6 months had reduced endometrial thickness and benign endometrial pathology.
• Women who took elagolix 150 mg daily or 200 mg two times a day for 6 months had fewer instances of nonmenstrual pelvic pain, dysmenorrhea and dyspareunia.

Robins said another major topic at the meeting was genetics’ role in gynecology, which he said he found personally enriching.

“Genetics is the future of medicine, including gynecology,” Robins, who is also chief of reproductive endocrinology and infertility in the department of obstetrics and gynecology, associate professor of obstetrics and gynecology, Northwestern University Feinberg School of Medicine, said in the interview.

“People are looking at genetics as it relates to cancer, and we had several presentations that looked at gene mutations that can predict cancer, so that screening is more effective, preventing cancer or treating cancer, genetics is proving valuable. It’s a huge part of where gynecology is heading at the moment.”

Some of the genetic-themed presentations include:

• BRCA mutation testing for female first-degree relatives of patients with high-grade serous carcinomas resulted in a higher average quality-adjusted life year gain at acceptable cost vs. those who did not have BRCA testing.

• Patients at high risk for hereditary cancer syndromes should be given a referral for genetic counseling based on extensive review of family history on both sides, including the ages that the cancer begins.
• More than one in 10 women at one institution had at least one deleterious mutation of the BRCA gene, leading researchers to suggest family histories should be worked into routine obstetrician-gynecologist visits and discuss generic panel testing when situations warrant.
• Women with early onset ovarian cancer were less likely to have a pathogenic variant than those who received the same diagnosis at age 30 or older.

Robins added that other important ACOG presentations included those that discussed intrapartum care. Some of the posters and abstracts that covered this topic included:

• An increase in attendance to a postpartum BP check and increased intrapartum IV antihypertensive treatment rates after the ACOG released the Hypertension in Pregnancy guidelines in November 2013 in at least one hospital.
• A fourfold increase in fetal injury linked to cesarean delivery and high-risk care at one hospital, leading researchers to suggest that improvements are needed in the documentation of fetal injury at the time of cesarean delivery.
• Black women hospitalized during the antepartum period were more likely to experience severe maternal morbidities during the interpartum period, based on an analysis of National Inpatient Sample from the Healthcare Cost and Utilization Project from 2002 to 2014.
• Informing antepartum and intrapartum care and adding preconceptional counseling in women with varying degrees of vessel vasculitis can lead to excellent maternal and fetal outcomes.

Other Healio Family Medicine and Healio Internal Medicine coverage from this and past years of the ACOG’s annual clinical and scientific meeting can be found by clicking here. Stay tuned for coverage of the organization’s 2019 meeting in Nashville, Tennessee. – by Janel Miller

References:

Carr BR, et al. Endometrial evaluation in elagolix-treated women with uterine fibroids and heavy menstrual bleeding.

Diamond M, et al. Elagolix reduces productivity losses in uterine fibroid patients with heavy menstrual bleeding.

Frost ASH, et al. The benefits of cancer genetic panel testing in at-risk women: A single institution experience.

Hong L, et al. Referral patterns for genetic counseling for hereditary breast and ovarian cancer syndromes.

Kwon JS et al. BRCA mutation testing for first-fegree relatives of women with high-grade serous ovarian cancer.

Liese KL, et al. Racial disparities in severe maternal morbidities across the pregnancy continuum in the United States.

Marshall M, et al. Pathogenic variants identified in women with epithelial ovarian cancer diagnosed before age 31.

Nguyen V, et al. Pregnancy outcomes in women with primary systemic vasculitis.

Surrey E, et al. Long-term safety and efficacy of elagolix treatment in women with endometriosis-associated pain.

Vander Haar EL, et al. Fetal laceration injury at cesarean delivery: comparison between low-risk and high-risk intrapartum care.

Weeks CM, et al. How do hypertension in pregnancy practice guidelines change hypertension management in a single academic center?

All presented at: American College of Obstetricians and Gynecologists annual clinical and scientific meeting. April 27-30, 2018; Austin, Texas.

Disclosure: Robins reports no relevant financial disclosures. Please see the abstracts for the authors’ relevant financial disclosures.