New Findings Featured at ACOG

High Success Rate with Vaginal Birth after Cesarean
High success rates and minimal complications make vaginal birth after cesarean (VBAC) delivery a sound option for patients who have received appropriate counseling, particularly for women who present with spontaneous labor before 41 weeks of gestation or have had a previous vaginal delivery, according to the results of a new study presented at the meeting.

The investigators examined outcomes in 1035 women who had had a VBAC between 2004 and 2008 (84.4% Hispanic; 6.3% African American; 4.3% Caucasian; and 5.0% other ethnicity). Of these women, 84% (n = 869) had a successful VBAC.

In addition, of the 577 women who had a previous successful vaginal delivery, 93% (n = 536) had a successful VBAC.

No fetal, neonatal, or maternal deaths were reported in any of the study participants and no cesarean hysterectomies were performed.

Many Women Unaware of Emergency Contraception
Greater educational outreach is needed to spread awareness of emergency contraception among women wishing to prevent pregnancy, according to study results presented at the meeting. The investigators identified many women presenting to an abortion clinic in Charleston, SC, who were unaware of emergency contraception availability.

For the study, 623 women completed an emergency contraception awareness survey. Lack of awareness of overthe- counter emergency contraception was reported by 31.7% of participants.

Risk factors for being unaware of emergency contraception included:

• Black race
• Lower educational level
• Nonuse of contraception
• Increasing parity.

In women aware of emergency contraception, 5.3% reported using it during their current pregnancy and 21% reported past emergency contraception use. Women who were aware of this contraceptive method had a higher likelihood of using it in the future (88% vs 82%).

Among women aware of emergency contraception but not using it, the following reasons were cited for nonuse:

• “Taking a chance,” 24.1%
• Contraception failure, 20.1%
• Inability to obtain emergency contraception within 3 days, 18.6%
• Financial reasons, 2.4%
• Ignorance of emergency contraception being available over the counter, 4.7%
• Pharmacy unavailability, 0.7%
• Other reasons, 2.6%.

OB/GYN Residents Ignorant about Female Sexual Dysfunction
A majority of third- and fourthyear OB/GYN residents have subpar comprehension and confidence for treating problems with female sexual dysfunction (FSD), according to survey results discussed at ACOG.

This internet-based survey queried 234 residents, of which 91.5% reported having attended ≤5 educational activities on FSD; 19.6% reported always or often screening for FSD, and the majority had little to no knowledge about FSD screening questionnaires.

In addition, 82.8% stated they were confident in their ability to obtain a complete sexual history but only 54.7% felt equipped to conduct a targeted physical examination.

More than half (55.1%) of respondents had treated women with dyspareunia (pain during intercourse); 18.4% treated women for low sexual desire; 16.7% treated vaginismus; 8.1% treated arousal problems; and 5.6% treated anorgasmia. Moreover, 34% to 56% reported rarely or never recommending counseling or medications as ancillary therapy for FSD. Nearly all the residents responded that their confidence level with FSD would increase with further education, such as lectures, 97.9%; patient observation, 97.4%; rotations with a urogynecologist, 94.4%; and online modules, 90.6%.

New OC Effective for Menstrual Bleeding Problems
In women with heavy and/or prolonged menstrual bleeding who have no organic pathology, the oral contraceptive (OC) estradiol valerate/ dienogest (E2V/DNG) has been shown to be very effective treatment, researchers reported at the meeting. The new OC, marketed under that trade name Natazia, received US Food and Drug Administration (FDA) approval in May 2010. It is not currently FDA approved for treating menstrual bleeding problems.

This study was a pooled analysis of 2 multicenter, double-blind, randomized, placebo-controlled trials with identical design. One study was conducted in the United States and Canada, and the other in Europe and Australia.

The women were randomized to E2V/DNG or to placebo for 196 days. Of those who completed the study, 193 were randomized to E2V/DNG and 113 to placebo. In the E2V/DNG group, 42.0% were considered complete responders compared with 2.7% in the placebo group.

During 90 days of observation, a significantly greater mean reduction in menstrual blood loss was observed in the E2V/DNG group (–414 mL ± 373 mL) compared with the placebo group (–109 mL ± 300 mL).

Daily Messages Don’t Improve Adherence to OCs
Using daily text messages as a reminder for women to take their OCs proved unsuccessful in a randomized, controlled trial. The study tracked OC adherence among new users for 3 months, with the use of an electronic monitoring device. Among 73 women who completed the study, there was no significant difference in the mean number of missed pills between women randomized to text messaging (4.1 ± 2.6) and those in the control group (3.7 ± 3.4).

The researchers noted that the nonsignificant difference may be a result of the use of other reminder systems among the control group, but pointed out that the number of missed pills was high for the entire study population.