Knowledge is power? Cervical cancer prevention in female OB/GYNs compared to other female physicians

Cervical cancer (CC) screening and prevention are crucial responsibilities of obstetrician-gynecologists (OB/GYNs). Our study aimed to investigate whether knowledge impacts OB/GYNs' (n = 42) adherence to CC prevention measures by comparing them to non-OB/GYN physicians (n = 80). An anonymous questionnaire collected demographic information, personal screening habits and evaluated their knowledge of CC prevention. Results revealed that OB/GYNs exhibited superior knowledge of CC risk factors and prevention compared to non-OB/GYNs. Of note, a lower percentage of OB/GYN residents correctly identified the recommended upper age limit for cervical screening and for HPV vaccination compared to attending OB/GYNs (50% vs. 83%, p = 0.04 and 11% vs. 50%, p = 0.01, respectively). Despite these findings, most physicians from both groups recommended HPV vaccination. Cervical screening rates were similar between OB/GYNs and non-OB/GYNs (75% vs. 83%, p = 0.3). Half of OB/GYNs initiated their own cervical screening, similar to non-OB/GYNs. Interestingly, residents had higher HPV vaccination rates compared to attending physicians, irrespective of specialty (OB/GYNs - 38.89% vs. 4.76%, p = 0.0149; non-OB/GYNs - 51.06% vs. 15.38%, p = 0.0028). In conclusion, contrary to the assumption that physicians prioritize personal well-being, our study reveals the opposite. While skilled in guiding patients through CC screening and prevention, female OB/GYNs often neglect their own health. OB/GYNs must also be educated and supported in safeguarding their health, setting an essential example for patients.

A multicenter interdisciplinary survey of practices and opinions regarding oral intake during labor

INTRODUCTION

Different society guidelines diverge regarding oral intake in labor. Our goal was to assess practices and opinions in Israeli labor and delivery units, comparing different disciplines.

METHODS

An anonymous Google Forms survey was sent to anesthesiologists, obstetricians and midwives in all Israeli labor and delivery units.

RESULTS

Responses were collected from all 27 labor and delivery units contacted, with a total of 501 respondents comprising 161 anesthesiologists, 102 obstetricians and 238 midwives. Forty-eight per cent stated there were no institutional guidelines for oral intake. The most common oral intake permitted was light food (60%). Midwives were significantly more likely than anesthesiologists and obstetricians to consider that women who are both low risk for cesarean delivery (P <0.00001) and high risk for cesarean delivery (P=0.001) should eat. Epidural analgesia did not impact recommendations regarding oral intake. The most common reasons for restricting oral intake were obstetric. Sixty-two per cent identified aspiration as the main risk associated with eating during labor, but 19% of midwives compared with 4% of anesthesiologists and obstetricians stated there were no risks (P <0.00001). The annual delivery volume of the unit did not impact staff practices.

CONCLUSIONS

There was a discrepancy between opinions and practices across all disciplines. Permissive practices identified in this survey should be addressed to find the safe middle ground between restrictive and permissive policies for low- and high-risk women.

The effect of high-dose versus low-dose epidural fentanyl on gastric emptying in nonfasted parturients: A double-blinded randomised controlled trial

BACKGROUND

Epidural fentanyl doses above 100 μg have been shown, using the paracetamol absorption test, to reduce gastric emptying in fasted labouring women.

OBJECTIVE

To investigate the effect of fentanyl dose on gastric emptying in nonfasted labouring women using gastric ultrasonography.

DESIGN

A double-blinded randomised controlled study.

SETTING

A tertiary medical centre in Tel Aviv, Israel between 30 July 2020 and 11 October 2020.

PATIENTS

Eighty labouring women with cervical dilation 5 cm or less, at least 18 years age, at least 37 weeks gestation with a singleton pregnancy and cephalad foetus.

INTERVENTIONS

Women randomised to high (>100 μg) or low (<100 μg) cumulative epidural fentanyl had ultrasound gastric content assessment, measuring antral cross-sectional area (CSA) at epidural placement and 2 h thereafter (T2  h).

MAIN OUTCOME MEASURES

The primary outcome was CSA at T2  h comparing high-dose versus low-dose fentanyl. Secondary outcomes included change in CSA between baseline and T2  h. Sub-group analysis compared stomach content at T2  h according to baseline stomach content, empty (CSA <381 mm2) or full (CSA ≥381 mm2), and high-dose versus low-dose fentanyl.

RESULTS

Data from 80 women were analysed; 63 had empty and 17 had full stomach at baseline. There was no significant difference in CSA at T2  h between high-dose, mean 335 ± SD 133 mm2, versus low-dose fentanyl, mean 335 ± SD 172 mm2, P = 0.991. Change in CSA baseline to T2  h was 46 ± SD 149 mm2 for high and 49 ± SD 163 mm2 for low-dose group, P = 0.931. The subgroup analysis according to baseline stomach content showed no statistically significant differences in CSA at T2  h.

CONCLUSION

The CSA at T2  h was similar for women who received high-dose versus low-dose epidural fentanyl, measured by ultrasound, in our nonfasted labouring cohort.

TRIAL REGISTRATION

Clinicaltrials.gov number: NCT04202887.