E-Poster | Gynecology | Obstetrics | Women Health

Urinary Tract Infections Before Surgery Elevate Readmission Odds in Hysterectomy Patients: Study Shows

2025-05-30 - 2025-05

USA: A recent large-scale retrospective study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology has shed light on the impact of preoperative urinary tract infections (UTIs) on surgical outcomes in women undergoing benign hysterectomy.
"Although UTIs did not significantly increase the overall rate of postoperative complications, the findings suggest a notably higher risk of readmission within 30 days following the procedure," the researchers reported.
Preoperative urinary tract infections have been linked to adverse surgical outcomes in specific patient groups. In this context, Laura Douglass, Section of Minimally Invasive Gynecologic Surgery, University of Chicago, Chicago, IL, USA, and colleagues aimed to evaluate the impact of a preoperative UTI on the likelihood of 30-day postoperative complications among women undergoing benign hysterectomy.
For this purpose, the researchers conducted a retrospective cohort study using data from the 2014 to 2021 American College of Surgeons National Surgical Quality Improvement Program database. They identified surgeries based on CPT codes and categorized surgical indications using ICD-9 and ICD-10 codes. A preoperative urinary tract infection was defined as a symptomatic UTI in patients who had not yet started or were undergoing antibiotic treatment at the time of surgery.
The primary outcome measured was the occurrence of any postoperative complication within 30 days. To compare groups, statistical analyses such as the Chi-square and Fisher's exact tests were used for categorical variables, while the Mann-Whitney U test was applied for continuous variables.
Key Findings:
Patients with preoperative UTI were generally older and had higher rates of ASA physical status class 3 or 4.
The incidence of vaginal hysterectomy and surgical indications such as pain or prolapse was greater among those with UTI.
Operative time and reoperation rates were significantly higher in the UTI group.
Overall, 5.6% of all patients undergoing benign hysterectomy experienced a postoperative complication within 30 days.
Patients with a preoperative UTI had a higher 30-day complication rate (8.2%) compared to those without UTI (5.6%).
After adjusting for confounding factors, preoperative UTI was no longer independently associated with overall 30-day complications.
However, patients with UTI had nearly four times the odds of readmission within 30 days (adjusted OR 3.98).
The researchers concluded that although a preoperative urinary tract infection did not significantly impact the overall risk of postoperative complications, it was strongly linked to a nearly fourfold increase in 30-day readmission rates following benign hysterectomy. This highlights the importance of identifying and addressing UTIs before surgery as a potentially modifiable factor to improve surgical outcomes.

Cost Comparison Shows Intrauterine Balloon Tamponade as Practical First-Line Option for Postpartum Hemorrhage: Study

2025-05-29 - 2025-05

Netherlands: A recent study published in the International Journal of Gynecology & Obstetrics sheds light on the cost-effectiveness of two commonly used interventions for managing persistent postpartum hemorrhage (PPH)-intrauterine balloon tamponade and uterine artery embolization. While both approaches showed similar overall costs, the study highlights that balloon tamponade, being less invasive and easier to administer, may be a more practical and accessible first-line option, particularly in settings with limited resources.
The study analyzed the cost-effectiveness of two primary interventions for managing persistent postpartum hemorrhage (PPH): intrauterine balloon tamponade and uterine artery embolization. The findings suggest that while both strategies have similar financial implications, intrauterine balloon tamponade may offer practical advantages due to its less invasive approach.
Persistent PPH, defined as postpartum bleeding unresponsive to initial treatments, remains a significant cause of maternal morbidity. In the study, Lisanne R. Bonsen, Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, the Netherlands, and colleagues conducted a cost comparison between two clinical management strategies by retrospectively analyzing a matched cohort of women who underwent either intrauterine balloon tamponade (scenario 1) or uterine artery embolization (scenario 2).
The study involved a propensity score-matched sample of 100 women, with 50 patients in each group.
The key findings of the study were as follows:
In the balloon tamponade group, bleeding was successfully controlled in 29 women, accounting for 58% of the group.
The average cost per patient in this group was approximately 7060 Euros, with a standard deviation of 2846 Euros.
In the embolization group, 42 women (84%) experienced successful bleeding control.
The mean cost per patient in this group was 7122 Euros, with a standard deviation of 2918 Euros.
Both groups had the same rate of peripartum hysterectomy, with six women (12%) undergoing the procedure in each group.
The cost difference between the two approaches was minimal, with balloon tamponade being 62 Euros less expensive on average.
The negligible cost difference suggests that factors beyond economics should influence the choice of intervention.
Despite the slightly higher success rate of embolization, the researchers argue that intrauterine balloon tamponade is a favorable option. Its minimally invasive nature, ease of application, and potential for earlier use in the treatment pathway make it a practical first-line approach, especially in settings with limited access to interventional radiology services.
The study concludes that while both methods demonstrate near-equivalent costs and outcomes, intrauterine balloon tamponade should be considered a frontline strategy due to its safety profile and operational convenience. These findings could have significant implications for obstetric care protocols, particularly in resource-constrained environments.
"Overall, the research highlights the importance of integrating clinical effectiveness with cost considerations to optimize maternal health outcomes," the researchers wrote.

Women's Health Month: Multi-institutional study highlights role of robotic-assisted surgery in reshaping gynaecological care in India

2025-05-28 - 2025-05

As India observes Women's Health Month, a study conducted across five tertiary care hospitals by analysing the data of surgeries performed by using the da Vinci technology over a decade is shedding light on how robotic-assisted surgery (RAS) is steadily transforming gynaecological care across the country. The study documents a significant rise in the use of robotic surgery for both benign and malignant conditions and is significant for its implications on access, recovery, and surgical outcomes for women.
The multi-institutional study-'Trends in Gynecological Robotic Surgery in India: A Real-World Scenario'-analyzed data from ten years across five hospitals: Apollo Health City (Hyderabad), PGIMER (Chandigarh), Manipal Hospital (Bengaluru), Narayana Health (Bengaluru), and Tata Memorial Hospital (Mumbai). Notably, over 70% of robotic gynaecological procedures took place in the final five years, indicating a strong upward trajectory.
"Women's Health Month is a time to reflect on how surgical technology innovations like the da Vinci robotic technology are enhancing healthcare outcomes for women," said Dr. Rooma Sinha, Honorary Professor and Chief Gynaecologist at Apollo Health City, Hyderabad, one of the surgeons who oversaw the study. "Robotic-assisted surgery is increasingly being used to manage benign gynaecological conditions such as fibroids and endometriosis, offering enhanced precision and improved outcomes across a wide range of cases."
Many studies across the globe show reduced blood loss and faster recovery times for robotic-assisted surgery compared to other modalities. The patients in this study similarly experienced minimal blood loss and faster recovery times. Dr. Sinha, who is also the Founder-President of Association of Gynecological Robotic Surgeons, noted that "Even in cases involving large fibroids or endometriosis, we were able to keep blood loss low, recovery times short, and port-site pain/discomfort minimal. That matters a lot in a country like India, where patients often travel long distances for care and want to return home quickly."
Patient body mass index (BMI) was comparable across both groups, suggesting that RAS outcomes are consistent regardless of weight. Improvements were also noted in surgical workflow, including reductions in docking time as teams became more experienced.
"We have seen that with robotic procedures, women often spend less time in the hospital and experience fewer complications related to blood loss," said Dr. Vanita Jain, Head of Obstetrics and Gynaecology at PGIMER, Chandigarh, who was also part of the study. "It is not just about using new technology-it is about making recovery more manageable, especially for women who are balancing responsibilities at home and work."
The study found that fibroids were the most common benign indication for robotic surgery, followed by endometriosis, adenomyosis, vault prolapse, and ovarian cysts. These conditions often require careful dissection and suturing, particularly when fertility preservation is important.
"Myomectomy, or the removal of fibroids while preserving the uterus, especially calls for such precision," explained Dr. Subhas C Saha, Professor, Department of Obstetrics and Gynaecology, PGIMER, Chandigarh, another key facilitator of the study. "Advanced robotic systems like the da Vinci platform offer us better visualisation and manoeuvrability, which can make a real difference in these challenging cases."
While more public and private insurers are beginning to include robotic-assisted surgery (RAS) in their coverage, the study highlights that there is still room to improve affordability and access. To optimise value and accessibility, surgeons are refining techniques-using fewer robotic arms and incorporating multifunctional instruments-to reduce costs while still delivering high-quality care and better patient outcomes.
"Given the clear benefits demonstrated in studies like this, there is a strong case for insurance payers to further expand coverage for robotic-assisted surgery. Broader, streamlined reimbursement support can help ensure more women across India have access to advanced surgical options," Dr. Saha added.

New Study Suggests Hormone Therapy May Improve Certain Heart Health Markers in Menopausal Women

2025-05-20 - 2025-05

There has been a lot of chatter in and out of the scientific community about the use of hormone therapy for women in menopause. Preliminary results released in 2003 from the Women's Health Initiative (WHI) clinical trial linked hormone therapy used to treat symptoms of menopause to a higher risk of developing serious health conditions, including heart disease and stroke. But research since then has found flaws in those findings.
Now, new research adds to the evidence challenging those initial findings on hormone therapy and heart health: It found that women in menopause who took oral hormone therapy showed improvements in certain biomarkers of cardiovascular health, including cholesterol.
Here's what the research found, plus why hormone therapy may help heart health in menopause.
What did the study find?
The study, which was published in the journal Obstetrics & Gynecology, analyzed data from the WHI, which is a long-term national study focused on menopausal women. The researchers analyzed biomarkers linked with cardiovascular health in nearly 2,700 women over a six-year period.
The women were broken into two groups: Those who took estrogen and those who took a combination of estrogen and progesterone. The women were between the ages of 50 and 79. They provided blood samples at the start and various other times during the study.
The researchers discovered that hormone therapy had a positive impact on certain cardiovascular biomarkers in the group that took estrogen, as well as those who took estrogen and progesterone. Specifically, levels of LDL ("bad" cholesterol) dropped by about 11%, while total cholesterol and insulin resistance (when your body's cells don't respond as well to the hormone insulin) also dropped.
Levels of HDL (or "good" cholesterol) increased by 13% in the estrogen-only group and 7% in the estrogen-progesterone group.
Levels of a cholesterol molecule called lipoprotein(a) dropped by 15% and 20% in the estrogen-only and the estrogen-plus-progesterone groups. This finding surprised researchers because the molecule is believed to be mostly influenced by genetics.
There was one noteworthy unfavorable outcome: Triglycerides and coagulation factors, which are proteins in the blood that help form blood clots, increased, which is a potential downside of hormone therapy. For this reason, if you have a history of blood clots, it's extra important to talk to your healthcare provider before taking hormone therapy.
Interestingly, the study found that, with the exception of triglycerides, hormone therapy had positive effects regardless of age, which contrasts to prior findings. "A lot of data suggests that the safest time to give hormone therapy is within 10 years of the menopause transition," Dr. Streicher says. Still, the study concludes that the results may be used to counsel younger menopausal women with bothersome symptoms, likely because broader research shows that it's safest to start hormone therapy closer to when menopause starts. (Note: hormone therapy isn't FDA approved to treat the risk of coronary artery disease or stroke.)
Why is hormone therapy in menopause controversial?
It traces back to the early 2000s when those preliminary results were published from the WHI that linked hormone therapy to a higher risk of developing serious health conditions like heart disease and stroke. The study was actually stopped as a result and many women have avoided hormone therapy to treat symptoms of menopause since.
But the preliminary conclusions were later debunked. Other researchers analyzed the data and discovered that the original study looked at women who were 65 and up who already had a greater risk of heart attack, stroke, blood clots, and more-and that had skewed the data.
The preliminary findings also didn't look at how old the women were when they started hormone therapy, which further muddled the results, explains Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.
In May 2024, a follow-up to the WHI study was released in JAMA with the conclusion that hormone therapy "is appropriate" for those with vasomotor symptoms (which could include hot flashes, for example) for interested women in early menopause without any contraindications.

Use of hair, cosmetic products linked to increased phthalate exposure in pregnancy

2025-05-19 - 2025-05

Frequent use of hair products and cosmetics during pregnancy may increase exposure to phthalates-endocrine-disrupting chemicals linked to adverse birth outcomes-according to findings presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting.1,2
The study analyzed data from 153 participants in the Atlanta African American Maternal-Child Cohort, focusing on a population that faces higher rates of adverse pregnancy outcomes, including preterm birth. Researchers assessed the relationship between personal care product (PCP) use and urinary phthalate levels early in pregnancy.
Phthalates, commonly found in PCPs such as cosmetics, hair relaxers, and moisturizers, are a known concern for reproductive health. While previous studies have explored phthalates in the general population, few have focused on whether PCP use contributes to phthalate levels of emerging concern, particularly during pregnancy.
Urine samples collected from participants between 8 and 14 weeks of gestation were tested for 12 individual phthalate metabolites. In addition, participants completed questionnaires about the frequency of their personal care product use. Researchers then applied linear regression models to evaluate associations between PCP use and urinary concentrations of several phthalate groups, including the sum of di(2-ethylhexyl) phthalate metabolites (SDEHP), di(isononyl) phthalate metabolites (SDINP), antiandrogenic phthalate metabolites (SAA), and specific individual metabolites such as monocarboxyisononyl phthalate (MCINP).
Results showed that individuals who reported more frequent PCP use had significantly higher urinary phthalate levels. Monthly hair product use was associated with a statistically significant increase in antiandrogenic phthalates (SAA), with a beta coefficient of 0.8 (95% CI, 0.02 to 1.57). Meanwhile, participants who reported weekly or daily use of hair relaxers had significantly lower concentrations of SDEHP (β = -0.16; 95% CI, -0.48 to -0.03), compared with those who did not use relaxers.
Cosmetic use was particularly associated with elevated levels of several phthalates. Users had significantly higher concentrations of SDEHP, SAA, and MCINP compared to non-users.
These findings underscore a potential modifiable exposure risk during early pregnancy. "Among African American pregnant persons, more frequent use of hair products and cosmetics was associated with a significant increase in urinary concentration of phthalates," the authors concluded.
Given the associations between phthalate exposure and adverse birth outcomes-including preterm birth-researchers emphasized the importance of patient counseling on safer product choices. Reducing the use of phthalate-containing personal care products could serve as a practical strategy to limit exposure during pregnancy.
The study adds to a growing body of evidence suggesting that product formulation and personal care routines can influence maternal health and prenatal environmental exposures.

Early Placement of Postpartum Hemorrhage control Devices improves Outcomes: Study

2025-05-18 - 2025-05

Researchers have found similar outcomes in terms of blood loss, transfusion rates, and device failure in a study comparing two postpartum hemorrhage-control devices; intrauterine balloon tamponade and vacuum-induced devices. However, earlier placement of either device significantly reduced the need for transfusion and the likelihood of device failure, highlighting the importance of timely intervention. The study was conducted by Shields L. and fellow researchers published in Obstetrics & Gynecology journal.
The research was conducted under a quality improvement initiative to improve postpartum hemorrhage management. Data were collected prospectively from August 2022 to February 2024, during 123,292 deliveries, of which 5,931 (4.8%) had postpartum hemorrhage. Hemorrhage-control devices were utilized in 666 cases (11.2%), intrauterine balloon tamponade being used in 300 cases and vacuum-induced devices in 366 cases. The key outcomes measured were quantitative blood loss following device placement, requirement for packed red blood cell (RBC) transfusion, transfusion of 3 or more RBC units, and failure of the device.
The research employed a standardized three-stage postpartum hemorrhage response protocol. Hemorrhage-control devices were used in stage 2 or 3 of the protocol. Quantitative blood loss was quantitated, and the proportions of blood transfusion, utilization of 3 or more RBC units, and device failure were compared.
Key Findings
The median quantitative blood loss during device placement was 194 mL (67-440 mL) for intrauterine balloon tamponade and 240 mL (113-528 mL) for vacuum-induced devices (P=0.40).
Packed RBC transfusion rates were 59.7% for balloon tamponade and 50.0% for vacuum devices (P=0.08).
3 or more RBC units transfusion was 27.0% of tamponade cases and 24.9% of vacuum device cases (P=0.53).
Failure rates for devices were 7.7% for tamponade and 8.5% for vacuum (P=0.70).
Preceding device insertion at blood loss of 1,000-1,499 mL decreased RBC transfusion rates (39.1% vs 70.3%, P<.001), requirement for 3 or more RBC units (13.7% vs 38.1%, P<.001), and device failure (3.4% vs 12.9%, P<0.001).
The study authors concluded that prior placement of hemorrhage-control devices during postpartum hemorrhage greatly reduces blood transfusion needs and device failure. Both intrauterine balloon tamponade and vacuum-induced devices worked, but timing is all about maximizing outcomes.

PICO sNPWT Significantly Reduces C-Section Complications, Lowers Cost, Study Finds

2025-05-14 - 2025-05

A single-use negative pressure wound therapy (sNPWT) device developed by Smith+Nephew significantly reduced postsurgical complications, including infections, wound separation, and seroma compared with another sNPWT system, according to a study.1
The retrospective cohort study, published in WOUNDS, also highlights meaningful cost savings and improved emotional and physical recovery outcomes for new mothers, particularly those at high risk.
"Postpartum is already a very vulnerable period for mothers, even without complications," said study coauthor, Tia Welsh, MD, chair of obstetrics and gynecology, Valley Medical Group, in a statement. "SSCs [surgical site complications] add physical pain, prolonged recoveries, emotional distress, and disrupt critical early bonding with newborns. These interruptions carry emotional and practical burdens, increasing the risks of postpartum depression, anxiety, and trauma-costs that can't be captured in dollars alone."
The study utilized patient data encompassing inpatient claims from a geographically diverse mix of US community and teaching hospitals between January 2017 and June 2022.2 Adult patients undergoing Cesarean (C-section) deliveries were identified using International Classification of Diseases, 10th Edition, Procedure Coding System codes and hospital billing charge descriptions for sNPWT devices set at either -80 mm Hg or -125 mm Hg. Patients treated with both devices and those with preexisting surgical site complications (SSCs), open wounds, multiple surgeries within 30 days, or inadequate follow-up were excluded.
Primary outcomes included incidence of SSCs at 30 and 90 days, as well as health care resource utilization metrics such as length of stay and cost.
The study revealed that Smith+Nephew's PICO sNPWT device was associated with significantly better clinical outcomes and lower health care costs for patients recovering from C-sections compared with another sNPWT device.1 Real-world data from over 10,000 patients who underwent C-section showed that use of PICO sNPWT led to statistically significant reductions in overall surgical site infections (SSIs) (P = .018), superficial SSIs (P = .017), wound dehiscence (P = .005), and seroma formation (P = .050).
Complementing these clinical findings, a patient survey highlighted the broader human impact of postsurgical complications. Mothers who experienced SSCs were 5-times more likely to describe their recovery as traumatic, over 50% reported depression, and they were 5.4 times more likely to struggle with breastfeeding. Furthermore, 66.3% said their complications negatively affected bonding with their newborn.
"We've long understood the benefits of NPWT in surgical recovery, but this is the first large-scale study to directly compare different pressure levels in a real-world setting," said the study's lead author Annmarie Vilkins, DO, director of obstetrics and gynecology, Henry Ford Health, in a statement. "We found that PICO sNPWT showed significantly improved outcomes through optimizing pressure, fluid management, and skin adhesion. Its unique design helped maintain a high moisture vapor transmission rate supporting an ideal healing environment for recovery, particularly critical for high-risk incisions like C-sections under skin folds, where moisture buildup can lead to infection."
In addition to clinical advantages, the study demonstrated that use of the PICO sNPWT device offered significant economic value. Compared with another sNPWT device, PICO was associated with a 3.8% reduction in mean index admission costs and an estimated cost savings of $728,220 per 1000 patients (P < .001). These savings are particularly meaningful given that SSIs alone contribute to more than $900 million in health care costs annually.

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