April 18, 2012
Volume 7 - Issue 16    

DynaMed Weekly Update

For the week ending April 13, 2012 

Last week 787 articles were evaluated via DynaMed's Systematic Literature Surveillance and 271 were added to DynaMed content.    

 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," two articles of significant interest was selected for the DynaMed Weekly Update. 
Feature Article

Addition of Cervical Pessary to Expectant Management Reduces Risk of Preterm Birth in Women with Short Cervical Length

 

Short cervical length is associated with increased risk of preterm birth, a major cause of perinatal morbidity and mortality. Some women are treated with cervical cerclage, but cerclage is indicated for women with short cervix length only if they have a history of at least 1 previous preterm delivery. Observational studies have suggested that cervical pessaries may reduce preterm births, but evidence from randomized trials has been lacking. A new large trial compared the use of a cervical pessary plus expectant management vs. expectant management only in 385 pregnant women with cervical length ≤ 25 mm (measured by transvaginal ultrasound at 18-22 weeks gestation).

 

All women were asymptomatic at randomization and had no major fetal abnormalities. About 11% had a history of preterm birth and 50% were nulliparous. Expectant management included clinical examination every month until delivery and transabdominal ultrasound assessment of fetal biometries and wellbeing. Women in the pessary group were given instructions on management and advised to report any symptoms immediately.

 

The rate of spontaneous delivery < 34 weeks was significantly lower in the pessary group (6% vs. 27%, p < 0.0001, NNT 5) (level 1 [likely reliable] evidence). The pessary group also had lower rates of spontaneous delivery at < 28 weeks (2% vs. 8%, p = 0.0058, NNT 17) and < 37 weeks (22% vs. 59%, p < 0.0001, NNT 3). Corticosteroids were given for fetal maturation in 42% vs. 64% (p < 0.001, NNT 5), and the incidence of respiratory distress in neonates was 3% vs. 12% (p = 0.003, NNT 11). Neonates born to women in the pessary group had lower rates of birth weight < 1500 g (5% vs. 14%, p = 0.004), and < 2500 g (9% vs. 29%, p < 0.0001). All women with pessaries reported increased vaginal discharge compared to 46% in the control group (p = 0.002, NNH 2) (Lancet 2012 Apr 2 early online). These results suggest that a cervical pessary may be an alternative for women considering a cerclage procedure and is an option when cerclage is not indicated.

 

For more information, see the Prevention of preterm birth and preterm labor topic in DynaMed.


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American College of Physicians (ACP) Conference

Please stop by the DynaMed booth (#1517) at the ACP Conference April 19th through the 21st. It's a great opportunity to give feedback, offer content suggestions, and explore collaboration opportunities.

Society of Teachers of Family Medicine (STFM) Conference 

Learn more about EBM and scholarly activity at seminars and education sessions at the STFM Annual Spring Conference April 25th through the 29th.

Saturday, April 28

S41: 10:30-12:00; Engaging Scholarly Activity: Electronic Peer Review of Evidence William Cayley Jr, MD; Brian Alper, MD, MSPH; Michael Mendoza, MD, MPH; Susan Hadley, MD

S43: 1:45-3:15; Using Electronic Knowledge Resources at the Point of Precepting William Cayley Jr, MD; Michael Mendoza, MD, MPH; Ingrid Watkins, MD; Mathew Devine, DO; Alexander Chessman, MD  

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information

CREDITS

Physicians:
0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
 
Release Date: April 18, 2012
Expiration Date: April 18, 2013
Estimated Completion Time:
15 minutes
 
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
 
Faculty Information
 
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

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Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
 
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ACCME This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians.  Antidote Education Company designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each weekly update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102072G.

 
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