High Cesarean Delivery Rates Disputed at ACOG

Tara Haelle

April 24, 2018

AUSTIN, Texas — The current rate of cesarean delivery in the United States is too high, delegates will hear at the upcoming American College of Obstetricians and Gynecologists (ACOG) 2018 Annual Meeting.

An "epidemic" of cesarean delivery is underway, according to Aaron Caughey, MD, PhD, chair of the Department of Obstetrics and Gynecology and associate dean for Women's Health Research and Policy at the Oregon Health & Science University School of Medicine in Portland, who will give a talk on how groups across the country are working to decrease the number of cesarean deliveries.

During his presentation, he will examine existing data that refute the claim that "cesareans are higher with induction of labor, and will summarize recent preliminary findings from the ARRIVE trial [NCT01990612] that suggest that induction of labor at an earlier gestational age may actually reduce the risk of cesarean," Caughey told Medscape Medical News.

The theme of this year's meeting is medical and surgical innovations in healthcare. Advances in healthcare will be evident throughout the meeting, including in the way research and ideas are presented, said Sandra Carson, MD, vice president of education for the ACOG and lead organizer of the meeting.

During a new type of oral presentation, called a trifecta clinical seminar, a single topic will be addressed by three speakers who will each discuss a different aspect of one topic at the same time.

"The three speakers will be simultaneously on stage with their sets of slides, and the attendees can see all slides and can decide at any point what they want to listen to," Carson told Medscape Medical News.

For example, during the trifecta clinical seminar on sexuality, the three speakers will be focusing on adolescence, postmenopausal women, and the cancer patient. The topics of the other two trifecta clinical seminars will be abnormal placentation and surgery in the transgender patient.

Innovation Rodeo

The meeting will also feature an innovation rodeo, during which attendees can observe a virtual reality demonstration of a vaginal hysterectomy, ride a bicycle to create a smoothie, hear multiple 15-minute lectures on ergonomics, and compete against other attendees in an educational game.

In addition to live laparoscopic telesurgeries from Belgium and Atlanta, the meeting will hold debates on the use of nitrous oxide during labor and whether the surgical treatment of uterine myxomas will become obsolete.

Mobile apps will also be in the spotlight at the meeting. Apps can provide up-to-date information instantly, said Katherine Chen, MD, from the Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai in New York City.

Chen will introduce a variety of apps — both general and specific to obstetrician–gynecologists — to the audience using hypothetical patient visits during her John I Brewer Memorial Lecture, entitled Smart Phones, Tablets, and Phablets: Delivering Apps for the OB/GYN.

When you enter a search term — diabetes, for example — hundreds of apps are retrieved. Many of these are not accurate or vetted by medical professionals, and it is difficult to know which will be helpful in clinical practice, she explained.

Most of Chen's research focuses on the accuracy and quality of apps designed for use by obstetrician–gynecologists, as previously reported by Medscape Medical News.

Having a place to start can overcome the barrier of "app overload" that physicians often face when they search app libraries, she told Medscape Medical News.

Chen reports receiving royalties from UpToDate. Carson and Caughey have disclosed no relevant financial relationships.

Follow Medscape OBGYN on Twitter @MedscapeObGyn and Tara Haelle @TaraHaelle


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