MDEDGE.COM/OBGMANAGEMENT | VOL 30, NO 4 | APRIL 2018 Visit OBG MANAGEMENT at ACOG’s Annual Clinical MeetingÑBooth 5020 Tactics for reducing SSI at cesarean delivery Robert L. Barbieri, MD Patient experience: It’s not about satisfaction Update on prenatal carrier screening Mary E. Norton, MD HowHow wouldwould you managemanage thisthis prolapse?prolapse? Experts debate the options In collaboration with ACOG How can we educate residents on how much things cost? CPT and Medicare coding changes for 2018, at mdedge.com/obgmanagement HIGHLIGHTS FROM THE 2018 MEETING OF THE SOCIETY OF GYNECOLOGIC SURGEONS See page SS1 Follow us on Facebook and Twitter C1 0418.indd 1 3/29/18 2:36 PM Hear About ROLE OF ESTROGEN Dr. S. Zev Williams’ What’s really driving Treatment Strategy endometriosis for Endometriosis symptoms? CLICK HERE LEARN MORE The Need for ENDOMETRIOSIS PAIN Endometriosis Is suppressing the Pain Management ovulatory cycle enough? EVEN WHEN IT’S NOT YOUR PATIENT’S PERIODLEARN MORE LEARN MORE See How Dr. S. Zev Williams Common Therapeutic Treats Non-Cyclic Approachesto Treating Pelvic Pain Endometriosis Pain LEARN MORE LEARN MORE Download Interested in an Materials for Endometriosis Patients Like These Speaker Series? CLICK HERE LEARN MORE impact tracker treatment plan flashcard discussion guide questionnaire HER ENDOMETRIOSIS IS PART OF THE FAMILY1,2 Results of a survey of diagnosed endometriosis patients (n=336) revealed that Nearly 1 out of 3 endometriosis patients have a hard time expressing just how much pain they’re still in5 11hr In an international multicenter survey of patients treated inIn an tertiary international multicenter care survey centers, of patients it was reported that treated in tertiary care centers, it was reported that 45% endometriosis patients patients experience experience unresolved pain 2 unresolveddespite management7 pain despite management Could your endometriosis patients be suffering in silence? Discover resources at HerEndometriosisReality.com that can help yourIn anpatients international multicenter open survey of up patients about the true impact of their treated in tertiary care centers % endometriosisof endometriosis pain. patients 85 report that their disease detrimentally aects their job7,9 References: 1. Fourquet J, Gao X, Zavala D, et al. Patients’ report on how endometriosis affects health, work, and daily life. Fertil Steril. 2010;93(7):2424-2428. 2. De Graaff AA, D’Hooghe TM, Dunselman GAJ, Dirksen CD, Hummelshoj L; WERF EndoCost Consortium, Simoens S. The significant effect of endometriosis on physical, mental and social wellbeing: results from an international cross-sectional VISIT survey. Hum Reprod. 2013;28(10):2677-2685. ©2017 AbbVie Inc. North Chicago, IL 60064 206-1930424 October 2017 567 x 774 #1 IN READERSHIP!* mdedge.com/obgmanagement Enhancing the quality of women’s health care and the professional development of ObGyns and all women’s health care clinicians EDITOR IN CHIEF Robert L. Barbieri, MD Chief, Department of Obstetrics and Gynecology Brigham and Women’s Hospital Kate Macy Ladd Professor of Obstetrics, Gynecology, and Reproductive Biology Harvard Medical School Boston, Massachusetts BOARD OF EDITORS Arnold P. Advincula, MD David G. Mutch, MD Vice Chair and Levine Family Professor of Women’s Health, Ira C. and Judith Gall Professor of Obstetrics and Gynecology, and Department of Obstetrics & Gynecology, Columbia University Vice Chair, Department of Obstetrics and Gynecology, Washington Medical Center; Chief of Gynecology, Sloane Hospital for Women, University School of Medicine, St. Louis, Missouri New York-Presbyterian Hospital/Columbia University, New York, New York Errol R. Norwitz, MD, PhD, MBA, Section Editor Chief Scientifi c Offi cer, Tufts Medical Center; Louis E. Phaneuf Linda D. Bradley, MD Professor and Chairman, Department of Obstetrics & Gynecology, Professor of Surgery and Vice Chairman, Obstetrics, Gynecology, Tufts University School of Medicine, Boston, Massachusetts and Women’s Health Institute, and Director, Center for Menstrual Disorders, Fibroids, & Hysteroscopic Services, Cleveland Clinic, Cleveland, Ohio JoAnn V. Pinkerton, MD, NCMP Professor, Department of Obstetrics and Gynecology, and Amy L. Garcia, MD Director, Midlife Health, University of Virginia Health System, Charlottesville, Virginia; Executive Director, Th e North American Medical Director, Garcia Sloan Centers, Menopause Society, Pepper Pike, Ohio Center for Women’s Surgery, and Clinical Assistant Professor, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, New Mexico John T. Repke, MD University Professor, Department of Obstetrics and Gynecology, Steven R. Goldstein, MD, NCMP, CCD Penn State University College of Medicine, Hershey, Pennsylvania Professor, Department of Obstetrics and Gynecology, New York University School of Medicine; Director, Gynecologic Joseph S. Sanfi lippo, MD, MBA Ultrasound, and Co-Director, Bone Densitometry and Body Professor, Department of Obstetrics, Gynecology, and Composition, New York University Medical Center, Reproductive Sciences, University of Pittsburgh; New York, New York Academic Division Director, Reproductive Endocrinology and Infertility, Magee-Womens Hospital, Cheryl B. Iglesia, MD Pittsburgh, Pennsylvania Director, Section of Female Pelvic Medicine and Reconstructive Surgery, MedStar Washington Hospital Center; James A. Simon, MD, CCD, IF, NCMP Professor, Departments of ObGyn and Urology, Clinical Professor, Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC George Washington University; Medical Director, Women’s Health & Research Consultants, Washington, DC Andrew M. Kaunitz, MD, NCMP, Section Editor University of Florida Term Professor and Associate Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville; Medical Director and Director of Menopause and Gynecologic Ultrasound Services, UF Women’s Health Specialists at Emerson, Jacksonville, Florida *Source: Kantar Media, Medical Surgical Study December 2017, Obstetrics/Gynecology Combined Office & Hospital Readers. 2 OBG Management | April 2018 | Vol. 30 No. 4 mdedge.com/obgmanagement Masthead 0418.indd 2 3/29/18 2:50 PM NOW AVAILABLE DEMONSTRATED TO SIGNIFICANTLY DECREASE MODERATE TO SEVERE DYSPAREUNIA DUE TO MENOPAUSE1 Not actual size. NON-ESTROGEN BASED, CONVERTS TO ESTROGENS AND ANDROGENS* Prasterone is a precursor that is locally converted to estrogens and androgens with minimal systemic exposure.1,2 *The mechanism of action of INTRAROSA NNOO FDA BBOXEDOXED WARNINGWARNING2 is not fully established1 No restrictions on duration of use2,3 ONCE-DAILY TREATMENT Individually wrapped vaginal inserts with disposable applicators1 To order samples and learn more about INTRAROSA, including our patient savings program, visit IntrarosaHCP.com Indication INTRAROSA is a steroid indicated for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause. Important Safety Information INTRAROSA is contraindicated in women with undiagnosed abnormal genital bleeding. Estrogen is a metabolite of prasterone. Use of exogenous estrogen is contraindicated in women with a known or suspected history of breast cancer. INTRAROSA has not been studied in women with a history of breast cancer. In four 12-week randomized, placebo-controlled clinical trials, the most common adverse reaction with an incidence ≥2 percent was vaginal discharge. In one 52-week open-label clinical trial, the most common adverse reactions with an incidence ≥2 percent were vaginal discharge and abnormal Pap smear. Brief Summary: Consult full Prescribing Information for complete INTRAROSA treatment group with an incidence of ≥2 percent and product information. greater than reported in the placebo treatment group. There were 38 cases in 665 participating postmenopausal women (5.71 percent) CONTRAINDICATIONS in the INTRAROSA treatment group compared to 17 cases in 464 Undiagnosed abnormal genital bleeding: Any postmenopausal participating postmenopausal women (3.66 percent) in the placebo woman with undiagnosed, persistent or recurring genital bleeding treatment group. should be evaluated to determine the cause of the bleeding before consideration of treatment with INTRAROSA. In a 52-week non-comparative clinical trial [92% - White Caucasian non-Hispanic women, 6% - Black or African American women, and WARNINGS AND PRECAUTIONS Current or Past History of 2% - “Other” women, average age 57.9 years of age (range 43 to Breast Cancer 75 years of age)], vaginal discharge and abnormal Pap smear at Estrogen is a metabolite of prasterone. Use of exogenous estrogen 52 weeks were the most frequently reported treatment-emergent is contraindicated in women with a known or suspected history of adverse reactions in women receiving INTRAROSA with an breast cancer. INTRAROSA has not been studied in women with a incidence of ≥2 percent. There were 74 cases of vaginal discharge history of breast cancer. (14.2 percent) and 11 cases of abnormal Pap smear (2.1 percent) in ADVERSE REACTIONS Clinical Trials Experience 521 participating postmenopausal women. The eleven (11) cases of Because clinical trials are conducted under widely varying abnormal Pap smear at 52 weeks include one (1) case of low-grade conditions, adverse reaction rates observed in the clinical trials of squamous intraepithelial lesion (LSIL), and ten (10) cases of atypical a drug cannot be directly compared to rates in the