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ACOG Issues New Guidelines On Fetal Monitoring To Resolve Inconsistencies In Interpretation
The American College of Obstetrics and Gynecology recently published new guidelines on electronic fetal monitoring in an attempt to increase consistency in the way physicians interpret and act on the results, the New York Times reports. Electronic fetal monitoring, which was introduced in the 1970s, is used during labor for more than 85% of the four million infants born alive in the U.S. annually, the Times reports. According to the Times, use of fetal monitors became standard obstetrical practice before it was known if the benefits outweighed the risks. The new guidelines refine the meaning of various readings from fetal monitors and could help doctors make better decisions about whether to intervene during labor.According to experts, the widespread adoption of fetal monitoring has produced both negative and positive consequences, including significant increases in caesarean deliveries and the use of forceps during vaginal deliveries. Monitoring has not been found to reduce the risk of either cerebral palsy or fetal death resulting from inadequate oxygen to the fetal brain, as it was intended to do. Furthermore, lawyers commonly use monitoring results to support malpractice cases that might have little merit, which in turn has driven rising malpractice insurance costs and prompted some obstetricians to stop delivering infants.The new guidelines divide monitor readings into three categories to help doctors interpret readings more consistently. The old guidelines had two categories -- reassuring and non-reassuring -- and it was up to the obstetrician to determine whether a non-reassuring reading required intervention. Under the new guidelines, the first category applies when tracings of the fetal heart rate are normal and no specific action is required. The second category is for indeterminate tracings that require evaluation, continuous surveillance and re-evaluation. Obstetricians treating patients in this category should consider other clinical factors that could affect the fetus and whether the patient could be safely moved to category one, according to Catherine Spong of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, which produced recommendations on which the guidelines are based. The final category is for abnormal tracings that require immediate evaluation and efforts to reverse the abnormal heart rate. The Times reports that more refinements to the guidelines are expected to be released in 2010 (Brody, New York Times, 7/7).

FDA Warns Consumers Not To Use Body Building Products Marketed As Containing Steroids Or Steroid-Like Substances
The U.S. Food and Drug Administration issued a Public Health Advisory (PHA) warning consumers to stop using body building products that are represented as containing steroids or steroid-like substances. Many of these products are marketed as dietary supplements.
News of the day
President Obama To Visit Ghana Friday
IRIN reports that Ghanaians "are mixing high hopes with caution" in anticipation of President Obama"s arrival in the country Friday - "his first visit to sub-Saharan Africa." Obama is expected to "make a major policy statement," according to IRIN. The article looks back at some of the commitments that former Presidents Bush and Clinton previously made to Africa (7/8).
Diagnostics

Ongoing Study Shows That Endovascular Therapy Is Associated With High Cure Rate For Childhood Eye Cancer

Expanded results of a study conducted on children with eye cancer (retinoblastoma) shows that chemotherapy delivered through endovascular (through the vessel) means not only successfully cures the cancer in a majority of cases, but achieves this cure with preserved vision. Study outcomes were presented this week at the Society of NeuroInterventional Surgery (SNIS) 6th Annual Meeting in Boca Raton, FL by lead author Pierre Gobin, Professor of Radiology in Neurosurgery and Neurology at the Weill Cornell Medical Center at New York Presbyterian Hospital in New York City. "This is an exciting development in the neurointerventional community, as results prove that chemotherapy delivered through endovascular techniques is a powerful tool in addressing the most severe forms of retinoblastoma," says Gobin, who says that the study is the product of teamwork between New York Presbyterian Hospital and the Eye Cancer Center of Memorial Sloan Kettering Cancer Center, New York City, with support from David Abramson, M.D., Brian Marr, M.D., Ira Dunkel, M.D. And Scott Brodie, M.D. Retinoblastoma, the seventh most common pediatric cancer, is a malignant eye tumor in children that arises in cells in the developing retina. Typically, this cancer is associated with a late diagnosis as one of the only symptoms, a white pupil replacing the normal black, presents when the tumor occupies over one-third of the eye. Conventional therapy for this cancer includes laser treatment, as well as techniques that utilize extreme cold to freeze and destroy abnormal cells or deliver radioactive substances in timed intervals to kill the tumor. If these treatments fail, physicians resort to intravenous chemotherapy or radiation therapy. Despite this wide array of treatment options, however, a late diagnosis often requires the removal of the eye. According to Gobin, the study was initiated in 2006 to determine if chemotherapy delivered through endovascular methods (through a catheter inserted in the groin and threaded up through the vessels to the site of the tumor), otherwise known as chemosurgery, would produce better outcomes for retinoblastoma patients, including preserving the eye and vision as well as avoiding intravenous chemotherapy, which is administered over the course of six months to a year and can be frequently associated with port infections and sickness for the duration of that time. Since the study was initiated, 49 children, ranging in age from 1 month to 10 years, have been treated with this technique. Of this number, all suffered from advanced retinoblastoma and were candidates for removal of the eye. Additionally, half of the patients had already failed prior conventional treatments, including intravenous chemotherapy or radiation therapy; nine patients had already had an eye removed. Study participants were chosen following an eye examination under anesthesia, allowing physicians to confirm the diagnosis and determine the extent of the disease. For those who qualified, chemosurgery was performed soon thereafter, and was repeated every three to four weeks, up to six times. To date, 144 chemosurgeries have been performed, which equates to a mean of three per patient. Results indicate that physicians were able to technically perform the procedure successfully in almost every case. Short-term follow-up, occurring after six or more months of stability after the last treatment, showed that of 27 eyes, 21 are cured (77 percent) and 13 are cured with preserved vision (48 percent). Six eyes could not be saved. Overall, of the population of eyes that were treated, 50 percent of patients would have lost an eye on conventional treatment; of those who kept an eye, a majority would not have experienced useful vision. With chemosurgery, only ten percent of patients lost an eye. In general, patients tolerated the procedure well with minimal side effects that resolved once addressed. In only four out of 46 eyes treated did severe complications occur which eventually led to blindness. All four eyes had received previous extensive treatment consisting of intravenous chemotherapy and radiation therapy. Due to the overwhelming success observed with chemosurgery, Gobin says this treatment option has considerably reduced the number of conventional treatments, including the toxic intravenous chemotherapy, and most significantly, the number of eye losses. "The results really do have the potential to change the entire treatment approach to advanced retinoblastoma. In our center, chemosurgery is now the first line of treatment for this potentially devastating condition." Retinoblastoma occurs in approximately 350 - 400 children each year. Approximately 80 percent of patients are diagnosed under 3 years of age. About SNIS SNIS members are neurointerventional practitioners with backgrounds in neuroradiology, neurosurgery and neurology that come together in the shared discipline of neurointerventional surgery. Our practitioners specialize in minimally invasive and endovascular procedures to treat stroke, aneurysms, carotid stenosis and spine fractures. Over the past two decades, our physicians have made numerous contributions to the neurosciences including: advancing stroke treatment through catheter based therapy; innovating endovascular coiling for aneurysms; pioneering interventional procedures to treat fractures in the spine; and initiating the first-ever stroke registry to track procedural success in the treatment of acute stroke. Society of NeuroInterventional Surgery


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