ACOG Issues Evidence-Based Guidelines for Managing First and Second Stages of Labor

USA: The American College of Obstetricians and Gynecologists (ACOG) has issued comprehensive guidelines on managing labor’s first and second stages. The guidelines define labor progression, address labor arrest, and optimize outcomes through evidence-based practices. These recommendations aim to assist healthcare providers in ensuring effective and individualized care for pregnant individuals.

The Clinical Practice Guideline outlines definitions of labor and labor arrest and provides recommendations for managing dystocia during the first and second stages of labor. The recommendations are categorized based on their strength and the quality of supporting evidence. Additionally, Ungraded Good Practice Points offer guidance in areas where formal recommendations could not be made due to limited or insufficient evidence.
For the first stage of labor, ACOG emphasizes that active labor begins at 6 cm of cervical dilation. Active phase arrest is defined as no further cervical dilation despite 4 hours of adequate uterine activity or 6 hours with oxytocin augmentation. To manage prolonged labor, interventions such as amniotomy and oxytocin administration are strongly recommended to enhance uterine contractions and reduce labor duration.
In dystocia cases during the first stage, intrauterine pressure catheters may be used to accurately assess contraction adequacy, especially when external monitoring is inconclusive. These strategies aim to minimize the risk of operative deliveries, including cesarean sections, by promoting effective labor progress.
For the second stage of labor, prolonged pushing is defined as exceeding three hours for first-time mothers or two hours for those with prior vaginal deliveries. Decisions regarding second-stage arrest should incorporate clinical progress, the likelihood of vaginal delivery, and patient preferences. Neuraxial anesthesia is recommended to alleviate labor pain during any stage, enhancing patient comfort.
Management of dystocia in the second stage includes initiating pushing upon complete cervical dilation and considering operative vaginal delivery as an alternative to cesarean delivery for certain cases. Arrest in this stage may be identified earlier by observing a lack of fetal descent or rotation despite adequate contractions and maternal effort.
When labor arrest occurs, cesarean delivery is advised for active-phase arrest during the first stage. However, the second-stage arrest should be assessed for possible operative vaginal delivery before resorting to cesarean section, ensuring tailored care for each patient’s circumstances.
The guidelines emphasize the importance of individualized care and shared decision-making. Strong recommendations are supported by high-quality evidence, while conditional recommendations encourage consideration of patient values and preferences. ACOG’s recommendations aim to optimize maternal and fetal outcomes while addressing the complexities of labor management with a balanced, evidence-based approach.
“Both operative vaginal delivery, when performed by a qualified clinician for a suitable candidate, and cesarean delivery are evidence-supported options for managing second-stage labor arrest,” the guideline stated.
Reference: https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2024/01/first-and-second-stage-labor-management

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Men at high risk of CVD face brain health decline 10 years earlier than women: Study

Men with cardiovascular disease risk factors, including obesity face brain health decline a decade earlier-from their mid 50s to mid 70s-than similarly affected women who are most susceptible from their mid 60s to mid 70s, suggest the findings of a long term study, published online in the Journal of Neurology Neurosurgery & Psychiatry.

The most vulnerable regions of the brain are those involved in processing auditory information, aspects of visual perception, emotional processing and memory, with the damaging effects just as evident in those who didn’t carry the high risk APOE ε4 gene as those who did, the findings show.

It’s clear that cardiovascular disease risk factors, such as type 2 diabetes, obesity, high blood pressure, and smoking are associated with a heightened risk of developing dementia.

But when might be the best time to intervene with appropriate treatment to stave off the associated neurodegeneration, and whether this timing might differ between the sexes, isn’t clear, say the researchers.

To explore this further, they drew on 34,425 participants of the UK Biobank all of whom had had both abdominal and brain scans. Their average age was 63, but ranged from 45 to 82.

Cardiovascular disease risk was assessed using the Framingham Risk Score, which is based on: age; blood fats; systolic blood pressure-the maximum arterial pressure exerted when the heart contracts and pumps blood, and represented by the first higher number in a reading-blood pressure medication; smoking; and diabetes.

Additionally, changes in brain structure and volume were recorded using a neuroimaging technique called Voxel-based morphometry (VBM) to identify the influence of cardiovascular risk, abdominal fat, and the fat that surrounds body organs (visceral adipose tissue) on brain neurodegeneration.

Analysis of the data showed that higher levels of abdominal fat and visceral adipose tissue were associated with lower brain grey matter volume in both men and women.

The strongest influence of cardiovascular risk and obesity on brain neurodegeneration occurred a decade earlier in men than in women and was sustained over two decades, the data revealed. The effects were also stronger in men than they were in women.

Men were most susceptible to the damaging effects between the ages of 55 and 74, while women were most susceptible between the ages of 65 and 74.

High cardiovascular risk and obesity predisposed to gradual loss of brain volume over several decades, occurring in a bell-shaped curve over time, with susceptibility lower at younger (under 55) and older ages (75+), although there were relatively few participants of either sex in these age groups, note the researchers.

Importantly, the associations remained, irrespective of whether or not those affected were carriers of the high risk APOE ε4 gene.

The most vulnerable regions of the brain were the temporal lobes, located in the cerebral cortex, the brain’s outer surface. These regions are involved in aural, visual, and emotional information processing, and memory-regions affected early on in the development of dementia.

“The detrimental impact of cardiovascular risk was widespread throughout cortical regions, highlighting how cardiovascular risk can impair a range of cognitive functions,” note the researchers.

“Therefore, modifiable cardiovascular risk factors, including obesity, deserve special attention in the treatment/prevention of neurodegenerative diseases, including Alzheimer’s disease,” they add.

“This highlights the importance of aggressively targeting cardiovascular risk factors before the age of 55 years to prevent neurodegeneration and Alzheimer’s disease, in addition to the benefit of preventing other cardiovascular events, such as myocardial infarction [heart attack] and stroke,” they emphasise.

“One such possibility may be in the repurposing of agents used for obesity and type 2 diabetes mellitus for the treatment of Alzheimer’s disease,” they suggest, adding that other drugs used for the treatment of cardiovascular disease have also shown promise.

This is an observational study, so no firm conclusions can be drawn about cause and effect. And the researchers acknowledge various limitations to their findings, including that the UK Biobank didn’t record specific biomarkers for Alzheimer’s disease.

Atrophy of frontal, parietal, and temporal brain regions is also typical of normal ageing, making it difficult to precisely differentiate between the impact of cardiovascular risk on general ageing processes and the risk of specific neurodegenerative conditions, they add.

But there are plausible biological explanations for the observed neuronal damage, they explain. These include inflammation, central leptin and insulin resistance, as well as the breakdown of the blood-brain barrier.

And they conclude: “Targeting cardiovascular risk and obesity a decade earlier in males than females may be imperative for potential candidates to achieve a therapeutic benefit in preventing neurodegeneration and cognitive decline.” 

Reference:

Cardiovascular risk and obesity impact loss of grey matter volume earlier in males than females. Journal of Neurology Neurosurgery & Psychiatry. DOI: 10.1136/jnnp-2024-333675

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Ultraprocessed Foods Linked to Active Psoriasis Risk, finds study

Recent findings from a new study have revealed that heavy ultraprocessed foods intakes, such as that by sodas and frozen pizzas, have been correlated to risk of active psoriasis. This study was conducted by Penso L. and colleagues which was then published in JAMA Dermatology.

Psoriasis, a chronic autoimmune disease affecting the skin which has long been considered to be related to systemic inflammation. Other lifestyle-related risk factors, including obesity and alcohol intake, have also been reported; however, the specific role of ultraprocessed food intake in the activity of psoriasis remains to be ascertained. Data from this investigation were drawn from the NutriNet-Santé cohort, a very large observational study in France that controlled for age, BMI, alcohol intake, and comorbidities.

The study had 18,528 participants between November 2021 and June 2022. Comprehensive questionnaires on diet, sociodemographic characteristics, physical activity, and health status were completed by the participants. Foods were classified as either processed or ultraprocessed based on their composition, and dietary records were used to calculate the proportion of ultraprocessed foods consumed by weight relative to the total intake of food and beverages. Psoriasis status was self-reported as “never-had,” “nonactive,” or “active.”

Key Findings

Ultraprocessed Food Intake and Psoriasis Activity:

  • The highest tertile of ultraprocessed food intake was significantly more likely among individuals with active psoriasis compared to those without (adjusted OR 1.36, 95% CI 1.14-1.63, P<0.001).

Comorbidities:

  • Compared to participants without psoriasis, those with active psoriasis had higher rates of cardiovascular disease (7% vs 5%), diabetes (6% vs 4%), inflammatory bowel disease (2% vs 1%), and inflammatory rheumatism (9% vs 3%).

Demographic Trends:

  • The active psoriasis group had fewer women (68%) than the “never-had” and “nonactive” groups (74% and 75%, respectively).

  • A higher prevalence of BMI >30 was observed in the active psoriasis group (16%) compared to “never-had” (9%) and “nonactive” (11%) groups.

Validation by Dermatologists:

  • When psoriasis cases were limited to those validated by dermatologists, the link between ultraprocessed food intake and active psoriasis was not statistically significant (adjusted OR 1.32, 95% CI 1.06-1.64, P=0.13).

Significant consumption of ultraprocessed foods is associated with active psoriasis, suggesting a proinflammatory effect. These data suggest that dietary interventions might assume an important role in chronic inflammatory conditions such as psoriasis. These findings set the stage for dietary counseling to be considered in both the prevention and management of psoriasis.

Reference:

Penso, L., Touvier, M., Srour, B., Ezzedine, K., & Sbidian, E. (2024). Ultraprocessed food intake and psoriasis. JAMA Dermatology (Chicago, Ill.). https://doi.org/10.1001/jamadermatol.2024.4832

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Yet another ragging allegation surfaces from MKCG Medical College

Odisha- Recently, a junior student of Odisha’s prestigious MKCG Medical College and Hospital has accused his seniors of ragging. Complaining to the anti-ragging cell, the medico claimed that he was mentally and physically tortured when he refused to follow the orders of the seniors.

Junior medico of MKCG Medical College and Hospital complained to the anti-ragging cell that they were being ragged by their seniors and made to do non-academic tasks. 

Also Read: UGC Receives 55 ragging Complaints within Weeks of Commencement of MBBS Academic Session: Report

Based on the complaint, the Anti-Ragging Cell of MKCG Medical College and Hospital has called an immediate meeting to investigate the matter thoroughly.

As per Odisha TV report, a day earlier, the father of a second-year MBBS student had also complained to the anti-ragging cell about the seniors ragging at the prestigious institute. He had reportedly appealed to the medical college authorities not to allow boys into the girls’ hostel.

In this regard, speaking to the OdishaTV, Suchitra Dash, dean-principal of the medical college informed,“We had received a complaint from a student’s father that seniors had forced juniors to write their records. However, the student claimed that the person was not her father. Moreover, the juniors have also declined any such record writing. The anti-ragging cell is very active and keeps a strict vigil. Strict action will be taken against the seniors if their records are found in any room of juniors”.

“We had also conducted a surprise raid and we have not recovered any record of any kind. We have a meeting in the evening, the next course of action will be decided there”, the dean further added.

Medical Dialogues had earlier reported that based on the recommendation of the anti-ragging committee, the state-run MKCG Medical College and Hospital in Odisha’s Ganjam district suspended five fourth-year MBBS students from the hostel for six months for allegedly ragging second-year students.

Also Read:MKCG Medical College ragging case: 5 MBBS students suspended for 6 months

Also Read: Violation of Anti-ragging protocols! 7 MBBS students of BRD Medical College suspended

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Lung cancer screening with computed tomography finds coronary artery disease in 83% of cases

Lung cancer screening with low-dose chest computed tomography (CT) may detect more than just lung cancer. As research in the Canadian Medical Association Journal shows, these CTs can identify coronary artery calcium, a strong risk factor for coronary artery disease (CAD), in patients without cardiac symptoms.

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HIV infections can be prevented—why some people act to protect themselves, and others don’t

The number of new HIV infections has fallen over the years—it declined by 39% from 2010 to 2023. But HIV’s devastating impact on global health persists. In 2023, 1.3 million people acquired HIV—three times more than the 370,000 target set by UNAids. In sub-Saharan Africa, HIV incidence among young women aged 15–24 is decreasing—but they accounted for 27% of all new infections in 2023, and were three times more likely to acquire HIV than male counterparts.

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Mosquito-borne diseases are on the rise—here’s how collecting mozzies in your backyard can help science

Warm weather is here and mosquitoes are on the rise in Australia. Unseasonably large swarms are causing problems in some parts of Sydney already.

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What is a Galleri blood test and how can it help diagnose multiple forms of cancer?

Tad Carper had no idea the technology to detect more than 50 cancers with one test existed. He does now, and the Dallas Cowboys senior vice president of communication wants to help spread the word.

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How to avoid eye infections—and what to do if you get one

Sir Elton John recently revealed on ABC’s Good Morning America that he lost the sight in his right eye after suffering from an eye infection. With poor vision in his left eye too, John said. “It’s been four months now since I haven’t been able to see.”

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Anti-Obesity Medications Linked to Reduced Alcohol Use: New Insights from Weight Loss Programs, Study Reveals

USA: A recent study, published in JAMA Network Open as a research letter, highlights a significant link between anti-obesity medications (AOMs) and changes in alcohol consumption among individuals participating in weight loss programs. The research observed that nearly half of the participants who consumed alcohol at the start of the program reduced their alcohol intake following the initiation of AOM treatment.

Anti-obesity medications, such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are recognized for their effectiveness in promoting weight loss. Moreover, the use of GLP-1 RAs has been linked to a reduced incidence and recurrence of alcohol use disorder. Investigating different AOMs alongside variations in alcohol consumption could provide valuable comparative insights into their broader potential effects.

Against the above background, Lisa R. Miller-Matero, Center for Health Policy & Health Services Research, Henry Ford Health, Detroit, Michigan, and colleagues aimed to evaluate shifts in alcohol consumption among individuals participating in a telehealth weight management program following the start of an AOM.

This cohort study, approved by the Henry Ford Health Institutional Review Board, analyzed deidentified data from participants in the WeightWatchers (WW) Clinic telehealth weight management program. Eligible individuals initiated and refilled an AOM between January 2022 and November 2023. AOMs included metformin, bupropion/naltrexone, and first—and second-generation GLP-1 RAs. Participants completed baseline and refill surveys reporting demographics, BMI, and weekly alcohol use. Those with prior AOM use or bariatric surgery were excluded. Alcohol use changes were analyzed using multivariate logistic regression with covariates.

The following were the key findings of the study:

  • The study included 14,053 participants (86.0% female, mean age 43.17 years, mean BMI 35.97).
  • Most participants (86.2%) were prescribed second-generation GLP-1 RAs.
  • At baseline, 53.3% (7,491) reported consuming alcohol.
  • Overall, 24.2% (3,395) reduced their alcohol use after AOM initiation.
  • Among baseline drinkers, 45.3% reduced use, 52.4% reported no change and 2.3% increased use.
  • Participants with higher obesity levels or heavier drinking habits were more likely to reduce alcohol use.
  • Bupropion and naltrexone users initially showed greater reductions in alcohol use compared to metformin, but this effect was not significant after adjusting for weight loss.

This study found that nearly half of participants consuming alcohol at baseline reduced their intake after starting AOMs. This effect may be linked to specific AOM properties, such as naltrexone’s ability to curb alcohol cravings and GLP-1 RAs’ reduction of alcohol’s rewarding effects.

“Unexpectedly, metformin users also reported decreased alcohol use, possibly due to behavioral changes encouraged in the weight management program. Further research, including randomized trials, is needed to explore these findings,” the researchers concluded.

Reference:

Miller-Matero LR, Yeh H, Ma L, et al. Alcohol Use and Antiobesity Medication Treatment. JAMA Netw Open. 2024;7(11):e2447644. doi:10.1001/jamanetworkopen.2024.47644

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