Overall, the American College of Obstetricians and Gynecologists (ACOG) 2014 meeting was a great conference. Of particular interest were the following three panel discussions:
1) Reasons for the high rate of C sections in China: C section rates have increased beyond their WHO recommended level of 15% in China. One of the primary reasons for this trend is the rapid advent of advanced health care technologies. Thus many urban as well as rural women increasingly seek early antenatal and delivery care and opt to go for safer and relatively painless C section procedures. In addition, the repercussions for gynecologists in the case of adverse outcomes are extreme in China ranging from harassment to physical injury. Therefore, physicians are also very enthusiastic to undertake C section procedures in order to avoid even potentially dangerous situations.
2) Falling number of vaginal hysterectomy volumes and reasons that they should go up: Vaginal hysterectomies have been declining significantly in recent years. In fact, more than 80% of gynecologists now perform less than 5 vaginal hysterectomies per year. Currently, robotic and laparoscopic hysterectomies make up the bulk of all hysterectomies performed in the US. Dr. Roseanne Kho at ACOG argued, however, that vaginal hysterectomies should be the more preferred approach among physicians. Vaginal hysterectomies are not only much cheaper to perform than robotic or laparoscopic hysterectomies but are also associated with better outcomes and fewer complications such as febrile morbidity and the need for additional blood transfusions
3) Comparison between the OVA1 and ROMA test for ovarian cancer detection: The current serum biomarker CA125 is an imperfect tool for the detection of ovarian cancer. Only a small proportion of women with ovarian cancer are detected early and referred to gynecologic oncologists for further treatment. This has led to additional work in the development of novel biomarkers such as OVA1 and ROMA. The OVA1 was suggested at ACOG to be the preferred test for ovarian cancer detection since it is a highly sensitive test that helps identify cancers that would otherwise have been missed using the other markers.