One of the main themes at the Annual College for Obstetricians and Gynecologists (ACOG) conference 2018 was highlighted in a talk given by cardiologist and former American College of Cardiology President, Dr. Mary N. Walsh during the opening ceremony. She outlined the need for collaboration between ACOG’s members and cardiologists because many women are having children at an older age and are increasingly at risk of hypertension during pregnancy.
The forming of interdisciplinary teams was a consistent trend throughout the conference, with various members of the ACOG community speaking about innovations made within their specialty through partnerships they had formed with those across other specialties. For example, bariatric specialists have aided the advancement of gynecological treatments in obese patients; technological partnerships have allowed gynecologists in Arkansas to treat patients in rural areas of the state; the Food and Drug Administration (FDA) is working with gynecologists to implement sex-specific considerations in the research and approval process; and even the United States Environmental Protection Agency (EPA) has joined gynecologists to help prevent gynecological ailments caused by environmental factors. These developments, outlined in detail below, will all improve the patient experience and expand the eligible population for gynecological treatments.
Gynecologists are partnering with bariatric specialists for improved success in minimally invasive gynecological surgery
- Minimally invasive gynecologic surgery for obese patients is technically challenging, and because of this, many gynecologists often elect for simpler open surgery. This unfortunately leads to a higher risk of infection and other complications for patients.
- The gynecologist who presented on this topic had completed two tours in Afghanistan and compared preparing for minimally invasive gynecologic surgery for obese patients to the extensive preparation required before going into battle. The key to this preparation was consulting with and receiving help from specialists across the medical spectrum. Because of the comorbidities often present in obese patients, endocrinologists, cardiologists, and bariatric specialists are frequently involved in the workup prior to surgery.
- Ultimately, the success of his use of an interdisciplinary approach has allowed women to receive minimally invasive surgery with faster recovery time and a lower risk of infection.
Physicians are working with tech companies to collaborate across the state of Arizona
- A large issue in the United States is the significant disparity in the level of healthcare available between rural and urban populations. This is particularly the case in Arkansas, where much of the population lives far away from major cities, mainly in rural areas with fewer physicians and hospitals, where they typically receive poorer care overall.
- In 2003, the University of Arkansas for Medical Sciences (UAMS) Telehealth Program was created as a collaboration between technology companies, gynecologists, generalist physicians, nurse practitioners, and many more across healthcare. The goal was to use broadband internet to allow physicians to reach rural areas to provide care electronically.
- The program received a spark in 2012 with funding of over a hundred million dollars from the government. Since then, the program has been a success, allowing for consultations across the state, tele-education, live-streaming ultrasounds, 24-hour call centers, telemedicine visits, and physician collaborations on difficult cases. This example of technology-enabled care has, among other achievements, moved the healthcare system in Arkansas from being the 52nd- to the 6th-ranked state in terms of death rates from stroke since the implementation of the program.
Gynecologists are working with the FDA to ensure proper sex-specific and pregnancy-specific regulation
- Historically, there has been little difference in the regulation of treatments between men and women. Furthermore, the vast majority of pharmaceuticals that are approved for the general public are also approved for pregnant women. A regulatory body within the FDA has partnered with ACOG to try to address this issue.
- The impetus for this is simply because of the anatomical differences between men and women; many treatments will have a drastically different impact on each sex. In particular, pregnant women react differently to medication than those who are not pregnant.
- Since the formation of this committee, the FDA now considers sex as a biological variable in the research and approval process. Sex-specific data has been incorporated in medical device clinical trials, and a new section of drug labels has been added that will break down recommendations for men and women separately.
- Ultimately, a task force report on the sex-specific research—as well as the inclusion of more women and pregnant women in clinical trials—will be released by the collaborative committee in September 2018. All of these efforts have and will continue to lead to better and more specialized care for women in fields that expand beyond gynecology and obstetrics.
Specialists across the healthcare spectrum are partnering to fight environmental-based developmental and endocrine issues in children and pregnant women
- Project TENDR is a collaboration between scientists, environmental activists, and healthcare professionals to generate solutions to the growing issue of toxic chemicals impacting the health of pregnant women and developing children.
- Epidemiologists have found that within the last 30 years, the rates of chronic neurological and endocrine diseases have been skyrocketing. Scientists and environmental advocates have shown a correlated increase in the rate of exposure to toxic chemicals over that time period, while physicians and scientists have demonstrated the direct impact of those chemicals on the developing brain and endocrine system of pregnant women.
- Overall, this is an enormous issue for families and our next generation. At ACOG 2018, a gynecologist working for Project TENDR presented some of the work his team has achieved. For example, they have identified products used in body care, geographical areas, pesticides, and food products that are high in toxins, and have made recommendations to physicians and the EPA on how to manage these conditions. As the EPA becomes increasingly involved with Project TENDR, nationwide policy changes could be on the horizon.