P RESCRIBING M ETHADONE PAIN , FOR PAGE 23 Ob.Gyn. News VO L . 4 1 , N O. 2 3 www.obg ynnews.com T he Leading Inde p endent Ne wspaper for the Obstetrician/Gynecologist—Since 1966 THE LEADER IN NEWS AND MEETING COVERAGE DECEMBER 1, 2006 Hypertension in Pregnancy Linked To Later CV Events INSIDE Incidence of stroke was 5.2% vs. 2.7%. Frozen Ova BY MITCHEL L. ZOLER ©PARKER S MITH Vitrification may be superior to the older slow-freeze technique. Philadelphia Bureau C H I C A G O — Women who develop hypertension during pregnancy face a substantially increased risk of cardiovascular events later in life, based on a review of more than 4,000 women. Hypertension in pregnancy is an “underrecognized risk factor” for subsequent cardiovascular events and for developing other markers of elevated cardiovascular risk, Dr. Vesna D. Garovic said at the annual scientific sessions of the American Heart Association. “Traditionally, hypertension in pregnancy was not thought to play a major role in cardiovascular disease,” noted Dr. Garovic, a PAGE 17 Dr. Ban Mishu Allos said that many older adolescents would have been vaccinated during the summer before the start of college. Master Class Dr. Charles March discusses management of intrauterine adhesions. Guillain-Barré Risk Small With MCV4 Senior Writer A T L A N T A — Guillain-Barré syndrome has been reported in 17 recipients of the tetravalent meningococcal conjugate vaccine, but it’s unclear whether the association is causal, Dr. Robert L. Davis said at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. “There is evidence for a small increased risk of GBS after MCV4 [tetravalent meningococcal conjugate vaccine]. The timing of neurologic symptoms within 1-5 weeks of vaccination among reported cases is of concern,” Dr. Davis said. The increased risk appears confined to older adolescents, with a relative risk of 0.27 per 100,000 person-months among those aged 11-14 years (based on 1 case out of 2.5 million doses distributed), compared with 2.55 per 100,000 person-months in the 15to 19-year-old group (14 cases among 3.5 million doses). Dr. Ban Mishu Allos, an ACIP member from the department of infectious diseases at Vanderbilt University, Nashville, noted that many of the older adolescents would likely have received the vaccine during the summer prior to the start of college classes, which happens to be the season for Campylobacter jejuni infection, a frequent antecedent to GBS. The younger teens, in contrast, would be more likely to receive the vaccine at other times of the year as well. No patient had reported diarrheal prodromes, and none of the four individuals tested for campylobacter were positive. However, the infection is often asymptomatic, and the organism would not be detected in stool by the time GBS symptoms appeared, Dr. Allos remarked. The data, also reported in CDC’s Morbidity and Mortality Weekly Report (2006;55:1120-4), suggest an excess risk for GuilSee GBS Risk page 4 FDA Reverses 14-Year Ban On Silicone Breast Implants Detection Story Laparoscopy enhanced with near-infrared fluorescence can better detect ovarian tumors. B Y S H E R RY B O S C H E R T San Francisco Bureau T PAGE 46 VITAL SIGNS Men Make More Than Women in Ob.Gyn. Men Women $269,443 $379,010 $280,000 $242,996 $184,458 General Ob.Gyn $178,133 Gynecology Only Maternal and Fetal Medicine Note: Based on median compensation of ob.gyns. in group practice. Source: 2005 survey data, Medical Group Management Association J ULIE K ELLER /E LSEVIER G LOBAL M EDICAL N EWS BY MIRIAM E. TUCKER PAGE 36 nephrologist at the Mayo Clinic in Rochester, Minn. But based on these findings, physicians who care for middle-aged or elderly women should take note of their pregnancy outcomes. Women with a history of hypertension in pregnancy need aggressive treatment to reduce their modifiable risk factors, and close monitoring for the onset of cardiovascular events, she said. It’s likely that results from prior studies of women who had hypertension in pregnancy failed to establish these links because they involved relatively few women and had relatively brief follow-up. These earlier studies also lacked racial and ethnic diSee Hypertension page 5 he Food and Drug Administration approved the marketing of silicone gel–filled breast implants for reconstructive or breast augmentation surgery in women, lifting a 14-year ban on their use outside of clinical studies. Long-standing controversy surrounding the implants continues, however, with some physicians praising the approval and critics decrying the quality of the science on which it was based. The Food and Drug Administration (FDA) approved the im- plants for women of any age undergoing breast reconstruction and for women aged 22 years or older undergoing breast augmentation. The approval applies to silicone gel–filled implants manufactured by two companies—Allergan Corp., which makes Inamed implants, and Mentor Corp., which makes MemoryGel implants. The FDA has restricted use of the implants for breast augmentation to women aged 22 years or older to ensure that breast development has finished before augmentation is performed and beSee Implants page 5