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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).
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Insights Into Failed HIV-1 Vaccine Trial: Study
Following the disbandment of the STEP trial to test the efficacy of the Merck HIV-1 vaccine candidate in 2007, the leading explanation for why the vaccine was ineffective - and may have even increased susceptibility to acquiring the virus - centered on the hypothesis that high levels of baseline Ad5-specific neutralizing antibodies may have increased HIV-1 acquisition among the study subjects who received the vaccine by increasing Ad5-specific CD4+ T-cells that were susceptible to HIV-1 infection.
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Editorial Calls Supreme Court's Pregnancy Leave Decision 'Not Just'
"The Supreme Court keeps finding ways to deny women equal pay and benefits," a New York Times editorial states in response to the court"s 7-2 ruling on Monday that employers are not required to award women credit toward pension benefits for pregnancy leave taken before Congress passed the 1978 Pregnancy Discrimination Act. According to the Times, the ruling reflects reasoning similar to the court"s 2007 decision in which it denied former Goodyear employee Lilly Ledbetter"s "claim for equal pay because it thought she waited too long to file it." In Monday"s decision, the majority "reasoned mainly that the pregnancy leaves predated the 1978 law, and since the law was not retroactive, the discrepancy in benefits was the product of "past completed events that were entirely lawful at the time they occurred,"" the editorial states. It notes that the majority included "two generally reliable votes for equality, Justices John Paul Stevens and David Souter." The editorial continues, "This may sound logical, but it is not just." The editorial says that Justice Ruth Bader Ginsburg, in writing the dissent, "quite correctly" recognized a company"s "ongoing denial of equal benefits not as past discriminatory behavior that started and ended decades ago, but as a current violation of the act." In a similar way, "Goodyear discriminated against Lilly Ledbetter by maintaining her unequal pay for years, not merely the first time the company underpaid her." The Times calls on Congress to "write corrective legislation" on pregnancy leave (New York Times, 5/21).
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Obama To Review Court Picks Over Weekend

President Obama on Wednesday said he would review potential Supreme Court nominees to replace retiring Justice David Souter over the weekend, prompting those involved with the process to believe he will make an announcement within days, the Washington Post reports. Obama was speaking to a group of senators that included Majority Leader Harry Reid (D-Nev.), Minority Leader Mitch McConnell (R-Ky.), Judiciary Committee Chair Patrick Leahy (D-Vt.) and the committee"s ranking Republican Sen. Jeff Sessions (R-Ala.). According to White House spokesperson Robert Gibbs, Obama told the senators that he "would choose a nominee who respects the Constitution and judicial precedent and also has the good judgment and common sense to reach fair decisions" (Murray, Washington Post, 5/14). Although a list of six to eight potential names has been circulating in public, a White House official said an official pick is not likely to be announced before Memorial Day (Weisman, Wall Street Journal, 5/14).During the meeting, the president also urged senators to act quickly during the confirmation hearing so the new justice is confirmed prior to the court"s next session, which begins in October. Obama told Reid that the goal was to hold the confirmation vote before the Senate leaves for its summer recess, for which the official adjournment date is Aug. 7 (Washington Post, 5/14). However, Republican members at the meeting "poured cold water on that idea," the Journal reports. According to McConnell, 60 days usually passes between the naming of a nominee and the first confirmation hearing in the Judiciary Committee. According to the Journal, Obama is aiming to avoid partisan controversy over the summer and "ease his choice onto the court." Obama "got a lift" from Sessions during the meeting when the senator indicated that a filibuster attempt is not in the works, the Journal reports (Weisman, Wall Street Journal, 5/14).Court Watchers Say Next Pick Likely To Be a WomanWhile there has been much speculation on who will be nominated, court watchers have said Souter"s successor likely will be a woman, as the "lack of women [on the court] is widely perceived as the gap that most needs to be addressed," the Journal reports. Advocates for a female nominee argue that the need for a woman on the court is not only a matter of perception. Hannah Brenner, executive director of the University of Texas Center for Women in Law, said that the U.S. and the court benefit from justices with differing experiences and viewpoints. She added that "there is no one who can argue there is not (an) overwhelming number of qualified women who could be nominated to the court" (Forsyth, Wall Street Journal, 5/14).NPR"s "All Things Considered" reports that a list of potential nominees circulating in the public includes the following names: Sonia Sotomayor, a federal appeals judge in New York; Diane Wood of Chicago"s federal appeals court; Elena Kagan, the new solicitor general and former Harvard Law School dean; Michigan Gov. Jennifer Granholm (D); and Department of Homeland Security Secretary Janet Napolitano. Merrick Garland of the Washington, D.C., federal appeals court is the only male included on the list. The "triumvirate mentioned most often" is Sotomayor, Wood and Kagan, "All Things Considered" reports (Totenberg, "All Things Considered," NPR, 5/13).However, some critics -- namely conservatives -- say that there is danger in using gender or race as the primary criteria for selecting a nominee, arguing that such an approach could cause justices to believe they need to reflect the views of a particular group instead of act as a neutral figure. Stephen Presser, a legal historian at Northwestern University, said, "You have to be very careful of having the court be a representative body and thinking about it in political terms, because that weakens the rule of law." Deborah Rhode, director of the Center on the Legal Profession at Stanford University, said that studies show a justice"s legal ideology to be a greater predictor of decisions than his or her gender. She said, "People who care about women"s issues realize that not just any woman will do" (Wall Street Journal, 5/14). Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women"s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women"s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company. © 2009 The Advisory Board Company. All rights reserved.


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