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Clinical Obstetrics and Gynecology

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https://www.readbyqxmd.com/read/29334494/state-based-review-of-maternal-deaths-the-ohio-experience
#1
Cynthia Shellhaas, Elizabeth Conrey
Ohio established a Pregnancy-Associated Mortality Review system in 2010 to ensure that all maternal deaths are identified and preventive actions developed. The need for detailed and reliable information to supplement vital statistics data has led to the development of state-based and urban-based maternal death reviews. Although processes vary from state to state, in general, an expert panel is convened to review individual cases and make recommendations for systems change. This article describes the development and operation of Ohio's state-based maternal death review including interventions developed and actions taken based on review data...
January 12, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29334493/understanding-severe-maternal-morbidity-hospital-based-review
#2
Sarah J Kilpatrick
Cases of severe maternal morbidity (SMM) share similarities to maternal deaths, including increasing in frequency and having similar rates of preventability. This article will review steps to organizing and implementing standard reviews of all cases of SMM. These steps include create multidisciplinary SMM review committee; identify potential SMM cases and confirm true SMM; identify the morbidity; abstract and summarize data; present case to review committee for discussion; determine events leading to morbidity; determine opportunities to improve outcome; assess provider, system and patient factors in cases with opportunities to improve outcome; make recommendations; and effect change and evaluate improvement...
January 12, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319592/primary-prenatal-care-screening-prevention-and-treatment-of-viral-infections
#3
Alexandra Spadola
Prenatal care providers are responsible for a basic understanding of the viral contagions that place women and fetal well-being at risk during pregnancy. This article reviews the evidence-based routine prenatal screening guidelines for previously unrecognized maternal infection, counseling toward risk reduction, recommended maternal immunizations, and the management of maternal and fetal complications of some viral exposures and infections.
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319591/zika-virus-infection-in-the-pregnant-woman
#4
Meghan Holtzman, William C Golden, Jeanne S Sheffield
Zika virus is a single-stranded RNA virus from the Flaviviridae family. Transmission is typically from the bite of an infected mosquito though mother-to-child, sexual and blood donation transmissions can occur. Although maternal symptoms are uncommon and rarely severe, the consequences of congenital infections are devastating. The emergence of congenital Zika syndrome is a world-wide public health crisis. The Centers for Disease Control and Prevention, ACOG, and SMFM have developed algorithms for screening and managing women exposure to and diagnosed with Zika virus infection...
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319590/ultrasound-findings-associated-with-antepartum-viral-infection
#5
Jude P Crino, Rita W Driggers
This article reviews the sonographic manifestations of fetal infection and the role of ultrasound in the evaluation of the fetus at risk for congenital infection. Several ultrasound findings have been associated with in utero fetal infections. For the patient with a known or suspected fetal infection, sonographic identification of characteristic abnormalities can provide useful information for counseling and perinatal management. Demonstration of such findings in the low-risk patient may serve to identify the fetus with a previously unsuspected infection...
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319589/preconception-care-for-the-general-ob-gyn
#6
Jessica C Arluck, Allison C Mayhew
Preconception counseling is an important aspect of the care of reproductive-aged women. Asking each woman with each interaction her wishes regarding pregnancy allows the health care provider to investigate her history. The areas to review include environmental toxins, nutrition, genetics, substance abuse, medical conditions, infectious diseases, and psychosocial issues. Then preconception counseling can be individualized. The goal is to decrease or eliminate risks that can cause detriments to the patient or her future pregnancies...
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319588/abnormal-uterine-bleeding-treatment-options
#7
Erica Oberman, Valentina Rodriguez-Triana
Abnormal uterine bleeding is one of the most common reasons for outpatient gynecologic visits. Proper evaluation and diagnosis is essential and allows the clinician to present individualized treatment options to their patients.
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319587/perinatal-viral-infections-considering-achievements-opportunities-and-paradoxes-in-management
#8
Helene B Bernstein
No abstract text is available yet for this article.
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29319586/the-role-of-the-anesthesiologist-in-preventing-severe-maternal-morbidity-and-mortality
#9
Emily McQuaid, Lisa R Leffert, Brian T Bateman
Anesthesiologists are responsible for the safe and effective provision of analgesia for labor and anesthesia for cesarean delivery and other obstetric procedures. In addition, obstetric anesthesiologists often have a unique role as the intensivists of the obstetric suite. The anesthesiologist is frequently the clinician with the greatest experience in the acute bedside management of a hemodynamically unstable patient and expertise in life-saving interventions. This review will discuss (1) risks associated with neuraxial and general anesthesia for labor and delivery, and (2) clinical scenarios in which the obstetric anesthesiologist is commonly called upon to function as a "peridelivery intensivist...
January 9, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29309285/addressing-obesity-in-clinical-gynecology-practice
#10
Scott Kahan, Ginger Winston
Obesity disproportionately affects women, and many patients presenting at obstetric and gynecologic clinics will have, or be at risk for, obesity and its associated comorbid conditions. Given the high frequency of interaction between women and their gynecologists, this setting may be an ideal opportunity to support patients who would benefit from obesity treatment. This article describes evidence-based obesity treatment strategies, including behavioral counseling, pharmacotherapy, and bariatric surgery.
January 5, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29309284/topics-of-interest-to-specialists-in-general-obstetrics-and-gynecology
#11
Lisa M Keder
No abstract text is available yet for this article.
January 5, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29309283/hiv-infection-antepartum-treatment-and-management
#12
Helene B Bernstein, Adam D Wegman
Human immunodeficiency virus (HIV) is a retrovirus which became pandemic in the early 1980s. Since its initial characterization, advancements in diagnosis and management have transformed HIV infection from a terminal diagnosis to a chronic, manageable condition. Effective antiretroviral therapy, acting at multiple steps in the viral lifecycle, durably suppresses viral replication, preserves maternal health and prevents mother to child HIV transmission. Here, we review the salient clinical and ethical considerations of managing HIV infection during pregnancy and delivery...
January 5, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29300198/addressing-implicit-bias-to-improve-cross-cultural-care
#13
Brenda Pereda, Margaret Montoya
Health disparities cluster around race, ethnicity, education, neighborhoods, and income. Systems of exclusion that correlate with social determinants compound the disproportionate burden of poor health experienced by people of color. By 2056, ~50% of the population is expected to fall into categories currently labeled "under-represented minorities" (URMs), primarily African Americans, Latinxs, and American Indians. Although URMs comprise 30% of the general population, only 9% of medical doctors [Association of American Medical Colleges (AAMC)] are URMs...
January 3, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29298169/premenstrual-syndrome-evidence-based-evaluation-and-treatment
#14
Sarah M Appleton
Premenstrual dysphoric disorder (PMDD) is defined by both physical and psychiatric symptoms that impact a woman significantly during the luteal phase of her menstrual cycle. Diagnostic criteria for PMDD were firmly established in the Diagnostic and Statistical Manual of Mental Disorders V in 2013, but many patients fall short of the diagnosis while still appreciably affected by severe premenstrual symptoms. More recent and robust investigations have evaluated the efficacy of treatment ranging from serotonergic therapy to hormonal treatment as well as lifestyle and herbal remedies...
January 2, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29283903/patient-centered-contraceptive-counseling-and-prescribing
#15
Katherine Rivlin, Michelle M Isley
Learning how to best meet a patient's contraceptive needs improves her chances of using her birth control consistently and is crucial to providing patient-centered care. The best contraceptive method for an individual patient is the one that is safe and that she is most comfortable using. Women's health care providers must be equipped to talk to each patient about her needs and options. The shared decision-making model in contraceptive counseling allows the patient and provider to work together in order to meet a patient's needs while remaining medically safe...
December 27, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29283902/herpesviridae-infection-prevention-screening-and-management
#16
Akila Subramaniam, William J Britt
Bacterial, viral, and parasitic pathogens add significant morbidity and even mortality to pregnancy-with adverse effects extending to both the gravida and the newborn. Three herpesviruses deserve considerable attention given the effects of perinatal infection on obstetric outcomes, specifically maternal and neonatal morbidity. In the following review, we will provide a description of cytomegalovirus, herpes simplex virus, and varicella zoster virus. For each viral pathogen, we will describe the epidemiology, natural history, screening and diagnosis modalities, treatments, and implications for antepartum care...
December 27, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29252924/cervical-cancer-screening
#17
Richard Guido
Cervical cancer screening has significantly reduced the incidence of cervical cancer in the United States. National recommendations have evolved to keep pace with advancement in our understanding of human papilloma virus (HPV) biology as well as improvements in HPV testing. This chapter summarizes present national screening guidelines, reviews information regarding recent development in HPV biology and testing, discusses some of the controversies related to screening and provides clinicians with talking points for their patients...
December 15, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29252923/management-of-hepatitis-b-infection-in-pregnancy
#18
Marguerite L Bartholomew, Men-Jean Lee
In many parts of the world, perinatal transmission is the most common route of infection for hepatitis B virus. In the United States, sexual contact is the most common source of hepatitis B virus infection. As a result, it is essential that women's health care providers become aware of the recommended strategies used to identify women infected with hepatitis B and to subsequently reduce perinatal transmission, particularly now that immigration and globalization is more common and reproductive science makes pregnancy more possible for women with liver disease...
December 15, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29045299/the-future-of-cesarean-delivery-rates-in-the-united-states
#19
Mark A Clapp, William H Barth
The US cesarean delivery rate remains 30%-32%. Increases in maternal age, obesity, and diabetes put upward pressure on this rate. Alternatives to cesarean delivery, vaginal birth after cesarean (VBAC), and operative vaginal delivery, are underutilized and there are substantial challenges to their resurgence. Practice guidelines offer promise, but demonstrate only minor reductions in cesarean delivery. We estimate that the overall rate in the US will remain 27%-30% for the immediate future. As more states move to recognize the independent practice of midwifery and more payers seek lower cost options for childbirth, we anticipate the overall rate will drop to 20% or 25%, but not for another 15 years or more...
December 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29045298/foreword
#20
Thomas Gellhaus
No abstract text is available yet for this article.
December 2017: Clinical Obstetrics and Gynecology
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