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Obstetrics and Gynecology

Helena C Bartels, Ailin C Rogers, Donal O'Brien, Ruaidhri McVey, Jennifer Walsh, Donal J Brennan
OBJECTIVE: To compare maternal outcomes in patients with morbidly adherent placenta managed in a multidisciplinary team setting compared with standard care. DATA SOURCES: A literature search was performed for publications reporting multidisciplinary pathways in the management of cesarean delivery for patients with morbidly adherent placenta. EMBASE, MEDLINE, PubMed, PubMed Central,, and Cochrane databases were searched. METHODS OF STUDY SELECTION: Databases were searched for studies reporting maternal morbidity of patients with morbidly adherent placenta managed by a multidisciplinary team in a specialist center compared with standard care...
September 18, 2018: Obstetrics and Gynecology
Torri D Metz, Laura M Borgelt
The prevalence and perceived safety of marijuana use in pregnancy are increasing with expanding legalization. Marijuana crosses the placenta and passes into breast milk, resulting in fetal and neonatal exposure. Many women cite medical reasons for prenatal marijuana use such as nausea and vomiting of pregnancy, anxiety, and chronic pain. The scientific literature regarding marijuana in pregnancy is mixed, resulting in confusion among practitioners as to how to counsel women about risks of use. In addition, there is a paucity of literature related to marijuana use and breastfeeding...
September 18, 2018: Obstetrics and Gynecology
Verda J Hicks
No abstract text is available yet for this article.
September 11, 2018: Obstetrics and Gynecology
Gloriana Arroyo Sánchez, Ophelia J Langhorne, Ahizechukwu C Eke, Nancy C Chescheir
No abstract text is available yet for this article.
September 11, 2018: Obstetrics and Gynecology
Thomas W Riggs, Dwight J Rouse
No abstract text is available yet for this article.
September 11, 2018: Obstetrics and Gynecology
Dale W Stovall
This month we focus on current research in endometriosis. Dr. Stovall discusses four recent publications, which are concluded with a "bottom-line" that is the take-home message. A complete reference for each can be found in Box 1 on this page along with direct links to the abstracts.
September 11, 2018: Obstetrics and Gynecology
Dong Bach Nguyen, Jeffrey How, Cleve Ziegler, Jaclyn Madar
INTRODUCTION: Although uterine artery embolization has been established as a less invasive alternative to hysterectomy or myomectomy for the treatment of uterine leiomyomas, it is not devoid of life-threatening complications. CASE: We present the case of a 44-year-old patient who developed a severe systemic inflammatory response and acute respiratory distress syndrome 5 weeks after uterine artery embolization of a large multileiomyomatous uterus. Deterioration of her clinical status prompted an emergency hysterectomy that led to rapid improvement...
September 7, 2018: Obstetrics and Gynecology
Susan B Brogly, Kelley E Saia, Martha M Werler, Emily Regan, Sonia Hernández-Díaz
OBJECTIVE: To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder. METHODS: Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts...
September 7, 2018: Obstetrics and Gynecology
Cresta W Jones, Mishka Terplan
A 25-year-old woman, gravida 3 para 2 at 12 weeks of gestation, with two prior cesarean deliveries, presents for prenatal care. She is in treatment for opioid use disorder on extended-release naltrexone injection, with a history of opioid overdose, relapse, and poor treatment adherence on methadone and buprenorphine. She asks, "Is it safe for my baby if I continue on this medication? How will you manage my postoperative pain?"
September 7, 2018: Obstetrics and Gynecology
Annie M Dude, Sarrah Shahawy, William A Grobman
OBJECTIVE: To estimate whether weight gain between deliveries is associated with an increased risk of hypertensive disorders in a subsequent pregnancy. METHODS: This is a case-control study of women who had two live singleton births of at least 24 weeks of gestation at a single maternity hospital from January 1, 2005, to December 31, 2015, with no hypertensive disorder documented in the index pregnancy. Maternal weight gain between deliveries was measured as the change in body mass index (BMI) at delivery...
September 7, 2018: Obstetrics and Gynecology
Michelle A Kominiarek, George Saade, Lisa Mele, Jennifer Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, John M Thorp, Steve N Caritis, Mona Prasad, Alan T N Tita, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa
OBJECTIVE: To evaluate the association between gestational weight gain and maternal and neonatal outcomes in a large, geographically diverse cohort. METHODS: Trained chart abstractors at 25 hospitals obtained maternal and neonatal data for all deliveries on randomly selected days over 3 years (2008-2011). Gestational weight gain was derived using weight at delivery minus prepregnancy or first-trimester weight and categorized as below, within, or above the Institute of Medicine (IOM) guidelines in this retrospective cohort study...
September 7, 2018: Obstetrics and Gynecology
Camran Nezhat, Megan Kennedy Burns, Michelle Wood, Ceana Nezhat, Azadeh Nezhat, Farr Nezhat
Vaginal cuff dehiscence is an infrequent complication of hysterectomy, with the potential for evisceration and additional morbidity. This review aims to describe the incidence, risk factors, preventative measures, and management. Identification of specific risk factors is problematic because many studies either lack comparison groups or are underpowered as a result of the rarity of this complication. Good surgical technique to optimize vaginal cuff healing and minimize the risk of postoperative cuff infection are important as is avoidance of early intercourse, traumatic vaginal penetration, or excess strain on the vaginal cuff during the postoperative period...
September 7, 2018: Obstetrics and Gynecology
Eli Y Adashi, Roee Gutman
OBJECTIVE: To establish the annual and cumulative multiyear contribution of delayed childbearing to the national plural birth excess. METHODS: Using publicly available national birth data reported by the National Center for Health Statistics, we estimated the contribution of delayed childbearing to the national plural birth excess through 2016. To this end, the observed as well as the maternal age- and race-adjusted national plural birth rates were assessed before (1949-1966; n=71,570,717) and during (1971-2016; n=166,817,655) the assisted reproduction era...
September 7, 2018: Obstetrics and Gynecology
Elizabeth F Sutton, Alisse Hauspurg, Steve N Caritis, Robert W Powers, Janet M Catov
OBJECTIVE: To evaluate maternal and neonatal outcomes in healthy, nulliparous women classified with stage 1 hypertension under the revised American College of Cardiology and American Heart Association Guidelines and to evaluate the effects of low-dose aspirin on maternal and neonatal outcomes in this population. METHODS: We conducted a secondary analysis of data from a multicenter randomized, double-blind, placebo-controlled trial of low-dose aspirin for prevention of preeclampsia in nulliparous, low-risk women recruited between 13 and 25 weeks of gestation...
September 7, 2018: Obstetrics and Gynecology
Tetsuya Kawakita, Chun-Chih Huang, Helain J Landy
OBJECTIVE: To examine the rate of surgical site infection according to the choice of antibiotics in women undergoing cesarean delivery. METHODS: We conducted a retrospective cohort study of women undergoing cesarean delivery (labored, unlabored, and scheduled) from 2012 to 2017. Women with chorioamnionitis and those who did not receive any antibiotics were excluded. Our primary outcome was defined a priori as a composite of cellulitis, endometritis, deep wound infection, abdominopelvic abscess, and sepsis...
September 7, 2018: Obstetrics and Gynecology
Torri D Metz
The crisis of a rising maternal mortality ratio in the United States continues to receive attention in both the scientific literature and the lay press. To continue to make progress in preventing these deaths, we must celebrate our successes and clearly delineate the next steps. The Centers for Disease Control and Prevention program, Building U.S. Capacity to Review and Prevent Maternal Deaths, recently published a report from nine maternal mortality review committees, which accomplishes just that. The report is a collaborative effort from maternal mortality review committees demonstrating the capacity to do three important tasks: 1) collect data in a standardized fashion across maternal mortality review committees throughout the United States, 2) assess preventability of maternal deaths by consensus from experts on multidisciplinary state committees, and 3) create recommendations based on maternal death review with far-reaching effect...
September 7, 2018: Obstetrics and Gynecology
Candace M Tingen, Donna Mazloomdoost, Lisa M Halvorson
In May 2016, the newly formed Gynecologic Health and Disease Branch in the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited experts to a 2-day meeting aimed at identification of emerging opportunities in gynecologic investigation. Four primary disorders were chosen for emphasis because they represent the majority of the current Gynecologic Health and Disease Branch portfolio: uterine leiomyomas, endometriosis, pelvic floor disorders, and gynecologic pain conditions. Discussions generated a set of seven cross-cutting themes, which encompass both gaps in our current knowledge and potential directions for further research...
September 7, 2018: Obstetrics and Gynecology
Cassandra R Duffy, Jason D Wright, Ruth Landau, Mirella J Mourad, Zainab Siddiq, Adina R Kern-Goldberger, Mary E D'Alton, Alexander M Friedman
OBJECTIVE: To assess trends in use of long-acting opioids during delivery hospitalizations. METHODS: The Perspective database, an administrative inpatient database that includes medication receipt, was analyzed to evaluate patterns of long-acting opioid use during delivery hospitalizations from January 2006 through March 2015. Medications evaluated included methadone, formulations including buprenorphine and extended-release formulations of oxycodone, morphine, fentanyl, and other opioids...
September 7, 2018: Obstetrics and Gynecology
Nancy C Chescheir, Rebecca S Benner
Obstetrician-gynecologists (ob-gyns) face similar types of biases in the workplace as any people in society. In this first of three articles exploring this issue, we present the stories from ob-gyns who describe their experiences dealing with these biases. These stories serve to personalize the issue and to encourage us to personally face bias in the workplace to build our own resilience and strength, to support those who are personally attacked or diminished, and to develop workplace cultures that are inclusive, diverse, and strong...
September 7, 2018: Obstetrics and Gynecology
Kacey Y Eichelberger, Nancy C Chescheir, Laura E Riley
Institutional harassment and discrimination are prevalent in the field of medicine and are detrimental to the well-being of individuals, teams, and the work environment. The familiar framework of an obstetric safety bundle is used here to propose 11 practical steps a health care team or institution may take to prepare for and respond to workplace harassment and discrimination in a systematic fashion.
September 7, 2018: Obstetrics and Gynecology
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