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Obstetrics and Gynecology Clinics of North America

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https://www.readbyqxmd.com/read/29078950/evidence-based-management-of-labor-and-delivery-what-do-we-still-need-to-know
#1
EDITORIAL
Aaron B Caughey
No abstract text is available yet for this article.
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078949/addressing-common-management-dilemmas-in-labor-and-delivery
#2
EDITORIAL
William F Rayburn
No abstract text is available yet for this article.
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078948/quality-improvement-and-patient-safety-on-labor-and-delivery
#3
REVIEW
Bethany Sabol, Aaron B Caughey
There has been an emphasis on redesigning our health care system to eliminate medical errors and create a culture of safety. The American College of Obstetrics and Gynecologists defines a culture of safety as an environment in which all care providers are empowered to identify errors, near misses, risky behaviors and broader systems issues while engaging in active collaboration to improve and resolve processes and system failures. This article reviews key components that promote a culture of safety and help to implement safer, more effective, evidence-based quality care on labor and delivery units...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078947/vaginal-birth-after-cesarean-trends-which-way-is-the-pendulum-swinging
#4
REVIEW
James Sargent, Aaron B Caughey
The cesarean delivery rate has plateaued at 32%; concurrently, after peaking in the mid-1990s, trial of labor after cesarean (TOLAC) rates have declined. Less than 25% of women with a prior cesarean delivery attempt a future TOLAC. This decreasing trend in TOLAC is caused by inadequate resource availability, malpractice concerns, and lack of knowledge in patients and providers regarding the perceived risks and benefits. This article outlines the factors influencing recent vaginal birth after cesarean trends in addition to reviewing the maternal and neonatal outcomes associated with TOLAC, specifically in high-risk populations...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078946/labor-and-delivery-of-twin-pregnancies
#5
REVIEW
Stephanie Melka, James Miller, Nathan S Fox
Obstetricians who care for twin pregnancies should be aware of the challenges that may arise during the labor and delivery. With recognition of these issues and proper training, providers should be able to help women with twin pregnancies achieve a safe delivery for them and their babies. With the use of breech extraction of the second twin and active management of the second stage of labor, women with twin pregnancies can also achieve a high vaginal delivery rate of both twins.
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078945/fetal-malpresentation-and-malposition-diagnosis-and-management
#6
REVIEW
Rachel A Pilliod, Aaron B Caughey
Fetal malpresentation and fetal malposition are frequently interchanged; however, fetal malpresentation refers to a fetus with a fetal part other than the head engaging the maternal pelvis. Fetal malposition in labor includes occiput posterior and occiput transverse positions. Both fetal malposition and malpresentation are associated with significant maternal and neonatal morbidity, which have significant impact on patients and providers. Accurate diagnosis of both conditions is necessary for appropriate management...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078944/the-evolution-of-the-laborist
#7
REVIEW
Allison J Allen, Aaron B Caughey
The laborist movement was introduced as a means to improve the quality of care patients receive in the labor suite and decrease physician burnout and malpractice claims. This model of care has rapidly expanded, and there is evidence of its potential role in improving labor outcomes. This article outlines the different models of laborist care, reviews the evidence for its potential impact on labor outcomes, and discusses the economic impact the employment of laborists can have.
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078943/update-on-fetal-monitoring-overview-of-approaches-and-management-of-category-ii-tracings
#8
REVIEW
Nandini Raghuraman, Alison G Cahill
Electronic fetal monitoring (EFM) is widely used to assess fetal status in labor. Use of intrapartum continuous EFM is associated with a lower risk of neonatal seizures but a higher risk of cesarean or operative delivery. Category II fetal heart tracings (FHTs) are indeterminate in their ability to predict fetal acidemia. Certain patterns of decelerations and variability within this category may be predictive of neonatal morbidity. Adjunct tests of fetal well-being can be used during labor to further triage patients...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078942/elective-induction-of-labor-what-is-the-impact
#9
REVIEW
Sarah E Little
Elective induction of labor (ie, without a maternal or fetal indication) is common in the United States. When using the correct comparison group (elective induction vs expectant management) induction is not associated with an increased risk of cesarean delivery. Moreover, elective induction after 39 weeks seems to have maternal benefits (eg, lower infection rates) as well as a reduction in neonatal morbidity and the potential for a decrease in term stillbirth. However, these risks, especially stillbirth, are low in a healthy cohort and there are potential negative impacts on maternal satisfaction, breastfeeding, and cost/resource use that must be considered...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078941/augmentation-of-labor-a-review-of-oxytocin-augmentation-and-active-management-of-labor
#10
REVIEW
Annessa Kernberg, Aaron B Caughey
Labor augmentation can be used to hasten labor, shorten the time to delivery, and perhaps reduce the risk of cesarean delivery. Particularly in women with longer labors or less frequent contractions, oxytocin augmentation seems to have positive impacts on these outcomes. Despite this, the evidence for augmentation alone on the risk of cesarean delivery is unclear, with varying evidence. More recently, oxytocin protocols have been recommended to standardize care and ensure patient safety.
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078940/is-there-a-place-for-outpatient-preinduction-cervical-ripening
#11
REVIEW
Beth Leopold, Anthony Sciscione
Induction of labor continues to be one of the most commonly performed tasks in obstetrics. If trials like the National Institute of Child Health and Human Development's ARRIVE trial show that delivery for all women at 39 weeks provides a significant advantage in pregnancy outcomes, the number of women who require induction of labor will considerably increase. Strategies to improve patient/family satisfaction, decrease resource allocation and costs, and assure safety are paramount. Although there are many potential candidates, it seems that outpatient preinduction cervical ripening with the Foley catheter meets these criteria in a properly selected group of low-risk women...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078939/labor-induction-techniques-which-is-the-best
#12
REVIEW
Christina A Penfield, Deborah A Wing
Induction of labor is a common procedure undertaken whenever the benefits of prompt delivery outweigh the risks of expectant management. Cervical assessment is essential to determine the optimal approach. Indication for induction, clinical presentation and history, safety, cost, and patient preference may factor into the selection of methods. For the unfavorable cervix, several pharmacologic and mechanical methods are available, each with associated advantages and disadvantages. In women with a favorable cervix, combined use of amniotomy and intravenous oxytocin is generally the most effective approach...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078938/defining-and-managing-normal-and-abnormal-second-stage-of-labor
#13
REVIEW
Yvonne W Cheng, Aaron B Caughey
The American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 49 on Dystocia and Augmentation of Labor defines a prolonged second stage as more than 2 hours without or 3 hours with epidural analgesia in nulliparous women, and 1 hour without, or 2 hours with epidural in multiparous women. This definition diagnoses 10% to 14% of nulliparous and 3% to 3.5% of multiparous women as having a prolonged second stage. Although current labor norms remained largely based on data established by Friedman in the 1950s, modern obstetric population and practice have evolved with time...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078937/defining-and-managing-normal-and-abnormal-first-stage-of-labor
#14
REVIEW
Janine S Rhoades, Alison G Cahill
Modern data have redefined the normal first stage of labor. Key differences include that the latent phase of labor is much slower than was previously thought and the transition from latent to active labor does not occur until about 6 cm of cervical dilatation, regardless of parity or whether labor was spontaneous or induced. Providers should have a low threshold to use one of the safe and effective interventions to manage abnormal progression in the first stage of labor, including oxytocin, internal tocodynamometry, and amniotomy...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29078936/evidence-based-labor-and-delivery-management-can-we-safely-reduce-the-cesarean-rate
#15
REVIEW
Aaron B Caughey
This article provides an overview of the approaches that might be used to safely reduce the cesarean rate. Although cesarean delivery may be a safe alternative to vaginal delivery, its use in 1 in 3 women giving birth is likely too high. The downstream impact of cesarean delivery on future pregnancies is likely not well-considered when the first cesarean is being performed. Through quality improvement, environmental changes will allow clinicians to adopt the range of practices described. However, without such environmental changes, clinicians may not be able to change their own practice patterns given environments in which they practice...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/28778648/evaluation-and-management-of-vulvar-disease
#16
EDITORIAL
Aruna Venkatesan
No abstract text is available yet for this article.
September 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/28778647/differentiating-between-normal-benign-and-potentially-serious-vulvar-conditions
#17
EDITORIAL
William F Rayburn
No abstract text is available yet for this article.
September 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/28778646/pelvic-floor-physical-therapy-for-vulvodynia-a-clinician-s-guide
#18
REVIEW
Stephanie A Prendergast
Vulvar pain affects up to 20% of women at some point in their lives, and most women with vulvar pain have associated pelvic floor impairments. Pelvic floor dysfunction is associated with significant functional limitations in women by causing painful intercourse and urinary, bowel, and sexual dysfunction. A quick screening of the pelvic floor muscles can be performed in the gynecology office and should be used when patients report symptoms of pelvic pain. It is now known the vulvar pain syndromes are heterogeneous in origin; therefore, successful treatment plans are multimodal and include physical therapy...
September 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/28778645/vulvodynia-diagnosis-and-management
#19
REVIEW
Amy L Stenson
Vulvodynia is a common condition that negatively affects sexual health and quality of life for many women. A new classification system has been adopted that divides vulvodynia into subtypes based on pain characteristics. Diagnosis relies on ruling out possible contributing pathologic conditions. A multidisciplinary approach to treatment is likely to achieve the best outcome for all types. Medical therapy with systemic neuromodulators is suggested for generalized vulvodynia. For patients with vestibulodynia, topical therapy may be beneficial...
September 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/28778644/vulvovaginal-graft-versus-host-disease
#20
REVIEW
Rachel I Kornik, Alison S Rustagi
Vulvovaginal chronic graft-versus-host disease (cGVHD) is an underrecognized complication of stem cell transplantation. Early recognition may prevent severe sequelae. Genital involvement is associated with oral, ocular, and skin manifestations. Treatment includes topical immunosuppression, dilator use, and adjuvant topical estrogen. Clinical and histologic features may mimic other inflammatory vulvar conditions. In the right clinical context, these findings are diagnostic of chronic GVHD. Female recipients of allo-hematopoietic stem cell transplantation (HCT) are at higher risk of condylomas, cervical dysplasia, and neoplasia...
September 2017: Obstetrics and Gynecology Clinics of North America
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