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Obstetrics and Gynecology Clinics of North America

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https://www.readbyqxmd.com/read/27816165/contemporary-obstetric-intensive-care
#1
EDITORIAL
Carolyn M Zelop, Stephanie R Martin
No abstract text is available yet for this article.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816164/an-end-to-happiness%C3%A2-attention-to-the-critically-ill-parturient
#2
EDITORIAL
William F Rayburn
No abstract text is available yet for this article.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816163/obstetric-transport
#3
REVIEW
Julie Scott
Obstetric transport is a specialized medical transport for maternal, fetal, and neonatal concerns. Perinatal regionalization of care provides a broader geographic availability of obstetric services with defined levels of maternal and neonatal care so that women can be transported to centers with increased resources and capabilities to reduce morbidity and mortality. The Emergency Medical Treatment and Active Labor Act provides regulatory guidance for care of laboring women who require transfer to a higher level of care...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816162/cardiac-arrest-and-resuscitation-unique-to-pregnancy
#4
REVIEW
Terri-Ann Bennett, Vern L Katz, Carolyn M Zelop
Maternal cardiopulmonary arrest (MCPA) is a catastrophic event that can cause significant morbidity and mortality. A prepared, multidisciplinary team is necessary to perform basic and advanced cardiac life support specific to the anatomic and physiologic changes of pregnancy. MCPA is a challenging clinical scenario for any provider. Overall, it is an infrequent occurrence that involves 2 patients. However, key clinical intervention performed concurrently can save the life of both mother and baby.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816161/trauma-and-considerations-unique-to-pregnancy
#5
REVIEW
Christy Pearce, Stephanie R Martin
Trauma complicates 6% to 7% of all pregnancies and requires multidisciplinary education and training for both trauma and obstetric teams to achieve the best outcome. It is important to understand the mechanisms of certain adverse maternal and fetal/neonatal outcomes incurred as a result of trauma, as well as caveats to pregnancy physiology that make some injuries more likely and detection of maternal compromise more difficult. This article focuses on these caveats and how to incorporate these into ongoing trauma protocols and offers suggestions for the formation of obstetric trauma response team...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816160/amniotic-fluid-embolism
#6
REVIEW
Amir A Shamshirsaz, Steven L Clark
Amniotic fluid embolism remains one of the most devastating conditions in obstetric practice with an incidence of approximately 1 in 40,000 deliveries and a reported mortality rate ranging from 20% to 60%. The pathophysiology involves an abnormal maternal response to fetal tissue exposure associated with breaches of the maternal-fetal physiologic barrier during parturition. This response and its subsequent injury involve activation of proinflammatory mediators similar to that seen with the classic systemic inflammatory response syndrome...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816159/obesity-and-the-critical-care-pregnant-patient
#7
REVIEW
Garrett K Lam
The rise of obesity among gravid women has been tracked and documented in many first-world countries, but a dramatic rise has been noted over the last 15 years. Definitions of "normal-weight, overweight and obese" have been defined; however, new terms are used to describe more severe degrees of obesity. Obesity in any form or degree increases morbidities in mothers. The unique physiologic characteristics of the obese gravida set up unique challenges in her management, especially in an acute setting such as labor...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816158/management-of-acute-kidney-injury-in-pregnancy-for-the-obstetrician
#8
REVIEW
Anjali Acharya
Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of AKI during pregnancy range from a minimal elevation in serum creatinine to renal failure requiring renal replacement therapy, similar to AKI in the general population. Recent epidemiologic studies in the general population show an increase in mortality associated with AKI, particularly when dialysis is required...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816157/evaluation-and-management-of-maternal-cardiac-arrhythmias
#9
REVIEW
Torri D Metz, Amber Khanna
Pregnant women often complain of palpitations. The differential diagnosis for new-onset palpitations in pregnancy ranges from benign conditions to life-threatening arrhythmias. Maternal arrhythmias can occur in isolation or in the setting of underlying structural heart disease. Optimal management of maternal cardiac arrhythmias includes identification of the specific arrhythmia, diagnosis of comorbid conditions, and appropriate intervention. In general, management of maternal cardiac arrhythmias is similar to that of the general population...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816156/cardiac-lesions-in-the-critical-care-setting
#10
REVIEW
Manisha Gandhi, Amir A Shamshirsaz
The long-held belief that pregnancy is absolutely contraindicated in maternal cardiovascular disease is no longer justifiable using evidence-base medicine. There are some conditions in which pregnancy is contraindicated, and high maternal risk and poor fetal outcome can be predicted. However, in many women with heart disease, a more favorable maternal and fetal outcome is expected. This article focusses on the cardiac conditions that require more attention and have the potential to require observation in the intensive care unit setting...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816155/respiratory-considerations-including-airway-and-ventilation-issues-in-critical-care-obstetric-patients
#11
REVIEW
Holly Ende, Dirk Varelmann
Critical care management of the obstetric patient can present unique challenges. Parturients who present with respiratory distress can suffer from a multitude of etiologies, and each diagnosis must be pursued as appropriate to the clinical picture. Normal physiologic changes of pregnancy may obscure the presentation and diagnosis, and irrelevant of the cause, pregnancy may complicate the management of hypoxic and hypercarbic respiratory failure in this patient population. In addition to these concerns, both anticipated and unanticipated difficult airway management, including difficulty ventilating and intubating, are more common during pregnancy and may be encountered during endotracheal tube placement...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816154/immune-regulation-in-pregnancy-a-matter-of-perspective
#12
REVIEW
Elizabeth A Bonney
The maternal immune system is complex and governed by multiple hormonal and metabolic factors, including those provided to the mother via the fetus. Understanding of the balance between maternal tolerance and protection of the fetus may require thinking from multiple theoretical approaches to the general problem of immune activation and tolerance. This article provides a brief review of the immune system, with aspects relevant to pregnancy. The references include reviews that expand on the elements discussed...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816153/management-of-sepsis-and-septic-shock-for-the-obstetrician-gynecologist
#13
REVIEW
Lauren A Plante
The incidence of sepsis is increasing in the United States, both in the general adult population and among pregnant and postpartum women. Neither infection nor bacteremia are synonymous with sepsis: it is a dysregulated host response to a pathogen in which organ dysfunction is key. New clinical criteria have been released. Cornerstones of management are early suspicion and recognition, effective fluid resuscitation, and appropriate antimicrobial therapy.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816152/management-of-infection-for-the-obstetrician-gynecologist
#14
REVIEW
Catherine Eppes
Pregnant women have an increased morbidity and mortality for certain illnesses owing to the physiologic and immunologic changes in pregnancy. Certain infections are common during pregnancy, including urinary tract infections and pneumonia. Others are uncommon, but yield increased severity, including influenza. Human immunodeficiency virus, although it does not increase in pathogenesis during pregnancy, requires specific attention and management in the context of pregnancy.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816151/management-of-hypertensive-crisis-for-the-obstetrician-gynecologist
#15
REVIEW
Jamil ElFarra, Cynthia Bean, James N Martin
Hypertensive disorders of pregnancy are among the leading preventable contributors of maternal and fetal adverse outcomes, including maternal and fetal death. Blood pressure increase has a strong association with unfavorable pregnancy outcomes, including stroke and pulmonary edema. A persistent blood pressure measurement greater than or equal to 160/110 mm Hg lasting for more than 15 minutes, during pregnancy or postpartum, is considered an obstetric emergency and requires rapid appropriate treatment. Following evidence-based guidelines, implementing institutional polices, and understanding the classification and pathophysiology of hypertensive disorders of pregnancy are essential and can significantly improve the rate of preventable complications...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27816150/critical-care-for-the-obstetrician-and-gynecologist-obstetric-hemorrhage-and-disseminated-intravascular-coagulopathy
#16
REVIEW
Arthur Jason Vaught
Obstetric hemorrhage accounts for 5% all deliveries in the United States and accounts for high maternal morbidity and mortality. Many hemorrhages are secondary to uterine atony and are quickly ameliorated with appropriate uterotonic use. However, for a subset of cases, severe hemorrhage may require advanced resuscitative techniques, and innovative procedural and surgical techniques. This article guides a provider through such a resuscitation.
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27521888/hysterectomy-and-the-alternatives
#17
EDITORIAL
John A Occhino, Emanuel C Trabuco
No abstract text is available yet for this article.
September 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27521887/fewer-hysterectomies-and-so-many-alternatives
#18
EDITORIAL
William F Rayburn
No abstract text is available yet for this article.
September 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27521886/current-issues-with-hysterectomy
#19
REVIEW
Matthew A Barker
Hysterectomy is one of the most common gynecologic surgeries. Early adoption of surgical advancements in hysterectomies has raised concerns over safety, quality, and costs. The risk of potential leiomyosarcoma in women undergoing minimally invasive hysterectomy led the US Food and Drug Administration to discourage the use of electronic power morcellator. Minimally invasive hysterectomies have increased substantially despite lack of data supporting its use over other forms of hysterectomy and increased costs...
September 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27521885/surgical-simulation-and-competency
#20
REVIEW
Shunaha Kim-Fine, Erin A Brennand
Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy...
September 2016: Obstetrics and Gynecology Clinics of North America
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