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https://www.readbyqxmd.com/read/29733840/clinical-opinion-doing-something-about-the-cesarean-delivery-rate
#1
S L Clark, T J Garite, E J Hamilton, M A Belfort, G D Hankins
There is a general consensus that the cesarean delivery rate in the U.S. is too high, and that practice patterns of obstetricians are largely to blame for this situation. In reality, the U.S. cesarean delivery rate is the result of 3 forces largely beyond the control of the practicing clinician: patient expectations and misconceptions regarding the safety of labor, the medical-legal system, and limitations in technology. Efforts to "do something" about the cesarean delivery rate by promulgating practice directives which are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful...
May 4, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29703800/comparing-standard-office-based-follow-up-with-text-based-remote-monitoring-in-the-management-of-postpartum-hypertension-a-randomised-clinical-trial
#2
Adi Hirshberg, Katheryne Downes, Sindhu Srinivas
BACKGROUND: Monitoring blood pressure at 72 hours and 7-10 days post partum in women with hypertensive disorders is recommended to decrease morbidity. However, there are no recommendations as to how to achieve this. OBJECTIVE: To compare the effectiveness of text-based blood pressure monitoring to in-person visits for women with hypertensive disorders of pregnancy in the immediate postpartum period. METHODS: Randomised clinical trial among 206 postpartum women with pregnancy-related hypertension diagnosed during the delivery admission between August 2016 and January 2017...
April 27, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29688040/commentary
#3
Victoria Mango, Yolanda Bryce, Elizabeth Anne Morris, Elisabetta Gianotti, Katja Pinker
Screening mammography reduces breast cancer mortality in average-risk women. However, adverse consequences include false-positive findings possibly leading to benign breast biopsies and patient anxiety. There is also potential for overdiagnosis and overtreatment. Differences in how to balance benefits and harms have led to varying recommendations by the U.S. Preventive Services Task Force, the American Cancer Society, the National Comprehensive Cancer Network and the American College of Radiology/Society of Breast Imaging...
April 24, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29684382/maternal-plasma-concentrations-of-macrophage-migration-inhibitory-factor-at-first-trimester-as-a-predictive-biomarker-of-preterm-delivery-in-chinese-women
#4
Hui Zhu, Mei-Jun Yang
BACKGROUND: Infection and/or inflammation have been proposed play role in the preterm delivery (PTD) pathogenesis. Macrophage migration inhibitory factor(MIF), a mediator of innate immunity and inflammation, is induced in various infections, including those that occur during pregnancy. We assessed the relation between maternal early pregnancy plasma concentrations of MIF and PTD. METHODS: Women were recruited before 14 weeks gestation and were followed up until delivery...
April 20, 2018: Clinica Chimica Acta; International Journal of Clinical Chemistry
https://www.readbyqxmd.com/read/29683910/acog-committee-opinion-no-735-adolescents-and-long-acting-reversible-contraception-implants-and-intrauterine-devices
#5
(no author information available yet)
The phenomenon of adolescent childbearing is complex and far reaching, affecting not only the adolescents but also their children and their community. The prevalence and public health effect of adolescent pregnancy reflect complex structural social problems and an unmet need for acceptable and effective contraceptive methods in this population. In 2006-2010, 82% of adolescents at risk of unintended pregnancy were currently using contraception, but only 59% used a highly effective method, including any hormonal method or intrauterine device...
May 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29683905/acog-committee-opinion-no-735-summary-adolescents-and-long-acting-reversible-contraception-implants-and-intrauterine-devices
#6
(no author information available yet)
The phenomenon of adolescent childbearing is complex and far reaching, affecting not only the adolescents but also their children and their community. The prevalence and public health effect of adolescent pregnancy reflect complex structural social problems and an unmet need for acceptable and effective contraceptive methods in this population. In 2006-2010, 82% of adolescents at risk of unintended pregnancy were currently using contraception, but only 59% used a highly effective method, including any hormonal method or intrauterine device...
May 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29674201/placental-histopathological-lesions-in-correlation-with-neonatal-outcome-in-preeclampsia-with-and-without-severe-features
#7
Eran Weiner, Ohad Feldstein, Liliya Tamayev, Ehud Grinstein, Elad Barber, Jacob Bar, Letizia Schreiber, Michal Kovo
OBJECTIVE: We aimed to compare pregnancy outcome and placental histopathology in women with preeclampsia (PE) with and without severe features. METHODS: The medical records and placental pathology reports of all pregnancies complicated by PE during 2008-2016, were reviewed. Results were compared between those with and without severe features (severe PE vs. mild PE groups), according to current ACOG guidelines. Placental lesions were classified to maternal/fetal vascular supply lesions, and maternal/fetal inflammatory responses...
February 7, 2018: Pregnancy Hypertension
https://www.readbyqxmd.com/read/29673570/pregnancy-and-parental-leave-among-obstetrics-and-gynecology-residents-results-of-a-nationwide-survey-of-program-directors
#8
Eduardo Hariton, Benjamin Matthews, Abigail Burns, Chitra Akileswaran, Lori R Berkowitz
INTRODUCTION: The health and economic benefits of paid parental leave have been well documented. In 2016, the American College of Obstetrics and Gynecology (ACOG) released a policy statement on recommended parental leave for trainees, yet, data on adoption of said guidelines is nonexistent and published data on parental leave policies in Ob-Gyn is outdated. The objective of our study is to understand existing parental leave policies in Ob-Gyn training programs and to evaluate program director opinions on these policies and on parenting in residency...
April 16, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29553433/management-of-pregnancy-loss-in-the-first-trimester-a-retrospective-audit
#9
Rami Musallam, Nabeel Salem, Ramez Al Halol, Hammam Al Deeb, Bettina Bottcher, Hanaa AlHamaida
BACKGROUND: Early pregnancy loss occurs in 10% of all clinically recognised pregnancies. 80% of pregnancy losses occur in the first trimester. Offering choice and participation in the management decisions is essential to patient-centred care. The aim of this study was to assess the management of first trimester pregnancy loss at the Emirati Hospital in Rafah, Gaza Strip. METHODS: In this retrospective audit, we compared the management of first trimester pregnancy loss at Emirati Hospital using the American College of Obstetricians and Gynecologists guidelines (ACOG, No...
February 21, 2018: Lancet
https://www.readbyqxmd.com/read/29470343/acog-practice-bulletin-no-193-tubal-ectopic-pregnancy
#10
(no author information available yet)
Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence...
March 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29470339/acog-practice-bulletin-no-193-summary-tubal-ectopic-pregnancy
#11
(no author information available yet)
Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence...
March 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29451847/appropriate-use-of-prophylactic-antibiotic-agents-in-gynecologic-surgeries-at-a-midwestern-teaching-hospital
#12
Locke Uppendahl, Caitlin Chiles, Stephanie Shields, Fanglong Dong, Elizabeth Kraft, Jennifer Duong, James Delmore
BACKGROUND: The purpose of this study was to establish compliance with guidelines published by the American College of Obstetricians and Gynecologists (ACOG) regarding prophylactic antibiotic use in gynecologic surgery at our institution, and define areas of improvement to promote antibiotic stewardship. PATIENTS AND METHODS: This was a retrospective cohort study at a single, large tertiary care and teaching hospital in Kansas. Patients who underwent inpatient or outpatient gynecologic surgery during 2013 were included...
February 16, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29447091/obesity-in-pregnancy-a-comparison-of-four-national-guidelines
#13
Dana Vitner, Kristin Harris, Cynthia Maxwell, Dan Farine
BACKGROUND: Obesity in pregnancy has become one of the most important challenges in obstetrical care given its prevalence and potential adverse impact on both mother and fetus. The primary objective of this descriptive review is to identify common themes and distinctions within the current recommendations for maternal obesity in the most updated version of four published national guidelines. METHODS: We reviewed the following guidelines for obesity in pregnancy: American College of Obstetricians and Gynecologists (ACOG) 2015, Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG) 2013, Royal College of Obstetrics and Gynecology (RCOG) 2010, and Society of Obstetrics and Gynecologists of Canada (SOGC) 2010...
February 26, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29372146/history-indicated-cerclage-the-association-between-previous-preterm-history-and-cerclage-outcome
#14
Kyong-No Lee, Eun-Jee Whang, Kylie Hae-Jin Chang, Ji-Eun Song, Ga-Hyun Son, Keun-Young Lee
Objective: Our hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome...
January 2018: Obstetrics & Gynecology Science
https://www.readbyqxmd.com/read/29370048/acog-committee-opinion-no-730-fatigue-and-patient-safety
#15
(no author information available yet)
Fatigue and sleep deprivation may affect a health care provider's skills and communication style, and also may affect clinical outcomes. The National Sleep Foundation recommends 7-9 hours of sleep per night for an adult. However, there are no current guidelines limiting the volume of deliveries and procedures performed by a single individual or on the length of time he or she may be on call. Medical literature has shown that even a single night of missed sleep measurably affects cognitive performance. When adults do not sleep at least 5 hours per night, language and numeric skills, retention of information, short-term memory, and concentration all decrease on standardized testing...
February 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29370047/acog-practice-bulletin-no-190-gestational-diabetes-mellitus
#16
(no author information available yet)
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. However, debate continues to surround the diagnosis and treatment of GDM despite several recent large-scale studies addressing these issues. The purposes of this document are the following: 1) provide a brief overview of the understanding of GDM, 2) review management guidelines that have been validated by appropriately conducted clinical research, and 3) identify gaps in current knowledge toward which future research can be directed...
February 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29370046/acog-committee-opinion-no-730-summary-fatigue-and-patient-safety
#17
(no author information available yet)
Fatigue and sleep deprivation may affect a health care provider's skills and communication style, and also may affect clinical outcomes. The National Sleep Foundation recommends 7-9 hours of sleep per night for an adult. However, there are no current guidelines limiting the volume of deliveries and procedures performed by a single individual or on the length of time he or she may be on call. Medical literature has shown that even a single night of missed sleep measurably affects cognitive performance. When adults do not sleep at least 5 hours per night, language and numeric skills, retention of information, short-term memory, and concentration all decrease on standardized testing...
February 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29370045/acog-practice-bulletin-no-191-summary-tubal-ectopic-pregnancy
#18
(no author information available yet)
Ectopic pregnancy is defined as a pregnancy that occurs outside of the uterine cavity. The most common site of ectopic pregnancy is the fallopian tube. Most cases of tubal ectopic pregnancy that are detected early can be treated successfully either with minimally invasive surgery or with medical management using methotrexate. However, tubal ectopic pregnancy in an unstable patient is a medical emergency that requires prompt surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence...
February 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29370044/acog-practice-bulletin-no-190-summary-gestational-diabetes-mellitus
#19
(no author information available yet)
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. However, debate continues to surround the diagnosis and treatment of GDM despite several recent large-scale studies addressing these issues. The purposes of this document are the following: 1) provide a brief overview of the understanding of GDM, 2) review management guidelines that have been validated by appropriately conducted clinical research, and 3) identify gaps in current knowledge toward which future research can be directed...
February 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29335907/content-of-first-prenatal-visits
#20
J Dyer, G Latendresse, E Cole, J Coleman, E Rothwell
Objective The purpose of this study was to examine the content of the first prenatal visit within an academic medical center clinic and to compare the topics discussed to 2014 American College of Obstetrics and Gynecologists guidelines for the initial prenatal visit. Methods Clinical interactions were audio recorded and transcribed (n = 30). A content analysis was used to identify topics discussed during the initial prenatal visit. Topics discussed were then compared to the 2014 ACOG guidelines for adherence...
May 2018: Maternal and Child Health Journal
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