Seminars in perinatology
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Seminars in perinatology · Dec 2010
ReviewStillbirths: epidemiology, evidence, and priorities for action.
The annual global burden of stillbirths amounts to an estimated 3.2 million%, 98% of which occur in low- and middle-income countries (LMICs). Of these, 1.02 million (32%) are intrapartum, ie, taking place during labor. The most important causes of stillbirths in LMICs include obstructed or prolonged labor, hypertensive diseases of pregnancy, syphilis and gram-negative infections, malaria in endemic areas, and undernutrition. ⋯ Balanced energy protein supplementation is an important nutritional intervention to prevent stillbirths in undernourished women, especially in LMICs. Creation of increased demand for health services within communities and increasing their uptake also can play a role in averting stillbirths. Other potential social and behavioral interventions include birth spacing, smoking cessation and indoor air pollution control, although the evidence for these is weak.
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The promulgation of the immediately available physician standard has contributed to the rapid decline in vaginal birth after cesareans (VBACs). While having an immediately available obstetrician during a VBAC trial will reduce risk, it is not clear that similar advantage wouldn't also accrue to women without uterine scars. However, many hospitals can't staff up to that standard. In this article we suggest 1) set a goal of providing an immediately available team for all women in labor, 2) tailor informed consent to women's unique risks- unique because of their own risk profile (e.g., previous scar, hypertension, etc) or unique because of characteristics of the birthing site (e.g. a team is or is not available), 3) in smaller hospitals, if an immediately available team cannot be routinely provided, consideration should be given to bringing in a team for the occasional patient requesting a trial, and to allowing labor for lower risk trials.
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Seminars in perinatology · Apr 2010
From developing guidelines to implementing legislation: actions of the US Advisory Committee on Heritable Disorders in Newborns and Children toward advancing and improving newborn screening.
Federal advisory committees (or commissions, councils, or task forces) are created either by congressional action or a federal department to bring together a variety of viewpoints on specific policy issues. The committees or advisory bodies are generally directed to advise various bodies within the government, either by congressional mandate, government decree, or executive order. The committees are often created to aid the government in subject matters with difficult issues. ⋯ This article describes the Secretary's Advisory Committee on Heritable Disorders in Newborns and Children. Its history offers insight into connection of the development of policy guidelines and the creation of legislation to implement that policy. Its current activities have affected and will continue to affect not only state newborn screening programs but also the policy and practice of screening children for heritable disorders.
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Seminars in perinatology · Feb 2010
ReviewCranial ultrasonography in neonates: role and limitations.
In experienced hands, cranial ultrasonography (cUS) is an excellent tool to detect the most frequently occurring brain abnormalities in preterm and full-term neonates, to study the evolution of lesions, and to follow brain maturation. It enables screening of the brain and serial imaging in high-risk neonates. ⋯ We will pay attention to the standard cUS procedure and expand on optimizing the possibilities of cUS by using supplemental acoustic windows and changing transducers and focus points. For illustration numerous cUS images are provided.
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The Texas Advance Directives Act was first passed in 1999 to help resolve conflicts between families and physicians when disagreements exist over continuing or halting treatments of patients. When the physician feels that continued treatment is ethically or morally unjustified and seeks to end life support for a patient against the wishes of the family, it establishes a specific path that must be followed to afford legal protection to the physician and institution. Its proponents believe that it reduces morally unjustifiable treatment of terminal patients, while its opponents argue that it places too much power in the hands of physicians and institutions. This review analyzes both sides of the argument, gives 2 examples of its application, and concludes that it is a good model but requires modification to correct some flaws.