Current opinion in obstetrics & gynecology
-
Curr. Opin. Obstet. Gynecol. · Dec 2011
ReviewThe morbidly adherent placenta: diagnosis and management options.
Randomized controlled trials and large cohort studies regarding the diagnosis and management of placenta accreta are lacking. This review examines the available evidence. ⋯ Women with an antenatal diagnosis of placenta accreta should be managed in a tertiary facility with multidisciplinary input. To determine optimum management strategies, it is imperative that larger studies are carried out in the future. It is essential that the continual monitoring and containment of rising caesarean section rates becomes a priority to prevent a further increase in the incidence of placenta accreta.
-
Curr. Opin. Obstet. Gynecol. · Dec 2011
ReviewA review of current anesthetic concerns and concepts for cesarean hysterectomy.
Peripartum hemorrhage still remains a significant source of maternal morbidity and mortality worldwide. Abnormal placentation is one of the leading causes of peripartum hemorrhage. ⋯ The present article is an update on the state-of-the art multidisciplinary management of parturients undergoing cesarean hysterectomy with special emphasis on anesthetic considerations. It summarizes the prevention, management and treatment of obstetric hemorrhages in parturients with abnormal placentation and highlights recent advances and developments. The obstetrician and the obstetric anesthesiologist must know, on the spot, how to deal with abnormal placentation-related peripartum bleeding. A multidisciplinary approach results in best outcomes.
-
Curr. Opin. Obstet. Gynecol. · Dec 2011
ReviewRecommendations of the IOM clinical preventive services for women committee: implications for obstetricians and gynecologists.
In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. ⋯ The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being.
-
Curr. Opin. Obstet. Gynecol. · Dec 2011
ReviewVitamin D status during pregnancy: maternal, fetal, and postnatal outcomes.
To consider evidence from recent studies linking maternal vitamin D status during pregnancy with maternal, fetal, and postnatal outcomes. ⋯ Recent evidence supports a role of maternal vitamin D status, particularly early in pregnancy, in modulating the risk of pregnancy complications and in sustaining fetal growth, bone development, and immune maturation.