American journal of obstetrics and gynecology
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In the 1970s, studies demonstrated that timely access to risk-appropriate neonatal and obstetric care could reduce perinatal mortality. Since the publication of the Toward Improving the Outcome of Pregnancy report, more than 3 decades ago, the conceptual framework of regionalization of care of the woman and the newborn has been gradually separated with recent focus almost entirely on the newborn. ⋯ The proposed classification system for levels of maternal care pertains to birth centers, basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV). The goal of regionalized maternal care is for pregnant women at high risk to receive care in facilities that are prepared to provide the required level of specialized care, thereby reducing maternal morbidity and mortality in the United States.
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Am. J. Obstet. Gynecol. · Mar 2015
Partnering with patients to realize the benefits of social media.
Despite widespread concern about the potential risks of the use of social media, we are optimistic that social networks and blogs have the potential to enhance the practice of medicine by allowing clinicians to share ideas and information within the health care community, with patients, and with the general public. In particular, we believe that there can be value in posting information related to a patient encounter on social media, but only if care has been taken to consider the consequences of such a post from the patient's perspective. Thus, having a discussion with a patient and obtaining verbal consent before posting even deidentified patient information should become standard practice for all physicians who use social media.
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Am. J. Obstet. Gynecol. · Mar 2015
Evaluation of ethics education in obstetrics and gynecology residency programs.
The objective of the study was to assess the current status of ethics education in obstetrics-gynecology residency programs. ⋯ This study found that a lack of structured curricula, inadequate faculty expertise, and limited time were important barriers for ethics education in obstetrics-gynecology programs across the nation. Despite these existing challenges, program directors have a strong interest in increasing ethics education in residency training. Therefore, additional resources are needed to assist program directors in enhancing resident ethics education.
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Am. J. Obstet. Gynecol. · Mar 2015
Randomized Controlled TrialDelayed cord clamping with and without cord stripping: a prospective randomized trial of preterm neonates.
Autologous blood transfusion from the placenta to the neonate at birth has been proven beneficial. Transfusion can be accomplished by either delayed cord clamping or cord stripping. Both are equally effective in previous randomized trials. We hypothesized that combining these 2 techniques would further improve outcomes in preterm neonates. ⋯ Adding cord stripping to the delayed cord clamp does not result in an increased hematocrit. Data suggest trends in lower mortality and higher hematocrit in neonates born less than 28 weeks, but these were not statistically significant.
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Am. J. Obstet. Gynecol. · Mar 2015
Comparative StudyNeonatal morbidity associated with shoulder dystocia maneuvers.
We sought to examine neonatal morbidity associated with different maneuvers used among term patients who experience a shoulder dystocia. ⋯ We found no association between shoulder dystocia maneuvers and neonatal morbidity after adjusting for duration, a surrogate for severity. Our results demonstrate that clinicians should utilize the maneuver most likely to result in successful delivery.