American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 2019
Observational StudyOpioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator.
In the setting of America's opioid epidemic, judicious postoperative opioid prescribing is important. Gynecologists lack standard guidelines about postoperative opioid prescriptions. ⋯ On average, surgeons prescribed 4 times the amount of opioids than was needed for patients undergoing laparoscopic hysterectomy for acute postoperative pain control. Individualizing patients' opioid prescriptions based on preoperative risk factors could help reduce excess prescription opioids.
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Am. J. Obstet. Gynecol. · Mar 2019
Multicenter Study Comparative StudyMaternal and newborn outcomes with elective induction of labor at term.
A growing body of evidence supports improved or not worsened birth outcomes with nonmedically indicated induction of labor at 39 weeks gestation compared with expectant management. This evidence includes 2 recent randomized control trials. However, concern has been raised as to whether these studies are applicable to a broader US pregnant population. ⋯ Elective induction of labor at 39 weeks gestation is associated with a decrease in cesarean birth in nulliparous women, decreased pregnancy-related hypertension in multiparous and nulliparous women, and increased time in labor and delivery. How to use this information remains the challenge.
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Am. J. Obstet. Gynecol. · Mar 2019
Meta AnalysisDepressive symptoms among women with endometriosis: a systematic review and meta-analysis.
To evaluate whether endometriosis is associated with depressive symptoms, and whether the association is modulated by pelvic pain. ⋯ The association between endometriosis and depressive symptoms is largely determined by chronic pain but may also be modulated by individual and context vulnerabilities. Awareness of the complex relationship between endometriosis and depressive symptoms informs tailored care and patient-centered research outcomes.
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Am. J. Obstet. Gynecol. · Mar 2019
Responsiveness and minimally important difference of SF-6D and EQ-5D utility scores for the treatment of pelvic organ prolapse.
Utility preference scores are standardized, generic, health-related quality of life (HRQOL) measures that quantify disease severity and burden and summarize morbidity on a scale from 0 (death) to 1 (optimal health). Utility scores are widely used to measure HRQOL and in cost-effectiveness research. ⋯ The SF-6D and EQ-5D have good validity properties and are responsive, preference-based, utility and general HRQOL measures for women undergoing surgical treatment for prolapse. The MIDs for SF-6D and EQ-5D are similar and within the range found for other medical conditions.
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Changes in the make-up of the Supreme Court make an overturn of the Roe v Wade decision a realistic possibility. In order to mitigate any adverse health consequences that could result from a change in the law, all stakeholders in women's health have to start to plan for that contingency. ⋯ Among the tasks for physicians and their professional organization, we include education about the management of women injured by unsafe abortions, post-residency training for physicians with reduced access to residency training in abortion, and planning for the management of medically complicated pregnancies that currently are often terminated (eg, Eisenmenger's syndrome). In this piece, we argue for preparation for a potential post-Roe world.