Obstetrics and gynecology
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Obstetrics and gynecology · Apr 2007
Practice GuidelineACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists.
Preterm delivery occurs in approximately 12% of all births in the United States and is a major factor contributing to perinatal morbidity and mortality (1, 2). Despite extensive research in this area, the rate of preterm birth has increased by 38% since 1981 (3). Premature rupture of membranes (PROM) is a complication in approximately one third of preterm births. ⋯ Management hinges on knowledge of gestational age and evaluation of the relative risks of preterm birth versus intrauterine infection, abruptio placentae, and cord accident that could occur with expectant management. The purpose of this document is to review the current understanding of this condition and to provide management guidelines that have been validated by appropriately conducted outcome-based research. Additional guidelines on the basis of consensus and expert opinion also are presented.
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There are several obstetric, medical, and surgical disorders that share many of the clinical and laboratory findings of patients with severe preeclampsia-hemolysis, elevated liver enzymes, and low platelets syndrome. Imitators of severe preeclampsia-hemolysis, elevated liver enzymes, and low platelets syndrome are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal mortality, and survivors may face long-term sequelae. ⋯ It is important that the clinician make the accurate diagnosis when possible because the management and complications from these syndromes may be different. For example, severe preeclampsia and acute fatty liver of pregnancy are treated by delivery, whereas it is possible to continue pregnancy in those with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome and exacerbation of systemic lupus erythematosus. This review focuses on diagnosis, management, and counseling of women who develop these syndromes based on results of recent studies.
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Obstetrics and gynecology · Apr 2007
Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor.
To compare maternal and neonatal outcomes when primary cesarean delivery is performed in the second stage of labor compared with the first stage. ⋯ II.
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Obstetrics and gynecology · Apr 2007
Predictors of physician career satisfaction, work-life balance, and burnout.
To explore factors associated with physician career satisfaction, work-life balance, and burnout focusing on differences across age, gender, and specialty. ⋯ II.