Obstetrics and gynecology
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Obstetrics and gynecology · Nov 2019
Case ReportsExtracorporeal Therapies for Amniotic Fluid Embolism.
Amniotic fluid embolism (AFE) is a catastrophic disease with significant mortality. Because the cardiopulmonary dysfunction associated with AFE is self-limited, the disease could be well suited to the use of extracorporeal therapies. ⋯ Extracorporeal therapies can support severely ill women affected by AFE and could be considered even in the presence of disseminated intravascular coagulation and bleeding.
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Obstetrics and gynecology · Nov 2019
Comparative StudyComparison of Midwifery and Obstetric Care in Low-Risk Hospital Births.
To compare midwife and obstetrician labor practices and birth outcomes in women with low-risk pregnancies delivered in the hospital. ⋯ In low-risk pregnancies, midwifery care in labor was associated with decreased intervention, decreased cesarean and operative vaginal births, and, in multiparous women, an increased risk for shoulder dystocia. Greater integration of midwifery care into maternity services in the United States may reduce intervention in labor and potentially even cesarean delivery, in low-risk pregnancies. Larger research studies are needed to evaluate uncommon but important maternal and newborn outcomes.
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Obstetrics and gynecology · Nov 2019
Decreasing Opioid Use Postpartum: A Quality Improvement Initiative.
To estimate the effects of an inpatient initiative to decrease opioid use among women admitted to labor and delivery. ⋯ A standardized multimodal pain power plan reduced opioid use among a large cohort of women admitted to labor and delivery in Central Texas. Despite meeting functional goals, some women reported increased pain during their hospital stay.
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Obstetrics and gynecology · Oct 2019
ReviewPregnancy and the Postpartum Period as an Opportunity for Cardiovascular Risk Identification and Management.
Cardiovascular disease (CVD) is the leading cause of death in women. Because women generally present with more atypical symptoms of CVD than do men and because underlying CVD risk factors are often present for years before the onset of CVD, it is important to use innovative ways to identify women who should undergo CVD risk screening at a younger age. Pregnancy and the postpartum period afford us that opportunity, given that the development of certain pregnancy complications (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, delivery of a neonate with fetal growth restriction, and significant placental abruption) can reliably identify women with underlying, often unrecognized, CVD risk factors. ⋯ Longer-term follow-up and recommendations should be individualized based on findings and risks. There is also an opportunity for future pregnancy counseling and discussion about the importance of weight loss between pregnancies, initiation of a routine involving physical activity, use of preconception folic acid, and the potential initiation of low-dose aspirin for those women at risk for future preeclampsia and fetal growth restriction or the use of progesterone for women at risk for preterm labor. The link between pregnancy complications and future CVD affords us with the earliest opportunity for CVD risk assessment for health preservation and disease prevention.
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Obstetrics and gynecology · Oct 2019
Randomized Controlled TrialClosed Incision Negative Pressure Therapy in Morbidly Obese Women Undergoing Cesarean Delivery: A Randomized Controlled Trial.
To evaluate the efficacy of incisional negative pressure wound therapy in the prevention of postoperative wound morbidity in women with class III obesity undergoing cesarean delivery. ⋯ ClinicalTrials.gov, NCT02289157.