Obstetrics and gynecology
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Obstetrics and gynecology · Jan 2007
ACOG Committee Opinion No. 359: commercial enterprises in medical practice.
Increasing numbers of physicians sell and promote both medical and nonmedical products as part of their practices. Physicians always have rendered advice and treatment for a fee, and this practice is appropriate. ⋯ It is ethical and appropriate, however, to sell products to patients as follows: sale of devices or drugs that require professional administration in the office setting; sale of therapeutic agents, when no other facilities can provide them at reasonable convenience and at reasonable cost; sale of products that clearly are external to the patient-physician relationship, when such a sale would be considered appropriate in an external relationship; and sale of low-cost products for the benefit of community organizations. A rationale is provided for both the prohibited activities and exceptions.
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Obstetrics and gynecology · Dec 2006
ReviewCesarean delivery on maternal request: maternal and neonatal outcomes.
To review systematically the evidence about maternal and infant outcomes of cesarean delivery on maternal request and planned vaginal delivery. ⋯ The evidence is significantly limited by its minimal relevance to primary cesarean delivery on maternal request. Future research requires developing consensus about terminology, creating a minimum data set for cesarean delivery on maternal request, improving study design and statistical analyses, attending to major outcomes and their special measurement issues, assessing both short- and long-term outcomes with better measurement strategies, dealing better with confounders, and considering the value or utility of different outcomes.
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Obstetrics and gynecology · Dec 2006
ACOG Committee Opinion No. 353: Medical emergency preparedness.
Patient care emergencies may occur at any time in a hospital or an outpatient setting. To respond to these emergencies, it is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies that might occur, creating plans that include establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify what went well and what are opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.
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Obstetrics and gynecology · Dec 2006
Randomized Controlled Trial Comparative StudyTraining for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins.
To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity mannequin with that using traditional devices. ⋯ I.
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The purpose of this review was to examine the impact of varying degrees of renal insufficiency on pregnancy outcome in women with chronic renal disease. Our search of the literature did not reveal any randomized clinical trials or meta-analyses. The available information is derived from opinion, reviews, retrospective series, and limited observational series. ⋯ These women will require frequent visits and monitoring of renal function during pregnancy. Women whose renal disease is further complicated by hypertension should be counseled regarding the increased risk of adverse outcome and need for blood pressure control. Some antihypertensives, especially angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, should be avoided during pregnancy, if possible, because of the potential for both teratogenic (hypocalvaria) and fetal effects (renal failure, oliguria, and demise).