Obstetrics and gynecology
-
Obstetrics and gynecology · Nov 2018
Clinical Updates in Women's Health Care Summary: Perioperative Pain Management: Primary and Preventive Care Review.
The opioid epidemic in the United States has become a public health crisis, which continues to worsen. The purpose of this monograph is to help obstetrician-gynecologists develop a perioperative framework with which to identify patients at risk of dependence and addiction and to describe a multimodal approach to postoperative pain management using the pathways of enhanced recovery after surgery. Preoperative counseling and optimization of comorbid medical conditions, comprehensive patient education, and optimal postoperative management also will be reviewed.
-
Obstetrics and gynecology · Oct 2018
Case ReportsSuccessful Use of Extracorporeal Membrane Oxygenation for Status Asthmaticus in a Woman With a Periviable Pregnancy.
Status asthmaticus is a severe asthma exacerbation with persistent airway obstruction despite standard therapy. Use of extracorporeal membrane oxygenation (ECMO) as rescue therapy in pregnancy is exceedingly rare. We describe a case of ECMO for treatment of status asthmaticus in woman with a periviable pregnancy culminating in a term delivery. ⋯ Venovenous ECMO can be used successfully for status asthmaticus during a periviable pregnancy and enable delivery at term.
-
Obstetrics and gynecology · Sep 2018
Randomized Controlled Trial Comparative StudyIndividualized Compared With Standard Postdischarge Oxycodone Prescribing After Cesarean Birth: A Randomized Controlled Trial.
To evaluate whether individualized postdischarge oxycodone prescribing guided by inpatient opioid use reduces the number of unused opioid tablets after cesarean birth. ⋯ ClinicalTrials.gov, NCT03168425.
-
Obstetrics and gynecology · Sep 2018
Practice GuidelineACOG Practice Bulletin No. 199 Summary: Use of Prophylactic Antibiotics in Labor and Delivery.
The use of antibiotics to prevent infections during the antepartum, intrapartum, and postpartum periods is different than the use of antibiotics to treat established infections. For many years, the use of prophylactic antibiotics was thought to have few adverse consequences. Concerns about the emergence of resistant strains of common bacteria, in addition to the emergence of strains with increased virulence, have resulted in increased scrutiny of the use of antibiotics, particularly in the hospital setting. ⋯ The purpose of this Practice Bulletin is to present a review of clinical situations in which prophylactic antibiotics are frequently prescribed and to weigh the evidence that supports the use of antibiotics in these scenarios. This Practice Bulletin is updated to reflect a limited change to clarify and provide additional information on recommendations from recent consensus guidelines for antimicrobial prophylaxis in surgery and the prevention of surgical site infection. The following practices related to cesarean delivery include preoperative skin and vaginal cleansing, weight-based dosage for cefazolin antibiotic prophylaxis, the addition of adjunctive azithromycin antibiotic prophylaxis, and antibiotic selection and dosage for women with a penicillin allergy.
-
Obstetrics and gynecology · Sep 2018
Meta AnalysisRisk of Cervical Intraepithelial Neoplasia 2 or Worse by Cytology, Human Papillomavirus 16/18, and Colposcopy Impression: A Systematic Review and Meta-analysis.
To calculate pooled risk estimates for combinations of cytology result, human papillomavirus (HPV) 16/18 genotype and colposcopy impression to provide a basis for risk-stratified colposcopy and biopsy practice. ⋯ Our results support a risk-based approach to colposcopy and biopsy with modifications of practice at the lowest and highest risk levels.