Obstetrics and gynecology
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Obstetrics and gynecology · Jul 2018
Perioperative Management and Implementation of Enhanced Recovery Programs in Gynecologic Surgery for Benign Indications.
Enhanced recovery after surgery (ERAS) programs are a multimodal approach to optimize the surgical experience. Intraoperative and postoperative pain management is essential because the stress of surgery results in significant neurohormonal and metabolic shifts that can influence patient analgesia. Enhanced recovery after surgery programs address the physiologic and psychological factors that contribute to pain outcomes and overall satisfaction scores. ⋯ Intraoperatively, euvolemia and normothermia are essential in reducing the adverse metabolic effects of surgery. Postoperatively, pain management, reduction in postoperative nausea and vomiting, proactive mobilization, and early enteral feeing minimize patient discomfort and decrease the duration until return to baseline. Although incorporation of all phases of the ERAS pathway will maximize patient benefit, stepwise incorporation of the phases of the pathway can still improve the surgical experience at minimal cost.
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Obstetrics and gynecology · Jul 2018
Randomized Controlled TrialLiposomal Bupivacaine Block at the Time of Cesarean Delivery to Decrease Postoperative Pain: A Randomized Controlled Trial.
To evaluate whether a liposomal bupivacaine incisional block decreases postoperative pain and represents an opioid-minimizing strategy after scheduled cesarean delivery. ⋯ ClinicalTrials.gov, NCT02959996.
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Obstetrics and gynecology · Jul 2018
Practice GuidelineACOG Practice Bulletin No. 197 Summary: Inherited Thrombophilias in Pregnancy.
Inherited thrombophilias are associated with an increased risk of venous thromboembolism and have been linked to adverse outcomes in pregnancy. However, there is limited evidence to guide screening for and management of these conditions in pregnancy. The purpose of this document is to review common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy. This Practice Bulletin has been revised to provide additional information on recommendations for candidates for thrombophilia evaluation, updated consensus guidelines regarding the need for prophylaxis in women with an inherited thrombophilia during pregnancy and the postpartum period, and discussion of new published consensus guidelines from the Society for Obstetric Anesthesia and Perinatology addressing thromboprophylaxis and neuraxial anesthetic considerations in the obstetric population.
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Obstetrics and gynecology · Jul 2018
Practice GuidelineACOG Practice Bulletin No. 197: Inherited Thrombophilias in Pregnancy.
Inherited thrombophilias are associated with an increased risk of venous thromboembolism and have been linked to adverse outcomes in pregnancy. However, there is limited evidence to guide screening for and management of these conditions in pregnancy. The purpose of this document is to review common thrombophilias and their association with maternal venous thromboembolism risk and adverse pregnancy outcomes, indications for screening to detect these conditions, and management options in pregnancy. This Practice Bulletin has been revised to provide additional information on recommendations for candidates for thrombophilia evaluation, updated consensus guidelines regarding the need for prophylaxis in women with an inherited thrombophilia during pregnancy and the postpartum period, and discussion of new published consensus guidelines from the Society for Obstetric Anesthesia and Perinatology addressing thromboprophylaxis and neuraxial anesthetic considerations in the obstetric population.
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Obstetrics and gynecology · Jul 2018
Randomized Controlled TrialLong-Term Outcomes of Elagolix in Women With Endometriosis: Results From Two Extension Studies.
To evaluate the efficacy and safety of elagolix, an oral, nonpeptide gonadotropin-releasing hormone antagonist, over 12 months in women with endometriosis-associated pain. ⋯ ClinicalTrials.gov, NCT01760954 and NCT02143713.