Obstetrics and gynecology
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Obstetrics and gynecology · May 2015
Case ReportsIatrogenic Wernicke encephalopathy in a patient with severe hyperemesis gravidarum.
Hyperemesis gravidarum complicates 0.5-2.0% of pregnancies and may lead to substantial nutritional deficiencies. Total parenteral nutrition can be used in severe cases in an attempt to avoid such deficiencies. Rarely, thiamine deficiency resulting in Wernicke encephalopathy occurs, with significant maternal morbidity. ⋯ Pregnancies complicated by hyperemesis gravidarum treated with total parenteral nutrition represent potential high-risk clinical scenarios for thiamine deficiency. Compositions of total parenteral nutrition are not standardized. Thus, physicians must confirm repletion of all essential components to avoid significant morbidity.
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Obstetrics and gynecology · May 2015
Screening for human immunodeficiency virus and other sexually transmitted diseases among U.S. women with prenatal care.
To estimate prenatal sexually transmitted disease-human immunodeficiency virus (HIV) screening rates among insured women with prenatal care and the association of chlamydia and gonorrhea screening with Pap testing. ⋯ III.
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Obstetrics and gynecology · May 2015
The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression.
Perinatal depression, which includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery, is one of the most common medical complications during pregnancy and the postpartum period, affecting one in seven women. It is important to identify pregnant and postpartum women with depression because untreated perinatal depression and other mood disorders can have devastating effects on women, infants, and families. ⋯ Although definitive evidence of benefit is limited, the American College of Obstetricians and Gynecologists recommends that clinicians screen patients at least once during the perinatal period for depression and anxiety symptoms using a standardized, validated tool. Although screening is important for detecting perinatal depression, screening by itself is insufficient to improve clinical outcomes and must be coupled with appropriate follow-up and treatment when indicated; clinical staff in obstetrics and gynecology practices should be prepared to initiate medical therapy, refer patients to appropriate behavioral health resources when indicated, or both.
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Obstetrics and gynecology · Apr 2015
Committee Opinion No. 629: Clinical guidelines and standardization of practice to improve outcomes.
Protocols and checklists have been shown to reduce patient harm through improved standardization and communication. Implementation of protocols and guidelines often is delayed because of lack of health care provider awareness or difficult clinical algorithms in medical institutions. However, the use of checklists and protocols clearly has been demonstrated to improve outcomes and their use is strongly encouraged. Checklists and protocols should be incorporated into systems as a way to help practitioners provide the best evidence-based care to their patients.