Obstetrics and gynecology
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Obstetrics and gynecology · May 2014
ACOG Committee Opinion no 595: Committee on Gynecologic Practice: Preexposure prophylaxis for the prevention of human immunodeficiency virus.
Preexposure prophylaxis is defined as the administration of antiretroviral medications to individuals who are not infected with human immunodeficiency virus (HIV) and are at the highest risk of acquiring HIV infection. In combination with other proven HIV-prevention methods, preexposure prophylaxis may be a useful tool for women at the highest risk of HIV acquisition. ⋯ The Centers for Disease Control and Prevention's guidance for preexposure prophylaxis is likely to evolve in the coming years, and obstetrician-gynecologists should remain aware of new developments in this area. Risk reduction for all women at risk of HIV infection should include counseling about testing, safe-sex practices (including condom use), and other behavioral interventions.
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Obstetrics and gynecology · Apr 2014
ACOG Committee Opinion no. 594: Immersion in water during labor and delivery.
Immersion in water has been suggested as a beneficial alternative for labor, or delivery, or both and over the past decades has gained popularity in many parts of world. Immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor. ⋯ Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent. Facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and immediately and safely moving women out of the tubs if maternal or fetal concerns develop.
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Obstetrics and gynecology · Mar 2014
Practice GuidelineCommittee opinion no. 590: preparing for clinical emergencies in obstetrics and gynecology.
Patient care emergencies may occur at any time in any setting, particularly the inpatient setting. It is important that obstetrician-gynecologists prepare themselves by assessing potential emergencies, establishing early warning systems, designating specialized first responders, conducting emergency drills, and debriefing staff after actual events to identify strengths and opportunities for improvement. Having such systems in place may reduce or prevent the severity of medical emergencies.
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Obstetrics and gynecology · Mar 2014
Practice GuidelineCommittee opinion no. 591: challenges for overweight and obese women.
Overweight and obesity are epidemic in the United States. Obesity is a risk factor for numerous conditions, including diabetes, hypertension, high cholesterol, stroke, heart disease, certain types of cancer, and arthritis. ⋯ Many women, irrespective of demographic characteristics or income, are vulnerable to becoming overweight or obese because of limited resources for physical activity and healthy food choices, work commitments, and family demands. Clinicians and public health officials should address not only individual behavior but also the built environment in their efforts to reduce overweight and obesity in their patient populations.
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Obstetrics and gynecology · Mar 2014
Delivering the truth: challenges and opportunities for error disclosure in obstetrics.
Disclosing harmful medical errors to patients is a prominent component of the patient safety movement. Patients expect it and safety agencies and experts advocate its implementation. ⋯ Despite these challenges, transparent communication with parents about unexpected adverse birth outcomes remains critical. We call on clinicians and professional societies to pursue a deeper understanding of the unique challenges of disclosure in obstetrics and prepare themselves to conduct these difficult conversations well.