Obstetrics and gynecology
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Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. ⋯ The decision for delivery in the setting of antepartum severe sepsis or septic shock can be challenging but must be based on gestational age, maternal status, and fetal status. The natural inclination is to proceed with emergent delivery for a concerning fetal status, but it is imperative to stabilize the mother first, because in doing so the fetal status will likewise improve. Aggressive [corrected] treatment of sepsis can be expected to reduce the progression to severe sepsis and septic shock and prevention strategies can include preoperative skin preparations and prophylactic antibiotic therapy as well as appropriate immunizations.
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Obstetrics and gynecology · Sep 2012
Preventing maternal and newborn deaths globally: using innovation and science to address challenges in implementing life-saving interventions.
We have made important progress toward achieving Millennium Development Goals 4 and 5, with an estimated 47% decrease in maternal deaths and 28% decrease in newborn deaths globally since 1990. However, rapidly accelerating this progress is vital because far too many maternal and newborn deaths still occur each day. Fortunately, there are major initiatives underway to enhance global efforts in preventing these deaths, including the United Nations Secretary General's Global Strategy for Women's and Children's Health. ⋯ We will need to develop conceptual and operational frameworks that link innovation and implementation science to implementation challenges for the Global Strategy. Likewise, we will need to expand and strengthen close cooperation between those with responsibilities for implementation and those with responsibilities for developing and supporting science-driven interventions. Realizing the potential for the Global Strategy will require commitment, coordination, collaboration, and communication-and the women and newborns we serve deserve no less.
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Obstetrics and gynecology · Sep 2012
Pursuit of accredited subspecialties by graduating residents in obstetrics and gynecology, 2000-2012.
To estimate whether there has been an increase in resident graduates pursuing fellowship training in the currently accredited subspecialties and to compare whether any trend toward subspecialization is similar to those seen in other specialties. ⋯ Like with residents in other specialties, more graduates in obstetrics and gynecology are pursuing accredited subspecialty fellowship training, adding to the complexities of workforce planning. The percent of obstetrics and gynecology residents who pursued accredited subspecialty fellowship training was lower than all but one other specialty.