Obstetrics and gynecology
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Postpartum tubal sterilization is one of the safest and most effective methods of contraception. Women who desire this type of sterilization typically undergo thorough counseling and informed consent during prenatal care and reiterate their desire for postpartum sterilization at the time of their hospital admission. Not all women who desire postpartum sterilization actually undergo the surgical procedure, and women with unfulfilled requests for postpartum sterilization have a high rate of repeat pregnancy (approaching 50%) within the following year. ⋯ The differences in the requirements surrounding consent for sterilization procedures based on the type of insurance a patient has must be addressed in order to establish fair and equitable access to sterilization procedures for all women. Policies and procedures that remove barriers to and increase efficiency in performing postpartum sterilization could reduce cancellations of the procedure. Improving consistency in accomplishing desired postpartum sterilization is an important strategy to reduce high rates of unintended pregnancy in the United States.
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Obstetrics and gynecology · Jun 2012
Randomized Controlled TrialIntra-abdominal irrigation at cesarean delivery: a randomized controlled trial.
To determine whether avoiding intra-abdominal irrigation at cesarean delivery will decrease rates of intraoperative and postoperative gastrointestinal disturbance without increasing postoperative morbidity. ⋯ I.
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Obstetrics and gynecology · May 2012
Distribution of American Congress of Obstetricians and Gynecologists fellows and junior fellows in practice in the United States.
To develop effective policies addressing access to health care for all women in the United States, we report the distribution of the American Congress of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in practice at county and state levels. ⋯ III.
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Obstetrics and gynecology · May 2012
Maternal drug use and its effect on neonates: a population-based study in Washington State.
To estimate the effect of maternal illicit and prescription drug use on neonates in Washington State between 2000 and 2008. ⋯ II.
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Obstetrics and gynecology · May 2012
ACOG Committee Opinion No. 524: Opioid abuse, dependence, and addiction in pregnancy.
Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. The current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should be considered. Medically supervised tapered doses of opioids during pregnancy often result in relapse to former use. ⋯ During the intrapartum and postpartum period, special considerations are needed for women who are opioid dependent to ensure appropriate pain management, to prevent postpartum relapse and a risk of overdose, and to ensure adequate contraception to prevent unintended pregnancies. Patient stabilization with opioid-assisted therapy is compatible with breastfeeding. Neonatal abstinence syndrome is an expected and treatable condition that follows prenatal exposure to opioid agonists.