Obstetrics and gynecology
-
Obstetrics and gynecology · Jun 2011
Unjustified increase in cost of care resulting from U.S. Food and Drug Administration approval of Makena (17α-hydroxyprogesterone caproate).
U. S. Food and Drug Administration (FDA) approval of 17α-hydroxyprogesterone caproate for the indication of decreasing the risk of preterm delivery in those high-risk patients who previously had spontaneous preterm birth has come at considerable cost to the health care system. ⋯ This increased health care cost is not justified at this time. The price barrier to access imposed by KV Pharmaceutical actually could result in an increase in preterm deliveries over current rates. Actions are needed by the FDA, national societies, and the manufacturer to ensure that all high-risk patients continue to get the needed therapy to reduce the number of preterm births.
-
Obstetrics and gynecology · May 2011
Multicenter StudyAdmixture mapping to identify spontaneous preterm birth susceptibility loci in African Americans.
Preterm birth is 1.5 times more common in African American (17.8%) than European American women (11.5%), even after controlling for confounding variables. We hypothesize that genetic factors may account for this disparity and can be identified by admixture mapping. ⋯ Spontaneous preterm birth in African American women may be genetically mediated by a susceptibility locus on chromosome 7. This region contains multiple potential candidate genes, including collagen type 1-α-2 gene and genes involved with calcium regulation.
-
Obstetrics and gynecology · May 2011
ReviewRole of hysterectomy in the treatment of chronic pelvic pain.
Chronic pelvic pain affects nearly 15% of women annually in the United States. It is associated with significant comorbidity, and annual costs to the health care system are estimated at approximately 2 billion dollars per year. The multifactorial nature of chronic pelvic pain makes it difficult to evaluate and treat. ⋯ Comorbidities such as preoperative depression may lower the chances of pain resolution after hysterectomy. Approximately 14% of women report having results worse than expected and almost 26% may have a slower recovery than expected. To maximize the chances of pain resolution, all women with chronic pelvic pain should undergo a full evaluation of the urologic, gastroenterologic, neurologic, and musculoskeletal organ systems before surgery to exclude nonreproductive causes of pain.
-
Obstetrics and gynecology · May 2011
CommentObstetric ethics: an essential dimension of planned home birth.
The American College of Obstetricians and Gynecologists (the College) Committee Opinion, "Planned Home Birth," invokes two core concepts of obstetric ethics, the right of a woman to make a medically informed decision about delivery and the informed consent process. We set out a framework for obstetric ethics that empowers the autonomy of pregnant women by focusing on when, in beneficence-based clinical judgment, clinical management should be offered, should be recommended, and should be recommended against in the informed consent process. Using this ethical framework, we show that the College statement does not provide adequate guidance to obstetricians in fulfilling their ethical obligations in the informed consent process with pregnant women who express an interest in, or preference for planned home birth. ⋯ As a matter of beneficence-based professional integrity, obstetricians should not participate in planned home birth. At the same time, obstetricians have a beneficence-based obligation to continue to provide prenatal and emergency obstetric care. The obstetric profession should continuously strive to make hospital births more humane and support home-birth-like environments in the hospital as well as continuously improve safety for both pregnant and fetal patients.