Clinical obstetrics and gynecology
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Women continue to die from pregnancy-related causes at an alarming rate. Maternal mortality was first called a neglected epidemic in 1985, but to date, no significant improvements have been realized. Great disparity exists as lifetime risk of dying from pregnancy is 1 in 26 in Africa, 1 in 7300 in high-income areas. The UN Millennium Development Goals call for a 75% reduction in maternal mortality by 2015, which will only be realized when priority setting, funding, and program implementation can create conditions for appropriate human resources, infrastructure, and patient education for high-quality obstetric care.
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Determining the cause of acute pelvic pain in the female patient is often a clinical challenge. Diagnostic imaging can be invaluable in this situation. Ectopic pregnancy, pelvic inflammatory disease, and hemorrhagic ovarian cysts are the most commonly diagnosed gynecologic conditions presenting with acute pelvic pain. ⋯ Other causes to consider include endometriosis, and postpartum causes such as endometritis, or ovarian vein thrombosis. Finally, nongynecologic conditions may overlap in their presentation of acute pelvic pain and should also be considered. The most important of these is acute appendicitis.
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Changing to a teamwork culture in labor and delivery requires a real commitment. The skills involved can be taught to all healthcare providers. The benefits of a teamwork culture may include improved patient outcomes, less medical errors, and improved patient and staff satisfaction. Malpractice claim reduction may possibly occur through these improved outcomes and better communication with our patients.
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Traditional patient and physician attitudes toward disclosure are discussed. Studies show that full disclosure does not lead to more litigation, but has decreased the number of claims filed and the average settlement value. There is a current movement toward full disclosure by healthcare institutions. As full disclosure policies are adopted by more institutions and legislation that protects expressions of apology and sympathy accompanying those disclosures is enacted, the result will be improved patient care and a decrease in future errors.
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Clin Obstet Gynecol · Sep 2008
ReviewVaccines for pertussis and influenza: recommendations for use in pregnancy.
The active immunization of pregnant women during pregnancy to protect them from disease and protect their neonate with passive antibodies is a biologic fact. Fortunately, many infectious diseases occur infrequently due to excellent pediatric vaccine programs. ⋯ Only 2% of the adult US population is protected against pertussis and it is estimated that only 25% of pregnant women receive influenza vaccine during the influenza season. This chapter discusses trivalent inactivated influenza vaccine and TdaP use during pregnancy, the diseases they prevent, and the benefit to the neonate.