Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Dec 2012
Early recognition of serious infections in obstetrics and gynecology.
Pelvic infections commonly occur in pregnant and postoperative women. Most of these infections are readily diagnosed because of their typical clinical manifestations and prompt antimicrobial therapy that leads to the resolution of disease. However, uncommon cases may escape detection and the severity of the process may also go unrecognized without a careful assessment of clues available through physical examination and laboratory testing. In some cases a particularly virulent pathogen can lead to severe infection, septic shock and its consequences, even death, despite clinicians acting appropriately.
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Chronic hypertension in pregnancy is one of the most common medical diseases affecting pregnancy. It is associated with serious maternal and fetal complications, including superimposed pre-eclampsia, fetal growth restriction, premature delivery, placental abruption, and stillbirth. ⋯ An optimal plan for maternal treatment and fetal surveillance can then be formulated. Coordination of care after delivery is important for long-term maternal health and future pregnancies.
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Gynecologic invasive procedures have moved into the physician's office due to improved reimbursement and convenience. Creating a just and safe office culture has generated robust conversations in the medical literature. This article reviews the foundational principles relating to safe practices in the office including: checklists, drills, selecting a safety officer, achieving office certification, medication usage, and engaging the patient in the safety culture. Reduction of medical errors in the office will require open dialogue between the stake holders: providers, insurers, patients, state and federal agencies, and educational bodies such as the American College of Obstetricians and Gynecologists.
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A review of the approach in pregnancy to a very commonly encountered neurological disorder (headache), along with less commonly encountered neurological entities that none the less deserve the obstetrician's attention. Definitions of specific disorders and differential diagnoses are reviewed, along with treatment options and pregnancy-associated morbidities. ⋯ The disabling neurological disorders-multiple sclerosis, cerebral palsy, and spinal cord injury are grouped due to common morbidities affecting pregnancy. Finally, Bell palsy is also reviewed.
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Breast cancer screening is a highly complex and more recently a controversial topic. Conventional screening includes breast self-examination, clinical breast examination, and screening mammography. ⋯ Novel imaging techniques like positron emission mammography are currently under clinical investigation in the hopes of improving the sensitivity of breast cancer screening. In addition, the development of biochemical assays, which employ minimally invasive sampling are also promising.