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OBSTETRICS AND GYNECOLOGY (206 journals)                  1 2 | Last

Showing 1 - 200 of 206 Journals sorted alphabetically
Acta Obstétrica e Ginecológica Portuguesa     Open Access   (Followers: 1)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 15)
Advances in Neonatal Care     Hybrid Journal   (Followers: 47)
Advances in Reproductive Sciences     Open Access   (Followers: 2)
Advances in Sexual Medicine     Open Access   (Followers: 7)
African Journal for Infertility and Assisted Conception     Open Access   (Followers: 1)
African Journal of Midwifery and Women's Health     Full-text available via subscription   (Followers: 11)
African Journal of Reproductive Health     Open Access   (Followers: 8)
Aktuální Gynekologie a Porodnictví     Open Access   (Followers: 1)
American Journal of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 1)
American Journal of Obstetrics and Gynecology     Hybrid Journal   (Followers: 275)
American Journal of Perinatology     Hybrid Journal   (Followers: 39)
American Journal of Perinatology Reports     Open Access   (Followers: 18)
American Journal of Reproductive Immunology     Hybrid Journal   (Followers: 6)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Archives of Gynecology and Obstetrics     Hybrid Journal   (Followers: 19)
Asian Pacific Journal of Reproduction     Open Access  
Australian and New Zealand Journal of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 52)
Best Practice & Research Clinical Obstetrics & Gynaecology     Hybrid Journal   (Followers: 34)
Biology of Reproduction     Full-text available via subscription   (Followers: 11)
Birth     Hybrid Journal   (Followers: 39)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 8)
BJOG : An International Journal of Obstetrics and Gynaecology     Partially Free   (Followers: 299)
British Journal of Midwifery     Full-text available via subscription   (Followers: 89)
Case Reports in Obstetrics and Gynecology     Open Access   (Followers: 11)
Case Reports in Perinatal Medicine     Hybrid Journal   (Followers: 11)
Clínica e Investigación en Ginecología y Obstetricia     Full-text available via subscription  
Clinical Lactation     Open Access   (Followers: 22)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Obstetrics & Gynecology     Full-text available via subscription   (Followers: 26)
Clinics in Perinatology     Full-text available via subscription   (Followers: 25)
Contemporary OB GYN - Obstetrics-Gynecology & Women's Health     Full-text available via subscription   (Followers: 6)
Contraception     Hybrid Journal   (Followers: 20)
Contraception : X     Open Access   (Followers: 1)
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Current Obstetrics and Gynecology Reports     Hybrid Journal   (Followers: 4)
Current Opinion in Obstetrics & Gynecology     Hybrid Journal   (Followers: 13)
Current Women's Health Reviews     Hybrid Journal   (Followers: 5)
Early Human Development     Hybrid Journal   (Followers: 13)
Ecography     Hybrid Journal   (Followers: 26)
EMC - Ginecología-Obstetricia     Full-text available via subscription   (Followers: 1)
European Clinics in Obstetrics and Gynaecology     Hybrid Journal   (Followers: 5)
European Journal of Contraception & Reproductive Health Care     Hybrid Journal   (Followers: 5)
European Journal of Obstetrics & Gynecology and Reproductive Biology     Hybrid Journal   (Followers: 29)
European Journal of Obstetrics & Gynecology and Reproductive Biology : X     Open Access  
Expert Review of Obstetrics & Gynecology     Hybrid Journal   (Followers: 5)
Fertility and Sterility     Full-text available via subscription   (Followers: 79)
Fertility Research and Practice     Open Access   (Followers: 2)
Fertility Science and Research     Open Access  
Fetal and Maternal Medicine Review     Hybrid Journal   (Followers: 6)
Fetal Diagnosis and Therapy     Full-text available via subscription   (Followers: 10)
Ginekologia i Perinatologia Praktyczna     Hybrid Journal  
Ginekologia Polska     Open Access  
Global Reproductive Health     Open Access  
gynäkologie + geburtshilfe     Full-text available via subscription   (Followers: 2)
Gynäkologisch-geburtshilfliche Rundschau     Full-text available via subscription   (Followers: 1)
Gynakologische Endokrinologie     Hybrid Journal  
Gynecologic and Obstetric Investigation     Full-text available via subscription   (Followers: 5)
Gynecologic Oncology     Hybrid Journal   (Followers: 28)
Gynecologic Oncology Reports     Open Access   (Followers: 11)
Gynecologic Oncology Research and Practice     Open Access   (Followers: 1)
Gynecological Endocrinology     Hybrid Journal   (Followers: 6)
Gynecological Surgery     Open Access   (Followers: 4)
Gynécologie Obstétrique & Fertilité     Full-text available via subscription   (Followers: 1)
Gynécologie Obstétrique Fertilité & Sénologie     Hybrid Journal   (Followers: 1)
Gynecology     Open Access  
Gynecology and Minimally Invasive Therapy     Open Access  
Gynecology Obstetrics & Reproductive Medicine     Open Access   (Followers: 1)
Health Care For Women International     Hybrid Journal   (Followers: 8)
Human Reproduction     Hybrid Journal   (Followers: 77)
Human Reproduction Open     Open Access   (Followers: 1)
Human Reproduction Update     Hybrid Journal   (Followers: 19)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Indian Journal of Gynecologic Oncology     Hybrid Journal  
Indonesian Journal of Obstetrics and Gynecology     Open Access  
Infectious Diseases in Obstetrics and Gynecology     Open Access   (Followers: 5)
International Journal of Anatomical Variations     Open Access  
International Journal of Childbirth     Hybrid Journal   (Followers: 8)
International Journal of Gynecological Cancer     Hybrid Journal   (Followers: 24)
International Journal of Gynecological Pathology     Hybrid Journal   (Followers: 9)
International Journal of Gynecology & Obstetrics     Hybrid Journal   (Followers: 26)
International Journal of Neonatal Screening     Open Access   (Followers: 3)
International Journal of Obstetric Anesthesia     Full-text available via subscription   (Followers: 14)
International Journal of Obstetrics, Perinatal and Neonatal Nursing     Full-text available via subscription  
International Journal of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 14)
International Journal of Reproductive Medicine     Open Access   (Followers: 5)
International Urogynecology Journal     Hybrid Journal   (Followers: 4)
Italian Journal of Anatomy and Embryology     Open Access   (Followers: 1)
Journal de Gynécologie Obstétrique et Biologie de la Reproduction     Full-text available via subscription  
Journal für Gynäkologische Endokrinologie / Schweiz     Hybrid Journal  
Journal für Gynäkologische Endokrinologie/Österreich     Hybrid Journal  
Journal of Assisted Reproduction and Genetics     Hybrid Journal   (Followers: 6)
Journal of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
Journal of Breast Health     Open Access  
Journal of Clinical Gynecology and Obstetrics     Open Access   (Followers: 7)
Journal of Endometriosis and Pelvic Pain Disorders     Hybrid Journal  
Journal of Evidence-based Care     Open Access   (Followers: 8)
Journal of Family Planning and Reproductive Health Care     Hybrid Journal   (Followers: 12)
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Gynecologic Surgery     Hybrid Journal   (Followers: 1)
Journal of Gynecology Obstetrics and Human Reproduction     Hybrid Journal  
Journal of Human Lactation     Hybrid Journal   (Followers: 30)
Journal of Human Reproductive Sciences (JHRS)     Open Access   (Followers: 3)
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Maternal and Child Health     Open Access  
Journal of Maternal-Fetal & Neonatal Medicine     Hybrid Journal   (Followers: 40)
Journal of Midwifery     Open Access   (Followers: 2)
Journal of Midwifery & Women's Health     Hybrid Journal   (Followers: 66)
Journal of Midwifery and Reproduction     Open Access   (Followers: 5)
Journal of Midwifery and Reproductive Health     Open Access   (Followers: 15)
Journal of Minimally Invasive Gynecology     Full-text available via subscription   (Followers: 12)
Journal of Neonatal-Perinatal Medicine     Hybrid Journal   (Followers: 14)
Journal of Obstetric Anaesthesia and Critical Care     Open Access   (Followers: 22)
Journal of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 36)
Journal of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 35)
Journal of Obstetrics and Gynaecology Canada     Hybrid Journal   (Followers: 1)
Journal of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 9)
Journal of Obstetrics and Gynecology of India     Hybrid Journal   (Followers: 4)
Journal of Obstetrics and Women's Diseases     Open Access  
Journal of Pediatric and Adolescent Gynecology     Full-text available via subscription   (Followers: 3)
Journal of Perinatal Education     Hybrid Journal   (Followers: 5)
Journal of Perinatal Medicine     Hybrid Journal   (Followers: 12)
Journal of Perinatology     Hybrid Journal   (Followers: 7)
Journal of Psychosomatic Obstetrics & Gynecology     Hybrid Journal   (Followers: 2)
Journal of Reproduction and Contraception     Full-text available via subscription   (Followers: 4)
Journal of Reproductive and Infant Psychology     Hybrid Journal   (Followers: 23)
Journal of Reproductive Biotechnology and Fertility     Open Access   (Followers: 2)
Journal of Reproductive Health and Medicine     Full-text available via subscription   (Followers: 2)
Journal of Reproductive Immunology     Hybrid Journal   (Followers: 2)
Jurnal Kebidanan Midwiferia     Open Access  
Jurnal Ners     Open Access  
La Revue Sage-Femme     Full-text available via subscription  
Majalah Obstetri & Ginekologi     Open Access  
Maternal Health, Neonatology and Perinatology     Open Access   (Followers: 9)
Menopause     Hybrid Journal   (Followers: 14)
Menopause International     Hybrid Journal   (Followers: 9)
MHR: Basic science of reproductive medicine     Hybrid Journal   (Followers: 2)
Middle East Fertility Society Journal     Open Access   (Followers: 3)
Midwifery     Hybrid Journal   (Followers: 74)
Midwifery Today     Full-text available via subscription   (Followers: 15)
Nascer e Crescer : Birth and Growth Medical Journal     Open Access  
Neonatal Network - Journal of Neonatal Nursing     Hybrid Journal   (Followers: 25)
Neonatology     Full-text available via subscription   (Followers: 48)
Nepal Journal of Obstetrics and Gynaecology     Open Access   (Followers: 2)
OA Women's Health     Open Access   (Followers: 1)
Obstetric Anesthesia Digest     Full-text available via subscription   (Followers: 1)
Obstetric Medicine     Hybrid Journal   (Followers: 8)
Obstetrical & Gynecological Survey     Hybrid Journal   (Followers: 14)
Obstetrics & Gynecology     Partially Free   (Followers: 93)
Obstetrics and Gynaecology Forum     Full-text available via subscription   (Followers: 1)
Obstetrics and Gynecology Clinics of North America     Full-text available via subscription   (Followers: 21)
Obstetrics and Gynecology International     Open Access   (Followers: 7)
Obstetrics, Gynaecology & Reproductive Medicine     Full-text available via subscription   (Followers: 17)
Open Journal of Obstetrics and Gynecology     Open Access   (Followers: 5)
Paediatric and Perinatal Epidemiology     Hybrid Journal   (Followers: 9)
Perinatología y Reproducción Humana     Open Access   (Followers: 1)
Perspectives On Sexual and Reproductive Health     Hybrid Journal   (Followers: 7)
Placenta     Hybrid Journal   (Followers: 2)
Postgraduate Obstetrics & Gynecology     Full-text available via subscription   (Followers: 1)
Proceedings in Obstetrics and Gynecology     Open Access   (Followers: 4)
Progresos de Obstetricia y Ginecología     Full-text available via subscription   (Followers: 1)
Reprodução & Climatério     Open Access   (Followers: 1)
Reproduction     Full-text available via subscription   (Followers: 7)
Reproduction Fertility and Development     Hybrid Journal   (Followers: 5)
Reproductive Biology and Endocrinology     Open Access   (Followers: 4)
Reproductive BioMedicine Online     Full-text available via subscription   (Followers: 9)
Reproductive Endocrinology     Open Access   (Followers: 3)
Reproductive Health     Open Access   (Followers: 2)
Reproductive Health Matters     Open Access   (Followers: 5)
Reproductive Medicine and Biology     Open Access   (Followers: 3)
Reproductive Sciences     Hybrid Journal   (Followers: 1)
Research and Reports in Neonatology     Open Access   (Followers: 5)
Research in Obstetrics and Gynecology     Open Access   (Followers: 2)
Research Journal of Obstetrics and Gynecology     Open Access   (Followers: 5)
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics     Open Access  
Revista Chilena de Obstetricia y Ginecologia     Open Access   (Followers: 1)
Revista Cubana de Obstetricia y Ginecología     Open Access  
Revista Internacional de Andrología     Full-text available via subscription  
Revista Peruana de Ginecología y Obstetricia     Open Access  
Revue de médecine périnatale     Hybrid Journal   (Followers: 1)
Scientific Journal of Hamadan Nursing & Midwifery Faculty     Open Access   (Followers: 1)
Seksuologia Polska     Full-text available via subscription  
Seminars in Breast Disease     Hybrid Journal   (Followers: 1)
Seminars in Perinatology     Hybrid Journal   (Followers: 21)
Seminars in Reproductive Medicine     Hybrid Journal  
Sexes     Open Access  
Siklus : Journal Research Midwifery Politeknik Tegal     Open Access   (Followers: 2)
South African Journal of Obstetrics and Gynaecology     Open Access   (Followers: 2)
Southern African Journal of Gynaecological Oncology     Open Access   (Followers: 1)
Sri Lanka Journal of Obstetrics and Gynaecology     Open Access   (Followers: 1)
Systems Biology in Reproductive Medicine     Hybrid Journal  
Taiwanese Journal of Obstetrics and Gynecology     Open Access   (Followers: 1)
Teratology Studies     Open Access  
Thai Journal of Obstetrics and Gynaecology     Open Access  
The Obstetrician & Gynaecologist     Hybrid Journal   (Followers: 7)
The Practising Midwife     Full-text available via subscription   (Followers: 7)
Trends in Urology Gynaecology & Sexual Health     Hybrid Journal   (Followers: 2)
Tropical Journal of Obstetrics and Gynaecology     Open Access   (Followers: 2)
Ultrasound in Obstetrics and Gynecology     Hybrid Journal   (Followers: 22)

        1 2 | Last

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Obstetrics & Gynecology
Journal Prestige (SJR): 2.563
Citation Impact (citeScore): 3
Number of Followers: 93  
 
  Partially Free Journal Partially Free Journal
ISSN (Print) 0029-7844 - ISSN (Online) 1873-233X
Published by LWW Wolters Kluwer Homepage  [299 journals]
  • Ovarian Cancer Care in the Affordable Care Act Era: Ovarian Cancer
           Breaking the Silence'
    • Authors: Bull Phelps; Shawna L.; Jackson-Moore, Lisa A.
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Association of the Affordable Care Act With Ovarian Cancer Care
    • Authors: Smith; Anna Jo Bodurtha; Fader, Amanda Nickles
      Abstract: imageOBJECTIVE: To estimate how implementation of the 2010 Affordable Care Act (ACA) might be associated with stage at diagnosis and time to treatment for women with ovarian cancer.METHODS: We conducted a retrospective cohort study using difference-in-differences analysis comparing stage at diagnosis and time to treatment before and after implementation of the ACA among women with ovarian cancer aged 21–64 years (exposure group) compared with women aged 65 years or older (control group). Using 2004–2015 data from the National Cancer Database, outcomes were analyzed overall and by insurance type and race, adjusting for urban-rural, income and education level, comorbidities, distance traveled for care, region, and care at an academic center.RESULTS: A total of 39,999 ovarian cancer cases prereform and 36,564 postreform were identified for women aged 21–64 years compared with 31,290 cases prereform and 29,807 postreform for women aged 65 years or older. The ACA was associated with increased early-stage diagnosis detection for women aged 21–64 years compared with women 65 and older (difference-in-differences 1.4%, 95% CI 0.4–2.4). The ACA was associated with more women receiving treatment within 30 days of ovarian cancer diagnosis (2.3%, 95% CI 1.7–3.0). Among women with public insurance, the ACA was associated with a significant improvement in early-stage diagnosis and receipt of treatment within 30 days of diagnosis (difference-in-differences 2.7%, 95% CI 1.0–4.5, difference-in-differences 2.5%, 95% CI 1.2–3.8). Improvements in time to treatment were seen across race and income groups.CONCLUSION: Implementation of the ACA was associated with earlier ovarian cancer stage at detection and treatment within 30 days of diagnosis.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Hysterectomy in Residency Training: The New Numbers Game'
    • Authors: Guntupalli; Saketh R.
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Hysterectomy Route and Numbers Reported by Graduating Residents in
           Obstetrics and Gynecology Training Programs
    • Authors: Gressel; Gregory M.; Potts, John R. III; Cha, Sandolsam; Valea, Fidel A.; Banks, Erika
      Abstract: imageOBJECTIVE: To characterize trends in self-reported numbers and routes of hysterectomy for obstetrics and gynecology residents using the Accreditation Council for Graduate Medical Education (ACGME) case log database.METHODS: Hysterectomy case log data for obstetrics and gynecology residents completing training between 2002–2003 and 2017–2018 were abstracted from the ACGME database. Total numbers of hysterectomies and modes of approach (abdominal, laparoscopic, and vaginal) were compared using bivariate statistics, and trends over time were analyzed using simple linear regression.RESULTS: Hysterectomy data were collected from 18,982 obstetrics and gynecology residents in a median of 243 (interquartile range 241–246) ACGME-accredited programs. The number of graduating residents increased significantly over time (12.1/year, P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Maternal Mortality: Addressing Disparities and Measuring What We Value
    • Authors: Callaghan; William M.
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Racial Inequities in Preventable Pregnancy-Related Deaths in Louisiana,
           2011–2016
    • Authors: Mehta; Pooja K.; Kieltyka, Lyn; Bachhuber, Marcus A.; Smiles, Dana; Wallace, Maeve; Zapata, Amy; Gee, Rebekah E.
      Abstract: imageOBJECTIVE: To examine preventable pregnancy-related deaths in Louisiana by race and ethnicity and maternal level of care to inform quality improvement efforts.METHODS: We conducted a retrospective observational descriptive analysis of Louisiana Pregnancy-Associated Mortality Review data of 47 confirmed pregnancy-related deaths occurring from 2011 to 2016. The review team determined cause of death, preventability, and contributing factors. We compared preventability by race–ethnicity and maternal level of care of the facility where death occurred (from level I: basic care to level IV: regional perinatal health center) using odds ratios (ORs) and 95% CIs.RESULTS: The rate of pregnancy-related death among non-Hispanic black women (22.7/100,000 births, 95% CI 15.5–32.1, n=32/140,785) was 4.1 times the rate among non-Hispanic white women (5.6/100,000, 95% CI 2.8–10.0, n=11/197,630). Hemorrhage (n=8/47, 17%) and cardiomyopathy (n=8/47, 17%) were the most common causes of pregnancy-related death. Among non-Hispanic black women who experienced pregnancy-related death, 59% [n=19] of deaths were deemed potentially preventable, compared with 9% (n=1) among non-Hispanic white women (OR 14.6, 95% CI 1.7–128.4). Of 47 confirmed pregnancy-related deaths, 58% (n=27) occurred at level III or IV birth facilities. Compared with those at level I or II birth facilities (n=2/4, 50%), pregnancy-related deaths occurring at level III or IV birth facilities (n=14/27, 52%) were not less likely to be categorized as preventable (OR 2.0, 95% CI 0.5–8.0).CONCLUSION: Compared with non-Hispanic white women, pregnancy-related deaths that occurred among non-Hispanic black women in Louisiana from 2011 to 2016 were more likely to be preventable. The proportion of deaths that were preventable was similar between lower and higher level birth facilities. Hospital-based quality improvement efforts focused on addressing hemorrhage, hypertension, and associated racial inequities may prevent pregnancy-related deaths in Louisiana.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal
           Morbidity Disparities
    • Authors: Howell; Elizabeth A.; Egorova, Natalia N.; Janevic, Teresa; Brodman, Michael; Balbierz, Amy; Zeitlin, Jennifer; Hebert, Paul L.
      Abstract: imageOBJECTIVE: To examine within-hospital racial and ethnic disparities in severe maternal morbidity rates and determine whether they are associated with differences in types of medical insurance.METHODS: We conducted a population-based, cross-sectional study using linked 2010–2014 New York City discharge and birth certificate data sets (N=591,455 deliveries) to examine within-hospital black–white, Latina–white, and Medicaid–commercially insured differences in severe maternal morbidity. We used logistic regression to produce risk-adjusted rates of severe maternal morbidity for patients with commercial and Medicaid insurance and for black, Latina, and white patients within each hospital. We compared these within-hospital adjusted rates using paired t-tests and conditional logit models.RESULTS: Severe maternal morbidity was higher among black and Latina women than white women (4.2% and 2.9% vs 1.5%, respectively, P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Severe Maternal Morbidity and Mortality Among Indigenous Women in the
           United States
    • Authors: Kozhimannil; Katy B.; Interrante, Julia D.; Tofte, Alena N.; Admon, Lindsay K.
      Abstract: imageOBJECTIVE: To describe delivery-related severe maternal morbidity and mortality among indigenous women compared with non-Hispanic white (white) women, distinguishing rural and urban residents.METHODS: We used 2012–2015 maternal hospital discharge data from the National Inpatient Sample to conduct a pooled, cross-sectional analysis of indigenous and white patients who gave birth. We used weighted multivariable logistic regression and predictive population margins to measure health conditions and severe maternal morbidity and mortality (identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes) among indigenous and white patients, to test for differences across both groups, and to test for differences between rural and urban residents within each racial category.RESULTS: We identified an estimated 7,561,729 (unweighted n=1,417,500) childbirth hospitalizations that were included in the analyses. Of those, an estimated 101,493 (unweighted n=19,080) were among indigenous women, and an estimated 7,460,236 (unweighted n=1,398,420) were among white women. The incidence of severe maternal morbidity and mortality was greater among indigenous women compared with white women (2.0% vs 1.1%, respectively; relative risk [RR] 1.8, 95% CI 1.6–2.0). Within each group, incidence was higher among rural compared with urban residents (2.3% for rural indigenous women vs 1.8% for urban indigenous women [RR 1.3, 95% CI 1.0–1.6]; 1.3% for rural white women vs 1.2% for urban white women [RR 1.1, 95% CI 1.1–1.2]).CONCLUSION: Severe maternal morbidity and mortality is elevated among indigenous women compared with white women. Incidence is highest among rural indigenous residents. Efforts to improve maternal health should focus on populations at greatest risk, including rural indigenous populations.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Association of Acculturation With Adverse Pregnancy Outcomes
    • Authors: Premkumar; Ashish; Debbink, Michelle P.; Silver, Robert M.; Haas, David M.; Simhan, Hyagriv N.; Wing, Deborah A.; Parry, Samuel; Mercer, Brian M.; Iams, Jay; Reddy, Uma M.; Saade, George; Grobman, William A.
      Abstract: imageOBJECTIVE To evaluate the relationship between acculturation and adverse pregnancy outcomes, and whether these relationships differ across racial or ethnic groups.METHODS This is a planned secondary analysis of the nuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study of 10,038 pregnant women at eight academic health care centers in the United States. Nulliparous pregnant women with singleton gestations were recruited between 6 0/7 and 13 6/7 weeks of gestation from October 2010–September 2013. Acculturation was defined by birthplace (United States vs non–United States), language used during study visits (English or Spanish), and self-rated English proficiency. The adverse pregnancy outcomes of interest were preterm birth (less than 37 weeks of gestation, both iatrogenic and spontaneous), preeclampsia or eclampsia, gestational hypertension, gestational diabetes, stillbirth, small for gestational age, and large for gestational age. Multivariable regression modeling was performed, as was an interaction analysis focusing on the relationship between acculturation and adverse pregnancy outcomes by maternal race or ethnicity.RESULTS Of the 10,006 women eligible for this analysis, 8,100 (80.9%) were classified as more acculturated (eg, born in the United States with high English proficiency), and 1,906 (19.1%) were classified as having less acculturation (eg, born or not born in the United States with low proficiency in English or use of Spanish as the preferred language during study visits). In multivariable logistic regression modeling, more acculturation was significantly associated with higher frequency of preterm birth (odds ratio [OR] 1.46, adjusted odds ratio [aOR] 1.50, 95% CI 1.16–1.95); spontaneous preterm birth (OR 1.54, aOR 1.62, 95% CI 1.14–2.24); preeclampsia or eclampsia (OR 1.39, aOR 1.31, 95% CI 1.03–1.67); preeclampsia without severe features (OR 1.44, aOR 1.43, 95% CI 1.03–2.01); and gestational hypertension (OR 1.68, aOR 1.48, 95% CI 1.22–1.79). These associations did not differ by self-described race or ethnicity.CONCLUSION In a large cohort of nulliparous women, more acculturation, regardless of self-described race or ethnicity, was associated with increased odds of several adverse pregnancy outcomes.CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01322529.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Lidocaine–Prilocaine Cream Compared With Injected Lidocaine for Vulvar
           Biopsy: A Randomized Controlled Trial
    • Authors: Williams; Logan K.; Weber, Jeremy M.; Pieper, Carl; Lorenzo, Amelia; Moss, Haley; Havrilesky, Laura J.
      Abstract: imageOBJECTIVE: To compare pain control during vulvar biopsy after either application of 5% lidocaine–prilocaine cream or injection of 1% lidocaine.METHODS: In a single-site randomized trial, patients who needed vulvar biopsy on a non–hair-bearing surface were recruited from a gynecologic oncology clinic to compare lidocaine–prilocaine cream (placed at least 10 minutes before biopsy) with lidocaine injection (at least 1 minute prior). A sample size of 53 participants in each arm (N=106) was planned. Pain was recorded using a 100 mm visual analog scale at three time points: baseline, after application of anesthesia, and after biopsy. The primary outcome was highest pain score recorded. Secondary outcomes were pain score at biopsy, patient experience, and tolerability and acceptability. Linear regression was used to compare the primary outcome between arms while controlling for baseline vulvar pain. A convenience analysis was performed in March 2019.RESULTS: From October 2018 to March 2019, 38 patients completed informed consent and were randomized. Participants were women with median age of 60 years. Most characteristics between groups were similar. Nineteen were analyzed in the lidocaine–prilocaine group, and 18 were analyzed in the lidocaine injection group. The median highest pain score in the lidocaine–prilocaine group was 20.0 mm vs 56.5 mm in the lidocaine injection group. Controlling for baseline pain, the highest pain score in the lidocaine–prilocaine arm was 25.7 mm lower than in the lidocaine injection arm (95% CI [−45.1 to −6.3]; P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Relative Risk of Cervical Neoplasms Among Copper and
           Levonorgestrel-Releasing Intrauterine System Users
    • Authors: Spotnitz; Matthew E.; Natarajan, Karthik; Ryan, Patrick B.; Westhoff, Carolyn L.
      Abstract: imageOBJECTIVE: To evaluate the relative risk of cervical neoplasms among copper intrauterine device (Cu IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) users.METHODS: We performed a retrospective cohort analysis of 10,674 patients who received IUDs at Columbia University Medical Center. Our data were transformed to a common data model and are part of the Observational Health Data Sciences and Informatics network. The cohort patients and outcomes were identified by a combination of procedure codes, condition codes, and medication exposures in billing and claims data. We adjusted for confounding with propensity score stratification and propensity score 1:1 matching.RESULTS: Before propensity score adjustment, the Cu IUD cohort included 8,274 patients and the LNG-IUS cohort included 2,400 patients. The median age for both cohorts was 29 years at IUD placement. More than 95% of the LNG-IUS cohort used a device with 52 mg LNG. Before propensity score adjustment, we identified 114 cervical neoplasm outcomes. Seventy-seven (0.9%) cervical neoplasms were in the Cu IUD cohort and 37 (1.5%) were in the LNG-IUS cohort. The propensity score matching analysis identified 7,114 Cu IUD and 2,174 LNG-IUS users, with covariate balance achieved over 16,827 covariates. The diagnosis of high-grade cervical neoplasia was 0.7% in the Cu IUD cohort and 1.8% in the LNG-IUS cohort (2.4 [95% CI 1.5–4.0] cases/1,000 person-years and 5.2 [95% CI 3.7–7.1] cases/1,000 person-years, respectively). The relative risk of high-grade cervical neoplasms among Cu IUD users was 0.38 (95% CI 0.16–0.78, P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • A Risk-Adjusted Model for Ovarian Cancer Care and Disparities in Access to
           High-Performing Hospitals
    • Authors: Bristow; Robert E.; Chang, Jenny; Villanueva, Carolina; Ziogas, Argyrios; Vieira, Veronica M.
      Abstract: imageOBJECTIVE: To validate the observed/expected ratio for adherence to ovarian cancer treatment guidelines as a risk-adjusted measure of hospital quality care, and to identify patient characteristics associated with disparities in access to high-performing hospitals.METHODS: This was a retrospective population-based study of stage I–IV invasive epithelial ovarian cancer reported to the California Cancer Registry between 1996 and 2014. A fit logistic regression model, which was risk-adjusted for patient and disease characteristics, was used to calculate the observed/expected ratio for each hospital, stratified by hospital annual case volume. A Cox proportional hazards model was used for survival analyses, and a multivariable logistic regression model was used to identify independent predictors of access to high-performing hospitals.RESULTS: The study population included 30,051 patients who were treated at 426 hospitals: low observed/expected ratio (n=304) 23.5% of cases; intermediate observed/expected ratio (n=92) 57.8% of cases; and high observed/expected ratio (n=30) 18.7% of cases. Hospitals with high observed/expected ratios were significantly more likely to deliver guideline-adherent care (53.3%), compared with hospitals with intermediate (37.8%) and low (27.5%) observed/expected ratios (P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With
           Late Consequences of a Poorly Healed Second-Degree Perineal Tear: A
           Randomized Controlled Trial
    • Authors: Bergman; Ida; Westergren Söderberg, Marie; Ek, Marion
      Abstract: imageOBJECTIVE: To evaluate outcomes after pelvic floor muscle therapy, as compared with perineorrhaphy and distal posterior colporrhaphy, in the treatment of women with a poorly healed second-degree obstetric injury diagnosed at least 6 months postpartum.METHODS: We performed a single center, open-label, randomized controlled trial. After informed consent, patients with a poorly healed second-degree perineal tear at minimum 6 months postpartum were randomized to either surgery or physical therapy. The primary outcome was treatment success, as defined by Patient Global Impression of Improvement, at 6 months. Secondary outcomes included the Pelvic Floor Distress Inventory, the Pelvic Floor Impact Questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, and the Hospital Anxiety and Depression Scale. Assuming a 60% treatment success in the surgery group and 20% in the physical therapy group, plus anticipating a 20% loss to follow-up, a total of 70 patients needed to be recruited.RESULTS: From October 2015 to June 2018, 70 of 109 eligible patients were randomized, half into surgery and half into tutored pelvic floor muscle therapy. The median age of the study group was 35 years, and the median duration postpartum at enrollment in the study was 10 months. There were three dropouts in the surgery group postrandomization. In an intention-to-treat analysis, with worst case imputation of missing outcomes, subjective global improvement was reported by 25 of 35 patients (71%) in the surgery group compared with 4 of 35 patients (11%) in the physical therapy group (treatment effect in percentage points 60% [95% CI 42–78%], odds ratio 19 [95% CI 5–69]). The surgery group was superior to physical therapy regarding all secondary endpoints.CONCLUSION: Surgical treatment is effective and superior to pelvic floor muscle training in relieving symptoms related to a poorly healed second-degree perineal tear in women presenting at least 6 months postpartum.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02545218.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Effect of Surgery for Stress Incontinence on Female Sexual Function
    • Authors: Glass Clark; Stephanie M.; Huang, Qi; Sima, Adam P.; Siff, Lauren N.
      Abstract: imageOBJECTIVE: To evaluate the effects of four different surgical interventions for stress urinary incontinence (SUI) on 2-year postoperative sexual function.METHODS: This is a combined secondary analysis of SISTEr (Stress Incontinence Surgical Treatment Efficacy Trial) and TOMUS (Trial of Mid-Urethral Slings). Women in the original trials were randomized to receive surgical treatment for SUI with an autologous fascial sling or Burch colposuspension (SISTEr), or a retropubic or transobturator midurethral sling (TOMUS). Sexual function (assessed by the short version of the PISQ-12 [Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire]) was compared between groups at baseline, 12 and 24 months. Secondarily, the effects of subjective and objective surgical cure rates and the effect of concomitant surgical procedures on 24-month sexual function was explored.RESULTS: Nine hundred twenty-four women were included in this study: 249 (26.9%) had an autologous fascial sling, 239 (25.9%) underwent Burch colposuspension, 216 (23.3%) had a retropubic midurethral sling placed, and 220 (23.8%) had transobturator midurethral sling placed. Baseline characteristics (including PISQ-12 scores) were similar between the four treatment arms, with notable exceptions including race–ethnicity, prolapse stage, concomitant surgery, and number of vaginal deliveries. After adjustment for differences between the groups, there was a clinically important improvement in PISQ-12 scores over the 24-month postoperative period for all treatment groups, with no significant differences attributed to the type of anti-incontinence procedure (baseline PISQ-12: 32.6, 33.1, 31.9, 31.4; 24-month PISQ-12: 37.7, 37.8, 36.9, 37.1, P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Sexual and Reproductive Health Characteristics of Women in Substance Use
           Treatment in Michigan
    • Authors: MacAfee; Lauren K.; Harfmann, Roxanne F.; Cannon, Lindsay M.; Kolenic, Giselle; Kusunoki, Yasamin; Terplan, Mishka; Dalton, Vanessa K.
      Abstract: imageOBJECTIVE: To evaluate the sexual and reproductive health characteristics of women in treatment for opioid use disorder in Michigan and explore services provided and desired.METHODS: We conducted a cross-sectional study of female patients aged 18–50 years who accessed opioid use disorder treatment at 22 randomly selected facilities in Michigan from December 2015 to May 2017. Computer-assisted self-interviews were completed using online survey management software to assess prior substance use and use disorder treatment, sexual and reproductive health history, and sexual and reproductive health services received in the previous 12 months through a treatment program, and desire for and barriers to sexual and reproductive health services within substance use disorder treatment. Descriptive statistics were calculated.RESULTS: The final sample consisted of 260 participants. About half (51.5%) had ever had an abnormal Pap test result, and 57.3% had ever tested positive for a sexually transmitted infection. Unintended pregnancy was common (61.2%), as was substance use during pregnancy (74.2%). Nearly half (46.5%) were not currently using a method of contraception, and only 28.5% were using a highly effective method. Common barriers to accessing reproductive health services included fear of being treated poorly or judged because of substance use, fear of child protective services, and structural barriers such as cost and lack of transportation. Most participants (80.4%) indicated interest in receiving sexual and reproductive health services on site or by referral from their substance use disorder treatment programs.CONCLUSION: Women in treatment for opioid use disorder in Michigan have high rates of adverse sexual and reproductive health experiences and face barriers to accessing care.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Telehealth Interventions to Improve Obstetric and Gynecologic Health
           Outcomes: A Systematic Review
    • Authors: DeNicola; Nathaniel; Grossman, Daniel; Marko, Kathryn; Sonalkar, Sarita; Butler Tobah, Yvonne S.; Ganju, Nihar; Witkop, Catherine T.; Henderson, Jillian T.; Butler, Jessica L.; Lowery, Curtis
      Abstract: imageOBJECTIVE: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews.TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms.CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Diffuse Large B-Cell Lymphoma During Third-Trimester Pregnancy and
           Lactation
    • Authors: Hersey; Alicia E.; Giglio, Patricia; Kurt, Habibe; Tarabulsi, Gofran; Chen, Kenneth K.
      Abstract: imageBACKGROUND: Diffuse large B-cell lymphoma is the most common type of non-Hodgkin's lymphoma affecting pregnancy. These tumors may be aggressive and rapidly growing in pregnancy. Management is based on the balance of risks and benefits to both the pregnant patient and the fetus.CASE: We present a case of diffuse large B-cell lymphoma diagnosed in the third trimester of pregnancy. The patient underwent labor induction at 34 weeks of gestation, started a standard chemotherapy protocol postpartum, and breastfed following a timed lactation protocol.CONCLUSION: Management of lymphoma during pregnancy highlights the need to consider all aspects of proposed oncologic and obstetric care as well as neonatal risks. Considerations highlighted in this case include staging methods, administration of antenatal steroids, timing of delivery, and lactation during chemotherapy.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Reported Prevalence of Maternal Hepatitis C Virus Infection in the United
           States
    • Authors: Rossi; Robert M.; Wolfe, Christopher; Brokamp, Richard; McAllister, Jennifer M.; Wexelblatt, Scott; Warshak, Carri R.; Hall, Eric S.
      Abstract: imageOBJECTIVE: To quantify the reported prevalence and trend of maternal hepatitis C virus (HCV) infection in the United States (2009–2017) and identify maternal characteristics and obstetric outcomes associated with HCV infection during pregnancy.METHODS: We conducted a population-based retrospective cohort study of all live births in the United States for the period 2009 through 2017 using National Center for Health Statistics birth records. We estimated reported prevalence and trends over this time period for the United States. We also evaluated demographic factors and pregnancy outcomes associated with maternal HCV infection for a contemporary U.S. cohort (2014–2017).RESULTS: During the 9-year study period, there were 94,824 reported cases of maternal HCV infection among 31,207,898 (0.30%) live births in the United States. The rate of maternal HCV infection increased from 1.8 cases per 1,000 live births to 4.7 cases per 1,000 live births (relative risk [RR] 2.7, 95% CI 2.6–2.8) in the United States. After adjusting for various confounders in the contemporary U.S. cohort (2014–2017), demographic characteristics associated with HCV infection included non-Hispanic white race (adjusted RR 2.8, 95% CI 2.7–2.8), Medicaid insurance (adjusted RR 3.3, CI 3.2–3.3), and cigarette smoking (adjusted RR 11.1, CI 10.9–11.3). Co-infection during pregnancy with hepatitis B (adjusted RR 19.2, CI 18.1–20.3), gonorrhea, chlamydia, or syphilis were also associated with maternal HCV infection. Obstetric and neonatal outcomes associated with maternal HCV infection included cesarean delivery, preterm birth, maternal intensive care unit admission, blood transfusion, having small-for-gestational-age neonates (less than the 10th percentile) birth weight, neonatal intensive care unit admission, need for assisted neonatal ventilation, and neonatal death.CONCLUSION: The reported prevalence of maternal HCV infection has increased 161% from 2009 to 2017.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Acute Herpes Simplex Virus Hepatitis in Pregnancy
    • Authors: Calix; Roberto X.; Loeliger, Kelsey B.; Burn, Martina S.; Campbell, Katherine H.
      Abstract: imageBACKGROUND: Herpes simplex virus (HSV) causes only 2–4% of all acute hepatitis but has high morbidity and mortality. Pregnancy is a risk factor for HSV hepatitis. We describe a case of gestational HSV hepatitis.CASE: A 32-year old woman, gravida 2 para 1, presented at 38 2/7 weeks of gestation with back pain and fetal tachycardia. She became febrile after admission, had spontaneous rupture of membranes, and was delivered by cesarean for malpresentation. Postpartum, she became persistently febrile and developed transaminitis, symptomatic hypotension, and pancytopenia despite antibiotics. Imaging revealed acute liver injury, splenomegaly, pleural effusions, and cardiomyopathy. Serum polymerase chain reaction (PCR) screening identified HSV-1 infection. The patient recovered on acyclovir. There was no evidence of neonatal seroconversion.CONCLUSION: Herpes simplex virus hepatitis causes significant morbidity, and pregnant women are susceptible to severe infections. Pregnant or peripartum women with acute febrile hepatitis require prompt evaluation for HSV with serum PCR screening.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Penicillin Allergy in Pregnancy: Moving From “Rash” Decisions
           to Accurate Diagnosis
    • Authors: Turrentine; Mark A.; King, Tekoa L.; Silverman, Neil S.
      Abstract: imageThe emergence of beta-lactam–resistant pathogenic organisms has resulted in limitation or even elimination of drugs such as penicillin and ampicillin from available antibiotic choices for treating common infections in obstetrics and gynecology. In clinical situations for which penicillins and cephalosporins are appropriate or recommended first-line agents, the problem of patient-reported penicillin allergies has led to routine use of alternative but potentially less effective agents. The use of broader-spectrum and potentially suboptimal alternative antibiotic regimens for intrapartum antibiotic prophylaxis against group B streptococcus or for surgical prophylaxis for cesarean delivery in women with a reported penicillin allergy may affect these women during labor and birth. Most individuals who report a penicillin allergy are neither truly allergic nor at risk of developing a hypersensitivity reaction after exposure to penicillin. The available evidence suggests that there are important roles for both targeted history-taking, to determine the nature of drug allergies and penicillin allergy testing in pregnant women, to optimize their antibiotic-related treatment both during pregnancy and for their lifetimes. Wider consideration and adoption of penicillin allergy testing in pregnant women specifically, as well as the general population of women cared for by providers of obstetrics and gynecology, is recommended.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Operative Technique and Experience of One Referral Center With Vaginal
           Cesarean Delivery
    • Authors: Delplanque; Sophie; Le Lous, Maela; Isly, Hélène; Coiffic, Jean; Lassel, Linda; Levêque, Jean; Lavoué, Vincent; Nyangoh Timoh, Krystel
      Abstract: imageBACKGROUND: To report the experience of vaginal cesarean delivery and describe the surgical technique.METHOD: This is a retrospective case series from one referral center of patients who underwent vaginal cesarean delivery from 2000 to 2017, presenting a step-by-step operative technique with a video. The operative technique consists of: 1) development of a transvaginal bladder flap by dissecting the bladder off the cervix, thereby exposing the lower uterine segment; 2) making a vertical segment incision up to the highest part of the lower uterine segment, just below the muscular portion of the uterus; 3) extraction of the fetus; and 4) reconstruction of the lower uterine segment and vagina.EXPERIENCE: Seven patients with maternal indications for urgent premature delivery who underwent vaginal cesarean delivery were included. Indications were severe bleeding (n=3), severe previable preeclampsia (n=2), severe heart failure (n=1), and stroke (n=1). The average gestational age at delivery was 21 2/7 weeks (18 2/7–24 1/7 weeks); median fetal birth weight was 300 g (179–500 g). There were no intraoperative complications attributable to the procedure.CONCLUSION: Vaginal cesarean delivery is a valuable technique for rapid fetal extraction of deceased or nonviable fetuses for severe maternal indications.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • A Quality Improvement Initiative to Increase the Frequency of Vaginal
           Delivery in Brazilian Hospitals
    • Authors: Borem; Paulo; de Cássia Sanchez, Rita; Torres, Jacqueline; Delgado, Pedro; Petenate, Ademir Jose; Peres, Daniel; Parry, Gareth; Pilar Betrán, Ana; Barker, Pierre
      Abstract: imageOBJECTIVE: To evaluate a quality improvement (QI) initiative designed to increase the frequency of vaginal delivery in Brazilian hospitals.METHODS: Twenty-eight hospitals enrolled in a 20-month (May 2015–December 2016) Breakthrough Series Collaborative that used QI methods to increase implementation of obstetric approaches with potential to increase the frequency of vaginal delivery. All hospitals contributed qualitative data for iterative redesign. Thirteen intervention hospitals with complete data contributed to an analysis of changes in vaginal delivery in a targeted population over time. Hospitals from the São Paulo region (five intervention and eight nonintervention) contributed to a comparator analysis of changes in vaginal delivery for all deliveries over time.INTERVENTION: Most hospitals targeted low-risk pregnancies in primiparous women, delivered by hospital-employed obstetricians or admitted through emergency departments, and some included all pregnant women. The collaborative tested four interventions to increase vaginal delivery: 1) coalition building of stakeholders with the common purpose of ensuring “appropriate delivery,” 2) empowering pregnant women to choose their preferred mode of delivery, 3) implementation of new care models favoring physiologic birth, and 4) improved information systems for continuous learning by health care providers.RESULTS: For 119,378 targeted deliveries (36% of all deliveries) in 13 intervention hospitals, vaginal delivery increased from 21.5% in 2014 to 34.8% in 2016, a relative increase of 1.62 (95% CI 1.27–2.07, P
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Ropivacaine and Ketorolac Wound Infusion for Post–Cesarean Delivery
           Analgesia: A Randomized Controlled Trial
    • Authors: Barney; Emily Z.; Pedro, Christina D.; Gamez, Brock H.; Fuller, Matthew E.; Dominguez, Jennifer E.; Habib, Ashraf S.
      Abstract: imageOBJECTIVE: To evaluate the efficacy of wound infusion with ropivacaine plus ketorolac compared with placebo for post–cesarean delivery analgesia in women who received a multimodal analgesic regimen including intrathecal morphine.METHODS: In a randomized double-blind study, women undergoing scheduled cesarean delivery under spinal or combined spinal epidural anesthesia were randomized to wound infusion with ropivacaine 0.2% plus ketorolac, or saline placebo using an elastometric pump for 48 hours. The primary outcome was pain score with movement at 24 hours after surgery (0–10 scale, 0=no pain and 10=worst possible pain). Secondary outcomes included pain scores at rest at 24 hours, pain scores at rest and with movement at 2 and 48 hours, opioid consumption, and time to first rescue analgesic. A sample size of 35 per group (n=70) was planned.RESULTS: From November 8, 2016, to May 17, 2019, 247 women were screened, and 71 completed the study per protocol: 38 in the placebo group and 33 in the ropivacaine plus ketorolac group. Patient demographics and intraoperative characteristics were comparable between the groups. There was no significant difference between the groups in the primary outcome of pain score with movement at 24 hours (difference in median score 0, 95% CI −1 to 2, P=.94). There were also no significant differences between the placebo and ropivacaine plus ketorolac groups in pain scores at other time points, in total opioid consumption (difference in median consumption −12.5 mg, 95% CI −30 to 5, P=.11), or in time to rescue analgesics (median [interquartile range] 660 [9–1,496] vs 954 [244–1,710] minutes, hazard ratio 0.69, 95% CI 0.41 to 1.17, P=.16).CONCLUSION: There was no benefit of wound infusion with ropivacaine and ketorolac in women who received intrathecal morphine and a multimodal analgesic regimen.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02829944.FUNDING SOURCE: The study was supported in part by Avanos Medical Inc.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Association of Oxytocin Use and Artificial Rupture of Membranes With
           Cesarean Delivery in France
    • Authors: Girault; Aude; Bonnet, Camille; Goffinet, François; Blondel, Béatrice; Le Ray, Camille
      Abstract: imageOBJECTIVE: To evaluate whether the decrease in the frequency of oxytocin administration and artificial rupture of membranes observed between the 2010 and 2016 French Perinatal Surveys was associated with a change in the frequency of cesarean delivery or cesarean delivery indications among women who entered labor spontaneously.METHODS: This cross-sectional study included women who participated in the 2010 and 2016 French National surveys who had singleton pregnancies and who gave birth at at least 37 weeks of gestation after spontaneous labor to a liveborn neonate in cephalic presentation. To test whether the observed decrease of oxytocin administration and artificial rupture of membranes between the two study years was explained by the women's individual characteristics and maternity units' organizational characteristics change, multivariable analyses were performed. The same strategy was applied for the change in intrapartum cesarean delivery rates between the 2 years. These analyses were repeated in nulliparous, low obstetric risk women, multiparous low obstetric risk women, and women with a previous cesarean delivery. The cesarean delivery indications were compared in 2010 and 2016.RESULTS: Oxytocin administration decreased significantly from 58.3% in 2010 to 45.2% in 2016 (adjusted odds ratio [aOR] 0.51; 95% CI 0.47–0.55), as did artificial rupture of membranes, from 52.4% to 42.6% (aOR 0.66; 95% CI 0.62–0.71). The intrapartum cesarean delivery rate remained stable—6.9% compared with 6.6% (aOR 0.93; 95% CI 0.82–1.06). The same patterns were observed in low risk groups and women with a previous cesarean delivery. The cesarean delivery indications were similar in both years.CONCLUSION: The significant decrease in oxytocin administration and artificial rupture of membranes in 2016 compared with 2010 was not accompanied by an increase in the intrapartum cesarean delivery rate for women in France who entered labor spontaneously. These results support the recent international guidelines.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Patient Decision Aids to Facilitate Shared Decision Making in Obstetrics
           and Gynecology: A Systematic Review and Meta-analysis
    • Authors: Poprzeczny; Amanda J.; Stocking, Katie; Showell, Marian; Duffy, James M. N.
      Abstract: imageOBJECTIVE: To assess the effectiveness of patient decision aids to facilitate shared decision making in obstetrics and gynecology.DATA SOURCES: We searched ClinicalTrials.gov, MEDLINE, CENTRAL, Cochrane Gynaecology and Fertility specialized register, CINAHL, and EMBASE from 1946 to July 2019.METHODS OF STUDY SELECTION: We selected randomized controlled trials comparing patient decision aids with usual clinical practice or a control intervention.TABULATION, INTEGRATION, AND RESULTS: Thirty-five randomized controlled trials, which reported data from 9,790 women, were included. Patient decision aids were evaluated within a wide range of clinical scenarios relevant to obstetrics and gynecology, including contraception, vaginal birth after cesarean delivery, and pelvic organ prolapse. Study characteristics and quality were recorded for each study. The meta-analysis was based on random-effects methods for pooled data. A standardized mean difference of 0.2 is considered small, 0.5 moderate, and 0.8 large. When compared with usual clinical practice, the use of patient decision aids reduced decisional conflict (standardized mean difference −0.23; 95% CI −0.36, to −0.11; 19 trials; 4,624 women) and improved patient knowledge (standardized mean difference 0.58; 95% CI 0.44 to 0.71; 17 trials; 4,375 women). There was no difference in patient anxiety (standardized mean difference −0.04; 95% CI −0.14 to 0.06; 12 trials; 2,714 women) or satisfaction (standardized mean difference 0.17; 95% CI 0.09 to 0.24; 6 trials; 2,718 women).CONCLUSION: Patient decision aids are effective in facilitating shared decision making and can be helpful in clinical practice to support patient centered care informed by the best evidence.SYSTEMATIC REVIEW REGISTRATION: PROSPERO International Register of Systematic Reviews, www.crd.york.ac.uk/prospero/89953, CRD42018089953.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Fetal Movement Counting and Perinatal Mortality: A Systematic Review and
           Meta-analysis
    • Authors: Bellussi; Federica; Po', Gaia; Livi, Alessandra; Saccone, Gabriele; De Vivo, Valentino; Oliver, Emily A.; Berghella, Vincenzo
      Abstract: imageOBJECTIVE: To assess the association of fetal movement counting with perinatal mortality.DATA SOURCES: Electronic databases (ie, MEDLINE, ClinicalTrials.gov, ScienceDirect, the Cochrane Library at the CENTRAL Register of Controlled Trials) were searched from inception until May 2019. Search terms used were: “fetal movement,” “fetal movement counting,” “fetal kick counting,” “stillbirth,” “fetal demise,” “fetal mortality,” and “perinatal death.”METHODS OF STUDY SELECTION: We included all randomized controlled trials comparing perinatal mortality in those women randomized to receive instructions for fetal movement counting compared with a control group of women without such instruction.TABULATION, INTEGRATION AND RESULTS: The primary outcome was perinatal mortality. Five of 1,290 identified articles were included, with 468,601 fetuses. Definitions of decreased fetal movement varied. In four of five studies, women in the intervention group were asked to contact their health care providers if they perceived decreased fetal movement; the fifth study did not provide details. Reported reduction in fetal movement usually resulted in electronic fetal monitoring and ultrasound assessment of fetal well-being. There was no difference in the incidence of perinatal outcome between groups. The incidence of perinatal death was 0.54% (1,252/229,943) in the fetal movement counting group and 0.59% (944/159,755) in the control group (relative risk [RR] 0.92, 95% CI 0.85–1.00). There were no statistical differences for other perinatal outcomes as stillbirths, neonatal deaths, birth weight less than 10th percentile, reported decreased fetal movement, 5-minute Apgar score less than 7, neonatal intensive care unit admission or perinatal morbidity. There were weak but significant increases in preterm delivery (7.6% vs 7.1%; RR 1.07, 95% CI 1.05–1.10), induction of labor (36.6% vs 31.6%; RR 1.15, 95% CI 1.09–1.22), and cesarean delivery (28.2% vs 25.3%; RR 1.11, 95% CI 1.10–1.12).CONCLUSION: Instructing pregnant women on fetal movement counting compared with no instruction is not associated with a clear improvement in pregnancy outcomes. There are weak associations with some secondary outcomes such as preterm delivery, induction of labor, and cesarean delivery.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019123264.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Topical Hemostatic Agents in Gynecologic Surgery for Benign Indications
    • Authors: Stachowicz; Anne M.; Whiteside, James L.
      Abstract: imageSince a variety of procoagulant products, collectively called hemostatic agents, became available to surgeons in the mid-20th century, their use has increased across multiple specialties, including gynecology. Congruent with past research on the causes of regional variation in the practice of medicine, available evidence suggests that a central predictor for use of these products is physician preference rather than documented clinical necessity. Use of these products adds risks and avoidable cost. This article seeks to highlight specific gynecologic circumstances in which evidence and surgical judgment supports hemostatic agent use and other settings in which use should be reconsidered.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Fetal Heart Rate Monitoring: Still a Mystery More Than Half a Century
           Later
    • Authors: Andrews; William W.; Tita, Alan Thevenet N.
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Accomplices Wanted: Combining Lived Experience and Learned Expertise to
           Provide Affirming Medical Care to Transgender Patients
    • Authors: Lynch; Kyan
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Best Practices for Lactation Support at Conferences and Standardized
           Testing Centers
    • Authors: Cleveland Manchanda; Emily C.; Vogel, Lara D.; Kass, Dara; Rouhani, Shada A.
      Abstract: Breastfeeding has demonstrable benefits for children and their mothers; however, breastfeeding can be particularly difficult for women who return to the workplace in the months after a child's birth. The challenge of continuing to provide breast milk to an infant after a mother returns to work is evident in the day-to-day lives of health professionals who choose to do so and is reflected in the literature, which shows a marked reduction in breastfeeding rates corresponding to a woman's return to work. These barriers are even more apparent when travel is required for professional obligations or advancement, such as to attend or present at national conferences or to take standardized examinations at test centers. This article provides guidelines and practical advice for event organizers and testing centers to support a lactating mother's ability to provide for her child without compromising her professional career. In particular, we describe the physical requirements of lactation spaces, considerations for milk storage, ways to create a lactation-friendly environment, and unique considerations and accommodations for test takers and test centers. Supporting lactating health professionals should be seen as part of a larger endeavor to support gender equity, advance women in medicine, and integrate wellness and family into our professional lives.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Connect the Dots—February 2020
    • Authors: Abbasi; Annam; Watters, Julie; Kim, Tesia; Chescheir, Nancy C.
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Aspiration Pneumonitis Causing Respiratory Collapse in a Pregnant Patient
           Not in Labor
    • Authors: Lozada; M. James; Goyal, Varun K.; Kiczek, Matthew P.; Pacheco, Luis D.
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • In Reply
    • Authors: Westerfield; Katie Lynn; Bhavsar, Amit; Green, Samantha
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Comparison of Midwifery and Obstetric Care in Low-Risk Hospital Births
    • Authors: Alouini; Souhail
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Response to Letter
    • Authors: Souter; Vivienne; Nethery, Elizabeth; Lou Kopas, Mary; Wurz, Hannah; Sitcov, Kristin; Caughey, Aaron B.
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Development and Validation of a Machine Learning Algorithm for Predicting
           Response to Anticholinergic Medications for Overactive Bladder Syndrome
    • Authors: Rahman; Syed N.; Monaghan, Thomas F.; Weiss, Jeffrey P.
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Response to Letter
    • Authors: Sheyn; David; Hijaz, Adonis; Mahajan, Sangeeta; El-Nashar, Sherif; Ray, Soumya; Mangel, Jeffrey
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Providing Patient-Centered Perinatal Care for Transgender Men and
           Gender-Diverse Individuals: A Collaborative Multidisciplinary Team
           Approach
    • Authors: Voutsos; Lester
      Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Response to Letter
    • Authors: Hahn; Monica Ulhee; Sheran, Neal; Weber, Shannon; Cohan, Deborah; Obedin-Maliver, Juno
      Abstract: imageNo abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • ACOG Publications: February 2020
    • Abstract: No abstract available
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG
           Committee Opinion Summary, Number 797
    • Abstract: imageABSTRACT: Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1–2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal–rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal–rectal cultures at 36 0/7–37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including Table 1, Box 2, and Figures 1–3, updates and replaces the obstetric components of the CDC 2010 guidelines, “Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010.”
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Implementing Telehealth in Practice: ACOG Committee Opinion Summary,
           Number 798
    • Abstract: ABSTRACT: The term “telemedicine” often is used to refer to traditional clinical diagnosis and monitoring that are delivered by technology. The term “telehealth” refers to the technology-enhanced health care framework that includes services such as virtual visits, remote patient monitoring, and mobile health care. Evidence suggests that telehealth provides comparable health outcomes when compared with traditional methods of health care delivery without compromising the patient–physician relationship, and it also has been shown to enhance patient satisfaction and improve patient engagement. Obstetrician–gynecologists and other physicians who provide telehealth should make certain that they have the necessary hardware, software, and a reliable, secure internet connection to ensure quality care and patient safety. To implement a telehealth program effectively, participating sites must undergo resource assessments to evaluate equipment readiness. Credentialing and privileging in telemedicine depend on the requirements of the facilities where the physician practices and the source of service payment or reimbursement. Obstetrician–gynecologists and other physicians who provide telehealth must meet many safeguards before delivering telehealth services, including federal, state, and local regulatory laws and licensure requirements. Insurance carriers should provide clear guidelines to physicians who provide telehealth to ensure appropriate health insurance coverage for tele-encounters. Telehealth has quickly become integrated into nearly every aspect of obstetrics and gynecology, and current trends in patient-generated data and big data analytics portend increased use. These technology-enhanced health care delivery opportunities enhance, not replace, the current standard of care.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG
           Committee Opinion, Number 797
    • Abstract: imageABSTRACT: Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1–2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal–rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal–rectal cultures at 36 0/7–37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including Table 1, Box 2, and Figures 1–3, updates and replaces the obstetric components of the CDC 2010 guidelines, “Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010.”
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
  • Implementing Telehealth in Practice
    • Abstract: ABSTRACT: The term “telemedicine” often is used to refer to traditional clinical diagnosis and monitoring that are delivered by technology. The term “telehealth” refers to the technology-enhanced health care framework that includes services such as virtual visits, remote patient monitoring, and mobile health care. Evidence suggests that telehealth provides comparable health outcomes when compared with traditional methods of health care delivery without compromising the patient–physician relationship, and it also has been shown to enhance patient satisfaction and improve patient engagement. Obstetrician–gynecologists and other physicians who practice telehealth should make certain that they have the necessary hardware, software, and a reliable, secure internet connection to ensure quality care and patient safety. To implement a telehealth program effectively, participating sites must undergo resource assessments to evaluate equipment readiness. Credentialing and privileging in telemedicine depend on the requirements of the facilities where the physician practices and the source of service payment or reimbursement. Obstetrician–gynecologists and other physicians who provide telehealth must meet many safeguards before delivering telehealth services, including federal, state, and local regulatory laws and licensure requirements. Insurance carriers should provide clear guidelines to physicians who provide telehealth to ensure appropriate health insurance coverage for telehealth encounters. Telehealth has quickly become integrated into nearly every aspect of obstetrics and gynecology, and current trends in patient-generated data and big data analytics portend increased use. These technology-enhanced health care delivery opportunities enhance, not replace, the current standard of care.
      PubDate: Sat, 01 Feb 2020 00:00:00 GMT-
       
 
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