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Obstetrics & Gynecology
Journal Prestige (SJR): 2.563
Citation Impact (citeScore): 3
Number of Followers: 96  
 
  Partially Free Journal Partially Free Journal
ISSN (Print) 0029-7844 - ISSN (Online) 1873-233X
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Postpartum Heparin Thromboprophylaxis: More Harm Than Good

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      Authors: Kotaska; Andrew
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Evaluation of a Risk-Stratified, Heparin-Based, Obstetric
           Thromboprophylaxis Protocol

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      Authors: Lu; Michelle Y.; Blanchard, Christina T.; Ausbeck, Elizabeth B.; Oglesby, Kacie R.; Page, Margaret R.; Lazenby, Allison J.; Cozzi, Gabriella D.; Muñoz Rogers, Rodrigo D.; Bushman, Elisa T.; Kaplan, Elle R.; Ruzic, Martha F.; Mahalingam, Mythreyi; Dunk, Sarah; Champion, Macie; Casey, Brian M.; Tita, Alan T.; Kim, Dhong-Jin; Szychowski, Jeff M.; Subramaniam, Akila
      Abstract: imageOBJECTIVE: To evaluate outcomes before and after implementation of a risk-stratified heparin-based obstetric thromboprophylaxis protocol.METHODS: We performed a retrospective cohort study of all patients who delivered at our tertiary care center from 2013 to 2018. Deliveries were categorized as preprotocol (2013–2015; no standardized heparin-based thromboprophylaxis) and postprotocol (2016–2018). Patients receiving outpatient anticoagulation for active venous thromboembolism (VTE) or high VTE risk were excluded. Coprimary effectiveness and safety outcomes were postpartum VTEs and wound hematomas, respectively, newly diagnosed after delivery and up to 6 weeks postpartum. Secondary outcomes were other wound or bleeding complications, including unplanned surgical procedures (eg, hysterectomies, wound explorations) and blood transfusions. Outcomes were compared between groups, and adjusted odds ratios (aORs) and 95% CIs were calculated using the preprotocol group as reference.RESULTS: Of 24,229 deliveries, 11,799 (49%) occurred preprotocol. Although patients were more likely to receive heparin-based prophylaxis postprotocol (15.6% vs 1.2%, P
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Coronavirus Disease 2019 (COVID-19) and Pregnancy Outcomes: State of the
           Science

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      Authors: Joseph; Naima Thavory; Metz, Torri D.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy Outcomes in a
           U.S. Population

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      Authors: Son; Moeun; Gallagher, Kieran; Lo, Justin Y.; Lindgren, Eric; Burris, Heather H.; Dysart, Kevin; Greenspan, Jay; Culhane, Jennifer F.; Handley, Sara C.
      Abstract: imageOBJECTIVE: To examine whether the coronavirus disease 2019 (COVID-19) pandemic altered risk of adverse pregnancy-related outcomes and whether there were differences by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status among pregnant women.METHODS: In this retrospective cohort study using Epic's Cosmos research platform, women who delivered during the pandemic (March–December 2020) were compared with those who delivered prepandemic (matched months 2017–2019). Within the pandemic epoch, those who tested positive for SARS-CoV-2 infection were compared with those with negative test results or no SARS-CoV-2 diagnosis. Comparisons were performed using standardized differences, with a value greater than 0.1 indicating meaningful differences between groups.RESULTS: Among 838,489 women (225,225 who delivered during the pandemic), baseline characteristics were similar between epochs. There were no significant differences in adverse pregnancy outcomes between epochs (standardized difference
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Causes of Maternal Mortality in Rwanda, 2017–2019

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      Authors: Rulisa; Stephen; Ntihinyurwa, Polyphile; Ntirushwa, David; Wong, Andrew; Olufolabi, Adeyemi
      Abstract: imageOBJECTIVE: To assess the causes of maternal mortality at a referral hospital in Rwanda.METHODS: A secondary data analysis of 217 women with recorded maternal mortality from 2017 to 2019 was conducted among 11,308 total maternal admissions. Demographics, diagnosis, management, referring hospital source, and outcomes were recorded.RESULTS: The mean (±SD) age of maternal death was 30.7±7.2 years (range 16–57 years). The overall maternal mortality rate was 1.99%, with yearly rates of 2.45%, 2.53%, and 1.84% in 2017, 2018, and 2019, respectively. A significant seasonal variation was noted. Sepsis was the most common cause of maternal death (50%), followed by hemorrhage (19%) and hypertensive disorders (15%). Causes of maternal deaths included preeclampsia (13%) and abortion (8%). Furthermore, 82% of all the deaths were referrals from smaller community hospitals.CONCLUSION: Maternal death due to sepsis remain a major cause of maternal deaths in Rwanda. Infection prevention and the early diagnosis and management of sepsis must be a priority in reducing maternal mortality.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Stepwise Approach to the Management of Endometriosis-Related Dysmenorrhea:
           A Cost-Effectiveness Analysis

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      Authors: Bohn; Jacqueline A.; Bullard, Kimberley A.; Rodriguez, Maria I.; Ecker, Amanda M.
      Abstract: imageOBJECTIVE: To evaluate the cost effectiveness of sequential medical and surgical therapy for the treatment of endometriosis-related dysmenorrhea.METHODS: A cost-effectiveness model was created to compare three stepwise medical and surgical treatment strategies compared with immediate surgical management for dysmenorrhea using a health care payor perspective. A theoretical study cohort was derived from the estimated number of reproductive age (18–45) women in the United States with endometriosis-related dysmenorrhea. The treatment strategies modeled were: strategy 1) nonsteroidal antiinflammatory drugs (NSAIDs) followed by surgery; strategy 2) NSAIDs, then short-acting reversible contraceptives or long-acting reversible contraceptives (LARCs) followed by surgery; strategy 3) NSAIDs, then a short-acting reversible contraceptive or LARC, then a LARC or gonadotropin-releasing hormone modulator followed by surgery; strategy 4) proceeding directly to surgery. Probabilities, utilities, and costs were derived from the literature. Outcomes included cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. Univariate, bivariate, and multivariate sensitivity analyses were performed.RESULTS: In this theoretical cohort of 4,817,894 women with endometriosis-related dysmenorrhea, all medical and surgical treatment strategies were cost effective at a standard willingness-to-pay threshold of $100,000 per QALY gained when compared with surgery alone. Strategy 2 was associated with the lowest cost per QALY gained ($1,155). Requiring a trial of a third medication before surgery would cost an additional $257 million, compared with proceeding to surgery after failing two medical treatments. The probability of improvement with surgery would need to exceed 83% for this to be the preferred first-line approach.CONCLUSION: All sequential medical and surgical management strategies for endometriosis-related dysmenorrhea were cost effective when compared with surgery alone. A trial of hormonal management after NSAIDs, before proceeding to surgery, may provide cost savings. Delaying surgical management in an individual with pain refractory to more than three medications may decrease quality of life and increase cost.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Outcomes of the First Pregnancy After Fertility-Sparing Surgery for
           Early-Stage Cervical Cancer

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      Authors: Nitecki; Roni; Floyd, Jessica; Lamiman, Kelly; Clapp, Mark A.; Fu, Shuangshuang; Jorgensen, Kirsten; Melamed, Alexander; Brady, Paula C.; Kaimal, Anjali; del Carmen, Marcela G.; Woodard, Terri L.; Meyer, Larissa A.; Giordano, Sharon H.; Ramirez, Pedro T.; Rauh-Hain, J. Alejandro
      Abstract: imageOBJECTIVE: To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer.METHODS: We performed a population-based study of women aged 18–45 years with a history of stage I cervical cancer reported to the 2000–2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.RESULTS: Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4–5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0–3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2–5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.CONCLUSION: In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Role of Subcutaneous Depot Medroxyprogesterone Acetate in Equitable
           Contraceptive Care: A Lesson From the Coronavirus Disease 2019 (COVID-19)
           Pandemic

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      Authors: Burlando; Audrey M.; Flynn, Anne N.; Gutman, Sarah; McAllister, Arden; Roe, Andrea H.; Schreiber, Courtney A.; Sonalkar, Sarita
      Abstract: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, health care professionals have made swift accommodations to provide consistent and safe care, including emphasizing remote access to allow physical distancing. Depot medroxyprogesterone acetate intramuscular injection (DMPA-IM) prescription is typically administered by a health care professional, whereas DMPA-subcutaneous has the potential to be safely self-injected by patients, avoiding contact with a health care professional. However, DMPA-subcutaneous is rarely prescribed despite its U.S. Food and Drug Administration approval in 2004 and widespread coverage by both state Medicaid providers and many private insurers. Depot medroxyprogesterone acetate users are disproportionately non-White, and thus the restriction in DMPA-subcutaneous prescribing may both stem from and contribute to systemic racial health disparities. We review evidence on acceptability, safety, and continuation rates of DMPA-subcutaneous, consider sources of implicit bias that may impede prescription of this contraceptive method, and provide recommendations for implementing DMPA-subcutaneous prescribing.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Website Review of Variation in Individual State Medicaid Sterilization
           Policies

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      Authors: Bouma-Johnston; Heather; Arora, Kavita Shah
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Invasive Cervical Cancer After a Positive Pap Test Result and Negative
           Human Papillomavirus Test Result

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      Authors: Locke; Alexander; Shah, Nina R.; Fetterman, Barbara; Poitras, Nancy; Wi, Soora; Castle, Philip E.; Wentzensen, Nicolas; Kinney, Walter; Clarke, Megan A.; Lorey, Thomas
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Reduction in Cesarean Delivery Rates Associated With a State Quality
           Collaborative in Maryland

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      Authors: Callaghan-Koru; Jennifer A.; DiPietro, Bonnie; Wahid, Inaya; Mark, Katrina; Burke, Ann B.; Curran, Geoffrey; Creanga, Andreea A.
      Abstract: imageOBJECTIVE: To assess the extent to which hospitals participating in the MDPQC (Maryland Perinatal-Neonatal Quality Care Collaborative) to reduce primary cesarean deliveries adopted policy and practice changes and the association of this adoption with state-level cesarean delivery rates.METHODS: This prospective evaluation of the MDPQC includes 31 (97%) of the birthing hospitals in the state, which all voluntarily participated in the 30-month collaborative from June 2016 to December 2018. Hospital teams agreed to implement practices from the “Safe Reduction of Primary Cesarean Births” patient safety bundle, developed by the Council on Patient Safety in Women's Health Care. Each hospital's implementation of practices in the bundle was measured through surveys of team leaders at 12 months and 30 months. Half-yearly cesarean delivery rates were calculated from aggregate birth certificate data for each hospital, and differences in rates between the 6 months before the collaborative (baseline) and the 6 months afterward (endline) were tested for statistical significance.RESULTS: Among the 26 bundle practices that were assessed, participating hospitals reported having a median of seven practices (range 0–23) already in place before the collaborative and implementing a median of four (range 0–17) new practices during the collaborative. Across the collaborative, the cesarean delivery rates decreased from 28.5% to 26.9% (P=.011) for all nulliparous term singleton vertex births and from 36.1% to 31.3% (P
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy
           Prenatal Care Recommendations

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      Authors: Peahl; Alex Friedman; Zahn, Christopher M.; Turrentine, Mark; Barfield, Wanda; Blackwell, Sean D.; Roberts, Suni Jo; Powell, Allison R.; Chopra, Vineet; Bernstein, Steven J.
      Abstract: imageOBJECTIVE: To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery.METHODS: We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using sequential steps: 1) definition and scope of key terms, 2) literature review and data synthesis, 3) case scenario development, 4) panel selection and scenario revisions, and 5) two rounds of panel appropriateness ratings with deliberation. Recommendations were developed for average-risk pregnant individuals (eg, individuals not requiring care by maternal–fetal medicine specialists). Because prenatal services (eg, laboratory tests, vaccinations) have robust evidence, panelists considered only how services are delivered (eg, visit frequency, telemedicine).RESULTS: The appropriateness of key aspects of prenatal care delivery across individuals with and without common medical and pregnancy complications, as well as social and structural determinants of health, was determined by the panel. Panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for: 1) prenatal visit schedules (care initiation, visit timing and frequency, routine pregnancy assessments), 2) integration of telemedicine (virtual visits and home devices), and 3) care individualization. Panelists recognized significant gaps in existing evidence and the need for policy changes to support equitable care with changing practices.CONCLUSION: The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • A Review of Prenatal Care Delivery to Inform the Michigan Plan for
           Appropriate Tailored Healthcare in Pregnancy Panel

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      Authors: Barrera; Chloe M.; Powell, Allison R.; Biermann, Chloe Ramirez; Siden, Jonathan Y.; Nguyen, Buu-Hac; Roberts, Suni Jo; James, LaTeesa; Chopra, Vineet; Peahl, Alex
      Abstract: imageOBJECTIVE: To perform a literature review of key aspects of prenatal care delivery to inform new guidelines.DATA SOURCES: A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov.METHODS OF STUDY SELECTION: We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction.TABULATION, INTEGRATION, AND RESULTS: Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth.CONCLUSION: Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Evaluation of Respiratory Emissions During Labor and Delivery: Potential
           Implications for Transmission of Severe Acute Respiratory Syndrome
           Coronavirus 2 (SARS-CoV-2)

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      Authors: Mok; Thalia; Harris, Elijah; Vargas, Andres; Afshar, Yalda; Han, Christina S.; Karagozian, Ann; Rao, Rashmi
      Abstract: imageOBJECTIVE: To characterize respiratory emissions produced during labor and vaginal delivery vis-à-vis the potential for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).METHODS: Observational study of three women who tested negative for SARS-CoV-2 and had uncomplicated vaginal deliveries. Using background-oriented schlieren imaging, we evaluated the propagation of respiratory emissions produced during the labor course and delivery. The primary outcome was the speed and propagation of breath over time, calculated through processed images collected throughout labor and delivery.RESULTS: In early labor with regular breathing, the speed of the breath was 1.37 meters/s (range 1.20–1.55 meters/s). The breath appeared to propagate faster with a cough during early labor at a speed of 1.69 meters/s (range 1.22–2.27 meters/s). During the second stage of labor with Valsalva and forced expiration, the propagation speed was 1.79 meters/s (range 1.71–1.86 meters/s).CONCLUSION: Labor and vaginal delivery increase the propagation of respiratory emissions that may increase risk of respiratory transmission of SARS-CoV-2.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Neonatal Outcomes After Delivery in Water

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      Authors: Lanier; Ariel L.; Wiegand, Samantha L.; Fennig, Kathleen; Snow, E. Kaye; Maxwell, Rose A.; McKenna, David
      Abstract: imageOBJECTIVE: To assess neonatal intensive care unit (NICU) admissions and neonatal outcomes after water birth or land birth in an alternative birthing center.METHODS: We conducted a prospective observational study of preselected low-risk parturients separated into three groups depending on their location for labor and delivery: land–land, water–land, and water–water. Delivery outcomes, labor length, maternal pain assessment, need for newborn resuscitation, and NICU admission and diagnoses were collected. The primary outcome was admission to the NICU.RESULTS: There were 2,077 total deliveries from April 2015 to December 2019, consisting of 458 land–land deliveries, 730 water–land deliveries, and 889 water–water deliveries. The rate of NICU admission was 2.8% (95% CI 1.5–4.8%) for land–land deliveries, 4.1% (2.8–5.8%) for water–land deliveries, and 2.0% (1.2–3.2%) for water–water deliveries. A post hoc power analysis revealed a 70% power to detect a 2.1% difference in NICU admissions between the water–land and water–water groups.CONCLUSION: In this cohort of low-risk pregnant women, births in water and on land were associated with similar rates of admission to the NICU.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Evaluation of an Initiative to Decrease the Use of Oxygen Supplementation
           for Category II Fetal Heart Rate Tracings

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      Authors: Burd; Julia E.; Anderson, Kathryn; Berghella, Vincenzo; Duncan, Daniel G.; Baxter, Jason K.; Quist-Nelson, Johanna
      Abstract: imageOBJECTIVE: To examine compliance with a guideline to reduce exposure to supplemental oxygen for category II fetal heart rate (FHR) tracings in normally oxygenated laboring patients.METHODS: All patients in labor in an urban academic medical center from January 1 to July 31, 2020 were assessed. The preintervention group included those who delivered from January 1 to March 19, 2020. On March 20, 2020, a new guideline took effect that recommended no maternal supplemental oxygen for category II FHR tracings. The postintervention group delivered from March 20 to July 31, 2020. Exclusion criteria were planned cesarean delivery, multiple gestations, delivery at less than 24 weeks of gestation, intrauterine fetal death, and patients who received supplemental oxygen for an oxygen saturation lower than 95%. The primary outcome was the percentage of patients who received oxygen in labor analyzed by control charts and the rules of special cause variation. Chi-squared and t tests were used for secondary outcome assessment. P
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Associations Between Maternal Depression, Antidepressant Use During
           Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data
           Meta-analysis

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      Authors: Vlenterie; Richelle; van Gelder, Marleen M. H. J.; Anderson, H. Ross; Andersson, Liselott; Broekman, Birit F. P.; Dubnov-Raz, Gal; El Marroun, Hanan; Ferreira, Ema; Fransson, Emma; van der Heijden, Frank M. M. A.; Holzman, Claudia B.; Kim, J. Jo; Khashan, Ali S.; Kirkwood, Betty R.; Kuijpers, Harold J. H.; Lahti-Pulkkinen, Marius; Mason, Dan; Misra, Dawn; Niemi, Maria; Nordeng, Hedvig M. E.; Peacock, Janet L.; Pickett, Kate E.; Prady, Stephanie L.; Premji, Shahirose S.; Räikkönen, Katri; Rubertsson, Christine; Sahingoz, Mine; Shaikh, Kiran; Silver, Richard K.; Slaughter-Acey, Jaime; Soremekun, Seyi; Stein, Dan J.; Sundström-Poromaa, Inger; Sutter-Dallay, Anne-Laure; Tiemeier, Henning; Uguz, Faruk; Varela, Pinelopi; Vrijkotte, Tanja G.M.; Winterfeld, Ursula; Zar, Heather J.; Zervas, Iannis M.; Prins, Judith B.; Pop-Purceleanu, Monica; Roeleveld, Nel
      Abstract: imageOBJECTIVE: To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores.DATA SOURCES: MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016.METHODS OF STUDY SELECTION: Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores.
      Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis.TABULATION, INTEGRATION, AND RESULTS: We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2–2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7–3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3–1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0–2.5 and OR 1.9, 95% CI 1.2–2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1–2.8).CONCLUSION: Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42016035711.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Retrograde Bladder Filling After Outpatient Gynecologic Surgery: A
           Systematic Review and Meta-analysis

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      Authors: Thiel; Peter S.; Mathur, Siddhi; Zakhari, Andrew; Matelski, John; Walsh, Chris; Murji, Ally
      Abstract: imageOBJECTIVE: To systematically review and meta-analyze randomized controlled trials (RCTs) comparing postoperative bladder retrofilling to passive filling after outpatient gynecologic surgery to evaluate effects on postoperative outcomes.DATA SOURCES: We searched MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and ClinicalTrials.gov from 1947 to August 2020.METHODS OF STUDY SELECTION: Two reviewers screened 1,465 articles. We included RCTs that compared postoperative bladder retrofilling to passive filling in patients who underwent outpatient gynecologic surgery by any approach. The primary outcome was the time to first void. Secondary outcomes included time to discharge, postoperative urinary retention, urinary tract infection, and patient satisfaction. Mean differences and relative risks (RRs) were calculated for the meta-analysis. Risk of bias was assessed using the Cochrane Risk of Bias Tool.TABULATION, INTEGRATION, AND RESULTS: We included eight studies with 1,173 patients. Bladder retrofilling in the operating room resulted in a significant decrease in the time to first void (mean difference −33.5 minutes; 95% CI −49.1 to −17.9, 4 studies, 403 patients) and time to discharge (mean difference –32.0 minutes; 95% CI −51.5 to −12.6, eight studies, 1,164 patients). Bladder retrofilling did not shorten time to discharge when performed in the postanesthetic care unit (mean difference –14.8 min; 95% CI −62.6 to 32.9, three studies, 258 patients) or after laparoscopic hysterectomy (mean difference –26.0 min; 95% CI −56.5 to 4.5, five studies, 657 patients). There were no differences in postoperative urinary retention (RR 0.77; 95% CI 0.45–1.30, five studies, 910 patients) or risk of urinary tract infection between the retrofill and passive fill groups (RR 0.50; 95% CI 0.14–1.77, four studies, 387 patients). Patient satisfaction was comparable between groups.CONCLUSION: Retrofilling the bladder in the operating room after outpatient gynecologic surgery modestly reduces the time to first void and discharge with no increase in adverse events.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42020203692.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Home Induction of Buprenorphine for Treatment of Opioid Use Disorder in
           Pregnancy

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      Authors: Kelly; Jeannie C.; Raghuraman, Nandini; Stout, Molly J.; Russell, Sharman; Perez, Marta; Nazeer, Sarah; El Helou, Nicole; Zhang, Fan; Carter, Ebony
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Pregnancy Outcomes and Maternal Complications During the Second Wave of
           Coronavirus Disease 2019 (COVID-19) in India

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      Authors: Mahajan; Niraj N.; Pophalkar, Madhura; Patil, Sarika; Yewale, Bhagyashree; Chaaithanya, Itta Krishna; Mahale, Smita D.; Gajbhiye, Rahul K.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Iron Deficiency Anemia in Pregnancy

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      Authors: James; Andra H.
      Abstract: imageAnemia is defined as a low red blood cell count, a low hematocrit, or a low hemoglobin concentration. In pregnancy, a hemoglobin concentration of less than 11.0 g/dL in the first trimester and less than 10.5 or 11.0 g/dL in the second or third trimester (depending on the guideline used) is considered anemia. Anemia is the most common hematologic abnormality in pregnancy. Maternal anemia is associated with adverse fetal, neonatal and childhood outcomes, but causality is not established. Maternal anemia increases the likelihood of transfusion at delivery. Besides hemodilution, iron deficiency is the most common cause of anemia in pregnancy. The American College of Obstetricians and Gynecologists recommends screening for anemia with a complete blood count in the first trimester and again at 24 0/7 to 28 6/7 weeks of gestation. Mild anemia, with a hemoglobin of 10.0 g/dL or higher and a mildly low or normal mean corpuscular volume (MCV) is likely iron deficiency anemia. A trial of oral iron can be both diagnostic and therapeutic. Mild anemia with a very low MCV, macrocytic anemia, moderate anemia (hemoglobin 7.0–9.9 g/dL) or severe anemia (hemoglobin 4.0–6.9 g/dL) requires further investigation. Once a diagnosis of iron deficiency anemia is confirmed, first-line treatment is oral iron. New evidence suggests that intermittent dosing is as effective as daily or twice-daily dosing with fewer side effects. For patients with iron deficiency anemia who cannot tolerate, cannot absorb, or do not respond to oral iron, intravenous iron is preferred. With contemporary formulations, allergic reactions are rare.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Cochrane Review Summaries—October 2021

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      Authors: Hadaie; Bachar; Haas, David M.
      Abstract: imageIn this month's issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we highlight a review of low-dose oral misoprostol for labor induction, strategies to increase continuation of shorter-term hormonal contraception, and early postnatal discharge. The summaries are published below. The complete references with hyperlinks are listed in Box 1.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Connect the Dots—October 2021

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      Authors: Kaiser; Samantha B.; Morrison, Aimee; Boyajian, Christine; Rouse, Dwight J.
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Pain Associated With Cervical Priming for First-Trimester Surgical
           Abortion: A Randomized Controlled Trial

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      Authors: Creinin; Mitchell D.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes
           Mellitus

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      Authors: Coustan; Donald R.; Dyer, Alan R.; Metzger, Boyd E.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Delivery Mode After Manual Rotation of Occiput Posterior Fetal Positions:
           A Randomized Controlled Trial

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      Authors: Durand; Yves-Gérard; Vachette, Maud; Desseauve, David
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • In Reply

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      Authors: Verhaeghe; Caroline; Corroenne, Romain; Spiers, Andrew; Descamps, Philippe; Gascoin, Géraldine; Bouet, Pierre-Emmanuel; Parot-Schinkel, Elsa; Legendre, Guillaume
      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • ACOG Practice Bulletin No. 228: Management of Symptomatic Uterine
           Leiomyomas: Correction

    • Free pre-print version: Loading...

      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • ACOG Committee Opinion No. 804: Physical Activity and Exercise During
           Pregnancy and the Postpartum Period: Correction

    • Free pre-print version: Loading...

      Abstract: imageNo abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • ACOG Publications: October 2021

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      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Complementary and Integrative Approaches in Obstetrics and Gynecology:
           Clinical Updates In Women’s Health Care Primary and Preventive Care
           Review

    • Free pre-print version: Loading...

      Authors: Barbieri; Anna; Fenske, Suzanne
      Abstract: : Integrative medicine is a holistic approach to health care that acknowledges multiple dimensions of health, including its physical, emotional, and spiritual aspects. It approaches health not just as absence of disease but as a state of optimal vitality, and utilizes all appropriate evidence-based modalities, including lifestyle interventions, complementary treatments, and conventional allopathic methods, in one paradigm. Utilization of non-conventional therapies by women and interest in integrative care is very high. Much disinformation exists and many women engage in non-conventional therapies without medical advice, sometimes benefiting from them, but also possibly delaying needed care or placing themselves at risk. Research and clinical interest in non-conventional methods also is rising within the medical community, with increased recognition of the value of an integrative health model for individuals and communities. Obstetrician–gynecologists are in a unique position to support their patients in holistic health optimization by choosing beneficial integrative strategies while identifying potentially harmful practices.Integrative medicine is a holistic approach to health care that acknowledges multiple dimensions of health, including its physical, emotional, and spiritual aspects. It approaches health not just as absence of disease but as a state of optimal vitality, and utilizes all appropriate evidence-based modalities, including lifestyle interventions, complementary treatments, and conventional allopathic methods, in one paradigm. Utilization of non-conventional therapies by women and interest in integrative care is very high. Much disinformation exists and many women engage in non-conventional therapies without medical advice, sometimes benefiting from them, but also possibly delaying needed care or placing themselves at risk. Research and clinical interest in non-conventional methods also is rising within the medical community, with increased recognition of the value of an integrative health model for individuals and communities. Obstetrician–gynecologists are in a unique position to support their patients in holistic health optimization by choosing beneficial integrative strategies while identifying potentially harmful practices.© 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
  • Presidential Task Force Summary: Revisit the Visit: Leveraging Access and
           Trust To Prevent Chronic Disease Through Personalized Care

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      Authors: Keyser; Erin A.; Ireland, Luu; McHugh, Katie; Ramos, Diana; O'Reilly, Nancy E.; Rosser, Mary L.
      Abstract: No abstract available
      PubDate: Fri, 01 Oct 2021 00:00:00 GMT-
       
 
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