Cervical cerclage for the woman with prior adverse pregnancy outcome
June 1st 2010A 19-year-old patient (gravida 2, para 1) at 12 weeks' gestation had a preterm birth at 23 weeks in her last pregnancy. Delivery was preceded by spontaneous rupture of the membranes and a brief time of irregular contractions. Certain information would assist in determining whether cervical insufficiency was part of her pregnancy outcome.
Preventing retained foreign objects in ob/gyn surgery
June 1st 2010A 44-year-old woman underwent an uneventful abdominal supracervical hysterectomy. Sponge and needle counts were reported as correct on multiple occasions during surgery. On postoperative day 2, the patients reported abdominal pain and mild abdominal distention. Despite conservative measures taken, the pain and distention did not resolve. On postoperative day 4, she was vomiting and her abdomen appeared further distended. An X-ray revealed an intra-abdominal laparatomy pad and small bowel obstruction.
Commentary: How to respond to the trend of increasing cesarean delivery
June 1st 2010In 2007, 31.8% of deliveries in the United States were accomplished by cesarean delivery, with more than 1,370,000 women undergoing the procedure. This marks a 2% increase over 2006 and a more than 50% increase since 1996. This figure is not accounted for by repeat procedures only.
Conference Addresses Vaginal Birth After Cesarean
June 1st 2010In March, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) convened a consensus conference on vaginal birth after cesarean (VBAC). Various experts described what is known and not known about the safety of trials of labor after prior cesarean delivery.
Legally Speaking: Did misoprostol cause this postpartum hemorrhage?
May 1st 2010The patient, a then 34-year-old gravida 1, para 0, was admitted to the defendant hospital on May 8 under the care of defendant ob/gyn "A." Her blood pressure on admission was 150/90 mmHg (up from 140/90 mmHg at the o ce that morning), and she was past her expected delivery date,April 30. Prenatal records were signi cant for an anatomic ultrasound re ecting a partial placenta previa.
Grand Rounds: Practical perspective on cesarean hysterectomy: When, why, and how
May 1st 2010Cesarean hysterectomy and postpartum hysterectomy are commonly performed emergently for severe uterine hemorrhage that is unresponsive to conservative therapies. These procedures differ in timing. Cesarean hysterectomy is performed immediately after a cesarean delivery for severe hemorrhage or, less commonly, as a planned procedure to treat preexisting gynecologic disease. Postpartum hysterectomy is performed after a vaginal delivery for delayed hemorrhage or infectious complications.
Funded breast cancer screening/diagnosis decreases diagnostic delays
May 1st 2010A case-management program that is part of the National Breast and Cervical Cancer Early Detection Program (BCCEDP) has had a positive effect on the timeliness of care in women with an abnormal mammogram, according to a new report.
NAMS Notes: Position statement addresses hormone therapy in postmenopausal women
May 1st 2010Data on hormone therapy (HT) for treating menopause-related symptoms and preventing disease in postmenopausal women are evolving rapidly. To guide therapy and to put the risks and benefits of HT, estrogen therapy (ET), or combined estrogen-progestogen therapy (EPT) in perspective for healthcare professionals and the public, the North American Menopause Society (NAMS) has updated its evidence-based 2008 statement in light of subsequently published scientific data.
Stop screening for inherited thrombophilias in patients with adverse pregnancy outcomes
May 1st 2010It's important to understand that most positive associations between inherited thrombophilias and adverse pregnancy outcomes were derived from small case-control studies subject to selection and ascertainment biases.
Brachial plexus injury causation in newborns debated
May 1st 2010Brachial plexus injury in newborns is commonly ascribed to the occurrence of head rotation with entrapment of the shoulders and subsequent downward traction by the accoucheur on the fetal head, resulting in avulsion of the brachial plexus nerve roots with permanent paralysis. In brachial plexus injury cases, plaintiff attorneys usually contend that damage to the brachial plexus is always caused by negligence of the birth attendant. However, a review of current literature reveals evidence that additional etiologies may underpin brachial plexus injury and raises questions regarding the level of responsibility of the birth attendant in connection with the injury.
Do patients with breast cancer understand genomic test results?
May 1st 2010A study involving 77 women with early stage breast cancer who underwent Oncotype DX, a genomic test that provides recurrence risk estimates to help plan adjuvant treatment, found that about one-third of patients did not fully understand subsequent discussions about their test results.