Postpartum is the time to worry about venous thromboembolism
February 1st 2006While the risks for a first-time venous thromboembolism (VTE) or pulmonary embolism (PE) increase with each trimester of pregnancy, they peak during the postpartum period when they are five and 15 times greater, respectively, than during pregnancy, according to the findings of a 30-year population-based study of 50,000 women.
New guidelines for breast biopsies
February 1st 2006In an effort to improve the diagnosis of breast cancer, an international panel of 23 expert surgeons, radiologists, pathologists, and oncologists recently recommended expanding the roles of minimally invasive needle and sentinel node biopsies and severely limiting the role of open surgical biopsies, citing that almost one third of the 1.7 million breast biopsies performed in the United States are still done surgically.
Pelvic Floor Electromyography in Men with Chronic Pelvic Pain Syndrome
January 24th 2006The objectives of this study were 1. To identify differences between men with Chronic Pelvic Pain Syndrome (CPPS), compared with pain-free men, in surface electromyography (sEMG)/Biofeedback (BFB) readings of pelvic floor muscles and 2.
Grand Rounds: Lessons from the cockpit: How team training can reduce errors on L&D
January 1st 2006Although many ob/gyns believe they already work on an interdisciplinary team, most don't really apply the principles of teamwork on labor and delivery. This Harvard team has discovered that applying the concepts used by military and commercial flight teams—an approach called Crew Resource Management—can improve patient safety and reduce the epidemic of lawsuits plaguing the specialty.
Sign Out: Maternal and newborn mortality: the silent tragedies
January 1st 2006No issue is more central to global well-being than the health of mothers and their babies. Every individual, every family, every community at some point or another is intimately involved with pregnancy and the success of childbirth. And yet every day, 1,600 women and more than 10,000 newborns die due to complications that could have been prevented.
U/S Clinics: Putting the FASTER results into clinical practice
January 1st 2006Counseling patients on screening for Down syndrome has long been a challenge. Findings from the FASTER trial provide solid evidence upon which to base recommendations for first- or second-trimester testing, or a combination of both.
When should you screen for and treat mild hypothyroidism?
January 1st 2006Whether to treat mild hypothyroidism is controversial—but ob/gyns are increasingly concerned about links with menstrual dysfunction, infertility, early labor, and poor neurodevelopmental outcomes in offspring. In the first of two articles on subclinical thyroid disease, two experts provide the information needed to make that call.
Grand Rounds: Lessons from the cockpit: How team training can reduce errors on L&D
January 1st 2006Although many ob/gyns believe they already work on an interdisciplinary team, most don't really apply the principles of teamwork on labor and delivery. This Harvard team has discovered that applying the concepts used by military and commercial flight teams—an approach called Crew Resource Management—can improve patient safety and reduce the epidemic of lawsuits plaguing the specialty.
Wisconsin is latest to pass fetal pain law
January 1st 2006Physicians who perform abortions in Wisconsin may have another legal requirement to fulfill in order to terminate a pregnancy in cases other than a medical emergency. If SB138 becomes law, a physician in the state will be required to inform a woman seeking an abortion that, if the fetus is at least 20 weeks, it "has the physical structures necessary to experience pain and that abortions can cause substantial pain to the fetus," reported the Associated Press (11/10/05).
Liability premiums leveling off
January 1st 2006The 15th annual rate survey by Medical Liability Monitor (10/2005) shows that, although medical malpractice premiums continued to increase in 2005, the increases were lower than in recent years. The survey found that the majority of rate changes this year were between 0% and 14.8%, whereas half of the rate changes in 2004 were between 6.9% and 24.9%. In addition, about 64% of insurers dropped their rates, made no change to rates, or increased rates less than 10%. These figures may demonstrate that insurance premiums are leveling off.
Do pay-for-performance programs really produce quality care?
January 1st 2006Not really, according to a study in the Journal of the American Medical Association (10/12/05). The study compared the impact of a pay-for-performance program on quality of care within two sets of physician groups within PacifiCare Health Systems. The study involved an intervention group, which received bonuses for meeting or exceeding 10 clinical and service quality targets, and a comparison group. Both groups were assessed against three measures: cervical cancer screening, mammography, and hemoglobin A1c testing.
The art of presenting bad news vs. the risk of getting sued
January 1st 2006No matter how busy physicians are when a pregnancy loss occurs, they should go to the mother's bedside to talk about the event for 10 minutes. Doing so just may "avoid 6 weeks in court," advised James R. Woods, Jr., MD, Henry A. Thiede Professor and Department of Obstetrics and Gynecology Chair at the University of Rochester, speaking at the ACOG District II/NY Annual Meeting in New York City.
Cholesterol levels and drugs don't alter breast cancer risk
January 1st 2006Although there's some evidence to suggest that statins reduce the threat of breast cancer, a large, prospective cohort study has concluded that serum lipid levels and cholesterol-lowering drugs, including statins, do not seem to affect a woman's risk of breast cancer.
Increase stress levels to lower Br Ca risk?
January 1st 2006It seems chronic stress has a fringe benefit: It protects women from breast cancer. A recent prospective cohort study of almost 7,000 women participating in the Copenhagen City heart study finds that women with self-perceived high levels of stress have a 40% lower risk of first-time primary breast cancer than less stressed counterparts.
Treat sudden jump in systolic blood pressure as emergency in preeclamptic patients
January 1st 2006Abiding by the old rules and waiting for a severely preeclamptic patient's diastolic blood pressure (BP) to reach or rise above 110 mm Hg before beginning to treat hypertension can invite a deadly stroke, warned a leading Jackson, Miss. maternal-fetal medicine researcher. Instead, consider treating as a hypertensive emergency a pregnant patient's sudden severe systolic BP reading of 155 to 160 mm Hg or more, regardless of the diastolic reading, said James N. Martin, Jr., MD, Professor of Obstetrics and Gynecology, and Director of Maternal-Fetal Medicine and Obstetrics at the University of Mississippi School of Medicine.
Birth control patch-wearers at higher risk of blood clots
January 1st 2006Users of the Ortho Evra birth control patch (Ortho McNeil Pharmaceuticals) are exposed to higher overall levels of estrogen than users of birth control pills and thus may be at higher risk for blood clots and other serious side effects, according to the FDA.
Short cervix increases risk of preterm birth thirteenfold
January 1st 2006In women with uterine anomalies, such as bicornuate uterus, unicornuate uterus, septate uterus, and uterus didelphys, a cervical length of less than 25 mm on transvaginal ultrasonography makes preterm birth 13 times more likely, according to results from a prospective study of 64 women.