Cesarean delivery (Part 3): Is it time to embrace elective procedures?
December 1st 2004In June 2000, I arrived a few minutes late to the American College of Obstetricians and Gynecologists' headquarters for a meeting of the Committee on Obstetric Practice. As Chair, I was used to dealing with political hot potatoes, but that day, I was handed a real sizzler. Earlier that morning, then ACOG president, Benjamin Harer, MD, speaking for himself and not the College, had seemingly endorsed "elective" cesarean deliveries (CD) in an interview with Diane Sawyer on "Good Morning America." After watching an excerpt of the interview in which Dr. Harer debated a non-physician advocate of home VBACs attended by midwives, I was struck by the logic of his arguments and his grace under fire. Yet it fell to my committee to restate ACOG's official position against such surgeries, which we did in a press release
Editorial: Cesarean delivery (Part 2): Managing the logjam
November 1st 2004Last month, I reviewed the factors that have driven the dramatic increase in cesarean delivery (CD) rates over the past several years. This month, I'll review the potential impact of this trend on a "typical" obstetric service. While both staff and physical capacity will be taxed by increased CD rates, I believe that patient safety may also be threatened as a result of the incremental demand on limited obstetrical operating room (OR) availability. I offer several strategies to manage the coming chaos.
Roundtable: The ob/gyn and legal liability: condition critical, Part 1
November 1st 2004It's hard to imagine a more serious crisis than the current legal liability debacle facing American ob/gyns. Dr. Charles Lockwood has gathered the profession's thought leaders to help analyze its complexities and discuss possible solutions.
Grand Rounds: What's the best approach to spontaneous premature ovarian failure?
November 1st 2004Learning that she has what used to be called premature menopause can devastate a woman in her 20s or 30s. Diagnose this mysterious condition without delay, deliver the bad news in person, and provide sensitiveanswers to four basic questions.
How reproductive genetics puts ob/gyns at legal risk
November 1st 2004Using reproductive and genetic technologies to provide prospective parents with information about a future child or to avoid having a child with a genetic abnormality is an emerging field of medicine-one that has its share of legal risks, according to a report entitled "Reproductive Genetics and the Law."
WHI data suggest O/Cs prevent heart disease and cancer
November 1st 2004While the Women's Health Initiative questioned the value of long-term HRT in preventing cardiovascular disease (CVD), a new analysis of the raw data presented at the annual ASRM meeting in Philadelphia strongly suggests that long-term use of OCs does protect a woman's heart, and reduces the threat of cancer.
Oocyte freezing: Is it ready for prime time?
November 1st 2004In a recent issue of Lancet, researchers reported on one of the first successful cases in which ovarian tissue that had been removed and frozen before a patient underwent cancer chemotherapy was later re-implanted and led to a successful pregnancy.
Does needle biopsy encourage breast Ca spread?
November 1st 2004Women who receive fine-needle aspiration (FNA) or large-gauge needle core biopsy of breast cancer tissue are about 50% more likely to have sentinel node metastases than women who undergo tumor removal, according to a recent prospective database study from California.
Patient ed tool improves decision making for breast Ca
November 1st 2004Specially designed visual aids and written materials-intended to help surgeons present treatment options to women newly diagnosed with early-stage breast cancer and to help them participate in the treatment decision process-left women better educated about their disease and treatment options.
Radiation after lumpectomy: not always necessary
November 1st 2004While women younger than 70 years of age with invasive breast cancer should probably still receive radiotherapy plus tamoxifen following lumpectomy, those over age 70 who receive lumpectomy early, estrogen-receptor-positive breast tumors can probably get by with just tamoxifen.