No 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.
Counseling 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.
Whether 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.
Although 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.
Physicians 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).
The 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.
Not 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.
Ob/gyn practices across the country are learning that consolidation into bigger practices may just be the key to negotiating better contracts with managed-care companies and underwriting expensive equipment. At least that's what a few ob/gyn practices have found.
No 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.
Although 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.
Researchers from Scotland have created a model to accurately predict for how long a woman treated with ovarian radiation can still become pregnant.
It 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.
Abiding 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.
Users 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.
In 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.
A cholesterol-lowering diet during pregnancy may do more than just modify maternal lipid levels; it may significantly reduce the rate of preterm birth among low-risk women, according to researchers from Norway.
It seems that "patient safety" initiatives are abuzz at every hospital and medical school I visit. Medical errors are much too common. It's time for that to change.
From the Internet to salacious headlines in the mainstream media, consumers have never been so inundated with health-care information and advice. To truly empower women to take control of their health, we have to provide them with the knowledge they need to make informed decisions. But we also need to make sure the information is credible.
We've been doing cerclage for roughly half a century—but where's the evidence that it prevents preterm birth? The authors make the case for limiting this surgery to select patients, cautioning that for multiple gestations, it might just make things worse.
As gynecologic surgeons have honed their laparoscopic skills, the tools used for minimally invasive gynecologic surgery have followed suit. Better specimen removal and vessel ligation devices, improved trocars, and automatic morcellators are among the reasons this approach has become easier—and safer.
It seems that making emergency contraception (EC) available over-the-counter (OTC) changes nothing except where such contraception is obtained.
It seems obese breast cancer patients are frequently underdosed when it comes to chemotherapy.
Gabapentin at a dosage of 900 mg/day, but not at 300 mg/day, provides effective relief of hot flashes in women with breast cancer.
While women who have had a prior cesarean section can safely attempt vaginal delivery beyond their estimated due date, they are 36% more likely to fail than women who attempt vaginal delivery prior to 40 weeks' gestation.
Spinal/epidural pain relief provided to women in active labor during afternoon hours lasts about 27% longer than when the same pain relief is provided at night, according to a study of about 70 nulliparous women.
Regardless of the specific screening option chosen, what is clear is that the inclusion of NT measurements optimizes Down syndrome screening.
This preliminary report suggests not, unless the fibroids are large and very close to the endometrial cavity.
