Obstetrics and gynecology clinics of North America
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Despite the fact that childbirth is often a time of joy for a family, the occurrence of perinatal depression is very common. It is essential for the depressed patient to be identified and treated during the pregnancy or postpartum because the failure to treat can have significant morbidity and even mortality for the woman and the child. Despite various concerns several antidepressant medications are generally safe and, after a careful risk/benefit analysis and informed consent, indicated for the severely depressed pregnant or lactating patient.
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Obstet. Gynecol. Clin. North Am. · Mar 2008
ReviewTeam function in obstetrics to reduce errors and improve outcomes.
Crew resource management (CRM), adapted from aviation for the practice of medicine, offers the potential of reducing medical errors, increasing employee retention, and improving patient satisfaction. CRM, however, requires a culture that promotes teamwork and acceptance of new concepts. ⋯ Culture change can be fostered through teamwork activities that, when made part of a daily routine, provides the basis for modeling teamwork skills and sets the stage for sustained culture change. New tools are available to measure processes as well as patient and staff satisfaction.
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In the successful management of a pregnant Jehovah's Witness, many issues must be addressed beyond those normally required for routine prenatal care. The clinician who undertakes such care should be well versed in the potential complications related to blood refusal, the antepartum management of anemia, and the intrapartum management of obstetric hemorrhage. Furthermore, these patients should be delivered in a tertiary care center because this increases their options for obtaining alternative management of hemorrhage. A woman who is well informed about her options can then decide exactly what she wants done in the event of a life-threatening obstetrical hemorrhage.
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Obstet. Gynecol. Clin. North Am. · Sep 2007
ReviewEarly goal directed therapy for sepsis during pregnancy.
Sepsis is a leading cause of death in pregnancy and results in significant perinatal mortality. These deaths occur despite the younger age of pregnant patients, the low rate of comorbid conditions and the potential for effective interventions that should result in rapid resolution of illness. ⋯ Coordination of care and good communication amongst team members is essential. Incorporation of early goal directed therapy for suspected sepsis into obstetric practice is needed to optimize maternal and neonatal outcomes.
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Ectopic pregnancy continues to be one of the most common gynecologic emergencies and is the leading cause of pregnancy-related first-trimester death in the United States. The rate of ectopic pregnancy continues to rise because of increases in the incidences of its risk factors. However, improved modalities of early diagnosis and treatment have reduced both mortality and morbidity of this condition. In this article, the authors present an evidence-based review of the risk factors and presentation of ectopic pregnancy, including the utility of various diagnostic techniques, and compare the appropriateness and effectiveness of different therapeutic approaches.