American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Feb 2018
ReviewPerioperative pain management: an update for obstetrician-gynecologists.
The opioid epidemic in the United States is unprecedented and continues to worsen. Many opioid abusers obtain their pills through legitimate prescriptions, directly or indirectly, from a medical provider. While practitioners have a responsibility to treat pain, it is now becoming clear that aggressive opioid prescription practices contribute to an epidemic of abuse. ⋯ Therefore, the objective of this publication was to familiarize obstetricians and gynecologists with contemporary concepts in pain management and summarize recent guidelines in a manner that is applicable to our specialty. We focus on perioperative pain management, which is the time period immediately before, during, and after surgery. Topics reviewed include proper risk assessment to evaluate a patient's potential for poor pain control or development of chronic pain or misuse of opioids; multimodal pain management with nonpharmacological, nonopioid alternatives, safe opioid-use strategies; education and documentation; and special considerations for women, veterans, and lactation concerns.
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Am. J. Obstet. Gynecol. · Feb 2018
Review Meta AnalysisProphylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis.
The objective of the study was to assess the effect of prophylactic negative-pressure wound therapy on surgical site infections and other wound complications in women after cesarean delivery. ⋯ Studies on the effectiveness of prophylactic negative-pressure wound therapy at cesarean delivery are heterogeneous but suggest a reduction in surgical site infection and overall wound complications. Larger definitive trials are needed to clarify the clinical utility of prophylactic negative-pressure wound therapy after cesarean delivery.
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Am. J. Obstet. Gynecol. · Feb 2018
Review Meta AnalysisProphylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis.
The objective of the study was to assess the effect of prophylactic negative-pressure wound therapy on surgical site infections and other wound complications in women after cesarean delivery. ⋯ Studies on the effectiveness of prophylactic negative-pressure wound therapy at cesarean delivery are heterogeneous but suggest a reduction in surgical site infection and overall wound complications. Larger definitive trials are needed to clarify the clinical utility of prophylactic negative-pressure wound therapy after cesarean delivery.
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Am. J. Obstet. Gynecol. · Feb 2018
Review Meta AnalysisVaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data.
The efficacy of vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix has been questioned after publication of the OPPTIMUM study. ⋯ Vaginal progesterone decreases the risk of preterm birth and improves perinatal outcomes in singleton gestations with a midtrimester sonographic short cervix, without any demonstrable deleterious effects on childhood neurodevelopment.
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Am. J. Obstet. Gynecol. · Feb 2018
Review Meta AnalysisVaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix: a meta-analysis of individual patient data.
The efficacy of vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in singleton gestations with a short cervix has been questioned after publication of the OPPTIMUM study. ⋯ Vaginal progesterone decreases the risk of preterm birth and improves perinatal outcomes in singleton gestations with a midtrimester sonographic short cervix, without any demonstrable deleterious effects on childhood neurodevelopment.