American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 2019
Incidence and risk factors of early postoperative small bowel obstruction in patients undergoing hysterectomy for benign indications.
Small bowel obstruction (SBO) is a major cause of postoperative mortality and morbidity following abdominal and pelvic surgery, with 225,000-345,000 annual admissions. SBO may be classified based on onset from day of surgery. Early SBO occurs within the first 30 days following surgery, whereas late SBO occurs after the initial 30-day postoperative window. The majority of either type of bowel obstruction is believed to be secondary to intra-abdominal adhesions. Early SBO warrants special attention because of the difficulty in distinguishing between mechanical and nonmechanical obstruction during this period. Whereas conservative management often leads to resolution of nonmechanical obstruction and some partial SBO, surgical management is associated with a higher rate of complications compared to surgery for late SBO because of the presence of hypervascular adhesions in the early postoperative period. The current literature regarding SBO, and early SBO in particular, following hysterectomy is limited. Given that approximately 400,000 hysterectomies are performed annually, understanding the risk factors associated with SBO following these types of surgeries is imperative for improving patient outcomes. ⋯ Early SBO is a rare complication of benign hysterectomy. Although route of hysterectomy was not found to be a significant risk factor for early SBO, variables typically associated with abdominal hysterectomy compared to minimally invasive hysterectomy, including higher wound class, larger uteri, and perioperative transfusion (a marker of intraoperative blood loss), were strongly correlated with subsequent development of early obstruction.
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Am. J. Obstet. Gynecol. · Mar 2019
Observational StudyOpioid use after laparoscopic hysterectomy: prescriptions, patient use, and a predictive calculator.
In the setting of America's opioid epidemic, judicious postoperative opioid prescribing is important. Gynecologists lack standard guidelines about postoperative opioid prescriptions. ⋯ On average, surgeons prescribed 4 times the amount of opioids than was needed for patients undergoing laparoscopic hysterectomy for acute postoperative pain control. Individualizing patients' opioid prescriptions based on preoperative risk factors could help reduce excess prescription opioids.
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Am. J. Obstet. Gynecol. · Mar 2019
Observational StudyComputerized analysis of cardiotocograms and ST signals is associated with significant reductions in hypoxic-ischemic encephalopathy and cesarean delivery: an observational study in 38,466 deliveries.
Intrapartum cardiotocography is widely used in high-resource countries and remains at the center of fetal monitoring and the decision to intervene, but there is ample evidence of poor reliability in visual interpretation as well as limited accuracy in identifying fetal hypoxia. Combined monitoring of intrapartum cardiotocography and ST segment signals was developed to increase specificity, but analysis relies heavily on intrapartum cardiotocography interpretation and is therefore also affected by the previously referred problems. Computerized analysis was developed to overcome these limitations, aiding in the quantification of parameters that are difficult to evaluate visually, such as variability, integrating the complex guidelines of combined intrapartum cardiotocography and ST analysis, and using visual and sound alerts to prompt health care professionals to reevaluate features associated with fetal hypoxia. ⋯ Introduction of computerized analysis of intrapartum cardiotocography and ST signals in a tertiary care hospital was associated with a significant reduction in the incidence of hypoxic-ischemic encephalopathy and a modest reduction in cesarean deliveries.
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Changes in the make-up of the Supreme Court make an overturn of the Roe v Wade decision a realistic possibility. In order to mitigate any adverse health consequences that could result from a change in the law, all stakeholders in women's health have to start to plan for that contingency. ⋯ Among the tasks for physicians and their professional organization, we include education about the management of women injured by unsafe abortions, post-residency training for physicians with reduced access to residency training in abortion, and planning for the management of medically complicated pregnancies that currently are often terminated (eg, Eisenmenger's syndrome). In this piece, we argue for preparation for a potential post-Roe world.
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Am. J. Obstet. Gynecol. · Mar 2019
Multicenter Study Comparative StudyMaternal and newborn outcomes with elective induction of labor at term.
A growing body of evidence supports improved or not worsened birth outcomes with nonmedically indicated induction of labor at 39 weeks gestation compared with expectant management. This evidence includes 2 recent randomized control trials. However, concern has been raised as to whether these studies are applicable to a broader US pregnant population. ⋯ Elective induction of labor at 39 weeks gestation is associated with a decrease in cesarean birth in nulliparous women, decreased pregnancy-related hypertension in multiparous and nulliparous women, and increased time in labor and delivery. How to use this information remains the challenge.