American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Sep 2019
Tranexamic acid in the routine treatment of postpartum hemorrhage in the United States: a cost-effectiveness analysis.
The World Maternal Antifibrinolytic trial demonstrated that tranexamic acid administered during postpartum hemorrhage reduces hemorrhage-related mortality and laparotomies. The World Health Organization has thus recommended early use of tranexamic acid in the treatment of postpartum hemorrhage. This recommendation has not been universally adopted in the United States, in part because of concerns about cost-effectiveness. ⋯ A policy of routine tranexamic acid early in the treatment of postpartum hemorrhage is likely to be cost saving in the United States. This conclusion holds true even when the relative risk reduction with tranexamic acid is significantly less than reported in the World Maternal Antifibrinolytic trial and when tranexamic acid is significantly more expensive than currently reported.
-
Am. J. Obstet. Gynecol. · Sep 2019
Multicenter Study Observational StudyInternational validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery.
Enhanced Recovery After Surgery Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively. ⋯ Audit of surgical practices demonstrates that improved compliance with Enhanced Recovery After Surgery Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of Enhanced Recovery After Surgery implementation.
-
Am. J. Obstet. Gynecol. · Sep 2019
Observational StudyBlood pressure trajectory and category and risk of hypertensive disorders of pregnancy in nulliparous women.
Recently updated American College of Cardiology/ American Heart Association (ACC/AHA) guidelines redefine blood pressure categories as stage 1 hypertension (systolic, 130-139 mm Hg or diastolic, 80-89 mm Hg), elevated (systolic, 120-129 mm Hg and diastolic, <80 mm Hg), and normal (<120/<80 mm Hg), but their relevance to an obstetric population is uncertain. ⋯ In nulliparous women, blood pressure category and trajectory in early pregnancy are independently associated with risk of preeclampsia and gestational hypertension. Our study demonstrates that blood pressure categories with lower thresholds than those traditionally used to identify individuals as hypertensive may identify more women at risk for preeclampsia and gestational hypertension.
-
Am. J. Obstet. Gynecol. · Sep 2019
Practice GuidelineGuidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3).
This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus. ⋯ As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.
-
Am. J. Obstet. Gynecol. · Sep 2019
Randomized Controlled Trial Multicenter StudyPain and activity after vaginal reconstructive surgery for pelvic organ prolapse and stress urinary incontinence.
Little is known about short- and long-term pain and functional activity after surgery for pelvic organ prolapse. ⋯ Pain and functional activity improve for up to 2 years after native tissue reconstructive surgery with uterosacral or sacrospinous vaginal vault suspension and midurethral sling for stages 2-4 pelvic organ prolapse. On average, immediate postoperative pain is low and improves to below baseline levels by 4-6 weeks.