American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Sep 2015
Comparative StudyConsiderations about retirement from clinical practice by obstetrician-gynecologists.
Retirement of obstetrician-gynecologists is becoming a matter of increasing concern in light of an expected shortage of practicing physicians. Determining a retirement age is often complex. We address what constitutes a usual retirement age range from general clinical practice for an obstetrician-gynecologist, compare this with practitioners in other specialties, and suggest factors of importance to obstetrician-gynecologists before retirement. ⋯ The large cohort of "baby boomer" physicians who are approaching retirement (approximately 15,000 obstetrician-gynecologists) deserves tracking while an investigation of integrated women's health care delivery models is conducted. Relevant considerations would include strategies to extend the work longevity of those who are considering early retirement or desiring part-time employment. Likewise volunteer work in underserved community clinics or teaching medical students and residents offers continuing personal satisfaction for many retirees and preservation of self-esteem and medical knowledge.
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Am. J. Obstet. Gynecol. · Sep 2015
Randomized Controlled Trial Multicenter StudyDoes magnesium exposure affect neonatal resuscitation?
Research on immediate neonatal resuscitation suggests that maternal magnesium exposure may be associated with increased risk of low Apgar scores, hypotonia, and neonatal intensive care unit admission. However, not all studies support these associations. Our objective was to determine whether exposure to magnesium at the time of delivery affects initial neonatal resuscitation. ⋯ Exposure to magnesium sulfate did not affect neonatal resuscitation or other short-term outcomes. These findings may be useful in planning neonatal care and patient counseling.
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Am. J. Obstet. Gynecol. · Sep 2015
MRI evaluation of maternal cardiac displacement in pregnancy: implications for cardiopulmonary resuscitation.
The purpose of this study was to determine, with the use of cardiac magnetic resonance imaging, whether there is vertical displacement of the heart during pregnancy. Cardiopulmonary resuscitation guidelines during pregnancy recommend placing the hands 2-3 cm higher on the sternum than in nonpregnant individuals. This recommendation is based on the presumption that the heart is displaced superiorly by the diaphragm during the third trimester. Whether there is true cardiac displacement because of the expanding uterus in pregnancy remains unknown. ⋯ Contrary to popular assumption, there is no significant vertical displacement of the heart in the third trimester of pregnancy relative to the nonpregnant state. Accordingly, there is no need to alter hand placement for chest compressions during cardiopulmonary resuscitation in pregnancy.
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Am. J. Obstet. Gynecol. · Sep 2015
Comparative Study Clinical TrialIncreased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women.
The purpose of this study was to determine tissue concentrations of cefazolin after the administration of a 3-g prophylactic dose for cesarean delivery in obese women (body mass index [BMI] >30 kg/m(2)) and to compare these data with data for historic control subjects who received 2-g doses. Acceptable coverage was defined as the ability to reach the minimal inhibitory concentration (MIC) of 8 μg/mL for cefazolin. ⋯ Higher adipose concentrations of cefazolin were observed after the administration of an increased prophylactic dose. This concentration-based pharmacology study supports the use of 3 g of cefazolin at the time of cesarean delivery in obese women. Normal and overweight women (BMI <30 kg/m(2)) reach adequate cefazolin concentrations with the standard 2-g dosing.
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Am. J. Obstet. Gynecol. · Sep 2015
Randomized Controlled Trial Multicenter Study17-hydroxyprogesterone caproate for preterm rupture of the membranes: a multicenter, randomized, double-blind, placebo-controlled trial.
Preterm rupture of membranes (PROM) is associated with an increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHP-C) reduces the risk of preterm birth in some women who are at risk for preterm birth. We sought to test whether 17OHP-C would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes. ⋯ Compared with placebo, weekly 17OHP-C injections did not prolong pregnancy or reduce perinatal morbidity in patients with PROM in this trial.