American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Nov 2018
Implementation of a urogynecology-specific enhanced recovery after surgery (ERAS) pathway.
Enhanced recovery after surgery protocols were developed for colorectal surgery to hasten postoperative recovery. Variations of the protocol are being adopted for gynecological procedures despite limited population and procedure-specific outcome data. Our objective was to evaluate whether implementation of an enhanced recovery after surgery pathway would facilitate reduced length of admission in a urogynecology population. ⋯ Enhanced recovery after surgery implementation in a urogynecology population resulted in a greater proportion of same-day discharge and high patient satisfaction but with slightly increased hospital readmissions within 30 days.
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Am. J. Obstet. Gynecol. · Oct 2018
Observational StudyCervical cerclage for singleton pregnant patients on vaginal progesterone with progressive cervical shortening.
Premature cervical ripening plays a significant role in spontaneous preterm birth. Vaginal progesterone is the recommended treatment in singleton pregnancy with incidental short cervix. There is lack of evidence on whether it is beneficial to reinforce the cervix with cerclage when the cervical length becomes progressively shortened <10 mm while on vaginal progesterone. ⋯ Our study showed that cerclage plus vaginal progesterone in women with extremely shortened cervix significantly decreased overall spontaneous preterm birth rates, prolonged pregnancy latency by 2-fold, and decreased the overall neonatal morbidity and mortality.
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Am. J. Obstet. Gynecol. · Oct 2018
Meta AnalysisProgestogens in singleton gestations with preterm prelabor rupture of membranes: a systematic review and metaanalysis of randomized controlled trials.
Preterm prelabor rupture of membranes occurs in 3% of all pregnancies. Neonatal benefit is seen in uninfected women who do not deliver immediately after preterm prelabor rupture of membranes. The purpose of this study was to evaluate whether the administration of progestogens in singleton pregnancies prolongs pregnancy after preterm prelabor rupture of membranes. ⋯ Progestogen administration does not prolong pregnancy in singleton gestations with preterm prelabor rupture of membranes.
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Am. J. Obstet. Gynecol. · Oct 2018
Postpartum venous thromboembolism readmissions in the United States.
There are limited data on when postpartum readmissions for thromboembolism occur after delivery hospitalizations on a population basis in the United States. ⋯ While the majority of events occurred within 20 days of discharge, risk factors other than thrombophilia and prior venous thromboembolism were generally associated with modestly increased odds of events, and only a small proportion of readmissions occurred among women with thrombophilia and prior events. Our data demonstrate both the challenging nature and urgent need for further research to determine which clinical practices and interventions may reduce risk for venous thromboembolism readmissions on a population basis.
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Women in medicine have made strides towards equality and yet the gender gap continues to exist. Despite being the specialty dedicated to the promotion of women's health, obstetrics and gynecology is also marred by gender disparity. ⋯ Both men and women have a vested interest in promoting greater gender parity in obstetrics and gynecology, and participation of men is critical for realization of this goal. For the obstetrician-gynecologist, sexism is not just a "women's issue".