Obstetrics and gynecology
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Obstetrics and gynecology · Oct 2014
ReviewThe maternal early warning criteria: a proposal from the national partnership for maternal safety.
Case reviews of maternal death have revealed a concerning pattern of delay in recognition of hemorrhage, hypertensive crisis, sepsis, venous thromboembolism, and heart failure. Early-warning systems have been proposed to facilitate timely recognition, diagnosis, and treatment for women developing critical illness. A multidisciplinary working group convened by the National Partnership for Maternal Safety used a consensus-based approach to define The Maternal Early Warning Criteria, a list of abnormal parameters that indicate the need for urgent bedside evaluation by a clinician with the capacity to escalate care as necessary in order to pursue diagnostic and therapeutic interventions. This commentary reviews the evidence supporting the use of early-warning systems and describes The Maternal Early Warning Criteria, along with considerations for local implementation.
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Obstetrics and gynecology · Oct 2014
ReviewApplying a science-based method to improve perinatal care: the institute for healthcare improvement perinatal improvement community.
The Institute for Healthcare Improvement applies a systems-focused, science-based approach to improving perinatal care. This approach is based on the pioneering work in quality improvement and statistical process control performed by Walter Shewhart and W. Edwards Deming, and it uses the Model for Improvement, a simple and effective tool for accelerating improvement. ⋯ The Institute for Healthcare Improvement's collaborative effort to improve perinatal care-the Perinatal Improvement Community-is an ideal example of work that pursues all three dimensions of the Triple Aim. The improvement method used in the community creates the foundation for the kind of cultural transformation that Perinatal Improvement Community leaders and participants have learned is necessary to make significant and lasting change. Using a systems-focused and science-based approach to improvement equips obstetricians and gynecologists with the knowledge, skills, and tools they need to improve the systems of care they work in so they can deliver the best evidence-based care to all of their patients, all of the time.
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Obstetrics and gynecology · Jul 2014
Review Meta AnalysisReducing postoperative pain after tubal ligation with rings or clips: a systematic review and meta-analysis.
To assess the effectiveness of using local anesthesia during interval laparoscopic tubal ligation to control postoperative pain. ⋯ Use of local anesthetic during laparoscopic tubal ligation substantially reduces postoperative pain up to 8 hours after surgery.
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Obstetrics and gynecology · Jul 2014
Review Meta AnalysisPlacental transfusion strategies in very preterm neonates: a systematic review and meta-analysis.
To investigate the effects of interventions promoting placental transfusion at delivery (delayed cord clamping or umbilical cord milking) compared with early cord clamping on outcomes among premature neonates of less than 32 weeks of gestation. ⋯ Results of this meta-analysis suggest that enhanced placental transfusion (delayed umbilical cord clamping or umbilical cord milking) at birth provides better neonatal outcomes than does early cord clamping, most notably reductions in overall mortality, lower risk of intraventricular hemorrhage, and decreased blood transfusion incidence. The optimal umbilical cord clamping practice among neonates requiring immediate resuscitation remains uncertain.
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Obstetrics and gynecology · Jun 2014
Review Meta AnalysisPreemptive use of gabapentin in abdominal hysterectomy: a systematic review and meta-analysis.
To examine the evidence of preemptive use of gabapentin in abdominal hysterectomy. ⋯ I.