Clinical obstetrics and gynecology
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In many parts of the world, perinatal transmission is the most common route of infection for hepatitis B virus. In the United States, sexual contact is the most common source of hepatitis B virus infection. As a result, it is essential that women's health care providers become aware of the recommended strategies used to identify women infected with hepatitis B and to subsequently reduce perinatal transmission, particularly now that immigration and globalization is more common and reproductive science makes pregnancy more possible for women with liver disease. This article reviews evidence-based strategies for management of hepatitis B infection during pregnancy.
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Zika virus is a single-stranded RNA virus from the Flaviviridae family. Transmission is typically from the bite of an infected mosquito though mother-to-child, sexual and blood donation transmissions can occur. ⋯ The Centers for Disease Control and Prevention, ACOG, and SMFM have developed algorithms for screening and managing women exposure to and diagnosed with Zika virus infection. Prevention is the mainstay of infection control as there is currently no vaccine or therapy available.
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Clin Obstet Gynecol · Sep 2017
Cervical Evaluation in Pregnancy: Proper Measurement, Evaluation, and Management.
Preterm birth is the leading cause of perinatal morbidity and mortality in developed nations. The heterogeneous causes of spontaneous preterm birth make prediction and prevention difficult. ⋯ Cervical length may be useful in identifying women who are candidates for cervical cerclage or progesterone therapy for preterm birth prevention. Together, cervical length and fibronectin can be used in the triaging of women symptomatic for preterm labor.
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Although it is the most effective method to treat labor pain, neuraxial analgesia may be undesired, contraindicated, unsuccessful, or unavailable. Providing safe choices for labor pain relief is a central goal of health care providers alike. ⋯ In addition to nonpharmacologic alternatives, inhaled nitrous oxide and systemic opioids represent two broad classes of non-neuraxial pharmacologic labor analgesia most commonly available. This review summarizes the current published literature for these non-neuraxial labor analgesic options.
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Clin Obstet Gynecol · Jun 2017
ReviewPeripartum Anesthetic Management of the Opioid-tolerant or Buprenorphine/Suboxone-dependent Patient.
Opioid abuse and dependence continues to rise in both the general population and pregnancy, with opioid overdose deaths having quadrupled in the last 15 years. Illicit drug use in last 30 days of pregnancy was over 4% with almost 0.6% documented maternal opiate use at time of birth. ⋯ Options for treatment of opioid dependence, acute pain management, and perioperative multimodal analgesia are discussed. The effects of maternal management on neonatal abstinence syndrome are also reviewed.