Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Mar 2013
ReviewPharmacologic management of neonatal abstinence syndrome in a community hospital.
Neonatal abstinence syndrome has become a growing concern in infants born to substance-abusing mothers in the State of Florida. At Sarasota Memorial Hospital in Sarasota, FL, methadone and morphine treatment strategies have been formulated to manage symptomatic neonates after birth. We report our findings over a 5-year period utilizing each of these protocols in a community hospital setting.
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Chronic hypertension in pregnancy is one of the most common medical diseases affecting pregnancy. It is associated with serious maternal and fetal complications, including superimposed pre-eclampsia, fetal growth restriction, premature delivery, placental abruption, and stillbirth. ⋯ An optimal plan for maternal treatment and fetal surveillance can then be formulated. Coordination of care after delivery is important for long-term maternal health and future pregnancies.
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Gynecologic invasive procedures have moved into the physician's office due to improved reimbursement and convenience. Creating a just and safe office culture has generated robust conversations in the medical literature. This article reviews the foundational principles relating to safe practices in the office including: checklists, drills, selecting a safety officer, achieving office certification, medication usage, and engaging the patient in the safety culture. Reduction of medical errors in the office will require open dialogue between the stake holders: providers, insurers, patients, state and federal agencies, and educational bodies such as the American College of Obstetricians and Gynecologists.
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A review of the approach in pregnancy to a very commonly encountered neurological disorder (headache), along with less commonly encountered neurological entities that none the less deserve the obstetrician's attention. Definitions of specific disorders and differential diagnoses are reviewed, along with treatment options and pregnancy-associated morbidities. ⋯ The disabling neurological disorders-multiple sclerosis, cerebral palsy, and spinal cord injury are grouped due to common morbidities affecting pregnancy. Finally, Bell palsy is also reviewed.
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Clin Obstet Gynecol · Mar 2012
ReviewPlacenta, umbilical cord and amniotic fluid: the not-less-important accessories.
The placenta and umbilical cord are crucial to the survival and well-being of the fetus. In fact, disorders of either of these may lead to fetal death or severe morbidity. Yet, they are often not accorded appropriate attention in the prenatal sonographic examination. ⋯ Detection allows interventions that may improve perinatal and maternal outcomes. However, not infrequently, controversial findings, of uncertain significance, demonstrated on routine sonography lead to anxiety and worry. The goal of this chapter is to address the normal appearances of the placenta, cord, and fluid and to describe several of the more common conditions affecting these structures that the clinician may have to deal within pregnancy.