Cervical Ripening for Induction of Labor

Decrease in Cervidil use for cervical ripening by 20% of anticipated doses prior to Dec 1, 2018 (6 mos) , with a potential for cost savings = 40 doses x approx. $2000/dose =$80,000

Le Forum, Vol. 42 No. 2

https://digitalcommons.library.umaine.edu/francoamericain_forum/1095/thumbnail.jp

The Amniotic Fluid Index and Oligohydramnios: A Deeper Dive into the Shallow End

Second and third trimester obstetrical ultrasound examinations include an amniotic fluid volume assessment. Professional organizations\u27 clinical guidance recommends using semi-quantitative techniques such as the single deepest vertical pocket or amniotic fluid index for this purpose. The single deepest vertical pocket is described as the preferred method of assessing amniotic fluid volume based on fewer oligohydramnios diagnoses and labor inductions with no demonstrable differences in pregnancy outcomes compared to the amniotic fluid index. We offer an alternative interpretation of the evidence for this advice, drawn from six randomized clinical trials and two meta-analyses comparing the single deepest vertical pocket to the amniotic fluid index. Individually and collectively, these reports are underpowered to detect significant differences in maternal and perinatal outcomes by study group. Moreover, randomized clinical trials comparing maternal and perinatal outcomes resulting from a policy of labor induction at or beyond 37 weeks\u27 gestation versus expectant care consistently favor labor induction, the very intervention paradoxically cited as favoring the single deepest vertical pocket over the amniotic fluid index. We conclude that the amniotic fluid index should be considered a reasonable method for third-trimester amniotic fluid assessment and diagnosing oligohydramnios

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. The primary importance of transvaginal cervical sonography and cervicovaginal fetal fibronectin lies in their high negative predictive values in assessing risk for preterm birth. 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

Workplace Violence in Health Care--It\u27s Not Part of the Job .

IMPORTANCE: While health care workers comprise just 13% of the US workforce, they experience 60% of all workplace assaults. This violence is the second leading cause of fatal occupational injury. Women comprise 45% of the US labor force but 80% of health care workers, the highest proportion of females in any industry. OBJECTIVE: The purpose was to describe the prevalence, forms, and consequences of health care workplace violence (WPV). The role and components of prevention programs for avoiding or mitigating violence are discussed, including opportunities for participation by obstetrician-gynecologists. EVIDENCE ACQUISITION: A search of PubMed from 1990 to February 1, 2016, identified relevant manuscripts. Additional studies were found by reviewing the manuscripts\u27 references. Government Web sites were visited for relevant data, publications, and resources. RESULTS: Health care WPV continues to rise despite an overall decrease in US WPV. While workers are most likely to be assaulted by clients or patients, they are most frequently bullied and threatened by coworkers. All incidents are markedly underreported in the absence of physical injury or lost work time. Sequelae include physical and psychological trauma, adverse patient outcomes, and perceived lower quality of care. CONCLUSIONS: The human, societal, and economic costs of health care WPV are enormous and unacceptable. Comprehensive prevention, planning, and intervention offer the best means of mitigating risks. As women\u27s health physicians and health care workers, obstetrician-gynecologists should be encouraged to participate in such efforts

Preparing a research presentation: a guide for investigators.

Many obstetrics and gynecology residencies require trainees to complete a research project as a graduation requirement. These projects may be submitted for publication in a peer-review journal or presentation at a professional meeting. Although written instructions are available for novice authors, few references target research abstract submission and presentation. This paper provides investigators with the advice to successfully negotiate this process

Biophysical and biochemical screening for the risk of preterm labor: an update.

The heterogeneous causes of spontaneous preterm birth make prediction and prevention difficult. Recently developed biochemical and biophysical tests add significantly to clinicians\u27 ability to evaluate and treat women at risk for spontaneous preterm birth. The primary importance of transvaginal cervical sonography and cervicovaginal fetal fibronectin lies in the high negative predictive values of the tests for preterm delivery risk. 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

Promoting preconception, pregnancy, and postpartum care following bariatric surgery: a best practice planning toolkit for patients and their physicians.

Most bariatric procedures are performed in reproductive-aged women. Managing sequelae of postoperative anatomic and physiologic changes can be complex, particularly in women. Standardizing preconception, pregnancy, and postpartum management may limit practice variation and improve pore. We therefore provide a clinical toolkit consisting of physician checklists and corresponding written patient educational material to achieve these goals