Showing papers in "Obstetrics & Gynecology in 2018"

TL;DR: Therapeutic decisions in PCOS depend on the patients' phenotype, concerns, and goals, and should focus on 1) suppressing and counteracting androgen secretion and action, 2) improving metabolic status, and 3) improving fertility.

TL;DR: Optimal management involves a standardized approach with a comprehensive multidisciplinary care team accustomed to management of placenta accreta spectrum, which outcomes are optimized when delivery occurs at a level III or IV maternal care facility before the onset of labor or bleeding and with avoidance of placental disruption.

TL;DR: Pregnant women in Massachusetts have high rates of OUD and the year after delivery is a vulnerable period for women with OUD, so additional longitudinal supports and interventions tailored to women in the first year postpartum are needed to prevent and reduce overdose events.

TL;DR: Among a large and geographically diverse cohort of nulliparous women with singleton gestations, non-Hispanic black women are most likely to experience preterm birth, hypertensive disease of pregnancy, and small-for-gestational-age (SGA) birth.

TL;DR: Programs for reducing racial and ethnic disparities in severe maternal morbidity may have the greatest effect focusing on women at highest risk for blood transfusion and maternity care management for women with comorbid chronic conditions, particularly multiple chronic conditions.

TL;DR: Nearly 70% of Colorado cannabis dispensaries contacted recommended cannabis products to treat nausea in the first trimester, and as cannabis legalization expands, policy and education efforts should involve dispensaries.

TL;DR: Although all agree that there is not yet evidence to support general population screening, recommendations for high-risk screening vary between countries, a key finding from the screening trials has been the better performance of longitudinal algorithms compared with a single cutoff for CA 125.

TL;DR: Women older than 40 years have a higher risk of chromosomal abnormalities, miscarriage, and birth before 34 weeks of gestation than younger women and should be monitored accordingly.

TL;DR: Pregnant women should be advised to refrain from using marijuana during pregnancy and lactation because the harms are biologically plausible given the role of the endocannabinoid system in pregnancy implantation, placentation, and fetal neurologic development.

TL;DR: Implementation of an ERAS program was associated with significantly decreased opioid use after surgery and improvement in key patient-reported outcomes associated with functional recovery after surgery without compromising pain scores.

TL;DR: The scarcity of research since the 2015 opinion is unacceptable, so why did ACOG not call for funding epidemiologic research (trends, patterns of use)?

TL;DR: In an effort to achieve health equity in maternal morbidity and mortality, a multidisciplinary workgroup of the National Partnership for Maternal Safety and within the Council on Patient Safety in Women's Health Care developed a concept article for the bundle on reduction of peripartum disparities.

TL;DR: The current U.S. maternal mortality ratio is heavily influenced by a higher rate of death among non-Hispanic black or unmarried patients with unplanned pregnancies, and racial disparities in health care availability and access or utilization by underserved populations are important issues faced by states seeking to decrease maternal mortality.

TL;DR: In this paper, the association between prior invasive gynecologic procedures and the risk of subsequent abnormally invasive placenta (i.e., percreta) was evaluated.

TL;DR: Delta-9-tetrahydrocannabinol was transferred into mother's milk such that exclusively breastfeeding infants ingested an estimated mean of 2.5% of the maternal dose (the calculated relative infant dose=2.5%, range 0.4-8.7%).

TL;DR: This Practice Bulletin was unclear as to when to pursue aggressive nutrition interventions in women with severe hyperemesis gravidarum, but timely nutrition intervention can mitigate gestational malnutrition, addressing both macronutrients and micronutrient deficiencies.

TL;DR: In this geographically and ethnically diverse cohort of nulliparous pregnant women, medication use was nearly universal and polypharmacy was common.

TL;DR: Application of the new American College of Cardiology-American Heart Association guidelines in a pregnant population identifies a cohort of women who are at increased risk for preeclampsia, gestational diabetes mellitus, and preterm birth.

TL;DR: The safety was consistent with reduced estrogen levels and no new safety concerns were associated with long-term elagolix use, and sustained reductions in dysmenorrhea, nonmenstrual pelvic pain, and dyspareunia were provided.

TL;DR: In this paper, the authors evaluated the effect of a healthy lifestyle package (an antenatal behavior change intervention supported by smartphone application technology) on the incidence of gestational diabetes mellitus (GDM) in overweight and obese women.

TL;DR: In this paper, a systematic review of maternal and neonatal outcomes associated with opioid detoxification during pregnancy was conducted, and the outcomes were searched from January 1, 1966, to September 1, 2016.

TL;DR: In a large, diverse cohort with prospectively collected data, gestational weight gain below or above guidelines is associated with a variety of adverse pregnancy outcomes.

TL;DR: Women with morbidly adherent placenta requiring urgent delivery have a worse outcome than women with planned delivery, and scheduling delivery before the standard 34- to 35-week timeframe may be reasonable.

TL;DR: The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop on research gaps in gestational diabetes mellitus with a focus on early pregnancy diagnosis and treatment and pharmacologic treatment strategies, which identified topics in need of further research.

TL;DR: Analysis of expulsion rates at less than 4 weeks postpartum indicated that the levonorgestrel intrauterine system was associated with a higher risk of expulsion compared with CuT380A, and these results can aid in counseling women to make an informed choice about when to initiate their IUD and to help institutions implement post partum contraception programs.

TL;DR: Pregnancy rates or probabilities varied widely across different fertility awareness-based methods (and in some cases, within method types), even after excluding low-quality studies.

TL;DR: There is an urgent need for increased efforts to improve ob-gyns' knowledge of opioid use, misuse, disposal, and best prescribing practices.

TL;DR: Vacuum-assisted vaginal delivery conferred the highest odds of obstetric anal sphincter injury followed by prolonged duration of the second stage of labor, particularly among certain subpopulations.