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Despite advances in medical technology and patient safety initiatives, maternal morbidity and mortality rates continue to increase. Maternal mortality trends in the US as reported from the CDC from 1989-2009 demonstrate increasing mortality trends from 7.2 deaths per 100,000 live births in 1987 to 17.8 deaths per 100,000 live births in 2009. To combat this problem, a thorough understanding of the critical medical and surgical issues that are often encountered in pregnancy is essential. Each article addresses a topic relevant to care of the critically ill gravida.
Despite advances in medical technology and patient safety initiatives, maternal morbidity and mortality rates continue to increase. Maternal mortality trends in the US as reported from the CDC from 1989-2009 demonstrate increasing mortality trends from 7.2 deaths per 100,000 live births in 1987 to 17.8 deaths per 100,000 live births in 2009. To combat this problem, a thorough understanding of the critical medical and surgical issues that are often encountered in pregnancy is essential. Each article addresses a topic relevant to care of the critically ill gravida.
Obstetrician Gynecologists are frequently responsible for management of the primary care needs of their patients. A survey performed in 2005 found an estimated 37% of, non-pregnant patients, relies on gynecologists for routine primary care. The same study found that almost a quarter of gynecologists reported they needed additional primary care training across a broad set of medical topics (Acad Med. 2007; 82:602–607). The impetus for training in primary care skills is increasing. In response to language in the Affordable Care Act, the Institute of Medicine developed a report on clinical preventative services necessary for women (Clinical Preventative Services for Women: Closing the Gaps IOM. 2011; also Current Opinion in Obstetrics and Gynecology 2011, 23:471–480). The US Department of Health and Human services has adopted these IOM recommendations and, as a result, health plans are required to include these services. While initiatives such as the American Congress of Obstetricians and Gynecologists’ Well-Woman Task Force and recent cross-specialty ACOG educational collaborations have begun to address supplemental educational needs, additional resources covering key primary care topics are necessary. This issue of Obstetrics and Gynecology Clinics is an ideal means for accomplishing this important goal.
Vulvar disorders are prevalent but often overlooked conditions in the curricula of obstetrics and gynecology, dermatology, and primary care residency training programs. This has led many outpatient clinicians to feel unprepared to evaluate the patient with a vulvar complaint. Often patients with complex, chronic vulvar disorders have seen multiple providers in consultation before they are appropriately diagnosed and treated, leading to frustration amongst patients and providers alike as well as excessive health care costs. The goal of this issue is to present a practical review on vulvar disease for outpatient clinicians to improve patient care. The topics highlighted in this issue represent gaps in knowledge among residents, fellows, providers, and course and conference attendees. The issue begins with a general approach to the evaluation and management of vulvar disorders and then moves on to an article on vulvar pathology that will help clinicians obtain the most useful pathology reads from their biopsies. Also addressed are specific vulvar disorders or presenting findings that are common or challenging. A pelvic floor physical therapy colleague provides information on how this modality can help manage vulvar pain. The issue concludes with an article on hot topics in vulvar disease. In the last several years there has been a growing number of newly trained physicians committed to advancing patient care in the area of vulvar disease, and many of this issue’s authors are part of this group. This issue should serve as a useful resource in the office of any provider who evaluates patients with vulvar complaints.
The Guest Editors have created a comprehensive issue devoted to the most current and clinically relevant approach to hysterectomies and their alternatives. Top experts have written articles on the following topics: Alternatives to Hysterectomy: Management of Uterine Fibroids; Alternatives to Hysterectomy: Management of Menorrhagia; Hysterectomy for benign conditions of the uterus: Total Abdominal Hysterectomy; Hysterectomy for benign conditions of the uterus: Total Vaginal Hysterectomy; Hysterectomy for benign conditions of the uterus: Total Laparoscopic Hysterectomy/Laparoscopically Assisted Vaginal Hysterectomy; Hysterectomy for benign conditions of the uterus: Radical Hysterectomy Evidence basis for hysterectomy; Cesarean Hysterectomy; Management of ovaries at the time of benign Hysterectomy; Management of the peri- and postoperative patient undergoing hysterectomy; and Simulation and surgical competency: Current issues.
Develop top-level guidelines for high-risk and critically ill pregnancy women with AWHONN High-Risk & Critical Care Obstetrics, 4th Edition, an official publication of the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN). This comprehensive analysis of critical care obstetrics concepts offers summary of research findings and top-notch clinical expertise. This is the expert guidance you need to navigate complex patient conditions and promote safe, effective perinatal care.
In this issue of Obstetrics and Gynecology Clinics of North America, guest editors Drs. Amy VanBlaricom and Brigid McCue bring their considerable expertise to the topic of Obstetrics and Gynecologic Hospitalists and Laborists. Top experts provide clinical updates to help obstetrics and gynecology hospitalists stay current, including important topics such as restricted access to termination; medical innovations; crisis management; risk mitigation; and diversity, equity, and inclusion. - Contains 14 relevant, practice-oriented topics including obstetric and gynecologic hospitalist fellowships; medical innovation for obstetrics and gynecologist hospitalists' practice and patient experience; the gynecologic hospitalist; can obstetrics/gynecology hospitalists reduce severe maternal morbidity; and more. - Provides in-depth clinical reviews on obstetrics and gynecologic hospitalists and laborists, offering actionable insights for clinical practice. - Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.
Dr. Iglesia has created an issue devoted to pelvic floor disorders that has a strong focus on the evidence behind current treatments and diagnostic methods. The authors are top experts in their areas and have contributed reviews on the most important topics in pelvic floor disorders, including Stress Urinary Incontinence; Urge Urinary Incontinence; Pelvic Organ Prolapse Native Tissue repairs; Pelvic Organ Prolapse Vaginal and Laparoscopic Mesh; Fecal Incontinence; PFDR Pelvic Floor Disorders Registry; Ultrasound Imaging of the Pelvic Floor; and Childbirth/Pelvic Floor Epidemiology to name a few.
This issue of the Obstetrics and Gynecology Clinics in North America will focus on the advances in the evaluation and management of Recurrent Pregnancy Loss (RPL) that have emerged within the last few years. Although spontaneous pregnancy loss occurs in approximately 15% to 20% of clinically recognized pregnancies in reproductive-aged women, RPL occurs in 2% to 5% of the same population. Recent reports on large populations of women with RPL have helped to characterize the incidence and diversity of this heterogeneous disorder, and a definite cause of pregnancy loss can be established on over 50% of all couples after a thorough evaluation. New diagnostic strategies, which include 23-chromosome microarray genetic testing of the products of conception in failed pregnancies, offer the promise of understanding the cause of most pregnancy losses. These recent advances, combined with the contributions from the authors in this issue of Clinics and many others interested in this field, lead to the publication of the long-awaited publication on evaluation and treatment of RPL from the Practice Committee of the American Society for Reproductive Medicine. A complete evaluation will include investigations into genetic, anatomic, immunologic, endocrinologic, and iatrogenic factors.
Co-published with the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), this book is a comprehensive clinical resource for practicing perinatal nurses and an excellent staff educator's guide and textbook. It provides commonly accepted guidelines for practice and evidence-based care and includes algorithms to support decision-making. Numerous photographs complement the text and summary boxes highlight key points. Appendices provide patient care examples and practice guidelines. This edition has been extensively revised and updated. New features include more than 650 end-of-chapter review questions and answers and selected AWHONN protocols.