Pediatrics

While most ob/gyns can recite a long list of risk factors for this lethal complication, mounting evidence suggests that maternal hypotension should be taken into account as well.

Clinical situations that typically result in litigation and the variation in jury verdicts and awards across the nation.

The majority of Americans are in favor of using a newly approved vaccine to prevent human papillomavirus, according to The Wall Street Journal (8/8/2006). About 70% of Americans agree that girls and young women should be encouraged to receive the HPV vaccine to prevent the spread of cervical cancer, while 7% disagreed and 23% were not sure.

The rate of nares colonization with methicillin-resistant Staphylococcus aureus (MRSA) is low in obstetric populations, according to two presentations at this year's annual IDSOG meeting. Although the rate of MRSA colonization is estimated to be 6% to 8% in new hospital admissions, the rate of colonization in obstetric populations was 2% in both studies, performed by Dr. Mara Dinsmoor at Evanston Hospital in Evanston, Ill. and by Dr. Richard Beigi at Cleveland Metro Health Center in Cleveland, Ohio. The study from Illinois reported that over 50% of the colonized mothers had risk factors for MRSA colonization. There was one case of MRSA sepsis in a neonate born to a colonized woman, but the two strains of MRSA were genetically distinct, arguing against vertical transmission from mother to baby.

Waiting 2 minutes-rather than 10 seconds-after delivery of an infant's shoulders to clamp the umbilical cord of normal-weight, full-term infants helps prevent iron deficiency from developing before 6 months of age, according to the results of a randomized, controlled trial involving almost 400 mother-infant pairs in Mexico City

Weekly doses of prenatal steroids do not improve overall outcome and are associated with lower birthweight and smaller size for gestational age compared to a single dose, according to a study published in the September issue of the American Journal of Obstetrics & Gynecology.

The DeLee device has been around for more than 30 years, and with it the theory that mechanical suction at delivery can help prevent MAS. The latest evidence paints a different picture.

One in eight women of reproductive age has trouble getting pregnant. Knowing what drug treatments are available and how to use them can help you improve patient outcomes.

Although most cases of mild-to-moderate maternal disease are caused by gestational thrombocytopenia and rarely cause problems, the OB is obliged to rule out more serious causes. And for far-less-common fetal disease, these experts help you differentiate the potentially life-threatening fetal alloimmune thrombocytopenia from a benign drop in platelet count.

Hospital groups nationwide are adopting programs and policies aimed at making childbirth safer. The move comes in the wake of soaring liability insurance premiums for obstetric units, as well as mounting evidence that labor-inducing drugs and other delivery room practices are endangering mothers and infants, according to the Wall Street Journal (7/12/2006).

It seems so according to a report from tje office of U.S. Rep. Henry Waxman, D-Calif. The report notes that crisis pregnancy centers that are federally funded receive monies funneled through the abstinence-only-until-marriage program. It also found that 87% of these centers provided "false and misleading information about the physical and mental health effects of abortion and exaggerated the medical risks of abortion," reported the American College of Obstetricians and Gynecologists government relations newsletter Inside Scoop (07/21/2006).

Mothers who smoke during pregnancy are more likely to have overweight or obese children than mothers who do not smoke during pregnancy, according to a new longitudinal analysis.

In June, the Food and Drug Administration approved the first vaccine developed to protect women against cervical cancer. Known as Gardasil and developed by Merck & Co., the drug is highly effective against four types of human papillomavirus, including two that cause cervical cancer.

In the management of Rh-alloimmunized pregnancies, Doppler ultrasonography (U/S) of the middle cerebral artery is superior to amniocentesis in predicting fetal anemia and is a safe alternative for monitoring such pregnancies, according to a study in the July 13 issue of the New England Journal of Medicine.

Supplementation with the antioxidant vitamins C and E during pregnancy doesn't reduce the risks of preeclampsia, intrauterine growth restriction, infant death, or other serious infant outcomes in nulliparous women, according to the results of a recent multicenter, randomized trial. In fact, women taking the vitamins may be more likely to develop hypertension and to require treatment with antihypertensive drugs.

A leading expert helps you educate yourself-and your patients-about putting combined HPV-Pap testing into practice. Patient education should stress how common HPV is and explain the high level of reassurance testing negative on both tests affords.

You can accurately test for Neisseria gonorrheae (NG) and Chlamydia trachomatis (CT) using the same liquid Pap specimens collected for cervical cytology, researchers from University of Oklahoma college of Medicine in Tulsa have concluded.

Pregnant patients with severe nausea and vomiting should probably not be managed with a peripherally inserted central catheter (PICC), suggests a relatively small trial presented at this year's American College of Obstetricians and Gynecologists meeting.

Three immunizations with a bivalent human papillomavirus (HPV)-16/18 L1 virus-like particle AS04 vaccine safely induces sustained high levels of antibodies that provide long-term protection against HPV-16 and -18 infection and associated cervical lesions and possibly against HPV 45 and HPV 31-the third and fourth most common HPV types associated with cervical cancer-for up to 4.5 years.

What right does a teenager have to confidential health care? What influence does HIPAA have on that right? How you apply the answers in your practice could determine whether an adolescent seeks health services-or forgoes necessary care.

It seems laser conization is associated with a slightly lower riskof adverse pregnancy outcomes than cold knife conization or largeloop excision of the transformation zone (LLETZ), and laserablation entails the lowest risk of all-findings that couldprove very important to the many women of reproductive agereceiving treatment for intraepithelial or early invasive cervicallesions.

Pregnant patients are more likely than ever to ask about stem cells and umbilical cord blood banking. In this article, an expert provides an update on the pros and cons of cord blood banking, and the controversy over private versus public banks, to help you counsel appropriately.

Yes, says a new cost comparison of immediate colposcopy, HPV DNA testing, and conservative management in nearly 3,500 women over a 2-year period. The data are from ALTS?atypical squamous cells of undetermined significance [ASCUS] and low-grade squamous intraepithelial lesion [LSIL] Triage Study.

Risk management in obstetrics and gynecology

In light of the FDA's black box warning about potential bone loss in teenagers, how do you counsel teenagers about this highly effective birth control method? Recommendations from the World Health Organization provide a practical, evidence-based approach to weighing the risks.

If there's really been such a sea change in how and when to screen for cervical cancer, when are clinicians going to take the plunge and start applying new recommendations? An expert comes to the rescue by sifting through the new ACS and ACOG guidelines, to help you put them into practice.

Apparently not. In a FASTER-related study, researchers from seven centers who studied more than 10,000 patients concluded that the association between subclinical hypothyroidism and lower pediatric IQ does not appear to result from obstetric factors. The finding is of special note given controversy on this question raised by recent studies.