{"title":"Care of the Older Pregnant Patient Part II: Managing Pregnancy and Ethical Considerations","authors":"A. Fechner, A. Al‐Khan","doi":"10.1097/01.PGO.0000415091.34384.18","DOIUrl":"https://doi.org/10.1097/01.PGO.0000415091.34384.18","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128448112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Care of the Older Pregnant Patient: Part I Preconception Counseling and Achieving Pregnancy","authors":"A. Fechner, A. Al‐Khan","doi":"10.1097/01.PGO.0000415006.15595.F8","DOIUrl":"https://doi.org/10.1097/01.PGO.0000415006.15595.F8","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"11 22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128538455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"First-Trimester Screening for Preeclampsia","authors":"L. Dugoff","doi":"10.1097/01.PGO.0000414233.12226.44","DOIUrl":"https://doi.org/10.1097/01.PGO.0000414233.12226.44","url":null,"abstract":"Preeclampsia is the leading cause of maternal and fetal morbidity and mortality internationally, affecting approximately 2% to 5% of pregnancies.1 This pregnancy-specific syndrome generally develops after the 20th week of gestation, and is characterized by hypertension, edema, and proteinuria. Hemolysis, thrombocytopenia, and seizures may occur in more serious cases, and stroke, kidney, and multiorgan failure can lead to major maternal morbidity or death in the most severe cases. At the same time, reduced placental blood flow can lead to fetal growth restriction, prematurity, and fetal morbidity and mortality. The definitive treatment of preeclampsia is delivery. The signs, symptoms, and major risks of preeclampsia usually improve or even resolve within hours after the placenta has been removed. However, preeclampsia often develops many weeks before the mother’s due date, when immediate delivery is undesirable. If the baby must be delivered prematurely due to deteriorating maternal condition, the typical challenges associated with prematurity are exacerbated by chronic fetal insults associated with preeclampsia. Severe preeclampsia requiring delivery before 34 weeks’ gestation, also referred to as early-onset preeclampsia, occurs in approximately 0.5% of pregnancies.2 Medically indicated premature delivery as a result of severe preeclampsia is responsible for 15% of preterm births in the United States.3 In view of the potentially dramatic impact of preeclampsia, it is incumbent on all obstetricians to be aware of new data that may help in the diagnosis and/or treatment of this condition. Because research in this field is moving so quickly, there is a gap in the knowledge of many practitioners in this regard. The goal of this lesson is to update practitioners on emerging data regarding the development of preeclampsia prediction models so that they will be prepared to expeditiously introduce these models into their clinical practice once verified as effective.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127355931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Progesterone for Prevention of Preterm Birth","authors":"Michelle J. Khan, Donna M. Neale","doi":"10.1097/01.PGO.0000413593.90081.6f","DOIUrl":"https://doi.org/10.1097/01.PGO.0000413593.90081.6f","url":null,"abstract":"Preterm birth is a major cause of perinatal mortality and morbidity. It is also the main directed cause of neonatal death globally (1) . Preterm birth is responsible for more than 80% of neonatal deaths and 50% of long term morbidity in the surviving infants (1-3) . Preterm birth rates have been rising over the past 3 decades. The worldwide incidence of preterm birth is 9.6 % with the highest rate occurs in the least developed regions (4) . The increase in assisted reproductive technologies, labor induction or elective cesarean section during preterm period may be responsible for these high rates (2) . Various risk factors are associated with preterm birth but only half of them can be identified (5) . Although there are many interventions to prevent or treat preterm births, none of them appears to be efficacious (6) . Recent evidences showed that progesterone supplementations are helpful to prevent preterm birth. This article pays attention to the role of progesterone for the prevention of preterm birth.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128514222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Operative Vaginal Delivery: Past, Present, and Future","authors":"A. Gimovsky, N. Gaba","doi":"10.1097/01.PGO.0000413184.45880.c9","DOIUrl":"https://doi.org/10.1097/01.PGO.0000413184.45880.c9","url":null,"abstract":"The incidence of operative vaginal delivery (OVD) in the United States has been declining, and OVD is currently performed in approximately 4.5% of vaginal deliveries. In addition, it has been observed that the proportion of forceps deliveries is declining as compared with vacuum extraction. The Northeast United States has the lowest rate of forceps use, whereas the use of forceps remains highest in the South; this may be due to training differences among providers. There are several hypotheses as to why a decline in OVD has occurred during the past half-century. One reason is that cesarean delivery (CD) has become much safer with the ease of accessibility of blood products, improved antibiotics, and better anesthetic options. Another important factor has been the almost universal application of continuous fetal heart rate monitoring during the second stage of labor. In addition, OVD has likely decreased because of a fear of litigation and patient misconception. The result of diminished use of OVD is fewer providers capable of teaching new generations of obstetricians how to use these specialized instruments. Given these trends, there is an emerging gap between the present paradigm and ideal practice of OVD. The goal of this article is to address this gap and better enable practicing obstetricians to elect OVD or CD on the basis of the available evidence.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127033006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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