Marielle G van Pampus, Joris A M van der Post, Corine J Verhoeven, Corine M Koopmans, Josje Langenveld, Kim Broekhuijsen, Catherine M W de Sonnaville, Karin van der Tuuk, Kim Boers, Henk Groen, Sylvia Vijgen, Denise Bijlenga, Sicco Scherjon, Ben W Mol
In 2003, in the context of a national research funding program in which obstetric research was prioritized, several perinatal centers took the initiative to jointly submit a number of applications to the subsidy programs of Effectiveness Research and Prevention of ZonMw. This has led to the funding of the Obstetric Consortium with several projects, including the "Hypertension in Pregnancy Intervention Trial At Term" and the "Disproportionate Intrauterine Growth Intervention Trial At Term" studies. The studies showed that induction of labor for hypertension and growth restriction at term was the appropriate management...
April 10, 2024: Clinical Obstetrics and Gynecology
James R Scott, Steven G Gabbe
No abstract text is available yet for this article.
April 10, 2024: Clinical Obstetrics and Gynecology
Lauren A Gimbel
An early reflection on a career just begun.
April 9, 2024: Clinical Obstetrics and Gynecology
Dee E Fenner
As I reflect on my 30 years in academic medicine, my professional journey is uniquely intertwined with the growth and development of the field of urogynecology and the ultimate subspecialty recognition by the American Board of Obstetrics and Gynecology (ABOG), the Association of American Medical Colleges (AAMC), and the American Board of Medical Specialties (ABMS). In this article, I will retrace that journey from personal memories and notes, conversations with the leaders in the room, and documents and minutes generously provided by ABOG and the American Urogynecologic Society (AUGS)...
April 8, 2024: Clinical Obstetrics and Gynecology
Cynthia Gyamfi-Bannerman
The editors' request to reflect on one's career is a daunting one. There is an inherent implication that some pivotal point has been achieved, and usually, it's the point of retirement. There is also an assumption that the author can be impartial, though some writers will be laudatory and others excessively critical. I tend to fall in the latter group, and I firmly believe that it stems from my experience as an immigrant. What follows will be my thoughts about my experiences as a mentee and eventual mentor framed in the context of my upbringing...
April 8, 2024: Clinical Obstetrics and Gynecology
Roberto Romero, Arun Meyyazhagan, Sonia S Hassan, George W Creasy, Agustin Conde-Agudelo
The PREGNANT trial was a randomized, placebo-controlled, multicenter trial designed to determine the efficacy and safety of vaginal progesterone (VP) to reduce the risk of birth <33 weeks and of neonatal complications in women with a sonographic short cervix (10 to 20 mm) in the mid-trimester (19 to 23 6/7 wk). Patients allocated to receive VP had a 45% lower rate of preterm birth (8.9% vs 16.1%; relative risk = 0.55; 95% CI: 0.33-0.92). Neonates born to mothers allocated to VP had a 60% reduction in the rate of respiratory distress syndrome...
April 5, 2024: Clinical Obstetrics and Gynecology
Mary D'Alton
Dr. Mary D'Alton's career journey intertwines her upbringing in County Mayo, Ireland, with impactful contributions to Obstetrics and Gynecology in New York City. From childhood lessons in community care to transformative experiences in Canada and prestigious mentorships, her leadership at Columbia University and NewYork-Presbyterian has fostered innovative initiatives addressing maternal health. Philanthropy plays a pivotal role in realizing her vision, including mental health integration within women's health care...
March 18, 2024: Clinical Obstetrics and Gynecology
William A Grobman
No abstract text is available yet for this article.
March 15, 2024: Clinical Obstetrics and Gynecology
Haywood L Brown
Having been afforded many opportunities throughout my academic career, I took on the challenges that chronicled my path to leadership. In many instances, I was the first person of color to enter that educational and leadership environment. I am grateful to many mentors who have guided and supported me over the 4 decades since the time of my residency through fellowships and the various institutions to which I have been affiliated. It continues to be a great journey, making a contribution to the Ob Gyn academic community and advocating for quality and equitable women's health care...
March 14, 2024: Clinical Obstetrics and Gynecology
Mark B Landon
After the 2006 hyperglycemia and adverse pregnancy outcomes study, which confirmed the relationship between maternal glycemia and pregnancy outcomes, the debate remained on whether treatment benefited gestational diabetes mellitus (GDM). Nonetheless, practitioners continued to universally screen for and treat women identified as GDM. To assess the benefits and harms of screening and treatment of GDM, the National Institute of Child Health and Human Development Maternal and Fetal Medicine Unit Network designed and conducted a well-designed randomized controlled trial in women with mild GDM...
March 12, 2024: Clinical Obstetrics and Gynecology
Ayodeji A Sanusi, Rachel G Sinkey, Alan T N Tita
We describe the evolution of treatment recommendations for chronic hypertension (CHTN) in pregnancy, the CHTN and pregnancy (CHAP) trial, and its impact on obstetric practice. The US multicenter CHAP trial showed that antihypertensive treatment for mild CHTN in pregnancy [blood pressures (BP)<160/105 mm Hg] to goal<140/90 mm Hg, primarily with labetalol or nifedipine compared with no treatment unless BP were severe reduced the composite risk of superimposed severe preeclampsia, indicated preterm birth <35 weeks, placental abruption, and fetal/neonatal death...
March 11, 2024: Clinical Obstetrics and Gynecology
Stephanie A Fisher, Nigel Madden, Mariana Espinal, Patricia M Garcia, Jennifer K Jao, Lynn M Yee
Over the last 4 decades, significant advances in the care of HIV during pregnancy have successfully reduced, and nearly eliminated, the risk of perinatal HIV transmission. The baseline risk of transmission without intervention (25% to 30%) is now <1% to 2% in the United States with contemporary antepartum, intrapartum, and postnatal interventions. In this review, we discuss 3 landmark clinical trials that substantially altered obstetric practice for pregnant individuals with HIV and contributed to this extraordinary achievement: 1) the Pediatric AIDS Clinical Trials Group 076 Trial determined that antepartum and intrapartum administration of antiretroviral drug zidovudine to the pregnant individual, and postnatally to the newborn, could reduce the risk of perinatal transmission by approximately two-thirds; 2) the European Mode of Delivery Collaboration Trial demonstrated performance of a prelabor cesarean birth before rupture of membranes among pregnant people with viremia reduced the risk of perinatal transmission compared with vaginal birth; and 3) the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 Trial identified that dolutegravir-containing, compared with efavirenz-containing, antiretroviral regimens during pregnancy achieved a significantly higher rate of viral suppression at delivery with shorter time to viral suppression, with fewer adverse pregnancy outcomes...
March 7, 2024: Clinical Obstetrics and Gynecology
Dwight J Rouse
The BEAM Trial.
February 29, 2024: Clinical Obstetrics and Gynecology
Dale B Hull
Life sometimes provides unannounced challenges that threaten the structure of our existence. This personal account of an ob-gyn's encounter with paralysis will illustrate the impact of one such experience.
February 12, 2024: Clinical Obstetrics and Gynecology
E Albert Reece
The career path of everyone is quite unique based on the goals and the choices we make, and success can take time to unfold. My career choices have been greatly influenced by remarkable mentors and opportunities. Reciprocally I have had the pleasure, as a faculty member, department chair, and medical school dean to mentor promising young physicians and scientists to launch successful careers. We need to continue to attract physicians and scientists to academic medicine to ensure that our field continues to innovate and improve the lives of our patients...
January 22, 2024: Clinical Obstetrics and Gynecology
Kathryn A Witzeman, Alison Lieberman, Elizabeth Joy Beckman, Kaitlin V Ross, Helen L Coons
Persons with persistent gynecologic conditions frequently cope with complex biopsychosocial challenges and benefit from integrated behavioral health evaluation and treatment within gynecologic practices. Integrated care refers to the provision of behavioral health services within a health care setting which contributes to improved patient, provider, and practice outcomes, however, has not been commonly provided in traditional gynecologic practices. Several models of integrated behavioral health are reviewed...
March 1, 2024: Clinical Obstetrics and Gynecology
Sarah Nagle-Yang, Emily S Miller, Lindsay G Lebin, Gabriella Blissett, Emily C Dossett
Perinatal mental health conditions are the most common complications of childbirth and have well-established enduring negative effects. Obstetric (Ob) clinicians care for patients with perinatal mental health conditions across a spectrum of acuity, severity, and complexity. Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients. This chapter provides an overall framework for Ob-psychiatric clinician collaboration with examples of innovation in care delivery...
March 1, 2024: Clinical Obstetrics and Gynecology
Melissa A Kwitowski, Lindsay G Lebin, Jessalyn Kelleher, Meggan Zsemlye, Sarah Nagle-Yang
Perinatal mood and anxiety disorders and substance use disorders are the primary causes of maternal mortality in the postpartum period and represent major public health concerns. Despite this, these conditions remain undertreated. Behavioral health integration in outpatient obstetric settings is necessary but insufficient to meet the needs of all patients. Inpatient behavioral health integration represents a promising avenue for addressing gaps in care. Results from recent program development indicate that needs assessment, stakeholder backing, collaboration with existing programs, and adaptability are key factors in successful implementation...
March 1, 2024: Clinical Obstetrics and Gynecology
Lauren A Gimbel, Martha Zimmermann, Nancy Byatt, Tiffany A Moore Simas, M Camille Hoffman
Perinatal mood and anxiety disorders (PMADs) are common, yet obstetricians receive little training prior to independent practice on screening, assessing, diagnosing, and treating patients with depression and anxiety. Untreated PMADs lead to adverse pregnancy and fetal outcomes. Obstetricians are in a unique position to address PMADs. The following serves as a resource for addressing PMADs in obstetric practice.
March 1, 2024: Clinical Obstetrics and Gynecology
Martha Zimmermann, Tiffany A Moore Simas, Margaret Howard, Nancy Byatt
Mental health and substance use conditions are prevalent among perinatal individuals. These conditions have a negative impact on the health of perinatal individuals, their infants, and families, yet are underdiagnosed and undertreated. Populations that have been marginalized disproportionately face barriers to accessing care. Integrating mental health into obstetric care could address the perinatal mental health crisis. We review perinatal mental health conditions and substance use, outline the impact associated with these conditions, and describe the promise and potential of integrating mental health into obstetric settings to improve outcomes for patients receiving obstetric and gynecologic care...
March 1, 2024: Clinical Obstetrics and Gynecology
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