journal
https://read.qxmd.com/read/36162093/race-based-versus-race-conscious-medicine-in-obstetrics-and-gynecology
#1
JOURNAL ARTICLE
Joselle O'Brien, Camille A Clare
Race is a social and power construct whose meaning has shifted over time. Racist beliefs in medicine fostered the continuation of these notions. In this commentary, we review race-based medicine versus race-conscious medicine. Race-conscious medicine emphasizes racism as a key determinant of illness and health. Racism in obstetrics and gynecology has deep roots in its history. The use of race in clinical decision-making tools, such as those that predict successful vaginal birth after cesarean delivery, should be eliminated...
September 27, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162090/proposed-solutions-for-improving-maternal-health-care-in-rural-america
#2
JOURNAL ARTICLE
Kelly K Garcia, Stephen K Hunter
Increasing hospital and labor & delivery (L&D) closures have led to declining access to hospital obstetric care in rural areas across the country. These closures increase the burden on women and families living in rural communities, who often must drive long distances for prenatal visits and delivery. The lack of maternal health care in rural America can also result in several adverse maternal and infant outcomes including premature birth, low birth weight, out of hospital births, maternal and infant morbidity and mortality, and increased risk of postpartum depression...
September 27, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162083/obstetrical-readiness-preparing-rural-emergency-departments-without-hospital-based-obstetrical-services
#3
JOURNAL ARTICLE
Jeana Forman, Jill Henkle
In rural states, hospitals that provide birthing services are closing at an alarming rate, increasing the distance birthing people are traveling, rural Emergency Departments play a vital role in reducing maternal morbidity and mortality. An interdisciplinary education and simulation with debriefing program was created to improve the care by non-obstetric providers for routine and emergent obstetrical care. The program includes monthly lectures, hands on skills training, and in-situ interdisciplinary simulations with debriefings to build a foundation of knowledge and skill for rural Emergency Department staff statewide...
September 27, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162088/cnm-cms-fill-the-gap-in-rural-maternal-care
#4
JOURNAL ARTICLE
Lastascia Nicole Granger Coleman
The United States is in the midst of a maternity care crisis. A key driver is workforce shortages, which impacts maternity care service delivery in rural areas significantly. The midwifery model of care remains underutilized. Midwifery care delivered by certified nurse-midwives and certified midwives is heavily endorsed and supported in the extant literature, but no firm national actions have been taken to move recommendations into funding or practice. Certified nurse-midwives and Certified Midwives are able to care for low-risk pregnancies and are uniquely situated to address factors associated with social determinants of health in rural areas...
September 26, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162092/treatment-of-arrhythmias-during-pregnancy
#5
JOURNAL ARTICLE
Luis D Pacheco, Mostafa Eyada, George R Saade
Cardiac disease is the most common cause of maternal mortality in developed nations. Cardiac arrhythmias are frequent among patients with structural heart disease and may require immediate treatment to prevent hemodynamic instability leading to acute maternal and fetal decompensation. Antiarrhythmic therapy during pregnancy should follow the same principles recommended for nonpregnant individuals. Although multidisciplinary management is recommended, obstetricians, and maternal-fetal medicine specialists may sometimes need to emergently recognize and treat rhythm anomalies before support services become available...
September 22, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162087/the-role-of-the-family-physician-in-rural-maternity-care
#6
JOURNAL ARTICLE
Jeffrey D Quinlan
Of the 28 million rural women of reproductive age in the United States, ∼7 million of them live in areas of limited access to maternity care. While only 6.7% of Family Physicians currently provide maternity care, they are the only delivering physicians in 27% of rural hospitals. Of the 1.6% of Family Physicians performing cesarean deliveries as a primary surgeon, 57.3% do so in a rural county and 38.6% do so in a county without an obstetrician. Cultivation of the next generation of Family Physicians providing maternity care is essential to prevent further spread of existing maternity care deserts...
September 22, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162089/project-med-medicine-exposure-and-development-promoting-access-to-healthcare-education-for-historically-underrepresented-groups-through-community-engagement-sustainability-and-technology
#7
JOURNAL ARTICLE
Irene L Quan, Nikhil Sriram, Emily Lam, Rishi Jain, Nathalie Boadi, Aru Singh, Valentina Velasco, Catherine A O'Brian, Sharon L Post, Melissa A Simon
In the U.S., disparities in the healthcare workforce have led to inadequate health outcomes in communities of historically underserved groups. To address the lack of resources and opportunities in health career education for historically underserved group students, Project MED was established. The mission is to expose high school students to the breadth of opportunities in the healthcare field and to prepare students for successful careers in healthcare. Through 3 main pillars-Learn, Lead, and Launch-Project MED has developed a robust repository of 20 workshops, recruited and trained eight mentors, and curated a database of ≥100 opportunities for over 50 students...
September 5, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260014/need-for-improved-collection-and-harmonization-of-rural-maternal-healthcare-data
#8
REVIEW
Donna A Santillan, Heather A Davis, Elissa Z Faro, Boyd M Knosp, Mark K Santillan
Representation in data sets is critical to improving healthcare for the largest possible number of people. Unfortunately, pregnancy is a very understudied period of time. Further, the gap in available data is wide between pregnancies in urban areas versus rural areas. There are many limitations in the current data that is available. Herein, we review these limitations and strengths of available data sources. In addition, we propose a new mechanism to enhance the granularity, depth, and speed with which data is made available regarding rural pregnancy...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260013/rural-maternal-health-care-outcomes-drivers-and-patient-perspectives
#9
JOURNAL ARTICLE
Annemarie J Anglim, Stephanie M Radke
Rural communities are a vital segment of the US population; however, these communities are shrinking, and their population is aging. Rural women experience health disparities including increased risk of maternal morbidity and mortality. In this article, we will explore these trends and their determinants both within and external to the health care system. Health care providers, public health professionals, and policymakers should be aware of these social and structural factors that influence health outcomes and take action to reduce generational cycles of health disparity...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260012/foreword-maternity-care-in-rural-america
#10
JOURNAL ARTICLE
Stephen K Hunter
No abstract text is available yet for this article.
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260011/contributors-maternity-care-in-rural-america
#11
JOURNAL ARTICLE
(no author information available yet)
No abstract text is available yet for this article.
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260010/syndromic-treatment-of-stis-in-low-income-countries-is-inadequate-current-threats-and-future-directions
#12
JOURNAL ARTICLE
Rachel Kopkin, Jessica M Grenvik, Chikondi Chiweza, Ibe Iwuh, Jeffrey Wilkinson
Sexually transmitted infections (STIs) pose a serious public health threat with more than 1 million curable infections diagnosed every day. While these infections are prevalent globally, the approach to evaluation and treatment varies greatly based on the capacity to make an accurate diagnosis. In low-resource settings, a syndromic approach is often used over an etiologic-based evaluation and management. Syndromic treatment of STIs recognizes groups of symptoms and recommends a multidrug empiric treatment that will cover the most likely causative organisms...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260009/imperforate-hymen-clinical-pearls-and-implications-of-management
#13
JOURNAL ARTICLE
Angie Hamouie, Jennifer E Dietrich
Imperforate hymen is a common condition that with classic appearance and presentation in puberty. This may be diagnosed in a neonate when mucocolpos is noted. There are many great pretenders of this condition, but the hallmarks include a bulging hymen with blue hue at puberty. If this is not seen on external genital exam, the provider should proceed with magnetic resonance imaging to better assess the reproductive tract anatomy before engaging in surgery. For providers uncomfortable in managing conditions often confused with an imperforate hymen, referral to a Pediatric and Adolescent Gynecologist or specialist comfortable managing these conditions, is recommended...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36260008/contributors-controversies-in-gynecology
#14
JOURNAL ARTICLE
(no author information available yet)
No abstract text is available yet for this article.
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162095/how-state-perinatal-quality-collaboratives-can-improve-rural-maternity-care
#15
JOURNAL ARTICLE
Elliott K Main, Christa Sakowski
Perinatal Quality Collaboratives (PQCs) are now present in nearly all states and provide important tools and strategies for improving maternal outcomes. State PQCs can focus their strengths to address rural maternal health challenges using support groups of rural hospitals, of tertiary facilities that network with them, and of other PQCs to share best practices for rural hospitals to: (1) Support networks of care and telehealth; (2) Support remote education and training; (3) Implement rural appropriate versions of National Safety Bundles; (4) Engage and support providers beyond obstetricians; and (5) Engage community members and resources...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/35703212/when-and-how-to-utilize-pudendal-nerve-blocks-for-treatment-of-pudendal-neuralgia
#16
REVIEW
Abigail Cain, Kimberly Carter, Christina Salazar, Amy Young
Chronic pelvic pain is a common cause of pain in reproductive age women with debilitating consequences for affected women's health and quality of life. Treatment providers must be well versed in all treatment options for these patients, understanding the overlap in the management and treatment of chronic pelvic pain caused by pudendal neuralgia, myofascial pelvic pain, and vulvodynia. Pudendal blocks are a simple and quick procedure that can be performed in the office and often helps improve all the above conditions when used along with other treatment options...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/35385852/laser-therapy-for-recalcitrant-vulvar-lichen-sclerosus-a-review-of-the-literature
#17
REVIEW
Mary L Marnach, Petra M Casey
Vulvar lichen sclerosus (LS) is a chronic vulvar dermatosis potentially impacting quality of life and sexual function. While most women with LS respond to topical corticosteroids and/or calcineurin inhibitors, some require additional therapy. Systemic therapies have been used successfully in oral and vulvovaginal lichen planus with minimal data in the setting of LS. Likewise, while vaginal laser therapy has shown potential benefit for genitourinary syndrome of menopause, there is a paucity of data in the setting of LS...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/35293368/the-use-of-feticidal-agents-before-dilation-and-evacuation-or-induction-of-labor-for-later-abortion
#18
JOURNAL ARTICLE
Preetha Nandi, Abby Schultz, Danielle Roncari
Abortion is a common medical procedure in the United States that is frequently the target of political and legal restrictions. These restrictions can negatively impact care and interfere with the patient-provider relationship. In this paper, we aim to review the historic context in which feticidal agents became more utilized in later abortion; describe current practices and protocols of using feticidal agents use for later abortion by dilation and evacuation and induction of labor; evaluate patient and provider perspectives on feticidal agent use; and propose areas of further ethical and research inquiry to characterize the use of these agents in later abortion procedures...
December 1, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36162097/tackling-gynecologic-cancer-disparities-an-assessment-of-2-interventions-for-improving-information-exchange-with-racial-ethnic-communities
#19
JOURNAL ARTICLE
Nihmotallahi Adebayo, Will Dunne, Julie Robin Dean, Catherine O'Brian, Rabih Dahdouh, Melissa Simon
Racial health disparities continue to greatly impact the incidence and mortality rates of gynecologic cancers. Although there are many drivers for these disparities, limited inclusion of vulnerable populations in clinical research and narrowed medical knowledge of patients are large contributors that disproportionately affect racial/ethnic communities. To mitigate these disparities, we must look for avenues that connect patients from these communities to cancer researchers. In this review, we summarize 2 projects that can serve as models for future interventions that promote education and engagement in clinical research for populations most impacted by gynecologic cancer disparities...
September 2, 2022: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/36264204/contributors-respectful-equitable-and-supportive-postpartum-care
#20
JOURNAL ARTICLE
(no author information available yet)
No abstract text is available yet for this article.
September 1, 2022: Clinical Obstetrics and Gynecology
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