Do obstetricians apply the national guidelines? A vignette-based study assessing practices for prevention of preterm birth.

To describe spontaneous preterm birth prevention practices self-reported before and after the dissemination of relevant guidelines and to identify personal and organisational factors associated with adherence.A repeated cross-sectional vignette-based survey […]

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Menstrual bleeding and spotting with the Levonorgestrel Intrauterine System (52 mg) during the first-year post-insertion: a systematic review and meta-analysis.

Abstract: Changes in menstrual bleeding concern many users of the 52 mg Levonorgestrel Intrauterine System (LNG-IUS). Prescribing information for LNG-IUS devices describe an overall decrease in bleeding and spotting days […]

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Prophylactic antibiotics in caesarean delivery before or after cord clamping – Protecting the mother at the expense of the infant’s microbiota?

Abstract: To prevent postoperative infections after caesarean deliveries, most obstetric guidelines recommend intravenous antibiotic prophylaxis before skin incision as opposed to after cord clamping (1). However, the clinical reality may […]

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Undetectable Equals Untransmittable (U=U): Implications for Preconception Counseling for Human Immunodeficiency Virus Serodiscordant Couples.

Abstract: Although limited by society guidelines from the American Society for Reproductive Medicine and the Centers for Disease Control in the past, many human immunodeficiency virus serodiscordant American couples who […]

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Geographic variation in the use of lymphadenectomy and external-beam radiotherapy for endometrial cancer: a cross-sectional analysis of population-based data.

Abstract: To quantify geographic variation in the use of lymphadenectomy and/ or external beam radiotherapy (EBRT) for endometrial cancer in England.Cross-sectional analysis of population-based data.English cancer registry data, linked to […]

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Gynecologic cancers in pregnancy: guidelines based on a third international consensus meeting.

Abstract: We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous guidelines were […]

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Methodological decisions influence the identification of potential core outcomes in pre-eclampsia related studies: a sensitivity analysis informing the development of guidelines for future core outcome set developers.

To quantify the effect of different methodological decisions on the identification of potential core outcomes to inform the development of recommendations.Mixed methods study.A core outcome set for pre-eclampsia was used as an exemplar.A long list of potential core outcomes was developed by undertaking a systematic review of pre-eclampsia trials and performing a thematic analysis of in-depth patient interviews.Specific methods used to generate long lists of potential core outcomes were evaluated, including limitations placed within the search strategy and varied approaches in the extraction of outcomes from published trial reports.Different methodological decisions had a substantial impact on the identification of potential core outcomes. Extracting outcomes from published pre-eclampsia trials was an effective way of identifying 48 maternal, eight fetal, 25 neonatal outcomes, and eight patient-reported outcomes. Limiting the extraction of outcomes to primary outcomes or outcomes commonly reported in pre-eclampsia trials reduced the number and diversity of potential core outcomes identified. Thematic analysis of in-depth patient interviews ensured an additional five patient reported outcomes and six outcomes related to future child health were identified.Future core outcome set developers should use quantitative and qualitative methods when developing a long list of potential core outcomes. This article is protected by copyright. All rights reserved.

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Obstetric Care Consensus, Number 9: Levels of Maternal Care: (Replaces Obstetric Care Consensus Number 2, February 2015).

Maternal mortality and severe maternal morbidity, particularly among women of color, have increased in the United States. The leading medical causes of maternal mortality include cardiovascular disease, infection, and common obstetric complications such as hemorrhage and vary by timing relative to the end of pregnancy. Although specific modifications in the clinical management of some of these conditions have been instituted, more can be done to improve the system of care for high-risk women at facility and population levels. The goal of levels of maternal care is to reduce maternal morbidity and mortality, including existing disparities, by encouraging the growth and maturation of systems for the provision of risk-appropriate care specific to maternal health needs. To standardize a complete and integrated system of perinatal regionalization and risk-appropriate maternal care, this classification system establishes levels of maternal care that pertain to basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV). The determination of the appropriate level of care to be provided by a given facility should be guided by regional and state health care entities, national accreditation and professional organization guidelines, identified regional perinatal health care service needs, and regional resources. State and regional authorities should work together with the multiple institutions within a region, and with the input from their obstetric care providers, to determine the appropriate coordinated system of care and to implement policies that promote and support a regionalized system of care. These relationships enhance the ability of women to give birth safely in their communities while providing support for circumstances when higher level resources are needed. This document is a revision of the original 2015 Levels of Maternal Care Obstetric Care Consensus, which has been revised primarily to clarify terminology and to include more recent data based on published literature and feedback from levels of maternal care implementation.

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Levels of Maternal Care: Obstetric Care Consensus No, 9.

Maternal mortality and severe maternal morbidity, particularly among women of color, have increased in the United States. The leading medical causes of maternal mortality include cardiovascular disease, infection, and common obstetric complications such as hemorrhage, and vary by timing relative to the end of pregnancy. Although specific modifications in the clinical management of some of these conditions have been instituted, more can be done to improve the system of care for high-risk women at facility and population levels. The goal of levels of maternal care is to reduce maternal morbidity and mortality, including existing disparities, by encouraging the growth and maturation of systems for the provision of risk-appropriate care specific to maternal health needs. To standardize a complete and integrated system of perinatal regionalization and risk-appropriate maternal care, this classification system establishes levels of maternal care that pertain to basic care (level I), specialty care (level II), subspecialty care (level III), and regional perinatal health care centers (level IV). The determination of the appropriate level of care to be provided by a given facility should be guided by regional and state health care entities, national accreditation and professional organization guidelines, identified regional perinatal health care service needs, and regional resources. State and regional authorities should work together with the multiple institutions within a region, and with the input from their obstetric care providers, to determine the appropriate coordinated system of care and to implement policies that promote and support a regionalized system of care. These relationships enhance the ability of women to give birth safely in their communities while providing support for circumstances when higher level resources are needed. This document is a revision of the original 2015 Levels of Maternal Care Obstetric Care Consensus, which has been revised primarily to clarify terminology and to include more recent data based on published literature and feedback from levels of maternal care implementation.

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