Search

Objective To estimate obstetrician-gynecologists’ (ob-gyns) willingness to provide medication abortion if the in-person dispensing requirement for mifepristone were removed. Study design We analyzed a subsample (n = 868) from a 2016 to 2017 national survey of ob-gyns, focusing on questions related to provision of medication abortion. Results In the survey, 164 (19%) ob-gyns reported providing medication abortion in the prior year. When we asked those not providing medication abortion if they would offer the method to their patients if the in-person dispensing requirement for mifepristone were removed, 171 (24%) ob-gyns reported they would, suggesting a potential doubling of providers (+104%, 95% confidence interval (CI): 97%−112%). The largest theoretical increases were in the Midwest (+189%, 95% CI: 172%−207%) and South (+118%, 95% CI: 103%−134%). In multivariable regression analysis, female ob-gyns and those in university faculty practices had higher odds of reporting they would start providing medication abortion if the dispensing requirement were removed, while those in practice >10 years had lower odds. Conclusions Removal of the in-person dispensing requirement could increase provision of medication abortion, including in regions with limited abortion access. Implications In order to improve access to medication abortion, the mifepristone Risk Evaluation and Mitigation Strategy should be modified or removed to allow clinicians to prescribe the medication with dispensing by pharmacies, including mail-order pharmacies.

Annotation. During pregnancy the body's needs for macro and micronutrients increases 2-3-fold. The woman's diet has great importance for the normal development of the fetus and the course of pregnancy. A balanced amount of protein, fat, carbohydrates and fiber prevents a lot of complications. However, research in recent years has found that a balanced diet is not enough for a pregnant woman. Micronutrients have the main role in the prevention of congenital malformations and complications of pregnancy, the need for which increases not only during pregnancy but also during lactation. Optimal levels of folic acid, iodine, vitamin D3, calcium and iron mainly ensure the normal course of pregnancy and fetal development. In this article the effect of each micronutrient on the body of a pregnant woman was considered.

Reproductive health care is crucial to women's well-being and that of their families. State and federal laws restricting access to contraception and abortion in the United States are proliferating. Often the given rationales for these laws state or imply that access to contraception and abortion promote promiscuity, and/or that abortion is medically dangerous and causes a variety of adverse obstetric, medical, and psychological sequelae. These rationales lack scientific foundation. This article provides the evidence for the safety of abortion, for both women and girls, and encourages readers to advocate against restrictions.

Physician review websites can serve as a means for patients to address physician actions, both good and bad. At times, patient reviews may be negative and perceived as defamatory. Yet there are specific legal requirements that must be met for an online review to be considered defamatory. Prior cases indicate that pursuing a defamation lawsuit, although appropriate in some circumstances, is oftentimes a difficult and futile endeavor. To avoid litigation, physicians can take proactive approaches to address questionable reviews and to bolster their online reputations.

Screening for intimate partner violence is recommended by the medical community. This study investigated obstetrician-gynecologists' intimate partner violence screening patterns and physician and patient factors associated with screening. Four hundred obstetricians-gynecologists completed the Physician Readiness to Manage Intimate Partner Violence Survey between December 2014 and July 2015. Their patients completed the Patient Safety and Satisfaction Survey. Hierarchical generalized linear modeling analyzed physician and patient variables related to the likelihood of being screened. Forty-four physicians responded. The viable patient response rate was 81.3 percent (

Congenital gynecologic anomalies result from interruption of embryologic development of the female reproductive tract. The anomalies may be hymenal, vaginal, cervical, or uterine. The impact of these anomalies is variable: some are asymptomatic, incidental findings that require no intervention, others require simple surgical management, while some complex anomalies may require a multidisciplinary approach with extensive surgical expertise for optimal outcomes. Uterovaginal anomalies may occur in isolation or in association with other malformations, such as renal anomalies. The origin, presentation, evaluation and treatment of these conditions are reviewed here.

a pentalogía de Cantrell es la conjunción de cinco defectos congénitos (defectos del corazón, pericardio, diafragma, esternón y la pared abdominal anterior), que representa un desafío único para los gineco-obstetras. Aunque la incidencia es pequeña, es fundamental identificarlo en el primer trimestre. En este reporte se comunica un caso de pentalogía de Cantrell diagnosticado en su primer control prenatal en el segundo trimestre de gestación.

Query of Prescription Drug Monitoring Programs (PDMPs) is recommended before prescribing opioids by the US Centers for Disease Control and Prevention, to inform clinical practice and aid diversion prevention. Many states mandate prescriber PDMP use; however, little is known about PDMP perception of utility and use among Obstetricians-Gynecologists (OB/GYN), who are the primary provider for most women during pregnancy. This study examined OB/GYN perceptions and utilization of their state PDMP. Survey items were developed by expert consensus. A voluntary anonymous survey was emailed to a random sample of 5000 OB/GYNs (adjusted participants n = 1470, minus unread/refusals). Responses were stratified by state policy environment, where response frequency distributions were compared for OB/GYNs practicing in states with mandatory vs voluntary PDMP query. Adjusted response rate was 27% (n = 397). Most OB/GYNs (78%) were registered with their PDMP. The majority agreed that “…mandating physician use of the PDMP was a good idea” (51.4% mandatory state vs 58.3% voluntary state). Respondents in mandatory states reported that the primary purpose of the PDMP was “to allow the physician to verify medications that the patient is being prescribed” less frequently than those in voluntary states (38.3% vs 52.8%). Several report speaking with patients about controlled substance prescriptions after viewing PDMP reports (27.8% in mandatory vs 26.3% in voluntary states). In qualitative responses, reported frustration with PDMPs was evident. OB/GYNs are diverse in their perceptions regarding the utility and purpose of PDMPs. Tailored education is needed regarding clinical utility of PDMPs for OB/GYN practice.

Background Orthopedic and obstetrician-gynecologist (OB/GYN) surgeons have risks for musculoskeletal disorders (MSD) during work in the operating room (OR). Risks for MSD have not been identified as a result of work outside the OR or during non-work tasks. Objective The purpose of the study was to determine risk factors for MSD in an orthopedic and OB/GYN surgeon. Methods A case study format and mixed method design were used to gather data by using the Rapid Upper Limb Assessment (RULA) to measure MSD risks in the OR; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure surgeons' upper extremity disability; observation of surgeon office hours; and semi-structured interviews to gather qualitative data. Results Both surgeons had risks for MSD during occupational performance outside of work, with some risks similar to those experienced at work. Both surgeons had MSD risks during work inside and outside the OR. Both surgeons experienced MSD symptoms exacerbated by work and non-work tasks. Conclusions Identifying and reducing MSD risk should include a comprehensive analysis of occupational performance for orthopedic and OB/GYN surgeons.

Background: Medication use among pregnant women is widespread, despite limited evidence about the teratogenicity of most medications. Improved physician-patient communication about pregnancy-related medication safety has been identified as a strategy to address this critical issue; however, little is known about physicians' knowledge, attitudes, and practices that could inform tools for information access and sharing to support such communication. The primary objective of this study is to address gaps in what is known about obstetrician-gynecologist views, practices, and needs related to accessing and sharing pregnancy-related medication safety information with patients. Materials and Methods: The basis for this study is a nationally representative, randomized survey of 506 practicing obstetrician-gynecologists. The survey was completed by mail or online between October 26, 2015 and May 8, 2016 with a 52% response rate. Data were weighted to population parameters to reduce the risk of potential nonresponse biases. Analyses included univariate distributions and comparisons between physicians in different residency cohorts using all-pairs dependent t-tests. Results: Findings point to critical features of obstetrician-gynecologist access and sharing of medication safety information. Obstetrician-gynecologists often retrieve medication safety information during a clinical visit. There is widespread provision of potentially problematic "safe lists" to patients, particularly by younger cohorts, and limited counseling for reproductive-aged patients not actively planning a pregnancy. Conclusions: To improve clinical care, physician-patient communication may be enhanced with technical and policy solutions, including improved digital information tools for retrieving and discussing information in the clinical setting; evidence-based, written information for physicians to share with patients; and encouragement for counseling all women of reproductive age receiving teratogenic medications.

Парвовирус В19 (PV B19, инфекционная эритема, «пятая болезнь», «синдром пощечины») – это патогенный для человека одноцепочечный ДНК-содержащий вирус из семейства парвовирусов, который размножается в эритроидных клетках-предшественниках и вызывает их гибель. Репликация вируса происходит преимущественно в клетках-предшественниках эритроидного ряда (эритробластах), мегакариоцитах и макрофагах костного мозга, селезенки, а также клетках эндотелия плаценты, в тканях миокарда, печени, легких, почек и синовиальных оболочках плода. Лица, у которых генетически отсутствует Р-антиген (1 из 200 тыс. человек), устойчивы к заражению парвовирусом B19. Риск первичного инфицирования во время беременности в зависимости от эпидемиологической ситуации составляет от 1,5 до 14,5%. У 70% инфицированных беременных женщин не будет клинических проявлений заболевания. Риск вертикальной передачи парвовируса В19 составляет 35%. До 85% всех случаев фетальной водянки составляет неиммунная водянка плода. С ее развитием связаны три основных механизма: внутрутробная анемия, сердечная недостаточность и гипопротеинемия. При поражении парвовирусом В19 неиммунная водянка плода развивается до 27% случаев, наиболее часто – в гестационном возрасте 10–20 недель. Рекомендовано обследовать беременных, которые контактировали с больными парвовирусом В19, или у которых есть подобные клинические проявления заболевания, с целью определения их иммунного статуса. Диагностика на парвовирус В19 выполняется в случаях развития неиммунной водянки плода или его внутриутробной гибели. МЛ «ДИЛА» предлагает европейское качество результатов исследований – иммуноблот IgM и IgG. Широкий выбор биологического материала для проведения ПЦР-исследования на парвовирус В19 (кровь, слюна, хорион и другие виды биоматериала: мазок из ротовой полости, ликвор, амниотическая жидкость, биоптат костного мозга). Возможность проведения дифференциации иммуноглобулинов матери и новорожденного. Высокая точность количественного исследования результатов: чувствительность 92,2%, специфичность 100%.

Низькі концентрації вітаміну D діагностуються у значної частини сучасного населення багатьох країн світу. Багато захворювань людей різних вікових категорій безпосередньо пов’язані з дефіцитом вітаміну D. Встановлено вплив рівня вітаміну D на репродуктивну функцію як у чоловіків, так і в жінок. Встановлено, що низький рівень вітаміну D у жінок порушує гіпоталамо-гіпофізарну регуляцію, що призводить до розладу оваріально-менструального циклу. Недостатність 25(ОН)D призводить до патології імунної регуляції в Т- та В-лімфоцитах, що є патогенетичною ланкою розвитку ендометріозу. Крім того, зниження рівня вітаміну D пов’язане із виникненням лейоміоми матки. Через синтез кателіцидинів вітамін D підтримує нормоценоз піхви, тому зниження його рівня призводить до бактеріального вагінозу. Численними епідеміологічними дослідженнями доведено, що низькі концентрації вітаміну D у матері впливають на показники здоров’я її дитини. Ускладненнями вагітності при низькому рівні вітаміну D є прееклампсія, гестаційний діабет та передчасні пологи. Доведено, що призначення вітаміну D жінкам під час вагітності зменшує частку кесаревого розтину в пологах. Численні автори доводять роль вітаміну D у патогенетичному ланцюзі синдрому полікістозних яєчників. Встановлено, що під час менопаузи внаслідок порушення стероїдогенезу відзначається втрата кісткової маси через недостатність вітаміну D. Визнано, що наведені у статті терапевтичні схеми призначення препарату вітаміну D не є шкідливими і можуть мати як короткострокові, так і довгострокові позитивні клінічні ефекти для здоров’я людини. Своєчасна корекція дефіциту вітаміну D стає дуже важливою у вирішенні репродуктивних проблем. У статті основна увага приділяється проблемі корекції рівня вітаміну D в різних групах жіночого населення. Терапія жінок із дефіцитом вітаміну D і профілактичне застосування вітаміну D є безпечними і рекомендуються для всіх вагітних або жінок, що годують груддю.

The article highlights diagnostic and therapeutic approaches in the syndrome of hyperprolactinemia. General information about the secretion of prolactin, its isoforms, the issues of diagnostic and therapeutic tactics for different genesis of hyperprolactinemia, aspects of monitoring patients, including during pregnancy and breastfeeding, are presented. Key words: hyperprolactinemia, dopamine, prolactinoma, reproductive health, hyperprolactinemic hypogonadism, cabergoline, pregnancy.

Physician wellness directly affects patient and physician health and has broader implications for our health systems. A summary of what is known about physician wellness in medicine, and obstetrics and gynecology in particular, identifies several areas for future focus. To change our culture and the structure of our academic health centers in a way that promotes resilience, we suggest greater attention to preparedness for practice and attention to work-life integration as well as mentoring and professional development.

Although abortion is often declared as the right of choice that belongs only to the pregnant woman, it is important to emphasize the significance of the free and informed consent. Lithuania has no systematical help provided for women undergoing crisis pregnancy. The aim of the research is to find bases for model parameters for such kind of help. The qualitative research consists of six individual half structured interviews. In order to receive data that is objective and reflects different sides of the problem the interviews were carried out with obstetrician gynecologists and psychologists working with women in crisis pregnancy. The data received during the interviews has revealed a various needs for help: To be consulted by an obstetrician gynecologist, a psychologist, a social worker, a priest, an embryologist, a lawyer, a psychiatrist, an oncologist and a specialist in infertility issues. Besides, the research has revealed the need of consultations for both parents of the unborn. Keywords: crisis pregnancy; counseling; abortion; psychologist; obstetrician gynecologist

The article presents the program and stages of breast examination in patients seeking an obstetrician-gynecologist. The classification of benign breast diseases (BBD), the possibility of treatment of gynecological diseases with dyshormonal pathology and the effectiveness of this therapy in mastitis and mastodynia. Submitted by the products developed and registered for the treatment of BBD. Attention is paid to drug Mastodynon possessing a multifaceted effect on various parts of the endocrine system in the treatment of premenstrual syndrome, defective lutein phase, mastitis and mastodynia.

Surgeons have to deal with sudden unexpected emergencies as a routine and do not always have the luxury of time. Obstetricians and gynecologists are particularly more vulnerable as compared to surgeons of other specialties. They need to take quick decisions, must be good at multitasking, and are required to perform emergency caesareans even when patients have multiple risk factors. Compared to surgeons of other specialties, they are at disadvantage, because outcomes are generally expected to be good even in the presence of multiple risk factors. Bowel, bladder, and ureteric injuries are known complications during obstetric and gynecological surgeries and should be repaired by a surgeon of the concerned specialty only. Sometimes injuries to the bowel and the ureter could be intentional-as a part of the proposed treatment. For example, bowel resection and anastomosis and ureteric reimplantation in a case of endometriosis involving the bowel and ureter. But most of the time, injuries to the bowel, ureter, and bladder are a surgical complication. The decision of when to involve colleagues of other specialties and when one should manage the patient independently or with the help of a fellow gynecologist is important. Having an appropriate surgical assistant or co-surgeon is necessary to prevent complications and also for moral support. One should not hesitate to call a colleague when a situation is beyond one’s scope.

Residency training in obstetrics-gynecology has changed significantly over time, with residents expected to master an increasing number of surgical procedures. Residency operative case logs are tracked by the Accreditation Council for Graduate Medical Education, which sets case minimums for all procedures. In 2018, the Accreditation Council for Graduate Medical Education created a combined minimally invasive hysterectomy category and now requires graduating residents to complete a minimum of 70 minimally invasive hysterectomies.The objectiges of the study were to evaluate the range of operative gynecological experience across graduating obstetrician-gynecologist residents in the United States and to estimate the number of residents able to meet new Accreditation Council for Graduate Medical Education minimum hysterectomy cases.Accreditation Council for Graduate Medical Education surgical case logs of graduating obstetrician-gynecologist residents from 2009 to 2017 were analyzed for case volume trends.The average total number of gynecological cases per resident decreased from 438.2 to 431.5 (P.0001). Minimally invasive hysterectomy averages increased from 43.6 to 69.3 (P.0001), a trend driven principally by an increase in total laparoscopic hysterectomies. Mean case log decreases were noted in invasive cancer (70.7 to 54.3), incontinence and pelvic floor (85.6 to 56.7), and total abdominal hysterectomies (74.4 to 42.9); (P.0001 for all). Mean increases were seen in total laparoscopic (118.8 to 146.3) and operative hysteroscopy (68.6 to 77.1) cases (P.0001 for all). The ratio of the 90th percentile to the 10th percentile of resident case logs showed substantial variation in surgical volume for all procedures, although this ratio decreased over time. Graduates who logged 70 minimally invasive hysterectomy cases were estimated to fall at the 51st percentile in 2017; this was down from the 91st percentile in 2009.Nationwide, graduates of obstetrician-gynecologist residency experience significant variability in their surgical training. Based on our extrapolation of Accreditation Council for Graduate Medical Education data, approximately half of residency graduates fell below the 70 case minimally invasive hysterectomy minimum in 2017. Meeting the new Accreditation Council for Graduate Medical Education hysterectomy minimums may be challenging for a significant proportion of residency programs. Understanding the scope and variability of gynecology training is needed to continue to improve and address gaps in resident education.

Because of conflicting guidelines, providing appropriate breast cancer screening recommendations to our patients has become challenging. Given the high prevalence of genitourinary syndrome of menopause (GSM) overall, and among breast cancer survivors, and the understandable reluctance of physicians to prescribe effective hormonal treatments to survivors with this condition, addressing the needs of breast cancer survivors with bothersome GSM is both a common and controversial issue. In this review, we detail current breast cancer screening recommendations, breast cancer risk assessment, and management of GSM in breast cancer survivors.

Lymphangioma is a benign tumor of the lymphatic system which often develops during the embrionic period. The manifestation usually takes place before the age of 1 with non-specific clinical presentation. An obstetrician-gynecologist may face this pathology in the fetus and newborn as well as rendering emergency aid. The article presents two clinical cases of lymphangioma in a fetus and the newborn, and a 16 year-old child.

In this article we have reviewed the specific implications of NSAIDs in obstetrics, gynecology and infertility. These medications were found to be effective not only in pain management, but also had additional beneficial influence such as decreasing menstrual bleeding, preventing premature ovulation in natural IVF cycles and serving as tocolytics in preterm labor. Key words: diclofenac, non-steroidal anti-inflammatory drugs, obstetrics and gynecology.

Physicians’ work challenges them to learn and grow from their experiences with patients. Male obstetrician-gynecologists are uniquely blessed and challenged by their experiences in women’s health care. The following is a reflection by one male obstetrician-gynecologist who considers the role of Saint Joseph in the holy family in contemplating his own role in providing women’s health care. Summary: One hundred twenty-five men who underwent therapy trying to change sexual orientation from homosexual to heterosexual were asked about negative and positive experiences. About two-thirds recorded changes of varying extent. There was also much decrease in suicidality, depression, and substance abuse, and increases in social functioning and self-esteem. Almost all harmful effects were none to slight and comparable to therapies for other unwelcome conditions.

The provision of hormone therapy, both estrogens and antiandrogens, to adult transgender females is well within the scope of practice of the obstetrician gynecologist. The goal is to induce feminizing changes and suppress previously developed masculinization. Estrogens in sufficient doses will usually achieve both goals with augmentation by antiandrogens. The primary short-term risk of estrogens is thrombosis, but long-term risk in transgender females is unclear. Optimal care requires pretreatment education and assessment, individualized dosing, ongoing routine monitoring, and standard breast and prostate cancer screening.

Depression in women is more common during perimenopause (the transition to menopause) than at other times in the life cycle. Symptoms of depression may be different in perimenopausal women compared to younger or older women, and are often dismissed as part of normal menopause. This is an expert narrative review. There are several evidence-based screening modalities which can be integrated into routine women's health visits, and can facilitate distinguishing between depression and normal perimenopausal symptoms. There is emerging evidence regarding the effect of hormonal changes on the development of perimenopausal depression and its optimal treatment, though critical research gaps remain. Obstetrician-gynecologists and other primary care providers play a vital role in the detection and management of depression in women. Providers caring for women during perimenopause have a unique opportunity to diagnose depression in their patients and identify appropriate treatment options.

OBJECTIVE To assess trends in the percentage of U.S. women who visit an obstetrician-gynecologist (ob-gyn) and the percentage who visit a general physician (general practitioner, family medicine, and internist). METHODS We used data from the 2000-2015 National Health Interview Surveys, cross-sectional nationally representative surveys, to identify the percentage of U.S. women who have visited an ob-gyn and the percentage who have visited a general physician during the preceding 12 months. Unadjusted percentages, and percentages adjusted for sociodemographic and health factors, were entered into joinpoint regressions to assess unadjusted and adjusted trends over time. RESULTS The adjusted percentage of U.S. women who saw a general physician during the preceding 12 months did not significantly change from 2000 to 2015, ranging from 70.1% in 2007 to 74.2% in 2003 (P>.05 for trend). However, although the adjusted percentage that saw an ob-gyn in the preceding 12 months did not change from 2000 to 2003 or 2007-2011 (P>.05), it declined from 45.0% to 41.2% between 2003 and 2007 and from 41.8% to 38.4% between 2011 and 2015 (P

The article is devoted to the life, professional, scientific, social and political activities of an obstetrician-gynecologist – Feliks Shchasnyi-Selskyi.

Disorders (differences) of sex development (DSD) are identified when there is atypical chromosomal, gonadal, or anatomic sex. Given the complexity of DSD conditions, the consensus guidelines recommend that affected individuals be evaluated and cared for by teams with expertise in DSD conditions. Obstetrician gynecologists are experts in genital and reproductive anatomy, hormonal function, fertility, sexuality, and obstetrics, allowing them to provide a unique and essential function within the DSD team. Furthermore, obstetrician gynecologists with expertise in Pediatric and Adolescent Gynecology may follow individuals from birth into adulthood and provide reproductive health care for all ages, allowing these patients to "grow up" with them. Thus it is essential that gynecologists be part of a multidisciplinary team from birth through the reproductive lifespan. The purpose of this paper is to describe the role that the obstetrician gynecologist plays in the care of individuals with DSD conditions.

Women are at a higher risk for depression than are men, and this risk is especially pronounced at specific reproductive periods of vulnerability: adolescence, pregnancy, postpartum,, and the menopausal transition. Obstetrician–gynecologists are often the health care providers that women consult during these vulnerable periods, usually presenting with conditions or complaints other than depression or anxiety. Presenting symptoms are frequently known comorbidities with depression, or are risk factors for depression. Thus, by screening for depression and other mood disorders in these critical periods, in addition to screening at routine intervals such as annual examinations, obstetricians and gynecologists can play an important role in early detection, prevention, and treatment of mood disorders and their comorbid conditions. We provide a framework for depression management within busy obstetric gynecology settings using new integrated care models for mental health.

Objective: It would generally be thought of that the Muslim women especially preferred female obstetricians/gynecologists (ob/gyn). The aim of this study is to investigate the gender preference of Turkish Muslim women regarding ob/gyn, and identify other features that affect their choice. Methods: In this study it has been included 710 women attending to gynecology and antenatal clinics and they have been asked to complete a survey questionnaire containing 16 items and requiring opinion on whether they want to be examined medically by a female or male ob/gyn and have no preference. The questions have also contained the reasons for the stated preference. Results: Of all participants, 230 (32,3%) preferred to have a female ob/gyn, 380(53,5%) declared no preference, and 100(14,2%) preferred to have a male ob/gyn. The reasons for female preference were i) having a very good communication (36%), ii) embarrassment (32%) and iii) feeling comfortable with female ob/gyn (27%). Surprisingly, only 5% women responded that the religious orders are important in their preference. The participants who have larger family, lower level of education, lower income, higher unemployment, parity of 4 and over, and first gynecological examination, have preferred female ob/gyn (p

Pregnant women with eating disorders are at risk for multiple complications to both the woman and the fetus. Eating disorders are particularly prevalent among adolescent girls and young women. This paper suggests a road map for the obstetrician gynecologist caring for women who either have an active eating disorder, report a history of a prior eating disorder, or when the clinician suspects that the woman may have an eating disorder which has not been previously identified. Proposed treatment guidelines are outlined.

The laborist model offers the best approach to standardize care and improve patient safety on the labor unit, improve physician well-being, and decrease physician dissatisfaction/burnout. The concept of the laborist was based on the hospitalist model. The laborist is free of the stresses of a private practice, works a constant and controllable schedule, and can have work shift limitations, thereby eliminating the issue of fatigue and impairment, and improving patient safety while decreasing the potential for adverse outcomes that may result in a liability action. This is what is being demanded both by patients and generation Y physicians.

El presente trabajo corresponde a la experiencia en el manejo del MITYVAC VACUUM DELIVERY SYSTEM y el nuevo CMI VACUUM D.S. presentada en un hospital materno infantil de Lima, Perú, distrito del Rímac y pacientes privados. Ampliando nuestra experiencia a una publicación del año 87. La significación tan importante que ha tenido el uso en el Perú de este instrumento ha permitido un importante apoyo en la dura y riesgosa jornada de la vida, que es el nacimiento. El MITYVAC se compone de un vacuum extractor, instrumento sencillo cuya difusión es cada vez mayor en hospitales de los Estados Unidos de Norte América, lo mismo que en Latinoamérica. Particularmente en el Perú su utilización se presenta desde el año 1986 desplazando al FORCEPS y al VACUUM EXTRACTOR DE MALMSTRONG reduciendo de esta manera los riesgos al momento del parto. La creación del MITYVAC VACUUM DELIVERY SYSTEM obedece a la COLUMBIA MEDICAL & SURGICAL, de esta manera miles de especialistas están poniendo en práctica una de las más importantes logros en cuanto a instrumental gineco obstetra se refiere, de los últimos años. Consideramos basados en la experiencia ilustrativa de su manejo, que con el MITYVAC VACUUM DELIVERY SYSTEM se facilita y se otorga máxima seguridad para la madre y el infante en aquellos partos que pudiese presentar dificultades. Lo consideramos: Simple, seguro, muy efectivo y de uso inmediato estando preparado estérilmente con equipos descartables. Su uso es responsabilidad del especialista basado en su evaluación y experiencia como factor decisivo para indicar el momento preciso para su aplicación. El MITYVAC está preparado para aumentar la potencia expulsiva de la madre y facilitar la natural rotación de la cabeza fetal, acortándose el periodo expulsivo durante el parto vaginal; pudiéndose también usar en operaciones cesáreas.

During routine fetal auscultation, it is not uncommon to encounter an abnormal fetal heart rate. The rate may be abnormally slow or fast, or irregular. This article focuses on fetal dysrhythmias, defined as any irregular fetal cardiac rhythm or a regular rhythm with an abnormal rate outside the range of 120 to 160 beats per minute (Am J Obstet Gynecol. 2000;182:813-819). This article also helps the reader to recognize the most common types of fetal arrhythmias, understand the fetal risks associated with many fetal arrhythmias, and identify some of the pharmacological options used to treat fetal arrhythmias.

Background: The hospitalist model in obstetric care which was introduced over the last decades now has an important role in care delivery management with the potential positive impact on maternal and neonatal outcomes.Objective: The aim of this study was to evaluate the effect of hospitalist model towards surgical emergency response time.Method: This research design was cohort a retrospective study. Participants included were the patient in the time before and after implementation of obstetrician/gynecologist full-hospitalist policy during October 2013 until September 2014. The outcome measured were mean response time and possible hospital factors which contribute to response time.Result and Discussion: We included a total of 71 patients (30 on-call obstetrician group and 41 full-time hospitalist group). Univariate analysis indicated mean response time was significantly differ in full-time hospitalist group when compared to the on-call obstetrician group (65.3 + 25.89 vs. 84 + 22.29 mins; p = 0.002). Multivariable analysis determined that hospital factors which contribute to response time are readiness of operating theatre.Conclusion: Implementation of full-time hospitalist model is associated with a significant improvement of response time in emergency obstetric care.Keywords: Maternal mortality, Obstetrician/Gynecology Hospitalist, C-section, Response Time