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Investigators addressed this question by evaluating whether any diagnosis of critical congenital heart disease (CHD) was missed in a group of fetuses diagnosed with Down syndrome (DS) that had normal [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.07.027 Byline: Stanley A. Gall Keywords: Gynecology; Hepatitis A; Hepatitis B; Obstetrics; Risk factors; Vaccine Abstract: Current pediatric vaccination schedules in the United States are based on age. In contrast, adults are vaccinated against most infectious diseases, including hepatitis A and B, only when they are identified as at high risk or after a known exposure. There are multiple risk factors for hepatitis A and B of which clinicians often are not aware. Consequently, many persons at high risk are never vaccinated. Universal vaccination against hepatitis A and B is recommended for adults to halt transmission of the virus and prevent long-term sequelae. Women and their offspring are an especially important population to consider in efforts to reduce the incidence of hepatitis. The following recommendations for expanding the use of hepatitis vaccines in obstetrics and gynecology are made in this article: all older adolescents and adults should be vaccinated regardless of risk factors, and greater efforts should be made to educate physicians about the need to vaccinate their patients against hepatitis. Author Affiliation: Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky, USA

The use of upper vaginectomy for the treatment of vaginal intraepithelial neoplasia (VAIN) is evaluated. Upper vaginectomy was found to be efficacious for the treatment of VAIN and also led to the diagnosis of occult invasive cancer in 12 percent of the patients.

Objective--To examine whether intrapartum care and delivery of low risk women in a midwife managed delivery unit differs from that in a consultant led labour ward. Design--Pragmatic randomised controlled trial. [...]

Despite the abundance of risks and relative dearth of true medical indications, clinically induced and augmented labor played a role in 60 percent of births worldwide in the early 1980s. […]

The use of fertility drugs has increased the incidence of multiple pregnancies, those involving more than two fetuses. The outcome of a multiple pregnancy depends on the number of fetuses and the quality of medical care given to the mother and the fetuses. Improved diagnostic methods, improved neonatal care and the use of selective termination to reduce the number of fetuses carried to term, has influenced the outcome of multiple pregnancies. An evaluation of 24 triplet, five quadruplet and one quintuplet pregnancies from one hospital over a 10-year period was conducted. The rate of death occurring during the first seven days of life was 31.6 per 1000 live infants and the late mortality (the rate of death occurring between seven and 28 days after birth) was 21. The perinatal death rate (during pregnancy and one week after birth) was 51.5. The number of infants surviving and discharged from the hospital was 98 percent. Respiratory distress syndrome, a breathing disorder caused by immature lung tissue, affected 43 percent of the infants. Bronchopulmonary dysplasia, abnormal tissue in the breathing structures, was present in six percent. Other complications included disorders of the eye (retinopathy of immaturity) in three percent, bleeding in the brain (intraventricular hemorrhage) in four percent and cerebral palsy in two percent. Only one child had a moderate handicap (spastic diplegia) at follow-up 10 years later. The remaining 99 percent of the infants had no evidence of further medical problems. A favorable outcome of multiple pregnancies is improved by early diagnosis, meticulous care during pregnancy, continuous monitoring of fetal well-being, early hospitalization, cesarean delivery and the immediate availability of a neonatologist during delivery. Although selective termination of fetuses in multiple pregnancies may be an option in some obstetrical cases, the 90 percent survival rate of multiple pregnancies does not support this type of management. (Consumer Summary produced by Reliance Medical Information, Inc.)

Recognising life-threatening problems is a vital skill, even if a diagnosis is not reached, says Professor Malcolm Woollard. A recent Confidential Enquiry into Maternal and Child Health report recommends all [...]

Table of Contents Abstract Case Report Discussion Conclusion References Abstract We present a case of an unexplained intrauterine death at 29 weeks gestation, in the absence of any risk factors; [...]

Many Australian women who came of age during the feminist political movement and who were taught the benefits of natural childbirth are choosing traditional methods for giving birth to their own children. Reasons vary for their choices. Some women prefer hospitals. Other women have no alternative. Doctors state women are becoming more involved in childbirth decisions.