Teaching point-of-care ultrasound using a serious game: a randomized controlled trial.

Background: Point-of-care ultrasound (POCUS) is an important diagnostic tool for internists. However, there are important barriers in learning POCUS, including lack of practice time and lack of experts for supervision. Alternative learning tools may assist in overcoming these barriers.

Interprofessional collaborative practice in obstetrics and midwifery.

As the health care system transforms to accommodate an increased need for primary care services and more patients, new models of health care delivery are needed that can provide quality health care services efficiently. An integrated collaborative practice of certified nurse-midwives, obstetrician-gynecologists, and perinatologists is best suited to meet the rapidly changing needs of the maternity health care delivery system. This article reviews the literature on interprofessional collaborative practice and describes the structure, function, and essential elements of successful collaboration in health care.

Magnetic resonance imaging of cervical ectopic pregnancy in the second trimester.

Objective: To describe the magnetic resonance imaging findings of cervical ectopic pregnancy in the second trimester.

Conclusions: Magnetic resonance imaging findings of cervical ectopic pregnancy in the second trimester include intracervical location of the fetus, endometrial hyperplasia within an otherwise empty endometrial cavity, and irregular placentation in the cervix. Correct recognition of the condition is critical because of the potential for catastrophic and life-threatening maternal bleeding.

Impending macrosomia: will induction of labour modify the risk of caesarean delivery?

Objective: To compare the annual incidence rates of caesarean delivery between induction of labour and expectant management in the setting of macrosomia.

Design: This is a retrospective cohort study.

Setting: Deliveries in the USA in 2003.

Cost-effectiveness of private umbilical cord blood banking.

Objective: To investigate the cost-effectiveness of private umbilical cord blood banking.

Methods: A decision-analytic model was designed comparing private umbilical cord blood banking with no umbilical cord blood banking. Baseline assumptions included a cost of $3,620 for umbilical cord blood banking and storage for 20 years, a 0.

Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation.

There has been a substantial increase in the use of computed tomography (CT) and magnetic resonance imaging (MRI) in pregnancy and lactation. Among some physicians and patients, however, there are misperceptions regarding risks, safety, and appropriate use of these modalities in pregnancy. We have developed a set of evidence-based guidelines for the use of CT, MRI, and contrast media during pregnancy for selected indications including suspected acute appendicitis, pulmonary embolism, renal colic, trauma, and cephalopelvic disproportion.

Time of delivery and neonatal morbidity and mortality.

Objective: The objective of the study was to examine the association between time of delivery and neonatal outcomes in term deliveries.

Study Design: We conducted a retrospective cohort study of all term pregnancies delivered at an academic institution with 24-hour in-house obstetric and anesthesia coverage. Time of delivery was categorized as day (7 am to 6 pm), evening (6 pm to 12 midnight), and late night (12 midnight to 7 am).

Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes.

Objective: This study was undertaken to examine perinatal outcomes associated with the second stage of labor in multiparous women.

Study Design: This is a retrospective cohort study of all term, cephalic, singleton births delivered by multiparous women between 1991 and 2001. Duration of the second stage of labor was stratified into hourly intervals: 0-1 hour, 1-2 hours, 2-3 hours, and 3 hours or longer.

Presence of the sickle cell trait and preterm delivery in African-American women.

Objective: To estimate the association between presence of the sickle cell trait and preterm delivery among African-American women.

Methods: A retrospective cohort study was conducted to study all deliveries by African-American women at one institution between 1976 and 2001. The primary predictor of interest was the presence of the sickle cell trait, and the primary outcome was preterm delivery.

Outcomes associated with cesarean section versus vaginal breech delivery at a university hospital.

Objective: To determine whether vaginal breech delivery is associated with increased morbidity in term breech singletons using strict selection criteria. This study encompasses our previous studies (in 1987 and 1995) and extends our experience to 21 years.

Study Design: Retrospective cohort study from 1980 to 2001 including term, non-anomalous singleton breech deliveries selected by strict criteria.

Manual rotation of the fetal occiput: predictors of success and delivery.

Objective: The purpose of the study was to define predictors of successful rotation and rate of cesarean delivery after manual rotation of the fetal occiput from occiput posterior or transverse position.

Study Design: A retrospective cohort study comprised patients who underwent a trial of manual rotation of the fetal occiput from occiput posterior or occiput transverse position. Successful rotation was defined as delivery in the occiput anterior position.

Face presentation: predictors and delivery route.

Objective: We sought to identify associated characteristics of face presentation and to examine factors that were associated with mode of delivery in the setting of face presentation.

Study Design: This was a retrospective cohort study of women who were diagnosed with face presentation during labor. We examined maternal, fetal, and labor characteristics to determine the associations and predictors of cesarean delivery.

Forceps compared with vacuum: rates of neonatal and maternal morbidity.

Objective: To compare perinatal outcomes between forceps- and vacuum-assisted deliveries. Our hypothesis was that the force vectors achieved in forceps delivery will lead to fewer shoulder dystocias, but greater perineal lacerations.

Methods: This was a retrospective cohort study of 4,120 term, cephalic, singleton, nonrotational operative vaginal deliveries at a single institution.

Racial/ethnic differences in perineal, vaginal and cervical lacerations.

Objective: To determine if variation exists between ethnicities for risk of perineal, vaginal, and cervical laceration at vaginal delivery.

Study Design: Retrospective cohort study of nulliparous women who underwent vaginal delivery of a vertex presentation. Predictor variable was ethnicity with outcome variables cervical, vaginal, and second-, third-, or fourth-degree perineal laceration.

Presidential address: medical-legal issues in obstetrics and gynecology.

Patients, physicians, insurance companies, and legislators are expressing mounting concern in the area of malpractice insurance costs and its effect on the availability of health care. In 1986, the highest award in the history of medical-legal claims, 1,200,000 US dollars, was paid. By 2001, the average award had increased to 3,500,000 US dollars.

Neonatal complications of term pregnancy: rates by gestational age increase in a continuous, not threshold, fashion.

Objective: The purpose of this study was to determine whether, when, and how rates of short-term neonatal complications increase beyond 37 weeks of gestation.

Study Design: A retrospective cohort study was conducted of all low-risk, term, cephalic, and singleton births that were delivered at the University of California, San Francisco, between 1976 and 2001. Primary outcomes included neonatal umbilical artery pH, umbilical artery base excess, the presence of meconium, macrosomia, 5-minute Apgar scores, and admission to the intensive care nursery.

Obstetric attending physician characteristics and their impact on vacuum and forceps delivery rates: University of California at San Francisco experience from 1977 to 1999.

Objective: The objective of our study was to determine the impact of obstetric attending physician characteristics (eg, region of previous residency training, sex, year of graduation from residency) on the rates of vacuum and forceps delivery at our institution.

Study Design: The analysis was based on 19,897 vaginal deliveries that were performed by 171 attending physicians and 160 resident physicians between 1977 and 1999 at the University of California at San Francisco Medical Center. Z -tests and multivariate logistic regression were performed on a perinatal database that contained standard obstetric variables.

Maternal and neonatal outcomes after uterine rupture in labor.

Objective: There is significant controversy about the risks related to attempted vaginal birth after cesarean and the implications for informed consent of the patient. Recent data suggest that women who deliver in hospitals with high attempted vaginal birth after cesarean rates are more likely to experience successful vaginal birth after cesarean, as well as uterine ruptures. We conducted a study to evaluate maternal and neonatal morbidity and mortality after uterine rupture at a tertiary care center.

Maternal and fetal outcomes in pregnancies affected by von Willebrand disease type 2.

We report a case series that lends support for both the maternal and neonatal safety of vaginal delivery in pregnancies complicated by heritable von Willebrand disease types 2A and 2B. With proper hematologic support, a cesarean delivery may be indicated only for obstetric reasons.

Incidence of persistent birth injury in macrosomic infants: association with mode of delivery.

Objective: Our purpose was to determine the incidence of birth injury in a cohort of macrosomic infants (birth weight >4000 gm) and analyze the association between persistent injury and delivery method.

Study Design: Deliveries of 2924 macrosomic infants were reviewed. Outcomes were compared with those of 16,711 infants with birth weights between 3000 and 3999 gm.

Hyperreactio luteinalis differentiated from severe ovarian hyperstimulation syndrome in a spontaneously conceived pregnancy.

The clinical presentation of hyperreactio luteinalis can mimic ovarian hyperstimulation. Historically, though, the former most often leads to unnecessary surgery whereas the latter is treated supportively. We present a case of a 32-year-old woman who was initially seen with markedly enlarged multicystic ovaries, ascites, and pleural effusions in the tenth week of a spontaneously conceived gestation.

Umbilical cord blood acid-base state: what is normal?

Objective: Umbilical cord blood gases and acid-base data from vigorous neonates were examined to determine normal values and ranges.

Study Design: The University of California, San Francisco, Perinatal Data Base was used to retrieve information from deliveries between 1977 and 1993. Newborns with 5-minute Apgar scores > or = 7 were selected because it is generally accepted that a vigorous newborn has not had substantial intrapartum asphyxia lasting until delivery.

The cost of teaching residents outpatient obstetrics and gynecology in a university medical center.

Objective: To quantify the cost of teaching residents ambulatory obstetrics and gynecology, expressed as the difference in revenue generated between a faculty physician practicing as a private practitioner and a faculty physician serving as a resident supervisor.

Method: Outpatient revenue generated by faculty generalists and residents was analyzed. The net gain in revenue was calculated per half-day session for faculty and residents by subtracting contractual allowances and expenses from gross patient charges.