Fetal extrasystole may predict poor neonatal outcome.

Extrasystoles particularly premature atrial contractions noted during labour on the fetal heart rate monitoring strip are usually thought to be benign. In pregnancies complicated by fetal infection and/or the fetal inflammatory response syndrome, there are some data that extrasystoles noted during the intrapartum period may be related to neonatal sepsis and eventual poor neonatal outcome including death or neonatal encephalopathy. Additional observations are needed to substantiate this hypothesis.

An ethical justification and policy for making commitments during computerized residency application processes: The US matching program as a laboratory for needed reform.

The US National Residency Matching Program (NRMP) is a computerized, national system for matching residency applicants to programs. Similar systems exist in Canada, Australia, and New Zealand, and the need for such a program will probably make itself felt in the European Union soon. NRMP is an important laboratory for the ethical challenges that computerized matching programs create, especially its current prohibition of making commitments by both applicants and residency programs.

The clinical content of preconception care: alcohol, tobacco, and illicit drug exposures.

Substance abuse poses significant health risks to childbearing-aged women in the United States and, for those who become pregnant, to their children. Alcohol is the most prevalent substance consumed by childbearing-aged women, followed by tobacco, and a variety of illicit drugs. Substance use in the preconception period predicts substance use during the prenatal period.

The clinical content of preconception care: infectious diseases in preconception care.

A number of infectious diseases should be considered for inclusion as part of clinical preconception care. Those infections strongly recommended for health promotion messages and risk assessment or for the initiation of interventions include Chlamydia infection, syphilis, and HIV. For selected populations, the inclusion of interventions for tuberculosis, gonorrheal infection, and herpes simplex virus are recommended.

The clinical content of preconception care: immunizations as part of preconception care.

Many vaccine-preventable diseases have serious consequences for the pregnant mother, the fetus, and the neonate. This article reviews the rationale and impact of including vaccinations as part of preconception care and provides recommendations for clinical care. Vaccinations that are recommended highly in preconception care include the hepatitis B and the measles, mumps, and rubella vaccines.

Where is the "W"oman in MCH?

Scientific evidence indicates that improving a woman's health before pregnancy will improve pregnancy outcomes. However, for many years, our efforts have focused primarily on prenatal care and on caring for infants after birth. The concept of preconception care has been identified repeatedly as a priority for improving maternal and infant health.

Hospital primary cesarean delivery rates and the risk of poor neonatal outcomes.

Objective: The purpose of this study was to determine whether risk-adjusted hospital primary cesarean delivery rates are associated with poor neonatal outcomes.

Study Design: The Washington State Birth Events Records for 1995 and 1996 were used. Predicted primary cesarean delivery rates were calculated for each hospital.

Career transitions:planning for alternative futures.

Transition to retirement is a necessary step for all physicians because of the physical and emotional changes that occur with the aging process, the physician's ethical responsibilities to patients, and at times, because there is a desire to pursue different goals. It is important to begin to plan for this transition early in one's career so that some planning for postretirement vocation and avocation can be made and financial concerns can be addressed. A recent ACOG survey of 1000 Fellows ages 40-60 demonstrates that this planning is not occurring universally and the assistance of Fellows in preparation for this transition is now becoming an ACOG initiative.