New Thinking in OBGYN

Want to see the future in OBGYN? Just keep reading my blog. This morning’s email (2014) contained a newsletter that updates obstetricians on the latest trends. Some of which I wrote about in 2009 and 2011. Now, if we could just get these ideas into practice.

OBGYN Clinical Updates/ July 23, 2014 Analysis Questions Use of Antibiotics for Group B Strep During Labor
Do prophylactic antibiotics for group B strep do more harm than good? The practice of giving prophylactic antibiotics to women in labor who are positive for group B Streptococcus was based on studies with poor methodology, an analysis finds.
Gloria’s blog Sept 2011:

OBGYN Clinical Updates/ July 23, 2014: Medicare Costs for Screening Mammos Have Soared: New Strategies Needed
Spending on screening mammography has increased 44% ($296 million) in 8 years, without a corresponding increased benefit of earlier detection of breast cancer. Analysts suggest this spending increase is unsustainable, and new screening strategies are needed.
Gloria’s blog 2009:

OBGYN Clinical updates/ July 23, 2014 POLL
Is the Pelvic Exam Important?
New recommendations against routine pelvic exams in adult women with no symptoms have been issued by the American College of Physicians. Many women will be happy to hear this. As a provider, are you?
Gloria’s blog 2009:

Just say "no" to stripping membranes.

Just say “no” to stripping membranes.

Added to post April 10, 2015
AROM (Artificial Rupture of the Membranes) October 30, 2007
Vital Signs
Childbirth: Purposely Breaking Water Does Not Speed Delivery By NICHOLAS BAKALAR

A large review of studies suggests that a common procedure in labor, intentionally breaking the water, has no effect in reducing the labor time or assuring the baby’s health.

The procedure, sometimes called amniotomy, involves rupturing the amniotic membranes to speed contractions. The procedure has been in use for at least
250 years, although its popularity has varied.

The researchers reviewed 14 randomized controlled trials involving almost
5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.

The report, published Oct. 17 in The Cochrane Reviews, did find that the procedure might be associated with an increase in Caesarean sections and a reduced risk of a lower reading on the Apgar scale, which rates the baby’s condition at birth. But neither finding was statistically significant.

“We advise women whose labors are progressing normally to request their waters be left intact,” said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. “There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.”

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