lippincott obstetrics and gynecology pdf Saturday, May 15, 2021 2:41:10 AM

Lippincott Obstetrics And Gynecology Pdf

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Published in collaboration with ACOG, this highly respected resource provides the foundational knowledge medical students need to complete an ob-gyn rotation, pass national standardized exams, and competently care for women in clinical practice. Fully compliant with ACOG's guidelines, treatment recommendations, and Committee Opinions, the text also aligns with the Association of Professors of Gynecology and Obstetrics' educational objectives, upon which most clerkship evaluations and final exams are based. Bulk pricing was not found for item.

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Rigmor C. Box , St. Olavsplass, N Oslo, Norway. We included 44 primary studies, of which 28 were comparative, involving almost 3 million participants.

The methodological study quality was generally low, but several studies reported the same outcome and were sufficiently similar to warrant pooling of effect sizes in meta-analyses. There was no significant difference in risk with respect to cesarean section and episiotomy. The procedure, variously termed across disciplines and perspectives, is classified by the World Health Organization into four types depending on the extent of tissue removed, where type III, infibulation, is the most extensive [ 3 ].

The procedure of infibulation derives its name from the Roman word fibula clasp , which was fastened through the prepuce of men and labia of women to enforce chastity. Studies have also revealed that many members of practicing communities believe that the procedure ensures safe labour [ 5 , 6 ]. This systematic review is an abridged and revised communication of a technical report conducted at the Norwegian Knowledge Centre for the Health Services [ 22 ].

We followed an open process for this systematic review with input from stakeholders and a protocol, published in PROSPERO, that followed standards for systematic reviews [ 11 , 12 , 23 ]. A full technical report with detailed search strategies, methods, and evidence tables is available elsewhere [ 22 ].

To maximize the sensitivity of database searches, we neither applied methodology search filters nor restricted the searches to any specific languages or publication dates.

The processes of study selection, methodological quality appraisal, and data extraction were conducted by two investigators, first independently and then jointly. Discrepancies were resolved through discussion and further inspection of the texts. If consensus had not been reached, we would have consulted a third person, but this was not necessary.

Two investigators first screened titles and abstracts. We retrieved the full text of potentially relevant studies, reviewing each article using a standardized form with a priori eligibility criteria. We included studies providing quantitative data on physical consequences if they were of any study design, except qualitative studies. Study design features as defined in the Cochrane glossary [ 11 ] , not study design labels, were used to designate the studies. Both studies with and without a comparison group were considered.

Concerning outcomes, the range of physical outcomes were included. Other outcomes and results will be detailed in forthcoming technical reports available from the Norwegian Knowledge Centre for the Health Services. Two investigators rated the methodological quality of included studies using design specific checklists and extracted data using a standardized form.

When outcome data were missing in the publication, we contacted the corresponding author s via e-mail and requested that they send us the data. We conducted meta-analyses in RevMan v5. We combined risk ratios for dichotomous outcomes using the Mantel-Haenszel random-effects model, which weighted studies by the inverse of their variances, giving more weight to precise studies. We quantified statistical heterogeneity using the and statistics where a high value shows that most of the variability across studies is due to heterogeneity rather than to chance.

We conducted sensitivity analyses for study type and outcome definition and measurement when possible. For clarity of presentation, when such tests showed no significant differences we present the final meta-analysis result.

We calculated absolute risk differences for the adverse events to enhance interpretation of results. For each outcome eligible for meta-analysis, we examined five domains: methodological quality of study, consistency, directness, precision, and publication bias. If admissible, we would have examined also strength of evidence of association, evidence of a dose-response gradient, and all plausible confounders.

In this systematic review, all included studies were necessarily observational; thus, the evaluation of evidence started from a position of low quality. A total of 5, unique study reports were identified Figure 1.

After sorting eligible studies according to outcomes, we included 44 primary publications reporting on obstetric outcomes: 21 comparative studies [ 14 — 20 , 28 — 47 ], 7 single group cross-sectional studies [ 48 — 54 ], 5 case series [ 6 , 55 — 58 ], and 4 case reports [ 59 — 62 ]. In line with the prioritization to present results from the studies with highest internal validity, the 16 noncomparative studies are relegated to Appendix B.

When groups being compared are selected from different populations it offers less confidence in the effect estimates. The most frequently reported outcomes were cesarean section, episiotomy, and obstetric tears. Several studies reported the same outcome and were sufficiently similar to warrant pooling of effect sizes in meta-analyses. The outcome data from each study are shown with the meta-analyses or in tables. Unless otherwise noted, all data are published data, and as shown in the figures, the meta-analyses evidenced large, unexplained heterogeneity across studies.

This is best achieved through controlled research designs, but also through strength of evidence of association and evidence of a dose-response gradient [ 63 ]. In this systematic review, all included studies were necessarily observational and the majority of the studies had methodological shortcomings.

We conducted meta-analysis for this outcome, pooling available data from five studies reporting a dichotomous measure of prolonged labor. The outcome data are shown with the meta-analysis Figure 2. There were 2. We also conducted meta-analysis of the outcome episiotomy Figure 5.

Eight studies, including 3 registry studies, reported on instrumental delivery 2. In the studies, instrumental delivery was described as ventouse, forceps, operative, or instrumental delivery. Sensitivity analyses were conducted for study type and showed a significant difference between the cross-sectional studies and the registry studies. There was large, unexplained heterogeneity across the registry studies, but not the cross-sectional studies.

Nine of the studies measured this as a dichotomous outcome and were sufficiently similar to warrant pooling in meta-analysis. The sensitivity analysis demonstrated a significant difference between cross-sectional, Africa-based studies and the registry study. Further, inelastic scar tissue may contribute to obstructions, which may prolong labor.

Browning et al. It is possible that lack of episiotomy contributes to the occurrence of obstetric lacerations, as suggested by experts [ 64 ]. Larsen and Okonofua [ 16 ] explain that in these areas, motherhood is a principal source of support, status, and security.

While the health and financial loss on an individual level may seem small, overall, the estimated national costs ranged from 0. By extension, the financial costs of obstetric complications are merely one among many possible costs associated with the practice.

Experiencing a birth-related complication inflicts distress not just on the individual woman, but potentially also her baby, partner, family, and there are economic burdens imposed on the health system from providing care for these women.

In fact, many women give birth at home [ 70 , 71 ] and in eastern and southern Africa, half of all births occur without the support of a skilled birth attendant [ 72 ]. This could be related to Somali women holding culturally anchored beliefs about natural childbirth that lead to reluctance to accept obstetric interventions. According to qualitative studies, Somali women in diaspora express anxiety about childbirth interventions, a general dislike of interference in the birth process, and difficulties in communication with caregivers [ 73 — 75 ].

Some caution is warranted in interpreting these meta-analytic results. While the results rest on a methodology that meets the PRISMA criteria for systematic reviews [ 12 ], our search was completed in January , and newer studies may exist. Despite a comprehensive search strategy, publication bias may be present with the likeliest scenario being that the results are biased to the positive. We failed to obtain 13 relevant records in full text as well as primary data from 3 studies which potentially could have been included in meta-analyses [ 15 , 34 , 36 ].

On the other hand, we received and included unpublished data from the WHO study group on female genital mutilation and obstetric outcome [ 19 ]. Despite the large sample sizes for all of the pooled analyses range 11,—2. The inclusion of missed studies and future outcome research could narrow the confidence intervals, but for most outcomes only very large studies would alter the direction of effect.

It was also a strength that measurement of the majority of the obstetric outcomes was clinically based. On the other hand, there was a lack of a unified approach and standardized definitions to measure common outcomes such as prolonged labor. When definitions were missing we relied on the terminology and categories used in the publications, but we could not always be sure that similarly labeled outcomes were identically defined and measured in each study.

Additional cross-sectional studies would possibly narrow the confidence intervals, but it is unlikely that the direction of the estimates of obstetric outcomes would change. Lastly, any future research should be based on a methodology that ensures representativeness and equivalency between exposed and unexposed groups of women, and that applies standardized definitions and clinical measures for exposure as well as outcomes.

WHO and NORAD commissioned the systematic review but did not participate in the literature search, data screening and assessment, data analysis, or interpretation of the results. Johansen helped in locating full text of studies and data , and five experts who commented on earlier versions of the study report: Tove Ringerike, Ingeborg B. The work was financed in part by the WHO. Berg and Vigdis Underland. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Journal overview. Special Issues. A Letter to Editor for this article has been published. Academic Editor: Johanne Sundby. Received 27 Apr Accepted 10 Jun Published 26 Jun Materials and Methods We followed an open process for this systematic review with input from stakeholders and a protocol, published in PROSPERO, that followed standards for systematic reviews [ 11 , 12 , 23 ]. Study Selection The processes of study selection, methodological quality appraisal, and data extraction were conducted by two investigators, first independently and then jointly.

Methodological Quality Assessment and Data Extraction Two investigators rated the methodological quality of included studies using design specific checklists and extracted data using a standardized form. Result and Discussion A total of 5, unique study reports were identified Figure 1. Figure 1. Table 1. Included comparative studies reporting on obstetric events. Figure 2. Forest plot, prolonged labor. Note: Sensitivity analyses for outcome prolonged labor stage and study type were not statistically significant.

Table 2.

Diagnostic procedures in gynecology

Rigmor C. Box , St. Olavsplass, N Oslo, Norway. We included 44 primary studies, of which 28 were comparative, involving almost 3 million participants. The methodological study quality was generally low, but several studies reported the same outcome and were sufficiently similar to warrant pooling of effect sizes in meta-analyses. There was no significant difference in risk with respect to cesarean section and episiotomy. The procedure, variously termed across disciplines and perspectives, is classified by the World Health Organization into four types depending on the extent of tissue removed, where type III, infibulation, is the most extensive [ 3 ].

Johns Hopkins Manual of Gynecology and Obstetrics

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Read terms. Fretts, MD; Uma M. Turrentine, MD. In developed countries, the most prevalent risk factors associated with stillbirth are non-Hispanic black race, nulliparity, advanced maternal age, obesity, preexisting diabetes, chronic hypertension, smoking, alcohol use, having a pregnancy using assisted reproductive technology, multiple gestation, male fetal sex, unmarried status, and past obstetric history. Although some of these factors may be modifiable such as smoking , many are not. The study of specific causes of stillbirth has been hampered by the lack of uniform protocols to evaluate and classify stillbirths and by decreasing autopsy rates.

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 Забавное имя. Сам придумал. - А кто же еще! - ответил тот с гордостью.  - Хочу его запатентовать.

 Нам нужна ваша помощь. Она с трудом сдерживала слезы. - Стратмор… он… - Мы знаем, - не дал ей договорить Бринкерхофф.

 Стопроцентный бестселлер.

 Т-ты… - заикаясь, он перевел взгляд на ее непроколотые уши, - ты, случайно, серег не носила. В ее глазах мелькнуло подозрение. Она достала из кармана какой-то маленький предмет и протянула. Беккер увидел в ее руке сережку в виде черепа.

Она вспомнила об алгоритме Попрыгунчик. Один раз Грег Хейл уже разрушил планы АНБ. Что мешает ему сделать это еще. Но Танкадо… - размышляла.  - С какой стати такой параноик, как Танкадо, доверился столь ненадежному типу, как Хейл.

 Каким временем мы располагаем. - У нас есть около часа, - сказал Джабба.

 - Его доводы звучали волне убедительно. Сьюзан перевела дыхание. Энсей Танкадо умер. Вина ляжет на АНБ.

Уже несколько лет Танкадо пытался рассказать миру о ТРАНСТЕКСТЕ, но ему никто не хотел верить. Поэтому он решил уничтожить это чудовище в одиночку. Он до самой смерти боролся за то, во что верил, - за право личности на неприкосновенность частной жизни.

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Направляясь к центру Третьего узла, Сьюзан пыталась привести свои мысли в порядок. Странно, что она чувствует нервозность в такой знакомой ей обстановке. В темноте все в Третьем узле казалось чужим. Но было что-то .

Я протестую против ваших инсинуаций в отношении моего заместителя, который якобы лжет. Я протестую… - У нас вирус, сэр. Моя интуиция подсказывает мне… - Что ж, ваша интуиция на сей раз вас обманула, мисс Милкен. В первый раз в жизни. Мидж стояла на своем: - Но, сэр.

Management of Stillbirth

Именно это и нравилось ей в нем - спонтанность решений. Она надолго прижалась губами к его губам. Он обвил ее руками, и они сами собой начали стягивать с нее ночную рубашку.

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