DOCSLIB.ORG

Clinical Practice Guideline for Care in Pregnancy and Puerperium

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Practice Guideline for Care in Pregnancy and Puerperium Clinical Practice Guideline for Care in Pregnancy and Puerperium CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS MINISTRY OF HEALTH, SOCIAL SERVICES AND EQUALITY CONSEJERÍA DE IGUALDAD, SALUD Y POLÍTICAS SOCIALES CPG FOR CARE IN PREGNANCY AND PUERPERIUM a Clinical Practice Guideline for Care in Pregnancy and Puerperium CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS MINISTRY OF HEALTH, SOCIAL SERVICES AND EQUALITY MINISTERIO MINISTERIO DE ECONOMÍA DE SANIDAD, SERVICIOS SOCIALES Y COMPETITIVIDAD E IGUALDAD CONSEJERÍA DE IGUALDAD, SALUD Y POLÍTICAS SOCIALES This CPG is an aid to decision making in healthcare. The compliance of this guide is not mandatory, nor does it replace the clinical judgement of the healthcare personnel. Edition: 2014 Edited by: Ministry of Health, Social Services and Equality. Edited by: Andalusian Agency for Healthcare Technology and Assessment. Regional Ministry of Equality, Health and Social Policy - CONSEJERÍA DE IGUALDAD, SALUD Y POLÍTICAS SOCIALES NIPO: 680-13-122-7 This CPG has been produced under the collaboration agreement signed by the Carlos III Health Institute, an autonomous body of the Ministry of Science and Innovation and the Fundación Progreso y Salud of the Ministry of Gender, Health and Social Policies of the Regional Government of Andalusia in the framework of developing activities of the Spanish Network of Agenciesfor Health Technology Assessment and NHS benefits, financed by the Ministry of Health, Social Services and Equality. Suggested citation Working Group of the Clinical Practice Guidelines for Care in Pregnancy and Puerperium. Clinical Practice Guideline for Care in Pregnancy and Puerperium. Ministry of Health, Social Services and Equality. Agency for Healthcare Technology Assessment of Andalusia; 2014. Clinical Practice Guidelines in the Spanish NHS: AETSA 2011/10 MINISTERIO MINISTERIO DE ECONOMÍA DE SANIDAD, SERVICIOS SOCIALES Y COMPETITIVIDAD E IGUALDAD CONSEJERÍA DE IGUALDAD, SALUD Y POLÍTICAS SOCIALES Table of contents Presentation 7 Authorship and collaborations 9 Key questions 13 Levels of evidence and grades of recommendation 19 Recommendations of the CPG 20 1. Introduction 35 2. Scope and aims 37 3. Methodology 41 4. Preconception Visit 43 4.1. Aims and content of the preconception visit 43 5. Care during pregnancy 53 5.1. Visits and monitoring during pregnancy 53 5.2. Vaccines during pregnancy 146 5.3. Lifestyles during pregnancy 152 5.4. Managing common problems during pregnancy 218 5.5. Management of breech pregnancy from week 35 248 5.6. Preparation for birth 255 5.7. Managing pregnancy from week 41 260 6. Care during Puerperium 263 6.1. Hospital care during puerperium 263 6.2. Discharge and advice on care during the puerperium 277 6.3. Monitoring visits during the puerperium in primary care 286 6.4. Managing common problems in the puerperium 293 6.5. Contraception during the puerperium 305 6.6. Mental health during the puerperium 310 6.7. Breastfeeding 319 7. Diagnostic and therapeutic strategies 333 8. Dissemination and implementation 339 8.1 Formats of the guide, dissemination and implementation 339 9. Recommendations for future research 341 Appendixes 343 Appendix 1. Declaration of interest 343 Appendix 2. Classification of the rating quality of evidence and grading strength of recommendations through the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. 344 A) Classification of scientific quality of the evidence 344 B) Grading strength of the recommendations 345 Appendix 3. Tables 347 Appendix 4. Abbreviations 354 Appendix 5. Edinburgh Postnatal Depression Scale (EPDS) 355 Validated Spanish version (adapted from Garcia-Esteve 2003) 355 Bibliography 357 Presentation Documenting the variability in clinical practice, analyse its causes and adopt strategies aimed at eliminating it, have proven to be initiatives that promote safe and effective decision-making by health professionals, being patient-centred and shared by them. Such strategies include preparing Clinical Practice Guidelines (CPG), “a set of recommendations based on a systematic review of the evidence and the assessment of the risks and benefits of different alternatives in order to optimize health care patients.” The priorities of the Ministry of Health, Social Services and Equality, include continuing to promote the development and use of reports from health technology assess ment and CPGs, consolidating the Network of Agencies for Health Technology Assessment and Performance of National Health and the GuíaSalud Project. Pregnancy or gestation is defined as a period during which the embryo develops and grows inside the mother’s body and whose duration ranges from egg fertilisation until birth. This CPG aims to answer clinical questions concerning this process and has the mission to offer the various professionals involved in both primary care and hospital care, guidelines for quality care to women during pregnancy and after childbirth, besides dealing with different aspects of the newborn. This guide is the result of work carried out by a large group of professionals from different Autonomous Communities, who represent all the disciplines involved in the care of the reproductive process. Women belonging to associations involved in promoting adequate care before, during and after childbirth have also participated in its elaboration. Prestigious professionals belonging to the corresponding scientific societies have performed the external review process. In the Directorate General of Public Health, Quality and Innovation, we are very satisfied with the work done and hope this guide allows making secure and efficient decisions, improve the quality of health care. We place women and children as main protagonists of such a unique event as well as important which is giving life and delivering it. M. MERCEDES VINUESA SEBASTIÁN Director General of Public Health, Quality and Innovation CPG FOR CARE IN PREGNANCY AND PUERPERIUM 7 Authors and Collaborations Working Group of the CPG for care in pregnancy and puerperium Carmen Beltrán-Calvo. Head of Technology Assessment Unit, Andalusian Health Technologies Assessment Agency, (AETSA), Seville. Juliana Ester Martín-López. Specialist in Family and Community Medicine, Andalusian Health Technologies Assessment Agency (AETSA), Seville. Ivan Solà-Arnau. Researcher, Iberoamerican Cochrane Centre (CCIb), Barcelona. Longinos Aceituno-Velasco. Specialist in Gynaecology and Obstetrics, Director of the Clinical Management of Gynaecology and Obstetrics from the Hospital de la Inmaculada, Health Management Area Norte de Almería, Almería. Margalida Alomar-Castell. Midwife, Primary Care Management, Can Pastilla Healthcare centre, Mallorca. Carmen Barona-Vilar. Physician, Head of Perinatal Health Unit in the Public Health General Office. Researcher in the Public Health Research Centre. Generalitat Valenciana, Valencia. Isabel Corona-Páez. Specialist in Family and Community Medicine, Palma Palmilla Clinical Management Unit, Primary Care District of Málaga, Málaga. Dolors Costa-Sampere. Midwife, Maternal and Child care and Sexual and Reproductive care Coordintator. Instituto Catalán de la salud, Barcelona. Manuel Fillol Crespo. Gynaecologist, Head of Gynaecology and Obstetrics of the Hospital de La Plana de Villarreal, Castellón. Isabel Espiga-López. Nurse, Diploma on Public Health and Gender, Head of the Women Healthcare Observatory Service, Sub-directorate General of Quality and Cohesion, Ministry of Health, Social Services and Equality. Laura García-Carrascosa. Biochemist, El Parto es Nuestro Association, Madrid. Yolanda Martín-Seco. Midwife, Meruelo Gama Healthcare centre, Cantabria. María Dolores Martínez-Romero. Midwife, Welfare Process and Program Technician, Galician Healthcare Service, Santiago de Compostela, A Coruña. Angela Elisabeth-Müller. Architect, El Parto es Nuestro Association, Madrid Ibone Olza-Fernandez. Paediatric Psychiatrist, Puerta de Hierro University Hospital, Madrid. Marta Parra-Casado. Architect, President of the El Parto es Nuestro Association, Madrid Rosario Quintana-Pantaleón. Gynaecologist, Sierrallana Hospital, Torrelavega. Carmen Tejero-Lainez. Social worker, Vía láctea Association, Zaragoza. Rafael Torrejón-Cardoso. Specialist in Gynaecology and Obstetrics, Integrated Women Care Clinical Management Unit, Puerta del Mar/Universidad de Cádiz University Hospital, Cádiz. Casilda Velasco-Juez. Midwife, Gynaecology and Obstetrics Clinical Management Unit, Jaén Hospital, Jaén. CPG FOR CARE IN PREGNANCY AND PUERPERIUM 9 Coordination Carmen Beltrán-Calvo. Head of Technology Assessment Unit, Andalusian Health Technologies Assessment Agency, (AETSA), Seville. Juliana Ester Martín-López. Specialist in Family and Community Medicine, Andalusian Health Technologies Assessment Agency (AETSA), Seville. Ivan Solà-Arnau. Researcher, Iberoamerican Cochrane Centre (CCIb), Barcelona. Expert Collaboration Mónica Ballesteros-Polo. Specialist in Preventine Medicine and Public Health, Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau , Barcelona. África Caño-Aguilar. Specialist in Gynaecology and Obstetrics, Gynaecology and Obstetrics Clinical Management Unit, San Cecilio/Universidad de Granada University Hospital, Granada. Ana María Carlos-Gil. Specialist in Family and Community Medicine, Andalusian Health Technologies Assessment Agency (AETSA), Seville. Raúl García-Estepa. Bsc in Pharmacy, Andalusian Health Technologies Assessment Agency (AETSA), Seville. Rocío García-Aguilar. Diploma in Nursing, Andalusian Health Technologies
Load more

Recommended publications
  • Sex and Reproduction
    vv ISSN: 2690-0815 DOI: https://dx.doi.org/10.17352/ijsrhc LIFE SCIENCES GROUP Mohamed Nabih EL-Gharib* and Sherin Barakat Albehoty Review Article Department of Obstetrics & Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt Sex and Reproduction Received: 10 March, 2018 Accepted: 11 April, 2018 Published: 12 April, 2018 Abstract *Corresponding author: Mohamed Nabih EL-Gharib, Department of Obstetrics & Gynecology, Faculty of Sexual intercourse is a union between two people of different sexual acting in a social context in Medicine, Tanta University, Tanta, Egypt, accordance with their physiological and psychological needs. Sexual relationship provides a physical E-mail: closeness which gives the comfort and support which is essential for all relationships. Keywords: Sexual intercourse; Pregnancy; Positions Many years ago, Aristotle was aware of a woman’s ability to conceive in any coital position. The time of sexual intercourse of ovulation is the main determinant of conception, not coital position. As regards pregnancy, it is not a safe thought to stop coitus until the time of ovulation because one might overlook it. https://www.peertechz.com Pregnancy often has an infl uence on a couple’s sexual activity, although it has no uniform effect on sexual feelings or function. Some women will fi nd that their sex drive signifi cantly increases during their pregnancy, while others will experience a decreased interest in sex. Lastly, we answered the question what are the best coital positions during pregnancy. Introduction Although sexual activity has, until very lately, being essential to breeding, this did not preclude the non- In biological terms, the urge to reproduce is one of the reproductive importance of sexual relationships and non- strongest basic drives.
    [Show full text]
  • Topics in Human Sexuality: Sexuality Across the Lifespan Adulthood/Male and Female Sexuality
    Most people print off a copy of the post test and circle the answers as they read through the materials. Then, you can log in, go to "My Account" and under "Courses I Need to Take" click on the blue "Enter Answers" button. After completing the post test, you can print your certificate. Topics in Human Sexuality: Sexuality Across the Lifespan Adulthood/Male and Female Sexuality Introduction The development of sexuality is a lifelong process that begins in infancy. As we move from infancy to adolescence and adolescence to adulthood, there are many sexual milestones. While adolescent sexuality is a time in which sexual maturation, interest and experience surge, adult sexuality continues to be a time of sexual unfolding. It is during this time that people consolidate their sexual orientation and enter into their first mature, and often long term, sexual relationships. This movement towards mature sexuality also has a number of gender-specific issues as males and females often experience sexuality differently. As people age, these differences are often marked. In addition to young and middle age adults, the elderly are often an overlooked group when it comes to discussion of sexuality. Sexuality, however, continues well into what are often considered the golden years. This course will review the development of sexuality using a lifespan perspective. It will focus on sexuality in adulthood and in the elderly. It will discuss physical and psychological milestones connected with adult sexuality. Educational Objectives 1. Discuss the process of attaining sexual maturity, including milestones 2. Compare and contrast remaining singles, getting married and cohabitating 3.
    [Show full text]
  • Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters
    Open Access Original Article DOI: 10.7759/cureus.13631 Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters Marco Siccardi 1, 2 , Cristina Valle 3, 4 , Fiorenza Di Matteo 2 1. Obstetrics and Gynecology, Primal Osteopathy Institute, Savona, ITA 2. Obstetrics and Gynecology, San Paolo Hospital, Savona, ITA 3. Obstetrics and Gynaecology, San Paolo Hospital, Savona, ITA 4. Yoga and Cranial Osteopathy, Primal Osteopathy Institute, Savona, ITA Corresponding author: Marco Siccardi, [email protected] Abstract Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological techniques have shown that maternal shifting positions during pregnancy and labor can create more room in the pelvis for safe delivery. The external and internal pelvic diameters are related. The present study aims to evaluate the external obstetric pelvic diameters in shifting positions using a clinical technique suitable for daily practice in every clinical setting: the dynamic external pelvimetry test (DEP test). Seventy pregnant women were recruited, and the obstetric external pelvic diameters were measured, moving the position from kneeling standing to "hands-and-knees" to kneeling squat position. Results showed modification of the pelvic diameters in shifting position: the transverse and longitudinal diameters of Michaelis sacral area, the inter-tuberosities diameter, the bi-trochanters diameter, and the external conjugate widened; the bi-crestal iliac diameter, the bi-spinous iliac diameter, and the base of the Trillat's triangle decreased.
    [Show full text]
  • Reproductive Medicine
    Article Type: Commentary Reproductive medicine: still more ART than science? J Wilkinson1, S Bhattacharya2, JMN Duffy3,4, MS Kamath5, J Marjoribanks6, S Repping7, A Vail1, M van Wely7, CM Farquhar6 1 Centre for Biostatistics, University of Manchester, Manchester, United Kingdom. 2 The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Article Kingdom. 3 Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. 4 Balliol College, University of Oxford, Oxford, United Kingdom. 5 Reproductive Medicine Unit, Christian Medical College, Vellore, India. 6 Cochrane Gynecology and Fertility Group, University of Auckland, Auckland, New Zealand. 7 Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1471-0528.15409 Accepted This article is protected by copyright. All rights reserved. Corresponding author: J Wilkinson Centre for Biostatistics, University of Manchester, Manchester, United Kingdom. [email protected] Running title: Reproductive medicine: still more ART than science? Article The history of obstetrics and gynaecology is not a tale of evidence-based practice. Tradition, expert opinion, and the lure of new technology have frequently superseded evidence as the primary driver for clinical decision making 1. The proof can be found in a litany of dubious interventions which have gained widespread popularity despite an absence of high quality data attesting to their effectiveness and, in some cases, ample credible evidence demonstrating harm.
    [Show full text]
  • Hazards and Uses of Prenatal Diagnostic X-Radiation
    Hazards and Uses of Prenatal Diagnostic X-Radiation Lee C. Schussman, MD, and Lawrence J. Lutz, MD Salt Lake City, Utah Diagnostic x-ray studies during any stage of gestation have been shown to increase the risk of childhood cancer in the irradiated fetus. This study reviews those risks and examines the uses of pregnant abdomen and x-ray pelvimetry studies. The abdominal films appear to have provided useful and nec­ essary information in the management of labors and deliveries; however, the x-ray pelvimetry results appear to have provided much less usable information. The predictive values of both positive and negative x-ray pelvimetry studies were low, .57 and .66, respectively. The predictive values were low for both vertex and breech presentations. The definite hazards of pre­ natal diagnostic radiation studies should be carefully weighed against their possible benefits. There is substantial evidence that diagnostic in pregnancy, but very few of these clinicians were x-radiation received by a woman at any time dur­ familiar with the potential hazards associated with ing pregnancy may be detrimental to the fetus. To diagnostic pelvic radiation late in pregnancy. discover the extent of knowledge of practicing There is controversy over the potential benefits clinicians regarding the hazards of x-ray examina­ vs risks of cancer induction associated with diag­ tion during pregnancy, the authors surveyed a nostic pelvic x-radiation during pregnancy, and number of their colleagues (obstetricians, family yet these procedures are being used with pregnant physicians who practice obstetrics, and radiolo­ women. Thus, the purposes of this paper are (1) to gists).
    [Show full text]
  • Gtg-No-20B-Breech-Presentation.Pdf
    Guideline No. 20b December 2006 THE MANAGEMENT OF BREECH PRESENTATION This is the third edition of the guideline originally published in 1999 and revised in 2001 under the same title. 1. Purpose and scope The aim of this guideline is to provide up-to-date information on methods of delivery for women with breech presentation. The scope is confined to decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. External cephalic version is the topic of a separate RCOG Green-top Guideline No. 20a: ECV and Reducing the Incidence of Breech Presentation. 2. Background The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3–4% at term, as most babies turn spontaneously to the cephalic presentation. This appears to be an active process whereby a normally formed and active baby adopts the position of ‘best fit’ in a normal intrauterine space. Persistent breech presentation may be associated with abnormalities of the baby, the amniotic fluid volume, the placental localisation or the uterus. It may be due to an otherwise insignificant factor such as cornual placental position or it may apparently be due to chance. There is higher perinatal mortality and morbidity with breech than cephalic presentation, due principally to prematurity, congenital malformations and birth asphyxia or trauma.1,2 Caesarean section for breech presentation has been suggested as a way of reducing the associated perinatal problems2,3 and in many countries in Northern Europe and North America caesarean section has become the normal mode of breech delivery.
    [Show full text]
  • Preenisha Naicker
    Sexual risk amongst teenage mothers in a selected KwaZulu-Natal secondary school within a context of HIV/AIDS. Preenisha Naicker A dissertation submitted for the degree of Master of Education in the School of Education, University of KwaZulu-Natal. December 2014 0 Declaration I, Preenisha Naicker (Student No: 208510657) declare that: i. The research report in this thesis, except where otherwise stated is my original work. ii. This thesis has not been submitted for any degree or examination at any other university. iii. This thesis does not contain other person’s data, pictures, graphs or other information, unless specifically acknowledged as being sourced from other researchers. Where other sources have been quoted, then: a) Their words have been re-written but the general information attributed to them has been referenced. b) Where their exact words have been used, their writing had been placed inside quotation marks, and referenced. iv. The work described in this thesis was carried out in the School of Education, University of KwaZulu-Natal, from 2013 to 2014 under the supervision of Dr S Singh (research supervisor) and v. The Ethical Clearance No: HSS/0676/013M was granted prior to undertaking the fieldwork. Signed by me: _______________________ 1 Dedication My Humble Pranams at Thy Lotus Feet of my Divine Guru - Bhagawan Shri Sathya Sai Baba whose divine omnipresence, grace, teachings and plans to prosper me have been instrumental in shaping this journey in incredible ways. TO: My parents, the epitomes of selflessness and unconditional love, to whom I dedicate this dissertation. I sincerely thank you for being my pillars of strength and reassuring me every step of this journey.
    [Show full text]
  • Sexuality Across the Lifespan Childhood and Adolescence Introduction
    Topics in Human Sexuality: Sexuality Across the Lifespan Childhood and Adolescence Introduction Take a moment to think about your first sexual experience. Perhaps it was “playing doctor” or “show me yours and I’ll show you mine.” Many of us do not think of childhood as a time of emerging sexuality, although we likely think of adolescence in just that way. Human sexual development is a process that occurs throughout the lifespan. There are important biological and psychological aspects of sexuality that differ in children and adolescents, and later in adults and the elderly. This course will review the development of sexuality using a lifespan perspective. It will focus on sexuality in infancy, childhood and adolescence. It will discuss biological and psychological milestones as well as theories of attachment and psychosexual development. Educational Objectives 1. Describe Freud’s theory of psychosexual development 2. Discuss sexuality in children from birth to age two 3. Describe the development of attachment bonds and its relationship to sexuality 4. Describe early childhood experiences of sexual behavior and how the child’s natural sense of curiosity leads to sexual development 5. Discuss common types of sexual play in early childhood, including what is normative 6. Discuss why it is now thought that the idea of a latency period of sexual development is inaccurate 7. Discuss differences in masturbation during adolescence for males and females 8. List and define the stages of Troiden’s model for development of gay identity 9. Discuss issues related to the first sexual experience 10. Discuss teen pregnancy Freud’s Contributions to Our Understanding of Sexual Development Prior to 1890, it was widely thought that sexuality began at puberty.
    [Show full text]
  • Postpartum Visit and Contraception Study
    Postpartum Visit and Contraception Study Arden Handler, DrPH, Rachel Caskey, MD, Kristin Rankin, PhD, Sadia Haider, MD, MPH University of Illinois School of Public Health Prepared for the Illinois Department of Healthcare and Family Services Project Dates: May 16th, 2014 to January 31st, 2015 Project Director: Katrina Stumbras, MPH Research Assistants: Vida Henderson, PharmD, MPH, Molly Murphy, MPH, Elizabeth Berkeley, Micaella Verro, Amy Solsman A special thank you to Tierra Williams, Sonya Dhanvanthari, and April Parks for their assistance with this project. This document was developed under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government. Postpartum Visit and Contraception Executive Summary Background Researchers at the University of Illinois School of Public Health undertook a multi-part effort to: identify and summarize the research related to what is known about the postpartum visit, strategies for increasing its use, as well as strategies for increasing uptake of postpartum contraception; to determine women’s and providers’ perspectives on alternative approaches to the delivery of postpartum care and contraception; and, to specifically explore the role of the Well-Baby Visit (WBV) in the early postpartum period as a time for women to discuss reproductive life planning and family planning needs. This work was funded by the Illinois Department of Healthcare and Family Services through its CHIPRA initiative. Why is this research important? Unintended pregnancy is highly prevalent in the US and is associated with increased risk of adverse reproductive and perinatal outcomes.
    [Show full text]
  • Pretest Obstetrics and Gynecology
    Obstetrics and Gynecology PreTestTM Self-Assessment and Review Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the prod- uct information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Obstetrics and Gynecology PreTestTM Self-Assessment and Review Twelfth Edition Karen M. Schneider, MD Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Houston Medical School Houston, Texas Stephen K. Patrick, MD Residency Program Director Obstetrics and Gynecology The Methodist Health System Dallas Dallas, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc.
    [Show full text]
  • Pregnancy Research Review: Data and Methods Report
    EUROPE SUSAN GUTHRIE, CATHERINE A. LICHTEN, BRANDI LEACH, JACK POLLARD, SARAH PARKINSON, MARLENE ALTENHOFER Pregnancy research review Data and methods report For more information on this publication, visit www.rand.org/t/RR4340 Published by the RAND Corporation, Santa Monica, Calif., and Cambridge, UK © Copyright 2020 RAND Corporation R® is a registered trademark. RAND Europe is a not-for-profit research organisation that helps to improve policy and decision making through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving/contribute www.rand.org www.randeurope.org Preface This report sets out the results of a study – commissioned by the UK Clinical Research Collaboration – that aimed to characterise the pregnancy-research landscape in the UK, assess the level of funding for pregnancy research in the UK, and understand the extent to which funded research addresses the research priorities identified by stakeholders. This data and methods report sets out the methods used for the study, and presents in detail the results of the study and the data it produced.
    [Show full text]
  • Board-Review-Series-Obstetrics-Gynecology-Pearls.Pdf
    ObstetricsandGynecology BOARDREVIEW Third Edition Stephen G. Somkuti, MD, PhD Associate Professor Department of Obstetrics and Gynecology and Reproductive Sciences Temple University School of Medicine School Philadelphia, Pennsylvania Director, The Toll Center for Reproductive Sciences Division of Reproductive Endocrinology Department of Obstetrics and Gynecology Abington Memorial Hospital Abington Reproductive Medicine Abington, Pennsylvania New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2008 by the McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-164298-6 The material in this eBook also appears in the print version of this title: 0-07-149703-X. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more information, please contact George Hoare, Special Sales, at [email protected] or (212) 904-4069. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc.
    [Show full text]