scholarly journals Evidence-Based Cesarean Delivery for the Nonobstetrician

2015 ◽  
Vol 02 (01) ◽  
pp. e1-e6 ◽  
Author(s):  
Joshua Dahlke ◽  
Hector Mendez-Figueroa ◽  
Jeffrey Sperling ◽  
Lindsay Maggio ◽  
Brendan Connealy ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Postpartum Hemorrhage ◽  
Surgical Techniques ◽  
The United States ◽  
Skin Incision ◽  
Adhesion Prevention ◽  
Evidence Based ◽  
Skin Closure ◽  
Thromboembolism Prophylaxis ◽  
Surgical Morbidity

Cesarean delivery (CD) is one of the most common major surgeries performed in the United States and worldwide. Surgical techniques evaluated in well-designed randomized controlled trials (RCTs) that demonstrate maternal benefit should be incorporated into practice. The objective of this review is to provide a summary of surgical techniques of the procedure and review the evidence basis for them for the nonobstetrician. The following techniques with the strongest evidence should be commonly performed, when feasible: (1) prophylactic antibiotics with a single dose of ampicillin or first-generation cephalosporin prior to skin incision; (2) postpartum hemorrhage prevention with oxytocin infusion of 10 to 40 IU in 1 L crystalloid over 4 to 8 hours; (3) low transverse skin incision; (4) blunt or sharp subcutaneous and fascial expansion; (5) blunt, cephalad–caudad uterine incision expansion; (6) spontaneous placental removal; (7) blunt-tip needle usage during closure; (8) subcutaneous suture closure (running or interrupted) if thickness is ≥2 cm; and (9) skin closure with suture. Although the number of RCTs designed to optimize maternal and neonatal outcomes of this common procedure is encouraging, further work is needed to minimize surgical morbidity. Optimal methods for postpartum hemorrhage prevention, adhesion prevention, and venous thromboembolism prophylaxis remain ongoing areas of active research, with outcomes that could markedly improve maternal morbidity and mortality. If evidence of a surgical technique appears preferred over another, clinicians should be comfortable adopting the evidence-based technique when performing and teaching CD.

scholarly journals Cesarean section one hundred years 1920–2020: the Good, the Bad and the Ugly

2021 ◽  
Vol 49 (1) ◽  
pp. 5-16
Author(s):  
Clarel Antoine ◽  
Bruce K. Young
Keyword(s):  
United States ◽  
Black Women ◽  
Cesarean Section ◽  
Cesarean Delivery ◽  
Surgical Techniques ◽  
The United States ◽  
Delivery Rate ◽  
Mortality And Morbidity ◽  
Perceived Safety ◽  
Cesarean Delivery Rate

AbstractIn present-day obstetrics, cesarean delivery occurs in one in three women in the United States, and in up to four of five women in some regions of the world. The history of cesarean section extends well over four centuries. Up until the end of the nineteenth century, the operation was avoided because of its high mortality rate. In 1926, the Munro Kerr low transverse uterine incision was introduced and became the standard method for the next 50 years. Since the 1970’s, newer surgical techniques gradually became the most commonly used method today because of intraoperative and postpartum benefits. Concurrently, despite attempts to encourage vaginal birth after previous cesareans, the cesarean delivery rate increased steadily from 5 to 30–32% over the last 10 years, with a parallel increase in costs as well as short- and long-term maternal, neonatal and childhood complications. Attempts to reduce the rate of cesarean deliveries have been largely unsuccessful because of the perceived safety of the operation, short-term postpartum benefits, the legal climate and maternal request in the absence of indications. In the United States, as the cesarean delivery rate has increased, maternal mortality and morbidity have also risen steadily over the last three decades, disproportionately impacting black women as compared to other races. Extensive data on the prenatal diagnosis and management of cesarean-related abnormal placentation have improved outcomes of affected women. Fewer data are available however for the improvement of outcomes of cesarean-related gynecological conditions. In this review, the authors address the challenges and opportunities to research, educate and change health effects associated with cesarean delivery for all women.

Postoperative Venous Thromboembolism Prophylaxis: Changes in the Daily Clinical Practice, Modified Guidelines

2019 ◽  
Vol 46 (01) ◽  
pp. 083-088 ◽  
Author(s):  
Charles Marc Samama
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Fast Track ◽  
Surgical Techniques ◽  
The United States ◽  
Day Case ◽  
Thromboembolism Prophylaxis ◽  
Mechanical Prophylaxis ◽  
Total Knee ◽  
Strong Control

AbstractWith current clinical practice, postoperative venous thromboembolism (VTE) risk is not only well controlled, but it is steadily decreasing, especially in orthopaedic surgery, thanks to fast-track and day case procedures, new surgical techniques, and potent antithrombotic agents. Thromboprophylaxis is becoming increasingly adapted to these patients. Aspirin is also extensively prescribed in total hip replacement and total knee replacement procedures in the United States and Australia. Mechanical prophylaxis is sometimes applied alone but most often combined with anticoagulant agents. However, large evidence-based studies are still needed to confirm these optimistic tendencies. In the meantime, physicians have to keep strong control over the VTE risk to prevent the reappearance of pulmonary embolism after admission to the surgical wards.

Abnormally invasive placenta (AIP): pre-cesarean amnion drainage to facilitate exteriorization of the gravid uterus through a transverse skin incision

2018 ◽  
Vol 47 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Thorsten Braun ◽  
Katharina Weizsäcker ◽  
Mustafa Zelal Muallem ◽  
Janina Tillinger ◽  
Larry Hinkson ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Operative Management ◽  
The United States ◽  
Skin Incision ◽  
Uterine Wall ◽  
Gravid Uterus ◽  
Invasive Placenta ◽  
Transverse Skin Incision ◽  
Abnormally Invasive Placenta

Abstract The number of pregnant women with abnormally invasive placenta (AIP) including clinical relevant placenta increta and percreta has markedly increased with a reported incidence of as high as one in 731, By 2020 in the United States, there will be an estimated 4504 new cases of AIP and 130 AIP-associated maternal deaths annually. The preoperative diagnosis and operative management of AIP is challenging. In a planned cesarean delivery, a vertical lower abdominal skin incision is widely used in order to have enough space to perform a hysterotomy above the cranial edge of the placenta to avoid significant fetal and/or maternal hemorrhage. We have used preoperative drainage of the amniotic fluid after epidural anesthesia and immediately before a planned cesarean delivery through a transverse skin incision in five patients with AIP of the anterior uterine wall. With less uterine volume, exteriorization of the gravid uterus is easily performed through a transverse laparotomy. The combination of amnion drainage, transverse laparotomy and exteriorization of the gravid uterus facilitates identification of the exact site of placental implantation, provides adequate space for performing fundal or high anterior or even posterior uterine wall incisions and to deliver the fetus safely while minimizing the risk of placental separation and subsequent uncontrolled blood loss. Furthermore, this technique provides the chance to leave the untouched placenta in situ or to remove the placenta in toto with a uterine wall segment.

The Speech-Language Assessment of English Language Learning Students: A Non-Standardized Approach

2013 ◽  
Vol 14 (4) ◽  
pp. 95-101 ◽  
Author(s):  
Robert Kraemer ◽  
Allison Coltisor ◽  
Meesha Kalra ◽  
Megan Martinez ◽  
Bailey Savage ◽  
...  
Keyword(s):  
Language Learning ◽  
Language Impairment ◽  
Specific Language Impairment ◽  
English Language ◽  
Language Assessment ◽  
The United States ◽  
English Language Learning ◽  
Assessment Practices ◽  
Evidence Based ◽  
English Speaking

English language learning (ELL) children suspected of having specific-language impairment (SLI) should be assessed using the same methods as monolingual English-speaking children born and raised in the United States. In an effort to reduce over- and under-identification of ELL children as SLI, speech-language pathologists (SLP) must employ nonbiased assessment practices. This article presents several evidence-based, nonstandarized assessment practices SLPs can implement in place of standardized tools. As the number of ELL children SLPs come in contact with increases, the need for well-trained and knowledgeable SLPs grows. The goal of the authors is to present several well-establish, evidence-based assessment methods for assessing ELL children suspected of SLI.

440: Barriers to the Practice of Evidence Based Urology in the United States

2007 ◽  
Vol 177 (4S) ◽  
pp. 147-148
Author(s):  
Philipp Dahm ◽  
Hubert R. Kuebler ◽  
Susan F. Fesperman ◽  
Roger L. Sur ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Evidence Based

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

1367-P: Risk and Indications for Cesarean Delivery among Women with Diabetes in the United States

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1367-P
Author(s):  
JENNIFER GRASCH ◽  
KATHERINE MILLER ◽  
DAVID HAAS ◽  
METHODIUS TUULI ◽  
CHRISTINA M. SCIFRES
Keyword(s):  
United States ◽  
Cesarean Delivery ◽  
The United States

Fidelity and Its Relationship to Implementation Effectiveness, Adaptation, and Dissemination

2017 ◽  
Author(s):  
Jennifer D. Allen ◽  
Rachel C. Shelton ◽  
Karen M. Emmons ◽  
Laura A. Linnan
Keyword(s):  
Public Health ◽  
Treatment Strategies ◽  
Implementation Fidelity ◽  
Population Level ◽  
The United States ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Health Gains ◽  
Significant Public Health ◽  
Research Continuum

There is substantial variability in the implementation of evidence-based interventions across the United States, which leads to inconsistent access to evidence-based prevention and treatment strategies at a population level. Increased dissemination and implementation of evidence-based interventions could result in significant public health gains. While the availability of evidence-based interventions is increasing, study of implementation, adaptation, and dissemination has only recently gained attention in public health. To date, insufficient attention has been given to the issue of fidelity. Consideration of fidelity is necessary to balance the need for internal and external validity across the research continuum. There is also a need for a more robust literature to increase knowledge about factors that influence fidelity, strategies for maximizing fidelity, methods for measuring and analyzing fidelity, and examining sources of variability in implementation fidelity.

scholarly journals 511 Choosing the optimal skin incision for cesarean delivery in patients with morbid obesity

2021 ◽  
Vol 224 (2) ◽  
pp. S322-S323
Author(s):  
Karl E. Seif ◽  
Katherine Goetzinger ◽  
Ozhan Turan
Keyword(s):  
Morbid Obesity ◽  
Cesarean Delivery ◽  
Skin Incision
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