Induction of labor with an unfavorable cervix.
Current opinion in obstetrics & gynecology
Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may take several days. In this review, we focus on the efficacy and safety of methods of labor induction for the unfavorable cervix.Recent evidence on the use of mechanical cervical preparation with transcervical balloons suggests balloons are the most effective option for decreasing time to delivery in the nulliparous patient. Single and double balloons are equally effective, with a volume of more 30?ml being more effective. The addition of misoprostol or oxytocin concurrently with a balloon further expedites time to delivery.Mechanical dilation should be considered when available and technically possible for labor induction in patients with an unfavorable cervix. Misoprostol is an effective adjunct to trans-cervical balloons, further decreasing time to delivery as compared with balloon alone. When misoprostol is contraindicated, oxytocin is a safe, effective, alternative adjunct to trans-cervical balloons. More research is needed to evaluate safe outpatient options, induction methods in the setting of prior cesarean with an unfavorable cervix, and to directly compare misoprostol with oxytocin as adjuncts to transcervical balloons.
View details for DOI 10.1097/GCO.0000000000000608
View details for PubMedID 32004172
- Physician Work-Life Integration: Challenges and Strategies for Improvement CLINICAL OBSTETRICS AND GYNECOLOGY 2019; 62 (3): 455?65
Physician Work-Life Integration: Challenges and Strategies for Improvement.
Clinical obstetrics and gynecology
Increasing evidence shows physician well-being is linked to patient outcomes, patient and physician satisfaction, and workforce retention. Physician well-being is a broad construct that includes various dimensions of distress (stress, anxiety, fatigue, burnout) and professional fulfillment (meaning in work, engagement). Work-life integration (WLI) is one important component of physician well-being. We will review the current state of WLI among physicians as well as some strategies to improve this aspect of physician well-being. We address this topic through the lens of obstetrics and gynecology, including a discussion of specialty-specific characteristics that present unique challenges and opportunities to improve WLI.
View details for PubMedID 30950862
- Therapist Guided Exposure Treatment for Vaginismus: Simulation and Immersive Learning Applications LIPPINCOTT WILLIAMS & WILKINS. 2018: 150S