Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Index Source Type: research

Proposed Solutions for Improving Maternal Health Care in Rural America
Increasing hospital and labor & delivery (L&D) closures have led to declining access to hospital obstetric care in rural areas across the country. These closures increase the burden on women and families living in rural communities, who often must drive long distances for prenatal visits and delivery. The lack of maternal health care in rural America can also result in several adverse maternal and infant outcomes including premature birth, low birth weight, out of hospital births, maternal and infant morbidity and mortality, and increased risk of postpartum depression. The reasons for these closures are multifactorial, and...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

Need for Improved Collection and Harmonization of Rural Maternal Healthcare Data
Representation in data sets is critical to improving healthcare for the largest possible number of people. Unfortunately, pregnancy is a very understudied period of time. Further, the gap in available data is wide between pregnancies in urban areas versus rural areas. There are many limitations in the current data that is available. Herein, we review these limitations and strengths of available data sources. In addition, we propose a new mechanism to enhance the granularity, depth, and speed with which data is made available regarding rural pregnancy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

How State Perinatal Quality Collaboratives Can Improve Rural Maternity Care
Perinatal Quality Collaboratives (PQCs) are now present in nearly all states and provide important tools and strategies for improving maternal outcomes. State PQCs can focus their strengths to address rural maternal health challenges using support groups of rural hospitals, of tertiary facilities that network with them, and of other PQCs to share best practices for rural hospitals to: (1) Support networks of care and telehealth; (2) Support remote education and training; (3) Implement rural appropriate versions of National Safety Bundles; (4) Engage and support providers beyond obstetricians; and (5) Engage community membe...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

The Need for Reliable Robust Maternal Transport Program to Improve Maternal Outcomes in Rural America
There is great evidence to support improved maternal and neonatal outcomes when a patient delivers in a center that is suited to the needs of both the birthing person and the fetus. As rural centers have closed, access remains challenging. This manuscript examines The Emergency Medical Treatment and Labor Act, Emergency Medical Services (EMS) challenges, needs of rural hospitals including education, and elaborates further upon the need to expand maternal transport in rural areas to improve outcomes in the future. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

Obstetrical Readiness: Preparing Rural Emergency Departments Without Hospital-Based Obstetrical Services
In rural states, hospitals that provide birthing services are closing at an alarming rate, increasing the distance birthing people are traveling, rural Emergency Departments play a vital role in reducing maternal morbidity and mortality. An interdisciplinary education and simulation with debriefing program was created to improve the care by non-obstetric providers for routine and emergent obstetrical care. The program includes monthly lectures, hands on skills training, and in-situ interdisciplinary simulations with debriefings to build a foundation of knowledge and skill for rural Emergency Department staff statewide. (So...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

Using Simulation to Improve and Maintain Obstetrical Skills in Rural Hospitals
Rural obstetric providers have differing educational needs, compared with those in large urban settings based on challenges faced when delivering maternal health care. There are 2 groups of rural obstetric providers, those with and without previous obstetric training, which dictates for each group, differing goals for skills improvement and maintenance. Training in rural hospitals should focus on infrequent high-risk events, constrained by systems deficiencies, all which are ideally addressed with in-situ simulation. Using a mobile simulation approach, visiting each facility with a single set of high-fidelity equipment and...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

CNM/CMs Fill the Gap in Rural Maternal Care
The United States is in the midst of a maternity care crisis. A key driver is workforce shortages, which impacts maternity care service delivery in rural areas significantly. The midwifery model of care remains underutilized. Midwifery care delivered by certified nurse-midwives and certified midwives is heavily endorsed and supported in the extant literature, but no firm national actions have been taken to move recommendations into funding or practice. Certified nurse-midwives and Certified Midwives are able to care for low-risk pregnancies and are uniquely situated to address factors associated with social determinants of...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

The Role of the Family Physician in Rural Maternity Care
Of the 28 million rural women of reproductive age in the United States, ∼7 million of them live in areas of limited access to maternity care. While only 6.7% of Family Physicians currently provide maternity care, they are the only delivering physicians in 27% of rural hospitals. Of the 1.6% of Family Physicians performing cesarean deliveries as a primary surgeon, 57.3% do so in a rural county and 38.6% do so in a county without an obstetrician. Cultivation of the next generation of Family Physicians providing maternity care is essential to prevent further spread of existing maternity care deserts. (Source: Clinical Obste...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

Rural Maternal Health Care Outcomes, Drivers, and Patient Perspectives
Rural communities are a vital segment of the US population; however, these communities are shrinking, and their population is aging. Rural women experience health disparities including increased risk of maternal morbidity and mortality. In this article, we will explore these trends and their determinants both within and external to the health care system. Health care providers, public health professionals, and policymakers should be aware of these social and structural factors that influence health outcomes and take action to reduce generational cycles of health disparity. Opportunities to improve the health and pregnancy ...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

Foreword: Maternity Care in Rural America
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Maternity Care in Rural America Source Type: research

Contributors: Maternity Care in Rural America
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Contributors: Gene Therapy in Obstetrics Source Type: research

Persistent Pelvic Pain in Patients With Endometriosis
As our understanding of chronic pain conditions, including endometriosis-related pain and chronic pelvic pain evolves, the evaluation and management of patients should reflect our increasing appreciation of the role of central sensitization, comorbid conditions and biopsychosocial factors on the pain experience and treatment outcomes. This review provides a systematic approach to persistent pain in patients with endometriosis. Expanding the evaluation and treatment of endometriosis-related pain by all health care providers could limit unnecessary surgical interventions and best meet our patient’s needs. (Source: Clinical...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Controversies in Gynecology Source Type: research

Laser Therapy for Recalcitrant Vulvar Lichen Sclerosus: A Review of the Literature
Vulvar lichen sclerosus (LS) is a chronic vulvar dermatosis potentially impacting quality of life and sexual function. While most women with LS respond to topical corticosteroids and/or calcineurin inhibitors, some require additional therapy. Systemic therapies have been used successfully in oral and vulvovaginal lichen planus with minimal data in the setting of LS. Likewise, while vaginal laser therapy has shown potential benefit for genitourinary syndrome of menopause, there is a paucity of data in the setting of LS. We review retrospective and prospective studies along with randomized controlled trials utilizing vulvova...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Controversies in Gynecology Source Type: research

Management of Menstruation in Transgender and Gender Nonbinary Adolescents
A growing number of adolescents in the United States identify as transgender and gender nonbinary, and many will seek medical management of menstruation. In this evidence-based review, we recommend a model of gender-affirming care grounded in the tenants of reproductive justice, emphasizing patient autonomy and the development of holistic management plans centered around the patient’s unique goals for affirming their gender identity. We then review strategies for achieving menstruation suppression for transgender and gender nonbinary adolescents, including dosing considerations, menstruation, ovulation, contraceptive eff...
Source: Clinical Obstetrics and Gynecology - October 19, 2022 Category: OBGYN Tags: Controversies in Gynecology Source Type: research