Showing 1-20 of 24 for: Essential Evidence Topics > Pregnancy and childbirth 
- Abnormal uterine bleeding
Essential Evidence Topics, 11-Nov-2022
Overall Bottom Line: For patients of reproductive age with irregular menses, order/perform a pregnancy test, thyroid-stimulating hormone (TSH) and serum prolactin levels, and an endometrial biopsy in those older than 45 years. Consider endometrial biops
- Abruptio placentae
Essential Evidence Topics, 21-Jan-2022
Overall Bottom Line: Vaginal bleeding (70%), abdominal pain (51%), blood-tinged amniotic fluid (50%), and fetal heart rate abnormalities (69%) are the most common manifestations. Definitive management should never be delayed for ultrasound evaluation be
- Breech delivery
Essential Evidence Topics, 27-Apr-2021
Overall Bottom Line: Physical examination is unreliable; ultrasound is the recommended diagnostic test for malpresentation. Planned cesarean section for a singleton term infant in persistent breech presentation decreases short-term perinatal or neonatal
- Contraception
Essential Evidence Topics, 12-Apr-2023
OVERALL BOTTOM LINE: Oral contraceptives (OCs) can be safely initially provided to patients without a pelvic or breast examination. Combined OCs are a good choice for patients who need efficacy, reversibility, and safety; they should not be used in thos
- Ectopic pregnancy
Essential Evidence Topics, 18-Aug-2021
Overall Bottom Line: History and physical findings cannot reliably exclude or confirm the diagnosis of ectopic pregnancy (EP). Use diagnostic strategies that include both pelvic ultrasound and beta-human chorionic gonadotropin (hCG) measurements to diag
- Endometritis
Essential Evidence Topics, 8-Jun-2021
Overall Bottom Line: Use of a single dose prophylactic antibiotic in women undergoing cesarean section and vaginal preparation with povidone-iodine solution immediately before cesarean delivery reduce the incidence of endometritis. For women undergoing
- Fetal alcohol syndrome
Essential Evidence Topics, 24-Sep-2021
Overall Bottom Line: Fetal alcohol syndrome (FAS) defects are permanent and may prevent affected individuals from living independently. High rates of co-morbid conditions are found in children with FAS including attention deficit hyperactivity disorder
- HELLP syndrome
Essential Evidence Topics, 1-Oct-2021
Overall Bottom Line: In any pregnant woman >20 weeks gestation with hypertension, obtain hemoglobin, hematocrit, platelets, AST, ALT, LDH, creatinine, 24-hour urine for protein and uric acid, as well as a complete fetal ultrasound and NST to evaluate f
- Hydatidiform mole
Essential Evidence Topics, 6-Jul-2021
Overall Bottom Line: The diagnosis of hydatidiform mole (HM) should be considered if a patient presents with first trimester bleeding and/or any of the following findings: previous molar pregnancy, hyperemesis, uterine size greater than dates, gestational
- Hyperemesis gravidarum
Essential Evidence Topics, 22-Feb-2023
Overall Bottom Line: Diagnose early to prevent maternal and infant morbidity; offer dietary counseling, ginger, vitamin B6, and doxylamine to women presenting with protracted nausea and vomiting of pregnancy (NVP). Many antiemetic medications are safe i
- Hyperprolactinemia
Essential Evidence Topics, 17-Oct-2019
Overall Bottom Line: Symptoms of hyperprolactinemia include galactorrhea (rare in men), amenorrhea or irregular menstruation, decreased libido, and infertility. Many patients are asymptomatic. Begin work-up by ruling out pregnancy. It is also important
- Hypertensive disorders of pregnancy, including eclampsia and preeclampsia
Essential Evidence Topics, 8-Nov-2022
Overall Bottom Line: In women at high risk for pre-eclampsia, calcium supplementation ( ), low-dose aspirin (starting after 12-weeks gestation, ), and vitamin D supplementation (in white and non obese women, ) can be considered to reduce the risk of pre
- Induction of labor
Essential Evidence Topics, 17-Apr-2022
Bottom Line: Induction of labor is indicated when the health of the mother or fetus is at risk. The Bishop score is an effective cervical assessment tool to predict induction success. ACOG endorses either a ‘low-dose’ or ‘high-dose’ intravenous oxytocin
- Management of labor
Essential Evidence Topics, 23-Jan-2023
Bottom Line: Labor is a natural process for which selected medical intervention can reduce maternal morbidity and improve fetal outcomes. Routine external fetal monitoring in labor has no benefit in terms of neonatal outcome. Epidural analgesia in lab
- Meckel's diverticulum
Essential Evidence Topics, 17-Mar-2020
Overall Bottom Line: Meckel's diverticulum occurs in 0.3% to 2.9% of the population and most often remain asymptomatic during a lifetime. Meckel's diverticulum should be considered as the source of GI bleeding in young children that is bright red to sli
- Miscarriage
Essential Evidence Topics, 8-Jun-2021
Overall Bottom Line: Miscarriage is common, occurring in 75% of women during their reproductive lives. Common presentations of miscarriage include vaginal bleeding, lack of fetal heart tones, and abdominal pain. Oral progesterone appears to be effecti
- Neonatal abstinence syndrome
Essential Evidence Topics, 13-Oct-2022
Overall Bottom Line: Almost all infants exposed to prolonged in utero opioids will demonstrate some symptoms of withdrawal, with ~50% having signs and symptoms severe enough to require pharmacologic treatment. The use of a standardized symptom assessmen
- Placenta previa and placenta accreta
Essential Evidence Topics, 3-Aug-2021
Overall Bottom Line: Obstetric ultrasound should be performed for placental localization in women who present with painless vaginal bleeding in late pregnancy. Placenta previa (placenta covers or overlaps the cervical os) diagnosed in the second trimest
- Postpartum depression
Essential Evidence Topics, 26-Aug-2021
Overall Bottom Line: The United States Preventive Services Task Force (USPSTF) recommends screening for depression for pregnant and postpartum women; screening may occur at the postpartum visit or 2-month well child check . Diagnosis is greatly improved
- Postpartum hemorrhage
Essential Evidence Topics, 6-Mar-2020
Overall Bottom Line: Active management of the third stage of labor is superior to expectant management for reducing postpartum hemorrhage (PPH) with an NNT of 12; obstetric care facilities should have guidelines for routine administration of uterotonics.
