Systematic approaches to adverse events in obstetrics, Part II: Event analysis and response
This article reviews the important tasks that should be familiar to any team approaching a serious event on an obstetrics unit. Root cause analysis is a critical, but often misunderstood, tool for dissecting the contributing factors leading to an adverse event. Successful root cause analyses have a standardized approach that result in meaningful action plans. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 22, 2017 Category: Perinatology & Neonatology Authors: Christian M. Pettker Source Type: research
Genetic approach to ambiguous genitalia and disorders of sex development: What clinicians need to know
Genetic tools such as microarray and next-generation sequencing have initiated a new era for the diagnosis and management of patients with disorders of sex development (DSDs). These tools supplement the traditional approach to the evaluation and care of infants, children, and adolescents with DSDs. These tests can detect genetic variations known to be associated with DSDs, discover novel genetic variants, and elucidate novel mechanisms of gene regulation. Herein, we discuss these tests and their role in the management of patients with DSDs. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 22, 2017 Category: Perinatology & Neonatology Authors: Svetlana A. Yatsenko, Selma Feldman Witchel Source Type: research
Restoring normal anatomy in female patients with atypical genitalia
Female patients with congenital adrenal hyperplasia (CAH) have varying degrees of atypical genitalia secondary to prenatal and postnatal androgen exposure. Surgical treatment is focused on restoring normal genitalia anatomy by bringing the vagina to the normal position on the perineum, separating the distal vagina from the urethra, forming a normal introitus and preserving sexual function of the clitoris by accepting moderate degrees of hypertrophy as normal and strategically reducing clitoral size only in the most severely virilized patients. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 20, 2017 Category: Perinatology & Neonatology Authors: Laurence S. Baskin Source Type: research
Pragmatic approach to intersex, including genital ambiguity, in the newborn
The evaluation and management of a newborn with ambiguous genitalia must be undertaken as quickly as possible and with great sensitivity for the child ’s family. Where possible, a comprehensive team approach with a pediatric urologist, endocrinologist, geneticist, neonatologist, and child psychiatrist/psychologist should work closely with the family to establish the diagnosis and determine gender. Although the preferred gender assignment is not always clear, a thorough examination of endocrine function, karyotype, and potential for fertility should guide the determination. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 20, 2017 Category: Perinatology & Neonatology Authors: Kanthi Bangalore Krishna, Christopher P. Houk, Peter A. Lee Source Type: research
Gender identity outcomes in children with disorders/differences of sex development: Predictive factors
Disorders/differences of sex development (DSD) comprise multiple congenital conditions in which chromosomal, gonadal, and/or anatomical sex are discordant. The prediction of future gender identity (i.e., self-identifying as male, female, or other) in children with DSD can be imprecise, and current knowledge about the development of gender identity in people with, and without DSD, is limited. However, sex of rearing is the strongest predictor of gender identity for the majority of individuals with various DSD conditions. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 3, 2017 Category: Perinatology & Neonatology Authors: Dana M. Bakula, Alexandria J. Mullins, Christina M. Sharkey, Cortney Wolfe-Christensen, Larry L. Mullins, Amy B. Wisniewski Source Type: research
Legal, ethical, and human rights considerations for physicians treating children with atypical or ambiguous genitalia
Some governments, human rights organizations, intersex organizations, and doctors have called for a moratorium on genital and gonadal surgeries for infants born with atypical or ambiguous genitalia. Moratorium supporters believe that the surgeries carry physical and emotional risks, the psychosocial benefits of these procedures have not been proven, and the surgeries violate the patients ׳ fundamental human rights if they are performed before these patients can provide informed consent. Given these calls for a moratorium, treatment teams must determine how to treat their patients and how to counsel their patients׳ parent...
Source: Seminars in Perinatology - May 3, 2017 Category: Perinatology & Neonatology Authors: Julie A. Greenberg Source Type: research
Fluidity models in ancient Greece and current practices of sex assignment
Disorders of sexual differentiation such as androgen insensitivity and gonadal dysgenesis can involve an intrinsic fluidity at different levels, from the anatomical and biological to the social (gender) that must be considered in the context of social constraints. Sex assignment models based on George Engel ’s biopsychosocial aspects model of biology accept fluidity of gender as a central concept and therefore help establish expectations within the uncertainty of sex assignment and anticipate potential changes. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - May 3, 2017 Category: Perinatology & Neonatology Authors: Min-Jye Chen, Bonnie McCann-Crosby, Sheila Gunn, Paraskevi Georgiadis, Frank Placencia, David Mann, Marni Axelrad, L.P Karaviti, Laurence B. McCullough Source Type: research
Update on the surgical approach for reconstruction of the male genitalia
The majority of patients with DSD will be found to carry an XY karyotype and be assigned male gender. From a phenotypical standpoint, most will present with proximal hypospadias ± cryptorchidism. In this review article, the authors present the current status of reconstruction of the male genitalia in this setting. The report addresses the following topics: surgical input in the evaluation of the newborn with an undervirilized external genitalia, including gender assignment considerations; controversies surrounding timing and indication for hypospadias surgery in proximal cases as well as use of testosterone; surgical tech...
Source: Seminars in Perinatology - May 3, 2017 Category: Perinatology & Neonatology Authors: Rodrigo L.P. Romao, Joao L. Pippi Salle Source Type: research
Maternal early warning systems —Towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness
Despite increasing awareness of obstetric safety initiatives, maternal mortality and severe maternal morbidity in the United States have continued to increase over the past 20 years. Since results from large-scale surveillance programs suggest that up to 50% of maternal deaths may be preventable, new efforts are focused on developing and testing early warning systems for the obstetric population. Early warning systems are a set of specific clinical signs or symptoms that trigger the awareness of risk and an urgent patient evaluation, with the goal of reducing severe morbidity and mortality through timely diagnosis and trea...
Source: Seminars in Perinatology - April 14, 2017 Category: Perinatology & Neonatology Authors: Lisa C. Zuckerwise, Heather S. Lipkind Source Type: research
Introduction
First, do no harm. This is a simple, primary promise physicians give when they begin their careers. Yet, this message has often become lost in the more obvious mission of healthcare: to cure, restore health, and alleviate suffering. This is especially evident as we consider how advanced, complex, and effective medical care in the 21st century has become. An early proponent of the patient safety movement, Sir Cyril Chantler, has said it best: “Medicine used to be simple, ineffective, and relatively safe. (Source: Seminars in Perinatology)
Source: Seminars in Perinatology - April 13, 2017 Category: Perinatology & Neonatology Authors: Christian M. Pettker, Munish Gupta Source Type: research
Central line-associated bloodstream infections in the NICU: Successes and controversies in the quest for zero
Central line-associated bloodstream infections (CLABSI) are among the most common healthcare-acquired infections in the neonatal intensive care unit (NICU) population and are associated with an increased risk of morbidity and mortality, as well as increased healthcare costs, and duration of hospitalization. Over the past decade, numerous local, statewide, and national quality improvement initiatives have resulted in a significant reduction in CLABSI rates. The majority of successful initiatives have utilized similar strategies to implement and sustain their efforts, including education of NICU staff in the principles of qu...
Source: Seminars in Perinatology - April 13, 2017 Category: Perinatology & Neonatology Authors: Ren ée E. Mobley, Matthew J. Bizzarro Source Type: research
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Source: Seminars in Perinatology - March 1, 2017 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - March 1, 2017 Category: Perinatology & Neonatology Source Type: research
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Source: Seminars in Perinatology - March 1, 2017 Category: Perinatology & Neonatology Source Type: research
