Obstetric evidence based guidelines, 2nd edition

About the book This new edition of an acclaimed text reviews the evidence for best practice in obstetric medicine, to present the reader with the right information, with appropriate use of proven interventions and avoidance of ineffectual or harmful ones, and by rating the evidence of the key references The information is presented in the right format by summarizing evidence succinctly and clearly in tables and algorithms The aim is to inform the clinician, to reduce errors and “to make it easy to it right.” The volume can be purchased separately or together with a companion volume on Maternal-Fetal Evidence Based Guidelines (set ISBN 9781841848266) The Series in Maternal-Fetal Medicine is published in conjunction with The Journal of Maternal-Fetal and Neonatal Medicine About the editor Vincenzo Berghella, MD, FACOG Director, Division of Maternal-Fetal Medicine Professor, Dept of Obstetrics and Gynecology Jefferson Medical College of Thomas Jefferson University Philadelphia, Pennsylvania, USA This new edition of an acclaimed text reviews the evidence for best practice in obstetric medicine, to present the reader with the right information, with appropriate use of proven interventions and avoidance of ineffectual or harmful ones, and by rating the evidence of the key references The information is presented in the right format by summarizing evidence succinctly and clearly in tables and algorithms The aim is to inform the clinician, to reduce errors and “to make it easy to it right.” The volume can be purchased separately or together with a companion volume on Maternal-Fetal Evidence Based Guidelines (set ISBN 9781841848266) The Series in Maternal-Fetal Medicine is published in conjunction with The Journal of Maternal-Fetal and Neonatal Medicine About the editor Third EdiTion Maternal-Fetal Evidence Based Guidelines Second edition Obstetric Evidence Based Guidelines About the book This new edition of an acclaimed text reviews the evidence for best practice in maternal-fetal medicine, to present the reader with the right information, with appropriate use of proven interventions and avoidance of ineffectual or harmful ones, and by rating the evidence of the key references The information is presented in the right format by summarizing evidence succinctly and clearly in tables and algorithms The aim is to inform the clinician, to reduce errors and “to make it easy to it right.” The volume can be purchased separately or together with a companion volume on Obstetric Evidence Based Guidelines (set ISBN 9781841848266) The Series in Maternal-Fetal Medicine is published in conjunction with The Journal of Maternal-Fetal and Neonatal Medicine About the editor Vincenzo Berghella, MD, FACOG Director, Division of Maternal-Fetal Medicine Professor, Dept of Obstetrics and Gynecology Jefferson Medical College of Thomas Jefferson University Philadelphia, Pennsylvania, USA Vincenzo Berghella, MD, FACOG Director, Division of Maternal-Fetal Medicine Professor, Dept of Obstetrics and Gynecology Jefferson Medical College of Thomas Jefferson University Philadelphia, Pennsylvania, USA Maternal-Fetal Evidence Based Guidelines Second Edition Vincenzo Berghella Second Edition Second Edition Berghella Third EdiTion Second Edition Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature Hypertensive rupture disorders of • Cardiac disease • Obesity • Pregestational diabetes • Gestational diabetes • Hypothyroidism • Hyperthyroidism • Prolactinoma membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term • Nausea/vomiting pregnancy of pregnancy and hyperemesis gravidarum (HG) • Intrahepatic cholestasis of pregnancy • Inflammatory bowel disease • Gallbladder • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrentdisease pregnancy • Pregnancy loss • after transplantation • Maternal anemia • Sickle cell disease • Von Willebrand disease • Renal disease • Headache • Seizures • Spinal Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranescord at orinjury near •term Mood • disorders • Smoking • Drug abuse • Respiratory diseases: asthma, pneumonia, influenza, and tubercolosis • Hypertensive disorders Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta • Cardiac previa, placenta disease • Obesity • Pregestational diabetes • Gestational diabetes • Hypothyroidism • Hyperthyroidism • Prolactinoma • Nausea/vomiting of accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention pregnancy of pretermand birthhyperemesis • gravidarum (HG) • Intrahepatic cholestasis of pregnancy • Inflammatory bowel disease • Gallbladder disease • Pregnancy Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation after transplantation and • Maternal anemia • Sickle cell disease • Von Willebrand disease • Renal disease • Headache • Seizures • Spinal cord injury • Mood malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa disorders previa • Abruptio • Smoking • Drug abuse • Respiratory diseases: asthma, pneumonia, influenza, and tubercolosis • Hypertensive disorders • Cardiac disease placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture • Obesity of membranes • Pregestational • diabetes • Gestational diabetes • Hypothyroidism • Hyperthyroidism • Prolactinoma • Nausea/vomiting of pregnancy and Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia hyperemesis • Abnormal gravidarum (HG) • Intrahepatic cholestasis of pregnancy • Inflammatory bowel disease • Gallbladder disease • Pregnancy after transplantation third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum • Maternal infections anemia • The • Sickle cell disease • Von Willebrand disease • Renal disease • Headache • Seizures • Spinal cord injury • Mood disorders • Smoking neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • •Premature Drug abuse rupture • Respiratory diseases: asthma, pneumonia, influenza, and tubercolosis • Hypertensive disorders • Cardiac disease • Obesity • Pregestational of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of diabetes labor • •Post-term Gestational diabetes • Hypothyroidism • Hyperthyroidism • Prolactinoma • Nausea/vomiting of pregnancy and hyperemesis gravidarum (HG) • pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent Intrahepatic pregnancy cholestasis of pregnancy • Inflammatory bowel disease • Gallbladder disease • Pregnancy after transplantation • Maternal anemia • Sickle cell loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes disease at or •near Von term Willebrand • disease • Renal disease • Headache • Seizures • Spinal cord injury • Mood disorders • Smoking • Drug abuse • Respiratory Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta diseases: previa,asthma, placenta pneumonia, influenza, and tubercolosis • Hypertensive disorders • Cardiac disease • Obesity • Pregestational diabetes • Gestational diabetes accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention •ofHypothyroidism preterm birth • • Hyperthyroidism • Prolactinoma • Nausea/vomiting of pregnancy and hyperemesis gravidarum (HG) • Intrahepatic cholestasis of Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation pregnancy • Inflammatory and bowel disease • Gallbladder disease • Pregnancy after transplantation • Maternal anemia • Sickle cell disease • Von Willebrand Berghella malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa disease previa • Abruptio Renal disease • Headache • Seizures • Spinal cord injury • Mood disorders • Smoking • Drug abuse • Respiratory diseases: asthma, pneumonia, placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture influenza, of membranes and tubercolosis • • Hypertensive disorders • Cardiac disease • Obesity • Pregestational diabetes • Gestational diabetes • Hypothyroidism • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal• Prolactinoma • Nausea/vomiting of pregnancy and hyperemesis gravidarum (HG) • Intrahepatic cholestasis of pregnancy • Inflammatory Hyperthyroidism third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections bowel disease• •The Gallbladder disease • Pregnancy after transplantation • Maternal anemia • Sickle cell disease • Von Willebrand disease • Renal disease neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • •Premature Headacherupture • Seizures • Spinal cord injury • Mood disorders • Smoking • Drug abuse • Respiratory diseases: asthma, pneumonia, influenza, and of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of tubercolosis labor • Post-term • Hypertensive disorders • Cardiac disease • Obesity • Pregestational diabetes • Gestational diabetes • Hypothyroidism • Hyperthyroidism • pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy Prolactinoma • Nausea/vomiting of pregnancy and hyperemesis gravidarum (HG) • Intrahepatic cholestasis of pregnancy • Inflammatory bowel disease loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes or near term • • Pregnancy after transplantation • Maternal anemia • Sickle cell disease • Von Willebrand disease • Renal disease • Headache • at Gallbladder disease Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta • Seizures • Spinal cord injury • Mood disorders • Smoking • Drug abuse • Respiratory diseases: asthma, pneumonia, influenza, and tubercolosis • accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention Hypertensive of preterm birth • disorders • Cardiac disease • Obesity • Pregestational diabetes • Gestational diabetes • Hypothyroidism • Hyperthyroidism • Prolactinoma Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation and of pregnancy and hyperemesis gravidarum (HG) • Intrahepatic cholestasis of pregnancy • Inflammatory bowel disease • Gallbladder • Nausea/vomiting malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa disease previa • Abruptio Pregnancy after transplantation • Maternal anemia • Sickle cell disease • Von Willebrand disease • Renal disease • Headache • Seizures • Spinal placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture membranes • disorders • Smoking • Drug abuse • Respiratory diseases: asthma, pneumonia, influenza, and tubercolosis • Hypertensive disorders cordofinjury • Mood Edited by The book does a great job at coming to evidence-based conclusions on various spects of obstetrical care [The book] is a worthy purchase for anyone caring for the general obstetric patient Physicians in positions to create protocols and guidelines also can gain valuable insight from this book Doody’s Reviews Edited by Vincenzo Berghella Second Edition About the book Maternal-Fetal Evidence Based Guidelines Second edition Obstetric Evidence Based Guidelines Obstetric Evidence Based Guidelines Obstetric Evidence Based Guidelines is a text that will prove useful to residents and fellows as well as to practicing obstetric clinicians Furthermore, it can be used as a source for the development of hospital policies for the management of these obstetric problems The major advantage of this text is that it provides guidelines for the management of commonly encountered obstetric issues in a single book JAMA Berghella 119 Farringdon Road, London EC1R 3DA, UK 52 Vanderbilt Avenue, New York, NY 10017, USA Third Edition Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Second edition Obstetric Evidence Based Guidelines Obstetric Evidence Based Guidelines Obstetric Evidence Based Guidelines Second Edition Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupt membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term preg • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near t Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, pl accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm b Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentatio malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Ab placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membr Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abn third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature r of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Pos pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent preg loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near t Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, pl accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm b Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentatio malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Ab placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membr Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abn third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature r of membranes at or near term • Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Pos pregnancy • Placenta previa, placenta accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent preg loss • Prevention of preterm birth • Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near t Meconium • Malpresentation and malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, pl accreta and vasa previa • Abruptio placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm b Preterm premature rupture of membranes • Induction of labor • Premature rupture of membranes at or near term • Meconium • Malpresentatio malposition • Shoulder dystocia • Abnormal third stage of labor • Post-term pregnancy • Placenta previa, placenta accreta and vasa previa • Ab placentae • Postpartum infections • The neonate • Recurrent pregnancy loss • Prevention of preterm birth • Preterm premature rupture of membr Edited by Vincenzo Berghella [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Obstetric Evidence Based Guidelines [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] SERIES IN MATERNAL-FETAL MEDICINE Published in association with the Journal of Maternal-Fetal and Neonatal Medicine Editors in Chief: Gian Carlo Di Renzo and Dev Maulik Recent and Forthcoming Titles Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, second edition ISBN 9781841848228 Howard Carp, Recurrent Pregnancy Loss: Causes, Controversies and Treatment ISBN 9780415421300 Fabio Facchinetti, Gustaaf A Dekker, Dante Baronciani, George Saade, Stillbirth: Understanding and Management ISBN 9780415473903 Moshe Hod, Lois Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, second edition ISBN 9780415425606 Michael S Marsh, Lina A.M Nashef, Peter A Brex, Neurology and Pregnancy: Clinical Management ISBN 9781841846521 Simcha Yagel, Norman H Silverman, Ulrich Gembruch, Fetal Cardiology: Embryology, Genetics, Physiology, Echocardiographic Evaluation, Diagnosis and Perinatal Management of Cardiac Diseases, second edition ISBN 9780415432658 [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] Obstetric Evidence Based Guidelines Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Second Edition Edited by Vincenzo Berghella, MD, FACOG Director, Division of Maternal-Fetal Medicine Professor, Department of Obstetrics and Gynecology Jefferson Medical College of Thomas Jefferson University Philadelphia, Pennsylvania USA [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] First published in 2012 by Informa Healthcare, 119 Farringdon Road, London EC1R 3DA, UK Simultaneously published in the USA by Informa Healthcare, 52 Vanderbilt Avenue, 7th Floor, New York, NY 10017, USA Informa Healthcare is a trading division of Informa UK Ltd Registered Office: 37–41 Mortimer Street, London W1T 3JH, UK Registered in England and Wales number 1072954 # 2012 Informa Healthcare, except as otherwise indicated No claim to original U.S Government works Reprinted material is quoted with permission Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, unless with the prior written permission of the publisher or in accordance with the provisions of the Copyright, Designs and Patents Act 1988 or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP, UK, or the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA (http://www.copyright.com/ or telephone 978-750-8400) Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe This book contains information from reputable sources and although reasonable efforts have been made to publish accurate information, the publisher makes no warranties (either express or implied) as to the accuracy or fitness for a particular purpose of the information or advice contained herein The publisher wishes to make it clear that any views or opinions expressed in this book by individual authors or contributors are their personal views and opinions and not necessarily reflect the views/opinions of the publisher Any information or guidance contained in this book is intended for use solely by medical professionals strictly as a supplement to the medical professional’s own judgement, knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines Because of the rapid advances in medical science, any information or advice on dosages, procedures, or diagnoses should be independently verified This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as appropriately to advise and treat patients Save for death or personal injury caused by the publisher’s negligence and to the fullest extent otherwise permitted by law, neither the publisher nor any person engaged or employed by the publisher shall be responsible or liable for any loss, injury or damage caused to any person or property arising in any way from the use of this book A CIP record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data available on application ISBN-10: 1841848247 ISBN-13: 9781841848242 eISBN: 9781841848259 Maternal-Fetal and Obstetric Evidence Based Guidelines – Two-Volume Set, Second Edition, ISBN-10: 1841848263; ISBN-13: 978-1841848266 Orders may be sent to: Informa Healthcare, Sheepen Place, Colchester, Essex CO3 3LP, UK Telephone: +44 (0)20 7017 5540 Email: CSDhealthcarebooks@informa.com Website: http://informahealthcarebooks.com For corporate sales please contact: CorporateBooksIHC@informa.com For foreign rights please contact: RightsIHC@informa.com For reprint permissions please contact: PermissionsIHC@informa.com Typeset by MPS Ltd, Delhi Printed and bound in the United Kingdom Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] To Paola, Andrea, Pietro, mamma, and papa`, for giving me the serenity, love, and strength at home now, then, and in the future to fulfill my dreams and spend my talents as best as possible To all those who loved the first edition To the health of mothers and babies And, as I often toast: To the next generation! Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Introduction To me, pregnancy has always been the most fascinating and exciting area of interest, as care involves not one but at least two persons—the mother and the fetus—and leads to the miracle of a new life I was a third-year medical student, when, during a lecture, a resident said: ‘‘I went into obstetrics because this is the easiest medical field Pregnancy is a physiologic process, and there isn’t much to know It’s simple.’’ I knew from my ‘‘classic’’ background that ‘‘obstetrics’’ means to ‘‘stand by, stay near,’’ and that indeed pregnancy used to receive no medical support at all After over 20 years practicing obstetrics, I know now that while physiologic and at times simple, obstetrics and maternal-fetal medicine can be the most complex of the medical fields: pregnancy is based on a different physiology than for nonpregnant women, can include any medical disease, requires surgery, etc It is not so simple In fact, ignorance can kill, in this case with the health of the woman and her baby both at risk Too often I have gone to a lecture, journal club, rounds, or other didactic event to hear presented only one or a few articles regarding the subject, without the presenter reviewing the pertinent best literature and data It is increasingly difficult to read and acquire as knowledge all that is published, certainly in obstetrics, with about 3000 scientific manuscripts published monthly on this subject Some residents or even authorities would state at times that ‘‘there is no evidence’’ on a topic We indeed used to be the field with the worst use of randomized trials (1) As the best way to find something is to look for it, my coauthors and I searched for the best evidence On careful investigation, indeed there are data on almost everything we in obstetrics, especially on our interventions Indeed, our field is now the pioneer for numbers of meta-analysis and extension of work for evidence-based reviews (2) Obstetricians are now blessed with lots of data, and should make the best use of it The aims of this book are to summarize the best evidence available in the obstetrics and maternal-fetal medicine literature, and make the results of randomized trials and meta-analyses easily accessible to guide clinical care The intent is to bridge the gap between knowledge (the evidence) and its easy application To reach these goals, we reviewed all trials on effectiveness of interventions in obstetrics Millions of pregnant women have participated in thousands of properly conducted randomized controlled trials The efforts and sacrifice of mothers and their fetuses for science should be recognized at least by the physicians’ awareness and understanding of these studies Some of the trials have been summarized in over 400 Cochrane reviews, with hundreds of other meta-analyses also published in obstetrical topics (Table 1) All of the Cochrane reviews, other meta-analyses and trials in obstetrics and maternal-fetal medicine were reviewed and referenced The material presented in single trials or meta-analyses is too detailed to be readily translated to advice for the busy clinician who needs to make dozens of clinical decisions a day Even the Cochrane Library, the undiscussed leader for evidencebased medicine efforts, has been criticized for its lack of flexibility and relevance in failing to be more easily understandable and clinically readily usable (3) It is the gap between research and clinicians that needed to be filled, making sure that proven interventions are clearly highlighted and are included in today’s care Like all pilots fly planes under similar rules to maximize safety, all obstetricians should manage all aspects of pregnancy with similar, evidence-based rules Indeed only interventions that have been proven to provide benefit should be used routinely However, primum non nocere: interventions that have clearly been shown to be not helpful or indeed harmful to mother and/or baby should be avoided Another aim of the book is to make sure the pregnant woman and her unborn child are not penalized by the medical community In most circumstances, medical disorders of pregnant women can be treated as in nonpregnant adults Moreover, there are several effective interventions for preventing or treating specific pregnancy disorders [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] viii INTRODUCTION Table Obstetrical Evidence Over 400 current Cochrane reviews Hundreds of other current meta-analyses More than 1000 RCTs Millions of pregnant women randomized Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Abbreviation: RCTs, randomized controlled trials Evidence-based medicine is the concept of treating patients according to the best available evidence While George Bernard Shaw said: ‘‘I have my own opinion, not confuse me with the facts,’’ this can be a deadly approach, especially in medicine, and compromise two or more lives at the same time in obstetrics and maternal-fetal medicine What should be the basis for our interventions in medicine? Meta-analyses provide a comprehensive summary of the best research data available As such, they provide the best guidance for ‘‘effective’’ clinical care (4) It is unscientific and unethical to practice medicine or to teach or conduct research without first knowing all that has already been proven (4) In the absence of trials or meta-analyses, lower level evidence is reviewed This book aims at providing a current systematic review of the evidence, so that current practice and education, as well as future research, can be based on the full story from the best-conducted research, not just the latest data or someone’s opinion (Table 2) These evidencebased guidelines cannot be used as a ‘‘cookbook,’’ or a document dictating the best care The knowledge from the best evidence presented in the guidelines needs to be integrated with other knowledge gained from clinical judgment, individual patient circumstances, and patient preferences, to lead to best medical practice These are guidelines, not rules Even the best scientific studies are not always perfectly related to any given individual, and clinical judgment must still be applied to allow the best ‘‘particularization’’ of the best knowledge for the individual, unique patient Evidence-based medicine informs clinical judgment but does not substitute it It is important to understand though that greater clinical experience by the physician actually correlates with inferior quality of care, if not integrated with knowledge of the best evidence (5) The appropriate treatment is given in only 50% of visits to general physicians (5) At times, limitations in resources may also limit the applicability of the guidelines, but should not limit the physicians’ knowledge Guidelines and clinical pathways based on evidence not only point to the right management but can also decrease medicolegal risk (6) We aimed for brevity and clarity Suggested management of the healthy or sick mother and child is stated as straightforwardly as possible, for everyone to easily understand and implement (Table 3) If you find the Cochrane reviews, scientific Table Aims of This Book l l l l l l l l Improve the health of women and their children ‘‘Make it easy to it right’’ Implement the best clinical care based on science (evidence), not opinion Research ideas Education Develop lectures Decrease disease, use of detrimental interventions, and therefore costs Reduce medicolegal risks Table This Book Is For l l l l l l l l l l l Obstetricians Midwives Family medicine and others (practicing obstetrics) Residents Nurses Medical students MFM attendings MFM fellows Other consultants on pregnancy Lay public who wants to know ‘‘the evidence’’ Politicians responsible for health care Abbreviation: MFM, maternal-fetal medicine [ram][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/978-1-8418-48242_CH0000_O.3d] [14/2/012/16:22:13] [1–20] INTRODUCTION manuscripts, and books difficult to ‘‘translate’’ into care of your patients, this book is for you We wanted to prevent information overload However, ‘‘everything should be made as simple as possible, but not simpler’’ (A Einstein) Key management points are highlighted at the beginning of each guideline, and in bold in the text The chapters are divided into two volumes, one on obstetrics and one on maternal-fetal medicine; cross-references to chapters in Maternal-Fetal Evidence Based Guidelines have been noted in the text where applicable Please contact us (vincenzo berghella@jefferson.edu) for any comments, criticisms, corrections, missing evidence, etc I have the most fun discovering the best ways to alleviate discomfort and disease The search for the best evidence for these guidelines has been a wonderful, stimulating journey Keeping up with evidence-based medicine is exciting The most rewarding part, as a teacher, is the dissemination of knowledge I hope, truly, that this effort will be helpful to you, too Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only REFERENCES Cochrane AL 1931–1971: a critical review, with particular reference to the medical profession In: Medicines for the Year 2000 London: Office of Health Economics, 1979:1–11 [Review] Dickersin K, Manheimer E The Cochrane Collaboration: evaluation of health care and services using systematic reviews of the results of randomized controlled trials Clinic Obstet Gynecol 1998; 41:315–331 [Review] Summerskill W Cochrane Collaboration and the evolution of evidence Lancet 2005; 366:1760 [Review] Chalmers I Academia’s failure to support systematic reviews Lancet 2005; 365:469 [III] Arky RA The family business—to educate N Engl J Med 2006; 354:1922–1926 [Review] Ransom SB, Studdert DM, Dombrowski MP, et al Reduced medico-legal risk by compliance with obstetric clinical pathways: a case-control study Obstet Gynecol 2003; 101:751–755 [II-2] ix [achary][285Â214mm-Tight_Design][D:/informa_Publishing/Berghella-II_2400090/z_production/z_3B2_3d_files/ 978-1-8418-4824-2_CH0031_O.3d] [14/2/012/9:41:9] [270–274] CERVICAL CANCER SCREENING 273 Downloaded from informahealthcare.com by Yale School of Medicine on 05/17/12 For personal use only Table 31.3 Staging and Management of Cervical Cancer in Pregnancy Stage Carcinoma in situ Stage I The tumor is confined to the cervix IA Microinvasive disease, with the lesion not grossly visible: no deeper than mm and no wider than mm IA1 invasion 3 mm but