Abstract:
:We provide a justification for preventive ethics in obstetric practice. Four clinical guides to resolving ethical conflicts between pregnant women and their physicians can be identified: (1) informed consent as an ongoing dialogue between the pregnant woman and her physician, (2) negotiation as a clinical strategy, (3) respectful persuasion as a clinical strategy, and (4) the proper use of ethics committees. :The authors do not universally respect maternal autonomy in receiving obstetric care as an absolute ethical principle. In cases where a fetus' life may be saved through obstetric intervention, the paper provides ethical alternatives in support of avoiding and preventing patient-physician conflict over intervention in decision-making. Obstetrician-maternal dialogue may instead by proactive as both parties envision and discuss potential ethical conflicts in practice before they arise rather than waiting until a reactive approach becomes necessary. The authors identify 4 clinical guides for resolving ethical conflicts between pregnant women and their physicians including informed consent as an ongoing dialogue between both parties, negotiation as a clinical strategy, respectful persuasion as a clinical strategy, and the use of ethics committees. These proactive formats are advantageous due to their focus upon similarities and differences in values and beliefs rather than upon specific decisions, their reducing effect upon emotional stress and ethical risks, and the attention placed upon matters of significant consequence to both parties. Moreover, the need to resort to court orders should diminish with the increased possibility of detecting irreconcilable value-based differences early in the patient-physician relationship, allowing time to end in the relationship if so concluded by either or both parties.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Chervenak FA,McCullough LBdoi
10.1016/0002-9378(90)90374-gsubject
Has Abstractpub_date
1990-02-01 00:00:00pages
303-7issue
2eissn
0002-9378issn
1097-6868pii
0002-9378(90)90374-Gjournal_volume
162pub_type
杂志文章abstract:OBJECTIVE:This study was undertaken to determine whether the frequency of fetal surveillance could be safely reduced from twice weekly to fortnightly in the case of small-for-gestational-age fetuses with normal results of umbilical artery Doppler velocimetry studies. STUDY DESIGN:Pregnant women between 24 and 36 weeks...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9378(00)70494-7
更新日期:2000-01-01 00:00:00
abstract::We investigated the appearance of pulmonary lamellar bodies (LBs) in human amniotic fluid as a function of fetal age. We also studied their relationship to the lecithin/sphingomyelin (L/S) ratio and to the results of the rapid surfactant test (RST). LBs observed in amniotic fluid generally ranged in diameter from 1.5 ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90565-7
更新日期:1980-01-01 00:00:00
abstract::The intrauterine pressure data obtained from oxytocin-treated patients in dysfunctional labor, managed by a specific oxytocin regimen and a computer-defined goal of uterine activity, are analyzed. Questions asked concern the efficacy of the computer diagnosis of hypocontractility, the quantity of uterine activity need...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)91189-4
更新日期:1983-03-01 00:00:00
abstract::Sponsored by the nonprofit Berlex Foundation, this 6-day Faculty Development Course introduces small groups of new faculty to research design, critical appraisal of the literature, scientific writing, and evidence-based medicine. The course includes didactic presentations, small group discussions, and individual proto...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1067/mob.2000.107381
更新日期:2000-10-01 00:00:00
abstract::A case of primary hypothyroidism associated with postpartum galactorrhea-amenorrhea is reported. The configuration of the sella was compatible with pituitary adenoma, but prolactin dynamics did not support an autonomous secretory state. Replacement therapy with thyroxine led to complete reversal of clinical, radiologi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)33129-5
更新日期:1978-08-15 00:00:00
abstract:OBJECTIVE:This study was undertaken to investigate the involvement of maternal and infant B vitamins and homocysteine as risk factors for orofacial clefting. STUDY DESIGN:Venous blood samples were taken from 96 infants with nonsyndromic orofacial clefts and 88 infants without a congenital malformation and from their m...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/s0002-9378(03)00592-1
更新日期:2003-10-01 00:00:00
abstract::In an evaluation of the limulus lysate assay (LLA) as a method for detecting gonococcal endotoxin in cervical exudates diluted 1:800, positive LLA results were obtained from 17 of 18 patients (94%) with culture-proved gonococcal cervicitis, and negative results were obtained from 22 of 22 patients (100%) with culture-...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90702-4
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVE:The objectives of this study were to determine whether insulin autoantibodies are present in umbilical cord blood from normal pregnancies, determine whether cord blood insulin autoantibody levels correlate with respective maternal levels at delivery, determine whether cord blood insulin autoantibody levels ar...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90445-x
更新日期:1995-12-01 00:00:00
abstract:OBJECTIVE:In 1994, the National Institutes of Health recommended a full course of antenatal corticosteroids (ACS) to women who were at risk of delivery at 24-32 weeks of gestation. In 2010, the Joint Commission on Accreditation of Healthcare Organization incorporated ACS administration rates as a perinatal core quality...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2013.09.024
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:Our purpose was to investigate levels of fetal fibronectin in maternal plasma, amniotic fluid, and umbilical cord plasma from patients with severe preeclampsia. STUDY DESIGN:The study group comprised 20 patients with severe preeclampsia (group A). An antepartum comparison group was composed of 20 healthy pat...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(95)90587-1
更新日期:1995-02-01 00:00:00
abstract:OBJECTIVE:Our purpose was to review our results of multimodality treatment of lymph node metastasis in endometrial cancer (stage IIIC). STUDY DESIGN:All patients underwent surgical staging for endometrial cancer with complete pelvic and aortic lymphadenectomy. All macroscopic nodal metastases were resected. Patients w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.115225
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:Clinically based anxiety questionnaires measure 2 forms of anxiety that are known as state anxiety and trait anxiety. State anxiety is temporary and is sensitive to change; trait anxiety is a generalized propensity to be anxious. OBJECTIVE:Our study aims to characterize the reasons for anxiety among women a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.06.001
更新日期:2019-11-01 00:00:00
abstract::The effects of prolonged mild hypoxemia on the fetus have received little attention. We investigated the response to a decrease in fetal arterial Po2 of 5 mm Hg or less sustained for a period of 24 hours in the chronically instrumented fetal lamb. Hypoxemia was induced by an infusion of nitrogen via the maternal trach...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(87)80261-2
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVE:An infrequent clinical dilemma arises when a patient with uterine prolapse that is best treated vaginally is discovered to have coexisting endometrial cancer. Often the underlying cancer is only discovered intraoperatively or postoperatively. We have reviewed our experience in this situation in an effort to e...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/0002-9378(95)91399-8
更新日期:1995-06-01 00:00:00
abstract::This study was undertaken to evaluate the catecholamine response of the fetal rat to insulin-induced hypoglycemia in the mother. Twenty-four Sprague-Dawley rats at day 21 of gestation were used. Hypoglycemia was induced with regular insulin; then at timed intervals, the rats were anesthetized with pentobarbital. When ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(81)90317-3
更新日期:1981-02-15 00:00:00
abstract:BACKGROUND:Early spontaneous preterm delivery is often associated with microbial invasion of the amniotic cavity and/or intraamniotic inflammation. OBJECTIVE:The objective of the study was to develop and validate clinically feasible multivariable prediction models of spontaneous delivery within 7 days and microbial in...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2020.02.049
更新日期:2020-09-01 00:00:00
abstract::Report of a study of Rh antibody titers in the amniotic fluids from 42 Rh-negative sensitized pregnancies is presented. Amniocentesis was performed in the pregnant Rh-negative women having serum Rh antibody titers (indirect Coombs) ranging from 1/64 to 1/4,096. Spectrophotometric analysis was done on the antiRh-D ti...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:
更新日期:1969-12-15 00:00:00
abstract::With the "double PG impact" (DPGI) technique in 100 sedated first- and second-trimester volunteers, pregnancy was terminated successfully in 99 with a total extraovular PGF2alpha dose of 19.0 +/- 1.5 mg. in 16.9 +/- 0.9 hours. Two thirds of the patients received only the initial dose of 11.6 +/- 0.5 mg. of PG and abor...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90002-8
更新日期:1976-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes mellitus (GDM) and maternal and perinatal outcomes. STUDY DESIGN:We conducted a secondary analysis of a multicenter randomized treatment trial of mild GDM in whic...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ajog.2015.06.022
更新日期:2015-10-01 00:00:00
abstract::Epidermal inclusion cysts are a late complication of female genital circumcision, which is a practice that affects 125 million women primarily from Africa and the Middle East. A 30-year-old woman, gravida 4, para 1, presented to our clinic with an 8-year history of a slowly enlarging periclitoral mass. The patient had...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.03.026
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the impact of substance use and psychotherapeutic medications on menstrual characteristics in women who are human immunodeficiency virus seropositive and seronegative. STUDY DESIGN:Menstrual calendars were prospectively collected for 1075 women who were human immunod...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2003.209
更新日期:2003-04-01 00:00:00
abstract::Abnormal uterine bleeding is often the presenting complaint in women with underlying coagulopathies. A clear understanding of the pathophysiology of common bleeding disorders will help the practicing obstetrician/gynecologist in the diagnosis and treatment of these conditions. The normal hemostatic process can be divi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(96)80083-4
更新日期:1996-09-01 00:00:00
abstract::Botulinum toxin A is the newest therapy for the treatment of a variety of medical disorders caused by abnormalities of muscle activity. After successful use in other medical subspecialties, the newest applications of this potent neurotoxin are within the lower urinary tract. The toxin has evolved from a cause of fatal...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.ajog.2006.03.108
更新日期:2007-01-01 00:00:00
abstract::An abnormal result of an umbilical artery Doppler study reflects the presence of placental vascular pathologic mechanisms and identifies pregnancies at increased risk for perinatal mortality. Recent reviews of the clinical utility of umbilical artery Doppler study have concluded that it should not be routinely used as...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1016/s0002-9378(96)70365-4
更新日期:1996-01-01 00:00:00
abstract::Vitamin D is an essential fat soluble vitamin and a key modulator of calcium metabolism in children and adults. Because calcium demands increase in the third trimester of pregnancy, vitamin D status becomes crucial for maternal health, fetal skeletal growth, and optimal maternal and fetal outcomes. Vitamin D deficienc...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2009.09.002
更新日期:2010-05-01 00:00:00
abstract::To determine whether anesthesia lowers fetal oxygen consumption, sodium pentobarbital (10 mg/kg) was given intravenously to seven chronically instrumented pregnant ewes (123 to 144 days' gestation). Oxygen consumption fell by 23% in association with a rise in fetal vascular PO2. Fetal breathing movements were abolishe...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90628-9
更新日期:1986-03-01 00:00:00
abstract:OBJECTIVE:Circulating adrenomedullin is increased in pregnancy, and placental and fetal membranes participate significantly in its secretion. Recent studies have suggested a potential role for this peptide in the regulation of fetoplacental circulation and placental hormonal secretion. Because adrenomedullin acts also ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2001.117189
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVE:This study is a survey of the determinants of refractoriness to the pressor effects of angiotensin II during normal pregnancy. STUDY DESIGN:In 25 normal pregnant women, the effective angiotensin II pressor dose was determined 88 times from the twenty-fifth to the thirty-second week of gestation. Immediately ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)90617-6
更新日期:1992-04-01 00:00:00
abstract::Based on ultrasonographic mensuration, a number of equations have previously been devised for the purpose of estimating fetal weights. The objective of this study was to develop a mathematical equation that is simple, accurate, and easy to use when applied to preterm or low-birth weight fetuses (less than 2,500 gm). R...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)91195-x
更新日期:1983-03-01 00:00:00
abstract:BACKGROUND:Data regarding pregnancy outcomes in sickle cell disease are conflicting. Previous studies are limited by small sample size, narrow geographic area, and a wide range of resource availability. OBJECTIVE:The purpose of this study was to examine the association between maternal sickle cell disease and adverse ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.05.032
更新日期:2016-10-01 00:00:00