Introducing evidence-based medicine into a department of obstetrics and gynecology.


:Evidence-based medicine, the new practice paradigm, is rapidly replacing medicine by authority, the traditional paradigm. In 1993, we introduced evidence-based practice into our Department of Obstetrics, Gynecology, and Reproductive Sciences at San Francisco General Hospital, University of California, San Francisco. We orient all fellows, residents, and students to new methods of clinical decision making that use formal rules of evidence. We changed the format of clinical conferences from didactic lectures to clinical problem-solving sessions using the evidence-based medicine approach. Useful resources include the Cochrane Pregnancy and Childbirth Database on computer; Epi Info, version 6, a public-domain software package for microcomputers; 24-hour access to free MEDLINE searches via the Internet; the ACOG Resource Center; ACOGNET; and several paperback texts on critical appraisal. Evidence-based medicine helps to level the intellectual playing field in an academic department. This approach directly improves patient care by placing practice on a more secure scientific foundation. Moreover, evidence-based medicine provides clinicians with the skills to practice safe and effective obstetrics and gynecology as practice evolves.


Obstet Gynecol


Grimes DA




Has Abstract


1995-09-01 00:00:00














  • Titrated oral compared with vaginal misoprostol for labor induction: a randomized controlled trial.

    abstract:OBJECTIVE:To compare the efficacy and safety of titrated oral misoprostol and vaginal misoprostol for labor induction. METHODS:Women between 34 and 42 weeks of gestation with an unfavorable cervix (Bishop score less than or equal to 6) and an indication for labor induction were randomLy assigned to receive titrated or...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,随机对照试验


    authors: Cheng SY,Ming H,Lee JC

    更新日期:2008-01-01 00:00:00

  • Serum 17 alpha-hydroxyprogesterone in patients with gestational trophoblastic neoplasms.

    abstract::Serum 17alpha-hydroxprogesterone (17-OHP), progesterone (P), and human chorionic gonadotropin (hCG) levels were measured by specific radioimmunoassay in 19 patients undergoing laparoscopy or laparotomy with either unevacuated molar pregnancy or nonmetastatic gestational trophoblastic neoplasms (GTN), in 10 normal preg...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Osathanondh R,Goldstein DP,Tulchinsky D,Finn AE

    更新日期:1977-01-01 00:00:00

  • Transvaginal endometrial sonography in postmenopausal women taking tamoxifen.

    abstract:OBJECTIVE:To evaluate sonographic measurements of endometrial thickness in postmenopausal women taking adjuvant tamoxifen therapy for breast cancer, and to correlate sonographic and pathologic findings to symptoms and duration of tamoxifen therapy. METHODS:Medical records and sonograms of 80 postmenopausal women treat...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Tesoro MR,Borgida AF,MacLaurin NA,Asuncion CM

    更新日期:1999-03-01 00:00:00

  • Relationship of ultrasound findings after cesarean section to operative morbidity.

    abstract::Postcesarean section febrile morbidity remains a common problem on obstetric services. Although a few preliminary studies have reported on the use of ultrasound to assess the postcesarean section patient, they have not compared sonographic findings with either intraoperative or postoperative events. These reports have...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Faustin D,Minkoff H,Schaffer R,Crombleholme W,Schwarz R

    更新日期:1985-08-01 00:00:00

  • Stripping of membranes as a safe method to reduce prolonged pregnancies.

    abstract:OBJECTIVE:To evaluate weekly stripping of membranes at term to determine its safety and effectiveness in reducing the incidence of prolonged and postterm pregnancies. METHODS:One hundred forty-two pregnant women with certain gestational dates were randomly selected to receive, starting at 38 weeks, either weekly strip...

    journal_title:Obstetrics and gynecology

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Berghella V,Rogers RA,Lescale K

    更新日期:1996-06-01 00:00:00

  • Splenic artery aneurysm rupture: the seventh instance of maternal and fetal survival.

    abstract::Rupture of a splenic artery aneurysm is an uncommon occurrence but carries a high maternal and fetal mortality rate. This article presents the seventh case of both maternal and fetal survival and discusses some features salient to spontaneous rupture of a splenic artery aneurysm. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Lowry SM,O'Dea TP,Gallagher DI,Mozenter R

    更新日期:1986-02-01 00:00:00

  • Bias in the Peer Review Process: Can We Do Better?

    abstract::Peer review is the major method used by the scientific community to evaluate manuscripts and decide what is suitable for publication. However, this process in its current design is not bulletproof and is prone to reviewer and editorial bias. Its lack of objectivity and transparency raise concerns that manuscripts migh...

    journal_title:Obstetrics and gynecology

    pub_type: 社论


    authors: Tvina A,Spellecy R,Palatnik A

    更新日期:2019-06-01 00:00:00

  • Sickle-delta beta thalassemia: mild sickling disorder with serious morbidity in pregnancy.

    abstract::Two patients with sickle-delta gamma thalassemia are reported who experienced the typical complications of sickling disorders in the last 2 months of 4 pregnancies. The diagnosis, genetics, and management of pregnancy in this rare hematologic disease, which causes minimal morbidity in the nonpregnant woman, are discus...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Cohen AW,Russell MO,Mennuti MT

    更新日期:1981-07-01 00:00:00

  • Cervical adenosquamous carcinoma: tumor implantation in an episiotomy scar.

    abstract:BACKGROUND:We report a rare case of a cervical adenosquamous carcinoma, initially diagnosed during delivery, with subsequent implantation in the episiotomy scar 5 weeks postpartum. CASE:A 35-year-old woman with cervical adenosquamous carcinoma diagnosed during delivery was treated with radical abdominal hysterectomy w...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Neumann G,Rasmussen KL,Petersen LK

    更新日期:2007-08-01 00:00:00

  • Antipsychotics leading to neuroleptic malignant syndrome in pregnancy.

    abstract:BACKGROUND:Neuroleptic malignant syndrome (NMS) is characterized by a tetrad of mental status changes, extrapyramidal symptoms, hyperpyrexia, and autonomic instability and can develop after the use of antipsychotics. CASE:A young, multiparous woman presented at 26 weeks of gestation with acute psychosis and was treate...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Ghaffari N,Dossett E,Lee RH,Aghajanian P

    更新日期:2012-02-01 00:00:00

  • Pulsion enterocele: long-term results of an abdominoperineal technique.

    abstract::Surgical correction of large pulsion enterocele is a contentious subject and until a technique is founded upon proper anatomic facts, the arguments will continue. Pulsion enterocele follows changes in the pelvic cellular tissues and levator ani complex; both defects must be corrected. Synchronous abdominoperineal repa...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Zacharin RF,Hamilton NT

    更新日期:1980-02-01 00:00:00

  • Transabdominal cerclage: a laparoscopic approach.

    abstract:BACKGROUND:The placement of a transabdominal cervical cerclage has been regarded as considerably more morbid than a transvaginal cerclage, in part due to the need for two laparotomies. We describe a technique for the laparoscopic placement and removal of a transabdominal cerclage. CASES:Two cases of women with insuffi...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Lesser KB,Childers JM,Surwit EA

    更新日期:1998-05-01 00:00:00

  • Vaginal Microbiome and Its Relationship to Behavior, Sexual Health, and Sexually Transmitted Diseases.

    abstract::The vaginal microbiota has great significance in maintaining vaginal health and protecting the host from disease. Recent advances in molecular techniques and informatics allow researchers to explore microbial composition in detail and to compare the structure of vaginal microbial communities with behavior and health o...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审


    authors: Lewis FMT,Bernstein KT,Aral SO

    更新日期:2017-04-01 00:00:00

  • Urinary retention secondary to a Gartner's duct cyst.

    abstract::A 22-month-old child with a large cyst of Gartner's duct suffered from recurrent episodes of urinary retention. Excision of such large symptomatic cysts has been recommended in the past. Marsupialization is discussed as an alternative to extensive excision. ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Muram D,Jerkins GR

    更新日期:1988-09-01 00:00:00

  • Histomorphometric changes in the skeleton of postmenopausal women with low bone mineral density treated with percutaneous estradiol implants.

    abstract:OBJECTIVE:To identify the effects of percutaneous estradiol (E2) implants on bone histology and bone mass of postmenopausal women with low bone mineral density. METHODS:Sixteen postmenopausal women with low bone mineral density were treated with 75-mg E2 implants. Each had iliac crest bone biopsies performed, followin...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Holland EF,Chow JW,Studd JW,Leather AT,Chambers TJ

    更新日期:1994-03-01 00:00:00

  • Fetal biometry as a screening tool for the detection of chromosomally abnormal pregnancies.

    abstract::Recent studies suggest that fetal biometry may allow recognition of pregnancies at risk for Down syndrome. Second-trimester biparietal diameter (BPD)/femur length and observed-to-expected femur length ratios were examined in 48 chromosomally abnormal fetuses and compared with those of a control population composed of ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Dicke JM,Gray DL,Songster GS,Crane JP

    更新日期:1989-11-01 00:00:00

  • Biophysical profile scoring in the management of the diabetic pregnancy.

    abstract::Biophysical profile scoring was the principal technique of antepartum fetal surveillance in 238 well-controlled diabetic pregnancies. Fifty insulin-dependent diabetics had twice-weekly testing, and 188 gestational diabetics had weekly testing. Intervention was not pursued unless there were maternal or fetal complicati...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Johnson JM,Lange IR,Harman CR,Torchia MG,Manning FA

    更新日期:1988-12-01 00:00:00

  • Presumed diagnosis of ectopic pregnancy.

    abstract:OBJECTIVE:To evaluate the accuracy of the diagnosis of presumed ectopic pregnancy. METHODS:This was a retrospective cohort analysis at a tertiary care medical center. The patient population was composed of 1) clinically stable pregnant women with human chorionic gonadotropin (hCG) above 2000 mIU/mL and no evidence of ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Barnhart KT,Katz I,Hummel A,Gracia CR

    更新日期:2002-09-01 00:00:00

  • Gonococcemia in pregnancy.

    abstract::A case of gonococcemia in pregnancy in which the patient presented with the classic clinical manifestations of gonococcemia--cutaneous lesions, arthritis, and possibly pericarditis--is reported. A review of the literature reveals a dramatic increase in incidence of gonorrhea and the increasing importance of the compli...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Watring WG,Vaughn DL

    更新日期:1976-10-01 00:00:00

  • High rates of atypical cervical cytology: occurrence and clinical significance.

    abstract::The current literature suggests that atypical (benign atypia or class II) Papanicolaou smears occur at a frequency of 1.6-5.4% and are associated with a substantial rate of underlying cervical dysplasia. However, we noted that our rate of atypia exceeded these figures, particularly in our clinic population. To quantif...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Pearlstone AC,Grigsby PW,Mutch DG

    更新日期:1992-08-01 00:00:00

  • Peak expiratory flow rate in normal pregnancy.

    abstract:OBJECTIVE:To determine whether peak expiratory flow rate changes with pregnancy and advancing gestation. METHODS:We measured the peak expiratory flow rate in 57 women during each trimester of pregnancy and postpartum. During four visits, all subjects exhaled forcefully three times into a peak flow meter. For each visi...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Brancazio LR,Laifer SA,Schwartz T

    更新日期:1997-03-01 00:00:00

  • Committee Opinion No. 692: Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period.

    abstract::Acute-onset, severe systolic hypertension; severe diastolic hypertension; or both can occur during the prenatal, intrapartum, or postpartum periods. Pregnant women or women in the postpartum period with acute-onset, severe systolic hypertension; severe diastolic hypertension; or both require urgent antihypertensive th...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,实务指引


    authors: Committee on Obstetric Practice.

    更新日期:2017-04-01 00:00:00

  • Committee Opinion No. 655: Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus Infections in Obstetrician-Gynecologists.

    abstract::To prevent transmission of bloodborne pathogens, it is important that health care providers adhere to standard precautions, follow fundamental infection-control principles, and use appropriate procedural techniques. All obstetrician-gynecologists who provide clinical care should receive the hepatitis B virus vaccine s...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: American College of Obstetricians and Gynecologists' Committee on Gynecological Practice.

    更新日期:2016-02-01 00:00:00

  • Correlation of nonstressed fetal heart rate with sequential contraction stress test.

    abstract::Two hundred seven high-risk patients were studied prospectively by standardized nonstressed fetal heart rate monitoring followed immediately by contraction stress testing (CST). Of the 604 combined procedures examined, 90.2% of nonstress tests (NST) were interpreted as reactive; none was associated with a positive CST...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Gibbons JM Jr,Nagle P

    更新日期:1980-05-01 00:00:00

  • Chorioamnionitis and cerebral palsy: a meta-analysis.

    abstract:OBJECTIVE:To examine the relationships between clinical or histological chorioamnionitis and cerebral palsy using a meta-analysis approach. DATA SOURCES:A systematic review of the literature appeared in PubMed between 2000 and 2009 was conducted using the search terms "cerebral palsy" and "infection," with broad-scope...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,meta分析,评审


    authors: Shatrov JG,Birch SCM,Lam LT,Quinlivan JA,McIntyre S,Mendz GL

    更新日期:2010-08-01 00:00:00

  • Treatment of ectopic pregnancy by transvaginal intratubal methotrexate administration.

    abstract::Twelve women with tubal pregnancies were treated with intratubal transvaginal methotrexate injection (1 mg/kg body weight). Serum beta-hCG levels decreased in all patients, and the resolution time from injection to undetectable beta-hCG levels was 14-120 days. In spite of declining serum beta-hCG and unruptured tubal ...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Tulandi T,Bret PM,Atri M,Senterman M

    更新日期:1991-04-01 00:00:00

  • Intrauterine aspiration of a large fetal ovarian cyst.

    abstract::Most large series of neonatal ovarian cysts are limited to those diagnosed in the newborn period. Eight cases of fetal ovarian cysts diagnosed prenatally by ultrasound have been reported, only one of which was aspirated in utero. Reported is the youngest fetus to undergo in utero aspiration of an ovarian cyst to reduc...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Landrum B,Ogburn PL Jr,Feinberg S,Bendel R,Ferrara B,Johnson DE,Thompson TR

    更新日期:1986-09-01 00:00:00

  • Prospective evaluation of 618 pregnant women exposed to parvovirus B19: risks and symptoms.

    abstract:OBJECTIVE:To assess the risk of maternal parvovirus B19 infection from exposure to various sources and the fetal morbidity of those infections. METHODS:We obtained demographic and occupational information about pregnant women exposed to sources of B19 and about the nature and duration of the exposures. We performed se...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章


    authors: Harger JH,Adler SP,Koch WC,Harger GF

    更新日期:1998-03-01 00:00:00

  • Suspected ectopic pregnancy.

    abstract::Women who present with pain and bleeding in the first trimester are at risk for ectopic pregnancy, a life-threatening condition. Conditions that predispose a woman to ectopic pregnancy are damaged fallopian tubes from prior tubal surgery or previous pelvic infection, smoking, and conception using assisted reproduction...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审


    authors: Seeber BE,Barnhart KT

    更新日期:2006-02-01 00:00:00

  • Documenting the current definitions of chronic pelvic pain: implications for research.

    abstract:OBJECTIVE:We examined chronic pelvic pain definitions used in published research, because the definition has direct implications for investigating causation and evaluating treatment. DATA SOURCES:MEDLINE was searched for published articles in an Abridged Index Medicus journal from 1966 to 2001, restricted to humans, f...

    journal_title:Obstetrics and gynecology

    pub_type: 杂志文章,评审


    authors: Williams RE,Hartmann KE,Steege JF

    更新日期:2004-04-01 00:00:00