Abstract:
:Revamping the delivery of women's health care to meet future demands will require a number of changes. In the first 2 articles of this series, we introduced the reasons for change, suggested the use of the 'Triple Aim' concept to (1) improve the health of a population, (2) enhance the patient experience, and (3) control costs as a guide post for changes, and reviewed the transformational forces of payment and care system reform. In the final article, we discuss the valuable use of information technology and disruptive clinical technologies. The new health care system will require a digital transformation so that there can be increased communication, availability of information, and ongoing assessment of clinical care. This will allow for more cost-effective and individualized treatments as data are securely shared between patients and providers. Scientific advances that radically change clinical practice are coming at an accelerated pace as the underlying technologies of genetics, robotics, artificial intelligence, and molecular biology are translated into tools for diagnosis and treatment. Thriving in the new system not only will require time-honored traits such as leadership and compassion but also will require the obstetrician/gynecologist to become comfortable with technology, care redesign, and quality improvement.
journal_name
Am J Obstet Gynecoljournal_title
American journal of obstetrics and gynecologyauthors
Lagrew DC Jr,Jenkins TRdoi
10.1016/j.ajog.2014.08.022subject
Has Abstractpub_date
2015-01-01 00:00:00pages
28-33.e1issue
1eissn
0002-9378issn
1097-6868pii
S0002-9378(14)00858-8journal_volume
212pub_type
杂志文章abstract:OBJECTIVE:The International Federation of Gynecology and Obstetrics (FIGO) staging for cervical cancer is based on clinical examination. Previous studies have demonstrated significant upstaging with surgical staging. However, no randomized trial has ever shown a survival benefit when radiation combined with chemoradiat...
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.2015.05.026
更新日期:2015-10-01 00:00:00
abstract::Patients with pregnancy-induced hypertension have higher prostaglandin (PG) F concentrations in radial arterial blood (0.39 +/- 0.03 ng/ml) than control subjects (0.24 +/- 0.03 ng/ml) and higher (PGE plus PGF) concentrations in uterine venous blood obtained at the time of cesarean section (1.62 +/- 0.18 versus 1.03 +/...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(83)90333-2
更新日期:1983-01-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to describe the outcome of peripartum cardiomyopathy in patients cared for in a community hospital. STUDY DESIGN:The cases of peripartum cardiomyopathy treated at Central Baptist Hospital in Lexington, Kentucky, from January 1, 1992, to December 31, 1998, were reviewed. RESULTS...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.105402
更新日期:2000-05-01 00:00:00
abstract::The spiral arteries of the placental bed lose clearly recognizable arterial features early in pregnancy because of their invasion by extravillous trophoblast. Extensive structural alterations take place in the walls of invaded arteries, their walls containing an amorphous acidophilic "fibrinoid" matrix in which endova...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(84)90393-4
更新日期:1984-12-15 00:00:00
abstract:OBJECTIVES:The purpose of this study was to establish estimates for recurrence risk of preeclampsia based on gestational age at delivery of the first pregnancy complicated by preeclampsia and to determine whether interbirth interval, paternity, and body mass index (BMI) modify that risk in women with prior preeclampsia...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.11.058
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to study the incidence of severe cerebral injury in monochorionic (MC) twins with selective intrauterine growth restriction (sIUGR) and/or birthweight discordance. STUDY DESIGN:All MC twin pregnancies with 2 liveborn twins were included in the study. We excluded all cases with ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2008.06.008
更新日期:2008-12-01 00:00:00
abstract::Providing reliable prenatal screening performance estimates is critical for patient counseling and policy-making. Women who choose prenatal screening for aneuploidy are likely to be concerned not only with the common aneuploidies but with all causes of intellectual disability and serious birth defects. Sequential pren...
journal_title:American journal of obstetrics and gynecology
pub_type: 社论
doi:10.1016/j.ajog.2016.06.046
更新日期:2016-11-01 00:00:00
abstract::A patient seen for infertility developed severe endometriosis within 2 years of neosalpingostomy for bilateral fallopian tube obstruction. A retrospective review of infertility surgeries revealed none of 20 patients with obstructed tubes to have endometriosis, compared with 66 of 125 (52.8%) with at least one patent f...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(94)70160-1
更新日期:1994-05-01 00:00:00
abstract::We describe 1 case of placenta increta and 1 of placenta percreta, both associated with elevated maternal serum creatine kinase concentration. In patients with placenta previa and ultrasonographic findings of an abnormally adherent placenta, an unexplained elevation in maternal serum creatine kinase level should alert...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(99)70683-6
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:Our goal was to evaluate an antibiotic protocol for treatment of postcesarean endometritis. STUDY DESIGN:Endometritis was diagnosed as a persistent fever > or =100.4 degrees F beyond 24 hours after cesarean delivery and one or more of the following: uterine tenderness, tachycardia, foul lochia, or leukocytos...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1067/mob.2000.103249
更新日期:2000-05-01 00:00:00
abstract::The results of therapy of 226 women receiving frozen and fresh donor semen are reported. Overall, 45.6% of patients conceived with a monthly fecundability of 0.102. The effect of a variety of factors on fertility rates was analyzed in life-table analysis of 1000 cycles. Optimal pregnancy rates were obtained in couples...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(86)90258-9
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:We sought to compare the outcomes of cervicoisthmic (CI) cerclage using traditional transabdominal (TA) approach vs the lesser used transvaginal (TV) approach. STUDY DESIGN:We conducted a retrospective cohort study of women who underwent placement of a CI cerclage. RESULTS:Before CI placement, the abdominal...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2009.03.020
更新日期:2009-07-01 00:00:00
abstract:OBJECTIVE:We evaluated four oral combinations of conjugated estrogens (Premarin) and medroxyprogesterone acetate in preventing endometrial hyperplasia, which can occur with conjugated estrogens alone. STUDY DESIGN:This was a 1-year prospective, double-blind, randomized, multicenter study in 1724 postmenopausal women. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-9378(94)70129-6
更新日期:1994-05-01 00:00:00
abstract::Presented is a scheme by which an index of high-risk pregnancy can be evaluated. The proposed scheme is applied to a risk index developed for the purpose of illustration. The usefulness of risk indices (or any other predictive measure) can be judged in clear statistical terms. The illustrative model developed here beh...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(82)90537-3
更新日期:1982-07-01 00:00:00
abstract::Concentrations of immunoglobulins (Ig)A1, and IgA2, IgD, IgE, IgG, and IgM have been determined in cord blood, amniotic fluid, and maternal serum in a group of patients with a history of prematurely ruptured membranes (PRM) prior to the onset of labor and in a control group of patients undergoing normal delivery and w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(76)90543-3
更新日期:1976-10-01 00:00:00
abstract:BACKGROUND:Readmission rates are used as a quality metric in medical and surgical specialties; however, little is known about obstetrics readmissions. OBJECTIVE:Our goals for this study were to describe the trends in postpartum readmissions over time; to characterize the common indications and associated diagnoses for...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2016.01.174
更新日期:2016-07-01 00:00:00
abstract::The presence of fetal breathing, even if episodic in character, may not indicate fetal well being. In a study of fetal lambs with long-term implantation of catheters and electrodes, five of six lambs which died before the onset of labor had terminal episodes of continuous breathing, preceded by 4 1/4 to 45 1/2 hours o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(16)33138-6
更新日期:1978-08-15 00:00:00
abstract:BACKGROUND:Hyperglycosylated human chorionic gonadotropin, the predominant human chorionic gonadotropin variant secreted following implantation, is associated with trophoblast invasion. OBJECTIVE:To determine whether the initial serum hyperglycosylated human chorionic gonadotropin differs between ongoing and failed pr...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2019.08.004
更新日期:2020-01-01 00:00:00
abstract::Color Doppler imaging could easily and rapidly detect the absence of an umbilical artery, despite the presence of oligohydramnios in one case and multiple cord loops involving a normal cord in the other case. In the third case, which on gray-scale imaging appeared as an indeterminate cystic structure of the cord, colo...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(89)90663-7
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to determine if gap junctions are a necessary component of the human laboring uterus and if their presence in myometrium is a prerequisite for both term and preterm labor. STUDY DESIGN:We obtained 27 human myometrial samples at cesarean section or nongravid hysterectomy. Gap jun...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(11)90806-0
更新日期:1993-05-01 00:00:00
abstract::Histidyl proline diketopiperazine values have been established in human amniotic fluid (n = 81) and maternal serum (n = 36) throughout gestation (10 to 42 weeks). Newborn cord serum (n = 10) and first-voided fetal urine (n = 10) levels were also documented. These measurements reveal increasing amniotic fluid levels wi...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(90)90998-m
更新日期:1990-03-01 00:00:00
abstract::This is the first case of a 65 year old healthy woman developing de novo mental confusion during treatment with 2 mg tolterodine twice daily. It is a rare complication of therapy for overactive bladder and resolved when dosage was reduced to 1 mg, although overactive bladder symptoms were still controlled. ...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2007.04.051
更新日期:2007-08-01 00:00:00
abstract::Experiments were conducted with 11 chronically catheterized fetal sheep to determine the effects of norepinephrine on the distribution of umbilical venous blood through the ductus venosus, and within the fetal liver. An intraumbilical infusion of 1.1 microgram/kg/min of norepinephrine increased placental blood flow bu...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(80)90388-9
更新日期:1980-05-01 00:00:00
abstract:OBJECTIVE:Seventeen-alpha-hydroxyprogesterone caproate (17-OHPC) reduces recurrent preterm birth (PTB). We hypothesized that single nucleotide polymorphisms in the human progesterone receptor (PGR) affect response to 17-OHPC in the prevention of recurrent PTB. STUDY DESIGN:We conducted secondary analysis of a study of...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ajog.2011.03.048
更新日期:2011-08-01 00:00:00
abstract::The pulsatility index of the fetal umbilical arteries was evaluated in 14 high-risk pregnant patients delivered by cesarean section between 30 and 35 weeks of gestation. Transabdominal cord sampling by ultrasonic guidance was performed on 10 of these patients. Umbilical arterial and venous blood was obtained in all pa...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(88)90418-8
更新日期:1988-11-01 00:00:00
abstract::One hundred incidental appendectomies were performed in patients undergoing operative laparoscopy (videolaseroscopy) for evaluating and treating various major diseases of the reproductive organs. Except for a fever resolving within 24 hours in one case and mild periumbilical ecchymosis, there were no intraoperative or...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(91)90284-x
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to assess the involvement of rho kinase (ROK) in agonist-dependent contraction of omental, myometrial, and placental arteries of pregnant women at term. STUDY DESIGN:Wire myography was used to assess if contractions of intact or alpha-toxin-permeabilized arteries obtained from w...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/j.ajog.2005.02.076
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:Adrenomedullin is increased in maternal plasma in pregnancy and has been found in very high concentrations in amniotic fluid and umbilical plasma. To identify adrenomedullin-producing tissue in pregnancy we measured adrenomedullin concentration and distribution in fetoplacental tissues. STUDY DESIGN:By use o...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70083-3
更新日期:1998-09-01 00:00:00
abstract:OBJECTIVE:The interaction between maternal hemodynamics and uterine activity in the upright position was investigated longitudinally (358 measurements) in 40 healthy pregnant women from 20 gestational weeks to term. STUDY DESIGN:Maternal-fetal hemodynamic parameters and uterine contractions were measured noninvasively...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/0002-9378(93)90160-k
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVE:The effect of antibiotics in the prevention of preterm labor needs to be further investigated. The aim of this study was to determine the effect of ampicillin on prostaglandin E release from amnion as a possible explanation for its ability to retard preterm labor. STUDY DESIGN:The effect of the beta-lactam a...
journal_title:American journal of obstetrics and gynecology
pub_type: 杂志文章
doi:10.1016/s0002-9378(98)70488-0
更新日期:1998-04-01 00:00:00