The purpose of this document is offers recommendations for treating infants and adults. It will also high-light the need to view syphilis screening and control programs through the perspectives of multiple stakeholders so as to identify barriers to, and opportunities for improving the formulation and implementation of national policies. Devising an effective political strategy might represent one of the most challenging facets of implementing a sustainable program. Both structured and unstructured approaches are useful, and applying aspects of both may provide rich analysis of why an intervention like antenatal syphilis screening is not being implemented. In USA a record low incidence of congenital syphilis, 20.6 cases per 100,000 live births, was recorded in 1998 by the Centers for Disease Control and Prevention (CDC) (1999a), resulting in creation of the National Plan for Syphilis Elimination.Read More

Between 1996 and 2003 the cesarean delivery rate in the United States increased dramatically from21.2% to 27.1%. Over the same interval vaginal birth after cesarean birth (VBAC) has decreased from 28.3% to 10.6%. This decrease may be attributed to concerns regarding the risks during trial of labor, such as uterine rupture, estimated to occur in 0.3-4.0% of pregnancies with history of cesarean delivery. As the VBAC rate increased, so did the number of well-publicized reports of uterine rupture and other complications during trials of labor after previous cesarean deliveries. As a result, many physicians and hospitals have discontinued the practice altogether. This abrupt change in practice has contributed to the cesarean delivery rate in the United States increasing again, reaching an all-time high of 26.1% in 2002, while the VBAC rate has decreased by 55% to 12.6%. The risk for poor obstetric outcome in a subsequent pregnancy has been shown to be related to surgical technique, with classical cesarean delivery having the highest risk for rupture and lower segment incisions having a lower risk. Clinical significance of uterine scar dehiscence in women with previous cesarean delivery is also discussed.Read More

Many viral infections are associated with significant maternal and fetal consequences if acquired during pregnancy. In the United States, some the most commonly encountered infections with subsequent perinatal effects include cytomegalovirus (CMV), parvovirus B19 (fifth disease), varicella zoster virus (VZV). The purpose of this document is to describe these infections, their mode of transmission, and their maternal and fetal effects. Guidelines for counseling about and management of these infections during pregnancy are also discussed. In general, perinatal infections have more severe fetal consequences when they occur early in gestation, because first-trimester infections may disrupt organogenesis. Second and third trimester infections can cause neurologic impairment or growth restriction.Read More

Herpes simplex virus (HSV) infection of the genital tract is one of the most common viral sexually transmitted diseases (STDs). Approximately 45 million adolescent and adult Americans have been infected with genital herpes based on positive serology test results for HSV-2 and estimates of genital HSV-1 infection. About 30% of the female population in the United States has antibodies to HSV-2. The purpose of this document is to define the stages of herpetic infection, outline the spectrum of maternal and neonatal infection and provide the management guidelines.Read More

The purpose of this document is to present evidence regarding methodology, indications, benefits, and risks of obstetric ultrasonography in specific clinical situations. Sections of the document addressing physician qualifications and responsibilities, documentation, quality control, infection control and patient education are the recommendations of Women's Health and Education Center (WHEC). We are hopeful that this text will serve two purposes: to educate and to intrigue. Through the education process of the healthcare providers will help alleviate errors in diagnosis. Casual use of ultrasonography, especially during pregnancy, should be avoided. Before an ultrasound examination is performed, patients should be counseled about the limitations of ultrasonography for diagnosis.Read More

Ultrasound emerged as a major tool in medical imaging in the 1970s, and its impact has been very dramatic in obstetrics. The ability of sonography to detect fetal abnormalities prior to delivery and to direct minimally invasive therapy has revolutionized the field of obstetrics. The marked improvement in ultrasound image quality in recent years and the ability to store high quality digital images and video clips have enhanced ultrasound's role in obstetrics. The purpose of this document is to discuss various diagnostic procedures available and their indications. The most commonly used ultrasound-guided diagnostic obstetrical procedures are: 1) Amniocentesis; 2) Chorionic Villus Sampling (CVS); 3) Percutaneous Umbilical Blood Sampling.Read More

The transformation of the human immunodeficiency virus (HIV) epidemic over the last 20 years has been remarkable. With access to appropriate therapies, clinicians can now offer infected women a much improved prognosis as well as a very high likelihood of birthing children who will be HIV uninfected. Prevention of transmission of HIV from mother to fetus or newborn (vertical transmission) is a major goal in the care of pregnant women infected with HIV. In this article, the most recent developments in the field are summarized in a fashion that should allow the integration into the practice of obstetrics and thereby assure the HIV-infected women the best possible prognosis for themselves and for their children. The focus of this work is on the dual responsibilities of obstetricians, assuring the health of women and minimizing the risks of transmission.Read More