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Preventing Cesarean Delivery

    • Cesarean delivery is a significant contributor to maternal morbidity and mortality. The rise in cesarean delivery has not been associated with a decrease in cerebral palsy in offspring.
    • A multi-strategy quality improvement approach that accounts for fetal heart tracing assessment, progress in labor, and environmental stress may lead to a reduction in cesarean delivery rates.
    • Many cesarean deliveries occur because of subjective interpretation of fetal heart rate tracings. Standardization of interpretation of fetal heart rate tracings using NICHD-endorsed terminology may help to decrease the incidence of cesarean for “nonreassuring” fetal heart tracings
    • Allowing patience with the labor curve may achieve increased numbers of safe vaginal deliveries. Redefining arrest and protraction could potentially decrease the cesarean rate and the resultant morbidity. Of particular importance for clinicians, active labor may not begin until 6cm of cervical dilation, and before diagnosing arrest of labor in the second stage, providers should allow for at least 2 hours of pushing in multiparous women and 3 hours in nulliparous women.  ACOG and SMFM also endorse longer second stages on an individualized basis.

Preventing Cesarean Delivery

    • Cesarean delivery is a significant contributor to maternal morbidity and mortality. The rise in cesarean delivery has not been associated with a decrease in cerebral palsy in offspring.
    • A multi-strategy quality improvement approach that accounts for fetal heart tracing assessment, progress in labor, and environmental stress may lead to a reduction in cesarean delivery rates.
    • Many cesarean deliveries occur because of subjective interpretation of fetal heart rate tracings. Standardization of interpretation of fetal heart rate tracings using NICHD-endorsed terminology may help to decrease the incidence of cesarean for “nonreassuring” fetal heart tracings
    • Allowing patience with the labor curve may achieve increased numbers of safe vaginal deliveries. Redefining arrest and protraction could potentially decrease the cesarean rate and the resultant morbidity. Of particular importance for clinicians, active labor may not begin until 6cm of cervical dilation, and before diagnosing arrest of labor in the second stage, providers should allow for at least 2 hours of pushing in multiparous women and 3 hours in nulliparous women.  ACOG and SMFM also endorse longer second stages on an individualized basis.

The Psychiatric Interview and Mental Status Examination

    • Patient assessment precedes the development of the  comprehensive treatment plan
    • The interview must be adjusted to suit the patient and circumstance
    • The mental status examination is the psychiatrist’s equivalent of the internist’s physical examination 

The Psychiatric Interview and Mental Status Examination

    • Patient assessment precedes the development of the  comprehensive treatment plan
    • The interview must be adjusted to suit the patient and circumstance
    • The mental status examination is the psychiatrist’s equivalent of the internist’s physical examination 

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients

Cardiac Arrhythmias, Acute Coronary Syndromes, and Heart Failure in the Surgical Patient

    • To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
    • Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
    • Recent progress in management ofheart failure in postoperative and traumatic patients
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