Q. If a pregnant woman is dependent on opiates, can I treat her addiction ?
A. Yes acutely, but only if she needs ongoing care it must be properly supervised. (WORD 104 k)
Q. How many deliveries does a provider need to maintain active privileges?
A. Those numbers should be set by the local Medical Staff. Here are some examples (WORD 79k)
Q.What is the evidence for the management of preterm labor? [8/01]
A. The AHRQ offers the latest evidence of what works and what doesn't: Summary | Full report
Q. What are the Indian Health procedures for HIV screening in pregnancy?
A. Our goal is to maximize our care by using ‘opt out’ HIV screening. (WORD 58k)
Q.How should I manage chronic hypertension in pregnancy? [8/01]
A. AHRQ offers the latest evidence based information. On-line: Summary | Full report. Download summary: MS Word (.DOC) 52K, Acrobat Reader (.PDF) 32K. Downloadable, zipped file collection: Word Perfect, 520K
Q.What preventive therapy is recommended for patients at high risk for pre-eclampsia?
A. Low dose aspirin is recommended for selected high risk patients. Calcium is less certain. (WORD 74k)
Q. What preventive therapy is recommended for patients at high risk for pre-eclampsia?
A. Low dose aspirin is recommended for selected high risk patients. Calcium is less certain. (WORD 74k)
Q. How do you assess osteoporosis risk?
A. Counsel all women on the risk factors for osteoporosis. Osteoporosis is a "silent" risk factor for fracture just as hypertension is for stroke; one out of two white women will experience an osteoporotic fracture at some point in her lifetime.
Q. What is the clinical significance of endometrial cells found on Pap smears?
A. It is only significant in women 40 years of age and then an endometrial biopsy should be performed. (WORD 33k)
Q. How long a shift can I work safely? What patient safety practices actually work? [8/01]
A. The AHRQ offers an evaluation of a wide variety of patient safety practices. On-line: Summary | Full report. Download summary: MS Word (.DOC) 56K, Acrobat Reader (.PDF) 32K. Downloadable, zipped file of the full report: MS Word, 954K.
Q. Is percutaneous drainage of tubo-ovarian abscess standard of care?
A. Yes, especially in women who have not completed their child-bearing. (WORD 43k)
Q. Can we test pregnant patients that have clinical indications for drug testing? Can we screen pregnant patients? [10-01]
A. This is a very complex issue that determined in large part by local laws and regulations. Here is how one Area has approached the problem. Downloadable file: MS Word (.DOC) 36K | Acrobat Reader (.PDF) 24K.
Q. What is the polycystic ovarian syndrome (P.C.O.S.) and what can I do about it? [2/02]
A. See The Endocrine Society, the P.C.O.S. Association, and PCOSupport Chapters.
Q. What is the latest evidence on the diagnosis and treatment of postmenopausal osteoporosis? [8/01]
A. The A.H.R.Q. offers the latest evidence based information on the diagnosis and treatment of postmenopausal osteoporosis: Summary.
Q. What is known about osteoporosis in American Indians and Alaska Natives (A.I./A.N.)? [10/01]
A. Very little is known about osteoporosis in A.I./A.N.. Here is a brief summary of an article about osteoporosis in Alaska Natives, plus the citations and conclusions to 8 articles on the topic from PubMed. Downloadable file: MS Word (.DOC) 32K | Acrobat Reader (.PDF) 16K.
Q. How do you assess osteoporosis risk?
A. Counsel all women on the risk factors for osteoporosis. Osteoporosis is a "silent" risk factor for fracture just as hypertension is for stroke; one out of two white women will experience an osteoporotic fracture at some point in her lifetime.
Q. Are there risk factors that suggest a provider should automatically move to treatment modalities to prevent postpartum hemorrhage?
A. There is not Level I data to support the automatic use of treatment modalities, other than the active management of labor, for a particular risk factor.
Q. Is there such a condition as the post tubal ligation syndrome? [10/01]
A. No. Look at this synopsis of the CREST study to find out why.
Q. Should we offer preconception folic
acid?
To patients with a previously diagnosed neural tube defect?
To patients without a previously diagnosed neural tube defect? [10-01]
A. YES. YES. YES. More info in downloadable file: MS Word (.DOC) 32K | Acrobat Reader (.PDF) 20K.
Q. Should I offer DNA screening for cystic fibrosis in preconception and prenatal care? (Note: 5 answers below.) [12/01]
A. A.C.O.G. recommends that Ob-Gyns make screening for cystic fibrosis available to all couples seeking care
Q. How should I manage chronic hypertension in pregnancy? [8/01]
A. AHRQ offers the latest evidence based information. On-line: Summary | Full report. Download summary: MS Word (.DOC) 52K, Acrobat Reader (.PDF) 32K. Downloadable, zipped file collection: Word Perfect, 520K
Q. What is the best screening cut-off for gestational diabetes mellitus?
A. See this discussion (WORD 71k)
Q. Is exercise actually recommended in pregnancy? If so, why?
A. Yes, exercise is highly recommended in uncomplicated pregnancy. It can help a lot.(WORD 49k)
Q. Should we offer preconception folic acid?
To patients with a previously diagnosed neural tube defect?
To patients without a previously diagnosed neural tube defect? [10-01]
A. YES. YES. YES. More info in downloadable file: MS Word (.DOC) 32K | Acrobat Reader (.PDF) 20K.
Q. What are some of the practical issues of medical drug use in pregnancy? [4/02]
A. Jennifer R. Niebyl, MD from Contemporary OB/GYN presents some of the practical issues of medical drug use in pregnancy.
Q. What do you use to treat pregnant women with migraines?
A. First of all make sure these are migraine headaches, then treat appropriately. See below. (WORD 76k)
Q. Can we use misoprostol for labor induction in asthma patients? (Medscape)
A. Yes, but PG-F2alpha analogs (Hemabate) should be avoided if possible or used with caution.
Q. What are some of the practical aspects of managing multiple pregnancy? [4/02]
A. Mary E. D'Alton, from Contemporary OB/GYN presents some of the practical aspects of managing multiple pregnancy.
Q. What is a safe amount of fish to eat during pregnancy? [12/01]
A. The FDA recommends women can safely eat 12 ounces per week of cooked fish including shellfish, canned fish, smaller ocean fish or farm-raised fish.
Q. What is the evidence for the management of preterm labor? [8/01]
A. The AHRQ offers the latest evidence of what works and what doesn't: Summary | Full report.
Q. Have you being using weekly 17-OH-progesterone caproate in your patient population?
A. Yes, we are using a progesterone regimen in a restricted fashion for selected patients.(WORD 50k)
Q. Should we perform routine urine dipstick protein screening in our prenatal clinic?
A. No, the urine dipstick tests are not sensitive, nor specific enough for routine screening for pre-eclampsia. There is more to the story, though. See below. (WORD 71k)
Q. What evidence based prevention strategies actually work? [12/01]
A. The A.H.R.Q. offers these evidence based prevention strategies and guide.
Q. Have you being using weekly 17-OH-progesterone caproate in your patient population?
A. Yes, we are using a progesterone regimen in a restricted fashion for selected patients.(WORD 50k)
Q. Is rectal misoprostol the first line agent for treating postpartum hemorrhage, now?
A. No, rectal misoprostol is not the first agent for treating PPH, but there is more to the story.
Q. Is it standard of care to obtain a 2nd ultrasound on low risk patients for a fetal survey?
A. There is evidence to obtain one ultrasound. The optimal timing (WORD 41k) is at 16 to 20 week.
Q. What is the significance 2nd trimester of ultrasound (US markers for Down syndrome?
A. If US markers are negative, then decrease the risk by serum testing in ~1/2. See the details (WORD 66k)
Q. Does there have to be Pediatrician at all emergency deliveries?
A. The standard is a healthcare worker experienced in neonatal resuscitation. See details. (WORD 53k)
Q. What is the significance of a ultrasound (US) 'soft marker' for Down Syndrome?
A.2nd trimester US markers for Down syndrome are varied in their significance. See details (WORD 51k)
Q. What are the main risks for expectant mothers in day care settings?
A. The common perinatal pathogens are cytomegalovirus and parvovirus B19. See details (WORD 79k)
Q. Does the active management of the third stage of labor really work?
A. Yes, active management of the third stage of labor decreases blood loss. See details (WORD 66k)
Q. Should we do a test of cure for Chlamydia in pregnancy? If so, when?
A. Yes, you should do a test of cure in pregnancy. See the details below (WORD 70k)
Q. Should, we be performing some type of long term follow-up on our GDM patients?
A. Yes, perform a 75 gm OGTT initially at 6 wks pp, and a FPG or OGTT q 3 yrs. See details (WORD 59k)
Q. Should we use glargine use in pregnancy?
A. Short and intermediate acting insulin(s) are recommended at this time. See details below (WORD 52k)
Q. Should a urine test be performed on every pregnant patient each prenatal visit?
A. No, routine urine testing in pregnancy is very insensitive and non-specific. See details (WORD 94k)
Q. What is the safest, most effective approach to prodromal labor?
A. First, be sure of the diagnosis, and then there are a variety of appropriate options. (WORD 84k)
Q. Is repetitive intrathecal anesthesia a good alternative to epidural anesthesia in labor?
A. Continuous epidural anesthesia is often the more satisfactory approach. See details. (WORD 59k)
Q. Do we have an Indian Health policy on positive skin tests in pregnancy for TB--and treatment?
A. Yes, here is a discussion on screening and treatment during pregnancy and lactation. (WORD 94k)
Q. Does the IHS have a procedure for payment in pregnancy termination?
A. IHS provides support for abortion services in three selected cases (WORD 44k)
Q. Can we perform one step GDM screening in AI/AN?
A. Yes, ACOG and IHS discussed it 1993 and it is endorsed by the ADA (WORD 53k)
Q. What are some of the issues about viability in the range of 23-25 EGA weeks?
A. Try a collaborative approach that involves providers and the parents in decisions. See details (WORD 101k)
Q. Can we use a protein to creatinine ratio instead of a 24 urine protein in preeclampsia?
A. P:C is a standard metric for chronic renal disease. Here are the details in the OB setting (WORD 400k)
Q. How do you manage retinal detachment in pregnancy?
A. Management depends on which of the types of retinal detachment. See details (WORD 105k)
Q. Is cholestasis in pregnancy significant in American Indians and Alaska Natives?
A. Yes, cholestasis can be associated with infant mortality and maternal discomfort. See details (WORD 97k)
Q. How do I get clinical privileges in _______ (deliveries, ultrasound, colposcopy, etc…)
A. It requires documentation of training, experience, and current competence. See details (WORD 50k)
Q. Is my first trimester patient always hyperthyroid if her labs are abnormal?
A. No, not necessarily. If she is clinically stable, then wait till 18-20 weeks to decide. See details (WORD 46k)
Q. Are there any ______ (forms, guidelines, Pt. Ed materials, etc) I can use as templates?
A. Yes, the Indian Health website has sites for all those. See details (WORD 69k)
Q. Are there any clinical pointers for alcohol withdrawal in pregnancy?
A. Pregnant women shouldn’t be excluded from detoxification programs. See details (WORD 112k)
Q. How many rubella vaccines does a mother really need to get?
A. If negative, then revaccination with one dose of MMR, and no further serologic testing (WORD 105k)
Q. Should patients use sweat lodges during pregnancy?
A. A sweat lodge that does not elevate the maternal core temperature would be acceptable. (WORD - 46K)
Q. What is recommended about peyote use in pregnancy?
A. Use of hallucinogens are not recommended in pregnancy (WORD - 38K)
Q. How should we manage a patient with a previous abruptio placenta?
A. There are significant risks after 2 abruptions or if fetal death (see detals) (WORD - 46k)
Q. Is there an association between thyroid auto-antibodies and fetal Down’s Syndrome?
A. Upon review no association was found. We have better methods now, e.g., quad, NT, etc… (WORD 42k)