Multiple pregnancy: Knowledge and practice patterns of obstetricians and gynecologists - Reply
ABSTRACT We sought to assess knowledge and practices of obstetricians regarding multiple gestation.
A questionnaire investigating knowledge and practice patterns pertaining to multiple gestation was mailed to randomly selected American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows in January 2003. Fifty-one percent (589/1,146) of the surveys were returned.
Statistical analysis included the responses from 430 practicing obstetricians. More than 60% rated their training regarding management of multiples as adequate. Men (56.5%) were older and had been in practice longer than females. Sixty-two percent of general obstetrician-gynecologists managed twins without input from a maternal-fetal medicine specialist. An understanding of chorionicity was less than anticipated. The majority of practitioners managed twins according to recent ACOG educational materials. They did not use prophylactic cerclage, home uterine-activity monitoring, or tocolytics. Fort-six percent encouraged prophylactic bed rest. The management of breech second twins varied.
Most obstetricians manage multiples according to current ACOG educational materials independent of maternal-fetal medicine specialists. This survey identified knowledge gaps, specifically in chorionicity, indicating the need to develop educational strategies addressing these insufficiencies.
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ABSTRACT: Obstetrician/gynecologists are taking on more primary care responsibilities and thus are expected to have a wider base of medical knowledge on a variety of women's health issues. The Collaborative Ambulatory Research Network (CARN) was created in 1990 to investigate issues pertinent to Women's health and to the practice of obstetrics and gynecology in the outpatient setting. This article summarizes the findings of CARN studies from 2001 to 2004, covering topics of abnormal pregnancy outcomes, complications of pregnancy, and psychologic disorders. Each study provides a glimpse into the current practice patterns, attitudes, and knowledge of the practicing obstetrician/gynecoloclist. Although aggregate results suggest that clinicians are consistent and knowledgeable in traditional areas of practice, there appears to be a need for comprehensive educational programs to increase clinicians' comfort level with and knowledge of many primary care issues. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to summarize the findings of the Collaborative Ambulatory Research Network Studies regarding abnormal pregnancy outcomes, complications of pregnancy, and psychological disorders.Obstetrical and Gynecological Survey 11/2004; 59(11):787-794. DOI:10.1097/01.ogx.0000143776.92687.ea · 2.36 Impact Factor
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ABSTRACT: Multiple gestations are high-risk compared with singleton pregnancies. Prematurity and intrauterine growth restrictions are the major sources of morbidity and mortality common to all twin gestations. Monochorionic twins are at a higher risk for twin-twin transfusion, fetal growth restriction, congenital anomalies, vasa previa, velamentous insertion of the umbilical cord and fetal death. Therefore, determination of multiple gestation, amnionicity and chorionicity in the first trimester is important. Follow up examinations to evaluate fetal well-being include assessment of fetal growth and amniotic fluid volume, umbilical artery Doppler, nonstress test and biophysical profile. To date, there is a paucity of literature regarding imaging schedules for follow-up. At the very least, antepartum testing in multiple gestations is recommended in all situations in which surveillance would ordinarily be performed in a singleton pregnancy.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed biennially by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging.Ultrasound quarterly 06/2012; 28(2):149-55. DOI:10.1097/RUQ.0b013e31824bfc06 · 1.40 Impact Factor
- Obstetrics and Gynecology 02/2005; 105(1):215; author reply 215-6. DOI:10.1097/01.AOG.0000149161.82516.f1 · 4.37 Impact Factor