Evidence Based Management of Labor.

Importance: Induction of labor (IOL) is a common obstetric intervention. Augmentation of labor and active management of the second stage is frequently required in obstetric practice. However, techniques around labor and induction management vary widely. Evidence-based practice regarding induction and labor management can reduce birth complications such as infection and hemorrhage and decrease rates of cesarean delivery. Objective: To review existing evidence on IOL and labor management strategies with respect to preparing for induction, cervical ripening, induction and augmentation, and second stage of labor techniques. Evidence acquisition: Review of recent original research, review articles, and guidelines on IOL using PubMed (2000-2022). Results: Preinduction, pelvic floor training and perineal massage reduce postpartum urinary incontinence and perineal trauma, respectively. Timely membrane sweeping (38 weeks) can promote spontaneous labor and prevent postterm inductions. Outpatient Foley bulb placement in low-risk nulliparous patients with planned IOL reduces time to delivery. Inpatient Foley bulb use beyond 6 to 12 hours shows no benefit. When synthetic prostaglandins are indicated, vaginal misoprostol should be preferred. For nulliparous patients and those with obesity, oxytocin should be titrated using a high-dose protocol. Once cervical dilation is complete, pushing should begin immediately. Warm compresses and perineal massage decrease risk of perineal trauma. Conclusion and relevance: Several strategies exist to assist in successful IOL and promote vaginal delivery. Evidence-based strategies should be used to improve outcomes and decrease risk of complications and cesarean delivery. Recommendations should be shared across interdisciplinary team members, creating a model that promotes safe patient care.

Trends in Fellow Education Research Among Obstetric and Gynecologic Subspecialties.

OBJECTIVE: To evaluate the frequency at which fellow education-related abstracts are presented at national meetings and compare presentation rates before and after the accreditation transition. METHODS: This cross-sectional study evaluated abstracts from the five most recent national meetings of the Society for Maternal-Fetal Medicine (SMFM), the Society of Gynecologic Oncology, the American Society for Reproductive Medicine (ASRM), the American Urogynecologic Society (AUGS), and the Council on Resident Education in Obstetrics and Gynecology (CREOG) and Association of Professors of Gynecology and Obstetrics (APGO). Three independent reviewers assessed abstracts for education-specific content. Abstracts were included if two or greater reviewers identified them as related to fellow education. Descriptive statistics were used for data analysis. RESULTS: Fourteen thousand six hundred thirty abstracts were presented at obstetric and gynecologic subspecialty meetings between 2012 and 2017. Of these, 29 (0.20%) pertained to fellows' education. The percent of total abstracts that were fellow-related remained relatively constant over time. Of the four subspecialties, the AUGS presented fellow education research almost five times more frequently than ASRM (P<.01) or SMFM (P<.01). Over the study period, 1,283 abstracts were presented at the CREOG and APGO meeting, with four (0.31%) pertaining to fellows' education. At the CREOG and APGO meeting, fellow-related abstracts did not appear to increase over the period studied. CONCLUSION: Research regarding fellows' education is rarely presented at national meetings, representing less than 1% of all abstracts, and has not substantially increased since the transition to the Accreditation Council for Graduate Medical Education.

Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers.

BACKGROUND: Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC). STUDY OBJECTIVE: This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population. METHODS: We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers. Surveys were administered over 2 weeks in July 2015. Interpreter-mediated appointment and sliding-fee-scale data from a period 7 months that spanned survey administration were also assessed. RESULTS: Diabetes and hypertension were the most common health concerns. Thirty-two percent of participants reported 10 or more days of depressed mood in the past month. Insurance and language were the most common barriers to health care and employers and on-site clinics were the most common facilitators. Appointments most often addressed women's health, gastrointestinal problems, health maintenance, diabetes, and back pain. Thirty FQHC sliding-fee-scale applications were completed by workers. CONCLUSIONS: These Spanish-speaking dairy-farm workers have many health concerns and perceive substantial barriers to health care. Collaboration between medical students, a rural FQHC, and farm employers provides important services that facilitate health care access among this population.