Jane Mashburn

Vaginal Infections Update

Vaginal symptoms are one of the leading reasons that women visit their health care providers. Women often self-diagnose and may treat themselves inappropriately. This article describes the etiology, risk factors, symptoms, diagnosis, and treatment of the 3 most common vaginal infections: bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis.

TELEPHONE TRIAGE IN THE OFFICE SETTING

During a six-month period in 1988, two nurse-midwives documented the telephone calls they received in an OB/GYN/CNM practice. Calls were then tallied and categorized for analysis. A discussion of the numbers and types of calls is presented as well as a review of the literature on telephone triage/management.

Ectopic pregnancy: triage do's and don'ts.

Ectopic pregnancy is on the rise and accounts for 2% of all reported pregnancies. This article introduces the reader to the complexities of the condition and explores risk factors as well as differential diagnosis and methods of treatment. The importance of early diagnosis is discussed as well as the implications of misdiagnosis. The role of the midwife/practitioner in the triage of patients with ectopic pregnancy is detailed.

IDENTIFICATION AND MANAGEMENT OF SHOULDER DYSTOCIA

Abstract Shoulder dystocia is most often an unpredictable occurrence. Inappropriate management may lead to long term sequelae for both mother and infant. Correct management includes specific steps to follow when attempting to deliver the infant with shoulder dystocia. It is imperative that we as nurse-midwives be thoroughly familiar with the difficulties encountered with shoulder dystocia and commit the management steps to memory. This paper presents an overview of the problem as well as the steps included in clinical management.Shoulder dystocia is most often an unpredictable occurrence. Inappropriate management may lead to long term sequelae for both mother and infant. Correct management includes specific steps to follow when attempting to deliver the infant with shoulder dystocia. It is imperative that we as nurse-midwives be thoroughly familiar with the difficulties encountered with shoulder dystocia and commit the management steps to memory. This paper presents an overview of the problem as well as the steps included in clinical management.

Evolution of the evidence-based Papanicolaou smear

Cervical cancer rates have decreased over the past century, but rates have remained relatively constant during the last decade. Evidence-based management of the abnormal Papanicolaou (Pap) smear and the use of additional testing at the time of the Pap smear are discussed in light of the current evidence. Also explored in-depth is the evidence base for Papanicolaou smear collection and retrieval methods, especially as it relates to their influence on the validity of the smear results. In addition, issues that need to be considered by the clinician, including the use of colposcopy, especially in light of health service implications such as the need for adequately trained personnel, increased clinical visit time, and increased cost are presented.

Endometrial biopsy in the office setting

In the past few years, endometrial biopsy has become a procedure that can be performed on an outpatient basis, causing relatively minor discomfort to the client. It is frequently used as a method of dating the endometrium but has also become an important tool in screening for endometrial hyperplasia and carcinoma. It is also recommended by some as a part of the routine screening for women on hormone replacement therapy. This article presents the indications, contraindications, and technical procedure for performing endometrial biopsies in the office setting. In addition, complications and follow-up care are discussed.