A Guide to Terminology for Rh Immunoprophylaxis.

Rh immunoprophylaxis for Rh-negative women requires an understanding of terminology used for Rh blood typing laboratory reports. The pathophysiology of Rh hemolytic disease of the fetus and newborn was elucidated by studies in rhesus monkeys. Subsequent studies revealed that the human blood group antigen responsible for Rh hemolytic disease of the newborn (D antigen) is related to, but different from, the rhesus monkey antigen. Weak expression of the D antigen on red cells, originally termed D, is currently reported by laboratories as a "serologic weak D phenotype," which can be further defined by RHD genotyping to be either a weak D type or a partial D phenotype. Weak D types 1, 2, or 3 are molecularly defined RHD weak D types, which have an adequate number of intact D antigens to be managed safely as Rh-positive. Partial D phenotypes result from mutations causing loss of one or more D epitopes. Most persons with a partial D phenotype have sufficient D antigen to type as Rh-positive. Some women with a partial D phenotype are detected as serologic weak D phenotypes by routine Rh typing. Whether they type as Rh-positive or serologic weak D phenotype, after being exposed to Rh-positive red cells by transfusion or pregnancy, women with partial D phenotype can form anti-D antibodies and, if they do, are at risk for hemolytic disease of the fetus and newborn. A pregnant woman with a laboratory report of a serologic weak D phenotype should be further tested for her RHD genotype to resolve whether her case should be managed as Rh-positive or Rh-negative. For more than five decades, the practice of Rh immunoprophylaxis has remained unchanged in terms of the dose of Rh immune globulin and timing of injections. In contrast, advances in the science of Rh blood typing have resulted in a continuously evolving terminology, obliging obstetricians to update their vocabulary to guide their practice. The following review and glossary provide guidance for current Rh terminology and the rationale for changes.

Racial and ethnic disparities in breastfeeding.

This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.

Academy of Breastfeeding Medicine Founder's Lecture 2010: breastfeeding: an obstetrician's view.

The value of breastfeeding for mothers, babies, and society is well established, yet in the United States too many women do not breastfeed. The U.S. Public Health Service set forth breastfeeding goals for 2010 and subsequently developed report cards so that breastfeeding trends could be followed for each state. Many efforts are made by healthcare professionals to encourage and support new mothers, but some areas in the United States have low levels of breastfeeding. This report examines aspects of obstetricians' education, role, and responsibility to promote and support breastfeeding. Additionally, some current trends affecting the practice of breastfeeding are considered, including shorter hospital stays, rapidly rising cesarean delivery rates (soon to approach 50%), and increasing proportion of working mothers. Because obstetricians often have the first contact with expectant mothers and there are over 20 million prenatal visits annually in the United States, obstetricians have many opportunities to promote breastfeeding. Together with the efforts of other physicians, nurses, and lactation specialists, we can improve the efforts to promote and support breastfeeding.

Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: "tap early and often" versus hospitalization.

OBJECTIVE: To compare the cost of two treatment regimens for moderate to severe ovarian hyperstimulation syndrome (OHSS): conservative inpatient versus outpatient management with paracentesis. DESIGN: A decision-tree mathematical model comparing conservative inpatient versus outpatient management of moderate to severe OHSS was created. The common final pathway of either management was resolution of OHSS. Sensitivity analyses were performed over the range of variables. MAIN OUTCOME MEASURE(S): Total management cost of OHSS. RESULT(S): The cost of conservative therapy including first-tier complications was $10,099 (range $9,655-$15,044). The cost of outpatient management with paracentesis was $1954 (range $788-$12,041). This resulted in an estimated cost savings of $8145 with outpatient management with paracentesis. One-way sensitivity analyses were performed. Varying the probability of admission after outpatient treatment still indicated that outpatient treatment was the most cost-effective (probability = 1.0, cost = $6110). Varying the duration of hospitalization with primary inpatient treatment was equal to outpatient treatment costs only at a stay of 0.71 days or shorter. CONCLUSION(S): Our model suggests early outpatient paracentesis for moderate to severe OHSS is the most cost-effective management plan when compared with traditional conservative inpatient therapy. The cost savings for outpatient management persisted throughout a variety of outcome probabilities.