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To ensure prioritization and growth of Quality Improvement (QI) work in Obstetrics and Gynecology, attention must be taken to teaching clinicians and learners. Recently, formal curricula and training programs in QI have emerged, as governing bodies endorse education and competence in QI across the spectrum of medical education. However, comprehensive recommendations for teaching QI in Obstetrics and Gynecology are not well established. The authors present best practices, suggestions, and common pitfalls in teaching QI in Obstetrics and Gynecology based on current literature and their own experiences, broken down into curriculum development, implementation into training programs, and mentorship in QI.
Public reports offer comparative quality information across providers and have become an accepted way of improving both the accountability and quality of our health care delivery system. Given the continued challenges of maternal morbidity and mortality in the United States, report cards serve as a useful tool for helping drive improvements in care quality. This article provides an overview of public reports of perinatal and women's health in the United States, including which indicators have been developed, which are used in public reports, which entities do the reporting, the successes and challenges of these public reports, and opportunities for improvement.
Colposcopy is an office-based procedure performed to identify precancerous or cancerous lesions of the cervix. In 2017, colposcopy guidelines were developed by the American Society for Colposcopy and Cervical Pathology to standardize terminology, protocolize the procedure, and propose quality metrics. As a result of changes in cervical cancer screening and management guidelines, the volume of colposcopy within the United States has significantly decreased over the past 3 decades, and with the adoption of the human papillomavirus vaccination is anticipated to continue to decline. Therefore, colposcopic quality assessment and improved provider training is of increasing importance.
This article examines the ongoing marginalization of transgender and gender diverse (TGD) populations across social, economic, legal and health care systems. Despite recent progress, TGD individuals continue to face stigma, discrimination, and limited access to quality care. Providers should use inclusive terminology with clear understanding distinctions and definitions for respectful communication. A major barrier remains the lack of provider education, especially in obstetrics and gynecology training. Also, the article reviews a framework for inclusive gender-affirming care emphasizing leadership support, inclusive environment, and patient advocacy to promote equity, dignity, and engagement in health care for TGD communities.
Gender-affirming medical treatment for transgender and gender-diverse individuals effectively aligns secondary sex characteristics with gender identity improving psychological well-being, quality of life, and social functioning. This article focuses on gender-affirming hormone therapy (GAHT) synthesizing current evidence and guideline recommendations for feminizing and masculinizing GAHT, including dosing strategies, monitoring protocols, fertility counseling, and management of common side effects. Future priorities include optimizing low-dosing protocols for nonbinary patients. GAHT, when provided through informed-consent and evidence-based monitoring, represents safe, effective, and life-affirming care. Continued innovation and global research are essential to advance equity and ensure high-quality gender-affirming medicine for all.
The first defense against a medical malpractice lawsuit is avoiding the lawsuit altogether. The probability of being sued can be reduced through compassion and thorough attention to the patient. A proper response to an adverse event or bad result can be crucial to avoidance of later being sued. The content of the medical and hospital chart can support a defense or, at times, can imperil the defense of the physician being sued. Aggrieved patients can pursue multiple theories of liability against an obstetrician or gynecologist.
This article reviews the burden of vasomotor symptoms (VMS) during the menopause transition and highlights persistent underuse and inequities in evidence-based treatment. Although menopausal hormone therapy (MHT) is the most effective and evidence-based first-line therapy for VMS, utilization remains strikingly low, particularly among publicly insured, Black, rural, and underserved populations. The authors synthesize evidence that low and inequitable MHT use is multifactorial, driven by patient beliefs, misinformation, insurance and reimbursement structures, workforce limitations, and care delivery contexts. Finally, the article proposes scalable solutions including group-based menopause care and risk-based, tiered care pathways to expand equitable access to high-quality menopause care.
Over the last 50 years, the percentage of women in medicine has more than doubled. Every medical specialty now has a critical mass of females, defined as ≥15%, and 6 specialties have greater than 50% women. Obstetrics and gynecology (OB/GYN) has undergone an almost complete reversal of the gender makeup of the specialty and soon will have less than a critical mass of men. Certain gender-based inequities persist despite OB/GYN being majority female since 2008. Moving forward, the specialty must continue supporting women's advancement to leadership positions and recruiting male medical students to OB/GYN residency.
Continuous process improvement at the front lines of care is critical to providing compassionate, high-value care to our patients and their families within our ever-changing health care landscapes. This article aims to serve as a high-level, non-MBA primer on the concepts of Lean and Six Sigma process improvement techniques that can be used to change how individual practices deliver care. By improving the efficiency of the care delivery systems within our office practices, we can enhance patient experience, provide high-value care, improve financial performance, reduce burnout, and bolster work-life balance.
Best practice guidelines for preconception, pregnancy, and postpartum care of transgender men do not exist due to a lack of large-scale data. Decisions about testosterone use in the preconception and postpartum period should be weighed against risks to the pregnancy and exacerbation of gender dysphoria. Because patients' experiences with bodily changes during and after pregnancy can vary from gender-affirming to dysphoric, prenatal and peripartum care should aim to be individualized through a gender-affirming lens. Obstetric outcomes do not seem to be worse in transgender men, but more robust studies are needed for generalizability.
Effective labor and delivery care hinges on tightly knit teams, shared goals, and a culture of safety. This article outlines how diverse professionals-from physicians and nurses to anesthesiologists and families-become a functioning unit through clearly defined roles, leadership, and a common mental model. It emphasizes structured tools, standardized language, and safety huddles (bedside and unit) to align care, reduce delays, and manage emergencies. Frameworks like Situation, Background, Assessment, and Recommendation and Illness severity, Patient, Action, Synthesis, Summary support clear communication; color-based cesarean grading clarifies urgency; and a fetal heart rate observer improves monitoring vigilance.
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Transgender and gender diverse (TGD) youth face significant health disparities, underscoring the critical need for equitable, evidence-based care. Based on substantial evidence, the gender-affirming care model remains the standard of care. TGD youth may seek gynecologic expertize for a variety of reproductive health care concerns. This article outlines essential considerations for clinicians when providing gender-inclusive services to pediatric patients. Key areas addressed include creating a safe clinical environment, managing psychosocial comorbidities, administering gender affirming medical therapy, and addressing gynecologic needs such as menstrual suppression, contraception, sexual health screening, and fertility counseling.
Enhanced recovery after cesarean delivery (ERAC) can be defined as a set of evidence-based interventions to standardize the perioperative care of patients. In this narrative review, the author consider the general principles and perioperative elements of ERAC, standardization of outcome measures for audit, quality improvement and research purposes, and the influence of ERAC on outcomes and recovery.
During the menopausal transition and into early menopause, women gain body fat, particularly centrally, and lose lean mass. There is a worsening of cardiometabolic risk factors including insulin resistance, dyslipidemia, and vascular function. Combined diet and exercise interventions, particularly when employed during the menopausal transition, show evidence for improvement in weight, body composition, and metabolic risk factors. Although there are limited data on the effects of first-generation and second-generation antiobesity medications and bariatric surgery, glucagon-like peptide 1 receptor agonists are promising agents to prevent and mitigate adverse changes in body composition and cardiometabolic risk.
The menopausal transition is characterized by significant hormonal fluctuations, culminating in a decline in estrogen levels. This decline impacts synaptic plasticity, neurotransmitter regulation, the blood brain barrier, cerebral blood flow, and metabolism, leading to cognitive symptoms often described as brain fog. Menopause-related cognitive changes, often transient, differ from the progressive decline seen in Alzheimer's Disease (AD). Research continues to explore estrogen's role in AD risk, but current evidence does not support using exogenous estrogen solely for dementia prevention. Hormone therapy can help manage menopausal symptoms and should be personalized based on factors like age, timing, and overall brain health.
Vector-borne diseases, including dengue, Zika virus, chikungunya, and Oropouche, pose significant health risks during pregnancy, with potential adverse outcomes for both mother and fetus. As a result of expanding vector habitats, there is increasing likelihood that obstetricians will encounter these illnesses in their clinical practice. This clinical guidance aims to provide evidence-based recommendations for the diagnosis and management of tropical vector-borne diseases in pregnant individuals, emphasizing clinical risk stratification based on epidemiologic risk factors. The clinical overlap with other obstetric syndromes such as intrauterine inflammation and infection underscores the importance of early detection to mitigate adverse pregnancy outcomes. Discussion of preventive measures, including vector control, the use of repellents, and vaccination, is included.
The menopause transition can be a time of significant symptoms that impact quality of life and long-term health. Symptoms often go untreated due to lack of clinician knowledge about the safety of menopause hormone therapy (MHT) or comfort and facility with its prescribing. Experts agree that MHT is safe and effective for most people. The timing, route, and dose of therapy are important considerations for practical and safe prescribing.
The menopause transition and post-menopause are associated with genitourinary changes that can impact sexual function and overall quality of life. Declining estrogen levels due to cessation of ovarian follicular function triggers these changes and may also contribute to or exacerbate other vulvar conditions. Prompt recognition of the spectrum of normal menopausal vulvovaginal changes, distinguishing them from pathologic conditions, and understanding the multifactorial influences on vulvovaginal health is integral to care of women in midlife and beyond.
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