Preface

The field of OB/GYN hospital medicine is new, but expanding exponentially. First described in 2002, it is estimated that there are more than 275 OB/GYN hospitalist programs in the United States today, with one to two new programs added each month. Despite this rapid growth, there is a paucity of high-quality, easily approachable, and comprehensive medical education materials available for OB/GYN hospitalists.

The rising cost of litigation from OB/GYN complications and the Affordable Care Act (ACA) have made patient safety one of the most critical concerns of hospitals nationwide. At the same time, there is a growing trend for establishing a better work-life balance for physicians. This confluence has created the perfect environment for the burgeoning field of OB/GYN hospital medicine, which enhances patient safety and clinical outcomes while improving physician satisfaction. Hospitals are eager to start their own programs, physicians are excited to become part of this field, and they can now use this textbook as a medical resource.

We envision this textbook as the critical foundation for every medical school, residency program, OB/GYN, and hospital looking to take advantage of this emerging field. It provides comprehensive coverage of all aspects of OB/GYN hospital medicine encompassing clinical practice, as well as program development and business models. The book lays out the necessary steps to ensure that new programs operate seamlessly within the hospital, and it will be an important tool to help ensure that physicians, nurses, administrators, and staff understand how to make the most of a hospitalist program. To stay on the cutting edge, this textbook is available both in print and online, with associated surgical videos.

Jennifer R. Butler

Alpesh N. Amin

Laura E. Fitzmaurice

Christine M. Kim

The Society of OB/GYN Hospitalists (SOGH) is a non-profit membership organization dedicated to improving outcomes for hospitalized women.

The SOGH Board of Directors considers this publication to be of educational value to its members. Although the SOGH may not agree with every recommendation or statement in the publication, we support the scholarly efforts and find the OB/GYN Hospital Medicine: Principles and Practice to be in line with our mission.

For more information about the SOGH visit us at www.societyofobgynhospitalists.org

Editors' Note: The following practice updates were released just prior to publication and are included here due to space constraints in the respective chapters.

In the recently revised Practice Bulletin, Use of Prophylactic Antibiotics in Labor and Delivery, Number 199, August 2018, ACOG does not formally add adjuvant azithromycin to its recommendations; however, it does state that, "the addition of azithromycin, infused over 1 hour, to a standard antibiotic prophylaxis regimen may be considered for women undergoing a nonelective cesarean delivery."1 This statement is based primarily on the results of a large randomized, placebo-controlled trial of 2,013 women undergoing nonelective cesarean delivery where women who received 500 mg of adjuvant azithromycin had a significant reduction in the composite outcome of endometritis, wound infection or other infections (RR, 0.51; 95% CI, 0.38-0.68, P<.001).2 Of note, this recommendation was not extended to women undergoing elective cesarean delivery.

PRACTICE UPDATE: HYSTEROSCOPIC STERILIZATION

Due to unexpectedly high rates of reported adverse reactions and events associated with the Essure device, in 2016 the FDA mandated a black box warning, and in April 2018 placed restrictions limiting the doctors/practices able to perform Essure placement. In July 2018, Bayer announced they would be discontinuing sale of the device. Hysteroscopic sterilization is therefore not a viable alternative to inpatient female sterilization procedures, as of this printing. For more information, go to https://www.fda.gov/medicaldevices/productsandmedicalprocedures/implantsandprosthetics/essurepermanentbirthcontrol/ucm452254.htm.

1. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 199: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2018 Sep;132(3):798–800.

2. Tita AT, Szychowski JM, Boggess K, Saade G, Longo S, et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med 2016; 375 (13):1231–41.