eMedicine Specialties > Obstetrics and Gynecology > Labor and Delivery

Cesarean Delivery: Workup

Author: Saju Joy, MD, MS, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Coauthor(s): Stephen A Contag, MD, Instructor, Fellow in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Apr 2, 2009

Workup

Laboratory Studies

When patients are admitted for labor and delivery, most have blood for a CBC count and type and screen drawn when an intravenous line is started, which is a basic requirement for patients when they are admitted to the labor floor. These tests are drawn in addition to HIV antibodies, hepatitis B surface antigen, and a screening test for syphilis if they have not been recently obtained. If the patient has a hemoglobin level within the reference range, has had an uncomplicated pregnancy, and is anticipated to have a vaginal delivery, the use of having blood submitted to the lab for a routine CBC and type and screen has been debated from a cost-benefit standpoint. In many centers, blood is drawn and simply held in case the patient's course changes. If the decision is made to perform a cesarean delivery for an abnormal labor course, nonreassuring fetal testing, or abnormal bleeding, then the blood work is submitted.
 
Several situations can occur in which a CBC count and type and screen will be submitted upon admission to labor and delivery: (1) when a patient is admitted for a planned cesarean delivery, (2) a grand multipara, or (3) a history of postpartum hemorrhage or a bleeding disorder. Occasionally, a coagulation profile is necessary. In patients with thrombocytopenia, a history of a bleeding disorder, preeclampsia, or conditions with suspect DIC whether consumptive or secondary to thromboplastin release, a CBC and coagulation studies including prothrombin time, activated partial thromboplastin time, and fibrinogen may be ordered to assist the attending anesthesiologist in determining the safety of attempting regional anesthesia with an epidural or spinal procedure.
 
Most known thrombophilias, hemophilias, or other medical conditions that could compromise cardiac, circulatory, or respiratory function during surgery should be addressed with the anesthesiologist prior to admission for cesarean delivery. This includes patients with morbid obesity in which airway access as well as vascular access can be extremely challenging.
 
Some patients require blood to be crossmatched, with blood in storage available. The most common situation is a patient who has had prior laparotomies (including several prior cesarean deliveries), patients with known or suspect placenta previa or placenta accreta, or one who develops a coagulopathy from either severe preeclampsia or significant hemorrhage.

Imaging Studies

Upon arrival to labor and delivery, fetal position and estimated fetal weight should be always be documented. Ultrasonography is commonly used to estimate fetal weight despite evidence from a prospective study reporting the sensitivity of clinical and ultrasonographic prediction of macrosomia as 68% and 58%, respectively.49 Despite the notion that estimations have an inherent margin of error, legal texts and journals have maintained that a physician’s failure to assess fetal weight during pregnancy or labor constitutes a deviation from standards of practice.48

More on Cesarean Delivery

Overview: Cesarean Delivery
Workup: Cesarean Delivery
Treatment: Cesarean Delivery
Follow-up: Cesarean Delivery
References
[ CLOSE WINDOW ]

References

  1. Menacker F. Trends in cesarean rates for first births and repeat cesarean rates for low-risk women: United States, 1990-2003. Natl Vital Stat Rep. Sep 22 2005;54(4):1-8. [Medline].

  2. Reiss H. Abdominal delivery in the 16th century. J R Soc Med. Jul 2003;96(7):370. [Medline].

  3. Todman D. A history of caesarean section: from ancient world to the modern era. Aust N Z J Obstet Gynaecol. Oct 2007;47(5):357-61. [Medline].

  4. Beck AC. Observations on a series of cesarean sections done at the Long Island College Hospital during the past six years. Am J Obstet Gynecol. 1919;79:197.

  5. Kerr JMM. The technic of Caesarean section with special reference to the lower uterine segment incision. Am J Obstet Gynecol. 1926;12:726.

  6. Placek PJ, Taffel SM. Recent patterns in cesarean delivery in the United States. Obstet Gynecol Clin North Am. Dec 1988;15(4):607-27. [Medline].

  7. MacDorman MF, Menacker F, Declercq E. Cesarean birth in the United States: epidemiology, trends, and outcomes. Clin Perinatol. Jun 2008;35(2):293-307, v. [Medline].

  8. Harper MA, Byington RP, Espeland MA, et al. Pregnancy-related death and health care services. Obstet Gynecol. Aug 2003;102(2):273-8. [Medline].

  9. Hamilton BE, Martin JA, Sutton PD. Births: preliminary data for 2003. Natl Vital Stat Rep. Nov 23 2004;53(9):1-17. [Medline].

  10. Betrán AP, Merialdi M, Lauer JA, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol. Mar 2007;21(2):98-113. [Medline].

  11. Villar J, Valladares E, Wojdyla D, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet. Jun 3 2006;367(9525):1819-29. [Medline].

  12. Cho MK, Kim YH, Song TB. Predictive factors for vaginal birth after cesarean delivery. Int J Gynaecol Obstet. Sep 2004;86(3):392-3. [Medline].

  13. Martin JA, Hamilton BE, Sutton PD, et al. Final data for 2005. National vital statistics reports. In: Births. 56. (6). Hyattsville, MD: National Center for Health Statistics; 2007.

  14. Hannah ME, Hannah WJ, Hewson SA, et al. Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group. Lancet. Oct 21 2000;356(9239):1375-83. [Medline].

  15. Glezerman M. Five years to the term breech trial: the rise and fall of a randomized controlled trial. Am J Obstet Gynecol. Jan 2006;194(1):20-5. [Medline].

  16. ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. Obstet Gynecol. Jul 2006;108(1):235-7. [Medline].

  17. Meis PJ, Klebanoff M, Thom E, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. Jun 12 2003;348(24):2379-85. [Medline].

  18. Rouse DJ, Hirtz DG, Thom E, et al. A randomized, controlled trial of magnesium sulfate for the prevention of cerebral palsy. N Engl J Med. Aug 28 2008;359(9):895-905. [Medline].

  19. O'Shea M. Cerebral palsy. Semin Perinatol. Feb 2008;32(1):35-41. [Medline].

  20. Foley ME, Alarab M, Daly L, et al. Term neonatal asphyxial seizures and peripartum deaths: lack of correlation with a rising cesarean delivery rate. Am J Obstet Gynecol. Jan 2005;192(1):102-8. [Medline].

  21. Notzon FC, Cnattingius S, Bergsjo P, et al. Cesarean section delivery in the 1980s: international comparison by indication. Am J Obstet Gynecol. Feb 1994;170(2):495-504. [Medline].

  22. Hankins GD, Clark SM, Munn MB. Cesarean section on request at 39 weeks: impact on shoulder dystocia, fetal trauma, neonatal encephalopathy, and intrauterine fetal demise. Semin Perinatol. Oct 2006;30(5):276-87. [Medline].

  23. Grobman WA, Gersnoviez R, Landon MB, et al. Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol. Dec 2007;110(6):1249-55. [Medline].

  24. State-of-the-Science Conference Statement Cesarean Delivery on Maternal Request 27–29 March 2006. NIH. Available at http://consensus.nih.gov/2006/2006CesareanSOS027main.htm. Accessed October 30, 2008.

  25. Schenker JG, Cain JM. FIGO Committee Report. FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health. International Federation of Gynecology and Obstetrics. Int J Gynaecol Obstet. Mar 1999;64(3):317-22. [Medline].

  26. Lee YM, D'Alton ME. Cesarean delivery on maternal request: maternal and neonatal complications. Curr Opin Obstet Gynecol. Dec 2008;20(6):597-601. [Medline].

  27. ACOG technical bulletin. Dystocia and the augmentation of labor. Number 218--December 1995 (replaces no. 137, December 1989, and no. 157, July 1991). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. Apr 1996;53(1):73-80. [Medline].

  28. Cruikshank DP. Intrapartum management of twin gestations. Obstet Gynecol. May 2007;109(5):1167-76. [Medline].

  29. Alexander JM, Leveno KJ, Rouse D, et al. Cesarean delivery for the second twin. Obstet Gynecol. Oct 2008;112(4):748-52. [Medline].

  30. Sakala EP, Andree I. Optimal route of delivery for meningomyelocele. Obstet Gynecol Surv. Apr 1990;45(4):209-12. [Medline].

  31. Preis K, Swiatkowska-Freund M, Janczewska I. Spina bifida--a follow-up study of neonates born from 1991 to 2001. J Perinat Med. 2005;33(4):353-6. [Medline].

  32. Luthy DA, Wardinsky T, Shurtleff DB, et al. Cesarean section before the onset of labor and subsequent motor function in infants with meningomyelocele diagnosed antenatally. N Engl J Med. Mar 7 1991;324(10):662-6. [Medline].

  33. How HY, Harris BJ, Pietrantoni M, et al. Is vaginal delivery preferable to elective cesarean delivery in fetuses with a known ventral wall defect?. Am J Obstet Gynecol. Jun 2000;182(6):1527-34. [Medline].

  34. Salihu HM, Emusu D, Aliyu ZY, et al. Mode of delivery and neonatal survival of infants with isolated gastroschisis. Obstet Gynecol. Oct 2004;104(4):678-83. [Medline].

  35. Puligandla PS, Janvier A, Flageole H, Bouchard S, Laberge JM. Routine cesarean delivery does not improve the outcome of infants with gastroschisis. J Pediatr Surg. May 2004;39(5):742-5. [Medline].

  36. Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep. Dec 17 2003;52(10):1-113. [Medline].

  37. Thacker SB, Stroup D, Chang M. Continuous electronic heart rate monitoring for fetal assessment during labor. Cochrane Database Syst Rev. 2001;CD000063. [Medline].

  38. Scheller JM, Nelson KB. Does cesarean delivery prevent cerebral palsy or other neurologic problems of childhood?. Obstet Gynecol. Apr 1994;83(4):624-30. [Medline].

  39. MacKenzie IZ, Cooke I. What is a reasonable time from decision-to-delivery by caesarean section? Evidence from 415 deliveries. BJOG. May 2002;109(5):498-504. [Medline].

  40. Brown ZA, Wald A, Morrow RA, et al. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA. Jan 8 2003;289(2):203-9. [Medline].

  41. Clinical Guidelines Portal. Available at http://www.aidsinfo.nih.gov/Guidelines/. Accessed Nov 8, 2008.

  42. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. Mar 2003;13(3):175-90. [Medline].

  43. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol. Jul 1985;66(1):89-92. [Medline].

  44. Buchmann EJ, Libhaber E. Sagittal suture overlap in cephalopelvic disproportion: blinded and non-participant assessment. Acta Obstet Gynecol Scand. 2008;87(7):731-7. [Medline].

  45. Cheng YW, Hopkins LM, Laros RK Jr, et al. Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes. Am J Obstet Gynecol. Jun 2007;196(6):585.e1-6. [Medline].

  46. Landon MB. Vaginal birth after cesarean delivery. Clin Perinatol. Sep 2008;35(3):491-504, ix-x. [Medline].

  47. Mehta SH, Bujold E, Blackwell SC, et al. Is abnormal labor associated with shoulder dystocia in nulliparous women?. Am J Obstet Gynecol. Jun 2004;190(6):1604-7; discussion 1607-9. [Medline].

  48. Gottlieb AG, Galan HL. Shoulder dystocia: an update. Obstet Gynecol Clin North Am. Sep 2007;34(3):501-31, xii. [Medline].

  49. Weiner Z, Ben-Shlomo I, Beck-Fruchter R, et al. Clinical and ultrasonographic weight estimation in large for gestational age fetus. Eur J Obstet Gynecol Reprod Biol. Oct 10 2002;105(1):20-4. [Medline].

  50. Grootscholten K, Kok M, Oei SG, et al. External cephalic version-related risks: a meta-analysis. Obstet Gynecol. Nov 2008;112(5):1143-51. [Medline].

  51. Crenshaw JT, Winslow EH. Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth. J Obstet Gynecol Neonatal Nurs. Mar-Apr 2006;35(2):257-64. [Medline].

  52. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. Mar 1999;90(3):896-905. [Medline].

  53. Bucklin BA, Hawkins JL, Anderson JR, et al. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. Sep 2005;103(3):645-53. [Medline].

  54. [Best Evidence] Afolabi BB, Lesi FE, Merah NA. Regional versus general anaesthesia for caesarean section. Cochrane Database Syst Rev. Oct 18 2006;CD004350. [Medline].

  55. Alexander JW, Aerni S, Plettner JP. Development of a safe and effective one-minute preoperative skin preparation. Arch Surg. Dec 1985;120(12):1357-61. [Medline].

  56. Balthazar ER, Colt JD, Nichols RL. Preoperative hair removal: a random prospective study of shaving versus clipping. South Med J. Jul 1982;75(7):799-801. [Medline].

  57. Pritchard JA, Baldwin RM, Dickey JC, et al. Blood volume changes in pregnancy and the puerperium. Am J Obstet Gynecol. 1962;84:1271–82.

  58. [Best Evidence] Hofmeyr GJ, Mathai M, Shah A, et al. Techniques for caesarean section. Cochrane Database Syst Rev. Jan 23 2008;CD004662. [Medline].

  59. [Best Evidence] Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery. Am J Obstet Gynecol. Nov 2005;193(5):1607-17. [Medline].

  60. Holmgren G, Sjoholm L, Stark M. The Misgav Ladach method for cesarean section: method description. Acta Obstet Gynecol Scand. Aug 1999;78(7):615-21. [Medline].

  61. Giacalone PL, Daures JP, Vignal J, et al. Pfannenstiel versus Maylard incision for cesarean delivery: A randomized controlled trial. Obstet Gynecol. May 2002;99(5 Pt 1):745-50. [Medline].

  62. Hohlagschwandtner M, Ruecklinger E, Husslein P, et al. Is the formation of a bladder flap at cesarean necessary? A randomized trial. Obstet Gynecol. Dec 2001;98(6):1089-92. [Medline].

  63. Rodriguez AI, Porter KB, O'Brien WF. Blunt versus sharp expansion of the uterine incision in low-segment transverse cesarean section. Am J Obstet Gynecol. Oct 1994;171(4):1022-5. [Medline].

  64. Dodd JM, Anderson ER, Gates S. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev. Jul 16 2008;CD004732. [Medline].

  65. Sung JF, Daniels KI, Brodzinsky L, et al. Cesarean delivery outcomes after a prolonged second stage of labor. Am J Obstet Gynecol. Sep 2007;197(3):306.e1-5. [Medline].

  66. Lurie S, Sulema V, Kohen-Sacher B, et al. The decision to delivery interval in emergency and non-urgent cesarean sections. Eur J Obstet Gynecol Reprod Biol. Apr 15 2004;113(2):182-5. [Medline].

  67. Levy R, Chernomoretz T, Appelman Z, et al. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. Eur J Obstet Gynecol Reprod Biol. Jul 1 2005;121(1):24-6. [Medline].

  68. Atkinson MW, Owen J, Wren A, et al. The effect of manual removal of the placenta on post-cesarean endometritis. Obstet Gynecol. Jan 1996;87(1):99-102. [Medline].

  69. Morales M, Ceysens G, Jastrow N, et al. Spontaneous delivery or manual removal of the placenta during caesarean section: a randomised controlled trial. BJOG. Sep 2004;111(9):908-12. [Medline].

  70. Cartwright PS, Pittaway DE, Jones HW 3rd, et al. The use of prophylactic antibiotics in obstetrics and gynecology. A review. Obstet Gynecol Surv. Sep 1984;39(9):537-54. [Medline].

  71. Costantine MM, Rahman M, Ghulmiyah L, et al. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol. Sep 2008;199(3):301.e1-6. [Medline].

  72. Coutinho IC, Ramos de Amorim MM, Katz L, et al. Uterine exteriorization compared with in situ repair at cesarean delivery: a randomized controlled trial. Obstet Gynecol. Mar 2008;111(3):639-47. [Medline].

  73. Chapman SJ, Owen J, Hauth JC. One- versus two-layer closure of a low transverse cesarean: the next pregnancy. Obstet Gynecol. Jan 1997;89(1):16-8. [Medline].

  74. Durnwald C, Mercer B. Uterine rupture, perioperative and perinatal morbidity after single-layer and double-layer closure at cesarean delivery. Am J Obstet Gynecol. Oct 2003;189(4):925-9. [Medline].

  75. Bujold E, Bujold C, Hamilton EF, et al. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol. Jun 2002;186(6):1326-30. [Medline].

  76. Gyamfi C, Juhasz G, Gyamfi P, et al. Single- versus double-layer uterine incision closure and uterine rupture. J Matern Fetal Neonatal Med. Oct 2006;19(10):639-43. [Medline].

  77. Harrigill KM, Miller HS, Haynes DE. The effect of intraabdominal irrigation at cesarean delivery on maternal morbidity: a randomized trial. Obstet Gynecol. Jan 2003;101(1):80-5. [Medline].

  78. Komoto Y, Shimoya K, Shimizu T, et al. Prospective study of non-closure or closure of the peritoneum at cesarean delivery in 124 women: Impact of prior peritoneal closure at primary cesarean on the interval time between first cesarean section and the next pregnancy and significant adhesion at second cesarean. J Obstet Gynaecol Res. Aug 2006;32(4):396-402. [Medline].

  79. Chelmow D, Rodriguez EJ, Sabatini MM. Suture closure of subcutaneous fat and wound disruption after cesarean delivery: a meta-analysis. Obstet Gynecol. May 2004;103(5 Pt 1):974-80. [Medline].

  80. Hellums EK, Lin MG, Ramsey PS. Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery--a metaanalysis. Am J Obstet Gynecol. Sep 2007;197(3):229-35. [Medline].

  81. [Best Evidence] Rousseau JA, Girard K, Turcot-Lemay L, Thomas N. A randomized study comparing skin closure in cesarean sections: staples vs subcuticular sutures. Am J Obstet Gynecol. Mar 2009;200(3):265.e1-4. [Medline].

  82. Barclay DL. Cesarean hysterectomy. Thirty years' experience. Obstet Gynecol. Jan 1970;35(1):120-31. [Medline].

  83. Cunningham FG, MacDonald PC, Gant NF (eds). Williams Obstetrics. 19th ed. Norwalk, Conn: Appleton & Lange; 1993.

  84. Depp R. Cesarean section. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics. 3rd ed. New York, NY: Churchill Livingston; 1996.

  85. Duff P. Pathophysiology and management of postcesarean endomyometritis. Obstet Gynecol. Feb 1986;67(2):269-76. [Medline].

  86. Swartz WH, Grolle K. The use of prophylactic antibiotics in cesarean section. A review of the literature. J Reprod Med. Dec 1981;26(12):595-609. [Medline].

  87. Mowat J, Bonnar J. Abdominal wound dehiscence after caesarean section. Br Med J. May 1 1971;2(756):256-7. [Medline].

  88. Bonnar J. Venous thromboembolism and pregnancy. Clin Obstet Gynaecol. Aug 1981;8(2):455-73. [Medline].

  89. Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. Nov 15 2005;143(10):697-706. [Medline].

  90. Laros RK Jr, Alger LS. Thromboembolism and pregnancy. Clin Obstet Gynecol. Dec 1979;22(4):871-8. [Medline].

  91. Duff P, Gibbs RS. Pelvic vein thrombophlebitis: diagnostic dilemma and therapeutic challenge. Obstet Gynecol Surv. Jun 1983;38(6):365-73. [Medline].

  92. Brown CE, Stettler RW, Twickler D, et al. Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy. Am J Obstet Gynecol. Jul 1999;181(1):143-8. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

caesarean section, caesarean birth, cesarean section, C section, cesarean birth, vaginal delivery, childbirth, parturition, delivery, birthing, laparotomy, hysterotomy, low transverse incision, classical incision, vertical incision

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Saju Joy, MD, MS, Assistant Professor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Saju Joy, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Stephen A Contag, MD, Instructor, Fellow in Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University School of Medicine
Stephen A Contag, MD is a member of the following medical societies: American Institute of Ultrasound in Medicine and Society for Maternal-Fetal Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jordan G Pritzker, MD, Assistant Professor of Obstetrics, Gynecology, and Women's Health, Women's Comprehensive Health Center, Albert Einstein College of Medicine; Physician-In-Charge, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard S Legro, MD, Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center
Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

David Chelmow, MD, Professor of Obstetrics and Gynecology, Tufts University School of Medicine; Program Director, Tufts University Affiliated Hospitals OB/GYN Residency Program; Chair, Tufts University Health Sciences Campus Institutional Review Board; Vice Chair for Research and Education, Dept of OB/GYN, Tufts Medical Center
David Chelmow, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, Phi Beta Kappa, Sigma Xi, Society for Gynecologic Investigation, and Society for Medical Decision Making
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.