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MFM Practice Guidelines

Book cover: Obstetric Evidence Based Guidelines
Obstetric Evidence
Based Guidelines

The Division of Maternal-Fetal Medicine aims at providing care that is evidence-based. Evidence-based medicine is the concept of treating patients according to the best available evidence. It is unscientific and unethical to practice medicine, teach or conduct research without first knowing all that is already been proven. Years of study of the best evidence, i.e. that based mostly on randomized trials and meta-analyses of these trials, lead to the publication of two volumes of guidelines, entitled ‘Obstetric Evidence Based Guidelines’ and ‘Maternal-Fetal Evidence Based Guidelines’ (Second Editions).
Use these links to purchase the individual titles through amazon.com. Also available in the Hardcover Two-Volume Set (First Edition) Obstetric and Maternal-Fetal Evidence-Based Guidelines.

Book Cover: Maternal-Fetal Evidence Based Guidelines
Maternal-Fetal Evidence
Based Guidelines

These books aim at providing a current systematic review of the evidence, so that current practice and education, as well as future research, can be based on the full story from the best-conducted research, not just the latest data or someone’s opinion. These evidence-based guidelines cannot be used as a ‘cookbook’, or a document dictating the best care. The knowledge from the best evidence presented in the guidelines needs to be integrated with other knowledge gained from clinical judgment, individual patient circumstances, and patient preferences, to lead to best medical practice. These are guidelines, not rules. Even the best scientific studies are not always perfectly related to any given individual, and clinical judgment must still be applied to allow the best ‘particularization’ of the best knowledge for the individual, unique patient. Evidence-based medicine informs clinical judgment, but does not substitute it.

On careful investigation, indeed there is data on almost everything we do in obstetrics, especially on our interventions. Indeed, our field is now the pioneer for numbers of meta-analysis and extension of work for evidence-based reviews. Obstetricians are now blessed with lots of data, and should make the best use of it. It is the gap between research and clinicians that needed to be filled, making sure that proven interventions are clearly highlighted, and are included in today’s care. Like all pilots fly planes under similar rules to maximize safety, all obstetricians should manage all aspects of pregnancy with similar, evidenced-based rules. Indeed only interventions that have been proven to provide benefit should be used routinely. On the other hand, primum non nocere: interventions that have clearly been shown to be not helpful or indeed harmful to mother and/or baby should be avoided. Another aim of the books is to make sure the pregnant woman and her unborn child are not penalized by the medical community. In most circumstances, medical disorders of pregnant women can be treated as in non-pregnant adults. Moreover, there are several effective interventions for preventing or treating specific pregnancy disorders.

We aimed for brevity and clarity. Suggested management of the healthy or sick mother and child is stated as straightforwardly as possible, for everyone to easily understand and implement. Key management points are highlighted at the beginning of each guideline, and in bold in the text. The chapters are divided in two volumes, one on Obstetrics and one on Maternal-Fetal Medicine. Please contact us for any comments, criticisms, corrections, missing evidence, etc.

I have the most fun discovering the best ways to alleviate discomfort and disease. The search for the best evidence for these guidelines has been a wonderful, stimulating journey. Keeping up with evidence-based medicine is exciting. The most rewarding part, as a teacher, is the dissemination of knowledge. I hope, truly, that this effort will be helpful to you, too.

Table 1
Why did we write this book?
Many aims:

  • Improve the health of women and their children
  • ‘Make it easy to do it right’
  • Clinical best care
  • Research ideas
  • Education
  • Develop lectures
  • Decrease disease, use of detrimental interventions, and therefore costs
  • Reduce medico-legal risks

Table 2
Who is this book for:

  • Generalists
  • Residents
  • Nurses
  • Medical students
  • MFM attendings
  • MFM fellows
  • Other consultants on pregnancy
  • Even lay public who wants to know ‘the evidence’
  • Politicians responsible for health care