Myofascial pelvic pain is a common, nonarticular musculoskeletal disorder characterized by the presence of myofascial trigger points in the lower abdominal wall and/or pelvic floor muscles. Myofascial pelvic pain is involved in an estimated 22% to 94% of cases of chronic pelvic pain, which is one of the most common gynecologic conditions in the United States. Myofascial pelvic pain may exist independently or in conjunction with disorders such as vaginismus, dysmenorrhea, and endometriosis and is frequently a causative factor in sexual pain or dyspareunia. This article reviews the pathophysiology, assessment, and treatment options for myofascial pelvic pain, with a particular focus on trigger point injections. Increased recognition and treatment of this commonly overlooked diagnosis has the potential to improve care and outcomes for many patients suffering from chronic pelvic pain.

Advances in health care science and delivery, coupled with patient need for access to care, have driven expanded practice in midwifery for decades. The process for development and implementation of expanded practices for midwives and midwifery practices is described. Important components include assessment of need, identifying stakeholders and supporters, development of a program proposal, obtaining privileges, developing training programs, and conducting ongoing quality management and program evaluation. Examples of expanded practice in midwifery are presented.

A newborn who presents for care with bruising, lethargy, or poor feeding requires immediate evaluation. It is important to take a complete history and physical examination to determine what further testing is warranted. Differential diagnoses should include, but are not limited to, nonaccidental trauma, sepsis, or clotting disorders. A history for the baby should include newborn medications after birth, vaccination history, nutrition, and any social information pertinent to the living situation. Maternal medical history should include a list of current medications as well as those taken during pregnancy, any complications related to pregnancy or birth, and pertinent chronic health problems. Bruising on a baby in the first year of life should include laboratory work and may indicate additional radiologic studies to assess for intracranial hemorrhage. This article will help the clinician work through a case study for evaluation and treatment.

No abstract