MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Obstetrics and Gynecology Clinics' source. Mon, 30 Jan 2012 00:18:00 +0100 http://www.medworm.com/index.php?rid=5460044&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001161%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460044 Thu, 01 Dec 2011 05:00:00 +0100 5460044 http://www.medworm.com/index.php?rid=5460043&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001082%2Fabstract%3Frss%3Dyes This article discusses the specific dissection techniques of expert surgeons, the rationale for their use, and then defines the anatomic areas of gynecologic surgery in the pelvis and the relevant structural anatomy that defines each of these areas. No surgeon can expect surgical outcomes to be any better than their surgical dissection skills. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460043 Thu, 01 Dec 2011 05:00:00 +0100 5460043 http://www.medworm.com/index.php?rid=5460042&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001069%2Fabstract%3Frss%3Dyes This article discusses the laparoscopic approach to treatment of abdominal diseases during pregnancy and in the pediatric patient. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460042 Thu, 01 Dec 2011 05:00:00 +0100 5460042 http://www.medworm.com/index.php?rid=5460041&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100101X%2Fabstract%3Frss%3Dyes Laparoscopic surgery has become the standard approach for many gynecologic procedures. The benefits of this approach over laparotomy relating to recovery, decreased morbidity, quality of life, and cosmesis are well established. In the last decade, there have been multiple advances in the technology of minimally invasive surgery enabling more complex procedures to be offered via a less invasive approach. Examples include advanced imaging platforms such as digital cameras and high definition monitors, suture-assist devices, “smart” energy devices, and robotics. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460041 Thu, 01 Dec 2011 05:00:00 +0100 5460041 http://www.medworm.com/index.php?rid=5460040&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001008%2Fabstract%3Frss%3Dyes Simulation training has suddenly become the rage in healthcare, with every week some new center marketing themselves as the first simulation training center in the area. Most announcements elaborate upon the attributes of this “brand new” technology, when in fact most other industries have used sophisticated simulation training for decades … and healthcare is only now trying to catch up! Aviation and nuclear energy are only 2 of the many industries that have for years embedded simulation into both their education and quality improvement programs. Aviation is noteworthy in that today a regularly scheduled assessment on sophisticated flight simulators is a well-ingrained part of an airline pilot's maintenance of licensure and accreditation. As in gynecologic surgery today, the simulato... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460040 Thu, 01 Dec 2011 05:00:00 +0100 5460040 http://www.medworm.com/index.php?rid=5460039&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000994%2Fabstract%3Frss%3Dyes Uterine leiomyomas are extremely common neoplasms that by the age of 50 are found in the uterus of almost 70% of white women and more than 80% of women of African ancestry. Growth of leiomyomas is largely dependent on female gonadal steroids, especially estrogens and progesterone, and following menopause they spontaneously regress. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460039 Thu, 01 Dec 2011 05:00:00 +0100 5460039 http://www.medworm.com/index.php?rid=5460038&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000982%2Fabstract%3Frss%3Dyes Electricity is a form of electromagnetic energy that flows between atoms. Electrical current (I) is defined as the amount of electricity moving through a conductor over a specific amount of time. Given a significant difference in electrical potential, electrons are set in motion in a particular direction within a conductor to carry an electrical current that is measured in amperes (A) and represents the rate of flow of electrical charge. The electromotive force that drives the current through the conductor is referred to as voltage (V). Resistance (termed impedance with high-frequency AC), is measured in Ohms and represents the property of a conductor that opposes the flow of the current (). (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460038 Thu, 01 Dec 2011 05:00:00 +0100 5460038 http://www.medworm.com/index.php?rid=5460037&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000970%2Fabstract%3Frss%3Dyes Endometriosis is the presence of tissue with the histologic appearance of endometrium outside of the endometrial cavity. Its prevalence is not known, but it is estimated to affect 10% to 15% of women of reproductive age. It is an enigmatic disease in that it may cause no symptoms in some women, yet result in incapacitating pain or resistant infertility in others. It may behave in a manner similar to malignancy in many women, with widespread and even metastatic disease, but differs from a malignancy in that it is almost never a source of mortality. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460037 Thu, 01 Dec 2011 05:00:00 +0100 5460037 http://www.medworm.com/index.php?rid=5460036&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000969%2Fabstract%3Frss%3Dyes The discovery of an adnexal mass is a common clinical problem affecting women of all ages. From 5% to 10% of American women will undergo a surgical procedure in their lifetime owing to a suspected ovarian neoplasm and between 13% and 21% of these women will be diagnosed with ovarian cancer. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460036 Thu, 01 Dec 2011 05:00:00 +0100 5460036 http://www.medworm.com/index.php?rid=5460035&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000957%2Fabstract%3Frss%3Dyes The first successful vaginal hysterectomy was performed in 1813 by Conrad Langenbeck, followed 40 years later by the first abdominal hysterectomy. It was not until the work of laparoscopic surgical pioneers Kurt Semm and Harry Reich in the late 1980s, however, that a significant procedural transformation occurred with the introduction of laparoscopic hysterectomy. Hysterectomy surveillance data reveal that nearly 600,000 hysterectomies are performed in the United States annually, with nearly a quarter of US women undergoing the procedure by the time they reach age 60. As of 2005, the most common benign indications for hysterectomy include uterine leiomyomas (41%), endometriosis (18%), and prolapse (15%). Other frequent indications are chronic pelvic pain and abnormal uterine bleeding, alth... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460035 Thu, 01 Dec 2011 05:00:00 +0100 5460035 http://www.medworm.com/index.php?rid=5460034&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000945%2Fabstract%3Frss%3Dyes The term “minimally invasive” generally represents the efforts on the part of the surgeon to reduce the impact of surgery on the patient, both in terms of incision burden, as well patient discomfort and recovery of normal health status. The recognition of the importance of these characteristics has pervaded all aspects of surgery—there is widespread acceptance of the role of minimization of incision size, use of self-retaining retractors, and other measures to improve the patients' overall experience and recovery, and these might be considered efforts to reduce the invasiveness of surgery in general, even laparotomy. There is more at stake than short term discomfort, cosmesis, and return to activities, though; a growing body of evidence suggests that, at least in some populations suc... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460034 Thu, 01 Dec 2011 05:00:00 +0100 5460034 http://www.medworm.com/index.php?rid=5460033&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001070%2Fabstract%3Frss%3Dyes Advances in the knowledge and technical skills in laparoscopy and minimally invasive surgery support the need for a special issue dedicated to this subject in Obstetrics and Gynecology Clinics of North America. The discipline of gynecology has changed in the past decades, with the emergence of specialties with fellowship training requirements in advanced laparoscopy. In addition, special interest groups have organized to form societies dedicated to advances in laparoscopy, minimally invasive surgery, and office procedures. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460033 Thu, 01 Dec 2011 05:00:00 +0100 5460033 http://www.medworm.com/index.php?rid=5460032&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100115X%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460032 Thu, 01 Dec 2011 05:00:00 +0100 5460032 http://www.medworm.com/index.php?rid=5460031&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001148%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460031 Thu, 01 Dec 2011 05:00:00 +0100 5460031 http://www.medworm.com/index.php?rid=5460030&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001136%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460030 Thu, 01 Dec 2011 05:00:00 +0100 5460030 http://www.medworm.com/index.php?rid=5460029&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511001227%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5460029 Thu, 01 Dec 2011 05:00:00 +0100 5460029 http://www.medworm.com/index.php?rid=5263053&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000891%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263053 Thu, 01 Sep 2011 04:00:00 +0100 5263053 http://www.medworm.com/index.php?rid=5263052&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000751%2Fabstract%3Frss%3Dyes Depression exacts great emotional, social, and economic costs in the form of treatment expenses, lost productivity, and emotional and social impairment. This is particularly consequential for women because the lifetime prevalence of major depression (MD) alone is more than 20%. Women have a 2-fold greater risk for depression than men. These gender differences have been found for both major depressive disorder as well as depressive symptoms in a large European study (the Depressive Research in European Society). Considerable research has focused on the physiologic and psychosocial differences between men and women as sources of depression. An important target of study has been the periods of reproductive changes and events that occur at puberty, postpartum, and menopause. (Source: Obstetric... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263052 Thu, 01 Sep 2011 04:00:00 +0100 5263052 http://www.medworm.com/index.php?rid=5263051&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100074X%2Fabstract%3Frss%3Dyes In broad strokes, the nature of change in menstrual bleeding patterns as women approach and transition through the menopause were well defined more than 40 years ago by the classic menstrual calendar studies of Treloar and colleagues, Vollman, and others. Our current attribution of menopause, defined retrospectively after 12 months of amenorrhea have been observed and derived from the groundbreaking paper on the probability of natural menopause after age 40, is based on the Treloar data (now referred to as TREMIN). However, these early studies told us little about subpopulation differences in the menopausal experience, nor did they provide clear insights into the specific bleeding changes that mark the onset of the transition. Over the past 15 years, a more nuanced understanding of the ran... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263051 Thu, 01 Sep 2011 04:00:00 +0100 5263051 http://www.medworm.com/index.php?rid=5263050&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000738%2Fabstract%3Frss%3Dyes Sexual functioning is an important component of women's lives and has increasingly received public health, pharmaceutical, and medical attention. More than 75% of the middle-aged women in the Study of Women's Health Across the Nation (SWAN) reported that sex was moderately to extremely important to them. Sexual functioning, however, declines with age, leading to much debate about the contribution of menopause to sexual activity and functioning among women. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263050 Thu, 01 Sep 2011 04:00:00 +0100 5263050 http://www.medworm.com/index.php?rid=5263049&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000775%2Fabstract%3Frss%3Dyes Is there evidence for a perimenopausal sleep disorder? Krystal and colleagues raised this question in considering factors associated with sleep disruption among midlife women that could be uniquely attributed to the menopausal transition, encompassing the perimenopausal and early postmenopausal years. In recent years, many reviews addressing the topic of perimenopausal sleep have been published. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263049 Thu, 01 Sep 2011 04:00:00 +0100 5263049 http://www.medworm.com/index.php?rid=5263048&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000726%2Fabstract%3Frss%3Dyes Habitual participation in physical activity results in many health benefits, including increased longevity, decreased risk of cardiorespiratory and metabolic diseases and some cancers (most notably colon and breast), maintenance of energy balance, and improved musculoskeletal, functional and mental health. The extensive evidence base demonstrating these beneficial effects suggests that they apply to the adult population as a whole, women as well as men and older as well as younger. However, the question of whether physical activity attenuates any of the adverse health effects that frequently accompany the menopausal transition, such as occurrence of vasomotor symptoms (VMS), increases in weight and body fat, decreases in bone density, and changes in mood and somatic symptoms, has not been ... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263048 Thu, 01 Sep 2011 04:00:00 +0100 5263048 http://www.medworm.com/index.php?rid=5263047&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000714%2Fabstract%3Frss%3Dyes Is the perimenopausal transition detrimental to cognitive function? This is an often-asked question in clinical practice, because self-reported memory problems are common during midlife. The Seattle Midlife Women's Health Study reported that of 230 women aged 33 to 55 years who were interviewed about their perceived cognitive function, 60% noticed an unfavorable memory change “over the past few years.” In this cross-sectional survey, women reported problems with recall of words and numbers, disruptions in everyday behavior (eg, losing household items), difficulty concentrating, needing to use memory aids, and forgetting events (eg, appointments). Factors that were associated with perceived memory dysfunction were being a worker, job stress and multiple life roles—but not perimenopaus... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263047 Thu, 01 Sep 2011 04:00:00 +0100 5263047 http://www.medworm.com/index.php?rid=5263046&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000787%2Fabstract%3Frss%3Dyes The loss of ovarian function during the menopausal transition has a profound impact on female skeletal health. Currently, it is estimated that 1 in every 2 Caucasian women will experience an osteoporotic fracture during her lifetime, contributing to considerable morbidity and an enormous economic burden within the aging female population. However, most studies have been conducted in postmenopausal women, with fewer investigations focusing specifically on perimenopausal bone health. The Study of Women's Health Across the Nation (SWAN) is the largest prospective cohort to date where changes in bone mineral density (BMD) and bone turnover have been examined in relation to ovarian aging among women followed across the menopausal transition. As defined by bleeding pattern in SWAN, early perimen... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263046 Thu, 01 Sep 2011 04:00:00 +0100 5263046 http://www.medworm.com/index.php?rid=5263045&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000702%2Fabstract%3Frss%3Dyes The Study of Women's Health across the Nation (SWAN) is among the largest and most ethnically diverse longitudinal studies of the menopausal transition. SWAN enrolled 3302 midlife women across 5 racial/ethnic groups, and has followed these women for more than 10 years. During this time, a wealth of information about SWAN participants was collected annually, including information about vasomotor and other menopause-related symptoms, health behaviors, social and psychological functioning, as well as a range of physiologic indices. Thus, SWAN, with its longitudinal design, multiethnic sample, and biopsychosocial perspective, has allowed unique insights into vasomotor symptoms (VMS), serving to advance the field of midlife women's health. Herein we have summarized some of the insights gained f... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263045 Thu, 01 Sep 2011 04:00:00 +0100 5263045 http://www.medworm.com/index.php?rid=5263044&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000696%2Fabstract%3Frss%3Dyes Cardiovascular disease is the leading cause of death in women in developed countries, causing more than 400,000 deaths per year. For women at the age of 40, their remaining lifetime risk is 1 in 3 for coronary heart disease (CHD), and 1 in 2 for all cardiovascular diseases. The incidence rates of cardiovascular disease in women typically lag approximately 10 years behind that of men until midlife, with a marked increase in incidence rates seen after menopause. In addition, the risk of cardiovascular disease is more than doubled among women who undergo bilateral oophorectomy compared with premenopausal women. Therefore, it has long been postulated that estrogen is cardioprotective, and that the alteration in reproductive hormonal balance related to menopause contributes to the risk of cardi... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263044 Thu, 01 Sep 2011 04:00:00 +0100 5263044 http://www.medworm.com/index.php?rid=5263043&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000763%2Fabstract%3Frss%3Dyes Until recently, the prevailing dogma was that adrenal weak androgen production in both men and women declined after the third decade of life. In the last 10 years, this concept has changed after the analysis of the longitudinal data collected in the Study of Women's Health Across the Nation (SWAN). Failure to adequately attribute phenotype, symptoms and health trajectories to the observed longitudinal changes in circulating estradiol (E2) and progesterone have led to investigations that focus on adrenal contributions to circulating sex steroids. Emerging data show that there are more ethnic and individual endocrine differences in mid-aged women in circulating adrenal steroids than in either E2 or cyclic hormone profiles, particularly during the early perimenopause. Thus, adrenal steroid pr... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263043 Thu, 01 Sep 2011 04:00:00 +0100 5263043 http://www.medworm.com/index.php?rid=5263042&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000684%2Fabstract%3Frss%3Dyes Women undergo progressive follicle loss throughout life. Although the majority of follicles in an individual woman's ovaries are lost in fetal life, there is progressive, exponential loss of oocytes through a woman's reproductive life span. Most mathematical models of oocyte loss indicate an exponential process, and an acceleration of follicle loss as women enter the menopausal transition (MT), indicating that a woman loses follicles at the fastest rates when she is the most reproductively aged. Moreover, there is evidence that the structural and functional quality of oocytes deteriorates with reproductive aging. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263042 Thu, 01 Sep 2011 04:00:00 +0100 5263042 http://www.medworm.com/index.php?rid=5263041&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000672%2Fabstract%3Frss%3Dyes The prevalence of obesity has reached epidemic proportions in the United States and other developed countries, and is rapidly becoming a primary public health concern in developing countries. In the United States, the frequency of obesity [body mass index (BMI) ≥30 kg/m2) is higher among women than men; grade 2 or 3 obesity (BMI ≥35 kg/m2 and ≥40 kg/m2, respectively) is especially prevalent among women (17.8% in women vs 10.7% in men in recent U.S. National Health and Nutrition Examination Survey data). In the United States, which is relatively far along in the obesity epidemic, obesity rates among women are stabilizing; however, there is no evidence that rates are decreasing. The prevalence of abdominal obesity, the depot more strongly associated with negative health consequences, i... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263041 Thu, 01 Sep 2011 04:00:00 +0100 5263041 http://www.medworm.com/index.php?rid=5263040&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000660%2Fabstract%3Frss%3Dyes The age at the final menstrual period holds intrinsic clinical and public health interest because the age at which natural menopause occurs may be a marker of aging and health. Later age at natural menopause has been associated with: In addition, women who have undergone bilateral oophorectomy under the age of 45 years have been observed to be at increased risk of mortality from cardiovascular disease, particularly if they were not treated with estrogen. However, women who underwent natural menopause before age 45 years had an increased risk of ischemic heart disease that was not attenuated by use of hormone therapy. Further, early menopause has been associated with earlier decline in cognitive function. Because 40 million women in the United States alone and several hundred million worldw... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263040 Thu, 01 Sep 2011 04:00:00 +0100 5263040 http://www.medworm.com/index.php?rid=5263039&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000659%2Fabstract%3Frss%3Dyes Menopause transects the aging process in women and presents an immediate dilemma for health care providers, who are often prevailed upon to determine whether or not a specific symptom or problem is attributable to the ovarian hormonal changes associated with menopause or simply to the aging process. Whereas the former is sometimes treatable with hormone therapy or other nonhormonal remedy that addresses the lack of ovarian function, the latter problems are often irreversible and only addressed by strategies designed to treat or delay the development of a chronic condition. It is therefore important for clinicians to have as clear as possible a categorization of the menopausal process and attribution of symptoms. In addition, the development of chronic diseases of aging should be predicted ... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263039 Thu, 01 Sep 2011 04:00:00 +0100 5263039 http://www.medworm.com/index.php?rid=5263038&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000799%2Fabstract%3Frss%3Dyes The Study of Women's Health Across the Nation (SWAN) was begun in 1994 to assess the impact of the menopausal process on American women. It's hard to believe our SWAN is now 17 years old! The SWAN Study is the largest cohort of its kind in the world, and the hours of time and hundreds of thousands of surveys and samples the women in our cohorts have provided are a tremendous gift to science. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263038 Thu, 01 Sep 2011 04:00:00 +0100 5263038 http://www.medworm.com/index.php?rid=5263037&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000805%2Fabstract%3Frss%3Dyes This issue of the Obstetrics and Gynecology Clinics, edited by Nanette Santoro, MD, provides an important update about the perimenopause and its impact on American women. A clearer picture of this transition period is provided by the authors using survey results from women through the National Institutes of Health's funded Study of Women's Health Across the Nation (SWAN). Menopause is the permanent cessation of any vaginal bleeding. Those years before menopause that encompass the change from normal ovulatory cycles to the cessation of menses are known as the perimenopause or the menopausal transition. The median age for the onset of the perimenopause process is 47–48 years, while this transition period from reproductive to postreproductive status lasts between 2 to 8 years for most women... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263037 Thu, 01 Sep 2011 04:00:00 +0100 5263037 http://www.medworm.com/index.php?rid=5263036&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100088X%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263036 Thu, 01 Sep 2011 04:00:00 +0100 5263036 http://www.medworm.com/index.php?rid=5263035&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000878%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263035 Thu, 01 Sep 2011 04:00:00 +0100 5263035 http://www.medworm.com/index.php?rid=5263034&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000866%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263034 Thu, 01 Sep 2011 04:00:00 +0100 5263034 http://www.medworm.com/index.php?rid=5263033&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000933%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=5263033 Thu, 01 Sep 2011 04:00:00 +0100 5263033 http://www.medworm.com/index.php?rid=4834347&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000593%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834347 Thu, 19 May 2011 14:21:10 +0100 4834347 http://www.medworm.com/index.php?rid=4834346&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000489%2Fabstract%3Frss%3Dyes This article focuses on the updated Institute of Medicine gestational weight gain recommendations and measures directed at maintaining those guidelines and improving pregnancy outcome. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834346 Thu, 19 May 2011 14:21:09 +0100 4834346 http://www.medworm.com/index.php?rid=4834345&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000349%2Fabstract%3Frss%3Dyes The finding of oligohydramnios in pregnancy is problematic. The various mechanisms that control amniotic fluid, the inability to precisely measure and quantify the amount, and the relevance of a “decreased” amount of fluid make the management of this finding unclear. Given the limited amount of data, the single deepest vertical pocket may be a better method than the amniotic fluid index to define oligohydramnios. A large prospective study is needed to develop the most optimal management recommendations, especially for idiopathic oligohydramnios at or near term. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834345 Thu, 19 May 2011 14:21:09 +0100 4834345 http://www.medworm.com/index.php?rid=4834344&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000337%2Fabstract%3Frss%3Dyes Cervical cerclage is associated with prolongation of gestation in singleton pregnancies with prior spontaneous preterm delivery and a short cervix on vaginal ultrasonography in the mid-trimester. Ultrasound screening of cervical length is not indicated in low-risk singleton pregnancies and in women with multiple gestations. 17α-Hydroxyprogesterone does not prevent preterm delivery in twin gestations with a short cervix. Cervical cerclage may cause detrimental effects in twin gestations. Vaginal pessary for the prevention of preterm birth in women with a short cervix is currently under active investigation. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834344 Thu, 19 May 2011 14:21:09 +0100 4834344 http://www.medworm.com/index.php?rid=4834343&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000325%2Fabstract%3Frss%3Dyes Cerebral palsy is a leading cause of childhood neuromotor disability and is strongly associated with preterm delivery. Basic science research and some observational studies have suggested a neuroprotective benefit from antenatal exposure to magnesium sulfate. Recent randomized controlled studies and meta-analyses suggest that antenatal exposure to magnesium sulfate before anticipated preterm birth is associated with reduction in the risk of developing cerebral palsy or its associated neurologic disabilities in surviving infants. More importantly. this benefit has been achieved without increasing the risk of perinatal mortality. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834343 Thu, 19 May 2011 14:21:09 +0100 4834343 http://www.medworm.com/index.php?rid=4834342&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000477%2Fabstract%3Frss%3Dyes This article presents a practical approach to the contemporary issue of instrumental deliveries, outlining supporting evidence (when available) and the most current position of professional colleges in obstetrics and gynecology. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834342 Thu, 19 May 2011 14:21:09 +0100 4834342 http://www.medworm.com/index.php?rid=4834341&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000313%2Fabstract%3Frss%3Dyes Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality worldwide, and abnormal placentation, including placenta accreta, is currently the most common indication for peripartum hysterectomy. Prenatal identification of these cases and early referral to centers with the capability to manage them will likely result in improved outcomes. Interventions that may limit transfusion requirements include normovolemic hemodilution, selective embolization of pelvic vessels by interventional radiology, conservative management of accretism in a few selected cases, and the use of the cell saver intraoperatively. Current understanding of the mechanisms of acute coagulopathy has questioned the current transfusion guidelines, leading to a tendency to apply massive transfusi... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834341 Thu, 19 May 2011 14:21:09 +0100 4834341 http://www.medworm.com/index.php?rid=4834340&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000301%2Fabstract%3Frss%3Dyes Smoking in pregnancy can cause serious adverse antenatal and postnatal morbidities, and a significant number of women continue to smoke in pregnancy despite these consequences. Early intervention in the form counseling from their physicians, pregnancy-specific self-help materials, counseling sessions with a health educator, and/or continued follow-up can result in better pregnancy outcomes and possibly long-term cessation. If a woman cannot quit despite these measures, pharmacotherapy can be considered. Currently, nicotine replacement therapy (NRT), transdermal patches, and bupropion are used in pregnancy, but data on the safety and efficacy are largely lacking. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834340 Thu, 19 May 2011 14:21:08 +0100 4834340 http://www.medworm.com/index.php?rid=4834339&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000295%2Fabstract%3Frss%3Dyes This article reviews the most up-to-date knowledge of prevalence, pathogenesis, and diagnosis of acquired and inherited thrombophilias and their relationship and association with pregnancy complications. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834339 Thu, 19 May 2011 14:21:08 +0100 4834339 http://www.medworm.com/index.php?rid=4834338&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000283%2Fabstract%3Frss%3Dyes Despite persisting controversy over shoulder dystocia prediction, prevention, and injury causation, the authors find considerable evidence in recent research in the field to recommend additional guidelines beyond the current American College of Obstetricians and Gynecologists and Royal College of Obstetricians and Gynecologists guidelines to improve clinical practice in managing patients at risk for experiencing shoulder dystocia. In this article, the authors offer health care providers information, practical direction, and advice on how to limit shoulder dystocia risk and, more importantly, to reduce adverse outcome risk. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834338 Thu, 19 May 2011 14:21:08 +0100 4834338 http://www.medworm.com/index.php?rid=4834337&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000271%2Fabstract%3Frss%3Dyes This article reviews the literature on 17 alpha-hydroxyprogesterone caproate (17-P) and natural progesterone and concludes that 17-P is indicated for prevention of preterm birth in women with a documented history of a preterm birth before 37 weeks. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834337 Thu, 19 May 2011 14:21:08 +0100 4834337 http://www.medworm.com/index.php?rid=4834336&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100026X%2Fabstract%3Frss%3Dyes Multiple studies have been published illustrating the use of oral hypoglycemic agents in pregnancy. Glyburide and metformin have been shown to be as effective as insulin for the treatment of gestational diabetes. Both are safe with breastfeeding. Although both glyburide and metformin appear safe for the treatment of type 2 diabetes mellitus, more studies are needed to support this practice. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834336 Thu, 19 May 2011 14:21:08 +0100 4834336 http://www.medworm.com/index.php?rid=4834335&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000258%2Fabstract%3Frss%3Dyes This article reviews the essential criteria for inductions of labor, weighing both the advantages and disadvantages of labor induction, and the various mechanical and pharmacologic agents available for cervical ripening. At the end of this article, one should be able to counsel women about the potential risks and benefit of labor induction and understand the neonatal consequences of elective induction of labor before 39 weeks of gestation. This article also discusses the different mechanical and pharmacologic agents available for cervical ripening. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834335 Thu, 19 May 2011 14:21:08 +0100 4834335 http://www.medworm.com/index.php?rid=4834334&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000246%2Fabstract%3Frss%3Dyes The antepartum administration of fluorinated corticosteroids for fetal maturation represents the most important clinical contribution in the battle against prematurity. This treatment reduces the risk of neonatal death and handicap. It is also known that on corticosteroid exposure, fetuses are subjected to transiently increased physiologic and metabolic demands. Healthy fetuses are able to cope, although emerging evidence suggests this may not be the case with severely growth-restricted fetuses. This review presents evidence of efficacy and safety pertaining to corticosteroid administration in fetal growth restriction–affected pregnancies, offers guidance to clinicians, and points out questions that still need answers. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834334 Thu, 19 May 2011 14:21:08 +0100 4834334 http://www.medworm.com/index.php?rid=4834333&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000490%2Fabstract%3Frss%3Dyes A large proportion of clinical decision-making related to the care and treatment of pregnant women is not based on level I evidence (eg, RCTs). Although progress is being made by increasing the involvement and access of RCTs to pregnant women, it is likely that this disparity will continue for quite some time. In the meantime, what should clinicians do when there are limited data or significant controversy for a specific condition or treatment? What should guide their practice? (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834333 Thu, 19 May 2011 14:21:08 +0100 4834333 http://www.medworm.com/index.php?rid=4834332&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000507%2Fabstract%3Frss%3Dyes This issue of the Clinics, with Dr Sean Blackwell and Dr George Saade as Guest Editors, provides a timely update on topics of active interest in obstetrics. Highlighted are chapters which deal with labor and delivery, management of select medical preterm disorders, and conditions that affect fetal growth and placental integrity. This issue highlights those areas where problems can occur, their warning signs, and ways to prevent or reduce additional risks. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834332 Thu, 19 May 2011 14:21:07 +0100 4834332 http://www.medworm.com/index.php?rid=4834331&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000581%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834331 Thu, 19 May 2011 14:21:07 +0100 4834331 http://www.medworm.com/index.php?rid=4834330&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100057X%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834330 Thu, 19 May 2011 14:21:07 +0100 4834330 http://www.medworm.com/index.php?rid=4834329&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000568%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834329 Thu, 19 May 2011 14:21:07 +0100 4834329 http://www.medworm.com/index.php?rid=4834328&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000635%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4834328 Thu, 19 May 2011 14:21:07 +0100 4834328 http://www.medworm.com/index.php?rid=4602536&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000209%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602536 Tue, 01 Mar 2011 00:00:00 +0100 4602536 http://www.medworm.com/index.php?rid=4602535&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000106%2Fabstract%3Frss%3Dyes Screening mammography performed annually on all women beginning at age 40 years has reduced breast cancer deaths by 30% to 50%. The cost per year of life saved is well within the range for other commonly accepted medical interventions. Various studies have estimated that reduction in treatment costs through early screening detection may be 30% to 100% or more of the cost of screening. Magnetic resonance imaging (MRI) screening is also cost-effective for very high-risk women, such as BRCA carriers, and others at 20% or greater lifetime risk. Further studies are needed to determine whether MRI is cost-effective for those at moderately high (15%–20%) lifetime risk. Future technical advances could make MRI more cost-effective than it is today. Automated whole-breast ultrasonography will prob... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602535 Tue, 01 Mar 2011 00:00:00 +0100 4602535 http://www.medworm.com/index.php?rid=4602534&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451100009X%2Fabstract%3Frss%3Dyes This article discusses the current clinical indications for breast MR including screening for breast cancer, diagnostic indications for breast MR, and MR guidance for interventional procedures. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602534 Tue, 01 Mar 2011 00:00:00 +0100 4602534 http://www.medworm.com/index.php?rid=4602533&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000088%2Fabstract%3Frss%3Dyes Breast cancer is the most common cancer in women. One in 8 women develops breast cancer and approximately 30% of all affected women die of the disease. By performing a nationwide screening program in the Netherlands, a mortality reduction of 1.2% annually was achieved. The screening program is for women between the ages of 50 and 75 years; however, women with an increased risk for developing breast cancer are mostly younger. The role of MRI in this particular group of women has been described in different studies. MRI of the breast in this group of women has a higher sensitivity than mammography, but the highest sensitivity is reached by the combination of these two imaging modalities. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602533 Tue, 01 Mar 2011 00:00:00 +0100 4602533 http://www.medworm.com/index.php?rid=4602532&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000076%2Fabstract%3Frss%3Dyes Vaginal bleeding is the most common cause of emergency care in the first trimester of pregnancy and accounts for the majority of premenopausal bleeding cases. Ultrasound evaluation combined with a quantitative beta human chorionic gonadotropin test is an established diagnostic tool to assess these patients. Spontaneous abortion because of genetic abnormalities is the most common cause of vaginal bleeding; ectopic pregnancy and gestational trophoblastic disease are other important causes and in all patients presenting with first trimester bleeding, ectopic pregnancy should be suspected and excluded, as it is associated with significant maternal morbidity and mortality. A thorough knowledge of the normal sonographic appearance of intrauterine gestation is essential to understand the manifest... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602532 Tue, 01 Mar 2011 00:00:00 +0100 4602532 http://www.medworm.com/index.php?rid=4602531&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000064%2Fabstract%3Frss%3Dyes Ultrasound should be considered the first-line imaging modality of choice in women presenting with acute or chronic pelvic pain of suspected gynecologic or obstetric origin because many, if not most, gynecologic/obstetric causes of pelvic pain are easily diagnosed on ultrasound examination. Since the clinical presentation of gynecologic causes of pelvic pain overlaps with gastrointestinal and genitourinary pathology, referral to CT or MRI, especially in pregnant patients, should be considered if the US examination is nondiagnostic. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602531 Tue, 01 Mar 2011 00:00:00 +0100 4602531 http://www.medworm.com/index.php?rid=4602530&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000052%2Fabstract%3Frss%3Dyes Acute pelvic pain in women is a common presenting complaint that can result from various conditions. Because these conditions can be of gynecologic or nongynecologic origin, they may pose a challenge to the diagnostic acumen of physicians, including radiologists. A thorough workup should include clinical history, physical examination, laboratory data, and appropriate imaging studies, all of which should be available to the radiologist for evaluation. Ultrasound is the primary imaging modality in women with acute pelvic pain because of its high sensitivity, low cost, wide availability, and lack of ionizing radiation, particularly when a gynecologic disorder is suspected as the underlying cause. However, other modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) m... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602530 Tue, 01 Mar 2011 00:00:00 +0100 4602530 http://www.medworm.com/index.php?rid=4602529&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000040%2Fabstract%3Frss%3Dyes This article reviews the role of radiologic imaging for the characterization of gynecologic masses and for staging, planning, and monitoring treatment, as well as for the assessment of tumor recurrence of the most common gynecologic malignancies. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602529 Tue, 01 Mar 2011 00:00:00 +0100 4602529 http://www.medworm.com/index.php?rid=4602528&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000039%2Fabstract%3Frss%3Dyes Pelvic floor ultrasound is a valuable adjunct in elucidation of cause, diagnosis, and treatment of pelvic floor disorders. Three-dimensional ultrasound specifically has been shown to have many advantages over conventional imaging modalities. Proper evaluation of pelvic floor muscle function, strength, and integrity is an important component of diagnosis and treatment of pelvic floor disorders. The pelvic floor muscle training used to change the structural support and strength of muscle contraction requires clinicians to be able to conduct high-quality measurements of pelvic floor muscle function and strength. Ultrasound is a useful modality to assess the pelvic floor and its function. As practitioners become more familiar with the advantages and capabilities of ultrasound, this tool should... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602528 Tue, 01 Mar 2011 00:00:00 +0100 4602528 http://www.medworm.com/index.php?rid=4602527&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000027%2Fabstract%3Frss%3Dyes This article briefly reviews the epidemiology, diagnosis, and treatment of the common gynecologic malignancies, with an emphasis on the shortcomings of current clinical practice. The persistent need to achieve early diagnosis, adjust proper treatment, enhance surveillance, and improve the outcome of these patients has led to the development of new diagnostic modalities. Novel tools such as 18F-fluorodeoxyglucose PET/CT should aim at enhancing the clinician's ability to make critical decisions in treating difficult scenarios. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602527 Tue, 01 Mar 2011 00:00:00 +0100 4602527 http://www.medworm.com/index.php?rid=4602526&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000118%2Fabstract%3Frss%3Dyes This unique issue of the Obstetrics and Gynecology Clinics of North America deals with updates on diagnostic imaging techniques that apply to women’s health. Such techniques can be integral cornerstones of gynecology since most patients, at one time or another, undergo some form of imaging to enhance clinical diagnosis in directing their care. As the availability of diagnostic imaging tools has increased and become more diverse and sophisticated, information obtained from these techniques for the obstetrician-gynecologist has added not only more detailed morphologic, but also functional diagnostic information. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602526 Tue, 01 Mar 2011 00:00:00 +0100 4602526 http://www.medworm.com/index.php?rid=4602525&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000192%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602525 Tue, 01 Mar 2011 00:00:00 +0100 4602525 http://www.medworm.com/index.php?rid=4602524&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000180%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602524 Tue, 01 Mar 2011 00:00:00 +0100 4602524 http://www.medworm.com/index.php?rid=4602523&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000179%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602523 Tue, 01 Mar 2011 00:00:00 +0100 4602523 http://www.medworm.com/index.php?rid=4602522&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854511000453%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4602522 Tue, 01 Mar 2011 00:00:00 +0100 4602522 http://www.medworm.com/index.php?rid=4184990&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510001051%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184990 Sat, 20 Nov 2010 10:41:18 +0100 4184990 http://www.medworm.com/index.php?rid=4184989&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000926%2Fabstract%3Frss%3Dyes Since its initial approval by the US Food and Drug Administration (FDA) 20 years ago for the treatment of strabismus, hemifacial spasm, and blepharospasm in adults, botulinum toxin (BTX) has become one of the most frequently requested products in cosmetic rejuvenation around the world. After years of clinical success and consistent safety in the upper face, the use of BTX has expanded and evolved to include increasingly complicated indications. In the hands of adept injectors, the focus has shifted from the treatment of individual dynamic rhytides to shaping, contouring, and sculpting, alone or in combination with other cosmetic procedures, to enhance the aesthetic appearance of the face. Although recent reports have questioned the safety of BTX, 25 years of therapeutic and over 20 years o... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184989 Sat, 20 Nov 2010 10:41:18 +0100 4184989 http://www.medworm.com/index.php?rid=4184988&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000902%2Fabstract%3Frss%3Dyes This article reviews how to incorporate various cosmeceuticals into the treatment regime of patients, depending on the diagnosis and therapies chosen. The practical application of when, why, and on whom to use different products will enable dermatologists to improve the methodology of product selection and, ultimately, improve patient's clinical results. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184988 Sat, 20 Nov 2010 10:41:17 +0100 4184988 http://www.medworm.com/index.php?rid=4184987&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000872%2Fabstract%3Frss%3Dyes Breast augmentation is the most commonly performed cosmetic procedure among American women. Saline implants, silicone implants, and autologous fat injections are the most common options. The inframammary, periareolar, and axillary routes with or without endoscopy are the most common routes of implantation. The subpectoral dual-plane and the subglandular plane are the most common pockets. The most common complications are capsular contracture for implants and volume loss for injected fat. Breast augmentation does not appear to increase breast cancer risk or survival rates. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184987 Sat, 20 Nov 2010 10:41:17 +0100 4184987 http://www.medworm.com/index.php?rid=4184986&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000938%2Fabstract%3Frss%3Dyes Adding volume to the aging face is a notion that has come into vogue as of late but is, however, not a new idea. With the advent of miro-liposuction techniques, there is renewed interest in the use of aspirated fat. Commercial fillers have a valuable place in the cosmetic surgeon's armamentarium and offer immediate volume correction with a more modest financial commitment. Nevertheless, the standardization of fat grafting techniques marks an exciting shift in facial aesthetics with the ability to correct all aspects of the aging face with safe, natural, and lasting results. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184986 Sat, 20 Nov 2010 10:41:17 +0100 4184986 http://www.medworm.com/index.php?rid=4184985&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000884%2Fabstract%3Frss%3Dyes is the most common cosmetic surgical procedure worldwide. It provides effective contouring of the torso, extremities, and submental areas in properly selected patients. Tumescent liposuction, a local anesthesia technique, and superwet liposuction, a systemic anesthesia technique, are the most common methods. The safety profile of both methods is excellent, but local anesthesia avoids the specific risks associated with general anesthesia. The most common complications of liposuction are contour irregularities and transient bruising. No technology seems to provide superior results over conventional methods. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184985 Sat, 20 Nov 2010 10:41:17 +0100 4184985 http://www.medworm.com/index.php?rid=4184984&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000859%2Fabstract%3Frss%3Dyes This article will introduce the clinician to this issue and describe treatment, which may be accomplished with the same lasers used for laser hair reduction. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184984 Sat, 20 Nov 2010 10:41:16 +0100 4184984 http://www.medworm.com/index.php?rid=4184983&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000896%2Fabstract%3Frss%3Dyes Intense Pulsed Light (IPL) is an FDA-approved photo therapy for the treatment of a variety of conditions such as acne and hirsutism. It utilizes the principle of selective photothermolysis. Photothermolysis allows a specific wavelength to be delivered to a chromophore of a designated tissue while leaving the surrounding tissue unaffected. The results of IPL are similar to that of laser treatments but it offers the advantage of a relative low cost. It is a safe and rapid treatment with minimal discomfort to the patient. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184983 Sat, 20 Nov 2010 10:41:16 +0100 4184983 http://www.medworm.com/index.php?rid=4184982&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000914%2Fabstract%3Frss%3Dyes This article introduces the practicing gynecologist to aesthetic lasers and the procedure of laser hair removal. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184982 Sat, 20 Nov 2010 10:41:16 +0100 4184982 http://www.medworm.com/index.php?rid=4184981&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000860%2Fabstract%3Frss%3Dyes Laser aesthetic procedures have substantially increased in popularity for both women and men over the past several years. As public awareness grows, so does the demand for the safe and effective delivery of these services. Gynecologists and other primary care providers are offering laser aesthetic procedures to meet their own patient demand. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184981 Sat, 20 Nov 2010 10:41:16 +0100 4184981 http://www.medworm.com/index.php?rid=4184980&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451000094X%2Fabstract%3Frss%3Dyes This issue describes cosmetic procedures that can be incorporated into gynecologic practice successfully by additional education and training that is readily available through credible post residency educational programs. While it is recognized that typical post graduate training in obstetrics and gynecology does not provide adequate preparation for the inclusion of cosmetic therapies into safe, quality practice, many obstetricians/gynecologists also recognize that there is not only demand by patients, but also other compelling reasons to consider including these procedures into their scope of practice. In addition to a rapidly growing consumer demand, there are other issues that may affect the obstetrician/gynecologist’s decision to learn and provide these treatments, including an ever-... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184980 Sat, 20 Nov 2010 10:41:16 +0100 4184980 http://www.medworm.com/index.php?rid=4184979&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000951%2Fabstract%3Frss%3Dyes I have been eager to review this issue dealing with cosmetic procedures in gynecology by guest editor, Douglas Laube, MD, since an obstetrician-gynecologist’s practice includes more than reproductive health care. The specialty’s broad scope on women’s health could include cosmetic procedures in its boundaries, just as it has for primary and preventive care. As cosmetic procedures receive more attention from the media and from patients, there is a corresponding need to determine the obstetrician-gynecologists’ role in this evolving field. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184979 Sat, 20 Nov 2010 10:41:16 +0100 4184979 http://www.medworm.com/index.php?rid=4184978&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451000104X%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184978 Sat, 20 Nov 2010 10:41:16 +0100 4184978 http://www.medworm.com/index.php?rid=4184977&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510001038%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184977 Sat, 20 Nov 2010 10:41:16 +0100 4184977 http://www.medworm.com/index.php?rid=4184976&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510001026%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184976 Sat, 20 Nov 2010 10:41:16 +0100 4184976 http://www.medworm.com/index.php?rid=4184975&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000963%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=4184975 Sat, 20 Nov 2010 10:41:15 +0100 4184975 http://www.medworm.com/index.php?rid=3810834&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451000077X%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810834 Tue, 03 Aug 2010 07:22:09 +0100 3810834 http://www.medworm.com/index.php?rid=3810833&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000616%2Fabstract%3Frss%3Dyes Reproductive tract surgery carries a risk of injury to the bladder, ureter, and gastrointestinal (GI) tract. This is due to several factors including close surgical proximity of these organs, disease processes that can distort anatomy, delayed mechanical and energy effects, and the inability to directly visualize organ surfaces. The purpose of this article is to review strategies to prevent, recognize, and repair injury to the GI and urinary tract during gynecologic surgery. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810833 Tue, 03 Aug 2010 07:22:09 +0100 3810833 http://www.medworm.com/index.php?rid=3810832&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000653%2Fabstract%3Frss%3Dyes This article presents the nerves that are at greatest risk of injury during gynecologic surgery through a series of vignettes. Suggestions for protection of each nerve are provided. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810832 Tue, 03 Aug 2010 07:22:09 +0100 3810832 http://www.medworm.com/index.php?rid=3810831&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000677%2Fabstract%3Frss%3Dyes Complications may occur during laparoscopic surgery, even with a skilled surgeon and under ideal circumstances; human error is inevitable. Videotaped procedures from malpractice cases are evaluated to ascertain potential contributing cognitive factors, systems errors, equipment issues, and surgeon training. Situation awareness and principles derived from aviation crew resource management may be adapted to help avoid systems error. The current process of surgical training may need to be reconsidered. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810831 Tue, 03 Aug 2010 07:22:09 +0100 3810831 http://www.medworm.com/index.php?rid=3810830&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000604%2Fabstract%3Frss%3Dyes This article discusses the methods of preoperative management of anemia, including use of iron, recombinant erythropoietin, and gonadotropin-releasing hormone agonists. The authors have also reviewed the methods of intraoperative and postoperative management of bleeding. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810830 Tue, 03 Aug 2010 07:22:09 +0100 3810830 http://www.medworm.com/index.php?rid=3810829&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451000063X%2Fabstract%3Frss%3Dyes Adverse events associated with hysteroscopic procedures are in general rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. A spectrum of complications exist ranging from those that relate to generic components of procedures such as patient positioning and anesthesia and analgesia, to a number that are specific to intraluminal endoscopic surgery (perforation and injuries to surrounding structures and blood vessels). The response of premenopausal women to excessive absorption of nonionic fluids deserves special attention. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar uterine resectoscopes that involve thermal injury to the vulva and vagina. The uterus that has previously undergo... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810829 Tue, 03 Aug 2010 07:22:09 +0100 3810829 http://www.medworm.com/index.php?rid=3810828&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000598%2Fabstract%3Frss%3Dyes This article reviews methods for avoiding major vessel injury while gaining laparoscopic access, including anatomic relationships of abdominal wall landmarks to the major retroperitoneal vessels. Methods for periumbilical placement of the Veress needle and primary trocar are reviewed in terms of direction and angle of insertion, and alternative methods and locations are discussed. Methods for secondary port placement are reviewed in terms of direction, depth, and speed of placement. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810828 Tue, 03 Aug 2010 07:22:09 +0100 3810828 http://www.medworm.com/index.php?rid=3810827&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000586%2Fabstract%3Frss%3Dyes This article outlines the risks that lead to SSIs and the preventive measures, including antimicrobial prophylaxis, which decrease the incidence of infection. This article also reviews the diagnosis and treatment of gynecologic SSIs. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810827 Tue, 03 Aug 2010 07:22:09 +0100 3810827 http://www.medworm.com/index.php?rid=3810826&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000641%2Fabstract%3Frss%3Dyes This article is intended to educate the clinician regarding the basis of electrosurgery and provide an explanation on how injuries may occur as well as how they may be prevented. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810826 Tue, 03 Aug 2010 07:22:09 +0100 3810826 http://www.medworm.com/index.php?rid=3810825&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000628%2Fabstract%3Frss%3Dyes It is more enjoyable to read about complications than to manage them. Surgical complications are challenging for several reasons. It is difficult to watch patients and their families suffer. Although some complications are minor setbacks that resolve over time, some lead to longstanding disability. As surgeons, we sometimes doubt ourselves in the wake of a complication and lose confidence in our abilities. In some cases, surgeons avoid surgery or practice heightened defensive surgery, rendering them surgically dysfunctional. We should ask ourselves, “Is there something I should have done differently?” “Could this have been avoided?” and “Should I have recognized something earlier?” These are questions I ask each week at our institution's morbidity and mortality conference. (Sou... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810825 Tue, 03 Aug 2010 07:22:09 +0100 3810825 http://www.medworm.com/index.php?rid=3810824&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000689%2Fabstract%3Frss%3Dyes A patient's operative care should be planned with attention to detail and awareness of potential complications. This issue, guest edited by Dr Howard Sharp, pertains to the prevention and management of complications from gynecologic surgery. Major objectives are to restore the patient's physiologic and psychologic health. The operating room presents the possibility for immediate or delayed errors. Adverse surgical events are relatively infrequent compared with other types of medical errors, although these problems often receive increased attention. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810824 Tue, 03 Aug 2010 07:22:09 +0100 3810824 http://www.medworm.com/index.php?rid=3810823&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000768%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810823 Tue, 03 Aug 2010 07:22:09 +0100 3810823 http://www.medworm.com/index.php?rid=3810822&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000756%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810822 Tue, 03 Aug 2010 07:22:09 +0100 3810822 http://www.medworm.com/index.php?rid=3810821&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000744%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810821 Tue, 03 Aug 2010 07:22:09 +0100 3810821 http://www.medworm.com/index.php?rid=3810820&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000811%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3810820 Tue, 03 Aug 2010 07:22:09 +0100 3810820 http://www.medworm.com/index.php?rid=3627686&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000549%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627686 Mon, 31 May 2010 23:00:00 +0100 3627686 http://www.medworm.com/index.php?rid=3627685&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000094%2Fabstract%3Frss%3Dyes This article discusses the relevant ethical principles, identifies unique features of obstetrical ethics, examines ethical principles as they apply to pregnant patient and her fetus, and thereby, provides a conceptual framework for considering ethical issues and facilitating decision making in clinical obstetrics. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627685 Mon, 31 May 2010 23:00:00 +0100 3627685 http://www.medworm.com/index.php?rid=3627684&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000082%2Fabstract%3Frss%3Dyes The objective of this review is to detail which patients are at clinically important increased risk for VTE, are candidates for thrombophilia screening, and warrant thromboprophylaxis. Recommended management regimens for use in specific patient subgroups are also provided. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627684 Mon, 31 May 2010 23:00:00 +0100 3627684 http://www.medworm.com/index.php?rid=3627683&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000136%2Fabstract%3Frss%3Dyes This article reviews the impact of seasonal influenza on pregnancy with particular emphasis on the 2009 novel H1N1 pandemic. Antiviral therapy for influenza, as well as recommendations and safety data on vaccination are discussed. In addition, the impact of hepatitis A, B, and C in pregnancy is addressed with a focus on prevention and treatment strategies for hepatitis B and C. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627683 Mon, 31 May 2010 23:00:00 +0100 3627683 http://www.medworm.com/index.php?rid=3627682&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000148%2Fabstract%3Frss%3Dyes This article reviews the perinatal outcomes and provides recommendations for care regarding the unique issues that arise during a pregnancy after bariatric surgery. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627682 Mon, 31 May 2010 23:00:00 +0100 3627682 http://www.medworm.com/index.php?rid=3627681&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000070%2Fabstract%3Frss%3Dyes This article discusses the pathogenesis, risk factors, diagnosis, management, and prognosis of this condition. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627681 Mon, 31 May 2010 23:00:00 +0100 3627681 http://www.medworm.com/index.php?rid=3627680&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451000015X%2Fabstract%3Frss%3Dyes Intrahepatic cholestasis (ICP) of pregnancy is a disease that is likely multifactorial in etiology and has a prevalence that varies by geography and ethnicity. The diagnosis is made when patients have a combination of pruritus and abnormal liver-function tests. It is associated with a high risk for adverse perinatal outcome, including preterm birth, meconium passage, and fetal death. As of yet, the cause for fetal death is unknown. Because fetal deaths caused by ICP appear to occur predominantly after 37 weeks, it is suggested to offer delivery at approximately 37 weeks. Ursodeoxycholic acid appears to be the most effective medication to improve maternal pruritus and liver-function tests; however, there is no medication to date that has been shown to reduce the risk for fetal death. (Sourc... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627680 Mon, 31 May 2010 23:00:00 +0100 3627680 http://www.medworm.com/index.php?rid=3627679&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000215%2Fabstract%3Frss%3Dyes As the rate of obesity increases in adolescent and adult women in the United States, practitioners of obstetrics see higher rates of gestational diabetes. Recent clinical studies suggest that women with gestational diabetes have impaired pancreatic beta-cell function and reduced beta-cell adaptation resulting in insufficient insulin secretion to maintain normal glycemia. Despite recent evidence that even mild hyperglycemia is associated with adverse pregnancy outcomes, controversies still exist in screening, management, and treatment of gestational diabetes. Initial studies regarding glyburide for treatment of gestational diabetes are promising. Overall, only about half of the women with gestational diabetes are screened in the postpartum period, an ideal time for education and interventio... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627679 Mon, 31 May 2010 23:00:00 +0100 3627679 http://www.medworm.com/index.php?rid=3627678&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000173%2Fabstract%3Frss%3Dyes This article discusses the role of angiogenic factors in the pathogenesis, prediction, diagnosis, and possible treatment of preeclampsia. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627678 Mon, 31 May 2010 23:00:00 +0100 3627678 http://www.medworm.com/index.php?rid=3627677&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000197%2Fabstract%3Frss%3Dyes This article examines pregnancy-associated complications in SSD and the management of sickle cell disorders in pregnant women. Outcomes have improved for pregnant women with SSD and nowadays the majority can achieve a successful live birth. However, pregnancy is still associated with an increased incidence of morbidity and mortality. Optimal management during pregnancy should be directed at preventing pain crises, chronic organ damage, optimization of fetal health and minimizing early maternal mortality using a multidisciplinary team approach and prompt, effective and safe relief of acute pain episodes. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627677 Mon, 31 May 2010 23:00:00 +0100 3627677 http://www.medworm.com/index.php?rid=3627676&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000124%2Fabstract%3Frss%3Dyes March 10th, 1958, is the birthday of the first baby born to a kidney transplant recipient. The pregnancy went to term and the baby was delivered by cesarean section for fear that a vaginal birth could adversely affect the allograft kidney sitting in the iliac fossa. Undoubtedly, this pregnancy more than 50 years ago was considered high risk because of its pioneering nature. However, given that the transplant recipient had received her kidney from her identical twin sister approximately 2 years before and was not taking any immunosuppressive medications, the pregnancy was associated with far fewer risks than most pregnancies in transplant recipients of today. Not only are immunosuppressants now available that have potential adverse affects on the developing fetus but also many kidney transp... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627676 Mon, 31 May 2010 23:00:00 +0100 3627676 http://www.medworm.com/index.php?rid=3627675&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000161%2Fabstract%3Frss%3Dyes This article discusses renal physiology and assessment of renal function in pregnancy and the effect of pregnancy on renal disease in patients with diabetes, lupus, chronic glomerulonephritis, polycystic kidney disease, and chronic pyelonephritis. Renal diseases occasionally present for the first time in pregnancy, and diagnoses of glomerulonephritis, acute tubular necrosis, hemolytic uremic syndrome, and acute fatty liver of pregnancy are described. Finally, therapy of end-stage renal disease in pregnancy, dialysis, and renal transplantation are reviewed. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627675 Mon, 31 May 2010 23:00:00 +0100 3627675 http://www.medworm.com/index.php?rid=3627674&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000112%2Fabstract%3Frss%3Dyes Thyroid disease is common, affecting 1% to 2% of pregnant women. Pregnancy may modify the course of thyroid disease, and pregnancy outcomes can depend on optimal management of thyroid disorders. Consequently, obstetric providers must be familiar with thyroid physiology and management of thyroid diseases in pregnancy. Following a brief overview of physiology, this article provides an in-depth review of diagnosis and management of the spectrum of thyroid disease occurring in pregnancy. Recommendations for screening and treatment of hypo- and hyperthyroidism are summarized. Specific attention is given to the limitations of current research and the status of ongoing work. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627674 Mon, 31 May 2010 23:00:00 +0100 3627674 http://www.medworm.com/index.php?rid=3627673&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000100%2Fabstract%3Frss%3Dyes This article addresses the group of pregnant women with symptomatic asthma as well as those whose asthma is asymptomatic as a result of good control. The incidence, the pathophysiologic changes of pregnancy, and the interplay between these changes and asthma are reviewed in this article. The classification of these patients and appropriate management strategies are discussed. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627673 Mon, 31 May 2010 23:00:00 +0100 3627673 http://www.medworm.com/index.php?rid=3627672&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000185%2Fabstract%3Frss%3Dyes The prevalence of preexisting diabetes in pregnancy is increasing largely because of an increase in type 2 diabetes. Outcomes of diabetic pregnancies for mother and newborn have improved greatly in recent decades from advances in understanding the disease process, improved education, and new treatment modalities delivered in a team approach. Nausea and vomiting from pregnancy and pregnancy-associated insulin resistance can make glycemic control a challenge. Care of women with preexisting diabetes demands careful monitoring in the preconception, prenatal, and peripartum periods. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627672 Mon, 31 May 2010 23:00:00 +0100 3627672 http://www.medworm.com/index.php?rid=3627671&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000203%2Fabstract%3Frss%3Dyes I am delighted to have the opportunity to edit this important issue of Obstetrics and Gynecology Clinics of North America on the topic of Medical Complications in Pregnancy. The broad field of medicine changes rapidly, with constantly occurring new breakthroughs, approaches, and recommendations. The area of medical disorders in pregnancy encompasses a broad range of diseases; a woman may have a long-term chronic disorder that can have major implications for undertaking a pregnancy. Yet, other medical conditions are unique to pregnancy but also influence gestational outcomes. Although the obstetrician has to be knowledgeable in regard to the normal physiologic changes occurring with gestation, understanding the interplay of medical conditions with these changes on not only 1 but 2 patients,... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627671 Mon, 31 May 2010 23:00:00 +0100 3627671 http://www.medworm.com/index.php?rid=3627670&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000240%2Fabstract%3Frss%3Dyes This issue of Obstetrics and Gynecology Clinics of North America, with Dr Judith Hibbard as Guest Editor, provides a timely update on topics pertaining to medical disorders in pregnancy. It is important that obstetricians have working knowledge of medical diseases common to women of childbearing age. It is difficult, however, to quantify accurately the broad range of medical illnesses that complicate pregnancy. Estimates have been derived from conditions warranting hospitalization. One study reported an overall antenatal hospitalization rate of 10 per 100 deliveries in their managed-care population of more than 46,000 pregnant women. About one third of those admissions were for nonobstetric conditions, such as renal, gastrointestinal, pulmonary, and infectious diseases. The care for some o... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627670 Mon, 31 May 2010 23:00:00 +0100 3627670 http://www.medworm.com/index.php?rid=3627669&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000537%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627669 Mon, 31 May 2010 23:00:00 +0100 3627669 http://www.medworm.com/index.php?rid=3627668&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000525%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627668 Mon, 31 May 2010 23:00:00 +0100 3627668 http://www.medworm.com/index.php?rid=3627667&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000513%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627667 Mon, 31 May 2010 23:00:00 +0100 3627667 http://www.medworm.com/index.php?rid=3627666&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000434%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3627666 Mon, 31 May 2010 23:00:00 +0100 3627666 http://www.medworm.com/index.php?rid=3597542&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000380%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597542 Mon, 01 Mar 2010 00:00:00 +0100 3597542 http://www.medworm.com/index.php?rid=3597541&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS088985451000029X%2Fabstract%3Frss%3Dyes An error appeared in the article “Pharmacologic Management of Urinary Incontinence, Voiding Dysfunction, and Overactive Bladder” in the September 2009 issue of Obstetrics and Gynecology Clinics of North America (Volume 36, Issue 3). in the original article should be replaced with the figure below: (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597541 Mon, 01 Mar 2010 00:00:00 +0100 3597541 http://www.medworm.com/index.php?rid=3597540&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000252%2Fabstract%3Frss%3Dyes This article provides an overview of the molecular changes associated with inherited gynecologic malignancies and the incorporation of this information in the counseling of individuals at increased risk for developing malignancies, as well as conventional and emerging approaches to the screening of the general population. Cancer genetic counseling and its role in women's health care is examined. The focus is hereditary breast and ovarian cancer; however, cancer predisposition caused by genes other than BRCA1 and BRCA2 is also considered. The aim is to provide a foundation for counseling based on fundamental knowledge of the genes and their clinical consequences. The reader is then guided through the mechanics of risk assessment for individual patients, concluding with the psychosocial impl... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597540 Mon, 01 Mar 2010 00:00:00 +0100 3597540 http://www.medworm.com/index.php?rid=3597539&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000227%2Fabstract%3Frss%3Dyes Inherited thrombophilias present an opportunity to review population-based screening paradigms. Inherited thrombophilias are a group of complex conditions, and women who carry mutations in implicated genes have an increased risk of adverse pregnancy outcomes as well as venous thromboembolism. That asymptomatic carriers are at risk of manifesting phenotypes moves these conditions out of the traditional molecular genetic “screening” paradigm. Like most complex disorders, residual risk remains after molecular testing for thrombophilia, and the magnitude of this risk has not been quantified. Family and personal history are important factors to consider when providing personal risk assessment to patients. Overall, “testing” for thrombophilias according to a personalized medicine model i... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597539 Mon, 01 Mar 2010 00:00:00 +0100 3597539 http://www.medworm.com/index.php?rid=3597538&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000057%2Fabstract%3Frss%3Dyes Current prenatal cytogenetic diagnosis uses mostly G-banded karyotyping of fetal cells from chorionic villi or amniotic fluid cultures, which readily detects any aneuploidy and larger structural genomic rearrangements that are more than 4 to 5 megabases in size. Fluorescence in situ hybridization (FISH) is also used for rapid detection of the common aneuploidies seen in liveborns. If there is prior knowledge that increases risk for a specific deletion or duplication syndrome, FISH with a probe specific for the region in question is done. Over the past decade, array-based comparative genomic hybridization (aCGH) has been developed, which can survey the entire genome for submicroscopic microdeletions and microduplications, in addition to all unbalanced chromosomal abnormalities that are also... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597538 Mon, 01 Mar 2010 00:00:00 +0100 3597538 http://www.medworm.com/index.php?rid=3597537&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000264%2Fabstract%3Frss%3Dyes Healthy women who carry a ‘‘premutation'’ in the FMR1 gene (or fragile X mental retardation protein) can pass on a further mutated copy of FMR1 to either male or female offspring, leading to fragile X syndrome (FXS). Premutation carriers do not have manifestations of FXS in cognitive deficits, behavioral abnormalities, or classic physical features, but are at increased risk for development of the ‘‘fragile X–associated disorders'’: premature ovarian insufficiency and fragile X–associated tremor and ataxia syndrome. When considering widespread prenatal carrier screening programs for fragile X, significant resources must be available for at-risk individuals, including counseling, accurate diagnostic options for fetal testing, and choice regarding continuation of a pregnancy. ... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597537 Mon, 01 Mar 2010 00:00:00 +0100 3597537 http://www.medworm.com/index.php?rid=3597536&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000069%2Fabstract%3Frss%3Dyes Cystic fibrosis is the first genetic disorder for which universal screening of preconceptional or prenatal patients became a component of standard prenatal care. The molecular genetics and mutation profile of the CFTR gene are complex, with a wide range of phenotypic consequences. Carrier screening can facilitate risk assessment for prospective parents to have an affected offspring, although there remains a small residual risk for carrying a mutation even with a negative screening result. There are ethnic differences with respect to disease incidence and effectiveness of carrier testing, which may complicate counseling. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597536 Mon, 01 Mar 2010 00:00:00 +0100 3597536 http://www.medworm.com/index.php?rid=3597535&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000021%2Fabstract%3Frss%3Dyes Ashkenazi Jewish genetic screening has expanded significantly in the past 4 decades. Individuals of Eastern European (Ashkenazi) Jewish (AJ) descent are at increased risk of having offspring with particular genetic diseases that have significant morbidity and mortality. In addition, there are some disorders, such as cystic fibrosis, for which northern European Caucasians are at comparable risk with those of an AJ background. Carrier screening for many of these Jewish genetic disorders has become standard of care. As technology advances, so does the number of disorders for which screening is available. Thus, we need to continue to be cognizant of informed consent, test sensitivity, confidentiality, prenatal diagnosis, preimplantation genetic screening, and public health concerns regarding t... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597535 Mon, 01 Mar 2010 00:00:00 +0100 3597535 http://www.medworm.com/index.php?rid=3597534&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000239%2Fabstract%3Frss%3Dyes This article focuses on the prevention of SMA through population carrier screening and newborn screening as a means of ensuring early intervention for SMA. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597534 Mon, 01 Mar 2010 00:00:00 +0100 3597534 http://www.medworm.com/index.php?rid=3597533&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000033%2Fabstract%3Frss%3Dyes Newborn screening is a complex public health program that has been very successful at significantly reducing infant morbidity and mortality from specific genetic conditions. As this program continues to expand, the role of the obstetrician as patient educator has become increasingly important. The need and desire for prenatal education about newborn screening has been demonstrated, and obstetricians are in the prime position to satisfy this vital role. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597533 Mon, 01 Mar 2010 00:00:00 +0100 3597533 http://www.medworm.com/index.php?rid=3597532&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000045%2Fabstract%3Frss%3Dyes This article discusses the genetic counseling resources available to the obstetrician gynecologist, including contact with referral centers near their practice and web-based resources for current genetic information. Indications for genetic counseling that incorporate new approaches and technologies are highlighted. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597532 Mon, 01 Mar 2010 00:00:00 +0100 3597532 http://www.medworm.com/index.php?rid=3597531&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000276%2Fabstract%3Frss%3Dyes When the first edition of Genetic Screening and Counseling was published in 2002, the draft of the human genome had just been declared sequenced. Since then, the sequence has become nearly finalized, and the focus is turning to translation of this information to the bedside. The genomics era is increasingly bearing fruit and promises a paradigm shift in research and medical practice. To the clinician, counseling and genetic diagnoses will become an increasing part of daily practice. The generalist obstetrician/gynecologist is included. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597531 Mon, 01 Mar 2010 00:00:00 +0100 3597531 http://www.medworm.com/index.php?rid=3597530&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000288%2Fabstract%3Frss%3Dyes This issue, edited by Anthony Gregg, MD, and Joe Leigh Simpson, MD, is a much needed update of the 2002 issue pertaining to genetic screening and counseling for obstetrician-gynecologists. The purpose of this issue is to assist obstetrician-gynecologists in understanding and applying the concepts of molecular genetics to clinical practice, research, and the provision of health care in the community. In conjunction with genetics counselors, this issue reviews the basics of contemporary prenatal counseling. This issue of Obstetrics and Gynecology Clinics on genetics contains all of the current topics of active clinical relevance. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597530 Mon, 01 Mar 2010 00:00:00 +0100 3597530 http://www.medworm.com/index.php?rid=3597529&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000379%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597529 Mon, 01 Mar 2010 00:00:00 +0100 3597529 http://www.medworm.com/index.php?rid=3597528&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000367%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597528 Mon, 01 Mar 2010 00:00:00 +0100 3597528 http://www.medworm.com/index.php?rid=3597527&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000355%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597527 Mon, 01 Mar 2010 00:00:00 +0100 3597527 http://www.medworm.com/index.php?rid=3597526&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854510000422%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3597526 Mon, 01 Mar 2010 00:00:00 +0100 3597526 http://www.medworm.com/index.php?rid=3035274&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509001144%2Fabstract%3Frss%3Dyes (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035274 Sat, 28 Nov 2009 14:46:25 +0100 3035274 http://www.medworm.com/index.php?rid=3035273&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000886%2Fabstract%3Frss%3Dyes Up to 7% of women report premenstrual symptoms severe enough to impair daily function, and are said to suffer from premenstrual dysphoric disorder (PMDD). Although PMDD is predominately regarded as a biologically based condition, sociocultural factors, and particularly life stress, past sexual abuse, and cultural socialization, likely interact with hormonal changes. This integrative model has implications for etiology and treatment of PMDD. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035273 Sat, 28 Nov 2009 14:46:25 +0100 3035273 http://www.medworm.com/index.php?rid=3035272&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000862%2Fabstract%3Frss%3Dyes Substance abuse poses significant health risks to reproductive age women in the United States and, for those who become pregnant, to their children. Substance abuse or dependence is defined as a maladaptive pattern of substance use marked by recurrent and significant negative consequences related to the repeated use of substances. Alcohol is the most prevalent substance consumed by childbearing-aged women, followed by tobacco and various illicit drugs. Substance use in the preconception period predicts continued but often limited substance use during the prenatal period. Providers must be aware of reproductive age women's unique physiologic, psychological, and social needs and the related legal and ethical ramifications surrounding substance abuse before referral to a community-based multi... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035272 Sat, 28 Nov 2009 14:46:25 +0100 3035272 http://www.medworm.com/index.php?rid=3035271&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000813%2Fabstract%3Frss%3Dyes Millions of American girls and women have been drawn to smoking by an industry that has been clearly and systematically targeting women of all ages and life circumstances. Tobacco marketing strategies skillfully link cigarette use to typical female values. Biologically speaking, women are especially vulnerable to the legion of health problems of tobacco use. Smoking is a critical hazard for women in their reproductive years, particularly when they are pregnant. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035271 Sat, 28 Nov 2009 14:46:25 +0100 3035271 http://www.medworm.com/index.php?rid=3035270&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000801%2Fabstract%3Frss%3Dyes Sexual dysfunctions diminish the quality of life for many women, frequently causing enough distress to warrant the diagnosis of a sexual disorder. Problems with sexual function can occur in any stage of the sexual response cycle. Dysfunction is further influenced by a variety of factors: medical, psychiatric, cultural, and stage of life. A variety of treatment modalities exist, though current research has not yet provided Food and Drug Administration approved therapies for sexual disorders in women. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035270 Sat, 28 Nov 2009 14:46:24 +0100 3035270 http://www.medworm.com/index.php?rid=3035269&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000898%2Fabstract%3Frss%3Dyes Intimate partner violence (IPV) is a common problem affecting many women who present to obstetrics and gynecology practices. It takes on many forms, including psychologic/emotional, physical, and sexual abuse, and its effects on the health of victims and their children vary. Although many women's health care professionals may be uncomfortable inquiring about IPV, a knowledge of patients' IPV victimization may help physicians develop a better understanding of patients' presenting symptoms and health risks, form more effective therapeutic relationships, and work toward reducing the myriad health risks associated with IPV. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035269 Sat, 28 Nov 2009 14:46:24 +0100 3035269 http://www.medworm.com/index.php?rid=3035268&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000825%2Fabstract%3Frss%3Dyes This article describes the circumstances under which women may develop insomnia and the various treatment options, including hypnotic medication and nonpharmacologic approaches. The efficacy and safety of these treatments are reviewed. The choice of treatment depends on the nature of the insomnia, the stage of a woman's life, the presence of medical or mental health conditions, the availability of treatments, and personal preference. For immediate, short-term relief of acute insomnia, hypnotic medication, especially the nonbenzodiazepines (zolpidem, zopiclone, eszopiclone) are options. For chronic insomnia, insomnia-specific cognitive and behavioral therapies are generally the interventions of choice. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035268 Sat, 28 Nov 2009 14:46:24 +0100 3035268 http://www.medworm.com/index.php?rid=3035267&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000795%2Fabstract%3Frss%3Dyes Nocturnal sleep is characterized by a unique pattern of endocrine activity, which comprises reciprocal influences on the hypothalamo-pituitary-adrenal (HPA) and the somatotropic system. During early sleep, when slow wave sleep (SWS) prevails, HPA secretory activity is suppressed whereas growth hormone (GH) release reaches a maximum; this pattern is reversed during late sleep when rapid eye movement (REM) sleep predominates. SWS benefits the consolidation of hippocampus-dependent declarative memories, whereas REM sleep improves amygdala-dependent emotional memories and procedural skill memories involving striato-cortical circuitry. Manipulation of plasma cortisol and GH concentration during sleep revealed a primary role of HPA activity for memory consolidation. Pituitary-adrenal inhibition ... Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035267 Sat, 28 Nov 2009 14:46:24 +0100 3035267 http://www.medworm.com/index.php?rid=3035266&cid=s_33240_29_f&fid=33240&url=http%3A%2F%2Fwww.obgyn.theclinics.com%2Farticle%2FPIIS0889854509000837%2Fabstract%3Frss%3Dyes This article reviews the evidence for clinical efficacy, active ingredients, mechanisms of action, recommended dosages, and toxicities of the 3 best-studied putative natural antidepressants, St. John's wort (hypericum), S-adenosyl methionine, and the Ω-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid. Despite growing evidence for efficacy and safety, more comprehensive studies are required before these remedies can be recommended as safe and effective alternatives or adjuncts to conventional psychotropic agents. There are limited data regarding safety in pregnancy and during lactation, and caution is therefore recommended in women who are pregnant or breastfeeding. (Source: Obstetrics and Gynecology Clinics) Obstetrics and Gynecology Clinics journals http://www.medworm.com/rss/comments.php?id=3035266 Sat, 28 Nov 2009 14:46:24 +0100 3035266