Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Index: PDF Only Source Type: research

Psychological Impact of Pregnancy Loss: Best Practice for Obstetric Providers
This article integrates findings from prominent lineages of theory to offer the obstetric provider an evidence-based framework for patient care. Current consensus across fields of study is that preexisting depression and anxiety are the strongest predictors of psychological functioning after loss and through the subsequent pregnancy. Compassionate care, informational guidance and timed follow-up positively impact patient outcomes. The article concludes with recommendations for obstetric provider training and self-care. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Psychiatric Emergencies in Pregnancy and Postpartum
The perinatal period is a vulnerable time for the acute onset and recurrence of psychiatric illness. Primary care providers are opportunely positioned to intervene for women who present with mood decompensation, excessive anxiety, or psychosis during the perinatal period. Owing to increased screening efforts in obstetrical clinics and amount of contact during the perinatal period, obstetricians may be able to identify patients who need treatment before their symptoms become severe. In this article, we address imminent and emergent psychiatric symptoms in the perinatal period including management and risk reduction to help ...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Treatment of Postpartum Depression: Recommendations for the Clinician
Postpartum depression is a significant public health problem affecting almost 600,000 US women every year. It may arise de novo in the postpartum period or continue from pregnancy. A number of evidence-based psychotherapies and medical treatments exist for major depression and postpartum depression. The obstetrical team has many opportunities to identify high risk and depressed women and refer them to mental health professionals or begin treatment with antidepressant medication. Careful assessment of risk factors for postpartum depression during pregnancy and monitoring depressive symptoms during pregnancy and the postpart...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Predictors of Postpartum Depression: A Comprehensive Review of the Last Decade of Evidence
Postpartum depression (PPD) is one of the most frequent complications of childbirth affecting ~500,000 women annually (prevalence 10% to 15%). Despite the documented adverse outcomes for mother and child, there remains a great need to develop prospective approaches to identify women at risk. This review examines some of the best-characterized molecular and clinical risk factors for PPD. We illustrate that this is a growing literature but there remains a lack of reliable molecular predictors for PPD. Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for i...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

A Systematic Review of Integrated Care Interventions Addressing Perinatal Depression Care in Ambulatory Obstetric Care Settings
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research. Critical to its real-world success will be consideration for practice workflow and logistics, ...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Psychotherapeutic Treatments for Depression During Pregnancy
Depression during pregnancy is a significant public health problem that is associated with adverse consequences for women and children. Despite the availability of treatment options, depression during pregnancy is often undertreated. Most pregnant women prefer nonpharmacological interventions over antidepressant medications. We review the evidence base for psychotherapeutic treatment approaches to depression during pregnancy. Treatments reviewed include interpersonal therapy, cognitive-behavioral therapy, behavioral activation, and mindfulness-based cognitive therapy. We review both traditional face-to-face delivery and di...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Pharmacotherapy for Perinatal Depression
Perinatal depression is associated with serious risks for the mother, baby, and family. When considering treating perinatal depression with a drug indicated for the treatment of depression, the major concerns are whether the drug increases the risks of teratogenicity, pregnancy complications, poor neonatal adaptation, or neurodevelopmental disorders. Although different studies have produced different results, the majority have not shown increases in risk for selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, or the noradrenergic/dopaminergic drug bupropion. In ...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Consequences of Antepartum Depression
To counsel women about risks and benefits of depression treatment during pregnancy, clinicians must appreciate the potential consequences of untreated depression on the mother and her unborn child. Many studies have demonstrated associations between untreated depression during pregnancy and a range of adverse outcomes, including low birth weight, preterm delivery, preeclampsia, emergent operative delivery, postpartum depression, and both cognitive and behavioral deficits in the child. Although most of these associations are marked by low odds ratios and a host of potential confounding issues, they collectively provide cons...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Screening for Depression in Pregnancy and the Postpartum Period
Depression in pregnancy and the postpartum period is common, burdensome, and underrecognized. Guidelines from multiple organizations support routine screening once during pregnancy and again in the postpartum period. A variety of validated patient questionnaires are effective screening tools for pregnant and postpartum women. Universal screening programs can successfully overcome patient, clinician, and system barriers and reduce the burden of disease. Novel approaches include postpartum screening in pediatric settings and the use of e-screening to optimize privacy and facilitate scoring and interpretation. Implementation ...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Foreword: Depression in the Pregnant Patient
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Depression in the Pregnant Patient Source Type: research

Contributors: Depression in the Pregnant Patient
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Contributors: Depression in the Pregnant Patient: PDF Only Source Type: research

Extended Use of Systemic Menopausal Hormone Therapy
Because clinical trial data assessing more than 10 years of hormone therapy (HT) use are not available, providing guidance to menopausal women regarding duration of systemic HT is controversial. However, clinicians routinely encounter this issue in practice. Using available evidence and clinical experience, this chapter provides guidance for clinicians who care for patients who may be candidates for extended use of systemic HT. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Genitourinary Syndrome of Menopause
Genitourinary syndrome of menopause (GSM) describes a collection of exam findings and bothersome symptoms associated with estrogen deficiency involving changes to the labia, introitus, clitoris, vagina, urethra, and bladder. Vulvovaginal atrophy is a component of GSM. GSM is a highly prevalent medical condition with adverse effects on the health and quality of life of midlife women. There are many effective treatment options, including nonhormonal lubricants and moisturizers, physical therapy, low-dose vaginal estrogen therapy, vaginal dehydroepiandrosterone, and oral ospemifene. Despite the availability of safe and effect...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Managing Menopause by Combining Evidence With Clinical Judgment
Menopause occurring before the age of 40 harbors unique challenges as well as lifetime burden resulting from premature deprivation from ovarian hormones, primarily estrogen. Cessation of ovarian function before age 40 is considered premature (ovarian insufficiency), whereas if occurring before age 45, it is deemed “early.” Early/premature menopause may be idiopathic, medically, or surgically induced. Regardless of the cause, for such women, menopausal hormone therapy is truly replacement and should continue until at least the average age of menopause. Hormone therapy offers the benefit of symptom control, and p...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Menopausal Hormone Therapy in Gynecologic Cancer Survivors: A Review of the Evidence and Practice Recommendations
Gynecologic cancers are common in the United States and represent a significant health burden. Treatment of these cancers often causes premature cessation of ovarian function, with resultant symptoms that are often more severe than those associated with natural menopause. Hormone therapy is the most effective treatment for menopausal symptoms, but the decision-making process about its use can be complex for survivors of gynecologic cancer. In this review, we provide evidence-based recommendations about the use of hormone therapy after gynecologic cancer. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Hormone Therapy in Breast Cancer Survivors and Those at High Risk for Breast Cancer
Women and health care providers are often fearful of using hormone therapy to deal with distressing menopausal symptoms in circumstances where there is a perceived or real increased risk of breast cancer. This paper examines the evidence for and against hormone therapy use in 3 common clinical situations: the woman with a positive family history in a first-degree relative, the woman who has undergone risk-reducing salpingo-oophorectomy due to a known genetic mutation, and the woman in whom treatment of breast cancer has induced premature menopause. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Managing Menopause by Combining Evidence With Clinical Judgment
In the United States, nearly 10 million women are currently in the menopause transition and 2.25 million women are 51 years of age, which is the average age of menopause. Approximately 75% of these women will experience vasomotor symptoms such as hot flashes and night sweats. Menopause hormone therapy (HT) remains the most effective treatment for menopausal symptoms, but the decision to use HT is complex and requires balancing the benefits and risks for the individual patient. The decision also requires clinical judgment and shared decision making with the patient. In this review, we discuss the current guidelines for HT u...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Tissue-selective Estrogen Complex for Menopausal Hormone Therapy
The first approved tissue-selective estrogen complex is a pairing of conjugated estrogen combined with the selective estrogen-receptor modulator, bazedoxifene. Advantages include relief of menopausal symptoms without the increased chance of bleeding or breast tenderness unlike with traditional estrogen-progestin therapy, which is associated with both bleeding and breast tenderness. Tissue-selective estrogen complex effects on relief of vasomotor symptoms, prevention of bone loss, improvement in vaginal symptoms, lack of significant cardiovascular effects beyond the expected 2-fold increase in venous thrombosis, neutral eff...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Differential Effects of Progestogens Used for Menopausal Hormone Therapy
Recommendations regarding menopausal hormone therapy continue to evolve as more studies are completed. Progestogens, indicated for endometrial protection in women on estrogen therapy who have an intact uterus, seem to confer greater health risks than estrogen alone. Thus, it is important for clinicians to be well informed when prescribing these medications. This review focuses on the different types and use of progestogens in women with an intact uterus using systemic menopausal hormone therapy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Hormone Therapy: Key Points From NAMS 2017 Position Statement
The goal of the 2017 North American Menopause Society Hormone Therapy (HT) Position Statement is to remove fear about HT and encourage individualized shared decision making, using best available evidence. Systemic HT is safe and effective for symptomatic menopausal women aged younger than 60 years and within 10 years of menopause. Special populations of early menopause, high risk for fracture, risk of breast or uterine cancer, and extended duration are discussed. With longer duration of use, periodic evaluation and reassessment of health risks are needed. Lowered doses, transdermal therapies or newer options may enhance th...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Vasomotor and Related Menopause Symptoms
Vasomotor symptoms are the most common manifestation of the menopause transition and postmenopausal phases of reproductive life. They interfere not only in quality of life, but also contribute to sleep and mood disturbances that potentially compromise home and work effectiveness. Treatment options include hormone therapy (HT), nonhormonal prescription drugs, mind body and behavior therapies, and over-the-counter preparations. Evidence confirms that HT is the most effective option. The initial reticence to prescribe HT immediately following publication of the Women’s Health Initiative has been replaced by clear guidel...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Management of the Perimenopause
Perimenopause, or the menopausal transition, represents a period of time during which newly arising symptoms can present complex management decisions for providers. Many women present to care with complaints of hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns. The effect of these symptoms on quality of life, even before a woman enters menopause, can be significant. The appropriate evaluation and evidence-based management of women in this transition is reviewed in this article. Two case vignettes are used to highlight certain evaluation and treatment challenges. (Source: Clinic...
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Foreword: Managing Menopause by Combining Evidence With Clinical Judgment
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Managing Menopause by Combining Evidence With Clinical Judgment Source Type: research

Contributors: Managing Menopause by Combining Evidence With Clinical Judgment
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 26, 2018 Category: OBGYN Tags: Contributors: Managing Menopause by Combining Evidence With Clinical Judgment: PDF Only Source Type: research

Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Index: PDF Only Source Type: research

The Alliance for Innovation in Maternal Health Care: A Way Forward
The Alliance for Innovation in Maternal Health is a program supported by the Health Services Resource Administration to reduce maternal mortality and severe maternal morbidity in the United States. This program develops bundles of evidence based action steps for birth facilities to adapt. Progress is monitored at the facility, state and national levels to foster data-driven quality improvement efforts. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Reducing Disparities in Severe Maternal Morbidity and Mortality
This article reviews racial and ethnic disparities in severe maternal morbidities and mortality, underlying drivers of these disparities, and potential levers to reduce their occurrence. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

The Role of the Anesthesiologist in Preventing Severe Maternal Morbidity and Mortality
Anesthesiologists are responsible for the safe and effective provision of analgesia for labor and anesthesia for cesarean delivery and other obstetric procedures. In addition, obstetric anesthesiologists often have a unique role as the intensivists of the obstetric suite. The anesthesiologist is frequently the clinician with the greatest experience in the acute bedside management of a hemodynamically unstable patient and expertise in life-saving interventions. This review will discuss (1) risks associated with neuraxial and general anesthesia for labor and delivery, and (2) clinical scenarios in which the obstetric anesthe...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Reducing Maternal Mortality and Severe Maternal Morbidity: The Role of Critical Care
Throughout most of the 20th century, the risk of maternal mortality in high resource countries decreased dramatically; however, this trend recently has stalled in the United States and appears to have reversed. Equally alarming is that for every reported maternal death, there are numerous severe maternal morbidities or near misses. Shifting maternal demographics (eg, obesity, advanced maternal age, multifetal pregnancies), with attendant significant medical comorbidities (eg, hypertension, diabetes, cardiac disease) and the increase in cesarean deliveries significantly contribute to increased maternal morbidity and mortali...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

A View From the UK: The UK and Ireland Confidential Enquiry into Maternal Deaths and Morbidity
The UK Confidential Enquiry into Maternal Deaths has been in operation for more than 60 years, during which time maternal mortality rates have fallen 10-fold. The program includes two aspects, surveillance and confidential case review, providing different information to aid quality improvement in maternity care. The enquiry now also reviews the care of women with specific severe morbidities. Recommendations have very clearly led to improved outcomes for women, most notably shown in the very low mortality rate due to hypertensive and related disorders of pregnancy. Maternal cardiac disease and mental health problems remain ...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Understanding Severe Maternal Morbidity: Hospital-based Review
This article will review steps to organizing and implementing standard reviews of all cases of SMM. These steps include create multidisciplinary SMM review committee; identify potential SMM cases and confirm true SMM; identify the morbidity; abstract and summarize data; present case to review committee for discussion; determine events leading to morbidity; determine opportunities to improve outcome; assess provider, system and patient factors in cases with opportunities to improve outcome; make recommendations; and effect change and evaluate improvement. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

State-based Review of Maternal Deaths: The Ohio Experience
This article describes the development and operation of Ohio’s state-based maternal death review including interventions developed and actions taken based on review data. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Reducing Maternal Mortality and Severe Maternal Morbidity Through State-based Quality Improvement Initiatives
State Perinatal Quality Collaboratives (PQCs) represent a major advance for scaling up quality improvement efforts for reducing maternal mortality and severe maternal morbidity. The critical roles of partners, rapid-cycle low-burden data systems, and linkage to maternal mortality review committees are reviewed. The choice of measures is also explored. California’s experience with its PQC, data center, quality improvement efforts, and promising results for reduction of maternal mortality and morbidity from hemorrhage are presented. Early data from other states is also shared. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Severe Maternal or Near Miss Morbidity: Implications for Public Health Surveillance and Clinical Audit
This chapter reviews the historical development of indicators to identify severe maternal morbidity/maternal near miss (SMM/MNM), and their use for public health surveillance, research, and clinical audit. While there has been progress toward identifying standard definitions for SMM/MNM within countries, there remain inconsistencies in the definition of SMM/MNM indicators and their application between countries. Using these indicators to screen for events that then trigger a clinical audit may both under identify select SMM/MNM (false negative)and over identify select SMM/MNM (false positive). Thus, indicators which suppor...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Maternal Mortality in the United States: A Review of Contemporary Data and Their Limitations
This article provides a review of maternal mortality data and their limitations in the United States. National maternal mortality data, which rely heavily on vital statistics, document that the risk of death from pregnancy-related causes has not declined for>25 years and that striking racial disparities persist. State-based maternal mortality reviews, functional in many states, obtain detailed information on medical and nonmedical factors contributing to maternal deaths. Without this detailed knowledge from state-level data and without addressing recognized quality problems with vital statistics data at the national-lev...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Foreword: Maternal Mortality and Severe Maternal Morbidity
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Maternal Mortality and Severe Maternal Morbidity Source Type: research

Contributors: Maternal Mortality and Severe Maternal Morbidity
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Contributors: Maternal Mortality and Severe Maternal Morbidity: PDF Only Source Type: research

Perioperative Management of the Gynecologic Patient on Long-term Anticoagulation
This article describes specific strategies for whether and how these medications should be interrupted before gynecologic procedures, when they can be restarted following the procedure, and whether bridging therapy should be considered. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Thrombosis and Thromboprophylaxis in Gynecology Surgery
Gynecologic surgery offers unique challenges, as pelvic surgery places patients at an increased risk of venous thromboembolism (VTE). Prevention of VTE is a goal of patients, policy makers, and surgeons. In this review, we address the current research and recommendations for VTE prophylaxis. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Management of Menopausal Symptoms for Women Who Are at High Risk of Thrombosis
For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone therapy increases the risk of venous thromboembolism by 2-fold to 3-fold. Observational studies suggest less thrombotic risk with transdermal therapies and with progesterone over synthetic progestogens (progestins), but the data are limited. Beneficial nonpharmacologic therapies include cognitive behavioral therapy and clinical hypnosis, whereas beneficial nonhormonal pharmacologic therapies include selective serotonin reuptake inhibitors and serotonin-norepin...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Managing Heavy Menstrual Bleeding in Women at Risk of Thrombosis
Management of heavy menstrual bleeding (HMB) in a woman with a history of thrombosis, or who is otherwise at high risk of thrombosis, or who takes medications for anticoagulation can present a challenge to health care providers. The goal of treating HMB is to reduce menstrual blood loss. First-line therapy is typically hormonal, and hormonal therapy can be contraindicated in women with a history of thrombosis unless they are on anticoagulation. As 70% of women on anticoagulation experience HMB, successful management of HMB may involve a modification in the anticoagulation or antiplatelet regimen, hormonal therapy tailored ...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Contraceptive Management for Women Who Are at High Risk of Thrombosis
Managing contraception for women at high risk for thrombosis poses unique challenges. Combined estrogen and progestin contraceptives increase the risk of both venous and arterial thrombosis. They are contraindicated in women with a history of thrombosis and in other women at high risk for thrombosis. However, progestin-only contraceptives are generally considered safe in this patient population. This paper reviews the evidence linking hormonal contraception and clotting risk, outlines appropriate contraceptive methods for women at high risk for thrombosis, discusses surgical risk for sterilization in the setting of current...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Prevention and Management of Stroke in Obstetrics and Gynecology
The objective of this review is to provide an evidence-based summary of stroke incidence, risk factors, prevention, and treatment of stroke in pregnancy. The impact of postpartum contraceptive use can on stroke risk is summarized. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Prevention and Management of Thromboembolism in Pregnancy When Heparins Are Not an Option
Heparins, unfractionated heparin, and low molecular weight heparin, are the preferred anticoagulants in pregnancy. There are circumstances, however, in which an alternative to heparin should be considered. These circumstances include, the presence of heparin resistance, a heparin allergy manifesting as heparin-induced skin reactions or heparin-induced thrombocytopenia, and the presence of a mechanical heart valve. From time to time, the obstetrician is called on to make recommendations about anticoagulants in pregnancy, including in circumstances in which an alternative to heparin has been suggested or is necessary. In thi...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Radiologic Aspects of the Diagnosis of Pulmonary Embolism in Pregnancy
Pulmonary embolism in pregnancy is a leading cause of maternal mortality. The clinical presentation is often nonspecific, making imaging essential for accurate diagnosis. After reviewing the literature on the radiologic diagnosis of pulmonary embolism in pregnancy, we concluded that both computed tomography pulmonary angiography and lung perfusion scintigraphy are sensitive with high positive predictive values in the presence of high clinical suspicion, but lung perfusion scintigraphy is recommended given lower maternal breast exposure to ionizing radiation and lower fetal contrast exposure. However, if a chest x-ray is ab...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Diagnosis and Management of VTE in Pregnancy
Venous thromboembolism is a leading cause of maternal death. Because of the low absolute frequency of events, however, outcome-based clinical data are limited. Consequently, clinicians must additionally rely both on published guidelines and on extrapolation of data from studies focused on nonpregnant individuals. The diagnosis and treatment of deep vein thrombosis, pulmonary embolism, and cerebral vein and dural sinus thrombosis are complicated by pregnancy, and often require modifications to standard diagnostic and treatment algorithms outside of pregnancy. Treatment of VTE in pregnant women is in particular need of futur...
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Foreword: The Prevention and Management of Thrombosis in Obstetrics and Gynecology
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: The Prevention and Management of Thrombosis in Obstetrics and Gynecology Source Type: research

Contributors: The Prevention and Management of Thrombosis in Obstetrics and Gynecology
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 26, 2018 Category: OBGYN Tags: Contributors: The Prevention and Management of Thrombosis in Obstetrics and Gynecology: PDF Only Source Type: research

Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - March 1, 2018 Category: OBGYN Tags: Index: PDF Only Source Type: research