Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Index: PDF Only Source Type: research

The Role of Centers of Excellence With Multidisciplinary Teams in the Management of Abnormal Invasive Placenta
This article highlights the desired features for developing and managing a multidisciplinary team dedicated to the treatment of AIP in center of excellence. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Blood Products in the Management of Abnormal Placentation
A critical tool in the successful management of patients with abnormal placentation is an established massive transfusion protocol designed to rapidly deliver blood products in obstetrical and surgical hemorrhage. Spurred by trauma research and an understanding of consumptive coagulopathy, the past 2 decades have seen a shift in volume resuscitation from an empiric, crystalloid-based method to balanced, targeted transfusion therapy. The present article reviews patient blood management in abnormal placentation, beginning with optimizing the patient’s status in the antenatal period to the laboratory assessment and tran...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Peripartum Anesthesia Considerations for Placenta Accreta
Placenta accreta spectrum is becoming more common and is the most frequent indication for peripartum hysterectomy. Management of cesarean delivery in the setting of a morbidly adherent placenta has potential for massive hemorrhage, coagulopathies, and other morbidities. Anesthetic management of placenta accreta spectrum presents many challenges including optimizing surgical conditions, providing a safe and satisfying maternal delivery experience, preparing for massive hemorrhage and transfusion, preventing coagulopathies, and optimizing postoperative pain control. Balancing these challenging goals requires meticulous prepa...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

The Utilization of Interventional Radiologic Procedures in the Surgical Management of Placenta Accreta Syndrome
The role of Interventional radiologic procedures for the management of suspected placenta accreta spectrum (PAS) has evolved considerably over last 3 decades. In this article, the authors describe the various techniques of vascular occlusion for the management of PAS and provide a brief review of the literature examining the pros and cons in the use of these devices. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Conservative Management of Placenta Accreta Spectrum
The purpose of this review was to assist obstetricians and gynecologists in considering the most appropriate conservative treatment option to manage women with placenta accreta spectrum according to their individual need and local expertise of the heath care team. The issue is challenging, as the quality of evidence with regard to efficacy is poor, and is mainly based on retrospective studies with limited sample size. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Surgical Management of Placenta Accreta Spectrum
This is a discussion of the standard surgical treatment of placenta accreta spectrum disorders including preoperative considerations, diagnostic imaging, surgical steps for cesarean hysterectomy, and postoperative management. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Antenatal Management of Placenta Accreta
Predelivery diagnosis of placenta accreta, increta, and percreta (from here referred to as placenta accreta, unless otherwise noted) has increasingly created opportunities to optimize antenatal management. Despite the increased frequency of placenta accreta today, occurring in as many as 1 in 533 to 1 in 272 deliveries, high-quality data are lacking for many aspects of antenatal management. This chapter will discuss antenatal management of, and risks faced by, women with suspected placenta accreta, a condition that most frequently requires a potentially morbid cesarean hysterectomy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Imaging of Placenta Accreta Spectrum
Placenta accreta spectrum (PAS) refers to an abnormally invasive implantation of the placenta into the uterine myometrium. The resultant risk is that of severe maternal hemorrhage and significant maternal morbidity and even mortality. The 2 strongest risk factors for the development of PAS are a history of a prior cesarean section and a placenta previa in the current pregnancy. Clinically, most patients are asymptomatic but some will present with vaginal bleeding and abdominal cramping. The goal of this article is to discuss the common clinical presentation and risk factors for placenta accreta spectrum, and to review in d...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Pathophysiology of Placenta Accreta Spectrum Disorders: A Review of Current Findings
Current findings continue to support the concept of a biologically defective decidua rather than a primarily abnormally invasive trophoblast. Prior cesarean sections increase the risk of placenta previa and both adherent and invasive placenta accreta, suggesting that the endometrial/decidual defect following the iatrogenic creation of a uterine myometrium scar has an adverse effect on early implantation. Preferential attachment of the blastocyst to scar tissue facilitates abnormally deep invasion of trophoblastic cells and interactions with the radial and arcuate arteries. Subsequent high velocity maternal arterial inflow ...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

The Placenta Accreta Spectrum: Epidemiology and Risk Factors
The placenta accreta spectrum has become an important contributor to severe maternal morbidity. The true incidence is difficult to ascertain, but likely falls near 1/1000 deliveries. This number seems to have increased along with the rate of risk factors. These include placenta previa, previous cesarean section, use of assisted reproductive technologies, uterine surgeries, and advanced maternal age. With increased uterine conservation, previous retained placenta or placenta accreta have become significant risk factors. Understanding placenta accreta spectrum risk factors facilitates patient identification and safe delivery...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Foreword: Management of Abnormal Placentation
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Management of Abnormal Placentation Source Type: research

Contributors: Management of Abnormal Placentation
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Contributors: Management of Abnormal Placentation: PDF Only Source Type: research

Role for OBGYNs in Gender-Affirming Surgical Care of Transgender and Gender Nonconforming Individuals
Many transgender and gender nonconforming individuals have undergone, or plan to pursue, gender-affirming surgery as part of their transition. While not all gender-affirming surgeries are provided by Obstetricians and Gynecologists (OBGYNs), OBGYNs are uniquely skilled to perform certain gender-affirming surgeries such as hysterectomies, bilateral oophorectomies, and vaginectomies. OBGYNs are also well positioned to provide anatomy-specific cancer screening as dictated by patient’s hormonal and surgical status, and to address postsurgical or natal vulvovaginal concerns. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Gender-Affirming Hormone Therapy for Transgender Females
The provision of hormone therapy, both estrogens and antiandrogens, to adult transgender females is well within the scope of practice of the obstetrician gynecologist. The goal is to induce feminizing changes and suppress previously developed masculinization. Estrogens in sufficient doses will usually achieve both goals with augmentation by antiandrogens. The primary short-term risk of estrogens is thrombosis, but long-term risk in transgender females is unclear. Optimal care requires pretreatment education and assessment, individualized dosing, ongoing routine monitoring, and standard breast and prostate cancer screening....
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Gender-Affirming Hormone Therapy for Transgender Men
There are an estimated 1.4 million transgender adults in the United States, and lack of providers knowledgeable in transgender care is a barrier to health care. Obstetricians and Gynecologists can help increase access in part by becoming competent in gender-affirming hormone therapy. For transgender men, testosterone protocols can be extrapolated from those used for hypogonadal cisgender men. Unfortunately, there are not any high-quality, long-term prospective studies on the effectiveness and safety of different testosterone regimens specifically in transgender men, but the available data suggest that gender-affirming test...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Unique Primary Care Needs of Transgender and Gender Non-Binary People
It is important for the practicing primary care provider to become familiar with the unique health care needs for people who identify as transgender men, transgender women, and non-binary people, who are all within the scope of practice of a general obstetrician-gynecologist and other primary care providers. A review of the unique health needs and essential terminology is presented. This knowledge is a basic foundation to develop a welcoming and inclusive practice for people who are gender nonconforming. This fund of knowledge is essential the practicing primary care providers and support staff. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Clinical Care of Lesbian and Bisexual Women for the Obstetrician Gynecologist
This article seeks to discuss health care disparities as well as health behaviors and outcomes in this population. In addition, it will review the appropriate recommendations for clinical care of sexual minority women for the obstetrician/gynecologist. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Developing an Inclusive and Welcoming LGBTQ Clinic
People who identify as lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) are underserved and face barriers to knowledgeable health care. Most health systems are ill prepared to provide care that addresses the needs of the LGBTQ community. Basic steps to developing an LGBTQ welcoming health care program are presented. It can be adapted to diverse health care models, from obstetrics and gynecology and other primary care services whether public or private and to hospitals and specialty clinics. This LGBTQ inclusive health care model was developed in collaboration with the LGBTQ community, a multidisciplinary...
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Foreword: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People Source Type: research

Contributors: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 20, 2018 Category: OBGYN Tags: Contributors: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People: PDF Only Source Type: research

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