Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Index: PDF Only Source Type: research

Pancreatic Disorders of Pregnancy
The pancreas is an organ with both exocrine and endocrine functions that has a vital role in both digestion as well as glucose metabolism. Although pancreatic dysfunction and disorders are rare in pregnancy, they are becoming increasingly more common. Recognition of these disorders and understanding how they can affect pregnancy is imperative to allow for proper management. We provide an overview of the most common pancreatic disorders that are seen in pregnancy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Gallbladder and Biliary Disease in Pregnancy
This article represents a review of the existing literature on the entire spectrum of biliary disease. The physiology, clinical presentation, and diagnostic evaluation of a variety of conditions are reviewed. Historical and contemporary data regarding pregnancy implications and treatment options are discussed. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Chronic Liver Disease in the Obstetric Patient
Chronic liver disease in pregnancy is rare. Historically, many chronic liver diseases were considered contraindications to pregnancy; however, with current monitoring and treatment strategies, pregnancy may be considered in many cases. Preconception and initial antepartum consultation should focus on disease activity, medication safety, risks of pregnancy, as well as the need for additional monitoring during pregnancy. In most cases, a multidisciplinary approach is necessary to ensure optimal maternal and fetal outcomes. Despite improving outcomes, pregnancy in women with the chronic liver disease remains high risk. (Sourc...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Infectious Hepatitis in Pregnancy
Infectious hepatitis in pregnancy is clinically significant in both the acute and chronic phases. Here, we review the perinatal implications of chronic hepatitis B and C and acute hepatitis A and E. Familiarity with screening, transmission, diagnosis, and management of infectious hepatitis is of ongoing importance during obstetric care, as these diseases are endemic in much of the world. Pregnancy and interpregnancy care provide opportunities to prevent infection and transmission of hepatitis. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Hepatic Complications in Preeclampsia
In cases of preeclampsia with severe features and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, hepatic complications portend significant short-term and long-term maternal health implications. In this section, we will discuss the physiology of normal hepatic function in pregnancy, the pathophysiology of the abnormalities noted in hepatic function during the process of preeclampsia development, the diagnosis and management of preeclampsia, imitators of HELLP syndrome, the utility of various biomarkers in the diagnosis and prognosis of the preeclampsia disease spectrum, possible underlying genetic fac...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Acute Fatty Liver of Pregnancy
Acute fatty liver of pregnancy (AFLP) is a rare, but potentially fatal condition, characterized by hepatic failure typically in the third trimester of pregnancy that is associated with multiorgan involvement resulting in a number of clinical and laboratory abnormalities. The cornerstone of management of AFLP includes prompt recognition, preparation for delivery, and supportive care such as reversal of coagulopathy. Early diagnosis, prompted delivery, and supportive care have resulted in improved maternal morbidity and mortality. This review focuses on the epidemiology, etiology, clinical presentation, diagnosis, management...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy is a common disorder of pregnancy manifested by pruritus and elevated bile acids. The etiology of cholestasis is poorly understood and management is difficult due to the paucity of data regarding its diagnosis, treatment, and related adverse outcomes. In this article, we review the epidemiology, pathophysiology, risk factors, laboratory findings, complications, treatment, management, and current evidence surrounding intrahepatic cholestasis of pregnancy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

The Hepatobiliary System: An Overview of Normal Function and Diagnostic Testing in Pregnancy
Pregnancy is associated with physiological adaptions that affect every organ system. Changes in liver function in pregnancy have important effects on nutrient metabolism, protein synthesis, and the biotransformation of substances in preparation for excretion. A clear understanding of the anatomic and functional changes of the hepatobiliary system is necessary for the diagnosis and evaluation of disease, as well as understanding how these changes predispose women to pregnancy-specific hepatic conditions. In this review, the effect of gestational changes in hepatobiliary function on laboratory tests and the role of diagnosti...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Foreword: Liver Disease in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research

Contributors: Liver Disease in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Contributors: Liver Disease in Pregnancy: PDF Only Source Type: research

Characterization of a TP53 Somatic Variant of Unknown Function From an Ovarian Cancer Patient Using Organoid Culture and Computational Modeling
In our proof-of-concept study of 1 patient with stage IIIC carcinosarcoma of the ovary, we discovered a rare mutation in the tumor suppressor, TP53, that results in the deletion of N131. Immunofluorescence imaging of the organoid culture revealed hyperstaining of p53 protein. Computational modeling suggests this residue is important for maintaining protein conformation. Drug screening identified the combination of a proteasome inhibitor with a histone deacetylase inhibitor as the most effective treatment. These data provide evidence for the successful culture of a patient tumor and analysis of drug response ex vivo. (Sourc...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Prediction of Epithelial Ovarian Cancer Outcomes With Integration of Genomic Data
Some of the patients with epithelial ovarian cancer will not respond to initial therapy. These patients have a poor prognosis. Our aim was to identify patients with a worse prognosis by integrating clinical, pathologic, and genomic data. Using publicly available genomic data and integrating it with clinical data, we significantly improved the prediction of patients with worse surgical outcomes and those who do not respond to initial chemotherapy. We further improved these models with more precise data collection and better understanding of the genetic background of the studied population. Better prediction will lead to bet...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Maintenance Therapy in the Treatment of Recurrent Epithelial Ovarian Cancer
A diagnosis of recurrent epithelial ovarian cancer carries with it a very poor prognosis despite aggressive chemotherapy with or without secondary surgical cytoreduction. Recently, maintenance treatment after second-line chemotherapy has gained momentum given promising results of antiangiogenics and PARP inhibitors used in this setting. When used appropriately, these agents may provide a meaningful survival benefit with minimal effects on quality of life. This paper reveals the current literature evaluating the use of maintenance therapy in the recurrent setting for the epithelial ovarian, fallopian tube, or primary perito...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Maintenance Therapy in the Primary Treatment of Epithelial Ovarian Cancer
Despite aggressive upfront treatment with a combination of surgery and chemotherapy, most women with advanced epithelial malignancy will experience disease recurrence. The goal of treatment in the recurrent setting shifts away from a curative approach towards palliation of symptoms. In an attempt to delay time to first recurrence, the concept of maintenance chemotherapy emerged. This paper reviews the available literature evaluating the use of maintenance chemotherapy in the primary treatment setting and its effect on progression-free survival and overall survival. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Advanced Ovarian Cancer: Weighing the Risks and Benefits of Surgery
Treatment for patients with advanced ovarian cancer includes a combination of platinum-based chemotherapy and maximally cytoreductive surgery. The 2 options for initial treatment include upfront surgery followed by adjuvant chemotherapy or neoadjuvant chemotherapy followed by interval surgery. Deciding between which approach is a on the basis of several factors: (1) resectability of disease; (2) patient factors such as age, albumin, and body mass index; (3) patient wishes; and (4) overall functional status. Research is needed to further refine these approaches and create a patient-focused treatment plan which includes nove...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Preventing Ovarian Cancer in High-risk Women: One Surgery at a Time
Eleven genes have been identified that increase the lifetime risk of developing ovarian cancer. The cumulative cancer risk of ovarian cancer varies with the mutation type and age. Ovarian cancer risk management options include surgical risk reduction with salpingo-oophorectomy and a newer step-wise approach with interval salpingectomy and delayed oophorectomy. Women should be counseled on the pros and cons of hysterectomy in the setting of reducing the risk of other cancers; eliminating the risk of endometrial cancer in Lynch Syndrome, potential risk of serous/serous-like endometrial cancer in BRCA1 carriers, and eliminati...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Immunotherapy for Gynecologic Cancer: Current Applications and Future Directions
The role of the immune system in the development of cancer has been a subject of ongoing clinical investigation in recent years. Emerging data demonstrate that tumorigenesis resulting in ovarian, uterine, and cervical cancers is a consequence of impaired host immune responses to cancerous cells. Leveraging the immune system through the use of immune checkpoint inhibitors, therapeutic vaccine therapy, and adoptive cell transfer presents a profound opportunity to revolutionize cancer treatment. This review will encompass the role of the immune system in development of gynecologic cancers and highlight recent data regarding i...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Integration of Clinical and Molecular Features into Prediction Models for Outcomes in Endometrial Cancer
Endometrial cancer recurrence carries a poor prognosis. The rising incidence of endometrial cancer calls for improvements in treatment of advanced and recurrent diseases. Efforts have been made to molecularly characterize endometrial cancer with the goal of improving therapies. The study presented here describes the utilization of molecular features of endometrial cancer tumors that are likely to recur, along with clinical characteristics utilized together to predict recurrence. This work further studies recurrent endometrial cancers to group them into “clusters” based on the tumor’s molecular makeups wit...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Gynecologic Oncology: Challenges of Minimally Invasive Surgery In a Field of Maximal Complexities
Minimally invasive surgery has become a standard in the surgical treatment for many women with gynecologic cancers. Within the scope of minimally invasive surgery, several techniques exist. Here, we provide an overview of the challenging and controversial aspects of minimally invasive surgery in the field of gynecologic oncology, including single-site surgery, operating on morbidly obese patients, sentinel lymph node mapping, and recent trials and controversy of treating gynecologic cancer patients with a minimally invasive surgical approach. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Minimally Invasive Robotic Surgery for Gynecologic Cancers: A Review
This article reviews the current utilization of robotic surgery and its role for future treatment in gynecologic oncology. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Sentinel Lymph Nodes and Precision Surgery in Gynecologic Cancer
Besides histologic features, the presence of nodal metastasis is the most crucial prognostic factor for recurrence and survival for patients with gynecologic cancer. Conventionally, lymphadenectomy has been performed routinely to assess lymphatic metastasis. However, lymphadenectomy may be unnecessary in early-stage gynecologic cancer, because the percentage of patients with lymph node involvement is very low. The recent use of sentinel lymph node mapping has provided high feasibility, safety, and accuracy in the assessment of nodal metastasis. The National Comprehensive Cancer Network Clinical Practice Guidelines have inc...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Updates in Cervical Cancer Treatment
Although rates of cervical cancer in the United States have been declining due to vaccination and screening efforts, it remains the fourth most common cancer in women worldwide and is still far from being eradicated, even in developed nations. This review discusses recent developments in cervical cancer treatment and reviews the literature supporting recent practice changes encompassing staging, surgical management, radiation, chemotherapy, targeted agents including immunotherapy, and imaging. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Foreword: New and Novel Treatments for Gynecologic Cancer
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research

Contributors: New and Novel Treatments for Gynecologic Cancer
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Contributors: New and Novel Treatments for Gynecologic Cancer: PDF Only Source Type: research

Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Index: PDF Only Source Type: research

Prophylaxis for Tuberculosis in Pregnant Women
As more women at increased risk for tuberculosis (TB) reactivation immigrate to the United States, perinatal screening and chemoprophylaxis are increasingly important. Interferon-gamma release assays and the tuberculin skin test are acceptable screening tests with the latter supported by more data in pregnancy. Women screening positive should have active TB excluded, and if negative, latent TB is likely. Prophylaxis should be deferred until 3 months postpartum except in those severely immunosuppressed, human immunodeficiency virus positive, or recently exposed. Isoniazid with pyridoxine for 9 months is preferred with reaso...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Evidence for Use of Tenofovir in Pregnancy to Prevent Perinatal Transmission of Hepatitis B Infection
Perinatal transmission of hepatitis B virus continues to be a serious global public health concern. Transmission failures are related to high maternal viremia. Several antiviral therapies reduce maternal viremia around the time of delivery and decrease maternal-to-child-transmission. This chapter is a review of current studies that, ultimately, have provided strong evidence for the efficacy and safety of 3 antiviral drugs in pregnancy—lamivudine, telbivudine and tenofovir. The latter drug is the particular focus of this chapter which will show that tenofovir is the preferred antiviral therapy in pregnant women becaus...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

New Antiviral Agents for Treatment of Hepatitis C
Between 70 and 170 million people worldwide are infected with hepatitis C virus (HCV) which frequently causes chronic liver disease and cirrhosis. There are several genotypes and many subtypes of HCV. Direct-acting antiviral agents are effective at eradicating HCV in the vast majority of patients, producing much higher cure rates than were seen with interferon and ribavirin regimens only a few years ago. The chapter reviews the epidemiology and virology of HCV infection. Treatment regimens are complex but a straightforward approach to selection of patients, choice of direct-acting antiviral agents and follow-up is presente...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Prevention of Opportunistic Infections in Women With HIV Infection
Opportunistic infections are those that are either more frequent or more severe as a result of the patient’s immunosuppressed condition. Opportunistic infections are, of course, the distinguishing feature of HIV infection, and they can be the cause of serious morbidity and even mortality. Some opportunistic infections can be prevented by vaccination, for example, pneumococcal infection, meningococcal infection, influenza, hepatitis A and B, and varicella. Other major opportunistic infections require prophylactic antibiotics or antiviral medications. In obstetric patients, pneumocystis infections and toxoplasmosis are...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Single-Tablet Combination Therapy for HIV Infection in Pregnancy
Advances in the management of human immunodeficiency virus infection during pregnancy have led to improved maternal health and significant declines in rates of mother-to-child transmission of human immunodeficiency virus. A critical contributor to this success has been the development of better tolerated, safer, and more convenient antiretroviral medication regimens. Today, 12 fixed-dose, single-tablet combination antiretroviral regimens are available in the United States. These regimens are commonly used in nonpregnant individuals. However, because of altered pharmacokinetics of many drugs during pregnancy and concerns re...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Antibiotics for the Treatment of Staphylococcal Infections in the Obstetric Patient
This review addresses current epidemiology and treatment of obstetric staphylococcal infections. It also examines current prophylaxis methods and the efficacy of universal screening. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Treatment and Prevention of Pneumococcal Infection
Streptococcus pneumoniae, a gram-positive diplococcus, is the most common cause of bacterial pneumonia. The diagnosis of pneumococcal pneumonia is usually confirmed by chest x-ray and gram stain. The most appropriate antibiotics for treatment pneumococcal infection are macrolides, beta-lactams, and quinolones. Two vaccines, PPSV23 and PCV13, are highly effective in preventing infection. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Prophylaxis Against Early-onset Group B Streptococcus Infections in Pregnant Women Who Are Allergic to Penicillin
This article will review established screening techniques, intrapartum antibiotic prophylactic regimens, and management specifically of the penicillin-allergic pregnant woman who is colonized with GBS. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Prevention of Infection After Cesarean Delivery
The critical measures of importance in reducing the frequency of postcesarean infection are preoperative cleansing of the vagina with a povidone-iodine solution, administration of cefazolin plus azithromycin before surgery, preparation of the abdomen with a chlorhexidine solution, removal of the placenta by traction on the cord, closure of the deep part of the subcutaneous layer, and closure of the skin with sutures rather than staples. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Foreword: New Antibiotics and Antibiotic Prophylaxis in Obstetrics
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: New Antibiotics and Antibiotic Prophylaxis in Obstetrics Source Type: research

Contributors: New Antibiotics and Antibiotic Prophylaxis in Obstetrics
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Contributors: New Antibiotics and Antibiotic Prophylaxis in Obstetrics: PDF Only Source Type: research

Lymphadenectomy in the Management of Gynecologic Cancer
Among nearly all gynecologic cancers, knowing whether the cancer has metastasized to lymph nodes impacts the ultimate management of the cancer. Lymph node status assists in cancer staging, prognostication, guidance of surgical intervention and adjuvant therapy, and removal of positive lymph nodes may be therapeutic in some cancers. Surgical staging through lymph node removal and pathologist assessment is standard of care for most gynecologic cancers. This section reviews the anatomic lymphatic drainage patterns of each gynecologic organ and the evolution and current practice of surgical lymph node assessment along the spec...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Updates and Controversies of Robotic-Assisted Surgery in Gynecologic Surgery
minimally invasive surgery (MIS) is the standard approach to performance of several gynecologic procedures, including hysterectomy, gynecologic cancer staging procedures, myomectomy, pelvic organ prolapse repair, and select adnexal procedures. Robotic-assisted surgery, a computer-based MIS approach, has been adopted widely in the United States and several other countries. Robotics may offer technological and ergonomic benefits that overcome limitations associated with conventional laparoscopy; however, it is not clear that reported claims of superiority translate into improved gynecologic patient outcomes compared with oth...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Morcellation for Gynecologic Surgery
Morcellation is necessary for many women with fibroids who choose to undergo laparoscopic myomectomy or hysterectomy. After open and laparoscopic myomectomy, myometrial cells can be detected in the abdomen and pelvis. After morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue with or without the use of containment bags. Leiomyosarcoma has a poor prognosis because of early hematogenous metastasis and has a high propensity for recurrence despite the performance of total abdominal hysterectomy. Eliminating residual tissue in the pelvis a...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Office-based Approach to Evaluation and Management of Abnormal Uterine Bleeding
Evaluation and management of abnormal uterine bleeding (AUB) are possible in the office. Approaching AUB evaluation from an etiology-based perspective allows the gynecologist to focus evaluation efforts on the most probable causes of AUB for a particular patient and therefore customize the management accordingly. Developing skills with imaging such as transvaginal ultrasound, saline infusion sonography, and diagnostic hysteroscopy are important for AUB etiology diagnosis. Operative hysteroscopy experience can be developed for AUB management in the office and endometrial ablation provides a minimally invasive solution for s...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Urinary Incontinence: Evaluation and Management
Urinary incontinence is a major public health issue in the United States with physical, mental, social, and economic repercussions. History and in-office evaluation are paramount to diagnosis and formation of an appropriate treatment plan. Lifestyle modifications, which include pelvic floor muscle training and behavioral changes, are appropriate for initial management. Patients with overactive bladder syndrome whose symptoms are not adequately controlled with conservative treatment can be offered medical or procedural management. Stress urinary incontinence refractory to first-line treatment can be treated with surgical op...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Practical Cancer Genetics and Genomics in Women’s Health
There have been rapid advances in precision medicine since the Human Genome Project was completed in 2003, including several noteworthy advances in Women’s Health. This includes significant advances in predicting individualized cancer risk based on hereditary cancer genetic testing, with the number of known cancer-predisposition genes extending well beyond BRCA1 and BRCA2. This has been coupled with gene-specific management guidelines for several gynecologic cancers. In addition, genetic testing can also inform therapy selection for women with gynecologic cancers. Here we address hereditary cancer and practical cance...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Management of Menopause and the Role For Hormone Therapy
Hormone therapy remains the most effective treatment for menopausal symptoms but decisions are complex, requiring an assessment of benefits and risks and determination of best treatment type, dose, and duration. Benefits exceed risks for most women with bothersome menopausal symptoms or high risk for fracture if initiated under age 60 years or within 10 years since menopause. Long-term mortality and safety data from the Women’s Health Initiative is reassuring, with no increase in deaths from cardiovascular disease or cancer compared with placebo after 18 years of follow-up and a trend towards less mortality in those ...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Updates in the Approach to Chronic Pelvic Pain: What the Treating Gynecologist Should Know
Chronic pelvic is a multifaceted condition that often has both peripheral and central generators of pain. Despite its high prevalence, the evaluation and management of a pelvic pain patient often present many challenges to the practicing gynecologist. As with many other chronic pain conditions, pain severity does not always correlate with pelvic pathology and standard medical and surgical therapies are not always effective. An understanding of neurobiology and neuropsychology of chronic pelvic pain along with clinical pearls in the history and physical examination should guide management. Successful treatment of pelvic pai...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Enhanced Recovery After Surgery and Acute Postoperative Pain Management
Enhanced recovery pathways were first developed in colorectal surgery and have since been adapted to other surgical subspecialties including gynecologic surgery. Mounting evidence has shown that the adoption of a standardized perioperative pathway based on evidence-based literature reduces length of hospital stay, reduces cost, reduces opioid requirements with stable to improved pain scores, and accelerates return to normal function as measured by validated patient reported outcomes measurements. The many elements of enhanced recovery may be distilled into 3 concepts: (1) optimizing nutrition before and after surgery, reco...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Clinical Controversies in Cervical Cancer Screening
Through the implementation of systematic cervical cancer screening in the mid-20th century, the United States and other developed countries have seen death rates from cervical cancer decreased by ≥70%.The purpose of this article is to address several of the most controversial issues associated with cervical cancer screening recommendations in light of historical and evolving data. In this article, we will explore the controversies around the age at which to initiate and exit screening, human papilloma virus testing alone as a primary screening approach, and the impact of human papilloma virus vaccination on cervical can...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Breast Cancer and the Obstetrician-Gynecologist: A Focus on Screening, Risk Assessment and Treatment of Survivors With Genitourinary Syndrome of Menopause
Because of conflicting guidelines, providing appropriate breast cancer screening recommendations to our patients has become challenging. Given the high prevalence of genitourinary syndrome of menopause (GSM) overall, and among breast cancer survivors, and the understandable reluctance of physicians to prescribe effective hormonal treatments to survivors with this condition, addressing the needs of breast cancer survivors with bothersome GSM is both a common and controversial issue. In this review, we detail current breast cancer screening recommendations, breast cancer risk assessment, and management of GSM in breast cance...
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Foreword: Clinical Dilemmas and Unresolved Issues in Gynecology
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Clinical Dilemmas and Unresolved Issues in Gynecology Source Type: research

Contributors: Clinical Dilemmas and Unresolved Issues in Gynecology
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 23, 2019 Category: OBGYN Tags: Contributors: Clinical Dilemmas and Unresolved Issues in Gynecology: PDF Only Source Type: research