Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Index: PDF Only Source Type: research

Opioid Use Disorder in Pregnancy
Opioid use disorders during pregnancy are a major risk factor for pregnancy-associated deaths. Women with opioid use disorders also experience increases in the incidence of cardiac arrest, renal failure, cesarean delivery, and blood transfusion. As such there is a tremendous need by obstetricians to understand and treat opiate use as a holistic public health problem with its own unique risk factors, and management strategies. Universal screening with brief intervention and referral, referral to psychotherapy, and pharmacotherapy are all recommended strategies for opioid use disorder in pregnancy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Marijuana Use in Pregnancy: An Updated Look at Marijuana Use and Its Impact on Pregnancy
This article aims to provide an updated look at the use of marijuana in the United States and its impact on pregnancy. First, the prevalence of marijuana use is examined, including use both in and outside of pregnancy. The literature surrounding attitudes and beliefs with regard to use in pregnancy is reviewed. The impact on pregnancy outcomes is reviewed along with the evidence of marijuana’s impact on neural development of the fetus. Finally, clinical considerations for providers are discussed. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women
Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women. Development of effective ...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Benzodiazepines in Pregnancy
Benzodiazepine use and dependence are on the rise as well as the number of deaths attributable to the combination of opioids and benzodiazepines. Anxiety, the most frequent condition for which benzodiazepines are prescribed, occurs commonly, and is increasingly noted to coincide with pregnancy. Use of both benzodiazepine anxiolytics and anxiety in pregnancy is associated with preterm delivery and low birth weight. Short-term neonatal effects of hypotonia, depression, and withdrawal are described but long-term sequelae, if any, are poorly understood. Benzodiazepines are associated with physical dependence and withdrawal sym...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Alcohol Use in Pregnancy
Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitiga...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Tobacco Use During Pregnancy
Smoking during pregnancy is the most common preventable cause of infant morbidity and mortality. Cessation by the third trimester has consistently been associated with improved birth outcomes; however, the majority of women who obtain cessation during pregnancy, relapse in the first year postpartum. The majority of women who smoke during pregnancy developed their addiction to tobacco in early life, thus the need to intervene in the familial transmission of nicotine dependence is clear. This review discusses the epidemiology of tobacco use amongst pregnant women and factors associated with cessation. Specific intervention s...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Neurobiology of Addiction
Drugs of abuse can cause changes in the brain leading to addiction. Current scientific focus has been on how these drugs interact with the brain and the changes they cause, how those changes affect human behavior and how they may last beyond termination of drug use. Compulsiveness in seeking the drug, impulsiveness in consuming the drug, and negative affect when the drug is withheld are characteristic of addiction. Each of these characteristics has a root in neurobiology and understanding their mechanisms helps us to understand addiction and see potential targets for treatment. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Substance Abuse in Pregnancy
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Like many other chronic diseases, addiction often involves cycles of relapse and remission. It is key that clinicians understand it as such and treat it appropriately with evidence-based interventions including medication-assisted treatment. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Foreword: Substance Abuse in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Substance Abuse in Pregnancy Source Type: research

Contributors: Substance Abuse in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Contributors: Substance Abuse in Pregnancy: PDF Only Source Type: research

Weaning From Long-term Opioid Therapy
Opioid use for chronic noncancer pain poses a challenge to the gynecologist, and weaning opioids is often a goal for clinicians and patients. In some cases, opioid cessation can be achieved by weaning a patient’s prescribed opioid or with symptomatic management with long-acting opioids or alpha2-adrenergic medications. This review imparts a basic understanding of the physiology of opioid withdrawal, strategies for achieving opioid abstinence, medications for treating the symptoms of withdrawal, and alternatives to opioid taper. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Treating Opioid Dependence: Pain Medicine Physiology of Tolerance and Addiction
Inappropriate and excessive opioid prescribing practices for treatment of chronic nonmalignant pain contributed to rising rates of opioid related mortality. Effective and widely available opioid addiction treatment resources are needed to ensure successful resolution of the “opioid epidemic”. This chapter outlines the basic pathophysiology of addiction as well as principles of opioid addiction management focusing on the pharmacological and nonpharmacological aspects of care. Pharmacological treatment focuses on opioid substitution therapy, with aim at prevention of opioid cravings and opioid withdrawal symptoms...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Opioid Use in the Postoperative Arena: Global Reduction in Opioids After Surgery Through Enhanced Recovery and Gynecologic Surgery
Enhanced recovery programs aim to reduce surgical stress to improve the patient perioperative experience. Through a combination of multimodal analgesia and maintaining a physiological state, postoperative recovery is improved. Many analgesic adjuncts are available that improve postoperative pain control and limit opioid analgesia requirements. Adjuncts are often used in combination, but different interventions may be incorporated for patient-specific and procedure-specific needs. Postoperative pain control can be optimized by continuing nonopioid adjuncts, and prescribing opioid analgesia to address breakthrough pain. Pres...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Guidelines for Monitoring Patients Using Opioid Therapy
Opioid-related morbidity and mortality have increased to epidemic proportions over the past 20 years. Gynecologists play an integral role in addressing this epidemic through management of patients with pain, specifically through prescribing and monitoring practices. Practical recommendations are provided for clinicians caring for noncancer patients on chronic opioid therapy. Recommendations are largely based on national consensus guidelines with a focus on frequency and content of follow-up, identification of high risk behaviors, and reassessment of goals of treatment. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Selecting the Appropriate Patient for Opioid Therapy: Risk Assessment and Treatment Strategies for Gynecologic Pain
Chronic pelvic pain is a commonly encountered clinical entity, and many women with this chronic pain condition will be treated at some point in time with opioids for management of their pain. Clinicians in women’s health are frequently asked and expected to participate in the care of women with chronic pelvic pain, as well as other gynecologic pain conditions, and should be familiar with the role of opioid therapy for these conditions. The goal of this article is to help determine which patients may be appropriate candidates for the initiation or continuation of opioid therapy for gynecologic pain. In addition, this ...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Opioid Adjuncts: Optimizing Opioid Therapy With Nonopioid Medications
In this article, we describe a variety of medications that physicians managing outpatient chronic pain should familiarize themselves with to better aid their approach to multimodal pain therapy. Physicians should always consider the use of an adjuvant or coanalgesic drug as first-line treatments. Although many of these medications are not primarily analgesics, in clinical practice they have independent analgesic effects or synergistic analgesic properties when used with opioids. The use of adjunct analgesics reduces opioid-related adverse effects and optimizes pain management. Although there may be some medication overlap ...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment
Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Physiological Response to Opioids
This article includes a thorough system-based review of opioid-containing medications on physiological systems. Women’s health providers should have an in-depth understanding of such reverberations on patients’ wellbeing to maintain the safest level of care. A solid grasp of physiological repercussions of opioid use would encourage physicians to seek alternative treatment options. Such practice is essential in curbing the opioid epidemic our patients are facing. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

The Endogenous Opioid System: Role and Dysfunction Caused by Opioid Therapy
The endogenous opioid system is comprised of a wide array of receptors and ligands that are present throughout the central and peripheral nervous system, the gastrointestinal tract, and the immune system. This explains the multitude of physiological functions it is responsible for including analgesia, mood regulation, and modulation of the stress response. It also plays a pivotal role in modulating the brain’s reward center with behavioral and social implications on mood disorders and addiction. Exogenous opioid therapy hijacks the endogenous system and alters its functions contributing to an imbalance that is respon...
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Foreword: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic Source Type: research

Contributors: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 22, 2019 Category: OBGYN Tags: Contributors: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic: PDF Only Source Type: research

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