Bone Health and Osteoporosis Prevention and Treatment
Postmenopausal osteoporosis is a common condition and is associated with increased risk of fracture, including hip and vertebral fractures that in turn can have devastating consequences on morbidity and mortality. In this article, we review the pathogenesis and diagnostic approach to postmenopausal osteoporosis. We review available nonpharmacologic and pharmacologic therapies and we discuss their clinical efficacy and complications, with a detailed discussion of atypical femur fractures and osteonecrosis of the jaw. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
Vulvodynia
is a heterogenous, chronic pain condition of unknown etiology that affects 7% to 15% of women. It affects sexual function and quality of life. Vulvodynia can be primary or secondary, localized or generalized, and spontaneous or provoked. Contributing factors for provoked vulvodynia might include vulvovaginal infections, low estrogen states, and underlying anxiety disorder. Generalized vulvodynia likely arises from underlying connective tissue or neurological dysfunction. Vulvodynia treatment must be individualized on the basis of the patient’s presentation and physical examination findings. Surgical excision of the vulv...
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
Current Approaches to Fertility Preservation
The 5 principal reasons a patient may consider fertility preservation are: treatment for cancer that may affect fertility, treatment for nonmalignant medical conditions that may affect fertility, planned indications, planned gender-affirming hormone therapy or surgery, or in the setting of genetic conditions that may increase the risks of premature ovarian insufficiency or early menopause. This paper will focus on describing who may consider preserving their fertility, how to provide the best clinical evaluation of those seeking fertility preservation, and current and future fertility preservation techniques. Last, we will...
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
What Every Gynecologist Should Know About Perimenopause
Perimenopause often represents a physiologically challenging phase in women’s lives. The clinical presentation of the perimenopause includes infertility, irregular menstrual cycles, menorrhagia, and new onset of or worsening of mood disorders. Unlike menopause, which is characterized by low levels of estradiol and progesterone, the hallmark of perimenopause is highly variable levels of estradiol and progesterone with abrupt increases and decreases that are often described as a hormonal roller coaster. This chapter invites general gynecologists to understand the hormonal basis of the common complaints of perimenopause and...
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
A Clinician’s Guide to Functional Hypothalamic Amenorrhea
Patients and clinicians alike want to know if stress causes infertility. Stress could impair with reproductive function by a variety of mechanisms, including compromise of ovarian function, spermatogenesis, fertilization, endometrial development, implantation, and placentation. Herein we focus on the pathogenesis and treatment of stress-induced anovulation, which is often termed functional hypothalamic amenorrhea (FHA), with the objective of summarizing the actual knowledge as a clinical guide. FHA is a reversible form of anovulation due to slowing of gonadotropin-releasing hormone pulse frequency that results in insuffici...
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
Genetics of Primary Ovarian Insufficiency
The diagnosis of primary ovarian insufficiency (POI) has untold effects on women and a better understanding alongside potential treatments are paramount to improve quality of life of these women. Various causes have been linked to the development of POI with genetics playing a key role. A better understanding of the genetics of POI could lead to earlier diagnosis and broaden fertility options. This chapter discusses previously known and more recently discovered genes that have been implicated in the development of POI. It explores the varying phenotypic expressions of some genes in different populations and areas for furth...
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
Foreword: What the Generalist Should Know About REI
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: What the Generalist Should Know About REI Source Type: research
Contributors: What the Generalist Should Know About REI
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - October 27, 2020 Category: OBGYN Tags: Contributors: What the Generalist Should Know About REI Source Type: research
Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Index Source Type: research
The Golden Hours of Fetal Heart Rate Monitoring: Systematic Approach to the Critical Times of Labor and Delivery
We present checklists for the first and last hour of labor for use on labor and delivery to help standardize and optimize the approach to care during these times. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
Management of the Category II Fetal Heart Rate Tracing
Management of the category II fetal heart rate (FHR) tracing presents a common challenge in obstetrics. Up to 80% of women will have a category II FHR tracing at some point during labor. Here we propose a management algorithm to identify specific features of the FHR tracing that correlate with risk for fetal acidemia, target interventions to address FHR decelerations, and guide clinicians about when to proceed toward operative vaginal delivery or cesarean to achieve delivery before there is a high risk for significant fetal acidemia with potential for neurological injury or death. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
Unusual Circumstances and Additional Procedures for Fetal Evaluation in Labor
This chapter describes several circumstances in which the interpretation of the intrapartum fetal heart rate pattern falls outside the usual frame of reference. This includes a more extensive discussion of causes of tachycardia and bradycardia. Ways in which a fetal dysrhythmia may manifest itself in the context of heart rate monitoring are described. Finally, the chapter reviews technological innovations designed to clarify the fetal status when compromise is suspected from the fetal heart rate pattern. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
Interventions for Intrapartum Fetal Heart Rate Abnormalities
Intrapartum fetal heart rate (FHR) decelerations may represent interrupted oxygen transfer to the fetus. In many cases, these interruptions are transient and do not result in progressive fetal acidemia with risk for asphyxia and neurological compromise. When significant FHR decelerations are present, reversible causes of reduced fetal oxygen delivery should be considered and corrective measures should be undertaken to optimize oxygenation. In this review, we describe potential intrapartum causes of reduced fetal oxygen delivery and the efficacy of common interventions for an abnormal FHR tracing. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
Interpretation of Fetal Heart Rate Monitoring in the Clinical Context
Use of intrapartum fetal heart rate (FHR) monitoring has had limited success in preventing hypoxic injury to neonates. One of the most common limitations of FHR interpretation is the failure to consider chronic and acute clinical factors that may increase the risk of evolving acidemia. This manuscript reviews common clinical factors that may affect the FHR and should be considered when determining the need for early intervention based on changes in the FHR. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
Identification of the Fetus at Risk for Metabolic Acidemia Using Continuous Fetal Heart Rate Monitoring
The fetal heart rate can be used to assess the current metabolic state of the fetus and predict the risk of the evolution of metabolic acidemia through the course of labor. In this chapter, we will present the pathophysiology of the development of fetal acidemia and provide an organized approach to identifying the risk of worsening acidemia using changes noted in the fetal heart rate pattern to allow for interventions that might alter this course. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
