Physiology of Fetal Heart Rate Monitoring
Fetal heart tracings (FHTs) are useful as a window into the oxygenation status of the fetal brain. Patterns in the FHT reflect the oxygen status of the fetal brain. Fetal adaptive response to progressive hypoxemia and acidosis are detectable and produce recognizable patterns in the fetal heart rate. The basic physiology and adaptive responses that regulate the fetal heart rate and physiological fetal adaptations to stress as reflected in the FHTs are described. Mechanisms of oxygen delivery to the fetus including ways in which those mechanisms can be disrupted are reviewed. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
The Goal of Continuous Fetal Heart Rate Monitoring During Labor: Have We Been Successful?
Despite its ubiquitous use, fetal heart rate (FHR) monitoring has not resulted in a significant reduction in hypoxic-ischemic encephalopathy following delivery. This manuscript reviews the reasons for this failure including limitations of FHR to accurately predict hypoxia, low prevalence of hypoxic-ischemic encephalopathy, and lack of standardization of interpretation and intervention. We propose an alternative goal for FHR monitoring during labor to provide optimal care by early identification of truly concerning features, initiation of appropriate interventions, clear documentation of concerns and plans, and clear commun...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Management of Abnormal FHR Tracings Source Type: research
Foreword: Management of Abnormal FHR Tracings
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Clinical Obstetrics and Gynecology Source Type: research
Contributors: Management of Abnormal FHR Tracings
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Contributors: Management of Abnormal FHR Tracings Source Type: research
Transgender Men and the Gynecologist
Recently, greater attention has been paid to the care of gender dysphoric and gender incongruent individuals. Gynecologists may be called upon to care for individuals who were assigned female at birth throughout or following social, medical, or surgical gender transition. Thus, gynecologists need to be aware of language regarding sex and gender, treatment typically used for the care of gender dysphoric or incongruent individuals, and aspects of well gynecologic care necessary for these individuals. This review highlights these aspects of care for transgender males to aid the general gynecologist in the care and treatment o...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Fertility Preservation for Adolescents Receiving Cancer Therapies
According to the National Cancer Institute, ∼300,000 children globally are diagnosed with cancer each year. Advancements in chemotherapy and radiotherapy have revolutionized cancer treatment and improved long-term survival. Although many survivors will remain in good health with disease-free prognoses, three fourths will experience short-term and long-term effects from treatment. The cancer care paradigm has now appropriately shifted to include quality of life in survivorship with fertility cited as one of the most important quality of life indicators by survivors. A comprehensive approach to fertility preservation in ad...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Providing Long-acting Reversible Contraception to Adolescents: A Review
Unintended teen pregnancy continues to be a problem in the United States which has the highest rate of adolescent pregnancy among developed nations. Long-acting reversible contraception (LARC) has much higher continuation rates compared with moderately effective reversible contraception; however, moderately effective reversible contraception is more commonly used by adolescents. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend LARC as first-line contraception for adolescents. Clinicians providing contraception to adolescents should be knowledgeable of LARC indications...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
HMB in the Adolescent: A Review of the Modern Approach to Diagnosis and Management
Heavy menstrual bleeding in the adolescent is a cause for concern whether occurring acutely or chronically. There are a number of important considerations during the initial presentation that will help guide the practitioner during workup, which ultimately guides management strategies. The cornerstone of management in the adolescent is that of medical therapy (hormonal and nonhormonal), with avoidance of invasive and irreversible measures, as maintenance of fertility is paramount. Ultimately, the majority of adolescents can be successfully managed in the acute setting and transitioned to maintenance therapy for long-term c...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Diagnosis and Treatment of Polycystic Ovary Syndrome in Adolescent Females
The diagnosis of polycystic ovary syndrome (PCOS) in adolescents is complicated by the overlap of normal puberty with features of PCOS. To address this difficulty, recent diagnostic guidelines have worked to modify adult diagnostic criteria for use in adolescents. These guidelines stress that a definitive diagnosis of PCOS is not needed to initiate treatment. Deferring diagnosis, while providing symptom treatment and regular follow-up, is one recommended option. Treatment options for PCOS should be individualized to the presentation, needs, and preferences of each patient. The goals of treatment are to improve the quality ...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Dysmenorrhea and Endometriosis: Diagnosis and Management in Adolescents
Dysmenorrhea is common in adolescents. Most have primary dysmenorrhea and respond to empiric treatment with nonsteroidal anti-inflammatory drugs and/or hormonal therapies. Infrequently, patients have persistent symptoms requiring further evaluation including a pelvic examination, ultrasonography, and/or diagnostic laparoscopy. The most common cause of secondary dysmenorrhea in adolescents is endometriosis. Endometriosis is an estrogen-dependent, inflammatory condition with no surgical or medical cure. Treatment is individualized and typically includes surgical diagnosis with resection and/or ablation limited to visible les...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
The Adolescent and Genital Dissatisfaction
Genital dissatisfaction in healthy young women is on the rise. Pubic hair removal reveals genital tissue previously hidden, while social trends promote the absence of any protruding genital tissue as the feminine ideal. Information with regard to the natural diversity of external genitalia anatomy, and lifestyle changes to improve physical symptoms related to labial tissue may suffice to reassure a distressed adolescent. Female genital cosmetic surgery is rarely supported, before attaining genital maturity. However, genital dissatisfaction may lead to significant embarrassment and anxiety, requiring formal psychological co...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Uterovaginal Anomalies: A Guide for the Generalist Obstetrician-Gynecologist
Congenital gynecologic anomalies result from interruption of embryologic development of the female reproductive tract. The anomalies may be hymenal, vaginal, cervical, or uterine. The impact of these anomalies is variable: some are asymptomatic, incidental findings that require no intervention, others require simple surgical management, while some complex anomalies may require a multidisciplinary approach with extensive surgical expertise for optimal outcomes. Uterovaginal anomalies may occur in isolation or in association with other malformations, such as renal anomalies. The origin, presentation, evaluation and treatment...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Adolescents and Bone Health
Adolescence is a critical time for the acquisition of peak bone mass. There are modifiable factors that may influence bone health in an adolescent. For those at risk for bone fragility, initial management includes optimization of calcium and vitamin D, weight-bearing exercise, and maintenance of a normal body weight. In certain scenarios, bisphosphonate treatment is indicated, as is reviewed. How hormonal contraceptives affect bone mineral density is unclear, but in patients with risk factors or known bone fragility, prescribers should consider their skeletal effects. Some conditions, including restrictive eating disorders...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Pubertal Development: What’s Normal/What’s Not
Onset of puberty, as defined by breast stage 2, appears to be starting at younger ages since the 1940s. There is an ongoing controversy regarding what is normative, as well as what is normal, and the evaluation that is deemed necessary for girls maturing before 8 years of age. There are potential implications of earlier pubertal timing, including psychosocial consequences during adolescence, as well as longer term risks, such as breast cancer and cardiometabolic risks. There are additional consequences derived from slower pubertal tempo, for age of menarche has not decreased as much as age of breast development; these incl...
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
Sexual Abuse in Children: What the General Practice Ob/Gyn Needs to Know
This article will provide some history about how guidelines for medical care of these children have been developed, and list some of the findings that are normal or normal variants, caused by other conditions, or due to trauma or infection. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research
