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

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 ...
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

Prepubertal Vulvovaginitis
Vulvovaginitis is a common gynecologic complaint in prepubertal girls. It typically presents with complaints of vulvovaginal itching, burning, irritation, discharge, or skin changes. Prepubertal females have anatomic, physiological, and behavioral factors that most often contribute to the development of symptoms. Careful attention to history and associated complaints will direct evaluation, diagnosis, and treatment. Most cases are nonspecific in origin and treatment includes counseling to patients and parents on hygiene and voiding techniques. Antibiotic treatment for specific pathogens may be indicated. Other less common ...
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

Foreword: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know
No abstract available (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

Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - July 30, 2020 Category: OBGYN Tags: Contributors: Pediatric and Adolescent Gynecology: What the Generalist Ob/Gyn Needs to Know Source Type: research

Index
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Index Source Type: research

Maternal Fetal Surgery: Intervention and Management
Congenital malformations occur in about 3% of all live births and are a leading cause of perinatal morbidity and mortality. An evolving understanding of the developing human fetus, advances in imaging, availability of cutting-edge instrumentation, and enhanced understanding of fetal pathophysiology, have allowed for prenatal surgical interventions to improve fetal diseases and neonatal outcomes. Fetal surgical therapy is no longer restricted to life-threatening prenatal diagnoses and can be categorized into either open surgical techniques or minimally invasive endoscopic/ultrasound-guided techniques. Patient selection requ...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Trauma in Pregnancy
One of the most common causes of obstetric morbidity and mortality is trauma in pregnancy. Several maternal physiological changes during pregnancy have a significant impact on the mechanism, presentation, and management of trauma in this population. It is crucial for health providers dealing with trauma to know and understand these differences between pregnant and nonpregnant patients. The obstetric trauma patient requires a multidisciplinary approach, including obstetrics, maternal fetal medicine, anesthesiology, surgery, and intensive care teams. The aim of this article is to review the most updated information on trauma...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Cardiac Surgery During Pregnancy
The need for cardiac surgery during pregnancy is rare. Only 1% to 4% of pregnancies are complicated by maternal cardiac disease and most of these can be managed with medical therapy and lifestyle changes. On occasion, whether due to natural progression of the underlying cardiac disease or precipitated by the cardiovascular changes of pregnancy, cardiac surgical therapy must be considered. Cardiac surgery is inherently dangerous for both, the mother and fetus with mortality rates near 10% and 30%, respectively. For some conditions, percutaneous cardiac intervention offers effective therapy with far less risk to the mother a...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Surgery in the Obese Pregnant Patient
This chapter reviews issues which complicate surgery in obese pregnant patients. Maternal obesity is prevalent in the United States and is associated with numerous adverse health outcomes. When surgery is indicated during pregnancy, the presence of maternal obesity increases surgical risks for both the fetus and mother. Specific risks are identified and strategies to avoid them are evaluated. The prognosis and management of pregnant women who have undergone bariatric surgery is also discussed, and practical guidelines for obstetric management of these patients are presented. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Appendicitis and Cholecystitis in Pregnancy
Up to 2% of pregnant women develop a disease that requires nonobstetrical operative intervention during pregnancy. We discuss the issues unique to pregnant patients as they pertain to the presentation, diagnosis, and management of nonobstetric surgical disease, with an emphasis on 2 of the most common diseases that affect pregnant women: appendicitis and cholecystitis. Surgery has been demonstrated to be safe and effective during pregnancy, provided proper precautions are taken into account. It is the consensus of multiple professional committees and societies that no pregnant women should be delayed or denied a necessary ...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Adnexal Masses in Pregnancy
With the increased use and quality of ultrasound in pregnancy, adnexal masses are being encountered with greater frequency. Fortunately, the vast majority of such masses are benign and resolve on their own. However, it is important for clinicians to be familiar with the types of adnexal masses that may be visualized in pregnancy to best counsel these women. In addition, complications such as ovarian torsion, and rarely, even malignancy can occur. In this article, we review the available literature on this subject to help guide the clinician in the diagnosis and management of adnexal masses in pregnancy. (Source: Clinical O...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Minimally Invasive Surgery in Pregnancy
This article will review the safety of surgery in pregnancy, maternal physiology, fetal considerations, maternal obesity, laparoscopic cerclage, large adnexal mass, and complications. Guidelines for surgery will be reviewed as well. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Intraoperative Fetal Monitoring for Nonobstetric Surgery
Necessary nonobstetric surgical procedures should not be withheld from pregnant women for fear of risks to the women and their pregnancies; however, careful preoperative planning should be undertaken to mitigate risks that may be present. Fetal monitoring recommendations will be dependent on the woman’s preferences, gestational age of the pregnancy, and situational-specific risks (including anticipated risk of cardiovascular instability). Some fetal heart rate changes (lower baseline, less variability) can be anticipated, depending on anesthetic agents utilized during the procedure, and should not routinely prompt de...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Diagnostic Imaging and Outcomes for Nonobstetric Surgery During Pregnancy
A surgical disease occurring during pregnancy can present a diagnostic dilemma due to the desire to make a timely and accurate diagnosis within the constraints of limiting radiation exposure to the fetus. However, required diagnostic imaging should be pursued when indicated and attempts made to minimize the radiation dose by utilizing abdominal shielding and low-dose protocols when feasible. When surgery is indicated due to disease processes, treatment should not be altered or delayed due to pregnancy as the evidence for adverse pregnancy outcomes including early pregnancy loss and preterm delivery are overall of low quali...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Anesthesia for Nonobstetric Surgery in Pregnancy
Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis. Emergency procedures should be perf...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Foreword: Nonobstetric Surgery in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Nonobstetric Surgery in Pregnancy Source Type: research

Contributors: Nonobstetric Surgery in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Contributors: Nonobstetric Surgery in Pregnancy Source Type: research

When Should Prophylactic Oophorectomy Be Recommended at the Time of Elective Hysterectomy?
Gynecologists are frequently confronted with the decision of when to recommend oophorectomy at the time of an elective hysterectomy. When deciding if oophorectomy should be recommended, first a careful history and risk assessment must be performed to determine if a patient is a candidate for a risk-reducing oophorectomy. If the patient does not have a hereditary ovarian cancer risk, then it is recommended the surgeon carefully consider the implications of ovarian removal on the health of their patient. This review covers the potential benefits and risks of prophylactic oophorectomy and offers a decision aid for when to rec...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

To Robot or Not To Robot: The Use of Robotics in Benign Gynecologic Surgery
This article discusses the current literature regarding the use of robotic-assisted surgery in benign gynecologic surgery. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

Secondary Prevention of Intrauterine Adhesions Following Hysteroscopic Surgery in Women With Asherman Syndrome: Is Something Better Than Nothing?
Asherman syndrome is a reproductive disorder characterized by intrauterine adhesions and amenorrhea, infertility, abnormal placentation, or pregnancy loss. Treatment of Asherman syndrome involves hysteroscopic lysis of adhesions. Many surgeons utilize postoperative measures such as hormone therapy, solid mechanical devices, or barrier gels to prevent recurrent adhesions in this setting. However, there is limited high-quality evidence to support their use. Additional research is needed on the safety and efficacy of these commonly used methods to guide patient care. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

Tissue Extraction in Gynecologic Surgery: Past, Present, and Future
Fibroid tissue extraction during hysterectomy and myomectomy has become increasingly controversial. A wave of research has tried to clarify difficult questions around the prevalence of occult malignancies, the effect of morcellation on cancer outcomes, proper informed consent, and surgical options for tissue extraction. This review examines the history of these controversies and discusses tissue extraction techniques and continued areas of debate in the field. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

Deliberate Practice: Applying the Expert Performance Approach to Gynecologic Surgical Training
This article discusses methods for implementing deliberate practice and the expert performance approach into gynecologic surgical training programs. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

Vasectomy: An Opportunity for Obstetricians and Gynecologists
Vasectomy is a safe, effective, and cost-effective contraceptive method, with a failure rate lower than that of female sterilization. Nevertheless, vasectomy is underutilized—only 6% of American women rely on vasectomy. Access to vasectomy may be limited by provider advocacy and availability. Obstetricians and gynecologists can increase both the acceptability of and access to this method if adequately trained to counsel about and provide the procedure. Although some concerns may persist surrounding obstetricians and gynecologists performing a vasectomy, increasing the availability and uptake of vasectomy avoids unnec...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

Controversies in Female Genital Cosmetic Surgeries
Female genital cosmetic surgery (FGCS) aims to alter the structure and appearance of female genitalia to attain the desired shape, size or look, or to decrease labial interference during intercourse, relieve pain and discomfort with clothing and exercise or decrease vaginal caliber and laxity. In the last 5 years, the number of labiaplasty surgeries performed in the United States rose by 53%. Despite the increasing popularity of FGCS, several divergent opinions regarding the ethics, safety, and efficacy of these procedures exist. Here we provide a brief overview of the terminology and techniques for FGCS and summarize curr...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

Introducing New Technologies and Techniques into Gynecologic Surgical Practice
The surgery practiced today is not the same as the surgery practiced a generation ago and because of the ever-evolving nature of medicine, ongoing education, and adoption of new technology is vital for all surgeons. New technology has the potential to revolutionize the way we practice medicine; however, it is important to understand the context in which new medical devices arise and to approach new medical devices with a healthy combination of skepticism and optimism. Surgeons should feel comfortable assessing, critiquing, and adopting new technology. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research

The Volume-Outcome Paradigm for Gynecologic Surgery: Clinical and Policy Implications
Studies over the past decade have clearly demonstrated an association between high surgeon and hospital volume and improved outcomes for women undergoing gynecologic surgical procedures. In contrast to procedures associated with higher morbidity, the association between higher volume and improved outcomes is often modest for gynecologic surgeries. The lower magnitude of this association has limited actionable policy changes for gynecologic surgery. These data have been driving initiatives such as regionalization of care, targeted quality improvement at low volume centers and volume-based credentialing in gynecology. (Sourc...
Source: Clinical Obstetrics and Gynecology - April 22, 2020 Category: OBGYN Tags: Controversies in Gynecologic Surgery Source Type: research