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Patient-reported outcome measures in benign gynecologic surgery: updates and selected tools
Purpose of review Use of patient-reported outcome measures in clinical practice and research is becoming more prevalent and reflects initiatives to center the patient in healthcare delivery and outcomes assessment. The purpose of this review is to provide a summary description of selected, validated tools used to assess outcomes related to several benign gynecologic conditions: abnormal uterine bleeding, fibroids and endometriosis. Recent findings Given the availability of several validated instruments to assess patient outcomes in benign gynecology, there is still significant heterogeneity in tools used in trials. S...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew Siedhoff Source Type: research

Optimizing surgical management of patients who decline blood transfusion
Purpose of review This review highlights the complexity of caring for gynecologic patients who refuse blood transfusion and discusses the importance of early, targeted perioperative and intraoperative medical optimization. We review alternative interventions and the importance of medical management to minimize blood loss and maximize hematopoiesis, particularly in gynecologic patients who may have significant uterine bleeding. The review also focuses on intraoperative interventions and surgical techniques to prevent and control surgical blood loss. Recent findings With improvements in surgical technique, greater avail...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew Siedhoff Source Type: research

Prevention and management of bowel injury during gynecologic laparoscopy: an update
Purpose of review The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury. Recent findings Recent reviews describe a low incidence of bowel injury that is likely affected by low rates of reporting and inconsistent definitions. The major risk factor for bowel injury is adhesive disease, and assessment and prevention techniques for the presence of adhesive disease are evolving. When bowel injury occurs, prompt diagnosis and intraoperative repair yields more favorable outcomes tha...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew Siedhoff Source Type: research

Informed consent in gynecologic surgery
Purpose of review Informed consent is frequently used interchangeably with obtaining a signature on a form. This oversimplification shifts the value from the process of informed consent to the documentation. This review focuses on the recommended components of the consent process, barriers encountered, factors influencing patient satisfaction, attempts to improve the consent practice, and considerations in special populations. Recent findings The process of informed consent is key to promoting shared decision-making and patient autonomy. Several barriers exist to providing optimal consent including time constraints as...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew Siedhoff Source Type: research

Applications of Tranexamic acid in benign gynecology
Purpose of review Bleeding at the time of benign gynecologic surgery, as well as from benign gynecologic conditions, is a major source of morbidity for many women. Few nonhormonal medical options exist for the treatment of heavy menstrual bleeding, and to reduce surgical bleeding during major gynecologic surgery. Interest in Tranexamic acid (TXA) as a means to reduce surgical blood loss has been growing across many surgical specialties. This review focuses on applications for TXA as a means to reduce heavy menstrual bleeding (HMB) as well as to reduce surgical bleeding during benign gynecologic surgery. Recent findings ...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew Siedhoff Source Type: research

Surgical management and gynecologic care of the transgender patient
Purpose of review Over 1.4 million adults are identified as transgender in 2014. Many of these individuals have undergone, or plan to undergo, gender-affirming surgery. This review summarizes the medical and surgical options available for the transgender population and reviews screening guidelines and fertility preservation options. In addition, it highlights the role gynecologists have in caring for this population. Recent findings Gynecologists perform certain gender-affirming surgeries, such as hysterectomies and bilateral salpingooophorectomies. They also can play an important role in providing hormone therapy, an...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew Siedhoff Source Type: research

Sleep and female reproduction
The objective of this review is to evaluate recent literature on the association between sleep disturbances and female reproduction. Recent findings There is accumulating evidence that sleep quality and duration are important for female reproduction, but epidemiologic research is limited. Recent studies provide suggestive evidence that sleep disorders are associated with increased menstrual irregularity, subfertility/infertility, and poor pregnancy and birth outcomes. Mechanisms underlying these associations are likely to be multifactorial and complex. In addition to genetics, circadian disruption may impact reproductiv...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

A critical review of recent advances in the diagnosis, classification, and management of uterine adenomyosis
Purpose of review The purpose of this review is to summarize and highlight recent critical advances in the diagnosis, classification, and management of adenomyosis. Recent findings Recent studies have clarified the specific mechanism through which adenomyotic lesions invade the underlying myometrium by epithelial–mesenchymal transition. Correlation studies using diagnostic MRI also strongly support the hypothesis of a different pathogenesis between the inner and outer myometrium forms of adenomyosis. Given advances in diagnostic imaging, several international organizations have also highlighted the importance of cla...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

New insights into human prolactin pathophysiology: genomics and beyond
Purpose of review To briefly summarize what is known regarding hyperprolactinemia and prolactin-secreting tumors, and review recent findings. Recent findings Prolactin was previously thought to inhibit secretion of gonadotropin-releasing hormone (GnRH) by directly inhibiting the firing of GnRH neurons, resulting in hypogonadotropic hypogonadism and infertility. However, kisspeptin has recently been implicated as the mediator of hyperprolactinemia-induced infertility, by acting upstream of the GnRH neurons as an integrator of endocrine signals. Macroprolactin is generally considered to be inactive and clinically insig...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

Impact of obesity on male and female reproductive outcomes
Purpose of review The association between obesity and infertility has gained increasing provider and public awareness. The purpose of this review is to outline the recent research into the pathophysiology regarding obesity and its impact of reproductive function in both women and men. Recent findings A BMI more than 25 has a detrimental impact on the hypothalamus-pituitary-gonadal (HPG) axis in both men and women, leading to alterations of HPG hormones, gametogenesis, as well as an increase in inflammation and lipotoxicity from excessive adipose tissue. Additionally, BMI likely impacts assisted reproductive technology...
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by David L. Olive Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - July 8, 2019 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

How does stress, depression and anxiety affect patients undergoing treatment?
Purpose of review To review latest findings about the impact of fertility care on emotional distress and effect of distress on treatment outcome. Recent findings Treatment failure and long agonist protocols are associated with increased emotional distress during treatment. Screening tools can be used to identify men and women at risk of emotional maladjustment at the start of fertility treatment and people unlikely to need emotional support during or after treatment. There are inconclusive results about the association between emotional distress and outcome of fertility treatment. Systematic review of studies evaluati...
Source: Current Opinion in Obstetrics and Gynecology - May 15, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Androgen supplementation in assisted reproduction: where are we in 2019?
Purpose of review The purpose of this review is to provide an overview of androgen supplementation in ART with the most updated evidence, from animal studies to its clinical applications in poor ovarian responders (POR) and the future studies to be published. Recent findings Animal studies, has shown that testosterone supplementation, can be an option to increase the recruitable follicular pool in POR. However, the potential mechanism of action, dose, and duration of treatment is still under investigation. Early studies in humans reported promising results in favor of androgens [dehydroepiandrosterone (DHEA) or testos...
Source: Current Opinion in Obstetrics and Gynecology - May 15, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

The association between assisted reproductive technologies and low birth weight
Purpose of review To examine the existing literature in regards to the relationship between assisted reproductive technologies (ART) and low birth weight (LBW). Recent findings In 2017, Martin et al. reported on the incidence of low birth weight in relation to the number of embryos transferred, and showed that incidence of low birth weight in singletons correlates with number of embryos transferred. Meanwhile, several studies have shown increased weight of singletons born after frozen embryo transfers compared with fresh embryo transfers. A recent study published by Sekhon et al., among others, disputes these findings...
Source: Current Opinion in Obstetrics and Gynecology - May 15, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Individualized luteal phase support
Purpose of review The aim of this review is to summarize the different aspects of luteal phase deficiency in IVF treatment and the possibilities of individualized luteal phase support. Recent findings After the application of human chorionic gonadotrophin (hCG) for final oocyte maturation, the vaginal route for progesterone administration is sufficient to maintain an adequate luteal phase support. New data point toward the possibility of oral medication; however, those data have yet to be confirmed in larger studies. Luteolysis after gonadotropinrealzing hormone (GnRH) agonist trigger is patient specific and not alway...
Source: Current Opinion in Obstetrics and Gynecology - May 15, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research