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Looking at cancer health disparities in gynecologic oncology in 2020
Purpose of review To summarize the most recent evidence on gynecologic cancer disparities and to describe studies investigating the social determinants of health and receipt of evidence-based care and potential interventions to address inequities in care. Recent findings Significant disparities in disease-specific survival by race/ethnicity, socioeconomic status, and payer status have persisted in women with gynecologic cancers. Compared with white women, black women have an increased likelihood of disease-specific mortality for endometrial cancer and are less likely to receive guideline-adherent care for ovaria...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: SPECIAL COMMENTARY Source Type: research

Common pediatric gynecological issues: a review
Purpose of review To provide clinicians with a review of recent research and methods for evaluation of common pediatric gynecology complaints and problems. Recent findings The examination and history of a pediatric gynecologic patient involve information gathering in order to limit anxiety for the child and optimize the ability to diagnose and treat her. Child abuse recognition is increasing, and its management requires special expertise. The early management of disorders of sexual development (DSDs) has changed with a focus towards early identification and consideration of delayed surgical management. The multi...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by Ruben Alvero Source Type: research

Environmental impact on reproductive health and risk mitigating strategies
Purpose of review The purpose of this review is to increase awareness among reproductive health professionals and trainees about the impact of environmental toxicants and climate change on women's health and mitigation strategies at the individual, professional and governmental levels. Recent findings Global health indicators reveal a meteoric rise of noncommunicable diseases over the past 50 years, which threaten reproductive health directly and indirectly. Evolutionary genetic mutations as contributors are unlikely in this timeframe, and environmental causes have been invoked. Notably, the past 75 years ha...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by Ruben Alvero Source Type: research

Factors contributing to persistent disparate outcomes of in vitro fertilization treatment
The objective of this review is to highlight factors contributing to the persistent racial/ethnic disparities in in vitro fertilization (IVF) outcomes. Recent findings Recent studies document poorer outcomes after IVF treatment. Black women have been shown to have lower live birth rates following IVF treatment for more than 15 years. Summary In an effort to better understand these negative outcomes, scientists and clinicians have investigated possible biological contributing factors including the vaginal microbiome, differences in oocyte quality, embryo viability, endometrial factors, and hormonal differenc...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by Ruben Alvero Source Type: research

Reproductive potential and fertility preservation in transgender and nonbinary individuals
Purpose of review To synthesize recent literature to better understand parenting desires and challenges of transgender individuals as well as the impact of gender-affirming care on reproductive potential. Recent findings Survey studies of transgender and nonbinary individuals demonstrate significant parenting interest, yet uptake in fertility preservation services remains low with potential for decisional regret. Masculinizing hormones have demonstrated variable effects on folliculogenesis and follicle distribution in the human ovary. In the mouse model, testosterone administration has demonstrated an increase i...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by Ruben Alvero Source Type: research

Editorial: It was the best of times; it was the worst of times: the impact of the SARS-CoV2 (COVID-19) pandemic on reproductive endocrinology
Purpose of review To review the impact that COVID-19 has had on the practice of reproductive endocrinology and infertility. Recent findings As in all areas of medicine, the COVID-19 pandemic has caused profound changes in reproductive endocrinology and infertility. However, the pandemic has encouraged providers and systems to change approaches and unmasked many opportunities that may have actually improved care. The pandemic also forced the field to provide society with fact-based information even as data was constantly emerging and evolving and to do so rapidly. Combating misinformation became an equally imp...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: REPRODUCTIVE ENDOCRINOLOGY: Edited by Ruben Alvero Source Type: research

Innovating patient care and gynecologic surgery instruction through tele-education
We describe our experience creating a surge schedule for OB/GYN residents that allowed for sufficient coverage of inpatient care while minimizing resident exposure and limited hospital resources, respecting work hour requirements, and plans for coverage due to illness or need for home quarantine. We also report innovative approaches to trainee education through the use of remote-learning technology and gynecologic surgery skills training in absence of normal clinical exposure. Summary Our approach serves as a model for adapting to unprecedented challenges and offers suggestions for creative transformations of tradit...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Minimally invasive management of retained products of conception and the adherent placenta
Purpose of review Retained products of conception (POC) may occur independently or as a consequence of placenta accreta spectrum (PAS). Managing these conditions depends on the clinical scenario, and in some cases, can involve the use of minimally invasive techniques. This review presents the role of hysteroscopy and laparoscopy in the treatment of retained POC and the adherent placenta. Recent findings Hysteroscopic resection of retained POC is reported to have favorable outcomes compared to blind dilation and curettage, including higher success rates and a lower risk of intrauterine adhesion formation. Hystero...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Quality metrics in minimally invasive gynecologic surgery
Purpose of review Quality improvement and patient safety are relevant to the advancement of clinical care, particularly in the field of minimally invasive gynecologic surgery (MIGS). Although safety and feasibility of MIGS have been established, identification of quality metrics in this field is also necessary. Recent findings Surgical quality improvement has focused on national overarching measures to reduce mortality, surgical site infections (SSIs), and complications. Quality improvement in minimally invasive surgery has additionally led to advancements in postoperative patient recovery and long-term outcomes...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Surgical site infections in gynecology: the latest evidence for prevention and management
Purpose of review Surgical site infection (SSI) remains one of the most common postoperative surgical complications. Prevention and appropriate treatment remain paramount. Recent findings Evidence-based recommendations include recognition and reduction of preoperative risks including hyperglycemia and smoking, treatment of preexisting infections, skin preparation with chlorhexidine gluconate, proper use of preoperative antibiotics, and implementation of prevention bundles. Consideration should be given to the use of dual antibiotic preoperative treatment with cephazolin and metronidazole for all hysterectomies. ...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Abdominal wall endometriosis: an update in diagnosis, perioperative considerations and management
Purpose of review Abdominal wall endometriosis (AWE) is rare with limited evidence guiding diagnosis and treatment. The purpose of this review is to provide an update of the diagnosis, perioperative considerations, and treatment of AWE. Recent findings Recent studies further characterize presenting symptoms and locations of AWE. Prior abdominal surgery remains the greatest risk factor for the development of AWE. Newer evidence suggests that increasing BMI may also be a risk factor. Ultrasound is first-line imaging for diagnosis. Magnetic resonance image is preferred for surgical planning for deep or extensive le...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Racial and ethnic disparities in access to minimally invasive gynecologic surgery for benign pathology
Purpose of review To review current US literature and describe the extent, source, and impact of disparities that exist among Black, Indigenous, and people of color (BIPOC) in surgical route and outcomes for hysterectomy, myomectomy, and endometriosis surgery. Recent findings Despite the nationwide trend toward minimally invasive surgery (MIS), BIPOC women are disproportionally less likely to undergo MIS hysterectomy and myomectomy and have higher rates of perioperative complications. African American women, in particular, receive significantly disparate care. Contemporary literature on the prevalence of endomet...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Don’t be STUMPed: description and management of uncommon pathologies encountered on specimens from benign gynecologic surgery
Purpose of review In this review, we aim to describe uncommon pathologies that gynecologic surgeons may reasonably encounter on surgical specimens following benign gynecologic surgery. Recent findings Herein, we describe uncommon pathologic findings of the uterus (e.g. squamous morular metaplasia, fibroid variants, stromal tumor of uncertain malignant potential), peritoneum and adnexa (e.g. endosalpingiosis, serous tubal intraepithelial carcinoma), endometriosis (e.g. stromal endometriosis, atypical endometriosis), and findings of particular interest in postmenopausal women (e.g. ovarian cortical stromal hyperpl...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

Perioperative management for gynecologic minimally invasive surgery during the COVID-19 pandemic
This article will review current guidelines regarding surgical protocols for elective and nonelective surgeries during the severe acute respiratory syndrome coronavirus 2 pandemic. Recent findings Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach ...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research

How to minimize bleeding in laparoscopic myomectomy
Purpose of review Laparoscopic myomectomy is a common surgical procedure for symptomatic myomas. However, bleeding control during surgery may pose a challenge. Therefore, the aim of this study was to review recent evidence regarding interventions to control bleeding during laparoscopic myomectomy. Recent findings The use of vasopressin resulted in less blood loss compared to placebo. Barbed sutures reduced blood loss compared to conventional sutures. Intravenous infusion of tranexamic acid (TXA) in the intraoperative period of large myomectomies showed no significant difference compared to placebo. Uterine arter...
Source: Current Opinion in Obstetrics and Gynecology - July 9, 2021 Category: OBGYN Tags: MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Matthew T. Siedhoff and Nisse V. Clark Source Type: research