Declining Fertility with Reproductive Aging
Protection of fertility shares many of the same concepts as optimization of general health, such as smoking cessation, maintenance of a healthy body weight, and moderation of alcohol intake. Increasing attention has been placed on minimizing exposures to known reproductive toxicants. There are few conclusive data to support specific diet patterns or supplements for fertility. Ovarian reserve testing has been explored as potential diagnostic tests for assessment of reproductive aging with some controversy. Finally, the development of vitrification in the assisted reproduction laboratory has increased the success and, theref...
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Molly M. Quinn, Marcelle I. Cedars Source Type: research

Onset of the Menopause Transition
This article offers current evidence for symptoms that occur in the early menopause transition, including vasomotor symptoms, mood changes, sleep problems, and changes in sexual functioning. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Clarisa R. Gracia, Ellen W. Freeman Source Type: research

Menstrual Cycle Changes as Women Approach the Final Menses
This article describes the STRAW+10 bleeding criteria for recognizing onset of the early and late menopausal transition, as well as the specific bleeding changes a woman may experience during this life stage, including how women ’s bleeding experiences differ. The high probability of episodes of excessive and prolonged bleeding as women approach their final menstrual period is documented, as is the continuing probability of ovulation as women reach their final menstrual period. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Siob án D. Harlow Source Type: research

Menstrual Cycle Hormone Changes Associated with Reproductive Aging and How They May Relate to Symptoms
Key cycle changes occur as women transition from reproductive life to menopause, and they can be roughly linked to menopausal staging. It is important to understand the types of studies that inform the current knowledge. Patterns of symptoms within menstrual cycles (sleep, headache) generally favor worsening in association with the perimenstrual phase of the cycle, and patterns of chronic symptoms, such as hot flashes and adverse mood, appear to be worse when hormones are more variable. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Amanda Allshouse, Jelena Pavlovic, Nanette Santoro Source Type: research

Vasomotor Symptoms Across the Menopause Transition
Vasomotor symptoms (VMS) are the primary menopausal symptoms, occurring in up 80% of women and peaking around the final menstrual period. The average duration is 10  years, longer in women with an earlier onset. Compared with non-Hispanic white women, black and Hispanic women are more likely and Asian women are less likely to report VMS. Risk factors include greater body composition (in the early stage of menopausal transition), smoking, anxiety, depression, s ensitivity to symptoms, premenstrual syndrome, lower education, and medical treatments, such as hysterectomy, oophorectomy, and breast cancer-related therapies....
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Nancy E. Avis, Sybil L. Crawford, Robin Green Source Type: research

Cardiovascular Implications of the Menopause Transition
This article focuses on the rela tionship between 2 main features of the MT and women’s cardiovascular health: (1) dynamic alterations of sex hormones, particularly endogenous estradiol and follicle-stimulating hormone, and (2) vasomotor symptoms, the cardinal symptom of the menopause. Limitations and future directions are discus sed. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Samar R. El Khoudary, Rebecca C. Thurston Source Type: research

Depression During and After the Perimenopause
Vulnerability to depression is increased across the menopause transition and in the early years after the final menstrual period. Clinicians should systematically screen women in this age group; if depressive symptoms or disorder are present, treatment of depression should be initiated. Potential treatments include antidepressants for moderate to severe symptoms, psychotherapy to target psychological and interpersonal factors, and hormone therapy for women with first-onset major depressive disorder or elevated depressive symptoms and at low risk for adverse effects. Behavioral interventions can improve physical activity an...
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Joyce T. Bromberger, Cynthia Neill Epperson Source Type: research

Sleep, Health, and Metabolism in  Midlife Women and Menopause
Sleep and metabolism are essential components of health. Metabolic health depends largely on individual ’s lifestyle. Disturbances in sleep health, such as changes in sleep patterns that are associated with menopause/reproductive aging and chronologic aging, may have metabolic health consequences. Sleep restriction and age-related changes in sleep and circadian rhythms may influence changes in appet ite and reproductive hormones, energy expenditure, and body adiposity. In this article, the authors describe how menopause-related sleep disturbance may affect eating behavior patterns, immunometabolism, immunometabolic d...
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Howard M. Kravitz, Rasa Kazlauskaite, Hadine Joffe Source Type: research

Physical Activity and Physical Function
Evidence supports that the physical disablement process starts earlier than previously thought, in midlife when women still have many years to live. Physical activity participation and interventions have been successful in preventing disability in older adults and may be promising for maintaining function at younger ages. Changing the conversation to more relevant topics in midlife, like positive changes in body composition, sleep, and improved mood, may move the dial on participation, as midlife women do not meet guidelines for physical activity. Exploring the role of reproductive aging beyond chronologic aging may provid...
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Sheila A. Dugan, Kelley Pettee Gabriel, Brittney S. Lange-Maia, Carrie Karvonen-Gutierrez Source Type: research

Genitourinary Changes with Aging
Both chronologic aging and menopause affect the physical, physiologic, and microbiological characteristics of the genitourinary tract. The genitourinary syndrome of menopause, characterized by vulvovaginal and lower urinary tract signs and symptoms, is prevalent and has a significant negative impact on women ’s lives. In this article, the authors detail the genitourinary tract changes associated with menopause and/or aging. They also review the 2014 North American Menopause Society’s definition of the genitourinary syndrome of menopause and present the epidemiology and impact of genitourinary aging in midlife a...
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Caroline M. Mitchell, L. Elaine Waetjen Source Type: research

Cognitive Changes with Reproductive Aging, Perimenopause, and Menopause
This article reviews the role of endogenous estrogen in neural and cognitive processing, followed by an examination of longitudinal cognitive data captured in various stages of the menopausal transition. The remaining text reviews the contradictory results from major hormone therapy trials to date, evidence for the “timing hypothesis,” and closes with recommendations for future research and for practicing clinicians. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Kelly N. Morgan, Carol A. Derby, Carey E. Gleason Source Type: research

Bone Health During the Menopause Transition and Beyond
The menopause transition is a critical period for bone health, with rapid losses in bone mass and strength occurring in a 3-year window bracketing the date of the final menstrual period. Declines in bone mass are accompanied by deleterious changes in bone macrostructure and microarchitecture, which may be captured by changes in composite strength indices and indices of trabecular thickness and connectivity. The onset of the rapid bone loss phase is preceded by changes in sex steroid hormones and increases in markers of bone resorption, measurements of which may be clinically useful in predicting the onset of the rapid loss...
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Arun S. Karlamangla, Sherri-Ann M. Burnett-Bowie, Carolyn J. Crandall Source Type: research

Female Sexual Function at Midlife and Beyond
Sexual function is an important component of quality of life for women. Midlife poses several challenges to optimal sexual function and intimacy for women. In addition to anatomic factors related to estrogen deficiency, such as genitourinary syndrome of menopause, vulvovaginal atrophy, and pelvic organ prolaps, psychosocial factors, including prior sexual trauma, play an important role in sexual function in women. Several treatments have emerged for female sexual dysfunction; long-term studies and head-to-head comparisons are lacking. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Holly N. Thomas, Genevieve S. Neal-Perry, Rachel Hess Source Type: research

The Disruptive Changes of Midlife: A Biopsychosocial Adventure
In addition to the psychosocial challenges of evolving family relationships, midcareer job stressors, and the recrudescence of childhood and sexual trauma, unpredictable changes in reproductive hormones may result in further destabilization of tissue function and end-organ manifestations. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Nanette Santoro, Howard M. Kravitz Tags: Preface Source Type: research

A More Complete Picture of Reproductive Aging and the Menopause Transition
This issue of the Obstetrics and Gynecology Clinics of North America, co-edited by Nanette Santoro, MD and Howard M. Kravitz, DO, MPH, deals with reproductive aging. A prior issue devoted to the perimenopause, which was published in September 2011 and was also edited by Dr Santoro, highlighted the findings of several worldwide, longitudinal cohort studies of midlife women. The present issue provides a more complete picture of reproductive aging and the menopause transition beginning with declining fertility with reproductive aging and menstrual cycle changes as women approach their final menses. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research

Reproductive Aging
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Authors: Nanette Santoro, Howard M. Kravitz Source Type: research

Copyright
Elsevier (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Source Type: research

Contributors
WILLIAM F. RAYBURN, MD, MBA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Source Type: research

Contents
William F. Rayburn (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Source Type: research

Forthcoming Issues
Gynecologic Cancer Care: Innovative Progress (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 26, 2018 Category: OBGYN Source Type: research

Identification and Treatment of Peripartum Anxiety Disorders
Anxiety disorders in the peripartum period are common and frequently overlooked. They can present de novo or as exacerbations of generalized anxiety disorder, obsessive compulsive disorder, panic disorder and social anxiety disorder, or posttraumatic stress disorder. Calculating a score on the Edinburgh postnatal depression scale is a useful method of screening for these disorders while also screening for perinatal depression. Treatment includes psychotherapy, specifically cognitive behavioral therapy, and antidepressants, the choice of which should be balanced between the severity of symptoms and impact of functioning, ri...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Katherine E. Williams, Hristina Koleva Source Type: research

Complementary Health Practices for Treating Perinatal Depression
This article provides a focused review of the evidence for several complementary health approaches (ie, omega-3 fatty acids, folate, vitamin D, selenium, zinc, magnesium, B vitamins, physical activity, yoga) in the treatment of perinatal depression. There is evidence that some of these treatments may be reasonable to consider in women during pregnancy or the postpartum period. However, there are little data on the comparative safety and efficacy of these relative to traditional treatments (eg, psychotherapy, pharmacotherapy). Adequately powered high-quality studies are necessary to determine the role of complementary healt...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Nafisa Reza, Kristina M. Deligiannidis, Elizabeth H. Eustis, Cynthia L. Battle Source Type: research

Perinatal Sleep Problems
Changes in sleep are ubiquitous in the perinatal period and it is important to be able to determine when these changes are significant enough to indicate sleep deficiency associated with increased risk for poor maternal and infant outcomes. Guidelines for identifying sleep deficiency include insomnia symptoms, excessively shortened sleep duration, and perception of insufficient or nonrestful sleep. Causes and complicating factors related to such sleep problems have been well-documented and are used to tailor behavioral and pharmacologic treatments for women who are pregnant or in the early postpartum period. (Source: Obste...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Allison K. Wilkerson, Thomas W. Uhde Source Type: research

Impact of Pregnancy Loss on Psychological Functioning and Grief Outcomes
This article discusses the prevalence and timing of perinatal loss. The impact that perinatal grief has on psychological functioning is presented, including common grief reactions and the risk factors for complicated grief. The ways that perinatal grief is processed by each parent and the impact that it has on the relationships is also discussed. The role of the health care professional is outlined and the process for them to assist grieving parents is outlined in 5 steps. The screening process and treatment of grieving parents is also presented. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Tonia M. Cassaday Source Type: research

Recognizing and Managing Postpartum Psychosis
Postpartum psychosis is a psychiatric emergency that affects 1 to 2 per 1000 women. Key clinical features include mood fluctuation, abnormal thoughts or behaviors, and confusion. Women with a history of bipolar disorder are at heightened risk, as are first-time mothers; current research on the causes focuses on biological triggers, such as immune dysregulation. Women with postpartum psychosis require inpatient hospitalization and should be treated with lithium, antipsychotics, and benzodiazepines. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Lauren M. Osborne Source Type: research

Psychosocial Aspects of Fertility and Assisted Reproductive Technology
Psychosocial aspects of fertility, infertility, and assisted reproductive technology (ART) can significantly impact patients ’ sense of self-identity and personal agency, mental well-being, sexual and marital relationships, reproductive efficiency, compliance with treatment, and pregnancy outcomes. Research is needed to understand how stress, anxiety, depression, mood disorders, and psychotropic medications impact ferti lity and infertility treatment. The psychosocial implications of ART on our society include a shift toward older maternal age at conception, the complexities of third-party reproduction, and considera...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Jamie Stanhiser, Anne Z. Steiner Source Type: research

Pharmacologic Treatment of Perinatal Depression
This review provides information about medications used to treat perinatal depression, including guidance around when to use certain medications and when to consult a mental health provider. For each group of medications, including selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, mirtazapine, bupropion, lithium, atypical antipsychotics, and lamotrigine, the risks and benefits of treatment during pregnancy and lactation are reviewed, and unique qualities of each medication. A treatment algorithm is included and a description of the Food and Drug Administration ’s approach to provi...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Mary C. Kimmel, Elizabeth Cox, Crystal Schiller, Edith Gettes, Samantha Meltzer-Brody Source Type: research

Perinatal Intimate Partner Violence
This article reviews the prevalence and outcomes of perinatal intimate partner violence (IPV). Reported rates of perinatal IPV range from 3.7% to 9.0%. Perinatal IPV is associated with a multitude of mental and obstetric health outcomes that affect the mother and child. Perinatal medical providers have an opportunity to detect victims of IPV and facilitate services for this population. Screening, safety planning, and referral procedures are essential for addressing this public health problem. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Christine K. Hahn, Amanda K. Gilmore, Rosaura Orengo Aguayo, Alyssa A. Rheingold Source Type: research

The Unwelcome Guest
Health care providers (HCPs) are often poorly prepared to respond to childhood sexual abuse (CSA) survivors ’ needs in reproductive health care. With few protocols addressing the CSA survivor population, HCPs struggle with delivering interventions that meet professional standards of care within the systemic constraints of reproductive health care. To bridge the gap that exists when the unwelcome guest o f CSA enters the reproductive health care arena, it is important to understand the psychological influences of trauma that affect CSA survivors, the symptoms or behavioral cues that are commonly revealed, and therapeu...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Phyllis M. Florian Source Type: research

Management of Attention Deficit Hyperactivity Disorder During Pregnancy
This article summarizes the available data regarding perinatal exposure to psychostimulants. It also highlights the importance of the risk-risk analysis for clinicians and patients to consider, weighing risks of medication exposure to risks of ADHD during pregnancy, including driving safety and major impairment in occupational roles. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Allison S. Baker, Marlene P. Freeman Source Type: research

Treatment of Perinatal Opioid Use Disorder
Opioid agonist therapy is the standard of care for pregnant women with Opioid Use Disorder, but medication-assisted withdrawal from opioid agonist therapy is increasingly prevalent. We review available literature evaluating the risks and benefits of medication-assisted withdrawal. We highlight the importance of supporting women in making an informed treatment choice that is best for them. Although it is tempting to choose medication-assisted withdrawal to decrease the risk of newborn opioid withdrawal, we caution against this practice. Facilitating treatment that assists pregnant women in recovery ultimately produces the b...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Lisa Boyars, Constance Guille Source Type: research

Treatment of Peripartum Bipolar Disorder
Bipolar disorder affects women throughout their childbearing years. During the perinatal period, women with bipolar disorder are vulnerable to depressive episode recurrences and have an increased risk for postpartum psychosis. Perinatal screening is critical to identify women at risk. Although medications are the mainstay of treatment, the choice of pharmacotherapy must be made by the patient based on a risk –benefit discussion with her physician. For optimal dosing in pregnancy, therapeutic drug monitoring may be required to maintain effective drug concentrations. Residual symptoms of bipolar depression are treatabl...
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Crystal T. Clark, Katherine L. Wisner Source Type: research

Perinatal Mental Health
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Authors: Constance Guille, Roger B. Newman Source Type: research

Copyright
ELSEVIER (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Source Type: research

Contributors
WILLIAM F. RAYBURN, MD, MBA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Source Type: research

Contents
William F. Rayburn (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Source Type: research

Forthcoming Issues
Reproductive Aging (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 7, 2018 Category: OBGYN Source Type: research

Treatment of Peripartum Mental Health Disorders: An Essential Element of Prenatal Care
Obstetricians and Gynecologists are acutely aware of the prevalence of maternal mental health disorders and the impact they can have on maternal, fetal, and newborn health and child development. Sadly, fewer than half of pregnant women with a mental health illness are identified in clinical settings. Among women who are identified, only 15% receive mental health treatment, fewer than 10% receive adequate treatment, and less than 5% achieve remission from their illness. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - July 10, 2018 Category: OBGYN Authors: Constance Guille, Roger Newman Tags: Preface Source Type: research

Pregnancy: An Opportune Time to Evaluate and Treat Mental Health Disorders
This issue of the Obstetrics and Gynecology Clinics of North America is dedicated to a contemporary and comprehensive look at perinatal mental health. The issue is capably edited by two well-recognized academicians in separate fields: a perinatal psychiatrist and maternal-fetal medicine specialist, Dr Constance Guille and Dr Roger Newman, respectively. I am now seeing more psychiatrists pursing expertise in women ’s behavioral health, especially in obstetrics, which is critical due to the insufficient number of experienced providers being available. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - July 10, 2018 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research

Management of Obstructive Sleep Apnea in Pregnancy
The spectrum of sleep-disordered breathing (SDB) ranges from mild snoring to obstructive sleep apnea, the most severe form of SDB. Current recommendations are to treat these women with continuous positive airway pressure despite limited data. SDB in early and mid-pregnancy is associated with preeclampsia and gestational diabetes. Pregnant women with a diagnosis of obstructive sleep apnea at delivery were at significantly increased risk of having cardiomyopathy, congestive heart failure, pulmonary embolism, and in-hospital death. These effects were exacerbated in the presence of obesity. Postpartum, these women are at risk ...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Jennifer E. Dominguez, Linda Street, Judette Louis Source Type: research

Pregestational Diabetes in Pregnancy
Diabetes is a common chronic condition in women of reproductive age. Preconception care is crucial to reducing the risk of adverse maternal and fetal outcomes, such as hypertensive disorders, abnormal fetal growth, traumatic delivery and stillbirth, associated with poor glycemic control. Insulin is the preferred medication to optimize glucose control in women with pregestational diabetes. Frequent dose adjustments are needed during pregnancy to achieve glycemic goals, and team-based multidisciplinary care may help. Postpartum care should include lactation support, counseling on contraceptive options, and transition to prim...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Ronan Sugrue, Chloe Zera Source Type: research

Gestational Diabetes
Gestational diabetes mellitus (GDM) is carbohydrate intolerance resulting in hyperglycemia with onset during pregnancy. The article aims to provide clinicians with a working framework to minimize maternal and neonatal morbidity. Landmark historical and recent data are reviewed and presented to provide clinicians with a quick, easy reference for recognition and management of GDM. Data presented tie in insights with underlying pathophysiologic processes leading to GDM. Screening and diagnostic thresholds are discussed along with management upon diagnosis. Good clinical practice regarding screening, diagnosis, and management ...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Jeffrey M. Denney, Kristen H. Quinn Source Type: research

Maternal Mortality in the Twenty-First Century
Maternal mortality plagues much of the world. There were 303,000 maternal deaths in 2015 representing an overall global maternal mortality ratio of 216 maternal deaths per 100,000 live births. In the United States, the maternal mortality ratio had been decreasing until 1987, remained stable until 1999, and then began to increase. Racial disparities exist in the rates of maternal mortality in the United States with maternal death affecting a higher proportion of black women compared with white women. To reduce maternal mortality, national organizations in the United States have called for standardized review of cases of mat...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: John A. Ozimek, Sarah J. Kilpatrick Source Type: research

Pregnancy in Women with Obesity
Pregnancy in women with obesity is an important public health problem with short- and long-term implications for maternal and child health. Obesity complicates almost all aspects of pregnancy. Given the growing prevalence of obesity in women, obstetric providers need to understand the risks associated with obesity in pregnancy and the unique aspects of management for women with obesity. Empathic and patient-centered care, along with knowledge, can optimize outcomes for women and children. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Cara D. Dolin, Michelle A. Kominiarek Source Type: research

Infections in Pregnancy and the Role of Vaccines
Pregnant women are at risk for infection and may have significant morbidity or mortality. Influenza, pertussis, zika, and cytomegalovirus produce mild or asymptomatic illness in the mother, but have profound implications for her fetus. Maternal immunization can prevent or mitigate infections in pregnant women and their infants. The Advisory Committee of Immunization Practices recommends 2 vaccines during pregnancy: inactivated influenza, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis during pregnancy. The benefits of MMR, varicella, and other vaccines are reviewed. Novel vaccine studies for use duri...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Kimberly B. Fortner, Claudia Nieuwoudt, Callie F. Reeder, Geeta K. Swamy Source Type: research

Thromboprophylaxis in Pregnancy
Venous thromboembolism is a leading cause of maternal morbidity and mortality worldwide. Identifying women who are at greatest risk for venous thromboembolism, and managing their pregnancies with appropriate thromboprophylaxis is essential to decreasing this life-threatening condition. Those at greatest risk are patients with thrombophilias, a personal or family history of venous thromboembolism, and those undergoing cesarean delivery. Current international guidelines on thromboprophylaxis vary in details, but all strategies rely on risk factor identification and thromboprophylaxis for the highest risk patients. All guidel...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Diana Kolettis, Sabrina Craigo Source Type: research

Cancer in Pregnancy
This article reviews some of the more common types of cancer that may be encountered during pregnancy. It reviews the unique challenges with the diagnosis and treatment of breast, cervical, hematologic, and colon cancers in pregnant patients. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Anna McCormick, Erika Peterson Source Type: research

Maternal Genetic Disorders in Pregnancy
The life expectancy and quality of life of women with genetic disorders continues to improve, resulting in more women reaching reproductive age and desiring fertility. It is becoming increasingly important that obstetricians become familiar with common genetic disorders and their associated risks in pregnancy. The authors review pregnancy in women with various genetic disorders, including review of pregnancy outcomes, management recommendations, and genetic risk assessment. Most data on pregnancies in women with genetic conditions are based on case reports and literature reviews. Additional studies, including pregnancy reg...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Sarah Harris, Neeta L. Vora Source Type: research

Maternal Congenital Heart Disease in Pregnancy
Congenital heart disease comprises most maternal cardiac diseases in pregnancy and is an important cause of maternal, fetal, and neonatal morbidity and mortality worldwide. Pregnancy is often considered a high-risk state for individuals with structural heart disease as a consequence of a limited ability to adapt to the major hemodynamic changes associated with pregnancy. Preconception counseling and evaluation are of utmost importance, as pregnancy is contraindicated in certain cardiac conditions. Pregnancy can be safely accomplished in most individuals with careful risk assessment before conception and multidisciplinary c...
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Megan E. Foeller, Timothy M. Foeller, Maurice Druzin Source Type: research

Hypertensive Disorders in Pregnancy
This article summarizes the diagnosis and management of each of the disorders in the spectrum of hypertension in pregnancy and highlights recent updates in the field. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - May 9, 2018 Category: OBGYN Authors: Amelia L.M. Sutton, Lorie M. Harper, Alan T.N. Tita Source Type: research