Current Quality of Gynecologic Cancer Care in North America
Evaluating the quality of care received by gynecologic cancer patients in the real world is essential for excellent outcomes. The recent population-based literature looking at quality of care was reviewed for all gynecologic malignancies. Outcomes are generally highest when care is provided by high-volume providers in high-volume cancer centers. Provision of care according to clinical practice guidelines has also been demonstrated to improve outcomes in many situations. Disparities exist for marginalized groups in terms of the care they receive and subsequent outcomes. Health systems need to improve care for these populati...
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Clare J. Reade, Laurie M. Elit Source Type: research

Cancer Screening and Prevention Highlights in Gynecologic Cancer
This article provides an up-to-date summary of screening approaches and key strategies in prevention of gynecologic malignancies. The Pap smear is the only proven screening intervention in the field of gynecologic oncology. Women should receive treatment for precancerous conditions of the cervix, vulva, vagina, and endometrial lining. Women with inherited conditions should consider having a risk-reducing surgery once they have finished childbearing. The human papilloma virus vaccination should be offered to all girls and boys aged 11 to 12  years, and can also be given as early as age 9 and through 26 years of ag...
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Jeanine N. Staples, Linda R. Duska Source Type: research

Germline and Somatic Tumor Testing in Gynecologic Cancer Care
New technologies have advanced the science of tumor biology and genomics. Commercially available germline and somatic testing modalities have the downstream benefits of enabling prevention strategies in women with hereditary cancers and their family members in addition to identifying women who benefit most from novel targeted therapeutics. The matrix of available testing is complex and evolving. Women ’s health providers need to be versed in benefits and limitations of available testing. Genetic counselors play a pivotal role in interpretation of relevant mutations, and in avoiding common pitfalls, but their skill se...
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Jill Alldredge, Leslie Randall Source Type: research

Less Is More: Minimally Invasive and Quality Surgical Management of Gynecologic Cancer
Surgery is a cornerstone of gynecologic oncology. Minimally invasive techniques have been adopted rapidly, in lieu of open approaches, in cervical and endometrial cancer staging. In addition, nodal assessment has undergone significant changes with the introduction of SLN biopsies. The movement toward less is more has also been seen with perioperative and postoperative care and the advent of ERAS protocols, which attempt to maintain normal physiology with the goal of improving functional recovery. It is imperative that new technology be critically evaluated to ensure that oncologic outcomes are not compromised. (Source: Obs...
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Evelyn Cantillo, Jenna B. Emerson, Cara Mathews Source Type: research

Ovarian Cancer
This article reviews contemporary trials of maintenance therapy and novel drug development. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Rebecca Ann Previs, Angeles Alvarez Secord Source Type: research

Endometrial Cancer
This article reviews available molecular data, the interplay between endometrial cancer carcinogenesis with obesity and genetics, as well as current targeted therapies. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Megan E. McDonald, David P. Bender Source Type: research

(At Least) Once in Her Lifetime: Global Cervical Cancer Prevention
Cervical cancer disproportionately burdens lower-resourced settings, in which nearly 90% of cervical cancer and cervical cancer –related deaths occur. Targeting human papillomavirus (HPV) by prophylactic HPV vaccination in young adolescent girls and HPV-based screening in mid-adult women offers the most cost-effective strategy to reduce cervical cancer burden worldwide and mitigate the health disparities in cervical cancer burden between low-resourced and high-resourced settings. Political and social will, along with the necessary financial investments, will be necessary to realize the opportunity for significant glo...
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Philip E. Castle, Amanda Pierz Source Type: research

Vulvar Cancer
This article reviews the epidemiology, diagnosis, and management of vulvar preinvasive lesions, squamous cell carcinoma, and melanoma. There is an emphasis on sentinel lymph node dissection for early stage disease and advances in chemoradiation for late-stage disease. A brief review of vulvar Paget disease is also included. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Daniel Weinberg, Ricardo A. Gomez-Martinez Source Type: research

Chemotherapy, Biologic, and Immunotherapy Breakthroughs in Cancer Care
As the understanding of cancer biology expands, a wider array of treatment options has become available in the field of gynecologic cancer. Therapies that target specific molecular pathways are now being used. Drugs that target cancer angiogenesis, signal transduction, DNA repair, and immune evasion mechanisms are currently being used, in addition to or in lieu of traditional chemotherapy, to achieve more personalized treatment of each patient and their unique disease. These therapies may lead to improved survival outcomes and quality of life during treatment and during remission. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Christine Rojas, Yovanni Casablanca Source Type: research

Personalized Medicine in Gynecologic Cancer
Personalized medicine in gynecologic oncology is an evolving field. In recent years, tumor profiling and large databases such as TCGA and NCI-Match have provided us with enormous amounts of molecular data. Several therapies that capitalize on novel genetic and immune discoveries including VEGF inhibitors, PARP inhibitors, and cancer vaccinations are discussed in this article. Additionally, we have seen direct to consumer marketing play an important role in cancer care and prevention as patients have increased ability to access genetic testing. This presents a unique challenge to gynecologic oncology providers as we learn t...
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Logan Corey, Ana Valente, Katrina Wade Source Type: research

Palliative Care in Gynecologic Oncology
This article reviews the background, benefits, barriers, and most practical delivery models of palliative care. It also discusses management of common symptoms experienced by gynecologic oncology patients. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Mary M. Mullen, James C. Cripe, Premal H. Thaker Source Type: research

Gynecologic Cancer Survivorship
This article reviews guidelines for surveillance of women with ovarian, endometrial, cervical, and vulvar cancer. It also reviews many of the long-term physical side effects of gynecologic cancer treatment including fatigue, neuropathy, lymphedema, cognitive dysfunction, sexual health concerns, menopausal symptoms, infertility, and economic stressors. Finally, survivorship care plans are reviewed as a tool for coordinating care for women with a history of gynecologic cancer. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Elizabeth Lokich Source Type: research

Innovation and Progress in Gynecologic Cancer Care: Faster than Ever
Gynecologic cancers affect millions of women worldwide across all ages often leading to significant disruption in general health, quality of life, and, in many cases, early death. Despite continued challenges in access to care and health literacy and lack of equality in screening and prevention, we now live in an era of rapid progress and utilization of technology to better understand the numerous mechanisms of cancer in search for actionable drug targets that can identify the “Achilles heel” of a particular cancer. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Carolyn Y. Muller Tags: Preface Source Type: research

Gynecologic Cancer Care: Innovative Progress
This issue of the Obstetrics and Gynecology Clinics of North America provides scientific and practice-changing updates in gynecologic oncology during the past 6 years. Once again, Carolyn Muller, MD has done a fine job as editor, coordinating and providing an excellent overview on the progress made in the specialty. It is clear that the field of gynecologic oncology continues to undergo remarkable evolution since our last issue on this subject in 2012. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research

Gynecologic Cancer Care: Innovative Progress
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Authors: Carolyn Y. Muller Source Type: research

Copyright
Elsevier (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Source Type: research

Contributors
WILLIAM F. RAYBURN, MD, MBA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Source Type: research

Contents
William F. Rayburn (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Source Type: research

Forthcoming Issues
Patient Safety in Obstetrics and Gynecology (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 24, 2019 Category: OBGYN Source Type: research

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