Immunology of the Placenta
In this article, the authors provide a general overview of the major immune cells present at the maternal-fetal interface, describe the key mechanisms used by the placenta to promote maternal immune regulation, tolerance, and adaptation, and discuss how dysregulation of these pathways could lead to obstetric complications such as pregnancy loss and preeclampsia. Finally, they conclude with a description of the innate immune properties of the human placenta that not only serve to protect the pregnancy from infection but also contribute to pregnancy complications such as preterm birth. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: Mancy Tong, Vikki M. Abrahams Source Type: research

What Obstetricians Need to Know About Placental Pathology
This article discusses the indications for placental submission to pathology; the essentials of gross examination, including elements that should be performed in the delivery suite; and the most common and clinically relevant histologic findings that may be encountered in the report. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: Sanjita Ravishankar, Raymond W. Redline Source Type: research

Placental Magnetic Resonance Imaging
This article describes the use of placental magnetic resonance imaging (MRI) relaxation times in the in  vivo assessment of placental function. It focuses on T2*-weighted placental MRI, the main area of the authors’ research over the past decade. The rationale behind T2*-weighted placental MRI, the main findings reported in the literature, and directions for future research and clinical application s of this method are discussed. The article concludes that placental T2* relaxation time is an easily obtained and robust measurement, which can discriminate between normal and dysfunctional placenta. Placenta T2* is ...
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: Anne S ørensen, Marianne Sinding Source Type: research

Placental Anatomy and Function in Twin Gestations
With an increasing incidence of twin gestations, understanding the inherent risks associated with these pregnancies is essential in modern obstetrics. The unique differences in placentation in twins contribute to the increased risks. Monochorionic twins are susceptible to complications because of their unique placental architecture, including twin-to-twin transfusion syndrome, the twin anemia-polycythemia sequence, selective intrauterine growth restriction, and the twin reversed arterial perfusion sequence. Knowing the clinical correlations of placental anatomy in these gestations helps perinatal pathologists perform a mor...
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: Matthew A. Shanahan, Michael W. Bebbington Source Type: research

Evidence for Corpus Luteal and Endometrial Origins of Adverse Pregnancy Outcomes in Women Conceiving with or Without Assisted Reproduction
Preeclampsia may arise from impaired decidualization in some women. Transcriptomics of mid-secretory biopsy endometrial stromal cells decidualized in vitro and of early gestation choriodecidua from women who experienced preeclampsia with severe features overlapped significantly with the classical endometrial disorders giving rise to the concept of “endometrium spectrum disorders”. That is, recurrent implantation failure and miscarriage, endometriosis, normotensive intrauterine growth restriction, preeclampsia and preterm birth may all lie on a continuum of decidual dysregulation, in which phenotypic expression ...
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: Kirk P. Conrad Source Type: research

Social Determinants of Placental Health and Future Disease Risks for Babies
Birthweight is a well-known predictor of adult-onset chronic disease. The placenta plays a necessary role in regulating fetal growth and determining birth size. Maternal stressors that affect placental function and prenatal growth include maternal overnutrition and undernutrition, toxic social stress, and exposure to toxic chemicals. These stressors lead to increased vulnerability to disease within any population. This vulnerability arises from placental and fetal exposure to stressors during fetal life. The biological drivers linking various social determinants of health to compromised placental function and fetal develop...
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: Kent L. Thornburg, Janne Boone-Heinonen, Amy M. Valent Source Type: research

The Human Placenta in Health and Disease
The placenta is arguably the most important organ for continued survival of Homo sapiens. The human placenta is the director of pregnancy, performing many diverse functions that control maternal metabolism and fetal growth and development that mediate survival of the offspring. Despite the biological importance of this organ, we have only begun to scratch the surface of understanding both normal placental function and, to an even lesser extent, the placental dysfunction that accompanies many disorders of pregnancy. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: D. Michael Nelson, Leslie Myatt Tags: Preface Source Type: research

The Placenta: Its Importance from Womb to Tomb
The placenta is a fantastic organ that provides the indispensable interface between mother and fetus. Discoveries from the study of placental implantation, anatomy, and function apply from the earliest stages of pregnancy until delivery of the baby and, in some circumstances, may predict eventual human morbidity and mortality (from Womb to Tomb). This issue, edited with expertise from D. Michael Nelson, MD, PhD and Leslie Myatt, PhD, brings to our attention how much we have to learn about both normal placental function and the abnormal function that accompanies many complications of pregnancy. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research

The Human Placenta in Health and Disease
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Authors: D. Michael Nelson, Leslie Myatt Source Type: research

Copyright
Elsevier (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Source Type: research

Contributors
WILLIAM F. RAYBURN, MD, MBA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Source Type: research

Contents
William F. Rayburn (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Source Type: research

Forthcoming Issues
Telemedicine and Connected Health in Obstetrics and Gynecology (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - January 31, 2020 Category: OBGYN Source Type: research

The Placenta as a Window to Maternal Vascular Health
Cardiovascular disease remains the leading killer of women, with sex-specific manifestation, mechanisms, and morbidity. Preeclampsia, fetal growth restriction, and a subset of preterm births demonstrate aberrancies in the maternal vessels supplying the placenta and damage to the placental parenchyma consistent with hypoxic/ischemic or oxidative injury. This constellation of findings, maternal vascular malperfusion (MVM) lesions, may hold the key to understanding and identifying the elevated risk for early cardiovascular disease in women who experience adverse pregnancy outcomes. This intriguing possibility has only begun t...
Source: Obstetrics and Gynecology Clinics - December 19, 2019 Category: OBGYN Authors: W. Tony Parks, Janet M. Catov Source Type: research

Placental Implantation Disorders
Primary disorders of placental implantation have immediate consequences for the outcome of a pregnancy. These disorders have been known to clinical science for more than a century, but have been relatively rare. Recent epidemiologic obstetric data have indicated that the rise in their incidence over the last 2  decades has been iatrogenic in origin. In particular, the rising numbers of pregnancies resulting from in vitro fertilization (IVF) and the increased use of caesarean section for delivery have been associated with higher frequencies of previa implantation, accreta placentation, abnormal placental shapes, a...
Source: Obstetrics and Gynecology Clinics - December 19, 2019 Category: OBGYN Authors: Eric Jauniaux, Ashley Moffett, Graham J. Burton Source Type: research

Key Infections in the Placenta
Congenital infections are an important cause of morbidity and mortality worldwide, especially in low-income settings. This review discusses the main pathways of infections and associated adverse maternal and fetal outcomes, considering the TORCH pathogens, including Zika virus; the acronym stands for Toxoplasma gondii infection, other (Listeria monocytogenes, Treponema pallidum, and parvovirus B19, among others, including Zika virus), rubella virus, cytomegalovirus, and herpes simplex viruses type 1 and type 2. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - December 19, 2019 Category: OBGYN Authors: Maria Laura Costa, Guilherme de Moraes Nobrega, Arthur Antolini-Tavares Source Type: research

The Placental Basis of Fetal Growth Restriction
Placental dysfunction is a major contributing factor to fetal growth restriction. Placenta-mediated fetal growth restriction occurs through chronic fetal hypoxia owing to poor placental perfusion through a variety of mechanisms. Maternal vascular malperfusion is the most common placental disease contributing to fetal growth restriction; however, the role of rare placental diseases should not be overlooked. Although the features of maternal vascular malperfusion are identifiable on placental pathology, antepartum diagnostic methods are evolving. Placental imaging and uterine artery Doppler, used in conjunction with angiogen...
Source: Obstetrics and Gynecology Clinics - December 19, 2019 Category: OBGYN Authors: Rebecca L. Zur, John C. Kingdom, W. Tony Parks, Sebastian R. Hobson Source Type: research

Diabetes Mellitus, Obesity, and the Placenta
The placenta is exposed to metabolic derangements in the maternal and fetal circulation. The effects of the early placental “exposome” determine further trajectories. Overstimulation of the fetal pancreas in early gestation results in fetal hyperinsulinemia, augmenting glucose transfer with adverse effects on the fetus. The manifold placental changes at the end of pregnancy can be regarded as adaptive responses to pr otect the fetus from diabetes and obesity. The causal role of the placenta, if any, in mediating long-term effects on offspring development is an important area of current and future research. (Sou...
Source: Obstetrics and Gynecology Clinics - December 19, 2019 Category: OBGYN Authors: Gernot Desoye, Mila Cervar-Zivkovic Source Type: research

Fetal Membranes, Not a Mere Appendage of the Placenta, but a Critical Part of the Fetal-Maternal Interface Controlling Parturition
Fetal membranes (FMs) play a role in pregnancy maintenance and promoting parturition at term. The FMs are not just part of the placenta, structurally or functionally. Although attached to the placenta, the amnion has a separate embryologic origin, and the chorion deviates from the placenta by the first month of pregnancy. Other than immune protection, these FM functions are not those of the placenta. FM dysfunction is associated with and may cause adverse pregnancy outcomes. Ongoing research may identify biomarkers for pending preterm premature rupture of the FMs as well as therapeutic agents, to prevent it and resulting p...
Source: Obstetrics and Gynecology Clinics - December 18, 2019 Category: OBGYN Authors: Ramkumar Menon, John J. Moore Source Type: research

When the Fetus Goes Still and the Birth Is Tragic
Because of the critical role that placental structure and function plays during pregnancy, abnormal placental structure and function is closely related to stillbirth: when an infant dies before birth. However, understanding the role of the placental and specific lesions is incomplete, in part because of the variation in definitions of lesions and in classifying causes of stillbirths. Nevertheless, placental abnormalities are seen more frequently in stillbirths than live births, with placental abruption, chorioamnionitis, and maternal vascular malperfusion most commonly reported. Critically, some placental lesions affect th...
Source: Obstetrics and Gynecology Clinics - December 18, 2019 Category: OBGYN Authors: Nicole Graham, Alexander E.P. Heazell Source Type: research

Gynecologic Ultrasound Evaluation of the Nongravid Woman with Pelvic Pain
Pelvic pain is a common condition. Many underlying gynecologic and nongynecologic conditions can contribute to this symptom. Pelvic ultrasound using comprehensive 2-dimensional interactive imaging techniques as well as color Doppler and 3-dimensional imaging optimizes the detection of inciting etiologies. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Bryann Bromley Source Type: research

Ultrasonography in Pelvic Floor Dysfunction
Obstetric anal sphincter injury (OASI) and levator ani muscle (LAM) trauma are common disorders in parous women. Four sonographic signs have been published in cases of OASI: external or internal anal sphincter discontinuity; thickening of external anal sphincter at the area of repair; thinning of internal anal sphincter in the area of rupture in conjunction with thickening opposite the rupture site ( “half-moon” sign); and abnormality of mucous folds (“mucosal star sign”). Levator trauma can be asymptomatic, with abnormality arising years later. Discontinuity of the LAM is the main sonographic sign ...
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Hadas Allouche Kam, Simcha Yagel, Vered H. Eisenberg Source Type: research

Nongynecologic Causes of Pelvic Pain
Ultrasonography (US) is often the first-line imaging study used to evaluate women who present with acute or chronic pelvic pain. Detection of nongynecologic causes of pelvic pain is critical, because delay in diagnosis can cause significant morbidity and mortality. Evaluation of these entities requires a variety of transducers to achieve optimal imaging depth and changes in patient positioning. Specific imaging techniques (such as graded compression) may be required if bowel pathology is suspected. Contrast-enhanced ultrasonography is increasingly used to improve detection of certain entities. The US appearance of common g...
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Mahan Mathur, Leslie M. Scoutt Source Type: research

Cesarean Scar Pregnancy
This article discusses the pathogenesis and diagnosis of cesarean scar pregnancy. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Ilan E. Timor-Tritsch, Ana Monteagudo, Giuseppe Cal ì, Francesco D’Antonio, Andrea Kaelin Agten Source Type: research

Cesarean Scar Pregnancy
There is no universally agreed upon and adopted management protocol supported by professional societies in the United States or around the world for the treatment of cesarean scar pregnancy. There is a wide range of management options in the literature, and many of them can to lead to severe bleeding complications, which can result in loss of fertility or even maternal death. If inadequately managed, it can lead to untoward complications throughout all 3 trimesters of the pregnancy. Early detection of CSP has a paramount clinical importance. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Ilan E. Timor-Tritsch, Ana Monteagudo, Giuseppe Cal ì, Francesco D’Antonio, Andrea Kaelin Agten Source Type: research

Ultrasound in Early Pregnancy
Ultrasound is essential in the evaluation and management of pregnancies of unknown location. Differential diagnoses include early pregnancy loss, pregnancy of unknown location, and ectopic pregnancies. Both transabdominal and transvaginal routes should be available, in addition to physical examination, for complete evaluation. Diagnostic criteria for early pregnancy loss have expanded in recent years to ensure false positive results do not lead to inappropriate evacuation of desired pregnancies. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Emily W. Scibetta, Christina S. Han Source Type: research

Ultrasound Evaluation in Female Infertility
Infertility is defined by failure to achieve a pregnancy after 12 months or more of appropriate timed unprotected intercourse or therapeutic donor insemination. Ultrasound has now become an essential component of the modern investigation of female infertility and the management of assisted conception. Scans are predominantly performed transvaginally and recent technological advances such as 3D and Doppler imaging enhance our understanding of ovarian function such as ovarian reserve, follicular maturity and the assessment of polycystic morphology in the identification of polycystic ovarian syndrome. This chapter describes t...
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Stuart Campbell Source Type: research

Ultrasound Evaluation in Female Infertility
This article discusses the role of ultrasound in assessing endometrial and uterine factors affecting the implantation of the embryo. Modern ultrasound equipment includes advanced Doppler and three-dimensional facilities that refine our understanding of factors that affect implantation such as endometrial blood flow. Three dimensional scanning is principally used to define the relationship of fibroids to the endometrial cavity, the position of polyps and other anatomic structures relative to the implantation site, to diagnose adenomyosis, to reveal and classify congenital uterine malformations and in the differential diagno...
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Stuart Campbell Source Type: research

Moving Ultrasound First in Women ’s Health
It is hard to believe that it was in 1984, and again in 1991, when one of us was a guest editor of the Obstetrics and Gynecology Clinics of North America on two issues focused on “Diagnostic Ultrasound.” Within those 2 issues, there were only 3 articles that were dedicated to imaging in the nonpregnant woman. Thirty years later, we now have an entire issue focused on ultrasound in the gynecologic patient. Even with 17 articles allotted, we did not find sufficient room to fully cover the wealth of knowledge that has been accrued over the last few decades. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Lawrence D. Platt, Christina S. Han Tags: Preface Source Type: research

A Practical and Contemporary Guide to Gynecologic Ultrasonography
Being a maternal-fetal medicine specialist, I have devoted many years to fetal evaluation by direct sonographic visualization. Gynecologic ultrasound performance seemed to be less routine and more as an adjunct in confirming clinical suspicions. At last, we have an issue in Obstetrics and Gynecology Clinics of North America that addresses the many advances of ultrasonography in gynecology and early pregnancy. A repeat editorial overview by Dr Lawrence Platt with valuable input from the coeditor Dr Christina Han has led to the production of an excellent resource for any gynecologist. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: William F. Rayburn Tags: Foreword Source Type: research

Ultrasonography in Gynecology and Early Pregnancy
OBSTETRICS AND GYNECOLOGY CLINICS OF NORTH AMERICA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Authors: Lawrence D. Platt, Christina S. Han Source Type: research

Copyright
Elsevier (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Source Type: research

Contributors
WILLIAM F. RAYBURN, MD, MBA (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Source Type: research

Contents
William F. Rayburn (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Source Type: research

Forthcoming Issues
The Human Placenta in Health and Disease (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 31, 2019 Category: OBGYN Source Type: research

Ultrasound Assessment of the Intrauterine Device
This article explores the role of ultrasound in evaluation of IUDs as well as the literature regarding ultrasound guidance for device placement. It also examines the evaluation and management of IUDs with a concurrent intrauterine pregnancy. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - October 3, 2019 Category: OBGYN Authors: Adam T. Evans, Kam Szlachetka, Loralei L. Thornburg Source Type: research

Three-Dimensional Volume Imaging in Gynecology
3D ultrasound imaging of the female pelvis is one of the most important recent advances in diagnostic imaging. Volume acquisitions can provide a large number of images of the pelvic organs simultaneously and in any plane or orientation desired. The coronal plane of the uterus is only visible when reconstructed from a volume and is key to imaging the uterus for indications such as uterine anomalies, IUD positioning, locations of fibroids and polyps, or early pregnancies. 3D ultrasonography has huge potential for evaluating infertile patients, performing difficult procedures under guidance, and studying patients with abnorma...
Source: Obstetrics and Gynecology Clinics - October 3, 2019 Category: OBGYN Authors: Beryl R. Benacerraf Source Type: research

First-Trimester Ultrasound
Since the 1980s, development of high-resolution transvaginal ultrasound transducers has significantly improved ultrasound evaluation at earlier gestational ages. Although many indications exist for first-trimester ultrasound in pregnancy, more emphasis has been placed on assessment of fetal anatomy recently. In turn, congenital diagnoses can also be made earlier in pregnancy, raising the question of whether anatomic assessment in the first trimester is one of choice or obligation. Combining transvaginal and transabdominal approach yields the highest detection rate overall. Some studies have shown that more than half of all...
Source: Obstetrics and Gynecology Clinics - October 3, 2019 Category: OBGYN Authors: Jenny Y. Mei, Yalda Afshar, Lawrence D. Platt Source Type: research

Coding and Legal Issues in Obstetric and Gynecologic Ultrasound
This article addresses coding and liability related to obstetric and gynecologic ultrasound examinations. The coding section includes an overview of general concepts, highlighting the differences between coding in hospital-owned facilities and provider-owned clinics. It also addresses the importance of correct International Classification of Diseases, 10th edition, coding, emphasizing the use of the most specific applicable codes. This section discusses proper coding and applicable parameters for early pregnancy and gynecologic ultrasound examination. The liability section addresses common errors leading to litigation in o...
Source: Obstetrics and Gynecology Clinics - October 3, 2019 Category: OBGYN Authors: James M. Shwayder, Joshua A. Copel, Hindi Stohl Source Type: research

Normal Pelvic Anatomy
This article reviews normal pelvic anatomic findings during ultrasound and discusses how to obtain and measure these images. Representative images of normal pelvic anatomy, with select videos, are included to assist in understanding the presented concepts and normal anatomic images. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 25, 2019 Category: OBGYN Authors: James M. Shwayder Source Type: research

Abnormal Uterine Bleeding
This article outlines the role of transvaginal ultrasonography in the evaluation of cases of AUB. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 25, 2019 Category: OBGYN Authors: Ashraf Khafaga, Steven R. Goldstein Source Type: research

The Abnormal Ovary
This article provides an evidence-based review of how these changes in diagnosis and management of ultrasound-detected abnormal ovarian lesions have occurred. Current recommended practices are summarized. The current literature on transvaginal screening for ovarian cancer also is reviewed and summarized. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 25, 2019 Category: OBGYN Authors: Kalesha Hack, Phyllis Glanc Source Type: research

Methods of Assessing Ovarian Masses
There are many diagnostic methods to assist clinicians in assessing adnexal masses on ultrasound. After suggesting a standardized terminology and measurement technique to evaluate adnexal masses, the International Ovarian Tumor Analysis (IOTA) group has developed different strategies such as the Simple Rules and Assessment of Different Neoplasias in the adneXa (ADNEX) model, which have been shown to outperform other available methods. Besides differentiating between benign neoplasms and malignancies, the ADNEX model can also give the predicted risk for different subtypes of malignant adnexal masses, which is clinically ver...
Source: Obstetrics and Gynecology Clinics - September 25, 2019 Category: OBGYN Authors: Wouter Froyman, Dirk Timmerman Source Type: research

Ultrasound Imaging in Endometriosis
Ultrasound examination is an indisputable imaging method in the diagnosis of endometriosis, as the first step in the detection, as the fundamental tool in planning the management, and as the best diagnostic instrument during surveillance of affected women. The aim of this article is to provide an update on the role of ultrasound in the detection, in the planning of medical and surgical treatment, and in the surveillance of patients with endometriosis. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - September 25, 2019 Category: OBGYN Authors: Francesca Moro, Martina Leombroni, Antonia Carla Testa Source Type: research

Preconception Health
An investment in assuring the health of women, before pregnancy, can reap improved health for women, children, and their families. A paradigm shift of health must occur if perinatal outcomes are to improve, moving beyond reactive care to preventive or preconception care. Preconception health is centered on an assumption a woman is planning on becoming pregnant. But for many women, pregnancy is unplanned and medical conditions may have a negative impact on the trajectory of pregnancy and health. A new paradigm focusing on prevention and wellness can prepare women for lifelong health and healthy perinatal outcomes. (Source: ...
Source: Obstetrics and Gynecology Clinics - August 2, 2019 Category: OBGYN Authors: Diana E. Ramos Source Type: research

Menstrual Health as a Part of Preventive Health Care
Menstrual health assessment facilitates identification of pathologic conditions (eg, abnormal uterine bleeding, endometriosis), offers the opportunity to educate women on what menstrual symptoms may be normal or abnormal, and provides the opportunity to initiate treatment for women who are suffering because of problems with menstrual bleeding or associated symptoms. Heavy bleeding, pain, fatigue, and mood changes significantly affect a woman ’s physical, social, and emotional quality of life. Promptly identifying and treating these disorders by incorporating their assessment into routine well-woman care has the poten...
Source: Obstetrics and Gynecology Clinics - August 2, 2019 Category: OBGYN Authors: Kristen A. Matteson, Kate M. Zaluski Source Type: research

Cancer Screening in Women
Advancements in cancer screening techniques have allowed for earlier detection of cancer at premalignant or early stages of disease. Several organizations have guidelines for screening strategies for breast, cervical, colon, and lung cancer. Ovarian cancer remains the deadliest cancer of the female reproductive tract; however, guidelines have yet to be shown effective in identifying ovarian cancer at earlier stages. It is important that providers familiarize themselves with up-to-date screening strategies in women at average risk and at increased risk of disease. The provider ’s role in guiding patients toward screen...
Source: Obstetrics and Gynecology Clinics - August 2, 2019 Category: OBGYN Authors: Alison Vogell, Megan L. Evans Source Type: research

Matters of the Heart
The authors ’ goal is to review the current recommendations for optimizing cardiovascular health beginning in adolescent years to adulthood, and to expand on the role that pregnancy complications may have as implications for future cardiovascular health. Attention to cardiac health begins in adolescence; howe ver, most young patients are not screened. Pregnancy, with its increased cardiovascular demands and host of antepartum cardiopulmonary complications, may provide a window into future cardiac health. The distinct shift in cardiac risk that occurs once a woman enters menopause is largely ignored in ro utine screen...
Source: Obstetrics and Gynecology Clinics - August 2, 2019 Category: OBGYN Authors: Rachel A. Newman, Afshan B. Hameed Source Type: research

Pelvic Floor Disorders
Pelvic floor disorders commonly affect women and may cause distress and difficulty with daily functions and self-image. Urinary incontinence may present as stress incontinence, urgency incontinence, or in some combination (mixed incontinence). Symptomatic pelvic organ prolapse (POP) occurs when the patient is bothered by the sensation of a herniation of the pelvic organs through the vagina. Although POP is often distressing and embarrassing, it is not considered life-threatening unless the patient cannot urinate or defecate. There are numerous ways to treat these conditions, including conservative (including observation), ...
Source: Obstetrics and Gynecology Clinics - August 2, 2019 Category: OBGYN Authors: Meadow Maze Good, Ellen R. Solomon Source Type: research

Strong Bones, Strong Body
Osteoporosis is a common condition among postmenopausal women. Women 65  years and older should receive bone mineral testing; younger women should undergo risk assessment using a formal risk assessment tool to determine if they should receive bone density testing. Many pharmacologic agents are available to treat women with osteoporosis on bone density testing. Women wi th previous hip or vertebral fractures should also receive osteoporosis pharmacotherapy. (Source: Obstetrics and Gynecology Clinics)
Source: Obstetrics and Gynecology Clinics - August 2, 2019 Category: OBGYN Authors: Carolyn J. Crandall Source Type: research