{"title":"Management of Postpartum Hemorrhage","authors":"T. Golen, S. Shainker","doi":"10.2310/OBG.19029","DOIUrl":"https://doi.org/10.2310/OBG.19029","url":null,"abstract":"Postpartum Hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality both in the United States and world-wide. To ensure prompt treatment, it is crucial to have a clear understanding of the causes of the PPH. Treatment includes both medical and surgical approaches, with the necessary escalation of care with ongoing hemorrhage. Invasive placentation (placenta accreta, increta, percreta) has become a more common cause of hemorrhage related morbidity and mortality. Patients with invasive placentation should be managed in a multidisciplinary fashion at a center familiar with this pathology and capable of managing massive hemorrhage. Obstetrical units should have a PPH protocol as a tool to assist in early recognition and treatment. Similarly, units should have a massive transfusion protocol at the ready for scenarios of ongoing obstetrical hemorrhage. \u0000\u0000This review contains 5 figures, 4 tables and 65 references\u0000Keywords: Postpartum Hemorrhage, Obstetrical Hemorrhage, Uterine Atony, Uterine Inversion, Uterine Tamponade Balloon, Invasive Placentation, Placenta Accreta, Obstetric Hemorrhage Protocol, Massive Transfusion Protocol","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130914294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infertility Treatment: Ovulation Induction and Insemination","authors":"Q. Katler, J. Zolton, A. DeCherney","doi":"10.2310/obg.19098","DOIUrl":"https://doi.org/10.2310/obg.19098","url":null,"abstract":"For the majority of infertility patients, ovulation induction is the initial therapy. Treatment is individualized for a couple based on ovarian reserve testing, semen analysis, and the presence of anatomic pathology. Candidates for ovulation induction include those who are anovulatory and couples with unexplained infertility. The majority of patients diagnosed with anovulation have polycystic ovarian syndrome. Treatment options include clomiphene citrate and letrozole. For patients with hypogonadotropic hypogonadism, treatment involves injections with gonadotropins. Treatment is typically combined with intrauterine insemination to maximize pregnancy rates, especially in patients with male factor infertility or unexplained infertility. A stepwise approach is necessary, as patients who are unsuccessful with less invasive and costly treatments may eventually require in vitro fertilization.\u0000\u0000This review contains 7 figures, 3 tables and 57 references\u0000Key Words: clomiphene citrate, gonadotropins, infertility, intrauterine insemination, letrozole, ovulation induction, polycystic ovarian syndrome, unexplained infertility","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128601090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evaluation of Infertility","authors":"J. Zolton, A. DeCherney","doi":"10.2310/obg.19097","DOIUrl":"https://doi.org/10.2310/obg.19097","url":null,"abstract":"In 2009, the World Health Organization formally recognized infertility as a disease of the reproductive system. This designation serves to ease access to infertility evaluation and treatment. Infertility is a disease of both men and women, and proper evaluation of both partners is necessary. Common causes of infertility are ovulatory dysfunction, tubal and pelvic pathology, unexplained infertility, and male factor. A complete history and physical examination may uncover the underlying etiology, although verification of tubal patency and normal semen analysis is warranted. This period also offers an opportunity to perform preconception testing and optimize women’s health before conception. Treatment for infertility is aimed to restore normal reproductive function and anatomy. In addition, patient education and counseling is indeed a very important aspect of infertility care.\u0000This review contains 5 figures, 5 tables and 60 references\u0000Key Words: anovulation, Antimullerian hormone, antral follicle count, hysterosalpingogram, infertility, infertility evaluation, ovarian reserve testing, polycystic ovarian syndrome, saline infusion sonohysterography","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115229180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Infertility","authors":"E. Levens, K. A. Green, A. DeCherney","doi":"10.1097/ju.0000000000000968","DOIUrl":"https://doi.org/10.1097/ju.0000000000000968","url":null,"abstract":"Infertility affects 12 to 18% of couples in the United States and may be due to female factors, male factors, or both. A systematic evaluation of the common causes of infertility can identify conditions that may be treated by the obstetrician-gynecologist to help the couple achieve their family-building goals or those that require referral to a subspecialist. This review discusses current recommendations regarding the workup and treatment of the common causes of infertility, including tubal and pelvic factors, ovulatory disorders, and male factors. Advances in assisted reproductive technology are also discussed, including the use of genetic screening in in vitro fertilization and fertility preservation options for individuals facing gonadotoxic therapy.\u0000This review contains 6 figures, 8 tables, and 53 references.\u0000Key words: anovulation, assisted reproductive technology, clomiphene citrate, infertility, letrozole, oocyte cryopreservation, ovulation induction, semen analysis, tubal factor, uterine factor","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128035971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Menopause","authors":"S. Reed, E. L. Sutton","doi":"10.2310/obg.1046","DOIUrl":"https://doi.org/10.2310/obg.1046","url":null,"abstract":"The female reproductive system matures in a continuous, natural process from menarche to menopause as the finite numbers of oocytes produced during fetal development are gradually lost to ovulation and senescence. Menopause is defined as the permanent cessation of menses; by convention, the diagnosis of menopause is not made until the individual has had 12 months of amenorrhea. Menopause is thus characterized by the menstrual changes that reflect oocyte depletion and subsequent changes in ovarian hormone production. However, hormonal changes, rather than the cessation of menstruation itself, cause the manifestations that occur around the time of menopause. Therefore, a woman who has undergone a hysterectomy but who retains her ovaries can experience normal menopausal symptoms as oocyte depletion leads to changes in estrogen levels, even though cessation of menstruation occurred with surgery. This review covers definitions, natural menopause, menopausal transition and postmenopausal symptom management, and premature ovarian insufficiency. Figures show stages of reproductive aging, serum concentrations of hormones during menopausal transition and postmenopause, hormonal changes associated with reproductive aging, symptoms of menopausal transition and menopause, treatment algorithm(s), and Women’s Health Initiative findings: risks and benefits of estrogen alone and estrogen plus progestin by age group: 50 to 59, 60 to 69, and 70 to 79 years. Tables list target tissues, physical manifestations, and menopausal symptoms; selective estrogen receptor modulators used in postmenopausal women; differential diagnosis and evaluation of common menopausal symptoms; estrogen doses; progestogen dosing for endometrial protection; nonhormonal pharmaceutical hot flash therapies; and pharmacologic therapy for genitourinary atrophy.\u0000This review contains 6 figures, 8 tables, and 122 references.","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123755483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nonsurgical Management of Overactive Bladder","authors":"S. Jakus-Waldman","doi":"10.2310/obg.19151","DOIUrl":"https://doi.org/10.2310/obg.19151","url":null,"abstract":"Overactive bladder affects up to one-third of elderly adults and 17% of adult women in the United States. The diagnosis is based on patient-reported symptoms of urinary urgency and frequency, with or without urinary incontinence after exclusion of any other possible pathology. Treatment options are based on a staged approach beginning with lifestyle and behavioral modifications. Bladder training and pelvic floor muscle training have been shown to be as effective as antimuscarinic medication and possibly most useful when these therapies are combined with medication. A newer class of OAB medication, β3-adrenergic agonists, has fewer side effects compared to antimuscarinics and is an important alternative for elderly patients at a risk of dementia.\u0000This review contains 5 figures and 63 references\u0000Key Words: anticholinergic medication, antimuscarinics, β-adrenergic agonists, nocturia, overactive bladder, urge incontinence, urinary frequency, urinary urgency","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128101724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gestational Trophoblastic Disease","authors":"D. Roque, A. Urh, E. Kalife","doi":"10.2310/obg.19167","DOIUrl":"https://doi.org/10.2310/obg.19167","url":null,"abstract":"Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively.\u0000 This review contains 5 figures, 8 tables and 49 references\u0000Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121042297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Menopause Transition: Physiology, Definition, Symptoms, Diagnosis, and Evaluation","authors":"Jessica L. Bauer, N. Santoro","doi":"10.2310/obg.19103","DOIUrl":"https://doi.org/10.2310/obg.19103","url":null,"abstract":"The menopause transition is a gradual physiologic process characterized by an intricate interplay between hypothalamic-pituitary axis dysfunction and ovarian follicle failure. Clinically, symptoms are variable and can range from minimal to severe. The hallmark symptom of the perimenopause and postmenopause is the hot flash; however, systemically low estrogen has widespread effects in the aging woman, including important changes in the cardiovascular, musculoskeletal, genitourinary, and central nervous systems. The diagnosis of menopause is a clinical one. Although there is no single laboratory marker that can predict the final menstrual period, an elevated follicle stimulating hormone is the classic marker of a menopausal state. Newer evidence suggests that antimullerian hormone may be more predictive of the final menstrual period; however, more studies are needed. An understanding of the physiology and symptomatology of the menopausal transition is crucial for educating women about their health risks later in life.\u0000\u0000This review contains 2 figures and 30 references\u0000Key Words: hot flashes, menopause, perimenopause, postmenopause, race/ethnicity in menopause, stages of transition in menopause, stress/psychological complications, women’s health","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134078492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Musculoskeletal Problems In The Female Athlete","authors":"I. Asif, K. Harmon, Mallory Shasteen","doi":"10.2310/obg.1512","DOIUrl":"https://doi.org/10.2310/obg.1512","url":null,"abstract":"Musculoskeletal injuries in the female athlete are, for the most part, similar to those in the male athlete. However, there are differences in the incidence of these injuries and in the sports in which they tend to occur. Female athletes have a higher rate of noncontact anterior cruciate ligament injuries than male athletes. Other musculoskeletal problems are also more common in females, such as multidirectional instability of the shoulder, adhesive capsulitis, and patellofemoral pain. This review addresses injuries that are seen commonly in female athletes and outlines current diagnosis and treatment options.\u0000This review contains 3 figures and 32 references\u0000Key words: ACL tear, adhesive capsulitis, atraumatic, female athlete, injection, knee, patellofemoral pain, shoulder","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128099765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stress Fractures And The Reproductive System In The Female Athlete","authors":"I. Asif, K. Harmon, Mallory Shasteen","doi":"10.2310/obg.1513","DOIUrl":"https://doi.org/10.2310/obg.1513","url":null,"abstract":"Stress fractures are more common in the female athlete. Stress fractures of the pubic ramus and femoral neck are particularly more common in females than in males. Rib stress fractures are an important injury to consider in the female rower, whereas spondylolysis is a common cause of low back pain in female athletes who hyperextend their spines. The higher incidence of stress fractures in females is mainly due to the higher prevalence of disordered eating and subsequent energy imbalance, which leads to detrimental effects on bone. This review discusses stress fractures and unique issues related to exercise and the female reproductive system.\u0000\u0000This review contains 6 figures, 5 tables and 49 references\u0000Key words: amenorrhea, bone mineral density, disordered eating, female athlete triad, femoral neck, pregnancy, pubic ramus, rib, spondylolysis, stress fracture","PeriodicalId":120074,"journal":{"name":"DeckerMed Obstetrics and Gynecology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115535876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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