I. Burd, M. Andrikopoulou, A. Farzin, J. Bienstock, E. Graham
{"title":"Neonatal Encephalopathy and Neurologic Outcome: New Guidelines Update","authors":"I. Burd, M. Andrikopoulou, A. Farzin, J. Bienstock, E. Graham","doi":"10.1097/01.PGO.0000453616.10359.0C","DOIUrl":"https://doi.org/10.1097/01.PGO.0000453616.10359.0C","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116115876","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":"Adenomyosis: Diagnosis, Treatment, and Impact on Fertility","authors":"K. Merriam, B. Hurst","doi":"10.1097/01.PGO.0000453368.61985.7f","DOIUrl":"https://doi.org/10.1097/01.PGO.0000453368.61985.7f","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125028010","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":"Weight Management in Pregnancy","authors":"J. Althaus","doi":"10.1097/01.PGO.0000451414.06880.56","DOIUrl":"https://doi.org/10.1097/01.PGO.0000451414.06880.56","url":null,"abstract":"If addressing weight issues in the general population has proved vexing for medical care providers, addressing obesity in the obstetric population is even more so. The obstetrician is faced with a paradoxical situation: treat a person who needs to lose weight while in a condition in which she is expected to gain weight. How does an obstetrician bridge this conflict? This article reviews what is—and is not—known about weight management during pregnancy with particular emphasis on the overweight or obese patient in an attempt to address the gap between typical and ideal practices. In addition, we identify discrete actions the care provider can take to assist the pregnant patient identified with a preexisting weight problem. No one needs to be told that obesity is a problem worldwide; within the United States, the statistics are clear. Up to one-third of all females in the United States are obese,1 and obesity is so prevalent that currently only one state— Colorado—has an obesity prevalence rate of less than 20%.2 The obstetrical population reflects this sad state as well, with 40% of all women entering pregnancy obese or overweight.2 Most lay people are aware that obesity is a risk factor for diabetes, hypertension, and cardiovascular disorders, but what is less known to the general population is the potential impact of obesity on pregnancy. Obesity itself confers an increased risk for a host of adverse outcomes that not only extend to the antepartum or intrapartum time periods but can impact the lifelong health of the fetus grown in an obesogenic environment. Table 1 lists the risks that have been associated with obesity and pregnancy.1,3-5 Accompanying the increased risk of cesarean deliveries, obesity also confers an increased risk for blood loss, anesthesia complications (failed epidural, failed/difficult intubation), and wound breakdown/infection. Without interval weight loss between pregnancies, there is a lower chance for a successful vaginal birth after cesarean. Congenital anomalies that have been associated with obesity include open neural tube defects, cardiac, and musculoskeletal anomalies. Thus, obesity is not just a social issue but also a distinct medical problem that jeopardizes the health of both the patient and the fetus. Complicating the recommendations to patients are 2 distinct weight issues in pregnancy: the person’s prepregnancy weight, most commonly assessed in the context of body mass index (BMI), and the gestational weight gain (GWG) that occurs in pregnancy. Although it may be unclear which of the 2 has a more significant effect on adverse pregnancy outcomes, the one amenable to manipulation in pregnancy is GWG.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130268804","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":"Trauma in Pregnancy","authors":"J. Foroutan, G. Ashmead","doi":"10.1097/01.PGO.0000451801.67742.A8","DOIUrl":"https://doi.org/10.1097/01.PGO.0000451801.67742.A8","url":null,"abstract":"Trauma during pregnancy is a common source of morbidity and mortality for both mother and fetus. Although the precise incidence is unknown, trauma is estimated to complicate 1 in 12 pregnancies.1 It is the leading cause of nonobstetric maternal mortality in the United States, accounting for up to 46% of maternal deaths.2 According to a fetal death certificate study, the rate of fetal death from maternal trauma is calculated to be 2.3 per 100,000 live births.3 Most incidents are minor, with only 4.1 injury-related hospitalizations of pregnant women per 1000 deliveries in the United States. Of women requiring admission, 24% to 38% proceed to delivery during hospitalization.4 The incidence of hospital admission parallels increasing gestational age.5 A pregnancy complicated by trauma can be hazardous for both the mother and the fetus. Maternal complications associated with trauma in pregnancy include maternal injury or death, shock, and internal hemorrhage.6 Possible fetal complications include spontaneous abortion, preterm birth, preterm premature rupture of membranes, direct fetal injury, uterine rupture, abruption, and stillbirth. Motor vehicle collision (MVC) is the leading cause of injury (49%) followed by falls (25%), assaults (18%), gunshots (4%), and burns (1%) (Figure 1).7 It is important to note that intimate partner violence (IPV) is emerging as one of the leading causes of maternal injury and death during pregnancy, according to the Centers for Disease Control and Prevention.8 Risk factors associated with trauma in pregnancy include younger maternal age, drug and alcohol use, and history of domestic violence.2 Consequently, it is important for the obstetrician/gynecologist to screen patients for all risk factors in an attempt to decrease the incidence of trauma during pregnancy. All obstetrician/gynecologists will encounter patients with pregnancy-related trauma and will need to provide accurate diagnosis and management. Although much has been written on the subject, there is a paucity of good evidence to direct optimal management of pregnant women after trauma. Thus, there is an inherent gap in information available to help physicians manage these relatively common events. The goal of this article is to review the currently available data to address this gap in knowledge and help develop an evidencebased approach that will optimize both maternal and fetal outcomes.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"1992 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128611815","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":"Diagnosis and Management of Congenital Adrenal Hyperplasia","authors":"Amy S. Dhesi, P. McGovern","doi":"10.1097/01.PGO.0000450250.49010.9e","DOIUrl":"https://doi.org/10.1097/01.PGO.0000450250.49010.9e","url":null,"abstract":"Congenital adrenal hyperplasia (CAH) is a condition of excess androgen production by the adrenal cortex as a result of deficient or decreased enzymatic activity in one of the precursors involved in corticosteroid production. CAH manifests in approximately 1 in 15,000 births.1 There are several types of CAH, depending on which enzyme production is lacking (Figure 1), and the mode of inheritance is autosomal recessive. The most common form of CAH is 21-hydroxylase deficiency (accounting for approximately 90%–95% of all CAH), which is attributable to a defect in the CYP21A2 gene on chromosome 6p21.3. The carrier rate in the general population is approximately 1:60. Higher carrier rates are seen in discrete populations such as Alaskan Yupik Eskimos and Ashkenazi Jews.1 Other forms of CAH include 11 -hydroxylase deficiency (5%–8% of all CAH with higher numbers in Moroccan Jews), 17 -hydroxylase and 17,20-lyase deficiencies (1% of all CAH and 5%–7% of CAH in Brazil), and 3 -hydroxysteroid dehydrogenase, p450 side chain, and P450 oxidoreductase deficiencies. This article focuses on 21-hydroxylase deficiency, given the overwhelming predominance of this defect in patients with CAH. Understanding this diagnosis is important for clinicians, as patients can present with a broad range of manifestations that can have significant implications to both gynecologic and obstetric practice. Because this is a confusing diagnosis, there is a gap between typical and ideal practices; the goal of this article is to address this gap. Classic CAH occurs when only 0% to 1% of enzymatic activity is present in the fetus in utero.2 Although the female internal genitalia are normally formed by the 10th week of gestation, the external genitalia are affected by excess adrenal androgen exposure. Varying degrees of female pseudohermaphroditism (fusion of labioscrotal folds and clitoral enlargement) develop depending on the timing of exposure, ranging from complete masculinization with early androgen exposure (10–12 weeks’ gestation) or isolated clitoral hypertrophy (18–20 weeks’ gestation).3 The clinician must suspect classic CAH when evaluating any infant born with genital ambiguity. In conjunction with virilization, salt-wasting can occur in some patients with CAH when aldosterone production is inadequate. These infants can present with electrolyte abnormalities and failure to thrive and should also be evaluated for CAH. This may be fatal within the first week of life if untreated. Nonclassic CAH is a milder form of CAH, which occurs when 20% to 50% of enzymatic activity is present.4 Symptoms Learning Objectives: After participating in this activity, the obstetrician/gynecologist should be better able to: 1. Appropriately screen and diagnose both classic and nonclassic congenital adrenal hyperplasia (CAH). 2. Medically manage patients with both classic and nonclassic CAH. 3. Identify a patient’s risk of offspring with CAH.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"627 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124636080","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":"Diagnosis and Management of Endometrial Hyperplasia","authors":"R. Woodburn, A. Fields","doi":"10.1097/01.PGO.0000445186.40810.7f","DOIUrl":"https://doi.org/10.1097/01.PGO.0000445186.40810.7f","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"38 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131932487","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}
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
