{"title":"Pessaries for Pelvic Organ Prolapse","authors":"K. Wohlrab, M. Pragana","doi":"10.1097/01.PGO.0000437761.26000.64","DOIUrl":"https://doi.org/10.1097/01.PGO.0000437761.26000.64","url":null,"abstract":"Pelvic floor disorders and pelvic organ prolapse (POP) affect a substantial proportion of women with increasing age. The Pelvic Floor Disorders Network estimates that 24% of American women are affected by this problem.1 When pelvic symptoms a re associated with a loss of structural support of the pelvic organs and vagina, vaginal support pessaries offer an important option for relief.2 Given the benefits of nonsurgical management of POP with pessary use, it is important for the obstetrician/gynecologist to be comfortable offering this treatment option to all patients with prolapse. This article reviews the types of pessaries available for use in patients with POP, the fitting and placement of pessaries, and care instructions related to each type. We also review management options for common symptoms associated with pessary use. After reading this article, the obstetrician/ gynecologist should be able to identify women with symptomatic POP who are candidates for a pessary trial, counsel patients with regard to various treatment options available, offer a pessary fitting as an option, be able to successfully predict which pessary type to use on the basis of a woman’s presenting symptoms and physical examination findings, and manage common symptoms associated with pessary use. Conservative, nonsurgical management of POP should be offered to all women regardless of age. Pessaries may be offered to avoid pelvic reconstructive surgery, to prevent worsening of prolapse, or to diagnose and provide relief of bothersome prolapse symptoms . Pessaries have been used to alleviate the discomfort of pelvic floor disorders for thousands of years. Ancient Egyptians first described the treatment of prolapse with ancient remedies such as honey and petroleum.3 Later, Hippocrates described reduction of uterine prolapse and placement of a pomegranate fruit in the vagina to prevent recurrence of the disease.4 Today, medical-grade silicone or rubber pessaries are flexible, pliable, long-lasting, nonabsorbent, biologically inert, nonallergenic, noncarcinogenic, and washable, and can be sterilized using an autoclave or a cold sterilization product.5 The modernization of the device, including various shapes and sizes, has allowed for broader use of the pessary. Up to 74% of women with POP can be fitted successfully with a pessary.6 Unfortunately, a successful pessary fitting does not guarantee successful long-term use. Sarma et al demonstrated that only 14% of pessary users were still using the device 6 years after successful fitting.7 Although one third of women will choose to proceed with pelvic reconstructive surgery, it is our opinion that women are less likely to discontinue use of the pessary with proper preplacement counseling and discussion of expectations. Learning objectives: After participating in this CME activity, the obstetrician/gynecologist should be better able to: 1. Identify women with pelvic floor disorders who may be candidates for a pessary trial. 2. ","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123992056","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":"Adolescent Girls With Migraine Headache: A Review of Treatment and Contraceptive Options","authors":"R. Seay, A. R. Seay, N. Gaba","doi":"10.1097/01.PGO.0000436090.45407.2e","DOIUrl":"https://doi.org/10.1097/01.PGO.0000436090.45407.2e","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133889592","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":"Chronic Hypertension in Pregnancy","authors":"Cecily Clark-Ganheart, Julia Timofeev","doi":"10.1097/01.PGO.0000435110.33799.db","DOIUrl":"https://doi.org/10.1097/01.PGO.0000435110.33799.db","url":null,"abstract":"Chronic hypertension affects approximately 65 million Americans, including 8% of reproductive-age women.1 One percent to 5% of all pregnancies occur in women with chronic hypertension.2 As overweight and obesity are well-established risk factors for the development of hypertension, and with the current epidemic of obesity in the United States, obstetricians will undoubtedly care for many patients with this condition. Nevertheless, there is a wide inconsistency in approaches to diagnosis and treatment of hypertension in pregnancy and therefor a gap between ideal, evidence-based care and that seen throughout the country. It is important to review the impact of this condition on maternal and neonatal outcomes and review current evidence regarding pregnancy management and potential implications of chronic hypertension during pregnancy.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133503651","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":"Pelvic Inflammatory Disease","authors":"Nathan R. Webb","doi":"10.1097/01.PGO.0000434362.87040.33","DOIUrl":"https://doi.org/10.1097/01.PGO.0000434362.87040.33","url":null,"abstract":"Pelvic inflammatory disease (PID) is a clinical syndrome comprising a spectrum of infectious and inflammatory diseases of the upper female genital tract. The diagnosis of pelvic inflammatory disease (PID) can include any combination of endometritis, salpingitis, tubo-ovarian abscess, or pelvic peritonitis.[1] Each of these disease processes is characterized by ascending spread of organisms from the vagina or cervix to the structures of the upper female genital tract. Although PID is most notable for the associated risk of severe, long-term sequelae, the infections may be asymptomatic (\"silent\") or overt with mild to severe symptoms. The clinical syndrome of acute (and subacute) PID—usually defined as symptoms for fewer than 30 days—can be due to a variety of pathogens, often including, but not limited to, Neisseria gonorrhoeae and Chlamydia trachomatis.[2] In contrast, chronic pelvic inflammatory disease (symptoms for greater than 30 days) is a separate disorder usually related to infection by Mycobacterium tuberculosis or Actinomyces species (Table 1).[2] This module will focus on acute and subacute PID.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114145093","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":"Fertility Preservation in Patients With Gynecologic Cancer—Part II: Current Options and the Ethics of Oncofertility","authors":"S. Lange, B. Hurst, M. Matthews, D. Tait","doi":"10.1097/01.PGO.0000434086.10618.CF","DOIUrl":"https://doi.org/10.1097/01.PGO.0000434086.10618.CF","url":null,"abstract":"","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124672637","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":"Fertility Preservation in Patients With Gynecologic Cancer—Part I: The Impact of Gynecologic Malignancies on Fertility","authors":"S. Lange, B. Hurst, M. Matthews, D. Tait","doi":"10.1097/01.PGO.0000433508.01985.e2","DOIUrl":"https://doi.org/10.1097/01.PGO.0000433508.01985.e2","url":null,"abstract":"Oncofertility was established as a new discipline in the field of obstetrics and gynecology in 2006, developed for the express purpose of preserving, expanding, and restoring the reproductive future of patients with cancer whose treatment may have compromised their fertility.1 Oncofertility as a discipline has far-reaching implications for the treatment of a malignancy and the preservation of fertility, and it spans all subspecialties of oncology. It can be a vital aspect of a patient’s cancer care, whether male or female and regardless of whether the patient has reached reproductive potential. Why is oncofertility just coming to the forefront of gynecologic and oncologic care? Currently, approximately 1 in 400 adults is a cancer survivor. More than 72,200 adolescents, young adults, and adults between the ages of 15 and 39 years were diagnosed with a malignancy in 2006, making cancer the leading cause of disease-related death in that age group.2 By 2030, there will be an anticipated 50% increase in the number of patients diagnosed with cancer. Approximately 45% of those patients will be female, and 10% of this group will be diagnosed with a gynecologic malignancy during their lives.3 As basic science and clinical research progress at an astounding rate, the medical community is able to diagnose malignancies earlier and with less-invasive methods, thus extending disease-free intervals and overall survival. The most common cancers in reproductive-age women are breast cancer, melanoma, cervical cancer, non-Hodgkin lymphoma, and leukemia.4 The 5-year female cancer survival rate is dependent on the stage at diagnosis but is currently 90% for breast cancer, 91% for melanoma, 71% for cervical cancer, 69% non-Hodgkin lymphoma, and 55% for leukemia at first diagnosis.5 For surgically treatable malignancies, the advent of minimally invasive surgery has allowed surgeons the opportunity to offer patients a “lowimpact” approach to surgical therapy, providing faster recovery and return to normal activity. Furthermore, new drug protocols and the development of targeted biologic agents allow for improved outcomes in disease-free survival and overall survival rates in patients diagnosed with cancer before or during their child-bearing years. Maintaining the ability to bear children is of the utmost importance for many patients diagnosed with a malignancy during their fertile years. Noyes et al6,7 stated that 55% of patients said that having a child was the most important event Learning Objectives: After completing this CME activity, the obstetrician/gynecologist should be better able to: 1. Define oncofertility as an emerging discipline in obstetrics and gynecology. 2. Describe the impact of gynecologic cancer treatment on fertility. 3. Describe the initial evaluation of ovarian reserve in a patient with a gynecologic malignancy.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133287444","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 Heavy Menstrual Bleeding in Adolescents","authors":"Gylynthia E Trotman, Akua Afriyie-Gray","doi":"10.1097/01.PGO.0000432842.05691.3f","DOIUrl":"https://doi.org/10.1097/01.PGO.0000432842.05691.3f","url":null,"abstract":"According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is defined as menstrual flow outside of normal volume, duration, regularity, or frequency.1 One of the most common reasons for an adolescent to be seen by a gynecologist, outside of birth control or sexually transmitted infection, is excessive or heavy menstrual bleeding (HMB), previously known as menorrhagia. Girls with excessive uterine bleeding may incur significant morbidity. As a result, both ACOG and the American Academy of Pediatrics (AAP) strongly encourage medical providers to assess patterns of menstrual bleeding routinely in all adolescent girls. To identify possible pathologic processes and to improve quality of life, these organizations recommend that menses be documented as a vital sign.2,3 Knowledge of what would be considered normal menses is important for practitioners caring for this patient population. However, there is a gap between typical understanding and management of bleeding in adolescents and the recommendations of ACOG and the AAP. The goal of this lesson is to help practitioners better define, diagnose, and manage abnormal bleeding in this population.","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122729668","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":"Cytomegalovirus Infection in Pregnancy","authors":"L. Parikh, V. Gomez-Lobo","doi":"10.1097/01.PGO.0000432438.03460.3E","DOIUrl":"https://doi.org/10.1097/01.PGO.0000432438.03460.3E","url":null,"abstract":"Cytomegalovirus (CMV) is a double-stranded DNA virus that is transmitted by blood, saliva, urine, or sexual activity. It can also be vertically transmitted across the placenta to the fetus during pregnancy. CMV is the most common congenital infection and the most common cause of congenital deafness.1 Diagnosing CMV infection and determining the timing of exposure are critical to counseling patients about the risks of severe neonatal sequelae. Despite the important potential impact of CMV in pregnancy, there is a significant gap between best practice and the care provided by many obstetrician-gynecologists. To a great extent, this reflects the lack of clarity about how best to approach this infection. Although we have tools to screen for CMV exposure and provide vaccination against the disease, the clinical usefulness of these interventions is still under debate. Furthermore, there are few experimental treatments to prevent congenital CMV infection. The goal of this lesson will be to update the practicing obstetrician/gynecologist on screening and appropriate therapies for this infection. How Do Primary Versus Secondary Infection and Timing of Exposure Affect Pregnancy Outcome?","PeriodicalId":208056,"journal":{"name":"Postgraduate Obstetrics & Gynecology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130978728","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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