4,712 results match your criteria Clinical Obstetrics and Gynecology [Journal]


Tobacco Use During Pregnancy.

Authors:
Tessa Crume

Clin Obstet Gynecol 2019 Mar;62(1):128-141

Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Smoking during pregnancy is the most common preventable cause of infant morbidity and mortality. Cessation by the third trimester has consistently been associated with improved birth outcomes; however, the majority of women who obtain cessation during pregnancy, relapse in the first year postpartum. The majority of women who smoke during pregnancy developed their addiction to tobacco in early life, thus the need to intervene in the familial transmission of nicotine dependence is clear. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000413DOI Listing
March 2019
6 Reads

Physiological Response to Opioids.

Clin Obstet Gynecol 2019 Mar;62(1):11-21

Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecologic Surgery, University of North Carolina, Chapel Hill, North Carolina.

The clinical setting in which women's health physicians practice, whether as generalist, obstetricians and gynecologists, or subspecialists, dictates our frequent clinical interaction with "pain." Opioid-containing medications are frequently prescribed within our specialty as a means of immediate pain relief. Opioid-containing medication causes a deep physiological alteration of several systems resulting in potential harm to acute and chronic opioid users. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000421DOI Listing
March 2019
1 Read

Substance Abuse in Pregnancy.

Authors:
Shawn A Ryan

Clin Obstet Gynecol 2019 Mar;62(1):112-117

BrightView, Cincinnati, Ohio.

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Like many other chronic diseases, addiction often involves cycles of relapse and remission. It is key that clinicians understand it as such and treat it appropriately with evidence-based interventions including medication-assisted treatment. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000427DOI Listing
March 2019
6 Reads

Contributors: Substance Abuse in Pregnancy.

Authors:

Clin Obstet Gynecol 2019 Mar;62(1):ix-x

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http://dx.doi.org/10.1097/01.grf.0000553315.55294.77DOI Listing
March 2019
1 Read

Foreword: Opioid Use, Misuse and Abuse: The Rise and Fall of a National Opioid Epidemic.

Authors:
Erin T Carey

Clin Obstet Gynecol 2019 Mar;62(1):1-2

Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

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http://dx.doi.org/10.1097/GRF.0000000000000426DOI Listing
March 2019
2 Reads

Foreword: Substance Abuse in Pregnancy.

Clin Obstet Gynecol 2019 Mar;62(1):110-111

Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah.

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http://dx.doi.org/10.1097/GRF.0000000000000420DOI Listing
March 2019
1 Read

Neurobiology of Addiction.

Clin Obstet Gynecol 2019 Mar;62(1):118-127

Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio.

Drugs of abuse can cause changes in the brain leading to addiction. Current scientific focus has been on how these drugs interact with the brain and the changes they cause, how those changes affect human behavior and how they may last beyond termination of drug use. Compulsiveness in seeking the drug, impulsiveness in consuming the drug, and negative affect when the drug is withheld are characteristic of addiction. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000416DOI Listing
March 2019
5 Reads

Benzodiazepines in Pregnancy.

Clin Obstet Gynecol 2019 Mar;62(1):156-167

St. Louis College of Pharmacy, St. Louis, Missouri.

Benzodiazepine use and dependence are on the rise as well as the number of deaths attributable to the combination of opioids and benzodiazepines. Anxiety, the most frequent condition for which benzodiazepines are prescribed, occurs commonly, and is increasingly noted to coincide with pregnancy. Use of both benzodiazepine anxiolytics and anxiety in pregnancy is associated with preterm delivery and low birth weight. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000417DOI Listing
March 2019
2 Reads

Opioid Use Disorder in Pregnancy.

Clin Obstet Gynecol 2019 Mar;62(1):191-207

Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama.

Opioid use disorders during pregnancy are a major risk factor for pregnancy-associated deaths. Women with opioid use disorders also experience increases in the incidence of cardiac arrest, renal failure, cesarean delivery, and blood transfusion. As such there is a tremendous need by obstetricians to understand and treat opiate use as a holistic public health problem with its own unique risk factors, and management strategies. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000419DOI Listing
March 2019
2 Reads

Opioid Adjuncts: Optimizing Opioid Therapy With Nonopioid Medications.

Clin Obstet Gynecol 2019 Mar;62(1):37-47

Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

In this article, we describe a variety of medications that physicians managing outpatient chronic pain should familiarize themselves with to better aid their approach to multimodal pain therapy. Physicians should always consider the use of an adjuvant or coanalgesic drug as first-line treatments. Although many of these medications are not primarily analgesics, in clinical practice they have independent analgesic effects or synergistic analgesic properties when used with opioids. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000423DOI Listing
March 2019
6 Reads

Treating Opioid Dependence: Pain Medicine Physiology of Tolerance and Addiction.

Clin Obstet Gynecol 2019 Mar;62(1):87-97

Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina.

Inappropriate and excessive opioid prescribing practices for treatment of chronic nonmalignant pain contributed to rising rates of opioid related mortality. Effective and widely available opioid addiction treatment resources are needed to ensure successful resolution of the "opioid epidemic". This chapter outlines the basic pathophysiology of addiction as well as principles of opioid addiction management focusing on the pharmacological and nonpharmacological aspects of care. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000422DOI Listing
March 2019
4 Reads

Opioids Misuse and Abuse: The Making of a National Opioid Epidemic.

Authors:
Erin T Carey

Clin Obstet Gynecol 2019 Jan 5. Epub 2019 Jan 5.

Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

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http://dx.doi.org/10.1097/GRF.0000000000000426DOI Listing
January 2019
2 Reads

Weaning From Long-term Opioid Therapy.

Clin Obstet Gynecol 2019 Mar;62(1):98-109

Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland.

Opioid use for chronic noncancer pain poses a challenge to the gynecologist, and weaning opioids is often a goal for clinicians and patients. In some cases, opioid cessation can be achieved by weaning a patient's prescribed opioid or with symptomatic management with long-acting opioids or alpha2-adrenergic medications. This review imparts a basic understanding of the physiology of opioid withdrawal, strategies for achieving opioid abstinence, medications for treating the symptoms of withdrawal, and alternatives to opioid taper. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000425DOI Listing
March 2019
2 Reads
1.532 Impact Factor

Stimulant Use in Pregnancy: An Under-recognized Epidemic Among Pregnant Women.

Clin Obstet Gynecol 2019 Mar;62(1):168-184

Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine.

Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000418DOI Listing
March 2019
8 Reads
1.532 Impact Factor

Guidelines for Monitoring Patients Using Opioid Therapy.

Clin Obstet Gynecol 2019 Mar;62(1):59-66

Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee.

Opioid-related morbidity and mortality have increased to epidemic proportions over the past 20 years. Gynecologists play an integral role in addressing this epidemic through management of patients with pain, specifically through prescribing and monitoring practices. Practical recommendations are provided for clinicians caring for noncancer patients on chronic opioid therapy. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000424DOI Listing
March 2019
1 Read

Alcohol Use in Pregnancy.

Clin Obstet Gynecol 2019 Mar;62(1):142-155

Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland.

Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000414DOI Listing
March 2019
1 Read

Marijuana Use in Pregnancy: An Updated Look at Marijuana Use and Its Impact on Pregnancy.

Authors:
Elaine Stickrath

Clin Obstet Gynecol 2019 Mar;62(1):185-190

Department of Obstetrics and Gynecology, Denver Health Medical Center, University of Colorado, Denver, Denver, Colorado.

This article aims to provide an updated look at the use of marijuana in the United States and its impact on pregnancy. First, the prevalence of marijuana use is examined, including use both in and outside of pregnancy. The literature surrounding attitudes and beliefs with regard to use in pregnancy is reviewed. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000415DOI Listing
March 2019
1 Read

Selecting the Appropriate Patient for Opioid Therapy: Risk Assessment and Treatment Strategies for Gynecologic Pain.

Clin Obstet Gynecol 2019 Mar;62(1):48-58

Department of Obstetrics and Gynecology, Wright-Patterson Medical Center, Wright State University Boonshoft School of Medicine, Dayton, Ohio.

Chronic pelvic pain is a commonly encountered clinical entity, and many women with this chronic pain condition will be treated at some point in time with opioids for management of their pain. Clinicians in women's health are frequently asked and expected to participate in the care of women with chronic pelvic pain, as well as other gynecologic pain conditions, and should be familiar with the role of opioid therapy for these conditions. The goal of this article is to help determine which patients may be appropriate candidates for the initiation or continuation of opioid therapy for gynecologic pain. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000411DOI Listing
March 2019
8 Reads

Opioid Use in the Postoperative Arena: Global Reduction in Opioids After Surgery Through Enhanced Recovery and Gynecologic Surgery.

Clin Obstet Gynecol 2019 Mar;62(1):67-86

Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.

Enhanced recovery programs aim to reduce surgical stress to improve the patient perioperative experience. Through a combination of multimodal analgesia and maintaining a physiological state, postoperative recovery is improved. Many analgesic adjuncts are available that improve postoperative pain control and limit opioid analgesia requirements. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000410DOI Listing
March 2019
11 Reads

The Endogenous Opioid System: Role and Dysfunction Caused by Opioid Therapy.

Clin Obstet Gynecol 2019 Mar;62(1):3-10

Mayo Clinic Health System, Mankato, Minnesota.

The endogenous opioid system is comprised of a wide array of receptors and ligands that are present throughout the central and peripheral nervous system, the gastrointestinal tract, and the immune system. This explains the multitude of physiological functions it is responsible for including analgesia, mood regulation, and modulation of the stress response. It also plays a pivotal role in modulating the brain's reward center with behavioral and social implications on mood disorders and addiction. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000409DOI Listing
March 2019
1 Read

Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment.

Clin Obstet Gynecol 2019 Mar;62(1):22-36

Anesthesiology, University of Michigan, Ann Arbor, Michigan.

Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340718PMC
March 2019
2 Reads

Imaging of Placenta Accreta Spectrum.

Clin Obstet Gynecol 2018 12;61(4):755-765

Eastern Virginia Medical School, Norfolk, Virginia.

Placenta accreta spectrum (PAS) refers to an abnormally invasive implantation of the placenta into the uterine myometrium. The resultant risk is that of severe maternal hemorrhage and significant maternal morbidity and even mortality. The 2 strongest risk factors for the development of PAS are a history of a prior cesarean section and a placenta previa in the current pregnancy. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000407DOI Listing
December 2018
3 Reads

Unique Primary Care Needs of Transgender and Gender Non-Binary People.

Clin Obstet Gynecol 2018 12;61(4):674-686

University of Iowa Carver College of Medicine, Iowa City, Iowa.

It is important for the practicing primary care provider to become familiar with the unique health care needs for people who identify as transgender men, transgender women, and non-binary people, who are all within the scope of practice of a general obstetrician-gynecologist and other primary care providers. A review of the unique health needs and essential terminology is presented. This knowledge is a basic foundation to develop a welcoming and inclusive practice for people who are gender nonconforming. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000404DOI Listing
December 2018
24 Reads

Foreword: Management of Abnormal Placentation.

Authors:
Robert M Silver

Clin Obstet Gynecol 2018 12;61(4):731-732

Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.

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http://dx.doi.org/10.1097/GRF.0000000000000408DOI Listing
December 2018
1 Read

Role for OBGYNs in Gender-Affirming Surgical Care of Transgender and Gender Nonconforming Individuals.

Clin Obstet Gynecol 2018 12;61(4):722-730

Center for Reproductive Medicine, University of Michigan, Ann Arbor, Michigan.

Many transgender and gender nonconforming individuals have undergone, or plan to pursue, gender-affirming surgery as part of their transition. While not all gender-affirming surgeries are provided by Obstetricians and Gynecologists (OBGYNs), OBGYNs are uniquely skilled to perform certain gender-affirming surgeries such as hysterectomies, bilateral oophorectomies, and vaginectomies. OBGYNs are also well positioned to provide anatomy-specific cancer screening as dictated by patient's hormonal and surgical status, and to address postsurgical or natal vulvovaginal concerns. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000402DOI Listing
December 2018
1 Read

Peripartum Anesthesia Considerations for Placenta Accreta.

Clin Obstet Gynecol 2018 12;61(4):808-827

Department of Anesthesiology, University of Utah, Salt Lake City, Utah.

Placenta accreta spectrum is becoming more common and is the most frequent indication for peripartum hysterectomy. Management of cesarean delivery in the setting of a morbidly adherent placenta has potential for massive hemorrhage, coagulopathies, and other morbidities. Anesthetic management of placenta accreta spectrum presents many challenges including optimizing surgical conditions, providing a safe and satisfying maternal delivery experience, preparing for massive hemorrhage and transfusion, preventing coagulopathies, and optimizing postoperative pain control. Read More

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http://Insights.ovid.com/crossref?an=00003081-900000000-9957
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http://dx.doi.org/10.1097/GRF.0000000000000403DOI Listing
December 2018
4 Reads

Developing an Inclusive and Welcoming LGBTQ Clinic.

Clin Obstet Gynecol 2018 12;61(4):646-662

University of Iowa Carver College of Medicine, Iowa City, Iowa.

People who identify as lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) are underserved and face barriers to knowledgeable health care. Most health systems are ill prepared to provide care that addresses the needs of the LGBTQ community. Basic steps to developing an LGBTQ welcoming health care program are presented. Read More

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http://Insights.ovid.com/crossref?an=00003081-900000000-9958
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http://dx.doi.org/10.1097/GRF.0000000000000405DOI Listing
December 2018
28 Reads

Pathophysiology of Placenta Accreta Spectrum Disorders: A Review of Current Findings.

Clin Obstet Gynecol 2018 12;61(4):743-754

Department of Physiology, Development and Neuroscience, The Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.

Current findings continue to support the concept of a biologically defective decidua rather than a primarily abnormally invasive trophoblast. Prior cesarean sections increase the risk of placenta previa and both adherent and invasive placenta accreta, suggesting that the endometrial/decidual defect following the iatrogenic creation of a uterine myometrium scar has an adverse effect on early implantation. Preferential attachment of the blastocyst to scar tissue facilitates abnormally deep invasion of trophoblastic cells and interactions with the radial and arcuate arteries. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000392DOI Listing
December 2018
3 Reads

Surgical Management of Placenta Accreta Spectrum.

Clin Obstet Gynecol 2018 12;61(4):774-782

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Utah Health, Salt Lake City, Utah.

This is a discussion of the standard surgical treatment of placenta accreta spectrum disorders including preoperative considerations, diagnostic imaging, surgical steps for cesarean hysterectomy, and postoperative management. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000406DOI Listing
December 2018
8 Reads

The Utilization of Interventional Radiologic Procedures in the Surgical Management of Placenta Accreta Syndrome.

Clin Obstet Gynecol 2018 12;61(4):795-807

Miller Children's & Women's Hospital/Long Beach, Long Beach, California.

The role of Interventional radiologic procedures for the management of suspected placenta accreta spectrum (PAS) has evolved considerably over last 3 decades. In this article, the authors describe the various techniques of vascular occlusion for the management of PAS and provide a brief review of the literature examining the pros and cons in the use of these devices. Read More

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http://Insights.ovid.com/crossref?an=00003081-900000000-9958
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http://dx.doi.org/10.1097/GRF.0000000000000401DOI Listing
December 2018
4 Reads

Clinical Care of Lesbian and Bisexual Women for the Obstetrician Gynecologist.

Clin Obstet Gynecol 2018 12;61(4):663-673

Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.

Sexual minority women are more likely to delay care, less likely to have a usual place of care, and more likely to exhibit higher risk behaviors such as smoking, obesity, heavy drinking resulting in a disproportionate number of chronic conditions. It is imperative for obstetrician-gynecologists to be at the forefront of providing comprehensive health care to all women, no matter their sexual orientation. This article seeks to discuss health care disparities as well as health behaviors and outcomes in this population. Read More

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http://Insights.ovid.com/crossref?an=00003081-900000000-9958
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http://dx.doi.org/10.1097/GRF.0000000000000399DOI Listing
December 2018
2 Reads

Foreword: Caring for Lesbians, Bisexual Women, Transgender, and Gender Nonconforming People.

Authors:
Susan R Johnson

Clin Obstet Gynecol 2018 12;61(4):643-645

Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.

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http://dx.doi.org/10.1097/GRF.0000000000000397DOI Listing
December 2018
2 Reads

Gender-Affirming Hormone Therapy for Transgender Men.

Authors:
Molly B Moravek

Clin Obstet Gynecol 2018 12;61(4):687-704

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of Michigan, Ann Arbor, Michigan.

There are an estimated 1.4 million transgender adults in the United States, and lack of providers knowledgeable in transgender care is a barrier to health care. Obstetricians and Gynecologists can help increase access in part by becoming competent in gender-affirming hormone therapy. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000398DOI Listing
December 2018
3 Reads

Blood Products in the Management of Abnormal Placentation.

Clin Obstet Gynecol 2018 12;61(4):828-840

Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.

A critical tool in the successful management of patients with abnormal placentation is an established massive transfusion protocol designed to rapidly deliver blood products in obstetrical and surgical hemorrhage. Spurred by trauma research and an understanding of consumptive coagulopathy, the past 2 decades have seen a shift in volume resuscitation from an empiric, crystalloid-based method to balanced, targeted transfusion therapy. The present article reviews patient blood management in abnormal placentation, beginning with optimizing the patient's status in the antenatal period to the laboratory assessment and transfusion strategy for blood products at the time of hemorrhage. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000400DOI Listing
December 2018
10 Reads

Gender-Affirming Hormone Therapy for Transgender Females.

Authors:
John F Randolph

Clin Obstet Gynecol 2018 12;61(4):705-721

Department of Obstetrics and Gynecology and Center for Reproductive Michigan Medicine, University of Michigan, Ann Arbor, Michigan.

The provision of hormone therapy, both estrogens and antiandrogens, to adult transgender females is well within the scope of practice of the obstetrician gynecologist. The goal is to induce feminizing changes and suppress previously developed masculinization. Estrogens in sufficient doses will usually achieve both goals with augmentation by antiandrogens. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000396DOI Listing
December 2018
13 Reads

Conservative Management of Placenta Accreta Spectrum.

Clin Obstet Gynecol 2018 12;61(4):783-794

Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah.

The purpose of this review was to assist obstetricians and gynecologists in considering the most appropriate conservative treatment option to manage women with placenta accreta spectrum according to their individual need and local expertise of the heath care team. The issue is challenging, as the quality of evidence with regard to efficacy is poor, and is mainly based on retrospective studies with limited sample size. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000395DOI Listing
December 2018
1 Read

Antenatal Management of Placenta Accreta.

Clin Obstet Gynecol 2018 12;61(4):766-773

Lucile Packard Children's Hospital at Stanford, Palo Alto, California.

Predelivery diagnosis of placenta accreta, increta, and percreta (from here referred to as placenta accreta, unless otherwise noted) has increasingly created opportunities to optimize antenatal management. Despite the increased frequency of placenta accreta today, occurring in as many as 1 in 533 to 1 in 272 deliveries, high-quality data are lacking for many aspects of antenatal management. This chapter will discuss antenatal management of, and risks faced by, women with suspected placenta accreta, a condition that most frequently requires a potentially morbid cesarean hysterectomy. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000394DOI Listing
December 2018
3 Reads

The Placenta Accreta Spectrum: Epidemiology and Risk Factors.

Authors:
Daniela A Carusi

Clin Obstet Gynecol 2018 12;61(4):733-742

Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.

The placenta accreta spectrum has become an important contributor to severe maternal morbidity. The true incidence is difficult to ascertain, but likely falls near 1/1000 deliveries. This number seems to have increased along with the rate of risk factors. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000391DOI Listing
December 2018
9 Reads

The Role of Centers of Excellence With Multidisciplinary Teams in the Management of Abnormal Invasive Placenta.

Clin Obstet Gynecol 2018 12;61(4):841-850

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.

Abnormal invasive placenta (AIP) causes significant maternal and perinatal morbidity and mortality. With the increasing incidence of cesarean delivery, this condition is dramatically more common in the last 20 years. Advances in grayscale and Doppler ultrasound have facilitated prenatal diagnosis of abnormal placentation to allow the development of multidisciplinary management plans. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000393DOI Listing
December 2018
7 Reads

Differential Effects of Progestogens Used for Menopausal Hormone Therapy.

Clin Obstet Gynecol 2018 09;61(3):454-462

Departments of Obstetrics and Gynecology and Reproductive Biology, Division of Reproductive Endocrinology and Infertility, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Recommendations regarding menopausal hormone therapy continue to evolve as more studies are completed. Progestogens, indicated for endometrial protection in women on estrogen therapy who have an intact uterus, seem to confer greater health risks than estrogen alone. Thus, it is important for clinicians to be well informed when prescribing these medications. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000364DOI Listing
September 2018
10 Reads

Foreword: Depression in the Pregnant Patient.

Clin Obstet Gynecol 2018 09;61(3):523-524

Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.

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http://dx.doi.org/10.1097/GRF.0000000000000390DOI Listing
September 2018
2 Reads

Managing Menopause by Combining Evidence With Clinical Judgment.

Clin Obstet Gynecol 2018 09;61(3):496-507

Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.

Menopause occurring before the age of 40 harbors unique challenges as well as lifetime burden resulting from premature deprivation from ovarian hormones, primarily estrogen. Cessation of ovarian function before age 40 is considered premature (ovarian insufficiency), whereas if occurring before age 45, it is deemed "early." Early/premature menopause may be idiopathic, medically, or surgically induced. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000384DOI Listing
September 2018
7 Reads

Psychotherapeutic Treatments for Depression During Pregnancy.

Clin Obstet Gynecol 2018 09;61(3):562-572

Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado.

Depression during pregnancy is a significant public health problem that is associated with adverse consequences for women and children. Despite the availability of treatment options, depression during pregnancy is often undertreated. Most pregnant women prefer nonpharmacological interventions over antidepressant medications. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000388DOI Listing
September 2018
5 Reads

Management of the Perimenopause.

Clin Obstet Gynecol 2018 09;61(3):419-432

Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.

Perimenopause, or the menopausal transition, represents a period of time during which newly arising symptoms can present complex management decisions for providers. Many women present to care with complaints of hot flashes, vaginal and sexual changes, altered mood and sleep, and changing bleeding patterns. The effect of these symptoms on quality of life, even before a woman enters menopause, can be significant. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082400PMC
September 2018
2 Reads

Hormone Therapy: Key Points From NAMS 2017 Position Statement.

Clin Obstet Gynecol 2018 09;61(3):447-453

University of Virginia Health System, Charlottesville, Virginia; The North American Menopause Society, Cleveland, Ohio.

The goal of the 2017 North American Menopause Society Hormone Therapy (HT) Position Statement is to remove fear about HT and encourage individualized shared decision making, using best available evidence. Systemic HT is safe and effective for symptomatic menopausal women aged younger than 60 years and within 10 years of menopause. Special populations of early menopause, high risk for fracture, risk of breast or uterine cancer, and extended duration are discussed. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000383DOI Listing
September 2018
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Foreword: Managing Menopause by Combining Evidence With Clinical Judgment.

Clin Obstet Gynecol 2018 09;61(3):417-418

Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, Virginia.

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http://dx.doi.org/10.1097/GRF.0000000000000387DOI Listing
September 2018
2 Reads

Vasomotor and Related Menopause Symptoms.

Clin Obstet Gynecol 2018 09;61(3):433-446

Division of Endocrinology and Metabolism, University of California School of Medicine, San Diego, La Jolla, California.

Vasomotor symptoms are the most common manifestation of the menopause transition and postmenopausal phases of reproductive life. They interfere not only in quality of life, but also contribute to sleep and mood disturbances that potentially compromise home and work effectiveness. Treatment options include hormone therapy (HT), nonhormonal prescription drugs, mind body and behavior therapies, and over-the-counter preparations. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000385DOI Listing
September 2018
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Tissue-selective Estrogen Complex for Menopausal Hormone Therapy.

Clin Obstet Gynecol 2018 09;61(3):463-469

University of Virginia Health System, Charlottesville, Virginia.

The first approved tissue-selective estrogen complex is a pairing of conjugated estrogen combined with the selective estrogen-receptor modulator, bazedoxifene. Advantages include relief of menopausal symptoms without the increased chance of bleeding or breast tenderness unlike with traditional estrogen-progestin therapy, which is associated with both bleeding and breast tenderness. Tissue-selective estrogen complex effects on relief of vasomotor symptoms, prevention of bone loss, improvement in vaginal symptoms, lack of significant cardiovascular effects beyond the expected 2-fold increase in venous thrombosis, neutral effect on breast, and protective effects on the endometrium are discussed. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000386DOI Listing
September 2018
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Psychiatric Emergencies in Pregnancy and Postpartum.

Clin Obstet Gynecol 2018 09;61(3):615-627

Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago.

The perinatal period is a vulnerable time for the acute onset and recurrence of psychiatric illness. Primary care providers are opportunely positioned to intervene for women who present with mood decompensation, excessive anxiety, or psychosis during the perinatal period. Owing to increased screening efforts in obstetrical clinics and amount of contact during the perinatal period, obstetricians may be able to identify patients who need treatment before their symptoms become severe. Read More

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http://dx.doi.org/10.1097/GRF.0000000000000377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143388PMC
September 2018
18 Reads