4,733 results match your criteria Clinical Obstetrics and Gynecology [Journal]


Treatment and Prevention of Pneumococcal Infection.

Clin Obstet Gynecol 2019 Apr 18. Epub 2019 Apr 18.

Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida.

Streptococcus pneumoniae, a gram-positive diplococcus, is the most common cause of bacterial pneumonia. The diagnosis of pneumococcal pneumonia is usually confirmed by chest x-ray and gram stain. The most appropriate antibiotics for treatment pneumococcal infection are macrolides, beta-lactams, and quinolones. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000451DOI Listing

The Impact of Burnout on the Obstetrics and Gynecology Workforce.

Clin Obstet Gynecol 2019 Apr 18. Epub 2019 Apr 18.

Surgery, The Ohio State University College of Medicine, Columbus, Ohio.

Although there has been discussion of a shortage of surgical specialties including OB/GYN, consensus is difficult because of the multiple variables involved in estimating both supply and demand. In addition, burnout has become more recognized as a variable that has not been taken into account in estimating a shortage of OB/GYNs. We estimate OB/GYN physician shortages of 17%, 24%, and 31% by 2030, 2040, and 2050, respectively. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000452DOI Listing

Prophylaxis Against Early-onset Group B Streptococcus Infections in Pregnant Women Who Are Allergic to Penicillin.

Clin Obstet Gynecol 2019 Apr 16. Epub 2019 Apr 16.

Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma.

Group B Streptococcus (GBS) infection remains a significant cause of neonatal morbidity and mortality. Adoption of screening for maternal genital tract colonization and intrapartum antibiotic prophylaxis has significantly reduced early-onset neonatal GBS infections. For women with an allergy to penicillin, recommended agents for prophylaxis have been well-outlined, but compliance with guideline recommendations is poor. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=00003081-900000000-9953
Publisher Site
http://dx.doi.org/10.1097/GRF.0000000000000455DOI Listing
April 2019
1 Read

Ovarian Reserve Testing: A Review of the Options, Their Applications, and Their Limitations.

Clin Obstet Gynecol 2019 Jun;62(2):228-237

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

Ovarian reserve refers to the number of oocytes remaining in a woman's ovaries that have the potential to yield a pregnancy. This is a concept based on the fact that the number of oocytes within a woman's ovaries and her ability to achieve pregnancy decline over time. There are 2 overlapping but distinct interpretations and utilizations of ovarian reserve testing (ORT)-biological and clinical. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000445DOI Listing

Fresh or Frozen Embryo Transfer in In Vitro Fertilization: An Update.

Clin Obstet Gynecol 2019 Jun;62(2):293-299

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

The past decade has witnessed a rapid increase in the number of frozen-thawed embryo transfer (FET) cycles. Several factors have contributed to the increase in FET cycles, including improvement in culture media, vitrification, and an increase in preimplantation genetic testing of embryos. However, the accelerated trend in FET cycles also suggests that FET may be preferred over fresh embryo transfer. Read More

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=00003081-900000000-9953
Publisher Site
http://dx.doi.org/10.1097/GRF.0000000000000456DOI Listing
June 2019
1 Read

Contemporary Management of Unexplained Infertility.

Clin Obstet Gynecol 2019 Jun;62(2):282-292

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

Infertility is estimated to affect about 10% to 15% of couples. Most cases of infertility have etiologies that can be attributed to tubal factors, ovulatory dysfunction, endometriosis, uterine factor, male factor, or diminished ovarian reserve, while the remainder often do not have a known attributable cause, that is, unexplained infertility. The current manuscript summarizes the contemporary management of unexplained infertility. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000450DOI Listing
June 2019
2 Reads

Contemporary Management of Polycystic Ovarian Syndrome.

Clin Obstet Gynecol 2019 Jun;62(2):271-281

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

PCOS remains one of the most intriguing endocrine disorders that physicians encounter even though it was first described over 80 years ago. Although the diagnostic criteria, nomenclature, and ideal therapeutic strategies are areas of active and ongoing debate, there is no doubt that we have made tremendous progress in improving the quality of life and reproductive outcomes of women who suffer from this wide-ranging disorder. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000449DOI Listing
June 2019
1 Read

Anti-Müllerian Hormone and Its Predictive Utility in Assisted Reproductive Technologies Outcomes.

Clin Obstet Gynecol 2019 Jun;62(2):238-256

Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Yale University School of Medicine, New Haven, Connecticut.

Anti-Müllerian hormone (AMH) has become one of the most informative biochemical markers of the ovary and is considered the earliest and most sensitive marker of reproductive aging. The accuracy of AMH in predicting ovarian response to controlled ovarian stimulation has led to AMH-based prognostication counseling and individualization of assisted reproductive technology (ART) stimulation protocols to optimize ovarian response and minimize hyperstimulation risks. Although AMH is considered a good predictor of quantitative ART outcomes, its correlation with qualitative ART outcomes is still controversial. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000436DOI Listing
June 2019
2 Reads

Hypothyroidism in Pregnancy.

Authors:
Scott A Sullivan

Clin Obstet Gynecol 2019 Jun;62(2):308-319

Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina.

Hypothyroidism in pregnancy is defined as the presence of an elevated thyroid stimulating hormone during gestation, affecting 2% to 3% of the population. Overt hypothyroidism is diagnosed by a decreased FT4, while patients with a normal FT4 are considered to have subclinical disease. Poorly controlled disease is associated with both pregnancy complications and developmental delays in the offspring. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000432DOI Listing
June 2019
2 Reads

An Update in REI and ART.

Clin Obstet Gynecol 2019 Apr 3. Epub 2019 Apr 3.

The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, New York.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000454DOI Listing

Burnout and Resilience in Obstetrics and Gynecology.

Clin Obstet Gynecol 2019 Apr 3. Epub 2019 Apr 3.

Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000453DOI Listing
April 2019
1 Read

Burnout Woman-Style: The Female Face of Burnout in Obstetrics and Gynecology.

Clin Obstet Gynecol 2019 Apr 3. Epub 2019 Apr 3.

University of California San Diego, La Jolla, California.

This summary will address important information on women physicians, focusing on those practicing OG. We will review traits more commonly found in women, societal influences that make women physicians more susceptible to burnout, as well as the unique features of the medical profession that affect women differently. We conclude with a discussion of the shared responsibilities of both individuals and institutions for implementing interventions that will effectively improve women's resilience, identification of and recovery from burnout. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000443DOI Listing
April 2019
3 Reads

Physician Work-Life Integration: Challenges and Strategies for Improvement.

Clin Obstet Gynecol 2019 Apr 3. Epub 2019 Apr 3.

Stanford University School of Medicine.

Increasing evidence shows physician well-being is linked to patient outcomes, patient and physician satisfaction, and workforce retention. Physician well-being is a broad construct that includes various dimensions of distress (stress, anxiety, fatigue, burnout) and professional fulfillment (meaning in work, engagement). Work-life integration (WLI) is one important component of physician well-being. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000442DOI Listing
April 2019
1 Read

Thyroid Nodules and Thyroid Cancer in Pregnancy.

Authors:
Scott A Sullivan

Clin Obstet Gynecol 2019 Jun;62(2):365-372

Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina.

Thyroid nodules and thyroid cancer discovered during pregnancy can result in significant anxiety for patients may present a challenge for providers. The prevalence of thyroid nodules is reported to vary between 3% and 21%. The estimated overall prevalence of thyroid cancer during pregnancy is 14. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000431DOI Listing

Evidence for Use of Tenofovir in Pregnancy to Prevent Perinatal Transmission of Hepatitis B Infection.

Clin Obstet Gynecol 2019 Mar 27. Epub 2019 Mar 27.

Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida.

Perinatal transmission of hepatitis B virus continues to be a serious global public health concern. Transmission failures are related to high maternal viremia. Several antiviral therapies reduce maternal viremia around the time of delivery and decrease maternal-to-child-transmission. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000438DOI Listing
March 2019
6 Reads

Burnout in Obstetricians and Gynecologists.

Authors:
Roger P Smith

Clin Obstet Gynecol 2019 Mar 27. Epub 2019 Mar 27.

Department of Obstetrics and Gynecology, Graduate Medical Education, Faculty and Academic Affairs, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.

Professional burnout threatens all high-functioning professionals and affects not only the individual, but, by extension, the patients they serve. The characteristics that make someone competitive for medical school, residency, or successful in academics or practice, make us particularly vulnerable to burnout: compulsive dedication to goals (and patients), motivation to succeed, self-reliance, leadership experience, delayed gratification, and others. Estimates of the prevalence of burnout in medicine vary widely but are consistently >40% and often as high as 75%. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000441DOI Listing

Case Studies in Thyroid Dysfunction and Pregnancy.

Clin Obstet Gynecol 2019 Jun;62(2):388-397

Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina.

This chapter represents a selection of 8 clinical scenarios that may commonly be encountered. They help summarize some of the literature and teaching points of the previous chapters. They are not meant to represent every possible presentation of thyroid disease, but rather to present common symptoms and findings that may aid a clinician in making a diagnosis or in selecting initial treatment. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000446DOI Listing
June 2019
1 Read

Parathyroid Diseases.

Authors:
Scott A Sullivan

Clin Obstet Gynecol 2019 Jun;62(2):347-358

Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina.

Although uncommon in pregnancy, parathyroid dysfunction may produce significant perinatal and maternal morbidity and mortality. The prevalence of hyperparathyroidism is 0.5%. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000447DOI Listing
June 2019
1 Read

Expanded Preconception Carrier Screening in Clinical Practice: Review of Technology, Guidelines, Implementation Challenges, and Ethical Quandaries.

Clin Obstet Gynecol 2019 Jun;62(2):217-227

Wright State University Boonshoft School of Medicine, Dayton, Ohio.

In the last 10 years, expanded preconception carrier screening has become widely available and helps patients/couples make more informed decisions with regard to their reproductive options and facilitates more effective preconception planning, prenatal diagnosis, condition-specific counseling, and condition-specific care. This review provides an overview of expanded preconception carrier screening's high-throughput genotyping and sequencing approaches, current guidelines, implementation challenges and evolving ethical quandaries. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000437DOI Listing
June 2019
3 Reads

Foreword: Thyroid Dysfunction in Pregnancy.

Authors:
Scott A Sullivan

Clin Obstet Gynecol 2019 Jun;62(2):300-301

Department of Obstetrics/Gynecology, Division of Maternal-Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000440DOI Listing

Endocrine Emergencies in Obstetrics.

Clin Obstet Gynecol 2019 Jun;62(2):339-346

Department of Obstetrics/Gynecology, Division of Maternal Fetal Medicine, Medical University of South Carolina, Charleston, South Carolina.

Endocrine emergencies in pregnancy can be life threatening and are associated with increased morbidity for both the mother and fetus. Thyroid storm, diabetic ketoacidosis, and hypercalcemic crisis require a high clinical suspicion, rapid treatment, and multidisciplinary care to ensure best outcomes. Critical care consultation and intensive care unit admission are often warranted. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000433DOI Listing
June 2019
3 Reads

Benzodiazepines in Pregnancy: Erratum.

Authors:

Clin Obstet Gynecol 2019 Mar 8. Epub 2019 Mar 8.

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000429DOI Listing

Postpartum Thyroiditis.

Clin Obstet Gynecol 2019 Jun;62(2):359-364

Medicine and Obstetrics and Gynecology, Division of Endocrinology, Diabetes & Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, California.

Postpartum thyroiditis (PPT) is an autoimmune-mediated destructive thyroiditis that occurs in the first year postpartum with a prevalence of 5%. In order to appropriately counsel and treat the patient, physicians need to recognize the signs and symptoms of PPT and distinguish PPT from Graves hyperthyroidism. This review of PPT will discuss the etiology, clinical course, risk factors, prognosis, and treatment of PPT. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000430DOI Listing
June 2019
1 Read

Iodine Deficiency and Supplementation in Pregnancy.

Clin Obstet Gynecol 2019 Jun;62(2):330-338

Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine, Boston, Massachusetts.

Iodine deficiency during pregnancy is an important global public health issue and the leading preventable cause of neurodevelopmental impairments worldwide. The effects of severe iodine deficiency during pregnancy, including adverse obstetric outcomes and decreased child intelligence quotient, have been clearly established. However, the effects of mild-to-moderate deficiency remain less well understood. Read More

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000428DOI Listing
June 2019
1 Read

Tobacco Use During Pregnancy.

Authors:
Tessa Crume

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

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

Physiological Response to Opioids.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000421DOI Listing
March 2019
2 Reads

Substance Abuse in Pregnancy.

Authors:
Shawn A Ryan

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=00003081-201903000-0001
Publisher Site
http://dx.doi.org/10.1097/GRF.0000000000000427DOI Listing
March 2019
10 Reads

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

Authors:
Erin T Carey

Clin Obstet Gynecol 2019 03;62(1):1-2

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

View Article

Download full-text PDF

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

Foreword: Substance Abuse in Pregnancy.

Clin Obstet Gynecol 2019 03;62(1):110-111

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

View Article

Download full-text PDF

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

Neurobiology of Addiction.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

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

Benzodiazepines in Pregnancy.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

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

Opioid Adjuncts: Optimizing Opioid Therapy With Nonopioid Medications.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

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

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

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000422DOI Listing
March 2019
8 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.

View Article

Download full-text PDF

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

Weaning From Long-term Opioid Therapy.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

Source
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 03;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

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6438363PMC
March 2019
13 Reads
1.532 Impact Factor

Guidelines for Monitoring Patients Using Opioid Therapy.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

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

Alcohol Use in Pregnancy.

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

Source
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 03;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

View Article

Download full-text PDF

Source
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 03;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

View Article

Download full-text PDF

Source
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 03;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

View Article

Download full-text PDF

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

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

Clin Obstet Gynecol 2019 03;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

View Article

Download full-text PDF

Source
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 03;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

View Article

Download full-text PDF

Source
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

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000407DOI Listing
December 2018
4 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

View Article

Download full-text PDF

Source
http://dx.doi.org/10.1097/GRF.0000000000000404DOI Listing
December 2018
31 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.

View Article

Download full-text PDF

Source
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

View Article

Download full-text PDF

Source
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

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=00003081-900000000-9957
Publisher Site
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

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=00003081-900000000-9958
Publisher Site
http://dx.doi.org/10.1097/GRF.0000000000000405DOI Listing
December 2018
34 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

View Article

Download full-text PDF

Source
http://Insights.ovid.com/crossref?an=00003081-900000000-9958
Publisher Site
http://dx.doi.org/10.1097/GRF.0000000000000392DOI Listing
December 2018
3 Reads