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Clinical Obstetrics and Gynecology

Mona R Prasad, Torri D Metz
No abstract text is available yet for this article.
January 9, 2019: Clinical Obstetrics and Gynecology
Casia Horseman, Avery Meyer
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. Each of these characteristics has a root in neurobiology and understanding their mechanisms helps us to understand addiction and see potential targets for treatment...
January 8, 2019: Clinical Obstetrics and Gynecology
Jaye M Shyken, Shilpa Babbar, Shaweta Babbar, Alicia Forinash
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. Short-term neonatal effects of hypotonia, depression, and withdrawal are described but long-term sequelae, if any, are poorly understood...
January 8, 2019: Clinical Obstetrics and Gynecology
Aalok R Sanjanwala, Lorie M Harper
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. Universal screening with brief intervention and referral, referral to psychotherapy, and pharmacotherapy are all recommended strategies for opioid use disorder in pregnancy...
January 8, 2019: Clinical Obstetrics and Gynecology
Dominika Lipowska James, Maryam Jowza
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. Pharmacological treatment focuses on opioid substitution therapy, with aim at prevention of opioid cravings and opioid withdrawal symptoms...
January 5, 2019: Clinical Obstetrics and Gynecology
Erin T Carey
No abstract text is available yet for this article.
January 5, 2019: Clinical Obstetrics and Gynecology
Noor Abualnadi, Arthur M Dizon, Lauren Schiff
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. The use of adjunct analgesics reduces opioid-related adverse effects and optimizes pain management...
January 4, 2019: Clinical Obstetrics and Gynecology
Marcela C Smid, Torri D Metz, Adam J Gordon
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...
December 31, 2018: Clinical Obstetrics and Gynecology
Patricia Overcarsh, Lara Harvey, Amanda Yunker
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. Recommendations are largely based on national consensus guidelines with a focus on frequency and content of follow-up, identification of high risk behaviors, and reassessment of goals of treatment...
December 31, 2018: Clinical Obstetrics and Gynecology
Chailee Moss, Carla Bossano, Silka Patel, Anna Powell, Rachel Chan Seay, Mostafa A Borahay
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...
December 27, 2018: Clinical Obstetrics and Gynecology
Katherine Dejong, Amy Olyaei, Jamie O Lo
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. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder...
December 19, 2018: Clinical Obstetrics and Gynecology
Elaine Stickrath
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. The impact on pregnancy outcomes is reviewed along with the evidence of marijuana's impact on neural development of the fetus. Finally, clinical considerations for providers are discussed.
December 14, 2018: Clinical Obstetrics and Gynecology
Austin D Findley, Emily Kemner
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...
November 20, 2018: Clinical Obstetrics and Gynecology
Janelle K Moulder, Jonathan D Boone, Jason M Buehler, Michelle Louie
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. Adjuncts are often used in combination, but different interventions may be incorporated for patient-specific and procedure-specific needs. Postoperative pain control can be optimized by continuing nonopioid adjuncts, and prescribing opioid analgesia to address breakthrough pain...
November 6, 2018: Clinical Obstetrics and Gynecology
Tarek Toubia, Tarek Khalife
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. Exogenous opioid therapy hijacks the endogenous system and alters its functions contributing to an imbalance that is responsible for the pathogenesis of several disease states...
November 5, 2018: Clinical Obstetrics and Gynecology
Sara R Till, Sawsan As-Sanie, Andrew Schrepf
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.
October 31, 2018: Clinical Obstetrics and Gynecology
Eliza M Berkley, Alfred Abuhamad
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. Clinically, most patients are asymptomatic but some will present with vaginal bleeding and abdominal cramping. The goal of this article is to discuss the common clinical presentation and risk factors for placenta accreta spectrum, and to review in detail the ultrasound features/markers of PAS in each trimester...
December 2018: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
December 2018: Clinical Obstetrics and Gynecology
Nicole L Nisly, Katherine L Imborek, Michelle L Miller, Susan D Kaliszewski, Rachel M Williams, Matthew D Krasowski
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. This fund of knowledge is essential the practicing primary care providers and support staff...
December 2018: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
December 2018: Clinical Obstetrics and Gynecology
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