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Clinical Obstetrics and Gynecology

Brittany L Bychkovsky, Don S Dizon, William M Sikov
Breast cancer is a heterogenous disease, comprised of at least 3 major subtypes: hormone receptor-positive/HER2-(HR+), HER2+, and HR-/HER2-(triple negative) breast cancers. The medical management of each subype is distinct. In this article, we review contemporary data supporting the use of chemotherapy, endocrine therapy and biologic therapies, especially HER2-directed agents, in the adjuvant and neoadjuvant setting in patients with newly diagnosed nonmetastatic (stage I-III) breast cancer.
October 12, 2016: Clinical Obstetrics and Gynecology
James V Fiorica
This article is an overview of the modalities available for breast cancer screening. The modalities discussed include digital mammography, digital breast tomosynthesis, breast ultrasonography, magnetic resonance imaging, and clinical breast examination. There is a review of pertinent randomized controlled trials, studies and meta-analyses which contributed to the evolution of screening guidelines. Ultimately, 5 major medical organizations formulated the current screening guidelines in the United States. The lack of consensus in these guidelines represents an ongoing controversy about the optimal timing and method for breast cancer screening in women...
October 12, 2016: Clinical Obstetrics and Gynecology
Samuel Smith
Shoulder dystocia is an obstetrical emergency that may result in significant neonatal complications. It requires rapid recognition and a coordinated response. Standardization of care, teamwork and communication, and clinical simulation are the key components of patient safety programs in obstetrics. Simulation-based team training and institutional protocols for the management of shoulder dystocia are emerging as integral components of many labor and delivery safety initiatives because of their impact on technical skills and team performance...
October 12, 2016: Clinical Obstetrics and Gynecology
Mary L Gemignani
No abstract text is available yet for this article.
October 5, 2016: Clinical Obstetrics and Gynecology
David J Hetzel
Surgical and radiation therapy for DCIS and early stage 1 and 2 invasive breast cancer is detailed and described.
October 5, 2016: Clinical Obstetrics and Gynecology
Ashley S Case
Breast cancer is one of the most common malignancies affecting pregnancy. Pregnancy-associated breast cancer refers to breast cancer that is diagnosed during pregnancy or within the first postpartum year. The incidence is increasing as more women delay childbearing. Breast cancer can be safely diagnosed, staged, and treated during pregnancy while protecting the fetus and mother with excellent outcomes for both. Avoiding diagnostic delays is vital to prognosis. This article provides an overview of the diagnosis, staging, management, and prognosis of pregnancy-associated breast cancer...
October 5, 2016: Clinical Obstetrics and Gynecology
Trevor Tejada-Bergés
As health care providers, we play a crucial role in the assessment of a patient's risk for hereditary breast cancer syndromes. The panorama of genetic assessment and testing has evolved dramatically since the identification of the BRCA genes. Next-generation sequencing technology has facilitated the development of multigene panels, but 1 consequence has been an increased identification of pathogenic variants at odds with a family history as well as variants of uncertain significance for which treatment guidelines are not defined...
October 5, 2016: Clinical Obstetrics and Gynecology
Robert B Gherman
No abstract text is available yet for this article.
September 27, 2016: Clinical Obstetrics and Gynecology
Melissa Murray
Percutaneous imaging-guided core needle biopsy (CNB) is a less invasive and less expensive alternative to surgical biopsy for the evaluation of breast lesions. After a CNB the radiologist determine if there is concordance between the pathology, imaging, and clinical findings. Patient management after CNB diagnosis of high-risk breast lesion varies. Surgical excision is warranted for lesions yielding a CNB diagnosis of ADH; however controversy exists regarding the need for surgical excision after CNB diagnosis of radial scar, papillary lesion, atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS)...
September 27, 2016: Clinical Obstetrics and Gynecology
Morgen S Doty, Leen Al-Hafez, Suneet P Chauhan
Since antepartum and intrapartum risk factors are poor at identifying women whose labor is complicated by shoulder dystocia, sonographic examination of the fetus holds promise. Though there are several measurements of biometric parameters to identify the parturient who will have shoulder dystocia, none are currently clinically useful. Three national guidelines confirm that sonographic measurements do not serve as appropriate diagnostic tests to identify women who will have shoulder dystocia with or without concurrent injury...
September 27, 2016: Clinical Obstetrics and Gynecology
Amer K Karam
There has been a steady decline in breast cancer mortality that has led to a significant increase in the number of patients surviving breast cancer. We will review in this manuscript the evidence and guidelines for posttreatment surveillance of patients with breast cancer as well as the management options for patients who are diagnosed with local-regional and distant recurrences.
September 27, 2016: Clinical Obstetrics and Gynecology
Damian McCARTAN, Mary L Gemignani
Despite advances in estimating prognosis and predicting response to adjuvant systemic therapy, the status of the axillary lymph nodes remains a critical component in initial surgical planning and in determining therapeutic strategies for patients with breast cancer. Buoyed by evidence from multi-institutional randomized clinical trials, the last 2 decades have witnessed remarkable and practice-changing advances in our approach to the axilla. This review concentrates on the current best practice in axillary management for both node-negative and node-positive patients, with particular focus on the evolving management of the axilla in the era of neoadjuvant systemic therapy...
September 22, 2016: Clinical Obstetrics and Gynecology
Angela K Shaddeau, Shad Deering
Shoulder dystocia is an unpredictable obstetric emergency that requires prompt interventions to ensure optimal outcomes. Proper technique is important but difficult to train given the urgent and critical clinical situation. Simulation training for shoulder dystocia allows providers at all levels to practice technical and teamwork skills in a no-risk environment. Programs utilizing simulation training for this emergency have consistently demonstrated improved performance both during practice drills and in actual patients with significantly decreased risks of fetal injury...
September 22, 2016: Clinical Obstetrics and Gynecology
Brian Orr, Joseph L Kelley
Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.
September 22, 2016: Clinical Obstetrics and Gynecology
Saila Moni, Colleen Lee, Dena Goffman
Shoulder dystocia is a term that evokes terror and fear among many physicians, midwives, and health care providers as they recollect at least 1 episode of shoulder dystocia in their careers. Shoulder dystocia can result in significant maternal and neonatal complications. Because shoulder dystocia is an urgent, unanticipated, and uncommon event with potentially catastrophic consequences, all practitioners and health care teams must be well-trained to manage this obstetric emergency. Preparation for shoulder dystocia in a systematic way, through standardization of process, practicing team-training and communication, along with technical skills, through simulation education and ongoing quality improvement initiatives will result in improved outcomes...
September 21, 2016: Clinical Obstetrics and Gynecology
Michele J Grimm
Childbirth is a complicated biomechanical process that many take for granted. However, the delivery forces generated by a mother (uterine contractions and maternal pushing) are strong and have a significant effect on the body and tissues of the fetus, especially during the second stage of labor. Although most infants are born without negative, force-related outcomes, in some infants the normal forces of labor cause an injury that can have either temporary or permanent sequelae. The biomechanical situation is further complicated when an infant's shoulder impacts the maternal pelvis, which provides increased resistance and creates added stresses within the neonatal body and tissues...
September 21, 2016: Clinical Obstetrics and Gynecology
Edith D Gurewitsch Allen
A prior history of delivery complicated by shoulder dystocia confers a 6-fold to nearly 30-fold increased risk of shoulder dystocia recurrence in a subsequent vaginal delivery, with most reported rates between 12% and 17%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, directing intervention efforts at the particular subgroup of women with a prior history of shoulder dystocia has merit. Potentially modifiable risk factors and individualized management strategies that may reduce shoulder dystocia recurrence and its associated significant morbidities are reviewed...
September 21, 2016: Clinical Obstetrics and Gynecology
Joseph G Ouzounian
Shoulder dystocia complicates ∼1% of vaginal births. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part its occurrence remains largely unpredictable and unpreventable.
September 21, 2016: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
December 2016: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
December 2016: Clinical Obstetrics and Gynecology
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