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Clinical Obstetrics and Gynecology

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https://www.readbyqxmd.com/read/29781874/extended-use-of-systemic-menopausal-hormone-therapy
#1
Andrew M Kaunitz
Because clinical trial data assessing more than 10 years of hormone therapy (HT) use are not available, providing guidance to menopausal women regarding duration of systemic HT is controversial. However, clinicians routinely encounter this issue in practice. Using available evidence and clinical experience, this chapter provides guidance for clinicians who care for patients who may be candidates for extended use of systemic HT.
May 17, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29762148/menopausal-hormone-therapy-in-gynecologic-cancer-survivors-a-review-of-the-evidence-and-practice-recommendations
#2
Ekta Kapoor, Daniel Benrubi, Stephanie S Faubion
Gynecologic cancers are common in the United States and represent a significant health burden. Treatment of these cancers often causes premature cessation of ovarian function, with resultant symptoms that are often more severe than those associated with natural menopause. Hormone therapy is the most effective treatment for menopausal symptoms, but the decision-making process about its use can be complex for survivors of gynecologic cancer. In this review, we provide evidence-based recommendations about the use of hormone therapy after gynecologic cancer...
May 14, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29762147/managing-menopause-by-combining-evidence-with-clinical-judgment
#3
Chrisandra Shufelt, Joann Manson
In the United States, nearly 10 million women are currently in the menopause transition and 2.25 million women are 51 years of age, which is the average age of menopause. Approximately 75% of these women will experience vasomotor symptoms such as hot flashes and night sweats. Menopause hormone therapy (HT) remains the most effective treatment for menopausal symptoms, but the decision to use HT is complex and requires balancing the benefits and risks for the individual patient. The decision also requires clinical judgment and shared decision making with the patient...
May 14, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29750683/hormone-therapy-in-breast-cancer-survivors-and-those-at-high-risk-for-breast-cancer
#4
Robert L Reid
Women and health care providers are often fearful of using hormone therapy to deal with distressing menopausal symptoms in circumstances where there is a perceived or real increased risk of breast cancer. This paper examines the evidence for and against hormone therapy use in 3 common clinical situations: the woman with a positive family history in a first-degree relative, the woman who has undergone risk-reducing salpingo-oophorectomy due to a known genetic mutation, and the woman in whom treatment of breast cancer has induced premature menopause...
May 10, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29659372/consequences-of-antepartum-depression
#5
Jonathan Schaffir
To counsel women about risks and benefits of depression treatment during pregnancy, clinicians must appreciate the potential consequences of untreated depression on the mother and her unborn child. Many studies have demonstrated associations between untreated depression during pregnancy and a range of adverse outcomes, including low birth weight, preterm delivery, preeclampsia, emergent operative delivery, postpartum depression, and both cognitive and behavioral deficits in the child. Although most of these associations are marked by low odds ratios and a host of potential confounding issues, they collectively provide considerable rationale for identifying depression in pregnancy and offering treatment for mothers at risk...
April 13, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29642083/severe-maternal-or-near-miss-morbidity-implications-for-public-health-surveillance-and-clinical-audit
#6
Elena V Kuklina, David A Goodman
This chapter reviews the historical development of indicators to identify severe maternal morbidity/maternal near miss (SMM/MNM), and their use for public health surveillance, research, and clinical audit. While there has been progress toward identifying standard definitions for SMM/MNM within countries, there remain inconsistencies in the definition of SMM/MNM indicators and their application between countries. Using these indicators to screen for events that then trigger a clinical audit may both under identify select SMM/MNM (false negative)and over identify select SMM/MNM (false positive)...
April 10, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29629924/thrombosis-in-obstetrics-and-gynecology
#7
Andra H James
No abstract text is available yet for this article.
April 6, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29596076/predictors-of-postpartum-depression-a-comprehensive-review-of-the-last-decade-of-evidence
#8
Jerry Guintivano, Tracy Manuck, Samantha Meltzer-Brody
Postpartum depression (PPD) is one of the most frequent complications of childbirth affecting ~500,000 women annually (prevalence 10% to 15%). Despite the documented adverse outcomes for mother and child, there remains a great need to develop prospective approaches to identify women at risk. This review examines some of the best-characterized molecular and clinical risk factors for PPD. We illustrate that this is a growing literature but there remains a lack of reliable molecular predictors for PPD. Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for increased depression screening across the perinatal period...
March 28, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29596075/managing-heavy-menstrual-bleeding-in-women-at-risk-of-thrombosis
#9
Andrew Rivara, Andra H James
Management of heavy menstrual bleeding (HMB) in a woman with a history of thrombosis, or who is otherwise at high risk of thrombosis, or who takes medications for anticoagulation can present a challenge to health care providers. The goal of treating HMB is to reduce menstrual blood loss. First-line therapy is typically hormonal, and hormonal therapy can be contraindicated in women with a history of thrombosis unless they are on anticoagulation. As 70% of women on anticoagulation experience HMB, successful management of HMB may involve a modification in the anticoagulation or antiplatelet regimen, hormonal therapy tailored to the patient's situation, and/or surgical therapy...
March 28, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29596074/psychological-impact-of-pregnancy-loss-best-practice-for-obstetric-providers
#10
Deborah Rich
Three overlapping areas of study form the foundation of the psychological impact of pregnancy loss: (1) transition to parenthood and the development of attachment, (2) perinatal mental health disorders, and (3) complicated grief. This article integrates findings from prominent lineages of theory to offer the obstetric provider an evidence-based framework for patient care. Current consensus across fields of study is that preexisting depression and anxiety are the strongest predictors of psychological functioning after loss and through the subsequent pregnancy...
March 28, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29561285/maternal-mortality-in-the-united-states-a-review-of-contemporary-data-and-their-limitations
#11
Andreea A Creanga
This article provides a review of maternal mortality data and their limitations in the United States. National maternal mortality data, which rely heavily on vital statistics, document that the risk of death from pregnancy-related causes has not declined for >25 years and that striking racial disparities persist. State-based maternal mortality reviews, functional in many states, obtain detailed information on medical and nonmedical factors contributing to maternal deaths. Without this detailed knowledge from state-level data and without addressing recognized quality problems with vital statistics data at the national-level, we will have difficulty understanding maternal death trends and preventing future such deaths...
March 20, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29561284/pharmacotherapy-for-perinatal-depression
#12
Shari I Lusskin, Sabrina J Khan, Carrie Ernst, Sally Habib, Madeleine E Fersh, Elizabeth S Albertini
Perinatal depression is associated with serious risks for the mother, baby, and family. When considering treating perinatal depression with a drug indicated for the treatment of depression, the major concerns are whether the drug increases the risks of teratogenicity, pregnancy complications, poor neonatal adaptation, or neurodevelopmental disorders. Although different studies have produced different results, the majority have not shown increases in risk for selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, or the noradrenergic/dopaminergic drug bupropion...
March 20, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29553986/a-systematic-review-of-integrated-care-interventions-addressing-perinatal-depression-care-in-ambulatory-obstetric-care-settings
#13
Tiffany A Moore Simas, Michael P Flynn, Aimee R Kroll-Desrosiers, Stephanie M Carvalho, Leonard L Levin, Kathleen Biebel, Nancy Byatt
This systematic review searched 4 databases (PubMed/MEDLINE, Scopus, CINAHL, and PsychINFO) and identified 21 articles eligible to evaluate the extent to which interventions that integrate depression care into outpatient obstetric practice are feasible, effective, acceptable, and sustainable. Despite limitations among the available studies including marked heterogeneity, there is evidence supporting feasibility, effectiveness, and acceptability. In general, this is an emerging field with promise that requires additional research...
March 16, 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29688936/foreword-maternal-mortality-and-severe-maternal-morbidity
#14
William M Callaghan
No abstract text is available yet for this article.
June 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29688935/contributors-maternal-mortality-and-severe-maternal-morbidity
#15
(no author information available yet)
No abstract text is available yet for this article.
June 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29688934/perioperative-management-of-the-gynecologic-patient-on-long-term-anticoagulation
#16
Ammon M Fager, Elizabeth Deans, Andra H James
The perioperative management of patients taking antithrombotic or antiplatelet medications is based on an assessment of the individual patient's risk for thrombosis or bleeding, the specific medication involved, and the nature of the planned procedure. This article describes specific strategies for whether and how these medications should be interrupted before gynecologic procedures, when they can be restarted following the procedure, and whether bridging therapy should be considered.
June 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29688933/radiologic-aspects-of-the-diagnosis-of-pulmonary-embolism-in-pregnancy
#17
Benjamin S Harris, Katherine C Bishop, Jeffrey A Kuller
Pulmonary embolism in pregnancy is a leading cause of maternal mortality. The clinical presentation is often nonspecific, making imaging essential for accurate diagnosis. After reviewing the literature on the radiologic diagnosis of pulmonary embolism in pregnancy, we concluded that both computed tomography pulmonary angiography and lung perfusion scintigraphy are sensitive with high positive predictive values in the presence of high clinical suspicion, but lung perfusion scintigraphy is recommended given lower maternal breast exposure to ionizing radiation and lower fetal contrast exposure...
June 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29688932/foreword-the-prevention-and-management-of-thrombosis-in-obstetrics-and-gynecology
#18
Andra H James
No abstract text is available yet for this article.
June 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29688931/contributors-the-prevention-and-management-of-thrombosis-in-obstetrics-and-gynecology
#19
(no author information available yet)
No abstract text is available yet for this article.
June 2018: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29629925/reducing-maternal-mortality-and-severe-maternal-morbidity-the-role-of-critical-care
#20
Amir A Shamshirsaz, Gary A Dildy
Throughout most of the 20th century, the risk of maternal mortality in high resource countries decreased dramatically; however, this trend recently has stalled in the United States and appears to have reversed. Equally alarming is that for every reported maternal death, there are numerous severe maternal morbidities or near misses. Shifting maternal demographics (eg, obesity, advanced maternal age, multifetal pregnancies), with attendant significant medical comorbidities (eg, hypertension, diabetes, cardiac disease) and the increase in cesarean deliveries significantly contribute to increased maternal morbidity and mortality...
June 2018: Clinical Obstetrics and Gynecology
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