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Clinical Obstetrics and Gynecology

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https://www.readbyqxmd.com/read/28098574/new-developments-in-robotics-and-single-site-gynecologic-surgery
#1
Catherine A Matthews
Within the last 10 years there have been significant advances in minimal-access surgery. Although no emerging technology has demonstrated improved outcomes or fewer complications than standard laparoscopy, the introduction of the robotic surgical platform has significantly lowered abdominal hysterectomy rates. While operative time and cost were higher in robotic-assisted procedures when the technology was first introduced, newer studies demonstrate equivalent or improved robotic surgical efficiency with increased experience...
January 17, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28098575/obstetric-anesthesia-liability-concerns
#2
Joanna M Davies, Linda S Stephens
Obstetric practice carries a high risk of medical liability and involves both obstetricians and anesthesiologists. Analysis of data from the Anesthesia Closed Claims Project database shows an increase in the proportion of anesthesia claims for maternal death and brain damage between the 1990s and 2000 and later, primarily due to hemorrhage. The proportion of claims for newborn brain damage remained unchanged while those for maternal nerve injury and minor injuries decreased. Use of massive transfusion protocols and clinical drills have been shown to improve outcomes from hemorrhage...
January 16, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28098573/managing-maternal-sepsis-early-warning-criteria-to-ecmo
#3
Cesar Padilla, Arvind Palanisamy
Maternal sepsis is now a leading cause of direct maternal death during pregnancy. This review addresses the latest advances in the identification and management of critically ill parturients. Specifically, this review will focus on the vulnerability of pregnant women to sepsis, the utility of early warning criteria in the identification of the septic parturient, emphasize the immediate antibiotic management of suspected sepsis, and elaborate upon the latest understanding in the ventilatory management of parturients with sepsis...
January 16, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28079556/cardiac-arrest-obstetric-cpr-acls
#4
Benjamin Cobb, Steven Lipman
In contrast with other high-resource countries, maternal mortality has seen an increase in the United States. Caring for pregnant women in cardiac arrest may prove uniquely challenging given the rarity of the event coupled by the physiological changes of pregnancy. Optimization of resuscitative efforts warrants special attention as described in the 2015 American Heart Association's "Scientific Statement on Maternal Cardiac Arrest." Current recommendations address a variety of topics ranging from the basic components of chest compressions and airway management to some of the logistical complexities and operational challenges involved in maternal cardiac arrest...
January 10, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28079555/epidural-labor-analgesia-and-maternal-fever
#5
Emily E Sharpe, Katherine W Arendt
Women receiving an epidural for labor analgesia are at increased risk for intrapartum fever. This relationship has been supported by observational, before and after, and randomized controlled trials. The etiology is not well understood but is likely a result of noninfectious inflammation as studies have found women with fever have higher levels of inflammatory markers. Maternal pyrexia may change obstetric management and women are more likely to receive antibiotics or undergo cesarean delivery. Maternal pyrexia is associated with adverse neonatal outcomes...
January 10, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28059847/angiogenic-and-antiangiogenic-markers-for-prediction-and-risk-classification-of-preeclampsia
#6
Amol K Malshe, Baha M Sibai
Preeclampsia is a pregnancy-specific hypertensive disorder with multisystem involvement and is a significant cause of obstetric morbidity and mortality worldwide. A major issue in the treatment of preeclampsia stems from its still significant rates of misclassification and misdiagnosis. Angiogenic factors have been speculated as a possible diagnostic modality due to a perceived imbalance in angiogenesis in preeclampsia. Factors currently studied include soluble fms-like protein kinase 1 and placental growth factor...
January 4, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28059846/ultrasound-in-infertility-treatments
#7
Violet E Klenov, Bradley J VAN Voorhis
Ultrasound (US) is very useful in diagnosing causes of infertility. Pelvic masses, mullerian anomalies, ovarian reserve, and tubal patency can all be assessed using ultrasonographic techniques. US has also proven to be a very useful aid in managing infertility treatments. In this chapter, we review the uses of US in monitoring follicular development, assessing the endometrium during treatment, and as an aid to embryo transfer during in vitro fertilization.
January 4, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28059845/imaging-in-gynecology
#8
Elizabeth E Puscheck
No abstract text is available yet for this article.
January 4, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28059844/gynecologic-surgery-preoperative-assessment-with-ultrasound
#9
Laurel Stadtmauer, Akhil Shah
Ultrasonography, especially 3D, is essential in the diagnosis and preoperative evaluation of gynecologic surgeries and is important in surgical planning and counseling of patients. In addition, it is useful during hysteroscopic procedures, particularly difficult Asherman syndrome cases, resection of transverse vaginal septum, and treatment of hematometria. 3D ultrasound is especially helpful for fibroid mapping as the simultaneous visualization of the endometrium and myometrium with the coronal view is possible, it can be done by the gynecologist and at a lower cost than an magnetic resonance imaging...
January 4, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28059842/counseling-management-and-outcome-in-women-with-severe-preeclampsia-at-23-to-28-weeks-gestation
#10
Olaide A Ashimi Balogun, Baha M Sibai
Preeclampsia with severe features (SPE) remote from term remains a major cause of maternal morbidity and mortality worldwide. With increasing diagnosis of SPE remote from term and improved methods for monitoring maternal and fetal well-being, several challenges have been made regarding management of preeclampsia. We reviewed the scientific literature of the diagnosis and outcome of SPE before 28 weeks. On the basis of this review, we will present our recommendations on management of SPE before 28 weeks' gestation...
January 4, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005597/imaging-of-adnexal-masses
#11
Mili Thakur, Dirk Timmerman
We review and emphasize the importance of gynecologic ultrasound scan for the preoperative evaluation of adnexal masses. Transvaginal ultrasound performed by a trained clinician has a good sensitivity and specificity for discriminating benign and malignant adnexal masses. In conjunction with a carefully obtained history, assessment of risk factors, a focused physical examination and serum markers, the information obtained by a gynecologic ultrasound evaluation can assist the clinician in the diagnosis and treatment of adnexal masses...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005596/tubal-disease-and-impersonators-masqueraders
#12
Olivia R Khouri, Ana Monteagudo, Ilan E Timor-Tritsch
Ultrasound is considered the first-line imaging modality in the evaluation of the fallopian tubes. This chapter reviews both the physiologic and pathologic sonographic findings of the fallopian tubes and how to recognize characteristic entities. Specifically, it describes how to use ultrasound techniques to distinguish between pathologic processes including chronic versus acute pelvic inflammatory disease, as well as infertility, torsion, and malignancy. It also describes how to employ modern ultrasound techniques, such as color Doppler, three-dimensional imaging, and salpingocentesis in clinical practice...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005595/pelvic-floor-ultrasound-a-review
#13
Hans Peter Dietz
Female pelvic floor dysfunction encompasses a number of prevalent conditions and includes pelvic organ prolapse, urinary and fecal incontinence, obstructed defecation, and sexual dysfunction. In most cases neither etiology nor pathophysiology are well understood. Imaging has great potential to enhance both research and clinical management capabilities, and to date this potential is underutilized. Of the available techniques such as x-ray, computed tomography, magnetic resonance imaging, and ultrasound, the latter is generally superior for pelvic floor imaging, especially in the form of perineal or translabial imaging...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005594/controversies-regarding-diagnosis-and-treatment-of-severe-hypertension-in-pregnancy
#14
John R Barton, Baha M Sibai
The objective of management of severe hypertension in pregnancy is not for the return of normal blood pressure but rather reduction of blood pressure to a level associated with a decreased risk of end-organ damage including cerebral, cardiac, or renal dysfunction. The parenteral agents labetalol and hydralazine are currently the most widely recommended antihypertensive agents for acute reductions of elevated blood pressure related to preeclampsia. Overcorrection of blood pressure with any antihypertensive agent is possible resulting in reduced uteroplacental blood flow, but is more likely to be encountered in patients <32 weeks' gestation and in those whose fetuses have intrauterine growth retardation...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005593/the-normal-female-pelvis
#15
Michelle K Roach, Rochelle F Andreotti
This article provides an overview of ultrasonographic evaluation of the normal female pelvis. Pertinent pelvic anatomy is reviewed, and there is an in-depth discussion of the normal appearance of the uterus and ovaries. In addition, the indications and technique for performing 3-dimensional imaging and saline-infused sonohysterography are covered.
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005592/ultrasound-in-assisted-reproductive-technologies-and-the-first-trimester-is-there-a-risk
#16
Jacques S Abramowicz
Ultrasound is routinely used in assisted reproductive technology for monitoring of follicular growth, oocyte retrieval and embryo transfer, as well as for the assessment of early embryonic development in the first 5 to 8 weeks of pregnancy. Ultrasound is a form of energy, which will affect live tissues it traverses (bioeffects) by being partially transformed into heat (thermal effect) and by alternating positive and negative pressures (nonthermal or mechanical effect). In the United States 2 indices (thermal and mechanical index) must be displayed on-screen to provide the clinicians an indication of possible thermal and nonthermal changes...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005591/hypertension-in-pregnancy
#17
Baha M Sibai
No abstract text is available yet for this article.
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005590/low-molecular-weight-heparin-for-the-prevention-of-placenta-mediated-pregnancy-complications
#18
Bassam Haddad, Edouard Lecarpentier, Cyril Touboul, Baha M Sibai
During the past decade, prophylactic doses of low-molecular-weight heparin (LMWH) have been suggested to decrease the risk of placental-mediated complications. Herein, we review the prospective randomized trials that addressed the usefulness of LMWH in preventing placental-mediated complications in high-risk women. Inclusion criteria and results of these trials are heterogeneous. Unlike older trials (3 of 4 are single center), recent trials (all are multicenter) do not show beneficial effect of LMWH. There is certainly a need of complementary research before stating on the usefulness of LMWH in the prevention of placenta-mediated pregnancy complications in women at high risk...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005589/transvaginal-ultrasound-for-the-diagnosis-of-abnormal-uterine-bleeding
#19
Karen C Wheeler, Steven R Goldstein
Transvaginal ultrasound is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. Transvaginal ultrasound can be used to diagnose structural causes of abnormal bleeding such as polyps, adenomyosis, leiomyomas, hyperplasia, and malignancy, and can also be beneficial in making the diagnosis of ovulatory dysfunction. Traditional 2-dimensional imaging is often enhanced by the addition of 3-dimension imaging with coronal reconstruction and saline infusion sonohysterography...
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005588/chronic-hypertension-in-pregnancy-diagnosis-management-and-outcomes
#20
Nana-Ama E Ankumah, Baha M Sibai
Chronic hypertension affects up to 5% of pregnancies. Women can be stratified into low-risk or high-risk chronic hypertension based on baseline laboratory and diagnostic work-up, comorbid conditions, and outcomes in prior pregnancies. Pregnancies complicated by chronic hypertension are at risk for increased adverse maternal and neonatal outcomes including superimposed preeclampsia, fetal growth restriction, placental abruption, and perinatal death. Mainstays of management include blood pressure control, close monitoring for development of superimposed preeclampsia, serial ultrasound assessment of fetal growth, and antenatal testing after 32 weeks...
December 21, 2016: Clinical Obstetrics and Gynecology
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