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Clinical Obstetrics and Gynecology

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https://www.readbyqxmd.com/read/28221179/natural-orifice-transluminal-endoscopic-surgery-notes-in-gynecology
#1
Karl Jallad, Mark D Walters
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging field in minimally invasive surgery. NOTES can be performed via a variety of approaches, including through the stomach, esophagus, bladder, and rectum, but the majority of cases have been performed transvaginally. Potential advantages of natural orifice surgery in gynecology include the lack of abdominal incisions, less operative pain, shorter hospital stay, improved visibility, and the possibility to circumvent extensive lysis of adhesion to reach the pelvic cavity...
February 17, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28221178/non-neuraxial-labor-analgesia-options
#2
John C Markley, Mark D Rollins
Although it is the most effective method to treat labor pain, neuraxial analgesia may be undesired, contraindicated, unsuccessful, or unavailable. Providing safe choices for labor pain relief is a central goal of health care providers alike. Consequently, knowledge of the efficacy, clinical implementation, and side effects of various non-neuraxial strategies is needed to provide appropriate options for laboring patients. In addition to nonpharmacologic alternatives, inhaled nitrous oxide and systemic opioids represent two broad classes of non-neuraxial pharmacologic labor analgesia most commonly available...
February 17, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28169855/the-anesthesiologist-s-role-in-the-national-partnership-for-maternal-safety-s-hemorrhage-bundle-a-review-article
#3
Thea Rosenbaum, Jill M Mhyre
Obstetric hemorrhage can bring significant challenges to the obstetrician and anesthestiologist. Optimal management requires a systems-based multidisciplinary and intraprofessinal approach, and implementation leadership is now the cornerstone of successful hemorrhage management. The National Partnership for Maternal Safety recently released a patient safety bundle for maternal hemorrhage. The bundle lists 13 resources that should be implemented in every delivery unit in the country to optimize readiness, recognition, response, and reporting and systems learning for obstetric hemorrhage...
February 6, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121646/minimally-invasive-myomectomy
#4
Rebecca Flyckt, Kathryn Coyne, Tommaso Falcone
Uterine fibroids can significantly impact a woman's health, fertility, and quality of life. When medical therapy fails, surgery is recommended; the gold standard in uterine-sparing surgery is myomectomy. The evidence-based benefits of minimally invasive myomectomy are detailed in this manuscript. Minimally invasive myomectomy techniques are reviewed, including laparoscopic, robotic-assisted, and laparoscopic or robotic-assisted with mini-laparotomy. Criteria for minimally invasive myomectomy are outlined and preoperative planning is discussed...
January 24, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121645/finding-the-value-of-minimally-invasive-gynecologic-surgery
#5
James L Whiteside
Minimally invasive surgery is indistinctly defined and some cases possess clinical outcomes that are similarly indistinct or excessively costly. Seeking to clarify these issues will offer organized medicine an opportunity to deliver value-based health care. Context (patient, society, and clinician) is critical to finding that clarity, although the clinician context likely offers the best insights into how the ideal of high-value care may be incorporated into minimally invasive gynecologic surgery.
January 24, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121644/peripartum-management-of-obstructive-sleep-apnea
#6
Jessica L Booth, Ashley M Tonidandel
The prevalence of obstructive sleep apnea is unknown during pregnancy, but the syndrome is likely underdiagnosed and rising in frequency along with the obesity epidemic. Obstructive sleep apnea is associated with adverse outcomes, including hypertensive disorders of pregnancy, gestational diabetes, preterm, and cesarean delivery. Obese pregnant women should be screened and referred to a sleep medicine specialist for evaluation. Continuous positive airway pressure is the treatment of choice with demonstrated safety and compliance in pregnancy...
January 24, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28121643/peripartum-care-of-the-jehovah-s-witness-patient
#7
Efrain Riveros-Perez, Rachel Kacmar
Postpartum hemorrhage is a leading cause of maternal mortality. Jehovah's Witnesses (JWs) refuse allogeneic blood transfusion, and thus treatment of hemorrhagic complications in this patient population is complex. Recognition and respect for religious beliefs are essential when caring for the JW parturient and several ethical and legal considerations must be taken into account. Interdisciplinary teamwork and communication as well as active patient participation are critical in the decision-making process for JW patients...
January 24, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28098574/new-developments-in-robotics-and-single-site-gynecologic-surgery
#8
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
#9
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
#10
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
#11
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
#12
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/28059845/imaging-in-gynecology
#13
Elizabeth E Puscheck
No abstract text is available yet for this article.
January 4, 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28005592/ultrasound-in-assisted-reproductive-technologies-and-the-first-trimester-is-there-a-risk
#14
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
#15
Baha M Sibai
No abstract text is available yet for this article.
December 21, 2016: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28106645/foreword
#16
Baha M Sibai
No abstract text is available yet for this article.
March 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28106644/contributors-hypertensive-disorders-in-pregnancy
#17
(no author information available yet)
No abstract text is available yet for this article.
March 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28106643/imaging-and-the-infertility-evaluation
#18
Roohi Jeelani, Elizabeth E Puscheck
Ultrasound (US) has transformed the fertility evaluation. With 1 consultation, blood work and 1 to 2 USs, the female fertility status can be fully evaluated. The initial US is best done early in the follicular cycle to evaluate the pelvic anatomy and ovarian reserve. A three-dimensional US is important to evaluate for uterine anomalies and color Doppler for any masses. A mid-cycle saline infusion sonohysterogram assesses the endometrial cavity better than a hysterosalpingogram as it identifies the cause of any filling defects...
March 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28106642/imaging-in-endometriosis-and-adenomyosis
#19
Luis R Hoyos, Beryl Benacerraf, Elizabeth E Puscheck
Endometriosis and adenomyosis may be accurately diagnosed using ultrasound (US). Several findings are characteristic and various US modalities have been described. Recent development of 3-dimensional transvaginal US has resulted in a major advance in the evaluation of adenomyosis. Endometriotic manifestations can also be accurately evaluated with US, which is and should remain the first-line approach for the evaluation of these conditions. Obvious advantages over magnetic resonance imaging include its wide-availability, tolerability, less time-consumption, more accessible price and familiarity of gynecologists with its use...
March 2017: Clinical Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28106641/foreword
#20
Elizabeth E Puscheck
No abstract text is available yet for this article.
March 2017: Clinical Obstetrics and Gynecology
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