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Current Opinion in Obstetrics & Gynecology

Reshama Navathe, Vincenzo Berghella
PURPOSE OF REVIEW: Tocolytic agents have been used for over 60 years in the fight against preterm labor, which ultimately can lead to preterm birth. Currently, clinicians can choose from a variety of drug classes to achieve the primary goal of delaying delivery by 48 h, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. However, there are currently no known therapies to maintain the tocolytic effect beyond those initial 48 h...
October 18, 2016: Current Opinion in Obstetrics & Gynecology
Rosemary Townsend, Asma Khalil
PURPOSE OF REVIEW: Selective intrauterine growth restriction (sIUGR) in twin pregnancies presents a complex management problem for the fetal medicine specialist. This review summarizes what is currently known about sIUGR pathophysiology, particularly in monochorionic pregnancies and looks at the results of early trials of fetal intervention in high-risk sIUGR pregnancies. RECENT FINDINGS: sIUGR in monochorionic pregnancies is due to unequal placental sharing, but the clinical outcome is determined by the characteristics of the placental vascular anastomoses...
October 15, 2016: Current Opinion in Obstetrics & Gynecology
Bassel H Al Wattar, Bronacha Mylrea-Lowndes, Catrin Morgan, Amanda P Moore, Shakila Thangaratinam
PURPOSE OF REVIEW: Accurate assessment of dietary intake in interventional trials is the key to evaluate changes in dietary behaviour and compliance. We evaluated the use of dietary assessment tools in randomized trials on diet-based interventions in pregnancy by a systematic review. RECENT FINDINGS: We updated our previous search (until January 2012) on trials of diet and lifestyle interventions in pregnancy using Medline and EMBASE up to December 2015. Two independent reviewers undertook study selection and data extraction...
October 15, 2016: Current Opinion in Obstetrics & Gynecology
Renaud de Tayrac, Vincent Letouzey
PURPOSE OF REVIEW: Over the past 20 years, several randomized studies have compared Valsalva and spontaneous pushing techniques during vaginal delivery. This review summarizes current medical knowledge concerning their maternal and fetal consequences, focusing on pelvic and perineal outcomes. RECENT FINDINGS: We selected nine randomized controlled trials comparing Valsalva and spontaneous pushing, and a secondary analysis of a randomized controlled trial comparing different methods of perineal protection...
October 5, 2016: Current Opinion in Obstetrics & Gynecology
Kate A Shaw, Klaira Lerma
PURPOSE OF REVIEW: To review the recent literature on surgical second-trimester abortion, with specific attention to cervical preparation techniques. RECENT FINDINGS: Confirming previous studies, a recent retrospective observational cohort study, including 54 911 abortions, estimated the total abortion-related complication rate to be 0.41% for second-trimester or later procedures. Cervical preparation is known to reduce risks associated with second-trimester dilation and evacuation (D&E)...
September 28, 2016: Current Opinion in Obstetrics & Gynecology
Wing Kay Fok, Paul D Blumenthal
PURPOSE OF REVIEW: Emergency contraception provides a critical and time-sensitive opportunity for women to prevent undesired pregnancy after intercourse. Both access and available options for emergency contraception have changed over the last several years. RECENT FINDINGS: Emergency contraceptive pills can be less effective in obese women. The maximum achieved serum concentration of levonorgestrel (LNG) is lower in obese women than women of normal BMI, and doubling the dose of LNG (3 mg) increases its concentration maximum, approximating the level in normal BMI women receiving one dose of LNG...
September 24, 2016: Current Opinion in Obstetrics & Gynecology
Sevan A Vahanian, Anthony M Vintzileos
PURPOSE OF REVIEW: Placental implantation abnormalities (PIAs) comprise a large group of disorders associated with significant maternal, fetal, and neonatal morbidity. RECENT FINDINGS: Risk factors include prior uterine surgery/myometrial scarring and the presence of placenta previa with or without prior cesarean delivery. Newly identified risk factors include previous prelabor cesarean delivery and previous postpartum hemorrhage. PIAs contribute substantially to preterm birth with prematurity rates ranging from 38 to 82%...
September 21, 2016: Current Opinion in Obstetrics & Gynecology
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No abstract text is available yet for this article.
October 2016: Current Opinion in Obstetrics & Gynecology
Arnaud Wattiez, Razan Nasir, Basma Al Maamari, Larissa Schindler
PURPOSE OF REVIEW: Recommendations for the surgical treatment of pelvic organ prolapse have undergone significant changes over the last few decades.First described to be too difficult, the laparoscopic technique has gained popularity but is still controversial. The recent warning on vaginal mesh was the sign of revival and we start now to have many articles published on results and on techniques for laparoscopic prolapse repair. RECENT FINDINGS: If nothing is new in the comparison of the routes including vaginal mesh placement, the new articles are very interesting in terms of technical information and recommendations...
October 2016: Current Opinion in Obstetrics & Gynecology
Erin H Sieke, Ellen S Rome
PURPOSE OF REVIEW: The purpose of this review is to discuss the diagnosis, medical complications, and treatment of eating disorders as defined by the newly released Diagnostic and Statistical Manual, 5th edition. RECENT FINDINGS: With the introduction of the Diagnostic and Statistical Manual, 5th edition, the diagnostic criteria for anorexia nervosa and bulimia nervosa have been revised to better capture the varied presentations of patients with eating disorders...
October 2016: Current Opinion in Obstetrics & Gynecology
Rui Liang, Katrina Knight, Steve Abramowitch, Pamela A Moalli
PURPOSE OF REVIEW: Polypropylene mesh has been widely used in the surgical repair of pelvic organ prolapse. However, low but persistent rates of complications related to mesh, most commonly mesh exposure and pain, have hampered its use. Complications are higher following transvaginal implantation prompting the Food and Drug Administration to release two public health notifications warning of complications associated with transvaginal mesh use (PHN 2008 and 2011) and to upclassify transvaginal prolapse meshes from Class II to Class III devices...
October 2016: Current Opinion in Obstetrics & Gynecology
Samantha E Vilano, Cynthia L Robbins
PURPOSE OF REVIEW: The purpose of this article is to provide an update for the GP on selected common vulvar concerns in prepubertal girls. Presentation, diagnostic criteria, and management of common vulvar conditions will be described. The following conditions are frequently encountered and may pose diagnostic or management challenges if unrecognized. RECENT FINDINGS: The article is a review of current literature on pediatric vulvar conditions and was conducted through searching PubMed and published books on this topic...
October 2016: Current Opinion in Obstetrics & Gynecology
Cheryl B Iglesia
PURPOSE OF REVIEW: The purpose of this review is to describe new terminology for vulvovaginal atrophy and female sexual dysfunction and to highlight recent findings related to vaginal moisturizers, lubricants and prescription estrogen preparations. RECENT FINDINGS: Sexual health is a marker for overall health. A minority (40%) of healthcare providers routinely ask about sexual problems and its impact on quality of life. New terminology by the American Psychiatric Association divides female sexual disorders into three categories: arousal/interest disorder, orgasmic disorder and genital pain and penetration disorder...
October 2016: Current Opinion in Obstetrics & Gynecology
John O L DeLancey
PURPOSE OF REVIEW: Provide an evidence-based review of pelvic floor functional anatomy related to pelvic organ prolapse. RECENT FINDINGS: Pelvic organ support depends on interactions between the levator ani muscle and pelvic connective tissues. Muscle failure exposes the vaginal wall to a pressure differential producing abnormal tension on the attachments of the pelvic organs to the pelvic sidewall. Birth-induced injury to the pubococcygeal portion of the levator ani muscle is seen in 55% of women with prolapse and 16% of women with normal support...
October 2016: Current Opinion in Obstetrics & Gynecology
John E Jelovsek
PURPOSE OF REVIEW: Many women choosing to have surgery for pelvic organ prolapse also choose to undergo continence surgery. This review focuses on available evidence that clinicians may use to counsel patients when choosing whether to perform continence surgery and how predictive analytic tools improve this decision-making process. RECENT FINDINGS: Midurethral sling, Burch cystourethropexy and bladder neck sling are highly effective for the surgical treatment of stress urinary incontinence...
October 2016: Current Opinion in Obstetrics & Gynecology
Robert E Gutman
PURPOSE OF REVIEW: Owing to growing interest in uterine preservation, this evidence-based review compares hysteropexy with hysterectomy during surgery for uterovaginal prolapse. RECENT FINDINGS: LeFort colpocleisis is preferred over vaginal hysterectomy and total colpocleisis. The majority of studies show no differences in outcomes comparing sacrospinous hysteropexy with vaginal hysterectomy native tissue prolapse repair except for a single randomized controlled trial showing increased apical recurrences with advanced prolapse...
October 2016: Current Opinion in Obstetrics & Gynecology
Eduardo Lara-Torre
No abstract text is available yet for this article.
October 2016: Current Opinion in Obstetrics & Gynecology
Anne-Marie Amies Oelschlager, Katherine Debiec, Heather Appelbaum
PURPOSE OF REVIEW: Primary vaginal dilation is patient controlled, safe, less painful, and much lower cost compared with operative vaginoplasty and is considered first-line treatment for vaginal agenesis for women with Mayer-Rokitansky-Küster-Hauser syndrome and androgen insensitivity syndrome. RECENT FINDINGS: This review will highlight studies that assess the optimal methods of primary vaginal dilation and clarify ideal counseling, frequency of dilation, management of side-effects, and long-term physical and psychological outcomes...
October 2016: Current Opinion in Obstetrics & Gynecology
Rebekah L Williams, Julia F Taylor
PURPOSE OF REVIEW: Best practices in adolescent care require the ability to provide confidential services, particularly for reproductive health care. As systems implement electronic health records and patients use health portals to access information and communicate with their healthcare team, special attention should be paid to protection of adolescent confidentiality in the electronic environment. RECENT FINDINGS: Professional organizations have issued guidance for electronic health records and portal use, but implementation has varied widely between systems, with multiple risks for breaches of confidentiality...
October 2016: Current Opinion in Obstetrics & Gynecology
Gylynthia E Trotman
PURPOSE OF REVIEW: The purpose is to review current recommendations for the evaluation and management of delayed puberty in the female patient. RECENT FINDINGS: Kisspeptin activation has emerged as an important factor for initiation of pubertal development. Causes of delayed puberty can be considered in four main categories: constitutional delay of growth and puberty, hypergonadotropic hypogonadism, permanent hypogonadotropic hypogonadism, and transient/functional hypogonadism...
October 2016: Current Opinion in Obstetrics & Gynecology
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