Reviews in Obstetrics and Gynecology

This review discusses in detail robotic tubal reanastomosis as one of the classic reproductive surgery procedures. Other applications of robotics in adnexal surgery are also reviewed, including adult and pediatric adnexectomy, resection of endometriosis, benign ovarian mass resection, early ovarian cancer resection and staging, ovarian transposition, and treatment of ovarian remnant syndrome and ovarian vein syndrome.

Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a significant and growing problem in both the United States and the larger global community. The costs to society include the degradation of human and women's rights, poor public health, disrupted communities, and diminished social development. Victims of sex trafficking acquire adverse physical and psychological health conditions and social disadvantages. Thus, sex trafficking is a critical health issue with broader social implications that requires both medical and legal attention...

Fetomaternal alloimmune thrombocytopenia (FMAIT) is a relatively uncommon disease, but is the leading cause of severe thrombocytopenia in the newborn. It can cause severe complications and long-term disabilities. The main objective of screening is to reduce both the morbidity and mortality associated with FMAIT, primarily by preventing intracranial hemorrhage. However, controversy surrounds both pre- and antenatal management. This article discusses pathogenesis, screening, diagnosis, and both pre- and neonatal management of FMAIT...

In addition to causing developmental disability in future offspring, fragile X carrier status has important reproductive and mental health implications for the individual being tested. Accordingly, prenatal carrier screening and diagnosis using DNA-based molecular methods has become crucial in early detection, intervention, and family planning. Although the list of known genetic disorders is growing daily, controversy remains over who should be tested for fragile X. FMR1 gene mutations can result in inherited intellectual disability, infertility, and neurodegeneration syndromes that are encountered by clinicians in a variety of settings...

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Nitrous oxide (N2O) is a commonly used labor analgesic in many Western countries, but is used infrequently in the United States. The University of California at San Francisco has been offering N2O for labor analgesia for more than 30 years. Vanderbilt University Medical Center recently began offering N2O as an option for pain relief in laboring women. Many women report that N2O provides effective pain relief during labor and argue that it should be made more widely available in the United States. This article discusses the use of N2O for pain management during labor, including its history, properties, clinical indications, and use and environmental safety issues...

Pregnancy success is determined by a complex progress that includes trophoblast invasion and placentation. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are metal-dependent endopeptidases capable of degrading extracellular matrix, and appear to play a critical role in trophoblast invasion. This article reviews in detail the role of MMPs, TIMPs, and their regulators in the mechanism of trophoblast invasion in early human pregnancy.

The doctrine of informed refusal may become difficult to adhere to in obstetric practice, especially in situations in which the fetus's life is at risk. One rare yet potentially problematic situation of informed refusal is the case of a pregnant woman who refuses to undergo a medically indicated cesarean delivery that would ensure the well-being of her fetus. Although some would argue that patient autonomy takes precedence and the woman's informed refusal should be respected, others would argue that beneficence, justice, and doing no harm to the viable fetus should ethically overrule the refusal of a surgery...

Cervical shortening is believed to be a marker for generalized intrauterine inflammation and has a strong association with spontaneous preterm birth. A variety of therapies, including vaginal and intramuscular progesterone, pessary, and cerclage, have been demonstrated to be effective in specific clinical circumstances. Cervical cerclage can be placed via transvaginal, open transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy. A laparoscopic approach may be superior to the transabdominal approach in terms of surgical outcomes, cost, and postoperative morbidity...

Fetal heart rate monitoring is the most common obstetric procedure, and yet it remains a frustrating technology, plagued by false-positive results and miscommunication between providers. A new generation of invasive and noninvasive monitoring technologies is under development and entering the clinic, including the STAN monitor (Neoventa Medical, Mölndal, Sweden), which improves monitoring accuracy by incorporating a proxy of the fetal ST-segment. New noninvasive fetal electrocardiography and uterine contraction monitoring technologies will bring novel metrics and potentially improved safety to obstetrics in coming years...

Electronic fetal monitoring (EFM) has been used for four decades, after its introduction without clinical trials. EFM spawned a birth injury litigation crisis centered on the myth that it predicts cerebral palsy (CP). The myth has resulted in lottery-like judgments against physicians. The American Congress of Obstetricians and Gynecologists (ACOG) and sister organizations worldwide have the power to halt EFM's clinical proliferation and the undeserved litigation verdicts against physicians unjustly blamed for causing CP...

Tetanus is an acute disease manifested by motor system and autonomic nervous system instability. Maternal and neonatal tetanus occur where deliveries are performed under unsanitary circumstances and unhygienic umbilical cord practices are prevalent. Neonatal tetanus is almost always fatal in the absence of medical care. These deaths can be prevented with changes in traditional obstetrical practices and maternal immunization. This situation led to the development of the Maternal and Neonatal Elimination Initiative by the World Health Organization...

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