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15 papers 0 to 25 followers
By German Garcia Academic and clínical physician
Colleen K Stockdale, Lori Boardman
Vulvar symptoms of pain, dyspareunia, and pruritus are common and may significantly affect a woman's sense of well-being and sexual function. Despite this, vulvar symptoms are often underreported by women. When identified, however, vulvovaginal symptoms should be addressed by health care providers to optimize care. The evaluation of patients with vulvovaginal complaints begins with a thorough history and physical examination. Biopsy is indicated when concern exists for malignancy or the diagnosis is uncertain...
February 2018: Obstetrics and Gynecology
Sukhbir S Singh, Liane Belland, Nicholas Leyland, Sarah von Riedemann, Ally Murji
Uterine fibroids (UF) are common in women of reproductive age and can have a significant impact on quality of life and fertility. Although a number of international OB/GYN societies have issued evidence-based clinical practice guidelines for the management of symptomatic UF, many of these guidelines do not yet reflect the most recent clinical evidence and approved indication for one of the key medical management options: the selective progesterone receptor modulator (SPRM) class. This paper aims to share the clinical experience gained with SPRMs in Europe and Canada by reviewing the historical development of SPRMs, current best practices for SPRM use based on available data, and potential future uses for SPRMs in UF and other gynecologic conditions...
December 21, 2017: American Journal of Obstetrics and Gynecology
Roy Mashiach, Yael Inbar, Jaron Rabinovici, Aya Mohr Sasson, Aviva Alagem-Mizrachi, Ronit Machtinger
OBJECTIVE: Intracavitary uterine fibroids and fibroids that distort the uterine cavity are associated with excessive vaginal bleeding and infertility. While intracavitary fibroids smaller than 4 cm are usually treated safely by operative hysteroscopy, larger fibroids may require multiple surgeries or more extensive surgery with possible damage to the integrity of the uterine wall. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a noninvasive approach for treating uterine fibroids, mainly the intramural type...
February 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Richard Guido
Cervical cancer screening has significantly reduced the incidence of cervical cancer in the United States. National recommendations have evolved to keep pace with advancement in our understanding of human papilloma virus (HPV) biology as well as improvements in HPV testing. This chapter summarizes present national screening guidelines, reviews information regarding recent development in HPV biology and testing, discusses some of the controversies related to screening and provides clinicians with talking points for their patients...
December 15, 2017: Clinical Obstetrics and Gynecology
(no author information available yet)
Metformin alone compared with placebo increases the ovulation rate in women with polycystic ovary syndrome (PCOS) but should not be used as first-line therapy for anovulation because oral ovulation induction agents such as clomiphene citrate (CC) or letrozole alone are much more effective in increasing ovulation, pregnancy, and live-birth rates in women with PCOS. There is fair evidence that metformin alone does not increase rates of miscarriage when stopped at the initiation of pregnancy and insufficient evidence that metformin in combination with other agents used to induce ovulation increases live-birth rates...
August 10, 2017: Fertility and Sterility
Sigurd Beier Sloth, Jeppe Bennekou Schroll, Annette Settnes, Helga Gimbel, Martin Rudnicki, Märta Fink Topsoee, Annemette Joergensen, Helene Nortvig, Charlotte Moeller
Hysterectomy for benign gynecological conditions is a common operation that has developed extensively through the last 20 years. Methods and surgical techniques vary throughout the regions in Denmark as well as internationally. Consequently, the Danish Health Authority initiated a national clinical guideline on the subject based on a systematic review of the literature. A guideline panel of seven gynecologists formulated the clinical questions for the guideline. A search specialist performed the comprehensive literature search...
September 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Mary L Brandt
Surgery is a demanding career with great rewards and equally great challenges. In order to sustain our careers as well as the careers of our colleagues, it is important to understand and address the physical, psychological and spiritual challenges of surgery. With rare exception, the majority of surgery residents and practicing surgeons who prematurely leave surgery do so because they find the work to be physically, emotionally or spiritually incompatible with the vision they have for their life. Understanding these issues and providing solutions to improve surgeon wellness can help prevent societal loss of these highly trained professionals and suffering for surgeons and their families...
October 2017: American Journal of Surgery
Lindsey N Valentine, Linda D Bradley
Operative hysteroscopy is a safe and effective minimally invasive treatment option for submucosal and intramural leiomyomas. We discuss preoperative evaluation, fluid management, postoperative complications, preventative measures, and hysteroscopic outcomes. Technical instructions and tips for successful hysteroscopy, as well as the various equipment options most commonly utilized in the United States, are also reviewed.
June 2017: Clinical Obstetrics and Gynecology
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...
June 2017: Clinical Obstetrics and Gynecology
M Soop, G L Carlson
BACKGROUND: Current guidance on the management of sepsis often applies to infection originating from abdominal or pelvic sources, which presents specific challenges and opportunities for efficient and rapid source control. Advances made in the past decade are presented in this article. METHODS: A qualitative systematic review was undertaken by searching standard literature databases for English-language studies presenting original data on the clinical management of abdominal and pelvic complex infection in adults over the past 10 years...
January 2017: British Journal of Surgery
Caroline E Jones, Robert H Hollis, Allison A Gullick, Tyler Wahl, Joshua S Richman, Laura A Graham, Adam T Lucy, Daniel I Chu, Melanie S Morris
BACKGROUND: We evaluated postoperative venous thromboembolism (VTE) chemical prophylaxis adherence to assess the preventability of VTEs. METHODS: A case-control study was performed using the 2011-2015 ACS-NSQIP single institution database. Cases were identified as patients who experienced postoperative VTE within 30 days following surgery. Controls were matched 2:1 on procedure, age, and BMI. Association between inpatient chemical prophylaxis adherence and postoperative VTE was evaluated with conditional logistic regression...
April 2017: American Journal of Surgery
Jamie Stanhiser, Kevin Chagin, J Eric Jelovsek
BACKGROUND: A model that predicts a patient's risk of receiving a blood transfusion may facilitate selective preoperative testing and more efficient perioperative blood management utilization. OBJECTIVE: We sought to construct and validate a model that predicts a patient's risk of receiving a blood transfusion after gynecologic surgery. STUDY DESIGN: In all, 18,319 women who underwent gynecologic surgery at 10 institutions in a single health system by 116 surgeons from January 2010 through June 2014 were analyzed...
May 2017: American Journal of Obstetrics and Gynecology
M G Munro, Hod Critchley, I S Fraser
No abstract text is available yet for this article.
January 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Pahh van der Heijden, Pmaj Geomini, M C Herman, S Veersema, M Y Bongers
OBJECTIVE: The objective was to assess whether patient-perceived pain during the insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS) depends on the timing during the menstrual cycle. DESIGN: A stratified two-armed non-inferiority randomised controlled trial. SETTING: Large teaching hospital in Veldhoven, the Netherlands. SAMPLE: From October 2013 to May 2014, 60 nulliparous and 60 multiparous women were randomised...
January 2017: BJOG: An International Journal of Obstetrics and Gynaecology
Gregory M Gressel, Vinita Parkash, Lubna Pal
BACKGROUND: Definitive management with hysterectomy could be appropriate for some patients with endometrial cancer and its precursor lesions, but poses challenges for those desiring future fertility. OBJECTIVES: To review risk factors for endometrial hyperplasia/cancer among premenopausal women and discuss management options for fertility preservation. SEARCH STRATEGY: A literature search through the PubMed, Ovid, and Cochrane databases was conducted using the terms "endometrial hyperplasia" and "endometrial cancer," cross-referenced with "fertility preservation...
December 2015: International Journal of Gynaecology and Obstetrics
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