Clinical Obstetrics and Gynecology

Tahmina Karimyar, Leonardo Pereira
This chapter reviews issues which complicate surgery in obese pregnant patients. Maternal obesity is prevalent in the United States and is associated with numerous adverse health outcomes. When surgery is indicated during pregnancy, the presence of maternal obesity increases surgical risks for both the fetus and mother. Specific risks are identified and strategies to avoid them are evaluated. The prognosis and management of pregnant women who have undergone bariatric surgery is also discussed, and practical guidelines for obstetric management of these patients are presented...
March 27, 2020: Clinical Obstetrics and Gynecology
Mauricio Vasco, Catalina M Valencia G
Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis...
March 20, 2020: Clinical Obstetrics and Gynecology
Lubna Chohan, J Biba Nijjar
If it is medically necessary to perform nonobstetrical abdominal surgery in pregnancy, a minimally invasive approach should be considered. The benefits of laparoscopy are well known and current studies promote the safety of laparoscopy in pregnancy, when certain guidelines are followed. This article will review the safety of surgery in pregnancy, maternal physiology, fetal considerations, maternal obesity, laparoscopic cerclage, large adnexal mass, and complications. Guidelines for surgery will be reviewed as well...
March 18, 2020: Clinical Obstetrics and Gynecology
Rebekah J McCURDY
Necessary nonobstetric surgical procedures should not be withheld from pregnant women for fear of risks to the women and their pregnancies; however, careful preoperative planning should be undertaken to mitigate risks that may be present. Fetal monitoring recommendations will be dependent on the woman's preferences, gestational age of the pregnancy, and situational-specific risks (including anticipated risk of cardiovascular instability). Some fetal heart rate changes (lower baseline, less variability) can be anticipated, depending on anesthetic agents utilized during the procedure, and should not routinely prompt delivery...
March 18, 2020: Clinical Obstetrics and Gynecology
Mauricio LA Rosa, Sara Loaiza, Maria A Zambrano, MarĂ­a F Escobar
One of the most common causes of obstetric morbidity and mortality is trauma in pregnancy. Several maternal physiological changes during pregnancy have a significant impact on the mechanism, presentation, and management of trauma in this population. It is crucial for health providers dealing with trauma to know and understand these differences between pregnant and nonpregnant patients. The obstetric trauma patient requires a multidisciplinary approach, including obstetrics, maternal fetal medicine, anesthesiology, surgery, and intensive care teams...
March 18, 2020: Clinical Obstetrics and Gynecology
Michael S Weinstein, Solomon Feuerwerker, Jason K Baxter
Up to 2% of pregnant women develop a disease that requires nonobstetrical operative intervention during pregnancy. We discuss the issues unique to pregnant patients as they pertain to the presentation, diagnosis, and management of nonobstetric surgical disease, with an emphasis on 2 of the most common diseases that affect pregnant women: appendicitis and cholecystitis. Surgery has been demonstrated to be safe and effective during pregnancy, provided proper precautions are taken into account. It is the consensus of multiple professional committees and societies that no pregnant women should be delayed or denied a necessary surgery because of pregnancy...
March 16, 2020: Clinical Obstetrics and Gynecology
Erin McMinn, Nadav Schwartz
With the increased use and quality of ultrasound in pregnancy, adnexal masses are being encountered with greater frequency. Fortunately, the vast majority of such masses are benign and resolve on their own. However, it is important for clinicians to be familiar with the types of adnexal masses that may be visualized in pregnancy to best counsel these women. In addition, complications such as ovarian torsion, and rarely, even malignancy can occur. In this article, we review the available literature on this subject to help guide the clinician in the diagnosis and management of adnexal masses in pregnancy...
March 11, 2020: Clinical Obstetrics and Gynecology
Mary C Tolcher, Steven L Clark
A surgical disease occurring during pregnancy can present a diagnostic dilemma due to the desire to make a timely and accurate diagnosis within the constraints of limiting radiation exposure to the fetus. However, required diagnostic imaging should be pursued when indicated and attempts made to minimize the radiation dose by utilizing abdominal shielding and low-dose protocols when feasible. When surgery is indicated due to disease processes, treatment should not be altered or delayed due to pregnancy as the evidence for adverse pregnancy outcomes including early pregnancy loss and preterm delivery are overall of low quality due to substantial confounding by the disease process itself...
March 11, 2020: Clinical Obstetrics and Gynecology
Carolyn W Swenson
No abstract text is available yet for this article.
February 25, 2020: Clinical Obstetrics and Gynecology
Lina Michala
Genital dissatisfaction in healthy young women is on the rise. Pubic hair removal reveals genital tissue previously hidden, while social trends promote the absence of any protruding genital tissue as the feminine ideal. Information with regard to the natural diversity of external genitalia anatomy, and lifestyle changes to improve physical symptoms related to labial tissue may suffice to reassure a distressed adolescent. Female genital cosmetic surgery is rarely supported, before attaining genital maturity...
February 5, 2020: Clinical Obstetrics and Gynecology
Jason D Wright
Studies over the past decade have clearly demonstrated an association between high surgeon and hospital volume and improved outcomes for women undergoing gynecologic surgical procedures. In contrast to procedures associated with higher morbidity, the association between higher volume and improved outcomes is often modest for gynecologic surgeries. The lower magnitude of this association has limited actionable policy changes for gynecologic surgery. These data have been driving initiatives such as regionalization of care, targeted quality improvement at low volume centers and volume-based credentialing in gynecology...
January 10, 2020: Clinical Obstetrics and Gynecology
Gabriela E Halder, Cheryl B Iglesia, Rebecca G Rogers
Female genital cosmetic surgery (FGCS) aims to alter the structure and appearance of female genitalia to attain the desired shape, size or look, or to decrease labial interference during intercourse, relieve pain and discomfort with clothing and exercise or decrease vaginal caliber and laxity. In the last 5 years, the number of labiaplasty surgeries performed in the United States rose by 53%. Despite the increasing popularity of FGCS, several divergent opinions regarding the ethics, safety, and efficacy of these procedures exist...
January 6, 2020: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
March 2020: Clinical Obstetrics and Gynecology
Kimberly K Leslie, Jesus Gonzalez Bosquet
No abstract text is available yet for this article.
March 2020: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
March 2020: Clinical Obstetrics and Gynecology
Jianling Bi, Kristina W Thiel, Jacob M Litman, Yuping Zhang, Eric J Devor, Andreea M Newtson, Michael J Schnieders, Jesus Gonzalez Bosquet, Kimberly K Leslie
In our proof-of-concept study of 1 patient with stage IIIC carcinosarcoma of the ovary, we discovered a rare mutation in the tumor suppressor, TP53, that results in the deletion of N131. Immunofluorescence imaging of the organoid culture revealed hyperstaining of p53 protein. Computational modeling suggests this residue is important for maintaining protein conformation. Drug screening identified the combination of a proteasome inhibitor with a histone deacetylase inhibitor as the most effective treatment. These data provide evidence for the successful culture of a patient tumor and analysis of drug response ex vivo...
March 2020: Clinical Obstetrics and Gynecology
Hadeal Ayoub, Megan E McDonald
Despite aggressive upfront treatment with a combination of surgery and chemotherapy, most women with advanced epithelial malignancy will experience disease recurrence. The goal of treatment in the recurrent setting shifts away from a curative approach towards palliation of symptoms. In an attempt to delay time to first recurrence, the concept of maintenance chemotherapy emerged. This paper reviews the available literature evaluating the use of maintenance chemotherapy in the primary treatment setting and its effect on progression-free survival and overall survival...
March 2020: Clinical Obstetrics and Gynecology
Khaled Ghoniem, Sherif A Shazly, Giorgia Dinoi, Valentina Zanfagnin, Gretchen E Glaser, Andrea Mariani
Besides histologic features, the presence of nodal metastasis is the most crucial prognostic factor for recurrence and survival for patients with gynecologic cancer. Conventionally, lymphadenectomy has been performed routinely to assess lymphatic metastasis. However, lymphadenectomy may be unnecessary in early-stage gynecologic cancer, because the percentage of patients with lymph node involvement is very low. The recent use of sentinel lymph node mapping has provided high feasibility, safety, and accuracy in the assessment of nodal metastasis...
March 2020: Clinical Obstetrics and Gynecology
Colette Gnade, Megan E McDonald
A diagnosis of recurrent epithelial ovarian cancer carries with it a very poor prognosis despite aggressive chemotherapy with or without secondary surgical cytoreduction. Recently, maintenance treatment after second-line chemotherapy has gained momentum given promising results of antiangiogenics and PARP inhibitors used in this setting. When used appropriately, these agents may provide a meaningful survival benefit with minimal effects on quality of life. This paper reveals the current literature evaluating the use of maintenance therapy in the recurrent setting for the epithelial ovarian, fallopian tube, or primary peritoneal cancers...
March 2020: Clinical Obstetrics and Gynecology
Jordan N Mattson, David P Bender
Minimally invasive robotic surgery has become an effective surgical technique for the treatment of gynecologic malignancies. This article reviews the current utilization of robotic surgery and its role for future treatment in gynecologic oncology.
March 2020: Clinical Obstetrics and Gynecology
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