journal
https://read.qxmd.com/read/32740042/polycystic-ovary-syndrome-and-medical-conditions
#1
Nanette L Rollene, Jessica A Lentscher, Ashleigh M Hemphill, Alan DeCHERNEY
Polycystic ovary syndrome is a common endocrinopathy that has been associated with many medical conditions across nearly every specialty. This chapter reviews the current understanding of polycystic ovary syndrome and associated medical conditions.
July 29, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32740041/introduction-to-building-the-cardio-obstetric-team
#2
Diana S Wolfe
The pregnant cardiac patient has become a national focus in the United States during the 21st century. Maternal mortality in the United States is on the rise, cardiac disease in pregnancy has been identified as the number one indirect cause and has driven the increase in maternal death rate greatly. This may be explained by the increasing number of women with congenital heart disease reaching reproductive age and a higher prevalence of chronic medical diseases. A triad solution includes cardiovascular screening, patient education and a multidisciplinary team...
July 29, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32701519/coronary-disease-in-pregnancy-myocardial-infarction-and-spontaneous-coronary-artery-dissection
#3
Katherine H Campbell, Marysia S Tweet
Pregnancy-related maternal mortality and morbidity rates continue to increase in the United States despite global improvements in maternal outcomes. The unique hemodynamic and physiological changes of pregnancy results in a 3- to 4-fold increased risk of acute myocardial infarction (AMI) which causes a substantial proportion of all maternal cardiac deaths. In addition to atherosclerosis, pregnancy-associated AMI is commonly caused by nonatherosclerotic etiologies such as spontaneous coronary artery dissection, embolus to the coronary artery, and coronary vasospasm...
July 21, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32701518/environmental-influences-and-polycystic-ovarian-syndrome
#4
Ariel J Dunn
Polycystic ovarian syndrome (PCOS) is a complex endocrine-metabolic disorder whose pathogenesis is not well-understood. While genetic insults have been hypothesized as possible causes, there are a large number of environmental chemicals known to have detrimental effects on the endocrine system and may be irreversible, especially when exposure occurs early in development. Many of these chemicals have been investigated as causes of PCOS by measuring serum and urinary levels of common endocrine disruptors in women and adolescents with PCOS as well as using animal models for PCOS induction with chemical exposures...
July 21, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32701517/clinical-presentation-and-diagnosis-of-polycystic-ovarian-syndrome
#5
Jessica A Lentscher, Alan DeCHERNEY
Polycystic ovarian syndrome (PCOS) is a common endocrinopathy with many clinical manifestations. The effects on women's lives start at puberty and can last throughout her lifetime. Women frequently experience anovulatory menstrual cycles, infertility, hirsutism, obesity and increased risk of diabetes mellitus, hypertension, lipid abnormalities, and metabolic syndrome. PCOS is a heterogenous disorder, and a diagnosis of exclusion. In general, women afflicted will have menstrual irregularities, ultrasound findings of abnormal ovarian size and morphology, and clinical or laboratory evidence of hyperandrogenism...
July 21, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32694295/polycystic-ovary-syndrome-menopause-and-malignancy
#6
Karine Matevossian, Olivia Carpinello
Polycystic ovary syndrome (PCOS) has been extensively studied in reproductive-aged women. However, accumulating research shows that PCOS can have lifelong effects on multiple aspects of women's health. PCOS can affect the onset and course of menopause and cardiovascular health in perimenopausal and postmenopausal patients. Moreover, PCOS may increase a woman's risk for both gynecologic and nongynecologic malignancies. When treating older PCOS patients, physicians should be cognizant of the syndrome's long-term effects and consider the unique needs of these women...
July 17, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32649322/management-of-the-category-ii-fetal-heart-rate-tracing
#7
Alexandra G Eller, Michael Sean Esplin
Management of the category II fetal heart rate (FHR) tracing presents a common challenge in obstetrics. Up to 80% of women will have a category II FHR tracing at some point during labor. Here we propose a management algorithm to identify specific features of the FHR tracing that correlate with risk for fetal acidemia, target interventions to address FHR decelerations, and guide clinicians about when to proceed toward operative vaginal delivery or cesarean to achieve delivery before there is a high risk for significant fetal acidemia with potential for neurological injury or death...
July 8, 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32735415/interpretation-of-fetal-heart-rate-monitoring-in-the-clinical-context
#8
Calla Holmgren
Use of intrapartum fetal heart rate (FHR) monitoring has had limited success in preventing hypoxic injury to neonates. One of the most common limitations of FHR interpretation is the failure to consider chronic and acute clinical factors that may increase the risk of evolving acidemia. This manuscript reviews common clinical factors that may affect the FHR and should be considered when determining the need for early intervention based on changes in the FHR.
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32732505/interventions-for-intrapartum-fetal-heart-rate-abnormalities
#9
Alexandra G Eller
Intrapartum fetal heart rate (FHR) decelerations may represent interrupted oxygen transfer to the fetus. In many cases, these interruptions are transient and do not result in progressive fetal acidemia with risk for asphyxia and neurological compromise. When significant FHR decelerations are present, reversible causes of reduced fetal oxygen delivery should be considered and corrective measures should be undertaken to optimize oxygenation. In this review, we describe potential intrapartum causes of reduced fetal oxygen delivery and the efficacy of common interventions for an abnormal FHR tracing...
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32732504/foreword-management-of-abnormal-fhr-tracings
#10
M Sean Esplin
No abstract text is available yet for this article.
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32732503/contributors-management-of-abnormal-fhr-tracings
#11
(no author information available yet)
No abstract text is available yet for this article.
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32732502/hmb-in-the-adolescent-a-review-of-the-modern-approach-to-diagnosis-and-management
#12
Chimsom Oleka, Jennifer E Dietrich
Heavy menstrual bleeding in the adolescent is a cause for concern whether occurring acutely or chronically. There are a number of important considerations during the initial presentation that will help guide the practitioner during workup, which ultimately guides management strategies. The cornerstone of management in the adolescent is that of medical therapy (hormonal and nonhormonal), with avoidance of invasive and irreversible measures, as maintenance of fertility is paramount. Ultimately, the majority of adolescents can be successfully managed in the acute setting and transitioned to maintenance therapy for long-term control of heavy menses...
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32732501/pediatric-and-adolescent-gynecology-what-the-generalist-ob-gyn-needs-to-know
#13
(no author information available yet)
No abstract text is available yet for this article.
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32649323/fertility-preservation-for-adolescents-receiving-cancer-therapies
#14
Leslie C Appiah
According to the National Cancer Institute, ∼300,000 children globally are diagnosed with cancer each year. Advancements in chemotherapy and radiotherapy have revolutionized cancer treatment and improved long-term survival. Although many survivors will remain in good health with disease-free prognoses, three fourths will experience short-term and long-term effects from treatment. The cancer care paradigm has now appropriately shifted to include quality of life in survivorship with fertility cited as one of the most important quality of life indicators by survivors...
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32604239/foreword-pediatric-and-adolescent-gynecology-what-the-generalist-ob-gyn-needs-to-know
#15
Paula J Adams Hillard
No abstract text is available yet for this article.
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32568802/transgender-men-and-the-gynecologist
#16
Allison C Mayhew, Ariel Cohen, Veronica Gomez-Lobo
Recently, greater attention has been paid to the care of gender dysphoric and gender incongruent individuals. Gynecologists may be called upon to care for individuals who were assigned female at birth throughout or following social, medical, or surgical gender transition. Thus, gynecologists need to be aware of language regarding sex and gender, treatment typically used for the care of gender dysphoric or incongruent individuals, and aspects of well gynecologic care necessary for these individuals. This review highlights these aspects of care for transgender males to aid the general gynecologist in the care and treatment of these individuals...
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32516156/the-golden-hours-of-fetal-heart-rate-monitoring-systematic-approach-to-the-critical-times-of-labor-and-delivery
#17
M Sean Esplin
The first hour after admission and the last hour before delivery are critical times for identifying and preventing hypoxic-ischemic encephalopathy. These are times of transition that require coordinated steps to identify fetuses at risk, institute effective plans for fetal heart rate monitoring, and to establish situational awareness. Interpretation and intervention based on fetal heart rate monitoring is an important part of the care provided during these crucial times. We present checklists for the first and last hour of labor for use on labor and delivery to help standardize and optimize the approach to care during these times...
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32516155/identification-of-the-fetus-at-risk-for-metabolic-acidemia-using-continuous-fetal-heart-rate-monitoring
#18
M Sean Esplin
The fetal heart rate can be used to assess the current metabolic state of the fetus and predict the risk of the evolution of metabolic acidemia through the course of labor. In this chapter, we will present the pathophysiology of the development of fetal acidemia and provide an organized approach to identifying the risk of worsening acidemia using changes noted in the fetal heart rate pattern to allow for interventions that might alter this course.
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32516154/the-goal-of-continuous-fetal-heart-rate-monitoring-during-labor-have-we-been-successful
#19
M Sean Esplin
Despite its ubiquitous use, fetal heart rate (FHR) monitoring has not resulted in a significant reduction in hypoxic-ischemic encephalopathy following delivery. This manuscript reviews the reasons for this failure including limitations of FHR to accurately predict hypoxia, low prevalence of hypoxic-ischemic encephalopathy, and lack of standardization of interpretation and intervention. We propose an alternative goal for FHR monitoring during labor to provide optimal care by early identification of truly concerning features, initiation of appropriate interventions, clear documentation of concerns and plans, and clear communication between team members on labor and delivery, including initiation of the chain of command as needed...
September 2020: Clinical Obstetrics and Gynecology
https://read.qxmd.com/read/32516153/unusual-circumstances-and-additional-procedures-for-fetal-evaluation-in-labor
#20
Douglas S Richards
This chapter describes several circumstances in which the interpretation of the intrapartum fetal heart rate pattern falls outside the usual frame of reference. This includes a more extensive discussion of causes of tachycardia and bradycardia. Ways in which a fetal dysrhythmia may manifest itself in the context of heart rate monitoring are described. Finally, the chapter reviews technological innovations designed to clarify the fetal status when compromise is suspected from the fetal heart rate pattern.
September 2020: Clinical Obstetrics and Gynecology
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