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Clinical Obstetrics and Gynecology

Scott A Sullivan
No abstract text is available yet for this article.
March 18, 2019: Clinical Obstetrics and Gynecology
Christopher G Goodier
Endocrine emergencies in pregnancy can be life threatening and are associated with increased morbidity for both the mother and fetus. Thyroid storm, diabetic ketoacidosis, and hypercalcemic crisis require a high clinical suspicion, rapid treatment, and multidisciplinary care to ensure best outcomes. Critical care consultation and intensive care unit admission are often warranted. Fetal testing may initially be concerning; however often improves with correction of the underlying metabolic derangement(s) and delivery is generally avoided until maternal status improves...
March 13, 2019: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
March 8, 2019: Clinical Obstetrics and Gynecology
Caroline T Nguyen, Jorge H Mestman
Postpartum thyroiditis (PPT) is an autoimmune-mediated destructive thyroiditis that occurs in the first year postpartum with a prevalence of 5%. In order to appropriately counsel and treat the patient, physicians need to recognize the signs and symptoms of PPT and distinguish PPT from Graves hyperthyroidism. This review of PPT will discuss the etiology, clinical course, risk factors, prognosis, and treatment of PPT. Understanding PPT is important for all physicians taking care of women in the peripartum period as women who have had PPT are at an increased risk of subsequent episodes of PP and at risk of permanent hypothyroidism...
March 5, 2019: Clinical Obstetrics and Gynecology
Sanjita B Chittimoju, Elizabeth N Pearce
Iodine deficiency during pregnancy is an important global public health issue and the leading preventable cause of neurodevelopmental impairments worldwide. The effects of severe iodine deficiency during pregnancy, including adverse obstetric outcomes and decreased child intelligence quotient, have been clearly established. However, the effects of mild-to-moderate deficiency remain less well understood. Pregnant and lactating women have higher iodine requirements than other adults; intakes of 220 to 250 µg/d in pregnancy and 250 to 290 µg/d in lactation...
March 1, 2019: Clinical Obstetrics and Gynecology
Erin T Carey
No abstract text is available yet for this article.
January 5, 2019: Clinical Obstetrics and Gynecology
Marcela C Smid, Torri D Metz, Adam J Gordon
Stimulant use, including cocaine, methamphetamines, ecstasy, and prescription stimulants, in pregnancy is increasingly common. In the United States, stimulants are the second most widely used and abused substances during pregnancy and pregnant women using stimulants in pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. In this review, we describe the pharmacology, pathophysiology, and epidemiology of stimulants, summarize the maternal and neonatal effects of perinatal stimulant use, and outline treatment options for stimulant use disorders among pregnant women...
December 31, 2018: Clinical Obstetrics and Gynecology
Chailee Moss, Carla Bossano, Silka Patel, Anna Powell, Rachel Chan Seay, Mostafa A Borahay
Opioid use for chronic noncancer pain poses a challenge to the gynecologist, and weaning opioids is often a goal for clinicians and patients. In some cases, opioid cessation can be achieved by weaning a patient's prescribed opioid or with symptomatic management with long-acting opioids or alpha2-adrenergic medications. This review imparts a basic understanding of the physiology of opioid withdrawal, strategies for achieving opioid abstinence, medications for treating the symptoms of withdrawal, and alternatives to opioid taper...
December 27, 2018: Clinical Obstetrics and Gynecology
Tessa Crume
Smoking during pregnancy is the most common preventable cause of infant morbidity and mortality. Cessation by the third trimester has consistently been associated with improved birth outcomes; however, the majority of women who obtain cessation during pregnancy, relapse in the first year postpartum. The majority of women who smoke during pregnancy developed their addiction to tobacco in early life, thus the need to intervene in the familial transmission of nicotine dependence is clear. This review discusses the epidemiology of tobacco use amongst pregnant women and factors associated with cessation...
March 2019: Clinical Obstetrics and Gynecology
Paul Tyan, Erin T Carey
The clinical setting in which women's health physicians practice, whether as generalist, obstetricians and gynecologists, or subspecialists, dictates our frequent clinical interaction with "pain." Opioid-containing medications are frequently prescribed within our specialty as a means of immediate pain relief. Opioid-containing medication causes a deep physiological alteration of several systems resulting in potential harm to acute and chronic opioid users. This article includes a thorough system-based review of opioid-containing medications on physiological systems...
March 2019: Clinical Obstetrics and Gynecology
Shawn A Ryan
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Like many other chronic diseases, addiction often involves cycles of relapse and remission. It is key that clinicians understand it as such and treat it appropriately with evidence-based interventions including medication-assisted treatment.
March 2019: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
March 2019: Clinical Obstetrics and Gynecology
Erin T Carey
No abstract text is available yet for this article.
March 2019: Clinical Obstetrics and Gynecology
(no author information available yet)
No abstract text is available yet for this article.
March 2019: Clinical Obstetrics and Gynecology
Mona R Prasad, Torri D Metz
No abstract text is available yet for this article.
March 2019: Clinical Obstetrics and Gynecology
Casia Horseman, Avery Meyer
Drugs of abuse can cause changes in the brain leading to addiction. Current scientific focus has been on how these drugs interact with the brain and the changes they cause, how those changes affect human behavior and how they may last beyond termination of drug use. Compulsiveness in seeking the drug, impulsiveness in consuming the drug, and negative affect when the drug is withheld are characteristic of addiction. Each of these characteristics has a root in neurobiology and understanding their mechanisms helps us to understand addiction and see potential targets for treatment...
March 2019: Clinical Obstetrics and Gynecology
Jaye M Shyken, Shilpa Babbar, Shaweta Babbar, Alicia Forinash
Benzodiazepine use and dependence are on the rise as well as the number of deaths attributable to the combination of opioids and benzodiazepines. Anxiety, the most frequent condition for which benzodiazepines are prescribed, occurs commonly, and is increasingly noted to coincide with pregnancy. Use of both benzodiazepine anxiolytics and anxiety in pregnancy is associated with preterm delivery and low birth weight. Short-term neonatal effects of hypotonia, depression, and withdrawal are described but long-term sequelae, if any, are poorly understood...
March 2019: Clinical Obstetrics and Gynecology
Aalok R Sanjanwala, Lorie M Harper
Opioid use disorders during pregnancy are a major risk factor for pregnancy-associated deaths. Women with opioid use disorders also experience increases in the incidence of cardiac arrest, renal failure, cesarean delivery, and blood transfusion. As such there is a tremendous need by obstetricians to understand and treat opiate use as a holistic public health problem with its own unique risk factors, and management strategies. Universal screening with brief intervention and referral, referral to psychotherapy, and pharmacotherapy are all recommended strategies for opioid use disorder in pregnancy...
March 2019: Clinical Obstetrics and Gynecology
Noor Abualnadi, Arthur M Dizon, Lauren Schiff
In this article, we describe a variety of medications that physicians managing outpatient chronic pain should familiarize themselves with to better aid their approach to multimodal pain therapy. Physicians should always consider the use of an adjuvant or coanalgesic drug as first-line treatments. Although many of these medications are not primarily analgesics, in clinical practice they have independent analgesic effects or synergistic analgesic properties when used with opioids. The use of adjunct analgesics reduces opioid-related adverse effects and optimizes pain management...
March 2019: Clinical Obstetrics and Gynecology
Dominika Lipowska James, Maryam Jowza
Inappropriate and excessive opioid prescribing practices for treatment of chronic nonmalignant pain contributed to rising rates of opioid related mortality. Effective and widely available opioid addiction treatment resources are needed to ensure successful resolution of the "opioid epidemic". This chapter outlines the basic pathophysiology of addiction as well as principles of opioid addiction management focusing on the pharmacological and nonpharmacological aspects of care. Pharmacological treatment focuses on opioid substitution therapy, with aim at prevention of opioid cravings and opioid withdrawal symptoms...
March 2019: Clinical Obstetrics and Gynecology
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