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The Guests Editors have assembled expert authors to present clinical reviews on the current knowledge and best practices for high-risk pregnancies. Authors are writing on Genetics: update on prenatal screening and diagnosis; Screening for congenital heart disease; What you need to know when managing twins; Short cervix dilemma; preterm labor: approach to decreasing complications of prematurity; Optimizing outcomes for the growth-restricted fetus; Preeclampsia: short- and long-term implications; pregnancy risk associated with obesity; prevention of first cesarean delivery, and diagnosis and management of placenta accreta.
This issue of Obstetrics and Gynecology Clinics of North America provides a summary of several more common maternal-fetal-infant infectious diseases. Several experts in the field of maternal and perinatal infection have contributed to this issue to provide an overview of the up-to-date preventive strategies, screening and diagnostic methods, and treatment guidelines. While guidelines such as universal vaccination to prevent influenza during pregnancy are fairly well justified by supporting data, there is much uncertainty about the appropriate screening guidelines for conditions such as cytomegalovirus, where the lack of a proven effective treatment diminishes the value of screening. Moreover, increasing issues of antibiotic resistance and the lack of significant advancement in developing newer effective agents imply that both providers and health care facilities must follow guidelines of antimicrobial stewardship (ie, coordinated efforts to improve and measure the appropriate use of antimicrobials). It is our hope that this issue will aid providers in navigating these complex issues while also understanding the current state-of-the-science
This issue will focus on the most common reproductive endocrine conditions encountered by healthcare providers. This series is timely and will be of interest to readers as there are many recent updates to the recommendations for appropriate evaluation and treatment of several reproductive conditions. Each chapter will address specific anatomic and hormonal conditions and will examine reproductive function from puberty to menopause. A thorough summary of abnormal uterine bleeding including recent 2012 updates for evaluation and management will be emphasized. Individual chapters on anatomic causes of bleeding, such as uterine fibroids and endometriosis, will be included with a focus on new treatment options. Polycystic ovarian syndrome (PCOS), a common hormonal cause of irregular bleeding and infertility, will also be reviewed. Recent studies provide insight into new fertility treatments for patients with PCOS including the use of aromatase inhibitors for ovulation induction. Other fertility related chapters include the evaluation of the infertile woman, ovulation induction, recurrent pregnancy loss, and age-related infertility. Finally, a transition to premature ovarian insufficiency and menopause will be provided. The Women’s Health Initiative publication in 2002 reported an association between hormone replacement therapy and breast cancer. There are several updates since this controversial publication and recent literature will be summarized. Attention will focus on appropriate evaluation and management of these common reproductive endocrine topics reviewing recent recommendations on best practices for clinicians.
There have been exciting new developments and research related to currently available contraceptives. In addition, in the last seven years, emergency contraception has gone from behind the counter to being FDA-approved for use. This issue addresses the most important clinical leaps in contraception and family planning in the last decade, with emphasis on new options for long-term, reversible contraception and emergency contraception. Information is also included to address the impact of Affordable Health Care and legal aspects of sterilization.
This issue of Obstetrics and Gynecology Clinics of North America attempts to provide an overview of the more common causes of chronic pelvic pain in women. It brings together experts in various fields of gynecology, gastroenterology, physical therapy, and urogynecology in an attempt to discuss the wide variety of common clinical conditions that can manifest as pain. The intent is to enable the physician to consider not only the common gynecologic causes but also the common nongynecologic causes based on certain symptom profiles and targeted clinical examination. Should the physician not feel comfortable in treating the nongynecologic causes, it would enable them to target their referral to a more appropriate physician rather than the patient being referred back to a general primary care physician. It is our hope that it will enable the reader to see the pelvis not as an ovary or a uterus but as a whole system of interacting organs, muscles, and nerves. In addtiion, there is very little in the Obstetrics and Gynecology literature about the treatment of the pain component with opioid and nonopioid medications. As one of my colleagues frequently states, we can treat the pain but not necessarily alleviate the suffering. The overview of complementary and alternative medications and opioid use will hopefully be useful to the practicing physician as it provides an evidence-based approach to the use of these therapies specifically for chronic pelvic pain.
This issue of Critical Care Clinics focuses on Obstetric and Gynecologic Emergencies in the ICU. Articles include: Respiratory Failure and Mechanical Ventilation in the Pregnant Patient, Anesthetic Complications in Pregnancy, Neurologic Complications in Pregnancy, Renal Failure in Pregnancy, Management Complex Cardiac Issues in the Pregnant Patient, Liver Failure in Pregnancy, Hypertensive Emergencies in Pregnancy, Ethical Issues in Pregnancy, and more!
The Ob/Gyn Hospitalist, the newest subspecialist in the field of obstetrics and gynecology, has the potential to improve patient safety, patient and provider satisfaction, workforce challenges and clinical outcomes. Programs are exploding across the country, mirroring the growth of the internal medicine hospitalist programs 10 years ago. Ob/Gyn hospitalist jobs are the most sought after in the field. We will present the history of the Ob/Gyn Hospitalist movement, available evidence to date supporting Ob/Gyn Hospitalists, and where we believe the field is going.
There is general consensus regarding threshold levels that describe the gray zone on the limits of viability, and gestational age alone should not be used solely in making a decision. This issue will bring light to the latest thoughts and clinical recommendations for delivery during the periviable period. Top thought leaders and clinicians have submitted articles in the following areas: Consequences of Birth at Periviable Gestions on Organ Systems; Medical and Surgical Interventions Before Birth; NICU Care: Nutrition/NEC; Pulmonary Care and Circulatory Support; NICU Stay and Microbiome; and Ethical Considerations and Counseling, to name a few. Readers will come away with the most current content written on this topic and details that can be incorporated into clinical care.
The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.
Dr. Iglesia has created an issue devoted to pelvic floor disorders that has a strong focus on the evidence behind current treatments and diagnostic methods. The authors are top experts in their areas and have contributed reviews on the most important topics in pelvic floor disorders, including Stress Urinary Incontinence; Urge Urinary Incontinence; Pelvic Organ Prolapse Native Tissue repairs; Pelvic Organ Prolapse Vaginal and Laparoscopic Mesh; Fecal Incontinence; PFDR Pelvic Floor Disorders Registry; Ultrasound Imaging of the Pelvic Floor; and Childbirth/Pelvic Floor Epidemiology to name a few.