Pub Date : 2024-01-30DOI: 10.1097/01.PGO.0000998088.06847.5a
Ntami P. Echeng, D. Burrell, Kate Zaluski
{"title":"Optimizing Operative Hysteroscopy in the Office Setting: Updated Techniques and Technology","authors":"Ntami P. Echeng, D. Burrell, Kate Zaluski","doi":"10.1097/01.PGO.0000998088.06847.5a","DOIUrl":"https://doi.org/10.1097/01.PGO.0000998088.06847.5a","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"2 7","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139591596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-15DOI: 10.1097/01.PGO.0000997432.60569.1c
Jack FitzSimmons, Laura Hart, Emily Oliver, Wadia R. Mulla
{"title":"Diagnosis of Venous Thromboembolism in Pregnancy","authors":"Jack FitzSimmons, Laura Hart, Emily Oliver, Wadia R. Mulla","doi":"10.1097/01.PGO.0000997432.60569.1c","DOIUrl":"https://doi.org/10.1097/01.PGO.0000997432.60569.1c","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"41 12","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139437133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.1097/01.PGO.0000997000.66558.cf
Shayna Rubenstein, Beth Cronin
{"title":"Care for the Transgender and Gender-Diverse Patient Population: A Review for the Obstetrician/Gynecologist","authors":"Shayna Rubenstein, Beth Cronin","doi":"10.1097/01.PGO.0000997000.66558.cf","DOIUrl":"https://doi.org/10.1097/01.PGO.0000997000.66558.cf","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"105 16","pages":"1 - 6"},"PeriodicalIF":0.0,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139135062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1097/01.pgo.0000992704.95503.4f
Abigail Barnes, Meredith Alston
opioid-induced hyperalgesia, indicating that patients who receive more opioids intraoperatively become sensitized and thus require more opioids postoperatively.1 These concerns also translate into the peripartum period, especially for patients requiring cesarean deliveries. In 2019, Peahl and colleagues2 reviewed rates of new persistent opioid use in recently delivered patients and found that 75% of patients who underwent cesarean delivery were discharged with an opioid prescription. Of these women, 1% to 2% became persistent users. When compared with the nationwide cesarean delivery rate, that is an astonishing number of new persistent opioid users. Obstetricians have a responsibility to manage pain effectively, while also working to decrease the risk of patients becoming persistent opioid users. This article presents options to support a multimodal approach to peripartum and perioperative pain management for patients undergoing cesarean delivery. It is the physician’s role to evaluate each patient and personalize their pain control regimen, so patients may effectively meet postoperative milestones, care for their newborns, be discharged home from the As physicians and surgeons, obstetricians are acutely aware of the nationwide opioid crisis and the importance of decreasing opioid use both inside and outside of the hospital setting. In one review of perioperative use, it was found that 6% to 10% of patients who underwent either minor or major surgery, not specific to obstetrics and gynecology procedures, were still using opioids 1 year after their procedure.1 This same review noted that opioid dosing during the operative procedure was positively correlated with the postoperative opioid requirement for analgesia. This is thought to be due to acute tolerance secondary to Perioperative Pain Control for Patients Undergoing Cesarean Delivery
{"title":"Perioperative Pain Control for Patients Undergoing Cesarean Delivery","authors":"Abigail Barnes, Meredith Alston","doi":"10.1097/01.pgo.0000992704.95503.4f","DOIUrl":"https://doi.org/10.1097/01.pgo.0000992704.95503.4f","url":null,"abstract":"opioid-induced hyperalgesia, indicating that patients who receive more opioids intraoperatively become sensitized and thus require more opioids postoperatively.1 These concerns also translate into the peripartum period, especially for patients requiring cesarean deliveries. In 2019, Peahl and colleagues2 reviewed rates of new persistent opioid use in recently delivered patients and found that 75% of patients who underwent cesarean delivery were discharged with an opioid prescription. Of these women, 1% to 2% became persistent users. When compared with the nationwide cesarean delivery rate, that is an astonishing number of new persistent opioid users. Obstetricians have a responsibility to manage pain effectively, while also working to decrease the risk of patients becoming persistent opioid users. This article presents options to support a multimodal approach to peripartum and perioperative pain management for patients undergoing cesarean delivery. It is the physician’s role to evaluate each patient and personalize their pain control regimen, so patients may effectively meet postoperative milestones, care for their newborns, be discharged home from the As physicians and surgeons, obstetricians are acutely aware of the nationwide opioid crisis and the importance of decreasing opioid use both inside and outside of the hospital setting. In one review of perioperative use, it was found that 6% to 10% of patients who underwent either minor or major surgery, not specific to obstetrics and gynecology procedures, were still using opioids 1 year after their procedure.1 This same review noted that opioid dosing during the operative procedure was positively correlated with the postoperative opioid requirement for analgesia. This is thought to be due to acute tolerance secondary to Perioperative Pain Control for Patients Undergoing Cesarean Delivery","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"44 ","pages":"1 - 5"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139203096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-30DOI: 10.1097/01.PGO.0000977892.92495.7e
H. Lerner
Pathophysiology of Ulcerative Vulvar Lesions Ulcerative vulvar lesions occur after vesicles or bullae on the vulva have been unroofed. The original lesions are filled with clear or yellowish serous fluid that collects between layers of vulvar epidermal cells or between the epidermis and the dermis. These lesions are categorized by size. Vesicles are less than 1 cm (Figure 1A), whereas bullae are more than 1 cm (Figure 1B). The degree of tenseness of the covering membrane of vesicles and bullae is due to the thickness of the layer of epithelium that becomes separated from the layer underlying it and is often a diagnostic clue. It is important to distinguish vesicles from pustules, which are also frequently seen on the vulva. Vesicles are filled with watery, serous fluid whereas pustules contain sebaceous or purulent discharge. This article is the first of 2 parts.
{"title":"Diagnosis and Management of Vulvar Ulcers: Part I—Common Vulvar Ulcers","authors":"H. Lerner","doi":"10.1097/01.PGO.0000977892.92495.7e","DOIUrl":"https://doi.org/10.1097/01.PGO.0000977892.92495.7e","url":null,"abstract":"Pathophysiology of Ulcerative Vulvar Lesions Ulcerative vulvar lesions occur after vesicles or bullae on the vulva have been unroofed. The original lesions are filled with clear or yellowish serous fluid that collects between layers of vulvar epidermal cells or between the epidermis and the dermis. These lesions are categorized by size. Vesicles are less than 1 cm (Figure 1A), whereas bullae are more than 1 cm (Figure 1B). The degree of tenseness of the covering membrane of vesicles and bullae is due to the thickness of the layer of epithelium that becomes separated from the layer underlying it and is often a diagnostic clue. It is important to distinguish vesicles from pustules, which are also frequently seen on the vulva. Vesicles are filled with watery, serous fluid whereas pustules contain sebaceous or purulent discharge. This article is the first of 2 parts.","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128791285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-15DOI: 10.1097/01.PGO.0000966992.08325.9b
Kate M Zaluski, D. Burrell
fluid overload and electrolyte disturbances. Since the 1990s, the FDA has approved several nonresectoscopic endometrial ablation systems (often referred to as global endometrial ablation), which have short ablation cycles and require less user expertise with similar effectiveness compared with resectoscopic methods.1 Although patient satisfaction between resectoscopic and nonresectoscopic techniques seems to be equivalent, nonresectoscopic techniques are associated with shorter operative times and are more often performed under local anesthesia.1 As such, they are much more feasible for use in the outpatient setting. Success of endometrial ablation is primarily measured by patient satisfaction rates and rates of additional intervention including hysterectomy in the months and years after the procedure. It is therefore critical to properly identify candidates for endometrial ablation and counsel them regarding risk factors for dissatisfaction and for subsequent hysterectomy. This article aims to review available nonresectoscopic endometrial ablation systems, to identify ideal candidates for this procedure, to optimize success in the outpatient setting, and to describe risk factors for endometrial ablation failure. Endometrial ablation is an attractive management option for many premenopausal patients with heavy menstrual bleeding as an alternative to medical therapy or hysterectomy. The goal of endometrial ablation is to reduce menstrual bleeding by local destruction of the endometrium. Resectoscopic endometrial ablation, although an effective treatment for heavy menstrual bleeding, requires specific hysteroscopic skills by the operator and carries the risk of Updates in Endometrial Ablation: Office Approaches
{"title":"Updates in Endometrial Ablation: Office Approaches","authors":"Kate M Zaluski, D. Burrell","doi":"10.1097/01.PGO.0000966992.08325.9b","DOIUrl":"https://doi.org/10.1097/01.PGO.0000966992.08325.9b","url":null,"abstract":"fluid overload and electrolyte disturbances. Since the 1990s, the FDA has approved several nonresectoscopic endometrial ablation systems (often referred to as global endometrial ablation), which have short ablation cycles and require less user expertise with similar effectiveness compared with resectoscopic methods.1 Although patient satisfaction between resectoscopic and nonresectoscopic techniques seems to be equivalent, nonresectoscopic techniques are associated with shorter operative times and are more often performed under local anesthesia.1 As such, they are much more feasible for use in the outpatient setting. Success of endometrial ablation is primarily measured by patient satisfaction rates and rates of additional intervention including hysterectomy in the months and years after the procedure. It is therefore critical to properly identify candidates for endometrial ablation and counsel them regarding risk factors for dissatisfaction and for subsequent hysterectomy. This article aims to review available nonresectoscopic endometrial ablation systems, to identify ideal candidates for this procedure, to optimize success in the outpatient setting, and to describe risk factors for endometrial ablation failure. Endometrial ablation is an attractive management option for many premenopausal patients with heavy menstrual bleeding as an alternative to medical therapy or hysterectomy. The goal of endometrial ablation is to reduce menstrual bleeding by local destruction of the endometrium. Resectoscopic endometrial ablation, although an effective treatment for heavy menstrual bleeding, requires specific hysteroscopic skills by the operator and carries the risk of Updates in Endometrial Ablation: Office Approaches","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128057086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-31DOI: 10.1097/01.PGO.0000944416.34212.a6
J. Cervino, D. Dang
who have bariatric surgery are adults, teenagers can also be candidates for weight-loss surgery if they have been evaluated by a multidisciplinary team and meet the criteria. In the United States, the 3 most commonly performed weight-loss surgeries are a sleeve gastrectomy (SG), Rouxen-Y gastric bypass (GB), and an adjustable gastric band (AGB). Other less common weight-loss surgeries include the biliopancreatic diversion with duodenal switch (BPD/DS), which is no longer commonly performed, and a single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S), which is a relatively newer procedure. An SG is a restrictive type of weight-loss surgery where approximately 80% of the stomach is removed. This aids weight loss through a restrictive process, by altering the size of the stomach and thereby reducing the quantity of food the patient can eat, while also removing the portion of the stomach that produces important metabolic hormones including leptin and ghrelin. This surgery is relatively quick, simple, and highly effective, making it the gold standard for weight-loss surgery. A benefit of this surgery is that it can be performed on certain patients who may be considered “high risk” with medical comorbidities. It can also act as a Overview of Bariatric Surgery Bariatric surgery is a class of weight-loss surgery that works by altering the anatomy of the gastrointestinal tract. According to the National Institutes of Health, candidates for bariatric surgery are: (1) patients with a body mass index (BMI) of 40 or more, or (2) a BMI of 35 or more with a serious health condition linked to obesity including type 2 diabetes, sleep apnea, or heart disease, or (3) a BMI of 30 or more with type 2 diabetes that is difficult to control with medication and lifestyle changes.1 Different institutions may have different criteria or protocols for which patients are candidates for bariatric surgery. Although most patients Bariatric Surgery and Pregnancy
接受减肥手术的是成年人，青少年也可以接受减肥手术，如果他们经过多学科团队的评估并符合标准。在美国，最常用的3种减肥手术是袖式胃切除术(SG)、Rouxen-Y胃旁路术(GB)和可调节胃带术(AGB)。其他不太常见的减肥手术包括胆胰分流与十二指肠开关(BPD/DS)，这已不再常见，以及单吻合术十二指肠油旁通与袖胃切除术(SADI-S)，这是一种相对较新的手术。SG是一种限制性的减肥手术，大约80%的胃被切除。这是一种限制性的减肥方法，通过改变胃的大小，从而减少病人可以吃的食物的数量，同时也消除了胃中产生重要代谢激素的部分，包括瘦素和胃饥饿素。这种手术相对快速、简单、高效，是减肥手术的黄金标准。这种手术的一个好处是，它可以对某些可能被认为有医疗合并症的“高风险”患者进行手术。它也可以作为减肥手术的概述减肥手术是一类减肥手术，通过改变胃肠道的解剖结构来工作。根据美国国立卫生研究院(National Institutes of Health)的数据，需要进行减肥手术的患者有:(1)身体质量指数(BMI)在40以上的患者;(2)身体质量指数(BMI)在35以上的患者，患有与肥胖相关的严重健康问题，包括2型糖尿病、睡眠呼吸暂停或心脏病;(3)身体质量指数(BMI)在30以上的患者，患有难以通过药物和改变生活方式来控制的2型糖尿病不同的机构可能有不同的标准或方案，病人是减肥手术的候选人。虽然大多数患者减肥手术和妊娠
{"title":"Bariatric Surgery and Pregnancy","authors":"J. Cervino, D. Dang","doi":"10.1097/01.PGO.0000944416.34212.a6","DOIUrl":"https://doi.org/10.1097/01.PGO.0000944416.34212.a6","url":null,"abstract":"who have bariatric surgery are adults, teenagers can also be candidates for weight-loss surgery if they have been evaluated by a multidisciplinary team and meet the criteria. In the United States, the 3 most commonly performed weight-loss surgeries are a sleeve gastrectomy (SG), Rouxen-Y gastric bypass (GB), and an adjustable gastric band (AGB). Other less common weight-loss surgeries include the biliopancreatic diversion with duodenal switch (BPD/DS), which is no longer commonly performed, and a single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S), which is a relatively newer procedure. An SG is a restrictive type of weight-loss surgery where approximately 80% of the stomach is removed. This aids weight loss through a restrictive process, by altering the size of the stomach and thereby reducing the quantity of food the patient can eat, while also removing the portion of the stomach that produces important metabolic hormones including leptin and ghrelin. This surgery is relatively quick, simple, and highly effective, making it the gold standard for weight-loss surgery. A benefit of this surgery is that it can be performed on certain patients who may be considered “high risk” with medical comorbidities. It can also act as a Overview of Bariatric Surgery Bariatric surgery is a class of weight-loss surgery that works by altering the anatomy of the gastrointestinal tract. According to the National Institutes of Health, candidates for bariatric surgery are: (1) patients with a body mass index (BMI) of 40 or more, or (2) a BMI of 35 or more with a serious health condition linked to obesity including type 2 diabetes, sleep apnea, or heart disease, or (3) a BMI of 30 or more with type 2 diabetes that is difficult to control with medication and lifestyle changes.1 Different institutions may have different criteria or protocols for which patients are candidates for bariatric surgery. Although most patients Bariatric Surgery and Pregnancy","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"92 19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125014002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-15DOI: 10.1097/01.PGO.0000943028.26626.ab
Swati Rajprohat, Dung Dang
after copper was found to have spermicidal effects. The levonorgestrel IUD (LNG-IUD) was developed in the 1970s after research by Dr. Antonio Scommegna demonstrated intrauterine progesterone could induce endometrial atrophy. This concept was used by Dr. Jouni Valter Tapani Luukkainen to develop Progestasert, the first hormonecontaining IUD, marketed in 1976, which was effective for 1 year. Progestasert resembled modern-day IUDs; it was T-shaped and made with polydimethylsiloxane (PDMS) coated with progesterone to allow for slow/controlled release of hormone. The natural hormone progesterone was later replaced with levonorgestrel (LNG), a synthetic progestin with more potent progesterone receptor (PR) agonistic effects that lasted for 5 years. This device is now known as Mirena (LNG-20).1 At the time of writing, there are 4 types of LNG-IUDs currently available in the United States: Mirena (LNG-20) and Liletta (LNG-18.6) both containing 52 mg of LNG and releasing 20 and 18.6 μg of LNG per day, respectively, Kyleena (LNG-19.5) containing 19.5 mg of LNG and releasing 17.5 μg Before the 20th century, there were no clear data with regard to use of intrauterine devices (IUDs) for contraception or for other indications in humans. Dr. Richard Richter from Germany first documented the use of silk worm gut rings in the uterus to prevent pregnancy in 1909. After this, Dr. Ernst Grafenberg developed the “silver ring,” a spiral wound circular nonhormonal IUD made of silk suture and wrapped in silver wire in 1928. Development of the contraceptive copper IUD in the 1960s occurred Use of the Levonorgestrel Intrauterine Device for Noncontraceptive Indications
在发现铜有杀精作用之后。左炔诺孕酮宫内节育器(LNG-IUD)是在20世纪70年代Antonio Scommegna博士研究发现宫内黄体酮可导致子宫内膜萎缩后开发出来的。这一概念被Jouni Valter Tapani Luukkainen博士用于开发Progestasert，这是第一个含激素的宫内节育器，于1976年上市，有效期为1年。孕激素类似于现代的宫内节育器;它是t形的，由涂有孕酮的聚二甲基硅氧烷(PDMS)制成，以允许缓慢/控制激素的释放。天然激素孕酮后来被左炔诺孕酮(LNG)取代，左炔诺孕酮是一种合成孕激素，具有更强的孕激素受体(PR)激动作用，持续5年。这种装置现在被称为menrena (lng - 1)在撰写本文时，美国目前有4种类型的LNG-IUDs: mrena (LNG-20)和Liletta (LNG-18.6)，分别含有52毫克LNG，每天释放20和18.6 μg LNG, Kyleena (LNG-19.5)含有19.5毫克LNG，释放17.5 μg。在20世纪之前，没有关于使用宫内节育器(IUDs)用于避孕或用于人类其他适应症的明确数据。1909年，德国的理查德·里希特博士首次记录了在子宫内使用蚕丝肠环来防止怀孕。在此之后，恩斯特·格拉芬伯格博士于1928年发明了“银环”，这是一种螺旋形的环形非激素宫内节育器，由丝缝线制成，用银丝包裹。铜宫内节育器在20世纪60年代出现，左炔诺孕酮宫内节育器用于非避孕适应症
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