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Volume 2, No 1 - Winter 2009

Volume 2, No 1 - Winter 2009

Table of Contents

Vacuum-Assisted Vaginal Delivery Technique Review
Approximately 5% (1 in 20) of all deliveries in the United States are operative vaginal deliveries. The past 20 years have seen a progressive shift away from the use of forceps in favor of the vacuum extractor as the instrument of choice. This article reviews in detail the indications, contraindications, patient selection criteria, choice of instrument, and technique for vacuum-assisted vaginal delivery. The use of vacuum extraction at the time of cesarean delivery will also be discussed. With vacuum extraction becoming increasingly popular, it is important that obstetric care providers are aware of the maternal and neonatal risks associated with such deliveries and of the options available to effect a safe and expedient delivery.[Rev Obstet Gynecol. 2009;2(1):5-17]
InterStim® Therapy: A Contemporary Approach to Overactive Bladder Treatment Update
Overactive bladder is a common and challenging condition for the practicing obstetrician-gynecologist. The prevalence of the condition is increasing with our aging population. Although some patients respond to first-line therapy, a significant number will require sacral nerve stimulation to address the underlying neurologic condition that causes overactive bladder as well as other pelvic floor conditions. This article summarizes the epidemiology and symptomatology, office evaluation, and treatment of overactive bladder with particular emphasis on sacral nerve stimulation (SNS). SNS technique, results, and future applications are also reviewed.[Rev Obstet Gynecol. 2009;2(1):18-27]
Bacterial Vaginosis: An Overview for 2009 Treatment Update
Bacterial vaginosis has been appreciated as a unique clinical entity for well over 50 years. Its essential manifestations are well established: a loss of the normal bacterial population of the vagina and their replacement by other species. Investigations into this condition have led to a better understanding of its prevalence and epidemiology. Microbiologic and biochemical studies have exposed the remarkably complex pathophysiologic events that occur with bacterial vaginosis. Several major morbidities accompany this condition. Advances have been made in treatment, including the recent availability of a new therapeutic agent, tinidazole. However, the root cause of the condition is elusive, and as a result managing bacterial vaginosis and its complications is unsatisfactory; moreover, data suggest that therapy now is less successful than in the past. This article brings together the current fund of knowledge about bacterial vaginosis in a way that offers clinicians a realistic view of our capabilities and concerns.[Rev Obstet Gynecol. 2009;2(1):28-37]
Preventing Adhesions in Obstetric and Gynecologic Surgical Procedures Treatment Update
Adhesive disease represents a significant cause of morbidity for postoperative patients. Most surgical procedures performed by obstetrician-gynecologists are associated with pelvic adhesions that cause subsequent serious sequelae, including small bowel obstruction, infertility, chronic pelvic pain, and difficulty in postoperative treatment, including complexity during subsequent surgical procedures. The technology of adhesion prevention has significantly progressed. There are 3 methods approved by the US Food and Drug Administration for the prevention of postoperative adhesions, including Adept®, Interceed®, and Seprafilm®. The latter barrier is the most widely studied. This article reviews the current choices available for adhesion prevention barriers as well as surgical adjuncts that traditionally have been studied for that purpose.[Rev Obstet Gynecol. 2009;2(1):38-45]
Recent Advances in Tape Slings for Female Urinary Stress Incontinence Treatment Update
Sling therapy is the enhanced surgical support of the urethra. In this article, the history of the use of slings for the surgical treatment of female urinary stress incontinence is reviewed, and the usual surgical routes for retropubic (transvaginal) or transobturator tape passage are described. The latest innovation in sling therapy is the use of minislings, which are short tape mesh implants inserted through a single vaginal incision; these slings may be placed in an office setting. Outcomes data are either lacking or suggest a considerable decrement of effectiveness of unstabilized minislings over full-length slings; however, the short-term efficacy of a stabilized, adjustable minisling is 97%. These results suggest benchmark effectiveness associated with full-length slings in a less invasive device that also has the capability of short-term adjustability.[Rev Obstet Gynecol. 2009;2(1):46-50]
Child Marriage: A Silent Health and Human Rights Issue
Marriages in which a child under the age of 18 years is involved occur worldwide, but are mainly seen in South Asia, Africa, and Latin America. A human rights violation, child marriage directly impacts girls’ education, health, psychologic well-being, and the health of their offspring. It increases the risk for depression, sexually transmitted infection, cervical cancer, malaria, obstetric fistulas, and maternal mortality. Their offspring are at an increased risk for premature birth and, subsequently, neonatal or infant death. The tradition, driven by poverty, is perpetuated to ensure girls’ financial futures and to reinforce social ties. One of the most effective methods of reducing child marriage and its health consequences is mandating that girls stay in school.[Rev Obstet Gynecol. 2009;2(1):51-56]
Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure The Operator's Manual
Vaginal and laparoscopic hysterectomies have been clearly associated with decreased blood loss, shorter hospital stay, speedier return to normal activities, and fewer abdominal wall infections when compared with abdominal hysterectomies. In this review, the authors outline the 10 steps to a successful laparoscopic hysterectomy.[Rev Obstet Gynecol. 2009;2(1):57-64]
Sexuality News and Views From the Literature
[Rev Obstet Gynecol. 2009;2(1):65-66]
Hormonal Contraception News and Views From the Literature
[Rev Obstet Gynecol. 2009;2(1):66]
Obstetrics News and Views From the Literature
[Rev Obstet Gynecol. 2009;2(1):67-68]
Miscellaneous News and Views From the Literature
[Rev Obstet Gynecol. 2009;2(1):68]
VCare Uterine Manipulator/Elevator, ConMed Endosurgery Winter 2009 Product Reviews
[Rev Obstet Gynecol. 2009;2(1):69-70]
Harvey Stirrups, William Harvey Medical Equipment Winter 2009 Product Reviews
[Rev Obstet Gynecol. 2009;2(1):70-71]