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Volume 6, No 3/4 - 2013

Volume 6, No 3/4 - 2013

Table of Contents

Dining at the Health Care Buffet
[Rev Obstet Gynecol. 2013;6(3/4):103-104 doi: 10.3909/riog634ed] © 2014 MedReviews®, LLC
One and the Same
[Rev Obstet Gynecol. 2013;6(3/4):105-106 doi: 10.3909/riog0223] © 2014 MedReviews®, LLC
Barbed Suture: A Review of the Technology and Clinical Uses in Obstetrics and Gynecology Technology Review
Surgical knots are simply a necessary evil needed to anchor smooth suture to allow it to function in its role in tissue reapproximation. Surgical knots reduce the tensile strength of all sutures by thinning and stretching the material. The tying of surgical knots introduces the potential of human error and interuser variability. Knot-secured smooth suture must create an uneven distribution of tension across the wound with the higher tension burdens placed at the knots. Given the excessive relative wound tension on the knot and the reasonable concerns of surgeons for suture failure due to knot slippage, there is a natural tendency toward overcoming these concerns by over-tightening knots; however, tighter knots may be worse for wound healing and strength than looser knots. In minimally invasive laparoscopic surgeries, the ability to quickly and properly tie surgical knots presents a new challenge. In cases in which knot tying is difficult, the use of knotless barbed suture can securely reapproximate tissues with less time, cost, and aggravation. This article reviews the technology behind barbed sutures with a focus on understanding how they differ from traditional smooth sutures and how barbed sutures have performed in in vitro and animal model testing, as well as in human clinical trials. [ Rev Obstet Gynecol. 2013;6(3/4):107-115 doi:10.3909/riog0231] © 2014 MedReviews®, LLC
Pregnancy After Solid Organ Transplantation: A Guide for Obstetric Management Management Update
Successful pregnancy outcomes are possible among all solid organ transplant recipients. Patients should be fully counseled regarding the potential adverse fetal outcomes, including prematurity and low birth weight. Transplant recipients are at an increased risk for both maternal and neonatal complications and should be seen by a high-risk obstetrician in conjunction with their transplant teams. Ideally, preconception counseling begins during the pretransplantation evaluation process. Initiating contraception early after transplantation is ideal, and long-acting reversible methods such as intrauterine devices and subdermal implants may be preferred. Pregnancy should be avoided for at least 1 year after transplantation to limit the potential risks of early pregnancy that may adversely affect both allograft function and fetal well-being. Hypertension, diabetes, and infection should be monitored and treated to minimize fetal risks during pregnancy. Maintenance of current immunosuppression is usually recommended, with the exception of mycophenolic acid products, which (when possible) should be discontinued before conception and replaced with an alternative medication. Throughout pregnancy, immunosuppression must be maintained at appropriate dosing to avoid graft rejection. During labor and delivery, cesarean delivery should be performed for obstetric reasons only. A multidisciplinary team should manage pregnant transplant recipients before, during, and following pregnancy. Breastfeeding and long-term in utero exposure to immunosuppressants for offspring of transplant recipients continue to require further investigation but have been encouraged by recent reports. Continued reporting of post-transplantation pregnancy outcomes to the National Transplantation Pregnancy Registry is highly encouraged. [Rev Obstet Gynecol. 2013;6(3/4):116-125 doi:10.3909/riog0230] © 2014 MedReviews®, LLC
Amniocentesis for Fetal Lung Maturity: Will It Become Obsolete? Diagnostic Update
Amniocentesis for fetal lung maturity has historically been performed for many reasons: uterine and placental complications, maternal comorbidities, fetal issues, and even obstetric problems. Even though the risks associated with third trimester amniocentesis are extremely low, complications have been documented, including preterm labor, placental abruptions, intrauterine rupture, maternal sepsis, fetal heart rate abnormalities, and fetal-maternal hemorrhage. This review presents the types of tests for fetal lung maturity, presents the indications and tests utilized, and discusses recommendations for when amniocentesis for fetal lung maturity may be appropriate. [Rev Obstet Gynecol. 2013;6(3/4):126-134 doi:10.3909/riog0216] © 2014 MedReviews®, LLC
Relationship Between Maternal Periodontal Status and Preterm Low Birth Weight Management Update
Throughout history, there has been the belief that diseases that affect the mouth, such as periodontal disease, can have an effect on the rest of the body. It is only very recently that scientists and clinicians have begun to provide an increasing body of scientific evidence suggesting that moderate untreated periodontitis may affect an individual systemically, and may contribute to cardiovascular disease, diabetes, and preterm low birth weight. Birth weight is affected by multiple factors and is considered as an outcome of a complex multifactorial system. Periodontitis is a remote gram-negative infection that may play a role in low birth weight. Periodontopathic microorganisms and their products have a wide range of effects mediated through host cytokine production in target cells. Many combined animal studies and data supporting plausible biologic mechanisms suggest that periodontal infection has a negative impact on pregnancy outcome in some women. [Rev Obstet Gynecol. 2013;6(3/4):135-140 doi: 10.3909/riog0220] © 2014 MedReviews®, LLC
Screening for Intimate Partner Violence During Pregnancy Screening and Management Review
Intimate partner violence (IPV) is defined as an actual or threatened abuse by an intimate partner that may be physical, sexual, psychological, or emotional in nature. Each year approximately 1.5 million women in the United States report some form of sexual or physical assault by an intimate partner; it is estimated that approximately 324,000 women are pregnant when violence occurs. Pregnancy may present a unique opportunity to identify and screen for patients experiencing IPV. This article provides health care practitioners and clinicians with the most current valid assessment and screening tools for evaluating pregnant women for IPV. [Rev Obstet Gynecol. 2013;6(3/4):141-148 doi:10.3909/riog0226] © 2014 MedReviews®, LLC
Overview and Long-term Outcomes of Patients Born With Twin-to-Twin Transfusion Syndrome Management Update
Twin-to-twin transfusion syndrome (TTTS) results from a disproportionate blood supply between two (or more) fetuses that share a single placenta. Multiple complications can occur as a result of the syndrome, including intrauterine growth restriction in the donor twin, cardiomyopathies in recipients, and neurodevelopmental morbidities in survivors. Studies indicate that patients with TTTS have higher incidences of congenital heart disease compared with the unaffected population, and even when compared with uncomplicated monochorionic diamniotic twins. If managed properly, TTTS can result in a positive outcome for most patients. [ Rev Obstet Gynecol. 2013;6(3/4):149-154 doi:10.3909/riog0227] © 2014 MedReviews®, LLC
Heavy Menstrual Flow: Current and Future Trends in Management Management Update
Menorrhagia accounts for a large number of secondary care referrals in the West. Women of different ages have different expectations from the treatment offered to them. Young women of reproductive age often demand treatment that simultaneously reduces bleeding, preserves fertility, and has very few side effects, whereas older women who ultimately wish to keep their reproductive organs may have reason to avoid hormonal manipulation. This article discusses possible management options and introduces a hierarchical approach to the management of menorrhagia based on the medical therapies and surgical procedures currently available. We explore the medical therapies for menorrhagia, which include hormone-modifying drug therapies and the new combined oral contraceptive pill. We also review novel fibroid surgical therapies and the latest surgical procedures, such as laparoscopic bilateral uterine artery occlusion, transvaginal Doppler-guided vascular clamp, and laparoscopic and intrauterine ultrasound-guided radiofrequency ablation. [ Rev Obstet Gynecol. 2013;6(3/4):155-164 doi:10.3909/riog0205] © 2014 MedReviews®, LLC
Modern Risk Assessment for Individualizing Treatment Concepts in Early-stage Breast Cancer Treatment Update
Validated prognostic and predictive factors currently play an important role in treatment planning for patients with early-stage breast cancer. The role of personalized medicine has led to the search for markers that can be applied to individual patients to optimize treatment regimens. In addition to traditional clinicopathologic measures, scores and gene tests have been developed to independently predict risk of patients in the neoadjuvant and adjuvant settings. The discovery of these markers provides the opportunity to identify patients at such low risk of recurrence that toxic therapy side effects are not justified. Selection and management of patients with early-stage, hormone receptor-positive breast cancer who are appropriately treated with endocrine therapy alone after receiving locoregional therapy but do not necessarily require adjuvant chemotherapy is currently problematic. This article reviews the current state-of-the-art biomarker assessment methods and discusses the potential role for the prediction of chemotherapy benefit focusing on endocrine sensitive disease. [ Rev Obstet Gynecol. 2013;6(3/4):165-173 doi:10.3909/riog0228] © 2014 MedReviews®, LLC
Tuberculosis and the Obstetrician-Gynecologist: A Global Perspective Women's Health in the Developing World
Tuberculosis (TB) infection poses substantial challenges for obstetricians and gynecologists globally, as gynecologic involvement may cause infertility, irregular bleeding, and pelvic pain. If TB-infected women are able to conceive, obstetric complications include intrauterine growth restriction and, more rarely, congenital transmission. Appropriate screening for high-risk populations is crucial for diagnosis and treatment of latent and active TB infection, which may prevent reproductive sequelae for individual patients and, eventually, contribute to complete eradication of the disease. [ Rev Obstet Gynecol. 2013;6(3/4):174-181 doi:10.3909/riog0229] © 2014 MedReviews®, LLC
Use of Thrombolytic Agents to Treat Pulmonary Embolism in Pregnancy
Pulmonary embolism in pregnancy is a major cause of maternal mortality and morbidity. We describe the case of a 27-year-old pregnant woman who underwent successful thrombolysis. Our patient presented to the emergency department after a fainting episode and complaining of shortness of breath. A computed tomography pulmonary angiogram revealed a pulmonary embolism, which was found to be causing significant right ventricular strain. After examination by our gynecologic and medical teams, she underwent successful thrombolysis, made a successful recovery, and carried an uneventful pregnancy. [Rev Obstet Gynecol. 2013;6(3/4):182-184 doi:10.3909/riog0206] © 2014 MedReviews®, LLC
News & Views From the Literature
[ Rev Obstet Gynecol. 2013;6(3/4):185-188 doi 10.3909/riog634LitRev] © 2014 MedReviews®, LLC