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Who's Haywood? Path to Leadership: I Am NO Jackie Robinson. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-03-14 Haywood L Brown
Having been afforded many opportunities throughout my academic career, I took on the challenges that chronicled my path to leadership. In many instances, I was the first person of color to enter that educational and leadership environment. I am grateful to many mentors who have guided and supported me over the 4 decades since the time of my residency through fellowships and the various institutions
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Reflections on the Multicenter Randomized Trial of Treatment for Mild Gestational Diabetes. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-03-12 Mark B Landon
After the 2006 hyperglycemia and adverse pregnancy outcomes study, which confirmed the relationship between maternal glycemia and pregnancy outcomes, the debate remained on whether treatment benefited gestational diabetes mellitus (GDM). Nonetheless, practitioners continued to universally screen for and treat women identified as GDM. To assess the benefits and harms of screening and treatment of GDM
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Clinical Trials That Have Changed Obstetric Practice: The Chronic Hypertension and Pregnancy (CHAP) Trial. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-03-11 Ayodeji A Sanusi, Rachel G Sinkey, Alan T N Tita
We describe the evolution of treatment recommendations for chronic hypertension (CHTN) in pregnancy, the CHTN and pregnancy (CHAP) trial, and its impact on obstetric practice. The US multicenter CHAP trial showed that antihypertensive treatment for mild CHTN in pregnancy [blood pressures (BP)<160/105 mm Hg] to goal<140/90 mm Hg, primarily with labetalol or nifedipine compared with no treatment unless
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The Beneficial Effects of Antenatal Magnesium (BEAM) Sulfate Trial. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-02-29 Dwight J Rouse
The BEAM Trial.
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When Change Chooses You: My Journey With Paralysis. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-02-12 Dale B Hull
Life sometimes provides unannounced challenges that threaten the structure of our existence. This personal account of an ob-gyn's encounter with paralysis will illustrate the impact of one such experience.
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The Road Well Traveled: Making Choices, Ensuring Progress While Heeding the "Clarion Call". Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-01-22 E Albert Reece
The career path of everyone is quite unique based on the goals and the choices we make, and success can take time to unfold. My career choices have been greatly influenced by remarkable mentors and opportunities. Reciprocally I have had the pleasure, as a faculty member, department chair, and medical school dean to mentor promising young physicians and scientists to launch successful careers. We need
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Teeter-Totter or Tapestry: A Life in Academic Medicine. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-01-18 Kirtly Parker Jones
Constructing a career in academic medicine involves more than a focus on work-life balance. That image of a teeter-totter suggests that life is what happens when you are not working. The nature of the scope of interests (clinical, research, teaching) and values (service, leadership, curiosity, transparency, and honesty) creates a larger framework through which home life and work life become one interwoven
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Improving the Lives of Women With Ovarian Cancer. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-01-15 Beth Y Karlan
Being a gynecologic oncologist is a privilege. Women with cancer address their challenges with grit and resilience. Their most basic questions motivated my career-long search for scientific answers hidden in genetics, novel therapeutics, and cancer prevention. But medicine is a team sport. Working alongside gifted colleagues and mentoring trainees to assume starring roles on the team has sustained
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Optimizing Management of the Second Stage of Labor: A Multicenter Randomized Controlled Trial. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-01-15 Alexander M Saucedo, Alison G Cahill
To review the findings of the Optimizing Management of the Second Stage of Labor randomized controlled trial in the context of prior and subsequent obstetric literature. A multi-database search was performed in addition to a review of the parent trial and secondary studies. Nulliparous patients with neuraxial anesthesia randomized to either immediate or delayed pushing showed no difference in vaginal
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Improving Sexual Health Across the Life Span Through Integrated Care in Obstetrics and Gynecology. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-01-04 Winnifred Hunter, Jessica Pettigrew, Kristen M Carpenter, Brett Worly, Helen L Coons
Sexual health is a vital part of physical, emotional, and relational well-being among adults across the life span. While patients are reluctant to discuss their sexual concerns, Obstetrics and Gynecology providers are especially well positioned to improve sexual functioning and satisfaction through screening, education, prevention and early intervention, treatment, and integrating behavioral health
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Integrating Mental Health Care in Ambulatory Obstetrical Practices: Strategies and Models. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2024-01-04 Keisha Bell, Bethany D Ashby, Stephen M Scott, Ellen Poleshuck
Perinatal mental health is recognized as a priority component of obstetrical care. Perinatal patients often turn to their obstetrician for help with mental health concerns as they view them as their primary health care provider. Unfortunately, obstetricians face challenges in providing adequate support due to time constraints and limited expertise. Integrated behavioral health care offers a collaborative
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Into the Unknown: Navigating a Path as an Early-stage Physician-scientist in Obstetrics and Gynecology. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-28 Sarah A Wernimont
This piece is a reflection of one early-stage physician-scientist's professional journey. It highlights a few challenges of navigating this path while calling for continued investment and support for physician-scientists to enhance maternal and child lifelong health.
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Career Reflections: Delivering Excellence by Building Great Teams. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-27 Charles J Lockwood
Building great teams who can act rapidly and training energetic leaders who are empowered to innovate have been central themes in my leadership journey: Career reflections of Charles J. Lockwood, MD, MHCM, dean of the USF Health Morsani College of Medicine and executive vice president of USF Health at the University of South Florida (USF).
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Integrated Behavioral Health Care in Reproductive Medicine: How and Why to Include Mental Health Professionals in Infertility Care Teams. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-25 Julia T Woodward, Nicole H Cirino, Susannah Copland, Teni Davoudian
Despite fertility patients' reports of significant distress, few have access to integrated mental health care services. We elucidate the benefits and challenges of mental health integration in infertility practices from the perspective of both patients and providers. We outline specific models of integration, financial viability, and the first steps fertility clinics could take to improve their patients'
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Screening, Assessment, and Treatment of Perinatal Mental Health in Obstetrical Settings. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-22 Lauren A Gimbel, Martha Zimmermann, Nancy Byatt, Tiffany A Moore Simas, M Camille Hoffman
Perinatal mood and anxiety disorders (PMADs) are common, yet obstetricians receive little training prior to independent practice on screening, assessing, diagnosing, and treating patients with depression and anxiety. Untreated PMADs lead to adverse pregnancy and fetal outcomes. Obstetricians are in a unique position to address PMADs. The following serves as a resource for addressing PMADs in obstetric
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Genitourinary Syndrome of Menopause: Prevalence and Predictors. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-21 Nancy F Woods, Joan F Shaver, Judith A Berg
The genitourinary syndrome of menopause (GSM) has been proposed as a diagnosis by a consensus of clinicians and investigators. Our purpose for this paper is to review extant evidence about: 1) the breadth of symptoms and symptom clusters as related to the syndrome; 2) the prevalence of GSM (includes vulvar and vaginal atrophy); 3) factors that are associated with, predict, or explain the syndrome;
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Clinical Practice Guidelines for Managing Genitourinary Symptoms Associated With Menopause. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-21 Monica Christmas, Annabelle Huguenin, Shilpa Iyer
Genitourinary syndrome of menopause encompasses the group of urogenital signs and symptoms resultant from hypoestrogenism, including genital dryness, burning or irritation, sexual discomfort, pain or dysfunction, and urinary urgency, dysuria, and recurrent urinary tract infections. Genitourinary syndrome of menopause can have a profound impact on well-being, functioning, and quality of life in postmenopausal
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Genitourinary Syndrome of Menopause in Cancer Survivors. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-18 Catherine L Dugan, Alisha A Othieno, Mindy E Goldman
Genitourinary syndrome of menopause (GSM) encompasses the symptoms of estrogen deprivation in the vaginal, vulva, and bladder areas. Because many cancer treatments induce a hypoestrogenic state, GSM is common in cancer survivors. The number of cancer survivors is increasing, and the unique aspects of GSM management for cancer survivors, such as the safety of hormonal therapies, is important to understand
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Integrated Care for Pregnant and Parenting People with Substance Use. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-14 Kaylin A Klie, Sarah Nagle-Yang, Lulu Zhao, Melanie E Fringuello
Caring for pregnant people with substance use requires knowledge about specific substances used, treatment options, and an integrated, trauma-informed care team. This chapter will discuss crucial information for clinicians regarding evidence-based practice for screening, intervention, and ongoing support for pregnant people and their families impacted by substance use.
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Genitourinary Syndrome of Menopause: Pathophysiology, Clinical Presentation, and Differential Diagnosis. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-11 Amanda L Clark, Martha F Goetsch
Scientific information is incomplete regarding the genitourinary syndrome of menopause. Both the lower genital and urinary tracts are rich in receptors for reproductive hormones and are highly susceptible to waning ovarian hormones at menopause. Symptoms of dryness and pain emerge in late perimenopause, but they can also result earlier from cancer therapies or bilateral oophorectomy. Lower urinary
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Perinatal Psychopharmacology: Innovative Approaches to Care Delivery. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-11 Sarah Nagle-Yang, Emily S Miller, Lindsay G Lebin, Gabriella Blissett, Emily C Dossett
Perinatal mental health conditions are the most common complications of childbirth and have well-established enduring negative effects. Obstetric (Ob) clinicians care for patients with perinatal mental health conditions across a spectrum of acuity, severity, and complexity. Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients
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Sexual Dysfunction and Dyspareunia in the Setting of the Genitourinary Syndrome of Menopause. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-06 Neha G Gaddam, Sheryl A Kingsberg, Cheryl B Iglesia
Sexual dysfunction is a common consequence of the genitourinary syndrome of menopause (GSM). In this book chapter, we discuss the pathophysiology, prevalence, evaluation, and evidence-based management of sexual dysfunction in patients affected by GSM. Additionally, we present an algorithm to guide clinicians in the management and treatment of sexual dysfunction in this setting based on available evidence
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Behavioral Health Integration on Inpatient Obstetric Units: Program Development, Strategies for Implementation, and Lessons Learned. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-06 Melissa A Kwitowski, Lindsay G Lebin, Jessalyn Kelleher, Meggan Zsemlye, Sarah Nagle-Yang
Perinatal mood and anxiety disorders and substance use disorders are the primary causes of maternal mortality in the postpartum period and represent major public health concerns. Despite this, these conditions remain undertreated. Behavioral health integration in outpatient obstetric settings is necessary but insufficient to meet the needs of all patients. Inpatient behavioral health integration represents
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The Pressing Need to Integrate Mental Health into Obstetric Care. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-12-04 Martha Zimmermann, Tiffany A Moore Simas, Margaret Howard, Nancy Byatt
Mental health and substance use conditions are prevalent among perinatal individuals. These conditions have a negative impact on the health of perinatal individuals, their infants, and families, yet are underdiagnosed and undertreated. Populations that have been marginalized disproportionately face barriers to accessing care. Integrating mental health into obstetric care could address the perinatal
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The ARRIVE Trial. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-11-28 William A Grobman
Timing of delivery such that maternal and perinatal outcomes are optimized is among the most important and commonplace decisions in obstetric care. Given the importance of this determination, it is somewhat surprising that there has been, until relatively recently, little in the way of high-quality evidence to guide obstetric clinicians in this decision. This chapter describes the evolution of studies
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Hormonal Medications for Genitourinary Syndrome of Menopause. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-11-21 JoAnn V Pinkerton, Monique H Vaughan, Andrew M Kaunitz
Genitourinary syndrome of menopause is a common, under-reported, and undertreated chronic progressive condition requiring long-term treatment. Hypoestrogenism in the urogenital tissues is associated with bothersome dyspareunia, vulvovaginal symptoms, overactive bladder, and frequent urinary tract infections. Vaginal hormone therapies, including vaginal estrogen and intravaginal dehydroepiandrostenedione
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The Postmenopausal Vaginal Microbiome and Genitourinary Syndrome of Menopause. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-11-20 Elizabeth Micks, Susan Reed, Caroline Mitchell
This review summarizes our current understanding of associations of the postmenopausal vaginal microbiome with genitourinary syndrome of menopause. We review the normal postmenopausal microbiota, examine the association of the microbiome with vulvovaginal symptoms, describe microbial communities associated with physical and laboratory findings, and report the impact of different treatments for genitourinary
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Genitourinary Syndrome of Menopause: Does Everyone Have It? Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-11-16 Jenny Doust, Annabelle Huguenin, Martha Hickey
In 2014, the North American Menopause Society and the International Society for the Study of Women's Sexual Health recommended using the term genitourinary syndrome of menopause (GSM) to cover a range of genital and urinary symptoms that might be experienced during and after menopause. The term as currently defined, however, includes symptoms that may not be menopausal symptoms. The term GSM also includes
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GSM and Quality of Life Measures. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-11-13 Susan J Diem, Elisheva R Danan
The impact of bothersome vulvovaginal symptoms related to hypoestrogenism on quality of life (QOL) has been evaluated in large international surveys and qualitative studies of vulvovaginal atrophy, most of which were completed before the introduction of the term genitourinary syndrome of menopause (GSM) and focus primarily on vulvovaginal atrophy. The QOL domain most affected in these studies is sexual
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Integrated Care for Persons With Persistent Gynecologic Conditions. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-10-17 Kathryn A Witzeman, Alison Lieberman, Elizabeth Joy Beckman, Kaitlin V Ross, Helen L Coons
Persons with persistent gynecologic conditions frequently cope with complex biopsychosocial challenges and benefit from integrated behavioral health evaluation and treatment within gynecologic practices. Integrated care refers to the provision of behavioral health services within a health care setting which contributes to improved patient, provider, and practice outcomes, however, has not been commonly
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First-trimester Procedural Abortion. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-09-19 Hillary McLaren, Catherine Hennessey
First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can include Rh typing, hemoglobin, and cervicitis testing as indicated by a patient's risk factors. Procedural abortion in the first trimester includes cervical dilation with or without cervical preparation, and uterine evacuation utilizing
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Contraception After Abortion. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-09-18 Marit Pearlman Shapiro, Paris Stowers, Shandhini Raidoo
After a spontaneous or induced abortion, people may desire to delay or prevent a future pregnancy and many desire to use contraceptive methods to do so. Contraception counseling and provision at the time of abortion care are important components to improve contraceptive access and convenience for people undergoing abortion care. The majority of hormonal and barrier contraceptive methods may be safely
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Reproductive Justice as a Framework for Abortion Care. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-09-18 Bianca Hall, Cynthia Akwatu, Antoinette A Danvers
This article presents an in-depth analysis of abortion access and rights within the Reproductive Justice framework, underscoring the health, social, and economic consequences of limited access. It emphasizes the critical role of abortion as essential, safe health care and highlights the complexities surrounding abortion decisions and the barriers faced by poor and historically marginalized populations
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Self-managed Medication Abortion in the United States. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-09-18 Christina Jung, Siripanth Nippita
Self-managed abortion (SMA) is ending a pregnancy without medical supervision, either by obtaining medications (known as self-managed medication abortion) or through other means. Many factors influence a person's decision to pursue self-managed abortion, such as time constraints, financial considerations, and local availability of abortion services. We present on the prevalence, methods and best practices
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Pain Management in Abortion Care. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-09-14 Johana Oviedo, Colleen C Denny
Both medication and procedural abortion are associated with pain. The experiences of pain depend on both physical and emotional factors. Several pain management options are available for abortion, depending on abortion type, clinical setting, and patient considerations, and a comprehensive approach is necessary to optimize pain management.
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HPV Testing and its Role in Cervical Cancer Screening. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-08-03 Megan A Clarke
The recognition that persistent infection with carcinogenic human papillomavirus (HPV) is a necessary cause of cervical precancer and cancer has led to the introduction of HPV testing into cervical cancer screening, either as a primary screening test or in conjunction with cervical cytology (i.e., co-testing). HPV testing has much higher sensitivity for detection of cervical precancer and provides
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Human Papillomavirus Vaccines. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-25 Christine Conageski
Human papillomavirus (HPV) vaccines are highly effective in preventing the transmission of HPV and thus downstream HPV-related lower genital tract neoplasias. First introduced in 2006, the HPV vaccine has demonstrated clinical efficacy in both men and women. Several commercially available vaccines now exist, but only one is available in the United States. Both prelicensure and postlicensure studies
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Management of Abnormal Cervical Cancer Screening Test: A Risk-based Approach. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-25 Richard Guido, Rebecca B Perkins
Cervical cancer screening plays a major role in preventing cervical cancer. The field is based on understanding the natural history of human papillomavirus and its role in cervical cancer. Screening has evolved to assessing the risk for cervical intraepithelial neoplasia grade 3, a true cancer precursor, and performing diagnostic tests based on those risks. This article summarizes the present state
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Emerging Treatment Options for Cervical Dysplasia and Early Cervical Cancer. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-25 Michelle Boisen, Richard Guido
of treatment strategies for cervical cancer precursors, review of medical therapies and emerging therapeutics for treatment of cervical cancers, and updates on new approaches to treating early-stage cervical cancers.
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Unique Challenges of NIPT for Sex Chromosome Aneuploidy. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-24 Louise Wilkins-Haug, Rebecca Reimers
Noninvasive prenatal testing (NIPT) for the sex chromosome aneuploidies (45,X, 47,XXY, 47,XXX, and 47,XYY) differs significantly from that for the autosomal aneuploidies (trisomy 13, 18, and 21). As a group, sex chromosome aneuploidies occur more commonly (1/400) than any one isolated autosomal aneuploidy, the phenotypic variation is greater, the role of mosaicism more challenging, and the positive
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Overview of Noninvasive Prenatal Testing (NIPT) for the Detection of Fetal Chromosome Abnormalities; Differences in Laboratory Methods and Scope of Testing. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-17 Peter Benn, Howard Cuckle
Although nearly all noninvasive prenatal testing is currently based on analyzing circulating maternal cell-free DNA, the technical methods usedvary considerably. We review the different methods. Based on validation trials and clinical experience, there are mostly relatively small differences in screening performance for trisomies 21, 18, and 13 in singleton pregnancies. Recent reports show low no-call
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Cell-free DNA Screening for Aneuploidy. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-17 Mary E Norton
Cell-free DNA (cfDNA) screening has high detection for the common fetal autosomal aneuploidies, but is not diagnostic. The positive predictive value should be utilized in counseling after a positive cell-free DNA screen, and diagnostic testing should be offered for confirmation. cfDNA screening does not report a result in ~3% of cases; nonreportable results indicate an increased risk for aneuploidy
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Chorionic Villous Testing Versus Amniocentesis After Abnormal Noninvasive Prenatal Testing. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-17 Rosemary Rogers, Anne Mardy
In the setting of a normal first-trimester ultrasound, an amniocentesis may be a better option than chorionic villous sampling for invasive diagnostic testing after a cell-free DNA high risk for trisomy 13, given the high rates of confined placental mosaicism. In unaffected fetuses, other evaluations should be considered depending on the cell-free DNA results, including maternal karyotyping for monosomy
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Navigation of Prenatal Care With Sex Discordance Between Cell-free DNA and Ultrasound Findings. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-17 Laurie B Griffin, Meghan McCarthy, Melissa L Russo
The utilization of cell-free DNA (cfDNA) screening has expanded rapidly across the age spectrum of pregnant persons. With cfDNA's widespread adoption, genetic fetal sex is now often known before a phenotypic assessment on anatomic survey. CfDNA detects sex discordance in 1/1500 to 2000 pregnancies. Upon detection of sex discordance, lab error or other factors should first be assessed. Once other causes
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Noninvasive Prenatal Screening for Single-Gene Disorders. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-17 Zenobia Gonsalves, Susan Klugman
Single-gene disorders (SGDs), also known as monogenic disorders, are caused by pathogenic variants at individual loci. Prenatal cell-free DNA screening for SGDs has been investigated for decades. Detecting paternal and de novo variants may be somewhat straightforward, whereas detecting maternally inherited variants poses a significant challenge. Although commercially available in both high-risk and
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Cell-based Noninvasive Prenatal Testing (cbNIPT)-A Review on the Current Developments and Future Prospects. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-17 Mohamad Ali Maktabi, Liesbeth Vossaert, Ignatia B Van den Veyver
Considering the diagnostic limitations of cfDNA-based noninvasive prenatal testing (NIPT), scientists have long been interested in isolating and analyzing rare intact fetal and trophoblast cells from maternal blood or endocervical samples to diagnose fetal genetic conditions. These cells may be scarce and difficult to isolate, but they are a direct source of pure fetal genetic material. In this review
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Incidental Detection of Malignancies With Cell-Free DNA Screening. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-14 Britton D Rink, Blair K Stevens
Cell-free circulating DNA is an evolving technology with important clinical applications in both obstetric care and oncology. In the challenging patient with pregnancy and co-existing malignancy, the utility of cell-free DNA both for aneuploidy screening and cancer identification is an area of active research. Understanding the physiology associated with circulating cell-free DNA and subsequent laboratory
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Anal Cancer and Anal Cancer Screening. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-13 Camryn M Cohen, Megan A Clarke
This chapter provides an overview of anal cancer and contemporary approaches for anal precancer detection, beginning with a discussion of the biology and natural history of anal squamous cell carcinoma, the predominant human papillomavirus -associated histologic subtype of anal cancer. This section is followed by a description of the epidemiology of anal cancer, including trends in incidence and mortality
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First Trimester Ultrasound and Aneuploidy Screening in Twins. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-13 Maeve K Hopkins, Olivia Neumann, Jeffrey A Kuller, Lorraine Dugoff
All patients with twin pregnancy should have first trimester ultrasound and be offered screening for chromosomal aneuploidy as well as diagnostic testing. Screening for aneuploidy in twins presents unique challenges compared with singletons. Cell-free DNA screening should be considered first-line; however, this option may not be available or may have limitations in certain clinical scenarios, such
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Prenatal Screening for Microdeletions and Rare Autosomal Aneuploidies. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-13 Desiree Fiorentino, Pe'er Dar
Noninvasive prenatal screening with cell-free DNA is now considered a first-line screening for common aneuploidies. Advancements in existing laboratory techniques now allow to interrogate the entirety of the fetal genome, and many commercial laboratories have expanded their screening panels to include screening for rare autosomal aneuploidies and copy number variants. Here, we review the currently
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Prenatal Genetic Screening in Twin Pregnancy. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-11 Lauren Buckley, Maeve Hopkins, Jeffrey A Kuller, Lorraine Dugoff
Twin pregnancy presents unique considerations for aneuploidy screening. Pre-test counseling regarding benefits, alternatives, and options for aneuploidy screening should be provided to all patients carrying twin pregnancy. This article aims to review the options for aneuploidy screening in twin pregnancy including the potential benefits and limitations.
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Cervical Cancer Screening: Evolution of National Guidelines and Current Recommendations. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-07-04 Michelle J Khan
Cancer of the cervix is preventable through vaccination against human papillomavirus and by screening and treatment of cervical precancers. Cervical cancer screening has evolved since the Pap smear was first discovered in the 1920s. Current guidelines from the US Preventive Services Task Force and the American Cancer Society incorporate the use of cervical cytology and high-risk human papillomavirus
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Medical Malpractice Lawsuits. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-26 Clayton Robinson, Caroline Kettering, Joseph S Sanfilippo
The tenets of a lawsuit are a deviation from the applicable standard of care that caused an injury. Elements must be addressed, including duty of care, deviation or breach of the duty to care, evidence the breach caused injury, and the identification of associated damages. Steps include consultation by a plaintiff with the attorney, pertinent records and imaging studies, and a review of the material
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Insemination "Fraud": Potentially Criminal Actions in Reproductive Medicine. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-26 Louise P King, Caroline Kettering, Joseph S Sanfilippo
Case law and statutory provisions ensure marital rules of paternity apply when artificial insemination is associated with the pregnancy. Virtually all jurisdictions in the United States provide for gamete donors to remain anonymous. Much of this has been challenged with access to donor information via 23 and me. A breach of trust and a number of lawsuits involving physician provider(s) have resulted
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Are Apologies a Way to Reduce Malpractice Risks? Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-26 Joseph S Sanfilippo, Caroline Kettering, Steven R Smith
Apologies are a means of responding to a medical error. Explanation of information related to the episode often fills a need for the patient and family to feel adequately informed. There are pros and cons related to the apology. The American College of Physicians, the American Medical Association, and the Joint Commission of the Accreditation of Health Care Organization Hospital strongly encourage
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Improving Health Care Responses to Obstetric Hemorrhage. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-05 Patrick Schneider
Obstetric hemorrhage is one of the most commonly encountered obstetrical complications. Decreases in maternal mortality and severe maternal morbidity have continued to be achieved despite the increasing incidence of obstetric hemorrhage over time through the diligent efforts of quality improvement initiatives. Approaches currently advocated to optimize the management of obstetrical hemorrhage are presented
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Interventions of Postpartum Hemorrhage. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-05 Sara E Post, Kara M Rood, Miranda K Kiefer
Postpartum hemorrhage is a common and potentially life-threatening obstetric complication, with successful management relying heavily on early identification of hemorrhage and prompt intervention. This article will review the management of postpartum hemorrhage, including initial steps, exam-specific interventions, medical therapy, minimally invasive, and surgical interventions.
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Maternal Coagulation Disorders and Postpartum Hemorrhage. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-01 T Caroline Bank, Marwan Ma'ayeh, Kara Rood
Coagulation disorders are rare causes of postpartum hemorrhage. Disturbances in coagulation should be suspected in patients with a family history of coagulopathy, those with a personal history of heavy menstrual bleeding, and those with persistent bleeding despite correction of other causes. The coagulopathic conditions discussed include disseminated intravascular coagulation, platelet disorders, and
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Postpartum Hemorrhage-Epidemiology, Risk Factors, and Causes. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-05-01 Kara Patek, Perry Friedman
The incidence of postpartum hemorrhage (PPH) is increasing worldwide and in the United States. Coinciding, is the increased rate of severe maternal morbidity with blood transfusion in the United States over the past 2 decades. Consequences of PPH can be life-threatening and carry significant cost burden to the health care system. This review will discuss the current trends, distribution, and risk factors
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Evaluation During Postpartum Hemorrhage. Clin. Obstet. Gynecol. (IF 1.5) Pub Date : 2023-04-27 Onur Turkoglu, Perry Friedman
Postpartum hemorrhage is an obstetric emergency that is the leading and the most preventable cause of maternal death that occurs on the day of birth. The treatment of postpartum hemorrhage in a timely fashion is crucial to prevent morbidity and mortality. The accurate assessment of blood loss during delivery and the postpartum period remains a major challenge. Hence, it is imperative to have a standardized