This chapter guides the reader on the general principles, clinical manifestations, and management of thyroid disease in hospitalized patients.
I fertilization (IVF), an established treatment for infertility, may result in pregnancy and live birth rates higher than following natural conception infertile couples. owever, IVF is associated with two major complications, namely, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). Women with polycystic ovaries (PCO), who are commonly seen in women presenting for infertility treatment are at an increased risk of developing OHSS as a result of ovulation induction for anovulatory compared with that of women with normal ovaries. PCO is diagnosed using Ultrasonography showing at least one ovary with 12 or more follicles of 2-9 mm and/or increased ovarian volume >10 ml, increased echogenic stroma, increased stromal blood flow velocity > 10 cm/s. US picture on one occasion suffices for diagnosis. PCOS refers to the presence of two of three criteria, namely, PCO on ultrasound, oligomenorrhea or irregular menstrual cycles and evidence of hyperandrogenism. Our previous studies have shown increased vascularity and stromal blood flow in women with PCO or PCOS compared with normal ovaries and this is due to higher levels of serum Vascular endothelial growth factor (VEGF) (p < 0.001) in women with PCO (3.4 + 0.7) or PCOS (3.2 + 0.66) than in normal ovaries (2.3 + ng/ml). Higher VEGF may account for increased risk of OHSS in women with PCO and PCOS when they undergo ovarian stimulation. However PCO/PCOS patient may need longer duration for pituitary suppression, they are more sensitive to gonadotropins with the greater risk of OHSS; therefore, use we use lower starting dose of gonadotropins with closer monitoring of ovarian stimulation. Another option is in-vitro maturation oocytes (IVM). This approach is, therefore, cheaper and safer than IVF. Patients exposed to gonadotoxic agents for the treatment of non-oncologic diseases such as systemic lupus erythematosus, who are undergoing surgery for endometriosis and who suffer from genetic disorders such as Turner syndrome and Fragile-X pre-mutation face similar risks. With an increased awareness of the options available, more women are being offered and are utilizing fertility preservation technologies. The methods can differ for women with medical conditions and for those who wish to defer childbearing for social reasons in the absence of a medical condition. IVM avoids treatment delay or exposure to increased estradiol levels associated with IVF and, combined with embryo or oocyte vitrification, provides previously unavailable options. Such as immature oocyte collection in the luteal phase for some patients and improves the services provided by a fertility preservation program. Primary-care physicians and oncologists should be made aware of the available fertility preservation options in order to allow referral of their patients, if desired, to an ART center that offers the full range of fertility preservation options. We have preserved fertility for over 300 women with various medical conditions. In a clinical trial of IVM and oocyte vitrification, we achieved a live-birth rate of 20% and the birth of the first four healthy babies.
I fertilization (IVF), an established treatment for infertility, may result in pregnancy and live birth rates higher than following natural conception infertile couples. owever, IVF is associated with two major complications, namely, multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). Women with polycystic ovaries (PCO), who are commonly seen in women presenting for infertility treatment are at an increased risk of developing OHSS as a result of ovulation induction for anovulatory compared with that of women with normal ovaries. PCO is diagnosed using Ultrasonography showing at least one ovary with 12 or more follicles of 2-9 mm and/or increased ovarian volume >10 ml, increased echogenic stroma, increased stromal blood flow velocity > 10 cm/s. US picture on one occasion suffices for diagnosis. PCOS refers to the presence of two of three criteria, namely, PCO on ultrasound, oligomenorrhea or irregular menstrual cycles and evidence of hyperandrogenism. Our previous studies have shown increased vascularity and stromal blood flow in women with PCO or PCOS compared with normal ovaries and this is due to higher levels of serum Vascular endothelial growth factor (VEGF) (p < 0.001) in women with PCO (3.4 + 0.7) or PCOS (3.2 + 0.66) than in normal ovaries (2.3 + ng/ml). Higher VEGF may account for increased risk of OHSS in women with PCO and PCOS when they undergo ovarian stimulation. However PCO/PCOS patient may need longer duration for pituitary suppression, they are more sensitive to gonadotropins with the greater risk of OHSS; therefore, use we use lower starting dose of gonadotropins with closer monitoring of ovarian stimulation. Another option is in-vitro maturation oocytes (IVM). This approach is, therefore, cheaper and safer than IVF. Patients exposed to gonadotoxic agents for the treatment of non-oncologic diseases such as systemic lupus erythematosus, who are undergoing surgery for endometriosis and who suffer from genetic disorders such as Turner syndrome and Fragile-X pre-mutation face similar risks. With an increased awareness of the options available, more women are being offered and are utilizing fertility preservation technologies. The methods can differ for women with medical conditions and for those who wish to defer childbearing for social reasons in the absence of a medical condition. IVM avoids treatment delay or exposure to increased estradiol levels associated with IVF and, combined with embryo or oocyte vitrification, provides previously unavailable options. Such as immature oocyte collection in the luteal phase for some patients and improves the services provided by a fertility preservation program. Primary-care physicians and oncologists should be made aware of the available fertility preservation options in order to allow referral of their patients, if desired, to an ART center that offers the full range of fertility preservation options. We have preserved fertility for over 300 women with various medical conditions. In a clinical trial of IVM and oocyte vitrification, we achieved a live-birth rate of 20% and the birth of the first four healthy babies.
This chapter guides the reader on the general principles, clinical manifestations, and management of thyroid disease in hospitalized patients.
This chapter presents a case study of a 28-year-old nulliparous patient at 17 weeks gestational age, who wanted to know her chances for prenatal detection of major fetal anomalies as well as options for treatment and any potential risks to her or the fetus if a major anomaly is diagnosed. It presents the background, fetal surgery, delivery mode, fetal risks, pregnancy termination, and maternal risks associated with fetal anomalies. Patients with structural ultrasound anomalies, especially more than one major anomaly, should be offered diagnostic testing. Fetal surgery can be performed via open hysterotomy or minimally invasive techniques (fetoscopy) for a narrow set of indications involving anomalies such as neural tube defects, fetal lung lesions, congenital diaphragmatic hernia, skeletal dysplasias, sacrococcygeal teratomas, and obstructive uropathy. A retrospective cohort study spanning two decades at a single institution compared stillbirth rates between anomalous and nonanomalous pregnancies and noted stillbirth to be significantly higher for fetuses with anomalies.
Infections can impact the outcome of pregnancy, causing pre-term labour, growth restriction and congenital malformations. Vertical transmission can cause significant morbidity and mortality to fetus and new born infant. Pregnant women with any infection are often seen first in primary care, and it is vital to recognise the implications of infections in pregnancy, as timely referral and treatment can have a positive influence on outcomes. This review focuses on some of the major infections affecting pregnancy, outlining the feto-maternal complications and management plans with key points relevant to primary care. The infections covered are cytomegalovirus, hepatitis B and C, herpes, parvovirus, rubella, syphilis, varicella, and zika virus. Human immunodeficiency virus, malaria and toxoplasmosis are not covered in this review. This article, consistent with the position of the Health Protection Agency, considers a clinically significant contact as being in the same room with an affected person for more than 15 minutes or face-to-face contact.
Rationale: Polycystic ovarian syndrome (PCOS) affects a percentage of 5–10% of women of reproductive age worldwide and has a prevalence of 6.6% (95% CI: 2.3–10.9%) in Mexican women and most common cause of infertility in developed countries. Treatment with insulin sensitizing drugs (metformin and pioglitazone) has been shown to improve menstrual cyclicity and fertility in the metabolic profile with polycystic ovarian patients. Incretins and DPP-4 inhibitors have been shown to enhance pancreatic β cell activity, increasing weight loss by its anorexic effect and resulting in an adequate weight control and improved fertility. Previous evidence has compared the effect of exenatide and alone or in combination with metformin in the treatment of PCOS, in this article we will compare sitagliptin and metformin alone or in combination. Study design: Blind, controlled and randomized clinical trial.
Post-term pregnancy, defined as a pregnancy that extends to 42 weeks 0 days and beyond or a gestational length of 294 days or more, occurs in 5–10% of all births. Post-term pregnancy has been associated with maternal and perinatal risks including postpartum hemorrhage, cephalopelvic disproportion, cesarean delivery, oligohydramnios, macrosomia, intrauterine growth restriction, and intrauterine fetal demise. Management strategies have been developed to evaluate and plan delivery for the post-term pregnancy.
The normal vaginal flora is predominately lactobacilli (aerobic organisms) The normal PH is range from 3.8 to 4.5 due to the H+ peroxide producing lactobacilli. The vagina is lined by nonkeratinized stratified squamous epithelium, which is powerfully influenced by estrogen and progesterone. The normal vagina epithelium is strongly estrogenized and rich in glycogen, which supports growth of lactic acid–producing lactobacilli. This results in a low pH (<4.7), which provide some protection in the lower reproductive tract from STIs, including human immunodeficiency virus (HIV). Infections of the vulva, vagina, and cervix are called (lower reproductive tract) and the uterine corpus, fallopian tubes, and ovaries are called (upper reproductive tract).
While all clinicians want to use the best evidence to make health care decisions, with 37 reviews, 47 randomized control trials (RCTs), and two guidelines published every day, it is impossible for practicing clinicians to keep up with all the new evidence and decide whether it is sufficient to suggest that they should change their practice. This book provides a summary of evidence for the major clinical areas of practice within the specialty of Obstetrics and Gynecology (OB/GYN), and this chapter (i) provides an overview and context, discussing the history of evidence based medicine (EBM) in OB/GYN; (ii) describes the importance and conduct of a systematic evidence review, a hallmark of EBM and contemporary evidence-based decision-making; and (iii) provides additional EBM resources and references for interested readers.
In the United States, approximately half of all pregnancies are unintended with nearly half of these women reporting no birth control or inconsistent use of birth control. While birth control pills and sterilization are the most popular methods of birth control, there are other highly effective, reversible methods of birth control. Intrauterine contraception and implants are highly effective, have minimal side effects and few contraindications to their use. When counseling women about their contraceptive options, it is important to discuss all options, effectiveness of various options, future pregnancy plans, the patient's own medical problems and method related side effects and risks.
Venous thromboembolism (VTE) is a significant cause of maternal morbidity and mortality worldwide. In addition to a variety of medical risk factors that increase VTE risk, the physiological adaptations of pregnancy aimed at minimizing hemorrhage augment VTE risk. Risk factors as well as the diagnosis, treatment, and prevention of VTE in pregnancy are discussed.
Menopause is defined as the permanent cessation of menstrual periods. It is determined retrospectively after one year of complete amenorrhea and is caused by a loss of ovarian follicle recruitment. Prior to menopause, women experience the menstrual transition, also known as perimenopause. This chapter explores the endocrinological changes associated with perimenopause and menopause. It explains the clinical symptoms associated with menopause. The chapter discusses the short and long term sequelae of menopause on the female body. One of the first hormonal indications of perimenopause is a rising follicle-stimulating hormone. Mirroring the hormonal fluctuations occurring during perimenopause, menstrual cycles are also in flux at this time and become increasingly irregular. During the menopausal transition, declining estrogen levels are associated with increased risk for cognitive decline and dementia. The chapter focuses on the role of ultrasound in patients with postmenopausal bleeding and incidental ultrasound findings in postmenopausal women and their significance.
