Heidi Anne Duerr, MPH

Pelvic pain and urinary symptoms can present following delivery, but how does delivery method impact these symptoms? Dr Daniel G. Kiefer, physician in the division of maternal-fetal medicine/obstetrics in Lehigh Valley Health Network in Allentown, Pennsylvania, and colleagues conducted a prospective observational cohort study to further explore this question.

Along with the excitement and joy of a new baby come stresses, increased health concerns for mom and the newborn, and other health service issues. Women with infants in the neonatal intensive care unit (NICU) often experience more distress than their counterparts with healthy infants, yet they may lack the resources to address these needs. Dr Kathryn Menard, director of the Center for Maternal and Infant Health and division director and distinguished professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill Medical School, and colleagues sought to ascertain the specific needs of this patient population to help determine if these needs can be met in the NICU setting.

The American College of Obstetricians and Gynecologists recommends that women begin Pap test screening at 21 years, but are there certain circumstances in which Pap tests are warranted at younger ages? Dr Amy M. Johnson of Hartford Hospital in Connecticut and colleagues hypothesized that teenage girls who engage in risky behaviors would benefit from early initiation of cervical screening.

Considered to be one of the most common sexually transmitted infections, human papillomavirus (HPV) infection affects an estimated 26.8% of females aged 14 years to 59 years. This statistic includes low-risk HPV, which can cause genital warts and other nonmalignant conditions, as well as high-risk HPV, which can cause cervical cancer.

Intrauterine devices (IUDs) represent a safe and effective option for preventing unwanted pregnancies. Yet studies have shown that gynecologists still have concerns over its safety and do not utilize evidence-based criteria to assist in the selection of IUD candidates. In order to overcome this obstacle, it is imperative that current obstetric and gynecology residents are receiving correct information on this treatment modality-but are they?

Advances in successful assisted reproductive technologies have enabled clinicians to further aid their patients who would otherwise be unable to conceive. However, little is known about this trend and its continued future growth.

Despite great advances in maternity care, the number of women who give birth to infants requiring special care is still high. The Centers for Disease Control and Prevention’s National Preconception Health Plan has called for care to ameliorate health problems, support pregnancy spacing, and improve future birth outcomes in those women with a previous adverse pregnancy outcome

As clinicians and patients strive to find oral contraceptives that are safe and effective, newer varieties have emerged on the market. Venous thromboembolism, an adverse event that has been associated with third-generation oral contraceptives, is a serious concern, especially with the growing popularity of these newer contraceptives.

Hypertension affects as many as 8% of all pregnancies. Not only does it pose complications during pregnancy, but even if it resolves after delivery, it places women at increased risk for cardiovascular disease. As such, these women should receive cardiovascular disease counseling and screening, including the monitoring of their blood pressure and cholesterol levels, implementation of lifestyle modifications, and awareness of heart attack symptoms.

Insulin resistance in pregnancy poses risks for the mother, including preeclampsia and many other pregnancy-related complications. In this editor’s choice article-fast-tracked for publication in the American Journal of Obstetrics and Gynecology due to its clinical importance-researchers explored the association between increased maternal midtrimester insulin resistance and subsequent preeclampsia.

Chronic hypertension plagues as many as 5% of pregnancies and can result in such adverse perinatal outcomes as preterm birth and fetal death. Further complications can present among women with chronic hypertension who develop superimposed preeclampsia, yet data on perinatal outcomes for such women are sparse.

Spontaneous preterm birth, the most common cause of premature birth, results from a multifactorial process. Its etiology is unknown, which makes it difficult to treat. In addition, there are few proven preventive measures.

Increases in the prevalence of asthma, especially in children, have raised concern in the medical community, resulting in research to find possible causes and to explore potential means of prevention. Recently there has been some evidence linking acetaminophen (known as paracetamol in New Zealand) use in pregnant women and subsequent increased risk for asthma in their offspring.

With more than 7 million infertile women in the United States, the need and demand for effective IVF treatment remains high. Unfortunately for these women/couples, the cost for such treatment is also relatively high.

Untreated sexually transmitted infections (STIs) in pregnancy can lead to such negative outcomes as spontaneous abortion, preterm birth, low birth weight, congenital infections, and other abnormalities.

One in 10 pregnant women experience depression with severe risks, and depression during pregnancy is associated with higher risks for complications as well as postpartum depression. Yet treating depression during pregnancy raises concerns for maternal well-being and fetus well-being alike, requiring clinicians to constantly balance the benefits of psychopharmacological agents for women while minimizing risks to their fetuses.

Intrauterine devices (IUDs) can be a safe, effective, and relatively easy birth control option. However, pregnancy can occur if the IUD dislodges or is not placed properly. Dr Elysia Moschos, associate professor of obstetrics and gynecology, and Dr Diane M. Twickler, professor of radiology, at the University of Texas Southwestern Medical Center in Dallas, studied ultrasound findings, clinical symptoms, and outcomes for women with first-trimester pregnancies despite having intrauterine devices to better understand this issue.

Concern that risks outweighed the possible benefits of estrogen use caused the cessation of the Women's Health Initiative Estrogen-Alone Trial. However, researchers decided to continue monitoring patients for outcomes despite the study protocol discontinuation to gain insight into the long-term effects of the conjugated equine estrogens (CEE) therapy. What they found was surprising-and somewhat positive.

Endometrial cancer remains the most commonly diagnosed gynecologic cancer in the United States. In fact, the number of women affected by the disease continues to rise despite a slight decline in annual incidence rates in the past 30 years.

To prevent over-distention of the bladder, clinicians rely on indwelling catheters for several days. However, little is know about the ideal length of time for catheter use. Although short-term catheterization can reduce hospital stays and urinary tract infections, it can also lead to increased postoperative voiding problems such as obstructive voiding and large residual volumes; these in turn can result in urinary tract infections and bladder dysfunction.

Performing surgeries laparoscopically offers patients faster recovery, decreased blood loss and transfusion rates, and less postoperative pain, but laparoscopic procedures in gynecologic oncology can be very challenging and requires significant technical expertise and experience. It is believed that the integration of robotics into these surgeries might offer a significant advantage in the learning curve, thus allowing more surgeons to offer this procedure to their patients. . . but is this an effective and safe alternative?

According to some estimates, hot flashes affect approximately 32 million women in the United States and may be the most common menopause-related discomfort. Although estrogen can effectively treat this symptom, concerns over estrogen’s safety have caused clinicians and patients alike to seek effective alternatives.

Obesity is a worldwide public health concern that affects many pregnant women. According to new research published in British Journal of Obstetrics and Gynaecology, pregnancy is an ideal time to initiate healthy weight and lifestyle discussions with patients.

Answering the Institute of Medicine’s call to improve patient safety, the New York Presbyterian Hospital-Weill Cornell Medical Center undertook a step-wise, comprehensive, and ongoing safety program. The program was conceived in 2002 and began with a review by independent consultants.

After reaching menopause, women experience body composition changes such as loss of lean body mass, increase in body fat mass, and a shift to central or android fat distribution-all of which are associated with negative health issues. Researchers have hypothesized that hormone therapy might help counter these changes, but thus far studies have been limited by size, type (ie, observational), or length of intervention.

The 2009 H1N1 pandemic caused anxiety and concern, especially for pregnant women and their physicians. The Centers for Disease Control (CDC) recognized this special patient population and the increased risk for serious problems and negative outcomes-both for the women and their unborn babies. As such, the CDC advised doctors to provide antiviral medicines to those with symptoms of the flu and vaccines to those pregnant women who were eligible. They further partnered with the American College of Obstetricians and Gynecology, the American Medical Association, and the American Academy of Family Physicians to educate clinicians and urge their participation in the 2009 H1N1 vaccination programs.

It’s Colorectal Cancer Awareness Month and two medical organizations are taking a stand to emphasize the importance of colorectal screening in women in hopes of further improving early detection and reducing deaths from the disease. Both the American College of Gastroenterology and the American College of Obstetricians and Gynecologists (ACOG) have released statements to increase the use of colorectal screening options in women.

According to government estimates, the incidence of ovarian cancer is almost 13 per 100,000 women per year, and most cases are diagnosed in an advanced stage. As such, proper treatment is critical to ensure survival. However, Dr Melissa M. Thrall, fellow in the department of obstetrics and gynecology at the University of Washington, found that less than 40% of women reliant on Medicare receive standard care.

When used properly, oral contraceptives are extremely effective in preventing unintended pregnancies, yielding only 3 pregnancies per 1000 users in the first year of use. In reality, however, women may not be as adherent as necessary to obtain this ideal rate-studies have shown that about 50% of women regularly miss at least 1 pill per cycle.

Primary care physicians are the entry point for care for many patients. They are often responsible for determining when additional expertise is needed and to which specialist a patient should go for additional care. Although studies have shown that gynecologic oncologists can improve surgical and survival outcomes for patients with ovarian cancer, the referral rate from primary care physicians to gynecologic oncologists remains relatively low.