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Infertility Treatment in ChinaOBGYN.net Conference CoverageOBGYN.net visits China-OBGYN.net in a meeting underwritten by InSightecMarch 2006
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What a Normal Pap Smear Means!Who should have a Pap Smear?Any woman who is sexually active or is at least 18 years old should have a Pap smear. Cervical cancer is most commonly caused by HPV (Human Papilloma Virus).
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Osteoporosis Ask The ExpertQuestions this month have been answered by:R. Wayne Whitted, MD., MPH, OBGYN.net Editorial Advisor
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Pelvic Pain and the Pelvic Floor - Diagnosis and TreatmentOBGYN.net Conference CoverageFrom IPPS - Simsbury, Connecticut - April/May, 1999
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The Incontinence Solution: Answers for Women of All AgesThis book is written to give understandable answers to women suffering from Incontinence. It explains the condition and gives realistic options to those suffering from this embarrassing condition. I read it and learned much from it.
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FDA Contraindicates Migraine Treatments for Pregnant WomenThe US Food and Drug Administration has announced that the children of mothers who took medications including or related to valproate sodium during pregnancy show decreased IQ scores, and that these drugs are now contraindicated for pregnant women.
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Hysteroscopic SterilizationAround 153 million women around the world have chosen to be sterilized for contraceptive purposes, of these 138 million are in the developing countries. 1 Approximately fifty percent of all female sterilization is performed during the puerperal period or a cesarean section, and the other fifty percent is called “interval sterilization” when there has been no pregnancy for the previous six weeks.
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Complications of Fluid Overload from Resectoscopic SurgeryExcess absorption of liquid distending media is one of the most frequent complications of operative hysteroscopy. Although most women recover uneventfully, we are seeing cases of permanent morbidity or death resulting from this complications.
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Anemia in Pregnancya. Deficiency: Iron, Folic A., Vitamin B12 b. Hemorrhagic: APH, Hookmworm c. Hereditary: Thalassemia, Sickle, H. Hemolotyic Anemia d. Bone Marrow Insufficiency: Aplastic Anemia e. Infections: Malaria, TB f. Chronic Renal Diseases or Neoplasm
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Ovarian CancerOBGYN.net Conference CoverageFrom First Congress on Controversies in Obstetrics, Gynecology & Infertility Prague CZECH REPUBLIC - October, 1999
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Biofeedback: The "Latest" Treatment for Urinary IncontinenceOn October 6, 2000 the Health Care Financing Administration (HCFA) announced that it was initiating a national policy for coverage of biofeedback treatments of urinary incontinence (UI). This is a significant development both for physicians already using biofeedback and for those contemplating adding conservative therapies to their practice.
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Laparoscopic rectosigmoid resection in case of deep endometriosisIntroduction: Intestinal endometriosis is a disabling disease present in 6% to 30% of deep endometriosis cases. It can be the cause of abdominal bloating, constipation, intestinal cramping and painful bowel movements, defecation pain and intestinal stenosis up to intestinal occlusion. Colorectal endometriosis requires surgical treatment that can be performed by abdominal route or by laparoscopy. The present study describes the total laparoscopic rectosigmoid resection in case of deep endometriosis with bowel involvement.
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The Treatment of Dyspareunia Resulting from Vulvar VestibulitisA Randomized Comparison of Group Cognitive-behavioral Therapy, Surface Electromyographic Biofeedback, andVestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis
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Podcast: What Should You Tell Your Patients About Bioidentical Hormones?Menopausal women often present with a list of complaints, questions and worries. While they seek effective treatment to alleviate their symptoms, they express their concerns regarding the potential adverse effects associated with conventional hormone treatment-namely, coronary heart disease, stroke and breast cancer. As a result, many women ask their clinicians about alternative options. They come armed with anecdotal stories, advice from friends, and information from television and internet sources.
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Strategies for Enhanced Physician Targeting and SegmentationOBGYN.net Conference Coverage from the recent Technology Supported Physician Detailing conference in Philadelphia, PA in September 2004
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Requiring Pharma to Disclose Payments Paints Doctors as VillainsObGyn.net blogger Richard Chudacoff, MD, FACOG, responds to the news that new health care laws will require pharmaceutical companies to disclose all payments to doctors.
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Don't Wait for a Fracture Identifying OsteoporosisLike the proverbial elephant, osteoporosis has been described in ways that vary according to the scientific orientation of the describer. It has been defined clinically as the presence of fracture; biomechanically as decreased bone strength; radiographically as osteopenia; histomorphometrically as reduced bone matrix per unit of bone volume; and epidemiologically as increased fracture risk.
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Hysteroscopy in the office settingOBGYN.net Conference CoverageFrom the 32nd Annual Meeting of the American Association of Gynecological Laparoscopists (AAGL)
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New Techniques in UrogynecologyOBGYN.net Conference CoverageFIGO 2000 INTERNATIONAL FEDERATION of GYNECOLOGY & OBSTETRICS: Washington DC, USA
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Difference in Obstetric Care between U.S. and Eastern European CountriesOBGYN.net Conference CoverageFrom American/Austrian Conference, Salzburg Austria March 4-10, 2000
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Pros and Cons of C-Section on Demand in Low Risk PatientsI think the problem was mainly put on the physicians because it was perceived that in the private sector the cesarean sections were done for monetary reasons. Currently, the issue is becoming a broader one because the women themselves want a cesarean section on request.
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Preventing Infection in NewbornsOBGYN.net Conference CoverageFrom American/Austrian Conference, Salzburg Austria March 4-10, 2000
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Disseminated Intravascular CoagulationDisseminated Intravascular Coagulation (DIC) By Prof. Rifaat Al-Shimmy, Al-azhar U.Definition of DIC A pathological condition associated with activation of both: • Coagulation system and • Fibrinolytic one It should be considered as a secondary phenomena of an underlying disease as...Common Obstetric ConditionsAssociated with: • Inadequate replacement of blood loss • Pre-eclampsia-Eclampsia…HELP syndrome • Ante partum hge (abruption placenta and P.P.) • I U F D when prolonged more than 4 weeks • Blood transfusion when massive or incompatible • Septic abortion or massive tissue injury • Amniotic fluid embolism • Saline I U infusionMassive Transfusion Is defined as the replacement of a patient's total blood volume in less than 24 hours,or as the acute administration of more than half the patient's estimated blood volume per hour. DIC is commonly a consequence of delayed or inadequate resuscitation page_break@DIC: Is it Predictable? • It can probably be predicted in all the previously mentioned high risk groups, except amniotic fluid embolism, as it is an unpredictable condition. • However, in AFE, DIC it always occurs only after resuscitation from the primary shocked state. page_break@Is it Preventable? • It can be avoided in most cases by proper ‘in time’ resuscitation and management of the underlying disease in proper time, e.g. Pre-eclampsiaPathogenesis • The most accepted theory is the Cascade theory in which there is activation of both Extrinsic and Intrinsic pathways leading to activation of factor xa leading to formation of thrombin from prothrombin to form fibrin from fibrinogen • With associated activation of fibrinolytic system as a protective mechanism.Pathophysiology, continued Pregnancy is considered as a hypercoagulable state by: • An increase in all coagulation factors except FXI/FXIII. Fibrinogen which increases to 400-650mg/dl in late pregnancy. • The fibrinolytic system is depressed during normal pregnancy and labor but returns to normal one hour after delivery of the placenta.Pathophysiology, continued Decrease in platelets count is a result of: 1. Consumption 2. Aggregation of plateletsPathophysiology, continued • So DIC is a state of increase thrombin activity at first, followed by increased fibrinolytic activity, leading to… • consumption of coagulation factor (source of old name consumptive coagulopathy) and the formation of FDP impairing homeostasis.Pathophysiology, continued • Deposition of fibrin in organs and tissues may lead to ischemic tissue damage. • The decreased number of platelets and elevated FDP increase the problem of homeostasis.Symptoms of DIC It is variable according to the cause, the presentation of the primary cause with: • Generalized or localized hemorrhage • Peticheae • Thromboembolc manifestation, organ failure as: liver, lung, kidneys, brain and frank gangrene have been described. • Chronic DIC, (that occurs with IUFD) may be asymptomatic.Diagnosis Although the definite diagnosis is only by histological finding of fibrin deposits, there are many indirect tests as: • Bedside clot retraction test • Skin puncture test, measure clotting time (fibrinogen) • D. Diamer (90%) • Platelets count (90%) • FDP (90%) • Thrombin time (80%) • PTT and PT (60%)Bedside Clot Retraction Tes(CT) • It simply tests the clotting time - a test of decreased fibrinogen • 2 ml blood in test tube - no clot formed but if occurs it is prolonged, soft and not retracted after half an hour, leaving a clot volume more than serum volume. (the clot doesn't retract)Skin Puncture Test (bleeding time) • Prolonged skin puncture ooze is observed when the platelets count is less than 100,000/ul • Continuous bleeding at puncture site occurs when pl count is less than 30,000 /ulOther laboratory tests • Platelets count decreases in 90% of cases (count less than 100,000/dl) • PT, which measures the time required by extrinsic pathway, elevated in 80% of DIC • PPT which measure the time required by intrinsic pathway - not helpful. • Thrombin time elevated in 80% of casesOther laboratory tests • Fibrinogen level/ less than150mg. This is present in 70% of cases. • Fibrin split product >40ug/dl, 90% of cases • D-Diamer - an antigen formed as a result of plasmin digestion, elevated in 90%of cases.Treatment of DIC • Essentially treat the underlying cause. In most cases prompt termination of pregnancy is required. • Supportive therapy should be directed to the correction of shock, acidosis and tissue ischemia. • Cardiopulmonary support including inotropic therapy, blood transfusion and assisted ventilationGuidelines by the Scottish Executive Committee of the RCOG
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Rob Newman from InSightec talks about a new method for treating fibroidsFrom the 34th Annual Meeting - Chicago, Illinois - November 2005
