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Roughly 30 million US women, young and old, are living with disabilities, and they need equal access to mammography, contraception, and ob/gyn exams. Special training in treating them would be ideal, but there are still practical ways to break down barriers and provide better care.

Evidence of the value of antepartum fetal surveillance is largely circumstantial. Studies suggest, however, that the NST can provide useful information when done alone, and even more so when combined with other variables.

A detailed history and physical exam can pinpoint problems like coronary artery and lung disease, which are most likely to lead to serious perioperative complications. These experts offer pre-op testing guidelines for higher-risk patients to limit complications and avoid delays in elective surgery.

While not as effective as oral estradiol for the treatment of vasomotor symptoms in postmenopausal women, electroacupuncture may decrease the number of hot flushes experienced by about 50%, making it a viable option, particularly for women who cannot or will not tolerate hormone therapy.

What causes male infertility? Look to the Y chromosome, says this leading expert. Among the high-tech solutions worth considering: testicular sperm extraction (TESE), microsurgical epididymal sperm retrieval (MESA), and intracytoplasmic sperm injection (ICSI).

Last night you were on call and delivered three babies, managed a patient with severe preeclampsia, treated a case of uterine atony, and readmitted a woman with a post-hysterectomy wound infection. Yesterday you covered the hospital's Women's Health Clinic; it's a twice-monthly pro bono service you provide to the community. And this morning, you're facing a waiting room full of patients and two assistant U.S. attorneys. The grave-looking men in dark suits say they are investigating you for up-coding of Medicare and Medicaid claims and private insurance reimbursement. You're facing possible federal criminal prosecution, but you're not alone because the hospital also is being investigated.

Ultrasound has made me a better gynecologist. The introduction of the vaginal probe in the mid 1980s revolutionized the way gynecology is practiced. For me, it has opened doors into understanding the workings of the female pelvis.

The American Medical Association's board of trustees endorsed a new policy supporting the right of physicians to charge patients an extra fee to offset the rising cost of medical liability insurance. The tactic is being implemented by physicians in a few states in response to the medical liability crisis.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.

Women with low levels of pregnancy-associated plasma protein A (PAPP-A) during the first 10 weeks of pregnancy are forty times more likely to have a stillbirth later in pregnancy, according to a multicenter, prospective cohort study conducted in Scotland.

Imagine practicing gynecology and performing the most challenging surgeries day and night without worrying about malpractice suits, managed-care pre-authorization, or CPT and ICD-9 codes. Wouldn't it be wonderful to have no concerns about being paid and patients who are grateful for care even when the outcome isn't perfect? That would never happen in this country but it's a scenario experienced by health-care professionals affiliated with PRN Relief International. These dedicated individuals minister to some of the planet's most needy-and grateful-patients. I was fortunate to be able to serve with them recently in Jamaica and it's an experience I'll never forget.

As described in the first half of this roundtable (see Contemporary OB/GYN, November 2004), the professional liability insurance crisis has had a broad and pernicious impact on the country's obstetrician/ gynecologists. As they conclude the discussion, the panelists move from reflecting on how the crisis came about to speculating about the prospects for reforming--or even completely replacing--the current tort system.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.

An estradiol dose of 14 ?g reduces bone turnover and preserves bone mineral density (BMD) in postmenopausal women, say results of a randomized trial presented at the 15th Annual Meeting of the North American Menopause Society. The once-a-week regimen also does not stimulate the endometrium or increase vaginal bleeding.

A study extending experience with raloxifene to 8 years shows no adverse impact on gynecologic health with longer-term use. Results of the Continuing Outcomes Relevant to EVISTA (CORE) trial build on and support previous findings from the 4-year Multiple Outcomes of Raloxifene Evaluation (MORE) trial.

Women who use oral contraceptives (OC) or hormone replacement therapy (HRT) have a two- to sixfold increased risk of a venous thromboembolic event (VTE) compared with nonusers, according to a recent review of available data. Users of OCs containing desogestrel or gestodene, as opposed to levonorgestrel, are at slightly higher risk. And users of OCs or HRT who carry an inherited hypercoaguable state are at exponentially higher risk.

Vaginal hysterectomy is about four times more likely to fail in women with a narrow pubic arch than in others, according to a prospective cohort study of 75 women.

In women who carry BRCA1 or BRCA2 mutations, MRI is more sensitive for detecting breast cancers than mammography, ultrasound, or clinical breast exam (CBE) alone, but whether this translates into reduced mortality is still unknown. This is according to the results of a surveillance study involving 236 Canadian women between the ages of 25 and 65.

Lasofoxifene is the first selective estrogen receptor modulator (SERM) to help vaginal atrophy, says a multicenter trial presented at the 15th Annual Meeting of the North American Menopause Society (NAMS). Investigators found the drug reduced dryness with few side effects.

Celiac disease-once believed to be rare-actually affects up to 1% of the US population. So underdiagnosed is the problem that the National Institutes of Health convened a consensus panel, which recently announced recommendations for appropriate diagnosis and management of the disease.

The sensitivity and specificity of screening mammography is lower in women taking hormone replacement therapy (HRT), those who have had breast surgery, and those who are thin, according to results from a sample of women from the Million Women Study.

While many hoped that ductal lavage might provide a means for detecting breast cancer sooner in women at high risk for the disease, a recent study finds that the method isn't as useful as we had hoped.