SASGOG's Pearls of Exxcellence

Contraception in Women with Cardiovascular Risk Factors

Cardiovascular risk factors include hypertension, diabetes, obesity, smoking and increasing age, and may limit options for contraception, particularly hormonal methods. Clinicians should use the USMEC to guide their counseling and...

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Monochorionic Twins

The risk for fetal and neonatal mortality and long-term morbidity in monochorionic twins is higher than dichorionic twins, with a 3- fold to 4-fold increase in intrauterine demise. Placental vascular...

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Antepartum Management of Dichorionic/Diamniotic Twins

Chorionicity in twins is determined by ultrasonography in the late first or early second trimester, with sensitivity of 90% or better. The twin peak sign (lambda or delta sign)...

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Management of the Breech Presenting at the Introitus

Breech presentation occurs in 2-3% of pregnancies at term. Frank breech accounts for over 50% of breech presentations. Risk factors vary by gestational age, with at term include advanced maternal...

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Management of Second Trimester Fetal Loss

Second trimester fetal loss complicates 1% to 2% of pregnancies and occurs between 14 and 27 weeks gestation and may encompass spontaneous abortion, stillbirth, and early preterm labor. Risk factors...

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Evaluation of Stress Urinary Incontinence

Stress urinary incontinence is an involuntary urinary loss from physical exertion related to increased abdominal pressure, resulting in a reduced quality of life. Of the 16% of adult women...

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Perioperative Management of Anticoagulation in Gynecologic Patients

Editor: Eduardo Lara-Torre, MD For patients using chronic antithrombotic therapy undergoing gynecologic surgery, interruption of therapy to reduce bleeding risk must be balanced against risk of...

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Metabolic Syndrome

The metabolic syndrome encompasses a cluster of risk factors including central obesity, dyslipidemia, elevated blood pressure, and raised fasting glucose. Together these factors increase the risk of atherosclerotic cardiovascular disease,...

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Postmenopausal Vulvar Disorders

A decline in skin barrier function associated with aging and estrogen deficiency contributes to an increased susceptibility to various postmenopausal vulvar conditions. The most common symptoms are itching and burning....

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Surgery in Morbidly Obese Patients

Surgical complications such as infection, venous thromboembolism (VTE), and wound complications are a major source of morbidity in obese women, but may be reduced with attention to preoperative, intraoperative and...

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Amniotic Fluid Embolism

Amniotic Fluid Embolism (AFE) is an uncommon, catastrophic obstetric emergency. The frequency of AFE is 2-7 cases per 100,000 births with a mortality rate as high as 60%. It is...

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Hematoma after Delivery

Puerperal hematomas occur in 1:300 to 1:1,500 deliveries and may pose life-threatening morbidity. A puerperal hematoma is an accumulation of blood in a pelvic avascular potential space. Injury...

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Primary Amenorrhea in a Teenager

Primary amenorrhea (PA) is defined absence of menarche by 15 years old. Secondary amenorrhea is defined as the cessation of regular menses for 3 months or the cessation of irregular...

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Elevated Maternal Serum AFP (MSAFP) During the Second Trimester

Alpha-fetoprotein (AFP) is produced by the fetal yolk sac and liver. Levels rise during the second trimester. Values are expressed as MoMs (multiples of the median) for each specific week...

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Management of Symptomatic Polyhydramnios

Polyhydramnios (or hydramnios) is an excessive amount of amniotic fluid relative to gestational age. It is thought to result from either increased production or decreased clearance of...

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Surgical Management of Patients with Hypertension

Approximately one in three adults in the United States has a diagnosis of systemic hypertension and almost half of them have uncontrolled blood pressure. Hypertension is the most common cause...

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Contraception for Women with Diabetes

The prevalence of diabetes mellitus is increasing worldwide, including among women of childbearing age, with an additional 150 million adult cases projected by 2030. Diabetes poses significant...

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Glycemic Control in Diabetic Patients Undergoing Gynecologic Surgery

Patients with diabetes undergoing surgery are at increased risk of morbidity and mortality from their hypermetabolic stress response, preoperative catabolic state, altered nutritional status, changes in circulation, immobility, and glucose...

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Prevention of Complications in Women with Diabetes Undergoing Surgery

Diabetes mellitus (DM) is a common and increasingly prevalent chronic medical condition affecting one in 11 persons worldwide. Approximately half of these cases are undiagnosed. Routine screening for...

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Evaluation and Management of Bleeding in Perimenopausal Women

The perimenopause is defined as the onset of intermenstrual cycle variability (±7 days) and/or classic menopausal symptoms through two years after the final menstrual period. Menopause is achieved after 12...

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Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease. While the incidence of ICP varies greatly among ethnic groups, in the United States incidence ranges from...

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Evaluation of Sexual Dysfunction

Female sexual dysfunction is defined as any sexual complaint or problem that results from disorders of desire, arousal, orgasm, or sexual pain and causes marked distress or interpersonal difficulty lasting...

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Persistent Postpartum Endometritis

When patients with postpartum endometritis do not respond to initial broad-spectrum antibiotic therapy and either demonstrate persistent temperatures over 38° Celsius after 48 hours or who are critically...

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Medical Management of Menopausal Symptoms

Menopausal symptoms vary for each woman. Symptoms can arise in the perimenopausal period and last throughout the rest of a woman’s lifetime. Vasomotor symptoms occur in 75 to 80%...

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Acute Cardiovascular Disease in Pregnancy

Cardiovascular disease is the leading cause of mortality during pregnancy and the postpartum period, accounting for 35% of maternal deaths worldwide. Nearly 4% of pregnancies in the United States are...

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Recurrent Pregnancy Loss

Pregnancy loss occurs in 15% to 25% of pregnancies, while recurrent pregnancy loss affects up to 2% of pregnancies. Recurrent pregnancy loss is defined by the loss of 2 or...

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