Pearls of Exxcellence

The Foundation for Exxcellence oversees a collaboration between ABOG and SASGOG which allows the most challenging topics from the oral exams to be reviewed by the Pearls Editorial Board.  The Editorial Board then generates and maintains the Pearls articles to help candidates for the certifying (oral) examinations to ensure adequate knowledge in these areas.  A short review and references will be posted periodically.  The Editorial Board continuously reviews, reaffirms and/or revises the library of articles.


The Society for Acedemic Specialists in General Obstetrics and Gynecology

 

Notice Regarding Use

** The Foundation for Exxcellence is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice.

These documents are designed to aid practitioners in providing appropriate obstetric and gynecologic care. Recommendations are derived from major society guidelines and high quality evidence when available, supplemented by the opinion of the author and editorial board when necessary. It should not be construed as dictating an exclusive course of treatment or procedure to be followed.

Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The Foundation for Exxcellence in Women's Health, Inc. reviews the articles regularly; however, these publications may not reflect the most recent evidence. While we make every effort to present accurate and reliable information, the publications are provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. The Foundation does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither The Foundation, the ABOG, SASGOG nor their respective officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

 

Pearls of Exxcellence articles
Log in now, or create a free account to access bonus Pearls features.

Management of Active Phase Arrest

In order to manage active phase arrest, the active phase must be correctly defined, and arrest properly diagnosed. The active phase begins when there is an acceleration in the rate...

Published: 7/1/2019
Category: Obstetrics
Author: Alice Sutton, M.D.

Download

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. ...

Published: 6/1/2019
Category: Office Practice
Author: Amy Markese. MD

Download

Migraine, Cluster, and Tension Headaches

Headache may be classified as primary or secondary. Primary headaches have no associated underlying pathologic abnormalities. The principal primary headaches include cluster, migraine, and tension-type headaches. These syndromes...

Published: 6/1/2019
Category: Office Practice
Author: Frederick Eruo, MD

Download

Management of Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of Premenstrual syndrome (PMS) associated with marked behavioral and emotional symptoms, in addition to physical symptoms According to the American Psychiatric Association...

Published: 5/1/2019
Category: Office Practice
Author: Vicky Mendiratta, MD

Download

Endometrial Ablation

Mentor: Meg Autry, MDEditor: Daniel Breitkopf, MD Endometrial ablation can be performed by several different minimally invasive procedures which cause surgical destruction of the endometrium to treat abnormal uterine...

Published: 3/1/2019
Category: Gynecology
Author: Sara Whetstone, MD, MHS

Download Listen

Intrahepatic Cholestasis of Pregnancy

Mentor: Eric Strand, MD Editor: Elizabeth Ferris-Rowe, MD Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy-specific liver disease. The incidence is between...

Published: 1/1/2019
Category: Obstetrics
Author: Shelby Dickison, MD

Download

Management of Prolonged Latent Phase

Mentor: Marygrace Elson, MD, MME, FACOG Editor: Tiffany A. Moore Simas, MD, MPH, MEd, FACOG Labor is divided into three stages. The first...

Published: 1/1/2019
Category: Obstetrics
Author: Callie Bauer, DO, FACOG

Download

Laparoscopic Sterilization

Mentor: Todd Jenkins, MD Editor: Abimbola Famuyide, MBBS Female permanent sterilization is the most common form of contraception in the United States and is used by nearly half...

Published: 12/1/2018
Category: Gynecology
Author: Tera Howard, MD

Download

Management of Late Term Pregnancy

Mentor: Tony Ogburn, MD Editor: Chesney Thompson, MD Late term pregnancy refers to pregnancies from 41 0/7 through 41 6/7 weeks gestation....

Published: 12/1/2018
Category: Obstetrics
Author: Jennifer Salcedo, MD, MPH, MPP

Download

Evaluation and Management of Bleeding in Perimenopausal Women

Mentor: Sireesha Reddy Editor: Daniel M. Breitkopf The perimenopause is defined as the onset of intermenstrual cycle variability (±7 days) through two years after the final menstrual period....

Published: 11/1/2018
Category: Office Practice
Author: Corrine Bazella, MD

Download

Laparoscopic Port Site Hernias

Elizabeth Ferries-Rowe, MD, FACOG Trocar site hernias occur in approximately 1% of laparoscopies. While rare, trocar site hernias are preventable. Risk factors for trocar site hernia include...

Published: 11/1/2018
Category: Gynecology
Author: Nicole Scott, MD, FACOG

Download

Management of pelvic pain after negative diagnostic laparoscopy

Mentor: Amy Young, MD, FACOG. Editor: Abimbola Famuyide, MBBS. Although considered gold standard in investigating acute or chronic pelvic pain, diagnostic laparoscopy may not demonstrate any causative factors...

Published: 10/1/2018
Category: Gynecology
Author: Michael Breen, MD, FACOG

Download

Fluid Management at Hysteroscopy

Mentor: Ashlyn Savage, MD Editor: Abimbola Famuyide, MD During hysteroscopy, systemic absorption of uterine distension fluid occurs largely through disrupted endometrial and myometrial venous sinuses as a...

Published: 10/1/2018
Category: Gynecology
Author: Michelle Meglin, MD

Download

Management of Preeclampsia at Term

Mentor: Tony Ogburn, MD Editor: Tiffany A. Moore Simas, MD, MPH, MEd Management of preeclampsia at term (≥ 37 0/7 weeks) involves assessing...

Published: 9/1/2018
Category: Obstetrics
Author: Maria Shaker, MD

Download

Evaluation and Management of an Ovarian Mass in a Patient with a Family History of Ovarian Cancer

Mentor: Pamela D. Berens, MD Editor: Daniel Breitkopf, MD Increasing age is the most important risk factor for ovarian cancer in the...

Published: 9/1/2018
Category: Gynecology
Author: Christina Wallace Huff, M.D.

Download

Management of Brow, Face, and Compound Malpresentations

Mentor: Lisa Keder MD Editor: Elizabeth Ferries-Rowe, MD Five percent of fetuses present in brow, face, or compound presentations, many of which result in vaginal...

Published: 8/1/2018
Category: Obstetrics
Author: Meera Kesavan, MD

Download

Vaginal Squamous Intraepithelial Lesions

Mentor: L. Chesney Thompson, MD Vaginal intraepithelial neoplasia (VaIN) affects 0.2 per 100,000 women in the United States. VaIN, like cervical intraepithelial neoplasia (CIN), is caused by Human...

Published: 8/1/2018
Category: Office Practice
Author: Christine Conageski, MD

Download

Management of Hirsutism in a PCOS Patient

Mentor: Lisa M. Keder, MD, MPH Editor: Eduardo Lara-Torre, MD Hirsutism is often a primary complaint in women with PCOS. The most effective treatment includes a long-term approach...

Published: 7/1/2018
Category: Office Practice
Author: Camille A. Clare, MD, MPH

Download

Evaluation and Management of Ruptured Membranes with Amnionitis at Term

Mentor: Paula J. Hilliard, MD Editor: Julie DeCesare, MD Intraamniotic infection (IAI), or amnionitis, is an inflammatory or infectious disorder involving any combination of amniotic...

Published: 6/1/2018
Category: Obstetrics
Author: Katie Shvartsman, MD

Download

Ultrasound Markers for Down Syndrome

Down Syndrome (trisomy 21) is the most common chromosomal disorder in live born infants. About 6,000 babies are born with Down Syndrome each year in the United States, or about...

Published: 5/1/2018
Category: Obstetrics
Author: Meaghan Shanahan, MD

Download

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...

Published: 4/1/2018
Category: Gynecology
Author: Joseph Peterson, MD

Download

Prevention of Complications in Women with Diabetes Undergoing Surgery

Mentor: Julie DeCesare, MD Editor: Christine Isaacs, MD Diabetes mellitus (DM) is a common and increasingly prevalent chronic medical condition with an incidence...

Published: 4/1/2018
Category: Gynecology
Author: Tara E. Kelly, MD

Download

Surgery in Morbidly Obese Patients

Mentor: Sireesha Reddy, MD Editor: Ches Thompson, MD Preoperative preparation for obese patients requires attention to health conditions more common with obesity, including coronary artery disease (CAD),...

Published: 3/1/2018
Category: Gynecology
Author: Bani M. Ratan, MD

Download

Hysteroscopic Bowel Injury

Although hysteroscopic complications are rare, uterine perforation can cause serious injury to adjacent structures. Compared to diagnostic procedures, operative hysteroscopy elevates the risk of uterine corpus perforation 16-fold, and increases...

Published: 3/1/2018
Category: Gynecology
Author: Makeba Williams, MD, FACOG. NCMP

Download

Evaluation of Preeclampsia at Term

Gravidas at term (≥37 weeks) with new-onset hypertension or symptoms suggesting potential end organ effects such as headache, visual changes, or right upper quadrant or epigastric pain, should be evaluated...

Updated: 5/1/2019
Published: 2/1/2018
Category: Obstetrics
Author: Cynthie K. Anderson, MD, MPH

Download

Abnormal Uterine Bleeding in Adolescents

Abnormal uterine bleeding (AUB) in adolescents is defined as excessive bleeding occurring between menarche and 19 years of age. During the first 12–18 months after the onset of menstruation, immaturity...

Published: 1/1/2018
Category: Office Practice
Author: Nyima Ali, M.D.

Download

Complications of Pessary Use

Pessary devices have been used for centuries for a number of indications including pelvic organ prolapse, urinary incontinence, and cervical insufficiency. They are considered a safe and reasonable long-term option...

Published: 1/1/2018
Category: Office Practice
Author: William Po, M.D., FACOG

Download

Pertussis in Pregnancy

Pertussis, also known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Infection causes paroxysms of coughing which can lead to dyspnea, hypoxia,...

Published: 12/1/2017
Category: Obstetrics
Author: Sarah Shaffer, DO

Download

The Management of Borderline Ovarian Tumors in Young Nulliparous Women

Borderline ovarian tumors, previously known as low-malignant potential (LMP) tumors, make up nearly 20% of ovarian epithelial cancers and have an excellent prognosis regardless of stage at diagnosis. Borderline ovarian...

Published: 11/1/2017
Category: Gynecology
Author: Erica L. Berry D.O., FACOG

Download

Perioperative Management of Women with Chronic Obstructive Airway Disease and Asthma

The overall incidence of postoperative pulmonary complications is 5-10%, but patients with poorly controlled chronic obstructive airway disease (COPD) and asthma are at increased risk with up to 40% risk...

Updated: 7/5/2019
Published: 10/1/2017
Category: Gynecology
Author: Roopina Sangha, M.D., MPH

Download

Management of Placenta Accreta at Delivery

Mentor: Nancy Gaba, MD Editor: Christine Isaacs, MD and Tiffany Moore-Simas, MD Placenta accreta occurs when all or part of the placenta invades and is...

Published: 9/1/2017
Category: Obstetrics
Author: Anjali Martinez, MD

Download

Infertility in patients with PCOS

Editors: Julie Decesare, MD and Eduardo Lara-Torre, MD Polycystic ovarian syndrome (PCOS) is the leading cause of infertility in reproductive age women. Anovulation is generally assumed to be the...

Published: 8/1/2017
Category: Office Practice
Author: Loriana Soma, MD

Download

Lynch Syndrome

Mentor: Todd Jenkins MD Editor: Elizabeth Ferries-Rowe Lynch syndrome is an autosomal dominant hereditary cancer syndrome which commonly presents with colon cancer, endometrial cancer, or ovarian cancer. ...

Published: 7/1/2017
Category: Office Practice
Author: Janeen Arbuckle M.D., PhD

Download

Postpartum Hemorrhage from Atony Unresponsive to First Line Uterotonics

Mentor: Tiffany A. Moore-Simas, MD Editor: Christine R. Isaacs, MD Primary postpartum hemorrhage (PPH), a leading cause of severe maternal morbidity in the US, is defined...

Published: 6/1/2017
Category: Obstetrics
Author: Efua Leke, MD

Download

Contraception in Women with Diabetes

Mentor: Todd Jenkins, MD Editor: Pamela D. Berens, MD The prevalence of diabetes mellitus is increasing worldwide, including among women of childbearing age,...

Published: 5/1/2017
Category: Office Practice
Author: Jane S. Limmer, MD

Download Listen

Trial of Labor after Cesarean (TOLAC)

Mentor: Thomas M. Gellhaus, MD Editor: Roger Smith, MD Options following a cesarean delivery include elective repeat cesarean delivery and trial of labor after cesarean (TOLAC)....

Published: 4/1/2017
Category: Obstetrics
Author: Sarah Shaffer, DO

Download

Contraception for Women with Migraines

Mentor: Marygrace Elson, MD, MME Editor: Eduardo Lara-Torre, MD Migraine headache is a common condition that affects...

Published: 3/1/2017
Category: Office Practice
Author: Abbey Hardy-Fairbanks, MD

Download

Overactive Bladder

Overactive bladder (OAB) is defined as “urinary urgency, typically accompanied by frequency and nocturia, with and without urge urinary incontinence, in the absence of urinary tract infection or other obvious...

Updated: 7/5/2019
Published: 2/1/2017
Category: Office Practice
Author: Julie DeCesare, MD

Download

Contraception in Women with Cardiovascular Risk Factors

Mentor: Todd Jenkins, MD Editor: Christopher M. Zahn, MD Cardiovascular risk factors include hypertension, diabetes, obesity, smoking and increasing age, and may limit options for contraception,...

Published: 1/18/2017
Category: Office Practice
Author: Margaret M. Boozer, MD

Download

Contraception in Women with Lupus

Mentor: Nancy D. Gaba, MD Editor: Ronald T. Burkman, MD Systemic Lupus Erythematosus (SLE) is an autoimmune disease with a highly variable presentation...

Published: 1/18/2017
Category: Office Practice
Author: Jennifer M. Keller, MD

Download

Hormonal Contraception in Women Taking Medications with Potential Drug Interactions

Mentor: Eric A. Strand, MD Editor: Pamela D. Berens, MD Interactions between hormonal contraceptives and other medications can cause alteration of therapeutic medication...

Published: 1/18/2017
Category: Office Practice
Author: Camaryn Chrisman-Robbins, MD

Download

Surgical Management of Women with Hypertension

Mentor: Daniel M. Breitkopf, MD Editor: Abimbola O. Famuyide, MD Approximately 1 in 3 adults in the United States have a diagnosis of systemic hypertension,...

Published: 1/1/2017
Category: Gynecology
Author: Mostafa Borahay, MBBS

Download

Clostridium Difficile Colitis

Editor: Ronald T. Burkman, MD Clostridium difficile should be suspected as a cause of acute diarrhea in patients with recent surgery or antibiotic use. Acute diarrhea is usually...

Published: 12/1/2016
Category: Gynecology
Author: Larry J. Copeland, MD

Download Listen

Management of Symptomatic Polyhydramnios

Mentor: Tiffany A. Moore-Simas, MD Editor: Martin E. Olsen, MD Polyhydramnios (or hydramnios) is an excessive amount of amniotic fluid relative to gestational age. It...

Published: 10/1/2016
Category: Obstetrics
Author: Jane S. Limmer, MD

Download

Minor Red Cell Antigens and Fetal Hemolytic Anemia

There are more than 300 recognized blood-group antigens, of which the Rhesus (Rh) blood-group system is the most common cause of maternal alloimmunization. It is comprised of the c, C,...

Published: 9/1/2016
Category: Obstetrics
Author: Patricia A. Smith, MD

Download

Cytomegalovirus Infection in Pregnancy

Cytomegalovirus (CMV) is the most common congenital viral infection, occurring in 0.2 – 2.2% of neonates. Up to 4% of women have a primary CMV infection during pregnancy. CMV may...

Updated: 5/1/2019
Published: 8/1/2016
Category: Obstetrics
Author: Michael Adler, MD

Download

Monochorionic Twins

In the United States, twin gestation is no longer a rare event due to the increase in maternal age at conception and the increase in use of assisted reproductive technology....

Published: 7/1/2016
Category: Obstetrics
Author: Sharon L. Seidel, MD

Download

Hyperthyroidism in Pregnancy

Mentor: Laurie S. Swaim, MD Editor: Eduardo Lara-Torre, MD Thyroid diseases in pregnancy must be differentiated from normal physiologic adaptations including increased thyroid volume (up to 30%)...

Published: 6/1/2016
Category: Obstetrics
Author: Helen R. Dunnington, MD

Antepartum Management of Dichorionic/Diamniotic Twins

Editor: Tiffany A. Moore Simas, MD, MPH, Med Chorionicity in twins is best determined by ultrasonography in the late first or early second trimester, with sensitivity of 90% or...

Published: 5/4/2016
Category: Obstetrics
Author: Marygrace Elson, MD

Management of the Breech Presenting at the Introitus

Mentor: Julie DeCesare, MD Editor: David Chelmow, MD Breech presentation occurs in 3-4 % of pregnancies at term. Frank breech accounts for over 50% of breech presentations....

Published: 5/4/2016
Category: Obstetrics
Author: Joseph E. Peterson, MD

Management of Twin Delivery

Important factors in determining the route of delivery for a twin gestation include: Chorionicity Fetal presentations Gestational age Estimated fetal weights and discordance ...

Published: 5/4/2016
Category: Obstetrics
Author: Holly-Marie Bolger, DO

Download

Management of Vaginal Cysts

Mentor: Thomas Gellhaus, MD Editor: Eduardo Lara-Torre, MD Vaginal cysts occur in 1% of all women. Most are benign, asymptomatic, discovered incidentally, and should be...

Published: 4/1/2016
Category: Office Practice
Author: Sarah Shaffer, DO

Download

Management of Second Trimester Fetal Loss

Mentor: Abimbola Famuyide, MD Editor: Regan Theiler, MD Second trimester fetal loss occurs between 14 and 27 weeks and may encompass...

Published: 3/1/2016
Category: Obstetrics
Author: Vanessa Torbenson, MD

Download

Management of Large Rectoceles in Geriatric Patients

Mentor: Tiffany Moore-Simas, MD Editor: Julie Decesare, MD Patients with rectoceles may be asymptomatic or have symptoms such as splinting, pelvic pressure, dyspareunia, constipation,...

Published: 3/1/2016
Category: Gynecology
Author: Anne Garrison, MD

Download

Management of Fetal Demise caused by Abruption at Term

Mentor: Nancy D. Gaba, MD Editor: Daniel Breitkopf, MD Placental abruption complicates 0.5 to 1% of pregnancies, but very rarely results in fetal demise. Fetuses that survive...

Published: 2/1/2016
Category: Obstetrics
Author: Shari M. Lawson, MD

Download

Post-pill Amenorrhea

Editor: Eduardo Lara-Torre, MD Combined hormonal contraceptives (CHC), including combined oral contraceptives (COC), inhibit ovulation through hypothalamic-pituitary inhibition of gonadotropin secretion. Historically, it was believed that...

Published: 2/1/2016
Category: Office Practice
Author: Ahn T. Nguyen, MD

Download

Evaluation of Stress Urinary Incontinence

Mentor: Christopher M. Zahn, MD Editor: Vanessa Gregg, MD There are several different types of urinary incontinence: stress, urge, chronic urinary retention (overflow), mixed, and...

Published: 1/1/2016
Category: Office Practice
Author: William D. Po, MD

Download Listen

Surgical Management of Stress Urinary Incontinence

Mentor: Laurie S. Swaim MD Editor: Christopher M. Zahn, MD Stress urinary incontinence (SUI), defined as involuntary leakage of urine during coughing, laughing, sneezing, or...

Published: 1/1/2016
Category: Gynecology
Author: Anitra D. Beasley MD, MPH

Download Listen

Non-surgical Management of Stress Urinary Incontinence

Mentor: Christine R. Isaacs, MD Editor: Tiffany Moore Simas, MD Stress urinary incontinence (SUI) is defined as the involuntary leakage of urine with cough, sneeze,...

Published: 1/1/2016
Category: Office Practice
Author: Natalie A. Bowersox, MD

Download

Management of Postoperative Ileus

Mentor: L. Chesney Thompson, MD Editor: Martin E. Olsen, MD Postoperative ileus is a absent or abnormal peristalsis after surgery causing a functional obstruction without mechanical blockage. A...

Published: 12/1/2015
Category: Gynecology
Author: Sarah M. Appleton, MD

Download

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...

Published: 12/1/2015
Category: Gynecology
Author: Christopher M. Zahn, MD

Download Listen

Postmenopausal Bleeding in a Woman with a Stenotic Cervix

Mentor: Sandra Dayaratna, MD Editor: Eduardo Lara-Torre, MD Postmenopausal bleeding (PMB), defined as any bleeding which occurs greater than 12 months after the final menstrual period, requires evaluation...

Published: 12/1/2015
Category: Gynecology
Author: Rebecca Jackson, MD

Sepsis

Mentor: Rajiv Gala, MD Editor: Chris Zahn, MD Sepsis is a systemic, dysregulated, inflammatory response with an identified source of infection. Septic shock and multiorgan dysfunction are subtypes...

Published: 12/1/2015
Category: Obstetrics
Author: Anita P. Tamirisa, MD

Download

Complications of TVT and TOT

Mentor: Ellen Brock, MD Editor: Eduardo Lara-Torre, MD Tension-free transvaginal tape (TVT) and transobturator tape (TOT) are polypropylene mesh “slings” placed in a midurethral...

Published: 11/1/2015
Category: Gynecology
Author: Aaron E. Goldberg, MD

Download

Trichomonas, Gonorrhea, and Chlamydia in Pregnancy

Mentor: Christine A. Carey, MD Editor: Christopher M. Zahn, MD Chlamydia trachomatis Most infections are asymptomatic, but may manifest with urethritis, Bartholin gland infection, or mucopurulent cervicitis....

Published: 11/1/2015
Category: Obstetrics
Author: Meredith J. Alston, MD

Download

Postpartum Eclampsia

Mentor: Anita K. Blanchard, MD Editor: Roger Smith, MD Eclampsia is defined as preeclampsia related new onset generalized tonic-clonic seizures and can result...

Published: 11/1/2015
Category: Obstetrics
Author: Maryam Siddiqui, MD

Download

Management of Primary and Recurrent HSV 2 Vulvar Infections

Editor: Rebecca P. McAlister, MD Serologic surveys show 26% of women 12 years and older have antibodies to HSV-2. While the initial presentation is similar for...

Published: 11/1/2015
Category: Office Practice
Author: Rajiv B. Gala, MD

Download

Contraception in Women with Thromboembolism and Thrombophilia

Mentor: David Chelmow, MD Editor: Christine R. Isaacs, MD Estrogen administration increases the risk of venous thromboembolism (VTE) in women with a history of prior thromboembolism or known...

Published: 10/1/2015
Category: Office Practice
Author: Frances Casey, MD

Download

Metabolic Syndrome

Mentor: Laurie S. Swaim, MD Editor: Paula J. Hillard, MD The metabolic syndrome encompasses a cluster of risk factors including central obesity, dyslipidemia, elevated blood pressure, and hyperglycemia....

Published: 10/1/2015
Category: Office Practice
Author: Anitra D. Beasley, MD

Download

Fecal Incontinence

Editor: Rebecca McAlister, MD Fecal incontinence is defined as the involuntary loss of liquid or solid stool, whereas anal incontinence, commonly termed “accidental bowel leakage” (ABL), also includes the...

Published: 10/1/2015
Category: Office Practice
Author: Catherine A. Matthews, MD

Download

Evaluation of the Adnexal Mass in an Older Woman

Editor: Martin E. Olsen, MD The evaluation and management of an adnexal mass in an older woman is an important clinical challenge. Adnexal masses arise...

Published: 10/1/2015
Category: Office Practice
Author: Todd R. Griffin, MD

Download

Management of Adnexal Masses in Pregnancy

Mentor: L. Chesney Thompson, MD Editor: Ronald T. Burkman, MD The overall prevalence of adnexal pathology in pregnancy is 1-6%, depending on the gestational age at presentation. The...

Published: 9/2/2015
Category: Obstetrics
Author: Patricia S. Huguelet, MD

Download

Management of Persistent and Recurrent Trichomonas

Trichomonas vaginalis (T. vaginalis) is a protozoan parasite. It is one of the most common sexually transmitted infections, with an estimated 3.1% prevalence in the United States. Risks for infection...

Updated: 7/5/2019
Published: 9/1/2015
Category: Office Practice
Author: Christine R. Isaacs, MD

Download

Management of Women on Hormonal Therapy or Contraception in Women Undergoing Surgery

Editor: Martin E. Olsen, MD Hormone therapy and use of combination hormonal contraceptives are associated with an increased risk of venous thromboembolism. Menopausal women taking estrogen plus progesterone therapy...

Published: 9/1/2015
Category: Office Practice
Author: Amanda Murchison, MD

Download

Postmenopausal Vulvar Disorders

Editor: Rebecca McAlister, MD The postmenopausal vulva is characterized by a decline in skin barrier function associated with aging and estrogen deficiency that contributes to increased susceptibility to a...

Published: 8/28/2015
Category: Office Practice
Author: Elizabeth A. Ferries-Rowe, MD

Download

Cystic Breast Masses in Young Women

The differential diagnosis of a cystic breast mass in a young woman includes benign cyst, fibrocystic changes, fibroadenoma, breast abscess, galactocele, fat necrosis, and malignancy. Evaluation should include history, exam,...

Updated: 7/1/2019
Published: 8/1/2015
Category: Office Practice
Author: Ashley Wright, MD

Download

Neonatal Encephalopathy and Cerebral Palsy

Mentor: Paul L. Ogburn, MD Editor: Martin E. Olsen, MD Neonatal encephalopathy is a clinical syndrome of neurologic dysfunction noted in the first days of life...

Published: 7/1/2015
Category: Obstetrics
Author: Moune Jabre, MD

Download

Management of a Patient who has Suffered Domestic Violence

Domestic violence, or intimate partner violence (IPV), is threatening or controlling behavior inflicted on a person by another person in the context of an intimate relationship. Intimate partner violence...

Updated: 5/1/2019
Published: 1/1/2015
Category: Office Practice
Author: Marygrace Elson, MD

Download

Evaluation and Management of Obstetric Anal Sphincter Injuries (OASIS)

All women having vaginal delivery should be closely examined for vaginal and perineal injuries and those with perineal laceration should have rectal examination to determine the extent of their injury...

Published: 12/1/2014
Category: Obstetrics
Author: Camaryn Chrisman-Robbins, MD

Download

Evaluation of Dyspnea and Management of Pulmonary Embolism after Surgery

The differential diagnosis for dyspnea in a patient after gynecologic surgery or cesarean delivery should include atelectasis, pneumonia, and pulmonary thromboembolism (PTE). Atelectasis is the most common cause, occurring...

Updated: 7/5/2019
Published: 11/1/2014
Category: Gynecology
Author: Sabrina N. Wyatt, MD

Download

Management of Grade 1 Adenocarcinoma of the Endometrium

Surgery is the cornerstone of treatment for endometrial carcinoma except for select premenopausal patients desiring fertility, and patients with significant medical comorbidities. In patients with known grade 1 adenocarcinoma,...

Updated: 7/5/2019
Published: 10/1/2014
Category: Gynecology
Author: Anitra D. Beasley, MD

Download

Evaluation of Postmenopausal Vaginal Bleeding

Mentor: Rebecca McAlister, MD Editor: Daniel Breitkopf, MD Postmenopausal bleeding (PMB) is defined as any staining, spotting, or bleeding that occurs more than 12 months...

Published: 8/1/2014
Category: Office Practice
Author: A. Savage, MD

Download

Management of Wound Complications of Cesarean Delivery

Mentor: Christopher M. Zahn, MD Editor: Tiffany A. Moore Simas, MD, MPH, Med Preoperative measures that reduce wound infection include prophylactic antibiotics given within one...

Published: 7/1/2014
Category: Obstetrics
Author: William D. Po, MD

Management of Evisceration of the Vaginal Cuff

Mentor: David Chelmow, MD Editor: Abimbola Famuyide, MD, MBBS Vaginal cuff dehiscence, a rare complication of vaginal hysterectomy, is the full or partial separation of the edges...

Published: 5/1/2014
Category: Gynecology
Author: Aaron Goldberg, MD

Management of Women with Multiple Fibroids who are Attempting Pregnancy

Although the presence of fibroids in most women will not impair their fertility or affect an ongoing pregnancy, some women with fibroids may face several pregnancy-related risks. Submucosal fibroids increase...

Published: 4/1/2014
Category: Office Practice
Author: Daniel Breitkopf, MD

Download

Fetal Heart Rate Baseline Abnormalities: Bradycardia

Editor: Paul Wendel, MD Editor: Elizabeth Ferries-Rowe, MD Fetal bradycardia is defined as a baseline fetal heart rate less than 110 beats per minute...

Published: 3/1/2014
Category: Obstetrics
Author: Adam Sandlin, MD and Paul Wendel, MD

Download

Perforation with Uterine Sound and Suction Cannula during a D&C

Editor: Eduardo Lara-Torre, MD Uterine perforation is one of the more common complications of cervical dilation and uterine curettage. The incidence is increased for a pregnant...

Published: 2/1/2014
Category: Gynecology
Author: Eugene C. Toy, MD

Download

Diagnosis and Management of Cervical Ectopic Pregnancy

Editor: Vanessa Gregg. MD Cervical ectopic pregnancy is the rare implantation of a pregnancy in the endocervical canal and accounts for less than 1% of...

Published: 1/1/2014
Category: Gynecology
Author: Paula Amato, MD

Download Listen

Proximal Tubal Occlusion

Editor: Rebecca McAlister, MD Proximal tubal occlusion is a common finding on hysterosalpingogram, occurring in up to 15% of studies. The occlusion is seen at the...

Published: 11/1/2013
Category: Office Practice
Author: Daniel R. Grow, MD

Download

Evaluation of Anemia in Pregnancy

Editor: Ronald T. Burkman, MD Anemia is common in pregnancy because blood volume expands by approximately 50% in a singleton gestation while total red blood cell mass only...

Published: 7/1/2013
Category: Obstetrics
Author: Julie L. Hansen, MD

Download

Ongoing Care of a Woman with Breast Cancer on an Aromatase Inhibitor

Editor: Daniel Breitkopf, MD Breast cancer is the second leading cause of cancer death among women in the United States. Seventy five percent of breast cancers are estrogen...

Published: 6/1/2013
Category: Office Practice
Author: Stephanie V. Blank, MD

Download

Management of Broad Ligament Extension and Hematoma during a Cesarean Delivery

Editor: Regan Theiler, MD The broad ligaments consist of anterior and posterior leaflets of peritoneum which cover the lateral uterine corpus and upper cervix and...

Published: 5/1/2013
Category: Obstetrics
Author: Paul J. Wendel, MD

Download

Amniotic Fluid Embolism

Editor: Elizabeth Ferris-Rowe, MD Amniotic Fluid Embolism (AFE) is an uncommon, catastrophic obstetric emergency. The frequency of AFE is 2-7 cases per 100,000 births. It is...

Published: 4/1/2013
Category: Obstetrics
Author: Mari-Paule Thiet, MD

Download Listen

Management of Bilateral Tubo-Ovarian Abscesses in Young Nulligravida

Editor: Eduardo Lara-Torre, MD Tubo-ovarian abscess (TOA) occurs in 15% of cases of pelvic inflammatory disease (PID), and 33% of patients with PID requiring admission....

Published: 3/1/2013
Category: Gynecology
Author: May Blanchard, MD

Download

Management of a Lost Pedicle At the Time of a Vaginal Hysterectomy

Editor: Rebecca McAlister, MD Clinically significant bleeding occurs in 1-2% of vaginal hysterectomies; subclinical hematomas, identified by sonography, may be seen in up to 15% of cases. Risk factors...

Published: 2/1/2013
Category: Gynecology
Author: Eugene C. Toy, MD

Download

Management of Atypical Glandular Cells

Editor: Paula J. Hillard, MD Atypical glandular cells (AGC) are uncommon, occurring in approximately 3 per 1000 specimens, but are a significant cervical cytology finding. Several retrospective studies...

Published: 1/1/2013
Category: Office Practice
Author: Andrew W. Menzin, MD

Download

Hematoma after Delivery

Editor: Roger Smith, MD Puerperal hematomas can occur after spontaneous or operative vaginal delivery. Frequently cited risk factors include the use of vacuum or forceps, nulliparity,...

Published: 12/1/2012
Category: Obstetrics
Author: Theodore Barrett, MD

Download

Management of Breakdown of Obstetrical Anal Sphincter Repairs

Editor: Pamela D. Berens, MD Obstetric anal sphincter injuries (OASIS) include 3rd and 4th degree lacerations. Risk factors include forceps or vacuum delivery, episiotomy, first vaginal delivery, higher...

Published: 10/1/2012
Category: Obstetrics
Author: Rebecca G. Rogers, MD

Download

Complications of Varicella Infection in the Third Trimester

Editor: David Chelmow, MD Varicella, a herpes virus, is highly contagious and associated with significant maternal and neonatal morbidity during pregnancy. Clinical features of maternal infection include a...

Published: 9/1/2012
Category: Obstetrics
Author: Deborah A. Driscoll, MD

Download

Management of Lateral Uterine Perforation at the Time of Hysteroscopy

Editor: Eduardo Lara-Torre, MD Lateral uterine perforation at the time hysteroscopy is a rare, but potentially dangerous complication. The overall rate of hysteroscopic complications is low and diagnostic...

Published: 7/1/2012
Category: Gynecology
Author: Jeffrey M. Rothenberg, MD

Download

Management of Ureteral Injuries

Editor: Abimbola O. Famuyide, MD Ureteral injuries are relatively uncommon, and may be more common with gynecologic than other types of abdominopelvic surgery. The incidence of ureteral injury...

Published: 6/1/2012
Category: Gynecology
Author: Larry J. Copeland, MD

Download Listen

Hyperprolactinemia

Editor: Eduardo Lara-Torre, MD Prolactin is mainly synthesized and secreted by the lactotroph cells in the pituitary gland. Elevations in serum prolactin usually result from conditions that cause hypersecretion...

Published: 4/1/2012
Category: Office Practice
Author: Paula J. Hillard, MD

Download Listen

Avoiding Trocar Injuries Associated with Laparoscopic Surgery

Editor: Abimbola O. Famuyide, MD Up to half of major intraoperative complications associated with laparoscopy, including major vascular injury, occur at the time of surgical entry. Half of...

Published: 2/1/2012
Category: Gynecology
Author: David E. Soper, MD

Download

Surgical Management of Endometriosis

Editor: Roger P. Smith, MD Endometriosis may be strongly suspected based on clinical presentation, but laparoscopy remains the gold standard for a definitive diagnosis. In patients...

Published: 1/1/2012
Category: Gynecology
Author: Robert S. Schenken, MD

Download

Singleton Breech Presentation

Editor: Pamela D. Berens, MD Approximately 3-4% of pregnancies at term are breech presentations. Presentation should be assessed in all pregnancies 36 weeks and beyond and suspected breech presentation...

Published: 12/1/2011
Category: Obstetrics
Author: Amy Burkett, MD

Download

Antepartum Management of Vasa Previa

Editor: Martin E. Olsen, MD Vasa previa occurs when fetal blood vessels, that are unprotected by the umbilical cord or placenta, run through the amniotic membranes and traverse the...

Published: 10/1/2011
Category: Obstetrics
Author: L. Chesney Thompson, MD

Download

Management of Pregnancy with ABO Incompatibility

Editor: David Chelmow, MD ABO incompatibility is the most common maternal-fetal blood group incompatibility and the most common cause of hemolytic disease of the newborn (HDN). ABO incompatibility...

Published: 9/1/2011
Category: Obstetrics
Author: Michael T. Mennuti, MD

Download

Desired Pregnancy after Essure Placement

Editor: Martin E. Olsen MD While permanent methods of sterilization should be considered just that, permanent, patients and their partners can and do change their minds. Pregnancies after...

Published: 8/1/2011
Category: Obstetrics
Author: Roger Smith, MD

Download

Management of Placenta Accreta Diagnosed at 20 Weeks

Editor: David Chelmow, MD The degree of invasion of the myometrium by the chorionic villi defines placenta accreta (adherent to the myometrium), increta (invading the myometrium) and percreta...

Published: 7/1/2011
Category: Obstetrics
Author: Roger Smith, MD

Download

Hypothyroidism

Editor: Paula J. Hillard, MD ETIOLOGY Hypothyroidism is much more common in women than men. It occurs in up to 5% of the population, with approximately 0.1-2% overt...

Published: 5/1/2011
Category: Office Practice
Author: Frank W. Ling, MD

Download

Primary Amenorrhea in a Teenager

Editor: Eduardo Lara-Torre, MD Primary amenorrhea (PA) has traditionally been defined as failure to menstruate by age 16. However, an evaluation should be initiated if a 15 year old...

Published: 3/1/2011
Category: Office Practice
Author: Priya B. Maseelall, MD

Download

Management of Urethral Diverticula

Editor: Ronald T. Burkman, MD Suburethral diverticula usually originate from the middle or distal portion of the posterior aspect of the urethra. The majority of urethral diverticula are thought...

Published: 2/1/2011
Category: Gynecology
Author: Philip J. DiSaia, MD

Download

Management of Adnexal Cysts

Adnexal cysts may be identified based on gynecologic symptoms or may be incidentally noted during pelvic exam or imaging for other reasons. Further actions depend on imaging characteristics and symptoms....

Updated: 7/5/2019
Published: 9/1/2010
Category: Office Practice
Author: Vivian E. von Gruenigen, MD

Download

Elevated Maternal Serum AFP (MSAFP) at 16 Weeks

Editor: Roger P. Smith, MD Alpha-fetoprotein is produced by the fetal liver. Levels rise during the second trimester. Values are expressed as MoMs (multiples of the median) for each...

Published: 6/1/2010
Category: Obstetrics
Author: Michael T. Mennuti, MD

Download

Management of Paget Disease of the Vulva

Extramammary Paget Disease (EMPD) of the vulva is a rare intra-epithelial adenocarcinoma of the vulvar skin presenting most commonly with pruritus. Unfortunately, diagnosis is often delayed as both patients and...

Updated: 7/5/2019
Published: 5/1/2010
Category: Office Practice
Author: Philip J. DiSaia, MD

Download

Anemia in Pregnancy with Normal Iron Studies

Pregnancy results in a physiologic anemia due to expanded plasma volume. The red cell mass also expands, but to a lesser degree. Lack of iron supplementation results in a smaller...

Published: 4/1/2010
Category: Obstetrics
Author: Michael T. Mennuti, MD

Download

Management of a Thyroid Nodule

The prevalence of thyroid nodules varies with the level of iodine sufficiency. Because iodine deficiency is relatively rare in the United States, only about 5% of US women will have...

Updated: 7/5/2019
Published: 1/1/2010
Category: Office Practice
Author: Nanette F. Santoro, MD

Download

Postoperative Urinary Fistulae

Although it has been estimated that the risk of injury to the urinary tract is 0.3% during pelvic surgery, particularly hysterectomy, many of these injuries are occult. When routine cystoscopy...

Updated: 7/5/2019
Published: 12/1/2009
Category: Gynecology
Author: Larry J. Copeland, MD

Download

Postpartum Perineal Pain

The diagnosis and management of postpartum perineal pain depends on history and physical examination. Because pain is rarely an isolated symptom, additional symptoms by history may also include bleeding,...

Published: 10/1/2009
Category: Obstetrics
Author: Frank W. Ling, MD

Download

Complications of Gynecologic Laparoscopic Surgery

Complications of gynecologic laparoscopy occur in 3 to 6 per 1000 cases, proportional to the complexity of the case. Approximately one-third to one-half occurs during initial access. There...

Updated: 5/1/2019
Published: 9/1/2009
Category: Gynecology
Author: Robert S. Schenken, MD

Download

Adnexal Masses in Adolescents

The prevalence of adnexal masses in adolescents is unknown. While the diagnosis of a “ruptured ovarian cyst” is common for adolescents presenting with abdominal and pelvic pain, often this...

Published: 5/1/2009
Category: Gynecology
Author: Robert S. Schenken, MD

Download

Fetal Ventral Abdominal Wall Defects

Gastroschisis and omphalocele are the most common fetal ventral abdominal wall defects. Omphalocele is a midline ventral abdominal wall defect through which abdominal contents herniate. The defect generally...

Published: 3/1/2009
Category: Obstetrics
Author: Ralph K. Tamura, MD

Download

Nonimmune Hydrops Fetalis

Hydrops fetalis is the presence of excessive fluid in two or more fetal compartments including skin edema, pleural effusion, pericardial effusion, ascites, and polyhydramnios. Fetal hydrops can be immune or...

Updated: 7/5/2019
Published: 1/1/2009
Category: Obstetrics
Author: Ralph K. Tamura, MD

Download

Toxoplasmosis in Pregnancy

Toxoplasma gondii is a protozoan which can lead to human infection through infected uncooked meat, exposure to contaminated soil or water, eating soil contaminated fruits or vegetables, or exposure to...

Published: 10/1/2008
Category: Obstetrics
Author: Michael L. Socol, MD

Download

Parvovirus in Pregnancy

Parvovirus B19 is a single stranded DNA virus which causes erythema infectiosum, also known as fifth disease. Clinical manifestations include flu-like signs and symptoms, low-grade fever, malaise, arthralgia, and a...

Published: 10/1/2008
Category: Obstetrics
Author: Michael L. Socol, MD

Download