Abstract:
:Many otherwise healthy women will experience a significant disruption in lifestyle from abnormal uterine bleeding. Most of those seeking medical attention will not be at risk for developing anemia. In each case, a thorough search for underlying systemic, hormonal, and organic causes should be instituted. The use of blind endometrial sampling to evaluate the uterine cavity, by itself, is an inaccurate technique for diagnosing pathologic conditions commonly associated with menorrhagia, such as endometrial polyps, submucous myomata, and focal endometrial abnormalities including adenocarcinoma and its precursors. The supplementary application of diagnostic hysteroscopy with directed biopsy will ensure the recognition of these intracavitary lesions. The majority of women found to have endometrial polyps and submucous myomata can gain a successful reduction in their menstrual flow without hysterectomy by undergoing hysteroscopic removal of these lesions. Those without other uterine or pelvic pathology and who are closer to perimenopause are more likely to sustain long-lasting relief from these procedures. Medical therapy should be the first line of treatment for premenopausal women who are found to have no obvious cause for their abnormal uterine bleeding. Many of those who do not respond to, are unable to tolerate, or are unwilling to attempt this approach will undergo hysterectomy as the final answer. The absence of uterine pathology in most of these cases places an absolute demand on our specialty to innovate, and, whenever suited, to use more conservative surgical solutions. Our efforts to alter this behavior will undoubtedly be closely monitored by agents of managed care aiming to reward measures that reduce cost and improve the quality of care. The use of hysteroscopic ablation and resection to treat women suffering from intractable menorrhagia can safely and effectively reduce menstrual blood flow and should significantly curtail the performance of unnecessary hysterectomy. The comparative benefits and long-term advantages of these techniques beyond hysterectomy await the results of further studies. Furthermore, the risks of these hysteroscopic procedures to produce iatrogenic adenomyosis or to conceal or delay the usual signs of adenocarcinoma have yet to be ascertained. Vigilance for endometrial disease must not dwindle in the face of amenorrhea, as evidenced by a recent case report describing the development of endometrial carcinoma after 5 years of amenorrhea following endometrial electrocoagulation. Future methods of endometrial destruction for the control of abnormal uterine bleeding may include the nonhysteroscopic use of radio frequency, thermal transfer, hyperthermia, and photodynamic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
journal_name
Clin Obstet Gynecoljournal_title
Clinical obstetrics and gynecologyauthors
Brill AIdoi
10.1097/00003081-199506000-00017subject
Has Abstractpub_date
1995-06-01 00:00:00pages
319-45issue
2eissn
0009-9201issn
1532-5520journal_volume
38pub_type
杂志文章,评审abstract::Significant advances have been made in the last 20 years in our knowledge about the subcellular events occurring during myometrial contractions and cervical ripening and in the mechanism of action of oxytocin and prostaglandins. These advances have been instrumental in furthering our understanding of the mechanism of ...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-200009000-00006
更新日期:2000-09-01 00:00:00
abstract::The relevance of extraneous factors on fetal and neonatal respiratory gas exchange and acid-base balance must be considered when interpreting umbilical cord blood values. However, although many of these factors can alter these values to a minor degree, the clinical impact is negligible in the unstressed fetus. The mor...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199303000-00009
更新日期:1993-03-01 00:00:00
abstract::Human papillomavirus (HPV) infection has been implicated in the intraepithelial cervical changes that cause most abnormal Papanicolaou smears. To date, 14 types of HPVs have been identified. All are small, nondeveloped, icosahedral DNA viruses that share a common internal antigen. In cases of cervical HPV infection...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00003081-198312000-00019
更新日期:1983-12-01 00:00:00
abstract::A brief review of cervical intraepithelial neoplasia has been presented. Attempts have been made to identify the high-risk patient, and etiologic considerations have been detailed. The conservative management of cervical intraepithelial neoplasia is available and applicable to many patients. Regardless of the definiti...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-198003000-00021
更新日期:1980-03-01 00:00:00
abstract::Determining which women should undergo dual-energy x-ray absorptiometry testing should be based on rational screening criteria. Screening tests should be simple to perform, readily available, and very sensitive. Clinical risk factors have been proposed by numerous professional societies as a way to screen women for fu...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3182a99814
更新日期:2013-12-01 00:00:00
abstract::1. The use of ultrasound may improve perinatal outcome in twin pregnancy. 2. Singleton growth curves for FL, BPD, and AC may be used to assess fetal growth prior to 28 weeks gestation. 3. After 28 weeks gestation, specific twin growth curves should be used. However, increased morbidity may be seen when fetal weight fa...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199003000-00008
更新日期:1990-03-01 00:00:00
abstract::Direct electronic urethrocystometry simultaneously records pressures in the bladder, proximal urethra, and abdomen in a patient at rest and under stress while the bladder fills with urine. It documents the presence or absence of detrusor contractions and is an essential part of the evaluation of patients with detrusor...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/00003081-197809000-00008
更新日期:1978-09-01 00:00:00
abstract::Norgestimate (NGM) is one of a class of newer, more selective progestins. The authors describe its structure and biologic activity, contraceptive effectiveness, cycle control, metabolic effects, carbohydrate metabolism, coagulation factors, and clinical side effects. NGM-containing oral contraceptives (OC), either a...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199538040-00019
更新日期:1995-12-01 00:00:00
abstract::In the last 10 years, expanded preconception carrier screening has become widely available and helps patients/couples make more informed decisions with regard to their reproductive options and facilitates more effective preconception planning, prenatal diagnosis, condition-specific counseling, and condition-specific c...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000437
更新日期:2019-06-01 00:00:00
abstract::American College of Obstetricians and Gynecologists' guidelines on vaginal birth after cesarean had both intended and unintended consequences for anesthesiologists. Epidural analgesia continues to play an important role in patient acceptance of a trial of labor after prior cesarean delivery. It does not impact the suc...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0b013e3182618937
更新日期:2012-12-01 00:00:00
abstract::In the United States, roughly half of women are either overweight (24.5%) or obese (21.4%) when they become pregnant. Women who are obese before pregnancy are at increased risk for a number of pregnancy complications relative to normal-weight women. Specifically, obesity is associated with significantly increased mate...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000173
更新日期:2016-03-01 00:00:00
abstract::With the increased use and quality of ultrasound in pregnancy, adenxal masses are being encountered with greater frequency. Fortunately, most of such masses are benign and resolve on their own. However, complications such as ovarian torsion can occur. In addition, a malignancy can be present in a small minority of cas...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181bea9d7
更新日期:2009-12-01 00:00:00
abstract::The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists confirm advantages of conventional minimally invasive surgery over laparotomy for benign gynecological procedures; however, adoption remains low for the general gynecologist. A systematic search for gynec...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e31822b4998
更新日期:2011-09-01 00:00:00
abstract::The drug abusing patient can provide a management dilemma for health care providers including nurses, obstetrician, anesthesiologist, and pediatrician. Certain illicit drugs may mimic other diseases of pregnancy and result in inappropriate treatment for the mother and child. Pain management may be challenging in such ...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e318282738b
更新日期:2013-03-01 00:00:00
abstract::Venous thromboembolism is a leading cause for maternal mortality. Because of the increase risk for thromboembolism in pregnancy and the postpartum period, the clinician must be on high alert for the signs and symptoms and use appropriate diagnostics in a timely manner so that prompt anticoagulation therapy can be init...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0b013e3181deb27e
更新日期:2010-06-01 00:00:00
abstract::Although there are fairly wide variations AFV normally undergoes characteristic changes across gestation in which it increases from 10-20 ml at 10 weeks gestation to average 800 ml at 24 weeks. Little change occurs from then until near term when AFV begins to decrease, and large decreases can occur in postterm pregnan...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199706000-00005
更新日期:1997-06-01 00:00:00
abstract::This article reviews the sonographic manifestations of fetal infection and the role of ultrasound in the evaluation of the fetus at risk for congenital infection. Several ultrasound findings have been associated with in utero fetal infections. For the patient with a known or suspected fetal infection, sonographic iden...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000342
更新日期:2018-03-01 00:00:00
abstract::Current findings continue to support the concept of a biologically defective decidua rather than a primarily abnormally invasive trophoblast. Prior cesarean sections increase the risk of placenta previa and both adherent and invasive placenta accreta, suggesting that the endometrial/decidual defect following the iatro...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000392
更新日期:2018-12-01 00:00:00
abstract::The purpose of this paper is to assist the clinician in recognizing pelvic floor muscle dysfunction in women with vulvar symptoms, to provide general treatment algorithms, and to facilitate understanding of the scientific rationale behind appropriate treatment. In short, this paper is meant to provide a "how-to" guide...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0000000000000135
更新日期:2015-09-01 00:00:00
abstract::There are many problems in the diagnosis and treatment of vaginitis. Often, the patient is not examined (telephone treatment) or examined improperly with lack of attention to the wet prep. In patients with recurrent vaginitis, it should not be assumed that the current infection is the same as a previous infection with...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199906000-00004
更新日期:1999-06-01 00:00:00
abstract::A variety of changes in the eye can occur during pregnancy. These can be physiological, pathologic related to the pregnancy, or pathologic unrelated to the pregnancy. Pregnancy also can affect preexisting conditions. Pregnant women often discuss changes in their health first with their obstetrician; therefore, knowled...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e31828f273c
更新日期:2013-06-01 00:00:00
abstract::In summary, ultrasound plays an important role in the evaluation of the postterm pregnancy, and its use should be considered in the following situations: 1) estimation of fetal weight in the potentially macrosomic infant before vaginal delivery is attempted; 2) frequent evaluation for oligohydramnios using the amnioti...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-198906000-00008
更新日期:1989-06-01 00:00:00
abstract::Periventricular-intraventricular hemorrhage is an important problem, resulting in significant mortality and morbidity. Attempts to reduce this complication require an understanding of its pathogenesis. In this chapter a model was proposed, consisting of a series of events resulting in rapid changes of cerebral blood f...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199106000-00014
更新日期:1991-06-01 00:00:00
abstract::The pharmacology and potential uses of RU-486, the only anti- progesterone to reach clinical trials, including luteolytic, abortifacient, menstrual regulator, postcoital contraceptive, oral contraceptive and other uses, are reviewed. RU-486 acts on the progesterone receptors in the endometrium, specifically the decid...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-198906000-00024
更新日期:1989-06-01 00:00:00
abstract::The present status of oral contraceptive steroids and the IUD, the 2 most effective and increasingly popular contraceptive methods (used by 41.6% of all U.S. married couples practicing contraception in 1970), is presented. Oral steroid contraceptives with varying quantity and activity of estrogen (ethinyl estradiol o...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-197403000-00007
更新日期:1974-03-01 00:00:00
abstract::There has been a steady decline in breast cancer mortality that has led to a significant increase in the number of patients surviving breast cancer. We will review in this manuscript the evidence and guidelines for posttreatment surveillance of patients with breast cancer as well as the management options for patients...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000243
更新日期:2016-12-01 00:00:00
abstract::Higher-order multiple gestations have increased since the advent of advanced reproductive technologies. These pregnancies present unique risks to both mothers and fetuses. It is imperative that early diagnosis of chronicity be determined and that proper counseling is performed, so patients understand the risks, evalua...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0000000000000121
更新日期:2015-09-01 00:00:00
abstract::The UK Confidential Enquiry into Maternal Deaths has been in operation for more than 60 years, during which time maternal mortality rates have fallen 10-fold. The program includes two aspects, surveillance and confidential case review, providing different information to aid quality improvement in maternity care. The e...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章
doi:10.1097/GRF.0000000000000352
更新日期:2018-06-01 00:00:00
abstract::Diagnosis of the cause of pruritus in a pregnant patient should be approached systematically, beginning with a detailed history (especially drug exposure) and physical examination. Systemic diseases must be excluded. Liver function tests and hepatitis screen are in order if symptoms suggest liver dysfunction. Stool ex...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/00003081-199012000-00007
更新日期:1990-12-01 00:00:00
abstract::Prenatal diagnostics has seen a rapid increase in the number of genetic disorders amenable to prenatal detection owing to advances in technology and research into the genetic etiology of many conditions. This article reviews the more traditional prenatal diagnostic techniques, such as amniocentesis and chorionic villu...
journal_title:Clinical obstetrics and gynecology
pub_type: 杂志文章,评审
doi:10.1097/GRF.0b013e3181616509
更新日期:2008-03-01 00:00:00