Latest Updates

Gestational Trophoblastic Disease

Elizabeth T Kalife, MD, Dario R Roque, MD, Anze Urh, MD
    • Gestational trophoblastic neoplasia (GTN) is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation.
    • Once a diagnosis of GTN has been made, the WHO prognostic score and FIGO 2000 staging are the best tools for establishing prognosis and treatment.
    • Treatment for low-risk GTN confined to the uterus may include a second suction curettage as 40% of patients treated with second curettage instead of single-agent chemotherapy had a β-hCG normalization within 6 months and avoided chemotherapy.
    • Patients with high-risk metastatic GTN should be treated by individuals who have experience in treating this relatively rare disease.

Nonsurgical Management of Overactive Bladder

Sharon Jakus-Waldman, MD, MPH
    • β3 adrenergic agonists
    • Dementia associated with anticholinergic use
    • Benefit of combining medication with behavioral or pelvic floor muscle therapy

Fecal Incontinence: Nonsurgical Management

Madeleine Blank, MD, Lilian Chen, MD
    • Fecal incontinence is a prevalent and often undiagnosed entity.
    • Fecal incontinence is associated with significant stigmata and decreased quality of life.
    • It is a multifactorial disease, and initial evaluation should be initiated with a thorough history and physical examination.
    • Initial management starts with medical management and pelvic floor physical therapy.

The Menopause Transition: Physiology, Definition, Symptoms, Diagnosis, and Evaluation

Jessica L Bauer, MD, MS, Nanette F Santoro, MD
    • Abnormal meiotic spindles as well as microtubule and mitochondrial dysfunctions are more common in aging oocytes and contribute to declining oocyte quality with age.
    • The Stages of Reproductive Aging Workshop developed a reliable and useful staging system that addresses the medical and social consequences of reproductive aging.
    • The Study of Women’s Health Across the Nation cohort has been examined multiple times to demonstrate the racial/ethnic, socioeconomic, and age-related disparities in symptomatology of the menopause transition.

Health of Immigrant and Refugee Women

Aniyizhai Annamalai, MD
    • It is increasingly recognized that health of migrants is significantly impacted by many factors before, during, and after migration.
    • Migrants are increasingly presenting with chronic health conditions similar to people in high-income countries.
    • There is a higher prevalence of posttraumatic stress disorder in forced migrants, which affects psychosocial health during resettlement.
    • Specific cultural practices (eg, female genital cutting) may still be seen in migrant women, and require appropriate follow-up and care.

Stress Fractures And The Reproductive System In The Female Athlete

Irfan M Asif, MD, Kimberly Harmon, MD, Mallory Shasteen, MD
    • Due to the radiation exposure involved with oblique radiography and CT, the recommended imaging modalities when spondylolysis is suspected include initial two-view radiography followed by MRI.
    • Surgery for spondylolysis is recommended only when bilateral spondylolysis is present and has progressed to significant spondylolisthesis.
    • Female athletes should have 1,500 mg/day of calcium and maintenance of vitamin D levels at 32 to 50 ng/mL, which may generally occur with 800 IU of vitamin D/day.
    • Female athletes should have baseline dual-energy x-ray absorptiometry if they have one or more “high-risk” triad risk factors or two or more “moderate-risk” triad risk factors. 

Musculoskeletal Problems In The ­Female Athlete

Irfan M Asif, MD, Kimberly Harmon, MD, Mallory Shasteen, MD
    • Operative treatment is not as successful for atraumatic shoulder instability as it is for traumatic instability. Treatment should start with a supervised exercise regimen.
    • Prevention programs, including neuromuscular and proprioceptive interventions, reduce ACL injuries by 50.7%.
    • There is a lack of evidence to show that knee orthoses reduce knee pain or improve function in individuals undergoing exercise programs for patellofemoral pain.

Cancer of the Endometrium

Kim B. Young, MD
    • Minimally invasive surgery (either laparoscopic or robotic assisted) is the preferred surgical approach for most patients with endometrial cancer.
    • Sentinel node biopsy may replace lymphadenectomy as the preferred method of lymph node assessment during surgery.
    • Vaginal brachytherapy is preferred over pelvic radiation for most patients with early endometrial cancer for whom adjuvant treatment is indicated.
    • Fertility-sparing treatment with progestin is an appropriate alternative to hysterectomy for selected patients with endometrial cancer desiring future childbearing.
    • Routine screening of endometrial cancer specimens for expression of mismatch repair proteins is effective in identifying patients with Lynch syndrome.
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