Latest Updates

Viral Infections in Pregnancy – Part 1: CMV, Ebola Virus, Viral Hepatitis, HSV, and HIV

    • Cytomegalovirus - Use of hyperimmune globulin and high-dose treatment with valacyclovir show promise for CMV infection in pregnancy.
    • Ebola virus – No definitive treatment exists. Testing is ongoing using such agents such as brincidofovir and favipiravir. Other investigational agents include immune sera from survivors, TKM-Ebola (RNA interference), and ZMap (combination of three anti-Ebola monoclonal antibodies).A candidate vaccine cAd3-ZEBOV derived from chimpanzee adenovirus is currently under investigation.
    • Hepatitis B - Tenofovir 200 mg PO from 32 weeks until delivery has been shown to reduce rates of perinatal transmission in patients with a high viral load (>1 million copies/mL).
    • Herpes Simplex Virus – PCR detection of HSV DNA in amniotic fluid is most useful diagnostic test and has a rapid turnaround.

Kidney Biopsy

Gearoid McMahon, MD, Adina Voiculescu, MD
    • Summarizes different indications
    • Helps select most appropriate technique of biopsy
    • Summarizes type and frequency of complications
    • Gives guidance for treatment of complications

Premenstrual Syndrome

Sarah L Berga, MD, Jessica B Spencer, MD, MSc
    • Oral contraceptives, vitamin supplements and calcium can be helpful.
    • Selected antidepressants can be used a first line of treatment.
    • Acupuncture and herbal medicines have insufficient evidence.

Premenstrual Syndrome

Sarah L Berga, MD, Jessica B Spencer, MD, MSc
    • Oral contraceptives, vitamin supplements and calcium can be helpful.
    • Selected antidepressants can be used a first line of treatment.
    • Acupuncture and herbal medicines have insufficient evidence.

Premenstrual Syndrome

Sarah L Berga, MD, Jessica B Spencer, MD, MSc
    • Oral contraceptives, vitamin supplements and calcium can be helpful.
    • Selected antidepressants can be used a first line of treatment.
    • Acupuncture and herbal medicines have insufficient evidence.

Stress Urinary Incontinence I: Nonsurgical Management

Sylvia M Botros, MD, Svjetlana Lozo, MD
    • urethral bulking agents – stem cells used for urethral bulking in trials
    • 2014 ACP Practice Guidelines: Nonsurgical Management of Urinary Incontinence in Women
    • 2018 SOGC Practice Guidelines: Evaluation of Stress Incontinence Prior to Primary Surgery
    • 2017 SOGC Practice Guidelines: Management of Recurrent Urinary Incontinence After Pelvic Floor Surgery

Human Papillomavirus Infection and Prevention In The Adolescent

Alexandria Richards, MD, PGY 3, Joanna Stacey, MD
    • HPV infection of certain high-risk oncotypes with viral persistence is thought to be necessary for development of serious dysplasia and cancer. HPV can enter a latent state and be reactivated at a later time.
    • The alarming rise in oropharyngeal cancers has been attributed to oncogenic HPV types previously only recognized for causing cervical cancer; adolescents who participate in noncoital sexual activity may be at higher risk than previously thought.
    • The HPV vaccine has proven to be safe and effective, and the inclusion of nine serotypes of HPV in the latest vaccine provides the most coverage against oncogenic subtypes to date.
    • Both boys and girls should be vaccinated against HPV at a target age of 11–12 years, but may receive the vaccination as early as 9 or as late as 26 years old. There is a revision of the vaccination schedule to require only two in the series if it is given prior to the age of 15.
    • Large decreases in HPV infection have been seen in past 10 years after vaccination has been available.

Primary and Preventive Care of Women

Janet B. Henrich, MD
    • Latest USPSTF recommendation on breast cancer screening
    • Latest USPSTF recommendation guide to clinical preventive services
    • Latest USPS evidence review on aspirin for the primary prevention of cardiovascular events
    • Latest USPSTF recommendations for use of antiretroviral drugs in pregnant HIV-infected women
    • Latest NOF clinician guide to prevention and treatment of osteoporosis
    • Latest ACS guideline for breast cancer screening for women at average risk
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