Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Jun 2008
ReviewCare of the overweight adolescent including polycystic ovarian syndrome.
Obstetrician-gynecologists are responsible for promoting healthy eating and physical activity in adolescents during annual screening examinations. Adolescents with a body mass index for age greater than or equal to the 95th percentile should undergo an in-depth health assessment to determine psychosocial morbidity and risk of cardiovascular disease. Further research is needed to determine the most efficacious approach to the prevention and treatment of obesity in adolescents. For now, it is best to extrapolate an approach from data pertaining to children and adults, while being cognizant of the special psychosocial and physical needs of adolescents.
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Trauma affects up to 6% to 7% of all pregnancies, and accounts for up to 46% of maternal death. Adverse consequences such as preterm labor and delivery, abruptio, fetomaternal hemorrhage, and fetal demise may be seen with even apparently minor degrees of injury. Maternal physiologic considerations are reviewed and a protocol for evaluation and management of the injured gravida is presented.
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Traumatic wounds of the female genitalia include accidental straddle injuries or impalement, chemical or thermal burns, insufflation injuries, blunt trauma, or crush injuries. Children and adolescents may be victims of rape, sexual abuse, and female genital mutilation. Information is provided on epidemiology, pathophysiology, and management. Treatment guidelines are offered using the best evidence available, and recommendations are provided when data are limited.
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This chapter will report to the frequency of neonatal hypoxic-ischemic encephalopathy. The pathophysiology and the childhood outcome of encephalopathy due to hypoxia-ischemia will be examined. ⋯ Hypothermia seems to offer the most promise as a therapy for neuroprotection in hypoxic-ischemic encephalopathy. The evidence-based trials of hypothermia will be reviewed along with recommendations regarding clinical applications for this therapy and need for long-term follow-up of children receiving this therapy.
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Clin Obstet Gynecol · Sep 2007
Optimizing outcomes of surgery in advanced age--perioperative factors to consider.
The gynecologic surgeon should be knowledgeable about the normal physiologic changes associated with aging and skilled at assessing baseline medical comorbidities, neuropsychiatric, nutritional, social, and functional status as increasing numbers of older women seek and undergo surgical interventions to improve their quality of life. A multidisciplinary approach to the perioperative care of the older woman, aiming for prevention and early intervention, can help minimize both typical surgical complications and "geriatric" complications.