Current opinion in obstetrics & gynecology
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Curr. Opin. Obstet. Gynecol. · Aug 2014
ReviewThe techniques and outcomes of hysteroscopic metroplasty.
To evaluate the reproductive outcomes and surgical techniques of the hysteroscopic metroplasty in women with septate uterus and recurrent abortions or primary unexplained infertility. ⋯ The hysteroscopic metroplasty with its simplicity, safety, and improved reproductive outcomes has liberalized the approach to treatment. Today, hysteroscopic metroplasty is a common practice to treat septate uterus with salutary effects both in infertile patients and in patients with recurrent pregnancy loss or premature labor, especially if in-vitro fertilization is being contemplated. Decisions on when to treat uterine septa are discussed in particular because of lack of prospective, randomized controlled trials.
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Curr. Opin. Obstet. Gynecol. · Aug 2014
ReviewNovel agents for the medical treatment of endometriosis.
Current medical treatments for endometriosis-associated pain, including oral contraceptives, progestins and GnRH agonists, are partially effective and have significant side-effects. The purpose of this review is to present new hormonal and nonhormonal treatment for endometriosis. ⋯ New drugs for the medical treatment of endometriosis targeting both hormonal (GnRH, estrogen and progesterone receptors) and nonhormonal pathways (inflammation, angiogenesis, adhesions, tissue invasion) are promising, but their efficacy and safety need to be established in randomized human trials before they can be used in clinical practice.
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Curr. Opin. Obstet. Gynecol. · Dec 2013
ReviewThe role of simulation training in obstetrics: a healthcare training strategy dedicated to performance improvement.
In this review, the role of simulation as a strategy for training and performance improvement is reviewed. The review is timely, as providing safe and high-quality healthcare is the goal of every healthcare system and soon reimbursement will be tied to quality measures. Simulation has emerged as a strategic approach that can result in improved quality and safety through training of individuals and teams, improvement in healthcare systems, and determination of competence. The rationale for this approach will be presented and discussed. ⋯ There is a rapidly developing body of literature supporting the use of simulation in healthcare. Although research is still needed to demonstrate the effectiveness of simulation for evaluation, healthcare systems should develop strategies to implement and maintain simulation training.
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Curr. Opin. Obstet. Gynecol. · Dec 2013
ReviewOver-the-counter access to oral contraceptives as a reproductive healthcare strategy.
The aim of this review is to summarize the current evidence on the safety and effectiveness of moving oral contraceptives from prescription-only to over-the-counter (OTC) status. The review also examines women's interest in OTC access to oral contraceptives, as well as potential barriers and facilitators to an OTC switch. ⋯ OTC access to oral contraceptives could help to reduce unintended pregnancy by increasing the number of pill users, improve continuation and reduce gaps in use. It is critical that a future OTC pill be made available at an accessible price, and it should be covered by insurance without a prescription. Research suggests that common concerns about the safety of oral contraceptives OTC and a potential negative effect on women's use of preventive services are largely unsupported.
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Despite global progress towards reducing maternal mortality, sepsis remains a leading cause of preventable maternal death. This review focuses on current measurement challenges, trends, causes and efforts to curb maternal death from sepsis in high and low-income countries. ⋯ The need for robust data with subsequent analyses is apparent. This will significantly increase our understanding of risk factors and their causal pathways, which are critical to informing effective treatment strategies in consideration of resource availability.