Clinical obstetrics and gynecology
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This article provides an overview of the components of the informed consent process for surgery including the components specific to hysterectomy. Shared decision making and informed consent for hysterectomy rely on a mutual understanding by the patient and surgeon of the goals, risks, benefits, and alternatives as well as the choice of hysterectomy technique. The importance of a patient-centered approach is emphasized with an explanation of several communication methods and resources for decision aids that will help to ensure that patients have a good understanding of the items listed above and are able to provide informed consent.
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This chapter provides a summary of the literature including results from large trials, meta-analyses, and recent major recommendations. Two well-accepted and recent recommendations include those from the Agency for Health Research and Quality on calcium and vitamin D supplementation and from the Institute of Medicine's dietary reference intakes for calcium and vitamin D. This review suggests that there is strong evidence for synergistic roles of calcium and vitamin D in maintaining bone health in postmenopausal women, but the correlation between vitamin D alone and bone health is overall inconclusive.
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Clin Obstet Gynecol · Dec 2013
ReviewOsteoporosis: therapeutic guidelines. Guidelines for practice management of osteoporosis.
Therapeutic guidelines of osteoporosis are reviewed from North American Menopause Society, American Association of Clinical Endocrinologists, American College of Obstetrics and Gynecology, and the National Osteoporosis Foundation. The various guidelines are compared and discussed.
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Clin Obstet Gynecol · Jun 2013
ReviewIndications, contraindications, and complications of mesh in surgical treatment of pelvic organ prolapse.
Women are seeking care for pelvic organ prolapse in increasing numbers and a significant proportion of them will undergo a second repair for recurrence. This has initiated interest by both surgeons and industry to utilize and design prosthetic mesh materials to help augment longevity of prolapse repairs. Unfortunately, the introduction of transvaginal synthetic mesh kits for use in women was done without the benefit of level 1 data to determine its utility compared with native tissue repair. This report summarizes the potential benefit/risks of transvaginal synthetic mesh use for pelvic organ prolapse and recommendations regarding its continued use.
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Myasthenia gravis is an autoimmune disease of the neuromuscular junction characterized by painless fluctuating skeletal muscle weakness. Disease exacerbations are more likely to occur in the first trimester or puerperium. ⋯ Mainstay treatments involve acetylcholine esterase inhibitors, corticosteroids and other immunosuppressants, and adequate rest. Newborns may suffer in utero or neonatal consequences, usually transient, of transplacental antibody exposure.