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Miss SC was a 21-year-old G4, P0030 at 21 weeks' gestation by last menstrual period and confirmed by second-trimester ultrasound. Her pregnancy, which had been managed through a clinic, was complicated by multiple urinary tract infections and she had recently been diagnosed with pyelonephritis. The condition was treated with IV antibiotics at a community hospital and she was discharged with a prescription for ampicillin to be taken for 7 days. Miss SC said she felt well until 2 days before her second admission to the same community hospital, when she began having sharp, intermittent right upper-quadrant pain that was unrelated to eating.

Although isolated CPCs rarely have any effect on cerebral function in a chromosomally normal fetus, researchers have recently linked them to trisomy 18. Two experts discuss when to consider invasive prenatal testing.

Whether you're trying to pinpoint one of the underlying mechanisms behind PCOS, detect diabetes in its preclinical stage, or work up a patient with metabolic syndrome, a more in-depth understanding of the various laboratory approaches to assess insulin function can only improve your diagnostic skills.

As more patients with abnormal uterine bleeding look for alternatives to hysterectomy, drug therapy, and D&C, clinicians are turning to endometrial ablation to meet their needs. This brief overview takes a look at some of the advantages and disadvantages of cryoablation.

Metabolic profiling of amniotic fluid (AF) is a new way to identify which women experiencing preterm labor are also at risk for preterm delivery, with and without infection or inflammation, according to prize-winning research presented at the SMFM meeting.

Perhaps so. Measuring middle cerebral artery (MCA) peak velocity on Doppler ultrasound is significantly better at predicting severe fetal anemia than traditional assessment via amniotic fluid ?OD450, says a well-designed clinical trial involving a large cohort of fetuses. In addition, it's noninvasive and can safely replace the AF assessment in managing Rh-alloimmunized pregnancies.

The risk of stillbirth does not increase after 20 weeks' gestation for pregnant women who've previously delivered by C/S; at least in the United States.

Contrary to conventional medical wisdom, metformin compares favorably with insulin for controlling blood sugar in A2 gestational diabetes—GD with elevated fasting blood sugar levels.

Amnioinfusion (AI) doesn't lower the risk of meconium aspiration syndrome (MAS), cesarean delivery, or other key complications in women in labor with thickly meconium-stained amniotic fluid, according to a international randomized trial involving nearly 2,000 patients presented at this year's SMFM meeting in Reno.

Although several studies have shown that patients with ovarian cancer fare better if they receive specialized care, many of these women are not being referred to a gynecologic oncologist. A recent chart review of over 1,000 patients with pelvic masses strongly suggests that when clinicians follow the expert referral guidelines issued by the Society of Gynecologic Oncologists and ACOG, patients are definitely the winners.

About 91% of low-grade abnormalities on Pap smears in immunocompetent young women regress within 3 years of their finding, and only about 3% progress to high-grade disease, according to a recent cohort study. The findings provide strong support for the position that subjecting all young women with low-grade squamous intraepithelial lesions (LSIL) to colposcopy is unwarranted.

Roughly 30 million US women, young and old, are living with disabilities, and they need equal access to mammography, contraception, and ob/gyn exams. Special training in treating them would be ideal, but there are still practical ways to break down barriers and provide better care.

Evidence of the value of antepartum fetal surveillance is largely circumstantial. Studies suggest, however, that the NST can provide useful information when done alone, and even more so when combined with other variables.

A detailed history and physical exam can pinpoint problems like coronary artery and lung disease, which are most likely to lead to serious perioperative complications. These experts offer pre-op testing guidelines for higher-risk patients to limit complications and avoid delays in elective surgery.

While not as effective as oral estradiol for the treatment of vasomotor symptoms in postmenopausal women, electroacupuncture may decrease the number of hot flushes experienced by about 50%, making it a viable option, particularly for women who cannot or will not tolerate hormone therapy.

What causes male infertility? Look to the Y chromosome, says this leading expert. Among the high-tech solutions worth considering: testicular sperm extraction (TESE), microsurgical epididymal sperm retrieval (MESA), and intracytoplasmic sperm injection (ICSI).

Last night you were on call and delivered three babies, managed a patient with severe preeclampsia, treated a case of uterine atony, and readmitted a woman with a post-hysterectomy wound infection. Yesterday you covered the hospital's Women's Health Clinic; it's a twice-monthly pro bono service you provide to the community. And this morning, you're facing a waiting room full of patients and two assistant U.S. attorneys. The grave-looking men in dark suits say they are investigating you for up-coding of Medicare and Medicaid claims and private insurance reimbursement. You're facing possible federal criminal prosecution, but you're not alone because the hospital also is being investigated.

Ultrasound has made me a better gynecologist. The introduction of the vaginal probe in the mid 1980s revolutionized the way gynecology is practiced. For me, it has opened doors into understanding the workings of the female pelvis.

The American Medical Association's board of trustees endorsed a new policy supporting the right of physicians to charge patients an extra fee to offset the rising cost of medical liability insurance. The tactic is being implemented by physicians in a few states in response to the medical liability crisis.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.

Women with low levels of pregnancy-associated plasma protein A (PAPP-A) during the first 10 weeks of pregnancy are forty times more likely to have a stillbirth later in pregnancy, according to a multicenter, prospective cohort study conducted in Scotland.

Imagine practicing gynecology and performing the most challenging surgeries day and night without worrying about malpractice suits, managed-care pre-authorization, or CPT and ICD-9 codes. Wouldn't it be wonderful to have no concerns about being paid and patients who are grateful for care even when the outcome isn't perfect? That would never happen in this country but it's a scenario experienced by health-care professionals affiliated with PRN Relief International. These dedicated individuals minister to some of the planet's most needy-and grateful-patients. I was fortunate to be able to serve with them recently in Jamaica and it's an experience I'll never forget.

As described in the first half of this roundtable (see Contemporary OB/GYN, November 2004), the professional liability insurance crisis has had a broad and pernicious impact on the country's obstetrician/ gynecologists. As they conclude the discussion, the panelists move from reflecting on how the crisis came about to speculating about the prospects for reforming--or even completely replacing--the current tort system.

PMS has been a legitimate diagnosis for several decades, but there are no FDA-approved therapies for it. Off-label use of medications that are FDA-approved for PMDD is common in clinical practice. For patients taking daily SSRIs for anxiety or mood symptoms, premenstrual dose adjustment offers a novel management strategy.