Effect of Radiofrequency Endometrial Ablation on Dysmenorrhea.

Study Objective: To examine rates of dysmenorrhea after radiofrequency endometrial ablation in patients with and without known dysmenorrhea symptoms prior to the procedure in a diverse population.

Design: Retrospective cohort study (Canadian Task Force classification II-2).

Setting: Academic gynecology practice.

The future of obstetrics/gynecology in 2020: a clearer vision. Transformational forces and thriving in the new system.

Revamping the delivery of women's health care to meet future demands will require a number of changes. In the first 2 articles of this series, we introduced the reasons for change, suggested the use of the 'Triple Aim' concept to (1) improve the health of a population, (2) enhance the patient experience, and (3) control costs as a guide post for changes, and reviewed the transformational forces of payment and care system reform. In the final article, we discuss the valuable use of information technology and disruptive clinical technologies.

The future of obstetrics/gynecology in 2020: a clearer vision. Why is change needed?

External and internal pressures are causing rapid changes to the delivery of health care that markedly will influence the practice of obstetrics and gynecology. These changes can be divided into broad categories: (1) Burden of the high cost of current health care on society; (2) demographic changes in women that include aging, obesity, diversity, and chronic medical conditions; and (3) workforce changes that include growing provider shortages, inexperience, and desires for improved lifestyles. The combination of these factors has brought health care to a strategic inflection point where current practice methods will lead to an inability to meet the demand for health care because of increasing volume while simultaneously controlling costs and improving quality.

The future of obstetrics/gynecology in 2020: a clearer vision: finding true north and the forces of change.

The pressure to transform health care has been building for many years, and many frameworks have been proposed for this transformation. The 'Triple Aim' concept of improving the health of the population, improving the experience of the patient, and controlling cost can be used as a guide post for the adoption of the necessary changes to thrive in a new construct of women's health care. Following these guiding principles should lead to improved clinical outcomes at affordable costs with high patient and provider satisfaction.

Evaluation and management of adnexal mass in pregnancy.

With widespread use of ultrasound in early pregnancy, incidental adnexal masses are detected frequently. This article reviews the differential diagnosis, appropriate evaluation, and current treatment options for adnexal masses in pregnancy. With the increased sophistication of ultrasound, observation has become a more viable option.

Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial.

Objective: To estimate whether an organized, consistent program of dietary and lifestyle counseling prevents excessive weight gain in pregnancy.

Methods: This randomized controlled trial assigned women to receive either an organized, consistent program of intensive dietary and lifestyle counseling or routine prenatal care. The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine (IOM) guidelines.

Does response to hormonal therapy predict presence or absence of endometriosis?

Study Objective: We sought to determine whether relief of chronic pelvic pain symptoms with hormonal treatment is predictive of presence or absence of endometriosis or location of endometriosis within the pelvis.

Design: A retrospective, chart review (Canadian Task Force classification II-3).

Setting: A private practice endometriosis referral center.

Laparoscopic Burch colposuspension.

Purpose Of Review: This review will describe the recent literature regarding laparoscopic Burch colposuspension.

Recent Findings: A 2006 Cochrane review found laparoscopic Burch colposuspension to be equivalent to open Burch colposuspension regarding subjective cure rate, but a reduced objective cure rate was reported. Three subsequent randomized trials have not identified any significant difference between the two procedures with respect to subjective or objective cure rates.

Patient satisfaction with 3 methods of postpartum contraceptive counseling: a randomized, prospective trial.

Objective: To compare patient satisfaction with 3 different postpartum contraceptive counseling methods.

Study Design: Randomized, prospective trial in an urban medical center. Patients were randomized to receive physician-patient counseling, written literature or an educational video.

Laparoscopic supracervical hysterectomy.

Laparoscopic supracervical hysterectomy is a minimally invasive procedure that was developed during the 1990s as a treatment for abnormal uterine bleeding. The literature regarding this procedure, mainly case series and retrospective comparisons, suggests that laparoscopic supracervical hysterectomy results in reduced operating time and blood loss and a quicker return to normal activity, compared with laparoscopic-assisted vaginal hysterectomy. A randomized, controlled trial that compared laparoscopic supracervical hysterectomy with hysteroscopic endometrial resection found that laparoscopic supracervical hysterectomy resulted in significantly better patient satisfaction at 2 years for similar costs.

It's time to challenge surgical dogma with evidence-based data.

Surgical training is an apprenticeship with surgical techniques passed from one physician to another. Often these techniques are based more on surgical dogma than scientific evidence. Despite surgical dogma to the contrary, electrocautery is the preferred technique for wound creation, and peritoneal closure has no significant advantage over nonclosure.