Updates on Evaluation and Treatment of Common Complaints in Pregnancy.

Patients experience many new and concerning symptoms during pregnancy and it is the role of the obstetric clinician to provide appropriate guidance, recommendations, and treatment options. Often times, these symptoms are related to hormonal and physiologic changes that occur and will resolve in the postpartum period. However, clinicians must be able to recognize more concerning pathologic symptoms that require further evaluation and treatment.

Prenatal Contraceptive Counseling.

Pregnancy care should include open discussions with patients about their ideal family size and pregnancy spacing. With these patient-voiced goals in mind, clinicians should review contraceptive tools to meet these goals, including special considerations after birth. For patients that desire contraception, it is important to prioritize the provision of their chosen method as soon as safely possible and desired after birth.

The evolving relationship between conservative states and access to contraception.

Poor access to contraception can lead to several undesired health outcomes, including high rates of unintended pregnancy, high rates of teen pregnancy, spontaneous preterm delivery, preeclampsia and maternal death. Properly addressing these public health issues often require a coordinated response at the state government level. States with conservative legislatures have traditionally fought attempts to expand access to contraception.

Effect of prenatal EPA and DHA on maternal and cord blood insulin sensitivity: a secondary analysis of the mothers, omega 3, and mental health study.

Background: We sought to determine whether prenatal supplementation with the omega-3 fatty acids eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) would increase markers of insulin sensitivity in maternal or cord blood compared with placebo supplementation. A secondary aim was to evaluate the association of serum EPA and DHA fractions with adiponectin, leptin and the adiponectin:leptin ratio (ALR). We hypothesized that omega-3 fatty acid supplementation would increase markers of insulin sensitivity in maternal and umbilical cord plasma.

Vulvar Cancer.

This article reviews the epidemiology, diagnosis, and management of vulvar preinvasive lesions, squamous cell carcinoma, and melanoma. There is an emphasis on sentinel lymph node dissection for early stage disease and advances in chemoradiation for late-stage disease. A brief review of vulvar Paget disease is also included.

Prevalence of alcohol use in pregnant women with substance use disorder.

Background: Prenatal care programs for women with opioid use disorder (OUD) often focus treatment/counseling plans around illicit substances, while concurrent use of alcohol might present an equal or greater risk to the fetus.

Methods: This study evaluated self-reported prevalence of alcohol use in patients participating in a comprehensive prenatal care program for women with substance use disorder (SUD; n = 295), of which 95% are treated for OUD, and pregnant women being served through general obstetrical clinics at the University of New Mexico (n = 365). During the screening phase of a prospective study, patients were asked to report alcohol use in the periconceptional period, and between the last menstrual period and pregnancy recognition.

Family Planning American Style Redux: Unintended Pregnancy Improves, Barriers Remain.

This article discusses barriers to reducing unintended pregnancy. Numerous factors may explain the high rate of unintended pregnancy in the United States, including inadequate sex education, confusing media messages about sex, cultural attitudes about sex and young parenting, conflation of contraception with abortion, inadequate health care access, burdensome contraceptive dispensing practices, and hospital merger limitations on care. Successful and promising approaches to expanding access to reproductive health care and reducing unintended pregnancy are discussed.

Methodology for a trial of brain-centered versus anticholinergic therapy in women with urgency urinary incontinence.

Introduction And Hypothesis: We describe the rationale and methodology for a study comparing mind-body treatment and pharmacotherapy in women with urgency urinary incontinence (UUI). To explore brain associations in UUI, a subset of patients will also undergo functional magnetic resonance imaging (fMRI). We hypothesize that hypnotherapy, a mind-body intervention, will be at least as effective as pharmacotherapy in treating UUI.

Methodology for a vaginal and urinary microbiome study in women with mixed urinary incontinence.

Introduction And Hypothesis: We describe the rationale and methods of a study designed to compare vaginal and urinary microbiomes in women with mixed urinary incontinence (MUI) and similarly aged, asymptomatic controls.

Methods: This paper delineates the methodology of a supplementary microbiome study nested in an ongoing randomized controlled trial comparing a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone for MUI. Women in the parent study had at least "moderate bother" from urgency and stress urinary incontinence symptoms (SUI) on validated questionnaire and confirmed MUI on bladder diary.

Nitrous oxide for pain management during in-office hysteroscopic sterilization: a randomized controlled trial.

Objectives: To evaluate whether inhaled nitrous oxide with oxygen (NO/O) is associated with less pain compared to oral sedation for pain management during in-office hysteroscopic sterilization.

Study Design: This double blinded randomized controlled trial enrolled women undergoing in-office hysteroscopic sterilization. All participants received pre-procedure intramuscular ketorolac and a standardized paracervical block.

Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history.

Introduction And Hypothesis: Urinary incontinence (UI) is common and the relationship among its subtypes complex. Our objective was to describe the natural history and predictors of the incontinence subtypes stress, urgency, and mixed, in middle-aged and older US women. We tested our hypothesis that UI subtype history predicted future occurrence, evaluating subtype incidence/remission over multiple time points in a stable cohort of women.

Smoking cessation in pregnancy.

More than 400,000 deaths occur per year in the United States that are attributable to cigarette smoking; the risks to the general public are widely known. The risk to women, especially those who are pregnant, is less commonly known. During pregnancy, smoking increases the risk of low birth weight infants, placental problems (previa and/or abruption), chronic hypertensive disorders, and fetal death.

Teratogenic risks from exposure to illicit drugs.

Substance use is prevalent in the United States, especially in the reproductive age population. Even though a reduction in substance use may occur during pregnancy, some women may not alter their drug use patterns until at least pregnancy is confirmed. For these reasons, a large number of fetuses are exposed to illicit substances, including during critical stages of organogenesis.