The 5th IVI International Congress: Reproductive Medicine and Beyond by ComtecMed 04-Apr-13 to 06-Apr-13 Seville , SPAIN (GYN - Contraception & Reproductive Health)
2013 AIUM Annual Convention by American Institute of Ultrasound in Medicine 06-Apr-13 to 10-Apr-13 New York (New York Marriott Marquis Hotel) , NY USA (CME - Medical Education)
Manejo clínico y terapéutico de la esterilidad. Segundo curso online by Fundacio Dexeus Salud de la Mujer 09-Apr-13 to 31-May-13 online , SPAIN(gynecology)
Pediatric Nursing: Care of the Hospitalized Child by Continuing Education Inc. 10-Apr-13 to 13-Apr-13 Anaheim (Hyatt Regency Orange County) , CA USA (CME - Obstetrics, Gynecology & Women's Health)
Medicina fetal Curso-Taller. Curso de Nivel I y II de la SESEGO by Fundacio Dexeus Salud de la Mujer 15-Apr-13 to 17-Apr-13 Barcelona (Auditorio Salud de la Mujer Dexeus) , SPAIN (OB - Maternal Fetal Medicine)
Female Urology & Urogynecology Symposium (FUUS) by Quadrant HealthCom, Inc 18-Apr-13 to 20-Apr-13 Las Vegas (ARIA) , NV USA (CME - Obstetrics, Gynecology & Women's Health)
Female Urology and Urogynecology Symposium (FUUS) 2013 by Quadrant HealthCom, Inc 18-Apr-13 to 20-Apr-13 Las Vegas (ARIA) , NV USA (CME - Obstetrics, Gynecology & Women's Health)
Uterine artery embolization for fibroids results in a tremendous reduction in menorrhagia. But while complication rates are low, up to 15% of patients are readmitted for indications like pain, bleeding and infection. More »
Though resection is still the most popular method of removing fibroids, the use of hysteroscopic morcellation has been on the rise since the first hysteroscopic morcellator became available in the United States in 2005. More »
The available evidence that selective estrogen receptor modulators (SERMs) can reduce the size of fibroids or improve clinical symptoms is inconsistent, according to the results of an updated intervention review conducted by the Cochrane Menstrual Disorders and Subfertility Group. More »
Radiofrequency volumetric thermal ablation is a safe and effective treatment for menorrhagia in women with symptomatic fibroids, providing both clinically and statistically significant reduction in blood loss, according to new research. More »
In a systematic review of UAE versus other surgical interventions for symptomatic uterine fibroids, researchers concluded that UAE offers substantial improvements in symptoms of uterine fibroids but may not help women who want to retain their reproductive potential. More »
A 39 year-old woman presented with urinary frequency and pelvic pressure. On pelvic examination, a large pelvic mass was felt adjacent to the uterus, deep in the pelvis. MRI showed a 12 cm subserosal fibroid adjacent to the right side of the uterus. More »
Ulipristal is a safe and effective option for women with uterine fibroids, according to two new studies published in the New England Journal of Medicine. In both studies, the oral selective progesterone receptor modulator was well-tolerated, rapidly reduced excessive bleeding, and decreased the size... More »
Like many of my patients, my life revolves around information. Personally, I use the same technology as most of you to keep track of obligations and loved ones. Professionally, the Houston Fertility Center team uses technology and constant communication to manage our patients' treatment plans.
Here's a situation that illustrates how fantastic medical advances don't always translate to patients benefiting in the clinic. For that to happen, the science needs to be carried along a pipeline of practitioner communication, all the way to the patient.
I know what you're thinking: How can an issue like infertility teach us about customizing healthcare? And how can the assisted reproduction field help raise standards in women's healthcare? But it can, and it does… or it should.
The purpose of this study was to estimate the total annual societal cost of uterine fibroid tumors in the United States, based on direct and indirect costs that include associated obstetric complications.|A systematic review of the literature was conducted to estimate the number of women who seek treatment for symptomatic fibroid tumors annually, the costs of medical and surgical treatment, the amount of work time lost, and obstetric complications that are attributable to fibroid tumors. Total annual costs were converted to 2010 US dollars. A sensitivity analysis was performed.|The estimated annual direct costs (surgery, hospital admissions, outpatient visits, and medications) were $4.1-9.4 billion. Estimated lost work-hour costs ranged from $1.55-17.2 billion annually. Obstetric outcomes that were attributed to fibroid tumors resulted in a cost of $238 million to $7.76 billion annually. Uterine fibroid tumors were estimated to cost the United States $5.9-34.4 billion
Uterine fibroids are the most common benign uterine tumours present in women of reproductive age. Mifepristone (RU-486) competitively binds and inhibits progesterone receptors. Studies have suggested that fibroid growth depends on the sexual steroids. Mifepristone has been shown to decrease fibroid size. This review summarises the effects of mifepristone treatment on fibroids and the associated adverse effects as described in randomised controlled trials.|To determine the efficacy and safety of mifepristone for the management of uterine fibroids in pre-menopausal women.|We searched the specialised register of the Cochrane Menstrual Disorders and Subfertility (Cochrane Menstrual Disorders and subfertility Review Group), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE, EMBASE, PsycINFO, and CINAHL (to November 2011). We handsearched a number of journals, and searched reference lists, databases of ongoing trials and the Internet.
Uterine leiomyomas (fibroids) are the most common tumors in women of reproductive age and a cause of significant morbidity in this patient population. Depending on the fibroid location, they can be the cause of a variety of symptoms, such as abnormal uterine bleeding, constipation, urinary frequency, and pain. Historically, hysterectomy has been the primary treatment option, and uterine fibroids remain the leading cause for hysterectomy in the United States. However, women who do not wish to undergo hysterectomy now have a variety of less invasive options available, including uterine artery embolization. This article discusses uterine artery embolization as well as some of the other treatment strategies for symptomatic uterine fibroids. In many situations, there may be no single best treatment option but several viable alternatives. Each option is discussed with consideration of outcomes, complications, and, when possible, cost-effectiveness. The recommendations in this article are
To investigate how uterine artery embolization (UAE) might alter the risk profile for pregnancies complicated by fibroids.|Systematic literature review and meta-analysis of existing studies.|Academic reproductive medicine unit.|Women with fibroids.|A systematic literature review, raw data extraction, and data analysis.|Rates of miscarriage, preterm delivery, malpresentation, intrauterine growth restriction (IUGR), cesarean delivery, and postpartum hemorrhage (PPH).|Two hundred twenty-seven completed pregnancies after UAE were identified. Miscarriage rates were higher in UAE pregnancies (35.2%) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 2.0-3.8). The UAE pregnancies were more likely to be delivered by cesarean section (66% vs. 48.5%; OR 2.1; 95% CI 1.4-2.9) and to experience PPH (13.9% vs. 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14% vs. 16%; OR 0.9; 95% CI 0.5-1.5), IUGR
Uterine leiomyomas (fibroids), the most common benign tumor in women of childbearing age, can cause symptoms including dysmenorrhea, menorrhagia, urinary symptoms, pain and infertility. Hysterectomy is a common approach to treating uterine fibroids, and less invasive surgical approaches such as myomectomy and uterine artery embolization also have been shown to alleviate symptoms. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is the only totally non-invasive surgical approved method for treating uterine fibroids. In clinical trials, MRgFUS resulted in significant relief of uterine fibroid symptoms. The safe and effective use of MRgFUS is affected by fibroid type and location, position relative to adjacent anatomical structures and the presence of co-existent pelvic disease. Additionally, successful outcomes with MRgFUS have been correlated with the volume of fibroids ablated during the procedure. Thus, selection of patients in whom sufficient fibroid volumes can be
Full Text View. Uterine Fibroid Pregnancy Registry. This study has been terminated. ... Purpose. The Uterine Fibroid Pregnancy Registry is a USA and European-based registry designed to monitor pregnancies in women with uterine fibroids in order to.
Full Text View. Laparoscopic Occlusion of Uterine Vessels Compared to Uterine Fibroid Embolization for Treatment of Uterine Fibroids. ... NCT00277680. Purpose. Women with symptomatic uterine fibroids are treated either by Uterine Fibroid Embolization (
Mifeprex shrinks fibroid tumors and improves the pain of endometriosis. Because the two drugs are chemically similar and have similar effects on the menstrual cycle, it is thought that CDB-2914 ... Repeat transvaginal ultrasound after 4-6 weeks of study
of in vitrofertilization ( IVF), to provide guidelines on the number of embryos to transfer in IVF-embryo transfer ( ET) in order to optimize healthy live births and minimize multiple pregnancies. ... Search terms included embryo transfer ( ET),
other disorders - associated with the PDGFRA gene. PDGFRA gene mutations that lead to a constitutively active PDGFRA protein are also associated with inflammatory fibroid polyps, which are small, noncancerous ( benign) tumors
Had a case the other day with the above finding on a pap. She was age 36 and had a Mirena in place. How do people feel about the idea of trying to do an EMB with an IUD in place? If not, how do we proceed?
Has anyone tried FetalGrowth app (App Store for iPhone/iPad) ? I'm interested in using a simple and handy tool to calculate fetal percentiles, and I came across this app, which seems it does the job (plots growth charts, as well). I haven't seen anything else, besides this app, so I was wondering if there are people who have already tried it.
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I helped another physician with removal of a retained placenta last night, we were unsuccessful in removing it vaginally, her cervix was too closed to allow manual removal and we could only get a few pieces out with ring forceps and a large curette, so we did a laparotomy/hysterotomy and were able to preserve the uterus. The placenta turned out not to be an accreta and it was easily removed via that route through a low vertical incision on the uterus. Any thoughts on the appropriate CPT code would be appreciated. The patient came in through the ER five days after home delivery by her husband. She was severely anemic, rcvd 7 units of blood and is still quite ill and in the ICU but improving.
Recently, I had the occasion to review a case of a term primigravida with PROM in a private hospital (no housestaff or in house obstetricians). She was seen by an obstetrician soon after arrival, evaluated, and pitocin induction begun.
She did not deliver for around 29 hours after admission, and the delivering obstetrician (a different physician) was physically present during the last 2 hours of labor prior to delivery.
Simply put, while the two involved obstetricians were in communication by phone with the nursing staff throughout labor (separately as their "shifts" did not overlap), no one actually came to the bedside and wrote a note) from admission until around 2 hours before delivery.
Medical staff bylaws call for a daily progress note; this bylaw was easily met.
In reviewing the case, it did not "feel good" that no one came to the bedside.
My questions:
1. Does anyone have or know of any guidelines to mandate such bedside attendance? Of course, we all hope that the involved physicians would not need said guidelines. 2. Does anyone have a suggestion of hospital/nursing protocols? Simply, in this case I would like to have had a charge nurse or bedside nurse simply say, "Hey, no one has been by for a while. What's up?"
I really need help from OB/GYNs and I'm having a hard time getting it. I find your opinions really valuable. I'm researching recommendations for cosleeping. This is for my dissertation, so your time is truly appreciated! Please complete the full survey. It will help me tremendously.
The study takes about 5 to 10 minutes to complete. Please don't hesitate to contact me at bhamel@pacificu.edu with any questions.
If you are interested in participating, please follow the link provided below:
Our hospital bought an electronic medical record (EMR) system for the clinics. There is a large hosptial group practice including pediatrics, medicine, FP, OB/GYN, and other specialities and sub-specialities. Furthermore, the hospitalists and the ER doctors are also employed in the same hosptial group practice.
The hospital spent millions of dollars on an EMR. As best I can tell there are only two useful things that the EMR does. One is to automatically calcualte the BMI, which it does very well. THe other is to make records available on any patient to any doctor anywhere in the practice. It does not do this well -- it requires lots of mouse movements and clicks and different documents come up in different formats, making it labor intenisve. But, with enough time, effort, and frustration, one can obtain copies of every document in the sustem, either on a computer screen or on paper.
Swith to the ER now. A paitnet whom I had seen the previous week in consultatio comes into the ER for a non-pregnancy problem. They call me on the telephone in the evening. "No problem", I say. I did a torough evaluation and wrote a detailed note on the patient and her OB and non-OB problems only a few days ago. "Just go to the EMR and you can print out my note with all the details."
Seems, however, that for some reason the EMR is not available in the ER (or on the wards for that matter). When I asked the hosptial administrator about it the next morning, he said that he and the hosptial lawyers were working on the problem.
Apparently the government thinks that the ER doctors and hospitalists have nothing better to do with their time than to print out copies of patients' medical records from the EMR and sell them on the black market. Therefore, we cannot let those nasty doctors have access to the EMR records. Nevermind that the ER doctors are in the same group practice as all the other doctors. Never mind that the patient is willing to sign a release so that the doctor who is taking care of her can see the records of the practice. We have to protect the patient even if it means that vital information is rendered unavailable and that things are made more difficult, complicated, and expensive. It reminds me of the Army in Viet Nam where they would have to "destroy a village in order to save it!" Apparently the EMR makes us destroy a patient in order to save her.
Thank GOD for the EMR. Three million dollars and the only benefit is that we can get a BMI 10 seconds faster.
I think the NEJM got it correct last month when they said in an atricle that the only ones who truly benefit from electronic medical record systems are the people who make and sell them.
There are a variety of complications that can occur during laparoscopic surgery. In this tutorial learn some of the complications and tips to avoid them.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Primary Care Can't Thrive Without Nurse Practitioners Courtney H. Lyder, ND, May 17, 2013 With a projected shortfall of primary-care physicians, it's time for alternate solutions to patient care. Nurse practitioners are one logical remedy.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy
