GnRHa may have a protective effect against the development of POF after gonadotoxic chemotherapy; however, the duration of benefit is unclear and requires further study.

Chronic pelvic pain is a complex condition with peripheral and central mechanisms of pain. Successful nonsurgical management typically relies on a multimodal approach, with integration of both pharmacologic and nonpharmacologic interventions. This article reviews nonpharmacologic therapies including pelvic floor physical therapy, dietary modifications, psychotherapy, and acupuncture. These interventions are low risk and should be incorporated into treatment for chronic pelvic pain, as they show promise for successful symptom relief in many overlapping chronic pain conditions. Common nonopioid medications for pelvic are also reviewed, including analgesics, hormone modulating agents, antidepressants, and anticonvulsants. Guidelines for cautious and responsible opioid use are also summarized. While data specific to chronic pelvic pain management remain limited, evidence supporting treatment of other chronic pain conditions is reviewed to help guide management.

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Operative hysteroscopy is a safe and effective minimally invasive treatment option for submucosal and intramural leiomyomas. We discuss preoperative evaluation, fluid management, postoperative complications, preventative measures, and hysteroscopic outcomes. Technical instructions and tips for successful hysteroscopy, as well as the various equipment options most commonly utilized in the United States, are also reviewed.

Objective: This article offers insight into an academic institute's approach to the rare phenomenon of abdominalwall endometriosis (AWE). The article also provides data on concurrent pelvic endometriosis, which has not often been assessed in previous studies. The aim here is to describe the characteristics and management of AWE at an academic institute. Materials and Methods: A retrospective chart review was conducted on 28 patients with pathologically confirmed AWE at an academic institute. Results: The most commonly reported symptoms were constant pain (19/28; 67.9%), cyclic pain (16/28; 57.1%), and palpable mass (16/28; 57.1%). All patients reported having had prior abdominal surgery. Preoperative imaging included 14 magnetic resonance imaging scans, 11 computed tomography scans, and 8 ultrasounds. Nine general surgery and 19 anesthesiology preoperative consultations occurred. AWE was found within 5 cm of a previous incision in 24 of 28 patients; these were 20 cesarean-section and 4 laparoscopic incisions. The average size of the lesions was 3.8 cm. Four patients required mesh and 26 patients underwent concurrent laparoscopy at the time of excision. Endometriosis and/or adenomyosis was noted in 25 patients (96.2%). Fifteen patients underwent regional anesthetic blocking. The average length of stay for these patients was 1158.3 versus 1705.7 minutes for those who did not. Conclusions: Pain and a mass at a previous surgical site warrants a workup for AWE. If AWE is suspected, one should consider laparoscopy for any patient with symptoms suggestive of pelvic endometriosis. Perioperative, regional anesthetic blocks should be also considered.

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Despite clear evidence that there is overrepresentation of male fetal sex in cases with placental abruption, prior studies have not investigated possible differential outcomes between female and male infants following abruption.This population-based case-control study investigated possible sex-related differences in short-term morbidity in cases with placental abruption. Data on pregnancy, delivery, and perinatal outcomes were collected from the Finnish Hospital Discharge Register and the Medical Birth Register for all women with a diagnosis of placental abruption between 1987 and 2005. A total of 4081 women with singleton pregnancy and placental abruption were matched with 12,752 controls without placental abruption by maternal age, parity, year of birth, and hospital district area. The final analysis included 3688 cases and 12,695 controls with live-born infants. The primary study outcome measure was placental abruption.There was a significant male sex overrepresentation in the placental abruption cases compared with the controls (cases: 0.548 vs. controls: 0.516, P ϭ 0.001). Male fetuses in the placental abruption group were born earlier than female fetuses (P ϭ 0.018).Cases were born earlier than the controls, and were also associated with lower birth weight, more frequent growth restriction, as well as lower Apgar scores and pH values (all comparisons, P Ͻ 0.001). Compared with controls, newborn infants in the abruption group more often needed special care, respirator treatment, intravenous antimicrobials, and phototherapy (all comparisons, P Ͻ 0.001). No difference occurred in perinatal outcomes between female and male infants in the placental abruption group.These findings show that placental abruption was more common and occurred earlier in pregnancy with male fetal sex compared with females but other short-term outcomes of the newborns were similar. Outcomes of newborns in the placental abruption group were worse compared with controls. ABSTRACTThere is a black-white disparity in birth outcomes. The risk of a low birth weight (LBW) infant and infant death is about twice more likely among African-American women than among non-Hispanic white women. Several studies have demonstrated worsening birth outcomes with increasing maternal age in African-American women; this phenomenon has been referred to as "weathering." Some investigators have suggested that weathering may result from the cumulative effect of socioeconomic disadvantages on the health of African-American women. Prior studies reported more frequent occurrence of weathering among African-American mothers living in low-income neighborhoods during pregnancy, even after adjustment for maternal health characteristics. There are little data on the effect of early life environment on weathering.The present study tested the hypothesis that African-American women who had never been exposed to poverty in low-income areas would not experience weathering, and that white women exposed to poverty throughout their life would show evidence of weathering. Data obt...

INTRODUCTION: The Essure is most commonly removed by bilateral salpingectomy with cornual resection (BS-CR) or total laparoscopic hysterectomy with bilateral salpingectomy (TLH-BS); however, limited data exists on Essure removal. The purpose of this study is to evaluate the safety and efficacy of Essure removal via BS-CR and TLH-BS. METHODS: A retrospective chart review and follow-up patient survey were conducted at an academic institute of patients undergoing surgical removal of the Essure device via BS-CR or TLH-BS between 2014 and 2017. RESULTS: 58 patients underwent Essure removal-33 via BS-CR and 25 via TLH-BS. The mean operative time for BS-CR was 61 minutes vs. 70.5 minutes for TLH-BS. All procedures had an estimated blood loss of less than 50mL. There were no intraoperative complications. Mean length of stay for BS-CR was 572.6 minutes vs. 772.4 minutes for TLH-BS. Postoperatively, 1 patient who underwent BS-CR presented to the emergency room (ER) due to subjective fevers; no pathology was identified. One TLH-BS patient was admitted with vaginal cuff cellulitis, and one presented to the ER for vaginal bleeding without cuff separation/dehiscence. Satisfaction was noted in 30/32 (93.8%) patients who underwent BS-CR vs. 20/20 (100%) who underwent TLH-BS. Improved quality of life was reported in 29/32 (90.6%) of patients who underwent BS-CR vs. 19/20 (95.0%) who underwent TLH-BS. 31/32 (96.9%) patients who underwent BS-CR reported they would undergo removal again vs. 19/20 (95.0%) who underwent TLH-BS. CONCLUSION: Bilateral salpingectomy with cornual resection and TLH-BS are likely comparable methods for Essure removal, with overall high satisfaction.