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In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.
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P.F. Sparling, and J.N. Wasserheit
Gonorrhea, which disproportionately affects marginalized populations, is the second most commonly reported communicable disease in the United States. Over the past 3 years, the gonococcus has shown decreased susceptibility to our last line of antimicrobial defense.
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and J.F. Strauss III
Maternal genetic contributions and the genetic status of the embryo can be analyzed by several methods, including fluorescence in situ hybridization, PCR assay, 24-chromosome single-nucleotidepolymorphism array, and comparative genomic hybridization.

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In this trial involving women with symptomatic fibroids who were planning to undergo surgery, treatment with the selective progesterone-receptor modulator ulipristal acetate was effective in controlling excessive bleeding and reducing fibroid size at 13 weeks.

and Others
In this trial comparing oral ulipristal acetate (5 mg or 10 mg daily) with once-monthly leuprolide acetate in women with symptomatic uterine fibroids before planned surgery, both doses of ulipristal acetate were noninferior to leuprolide acetate in controlling uterine bleeding.
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The unusual occurrence of adenocarcinoma of the vagina in eight patients born in New England hospitals between 1946 and 1951 led the investigators to conduct a retrospective investigation in search of factors that might be associated with tumor appearance. Maternal ingestion of diethylstilbestrol during early pregnancy appears to have enhanced the risk.
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Editorial
The Debate over Thyroid-Function Screening in Pregnancy
Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring. In surveys, almost half the obstetricians in private practices in Maine and the majority of obstetricians in a…
Original Article
Antenatal Thyroid Screening and Childhood Cognitive Function
Active secretion of thyroid hormone in the fetus does not start until about 18 to 20 weeks' gestation. Studies in animals suggest that until fetal hormone secretion begins, the fetus is dependent on circulating free thyroxine (T4) in the mother for growth and development, including central nervous…
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Perspective
The Emerging Threat of Untreatable Gonococcal Infection
It is time to sound the alarm. During the past 3 years, the wily gonococcus has become less susceptible to our last line of antimicrobial defense, threatening our ability to cure gonorrhea and prevent severe sequelae. Gonorrhea is the second most commonly reported communicable disease in the United…
Clinical Practice
Delayed Puberty
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 14-year-old…
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Original Article
Ulipristal Acetate versus Placebo for Fibroid Treatment before Surgery
Uterine leiomyomas, or fibroids, are benign, hormone-sensitive, smooth-muscle tumors that occur in 20 to 40% of women of reproductive age. The most common symptoms are menorrhagia and iron-deficiency anemia, which may lead to chronic fatigue that may not be adequately controlled with iron…
Editorial
Uterine Fibroids and Evidence-Based Medicine — Not an Oxymoron
The 2011 report from the Agency for Healthcare Research and Quality on comparative management of uterine fibroids noted, "Despite the prevalence and possible complications of uterine fibroids, few published studies examining the effectiveness of treatment strategies exist." Few therapies are…
Original Article
Ulipristal Acetate versus Leuprolide Acetate for Uterine Fibroids
Uterine leiomyomas, or fibroids, are the most common benign uterine tumors in women of reproductive age. In addition to anemia caused by heavy bleeding, fibroids can cause pelvic pain, pressure, dysmenorrhea, reduced quality of life, and infertility. Current management strategies consist mainly of…
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Original Article
Recurrent Somatic DICER1 Mutations in Nonepithelial Ovarian Cancers
Sex cord–stromal tumors and germ-cell tumors account for less than 10% of ovarian cancers. Unlike epithelial ovarian cancers, both sex cord–stromal tumors and germ-cell tumors can also occur in the testicle; testicular germ-cell tumors are the most common cancer in boys and men of European…
Perspective
The Politics of Emergency Contraception
On December 7, 2011, Health and Human Services (HHS) Secretary Kathleen Sebelius instructed Food and Drug Administration (FDA) Commissioner Margaret Hamburg not to approve the application for over-the-counter sales of Plan B One-Step, a single-dose emergency contraceptive. Dr. Hamburg issued her…
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Review Article
Genomic Medicine: Genomics and Perinatal Care
Among both prospective parents and providers of medical care, genetic and social concerns peak during the perinatal period. Advances in genomics and assisted reproductive technology have created new opportunities to detect genetic disorders and susceptibilities at multiple times during perinatal…
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Original Article
A Phase 3 Trial of Bevacizumab in Ovarian Cancer
Ovarian cancer is the fourth most common cause of cancer-related deaths in women, with an estimated 200,000 cases and 125,000 deaths occurring annually worldwide. For the past decade, the standard treatment for women with advanced ovarian cancer has been surgery and platinum-based chemotherapy.…
Original Article
Incorporation of Bevacizumab in the Primary Treatment of Ovarian Cancer
Epithelial ovarian cancer and related cancers lead to 15,000 deaths in the United States annually, representing the fifth leading cause of death from cancer among women. The poor prognosis is usually attributed to advanced stage at diagnosis and inadequate chemotherapy. Vascular endothelial growth…
Correspondence
Contraception in Primary Care — Embracing the Institute of Medicine Challenge
To the Editor: On July 19, the Institute of Medicine released a historic report outlining key preventive health services for women to be covered by insurers under the Affordable Care Act (ACA) without consumer cost sharing. Particularly notable was the report's inclusion of contraception, with the…
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Perspective
Making Sense of the New Cervical-Cancer Screening Guidelines
Over the past 60 years, U.S. mortality from cervical cancer has dropped by 70%, thanks to a successful screening program. In 1995, the American College of Obstetricians and Gynecologists (ACOG)recommended screening with the Papanicolaou (Pap) smear and pelvic examination at the initiation of sexual…
Clinical Practice
A Request for Abortion
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 22-year-old…
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Perspective
Learning about the Safety of Drugs — A Half-Century of Evolution
The end of 2011 marks the 50th anniversary of a constellation of events that transformed the way we think about drug safety. A half-century ago, the Food and Drug Administration (FDA) did not have authority to require a manufacturer to meet meaningful efficacy standards or demonstrate that a new…
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Case Records of the Massachusetts General Hospital
Case 35-2011 — A 33-Year-Old Woman with Postpartum Leukocytosis and Gram-Positive Bacteremia
Presentation of Case. Dr. Edwin C. Huang (Obstetrics and Gynecology): A 33-year-old woman was admitted to the intensive care unit (ICU) at this hospital 16.5 hours post partum because of leukocytosis and gram-positive rods in the blood. The patient had received routine prenatal care at this…
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Correspondence
Noninvasive Prenatal Diagnosis of a Fetal Microdeletion Syndrome
To the Editor: The definitive diagnosis of fetal aneuploidy and genomic imbalances requires invasive collection of fetal cells through amniocentesis or chorionic villus sampling. These methods are associated with fetal loss and parental anxiety. Analyses of DNA in maternal plasma have shown the…
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Images in Clinical Medicine
Bryant's and Stabler's Signs after a Difficult Delivery
Figure 1.
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