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Original Article
Effectiveness of Long-Acting Reversible Contraception
Unintended pregnancy is a major problem in the United States. Approximately 3 million pregnancies per year — 50% of all pregnancies — are unintended, and this rate is significantly higher than that in other developed countries. Unintended pregnancy in the United States results in 1.2 million…
- CME
Case Records of the Massachusetts General Hospital
Case 16-2012 — A 32-Year-Old Woman with HER2-Positive Breast Cancer
Presentation of Case. Dr. Steven Jay Isakoff (Hematology–Oncology): A 32-year-old woman was seen in the outpatient cancer center at this hospital because of infiltrating ductal carcinoma of the right breast. The patient had been well until 2 months before admission, when she became aware of a…
- CME
Correspondence
A Noninvasive Test to Determine Paternity in Pregnancy
To the Editor: Five percent of women who are raped become pregnant, which results in an estimated 32,000 pregnancies annually in the United States. In many circumstances, it is unclear whether the pregnancy resulted from the rape or from consensual intercourse. The only options available for…
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Perspective
Warning: Contraceptive Drugs May Cause Political Headaches
Foster Friess, a conservative political donor, recently discounted the importance of insurance coverage for contraceptives, saying, "Back in my days, they used Bayer Aspirin for contraception. The gals put it between their knees, and it wasn't that costly." Though his comment stunned interviewer…
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Correspondence
Pregnancy in a Woman with a Leptin-Receptor Mutation
To the Editor: Leptin is considered to have an important role in reproductive functions, including menstrual-cycle regulation, pregnancy, and lactation. The absence of leptin action caused by functional mutations in the leptin gene (LEP) or the leptin receptor gene (LEPR) has been linked to…
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Correspondence
Ovarian Toxicity from Sirolimus
To the Editor: Sirolimus prevents rejection of renal allografts by blocking the mammalian target of rapamycin (mTOR), a signaling pathway known to regulate ovarian function. Sirolimus is being assessed as a treatment for autosomal dominant polycystic kidney disease (ADPKD). Observational data…
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Clinical Practice
Uncomplicated Urinary Tract Infection
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 author's clinical recommendations. Stage. A 30-year-old…
- CME
- Full Text Audio
Original Article
A Randomized Trial of Nicotine-Replacement Therapy Patches in Pregnancy
Smoking in pregnancy is the leading preventable cause of morbidity and death among women and infants. Adverse pregnancy and birth outcomes associated with smoking include placental abruption, miscarriage, prematurity, low birth weight, congenital abnormalities, and neonatal or sudden infant death.…
- CME
Editorial
Nicotine Replacement for Smoking Cessation during Pregnancy
Cigarette smoking during pregnancy increases the risk of delivering a low-birth-weight or preterm infant, as well as the risks of pregnancy complications (premature rupture of membranes and placental abruption) and perinatal and infant death. Despite these risks, 10 to 12% of pregnant women in the…
Original Article
Brief Report: Inactivating KISS1 Mutation and Hypogonadotropic Hypogonadism
It is still unknown how puberty in humans, occurring during the early years of the second decade of life, is initiated. The hallmark of puberty is increased secretion of the gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which act in concert to stimulate the gonads…
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…
- CME
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…
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…
- CME
- Full Text Audio
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…
- CME
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…
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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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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