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Avoid ordering LH and FSH and either estradiol or testosterone for children with pubic hair and/or body odor but no other signs of puberty.
Choosing Wisely®
American Academy of Pediatrics - Section on Endocrinology
Premature adrenarche is usually the diagnosis and does not involve activation of the pituitary- gonadal axis but is due to an early increase in adrenal androgens. DHEA-S levels are elevated for age but do not alter the management of this common and generally benign condition.
ver más ... 2017Avoid opioid misuse in the chronic pelvic pain patient without compromising care through education, responsible opioid prescribing and advocacy.
Choosing Wisely®
AAGL – Elevating Gynecologic Surgery
Patients have a right to appropriate assessment and management of pain; however, opioid misuse has become a public health crisis. It is essential that providers become familiar with published FDA and CDC plans and guidelines. Providers must also educate and screen for risk factors for opioid misuse and follow patients on chronic opioid therapy for any signs of misuse.
ver más ... 2017Avoid the unaided removal of endometrial polyps without direct visualization when hysteroscopic guidance is available and can be safely performed.
Choosing Wisely®
AAGL – Elevating Gynecologic Surgery
Endometrial polyps are a common gynecologic disease. Though conservative management may be appropriate in some patients, hysteroscopic polypectomy is the mainstay of treatment. Removal without the aid of direct visualization should be avoided due to its low sensitivity and negative predictive value of successful removal compared to hysteroscopy and guided biopsy.
ver más ... 2017Do not routinely administer prophylactic antibiotics in low-risk laparoscopic procedures.
Choosing Wisely®
AAGL – Elevating Gynecologic Surgery
The use of prophylactic antibiotics in women undergoing gynecologic surgery is often inconsistent with published guidelines. Although the appropriate use of antibiotic prophylaxis for hysterectomy is high, antibiotics are increasingly being administered to women who are less likely to receive benefit. The potential results are significant resource use and facilitation of antimicrobial resistance.
ver más ... 2017It is not recommended to perform routine oophorectomy in premenopausal women undergoing hysterectomy for non-malignant indications who are at low risk for ovarian cancer.
Choosing Wisely®
AAGL – Elevating Gynecologic Surgery
Outside of high-risk populations, the association of oophorectomy with increased mortality in the general population has substantial implications, particularly as it relates to higher rates of coronary heart disease and cardiovascular death. The long-term risks associated with salpingo oophorectomy are most pronounced in women who are younger than 45-50 years who were not treated with estrogen.
ver más ... 2017