The following represent additions to UpToDate since the last version that were considered by the authors and editors to be of particular interest. The new material described below represents a small subset of the updating that has been performed, since approximately 40 percent of the topic reviews are updated during each four month cycle.

OBSTETRICS

Magnesium sulfate for neuroprotection — We suggest administration of magnesium sulfate to pregnant women under 32 weeks of gestation who are likely to have a preterm birth within 24 hours. Meta-analyses of randomized placebo-controlled trials of maternal administration of magnesium sulfate have demonstrated that fetal exposure to magnesium just prior to preterm delivery is associated with a significant decrease in postnatal risk of cerebral palsy and severe motor dysfunction [1-3]. (See "Neuroprotective effects of in utero exposure to magnesium sulfate".)

H1N1 influenza vaccine — The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices recommends administration of the pandemic H1N1 influenza vaccine to pregnant women and considers them a target group of high priority during limited vaccine availability [4]. (See "Prevention of pandemic H1N1 influenza ('swine influenza')", section on 'Indications during pregnancy' and "Immunization of pregnant women".)

Risk of uterine rupture — The largest prospective study of uterine rupture in a developed country reported 25 uterine ruptures in women with unscarred uteruses, accounting for 13 percent of ruptures in this study [5]. The incidence of rupture in unscarred and scarred uteruses was 0.7 and 5.1 per 10,000 deliveries, respectively. (See "Trial of labor after cesarean delivery", section on Incidence of uterine rupture.)

Induction for mild preeclampsia — Preeclamptic women can benefit from induction of labor, without incurring an increased risk of operative delivery or neonatal morbidity. A multicenter randomized trial (HYPITAT) found that women with mild preeclampsia or gestational hypertension who underwent induction of labor at ≥37 weeks of gestation had a lower risk of developing severe hypertension and a lower cesarean delivery rate than women managed expectantly with maternal/fetal monitoring [6]. (See "Management of preeclampsia", section on 'Indications for delivery'.)

Treatment of mild GDM improves pregnancy outcome — The value of treatment of mild gestational diabetes (GDM) was illustrated in a multicenter trial that randomly assigned women with mild GDM to a regimen of diet/blood glucose monitoring/insulin as needed or routine obstetrical care [7]. The treatment group has a significant reduction in the rate of macrosomia, shoulder dystocia, cesarean delivery, and preeclampsia/gestational hypertension. (See "Treatment and course of gestational diabetes mellitus", section on Rational for treatment.)

OFFICE GYNECOLOGY

Biopsy followed by curettage in endometrial hyperplasia — In women diagnosed with endometrial hyperplasia using office endometrial biopsy, a follow-up uterine curettage may help avoid a missed diagnosis of endometrial cancer. A retrospective study of 824 women with complex atypical hyperplasia diagnosed using office endometrial biopsy reported that, at time of hysterectomy, previously undiagnosed endometrial cancer was found less frequently in women who underwent a follow-up curettage after biopsy versus those who had a repeat biopsy or no repeat sampling (16 versus 23 or 47 percent) [8]. (See "Endometrial hyperplasia", section on 'Diagnostic evaluation'.)

Sonographic diagnosis of adenomyosis — Transvaginal ultrasound can be useful in the evaluation of women with suspected adenomyosis. A meta-analysis of 14 studies in which women underwent hysterectomy with pathologic confirmation of adenomyosis found that preoperative transvaginal sonography had a sensitivity of 83 percent and specificity of 85 percent for diagnosis of adenomyosis [9]. (See "Adenomyosis", section on 'Diagnosis'.)

REPRODUCTIVE ENDOCRINOLOGY

Discontinuing hormone therapy for mammography — Use of postmenopausal hormone therapy increases breast density and interferes with the performance of screening mammography. Short-term (one to two months) cessation of hormone therapy in women prior to mammography, although advised by some clinicians, had no effect on mammography recall rates in a randomized trial [10]. (See "Breast imaging: Mammography and ultrasonography", section on 'The dense breast'.)

GYNECOLOGIC ONCOLOGY

Ovarian sex cord-stromal tumor staging — Lymph node metastases are rare with ovarian sex-cord stromal tumors and it appears that staging lymphadenectomy provides no survival benefit. In a retrospective series of 257 patients with ovarian sex cord-stromal tumors, no positive nodes were found during staging [11]. In addition, nodal metastases were rare among patients whose disease eventually recurred. (See "Sex cord-stromal tumors of the ovary: Granulosa-stromal cell tumors", section on 'Staging and surgical treatment'.)

Positive peritoneal cytology in endometrial cancer — The prognostic significance of isolated positive peritoneal washings in endometrial cancer in the absence of extrauterine spread was addressed by a systematic review of over 50 studies [12]. Women with positive peritoneal cytology, but otherwise low risk disease (grade 1 or 2, myometrial invasion <50 percent, no cervical involvement, no lymphovascular space invasion) had a significantly lower rate of recurrence compared with those with positive peritoneal cytology with intermediate or high risk disease (4 versus 32 percent). (See "Endometrial cancer: Pretreatment evaluation, staging, and posttreatment surveillance", section on Peritoneal cytology.)

GYNECOLOGIC SURGERY

Microwave endometrial ablation — Two randomized trials found that menstrual flow reduction and patient satisfaction were similar for microwave ablation compared with endometrial resection or thermal balloon ablation [13,14]. Additionally, microwave ablation had several significant advantages over thermal balloon ablation, including shorter operating time, fewer device failures, and increased rate of hospital discharge by six hours [14]. (See "Endometrial ablation", section on 'Microwave ablation'.)

Reduced rates of serious infection in medical abortion — A retrospective study of over 220,000 women who underwent mifepristone/misoprostol abortion reported that rates of serious infection dropped significantly after the introduction of two protocol changes: routine use of doxycycline as a prophylactic antibiotic and administration of misoprostol buccally rather than vaginally [15]. The rate of serious infection declined from 0.93 to 0.06 per 1000 abortions. (See "Mifepristone for the medical termination of pregnancy", section on 'Infection' and "Mifepristone for the medical termination of pregnancy", section on 'Route of administration'.)

UROGYNECOLOGY

Vaginal mesh kits for apical prolapse repair — A meta-analysis compared traditional vaginal repairs, sacrocolpopexy and vaginal mesh kits [16]. Vaginal mesh kits had the lowest rate of reoperation for prolapse (1.3 percent), but had the highest rates of dyspareunia (2.2 percent), severe complications (12.9 percent) and reoperations (8.5 percent). (See "Reconstructive materials in urogynecology: Clinical applications", section on 'Mesh kits'.)