📖 Full bibliography

Ministerio de Salud Pública y Bienestar Social (MSPyBS/SPGO). (2018). Manual Nacional de Normas de Atención de las Principales Patologías Obstétricas (1st ed.). Asunción, Paraguay.

Contribution: stepwise tocolytic management protocols, magnesium sulfate neuroprotection, fetal lung maturation, treatment of intrahepatic cholestasis, and management of prolonged pregnancy and fetal demise.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2021). Guía de Manejo de la Hemorragia Posparto: Código Rojo Obstétrico (Resolution S.G. No. 2004/2021). Asunción, Paraguay.

Contribution: standardized roles, aggressive resuscitation, hypovolemic shock, and surgical/medical response times.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2022). Manual de Cuidados Perinatales (Resolution S.G. No. 1078/2022). Asunción, Paraguay.

Contribution: tiered preconception counseling, prenatal care, partograph, and postpartum management.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2023). Orientaciones Técnicas para la Atención Integral a la Mujer en Climaterio (Resolution S.G. No. 267/2023). Asunción, Paraguay.

Contribution: MRS scale, ORAI, postmenopausal endometrial thickness, and menopausal hormone therapy (MHT) regimens.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2025). Manual Nacional de Normas de Atención de Patologías Ginecológicas (Resolution S.G. No. 050/2025). Asunción, Paraguay.

Contribution: standardized algorithms for amenorrhea, precocious and delayed puberty, fibroids under the STEP-W classification, endometriosis (Law No. 7341/2024), and pelvic floor pathology.

Speroff, L., & Fritz, M. A. (2019). Clinical Gynecologic Endocrinology and Infertility (9th ed.). Lippincott Williams & Wilkins.

Contribution: follicular- and luteal-phase physiology, gonadotropin (LH/FSH) surges, the endometrial implantation window, basal body temperature curves, and diagnostic criteria for functional amenorrhea.

Mihm, M., Gangooly, S., & Muttukrishna, S. (2011). The normal menstrual cycle in women. Animal Reproduction Science, 124(3-4), 229–236.

Contribution: ultrasound and endocrine characterization of dominant follicle selection and luteolysis.

Melmed, S., Casanueva, F. F., Hoffman, A. R., et al. (2011). Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96(2), 273–288.

Contribution: serum prolactin cutoffs, ruling out macroprolactin and the hook effect, cabergoline/bromocriptine dosing, and neuroimaging indications.

Vilar, L., Abucham, J., Albuquerque, J. L., et al. (2019). Results of an explicit guideline for the management of prolactinomas? A series of 285 patients. Pituitary, 22(5), 491–500.

Contribution: titration criteria, long-term efficacy, and transsphenoidal surgical management in resistance or tumor apoplexy.

Teede, H. J., Tay, C. T., Laven, J. J., et al. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 120(4), 767–793.

Contribution: international diagnostic criteria, phenotypes A–D, transvaginal ultrasound follicle-count thresholds, AMH use, and comprehensive management.

The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1), 19–25.

Contribution: definition of the three classic criteria (anovulation, clinical/biochemical hyperandrogenism, and polycystic morphology).

Practice Committee of the American Society for Reproductive Medicine (ASRM). (2021). Diagnostic evaluation of the infertile female: a committee opinion. Fertility and Sterility, 116(5), 1255–1265.

Contribution: pillars of ovarian reserve testing (FSH, estradiol, AMH, AFC), hysterosalpingography, and ovulation confirmation.

World Health Organization (WHO). (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). Geneva: World Health Organization.

Contribution: minimum reference values for standard semen analysis (volume, concentration, progressive motility, vitality, and strict Kruger morphology).

Practice Committee of the American Society for Reproductive Medicine (ASRM). (2020). Use of clomiphene citrate and letrozole for ovulation induction in subfertile women: a committee opinion. Fertility and Sterility, 113(2), 274–282.

Contribution: low-complexity ovulation-induction protocols, mandatory baseline ultrasound on days 2–4, follicular maturity criteria, hCG trigger, and prevention of ovarian hyperstimulation syndrome (OHSS).

Leone, F. P., Timmerman, D., Bourne, T., et al. (2010). Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound in Obstetrics & Gynecology, 35(1), 103–112.

Contribution: standardized endometrial thickness measurement, echogenicity classification, definition of the endometrial-myometrial junction, and vascular patterns (Color Score 1–4).

Epstein, E., Fischerova, D., Valentin, L., et al. (2018). Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus: prospective cohort study. Ultrasound in Obstetrics & Gynecology, 51(6), 818–828.

Contribution: clinical validation of chaotic/branching Doppler flow and irregular borders for detecting malignant pathology.

American College of Obstetricians and Gynecologists (ACOG). (2018). Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Postmenopausal Patients with Abnormal Uterine Bleeding. Obstetrics & Gynecology, 131(5), e124–e129.

Contribution: ≤4mm ultrasound threshold in postmenopausal bleeding (NPV >99%) and indications for outpatient endometrial biopsy (Pipelle).

Revised American Society for Reproductive Medicine (rASRM). (1997). Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility, 67(5), 817–821.

Contribution: endometriosis stages I–IV based on scoring of peritoneal implants, endometriomas, and pelvic adhesions.

Keckstein, J., Saridogan, E., Ulrich, U. A., et al. (2021). The #Enzian classification: A comprehensive directory of deep endometriosis and its associated diseases. Human Reproduction Open, 2021(4), hoab038.

Contribution: standardized mapping of deep retroperitoneal endometriosis by anatomic compartments (A, B, C, and affected organs).

Munro, M. G., Critchley, H. O., Fraser, I. S., & FIGO Menstrual Disorders Committee. (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years, including PALM-COEIN. International Journal of Gynecology & Obstetrics, 143(3), 393–408.

Contribution: morphologic subclassification of uterine fibroids, FIGO types 0–8.

Bump, R. C., Mattiasson, A., Bø, K., et al. (1996). The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics and Gynecology, 175(1), 10–17.

Contribution: pelvic organ prolapse quantification system (POP-Q) and standardized clinical staging (grades 0–IV).

Heinemann, K., Ruebig, A., Potthoff, P., et al. (2004). The Menopause Rating Scale (MRS) scale: A methodological review. Health and Quality of Life Outcomes, 2, 45.

Contribution: validation of the somatic, psychological, and urogenital domains, and severity cutoffs for menopausal syndrome.

The 2022 Hormone Therapy Position Statement of The North American Menopause Society (NAMS). (2022). Menopause, 29(7), 767–794.

Contribution: window-of-opportunity criteria (age <60 or <10 years postmenopause), regimens with and without progestogen opposition, and absolute contraindications.

Stute, P., et al. (2026). 'Healthy menopause': The European Menopause and Andropause Society (EMAS) 2026 framework for precision, digital, and interdisciplinary midlife health. Maturitas, 212, 109060.

Contribution: multidisciplinary approach to healthy aging, metabolic stratification, and pharmacologic alternatives.

Anagnostis, P., Bosdou, J. K., Georgiou, T., & Goulis, D. G. (2025). Can menopausal hormone therapy be considered in postmenopausal women who are older than 60 years? Gynecological Endocrinology, 41(1), 2468957.

Contribution: safety guidance, ultra-low-dose transdermal therapy for refractory severe vasomotor symptoms, and non-hormonal preference after age 60.

Pratt, M. C., et al. (2023). Fezolinetant for the treatment of vasomotor symptoms associated with menopause. Expert Review of Clinical Pharmacology, 16(5), 389–398.

Contribution: NK3 receptor blockade at the hypothalamic level (KNDy neurons) as first-line non-hormonal therapy for hot flashes.

Manning, F. A., Platt, L. D., & Sipos, L. (1980). Antepartum fetal evaluation: development of a fetal biophysical profile score. American Journal of Obstetrics and Gynecology, 136(6), 787–795.

Contribution: definition of the 5 fetal biophysical parameters (fetal breathing, fetal movement, tone, NST, amniotic fluid volume) and their stepwise relationship to intrauterine asphyxia.

Ayres-de-Campos, D., Spong, C. Y., Chandraharan, E., & FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. (2015). FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. International Journal of Gynecology & Obstetrics, 131(1), 13–24.

Contribution: standardized criteria for normal, suspicious, and pathological cardiotocographic tracings.

Figueras, F., & Gratacós, E. (2014/2021). Stage-based management of fetal growth restriction. Fetal Diagnosis and Therapy, 36(1), 22–33 / Medicina Fetal Barcelona.

Contribution: hemodynamic classification of FGR in stages I–IV by Doppler of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus, with standardized delivery timing.

Mari, G., Deter, R. L., Carpenter, R. L., et al. (2000). Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. New England Journal of Medicine, 342(1), 9–14.

Contribution: middle cerebral artery peak systolic velocity (MCA-PSV ≥1.50 MoM) for the noninvasive diagnosis of severe fetal anemia.

American College of Obstetricians and Gynecologists (ACOG). (2020). Practice Bulletin No. 216: Macrosomia. Obstetrics & Gynecology, 135(1), e18–e35.

Contribution: criteria for planned preventive cesarean delivery when estimated fetal weight is ≥5,000g in non-diabetics and ≥4,500g in diabetics.

International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). (2018). ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound in Obstetrics & Gynecology, 52(4), 547–559.

Contribution: objective assessment of labor progress (angle of progression ≥120°, head-perineum distance, and fetal head direction).

Carel, J. C., Eugster, E. A., Rogol, A., Ghizzoni, L., Palmert, M. R., et al. (2009). Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics, 123(4), e752–e762.

Contribution: indication criteria, bone-age monitoring, and axis-suppression regimens with depot leuprolide acetate and triptorelin.

Speiser, P. W., Arlt, W., Auchus, R. J., Baskin, L. S., Conway, G. S., et al. (2018). Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 103(11), 4043–4088.

Contribution: basal 17-OHP cutoffs, the confirmatory ACTH 250µg test with a >10ng/mL cutoff for the non-classic form, and hydrocortisone suppression.

Latronico, A. C., Brito, V. N., & Carel, J. C. (2016). Causes, diagnosis, and treatment of central precocious puberty. The Lancet Diabetes & Endocrinology, 4(3), 265–274.

Contribution: etiologic differentiation between idiopathic central precocious puberty vs. CNS lesions, and indications for sellar/brain MRI.

Badouraki, M., Christoforidis, A., Economou, I., Dimitriadis, A. S., & Katzos, G. (2008). Evaluation of pelvic ultrasonography in the diagnosis and follow-up of girls with precocious puberty. Journal of Clinical Ultrasound, 36(5), 277–282.

Contribution: ultrasound parameters of pubertal stimulation: uterine length ≥40mm, uterine volume ≥3–4mL, body-to-cervix ratio 2:1, visible endometrial line, and ovarian volume >2–3mL.

Greulich, W. W., & Pyle, S. I. (1959). Radiographic Atlas of Skeletal Development of the Hand and Wrist (2nd ed.). Stanford University Press.

Contribution: the standard for assessing bone maturation on hand/wrist X-ray, and the definition of a pathological advance >1.5–2 years.

Marshall, W. A., & Tanner, J. M. (1969). Variations in pattern of pubertal changes in girls. Archives of Disease in Childhood, 44(235), 291–303.

Contribution: clinical staging of breast development (M1–M5) and pubic hair (P1–P5).