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Marí-Alexandre J, Barceló-Molina M, Olcina-Guillem M, García-Oms J, Braza-Boïls A, Gilabert-Estellés J. MicroRNAs: New players in endometriosis. World J Obstet Gynecol 2016; 5:28-38. [DOI: 10.5317/wjog.v5.i1.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/14/2015] [Accepted: 01/07/2016] [Indexed: 02/05/2023] Open
Abstract
Endometriosis is an estrogen-dependent inflammatory disorder that limits the quality of life of affected women. This pathology affects 10% of reproductive-age women, although the prevalence in those patients experiencing pain, infertility or both is as high as 35%-50%. Endometriosis is characterized by endometrial-like tissue outside the uterus, primarily on the pelvic peritoneum, ovaries and the pouch of Douglas. Despite extensive research endeavours, a unifying theory regarding the exact etiopathogenic mechanism of this high prevalent and incapacitating condition is still lacking, although it has been suggested that epigenetics could be involved. MicroRNAs (miRNAs), one of the epigenetic players, are small non-coding RNAs that can act as post-transcriptional regulators of gene expression, reducing the expression of their target mRNAs either inhibiting its translation or promoting its degradation. MiRNA expression profiles are specific of tissue and cell type. Abnormal miRNA expression has been described in different pathological conditions, such as a myriad of oncological, cardiovascular and inflammatory diseases and gynecological pathologies. In endometriosis, miRNA expression patterns of eutopic endometrium from patients and control women and from different endometriotic lesions have been described. These small non-coding molecules have become attractive candidates as novel biomarkers for an early non-invasive diagnosis of the disease, which could suppose a valuable benefit to the patients in terms of improvement of prognosis and reduction of the ratio of recurrence. In this systematic review we will focus on the role of miRNAs in the pathophisiology of endometriosis.
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Vinayagam D, Leslie K, Khalil A, Thilaganathan B. Preeclampsia - What is to blame? The placenta, maternal cardiovascular system or both? World J Obstet Gynecol 2015; 4:77-85. [DOI: 10.5317/wjog.v4.i4.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/03/2015] [Accepted: 10/08/2015] [Indexed: 02/05/2023] Open
Abstract
Preeclampsia (PE) is a pregnancy-specific syndrome, complicating 2%-8% of pregnancies. PE is a major cause of maternal mortality throughout the world with 60000 maternal deaths attributed to hypertensive disorders of pregnancy. PE also results in fetal morbidity due to prematurity and fetal growth restriction. The precise aetiology of PE remains an enigma with multiple theories including a combination of environmental, immunological and genetic factors. The conventional and leading hypotheses for the initial insult in PE is inadequate trophoblast invasion which is thought to result in incomplete remodelling of uterine spiral arteries leading to placental ischaemia, hypoxia and thus oxidative stress. The significant heterogeneity observed in pre-eclampsia cannot be solely explained by the placental model alone. Herein we critically evaluate the clinical (risk factors, placental blood flow and biomarkers) and pathological (genetic, molecular, histological) correlates for PE. Furthermore, we discuss the role played by the (dysfunctional) maternal cardiovascular system in the aetiology of PE. We review the evidence that demonstrates a role for both the placenta and the cardiovascular system in early- and late-onset PE and highlight some of the key differences between these two distinct disease entities.
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Kelekci S, Aydogmus S. Emergency contraception: What is new? World J Obstet Gynecol 2015; 4:95-101. [DOI: 10.5317/wjog.v4.i4.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/19/2015] [Accepted: 09/08/2015] [Indexed: 02/05/2023] Open
Abstract
Unintended pregnancy rates remain high throughout the World and increase the risk of poor maternal and infant outcomes. Most of unintended pregnancies occur in women who were not using contraception or who became pregnant despite the reported use of contraception. Women who have had recent unprotected intercourse including those who have had another form of contraception fail are potential candidates for this intervention. Currently used emergency contraceptive methods are pills that contain combined estrogen-progesterone, only progestin, antiprogestins and copper intrauterine devices. The most common form of this type of contraception is oral progestin-only pills (levonorgestrel). The most effective method is copper intrauterine devices followed by anti-progestins and oral progestin-only pills. The major pathogenesis of oral emergency contraceptives is the prevention or delay of ovulation. Although conception is possible on only a few days of the cycle, emergency contraception is offered when indicated without regard to the timing of the menstrual cycle because of uncertainty in the timing of the ovulation. Levonorgestrel and E/P regimes are most effective as soon as possible after unprotected sexual intercourse. A linear relationship has been shown between effectiveness and the time of dose. The effectiveness continues for 120 h, but it is recommended to be used within 72 h after intercourse. Intrauterine devices may prevent pregnancy when 5 d after ovulation.
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Craciunas L, Tsampras N, Kollmann M, Stirbu L, Raine-Fenning NJ. Use of hyaluronic acid for sperm immobilisation and selection before intracytoplasmic sperm injection: A systematic review and meta-analysis. World J Obstet Gynecol 2015; 4:113-123. [DOI: 10.5317/wjog.v4.i4.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To appraise critically the published randomised controlled trials (RCTs) reporting on the effectiveness of using hyaluronic acid (HA) for sperm immobilisation and selection before intracytoplasmic sperm injection (ICSI).
METHODS: Two authors used the PICO Method in order to perform a comprehensive literature search of the standard medical databases in June 2015. Data from the included studies was extracted independently by two authors using a predefined pro-forma. Review Manager (RevMan) was used to calculate the combined outcomes where multiple studies contributed with their results. Risk ratio (RR) with a 95%CI using the Mantel-Haenszel method was calculated for binary data variables. Heterogeneity was measured using the χ2 test and quantified using I2. In case of substantial heterogeneity (P < 0.10 for χ2 test or I2 > 50%) the combined outcome was calculated using the random effects model. The results from the meta-analysis were displayed as forest plots. The guideline of the Cochrane Collaboration was used to assess the risk of bias and it was illustrated as a risk of bias graph.
RESULTS: The systematic literature search identified 166 different studies related to sperm immobilisation and selection for ICSI. Eleven RCTs involving 13719 oocyte intracytoplasmatic injections with sperm immobilised and selected using HA or polyvinylpyrrolidone (PVP) were included in this systematic review and meta-analysis. There was low heterogeneity among the included trials (χ2 = 16.86, df = 11, P = 0.11; I2 = 35%). There was no statistical difference between HA and PVP groups in terms of fertilisation rate (RR = 1.01; 95%CI: 0.99-1.03; z = 0.75; P = 0.45), good embryos rate (RR = 1.01; 95%CI: 0.96-1.06; z = 0.30; P = 0.76), live birth rate (RR = 1.15; 95%CI: 0.86-1.54; z = 0.92; P = 0.36), clinical pregnancy rate (RR = 1.04; 95%CI: 0.92-1.17; z = 0.62; P = 0.53) and implantation rate (RR = 1.17; 95%CI: 0.94-1.46; z = 0.40; P = 0.16). The quality of most of the included studies was moderate to poor because of unclear randomisation technique, inadequate allocation concealment and blinding.
CONCLUSION: This systematic review and meta-analysis provides evidence of similar efficiency between using HA or PVP for sperm immobilisation and selection before ICSI.
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Giordano PC. Universal screening for hemoglobinopathies in today's multi-ethnic societies: How and when. World J Obstet Gynecol 2015; 4:86-94. [DOI: 10.5317/wjog.v4.i4.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/23/2015] [Accepted: 10/19/2015] [Indexed: 02/05/2023] Open
Abstract
Increasing multi-ethnicity in countries endemic or non-endemic for hemoglobinopathies has brought fundamental changes to the screening strategies for these traits. While in the past pre-screening on microcytosis was a reasonable method to economize upon follow up analysis, selecting low mean corpuscular volume means today missing all those normocytic carriers of common traits associated with severe conditions. Therefore, blood count should not be considered as a pre-selection tool but as additional information to be used for the interpretation of the provisional results, obtained by routine high throughput separation and measurement of the hemoglobin (Hb) fractions. Moreover, the moment of screening should be well planned depending on the social and cultural situation. Screening for genetic diseases in a modern multi-ethnic society should be offered to couples seeking progeny when both partners are more likely to be equally concerned with the good health of their children. In several societies screening before marriage and changing partner choice is culturally accepted. However, new generations are bound to disagree with these more or less imposed conditions and may decide not to renounce the choice of their partner asking for other preventive methods. In addition, a carrier state during pre-marital screening may in some cultures stigmatize the carrier, mostly the female with adverse social consequences. Therefore, screening for hemoglobinopathies early in pregnancy is the most sensible alternative in modern countries. Adding hemoglobinopathies to the routine rhesus screening using a simple separation of the Hb fractions on dedicated devices (high performance liquid chromatography or capillary electrophoresis) will virtually identify all female carriers of all common traits responsible for the severe conditions mainly sickle cell disease and thalassemia major in time for partner analysis, counseling and primary prevention.
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Abstract
Unexplained infertility in females may be a devastating event for the reproductive-aged female. However, infertility may be due to ovarian failure associated with celiac disease, an immune-mediated disorder that may have few or no symptoms and can be successfully treated. In some prospective serologically-based studies, over 4% of infertile females may prove to have celiac disease. Serological screening for celiac disease is relatively inexpensive and involves testing for antibodies to tissue transglutaminase. If positive, a small intestinal biopsy should be done to confirm the diagnosis. The initial treatment for this disorder is a gluten-free diet. To date, a number of reports have indicated that this treatment for celiac disease may result in successful pregnancy, in spite of prolonged periods of infertility. Celiac disease, when untreated, may also lead to several adverse events following pregnancy including increased risk of recurrent abortions, low birthweight and impaired fetal growth. Recent molecular and pathological studies from different laboratories suggest that altered placental function may be due to binding to cells in the trophoblast by tissue transglutaminase antibodies impairing embryo implantation and leading to failure of early pregnancy or retarded intrauterine growth.
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Alcazar JL, Martinez N, Juez L, Caparros M, Salas A, Errasti T. Ovarian simple cysts in asymptomatic postmenopausal women detected at transvaginal ultrasound: A review of literature. World J Obstet Gynecol 2015; 4:108-112. [DOI: 10.5317/wjog.v4.i4.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/04/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To answer some questions related to the problem of ovarian simple cysts in asymptomatic postmenopausal women.
METHODS: A literature search and systematic review using MEDLINE (PubMed) database from 1980 to 2014 was performed using the following terms: “simple cyst”, “postmenopause”, “postmenopausal”, “ultrasound”, “ovary”, “ovarian”, “asymptomatic”. Papers not related to the topic, reviews, letters to editor, opinion letter, commentaries and studies published in non-English language were excluded. Two authors then reviewed the full paper of all the studies initially selected. This review does not claim to be a meta-analysis. Therefore, meta-analysis statistics were not applied and PRISMA guidelines were not strictly followed. Simple descriptive statistics were used providing absolute numbers and corresponding percentages as well as range.
RESULTS: Nine papers were ultimately included in this review, accounting for 98899 postmenopausal women. We have found that ovarian simple cysts are relatively common in asymptomatic postmenopausal women (prevalence: 8.7%). The risk of malignancy is very low (0.19%). More than 90% of these cysts were smaller than 5 cm. Bilaterality rate ranged from 3.7% to 15%. Histologically, most cysts are serous cystadenomas (61%). When managed conservatively, a significant number resolve spontaneously (46.1%) or remain unchanged (39%).
CONCLUSION: According to these data, conservative management should be the first option to offer to these women.
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Nicolau Y, Purkeypile A, Merritt TA, Goldstein M, Oshiro B. Outcomes of surrogate pregnancies in California and hospital economics of surrogate maternity and newborn care. World J Obstet Gynecol 2015; 4:102-107. [DOI: 10.5317/wjog.v4.i4.102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/15/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To describe maternity and newborn charges for an economic analysis of surrogate pregnancies on the health care resource utilization.
METHODS: A retrospective chart review of all women identified as being surrogates and the infants born from these pregnancies was performed between January 1, 2012 and December 31, 2013. Selected maternity diagnoses, mode of delivery, duration of hospitalization, and hospital charges were collected together with infants’ birth weights, gestational age, length of hospital stay, and hospital charges. Charges associated with the in vitro fertilization cycles, artificial insemination, or embryo(s) transfer into the surrogate were not considered in the maternity charges. A ratio contrasting the maternity hospital charges for the surrogate carrier was compared as a ratio to the mean charges for 2540 infants delivered in 2013 after natural conception and adjusted to the baseline hospital charges for both maternity and newborn care.
RESULTS: Analysis of sixty-nine infants delivered from both gestational and traditional surrogate women found an increased in multiple births, NICU admission, and length of stay with hospital charges several multiples beyond that of a term infant conceived naturally and provided care in our nursery. Among singletons and twins (per infant) hospital charges were increased 26 times (P < 0.001) and in triplets charges were increased 173 times (P < 0.0001) when compared to a term infant provided care in a normal nursery at our center.
CONCLUSION: Maternity costs for surrogates exceed those of women who conceive naturally, and these costs are especially magnified in women with triplets and multiple births.
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Serels S. Single incision slings: Past, present, and future. World J Obstet Gynecol 2015; 4:68-71. [DOI: 10.5317/wjog.v4.i3.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/20/2015] [Accepted: 06/19/2015] [Indexed: 02/05/2023] Open
Abstract
Pubovaginal slings have become the gold standard to treat stress urinary incontinence. Traditionally, the sling referred to a suspensory that was placed under the urethra and brought through the retropubic space and anchored on either side of the midline. Since this original concept, there have been many materials used for the sling, and there have been many different anchoring approaches. Most agree that one of the best materials is polypropylene mesh. However, the means of anchoring the device and where best to have this anchorage placed is debatable. The options for anchoring simply include using darts vs not to hold the sling in place. The location of this anchorage, on the other hand, is much more controversial. The main locations are retropubic, transobturator, and via a single incision. The obturator and retropubic slings have become the standard of care over time. The single incision sling, on the other hand, is starting to be more acceptable which has resulted in it being used more frequently. The single incision relies on mainly anchoring the sling through the obturator internus muscle with possible inclusion of the obturator membrane. The purpose of this review article is to present the data that exists for the use of the single incision sling.
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Goldsmith C, Nelson AL. Urgent need to change clinical practices about postpartum contraception. World J Obstet Gynecol 2015; 4:52-57. [DOI: 10.5317/wjog.v4.i3.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/26/2015] [Accepted: 05/11/2015] [Indexed: 02/05/2023] Open
Abstract
In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device - has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.
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Fylstra DL. Avoiding misdiagnosing an early intrauterine pregnancy as an ectopic pregnancy. World J Obstet Gynecol 2015; 4:58-63. [DOI: 10.5317/wjog.v4.i3.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/16/2015] [Accepted: 07/17/2015] [Indexed: 02/05/2023] Open
Abstract
In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment for ectopic pregnancy. The diagnosis of ectopic pregnancy, unless directly visualized with transvaginal ultrasound, is made with the exclusion of an intrauterine pregnancy. Measurement of human chorionic gonadotrophin and progesterone levels, and transvaginal ultrasound are the tools used to evaluate early pregnancy. In women at risk for an ectopic pregnancy, every effort should be made to exclude the presence of an intrauterine pregnancy before embarking on an irreversible treatment course. Methotrexate is an antimetabolite that inhibits DNA synthesis and repair and cell replication. It is administered to ostensible destroy a pregnancy, especially ectopic pregnancies. When administered to an intrauterine pregnancy, embryonic death and missed abortion is the most common result, but early embryos that survive this exposure are likely to have multiple anomalies. The mistaken administration of methotrexate to an intrauterine pregnancy is made because of misinterpretation of the discriminatory zone of human chorionic gonadotropin (hCG), misinterpretation of early hCG serum levels, misinterpretation of early transvaginal ultrasound images, and failure to clinically correlate hCG levels and ultrasound findings.
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Coccolini F, Catena F, Manfredi R, Montori G, Manegold JE, Ansaloni L. Value of neoadjuvant chemotherapy in advanced ovarian cancer. World J Obstet Gynecol 2015; 4:64-67. [DOI: 10.5317/wjog.v4.i3.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/20/2015] [Accepted: 06/19/2015] [Indexed: 02/05/2023] Open
Abstract
Data regarding the role of neoadjuvant chemotherapy (NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy (HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.
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Zhang XQ, Zhang LJ, Yang WH, Draper ML. Effect of the maternal-fetal interface immunoregulation on the occurrence of intrahepatic cholestasis of pregnancy. World J Obstet Gynecol 2015; 4:40-45. [DOI: 10.5317/wjog.v4.i2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/14/2015] [Accepted: 02/02/2015] [Indexed: 02/05/2023] Open
Abstract
Maternal immune tolerance of the fetus is indispensable for a healthy pregnancy. Currently, the study of the immune microenvironment of the maternal-fetal interface has been a heated topic in reproductive immunology research. More and more studies show that the immune imbalance in the maternal-fetal interface plays a very important role in the incidence of intrahepatic cholestasis of pregnancy (ICP). However, the precise etiology and mechanism of immune imbalance in the occurrence of ICP is still unknown. In order to clarify the potential immunologic mechanisms of ICP, this review summarizes the recent studies of the decidual immunology microenvironment and the potential immunologic mechanisms related to the development of ICP.
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Sacco E, Recupero S, Bientinesi R, Palermo G, D’Agostino D, Currò D, Bassi P. Pioneering drugs for overactive bladder and detrusor overactivity: Ongoing research and future directions. World J Obstet Gynecol 2015; 4:24-39. [DOI: 10.5317/wjog.v4.i2.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 01/31/2015] [Accepted: 04/14/2015] [Indexed: 02/05/2023] Open
Abstract
The ongoing research on pioneering drug candidates for the overactive bladder (OAB) aimed to overcome the limitations of currently licensed pharmacotherapies, such as antimuscarinics, β3-adrenergic agents, and botulinum neurotoxin, has been reviewed performing a systematic literature review and web search. The review covers the exploratory agents alternative to available medications for OAB and that may ultimately prove to be therapeutically useful in the future management of OAB patients based on preclinical and early clinical data. It emerges that many alternative pharmacological strategies have been discovered or are under investigation in disease-oriented studies. Several potential therapeutics are known for years but still find obstacles to pass the clinical stages of development, while other completely novel compounds, targeting new pharmacological targets, have been recently discovered and show potential to translate into clinical therapeutic agents for idiopathic and neurogenic OAB syndrome. The global scenario of investigational drugs for OAB gives promise for the development of innovative therapeutics that may ultimately prove effective as first, combined or second-line treatments within a realistic timescale of ten years.
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Khajehei M. Mental health of perinatal women. World J Obstet Gynecol 2015; 4:46-51. [DOI: 10.5317/wjog.v4.i2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/06/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Pregnancy and childbirth are major stressors for some women. They can be followed by deterioration in mental health status and cause mental illnesses during perinatal period. Undetected and untreated perinatal mental illnesses can have negative unexpected impacts on parenting skills of the women and children’s development. Mentally ill mothers may not effectively attend their children’s needs in a timely manner and may experience an unfavourable mother-child attachment affecting the child’s language, social, emotional and cognitive development. The rate of pregnancy and postnatal health complications and interventions is higher among mentally ill women with some certain risk factors. The mentally ill mothers along with their partners need comprehensive support and counselling to be able to care for their infants and establish strong parent-child bond and attachment. Mental health campaigns across the world have endeavoured to increase the knowledge and awareness of the public towards perinatal mental health illnesses. To this aim, a routine screening is recommended in order to identify the women who are at risk of mood or anxiety disorder during perinatal period. The development of knowledge on perinatal mental illnesses among public and the health professionals has resulted in timely recognition and treatment of perinatal mental illnesses. Although great volumes of research show high prevalence of perinatal mental illnesses and their impacts on parenting confidence and competence as well as child’s developmental process, there is still lack of research on various aspects of perinatal mental illnesses. To enable early prevention, diagnosis and intervention, it is crucial to identify families who are at an increased risk of perinatal mental illnesses and provide support and intervention to minimise the adverse outcomes. The children’s needs may not be met by providing treatment to parental mental illnesses alone. It is also important to understand the impact of specific parenting behaviours on child outcomes which is modified by the quality of parenting.
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Abdi F, Novin MG, Afrakhteh M, Khorvash F. Hepatitis B and pregnancy: An update review article. World J Obstet Gynecol 2015; 4:1-8. [DOI: 10.5317/wjog.v4.i1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/24/2014] [Accepted: 11/03/2014] [Indexed: 02/05/2023] Open
Abstract
Chronic hepatitis B, as a global health problem, is a disease that begins in the prenatal period and its complications gradually become clear later in life. About 5% of women worldwide are carriers of chronic hepatitis B virus (HBV). The most common method of transmission of HBV around the world is from mother to infant. This article aims to review the unique challenges of hepatitis B in pregnancy. Data for this review were collected from our previous studies and experiences plus various data banks, such as PubMed, EMBASE, ISI Web of science, Scopus, Google Scholar and Iranian databases. A comprehensive search was performed using the combinations of the keywords to review relevant literature and higher education journals. All published data up to February 2014 have been included in this review. This article addresses several interesting aspects. First, hepatitis B in pregnancy can vary regarding prevalence, virus behavior, prenatal transmission and outcome of the pregnancy. Second, the women of reproductive age with chronic HBV remain a major source for continued spread of the virus. Finally, pregnant women need screening in prenatal care to enable early intervention when necessary.
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Tortora R, Imperatore N, Ciacci C, Zingone F, Capone P, Siniscalchi M, Pellegrini L, Stefano GD, Caporaso N, Rispo A. High prevalence of post-partum depression in women with coeliac disease. World J Obstet Gynecol 2015; 4:9-15. [DOI: 10.5317/wjog.v4.i1.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To explore the prevalence of post-partum depression (PPD) in coeliac disease (CD).
METHODS: We performed a case-control study evaluating the prevalence of PPD in CD patients on gluten-free diet (GFD) compared to that of healthy subjects experiencing a recent delivery. All participants were interviewed about menstrual features, modality and outcome of delivery and were evaluated for PPD by Edinburgh Postnatal Depression Scale (EPDS).
RESULTS: The study included 70 CD patients on GFD (group A) and 70 controls (group B). PPD was present in 47.1% of CD women and in 14.3% of controls (P < 0.01; OR = 3.3). Mean EPDS score was higher in CD compared to the controls (mean score: group A 9.9 ± 5.9; group B 6.7 ± 3.7; P < 0.01). A significant association was observed between PPD and menstrual disorders in CD (69.7% vs 18.9%; P < 0.001; OR = 3.6).
CONCLUSION: PPD is frequent in CD women on GFD, particularly in those with previous menstrual disorders. We suggest screening for PPD in CD for early detection and treatment of this condition.
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Song M, Tomoeda M, Jin YF, Kubo C, Yoshizawa H, Kitamura M, Nagata S, Ohta Y, Kamiura S, Nakamura H, Tomita Y. Hepatoma-derived growth factor expression as a prognostic marker in cervical cancer. World J Obstet Gynecol 2015; 4:16-23. [DOI: 10.5317/wjog.v4.i1.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/24/2014] [Accepted: 11/03/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine the association of hepatoma-derived growth factor (HDGF) expression with the prognosis of patients with cervical cancer of the uterus (CC).
METHODS: HDGF is a unique nuclear growth factor, and it may play an important role in the development and progression of carcinoma. HDGF expression in 88 CC patients aged 23 to 76 years (median, 54 years) was analyzed by immunohistochemistry. A rabbit polyclonal antibody against the C-terminal amino acids (aa 231-240) of the human HDGF sequence was used as primary antibody at a dilution of 1:5000. This specific anti-HDGF antibody was purified using C-terminal peptide-conjugated Sepharose columns. Staining of endothelial cells in the noncancerous areas of each specimen was used as an internal positive control. Samples with more than 80% of tumor cells showing positive immunoreactivity in both the nucleus and cytoplasm were regarded as HDGF index level 2, more than 80% positive immunoreactivity in either the nucleus or cytoplasm as level 1, and less than 80% in both the nucleus and cytoplasm as level 0. The chi-square test and Fisher’s exact probability test were used to examine the relationship between HDGF expression and clinicopathologic parameters, and statistical significance was examined by the log-rank test. Multivariate analysis of factors related to survival was performed using Cox’s proportional hazards regression model. Statistical significance was set at P < 0.05.
RESULTS: The five-year overall survival rate was 82.9%. Fourteen patients died due to tumors, nine of whom had tumor recurrence at 2-21 mo (median, 10 mo) after surgery. Tumor recurrence in five patients was determined at the time of the patients’ deaths. Nineteen cases were regarded as HDGF index level 0, 11 as level 1, and 58 as level 2. Patients with level 2 expression showed higher rates of histological classification of keratinized squamous cell carcinoma and adenosquamous carcinoma (44.8% of level 2 patients and 13.3% in levels 0 and 1), deep invasion (pT2-4 in 65.5% of level 2 patients, and 30.0% in levels 0 and 1), the presence of lymphatic invasion (50.0% in level 2, and 20.0% in levels 0 and 1), and the presence of lymph node metastasis (37.9% in level 2, and 6.7% in levels 0 and 1). Patients with an HDGF index of level 2 CC showed poorer 5-year overall survival rates than those with level 0 or 1 CC (74.0% and 100%, respectively, P = 0.0036). Univariate analysis revealed that histological classification (P = 0.04), depth of tumor invasion (P = 0.0001), vascular invasion (P = 0.004), and lymph node metastasis (P = 0.0001) were significant factors affecting overall survival in addition to HDGF expression. Multivariate analysis revealed HDGF expression level and lymph node metastasis as independent prognostic factors for overall survival (P = 0.0148 and P = 0.0197, respectively). The prognostic significance of HDGF was further analyzed in pT1 and pT2-4 patient groups, respectively. Among patients with pT1 CC, one the 39 analyzed patients died during the study, and no difference was observed among patients with HDGF index level 0, 1, or 2 CC. However, prognostic significance of the HDGF index was observed in the pT2-4 patient group, in which the mortality rates of patients with HDGF index level 2 CC and those with level 0 or 1 CC significantly differed (P = 0.0463).
CONCLUSION: The HDGF expression level is of prognostic significance in CC.
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Iffy L. Prevention of shoulder dystocia related birth injuries: Myths and facts. World J Obstet Gynecol 2014; 3:148-161. [DOI: 10.5317/wjog.v3.i4.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 07/14/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Traditionally, brachial plexus damage was attributed to excessive traction applied on the fetal head at delivery. Recently, it was proposed that most injuries occur spontaneously in utero. The author has studied the mechanism of neurological birth injuries based on 338 actual cases with special attention to (1) fetal macrosomia; (2) maternal diabetes; and (3) methods of delivery. There was a high coincidence between use of traction and brachial plexus injuries. Instrumental extractions increased the risk exponentially. Erb’s palsy following cesarean section was exceedingly rare. These facts imply that spontaneous neurological injury in utero is extremely rare phenomenon. Literary reports show that shoulder dystocia and its associated injuries increased in the United States several-fold since the introduction of active management of delivery in the 1970’s. Such a dramatic change in a stable population is unlikely to be caused by incidental spontaneous events unrelated to external factors. The cited investigations indicate that brachial plexus damage typically is traction related. The traditional technique which precludes traction is the optimal method for avoiding arrest of the shoulders and its associated neurological birth injuries. Effective prevention also requires meticulous prenatal care and elective abdominal delivery of macrosomic fetuses in carefully selected cases.
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Breborowicz A, Klatsky P. Association between gamete source, exposure and preeclampsia: A review of literature. World J Obstet Gynecol 2014; 3:141-147. [DOI: 10.5317/wjog.v3.i4.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/30/2014] [Accepted: 09/17/2014] [Indexed: 02/05/2023] Open
Abstract
Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis of preeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.
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Perrone AM, Pozzati F, Santini D, Rossi M, Procaccini M, Casalini L, Santi E, Tesei M, Zamagni C, Iaco PD. Gynecological malignancies and hormonal therapies: Clinical management and recommendations. World J Obstet Gynecol 2014; 3:162-170. [DOI: 10.5317/wjog.v3.i4.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/15/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Every year in the world a large number of women receive a diagnosis of gynecological cancer and undergo a therapy such as surgery, chemotherapy and radiotherapy to the pelvic region. A large portion of these patients are already in menopause, but for younger patients therapies are responsible of early menopause. The physical and psychological symptoms due to iatrogenic menopause significantly reduce the quality of life; however hormone replacement therapy (HRT) has a high efficacy in reducing menopausal symptoms. The prescription of HRT in patients with story of gynecological cancer is debated because its safety has not been completely proven. The main criticism is based on the theory that the hormone replacement could stimulate growth of residual cancer cells increasing the risk of recurrence.
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Lim PS, Ismail NAM, Ghani NAA, Kampan NC, Sulaiman AS, Ng BK, Chew KT, Karim AKA, Yassin MAJM. Retained placenta: Do we have any option? World J Obstet Gynecol 2014; 3:124-129. [DOI: 10.5317/wjog.v3.i3.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 06/06/2014] [Accepted: 07/14/2014] [Indexed: 02/05/2023] Open
Abstract
Retained placenta is a known cause of post-partum haemorrhage and maternal mortality. A recent systemic review has confirmed that the incidence of retained placenta had increased all over the world, which is more common in developed countries. Failure of retro-placental myometrium contraction is the main cause of retained placenta. Maternal age greater than 35 years, grandmultipara, preterm labor, history of previous retained placenta, and caesarean section were the risk factors for retained placenta. Manual removal of the placenta has been the treatment of choice. Attempts had been made by clinician and researchers to find a safe, effective and reliable method to avoid the need for surgical intervention. The efficacy and safety of prostaglandin, nitroglycerin or acupuncture in the management of retained placenta are yet to be further evaluated. Nonetheless, till date only intra-umbilical vein oxytocin has been studied extensively but with varied success. More randomized clinical trials are needed to address this issue. However, if immediate manual placenta removal service is unavailable, a trial of intra-umbilical vein oxytocin 100 IU at a total volume of at least 40 mL while preparing for transfer to a tertiary center or theatre may result in spontaneous expulsion of the placenta.
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Madaan M, Singh A, Puri M, Kaur H, Trivedi SS. Effect of vaginal speculum lubrication on cervical cytology and discomfort during smear examination. World J Obstet Gynecol 2014; 3:134-137. [DOI: 10.5317/wjog.v3.i3.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/25/2014] [Accepted: 04/16/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the role of lubricant gel in the cytology of a Pap smear and whether it results in an improvement in the discomfort experienced by women while undergoing Pap smear screening.
METHODS: A total of 151 women were analyzed in the study. After screening for inclusion criteria, a Pap smear was taken with no lubricant in all the women and the discomfort experienced was rated on a visual analogue scale. The women underwent a second Pap smear on the next visit using a lubricant gel and were again rated on a visual analogue scale for the discomfort felt. The pathologist was blinded to the fact of whether the lubricating gel was used.
RESULTS: The number of unsatisfactory smears in the no gel group was 3 vs 5 in the gel group, P < 0.05. However, a significant difference (P = 0.00) was observed in the visual analogue pain score in both groups, suggesting that application of lubricant gel over the speculum improves the pain experienced by women.
CONCLUSION: Using a small amount of lubricant over the speculum does not impair cervical cytology but significantly improves the discomfort experienced by women while undergoing a Pap smear.
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Gilabert-Estelles J, Aghababyan C, Garcia P, Moscardo J, Royo S, Aniorte S, Gilabert-Aguilar J. Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer. World J Obstet Gynecol 2014; 3:109-117. [DOI: 10.5317/wjog.v3.i3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 06/11/2014] [Accepted: 07/14/2014] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is one of the most common causes of cancer-related death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defined prior to surgery and several scoring systems may be useful for this purpose. Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. In the last decade concerns have been raised regarding the risk of cyst rupture and tumour spillage as a consequence of the laparoscopic technique itself both in early and advanced stages of ovarian cancer. Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effective when compared to laparotomy. The precise role of laparoscopy in patients with more advanced cancer is still to be defined, and the risk of suboptimal surgery should never outweigh the potential benefits of minimally invasive surgery. Thus, a tailored prediction of optimal laparoscopic debulking is mandatory in these patients.
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Rovas L, Dauksas R, Simavicius A. Leiomyoma of the umbilical cord artery: A case report. World J Obstet Gynecol 2014; 3:138-140. [DOI: 10.5317/wjog.v3.i3.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/08/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
A leiomyoma is a benign tumor originating from non-striated muscle that is typically found in the uterus. Intravenous leiomyomatosis is a rare form found within the veins, usually associated with uterine fibroids, and tends to recur. These masses can spread from the uterus throughout the venous system. A rare case involving a subendothelial leiomyoma found in an umbilical cord artery is presented in this article. A 21-year-old patient presented with symptoms of preterm labor, which resulted in the premature birth of a female below the 10th percentile for 24-wk gestational age. The newborn died three days later, and microscopic analysis of the umbilical cord revealed occlusion of the artery by nodular structures. The antepartum diagnosis of intravascular leiomyoma was identified by immunohistochemistry showing that approximately 70% of all tumor cells were diffusely positive for smooth muscle markers, including desmin and smooth muscle actin. These findings indicate the possibility of a pathologic association between the umbilical cord leiomyoma, restriction of fetal growth and preterm delivery due to impaired circulation of blood in the umbilical cord.
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Moore LE, Clokey D. Utility of a hemoglobin A1C obtained at the first prenatal visit. World J Obstet Gynecol 2014; 3:130-133. [DOI: 10.5317/wjog.v3.i3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/20/2014] [Accepted: 06/11/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the utility of the hemoglobin A1C (HbA1C) at the first prenatal visit as a triaging tool in patients at high risk for gestational diabetes (GDM).
METHODS: The HbA1C was obtained at the first prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% (group one) were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% (group two) were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C < 5.7% (group three) were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL (5.3 mmol/L) and 2 h postprandial ≤ 120 mg/dL (6.7 mmol/L).
RESULTS: In group one (n = 16), 15/16 (95%) required medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients (87%) remained diabetic. Group two contained 82 patients. Sixty-sixpatients (80%) were given a diagnosis of GDM and 52 patients (64%) required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients (8.7%) were diagnosed with GDM and 13 patients (6%) required medication. In comparison to group three, patients in group one were 220 times more likely to require medication (95%CI: 26.9- > 999, P < 0.0001). Patients in group two were 26 times more likely to require medication (95%CI: 12.5-54.3, P < 0.0001).
CONCLUSION: A HbA1C obtained at the first prenatal visit can be used to triage patients based on the level of glucose intolerance found.
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Montagnoli C, Larciprete G. Preeclampsia: Definitions, screening tools and diagnostic criteria in the supersonic era. World J Obstet Gynecol 2014; 3:98-108. [DOI: 10.5317/wjog.v3.i3.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/15/2014] [Accepted: 05/19/2014] [Indexed: 02/05/2023] Open
Abstract
Preeclampsia is still a major risk factor for maternal-fetal health. Therefore, early identification of pregnant women at risk for preeclampsia is a big priority in obstetrics in order to decrease the mortality and morbidity associated with this disease. On the basis of well known and new pathophysiological mechanisms of preeclampsia, different biochemical and ultrasonographic parameters have been investigated in the literature, without finding an ideal marker for early screening. In this brief review, we present the best studied ultrasonographic markers and the most recent genetic factors and promising emerging biomarkers of preeclampsia, to date. We hope that in the future the combination of these tests will allow us to predict which women are at risk of preeclampsia.
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Chhabra S, Kumar N. Unwanted pregnancies, unwanted births, consequences and unmet needs. World J Obstet Gynecol 2014; 3:118-123. [DOI: 10.5317/wjog.v3.i3.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/09/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
Worldwide women have to cope up with heavy burden of unwanted pregnancies, mistimed, unplanned, with risk to their health. Their children and families also suffer. Such pregnancies are root cause of induced abortions (safe/unsafe) and grave consequences. Women, their partners can, for most part, prevent unwanted pregnancies by using contraceptives. However many women either do not use any contraceptive or use methods, with high failure rates. These women account for 82% of pregnancies that are not desired. Remaining unintended pregnancies occur among women who use modern contraceptive, either because they had difficulty using method consistently or because of failure. Helping women, their partner use modern contraceptives effectively is essential in achieving Millennium Development Goals for improving women’s health, reducing poverty. If all women in developing countries use modern contraceptives, there would be 22 million less unplanned births, 25 million fewer induced, 15 million fewer unsafe abortions, 90000 less maternal deaths and 390000 less children losing their mothers. Also making abortion services broadly legal, by understanding size, type of unmet needs, most important by creating awareness in communities can surely help tackle this problem to a large extent.
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Quincy BL. Acceptability of self-collected human papillomavirus specimens in cervical cancer screening: A review. World J Obstet Gynecol 2014; 3:90-97. [DOI: 10.5317/wjog.v3.i3.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/03/2014] [Accepted: 06/16/2014] [Indexed: 02/05/2023] Open
Abstract
Cervical cancer morbidity and mortality is an important public health problem around the world. Some of the barriers to cervical cancer screening include the embarrassment, discomfort, lack of privacy and time and cost associated with clinician-collected, clinic-based screening with cytology or human papillomavirus tests. Self-collection of a human papillomavirus (HPV) test has been found to be generally more acceptable, less embarrassing, more comfortable, more private and easy to do and preferred to pelvic examination for cervical cytology by many women worldwide. The most commonly reported limitation to self-collection is a woman’s lack of confidence in her ability to perform it correctly. Self-collected human papillomavirus tests have been shown to be as or more sensitive than cytology or clinician-collected HPV tests. With confidence-building education about self-collection, it is likely a viable method to extend the reach of screening in high and low-resource areas around the world.
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Farthing A. Fertility sparing management of endometrial complex hyperplasia and endometrial carcinoma. World J Obstet Gynecol 2014; 3:42-44. [DOI: 10.5317/wjog.v3.i2.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 08/09/2013] [Indexed: 02/05/2023] Open
Abstract
The standard treatment of endometrial cancer or atypical hyperplasia is surgical removal of the uterus and ovaries. In early stage disease this has an excellent chance of cure but results in infertility. Although the majority of patients are postmenopausal an increasing number of patients with atypical hyperplasia or endometrial cancer are presenting with a desire to retain their fertile potential. In the last 8 years a number of studies have been published involving 403 patients with endometrial cancer and 151 patients with Atypical hyperplasia treated with high dose progestagens. The response rate is 76.2% and 85.6% respectively with endometrial cancer having a recurrence rate of 40.6%. There is a 26% recurrence rate in atypical hyperplasia. Overall 26.3% of those wishing to conceive had a live baby. Although concerns exist about the risks of medical treatment, those that fail this treatment do not appear to have a significantly poorer prognosis although 20 patients (3.6%) had either ovarian cancer or metastatic disease discovered during treatment or follow up.
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Doehrman P, Erickson L, Galfione K, Geier B, Kahol K, Ashby A. Simulation training in contemporary obstetrics education. World J Obstet Gynecol 2014; 3:85-89. [DOI: 10.5317/wjog.v3.i2.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/17/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the use of the Gaumard’s Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.
METHODS: Twenty two (n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year (PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard’s simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort’s mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to the baseline pretest score using a paired student t-test.
RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7 (SD = 3.14) vs 7.9 (SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6 (SD = 5.5, 95%CI: 2.21-7.07), 4.4 (SD = 5.2, 95%CI: 2.13-6.70), and 5.6 (SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5 (SD = 2.27, 95%CI: 2.13-5.00), 7.25 (SD = 6.70, 95%CI: 1.50-13.00), 10.75 (SD = 1.5, 95%CI: 9.50-12.00), 12.17 (SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75 (SD = 1.49, 95%CI: 12.75-14.63), 10.25 (SD = 0.24, 95%CI: 4.25-14.00), 15.00 (SD = 1.16, 95%CI: 14.00-16.00), 15.17 (SD = 0.75, 95%CI: 14.67-15.67).
CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.
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Abstract
The rising tide of obesity has seen the prevalence of overweight and obese women presenting for antenatal care approach 50% in recent years. In addition, many pregnant women have gestational weight gain in excess of Institute of Medicine guidelines and develop obesity as a result of pregnancy. Both variables impact adversely upon pregnancy outcome. Individualised programs are not financially viable for cash strapped health systems. This review outlines an evidence-based, public health approach to the management of obesity in pregnancy. The interventions are affordable and in randomised and epidemiological trials, achieve benefits in pregnancy outcome.
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Stewart SL, Cooney D, Hirsch S, Westervelt L, Richards TB, Rim SH, Thomas CC. Effect of gynecologic oncologist availability on ovarian cancer mortality. World J Obstet Gynecol 2014; 3:71-77. [PMID: 26478860 PMCID: PMC4605894 DOI: 10.5317/wjog.v3.i2.71] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/11/2013] [Accepted: 02/18/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine the association between the distribution of gynecologic oncologist (GO) and population-based ovarian cancer death rates.
METHODS: Data on ovarian cancer incidence and mortality in the United States was supplemented with United States census data, and analyzed in relation to practicing GOs. GO locations were geocoded to link association between county variables and GO availability. Logistic regression was used to measure areas of high and low ovarian cancer mortality, adjusting for contextual variables.
RESULTS: Practicing GOs were unevenly distributed in the United States, with the greatest numbers in metropolitan areas. Ovarian cancer incidence and death rates increased as distance to a practicing GO increased. A relatively small number (153) of counties within 24 miles of a GO had high ovarian cancer death rates compared to 577 counties located 50 or more miles away with high ovarian cancer death rates. Counties located 50 or more miles away from a GO practice had an almost 60% greater odds of high ovarian cancer mortality compared to those with closer practicing GOs (OR = 1.59, 95%CI: 1.18-2.15).
CONCLUSION: The distribution of GOs across the United States appears to be significantly associated with ovarian cancer mortality. Efforts that facilitate outreach of GOs to certain populations may increase geographic access.
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Abstract
Malignancy is a serious disease that can lead to serious morbidity and mortality. However, the survival rates for women with cancers have increased significantly during the past decades, reflecting improved diagnosis and treatment. With the increased survival in young women with cancer, more attention is being paid to preservation of fertility, which is potentially jeopardized by chemotherapy and radiation therapy, aiming to limit the devastating sequelae of this serious illness by providing these young women with a hope for motherhood. In vitro fertilization with oocyte or embryo cryopreservation has emerged as an astounding method to preserve fertility. It entails induction of ovulation to produce oocytes, the number and quality of which are imperative factors predicting the potential efficacy of the fertility preservation procedure. The aim of this review is to discuss ovarian stimulation for fertility preservation in women with gynecological cancer.
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85
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Welsh LC, Taylor A. Impact of pelvic radiotherapy on the female genital tract and fertility preservation measures. World J Obstet Gynecol 2014; 3:45-53. [DOI: 10.5317/wjog.v3.i2.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/16/2013] [Accepted: 06/04/2013] [Indexed: 02/05/2023] Open
Abstract
Radiotherapy to the pelvis can have a major and deleterious impact on the female genital tract. Despite significant advances in the technical delivery of radical pelvic radiotherapy there remains no way to avoid delivering substantial radiation doses to the ovaries and uterus for patients undergoing treatment for gynaecological cancers. Due to improved cure rates from radical chemo-radiotherapy and social trends toward delayed childbirth many women treated for cervical cancer with radical chemo-radiotherapy will wish to attempt to preserve their fertility. Whilst there are now established and emerging techniques for preserving ovarian function and ovarian tissue, there remains the difficulty of the irradiated uterus which, even if pregnancy can be achieved, results in an increased risk for pregnancy-related complications. Future developments may offer women in this difficult situation more and improved options for fertility preservation.
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Sacco JJ, Cliff J, Green JA. Chemotherapy for gynaecological malignancies and fertility preservation. World J Obstet Gynecol 2014; 3:54-60. [DOI: 10.5317/wjog.v3.i2.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/31/2013] [Accepted: 08/06/2013] [Indexed: 02/05/2023] Open
Abstract
Infertility is an increasingly important issue for patients surviving cancer. Significant improvements in cancer management have led to greater numbers of patients living healthy and fulfilling lives for many years after a diagnosis of cancer, and the ability to bear children is a major component of well-being. Infertility is particularly challenging in gynaecological cancer, where multiple treatment modalities are often employed. Surgery may involve the removal of reproductive organs and subsequent chemotherapy may also lead to infertility. Mitigation of this through the use of cryopreservation of embryos, oocytes or ovarian tissue before chemotherapy may enable subsequent pregnancy in the patient or a surrogate mother. Suppression of ovarian function during chemotherapy is less well established, but promises a reduction in infertility without the risks associated with surgery. Similarly, evolving chemotherapy regimens with replacement of alkylating agents will reduce the incidence of infertility. With a combination of these techniques, an increasing proportion of patients may be able to conceive after completion of treatment, and there is no evidence of an increase in congenital abnormalities. This review discusses chemotherapy-induced infertility, interventions and success rates, and demonstrates that individualisation of management is required for optimum outcome.
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Ding YL, Zhang LJ, Wang X, Zhou QC, Li N, Wang CX, Zhang XQ. Fetal lung surfactant and development alterations in intrahepatic cholestasis of pregnancy. World J Obstet Gynecol 2014; 3:78-84. [DOI: 10.5317/wjog.v3.i2.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/07/2013] [Accepted: 01/14/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the association between total bile acid (TBA) level during intrahepatic cholestasis of pregnancy (ICP) and fetal lung surfactant alteration.
METHODS: We recruited 42 ICP and 32 normal pregnancy women in this study. The maternal blood, fetal blood and amniotic fluid TBA level were detected using a circulating enzymatic method. Umbilical blood pulmonary surfactant protein A (SP-A) was evaluated with enzyme-linked immunosorbent assay. High performance liquid chromatography was used for the determination of phosphatidyl choline (PC), phosphatidyl inositol (PI), lysolecithin (LPC) and sphingomyelin (SM). Amniotic fluid lamellar body was counted with a fully automatic blood cell counter. Fetal lung area and fetal body weight were calculated from data obtained with an iu22 color supersonic diagnostic set. Clinical information of a nonstress test, amniotic fluid properties and neonatal Apgar score, and birth weight were recorded for review.
RESULTS: The TBA level in maternal blood, fetal blood and amniotic fluid in the ICP group were significantly higher than that in the control group (maternal blood: 34.11 ± 6.75 mmol/L vs 4.55 ± 1.72 mmol/L, P < 0.05; fetal blood: 11.9 ± 2.23 mmol/L vs 3.52 ± 1.56 mmol/L, P < 0.05; amniotic fluid: 3.89 ± 1.99 mmol/L vs 1.43 ± 1.14 mmol/L, P < 0.05). Amniotic fluid PC and PI in the ICP group were significantly lower than that in the control group (PC: 65.71 ± 7.23 μg/mL vs 69.70 ± 6.68 μg/mL, P < 0.05; PI: 3.87 ± 0.65 μg/mL vs 4.28 ± 0.74 μg/mL, P < 0.05). PC/LPC ratio of the ICP group was lower than that of the control group (14.40 ± 3.14 vs 16.90 ± 2.52, P < 0.05). Amniotic LB in the ICP group was significantly lower than that of the control group ((74.13 ± 4.37) × 109/L vs (103.0 ± 26.82) × 109/L, P < 0.05). Fetal umbilical blood SP-A level in the ICP group was significantly higher than that of the control group (30.26 ± 7.01 ng/mL vs 22.63 ± 7.42 ng/mL, P < 0.05). Fetal lung area/body weight ratio of the ICP group was significantly lower than that of the control group (5.76 ± 0.63 cm2/kg vs 6.89 ± 0.48 cm2/kg, P < 0.05). In the ICP group, umbilical cord blood TBA concentration was positively correlated to the maternal blood TBA concentration (r = 0.746, P < 0.05) and umbilical blood SP-A (r = 0.422, P < 0.05), but it was negatively correlated to the amniotic fluid lamellar corpuscle (r = 0.810, P < 0.05) and fetal lung area/body weight ratio (r = 0.769, P < 0.05). Furthermore, umbilical blood TBA showed a negative correlation to PC, SM and PI (rpc = 0.536, rsm = 0.438, rpi = 0.387 respectively, P < 0.05). The neonatal asphyxia, neonatal respiratory distress syndrome, fetal distress and perinatal death rates in the ICP group are higher than that of the control group.
CONCLUSION: ICP has higher TBA in maternal and fetal blood and amniotic fluid. The high concentration of TBA may affect fetal pulmonary surfactant production and fetal lung maturation.
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Sabaa BME. Pathological conditions predisposing to infertility and gynaecological neoplasia. World J Obstet Gynecol 2014; 3:28-34. [DOI: 10.5317/wjog.v3.i2.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Revised: 03/04/2013] [Accepted: 04/11/2013] [Indexed: 02/05/2023] Open
Abstract
Some of the conditions long blamed for female factor infertility are now acknowledged as well established risk factors of gynecological neoplasia. This realization has lead to the proposition that infertility might be a risk factor for the development of several types of gynecological neoplasms. This review addresses different conditions that play a role in both infertility and gynaecological neoplasia. An intricate interplay between growth factors and hormonal factors (estrogens and progestins, androgens and gonadotropins) is said to link the state of infertility to some gynecological tumors. The relation between endometriosis -as one of the well established causes of female infertility - and ovarian cancer is well known. Endometriosis has been particularly related to endometrioid and clear-cell ovarian carcinomas. Another evidence for this association is embodied in finding endometriotic lesions adjacent to ovarian cancers. The polycystic ovary syndrome (PCOS), one of the most prevalent endocrine disorders and a long studied cause of female infertility increases the risk of endometrial carcinoma. The link between PCOS and endometrial carcinoma seems to be endometrial hyperplasia. PCOS-associated endometrial carcinoma tends to present at a younger age and early stage, with lower grade and lower risk of metastasis. Turner’s syndrome and other types of ovarian dysgenesis constitute a rare cause of infertility and are known to confer a definite risk of germ cell tumors. There seems to be a link between infertility and an increased risk of gynecological neoplasia. Hence, it is important to assess the risk of malignancy in each category of infertile patients so as to provide optimal and timely intervention.
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Magdy N, El-Bahrawy M. Fallopian tube: Its role in infertility and gynecological oncology. World J Obstet Gynecol 2014; 3:35-41. [DOI: 10.5317/wjog.v3.i2.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/03/2013] [Accepted: 06/19/2013] [Indexed: 02/05/2023] Open
Abstract
Disorders of the fallopian tube play a very important role in both infertility and gynaecological oncology. Tubal factor infertility is considered among the leading causes of female factor infertility. Many tubal disorders are related to infertility including congenital anomalies, acute and chronic inflammatory diseases, endometriosis and other pathologies that result in partial or total fallopian tube obstruction. In the field of gynaecological oncology, ovarian surface epithelial tumors remain one of the most fatal malignancies in women worldwide carrying the worst prognosis among female genital malignancies. For decades, the cell of origin of epithelial tumors has remained controversial and was largely believed to be surface ovarian epithelium. Recently several studies suggested that there is a major role of the fallopian tube in the development of ovarian surface epithelial tumors, mainly high grade serous carcinoma and other tumour types. In this article we review the role of the fallopian tube in both infertility and gynaecological oncology.
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El-Bahrawy M. Infertility and gynaecological oncology. World J Obstet Gynecol 2014; 3:26-27. [DOI: 10.5317/wjog.v3.i2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/24/2014] [Accepted: 04/19/2014] [Indexed: 02/05/2023] Open
Abstract
Infertility and gynaecological cancer are two major problems in the field of women’s health, where both have serious implications on a woman’s physical, social and emotional wellbeing. There are well established links between many aspects of infertility and different types of gynaecological malignancies, including etiology, pathogenesis and disease management. In this special issue there are valuable articles that highlight different aspects of the relationship between infertility and gynaecological oncology. The issue covers conditions that represent risk factors for both infertility and gynaecological neoplasia. There is emphasis on the role of the fallopian tube being a critical organ for both conditions. There is a review on the advances in cancer diagnosis and treatment with consideration of the preservation of patient fertility. The various technologies for fertility preservation are reviewed and their strengths and weaknesses discussed. One of the important fertility preservation techniques is cryopreservation of embryo oocytes or ovarian tissue. This special issue emphasises that fertility preservation is now an important consideration in oncology clinics, and the options available to patients are routinely offered. Future developments will offer women in this difficult situation more options for fertility preservation, with an individualised approach for each patient. Equally, for infertile patients it is important to assess the risk of malignancy so as to provide optimal and timely intervention.
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Moawad NS, Canning A. Centers of excellence in minimally invasive gynecology: Raising the bar for quality in women's health. World J Obstet Gynecol 2014; 3:1-6. [DOI: 10.5317/wjog.v3.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/26/2013] [Accepted: 11/05/2013] [Indexed: 02/05/2023] Open
Abstract
The ‘‘Center of Excellence’’ concept has been employed in healthcare for several decades. This concept has been adopted in several disciplines; such as bariatric surgery, orthopedic surgery, diabetes and stroke. The most successful model in surgery thus far has been the bariatric program, with a very extensive network and a large prospective database. Recently, the American Association of Gynecologic Laparoscopists has introduced this concept in gynecologic surgery. The ‘‘Center Of Excellence in Minimally Invasive Gynecology’’ (COEMIG) designation program has been introduced with the goals of increasing safety and efficiency, cutting cost and increasing patient awareness and access to minimally invasive surgical options for women. The program may harbor challenges as well, such as human and financial resources, and difficulties with implementation and maintenance of such designation. This commentary describes the COEMIG designation process, along with its potential benefits and possible challenges. Though no studies have been published to date on the value of this concept in the field of gynecologic surgery, we envision this commentary to provoke such studies to examine the relative value of this new program.
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Nacoti M, Colombetti E, Spada MS, Ceresoli M, Ansaloni L, Marchesi G, Lorini L, Corbella D, Coccolini F. Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study. World J Obstet Gynecol 2014; 3:14-20. [DOI: 10.5317/wjog.v3.i1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/26/2013] [Accepted: 11/05/2013] [Indexed: 02/05/2023] Open
Abstract
This article provides a brief description of an epithelial ovarian cancer (EOC) case (stage IV) treated with the association of complete CytoReductive Surgery and hypertermic intraPEritoneal chemotherapy (HIPEC). The use of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treatment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since definitive cure is unlikely. We reviewed the entire decision making process considering the risk/benefit of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization-International Classification of Functioning, Disability and Health that permits evaluation of the person in relation to the psycho-social context is presented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survivors are of central importance for decision making.
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Rauff S, Ng JS, Ilancheran A. Metastasis to a uterine leiomyoma originating from lung cancer: A case report. World J Obstet Gynecol 2014; 3:21-25. [DOI: 10.5317/wjog.v3.i1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 10/24/2013] [Accepted: 11/05/2013] [Indexed: 02/05/2023] Open
Abstract
The uterus is an uncommon site of metastasis especially from a primary lung adenocarcinoma. More frequently, extragenital primary tumours, including lung cancer, metastasize to the ovaries. In the literature, lung cancer metastasizing to the uterus is rare and has been reported to involve the endometrium and uterine serosa. Here, we report an unusual case of a 58-year-old woman who had a history of lung adenocarcinoma with subsequent metastasis to a single uterine fibroid only. The patient was known to have a long history of asymptomatic fibroids. In 2008, she was diagnosed with lung adenocarcinoma which was treated with primary surgery and adjuvant chemotherapy. Four years later, a routine abdominal computerised tomography scan showed an enlargement of the fibroid and she underwent a hysterectomy and bilateral salpingo-oophorectomy. Pathology reported a lung adenocarcinoma metastatic to the uterine leiomyoma with a similar morphology to the original pulmonary malignancy and this was confirmed with immunohistochemical staining. She had no evidence of metastatic disease elsewhere. The final diagnosis was metastasis of a primary lung adenocarcinoma confined to a uterine leiomyoma. Our patient also fulfilled the criteria for a phenomenon called tumour-to-tumour metastasis in this case a primary malignancy having metastasized to a benign tumour. In conclusion, metastasis of a primary lung cancer to the female reproductive tract has been documented, but clinicians should also be aware that metastasis to benign gynaecological tumours such as fibroids can also occur, especially in the setting of tumour-to-tumour metastasis. In addition, the clinical history and use of immunohistochemistry are invaluable in reaching a diagnosis.
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Giannitsas K, Athanasopoulos A. Desmopressin for the treatment of female storage lower urinary tract symptoms. World J Obstet Gynecol 2014; 3:7-13. [DOI: 10.5317/wjog.v3.i1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/14/2013] [Accepted: 12/11/2013] [Indexed: 02/05/2023] Open
Abstract
Female storage lower urinary tract symptoms are prevalent and bothersome. They are usually attributed to an overactive bladder and treated with antimuscarinics. Nevertheless, failure of conventional treatment to alleviate nocturia in particular and epidemiological data suggesting that nocturnal polyuria is the only or a contributing factor to nocturia, has attracted interest in decreasing nighttime urine production as a method of managing nocturia. A reduction in urine production could also, at least temporarily, delay daytime storage symptoms by delaying bladder filling. Therefore, desmopressin, the synthetic analogue or naturally occurring antidiuretic hormone, could have a role in the management of female frequency, urgency and urgency incontinence. This work aims to review data on the use of desmopressin in females with storage symptoms. Available evidence indicates that desmopressin is efficacious in reducing nighttime urine production and episodes of nocturia, resulting in fewer sleep interruptions. This translates into improved quality of life. Desmopressin is also effective in postponing micturition, urgency and incontinence for several hours after being taken on demand. The tolerability profile of desmopressin is good and significantly improved compared to historical figures due to the introduction of new oral formulations, tailoring the dose according to gender and age and adhering to instructions for fluid restriction before administration. The incidence of hyponatremia, desmopressin’s most important side-effect, is less than 3% in recent trials. The efficacy of desmopressin, combined with its improved safety profile, makes it an interesting method for treating female storage lower urinary tract symptoms.
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Chaudhary V, Sachdeva P, Arora R, Kumar D, Karanth P. Pelvic arterial embolization in obstetric hemorrhage. World J Obstet Gynecol 2013; 2:185-191. [DOI: 10.5317/wjog.v2.i4.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 05/20/2013] [Accepted: 07/18/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze safety and efficacy of pelvic arterial embolization (PAE) in preventing and treating obstetrical hemorrhage.
METHODS: A consecutive study of eight cases undergoing pelvic artery embolization from January 2010 to October 2012 in Department of Obstetric and Gynecology of Maulana Azad Medical College for intractable obstetric hemorrhage was done. All embolization were carried out in cath lab of cardiology Department at associated GB Pant Hospital.
RESULTS: Clinical success was defined as arrest of bleeding after PAE without need for repeat PAE or additional surgery which was 75% in our series. PAE was successful in controlling obstetrical hemorrhage in all except one who had mortality. Other had hysterectomy due to secondary hemorrhage. Five resumed menstruation. None of the women intended to conceive, hence are practicing contraception.
CONCLUSION: PAE is minimally invasive procedure which should be offered early for hemostasis in intractable obstetrical haemorrhage unresponsive to uterotonic. It is a fertility sparing option with minor complications.
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Lotti M, Busci LM, Campanati L, Catena F, Coccolini F, Bakrin N, Iaco PD, Ercolani G, Grosso G, Pisano M, Poiasina E, Rossetti D, Rossi M, Zamagni C, Bertoli P, Pinna AD, Frigerio L, Ansaloni L. Cytoreductive surgery and HIPEC after neoadjuvant chemotherapy for advanced epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:167-175. [DOI: 10.5317/wjog.v2.i4.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/23/2013] [Accepted: 07/11/2013] [Indexed: 02/05/2023] Open
Abstract
AIM: To reduce postoperative complications and to make possible an optimal cytoreduction, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery has been applied with encouraging results.
METHODS: Between December 2009 and February 2012, patients with stage IIIC-IV epithelial ovarian cancer (EOC) underwent diagnostic laparoscopy, to assess the feasibility of optimal debulking surgery. The modified Fagotti score was applied to assess the feasibility of resection with zero residual tumor. Patients who were not candidate for upfront debulking surgery were submitted to NACT, then reassessed according to the RECIST 1.1 criteria and submitted to cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) if they showed clinical response or stable disease. The remaining cycles of adjuvant systemic chemotherapy (ASCT) were administered postoperatively, to complete 6 cycles of systemic chemotherapy.
RESULTS: Nine patients were included. Clinical response to NACT was complete in 3 patients and partial in 5 patients; one patient had stable disease. All patients underwent CRS resulting in CC0 disease prior to HIPEC. Average operative time was 510 min. Average intensive care unit stay was 2 d. Average postoperative hospital stay was 25 d. No postoperative mortality was observed. One patient experienced pelvic abscess. One patient refused ASCT. The remaining 8 patients started ASCT. Average time to chemotherapy was 36 d. All patients are alive, with an average follow up of 11 mo. Eight patients are disease-free at follow up.
CONCLUSION: HIPEC after CRS for advanced EOC is feasible with acceptable morbidity and mortality. NACT may increase the chance for achieving complete cytoreduction. Phase 3 studies are needed to determine the effects of HIPEC on survival.
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Zhang XQ, Ding YL, Zhang LJ. Why more attentions to fetus in cases of intrahepatic cholestasis of pregnancy? World J Obstet Gynecol 2013; 2:62-64. [DOI: 10.5317/wjog.v2.i4.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a peculiar disease in middle-late pregnancy with the pathological characteristics of hepatic capillary bile duct silts and is accompanied by clinical presentations of pruritus and bile acid (BA) elevation in serum. Maternal outcomes for patients diagnosed with ICP are usually good. However, fetal outcomes can be devastating with high frequencies of perinatal complications. Patients with ICP generally have an early delivery due to fetal complications. The current hypothesis is that ICP has higher frequencies of fetal complications due to high concentrations of BA which has toxic cellular effects to many organs. In lungs, it destroys the AT-II cells, decreasing phospholipids synthesis leading to the alveolar capillary permeability to increase and pulmonary surfactant to decrease. In heart, cholate can cross into the fetal compartment and causing fetal arrhythmias and decreased contractility. In the nervous system, high BAs can cause nerve cell denaturation and necrosis, mitochondria edema and membrane dissolve. In the placenta, high BA concentration can cause edema of the villous, decrease number of villous, intervillous thickening and balloon formation. In addition, high total BA can result in chorionic vein constriction and impaired fetal adrenal function.
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Coccolini F, Ansaloni L, Corbella D, Lotti M, Glehen O. Criticalities in randomized controlled trials on HIPEC for ovarian cancer. World J Obstet Gynecol 2013; 2:124-128. [DOI: 10.5317/wjog.v2.i4.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/11/2013] [Accepted: 03/27/2013] [Indexed: 02/05/2023] Open
Abstract
Since the 1990s, many oncological surgery groups around the world started to apply hyperthermic intra-peritoneal chemotherapy (HIPEC) to the different peritoneal spread cancers. The rationale of the application of HIPEC after surgery is to complete the cytoreductive procedure. This combined treatment has now been successfully applied to many different intra-abdominal neoplasms. However, the treatment of peritoneal surface malignancies and the administration of HIPEC still lack high graded evidence data, especially in ovarian cancer. Experimental data exists about every step of the treatment of peritoneal spread ovarian cancer but unfortunately they have not yet been translated into phase III clinical randomized trials. Moreover, treatment protocols differ between different centers. A systematic review of published randomized trial protocols was performed. HIPEC techniques are miscellaneous and not yet standardized. Well structured phase III randomized trials among specialized centers are needed to investigate the efficacy of this therapeutic approach, as well as technical details that may contribute to the standardization of the procedure and limit morbidity and mortality. In particular, new criteria are mandatory to uniformly stage the disease, to objectively evaluate the extension of cytoreduction and consequently the residual disease, to decide the best method of performing hyperthermia and to perfuse drugs. Moreover, pharmacokinetic and pharmacodynamic studies are urgently needed to assess the best type and dose of anticancer drugs.
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Mannella P, Palla G, Pérez-Roncero G, López-Baena MT, Pérez-López FR. Female urinary incontinence during pregnancy and after delivery: Clinical impact and contributing factors. World J Obstet Gynecol 2013; 2:74-79. [DOI: 10.5317/wjog.v2.i4.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 10/16/2013] [Indexed: 02/05/2023] Open
Abstract
Urinary incontinence (UI) is a common condition affecting adult women of all ages and it could have a negative influence on quality of life. The etiology of UI is multifactorial, but some of the most important risk factors are obesity and ageing, as well as adverse obstetric events. Pregnancy and delivery per se have been implicated in the etiology of UI. Although several studies have demonstrated a direct association between UI and vaginal delivery in short, medium and long-term, the role of childbirth on the risk of UI remains controversial. The mechanical strain during delivery may induce injuries to the muscle, connective and neural structures. Vaginal birth can be associated with relaxation or disruption of fascial and ligamentous supports of pelvic organs. Parity, instrumental delivery, prolonged labor and increased birth weights have always been considered risk factors for pelvic floor injury. Also genetic factors have been recently raised up but still there are not appropriate guidelines or measures to reduce significantly the incidence of UI. The role of pelvic floor muscle training (PFMT) in the prevention and treatment of UI is still unclear. However, PFMT seems to be useful when supervised training is conducted and it could be incorporated as a routine part of women’s exercise programmes during pregnancy and after childbirth.
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Sammartino P, Cornali T, Malatesta MFD, Piso P. Cytoreductive surgery after recurrent epithelial ovarian cancer and at other timepoints. World J Obstet Gynecol 2013; 2:101-107. [DOI: 10.5317/wjog.v2.i4.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/10/2013] [Indexed: 02/05/2023] Open
Abstract
In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient’s symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defined. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these findings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials (Arbeitsgemeinschaft Gynäkologische Onkologie-Desktop III and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a definitive answer to the matter.
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