Ethnic disparities: Genetics vs (social) environment

To define “ethnicity” in the context of perinatal care is a tough job. The word makes us think: “racial, social, cultural, national…”. An ethnic group is generally considered a group of people with a common history, usually (but not always) a common religion and language, sharing aspects of culture such as nutrition and traditions concerning pregnancy, childbirth, the way they care for children. As procreation occurs mostly in-group, every ethnic group will demonstrate a higher prevalence of, more or less well-known, genes and their connected diseases. For some populations, such as Ashkenazi Jewish people, the prevalence and associated risks of these autosomal diseases are well known, as in the case of “Jewish genetic disease”, and specific screening programs are available.

Intrauterine growth restriction and genetic determinants - existing findings, problems, and further direction

Fetal growth is determined largely by the nutrient supply, placental transport function, and growth hormones. Recently, gene mutation and expression, especially of those genes associated with the proteins that are related to the fetal growth, have been reported to play an important role in the development of intrauterine growth restriction (IUGR). Fetal growth epigenetics, a new concept in fetal growth, has resulted from studies on fetal programing. This paper outlines the findings of our serial studies on IUGR, and summarizes data on IUGR animal models, placental function in transferring nutrients, cell proliferation dynamics in IUGR, and experimental treatment of IUGR. We review genetic approaches to IUGR, especially those relating to growth factor genes, angiotensinogen genes and other gene mutations. We also discuss the epigenetics of fetal growth and future study directions on fetal growth restriction. These should be valuable in elucidating the mechanisms employed by the fetus and in helping to develop interventional strategies that might prevent the development of IUGR.

Prevention and not merely prediction of preterm labor and delivery

Different methods have been proposed to screen for preterm labor and delivery; most of these aim to predict the risk that preterm delivery is going to take place. However, interesting though this knowledge might be, knowing the future is of no use when no changes can be made. Recent publications have suggested new and exciting modalities to actually diminish the frequency of preterm birth in patients selected by transvaginal cervical length measurement; these modalities include vaginal progesterone and vaginal pessaries. Although promising, many questions remain to be answered; not least about the long term outcome for both neonates and mothers, but also on the eventual introduction of such strategies to the general obstetric population. One of the main problems that urgently needs clarification is how we are going to offer this best of medicine to those needing it most: deprived and socially isolated women who have the highest risk for preterm labor and delivery, probably not due to any congenital cervical problems, but to a combination of environmental, microbiological and social factors, including transgenerational poverty and deprivation.

Free radicals generation in an in vitro fertilization setting and how to minimize them

Several studies report an increase in both male and female factors in infertility worldwide. In recent years there has been a tremendous increase in couples seeking assisted reproductive technology (ART) procedures in order to have children. However, the success rates of these procedures still remain very low. One of the major contributing factors to the low success rate in ART has been the damage caused by free radicals to the gametes and the developing embryo. The manipulation of gametes and embryos in an in vitro environment when performing assisted reproductive techniques carries the risk of exposure of these cells to supraphysiological levels of free radicals; namely, reactive oxygen species (ROS) and reactive nitrogen species. Oxidative stress can originate from the early steps of ART involving the oocyte, sperm and embryo, as well as in the endometrial environment later on following embryo transfer. The common sources of free radicals in an in vitro fertilization setting include the developing embryo, spermatozoa and leukocytes, semen centrifugation, oxygen partial pressure, light, culture media and cryopreservation/thawing. These free radicals are measured using different techniques, such as the cytochrome C reduction method and chemiluminescence-based techniques. Different efforts are being employed to minimize the excess generation of free radicals in the ART setting, with the aim of improving the success rate, and antioxidant supplementation has emerged as one of the viable routes. Moreover, it is very important to inform ART personnel about the sources of ROS in the laboratory so that they can stop the use of procedures that are deleterious and start to use safer procedures.

Platinum-resistant ovarian cancer: Prematurely stopped phase II Austrian AGO chemotherapy studies

AIM: To report the results of two phase II studies of chemotherapy in patients with platinum-resistant and platinum-refractory ovarian cancer and discuss the current status of systemic therapy in this disease.

METHODS: Two subsequent Austrian Arbeitsgemeinschaft für Gynäkologische Onkologie (AGO) phase II studies have been carried out. Patients either had platinum-refractory or platinum-resistant disease, i.e., disease progression during first line platinum-based therapy or recurrence within 6 mo following the last platinum-containing chemotherapy, respectively. In the first study, 6 cycles of irinotecan at 55 mg/m² and docetaxel 25 mg/m² were both administered on days 1, 8 and 15 of a 4 wk cycle. In the second phase II study, either non-pegylated (PEG) liposomal doxorubicin (L-DXR) 60 mg/m² monotherapy on day 1 and PEG filgrastim on day 2 (arm A) or L-DXR at 50 mg/m² and gemcitabine (GEM) at 650 mg/m² on day 1 and GEM on day 8 (arm B) were administered every 4 wk. Patients in arm B received prophylactic filgrastim 5 μg/kg per day from days 3 to 6 and from days 9 to 12, respectively.

RESULTS: Response rates in studies were 14% and 17%, respectively. The progression-free survival was less than 3 mo. Diarrhea was most prevalent in patients treated with irinotecan + docetaxel, while stomatitis/mucositis occurred in a quarter of patients treated with L-DXR +/- GEM + granulocyte colony stimulating factor, respectively. Following treatment with the latter regimen, a total of 11 serious adverse events were recorded among the 12 patients included. The rate of remissions of the regimens used in these two Austrian AGO studies was low and their toxicity significant. Due to their low therapeutic index, neither of these regimens can be recommended in this heavily pretreated patient population with platinum-resistant ovarian cancer exhibiting a high tumor-associated symptom burden.

CONCLUSION: The two reported phase II studies of the Austrian AGO in platinum-resistant disease had to be terminated prematurely due to a low therapeutic index. Treatment of this disease remains a clinical dilemma. Bevacizumab seems to be active at this late-stage disease but may be associated with significant bowel toxicity.

Sexuality after childbirth: Gaps and needs

Childbirth is a stressful event for a majority of women and can have many consequences one of which is female sexual dysfunction. The main aim of pre- and postnatal health services is to fulfil physical and emotional needs of mothers and babies but not sexual function of women. Also, the fact that sexual satisfaction is part of general well being and mental health is generally neglected. Sexual function of women not only is affected by childbirth, but also is influenced by many other factors. One of these factors is culture and religion. Women’s sexual life after childbirth has different meaning in different cultures. In many conservative societies with certain cultural and religious beliefs women are prohibited from having sex after childbirth. In these societies, women hear conflicting stories about risks and benefits of having sexual intercourse during postpartum period the majority of which may not be true. It has been reported that some women may be at greater risk of postpartum sexual dysfunction as neurobiological factors and genetics have been recently suggested to impact female sexual functioning. Considering the multidimensional nature of female sexual dysfunction, this problem cannot be resolved by a simple solution and not all postpartum women can be treated by the same protocol. Various treatment options, such as the use of medications, behavioural interventions and psychotherapy have been investigated in research studies and there is still controversy over the issue. Regarding the fact that sexually satisfied women are more mentally healthy, routine screening during prenatal, antenatal and postnatal visits are suggested to uncover hidden difficulties with sexual functioning of women and improve their quality of life.

Survey of the management of borderline ovarian tumors in the United Kingdom

Borderline ovarian tumors (BOTs) represent approximately 10% of ovarian neoplasms and are a heterogeneous group of tumors with variable biological behaviour. The majority present with disease confined to the ovary and have an excellent prognosis after surgical removal. A small proportion subsequently has recurrent disease or progression to invasive cancer. Tumor recurrence can occur up to 20 years after surgical resection. There are no robust clinical, histological or molecular markers that distinguish high risk cases and no satisfactory treatment for patients with progressive disease. This results in great variability in management in different centres. We conducted a national survey on the management of borderline ovarian tumors in cancer centres representing different regions in the United Kingdom. In this article we review the literature for the current concepts in diagnosis, treatment and follow up of BOTs and we report the results of the survey of current practice in the United Kingdom. On that basis we provide recommendations for the management of patients with BOTs.

What is the purpose of launching the World Journal of Obstetrics and Gynecology?

World Journal of Obstetrics and Gynecology (WJOG) is a new member of the World Series journals and is launched in June 10, 2012. WJOG is an open access peer-reviewed bimonthly journal that will cover obstetrics and gynecology including reproductive medicine. The intention of WJOG is to publish papers that describe and influence the situation all around the world. The journal will publish both basic research and well as clinical findings. The focus shall be on translational work. Please send your important findings and comments to WJOG.