Chronic Liver Disease in the Obstetric Patient
Chronic liver disease in pregnancy is rare. Historically, many chronic liver diseases were considered contraindications to pregnancy; however, with current monitoring and treatment strategies, pregnancy may be considered in many cases. Preconception and initial antepartum consultation should focus on disease activity, medication safety, risks of pregnancy, as well as the need for additional monitoring during pregnancy. In most cases, a multidisciplinary approach is necessary to ensure optimal maternal and fetal outcomes. Despite improving outcomes, pregnancy in women with the chronic liver disease remains high risk. (Sourc...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
Infectious Hepatitis in Pregnancy
Infectious hepatitis in pregnancy is clinically significant in both the acute and chronic phases. Here, we review the perinatal implications of chronic hepatitis B and C and acute hepatitis A and E. Familiarity with screening, transmission, diagnosis, and management of infectious hepatitis is of ongoing importance during obstetric care, as these diseases are endemic in much of the world. Pregnancy and interpregnancy care provide opportunities to prevent infection and transmission of hepatitis. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
Hepatic Complications in Preeclampsia
In cases of preeclampsia with severe features and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, hepatic complications portend significant short-term and long-term maternal health implications. In this section, we will discuss the physiology of normal hepatic function in pregnancy, the pathophysiology of the abnormalities noted in hepatic function during the process of preeclampsia development, the diagnosis and management of preeclampsia, imitators of HELLP syndrome, the utility of various biomarkers in the diagnosis and prognosis of the preeclampsia disease spectrum, possible underlying genetic fac...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
Acute Fatty Liver of Pregnancy
Acute fatty liver of pregnancy (AFLP) is a rare, but potentially fatal condition, characterized by hepatic failure typically in the third trimester of pregnancy that is associated with multiorgan involvement resulting in a number of clinical and laboratory abnormalities. The cornerstone of management of AFLP includes prompt recognition, preparation for delivery, and supportive care such as reversal of coagulopathy. Early diagnosis, prompted delivery, and supportive care have resulted in improved maternal morbidity and mortality. This review focuses on the epidemiology, etiology, clinical presentation, diagnosis, management...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
Intrahepatic Cholestasis of Pregnancy
Intrahepatic cholestasis of pregnancy is a common disorder of pregnancy manifested by pruritus and elevated bile acids. The etiology of cholestasis is poorly understood and management is difficult due to the paucity of data regarding its diagnosis, treatment, and related adverse outcomes. In this article, we review the epidemiology, pathophysiology, risk factors, laboratory findings, complications, treatment, management, and current evidence surrounding intrahepatic cholestasis of pregnancy. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
The Hepatobiliary System: An Overview of Normal Function and Diagnostic Testing in Pregnancy
Pregnancy is associated with physiological adaptions that affect every organ system. Changes in liver function in pregnancy have important effects on nutrient metabolism, protein synthesis, and the biotransformation of substances in preparation for excretion. A clear understanding of the anatomic and functional changes of the hepatobiliary system is necessary for the diagnosis and evaluation of disease, as well as understanding how these changes predispose women to pregnancy-specific hepatic conditions. In this review, the effect of gestational changes in hepatobiliary function on laboratory tests and the role of diagnosti...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
Foreword: Liver Disease in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Liver Disease in Pregnancy Source Type: research
Contributors: Liver Disease in Pregnancy
No abstract available (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: Contributors: Liver Disease in Pregnancy: PDF Only Source Type: research
Characterization of a TP53 Somatic Variant of Unknown Function From an Ovarian Cancer Patient Using Organoid Culture and Computational Modeling
In our proof-of-concept study of 1 patient with stage IIIC carcinosarcoma of the ovary, we discovered a rare mutation in the tumor suppressor, TP53, that results in the deletion of N131. Immunofluorescence imaging of the organoid culture revealed hyperstaining of p53 protein. Computational modeling suggests this residue is important for maintaining protein conformation. Drug screening identified the combination of a proteasome inhibitor with a histone deacetylase inhibitor as the most effective treatment. These data provide evidence for the successful culture of a patient tumor and analysis of drug response ex vivo. (Sourc...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
Prediction of Epithelial Ovarian Cancer Outcomes With Integration of Genomic Data
Some of the patients with epithelial ovarian cancer will not respond to initial therapy. These patients have a poor prognosis. Our aim was to identify patients with a worse prognosis by integrating clinical, pathologic, and genomic data. Using publicly available genomic data and integrating it with clinical data, we significantly improved the prediction of patients with worse surgical outcomes and those who do not respond to initial chemotherapy. We further improved these models with more precise data collection and better understanding of the genetic background of the studied population. Better prediction will lead to bet...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
Maintenance Therapy in the Treatment of Recurrent Epithelial Ovarian Cancer
A diagnosis of recurrent epithelial ovarian cancer carries with it a very poor prognosis despite aggressive chemotherapy with or without secondary surgical cytoreduction. Recently, maintenance treatment after second-line chemotherapy has gained momentum given promising results of antiangiogenics and PARP inhibitors used in this setting. When used appropriately, these agents may provide a meaningful survival benefit with minimal effects on quality of life. This paper reveals the current literature evaluating the use of maintenance therapy in the recurrent setting for the epithelial ovarian, fallopian tube, or primary perito...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
Maintenance Therapy in the Primary Treatment of Epithelial Ovarian Cancer
Despite aggressive upfront treatment with a combination of surgery and chemotherapy, most women with advanced epithelial malignancy will experience disease recurrence. The goal of treatment in the recurrent setting shifts away from a curative approach towards palliation of symptoms. In an attempt to delay time to first recurrence, the concept of maintenance chemotherapy emerged. This paper reviews the available literature evaluating the use of maintenance chemotherapy in the primary treatment setting and its effect on progression-free survival and overall survival. (Source: Clinical Obstetrics and Gynecology)
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
Advanced Ovarian Cancer: Weighing the Risks and Benefits of Surgery
Treatment for patients with advanced ovarian cancer includes a combination of platinum-based chemotherapy and maximally cytoreductive surgery. The 2 options for initial treatment include upfront surgery followed by adjuvant chemotherapy or neoadjuvant chemotherapy followed by interval surgery. Deciding between which approach is a on the basis of several factors: (1) resectability of disease; (2) patient factors such as age, albumin, and body mass index; (3) patient wishes; and (4) overall functional status. Research is needed to further refine these approaches and create a patient-focused treatment plan which includes nove...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
Preventing Ovarian Cancer in High-risk Women: One Surgery at a Time
Eleven genes have been identified that increase the lifetime risk of developing ovarian cancer. The cumulative cancer risk of ovarian cancer varies with the mutation type and age. Ovarian cancer risk management options include surgical risk reduction with salpingo-oophorectomy and a newer step-wise approach with interval salpingectomy and delayed oophorectomy. Women should be counseled on the pros and cons of hysterectomy in the setting of reducing the risk of other cancers; eliminating the risk of endometrial cancer in Lynch Syndrome, potential risk of serous/serous-like endometrial cancer in BRCA1 carriers, and eliminati...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
Immunotherapy for Gynecologic Cancer: Current Applications and Future Directions
The role of the immune system in the development of cancer has been a subject of ongoing clinical investigation in recent years. Emerging data demonstrate that tumorigenesis resulting in ovarian, uterine, and cervical cancers is a consequence of impaired host immune responses to cancerous cells. Leveraging the immune system through the use of immune checkpoint inhibitors, therapeutic vaccine therapy, and adoptive cell transfer presents a profound opportunity to revolutionize cancer treatment. This review will encompass the role of the immune system in development of gynecologic cancers and highlight recent data regarding i...
Source: Clinical Obstetrics and Gynecology - January 25, 2020 Category: OBGYN Tags: New and Novel Treatments for Gynecologic Cancer Source Type: research
