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Morcellation in gynecologic oncology
Purpose of review Morcellation of uteri with unsuspected malignancies has been the focus of reports for decades. More intensive evaluation of clinical outcomes and evaluation of impact of changes in practice has occurred since the release of FDA statement advising against the use of power morcellators. The review summarizes some of the most relevant publications on this topic. Recent findings The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists concur that symptomatic women should undergo appropriate evaluation, morcellation should not be performed whenever malignancy is susp...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Economics of gynecologic morcellation
Purpose of review As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. Recent findings Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspec...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

The prevalence of occult leiomyosarcoma in women undergoing presumed fibroid surgery and outcomes after morcellation
Purpose of review To review the data-derived prevalence rates for occult leiomyosarcoma (LMS), and outcomes for women who have these tumors inadvertently morcellated. Recent findings In 2014, the Food and Drug Administration presented data showing the prevalence rates of occult LMS at 2.02/1000 surgeries for presumed benign fibroids. They also attributed poorer outcomes for women undergoing power morcellation of these tumors. Two more recent meta-analyses have shown much lower rates, as low as one in 8300 surgeries when including only prospective studies, and one in 1428 surgeries when including both prospective and r...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Indications for morcellation in gynecologic surgery
Purpose of review Minimally invasive gynecologic procedures, in particular laparoscopic hysterectomy and myomectomy, often require tissue morcellation. Recent findings Whether morcellated or not, myometrial cells can be found in the abdomen and pelvis after either laparoscopic or open myomectomy. Following morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue and cells without the use of containment bags. The dogma of not ‘cutting-through’ cancer is not correct for many surgical specialties and irrelevant with regards ...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Morcellation equipment: past, present, and future
This article will review the most current research on electronic power morcellation and the multiple attempts to prove superiority from the many different types of equipment, and also the many different approaches to morcellation. In addition, with the adaptation to contained morcellation, this review will cover research focused on optimizing a containment system and the techniques involved. Summary In summary, this review is aimed at describing many of the currently available power morcellation products and contained morcellation systems in an effort to allow physicians to understand the different options available, an...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Development and history of morcellators
Purpose of review Controversy exists surrounding extraction of tissue in gynecologic surgery using morcellators following cases of disseminated uterine cancers discovered after the use of electromechanical morcellators. This chapter traces the history of tissue extraction in gynecology and reviews the evolving scientific data and opinions regarding the future of morcellation. Recent findings Since the initial Food and Drug Administration warning about morcellation in 2014, subsequent studies do not support the Food and Drug Administration's high incidence of occult uterine cancer. Current research continues, focusing ...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Alternative facts and morcellation
Purpose of review Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated. Recent findings Misrepresentation of the ethics surrounding this procedure,...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Advances in targeting HER2-positive breast cancer
Purpose of review Breast cancer is the most common malignancy in women and HER2-positive disease comprises about 15% of all breast cancer cases. Over the last few years, substantial advances have been made in treatment of early breast cancer (EBC) and advanced (ABC) HER2-positive (HER2+) breast cancer. The present review summarizes the major publications on HER2+ breast cancer in the year 2017 and discusses their clinical relevance. Recent findings The clinically most relevant data in 2017 relates to the EBC setting. The St. Gallen Consensus 2017 for the first time recommended neoadjuvant treatment as standard of care...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Gottfried E. Konecny Source Type: research

Hormone receptor positive breast cancer: state of the art
Purpose of review Hormone receptor (HR) positive breast cancer represents the vast majority of breast cancer cases. Treatment for these patients has been 5 years of endocrine therapy in the localized setting and endocrine therapy alone in the metastatic setting until progression of disease and switch to chemotherapy until quite recently. Recent findings The current article will review recent data on role of extended endocrine therapy with tamoxifen and aromatase inhibitors and adjuvant bisphosphonates in the localized disease setting. It will then review the role of targeted agents such as cyclin dependent kinases 4/6...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Gottfried E. Konecny Source Type: research

The target invites a foe: antibody–drug conjugates in gynecologic oncology
Purpose of review Antibody–drug conjugates (ADCs) represent a promising new class of cancer therapeutics. Currently more than 60 ADCs are in clinical development, however, only very few trials focus on gynecologic malignancies. In this review, we summarize the most recent advances in ADC drug development with an emphasis on how this progress relates to patients diagnosed with gynecologic malignancies and breast cancer. Recent findings The cytotoxic payloads of the majority of the ADCs that are currently in clinical trials for gynecologic malignancies or breast cancer are auristatins (MMAE, MMAF), maytansinoids (...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Palliative care in gynecologic oncology
Purpose of review Patients with gynecologic malignancies face many difficult issues in the course of their diseases, ranging from physical symptoms to advance care planning in light of a poor prognosis. This review examines the evidence supporting integration of palliative care early in the course of disease and symptom management, and provides a framework for difficult conversations. Recent findings Palliative care has been demonstrated to improve quality of life and promote survival if integrated early in the course of disease. An evidence-based approach should guide symptom management, such as pain and nausea. Adva...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Cell-based immunotherapy in gynecologic malignancies
Purpose of review To provide an overview of the principles, safety and efficacy of adoptive cell therapy (ACT) in solid tumors particularly in gynecological cancers. Recent findings Efforts to target solid tumors using tumor-infiltrating lymphocytes and genetically modified T cells have shown promising efficacy in some patients. Two food and drug administration approvals for the treatment of leukemia are the first gene therapies available for cancer treatment in the United States. Summary Genetic engineering of antitumor immunity using T cells has the potential to target specific tumor-associated antigens and overc...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Endocrine therapy in ovarian cancer: where do we stand?
Purpose of review Hormonal factors play a pivotal role in epithelial ovarian tumorigenesis and steroid receptor expression has been associated with epithelial ovarian cancer (EOC) response and survival in recent studies. However, the degree of activity of endocrine therapy overall and by specific agents remains unclear. The purpose of this work is to summarize the evidence provided by the recent literature on the effectiveness of endocrine treatment for advanced EOC. Recent findings The results of 53 trials of different endocrine therapies in EOC indicate a clinical benefit of 41% [95% confidence interval (CI), 0.34&n...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Novel poly-ADP-ribose polymerase inhibitor combination strategies in ovarian cancer
Purpose of review The recent United States Food and Drug Administration approvals of niraparib and olaparib as maintenance monotherapy for platinum-sensitive, high-grade ovarian cancers independent of BRCA status reflect a willingness to seek indications for poly-ADP-ribose polymerase (PARP) inhibitors beyond cancers with deleterious breast cancer 1 and breast cancer 2 mutations. In this review, I describe the rationale behind current PARP combination clinical trials with chemotherapies, angiogenesis inhibitors, cell cycle checkpoint inhibitors, and inhibitors of the phosphoinositide 3-kinase/AK thymoma/mechanistic targe...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Frontline therapy of ovarian cancer: trials and tribulations
Purpose of review The current article reviews the advances and challenges in the fight with cancer and the hope for cure, with a focus on clinical trials, at the one time with the best outcomes; first-line therapy. Recent findings To date there have been four great stories that bridge inception to development of new drugs in ovarian cancer: Serendipitous insight into the role of platinum, discovery of taxanes, understanding the microenvironment and angiogenesis, and following the science in the development of Poly (ADP-Ribose) Polymerase (PARP) inhibitors. There is a fundamental difference between overall survival (OS...
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - January 17, 2018 Category: OBGYN Tags: Editorial Introductions Source Type: research

Morcellation in gynecologic oncology
Purpose of review Morcellation of uteri with unsuspected malignancies has been the focus of reports for decades. More intensive evaluation of clinical outcomes and evaluation of impact of changes in practice has occurred since the release of FDA statement advising against the use of power morcellators. The review summarizes some of the most relevant publications on this topic. Recent findings The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists concur that symptomatic women should undergo appropriate evaluation, morcellation should not be performed whenever malignancy is susp...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Economics of gynecologic morcellation
Purpose of review As the Food and Drug Administration raised concern over the power morcellator in 2014, the field has seen significant change, with patients and physicians questioning which procedure is safest and most cost-effective. The economic impact of these decisions is poorly understood. Recent findings Multiple new technologies have been developed to allow surgeons to continue to afford patients the many benefits of minimally invasive surgery while minimizing the risks of power morcellation. At the same time, researchers have focused on the true benefits of the power morcellator from a safety and cost perspec...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

The prevalence of occult leiomyosarcoma in women undergoing presumed fibroid surgery and outcomes after morcellation
Purpose of review To review the data-derived prevalence rates for occult leiomyosarcoma (LMS), and outcomes for women who have these tumors inadvertently morcellated. Recent findings In 2014, the Food and Drug Administration presented data showing the prevalence rates of occult LMS at 2.02/1000 surgeries for presumed benign fibroids. They also attributed poorer outcomes for women undergoing power morcellation of these tumors. Two more recent meta-analyses have shown much lower rates, as low as one in 8300 surgeries when including only prospective studies, and one in 1428 surgeries when including both prospective and r...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Indications for morcellation in gynecologic surgery
Purpose of review Minimally invasive gynecologic procedures, in particular laparoscopic hysterectomy and myomectomy, often require tissue morcellation. Recent findings Whether morcellated or not, myometrial cells can be found in the abdomen and pelvis after either laparoscopic or open myomectomy. Following morcellation, careful inspection for and removal of tissue fragments and copious irrigation and suctioning of fluid can remove residual tissue and cells without the use of containment bags. The dogma of not ‘cutting-through’ cancer is not correct for many surgical specialties and irrelevant with regards ...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Morcellation equipment: past, present, and future
This article will review the most current research on electronic power morcellation and the multiple attempts to prove superiority from the many different types of equipment, and also the many different approaches to morcellation. In addition, with the adaptation to contained morcellation, this review will cover research focused on optimizing a containment system and the techniques involved. Summary In summary, this review is aimed at describing many of the currently available power morcellation products and contained morcellation systems in an effort to allow physicians to understand the different options available, an...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Development and history of morcellators
Purpose of review Controversy exists surrounding extraction of tissue in gynecologic surgery using morcellators following cases of disseminated uterine cancers discovered after the use of electromechanical morcellators. This chapter traces the history of tissue extraction in gynecology and reviews the evolving scientific data and opinions regarding the future of morcellation. Recent findings Since the initial Food and Drug Administration warning about morcellation in 2014, subsequent studies do not support the Food and Drug Administration's high incidence of occult uterine cancer. Current research continues, focusing ...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Alternative facts and morcellation
Purpose of review Since the recent black-box warning regarding the use of electromechanical morcellation, there has been a hesitancy to utilize the product and even to perform other types of morcellation by gynecologists. Unfortunately, this Food and Drug Administration action and the continued public criticisms of this procedure are grounded in poor data and faulty reasoning. To truly perform informed consent to patients considering procedures involving morcellation, a thorough review of the facts, not alternative facts, must be communicated. Recent findings Misrepresentation of the ethics surrounding this procedure,...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC MORCELLATION: Edited by David L. Olive Source Type: research

Advances in targeting HER2-positive breast cancer
Purpose of review Breast cancer is the most common malignancy in women and HER2-positive disease comprises about 15% of all breast cancer cases. Over the last few years, substantial advances have been made in treatment of early breast cancer (EBC) and advanced (ABC) HER2-positive (HER2+) breast cancer. The present review summarizes the major publications on HER2+ breast cancer in the year 2017 and discusses their clinical relevance. Recent findings The clinically most relevant data in 2017 relates to the EBC setting. The St. Gallen Consensus 2017 for the first time recommended neoadjuvant treatment as standard of care...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Gottfried E. Konecny Source Type: research

Hormone receptor positive breast cancer: state of the art
Purpose of review Hormone receptor (HR) positive breast cancer represents the vast majority of breast cancer cases. Treatment for these patients has been 5 years of endocrine therapy in the localized setting and endocrine therapy alone in the metastatic setting until progression of disease and switch to chemotherapy until quite recently. Recent findings The current article will review recent data on role of extended endocrine therapy with tamoxifen and aromatase inhibitors and adjuvant bisphosphonates in the localized disease setting. It will then review the role of targeted agents such as cyclin dependent kinases 4/6...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Gottfried E. Konecny Source Type: research

The target invites a foe: antibody–drug conjugates in gynecologic oncology
Purpose of review Antibody–drug conjugates (ADCs) represent a promising new class of cancer therapeutics. Currently more than 60 ADCs are in clinical development, however, only very few trials focus on gynecologic malignancies. In this review, we summarize the most recent advances in ADC drug development with an emphasis on how this progress relates to patients diagnosed with gynecologic malignancies and breast cancer. Recent findings The cytotoxic payloads of the majority of the ADCs that are currently in clinical trials for gynecologic malignancies or breast cancer are auristatins (MMAE, MMAF), maytansinoids (...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Palliative care in gynecologic oncology
Purpose of review Patients with gynecologic malignancies face many difficult issues in the course of their diseases, ranging from physical symptoms to advance care planning in light of a poor prognosis. This review examines the evidence supporting integration of palliative care early in the course of disease and symptom management, and provides a framework for difficult conversations. Recent findings Palliative care has been demonstrated to improve quality of life and promote survival if integrated early in the course of disease. An evidence-based approach should guide symptom management, such as pain and nausea. Adva...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Cell-based immunotherapy in gynecologic malignancies
Purpose of review To provide an overview of the principles, safety and efficacy of adoptive cell therapy (ACT) in solid tumors particularly in gynecological cancers. Recent findings Efforts to target solid tumors using tumor-infiltrating lymphocytes and genetically modified T cells have shown promising efficacy in some patients. Two food and drug administration approvals for the treatment of leukemia are the first gene therapies available for cancer treatment in the United States. Summary Genetic engineering of antitumor immunity using T cells has the potential to target specific tumor-associated antigens and overc...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Endocrine therapy in ovarian cancer: where do we stand?
Purpose of review Hormonal factors play a pivotal role in epithelial ovarian tumorigenesis and steroid receptor expression has been associated with epithelial ovarian cancer (EOC) response and survival in recent studies. However, the degree of activity of endocrine therapy overall and by specific agents remains unclear. The purpose of this work is to summarize the evidence provided by the recent literature on the effectiveness of endocrine treatment for advanced EOC. Recent findings The results of 53 trials of different endocrine therapies in EOC indicate a clinical benefit of 41% [95% confidence interval (CI), 0.34&n...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Novel poly-ADP-ribose polymerase inhibitor combination strategies in ovarian cancer
Purpose of review The recent United States Food and Drug Administration approvals of niraparib and olaparib as maintenance monotherapy for platinum-sensitive, high-grade ovarian cancers independent of BRCA status reflect a willingness to seek indications for poly-ADP-ribose polymerase (PARP) inhibitors beyond cancers with deleterious breast cancer 1 and breast cancer 2 mutations. In this review, I describe the rationale behind current PARP combination clinical trials with chemotherapies, angiogenesis inhibitors, cell cycle checkpoint inhibitors, and inhibitors of the phosphoinositide 3-kinase/AK thymoma/mechanistic targe...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Frontline therapy of ovarian cancer: trials and tribulations
Purpose of review The current article reviews the advances and challenges in the fight with cancer and the hope for cure, with a focus on clinical trials, at the one time with the best outcomes; first-line therapy. Recent findings To date there have been four great stories that bridge inception to development of new drugs in ovarian cancer: Serendipitous insight into the role of platinum, discovery of taxanes, understanding the microenvironment and angiogenesis, and following the science in the development of Poly (ADP-Ribose) Polymerase (PARP) inhibitors. There is a fundamental difference between overall survival (OS...
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: GYNECOLOGIC ONCOLOGY: Edited by Gottfried E. Konecny Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - January 2, 2018 Category: OBGYN Tags: Editorial Introductions Source Type: research

Updates on the diagnostic tools for evaluation of pelvic floor disorders
We describe recent advances in the evaluation and measurement of pelvic floor disorders (PFDs). Recent findings We describe recent developments in pelvic floor assessment of women with pelvic floor dysfunction. Summary Complex integration of multiple anatomic structures and their function are necessary for pelvic floor function. Although the pillars of a complete assessment are a thorough history and physical exam, diagnostic tools can aid in fleshing out the correct and complete analysis of the patient suffering from PFDs. (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: Special Commentary Source Type: research

Difficult implant removals
Purpose of review Subdermal contraceptive implant insertions have rapidly increased worldwide. These devices are usually removed 3–5 years after insertion. Although removals are generally straightforward, difficult removals can occur. This review discusses the overall approach to potentially problematic removals and the appropriate steps to avoid complications and safely remove implants. Recent findings Given the rapid uptake of contraceptive implants and subsequent need for removals, an Implants Removal Task Force was formed to create standard protocols for difficult implant removals worldwide. These protocols ...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Contraceptive counseling for continuation and satisfaction
Purpose of review Quality contraceptive counseling has been identified as a potential means to reduce unintended pregnancy and to increase contraceptive continuation and satisfaction. Past approaches that focused on autonomous decision making and directive counseling have not been shown to meet these goals consistently. Women's health organizations globally are calling for improved counseling through more thorough discussion of side-effects and bleeding changes, and renewed focus on shared decision making and patient-centered care. Recent findings Reproductive life planning can help initiate contraceptive counseling b...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Simulation training for family planning procedures
Purpose of review To review the current evidence for use of simulation in family planning procedural training. Recent findings A variety of simulation models exist for abortion, contraception, and sterilization procedures, ranging from low to high fidelity. Most models for abortion and contraception are low fidelity, inexpensive, and provide opportunities for acquisition and practice of procedural skills. Hysteroscopic and laparoscopic simulation models for sterilization procedures are generally higher fidelity, and their use has been shown to increase knowledge, skill performance, and procedural comfort. Summary E...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Contraception in US servicewomen: emerging knowledge, considerations, and needs
We describe current literature regarding contraceptive use among women serving in the military. We explore the state of contraceptive use by female servicewomen, gaps in knowledge, special considerations, and evidence of unmet needs. Recent findings Recent data on US servicewomen show that overall rates of contraceptive use remain low. Data highlight disparities and suggest barriers to contraceptive uptake persist, with contraceptive use being lower around the time of deployment. Methods that do not require daily use or prescription refills, such as long-acting reversible contraception (LARC) – intrauterine device...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Abortion in the media
Purpose of review To review updates in how abortion care is depicted and analysed though various media outlets: news, television, film, and social media. Recent findings A surge in recent media-related abortion research has recognized several notable and emerging themes: abortion in the news media is often inappropriately sourced and politically motivated; abortion portrayal in US film and television is frequently misrepresented; and social media has a new and significant role in abortion advocacy. Summary The portrayal of abortion onscreen, in the news, and online through social media has a significant impact on c...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

HIV and contraception
Purpose of review Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use. Recent findings Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and ef...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Update on second trimester medical abortion
Purpose of review To review recent literature on second trimester abortion with medical methods. Recent findings Across studies published in the recent past, it is apparent that women prefer shorter procedures and procedure times. Several randomized controlled trials have confirmed adding mifepristone to the second trimester medication abortion regimen results in shorter abortion intervals from first misoprostol administration to complete fetal expulsion. A study of simultaneous administration of mifepristone and misoprostol yielded shorter mean ‘total’ abortion times, presenting several logistical advanta...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

To image or not in noncyclic breast pain? A systematic review
Purpose of review Investigation of noncyclic mastalgia in women without signs or risk factors for cancer is controversial. An initial imaging strategy can diagnose breast cancer early, potentially leading to better treatment and survival. However, cancer diagnosis is very uncommon in these cases, and this approach can be harmful, as false positives or suspicion results will lead to unneeded interventions and follow-up. The purpose of this review is to analyse the trade-offs between desirable and undesirable consequences of initial imaging tests against clinical follow-up. Recent findings We found seven relevant studie...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Current insights in obstetric antiphospholipid syndrome
Purpose of review Antiphospholipid syndrome (APS) is defined as the association of thrombotic events and/or obstetric morbidity in patients persistently positive for antiphospholipid antibodies (aPL). In this review, we will highlight the most important clinical presentations of APS with a focus on the obstetric morbidity, the current management strategies and the outlook for the future. Recent findings The use of aspirin and heparin has improved the pregnancy outcome in obstetric APS and approximately 70% of pregnant women with APS have a successful pregnancy outcome. Unfortunately, the current standard of care does ...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Medical comorbidity in polycystic ovary syndrome with special focus on cardiometabolic, autoimmune, hepatic and cancer diseases: an updated review
Purpose of review Polycystic ovary syndrome (PCOS) is defined by hyperandrogenism, irregular menses and polycystic ovaries when other causes are excluded. The possible implication of increased morbidity in PCOS for screening and follow-up is uncertain and is reviewed in this article. Recent findings The increased risk of type 2 diabetes and cardiovascular disease in PCOS is closely associated with BMI. Women with PCOS should be screened for the elements of the metabolic syndrome upon diagnosis. Measurement of HbA1c and the lipid accumulation product could be important tools to differentiate women with high metabolic r...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Cardiovascular origins of preeclampsia
Purpose of review To review the current data on maternal cardiovascular adaptation in normal pregnancy and preeclampsia. Recent findings Defective placentation causes early-onset preeclampsia, a disease entity that is considered more or less distinct from late-onset preeclampsia. The latter has been attributed as ‘maternal’ preeclampsia. There are inconsistencies with the placental origins hypothesis, especially when considering the lack of a causative association with abnormal placental histology or impaired fetal growth. An alternative explanation is that placental dysfunction is secondary to maternal ca...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Accuracy of tests used to detect infection with Chlamydia trachomatis in asymptomatic pregnant women: a systematic review
Purpose of review Infection with Chlamydia trachomatis in pregnancy is linked to increased risk of miscarriage, stillbirth, and preterm birth. Currently, PCR or DNA-based tests are the gold standard when detecting the infection; however, they are costly and require access to specialist equipment. The aim of this systematic review was to assess the accuracy of available tests to detect infection in an asymptomatic pregnant population. Recent findings There was evidence of the superior accuracy of nucleic acid amplification tests to cell culture in nonpregnant asymptomatic women; however, there are multiple commercial n...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

First trimester prediction and prevention of adverse pregnancy outcomes related to poor placentation
Purpose of review To summarize recent research findings related to first trimester prediction and prevention of adverse pregnancy outcomes associated with poor placentation. Recent publications related to prediction and prevention of preeclampsia, intrauterine growth restriction (IUGR) and stillbirth were reviewed. Recent findings Researchers continue to identify markers that will help predict pregnancies that go on to develop preeclampsia through screening at 11–13+6 weeks. A number of multivariate algorithms describing risks for preeclampsia have been published and some of these have been validated in independ...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Does mindfulness meditation improve chronic pain? A systematic review
The objective was to evaluate the effects of mindfulness meditation in chronic pain. Recent findings A systematic search of four databases identified 534 citations; 13 Randomised controlled trials satisfied the inclusion criteria. Mindfulness meditation significantly reduced depression [Standardised mean difference (SMD) −0.28; 95% confidence interval (CI) −0.53, −0.03; P = 0.03; I2 = 0%]. For affective pain (SMD −0.13; 95% CI −0.42, 0.16; I2 = 0%), sensory pain (SMD −0.02; 95% CI −0.31, 0.27; I2 = 0%) and anxiety (SMD −0.16; 95% CI −0.47, 0.15; I2 ...
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - November 10, 2017 Category: OBGYN Tags: Editorial Introductions Source Type: research

Lasers for pelvic floor dysfunctions: is there evidence?
Purpose of review: The purpose of this review is to discuss the available energy sources used in the vaginal canal that are currently being promoted for certain pelvic floor conditions and explore the body of peer-reviewed literature supporting their use. Recent findings: The majority of research has focused on the use of fractional CO2 laser treatment for genitourinary syndrome of menopause (GSM). Most of these studies are nonrandomized prospective studies, but their data consistently shows an improvement in symptoms without significant side effects. Summary: Vaginal laser treatment for GSM is of particular interest to ...
Source: Current Opinion in Obstetrics and Gynecology - September 5, 2017 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Andrew Sokol Source Type: research

Restrictions and limitations after pelvic floor surgery: what's the evidence?
Purpose of review: A common concern regarding pelvic floor surgery is the relatively high risk of recurrence. In an effort to minimize this risk, many surgeons instruct their patients to avoid certain activities during the healing process so as not to damage the repair before proper healing has occurred. However, many of these restrictions have been historically based on little to no hard evidence. The purpose of this review is to present the latest evidence-based recommendations regarding restrictions and limitations after pelvic floor surgery. Recent findings: The current review covers postoperative activities that coul...
Source: Current Opinion in Obstetrics and Gynecology - September 5, 2017 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Andrew Sokol Source Type: research