How does stress, depression and anxiety affect patients undergoing treatment?
Purpose of review To review latest findings about the impact of fertility care on emotional distress and effect of distress on treatment outcome. Recent findings Treatment failure and long agonist protocols are associated with increased emotional distress during treatment. Screening tools can be used to identify men and women at risk of emotional maladjustment at the start of fertility treatment and people unlikely to need emotional support during or after treatment. There are inconclusive results about the association between emotional distress and outcome of fertility treatment. Systematic review of studies evaluati...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Androgen supplementation in assisted reproduction: where are we in 2019?
Purpose of review The purpose of this review is to provide an overview of androgen supplementation in ART with the most updated evidence, from animal studies to its clinical applications in poor ovarian responders (POR) and the future studies to be published. Recent findings Animal studies, has shown that testosterone supplementation, can be an option to increase the recruitable follicular pool in POR. However, the potential mechanism of action, dose, and duration of treatment is still under investigation. Early studies in humans reported promising results in favor of androgens [dehydroepiandrosterone (DHEA) or testos...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

The association between assisted reproductive technologies and low birth weight
Purpose of review To examine the existing literature in regards to the relationship between assisted reproductive technologies (ART) and low birth weight (LBW). Recent findings In 2017, Martin et al. reported on the incidence of low birth weight in relation to the number of embryos transferred, and showed that incidence of low birth weight in singletons correlates with number of embryos transferred. Meanwhile, several studies have shown increased weight of singletons born after frozen embryo transfers compared with fresh embryo transfers. A recent study published by Sekhon et al., among others, disputes these findings...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Individualized luteal phase support
Purpose of review The aim of this review is to summarize the different aspects of luteal phase deficiency in IVF treatment and the possibilities of individualized luteal phase support. Recent findings After the application of human chorionic gonadotrophin (hCG) for final oocyte maturation, the vaginal route for progesterone administration is sufficient to maintain an adequate luteal phase support. New data point toward the possibility of oral medication; however, those data have yet to be confirmed in larger studies. Luteolysis after gonadotropinrealzing hormone (GnRH) agonist trigger is patient specific and not alway...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Fertility preservation options for transgender and gender-nonconforming individuals
Purpose of review To provide an overview of the current state of knowledge of fertility risks of gender-affirming therapy, review fertility preservation options for transgender individuals and ways to minimize gender dysphoria during fertility treatment, and identify gaps in knowledge. Recent findings Recent studies have corroborated older data that gender-affirming hormone therapy creates histopathological changes in the gonads; however, the newer data suggests that some function of the gametes may be preserved. One study in transgender men reported successful in-vitro maturation of testosterone-exposed oocytes with ...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Endocrine and reproductive profile of boys and young adults conceived after ICSI
Purpose of review The impact of intracytoplasmic sperm injection (ICSI), on the reproductive health of the offspring is largely unknown. Here we provide a comprehensive overview of the endocrine and reproductive profile in boys and young male adults born after ICSI using ejaculated spermatozoa alleviating male factor infertility in their parents. Recent findings Levels of testosterone, anti-Müllerian hormone and inhibin B were found comparable in prepubertal and pubertal boys conceived by ICSI when compared with levels in boys conceived spontaneously. Also, at young adulthood, mean levels of reproductive hormones...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Treatment potential of bone marrow-derived stem cells in women with diminished ovarian reserves and premature ovarian failure
Purpose of review We review the techniques recently tested in both animal models and humans to provide a state-of-the-art on adult stem cell ovarian transplant to achieve ovarian rejuvenation in patients with diminished ovarian reserves. Recent findings As the firsts reports of spontaneous pregnancies achieved after bone marrow transplantation in oncologic women with primary ovarian insufficiency, increasing evidence supports the regenerative effects of stem cell-based therapies in the ovarian niche. Adult stem cells from several origins promote follicular development, increase ovarian local vascularization, increase ...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

A Strength, Weaknesses, Opportunities and Threats analysis on time lapse
Purpose of review The study of embryonic development through conventional microscopy has contributed significantly to the success of IVF. However, clinical pregnancy rates per transfer remain as low as 30% according to the latest records of European society if human reproduction and society if assisted reproduction. Considering the increased need to reduce the number of multiple pregnancies, the embryologist is required to improve embryo selection methods to reduce the number of embryos transferred and identify those with the highest implantation potential. This represents a big challenge considering that applying this s...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Diminished ovarian reserve versus ovarian aging: overlaps and differences
Purpose of review Diminished ovarian reserve, in general, implies a quantitative decline in the oocyte pool. However, whether this quantitative decline is necessarily accompanied by a qualitative decline, remains to be determined. Recent findings Studies of natural conception suggest that fecundity of women with a quantitative decline in ovarian reserve is similar to age-matched women with normal ovarian reserve. Data on rates of pregnancy loss and fetal chromosomal abnormality do not consistently suggest a decline in oocyte quality in women who has a lower ovarian reserve. In assisted reproductive technology (ART) cy...
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 16, 2019 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Application of next-generation sequencing for the diagnosis of fetuses with congenital heart defects
Purpose of review Congenital heart defects (CHDs) are the most common type of birth defects, and are thought to result from genetic–environmental interactions. Currently, karyotype and chromosomal microarray analyses are the primary methods used to detect chromosomal abnormalities and copy number variations in fetuses with CHD. Recently, with the introduction of next-generation sequencing (NGS) in prenatal diagnosis, gene mutations have been identified in cases of CHD. The purpose of this review is to summarize current studies about the genetic cause of fetal CHD, paying particular attention to the application of N...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Impact of preimplantation genetic testing for aneuploidy on obstetrical practice
Purpose of review To provide updated information on preimplantation genetic testing for aneuploidy (PGT-A), focusing on its implications on prenatal diagnostic approaches after transferal of mosaic aneuploid embryos. Recent findings PGT-A is a technology to screen for chromosome aneuploidy or major chromosome structural rearrangement in embryos before implantation using different cytogenetic analyses. PGT-A has been shown to reduce the negative effect of increasing maternal age on in-vitro fertilization (IVF) outcomes. PGT-A also encourages clinicians and patients to accept single embryo transfer after IVF-PGT-A to re...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Systemic lupus erythematosus in pregnancy: high risk, high reward
Purpose of review The aim of this study was to describe risks of systemic lupus erythematosus (SLE) in pregnancy and the importance of preconception counselling, medication optimization and close surveillance. Recent findings Advances in care for pregnant patients with SLE have led to improved obstetric outcomes, but maternal and foetal risks continue to be elevated. Conception during periods of disease quiescence and continuation of most medications decrease adverse pregnancy outcomes. Hydroxychloroquine (HCQ) appears protective against flares in pregnancy, neonatal congenital heart block and preterm birth. Summary ...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Recognizing maternal mental health disorders: beyond postpartum depression
Purpose of review Maternal mental health disorders, including anxiety and depression, are one of the most common obstetric complications, presenting in pregnancy and postpartum. Recent findings Maternal mental health disorders are associated with adverse maternal and neonatal outcomes. Screening women in pregnancy and postpartum for mental health disorders is key to early identification and treatment of anxiety and depression in the perinatal population. Although universal screening is now recommended by numerous professional organizations, rates of screening are low and often not performed with a validated screening ...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Magnesium sulfate use for fetal neuroprotection
Purpose of review The aim of this review is to describe the proposed mechanisms of action of magnesium sulfate for fetal neuroprotection, different dosing regimens of the drug that have shown benefit, and to review recent pharmacokinetic studies of the drug to better inform clinicians regarding expected benefits and remaining research questions. Recent findings Retrospective secondary analysis of the beneficial effects of antenatal magnesium sulfate trial database and prospective pharmacokinetic/pharmacodynamic modeling indicate magnesium sulfate administration for duration longer than 18 h, given within 12 h of d...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Neurological diseases in pregnancy
Purpose of review To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother–infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed. Recent findings Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Additionally, as more data is being published on medication safety ...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Maternal sepsis: new concepts, new practices
Purpose of review Sepsis is a leading cause of severe maternal morbidity and maternal death. As pregnancy-related sepsis can be difficult to recognize, clinicians should maintain a low threshold for early evaluation and treatment. Recent findings Definitions and treatment guidelines for maternal sepsis were recently revised in 2016 and 2017 by the Surviving Sepsis Campaign and WHO. Multiple clinical decision tools have been created to aid clinicians in early recognition and risk prediction for sepsis in obstetric populations, but currently, an optimal screening tool does not exist. Early recognition and urgent treatme...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Opioid prescribing after childbirth: overprescribing and chronic use
Purpose of review Overprescribing opioids contributes to the epidemic of drug overdoses and deaths in the United States. Opioids are commonly prescribed after childbirth especially after caesarean, the most common major surgery. This review summarizes recent literature on patterns of opioid overprescribing and consumption after childbirth, the relationship between opioid prescribing and chronic opioid use, and interventions that can help reduce overprescribing. Recent findings It is estimated that more than 80% of women fill opioid prescriptions after caesarean birth and about 54% of women after vaginal birth, althoug...
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - March 5, 2019 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Circulating tumor cells in metastatic breast cancer: clinical relevance and biological potential
Purpose of review The possibility of tumor dissemination through the blood system has been known for years. Circulating tumor cells (CTCs) are detectable in the peripheral blood of patients with early as well as metastatic breast cancer. The prognostic relevance of this biomarker has already been described. By the use of repeated blood sampling along the course of disease, CTCs can be monitored in terms of a regular ‘liquid biopsy’. This review aims to summarize recent research findings and actual ongoing clinical studies to demonstrate the actual and future relevance of CTCs in daily clinical routine. Recen...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Peter A. Fasching Source Type: research

Translational highlights in breast cancer research and treatment: recent developments with clinical impact
Purpose of review Over the last decades the time which is needed to translate a preclinical finding or idea in the clinic has reduced continuously. Especially but not only for breast cancer the number of tested drugs and targeted pathways have increased immensely. In addition, the introduction of immune-oncological treatments has further advanced the possibilities for future treatments. This review focuses on recent developments in the prevention and treatment of breast cancer including results from major clinical trials and recent conferences. Recent findings Many pathways involved in the progression or treatment of ...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Peter A. Fasching Source Type: research

Cyclin-dependent kinase 4/6 inhibitors: what have we learnt across studies, therapy situations and substances
Purpose of review Cyclin-dependent kinases (CDK) are key regulatory enzymes that control cell cycle and cell division. In the recent years, new therapeutic options selectively targeting CDK 4 and 6 have shown promising clinical activity in several solid tumors. Since 2015, three CDK 4/6 inhibitors have been approved for treatment of hormone receptor-positive HER2-negative metastatic breast cancer: palbociclib, ribociclib and abemaciclib. These drugs share a common mechanism of action and have been evaluated in studies with a similar design. The following review gives a clinical overview of the CDK 4/6 inhibitors in breas...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: BREAST CANCER: Edited by Peter A. Fasching Source Type: research

Single-cell sequencing in ovarian cancer: a new frontier in precision medicine
This article discusses the advances, applications and challenges of using single-cell RNA sequencing data in guiding treatment decisions for ovarian cancer. Recent findings Genetic heterogeneity is a hallmark of ovarian cancer biology and underlies treatment resistance. Defining the different cell types present within a single ovarian cancer is difficult, but could ultimately lead to improvements in diagnosis and treatment. Next-generation sequencing technologies have rapidly increased our understanding of the molecular landscape of epithelial ovarian cancers, but the majority of these studies are conducted on bulk samp...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Cell-based immunotherapy in gynecologic malignancies
Purpose of review To provide an update on cell-based immunotherapies in solid tumors particularly in gynecological cancers. Recent findings Improvements have been made in engineering T cells to overcome the immunosuppressive environment in ovarian cancer. Significant efforts are underway to create ‘off the shelf’ cell therapies which leverage natural killer (NK) cells and would not rely on engineering a patient's T cells. Summary Efforts to target solid tumors using cell-based therapies are expanding into cell types other than T cells (NK cells and macrophages) which may have a lower risk of significant...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Recent advances in gynecologic radiation oncology
Purpose of review Radiation has long been a primary treatment modality in locally advanced gynecologic carcinomas and a tool for palliation of metastatic disease. Here we review advances in imaging and radiation technologies and the corresponding clinical evolution of the role for radiation oncology in the treatment of gynecologic malignancies. Recent findings Advances in MRI are impacting diagnosis, radiation target delineation, planning, treatment delivery, and response assessment. The combination of MRI and PET-computed tomography (PET-CT) has the potential to significantly change treatment recommendations as compa...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Updates on adjuvant chemotherapy and radiation therapy for endometrial cancer
This article will provide an opinion on adjuvant treatment of stage I–III endometrial cancer based on existing and evolving evidence. Recent findings For early-stage (I and II) intermediate risk endometrial cancer, vaginal brachytherapy reduces the risk of locoregional relapse. Recent studies have investigated the use of chemotherapy in early stage, high-risk patient population, but did not demonstrate a survival benefit. As such, chemotherapy is only recommended for selected patients at high risk for distant recurrence. On the other hand, for stage III disease, chemotherapy has a well established role. A landmark...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Molecular characterization of endometrial cancer and therapeutic implications
Purpose of review The present article reviews genomic subtyping of endometrial carcinoma and new molecular markers with therapeutic and prognostic implications. Recent findings Endometrial cancer has historically been classified through histology into endometrioid (type 1) and nonendometrioid (type II, mainly serous) subtypes. Molecular classification through genomic analysis now allows for a major advance in characterization; four distinct subgroups have been identified: polymerase ε (POLE) ultramutated, microsatellite unstable, copy number low/microsatellite stable, and copy number high/'serous-like’. ...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Antibody–drug conjugates for ovarian cancer: current clinical development
Purpose of review Antibody drug conjugates (ADC) are a novel class of cancer therapeutics, delivering cytotoxic therapy directly to cancer cells, and show promise in the management of platinum-resistant ovarian cancer. Herein we summarize the ADC landscape currently in clinical study. Recent findings Mirvetuximab Soravtansine, IMGN853, is an ADC targeting the folate receptor alpha (FRα) and has demonstrated promising single agent activity and a favorable toxicity profile in FRα-positive, platinum-resistant, epithelial ovarian cancer (EOC). The antitumor effect is seen primarily in less heavily pretreated E...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Poly-ADP-ribosyl-polymerase inhibitor resistance mechanisms and their therapeutic implications
Purpose of review Poly-ADP-ribosyl-polymerase (PARP) inhibitors are an increasingly-utilized therapy in women with high-grade serous ovarian carcinoma, but tumor resistance to PARP inhibitor monotherapy is inevitable. Recent findings PARP inhibitors have been most studied in patients with breast and ovarian cancers associated with deleterious germline BRCA1 or BRCA2 mutations, though their role has expanded to include use as maintenance therapy in women with platinum-sensitive high-grade serous ovarian cancer due to the high propensity of such cancers to have defects in DNA repair by homologous recombination. As mecha...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Update in the use and evaluation of poly (ADP-ribose) polymerase inhibitors in epithelial ovarian cancer: current and pending clinical research
Purpose of review This review will provide an update of recently presented clinical data as well as discuss ongoing trials focused on the incorporation of poly (ADP-ribose) polymerase inhibitors (PARPi) into the treatment paradigm for ovarian cancer. Recent findings As of this publication, PARPi have indications in many parts of the globe as maintenance therapy following response to platinum-based chemotherapy in the setting of platinum-sensitive recurrence. In addition, in the United States, two PARPi have indications as monotherapy treatment for recurrent ovarian cancer in patients with a BRCA mutation and at least ...
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Editorial: The potential for precision medicine to improve care and speed the development of new treatments in breast and gynecologic malignancies
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - December 22, 2018 Category: OBGYN Tags: GYNECOLOGIC CANCER: 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 - December 22, 2018 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Expanding adolescent access to hormonal contraception: an update on over-the-counter, pharmacist prescribing, and web-based telehealth approaches
This article reviews innovations in contraceptive access. Recent findings The three biggest innovations are over-the-counter oral contraceptives (OTC-OCs), pharmacist-prescribing, and web-based telehealth platforms. In many countries, oral contraceptives are available OTC, and FDA trials for OTC-OCs are underway in the United States. Many states have passed legislation allowing pharmacists to prescribe contraceptives after a brief health screening. Web-based telehealth platforms also provide prescription contraceptive access. There is a small but growing body of literature that demonstrates young people's interest in, a...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: SPECIAL COMMENTARY Source Type: research

Evaluation and management of defecatory dysfunction in women
Purpose of review To summarize the current recommendations for the evaluation and management of defecatory dysfunction in women and highlight key relationships between defecatory dysfunction and other pelvic floor disorders, including pelvic organ prolapse, fecal incontinence, and voiding dysfunction. Recent findings Conservative measures including lifestyle modifications, pharmacotherapy, and biofeedback continue to be the mainstay of treatment with newer therapies emerging. Physiologic testing and/or radiologic imaging should be considered for those who fail conservative therapy or are clinically complex. Surgical m...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Pelvic floor disorders in women with gynecologic malignancy
This article serves as an update on issues relating to the intersection of pelvic floor disorders and gynecology oncology. Recent findings Gynecologic cancer survivors experience pelvic floor disorders (PFDs) at a higher rate than their age-matched peers, often because of shared risk factors and as sequelae of cancer treatment. Concomitant pelvic floor and oncologic surgery can serve as a method to promote quality of life. Studies have demonstrated concomitant surgery to be well tolerated in appropriately selected patients, but only about 2% of oncologic surgeries are coordinated to include the treatment of PFDs. Conver...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Cystoscopy at the time of incontinence and prolapse surgery
This article provides an update on the use of cystoscopy at the time of prolapse and incontinence surgery. Recent findings Iatrogenic lower urinary tract injury is a known complication of antiincontinence procedures and surgical repair of pelvic organ prolapse. Intraoperative cystoscopy improves detection of lower urinary tract injuries in women undergoing pelvic floor surgery. The pelvic surgeon has a number of agents available to aid in the cystoscopic visualization of ureteral efflux. When injuries of the urinary tract are identified and treated intraoperatively, there is decreased morbidity, lower healthcare costs, ...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Ergonomics in gynecologic surgery
Purpose of review Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and result in significant disability. We aimed to review the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations of gynecologic surgery. Recent findings Surgeon WMSDs are prevalent, with rates ranging from 66 to 94% for open surgery, 73–100% for conventional laparoscopy, 54–87% for vaginal surgery, and 23–80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparo...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Family planning as a contributor to environmental sustainability: weighing the evidence
Purpose of review To highlight recent evidence that family planning, readily accessible to all who seek it and exercised as a human right, can contribute to environmental sustainability. As global concern increases about the health of our planet, better understanding of the role family planning programs play in maintaining a sustainable environment could bolster public and policymaker support for access to family planning. Recent findings A recent Worldwatch Institute review of scientific literature (FPESA) exploring this relationship covered two potential cause–effect pathways: one demographic, one personal. Al...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Advances in the management of early pregnancy loss
Purpose of review To describe recent advances in management of early pregnancy loss. Recent findings Addition of mifepristone to current protocols for medical management of miscarriage increases effectiveness of a single dose of misoprostol and significantly reduces subsequent aspiration procedures. Women with an incomplete evacuation after medical management may be treated expectantly with similar rates of complete expulsion compared with surgical management at 6 weeks. As cytogenetic analysis improves, analysis of products of conception can be performed whether collected after surgical or medical management and is a...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Health outcomes associated with use of hormonal contraception: breast cancer
Purpose of review To review recent literature on health outcomes associated with use of hormonal contraception with a focus on breast cancer. Recent findings A large cohort study documented an increased risk of breast cancer among hormonal contraceptive users compared to those who had never used hormonal contraception. The overall relative risk of breast cancer among current or recent users was 1.2 [95% confidence interval (CI), 1.14–1.26]. Overall, this translates into one additional case of breast cancer for every 7690 users of hormonal contraception. Recent publications have also documented a decrease in risk...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

The patient perspective: perceptions of the quality of the abortion experience
Purpose of review Abortion services are essential in sexual and reproductive health and should be held to the same standards as other health services. Patient (or person)-centeredness is a key dimension of healthcare quality that incorporates the perspectives of patients in care provision. The purpose of this review is to summarize studies published in the last year examining women's experiences with abortion care and to describe facilitators and barriers to person-centered care. Recent findings Considering person-centeredness in abortion care using dimensions of dignity, autonomy, privacy, communication, social suppo...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Pericoital contraception
Purpose of review To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception. Recent findings Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data. Summary Repeat pericoital dosing of 1.5-mg LNG is approximately as effect...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Abortion through telemedicine
Purpose of review Medical abortion offers a well tolerated and effective method to terminate early pregnancy, but remains underutilized in the United States. Over the last decade, ‘telemedicine’ has been studied as an option for medical abortion to improve access when patients and providers are not together. A number of studies have explored various practice models and their feasibility as an alternative to in-person service provision. Recent findings A direct-to-clinic model of telemedicine medical abortion has similar efficacy with no increased risk of significant adverse events when compared with in-per...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Developments in family planning and abortion care: from the personal to the planetary
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Vasa previa: prenatal diagnosis and management
Purpose of review Vasa previa is a rare disorder of placentation associated with a high rate of perinatal morbidity and mortality when undetected before delivery. We have evaluated the recent evidence for prenatal diagnosis and management of vasa previa. Recent findings Around 85% of cases of vasa previa have one or more identifiable risk factors including in-vitro fertilization, multiple gestations, bilobed, succenturiate or low-lying placentas, and velamentous cord insertion. The development of standardized prenatal targeted scanning protocols may improve perinatal outcomes. There is no clear consensus on the optima...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

The challenge of cardiomyopathies and heart failure in pregnancy
Purpose of review To discuss the risk preexisting or new onset cardiomyopathy/heart failure (CMP/heart failure) in pregnant woman, and recent insights regarding their management and therapy. Recent findings Recent data from the European Registry on Pregnancy and Heart disease of the European Society of Cardiology (ROPAC) suggest that, after an adequate prepregnancy evaluation in specialized centres, the vast majority of pregnancies are safe for both mother and foetus. A tailored approach is required according to cardiac phenotype (i.e. type of cardiomyopathy), clinical and functional status, and new potential treatmen...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

The role of ultrasound in the evaluation of acute pelvic pain in pregnancy and postpartum period: a review
Purpose of review Acute pelvic pain in pregnant and postpartum patients presents diagnostic and therapeutic challenges. Ultrasound remains the primary imaging modality of choice for assessing pregnant and postpartum women. The purpose of this review is to help practitioners ensure a correct diagnosis of acute pelvic pain in pregnancy and the postpartum period. Recent findings This review describes the various causes and highlights the sonographic features and characteristics of acute pelvic pain in pregnancy and the postpartum period. Summary Evaluation of acute pelvic pain in pregnancy and the postpartum period is...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Obesity and abnormal glucose tolerance in the offspring of mothers with diabetes
Purpose of review Type 2 diabetes and obesity during childhood, puberty, and adulthood have become more common. This trend presents a global problem in terms of public health and health economics. Associations between intrauterine exposure to hyperglycemia, obesity, and abnormal glucose tolerance (AGT) in offspring have been reported in populations at high risk of diabetes such as Pima Indians, but these associations have not been established in other groups. In this review, we summarize the evidence on obesity and AGT in the offspring of mothers with diabetes. Recent findings Although there are many reports indicatin...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Antenatal treatment options for primary cytomegalovirus infections
In this study, the transmission rate was 2.5%, which is significantly less than expected. Leruez-Ville et al. treated mothers with known transmission of CMV to the fetus with 8 g of valaciclovir daily. They observed a significant reduction in the number of neonatal symptoms in the treated cases. Summary Protocols are available to prevent primary CMV infections during pregnancy and, in cases where an infection does occur, steps can be taken to reduce its effect on the fetus thereby reducing the chance of long-term sequelae. (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Clinical significance of cerebroplacental ratio
Purpose of review Two-thirds of the pregnancies complicated by stillbirth demonstrate growth restriction. Identification of the foetus at risk of growth restriction is essential to reduce the risk of stillbirth. The aim of this review is to critically appraise the current evidence regarding clinical utility of cerebroplacental ratio (CPR) in antenatal surveillance. Recent findings The CPR has emerged as an assessment tool for foetuses at increased risk of growth disorders. CPR is a better predictor of adverse events compared with middle-cerebral artery or umbilical artery Doppler alone. The predictive value of CPR for...
Source: Current Opinion in Obstetrics and Gynecology - November 9, 2018 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research