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Predicting fetoplacental mosaicism during cfDNA-based NIPT
Purpose of review Cell-free DNA-based noninvasive prenatal testing (cfDNA-based NIPT) using maternal blood is highly sensitive for detecting fetal trisomies. However, false-positive and false-negative results can occur, which prevents NIPT from being a diagnostic test. Fetoplacental mosaicism is one of the main reasons for discordant test results. It is therefore important to understand this phenomenon to enable more comprehensive and appropriate genetic counselling. The present review aims to summarize the current knowledge of fetoplacental mosaicism ascertained during cfDNA-based NIPT and refers to the development of r...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Fetal surgery and stem cell therapy for meningomyelocele
Purpose of review To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). Recent findings Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single ...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

A review of the intriguing interaction between testosterone and neurocognitive development in males with 47,XXY
Purpose of review Although 47,XXY (Klinefelter syndrome) was first discovered more than 50 years ago, there have been limited comprehensive studies on this disorder. The present review explains the study of neurodevelopmental dysfunction and the impact of testosterone replacement at specific junctions in the life of males with 47,XXY. The intricate relationship between testosterone, neurodevelopment, health, and well being warrants an in-depth investigation in order to achieve optimal outcomes. Recent findings Current literature suggests that the implementation of biological treatment has a positive impact on numerous...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Genetic counseling for fetal gastrointestinal anomalies
Purpose of review Congenital gastrointestinal anomalies are common findings with relatively established methods of treatment. However, the genetic cause of how these defects occur and how that may impact a child's lifelong care is less established. Genetic testing has improved significantly in recent years, yet reviews documenting prenatal genetic counseling and testing guidelines have not been comprehensively updated. Recent findings Congenital anomalies of the foregut, such as tracheoesophageal fistula carry a high association with genetic disorders, both in isolation and syndromic forms. Duodenal atresia remains hi...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

From screening chromosomal anomalies to early diagnosis of fetal malformations
Purpose of review The aim of this review is to understand why and how to improve the detection rate of the fetal anomalies in the first trimester. Recent findings The role of the first trimester is evolving from aneuploid and basic anatomical screening to a necessary tool to identifying early fetal malformations. In the past 20 years, several studies were conducted to assess the detection rate of anomalies in the first trimester, and despite the improvement in the diagnoses of spina bifida and cleft lip, many anomalies detectable in the first trimester are still being diagnosed in the second trimester scan. Analyzing ...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

New approaches to congenital diaphragmatic hernia
Purpose of review Congenital diaphragmatic hernia (CDH) is a structural birth defect that results in significant neonatal morbidity and mortality. CDH occurs in 2–4 per 10 000 pregnancies, and despite meaningful advances in neonatal intensive care, the mortality rate in infants with isolated CDH is still 25–30%. In this review, we will present data on the molecular underpinnings of pathological lung development in CDH, prenatal diagnosis, and prognostication in CDH cases, existing fetal therapy modalities, and future directions. Recent findings Developments in the prenatal assessment and in-utero therapy of pregna...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Enhanced recovery after surgery for cesarean delivery
Purpose of review The aim of this article is to describe enhanced recovery after surgery (ERAS) and its application to cesarean delivery. Recent findings ERAS is a standardized, multidisciplinary approach to improving the care of surgical patients, from the preoperative planning through the surgery and postoperative period. ERAS is associated with many benefits, including improved patient outcomes and satisfaction as well as reduced length-of-stay and cost. Obstetric implementation of ERAS protocols has lagged compared to other surgical subspecialties. Given the volume of cesarean deliveries worldwide, improving the q...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Induction of labor with an unfavorable cervix
Purpose of review Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may take several days. In this review, we focus on the efficacy and safety of methods of labor induction for the unfavorable cervix. Recent findings Recent evidence on the use of mechanical cervical preparation with transcervical balloons suggests balloons are the most effective option for decreasing time to delivery in the nulliparous patient. Single and double balloons are equally effective, with a volume of more 30 ml being more effecti...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 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 3, 2020 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Prognostic and predictive markers for adjuvant therapy
Purpose of review To avoid both overtreatment and undertreatment accurate risk assessment is mandatory. The present review gives an overview of recently published articles covering prognostic and predictive factors for adjuvant therapy in early breast cancer. Recent findings Gene expression signatures enhance prognostic accuracy with a high level of evidence. These signatures can be further improved by incorporating traditional pathological factors like tumor size. Newer genomic techniques like next-generation sequencing lead to a deeper understanding of the relationship between somatic mutations and prognosis or pred...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: BREAST CANCER: Edited by Michael Untch Source Type: research

Breast and axillary surgery in malignant breast disease: a review focused on literature of 2018 and 2019
Purpose of review There have been fundamental changes in the surgical approach to breast cancer management over the last decades. The primary objective of achieving locoregional control, however, remains unchanged. Recent findings In addition to strategies optimizing systemic treatment and radiotherapy, current discussions focus on improving the surgical approach to breast cancer. Especially in view of the increasingly pivotal role of neoadjuvant chemotherapy NAT/NAC (NACT), gauging the extent of tissue removal in the breast and the width of resection margins in breast-conserving surgery is highly important, as is the...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: BREAST CANCER: Edited by Michael Untch Source Type: research

Biomarkers that may predict response to immunotherapy in ovarian malignancies
Purpose of review Immune checkpoint blockade (ICB) is a promising area of cancer therapeutic research. Therapies targeting the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) mechanism of tumor immune evasion have resulted in durable responses in many difficult-to-treat tumor types. While these inhibitors are being actively investigated in clinical trials for ovarian cancer, most patients fail to respond to initial treatment with immune therapy. This review focuses on biomarkers for predicting response to treatment, and discusses clinical trials using ICB for recurrent ovarian cancer. Recent fin...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 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 molecular subtyping and genomic characterization of endometrial carcinoma, and the associated therapeutic and prognostic implications. Recent findings Endometrial cancer has historically been classified through histology into endometrioid and nonendometrioid subtypes with poor prognostic predictability. Molecular classification through genomic analysis now allows for a major advance in characterization. Four distinct subgroups have been identified: polymerase (POLE) ultramutated, microsatellite unstable, copy number-low--microsatellite stable, and copy number-high—‘ser...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Symptom relief and palliative care in gynecologic oncology
Purpose of review Patients with gynecologic malignancies experience varied and often difficult-to-manage symptoms through their disease course, along with decisions surrounding preferences for advance care planning. This review focuses on evidence-based symptom management for these patients and offers a framework for conversations regarding goals of therapy. Recent findings There is increasing literature on palliative care specifically in gynecologic oncology, including barriers and possible solutions for early palliative care use, along with updated guidelines on postoperative pain management and tools for communicat...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Targeting human epidermal growth factor receptor 2 (HER2) in gynecologic malignancies
Purpose of review The purpose of this review is to describe the role of the human epidermal growth factor receptor 2 (HER2) as a biomarker and potential target in gynecologic malignancies and to describe contemporary updates in the use of anti-HER2 treatments for these cancers. Recent findings Approximately 25–30% of all patients with uterine serous carcinoma overexpress tumoral HER2. The anti-HER2 antibody trastuzumab represents an effective, targeted therapy with significant efficacy in the treatment of HER2-positive breast and gastric cancer. Recently, trastuzumab efficacy has also been demonstrated in a randomiz...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research