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Best Practice & Research. Clinical Obstetrics & Gynaecology

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https://www.readbyqxmd.com/read/28202331/genetics-of-gynaecological-cancers
#1
REVIEW
Panayiotis Constantinou, Marc Tischkowitz
Gynaecological cancers accounted for 16.3% of all cancers and 13.9% of all cancer deaths in women globally in 2012. Cancer of the cervix is the most common gynaecological cancer, followed by cancers of the uterus and the ovary. Although cervical cancer is almost exclusively triggered by human papilloma virus infection, approximately 5% of all uterine cancers and 20% of all ovarian cancers are caused by germline mutations in cancer predisposition genes. A number of genetic syndromes are associated with rarer gynaecological tumours...
January 24, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28215395/microarrays-in-prenatal-diagnosis
#2
REVIEW
Beatrice Oneda, Anita Rauch
In prenatal diagnosis, chromosomal microarray (CMA) has not yet fully replaced conventional karyotyping but has rapidly become the recommended test in pregnancies with ultrasound abnormalities. In this review, we provide an overview of the published data concerning this technology and the controversies concerning its use in the prenatal setting. There is abundant evidence indicating the added detection of pathogenic abnormalities with CMA in comparison to the traditional karyotyping, especially in fetuses with multiple or isolated ultrasound abnormalities such as congenital heart disease, increased nuchal translucency, or oral cleft...
January 23, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28202330/ethical-issues-in-cesarean-delivery
#3
REVIEW
Frank A Chervenak, Laurence B McCullough
Cesarean delivery is the most common and important surgical intervention in obstetric practice. Ethics provides essential guidance to obstetricians for offering, recommending, recommending against, and performing cesarean delivery. This chapter provides an ethical framework based on the professional responsibility model of obstetric ethics. This framework is then used to address two especially ethically challenging clinical topics in cesarean delivery: patient-choice cesarean delivery and trial of labor after cesarean delivery...
January 23, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28190696/ethical-issues-in-research
#4
REVIEW
Raul Artal, Sheldon Rubenfeld
Biomedical research is currently guided by ethical standards that have evolved over many centuries. Historical and political events, social and legal considerations, and continuous medical and technological advances have led to the prevailing research ethics and practice. Currently, patients and research subjects have complete autonomy while under medical care or when volunteering as research subjects. Enrolling volunteers in human subjects research includes a detailed and meaningful informed consent process that follows the cardinal principles of ethics: autonomy, beneficence, nonmaleficence, and justice...
January 23, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28190695/ethical-dimensions-of-the-fetus-as-a-patient
#5
REVIEW
Frank A Chervenak, Laurence B McCullough
In this chapter, we present an account of the ethical concept of the fetus as a patient to guide clinical judgment and decision-making in the obstetrician-patient relationship. We explicate this concept and explore its clinical implications on the basis of the professional responsibility model of obstetric ethics. We will emphasize a preventive ethics approach, which is based on the recognition of the potential for ethical conflict in patient care and adopts ethically justified strategies to prevent those conflicts from occurring...
January 23, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28209376/-ethics-surrounding-the-provision-of-abortion-care
#6
REVIEW
Anibal Faúndes, Laura Miranda
The provision of abortion care represents a great ethical challenge to physicians, particularly in countries where the law states that abortion is a crime. The concept that it is a crime carries a stigma that is worse than that associated with other acts qualified by law as crimes. This stigma leads to at least two different kinds of unethical behavior. One is the refusal to provide safe abortion services to women who comply with the legal requirements, alleging conscientious objection, and the other is to discriminate against women with complications of induced abortion...
January 20, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28169130/the-history-and-use-of-the-progesterone-receptor-modulator-ulipristal-acetate-for-heavy-menstrual-bleeding-with-uterine-fibroids
#7
REVIEW
Philippe Bouchard, Nathalie Chabbert-Buffet
Progesterone receptor modulators (PRM) or selective progesterone receptor modulators have two remarkable effects in treated women. They considerably suppress endometrial bleeding by incompletely understood mechanisms, and when administered in women with symptomatic fibroids, they produce a significant and potentially long-term decrease in fibroid volume. The crucial advantage of this therapy lies with the absence of suppression of ovarian oestrogen secretion, which is in contrast to GnRH agonists. Long-term treatments have proven to be useful, especially in women approaching the menopausal transition...
December 18, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28111228/targeted-therapies-for-ovarian-cancer
#8
REVIEW
Tami Grunewald, Jonathan A Ledermann
Epithelial ovarian cancer has the highest mortality rate of all gynaecological malignancies. Most women present with advanced disease and develop a recurrence after radical surgery and chemotherapy. Improving the results of first- or subsequent-line chemotherapy has been slow, and novel approaches to systemic treatment are needed. Ovarian cancer is a heterogeneous disease with complex molecular and genetic changes. Understanding these better will provide information on the mechanisms of resistance and opportunities to target therapy more rationally, exploiting specific changes in the tumour...
December 8, 2016: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27890718/thalassaemia-screening-and-confirmation-of-carriers-in-parents
#9
REVIEW
Angela N Barrett, Ramasamy Saminathan, Mahesh Choolani
Haemoglobinopathies are among the most common inherited monogenic disorders worldwide. Thalassaemia screening for carrier status is recommended for adults of reproductive age if suspected of being at risk. Conventional laboratory methods for screening include the assessment of haematological indices, and high-performance liquid chromatography, capillary electrophoresis or isoelectric focusing to measure the levels of HbA2 and HbF, and to identify haemoglobin variants. Each screening method has its advantages and disadvantages, the main disadvantage being that none can fully resolve all variants...
February 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27889305/invasive-prenatal-diagnosis-of-fetal-thalassemia
#10
REVIEW
Dong-Zhi Li, Yan-Dong Yang
Thalassemia is the most common monogenic inherited disease worldwide, affecting individuals originating from many countries to various extents. As the disease requires long-term care, prevention of the homozygous state presents a substantial global disease burden. The comprehensively preventive programs involve carrier detections, molecular diagnostics, genetic counseling, and prenatal diagnosis. Invasive prenatal diagnosis refers to obtaining fetal material by chorionic villus sampling (CVS) at the first trimester, and by amniocentesis or cordocentesis at the second trimester...
February 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27887921/non-invasive-prenatal-diagnosis-of-thalassemias-using-maternal-plasma-cell-free-dna
#11
REVIEW
Irena Hudecova, Rossa W K Chiu
Non-invasive prenatal testing (NIPT) using maternal plasma cell free DNA has already reshaped the existing prenatal care system for pregnancies screened for common chromosomal aneuploidies. On the other hand, much progress has been made in developing NIPT for monogenic diseases. Thalassemia served as a disease model to develop strategies for NIPT of monogenic traits. One approach focuses on the detection or exclusion of paternally inherited fetal mutations that are absent from the mother's genome. The assessment of maternally inherited mutations in maternal plasma requires the use of highly sensitive DNA quantification techniques...
February 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27940123/an-integrated-approach-to-fetal-growth-restriction
#12
REVIEW
Francesc Figueras, Eduard Gratacos
Fetal growth restriction (FGR) is among the most common complications of pregnancy. FGR is associated with placental insufficiency and poor perinatal outcomes. Clinical management is challenging because of variability in clinical presentation. Fetal smallness (estimated fetal weight <10th centile for gestational age) remains the best clinical surrogate for FGR. However, it is commonly accepted that not all forms of fetal smallness represent true FGR. In a significant subset of small fetuses, there is no evidence of placental involvement, perinatal outcomes are nearly normal, and they are clinically referred to as "only" small for gestational age (SGA)...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27923540/fetal-cytomegalovirus-infection
#13
REVIEW
Marianne Leruez-Ville, Yves Ville
Cytomegalovirus (CMV) congenital infection affects 0.7% of live births worldwide and is the leading cause of congenital neurological handicap of infectious origin. However, systematic screening for this infection has not been implemented in pregnancy or at birth in any country. This apparent paradox had been justified by persisting gaps in the knowledge of this congenital infection: uncertain epidemiological data, difficulty in the diagnosis of maternal infection, absence of validated prenatal prognostic markers, unavailability of an efficient vaccine and scarcity of data available on the treatment...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27894704/antenatal-fetal-surveillance-in-multiple-pregnancies
#14
REVIEW
Dick Oepkes, Marieke Sueters
Multiple pregnancies occur either spontaneously or because of assisted reproduction techniques in 1-3% of pregnancies. The presence of more than one fetus in the womb is associated with a range of possible complications, both for the mother and fetuses. Early detection of these complications followed by timely and appropriate management will reduce the risk of adverse outcomes. The techniques, skills, and experience for timely detection of complications and managing them appropriately require sufficient training and exposure...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27866937/antenatal-foetal-heart-monitoring
#15
REVIEW
Henry Murray
Antenatal foetal heart rate assessment was introduced into clinical medicine before clear evidence of any benefits had been reported. Ad hoc definitions were used to define normal and abnormal recordings resulting in a high false-positive rate for foetal compromise. The understanding of the foetal states resulted in an improved physiologically based assessment of the antenatal tracings and allowed their classification as (i) reactive - 2 accelerations in 10 min within a recording period of 120 min, (ii) unreactive - no accelerations seen in 120 min of tracing and (iii) decelerative - the presence of repetitive decelerations on an otherwise unreactive trace...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27838189/preface
#16
EDITORIAL
Asma Khalil, Basky Thilaganathan
No abstract text is available yet for this article.
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27756534/antenatal-fetal-surveillance-assessment-of-the-afv
#17
REVIEW
Dawn S Hughes, Everett F Magann
The evaluation of amniotic fluid volume (AFV) is an established part of the antenatal surveillance of pregnancies at risk for an adverse pregnancy outcome. The two most commonly used ultrasound techniques to estimate AFV are the amniotic fluid index (AFI) and the single deepest pocket (SDP). Four studies have defined normal AFVs, and although their normal volumes have similarities, there are also differences primarily due to the statistical methodology used in each study. Dye-determined AFV correlates with ultrasound estimates for normal fluid volumes but correlates poorly for oligohydramnios and polyhydramnios...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27729208/screening-and-prevention-of-stillbirth
#18
REVIEW
Gordon C S Smith
Stillbirth is delivery of a baby at or after 24 weeks of gestational age (UK definition) not showing any signs of life. It affects almost one in 200 pregnancies and is the single major cause of perinatal death. Stillbirth is associated with a wide range of maternal demographic characteristics, but most of the variations in stillbirth risk are independent of these characteristics. Stillbirth is the end point of multiple processes, but the single most common cause is probably placental dysfunction. Stillbirth is associated with a wide range of biochemical and ultrasonic predictors, but there is limited evidence to support population-based screening...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27727018/macrosomia
#19
REVIEW
Edward Araujo Júnior, Alberto Borges Peixoto, Ana Cristina Perez Zamarian, Júlio Elito Júnior, Gabriele Tonni
Fetal macrosomia is defined as birth weight >4000 g and is associated with several maternal and fetal complications such as maternal birth canal trauma, shoulder dystocia, and perinatal asphyxia. Early identification of risk factors could allow preventive measures to be taken to avoid adverse perinatal outcomes. Prenatal diagnosis is based on two-dimensional ultrasound formulae, but accuracy is low, particularly at advanced gestation. Three-dimensional ultrasound could be an alternative to soft tissue monitoring, allowing better prediction of birth weight than two-dimensional ultrasound...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/27720309/role-of-uteroplacental-and-fetal-doppler-in-identifying-fetal-growth-restriction-at-term
#20
REVIEW
Asma Khalil, Basky Thilaganathan
Identification of the fetus at risk of adverse outcome at term is a challenge to both clinicians and researchers alike. Despite the fact that fetal growth restriction (FGR) is a known risk factor for stillbirth, at least two thirds of the stillbirth cases at term are not small for gestational age (SGA) - a commonly used proxy for FGR. However, the majority of SGA fetuses are constitutionally small babies and do not suffer from adverse perinatal outcome. The cerebroplacental ratio (CPR) is emerging as a marker of failure to reach growth potential at term...
January 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
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