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Best Practice & Research. Clinical Obstetrics & Gynaecology

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https://www.readbyqxmd.com/read/29128205/endometrial-ablation
#1
REVIEW
Malcolm G Munro
Endometrial ablation (EA) includes a spectrum of procedures performed with or without hysteroscopic direction, designed to destroy the endometrium for the treatment of the symptom of heavy menstrual bleeding (HMB) secondary to a spectrum of causes, but most commonly those that are endometrial in origin (AUB-E) or ovulatory disorders (AUB-O). Resectoscopic endometrial ablation (REA) is often mistakenly referred to as the "first generation" technique, while proprietary devices that do not use the resectoscope (nonresectoscopic EA or NREA) are often misperceived as "second generation" devices...
October 20, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29126743/benign-and-malignant-pathology-of-the-uterus
#2
REVIEW
V Tanos, K E Berry
The diagnosis of a uterine myoma size and location can be very precise when a 3D sonograph and knowledge are available. The majority of fibroids are asymptomatic, and expectant management is recommended. In young patients, fibroids cause infertility and in middle-aged women, abnormal uterine bleedings. Laparoscopic myomectomy is the preferred way of surgery for IM and SS fibroids, versus hysteroscopy for SM fibroids. In both cases, the size, number of fibroids and the surgeon's experience determine the limitations of the MIGS...
October 16, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29089184/patient-counselling-and-consent
#3
REVIEW
Akanksha Sood, Janesh Gupta
To the patient, illness entails not only the physical discomfort but all the psychological, social and emotional ramifications. Patient autonomy and choice are now an integral part of patient care pathways. There has been a steady shift in patient counselling and consent towards supporting patient autonomy over medical paternalism. Patients should be the prime decision makers but they can only do this if they are fully informed. The ultimate and desired goal for the health care teams is to provide a high quality clinical service, which is consistent with evidence based guidelines...
October 13, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29078976/abnormal-uterine-bleeding-including-coagulopathies-and-other-menstrual-disorders
#4
REVIEW
Efthimios Deligeoroglou, Vasileios Karountzos
Abnormal Uterine Bleeding (AUB) is a frequent cause of visits to the emergency department and a major reason for concern among adolescents and their families. The most common cause of AUB, in otherwise healthy adolescents, is ovulatory dysfunction, although 5-36% of adolescents who present with heavy menstrual bleeding, have an underlying bleeding disorder (BD). The most common form of BDs is von Willebrand Disease, reflecting 13% of adolescents with AUB. Management of AUB depends on the underlying etiology, the bleeding severity, as well as the need for hospitalization...
October 9, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29074037/high-intensity-focused-ultrasound-therapy
#5
REVIEW
Vincent Y T Cheung
High-intensity focused ultrasound therapy has received increasing interest in the management of benign uterine tumors. Either magnetic resonance or ultrasound imaging has been used to target and monitor the ablation process. This article provides an overview of the background, clinical use, treatment outcomes, and safety of high-intensity focused ultrasound in the treatment of uterine fibroids and adenomyosis, including a summary of clinical trials comparing magnetic resonance- or ultrasound-guided high-intensity focused ultrasound with other minimally invasive or surgical interventions...
October 3, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29054502/epidemiology-and-risk-factors-of-uterine-fibroids
#6
REVIEW
Dora Pavone, Sara Clemenza, Flavia Sorbi, Massimiliano Fambrini, Felice Petraglia
Risk factors, both modifiable and non-modifiable, are associated with the development of fibroids. These include age, race, endogenous and exogenous hormonal factors, obesity, uterine infection, and lifestyle (diet, caffeine and alcohol consumption, physical activity, stress, and smoking). Some of the epidemiological data were conflicting; consequently, further studies are needed to better understand the factors that influence fibroid prevalence.
October 1, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29122490/robot-assisted-laparoscopy-in-benign-gynecology-advantageous-device-or-controversial-gimmick
#7
REVIEW
Obianuju Sandra Madueke-Laveaux, Arnold P Advincula
The growth of robot-assisted laparoscopic surgery has been exponential since its FDA approval for use in gynecologic surgery in the spring of 2005; however, controversy surrounding its use has been associated with this rise in utilization. Much of this discussion has pitted the conventional laparoscopist against the robotic surgeon particularly as it relates to issues such as operative time, costs, and the current scientific evidence. Although drawbacks exist in robotic technology, there are also clear and obvious advantages that are difficult to quantify in the scientific literature but evident to users...
September 30, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29128204/uterine-artery-embolization-a-review-of-current-concepts
#8
REVIEW
Jonathan J Keung, James B Spies, Theresa M Caridi
Uterine artery embolization (UAE) has gained traction as a safe and effective treatment modality for symptomatic uterine leiomyomata since its introduction nearly two decades ago. This review includes an overview of current concepts with regard to patient selection, technique, and outcomes following UAE. Specific topics also include the impact of this procedure on fertility and pregnancy, the emerging role of UAE in the treatment of adenomyosis, and how UAE compares with surgical intervention for the treatment of symptomatic leiomyomata...
September 29, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29103894/robot-assisted-myomectomy
#9
REVIEW
Celine Lonnerfors
Uterine fibroids are the most common tumors of the uterus and the female pelvis and are associated with substantial morbidity for several women. In women with a wish to preserve fertility, a myomectomy is the surgical procedure of choice when medical therapy is inadequate. Despite evidence that minimally invasive surgery is preferable to laparotomy, most myomectomies are still performed by laparotomy. Robotic surgery was introduced to overcome some of the difficulties associated with laparoscopic surgery. A myomectomy is a suture-intensive surgery where the properties of a surgical robot have been suggested to be of particular value...
September 29, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29078975/laparoscopic-myomectomy-and-morcellation-a-review-of-techniques-outcomes-and-practice-guidelines
#10
REVIEW
Laura M Glaser, Jaclyn Friedman, Susan Tsai, Angela Chaudhari, Magdy Milad
Laparoscopic myomectomy is a minimally invasive surgical approach to treat symptomatic uterine fibroids in women wishing for a uterine-sparing procedure. With careful patient selection, these procedures are associated with favorable reproductive outcomes and low perioperative morbidity. Current available methods for specimen retrieval include power and hand morcellation. The 2014 FDA safety warnings regarding power morcellation arose from concerns about the spread of occult malignancy and prompted widespread use of containment systems that may limit spread of myometrial cells...
September 29, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29117923/genital-injuries-acute-evaluation-and-management
#11
REVIEW
Heather N Lopez, Mariel A Focseneanu, Diane F Merritt
Genital trauma may result in external injuries to the labia, vulva or vagina, urethra and anus and internal injuries to the bony pelvis, bladder, bowels and reproductive organs. Worldwide, the most common cause of genital trauma in reproductive age women is injury sustained during childbirth, but in this chapter we will focus on accidental genital injuries as well as those arising from sexual violence, and female genital mutilation. While genital injuries alone rarely result in death; if not properly managed, chronic discomfort, dyspareunia, infertility, or fistula formation may result...
September 28, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29108943/therapeutic-hpv-vaccines
#12
REVIEW
Gemma Hancock, Karin Hellner, Lucy Dorrell
High-risk human papillomavirus (HPV) infection is known to be a necessary factor for cervical and anogenital malignancies. Cervical cancers account for over a quarter of a million deaths annually. Despite the availability of prophylactic vaccines, HPV infections remain extremely common worldwide. Furthermore, these vaccines are ineffective at clearing pre-existing infections and associated preinvasive lesions. As cervical dysplasia can regress spontaneously, a therapeutic HPV vaccine that boosts host immunity could have a significant impact on the morbidity and mortality associated with HPV...
September 28, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29066045/medical-therapy-for-fibroids-an-overview
#13
REVIEW
Vikram Sinai Talaulikar
Uterine fibroids are the most common benign tumours in women of reproductive age group and are a cause of significant healthcare burden. Although surgical treatments have been the traditional gold standard for symptomatic uterine fibroids, several medical therapeutic approaches have been used to achieve symptom suppression in women who wish to preserve their uterus or are at elevated risk of complications during surgery. Medical therapies used for uterine fibroids include tranexamic acid, NSAIDs, contraceptive steroids, progesterone coil, GnRH analogues, aromatase inhibitors, SERMs and progesterone receptor modulators...
September 28, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29046244/endometrial-resection-and-global-ablation-in-the-normal-uterus
#14
REVIEW
S J Leathersich, P M McGurgan
There are various methods that can be used to destroy the endometrium as a treatment for menorrhagia. This chapter reviews the history, rationale, evidence, indications and long-term safety and efficacy of the current techniques. It also discusses endometrial ablation in the context of its clinical utility in comparison with existing alternative treatments.
September 28, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29032945/contraception-options-aspects-unique-to%C3%A2-adolescent-and-young-adult
#15
REVIEW
Dan Apter
Sexual health for adolescents is based on three components: recognizing sexual rights, sexuality education and counseling, and thirdly confidential high quality services. Contraception needs to include prevention of both STIs and pregnancies. The first option for adolescents is condoms backed-up by emergency contraception; and later hormonal contraceptives in a longer, mutually monogamous relationship. Condoms and hormonal contraception together can be well recommended for adolescents for dual protection. Long acting reversible contraception (LARC) including both intrauterine contraception and implants are safe and highly effective and thus well suited for adolescents...
September 28, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28988885/robotic-surgery-in-gynecology
#16
EDITORIAL
Hextan Y S Ngan, Peter C Lim
No abstract text is available yet for this article.
September 27, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/29030149/clinical-management-of-women-presenting-with-field-effect-of-hpv-and-intraepithelial-disease
#17
REVIEW
T S Adams, N H Mbatani
Anogenital human papillomavirus is the most common sexually transmitted infection acquired through skin-to-skin contact. Most infections are cleared by an intact immune system. Persistence of these infections results in precancerous lesions and, eventually, to cancers of the cervix, vagina, vulva, and perianal area. The introduction of the prophylactic human papilloma virus (HPV) vaccinations may reduce the incidence of these infections, but the effect of these vaccinations will be seen only in the decades that follow...
September 6, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28988647/secondary-prevention-of-cervical-cancer
#18
REVIEW
Partha Basu, Srabani Mittal, Diama Bhadra Vale, Youssef Chami Kharaji
Cervical cancer affects women in their reproductive ages. Screening is an important secondary prevention strategy. The long process of carcinogenic transformation from human papillomavirus (HPV) infection to invasive cancer provides ample opportunities to detect the disease at a stage when treatment is highly effective. Suitable screening tests are cytology, visual inspection after acetic acid application and HPV detection tests. Evidence of effectiveness of the tests to reduce cervical cancer mortality and the cost-effectiveness of screening programs have been demonstrated...
September 6, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28986092/population-based-hpv-vaccination-programmes-are-safe-and-effective-2017-update-and-the-impetus-for-achieving-better-global-coverage
#19
REVIEW
Julia M L Brotherton, Paul N Bloem
Persistent oncogenic human papillomavirus (HPV) is the cause of cervical cancer, as well as cancers of the anus, penis, vulva, vagina and oropharynx. There is good evidence that prophylactic HPV vaccines are immunogenic and effective against targeted-type HPV infections and type-specific genital lesions, including high-grade cervical intraepithelial neoplasia (CIN), when administered prior to HPV infection. There is good evidence that HPV vaccines are safe in population usage, with the most frequent adverse event being injection-site reactions...
September 6, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://www.readbyqxmd.com/read/28964706/the-natural-history-of-human-papillomavirus-infection
#20
REVIEW
Silvia de Sanjosé, Maria Brotons, Miguel Angel Pavón
Human papillomavirus (HPV) is a small double-stranded DNA virus that commonly infects humans. The oncogenic characteristics of HPV derive from the oncoproteins E6 and E7 that act inhibiting p53 and pRB tumor suppressors. About 5% of all cancers worldwide are attributable mainly to those known as high-risk, including HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. Infection with HPV is common after sexual initiation, but the majority of HPV infections do not cause symptoms or disease and are cleared within 12-24 months post-infection...
September 6, 2017: Best Practice & Research. Clinical Obstetrics & Gynaecology
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