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Best Practice & Research. Clinical Obstetrics & Gynaecology

Lauren Reschke, Ronald McCarthy, Erik D Herzog, Justin C Fay, Emily S Jungheim, Sarah K England
Circadian rhythms, endogenous and entrainable adaptations to 24-hour cycles of light and dark, influence almost all physiologic functions. Emerging evidence suggests that the disruption of normal circadian rhythms, termed chronodisruption, could affect a wide range of disease-related processes. In this review, we describe the molecular generation of circadian rhythms, the effects of chronodisruption on human health, the circadian timing of birth in multiple species, the possible effects of chronodisruption on preterm birth, and some of the open questions in this field...
August 20, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Carol Coughlan
Recurrent implantation failure (RIF) is very distressing for couples and frustrating for their clinicians who seek to find a solution. RIF is defined as the failure to achieve a clinical pregnancy following the transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman of age below 40 years. An agreed local protocol regarding how couples with RIF should be further investigated and managed should be in place. Ovarian function should be assessed by measuring antral follicle count, FSH, and AMH...
August 2, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Catharyn Stern, Franca Agresta
With improved survival rates from cancer, young people can expect to lead a normal life, including having their own children. However, cancer or other serious disease itself, and more often its treatment, often leads to a significant reduction in fertility or premature gonadal insufficiency. There is increasing acknowledgement for the importance of fertility preservation (FP) options to be discussed and offered to young people whose fertility is at risk, ideally before the gonadotoxic therapy begins. FP options currently include oocyte, embryo and ovarian tissue cryopreservation; ovarian protection during chemotherapy and semen, sperm and testicular tissue cryopreservation...
August 1, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Rachel Cutting
There is a global recognition of the need to reduce multiple pregnancies following assisted reproductive technology. Complications of multiple pregnancies can be simply avoided by replacing one embryo at a time. Most policies to reduce the number of double or higher order embryo transfers involve predicting which patients are at most risk by using a multiple birth minimisation strategy. These frequently consider factors such as patient age, previous treatments and embryo quality. However, with improvements in methods of embryo culture, embryo selection and cryopreservation, this chapter will question whether, at present, it is time to move to single embryo transfer (SET) for all...
July 31, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Urooza C Sarma, Jock K Findlay, Karla J Hutt
Folliculogenesis describes the process of activating an oocyte-containing primordial follicle from the ovarian reserve and its development to the mature ovulatory stage. This process is highly complex and is controlled by extra- and intra-ovarian signaling events. Oocyte competence and capacity for fertilization to support a viable pregnancy are acquired during folliculogenesis. Cancer and cancer-based therapies can negatively affect this process, compromising fertility. Currently, preservation of fertility in these patients remains limited to surrogacy, oocyte freezing, oocyte donation, or in vitro maturation (IVM)...
July 27, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Casey M Cosgrove, Ritu Salani
Oncologic therapy including chemotherapy and radiation can have a significant impact on ovarian function for young women and girls. Poor health outcomes and loss of fertility are major considerations. The effect of radiation and chemotherapy on ovarian function varies depending on patient age, therapy type and dosage, and cancer type. Surgical and medical interventions are available to reduce the morbidity of premature ovarian failure associated with cancer-directed therapy. Fertility preservation is an important consideration, and several options are available for it; therefore, early consultation with a reproductive or oncofertility specialist is an essential part of oncologic care in young women or girls...
July 26, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Susan M Maxwell, James A Grifo
Aneuploid conceptions constitute the majority of pregnancy failures in women of advanced maternal age. The best way to combat age-related decline in fertility is through preimplantation genetic testing for aneuploidy (PGT-A). PGT-A allows for better embryo selection, which improves implantation rates with single embryo transfer and reduces miscarriage rates. Single embryo transfers decrease multiple gestations and adverse pregnancy outcomes such as preterm or low birth weight infants. Advancements in extended embryo culture, blastocyst biopsy techniques, and 24-chromosome aneuploidy screening platforms have made PGT-A safe and accessible for all patients who undergo in vitro fertilization...
July 25, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
A L Shafrir, L V Farland, D K Shah, H R Harris, M Kvaskoff, K Zondervan, S A Missmer
Endometriosis affects approximately 10% of women of reproductive age. Characteristics robustly associated with a greater risk for endometriosis include early age at menarche, short menstrual cycle length, and lean body size, whereas greater parity has been associated with a lower risk. Relationships with other potential characteristics including physical activity, dietary factors, and lactation have been less consistent, partially because of the need for rigorous data collection and a longitudinal study design...
July 3, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Wanyuan Cui, Kelly-Anne Phillips
Globally, breast cancer is the most common female reproductive cancer. Although alkylating chemotherapy is not part of initial curative-intent treatment in women with other reproductive cancers, it is often used to treat women with curable breast cancer. Chemotherapy-associated ovarian failure (COF) is a potential consequence of this treatment and can cause infertility and increase the risk of cognitive impairment, cardiovascular disease and fractures from reduced bone mineral density. Although cryopreservation of embryos and oocytes is often effective for fertility preservation, this does not prevent COF and its associated complications...
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Lisa Kaestner
The presentation and management of bladder, ureteric and urethral injuries during and following urogynaecology surgery are discussed. Applied anatomy is reviewed, and the surgical management of injuries diagnosed intra- and post-operatively is discussed.
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Hans Peter Dietz
Imaging is increasingly being used in urogynaecology. Because of low cost and universal availability, ultrasound (US) is the most commonly used diagnostic modality, which allows the observation of manoeuvres such as Valsalva and pelvic floor muscle contraction in real time. The ability to see beyond surface anatomy is particularly important in the posterior compartment and in obstructed defecation where this method may replace defecation proctography. Imaging is especially useful in the form of 3D/4D multiplanar and tomographic translabial US, as these modalities give access to the axial plane and the levator ani...
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Ian Milsom, Maria Gyhagen
Urinary incontinence (UI) and fecal incontinence (FI) together with pelvic organ prolapse (POP) constitute a huge global health problem affecting millions of women throughout the world. These pelvic floor disorders (PFDs) can have a negative influence on a woman's well-being, quality of life, and sexual function and prevent many women from participating in recreational and sporting activities. The global costs of PFDs to health care systems and society are enormous and approximately one in five women will undergo surgery for genital prolapse or UI by the age of 85 years...
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Melanie L Walls, Roger J Hart
In vitro maturation (IVM) is an in vitro fertilisation (IVF) technique modified to collect immature oocytes from antral follicles, with the final stages of meiosis completed during in vitro culture. The primary benefit of IVM is that it reduces gonadotrophin stimulation in the patient, thereby eliminating the risk of ovarian hyperstimulation syndrome (OHSS) in high-risk patients such as those with polycystic ovaries (PCO) and polycystic ovary syndrome (PCOS). IVM has additional benefits for fertility preservation, particularly in oncofertility patients...
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Michael Breen, Michael Ingber
Achieving 100% closure and continence rate in the management of vesicovaginal fistulas remains a challenge. There is still debate about several aspects of the care including the following.
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Joël Fokom Domgue, Kathleen M Schmeler
Recent advances in screening and early diagnosis have decreased cervical cancer incidence and mortality rates in high-resource settings. The postponement of childbearing, combined with an increased number of cervical cancer survivors, has yielded new paradigms in patient care. In recent years, radical surgery has been challenged as the standard of care for early-stage cervical cancer owing to its significant morbidity and fertility impairment. Attention has been directed to assessing more conservative procedures that can reduce treatment-induced morbidity without compromising oncologic safety and reproductive potential of patients with early-stage disease...
June 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
S R Ramphal
The surgical repair of vesicovaginal fistula (VVF) over the last two decades has evolved from the transabdominal/transvaginal route to minimally invasive techniques of laparoscopy and robotic surgery. The indications for laparoscopic repair include supratrigonal fistulae, and stenotic/narrow vaginas that make vaginal access to the fistula site difficult. In the current published literature, comparable results have been reported with open surgery. The initial techniques were performed to simulate the open classic technique described by O'Conor, but with better imaging, exposure and magnification, the modified O'Conor (smaller cystotomy) and the extravesical approaches (no cystotomy) are being performed with comparable results...
June 27, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Thomas M D'Hooghe
No abstract text is available yet for this article.
July 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Dorien F O, Idhaliz Flores, Etienne Waelkens, Thomas D'Hooghe
A noninvasive biomarker-based test could help shorten the diagnostic delay for endometriosis. The most investigated biomarker sources are peripheral blood and endometrium. Discovery of endometriosis biomarkers is often hypothesis-driven, i.e. when one or a few biomarkers are investigated based on their role in the disease pathogenesis. Alternatively, a hypothesis-generating approach has been followed using the "omics" technologies. A variety of biomarkers for endometriosis have been investigated, but no biomarker has been validated for clinical use...
July 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
E I Geukens, S Apers, C Meuleman, T M D'Hooghe, E A F Dancet
The patient-centeredness of care is important for health care quality, especially because it was recently associated with health-related quality of life, which is increasingly being recognized as the ultimate outcome parameter of health care. Therefore, insight into the definition, measurement, and current status of the patient-centeredness of clinics is important for all health care professionals caring for patients with endometriosis. The definition of patient-centered endometriosis care is based on research into the most common preferences, needs, and values of patients with endometriosis and can be summarized in ten dimensions...
July 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Bansari G Patel, Emily E Lenk, Dan I Lebovic, Yimin Shu, Jie Yu, Robert N Taylor
Despite an estimated prevalence of 11% in women and plausible historical descriptions dating back to the 17th century, the etiology of endometriosis remains poorly understood. Classical theories of the histological origins of endometriosis are reviewed below. Clinical presentations are variable, and signs and symptoms do not correlate well with the extent of disease. In this summary, we have attempted to synthesize the growing evidence that hormonal and immune factors conspire to activate a local inflammatory microenvironment that encourages endometriosis to persist and elaborate mediators of its two cardinal symptoms: pain and infertility...
July 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
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