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Best Practice & Research. Clinical Obstetrics & Gynaecology

William Ledger
No abstract text is available yet for this article.
October 29, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
V Vannevel, C Swanepoel, R C Pattinson
No abstract text is available yet for this article.
October 3, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Daniel B Shapiro
Compensated egg donation has been available in the USA since 1984 and is subject to a variety of regulations. The impact of variation from state to state on the regulation of egg donor compensation can be discerned from an analysis of data reporting to both the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART). Although the CDC data sets are considered as the most complete, they did not, and do not, separately account for cycles conducted with frozen donor eggs, though SART data beginning in 2013 do account for these cycles...
September 28, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Lynne Sykes, Phillip R Bennett
Preterm birth (PTB) occurs in 5-18% of pregnancies and is the leading cause of neonatal morbidity, mortality and infant death. Up to 30% of PTBs are due to iatrogenic reasons, but the remainder are due to the spontaneous onset of labour or pre-labour premature rupture of membranes (P-PROM). During pregnancy, the uterus remains quiescent and the cervix remains long and closed. Although the exact mechanisms that lead to spontaneous PTB (sPTB) are not fully understood, it is likely that the terminal pathways that are common to term labour are activated prematurely...
September 8, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Debra A Gook, David H Edgar
Storing female reproductive potential can offer enhanced prospects for future conception in women whose fertility is threatened by cytotoxic therapies. Human female reproductive potential can be cryopreserved and stored at very low temperatures as embryos or gametes. Gamete (oocyte) cryopreservation circumvents potential issues associated with ownership when future use is being considered and may, therefore, be more generally acceptable as an approach. Advances in the technology, in particular the clinical application of vitrification, have significantly improved the outcomes from mature oocyte cryopreservation, which are now comparable to those from embryo cryopreservation...
August 31, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
M Janda, S McGrath, A Obermair
Uterine cancer is the fifth most common cancer in women worldwide with an estimated 320,000 annual diagnoses. Its most common form, endometrioid adenocarcinoma of the endometrium (endometrial adenocarcinoma [EAC]), is thought to develop through excessive proliferation of endometrial glands, and then increasing steadily in incidence. The current standard treatment for EAC is hysterectomy, which is often curative. However, it may be unacceptably expensive for women with severe medical comorbidities, those who are at risk of intra- and postoperative adverse events and those who desire fertility...
August 31, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Valarmathy Kandavel, Ying Cheong
Intra-uterine insemination (IUI) is a cheaper, less intensive treatment modality for achieving a pregnancy in couples with specific indications. The use of IUI seems to have declined after NICE guideline 2013 (CG 156) recommended IVF over IUI in couples with unexplained and mild male factor infertility. This review examines the current evidence and the applicability of IUI as a first-line option of treatment in couples with unexplained and mild male factor subfertility. The outcome of the review supports this argument...
August 25, 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Thomas F Baskett
This chapter will cover the evolution of forceps and vacuum-assisted delivery of the foetus in cephalic presentation. The options available before the development of obstetric forceps are briefly reviewed. The invention of the forceps in the early 17th century was followed by their evolution over four centuries with the introduction of the pelvic curve, axis-traction and rotational forceps. The phase of prophylactic forceps delivery will be discussed. The development of vacuum-assisted delivery has evolved over the past 150 years...
August 23, 2018: 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
Carla Tomassetti, Thomas D'Hooghe
When evaluating the correlation between endometriosis and infertility with application of the evidence-based guidelines to establish causality in medicine, it becomes apparent that endometriosis causes infertility. This is supported by a strong and consistent association between the two in various settings (prevalence, natural conception, intrauterine insemination (IUI), and assisted reproductive technologies (ARTs)), evidence for a temporal relation, arguments for a dose-response gradient, and proven effects of the removal of lesions on infertility...
August 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
Federico Prefumo, A Cristina Rossi
Endometriosis and infertility are linked in a complex relationship, and a number of different pathogenetic mechanisms may associate the two. Endometriosis is diagnosed in 6-8% of women undergoing ART. Women with endometriosis appear to have similar ART outcomes compared to controls in terms of live birth rates, despite a lower oocyte quality. Laparoscopy should not be routinely performed before ART with the only aim to diagnose mild or moderate endometriosis, but if the latter is found, surgical removal can be considered, as it might improve pregnancy rates...
August 2018: Best Practice & Research. Clinical Obstetrics & Gynaecology
Thierry Van den Bosch, Dominique Van Schoubroeck
Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma according to robust prospective data together with guidelines as to adequate reporting of the location of deep infiltrating endometriosis will be given. The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed...
August 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
Yves Ville, Patrick Rozenberg
Cervical length (CL) measured by transvaginal ultrasound examination (TVUE) best identifies the risk for preterm birth (PTB). It identifies women at risk who can benefit from corticosteroids or in utero transfer. Early screening improves effectiveness of tocolysis. It reduces iatrogenicity and cost. In preterm premature rupture of membranes (PPROM), CL is devoid of infectious risk and predicts duration of the latency phase but not the risk of perinatal sepsis. Asymptomatic women at risk should be screened at a 2-week interval starting from 16 to 18 weeks, up to 24 weeks...
July 7, 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
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