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Pregnancy guidelines

Barbara Jagels, Leila Amin, Annika Gustafson
Systematic gaps for pregnancy screening and testing of patients with cancer persist. Absent or inconsistent guidelines and policies are barriers to standardized practice. Awareness among oncology nurses is needed to promote safe cancer care, prevent patient harm, and uphold patient-centered care.
April 1, 2018: Clinical Journal of Oncology Nursing
Sonam Puri, Kelly A Hyland, Kristine Crowe Weiss, Gillian C Bell, Jhanelle E Gray, Richard Kim, Hui-Yi Lin, Aasha I Hoogland, Brian D Gonzalez, Ashley M Nelson, Anita Y Kinney, Stacy M Fischer, Daneng Li, Paul B Jacobsen, Howard L McLeod, Heather S L Jim
PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) is common among cancer patients. Early identification of patients at risk for CINV may help to personalize anti-emetic therapies. To date, few studies have examined the combined contributions of patient-reported and genetic risk factors to CINV. The goal of this study was to evaluate these risk factors. METHODS: Prior to their first chemotherapy infusion, participants completed demographic and risk factor questionnaires and provided a blood sample to measure genetic variants in ABCB1 (rs1045642) and HTR3B (rs45460698) as well as CYP2D6 activity score...
March 15, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Sangmin Lee, Amy Metcalfe, Maitreyi Raman, Yvette Leung, Fariba Aghajafari, Nicole Letourneau, Remo Panaccione, Gilaad G Kaplan, Cynthia H Seow
Background and Aims: Vitamin D insufficiency is prevalent in individuals with inflammatory bowel disease, as well as in pregnant women; however, the prevalence of vitamin D insufficiency in pregnant women with IBD is unknown. This study assessed the prevalence of vitamin D insufficiency in pregnant women with IBD and the adequacy of recommended supplementation. Methods: A cross-sectional study was conducted in pregnant women with inflammatory bowel disease (Crohn's disease=61, ulcerative colitis=41) and without inflammatory bowel disease (n=574)...
March 13, 2018: Journal of Crohn's & Colitis
E Mathieu d'Argent, J Cohen, C Chauffour, J L Pouly, J Boujenah, C Poncelet, C Decanter, P Santulli
Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%...
March 12, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
B Borghese, P Santulli, L Marcellin, C Chapron
Endometriosis and adenomyosis are histologically defined. The frequency of endometriosis cannot be precisely estimated in the general population. Endometriosis is considered a disease when it causes pain and/or infertility. Endometriosis is a heterogeneous disease with three well-recognized subtypes that are often associated with each other: superficial endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). DIE is frequently multifocal and mainly affects the following structures: the uterosacral ligaments, the posterior vaginal cul-de-sac, the bladder, the ureters, and the digestive tract (rectum, recto-sigmoid junction, appendix)...
March 11, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Leena Nahata, Nicole M Caltabellotta, Nicholas D Yeager, Vicky Lehmann, Stacy L Whiteside, Sarah H O'Brien, Gwendolyn P Quinn, Cynthia A Gerhardt
Infertility is a common and distressing late effect of cancer treatment among male survivors. Investigators examined desire for parenthood, prioritization of fertility compared to other life goals, and reports of fertility-related discussions among a cohort of male adolescent and young adult survivors. Eighty percent desired a biological child, yet only 31% ranked having a child among their "top 3" life goals. Only 40% reported fertility-related discussions with their health care providers in survivorship...
March 14, 2018: Pediatric Blood & Cancer
Norita Hussein, Stephen F Weng, Joe Kai, Jos Kleijnen, Nadeem Qureshi
BACKGROUND: Globally, about five per cent of children are born with congenital or genetic disorders. The most common autosomal recessive conditions are thalassaemia, sickle cell disease, cystic fibrosis and Tay-Sachs disease, with higher carrier rates in specific patient populations. Identifying and counselling couples at genetic risk of the conditions before pregnancy enables them to make fully informed reproductive decisions, with some of these choices not being available if genetic counselling is only offered in an antenatal setting...
March 14, 2018: Cochrane Database of Systematic Reviews
M Y Tan, D Wright, A Syngelaki, R Akolekar, S Cicero, D Janga, M Singh, E Greco, A Wright, K Maclagan, L C Poon, K H Nicolaides
OBJECTIVE: To test the hypothesis that the performance of first-trimester screening for pre-eclampsia (PE) by a method that uses Bayes' theorem to combine maternal factors with biomarkers is superior to that defined by current National Institute for Health and Care Excellence (NICE) guidelines. METHODS: This was a prospective multicenter study (screening program for pre-eclampsia (SPREE)) in seven National Health Service maternity hospitals in England, of women recruited between April and December 2016...
March 14, 2018: Ultrasound in Obstetrics & Gynecology
Shiri Shinar, Howard Berger
The present literature review was conducted to evaluate early diabetes screening in pregnancy. The review focuses on the various guidelines for early screening, the target populations for screening, and the assessment of various early screening targets and strategies. The advantages and disadvantages of each screening method are highlighted. The review emphasizes that there are no validated criteria for selecting high-risk pregnant women for early screening. The different early screening modalities, including fasting plasma glucose, random plasma glucose, postload glucose, and hemoglobin A1c, lack concordance and have not been validated for the early diagnosis of diabetes in pregnancy...
March 14, 2018: International Journal of Gynaecology and Obstetrics
M Ballester, H Roman
Deep endometriosis with colorectal involvement is considered one of the most severe forms of the disease due to its impact on patients' quality of life and fertility but also by the difficulties encountered by the clinicians when proposing a therapeutic strategy. Although the literature is very rich, evidence based medicine remains poor explaining the great heterogeneity concerning the management of such patients. Surgery therefore remains a therapeutic option. It improves the intensity of gynecological, digestive and general symptoms and the quality of life...
March 10, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
S Geoffron, J Cohen, M Sauvan, G Legendre, J M Wattier, E Daraï, H Fernandez, N Chabbert-Buffet
The available literature, from 2006 to 2017, on hormonal treatment has been analysed as a contribution to the HAS-CNGOF task force for the treatment of endometriosis. Available data are heterogeneous and the general level of evidence is moderate. Hormonal treatment is usually offered as the primary option to women suffering from endometriosis. It cannot be used in women willing to conceive. In women who have not been operated, the first line of hormonal treatment includes combined oral contraceptives (COC) and the levonorgestrel-releasing intra uterine system (52mg LNG-IUS)...
March 10, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
J Niro, P Panel
OBJECTIVE: In women with symptomatic endometriosis and no desire for pregnancy, hysterectomy with or without bilateral oophorectomy is often presented as a definitive solution to their symptoms. Despite this radical treatment, it should be known that nearly 15% of these patients will have persistent pain. Thus the objective of this review was to determine the interest of total hysterectomy with or without bilateral oophorectomy for the treatment of deep endometriosis. METHOD: The research was conducted from the US National Library of Medicine's National Institutes of Health from the following keywords: endometriosis, hysterectomy, oophorectomy, ovariectomy, radical treatment...
March 9, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Suzanne Phelan, Rena R Wing, Anna Brannen, Angelica McHugh, Todd A Hagobian, Andrew Schaffner, Elissa Jelalian, Chantelle N Hart, Theresa O Scholl, Karen Munoz-Christian, Elaine Yin, Maureen G Phipps, Sarah Keadle, Barbara Abrams
Background: Behavioral lifestyle interventions during pregnancy can prevent excessive gestational weight gain (GWG) in women with normal weight; however, effective interventions to reduce GWG in ethnically diverse women with obesity are lacking. Objective: A randomized controlled trial was conducted to test whether a behavioral lifestyle intervention with partial meal replacement reduces GWG rate in Hispanic and non-Hispanic women with overweight or obesity relative to enhanced usual care...
February 1, 2018: American Journal of Clinical Nutrition
Solina Tith, Garinder Bining, Laurent Bollag
Background : Opioid use during pregnancy is a growing concern in the United States. Buprenorphine has been recommended by "The American College of Obstetrics and Gynecology" as an alternative to methadone to decrease risks associated with the use of illicit opioids during pregnancy. The partial μ-opioid agonists' unique pharmacology, including its long half time and high affinity to the μ-opioid receptor, complicates patient management in a highly kinetic, and often urgent field like obstetric anesthesia...
2018: F1000Research
H Roman, M Ballester, J Loriau, M Canis, P A Bolze, J Niro, S Ploteau, C Rubod, C Yazbeck, P Collinet, B Rabischong, B Merlot, X Fritel
The article presents French guidelines for surgical management of endometriosis. Surgical treatment is recommended for mild to moderate endometriosis, as it decreases pelvic painful complaints and increases the likelihood of postoperative conception in infertile patients (A). Surgery may be proposed in symptomatic patients with ovarian endometriomas which diameter exceeds 20mm. Cystectomy allows for better postoperative pregnancy rates when compared to ablation using bipolar current, as well as for lower recurrences rates when compared to ablation using bipolar current or CO2 laser...
March 8, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Napoleon N Ekem, Lucky O Lawani, Robinson C Onoh, Chukwuemeka A Iyoke, Leonard O Ajah, Emeka O Onwe, Azubuike K Onyebuchi, Love C Okafor
Preconception care (PCC) is a preventive strategy for maternal and perinatal morbidity and mortality. This study aimed to assess the level of awareness and utilisation of PCC services. A descriptive cross-sectional survey was conducted at a teaching hospital. Interviewer-administered questionnaires were used to extract information. A total of 450 participants responded; 44.2% (190/450) were aware, 31.7% (143/450) had good knowledge, while only 10.3% (46/450) received PCC. Health care providers were the main source of information (77...
March 12, 2018: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Swetha Narayanan, Bruce Blumberg, Marla L Clayman, Vivian Pan, Catherine Wicklund
Exome sequencing is a clinical diagnostic test offered primarily for children and adults with suspected genetic conditions. The purpose of this study was to explore issues related to exome sequencing in a reproductive clinical setting. This was a qualitative study using semi-structured interviews. Participants were professionals drawn from four key stakeholder groups-healthcare providers, laboratory/industry, ethics, and government. Transcribed interviews were analyzed for emergent themes. Most participants saw potential clinical utility in offering prenatal exome sequencing for diagnostic purposes as opposed to screening...
March 10, 2018: Journal of Genetic Counseling
Nina M Molenaar, Marlies E Brouwer, Johannes J Duvekot, Huibert Burger, Esther M Knijff, Witte J Hoogendijk, Claudi L H Bockting, G S de Wolf, Mijke P Lambregtse-van den Berg
BACKGROUND AND OBJECTIVES: prescription rates of antidepressants during pregnancy range from 2-3% in The Netherlands to 6.2% in the USA. Inconclusive evidence about harms and benefits of antidepressants during pregnancy leads to variation in advice given by gynaecologists and midwives. The objective was to investigate familiarity with, and adherence to the Dutch multidisciplinary guideline on Selective Serotonin Reuptake Inhibitor (SSRI) use during pregnancy by gynaecologists and midwives in the Netherlands...
February 21, 2018: Midwifery
C Chauffour, J-L Pouly, A-S Gremeau
Should the presence of endometriosis change the management of assisted reproductive technology? There is no difference in pregnancy rate after IVF between an agonist or antagonist protocol in patients with endometriosis, so the choice between one or the other of these protocols is free. But the review of the literature has shown an improvement in the chances of pregnancy in case of prolonged ovulation suppression before stimulation for IVF with a GnRH agonist analogue or with oral contraception, especially in cases of severe endometriosis...
March 6, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
Abigail R Koch, Pamela T Roesch, Caitlin E Garland, Stacie E Geller
CONTEXT: Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. IMPLEMENTATION: Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum...
March 7, 2018: Journal of Public Health Management and Practice: JPHMP
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