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Best Practice & Research. Clinical Obstetrics & Gynaecology

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https://read.qxmd.com/read/31103529/practical-approaches-to-managing-postpartum-haemorrhage-with-limited-resources
#1
REVIEW
Susan Fawcus
Mortality from postpartum haemorrhage (PPH) is higher in low resource settings due to increased incidence, higher case fatality rates and poor general health of the population. The challenges of managing PPH with limited resources are presented. Feasible interventions for preventing and treating PPH for home births are described. Given that maternity care is organised around levels of care in low resource settings, guidance is provided for what measures can be performed to manage PPH at different levels of care (clinic, community health centre, district hospital, regional and central hospital); and by which cadre (midwife, clinical officer, general doctor, specialist)...
May 7, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/31072749/preface-renal-disease-in-pregnancy
#2
EDITORIAL
Kate Bramham, Laura A Magee
No abstract text is available yet for this article.
April 8, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/31031053/drugs-in-renal-disease-and-pregnancy
#3
REVIEW
Asif Sarwar
This review aims to summarise historic and the latest evidence of commonly used drugs in pregnant women with chronic kidney disease (CKD). Data regarding safety of drugs in breastfeeding are also described. Practical recommendations are made on the use of newer agents that have limited information of use in pregnant women with CKD. Pharmacokinetic and dynamic issues are outlined, and general principles for prescribing drugs in pregnant women with CKD are listed. Resources to investigate drug safety are presented...
April 3, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/31003902/immunotherapy-of-gynecological-cancers
#4
REVIEW
Emad Matanes, Walter H Gotlieb
Oncology treatments have evolved from intuitive, via empiric, to the present precision medicine, with the integration of molecular targeted therapies in our treatment arsenal. The use of the patients' powerful immune system has long been contemplated and recently led to the integration of immunotherapy to overturn the well-documented inhibitory effects of the tumor on the immune system and restore it to a state of activity against the cancer. Recent favorable results have shown the value and effectiveness of immunotherapy against gynecological cancers...
March 21, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/31078425/open-fetal-surgery-for-neural-tube-defects
#5
REVIEW
Julie S Moldenhauer, Alan W Flake
The most common congenital defect of the central nervous system is myelomeningocele (MMC), which results in significant physical limitations for those affected. Neurologic injury associated with MMC begins with abnormal neurulation and is perpetuated by subsequent traumatic and toxic injury sustained in utero. Treatment historically has involved surgical closure of the MMC after birth along with neonatal management of the associated sequelae including cerebrospinal fluid diversion by ventricular shunting. With improvements in prenatal diagnosis, a defined antenatal natural history, and the concept of fetal intervention to arrest or reverse ongoing in utero damage, maternal-fetal surgery for MMC closure developed as a feasible therapy...
March 18, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/31047850/autoimmune-diseases-role-of-steroid-hormones
#6
REVIEW
Marisa Benagiano, Paola Bianchi, Mario Milco D'Elios, Ivo Brosens, Giuseppe Benagiano
Autoimmune diseases (AIDs) are a heterogeneous group of disorders in terms of clinical manifestations, pathogenesis, and prevalence, and there is no agreement to date on a common classification. Adaptive immune responses are responsible for the existence of AIDs, although innate immunity is also involved in misguiding the immune response against self-antigens. Hormones, in general, and in particular steroid hormones, play a critical role in the physiology and pathology of the immune system, especially in adaptive immunity...
March 16, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30981539/maturation-of-the-immune-system-in-the-fetus-and-the-implications-for-congenital-cmv
#7
REVIEW
Erez Rechavi, Raz Somech
Congenital cytomegalovirus (CMV) infection is the most prevalent and consequential congenital infection, among others, that affects approximately 0.6% of all live births worldwide. Timing of maternal infection and maternal immune status largely determine the likelihood of a symptomatic infection. However, recent studies suggest that the fetal immune system, long perceived as naïve and immature, may also play a role in deciding the outcome of congenital CMV infection. Here, we review the development of four immune cells most pertinent to CMV control in the human fetus...
March 16, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30910447/fetal-stem-cell-transplantation-and-gene-therapy
#8
REVIEW
Rachel Sagar, Cecilia Götherström, Anna L David, Magnus Westgren
The present chapter summarizes our current knowledge on fetal stem cell and gene therapy. It focuses on these therapeutic alternatives in regard to past experiences and ongoing and planned studies in humans. Several methodological challenges are discussed that may have wide implications on how these methods could be introduced in clinical practices. Although still promising, the methods are afflicted with very special requirements not least in regard to safety and ethical questions. Furthermore, careful monitoring and extended follow-up of the child and his/hers mother who receive prenatal stem cell or gene treatments are of outmost importance...
March 5, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30992125/operative-vaginal-delivery-and-post-partum-infection
#9
REVIEW
Olaa Mohamed-Ahmed, Kim Hinshaw, Marian Knight
During the past decade, there has been an increase in the awareness of infections associated with pregnancy and delivery. The most significant cause of post-partum infection is caesarean section; 20-25% of operations are followed by wound infections, endometritis or urinary tract infections. Approximately 13% of women in the UK undergo operative vaginal delivery (OVD) with forceps or vacuum, which is also associated with an increased risk of infection, estimated at 0.7%-16% of these deliveries. Despite this, previous reviews have identified only one small trial of antibiotic prophylaxis in 393 women and concluded that there was insufficient evidence to support the routine use of prophylactic antibiotics after OVD...
April 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30850327/operative-vaginal-delivery-and-pelvic-floor-complications
#10
REVIEW
Richard P Deane
Operative vaginal delivery (OVD) is associated with injury to the pelvic floor and compromise to the urinary, genital and gastrointestinal systems. There has been significant evolution in recent years in the practice of OVD (from the use of forceps to vacuum delivery), the conduct of delivery (from routine to selective episiotomy) and the recognition and management of obstetric anal sphincter injury (OASIS). This review article considers a number of key questions from the perspective of the clinical practitioner: What effects does OVD have on the pelvic floor? How can the effects of OVD on the pelvic floor be reduced? When and how should episiotomy be performed during OVD? How should future pregnancies following OVD and OASIS be managed? The place of episiotomy during OVD, a much debated strategy to prevent injury to the obstetric anal sphincter during OVD, is considered...
April 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30930143/renal-disease-in-pregnancy-fetal-neonatal-and-long-term-outcomes
#11
REVIEW
Emily Haseler, Nabil Melhem, Manish D Sinha
Renal disease in women of childbearing age is estimated to be approximately 3%; consequently, renal disease is not an uncommon comorbidity in pregnancy. There has been considerable evidence published over the last 20 years to suggest that renal disease in pregnancy is associated with higher maternal, fetal, and offspring morbidity. Studies published are largely heterogeneous; include unmatched cohort studies; and focus on early neonatal outcomes such as prematurity, small for gestational age, and neonatal unit admission...
February 15, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30910446/surgical-management-of-congenital-uterine-anomalies-including-indications-and-surgical-techniques
#12
REVIEW
Theodoros D Theodoridis, Panagiotis D Pappas, Grigoris F Grimbizis
The prevalence of congenital uterine anomalies (CUA) is reported to be 4.3-6.7% in the general population, 3.4%-8% in the infertile population, and 12.6-18.2% of those with recurrent miscarriages. They are the result of abnormal formation, differentiation, and fusion of the Müllerian or paramesonephric ducts during fetal life. To date, various classification systems have been proposed for the categorization of CUA, but the recently introduced ESHRE/ESGE classification seems to be a new, clear, and systematic categorization, which could be the basis for clinicians to rely on when they refer to CUA and their clinical impact either generally or concerning pregnancy outcomes...
February 15, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30910445/-strategies-to-increase-the-accuracy-and-safety-of-ovd-clinical-assessment-skills-and-role-of-ultrasound-simulation-training-and-new-technologies-to-enhance-instrument-application
#13
REVIEW
M Ramphul
Operative vaginal delivery (OVD) is commonly performed in the UK and Ireland. With skillful practice, the risks to mothers and babies are low. Caesarean section at full dilatation, particularly after failed OVD, can be more hazardous for mothers and babies. It is important to maintain and develop skills in OVD in order to provide it as a safe delivery option when the benefits outweigh the risks. As ultrasound machines have become more readily available on the labour ward, ultrasound assessment has been used to help clinicians diagnose the fetal head position and station, and also to try predict the success of the delivery...
February 15, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30827817/operative-vaginal-delivery
#14
EDITORIAL
Deirdre J Murphy
No abstract text is available yet for this article.
February 12, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30827815/forceps-delivery-for-non-rotational-and-rotational-operative-vaginal-delivery
#15
REVIEW
Mairead Black, Deirdre J Murphy
Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomised trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma...
February 11, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30826158/nontechnical-skills-and-decision-making-in-operative-vaginal-delivery
#16
REVIEW
Lisa Kirk, Rachna Bahl
Nontechnical skills are defined as social, cognitive and personal resource skills that are necessary to conduct any technical skill safely. Whilst the skills are categorised into three domains: social, cognitive and personal resources, these are dependent on each other and the development and effectiveness of one relies on the other two. Effective nontechnical skills are essential in the safe care of patients in any setting, and their importance can be clearly demonstrated in the safe development of skills in many areas of medicine and surgery...
February 11, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30837118/uterine-scar-rupture-prediction-prevention-diagnosis-and-management
#17
REVIEW
Vasilios Tanos, Zara Abigail Toney
The increasing rate of elective and indicated caesarean sections worldwide has led to new pathologies and management challenges. The number of patients undergoing trial of labor after caesarean section (TOLAC) is also increasing. Three professional societies provide detailed guidelines based on scientific evidence for the management of patients attempting vaginal birth after caesarean section (VBAC). However, they do not provide any recommendations for the actual surgical steps to be followed to minimize the risks of uterine rupture (UR) during TOLAC...
February 10, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30827818/medico-legal-considerations-and-operative-vaginal-delivery
#18
REVIEW
Deirdre J Murphy
Women undergo operative vaginal delivery (OVD) as an alternative to caesarean section when complications arise in the second stage of labour. The perinatal mortality associated with OVD is very low, and most of the perinatal morbidity is minor. However, when serious adverse events occur, such as traumatic birth injury, shoulder dystocia, cerebral palsy and perinatal death, there are medico-legal implications. There is also the potential for litigation in relation to maternal pelvic floor injury, which is increased with OVD...
February 10, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30857979/training-and-qualification-in-gynecological-minimal-access-surgery-a-systematic-review
#19
REVIEW
Luz Angela Torres-de la Roche, Lasse Leicher, Isabell Steljes, Jennifer Eidswick, Oleg Larionov, Maya Sophie de Wilde, Rudi Campo, Vasilios Tanos, Rudy Leon De Wilde
Minimally invasive surgery demands specific endoscopic psychomotor skills that are usually acquired outside the operating theatre. We present the results of a systematic analysis to identify how simulation is used during training and qualification in minimal access surgery to improve gynecologist's surgical skills. We found that despite the availability of simulation tools along with methods for training and testing specific endoscopic psychomotor and technical skills, there is no clear evidence of the superiority of one tool or method over the others in skill acquisition...
February 6, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
https://read.qxmd.com/read/30837119/role-of-general-gynaecologists-in-the-prevention-of-infertility
#20
REVIEW
Ertan Saridogan
Gynaecologists are frequently involved in the management of conditions that may result in reduced fertility or treatments they administer can lead to infertility. Sexually transmitted infections and pelvic inflammatory disease are the most common cause of tubal damage. Gynaecologists can play an important role in the identification and early treatment of these diseases. Pelvic surgery for conditions such as leiomyoma, ovarian cysts and endometriosis can lead to pelvic adhesions and iatrogenic infertility. By avoiding unnecessary operations by careful assessment of women with these conditions and by identifying those who can be managed without surgery, the future risk of infertility can be avoided...
February 6, 2019: Best Practice & Research. Clinical Obstetrics & Gynaecology
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