Journals Best Practice & Research. Clin...

Best Practice & Research. Clinical Obstetrics & Gynaecology
Simone Ferrero
No abstract text is available yet for this article.
May 14, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Peter Thiel, Anna Kobylianskii, Meghan McGrattan, Nucelio Lemos
Somatic nerve entrapment caused by endometriosis is an underrecognized and often misdiagnosed issue that leads to many women suffering unnecessarily. While the classic symptoms of endometriosis are well-known to the gynaecologic surgeon, the dermatomal-type pain caused by endometriosis impacting neural structures is not within gynecologic day-to-day practice, which often complicates diagnosis and delays treatment. A thorough understanding of pelvic neuroanatomy and a neuropelveologic approach is required for accurate assessments of patients with endometriosis and nerve entrapment...
May 8, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Marcello Ceccaroni, Gianmarco D'Ancona, Giovanni Roviglione, Sarah Choi, Tommaso Capezzuoli, Andrea Puppo, Ashot Drampyan, Fabio Barra
Diaphragmatic endometriosis (DpE) is a rare disease localization which represents an important clinical challenge. The main criticisms toward the proper DpE management consist of poor consensus on both surgical indications and the choice between different surgical techniques available to treat the disease. Furthermore, only weak recommendations are provided by current guidelines and surgical management is mostly based on surgeon's experience. As consequence, the lack of standardization about the surgical treatment led to the risk of under- or over-treatments in patients suffering from this form of endometriosis...
May 3, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Alaa El-Ghobashy
No abstract text is available yet for this article.
April 24, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
F Massimello, V Cela
Robot-assisted Single-Site Laparoscopy (R-LSS) is a rapidly evolving minimally invasive technique. Although it is a very recent technology, the use of R-LSS have been increasingly report in gynecology, for both benign and malignant indications. This review aims to summarize the evolution of this innovative technique and to examine its feasibility and safety for gynecological surgical procedures. We evaluated studies dealing about R-LSS in gynecological surgery. We performed a comprehensive literature research on PubMed and the Cochrane Library in February 2024...
April 19, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Simone Ferrero, Irene Gazzo, Marco Crosa, Francesco Paolo Rosato, Fabio Barra, Umberto Leone Roberti Maggiore
This narrative review aims to summarize available evidence on the IVF-associated outcomes after surgery for endometriosis. Only one retrospective study investigated if surgical treatment of superficial/peritoneal endometriosis may modify the outcomes of IVF; therefore, more data are needed to confirm the benefit of surgery for this type of disease for improving ART outcomes, and to be able to support it in routine practice. Solid evidence from several meta-analyses demonstrates that surgical treatment of endometriomas does not enhance the outcomes of IVF...
April 9, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Louisa R Chatroux, Jon I Einarsson
Endometriosis surgery involving the ureter poses significant challenges requiring meticulous surgical techniques and vigilant postoperative care. This chapter addresses key aspects of ureterolysis techniques, intraoperative management of ureteral injuries, and postoperative care in the context of endometriosis surgery. Ureterolysis methods aim to isolate and mobilize the ureter while preserving its vascularity. Cold instruments and careful dissection are recommended to prevent thermal injury during surgery...
April 8, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
G S Gebhardt, L de Waard
Maternal and/or perinatal death review or audits aim to improve the quality of health services and reduce deaths due to causes identified. A death review audit cycle identifies causes of deaths and possible modifiable factors, these can point to potential breaks in the continuity of health care and other health systems faults and challenges. It is an important function of audit cycles to develop, implement, monitor, and review action plans to improve the service. The WHO has produced two handbooks (Making Every Baby Count and Monitoring Emergency Obstetric Care) to guide maternal and perinatal death reviews...
April 3, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Fabio Barra, Simone Ferrero, Carlotta Zorzi, Giulio Evangelisti, Umberto Perrone, Irene Valente, Tommaso Capezzuoli, Gianmarco D'Ancona, Stefano Bogliolo, Giovanni Roviglione, Marcello Ceccaroni
Deep endometriosis (DE) can be localized in the parametrium, a complex bilateral anatomical structure, sometimes necessitating intricate surgical intervention due to the potential involvement of autonomic nerves, uterine artery, and ureter. If endometriotic ovarian cysts have been considered metaphorically representative of "the tip of the iceberg" concerning concealed DE lesions, it is reasonable to assert that parametrial lesions should be construed as the most profound region of this iceberg. Also, based on a subdual clinical presentation, a comprehensive diagnostic parametrial evaluation becomes imperative to strategize optimal management for patients with suspected DE...
April 2, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Adrien Crestani, Benjamin Merlot, Paul-Henri Goualard, Georgios Grigoriadis, Isabelle Chanavaz Lacheray, Thomas Dennis, Horace Roman
Bowel endometriosis is the most common form of severe deep endometriosis. Surgery is an option in case of infertility and/or chronic pain or in the presence of a stenotic lesion. Clinical examination and preoperative imaging must provide an identity card of the lesion so that customized surgery can be proposed. The primary objective of this tailor-made surgery will always be to preserve the organ. The surgeon then has three options: shaving, discoid resection and segmental resection. The more extensive the resection, the greater the risk of severe short- and long-term complications...
March 31, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Farah Siddiqui, Karim Kalache, Badreledeen Ahmed, Justin C Konje
Obesity rates are increasing world-wide with most of the increase in women of the reproductive age group. While recognised as an important contributor to non-communicable diseases, pregnant women with obesity are particularly at risk of not only maternal and pregnant complications but also have an increased risk of congenital malformations. Furthermore, pregnant obese women are more likely to be older and therefore at a greater risk of aneuploidy. Prenatal diagnosis in these women especially those who are morbidly obese is challenging due not only to their weight but the implications of the increase adiposity on biochemical markers of aneuploidy...
March 21, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Cássia R T Juliato, Montas Laporte, Fernanda Surita, Luis Bahamondes
The aim of our article is to discuss barriers associated with post-pregnancy contraception in Brazil during the SARS-CoV-2 (COVID-19) pandemic. Socioeconomic differences in gaining access to long-acting reversible contraceptive (LARC) methods became greater during the COVID-19 pandemic. The inadequate distribution of existing resources and the reduced capacity for elective care meant that healthcare providers in family planning had to be reallocated to respond to COVID-19 emergencies. In Brazil, 74% of the population depends on the national health service (Sistema Unico de Saúde) including for the provision of free contraception...
February 23, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
James M Roberts
Preeclampsia/eclampsia was first described 2000 years ago. Concepts guiding diagnosis have changed over time making longitudinal studies challenging. Similarly, concepts of pathophysiology have evolved from eclampsia as a pregnancy seizure disorder to preeclampsia as a hypertensive and renal disorder to our current concept of a preeclampsia as a pregnancy specific, multisystemic inflammatory disorder. Although preeclampsia is pregnancy specific and many pathophysiologic findings begin to resolve with delivery, its impact extends beyond pregnancy...
February 22, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Lindokuhle Thela, Saeeda Paruk, Busisiwe Bhengu, Bonginkosi Chiliza
Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium...
February 21, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
José Rojas-Suarez, Fathima Paruk
Despite notable advancements in minimizing maternal mortality during recent decades, a pronounced disparity persists between high-income nations and low-to middle-income countries (LMICs), particularly in intensive and high-care for pregnant and postpartum individuals. This divergence is multifactorial and influenced by factors such as the availability and accessibility of community-based maternity healthcare services, the quality of preventive care, timeliness in accessing hospital or critical care, resource availability, and facilities equipped for advanced interventions...
March 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Emmanuel C Ejim, Kamilu M Karaye, Samuel Antia, Godsent C Isiguzo, Paschal O Njoku
Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women without known cardiovascular disease. PPCM is a global disease, but with a significant geographical variability within and between countries. Its true incidence in Africa is still unknown because of the lack of a PPCM population-based study. The variability in the epidemiology of PPCM between and within countries could be due to differences in the prevalence of both genetic and non-genetic risk factors...
March 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Laura Melado, Baris Ata
As a chronic inflammatory disease, endometriosis generates fibrosis and anatomic distortion, which add extra-challenges to assisted reproductive technology cycles and requires a personalized approach. Patients with endometriomas have significantly decreased ovarian reserve and the ultrasound examination tends to be challenging, possibly underestimating follicle counts. It is crucial to assess the feasibility of oocyte retrieval procedure during the initial examination of the patient, as the distortion of the pelvic anatomy, the presence of hydrosalpinges and endometriomas might render the procedure difficult and increase the risk of complications...
March 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Georgios Grigoriadis, Angelos Daniilidis, Benjamin Merlot, Konstantinos Stratakis, Thomas Dennis, Adrien Crestani, Isabella Chanavaz-Lacheray, Horace Roman
Deep endometriosis (DE) is the most severe form of endometriosis and is commonly associated with infertility. Surgical treatment of DE appears to increase chances of spontaneous conception in appropriately selected patients wishing to conceive. Identifying, however, the exact impact of DE, and its surgical removal, on natural conception is highly challenging. The surgical approach should be favoured in symptomatic patients with pregnancy intention. Limited data from infertile patients suggest that outcomes may not differ from patients without known infertility...
March 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Albaro José Nieto-Calvache, Jose M Palacios-Jaraquemada, Ahmed M Hussein, Eric Jauniaux, Conrado Milani Coutinho, Marcus Rijken
Placenta accreta spectrum (PAS) can be associated massive intra- and post-operative hemorrhage which when not controlled can lead to maternal death. Important advances have occurred in understanding the pathophysiology and therapeutic options for this condition. The prevalence of PAS at birth is direct association with the cesarean delivery (CD) rate in the corresponding population and is increasing worldwide. Limited health infrastructure in low- and middle-income countries increases the morbidity and mortality of patients with PAS at birth...
February 17, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
Osric B Navti, Sue Pavord
Venous thrombosis and thromboembolism (VTE) remain the leading cause of direct maternal deaths, occurring within 42 days of the end of pregnancy in the UK. Pregnancy is associated with an overall 10-fold higher incidence of VTE than in the non-pregnant state and has been reported to reach up to 30-fold higher in the puerperium. This increased risk is further exacerbated by maternal obesity in a relationship that appears to be proportional with increasing Body Mass Index (BMI). Maternal obesity is the most common health problem in women of reproductive age with clinically significant health risks to women during pregnancy and after delivery...
February 16, 2024: Best Practice & Research. Clinical Obstetrics & Gynaecology
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