Reviews in Gynaecological and Perinatal Practice最新文献

After an introduction recounting the pronatalist views of the world's religions, the article goes on to explore each of the major religions, Judaism, Christianity, Islam, Hinduism, Sikhism and Buddhism and their belief systems in relation to contraception and abortion. This is followed by a discussion of the practical consequences of these beliefs and of the role of the professional in helping women and couples of the varied faiths in their choice of methods. How these choices may affect religious practices and vice versa is also considered.

There is a large body of literature investigating the mechanism, risk factors, and pathophysiology of postpartum urinary retention; it is usually a temporary condition where early diagnosis and appropriate management can avoid long term complication. This article reviews the etiology, prevention, management and long-term implications of retention for bladder functions.

Until recently, the treatment of choice for Stage 1A cervical cancer has been simple or radical hysterectomy. With excellent survival rates and an increasing desire to conserve fertility, conservative surgical methods are being used. The object of this review is to discuss prognostic factors, treatment options and methods of follow-up for women with microinvasive cervical cancer.

This review article aims to give a comprehensive insight into both the historical and current thoughts on all aspects of endometriosis including aetiology, diagnosis, and medical and surgical treatments. The prevalence of endometriosis is about 6–8%, and may affect up to two million women in the United Kingdom. It causes, through pain and infertility, a significant problem for sufferers, their families and society as a whole. There is no conclusive evidence to explain its aetiology although our understanding of the basic pathophysiology is improving. However, there remains a substantial lack of understanding in all areas of disease.

A rationale is presented for surgical therapy as the preferred approach for diagnosis and treatment. The recognised gold standard for diagnosis is laparoscopy. Surgery is the only treatment modality that consistently eradicates all macroscopic diseases and can be carried out at the same time as diagnosis. There is no evidence that medical treatment is superior to surgical treatment. Surgical removal of endometriotic lesions is the only treatment that improves spontaneous conception rates in endometriosis-associated infertility. The evidence for the surgical techniques and energy modalities used for the surgical management of minimal to moderate endometriosis, endometriomas and recto-vaginal disease are described in greater detail.

Group B streptococci can be isolated from the vagina of 15–40% of pregnant women. Vertical transmission to the infant occurs in 50% of deliveries involving colonised women. Most infants remain asymptomatic, but 1–2% develop clinical infection, which is associated with significant morbidity and mortality. Vertical transmission can be successfully prevented by intrapartum administration of antibiotics. Other proposed methods include vaccines and intrapartum vaginal or neonatal washing with antiseptics.

Selection of women for prophylactic antibiotics can be based on risk factors, screening or a combination of both. Benefits of prophylaxis should be balanced against cost, medicalisation of labour and the risks of anaphylaxis and bacterial resistance.

We present an overview of vaginal group B streptococcal isolation methods and antenatal strategies for prevention of neonatal infection.

The etiology of endometriosis remains unclear and at the moment most of the therapeutic options are directed towards the relief of symptoms. In this context, in vitro fertilisation (IVF) overcomes anatomical distortion but our ability to influence environmental factors still seems to be limited. The improvement in pregnancy rates in endometriosis associated infertility is as important as the reduction in complications, and a careful analysis for the indications of each treatment option should be guaranteed. The use of gonadotropin releasing hormone agonists (GnRHa) for 3–6 months has shown to improve IVF outcomes, while increasing literature questions the role of surgery prior to the start of an IVF treatment cycle in views of fertility improvement. Early referral of these women to specialised centres is advised.

Endometriosis is a common condition affecting around 2–10% of women of reproductive age. Various medical therapies are in widespread use for control of symptoms, however, very little is known of the effect of these therapies on the disease itself. In addition, the natural history of the condition when left untreated is far from clearly understood. If one uses medical therapies for symptom control it is possible the underlying disease may progress insidiously such that, if surgery is required in the future, may be increasingly difficult and hazardous. We reviewed the literature to assess the efficacy of any medically treatment used in endometriosis at causing regression of disease. Despite an extensive search, this issue is addressed adequately by very few studies. The data that are available suggests medroxyprogesterone acetate (MPA) and luteal phase dydrogesterone are probably ineffective at causing disease regression whilst gestrinone appears to be effective. The effects of danazol and triptorelin are inconclusive.

Laparoscopy entered the field of gynaecology in the mid-1950s, but the technique was slow to evolve until the beginning of the 1990s, when it became more widely applied in gynecological oncology. Although few trials have looked at the safety of laparoscopy in oncology, it is now widely used for most gynaecological malignancies. Cervical cancer has probably the strongest literature devoted to it, and so far this does not seem to demonstrate a detrimental survival profile. Uterine cancer relies on laparoscopy for the initial surgery or staging of an unstaged patient. In ovarian cancer, the technique is mostly used in early cases for staging purposes, or in advanced cases before neoadjuvant chemotherapy. Trocar metastasis is probably not as frequent as initially suggested, but good surgical technique is of paramount importance in preventing this. Although laparoscopy is very promising and probably oncologically safe, and although there are few published prospective trials, the technique demands satisfactory additional training and, in the setting of gynaecological cancers, should be reserved for trained subspecialists.