Pub Date : 2013-11-14DOI: 10.1586/17474108.2013.847622
A. Ayadi, N. Robinson, S. Geller, Suellen Miller
Postpartum hemorrhage (PPH) is the largest contributor to maternal mortality, occurring in between 1 and 5% of deliveries. Prophylactic uterotonics are widely recommended to prevent atonic hemorrhage. Rapid recognition of PPH and identification of hemorrhage etiology is essential to reduce mortality and morbidity. Treatment is etiology-specific and comprises a range of medical, mechanical, temporizing and surgical procedures. Important developments from trauma and emergency medicine around massive hemorrhage protocols are newly implemented for PPH, and the evidence base for PPH medical management is expanding, with clinical trials ongoing. Improving the management of PPH in limited-resource settings will require continued attention to ensure the availability of low-cost accessible prevention and treatment options, in addition to a focus on skilled care providers.
{"title":"Advances in the treatment of postpartum hemorrhage","authors":"A. Ayadi, N. Robinson, S. Geller, Suellen Miller","doi":"10.1586/17474108.2013.847622","DOIUrl":"https://doi.org/10.1586/17474108.2013.847622","url":null,"abstract":"Postpartum hemorrhage (PPH) is the largest contributor to maternal mortality, occurring in between 1 and 5% of deliveries. Prophylactic uterotonics are widely recommended to prevent atonic hemorrhage. Rapid recognition of PPH and identification of hemorrhage etiology is essential to reduce mortality and morbidity. Treatment is etiology-specific and comprises a range of medical, mechanical, temporizing and surgical procedures. Important developments from trauma and emergency medicine around massive hemorrhage protocols are newly implemented for PPH, and the evidence base for PPH medical management is expanding, with clinical trials ongoing. Improving the management of PPH in limited-resource settings will require continued attention to ensure the availability of low-cost accessible prevention and treatment options, in addition to a focus on skilled care providers.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"175 1","pages":"525-537"},"PeriodicalIF":0.0,"publicationDate":"2013-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77784189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.847638
T. Kalir, A. Firpo-Betancourt, F. Nezhat
Among American women, the most common cause of death from gynecologic malignancy is ovarian cancer. With the discovery and publicizing of hereditary cancer gene mutations, patients are actively seeking their physician’s advice on how to manage risk. As a cancer prevention measure, risk-reducing surgery has become a popular procedure. Based on studies of salpingo-oophorectomies from BRCA-positive women, the fallopian tube has been put forth as the cause of high-grade ovarian cancer. More recently, ovarian surface hilar stem cells have been suggested as the putative cells of origin. In this exciting time of new thinking about its origins, we stand on the threshold of new and promising strategies for more precise management of ovarian cancer patients.
{"title":"Update on ovarian cancer pathogenesis: history, controversies, emerging issues and future impact","authors":"T. Kalir, A. Firpo-Betancourt, F. Nezhat","doi":"10.1586/17474108.2013.847638","DOIUrl":"https://doi.org/10.1586/17474108.2013.847638","url":null,"abstract":"Among American women, the most common cause of death from gynecologic malignancy is ovarian cancer. With the discovery and publicizing of hereditary cancer gene mutations, patients are actively seeking their physician’s advice on how to manage risk. As a cancer prevention measure, risk-reducing surgery has become a popular procedure. Based on studies of salpingo-oophorectomies from BRCA-positive women, the fallopian tube has been put forth as the cause of high-grade ovarian cancer. More recently, ovarian surface hilar stem cells have been suggested as the putative cells of origin. In this exciting time of new thinking about its origins, we stand on the threshold of new and promising strategies for more precise management of ovarian cancer patients.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"1 1","pages":"539-547"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72976125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.848596
Monica N Modi, R. Heitmann, A. Armstrong
Unintended pregnancies are a worldwide problem, which disproportionately impact developing countries. Studies estimate that 41% of the 208 million pregnancies that occurred in 2008 were unintended....
{"title":"Unintended pregnancy and the role of long-acting reversible contraception","authors":"Monica N Modi, R. Heitmann, A. Armstrong","doi":"10.1586/17474108.2013.848596","DOIUrl":"https://doi.org/10.1586/17474108.2013.848596","url":null,"abstract":"Unintended pregnancies are a worldwide problem, which disproportionately impact developing countries. Studies estimate that 41% of the 208 million pregnancies that occurred in 2008 were unintended....","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"25 1 1","pages":"549-558"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76555294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.842689
J. Boyle, H. Teede, M. Misso
Polycystic ovary syndrome (PCOS) is one of the most common medical conditions in women of reproductive age and the most common cause of anovulatory infertility. Insulin resistance is one of the underpinning features of PCOS in most women. Metformin can improve insulin resistance and was introduced as a pharmacological agent to treat anovulation and infertility in the 1990s. Metformin does not increase ovarian hyperstimulation or multiple pregnancies and may in some clinical situations have a role as a single agent or in combination with clomiphene citrate (CC) however the evidence supports the efficacy of lifestyle intervention as first-line treatment for PCOS anovulatory infertility followed by CC. Here, we discuss the role of metformin in light of other therapies for the treatment of anovulatory infertility in women with PCOS.
{"title":"Infertility in women with polycystic ovary syndrome and the role of metformin in management","authors":"J. Boyle, H. Teede, M. Misso","doi":"10.1586/17474108.2013.842689","DOIUrl":"https://doi.org/10.1586/17474108.2013.842689","url":null,"abstract":"Polycystic ovary syndrome (PCOS) is one of the most common medical conditions in women of reproductive age and the most common cause of anovulatory infertility. Insulin resistance is one of the underpinning features of PCOS in most women. Metformin can improve insulin resistance and was introduced as a pharmacological agent to treat anovulation and infertility in the 1990s. Metformin does not increase ovarian hyperstimulation or multiple pregnancies and may in some clinical situations have a role as a single agent or in combination with clomiphene citrate (CC) however the evidence supports the efficacy of lifestyle intervention as first-line treatment for PCOS anovulatory infertility followed by CC. Here, we discuss the role of metformin in light of other therapies for the treatment of anovulatory infertility in women with PCOS.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"51 1","pages":"581-586"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91097970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.842684
J. Zarek, K. Delano, C. Nickel, C. Laskin, G. Koren
HMG-CoA reductase inhibitors (statins) are increasingly being prescribed. Their safety during pregnancy has not been determined. Statins are contraindicated during pregnancy based on the overarching concept that their benefits do not outweigh potential fetal risks of exposure. The role of cholesterol during gestation, combined with teratogenic effects seen in animal testing of lovastatin has supported this contraindication. However, statins have become exceedingly popular, women are delaying pregnancy, and obesity and subsequent cardiovascular risk has increased. The time off of therapy may have detrimental effects to both the fetus and mother. Additionally, statins have been shown to have benefits not related to cholesterol lowering effects, known as pleiotropic effects. These indications may support use during pregnancy for obstetrical complications. This article will systematically review statin safety during pregnancy. Included, we present a meta-analysis of controlled studies in an attempt to provide...
{"title":"Are statins teratogenic in humans? Addressing the safety of statins in light of potential benefits during pregnancy","authors":"J. Zarek, K. Delano, C. Nickel, C. Laskin, G. Koren","doi":"10.1586/17474108.2013.842684","DOIUrl":"https://doi.org/10.1586/17474108.2013.842684","url":null,"abstract":"HMG-CoA reductase inhibitors (statins) are increasingly being prescribed. Their safety during pregnancy has not been determined. Statins are contraindicated during pregnancy based on the overarching concept that their benefits do not outweigh potential fetal risks of exposure. The role of cholesterol during gestation, combined with teratogenic effects seen in animal testing of lovastatin has supported this contraindication. However, statins have become exceedingly popular, women are delaying pregnancy, and obesity and subsequent cardiovascular risk has increased. The time off of therapy may have detrimental effects to both the fetus and mother. Additionally, statins have been shown to have benefits not related to cholesterol lowering effects, known as pleiotropic effects. These indications may support use during pregnancy for obstetrical complications. This article will systematically review statin safety during pregnancy. Included, we present a meta-analysis of controlled studies in an attempt to provide...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"59 1","pages":"513-524"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87588774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.849418
Sajal Gupta, Jennifer Fedor, Kelly R Biedenharn, A. Agarwal
At present, between 10 to 15% of couples are infertile, and half of all infertility cases are credited to a female factor. Determination of the source of the problem may hold the key to improving fertility for women. Emerging research demonstrates that reactive oxygen species and oxidative stress (OS) have strong connections with female reproductive function; increases in OS which is associated with certain lifestyle factors can negatively impact female fertility. Lifestyle factors including being obese or underweight, exercising, cigarette smoking, alcohol and caffeine consumption, drug use, psychological stress and environmental and occupational exposures can all have adverse effects on fertility due to their complex interactions and impact exerted via OS on female reproductive processes. Our review highlights these linkages to explain their impact on female fertility, as well as provide suggestions to reduce OS and improve reproductive potential in women.
{"title":"Lifestyle factors and oxidative stress in female infertility: is there an evidence base to support the linkage?","authors":"Sajal Gupta, Jennifer Fedor, Kelly R Biedenharn, A. Agarwal","doi":"10.1586/17474108.2013.849418","DOIUrl":"https://doi.org/10.1586/17474108.2013.849418","url":null,"abstract":"At present, between 10 to 15% of couples are infertile, and half of all infertility cases are credited to a female factor. Determination of the source of the problem may hold the key to improving fertility for women. Emerging research demonstrates that reactive oxygen species and oxidative stress (OS) have strong connections with female reproductive function; increases in OS which is associated with certain lifestyle factors can negatively impact female fertility. Lifestyle factors including being obese or underweight, exercising, cigarette smoking, alcohol and caffeine consumption, drug use, psychological stress and environmental and occupational exposures can all have adverse effects on fertility due to their complex interactions and impact exerted via OS on female reproductive processes. Our review highlights these linkages to explain their impact on female fertility, as well as provide suggestions to reduce OS and improve reproductive potential in women.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"47 1","pages":"607-624"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76010032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.847620
I. Casikar, G. Condous
Over the past three decades, the diagno-sis and management of ectopic preg-nancy (EP) has witnessed significantchange. Key developments have been agreater awareness of EPs, tertiary hospi-tal early pregnancy units (EPUs), intro-duction of high resolution transvaginalultrasound (TVS) probes and availabilityof accurate and rapid serum human cho-rionic gonadotrophin (hCG) assays.However, EP is still a leading cause ofmaternal mortality and significant mor-bidity worldwide. On the basis of themost recent figures from the UK, EPaccounts for 54% of all first trimestermaternal deaths
{"title":"How to effectively diagnose ectopic pregnancy using ultrasound","authors":"I. Casikar, G. Condous","doi":"10.1586/17474108.2013.847620","DOIUrl":"https://doi.org/10.1586/17474108.2013.847620","url":null,"abstract":"Over the past three decades, the diagno-sis and management of ectopic preg-nancy (EP) has witnessed significantchange. Key developments have been agreater awareness of EPs, tertiary hospi-tal early pregnancy units (EPUs), intro-duction of high resolution transvaginalultrasound (TVS) probes and availabilityof accurate and rapid serum human cho-rionic gonadotrophin (hCG) assays.However, EP is still a leading cause ofmaternal mortality and significant mor-bidity worldwide. On the basis of themost recent figures from the UK, EPaccounts for 54% of all first trimestermaternal deaths","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"36 1","pages":"493-495"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87713980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.841452
D. Archer, I. Fraser
Heavy menstrual bleeding (HMB) seriously impacts physical and mental well-being of many women during their lifetimes. Many women turn to primary care providers or gynecologists seeking relief and resort to invasive surgical procedures such as endometrial ablation and/or hysterectomy. Pharmaceutical agents (e.g., progestogens, combined oral contraceptives, nonsteroidal anti-inflammatory drugs, hormone-releasing intrauterine devices and hemostatic agents) are all options for women who wish to avoid risks inherent to surgery, maintain fertility and limit the potential for early onset of menopausal symptoms. The response to these agents can be unpredictable and may depend on clinical- and patient-related factors. Agents with a contraceptive effect are not appropriate for women wishing to conceive. Tranexamic acid, an antifibrinolytic, has been used worldwide for over 50 years to effectively treat HMB, but a modified immediate-release formulation was only recently approved in the USA as the only approved treat...
{"title":"An expert review and commentary on the efficacy and safety of tranexamic acid for the treatment of heavy menstrual bleeding","authors":"D. Archer, I. Fraser","doi":"10.1586/17474108.2013.841452","DOIUrl":"https://doi.org/10.1586/17474108.2013.841452","url":null,"abstract":"Heavy menstrual bleeding (HMB) seriously impacts physical and mental well-being of many women during their lifetimes. Many women turn to primary care providers or gynecologists seeking relief and resort to invasive surgical procedures such as endometrial ablation and/or hysterectomy. Pharmaceutical agents (e.g., progestogens, combined oral contraceptives, nonsteroidal anti-inflammatory drugs, hormone-releasing intrauterine devices and hemostatic agents) are all options for women who wish to avoid risks inherent to surgery, maintain fertility and limit the potential for early onset of menopausal symptoms. The response to these agents can be unpredictable and may depend on clinical- and patient-related factors. Agents with a contraceptive effect are not appropriate for women wishing to conceive. Tranexamic acid, an antifibrinolytic, has been used worldwide for over 50 years to effectively treat HMB, but a modified immediate-release formulation was only recently approved in the USA as the only approved treat...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"154 1","pages":"499-511"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79715557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.850857
Rehana A Salam, Jai K. Das, A. Ali, Z. Lassi, Z. Bhutta
Though many countries are on-track in reducing poverty, less than a quarter of developing countries are on-track for achieving the goal of halving undernutrition. Maternal undernutrition is widely prevalent among women in the developing countries and encompasses both chronic energy as well as micronutrient deficiencies. Maternal undernutrition leads to intrauterine growth restriction and consequent low birth weight, stunting, wasting, underweight and other micronutrient deficiencies along with conditions predisposing to mortality. There are no effective therapies to reverse intrauterine growth restriction; hence focus should be on preventive strategies. In developing countries, the interventions likely to have the largest impact on intrauterine growth include caloric and micronutrient supplementation before and during pregnancy, coupled with supportive strategies for improving nutrition.
{"title":"Maternal undernutrition and intrauterine growth restriction","authors":"Rehana A Salam, Jai K. Das, A. Ali, Z. Lassi, Z. Bhutta","doi":"10.1586/17474108.2013.850857","DOIUrl":"https://doi.org/10.1586/17474108.2013.850857","url":null,"abstract":"Though many countries are on-track in reducing poverty, less than a quarter of developing countries are on-track for achieving the goal of halving undernutrition. Maternal undernutrition is widely prevalent among women in the developing countries and encompasses both chronic energy as well as micronutrient deficiencies. Maternal undernutrition leads to intrauterine growth restriction and consequent low birth weight, stunting, wasting, underweight and other micronutrient deficiencies along with conditions predisposing to mortality. There are no effective therapies to reverse intrauterine growth restriction; hence focus should be on preventive strategies. In developing countries, the interventions likely to have the largest impact on intrauterine growth include caloric and micronutrient supplementation before and during pregnancy, coupled with supportive strategies for improving nutrition.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"59 1","pages":"559-567"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83589674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-11-01DOI: 10.1586/17474108.2013.851533
S. Raman, V. Sung
Over 200 million people worldwide suffer from urinary incontinence. Urinary incontinence in women occurs frequently from middle age onward and is associated with a reduced quality of life. Stress urinary incontinence (SUI) is leakage of urine during sneezing, coughing, physical exercise, lifting, bending or even changing positions. These are all events that cause an increase in intra-abdominal pressure. SUI occurs when bladder pressure exceeds urethral pressure, in the setting of sudden increases of intra-abdominal forces. SUI affects upward of 40% of American women. The placement of the midurethral sling theoretically corrects inadequate urethral support. After a thorough understanding of potential complications, a patient may benefit from this safe and effective procedure that can improve a woman’s quality of life.
{"title":"The use of midurethral sling for the treatment of urinary incontinence","authors":"S. Raman, V. Sung","doi":"10.1586/17474108.2013.851533","DOIUrl":"https://doi.org/10.1586/17474108.2013.851533","url":null,"abstract":"Over 200 million people worldwide suffer from urinary incontinence. Urinary incontinence in women occurs frequently from middle age onward and is associated with a reduced quality of life. Stress urinary incontinence (SUI) is leakage of urine during sneezing, coughing, physical exercise, lifting, bending or even changing positions. These are all events that cause an increase in intra-abdominal pressure. SUI occurs when bladder pressure exceeds urethral pressure, in the setting of sudden increases of intra-abdominal forces. SUI affects upward of 40% of American women. The placement of the midurethral sling theoretically corrects inadequate urethral support. After a thorough understanding of potential complications, a patient may benefit from this safe and effective procedure that can improve a woman’s quality of life.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"40 1","pages":"597-606"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79470110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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