Ultrasound is an important investigational tool used in the antenatal period, and is increasingly being used in labor and the peripartum period. Research over the past two decades has focused on establishing objective ultrasound parameters to define fetal gestational age/estimated fetal weight in labor, to identify fetuses at risk of compromise in labor, to predict mode of delivery and to enhance the safety of operative deliveries. This review outlines the role of these various uses of ultrasound and explores whether there may be a role for routine use of ultrasound in the management of labor and delivery.
{"title":"Role of ultrasound on the labor ward","authors":"M. Ramphul, D. Murphy","doi":"10.1586/EOG.12.58","DOIUrl":"https://doi.org/10.1586/EOG.12.58","url":null,"abstract":"Ultrasound is an important investigational tool used in the antenatal period, and is increasingly being used in labor and the peripartum period. Research over the past two decades has focused on establishing objective ultrasound parameters to define fetal gestational age/estimated fetal weight in labor, to identify fetuses at risk of compromise in labor, to predict mode of delivery and to enhance the safety of operative deliveries. This review outlines the role of these various uses of ultrasound and explores whether there may be a role for routine use of ultrasound in the management of labor and delivery.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"17 1","pages":"615-625"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78034693","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}
Dzhamala Gilmandyar, Paula Zozzaro-Smith, L. Thornburg
Obesity is increasing worldwide, especially in the USA. This is reflected in the pregnant population, with up to a third of women classified as obese during their pregnancy. It poses a challenge to the practitioners throughout pregnancy, labor and delivery, as well as in postpartum care. Obesity is also a risk factor for multiple pregnancy complications including gestational diabetes, hypertensive disorders of pregnancy, iatrogenic preterm birth, fetal macrosomia and intrauterine fetal demise. Antenatal care challenges, including limitation of fetal ultrasound evaluation, contribute to a greater number of undetected anomalies and poor fetal weight estimation. Maternal risks such as increased rates of cesarean section, and subsequent postoperative complications such as wound infection and venous thromboembolic events, are increasing in prevalence. Optimal prenatal care requires knowledge of and attention to each of these risks and appropriate patient counseling.
{"title":"Complications and challenges in management of the obese expectant mother","authors":"Dzhamala Gilmandyar, Paula Zozzaro-Smith, L. Thornburg","doi":"10.1586/EOG.12.53","DOIUrl":"https://doi.org/10.1586/EOG.12.53","url":null,"abstract":"Obesity is increasing worldwide, especially in the USA. This is reflected in the pregnant population, with up to a third of women classified as obese during their pregnancy. It poses a challenge to the practitioners throughout pregnancy, labor and delivery, as well as in postpartum care. Obesity is also a risk factor for multiple pregnancy complications including gestational diabetes, hypertensive disorders of pregnancy, iatrogenic preterm birth, fetal macrosomia and intrauterine fetal demise. Antenatal care challenges, including limitation of fetal ultrasound evaluation, contribute to a greater number of undetected anomalies and poor fetal weight estimation. Maternal risks such as increased rates of cesarean section, and subsequent postoperative complications such as wound infection and venous thromboembolic events, are increasing in prevalence. Optimal prenatal care requires knowledge of and attention to each of these risks and appropriate patient counseling.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"35 1","pages":"585-593"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78369831","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}
{"title":"Associated risks of inducing labor at term in an uncomplicated pregnancy","authors":"R. Grivell, J. Dodd","doi":"10.1586/EOG.12.42","DOIUrl":"https://doi.org/10.1586/EOG.12.42","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"29 1","pages":"403-405"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84155314","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}
J. Alcázar, M. Aubá, Á. Ruiz-Zambrana, B. Olartecoechea, D. Diaz, J. Hidalgo, L. Pineda, J. Utrilla-Layna
Adnexal masses are among the most frequent pathologic conditions in gynecologic practice. Ultrasound is widely used for discriminating benign from malignant adnexal masses. Despite the significant amount of papers published about this topic in the last 30 years, research still goes on and new data appear almost every year. The objective of the present paper is to review and update published literature in the last 5 years about adnexal masses. From the studies reported in recent years it can be concluded that the use of pattern recognition by an expert examiner renders the best result in terms of diagnostic performance. Scoring systems or logistic models are not superior to subjective impression of an expert examiner. New technologies such as contrast ultrasound imaging, ovarian HistoScanning and 3D ultrasound are emerging.
{"title":"Ultrasound assessment in adnexal masses: an update","authors":"J. Alcázar, M. Aubá, Á. Ruiz-Zambrana, B. Olartecoechea, D. Diaz, J. Hidalgo, L. Pineda, J. Utrilla-Layna","doi":"10.1586/EOG.12.49","DOIUrl":"https://doi.org/10.1586/EOG.12.49","url":null,"abstract":"Adnexal masses are among the most frequent pathologic conditions in gynecologic practice. Ultrasound is widely used for discriminating benign from malignant adnexal masses. Despite the significant amount of papers published about this topic in the last 30 years, research still goes on and new data appear almost every year. The objective of the present paper is to review and update published literature in the last 5 years about adnexal masses. From the studies reported in recent years it can be concluded that the use of pattern recognition by an expert examiner renders the best result in terms of diagnostic performance. Scoring systems or logistic models are not superior to subjective impression of an expert examiner. New technologies such as contrast ultrasound imaging, ovarian HistoScanning and 3D ultrasound are emerging.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"3 1","pages":"441-449"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84193653","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}
Twin–twin transfusion syndrome is characterized by unequal blood exchange from the donor twin to the recipient co-twin through placental vascular anastomoses. Treatment of twin–twin transfusion syndrome consists of serial amnioreduction, septostomy, laser photocoagulation of placental vessels and umbilical cord occlusion of the apparently sick twin. Amnioreduction reduces maternal discomfort due to polyhydramnios and improves fetal circulation by reducing amniotic fluid pressure on the placenta. Septostomy equalizes amniotic fluid pressure between the two gestational sacs. Laser therapy interrupts intertwin blood shunting and restores two independent circulations. Umbilical cord occlusion is offered when signs of imminent death are present, such as hydrops and cardiac failure. Laser therapy is associated with increased neonatal survival rates and lower risk of adverse outcomes compared with other treatments.
{"title":"Treatment of twin–twin transfusion syndrome","authors":"A. Rossi","doi":"10.1586/EOG.12.45","DOIUrl":"https://doi.org/10.1586/EOG.12.45","url":null,"abstract":"Twin–twin transfusion syndrome is characterized by unequal blood exchange from the donor twin to the recipient co-twin through placental vascular anastomoses. Treatment of twin–twin transfusion syndrome consists of serial amnioreduction, septostomy, laser photocoagulation of placental vessels and umbilical cord occlusion of the apparently sick twin. Amnioreduction reduces maternal discomfort due to polyhydramnios and improves fetal circulation by reducing amniotic fluid pressure on the placenta. Septostomy equalizes amniotic fluid pressure between the two gestational sacs. Laser therapy interrupts intertwin blood shunting and restores two independent circulations. Umbilical cord occlusion is offered when signs of imminent death are present, such as hydrops and cardiac failure. Laser therapy is associated with increased neonatal survival rates and lower risk of adverse outcomes compared with other treatments.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"234 1","pages":"477-482"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77339556","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}
{"title":"Obesity and pregnancy: implications for maternal and fetal outcomes","authors":"M. Lučovnik, N. Tul, I. Blickstein","doi":"10.1586/EOG.12.47","DOIUrl":"https://doi.org/10.1586/EOG.12.47","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"8 1","pages":"399-401"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84813455","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}
World Congress on Building Consensus in Gynecology, Infertility and PerinatologyBarcelona, Spain, 3–6 May 2012.On 3–6 May 2012 The World Congress on Building Consensus out of Controversies in Gynecology, Infertility and Perinatology was held in Barcelona (Spain) and as usual there was discussion of topics from the disciplines of obstetrics, gynecology and infertility. The congress was very well organized, with a very satisfactory attendance of approximately 1000 participants.
{"title":"World Congress on Building Consensus in Gynecology, Infertility and Perinatology: controversies in obstetrics, gynecology and infertility","authors":"P. Barri","doi":"10.1586/eog.12.43","DOIUrl":"https://doi.org/10.1586/eog.12.43","url":null,"abstract":"World Congress on Building Consensus in Gynecology, Infertility and PerinatologyBarcelona, Spain, 3–6 May 2012.On 3–6 May 2012 The World Congress on Building Consensus out of Controversies in Gynecology, Infertility and Perinatology was held in Barcelona (Spain) and as usual there was discussion of topics from the disciplines of obstetrics, gynecology and infertility. The congress was very well organized, with a very satisfactory attendance of approximately 1000 participants.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"1 1","pages":"411-412"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79899982","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}
Endometriosis is a common gynecological disorder affecting mostly women of reproductive age. Its presenting symptoms include dysmenorrhea, chronic pelvic pain and infertility. There is a pressing need to develop more efficacious therapeutics, preferably with improved safety and cost profiles. Unfortunately, thus far the drug development progress has been frustratingly slow. In this article, published data in support of the notion that endometriosis is an epigenetic disease are reviewed. The desirable properties of histone deacetylase inhibitors as therapeutics for treating endometriosis are enumerated, and the obstacles in evaluating histone deacetylases in clinical trials are listed. It is argued that, from the drug discovery standpoint, repurposing of valproic acid is justifiable. Finally, the areas in need of further research are exposed.
{"title":"Histone deacetylase inhibitors as therapeutics for endometriosis","authors":"Xin Li, Xi-shi Liu, Sun-Wei Guo","doi":"10.1586/EOG.12.52","DOIUrl":"https://doi.org/10.1586/EOG.12.52","url":null,"abstract":"Endometriosis is a common gynecological disorder affecting mostly women of reproductive age. Its presenting symptoms include dysmenorrhea, chronic pelvic pain and infertility. There is a pressing need to develop more efficacious therapeutics, preferably with improved safety and cost profiles. Unfortunately, thus far the drug development progress has been frustratingly slow. In this article, published data in support of the notion that endometriosis is an epigenetic disease are reviewed. The desirable properties of histone deacetylase inhibitors as therapeutics for treating endometriosis are enumerated, and the obstacles in evaluating histone deacetylases in clinical trials are listed. It is argued that, from the drug discovery standpoint, repurposing of valproic acid is justifiable. Finally, the areas in need of further research are exposed.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"30 1","pages":"451-466"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81022623","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}
While the use of injectable bulking agents in the treatment of stress urinary incontinence may be infrequently considered due to lack of permanence, properly injected agents can be a good initial, minimally invasive, therapy or an excellent second-line therapy in very complex patients. Proper patient counseling and selection are essential to successful treatment. The use of bulking agents in fecal incontinence is young, with the refined technique and defined outcomes yet to be determined.
{"title":"Injectable bulking agents in fecal and urinary incontinence: current agents, techniques and rationale for their use","authors":"C. Jaeger, A. Carrasco, D. Lightner","doi":"10.1586/EOG.12.50","DOIUrl":"https://doi.org/10.1586/EOG.12.50","url":null,"abstract":"While the use of injectable bulking agents in the treatment of stress urinary incontinence may be infrequently considered due to lack of permanence, properly injected agents can be a good initial, minimally invasive, therapy or an excellent second-line therapy in very complex patients. Proper patient counseling and selection are essential to successful treatment. The use of bulking agents in fecal incontinence is young, with the refined technique and defined outcomes yet to be determined.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"32 1","pages":"431-440"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74411477","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}
L. Lazzeri, C. Tosti, S. Pinzauti, C. Orlandini, S. Luisi, F. Petraglia
Endometriosis is a chronic inflammatory disease characterized by dysmenorrhea, dyspareunia and infertility, which may be treated surgically and/or medically. The medical treatment of endometriosis may be used as a first-line option, as an alternative to surgery and for postoperative adjuvant use. The most commonly used drugs are hormones, which act via two major strategies: iatrogenic menopause and pseudopregnancy. In both cases, the goal is to create a steady hormonal environment with inhibition of ovulation, suppressing the ectopic implants and reducing the inflammatory status as well as the associated pain symptoms. The blockade of the growth and activity of endometriotic lesions is obtained, and long-term or repeated courses of medication may be required to control symptoms. To obtain reduced ovarian activity, gonadotropin-releasing hormone analogs, gonadotropin-releasing hormone analog antagonists or aromatase inhibitors are currently used or are under investigation. Pseudopregnancy is obtained by th...
{"title":"Hormonal strategy for the primary or secondary treatment of endometriosis","authors":"L. Lazzeri, C. Tosti, S. Pinzauti, C. Orlandini, S. Luisi, F. Petraglia","doi":"10.1586/EOG.12.46","DOIUrl":"https://doi.org/10.1586/EOG.12.46","url":null,"abstract":"Endometriosis is a chronic inflammatory disease characterized by dysmenorrhea, dyspareunia and infertility, which may be treated surgically and/or medically. The medical treatment of endometriosis may be used as a first-line option, as an alternative to surgery and for postoperative adjuvant use. The most commonly used drugs are hormones, which act via two major strategies: iatrogenic menopause and pseudopregnancy. In both cases, the goal is to create a steady hormonal environment with inhibition of ovulation, suppressing the ectopic implants and reducing the inflammatory status as well as the associated pain symptoms. The blockade of the growth and activity of endometriotic lesions is obtained, and long-term or repeated courses of medication may be required to control symptoms. To obtain reduced ovarian activity, gonadotropin-releasing hormone analogs, gonadotropin-releasing hormone analog antagonists or aromatase inhibitors are currently used or are under investigation. Pseudopregnancy is obtained by th...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"15 1","pages":"467-476"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75991005","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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