Pub Date : 2019-11-30DOI: 10.1097/01.PGO.0000604388.62943.e8
J. Johal, R. Alvero
as androstenedione and testosterone. These corticosteroids then move across to the granulosa cells where aromatase, stimulated by FSH, converts the androstenedione to estrone and, to a lesser extent, testosterone to estradiol.2 Subsequently, estrone is converted to estradiol by 17-β hydroxysteroid dehydrogenase (Figure 2). The conversion of androgens to estrogens is called aromatization and is inhibited by aromatase inhibitors. Aromatase inhibitors have 2 primary mechanisms of action. First, they reduce estradiol levels, which in turn blocks estradiol’s impact on estrogen-sensitive end organs. Second, a reduction of estradiol levels decreases the feedback inhibition of the hypothalamic-pituitary-ovarian (HPO) axis, leading to an increase in GnRH secretion and therefore an increase in pituitary gonadotropins (Figure 1B). This article reviews a variety of potential uses of aromatase inhibitors in the field of gynecology. It is important for obstetricians/gynecologists to understand the current evidence around their use and apply it toward potential treatment options for their patients.
{"title":"Aromatase Inhibitors in Gynecology","authors":"J. Johal, R. Alvero","doi":"10.1097/01.PGO.0000604388.62943.e8","DOIUrl":"https://doi.org/10.1097/01.PGO.0000604388.62943.e8","url":null,"abstract":"as androstenedione and testosterone. These corticosteroids then move across to the granulosa cells where aromatase, stimulated by FSH, converts the androstenedione to estrone and, to a lesser extent, testosterone to estradiol.2 Subsequently, estrone is converted to estradiol by 17-β hydroxysteroid dehydrogenase (Figure 2). The conversion of androgens to estrogens is called aromatization and is inhibited by aromatase inhibitors. Aromatase inhibitors have 2 primary mechanisms of action. First, they reduce estradiol levels, which in turn blocks estradiol’s impact on estrogen-sensitive end organs. Second, a reduction of estradiol levels decreases the feedback inhibition of the hypothalamic-pituitary-ovarian (HPO) axis, leading to an increase in GnRH secretion and therefore an increase in pituitary gonadotropins (Figure 1B). This article reviews a variety of potential uses of aromatase inhibitors in the field of gynecology. It is important for obstetricians/gynecologists to understand the current evidence around their use and apply it toward potential treatment options for their patients.","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123134302","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 : 2019-10-31DOI: 10.1097/01.pgo.0000585124.44107.2c
Beau Y Park
Most large adnexal masses greater than 10 cm are benign.5 Nevertheless, identifying a potential malignancy and determining referral to a gynecologic oncologist is the first important step in management of any adnexal mass. Assessing the likelihood of malignancy is based on a thor ough investigation that includes age and reproductive status, risk factors such as personal and family history, physical examination, characteristics on imaging, and biomarkers. In 2008, the International Ovarian Tumor Analysis group developed the Simple Rules, which lists a set of 5 ultra sound features indicative of a benign tumor and 5 ultra sound features of a malignant tumor (Table 1).6 The tumor is classified as benign if it only has benign features and malignant if it only has malignant features. Incorporating these rules in diagnostic evaluation allows up to 89% of all masses to be classified with a sensitivity of 95% and speci ficity of 95%.7,8 The updated American College of Obstetricians and Gynecologists/Society of Gynecologic Oncology Committee Opinion from March 2011 recommends consid eration of referral to a gynecologic oncologist when a woman has a pelvic mass suspicious for a neoplasm with the presence of at least one of the following9:
{"title":"Endoscopic Management of the Large Benign Adnexal Mass","authors":"Beau Y Park","doi":"10.1097/01.pgo.0000585124.44107.2c","DOIUrl":"https://doi.org/10.1097/01.pgo.0000585124.44107.2c","url":null,"abstract":"Most large adnexal masses greater than 10 cm are benign.5 Nevertheless, identifying a potential malignancy and determining referral to a gynecologic oncologist is the first important step in management of any adnexal mass. Assessing the likelihood of malignancy is based on a thor ough investigation that includes age and reproductive status, risk factors such as personal and family history, physical examination, characteristics on imaging, and biomarkers. In 2008, the International Ovarian Tumor Analysis group developed the Simple Rules, which lists a set of 5 ultra sound features indicative of a benign tumor and 5 ultra sound features of a malignant tumor (Table 1).6 The tumor is classified as benign if it only has benign features and malignant if it only has malignant features. Incorporating these rules in diagnostic evaluation allows up to 89% of all masses to be classified with a sensitivity of 95% and speci ficity of 95%.7,8 The updated American College of Obstetricians and Gynecologists/Society of Gynecologic Oncology Committee Opinion from March 2011 recommends consid eration of referral to a gynecologic oncologist when a woman has a pelvic mass suspicious for a neoplasm with the presence of at least one of the following9:","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114012677","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 : 2019-09-30DOI: 10.1097/01.PGO.0000580112.70584.ff
B. Slocum, V. Gomez-Lobo
To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This activity expires on September 29, 2021. abundance of offspring is vital for propagation and economic growth of society. Declining fertility will have tremendous impact on population demographics and availability of a healthy labor force, which will in turn have impacts on the division of political power, culture, and gross domestic product.2 Conventional demographic and economic theories argue that declining fertility is due to social and economic development. The chain of causation reasons that development, including increases in industrialization, and education have led to an alteration in human capital formation primarily through a decrease in the benefits of child rearing, an increase in its cost, and a decrease in infant mortality.3 Simultaneously, there has been an increase in family planning programs and contraceptive use, and a delay in the timing of motherhood. However, there is increasing concern that chemical environmental contaminants as part of economic development may also be contributing to decreasing fertility. This is in part because rising industrialization has been accompanied by a waxing trend in environmental regulation, which has led to an increase in chemical environmental pollutants.4,5 Furthermore, industrialization has independently been associated with declining fertility.6 The impact and contribution of these environmental pollutants on female fertility are largely underexplored and unknown, and subsequently serve as impetus for this review. This is not intended to be an exhaustive review of all of the available information related to the environmental impacts on female fertility. Instead, our purpose is to evaluate some of the more representative (and frequently cited) examples in order to assess the strength of support. It is Globally, fertility has declined in virtually all regions of the world. In addition to changes in socioeconomic structures related to industrialization, chemical environmental contaminants, including air pollutants, are hypothesized to contribute to declining fertility rates worldwide. This article presents some of the representative (and frequently cited) literature on the effects of various endocrine disruptors, heavy metals, and air pollution on female fertility. There is substantial evidence to suggest that these classes of chemicals have a negative impact on fertility, although further research is needed to fully elucidate the impacts and mechanisms. Fertility worldwide is expected to decline from a rate of 2.5 births per woman in 2010–2015 to a rate of 2.2 per woman in 2045–2050. In the United States, recent data have shown that the general fertility rate has declined 1% in 2016 to 62.0 births per 1000 women age 15 to 44 years, a rate that has decreased 11% since the most recent high in 2007.1 These trends will
{"title":"Environment and Infertility","authors":"B. Slocum, V. Gomez-Lobo","doi":"10.1097/01.PGO.0000580112.70584.ff","DOIUrl":"https://doi.org/10.1097/01.PGO.0000580112.70584.ff","url":null,"abstract":"To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This activity expires on September 29, 2021. abundance of offspring is vital for propagation and economic growth of society. Declining fertility will have tremendous impact on population demographics and availability of a healthy labor force, which will in turn have impacts on the division of political power, culture, and gross domestic product.2 Conventional demographic and economic theories argue that declining fertility is due to social and economic development. The chain of causation reasons that development, including increases in industrialization, and education have led to an alteration in human capital formation primarily through a decrease in the benefits of child rearing, an increase in its cost, and a decrease in infant mortality.3 Simultaneously, there has been an increase in family planning programs and contraceptive use, and a delay in the timing of motherhood. However, there is increasing concern that chemical environmental contaminants as part of economic development may also be contributing to decreasing fertility. This is in part because rising industrialization has been accompanied by a waxing trend in environmental regulation, which has led to an increase in chemical environmental pollutants.4,5 Furthermore, industrialization has independently been associated with declining fertility.6 The impact and contribution of these environmental pollutants on female fertility are largely underexplored and unknown, and subsequently serve as impetus for this review. This is not intended to be an exhaustive review of all of the available information related to the environmental impacts on female fertility. Instead, our purpose is to evaluate some of the more representative (and frequently cited) examples in order to assess the strength of support. It is Globally, fertility has declined in virtually all regions of the world. In addition to changes in socioeconomic structures related to industrialization, chemical environmental contaminants, including air pollutants, are hypothesized to contribute to declining fertility rates worldwide. This article presents some of the representative (and frequently cited) literature on the effects of various endocrine disruptors, heavy metals, and air pollution on female fertility. There is substantial evidence to suggest that these classes of chemicals have a negative impact on fertility, although further research is needed to fully elucidate the impacts and mechanisms. Fertility worldwide is expected to decline from a rate of 2.5 births per woman in 2010–2015 to a rate of 2.2 per woman in 2045–2050. In the United States, recent data have shown that the general fertility rate has declined 1% in 2016 to 62.0 births per 1000 women age 15 to 44 years, a rate that has decreased 11% since the most recent high in 2007.1 These trends will","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116662347","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 : 2019-09-15DOI: 10.1097/01.PGO.0000579548.37054.ed
B. Long
HPV is a double-stranded DNA virus composed of 2 capsid proteins (L1 and L2) and 6 early proteins (E1, E2, and E4–E7) that participate in replication and integration into the host genome. The virus is spread by skin or mucosal contact, can integrate into cervical DNA, and becomes carcinogenic when early proteins are expressed. These oncogenes, E6 and E7, disrupt host tumor suppressor genes p53 and RB, respectively, leading to dysplastic changes. Although approximately 40 subtypes can infect the genital tract, 12 oncogenic subtypes have been identified as hrHPV subtypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59). Additional subtypes have been classified as “probably high” risk and may be included in commercial HPV tests.3,4 HPV type 16 is the most common cause of cervical cancer, whereas HPV type 18 is the second leading cause and has the strongest association with adenocarcinoma. Together, HPV 16 and 18 account for approximately 70% of cervical cancers worldwide. Persistent infection is necessary for the development of high-grade cervical dysplasia or cancer.5 Persistent HPV infection can produce high-grade changes within a few years, whereas the progression from cervical intraepithelial neoplasia (CIN) 3 to cancer typically requires an additional Widespread adoption of Pap smear-based screening in the United States in the 1950s led to a 60% decline in cervical cancer incidence over the next 5 decades. However, in the last 20 years, the incidence of cervical cancer among American women has remained relatively stable.1 Despite recommendations for universal screening, more than 12,000 women in the United States are diagnosed with cervical cancer each year. Although many of these cases occur in underserved populations with inadequate or no screening, some cases may be due to suboptimal screening strategies. Cervical cytology alone is only 50% to 60% sensitive to detect high-grade dysplasia and cervical cancer, relying on repeat specimens to obtain higher detection rates.2 Cervical cytology is even less sensitive for the detection of nonsquamous malignancies such as cervical adenocarcinoma. Highrisk human papilloma virus (hrHPV) cotesting was incorporated into most major US guidelines in 2012 to increase sensitivity for detection of cervical cancer and its precursors. Primary hrHPV testing alone has been adopted more recently as a screening method. Obstetrician/gynecologists and other primary care providers should understand the natural history of HPV infection and the strengths and weaknesses of various screening methods to choose the VOLUME 39 • NUMBER 13 September 15, 2019
{"title":"High-Risk HPV Screening for Cervical Cancer","authors":"B. Long","doi":"10.1097/01.PGO.0000579548.37054.ed","DOIUrl":"https://doi.org/10.1097/01.PGO.0000579548.37054.ed","url":null,"abstract":"HPV is a double-stranded DNA virus composed of 2 capsid proteins (L1 and L2) and 6 early proteins (E1, E2, and E4–E7) that participate in replication and integration into the host genome. The virus is spread by skin or mucosal contact, can integrate into cervical DNA, and becomes carcinogenic when early proteins are expressed. These oncogenes, E6 and E7, disrupt host tumor suppressor genes p53 and RB, respectively, leading to dysplastic changes. Although approximately 40 subtypes can infect the genital tract, 12 oncogenic subtypes have been identified as hrHPV subtypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59). Additional subtypes have been classified as “probably high” risk and may be included in commercial HPV tests.3,4 HPV type 16 is the most common cause of cervical cancer, whereas HPV type 18 is the second leading cause and has the strongest association with adenocarcinoma. Together, HPV 16 and 18 account for approximately 70% of cervical cancers worldwide. Persistent infection is necessary for the development of high-grade cervical dysplasia or cancer.5 Persistent HPV infection can produce high-grade changes within a few years, whereas the progression from cervical intraepithelial neoplasia (CIN) 3 to cancer typically requires an additional Widespread adoption of Pap smear-based screening in the United States in the 1950s led to a 60% decline in cervical cancer incidence over the next 5 decades. However, in the last 20 years, the incidence of cervical cancer among American women has remained relatively stable.1 Despite recommendations for universal screening, more than 12,000 women in the United States are diagnosed with cervical cancer each year. Although many of these cases occur in underserved populations with inadequate or no screening, some cases may be due to suboptimal screening strategies. Cervical cytology alone is only 50% to 60% sensitive to detect high-grade dysplasia and cervical cancer, relying on repeat specimens to obtain higher detection rates.2 Cervical cytology is even less sensitive for the detection of nonsquamous malignancies such as cervical adenocarcinoma. Highrisk human papilloma virus (hrHPV) cotesting was incorporated into most major US guidelines in 2012 to increase sensitivity for detection of cervical cancer and its precursors. Primary hrHPV testing alone has been adopted more recently as a screening method. Obstetrician/gynecologists and other primary care providers should understand the natural history of HPV infection and the strengths and weaknesses of various screening methods to choose the VOLUME 39 • NUMBER 13 September 15, 2019","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"37 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133498323","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 : 2019-06-21DOI: 10.1007/978-1-84800-897-7_24
M. Antero, J. Greene, C. Morosky
{"title":"Uterine Fibroid Embolization","authors":"M. Antero, J. Greene, C. Morosky","doi":"10.1007/978-1-84800-897-7_24","DOIUrl":"https://doi.org/10.1007/978-1-84800-897-7_24","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117173651","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 : 2019-05-30DOI: 10.1097/01.PGO.0000557843.47072.60
M. Singer, E. Hernandez
{"title":"Carcinoma of the Uterine Cervix: Staging and Treatment Update","authors":"M. Singer, E. Hernandez","doi":"10.1097/01.PGO.0000557843.47072.60","DOIUrl":"https://doi.org/10.1097/01.PGO.0000557843.47072.60","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"406 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116579500","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 : 2019-05-15DOI: 10.1097/01.PGO.0000557785.23325.78
B. Parikh, F. Hussain, L. Brustman
The diagnosis and important aspects in treating acute abdomen tend to be delayed due to the peculiar physiological features of pregnancy and the restrictions imposed on image diagnostic techniques such as x-ray and CT. Physicians should pay attention in this regard as any delay may seriously deteriorate the condition of both mother and fetus. Detailed questioning of the patient and abdominal findings, especially information obtained by palpation, are considered essential in making a diagnosis and determining proper treatment. Ultrasonography is noninvasive to both the mother and fetus and is useful for diagnosing illness during pregnancy, including acute abdomen, acute appendicitis, and ileus. In treating the pregnant patient, high priority should be placed on improving the patient’s condition and determining the necessity of surgery. Rather than postpone the decision to opt for surgery, the physician in charge is advised to seek additional professional opinions and enlist the support of other surgeons in order to arrive at earlier diagnosis and treatment.
{"title":"Acute Abdomen in Pregnancy","authors":"B. Parikh, F. Hussain, L. Brustman","doi":"10.1097/01.PGO.0000557785.23325.78","DOIUrl":"https://doi.org/10.1097/01.PGO.0000557785.23325.78","url":null,"abstract":"The diagnosis and important aspects in treating acute abdomen tend to be delayed due to the peculiar physiological features of pregnancy and the restrictions imposed on image diagnostic techniques such as x-ray and CT. Physicians should pay attention in this regard as any delay may seriously deteriorate the condition of both mother and fetus. Detailed questioning of the patient and abdominal findings, especially information obtained by palpation, are considered essential in making a diagnosis and determining proper treatment. Ultrasonography is noninvasive to both the mother and fetus and is useful for diagnosing illness during pregnancy, including acute abdomen, acute appendicitis, and ileus. In treating the pregnant patient, high priority should be placed on improving the patient’s condition and determining the necessity of surgery. Rather than postpone the decision to opt for surgery, the physician in charge is advised to seek additional professional opinions and enlist the support of other surgeons in order to arrive at earlier diagnosis and treatment.","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130008522","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 : 2019-04-01DOI: 10.1097/01.PGO.0000557527.56593.eb
A. Jijon, A. Carrubba, C. DeStephano, T. Dinh
{"title":"Sentinel Lymph Node Dissection in Endometrial Cancer","authors":"A. Jijon, A. Carrubba, C. DeStephano, T. Dinh","doi":"10.1097/01.PGO.0000557527.56593.eb","DOIUrl":"https://doi.org/10.1097/01.PGO.0000557527.56593.eb","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114069533","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 : 2019-03-31DOI: 10.1097/01.PGO.0000554691.90644.2a
G. Whitmore, B. Bastow
{"title":"Cervical Stenosis: Identification and Effect on Obstetric and Gynecologic Care","authors":"G. Whitmore, B. Bastow","doi":"10.1097/01.PGO.0000554691.90644.2a","DOIUrl":"https://doi.org/10.1097/01.PGO.0000554691.90644.2a","url":null,"abstract":"","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115694963","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 : 2019-03-01DOI: 10.1097/01.PGO.0000577112.87173.44
Anjali Mitra, Krunal Patel, Lisa Gittens‐Williams
Sickle cell disease (SCD) is a chronic, multisystem disease. Despite decades of medical advances in SCD management, studies have revealed an increased risk of stillbirth, preterm delivery, small for gestational age, maternal mortality and preeclampsia, compared to the general population. Pregnant women with SCD should be cared for within the multidisciplinary team, comprised of specialist obstetricians, high risk midwives and haematologists. A national confidential enquiry into patient outcomes and death (NCEPOD), expressed concerns with a lack of consistent care for SCD patients in pregnancy. Within the UK, there is great geographical variation in the prevalence of SCD, with the highest incidence in large urban, multicultural centres. Trainee obstetricians practising outside of these areas may not gain substantial experience in managing these patients: therefore this review aims to highlight the key antenatal, intrapartum and postnatal elements involved in managing pregnant women with SCD.
{"title":"Sickle Cell Disease in Pregnancy","authors":"Anjali Mitra, Krunal Patel, Lisa Gittens‐Williams","doi":"10.1097/01.PGO.0000577112.87173.44","DOIUrl":"https://doi.org/10.1097/01.PGO.0000577112.87173.44","url":null,"abstract":"Sickle cell disease (SCD) is a chronic, multisystem disease. Despite decades of medical advances in SCD management, studies have revealed an increased risk of stillbirth, preterm delivery, small for gestational age, maternal mortality and preeclampsia, compared to the general population. Pregnant women with SCD should be cared for within the multidisciplinary team, comprised of specialist obstetricians, high risk midwives and haematologists. A national confidential enquiry into patient outcomes and death (NCEPOD), expressed concerns with a lack of consistent care for SCD patients in pregnancy. Within the UK, there is great geographical variation in the prevalence of SCD, with the highest incidence in large urban, multicultural centres. Trainee obstetricians practising outside of these areas may not gain substantial experience in managing these patients: therefore this review aims to highlight the key antenatal, intrapartum and postnatal elements involved in managing pregnant women with SCD.","PeriodicalId":193089,"journal":{"name":"Topics in Obstetrics & Gynecology","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117002103","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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