Pub Date : 2020-01-01DOI: 10.1093/med/9780198766360.003.0063
Nomonde H. Mbatani, Dominic G.D. Richards
Uterine cancers are the most common female genital cancer in the developed world and the fourth most common malignancy in women. In South Africa and most developing countries it is the second most common genital tract malignancy after cervical carcinoma. While the incidence of uterine cancers is marginally higher in developed countries (5.9 vs 4 per 100,000), the disease-specific mortality rate is higher in developing countries. Uterine cancers include tumours that develop in the endometrium (carcinomas), the endometrial support cells (endometrial stromal sarcomas), and the myometrium (sarcomas). Endometrial carcinomas represent over 90% of uterine cancers, the incidence of which is increasing and is most likely driven by longer life expectancy, obesity, and a sedentary lifestyle. Most endometrial carcinomas present in postmenopausal women; however, in women with significant risk factors (such as unopposed endogenous oestrogen production as occurs in women with polycystic ovarian syndrome) or a genetic predisposition such as hereditary non-polyposis colorectal cancer (HNPCC)/Lynch 2 syndrome, tumours may present before the age of 40 years. Sarcomas constitute less than 10% of uterine cancers, the majority of which are leiomyosarcomas. Only 2% of uterine sarcomas originate in the endometrial stromal tissue. Most sarcomas present between the age of 40 and 60 years. For the purpose of this chapter, endometrial carcinomas and sarcomas will be discussed separately.
{"title":"Uterine cancer","authors":"Nomonde H. Mbatani, Dominic G.D. Richards","doi":"10.1093/med/9780198766360.003.0063","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0063","url":null,"abstract":"Uterine cancers are the most common female genital cancer in the developed world and the fourth most common malignancy in women. In South Africa and most developing countries it is the second most common genital tract malignancy after cervical carcinoma. While the incidence of uterine cancers is marginally higher in developed countries (5.9 vs 4 per 100,000), the disease-specific mortality rate is higher in developing countries. Uterine cancers include tumours that develop in the endometrium (carcinomas), the endometrial support cells (endometrial stromal sarcomas), and the myometrium (sarcomas). Endometrial carcinomas represent over 90% of uterine cancers, the incidence of which is increasing and is most likely driven by longer life expectancy, obesity, and a sedentary lifestyle. Most endometrial carcinomas present in postmenopausal women; however, in women with significant risk factors (such as unopposed endogenous oestrogen production as occurs in women with polycystic ovarian syndrome) or a genetic predisposition such as hereditary non-polyposis colorectal cancer (HNPCC)/Lynch 2 syndrome, tumours may present before the age of 40 years. Sarcomas constitute less than 10% of uterine cancers, the majority of which are leiomyosarcomas. Only 2% of uterine sarcomas originate in the endometrial stromal tissue. Most sarcomas present between the age of 40 and 60 years. For the purpose of this chapter, endometrial carcinomas and sarcomas will be discussed separately.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123611270","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0038
V. Talaulikar, M. Matjila
Complications of early pregnancy, including pregnancy loss and threatened miscarriage, are common. Miscarriage affects almost one in five pregnancies and accounts for utilization of a significant proportion of healthcare resources. Women presenting with miscarriage should ideally be assessed, diagnosed, and managed in early pregnancy assessment units. They should be provided with comprehensive information about expectant, medical, and surgical management options, and helped to make informed decisions about their care. Early pregnancy loss can be a source of considerable distress to women and they should be provided with appropriate support and counselling. Recurrent miscarriage (RM) remains a challenge to patients and clinicians alike. Recognition of the psychosocial impact should prompt involvement of mental health specialists, counsellors, and social workers in patient management. Inconsistencies in definition (two or three consecutive miscarriages) confound research in RM. Although endocrinological, thrombotic, autoimmune, and uterine structural perturbations have been described in association with RM, antiphospholipid syndrome and embryonic karyotype abnormalities remain the two closest conditions for which a reasonable explanation can be offered to patients along with prognostication for future pregnancies. A diagnosis of RM has additional implications, not only for previable pregnancy loss, but an association with adverse obstetric and future maternal health outcomes. A global consensus on the definition of RM, along with phenotypic characterization of this heterogeneous condition would improve interpretation of available data and future research. A thorough understanding of the underlying molecular pathophysiological mechanisms in specific phenotypic categories of RM is the fundamental requisite for the advancement of this field.
{"title":"Miscarriage and recurrent miscarriage","authors":"V. Talaulikar, M. Matjila","doi":"10.1093/med/9780198766360.003.0038","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0038","url":null,"abstract":"Complications of early pregnancy, including pregnancy loss and threatened miscarriage, are common. Miscarriage affects almost one in five pregnancies and accounts for utilization of a significant proportion of healthcare resources. Women presenting with miscarriage should ideally be assessed, diagnosed, and managed in early pregnancy assessment units. They should be provided with comprehensive information about expectant, medical, and surgical management options, and helped to make informed decisions about their care. Early pregnancy loss can be a source of considerable distress to women and they should be provided with appropriate support and counselling. Recurrent miscarriage (RM) remains a challenge to patients and clinicians alike. Recognition of the psychosocial impact should prompt involvement of mental health specialists, counsellors, and social workers in patient management. Inconsistencies in definition (two or three consecutive miscarriages) confound research in RM. Although endocrinological, thrombotic, autoimmune, and uterine structural perturbations have been described in association with RM, antiphospholipid syndrome and embryonic karyotype abnormalities remain the two closest conditions for which a reasonable explanation can be offered to patients along with prognostication for future pregnancies. A diagnosis of RM has additional implications, not only for previable pregnancy loss, but an association with adverse obstetric and future maternal health outcomes. A global consensus on the definition of RM, along with phenotypic characterization of this heterogeneous condition would improve interpretation of available data and future research. A thorough understanding of the underlying molecular pathophysiological mechanisms in specific phenotypic categories of RM is the fundamental requisite for the advancement of this field.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126208261","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0013
M. Permezel, A. Shub
The importance of diabetes in pregnancy arises through two unrelated phenomena: an increased predisposition to impaired glucose tolerance in late pregnancy and an adverse impact of the increased glucose on important obstetric outcomes. There are marked differences in clinical outcomes and management between pregnancies in which a clinically significant impairment of glucose tolerance was first noticed during pregnancy (‘gestational diabetes mellitus’) and those where type 1 or type 2 diabetes mellitus had been known prior to pregnancy (‘prepregnancy diabetes’). Historically, GDM has been defined as the diagnosis of clinically significant impaired glucose tolerance in pregnancy in a woman not previously known to be diabetic. This has recently been complicated by recognizing that some diabetes mellitus will present for the first time in pregnancy and lack of clarity as to where the lower threshold for diagnosis should best be placed. Type 1 diabetes is present in approximately 0.2% of pregnant women, and the numbers are largely stable. In contrast, type 2 diabetes was once uncommon in pregnancy but is now also as high as 0.2%. This is likely to continue to increase as increased numbers of overweight and obese women enter the reproductive years. Prepregnancy diabetes provides the model of how pregnancy and maternal disease impact on each other, and how good preconception, antenatal and intrapartum care can make an enormous difference for these women and their babies.
{"title":"Diabetes in pregnancy","authors":"M. Permezel, A. Shub","doi":"10.1093/med/9780198766360.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0013","url":null,"abstract":"The importance of diabetes in pregnancy arises through two unrelated phenomena: an increased predisposition to impaired glucose tolerance in late pregnancy and an adverse impact of the increased glucose on important obstetric outcomes. There are marked differences in clinical outcomes and management between pregnancies in which a clinically significant impairment of glucose tolerance was first noticed during pregnancy (‘gestational diabetes mellitus’) and those where type 1 or type 2 diabetes mellitus had been known prior to pregnancy (‘prepregnancy diabetes’). Historically, GDM has been defined as the diagnosis of clinically significant impaired glucose tolerance in pregnancy in a woman not previously known to be diabetic. This has recently been complicated by recognizing that some diabetes mellitus will present for the first time in pregnancy and lack of clarity as to where the lower threshold for diagnosis should best be placed. Type 1 diabetes is present in approximately 0.2% of pregnant women, and the numbers are largely stable. In contrast, type 2 diabetes was once uncommon in pregnancy but is now also as high as 0.2%. This is likely to continue to increase as increased numbers of overweight and obese women enter the reproductive years. Prepregnancy diabetes provides the model of how pregnancy and maternal disease impact on each other, and how good preconception, antenatal and intrapartum care can make an enormous difference for these women and their babies.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132533228","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0050
R. Simpson, D. Nunns
This chapter aims to enhance knowledge and skills in patient assessment, vulval examination, and treatment of vulval disease, specifically dermatological conditions and vulval pain. The prompt identification and treatment of vulval conditions can reduce anxiety, alleviate symptoms, and preserve an acceptable level of functioning for patients. Often simple measures can benefit the patient (e.g. use of emollients), but many have complex disease and can present with more than one condition so careful assessment and individualized management is essential. Combining treatment strategies is sometimes needed. Vulvodynia is not a skin condition but a chronic pain syndrome and is also covered in this chapter. It is important that health professionals work within their own competencies. Patients with complicated, rare, and treatment-refractory disease should be referred on to a vulval service for a multidisciplinary opinion.
{"title":"Benign disease of the vulva","authors":"R. Simpson, D. Nunns","doi":"10.1093/med/9780198766360.003.0050","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0050","url":null,"abstract":"This chapter aims to enhance knowledge and skills in patient assessment, vulval examination, and treatment of vulval disease, specifically dermatological conditions and vulval pain. The prompt identification and treatment of vulval conditions can reduce anxiety, alleviate symptoms, and preserve an acceptable level of functioning for patients. Often simple measures can benefit the patient (e.g. use of emollients), but many have complex disease and can present with more than one condition so careful assessment and individualized management is essential. Combining treatment strategies is sometimes needed. Vulvodynia is not a skin condition but a chronic pain syndrome and is also covered in this chapter. It is important that health professionals work within their own competencies. Patients with complicated, rare, and treatment-refractory disease should be referred on to a vulval service for a multidisciplinary opinion.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131687868","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0026
D. Kanagalingam
Normal labour is a process of spontaneous expulsion of the fetus, placenta, and membranes at term. This process is initiated by complex endocrine mechanisms that cause uterine contractions which lead to effacement and dilatation of the cervix and descent of the fetus, resulting in delivery. About 10% of women go into labour in the preterm period. The progress is dependent on uterine contractions (power), the size and presentation of the fetus (passenger), and the size of the pelvis (passage). For ease of management, the observed labour is artificially divided into three stages. The partogram is used to manage labour and is where maternal and fetal observations can be plotted in addition to cervical dilatation and descent of the presenting part. The value of active management is still debated but has been adapted in routine practice. More research is needed to decide the best management of labour to optimize the maternal and fetal outcomes.
{"title":"The management of labour","authors":"D. Kanagalingam","doi":"10.1093/med/9780198766360.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0026","url":null,"abstract":"Normal labour is a process of spontaneous expulsion of the fetus, placenta, and membranes at term. This process is initiated by complex endocrine mechanisms that cause uterine contractions which lead to effacement and dilatation of the cervix and descent of the fetus, resulting in delivery. About 10% of women go into labour in the preterm period. The progress is dependent on uterine contractions (power), the size and presentation of the fetus (passenger), and the size of the pelvis (passage). For ease of management, the observed labour is artificially divided into three stages. The partogram is used to manage labour and is where maternal and fetal observations can be plotted in addition to cervical dilatation and descent of the presenting part. The value of active management is still debated but has been adapted in routine practice. More research is needed to decide the best management of labour to optimize the maternal and fetal outcomes.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117112505","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0005
L. Edozien
Clinical governance is the totality of structures and processes that are in place to ensure that, as far as practicable, the right person receives the right treatment, in the right way, at the right time, in the right place, with the right outcome. This goal does not happen by chance; it has to be secured by conscious effort, and that effort—creating and sustaining the required structures and processes—has to be actively and efficiently managed. This chapter describes the basic principles of clinical governance and provides a framework—the RADICAL framework—for delivering and monitoring clinical governance. The framework comprises the following domains: Raise awareness, Apply quality improvement methodology, Design for quality (including safety), Involve service users, Collect and Analyse data, and Learn from experience. The lofty aims of achieving optimal clinical outcomes and the best possible patient experience are best achieved when clinical practice addresses these integrated domains.
{"title":"Clinical governance","authors":"L. Edozien","doi":"10.1093/med/9780198766360.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0005","url":null,"abstract":"Clinical governance is the totality of structures and processes that are in place to ensure that, as far as practicable, the right person receives the right treatment, in the right way, at the right time, in the right place, with the right outcome. This goal does not happen by chance; it has to be secured by conscious effort, and that effort—creating and sustaining the required structures and processes—has to be actively and efficiently managed. This chapter describes the basic principles of clinical governance and provides a framework—the RADICAL framework—for delivering and monitoring clinical governance. The framework comprises the following domains: Raise awareness, Apply quality improvement methodology, Design for quality (including safety), Involve service users, Collect and Analyse data, and Learn from experience. The lofty aims of achieving optimal clinical outcomes and the best possible patient experience are best achieved when clinical practice addresses these integrated domains.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"388 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125482250","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0036
A. Weeks, J. Polk
Induction of labour has been described for many centuries. However, as fetal outcomes improve in general and the safety of the induction process increases, it is increasingly used to reduce the risk of adverse fetal outcomes in late pregnancy. Common obstetric indications include postdates pregnancy, hypertension, spontaneous membrane rupture, fetal growth restriction, and reduced fetal movements. Increased background risk is also an indication with potential benefits for women with increased age, body mass index, and a ‘bad obstetric history’. Induction without medical indication also appears to be safe and does not increase maternal or fetal adverse outcomes. A wide variety of induction methods are available and the choice between them depends on availability and setting. Vaginal dinoprostone, oral misoprostol, and the balloon catheter are all effective and safe methods.
{"title":"Induction of labour","authors":"A. Weeks, J. Polk","doi":"10.1093/med/9780198766360.003.0036","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0036","url":null,"abstract":"Induction of labour has been described for many centuries. However, as fetal outcomes improve in general and the safety of the induction process increases, it is increasingly used to reduce the risk of adverse fetal outcomes in late pregnancy. Common obstetric indications include postdates pregnancy, hypertension, spontaneous membrane rupture, fetal growth restriction, and reduced fetal movements. Increased background risk is also an indication with potential benefits for women with increased age, body mass index, and a ‘bad obstetric history’. Induction without medical indication also appears to be safe and does not increase maternal or fetal adverse outcomes. A wide variety of induction methods are available and the choice between them depends on availability and setting. Vaginal dinoprostone, oral misoprostol, and the balloon catheter are all effective and safe methods.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"271 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134569481","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0049
Sahana Gupta, I. Manyonda
The benign diseases of the uterus compromise endometrial polyps, adenomyosis, and uterine fibroids or leiomyomas. Polyps are often asymptomatic, or may cause intermenstrual bleeding, and recent technological developments allow for rapid diagnosis (transvaginal sonography) and treatment (outpatient hysteroscopy and polypectomy with or without local anaesthesia). Precious little progress has been made over the past few decades in the understanding of the pathophysiology of adenomyosis, or its effective management beyond hysterectomy. Until as recently as two decades ago, the only treatment options for fibroids were hysterectomy and myomectomy, but the advent of radiological interventions (uterine artery embolization and focused ultrasound surgery) has revolutionized uterine-preserving management options of fibroid disease, while the recent emergence of selective progesterone receptor modulators has, at long last, heralded effective medical therapy for fibroids. This rapid expansion in fertility-preserving treatments for fibroids could not have been more timely since in recent years there has been a dramatic shift in the demography of childbirth, with many women postponing childbirth to their late 30s and early 40s, when fibroids are more prevalent and more symptomatic. Parallel developments in assisted reproduction technology now allow women to achieve pregnancies at an age that was unthinkable three decades ago. Even when child bearing is not an issue, hysterectomy no longer need be the only effective treatment for the menstrual disturbance and other symptoms associated with benign diseases of the uterus—new minimally invasive procedures now allow for equally effective interventions that improve women’s quality of life.
{"title":"Benign disease of the uterus","authors":"Sahana Gupta, I. Manyonda","doi":"10.1093/med/9780198766360.003.0049","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0049","url":null,"abstract":"The benign diseases of the uterus compromise endometrial polyps, adenomyosis, and uterine fibroids or leiomyomas. Polyps are often asymptomatic, or may cause intermenstrual bleeding, and recent technological developments allow for rapid diagnosis (transvaginal sonography) and treatment (outpatient hysteroscopy and polypectomy with or without local anaesthesia). Precious little progress has been made over the past few decades in the understanding of the pathophysiology of adenomyosis, or its effective management beyond hysterectomy. Until as recently as two decades ago, the only treatment options for fibroids were hysterectomy and myomectomy, but the advent of radiological interventions (uterine artery embolization and focused ultrasound surgery) has revolutionized uterine-preserving management options of fibroid disease, while the recent emergence of selective progesterone receptor modulators has, at long last, heralded effective medical therapy for fibroids. This rapid expansion in fertility-preserving treatments for fibroids could not have been more timely since in recent years there has been a dramatic shift in the demography of childbirth, with many women postponing childbirth to their late 30s and early 40s, when fibroids are more prevalent and more symptomatic. Parallel developments in assisted reproduction technology now allow women to achieve pregnancies at an age that was unthinkable three decades ago. Even when child bearing is not an issue, hysterectomy no longer need be the only effective treatment for the menstrual disturbance and other symptoms associated with benign diseases of the uterus—new minimally invasive procedures now allow for equally effective interventions that improve women’s quality of life.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122245140","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0006
C. Binding, M. Karoshi
Preconceptional medicine may be a woman’s first introduction to preventative health, which has the potential to impact not only her own health, but the health of any future pregnancies. The concept of preconceptional medicine was initially recognized due to poor maternal and fetal outcomes associated with pre-existing maternal conditions. With counselling in the preconceptional period, modifiable risks including biomedical, behavioural, and social risks can be addressed in the period before pregnancy, in order to optimize the health of the pregnancy. This chapter focuses on counselling for women of reproductive age with common chronic medical disorders, as well as counselling for couples with pre-existing conditions or a complex past obstetric history.
{"title":"Preconceptional medicine","authors":"C. Binding, M. Karoshi","doi":"10.1093/med/9780198766360.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0006","url":null,"abstract":"Preconceptional medicine may be a woman’s first introduction to preventative health, which has the potential to impact not only her own health, but the health of any future pregnancies. The concept of preconceptional medicine was initially recognized due to poor maternal and fetal outcomes associated with pre-existing maternal conditions. With counselling in the preconceptional period, modifiable risks including biomedical, behavioural, and social risks can be addressed in the period before pregnancy, in order to optimize the health of the pregnancy. This chapter focuses on counselling for women of reproductive age with common chronic medical disorders, as well as counselling for couples with pre-existing conditions or a complex past obstetric history.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129102363","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 : 2020-01-01DOI: 10.1093/med/9780198766360.003.0062
W. Prendiville
Cervical cancer is a disease of poor and unscreened populations. Globally, it is the fourth most common cancer in women with over half a million new cases and over a quarter of a million deaths per year. About 85% of cases occur in less developed regions. Systematic high coverage and quality-assured population screening for precursors to cervical cancer is highly effective. Human papillomavirus (HPV) DNA testing will probably replace or complement cytology as the primary screening tool in many developed countries for women over 30 years of age. Because of the absolute relationship between oncogenic HPV and cervical cancer, its negative predictive value is very high. Management of cervical cancer is to determine the stage of the disease and to treat both the primary lesion and other extracervical disease. Cervical cancers spread by direct spread into the cervical stroma, parametrium, and beyond, and by lymphatic metastasis into parametrial, pelvic sidewall, and para-aortic nodes. Women should be fully staged using the International Federation of Gynecology and Obstetrics system and discussed in expert multidisciplinary forums with specialist surgeons, oncologists, pathologists, radiologists, and specialist nurses. Both surgery and radiotherapy are effective in early-stage disease, whereas locally advanced disease relies on treatment by radiation or chemoradiation. Surgery does provide the advantage of conservation of ovarian function. Women who have been treated for cervical precancer are much more likely to develop cervical cancer. Post-treatment HPV testing is the most sensitive test, has the best negative predictive values, and is the best test of cure.
{"title":"Premalignant and malignant disease of the cervix","authors":"W. Prendiville","doi":"10.1093/med/9780198766360.003.0062","DOIUrl":"https://doi.org/10.1093/med/9780198766360.003.0062","url":null,"abstract":"Cervical cancer is a disease of poor and unscreened populations. Globally, it is the fourth most common cancer in women with over half a million new cases and over a quarter of a million deaths per year. About 85% of cases occur in less developed regions. Systematic high coverage and quality-assured population screening for precursors to cervical cancer is highly effective. Human papillomavirus (HPV) DNA testing will probably replace or complement cytology as the primary screening tool in many developed countries for women over 30 years of age. Because of the absolute relationship between oncogenic HPV and cervical cancer, its negative predictive value is very high. Management of cervical cancer is to determine the stage of the disease and to treat both the primary lesion and other extracervical disease. Cervical cancers spread by direct spread into the cervical stroma, parametrium, and beyond, and by lymphatic metastasis into parametrial, pelvic sidewall, and para-aortic nodes. Women should be fully staged using the International Federation of Gynecology and Obstetrics system and discussed in expert multidisciplinary forums with specialist surgeons, oncologists, pathologists, radiologists, and specialist nurses. Both surgery and radiotherapy are effective in early-stage disease, whereas locally advanced disease relies on treatment by radiation or chemoradiation. Surgery does provide the advantage of conservation of ovarian function. Women who have been treated for cervical precancer are much more likely to develop cervical cancer. Post-treatment HPV testing is the most sensitive test, has the best negative predictive values, and is the best test of cure.","PeriodicalId":325232,"journal":{"name":"Oxford Textbook of Obstetrics and Gynaecology","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131544695","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：