Facts Views and Vision in ObGyn最新文献

Ovarian cancer (OC) is the seventh most common cancer in women. Although women diagnosed with OC are usually treated frontline with platinum-based chemotherapy, most of them relapse once treatment is halted. Therefore, maintenance therapies have been developed to secure the response and delay further chemotherapy. There are two established maintenance therapies for women affected by platinum-sensitive recurrent OC: bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growth factor, and olaparib, an inhibitor of poly (adenosine diphosphate [ADP]-ribose) polymerase (PARPi). Loss-of-function mutations in genes in the homologous recombination pathway, especially BRCA1 and BRCA2, predict higher rates of platinum sensitivity, better overall survival (OS), and better response to PARPi in women with OC. Among patients with platinum-sensitive recurrent OC, a BRCA mutation is the first genetically defined predictive marker for targeted therapy, since these patients are most likely to benefit from treatment with a PARPi, such as olaparib. In patients with platinum-sensitive recurrent OC without a BRCA mutation, bevacizumab currently seems to be the best maintenance option. Women with OC are progressively more routinely screened for germline BRCA mutations, and the implication of somatic BRCA mutations is increasingly being recognized in OC. Therefore, the recommendations should be updated to reflect the importance of both types of mutations. Together, these data highlight the fact that treatment of recurrent OC can be optimized using genomic contributions to individualize therapy and to improve treatment response.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility.

This paper compares two populations with respect to attitudes toward the regulation of reproductive care by the European Union. The two populations are 252 individuals who crossed a national border to receive treatment at an independent clinic in Spain and 45 Spanish citizens who received treatment in their home country. Online surveys were sent to former patients (from many different countries) of a private Spanish clinic. By comparing those who engaged in cross-border reproductive care (CBRC) with those who did not, we examined attitudes toward whether or not the EU should extend to all clients in all countries the type of services the clinic provided. These services included access to anonymous donors and conception via egg or embryo donation. We found that those who travelled abroad were less in favor of EU expanding regulation for the type of services they received than were those in Spain. This study is unusual in focusing on political attitudes rather than the nature of the experience and consequences of cross-border reproductive care. We suggest that individuals who engage in CBRC might be reluctant to see the EU extend reproductive care broadly because debates within both the EU and their home countries could result in the elimination of options that are now available through travel. We suggest that individuals from countries that are popular destinations for CBRC like Spain might want to extend EU reproductive care more broadly so as to reduce the pressure on the medical services in their own country. We suggest directions for further research.

This article outlines the trial model in reproductive medicine that was created as a first step in the development of a business model for medical subspecialty training to complement the current academic subspecialty training in South Africa. A two-tiered training model was developed over time. The hurdles that had to be overcome were the development of a curriculum and academic capacity, acquisition of appropriate funding, acceptance and accreditation of the decentralised training facility, and lastly, registration of the fellowship with the Health Professions Council of South Africa. The end result of the trial programme was a two-year full-time training with supportive funding, or a four-year programme, where the subspecialists would spend three weeks of the month in their home practice environment, attached to an accredited unit, and the last week in an academic institution. Due to the trial program's success for the South African context and the potential of such model for the developing world, it was evident that the trial programme had to be tested to determine whether and how it can be implemented on a wider basis.

Background: Pregnancy during lactation is common in Egypt and is often unplanned. Overlap between pregnancy and lactation could be associated with an increased risk for the pregnant mother, her fetus as well as her nursing child.

Aim of the study: The current study aims to compare the maternal and perinatal outcome of pregnancies occurred during lactation with those occurred after weaning in women with substandard nutrition.

Materials and methods: A prospective-cohort study was carried out in six Maternal and Child Health Centers in Assiut-Egypt. Estimated sample size was 540 women divided equally into two groups; the first included women who got pregnant during breastfeeding (PDBF), while the second included women who got pregnant after weaning (PAW). Tools were consisted of structured interview questionnaire including personal history, obstetrical data, breastfeeding, family planning histories and dietary intake during pregnancy. Pregnant women had been followed up to delivery to assess different maternal and fetal outcomes.

Results: Miscarriage rate was not statistically significant between both groups (2.2% in PDBF and 0.4% in PAW, p = 0.284). Women in PDBF group had higher prevalence of maternal anemia (54.1% versus 30.7%), intrauterine growth restriction (16.7% versus 4.8%), cesarean delivery (43.7% versus 31.5%), prolonged labor (13.3% versus 11.1%) and low birth weight infants (15.7% versus 8.8%) compared to women in PAW group.

Conclusion: Pregnancy during breastfeeding is associated with an increase in the overall complications of pregnancy as compared to PAW. Although it does not increase the miscarriage rate, it increases the prevalence of maternal anemia, delayed fetal growth, prolonged labor, cesarean section delivery and the prevalence of low birth weight infants.

A series of new technologies and adjuvant therapies have been advocated in order to improve the success of IVF treatment. Dehydro-epiandrostenedione, growth hormones, Coenzyme Q 10, calcium ionosphores, immune therapy, heparin, low-dose aspirin, and vasodilators are among commonly prescribed pharmacological adjuvants. New technologies that are proposed to improve IVF outcomes include advanced sperm selection procedures, time- lapse embryo monitoring, preimplantation genetic screening, assisted hatching endometrial injury or embryo-glue. This review looked into current evidence to justify the use of these co-interventions and whether some of them can still be offered while awaiting more robust evidence to con rm or refute their role.