Ahmed Darwish, O. Elyashiv, Radha Graham, Rowan E Miller
Surgical cytoreduction and platinum‐based chemotherapy are the mainstays of ovarian cancer treatment, but 70% of patients with advanced‐stage disease will relapse after responding to first‐line chemotherapy. Recent randomised controlled trials have shown significant improvement in progression‐free survival by adding maintenance therapy including either PARP inhibitors (PARPi), bevacizumab (VEGF‐A inhibitor), or both. Homologous recombination repair is a pathway to repair DNA breaks; homologous recombination deficiency (HRD) is encountered in approximately 50% of ovarian high‐grade serous cancers (HGSC). Patients with HRD tumours demonstrate better progression‐free survival outcomes with PARPi. HRD testing is now approved for patients with high‐grade ovarian cancers including HGSC.
{"title":"Recent trends in molecular testing and maintenance targeted therapies in ovarian cancer","authors":"Ahmed Darwish, O. Elyashiv, Radha Graham, Rowan E Miller","doi":"10.1111/tog.12880","DOIUrl":"https://doi.org/10.1111/tog.12880","url":null,"abstract":"Surgical cytoreduction and platinum‐based chemotherapy are the mainstays of ovarian cancer treatment, but 70% of patients with advanced‐stage disease will relapse after responding to first‐line chemotherapy. Recent randomised controlled trials have shown significant improvement in progression‐free survival by adding maintenance therapy including either PARP inhibitors (PARPi), bevacizumab (VEGF‐A inhibitor), or both. Homologous recombination repair is a pathway to repair DNA breaks; homologous recombination deficiency (HRD) is encountered in approximately 50% of ovarian high‐grade serous cancers (HGSC). Patients with HRD tumours demonstrate better progression‐free survival outcomes with PARPi. HRD testing is now approved for patients with high‐grade ovarian cancers including HGSC.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46574761","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}
Sentinel lymph node (SLN) biopsy is an alternative to systematic lymphadenectomy in the surgical staging of gynaecological malignancy. It is recommended in the management of vulval cancer and is increasingly used in endometrial and cervical cancer. SLN failed mapping algorithms require that side‐specific lymphadenectomy should be performed in the case of failed mapping, and that suspicious lymph nodes are removed. Ultrastaging protocols improve detection of lymph‐node metastasis and should be used for the pathological processing of SLNs.
{"title":"Sentinel lymph node mapping in the modern management of gynaecological malignancy","authors":"A. Collins, A. Phillips","doi":"10.1111/tog.12872","DOIUrl":"https://doi.org/10.1111/tog.12872","url":null,"abstract":"Sentinel lymph node (SLN) biopsy is an alternative to systematic lymphadenectomy in the surgical staging of gynaecological malignancy. It is recommended in the management of vulval cancer and is increasingly used in endometrial and cervical cancer. SLN failed mapping algorithms require that side‐specific lymphadenectomy should be performed in the case of failed mapping, and that suspicious lymph nodes are removed. Ultrastaging protocols improve detection of lymph‐node metastasis and should be used for the pathological processing of SLNs.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41695714","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}
CPD credits can be claimed for the following questions online via the TOG CPD submission system in the RCOG CPD ePortfolio. You must be a registered CPD participant of the RCOG CPD programme (available in the UK and worldwide) in order to submit your answers. Completion of TOG true/false questions can be claimed as a Specific Learning Event. Participants can claim two credits per set of questions if at least 70% of questions have been answered correctly. CPD participants are advised to consider whether the articles are still relevant for their CPD, in particular if there are more recent articles on the same topic available and if clinical guidelines have been updated since publication. Please direct all questions or problems to the CPD Office. Tel: +44 (0)20 7772 6307 or email: cpd@rcog.org.uk. The blue symbol denotes which source the questions refer to including the RCOG journals, TOG and BJOG, and RCOG guidance, such as Green-top Guidelines (GTGs) and Scientific Impact Papers (SIPs). All of the above sources are available to RCOG Members and Fellows via the RCOG website. RCOG Members, Fellows and Associates have full access to TOG content via the Wiley Online Library app (available for iOS and Android).
{"title":"CPD questions for volume 25 issue 2","authors":"","doi":"10.1111/tog.12868","DOIUrl":"https://doi.org/10.1111/tog.12868","url":null,"abstract":"CPD credits can be claimed for the following questions online via the TOG CPD submission system in the RCOG CPD ePortfolio. You must be a registered CPD participant of the RCOG CPD programme (available in the UK and worldwide) in order to submit your answers. Completion of TOG true/false questions can be claimed as a Specific Learning Event. Participants can claim two credits per set of questions if at least 70% of questions have been answered correctly. CPD participants are advised to consider whether the articles are still relevant for their CPD, in particular if there are more recent articles on the same topic available and if clinical guidelines have been updated since publication. Please direct all questions or problems to the CPD Office. Tel: +44 (0)20 7772 6307 or email: cpd@rcog.org.uk. The blue symbol denotes which source the questions refer to including the RCOG journals, TOG and BJOG, and RCOG guidance, such as Green-top Guidelines (GTGs) and Scientific Impact Papers (SIPs). All of the above sources are available to RCOG Members and Fellows via the RCOG website. RCOG Members, Fellows and Associates have full access to TOG content via the Wiley Online Library app (available for iOS and Android).","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41591941","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":"Obstetricians and midwives: an embarrassing history","authors":"J. Drife","doi":"10.1111/tog.12867","DOIUrl":"https://doi.org/10.1111/tog.12867","url":null,"abstract":"","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47848406","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}
Women who have experienced a postpartum haemorrhage (PPH) ‘requiring treatment or transfusion’ are typically advised to plan birth in obstetric-led settings in subsequent pregnancies. This study aimed to use the UK Midwifery Study System (UKMidSS), a system similar to the UK Obstetric Surveillance System (UKOSS) but which operates in midwifery-led units, to describe outcomes in women admitted for labour care to Alongside Midwifery Units (AMUs) following a previous PPH. It also sought to compare outcomes with other multiparous women admitted to the same AMUs and explore risk factors for recurrence. All 123 AMUs in the UK participated in the study. Between August 2018 and April 2019 there were 1866 women admitted to an AMU with a confirmed previous PPH, who were compared with 1850 multiparous women admitted to the same units. Women who experienced a previous PPH were significantly more likely than comparison women to: have a PPH requiring transfer to obstetric care (4.2% versus 2.4%, adjusted risk ratio [aRR] = 1.65, 95% CI = 1.14–2.38), be transferred to obstetric care for any reason (17.8% versus 11.9%; aRR = 1.41; 95% CI = 1.09– 1.83) and have any PPH ≥500 ml (22.7% versus 11.1%, aRR = 1.86, 95% CI = 1.49–2.32). Among women with a previous PPH, previous blood loss >1500 ml, uterotonics for previous PPH, caesarean associated with previous PPH, gestation at admission and higher infant birth weight were independent risk factors for PPH. This study showed that women considering birth in an AMU after a previous PPH should be advised that they are at increased risk of experiencing a subsequent PPH requiring transfer to obstetric care, compared with other multiparous women who have not had a PPH. However, the absolute risk of a subsequent PPH in this group is low and comparable to the overall risk of having a PPH among women having a spontaneous vaginal birth in England.
经历产后出血(PPH)“需要治疗或输血”的妇女通常被建议在随后的怀孕中计划在产科主导的环境中分娩。本研究旨在使用英国助产学研究系统(UKMidSS)，一个类似于英国产科监测系统(ukss)的系统，但在助产学领导的单位中运作，描述在先前PPH后接受分娩护理的妇女在助产学单位(AMUs)的结果。它还试图将结果与其他接受相同肿瘤治疗的多产妇女进行比较，并探索复发的危险因素。英国所有123名志愿者都参加了这项研究。在2018年8月至2019年4月期间，有1866名妇女被确认患有PPH，并被送入AMU，与同一单位的1850名多胎妇女进行比较。既往经历过PPH的妇女比对照组妇女更有可能发生PPH需要转到产科护理(4.2%对2.4%，调整风险比[aRR] = 1.65, 95% CI = 1.14-2.38)，因任何原因转到产科护理(17.8%对11.9%;aRR = 1.41;95% CI = 1.09 - 1.83)， PPH≥500 ml(22.7%对11.1%，aRR = 1.86, 95% CI = 1.49-2.32)。在既往PPH的妇女中，既往失血量超过1500毫升、既往PPH的子宫紧张术、既往PPH相关的剖腹产、入院时妊娠和婴儿出生体重较高是PPH的独立危险因素。这项研究表明，与其他没有PPH的多胎妇女相比，在先前PPH后考虑在AMU分娩的妇女应该被告知，她们经历随后的PPH需要转移到产科护理的风险增加。然而，该组中随后发生PPH的绝对风险很低，与英国自然阴道分娩的妇女发生PPH的总体风险相当。
{"title":"UKMidSS update","authors":"M. Knight","doi":"10.1111/tog.12865","DOIUrl":"https://doi.org/10.1111/tog.12865","url":null,"abstract":"Women who have experienced a postpartum haemorrhage (PPH) ‘requiring treatment or transfusion’ are typically advised to plan birth in obstetric-led settings in subsequent pregnancies. This study aimed to use the UK Midwifery Study System (UKMidSS), a system similar to the UK Obstetric Surveillance System (UKOSS) but which operates in midwifery-led units, to describe outcomes in women admitted for labour care to Alongside Midwifery Units (AMUs) following a previous PPH. It also sought to compare outcomes with other multiparous women admitted to the same AMUs and explore risk factors for recurrence. All 123 AMUs in the UK participated in the study. Between August 2018 and April 2019 there were 1866 women admitted to an AMU with a confirmed previous PPH, who were compared with 1850 multiparous women admitted to the same units. Women who experienced a previous PPH were significantly more likely than comparison women to: have a PPH requiring transfer to obstetric care (4.2% versus 2.4%, adjusted risk ratio [aRR] = 1.65, 95% CI = 1.14–2.38), be transferred to obstetric care for any reason (17.8% versus 11.9%; aRR = 1.41; 95% CI = 1.09– 1.83) and have any PPH ≥500 ml (22.7% versus 11.1%, aRR = 1.86, 95% CI = 1.49–2.32). Among women with a previous PPH, previous blood loss >1500 ml, uterotonics for previous PPH, caesarean associated with previous PPH, gestation at admission and higher infant birth weight were independent risk factors for PPH. This study showed that women considering birth in an AMU after a previous PPH should be advised that they are at increased risk of experiencing a subsequent PPH requiring transfer to obstetric care, compared with other multiparous women who have not had a PPH. However, the absolute risk of a subsequent PPH in this group is low and comparable to the overall risk of having a PPH among women having a spontaneous vaginal birth in England.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44528007","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}
Rhianna Davies, Michael Parker, A. Basu, D. Alleemudder
Uterine artery embolisation can be used as a minimally invasive technique for the management of benign gynaecological conditions refractory to other medical treatments. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR) recommend the use of interventional radiology (IR) techniques for the prophylaxis and management of postpartum haemorrhage. Interventional radiologists can percutaneously drain post‐operative collections or tubo‐ovarian abscesses. Interventional radiology plays a role in the management of early pregnancy complications such as ectopic pregnancy and gestational trophoblastic disease. Interventional radiology can aid the care of patients with gynaecological malignancies.
{"title":"The clinical applications of interventional radiological techniques in obstetrics and gynaecology","authors":"Rhianna Davies, Michael Parker, A. Basu, D. Alleemudder","doi":"10.1111/tog.12871","DOIUrl":"https://doi.org/10.1111/tog.12871","url":null,"abstract":"Uterine artery embolisation can be used as a minimally invasive technique for the management of benign gynaecological conditions refractory to other medical treatments. The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Radiologists (RCR) recommend the use of interventional radiology (IR) techniques for the prophylaxis and management of postpartum haemorrhage. Interventional radiologists can percutaneously drain post‐operative collections or tubo‐ovarian abscesses. Interventional radiology plays a role in the management of early pregnancy complications such as ectopic pregnancy and gestational trophoblastic disease. Interventional radiology can aid the care of patients with gynaecological malignancies.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42615794","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}
K. Reilly, C. McKenna, S. McCullough, S. McKee, F. Mone
In the presence of a fetal structural anomaly, fetal DNA can be obtained through invasive testing (e.g. amniocentesis and chorionic villus sampling) in order to undertake genomic testing to attempt to uncover a unifying genetic diagnosis. There are number of traditional and more novel genomic tests available, which can identify aneuploidy, chromosomal structural variation and/or sequence variants within genes. The cumulative diagnostic yield of such technologies is approximately 25%, 6% and up to 80% in some cohorts for QF‐PCR/G‐banding karyotype, chromosome microarray and exome sequencing, respectively.
{"title":"Prenatal genomic testing for ultrasound‐detected fetal structural anomalies","authors":"K. Reilly, C. McKenna, S. McCullough, S. McKee, F. Mone","doi":"10.1111/tog.12870","DOIUrl":"https://doi.org/10.1111/tog.12870","url":null,"abstract":"In the presence of a fetal structural anomaly, fetal DNA can be obtained through invasive testing (e.g. amniocentesis and chorionic villus sampling) in order to undertake genomic testing to attempt to uncover a unifying genetic diagnosis. There are number of traditional and more novel genomic tests available, which can identify aneuploidy, chromosomal structural variation and/or sequence variants within genes. The cumulative diagnostic yield of such technologies is approximately 25%, 6% and up to 80% in some cohorts for QF‐PCR/G‐banding karyotype, chromosome microarray and exome sequencing, respectively.","PeriodicalId":51862,"journal":{"name":"Obstetrician & Gynaecologist","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46434074","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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