Current opinion in obstetrics & gynecology
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Curr. Opin. Obstet. Gynecol. · Dec 2014
Review Meta AnalysisPlanned caesarean section or trial of vaginal delivery? A meta-analysis.
This systematic review with meta-analysis aims to determine whether maternal outcomes are better with antenatal choice to give birth by caesarean section compared to vaginal birth, in singleton pregnancies in low-risk women without a subsequent pregnancy. The main outcome measures used were as follows: postpartum haemorrhage, postnatal depression, urinary incontinence and maternal mortality. ⋯ On the basis of the current research and the findings of this review, planned caesarean section is associated with a lower risk of developing urinary incontinence symptoms postpartum or having a blood transfusion yet conversely results showed an increased risk of postpartum haemorrhage. The synthesized data are not applicable to clinical practice; however, they prompt much further investigation into planned delivery and its associated morbidity risk.
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Curr. Opin. Obstet. Gynecol. · Dec 2014
ReviewDoes current evidence support the use of intraoperative cell salvage in reducing the need for blood transfusion in caesarean section?
An important cause of maternal morbidity and direct maternal death is obstetric haemorrhage at caesarean section. Concerns regarding allogeneic blood safety, limited blood supplies and rising health costs have collectively generated enthusiasm for the utility of methods intended to reduce the use of allogeneic blood transfusion in cases of haemorrhage at caesarean section. This can be achieved by intraoperative cell salvage (IOCS). The aim of this review is to summarize and examine the evidence for the efficacy of IOCS during caesarean section, in women at risk of haemorrhage, in reducing the need for allogeneic blood transfusion. ⋯ Current evidence is limited to reported case series and two small controlled studies. Overall, IOCS may reduce the need for allogeneic blood transfusions during caesarean section. Future large randomized trials are required to assess effectiveness, cost effectiveness and safety. The results of the current ongoing SALVO (A randomised controlled trial of intra-operative cell salvage during caesarean section in women at risk of haemorrhage) trial will shed light on these aspects.
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To provide an overview of the care of the adolescent transgender patient with regard to the guidelines and recommendations that currently exist, and to review the role of the clinician caring for transgender youth. ⋯ Clinicians who care for adolescents can play an important role in the counseling, screening, health maintenance and support of their patients through the transition process.
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Curr. Opin. Obstet. Gynecol. · Aug 2014
ReviewThe techniques and outcomes of hysteroscopic metroplasty.
To evaluate the reproductive outcomes and surgical techniques of the hysteroscopic metroplasty in women with septate uterus and recurrent abortions or primary unexplained infertility. ⋯ The hysteroscopic metroplasty with its simplicity, safety, and improved reproductive outcomes has liberalized the approach to treatment. Today, hysteroscopic metroplasty is a common practice to treat septate uterus with salutary effects both in infertile patients and in patients with recurrent pregnancy loss or premature labor, especially if in-vitro fertilization is being contemplated. Decisions on when to treat uterine septa are discussed in particular because of lack of prospective, randomized controlled trials.
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Curr. Opin. Obstet. Gynecol. · Aug 2014
ReviewNovel agents for the medical treatment of endometriosis.
Current medical treatments for endometriosis-associated pain, including oral contraceptives, progestins and GnRH agonists, are partially effective and have significant side-effects. The purpose of this review is to present new hormonal and nonhormonal treatment for endometriosis. ⋯ New drugs for the medical treatment of endometriosis targeting both hormonal (GnRH, estrogen and progesterone receptors) and nonhormonal pathways (inflammation, angiogenesis, adhesions, tissue invasion) are promising, but their efficacy and safety need to be established in randomized human trials before they can be used in clinical practice.