Obstetrical & gynecological survey
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Obstet Gynecol Surv · Jun 2009
ReviewManagement of Bartholin duct cysts and abscesses: a systematic review.
To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses. ⋯ After completion of this article, the reader should be able to identify seven different treatments for Bartholin duct cysts or abscesses, contrast treatment choice complications and recurrence risks for the different options for treatment of Bartholin duct cysts or abscesses, and point out the limited quality and quantity of data upon which to choose best practices.
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To review the condition of pudendal neuralgia (PN) and its role in chronic pelvic pain in women. ⋯ PN does seem to exist as a clinical syndrome rather than a specific diagnosis. It is important to note that it does not have definite etiological implications, and there is no evidence to support equating the presence of this syndrome with a diagnosis of pudendal nerve entrapment although that may be 1 etiological condition.
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Obstet Gynecol Surv · Feb 2009
ReviewCarbetocin for the prevention of postpartum hemorrhage: a systematic review.
The objective of this review was to evaluate the efficacy and safety of carbetocin in the prevention of postpartum hemorrhage. All trials found during a targeted Medline and Cochrane database search were screened for eligibility. Outcome measures were estimated blood loss, uterine tone, amount and type of lochia, fundal position after delivery (number of centimeters above or below the umbilicus), side-effects, adverse effects, vital signs, levels of hemoglobin/hematocrit before delivery compared with 24 or 48 hours postpartum, the need for additional uterotonic therapy, and/or uterine massage and duration of the third stage of labor. ⋯ We conclude that carbetocin probably is as effective as oxytocin or syntometrine in the prophylactic management of the third stage of labor. Also carbetocin has a similar safety profile to oxytocin, which is now used as a standard prophylactic treatment. However, more research on this subject is needed.
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Obstet Gynecol Surv · Nov 2008
ReviewPresent and future fertility preservation strategies for female cancer patients.
As survival rates with cancer treatment are steadily increasing, many women are now facing sterility due to treatment induced ovarian failure. This review will attempt to summarize the options for trying to preserve fertility in these patients. The optimal approach depends on the type of cancer, the type of treatment (e.g., radiation and/or chemotherapy), time available till onset of treatment, patient's age, and whether the patient has a partner. Ovarian transposition remains the standard of care for women undergoing pelvic radiation, although it has been suggested that it may be combined with ovarian tissue cryopreservation. For patients about to receive chemotherapy or whole body radiation, in vitro fertilization (IVF) with embryo cryopreservation is a well established treatment with a good success rate. However, it requires delaying cancer treatment for 2 to 4 weeks and a partner or willingness to use donor sperm. When these criteria cannot be met, more experimental options include oocyte cryopreservation for later IVF and ovarian tissue cryopreservation. The tissue may be autotransplanted back to the pelvis, when the patient is in remission, to attempt spontaneous conception or subcutaneously for easy access of follicle aspiration for IVF. Alternatively, it may be xenografted to immunocompromised mice to induce follicle maturation in preparation for retrieval for IVF. Emerging treatment options for fertility preservation include medication to prevent chemotherapy-induced oocyte damage and oocyte construction from somatic cell nuclei. IVF with donor oocyte remains an established option with a very high success rate for those who fail to conceive with the above measures or who elect not to avail themselves to experimental procedures. ⋯ After completion of this article, the reader should be able to demonstrate knowledge about fertility preservation when counseling appropriate female cancer patients, recall current clinical strategies to assist women cancer patients to try to maintain their fertility if they wish, and appraise future strategies as they develop.
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Obstet Gynecol Surv · Oct 2008
ReviewMalignant conditions in children born after assisted reproductive technology.
This article reviews the risks of childhood malignancies and imprinting disorders in children born after assisted reproductive technology (ART). It is recognized that there is a theoretical potential of developing an excess of malignancies in children born after ART. With the advancement and introduction of newer techniques in ART there is an increase in the micromanipulation of gametes and embryos in vitro and extended exposure to the in vitro environment. These include the use of gonadotropins for superovulation, intracytoplasmic sperm injection, blastocyst culture, assisted hatching, and preimplantation genetic diagnosis. Although these approaches aim to enhance pregnancy rates and its outcome, the risk of associated long-term health hazards cannot be disregarded. More recently there is some evidence suggesting a link between ART and epigenetic alterations leading to DNA modifications and imprinting disorders. Two of these genetic imprinting disorders that are known to cause birth defects and childhood malignancies, Beckwith-Wiedmann syndrome and Angelman syndrome have been associated with ART. Systemic reviews of the literature identified published studies, but were unable to identify the precise risks of imprinting disorders and childhood cancers in children conceived with ART. Overall, most studies have not shown any increase in the incidence of childhood cancers after ART. With more women resorting to ART, careful counseling should be offered to all couples especially those requiring intracytoplasmic sperm injection for abnormal sperm parameters. ⋯ After completion of this article, the reader should be able to distinguish for patients the lack of irrefutable evidence for an increased risk of childhood malignancies in children conceived using assisted reproductive technology (ART), explain potential mechanisms of injury to the gametes and/or embryo during ART which might predispose to childhood illness, and appraise future articles on this topic for credibility both to likelihood of true relationship to possible childhood cancers as well as biologic basis for potential relationship.