Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Apr 2012
ReviewScreening for gynaecologic cancers in genetically predisposed women.
Hereditary breast and ovarian cancer syndrome and hereditary non-polyposis colon cancer syndrome are the two most important syndromes responsible for inherited cancers in gynaecology. Genetic testing is available for both these syndromes. Breast cancer gene testing is affordable and easy in women with ancestry where the mutation patterns are known, whereas other population groups need full gene screening. ⋯ Oophorectomy has the advantage of reducing breast cancer risk. In colorectal cancer syndromes, the risk for endometrial and ovarian cancer is much elevated. These risks should be recognised and addressed as these diseases are easy to prevent.
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Best Pract Res Clin Obstet Gynaecol · Feb 2012
ReviewMassive obstetric haemorrhage with disseminated intravascular coagulopathy.
Massive obstetric haemorrhage is a major contributor towards maternal morbidity and mortality. The main causes are abruptio placentae, placenta praevia and postpartum haemorrhage. Clinicians managing pregnant women should be equipped with the knowledge and skills for managing massive obstetric haemorrhage to institute timely and appropriate life-saving treatment. ⋯ Surgical measures used to avoid peripartum haemorrhage include uterine compression sutures, uterine balloon tamponade, uterine artery, and internal iliac artery ligation. Tranexamic acid and recombinant factor VII are more recent medical interventions in massive postpartum haemorrhage. Education, regular drills and adherence to guidelines and protocols are important to reduce haemorrhage-related maternal deaths.
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Women with inherited bleeding disorders may face several haemostatic challenges during pregnancy and childbirth. Pregnancy in these women requires specialised and individualised care. Prenatal diagnosis is primarily considered in families affected by severe bleeding disorder such as haemophilia. ⋯ However, they are at increased risk of primary and secondary postpartum haemorrhage. The fetus, if severely affected, is at risk of cranial bleeding during labour and delivery. Appropriate haemostatic cover during labour and delivery, avoidance of prolonged labour and traumatic delivery, and active management of third stage of labour can minimise the risk of bleeding complications for the mother and her fetus.
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Best Pract Res Clin Obstet Gynaecol · Oct 2011
New technologies and advances in colposcopic assessment.
To have a good grasp of clinical colposcopy, it is necessary to understand the histopathologic structure of the normal and dysplastic cervical epithelium. Previous meta-analyses had indicated high overall sensitivity of colposcopy in detecting dysplastic lesions, but recent studies have suggested that the technique has much lower sensitivity in detecting high-grade intraepithelial neoplasia. The best practice in colposcopy relies on accurately taking a biopsy from the correct (i.e. most morphological abnormal) site, and by taking more than one biopsy, the sensitivity for detection of high-grade cervical intraepithelial neoplasia can be increased. ⋯ Of all the currently available technological adjuncts to colposcopy, spectroscopy devices have demonstrated relatively high sensitivities, and seem to have the best potential to become the technique of choice in future routine clinical practice in developed countries following the human papillomavirus vaccination. Other alternatives may need to be used in parts of the globe with high disease incidence and without organised screening or vaccination programmes. Opportunities remain for global collaboration in research, education and training to promote more effective and affordable cervical screening, and to enhance the skills of colposcopists worldwide.
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Stress urinary incontinence is a common condition that can severely affect a woman's quality of life. Midurethral slings (tension-free vaginal tape and transobturator tape) are becoming first-line surgical treatments for stress urinary incontinence in women. ⋯ Sufficient data support the use of both retropubic and transobturator approaches for the placement of a midurethral sling. However, longer follow up in larger populations should assess the long-term reliability of these procedures.