Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Jun 2008
Maternal mortality in well-resourced countries: is there still a need for confidential enquiries?
The low maternal mortality rates in well-resourced countries are not an automatic consequence of prosperity. Morbidity cannot be avoided and preventing mortality requires good medical care. Now that deaths are infrequent in these countries, people expect investigation of every case and action to make pregnancy even safer. ⋯ Analysis is by practising clinicians from many specialties and recommendations are disseminated to clinicians, managers, politicians and the public. The confidential enquiry method has now been adopted by other specialties and by many countries. In countries without confidential enquiries there is under-reporting of maternal mortality, particularly among the poor.
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Best Pract Res Clin Obstet Gynaecol · Apr 2008
ReviewProgesterone for recurrent miscarriage: truth and deceptions.
Recurrent miscarriage is known to affect 0.5-2% of pregnant women, and the standard investigative protocol fails to identify a specific cause in 50% of cases. Progesterone, a key hormone in pregnancy maintenance, has been used to support early pregnancy for decades. ⋯ Some studies have revealed a remarkable improvement in pregnancy outcome after progestogen supplementation in women suffering from recurrent miscarriage. As most studies on this topic are of unsufficient statistical power, further research on the efficacy of progestogen treatment in affected women is required.
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Best Pract Res Clin Obstet Gynaecol · Apr 2008
ReviewAn evidence-based approach to hormonal therapies for premenopausal women with fibroids.
Ovarian steroids, particularly oestrogen, are important factors for fibroid growth. This has provided a rationale for the investigation of hormonal therapies for women with fibroids. This chapter will assess the role of hormonal therapies for pre-menopausal women with fibroids. ⋯ Limited short-term evidence of two progestogenic therapies indicates that low-dose mifepristone may improve quality of life and bleeding in the short term, and asoprisinil may improve bleeding and fibroid-related symptoms. In conclusion, more research is required on the role of hormonal therapies for women with fibroids, particularly add-back options and selective oestrogen and progesterone receptor modulators. No definitive conclusions can be reached on the basis of the limited evidence found.
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To review the diagnosis, management, and treatment options of tumors presenting during fetal development. ⋯ Prenatal diagnosis, surveillance, and treatment of fetal tumors is limited to case reports, small series, and single-institution experience.
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Best Pract Res Clin Obstet Gynaecol · Feb 2008
ReviewPrediction of outcome in isolated congenital diaphragmatic hernia and its consequences for fetal therapy.
Congenital diaphragmatic hernia (CDH) can be diagnosed in the prenatal period either as part of other anomalies or as an isolated birth defect. The clinical impact of this surgically correctable anatomical defect lies in its impairment of lung development. Currently, up to 30% of babies with isolated CDH die from the consequences of lung hypoplasia and/or pulmonary hypertension. ⋯ The feasibility and safety of percutaneous FETO have been established and the procedure seems to improve outcome in severe CDH. The lung response to, and outcome after, FETO depend on pre-existing lung size respectively gestational age at birth. Prenatal decision making can therefore be stratified according to measured lung size.