Current opinion in obstetrics & gynecology
-
Curr. Opin. Obstet. Gynecol. · Apr 2009
ReviewHerpes simplex virus: incidence of neonatal herpes simplex virus, maternal screening, management during pregnancy, and HIV.
Neonatal herpes simplex virus infection is often severe, if not fatal. What is our understanding of the epidemiology of this disease? How is it diagnosed? Would maternal screening for herpes simplex virus-2 (HSV-2) in pregnancy make a difference? Does maternal HSV alter transmission of HIV vertically or horizontally or both? These questions continue to be pursued and unfortunately, there are few clear answers. ⋯ Neonatal herpes simplex virus infection is a rare and serious neonatal illness. The true burden of disease is uncertain. Several recent retrospectively determined incidences identify a case rate of about one per eight thousand live births. HSV reactivation occurs more often than previously thought. Current prophylactic HSV strategies do not decrease horizontal or vertical transmission of HIV-1.
-
Curr. Opin. Obstet. Gynecol. · Feb 2009
ReviewTechniques for fertility preservation in patients with breast cancer.
To outline the risks of infertility from breast cancer treatment, and to illustrate current techniques in preserving fertility in breast-cancer patients who wish to become pregnant after treatment is concluded. ⋯ Ovarian stimulation with retrieval of ooctyes for in-vitro fertilization remains the best known option for fertility preservation in women with early stage breast cancer whose risk of fertility may be compromised by adjuvant chemotherapy.
-
Curr. Opin. Obstet. Gynecol. · Dec 2008
ReviewCesarean delivery on maternal request: maternal and neonatal complications.
A complicated but relevant and timely concept, cesarean delivery on maternal request (CDMR) is defined as a cesarean delivery for a singleton pregnancy on maternal request at term in the absence of medical or obstetrical indications. ⋯ Discussions regarding CDMR should be individualized. Until there are more data on CDMR and guidelines implemented, an explicitly executed informed consent should form the framework of any decision regarding mode of delivery.
-
We have recently identified three salient questions within the patient choice cesarean delivery controversy. First, is performing cesarean delivery on maternal request consistent with good professional medial practice? Second, how should physicians respond to or counsel patients who request patient choice cesarean delivery? Third, should patient choice cesarean delivery be routinely offered to all pregnant women? ⋯ When a patient makes a request for an elective cesarean delivery, obstetricians, in their capacity as patient advocate, must help guide their patient through the labyrinth of detailed medical information toward a decision that respects both the patient's autonomy and the physician's obligation to optimize the health of both the mother and the newborn.