European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Nov 2011
ReviewThe introduction of intra-operative cell salvage in obstetric clinical practice: a review of the available evidence.
Intra-operative blood salvage is common practice in many surgical specialties but its safety is questioned with concerns about the risks of contamination of recovered blood with amniotic fluid and of maternal-foetal alloimmunization. However, the role of cell salvage as a blood-saving measure in this clinical setting is progressively acquiring relevance thanks to the growing body of evidence regarding its quality and safety. ⋯ Maternal alloimmunization can be caused also by other foetal red cell antigens, but it should also be noted that the risk of alloimmunization of the mother from allogeneic transfusion may be even greater. Therefore the use of cell savers in obstetric clinical practice should be considered in patients at high risk for haemorrhage or in cases where allogeneic blood transfusion is difficult or impossible.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Nov 2011
Review Practice Guideline Comparative StudyInstrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians.
Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B). ⋯ Training must ensure that obstetricians can identify indications and contra-indications, choose the appropriate instrument, use the instruments correctly, and know the principles of quality control applied to operative vaginal delivery. Nowadays, traditional training can be accompanied by simulations. Training should be individualized and extended for some students.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Nov 2011
Review Case ReportsSurgical management of valvular heart diseases in pregnancy.
Heart disease in pregnancy remains one of the important causes for maternal and fetal mortality and morbidity. Cardiac surgery undertaken in pregnancy presents specific additional issues for both the mother and fetus; especially cardiopulmonary bypass and the factors associated with it. ⋯ We present our experience of two cases where cardiopulmonary bypass surgery for cardiac valve replacement was successfully performed during pregnancy without any maternal or fetal mortality. A review of published literature is also undertaken in order to present evidence based recommendations for undertaking such procedures in pregnancy.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Oct 2011
ReviewAn overview of biomarkers for the ovarian cancer diagnosis.
Even though there are a lot of options in treating gynecological malignancies, ovarian cancer still remains a leading cause of death. Diagnosis at an early stage is the most important determinant of survival. Current diagnostic tools applied at clinics have had very limited success in early detection. ⋯ With the progress of techniques in genomics and proteomics, numerous molecular biomarkers/panels were identified and showed promise for ovarian cancer diagnosis, but still need further validation. This article summarizes various types of markers investigated by different strategies/technologies for the ovarian cancer diagnosis at present, including gene-, protein-based and emerging ovarian cancer indicators (such as microRNA-, metabolite-based). Before biomarker tests are translated for routine use, more researches, such as retrospective and prospective clinical trials, are needed to evaluate the overall clinical utility of the tests.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2011
Review Meta AnalysisA systematic review and meta-analysis of randomized studies comparing misoprostol versus placebo for cervical ripening prior to hysteroscopy.
Hysteroscopy is an effective method for examining the uterine cavity but has some limitations, including the occasional need for cervical dilatation. Misoprostol is routinely used for cervical dilatation in various procedures but has not gained wide acceptance for use before hysteroscopy. ⋯ There is insufficient evidence to recommend the routine use of misoprostol before every hysteroscopy. As the lack of serious benefit from misoprostol is unlikely to be due to type II error, its use should be reserved for selected cases.