Best practice & research. Clinical obstetrics & gynaecology
-
Best Pract Res Clin Obstet Gynaecol · Aug 2019
ReviewUterine scar rupture - Prediction, prevention, diagnosis, and management.
The increasing rate of elective and indicated caesarean sections worldwide has led to new pathologies and management challenges. The number of patients undergoing trial of labor after caesarean section (TOLAC) is also increasing. Three professional societies provide detailed guidelines based on scientific evidence for the management of patients attempting vaginal birth after caesarean section (VBAC). ⋯ In patients with severe postoperative pain but hemodynamically stable follow up by US scan examination can direct the management decision. In those patients with active bleeding and deterioration of hysterotomy scar edema will be an indication to surgery. There is no firm evidence regarding which type of thread, knotting or sequence of suturing is more favorable to reduce the risk of UR after VBAC or hysterotomy after myomectomy.
-
Best Pract Res Clin Obstet Gynaecol · Jul 2019
ReviewEndoscopic fetal surgery for neural tube defects.
Prenatal repair of open spina bifida reduces shunt rates and may improve postnatal motor and neurodevelopmental outcomes. The hysterotomy required for the open fetal surgery leaves subsequent pregnancies at risk of uterine rupture. Hysterotomy site rupture confers significant morbidity and mortality risks for both mother and fetus. ⋯ However, the percutaneous approach is being modified, and outcomes are continuing improving, now delivery reached 35 weeks. Surgical techniques for the repair of the defect are not yet standardized, and the type of defect repair may affect long-term outcomes, especially regarding neurogenic bladder and cord tethering. The role of open fetal surgery in the management of spina bifida may be restricted to selected cases in the near future.
-
Best Pract Res Clin Obstet Gynaecol · Aug 2018
ReviewUltrasound diagnosis of endometriosis and adenomyosis: State of the art.
Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. ⋯ The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed. The available data in the literature on ultrasound diagnosis of pelvic endometriosis and adenomyosis, their clinical relevance, and their limitations are discussed.
-
Best Pract Res Clin Obstet Gynaecol · Jul 2018
ReviewNoninvasive diagnosis of endometriosis: Review of current peripheral blood and endometrial biomarkers.
A noninvasive biomarker-based test could help shorten the diagnostic delay for endometriosis. The most investigated biomarker sources are peripheral blood and endometrium. Discovery of endometriosis biomarkers is often hypothesis-driven, i.e. when one or a few biomarkers are investigated based on their role in the disease pathogenesis. ⋯ A variety of biomarkers for endometriosis have been investigated, but no biomarker has been validated for clinical use. Many challenges lie ahead in the endometriosis biomarker field. In the future, harmonized collection and reporting methods should allow large-scale international collaboration for highly powered studies.
-
Best Pract Res Clin Obstet Gynaecol · Feb 2018
ReviewPopulation-based HPV vaccination programmes are safe and effective: 2017 update and the impetus for achieving better global coverage.
Persistent oncogenic human papillomavirus (HPV) is the cause of cervical cancer, as well as cancers of the anus, penis, vulva, vagina and oropharynx. There is good evidence that prophylactic HPV vaccines are immunogenic and effective against targeted-type HPV infections and type-specific genital lesions, including high-grade cervical intraepithelial neoplasia (CIN), when administered prior to HPV infection. ⋯ There is limited evidence suggesting that HPV vaccines may be beneficial in preventing future disease in women treated for high-grade CIN. This chapter focuses on the accumulated evidence regarding the global use of the three licensed HPV vaccines including safety, immunogenicity, duration of protection, effectiveness, coverage to date and barriers to higher coverage.