Reviews in obstetrics & gynecology最新文献

{"title":"Noninvasive prenatal testing: the future is now.","authors":"Errol R Norwitz,&nbsp;Brynn Levy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Prenatal detection of chromosome abnormalities has been offered for more than 40 years, first by amniocentesis in the early 1970s and additionally by chorionic villus sampling (CVS) in the early 1980s. Given the well-recognized association between increasing maternal age and trisomy,1-3 the primary utilization of prenatal testing has been by older mothers. This has drastically reduced the incidence of aneuploid children born to older mothers.4 Although younger women have relatively low risks of conceiving a child with aneuploidy, the majority of pregnant women are in their late teens, 20s, and early 30s. As such, most viable aneuploid babies are born to these younger mothers.5 Invasive prenatal diagnosis (CVS and amniocentesis) is not a feasible option for all low-risk mothers, as these procedures carry a small but finite risk and would ultimately cause more miscarriages than they would detect aneuploidy. For this reason, a number of noninvasive tests have been developed-including first-trimester risk assessment at 11 to 14 weeks, maternal serum analyte (quad) screening at 15 to 20 weeks, and sonographic fetal structural survey at 18 to 22 weeks-all of which are designed to give a woman an adjusted (more accurate) estimate of having an aneuploid fetus using as baseline her a priori age-related risk. Ultrasound and maternal serum analysis are considered screening procedures and both require follow up by CVS or amniocentesis in screen-positive cases for a definitive diagnosis of a chromosome abnormality in the fetus. The ability to isolate fetal cells and fetal DNA from maternal blood during pregnancy has opened up exciting opportunities for improved noninvasive prenatal testing (NIPT). Direct analysis of fetal cells from maternal circulation has been challenging given the scarcity of fetal cells in maternal blood (1:10,000-1:1,000,000) and the focus has shifted to the analysis of cell-free fetal DNA, which is found at a concentration almost 25 times higher than that available from nucleated blood cells extracted from a similar volume of whole maternal blood. There have now been numerous reports on the use of cell-free DNA (cfDNA) for NIPT for chromosomal aneuploidies-especially trisomy (an extra copy of a chromosome) or monosomy (a missing chromosome)-and a number of commercial products are already being marketed for this indication. This article reviews the various techniques being used to analyze cell-free DNA in the maternal circulation for the prenatal detection of chromosome abnormalities and the evidence in support of each. A number of areas of ongoing controversy are addressed, including the timing of maternal blood sampling, the need for genetic counseling, and the use of confirmatory invasive testing. Future applications for this technology are also reviewed. </p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 2","pages":"48-62"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893900/pdf/RIOG006002_0048.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32064817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for intimate partner violence during pregnancy.","authors":"Neha A Deshpande,&nbsp;Annie Lewis-O'Connor","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intimate partner violence (IPV) is defined as an actual or threatened abuse by an intimate partner that may be physical, sexual, psychological, or emotional in nature. Each year approximately 1.5 million women in the United States report some form of sexual or physical assault by an intimate partner; it is estimated that approximately 324,000 women are pregnant when violence occurs. Pregnancy may present a unique opportunity to identify and screen for patients experiencing IPV. This article provides health care practitioners and clinicians with the most current valid assessment and screening tools for evaluating pregnant women for IPV. </p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 3-4","pages":"141-8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002190/pdf/RIOG006003_0141.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32416418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety considerations for office-based obstetric and gynecologic procedures.","authors":"Richard D Urman,&nbsp;Nathan Punwani,&nbsp;Maryanne Bombaugh,&nbsp;Fred E Shapiro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The migration of gynecologic procedures to office-based settings provides numerous advantages for patients and providers alike, including reduced patient expenses, improved scheduling convenience, favorable provider reimbursement, and enhanced continuity of care and patient satisfaction. With rising health care costs-a major concern in health care-procedures will continue to shift to practice environments that optimize care, quality, value, and efficiency. It is imperative that gynecologic offices ensure that performance and quality variations are minimized across different sites of care; physicians should strive to provide care to patients that optimizes safety and is at least equivalent to that delivered at traditional sites. The gynecologic community should nonetheless heed the Institute of Medicine's recommendations and embrace continuous quality improvement. By exercising leadership, office-based gynecologists can forge a culture of competency, teamwork, communication, and performance measurement.</p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 1","pages":"e8-e14"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651543/pdf/RIOG006001_00e8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31441723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex trafficking of women and girls.","authors":"Neha A Deshpande,&nbsp;Nawal M Nour","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sex trafficking involves some form of forced or coerced sexual exploitation that is not limited to prostitution, and has become a significant and growing problem in both the United States and the larger global community. The costs to society include the degradation of human and women's rights, poor public health, disrupted communities, and diminished social development. Victims of sex trafficking acquire adverse physical and psychological health conditions and social disadvantages. Thus, sex trafficking is a critical health issue with broader social implications that requires both medical and legal attention. Healthcare professionals can work to improve the screening, identification, and assistance of victims of sex trafficking in a clinical setting and help these women and girls access legal and social services.</p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 1","pages":"e22-7"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651545/pdf/RIOG006001_0e22.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31441721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lingual pyogenic granuloma gravidarum.","authors":"Sohini Bhattacharya,&nbsp;Sanjay Kumar Bhattacharyya,&nbsp;Bijan Patua","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 2","pages":"46-7"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848667/pdf/RIOG006002_0046.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31957767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine vascular lesions.","authors":"Abhishek Vijayakumar,&nbsp;Amruthashree Srinivas,&nbsp;Babitha Moogali Chandrashekar,&nbsp;Avinash Vijayakumar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Vascular lesions of the uterus are rare; most reported in the literature are arteriovenous malformations (AVMs). Uterine AVMs can be congenital or acquired. In recent years, there has been an increasing number of reports of acquired vascular lesions of the uterus following pregnancy, abortion, cesarean delivery, and curettage. It can be seen from these reports that there is confusion concerning the terminology of uterine vascular lesions. There is also a lack of diagnostic criteria and management guidelines, which has led to an increased number of unnecessary invasive procedures (eg, angiography, uterine artery embolization, hysterectomy for abnormal vaginal bleeding). This article familiarizes readers with various vascular lesions of the uterus and their management. </p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 2","pages":"69-79"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848669/pdf/RIOG006002_0069.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31957768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy after solid organ transplantation: a guide for obstetric management.","authors":"Neha A Deshpande, Lisa A Coscia, Veronica Gomez-Lobo, Michael J Moritz, Vincent T Armenti","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Successful pregnancy outcomes are possible among all solid organ transplant recipients. Patients should be fully counseled regarding the potential adverse fetal outcomes, including prematurity and low birth weight. Transplant recipients are at an increased risk for both maternal and neonatal complications and should be seen by a high-risk obstetrician in conjunction with their transplant teams. Ideally, preconception counseling begins during the pretransplantation evaluation process. Initiating contraception early after transplantation is ideal, and long-acting reversible methods such as intrauterine devices and subdermal implants may be preferred. Pregnancy should be avoided for at least 1 year after transplantation to limit the potential risks of early pregnancy that may adversely affect both allograft function and fetal well-being. Hypertension, diabetes, and infection should be monitored and treated to minimize fetal risks during pregnancy. Maintenance of current immunosuppression is usually recommended, with the exception of mycophenolic acid products, which (when possible) should be discontinued before conception and replaced with an alternative medication. Throughout pregnancy, immunosuppression must be maintained at appropriate dosing to avoid graft rejection. During labor and delivery, cesarean delivery should be performed for obstetric reasons only. A multidisciplinary team should manage pregnant transplant recipients before, during, and following pregnancy. Breastfeeding and long-term in utero exposure to immunosuppressants for offspring of transplant recipients continue to require further investigation but have been encouraged by recent reports. Continued reporting of post-transplantation pregnancy outcomes to the National Transplantation Pregnancy Registry is highly encouraged. </p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 3-4","pages":"116-25"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002187/pdf/RIOG006003_0116.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32339354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Early-onset Neonatal Group B Streptococcal Disease.","authors":"M J Soto Marió,&nbsp;I Valenzuela,&nbsp;A E Vásquez,&nbsp;S E Illanes","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is an opportunistic pathogen that colonizes the gastrointestinal and genitourinary tracts of up to 50% of healthy adults and newborns; it is responsible for significant morbidity and mortality. Early detection can be used to establish the use of antibiotic prophylaxis to significantly reduce neonatal sepsis. This article reviews methods of detection and prevention of GBS infection in the neonate. </p>","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 2","pages":"63-8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861949/pdf/RIOG006002_0063.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31973876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dining at the health care buffet.","authors":"James A Greenberg,&nbsp;Errol R Norwitz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"6 3-4","pages":"103-4"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002184/pdf/RIOG006003_0103.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32416415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Early-onset Neonatal Group B Streptococcal Disease.","authors":"M. Mario, I. Valenzuela, A. E. Vasquez, S. Illanes","doi":"10.3909/RIOG0218","DOIUrl":"https://doi.org/10.3909/RIOG0218","url":null,"abstract":"Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is an opportunistic pathogen that colonizes the gastrointestinal and genitourinary tracts of up to 50% of healthy adults and newborns; it is responsible for significant morbidity and mortality. Early detection can be used to establish the use of antibiotic prophylaxis to significantly reduce neonatal sepsis. This article reviews methods of detection and prevention of GBS infection in the neonate.","PeriodicalId":21170,"journal":{"name":"Reviews in obstetrics & gynecology","volume":"47 1","pages":"63-8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80856074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}