Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

{"title":"Pharmacogenomics of Preeclampsia therapies: Current evidence and future challenges for clinical implementation","authors":"Piya Chaemsaithong ,&nbsp;Mohitosh Biswas ,&nbsp;Waranyu Lertrut ,&nbsp;Puntabut Warintaksa ,&nbsp;Tuangsit Wataganara ,&nbsp;Liona CY. Poon ,&nbsp;Chonlaphat Sukasem","doi":"10.1016/j.bpobgyn.2023.102437","DOIUrl":"10.1016/j.bpobgyn.2023.102437","url":null,"abstract":"<div><p>Preeclampsia is a pregnancy-specific disorder, and it is a leading cause of maternal and perinatal morbidity and mortality. The application of pharmacogenetics to antihypertensive agents and dose selection in women with preeclampsia is still in its infancy. No current prescribing guidelines from the clinical pharmacogenetics implementation consortium (CPIC) exist for preeclampsia. Although more studies on pharmacogenomics are underway, there is some evidence for the pharmacogenomics of preeclampsia therapies, considering both the pharmacokinetic (PK) and pharmacodynamic (PD) properties of drugs used in preeclampsia. It has been revealed that the <em>CYP2D6*10</em> variant is significantly higher in women with preeclampsia who are non-responsive to labetalol compared to those who are in the responsive group. Various genetic variants of PD targets, i.e., <em>NOS3</em>, <em>MMP9</em>, <em>MMP2</em>, <em>TIMP1</em>, <em>TIMP3</em>, <em>VEGF</em>, and <em>NAMPT</em>, have been investigated to assess the responsiveness of antihypertensive therapies in preeclampsia management, and they indicated that certain genetic variants of <em>MMP9</em>, <em>TIMP1</em>, and <em>NAMPT</em> are more frequently observed in those who are non-responsive to anti-hypertensive therapies compared to those who are responsive. Further, gene–gene interactions have revealed that <em>NAMPT</em>, <em>TIMP1</em>, and <em>MMP2</em> genotypes are associated with an increased risk of preeclampsia, and they are more frequently observed in the non-responsive subgroup of women with preeclampsia. The current evidence is not rigorous enough for clinical implementation; however, an institutional or regional-based retrospective analysis of audited data may help close the knowledge gap during the transitional period from a traditional approach (a “one-size-fits-all” strategy) to the pharmacogenomics of preeclampsia therapies.</p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S152169342300144X/pdfft?md5=b727610755bb2eefe6f9716ee86b70cb&pid=1-s2.0-S152169342300144X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138504154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of preeclampsia in asymptomatic women","authors":"Nikki M.W. Lee ,&nbsp;Piya Chaemsaithong ,&nbsp;Liona C. Poon","doi":"10.1016/j.bpobgyn.2023.102436","DOIUrl":"10.1016/j.bpobgyn.2023.102436","url":null,"abstract":"<div><p><span>Preeclampsia<span> is a major cause of maternal and perinatal morbidity and mortality. It is important to identify women who are at high risk of developing this disorder in their first trimester<span> of pregnancy to allow timely therapeutic intervention. The use of low-dose aspirin<span><span> initiated before 16 weeks of gestation can significantly reduce the rate of preterm preeclampsia by 62 %. Effective screening recommended by the Fetal Medicine Foundation (FMF) consists of a combination of </span>maternal risk factors<span>, mean arterial pressure, </span></span></span></span></span>uterine artery<span><span><span> pulsatility index (UtA-PI) and </span>placental growth factor<span> (PLGF). The current model has detection rates of 90 %, 75 %, and 41 % for early, preterm, and term preeclampsia, respectively at 10 % false-positive rate. Similar risk assessment can be performed during the </span></span>second trimester in all pregnant women irrespective of first trimester screening results. The use of PLGF, UtA-PI, sFlt-1 combined with other investigative tools are part of risk assessment.</span></p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in timing and mode of delivery in morbidly obese women","authors":"Nivedita R. Aedla ,&nbsp;Tahir Mahmood ,&nbsp;Badreldeen Ahmed ,&nbsp;Justin C. Konje","doi":"10.1016/j.bpobgyn.2023.102425","DOIUrl":"10.1016/j.bpobgyn.2023.102425","url":null,"abstract":"<div><p><span>Globally obesity is increasing especially in the reproductive age group. Pregnant women with obesity have higher complication and intervention rates. They are also at increased risk of stillbirth and </span>intrapartum complications. Although organisations like NICE, RCOG, ACOG and WHO have published guidelines and recommendations on care of pregnant women with obesity the evidence from which Grade A recommendations can be made on timing and how to deliver is limited. The current advice is therefore to have discussions with the woman on risks to help her make an informed decision about timing, place, and mode of delivery.</p><p><span><span>Obesity is an independent risk factor for pregnancy complications including diabetes, hypertension and </span>macrosomia<span><span>. In those with these complications, the timing of delivery is often influenced by the severity of the complication. As an independent factor, population based observational studies in obese women have shown an increase in the risk of stillbirth. This risk increases linearly with weight from overweight through to class II obesity, but then rises sharply in those with class III obesity by at least 10-fold beyond 42 weeks when compared to normal weight women. This risk of stillbirth is notably higher in obese women from 34 weeks onwards compared to normal weight women. One modifiable risk factor for stillbirth as shown from various cohorts of pregnant women is prolonged pregnancy. Research has linked obesity to prolonged pregnancy. Although the exact mechanism is yet unknown some have linked this to maternal dysregulation of the </span>hypothalamic pituitary adrenal axis leading to hormonal imbalance delaying </span></span>parturition. For these women the two dilemmas are when and how best to deliver.</p><p><span>In this review, we examine the evidence and make recommendations on the timing and mode of delivery in women with obesity. For class I obese women there are no differences in outcome with regards to timing and mode of delivery when compared to lean weight<span><span><span> women. However, for class II and III obesity, planned induction or caesarean sections may be associated with a lower perinatal morbidity and mortality although this may be associated with an increased in </span>maternal morbidity especially in class III obesity. Studies have shown that delivery by 39 weeks is associated with lower </span>perinatal mortality compared to delivering after in these women. On balance the evidence would favour planned delivery (induction or caesarean section) before 40 weeks of gestation. In the morbidly obese, apart from the standard lower transverse skin </span></span>incision for CS, there is evidence that a supraumbilical transverse incision may reduce morbidity but is less cosmetic. Irrespective of the option adopted, it is important to discuss the pros and cons of each.</p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138517363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of endometriosis on the ovarian follicles","authors":"Maíra Casalechi,&nbsp;Giorgia Di Stefano,&nbsp;Gianfranco Fornelli,&nbsp;Edgardo Somigliana,&nbsp;Paola Viganò","doi":"10.1016/j.bpobgyn.2023.102430","DOIUrl":"https://doi.org/10.1016/j.bpobgyn.2023.102430","url":null,"abstract":"<div><p>A significant body of evidence has supported a negative impact of endometriosis<span><span><span> on ovarian follicles<span><span>; however, the origin and relevance of this ovarian impairment in endometriosis is still a matter of debate. The ovarian damage can be caused by endometriosis itself or by surgeries aiming to remove endometriotic lesions. In this review, we summarized the existing knowledge on the mechanisms by which endometriosis can impact the ovarian follicles, from molecular to clinical points of view. From a molecular standpoint, the presence of endometriosis or its consequences can induce oxidative stress<span>, inflammation, aberrant mitochondrial energy metabolism and inappropriate steroid production in granulosa cells, phenomena that may impair the quality of oocytes to variable degrees. These alterations may have clinical relevance on the accelerated exhaustion of the </span></span>ovarian reserve, on the ovarian response to </span></span>gonadotrophin stimulation in </span>IVF cycles and on the competence of the oocytes. Critical points to be considered in current clinical practices related to fertility issues in endometriosis are discussed.</span></p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138466930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IVF stimulation protocols and outcomes in women with endometriosis","authors":"Eduardo Goyri ,&nbsp;Graciela Kohls ,&nbsp;Juan Garcia-Velasco","doi":"10.1016/j.bpobgyn.2023.102429","DOIUrl":"10.1016/j.bpobgyn.2023.102429","url":null,"abstract":"<div><p><span>Endometriosis<span> is a complex medical condition with a high prevalence in women of reproductive age. Fertility is compromised in patients<span><span> with endometriosis, and success in IVF<span> treatments has been a challenge leading to evaluation of different stimulation protocols. The long-standing debate between GnRH agonist long protocols and short GnRH antagonist protocols is being resolved in favor of the latter, since in addition to presenting equivalent results with respect to the traditional option, they have the additional benefit of safety. The good results derived from vitrification techniques have led to the development of new stimulation strategies, such as progestin-primed ovarian stimulation (PPOS), with a greater degree of approval among patients. None of the stimulation protocols currently applied in women with endometriosis has been shown to be superior, so early intervention with an </span></span>Assisted Reproduction treatment, regardless of the chosen protocol, can provide these women with good chances of motherhood. Women with </span></span></span>endometrioma<span> should be counseled for fertility preservation before planned ovarian endometrioma excision. The number of cryopreserved oocytes or embryos can be increased by repeated cycles.</span></p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138504153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best practice and research clinical obstetrics and gynaecology volume 92","authors":"Justin C. Konje,&nbsp;Badreldeen Ahmed","doi":"10.1016/j.bpobgyn.2023.102431","DOIUrl":"https://doi.org/10.1016/j.bpobgyn.2023.102431","url":null,"abstract":"","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138439013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10. Role of high dimensional technology in preeclampsia (omics in preeclampsia)","authors":"Lina Youssef ,&nbsp;Lea Testa ,&nbsp;Francesca Crovetto ,&nbsp;Fatima Crispi","doi":"10.1016/j.bpobgyn.2023.102427","DOIUrl":"10.1016/j.bpobgyn.2023.102427","url":null,"abstract":"<div><p>Preeclampsia is a pregnancy-specific disease that has no known precise cause. Integrative biology approach based on multi-omics has been applied to identify upstream pathways and better understand the pathophysiology of preeclampsia. At DNA level, genomics and epigenomics studies have revealed numerous genetic variants associated with preeclampsia, including those involved in regulating blood pressure and immune response. Transcriptomics analyses have revealed altered expression of genes in preeclampsia, particularly those related to inflammation and angiogenesis. At protein level, proteomics studies have identified potential biomarkers for preeclampsia diagnosis and prediction in addition to revealing the main pathophysiological pathways involved in this disease. At metabolite level, metabolomics has highlighted altered lipid and amino acid metabolisms in preeclampsia. Finally, microbiomics studies have identified dysbiosis in the gut and vaginal microbiota in pregnant women with preeclampsia. Overall, omics technologies have improved our understanding of the complex molecular mechanisms underlying preeclampsia. However, further research is warranted to fully integrate and translate these omics findings into clinical practice.</p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521693423001347/pdfft?md5=5a009d5cee7a535b90e62ce4397385b2&pid=1-s2.0-S1521693423001347-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic assisted laparoscopy for deep infiltrating endometriosis","authors":"T. Hebert","doi":"10.1016/j.bpobgyn.2023.102422","DOIUrl":"10.1016/j.bpobgyn.2023.102422","url":null,"abstract":"<div><p>Deep infiltrative endometriosis is a condition affecting up to 15 % of women of childbearing age, defined by extra uterine location of endometrial like tissues.</p><p><span><span>The symptoms of endometriosis range from severe dysmenorrhea to infertility, </span>chronic pelvic pain<span>, bowel dysfunction and urinary tract involvement to name the most common. Endometriosis has an impact on the </span></span>quality of life of patients, with personal and social consequences.</p><p>Although medical treatment is indicated in the first instance, surgery may be necessary. Standard laparoscopy has become the gold standard for this surgery. However, surgery for deep infiltrative endometriosis is known to be highly complex, and the significant development of robotic assistance in recent years has had an impact on the evolution of surgical practice. This comprehensive review of the literature provides an overview of the contributions of robotic surgery in the field of endometriosis and gives an insight into the next steps in its development.</p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135670885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted surgery in high-risk surgical patients with endometrial cancer","authors":"Anna Collins ,&nbsp;Annie Jacob ,&nbsp;Esther Moss","doi":"10.1016/j.bpobgyn.2023.102421","DOIUrl":"https://doi.org/10.1016/j.bpobgyn.2023.102421","url":null,"abstract":"<div><p><span><span>Many patients diagnosed with an endometrial cancer are at high-risk for surgery due to factors such as advanced age, raised body mass index or </span>frailty. Minimally-invasive surgery, in particular robotic-assisted, is increasingly used in the surgical management of endometrial cancer however, there are a lack of </span>clinical trials investigating outcomes in high-risk patient populations. This article will review the current evidence and identify areas of uncertainty where future research is needed.</p></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134667074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preface: Health economics and outcomes research in reproductive medicine: Methods and comparative effectiveness of treatment protocols","authors":"Thomas M. D'Hooghe (Guest Editor)","doi":"10.1016/j.bpobgyn.2023.102424","DOIUrl":"10.1016/j.bpobgyn.2023.102424","url":null,"abstract":"","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":null,"pages":null},"PeriodicalIF":5.5,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89721080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}