It is estimated that 350 to 400 million individuals worldwide are chronically infected with hepatitis B virus (HBV). In regions of high endemicity, many of these are females of reproductive age who are an important source for perinatal transmission. There are a number of issues specific to the women of childbearing age who have chronic HBV infection, including the safety of antiviral therapy during pregnancy and breast-feeding, the changes in the immune system during pregnancy and postpartum that may impact on the natural history of HBV, and the emerging role of antivirals to reduce perinatal transmission of HBV. For women in their reproductive years who require treatment, many of the available antivirals have not been studied in pregnant or breast-feeding women and their use requires the development of a carefully considered strategy, considering the impact of both the disease and treatment on the mother and fetus/infant. The purpose of this article is to (1) review data regarding the mechanisms and timing of perinatal HBV infection; (2) review data on interventions, particularly antiviral therapy, to reduce perinatal transmission beyond the protection afforded by hepatitis B immunoglobulin and vaccination; (3) summarize the immunological changes associated with pregnancy and the potential effect these may have on the natural history of HBV infection; and (4) summarize the information currently available for antiviral therapy available for HBV treatment, focusing specifically on safety data pertaining to reproduction, pregnancy, and breast-feeding. Target Audience: Obstetricians & Gynecologists and Family Physicians Learning Objectives: After completing this CME activity physicians should be better able to classify the interventions to reduce mother-to-child transmission of hepatitis B including antivirals, caesarean section, hepatitis B immunoglobulin and hepatitis B vaccine, assess the immunological changes associated with pregnancy and the potential effect this may have on the natural history of HBV infection and apply the information currently available for antiviral therapy licensed for HBV treatment, focusing specifically on safety data in pregnancy and during breastfeeding.
PMID: 22278077 [PubMed - as supplied by publisher]
Urodynamic Outcomes After Hysterectomy for Benign Conditions: A Systematic Review and Meta-analysis.
Obstet Gynecol Surv. 2012 Jan;67(1):45-54
Authors: Duru C, Jha S, Lashen H
Abstract
Background. Hysterectomy, the most common gynecological surgery performed in the United Kingdom, has been highlighted as a possible etiological factor in urinary dysfunction in women who have undergone nonradical hysterectomy. Multiple studies in recent years have examined this question with both clinical and urodynamics metrics. Aims. The aim of this systematic review was to analyze urodynamic outcomes before and after total hysterectomy for benign conditions, and report if urinary function was changed after hysterectomy. Methods. English articles on MEDLINE and CINAHL from 1950 to February 2009 and on Web of Knowledge all years were searched. The search strategy used combinations of search terms related to urinary function and hysterectomy. The keywords used were “urodynamics,” “stress incontinence,” “urge incontinence,” “bladder instability,” “overactive bladder,” “detrusor overactivity,” and “hysterectomy.” Observational studies and randomized controlled trials investigating urodynamic outcomes before and after hysterectomy were included. The data were analyzed in Review Manager 5 software. Results. Overall, symptoms of urinary incontinence were significantly reduced after hysterectomy (relative risk [RR] = 1.37, 95% confidence interval [CI] [1.01, 1.84]). The urodynamic diagnosis of detrusor overactivity was significantly reduced after hysterectomy (RR = 1.58, 95% CI [1.16, 2.16]), but there was no significant reduction in the prevalence of urodynamic stress incontinence after hysterectomy (RR = 0.89, 95% CI [0.58, 1.38]). There was no significant change to urine flow rate after hysterectomy (RR = -0.36, 95% CI [-1.40, 0.68]). Conclusions. Hysterectomy for benign gynecological conditions does not adversely impact urodynamic outcomes nor does it increase the risk of adverse urinary symptoms and may even improve some urinary function. Target Audience: Obstetricians & Gynecologists and Family Physicians. Learning Objectives: After the completing the CME activity, physicians should be better able to categorize changes in urinary function following hysterectomy, assess changes in urinary symptoms following hysterectomy.
Vulvar pruritus and pain are common indications for consultation with a gynecologist. Contact dermatitis, lichen sclerosus, lichen planus, and vulvar intraepithelial neoplasia are vulvar dermatoses that are often associated with both pruritus and pain. Because these skin conditions are frequently misdiagnosed by providers and incorrectly self-treated by patients, vulvar biopsy is considered the gold standard for diagnosis. The etiology of these vulvar skin conditions is multifactorial; therefore, patient education, behavior modification, and regular follow-up with an experienced clinician are essential to ensure effective control of patient symptoms and management of the skin condition. Target Audience: Obstetricians & Gynecologists and Family Physicians. Learning Objectives: After completing this CME activity physicians should be better able to evaluate common vulvar skin conditions and identify these conditions as a source of significant morbidity for women, diagnose vulvar dermatoses using vulvar biopsy as the gold standard, create a differential diagnosis of vulvar skin disorders.
Management of pregnancy in women with genetic disorders: part 2: inborn errors of metabolism, cystic fibrosis, neurofibromatosis type 1, and turner syndrome in pregnancy.
Obstet Gynecol Surv. 2011 Dec;66(12):765-76
Authors: Chetty SP, Shaffer BL, Norton ME
Abstract
With early diagnosis and increasingly effective medical care, more women with genetic syndromes are undergoing pregnancy, often presenting challenges for providers. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who experience impaired fertility because of their underlying diagnosis. Management of these women requires health care providers from multiple specialties to provide coordinated care to optimize outcomes. Potentially, serious medical issues specific to each diagnosis may exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be understood to allow timely diagnosis and treatment. The fetus may also face issues, both related to risk for inheritance of the genetic disorder observed in the mother as well as risks related to her chronic disease status. In this article, the second of a 2-part series, we will review the key issues for managing women with various inborn errors of metabolism during pregnancy. Additionally, we will discuss the care of women with Turner syndrome, neurofibromatosis type 1, and cystic fibrosis. Target Audience: Obstetricians & Gynecologists and Family Physicians Learning Objectives: After the completing the CME activity, physicians should be better able to classify the pulmonary and nutritional issues facing women with cystic fibrosis in pregnancy, assess the baseline evaluation that should take place in women with Turner syndrome, NF1 and cystic fibrosis before attempting pregnancy and evaluate the fetal risks that can be observed in women with untreated inborn errors of metabolism.
Antidepressants in pregnancy: a review of commonly prescribed medications.
Obstet Gynecol Surv. 2011 Dec;66(12):777-87
Authors: Patil AS, Kuller JA, Rhee EH
Abstract
Perinatal depression is an increasingly common comorbidity of pregnancy and is associated with adverse birth outcomes. Newer classes of antidepressants have been developed with a variety of mechanisms and improved side effect profiles. There is increasing use of these medications in reproductive-aged women. Medical providers have to balance the need to prevent relapse of maternal depressive symptoms with the need to minimize fetal exposure to medications. We review the literature on 10 of the most commonly used antidepressant medications: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine, duloxetine, bupropion, and mirtazapine. The pharmacokinetic properties of the medications are detailed, as well as practical considerations for their use in pregnant and lactating women. Guidance on counseling and management of pregnancies complicated by perinatal depression is discussed. Target Audience: Obstetricians & Gynecologists and Family Physicians. Learning Objectives: After completing this CME activity, physicians should be better able to differentiate the current classes of medications utilized commonly for perinatal depression, evaluate the reported adverse effects of antidepressant medications on the patient and developing fetus and choose the appropriate antidepressant medications for a depressed patient who is breast-feeding.
A Case Report of Human Granulocytic Anaplasmosis (Ehrlichiosis) in Pregnancy and a Literature Review of Tick-Borne Diseases in the United States During Pregnancy.
Obstet Gynecol Surv. 2011 Dec;66(12):788-796
Authors: Qasba N, Shamshirsaz AA, Feder HM, Campbell WA, Egan JF, Shamshirsaz AA
Abstract
There is paucity of data regarding tick-borne diseases during pregnancy. Here, we report a case of human granulocytic anaplasmosis during pregnancy with successful treatment and a favorable neonatal outcome. We also review diagnosis, treatment, and outcomes of published case reports from 1983 to 2010 of human granulocytic anaplasmosis, Lyme disease, babesiosis, and human monocytic ehrlichiosis in the United States. Target Audience: Obstetricians and Gynecologists and Family Physicians Learning Objectives: After the completing the CME activity, physicians should be better able to diagnose tick-born diseases, implement best treatment options during the pregnancy, and assess the neonatal outcomes.
PMID: 22192463 [PubMed - as supplied by publisher]
Management of pregnancy in women with genetic disorders, part 1: disorders of the connective tissue, muscle, vascular, and skeletal systems.
Obstet Gynecol Surv. 2011 Nov;66(11):699-709
Authors: Chetty SP, Shaffer BL, Norton ME
Abstract
Due to early diagnosis and increasingly effective medical advances, the number of women with various genetic syndromes who are undergoing pregnancy is increasing, and this represents an important issue for providers of obstetric care. Each year more women with genetic disease reach childbearing age. Advances in assisted reproductive technology have enabled pregnancy in a cohort of woman who may experience impaired fertility due to their underlying diagnosis. Management of these women requires coordination of care by healthcare providers from multiple specialties to optimize outcomes. Potentially serious medical issues specific to each diagnosis often exist in the preconception, antepartum, intrapartum, and postpartum periods, all of which must be recognized to allow timely diagnosis and treatment. The fetus may also face issues related to risk for inheritance of the genetic disorder itself, as well as risks related to the chronic disease status of the mother. This article will explore the issues faced by women with various genetic disorders that may affect connective tissue, muscular, vascular, and skeletal systems. Target Audience: Obstetricians & Gynecologists and Family Physicians Learning Objectives: After the completing the CME activity, physicians should be better able to classify the cardiovascular manifestations observed in Marfan syndrome and Ehlers-Danlos, evaluate prenatal diagnostic options and limitations for various genetic syndromes, assess the risks to the fetus in women with various genetic syndromes. Determine whether there is a preferred mode of delivery for pregnant patients with various genetic syndromes described in this paper.
An update on the management of uterine carcinosarcoma.
Obstet Gynecol Surv. 2011 Nov;66(11):710-6
Authors: Gurumurthy M, Somoye G, Cairns M, Parkin DE
Abstract
Carcinosarcomas are rare aggressive neoplasms with a poor prognosis. The recent International Federation of Gynecology and Obstetrics (FIGO) 2009 categorizes uterine carcinosarcoma into the endometrial carcinoma group. This review highlights the prognosis, recurrence rate, and the treatment modalities. The primary treatment is surgery. Lymphadenectomy as part of the surgical procedure has shown to prolong survival even for early-stage disease. A combined chemo-radiotherapeutic approach has shown a survival benefit. Radiotherapy from various studies has shown a significant effect on local control of the disease, with no obvious benefit on overall survival. Various trials led by the gynecologic oncology group looking into different chemotherapeutic combinations have showed differing response rates. In the future, the emergence of combination of chemotherapeutic agents with molecular-targeted agents may show promising results. Target Audience: Obstetricians & Gynecologists and Family Physicians Learning Objectives: After completing this CME activity, physicians should be better able to appraise the aggressive nature of uterine carcinosarcoma and factors which would help in delaying or preventing recurrence, assess the importance of lymphadenectomy for uterine carcinosarcoma and its effect on survival, and evaluate various recent trials addressing the chemo-radiotherapeutic combinations as adjuvant therapy.
Failed induction of labor: strategies to improve the success rates.
Obstet Gynecol Surv. 2011 Nov;66(11):717-28
Authors: Talaulikar VS, Arulkumaran S
Abstract
The rates of induction of labor (IOL) are rising all over the world. In developed countries, one of every 4 babies is born after IOL at term. The recent World Health Organization guidelines on IOL recommend that failure of induction does not necessitate cesarean delivery [WHO recommendations for induction of labor. World Health Organization, 2011]. These guidelines come when there are concerns that failed primary inductions in nulliparous women, which have led to escalation of the cesarean delivery rates. Obstetricians must recognize the risks associated with IOL (including failure and need for cesarean delivery) and avoid inductions for borderline indications, which are not evidence based. The issue of “failed induction of labor” is topical, and there is a need to define this entity and offer alternatives to cesarean delivery in the management of this group of women. Research is required to develop a test to accurately identify those fetuses most at risk of morbidity or stillbirth who would truly benefit from an early IOL and assess the cost-effectiveness of policies of routine IOL. In this review, we summarized the current recommendations for best practice in the area of IOL, defined “failed induction,” and described options to improve the success rate after “failed primary induction of labor.” Target Audience: Obstetricians & Gynecologists and Family Physicians Learning Objectives: After the completing the CME activity, physicians should be better able to classify the factors determining success or failure of induction of labor, counsel women about risks and benefits of various methods of induction of labor, and compare the options of management available after failed primary induction of labor.
Herpes simplex virus and pregnancy: a review of the management of antenatal and peripartum herpes infections.
Obstet Gynecol Surv. 2011 Oct;66(10):629-38
Authors: Westhoff GL, Little SE, Caughey AB
Abstract
Genital herpes is one of the most common sexually transmitted infections, affecting 1 in 6 people in the United States. Women are twice as likely to be infected as men and infections in women of reproductive age carry the additional risk of vertical transmission to the neonate at the time of delivery. Neonatal herpes infections can be devastating with up to 50% mortality for disseminated herpes simplex virus (HSV) infections in the newborn. Rates of transmission are affected by the viral type of HSV infection and whether the infection around delivery is primary or recurrent. Current management approaches decrease rates of active lesions at the time of delivery and thereby cesarean deliveries, but have not been shown to decrease the incidence of neonatal herpes infections. More research is needed to better elucidate the risk factors for transmission to the neonate and to improve our current management methodology to further decrease vertical transmission. In this review, we will discuss management of antenatal and peripartum herpes infections, considerations for mode of delivery, and the course of neonatal HSV infections. Target Audience: Obstetricians & Gynecologists and Family Physicians Learning Objectives: After the completing the CME activity, physicians should be better able to diagnose and manage genital herpes in the pregnant population, counsel patients appropriately regarding risk for vertical transmission based on viral subtype and type of infection and categorize the severity of neonatal herpes infections.
PMID: 22112524 [PubMed - in process]
PubMed requires this notice of disclaimer is present.
