摘要:

Purpose of reviewTo summarize results from the Women's Health Initiative trial and other recent randomized placebo-controlled trials of hormone replacement therapy, which fundamentally changed our understanding of its risks and benefits.Recent findingsThe Women's Health Initiative study for the first time provided evidence of harmful effects of hormone replacement therapy on the cardiovascular system and also confirmed significantly increased risk of breast cancer which was previously documented in a metaanalysis. Most recent studies indicate a particularly harmful effect of combined estrogen/progestin regimens in terms of increased breast cancer risk.SummaryThe effects of hormone replacement therapy on coronary heart disease, stroke, venous thromboembolism, breast cancer, gallbladder, diabetes, cognitive function, health-related quality of life, colorectal cancer, osteoporosis and menopausal symptoms are discussed briefly. The emphasis is on providing concise clinical guidelines for hormone replacement therapy use in new circumstances. We also discuss some alternative therapeutic modalities for women who have menopausal symptoms, but contraindications for hormone replacement therapy.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThis review describes how the physiological demands of pregnancy act as a maternal stress test that can predict a woman's health in later life. Pregnancy transiently catapults a woman into a metabolic syndrome that predisposes to vascular endothelial dysfunction. Women who are already predisposed to this phenotype develop gestational hypertension or diabetes mellitus, which re-emerge in later life as the metabolic syndrome returns. Pregnancy can also temporarily unmask sub-clinical disease, which may return in later life when the effects of ageing diminish the limited reserves of a vulnerable organ.Recent findingsRecent studies have attempted to assess how gestational syndromes affect the risk for a woman of developing a diverse range of diseases in later life. As well as cardiovascular disease and diabetes mellitus, pregnancy can reveal a vulnerability to thyroid and pituitary disorders, liver and renal disease, depression, thrombosis and even cancer.SummaryAlthough our knowledge of this phenomenon is incomplete, women who have had gestational syndromes, in particular pregnancy-induced hypertension/preeclampsia or gestational diabetes, should make lifestyle changes that will reduce their risk of cardiovascular disease in later life.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThere are around 450 000 cases of cervical cancer per year with 300 000 deaths, making it one of the largest causes of death in women worldwide. Dramatic decreases in cervical cancer mortality rates have been seen following the introduction of screening in several industrialised countries. This is despite using a screening test (the cervical smear) that has a fairly poor sensitivity of approximately 55%. Research has centred on finding a better primary or adjunctive test. Issues of cost and acceptability also need to be addressed. It is now widely understood that virtually all cervical cancers are initiated by oncogenic high-risk type human papilloma virus infections, namely human papilloma viruses 16, 18, 30, 31, 33, and 45.Recent findingsThe confirmed negative predictive value (99%) of a negative human papilloma virus test makes it potentially valuable in the triage of minor smear abnormalities and as post-treatment surveillance. In addition to evidence of its value in triage, there is a growing debate about its use as a primary tool in cervical screening, particularly in settings that do not currently have a structured programme. However, the psychological impact of human papilloma virus testing is less clear. Ultimately, advances in vaccination may hold the key to the eradication of cervical cancer.SummaryThis article assesses the recent evidence on the place of human papilloma virus testing in three clinical settings, as a primary screening tool, in triage and as a test of cure. It also reviews the current understanding of the psychological impact of a positive human papilloma virus test.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo review the current literature on vaginal birth after cesarean delivery efficacy and safety.Recent findingsThere are two major themes in current vaginal birth after cesarean delivery research. The first is continued work on the short-term safety, including maternal events such as uterine rupture and perinatal death. The second theme focuses on identifying predictors for success and failure.SummaryCurrent information suggests that the rate of major maternal and neonatal complications with vaginal birth after cesarean delivery is low, and this option should be offered to women with a single prior low transverse cesarean. Future research should focus on an evaluation of both short-term and long-term consequences of vaginal birth after cesarean delivery compared with elective repeat cesarean section.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe purpose of this review is to provide a critical summary of recent studies on the clinical effects of metformin in polycystic ovary syndrome.Recent findingsAfter the recognition that hyperinsulinaemia is a fundamental disturbance in polycystic ovary syndrome, a novel and promising form of therapy in the form of insulin-sensitizing drugs has been introduced. Among these, metformin is the most widely used. This therapeutic intervention has been shown to exert beneficial effects on the endocrine and metabolic disturbances that characterize the syndrome and, more recently, to improve the reproductive outcome in women with polycystic ovary syndrome. With rapid progress in this area, metformin use has also been extended to the management of lean polycystic ovary syndrome patients.SummaryAlthough most studies are nonrandomized trials, current data provide a rationale for metformin as first-line management for women with polycystic ovary syndrome, alone or in combination with conventional treatments. Controversy still exists, however, regarding the mechanisms by which metformin exerts its beneficial effects in polycystic ovary syndrome.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewPreeclampsia is a common complication of pregnancy and a significant cause of fetal and maternal morbidity and mortality. The purpose of this review is to highlight and discuss aspects of some of the more recent clinical management papers published in the field of preeclampsia and eclampsia. The title explains the clinical nature of this paper and a detailed review of the basic science literature is beyond the scope of this article.Recent findingsSeveral controversial areas still exist in the current management of severe preeclampsia/eclampsia. We present a number of interesting papers dealing with practical management questions and discuss the optimum treatment regimen for preventing eclampsia. The findings of the MAGPIE study are discussed. Opinions are expressed as to the current management of preterm severe preeclampsia, and we outline a new hypothesis on the etiology of eclampsia.SummaryPreeclampsia/eclampsia remains a disease without a clear etiology. Despite this, clinical management issues are being addressed and maternal morbidity and mortality continue to fall.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewAn increasing number of patients present with symptoms of vulvar pain, soreness, burning or irritation, which become chronic. Clinicians are often uncertain of the diagnosis. Terminology and an understanding of aetiology and therapy are evolving.Recent findingsPrevious descriptions of vulvodynia have grouped patients according to whether pain is provoked by coitus (vulvar vestibulitis syndrome) or generalized and neuropathic pain (dysesthetic vulvodynia). Recent terminology debates have questioned whether ‘vulvodynia’ should be replaced by ‘dysesthesia’ and the term ‘vestibulitis’ avoided. Definitions of pain provocation, quality, duration, and distribution vary. Prevalence studies suggest one in six women may experience vulvodynia, although such a figure reflects clinic, patient or author reporting bias. Symptoms are as likely to be found in non-white as in white women. Although infection is often blamed, evidence for its role or that of inflammation is minimal. Immunohistochemistry has shown altered density of nerve endings and oestrogen receptors. There may be overlap with other pain syndromes. Several reviews have examined the many therapies available. Pharmacological alteration of nerve conduction (tricyclic antidepressants, gabapentin, local anaesthetics), biofeedback and sometimes surgery are helpful, but not always. Counselling and an understanding between patient and clinician/therapist are important for long-term results.SummaryGynaecologists should be aware that they will encounter patients with vulvodynia who will need assessment and management. There are increasing numbers of clinics or clinicians with expertise to whom these patients can be referred.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe most important acquired thrombophilia related to poor pregnancy outcome is probably antiphospholipid syndrome. Inherited thrombophilias that have been implicated in venous thromboembolism and poor pregnancy outcome and for which standard tests are generally available are antithrombin III deficiency, the factor V Leiden mutation, prothrombin G20210A mutation and the C677T polymorphism in the methylenetetrahydrofolate reductase system implicated in mild hyperhomocysteinaemia. The management of antiphospholipid syndrome with previous fetal losses is well documented and substantiated by small clinical trials. It is the purpose of this review to investigate new contributions to this field since June 2002.Recent findingsOnly one randomized trial was published during the review period, but a Cochrane review and several excellent review articles appeared detailing management.SummaryThere is a dire lack of randomized trials in the literature on the efficacy of heparin or other coagulation modulators on pregnancy outcome in patients with inherited thrombophilias. There is consensus on thrombo-prophylaxis for antiphospholipid syndrome. Protocols for the management of venous thromboembolism and pulmonary emboli related to pregnancy are well established.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewEndometriosis is a common cause of chronic pelvic pain and has a detrimental effect on the quality of life for women affected with the condition. It is also clear that early diagnosis with prompt effective management does not always occur. This review will discuss the medical and surgical treatment options and support conclusions with randomized double blind placebo-controlled studies where possible.Recent findingsAssessment of the pelvic pain associated with endometriosis can be categorized according to its relation to the menstrual cycle. Dysmenorrhoea and ovulatory pain occur with cyclical changes, as compared with chronic non-cyclic pain and deep dyspareunia. Dyskesia and urinary pain may have a relation to the menstrual cycle. The severity of pain symptoms, as well as the effect on the woman's quality of life, should be quantified. The preoperative symptoms can be compared with the operative findings and the stage of endometriosis according to the revised American Fertility Score.SummaryReview of the current literature demonstrates that a combined medical and conservative surgical approach is beneficial for most women with endometriosis associated pelvic pain.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe subject of misoprostol in the field of reproductive health care has courted much controversy. The aim of this review is to survey the literature published in this field over the past year, and to evaluate developments in this area. This article will cover termination of pregnancy, induction of labor and the issue of postpartum hemorrhageRecent findingsThe use of misoprostol as a single agent remains of clinical value when mifepristone is unavailable. The sublingual and rectal routes are alternative modes of administration. For induction of labor, the optimum dose and route of misoprostol is still undetermined. Lower doses of between 20 μg to 40 μg may increase the safety profile for labor induction. Misoprostol may be a useful adjunct to the therapeutic options available for the prevention and treatment of postpartum hemorrhage.SummaryThere are many potential uses for misoprostol in pregnancy. However clinicians must judge the evidence and the emotive debate surrounding this field and decide how it will influence their clinical practice depending on the priorities of their own clinical circumstances.

ISSN:1040-872X    

出版商:OVID    

年代:2003

数据来源: OVID