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"Gynecology and obstetrics"
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Human Cytomegalovirus Infection Elicits New Decidual Natural Killer Cell Effector Functions
During the first trimester of pregnancy the uterus is massively infiltrated by decidual natural killer cells (dNK). These cells are not killers, but they rather provide a microenvironment that is propitious to healthy placentation. Human cytomegalovirus (HCMV) is the most common cause of intrauterine viral infections and a known cause of severe birth defects or fetal death. The rate of HCMV congenital infection is often low in the first trimester of pregnancy. The mechanisms controlling HCMV spreading during pregnancy are not yet fully revealed, but evidence indicating that the innate immune system plays a role in controlling HCMV infection in healthy adults exists. In this study, we investigated whether dNK cells could be involved in controlling viral spreading and in protecting the fetus against congenital HCMV infection. We found that freshly isolated dNK cells acquire major functional and phenotypic changes when they are exposed to HCMV-infected decidual autologous fibroblasts. Functional studies revealed that dNK cells, which are mainly cytokines and chemokines producers during normal pregnancy, become cytotoxic effectors upon their exposure to HCMV-infected autologous decidual fibroblasts. Both the NKG2D and the CD94/NKG2C or 2E activating receptors are involved in the acquired cytotoxic function. Moreover, we demonstrate that CD56(pos) dNK cells are able to infiltrate HCMV-infected trophoblast organ culture ex-vivo and to co-localize with infected cells in situ in HCMV-infected placenta. Taken together, our results present the first evidence suggesting the involvement of dNK cells in controlling HCMV intrauterine infection and provide insights into the mechanisms through which these cells may operate to limit the spreading of viral infection to fetal tissues.
Journal Article
Menopause confidential : a doctor reveals the secrets to thriving through midlife
\"An authoritative guide to understanding and navigating the hormonal changes and health issues women experience in midlife and beyond, from one of the leading medical experts in the field. The physical changes that occur after women turn forty are unavoidable--and can be unnerving. Menopause affects every aspect of life--from sex and sleep to mood and mental clarity to weight and body temperature. While there are a number of resources available, many are confusing and contradictory. Now, Manhattan gynecologist Dr. Tara Allmen, an experienced, nationally board-certified menopause practitioner and the recipient of the 2015 Doctor's Choice National Award for Obstetrics & Gynecology, shares her knowledge to help women be their happiest and healthiest, and turn this challenging time into an exciting one. Written in her effervescent yet assured voice, Menopause Confidential provides simple strategies and cutting-edge information on: hormonal changes and the symptoms of perimenopause and menopause; the health risks associated with midlife--from cutting through the conflicting opinions and advice about health screenings (Do I really need a colonoscopy? How often should I get a mammogram?) to common medical conditions, such as osteoporosis; various remedies, both allopathic and natural, to combat symptoms and empower women to make the best choices for their individual needs; practical tips and resources for mitigating the effects of menopause. Fifty-one-year-old Dr. Allmen knows firsthand what women are going through, and shares stories of her own personal travails and solutions. Women can't turn back the clock, but they can take control of their health and flourish in midlife. Menopause Confidential encourages them to be informed, be proactive, and be their greatest selves\"-- Provided by publisher.
Book
Fertility-Sparing Surgery for Ovarian Cancer
(1) Background: although most patients with epithelial ovarian cancer (EOC) undergo radical surgery, patients with early-stage disease, borderline ovarian tumor (BOT) or a non-epithelial tumor could be offered fertility-sparing surgery (FSS) depending on histologic subtypes and prognostic factors. (2) Methods: we conducted a systematic review to assess the safety and fertility outcomes of FSS in the treatment of ovarian cancer. We queried the MEDLINE, PubMed, Cochrane Library, and Cochrane (“Cochrane Reviews”) databases for articles published in English or French between 1985 and 15 January 2021. (3) Results: for patients with BOT, FSS should be offered to young women with a desire to conceive, even if peritoneal implants are discovered at the time of initial surgery. Women with mucinous BOT should undergo initial unilateral salpingo-oophorectomy, whereas cystectomy is an acceptable option for women with serous BOT. Assisted reproductive technology (ART) can be initiated in patients with stage I BOT if infertility persists after surgery. For patients with EOC, FSS should only be considered after staging for women with stage IA grade 1 (and probably 2, or low-grade in the current classification) serous, mucinous or endometrioid tumors. FSS could also be offered to patients with stage IC grade 1 (or low-grade) disease. For women with serous, mucinous or endometrioid high-grade stage IA or low-grade stage IC1 or IC2 EOC, bilateral salpingo-oophorectomy and uterine conservation could be offered to allow pregnancy by egg donation. Finally, FSS has a large role to play in patients with non- epithelial ovarian cancer, and particularly women with malignant ovarian germ cell tumors.
Journal Article
The unexpected : navigating pregnancy during and after complications
\"From New York Times bestselling author of Expecting Better, a guide to navigating a second pregnancy when the first did not go as planned-with Dr. Nathan Fox, Maternal Fetal Medicine specialist. In Expecting Better, Emily Oster revolutionized the pregnancy landscape with her data-driven approach. In the years since, she kept hearing questions from readers on how to approach a second pregnancy when the first has not gone as planned. The Unexpected is a book that Oster hopes no one needs-but in reality, 50 percent of pregnancies include complications, and we don't talk about it. Preeclampsia, miscarriage, hyperemesis gravidarum, preterm birth, postpartum depression: these are lonely experiences, and that isolation makes treatment harder to access-and crucial research and policy change less likely to happen. The Unexpected lays out the data on recurrence and treatments shown to lower or mitigate risk for these conditions in subsequent pregnancies. It also provides readers roadmaps to facilitate productive conversations with their providers, with insights from lauded maternal fetal medicine specialist Dr. Nathan Fox. By bridging the knowledge gap and making space for difficult conversations, The Unexpected promises to make the hardest parts of pregnancy a little bit less so\"-- Provided by publisher.
Book
An International Continence Society (ICS)/ International Urogynecological Association (IUGA) joint report on the terminology for the assessment and management of obstetric pelvic floor disorders
Aims
The terminology of obstetric pelvic floor disorders should be defined and reported as part of a wider clinically oriented consensus.
Methods
This Report combines the input of members of two International Organizations, the International Continence Society (ICS) and the International Urogynecological Association (IUGA). The process was supported by external referees. Appropriate clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 12 main rounds of internal and 2 rounds of external review was involved to exhaustively examine each definition, with decision-making by consensus.
Results
A terminology report for obstetric pelvic floor disorders, encompassing 357 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it usable by different specialty groups and disciplines involved in the study and management of pregnancy, childbirth and female pelvic floor disorders. Clinical assessment, investigations, diagnosis, conservative and surgical treatments are major components. Illustrations have been included to supplement and clarify the text. Emerging concepts, in use in the literature and offering further research potential but requiring further validation, have been included as an Appendix. As with similar reports, interval (5–10 year) review is anticipated to maintain relevance of the document and ensure it remains as widely applicable as possible.
Conclusion
A consensus-based Terminology Report for obstetric pelvic floor disorders has been produced to support clinical practice and research.
Journal Article
Obstetrics and gynecology in low-resource settings : a practical guide
Obstetrics and Gynecology in Low-Resource Settings provides practical guidelines for ensuring the delivery of quality OB/GYN care to women in resource-poor countries. Including contributions from leading clinicians and researchers in the field, this overview is intended as a resource for doctors, clinicians, and medical students at all stages of their careers who work in the global health arena. The volume features hands-on, step-by-step instruction for the most pertinent OB/GYN conditions--both acute and chronic--that health care workers in the field confront. The authors examine a wide range of topics, including: strategies to reduce maternal mortality and stillbirths; infectious and sexually transmitted diseases, including malaria and HIV; cervical cancer; contraception; prenatal, delivery, and newborn care; and complications arising from gender-based violence and female genital cutting.-- Provided by publisher
Book
Sanfilippo's Textbook of Pediatric and Adolescent Gynecology
This textbook provides a comprehensive review of all the common and less often encountered pediatric and adolescent gynecology problems in daily practice, both in the ambulatory as well as in the surgical setting. This new edition has been updated to keep it closely aligned to what general gynecologists or family physicians will want to know when dealing with a paediatric or adolescent patient, with accompanying videos.
Joseph S Sanfilippo, MD, MBA : Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, and Academic Division Director, Reproductive Endocrinology and Infertility, Magee-Womens Hospital of UPMC, University of Pittsburgh Medical Center, Pittsburgh, Philadelphia, USA
Eduardo Lara-Torre, MD, FACOG: Vice Chair for Academic Affairs and Section Chief, Academic Specialists in General Obstetrics & Gynecology, Carilion Clinic; Professor, Department of Obstetrics & Gynecology and Pediatrics, Virginia Tech-Carilion School of Medicine, Roanoke, Virginia, USA
Veronica Gomez-Lobo, MD: Director of Pediatric and Adolescent Obstetrics & Gynecology, MedStar Washington Hospital Center/Children’s National; Professor of Obstetrics & Gynecology, Georgetown University, Washington, DC, USA
Normal pubertal development and the menstrual cycle as a vital sign. Communication strategies with the adolescent patient. The physical exam in the pediatric and adolescent patient. Adolescent sexual development and sexuality education. Pubertal abnormalities: Precocious and delayed. Congenital anomalies of the reproductive tract. Variation of sex differentiation. Common vulvar and vaginal complaints. Genital injuries in children and adolescents. Basic dermatology in children and adolescents. Pediatric urology. Adnexal masses in the neonate, child, and adolescent. Breast disorders in children and adolescents. Menstrual disorders and blood dyscrasias in adolescents. Polycystic ovary syndrome and hyperandrogenism in adolescents. Adolescent contraception. Sexually transmitted infections in adolescents. Chronic pelvic pain and endometriosis. Perioperative care of the pediatric and adolescent gynecology patient. Adolescent pregnancy. Nutrition and eating disorders. Reproductive effects of obesity in adolescents. Transgender care in adolescents. Reproductive health care for adolescents with developmental delay. Sexual abuse. Fertility preservation in pediatric and adolescent girls. Confidential care issues. Family and cultural factors in pediatric gynecology. Health-care transition. Legal considerations in pediatric and adolescent obstetrics and gynecology. Appendix 1: Additional video resources. Appendix 2: Establishing a pediatric and adolescent gynecology clinical and educational program. Index.
eBook
Management of unintended and abnormal pregnancy
The United States has the highest rate of unintended pregnancy in the developed world.Women in the United States seek abortion for nearly one quarter of all pregnancies and for approximately half of all unintended pregnancies.An estimated 34% of U.S.women will have at least one induced abortion by the time they reach age 45.
eBook
Histology of the vaginal wall in women with pelvic organ prolapse: a literature review
Introduction and hypothesis
The pathophysiology of pelvic organ prolapse (POP) is incompletely understood. The purpose of this study is to describe the current knowledge about histology of the vaginal wall and its possible involvement in the pathogenesis of pelvic organ prolapse.
Methods
Eligible studies were selected through a MEDLINE search covering January 1986 to December 2012. The research was limited to English-language publications.
Results
Investigations of changes in the vaginal tissue that occur in women with genital prolapse are currently still limited and produced contrary results. The heterogeneity of the patients and the control groups in terms of age, parity and hormonal status, of the localization of biopsies and the histological methods as well as the lack of validation of the quantification procedures do not allow clear and definitive conclusions to be drawn.
Conclusions
This review shows that current knowledge of the histological changes observed in women with POP are inconclusive and relatively limited. More studies are needed in this specific field to better understand the mechanisms that lead to POP.
Journal Article