Reviews in Gynaecological and Perinatal Practice RSS feed: Current Issue. Formerly Reviews in Gynaecological Practice. From 2006 the journal expands in scope to cover perinatal medicine, supported by additional editors with expertise in this area. This series of reviews aim to provide the reader with an up-to-date, practical evidence based series of articles on current, topical areas in the specialties spectrum of interest. The published articles seek to address the practical, clinical issues on key areas, following a problem oriented approach to include diagnosis, treatment and patient management. The invited authors are professionals at the fore front of the current advances in these areas. THIS JOURNAL CEASED PUBLICATION AT THE END OF 2006. FOR INFORMATION ABOUT OTHER JOURNALS IN THIS SUBJECT AREA, PLEASE FOLLOW THE "JOURNAL RELATED INFORMATION" LINK ON THE LEFT HAND NAVIGATION BAR TO "OTHER JOURNALS IN SAME SUBJECT AREA". http://www.rigpp.org/?rss=yesElsevier Inc.en © 2005 Published by Elsevier Inc. All rights reserved. Reviews in Gynaecological and Perinatal Practice1871-232063-4September 2006 © 2005 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.rigpp.org/article/PIIS1871232006000320/abstract?rss=yesEditorial Board and Aims and Scope10.1016/S1871-2320(06)00032-0Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7iihttp://www.rigpp.org/article/PIIS1871232006000344/abstract?rss=yesContents10.1016/S1871-2320(06)00034-4Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7iiiiiihttp://www.rigpp.org/article/PIIS1871232006000265/abstract?rss=yesAbstract: Approximately 10% of cancer deaths in women in Westernised countries are due to gynaecological malignancy. Cancer results from the accumulation of multiple genetic alterations. Some alterations occur in the germline and increase susceptibility to disease during an individual's lifetime. Such alterations often manifest themselves as a clustering of cancer cases within families. However, these are relatively rare. Most genetic changes are spontaneous, occurring in somatic cells, and are associated with a progressive tumour development. It is likely that the compliment of genetic changes that initiate and accumulate during tumour formation influence clinical features of disease including histopathological subtypes, response to therapy and, ultimately, patient survival. It is hoped that a greater understanding of the underlying genetic basis of tumourgenesis will lead to better risk prediction for individuals with susceptibility to cancer, an improved ability to detect cancer at an earlier, more treatable stage and to the identification of novel therapeutic targets. Many of these goals are dependent on the continuing progress of biotechnology to develop high throughput methods for the rapid analysis and characterisation of blood and tumour tissue specimens for implementation in routine clinical diagnostic procedures.Genetic mutations in gynaecological cancersKarim Elmasry, Simon A. Gayther10.1016/j.rigapp.2006.05.009Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7115125http://www.rigpp.org/article/PIIS1871232006000186/abstract?rss=yesAbstract: Until recently, the treatment of choice for Stage 1A cervical cancer has been simple or radical hysterectomy. With excellent survival rates and an increasing desire to conserve fertility, conservative surgical methods are being used. The object of this review is to discuss prognostic factors, treatment options and methods of follow-up for women with microinvasive cervical cancer.Treatment and follow-up of women with microinvasive cervical cancerMary Cairns, Margaret Cruickshank10.1016/j.rigapp.2006.05.001Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7126132http://www.rigpp.org/article/PIIS1871232006000253/abstract?rss=yesAbstract: The development of postpartum urinary symptoms such as incontinence and voiding dysfunction are not uncommon and often difficult to resolve. The urinary tract undergoes both structural and functional changes during pregnancy and after delivery. These changes may be specific in response to pregnancy and in some women may be compounded by pathological changes that persist after delivery. In labour, factors such as prolonged labour, assisted vaginal delivery, and perineal laceration have been associated with development of bladder dysfunction. Anatomical and functional changes to the pelvic floor may occur secondary to pelvic floor distension during descent of the fetal head and maternal expulsive efforts during the active second stage of labour. This chapter focuses on the effect of pregnancy and childbirth on the lower urinary tract and discusses the possible mechanisms by which pelvic floor damage may occur and their long-term sequelae and management.Postpartum bladder dysfunctionCharlotte Chaliha10.1016/j.rigapp.2006.05.007Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7133139http://www.rigpp.org/article/PIIS1871232006000046/abstract?rss=yesAbstract: There is a large body of literature investigating the mechanism, risk factors, and pathophysiology of postpartum urinary retention; it is usually a temporary condition where early diagnosis and appropriate management can avoid long term complication. This article reviews the etiology, prevention, management and long-term implications of retention for bladder functions.Management of postpartum urinary retentionRaheela M. Rizvi, Javed Rizvi10.1016/j.rigapp.2006.02.003Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7140144http://www.rigpp.org/article/PIIS1871232006000289/abstract?rss=yesAbstract: Female hirsutism is a distressing and embarrassing problem although there is rarely a sinister underlying pathology. It is characterised by excessive coarse terminal hairs in a male-like pattern and is due to increased androgen production or increased sensitivity of androgen receptors. Polycystic ovary syndrome (PCOS) is by far the commonest cause of hirsutism. A systematic evaluation of the patient will readily identify any serious underlying cause. Therapeutic options often include a combination of medical treatments targeting different sites of action, apart from mechanical ablation, cosmetic measures, or use of a new topical treatment to reduce the rate of hair growth. The combined oral contraceptive pill (OCP) is the most commonly used treatment and can supplement other medications but may not be ideal for obese patients. Finasteride and cyproterone acetate are effective treatments and new evidence suggests that low doses of these treatments can be just as effective. Spironolactone can be an effective treatment for hirsutism, although it is not as widely used in the UK as it is elsewhere in the world. Insulin sensitisers, particularly metformin, are being used increasingly with very promising results but more data are needed. Obesity can aggravate hirsutism and influence the choice of treatment. Weight reduction should be a crucial element of treatment in women who are overweight. Due to the long growth cycles of body hair, any objective benefit from a systemic treatment would not be expected before 6–12 months. Concomitant reliable contraception should be used to avoid the possible harm of antiandrogens on a male foetus. Vaniqa and Dianette are the only licensed treatments for hirsutism in the UK.The investigation and management of the hirsute womanNadia F. Soliman, Peter G. Wardle10.1016/j.rigapp.2006.06.002Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7145152http://www.rigpp.org/article/PIIS1871232006000241/abstract?rss=yesAbstract: The etiology of endometriosis remains unclear and at the moment most of the therapeutic options are directed towards the relief of symptoms. In this context, in vitro fertilisation (IVF) overcomes anatomical distortion but our ability to influence environmental factors still seems to be limited. The improvement in pregnancy rates in endometriosis associated infertility is as important as the reduction in complications, and a careful analysis for the indications of each treatment option should be guaranteed. The use of gonadotropin releasing hormone agonists (GnRHa) for 3–6 months has shown to improve IVF outcomes, while increasing literature questions the role of surgery prior to the start of an IVF treatment cycle in views of fertility improvement. Early referral of these women to specialised centres is advised.Optimising in vitro fertilisation (IVF) outcome in women with endometriosisAlejandro Chavez-Badiola, Andrew Drakeley10.1016/j.rigapp.2006.05.008Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7153160http://www.rigpp.org/article/PIIS1871232006000198/abstract?rss=yesAbstract: Endometriosis is a common condition affecting around 2–10% of women of reproductive age. Various medical therapies are in widespread use for control of symptoms, however, very little is known of the effect of these therapies on the disease itself. In addition, the natural history of the condition when left untreated is far from clearly understood. If one uses medical therapies for symptom control it is possible the underlying disease may progress insidiously such that, if surgery is required in the future, may be increasingly difficult and hazardous. We reviewed the literature to assess the efficacy of any medically treatment used in endometriosis at causing regression of disease. Despite an extensive search, this issue is addressed adequately by very few studies. The data that are available suggests medroxyprogesterone acetate (MPA) and luteal phase dydrogesterone are probably ineffective at causing disease regression whilst gestrinone appears to be effective. The effects of danazol and triptorelin are inconclusive.A systematic review to determine the effectiveness of medical therapies at causing disease regression in endometriosisT.T. Carpenter, A.S.H. Kent, R. Lawrenson10.1016/j.rigapp.2006.05.002Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7161167http://www.rigpp.org/article/PIIS1871232006000228/abstract?rss=yesAbstract: This review article aims to give a comprehensive insight into both the historical and current thoughts on all aspects of endometriosis including aetiology, diagnosis, and medical and surgical treatments. The prevalence of endometriosis is about 6–8%, and may affect up to two million women in the United Kingdom. It causes, through pain and infertility, a significant problem for sufferers, their families and society as a whole. There is no conclusive evidence to explain its aetiology although our understanding of the basic pathophysiology is improving. However, there remains a substantial lack of understanding in all areas of disease.A rationale is presented for surgical therapy as the preferred approach for diagnosis and treatment. The recognised gold standard for diagnosis is laparoscopy. Surgery is the only treatment modality that consistently eradicates all macroscopic diseases and can be carried out at the same time as diagnosis. There is no evidence that medical treatment is superior to surgical treatment. Surgical removal of endometriotic lesions is the only treatment that improves spontaneous conception rates in endometriosis-associated infertility. The evidence for the surgical techniques and energy modalities used for the surgical management of minimal to moderate endometriosis, endometriomas and recto-vaginal disease are described in greater detail.Endometriosis: A general review and rationale for surgical therapyP. Barton-Smith, K. Ballard, A.S.H. Kent10.1016/j.rigapp.2006.05.005Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7168176http://www.rigpp.org/article/PIIS1871232006000058/abstract?rss=yesAbstract: Gynaecologists are frequently referred women with chronic pelvic pain. These women are often frustrated as they seek to understand their pain and how to manage it. The investigation of women with chronic pelvic pain hinges on taking a full history including social and psychological issues and usually involves laparoscopy and transvaginal ultrasound. Management is often complex and includes taking a multidisciplinary approach as well as using hormonal agents, surgery and psychological interventions.Chronic pelvic pain: Aetiology and therapyCynthia Farquhar, Pallavi Latthe10.1016/j.rigapp.2006.02.004Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7177184http://www.rigpp.org/article/PIIS1871232006000277/abstract?rss=yesAbstract: Pelvic inflammatory disease and pelvic abscesses have been reported as a major complication following a wide variety of obstetrical, gynaecological and surgical procedures. The aim of this review article is to emphasize the need for a more aggressive approach to detect and to treat what can be a debilitating condition that if inadequately treated may result in mortality. The large numbers of options available are discussed under the headings of: conservative management, interventional radiological management and surgical treatment. Lastly, preventive strategies are discussed, as pelvic inflammatory disease may result in tubal factor infertility, ectopic pregnancies, chronic pelvic pain and tubo-ovarian/pelvic abscesses.Pelvic inflammatory disease and pelvic abscessesZeenat Eva Khan, Javed H. Rizvi10.1016/j.rigapp.2006.06.001Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7185191http://www.rigpp.org/article/PIIS1871232006000204/abstract?rss=yesAbstract: After an introduction recounting the pronatalist views of the world's religions, the article goes on to explore each of the major religions, Judaism, Christianity, Islam, Hinduism, Sikhism and Buddhism and their belief systems in relation to contraception and abortion. This is followed by a discussion of the practical consequences of these beliefs and of the role of the professional in helping women and couples of the varied faiths in their choice of methods. How these choices may affect religious practices and vice versa is also considered.Religious aspects of contraceptionElphis Christopher10.1016/j.rigapp.2006.05.003Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7192198http://www.rigpp.org/article/PIIS1871232006000216/abstract?rss=yesAbstract: The early human embryo develops in a tightly controlled, relatively protected environment. During the first 8–12 weeks of human gestation, the delivery of maternal blood, and therefore the amount of oxygen to the developing embryo is limited and the embryo is supplied with essential nutrients in part via the decidual uterine glands, the placental trophoblast and the secondary yolk sac. Factors that interfere with this process may well result in spontaneous miscarriage or adverse outcome later in pregnancy. There is mounting evidence for the presence of transporter systems for many substances including drugs and toxins from the maternal to the fetal compartments in early pregnancy. The role of these substances in both the protection of early pregnancy development and possible teratogenicity are explored in this chapter. Clearly, the timing of exposure to potentially damaging substances is crucial with effects on conception, implantation, placental development and organogenesis dependent on the gestation at which exposure occurs.Factors affecting the early embryonic environmentJemma Johns, Eric Jauniaux, Graham Burton10.1016/j.rigapp.2006.05.004Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7199210http://www.rigpp.org/article/PIIS1871232006000071/abstract?rss=yesAbstract: It is well established that there is a strong relationship between fetal growth and the subsequent development of type 2 diabetes and other features of the metabolic syndrome. The importance of the fetal environment has been shown in both human and rodent studies. Twin studies suggest that the relationship can be independent of genotype, and studies of individuals in gestation during famine clearly indicate the importance of the fetal environment. However the mechanistic basis of the relationship is as yet unknown. To investigate the underlying mechanisms behind this relationship, a number of animal models have been developed. Nutritional insults administered maternally such as calorie restriction, iron restriction, high fat feeding and protein restriction have all been shown to lead to features of the metabolic syndrome in the offspring. Exposure to hormones, surgical interventions and gestational diabetes have also been shown to have detrimental effects on the offspring. These animal models provide strong evidence that alterations in the fetal environment can lead to metabolic diseases in adult life.Intrauterine origins of metabolic diseaseN.H. Smith, S.E. Ozanne10.1016/j.rigapp.2006.03.002Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7211217http://www.rigpp.org/article/PIIS187123200600023X/abstract?rss=yesAbstract: Group B streptococci can be isolated from the vagina of 15–40% of pregnant women. Vertical transmission to the infant occurs in 50% of deliveries involving colonised women. Most infants remain asymptomatic, but 1–2% develop clinical infection, which is associated with significant morbidity and mortality. Vertical transmission can be successfully prevented by intrapartum administration of antibiotics. Other proposed methods include vaccines and intrapartum vaginal or neonatal washing with antiseptics.Selection of women for prophylactic antibiotics can be based on risk factors, screening or a combination of both. Benefits of prophylaxis should be balanced against cost, medicalisation of labour and the risks of anaphylaxis and bacterial resistance.We present an overview of vaginal group B streptococcal isolation methods and antenatal strategies for prevention of neonatal infection.Antenatal prevention of neonatal group B streptococcal infectionSophie Beal, Stephanie Dancer10.1016/j.rigapp.2006.05.006Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7218225http://www.rigpp.org/article/PIIS1871232006000290/abstract?rss=yesAbstract: Cervical incompetence is an important factor in the aetiology of preterm birth and mid-trimester miscarriage. Its diagnosis usually relies on clinical history, but recent studies have investigated the role of transvaginal ultrasound scanning, with the finding of shortened cervical length being associated with an increased risk of preterm delivery.Cervical incompetence can be treated using MacDonald and Shirodkar cervical sutures. The largest study to date found a significant reduction in preterm delivery in those women who had a suggestive clinical history. This finding has been supported by the insertion of sutures in women found to have a shortened cervix on ultrasound scan. These findings are inconsistent, with some studies failing to confirm benefit.Transabdominal cervical sutures have a role in treating women with previously failed cervical cerclage (success rates reported as over 80% in most studies) although the numbers of women who have undergone this treatment is small.Cervical sutures have been used in the management of multiple pregnancies, although to date there is no good evidence that cervical sutures have a significant role.The use of emergency cervical sutures seems to have a role in a select population of women who present with painless cervical dilatation, in the absence of infection; in these women gestation has been prolonged by up to seven weeks.The evidence for the use of cervical cerclageJennifer A. Brewster, James J. Walker10.1016/j.rigapp.2006.06.003Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7226232http://www.rigpp.org/article/PIIS1871232006000174/abstract?rss=yesAbstract: Obstetricians frequently need to decide whether to induce a woman who has previously been delivered by Caesarean section (LSCS). There is very little evidence from randomised controlled trials to aid their decision making. Observational studies, with their inherent flaws, suggest a 3.6% maternal complication rate in women undergoing repeat elective LSCS, and approximately 66% vaginal delivery rate and 1% uterine rupture rate in women who were induced. There is little evidence to guide the choice of induction agent. Various factors have been suggested to predict a successful vaginal delivery, but a previous vaginal delivery appears to be strongly predictive of a good outcome. Alternative strategies, such as stretching and sweeping the membranes or awaiting spontaneous labour, may reduce the need for induction. If labour is induced in a woman with a scarred uterus we should ensure that the high risk situation is not compounded by poor care in labour.Repeat Caesarean section or induction of labourSarah Vause, Stelios Christodoulou10.1016/j.rigapp.2006.04.001Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7233239http://www.rigpp.org/article/PIIS187123200600037X/abstract?rss=yesAuthor Index of Volume 610.1016/S1871-2320(06)00037-XReviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7IIhttp://www.rigpp.org/article/PIIS1871232006000381/abstract?rss=yesSubject Index of Volume 610.1016/S1871-2320(06)00038-1Reviews in Gynaecological and Perinatal Practice 6, 3 (2006)2006-09-01Reviews in Gynaecological and Perinatal Practice2006-09-0163-4S1871-2320(06)X0014-7IIIV