Expert Review of Obstetrics and Gynecology

Despite the lack of consensus among groups issuing recent guidelines, it is possible to identify options that are available for prenatal practitioners. Examples include the following: iodine supplements to protect against hypothyroidism; adjusting l-thyroxine dosage upward in women with previously diagnosed hypothyroidism to account for increased pregnancy needs; and screening for undetected thyroid deficiency via targeted questions and/or thyroid-stimulating hormone testing. Decision-making about thyroid status requires access to reliable, trimester-specific normative data for both thyroid-stimulating hormone and free thyroxine, as well as an understanding of the impact of human chorionic gonadotropin on thyroid function, especially during the first trimester. Continuity of care is enhanced by systematic follow-up postpartum, including attention to postpartum thyroid dysfunction that often occurs among women with raised antibody levels.

James E Haddow

Expert Review of Obstetrics & Gynecology

Preventing, identifying and managing thyroid deficiency in prenatal practice

预防、识别和管理产前甲状腺功能减退

The effect of uterine leiomyoma on fertility is subject to continuous debate. IVF provides a unique opportunity to examine the effect of leiomyoma on embryonic implantation rate. Over the last two decades, many studies were published associating fibroids and infertility. Taken together these publications indicate that the implantation rate and pregnancy outcome is impaired in women with uterine leiomyoma when they cause deformation of the uterine cavity. In such patients, surgical treatment should be considered prior to IVF because of the reduced implantation rate, however, there are few prospective controlled studies that test the hypothesis that myomectomy with its inherent risks can help. In patients with intramural leiomyoma not invading the uterine cavity, the confusion still persists. Furthermore, even if one accepts that a negative effect of such fibroids exists, there is no direct proof that myomectomy results offer a better prognosis.

Zion Ben-Rafael

Should we operate on fibroids before IVF?

我们应该在试管婴儿前切除子宫肌瘤吗？

This overview focuses on the recent developments in the safety and efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) on established indications, namely contraception, treatment of heavy menstrual bleeding as well as endometrial protection during estrogen therapy for menopausal symptoms. The LNG-IUS is one of the most efficacious reversible contraceptive methods available. It can be used by various patient groups, including nulliparous women, during breast-feeding, after elective pregnancy termination, in women suffering from various pre-existing medical conditions and menopausal women. This review provides an overview of the published literature on the LNG-IUS from the last 5 years, focusing on cost–effectiveness, safety-related outcomes, the use of LNG-IUS by young and/or nulliparous women as well as by various different patient groups. After decades of dominance by the ‘the Pill’, it is likely that in the future, long-acting reversible contraceptives, such as the LNG-IUS, will become the first-line contraceptive options, owing to their superior contraceptive effectiveness in real-life use, cost–effectiveness as well as their established safety profile.

Kristina Gemzell-Danielsson

Pirjo Inki

Oskari Heikinheimo

Safety and efficacy of the levonorgestrel-releasing intrauterine system: recent insights

左炔诺孕酮宫内缓释系统的安全性和有效性：最新见解

Selection of a spermatozoon presenting both motility and normal morphology is one of the main concerns in intracytoplasmic sperm injection. Spermatozoa appearing as morphologically normal at the 400× magnification could carry various structural abnormalities that could negatively influence embryo development and pregnancy establishment, but only be detected with the use of higher optical magnifications. This led to the development of motile sperm organelle morphology examination (MSOME), which can achieve magnification ranging from 6300× to 13000×. Several approaches were used to classify spermatozoa. However, the prevalence of morphologically normal spermatozoa in MSOME is low (usually less than 5%). The most striking abnormalities are vacuoles, thought to be of acrosomal and/or nuclear origin and related to failure of sperm chromatin condensation. Twelve years after the introduction of MSOME, many questions remain unsolved. A consensual definition of a ‘normal’ spermatozoon and a classification of abnormal spermatozoa accepted by all workers in this field is still awaited. We are far away from understanding the nature and the consequences of the vacuoles.

Aurore Perrin

Minh Huong Nguyen

Nathalie Douet-Guilbert

Frédéric Morel

Marc De Braekeleer

Motile sperm organelle morphology examination: where do we stand 12 years later?

运动精子细胞器形态学检查：12年后我们处于什么位置？

Multiple sclerosis (MS) is a chronic autoimmune disease of the CNS, which usually affects women during their childbearing years. Several studies have reported that pregnant MS patients have a low risk of disease progression and an even lower risk of exacerbation, especially in the third trimester, with a rise in relapse rate during the first 3 postpartum months. Although it has been demonstrated that pregnancy has no effect either on the lifetime course of the disease or long-term disability, it is not yet known exactly how well informed patients are as to the interactions between pregnancy and MS or how patients perceive the course of the disease during and after pregnancy. The heterogeneity of symptoms and their multifactorial impact on various sectors such as physical, psychological, familial, social and business necessitate the involvement of an interdisciplinary team with various professionals who work both with one another as well as with the MS patient. This article aims at providing the gynecologist with a brief overview of the most commonly encountered questions and situations to be faced when managing a pregnant woman with MS.

Elisa Picardo

Emilie Marion Canuto

Luca Marozio

Chiara Benedetto

Multiple sclerosis and pregnancy

多发性硬化症与妊娠

Keywords:: cervical ectopiccesarean section scar ectopicdiagnosisectopic pregnancyheterotopic pregnancyovarian ectopictubal ectopicultrasound

Ishwari Casikar

George Condous

How to effectively diagnose ectopic pregnancy using ultrasound?

如何利用超声波有效诊断宫外孕？

The menopause heralds a time of significant change in the hormonal milieu of a woman. This may present both physical and emotional challenges to the clinician, encompassing a wide time frame before and after the onset of menopause. While some symptoms are quite specific to menopause, some are not. The most commonly encountered problems in the early postmenopausal period in the urogynecological setting are: utero-vaginal/pelvic organ prolapse (POP), urinary incontinence (UI), recurrent urinary tract infections (RUTI) and uro-genital atrophy. This article reviews the presentation, assessment and initial management of these problems. A comprehensive review of the management of these conditions is beyond the scope of this article.

Niladri Sengupta

Timothy Hillard

Urogynecological risk assessment in postmenopausal women

绝经后妇女的泌尿妇科风险评估

Postpartum hemorrhage (PPH) is the largest contributor to maternal mortality, occurring in between 1 and 5% of deliveries. Prophylactic uterotonics are widely recommended to prevent atonic hemorrhage. Rapid recognition of PPH and identification of hemorrhage etiology is essential to reduce mortality and morbidity. Treatment is etiology-specific and comprises a range of medical, mechanical, temporizing and surgical procedures. Important developments from trauma and emergency medicine around massive hemorrhage protocols are newly implemented for PPH, and the evidence base for PPH medical management is expanding, with clinical trials ongoing. Improving the management of PPH in limited-resource settings will require continued attention to ensure the availability of low-cost accessible prevention and treatment options, in addition to a focus on skilled care providers.

Alison M El Ayadi

Nuriya Robinson

Stacie Geller

Suellen Miller

Advances in the treatment of postpartum hemorrhage

产后出血治疗的进展

At present, between 10 to 15% of couples are infertile, and half of all infertility cases are credited to a female factor. Determination of the source of the problem may hold the key to improving fertility for women. Emerging research demonstrates that reactive oxygen species and oxidative stress (OS) have strong connections with female reproductive function; increases in OS which is associated with certain lifestyle factors can negatively impact female fertility. Lifestyle factors including being obese or underweight, exercising, cigarette smoking, alcohol and caffeine consumption, drug use, psychological stress and environmental and occupational exposures can all have adverse effects on fertility due to their complex interactions and impact exerted via OS on female reproductive processes. Our review highlights these linkages to explain their impact on female fertility, as well as provide suggestions to reduce OS and improve reproductive potential in women.

Sajal Gupta

Jennifer Fedor

Kelly Biedenharn

Ashok Agarwal

Lifestyle factors and oxidative stress in female infertility: is there an evidence base to support the linkage?

生活方式因素与女性不孕症中的氧化应激：是否有证据支持其关联？

Among American women, the most common cause of death from gynecologic malignancy is ovarian cancer. With the discovery and publicizing of hereditary cancer gene mutations, patients are actively seeking their physician’s advice on how to manage risk. As a cancer prevention measure, risk-reducing surgery has become a popular procedure. Based on studies of salpingo-oophorectomies from BRCA-positive women, the fallopian tube has been put forth as the cause of high-grade ovarian cancer. More recently, ovarian surface hilar stem cells have been suggested as the putative cells of origin. In this exciting time of new thinking about its origins, we stand on the threshold of new and promising strategies for more precise management of ovarian cancer patients.

Tamara Kalir

Adolfo Firpo-Betancourt

Farr Nezhat

Update on ovarian cancer pathogenesis: history, controversies, emerging issues and future impact

卵巢癌发病机制的最新进展：历史、争议、新兴问题及未来影响

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Expert Review of Obstetrics and Gynecology

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