Endometriosis--is it treatable?

Its etiology remains uncertain, its pathogenesis disputed and its treatment poor. Most medical treatment is based on ovulation suppression and inducing amenorrhoea. New findings on the genetics, the possible roles of the environment and the immune system, intrinsic abnormalities in the endometrium and secreted products of endometriotic lesions have given explanation into the pathogenesis of this disorder and give us new trends for treatment the disease.     

Volutrauma. What is it, and how do we avoid it?

Lung injury can be initiated at birth with the delivery room resuscitation. Adequate tidal volume must be achieved gradually and adjusted with each subsequent breath to achieve adequate, but not excessive, tidal volume delivery. Time constants vary greatly within the lung because some alveoli are collapsed, and some are inflated. Excessive pressure or volume may lead to high stretch injury when already open alveoli are overdistended. Sufficient alveoli must be recruited to establish the optimal functional residual capacity. This establishes an inflation history of the lung that tends to resist alveolar collapse at the end of expiration, provided that adequate mean airway pressure is provided throughout the ventilatory cycle. The best volume of inflation is achieved at the lowest pressure cost. Maintaining alveolar recruitment with the use of exogenous surfactant and positive end-expiratory pressure avoids alveolar collapse and injury with succeeding distending breaths. Although there have been significant advances in neonatal respiratory care, further improvement in outcomes may be expected by successfully avoiding ventilator-induced lung injury.     

A second Pap smear during colposcopy: is it really worth it?

The aim of this study was to determine whether the clinical value of a second Pap smear during colposcopy outweighed its cost-effectiveness and reliability parameters. We studied retrospectively 569 cases focusing on A) The initial Pap smear, B) The smear performed during colposcopy, C) The colposcopic findings, and D) The histopathological reports of the cases where biopsy sampling was performed. In 380 patients (67%), the second Pap smear corresponded to the first one. In 13% of the patients, the cytological lesions were worse (particularly in 2% of the patients staging increased from HPV-associated reactive cellular changes to CIN II, or from CIN I to CIN III), and in 20% slighter than the initial. In 79% of the cases revealing more serious lesions in the second smear, the histological result of the biopsy corresponded to that of the initial smear. Conclusively, only 2% seem to benefit from a second repeat Pap smear during referral colposcopy.     

Why is it important to diagnose chorionicity and how do we do it?

Because the monochorionic (MC) placenta is designed for a singleton fetus, and might not provide adequate physiological support for twins, obstetric problems are more frequent in MC than dichorionic (DC) twins. Problems arise because asymmetric cord insertions cause growth discordance as a result of unequal sharing of placental tissue. Approximately 95% of MC twin placentas contain interfetal vascular connections of some kind, sometimes in several combinations. Such connections can cause twin-twin transfusion syndrome and twin reversed arterial perfusion. The survivor can also suffer damage if the co-twin dies spontaneously or from inappropriate methods of selective termination. These complications are progressive and often advanced by 18 weeks gestation. Monoamniotic twins carry greater risks than diamniotic twins, especially entangled cords. MC twins are often discordant for congenital anomalies. Diagnosis of MC twinning is optimal in the first trimester. Optimal management of these MC twin disorders is not yet established; long-term follow-up studies are unsatisfactory. In clinical practice, chorionicity is not always determined in the first trimester.     

Stillbirth: is it preventable?

In the UK stillbirth, describes the death of a baby before birth after 24 completed weeks of pregnancy. The rate has decreased in the UK over recent years but at a slower pace than other similar high-income countries. The association of certain risk factors (including maternal age, previous poor obstetric outcome, smoking and obesity) is clearly documented, though only a number of these factors can be modified. Use of interventions including the ‘Saving Babies Lives’ Care Bundle focussing on smoking cessation, assessment for small for gestational age (SGA) babies, educating women regarding reduced fetal movements and effective fetal monitoring during labour aim to reduce both antenatal and intrapartum stillbirth. As yet, it remains difficult to predict which pregnancies are at greatest risk of stillbirth but with further research, ongoing improvements in antenatal and intrapartum care, and improved patient education, it is anticipated that the incidence in the UK can be substantially reduced.     

VBAC--is it worth the risk?

Enthusiasm for vaginal birth after cesarean section has waned. As a result, the cesarean birth rate is again on the rise. As a medical community and society we must decide whether the most appropriate question is "What is safest for my baby?" or "Is the risk associated with vaginal birth after cesarean acceptable?" There are risks associated with vaginal birth after cesarean, but in a hospital setting with appropriate resources these risks are low and would still seem to be acceptable.     

Preconception care for women with diabetes: is it effective and who should provide it?

The association between hyperglycaemia and congenital malformations was first recognised over 40 years ago and was followed by the development of preconception clinics for women with diabetes. A fresh look at preconception care is needed as many studies were conducted during the late 1970s and early 1980s, before the introduction of regular home blood glucose monitoring and glycosylated haemoglobin assays, and when many patients with diabetes had microvascular complications. Recent observational studies and a meta-analysis suggest preconception care is effective with an approximately threefold reduction in the risk of malformations. There is now a worldwide epidemic of type 2 diabetes, but only few studies of preconception care have included women with type 2 diabetes. Furthermore, few studies have addressed the relationship between preconception care and perinatal morbidity. This article will review the evidence for preconception care in women with diabetes, evaluate different models of preconception care and discuss future strategies.     

Failed fertilization: is it predictable?

PURPOSE OF REVIEW: The purpose of this review is to critically examine the ability of screening tests to predict fertilization failure. RECENT FINDINGS: Failed fertilization occurs in 5-10% of in-vitro fertilization cycles and 2-3% of intracytoplasmic sperm injection cycles. Failed fertilization may result from impaired spermatozoa, oocyte deficiencies or defects in the in-vitro sperm/oocyte medium. In the in-vitro fertilization setting most cases are caused by male factor deficiencies, whereas failure of oocyte activation is the most common cause of failed fertilization after intracytoplasmic sperm injection. Although the standard semen analysis has limited ability to predict fertilization failure, strict sperm morphology criteria, sperm-zona binding ratios and zona pellucida induced acrosome reaction tests provide increased capacity to avoid this outcome. The quality of the semen sample on the day of oocyte retrieval and fertilization performance in previous in-vitro fertilization cycles may also guide the appropriate use of intracytoplasmic sperm injection. However, the routine use of the latter technique in cases of non-male factor infertility is contraindicated. SUMMARY: The ever improving techniques highlighted in this analysis offer improved ability to predict failed fertilization.     

Maternal mortality in the United States--why is it important and what are we doing about it?

Following dramatic reductions between the early 1900s and the early 1980s, the maternal mortality ratio began to rise, reaching a peak of almost 17 maternal deaths per 100,000 live births. Although this number pales in comparison with that found in sub-Saharan Africa and India, the troubling rise in the United States is a surrogate for medical care in general and obstetrical care in particular. Both Healthy People 2010 and the United Nations Millennium Goals were aimed at reducing maternal mortality worldwide. This presentation will review the trends in maternal mortality along with the efforts some jurisdictions, along with the American Congress of Obstetricians and Gynecologists, have taken to address this obstetrical tragedy. Although maternal death is the tip of the iceberg, thousands more women suffer a "near-miss" but survive to deal with lifelong medical consequences. Finally, you will be reminded that each maternal death is not just an isolated medical event but rather it permanently affects an ever-enlarging circle of society.     

Third-trimester fetal MRI in isolated 10- to 12-mm ventriculomegaly: is it worth it?

OBJECTIVE: The justification for magnetic resonance imaging (MRI) in isolated mild ventriculomegaly remains controversial. This study was undertaken to evaluate the contribution of third-trimester MRI in isolated 10- to 12-mm fetal ventriculomegaly. DESIGN: Observational prospective cohort study. SETTING: Universitary prenatal reference centre. POPULATION: From February 2000 to May 2005, we prospectively collected data concerning fetuses referred to us for cerebral MRI following detection of ventriculomegaly by ultrasound scan (n= 310). METHODS: Among these, we identified and analysed those cases in which ventriculomegaly was isolated and did not exceed 12 mm in ultrasound examinations prior to MRI scan (n= 185). MAIN OUTCOME MEASURE: Cases in which MRI provided additional information that was likely to have an impact on prenatal management were detailed. RESULTS: During the study period, 310 MRI were performed because of fetal ventriculomegaly. Hundred and eighty-five were suspected to be isolated 10- to 12-mm ventriculomegalies in ultrasound scan and formed our database. MRI confirmed the 10- to 12-mm isolated fetal ventriculomegaly in 106 cases (57.3%) and found other abnormalities in 5 (4.7%) of these 106 cases. MRI found ventricular measurement to be less than 10 mm in 43 cases (23.3%) and more than 12 mm in 36 cases (19.4%). Among these 36 fetuses with ventricle size more than 12 mm, 6 (16.7%) had other abnormalities, whereas MRI did not find other abnormalities in the 43 cases with ventricle size below 10 mm. CONCLUSION: Before advantages of MRI to ultrasound examination can be demonstrated, it seems reasonable that MRI should remain an investigational tool, restricted to selected clinical situations in which the results are expected to modify case management. Where ultrasound scan suspects isolated ventriculomegaly of 10 to 12 mm, our data suggest that when the finding is confirmed with MRI this could be expected in around 5% of cases. Therefore, the policy of routine MRI in such cases should depend on prenatal centres' priorities.     

DIY时代，Just Do it!

DIY．Do It Yourself，在今日已经是个不需额外解释就能理解的常用字汇，自己动手已经成为一种时尚。你，心动了吗？不妨先看下别人那些个性的DIY作品吧!