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Volume 5, No 1 - 2012

Volume 5, No 1 - 2012

Table of Contents

“The Times They Are a-Changin’”
[ Rev Obstet Gynecol. 2012;5(1):1 doi: 10.3909/riog0185] © 2012 MedReviews®, LLC
Bevacizumab-Mediated Interference With VEGF Signaling Is Sufficient to Induce a Preeclampsia-Like Syndrome in Nonpregnant Women
Preeclampsia (gestational proteinuric hypertension) complicates 5% to 8% of all pregnancies, and is a major cause of maternal and perinatal morbidity and mortality. It is a multisystem disorder specific to human pregnancy and the puerperium. Although the etiology is unknown, increasing evidence from both animal and human studies suggests that an imbalance in circulating pro- (vascular endothelial growth factor [VEGF], placental growth factor) and anti-angiogenic factors (soluble fms-like tyrosine kinase 1, soluble endoglin) may be important. Bevacizumab (Avastin®; Genentech, South San Francisco, CA), a humanized recombinant monoclonal IgG antibody that binds VEGF, has been shown to inhibit endothelial cell proliferation, suppress angiogenesis, and shrink a variety of solid tumors. We present two cases of bevacizumab toxicity that mimic preeclampsia with a reversible syndrome characterized by acute-onset severe hypertension, proteinuria, central nervous system irritability (headache, photophobia, blurred vision, seizures), abnormal laboratory tests (elevated liver function tests, thrombocytopenia), and evidence of reversible posterior leukoencephalopathy on neuroimaging. In both cases, the clinical and laboratory manifestations returned to normal with discontinuation of bevacizumab therapy and supportive care. Bevacizumab toxicity can mimic preeclampsia in nonpregnant women. These data suggest that interference with VEGF signaling is sufficient to induce a preeclampsia-like syndrome in nonpregnant patients. VEGF signaling therefore appears to play a central role—perhaps the central role—in the pathogenesis of preeclampsia, and provides a potential biomarker for the prediction, prevention, and treatment of this dangerous disorder. [ Rev Obstet Gynecol. 2012;5(1):2-8 doi: 10.3909/riog0179] ©2012 MedReviews®, LLC
Urinary Spot Albumin:Creatinine Ratio for Documenting Proteinuria in Women With Preeclampsia
Aim: To assess whether a single urinary spot urinary albumin:creatinine ratio (ACR) can be used to estimate 24-hour urinary protein excretion in women with preeclampsia. Methods: ACR and 24-hour urinary protein excretion were measured in 50 consecutive patients with preeclampsia. ACR was determined in a spot midstream urine sample and the amount of protein excretion was quantified in a 24-hour urine collection performed the following day. The correlation between the spot ACR and 24-hour urine protein excretion was assessed, and the diagnostic value of ACR was expressed in terms of specificity and sensitivity. Receiver operating characteristic curve analysis was used to determine the best cutoff values of the spot ACR for mild preeclampsia (proteinuria ≥ 0.3 g/24 h) and severe preeclampsia (defined in China as proteinuria ≥ 2 g/24 h). Results: A strong correlation was evident between the spot ACR and 24-hour urinary protein excretion (r = 5 .938; P < .001). The optimal spot ACR cutoff point was 22.8 mg/mmol for 0.3 g/24 h of protein excretion (mild preeclampsia) with a sensitivity and specificity of 82.4% and 99.4%, respectively, and 155.6 mg/mmol for 2 g/24 h of protein excretion (severe preeclampsia) with a sensitivity and specificity of 90.6% and 99.6%, respectively. Conclusions: Compared with 24-hour urinary protein excretion, the spot urinary ACR may be a simple, convenient, and accurate indicator of significant proteinuria in women with preeclampsia. [ Rev Obstet Gynecol. 2012;5(1):9-15 doi: 10.3909/riog0186] © 2012 MedReviews®, LLC
Sexual Function in Elderly Women: A Review of Current Literature The Aging Patient
Although sexuality remains an important component of emotional and physical intimacy that most men and women desire to experience throughout their lives, sexual dysfunction in women is a problem that is not well studied. The prevalence of sexual dysfunction among all women is estimated to be between 25% and 63%; the prevalence in postmenopausal women is even higher, with rates between 68% and 86.5%. Increasing recognition of this common problem and future research in this field may alter perceptions about sexuality, dismiss taboo and incorrect thoughts on sexual dysfunction, and spark better management for patients, allowing them to live more enjoyable lives. [ Rev Obstet Gynecol. 2012;5(1):16-27 doi: 10.3909/riog0156 ] © 2012 MedReviews®, LLC
Comprehensive Surgical Staging for Endometrial Cancer Management Review
Despite a shift from clinical to surgical staging of endometrial cancer in 1988, performance of comprehensive surgical staging for clinically early-stage endometrial cancer remains controversial. Low-, intermediate-, and high-risk groups have been defined pathologically. Herein, we describe the risks and benefits of comprehensive surgical staging. Comprehensive surgical staging is encouraged in high-risk histologies, whereas a method of triage should be used to determine who among the low-grade endometrioid histology may benefit from comprehensive staging. [ Rev Obstet Gynecol. 2012;5(1):28-34 doi: 10.3909/riog0177 ] © 2012 MedReviews®, LLC
An In Vitro Diagnostic Multivariate Index Assay (IVDMIA) for Ovarian Cancer: Harvesting the Power of Multiple Biomarkers Diagnostic and Management Update
In this review, OVA1® (Vermillion, Inc., Austin, TX), the first in vitro diagnostic multivariate index assay (IVDMIA) of protein biomarkers cleared by the US Food and Drug Administration (FDA), is used to explain the concept behind IVDMIA, the use of multiple markers to improve clinical performance of a diagnostic tool, and the key considerations in the development of IVDMIA. [ Rev Obstet Gynecol. 2012;5(1):35-41 doi: 10.3909/riog0182] © 2012 MedReviews®, LLC
Genetic Testing for Lynch Syndrome, an Inherited Cancer of the Bowel, Endometrium, and Ovary Management Update
Genetic screening for the mismatch repair genes found in patients with Lynch syndrome leads to improvements in health outcomes among carriers and members of their family. Clinicians now have a simple and easily employed means of determining if an individual carries the genetic mutations found with Lynch syndrome. This article reviews the background and incidence of Lynch syndrome and presents screening criteria, including the use of Web-based algorithms to estimate the likelihood of an individual having inherited Lynch mutations. Comprehensive management plans based on individual risk and family history plus appropriate preventive measures are recommended. Primary care providers including obstetrician-gynecologists are encouraged to adopt a proactive, evidence-based approach to address patients and their relatives with Lynch syndrome. [ Rev Obstet Gynecol. 2012;5(1):42-49 doi: 10.3909/riog0187] © 2012 MedReviews®, LLC
New Success With Microbicides and Pre-Exposure Prophylaxis for Human Immunodeficiency Virus (HIV): Is Female-Controlled Prevention the Answer to the HIV Epidemic? Women's Health in the Developng World
Women who cannot negotiate condom use with their partners, often due to socioeconomic factors and sexual abuse, have no means of preventing themselves from acquiring the human immunodeficiency virus (HIV). There is a need to develop HIV-preventive methods initiated and controlled by women. Microbicides and other pre-exposure prophylaxis may help fill that need. Although two decades of research on broad-spectrum microbicides have generally been disappointing, recent trials with HIV-specific agents have yielded promising initial results. A new era of clinical research involves novel biochemical prevention methods, including HIV-specific vaginal microbicides and oral antiretroviral chemoprophylaxis drugs (pre-exposure prophylaxis; PrEP) that may help provide more control for women. [ Rev Obstet Gynecol. 2012;5(1):50-55 doi: 10.3909/riog0173 ] © 2012 MedReviews®, LLC
Cervical Screening Routines Papanicolaou Testing
[ Rev Obstet Gynecol. 2012;5(1):56-57 doi 10.3909/riog0183a] © 2012 MedReviews®, LLC
Alcohol and Breast Cancer Breast Cancer
[ Rev Obstet Gynecol. 2012;5(1):57 doi 10.3909/riog0183b] © 2012 MedReviews®, LLC
Antihypertensives in Pregnancy Pregnancy
[ Rev Obstet Gynecol. 2012;5(1):57 doi 10.3909/riog0183b] © 2012 MedReviews®, LLC
Snippets Miscellaneous
[ Rev Obstet Gynecol. 2012;5(1):58-59 doi 10.3909/riog0183d] © 2012 MedReviews®, LLC
Spring 2012 Product Reviews SurgiCount Safety-Sponge™ System
[Rev Obstet Gynecol. 2012;5(1):60-62 doi: 10.3909/riog0180a] © 2012 MedReviews®, LLC
Spring 2012 Product Reviews Viking 3DHD Vision System
[Rev Obstet Gynecol. 2012;5(1):62-63 doi: 10.3909/riog0180b] © 2012 MedReviews®, LLC
Spring 2012 Product Reviews D-H. E. L. P.®
[Rev Obstet Gynecol. 2012;5(1):63-64 doi: 10.3909/riog0180c] © 2012 MedReviews®, LLC
Four Changes That Are Here to Stay
[Rev Obstet Gynecol. 2012;5(3/4):e119-e120 doi: 10.3909/riog0192] © 2012 MedReviews®, LLC
Electronic Fetal Monitoring: A Defense Lawyer’s View
Electronic fetal monitoring (EFM) has been used for four decades, after its introduction without clinical trials. EFM spawned a birth injury litigation crisis centered on the myth that it predicts cerebral palsy (CP). The myth has resulted in lottery-like judgments against physicians. The American Congress of Obstetricians and Gynecologists (ACOG) and sister organizations worldwide have the power to halt EFM’s clinical proliferation and the undeserved litigation verdicts against physicians unjustly blamed for causing CP. This power has been unused. If ACOG and other organizations would declare EFM unreliable, it could change the clinical standard of care and alleviate the CP-EFM malpractice lottery. [Rev Obstet Gynecol. 2012;5(3/4):e121-e125 doi: 10.3909/riog0191] © 2012 MedReviews®, LLC
Nitrous Oxide for Labor Analgesia: Expanding Analgesic Options for Women in the United States Management Update
Nitrous oxide (N2O) is a commonly used labor analgesic in many Western countries, but is used infrequently in the United States. The University of California at San Francisco has been offering N2O for labor analgesia for more than 30 years. Vanderbilt University Medical Center recently began offering N2O as an option for pain relief in laboring women. Many women report that N2O provides effective pain relief during labor and argue that it should be made more widely available in the United States. This article discusses the use of N2O for pain management during labor, including its history, properties, clinical indications, and use and environmental safety issues. Practical issues regarding implementation of N2O service in a medical center setting are also discussed. [Rev Obstet Gynecol. 2012;5(3/4):e126-e131 doi: 10.3909/riog0190] © 2012 MedReviews®, LLC
The Future of Fetal Monitoring Technology Update
Fetal heart rate monitoring is the most common obstetric procedure, and yet it remainsm a frustrating technology, plagued by false-positive results and miscommunication between providers. A new generation of invasive and noninvasive monitoring technologies is under development and entering the clinic, including the STAN monitor (Neoventa Medical, Mölndal, Sweden), which improves monitoring accuracy by incorporating a proxy of the fetal ST-segment. New noninvasive fetal electrocardiography and uterine contraction monitoring technologies will bring novel metrics and potentially improved safety to obstetrics in coming years. [Rev Obstet Gynecol. 2012;5(3/4):e132-e136 doi: 10.3909/riog0197] © 2012 MedReviews®, LLC
Regulation of Trophoblast Invasion: The Role of Matrix Metalloproteinases From the Bench: Primary Research From China
Pregnancy success is determined by a complex progress that includes trophoblast invasion and placentation. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are metal-dependent endopeptidases capable of degrading extracellular matrix, and appear to play a critical role in trophoblast invasion. This article reviews in detail the role of MMPs, TIMPs, and their regulators in the mechanism of trophoblast invasion in early human pregnancy. [Rev Obstet Gynecol. 2012;5(3/4):e137-e143 doi: 10.3909/riog0196] © 2012 MedReviews®, LLC