Best Practice & Research Clinical Obstetrics & Gynaecology RSS feed: Current Issue. In practical paperback format, each 200 page topic-based issue of Best Practice & Research Clinical Obstetrics & Gynaecology will provide a comprehensive review of current clinical practice and thinking within the specialties of obstetrics and gynaecology. All chapters are commissioned and written by an international team of practising clinicians with the Guest Editors for each issue drawn from a pool of renowned experts and opinion leaders. Reference is made to: • the latest original research • Cochrane Reviews • audits and confidential enquiries • national and international conferences • national and international guidelines • personal communications All chapters take the form of practical, evidence-based reviews that seek to address key clinical issues of diagnosis, treatment and patient management. Each issue follows a problem-orientated approach that focuses on the key questions to be addressed, clearly defining what is known and not known. Management will be described in practical terms so that it can be applied to the individual patient. Boxed and bulleted Learning Objectives and Practice Points are features within each chapter and will highlight the core and essential knowledge that will help the physician to provide the best care to their patients. The series' objective is to provide a continuous update for the busy clinician and researcher. 2009 Topics Volume 23 Issues 1-6 1. Menopause and menopause transition M. Lumsden (UK) 2. Contraception and sexual health J. Stephenson and C. Wilkinson (UK) 3. Near miss audit in obstetrics R. Pattinson (South Africa) 4. Acute gynaecology and early pregnancy complications - Volume 1 T. Bourne (UK) and G. Condous (Australia) 5. Acute gynaecology and early pregnancy complications - Volume 2 T. Bourne (UK) and G. Condous (Australia) 6. Intrauterine fetal growth restriction J. and S. Dornan (Ireland) 2010 Topics Volume 24 Issues 1-6 1. Reproduction and cancer J. Tzafettas (Greece) 2. Adolescent and paediatric gynaecology G. Creatsas (Greece) 3. Obstetric analgesia and anaesthesia N. Robinson and P. Howel (UK) 4. Abortion and post-abortion care: Vol. 1 T. Mahmood (UK) 5. Abortion and post-abortion care: Vol. 2 T. Mahmood (UK) 6. Training, education and assessment M. Murphy (UK)http://www.bestpracticeobgyn.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Best Practice & Research Clinical Obstetrics & Gynaecology1521-6934241February 2010 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.bestpracticeobgyn.com/article/PIIS1521693410000076/abstract?rss=yesAims and Scope/Editorial Board10.1016/S1521-6934(10)00007-6Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Obstetrics & Gynaecology2010-02-01241S1521-6934(10)X0002-5iiiiiihttp://www.bestpracticeobgyn.com/article/PIIS1521693409001448/abstract?rss=yes According to the United Nation's section on Human Rights: “All men and women, without racial, national or religious discrimination, preserve the right to create family and the right for reproduction”. Long term infertility, however, and ‘unwanted childnessness’, especially related with cancer, are responsible for one of the worst of crises humans have to endure.PrefaceJohn M. Tzafettas10.1016/j.bpobgyn.2009.11.006Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-12-25Best Practice & Research Clinical Obstetrics & Gynaecology2009-12-25241S1521-6934(10)X0002-512http://www.bestpracticeobgyn.com/article/PIIS1521693409001035/abstract?rss=yesCancers of the reproductive organs (i.e., ovaries, uterus and testes), like other cancers, occur as a result of a multi-stage interaction of genetic and environmental factors. A small proportion of cancers of the reproductive organs occur as part of a recognised cancer syndrome, as a result of inheritance of mutations in highly penetrant cancer susceptibility genes (e.g., BRCA1, BRCA2, MLH1 or MSH2). Recognition of individuals and families with inherited cancer predisposition syndromes and individuals at high risk due to familial cancer clustering is fundamentally important for the management and treatment of the current cancer and for future prevention of further cancers for the individual and their extended family.Cancer genetics and reproductionHelen Hanson, Shirley Hodgson10.1016/j.bpobgyn.2009.08.002Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-08-28Best Practice & Research Clinical Obstetrics & Gynaecology2009-08-28241S1521-6934(10)X0002-5318http://www.bestpracticeobgyn.com/article/PIIS1521693409000236/abstract?rss=yesThe relationship of infertility, endocrinology and cancer has become clearer in recent years. Polycystic ovaries (PCO) increase the risk of endometrial cancer. Prolonged amenorrhoea, therefore, should be prevented in such cases with the use of cyclical progestogens, in order for regular withdrawal bleeds to be induced and the endometrium protected from long-term unopposed oestrogen stimulation. There is no secure evidence base on which a relationship between PCO and breast cancer can be based. No specific breast screening for women with PCO is, therefore, recommended. Hyperandrogenaemia and hyperinsulinaemia are conditions whose significance in terms of increasing both endometrial and breast cancer risks is increasingly recognised. The exact mechanism with which they influence carcinogenesis is still far from clear. Whether they act in isolation or as expressions of the common background of the metabolic syndrome – in interaction with other components of this syndrome – is still the subject of research.Anovulation with or without PCO, hyperandrogenaemia and hyperinsulinaemia as promoters of endometrial and breast cancerSpyros Papaioannou, John Tzafettas10.1016/j.bpobgyn.2008.11.010Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-02-23Best Practice & Research Clinical Obstetrics & Gynaecology2009-02-23241S1521-6934(10)X0002-51927http://www.bestpracticeobgyn.com/article/PIIS1521693409001151/abstract?rss=yesHormonal contraception has a protective effect over ovarian and endometrial cancer development. Relative risk of ovarian cancer decreases by ∼20% for each 5 years of use; it is ∼50% for 15 years of use and decreasing with further use. The protective effect gained declines as time passes from its last use, but a significant effect remains a long time after ceasing. The effect is independent from the type of formulation used. Hormonal contraceptives do not protect from mucinous types of ovarian tumours. Relative risk reduction of endometrial cancer is even higher; the estimated relative risk decrease is ∼50% with 4 years of use, ∼70% with 12 years of use and decreasing with further use. After ceasing oral contraception, the risk begins to rise from its reduced levels but it is still ∼50% even after >20 years after its last use. Hormonal contraception could be used for primary protection from ovarian and endometrial cancer development.The use of hormonal contraception and its protective role against endometrial and ovarian cancerGrigoris F. Grimbizis, Basil C. Tarlatzis10.1016/j.bpobgyn.2009.08.010Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-10-12Best Practice & Research Clinical Obstetrics & Gynaecology2009-10-12241S1521-6934(10)X0002-52938http://www.bestpracticeobgyn.com/article/PIIS1521693409001072/abstract?rss=yesThere is evidence that endometriosis as well as drugs used in the process of in vitro fertilisation appear to associate with increased risk for gynaecological cancer. In this review, we attempt to describe this relationship according to the most recent epidemiologic data and to present the possible mechanisms on the molecular level that could potentially explain this correlation.There are data to support that ovarian endometriosis could have the potential for malignant transformation. Epidemiologic and genetic studies support this notion. It seems that endometriosis is associated with specific types of ovarian cancer (endometrioid and clear cell). There is no clear association between endometriosis and breast or endometrial cancer. More studies are needed to establish the risk factors that may lead to malignant transformation of this condition and to identify predisposed individuals who may require closer surveillance. Currently, there is no proven relationship between any type of gynaecological cancer and drugs used for infertility treatment. In principle, infertile women have increased risk for gynaecologic malignancies. Nulligravidas who received treatment are at increased risk for malignancy compared with women who had conceived after treatment. There is limited evidence that clomiphene citrate use for more than six cycles or 900mg or treatment of women over the age of 40 could increase their risk for ovarian and breast cancer. More studies with the appropriate statistical power and follow-up time are required to evaluate accurately the long-term effects of these drugs and procedures.Endometriosis, in vitro fertilisation and the risk of gynaecological malignancies, including ovarian and breast cancerNikos F. Vlahos, Konstantinos P. Economopoulos, Stylianos Fotiou10.1016/j.bpobgyn.2009.08.004Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-09-01Best Practice & Research Clinical Obstetrics & Gynaecology2009-09-01241S1521-6934(10)X0002-53950http://www.bestpracticeobgyn.com/article/PIIS1521693409001011/abstract?rss=yesThe management of women with abnormal cytology in pregnancy represents both a diagnostic and a therapeutic challenge for colposcopists. The emphasis should be on diagnosis and confirmation of cervical precancer (Cervical intraepithelial neoplasia (CIN) or Adenocarcinoma in situ (AIS), thus excluding invasive cancer). Following an initial assessment, careful follow-up is essential. This must include colposcopy and take into account the physiological changes of the cervix during pregnancy and the puerperium. The management of women with invasive cancer diagnosed during pregnancy depends on the gestation at diagnosis and requires careful assessment and multidisciplinary planning.The management of women with abnormal cervical cytology in pregnancyGrainne Flannelly10.1016/j.bpobgyn.2009.07.001Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-08-27Best Practice & Research Clinical Obstetrics & Gynaecology2009-08-27241S1521-6934(10)X0002-55160http://www.bestpracticeobgyn.com/article/PIIS1521693409001023/abstract?rss=yesCancer complicating pregnancy endangers two lives. Any approach should look at both maternal and foetal safety. Maternal prognosis will not improve by terminating the pregnancy. Imaging for staging purposes is possible, and sonar and magnetic resonance imaging are the preferred examinations. Abdominopelvic computed tomography exposes the foetus to the highest doses radiation and should be avoided.Provided a thorough maternal monitoring to ensure a stable uteroplacental blood flow and foetal oxygenation, surgical techniques that are used in non-pregnant patients are also safe for pregnant patients. Radiotherapy of the upper part of the body is possible during pregnancy, but during the third trimester the close distance may put the foetus at risk. Chemotherapy during the second or third trimester can be administered without increasing the incidence of congenital malformations. A systematic analysis, especially on the long-term outcome of the offspring after cancer treatment during pregnancy is still lacking.Here, we present a summary of issues related to the diagnosis and treatment of gynaecological malignancies during pregnancy. Firstly, we describe general diagnostic and cancer-treatment-related problems. In the second part, organ pathology including breast, cervical, ovarian, endometrial and vulvar cancer is discussed.Gynaecologic cancer complicating pregnancy: An overviewFrédéric Amant, Lieselot Brepoels, Michael J. Halaska, Mina Mhallem Gziri, Kristel Van Calsteren10.1016/j.bpobgyn.2009.08.001Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-08-25Best Practice & Research Clinical Obstetrics & Gynaecology2009-08-25241S1521-6934(10)X0002-56179http://www.bestpracticeobgyn.com/article/PIIS1521693409001114/abstract?rss=yesBreast cancer is the most frequently occurring cancer in women of developed countries, and as a result of new developments in breast cancer treatment, more women are cured after being diagnosed with this disease. It is important that fertility preservation strategies are addressed before chemotherapy, because chemotherapy may induce premature ovarian failure (depending on the woman's age, the drugs used, the dosage and duration of treatment). Among possible solutions are embryos or oocytes cryopreservation, ovarian tissue cryopreservation–freezing with a subsequent orthotopic and heterotopic autotransplantation, whole ovary cryopreservation, ovarian suppression with gonadotropin-releasing hormone (GnRH) analogues, which inhibit ovarian follicular depletion induced by chemotherapeutic agents and in vitro fertilisation (IVF) after ovulation induction with aromatase inhibitors or tamoxifen.Reproduction after breast cancerStefanos Zervoudis, George Iatrakis, Iordanis Navrozoglou10.1016/j.bpobgyn.2009.08.008Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-09-03Best Practice & Research Clinical Obstetrics & Gynaecology2009-09-03241S1521-6934(10)X0002-58186http://www.bestpracticeobgyn.com/article/PIIS1521693409001175/abstract?rss=yesAdvances in the diagnosis and treatment of childhood, adolescent and adult cancer have greatly increased the life expectancy of premenopausal women with cancer.The ovaries are very sensitive to cytotoxic treatment, especially to alkylating agents.The only established method of fertility preservation is embryo cryopreservation according to the Ethics Committee of the American Society for Reproductive Medicine (2005), but this option requires the patient to be of pubertal age, have a partner or use donor sperm and be able to undergo a cycle of ovarian stimulation, which is not possible when the chemotherapy has to be initiated immediately or when stimulation is contraindicated, according to the type of cancer.For patients who need immediate chemotherapy, cryopreservation of ovarian tissue is the only possible alternative.This article reports the techniques and results of orthotopic transplantation of cryopreserved ovarian tissue. Among almost 30 cases reported in the literature, six live births have been achieved to date.Ovarian tissue cryopreservation and transplantation in cancer patientsJacques Donnez, Pascale Jadoul, Jean Squifflet, Anne Van Langendonckt, Olivier Donnez, Anne-Sophie Van Eyck, Cristina Marinescu, Marie-Madeleine Dolmans10.1016/j.bpobgyn.2009.09.003Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-10-07Best Practice & Research Clinical Obstetrics & Gynaecology2009-10-07241S1521-6934(10)X0002-587100http://www.bestpracticeobgyn.com/article/PIIS152169340900145X/abstract?rss=yesIn vitro fertilization and embryo cryopreservation is regarded as the only established method for fertility preservation in female cancer patients. However, a possible delay in treatment of the primary disease due to ovarian stimulation, exposure to supraphysiologic estrogen levels induced by ovarian stimulation, the requirement for a male partner or willingness to use donor sperm for embryo production, legal, ethical, religious issues related to cryopreservation of embryos raise concerns for patients and physicians. Recent improvements achieved with oocyte vitrification have increased the effectiveness of oocyte cryopreservation rendering it a viable option, especially for patients without a male partner. In vitro maturation avoids treatment delay or exposure to increased estradiol levels associated with ovarian stimulation for in vitro fertilization. In vitro maturation combined with embryo or oocyte vitrification provides previously unavailable options for some patients and improves the services provided by a fertility preservation program.Cryopreservation of oocytes and embryos for fertility preservation for female cancer patientsBaris Ata, Ri-Cheng Chian, Seang Lin Tan, James Edmund Dodds Professor and Chairman Obstetrics and Gynecology, Obstetrician and Gynecologist-in-Chief10.1016/j.bpobgyn.2009.11.007Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-12-07Best Practice & Research Clinical Obstetrics & Gynaecology2009-12-07241S1521-6934(10)X0002-5101112http://www.bestpracticeobgyn.com/article/PIIS1521693409001163/abstract?rss=yesAlthough still experimental, cryopreservation and transplantation techniques for ovarian tissue have been well described, and a number of successful human pregnancies have occurred. Ovarian cryopreservation is the only fertility preservation procedure that can be offered to prepubertal children, and when cytotoxic treatment is urgent. There are two main approaches for autotransplantation of human ovarian tissue. In the heterotopic transplantation, cortical fragments can be grafted subcutaneously at various sites whereas in orthotopic transplantation cortical pieces are transplanted into its original location. Both approaches have their own advantages and disadvantages. While natural pregnancy can occur in orthotopic transplantation, heterotopic transplantation may be indicated if the pelvis is not suitable for transplantation due to previous radiation or severe scar formation. Furthermore, tissue monitoring may be easier in the heterotopic site. In this article, we reviewed the indications, limitations, risks and transplantation techniques for ovarian tissue.Orthotopic and heterotopic ovarian tissue transplantationMurat Sonmezer, Kutluk Oktay10.1016/j.bpobgyn.2009.09.002Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2009-10-07Best Practice & Research Clinical Obstetrics & Gynaecology2009-10-07241S1521-6934(10)X0002-5113126http://www.bestpracticeobgyn.com/article/PIIS1521693410000131/abstract?rss=yesIndex10.1016/S1521-6934(10)00013-1Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2010-02-01Best Practice & Research Clinical Obstetrics & Gynaecology2010-02-01241S1521-6934(10)X0002-5I1I1http://www.bestpracticeobgyn.com/article/PIIS1521693409001564/abstract?rss=yes The following statement(s) is/are correct concerning ovarian tissue cryopreservation and transplantation:Reproduction and Cancer Multiple Choice Questions for Vol. 24, No. 110.1016/j.bpobgyn.2009.12.005Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2010-01-11Best Practice & Research Clinical Obstetrics & Gynaecology2010-01-11241S1521-6934(10)X0002-5FrontmatterA1A5http://www.bestpracticeobgyn.com/article/PIIS1521693409001576/abstract?rss=yes1.(a) T(b) T(c) F(d) F(e) T Explanations:Intrauterine growth restriction: A contemporary review Answers to Multiple Choice Questions for Vol. 23, No. 610.1016/j.bpobgyn.2009.12.006Best Practice & Research Clinical Obstetrics & Gynaecology 24, 1 (2010)2010-01-11Best Practice & Research Clinical Obstetrics & Gynaecology2010-01-11241S1521-6934(10)X0002-5FrontmatterA7A15