Editors’ highlights Export

@article{citeulike:3656429, author = {Kunzel, W. and Drife, J.}, citeulike-article-id = {3656429}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.ejogrb.2008.10.001}, citeulike-linkout-1 = {http://linkinghub.elsevier.com/retrieve/pii/S0301211508003813}, comment = {Editors' highlights Wolfgang K\"{u}nzel and Jim Drife Available online 4 November 2008. Article Outline What is new? Obstetrics and maternal–fetal medicine Reproductive medicine and endocrinology Gynaecology and gynaecological oncology Politicians are responding more and more to the fact that Millennium Development Goal (MDG) 4 (reduction of infant mortality) and MDG 5 (improvement of maternal health) are still a long way from being achieved in 2015. The development of a Global Business Plan (GBP) during 2007 represented a new-found determination among development agencies and international stakeholders to reach these goals. The GBP reflected the frustration that after 20 years of the ” Safe Motherhood” initiative, little progress has been made. Now it has been superseded by the Global Campaign for the Health MDGs, launched in September 2007 by the leaders of Norway, Great Britain and Canada. Advocacy efforts to get MDGs 4 and 5 back on track will be led by the Partnership for Maternal, Newborn and Child Health (PMNCH), a coalition of 250 organisations working in this field. Norway has taken a leading role and it was timely that a conference in Oslo on 5–7 November 2008 focused on this topic. The 2008 International Stillbirth Conference of, jointly, the International Stillbirth Alliance and the World Health Organisation, was organised by the Norwegian Institute of Public Health and hosted by the Norwegian Society of Perinatal Medicine. It covered the whole field, including stillbirth in developing countries and social inequities, prevention of stillbirth, perinatal mortality studies, implementing prenatal care programmes, involving communities, infections as a cause of stillbirth, birth registry and the state of global political priority. It was a fascinating convention touching topics important not only for the developing world but also for the developed world in two ways: firstly, to continue the success story of maternal and infant mortality in the developed world and secondly, to offer help to those who are willing to find the right ways of reducing maternal and infant mortality in their country. What is new? Obstetrics and maternal–fetal medicine Free radicals and oxidative stress are now considered to be a basic thread of human life. Free radicals are constantly produced by a variety of cellular functions but pathological processes including infections, diabetes and even psychological stress are prone to disturb the balance between normal and pathological concentration. This balance is steered by antioxidants, which reduce the concentrations of free radicals and thus reduce oxidative stress. Antioxidants, or ” free radical catchers”, are provided by vitamins, carotinoids, flavanoids, isoflavins and others in fruits and vegetables. Saker and colleagues from Themcen, Algeria (page 95) investigated the interesting question of oxidant and antioxidant status in mothers and newborns. They compared groups of small for gestational age (SGA) and large for gestational age (LGA) babies with a normal (AGA) population. Total antioxidant activity (measured as oxygen radical absorbance capacity (ORAC) in plasma) was significantly lower in mothers and newborns in the SGA group compared with the other groups. In the LGA group, however, ORAC was reduced in newborns but not in their mothers. Similar observations were made in erythrocyte antioxidant enzyme activities. The data suggest an imbalance causing oxidative stress in both SGA and LGA babies. The authors suggest that in SGA cases, anti-oxidant therapy to the mother might help to shift this balance, while in LGA newborns, postnatal antioxidant supplementation might help to reduce long-term problems. It is an interesting theory and we look forward to further studies. Hypoxic stress to the fetus during pregnancy is demonstrated by typical changes in fetal heart rate and in the venous and arterial system of the fetus. Alves and colleagues from S\~{a}o Paulo, Brazil (page 100) investigated doppler findings in the ductus venosus on the day of delivery and compared these with postnatal outcomes. Their cases were 103 newborns delivered by caesarean section because of absent or reversed end diastolic flow (ARED) in the umbilical artery. Of these, 20 had ARED in the ductus venosus (Group A) and 83 had positive flow (Group B). Gestational age was 30 weeks in Group A and 30.9 weeks in Group B. ARED in the ductus venosus was associated with lower birth weight, lower Apgar scores at one and five minutes, higher intubation rate, increased incidence of pH less than 7.20 and a higher risk of postnatal death. The authors conclude that investigating the flow in the ductus venosus may facilitate the decision for operative intervention. The ” Hawthorne effect” is based on studies conducted between 1924 and 1932 at the Hawthorne factory of the Western Electric Company in Chicago. The aim was to investigate the work performance in the factory, and the effect refers to improvement in performance solely due to subject's knowledge that he or she is being studied. Fox and colleagues (page 111) investigated obstetricians' clinical estimation of fetal weight (EFW), asking whether the accuracy is influenced by the Hawthorne effect. They told a group of clinicians that their ability to estimate EFW was to be studied, and compared the results during the study period with results during the preceding 3 months. No difference could be found. It appears that EFW accuracy cannot be improved by observation, and therefore published results are likely to reflect those in clinical practice. Abdominal pain is the principal manifestation of an autosomal recessive disorder called ” Familial Mediterranean Fever”. This condition is associated with recurrent abortion, preterm delivery, labor induction and delivery by caesarean section, as shown by Ofir and colleagues from Israel (page 115) in a study of 239 affected pregnancies. Perinatal outcome, however, is comparable to the general population. This disease is rare in northern Europe and colleagues should be aware of this disorder if they see pregnant women from Arabia, Armenia, Israel or Turkey. The increase of caesarean section (CS) is a worldwide ” disease” which has many causes. One is the degree of urbanisation, as shown by Chen and colleagues from Taiwan on page 104. They studied over 200,000 pregnancies and found that the CS rate increases with advancing urbanisation level. Studies in other countries have linked urbanisation with conditions such as diabetes and asthma but few have made a link with CS rates. It would be of interest to study whether additional factors come into play. An easy approach would be to use a standard gravida (cephalic presentation at term) to compare various regions. This should reveal the influence of other factors, such as previous CS. ” Being male carries an increased risk of spontaneous but not iatrogenic preterm birth” is the conclusion of Bretell, Yeh and Impey from Oxford, UK, on page 123. They investigated 75,725 deliveries of which 4003 (5.3\%) were preterm and found that males delivered preterm more frequently (OR 1.13, 95\% CI 1.06–1.20). The larger size of males did not account for this increased risk, nor did their increased incidence of obstetric complications such as abruption, and the authors conclude that the reasons remain obscure. Reproductive medicine and endocrinology Changes of mood are often observed during the menstrual cycle and during cycles controlled by combined oral contraceptive (COC) pills. How these fluctuations are influenced by personality traits was an interesting analysis conducted by Borgstr\"{o}m and colleagues from Uppsala, Sweden (page 127) using the Swedish university Scales of Personality (SSP). Four groups of women were investigated and the results provide information regarding the influence of traits on mood. Higher scores of mistrust and detachment are more common among women who have discontinued COC treatment due to adverse mood effects. It is worth reading this stimulating article, especially as most gynaecologists in their day-to-day practice see many women taking COC pills. Emergency contraception (EC) is an option for preventing pregnancy after unprotected sexual intercourse. Among teenagers, however, awareness and usage of EC are poor. It is therefore to the credit of Drs. Xu and Cheng from Shanghai that they investigated the level of EC awareness among pregnant teenagers with unwanted pregnancies. They collected information on previous awareness, usage and reason for failure. The average age of the girls was 17.8 years: 49.1\% had experienced contraception failure and 99.3\% had had sex without any contraception in the past. Only half had heard about EC. The authors' conclusion is clear: both advocacy of EC and the awareness of the risk of unprotected sex should be improved through sex education programmes in schools in China. They also suggest that pharmacists should receive systematic training on EC and other contraceptive methods. The need for increased awareness is true not only for China but also for the rest of the world and especially for developing countries. Gynaecology and gynaecological oncology Surgical management of cervical intraepithelial neoplasia (CIN) aims at removing all lesions for histological examination. Various methods are available and which of them should be applied in HIV infected women was the question asked by Foulot and colleagues from Paris (page 153). They compared loop excision of the transformation zone (LLETZ) with electrosurgical conisation in 80 HIV infected women with 86 surgical excisions. Since residual CIN was mostly located in the endocervical portion they came to the conclusion that LLETZ should not be the preferred procedure in these patients. Metronidazole is an effective treatment for bacterial vaginosis but lengthy discussions have been conducted over what is the best method to give the drug—by vaginal application or oral intake. Brandt and colleagues from Erfurt, Germany (page 158) conducted a randomized, double blind placebo controlled trial in 129 women who were orally treated and 134 women who received the vaginal application. The conclusion is that intravaginal application was as effective as the oral administration and in addition had fewer side effects, which probably led to better patient compliance. During operative treatment of endometrial cancer the extent of the surgery depends on the degree of invasion of the carcinoma into the uterus. Histological examination, however, is not always feasible and intra-operative gross examination could be one method to check the degree of infiltration. This has been investigated by Mao and colleagues from Hangzhou, China (page 179), who compared intraoperative gross examination with the final histopathological results in 401 patients. They conclude that gross examination is a good method of predicting myometrial invasion but is not the ideal way to assess cervical involvement. The answer on how to overcome this difficult problem is still awaited. Enjoy reading this issue, }, doi = {10.1016/j.ejogrb.2008.10.001}, issn = {03012115}, journal = {European Journal of Obstetrics \& Gynecology and Reproductive Biology}, keywords = {commentary, endocrine, hypothesis, reproduction}, month = {December}, number = {2}, pages = {93--94}, posted-at = {2008-11-21 19:56:35}, priority = {2}, title = {Editors' highlights}, url = {http://dx.doi.org/10.1016/j.ejogrb.2008.10.001}, volume = {141}, year = {2008} }

TY - JOUR ID - citeulike:3656429 L3 - citeulike-article-id:3656429 IS - 2 JF - European Journal of Obstetrics & Gynecology and Reproductive Biology SN - 03012115 EP - 94 TI - Editors’ highlights VL - 141 SP - 93 KW - commentary KW - endocrine KW - hypothesis KW - reproduction N1 - Editors’ highlights Wolfgang Künzel and Jim Drife Available online 4 November 2008. Article Outline What is new? Obstetrics and maternal–fetal medicine Reproductive medicine and endocrinology Gynaecology and gynaecological oncology Politicians are responding more and more to the fact that Millennium Development Goal (MDG) 4 (reduction of infant mortality) and MDG 5 (improvement of maternal health) are still a long way from being achieved in 2015. The development of a Global Business Plan (GBP) during 2007 represented a new-found determination among development agencies and international stakeholders to reach these goals. The GBP reflected the frustration that after 20 years of the “Safe Motherhood” initiative, little progress has been made. Now it has been superseded by the Global Campaign for the Health MDGs, launched in September 2007 by the leaders of Norway, Great Britain and Canada. Advocacy efforts to get MDGs 4 and 5 back on track will be led by the Partnership for Maternal, Newborn and Child Health (PMNCH), a coalition of 250 organisations working in this field. Norway has taken a leading role and it was timely that a conference in Oslo on 5–7 November 2008 focused on this topic. The 2008 International Stillbirth Conference of, jointly, the International Stillbirth Alliance and the World Health Organisation, was organised by the Norwegian Institute of Public Health and hosted by the Norwegian Society of Perinatal Medicine. It covered the whole field, including stillbirth in developing countries and social inequities, prevention of stillbirth, perinatal mortality studies, implementing prenatal care programmes, involving communities, infections as a cause of stillbirth, birth registry and the state of global political priority. It was a fascinating convention touching topics important not only for the developing world but also for the developed world in two ways: firstly, to continue the success story of maternal and infant mortality in the developed world and secondly, to offer help to those who are willing to find the right ways of reducing maternal and infant mortality in their country. What is new? Obstetrics and maternal–fetal medicine Free radicals and oxidative stress are now considered to be a basic thread of human life. Free radicals are constantly produced by a variety of cellular functions but pathological processes including infections, diabetes and even psychological stress are prone to disturb the balance between normal and pathological concentration. This balance is steered by antioxidants, which reduce the concentrations of free radicals and thus reduce oxidative stress. Antioxidants, or “free radical catchers”, are provided by vitamins, carotinoids, flavanoids, isoflavins and others in fruits and vegetables. Saker and colleagues from Themcen, Algeria (page 95) investigated the interesting question of oxidant and antioxidant status in mothers and newborns. They compared groups of small for gestational age (SGA) and large for gestational age (LGA) babies with a normal (AGA) population. Total antioxidant activity (measured as oxygen radical absorbance capacity (ORAC) in plasma) was significantly lower in mothers and newborns in the SGA group compared with the other groups. In the LGA group, however, ORAC was reduced in newborns but not in their mothers. Similar observations were made in erythrocyte antioxidant enzyme activities. The data suggest an imbalance causing oxidative stress in both SGA and LGA babies. The authors suggest that in SGA cases, anti-oxidant therapy to the mother might help to shift this balance, while in LGA newborns, postnatal antioxidant supplementation might help to reduce long-term problems. It is an interesting theory and we look forward to further studies. Hypoxic stress to the fetus during pregnancy is demonstrated by typical changes in fetal heart rate and in the venous and arterial system of the fetus. Alves and colleagues from São Paulo, Brazil (page 100) investigated doppler findings in the ductus venosus on the day of delivery and compared these with postnatal outcomes. Their cases were 103 newborns delivered by caesarean section because of absent or reversed end diastolic flow (ARED) in the umbilical artery. Of these, 20 had ARED in the ductus venosus (Group A) and 83 had positive flow (Group B). Gestational age was 30 weeks in Group A and 30.9 weeks in Group B. ARED in the ductus venosus was associated with lower birth weight, lower Apgar scores at one and five minutes, higher intubation rate, increased incidence of pH less than 7.20 and a higher risk of postnatal death. The authors conclude that investigating the flow in the ductus venosus may facilitate the decision for operative intervention. The “Hawthorne effect” is based on studies conducted between 1924 and 1932 at the Hawthorne factory of the Western Electric Company in Chicago. The aim was to investigate the work performance in the factory, and the effect refers to improvement in performance solely due to subject's knowledge that he or she is being studied. Fox and colleagues (page 111) investigated obstetricians’ clinical estimation of fetal weight (EFW), asking whether the accuracy is influenced by the Hawthorne effect. They told a group of clinicians that their ability to estimate EFW was to be studied, and compared the results during the study period with results during the preceding 3 months. No difference could be found. It appears that EFW accuracy cannot be improved by observation, and therefore published results are likely to reflect those in clinical practice. Abdominal pain is the principal manifestation of an autosomal recessive disorder called “Familial Mediterranean Fever”. This condition is associated with recurrent abortion, preterm delivery, labor induction and delivery by caesarean section, as shown by Ofir and colleagues from Israel (page 115) in a study of 239 affected pregnancies. Perinatal outcome, however, is comparable to the general population. This disease is rare in northern Europe and colleagues should be aware of this disorder if they see pregnant women from Arabia, Armenia, Israel or Turkey. The increase of caesarean section (CS) is a worldwide “disease” which has many causes. One is the degree of urbanisation, as shown by Chen and colleagues from Taiwan on page 104. They studied over 200,000 pregnancies and found that the CS rate increases with advancing urbanisation level. Studies in other countries have linked urbanisation with conditions such as diabetes and asthma but few have made a link with CS rates. It would be of interest to study whether additional factors come into play. An easy approach would be to use a standard gravida (cephalic presentation at term) to compare various regions. This should reveal the influence of other factors, such as previous CS. “Being male carries an increased risk of spontaneous but not iatrogenic preterm birth” is the conclusion of Bretell, Yeh and Impey from Oxford, UK, on page 123. They investigated 75,725 deliveries of which 4003 (5.3%) were preterm and found that males delivered preterm more frequently (OR 1.13, 95% CI 1.06–1.20). The larger size of males did not account for this increased risk, nor did their increased incidence of obstetric complications such as abruption, and the authors conclude that the reasons remain obscure. Reproductive medicine and endocrinology Changes of mood are often observed during the menstrual cycle and during cycles controlled by combined oral contraceptive (COC) pills. How these fluctuations are influenced by personality traits was an interesting analysis conducted by Borgström and colleagues from Uppsala, Sweden (page 127) using the Swedish university Scales of Personality (SSP). Four groups of women were investigated and the results provide information regarding the influence of traits on mood. Higher scores of mistrust and detachment are more common among women who have discontinued COC treatment due to adverse mood effects. It is worth reading this stimulating article, especially as most gynaecologists in their day-to-day practice see many women taking COC pills. Emergency contraception (EC) is an option for preventing pregnancy after unprotected sexual intercourse. Among teenagers, however, awareness and usage of EC are poor. It is therefore to the credit of Drs. Xu and Cheng from Shanghai that they investigated the level of EC awareness among pregnant teenagers with unwanted pregnancies. They collected information on previous awareness, usage and reason for failure. The average age of the girls was 17.8 years: 49.1% had experienced contraception failure and 99.3% had had sex without any contraception in the past. Only half had heard about EC. The authors’ conclusion is clear: both advocacy of EC and the awareness of the risk of unprotected sex should be improved through sex education programmes in schools in China. They also suggest that pharmacists should receive systematic training on EC and other contraceptive methods. The need for increased awareness is true not only for China but also for the rest of the world and especially for developing countries. Gynaecology and gynaecological oncology Surgical management of cervical intraepithelial neoplasia (CIN) aims at removing all lesions for histological examination. Various methods are available and which of them should be applied in HIV infected women was the question asked by Foulot and colleagues from Paris (page 153). They compared loop excision of the transformation zone (LLETZ) with electrosurgical conisation in 80 HIV infected women with 86 surgical excisions. Since residual CIN was mostly located in the endocervical portion they came to the conclusion that LLETZ should not be the preferred procedure in these patients. Metronidazole is an effective treatment for bacterial vaginosis but lengthy discussions have been conducted over what is the best method to give the drug—by vaginal application or oral intake. Brandt and colleagues from Erfurt, Germany (page 158) conducted a randomized, double blind placebo controlled trial in 129 women who were orally treated and 134 women who received the vaginal application. The conclusion is that intravaginal application was as effective as the oral administration and in addition had fewer side effects, which probably led to better patient compliance. During operative treatment of endometrial cancer the extent of the surgery depends on the degree of invasion of the carcinoma into the uterus. Histological examination, however, is not always feasible and intra-operative gross examination could be one method to check the degree of infiltration. This has been investigated by Mao and colleagues from Hangzhou, China (page 179), who compared intraoperative gross examination with the final histopathological results in 401 patients. They conclude that gross examination is a good method of predicting myometrial invasion but is not the ideal way to assess cervical involvement. The answer on how to overcome this difficult problem is still awaited. Enjoy reading this issue, AU - Kunzel, W AU - Drife, J PY - 2008/12// UR - http://dx.doi.org/10.1016/j.ejogrb.2008.10.001 ER -