Genetic testing has advanced over the past few years, and everything about it continues to change, from cost, availability, players in the market, improvements in standards, and more. This is the year that prenatal genetic testing will be more widely available for women, regardless of age or risk. Here are my predictions for genetic testing in 2015.
A "benign" mass found in breast tissue known as atypical hyperplasia, or atypia, carries a greater risk of cancer than previously believed, a new scientific review found.Very high magnification of atypical ductal hyperplasia. Copyright © 2011 Nephron.
Given the significantly increased lifetime risk of cancer among women who have atypical hyperplasia, the researchers suggest that clinicians consider having those patients undergo MRI screening to better detect malignancies.
"By providing better risk prediction for this group, we can tailor a woman's clinical care to her individual level of risk," said Lynn Hartmann, MD, an oncologist at Mayo Clinic and lead author of the study, in a news release. "We need to do more for this population of women who are at higher risk, such as providing the option of MRI screenings in addition to mammograms and encouraging consideration of anti-estrogen therapies that could reduce their risk of developing cancer."
A recent article in Health Affairs highlighted the pressures some patients who desire a natural or vaginal birth may face in a culture of cesarean deliveries. The article details the experiences of Carla Keirns, MD, PhD, MSc, FACP, when she delivered her first child. As a physician (clinical ethics and palliative care), she knew she needed to advocate for herself and not be pressured into having a c-section on the basis of fear of what could go wrong instead of the medical facts of her case. She also had friends and colleagues she could turn to for second opinions, something most women wouldn't have access to.
The gist of her case, extremely simplified, is that she'd been laboring in an induction for nearly 2 days and the L&D clinicians had started to watch the clock, pushing for a c-section. However, when it finally came time for her to push, the room had yet to be set up for a vaginal delivery and her clinicians seemed unprepared, so much so that the neonatal team wasn't in the room. It seemed to her that she had been written off as a c-section, so no preparations for a vaginal delivery had been made.
The underlying causes of spontaneous preterm birth are still largely unknown. There are various risk factors for spontaneous preterm birth, but the primary risk factor is a previous preterm delivery. The sex of the unborn baby also seems to play a role in the process of being born prematurely, according to research presented last week in San Diego at The Pregnancy Meeting, the Society for Maternal-Fetal Medicine’s annual meeting.
The research was based on nearly 2 million (1,947,266) singleton births by white women between 1999 and 2010 involving a live fetus at the onset of labor. Cases with congenital anomalies or unknown fetal sex were excluded. The relative risk ratios for gender per week of gestation were assessed, as was gender-related risk on adverse neonatal outcomes. These outcomes were perinatal mortality and a composite of neonatal morbidity, including neonatal intensive care admission, sepsis, meconium aspiration, necrotizing enterocolitis, respiratory distress syndrome, and intraventricular hemorrhage.
Little is known about the efficacy of manually turning a baby early during the second stage of labor, leaving questions about its value in preventing a c-section or other type of operative delivery.
The editors of the Cochrane Pregnancy and Childbirth Group concluded that there is insufficient evidence to determine the usefulness of prophylactic manual rotation. They found just one small pilot study and noted that a second study is ongoing.
Commercially available vaginal estrogens provide postmenopausal women with effective options for the management of genitourinary syndrome of menopause (GSM), according to a review published by the Society of Gynecologic Surgeons in Obstetrics & Gynecology.
“Among those patients with more bothersome vulvovaginal atrophy symptoms or urinary complaints of urgency, frequency, nocturia, or stress urinary incontinence and urgency urinary incontinence, vaginal estrogen therapy may offer substantial improvement in symptoms,” wrote David D. Rahn, MD, of the University of Texas Southwestern Medical Center, and colleagues from the Society of Gynecologic Surgeons Systematic Group Review.
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