Current Women's Health Reviews - Volume 6, Issue 4, 2010

This review focuses on the genetics of human papilloma virus and immune dysregulation in cervical neoplasia. HPV, the putative agent in cervical cancer, is the most prevalent sexually transmitted infection worldwide. Cervical cancer is the second most common malignancy in women globally as well. Cervical neoplasia is increased in immuno- suppressed states, such as systemic lupus erythematosus. HPV has evolved mechanisms to evade the host immune system which are discussed. Malignant transformation from involves three steps: infection of the cervix, viral persistence, and progression to cancer. This process involves activation of viral oncogenes and integration of viral DNA into host genome. Cancer prevention and Screening strategies involve a combination of cervical cytology, high risk HPV testing, and colposcopy. Vaccination is effective in preventing primary HPV infection with the high risk HPV types causing the majority of cervical cancers. Experimental therapeutic vaccines offer new ways to treat cervical neoplasia.

Preeclampsia remains a leading cause of maternal and fetal morbidity and mortality in the United States and worldwide. Despite its significant prevalence (5% of all otherwise normal pregnancies may be affected), there is no early pregnancy screening test to recognize those at risk. Further, once diagnosed, there is no effective treatment beyond delivery. Emerging data are beginning to uncover the pathogenesis of this complex disease. In this review, the clinical presentation, current management, new evidence regarding pathogenesis, and future possibilities for screening and therapy will be discussed.

Pre-eclampsia is a pregnancy specific multi-system disorder associated with increased maternal and perinatal morbidity and mortality. In spite of intensive research for several decades into its pathophysiology, the aetiology remains unexplained. There is evidence that maternal tissue blood flow is reduced in pregnancies complicated by this disease, which precedes clinical onset, and persists after delivery. It is however unclear whether the reduced maternal tissue blood flow is associated with changes in tissue oxygenation and/or abnormal tissue oxygen homeostasis and whether this precedes or follows pre-eclampsia. This review examines the cause and effect relationship between hypoxia and pre-eclampsia and possible underlying mechanism(s) of impairment in oxygen regulation.

Objective: To identify risk factors for hyperemesis gravidarum, a severe form of nausea and vomiting that occurs in early pregnancy. Study Design: A systematic review used pre-defined eligibility criteria and a search of PubMed, CINAHL, ISI Web of Knowledge, and PsycINFO to identify original research articles (from any country, study year, and publication language and year) that examined risk factors for hyperemesis gravidarum. Information about the study design, population, and results of each of the forty-three included studies were extracted and compared. Results: Low pre-pregnancy weight, Helicobacter pylori infection, a history of hyperemesis gravidarum in a previous pregnancy, and carrying a female fetus appear to be risk factors for hyperemesis gravidarum. The associations between hyperemesis gravidarum and maternal age, gravidity, and parity, are not yet well defined. Conclusion: Additional studies are needed to evaluate the association between hyperemesis gravidarum and ethnicity, socioeconomic status, mental and physical health, and other understudied characteristics.

Objective: The objective of the present study was to review studies describing specifically the impact of certain personality traits, cognitive appraisals, coping strategies and social support on infertility related stress. Furthermore, the aim was to examine the interrelationships among these psychosocial potential predictors in order to develop a predictive psychosocial path-model of infertility related stress. The clinical application of the predictive model of infertility related stress would help the medical staff of fertility centers to identify infertile women who are at greater risk for infertility related stress and for adjustment difficulties and to foster the implementation of preventative and therapeutic interventions. Methods: A systematic search of the psychological and medical electronic databases (Medline, PsycINFO, CINAHL, EMBASE and Scopus) was performed. This review considered only quantitative, primary studies that were relevant to the objective of the review. Population of interest was considered to be infertile women undergoing fertility treatment. Independent variables were considered to be psychosocial predictors of infertility related stress. Outcomes (dependent variables) were considered to be anxiety, depression, and negative mood states. The development of the psychosocial path-model of infertility related stress was based on the principles of stress, appraisal and coping theories. Results: Nineteen studies met the inclusion criteria and finally included in the review. According to the review findings, psychosocial predictors of infertility related stress are: a) personality characteristics, such as neuroticism, pessimism and introversion, b) viewing infertility as a threat or a loss, c) low perceived control over the infertility condition and fertility treatment outcome, d) frequent use of avoidant/escape coping strategies, e) marital dissatisfaction and poor marital communication and f) impoverished social network. Based on the review findings, a predictive path-model of infertility related stress which diagrammatically represents the interrelationships among the independent variables and the interrelationships between the independent and dependent variables was developed. The produced diagrammatical-model shows that: a) the relationship between personality dispositions and fertility related stress is either direct or mediated by appraisal cognitions and coping strategies, b) the relationship between appraisal cognitions and fertility related distress is mediated by coping strategies and c) social support is associated with distress both directly and indirectly either through appraisal cognitions or through coping strategies. Conclusion: Although no single pattern of adjustment to infertility appears common, this review has identified several psychosocial factors that might make particular infertile individuals more vulnerable to stress. It is often a combination of factors which makes stress overwhelming. However, it is important to keep in mind that the risk posed by some factors may by mitigated by the presence of buffers. An insight into such risk and protective factors would facilitate the identification of women at risk of experiencing high infertility related stress and foster the implementation of tailored support, and therapeutic interventions.

The pre and post evaluation of 65 patients undergoing intensive group psychotherapy by the Hope Alive method, yielded useful information on 28 parameters. The results provide sufficient evidence of benefit to warrant continued use of this program and to investigate the various components to delineate the most effective aspects of the program. There is statistically significant global improvement, but some areas of change such as: self-esteem and relationship with partner and a hopeful outlook are greater than others. When patients did their homework assignments consistently and thoroughly, there was increased likelihood of insight, personal growth, and diminished psychological symptoms.

Introduction: In abortion counselling, the counsellor is generally supposed to be supportive, non-judgmental and neutral. However, counsellors can be confronted with strong internal emotions i.e., counter-transference reactions. Counter-transference may paralyse a counsellor’s investigation and push the counsellor to lose their position of neutrality. Objective: The objective of this article is to show counsellors the importance of integrating counter-transference in abortion counselling to increase the efficacy of their investigation and to maintain a neutral position. Method: A systematic search of the literature was performed. The studies retained for review had to discuss certain aspects of abortion counselling interview techniques, specifically maintaining neutrality and dealing with countertransference. Results: Eight studies matched our criteria. All studies stressed the danger of losing neutrality for the counsellor. A few authors suggested paying attention to this non-conscious process to better help patients. Conclusions: We propose applying the psychoanalytical theory on neutrality and counter-transference to the abortion counselling setting. A cognitive awareness of counter-transference feelings may help the counsellor to understand the non-conscious transference-counter-transference dynamic and to use the moment when neutrality is lost to improve the patient's comprehension of ambivalence.

Obesity is a public health problem that continues to rise despite preventive strategies. There is an association between excessive body weight and various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnoea, certain types of cancer, and osteoarthritis. Obesity adds to anaesthetic mortality and morbidity as well. The incidence of obesity in pregnant population is also on the rise. These patients pose considerable challenges to Obstetricians and Anaesthetists not only with increased co-morbidities but they also need higher level of technical skills. Obese parturients are at increased risk of superimposed antenatal disease such as preeclampsia and gestational diabetes. They have a tendency to labour abnormally, contributing to increased instrumental delivery and caesarean sections. Thus, obesity is associated with increased perioperative morbidity and mortality. These patients should have multidisciplinary assessment involving midwives, obstetricians and anaesthetists to plan their perinatal care. Midwives must prepare for this epidemic and must endeavour to help women who want to lose weight and dispel the myth that this cannot be achieved safely during pregnancy. In spite of technical difficulties, regional anaesthesia may reduce anaesthesia-related morbidity and mortality. Effective pain relief, chest physiotherapy and early mobilisation should be included in postoperative care.

Ovarian tissue cryopreservation is the key step towards the establishment of an ovarian tissue bank or the preservation of ovarian tissue for patients scheduled for gonadotoxic cancer therapies, aiming for fertility restoration later on. Conventional cryopreservation, or slow freezing, has been the mainstay of ovarian tissue cryopreservation. Vitrification has recently emerged as a new trend for biological specimen preservation. It has shown increasing success over slow freezing, especially with oocytes, which is mainly attributed to avoiding ice formation. Much research is underway to investigate the application of vitrification to ovarian tissue. Ovarian tissue vitrification may have specific challenges and requirements that differ from single cell or oocyte vitrification. The medical literature was searched for studies on ovarian tissue vitrification using the keywords: ovary, ovarian tissue, transplantation, vitrification, cryopreservation, and freezing. After author's agreement, relevant citations were analyzed. Thirty studies reported the ovarian tissue vitrification of 11 species, using different vitrification methods and different outcome measures. The vitrification of ovarian tissue is a promising alternative to slow freezing. However, proper ovarian tissue preparation and the specific method of vitrification are both key factors that determine the viability and functionality of preserved tissue in other applications, notably transplantation.

Uterine artery fibroid embolisation has now been used in the management of women with fibroids for over two decades. This review summarises the evidence on the efficacy of the procedure in the management of menstrual symptoms and the reproductive outcomes in women who have undergone embolisation. The reported literature suggests it to be an effective alternative to hysterectomy and myomectomy in the management of women with symptomatic fibroids with significant improvement in menstrual loss and reduction in fibroid size. The evidence on the reproductive outcomes following the procedure is less robust and is largely from non-randomised cohort studies and one randomised trial that assessed this as a primary outcome. These suggest a less favourable reproductive outcome compared to women undergoing myomectomy with higher miscarriage, Caesarean section and post-partum haemorrhage rates. In conclusion, the literature shows uterine artery fibroid embolisation to be a safe and effective option in women with fibroids. Caution, however, is needed when considering embolisation in women who wish to preserve fertility, and the latter remains a relative contra-indication for the procedure.

Heterosexual transmission of the human immunodeficiency virus type-1 (HIV-1) to women occurs after exposure of the mucosal surfaces of the female reproductive tract (FRT) to cell-free virus or to HIV-1 infected cells present in the seminal fluid of an infected male partner. However, exposure to virus at this site does not always result in transmission of HIV-1, indicating that the local microenvironment in the FRT at the time of viral exposure may influence a woman's susceptibility to infection. Cleary, the sex steroid hormones, estradiol and progesterone, play an important role in the FRT. Although the primary function of these hormones is to regulate the reproductive status of a woman, they also exert profound effects on the subsets of immune cells in the FRT as well as on their phenotype and functional activity. In addition, estradiol and progesterone regulate the local cytokine and chemokine milieu by influencing the activation state of immune cells. Fluctuations in estradiol and progesterone levels in the FRT regulate expression of HIV-1 receptors CD4 and galactosyl ceramide (Gal-Cer), as well as HIV-1 co-receptors CCR5 and CXCR4. Moreover, these hormones control the development of leukocyte aggregates in the FRT that contain T cells and macrophages, resulting in foci of potential target cells for HIV-1 infection. Estradiol has also been shown to enhance HIV-1 transcription from infected cells, thereby increasing levels of viral shedding from the genital tract. In sum, these steroid hormones serve to alter a woman's susceptibility to HIV-1 infection after exposure to virus in the genital tract.

The current paper presents the author's reports on her training courses in departments of breast surgery at the European Institute of Oncology, Milan, Italy; Careggi University, Florence, Italy; Mayo Clinic, Rochester, Minnesota, USA; Cancer Institute of Japanese Foundation for Cancer Research, Tokyo, Japan and Ivo Pitanguy Clinic, Santa Casa da Misericordia, Rio de Janeiro, Brazil between 2002-2008. A special emphasis is laid upon lifestyle, breast cancer incidence, imaging diagnostics, breast conserving therapy-mastectomy ratio, breast reconstruction, sentinel node biopsy and gene profiling in these populations.