Maternal use of marijuana, in which the exocannabinoid Delta(9)-tetrahydrocannabinol is the most active psychoactive ingredient, is known to have adverse effects on various aspects of reproduction including ovulation, spermatogenesis, implantation and pregnancy duration. Endogenous cannabinoids of which Anandamide is the prototype are widely distributed in the body especially in the reproductive tract and pregnancy tissues and act through the same receptors as the receptor as Delta(9)-tetrahydrocannabinol. Anandamide, has been reported to have pleiotropic effects on human reproduction and in experimental animal models. It appears to be the important neuro-cytokine mediator synchronizing the embryo-endometrial development for timed implantation, the development of the embryo into the blastocyst and transport of the embryo across the fallopian tubes. The mechanisms by which it exerts these effects are unclear but could be via direct actions on the various sites within the reproductive system or its differential actions on vascular tone dependent. In this review article we bring together the current knowledge on the role of endoccanabinoids in reproduction and postulate on the potential mechanisms on how these affect reproduction. In addition, we examine its role on the endothelium and vascular smooth muscle as a potential mechanism for adverse pregnancy outcome.

Objective Recent meta-analyses have shown that loop treatment of the cervix of >10 mm depth may be associated with adverse outcomes in future pregnancies. The aim of this study is to assess the rate of incomplete excision and recurrent disease in relation to depth of excision in women of reproductive age undergoing loop treatment.Design Observational cohort study.Setting Colposcopy Clinic, Northern Gynaecological Oncology Centre, Gateshead, UK.Population In all, 1558 women undergoing loop treatment for high-grade cervical intraepithelial neoplasia (HGCIN) between 1998 and 2003.Methods Women were followed up until 2008. Recurrence was analysed using Kaplan-Meier plots.Outcome measures Incomplete excision rates and recurrence rates. Recurrence was defined as post-treatment disease with highgrade histology. Any dyskaryotic cytology on follow-up was also documented.Results Recurrent high-grade disease on histology was found in 57/1558 (3.7%) women. In women £35 years old, despite a greater rate of incomplete excision at the endocervical margin at loop depths <10 mm compared with ‡10 mm (24.4% versus 13.3%, P < 0.01), the recurrence rate was similar between the two groups (4.3% versus 3.4%, log-rank, P = 0.52). In contrast, a loop depth <10 mm was associated with a higher disease recurrence rate (7.5% versus 3.0%, log-rank, P = 0.05) in women >35 years. ConclusionIn women of reproductive age requiring treatment for HGCIN, colposcopists performing loop excision should aim for <10 mm depth. This provides adequate treatment for HGCIN and minimises the potential risk of adverse outcomes in future pregnancies.

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Background Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment. Objectives To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer. Search methods We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult women with advanced primary epithelial ovarian cancer. Data collection and analysis Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed. Main results One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 women with stage IIIC advanced epithelial ovarian cancer who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among women receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 women with carcinomatosis, those who underwent ultra-radical surgery had significantly better disease specific survival than women who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias. Authors’ conclusions We found only low quality evidence comparing ultra-radical and standard surgery in women with advanced ovarian cancer and carcinomatosis. The evidence suggested that ultra-radical surgery may result in better survival. It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery. In order to determine the role of ultra-radical surgery in the management of advanced stage ovarian cancer, a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would ...