Clinical obstetrics and gynecology最新文献

In an effort to parallel the terminology and guidelines adopted by the International Federation of Gynecology and Obstetrics (FIGO) and published in July 2019, a panel of expert obstetric and perinatal pathologists (the Placenta Accreta Task Force) was convened within the Perinatal Subcommittee of the Society for Pediatric Pathology (SPP) in October 2019 to create consensus recommendations for the pathologic diagnosis and reporting of Placenta Accreta Spectrum (PAS). This chapter will discuss the approach to gross and histopathologic examination of PAS, standardized pathologic classification system, and reporting guidelines.

Management of the placenta accreta spectrum (PAS) in resource-limited settings poses significant challenges. Traditional approaches, which often involve hysterectomy and extensive technology in all the patients are being replaced by individualized treatment plans considering each patient's specific clinical situation, available resources, and team expertise. Using ultrasonographic and surgical staging based on PAS topographic classification can help design tailored surgical plans and optimize resource use. This article explores the need for personalized PAS management, safe surgical option selection, and how medical teams can adapt to provide more versatile treatment options in resource-constrained environments.

Transgender and gender expansive persons (TGE) are at increased risk for sexually transmitted infections (STIs) compared with other demographic groups and face barriers to health care access that may limit their ability to obtain testing and treatment. Herein, we highlight unique, yet vital, aspects of STI screening and treatment in TGE persons utilizing a gender-affirming care approach, including best practices for gender-inclusive care and special considerations for TGE persons who have undergone gender-affirming hormone therapy and/or surgery. Opportunities exist to improve sexual health in TGE persons, which can be achieved through culturally competent, gender inclusive STI testing and treatment.

Care of the pregnant patient with monochorionic (MC) twin gestation entails specific steps that are imperative in recognizing complications that are unique to MC placentation. Here, we will review recommendations for care of the patient with known MC twin gestation, as well as discuss the pathophysiology, diagnosis, and management of these complications including, but not limited to, twin-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), selective fetal growth restriction (SFGR), and twin reversed arterial perfusion (TRAP) sequence.

Advances in prenatal diagnostics, imaging, and surgical techniques have accelerated maternal-fetal interventions (MFI), fetal care centers, and expanded options for families. Progress in this field has also raised ethical issues surrounding maternal autonomy, informed consent and decision-making, innovation versus research, equitable access, and disability and reproductive rights. We review ethical frameworks to evaluate MFIs, from innovation to research and, ideally, clinical practice. Necessary oversight and resources are summarized to promote ethical, equitable innovation and research while protecting maternal autonomy and supporting the informed consent and decision-making process. Additional implications amidst abortion restrictions are discussed, along with areas for future research.

As the majority of female cancer survivors can now expect to live long lives beyond cancer diagnosis and treatment, there is a growing need to address the significant late effects of treatment. Unfortunately, sexual health remains a primary concern that often goes unaddressed among female cancer survivors. Sexual dysfunction is one of the most common and distressing effects of treatment. Management of issues related to sexual health and sexual function depends upon the type of malignancy, stage and other tumor characteristics, treatment, and the history, concerns, and goals of the individual patient.

Rare ultrasound placenta findings, such as avascular cystic lesions, hyperechogenic and thick placenta, and enlarged placenta, are associated with infarcts, perivillous fibrin deposition, and mesenchymal dysplasia. These lesions can be present in 20% of normal pregnancies but are more frequent in pregnant women with pre-eclampsia (PE) and/or fetal growth restriction, autoimmune diseases, and infections, and can increase the risk of perinatal complications, including fetal death. Evaluation of the placental surface may also identify cases with circumvallate placenta and chorioangiomas. These rare placental findings require close clinical follow-up and serial fetal evaluations to identify those at a higher risk of abnormal perinatal outcomes.

Aim: To describe orgasm disorders in women.

Results: Orgasmic problems are prevalent in women, and many experience distress related to the condition. The problem often co-exist with other sexual disorders and can be caused by many biopsychocial factors. A comprehensive assessment focusing on biopsychosocial factors contributing to the orgasmic problem is necessary. This includes a sexological, medical, and psychological history. Treatment should include cognitive and behavioral interventions, which may include the partner. No pharmacological treatment is approved to treat orgasmic disorders in women.

The umbilical cord is the connection between mother and fetus through which gases and nutrients are exchanged. It's remarkable structure allows for freedom of movement while providing a cushioned, protected conduit from mother to fetus. Fetal development and survival are dependent upon the umbilical cord. This article reviews abnormalities of the umbilical cord that can be seen with structural and chromosomal abnormalities and altered umbilical cord flow associated with fetal growth restriction and poor pregnancy outcomes.

Placental abruption is a complete or partial separation of the placenta from the uterine decidua. Clinical manifestations include vaginal bleeding, abdominal pain, uterine contractions, and abnormalities in the fetal heart rate tracing. Placental abruption occurs in 0.4% to 1.0% of all pregnancies. However, the pathophysiology remains incompletely understood. We present a review of the pathophysiology, diagnosis, and management of placental abruption, exploring overlapping processes which contribute to premature placental separation. Classic findings and limitations of ultrasound in evaluating placental abruption are explained. Finally, we discuss the management of placental abruption based on gestational age, fetal status, and maternal hemodynamic stability.