Clinical obstetrics and gynecology最新文献

In this symposium, we introduce a collection of reviews that delve into the diverse clinically relevant aspects of the placenta and umbilical cord. The symposium addresses placenta previa and abruption; pathology, genetics, and imaging of the placenta; infections of the placenta; and ischemic placental disease. The umbilical cord's essential function as a fetal lifeline is explored, with an emphasis on the clinical repercussions of its dysfunction, including vasa previa and other umbilical cord abnormalities. This curated collection of reviews, which synthesizes the placenta's and umbilical cord's fundamental role in maternal-fetal health, underscores the clinical importance of these structures in pregnancy.

Sexual assault is common, disproportionately impacting women, persons of color, and young adults. Evaluation should include a history and exam, collection of forensic evidence, and evaluation for mental health disorders. Management of sexually transmitted infections (STI) is important, as 15% will acquire an STI. Prophylaxis is recommended for gonorrhea, chlamydia, and, for individuals with vaginas, trichomonas. HIV and hepatitis B post-exposure prophylaxis are indicated in high-risk scenarios. HPV vaccination is recommended. Follow-up and lab monitoring is indicated for up to 6 months. We aim to summarize up-to-date evidence on the screening, evaluation, and management of STIs following sexual assault.

Interventional Radiology (IR) can be a crucial player in managing placenta accrete spectrum disorder (PAS), offering minimally invasive angiographic techniques that can prevent or control hemorrhage and preserve fertility. These include prophylactic balloon occlusion of the aorta or iliac arteries, preoperative catheter placement in the iliac or uterine arteries for subsequent embolization, or pre-emptive arterial embolization preceding hysterotomy and delivery. This review provides obstetricians with an overview of IR's role in the management of PAS by describing specific endovascular techniques; existing outcomes data; and considerations for protocol development, preoperative planning, and intraoperative dynamics for when IR assists with PAS cases.

The anesthetic management of the patient with placenta accreta spectrum begins before surgery by assessing the patient and their comorbidities and providing psychological preparation for the perioperative period. Choosing neuraxial or general anesthesia for surgery balances the procedure's clinical needs with the patient's desires. Intraoperatively, management of homeostasis during acute blood loss requires assessments of central volume to avoid over-transfusion. Viscoelastic testing may be useful to assess coagulation to target the replacement of coagulation factors. Postoperative care is an essential continuum of the procedure, and the availability of bedside ultrasound can aid rapid decision-making.

Up to 14% of endometrial cancers and 23% of epithelial ovarian cancers are associated with genetic predispositions. Referral for genetic testing and counseling can significantly impact a patient's oncologic outcomes. However, significant disparities in genetic referral and testing exist within medically underserved and minority populations in the United States. These disparities in care and access to care are multifactorial, often involving patient-level, health care-level, and system-level factors. In this review, we focus on disparities in genetic testing among patients with ovarian and uterine cancer, and the missed opportunities for primary cancer prevention among their relatives.

Germline and somatic genetic/genomic testing are commonly ordered for gynecologic oncology patients. Genetic tests can inform disease etiology, prognosis, treatment decisions, and risk to the patient's relatives. Variants of uncertain significance (VUSs) are frequently encountered and have a more nuanced interpretation than straightforward pathogenic or benign variant classifications. Clinical care providers should be familiar with why and how VUSs are reported, their clinical significance, variant reclassification practices, and patient perceptions of VUSs.

Hereditary cancer syndromes (HCS) are responsible for up to 10% of all cancers. At present, the majority of cancer susceptibility testing is initiated after a cancer diagnosis. There exists a significant opportunity for primary care providers including general obstetrician-gynecologists to engage in hereditary cancer risk assessment through adequate family history evaluation, initiation of genetic testing, and following the recommendations of national organizations. Identifying hereditary cancer genes may prompt primary prevention efforts such as enhanced screening, prevention, or personalized care strategies. We will review the literature regarding the approach and assessment of the most common gynecologic HCS.