Clinical obstetrics and gynecology最新文献

Enhanced recovery after surgery (ERAS) protocols have been widely adopted within gynecologic surgery to optimize perioperative outcomes. This chapter discusses the evidence behind preoperative gynecologic ERAS elements, including preadmission counseling, comorbidity optimization, fasting guidelines, preoperative medications, and prehabilitation. Much of the evidence is extrapolated from colorectal and other surgical populations but has been supported within gynecology. Prehabilitation is the newest element, aimed at improving preoperative functional status through exercise, nutrition, and psychological support, with gynecology-specific evidence emerging to support inclusion within ERAS protocols. Preoperative interventions are the foundation of ERAS bundles, and adherence to these elements should be encouraged.

Enhanced recovery after surgery (ERAS) refers to a comprehensive, multidisciplinary, evidence-based perioperative care pathway designed to minimize surgical stress and accelerate postoperative recovery. Initially adopted in colorectal surgery, the ERAS framework has expanded to multiple fields, including obstetrics and gynecology. However, as with any significant shift in clinical practice, there are challenges to be addressed, successfully incorporating ERAS principles into everyday care requires institutions to adjust protocols, restructure care pathways, and involve multiple stakeholders. This review discusses the key barriers to implementing the ERAS protocol in OB/GYN settings and explores potential solutions.

Fetal Growth Restriction (FGR) affects up to 10% of pregnancies and is linked to perinatal morbidity and mortality. This review summarizes current and emerging therapies aimed at preventing and treating placental-mediated FGR. Low-dose aspirin initiated before 16 weeks shows the strongest evidence for benefit. Low-molecular-weight heparin and other interventions-including phosphodiesterase-5 inhibitors, statins, nitric oxide donors, VEGF gene therapy, melatonin, and IGF-based strategies-remain investigational. Given shared pathophysiology with preeclampsia, FGR presents an opportunity for early intervention. Future efforts must focus on risk stratification and development of targeted therapies to improve placental function and fetal outcomes.

Enhanced recovery after surgery (ERAS) represents a global, multidisciplinary surgical quality improvement initiative to improve preoperative, intraoperative, and postoperative patient care with demonstrable economic benefit. In this narrative review, we outline 5 innovative ERAS initiatives, including an improved surgical safety checklist, ongoing advocacy for same-day discharge postoperatively, the role of application-based telehealth in supporting patients after hospital discharge, patient engagement in ERAS protocols and appropriate postoperative opioid prescribing. These innovative strategies are applicable to a broad array of disciplines; however, our focus in this paper is within the fields of gynecology and gynecologic oncology.

In this review article, we aim to provide a comprehensive update on enhanced recovery after surgery (ERAS) in gynecologic oncology. Specifically, we focus on topics including pelvic exenterations, hyperthermic intraperitoneal chemotherapy, vulvar surgery, optimal intraoperative fluid management, postoperative pain control, and disparities in ERAS care. In addition, we discuss contemporary practice patterns including prehabilitation in the ERAS pathway and smartphone applications for postoperative care in gynecologic oncology patients.

Enhanced Recovery After Surgery (ERAS) protocols have been implemented across multiple surgical specialties, including OB/GYN, to improve patients' perioperative experiences. ERAS protocols typically include multimodal pain regimens; opioids are frequently utilized. In the perioperative setting, nonopioid analgesics, including acetaminophen, NSAIDs, dexamethasone, gabapentinoids, ketamine, antidepressants, and local anesthesia may be used, which impacts perioperative opioid utilization. In some patients, opioid-sparing analgesia may be possible. Postdischarge, patients should utilize a multimodal pain regimen similar to that of their inpatient stay, with limited opioid quantities prescribed. Postoperative prescribing should balance optimal pain control while considering the risks and side effects of opioid analgesics.

Enhanced recovery after surgery (ERAS) is an evidence-based, multimodal, perioperative care pathway that has been demonstrated to improve outcomes for patients undergoing surgery. In gynecology, there is evidence that ERAS is associated in reduction in length of stay, perioperative complications, and health care costs. The purpose of this narrative review is to discuss the outcome measures and metrics of ERAS in gynecologic surgery. Furthermore, to consider future directions for outcomes and metrics for ERAS in gynecologic surgery.

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.

Fetal lower urinary tract obstruction (LUTO) is a severe malformation that is associated with significant neonatal and pediatric morbidity and mortality risk. Existing fetal shunts aimed at bypassing the obstruction and improving neonatal survival have significant limitations, primarily shunt dislodgement. Repeat in-utero invasive shunt replacement procedures are associated with maternal, fetal, and obstetric risks, highlighting a clinical need for a novel fetal shunt with improved performance. We used a biodesign approach to develop and validate a novel fetal shunt, the Vortex shunt, which can potentially reduce dislodgement and improve both neonatal and maternal outcomes. In this review, we will discuss our approach to assessing the clinical need, the initial prototyping and benchtop testing, and animal feasibility studies of the Vortex shunt. We will also discuss existing challenges and opportunities for innovation in the fetal medicine and surgery space, and how biodesign methodology can inform novel instrument development in high-impact small market areas.