Clinical obstetrics and gynecology最新文献

Advancements in surgical techniques over time have enhanced both the safety and efficacy of vaginoplasty, resulting in consistently high levels of patient satisfaction in terms of both functional and aesthetic outcomes. Given the rising volume of these procedures, it is increasingly probable that gynecologists will encounter transgender and gender-diverse (TGD) patients seeking specialized care. As experts in pelvic anatomy and reconstructive procedures, gynecologists are uniquely positioned to contribute meaningfully to the care of individuals seeking genital gender-affirming surgical interventions. This document aims to provide a comprehensive review of genital gender-affirming surgery for the transfeminine patient.

As the proportion of the population in the US that identifies as transgender and gender-diverse (TGD) increases, it is imperative that providers across all specialties be able to provide inclusive and affirming care. Here, we review recommendations for gynecologic care for TGD patients, including gender-inclusive terminology, screening examinations, birth control, preconception counseling, and management of common gynecologic complaints.

Over the past few decades, vulvovaginoplasty for transfeminine patients has rapidly advanced in both technique and access. However, a variety of barriers, including geographical access to surgeons, may make it difficult to access the original surgical team for evaluation and management of complications. Given this, local gynecologists and other health professionals may play a vital role in the evaluation and management of nonsurgical complications. Here, we review common complications and provide an overview of their related nonsurgical and surgical management for vulvovaginoplasty for transfeminine patients.

Advances in prenatal diagnosis, bioengineering, and minimally invasive surgical techniques have led investigators to reconsider in-utero therapy for fetal aqueductal stenosis, a form of congenital hydrocephalus that has been held under a moratorium since the 1980s. This article will review the definition, history, prenatal diagnosis, contemporary management, and future directions in clinical and basic science research for in-utero intervention for fetal aqueductal stenosis.

Congenital anomalies of the kidneys and urinary tract (CAKUT) are developmental defects affecting 1 in 465 live births and constitute 28% to 33% of neonatal ultrasound anomalies. CAKUT is a major contributor to chronic kidney disease in children and is the leading cause of end-stage kidney disease (ESKD) in this population, accounting for 40% to 50% of cases. Amniotic fluid volume reflects renal function. CAKUT that decreases amniotic fluid can result in serious complications. Although treatments such as amnioinfusion, vesicoamniotic shunting, and cystoscopy shows promise, they carry risks and uncertain long-term outcomes. This highlights the importance of further research to improve management of these conditions.

Transgender and gender-diverse patients seeking gynecologic care often have significant barriers to receiving inclusive care. These barriers can occur at every step of the care process from making appointments to seeing a clinician to reading a progress note in the medical record. By recognizing the shortcomings of current care models and incorporating inclusive practices into daily workflows, safer spaces can be achieved for patients obtaining gynecologic care.

It is recommended that transgender individuals undergo fertility preservation counseling before initiating gender-affirming hormone therapy and gender-affirming surgery. Counseling should include reviewing both the short-term and long-term impacts of medical and surgical therapy on fertility, as well as fertility preservation and assisted reproduction options for current or future reproduction. Fertility preservation options for transgender males include embryo, oocyte, and ovarian tissue cryopreservation, and options for transgender females include sperm cryopreservation. Testicular tissue cryopreservation is the only option available for prepubertal males and is considered experimental at this time.

Congenital diaphragmatic hernia (CDH) is a complex malformation complicating 0.02% to 0.03% of live births. The etiology of CDH is often multifactorial. Sonographic screening can aid in the detection of ~70% of CDH cases. Sonographic measures, that is, lung-to-head ratio, can also be utilized to predict the severity of fetal/neonatal disease and guide fetal eligibility for prenatal interventions, such as the FETO procedure. The FETO procedure has provided improved overall morbidity and mortality among fetuses with severe left-sided CDH, although limited data on its role in the treatment of right-sided CDH and long-term infant and childhood outcomes are limited.