Clinical obstetrics and gynecology最新文献

Fetal anemia encompasses a wide range of etiologies, most notably red cell alloimmunization, and poses serious risks to fetal and neonatal health if unrecognized. This narrative review outlines the pathophysiology, screening strategies, and evolving diagnostic tools such as noninvasive genotyping and MCA Doppler. We examine immunomodulatory therapies like IVIg and nipocalimab, and discuss technical considerations for intrauterine transfusions. Finally, we address neonatal management and long-term outcomes. With increasing access to prenatal diagnostics and targeted interventions, timely recognition and treatment of fetal anemia can significantly improve perinatal survival and reduce complications.

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.

Cesarean scar pregnancy (CSP) is among the most severe iatrogenic complications of cesarean delivery (CD) and is associated with a high risk of severe hemorrhage, uterine rupture, and progression towards placenta accreta spectrum disorders. Prenatal diagnosis of CSP has been recently standardized through a modified Delphi consensus, which also allows risk stratification according of this anomaly. However, several issues on the management of CSP are still under debate. The aim of the present review is to provide an up-to-date on the diagnosis and management of CSP.

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.

Parasitic sexually transmitted infections are spread through sexual contact (vaginal, oral, and/or anal sex). The majority of parasitic STIs involve protozoan pathogens (ie, Trichomonas vaginalis, Entamoeba histolytica, and Giardia duodenalis ); however, ectoparasitic infections ( Pthirus pubis and Sarcoptes scabiei ) are also included in this group. The purpose of this review is to provide a comprehensive summary of the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of parasitic sexually transmitted infections, with a particular focus on their impact on women.

Placenta accreta spectrum (PAS) is the result of the invasion of the placental trophoblasts into the myometrium. The rate of PAS continues to increase due to the increased number of cesarean sections. Other risk factors include increasing maternal age, multiparity, uterine surgeries, and placenta previa. Due to the high risk of maternal morbidity and mortality, prenatal diagnosis is essential to ensure proper resources and surgical planning before delivery. Ultrasound is considered the gold standard for diagnosis of PAS. Ultrasound findings include placental lacuna, loss of placental clear space, lower uterine segment thickness, and increased vascularity between the placenta and bladder.

Placenta accreta spectrum (PAS) disorders have traditionally been characterized based on histopathologic grading, emphasizing the invasion of trophoblasts into the myometrium, and uterine serosa. Recent research has shifted the etiological understanding of PAS, moving away from the concept of aggressive trophoblast invasion to focusing on the critical role of scarred decidual-myometrial interface. This shift highlights the importance of defective scar tissue as a primary factor, reshaping prevention strategies, diagnostic accuracy, and treatment approaches for this increasingly prevalent iatrogenic and morbid pregnancy complication.

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.

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.

This chapter provides insight into current management strategies for the placenta accreta spectrum (PAS). PAS is one of the most morbid conditions of pregnancy, with significant maternal hemorrhage and surgical morbidity risks, and its increasing incidence. Here, we review the available data to help guide the clinical management of PAS, from time of diagnosis through delivery and postpartum care, while acknowledging the many areas of continued uncertainty. The evidence is strong for the importance of team-based, patient-centered, and multidisciplinary care for patients with PAS. However, much else remains uncertain and is predominantly guided by expert opinion. Ultimately, we aim to provide a current understanding of available literature and to emphasize that continued research is paramount to explore management and surgical approaches to move toward optimization of patient outcomes, including the patient experience.