Obstetrical & Gynecological Survey最新文献

(Abstracted from Am J Obstet Gynecol 2025;233(1):4-11) Artificial intelligence (AI) chatbots are rising in popularity as new developments increase their abilities and accuracy; their function includes using large language models to generate responses based on history. The use of AI in clinical practice and medical education includes radiology imaging assessment, clinical decision support tools for diagnosis and treatment recommendations, and the potential for the enhancement of teaching, learning, and assessment in medical education.

(Abstracted from Int J Gynecol Cancer 2025;35(1):100007, doi:10.1016/j.ijgc.2024.100007) At the time of screening for cervical cancer, an external inspection of genitalia is a standard part of the procedure. This is in part due to inspection for signs of vulvar cancer, but evidence suggests that enough attention is not paid to this inspection as early diagnosis of vulvar cancer is still an issue.

(Abstracted from Contraception 2025:150:111016, doi:10.1016/j.contraception.2025.111016) Adenomyosis occurs when ectopic endometrial glands invade the myometrium and can cause symptoms such as an enlarged uterus, heavy menstrual bleeding, pelvic pain, infertility, and pregnancy complications. It occurs in an estimated 20% of asymptomatic and 45% of symptomatic women, and risk factors for its development include age, endometriosis, multiple births, uterine surgery, spontaneous miscarriage, and cervical conditions.

(Abstracted from N Engl J Med 2025;393(1), doi:10.1056/NEJMc2506080) Congenital thrombotic thrombocytopenic purpura (TTP) is a rare thrombotic microangiopathy caused by deficiency of the ADAMTS13 protein. Without a functional version of this enzyme, ultralarge von Willebrand factors accumulate inside small vessels, leading to early-onset, potentially life-threatening complications including hemolytic anemia, thrombocytopenia, and end-organ damage.

Importance: Cytomegalovirus (CMV) infection in pregnancy is the most common viral cause of congenital infection and is associated with serious sequelae.

Objectives: This study aimed to review and compare the recommendations from published guidelines on screening, diagnosis, and management prevention of CMV infection during pregnancy, as well as neonatal management.

Evidence acquisition: A descriptive review of guidelines from the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians & Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, and the European Congenital Infection Initiative (ECCI) on CMV infection in pregnancy was conducted.

Results: There is a consensus on the importance of prevention, whereas all guidelines underline that the severity of fetal infection results mainly from primary maternal infection occurring during the early periconceptional period or first trimester of pregnancy. Controversy exists regarding universal screening for CMV, with the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians & Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists stating against it, the Society of Obstetricians and Gynecologists of Canada recommending testing for CMV early for women at high-risk only in areas where avidity testing is available, and ECCI recommending routine screening up to 16 weeks of pregnancy. Moreover, there is relative consensus on the diagnosis of maternal infection, either with CMV immunoglobulin G seroconversion or with positive immunoglobulin M CMV in combination with low immunoglobulin G avidity, with ECCI recommending only the latter. Moreover, there is a disagreement among the reviewed guidelines on the antenatal management of maternal and fetal infection, whereas ECCI offers the most comprehensive recommendations in neonatal management compared with the other guidelines.

Conclusions: CMV infection in pregnancy is considered a major contributor to severe neurodevelopmental disability and hearing impairment in infants. Hence, consistent global guidelines should be issued to be integrated into everyday practice to achieve the optimal perinatal outcome.

Target audience: Obstetricians and gynecologists, family physicians.

Cme learning objectives: After participating in this activity, the learner should be better able to discuss hygiene strategies for the prevention of maternal infection from CMV; describe diagnostic methods for maternal CMV infection; and explain the optimal management of pregnant women with CMV infection.

(Abstracted from JAMA 2025;333(22):2006-2012) The US Preventive Services Task Force (USPSTF) has reaffirmed its recommendation for universal screening for syphilis in asymptomatic, pregnant adolescent and adult women early in pregnancy or at the first available opportunity. Through a reaffirmation process that considered whether new evidence warranted a change to its 2018 recommendation, the USPSTF concluded with high certainty that the recommendation has a "substantial net benefit."

(Abstracted from Lancet Oncol 2025;26(10):1370-1381) Fifteen percent to 20% of endometrial cancer patients have a high-risk form of the disease; this classification indicates a higher risk of cancer recurrence and cancer-related death. The standard therapy for high-risk endometrial cancer is pelvic radiotherapy.

Importance: Iron deficiency anemia (IDA) affects approximately one-third of pregnant women worldwide and is a significant contributor to adverse maternal and fetal outcomes, including preterm delivery, low birth weight, and cognitive impairment in children. Despite advancements in iron therapy, IDA remains prevalent, affecting 29.9% of women globally. This highlights a critical need for more effective management strategies during pregnancy.

Objective: To provide a comprehensive review of the mechanisms governing iron absorption, current guidelines for iron therapy, and the efficacy and safety profiles of various iron salts, with the aim of improving supplementation approaches for the effective management of IDA in pregnancy.

Evidence acquisition: The review evaluates existing literature on intestinal iron absorption and placental transport mechanisms of different iron salts. It also analyzes international guidelines recommending daily administration of oral and intravenous iron, alongside the clinical efficacy and safety profiles.

Results: The absorption and transport of iron are complex processes influenced by intestinal uptake and placental transport, regulated by maternal and fetal iron stores and hepcidin levels. Despite the availability of various iron formulations, none have proven ideal for managing IDA during pregnancy. Clinical trials demonstrate varying efficacy and safety profiles, indicating a significant gap in current treatment strategies.

Conclusion and relevance: Although advancements in iron therapy have been made, no single formulation has emerged as the optimal solution for managing IDA in pregnancy. This review underscores the need for a deeper understanding of iron absorption mechanisms and more effective supplementation approaches to address the ongoing burden of IDA among pregnant women worldwide.

Target audience: Obstetricians and gynecologists, family physicians.

Learning objectives: After participating in this activity, the learner should be better able to explain the complex mechanism of iron absorption and identify the physiological mechanisms governing the absorption of heme and nonheme iron; summarize how to diagnose IDA and apply international guidelines for iron supplementation in pregnancy; and compare the efficacy, bioavailability, and safety profiles of various oral and intravenous iron formulations to identify the most suitable options for managing IDA during pregnancy.

(Abstracted from Reprod Biomed Online 2025;51(3):104956, doi:10.1016/j.rbmo.2025.104956) Current guidance from the Royal College of Obstetricians and Gynecologists on the diagnosis of miscarriage includes confirmation with a transvaginal ultrasound with an empty gestational sac measuring 25 mm or more, or an embryo with a crown-rump length (CRL) measuring 7 mm or more with no heartbeat. The National Institute for Health and Care Excellence (NICE) guidelines indicate that a repeat scan should be taken with a minimum interval of 7 days; other evidence shows that a repeated scan at 14 days for an empty gestational sac should be performed to rule out false-positive diagnoses of miscarriage.

(Abstracted from Am J Obstet Gynecol 2025;233(3):152-161) One of the most commonly diagnosed female genital infections is vulvovaginal candidiasis (VVC), and data show that up to 75% of women have had VVC at least once. VVC is classified as uncomplicated or complicated; uncomplicated VVC occurs in approximately 90% of cases, and the first-line treatment for it is typically topical nystatin or topical or oral azole antifungal medications.