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Suboptimally Controlled Diabetes in Pregnancy: A Review to Guide Antepartum and Delivery Management. 妊娠期糖尿病控制不佳:指导产前和分娩管理的综述》。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-06-01 DOI: 10.1097/OGX.0000000000001270
Jennifer J M Cate, Elizabeth Bloom, Allison Chu, Samuel T Bauer, Jeffrey A Kuller, Sarah K Dotters-Katz

Importance: Diabetes mellitus is one of the most common complications in pregnancy with adverse maternal and neonatal risks proportional to the degree of suboptimal glycemic control, which is not well defined. Literature guiding providers in identifying and managing patients at highest risk of complications from diabetes is lacking.

Objective: This article reviews the definition, epidemiology, and pathophysiology of suboptimal control of diabetes in pregnancy, including "diabetic fetopathy"; explores proposed methods of risk stratification for patients with diabetes; outlines existing antepartum management and delivery timing guidelines; and guides direction for future research.

Evidence acquisition: Original research articles, review articles, and professional society guidelines on diabetes management in pregnancy were reviewed.

Results: The reviewed available studies demonstrate worsening maternal and neonatal outcomes associated with suboptimal control; however, the definition of suboptimal based on parameters followed in pregnancy such as blood glucose, hemoglobin A1c, and fetal growth varied from study to study. Studies demonstrating specific associations of adverse outcomes with defined suboptimal control were reviewed and synthesized. Professional society recommendations were also reviewed to summarize current guidelines on antepartum management and delivery planning with respect to diabetes in pregnancy.

Conclusions: The literature heterogeneously characterizes suboptimal glucose control and complications related to this during pregnancy in individuals with diabetes. Further research into antepartum management and delivery timing for patients with varying levels of glycemic control and at highest risk for diabetic complications is still needed.

重要性:糖尿病是妊娠期最常见的并发症之一,其对孕产妇和新生儿的不良风险与血糖控制不佳的程度成正比,而血糖控制不佳的程度尚未得到很好的界定。目前还缺乏指导医疗工作者识别和管理糖尿病并发症高危患者的文献:本文回顾了妊娠期糖尿病(包括 "糖尿病胎儿病")控制不佳的定义、流行病学和病理生理学;探讨了对糖尿病患者进行风险分层的建议方法;概述了现有的产前管理和分娩时机指南;并为未来的研究指明了方向:获取证据:对有关妊娠期糖尿病管理的原始研究文章、综述文章和专业协会指南进行了审查:结果:经审查的现有研究表明,孕产妇和新生儿的预后恶化与糖尿病控制不达标有关;然而,根据孕期血糖、血红蛋白 A1c 和胎儿生长等参数对糖尿病控制不达标的定义因研究而异。我们对证明不良后果与定义的次优控制有特定关联的研究进行了回顾和综合。此外,还对专业协会的建议进行了回顾,以总结当前有关妊娠期糖尿病的产前管理和分娩计划指南:文献对妊娠期糖尿病患者血糖控制不达标及相关并发症的特点进行了不同程度的描述。对于不同血糖控制水平和糖尿病并发症高风险患者的产前管理和分娩时机仍需进一步研究。
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引用次数: 0
Role of Branched-Chain Amino Acids in Metabolic Changes of Polycystic Ovary Syndrome. 支链氨基酸在多囊卵巢综合征代谢变化中的作用
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-06-01 DOI: 10.1097/OGX.0000000000001272
Fan-Cheng Jia, Xue-Lian Li

Importance: Polycystic ovary syndrome (PCOS) is a common endocrine syndrome with multiple causes and polymorphic clinical manifestations, which is one of the important causes of menstrual disorders in women of childbearing age. It has been found that branched-chain amino acids (BCAAs), a class of essential amino acids that cannot be synthesized by the human body, play a significant role in the metabolic changes of PCOS, which may be involved in the pathogenesis of PCOS.

Objective: The purpose of this review is to summarize the relevance between BCAAs and metabolic abnormalities in PCOS and to explore their possible mechanisms.

Evidence acquisition: The evidence is mainly obtained by reviewing the literature on PubMed related to PCOS, BCAAs, and related metabolic abnormalities and conducting summary analysis.

Results: The metabolism of BCAAs can affect the homeostasis of glucose metabolism, possibly by disrupting the balance of gut microbiota, activating mTORC1 targets, producing mitochondrial toxic metabolites, and increasing the expression of proinflammatory genes. The correlation between obesity and BCAAs in PCOS patients may be related to the gene expression of BCAA metabolism-related enzymes in adipose tissue. The association between BCAA metabolic changes and nonalcoholic fatty liver disease in PCOS patients has not been fully clarified, which may be related to the lipid accumulation caused by BCAAs. At present, it is believed that hyperandrogenism in patients with PCOS is not related to BCAAs. However, through the study of changes in BCAA metabolism in prostate cancer caused by hyperandrogenism, we speculate that the relationship between BCAAs and hyperandrogenism may be mediated by mTORC1 and amino acid transporters.

Conclusions and relevance: Review of prior articles reveals that BCAAs may be related to insulin resistance, obesity, nonalcoholic fatty liver, and hyperandrogenism in PCOS patients, and its mechanisms are complex, diverse, and interrelated. This review also discussed the mechanism of BCAAs and these metabolic disorders in non-PCOS patients, which may provide some help for future research.

重要性:多囊卵巢综合征(PCOS)是一种常见的内分泌综合征,具有多种病因和多态的临床表现,是导致育龄妇女月经紊乱的重要原因之一。研究发现,支链氨基酸(BCAAs)是一类人体不能合成的必需氨基酸,在多囊卵巢综合征的代谢变化中起着重要作用,可能参与了多囊卵巢综合征的发病机制:本综述旨在总结 BCAAs 与 PCOS 代谢异常之间的相关性,并探讨其可能的机制:证据主要通过查阅PubMed上与多囊卵巢综合征、BCAAs和相关代谢异常有关的文献并进行汇总分析获得:BCAAs的代谢可影响葡萄糖代谢的平衡,可能通过破坏肠道微生物群的平衡、激活mTORC1靶点、产生线粒体毒性代谢产物以及增加促炎基因的表达。多囊卵巢综合症患者肥胖与 BCAAs 之间的相关性可能与脂肪组织中 BCAA 代谢相关酶的基因表达有关。BCAA代谢变化与PCOS患者非酒精性脂肪肝之间的关系尚未完全明确,这可能与BCAA导致的脂质蓄积有关。目前,人们认为多囊卵巢综合症患者的高雄激素与 BCAAs 无关。然而,通过对高雄激素引起的前列腺癌中 BCAA 代谢变化的研究,我们推测 BCAAs 与高雄激素之间的关系可能是由 mTORC1 和氨基酸转运体介导的:综述以往的文章发现,BCAAs可能与多囊卵巢综合征患者的胰岛素抵抗、肥胖、非酒精性脂肪肝和高雄激素症有关,其机制复杂多样且相互关联。本综述还讨论了 BCAAs 与非多囊卵巢综合症患者这些代谢紊乱的机制,这可能会为未来的研究提供一些帮助。
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引用次数: 0
Placenta Accreta Spectrum: A Comprehensive Review of Guidelines. 胎盘早剥谱:指南全面回顾。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-06-01 DOI: 10.1097/OGX.0000000000001274
Sonia Giouleka, Ioannis Tsakiridis, Evangelia-Rafaela Chanioti, Kyriaki Ladas, Anastasios Liberis, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis

Importance: Placenta accreta spectrum (PAS) represents a range of disorders characterized by abnormal placental invasion and is associated with severe maternal morbidity and mortality.

Objective: The aim of this study was to review and compare the most recently published major guidelines on the diagnosis and management of this potentially life-threatening obstetric complication.

Evidence acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the International Society for Abnormally Invasive Placenta, the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada on PAS disorders was carried out.

Results: There is a consensus among the reviewed guidelines regarding the definition and the diagnosis of PAS using specific sonographic signs. In addition, they all agree that the use of magnetic resonance imaging should be limited to the evaluation of the extension to pelvic organs in case of placenta percreta. Moreover, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, International Federation of Gynecology and Obstetrics, and the Society of Obstetricians and Gynecologists of Canada agree that screening for PAS disorders should be based on clinical risk factors along with sonographic findings. Regarding management, they all highlight the importance of a multidisciplinary team approach and recommend delivery by elective cesarean section at a tertiary center with experienced staff and appropriate resources. Routine preoperative ureteric stenting and occlusion of pelvic arteries are universally not recommended. Moreover, hysterectomy following the delivery of the fetus, expectant management with placenta left in situ, and conservative management in case of focal disease and desired fertility are all considered as acceptable treatment options. The reviewed guidelines also suggest some measures for intraoperative and postoperative hemorrhage control and recommend prophylactic administration of antibiotics. Methotrexate after expectant management is unanimously discouraged. On the other hand, there is no common pathway with regard to the optimal timing of delivery, the recommended mode of anesthesia, the preferred skin incision, and the effectiveness of the delayed hysterectomy approach.

Conclusions: PAS disorders are mainly iatrogenic conditions with a constantly rising incidence and potentially devastating consequences for both the mother and the neonate. Thus, the development of uniform international practice protocols for effective screening, diagnosis, and management seems of paramount importance and will hopefully drive favorable pregnancy outcomes

重要性:胎盘早剥谱系(PAS)是以胎盘异常侵入为特征的一系列疾病,与严重的孕产妇发病率和死亡率相关:本研究旨在回顾和比较最近出版的关于诊断和处理这种可能危及生命的产科并发症的主要指南:对美国妇产科医师学会、澳大利亚和新西兰皇家妇产科医师学会、国际异常胎盘学会、英国皇家妇产科医师学会、国际妇产科联合会和加拿大妇产科医师学会关于PAS疾病的指南进行了描述性回顾:结果:参阅的指南就 PAS 的定义和使用特定超声波征象进行诊断达成了共识。此外,他们都认为磁共振成像的使用应仅限于评估胎盘早剥时向盆腔器官的延伸。此外,美国妇产科医师学会、英国皇家妇产科医师学会、国际妇产科联合会和加拿大妇产科医师学会都认为,PAS 疾病的筛查应基于临床风险因素和超声波检查结果。在处理方面,他们都强调了多学科团队方法的重要性,并建议在拥有经验丰富的工作人员和适当资源的三级中心进行选择性剖宫产。普遍不建议在术前常规进行输尿管支架植入和盆腔动脉闭塞。此外,胎儿娩出后的子宫切除术、胎盘留在原位的预期管理以及在病灶疾病和希望生育的情况下的保守管理都被认为是可以接受的治疗方案。经审查的指南还提出了一些术中和术后出血控制措施,并建议预防性使用抗生素。一致不鼓励在期待治疗后使用甲氨蝶呤。另一方面,在最佳分娩时间、推荐的麻醉方式、首选的皮肤切口以及延迟子宫切除术的有效性等方面,并没有共同的途径:PAS 疾病主要是先天性疾病,其发病率持续上升,可能对母亲和新生儿造成毁灭性后果。因此,为有效筛查、诊断和管理制定统一的国际实践方案似乎至关重要,并有望促进良好的妊娠结局。
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引用次数: 0
Antenatal Care: A Comparative Review of Guidelines. 产前护理:产前护理:指南比较评论》。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.1097/OGX.0000000000001261
Eirini Boureka, Ioannis Tsakiridis, Nikolaos Kostakis, Sonia Giouleka, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis

Importance: Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes.

Objective: The aim of this study was to review and compare the most recently published guidelines on antenatal care.

Evidence acquisition: A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted.

Results: There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage.

Conclusions: Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

重要性:产前护理在安全监控和确保孕期母亲和胎儿的健康方面发挥着至关重要的作用,最终可实现最佳的围产期结果:本研究旨在回顾和比较最新发布的产前护理指南:研究人员对美国国家健康与护理卓越研究所、加拿大公共卫生局、世界卫生组织以及澳大利亚和新西兰皇家妇产科医学院发布的产前护理指南进行了描述性回顾:结果:所审查的指南在以下方面达成了共识:产前期间必要的预约、引产的适当时机、用于评估母亲健康状况的实验室检查的次数和频率,以及孕期常见生理问题的处理策略,如恶心和呕吐、胃灼热、骨盆疼痛、腿抽筋和无症状阴道分泌物。此外,还应特别考虑精神健康问题并及时转诊至专科医生,保证孕产妇接种完整的疫苗,提供安全使用医疗制剂的咨询,并建议孕期戒烟戒酒。产前临床评估存在争议,尤其是常规使用口服葡萄糖耐量试验和干骺端身高测量来评估胎儿生长情况,而常规的心动图和胎动计数仅是澳大利亚和新西兰皇家妇产科医学院建议的做法。值得注意的是,只有加拿大公共卫生署和世界卫生组织提出了营养干预和补充的建议,但在最佳剂量方面略有差异:产前护理仍然是取得积极成果的关键因素,但各国的社会经济状况不同,产前护理也存在差异。因此,为最佳产前护理制定一致的国际协议至关重要。这有助于为医护人员提供安全指导,从而改善产妇和胎儿的预后。
{"title":"Antenatal Care: A Comparative Review of Guidelines.","authors":"Eirini Boureka, Ioannis Tsakiridis, Nikolaos Kostakis, Sonia Giouleka, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001261","DOIUrl":"10.1097/OGX.0000000000001261","url":null,"abstract":"<p><strong>Importance: </strong>Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published guidelines on antenatal care.</p><p><strong>Evidence acquisition: </strong>A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted.</p><p><strong>Results: </strong>There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage.</p><p><strong>Conclusions: </strong>Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Parvovirus B19 in Pregnancy. 妊娠期副病毒 B19
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.1097/OGX.0000000000001263
Jaye Boissiere, Virginia Watkins, Jeffrey A Kuller, Sarah K Dotters-Katz

Importance: Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed.

Objective: This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections.

Evidence acquisition: Original articles were obtained from literature search in PubMed, Medline, and OVID; pertinent articles were reviewed.

Results: Parvovirus B19 is a viral infection associated with negative pregnancy outcomes. Up to 50% of people of reproductive age are susceptible to the virus. The incidence of B19 in pregnancy is between 0.61% and 1.24%, and, overall, there is 30% risk of vertical transmission when infection is acquired during pregnancy. Although most pregnancies progress without negative outcomes, viral infection of the fetus may result in severe anemia, congestive heart failure, and hydrops fetalis. In addition, vertical transmission carries a 5% to 10% chance of fetal loss. In pregnancies affected by fetal B19 infection, Doppler examination of the middle cerebral artery peak systolic velocity should be initiated to surveil for fetal anemia. In the case of severe fetal anemia, standard fetal therapy involves an intrauterine transfusion of red blood cells with the goal of raising hematocrit levels to approximately 40% to 50% of total blood volume. One transfusion is usually sufficient, although continued surveillance may indicate the need for subsequent transfusions. There are fewer epidemiologic data concerning neonatal risks of congenital parvovirus, although case reports have shown that fetuses with severe anemia in utero may have persistent anemia, thrombocytopenia, and edema in the neonatal period.

Conclusions and relevance: Parvovirus B19 is a common virus; seropositivity in the geriatric population reportedly reaches 85%. Within the pregnant population, up to 50% of patients have not previously been exposed to the virus and consequently lack protective immunity. Concern for parvovirus B19 infection in pregnancy largely surrounds the consequences of vertical transmission of the virus to the fetus. Should vertical transmission occur, the overall risk of fetal loss is between 5% and 10%. Thus, understanding the incidence, risks, and management strategies of pregnancies complicated by parvovirus B19 is essential to optimizing care and outcomes. Further, there is currently a gap in evidence regarding delivery management, breastfeeding recommendations, and the risks of congenital abnormalities in p

重要性:虽然孕期感染 parvovirus B19 的风险和随后胎儿不良结局的风险都很低,但了解管理方法对于正确治疗非免疫性胎儿肾积水至关重要。此外,还需要继续调查分娩管理、母乳喂养建议以及与副病毒 B19 感染并发妊娠相关的先天性畸形:本综述介绍了妊娠期感染副病毒 B19 的相关风险以及垂直传播感染胎儿的管理策略:证据获取:从 PubMed、Medline 和 OVID 的文献检索中获取原始文章,并对相关文章进行综述:结果:副病毒 B19 是一种与不良妊娠结局相关的病毒感染。多达 50% 的育龄人群对该病毒易感。B19 在妊娠期的发病率为 0.61% 至 1.24%,总体而言,在妊娠期感染的垂直传播风险为 30%。虽然大多数妊娠不会出现不良后果,但胎儿感染病毒可能会导致严重贫血、充血性心力衰竭和胎儿水肿。此外,垂直传播还可能导致 5%到 10%的胎儿死亡。受 B19 病毒感染影响的孕妇应进行大脑中动脉收缩速度峰值的多普勒检查,以监测胎儿是否贫血。在胎儿严重贫血的情况下,标准的胎儿治疗包括宫内输注红细胞,目的是将血细胞比容水平提高到总血量的 40% 至 50% 左右。通常一次输血就足够了,但持续监测可能会显示需要进行后续输血。有关先天性副病毒对新生儿危害的流行病学数据较少,但有病例报告显示,宫内严重贫血的胎儿在新生儿期可能会出现持续性贫血、血小板减少和水肿:Parvovirus B19 是一种常见的病毒;据报道,老年人群中的血清阳性率高达 85%。在妊娠人群中,多达 50% 的患者以前未接触过该病毒,因此缺乏保护性免疫。对妊娠期感染 parvovirus B19 的担忧主要围绕病毒垂直传播给胎儿的后果。如果发生垂直传播,胎儿死亡的总体风险在 5%到 10%之间。因此,了解妊娠并发 parvovirus B19 的发病率、风险和管理策略对于优化护理和预后至关重要。此外,目前在分娩管理、母乳喂养建议以及副病毒 B19 并发症妊娠的先天性畸形风险方面还缺乏相关证据。我们需要对这部分患者的最佳分娩管理、喂养计划和新生儿监测建议进行更多的调查。
{"title":"Parvovirus B19 in Pregnancy.","authors":"Jaye Boissiere, Virginia Watkins, Jeffrey A Kuller, Sarah K Dotters-Katz","doi":"10.1097/OGX.0000000000001263","DOIUrl":"10.1097/OGX.0000000000001263","url":null,"abstract":"<p><strong>Importance: </strong>Although the risk of parvovirus B19 infection during pregnancy and subsequent risk of adverse fetal outcome are low, understanding management practices is essential for proper treatment of fetuses with nonimmune hydrops fetalis. In addition, continued investigation into delivery management, breastfeeding recommendations, and congenital abnormalities associated with pregnancies complicated by parvovirus B19 infection is needed.</p><p><strong>Objective: </strong>This review describes the risks associated with parvovirus B19 infection during pregnancy and the management strategies for fetuses with vertically transmitted infections.</p><p><strong>Evidence acquisition: </strong>Original articles were obtained from literature search in PubMed, Medline, and OVID; pertinent articles were reviewed.</p><p><strong>Results: </strong>Parvovirus B19 is a viral infection associated with negative pregnancy outcomes. Up to 50% of people of reproductive age are susceptible to the virus. The incidence of B19 in pregnancy is between 0.61% and 1.24%, and, overall, there is 30% risk of vertical transmission when infection is acquired during pregnancy. Although most pregnancies progress without negative outcomes, viral infection of the fetus may result in severe anemia, congestive heart failure, and hydrops fetalis. In addition, vertical transmission carries a 5% to 10% chance of fetal loss. In pregnancies affected by fetal B19 infection, Doppler examination of the middle cerebral artery peak systolic velocity should be initiated to surveil for fetal anemia. In the case of severe fetal anemia, standard fetal therapy involves an intrauterine transfusion of red blood cells with the goal of raising hematocrit levels to approximately 40% to 50% of total blood volume. One transfusion is usually sufficient, although continued surveillance may indicate the need for subsequent transfusions. There are fewer epidemiologic data concerning neonatal risks of congenital parvovirus, although case reports have shown that fetuses with severe anemia in utero may have persistent anemia, thrombocytopenia, and edema in the neonatal period.</p><p><strong>Conclusions and relevance: </strong>Parvovirus B19 is a common virus; seropositivity in the geriatric population reportedly reaches 85%. Within the pregnant population, up to 50% of patients have not previously been exposed to the virus and consequently lack protective immunity. Concern for parvovirus B19 infection in pregnancy largely surrounds the consequences of vertical transmission of the virus to the fetus. Should vertical transmission occur, the overall risk of fetal loss is between 5% and 10%. Thus, understanding the incidence, risks, and management strategies of pregnancies complicated by parvovirus B19 is essential to optimizing care and outcomes. Further, there is currently a gap in evidence regarding delivery management, breastfeeding recommendations, and the risks of congenital abnormalities in p","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Environmental and Occupational Noise on Maternal and Perinatal Pregnancy Outcomes. 环境和职业噪音对孕产妇和围产期妊娠结果的影响。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-04-19 DOI: 10.1097/ogx.0000000000001262
Mara Ulin, Nneoma Edokobi, Brandon Ganjineh, Everett F Magann, Megan D Whitham
Pregnant women are exposed to both occupational and environmental noise during their pregnancy. The association between noise and adverse health outcomes is well known. Less is known about the relationship between noise and its effects on the embryo/fetus and pregnancy.
孕妇在怀孕期间会受到职业和环境噪音的影响。噪声与不良健康后果之间的关系众所周知。但人们对噪声及其对胚胎/胎儿和妊娠的影响之间的关系了解较少。
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引用次数: 0
Diagnosis and Management of Macrosomia and Shoulder Dystocia: A Comprehensive Review of Major Guidelines. 巨大胎儿和肩难产的诊断与处理:主要指南的全面回顾。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-04-19 DOI: 10.1097/ogx.0000000000001253
Sonia Giouleka, Ioannis Tsakiridis, Elpida Ralli, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis
Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both associated with adverse pregnancy outcomes.
巨大胎儿是肩难产(SD)最重要的风险因素,而肩难产是阴道分娩的一种严重和紧急并发症。它们都与不良妊娠结局有关。
{"title":"Diagnosis and Management of Macrosomia and Shoulder Dystocia: A Comprehensive Review of Major Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Elpida Ralli, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/ogx.0000000000001253","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001253","url":null,"abstract":"Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both associated with adverse pregnancy outcomes.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140625605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cell-Free DNA Screening for Single-Gene Disorders. 单基因疾病的无细胞 DNA 筛查。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-03-01 DOI: 10.1097/OGX.0000000000001250
Brighton S Goodhue, Sky E Danity, Neeta Vora, Jeffrey A Kuller, Matthew R Grace

Importance: In pregnancy, cell-free DNA (cfDNA) represents short fragments of placental DNA released into the maternal blood stream through natural cell death. Noninvasive prenatal screening with cfDNA is commonly used in pregnancy to screen for common aneuploidies. This technology continues to evolve, and laboratories now offer cfDNA screening for single-gene disorders.

Objective: This article aims to review cfDNA screening for single-gene disorders including the technology, current syndromes for which screening may be offered, limitations, and current recommendations.

Evidence acquisition: Original research articles, review articles, laboratory white papers, and society guidelines were reviewed.

Results: Cell-free DNA screening for single-gene disorders is not currently recommended by medical societies. There may be a role in specific circumstances and only after comprehensive pretest counseling. It can be considered in the setting of some fetal ultrasound anomalies, and usually only after diagnostic testing is offered and declined.

Conclusions: Given the limitations of using cfDNA screening for single-gene disorders, caution is recommended when considering these tests. It should only be offered with involvement of a reproductive genetic counselor, medical geneticist, or maternal fetal medicine specialist to ensure comprehensive counseling and appropriate utilization.

重要性:在妊娠过程中,无细胞 DNA(cfDNA)是通过自然细胞死亡释放到母体血流中的胎盘 DNA 短片段。使用 cfDNA 进行无创产前筛查是孕期筛查常见非整倍体的常用方法。这项技术在不断发展,现在实验室可提供针对单基因疾病的 cfDNA 筛查:本文旨在对 cfDNA 单基因疾病筛查进行综述,包括该技术、目前可提供筛查的综合征、局限性及当前建议:结果:结果:目前医学会并不推荐对单基因疾病进行无细胞 DNA 筛查。在特定情况下,只有经过全面的检测前咨询,无细胞 DNA 筛查才有可能发挥作用。在某些胎儿超声异常的情况下,可以考虑进行无细胞 DNA 筛查,但通常是在提供诊断测试但被拒绝后:鉴于使用 cfDNA 筛查单基因疾病的局限性,建议在考虑这些检测时谨慎行事。只有在生殖遗传咨询师、医学遗传学家或孕产妇胎儿医学专家的参与下,才能进行此类筛查,以确保提供全面的咨询和适当的使用。
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引用次数: 0
Congenital Anomalies in Multiple Pregnancy: A Literature Review. 多胎妊娠先天畸形:文献综述。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-03-01 DOI: 10.1097/OGX.0000000000001251
Jae Eun Shin, Hyun Sun Ko, Jin Young Bae, Won Joon Seong, Tae Gyu Ahn, You Jung Han, Geum Joon Cho, In Yang Park

Importance: Multiple pregnancy is relatively common in many countries and is associated with various pregnancy complications, including preterm birth, low birth weight, and congenital anomalies. In particular, a poorer prognosis has been reported when congenital anomalies overlap with other pregnancy complications in multiple pregnancy compared with singleton pregnancy.

Objective: This study reviews the characteristics of congenital anomalies that occur in multiple gestations as compared with singleton pregnancies.

Evidence acquisition: An extensive manual search of major electronic databases was conducted in June 2023. This literature review provides a comprehensive coverage of the congenital anomalies in multiple pregnancy.

Results: Most studies have shown that multiple gestations are associated with an increased risk of congenital anomalies compared with singleton pregnancies. In addition, higher rates of congenital anomalies and concordance have been observed in monozygotic versus dizygotic twins. The effect of assisted reproductive therapies on the risk of congenital anomalies appears to be smaller in multiple gestations than in singleton pregnancies.

Conclusions: Multiple pregnancy is significantly associated with an increased risk of congenital anomalies.

Relevance: This review provides obstetrical providers with the requisite knowledge to offer appropriate antenatal care and prenatal anomaly screening to patients with multiple pregnancies.

重要性:多胎妊娠在许多国家都比较常见,与各种妊娠并发症有关,包括早产、低出生体重和先天性畸形。特别是有报道称,与单胎妊娠相比,多胎妊娠中先天畸形与其他妊娠并发症重叠时,预后较差:本研究回顾了多胎妊娠与单胎妊娠相比发生先天性畸形的特点:本研究回顾了多胎妊娠与单胎妊娠相比发生先天性异常的特点。本文献综述全面覆盖了多胎妊娠先天性异常的情况:大多数研究表明,与单胎妊娠相比,多胎妊娠发生先天性异常的风险更高。此外,还观察到单卵双胎与双卵双胎的先天畸形率和一致率更高。辅助生殖疗法对多胎妊娠先天性异常风险的影响似乎小于单胎妊娠:结论:多胎妊娠与先天性畸形风险的增加密切相关:本综述为产科医生提供了必要的知识,以便为多胎妊娠患者提供适当的产前护理和产前异常筛查。
{"title":"Congenital Anomalies in Multiple Pregnancy: A Literature Review.","authors":"Jae Eun Shin, Hyun Sun Ko, Jin Young Bae, Won Joon Seong, Tae Gyu Ahn, You Jung Han, Geum Joon Cho, In Yang Park","doi":"10.1097/OGX.0000000000001251","DOIUrl":"10.1097/OGX.0000000000001251","url":null,"abstract":"<p><strong>Importance: </strong>Multiple pregnancy is relatively common in many countries and is associated with various pregnancy complications, including preterm birth, low birth weight, and congenital anomalies. In particular, a poorer prognosis has been reported when congenital anomalies overlap with other pregnancy complications in multiple pregnancy compared with singleton pregnancy.</p><p><strong>Objective: </strong>This study reviews the characteristics of congenital anomalies that occur in multiple gestations as compared with singleton pregnancies.</p><p><strong>Evidence acquisition: </strong>An extensive manual search of major electronic databases was conducted in June 2023. This literature review provides a comprehensive coverage of the congenital anomalies in multiple pregnancy.</p><p><strong>Results: </strong>Most studies have shown that multiple gestations are associated with an increased risk of congenital anomalies compared with singleton pregnancies. In addition, higher rates of congenital anomalies and concordance have been observed in monozygotic versus dizygotic twins. The effect of assisted reproductive therapies on the risk of congenital anomalies appears to be smaller in multiple gestations than in singleton pregnancies.</p><p><strong>Conclusions: </strong>Multiple pregnancy is significantly associated with an increased risk of congenital anomalies.</p><p><strong>Relevance: </strong>This review provides obstetrical providers with the requisite knowledge to offer appropriate antenatal care and prenatal anomaly screening to patients with multiple pregnancies.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Luteal Phase Defects and Progesterone Supplementation. 黄体期缺陷与孕酮补充剂。
IF 6.2 4区 医学 Q2 Medicine Pub Date : 2024-02-01 DOI: 10.1097/OGX.0000000000001242
Lucas C Collins, Luke A Gatta, Sarah K Dotters-Katz, Jeffrey A Kuller, Danny J Schust

Importance: Luteal phase defects (LPDs), or an insufficiency of progesterone production during the luteal phase of the menstrual cycle, have been identified as a potential cause of recurrent pregnancy loss (RPL), but its exact contribution to RPL is not well-defined. In addition, the role of exogenous progesterone supplementation during pregnancy remains controversial.

Objective: The goal of this review is to provide an updated, evidence-based summary of LPD, including prevalence and potential pathophysiologic mechanisms, and to explore the current controversies regarding progesterone supplementation for management and treatment of RPL.

Evidence acquisition: A literature review identified relevant research using a PubMed search, Cochrane summaries, review articles, textbook chapters, databases, and society guidelines.

Results: Endogenous progesterone plays a crucial role in the first trimester of pregnancy, and therefore, insufficiency may contribute to RPL. However, the precise relationship between LPD and RPL remains unclear. Luteal phase defect is primarily a clinical diagnosis based on a luteal phase less than 10 days. Although there may be a possibility of incorporating a combined clinical and biochemical approach in defining LPD, the current lack of validated diagnostic criteria creates a challenge for its routine incorporation in the workup of infertility. Moreover, no treatment modality has demonstrated efficacy in improving fertility outcomes for LPD patients, including progesterone supplementation, whose inconsistent data do not sufficiently support its routine use, despite its minimal risk. It is imperative that women diagnosed with LPD should be worked up for other potential conditions that may contribute to a shortened luteal phase. Future work needs to focus on identifying a reproducible diagnostic test for LPD to guide treatment.

Conclusions and relevance: Currently, the perceived relationship between LPD and RPL is challenged by conflicting data. Therefore, patients with an abnormal luteal phase should undergo a thorough workup to address any other potential etiologies. Although supplemental progesterone is commonly utilized for treatment of LPD and RPL, inconsistent supporting data call for exogenous hormone therapy to be only used in a research setting or after a thorough discussion of its shortcomings.

重要性:黄体期缺陷(LPDs)或月经周期黄体期孕酮分泌不足已被确定为导致复发性妊娠丢失(RPL)的潜在原因,但其对复发性妊娠丢失的确切影响尚不明确。此外,孕期补充外源性孕酮的作用仍存在争议:本综述旨在提供最新的、基于证据的 LPD 总结,包括患病率和潜在的病理生理机制,并探讨目前有关补充孕酮以管理和治疗 RPL 的争议:文献综述:通过PubMed检索、Cochrane摘要、综述文章、教科书章节、数据库和协会指南确定了相关研究:内源性孕酮在妊娠头三个月起着至关重要的作用,因此,孕酮不足可能会导致 RPL。然而,LPD 和 RPL 之间的确切关系仍不清楚。黄体期缺陷主要是基于黄体期少于 10 天的临床诊断。虽然有可能结合临床和生化方法来定义 LPD,但由于目前缺乏有效的诊断标准,将其纳入不孕症的常规检查中面临挑战。此外,目前还没有任何治疗方法能有效改善LPD患者的生育预后,包括黄体酮补充剂,尽管其风险极低,但其不一致的数据不足以支持其常规使用。当务之急是,对确诊为 LPD 的女性进行检查,以确定是否存在其他可能导致黄体期缩短的潜在疾病。未来的工作重点是确定一种可重复的 LPD 诊断测试,以指导治疗:目前,LPD 和 RPL 之间的关系受到了相互矛盾的数据的质疑。因此,黄体期异常的患者应进行全面检查,以了解其他潜在病因。虽然补充黄体酮常用于治疗LPD和RPL,但由于支持性数据不一致,外源性激素疗法只能在研究环境中使用,或在充分讨论其缺点后使用。
{"title":"Luteal Phase Defects and Progesterone Supplementation.","authors":"Lucas C Collins, Luke A Gatta, Sarah K Dotters-Katz, Jeffrey A Kuller, Danny J Schust","doi":"10.1097/OGX.0000000000001242","DOIUrl":"10.1097/OGX.0000000000001242","url":null,"abstract":"<p><strong>Importance: </strong>Luteal phase defects (LPDs), or an insufficiency of progesterone production during the luteal phase of the menstrual cycle, have been identified as a potential cause of recurrent pregnancy loss (RPL), but its exact contribution to RPL is not well-defined. In addition, the role of exogenous progesterone supplementation during pregnancy remains controversial.</p><p><strong>Objective: </strong>The goal of this review is to provide an updated, evidence-based summary of LPD, including prevalence and potential pathophysiologic mechanisms, and to explore the current controversies regarding progesterone supplementation for management and treatment of RPL.</p><p><strong>Evidence acquisition: </strong>A literature review identified relevant research using a PubMed search, Cochrane summaries, review articles, textbook chapters, databases, and society guidelines.</p><p><strong>Results: </strong>Endogenous progesterone plays a crucial role in the first trimester of pregnancy, and therefore, insufficiency may contribute to RPL. However, the precise relationship between LPD and RPL remains unclear. Luteal phase defect is primarily a clinical diagnosis based on a luteal phase less than 10 days. Although there may be a possibility of incorporating a combined clinical and biochemical approach in defining LPD, the current lack of validated diagnostic criteria creates a challenge for its routine incorporation in the workup of infertility. Moreover, no treatment modality has demonstrated efficacy in improving fertility outcomes for LPD patients, including progesterone supplementation, whose inconsistent data do not sufficiently support its routine use, despite its minimal risk. It is imperative that women diagnosed with LPD should be worked up for other potential conditions that may contribute to a shortened luteal phase. Future work needs to focus on identifying a reproducible diagnostic test for LPD to guide treatment.</p><p><strong>Conclusions and relevance: </strong>Currently, the perceived relationship between LPD and RPL is challenged by conflicting data. Therefore, patients with an abnormal luteal phase should undergo a thorough workup to address any other potential etiologies. Although supplemental progesterone is commonly utilized for treatment of LPD and RPL, inconsistent supporting data call for exogenous hormone therapy to be only used in a research setting or after a thorough discussion of its shortcomings.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Obstetrical & Gynecological Survey
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