Obstetrical & Gynecological Survey最新文献

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 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 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 Lancet 2025;405(10497):2302-2312) Sierra Leone has one of the highest maternal mortality rates in the world, with 443 deaths per 100,000 live births in 2020. Adolescent girls between 10 and 19 years old represent up to 40% of maternal deaths.

(Abstracted from Diabetes Care 2025;48:887-895) After delivery, women who experience hyperglycemia during pregnancy are recommended to undergo a 2-hour oral glucose tolerance test (OGTT) to reclassify their glycemic status and assess type 2 diabetes risk. This test has proven to be an effective predictor, but uptake rates are low at around 50%, likely due to limited availability of new mothers and uncertainty about which provider is responsible for ordering the test.

(Abstracted from JAMA 2025;333(24):2176-2187) The development of childhood vaccine protocols has led to the elimination of many infectious diseases from the United States, including measles, rubella, diphtheria, and polio, by maintaining herd immunity. In recent years, especially since the COVID-19 pandemic, vaccination rates have declined due to policy changes, misinformation, distrust, and broader societal shifts.

(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 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.

(Abstracted from Am J Obstet Gynecol 2025;232:570.e1-570.e7) Shoulder dystocia occurs in up to 3% of deliveries. Adverse neonatal outcomes from shoulder dystocia include brachial plexus injuries, humeral and clavicular fractures, and, in rare cases, hypoxic ischemic encephalopathy, seizures, and death.

(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.