Obstetrical & Gynecological Survey最新文献

Importance: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder associated with significant maternal complications and increased neonatal morbidity and mortality.

Objective: The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of ICP, highlighting the discrepancies in key areas.

Evidence acquisition: A descriptive review of 6 national guidelines from the Society for Maternal-Fetal Medicine, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Society of Obstetric Medicine of Australia and New Zealand, the Chinese Medical Association, and the Working Group on Obstetrics and Prenatal Medicine of Germany was conducted along with a comparison of their recommendations regarding this pregnancy complication.

Results: There is an overall agreement among the reviewed guidelines regarding the definition and the diagnosis of ICP, although minor discrepancies exist with regard to the bile acid cutoff levels. They also highlight the importance of a detailed history and physical examination to exclude other potential causes of maternal pruritus and recommend the evaluation of liver function and the appropriate counseling on the associated maternal and neonatal complications following diagnosis. Ursodeoxycholic acid is recommended by all guidelines (except from the Royal College of Obstetricians and Gynecologists) as first-line treatment for symptoms relief. However, the recommendations regarding the classification of ICP, the frequency of bile acid monitoring, the necessity of fetal surveillance, and the optimal timing of delivery are inconsistent.

Conclusions: Obstetrics cholestasis is a severely pruritic form of reversible cholestasis of unknown pathophysiology that is associated with significant fetal risks and no definitive treatment. The variations among the existing guidelines reflect the heterogeneity of available evidence, while highlighting the necessity for further research.

Target audience: Obstetricians and gynecologists, family physicians.

Learning objectives: After participating in this activity, the learner should be better able to explain the process of differential diagnosis when ICP is suspected; identify the ICP-associated fetal and maternal risks on which affected individuals should be counseled; and describe the medical treatment options and the optimal timing of delivery.

(Abstracted from Acta Obstet Gynecol Scand 2025;104:839-849) Gestational diabetes mellitus (GDM), defined as high blood sugar onset in pregnancy, is associated with adverse outcomes and increased long-term maternal diabetes risk. Screening protocols vary internationally, with some countries testing only high-risk pregnancies, but Canada has recommended universal screening since 2003.

(Abstracted from Hum Reprod 2025;40(8):1562-1569) Successful pregnancy depends on many factors, including metabolic processes. Glucose fluctuation may hinder embryo development and/or implantation, but glucose is necessary to prepare the endometrium for successful implantation by producing glycogen.

(Abstracted from Lancet 2024;405:1743-1756) Shoulder dystocia is associated with several maternal and neonatal complications and is a common reason for litigation in obstetrics. Maternal complications include hemorrhage and third- and fourth-degree perineal severe tears; neonatal complications include fractures, brachial plexus injury, hypoxic ischemic encephalopathy, and neonatal death.

(Abstracted from N Engl J Med 2025;392:1698-1709) Leukocyte adhesion deficiency type I (LAD-I) is an autosomal recessive immune disorder marked by recurrent, life-threatening infections, with 25% to 39% mortality before age 2 years without curative therapy. Common symptoms include umbilical-cord complications, poorly healing cutaneous lesions, persistent leukocytosis, and periodontitis.

Importance: Breast cancer is one of the most common malignancies among women globally, with significant implications for reproductive health, including the use of contraception. The intersection of breast cancer and contraception presents unique challenges due to concerns about cancer recurrence, patient safety, and hormonal roles in cancer. The hormonal sensitivity of many breast cancers creates a complex approach to safe contraceptive options for patients. However, recent studies highlight the nuanced role of low-dose and nonestrogenic hormonal options, such as progestin-only methods, while emphasizing the need for further research on their long-term safety.

Objectives: An important aspect of breast cancer survivorship is addressed: reproductive health and contraceptive choices.

Evidence acquisition: A PubMed review was conducted using terms "breast cancer" AND "contraception" OR "contraceptive use." The search included review articles, original research databases, and guidelines on contraception for breast cancer patients and survivors.

Results: Nonhormonal contraceptives, including copper intrauterine devices, barrier methods, and sterilization, provide safe and effective alternatives but may be less preferred by some patients due to side effects or other limitations. Current guidelines may not offer specific recommendations for both breast cancer patients and breast cancer survivors.

Conclusions: A comprehensive counseling approach to address fertility in patients with breast cancer and survivors is most appropriate; nonhormonal contraceptive options provide the safest methods for patients.

Relevance: Current guidelines may not offer specific recommendations for both breast cancer patients and breast cancer survivors.

Target audience: Obstetricians and gynecologists, family physicians.

Learning objectives: After completing this activity, the learner will be better able to describe the unique contraceptive needs for breast cancer patients and survivors; discuss the safety and efficacy of various contraceptive options for patients; and identify gaps in current contraceptive guidelines for patients and survivors.

(Abstracted from Obstet Gynecol 2025;146:121-128) Syphilis during pregnancy has long been linked to poor maternal and fetal outcomes, including stillbirth, prematurity, neonatal intensive care unit (NICU) admission, and increased health care costs. With rates of both maternal and congenital syphilis rising over the past decade, there is a strong need for updated data on adverse outcomes in pregnancies affected by syphilis.

(Abstracted from Obstet Gynecol 2025;146(2):e23-e35) An estimated 10% to 15% of women who are of reproductive age are affected by endometriosis, defined as abnormal growth of endometrium-like tissue outside of the uterus. Symptoms can include cyclical or noncyclical abdominal pain, pain during intercourse, excessive menstruation, infertility, and others.

(Abstracted from BJOG 2025;132:805-815) Approximate 1 in 200 neonates in Canada is born with congenital cytomegalovirus (cCMV). CMV is an infection that can cause neurodevelopmental disability in children, including deafness, visual impairment, or cognitive delay.

(Abstracted from Hum Reprod 2025 ;40(8):1485-1494) Embryonic development relies heavily on 1-carbon metabolism, which is influenced heavily by folate and vitamin B12. Both placental and embryonic and fetal development are affected, and previous research has shown supplementation with folic acid during early pregnancy reduces the prevalence of neural tube defects; some research has also shown that deficiencies in folate and vitamin B12 may be associated with adverse pregnancy outcomes such as preeclampsia and low birth weight.