Pub Date : 2026-01-22DOI: 10.1016/j.bpobgyn.2026.102707
May Abiad , Ali Javinani , Maria C. Lopez , Hiba Mustafa , Eyal Krispin , Rodrigo Ruano , Alireza A. Shamshirsaz
Primary fetal pleural effusion involves the accumulation of fluid in the fetal pleural space, posing considerable challenges for perinatal diagnosis and management. Primary effusions, emerging from the maldevelopment of lymphatic vessels, differ significantly from secondary effusions, which are associated with a spectrum of anomalies and conditions, affecting clinical approach and prognosis. The diagnosis of primary fetal pleural effusion is one of exclusion. The natural history of the condition ranges from spontaneous resolution in mild cases to progression to life-threatening complications. Fetal interventional strategies, including thoracocentesis, pleurodesis, and thoracoamniotic shunt placement, have evolved with varying degrees of success. The prognosis is largely affected by gestational age at diagnosis, the presence of hydrops, and the implementation of fetal intervention, with improved outcomes observed in non-hydropic fetuses. This narrative review focuses on primary fetal pleural effusion, detailing its diagnosis, natural history, management options, and outcomes, with the aim of clarifying the best approaches to improve outcomes for affected fetuses.
{"title":"Diagnosis and management of primary fetal pleural effusion: A narrative review","authors":"May Abiad , Ali Javinani , Maria C. Lopez , Hiba Mustafa , Eyal Krispin , Rodrigo Ruano , Alireza A. Shamshirsaz","doi":"10.1016/j.bpobgyn.2026.102707","DOIUrl":"10.1016/j.bpobgyn.2026.102707","url":null,"abstract":"<div><div>Primary fetal pleural effusion involves the accumulation of fluid in the fetal pleural space, posing considerable challenges for perinatal diagnosis and management. Primary effusions, emerging from the maldevelopment of lymphatic vessels, differ significantly from secondary effusions, which are associated with a spectrum of anomalies and conditions, affecting clinical approach and prognosis. The diagnosis of primary fetal pleural effusion is one of exclusion. The natural history of the condition ranges from spontaneous resolution in mild cases to progression to life-threatening complications. Fetal interventional strategies, including thoracocentesis, pleurodesis, and thoracoamniotic shunt placement, have evolved with varying degrees of success. The prognosis is largely affected by gestational age at diagnosis, the presence of hydrops, and the implementation of fetal intervention, with improved outcomes observed in non-hydropic fetuses. This narrative review focuses on primary fetal pleural effusion, detailing its diagnosis, natural history, management options, and outcomes, with the aim of clarifying the best approaches to improve outcomes for affected fetuses.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102707"},"PeriodicalIF":4.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.bpobgyn.2026.102706
Anne K. Smith , Simran Bhullar , Alla Vash-Margita
Endometriosis, once considered rare in adolescents, is now recognized as a common cause of chronic pelvic pain and dysmenorrhea in individuals aged 10–21. This state-of-the-art review explores the evolution of knowledge regarding adolescent endometriosis from early misconceptions to current clinical understanding, highlighting epidemiology, pathophysiology, current diagnostic and management strategies, psychosocial implications, and key knowledge gaps. Adolescents often present with acyclic pain, and associated gastrointestinal (GI) or systemic symptoms, leading to frequent diagnostic delay. Laparoscopy remains the gold standard for diagnosis, though noninvasive strategies are increasingly being developed due to limitations in surgical access and risks of underdiagnosis. Lesions often appear atypical in adolescents, which can cause missed diagnosis. First-line treatment is suppression with hormonal medications and NSAIDs. Surgical intervention is generally reserved for refractory cases, but postoperative recurrence remains high without ongoing hormonal suppression. Psychosocial impacts of endometriosis in adolescents are profound, leading to significant impacts on school participation, emotional health, and social development.
{"title":"Endometriosis in adolescents: A state-of-the-art review","authors":"Anne K. Smith , Simran Bhullar , Alla Vash-Margita","doi":"10.1016/j.bpobgyn.2026.102706","DOIUrl":"10.1016/j.bpobgyn.2026.102706","url":null,"abstract":"<div><div>Endometriosis, once considered rare in adolescents, is now recognized as a common cause of chronic pelvic pain and dysmenorrhea in individuals aged 10–21. This state-of-the-art review explores the evolution of knowledge regarding adolescent endometriosis from early misconceptions to current clinical understanding, highlighting epidemiology, pathophysiology, current diagnostic and management strategies, psychosocial implications, and key knowledge gaps. Adolescents often present with acyclic pain, and associated gastrointestinal (GI) or systemic symptoms, leading to frequent diagnostic delay. Laparoscopy remains the gold standard for diagnosis, though noninvasive strategies are increasingly being developed due to limitations in surgical access and risks of underdiagnosis. Lesions often appear atypical in adolescents, which can cause missed diagnosis. First-line treatment is suppression with hormonal medications and NSAIDs. Surgical intervention is generally reserved for refractory cases, but postoperative recurrence remains high without ongoing hormonal suppression. Psychosocial impacts of endometriosis in adolescents are profound, leading to significant impacts on school participation, emotional health, and social development.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102706"},"PeriodicalIF":4.1,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-17DOI: 10.1016/j.bpobgyn.2026.102702
Tania Dumont , Magdelena Peeva , Marwa El Masri
Polycystic Ovary Syndrome (PCOS) presents unique diagnostic and management challenges in adolescents due to physiologic overlap with normal puberty. This review synthesizes current adolescent-specific guidelines to identify evidence-based diagnostic criteria for adolescent PCOS, to apply first- and second-line management strategies, and to recognize key areas of controversy and unmet need. We emphasize menstrual irregularities and hyperandrogenism as key diagnostic criteria, while noting the limited specificity of polycystic ovarian morphology and anti-Müllerian hormone (AMH) levels in this age group. Management focuses on lifestyle interventions and combined oral contraceptives, with additional pharmacologic options as needed. Individualized monitoring of metabolic risk and psychosocial impact is highlighted. Finally, we propose a research agenda to further explore diagnostic criteria, treatment efficacy, and the long-term metabolic and mental health outcomes in adolescents with PCOS.
{"title":"Diagnosis and treatment of PCOS in adolescents: a summary of guidelines and systematic reviews for practitioners","authors":"Tania Dumont , Magdelena Peeva , Marwa El Masri","doi":"10.1016/j.bpobgyn.2026.102702","DOIUrl":"10.1016/j.bpobgyn.2026.102702","url":null,"abstract":"<div><div>Polycystic Ovary Syndrome (PCOS) presents unique diagnostic and management challenges in adolescents due to physiologic overlap with normal puberty. This review synthesizes current adolescent-specific guidelines to identify evidence-based diagnostic criteria for adolescent PCOS, to apply first- and second-line management strategies, and to recognize key areas of controversy and unmet need. We emphasize menstrual irregularities and hyperandrogenism as key diagnostic criteria, while noting the limited specificity of polycystic ovarian morphology and anti-Müllerian hormone (AMH) levels in this age group. Management focuses on lifestyle interventions and combined oral contraceptives, with additional pharmacologic options as needed. Individualized monitoring of metabolic risk and psychosocial impact is highlighted. Finally, we propose a research agenda to further explore diagnostic criteria, treatment efficacy, and the long-term metabolic and mental health outcomes in adolescents with PCOS.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102702"},"PeriodicalIF":4.1,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by the congenital absence of the uterus and upper vagina, resulting from failed Müllerian duct development during embryogenesis. Given advancements in reproductive medicine enabling genetic motherhood, this study aims to systematically review published research on the genetic and epigenetic factors contributing to MRKH etiopathogenesis.
Methods
Original peer-reviewed studies were identified through a PubMed search and manual screening of references in included papers and relevant reviews.
Results
From 494 records identified in PubMed and 43 through reference screening, 97 studies are included in this systematic review, with 17 examining MRKH patients with additional congenital anomalies or developmental disorders. Implicated genes include WNT and HOXA family members, TBX6, GREB1L, LHX1, LRP10, PAX8, and GATA3, while limited data suggest that the AMH gene and its promoter may act synergistically in combination with other genes. Chromosomal regions such as 17q12, 16p11, 1q21-q22, 22q11, 1q44, 16p13.3, and Xp22.3 may also contribute to MRKH pathogenesis. Findings on epigenetic regulation show variability, with no consistent patterns of specific gene upregulation or downregulation.
Conclusions
Genetic aberrations explain the MRKH phenotype in only a subset of cases. Identifying genetic causes enables more targeted genetic counseling in the context of potential genetic motherhood. However, counseling remains complex due to variable expressivity and the poorly understood roles of epigenetic and environmental factors.
{"title":"The genetic background of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: A systematic review","authors":"Panagiotis Christopoulos , Ermioni Tsarna , Vasiliki Palamouti , Efstathia Davouti , Periklis Makrythanasis , Nikolaos F. Vlahos","doi":"10.1016/j.bpobgyn.2026.102703","DOIUrl":"10.1016/j.bpobgyn.2026.102703","url":null,"abstract":"<div><h3>Introduction</h3><div>Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by the congenital absence of the uterus and upper vagina, resulting from failed Müllerian duct development during embryogenesis. Given advancements in reproductive medicine enabling genetic motherhood, this study aims to systematically review published research on the genetic and epigenetic factors contributing to MRKH etiopathogenesis.</div></div><div><h3>Methods</h3><div>Original peer-reviewed studies were identified through a PubMed search and manual screening of references in included papers and relevant reviews.</div></div><div><h3>Results</h3><div>From 494 records identified in PubMed and 43 through reference screening, 97 studies are included in this systematic review, with 17 examining MRKH patients with additional congenital anomalies or developmental disorders. Implicated genes include WNT and HOXA family members, TBX6, GREB1L, LHX1, LRP10, PAX8, and GATA3, while limited data suggest that the AMH gene and its promoter may act synergistically in combination with other genes. Chromosomal regions such as 17q12, 16p11, 1q21-q22, 22q11, 1q44, 16p13.3, and Xp22.3 may also contribute to MRKH pathogenesis. Findings on epigenetic regulation show variability, with no consistent patterns of specific gene upregulation or downregulation.</div></div><div><h3>Conclusions</h3><div>Genetic aberrations explain the MRKH phenotype in only a subset of cases. Identifying genetic causes enables more targeted genetic counseling in the context of potential genetic motherhood. However, counseling remains complex due to variable expressivity and the poorly understood roles of epigenetic and environmental factors.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102703"},"PeriodicalIF":4.1,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-16DOI: 10.1016/j.bpobgyn.2026.102704
Aniek Peters , Eveline J. Roos
Sexting is defined as the exchange of sexually explicit or suggestive messages and images through digital platforms. Significant attention has been given to potential risks, although little is known about the role in sexual identity development. Therefore, this scoping review aims to examine the prevalence of sexting among adolescent girls and explore the positive developmental functions, including self-expression.
Eligibility criteria were adolescent girls aged 10–19 years, who examined sexting as the exchange of sexually explicit or suggestive digital content, and employed empirical methodologies. A systematic search was conducted in PubMed, PsycINFO, and Web of Science.
Seven studies were included. The reviewed studies reported a prevalence rate from 3 % to 70 %. Sexting contributes positively to adolescent psychosocial, emotional, relational, and sexual development and forms a sexual identity. A clear understanding of sexting is crucial for developing educational programs that address both the challenges and the developmental potential in adolescent girls.
性短信被定义为通过数字平台交换露骨或暗示性的信息和图片。人们对潜在的风险给予了极大的关注，尽管人们对其在性身份发展中的作用知之甚少。因此，本综述旨在研究青春期女孩中性短信的流行程度，并探讨其积极的发展功能，包括自我表达。资格标准是年龄在10-19岁的青春期女孩，她们将性短信作为交换性明示或暗示性的数字内容进行检查，并采用经验方法。在PubMed， PsycINFO和Web of Science中进行了系统的搜索。纳入了7项研究。所审查的研究报告的患病率从3%到70%。性短信对青少年的社会心理、情感、关系和性发展有积极的贡献，并形成了性身份。对性短信有一个清晰的认识，对于制定教育计划，解决青春期女孩面临的挑战和发展潜力至关重要。
{"title":"Sexting in adolescent girls: A new way of self-expression? A scoping review","authors":"Aniek Peters , Eveline J. Roos","doi":"10.1016/j.bpobgyn.2026.102704","DOIUrl":"10.1016/j.bpobgyn.2026.102704","url":null,"abstract":"<div><div>Sexting is defined as the exchange of sexually explicit or suggestive messages and images through digital platforms. Significant attention has been given to potential risks, although little is known about the role in sexual identity development. Therefore, this scoping review aims to examine the prevalence of sexting among adolescent girls and explore the positive developmental functions, including self-expression.</div><div>Eligibility criteria were adolescent girls aged 10–19 years, who examined sexting as the exchange of sexually explicit or suggestive digital content, and employed empirical methodologies. A systematic search was conducted in PubMed, PsycINFO, and Web of Science.</div><div>Seven studies were included. The reviewed studies reported a prevalence rate from 3 % to 70 %. Sexting contributes positively to adolescent psychosocial, emotional, relational, and sexual development and forms a sexual identity. A clear understanding of sexting is crucial for developing educational programs that address both the challenges and the developmental potential in adolescent girls.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102704"},"PeriodicalIF":4.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.bpobgyn.2025.102700
Assefa Desalew , Rafiki Nickson Mjema , Henk Schonewille , C. Ellen van der Schoot , Derek P. de Winter , Thomas van den Akker , Tadesse Gure , Jeremia Pyuza , Abera Kenay Tura , E.J.T. (Joanne) Verweij
Although hemolytic disease of the fetus and newborn (HDFN), caused by maternal alloimmunization against fetal erythrocytes, has been nearly eliminated in high-income settings, it likely remains a significant public health problem in low-resource settings in Africa and elsewhere. We performed a comprehensive literature review across six major databases to determine the proportion of RhD-negativity, anti-D immunoprophylaxis utilization, RhD-alloimmunization prevalence, and the burden of RhD-mediated HDFN among pregnant women in Africa. A random-effects model was used to determine pooled estimates. We included 74 studies from 17 countries (42 from Nigeria), published between 1960 and 2024, involving 245,046 pregnancies, mostly from tertiary centers. The proportion of RhD negativity was 4.8 % (95 % CI: 4.1–5.7 %). The proven RhD alloimmunization rate was 5.8 % (95 % CI: 4.1–8.2 %). In multigravida women, the proportion of RhD alloimmunization was 5.7 % (95 % CI: 3.1–10.4 %). Anti-D immunoprophylaxis utilization after a previous pregnancy, reported in 18 studies (1490/3756 women), was 29.7 % (95 % CI: 18.0–45.0 %), with no effect on alloimmunization rate. Nine studies (including 50 neonates from 168 alloimmunized women) provided data on HDFN, with a pooled prevalence of 36.2 % (95 % CI: 16.8–61.4 %). In many papers, the specificity of the alloantibodies was not determined. Data on gravidity and the clinical definition of HDFN were incomplete. We conclude that there is a lack of robust data from Africa, thereby hampering HDFN prevention efforts. To eliminate HDFN in Africa, integrated strategies are urgently needed, including universal RhD typing and antibody screening, access to polyclonal anti-D immunoprophylaxis, and population-based surveillance.
{"title":"RhD alloimmunization in pregnancy and hemolytic disease of the fetus and newborn in Africa: A systematic review and meta-analysis","authors":"Assefa Desalew , Rafiki Nickson Mjema , Henk Schonewille , C. Ellen van der Schoot , Derek P. de Winter , Thomas van den Akker , Tadesse Gure , Jeremia Pyuza , Abera Kenay Tura , E.J.T. (Joanne) Verweij","doi":"10.1016/j.bpobgyn.2025.102700","DOIUrl":"10.1016/j.bpobgyn.2025.102700","url":null,"abstract":"<div><div>Although hemolytic disease of the fetus and newborn (HDFN), caused by maternal alloimmunization against fetal erythrocytes, has been nearly eliminated in high-income settings, it likely remains a significant public health problem in low-resource settings in Africa and elsewhere. We performed a comprehensive literature review across six major databases to determine the proportion of RhD-negativity, anti-D immunoprophylaxis utilization, RhD-alloimmunization prevalence, and the burden of RhD-mediated HDFN among pregnant women in Africa. A random-effects model was used to determine pooled estimates. We included 74 studies from 17 countries (42 from Nigeria), published between 1960 and 2024, involving 245,046 pregnancies, mostly from tertiary centers. The proportion of RhD negativity was 4.8 % (95 % CI: 4.1–5.7 %). The proven RhD alloimmunization rate was 5.8 % (95 % CI: 4.1–8.2 %). In multigravida women, the proportion of RhD alloimmunization was 5.7 % (95 % CI: 3.1–10.4 %). Anti-D immunoprophylaxis utilization after a previous pregnancy, reported in 18 studies (1490/3756 women), was 29.7 % (95 % CI: 18.0–45.0 %), with no effect on alloimmunization rate. Nine studies (including 50 neonates from 168 alloimmunized women) provided data on HDFN, with a pooled prevalence of 36.2 % (95 % CI: 16.8–61.4 %). In many papers, the specificity of the alloantibodies was not determined. Data on gravidity and the clinical definition of HDFN were incomplete. We conclude that there is a lack of robust data from Africa, thereby hampering HDFN prevention efforts. To eliminate HDFN in Africa, integrated strategies are urgently needed, including universal RhD typing and antibody screening, access to polyclonal anti-D immunoprophylaxis, and population-based surveillance.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102700"},"PeriodicalIF":4.1,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Twin Reversed Arterial Perfusion (TRAP) sequence is an infrequent complication of monochorionic pregnancies, characterized by retrograde perfusion of an acardiac twin via arterio-arterial and veno-venous placental anastomoses, leading to severe malformations in the acardiac twin and hemodynamic strain on the pump twin. This narrative review explores the pathophysiology, diagnostic criteria, and prognostic factors influencing management decisions, including acardiac-to-pump twin weight ratio, Doppler abnormalities, and early signs of cardiac dysfunction. Expectant management remains a viable option in low-risk cases with close surveillance, but the presence of poor prognostic indicators—such as hydrops, reversed a-wave in the ductus venosus, or significant polyhydramnios—justifies timely fetal intervention. Surgical techniques such as intrafetal radiofrequency ablation, laser coagulation, and bipolar cord occlusion have demonstrated improved survival for the pump twin, especially when performed in the early second trimester. While minimally invasive approaches have advanced significantly, a prophylactic intervention strategy has gained traction in some centers to prevent unpredictable deterioration. Given the lack of randomized trials and limited long-term outcome data, individualized, gestational age–tailored management remains crucial, and further prospective studies are needed to optimize care in TRAP sequence pregnancies.
{"title":"Twin reversed arterial perfusion sequence, to treat or not to treat? and surgical approaches","authors":"Nikan Zargarzadeh , Ali Javinani , Asma Khalil , Alireza Shamshirsaz , Liesbeth Lewi","doi":"10.1016/j.bpobgyn.2025.102690","DOIUrl":"10.1016/j.bpobgyn.2025.102690","url":null,"abstract":"<div><div>Twin Reversed Arterial Perfusion (TRAP) sequence is an infrequent complication of monochorionic pregnancies, characterized by retrograde perfusion of an acardiac twin via arterio-arterial and veno-venous placental anastomoses, leading to severe malformations in the acardiac twin and hemodynamic strain on the pump twin. This narrative review explores the pathophysiology, diagnostic criteria, and prognostic factors influencing management decisions, including acardiac-to-pump twin weight ratio, Doppler abnormalities, and early signs of cardiac dysfunction. Expectant management remains a viable option in low-risk cases with close surveillance, but the presence of poor prognostic indicators—such as hydrops, reversed a-wave in the ductus venosus, or significant polyhydramnios—justifies timely fetal intervention. Surgical techniques such as intrafetal radiofrequency ablation, laser coagulation, and bipolar cord occlusion have demonstrated improved survival for the pump twin, especially when performed in the early second trimester. While minimally invasive approaches have advanced significantly, a prophylactic intervention strategy has gained traction in some centers to prevent unpredictable deterioration. Given the lack of randomized trials and limited long-term outcome data, individualized, gestational age–tailored management remains crucial, and further prospective studies are needed to optimize care in TRAP sequence pregnancies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102690"},"PeriodicalIF":4.1,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.bpobgyn.2025.102685
Megan McCracken, Nichole Tyson
This chapter provides an up to date review of primary ovarian insufficiency. We address the diagnosis, pathophysiology, presentation, evaluation, treatment, and long term follow up of the disease. We discuss a detailed review of the current literature in each section and also provide numerous tables and figures for ease of reading and understanding. Finally, we also provide a list of multiple patient resources for clinicians to provide to their patients.
{"title":"Primary ovarian insufficiency","authors":"Megan McCracken, Nichole Tyson","doi":"10.1016/j.bpobgyn.2025.102685","DOIUrl":"10.1016/j.bpobgyn.2025.102685","url":null,"abstract":"<div><div>This chapter provides an up to date review of primary ovarian insufficiency. We address the diagnosis, pathophysiology, presentation, evaluation, treatment, and long term follow up of the disease. We discuss a detailed review of the current literature in each section and also provide numerous tables and figures for ease of reading and understanding. Finally, we also provide a list of multiple patient resources for clinicians to provide to their patients.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102685"},"PeriodicalIF":4.1,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.bpobgyn.2025.102689
Alison Q. Campbell , Asma Khalil , Francesco D'Antonio , Hiba J. Mustafa
Preterm birth (PTB) remains a major complication following fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) and is associated with significant neonatal morbidity and mortality. This review examines the underlying pathophysiological mechanisms, clinical outcomes, and preventive strategies for PTB in TTTS-affected pregnancies. Primary contributors to PTB in TTTS include polyhydramnios-induced uterine overdistention, cervical shortening, and procedure-related membrane injury and inflammation. Despite its clinical relevance, there is currently no consensus regarding the optimal cervical length (CL) threshold for intervention in TTTS cases. Cervical cerclage has yielded inconsistent results in PTB prevention, although no randomized controlled trials (RCTs) exist. Current evidence supports its potential benefit primarily in cases with a very short cervix (<15 mm). Cervical pessary has not consistently demonstrated benefit in PTB prevention post-FLS. In cases with short cervix, vaginal progesterone may reduce the risk of very early PTB (<28 weeks) in TTTS, although data remains limited and primarily observational. Limitations in the existing literature include a lack of RCTs, small sample sizes, and heterogeneity in study designs. Despite numerous studies, robust evidence to guide PTB prevention in TTTS remains lacking, underscoring the urgent need for multicenter trials to optimize maternal and neonatal outcomes.
{"title":"Preterm birth following fetoscopic laser surgery for twin-to-twin transfusion syndrome: Current insights and future directions","authors":"Alison Q. Campbell , Asma Khalil , Francesco D'Antonio , Hiba J. Mustafa","doi":"10.1016/j.bpobgyn.2025.102689","DOIUrl":"10.1016/j.bpobgyn.2025.102689","url":null,"abstract":"<div><div>Preterm birth (PTB) remains a major complication following fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) and is associated with significant neonatal morbidity and mortality. This review examines the underlying pathophysiological mechanisms, clinical outcomes, and preventive strategies for PTB in TTTS-affected pregnancies. Primary contributors to PTB in TTTS include polyhydramnios-induced uterine overdistention, cervical shortening, and procedure-related membrane injury and inflammation. Despite its clinical relevance, there is currently no consensus regarding the optimal cervical length (CL) threshold for intervention in TTTS cases. Cervical cerclage has yielded inconsistent results in PTB prevention, although no randomized controlled trials (RCTs) exist. Current evidence supports its potential benefit primarily in cases with a very short cervix (<15 mm). Cervical pessary has not consistently demonstrated benefit in PTB prevention post-FLS. In cases with short cervix, vaginal progesterone may reduce the risk of very early PTB (<28 weeks) in TTTS, although data remains limited and primarily observational. Limitations in the existing literature include a lack of RCTs, small sample sizes, and heterogeneity in study designs. Despite numerous studies, robust evidence to guide PTB prevention in TTTS remains lacking, underscoring the urgent need for multicenter trials to optimize maternal and neonatal outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102689"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.bpobgyn.2025.102691
Nicholas Yung , Gwendolyn Towers , Anum Wani , Michael G. Caty , Robert A. Cowles , Daniel G. Solomon , Alla Vash-Margita
Pilonidal disease is a dermatologic condition of the natal cleft that affects primarily adolescents. Its severity ranges from asymptomatic to chronically recurring disease. Like pilonidal disease, polycystic ovary syndrome commonly begins to affect women in their adolescence. PCOS is increasing in prevalence, affecting 6–20 % of women, and can significantly compromise quality of life by contributing to acne, weight gain, hirsutism, development of diabetes mellitus, hypertension, mental disorders and infertility. It is therefore increasingly important to be aware of a recently reported association between polycystic ovary syndrome and pilonidal disease within the female adolescent population. The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome. Early diagnosis of these conditions is important in mitigating morbidity associated with either disease. This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease, with the goal of providing comprehensive management and mitigating morbidity.
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