Pub Date : 2025-10-28DOI: 10.1016/j.bpobgyn.2025.102675
Ali Javinani , Asma Khalil , Eyal Krispin
Twin-to-Twin Transfusion Syndrome (TTTS) occurs in about 15 % of monochorionic twin pregnancies, less frequently does it occur prior to 18 weeks of gestation. When occurring early, this severe complication presents unique diagnostic and management challenges. In this review we will focus on the pathophysiological mechanisms underlying early TTTS. We will be emphasizing the role of placental vascular anastomoses and hemodynamic imbalances in disease progression. Advances in imaging techniques allow early diagnosis of the disease, impacting on consultation and clinical decision-making. Current treatment strategies, specifically including fetoscopic laser photocoagulation, are reviewed with a focus on optimizing perinatal outcomes. By integrating insights from fetal physiology, diagnostic innovations, and therapeutic advancements, this review aims to refine clinical management approaches to improve survival and morbidity outcomes for monochorionic twin pregnancies complicated by early TTTS.
{"title":"Early twin-to-twin transfusion syndrome: From early gestational physiology to diagnosis and management","authors":"Ali Javinani , Asma Khalil , Eyal Krispin","doi":"10.1016/j.bpobgyn.2025.102675","DOIUrl":"10.1016/j.bpobgyn.2025.102675","url":null,"abstract":"<div><div>Twin-to-Twin Transfusion Syndrome (TTTS) occurs in about 15 % of monochorionic twin pregnancies, less frequently does it occur prior to 18 weeks of gestation. When occurring early, this severe complication presents unique diagnostic and management challenges. In this review we will focus on the pathophysiological mechanisms underlying early TTTS. We will be emphasizing the role of placental vascular anastomoses and hemodynamic imbalances in disease progression. Advances in imaging techniques allow early diagnosis of the disease, impacting on consultation and clinical decision-making. Current treatment strategies, specifically including fetoscopic laser photocoagulation, are reviewed with a focus on optimizing perinatal outcomes. By integrating insights from fetal physiology, diagnostic innovations, and therapeutic advancements, this review aims to refine clinical management approaches to improve survival and morbidity outcomes for monochorionic twin pregnancies complicated by early TTTS.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102675"},"PeriodicalIF":4.1,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465769","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 : 2025-10-27DOI: 10.1016/j.bpobgyn.2025.102683
R. Pothof , T.W. de Vos , E. Lopriore , D. Winkelhorst , C.E. van der Schoot , M. de Haas , E.J.T. Verweij
Affecting 1 per 1000 to 2000 pregnancies, Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) is the leading cause for (severe) thrombocytopenia in term neonates. Due to an incompatibility between fetal and maternal platelets, maternal alloantibodies are formed against paternally derived human platelet antigens (HPAs). The alloantibodies can cross the placenta into the fetal circulation, where they can destruct the fetal platelets. As a result, severe thrombocytopenia may occur, potentially leading to intracranial hemorrhage (ICH) or severe organ bleeding during pregnancy or shortly after birth. In the absence of a universal prenatal screening program focussed on HPA-1a, FNAIT is often diagnosed too late, typically after the onset of severe fetal or neonatal bleeding complications. A screening program could be very effective in identifying the first pregnancy complicated with FNAIT, allowing timely intervention and prevent severe ICH and its associated long-term permanent sequelae. The aim of this review is to provide a comprehensive overview of the existing evidence regarding a possible future screening program for FNAIT. Additionally, challenges will be explored that need to be addressed for successful implementation of a screening program.
{"title":"From concept to practice: Screening for fetal and neonatal alloimmune thrombocytopenia (FNAIT)","authors":"R. Pothof , T.W. de Vos , E. Lopriore , D. Winkelhorst , C.E. van der Schoot , M. de Haas , E.J.T. Verweij","doi":"10.1016/j.bpobgyn.2025.102683","DOIUrl":"10.1016/j.bpobgyn.2025.102683","url":null,"abstract":"<div><div>Affecting 1 per 1000 to 2000 pregnancies, Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) is the leading cause for (severe) thrombocytopenia in term neonates. Due to an incompatibility between fetal and maternal platelets, maternal alloantibodies are formed against paternally derived human platelet antigens (HPAs). The alloantibodies can cross the placenta into the fetal circulation, where they can destruct the fetal platelets. As a result, severe thrombocytopenia may occur, potentially leading to intracranial hemorrhage (ICH) or severe organ bleeding during pregnancy or shortly after birth. In the absence of a universal prenatal screening program focussed on HPA-1a, FNAIT is often diagnosed too late, typically after the onset of severe fetal or neonatal bleeding complications. A screening program could be very effective in identifying the first pregnancy complicated with FNAIT, allowing timely intervention and prevent severe ICH and its associated long-term permanent sequelae. The aim of this review is to provide a comprehensive overview of the existing evidence regarding a possible future screening program for FNAIT. Additionally, challenges will be explored that need to be addressed for successful implementation of a screening program.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102683"},"PeriodicalIF":4.1,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403022","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}
Approximately 7000 rare diseases affect 3.5–6.0 % of the global population. Technological advancements have improved disease identification and screening, enabling early interventions during fetal development; however, treatment options remain limited. Key considerations for advancing intrauterine therapy (IUT) into clinical practice include determining if prenatal intervention is superior to postnatal treatment, addressing technical aspects like delivery methods, target organ accessibility, cell preparation, and appropriate gestational age for therapy initiation. Critical resources include technical expertise, necessary equipment, and a multidisciplinary team for monitoring adverse events. Compliance with ethical, legal, and regulatory standards, including informed consent and parental counselling, is essential. Although IUT shows promise for treating genetic diseases, it is still experimental. This review examines the barriers, opportunities, and key considerations for initiating clinical trials in fetal genetic therapies.
{"title":"The future of clinical studies of in-utero therapy for genetic diseases","authors":"Gillian Gough , G. Owen Schaefer , Karen M.X. Lim , Mahesh Choolani , Citra N.Z. Mattar","doi":"10.1016/j.bpobgyn.2025.102678","DOIUrl":"10.1016/j.bpobgyn.2025.102678","url":null,"abstract":"<div><div>Approximately 7000 rare diseases affect 3.5–6.0 % of the global population. Technological advancements have improved disease identification and screening, enabling early interventions during fetal development; however, treatment options remain limited. Key considerations for advancing intrauterine therapy (IUT) into clinical practice include determining if prenatal intervention is superior to postnatal treatment, addressing technical aspects like delivery methods, target organ accessibility, cell preparation, and appropriate gestational age for therapy initiation. Critical resources include technical expertise, necessary equipment, and a multidisciplinary team for monitoring adverse events. Compliance with ethical, legal, and regulatory standards, including informed consent and parental counselling, is essential. Although IUT shows promise for treating genetic diseases, it is still experimental. This review examines the barriers, opportunities, and key considerations for initiating clinical trials in fetal genetic therapies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102678"},"PeriodicalIF":4.1,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416376","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 : 2025-10-26DOI: 10.1016/j.bpobgyn.2025.102674
Faezeh Aghajani , Claudio V. Schenone , Ali Javinani , Hiba J. Mustafa , Eyal Krispin , Ramesha Papanna , Ramen H. Chmait
Vasa previa is a life-threatening fetal condition in which unprotected fetal blood vessels traverse the membranes over or near the cervical os, placing the fetus at high risk of rapid exsanguination if the membranes rupture. Advances in prenatal diagnosis have markedly improved outcomes, but current standard management remains associated with notable perinatal morbidity due to preterm birth and risks associated with cesarean delivery for the mother. In the management of vasa previa, growing evidence supports outpatient monitoring and delayed delivery for carefully selected low-risk cases, aiming to balance fetal safety with maternal well-being and efficient use of healthcare resources. A major focus is the emerging role of fetoscopic laser photocoagulation (FLP), a minimally invasive procedure that ablates exposed fetal vessels in utero. FLP may allow for outpatient management. In selected cases of types II and III vasa previa, it could facilitate term delivery and vaginal birth. While preliminary results are encouraging, FLP remains investigational and should be confined to IRB-approved protocols at specialized centers. We emphasize the need for individualized care informed by anatomical subtype, clinical risk, and patient values. As clinical management moves away from uniform management toward more personalized strategies, future research must validate new approaches through prospective trials and long-term follow-up to optimize maternal and fetal outcomes.
{"title":"Vasa previa: A condition with diverse management approaches","authors":"Faezeh Aghajani , Claudio V. Schenone , Ali Javinani , Hiba J. Mustafa , Eyal Krispin , Ramesha Papanna , Ramen H. Chmait","doi":"10.1016/j.bpobgyn.2025.102674","DOIUrl":"10.1016/j.bpobgyn.2025.102674","url":null,"abstract":"<div><div>Vasa previa is a life-threatening fetal condition in which unprotected fetal blood vessels traverse the membranes over or near the cervical os, placing the fetus at high risk of rapid exsanguination if the membranes rupture. Advances in prenatal diagnosis have markedly improved outcomes, but current standard management remains associated with notable perinatal morbidity due to preterm birth and risks associated with cesarean delivery for the mother. In the management of vasa previa, growing evidence supports outpatient monitoring and delayed delivery for carefully selected low-risk cases, aiming to balance fetal safety with maternal well-being and efficient use of healthcare resources. A major focus is the emerging role of fetoscopic laser photocoagulation (FLP), a minimally invasive procedure that ablates exposed fetal vessels in utero. FLP may allow for outpatient management. In selected cases of types II and III vasa previa, it could facilitate term delivery and vaginal birth. While preliminary results are encouraging, FLP remains investigational and should be confined to IRB-approved protocols at specialized centers. We emphasize the need for individualized care informed by anatomical subtype, clinical risk, and patient values. As clinical management moves away from uniform management toward more personalized strategies, future research must validate new approaches through prospective trials and long-term follow-up to optimize maternal and fetal outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102674"},"PeriodicalIF":4.1,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395692","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 : 2025-10-25DOI: 10.1016/j.bpobgyn.2025.102672
Michelle Cooper , Sharon Cameron
Evidence indicates that regardless of how a pregnancy ends (birth, abortion, miscarriage, ectopic), that ovulation resumes quickly in most cases. Those who are sexually active soon afterwards therefore require an effective method of contraception to avoid an unintended pregnancy. Yet, lack of knowledge on contraceptive options or when they can or should be initiated can be barriers to starting a method. For those who have given birth the requirements of looking after a newborn and recovering from delivery adds to existing barriers of accessing a chosen method after pregnancy. It is vital therefore that access to contraception can be facilitated for women to start immediately post pregnancy. this chapter will outline some initiatives to empower individuals to choose contraception for following a pregnancy and also innovations to help them access that method.
{"title":"Innovations in post-pregnancy contraception","authors":"Michelle Cooper , Sharon Cameron","doi":"10.1016/j.bpobgyn.2025.102672","DOIUrl":"10.1016/j.bpobgyn.2025.102672","url":null,"abstract":"<div><div>Evidence indicates that regardless of how a pregnancy ends (birth, abortion, miscarriage, ectopic), that ovulation resumes quickly in most cases. Those who are sexually active soon afterwards therefore require an effective method of contraception to avoid an unintended pregnancy. Yet, lack of knowledge on contraceptive options or when they can or should be initiated can be barriers to starting a method. For those who have given birth the requirements of looking after a newborn and recovering from delivery adds to existing barriers of accessing a chosen method after pregnancy. It is vital therefore that access to contraception can be facilitated for women to start immediately post pregnancy. this chapter will outline some initiatives to empower individuals to choose contraception for following a pregnancy and also innovations to help them access that method.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102672"},"PeriodicalIF":4.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410952","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 : 2025-10-25DOI: 10.1016/j.bpobgyn.2025.102684
Sofia Albuquerque Brás, Leonor Ferreira
The first trimester ultrasound, performed between 11 + 0 and 13 + 6 weeks of gestation, plays an important role that goes beyond identifying ultrasound markers for aneuploidies. Its objectives include determining the number of fetuses and assessing chorionicity and amnionicity in cases of twin pregnancies; establishing gestational age; detecting major structural anomalies and evaluating uterine arteries for pre-eclampsia.
{"title":"First trimester scan in twins","authors":"Sofia Albuquerque Brás, Leonor Ferreira","doi":"10.1016/j.bpobgyn.2025.102684","DOIUrl":"10.1016/j.bpobgyn.2025.102684","url":null,"abstract":"<div><div>The first trimester ultrasound, performed between 11 + 0 and 13 + 6 weeks of gestation, plays an important role that goes beyond identifying ultrasound markers for aneuploidies. Its objectives include determining the number of fetuses and assessing chorionicity and amnionicity in cases of twin pregnancies; establishing gestational age; detecting major structural anomalies and evaluating uterine arteries for pre-eclampsia.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102684"},"PeriodicalIF":4.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416484","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 : 2025-10-25DOI: 10.1016/j.bpobgyn.2025.102680
Jeanine M.M. van Klink , Derek P. de Winter , Renske M. van ‘t Oever , Ratna N.G.B. Tan , E.J.T. Verweij Joanne , Masja de Haas , Enrico Lopriore
The mainstay for the management and treatment of severe alloimmune hemolytic disease of the fetus and newborn (HDFN) is based on timely detection and intrauterine transfusions (IUT) in cases with severe fetal anemia. Although long-term neurodevelopmental outcomes in children born following IUT for HDFN are nowadays considered ‘favorable’, reliable long-term outcome data remain scarce. Several studies suggests that children with a history of severe hydrops, cerebral injury, and preterm birth are at increased risk for neurodevelopmental impairment (NDI). However, follow-up studies are limited by small sample sizes, the absence of control groups, inconsistent criteria for neurodevelopmental outcome, and a lack of standardized developmental assessments. The prevalence of NDI in the literature to date is reported to be around 5 % but varies from 0 % to 18.8 %, depending on the studied cohort. When interpreting the data and extrapolating conclusions to the general population, consideration must be given to the fact that the majority was born moderate to late preterm, a population inherently at increased risk for adverse neurodevelopmental outcomes. Future research should incorporate more subtle impairments, as mild to moderate cognitive deficits, learning problems and socioemotional and behavioral difficulties can substantially impact long-term care needs and socioeconomic potential. A deeper understanding of the effects of fetal anemia and IUT on neurodevelopmental trajectories will enable effective screening and the implementation of timely, targeted interventions to optimize developmental outcomes for children at risk. In addition, the impact of the complicated pregnancy on the wellbeing of parents and the child-caregiver relationship is an underexposed and understudied outcome measure. With the introduction of new non-invasive therapies, international collaborative efforts are of utmost importance to reliably investigate not just survival or neonatal outcome but also long-term neurodevelopment and wellbeing of children and caregivers.
{"title":"Long-term neurodevelopmental outcomes after intrauterine transfusion for alloimmune hemolytic disease of the fetus and newborn","authors":"Jeanine M.M. van Klink , Derek P. de Winter , Renske M. van ‘t Oever , Ratna N.G.B. Tan , E.J.T. Verweij Joanne , Masja de Haas , Enrico Lopriore","doi":"10.1016/j.bpobgyn.2025.102680","DOIUrl":"10.1016/j.bpobgyn.2025.102680","url":null,"abstract":"<div><div>The mainstay for the management and treatment of severe alloimmune hemolytic disease of the fetus and newborn (HDFN) is based on timely detection and intrauterine transfusions (IUT) in cases with severe fetal anemia. Although long-term neurodevelopmental outcomes in children born following IUT for HDFN are nowadays considered ‘favorable’, reliable long-term outcome data remain scarce. Several studies suggests that children with a history of severe hydrops, cerebral injury, and preterm birth are at increased risk for neurodevelopmental impairment (NDI). However, follow-up studies are limited by small sample sizes, the absence of control groups, inconsistent criteria for neurodevelopmental outcome, and a lack of standardized developmental assessments. The prevalence of NDI in the literature to date is reported to be around 5 % but varies from 0 % to 18.8 %, depending on the studied cohort. When interpreting the data and extrapolating conclusions to the general population, consideration must be given to the fact that the majority was born moderate to late preterm, a population inherently at increased risk for adverse neurodevelopmental outcomes. Future research should incorporate more subtle impairments, as mild to moderate cognitive deficits, learning problems and socioemotional and behavioral difficulties can substantially impact long-term care needs and socioeconomic potential. A deeper understanding of the effects of fetal anemia and IUT on neurodevelopmental trajectories will enable effective screening and the implementation of timely, targeted interventions to optimize developmental outcomes for children at risk. In addition, the impact of the complicated pregnancy on the wellbeing of parents and the child-caregiver relationship is an underexposed and understudied outcome measure. With the introduction of new non-invasive therapies, international collaborative efforts are of utmost importance to reliably investigate not just survival or neonatal outcome but also long-term neurodevelopment and wellbeing of children and caregivers.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102680"},"PeriodicalIF":4.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403042","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 : 2025-10-25DOI: 10.1016/j.bpobgyn.2025.102681
Heidi Tiller , Maria Therese Ahlen
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the primary cause of severe neonatal thrombocytopenia and fetal/neonatal intracranial hemorrhage (ICH) in otherwise healthy term newborns. FNAIT occurs in 0.5–1:1000 newborns. FNAIT may occur if the mother and fetus have incompatible platelet antigens, leading to maternal alloimmunization with antibodies targeting the fetal platelets. The main clinical concern is the risk of ICH, with a reported incidence of 1:10,000 newborns. Most bleedings occurs prior to delivery. Due to the lack of HPA-1a screening in pregnancy, most pregnancies complicated by FNAIT are not diagnosed until after birth and the condition is underdiagnosed.
Current antenatal management protocols are focused on subsequent pregnancies, when a mother has had a previously affected neonate. The primary goal of treatment during the subsequent pregnancy is to prevent ICH in the current fetus/neonate. The predicted risk of ICH in subsequent pregnancies depends mainly on whether the previous FNAIT-affected sibling had ICH or not.
In most Western countries, weekly off-label administration of high-dose IVIg is used for pregnant HPA-1a-alloimmunized women to prevent ICH in the fetus/newborn. However, many experts advocate for a more stratified approach that limits which at-risk pregnancies are offered IVIg.
This non-systematic expert review will focus on ante- and perinatal clinical management of FNAIT, addressing both clinical (non-screening) and screening scenarios.
{"title":"Clinical management in FNAIT – navigating a complicated landscape","authors":"Heidi Tiller , Maria Therese Ahlen","doi":"10.1016/j.bpobgyn.2025.102681","DOIUrl":"10.1016/j.bpobgyn.2025.102681","url":null,"abstract":"<div><div>Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the primary cause of severe neonatal thrombocytopenia and fetal/neonatal intracranial hemorrhage (ICH) in otherwise healthy term newborns. FNAIT occurs in 0.5–1:1000 newborns. FNAIT may occur if the mother and fetus have incompatible platelet antigens, leading to maternal alloimmunization with antibodies targeting the fetal platelets. The main clinical concern is the risk of ICH, with a reported incidence of 1:10,000 newborns. Most bleedings occurs prior to delivery. Due to the lack of HPA-1a screening in pregnancy, most pregnancies complicated by FNAIT are not diagnosed until after birth and the condition is underdiagnosed.</div><div>Current antenatal management protocols are focused on subsequent pregnancies, when a mother has had a previously affected neonate. The primary goal of treatment during the subsequent pregnancy is to prevent ICH in the current fetus/neonate. The predicted risk of ICH in subsequent pregnancies depends mainly on whether the previous FNAIT-affected sibling had ICH or not.</div><div>In most Western countries, weekly off-label administration of high-dose IVIg is used for pregnant HPA-1a-alloimmunized women to prevent ICH in the fetus/newborn. However, many experts advocate for a more stratified approach that limits which at-risk pregnancies are offered IVIg.</div><div>This non-systematic expert review will focus on ante- and perinatal clinical management of FNAIT, addressing both clinical (non-screening) and screening scenarios.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102681"},"PeriodicalIF":4.1,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410935","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}
Contraception can be an overlooked aspect of perimenopausal healthcare. While background fertility is low, pregnancies in those aged over 40 years present a higher risk both to the fetus and mother, and have a higher chance of ending in miscarriage or abortion, compared to pregnancies in younger women. This chapter provides a review of key issues related to hormonal contraception in the perimenopause and evaluates each method's effectiveness and safety at a stage of life when venous and cardiovascular disease risks increase. Suitability is assessed considering the person's needs, circumstances and contraindications. Attention is also given to non-contraceptive advantages of certain methods, such as management of perimenopausal symptoms, heavy bleeding and reduction of risks for certain cancers. By highlighting current research and clinical guidelines, this chapter aims to equip healthcare providers with knowledge to support perimenopausal women in making informed reproductive health decisions.
{"title":"Hormonal contraception in perimenopausal women","authors":"Sara Whitburn , Kathleen McNamee , Clare Boerma , Deborah Bateson","doi":"10.1016/j.bpobgyn.2025.102655","DOIUrl":"10.1016/j.bpobgyn.2025.102655","url":null,"abstract":"<div><div>Contraception can be an overlooked aspect of perimenopausal healthcare. While background fertility is low, pregnancies in those aged over 40 years present a higher risk both to the fetus and mother, and have a higher chance of ending in miscarriage or abortion, compared to pregnancies in younger women. This chapter provides a review of key issues related to hormonal contraception in the perimenopause and evaluates each method's effectiveness and safety at a stage of life when venous and cardiovascular disease risks increase. Suitability is assessed considering the person's needs, circumstances and contraindications. Attention is also given to non-contraceptive advantages of certain methods, such as management of perimenopausal symptoms, heavy bleeding and reduction of risks for certain cancers. By highlighting current research and clinical guidelines, this chapter aims to equip healthcare providers with knowledge to support perimenopausal women in making informed reproductive health decisions.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102655"},"PeriodicalIF":4.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026294","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}
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