Pub Date : 2025-08-08DOI: 10.1016/j.bpobgyn.2025.102654
Richard A. Anderson
{"title":"Current challenges in fertility preservation","authors":"Richard A. Anderson","doi":"10.1016/j.bpobgyn.2025.102654","DOIUrl":"10.1016/j.bpobgyn.2025.102654","url":null,"abstract":"","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102654"},"PeriodicalIF":4.1,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933783","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 : 2025-07-31DOI: 10.1016/j.bpobgyn.2025.102645
Raphael Bartin M.D. , Nikan Zargarzadeh M.D. , Mohammadamin Parsaei M.D. , Alireza A. Shamshirsaz M.D. , Julien J. Stirnemann M.D. , Stephen P. Emery M.D.
Selective fetoscopic laser photocoagulation of communicating vessels (SFPL) is well established as the first line of therapy for stage II-IV twin-twin transfusion syndrome (TTTS). The optimal management of stage I TTTS is less well-defined. While many stage I patients resolve spontaneously or remain stage I with good pregnancy outcomes, a majority progress to higher stages. Risk factors that differentiate those who will remain stable or regress vs. those who will progress are lacking. This has led some centers to offer SFLP to patients with stage I disease either immediately or after a period of close observation. The objective of this manuscript is to review the current evidence on the merits of laser treatment versus expectant management for stage I TTTS. A search of PubMed and Google Scholar using the keywords “stage I,” “twin transfusion,” and “management” was undertaken. The results of this review suggest that expectant management of stable, asymptomatic stage I TTTS is a reasonable first-line treatment, whereas selective fetoscopic laser photocoagulation is an appropriate first step in some circumstances. Treatment of stage I TTTS should remain an option in select patients.
{"title":"Intervention or expectant management for stage I twin-twin transfusion syndrome","authors":"Raphael Bartin M.D. , Nikan Zargarzadeh M.D. , Mohammadamin Parsaei M.D. , Alireza A. Shamshirsaz M.D. , Julien J. Stirnemann M.D. , Stephen P. Emery M.D.","doi":"10.1016/j.bpobgyn.2025.102645","DOIUrl":"10.1016/j.bpobgyn.2025.102645","url":null,"abstract":"<div><div>Selective fetoscopic laser photocoagulation of communicating vessels (SFPL) is well established as the first line of therapy for stage II-IV twin-twin transfusion syndrome (TTTS). The optimal management of stage I TTTS is less well-defined. While many stage I patients resolve spontaneously or remain stage I with good pregnancy outcomes, a majority progress to higher stages. Risk factors that differentiate those who will remain stable or regress vs. those who will progress are lacking. This has led some centers to offer SFLP to patients with stage I disease either immediately or after a period of close observation. The objective of this manuscript is to review the current evidence on the merits of laser treatment versus expectant management for stage I TTTS. A search of PubMed and Google Scholar using the keywords “stage I,” “twin transfusion,” and “management” was undertaken. The results of this review suggest that expectant management of stable, asymptomatic stage I TTTS is a reasonable first-line treatment, whereas selective fetoscopic laser photocoagulation is an appropriate first step in some circumstances. Treatment of stage I TTTS should remain an option in select patients.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102645"},"PeriodicalIF":4.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780823","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 : 2025-07-25DOI: 10.1016/j.bpobgyn.2025.102649
Scott Infusino , Nitin Sajankila , Elle Nuttall , Darrell L. Cass , Michael Puricelli , Inna N. Lobeck
The Ex-Utero Intrapartum Treatment (EXIT) is a method of delivery utilized in the setting of fetal anomalies that can lead to respiratory or cardiovascular compromise with the transition to extrauterine life. With multidisciplinary collaboration, delivery occurs with uterine relaxation to preserve placental function, allowing for appropriate intervention while the maternofetal interface is maintained. Multiple types of EXIT procedures are described in the literature that differ based on fetal indication and specific clinical goals. These include EXIT-to-airway, EXIT-to-resection, EXIT-to-extracorporeal membrane oxygenation (ECMO), and EXIT-to-ventricular pacing. When considering an EXIT procedure, fetal benefit must be weighed against maternal risk, and patients require thorough counseling to make an informed decision. In many cases, an individualized approach is necessary. The goal of this review is to provide an overview of the prenatal evaluation, risk stratification, and technical planning necessary for the various forms of EXIT procedures.
{"title":"Decision-making and operative considerations for Ex-utero Intrapartum treatment (EXIT)","authors":"Scott Infusino , Nitin Sajankila , Elle Nuttall , Darrell L. Cass , Michael Puricelli , Inna N. Lobeck","doi":"10.1016/j.bpobgyn.2025.102649","DOIUrl":"10.1016/j.bpobgyn.2025.102649","url":null,"abstract":"<div><div>The Ex-Utero Intrapartum Treatment (EXIT) is a method of delivery utilized in the setting of fetal anomalies that can lead to respiratory or cardiovascular compromise with the transition to extrauterine life. With multidisciplinary collaboration, delivery occurs with uterine relaxation to preserve placental function, allowing for appropriate intervention while the maternofetal interface is maintained. Multiple types of EXIT procedures are described in the literature that differ based on fetal indication and specific clinical goals. These include EXIT-to-airway, EXIT-to-resection, EXIT-to-extracorporeal membrane oxygenation (ECMO), and EXIT-to-ventricular pacing. When considering an EXIT procedure, fetal benefit must be weighed against maternal risk, and patients require thorough counseling to make an informed decision. In many cases, an individualized approach is necessary. The goal of this review is to provide an overview of the prenatal evaluation, risk stratification, and technical planning necessary for the various forms of EXIT procedures.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102649"},"PeriodicalIF":4.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772553","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 : 2025-07-25DOI: 10.1016/j.bpobgyn.2025.102646
Hajra Malik , E.J.T. (Joanne) Verweij , Hiba J. Mustafa
Hemolytic Disease of the Fetus and Newborn (HDFN) results from maternal alloantibodies attacking fetal red blood cells, leading to fetal anemia and potentially severe complications such as hydrops fetalis. Effective management relies on early detection through maternal antibody screening, fetal antigen testing, and close monitoring of fetal anemia. In cases of severe anemia, intrauterine transfusion (IUT) remains the primary intervention to improve fetal outcomes. Despite this, there is an urgent need for novel medical therapies to prevent or delay disease progression in pregnancies at risk for HDFN.
{"title":"Hemolytic disease of the fetus and newborn: A review of pathophysiology, diagnosis, and management","authors":"Hajra Malik , E.J.T. (Joanne) Verweij , Hiba J. Mustafa","doi":"10.1016/j.bpobgyn.2025.102646","DOIUrl":"10.1016/j.bpobgyn.2025.102646","url":null,"abstract":"<div><div>Hemolytic Disease of the Fetus and Newborn (HDFN) results from maternal alloantibodies attacking fetal red blood cells, leading to fetal anemia and potentially severe complications such as hydrops fetalis. Effective management relies on early detection through maternal antibody screening, fetal antigen testing, and close monitoring of fetal anemia. In cases of severe anemia, intrauterine transfusion (IUT) remains the primary intervention to improve fetal outcomes. Despite this, there is an urgent need for novel medical therapies to prevent or delay disease progression in pregnancies at risk for HDFN.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102646"},"PeriodicalIF":4.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769444","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}
This article outlines a unique example of reverse innovation. Lessons from low- and middle-income countries (LMICs) shaped healthcare practices in a high-income setting. We describe how the FIGO Postpartum Intrauterine Device Initiative, implemented across six LMICs, informed the development of a postpartum contraception program in a UK-based NHS trust. Despite the well-documented benefits of postpartum family planning (PPFP), implementing dedicated PPFP services in the UK has been challenging due to fragmented healthcare funding and cross service integration barriers. The COVID-19 pandemic created an urgent need for adaptation, providing a unique opportunity to rapidly establish a comprehensive local PPFP service. We outline how strategies from LMICs - including task-sharing, provider training, and policy advocacy - were directly applied to overcome these barriers and drive successful implementation. This case study highlights the potential of South-to-North knowledge transfer in driving healthcare innovation, improving contraceptive access, and underscores the importance of global collaboration and adaptive learning in reproductive healthcare.
{"title":"Reverse innovation – South to North learnings in the provision of postpartum contraception: implementation in a high-income setting","authors":"Anita Makins , Hifsa Mahmood , Katherine Talbot , Claire Hordern , Neda Taghinejadi , Ruth Houlden , Suzanna Bright , Sabaratnam Arulkumaran","doi":"10.1016/j.bpobgyn.2025.102653","DOIUrl":"10.1016/j.bpobgyn.2025.102653","url":null,"abstract":"<div><div>This article outlines a unique example of reverse innovation. Lessons from low- and middle-income countries (LMICs) shaped healthcare practices in a high-income setting. We describe how the FIGO Postpartum Intrauterine Device Initiative, implemented across six LMICs, informed the development of a postpartum contraception program in a UK-based NHS trust. Despite the well-documented benefits of postpartum family planning (PPFP), implementing dedicated PPFP services in the UK has been challenging due to fragmented healthcare funding and cross service integration barriers. The COVID-19 pandemic created an urgent need for adaptation, providing a unique opportunity to rapidly establish a comprehensive local PPFP service. We outline how strategies from LMICs - including task-sharing, provider training, and policy advocacy - were directly applied to overcome these barriers and drive successful implementation. This case study highlights the potential of South-to-North knowledge transfer in driving healthcare innovation, improving contraceptive access, and underscores the importance of global collaboration and adaptive learning in reproductive healthcare.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102653"},"PeriodicalIF":4.1,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829234","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 : 2025-07-24DOI: 10.1016/j.bpobgyn.2025.102652
Suset Rodriguez, Pasquale Patrizio
Transgender individuals, whose gender identity differs from their assigned sex at birth, may undergo gender-affirming hormone therapy (GAHT) and gender-affirming surgery (GAS) to alleviate gender dysphoria. These treatments often impact future reproductive potential, necessitating fertility preservation (FP) discussions. Healthcare guidelines from the American Society of Reproductive Medicine (ASRM), World Professional Association for Transgender Health (WPATH), and the Endocrine Society recommend counseling on FP options, which include oocyte, sperm, and embryo cryopreservation. Challenges remain, including the impact of gender dysphoria during FP processes, the recommended length of being off hormonal treatments, the financial burden, and limited data on future pregnancy outcomes. This chapter explores FP options for transgender individuals, including those with ovaries or testes, and addresses challenges to utilization.
{"title":"Making fertility preservation happen for the transgender community","authors":"Suset Rodriguez, Pasquale Patrizio","doi":"10.1016/j.bpobgyn.2025.102652","DOIUrl":"10.1016/j.bpobgyn.2025.102652","url":null,"abstract":"<div><div>Transgender individuals, whose gender identity differs from their assigned sex at birth, may undergo gender-affirming hormone therapy (GAHT) and gender-affirming surgery (GAS) to alleviate gender dysphoria. These treatments often impact future reproductive potential, necessitating fertility preservation (FP) discussions. Healthcare guidelines from the American Society of Reproductive Medicine (ASRM), World Professional Association for Transgender Health (WPATH), and the Endocrine Society recommend counseling on FP options, which include oocyte, sperm, and embryo cryopreservation. Challenges remain, including the impact of gender dysphoria during FP processes, the recommended length of being off hormonal treatments, the financial burden, and limited data on future pregnancy outcomes. This chapter explores FP options for transgender individuals, including those with ovaries or testes, and addresses challenges to utilization.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102652"},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769445","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 : 2025-07-24DOI: 10.1016/j.bpobgyn.2025.102648
Linoy Batsry, Jimmy Espinoza, Eric Bergh
Today, prenatal therapy for congenital diaphragmatic hernia (CDH) primarily centers on fetoscopic endoluminal tracheal occlusion (FETO). This procedure involves the temporary occlusion of the fetal trachea to promote lung development. The TOTAL (Tracheal Occlusion to Accelerate Lung Growth) trial demonstrated a significant improvement in survival rates for fetuses with severe CDH following FETO. The outcomes of the TOTAL trial have sparked heightened interest in the FETO procedure, leading to the publication of numerous additional studies. Nevertheless, subsequent research has yielded inconsistent results outside of randomized controlled trials. This review examines the variations in patient selection, procedural techniques, and postnatal care that may contribute to this variability while also exploring potential future directions for the FETO procedure and prenatal therapy for CDH.
{"title":"Fetal surgery for congenital diaphragmatic hernia in the post-TOTAL trial era","authors":"Linoy Batsry, Jimmy Espinoza, Eric Bergh","doi":"10.1016/j.bpobgyn.2025.102648","DOIUrl":"10.1016/j.bpobgyn.2025.102648","url":null,"abstract":"<div><div>Today, prenatal therapy for congenital diaphragmatic hernia (CDH) primarily centers on fetoscopic endoluminal tracheal occlusion (FETO). This procedure involves the temporary occlusion of the fetal trachea to promote lung development. The TOTAL (Tracheal Occlusion to Accelerate Lung Growth) trial demonstrated a significant improvement in survival rates for fetuses with severe CDH following FETO. The outcomes of the TOTAL trial have sparked heightened interest in the FETO procedure, leading to the publication of numerous additional studies. Nevertheless, subsequent research has yielded inconsistent results outside of randomized controlled trials. This review examines the variations in patient selection, procedural techniques, and postnatal care that may contribute to this variability while also exploring potential future directions for the FETO procedure and prenatal therapy for CDH.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102648"},"PeriodicalIF":4.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724077","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 : 2025-07-23DOI: 10.1016/j.bpobgyn.2025.102650
Robert D. Christensen MD, Timothy M. Bahr MS, MD, Robin K. Ohls MD
The “late” anemia of hemolytic disease of the fetus and newborn (HDFN), first described over 65 years ago, remains incompletely understood and inconsistently treated. We suspect that deficiencies in understanding its pathogenesis and fostering uniformity in its management could be remedied by teams working collaboratively to test the best ideas through multicentered trials. We begin this review by proposing a data-based definition of anemia, and of “severe” anemia, among infants at birth and during the neonatal period. We then review early as well as recent reports of the “late” anemia of HDFN, suggesting that two pathogenic forms of the condition exist; hemolytic vs. non-hemolytic (hypoproductive). We then review the use of a noninvasive and rapid means of differentiating between these two possibilities, in any given case. Next, we review means of either preventing the “late” anemia or treating it without red blood cell transfusions, using erythropoietic stimulating agents (darbepoetin or erythropoietin). We present our preferred method, using darbepoetin, and explain what we see as the chief advantages. We call for the development of transfusion stewardship programs in each NICU, to establish NICU transfusion guidelines, periodically evaluate compliance, and provide advice for problem cases. In addition, these programs can endorse a consistent approach to managing neonates with HDFN, during their NICU stay and for the weeks after discharge. We end the review with a gap analysis and a call for new focused research aimed at producing better outcomes for these patients, and less uncertainty and stress for these families.
{"title":"Understanding, detecting, and managing the “late” anemia of hemolytic disease of the fetus and newborn","authors":"Robert D. Christensen MD, Timothy M. Bahr MS, MD, Robin K. Ohls MD","doi":"10.1016/j.bpobgyn.2025.102650","DOIUrl":"10.1016/j.bpobgyn.2025.102650","url":null,"abstract":"<div><div>The “late” anemia of hemolytic disease of the fetus and newborn (HDFN), first described over 65 years ago, remains incompletely understood and inconsistently treated. We suspect that deficiencies in understanding its pathogenesis and fostering uniformity in its management could be remedied by teams working collaboratively to test the best ideas through multicentered trials. We begin this review by proposing a data-based definition of anemia, and of “severe” anemia, among infants at birth and during the neonatal period. We then review early as well as recent reports of the “late” anemia of HDFN, suggesting that two pathogenic forms of the condition exist; <em>hemolytic vs. non-hemolytic (hypoproductive)</em>. We then review the use of a noninvasive and rapid means of differentiating between these two possibilities, in any given case. Next, we review means of either preventing the “late” anemia or treating it without red blood cell transfusions, using erythropoietic stimulating agents (darbepoetin or erythropoietin). We present our preferred method, using darbepoetin, and explain what we see as the chief advantages. We call for the development of transfusion stewardship programs in each NICU, to establish NICU transfusion guidelines, periodically evaluate compliance, and provide advice for problem cases. In addition, these programs can endorse a consistent approach to managing neonates with HDFN, during their NICU stay and for the weeks after discharge. We end the review with a gap analysis and a call for new focused research aimed at producing better outcomes for these patients, and less uncertainty and stress for these families.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102650"},"PeriodicalIF":4.1,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769446","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 : 2025-07-23DOI: 10.1016/j.bpobgyn.2025.102643
Dusan Djokovic , Patrícia Pinto , Inês Reis
Maternal adnexal masses are increasingly detected during pregnancy, primarily due to the widespread use of ultrasound in obstetrics. Most of them are functional cysts that resolve spontaneously. Lesions visualized by ultrasound in adnexal topography may be retroperitoneal or intraperitoneal (non-gynecologic or obstetric/gynecologic formations, such as pregnancy-related masses, subserosal uterine fibroids or true adnexal lesions). The largest number of adnexal lesions do not change their ultrasound morphology in pregnancy. However, endometriomas may decidualize, mimicking borderline or stage I invasive ovarian malignancies. The patient management can be conservative (ultrasound surveillance) or surgery. The decision depends on a series of factors including the risk of malignancy. Until mathematical models have been widely validated in pregnancy, the International Ovarian Tumor Analysis Group recommends using simple benign descriptors and expert subjective assessment to predict the risk of maternal adnexal malignancy in pregnancy. In the future, artificial intelligence could be useful.
{"title":"Maternal adnexal masses in pregnancy","authors":"Dusan Djokovic , Patrícia Pinto , Inês Reis","doi":"10.1016/j.bpobgyn.2025.102643","DOIUrl":"10.1016/j.bpobgyn.2025.102643","url":null,"abstract":"<div><div>Maternal adnexal masses are increasingly detected during pregnancy, primarily due to the widespread use of ultrasound in obstetrics. Most of them are functional cysts that resolve spontaneously. Lesions visualized by ultrasound in adnexal topography may be retroperitoneal or intraperitoneal (non-gynecologic or obstetric/gynecologic formations, such as pregnancy-related masses, subserosal uterine fibroids or true adnexal lesions). The largest number of adnexal lesions do not change their ultrasound morphology in pregnancy. However, endometriomas may decidualize, mimicking borderline or stage I invasive ovarian malignancies. The patient management can be conservative (ultrasound surveillance) or surgery. The decision depends on a series of factors including the risk of malignancy. Until mathematical models have been widely validated in pregnancy, the International Ovarian Tumor Analysis Group recommends using simple benign descriptors and expert subjective assessment to predict the risk of maternal adnexal malignancy in pregnancy. In the future, artificial intelligence could be useful.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102643"},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702444","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 : 2025-07-23DOI: 10.1016/j.bpobgyn.2025.102644
Felicia LeMoine, Neha Agarwal, Sarah Naranjo, Anthony Johnson, Sami Backley, Eric P. Bergh, Gustavo Vilchez Lagos, Edgar Hernandez-Andrade, Ramesha Papanna, Jimmy Espinoza
Large chorioangiomas, benign vascular tumors of the placenta measuring ≥ 4 cm in greatest diameter, may pose significant risks to an ongoing pregnancy and warrant thorough sonographic evaluation to assess for evidence of fetal cardiac compromise and fetal anemia. Significant perinatal morbidity and mortality has been associated with large chorioangiomas. Key sonographic markers indicative of fetal compromise in the setting of a large chorioangioma include 1) polyhydramnios, 2) elevated middle cerebral artery (MCA) PSV (multiples of the median [MoM] ≥ 1.5), 3) increased combined cardiac output (CCO) and/or tricuspid regurgitation (TR) with or without evidence of fetal cardiomegaly, and 4) fetal hydrops. When fetal compromise is suspected in the setting of a large placental chorioangioma, referral to a fetal center with high-volume expertise in management of complex fetal care should be considered to evaluate for in-utero intervention candidacy. If in-utero fetal intervention is indicated, the placental location, the number and caliber of “feeder vessels” to the chorioangioma, and the proximity of the chorioangioma to the placental cord insertion guide the decision of surgical approach. Despite in-utero fetal intervention, perinatal morbidity and mortality remains high with 30–40 % resulting in perinatal death and about 50 % resulting in preterm birth.
{"title":"Diagnosis and management of large placental chorioangiomas","authors":"Felicia LeMoine, Neha Agarwal, Sarah Naranjo, Anthony Johnson, Sami Backley, Eric P. Bergh, Gustavo Vilchez Lagos, Edgar Hernandez-Andrade, Ramesha Papanna, Jimmy Espinoza","doi":"10.1016/j.bpobgyn.2025.102644","DOIUrl":"10.1016/j.bpobgyn.2025.102644","url":null,"abstract":"<div><div>Large chorioangiomas, benign vascular tumors of the placenta measuring ≥ 4 cm in greatest diameter, may pose significant risks to an ongoing pregnancy and warrant thorough sonographic evaluation to assess for evidence of fetal cardiac compromise and fetal anemia. Significant perinatal morbidity and mortality has been associated with large chorioangiomas. Key sonographic markers indicative of fetal compromise in the setting of a large chorioangioma include 1) polyhydramnios, 2) elevated middle cerebral artery (MCA) PSV (multiples of the median [MoM] ≥ 1.5), 3) increased combined cardiac output (CCO) and/or tricuspid regurgitation (TR) with or without evidence of fetal cardiomegaly, and 4) fetal hydrops. When fetal compromise is suspected in the setting of a large placental chorioangioma, referral to a fetal center with high-volume expertise in management of complex fetal care should be considered to evaluate for in-utero intervention candidacy. If in-utero fetal intervention is indicated, the placental location, the number and caliber of “feeder vessels” to the chorioangioma, and the proximity of the chorioangioma to the placental cord insertion guide the decision of surgical approach. Despite in-utero fetal intervention, perinatal morbidity and mortality remains high with 30–40 % resulting in perinatal death and about 50 % resulting in preterm birth.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102644"},"PeriodicalIF":3.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711273","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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