Pub Date : 2025-07-22DOI: 10.1016/j.bpobgyn.2025.102647
Stephen P. Emery MD , Shohra Qaderi , Weston Northam MD , Alireza Shamshirsaz MD
Congenital obstructive hydrocephalus from aqueductal stenosis (AS) is a relatively rare but clinically significant fetal anomaly that results from obstruction of the antegrade flow of cerebrospinal fluid (CSF) from the third to the fourth cerebral ventricles. Cerebrospinal fluid accumulates in the lateral and third ventricles under pressure. That pressure is transferred to the developing fetal brain, causing permanent neurologic injury from tissue ischemia and neuronal shear. This review aims to provide an in-depth analysis of the pathophysiology, diagnosis, and current management strategies, followed by the rationale, eligibility, and potential techniques of prenatal intervention.
{"title":"Prenatal intervention in congenital obstructive hydrocephalus: Rationale, eligibility, and techniques","authors":"Stephen P. Emery MD , Shohra Qaderi , Weston Northam MD , Alireza Shamshirsaz MD","doi":"10.1016/j.bpobgyn.2025.102647","DOIUrl":"10.1016/j.bpobgyn.2025.102647","url":null,"abstract":"<div><div>Congenital obstructive hydrocephalus from aqueductal stenosis (AS) is a relatively rare but clinically significant fetal anomaly that results from obstruction of the antegrade flow of cerebrospinal fluid (CSF) from the third to the fourth cerebral ventricles. Cerebrospinal fluid accumulates in the lateral and third ventricles under pressure. That pressure is transferred to the developing fetal brain, causing permanent neurologic injury from tissue ischemia and neuronal shear. This review aims to provide an in-depth analysis of the pathophysiology, diagnosis, and current management strategies, followed by the rationale, eligibility, and potential techniques of prenatal intervention.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102647"},"PeriodicalIF":3.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711546","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 : 2025-07-22DOI: 10.1016/j.bpobgyn.2025.102651
Debeer A MD, PhD , Vanhole C MD, PhD
Hemolytic disease of the newborn (HDN) remains a significant clinical challenge in neonatal care. This review focuses on the early postnatal management of HDN and synthesizes current evidence-based recommendations to guide healthcare professionals in optimizing outcomes for affected neonates. Key areas of discussion include the diagnosis and monitoring of HDN, the management of hyperbilirubinemia, and the use of immunoglobulin therapy and exchange transfusion and transfusion policy. Practical challenges such as resource limitations, timely diagnosis, and the implementation of standardized protocols are highlighted. The review aims to provide a comprehensive overview of the latest evidence to support clinicians in making informed decisions in the management of HDN.
{"title":"Early postnatal management of neonatal RBC alloimmunization","authors":"Debeer A MD, PhD , Vanhole C MD, PhD","doi":"10.1016/j.bpobgyn.2025.102651","DOIUrl":"10.1016/j.bpobgyn.2025.102651","url":null,"abstract":"<div><div>Hemolytic disease of the newborn (HDN) remains a significant clinical challenge in neonatal care. This review focuses on the early postnatal management of HDN and synthesizes current evidence-based recommendations to guide healthcare professionals in optimizing outcomes for affected neonates. Key areas of discussion include the diagnosis and monitoring of HDN, the management of hyperbilirubinemia, and the use of immunoglobulin therapy and exchange transfusion and transfusion policy. Practical challenges such as resource limitations, timely diagnosis, and the implementation of standardized protocols are highlighted. The review aims to provide a comprehensive overview of the latest evidence to support clinicians in making informed decisions in the management of HDN.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102651"},"PeriodicalIF":3.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702445","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 : 2025-07-22DOI: 10.1016/j.bpobgyn.2025.102642
Felicity Martin , Wanda Cui
Premature ovarian insufficiency (POI) leading to infertility and early menopause is a serious potential adverse effect of cancer treatments. There are little robust data regarding the impact of novel classes of cancer treatment on ovarian function and fertility. Although cancer clinical trials collect very detailed information on a range of treatment-related adverse effects, ovarian toxicity is rarely assessed. In 2023, the first international research statement was published regarding assessment of ovarian toxicity in cancer clinical trials, to advocate for routine assessment of ovarian toxicity in cancer trials and to provide information to clinical trial stakeholders on how to do so, so that patients and clinicians have information about the possible long-term effects of treatment on ovarian function to facilitate informed decision-making regarding treatment options. The main recommendations from this statement are: 1) include measurement of ovarian toxicity in relevant clinical trials of anticancer agents in which premenopausal, post-pubertal patients with ovaries are enrolled, 2) collect ovarian function measures at baseline and at 12–24 months after cessation of the anticancer agent, as a minimum, and at later timepoints in line with the trial schedule, 3) include both clinical measures and biomarkers of ovarian function in clinical assessments. This statement is a key first step in prompting clinical trialists to collect ovarian function data routinely and systematically in clinical trials of anticancer agents and will, over time, enhance our understanding of novel anticancer agents and their effects on ovarian toxicity. Future work involves identifying the mechanism of ovarian toxicity for each class of novel cancer therapy, the contribution of other risk factors, such as age, and development of ovarian toxicity protection strategies.
{"title":"Establishing ovarian toxicity assessment in oncology trials","authors":"Felicity Martin , Wanda Cui","doi":"10.1016/j.bpobgyn.2025.102642","DOIUrl":"10.1016/j.bpobgyn.2025.102642","url":null,"abstract":"<div><div>Premature ovarian insufficiency (POI) leading to infertility and early menopause is a serious potential adverse effect of cancer treatments. There are little robust data regarding the impact of novel classes of cancer treatment on ovarian function and fertility. Although cancer clinical trials collect very detailed information on a range of treatment-related adverse effects, ovarian toxicity is rarely assessed. In 2023, the first international research statement was published regarding assessment of ovarian toxicity in cancer clinical trials, to advocate for routine assessment of ovarian toxicity in cancer trials and to provide information to clinical trial stakeholders on how to do so, so that patients and clinicians have information about the possible long-term effects of treatment on ovarian function to facilitate informed decision-making regarding treatment options. The main recommendations from this statement are: 1) include measurement of ovarian toxicity in relevant clinical trials of anticancer agents in which premenopausal, post-pubertal patients with ovaries are enrolled, 2) collect ovarian function measures at baseline and at 12–24 months after cessation of the anticancer agent, as a minimum, and at later timepoints in line with the trial schedule, 3) include both clinical measures and biomarkers of ovarian function in clinical assessments. This statement is a key first step in prompting clinical trialists to collect ovarian function data routinely and systematically in clinical trials of anticancer agents and will, over time, enhance our understanding of novel anticancer agents and their effects on ovarian toxicity. Future work involves identifying the mechanism of ovarian toxicity for each class of novel cancer therapy, the contribution of other risk factors, such as age, and development of ovarian toxicity protection strategies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102642"},"PeriodicalIF":3.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702446","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 : 2025-07-18DOI: 10.1016/j.bpobgyn.2025.102640
Harmonie B. Strohl, Nguyen T. Do, H. Irene Su
One in 20 cancers occurs in children, adolescents, and young adults, with some treatments leading to infertility or premature ovarian insufficiency. Cancer survivors and clinicians seek to estimate reproductive risks to guide fertility preservation and manage ovarian health post-treatment. Available data focus more on surrogate outcomes like amenorrhea and ovarian reserve markers than clinical outcomes such as ovarian insufficiency. Tools like the Cancer-Related Infertility Score Predictor (CRISP) and FDA-recommended data sources, including the FDA Adverse Event Reporting System, provide guidance on known ovarian toxicity risks. However, many novel and current cancer treatments lack comprehensive data. Emerging strategies include using real-world administrative data linked with lab results to estimate risks, large language models to streamline systematic reviews, regulatory guidance requiring ovarian toxicity data in new drug trials, and ex vivo ovary models for testing. This review highlights the need for improved methods and consistent assessment to support the reproductive health of young cancer survivors.
{"title":"Current and emerging data sources for assessment of ovarian toxicity in children, adolescents and young adults with cancer","authors":"Harmonie B. Strohl, Nguyen T. Do, H. Irene Su","doi":"10.1016/j.bpobgyn.2025.102640","DOIUrl":"10.1016/j.bpobgyn.2025.102640","url":null,"abstract":"<div><div>One in 20 cancers occurs in children, adolescents, and young adults, with some treatments leading to infertility or premature ovarian insufficiency. Cancer survivors and clinicians seek to estimate reproductive risks to guide fertility preservation and manage ovarian health post-treatment. Available data focus more on surrogate outcomes like amenorrhea and ovarian reserve markers than clinical outcomes such as ovarian insufficiency. Tools like the Cancer-Related Infertility Score Predictor (CRISP) and FDA-recommended data sources, including the FDA Adverse Event Reporting System, provide guidance on known ovarian toxicity risks. However, many novel and current cancer treatments lack comprehensive data. Emerging strategies include using real-world administrative data linked with lab results to estimate risks, large language models to streamline systematic reviews, regulatory guidance requiring ovarian toxicity data in new drug trials, and ex vivo ovary models for testing. This review highlights the need for improved methods and consistent assessment to support the reproductive health of young cancer survivors.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102640"},"PeriodicalIF":3.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679192","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 : 2025-07-17DOI: 10.1016/j.bpobgyn.2025.102641
Diane C. Saunders , Monica M. Laronda
Many individuals with ovaries that utilize fertility preservation because of their progressive disease or gonadotoxic treatment must use ovarian tissue cryopreservation (OTC). Currently, the only option for fertility and hormone restoration after OTC is ovarian tissue transplantation (OTT), or autologous grafting of ovarian tissue. Individuals with disease in their ovaries do not have options to produce a biological child or restore their full ovarian hormone milieu. The goal of developing a bioprosthetic ovary would support full fertility and hormone restoration long-term as a safer and ideally more efficient option than current OTT techniques. In order to develop a bioprosthetic ovary, the field must understand how to control the rate of primordial follicle activation and support the follicle growth through development and maturation into a good quality egg. The follicular microenvironment changes across the lifespan and the growing oocyte is surrounded by a different microenvironment as it is localized in different compartments within the ovary over folliculogenesis. The human ovarian interstitial cells, scaffold proteins and the juxtracrine, paracrine and endocrine signals that influence folliculogenesis are just being realized with the increased data generated by mapping technologies. Recent research has utilized bioengineering tools to interrogate these follicular microenvironment components and better understand the components that are necessary and sufficient to sustain folliculogenesis and produce good quality eggs. However, there are several biological, scalability and regulatory hurdles to overcome in order to realize a bioprosthetic ovary, including the ability to isolate sufficient primordial follicles from their dense stroma while maintaining their quiescence and subsequent transplant longevity. This chapter reviews these components and encourages researchers to continue on these research quests to increase the foundational understanding of human folliculogenesis and develop near-future solutions for infertility on the way to developing the ideal bioprosthetic ovary.
{"title":"Engineering strategies and challenges in building the follicular microenvironment for a bioprosthetic ovary","authors":"Diane C. Saunders , Monica M. Laronda","doi":"10.1016/j.bpobgyn.2025.102641","DOIUrl":"10.1016/j.bpobgyn.2025.102641","url":null,"abstract":"<div><div>Many individuals with ovaries that utilize fertility preservation because of their progressive disease or gonadotoxic treatment must use ovarian tissue cryopreservation (OTC). Currently, the only option for fertility and hormone restoration after OTC is ovarian tissue transplantation (OTT), or autologous grafting of ovarian tissue. Individuals with disease in their ovaries do not have options to produce a biological child or restore their full ovarian hormone milieu. The goal of developing a bioprosthetic ovary would support full fertility and hormone restoration long-term as a safer and ideally more efficient option than current OTT techniques. In order to develop a bioprosthetic ovary, the field must understand how to control the rate of primordial follicle activation and support the follicle growth through development and maturation into a good quality egg. The follicular microenvironment changes across the lifespan and the growing oocyte is surrounded by a different microenvironment as it is localized in different compartments within the ovary over folliculogenesis. The human ovarian interstitial cells, scaffold proteins and the juxtracrine, paracrine and endocrine signals that influence folliculogenesis are just being realized with the increased data generated by mapping technologies. Recent research has utilized bioengineering tools to interrogate these follicular microenvironment components and better understand the components that are necessary and sufficient to sustain folliculogenesis and produce good quality eggs. However, there are several biological, scalability and regulatory hurdles to overcome in order to realize a bioprosthetic ovary, including the ability to isolate sufficient primordial follicles from their dense stroma while maintaining their quiescence and subsequent transplant longevity. This chapter reviews these components and encourages researchers to continue on these research quests to increase the foundational understanding of human folliculogenesis and develop near-future solutions for infertility on the way to developing the ideal bioprosthetic ovary.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102641"},"PeriodicalIF":4.1,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772552","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}
The global unmet need for contraception continues to be unacceptably high at 218 million. The vast majority of these are women living in low and middle income countries, with a particularly high unmet need in the postpartum period. The FIGO PPIUD initiative demonstrated that it is feasible to embed counselling on contraception and insertion of PPIUD in maternity services. Implementation of these services was greatly enhanced by ensuring that counselling was culturally sensitive and appropriately given through specifically trained individuals, that task sharing was maximized in order to increase access, and that a high fundal placement was achieved resulting in low expulsion rates. Financing for contraception in LMICs is currently precarious and vulnerable to international politics. PPIUD is highly cost-effective. Expansion of contraception services including PPIUD has the potential to impact positively on climate change and a country's development profile if expanded on a large scale.
{"title":"Innovations and strategies for effective implementation of post pregnancy contraception services: Learnings from the FIGO PPIUD initiative","authors":"Anita Makins , Suzanna Bright , Emily-Anne Tunnacliffe , Sabaratnam Arulkumaran","doi":"10.1016/j.bpobgyn.2025.102639","DOIUrl":"10.1016/j.bpobgyn.2025.102639","url":null,"abstract":"<div><div>The global unmet need for contraception continues to be unacceptably high at 218 million. The vast majority of these are women living in low and middle income countries, with a particularly high unmet need in the postpartum period. The FIGO PPIUD initiative demonstrated that it is feasible to embed counselling on contraception and insertion of PPIUD in maternity services. Implementation of these services was greatly enhanced by ensuring that counselling was culturally sensitive and appropriately given through specifically trained individuals, that task sharing was maximized in order to increase access, and that a high fundal placement was achieved resulting in low expulsion rates. Financing for contraception in LMICs is currently precarious and vulnerable to international politics. PPIUD is highly cost-effective. Expansion of contraception services including PPIUD has the potential to impact positively on climate change and a country's development profile if expanded on a large scale.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102639"},"PeriodicalIF":3.9,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633905","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 : 2025-07-11DOI: 10.1016/j.bpobgyn.2025.102638
Myriam Safrai , Ellen Goossens , Rod T. Mitchell , Kyle E. Orwig , Callista L. Mulder , Ans M.M. van Pelt , Debra A. Gook , Aurélie Feraille , Emily Delgouffe , Jill P. Ginsberg , Jan-Bernd Stukenborg , Kathleen Duffin , Kirsi Jahnukainen , Claus Yding Andersen , Marianne D. van de Wetering , Michael P. Rimmer , Virginie Barraud-Lange , Nina Neuhaus , Sheila Lane , Hooman Sadri-Ardekani , Christine Wyns
Transplantations of cryopreserved immature testicular tissue (ITT) or spermatogonial stem cells (SSCs) represent promising approaches to restore fertility in patients with testicular tissue or cell suspension cryopreserved for fertility preservation. With over 3000 testicular samples cryopreserved globally, clinically viable and standardized protocols restoring fertility using cryopreserved testicular tissue/cells are urgently needed. Decades of research demonstrate the feasibility of immature testicular tissue transplantation (ITTT) or spermatogonial stem cell transplantation (SSCT) in animal models, including non-human primates. However, significant challenges remain in translating these options to human clinical practice.
Critical factors include rigorous patient selection, robust pre-transplant evaluations to mitigate risks of malignant cell reintroduction, and the optimization of transplantation timing to support spermatogenesis. Developing comprehensive follow-up protocols and international data-sharing frameworks is essential to optimize outcomes. While offering the potential for genetic parenthood and enhanced quality of life for cancer survivors, these techniques require further refinement to ensure safety, efficacy, and realistic expectations. This paper outlines the framework for advancing the clinical translation of autotransplantation of testicular tissue/cells through collaboration and innovation.
{"title":"Is the time right for transplanting immature testicular tissue or cells to restore male fertility? Expert perspectives on clinical implementation of autotransplantation of cryopreserved testicular tissue or cells for fertility restoration","authors":"Myriam Safrai , Ellen Goossens , Rod T. Mitchell , Kyle E. Orwig , Callista L. Mulder , Ans M.M. van Pelt , Debra A. Gook , Aurélie Feraille , Emily Delgouffe , Jill P. Ginsberg , Jan-Bernd Stukenborg , Kathleen Duffin , Kirsi Jahnukainen , Claus Yding Andersen , Marianne D. van de Wetering , Michael P. Rimmer , Virginie Barraud-Lange , Nina Neuhaus , Sheila Lane , Hooman Sadri-Ardekani , Christine Wyns","doi":"10.1016/j.bpobgyn.2025.102638","DOIUrl":"10.1016/j.bpobgyn.2025.102638","url":null,"abstract":"<div><div>Transplantations of cryopreserved immature testicular tissue (ITT) or spermatogonial stem cells (SSCs) represent promising approaches to restore fertility in patients with testicular tissue or cell suspension cryopreserved for fertility preservation. With over 3000 testicular samples cryopreserved globally, clinically viable and standardized protocols restoring fertility using cryopreserved testicular tissue/cells are urgently needed. Decades of research demonstrate the feasibility of immature testicular tissue transplantation (ITTT) or spermatogonial stem cell transplantation (SSCT) in animal models, including non-human primates. However, significant challenges remain in translating these options to human clinical practice.</div><div>Critical factors include rigorous patient selection, robust pre-transplant evaluations to mitigate risks of malignant cell reintroduction, and the optimization of transplantation timing to support spermatogenesis. Developing comprehensive follow-up protocols and international data-sharing frameworks is essential to optimize outcomes. While offering the potential for genetic parenthood and enhanced quality of life for cancer survivors, these techniques require further refinement to ensure safety, efficacy, and realistic expectations. This paper outlines the framework for advancing the clinical translation of autotransplantation of testicular tissue/cells through collaboration and innovation.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102638"},"PeriodicalIF":3.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670586","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 : 2025-06-27DOI: 10.1016/j.bpobgyn.2025.102629
Emma Greenberg , Katya Strage , Noelle Ozimek , Kamilah Abdur-Rashid , Guluzar Turan , Sarah Milgrom , Leslie Appiah
Advancements in cancer treatments and associated increased survival rates have led to a growing number of girls and women facing reproductive health challenges as a result of their oncologic treatments. Radiation and chemotherapy have been demonstrated to have adverse effects on fertility. Ovarian damage as a result of radiation and chemotherapy has been the subject of extensive study. Less well understood are the uterine changes mediated by these treatment modalities. Uterine damage from radiation therapy is related to dose, regimen, and patient age. Certain chemotherapies have demonstrated similar effects. Women with uterine damage have a lower likelihood of conceiving and a higher risk of pregnancy complications, including early pregnancy loss, preterm labor, and low birth weight infants. Surgical, medical, and genetic therapies are being evaluated to protect the uterus from treatment-related injury. Pre- and post-treatment consultation with oncofertility specialists is critical in assessing a patient's risk of uterine injury from a proposed cancer treatment plan as well as understanding treatment-induced injury to optimize fertility preservation.
{"title":"The effects of cancer treatments on uterine function","authors":"Emma Greenberg , Katya Strage , Noelle Ozimek , Kamilah Abdur-Rashid , Guluzar Turan , Sarah Milgrom , Leslie Appiah","doi":"10.1016/j.bpobgyn.2025.102629","DOIUrl":"10.1016/j.bpobgyn.2025.102629","url":null,"abstract":"<div><div>Advancements in cancer treatments and associated increased survival rates have led to a growing number of girls and women facing reproductive health challenges as a result of their oncologic treatments. Radiation and chemotherapy have been demonstrated to have adverse effects on fertility. Ovarian damage as a result of radiation and chemotherapy has been the subject of extensive study. Less well understood are the uterine changes mediated by these treatment modalities. Uterine damage from radiation therapy is related to dose, regimen, and patient age. Certain chemotherapies have demonstrated similar effects. Women with uterine damage have a lower likelihood of conceiving and a higher risk of pregnancy complications, including early pregnancy loss, preterm labor, and low birth weight infants. Surgical, medical, and genetic therapies are being evaluated to protect the uterus from treatment-related injury. Pre- and post-treatment consultation with oncofertility specialists is critical in assessing a patient's risk of uterine injury from a proposed cancer treatment plan as well as understanding treatment-induced injury to optimize fertility preservation.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102629"},"PeriodicalIF":3.9,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563621","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 : 2025-06-18DOI: 10.1016/j.bpobgyn.2025.102627
Britt Kempener , Emma Janssen , Jonas Ellerbrock , Chahinda Ghossein-Doha , Robert-Jan Alers , Jolijn Meex-van Neer , Gwyneth Jansen , Relinde Roumen , Philine Birkendahl , Sander van Kuijk , Sabine Landewé-Cleuren , Annemie van Haarlem , Jeanine Pinxt-Claessens , Angelique Hugens , Karen van Mechelen , Marc Spaanderman
Preeclampsia is thought to be superimposed upon cardiovascular and cardiometabolic risk factors, predominantly consistent with the metabolic syndrome. In this study, we developed and internally validated a prediction model for the development of later preeclampsia in pregnant women at routine second-trimester oral glucose tolerance testing.
Data were collected during a prospective clinical cohort study, including pregnant women undergoing routine gestational diabetes mellitus (GDM) screening. Routine clinical data during the GDM screening (e.g., oral glucose tolerance test) were considered as potential predictors. Univariable and multivariable logistic regression with Backward Wald elimination were performed to develop the prediction model. Internal validation was performed using bootstrapping. Predictive performance of the final model was evaluated in terms of discrimination and calibration, both before and after adjusting for overfitting.
Of 3227 pregnant women undergoing GDM screening, 137 (4.2 %) subsequently developed preeclampsia. The final prediction model included obstetric history of preeclampsia (yes/no), history of large for gestational age (yes/no), current antihypertensive drug use (yes/no), diastolic blood pressure (mmHg), fasting serum creatinine (μmol/l), fasting serum triglycerides (mmol/l), and urinary protein-creatinine ratio (g/mol creatinine). The area under the receiver operating characteristic curve of the model was 0.79 before and after internal validation, with good model calibration.
Upon external validation and impact analysis, the proposed second-trimester preeclampsia prediction model enables accurate estimation of individuals risk on predominantly later third trimester development of preeclampsia. The model could facilitate timely, tailored monitoring and early intervention among pregnant women at risk to improve pregnancy outcomes.
{"title":"Routine mid-gestational prediction of later preeclampsia","authors":"Britt Kempener , Emma Janssen , Jonas Ellerbrock , Chahinda Ghossein-Doha , Robert-Jan Alers , Jolijn Meex-van Neer , Gwyneth Jansen , Relinde Roumen , Philine Birkendahl , Sander van Kuijk , Sabine Landewé-Cleuren , Annemie van Haarlem , Jeanine Pinxt-Claessens , Angelique Hugens , Karen van Mechelen , Marc Spaanderman","doi":"10.1016/j.bpobgyn.2025.102627","DOIUrl":"10.1016/j.bpobgyn.2025.102627","url":null,"abstract":"<div><div>Preeclampsia is thought to be superimposed upon cardiovascular and cardiometabolic risk factors, predominantly consistent with the metabolic syndrome. In this study, we developed and internally validated a prediction model for the development of later preeclampsia in pregnant women at routine second-trimester oral glucose tolerance testing.</div><div>Data were collected during a prospective clinical cohort study, including pregnant women undergoing routine gestational diabetes mellitus (GDM) screening. Routine clinical data during the GDM screening (e.g., oral glucose tolerance test) were considered as potential predictors. Univariable and multivariable logistic regression with Backward Wald elimination were performed to develop the prediction model. Internal validation was performed using bootstrapping. Predictive performance of the final model was evaluated in terms of discrimination and calibration, both before and after adjusting for overfitting.</div><div>Of 3227 pregnant women undergoing GDM screening, 137 (4.2 %) subsequently developed preeclampsia. The final prediction model included obstetric history of preeclampsia (yes/no), history of large for gestational age (yes/no), current antihypertensive drug use (yes/no), diastolic blood pressure (mmHg), fasting serum creatinine (μmol/l), fasting serum triglycerides (mmol/l), and urinary protein-creatinine ratio (g/mol creatinine). The area under the receiver operating characteristic curve of the model was 0.79 before and after internal validation, with good model calibration.</div><div>Upon external validation and impact analysis, the proposed second-trimester preeclampsia prediction model enables accurate estimation of individuals risk on predominantly later third trimester development of preeclampsia. The model could facilitate timely, tailored monitoring and early intervention among pregnant women at risk to improve pregnancy outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102627"},"PeriodicalIF":3.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364974","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 : 2025-06-17DOI: 10.1016/j.bpobgyn.2025.102628
Ana Carocha , Maria Vicente , Joana Bernardeco , Cláudia Rijo , Álvaro Cohen , Jader Cruz
The second-trimester ultrasound is a crucial tool in prenatal care, typically conducted between 18 and 24 weeks of gestation to evaluate fetal anatomy, growth, and mid-trimester screening. This article provides a comprehensive overview of the best practices and guidelines for performing this examination, with a focus on detecting fetal anomalies.
The ultrasound assesses key structures and evaluates fetal growth by measuring biometric parameters, which are essential for estimating fetal weight. Additionally, the article discusses the importance of placental evaluation, amniotic fluid levels measurement, and the risk of preterm birth through cervical length measurements. Factors that can affect the accuracy of the scan, such as the skill of the operator, the quality of the equipment, and maternal conditions such as obesity, are discussed. The article also addresses the limitations of the procedure, including variability in detection.
Despite these challenges, the second-trimester ultrasound remains a valuable screening and diagnostic tool, providing essential information for managing pregnancies, especially in high-risk cases. Future directions include improving imaging technology, integrating artificial intelligence for anomaly detection, and standardizing ultrasound protocols to enhance diagnostic accuracy and ensure consistent prenatal care.
{"title":"2nd trimester ultrasound (anomaly)","authors":"Ana Carocha , Maria Vicente , Joana Bernardeco , Cláudia Rijo , Álvaro Cohen , Jader Cruz","doi":"10.1016/j.bpobgyn.2025.102628","DOIUrl":"10.1016/j.bpobgyn.2025.102628","url":null,"abstract":"<div><div>The second-trimester ultrasound is a crucial tool in prenatal care, typically conducted between 18 and 24 weeks of gestation to evaluate fetal anatomy, growth, and mid-trimester screening. This article provides a comprehensive overview of the best practices and guidelines for performing this examination, with a focus on detecting fetal anomalies.</div><div>The ultrasound assesses key structures and evaluates fetal growth by measuring biometric parameters, which are essential for estimating fetal weight. Additionally, the article discusses the importance of placental evaluation, amniotic fluid levels measurement, and the risk of preterm birth through cervical length measurements. Factors that can affect the accuracy of the scan, such as the skill of the operator, the quality of the equipment, and maternal conditions such as obesity, are discussed. The article also addresses the limitations of the procedure, including variability in detection.</div><div>Despite these challenges, the second-trimester ultrasound remains a valuable screening and diagnostic tool, providing essential information for managing pregnancies, especially in high-risk cases. Future directions include improving imaging technology, integrating artificial intelligence for anomaly detection, and standardizing ultrasound protocols to enhance diagnostic accuracy and ensure consistent prenatal care.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102628"},"PeriodicalIF":3.9,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313702","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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