Pub Date : 2025-06-16DOI: 10.1016/j.bpobgyn.2025.102626
Gian Paolo Novelli , Barbara Vasapollo , Marco Silvestrini , Fabio Bertoldo , Chiara Maria Pia Biscosi , Filomena Maellaro , Francesca Pometti , Daniele Farsetti , Herbert Valensise
Hypertensive disorders of pregnancy show different maternal hemodynamic and cardiovascular profiles going from a hyperdynamic to a hypodynamic condition. These different maternal cardiovascular situations might evolve towards different outcomes and might require targeted approaches. In particular, a hypodynamic maternal cardiovascular profile might be associated to severe and early complications of pregnancy (in particular fetal growth restriction, either isolated or associated to hypertensive disorders of pregnancy). This condition is characterized by a constriction of the vessels and a low plasma volume with low cardiac output and stroke volume. The assessment of the maternal hemodynamic condition requires an echocardiographic evaluation or the use of other non invasive devices, but in the absence of these instruments there is also a simple clinical method that can give us an idea of the maternal hemodynamic profile of the mother: the measurement of blood pressure and heart rate. In a hypodynamic low cardiac output condition, the choice of drugs that might reduce cardiac output and myocardial contractility to lower blood pressure might be irrational, whereas pharmacological interventions that directly act on the vessels reducing vasoconstriction, such as dihydropyridine calcium channel blockers and nitric oxide donors, might be more appropriate. This hemodynamic guided approach to therapy might have positive effect not only on maternal hemodynamics, but also on the fetal side, probably reducing or mitigating maternal and fetal complications.
{"title":"Definition, identification, implications and management of hypodynamic hypertension in pregnancy","authors":"Gian Paolo Novelli , Barbara Vasapollo , Marco Silvestrini , Fabio Bertoldo , Chiara Maria Pia Biscosi , Filomena Maellaro , Francesca Pometti , Daniele Farsetti , Herbert Valensise","doi":"10.1016/j.bpobgyn.2025.102626","DOIUrl":"10.1016/j.bpobgyn.2025.102626","url":null,"abstract":"<div><div>Hypertensive disorders of pregnancy show different maternal hemodynamic and cardiovascular profiles going from a hyperdynamic to a hypodynamic condition. These different maternal cardiovascular situations might evolve towards different outcomes and might require targeted approaches. In particular, a hypodynamic maternal cardiovascular profile might be associated to severe and early complications of pregnancy (in particular fetal growth restriction, either isolated or associated to hypertensive disorders of pregnancy). This condition is characterized by a constriction of the vessels and a low plasma volume with low cardiac output and stroke volume. The assessment of the maternal hemodynamic condition requires an echocardiographic evaluation or the use of other non invasive devices, but in the absence of these instruments there is also a simple clinical method that can give us an idea of the maternal hemodynamic profile of the mother: the measurement of blood pressure and heart rate. In a hypodynamic low cardiac output condition, the choice of drugs that might reduce cardiac output and myocardial contractility to lower blood pressure might be irrational, whereas pharmacological interventions that directly act on the vessels reducing vasoconstriction, such as dihydropyridine calcium channel blockers and nitric oxide donors, might be more appropriate. This hemodynamic guided approach to therapy might have positive effect not only on maternal hemodynamics, but also on the fetal side, probably reducing or mitigating maternal and fetal complications.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102626"},"PeriodicalIF":3.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313701","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 : 2025-06-05DOI: 10.1016/j.bpobgyn.2025.102618
Barbara Vasapollo , Gian Paolo Novelli , Daniele Farsetti , Francesca Pometti , Giulia Gagliardi , Simonetta Picone , Vito Mondì , Herbert Valensise
Fetal growth restriction is a challenging condition for the obstetricians associated to neonatal morbidity, unfavorable developmental outcomes, and long-term sequalae for the newborn. Guidelines divide this condition in two subtypes: early and late forms depending on biometric, Doppler parameters, and the gestational age at appearance (before or after 32 weeks gestation).
This condition is associated to a maternal cardiovascular profile detectable in the pre-conceptional period, in the early stages of pregnancy, as well in the second and third trimester of pregnancy.
The maternal cardiovascular alterations are similar in the two subtypes of fetal growth restriction, although they differ in the degree of expression.
Echocardiography and other non invasive cardiovascular devices are very useful for the characterization of the maternal cardiovascular profile, and allow the early identification of patients at risk for this pathological condition.
The particular maternal hemodynamic profile at the base of the development of fetal growth restriction is characterized by a hypovolemic hypodynamic state. This particular cardiovascular condition might be susceptible to be modified by promising non pharmacological and pharmacological interventions, although they need further clinical investigations to be routinely used.
{"title":"Maternal hemodynamics in early and late fetal growth restriction","authors":"Barbara Vasapollo , Gian Paolo Novelli , Daniele Farsetti , Francesca Pometti , Giulia Gagliardi , Simonetta Picone , Vito Mondì , Herbert Valensise","doi":"10.1016/j.bpobgyn.2025.102618","DOIUrl":"10.1016/j.bpobgyn.2025.102618","url":null,"abstract":"<div><div>Fetal growth restriction is a challenging condition for the obstetricians associated to neonatal morbidity, unfavorable developmental outcomes, and long-term sequalae for the newborn. Guidelines divide this condition in two subtypes: early and late forms depending on biometric, Doppler parameters, and the gestational age at appearance (before or after 32 weeks gestation).</div><div>This condition is associated to a maternal cardiovascular profile detectable in the pre-conceptional period, in the early stages of pregnancy, as well in the second and third trimester of pregnancy.</div><div>The maternal cardiovascular alterations are similar in the two subtypes of fetal growth restriction, although they differ in the degree of expression.</div><div>Echocardiography and other non invasive cardiovascular devices are very useful for the characterization of the maternal cardiovascular profile, and allow the early identification of patients at risk for this pathological condition.</div><div>The particular maternal hemodynamic profile at the base of the development of fetal growth restriction is characterized by a hypovolemic hypodynamic state. This particular cardiovascular condition might be susceptible to be modified by promising non pharmacological and pharmacological interventions, although they need further clinical investigations to be routinely used.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102618"},"PeriodicalIF":3.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241085","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 use of intrapartum ultrasound has increased extensively over the last two decades. This increase is mostly driven by its higher accuracy, reliability and intra- and interobserver agreement compared to the traditionally-used vaginal examination for the assessment of several labor parameters. Moreover, it is less invasive, better tolerated by women and has a lower risk of pregnancy-related infections. The most important parameters that can be assessed by intrapartum ultrasound include the fetal head position, station and attitude. In the first section of this review, we explain how to use intrapartum ultrasound to assess these parameters, providing a broad overview of the different available techniques. The second section describes the indications of intrapartum ultrasound and provides some insight on how intrapartum ultrasound may help to improve management of abnormal labor. In the last section, we discuss the future perspectives of intrapartum ultrasound. This includes topics such as the incorporation of new labor parameters, such as maternal pelvimetry, molding and caput succedaneum; the development of “sonopartograms”, and the use of artificial intelligence. This review is intended for obstetricians and midwives involved in daily practice in the labor ward.
{"title":"Intrapartum ultrasound","authors":"Ruben Ramirez Zegarra , Esteban Lizarraga Cepeda , Tullio Ghi","doi":"10.1016/j.bpobgyn.2025.102617","DOIUrl":"10.1016/j.bpobgyn.2025.102617","url":null,"abstract":"<div><div>The use of intrapartum ultrasound has increased extensively over the last two decades. This increase is mostly driven by its higher accuracy, reliability and intra- and interobserver agreement compared to the traditionally-used vaginal examination for the assessment of several labor parameters. Moreover, it is less invasive, better tolerated by women and has a lower risk of pregnancy-related infections. The most important parameters that can be assessed by intrapartum ultrasound include the fetal head position, station and attitude. In the first section of this review, we explain how to use intrapartum ultrasound to assess these parameters, providing a broad overview of the different available techniques. The second section describes the indications of intrapartum ultrasound and provides some insight on how intrapartum ultrasound may help to improve management of abnormal labor. In the last section, we discuss the future perspectives of intrapartum ultrasound. This includes topics such as the incorporation of new labor parameters, such as maternal pelvimetry, molding and caput succedaneum; the development of “sonopartograms”, and the use of artificial intelligence. This review is intended for obstetricians and midwives involved in daily practice in the labor ward.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102617"},"PeriodicalIF":3.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270145","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 : 2025-05-29DOI: 10.1016/j.bpobgyn.2025.102616
Hajra Malik , Brian A. Burnett , Hiba J. Mustafa , Ahmed A. Nassr
Congenital Lower Urinary Tract Obstruction (LUTO) is a rare but severe fetal condition, affecting approximately 2.2 per 10,000 live births. It is associated with complications such as oligohydramnios, pulmonary hypoplasia, and renal dysfunction. Prenatal interventions offer potential benefits in improving perinatal survival, however, selecting the most suitable candidates for interventions has been a challenge.
Recent research emphasizes the evaluation of LUTO patients with a multidisciplinary approach. Criteria for fetal intervention were established in an international Delphi consensus, and includes imaging findings indicative of LUTO, the absence of life-limiting structural or genetic anomalies, gestational age ≥16 weeks, and the presence of oligohydramnios. Although bladder refill and fetal urine biochemistry may provide additional insights into prognosis and counseling, their precise role in candidate selection remains uncertain.
Future research should focus on developing more reliable biomarkers to enhance the evaluation of LUTO and assess renal function.
{"title":"Assessing candidacy for fetal intervention in congenital lower urinary tract obstruction: A comprehensive review","authors":"Hajra Malik , Brian A. Burnett , Hiba J. Mustafa , Ahmed A. Nassr","doi":"10.1016/j.bpobgyn.2025.102616","DOIUrl":"10.1016/j.bpobgyn.2025.102616","url":null,"abstract":"<div><div>Congenital Lower Urinary Tract Obstruction (LUTO) is a rare but severe fetal condition, affecting approximately 2.2 per 10,000 live births. It is associated with complications such as oligohydramnios, pulmonary hypoplasia, and renal dysfunction. Prenatal interventions offer potential benefits in improving perinatal survival, however, selecting the most suitable candidates for interventions has been a challenge.</div><div>Recent research emphasizes the evaluation of LUTO patients with a multidisciplinary approach. Criteria for fetal intervention were established in an international Delphi consensus, and includes imaging findings indicative of LUTO, the absence of life-limiting structural or genetic anomalies, gestational age ≥16 weeks, and the presence of oligohydramnios. Although bladder refill and fetal urine biochemistry may provide additional insights into prognosis and counseling, their precise role in candidate selection remains uncertain.</div><div>Future research should focus on developing more reliable biomarkers to enhance the evaluation of LUTO and assess renal function.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102616"},"PeriodicalIF":3.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241084","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 : 2025-03-27DOI: 10.1016/j.bpobgyn.2025.102598
Daniela Denis Di Martino , Elisa Sabattini , Marco Parasiliti , Lucrezia Viscioni , Elena Zaccone , Serena Cerri , Gabriele Tinè , Enrico Ferrazzi
The best performing predicting Bayesian algorithm for preeclampsia, endorsed by FIGO, identifies high-risk women at first trimester screening who benefits of a closer monitoring and possibly preventive measures. Unfortunately, the most frequent late term and term preeclampsia are less efficiently predicted. This algorithm is based on statistical assumptions at odds with the physiopathology: preeclampsia is a disease and not a syndrome, as we know it is, and the contingent time-based criteria according to which all pregnancies if not terminated by nature should develop this “disease”.
In addition to this, we know that gestational hypertension might cause in fifty percent of cases severe outcome, comparable to preeclampsia. The very definition of preeclampsia as proteinuric hypertension is now extended to hypertension associated with other end-organ damage, including fetal growth restriction (FGR), this latter condition proceeding, in early onset cases, hypertension. Predicting phenotypes of hypertensive Disorders of pregnancy (HDP) could better help clinical practice.
This study reports exploratory observations in women resulted at high and low risk at first trimester screening followed up at second and third trimester, to term. The co-variates interrogated were sFlt1/PlGF ratio, the uterine arteries PI, the systemic vascular resistances (SVR), maternal total body water and visceral fat.
Women were classified as HDP-AGA, HDP-FGR, normotensive-FGR and uneventful pregnancies (controls). We performed a longitudinal Bayesian multivariate mixed-effects model corrected both for pre-gestational BMI and trimester of analysis.
The sFlt-1/PlGF ratio and SVR confirmed their significant difference in HDP-AGA, in normotensive FGR, and HDP-FGR along the three trimesters from controls, but with different strength along the three trimesters.
The bioimpedance analysis of total body water and visceral fat confirmed the association of these co-factors with women who will develop HDP-AGA.
The strength of longitudinal changes observed, even on a limited number of cases, provide evidence that Bayesian algorithms applied at screening tests at different gestational ages, should be based on co-variates significantly associated either with HDP-FGR or with HDP-AGA provided that the main causative co-factors involved are adopted by predictive models aimed at these distinct diseases.
{"title":"Exploring new predictors for hypertensive disorders of pregnancy","authors":"Daniela Denis Di Martino , Elisa Sabattini , Marco Parasiliti , Lucrezia Viscioni , Elena Zaccone , Serena Cerri , Gabriele Tinè , Enrico Ferrazzi","doi":"10.1016/j.bpobgyn.2025.102598","DOIUrl":"10.1016/j.bpobgyn.2025.102598","url":null,"abstract":"<div><div>The best performing predicting Bayesian algorithm for preeclampsia, endorsed by FIGO, identifies high-risk women at first trimester screening who benefits of a closer monitoring and possibly preventive measures. Unfortunately, the most frequent late term and term preeclampsia are less efficiently predicted. This algorithm is based on statistical assumptions at odds with the physiopathology: preeclampsia is a disease and not a syndrome, as we know it is, and the contingent time-based criteria according to which all pregnancies if not terminated by nature should develop this “disease”.</div><div>In addition to this, we know that gestational hypertension might cause in fifty percent of cases severe outcome, comparable to preeclampsia. The very definition of preeclampsia as proteinuric hypertension is now extended to hypertension associated with other end-organ damage, including fetal growth restriction (FGR), this latter condition proceeding, in early onset cases, hypertension. Predicting phenotypes of hypertensive Disorders of pregnancy (HDP) could better help clinical practice.</div><div>This study reports exploratory observations in women resulted at high and low risk at first trimester screening followed up at second and third trimester, to term. The co-variates interrogated were sFlt1/PlGF ratio, the uterine arteries PI, the systemic vascular resistances (SVR), maternal total body water and visceral fat.</div><div>Women were classified as HDP-AGA, HDP-FGR, normotensive-FGR and uneventful pregnancies (controls). We performed a longitudinal Bayesian multivariate mixed-effects model corrected both for pre-gestational BMI and trimester of analysis.</div><div>The sFlt-1/PlGF ratio and SVR confirmed their significant difference in HDP-AGA, in normotensive FGR, and HDP-FGR along the three trimesters from controls, but with different strength along the three trimesters.</div><div>The bioimpedance analysis of total body water and visceral fat confirmed the association of these co-factors with women who will develop HDP-AGA.</div><div>The strength of longitudinal changes observed, even on a limited number of cases, provide evidence that Bayesian algorithms applied at screening tests at different gestational ages, should be based on co-variates significantly associated either with HDP-FGR or with HDP-AGA provided that the main causative co-factors involved are adopted by predictive models aimed at these distinct diseases.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102598"},"PeriodicalIF":3.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747311","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 : 2025-03-22DOI: 10.1016/j.bpobgyn.2025.102604
Luis Bahamondes , M.Valeria Bahamondes , Cassia R.T. Juliato
The provision of long-acting reversible contraceptive (LARC) methods is one of the best tools available to avoid high rates of unplanned pregnancy (UP), a public health problem that affects millions of women worldwide. In this review we provide an update regarding subdermal contraceptive implants including etonogestrel (ENG) and levonorgestrel (LNG) implants. Implants have been shown to be one of the most effective forms of contraceptive, with failure in only 4/1000 women for up to five years. Thus, their provision is an excellent strategy for reducing UPs. After a single intervention, implants provide long-term contraception with minimal side effects. Implants have few contraindications, but care must be taken to check for drug interactions with topiramate, rifampin and efavirenz. Although the ENG implant is approved for up to three years of use, research is ongoing into the possibility of extending its use beyond that period.
{"title":"Subdermal contraceptive implants","authors":"Luis Bahamondes , M.Valeria Bahamondes , Cassia R.T. Juliato","doi":"10.1016/j.bpobgyn.2025.102604","DOIUrl":"10.1016/j.bpobgyn.2025.102604","url":null,"abstract":"<div><div>The provision of long-acting reversible contraceptive (LARC) methods is one of the best tools available to avoid high rates of unplanned pregnancy (UP), a public health problem that affects millions of women worldwide. In this review we provide an update regarding subdermal contraceptive implants including etonogestrel (ENG) and levonorgestrel (LNG) implants. Implants have been shown to be one of the most effective forms of contraceptive, with failure in only 4/1000 women for up to five years. Thus, their provision is an excellent strategy for reducing UPs. After a single intervention, implants provide long-term contraception with minimal side effects. Implants have few contraindications, but care must be taken to check for drug interactions with topiramate, rifampin and efavirenz. Although the ENG implant is approved for up to three years of use, research is ongoing into the possibility of extending its use beyond that period.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102604"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697740","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 : 2025-03-21DOI: 10.1016/j.bpobgyn.2025.102596
Thomas L. Archer
Chronic and recurrent obstruction of the inferior vena cava by the uterus during the second half of pregnancy are theorized to contribute to the causation of preeclampsia, fetal growth restriction, preterm birth, dysfunctional labor and postpartum uterine atony. Such obstruction is hypothesized to be asymptomatic for the mother but can be detected and minimized by non-invasive continuous trending of maternal cardiac output, because positional decreases in cardiac output can serve as a warning signal of obstruction of venous return. Injury may be caused by 1) decreased cardiac output, 2) increased uterine venous and intervillous pressures and 3) decreased intervillous perfusion. Wide variations in intervillous oxygen tension may be more harmful than low but stable oxygen tension. Clinical examples of asymptomatic but dramatic positional changes in maternal cardiac output in hospitalized patients are shown. Further research should begin with laboring patients, since cardiac output changes dramatically over time and with position during labor.
{"title":"Cardiac output-guided maternal positioning in pregnancy-- can it improve outcomes?","authors":"Thomas L. Archer","doi":"10.1016/j.bpobgyn.2025.102596","DOIUrl":"10.1016/j.bpobgyn.2025.102596","url":null,"abstract":"<div><div>Chronic and recurrent obstruction of the inferior vena cava by the uterus during the second half of pregnancy are theorized to contribute to the causation of preeclampsia, fetal growth restriction, preterm birth, dysfunctional labor and postpartum uterine atony. Such obstruction is hypothesized to be asymptomatic for the mother but can be detected and minimized by non-invasive continuous trending of maternal cardiac output, because positional decreases in cardiac output can serve as a <strong><em>warning signal</em></strong> of obstruction of venous return. Injury may be caused by 1) decreased cardiac output, 2) increased uterine venous and intervillous pressures and 3) decreased intervillous perfusion. Wide variations in intervillous oxygen tension may be more harmful than low but stable oxygen tension. Clinical examples of asymptomatic but dramatic positional changes in maternal cardiac output in hospitalized patients are shown. Further research should begin with laboring patients, since cardiac output changes dramatically over time and with position during labor.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102596"},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747310","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 : 2025-03-20DOI: 10.1016/j.bpobgyn.2025.102602
Kenneth J. Moise
There is no widely accepted definition for early onset hemolytic disease of the fetus and newborn (EOS-HDFN). Several reported series of patients managed with intravascular intrauterine transfusions (IVT's) prior to 20–22 weeks' gestation have been associated with a perinatal mortality of 20 %. It would therefore seem appropriate to define EOS-HDFN as a fetal demise, hydrops fetalis or the need for intrauterine transfusion for suspected fetal anemia prior to 20–22 weeks' gestation. Evaluation of the patient in her next pregnancy with EOS-HDFN history should include a free fetal DNA analysis at 10–12 weeks' gestation to confirm the at-risk fetus. Weekly middle cerebral artery peak systolic velocity determinations using Doppler ultrasound should be initiated by 15 weeks' gestation. Immunomodulation with intravenous immune globulin with or without plasmapheresis should be considered as early at 10–12 weeks' gestation. If IUT's are required prior to 20 weeks' gestation, an intraperitoneal approach can be used until a more advanced gestation can be attained when intravascular fetal access is possible. In the near future, neonatal Fc receptor blockade with a monoclonal antibody may supplant invasive IUT's in the treatment of EOS-HDFN.
{"title":"Considerations and approaches for early onset fetal anemia due to red cell alloimmunization","authors":"Kenneth J. Moise","doi":"10.1016/j.bpobgyn.2025.102602","DOIUrl":"10.1016/j.bpobgyn.2025.102602","url":null,"abstract":"<div><div>There is no widely accepted definition for early onset hemolytic disease of the fetus and newborn (EOS-HDFN). Several reported series of patients managed with intravascular intrauterine transfusions (IVT's) prior to 20–22 weeks' gestation have been associated with a perinatal mortality of 20 %. It would therefore seem appropriate to define EOS-HDFN as a fetal demise, hydrops fetalis or the need for intrauterine transfusion for suspected fetal anemia prior to 20–22 weeks' gestation. Evaluation of the patient in her next pregnancy with EOS-HDFN history should include a free fetal DNA analysis at 10–12 weeks' gestation to confirm the at-risk fetus. Weekly middle cerebral artery peak systolic velocity determinations using Doppler ultrasound should be initiated by 15 weeks' gestation. Immunomodulation with intravenous immune globulin with or without plasmapheresis should be considered as early at 10–12 weeks' gestation. If IUT's are required prior to 20 weeks' gestation, an intraperitoneal approach can be used until a more advanced gestation can be attained when intravascular fetal access is possible. In the near future, neonatal Fc receptor blockade with a monoclonal antibody may supplant invasive IUT's in the treatment of EOS-HDFN.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102602"},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759044","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 : 2025-03-20DOI: 10.1016/j.bpobgyn.2025.102597
Johannes J. Duvekot
During pregnancy, most maternal organ systems increase in function or size. This is indeed also the case for cardiovascular function and maternal hemodynamics. Most systems show enormous changes that put a serious strain on these systems. Gestational complications develop when an organ system is unable to meet the increased physiological demands of pregnancy. Pregnancy can be considered as the ultimate stress test for these organ systems. Preeclampsia and gestational hypertension may be considered as a derangement of the hemodynamic and cardiovascular system during pregnancy. During later life the hemodynamic and cardiovascular system again derails when aging has its toll. Cardiovascular morbidity and mortality are greatly increased after pregnancies complicated by hypertensive disorders of pregnancy. These complications must be acknowledged by health care providers as a risk factor for later cardiovascular disease. All women after HDP should be followed scrutinous at least during the first 5–10 years after their deliveries. The focus of the follow-up should be on the development of hypertension. Women with an increased risk are those with early-onset preeclampsia, recurrent preeclampsia and preeclampsia in the last pregnancy. Uncomplicated pregnancies after pregnancies complicated by HDP improve the prognosis substantially. Multiplet pregnancies with HDP tend to have lower risks for CVD in later life than singleton pregnancies with HDP.
{"title":"Do all women after hypertensive diseases of pregnancy have the same long-term risk of cardiovascular disease in later life?","authors":"Johannes J. Duvekot","doi":"10.1016/j.bpobgyn.2025.102597","DOIUrl":"10.1016/j.bpobgyn.2025.102597","url":null,"abstract":"<div><div>During pregnancy, most maternal organ systems increase in function or size. This is indeed also the case for cardiovascular function and maternal hemodynamics. Most systems show enormous changes that put a serious strain on these systems. Gestational complications develop when an organ system is unable to meet the increased physiological demands of pregnancy. Pregnancy can be considered as the ultimate stress test for these organ systems. Preeclampsia and gestational hypertension may be considered as a derangement of the hemodynamic and cardiovascular system during pregnancy. During later life the hemodynamic and cardiovascular system again derails when aging has its toll. Cardiovascular morbidity and mortality are greatly increased after pregnancies complicated by hypertensive disorders of pregnancy. These complications must be acknowledged by health care providers as a risk factor for later cardiovascular disease. All women after HDP should be followed scrutinous at least during the first 5–10 years after their deliveries. The focus of the follow-up should be on the development of hypertension. Women with an increased risk are those with early-onset preeclampsia, recurrent preeclampsia and preeclampsia in the last pregnancy. Uncomplicated pregnancies after pregnancies complicated by HDP improve the prognosis substantially. Multiplet pregnancies with HDP tend to have lower risks for CVD in later life than singleton pregnancies with HDP.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102597"},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-20DOI: 10.1016/j.bpobgyn.2025.102599
J.A. van der Zande , K. Rijs , A.A. Shamshirsaz , H. Soliman , A. Franx , R.M. Kauling , J.W. Roos-Hesselink , C.D. van der Marel , K. Verdonk , J.M.J. Cornette
Point-of-care ultrasound (POCUS) is an increasingly valuable tool in maternal medicine, offering rapid, bedside evaluation of critically ill pregnant patients. This study explores the expanding role of POCUS in obstetric care, particularly its application in assessing different organ systems. POCUS enables timely, accurate diagnoses and interventions, crucial for preventing maternal morbidity and mortality. While POCUS is widely used in emergency and intensive care, its potential in obstetric settings remains underexplored. Maternal and Fetal Medicine specialists, who already possess substantial ultrasound expertise, can easily integrate POCUS in daily practice.
{"title":"The role of point-of-care ultrasound (POCUS) in maternal medicine","authors":"J.A. van der Zande , K. Rijs , A.A. Shamshirsaz , H. Soliman , A. Franx , R.M. Kauling , J.W. Roos-Hesselink , C.D. van der Marel , K. Verdonk , J.M.J. Cornette","doi":"10.1016/j.bpobgyn.2025.102599","DOIUrl":"10.1016/j.bpobgyn.2025.102599","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) is an increasingly valuable tool in maternal medicine, offering rapid, bedside evaluation of critically ill pregnant patients. This study explores the expanding role of POCUS in obstetric care, particularly its application in assessing different organ systems. POCUS enables timely, accurate diagnoses and interventions, crucial for preventing maternal morbidity and mortality. While POCUS is widely used in emergency and intensive care, its potential in obstetric settings remains underexplored. Maternal and Fetal Medicine specialists, who already possess substantial ultrasound expertise, can easily integrate POCUS in daily practice.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102599"},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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