Current Opinion in Obstetrics & Gynecology最新文献

Purpose of review: Mesothelin (MSLN) is a CA125-binding surface glycoprotein that mediates cell adhesion and peritoneal metastasis development in mesothelioma, high-grade serous ovarian cancer (HGSOC), pancreatic ductal adenocarcinoma, and cholangiocarcinoma.

Recent findings: Because of its tumor-restricted expression and functional role in dissemination, MSLN is represents an attractive molecule to target in solid tumors. Several antibody-based therapeutic agents, vaccine and chimeric antigen receptor therapy directed against MSLN are object of clinical evaluation. MSLN-targeted therapies are limited by antigen shedding and on-target/off-target effects.

Summary: MSLN is expressed in solid tumor patients, with no differences in expression among histologies. MSLN expression is associated with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage and platinum sensitivity. Higher MSLN expression is detected among primary ovarian cancer patients and correlates with better survival data in HGSOC patients only. According to our data, treatment strategies targeting MSLN should be offered in first line setting rather than in relapse.

Purpose of review: This review focuses on the clinical and ethical complexities of managing pregnancies between 20 and 25 weeks and 6 days of gestation, known as periviability, where fetal survival is uncertain and viability cannot be uniformly defined.

Recent findings: Recent literature highlights that outcomes during periviability depend on a constellation of factors, including gestational age, fetal weight, institutional resources, and access to neonatal intensive care. Advances in neonatal and obstetric care have pushed the threshold of viability earlier, but survival and morbidity remain highly variable. The diagnosis of life-limiting fetal anomalies or severe maternal complications during this time frequently necessitates urgent decision-making around abortion. Legal changes post- Dobbs have further complicated access to abortion care. Additionally, new recommendations surrounding feticidal injection are highlighted. Studies also emphasize that parental decisions are guided more by intuitive beliefs than by statistics alone, underscoring the importance of values-based counseling.

Summary: Periviability challenges clinicians to balance medical, legal, and ethical considerations while supporting patients through highly individualized, time-sensitive decisions. A shared decision-making model grounded in ethical principles is essential. Ongoing dialogue and refined, patient-centered guidelines are needed to ensure compassionate, equitable, and evidence-based care at the threshold of viability.

Purpose of review: This review highlights the evolving role of ultrasound in family planning clinics. Given the increasing complexity of contraceptive management, abortion care, and early pregnancy assessments, understanding the utility of both traditional and point-of-care ultrasound (POCUS) is timely and relevant for improving patient outcomes and enhancing clinical efficiency.

Recent findings: The literature indicates that ultrasound significantly aids in intrauterine device (IUD) placement, localization, and removal, particularly with challenging anatomy. Studies suggest that ultrasound guidance can reduce procedure times, pain, and complications associated with IUD insertions. In addition, the review discusses the role of ultrasound in nonpalpable contraceptive implant removals and the use of ultrasound in abortion care, where it may enhance safety and efficacy. Early pregnancy assessments using ultrasound are also reviewed, with findings supporting its use in diagnosing ectopic pregnancies and early pregnancy loss.

Summary: The findings highlight the importance of integrating ultrasound into routine clinical practice for family planning and early pregnancy care. By facilitating rapid diagnosis and management within a single visit, POCUS can potentially reduce emergency department utilization and improve patient satisfaction. Future research should focus on standardizing ultrasound protocols and exploring its broader applications in reproductive health to further enhance clinical outcomes.

Purpose of review: Although ample evidence demonstrates the safety and effectiveness of medication abortion, its safety in individuals with anemia is not well understood; modern literature describing quantitative blood loss from medication abortion is limited. As medication abortion is increasingly utilized, reviewing current guidelines and literature related to anemia and blood loss from medication abortion may help inform practice and future research.

Recent findings: Guidelines have not established a safe minimum level of starting hemoglobin for medication abortion or a single standard for the provision of medication abortion in the setting of anemia. Studies assessing blood loss from early medication abortion report a low mean decrease in hemoglobin (0.1-0.7 g/dl); however, these studies used a variety of medication regimens, and most exclude individuals with significant anemia (hemoglobin < 9.5-10 g/dl) and gestational duration greater than 63 days.

Summary: Communities most severely impacted by abortion restrictions and bans also experience significantly higher rates of anemia. Guidelines that restrict medication abortion to patients who meet arbitrary hemoglobin cutoffs can lead to delays and barriers to care. Studies using current medication regimens and including patients with moderate-to-severe anemia and gestational duration greater than 63 days are needed to inform eligibility and safety, and support provider buy-in and equity.

Purpose of review: Transgender and gender diverse (TGD) individuals assigned female at birth have specific contraceptive needs that are often unmet. This can be because of bias, systemic barriers, and misinformation as this field continues to grow. As the TGD population increases, there remains a need for evidence-based guidance on gender-affirming, comprehensive contraceptive counseling.

Recent findings: TGD patients may pursue contraception for pregnancy prevention, menstrual suppression, or gender affirmation. Testosterone is not an approved form of contraception, so TGD patients on testosterone may choose other hormonal contraceptive options with side effects that may help alleviate gender dysphoria. Limited provider training and structural obstacles, such as insurance limitations and gendered clinical environments, continue to be barriers to care. Appropriate TGD care involves a trauma-informed, autonomy-centered approach to contraceptive counseling.

Summary: Providing high-quality contraceptive care to TGD patients requires individualized, affirming, and evidence-based counseling. Understanding the interaction between gender identity, reproductive goals, and contraceptive methods is essential. Clinicians must adopt inclusive practices and advocate for expanded research and policy reform to reduce disparities and support reproductive autonomy for TGD individuals.

Purpose of review: There is limited data on contraceptive options in the setting of gynecologic and breast dysplasia. Despite this, many patients who report a history of these precancers retain their reproductive organs and seek contraception to avoid pregnancy. These patients require evidence-based counseling to guide their contraceptive choices, particularly in the setting of hormonally driven pathology.

Recent findings: In this review article, we outline known data on contraceptive options for patients with borderline ovarian tumors, endometrial hyperplasia, cervical/vulvar dysplasia, and atypical lobular and ductal hyperplasia. We also identify gaps in knowledge and opportunities for further research.

Summary: Patients with gynecologic and breast dysplasia benefit from comprehensive contraception counseling. More research is needed on contraceptive options for patients with dysplasia.

Purpose of review: To synthesize the current literature regarding the evaluation and management of genitourinary fistula in women.

Recent findings: Genitourinary fistula are aberrant communications between the urinary tract and genital tract that present with urinary leakage per the vagina. Initial management often involves conservative measures, such as urethral catheter or ureteral stent placement, progressing to surgical repair when needed. Key surgical principles include a tension-free, watertight closure with well-vascularized tissue including tissue interposition as appropriate, and postoperative urinary drainage. When surgical management of vesicovaginal fistula is necessary, a transvaginal repair is the most common. Other minimally invasive approaches are increasing and result in similarly high success rates with lower patient morbidity compared to open abdominal surgeries. The initial management of ureterovaginal fistula commonly includes ureteral stent placement. When not feasible or in persistent fistula, laparoscopic and robotic surgical repair with ureteral reconstruction offers high success rates with lower morbidity than an open approach.

Summary: Successful management of genitourinary fistula ranges from conservative urinary tract drainage to surgical interventions based on etiology, location, and complexity. Approaches to repair are shifting toward less invasive procedures. With optimal technique and surgical planning, high success rates can be achieved, particularly in primary repairs.

Purpose of review: Social networks, now including social media platforms, are increasingly important sources of health information for many patients, particularly patients of reproductive age. Observing and understanding conversations about contraception happening on social media can help clinicians address patient concerns and misinformation.

Recent findings: Studies evaluating social media posts on contraception have found the most popular methods discussed across platforms are intrauterine devices and oral contraceptive pills. Side effects are the most frequently discussed topic on all social media formats, with negative effects discussed much more frequently than benefits. People viewing social media are often more drawn to posts around the logistics of contraception. Most videos are created by nonhealthcare professionals and are more likely to contain misinformation than videos created by healthcare professionals.

Summary: Social media is an important tool that patients are using to access information about contraception. Physicians and clinicians should understand the themes patients are discussing so that they can address them in counseling. Physicians, clinicians, and healthcare organizations should consider contributing high-quality information to social media to improve accuracy and counter misinformation.

Purpose of review: Multicompartment pelvic organ prolapse, including concurrent rectal and vaginal prolapse, is increasingly recognized in aging populations. This review summarizes recent advances in diagnostic imaging, multidisciplinary evaluation, and surgical techniques for combined repair.

Recent findings: Multicompartment prolapse is increasingly prevalent and often underrecognized without coordinated evaluation. Dynamic defecography, particularly upright or MRI-based, improves detection of multicompartment descent. Minimally invasive combined sacrocolpopexy (SCP) and ventral mesh rectopexy (VMR) is increasingly used with favorable outcomes. Surgical series report low complication rates and suggest a potential reduction in prolapse recurrence with combined repair. Robotic platforms, including newer systems, enhance precision, and visualization. Emerging techniques include laparoscopic resection rectopexy with SCP and selective use of biologic mesh. Multidisciplinary care improves coordination and recurrence prevention.

Summary: Contemporary management of multicompartment prolapse requires a collaborative, patient-centered approach. Advances in imaging and minimally invasive surgery, particularly robotic SCP and VMR, have improved outcomes. Future research should focus on standardizing techniques, optimizing mesh configurations, and long-term functional results.