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Intraoperative Management for Enhanced Recovery After Gynecologic Surgery. 提高妇科手术后恢复的术中管理。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-09 DOI: 10.1097/GRF.0000000000000975
Gavin G Ovsak, Gabriel E Mena, Javier D Lasala
{"title":"Intraoperative Management for Enhanced Recovery After Gynecologic Surgery.","authors":"Gavin G Ovsak, Gabriel E Mena, Javier D Lasala","doi":"10.1097/GRF.0000000000000975","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000975","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) protocols have revolutionized perioperative care, aiming to reduce surgical stress and expedite recovery. In gynecologic surgery, anesthesiologists play a pivotal role in implementing intraoperative strategies that align with ERAS principles. This manuscript delineates evidence-based intraoperative anesthetic management techniques tailored for gynecologic procedures within an ERAS framework, including multimodal analgesia, optimal fluid management, maintenance of normothermia, and lung protective ventilation (Figure 1). The integration of these strategies has demonstrated improvements in patient outcomes, including reduced hospital stays, decreased opioid consumption, and enhanced patient satisfaction.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Selective Fetal Growth Restriction in Monochorionic Twins: Updates and New Directions. 单绒毛膜双胞胎选择性胎儿生长限制：最新进展和新方向。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-09 DOI: 10.1097/GRF.0000000000000977
Kelsey Pape, Asma Khalil, Hiba J Mustafa
{"title":"Selective Fetal Growth Restriction in Monochorionic Twins: Updates and New Directions.","authors":"Kelsey Pape, Asma Khalil, Hiba J Mustafa","doi":"10.1097/GRF.0000000000000977","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000977","url":null,"abstract":"<p><p>Selective fetal growth restriction (sFGR) in monochorionic twin pregnancies is a major contributor to perinatal morbidity and mortality with unique pathophysiological mechanisms and management challenges. sFGR is defined by significant intertwin discordance in estimated fetal weight and abnormal Doppler findings, employing the Gratacós classification (types I, II, and III) for risk stratification and management. Epidemiological data indicate sFGR affects 10% to 26% of monochorionic twins, with early-onset cases associated with the highest risk of adverse outcomes. Surveillance strategies include frequent ultrasound and Doppler assessment, and management is tailored to sFGR type, gestational age, and fetal condition. Expectant management is favored for type I sFGR, while type II and III may require fetal intervention, including fetoscopic laser photocoagulation or selective reduction, though practice variation remains substantial. Recent meta-analyses highlight the importance of Doppler progression, gestational age at diagnosis, and ductus venosus findings as predictors of fetal demise. Advances in imaging, biomarkers, and intervention techniques are shaping future practice, but randomized trials are needed to clarify optimal strategies. Controversies persist regarding timing of intervention, ethical considerations, and outcome prediction. In conclusion, individualized, multidisciplinary management is essential, and ongoing research should focus on refining diagnostic criteria, improving neurodevelopmental outcomes, and developing evidence-based guidelines.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postoperative Enhanced Recovery After Surgery Pathways in Gynecologic Surgery. 妇科手术后增强恢复途径。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-09 DOI: 10.1097/GRF.0000000000000976
Jenna M Patterson, Madeline Freeman, Lisa C Hickman
{"title":"Postoperative Enhanced Recovery After Surgery Pathways in Gynecologic Surgery.","authors":"Jenna M Patterson, Madeline Freeman, Lisa C Hickman","doi":"10.1097/GRF.0000000000000976","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000976","url":null,"abstract":"<p><p>Surgical stress affects the physiology of nearly every organ system. Enhanced recovery after surgery (ERAS) protocols counter these stressors to maintain normal physiology and promote postoperative recovery. In gynecologic surgery, ERAS pathways are associated with many postoperative benefits, including shorter length of stay, decreased pain, faster return of bowel function and both lower complication and readmission rates. This review highlights the current evidence and recommendations regarding postoperative ERAS pathways in gynecologic surgery.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Role of Angiogenic Factors in Fetal Growth Restriction. 血管生成因子在胎儿生长限制中的作用。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-07 DOI: 10.1097/GRF.0000000000000972
Helena C Bartels, Sebastian R Hobson
{"title":"The Role of Angiogenic Factors in Fetal Growth Restriction.","authors":"Helena C Bartels, Sebastian R Hobson","doi":"10.1097/GRF.0000000000000972","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000972","url":null,"abstract":"<p><p>Fetal growth restriction complicates up to 10% of pregnancies, resulting in significant morbidity and mortality. Biomarkers of placental function, such as PIGF or the sFLT-1/PlGF ratio, are increasingly used in clinical practice, as an adjunct to ultrasound, with an aim of improving detection of the at-risk fetus and reducing morbidity and mortality. Current evidence suggests this combined approach is associated with improved prediction and hence prevention of adverse outcomes such as stillbirth, as well as optimizing delivery timing. Future research should focus on determining thresholds for intervention, possible therapeutic targets for angiogenic markers and provide cost-based analysis. Despite limitations, there is growing evidence to suggest placental biomarkers play an important role in the prenatal management of high-risk pregnancies.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predicting Perinatal Morbidity in Fetal Growth Restriction: Evidence, Challenges, and Opportunities. 预测胎儿生长受限的围产期发病率：证据、挑战和机遇。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-07 DOI: 10.1097/GRF.0000000000000974
Sara E Post, Nathan R Blue
{"title":"Predicting Perinatal Morbidity in Fetal Growth Restriction: Evidence, Challenges, and Opportunities.","authors":"Sara E Post, Nathan R Blue","doi":"10.1097/GRF.0000000000000974","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000974","url":null,"abstract":"<p><p>Risk stratification is a core challenge in fetal growth restriction (FGR) care, in part because FGR does not represent a single diagnosis but instead is a finding that is associated with morbidity. Considerable effort has been invested in the development and study of methods to identify fetuses at risk of morbidity and who warrant intervention across multiple domains: Doppler ultrasound, maternal biomarkers, multivariable modeling, and artificial intelligence. It is likely that the most promising advances will integrate findings from across these domains, but further investigation remains necessary.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145243847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gynecologic ERAS Preoperative Interventions. 妇科ERAS术前干预。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-06 DOI: 10.1097/GRF.0000000000000970
Natalie P Pate, Robert H Thiele
{"title":"Gynecologic ERAS Preoperative Interventions.","authors":"Natalie P Pate, Robert H Thiele","doi":"10.1097/GRF.0000000000000970","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000970","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) protocols have been widely adopted within gynecologic surgery to optimize perioperative outcomes. This chapter discusses the evidence behind preoperative gynecologic ERAS elements, including preadmission counseling, comorbidity optimization, fasting guidelines, preoperative medications, and prehabilitation. Much of the evidence is extrapolated from colorectal and other surgical populations but has been supported within gynecology. Prehabilitation is the newest element, aimed at improving preoperative functional status through exercise, nutrition, and psychological support, with gynecology-specific evidence emerging to support inclusion within ERAS protocols. Preoperative interventions are the foundation of ERAS bundles, and adherence to these elements should be encouraged.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Fetal Growth Assessment in Twin Pregnancies: Evidence-Based Evaluation of Singleton Versus Twin-Specific Growth Charts. 双胎妊娠的胎儿生长评估：单胎与双胎特异性生长图的循证评价。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-10-03 DOI: 10.1097/GRF.0000000000000973
Eileen Deuster, Hiba J Mustafa, Eileen M O'Conner McFerran, Asma Khalil
{"title":"Fetal Growth Assessment in Twin Pregnancies: Evidence-Based Evaluation of Singleton Versus Twin-Specific Growth Charts.","authors":"Eileen Deuster, Hiba J Mustafa, Eileen M O'Conner McFerran, Asma Khalil","doi":"10.1097/GRF.0000000000000973","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000973","url":null,"abstract":"<p><p>The epidemiology of twin pregnancies has shifted considerably over recent decades. Since 1980, the twin birth rate in the United States has increased by 76%, largely driven by the widespread use of assisted reproductive technologies (ART). This demographic change has reshaped clinical perspectives and evidence on the natural history of twin gestations, underscoring their unique risks and management needs. Twin pregnancies remain associated with a markedly higher risk of adverse outcomes compared with singletons. The perinatal mortality rate is estimated at 16.0 to 17.3 per 1000 births, with fetal growth restriction representing a major contributor. Selective fetal growth restriction (sFGR) complicates up to 10% of dichorionic and 15% of monochorionic twin pregnancies, respectively. Accurate and timely growth assessment is therefore central to surveillance strategies and clinical decision-making in these pregnancies. However, assessing growth in twins presents distinctive challenges. Physiological differences from singletons render singleton-based standards inadequate, often leading to over- or underdiagnosis of pathology. Evidence supports the use of twin-specific growth charts, particularly those stratified by chorionicity, which may improve prognostic accuracy and reduce unnecessary intervention. Additional considerations include intertwin discordance, sFGR, and evolving staging systems such as the Gratacós and modified classifications. The purpose of this review is to critically examine current approaches to fetal growth assessment in twin pregnancies. We summarize the limitations of applying singleton standards, evaluate the evidence supporting twin-specific references, and explore how chorionicity, longitudinal assessment, and Doppler studies can refine diagnosis and management. Finally, we highlight ongoing controversies, international variation in practice, and the need for further validation of diagnostic thresholds.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Evolution of Enhanced Recovery After Surgery (ERAS) in Gynecology: An Introduction. 妇科手术后增强恢复（ERAS）的发展：介绍。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-09-24 DOI: 10.1097/GRF.0000000000000964
Kevin M Elias
{"title":"The Evolution of Enhanced Recovery After Surgery (ERAS) in Gynecology: An Introduction.","authors":"Kevin M Elias","doi":"10.1097/GRF.0000000000000964","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000964","url":null,"abstract":"<p><p>Enhanced Recovery After Surgery (ERAS) represents a paradigm shift in perioperative care, emphasizing evidence-based, multimodal strategies to minimize surgical stress and accelerate recovery. Originating in colorectal surgery in the 1990s, ERAS principles have since permeated gynecologic practice, transforming care across benign, oncologic, and urogynecologic procedures. Subspecialty adaptations, including those for minimally invasive surgery, pediatric gynecology, and pelvic floor reconstruction, illustrate the flexibility of ERAS across clinical contexts. By embracing data-driven implementation and interdisciplinary collaboration, ERAS continues to redefine perioperative care in gynecology, delivering measurable improvements in patient recovery and surgical value.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Challenges of Implementing The Eras Protocol in Obstetrics and Gynecology. 在妇产科实施Eras协议的挑战。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-09-19 DOI: 10.1097/GRF.0000000000000966
Eliane Aoun, Maria D Iniesta
{"title":"The Challenges of Implementing The Eras Protocol in Obstetrics and Gynecology.","authors":"Eliane Aoun, Maria D Iniesta","doi":"10.1097/GRF.0000000000000966","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000966","url":null,"abstract":"<p><p>Enhanced recovery after surgery (ERAS) refers to a comprehensive, multidisciplinary, evidence-based perioperative care pathway designed to minimize surgical stress and accelerate postoperative recovery. Initially adopted in colorectal surgery, the ERAS framework has expanded to multiple fields, including obstetrics and gynecology. However, as with any significant shift in clinical practice, there are challenges to be addressed, successfully incorporating ERAS principles into everyday care requires institutions to adjust protocols, restructure care pathways, and involve multiple stakeholders. This review discusses the key barriers to implementing the ERAS protocol in OB/GYN settings and explores potential solutions.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhanced Recovery After Surgery Updates in Gynecologic Oncology Surgery. 妇科肿瘤外科手术后增强恢复的最新进展。
IF 1.4 4区 医学
Clinical obstetrics and gynecology Pub Date : 2025-09-16 DOI: 10.1097/GRF.0000000000000969
Vasanti Jhaveri, Sarah P Huepenbecker
{"title":"Enhanced Recovery After Surgery Updates in Gynecologic Oncology Surgery.","authors":"Vasanti Jhaveri, Sarah P Huepenbecker","doi":"10.1097/GRF.0000000000000969","DOIUrl":"https://doi.org/10.1097/GRF.0000000000000969","url":null,"abstract":"<p><p>In this review article, we aim to provide a comprehensive update on enhanced recovery after surgery (ERAS) in gynecologic oncology. Specifically, we focus on topics including pelvic exenterations, hyperthermic intraperitoneal chemotherapy, vulvar surgery, optimal intraoperative fluid management, postoperative pain control, and disparities in ERAS care. In addition, we discuss contemporary practice patterns including prehabilitation in the ERAS pathway and smartphone applications for postoperative care in gynecologic oncology patients.</p>","PeriodicalId":10415,"journal":{"name":"Clinical obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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