Obstetrical & Gynecological Survey最新文献

{"title":"Antibiotic Prophylaxis in Obstetrics and Gynecology: A Comparative Review of Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Eleni-Markella Chalkia-Prapa, Florentia Katzi, Anastasios Liberis, Georgios Michos, Ioannis Kalogiannidis, Apostolos Mamopoulos, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001371","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001371","url":null,"abstract":"<p><strong>Importance: </strong>The administration of prophylactic antibiotics in obstetrics and gynecology represents a pivotal intervention with a major contribution to the prevention of maternal and neonatal infectious morbidity.</p><p><strong>Objectives: </strong>The aim of this study was to review and compare the most recently published guidelines on prophylactic antibiotic use in obstetric and gynecologic procedures.</p><p><strong>Evidence acquisition: </strong>A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists on antibiotic prophylaxis was carried out.</p><p><strong>Results: </strong>There is a consensus among the reviewed guidelines regarding the importance of antibiotic prophylaxis prior to cesarean delivery, hysterectomy, colporrhaphy and surgical-induced abortions, the optimal choice of antibiotics, and the timing of administration, as well as the indications for increased and additional doses. First-generation cephalosporins are unanimously recommended as first-line antibiotics. All the reviewed guidelines recommend antibiotic prophylaxis in case of preterm prelabor rupture of membranes, whereas they discourage routine antibiotic use in case of active preterm labor with intact membranes or cervical cerclage placement. There is also an overall agreement that antibiotic prophylaxis should not be given for hysteroscopic and laparoscopic procedures with no entry into the bowel or the vagina, endometrial biopsy, intrauterine device insertion, or cervical tissue excision surgeries. Moreover, all the guidelines agree that women undergoing hysterosalpingography should receive a course of antibiotics only when the fallopian tubes are abnormal or there is a history of pelvic inflammatory disease. In contrast, inconsistency was identified on the need of antibiotic prophylaxis in case of obstetric anal sphincter injuries, operative vaginal delivery, and early pregnancy loss. Finally, American College of Obstetricians and Gynecologists states that antibiotics should not be routinely offered for oocyte retrieval and embryo transfer.</p><p><strong>Conclusions: </strong>Infectious complications following both obstetric and gynecological procedures are significant contributors of morbidity and mortality, rendering their prevention using antibiotic prophylaxis a crucial aspect of preoperative care. Nevertheless, antibiotic overuse should be avoided. Thus, it seems of paramount importance to develop consistent international practice protocols for the appropriate use of antibiotics in everyday practice to minimize their adverse effects and maximize their associated benefits.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 3","pages":"186-203"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625540","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}

{"title":"A Review of Cost-Effectiveness of Preimplantation Genetic Testing for Aneuploidy.","authors":"Olamide Akin-Olugbade, Tarun Jain, Allison Komorowski","doi":"10.1097/OGX.0000000000001373","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001373","url":null,"abstract":"<p><strong>Importance: </strong>Preimplantation genetic testing for aneuploidy (PGT-A) is an important focus area of reproductive medicine because of its potential to improve the odds of a live birth from in vitro fertilization (IVF) treatment.</p><p><strong>Objectives: </strong>Despite growing interest and use of this technology, there has been a limited, albeit growing, body of literature that has evaluated the cost-effectiveness of PGT-A for patients compared with IVF without PGT-A. This review aims to further explore this relationship and summarize current findings.</p><p><strong>Evidence acquisition: </strong>Studies were selected entering terms such as \"PGT-A,\" \"IVF,\" and \"cost-effectiveness\" in the PubMed database.</p><p><strong>Results: </strong>In some studies, PGT-A has been shown to be cost-effective in older patients and patients who have experienced recurrent pregnancy loss. In other studies, PGT-A use has shown comparable live birth rates to traditional IVF while carrying a more expensive price tag. In addition, PGT-A carries risk, including embryo damage and improper embryo classification, and has significant financial cost. Specifically with regards to cost-effectiveness, considerations such as age, reproductive timeline, and economic burden have been identified.</p><p><strong>Conclusions: </strong>Ultimately, there is incomplete data addressing factors such as mosaicism, patient perspectives of the economic cost, and patient experiences surrounding PGT-A. Further studies are needed to fully evaluate PGT-A outcomes, patient experiences, and cost-effectiveness.</p><p><strong>Relevance: </strong>As utilization of assisted reproductive technology continues to increase, a careful analysis of the cost-effectiveness of additional genetic screening tests is critical to patient counseling and shared decision making.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 3","pages":"169-173"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625539","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}

{"title":"Expert Review: Confronting Climate-Driven Heat Risks to Maternal and Fetal Health.","authors":"Catherine P Marudo, Vikasni Mohan, Michael J Paidas, Paloma Toledo, Eugene S Fu, Hudson P Santos, J Marshall Shepherd, Erin G McHugh, Michelle M Fletcher, James M Shultz","doi":"10.1097/OGX.0000000000001361","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001361","url":null,"abstract":"<p><strong>Importance: </strong>In the current era of climate change, extreme heat exposure poses escalating threats to maternal-fetal health. Despite the expansive scale of extreme heat exposure worldwide, dramatized by the record-breaking global ocean and atmospheric temperatures throughout 2023 and into 2024, the extent of the threat posed by heat is underestimated and underappreciated. Unlike the physical destruction wrought by climate-driven events like hurricanes and wildfires, heat exposure does not cause severe damage to the built environment. Yet, in most years, heat has been the deadliest hazard in the United States.</p><p><strong>Objectives: </strong>This expert review aims to illuminate how climate-related heat affects maternal-fetal health and exacerbates health inequities. It will also discuss current knowledge gaps and underscore the crucial role that obstetric providers play in safeguarding pregnant persons from exposure to hazardous heat and increasing patient awareness of climate-related heat.</p><p><strong>Evidence acquisition: </strong>Evidence for this review was primarily acquired through a comprehensive search of PubMed-indexed articles using MeSH terms and text words to search for concepts related to \"climate change,\" \"heat,\" \"obstetrics,\" \"pregnancy,\" \"heat stress disorders,\" and their synonyms.</p><p><strong>Results: </strong>Extreme heat exposure threatens the health and well-being of pregnant persons and elevates the likelihood of poor birth outcomes like preterm birth, fetal demise, and stillbirth, among other pregnancy complications. Extreme heat exposure also increases the risk of dehydration, heat exhaustion, heat stroke, and gestational hypertension for pregnant persons.</p><p><strong>Conclusions and relevance: </strong>Ultimately, obstetric professionals are essential to improving the care of pregnant persons at increased risk from salient climate-related heat exposure.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 3","pages":"174-185"},"PeriodicalIF":4.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625541","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}

{"title":"Management of Maternal Genetic Conditions in Pregnancy, Part 1: Disorders of the Connective Tissue, Muscle, Vascular, and Skeletal Systems.","authors":"Anne Mardy, Madeline Whitney","doi":"10.1097/OGX.0000000000001359","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001359","url":null,"abstract":"<p><strong>Importance: </strong>The number of patients with various genetic syndromes who are or seek to become pregnant is increasing due to advances in medical care and assisted reproductive technologies. Management of these patients requires multidisciplinary care teams and knowledge of the risks of increased morbidity and mortality. In addition, many of these inheritance patterns are autosomal dominant, with a 50% risk of an offspring inheriting the disorder with each pregnancy.</p><p><strong>Objectives: </strong>In this first of a 2-part series, common syndromes with connective tissue, muscle, vascular, or skeletal involvement will be discussed regarding surveillance and management of mother and fetus.</p><p><strong>Evidence acquisition: </strong>A literature search was performed for important updates in the literature regarding management of patients with genetic connective tissue disorders, aortopathies, muscular dystrophies, vascular disorders, and skeletal dysplasias.</p><p><strong>Results: </strong>Updates have been incorporated since the last publication in 2011, including updated diagnostic criteria for several conditions (such as Marfan syndrome), international guidelines in management of aortopathies and achondroplasia, an expanded section on hypermobile Ehlers-Danlos syndrome, and a new section on familial cerebral cavernous malformation.</p><p><strong>Conclusions: </strong>Since the last publication, many guidelines have been published or updated regarding management of pregnancies in patients with genetic disorders and are reviewed in this article.</p><p><strong>Relevance: </strong>Clinicians who care for pregnant patients with genetic disorders should be aware of updated guidelines and recommendations in order to optimize their care during pregnancy.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 2","pages":"99-111"},"PeriodicalIF":4.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382885","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}

{"title":"The Clinical Utility of Measures of Ovarian Reserve.","authors":"Katherine M Baker, Rodolfo FernandezCriado, Jennifer L Eaton, Virginia A Mensah","doi":"10.1097/OGX.0000000000001362","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001362","url":null,"abstract":"<p><strong>Importance: </strong>Measures of ovarian reserve, particularly anti-Müllerian hormone, have been increasingly and inaccurately utilized as \"fertility tests.\" It is important to understand the available measures of ovarian reserve and how to appropriately interpret and integrate their use into clinical practice.</p><p><strong>Objectives: </strong>The objectives of this article are to review the process of reproductive aging, define ovarian reserve, describe the available measures of ovarian reserve, and discuss the clinical utility of these measures.</p><p><strong>Evidence acquisition: </strong>A literature search was performed using the electronic database PubMed. Relevant guidelines, systematic reviews, and original research articles investigating ovarian reserve parameters and their clinical utility were reviewed.</p><p><strong>Results: </strong>The fecundity of women gradually declines with increasing reproductive age as oocyte quantity and quality decline. Ovarian reserve is defined as the quantity of oocytes remaining in the ovary. Ovarian reserve can be measured indirectly with the use of serum blood tests or ultrasound imaging. Measures of ovarian reserve are clinically useful in several circumstances, particularly for use during fertility treatment and cycles of assisted reproductive technology. However, measures of ovarian reserve are poor predictors of reproductive potential and should not be used as \"fertility tests.\"</p><p><strong>Conclusions and relevance: </strong>Measures of ovarian reserve are poor predictors of reproductive potential and should not be used as \"fertility tests.\" Age remains a stronger predictor of reproductive success than measures of ovarian reserve.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 2","pages":"121-133"},"PeriodicalIF":4.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382862","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}

{"title":"Ovarian Stem Cells: Will the Dream of Neo-Folliculogenesis After Birth Become Real?","authors":"Stefano Canosa, Erica Silvestris, Andrea Roberto Carosso, Alessandro Ruffa, Bernadette Evangelisti, Gianluca Gennarelli, Gennaro Cormio, Vera Loizzi, Alessandro Rolfo, Chiara Benedetto, Alberto Revelli","doi":"10.1097/OGX.0000000000001360","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001360","url":null,"abstract":"<p><strong>Importance: </strong>Ovarian stem cells (OSCs) represent a promising tool in reproductive medicine, particularly for the treatment of premature ovarian failure and fertility preservation.</p><p><strong>Objectives: </strong>Herein, we summarize the main characteristics of adult stem cells, their status, needs, and new challenges in the application in reproductive medicine.</p><p><strong>Evidence acquisition: </strong>Clinical studies have shown that OSCs transplantation can restore ovarian function and stimulate neo-folliculogenesis in patients with premature ovarian failure, enabling them to conceive naturally or through in vitro fertilization techniques. Moreover, OSCs gained increasing interest as a chance to preserve fertility in cancer patients undergoing gonadotoxic treatments affecting their fertility, as chemotherapy or radiotherapy.</p><p><strong>Results: </strong>The recruitment of OSCs from fresh or thawed ovarian fragments coupled with their capability to differentiate in vitro to mature oocytes could provide a novel opportunity to verify their suitability to be expanded in vitro as oocyte like cells.</p><p><strong>Conclusions and relevance: </strong>Research into OSCs and their applications in reproductive medicine is still in its infancy, but the results so far are promising and offer new possibilities for patients suffering from premature ovarian failure or cancer.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 2","pages":"112-120"},"PeriodicalIF":4.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382860","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}

{"title":"Nutritional Changes to Improve Female Fertility: Role of Obesity, Hormones, Dietary Patterns and Endocrine Disrupting Chemicals.","authors":"Clara Noguera-Navarro, Joana Candela-González, Esteban Orenes-Piñero","doi":"10.1097/OGX.0000000000001330","DOIUrl":"10.1097/OGX.0000000000001330","url":null,"abstract":"<p><strong>Importance: </strong>Infertility affects around 180 million people in the world and can be influenced by a number of nutritional factors.</p><p><strong>Objective: </strong>The idea of a pretreatment optimization including beneficial weight loss, adequate physical activity, and good lifestyle habits could enhance fertility for many couples who want to conceive a baby.</p><p><strong>Results: </strong>There are different aspects related to nutrition, such as obesity (affecting 23%-30% of reproductive-aged women), dietary patterns (type of diet, good or bad habits, and physical activity), nutrients (vitamins or minerals), hormones (adipokines, among others), and endocrine-disrupting chemicals (phytoestrogens and bisphenol A, among others) that have a clear impact on women's fertility.</p><p><strong>Evidence acquisition: </strong>Findings have shown that a Mediterranean or balanced diet with an adequate weight loss in case of obesity and an appropriate serum concentration of different nutrients with low endocrine-disrupting exposure could improve female fertility. In addition, the context is quite important, as there are many differences between overweight and low-weight women, and both can encounter difficulties conceiving.</p><p><strong>Conclusions and relevance: </strong>The aim of this review is to elucidate the impact of obesity and hormones in women's fertility. In addition, how dietary patterns could help people to increase probability of conception and birth using less fertility treatments cycles will be also analyzed. Moreover, the role of endocrine-disrupting chemicals, pollutants, and contaminants will be discussed.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 1","pages":"44-60"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007837","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}

{"title":"PICC Lines in Pregnancy and Other Peripartum Vascular Access Considerations.","authors":"Ellery Sarosi, Luke A Gatta, Deborah R Berman, Melissa Bauer, Jeffrey A Kuller","doi":"10.1097/OGX.0000000000001345","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001345","url":null,"abstract":"<p><strong>Importance: </strong>To decrease associated infectious and thrombotic morbidity, it is important to understand the indications and risks of peripherally inserted central catheters (PICCs) and other vascular access means in pregnancy.</p><p><strong>Objectives: </strong>The objectives are 3-fold: (1) discuss indications and contraindications, approach to placement, and associated complications for PICC lines, arterial catheters, centrally inserted central catheters, and peripheral intravenous catheters; (2) review available data regarding complications associated with these catheters in pregnancy; and (3) propose an evidence-based approach to clinical decision making regarding vascular access in 2 clinical scenarios among pregnant patients.</p><p><strong>Evidence acquisition: </strong>A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines, with a focus on obstetrical anesthesia and obstetric literature.</p><p><strong>Results: </strong>Data on vascular access complications in pregnancy are limited; therefore, rates of complications are extrapolated from studies including nonpregnant subjects. Catheter choice is dependent on resuscitation requirements, monitoring indications, parenteral therapeutic needs, need for inpatient versus outpatient care, and anticipated duration of use.</p><p><strong>Conclusions and relevance: </strong>All pregnant patients require vascular access. A subset requires more invasive catheters for management of specific conditions such as trauma in pregnancy, postpartum hemorrhage, and puerperal sepsis. In addition, vascular access plays an important role in operative planning for patients with placenta accreta spectrum disorder and fetal disorders requiring intrauterine surgery. Gaining an understanding of the types of catheters and their associated complications will allow obstetricians, family medicine physicians, midwives, nurses, intensivists, and anesthesiologists to make informed decisions regarding catheter selection and management.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"80 1","pages":"37-43"},"PeriodicalIF":4.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008036","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}

{"title":"Gastric and Esophageal Cancer in Pregnancy: A Review.","authors":"Kaitlyn H Taylor, Nafisa K Dajani, Julie R Whittington, Everett F Magann","doi":"10.1097/OGX.0000000000001328","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001328","url":null,"abstract":"<p><strong>Importance: </strong>Upper gastrointestinal cancers such as gastric and esophageal cancers are rare malignancies with poor prognosis because it is usually diagnosed in latter stages. Presenting symptoms are frequently presumed pregnancy related rather than malignancy related. This review will raise awareness to consider these aggressive cancers in evaluating gastrointestinal complaints during pregnancy.</p><p><strong>Objectives: </strong>This review describes pregnancies with gastric and esophageal cancers including presenting symptoms, diagnosis stage, treatments, pregnancy complications, and maternal/fetal outcomes.</p><p><strong>Evidence acquisition: </strong>Electronic databases (PubMed/EMBASE) were searched with English language limitation. Search terms, 1970-2023, included \"stomach cancer\" OR \"gastric cancer\" AND \"etiology\" OR \"risk factors\" OR \"diagnosis\" OR \"treatment\" OR \"management\" OR \"prognosis\" AND \"pregnancy\" OR \"pregnancy complications\" OR \"Esophageal Neoplasms\" OR \"esophageal carcinoma\" OR \"esophageal malignancy\" OR \"esophageal cancer\" OR \"esophageal neoplasm\" AND Pregnancy OR \"Pregnancy.\"</p><p><strong>Results: </strong>Of 611 abstracts reviewed, 63 full articles were identified as the basis of review. Gastric cancer stage was advanced stage III or IV in 88% of patients. Maternal mortality rate was 76%. First-trimester diagnosis occurred in 16%; second, 27%; and third, 18% totaling 61%. Thirty nine percent were found postpartum, postmortem, or undetermined. Ethnic groups most affected were East Asian. Half had cesarean delivery, 29% delivered vaginally, and the rest were not reported. Treatment varied: supportive care only, 8%; chemotherapy only, 34%; and chemotherapy and surgery, 21%. Neonatal outcomes were good overall: 90% survival among cases reported.</p><p><strong>Conclusions: </strong>Gastric and esophageal cancers are rare and frequently asymptomatic in early stages. When diagnosed in pregnancy, it is usually advanced with poor prognosis and high maternal mortality rate. Diagnostic testing and treatment should proceed as needed during pregnancy with close maternal and fetal surveillance. Abdominal delivery is reserved for usual obstetrical indications.</p><p><strong>Relevance: </strong>Gastric and esophageal cancers are rare conditions often missed or found late that affect management, mode of delivery, and maternal/fetal outcomes.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 12","pages":"727-734"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962220","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}

{"title":"Perinatal Management of Hepatic Adenomas.","authors":"Megan A Nocita, Carla W Brady, Jeffrey A Kuller, Luke A Gatta","doi":"10.1097/OGX.0000000000001331","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001331","url":null,"abstract":"<p><strong>Importance: </strong>With a strong association between hepatic adenomas and estrogen established, understanding the risks, evaluation, and perinatal management of hepatic adenomas is necessary for obstetric clinicians.</p><p><strong>Objective: </strong>The aim of this study is to review the preconception counseling, perinatal management, and postpartum care of hepatic adenomas.</p><p><strong>Evidence acquisition: </strong>A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines.</p><p><strong>Results: </strong>Hepatic adenomas require individualized recommendations based on their prepregnancy size and evolution over pregnancy. Hepatic adenomas measuring greater than 5 cm are associated with a significantly increased risk during pregnancy including rupture. Ideally, optimal management of hepatic adenoma includes accurate diagnosis, discontinuation of estrogen-containing contraception, and surgical resection of large masses prior to conception. Patients should undergo serial surveillance of the adenoma during the antenatal and postpartum periods, with surgical intervention as indicated with multidisciplinary planning.</p><p><strong>Conclusions and relevance: </strong>An individualized approach is necessary when managing hepatic adenomas in the patient who is pregnant or intends pregnancy. More contemporary data are required to guide management and patient counseling.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 12","pages":"735-740"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962235","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}