Obstetrical & Gynecological Survey最新文献

{"title":"Uterine Sarcomas: Clinical Management and a Review of Systemic Therapy.","authors":"Ana Kouri, Olivia Lara, Jacob Stein","doi":"10.1097/OGX.0000000000001513","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001513","url":null,"abstract":"<p><strong>Importance: </strong>Uterine sarcomas are rare but aggressive tumors with high rates of recurrence and limited effective treatment options; a deeper understanding of their molecular and histologic diversity is critical to improving outcomes.</p><p><strong>Objective: </strong>To provide a comprehensive overview of clinical management and current systemic treatment strategies for uterine sarcomas. Specific histologic subtypes and molecular features are also reviewed.</p><p><strong>Evidence acquisition: </strong>A thorough review of the literature was conducted using PubMed and clinical trial databases, with a focus on recent studies evaluating histology-specific management, molecular diagnostics, and novel systemic therapies across uterine sarcoma subtypes.</p><p><strong>Results: </strong>Uterine sarcomas comprise 3% to 5% of uterine malignancies and include multiple distinct subtypes such as leiomyosarcoma, low and high-grade endometrial stromal sarcoma, undifferentiated uterine sarcoma, and adenosarcoma. Each displays unique clinical behavior and molecular alterations that guide treatment. While surgery remains the foundation of management for early-stage disease, the role of adjuvant therapy is unclear and best guided by individual risk. In advanced disease, combination regimens such as doxorubicin and trabectedin have shown improved outcomes in the treatment of leiomyosarcomas. Targeted therapies, hormonal agents, and immunotherapy have variable activity across subtypes. Molecular diagnostics, including next-generation sequencing, are increasingly essential in diagnosis, prognostication, and treatment planning.</p><p><strong>Conclusions and relevance: </strong>The landscape of uterine sarcoma treatment is rapidly evolving due to advances in molecular biology and emerging systemic therapies. Personalized management based on histology and molecular profiling, along with the development of subtype-specific clinical trials, will be essential in improving survival. Centralized, multidisciplinary care remains a cornerstone for patients with these rare tumors.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 5","pages":"231-240"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840662","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":"Female Sexual Dysfunction: Current Models and Treatment Options.","authors":"Emma E H Peek, Meagan Kelly, Jeffrey A Kuller, Sarah Dotters-Katz, Jennifer O Howell","doi":"10.1097/OGX.0000000000001512","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001512","url":null,"abstract":"<p><strong>Importance: </strong>Male sexual dysfunction has been well described in scientific literature; however, female sexual dysfunction is an area of research that remains vastly overlooked.</p><p><strong>Objective: </strong>Female sexual dysfunction represents 4 separate diagnoses according to the DSM-5-sexual pain disorder, sexual interest/arousal disorder, orgasmic disorder, and medication/substance-induced sexual dysfunction. In this review, we will briefly discuss early studies of female sexual function. We will also describe each subtype of female sexual dysfunction, its etiology, vulnerable populations, and current treatment options. Treatment options discussed will include pharmacological options, as well as therapeutic techniques, including behavioral and physical therapy.</p><p><strong>Evidence acquisition: </strong>Information for this review was obtained by means of PubMed search with relevant keywords, in addition to the use of pertinent citations from original research.</p><p><strong>Results: </strong>We find evidence for multiple treatment options for patients with female sexual dysfunction specific to the subtype of disorder defined by the DSM-5.</p><p><strong>Conclusions: </strong>Treatment of female sexual dysfunction should include a team-based approach that involves the partner, a therapist, psychiatrist, physical therapist, and pharmacological intervention if appropriate.</p><p><strong>Relevance: </strong>Tremendous progress has been made in the last several decades in dedicating more research attention to the topic of female sexual dysfunction-there are a multitude of randomized clinical trials on both pharmacological and therapeutic options for each of the sexual dysfunction disorders. However, improved standardization of tools to measure sexual desire, satisfaction, and orgasm attainment remains a weakness in current studies, as does lack of data on sexual function in transgender women and lesbian women.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 5","pages":"219-230"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840414","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":"Heavy Menstrual Bleeding in the Gynecology Clinic: A Call for Awareness and Standardized Screening for Underlying Bleeding Disorders.","authors":"Silvia Luijten, Laurens Nieuwenhuizen, Karin P M van Galen, Marlies Y Bongers, Peggy M A J Geomini, Jaklien C Leemans","doi":"10.1097/OGX.0000000000001514","DOIUrl":"10.1097/OGX.0000000000001514","url":null,"abstract":"<p><strong>Importance: </strong>Heavy menstrual bleeding (HMB) is a common problem existing in nearly 30% of women worldwide. An underlying bleeding disorder has been identified as a cause of HMB in a significant proportion of women seeking gynecological care for HMB. In practice, however, there is a significant underdiagnosis of bleeding disorders in these patients, highlighting a need for improvement in awareness and detection.</p><p><strong>Objective: </strong>To present a comprehensive review of the literature on HMB and bleeding disorders and to increase awareness of their interrelation. In addition, to propose a standardized diagnostic approach to help identify which women with HMB may have an underlying bleeding disorder and require further hemostatic evaluation.</p><p><strong>Evidence acquisition: </strong>A literature review was performed using PubMed to identify relevant primary research and review articles on the topic of HMB and bleeding disorders in English. This was supplemented by manual reference searches and review of relevant guidelines in English and Dutch.</p><p><strong>Results: </strong>A significant proportion (10% to as much as 62%) of women with HMB have an underlying bleeding disorder, yet many such disorders go unrecognized. Various screening instruments, particularly the validated PBAC, Philipp tool or self-BAT, can help distinguish between HMB with or without a suspected bleeding disorder, and indicate who needs additional hemostatic evaluation.</p><p><strong>Conclusions and relevance: </strong>An underlying bleeding disorder is far more frequent in HMB than currently appreciated. Gynecologists should be aware of this and be familiar with screening instruments and a diagnostic workflow for bleeding disorders. Multidisciplinary collaboration between gynecology and hematology is crucial for accurately diagnosing and managing potential bleeding disorders in women with HMB.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 5","pages":"241-250"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth Trauma and Postpartum Childbirth-related Posttraumatic Stress Disorder: A Narrative Review of Pathology, Risk Factors, and Practice Recommendations.","authors":"Carmen Rauh Garrido, Jennifer Okunbor, Lillian B Boettcher, Jeffrey A Kuller, Sarah Dotters-Katz, Marie Claire Kimmel","doi":"10.1097/OGX.0000000000001493","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001493","url":null,"abstract":"<p><strong>Importance: </strong>Trauma and childbirth-related posttraumatic stress disorder (c-PTSD) are underrecognized possible consequences of birth and obstetric care that may affect maternal well-being, parent-infant bonding, and future reproductive decisions. Despite a growing body of research, gaps remain in the implementation of robust screening, timely diagnosis, and trauma-informed practices to prevent and address c-PTSD.</p><p><strong>Objective: </strong>Review our current understanding of psychological birth trauma and c-PTSD, emphasizing provider roles in prevention, identification, and management.</p><p><strong>Evidence acquisition: </strong>PubMed and Google Scholar literature search from 2000 to 2024.</p><p><strong>Results: </strong>Birth trauma is a subjective experience, often driven by factors such as poor communication, lack of informed consent, and perceived loss of control. Only a subset of individuals with traumatic births develops c-PTSD. Prior trauma, mental health conditions, obstetric complications, and inadequate support exacerbate risk. c-PTSD affects approximately 3% to 6% of low-risk, postpartum individuals and up to 18% of postpartum individuals in high-risk populations. Diagnosis requires assessment of associated symptoms with validated tools. Interventions range from psychosocial support, medications, and trauma-focused therapies. Preventive strategies include maternal mental health collaborative models and trauma-informed care that emphasizes respectful communication, autonomy, and continuity of care.</p><p><strong>Conclusions and relevance: </strong>Obstetric providers are key actors in shaping a positive childbirth experience through respectful communication and shared decision-making. Early follow-up, mental health screening, and collaborative, trauma-informed care may help mitigate long-term psychological sequelae of birth trauma and c-PTSD to improve outcomes for birthing individuals and families.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 4","pages":"177-185"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639422","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":"Letrozole for Ovulation Induction in Women With Polycystic Ovary Syndrome.","authors":"Xue-Lian Li","doi":"10.1097/OGX.0000000000001494","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001494","url":null,"abstract":"<p><strong>Importance: </strong>Polycystic ovary syndrome (PCOS) affects about 5% to 20% of women worldwide in their fertile years and often combines with infertility. Ovulation induction is often needed for those who want to get pregnant.</p><p><strong>Objective: </strong>To review the research advances of letrozole for ovulation induction in women with PCOS.</p><p><strong>Evidence acquisition: </strong>The papers are searched in Cochrane libraries, SinoMed, PUBMED, and EMBASE till June 2024 and reviewed.</p><p><strong>Results: </strong>Letrozole, one of the third-generation of aromatase inhibitors, is increasingly recommended as a first-line agent for ovulation induction in anovulatory PCOS women due to better pregnancy and live birth rates, especially in those with clomiphene citrate (CC) resistance (CC is an earlier contacted and frequently used ovulation inducer). In this review, we focus on the usages, advantages, and disadvantages of letrozole for ovulation induction in PCOS, and show that different timing of initiation, extending treatment duration, stair-step protocol, and letrozole combined with other drugs such as FSH, ethinylestradiol and cyproterone acetate, metformin, aspirin, dexamethasone, and N-acetylcysteine.</p><p><strong>Conclusions: </strong>Letrozole is effective for inducing ovulation and achieving pregnancy in patients with PCOS, and report variations in letrozole treatment protocols.</p><p><strong>Relevance: </strong>Better understanding of letrozole for ovulation induction is important for gynecologists and women with PCOS to achieve better pregnancy and live birth rates.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 4","pages":"186-191"},"PeriodicalIF":3.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639436","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 Role of Humoral Autoimmunity in the Pathophysiology of Preeclampsia.","authors":"Brian Wong, Justin Lee, Raymond Liang, Yan Hu, Ivan Velickovic, Samantha Cavusoglu, Mudar Dalloul, Ming Zhang","doi":"10.1097/OGX.0000000000001479","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001479","url":null,"abstract":"<p><strong>Importance: </strong>Preeclampsia (PE) remains a leading cause of maternal mortality worldwide. Research has shown multifactorial contributions to its pathophysiology. With recent evidence suggesting that humoral autoimmunity plays a crucial role, autoantibodies targeting vascular and immune pathways contribute to disease progression. Further research into the role of humoral autoimmunity in the etiology of PE and potential treatments could significantly improve maternal and fetal health.</p><p><strong>Objective: </strong>This study aims to provide an overview of current research on the role of autoantibodies in humoral autoimmunity and their contribution to the pathophysiology of PE.</p><p><strong>Evidence acquisition: </strong>A comprehensive search was conducted in the PubMed database using the keywords \"preeclampsia\" and \"autoantibody\" to identify potentially pathogenic autoantibodies in preeclampsia. We performed follow-up searches with the keywords \"preeclampsia\" and identified autoantibodies such as \"AT1-AA.\"</p><p><strong>Results: </strong>Autoantibodies, particularly angiotensin II type 1 receptor autoantibodies (AT1-AA) and endothelin-1 type A receptor autoantibodies (ETAR-AA), play a crucial role in PE by directly modulating vascular tone and promoting inflammation through mechanisms such as vasoconstriction and oxidative stress. Preeclampsia is also associated with other autoantibodies, including anti-beta-2-glycoprotein and lupus anticoagulant. Emerging research suggests that targeting these autoantibodies or their downstream receptors may be a promising therapeutic strategy for reducing disease severity.</p><p><strong>Conclusions and relevance: </strong>Humoral autoimmunity plays a significant role in the pathophysiology of PE, offering novel diagnostic and potential therapeutic avenues. Emerging treatments targeting these pathways show promise in alleviating PE symptoms. Further research into autoantibody mechanisms and targeted interventions is essential for improving outcomes in PE-affected pregnancies.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 3","pages":"127-137"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512923","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":"Penicillin Allergy in Pregnancy: A Practical Review for the Obstetrician.","authors":"Jennifer J M Cate, Allison Chu, Celeste Prado, Jeffrey A Kuller, Sarah K Dotters-Katz, Samuel T Bauer","doi":"10.1097/OGX.0000000000001480","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001480","url":null,"abstract":"<p><strong>Importance: </strong>Penicillin allergies are commonly reported in pregnancy, yet patients are rarely truly allergic. Identification of pregnant patients who would benefit from penicillin allergy testing is an important public health initiative to reduce alternative antibiotic usage and reduce associated adverse outcomes.</p><p><strong>Objective: </strong>This article reviews the epidemiology of penicillin allergy, the pathophysiology of allergy in general, in addition to penicillin allergy, the safety of penicillin allergy testing in pregnancy, the impact of penicillin allergy testing on maternal and neonatal outcomes, and considerations for quality improvement interventions.</p><p><strong>Evidence acquisition: </strong>Original research articles, review articles, and professional society guidelines on penicillin allergy evaluation in pregnancy were reviewed.</p><p><strong>Results: </strong>Penicillin allergy in pregnancy is associated with increased risks of adverse neonatal and maternal outcomes. The reviewed literature demonstrates that penicillin allergy testing in pregnancy is efficacious, with the majority of individuals undergoing penicillin allergy delabeling with low rates of allergy testing complications. In addition, penicillin allergy testing has been shown to be associated with a reduction in second-line antibiotic usage, although future studies are required to elucidate the full reduction in adverse outcomes associated with delabeling.</p><p><strong>Conclusions and relevance: </strong>Penicillin allergy in pregnancy is associated with increased risk of adverse outcomes. Given that the majority of individuals can be safely delabeled, efforts to explore opportunities for increased penicillin allergy assessment should be an ardent goal.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 3","pages":"138-146"},"PeriodicalIF":3.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513780","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":"Antenatal Corticosteroids for Fetal Maturation: A Comprehensive Review of Major Guidelines.","authors":"Sonia Giouleka, Lampriana Grigoropoulou, Georgios Michos, Antonios Siargkas, Eirini Boureka, Anastasios Liberis, Apostolos Mamopoulos, Ioannis Kalogiannidis, Ioannis Tsakiridis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001468","DOIUrl":"10.1097/OGX.0000000000001468","url":null,"abstract":"<p><strong>Importance: </strong>The administration of corticosteroids before anticipated preterm delivery represents a crucial antenatal intervention that enhances fetal lung maturity and reduces neonatal morbidity and mortality.</p><p><strong>Objective: </strong>This review aims to evaluate and compare the most recently published influential guidelines on the use of antenatal corticosteroids (ACS).</p><p><strong>Evidence acquisition: </strong>A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the International Federation of Gynecology and Obstetrics (FIGO), the European Association of Perinatal Medicine (EAPM), the World Association of Perinatal Medicine (WAPM), the World Health Organization (WHO), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) was carried out.</p><p><strong>Results: </strong>All the reviewed guidelines recommend the use of ACS between 24+0 and 33+6 weeks of gestation, when preterm delivery is anticipated and endorse the consideration of their use at the periviable period. In addition, there is an overall agreement regarding the recommended regimens and the use of ACS in case of pregnancies with existing comorbidities, such as preterm prelabor rupture of membranes, obesity, multiple pregnancy, fetal growth restriction, and diabetes. In contrast, the recommendations for the use of ACS in the late preterm period, in women with chorioamnionitis and in cases of recurrent or persistent threatened preterm delivery vary. Moreover, RCOG is the only medical society supporting that the administration of ACS in case of planned cesarean delivery should be considered up to 38+6 weeks of gestation.</p><p><strong>Conclusions: </strong>The favorable role of corticosteroids in improving the outcomes of preterm neonates is clearly outlined. However, the explicit articulation of the potential benefits and harms stemming from their use at different stages of pregnancy and in different delivery contexts is yet to be elucidated. Thus, it seems of paramount importance to develop consistent recommendations for the use of this antenatal intervention to maximize its beneficial effects and eliminate the associated risks.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 2","pages":"75-83"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227609","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":"Metabolic Dysfunction-Associated Steatotic Liver Disease in Pregnancy: A Review.","authors":"Daniel Core, Layne Landry, Christopher Menefee, Michael Mahoney, Shruti Vaidyanathan, David Lewis","doi":"10.1097/OGX.0000000000001481","DOIUrl":"10.1097/OGX.0000000000001481","url":null,"abstract":"<p><strong>Importance: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is characterized by fatty deposits in the liver, with histologic features like alcohol-induced liver injury, without associated alcohol misuse. This condition is associated with other metabolic comorbidities, particularly obesity and insulin resistance. MASLD is also associated with the development of pregnancy-related complications such as gestational diabetes mellitus and hypertensive disorders of pregnancy. MASLD is one of the most common liver diseases today, with a prevalence of 14% in pregnant individuals.</p><p><strong>Objective: </strong>The goal of this review was to explore the topic of MASLD with a discussion of its pathophysiology, diagnosis, clinical management, and complications related to pregnancy.</p><p><strong>Evidence acquisition: </strong>A literature search was conducted utilizing Rayyan to review 180 articles published between 2000 and 2024 for inclusion or exclusion in the review.</p><p><strong>Results: </strong>MASLD is an increasingly prevalent disease process likely underdiagnosed in pregnancy. Evidence suggests a synergistic pathway between obesity and the physiological changes of pregnancy, which can initiate or exacerbate liver steatosis. MASLD is associated with adverse outcomes in pregnancy and in the offspring of affected pregnancies.</p><p><strong>Conclusions and relevance: </strong>Further research is needed to demonstrate optimal screening, diagnosis, and management in pregnancy. If detected early, early diabetes screening and low-dose aspirin may be appropriate, given the significant association with gestational diabetes and gestational hypertensive disorders. Patients should be counseled on the increased risk of maternal morbidity, preterm birth, miscarriage, macrosomia, pregnancy-induced hypertension, cesarean delivery, gestational diabetes, and metabolic disease in the offspring.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 2","pages":"84-92"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227554","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":"Furcate Cord Insertions: A Comprehensive Review of Reported Cases, Outcomes, and Management Implications.","authors":"Brooke E Schroeder, Jeffrey A Kuller, Lillian Boettcher, Sarah K Dotters-Katz","doi":"10.1097/OGX.0000000000001478","DOIUrl":"10.1097/OGX.0000000000001478","url":null,"abstract":"<p><strong>Importance: </strong>Furcate umbilical cord insertion is a rare anomaly in which the umbilical vessels separate and lose Wharton jelly before placental insertion. This condition increases the risk of complications such as vessel avulsion and intrauterine fetal demise (IUFD). Despite these risks, data on this condition are limited, and no formal management guidelines exist for prenatally diagnosed cases.</p><p><strong>Objective: </strong>To provide an overview of abnormal umbilical cord insertions, with a focus on furcate cord insertions, as well as the evidence for the management of patients with furcate cord insertions.</p><p><strong>Evidence acquisition: </strong>Articles were identified through a PubMed and OVID literature search and reviewed for relevance.</p><p><strong>Results: </strong>We identified 158 cases of furcate cord insertion. Prenatal diagnosis occurred in only 20 cases (12.7%). IUFD was reported in 6 cases (3.8%), all where furcate cord went undiagnosed prenatally and nearly all (5/6) occurring after 37 weeks' gestation. Cesarean delivery was frequently performed when furcate cord insertion was detected prenatally, especially when co-occurring other comorbidities. Cord avulsion was reported in all cases of labor after 37 weeks, underscoring the risks associated with vaginal delivery.</p><p><strong>Conclusion: </strong>Furcate cord insertion is a rare placental anomaly associated with significant perinatal risk. Improved prenatal recognition may support evidence development and guide peripartum care. According to the limited available evidence, early-term cesarean delivery may be a reasonable option in prenatally diagnosed cases, though further research is needed.</p><p><strong>Relevance: </strong>This review offers an overview of the evidence for the detection and management of furcate cord insertions.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 2","pages":"93-98"},"PeriodicalIF":3.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227527","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}