Obstetrical & Gynecological Survey最新文献

{"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":"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}

{"title":"Prevention of Maternal Rh D Alloimmunization: A Comparative Review of Guidelines.","authors":"Eirini Boureka, Ioannis Tsakiridis, Sonia Giouleka, Anastasios Liberis, Georgios Michos, Ioannis Kalogiannidis, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001338","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001338","url":null,"abstract":"<p><strong>Importance: </strong>Rhesus alloimmunization refers to the sensitization of an Rh D-negative mother after exposure to D-positive fetal red blood cells, which can lead to significant fetal and neonatal morbidity and mortality.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published international guidelines on the prevention of maternal alloimmunization.</p><p><strong>Evidence acquisition: </strong>A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the British Committee for Standards in Hematology, the International Federation of Gynecology and Obstetrics, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada regarding the prevention of maternal Rh D alloimmunization was conducted.</p><p><strong>Results: </strong>There is consensus among the reviewed guidelines regarding the timing of antenatal antibody screening; the management of an already sensitized pregnancy; the administration and timing of postnatal prophylaxis with a D-positive neonate; and the need for prophylaxis after invasive procedures, abdominal trauma, and external cephalic version. Controversies exist regarding the management of women expressing weak D blood type and the optimal dose and regimen for routine antenatal prophylaxis, with recommendations suggesting administration between 28 and 34 weeks, versus specifically at 28 weeks. Moreover, significant discrepancies exist regarding the need for prophylaxis after some sensitizing events such as threatened, spontaneous, or surgical miscarriage; termination of pregnancy; and molar and ectopic pregnancy, as well as the optimal dose of anti-D globulin after invasive antenatal procedures, abdominal trauma, external cephalic version, and postnatal prophylaxis.</p><p><strong>Conclusions: </strong>Anti-D globulin remains an important tool for the prevention of maternal alloimmunization, thus contributing to a significant improvement in fetal and neonatal outcomes. However, due to lack of evidence, discrepancies exist between relevant guidelines. Hence, further studies and the development of consistent evidence-based protocols and algorithms are pivotal to safely guide through pregnancy and subsequently reduce fetal and neonatal morbidity, without subjecting women to unnecessary treatment.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 12","pages":"741-750"},"PeriodicalIF":4.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962308","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":"Disparities in Genetic Management of Breast and Ovarian Cancer Patients.","authors":"Susan Duyar-Ayerdi, Rebekah M Summey, Denise Uyar","doi":"10.1097/OGX.0000000000001332","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001332","url":null,"abstract":"<p><strong>Importance: </strong>Hereditary breast and ovarian cancer syndrome (HBOC) is most often caused by pathogenic variants in the <i>BRCA1</i> or <i>BRCA2</i> genes. Guidelines exist for genetic testing in patients at high risk, yet significant disparities in genetic testing and management remain. These disparities result in missed opportunities for cancer prevention and treatment.</p><p><strong>Objective: </strong>This review details the multiple layers of disparities in genomic knowledge, testing referral, completion, and posttesting risk reduction for at-risk populations.</p><p><strong>Evidence acquisition: </strong>A comprehensive search of the PubMed database was conducted in September 2023 for studies addressing disparities at all points of HBOC risk assessment and risk reduction.</p><p><strong>Results: </strong>Disparities in genomic knowledge, referral and testing, and in cancer risk reduction exist by race, ethnicity, insurance status, socioeconomic status, age, and care setting in the United States. Many mitigation strategies have been explored with some success.</p><p><strong>Conclusion: </strong>Each component contributes to a \"leaky pipe\" in <i>BRCA</i> testing and management whereby patients eligible for intervention trickle out of the pipe due to inequities at each step. Implementation of proven strategies aimed at disparity reduction in this setting is essential, as well as additional strategy development.</p><p><strong>Relevance: </strong>This review provides clinicians with a comprehensive understanding of disparities in the identification and management of individuals at risk for or diagnosed with HBOC and strategies to reduce disparities in their own practice.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 11","pages":"673-682"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639427","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":"Autologous Ovarian Tissue Transplantation: Preoperative Assessment and Preparation of the Patient.","authors":"Volkan Turan, Ozgur Oktem","doi":"10.1097/OGX.0000000000001325","DOIUrl":"10.1097/OGX.0000000000001325","url":null,"abstract":"<p><strong>Importance: </strong>Ovarian tissue cryopreservation (OTC) is an innovative and established fertility preservation method. More than 150 live births have been reported worldwide to date with the use of this strategy. OTC is one of the options to preserve fertility in prepubertal girls and for women who have time constraints and/or contraindications for ovarian stimulation for oocyte/embryo freezing before cancer treatment. The success rate of the ovarian tissue transplantation (OTT) depends on many interrelated factors. Therefore, preoperative evaluation and preparation of the candidate patients for the procedure are of paramount importance.</p><p><strong>Objective: </strong>In this review, our aim was to provide a guide for the clinicians, which demonstrates step-by-step assessment and preparation of the patients and ovarian tissue samples for transplantation.</p><p><strong>Evidence acquisition: </strong>We searched for published articles in the PubMed database containing key words, such as OTT, OTC, preoperative assessment, primordial follicle density, and cancer, in the English-language literature until May 2024. We did not include abstracts or conference proceedings.</p><p><strong>Results: </strong>OTT is still a developing method as an effective fertility preservation approach. It is essential to perform a thorough preoperative evaluation of the patient to improve the success rates of transplantation.</p><p><strong>Conclusions and relevance: </strong>Preoperative evaluation and preparation of women for ovarian transplantation surgery should include safety management to prevent reimplantation of malignant cells, transplanting ovarian tissue with minimum follicle loss and the decision of the best transfer site.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 11","pages":"683-688"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639426","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":"Nondiabetic Fetal Macrosomia: Causes, Outcomes, and Clinical Management.","authors":"Courtney A Bair, Jennifer Cate, Allison Chu, Jeffrey A Kuller, Sarah K Dotters-Katz","doi":"10.1097/OGX.0000000000001326","DOIUrl":"10.1097/OGX.0000000000001326","url":null,"abstract":"<p><strong>Importance: </strong>Fetal macrosomia (FM) is common in clinical practice and carries increased risk of adverse maternal and neonatal health outcomes. Maternal diabetes mellitus (DM) is a well-known cause of macrosomia with significant research and guidelines focusing on macrosomia in this population. Less is known about causes, prevention, and clinical management for suspected FM in individuals without diabetes.</p><p><strong>Objective: </strong>The objective of this review is to describe the risk factors associated with nondiabetic FM, review risks associated with macrosomia in pregnancy, and potential treatment considerations for this condition.</p><p><strong>Evidence acquisition: </strong>Original research articles, review articles, and guidelines on macrosomia were reviewed.</p><p><strong>Results: </strong>Risk factors for macrosomia in patients without DM include previous delivery of an infant with macrosomia, excessive pregnancy weight gain, and obesity. Maternal complications of FM include higher rates of cesarean delivery, postpartum hemorrhage, and vaginal laceration. Fetal complications include shoulder dystocia, decreased Apgar scores, and increased risk of childhood obesity. Exercise during pregnancy has been shown to reduce the risk of FM. Induction of labor prior to 39 weeks is not recommended in the setting of suspected macrosomia as there is a lack of adequate evidence to support that this decreases adverse neonatal or maternal outcomes. In addition, elective cesarean delivery for suspected macrosomia is not recommended to be considered unless estimated fetal weight is greater than 5000 g in the absence of DM.</p><p><strong>Conclusions and relevance: </strong>Delivery of an infant with macrosomia in patients without DM has increased maternal and fetal risks. Predicting infants who will meet criteria for macrosomia is challenging. More research is needed to identify ways to accurately estimate fetal weight, interventions to prevent macrosomia, and additional ways to mitigate risk in patients without DM who have suspected FM.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 11","pages":"653-664"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639428","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":"Treatment of Obesity Before, During, and After Pregnancy: Time for Obstetricians to Get Involved.","authors":"Deborah Gustafson, Farah Al-Sayyed, Howard Minkoff","doi":"10.1097/OGX.0000000000001329","DOIUrl":"10.1097/OGX.0000000000001329","url":null,"abstract":"<p><strong>Importance: </strong>Obesity is a major public health concern that is associated with serious health risks and consequences for people who want to be, are, or have been pregnant.</p><p><strong>Objective: </strong>We will describe the implications and consequences of obesity, and describe the factors fueling obesity's escalating prevalence. We will describe new treatment approaches including glucagon-like peptide-1 agonists, which may be an effective strategy for achieving weight loss and for improving the health of people who have been, are, or want to be pregnant.</p><p><strong>Evidence acquisition: </strong>Existing literature on obesity consequences, treatment options, and pregnancy implications was reviewed through a PubMed search.</p><p><strong>Results: </strong>Obesity has dire pregnancy-related health consequences and leads to multiple barriers to healthcare. Traditional interventions related to diet and exercise have fallen short, and newer medical therapies are emerging.</p><p><strong>Relevance: </strong>The periods before, during, and after pregnancy are crucial to mitigate potential morbidities of pregnancy pre, peri, and post. Obstetricians have a unique opportunity to tackle the problem of obesity at those times.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 11","pages":"665-672"},"PeriodicalIF":4.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639434","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":"Diagnosis and Management of Preterm Prelabor Rupture of Membranes: A Comprehensive Review of Major Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Garyfallia Emmanouilidou, Eirini Boureka, Ioannis Kalogiannidis, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001313","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001313","url":null,"abstract":"<p><strong>Importance: </strong>Preterm prelabor rupture of membranes (PPROM) represents a significant contributor of maternal and neonatal morbidity complicating a significant proportion of pregnancies worldwide.</p><p><strong>Objective: </strong>The aim of this review was to summarize and compare the most recently published guidelines on the diagnosis and management of this critical pregnancy complication.</p><p><strong>Evidence acquisition: </strong>A comparative review of 3 recently updated national guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, and the Society of Obstetricians and Gynaecologists of Canada on PPROM was conducted.</p><p><strong>Results: </strong>There is an overall agreement that the diagnosis of PPROM should be mainly based on sterile speculum examination and patient's history, followed by additional tests in equivocal cases, although the accuracy and contribution of both ultrasound and amniotic proteins tests in the diagnosis remain debatable. Following PPROM confirmation, all guidelines recommend the performance of vaginal and rectal swabs, the evaluation of fetal and maternal status, the administration of antibiotics and corticosteroids, and the immediate induction of labor, if severe complications are identified. Expectant management from viability until late preterm period is universally recommended; nevertheless, there are discrepancies on the optimal timing of delivery. Magnesium sulfate should be administered in case of imminent preterm delivery; however, there is no consensus on the upper gestational age limit. Recommendations on inpatient and outpatient management of PPROM are also inconsistent. Moreover, there is no common guidance on the use of tocolysis or antibiotic regimens. Finally, all medical societies agree that closer surveillance of future pregnancies is required.</p><p><strong>Conclusions: </strong>PPROM remains the most common identifiable risk factor of preterm delivery, despite constant improvement in prenatal provision of care. Thus, the establishment of consistent international practice protocols for the timely and accurate diagnosis and the optimal management of this complication seems of vital importance and will hopefully lead to significant reduction of the associated adverse outcomes.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"79 10","pages":"591-603"},"PeriodicalIF":4.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505041","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}