Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

{"title":"Exploring new predictors for hypertensive disorders of pregnancy","authors":"Daniela Denis Di Martino ,&nbsp;Elisa Sabattini ,&nbsp;Marco Parasiliti ,&nbsp;Lucrezia Viscioni ,&nbsp;Elena Zaccone ,&nbsp;Serena Cerri ,&nbsp;Gabriele Tinè ,&nbsp;Enrico Ferrazzi","doi":"10.1016/j.bpobgyn.2025.102598","DOIUrl":"10.1016/j.bpobgyn.2025.102598","url":null,"abstract":"<div><div>The best performing predicting Bayesian algorithm for preeclampsia, endorsed by FIGO, identifies high-risk women at first trimester screening who benefits of a closer monitoring and possibly preventive measures. Unfortunately, the most frequent late term and term preeclampsia are less efficiently predicted. This algorithm is based on statistical assumptions at odds with the physiopathology: preeclampsia is a disease and not a syndrome, as we know it is, and the contingent time-based criteria according to which all pregnancies if not terminated by nature should develop this “disease”.</div><div>In addition to this, we know that gestational hypertension might cause in fifty percent of cases severe outcome, comparable to preeclampsia. The very definition of preeclampsia as proteinuric hypertension is now extended to hypertension associated with other end-organ damage, including fetal growth restriction (FGR), this latter condition proceeding, in early onset cases, hypertension. Predicting phenotypes of hypertensive Disorders of pregnancy (HDP) could better help clinical practice.</div><div>This study reports exploratory observations in women resulted at high and low risk at first trimester screening followed up at second and third trimester, to term. The co-variates interrogated were sFlt1/PlGF ratio, the uterine arteries PI, the systemic vascular resistances (SVR), maternal total body water and visceral fat.</div><div>Women were classified as HDP-AGA, HDP-FGR, normotensive-FGR and uneventful pregnancies (controls). We performed a longitudinal Bayesian multivariate mixed-effects model corrected both for pre-gestational BMI and trimester of analysis.</div><div>The sFlt-1/PlGF ratio and SVR confirmed their significant difference in HDP-AGA, in normotensive FGR, and HDP-FGR along the three trimesters from controls, but with different strength along the three trimesters.</div><div>The bioimpedance analysis of total body water and visceral fat confirmed the association of these co-factors with women who will develop HDP-AGA.</div><div>The strength of longitudinal changes observed, even on a limited number of cases, provide evidence that Bayesian algorithms applied at screening tests at different gestational ages, should be based on co-variates significantly associated either with HDP-FGR or with HDP-AGA provided that the main causative co-factors involved are adopted by predictive models aimed at these distinct diseases.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102598"},"PeriodicalIF":3.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subdermal contraceptive implants","authors":"Luis Bahamondes ,&nbsp;M.Valeria Bahamondes ,&nbsp;Cassia R.T. Juliato","doi":"10.1016/j.bpobgyn.2025.102604","DOIUrl":"10.1016/j.bpobgyn.2025.102604","url":null,"abstract":"<div><div>The provision of long-acting reversible contraceptive (LARC) methods is one of the best tools available to avoid high rates of unplanned pregnancy (UP), a public health problem that affects millions of women worldwide. In this review we provide an update regarding subdermal contraceptive implants including etonogestrel (ENG) and levonorgestrel (LNG) implants. Implants have been shown to be one of the most effective forms of contraceptive, with failure in only 4/1000 women for up to five years. Thus, their provision is an excellent strategy for reducing UPs. After a single intervention, implants provide long-term contraception with minimal side effects. Implants have few contraindications, but care must be taken to check for drug interactions with topiramate, rifampin and efavirenz. Although the ENG implant is approved for up to three years of use, research is ongoing into the possibility of extending its use beyond that period.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102604"},"PeriodicalIF":3.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac output-guided maternal positioning in pregnancy-- can it improve outcomes?","authors":"Thomas L. Archer","doi":"10.1016/j.bpobgyn.2025.102596","DOIUrl":"10.1016/j.bpobgyn.2025.102596","url":null,"abstract":"<div><div>Chronic and recurrent obstruction of the inferior vena cava by the uterus during the second half of pregnancy are theorized to contribute to the causation of preeclampsia, fetal growth restriction, preterm birth, dysfunctional labor and postpartum uterine atony. Such obstruction is hypothesized to be asymptomatic for the mother but can be detected and minimized by non-invasive continuous trending of maternal cardiac output, because positional decreases in cardiac output can serve as a <strong><em>warning signal</em></strong> of obstruction of venous return. Injury may be caused by 1) decreased cardiac output, 2) increased uterine venous and intervillous pressures and 3) decreased intervillous perfusion. Wide variations in intervillous oxygen tension may be more harmful than low but stable oxygen tension. Clinical examples of asymptomatic but dramatic positional changes in maternal cardiac output in hospitalized patients are shown. Further research should begin with laboring patients, since cardiac output changes dramatically over time and with position during labor.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102596"},"PeriodicalIF":3.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do all women after hypertensive diseases of pregnancy have the same long-term risk of cardiovascular disease in later life?","authors":"Johannes J. Duvekot","doi":"10.1016/j.bpobgyn.2025.102597","DOIUrl":"10.1016/j.bpobgyn.2025.102597","url":null,"abstract":"<div><div>During pregnancy, most maternal organ systems increase in function or size. This is indeed also the case for cardiovascular function and maternal hemodynamics. Most systems show enormous changes that put a serious strain on these systems. Gestational complications develop when an organ system is unable to meet the increased physiological demands of pregnancy. Pregnancy can be considered as the ultimate stress test for these organ systems. Preeclampsia and gestational hypertension may be considered as a derangement of the hemodynamic and cardiovascular system during pregnancy. During later life the hemodynamic and cardiovascular system again derails when aging has its toll. Cardiovascular morbidity and mortality are greatly increased after pregnancies complicated by hypertensive disorders of pregnancy. These complications must be acknowledged by health care providers as a risk factor for later cardiovascular disease. All women after HDP should be followed scrutinous at least during the first 5–10 years after their deliveries. The focus of the follow-up should be on the development of hypertension. Women with an increased risk are those with early-onset preeclampsia, recurrent preeclampsia and preeclampsia in the last pregnancy. Uncomplicated pregnancies after pregnancies complicated by HDP improve the prognosis substantially. Multiplet pregnancies with HDP tend to have lower risks for CVD in later life than singleton pregnancies with HDP.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102597"},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations and approaches for early onset fetal anemia due to red cell alloimmunization","authors":"Kenneth J. Moise","doi":"10.1016/j.bpobgyn.2025.102602","DOIUrl":"10.1016/j.bpobgyn.2025.102602","url":null,"abstract":"<div><div>There is no widely accepted definition for early onset hemolytic disease of the fetus and newborn (EOS-HDFN). Several reported series of patients managed with intravascular intrauterine transfusions (IVT's) prior to 20–22 weeks' gestation have been associated with a perinatal mortality of 20 %. It would therefore seem appropriate to define EOS-HDFN as a fetal demise, hydrops fetalis or the need for intrauterine transfusion for suspected fetal anemia prior to 20–22 weeks' gestation. Evaluation of the patient in her next pregnancy with EOS-HDFN history should include a free fetal DNA analysis at 10–12 weeks' gestation to confirm the at-risk fetus. Weekly middle cerebral artery peak systolic velocity determinations using Doppler ultrasound should be initiated by 15 weeks' gestation. Immunomodulation with intravenous immune globulin with or without plasmapheresis should be considered as early at 10–12 weeks' gestation. If IUT's are required prior to 20 weeks' gestation, an intraperitoneal approach can be used until a more advanced gestation can be attained when intravascular fetal access is possible. In the near future, neonatal Fc receptor blockade with a monoclonal antibody may supplant invasive IUT's in the treatment of EOS-HDFN.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102602"},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 point-of-care ultrasound (POCUS) in maternal medicine","authors":"J.A. van der Zande ,&nbsp;K. Rijs ,&nbsp;A.A. Shamshirsaz ,&nbsp;H. Soliman ,&nbsp;A. Franx ,&nbsp;R.M. Kauling ,&nbsp;J.W. Roos-Hesselink ,&nbsp;C.D. van der Marel ,&nbsp;K. Verdonk ,&nbsp;J.M.J. Cornette","doi":"10.1016/j.bpobgyn.2025.102599","DOIUrl":"10.1016/j.bpobgyn.2025.102599","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) is an increasingly valuable tool in maternal medicine, offering rapid, bedside evaluation of critically ill pregnant patients. This study explores the expanding role of POCUS in obstetric care, particularly its application in assessing different organ systems. POCUS enables timely, accurate diagnoses and interventions, crucial for preventing maternal morbidity and mortality. While POCUS is widely used in emergency and intensive care, its potential in obstetric settings remains underexplored. Maternal and Fetal Medicine specialists, who already possess substantial ultrasound expertise, can easily integrate POCUS in daily practice.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102599"},"PeriodicalIF":3.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second trimester echocardiography","authors":"Enery Gómez-Montes,&nbsp;Ignacio Herraiz,&nbsp;Cecilia Villalain,&nbsp;Alberto Galindo","doi":"10.1016/j.bpobgyn.2025.102592","DOIUrl":"10.1016/j.bpobgyn.2025.102592","url":null,"abstract":"<div><div>Fetal echocardiography involves a comprehensive cardiac assessment aiming to make a complete structural examination of the heart as well as to detect signs of cardiovascular adaptation to different insults. For the former, this assessment entails expert's evaluation of the anatomy of the heart including additional views beyond the five axial views used in cardiac screening examinations and always complemented with colour and pulsed Doppler. Echocardiography may accurately diagnose most congenital heart defects in fetal life, which enables adjusting the perinatal management. For the latter, echocardiography encompasses cardiac morphometric assessment to identify signs of cardiac remodeling indicative of cardiac adaptation in structure, shape, and size in response to underlying diseases, and cardiac functional assessment to detect signs of systolic and/or diastolic dysfunction. The most used parameters to study the systolic function (stroke volume, cardiac output, ejection fraction, fractional shortening, and mitral and tricuspid annular plane systolic excursion), diastolic function (characteristics of flow in the precordial veins and through the atrioventricular valves) and global myocardial function (myocardial performance index) will be discussed in this review.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102592"},"PeriodicalIF":3.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3rd trimester ultrasound assessment","authors":"Cecilia Villalain,&nbsp;Alberto Galindo,&nbsp;Enery Gómez-Montes,&nbsp;Ignacio Herraiz","doi":"10.1016/j.bpobgyn.2025.102593","DOIUrl":"10.1016/j.bpobgyn.2025.102593","url":null,"abstract":"<div><div>The third-trimester scan allows not only the assessment of foetal growth but also its presentation and anatomy, and placental, amniotic fluid, and umbilical cord anomalies. Although there is a great disparity when considering its recommendation, most recent studies raise the question for its usefulness considering its impact in a potential reduction of perinatal morbidity and mortality. For this to be a reality in a population-wide setting, a systematic approach should be made considering performing it between 35 + 0 and 36 + 6 weeks’, including the assessment of estimated foetal weight, foetal Doppler (umbilical and middle cerebral artery), placenta, amniotic fluid, foetal anatomy, and presentation. In high-risk cases, additional evaluation of the placenta, umbilical cord, or advanced foetal anatomy assessment can be warranted. Furthermore, pre-defined and evidence-based protocols should be followed after anomalies are detected in order to improve maternal and perinatal outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102593"},"PeriodicalIF":3.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carrier screening and pregnancy","authors":"Borut Peterlin ,&nbsp;Ana Peterlin","doi":"10.1016/j.bpobgyn.2025.102601","DOIUrl":"10.1016/j.bpobgyn.2025.102601","url":null,"abstract":"<div><div>Recessive genetic conditions impose a significant burden, often leading to severe childhood disorders, many of which remain untreatable. It is estimated that 1–2 % of couples are at risk of having an affected child in the general population, with the risk being significantly higher in consanguineous couples. Understanding the increased risk of having a child with a recessive disorder empowers prospective parents to make informed reproductive choices. With technological advancements, genetic screening has evolved beyond identifying only a few common conditions. Expanded carrier screening (ESC) now offers a single test that covers a comprehensive list of recessive disorders, addressing those that contribute most significantly to the burden of these conditions within specific populations.</div><div>ESC is recommended for all couples planning a pregnancy, with particular emphasis on consanguineous couples or those who are subfertile. To ensure responsible use of ESC, clinical service delivery should adopt a multidisciplinary approach, providing couples with the information they need to make voluntary, informed decisions. This includes access to high-quality genetic testing, genetic counseling, and psychosocial support.</div><div>National professional societies and governments play a crucial role in shaping guidelines, policies, oversight, and funding to guarantee equitable access to high-quality ESC services.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102601"},"PeriodicalIF":3.9,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Doppler assessment in pregnancy","authors":"Jose H. Ochoa ,&nbsp;Daniel Cafici","doi":"10.1016/j.bpobgyn.2025.102594","DOIUrl":"10.1016/j.bpobgyn.2025.102594","url":null,"abstract":"<div><div>Fetal Doppler assessment plays a crucial role in monitoring the fetal well-being during pregnancy. This non-invasive technique assesses blood flow dynamics in key fetal vessels, namely the umbilical artery, middle cerebral artery, and ductus venosus.</div><div>The umbilical artery Doppler provides valuable insights into placental function aiding in the early detection of fetal growth restriction and fetal distress.</div><div>Assessment of the middle cerebral artery Doppler provides information on the adequacy of cerebral perfusion. It is highly sensitive to changes in fetal oxygenation and contributes to the management of advanced stages of early fetal growth restriction. It is also a valuable and sometimes standalone marker for late-term fetal hypoxic compromise and fetal anemia.</div><div>Doppler evaluation of ductus venosus offers additional data for identifying cardiac compromise and predicting adverse perinatal outcomes.</div><div>Incorporating these Doppler assessments into routine prenatal care enhances the ability to detect and manage fetal compromise, ultimately improving pregnancy outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"100 ","pages":"Article 102594"},"PeriodicalIF":3.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143767599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}