Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

{"title":"Connecting polycystic ovary syndrome and pilonidal disease in adolescents: State of the art review","authors":"Nicholas Yung ,&nbsp;Gwendolyn Towers ,&nbsp;Anum Wani ,&nbsp;Michael G. Caty ,&nbsp;Robert A. Cowles ,&nbsp;Daniel G. Solomon ,&nbsp;Alla Vash-Margita","doi":"10.1016/j.bpobgyn.2025.102691","DOIUrl":"10.1016/j.bpobgyn.2025.102691","url":null,"abstract":"<div><div>Pilonidal disease is a dermatologic condition of the natal cleft that affects primarily adolescents. Its severity ranges from asymptomatic to chronically recurring disease. Like pilonidal disease, polycystic ovary syndrome commonly begins to affect women in their adolescence. PCOS is increasing in prevalence, affecting 6–20 % of women, and can significantly compromise quality of life by contributing to acne, weight gain, hirsutism, development of diabetes mellitus, hypertension, mental disorders and infertility. It is therefore increasingly important to be aware of a recently reported association between polycystic ovary syndrome and pilonidal disease within the female adolescent population. The conditions share common risk factors such as obesity, hyperandrogenism, and metabolic syndrome. Early diagnosis of these conditions is important in mitigating morbidity associated with either disease. This clinical opinion suggests a reciprocal pathway for management of female adolescents who may be suffering from either polycystic ovary syndrome or pilonidal disease, with the goal of providing comprehensive management and mitigating morbidity.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102691"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673172","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":"Twin reversed arterial perfusion sequence, to treat or not to treat? and surgical approaches","authors":"Nikan Zargarzadeh ,&nbsp;Ali Javinani ,&nbsp;Asma Khalil ,&nbsp;Alireza Shamshirsaz ,&nbsp;Liesbeth Lewi","doi":"10.1016/j.bpobgyn.2025.102690","DOIUrl":"10.1016/j.bpobgyn.2025.102690","url":null,"abstract":"<div><div>Twin Reversed Arterial Perfusion (TRAP) sequence is an infrequent complication of monochorionic pregnancies, characterized by retrograde perfusion of an acardiac twin via arterio-arterial and veno-venous placental anastomoses, leading to severe malformations in the acardiac twin and hemodynamic strain on the pump twin. This narrative review explores the pathophysiology, diagnostic criteria, and prognostic factors influencing management decisions, including acardiac-to-pump twin weight ratio, Doppler abnormalities, and early signs of cardiac dysfunction. Expectant management remains a viable option in low-risk cases with close surveillance, but the presence of poor prognostic indicators—such as hydrops, reversed a-wave in the ductus venosus, or significant polyhydramnios—justifies timely fetal intervention. Surgical techniques such as intrafetal radiofrequency ablation, laser coagulation, and bipolar cord occlusion have demonstrated improved survival for the pump twin, especially when performed in the early second trimester. While minimally invasive approaches have advanced significantly, a prophylactic intervention strategy has gained traction in some centers to prevent unpredictable deterioration. Given the lack of randomized trials and limited long-term outcome data, individualized, gestational age–tailored management remains crucial, and further prospective studies are needed to optimize care in TRAP sequence pregnancies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"104 ","pages":"Article 102690"},"PeriodicalIF":4.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737205","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":"Biologics in red cell and platelet alloimmunizations: State of the science and future perspectives","authors":"Kenneth J. Moise Jr ,&nbsp;Eleonor Tiblad","doi":"10.1016/j.bpobgyn.2025.102682","DOIUrl":"10.1016/j.bpobgyn.2025.102682","url":null,"abstract":"<div><div>Hemolytic disease of the fetus and newborn (HDFN) is routinely treated with the intrauterine transfusion (IUT) of compatible donor red cells once fetal anemia is detected. Intravenous immune globulin (IVIG) is often used in patients with a previous history of early onset disease in a previous pregnancy. Although IUT's are still required in the majority of these pregnancies, IVIG appears to prolong the gestational age until these are necessary. IVIG with or without oral steroids is utilized in most countries to prevent thrombocytopenia and intracranial hemorrhage in cases of fetal/neonatal alloimmune thrombocytopenia (FNAIT). Nipocalimab, a humanized monoclonal antibody that blocks the neonatal Fc receptor, is currently undergoing clinical trials in both HDFN and FNAIT as a potential new form of immunotherapy for these alloimmune disorders of pregnancy.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102682"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416377","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":"Innovations in post-pregnancy contraception","authors":"Michelle Cooper ,&nbsp;Sharon Cameron","doi":"10.1016/j.bpobgyn.2025.102672","DOIUrl":"10.1016/j.bpobgyn.2025.102672","url":null,"abstract":"<div><div>Evidence indicates that regardless of how a pregnancy ends (birth, abortion, miscarriage, ectopic), that ovulation resumes quickly in most cases. Those who are sexually active soon afterwards therefore require an effective method of contraception to avoid an unintended pregnancy. Yet, lack of knowledge on contraceptive options or when they can or should be initiated can be barriers to starting a method. For those who have given birth the requirements of looking after a newborn and recovering from delivery adds to existing barriers of accessing a chosen method after pregnancy. It is vital therefore that access to contraception can be facilitated for women to start immediately post pregnancy. this chapter will outline some initiatives to empower individuals to choose contraception for following a pregnancy and also innovations to help them access that method.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102672"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410952","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":"Fetal therapy with mTOR inhibitors in cardiac rhabdomyoma and lymphatic malformations","authors":"Nikan Zargarzadeh ,&nbsp;Pegah Rashidian ,&nbsp;Tishi Shah ,&nbsp;Greg Ryan ,&nbsp;Yalda Afshar","doi":"10.1016/j.bpobgyn.2025.102673","DOIUrl":"10.1016/j.bpobgyn.2025.102673","url":null,"abstract":"<div><div>Fetal therapy has advanced with novel pharmacological approaches to address congenital tumors and malformations, including cardiac rhabdomyomas and lymphatic malformations (LMs). Cardiac rhabdomyomas, often associated with tuberous sclerosis complex (TSC), can lead to significant morbidity due to arrhythmias, left or right ventricular outflow tract obstruction and heart failure, particularly in neonates. LMs, resulting from abnormal development of the lymphatic system, can cause considerable morbidity, including airway obstruction, disfigurement, recurrent infections, bleeding into cysts, and impaired function of affected organs, depending on location. Recent therapies involving mammalian target rapamycin (mTOR) inhibitors, such as everolimus and sirolimus, offer promising interventions for these conditions. As mTOR inhibitors target dysregulated cell growth and angiogenesis, they can effectively reduce the size of both cardiac rhabdomyomas and LMs <em>in-utero</em>. Clinical studies in the pediatric population have shown that mTOR inhibitors promote regression of cardiac rhabdomyomas, leading to improved cardiac function, and similarly reduce the size of lymphatic malformations, thereby decreasing the need for surgical or interventional procedures. Sirolimus has also shown efficacy in treating complex LMs and is increasingly being used as a first line agent alone as well as in conjunction with other treatment modalities like surgery and sclerotherapy. Despite potential side effects, including gastrointestinal discomfort and an increased risk of infection, the risk–benefit ratio should be carefully evaluated on an individual patient basis. This review examines current evidence supporting the use of mTOR inhibitors in fetal therapy, highlighting their ability to mitigate postnatal complications and improve long-term outcomes. Further research is needed to optimize dosing protocols and assess the long-term safety of these therapies in the fetal population.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102673"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446795","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":"Hormonal methods for fertility regulation","authors":"Raymond Hang-Wun Li","doi":"10.1016/j.bpobgyn.2025.102671","DOIUrl":"10.1016/j.bpobgyn.2025.102671","url":null,"abstract":"","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102671"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158557","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":"Serial amnioinfusions as a regenerative therapy for pulmonary hypoplasia in fetuses with intrauterine renal failure: rationale, techniques, and ethical considerations","authors":"Tanvi Rana ,&nbsp;Jena L. Miller ,&nbsp;Mounira Habli","doi":"10.1016/j.bpobgyn.2025.102676","DOIUrl":"10.1016/j.bpobgyn.2025.102676","url":null,"abstract":"<div><div>This article is a comprehensive review of amniotic fluid, its crucial role in fetal development, particularly lung development, and the implications of its deficiency, oligohydramnios. It describes the various causes of fetal renal failure that lead to oligohydramnios, focusing on congenital anomalies of the urinary tract. The text then introduces amnioinfusion, an experimental therapy that involves infusing fluid into the amniotic sac to compensate for the lack of fetal urine production. It details the rationale for this intervention, outlines the different technical approaches employed, and discusses the potential complications and ethical considerations surrounding this experimental therapy. Lastly, the paper summarizes the rationale and design of the RAFT trial, a clinical study that explored the effectiveness and safety of amnioinfusion in the management of early pregnancy renal anhydramnios (EPRA).</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102676"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465770","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":"Current challenges in fertility preservation","authors":"Richard A. Anderson","doi":"10.1016/j.bpobgyn.2025.102654","DOIUrl":"10.1016/j.bpobgyn.2025.102654","url":null,"abstract":"","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102654"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933783","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":"First trimester scan in twins","authors":"Sofia Albuquerque Brás,&nbsp;Leonor Ferreira","doi":"10.1016/j.bpobgyn.2025.102684","DOIUrl":"10.1016/j.bpobgyn.2025.102684","url":null,"abstract":"<div><div>The first trimester ultrasound, performed between 11 + 0 and 13 + 6 weeks of gestation, plays an important role that goes beyond identifying ultrasound markers for aneuploidies. Its objectives include determining the number of fetuses and assessing chorionicity and amnionicity in cases of twin pregnancies; establishing gestational age; detecting major structural anomalies and evaluating uterine arteries for pre-eclampsia.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102684"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416484","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":"Long-term neurodevelopmental outcomes after intrauterine transfusion for alloimmune hemolytic disease of the fetus and newborn","authors":"Jeanine M.M. van Klink ,&nbsp;Derek P. de Winter ,&nbsp;Renske M. van ‘t Oever ,&nbsp;Ratna N.G.B. Tan ,&nbsp;E.J.T. Verweij Joanne ,&nbsp;Masja de Haas ,&nbsp;Enrico Lopriore","doi":"10.1016/j.bpobgyn.2025.102680","DOIUrl":"10.1016/j.bpobgyn.2025.102680","url":null,"abstract":"<div><div>The mainstay for the management and treatment of severe alloimmune hemolytic disease of the fetus and newborn (HDFN) is based on timely detection and intrauterine transfusions (IUT) in cases with severe fetal anemia. Although long-term neurodevelopmental outcomes in children born following IUT for HDFN are nowadays considered ‘favorable’, reliable long-term outcome data remain scarce. Several studies suggests that children with a history of severe hydrops, cerebral injury, and preterm birth are at increased risk for neurodevelopmental impairment (NDI). However, follow-up studies are limited by small sample sizes, the absence of control groups, inconsistent criteria for neurodevelopmental outcome, and a lack of standardized developmental assessments. The prevalence of NDI in the literature to date is reported to be around 5 % but varies from 0 % to 18.8 %, depending on the studied cohort. When interpreting the data and extrapolating conclusions to the general population, consideration must be given to the fact that the majority was born moderate to late preterm, a population inherently at increased risk for adverse neurodevelopmental outcomes. Future research should incorporate more subtle impairments, as mild to moderate cognitive deficits, learning problems and socioemotional and behavioral difficulties can substantially impact long-term care needs and socioeconomic potential. A deeper understanding of the effects of fetal anemia and IUT on neurodevelopmental trajectories will enable effective screening and the implementation of timely, targeted interventions to optimize developmental outcomes for children at risk. In addition, the impact of the complicated pregnancy on the wellbeing of parents and the child-caregiver relationship is an underexposed and understudied outcome measure. With the introduction of new non-invasive therapies, international collaborative efforts are of utmost importance to reliably investigate not just survival or neonatal outcome but also long-term neurodevelopment and wellbeing of children and caregivers.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102680"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403042","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}