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Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

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Maternal hemodynamics assessment: Key to unlocking ignored functionalities of the female circulation 母体血液动力学评估：解开女性循环被忽视功能的关键
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-03-01 DOI: 10.1016/j.bpobgyn.2025.102595
Wilfried Gyselaers , Pauline Dreesen
{"title":"Maternal hemodynamics assessment: Key to unlocking ignored functionalities of the female circulation","authors":"Wilfried Gyselaers ,&nbsp;Pauline Dreesen","doi":"10.1016/j.bpobgyn.2025.102595","DOIUrl":"10.1016/j.bpobgyn.2025.102595","url":null,"abstract":"<div><div>This chapter focuses on currently underappreciated aspects of the maternal circulation: blood pressure phenotypes, venous hemodynamics, intra-abdominal pressure, and body water homeostasis. Based on the hemodynamic balance between cardiac output and total peripheral resistance, flow-dominant and resistance-dominant phenotypes of normotension and hypertension exist, with different impacts on gestational outcome. Cardiac diastolic function and venous hemodynamics play a prominent role in gestational changes in cardiac output. An increase in intra-abdominal pressure during pregnancy interferes with body water volume homeostasis, similar to syndromes of multi-organ dysfunctions in non-pregnant individuals. Today, non-invasive maternal hemodynamics assessment allows for obtaining important information on these ignored circulatory functions in addition to conventional sphygmomanometric blood pressure measurement. This offers perspectives to improve current strategies for screening, diagnosis, and management of gestational hypertension disorders, a path, however, to be paved first by intensified multifaceted and multidisciplinary research.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"99 ","pages":"Article 102595"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644112","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}
引用次数: 0
Early medical abortion 早期药物流产
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-21 DOI: 10.1016/j.bpobgyn.2025.102588
Sharon T. Cameron
{"title":"Early medical abortion","authors":"Sharon T. Cameron","doi":"10.1016/j.bpobgyn.2025.102588","DOIUrl":"10.1016/j.bpobgyn.2025.102588","url":null,"abstract":"<div><div>Early medical abortion (EMA) with mifepristone and misoprostol is expanding access to safe abortion across the world. The drug regimen has changed and the steps involved in EMA have been significantly simplified since EMA was first introduced over 35 years ago. Evidence shows that women can safely self-administer both mifepristone and misoprostol themselves at home and self-manage the procedure including confirming the success of the procedure with a self-performed pregnancy test. Telemedicine has expanded access to EMA and evidence shows that it is associated with similar outcomes to traditional models of delivery and is acceptable to both women and clinicians. Further research is required to optimise the analgesic regimen for EMA. Greater efforts are required to expand availability of medical abortion at home at both very early gestations (less than 6 weeks) and up to the end of the first trimester. More evidence is needed to develop guidelines to support provision in remote settings.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"99 ","pages":"Article 102588"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488282","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}
引用次数: 0
Arterial stiffness in gestational diabetes: Latest insights 妊娠期糖尿病的动脉僵硬：最新见解
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-03 DOI: 10.1016/j.bpobgyn.2025.102587
Abigail R. Anness Dr. , Asma Khalil , Hatem A. Mousa
{"title":"Arterial stiffness in gestational diabetes: Latest insights","authors":"Abigail R. Anness Dr. ,&nbsp;Asma Khalil ,&nbsp;Hatem A. Mousa","doi":"10.1016/j.bpobgyn.2025.102587","DOIUrl":"10.1016/j.bpobgyn.2025.102587","url":null,"abstract":"<div><div>Increased arterial stiffness is a known cardiovascular risk factor, associated with hypertension and acute coronary events. Gestational diabetes (GDM) is associated with the development of placental-mediated disorders and future cardiovascular morbidity, raising the possibility of an association with increased arterial stiffness (AS). Several studies have now investigated this association through the assessment of pulse wave velocity and augmentation index. In the current review, we present the latest evidence regarding the changes in arterial stiffness in pregnancies complicated by GDM, before the onset of clinical disease, during its course, and after its resolution. We also review the evidence that AS could influence the need for different treatments for GDM, and the impact that the treatments, and in particular, metformin, could have on arterial stiffness.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"99 ","pages":"Article 102587"},"PeriodicalIF":3.9,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143428909","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}
引用次数: 0
Best Practice & Research clinical obstetrics & gynaecology 临床妇产科最佳实践与研究。
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2024.102574
Kate Swanson , Mary E. Norton
{"title":"Best Practice & Research clinical obstetrics & gynaecology","authors":"Kate Swanson ,&nbsp;Mary E. Norton","doi":"10.1016/j.bpobgyn.2024.102574","DOIUrl":"10.1016/j.bpobgyn.2024.102574","url":null,"abstract":"<div><div>Screening for fetal genetic disorders is a focus of prenatal care. Cell free DNA (cfDNA) screening for aneuploidies became available in 2011. Initially available only to high-risk individuals, this test is now standard of care in many settings. cfDNA screening has expanded to include sex chromosomal aneuploidies, copy number variants, and rare autosomal trisomies. However, the positive predictive value for rarer conditions is significantly lower, the number of conditions tested for is small, and abnormal results may occur due to maternal genetic findings. The field is changing quickly, and national recommendations for the use of cfDNA in screening for fetal and maternal diseases varies internationally. Research on the performance of screening for many different genetic disorders using cfDNA is ongoing, and suggests that this methodology may allow for testing of a much greater number of genetic conditions. Additionally, improved understanding of the cfDNA molecules themselves may provide additional insights: both high and low fetal fractions may suggest adverse pregnancy outcomes, and characteristics of the fragments themselves may help distinguish tissue of origin.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"98 ","pages":"Article 102574"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873744","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}
引用次数: 0
Considerations for hormonal contraception and people with larger bodies 激素避孕和体型较大人群的注意事项
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2025.102577
Julia Tasset, Alison Edelman
{"title":"Considerations for hormonal contraception and people with larger bodies","authors":"Julia Tasset,&nbsp;Alison Edelman","doi":"10.1016/j.bpobgyn.2025.102577","DOIUrl":"10.1016/j.bpobgyn.2025.102577","url":null,"abstract":"<div><div>People with larger bodies face discrimination in accessing health care, including equitable contraceptive care. Conscientious provision of person-centered contraception counseling is consistent with principles of the Health at Every Size and the Reproductive Justice movements. One facet of this care includes integration of evidence around unique considerations for steroid hormone efficacy and safety for patients with bigger bodies. Ultimately, this information should be used to empower and support reproductive decision making amongst patients of larger body sizes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"99 ","pages":"Article 102577"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143296228","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}
引用次数: 0
The clinical relevance of having more than one estrogen in combined hormonal contraception to address the needs of women 在联合激素避孕中使用一种以上雌激素以满足妇女需要的临床意义。
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2024.102571
Caroline Frisendahl , Helena Kopp Kallner , Kristina Gemzell-Danielsson
{"title":"The clinical relevance of having more than one estrogen in combined hormonal contraception to address the needs of women","authors":"Caroline Frisendahl ,&nbsp;Helena Kopp Kallner ,&nbsp;Kristina Gemzell-Danielsson","doi":"10.1016/j.bpobgyn.2024.102571","DOIUrl":"10.1016/j.bpobgyn.2024.102571","url":null,"abstract":"<div><div>This chapter examines the potential of natural estrogens, particularly estradiol and estetrol, in combined hormonal contraceptive pills as alternatives to the widely used synthetic ethinyl estradiol. Current evidence highlights the promise of these natural estrogens in providing effective contraception with improved safety profiles and maintained tolerability.</div></div><div><h3>What we know</h3><div>Estradiol and estetrol exhibit favorable safety and efficacy profiles compared to ethinyl estradiol.</div></div><div><h3>What we think we know</h3><div>Initial studies suggest that estetrol combined with drosperinone provide effective contraception with a predictable bleeding patternand reduced risk for venous thromboembolism compared to ethinyl estradiol containing pills. Such risk may also be further mitigated by non-oral administration of estradiol.</div></div><div><h3>What we do not know</h3><div>Long-term efficacy and safety data are needed to confirm the benefits of natural estrogens and their impact on diverse populations and comorbid conditions. By addressing these gaps, future research can enhance our understanding of natural estrogens in hormonal contraception, ultimately refining their use in clinical practice.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"98 ","pages":"Article 102571"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788089","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}
引用次数: 0
Improving access to emergency obstetric care in low- and middle-income countries 改善低收入和中等收入国家获得产科急诊的机会。
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2024.102572
Lawrence Chauke
{"title":"Improving access to emergency obstetric care in low- and middle-income countries","authors":"Lawrence Chauke","doi":"10.1016/j.bpobgyn.2024.102572","DOIUrl":"10.1016/j.bpobgyn.2024.102572","url":null,"abstract":"<div><div>While maternal deaths have declined by a third between 2000 and 2020, approximately 800 women continue to die every day due to pregnancy-related complications. For every woman who dies, many more experience life-debilitating conditions. Most of these deaths occur in low- and middle-income countries (LMICs). Women in Sub-Saharan Africa (SSA) face the highest risk of mortality, with a lifetime risk of dying from pregnancy-related complications estimated at 1 in 40. Given the unpredictable nature of pregnancy complications, emergency obstetric care (EmOC) remains the most effective strategy to reduce the global burden of maternal deaths due to pregnancy related complications. Investing in EmOC can assist countries struggling with high burden of maternal mortality in staying on track toward achieving the United Nations' 2030 Sustainable Development Goals (SDGs). However, LMICs encounter several challenges in accessing these life-saving interventions. This article utilises Thaddeus and Maine's three-delay model to analyse barriers to EmOC in LMICs and to propose potential solutions.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"98 ","pages":"Article 102572"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820284","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}
引用次数: 0
Fetal imaging, phenotyping, and genomic testing in modern prenatal diagnosis 胎儿成像，表型，和基因组检测在现代产前诊断。
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2024.102575
Matthew A. Shear , Peter N. Robinson , Teresa N. Sparks
{"title":"Fetal imaging, phenotyping, and genomic testing in modern prenatal diagnosis","authors":"Matthew A. Shear ,&nbsp;Peter N. Robinson ,&nbsp;Teresa N. Sparks","doi":"10.1016/j.bpobgyn.2024.102575","DOIUrl":"10.1016/j.bpobgyn.2024.102575","url":null,"abstract":"<div><div>Genetic tests available in the prenatal setting have expanded rapidly with next generation sequencing, and fetal imaging can detect a breadth of many structural and functional abnormalities. To identify a fetal genetic disease, deep phenotyping is increasingly important to generate a differential diagnosis, choose the most appropriate genetic tests, and inform the results of those tests. The Human Phenotype Ontology (HPO) organizes and defines the features of human disease to support deep phenotyping, and ongoing efforts are being made to improve the scope of the HPO to comprehensively include fetal phenotypes. There are important limitations of fetal phenotyping to understand, including ongoing structural development and limited knowledge of how many genetic diseases present uniquely <em>in utero</em>. This article provides an overview of the use of HPO terms and artificial intelligence in the approach to fetal phenotyping and genetic testing.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"98 ","pages":"Article 102575"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911347","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}
引用次数: 0
Common myths and misconceptions surrounding hormonal contraception 关于激素避孕的常见神话和误解。
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2024.102573
Kirsten I. Black , Maxime Vromman , Rebecca S. French
{"title":"Common myths and misconceptions surrounding hormonal contraception","authors":"Kirsten I. Black ,&nbsp;Maxime Vromman ,&nbsp;Rebecca S. French","doi":"10.1016/j.bpobgyn.2024.102573","DOIUrl":"10.1016/j.bpobgyn.2024.102573","url":null,"abstract":"<div><div>Numerous community and professional myths and misconceptions around hormonal contraception exist, many promulgated through social media. As a result of these and other factors, people are moving away from hormonal methods and potentially exposing themselves to increased risk of unintended pregnancy. A number of key myths and misconceptions have been identified in a range of papers and here we summarise the evidence around the basis for these misunderstandings. The themes we explore are the physical side effects, the mental health effects, the impact on sexuality, the concerns about infertility, the concept of “unnaturalness”, concerns about menstruation, concerns about safety and destigmatisation of side effects. For many of these themes, there is some evidence justifying the concern, but overall for most people, we argue that the benefits of hormonal contraception outweigh the disadvantages.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"98 ","pages":"Article 102573"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869797","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}
引用次数: 0
Preface: Emergency obstetrics in low- and middle-income countries 前言：低收入和中等收入国家的产科急诊。
IF 3.9 2区 医学
Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-02-01 DOI: 10.1016/j.bpobgyn.2024.102576
Nnabuike Chibuoke Ngene (Dr), Jagidesa Moodley (Emeritus Professor)
{"title":"Preface: Emergency obstetrics in low- and middle-income countries","authors":"Nnabuike Chibuoke Ngene (Dr),&nbsp;Jagidesa Moodley (Emeritus Professor)","doi":"10.1016/j.bpobgyn.2024.102576","DOIUrl":"10.1016/j.bpobgyn.2024.102576","url":null,"abstract":"","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"98 ","pages":"Article 102576"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873745","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}
引用次数: 0
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