Best Practice & Research Clinical Obstetrics & Gynaecology最新文献_第4页

The future of clinical studies of in-utero therapy for genetic diseases 子宫内治疗遗传病临床研究的未来

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-10-26 DOI: 10.1016/j.bpobgyn.2025.102678

Gillian Gough , G. Owen Schaefer , Karen M.X. Lim , Mahesh Choolani , Citra N.Z. Mattar

{"title":"The future of clinical studies of in-utero therapy for genetic diseases","authors":"Gillian Gough , G. Owen Schaefer , Karen M.X. Lim , Mahesh Choolani , Citra N.Z. Mattar","doi":"10.1016/j.bpobgyn.2025.102678","DOIUrl":"10.1016/j.bpobgyn.2025.102678","url":null,"abstract":"<div><div>Approximately 7000 rare diseases affect 3.5–6.0 % of the global population. Technological advancements have improved disease identification and screening, enabling early interventions during fetal development; however, treatment options remain limited. Key considerations for advancing intrauterine therapy (IUT) into clinical practice include determining if prenatal intervention is superior to postnatal treatment, addressing technical aspects like delivery methods, target organ accessibility, cell preparation, and appropriate gestational age for therapy initiation. Critical resources include technical expertise, necessary equipment, and a multidisciplinary team for monitoring adverse events. Compliance with ethical, legal, and regulatory standards, including informed consent and parental counselling, is essential. Although IUT shows promise for treating genetic diseases, it is still experimental. This review examines the barriers, opportunities, and key considerations for initiating clinical trials in fetal genetic therapies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102678"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416376","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

Hormonal contraception in perimenopausal women 围绝经期妇女的激素避孕

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-09-02 DOI: 10.1016/j.bpobgyn.2025.102655

Sara Whitburn , Kathleen McNamee , Clare Boerma , Deborah Bateson

引用次数: 0

The effect of valacyclovir on secondary prevention of congenital cytomegalovirus infection 缬昔洛韦对先天性巨细胞病毒感染的二级预防作用

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-10-29 DOI: 10.1016/j.bpobgyn.2025.102679

Christos Chatzakis , Nicolas Bourgon , Jacques Fourgeaud , Marianne Leruez-Ville , Yves Ville

{"title":"The effect of valacyclovir on secondary prevention of congenital cytomegalovirus infection","authors":"Christos Chatzakis , Nicolas Bourgon , Jacques Fourgeaud , Marianne Leruez-Ville , Yves Ville","doi":"10.1016/j.bpobgyn.2025.102679","DOIUrl":"10.1016/j.bpobgyn.2025.102679","url":null,"abstract":"<div><div>It has been established recently that oral valacyclovir 8g/day reduces significantly the vertical CMV transmission rate in pregnancies with primary Cytomegalovirus (CMV) infection acquired periconceptionally or during the first trimester. Aim of the present study is to expand the result of the previous studies by including any recent cohort study on the topic. MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (Central), the US Registry of clinical trials (<span><span>www.clinicaltrials.gov</span><svg><path></path></svg></span>) and grey literature sources were searched. Randomized controlled trials and cohort studies administering oral valacyclovir 8g/day in pregnancies with primary CMV infection acquired periconceptionally or during the first trimester were included. Cochrane's Risk of Bias 2 and Robins I tools were used for the risk of bias assessment. The result of amniocentesis was the primary outcome of interest. Two-stages individual patient data meta-analysis was performed and a subgroup analysis was carried out, assessing separately the periconceptional period and the first trimester infections. Four studies were included in the analysis (n = 860 participants). Valacyclovir reduced the vertical transmission rate, adjusted odds ratio (a0R) = 0.39 (95 % CI 0.25–0.59). This reduction was apparent both for periconceptional period aOR = 0.30 (95 % CI 0.13–0.68) and first trimester aOR = 0.47 (95 % CI 0.28–0.78) infections. Valacyclovir also reduced the rate of neonatal infection, a0R = 0.45 (95 % CI 0.25–0.83), both in periconceptional period aOR = 0.42 (95 % CI 0.20–0.90)] and in first trimester aOR = 0.54 (95 % CI 0.29–0.99) infections. Oral valacyclovir (8 g/day) reduces the vertical transmission rates of CMV following primary maternal infection acquired periconceptionally or in the first trimester.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102679"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416378","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

Clinical management in FNAIT – navigating a complicated landscape FNAIT的临床管理-导航一个复杂的景观。

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-10-25 DOI: 10.1016/j.bpobgyn.2025.102681

Heidi Tiller , Maria Therese Ahlen

{"title":"Clinical management in FNAIT – navigating a complicated landscape","authors":"Heidi Tiller , Maria Therese Ahlen","doi":"10.1016/j.bpobgyn.2025.102681","DOIUrl":"10.1016/j.bpobgyn.2025.102681","url":null,"abstract":"<div><div>Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the primary cause of severe neonatal thrombocytopenia and fetal/neonatal intracranial hemorrhage (ICH) in otherwise healthy term newborns. FNAIT occurs in 0.5–1:1000 newborns. FNAIT may occur if the mother and fetus have incompatible platelet antigens, leading to maternal alloimmunization with antibodies targeting the fetal platelets. The main clinical concern is the risk of ICH, with a reported incidence of 1:10,000 newborns. Most bleedings occurs prior to delivery. Due to the lack of HPA-1a screening in pregnancy, most pregnancies complicated by FNAIT are not diagnosed until after birth and the condition is underdiagnosed.</div><div>Current antenatal management protocols are focused on subsequent pregnancies, when a mother has had a previously affected neonate. The primary goal of treatment during the subsequent pregnancy is to prevent ICH in the current fetus/neonate. The predicted risk of ICH in subsequent pregnancies depends mainly on whether the previous FNAIT-affected sibling had ICH or not.</div><div>In most Western countries, weekly off-label administration of high-dose IVIg is used for pregnant HPA-1a-alloimmunized women to prevent ICH in the fetus/newborn. However, many experts advocate for a more stratified approach that limits which at-risk pregnancies are offered IVIg.</div><div>This non-systematic expert review will focus on ante- and perinatal clinical management of FNAIT, addressing both clinical (non-screening) and screening scenarios.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102681"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410935","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

In-utero repair of open neural tube defects, lesion closure techniques and the choice of patch 开放式神经管缺损的宫内修复、病变闭合技术及补片的选择

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-11-07 DOI: 10.1016/j.bpobgyn.2025.102677

Charles B. Stevenson , Stephen Fletcher , Thomas Larrew , Jason K. Chu

{"title":"In-utero repair of open neural tube defects, lesion closure techniques and the choice of patch","authors":"Charles B. Stevenson , Stephen Fletcher , Thomas Larrew , Jason K. Chu","doi":"10.1016/j.bpobgyn.2025.102677","DOIUrl":"10.1016/j.bpobgyn.2025.102677","url":null,"abstract":"<div><div>In 2011, the landmark Management of Myelomeningocele Study (MOMS) demonstrated unequivocal benefits for children undergoing prenatal closure of myelomeningocele. In addition to reducing the need for CSF diversion following delivery, the procedure was also shown to improve independent ambulation at school age and beyond, typically yielding a functional neurological level at least 2 better than the anatomic level in these patients. While prenatal myelomeningocele (MMC) closure can be more technically challenging and demanding than postnatal closure, the same basic surgical principles are typically employed during fetal intervention to obtain a multi-layered, water-tight closure with recapitulation of the normal anatomic relationships. Here we describe commonly utilized operative techniques for intrauterine MMC closure, with illustration of both open and endoscopic variations to perform the procedure. As maternal-fetal centers across the globe continue to gain experience with intrauterine MMC closure, it is incumbent that we constantly strive to improve both the efficacy and safety of the procedure, mitigating the potential complications of prenatal closure such that the benefits for the child far outweigh the associated risks for both mother and baby.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102677"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519763","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

Vasa previa: A condition with diverse management approaches 先兆性血管病：一种需要多种治疗方法的疾病。

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-10-26 DOI: 10.1016/j.bpobgyn.2025.102674

Faezeh Aghajani , Claudio V. Schenone , Ali Javinani , Hiba J. Mustafa , Eyal Krispin , Ramesha Papanna , Ramen H. Chmait

{"title":"Vasa previa: A condition with diverse management approaches","authors":"Faezeh Aghajani , Claudio V. Schenone , Ali Javinani , Hiba J. Mustafa , Eyal Krispin , Ramesha Papanna , Ramen H. Chmait","doi":"10.1016/j.bpobgyn.2025.102674","DOIUrl":"10.1016/j.bpobgyn.2025.102674","url":null,"abstract":"<div><div>Vasa previa is a life-threatening fetal condition in which unprotected fetal blood vessels traverse the membranes over or near the cervical os, placing the fetus at high risk of rapid exsanguination if the membranes rupture. Advances in prenatal diagnosis have markedly improved outcomes, but current standard management remains associated with notable perinatal morbidity due to preterm birth and risks associated with cesarean delivery for the mother. In the management of vasa previa, growing evidence supports outpatient monitoring and delayed delivery for carefully selected low-risk cases, aiming to balance fetal safety with maternal well-being and efficient use of healthcare resources. A major focus is the emerging role of fetoscopic laser photocoagulation (FLP), a minimally invasive procedure that ablates exposed fetal vessels in utero. FLP may allow for outpatient management. In selected cases of types II and III vasa previa, it could facilitate term delivery and vaginal birth. While preliminary results are encouraging, FLP remains investigational and should be confined to IRB-approved protocols at specialized centers. We emphasize the need for individualized care informed by anatomical subtype, clinical risk, and patient values. As clinical management moves away from uniform management toward more personalized strategies, future research must validate new approaches through prospective trials and long-term follow-up to optimize maternal and fetal outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102674"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145395692","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

From concept to practice: Screening for fetal and neonatal alloimmune thrombocytopenia (FNAIT) 从概念到实践：筛查胎儿和新生儿同种免疫性血小板减少症（FNAIT）。

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-10-27 DOI: 10.1016/j.bpobgyn.2025.102683

R. Pothof , T.W. de Vos , E. Lopriore , D. Winkelhorst , C.E. van der Schoot , M. de Haas , E.J.T. Verweij

{"title":"From concept to practice: Screening for fetal and neonatal alloimmune thrombocytopenia (FNAIT)","authors":"R. Pothof , T.W. de Vos , E. Lopriore , D. Winkelhorst , C.E. van der Schoot , M. de Haas , E.J.T. Verweij","doi":"10.1016/j.bpobgyn.2025.102683","DOIUrl":"10.1016/j.bpobgyn.2025.102683","url":null,"abstract":"<div><div>Affecting 1 per 1000 to 2000 pregnancies, Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) is the leading cause for (severe) thrombocytopenia in term neonates. Due to an incompatibility between fetal and maternal platelets, maternal alloantibodies are formed against paternally derived human platelet antigens (HPAs). The alloantibodies can cross the placenta into the fetal circulation, where they can destruct the fetal platelets. As a result, severe thrombocytopenia may occur, potentially leading to intracranial hemorrhage (ICH) or severe organ bleeding during pregnancy or shortly after birth. In the absence of a universal prenatal screening program focussed on HPA-1a, FNAIT is often diagnosed too late, typically after the onset of severe fetal or neonatal bleeding complications. A screening program could be very effective in identifying the first pregnancy complicated with FNAIT, allowing timely intervention and prevent severe ICH and its associated long-term permanent sequelae. The aim of this review is to provide a comprehensive overview of the existing evidence regarding a possible future screening program for FNAIT. Additionally, challenges will be explored that need to be addressed for successful implementation of a screening program.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"103 ","pages":"Article 102683"},"PeriodicalIF":4.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145403022","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 twin-to-twin transfusion syndrome: From early gestational physiology to diagnosis and management 早期双胞胎对双胞胎输血综合征：从早期妊娠生理学到诊断和管理

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-12-01 Epub Date: 2025-10-28 DOI: 10.1016/j.bpobgyn.2025.102675

Ali Javinani , Asma Khalil , Eyal Krispin

引用次数: 0

Decision-making and operative considerations for Ex-utero Intrapartum treatment (EXIT) 体外产内治疗（EXIT）的决策及手术考虑

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-09-01 Epub Date: 2025-07-25 DOI: 10.1016/j.bpobgyn.2025.102649

Scott Infusino , Nitin Sajankila , Elle Nuttall , Darrell L. Cass , Michael Puricelli , Inna N. Lobeck

{"title":"Decision-making and operative considerations for Ex-utero Intrapartum treatment (EXIT)","authors":"Scott Infusino , Nitin Sajankila , Elle Nuttall , Darrell L. Cass , Michael Puricelli , Inna N. Lobeck","doi":"10.1016/j.bpobgyn.2025.102649","DOIUrl":"10.1016/j.bpobgyn.2025.102649","url":null,"abstract":"<div><div>The Ex-Utero Intrapartum Treatment (EXIT) is a method of delivery utilized in the setting of fetal anomalies that can lead to respiratory or cardiovascular compromise with the transition to extrauterine life. With multidisciplinary collaboration, delivery occurs with uterine relaxation to preserve placental function, allowing for appropriate intervention while the maternofetal interface is maintained. Multiple types of EXIT procedures are described in the literature that differ based on fetal indication and specific clinical goals. These include EXIT-to-airway, EXIT-to-resection, EXIT-to-extracorporeal membrane oxygenation (ECMO), and EXIT-to-ventricular pacing. When considering an EXIT procedure, fetal benefit must be weighed against maternal risk, and patients require thorough counseling to make an informed decision. In many cases, an individualized approach is necessary. The goal of this review is to provide an overview of the prenatal evaluation, risk stratification, and technical planning necessary for the various forms of EXIT procedures.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102649"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772553","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

Making fertility preservation happen for the transgender community 让跨性别群体的生育能力得以保留。

IF 4.1 2区医学

Best Practice & Research Clinical Obstetrics & Gynaecology Pub Date : 2025-09-01 Epub Date: 2025-07-24 DOI: 10.1016/j.bpobgyn.2025.102652

Suset Rodriguez, Pasquale Patrizio

引用次数: 0