Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

{"title":"Innovations and strategies for effective implementation of post pregnancy contraception services: Learnings from the FIGO PPIUD initiative","authors":"Anita Makins ,&nbsp;Suzanna Bright ,&nbsp;Emily-Anne Tunnacliffe ,&nbsp;Sabaratnam Arulkumaran","doi":"10.1016/j.bpobgyn.2025.102639","DOIUrl":"10.1016/j.bpobgyn.2025.102639","url":null,"abstract":"<div><div>The global unmet need for contraception continues to be unacceptably high at 218 million. The vast majority of these are women living in low and middle income countries, with a particularly high unmet need in the postpartum period. The FIGO PPIUD initiative demonstrated that it is feasible to embed counselling on contraception and insertion of PPIUD in maternity services. Implementation of these services was greatly enhanced by ensuring that counselling was culturally sensitive and appropriately given through specifically trained individuals, that task sharing was maximized in order to increase access, and that a high fundal placement was achieved resulting in low expulsion rates. Financing for contraception in LMICs is currently precarious and vulnerable to international politics. PPIUD is highly cost-effective. Expansion of contraception services including PPIUD has the potential to impact positively on climate change and a country's development profile if expanded on a large scale.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102639"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633905","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":"Engineering strategies and challenges in building the follicular microenvironment for a bioprosthetic ovary","authors":"Diane C. Saunders ,&nbsp;Monica M. Laronda","doi":"10.1016/j.bpobgyn.2025.102641","DOIUrl":"10.1016/j.bpobgyn.2025.102641","url":null,"abstract":"<div><div>Many individuals with ovaries that utilize fertility preservation because of their progressive disease or gonadotoxic treatment must use ovarian tissue cryopreservation (OTC). Currently, the only option for fertility and hormone restoration after OTC is ovarian tissue transplantation (OTT), or autologous grafting of ovarian tissue. Individuals with disease in their ovaries do not have options to produce a biological child or restore their full ovarian hormone milieu. The goal of developing a bioprosthetic ovary would support full fertility and hormone restoration long-term as a safer and ideally more efficient option than current OTT techniques. In order to develop a bioprosthetic ovary, the field must understand how to control the rate of primordial follicle activation and support the follicle growth through development and maturation into a good quality egg. The follicular microenvironment changes across the lifespan and the growing oocyte is surrounded by a different microenvironment as it is localized in different compartments within the ovary over folliculogenesis. The human ovarian interstitial cells, scaffold proteins and the juxtracrine, paracrine and endocrine signals that influence folliculogenesis are just being realized with the increased data generated by mapping technologies. Recent research has utilized bioengineering tools to interrogate these follicular microenvironment components and better understand the components that are necessary and sufficient to sustain folliculogenesis and produce good quality eggs. However, there are several biological, scalability and regulatory hurdles to overcome in order to realize a bioprosthetic ovary, including the ability to isolate sufficient primordial follicles from their dense stroma while maintaining their quiescence and subsequent transplant longevity. This chapter reviews these components and encourages researchers to continue on these research quests to increase the foundational understanding of human folliculogenesis and develop near-future solutions for infertility on the way to developing the ideal bioprosthetic ovary.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102641"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772552","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 surgery for congenital diaphragmatic hernia in the post-TOTAL trial era","authors":"Linoy Batsry,&nbsp;Jimmy Espinoza,&nbsp;Eric Bergh","doi":"10.1016/j.bpobgyn.2025.102648","DOIUrl":"10.1016/j.bpobgyn.2025.102648","url":null,"abstract":"<div><div>Today, prenatal therapy for congenital diaphragmatic hernia (CDH) primarily centers on fetoscopic endoluminal tracheal occlusion (FETO). This procedure involves the temporary occlusion of the fetal trachea to promote lung development. The TOTAL (Tracheal Occlusion to Accelerate Lung Growth) trial demonstrated a significant improvement in survival rates for fetuses with severe CDH following FETO. The outcomes of the TOTAL trial have sparked heightened interest in the FETO procedure, leading to the publication of numerous additional studies. Nevertheless, subsequent research has yielded inconsistent results outside of randomized controlled trials. This review examines the variations in patient selection, procedural techniques, and postnatal care that may contribute to this variability while also exploring potential future directions for the FETO procedure and prenatal therapy for CDH.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102648"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724077","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":"Prenatal intervention in congenital obstructive hydrocephalus: Rationale, eligibility, and techniques","authors":"Stephen P. Emery MD ,&nbsp;Shohra Qaderi ,&nbsp;Weston Northam MD ,&nbsp;Alireza Shamshirsaz MD","doi":"10.1016/j.bpobgyn.2025.102647","DOIUrl":"10.1016/j.bpobgyn.2025.102647","url":null,"abstract":"<div><div>Congenital obstructive hydrocephalus from aqueductal stenosis (AS) is a relatively rare but clinically significant fetal anomaly that results from obstruction of the antegrade flow of cerebrospinal fluid (CSF) from the third to the fourth cerebral ventricles. Cerebrospinal fluid accumulates in the lateral and third ventricles under pressure. That pressure is transferred to the developing fetal brain, causing permanent neurologic injury from tissue ischemia and neuronal shear. This review aims to provide an in-depth analysis of the pathophysiology, diagnosis, and current management strategies, followed by the rationale, eligibility, and potential techniques of prenatal intervention.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102647"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711546","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":"Is the time right for transplanting immature testicular tissue or cells to restore male fertility? Expert perspectives on clinical implementation of autotransplantation of cryopreserved testicular tissue or cells for fertility restoration","authors":"Myriam Safrai ,&nbsp;Ellen Goossens ,&nbsp;Rod T. Mitchell ,&nbsp;Kyle E. Orwig ,&nbsp;Callista L. Mulder ,&nbsp;Ans M.M. van Pelt ,&nbsp;Debra A. Gook ,&nbsp;Aurélie Feraille ,&nbsp;Emily Delgouffe ,&nbsp;Jill P. Ginsberg ,&nbsp;Jan-Bernd Stukenborg ,&nbsp;Kathleen Duffin ,&nbsp;Kirsi Jahnukainen ,&nbsp;Claus Yding Andersen ,&nbsp;Marianne D. van de Wetering ,&nbsp;Michael P. Rimmer ,&nbsp;Virginie Barraud-Lange ,&nbsp;Nina Neuhaus ,&nbsp;Sheila Lane ,&nbsp;Hooman Sadri-Ardekani ,&nbsp;Christine Wyns","doi":"10.1016/j.bpobgyn.2025.102638","DOIUrl":"10.1016/j.bpobgyn.2025.102638","url":null,"abstract":"<div><div>Transplantations of cryopreserved immature testicular tissue (ITT) or spermatogonial stem cells (SSCs) represent promising approaches to restore fertility in patients with testicular tissue or cell suspension cryopreserved for fertility preservation. With over 3000 testicular samples cryopreserved globally, clinically viable and standardized protocols restoring fertility using cryopreserved testicular tissue/cells are urgently needed. Decades of research demonstrate the feasibility of immature testicular tissue transplantation (ITTT) or spermatogonial stem cell transplantation (SSCT) in animal models, including non-human primates. However, significant challenges remain in translating these options to human clinical practice.</div><div>Critical factors include rigorous patient selection, robust pre-transplant evaluations to mitigate risks of malignant cell reintroduction, and the optimization of transplantation timing to support spermatogenesis. Developing comprehensive follow-up protocols and international data-sharing frameworks is essential to optimize outcomes. While offering the potential for genetic parenthood and enhanced quality of life for cancer survivors, these techniques require further refinement to ensure safety, efficacy, and realistic expectations. This paper outlines the framework for advancing the clinical translation of autotransplantation of testicular tissue/cells through collaboration and innovation.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102638"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670586","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":"Understanding, detecting, and managing the “late” anemia of hemolytic disease of the fetus and newborn","authors":"Robert D. Christensen MD,&nbsp;Timothy M. Bahr MS, MD,&nbsp;Robin K. Ohls MD","doi":"10.1016/j.bpobgyn.2025.102650","DOIUrl":"10.1016/j.bpobgyn.2025.102650","url":null,"abstract":"<div><div>The “late” anemia of hemolytic disease of the fetus and newborn (HDFN), first described over 65 years ago, remains incompletely understood and inconsistently treated. We suspect that deficiencies in understanding its pathogenesis and fostering uniformity in its management could be remedied by teams working collaboratively to test the best ideas through multicentered trials. We begin this review by proposing a data-based definition of anemia, and of “severe” anemia, among infants at birth and during the neonatal period. We then review early as well as recent reports of the “late” anemia of HDFN, suggesting that two pathogenic forms of the condition exist; <em>hemolytic vs. non-hemolytic (hypoproductive)</em>. We then review the use of a noninvasive and rapid means of differentiating between these two possibilities, in any given case. Next, we review means of either preventing the “late” anemia or treating it without red blood cell transfusions, using erythropoietic stimulating agents (darbepoetin or erythropoietin). We present our preferred method, using darbepoetin, and explain what we see as the chief advantages. We call for the development of transfusion stewardship programs in each NICU, to establish NICU transfusion guidelines, periodically evaluate compliance, and provide advice for problem cases. In addition, these programs can endorse a consistent approach to managing neonates with HDFN, during their NICU stay and for the weeks after discharge. We end the review with a gap analysis and a call for new focused research aimed at producing better outcomes for these patients, and less uncertainty and stress for these families.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102650"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769446","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":"Early postnatal management of neonatal RBC alloimmunization","authors":"Debeer A MD, PhD ,&nbsp;Vanhole C MD, PhD","doi":"10.1016/j.bpobgyn.2025.102651","DOIUrl":"10.1016/j.bpobgyn.2025.102651","url":null,"abstract":"<div><div>Hemolytic disease of the newborn (HDN) remains a significant clinical challenge in neonatal care. This review focuses on the early postnatal management of HDN and synthesizes current evidence-based recommendations to guide healthcare professionals in optimizing outcomes for affected neonates. Key areas of discussion include the diagnosis and monitoring of HDN, the management of hyperbilirubinemia, and the use of immunoglobulin therapy and exchange transfusion and transfusion policy. Practical challenges such as resource limitations, timely diagnosis, and the implementation of standardized protocols are highlighted. The review aims to provide a comprehensive overview of the latest evidence to support clinicians in making informed decisions in the management of HDN.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102651"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702445","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 effects of cancer treatments on uterine function","authors":"Emma Greenberg ,&nbsp;Katya Strage ,&nbsp;Noelle Ozimek ,&nbsp;Kamilah Abdur-Rashid ,&nbsp;Guluzar Turan ,&nbsp;Sarah Milgrom ,&nbsp;Leslie Appiah","doi":"10.1016/j.bpobgyn.2025.102629","DOIUrl":"10.1016/j.bpobgyn.2025.102629","url":null,"abstract":"<div><div>Advancements in cancer treatments and associated increased survival rates have led to a growing number of girls and women facing reproductive health challenges as a result of their oncologic treatments. Radiation and chemotherapy have been demonstrated to have adverse effects on fertility. Ovarian damage as a result of radiation and chemotherapy has been the subject of extensive study. Less well understood are the uterine changes mediated by these treatment modalities. Uterine damage from radiation therapy is related to dose, regimen, and patient age. Certain chemotherapies have demonstrated similar effects. Women with uterine damage have a lower likelihood of conceiving and a higher risk of pregnancy complications, including early pregnancy loss, preterm labor, and low birth weight infants. Surgical, medical, and genetic therapies are being evaluated to protect the uterus from treatment-related injury. Pre- and post-treatment consultation with oncofertility specialists is critical in assessing a patient's risk of uterine injury from a proposed cancer treatment plan as well as understanding treatment-induced injury to optimize fertility preservation.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102629"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563621","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":"Hemolytic disease of the fetus and newborn: A review of pathophysiology, diagnosis, and management","authors":"Hajra Malik ,&nbsp;E.J.T. (Joanne) Verweij ,&nbsp;Hiba J. Mustafa","doi":"10.1016/j.bpobgyn.2025.102646","DOIUrl":"10.1016/j.bpobgyn.2025.102646","url":null,"abstract":"<div><div>Hemolytic Disease of the Fetus and Newborn (HDFN) results from maternal alloantibodies attacking fetal red blood cells, leading to fetal anemia and potentially severe complications such as hydrops fetalis. Effective management relies on early detection through maternal antibody screening, fetal antigen testing, and close monitoring of fetal anemia. In cases of severe anemia, intrauterine transfusion (IUT) remains the primary intervention to improve fetal outcomes. Despite this, there is an urgent need for novel medical therapies to prevent or delay disease progression in pregnancies at risk for HDFN.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102646"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769444","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":"Intervention or expectant management for stage I twin-twin transfusion syndrome","authors":"Raphael Bartin M.D. ,&nbsp;Nikan Zargarzadeh M.D. ,&nbsp;Mohammadamin Parsaei M.D. ,&nbsp;Alireza A. Shamshirsaz M.D. ,&nbsp;Julien J. Stirnemann M.D. ,&nbsp;Stephen P. Emery M.D.","doi":"10.1016/j.bpobgyn.2025.102645","DOIUrl":"10.1016/j.bpobgyn.2025.102645","url":null,"abstract":"<div><div>Selective fetoscopic laser photocoagulation of communicating vessels (SFPL) is well established as the first line of therapy for stage II-IV twin-twin transfusion syndrome (TTTS). The optimal management of stage I TTTS is less well-defined. While many stage I patients resolve spontaneously or remain stage I with good pregnancy outcomes, a majority progress to higher stages. Risk factors that differentiate those who will remain stable or regress vs. those who will progress are lacking. This has led some centers to offer SFLP to patients with stage I disease either immediately or after a period of close observation. The objective of this manuscript is to review the current evidence on the merits of laser treatment versus expectant management for stage I TTTS. A search of PubMed and Google Scholar using the keywords “stage I,” “twin transfusion,” and “management” was undertaken. The results of this review suggest that expectant management of stable, asymptomatic stage I TTTS is a reasonable first-line treatment, whereas selective fetoscopic laser photocoagulation is an appropriate first step in some circumstances. Treatment of stage I TTTS should remain an option in select patients.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102645"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144780823","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}