Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

{"title":"Reverse innovation – South to North learnings in the provision of postpartum contraception: implementation in a high-income setting","authors":"Anita Makins ,&nbsp;Hifsa Mahmood ,&nbsp;Katherine Talbot ,&nbsp;Claire Hordern ,&nbsp;Neda Taghinejadi ,&nbsp;Ruth Houlden ,&nbsp;Suzanna Bright ,&nbsp;Sabaratnam Arulkumaran","doi":"10.1016/j.bpobgyn.2025.102653","DOIUrl":"10.1016/j.bpobgyn.2025.102653","url":null,"abstract":"<div><div>This article outlines a unique example of reverse innovation. Lessons from low- and middle-income countries (LMICs) shaped healthcare practices in a high-income setting. We describe how the FIGO Postpartum Intrauterine Device Initiative, implemented across six LMICs, informed the development of a postpartum contraception program in a UK-based NHS trust. Despite the well-documented benefits of postpartum family planning (PPFP), implementing dedicated PPFP services in the UK has been challenging due to fragmented healthcare funding and cross service integration barriers. The COVID-19 pandemic created an urgent need for adaptation, providing a unique opportunity to rapidly establish a comprehensive local PPFP service. We outline how strategies from LMICs - including task-sharing, provider training, and policy advocacy - were directly applied to overcome these barriers and drive successful implementation. This case study highlights the potential of South-to-North knowledge transfer in driving healthcare innovation, improving contraceptive access, and underscores the importance of global collaboration and adaptive learning in reproductive healthcare.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102653"},"PeriodicalIF":4.1,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144829234","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":"Maternal adnexal masses in pregnancy","authors":"Dusan Djokovic ,&nbsp;Patrícia Pinto ,&nbsp;Inês Reis","doi":"10.1016/j.bpobgyn.2025.102643","DOIUrl":"10.1016/j.bpobgyn.2025.102643","url":null,"abstract":"<div><div>Maternal adnexal masses are increasingly detected during pregnancy, primarily due to the widespread use of ultrasound in obstetrics. Most of them are functional cysts that resolve spontaneously. Lesions visualized by ultrasound in adnexal topography may be retroperitoneal or intraperitoneal (non-gynecologic or obstetric/gynecologic formations, such as pregnancy-related masses, subserosal uterine fibroids or true adnexal lesions). The largest number of adnexal lesions do not change their ultrasound morphology in pregnancy. However, endometriomas may decidualize, mimicking borderline or stage I invasive ovarian malignancies. The patient management can be conservative (ultrasound surveillance) or surgery. The decision depends on a series of factors including the risk of malignancy. Until mathematical models have been widely validated in pregnancy, the International Ovarian Tumor Analysis Group recommends using simple benign descriptors and expert subjective assessment to predict the risk of maternal adnexal malignancy in pregnancy. In the future, artificial intelligence could be useful.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102643"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702444","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":"Establishing ovarian toxicity assessment in oncology trials","authors":"Felicity Martin ,&nbsp;Wanda Cui","doi":"10.1016/j.bpobgyn.2025.102642","DOIUrl":"10.1016/j.bpobgyn.2025.102642","url":null,"abstract":"<div><div>Premature ovarian insufficiency (POI) leading to infertility and early menopause is a serious potential adverse effect of cancer treatments. There are little robust data regarding the impact of novel classes of cancer treatment on ovarian function and fertility. Although cancer clinical trials collect very detailed information on a range of treatment-related adverse effects, ovarian toxicity is rarely assessed. In 2023, the first international research statement was published regarding assessment of ovarian toxicity in cancer clinical trials, to advocate for routine assessment of ovarian toxicity in cancer trials and to provide information to clinical trial stakeholders on how to do so, so that patients and clinicians have information about the possible long-term effects of treatment on ovarian function to facilitate informed decision-making regarding treatment options. The main recommendations from this statement are: 1) include measurement of ovarian toxicity in relevant clinical trials of anticancer agents in which premenopausal, post-pubertal patients with ovaries are enrolled, 2) collect ovarian function measures at baseline and at 12–24 months after cessation of the anticancer agent, as a minimum, and at later timepoints in line with the trial schedule, 3) include both clinical measures and biomarkers of ovarian function in clinical assessments. This statement is a key first step in prompting clinical trialists to collect ovarian function data routinely and systematically in clinical trials of anticancer agents and will, over time, enhance our understanding of novel anticancer agents and their effects on ovarian toxicity. Future work involves identifying the mechanism of ovarian toxicity for each class of novel cancer therapy, the contribution of other risk factors, such as age, and development of ovarian toxicity protection strategies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102642"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702446","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 and emerging data sources for assessment of ovarian toxicity in children, adolescents and young adults with cancer","authors":"Harmonie B. Strohl,&nbsp;Nguyen T. Do,&nbsp;H. Irene Su","doi":"10.1016/j.bpobgyn.2025.102640","DOIUrl":"10.1016/j.bpobgyn.2025.102640","url":null,"abstract":"<div><div>One in 20 cancers occurs in children, adolescents, and young adults, with some treatments leading to infertility or premature ovarian insufficiency. Cancer survivors and clinicians seek to estimate reproductive risks to guide fertility preservation and manage ovarian health post-treatment. Available data focus more on surrogate outcomes like amenorrhea and ovarian reserve markers than clinical outcomes such as ovarian insufficiency. Tools like the Cancer-Related Infertility Score Predictor (CRISP) and FDA-recommended data sources, including the FDA Adverse Event Reporting System, provide guidance on known ovarian toxicity risks. However, many novel and current cancer treatments lack comprehensive data. Emerging strategies include using real-world administrative data linked with lab results to estimate risks, large language models to streamline systematic reviews, regulatory guidance requiring ovarian toxicity data in new drug trials, and ex vivo ovary models for testing. This review highlights the need for improved methods and consistent assessment to support the reproductive health of young cancer survivors.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102640"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679192","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":"Diagnosis and management of large placental chorioangiomas","authors":"Felicia LeMoine,&nbsp;Neha Agarwal,&nbsp;Sarah Naranjo,&nbsp;Anthony Johnson,&nbsp;Sami Backley,&nbsp;Eric P. Bergh,&nbsp;Gustavo Vilchez Lagos,&nbsp;Edgar Hernandez-Andrade,&nbsp;Ramesha Papanna,&nbsp;Jimmy Espinoza","doi":"10.1016/j.bpobgyn.2025.102644","DOIUrl":"10.1016/j.bpobgyn.2025.102644","url":null,"abstract":"<div><div>Large chorioangiomas, benign vascular tumors of the placenta measuring ≥ 4 cm in greatest diameter, may pose significant risks to an ongoing pregnancy and warrant thorough sonographic evaluation to assess for evidence of fetal cardiac compromise and fetal anemia. Significant perinatal morbidity and mortality has been associated with large chorioangiomas. Key sonographic markers indicative of fetal compromise in the setting of a large chorioangioma include 1) polyhydramnios, 2) elevated middle cerebral artery (MCA) PSV (multiples of the median [MoM] ≥ 1.5), 3) increased combined cardiac output (CCO) and/or tricuspid regurgitation (TR) with or without evidence of fetal cardiomegaly, and 4) fetal hydrops. When fetal compromise is suspected in the setting of a large placental chorioangioma, referral to a fetal center with high-volume expertise in management of complex fetal care should be considered to evaluate for in-utero intervention candidacy. If in-utero fetal intervention is indicated, the placental location, the number and caliber of “feeder vessels” to the chorioangioma, and the proximity of the chorioangioma to the placental cord insertion guide the decision of surgical approach. Despite in-utero fetal intervention, perinatal morbidity and mortality remains high with 30–40 % resulting in perinatal death and about 50 % resulting in preterm birth.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"102 ","pages":"Article 102644"},"PeriodicalIF":3.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711273","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":"Routine mid-gestational prediction of later preeclampsia","authors":"Britt Kempener ,&nbsp;Emma Janssen ,&nbsp;Jonas Ellerbrock ,&nbsp;Chahinda Ghossein-Doha ,&nbsp;Robert-Jan Alers ,&nbsp;Jolijn Meex-van Neer ,&nbsp;Gwyneth Jansen ,&nbsp;Relinde Roumen ,&nbsp;Philine Birkendahl ,&nbsp;Sander van Kuijk ,&nbsp;Sabine Landewé-Cleuren ,&nbsp;Annemie van Haarlem ,&nbsp;Jeanine Pinxt-Claessens ,&nbsp;Angelique Hugens ,&nbsp;Karen van Mechelen ,&nbsp;Marc Spaanderman","doi":"10.1016/j.bpobgyn.2025.102627","DOIUrl":"10.1016/j.bpobgyn.2025.102627","url":null,"abstract":"<div><div>Preeclampsia is thought to be superimposed upon cardiovascular and cardiometabolic risk factors, predominantly consistent with the metabolic syndrome. In this study, we developed and internally validated a prediction model for the development of later preeclampsia in pregnant women at routine second-trimester oral glucose tolerance testing.</div><div>Data were collected during a prospective clinical cohort study, including pregnant women undergoing routine gestational diabetes mellitus (GDM) screening. Routine clinical data during the GDM screening (e.g., oral glucose tolerance test) were considered as potential predictors. Univariable and multivariable logistic regression with Backward Wald elimination were performed to develop the prediction model. Internal validation was performed using bootstrapping. Predictive performance of the final model was evaluated in terms of discrimination and calibration, both before and after adjusting for overfitting.</div><div>Of 3227 pregnant women undergoing GDM screening, 137 (4.2 %) subsequently developed preeclampsia. The final prediction model included obstetric history of preeclampsia (yes/no), history of large for gestational age (yes/no), current antihypertensive drug use (yes/no), diastolic blood pressure (mmHg), fasting serum creatinine (μmol/l), fasting serum triglycerides (mmol/l), and urinary protein-creatinine ratio (g/mol creatinine). The area under the receiver operating characteristic curve of the model was 0.79 before and after internal validation, with good model calibration.</div><div>Upon external validation and impact analysis, the proposed second-trimester preeclampsia prediction model enables accurate estimation of individuals risk on predominantly later third trimester development of preeclampsia. The model could facilitate timely, tailored monitoring and early intervention among pregnant women at risk to improve pregnancy outcomes.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102627"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364974","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":"Definition, identification, implications and management of hypodynamic hypertension in pregnancy","authors":"Gian Paolo Novelli ,&nbsp;Barbara Vasapollo ,&nbsp;Marco Silvestrini ,&nbsp;Fabio Bertoldo ,&nbsp;Chiara Maria Pia Biscosi ,&nbsp;Filomena Maellaro ,&nbsp;Francesca Pometti ,&nbsp;Daniele Farsetti ,&nbsp;Herbert Valensise","doi":"10.1016/j.bpobgyn.2025.102626","DOIUrl":"10.1016/j.bpobgyn.2025.102626","url":null,"abstract":"<div><div>Hypertensive disorders of pregnancy show different maternal hemodynamic and cardiovascular profiles going from a hyperdynamic to a hypodynamic condition. These different maternal cardiovascular situations might evolve towards different outcomes and might require targeted approaches. In particular, a hypodynamic maternal cardiovascular profile might be associated to severe and early complications of pregnancy (in particular fetal growth restriction, either isolated or associated to hypertensive disorders of pregnancy). This condition is characterized by a constriction of the vessels and a low plasma volume with low cardiac output and stroke volume. The assessment of the maternal hemodynamic condition requires an echocardiographic evaluation or the use of other non invasive devices, but in the absence of these instruments there is also a simple clinical method that can give us an idea of the maternal hemodynamic profile of the mother: the measurement of blood pressure and heart rate. In a hypodynamic low cardiac output condition, the choice of drugs that might reduce cardiac output and myocardial contractility to lower blood pressure might be irrational, whereas pharmacological interventions that directly act on the vessels reducing vasoconstriction, such as dihydropyridine calcium channel blockers and nitric oxide donors, might be more appropriate. This hemodynamic guided approach to therapy might have positive effect not only on maternal hemodynamics, but also on the fetal side, probably reducing or mitigating maternal and fetal complications.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102626"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313701","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":"Assessing candidacy for fetal intervention in congenital lower urinary tract obstruction: A comprehensive review","authors":"Hajra Malik ,&nbsp;Brian A. Burnett ,&nbsp;Hiba J. Mustafa ,&nbsp;Ahmed A. Nassr","doi":"10.1016/j.bpobgyn.2025.102616","DOIUrl":"10.1016/j.bpobgyn.2025.102616","url":null,"abstract":"<div><div>Congenital Lower Urinary Tract Obstruction (LUTO) is a rare but severe fetal condition, affecting approximately 2.2 per 10,000 live births. It is associated with complications such as oligohydramnios, pulmonary hypoplasia, and renal dysfunction. Prenatal interventions offer potential benefits in improving perinatal survival, however, selecting the most suitable candidates for interventions has been a challenge.</div><div>Recent research emphasizes the evaluation of LUTO patients with a multidisciplinary approach. Criteria for fetal intervention were established in an international Delphi consensus, and includes imaging findings indicative of LUTO, the absence of life-limiting structural or genetic anomalies, gestational age ≥16 weeks, and the presence of oligohydramnios. Although bladder refill and fetal urine biochemistry may provide additional insights into prognosis and counseling, their precise role in candidate selection remains uncertain.</div><div>Future research should focus on developing more reliable biomarkers to enhance the evaluation of LUTO and assess renal function.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102616"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241084","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":"Maternal hemodynamics in early and late fetal growth restriction","authors":"Barbara Vasapollo ,&nbsp;Gian Paolo Novelli ,&nbsp;Daniele Farsetti ,&nbsp;Francesca Pometti ,&nbsp;Giulia Gagliardi ,&nbsp;Simonetta Picone ,&nbsp;Vito Mondì ,&nbsp;Herbert Valensise","doi":"10.1016/j.bpobgyn.2025.102618","DOIUrl":"10.1016/j.bpobgyn.2025.102618","url":null,"abstract":"<div><div>Fetal growth restriction is a challenging condition for the obstetricians associated to neonatal morbidity, unfavorable developmental outcomes, and long-term sequalae for the newborn. Guidelines divide this condition in two subtypes: early and late forms depending on biometric, Doppler parameters, and the gestational age at appearance (before or after 32 weeks gestation).</div><div>This condition is associated to a maternal cardiovascular profile detectable in the pre-conceptional period, in the early stages of pregnancy, as well in the second and third trimester of pregnancy.</div><div>The maternal cardiovascular alterations are similar in the two subtypes of fetal growth restriction, although they differ in the degree of expression.</div><div>Echocardiography and other non invasive cardiovascular devices are very useful for the characterization of the maternal cardiovascular profile, and allow the early identification of patients at risk for this pathological condition.</div><div>The particular maternal hemodynamic profile at the base of the development of fetal growth restriction is characterized by a hypovolemic hypodynamic state. This particular cardiovascular condition might be susceptible to be modified by promising non pharmacological and pharmacological interventions, although they need further clinical investigations to be routinely used.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102618"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241085","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":"Intrapartum ultrasound","authors":"Ruben Ramirez Zegarra ,&nbsp;Esteban Lizarraga Cepeda ,&nbsp;Tullio Ghi","doi":"10.1016/j.bpobgyn.2025.102617","DOIUrl":"10.1016/j.bpobgyn.2025.102617","url":null,"abstract":"<div><div>The use of intrapartum ultrasound has increased extensively over the last two decades. This increase is mostly driven by its higher accuracy, reliability and intra- and interobserver agreement compared to the traditionally-used vaginal examination for the assessment of several labor parameters. Moreover, it is less invasive, better tolerated by women and has a lower risk of pregnancy-related infections. The most important parameters that can be assessed by intrapartum ultrasound include the fetal head position, station and attitude. In the first section of this review, we explain how to use intrapartum ultrasound to assess these parameters, providing a broad overview of the different available techniques. The second section describes the indications of intrapartum ultrasound and provides some insight on how intrapartum ultrasound may help to improve management of abnormal labor. In the last section, we discuss the future perspectives of intrapartum ultrasound. This includes topics such as the incorporation of new labor parameters, such as maternal pelvimetry, molding and caput succedaneum; the development of “sonopartograms”, and the use of artificial intelligence. This review is intended for obstetricians and midwives involved in daily practice in the labor ward.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"101 ","pages":"Article 102617"},"PeriodicalIF":3.9,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270145","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}