Current Opinion in Obstetrics & Gynecology最新文献

{"title":"Diagnosis and management of vulval lesions.","authors":"Claire Haigh, Helen Yiling Sun, Gayle Fischer","doi":"10.1097/GCO.0000000000001054","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001054","url":null,"abstract":"<p><strong>Purpose of review: </strong>The vulva is part of the skin. A wide spectrum of dermatological diseases affects the vulva, including infections, dermatoses, manifestations of hormonal and systemic conditions, and neoplasia. Vulval diseases are typically associated with significant delay in diagnosis due to limited healthcare practitioner knowledge amongst primary care physicians and specialists alike. This review article provides an update on the diagnosis and management of common vulval lesions.</p><p><strong>Recent findings: </strong>This article reviews the literature on vulval lesions and vulval dermatoses and was conducted through searching PubMed. Common causes of vulval lesions are presented, including vulval cancer, vulval squamous intraepithelial lesions, dermatitis, psoriasis, lichen simplex chronicus, acute and chronic candida vulvovaginitis, lichen sclerosus, lichen planus, and nonsexually acquired genital ulceration.</p><p><strong>Summary: </strong>Vulval complaints are common. It is important to not only be able to differentiate between benign findings and potentially premalignant or malignant lesions but also recognise and manage common causes of vulval lesions such as dermatitis, psoriasis, lichen sclerosus, infectious causes of disease, and nonsexually acquired genital ulceration.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive and ablative therapies for symptomatic uterine fibroids: a narrative review.","authors":"Tim Szilagyi Gemesi, Deirdre Lum, Diana Atashroo, Lisa Chao","doi":"10.1097/GCO.0000000000001056","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001056","url":null,"abstract":"<p><strong>Purpose of review: </strong>Uterine fibroids are benign smooth muscle growths that can cause abnormal uterine bleeding, bulk symptoms, and infertility. Traditional treatments include medical therapy and surgical interventions such as hysterectomy and myomectomy. In the past three decades, minimally invasive, uterus-sparing alternatives - namely, high-intensity focused ultrasound (HIFU), uterine artery embolization (UAE), and radiofrequency ablation (RFA) - have revolutionized the management of symptomatic fibroids. Although early studies suggest these modalities are effective, high-quality data on their long-term efficacy, safety profiles, and reproductive outcomes are limited.</p><p><strong>Recent findings: </strong>This paper presents a literature review on HIFU, UAE, and RFA for the treatment of symptomatic uterine fibroids. Studies report improvements in symptom severity and quality of life, with low complication rates. Optimal outcomes depend on careful patient selection, as certain factors increase the risk of treatment failure and the need for reintervention. Furthermore, little is known about pregnancy outcomes following these interventions, as studies are sparse and heterogenous.</p><p><strong>Summary: </strong>HIFU, UAE, and RFA are safe and effective options for the treatment of symptomatic uterine fibroids. Further research is needed to evaluate long-term effectiveness, fertility and pregnancy outcomes, and comparisons between treatment modalities.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of abnormal uterine bleeding in the adolescent patient.","authors":"Tambu Kudze, Angela Marie Hernandez","doi":"10.1097/GCO.0000000000001052","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001052","url":null,"abstract":"<p><strong>Purpose of review: </strong>Abnormal uterine bleeding (AUB) is a common complaint in adolescents and is mostly treated with hormonal medication. This review provides an update on adolescent AUB evaluation and treatment.</p><p><strong>Recent findings: </strong>Anovulatory cycles and coagulopathies remain the most common reasons for AUB. Structural causes of AUB are still overall rare in adolescents, but recent advances in imaging techniques show they are more prevalent than previously thought. Since hormonal medication is the main treatment for AUB, acknowledging updates about their safety in certain populations is necessary. Investigations on nonhormonal medications for AUB and conservative surgical approaches are promising.</p><p><strong>Summary: </strong>Recent updates to the safety of hormonal interventions impact management of AUB in adolescents. More research is needed to identify novel methods for managing AUB, as this can have negative impacts on both physical and mental health.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunistic salpingectomy for prevention of ovarian cancer among the general population.","authors":"Kirstie McLoughlin, Melissa A Merritt","doi":"10.1097/GCO.0000000000001051","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001051","url":null,"abstract":"<p><strong>Purpose of review: </strong>Ovarian cancer remains the most lethal gynaecological cancer. Early detection and treatment options are limited, so prevention is key. This article reviews the current opinion on opportunistic salpingectomy for ovarian cancer prevention within the general population.</p><p><strong>Recent findings: </strong>Salpingectomy (the removal of the fimbriated ends of the fallopian tubes) reduces ovarian cancer risk without inducing early menopause or depleting ovarian reserves. The International Federation of Gynecology and Obstetrics firmly supports the use of salpingectomy opportunistically (in addition to planned abdominal surgery) for ovarian cancer risk reduction. When salpingectomy should be provided as an elective surgery, and what nongynecological surgeries can be used as opportunities for salpingectomy, is an ongoing discussion.</p><p><strong>Summary: </strong>As understanding of the safety and efficacy of opportunistic salpingectomy has solidified into guidelines, its use for ovarian cancer risk reduction has increased. However, the uptake of opportunistic salpingectomy has varied between geographic regions and across institutions. In the US, roughly a third of women undergo a hysterectomy during their lifetime, each of these women should have a chance to consider opportunistic salpingectomy for ovarian cancer prevention. Education about the benefits and harms of opportunistic salpingectomy is both necessary and effective in reducing inequities in access to this risk-reducing surgery.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic endometritis, chronic questions: a narrative review of current practices.","authors":"Andres Reig","doi":"10.1097/GCO.0000000000001053","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001053","url":null,"abstract":"<p><strong>Purpose of review: </strong>Chronic endometritis is a condition that may affect reproductive outcomes, particularly in patients with unexplained infertility, recurrent implantation failure, or recurrent pregnancy loss. This review concisely summarizes the available literature, highlighting some of the controversies on this topic.</p><p><strong>Recent findings: </strong>Although embryo selection through preimplantation genetic testing for aneuploidy has improved, many euploid embryo transfers still fail, prompting interest in endometrial factors such as chronic endometritis. Chronic endometritis is typically asymptomatic and diagnosed by identifying plasma cells in endometrial biopsy specimens; however, diagnostic criteria vary widely regarding biopsy timing, staining techniques, and threshold definitions, contributing to inconsistent prevalence and outcomes across studies. It is often attributed to chronic infection and is treated with empirical or culture-guided antibiotics, though reported cure rates vary significantly. While some studies suggest that treating chronic endometritis improves reproductive outcomes, evidence is limited by methodological heterogeneity. Meta-analyses support treatment, yet diagnostic inconsistencies and potential effects of antibiotics on the microbiome remain concerns.</p><p><strong>Summary: </strong>While frequently diagnosed in the infertility setting, the true prevalence and impact of chronic endometritis remain unclear. The heterogeneity of the existing literature and the lack of large prospective cohort studies remain challenges to fully understanding the condition, particularly regarding the general infertile population.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonhormonal treatments for vasomotor symptoms.","authors":"Laura Zalles, Nanette Santoro","doi":"10.1097/GCO.0000000000001050","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001050","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Vasomotor symptoms or hot flashes are reported by 80% of women and have a median duration of 7 years. About 25-30% of women have severe enough symptoms that activities of daily living and workplace productivity are compromised. Although hormone therapy is the 'gold standard' for hot flash treatment, many women are unable or unwilling to use it.</p><p><strong>Recent findings: </strong>A number of nonhormone treatments for hot flashes are supported by medical evidence, but only two (paroxetine mesylate and fezolinetant) are currently Food and Drug Administration approved. Selective serotonin reuptake inhibitors and selective serotonin reuptake inhibitor-norepinephrine reuptake inhibitors, gabapentin, oxybutynin, clonidine, and fezolinetant are described. The new class of neurokinin-3 receptor antagonists includes both fezolinetant and elinzanetant and acts directly on the hypothalamic neurons that control body temperature regulation. These latter agents have an efficacy profile that approaches that of hormone therapy and lack the off-target side effects seen with other nonhormonal treatments.</p><p><strong>Summary: </strong>Women who cannot use or wish to avoid hormones have a number of nonhormonal options to choose from to treat hot flashes. New science elucidating the biology of hot flashes holds great promise for highly effective treatments that do not have off-target effects.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syphilis screening in pregnancy: no time for complacency.","authors":"Ameeta Eshri Singh, Tom Wong, Joan Robinson","doi":"10.1097/GCO.0000000000001049","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001049","url":null,"abstract":"<p><strong>Purpose of review: </strong>Congenital syphilis continues to result in devastating adverse pregnancy and infant outcomes globally, with significant rises noted in recent years in high-income countries (HIC). Prenatal screening and prompt treatment for syphilis in pregnant persons are important in contributing to healthy pregnancy outcomes, particularly in equity-denied populations. However, the implementation of these recommendations remains challenging, even in HIC.</p><p><strong>Recent findings: </strong>Although antenatal screening guidelines for syphilis universally recommend screening in pregnancy, the implementation of these recommendations has been challenging. In HIC, individuals grappling with poverty, unstable housing, addictions, and mental health concerns often encounter significant barriers to accessing essential healthcare services. Innovative approaches, such as the use of rapid/point-of-care tests, opportunistic screening, and community-based or outreach testing, are essential to reach key equity-denied populations. It is crucial to include members of key populations and community-based organizations in the design of interventions to effectively reach these populations.</p><p><strong>Summary: </strong>Given the resurgence of congenital syphilis in some regions, especially in HIC, we must address this preventable cause of maternal and fetal morbidity and mortality effectively. Collaboration between all levels of government and health services and the inclusion of key equity-denied populations is crucial.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introductions.","authors":"","doi":"10.1097/GCO.0000000000001026","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001026","url":null,"abstract":"","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":"37 3","pages":"I-II"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of women with endometriosis in the 21st century.","authors":"Attilio Di Spiezio Sardo, Christian M Becker, Stefan P Renner, Pia A Suvitie, Josep Estadella Tarriel, Silvia Vannuccini, Juan A Garcia Velasco, Jasper Verguts, Antonio Mercorio","doi":"10.1097/GCO.0000000000001027","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001027","url":null,"abstract":"<p><strong>Purpose of review: </strong>Endometriosis is a chronic inflammatory condition that significantly affects women's quality of life and fertility. Despite advancements in treatment, many areas of uncertainty persist in clinical management. This review provides a symptom-focused, patient-centered update, addressing cases from asymptomatic to those complicated by pain and infertility.</p><p><strong>Recent findings: </strong>Advancement in imaging technology has increased incidental diagnoses of asymptomatic endometriosis, raising the debate between immediate treatment and watchful waiting. Medical therapy primarily aims to suppress symptoms, with oral gonadotropin-releasing hormone antagonists and add-back therapy offering promising long-term pain control. Research into local neurogenesis and central sensitization supports complementary approaches, though high-quality evidence is still limited. For pain refractory to medical therapy, conservative surgical strategies can minimize postoperative complications without significantly increasing recurrence rates. In infertility, assisted reproductive technology (ART) provides effective options, although the optimal endometrial preparation and the necessity of pre-ART surgery remain to be fully elucidated.</p><p><strong>Summary: </strong>The optimal management of endometriosis requires a personalized, multidisciplinary approach within specialized centers. Long-term suppressive medical therapy remains the cornerstone of pain management while emerging targeted agents hold promise for better symptom control with fewer side effects. Surgical intervention should be performed by experienced surgeons as a single definitive procedure when possible. Tailored ART protocols can address infertility challenges. Standardized classification systems and robust randomized trials are crucial to refining treatment pathways, optimizing fertility outcomes, and enhancing quality of life.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":"37 3","pages":"149-157"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late bloomers: exploring the reproductive potential of day 7 embryos.","authors":"Blake Vessa, Jason Franasiak","doi":"10.1097/GCO.0000000000001021","DOIUrl":"10.1097/GCO.0000000000001021","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to evaluate the reproductive potential of day 7 embryos. With effective cryopreservation and subsequent frozen embryo transfers, extended blastocyst culture to day 7 is now possible. However, assessing the true reproductive potential of day 7 embryos is essential to adequately counsel patients on the expected pregnancy and live birth rates in comparison to embryos that reach the blastocyst stage on day 5 or day 6.</p><p><strong>Recent findings: </strong>Day 7 embryos have a lower blastulation rate and higher aneuploidy rate compared with day 5 and day 6 embryos. Although day 7 blastocysts comprise less than 10% of usable embryos for transfer, recent studies have repeatedly demonstrated lower, but not negligible, pregnancy and live birth rates with day 7 embryo transfers. Based on the current literature reviewed in this paper, the clinical pregnancy rates for euploid day 7 embryos appear to be between 16.7 and 52.6%, whereas the live birth rates are between 21.5 and 46%. Therefore, while the blastulation and pregnancy rates are lower and the aneuploidy rates are higher, euploid day 7 embryos have reproductive potential.</p><p><strong>Summary: </strong>While recent data supports reduced reproductive potential of euploid day 7 embryos when compared with the success rates of day 5 and 6 embryos, their associated pregnancy and live birth rates are nonzero and still represent a viable option for certain patients.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"158-163"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}