Obstetrical & Gynecological Survey

IMPORTANCE: Genetic carrier screening is performed to identify carriers of rare genetic diseases. Identification of carriers allows patients to make informed reproductive health choices and can decrease the incidence of genetic disorders with serious medical implications. OBJECTIVE: This review aims to provide an overview of the history of prenatal genetic screening and the various forms of carrier screening, a synopsis of recent changes in society recommendations and current practice guidelines, and discussion of clinical challenges associated with carrier screening...

IMPORTANCE: Multiple postpartum scenarios require uterine exploration or instrumentation. These may introduce bacteria into the uterus, increasing the risk of endometritis. Data on the use of antibiotics in these scenarios is limited, resulting in few guidelines and divergent care. OBJECTIVE: To describe postpartum scenarios requiring uterine exploration and/or instrumentation, review data on antibiotic prophylaxis, and delineate antibiotic recommendations for each scenario...

IMPORTANCE: Autoimmune and rheumatologic conditions can lead to multiple adverse maternal, obstetric, and neonatal outcomes, especially if they flare during pregnancy. Although many medications to control these conditions exist, concerns regarding their safety often unnecessarily limit their use. OBJECTIVE: We aim to review the current evidence available describing the use of monoclonal antibody (mAb) therapeutics in pregnancy and postpartum and understand the impact of their use on the developing fetus and neonate...

IMPORTANCE: Prenatal cannabis use is rising and is a major public health issue. Cannabis use in pregnancy and during lactation has been associated with increased maternal and offspring morbidity and mortality. OBJECTIVE: This review aims to summarize the existing literature and current recommendations for cannabis use during pregnancy or lactation. EVIDENCE ACQUISITION: A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: "cannabis," "cannabinoid," "delta-9-tetrahydrocannabinol," "THC," "cannabidiol," "fetal outcomes," "perinatal outcomes," "pregnancy," and "lactation...

IMPORTANCE: Peripartum separation of the pubic symphysis is a rare but potentially severe complication of childbirth, which may lead to prolonged immobilization. Thus, prompt diagnosis and treatment are paramount. OBJECTIVE: The purpose of this review is to define peripartum separation of the pubic symphysis and provide a thorough review of its etiology, clinical manifestations, diagnostic imaging techniques, management, and prognosis. EVIDENCE ACQUISITION: This was a literature review using PubMed and Google Scholar...

IMPORTANCE: As prenatal care is in transition after the COVID-19 pandemic, reviewing fundamental physical examination approaches is necessary for providers examining obstetrical patients. OBJECTIVE: The objective of this review is 3-fold: (1) convey why the age of telemedicine necessitates reconsideration of the standardized physical examination in routine prenatal care; (2) identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, pelvis, and fetal growth; and (3) propose an evidence-based prenatal physical examination...

IMPORTANCE: Pelvic girdle pain is often thought to be a recent phenomenon, but this condition was described as early as 400 BC by Hippocrates. Despite being identified for years, confusion continues about the definition and management of this ailment affecting many pregnancies. OBJECTIVE: The purpose of the review is to assess the incidence, etiology, pathophysiology, risk factors, diagnosis, management, and pregnancy outcomes/recovery of current pregnancies, and outcomes of future pregnancies complicated by pelvic girdle pain...

IMPORTANCE: Uterine rupture during labor is a calamitous event that can result in maternal/neonatal morbidity/mortality. Lower uterine segment (LUS) thickness measurement is a proposed method to determine the risk factor of uterine rupture in women undergoing trial of labor after cesarean. Does this measurement predict uterine rupture risk? OBJECTIVES: This review examines current evidence to determine if a thin LUS ultrasound diagnosis during pregnancy with prior cesarean delivery(s) can reliably predict uterine rupture risk while attempting vaginal birth after cesarean (VBAC)...

IMPORTANCE: Recurrent pregnancy loss (RPL) is one of the most frustrating clinical entities in reproductive medicine requiring not only diagnostic investigation and therapeutic intervention, but also evaluation of the risk for recurrence. OBJECTIVE: The aim of this study was to review and compare the most recently published major guidelines on investigation and management of RPL. EVIDENCE ACQUISITION: A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists, the European Society of Human Reproduction and Embryology, the American Society for Reproductive Medicine, the French College of Gynecologists and Obstetricians, and the German, Austrian, and Swiss Society of Gynecology and Obstetrics on RPL was carried out...

INTRODUCTION: Sepsis is one of the leading causes of maternal morbidity and mortality worldwide and a major public health concern, often associated with delayed diagnosis, suboptimal management, and poor perinatal outcomes. OBJECTIVES: The aim of this study was to review and compare the most recently published influential guidelines on the prevention, diagnosis, and management of this complication during antenatal, intrapartum, and postpartum periods. EVIDENCE ACQUISITION: A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists (RCOG), the Society for Maternal-Fetal Medicine (SMFM), the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), the World Health Organization (WHO), and the Society of Obstetricians and Gynecologists of Canada (SOGC) on maternal and puerperal sepsis was carried out...

IMPORTANCE: Climate change is affecting the earth, resulting in more extreme temperatures and weather, rising sea levels, more frequent natural disasters, and displacement of populations of plants and animals, including people and insects. These changes affect food and housing security, vector-borne illnesses, and access to clean air and water, all of which influence human health. EVIDENCE AND RESULTS: There are a number of adverse health outcomes linked to heat, air pollution from wildfires, stress from natural disasters, and other elements of climate change...

IMPORTANCE: The induction rate continues to increase in the United States placing pressure on the health care system with increasing cost and time spent on labor and delivery. Most labor induction regimens have evaluated uncomplicated singleton-term gestations. Unfortunately, the optimal labor regimens of medically complicated pregnancies have not been well described. OBJECTIVE: The aim of this study was to review the current available evidence regarding the various labor induction regimens and understand the evidence that exists for induction regimens in complicated pregnancies...

IMPORTANCE: Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare life-threatening event previously associated with endometriosis. Although pregnancy is thought to improve the symptoms of endometriosis, abrupt intraperitoneal bleeding can occur, jeopardizing both maternal and fetal outcomes. OBJECTIVE: The aim of this study was to review the published information regarding SHiP pathophysiology, presentation, diagnosis, and management in a flowchart approach. EVIDENCE ACQUISITION: A descriptive review of published articles in the English-language was carried out...

IMPORTANCE: Doulas are trained professionals that provide comprehensive support during the perinatal period. Doula-supported care is associated with improved maternal and infant outcomes including decreased preterm birth, increased breastfeeding initiation, and higher patient satisfaction. In addition, research suggests that doula support is a promising strategy to mitigate racial disparities in maternal and infant health outcomes. OBJECTIVE: This article reviews doulas' scope of practice, perinatal outcomes associated with doula-assisted care, and their impact on alleviating racial disparities in maternal-infant outcomes...

IMPORTANCE: Pregnancy-associated melanomas (PAMs)-this is how melanomas identified during the childbearing years or up to 1 year after birth have been defined, accounting for one third of women in whom it is diagnosed. The exact epidemiology of melanoma is difficult to determine. However, its incidence is undoubtedly increasing, most likely related to the increasing age of mothers. OBJECTIVE: The purpose of this study was to review the prognosis, diagnosis, and treatment; the effect of melanoma on pregnancy; and the effect of pregnancy on melanoma and melanocytic lesions...

IMPORTANCE: Adrenal hemorrhage in pregnancy is rare. The prevalence of pregnant patients whose pregnancies are complicated by preeclampsia or eclampsia is hypothesized to be slightly higher than the 0.4% to 1.1% occurrence rate in the nonpregnant population. However, the mortality rate of adrenal hemorrhage is reportedly as high as 15%. Therefore, it is critical for obstetric providers to have basic knowledge on the presentation, diagnosis, and management of adrenal hemorrhage in the pregnant population so that prompt diagnosis can be made...

IMPORTANCE: Obesity is one of the most common clinical entities complicating pregnancies and is associated with short- and long-term consequences for both the mother and the offspring. OBJECTIVE: The aim of this study were to review and compare the most recently published influential guidelines on the management of maternal obesity in the preconceptional, antenatal, intrapartum, and postpartum period. EVIDENCE ACQUISITION: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynecologists of Canada, the Royal College of Obstetricians and Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on obesity in pregnancy was carried out...

IMPORTANCE: The use and misuse of opioids in pregnancy have been increasing and are a major public health issue. Opioid use in pregnancy and during lactation has been associated with increased maternal and neonatal morbidity and mortality. OBJECTIVE: This review aims to summarize the existing literature and current recommendations for opioid use while pregnant or lactating. EVIDENCE ACQUISITION: A PubMed, Cochrane Library, and Google Scholar literature search using the following terms was performed to gather relevant data: "opioids," "opioid maintenance therapy," "opioid use disorder," "suboxone," "buprenorphine," "methadone," "medication for opioid use disorder," "fetal outcomes," "perinatal outcomes," "pregnancy," "lactation," and "neonatal abstinence syndrome...

IMPORTANCE: The postpartum period is a time of high risk for serious psychiatric symptoms and hospitalization. Postpartum psychosis (PPP) is the most severe disorder that emerges during this time, with significant and wide-ranging consequences that can include suicide and infanticide. EVIDENCE ACQUISITION: A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about PPP, including subtopics (eg, infanticide, maternal suicide). Citations in these articles were also reviewed for relevant references...

IMPORTANCE: Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats. OBJECTIVE: The objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines...