Successful anesthetic management of pregnant patients with cardiac disease requires an understanding of both maternal physiology and alterations induced by labor analgesia and anesthesia for cesarean delivery. This review provides an overview of physiological changes of pregnancy pertinent to obstetric anesthesiology in regard to patients with cardiac disease, including modifications to labor analgesic techniques, indications for additional monitoring, and both regional anesthetic and general anesthetic management of complex cardiac patients for cesarean delivery. The importance of a comprehensive pregnancy heart team cannot be overstated, especially when managing patients with very high-risk cardiac comorbidities.
Vasa previa is a life-threatening pregnancy complication in which unprotected fetal vessels traverse or are adjacent to the internal cervical os. This condition puts the fetus at risk of death if these vessels rupture in labor. Although prenatal diagnosis has improved our ability to identify these cases, optimal prenatal management remains controversial. Routine hospitalization at 30 to 34 weeks has been advocated but outpatient management achieves equivalent perinatal outcomes in recent publications. Routine hospitalization may be excessive and potentially wrought with maternal complications, therefore, an individualized, risk-stratified approach determining hospitalization may be warranted in light of more recent literature.
Maternal-fetal medicine specialists face strong financial incentives to absent themselves from labor floors and the management of laboring patients. Nevertheless, health care systems and medical education benefit from MFM involvement in every aspect of obstetrical care, and their presence on the labor floor will benefit patients, learners, and themselves.
This review explores transitioning toward a multidisciplinary, biopsychosocial framework for evaluating chronic pelvic pain (CPP), considered a global epidemic. The manuscript introduces the updated FIGO-IPPS CPP definition, which lowers the diagnostic threshold to pain typically lasting 3 months or more and prioritizes functional impairment. Central to this definition is the R U MOVVING SOMe classification system, enabling systematic identification of overlapping pain generators and central sensitization. The authors advocate for a cutting-edge methodology integrating trauma-informed care (TIC), specialized musculoskeletal and neurological examinations, and validated Patient-Reported Outcomes (PROs). This framework provides clinicians a standardized pathway to optimize diagnostic accuracy and treatment.
Vulvar lichen sclerosus (LS) and lichen planus (LP) are chronic inflammatory dermatoses that significantly impair quality of life through pruritus, pain, sexual dysfunction, and risk of scarring or malignancy. Although they share lichenoid histopathologic features, LS primarily affects keratinized skin, while LP commonly involves mucosal surfaces and may present with erosive, papulosquamous, or hypertrophic variants. Disease underrecognition often delays diagnosis and treatment. This review summarizes the epidemiology, pathophysiology, clinical presentation, histopathology, and management of vulvar LS and LP, highlighting distinguishing features, areas of diagnostic overlap, and best practices to optimize outcomes and prevent long-term complications.
The American Disabilities Act of 1990 (ADA) was established to protect individuals with disabilities from discrimination against access to health care and public services and to ensure they have equitable resources. It is imperative that obstetric providers understand the applications of the ADA requirements when caring for pregnant patients with disabilities ensuring they are able to physically access outpatient care and effectively communicate with their care team.
Chronic pelvic pain (CPP) severely impacts quality of life, presenting distinct perioperative management challenges. Patients face heightened anxiety, severe postoperative pain, prolonged recovery from fear of movement, and persistent pain amplified by concurrent chronic overlapping pain conditions (COPCs). While data on preoperative pain's precise impact remains limited, surgery often triggers severe flares. Consequently, comprehensive preoperative screening is crucial. Evaluating risk factors-including central sensitization, substance use, smoking, COPCs, specific pain generators, and psychological comorbidities-allows clinicians to manage expectations effectively. Ultimately, this targeted risk assessment equips patients with the necessary strategies and tools to optimize their surgical recovery.
Large, randomized control trials have shown the efficacy of low-dose aspirin (ldASA) in reducing rates of clinically significant severe preterm pre-eclampsia in high-risk populations. Multiple societies have recommended varying risk-stratifying criteria over the last decade. Unfortunately, current approaches to risk-based administration have failed to improve outcomes in an overall high-risk population in the US. Increasing evidence has shown universal ldASA prescription as a practical approach to bridging known gaps in health care for the highest risk patients. This review addresses the benefits of implementing a universal protocol for the administration of ldASA in pregnancy to reduce maternal morbidity and mortality.
Endometriosis is a chronic inflammatory condition that can result in chronic pain through complex nociceptive, neuropathic, and nociplastic pathways. This article provides a comprehensive background on endometriosis as well as future directions in diagnosis and management. The diagnosis of endometriosis is explored, including novel imaging techniques, biomarkers, and the integration of artificial intelligence. The medical management of endometriosis is reviewed, including a focus on new nonhormonal treatment options. Surgical treatments are reviewed along with surgical outcomes. We discuss nonpharmaceutical and behavioral interventions with growing interest. Finally, this article reviews future directions in endometriosis care, including precision medicine and AI.
As increasing numbers of individuals with cognitive disabilities have become integrated into society and have reached reproductive age, the number of patients with cognitive disabilities who desire pregnancy has also risen. This review highlights the disparities in pregnancy outcomes for patients with cognitive disabilities, addresses issues of capacity and consent, and identifies common challenges during the preconception, prenatal, intrapartum, and postpartum courses to provide tailored and comprehensive care for this patient population.
The American Disabilities Act of 1990 (ADA) was established to protect individuals with disabilities from discrimination against access to health care and public services and to ensure they have equitable resources. It is imperative that obstetric providers understand the applications of the ADA requirements when caring for pregnant patients with disabilities ensuring they are able to physically access outpatient care and effectively communicate with their care team.
Hereditary cancer syndromes are associated with up to 25% of ovarian and 5% of endometrial cancers, yet rates of genetic testing and counseling remain low. Artificial intelligence (AI) offers new opportunities to streamline risk assessment, enhance gene variant interpretation, and expand access to genetic counseling. This narrative review synthesizes current evidence on AI applications in gynecologic cancer genetic risk assessment, including chatbot-based risk assessment, natural language processing of electronic records, and machine-learning approaches to variant classification. We highlight key challenges, including data bias, privacy, and implementation barriers, and outline future directions for AI technologies in gynecologic cancer genetic risk assessment.
Visual impairment affects millions of reproductive-aged individuals worldwide, yet obstetric care for this population remains underrepresented in clinical guidelines and medical education. Patients with visual impairment face unique barriers throughout the reproductive continuum. This review provides a comprehensive, obstetrician-gynecologist-focused framework for the care of the visually impaired. Key topics include communication, optimization, screening for coercion and violence, prenatal care, labor and delivery, postpartum care, breast/chest feeding, and contraception. Emphasis is placed on patient autonomy, consent, trauma-informed care, and compliance with legal/ethical standards. Integrating disability-competent practices into obstetric care is essential to improving outcomes and advancing equity in reproductive health.
Disabilities are highly prevalent in the population, and people with disabilities have faced stigma for millennia. Despite federal mandates, persistent disparities in care remain for patients with disabilities seeking obstetric and gynecologic care. Lack of adequate clinician training, clinician stigma and biases, inaccessible clinical spaces, and suboptimal communication all contribute to care inequities. Updated regulations under federal disability rights statutes will require clinic spaces to have equipment that is accessible for patients of all abilities. Understanding these recommendations and mandated changes is the next step in improving care for disabled patients.
There is international agreement that third-trimester hospitalization is indicated for the one-third of patients with vasa previa who have risk factors for preterm birth. For the remaining two-thirds, it is controversial whether elective hospitalization or outpatient management should be recommended. There are no randomized trials comparing outcomes of the 2 strategies. Observational studies report similar outcomes with elective hospitalization and outpatient management, but are fraught with biases and are underpowered to permit a confident conclusion that outpatient management is safe. Elective hospitalization may be safer because cesarean can be performed immediately if bleeding occurs. Elective hospitalization should be the norm.
Menstrual management and access to reliable contraception are integral components of equitable reproductive health care for patients with disabilities. Concerns surrounding impending periods are common among caregivers of patients with physical and cognitive disabilities, even before menarche. There are several considerations in the approach to options for management of both periods and contraception in this patient population, and this article details the available options with a lens toward the unique needs of patients with disabilities.
Cerclage was originally devised by Shirodkar and McDonald for individuals who develop cervical changes in the second trimester. RCT data have confirmed the efficacy of ultrasound-indicated cerclage (UIC). After 70 years of research, the only evidence-based indications for history-indicated cerclage (HIC) are ≥3 early spontaneous preterm births (SPTBs) or early second-trimester losses, and UIC followed by preterm birth <32 weeks. All patients should undergo transvaginal ultrasound cervical length (TVU CL) screening, with UIC considered if the TVU CL shortens before 24 weeks to ≤20 mm in singletons without prior SPTB, ≤25 mm with prior SPTB, or ≤15 mm in twins.
