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A recent study reveals that specific Treg subpopulation changes in the first trimester may contribute to spontaneous preterm labor, shedding light on the role of immune regulation in pregnancy outcomes.

Regulatory T cell alterations in early pregnancy linked to spontaneous preterm labor  

A new study finds that children born to mothers with hypertensive disorders of pregnancy or gestational diabetes are at a higher risk of developing cardiovascular health issues by ages 10 to 14 years.

Maternal hypertension and diabetes linked to worse offspring cardiovascular health

A new study confirms that estimating fetal weight with ultrasound between 35 to 38 weeks’ gestation strongly predicts large for gestational age births, helping guide clinical management decisions.

Late third-trimester ultrasound accurately predicts large for gestational age births

In a recent study, the rate of infant deaths was increased by 5.6% in US states implementing abortion bans.

Study reports rising infant mortality with abortion bans

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

STIs

Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Neonatology, perinatology and neonatal resuscitation developed to a great extent during the 1970’s in response to an epidemic of litigation involving birth brain injury; fetal monitoring was detecting fetal distress in utero, and specialized perinatal intensive care promised great improvement in neonatal morbidity and mortality.

Neonatal Resuscitation: Life that Failed

What is your diagnosis based on these images of the ovary?

Challenge your diagnostic skills with this image quiz: Is this ovarian lesion cystic in nature or something else?

Image IQ: Ovarian Cyst or Something Else?

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

What structure or anomaly is the arrow pointing to in this image of a 20-week fetal spine?

Challenge your anatomy skills: Can you identify the spinal structure?

Clinical

Image IQ: Anatomy of the Fetal Spine

Wendie Berg, MD, PhD, Professor of Radiology, University of Pittsburgh School of Medicine, Chief Scientific Advisor 

, provided insight on the new National Breast Density Reporting Standard in a recent interview with 

®. Find out what this means for your practice and your patients below.

®: Can you briefly summarize the new National Breast Density Reporting Standard and what this means for physicians?

: As of September 10, 2024, all mammogram results will tell the patient if her breasts are dense or not dense. The results will include the information that dense tissue makes it harder to find cancer on a mammogram and also raises the risk of developing breast cancer. In patients with dense breasts, the results will also suggest that “other imaging tests, in addition to a mammogram, may help find cancers. ”It is important for women and their health care providers to know that dense tissue is normal and is seen in about 40% of women. But about 40% of breast cancers will go unseen on a mammogram when the tissue is dense.

There are actually 4 categories of breast density, and this detail is in the mammogram report sent to the patient’s health care provider. Fatty and scattered fibroglandular density categories are “not dense”. Heterogeneously dense and extremely dense are “dense”. The risk of cancer being hidden and also the risk of cancer developing increase with increasing breast density category.

®: With the implementation of the National Breast Density Reporting Standard, how do you foresee this affecting your conversations with patients, particularly those learning for the first time that they have dense breasts?

This information may be a little confusing at first for patients, but it should be seen as empowering. Women will now have important information about the screening and risk implications of dense breast tissue, and this can inform their discussions with health providers about what screening options are best for them. Health care providers should be prepared to either be a resource of information or recommend one.

®: From your perspective as a physician, how does this legislation enhance your ability to provide personalized care to patients with dense breasts?

I practice in Pennsylvania and, courtesy of the work of the Pennsylvania Breast Cancer Coalition, since 2014 a state law has required that we inform women of their specific category of breast density, as well as the risk and masking implications. Importantly, additional insurance laws have since been passed in PA (and in 30 states plus DC altogether) that require insurance coverage for additional screening with MRI or ultrasound for most women with dense breasts. This legislation will further increase patient and provider awareness. 

®: DBI has launched educational tools like "Is My Mammogram Enough?" and "Screening Tests After a Mammogram." How can physicians incorporate these resources into their practice to help patients better understand their breast density and associated risks?

Both patient educational tools can be linked to, shared with patients, or viewed in-office. 

 details risk factors to consider and screening recommendations based on them. 

 features a table showing the cancer detection of screening modalities in dense breasts. Additional tools like the 

 are free to download (and available in other languages).

 flowchart for providers, an MRI is recommended in addition to an annual mammogram in women who are at high risk for breast cancer. The current USPSTF and ACOG guidelines do not address women at higher than average risk. Providers should be aware that women who have dense breasts are at higher risk, and if they also have a family history of breast cancer, or personal history of breast cancer or atypical breast biopsy, then they should consider having an MRI every year as adding an MRI more than doubles detection of early breast cancer compared to even a 3D mammogram alone. Not all women can tolerate an MRI because of claustrophobia, in which case ultrasound can be considered, but it is not as good. Women and their doctors should be able to discuss risk factors and options for additional screening.

More and more women are going to be asking their radiologists and their doctors for information about screening options after a mammogram. As mentioned, the 

 table details the number of cancers we expect to find with each test in women with dense breasts. When we screen 1000 women with a mammogram, about 5 will be found to have cancer. 3D mammograms (tomosynthesis) are a little bit better, at 6 per 1000, but cancers are often still missed in dense breast tissue. If we add ultrasound, another 1-2 women of 1000 will be found to have cancer, but about another 4% to 7% of women will be called back for additional testing for findings that are not cancer. If we add MRI, another 13 women of 1000 will be found to have cancer the first year after a normal mammogram, with additional testing needed for about 10% of women who do not have cancer. After that “baseline” MRI, each year thereafter another 3 women per 1000 will be found to have cancer only the MRI after a normal mammogram, and additional testing will be needed for about 3% of women who do not have cancer.

To help physicians prepare for conversations about supplemental screening using current guidelines, please see 

. Also available for health providers is an educational 

 on breast density and supplemental screening.

®: Given the current inconsistencies in state insurance laws, how might the proposed Find it Early Act help ensure broader access to supplemental breast imaging for women with dense breasts? How do you currently navigate these inconsistencies with your patients?

Currently, 33 states plus Washington DC have some form of insurance law requiring coverage for additional imaging after a screening mammogram, including 30 with laws requiring coverage for screening MRI or ultrasound. The laws vary in coverage and some state laws exclude copays or deductibles. Unfortunately, many patients have insurance plans that are not subject to state law. This includes self-funded plans, out-of-state plans, and federal plans (Medicare, VHA, and TRICARE). At present, women need to check with their insurance before having any additional screening, and a prescription is needed from their health care provider. The 

 would provide a uniform national insurance coverage standard for no-cost screening and diagnostic imaging for women at increased risk or with dense breasts. Importantly, the Find It Early Act would be updated in accordance with guidelines from the National Comprehensive Cancer Network and the American College of Radiology.

Wendie Berg, MD, PhD, explains new breast density reporting standards, cancer risks, and the importance of supplemental imaging for dense breast tissue.

Wendie Berg, MD, PhD, discusses new breast density guidelines

New guidelines for better outcomes in pregnancy

Hematologic malignancies

GYN, Giselle Kidson-Gerber, MD, a hematologist with expertise in obstetric hematology, shared insights into new guidelines for managing hematological malignancies during pregnancy, specifically acute leukemia and aggressive lymphomas.

These conditions pose significant risks to maternal and fetal health, but advancements in management provide hope for better outcomes. Acute leukemia is life-threatening if untreated, with symptoms such as anemia, infection, and bleeding, although it is often detected through routine blood work during pregnancy. Aggressive lymphomas, on the other hand, may present with masses in the neck, chest, or abdomen, often identified through obstetric ultrasounds, or symptoms such as shortness of breath, fevers, or night sweats.

The guidelines emphasize the importance of delaying birth to optimize fetal neurocognitive development. Evidence shows that gestational age at delivery has a greater impact on long-term outcomes than in utero exposure to chemotherapy. Women diagnosed in the second or early third trimester are encouraged to undergo chemotherapy during pregnancy rather than opting for early delivery. PET scans, critical for diagnosing and monitoring lymphomas, are now considered safe during pregnancy when proper modeling of fetal radiation exposure is conducted. The guidelines also address breastfeeding and include data on the limited use of newer treatment agents during pregnancy.

A multidisciplinary approach is essential for managing these complex cases. Collaboration among maternal-fetal medicine specialists, obstetricians, hematologists, midwives, nurses, and allied health professionals ensures comprehensive care. Effective communication, seamless coordination, and detailed documentation are critical, especially in settings where hospital services may be physically separated. The guidelines stress the importance of creating a written management plan covering all trimesters, delivery, and postpartum care to guide both patients and health care teams.

The key clinical takeaways focus on avoiding premature decisions such as early termination or delivery, involving a multidisciplinary team, and reassuring patients that positive outcomes are achievable. Kitson-Gerber highlighted that most women with hematological malignancies can be treated effectively during pregnancy and encouraged health care providers to consult the guidelines for evidence-based strategies. With expert support and collaborative care, health care teams can help ensure favorable outcomes for both mother and child in these high-risk scenarios.

Discover updated strategies for treating leukemia and lymphomas during pregnancy, emphasizing delayed delivery, chemotherapy safety, and multidisciplinary care for optimal maternal and fetal health.

George Malcolm Morley, MB ChB, FACOG

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