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The measurement of human chorionic gonadotropin (hCG) levels in different body fluids is a commonly utilized tool in obstetrics and gynecology, as well as other fields. It is often one of the first steps in the medical workup of female patients, and the results and interpretation of this test can have significant downstream ramifications. It is essential to understand the uses and limitations of hCG as a testing and therapeutic measure to appropriately evaluate, counsel, and treat patients.The purpose of this article is to review the current literature on hCG, including its origins, structure, pharmacokinetics, metabolism, and utility in testing and medical treatment.Original research articles, review articles, and guidelines on hCG use were reviewed.While the primary function of hCG is to maintain early pregnancy, testing for hCG demonstrates that this molecule is implicated in a multitude of different processes where results of testing may lead to incorrect conclusions regarding pregnancy status. This could affect patients in a myriad of settings and have profound emotional and financial consequences. In addition, hCG testing may be revealing of alternative pathology, such as malignancy. It is imperative to understand the nuances of the physiology of hCG and testing methods to effectively use and interpret this test for appropriate patient management.

Ovarian cancer is the second most common gynecologic malignancy, but the most deadly female reproductive cancer in the United States. Epithelial ovarian cancer makes up approximately 90% of all cases and is responsible for more than 90% of ovarian cancer deaths. Elective salpingectomy has been shown to reduce ovarian cancer risk when performed at the time of a benign hysterectomy. Data regarding the risks and benefits of opportunistic bilateral salpingectomy performed at the time of cesarean delivery are limited.We aim to review the current evidence regarding safety and benefits of opportunistic bilateral salpingectomy at the time of cesarean delivery compared with bilateral tubal ligation.Original research articles, review articles, and guidelines on contraception were reviewed.Opportunistic bilateral salpingectomy at the time of cesarean delivery is feasible and safe. Operative time may be increased up to 15 minutes for salpingectomy performed by suture ligation compared with standard tubal ligation. Women with a history of 3 or more cesarean deliveries are more likely to require an alternative procedure. It is important to counsel women that although opportunistic bilateral salpingectomy may significantly decrease the risk of ovarian cancer, it does not eliminate the risk entirely.

For patients who present with prelabor rupture of membrane (PROM) in the late preterm period (34 to 36 6/7 weeks), management remains unclear due to lack of consensus. However, recent guidelines have suggested that shared decision-making may be used and expectant management can be considered up to 37 0/7 weeks.In this article, we review the contemporary studies comparing the risks and benefits of immediate delivery versus expectant management for patients with late preterm prelabor rupture of membranes (PPROM).Original research articles, review articles, and guidelines on management of late PPROM.Three randomized clinical trials and 2 meta-analyses comparing expectant management and immediate delivery outcomes in late PPROM showed no significant difference in neonatal sepsis rates between groups. Expectant management increased the likelihood that pregnancies reached term while decreasing the rate of cesarean delivery. However, data suggest an increased risk of antepartum hemorrhage among patients in the expectant management groups, as well as higher rates of histologic chorioamnionitis.We recommend that clinicians offer expectant management as an alternative to immediate delivery in the setting of late PPROM through a shared decision-making process that clearly outlines the risks and benefits.

Hypertensive complications of pregnancy comprise 16% of maternal deaths in developed countries and 7.4% of deaths in the United States. Rates of preeclampsia increased 25% from 1987 to 2004, and rates of severe preeclampsia have increased 6.7-fold between 1980 and 2003.The aim of this study was to review current and available evidence for common clinical questions regarding the management of hypertensive disorders of pregnancy.Original research articles, review articles, and guidelines on hypertension in pregnancy were reviewed.Severe gestational hypertension should be managed as preeclampsia with severe features. Serum uric acid levels can be useful in predicting development of superimposed preeclampsia for women with chronic hypertension. When presenting with preeclampsia with severe features before 34 weeks, expectant management should be considered only when both maternal and fetal conditions are stable. In the setting of hypertensive disorders of pregnancy, oral antihypertensive medications should be initiated when systolic blood pressure is greater than 160 mm Hg or when diastolic blood pressure is greater than 110 mm Hg, with the most ideal agents being labetalol or nifedipine. Furthermore, although risk of preeclampsia recurrence in future pregnancy is low, women with a history of preeclampsia should be managed with 81 mg aspirin daily for preeclampsia prevention.Despite the frequency with which hypertensive disorders of pregnancy are encountered clinically, situations arise frequently with limited evidence to guide providers in their management. An urgent need exists to better understand this disease to optimize outcomes for impacted patients.

Maternal obesity is associated with delayed lactogenesis and shorter duration of breastfeeding compared to patients with a normal BMI.We investigated the impact of excessive gestational weight gain, defined as greater than the Institute of Medicine guidelines (9.1 kg), on the initiation and duration of breastfeeding in patients with class III obesity.Retrospective cohort of patients with body mass index ≥40 in first trimester, delivering a singleton term infant at a tertiary care center between July 2013 and December 2017. Primary outcome was exclusive breastfeeding at discharge and at postpartum visit. Secondary outcomes included any breastfeeding at discharge and postpartum visit, and cessation of breastfeeding by the postpartum visit. Descriptive statistics were used to compare those whose gestational weight gain exceeded (eIOM) versus met (mIOM) Institute of Medicine guidelines. Regression models were performed to adjust for baseline confounding factors.Of 294 women included, 117(39.8%) were in the eIOM group. These women were more likely to be primigravida, have a higher delivery BMI, greater delivery blood loss, and have a neonate admitted to the intensive care unit. Exclusive breastfeeding at discharge was not different between eIOM and mIOM (66.7% vs 70.9%,Among women with class III obesity, excessive gestational weight gain did not impact the rate of exclusive breastfeeding at discharge or postpartum visit.

We sought to evaluate and describe the maternal and obstetric morbidity associated with Listeria infection in pregnancy. Retrospective cohort of pregnant women using the 2007-2018 National Inpatient Sample. Pregnant women with discharge diagnosis codes consistent with Listeria infection were identified. Outcomes of deliveries complicated by Listeria infection were compared to those of delivery without this infection. The primary outcome was a composite of severe maternal morbidity. Secondary outcomes included components of the composite, maternal length of stay, mode of delivery, stillbirth, and preterm delivery. We identified 134 maternity associated hospitalizations for Listeria (weighted national estimate 666), of which 72 (weighted national estimate of 358) were delivery admissions. Delivery admissions complicated by Listeria resulted in higher rates of severe maternal morbidity than those without, (30.9% vs. 1.6%, pppppp < 0.001) and stillbirth (13.5% vs. 0.7%, ppp

Venomous snake and spider bites are relatively rare in the Unites States and even more so in the pregnant population. However, the impact of a venomous bite, also known as an envenomation, can be serious in a pregnant patient. Thus, providers in endemic and high-risk areas must be familiar with the management of envenomation in the pregnant population.The purpose of this article is to review the current literature on the most common snake and spider envenomations in the United States, the effects of envenomation on maternal and fetal health, and the management of envenomation in pregnancy.Original research articles, review articles, and guidelines on snake and spider envenomation were reviewed.Snake envenomation carries higher risks of maternal morbidity and fetal morbidity and mortality than spider envenomation. Although the data are limited, current literature suggests that both snake and spider antivenom can be used in the pregnant population without significant adverse outcomes. However, the risks of an adverse hypersensitivity reaction with antivenom administration should be weighed carefully with the benefits.The use of antivenom therapy in the symptomatic envenomated pregnant population is likely safe with the appropriate monitoring and follow-up. Knowledge of the indications for antivenom therapy and proper escalation of care are vital to optimizing maternal and fetal outcomes. More research is needed to determine the effects of both envenomation and antivenom therapy on the pregnant patient and their fetus.

Acupuncture is a key component of therapy in traditional Chinese medicine. Only in the last few decades has acupuncture become popular in the United States. The mechanism behind acupuncture's effects on the body and brain has not been completely elucidated, but there is evidence that acupuncture has effects on the endocrine, immune, and sympathetic and parasympathetic nervous systems. It may also act through electrical and mechanical signaling through the connective tissue and fascia. Despite this uncertainty, the positive effects of acupuncture have been well established.In this review, we discuss the basic concepts of traditional Chinese medicine and acupuncture and examine the evidence regarding the use of acupuncture in obstetrics and gynecology.We conducted a literature review of acupuncture in obstetrics and gynecology using PubMed.The available data demonstrate that acupuncture is beneficial in the treatment of labor pain, back pain in pregnancy, and dysmenorrhea. It is unclear if acupuncture is effective for hyperemesis, chemotherapy-induced nausea and vomiting, and menopausal hot flushes, or if moxibustion is effective in correcting breech presentation. There are limited but positive data regarding menopause-related sleep disturbances, depression in pregnancy, and overactive bladder. Acupuncture is not beneficial for improving outcomes in in vitro fertilization.Acupuncture is an increasingly popular therapy with many potential applications in obstetrics and gynecology. A general understanding of the basic principles of acupuncture and the safety and efficacy of its practice is necessary for the general obstetrician and gynecologist to make informed recommendations to patients.