HIV in pregnancy

The United States Department of Health and Human Services (DHHS) recently updated its guidelines on the use of antiretroviral agents in pregnant women with HIV infection. Dolutegravir is newly listed as a preferred agent to initiate during the second and third trimester of pregnancy. However, the guidelines reiterate a conservative interim recommendation that dolutegravir not be initiated during the first trimester of pregnancy based on preliminary data from a study in Botswana raising concerns about a possible small increased risk of neural tube defects with maternal dolutegravir use around the time of conception. The recommendation will likely be clarified as further data become available. Our recommendations are generally consistent with these guidelines.

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The tumor necrosis factor inhibitor certolizumab pegol (CZP) is thought to be safe for use during pregnancy.

This biologic agent lacks the antibody Fc- region responsible for placental transfer of immunoglobulins.A recent analysis of the manufacturer’s pharmacovigilance database, representing the largest available cohort of exposed pregnant women (including over 300 women with rheumatic diseases and nearly 200 with Crohn disease), identified over 530 prospectively documented outcomes of maternal exposure. Over 80 percent…

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FIGO introduces changes to the cervical cancer staging system (November 2018)

The International Federation of Gynecology and Obstetrics (FIGO) has published an updated cervical cancer staging system. Among the changes, the list of tests and procedures that may be used to assign stage was expanded to include imaging and pathologic findings where available, tumor size criteria for some stages were revised, and lymph node metastases were included in staging. Since cervical cancer outcomes depend greatly on tumor size and lymph node involvement, these changes improve the ability of stage to predict prognosis and plan treatment.

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