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.

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.

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.

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.

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.

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.

This review summarizes evidence supporting history-indicated cerclage and the evolution of commonly used eligibility thresholds. Randomized trials and meta-analyses demonstrate that cerclage reduces very early preterm birth in high-risk pregnancies without meaningful heterogeneity of treatment effect across risk strata. Although studies comparing cervical length surveillance versus history-indicated cerclage report similar population-level outcomes, differences in patient selection and study design limit interpretation. History-indicated cerclage, therefore, remains an important option for selected patients at risk for pregnancy loss or extreme preterm birth. Current evidence highlights the importance of individualized counseling and shared decision-making that incorporates clinical history, risk assessment, and patient preferences.

Chronic pelvic pain (CPP) represents a complex condition where peripheral nociceptive drivers and central nervous system processes produce symptoms that extend beyond the pelvis. Central sensitization (CS) is a state of heightened neuronal responsiveness with amplified pain signaling and diminished inhibitory control, in which patients experience multifocal pain, fatigue, sleep disturbance, cognitive difficulties, and hypersensitivity to sensory stimuli. Management of CS requires a multimodal and comprehensive approach, including pain neuroscience education, targeted pelvic physical therapy, and behavioral therapies. As the field advances, incorporating sensitization science offers a more accurate, patient-centered framework to reduce symptom burden and improve quality of life.

Patients with physical disabilities face many barriers to obstetric care. Facility limitations affect the ability to perform routine exams, including fundal heights and patient weights. These patients are at increased risk of antepartum and intrapartum complications, including preterm labor, lower birth weight infants, worsening functional status, and autonomic dysreflexia as well as increased likelihood of cesarean delivery. Postpartum, they face decreased rates of breastfeeding, increased rates of postpartum depression, and a lack of accessible infant care items. Provider education focusing on the specific needs of these patients in the peripartum period is necessary to improve their care.

Chronic pelvic pain (CPP) is a debilitating and costly condition that imposes substantial physical, psychological, and economic burden. It is associated with a high prevalence of psychiatric comorbidity, and the persistent nature of pain significantly disrupts psychological well-being and social functioning, with profound effects on quality of life. This brief review synthesizes current evidence on the mechanistic pathways implicated in CPP, as well as associated psychological factors, including depression, anxiety, and post-traumatic stress disorder. In addition, the efficacy of established psychological interventions for CPP is reviewed including emerging treatments that have not yet been systematically assessed in individuals with CPP.

A multidisciplinary group of health care professionals and patients convened to discuss navigating obstetric care for nonspeaking individuals. The key lessons outlined in the manuscript include: (1) Identifying components of augmentative and alternative communication (AAC). (2) Expanding the health care team to support patients using AAC. (3) Anticipatory guidance and planning are paramount to navigating obstetric care for patients who are nonspeaking. (4) Call for electronic medical records to flag communication methods to ensure all health care providers are aware of patients' preferences.