A host of anti-hyperglycemic agents are currently available and widely prescribed for diabetes and weight loss management. In patients undergoing surgery, use of these agents poses a clinical challenge to surgeons, anesthesiologists, and other perioperative care providers with regard to optimal timing of discontinuation and resumption of use, as well as possible effects of these agents on physiology and risk of postoperative complications. Here, we provide a comprehensive review of anti-hyperglycemic medications’ effects on physiology, risks/benefits, and best practice management in the perioperative setting. Additionally, we report an illustrative case of small bowel obstruction in a patient taking semaglutide for 6 months prior to an otherwise uncomplicated laparoscopic hysterectomy and bilateral salpingo-oophorectomy. This review is meant to serve not as a replacement of, but rather as a consolidated complement to, various society guidelines regarding perioperative anti-hyperglycemic agent management.

Most pregnant individuals are exposed to at least one medication, whether prescription or over the counter, during pregnancy. Despite the ubiquity of medication use in pregnancy, there remains no standardized framework to guide clinicians in selecting the most appropriate pharmacotherapy that balances maternal needs with fetal safety. This gap contributes to variability in prescribing practices and uncertainty in clinical decision making. In this article, we propose a structured schema for evaluating and selecting drug therapy during pregnancy. Our approach emphasizes careful consideration of maternal and fetal factors, integration of the unique physiologic changes of pregnancy, and systematic appraisal of the best available evidence. Recognizing the frequent absence of robust pharmacokinetic and safety data, we also provide pragmatic principles and rules of thumb to guide clinicians in estimating the likelihood of placental transfer and potential fetal exposure. This framework is designed to support clinicians in making more informed, transparent, and evidence‐based decisions while also identifying areas for future research.

Cerebral aneurysms are rarely encountered in pregnancy. Their antepartum and intrapartum management remain clinically challenging, primarily due to concern regarding potential rupture. We present a case of a patient in preterm labor at risk for imminent delivery with a 10mm cerebral aneurysm. She was recommended for cesarean section (CS), yet delivered via spontaneous vaginal delivery in the operating room after induction of general anesthesia for the intended CS. Her aneurysm and neurologic function remained intact postpartum. Cerebral aneurysms <5mm are unlikely to undergo significant growth during pregnancy. The presence of a cerebral aneurysm is not automatically a contraindication to the Valsalva maneuver. The recommendation for which patients with unruptured cerebral aneurysms should deliver by CS, operative vaginal delivery, or unassisted vaginal delivery (i.e., which patients should avoid Valsalva maneuver intrapartum), is complex and requires multidisciplinary discussion.

Background/Objectives: Over 600,000 hysterectomies are performed in the United States annually, with uterine fibroids being the most common indication. It remains unknown whether removal of the uterus is associated with poor cardiometabolic outcomes. This study aimed to determine whether hysterectomy is associated with adverse cardiometabolic outcomes among patients with uterine fibroids (myomectomy and no surgery as controls). Methods: Retrospective cohort study utilizing MarketScan^® Database of U.S. healthcare claims dataset, including patients aged 18–55 with uterine fibroid diagnosis in 2010 or 2011 and 10 years of continuous enrollment. Patients were stratified into three groups: hysterectomy, myomectomy, and no surgery. Patients were then followed for 10 years to determine incidence of cardiometabolic disorders. The main outcome measures included coronary artery disease, congestive heart failure, cardiac arrhythmia, stroke, hypertension, hyperlipidemia, type II diabetes, and peripheral artery disease, which were defined using the ICD-9, ICD-10, and CPT codes. Results: 34,722 participants with uterine fibroids were identified. Among these, 8,196 (23.61%) patients underwent hysterectomy, 1351 patients (3.89%) underwent myomectomy, and 25,175 (72.50%) patients did not undergo surgery. Hysterectomy was associated with higher age-adjusted odds of developing stroke (aOR = 1.11), hypertension (aOR = 1.14), hyperlipidemia (aOR = 1.14), and type II diabetes (aOR = 1.20) compared to no surgery. Hysterectomy was associated with higher age-adjusted odds of developing hyperlipidemia (aOR = 1.26) compared to myomectomy. Hysterectomy with removal of ovaries versus hysterectomy with retention of ovaries had similar cardiometabolic outcomes. Conclusions: Among patients with fibroids, hysterectomy was associated with higher odds of developing adverse cardiometabolic outcomes compared to myomectomy or no surgery. Retention of the ovaries was not protective among those undergoing hysterectomy.

Sickle cell disease is an autosomal recessive hemoglobin disorder affecting about 100,000 people in the United States, predominantly those of African descent. A point mutation in the β-globin gene in red blood cells causes these cells to sickle under hypoxemic conditions, reducing blood flow and oxygen delivery to tissues. This manifests in the form of painful vaso-occlusive episodes, acute chest syndrome, and acute infarction of various organs, including the spleen, bone, and lung. While sickle cell disease complications such as hemolytic anemia, tissue hypoxia, and chronic organ damage are well studied, attention to the unique reproductive challenges faced by patients with sickle cell disease remains underrecognized and underappreciated. This review aims to explore key reproductive health issues in patients with sickle cell disease, including diminished ovarian reserve, infertility, and obstetric and perinatal risk. Secondly, this review aims to identify key counseling and care opportunities for providers to support patients with sickle cell disease in meeting their reproductive goals.