Obstetrical & Gynecological Survey最新文献

{"title":"Non-neurogenic Voiding Dysfunction in Pediatric Patients and Female Adults: Review of Current Clinical Trials.","authors":"Annika Sinha, Brandi Tuttle, Alison Weidner","doi":"10.1097/OGX.0000000000001467","DOIUrl":"10.1097/OGX.0000000000001467","url":null,"abstract":"<p><strong>Importance: </strong>Non-neurogenic voiding dysfunction is a common lower urinary tract condition that affects both pediatric and adult patients. Normal bladder physiology requires complex coordination of the brain, spinal cord, bladder, and surrounding pelvic floor musculature. Abnormalities in this cycle can lead to symptoms of voiding dysfunction. The pathophysiology of voiding dysfunction can be multifactorial and influenced by different clinical settings, such as the perioperative or post-obstetric care periods.</p><p><strong>Objective: </strong>The goal of this review is to review the definitions, pathophysiology, and treatments for pediatric and adult female non-neurogenic voiding dysfunction.</p><p><strong>Evidence acquisition: </strong>A literature review using PubMed of relevant randomized clinical trials on treatments for voiding dysfunction in adults and children from 2000 to 2024 was completed.</p><p><strong>Results: </strong>Of the 3397 abstracts initially reviewed, 97 full-text manuscripts were screened, and a total of 31 articles met the criteria for inclusion. These manuscripts were reviewed, and their findings were reported within the manuscript.</p><p><strong>Conclusions and relevance: </strong>Voiding dysfunction can present as inadequate functioning of the emptying stage of micturition. It can present in children and female adults and has overall similar management strategies in both populations. For clinicians, it is important to understand the definition, relevant physiology, and the current evidence for treatment approaches for voiding dysfunction.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"29-38"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis.","authors":"Thomas F McElrath, Arun Jeyabalan, Arkady Khodursky, Alison B Moe, Manfred Lee, Maneesh Jain, Laura Goetzl, Elizabeth F Sutton, Pamela M Simmons, George R Saade, Antonio Saad, Luis D Pacheco, Esther Park-Hwang, Antonina Frolova, Ebony B Carter, Ai-Ris Y Collier, Daniel G Kiefer, Vincenzo Berghella, Rupsa C Boelig, Michal A Elovitz, Cynthia Gyamfi-Bannerman, Joseph R Biggio, Kara Rood, William A Grobman, Carrie Haverty, Morten Rasmussen","doi":"10.1097/01.ogx.0001179548.39409.03","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179548.39409.03","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Preeclampsia affects ~8% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. From 2007 to 2019, rates of hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, doubled in the United States. This trend coincides with a rise in maternal mortality, which is now the highest among high-income nations. These statistics support the need to develop risk stratification tools that help to prevent and treat preeclampsia. Efforts to develop these risk assessments have not been successful in reproductive medicine, especially for preeclampsia. The US Preventive Services Task Force (USPSTF) has recommended a risk-based approach using clinical and demographic factors and, for individuals at increased risk, treatment with low-dose aspirin prophylaxis (AP) starting at 12 weeks of gestation. The aim of this study was to assess the proportions of a racially and geographically diverse population classified as low, moderate, or high risk for preeclampsia according to USPSTF criteria. This was a prospective cohort study conducted at 11 medical centers across the United States or through direct recruitment via social media. Included were individuals with singleton pregnancies who were 18 years or older and enrolled in the study before 22 weeks' gestation between July 2020 and March 2023. Participants were classified as high risk if they had at least 1 high-risk condition based on the USPSTF criteria. Participants were classified as moderate risk if they had ≥1 moderate risk factors but no high risk factors (moderate +1 risk category); this group was further subdivided into 2 categories: moderate 1 risk (defined as those with only 1 moderate risk factor) and moderate 2+ risk (those with ≥2 moderate risk factors). Those in the low-risk category had no high or moderate risk factors. AP recommendation with or without a prescription was the effect modification. The primary outcome was preeclampsia. A total of 5684 people were included in the analysis. The study population was identified as Asian (4.7%), black (21%), Hispanic (17.4%), white (48.6%), and other (8.3%). About 12% and 11% of participants were diagnosed with preeclampsia and gestational hypertension that progressed to preeclampsia, respectively. There were 18.5% in the high-risk category and 11.2% in the low-risk category. Approximately 70.3% were in the moderate +1 risk category, which was subdivided into the moderate risk 1 category (34.4%) and the moderate risk 2+ category (35.9%). While the incidence of preeclampsia varied by race, limited information was gleaned for sensitivity and specificity. A significantly increased risk of preeclampsia was observed in those with prior preeclampsia [risk ratio (RR), 1.44; 95% CI, 1.25-1.65; P&lt;0.001] or chronic hypertension (RR, 1.26; 95% CI, 1.10-1.44; P=0.001). Much of the statistical significance was lost for moderate risk factors, and none of the racial categories were associated with increase","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"5-7"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequence Diversity Lost in Early Pregnancy.","authors":"Gudny A Arnadottir, Hakon Johnsson, Tanja Schlaikjær Hartwig, Jennifer R Gruhn, Peter Loof Møller, Arnaldur Gylfason, David Westergaard, Andrew Chi-Ho Chan, Asmundur Oddsson, Lilja Stefansdottir, Louise le Roux, Steinthorsdottir, Kristjan H Swerford Moore, Sigurgeir Olafsson, Pall I Olason, Hannes P Eggertsson, Gisli H Halldórsson, G Bragi Walters, Hreinn Stefansson, Sigurjon A Gudjonsson, Gunnar Palsson, Brynjar O Jensson, Run Fridriksdottir, Jesper Friis Petersen, Agnar Helgason, Gudmundur L Norddahl, Palle Duun Gohde, Jona Saemundsdottir, Olafur Th Magnusson, Bjarni V Halldorsson, Sofie Bliddal, Karina Banasik, Daniel F Gudbjartsson, Mette Nyegaard, Patrick Sulem, Unnur Thorsteinsdottir, Eva R Hoffmann, Henriette S Nielsen, Kari Stefansson","doi":"10.1097/01.ogx.0001179580.14616.46","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179580.14616.46","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Germline mutations are heritable; they occur before the formation of a fertilized egg and are found in all cells. They can be detected through somatic tissue sampling, and de novo mutations (DNMs) are well-studied. The majority of known DNMs originate in paternal cells, but some include maternal contributions as well. Certain kinds of DNMs prevent a fertilized egg from developing to term, and these are much less well-characterized. Some also lack sequence variants in certain genes and some are never observed in a homozygous form; these are also not well studied. Recombination failure can cause aneuploidies (trisomies or monosomies), and an estimated half of pregnancy losses are explained by this phenomenon. Early pregnancy loss is understudied, and there are few therapeutic interventions. This study, the Copenhagen Pregnancy Loss (COPL) study, was designed to contribute to the understanding of pregnancy loss through trios of patients (mother, father, and fetus) with clinically diagnosed pregnancy loss, attempting to document sequence diversity and interplay between meiotic recombination and point mutations. This study included 664 cases of early pregnancy loss with 1439 fetal samples (multiple were collected from each loss, where possible). In 467 of the 664 cases, there was at least 1 fetal sample and 1 sample from both parents. A total of 59 losses indicated a higher-than-expected kinship with the mother, and 11 indicated a higher kinship with the father. Whole-genome sequencing (WGS) was used to assess aneuploidies, and detected them in 206 cases. Of these, monosomy X and trisomy 16 were the most common. In addition, 19 large de novo copy number variants (CNVs) were detected in 14 loss cases, none of which were near a common fragile site. Of these 14 cases, 11 were euploid losses and 6 contained aneuploidies. Failure at meiosis I results in the presence of both homologous chromosomes from the same parent. An estimated 27.2% of paternal and 32.3% of maternal triploidies occur at recombination hotspots, supporting the idea of meiosis failure. A total of 15,086 DNMs were pinpointed as paternal and 5967 as maternal, consistent with previous literature supporting a high paternal contribution to DNMs. Consistent with this, paternal triploidies showed a proportionally higher paternal fraction of phased mutations. DNMs shown in maternal triploidies indicated a lower paternal fraction than euploid fetuses. In addition, there was no correlation between sister/homologous state differences for high-AB DNMs in paternal triploidies. When searching for pathogenic single-site variants (SSVs) in the DNMs, 26 genotypes were found that were pathogenic or likely pathogenic; a total of 23 were DNMs and 3 were biallelic predicted loss-of-function variants (pLoF). The frequency of pathogenic SSVs in early pregnancy loss was higher compared with controls [odds ratio (OR) 2.98, P=5.7×10-6), and this effect remained after correction for parental age. These result","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"26-27"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of GLP1 Agonists on Reproduction.","authors":"Marie Couldwell, Anna Jane Tidwell, Ann E Taylor","doi":"10.1097/OGX.0000000000001487","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001487","url":null,"abstract":"&lt;p&gt;&lt;p&gt;About 2 decades ago, researchers discovered that glucagon-peptide 1 (GLP-1) stimulates insulin secretion and can treat type 2 diabetes. Some of the physiological effects of this drug class that allow for glycemic control include delayed gastric emptying, enhanced satiety, and anti-inflammatory effects. Since their discovery, the scope of GLPs has expanded into treatment for obesity, sleep apnea, osteoarthritis of the knees, renal failure, and heart failure across a wide range of drug variations. The aim of this study is to review and evaluate the currently available data on GLP-1 agonist use for the treatment of obesity-associated reproductive dysfunction. This narrative review used targeted searches of terms including \"GLP1,\" \"GLP1 receptor agonist,\" and \"GLP1 receptor\" in combination with \"female,\" \"male,\" \"reproduction,\" \"fertility,\" \"polycystic ovary syndrome,\" \"PCOS,\" \"oral contraceptives,\" \"gastric emptying,\" \"drug interactions,\" \"major congenital anomalies,\" and \"pregnancy\" through March 1, 2025. Prescribing information from FDA drug labels was also reviewed. Obesity is strongly associated with reproductive dysfunction in both men and women, with well-documented hormonal, structural, and gamete cell effects. In men, obesity can cause problems like reduced luteinizing hormone, testosterone, semen volume, and sperm count. These can cause diminished fertility through increased inflammation and oxidative stress, and reduced connection between the hypothalamic-pituitary-gonadal axis. Early evidence suggests that GLP-1 improves these pathways, with preclinical research showing action on gonadotropin-releasing hormone and Kiss neurons, remodeling testicular architecture, reduced oxidative stress, and improved testosterone and gonadotropin levels. Clinical studies of men have shown increased luteinizing hormone and follicle-stimulating hormone, improved sexual function, and greater sperm quality. Women have GLP-1 receptors in their ovarian and uterine tissue, and animal models of PCOS show improvements in ovarian follicle development, steroidogenesis, estrous cyclicity, and inflammatory markers. In clinical studies of women with PCOS, GLP-1 agonists improve androgen profiles, increase SHBG, reduce ovarian volume, regulate menstrual cycles, enhance ovulation, and improve both spontaneous and assisted pregnancy rates. Observational data also suggest lower rates of gestational diabetes, hypertensive disorders, preterm birth, and cesarean delivery among women who used GLP-1 agonists before pregnancy, even when matched for BMI, implying additional benefits beyond weight loss. At the same time, preclinical toxicology demonstrates fetal harm, and weight loss during pregnancy is associated with adverse fetal outcomes, underscoring the need for careful preconception management. Current recommendations emphasize counseling on improved fertility potential, possible reduced oral contraceptive efficacy due to altered gastric emptying, and the need for re","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"2-4"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Pathology During Pelvic Organ Prolapse Repair in an Urban Population.","authors":"Johanna Gandelsman-Ginis, Stephanie Bentley, Fareesa Khan, Cynthia Brincat, Michele O'Shea","doi":"10.1097/OGX.0000000000001482","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001482","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The prevalence of symptomatic pelvic organ prolapse (POP) in the United States is estimated at 3%, with around 300,000 patients undergoing surgical correction of POP annually. Surgical correction of POP often includes hysterectomy, and a potential risk of this procedure is unexpected pathology. Previous literature has shown the risk of premalignancy or malignancy in patients having procedures for benign indications to be 0.22% to 2.6%; understanding this risk is important when counseling patients as well as when considering preservation of the uterus. There is limited evidence, however, surrounding the rate of abnormal pathology at POP repair for racially and ethnically diverse populations. Preliminary evidence has suggested that rates may be higher in racial or ethnic subgroups, and this study was designed to assess this possibility. The purpose of this study was to provide a rate for abnormal uterine, cervical, fallopian tube, and ovarian pathology in a diverse population of nononcologic patients undergoing surgery for symptomatic POP. This was a retrospective study using data from an urban academic medical center. Inclusion criteria were patients above the age of 18 undergoing hysterectomy for POP between January 2018 and June 2023. Exclusion criteria were a primary indication for hysterectomy that did not include POP, patients who did not have a hysterectomy, patients who only received care from a benign gynecologist, and patients who had a known premalignant or malignant gynecologic lesion. The final analysis included 229 patients without a known premalignancy or malignancy before hysterectomy for POP. This cohort included 36% Hispanic individuals, 17% non-Hispanic Black individuals, and 38% non-Hispanic White individuals. A total of 75% of patients were postmenopausal, and ~23% had experienced abnormal bleeding. Incidence of unexpected pathology was 1.7%. Patients with abnormal findings included 2 patients with endometrial carcinoma (1 non-Hispanic black, 1 non-Hispanic White) and 2 patients with cervical dysplasia (1 non-Hispanic White, 1 Hispanic). These results indicate that the rate of unexpected malignancy was 1.7% in this cohort, much higher than the expected rate of 0.9%. This risk estimate may be useful in counseling patients who desire uterine preservation when undergoing surgical reconstruction for POP. Previous recommendations have indicated that in asymptomatic individuals, endometrial biopsy or evaluation is not necessary due to the low risk of unexpected malignancy, but if there is suspicion, such as abnormal uterine bleeding, greater age, menopausal status, hypertension, anemia, or weight loss, then endometrial assessment should be considered. This study's estimated risk of unexpected malignancy does not necessarily impact these recommendations, but does emphasize that care should be taken to assess all symptoms and counsel patients accordingly. Future research should focus on characterizing risks and benefits of uterin","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"18-19"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Management of Esophageal Varices.","authors":"Elisabeth N Adkins, Carla W Brady, Jeffrey A Kuller, Luke A Gatta","doi":"10.1097/OGX.0000000000001469","DOIUrl":"10.1097/OGX.0000000000001469","url":null,"abstract":"<p><strong>Importance: </strong>Physiological changes in pregnancy pose unique challenges for cirrhosis and portal hypertension, particularly during the third trimester and intrapartum setting. Pregnancy may increase the risk of worsening of esophageal varices and life-threatening variceal hemorrhage. Therefore, it is important that clinicians recognize risk factors for appropriate referral and management for delivery planning to mitigate risks associated with acute variceal bleeding in pregnancy.</p><p><strong>Objective: </strong>Review preconception counseling, antepartum surveillance, and intrapartum management of patients with esophageal varices, while emphasizing professional societal guidelines.</p><p><strong>Evidence acquisition: </strong>A literature review identified relevant research, review articles, databases, and societal guidelines.</p><p><strong>Results: </strong>Optimal management of esophageal varices in pregnancy requires an individualized, multidisciplinary team. Preconception counseling should include a screening endoscopy within 1 year of conception; with pregnancy, a second-trimester upper endoscopy should be considered. Small varices may be managed with a beta-blocker and surveillance. Medium and large varices should be managed with therapeutic endoscopy. Counseling regarding the mode of delivery is individualized, and attempting vaginal birth is acceptable in patients at low risk of variceal bleeding and with an anticipated short duration of the second stage of labor. Cesarean deliveries may be considered for patients with intensive care coordination needs and a high risk for variceal bleeding. Postpartum follow-up should include appropriate follow-up with Hepatology, contraception counseling, and follow-up for other comorbidities.</p><p><strong>Conclusions and relevance: </strong>Optimal management for patients with esophageal varices due to cirrhosis and portal hypertension requires highly individualized care. Clinical advancements, as well as a steady increase in rates of cirrhosis in reproductive-aged women, has led to a higher prevalence of clinicians caring for these patients.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"39-44"},"PeriodicalIF":4.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Vaginal Cuff Closure: A Systematic Review and Meta-Analysis of Barbed Versus Conventional Sutures in Total Laparoscopic and Robot-Assisted Hysterectomies.","authors":"Laura Vilar Planella, Ignacio Rodriguez Garcia, Silvia Franco Camps, Pere N Barri-Soldevila, Silvia Cabrera Diaz","doi":"10.1097/OGX.0000000000001483","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001483","url":null,"abstract":"&lt;p&gt;&lt;p&gt;A potential major complication of total endoscopic hysterectomy is vaginal cuff dehiscence (VCD), which is defined as partial or complete separation of the vaginal cuff edges after hysterectomy. Delayed diagnosis and treatment of VCD can lead to severe adverse outcomes such as bowel perforation, peritonitis, and sepsis; VCD incidence is higher for laparoscopic hysterectomy compared with abdominal or vaginal hysterectomy, and previous literature has estimated the risk of VCD at 0.64% to 4.93% for laparoscopic, 0.12% for abdominal, and 0.29% for vaginal methods. Vaginal cuff closure (VCC) can be performed with various methods, and preferences surrounding the performance of VCC vary based on provider and institution; VCC has been shown to decrease rates of VCD in laparoscopic hysterectomy. Vaginal cuff suture type can influence the duration of surgery and strength of sutures, which can both affect the risk of VCD. This study was designed to assess evidence surrounding barbed sutures compared with conventional sutures for VCC. This was a systematic review and meta-analysis, with databases searched including PubMed-MEDLINE and Embase between 2004 and 2024. The inclusion criteria for studies were peer-reviewed comparative studies focusing on the comparison of barbed to conventional sutures for VCC in patients undergoing total laparoscopic or robot-assisted hysterectomy. The exclusion criteria were abstract-only articles, editorials, commentaries, review articles without original data, single-arm studies, case studies, and case reports. The primary outcome of this study was VCD, with secondary outcomes of operative time, suture time, blood loss, total postoperative complications, surgical site infection, and development of granulation tissue. Publication bias was assessed with funnel plots and the Risk Of Bias in Nonrandomized Studies of Interventions for observational studies and the Risk of Bias 2 tool for randomized controlled trials. The final analysis included 24 studies, with 6 randomized controlled trials, 4 prospective cohort studies, 13 retrospective cohort studies, and 1 case-control study. VCD was investigated as a primary outcome in all the included studies. Among 1891 patients in 19 studies who had barbed sutures, VCD was observed in 13; out of 1746 patients across the same studies who had conventional sutures, 23 were diagnosed with VCD. This difference was not significant. No significant differences were detected in VCD incidence between laparoscopic and robotic approaches. For secondary outcomes, using barbed sutures resulted in a decreased operative time in both laparoscopic (8.58-min reduction) and robot-assisted hysterectomies (37.82-min reduction), although the results for laparoscopic surgery showed significant heterogeneity. Similarly, barbed sutures were found to significantly reduce suture time compared with conventional sutures for laparoscopic hysterectomy (a reduction of 4.90 min) but not for robot-assisted hysterectomie","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"16-18"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Satisfaction and QoL in SUI: Results With Single-incision or Full-length Slings.","authors":"Ty Erickson, Edward Gheiler, Craig E Hanson, Rebecca McCrery, Mitesh Parekh, Mohamad Parva, Le Mai Tu","doi":"10.1097/01.ogx.0001179568.95475.5a","DOIUrl":"10.1097/01.ogx.0001179568.95475.5a","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The estimated prevalence of urinary incontinence (UI) in females varies widely, from 15% to 69%, and is additionally presumed to be underreported because of under-evaluation as well as stigma associated with it. Stress urinary incontinence (SUI) is reported to affect between 50% and 80% of cases of UI. Significant impacts on quality of life (QoL) in both personal and social aspects are common in SUI, and previous research has shown high rates of anxiety and depression. Current treatments for SUI include management of symptoms as well as surgical management, including midurethral sling (MUS) and single incision sling (SIS) procedures. This study was designed to compare the safety and effectiveness of the Altis SIS with other full-length slings for the treatment of SUI. An additional goal of this study was to compare QoL before and after surgery over the course of 36 months. This was a secondary analysis of data from the Altis 522 study, which was a prospective, multicenter, nonrandomized, noninferiority cohort study. The primary outcomes of the initial study were patient-reported success as measured by 24-hour pad weight reduction and serious adverse events at 6 months and through 36 months. QoL was measured at 6, 12, 18, 24, and 36 months. The inclusion and exclusion criteria have been previously reported. The final analysis included 355 patients recruited between January 2015 and May 2018. At 36-month follow-up, assessment was performed for 140 patients with the Altis SIS and 101 patients with full-length slings in the control group. The patients who received Altis SIS were older and more likely to be postmenopausal compared with controls. The control group had a higher body mass index, reported more current smoking, and had higher baseline urinary distress scores, as well as a larger proportion of individuals with mixed urinary incontinence. The Urogenital Distress Inventory (UDI-6) showed no significant differences between the Altis SIS and control groups at 36-month follow-up, with both groups showing significant improvement. The Incontinence Impact Questionnaire (IIQ-7) also showed no significant difference between groups at 36-month follow-up, with similarly improved scores in both groups. The same was true of the Patient Global Impression of Improvement (PGI-I) and the Surgical Satisfaction Questionnaire (SSQ-8). These results indicate that the Altis SIS performed very similarly to controls with full-length slings for treatment of SUI, even at long-term follow-up. Both groups demonstrated meaningful improvement in QoL, and each questionnaire showed improvement. This is consistent with previous literature assessing improvement in QoL over objective cure rate. There is some potential for patient satisfaction to be affected by adverse events, and this was the case in a small number of patients in this study. Future research should focus on ways to reduce the occurrence of adverse events as well as assessing the impact of SIS on other re","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"21"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Treatment for Symptomatic Uterine Fibroids: Available Evidence and Therapeutic Dilemmas.","authors":"Noa S De Smit, Maria E de Lange, Martijn F Boomsma, Judith A F Huirnet, Wouter J K Hehenkamp","doi":"10.1097/OGX.0000000000001484","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001484","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Leiomyomas, or uterine fibroids, are benign tumors of the smooth muscle of the uterus with origins in the myometrium. Many women experience uterine fibroids, with an estimated prevalence ranging from 20% to 80%. Symptomatic fibroids can have a profound effect on quality of life and typically include symptoms such as heavy menstrual bleeding, pelvic pain, lower back pain, abdominal bloating, urinary symptoms, sexual dysfunction, fertility issues, and anxiety and depression resulting from physical symptoms. Treatment options have become more advanced in recent years, and this article is a review designed to assess evidence and raise awareness surrounding novel, minimally invasive or medicinal alternative treatments to hysterectomy or abdominal myomectomy. The goal of this article was to provide clinical guidance and contribute knowledge to personalized care and decision-making for patients while also identifying gaps in current literature. Current treatments for symptomatic fibroids included in this review are uterine artery embolization, magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU), laparoscopic radio-frequency ablation, transcervical radiofrequency ablation, ulipristal acetate intermittent treatment (four 12-week treatment regimens) and oral gonadotropin-releasing hormone receptor antagonists with add-back therapy. Uterine artery embolization includes blocking the blood supply to uterine fibroids and thus providing relief from symptoms as the fibroids shrink due to lack of blood flow. This is an inpatient hospital procedure done under local anesthesia with epidural or spinal anesthesia or intravenous pain medication postprocedure. Common side effects of this procedure include pain, nausea, groin hematoma, and fever, but most resolve within 24 to 72 hours. Studies comparing the effectiveness of uterine artery embolization and hysterectomy have shown that quality of life improvement is similar between the two, but hysterectomy is better in terms of controlling abnormal uterine bleeding. Comparisons to myomectomy have shown conflicting evidence in terms of quality of life improvement, with some showing myomectomy as superior and others showing uterine artery embolization as superior. There is little evidence surrounding fertility outcomes for uterine artery embolization, including pregnancy. MR-HIFU is a technique of thermal ablation that induces necrosis in uterine fibroids through a high-intensity ultrasound beam under MRI guidance. This is a noninvasive method with few side effects. Current treatments allow for 100% ablation of fibroids, and the procedure typically takes place over a 1-day admission to the hospital. There has been only 1 randomized controlled trial comparing MR-HIFU with a placebo, and an additional 3 have compared it to the standard of care. No study reported its effect on menstrual bleeding, but all reported improvement in quality of life at 12 weeks postintervention. Compared with placebo, howeve","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"15-16"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines on Placenta Accreta Spectrum Disorders: A Systematic Review.","authors":"Giulia Bonanni, Maria C Lopez-Giron, Lisa Allen, Karin Fox, Robert M Silver, Sebastian R Hobson, Albaro J Nieto-Calvache, Sally Collins, Miroslaw Wielgos, Eric Jauniaux, Helena C Bartels, Loïc Sentilhes, John Kingdom, Frederic Chantraine, Joseph R Wax, Alison Cahill, Alfred Abuhamad, Diogo Ayres de-Campos, Kjersti Aagaard, Amir A Shamshirsaz, Scott A Shainker, Alireza A Shamshirsaz","doi":"10.1097/01.ogx.0001179560.22096.dc","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179560.22096.dc","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Placenta accreta spectrum (PAS) is an obstetrical complication in which the placenta abnormally invades the uterine wall, increasing the risk of hemorrhage, surgical morbidity, and maternal mortality. Management is often complex and multidisciplinary, particularly when invasion extends beyond the uterus. For this reason, standardized guidelines are essential to support early diagnosis and coordinated care across specialties. Significant variations in clinical practice guidelines (CPGs) remain, especially between countries with differing levels of income. This systematic review evaluates national and international CPGs published within the last decade to identify areas of agreement, disagreement, and insufficient evidence across all stages of PAS care. To identify CPGs related to PAS, a comprehensive search of professional society websites, PubMed, the GIN Library, and the ECRI Guidelines Trust was conducted. Two independent reviewers evaluated the sources to extract relevant clinical recommendations, which were then sent to a panel of 15 to 18 experts who had authored their own PAS guidelines. During 2 rounds of structured feedback, the panel could comment on, clarify, or revise their own guidelines before the committee would evaluate them for consensus and sufficiency of evidence. Each guideline was categorized as demonstrating high agreement, poor consensus, or high levels of insufficient evidence. The data were visualized by quantifying the level of agreement and sorting each guideline into categories of epidemiology, diagnosis, antenatal management, surgical management, and postnatal care. A total of 18 articles from 14 national or international societies were included. There was high agreement on epidemiologic risk factors, diagnostic principles, and key elements of antenatal management. A history of cesarean delivery consistently emerged as a major risk factor, especially in patients with concurrent placenta previa. All guidelines supported ultrasound as the primary diagnostic tool, with most recommending standardized descriptors to enhance accuracy. Targeted second-trimester imaging was widely endorsed, with some guidelines supporting first-trimester screening for high-risk patients. There was also strong consensus surrounding antenatal management and the need for specialized care, emphasizing referral to tertiary centers with multidisciplinary expertise, adequate surgical and transfusion resources, and planned delivery around 34 to 35 weeks. In contrast, surgical and peripartum recommendations showed substantial variability and limited evidence, including uncertainty regarding optimal incision type, use of balloon occlusion catheters, anesthesia approaches, and conservative management strategies. Only 1 guideline offered specific recommendations for low- and middle-income countries. These findings indicate that while some aspects of PAS management, such as diagnosis and antenatal care, have a broad consensus, other areas remain unde","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"10-12"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}