Obstetrical & Gynecological Survey最新文献

{"title":"Evaluation of a New Model for Human Chorionic Gonadotropin Rise in Pregnancies of Unknown Viability","authors":"Kassie J. Bollig, Alex Finlinson, Kurt T. Barnhart, Christos Coutifaris, Danny J. Schust","doi":"10.1097/01.ogx.0000993688.03052.e5","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993688.03052.e5","url":null,"abstract":"Abstract For early pregnancy management, quantitative serum human chorionic gonadotropin (hCG) measurements and transvaginal ultrasonography are the standard clinical guides. Current guidelines use the change in hCG levels to determine likely location of the pregnancy but represent a minimal rate to predict viability. When incorrectly used, these are inaccurate. This study examined the performance of a new hCG threshold model and compared it with 3 established models. The study is a retrospective cohort study. All individuals with at least 2 consecutive quantitative hCG serum levels seen at the University of Missouri–Columbia from January 1, 2015, until March 1, 2020, were screened for study eligibility. Eligibility requirements were 3-fold: first, patients who presented with pregnancy of unknown viability; second, they had an initial hCG level between 2 and 5000 mIU/mL, maintaining the first interval of no greater than 7 days between testing; and third, the final pregnancy outcome was confirmed. Exclusion occurred for patients who had germ cell tumors, had molar pregnancies, had an intrauterine device in place, utilized hCG monitoring for a molar pregnancy or elective abortion, utilized assisted reproductive technology to achieve pregnancy, or were lost to follow-up. Results of the study came from a pool of 688 patients who met all the inclusion criteria. They contributed an average of 2.3 measurements per patient for a total of 1554 hCG measurements. There was an average of 10.1 days for follow-up. Of those patients included, 167 had viable intrauterine pregnancy (IUP) (24.3%), 463 experienced early pregnancy loss (67.3%), and 58 had ectopic pregnancies (8.4%). The rates of rise in values up to 4 days and again between 4 and 6 days were added for a total rate or rise. Because this was a retrospective study, a calculation was used when hCG levels were not available on day 4 or 6. The values were calculated to be conservative and to avoid incorrectly classifying any viable pregnancy as nonviable. Strengths of the study include its large sample size, its inclusion of all 3 pregnancy outcomes, verified pregnancy outcomes, and subsequent misclassification assessments based off of the aforementioned strength. This study confirmed 122 of 168 viable IUPs (72.6%) had live births, and the simple nature of the study allows for easy integration into clinical practice. Finally, the new model allows for greater variation in days on which a patient must present for care. Study limitations included imputed values from hCG samples not specifically collected on day 4 or 6. Despite this, application of the proposed model utilizing merely known values resulted in better performance. In addition, minimal rise for hCG rates in this data set may be a result of internal validation that may differ in larger, multi-institutional data sets. Furthermore, it must be remembered that current methods using hCG thresholds to determine pregnancy viability rely predominantly on ","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010146","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":"Analysis of Obstetric Outcomes by Hospital Location, Volume, and Teaching Status Associated With Non–Medically Indicated Induction of Labor at 39 Weeks","authors":"Alyssa R. Hersh, Kimberley A. Bullard, Bharti Garg, Megha Arora, Brooke F. Mischkot, Aaron B. Caughey","doi":"10.1097/01.ogx.0000993660.40718.03","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993660.40718.03","url":null,"abstract":"ABSTRACT Previous research has shown that non–medically indicated induction of labor contributes to some favorable outcomes compared with expectant management in low-risk pregnancies. Cesarean birth rates have risen in recent years and represent a significant impact on long-term health of both mother and child. Research has connected these 2 phenomena, showing that non–medically indicated induction may reduce the overall likelihood of cesarean delivery, but it is not yet known how these outcomes are affected by hospital facility variables. This study was designed to examine outcome differences in women undergoing non–medically indicated induction at 39 weeks' gestation based on hospital characteristics such as obstetric volume, location, and teaching status. This study was designed as a retrospective cohort study, analyzing births between January 1, 2007, and December 31, 2011. Inclusion criteria were singleton, nonanomalous births at 39 weeks 0 days' gestation to 41 weeks 6 days' gestation among nulliparous mothers. Births with missing data on induction or hospital type were excluded, as well as births to pregnant individuals with comorbid conditions, placenta previa, breech presentation, stillbirths, and elective or planned cesarean delivery. The primary outcome was cesarean birth, and secondary outcomes included perinatal outcomes of severe maternal morbidity, chorioamnionitis, postpartum hemorrhage, operative vaginal birth, and obstetric anal sphincter injury, as well as neonatal outcomes of neonatal intensive care unit admission for more than 24 hours, respiratory distress syndrome, and shoulder dystocia. Analysis included 455,044 births, with 24,272 (5.3%) experiencing non–medically indicated induction of labor. Significant differences were found between non–medically indicated induction and expectant management when the sample was stratified by urban versus rural settings. Cesarean birth was significantly less likely among those who underwent non–medically indicated induction, with lower odds for rural (adjusted odds ratio [aOR], 0.68; 99% confidence interval [CI], 0.53–0.86) versus urban hospitals (aOR, 0.78; 99% CI, 0.74–0.81). For other outcomes assessed based on location, urban hospitals showed significantly lower odds of severe maternal morbidity (aOR, 0.78; 95% CI, 0.61–0.98), chorioamnionitis (aOR, 0.26; 99% CI, 0.22–0.30), postpartum hemorrhage (aOR, 0.73; 99% CI, 0.65–0.83), operative vaginal birth (aOR, 0.85; 99% CI, 0.79–0.90), and obstetric anal sphincter injury (aOR, 0.90; 99% CI, 0.82–0.98). Odds were also decreased for the neonatal outcomes of neonatal intensive care unit admission for more than 24 hours (aOR, 0.71; 99% CI, 0.66–0.77) and respiratory distress syndrome (aOR, 0.64; 99% CI, 0.57–0.71). In an analysis stratified by obstetric volume, odds of cesarean delivery were lower for those with non–medically indicated induction in both medium- and high-volume hospitals (aORs, 0.86 [99% CI, 0.78–0.94] and 0.73 [99% CI, 0.69","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135963376","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":"Maternal Malignancy After Atypical Findings on Single-Nucleotide Polymorphism-Based Prenatal Cell-Free DNA Screening","authors":"Georgina Goldring, Cindy Trotter, Jeffrey T. Meltzer, Vivienne Souter, Lynn Pais, Wendy DiNonno, Wenbo Xu, Jeffrey N. Weitzel, Neeta L. Vora","doi":"10.1097/01.ogx.0000993676.90007.9c","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993676.90007.9c","url":null,"abstract":"ABSTRACT Technological advances in prenatal testing are allowing for earlier screening to detect fetal aneuploidies, infection, or abnormalities. Noninvasive tests in particular have enabled clinicians to screen early in pregnancy for conditions that severely affect fetal and neonatal outcomes (trisomies 21, 18, and 13, among others). Some of these methods rely on cell-free DNA (cfDNA) circulating in the maternal blood stream; although cfDNA can be released by the placenta, malignancy can be another cause for the release of cfDNA. The detection of such malignancies on noninvasive prenatal tests is rare but occurs. This study was designed to assess the incidence of cfDNA results indicating maternal malignancy and compare these findings to the existing literature. This was a retrospective cohort study, including data obtained from a commercial laboratory that performed single-nucleotide polymorphism (SNP)–based noninvasive prenatal screening between January 2015 and October 2021. Screenings were considered suggestive of malignancy if retrospective bioinformatics and SNP plots suggested multiple maternal copy number variants for at least 2 chromosomes; the laboratory returned these tests as fetal uninterpretable results. Of 2,004,428 samples included in the analysis, 38 (0.002%, or 1 in 52,748) were considered suggestive of malignancy. For 30 patients where follow-up was completed, health outcomes were analyzed for mother and child with maternal malignancy observed in 20 of them (66.7%). Six individuals had a preexisting diagnosis of cancer, 2 of which had a personal history of cancer but were thought to be in remission. Malignancies included lymphoma (10 patients), breast cancer (5 patients), and colon cancer (3 patients). Fetal outcomes for 15 of these patients were normal, with a few abnormal outcomes in the others; negative outcomes included fetal abnormality, multiple soft markers on prenatal ultrasound, and fetal growth restriction. Of the 10 patients without reported malignancy, 2 had identified fetal triploidy, 1 had maternal glomerulonephritis, and 1 had uterine leiomyomas. Of the original 30 patients with results suggestive of malignancy, 6 had no issues reported on follow-up. The findings reported in this study are similar to previous findings of maternal malignancy detected by noninvasive prenatal screenings. The prevalence of maternal malignancy identified in this study was lower than in previous studies, which estimated the prevalence to range from 1/2000 to 1/21,000. The percentage of patients with a confirmed malignancy after suspicious results in this study was 67% and has ranged from 8% to 73% in other studies. Some patients who had an identified malignancy were diagnosed as long as 11 months after the noninvasive prenatal screening; this indicates that longitudinal follow-up may result in higher rates of identified malignancy among those who have screening results suggestive of malignancy. Clinically, these findings highlight the ","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135963381","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":"Trial of a Patient-Directed eHealth Program to Ameliorate Perinatal Depression: The MomMoodBooster2 Practical Effectiveness Study","authors":"Brian G. Danaher, John R. Seeley, Richard K. Silver, Milagra S. Tyler, J. Jo Kim, Laura M. La Porte, Emily Cleveland, David R. Smith, Jeannette Milgrom, Jeff M. Gau","doi":"10.1097/ogx.0000000000001213","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001213","url":null,"abstract":"ABSTRACT Perinatal depression and postpartum depression represent a significant burden for those who experience them and are associated with preterm birth, low birth weight, postpartum hospitalization, diminished mother-child relationships, offspring developmental delay, and other important markers of health and well-being. Perinatal depression, in particular, is underidentified and thus undertreated. This study was designed to assess the MMB eHealth program (MomMoodBooster2 [MMB2]), which is targeted toward perinatal depression, with an aim to assess the effectiveness of the smartphone version of this tool. Primary outcomes were targeted toward analyzing the extent to which MMB2 relieved the severity of anxiety and depression symptoms in general (using both perinatal and postpartum tools); secondary outcomes focused on usage trends along with ratings of usability and helpfulness. Participants were recruited from the Perinatal Depression Program (PDP) in the NorthShore University HealthSystem. Eligibility criteria included pregnant women and women less than a year postpartum, age older than 18 years, no active suicidal ideation, access to internet, and English language proficiency. REDCap (Vanderbilt University Nashville, Tenn) was used for onboarding and randomization. Final analyses included 191 patients randomized into 2 groups, one with MMB2 and the PDP protocol and one with only PDP. After program completion, 93% of patients completed an associated posttest. Primary screenings were not significantly different between groups, and baseline characteristics were likewise consistent. Controlling for perinatal status, posttests showed a significant decrease in depression severity, anxiety, stress, and automatic thoughts ( P ≤ 0.001), as well as an increase in behavioral activation and self-efficacy. Further analysis showed that the MMB2 group showed greater decreases from baseline to posttest in both stress ( P = 0.019) and depression severity ( P = 0.003). No other significant effects were found when comparing the 2 groups. Usage of MMB2 varied, but generally showed that patients visited the program shortly after receiving the first invitation and then periodically on multiple distinct days between their first and last visit to their health care provider (mean [SD] visits, 49.4 [30.2] distinct days). Perinatal tools were used by 41% of participants, and 43% used postpartum tools, with 10% using both tools because of being pregnant at initial recruitment but delivering over the course of the study. The program included text messages for the first 12 weeks, and impact of these was not directly assessed. Of ratings provided, 96% rated the program as “somewhat” to “extremely” easy to use, and 83% of participants rated it as “somewhat” to “extremely” helpful. Many participants in both groups reported using other management strategies such as medication, therapy sessions, and physician advice, but use of these interventions did not differ between group","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136009764","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":"Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis","authors":"Tamara J. Oderkerk, Pleun Beelen, Ardy L. A. Bukkems, Sander M. J. van Kuijk, Hilde M. M. Sluijter, Mileen R. D. van de Kar, Malou C. Herman, Marlies Y. Bongers, Peggy M. A. J. Geomini","doi":"10.1097/ogx.0000000000001206","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001206","url":null,"abstract":"ABSTRACT A common gynecological problem for approximately 30% of women at reproductive age in European countries is heavy menstrual bleeding (HMB). Although hysterectomy is a highly successful treatment for this benign problem, it also risks serious complications due to its nature as a major operation. Less invasive HMB treatment options include insertion of a levonorgestrel-releasing intrauterine system, medical treatment (such as tranexamic acid and oral contraceptive pill), or endometrial ablation (which aims to destroy endometrial tissue and the superficial myometrium to reduce/stop menstrual bleeding). Endometrial ablation failure may result in the objective outcome of hysterectomy. This meta-analysis and review aimed to assess hysterectomy risk following nonresectoscopic endometrial ablation treatment to improve understanding and HMB patient counseling. Various nonresectoscopic ablation techniques versus their associated hysterectomy rates were investigated, and subgroup analyses were performed. Following a comprehensive and thorough search process of the MEDLINE, CENTRAL, and EMBASE databases, 53 articles ultimately met the inclusion criteria for inclusion in the systematic review. Between 1992 and 2017, in the included studies, 48,071 patients underwent endometrial ablation. A high risk of bias was found in 13 studies (mainly due to selection or reporting bias), whereas 12 studies maintained low risk of bias. However, exclusion of the 13 high-risk studies for a subgroup analysis yielded similar results to the original meta-analysis. Results of the analysis indicated a consistently increasing post–endometrial ablation hysterectomy, with 2% increments annually between 1 and 5 years following the procedure, rising to 4.3% after 1 year and 12.4% after 5 years. In 2 studies, a post–10-year follow-up found a mean hysterectomy rate of 21.3%. Between both various study designs and the different varieties of devices used, no major differences in hysterectomy rates were found, respectively. Limitations of the review include a high risk for heterogeneity found among studies in almost all analyses utilized by this analysis. Publication bias and methodological issues (variation of population size and study type) lent to the heterogeneity. Because of this variation, the authors performed analyses of subgroups with different study designs. In addition, of the 53 studies included, 15 of them included fewer than 50 participants, which was corrected in this analysis via an inverse variance. Overall, the study indicated that hysterectomy risk following endometrial ablation increases from 4.3% at the 1-year mark to 12.4% at the post–5-year mark. Neither differences in nonresectoscopic endometrial ablation techniques nor study design seemed to affect hysterectomy rates. This systematic review's data can be applied to clinical practice and used for counseling patients about hysterectomy risks within 5 years of endometrial ablation.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135963561","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 Surgical Wound Care in Obstetrics and Gynecology","authors":"Julia R. Salinaro, Penny S. Jones, Amelia B. Beatty, Sarah K. Dotters-Katz, Jeffrey A. Kuller, Nicole P. Kerner","doi":"10.1097/ogx.0000000000001204","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001204","url":null,"abstract":"Importance Obstetrics and gynecology (OB/GYN) accounts for at least half of all open abdominal surgeries performed. Rates of surgical wound complications after open procedures in OB/GYN range from 5% to 35%. Therefore, optimizing management of surgical wound complications has the potential to significantly reduce cost and morbidity. However, guidelines addressing best practices for wound care in OB/GYN are limited. Objective The objectives of this review are to describe the fundamentals of wound healing and to evaluate available evidence addressing surgical wound care. Based on these data, we provide recommendations for management of extrafascial surgical wound dehiscence after OB/GYN procedures. Evidence Acquisition Literature search was performed in PubMed, Medline, OVID, and the Cochrane database. Relevant guidelines, systematic reviews, and original research articles investigating mechanisms of wound healing, types of wound closure, and management of surgical wound complications were reviewed. Results Surgical wound complications in OB/GYN are associated with significant cost and morbidity. One of the most common complications is extrafascial dehiscence, which may occur in the setting of hematomas, seromas, or infection. Management includes early debridement and treatment of any underlying infection until healthy granulation tissue is present. For wounds healing by secondary intention, advanced moisture retentive dressings reduce time to healing and are cost-effective when compared with conventional wet-to-dry gauze dressings. Negative pressure wound therapy can be applied to deeper wounds healing by secondary intention. Review of published evidence also supports the use of delayed reclosure to expedite wound healing for select patients. Conclusions Optimizing surgical wound care has the potential to reduce the cost and morbidity associated with surgical wound complications in OB/GYN. Advanced moisture retentive dressings should be considered for wounds healing by secondary intention. Data support delayed reclosure for select patients, although further studies are needed. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After reading this article, the provider will be better able to explain the clinical significance of surgical wound complications, particularly in OB/GYN; identify the stages of wound healing and types of wound closure; discuss the TIME framework for wound care; and describe a recommended approach for the management of extrafascial wound dehiscence.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136009208","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":"Pain With Differing Insufflation Pressures During Robotic Sacrocolpopexy: A Randomized Controlled Trial","authors":"Gabriella M. Rustia, Michael G. Baracy, Emilee Khair, Karen H. Hagglund, Muhammad Faisal Aslam","doi":"10.1097/01.ogx.0000993684.04252.86","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993684.04252.86","url":null,"abstract":"ABSTRACT Pain after surgery may have different origins, such as incisions, affected viscera, surgical positioning, or peritoneal irritation from insufflation. Shoulder pain after gynecological laparoscopic surgery is a common concern thought to be associated with peritoneal irritation. Decreasing this pain is therefore a target for improvement of analgesic requirements and overall postoperative pain. This study aimed to determine changes in postoperative pain, surgical safety, and analgesic use via decreased insufflation pressures. The study was designed as a single-blinded, randomized clinical trial at a singular medical center within the United States where surgical treatment took place for pelvic organ prolapse via robotic-assisted sacrocolpopexy. Included were women 18 years or older who were able to complete the visual analog scale without assistance and who underwent scheduled robotic-assisted sacrocolpopexy. After inclusion, participants were randomized in a 1:1 ratio to undergo robotic-assisted sacrocolpopexy with peritoneal insufflation pressure at either 12 mm Hg (experimental) or 15 mm Hg (standard). Surgeries were performed by a single board-certified urogynecologist and resident assistant using a standard technique, the DaVinci Xi system, and an 8-mm AirSeal assist port. Surgeons and assisting OR professionals were not blinded to insufflation pressure. On the first postoperative day, all participants were asked to rate pain via a visual analog scale, as well as at 2 weeks postoperatively (with the addition of a PGI-I questionnaire). The 2-week surveys were collected by the principal investigator or primary surgeon (unblinded). A Likert scale of 0 to 10 was used to rate the highest preoperative and postoperative pain in the postanesthesia care unit. At the time of surgery, preoperative analgesia and opioid use were verified with active prescription records. After surgery, data were recorded for operative time, analgesic doses, conversion to laparotomy or increased insufflation pressure, additionally performed procedures, estimated blood loss, and length of stay. Enrollment occurred from April 27, 2021, to May 17, 2022, with final follow-up being completed on June 1, 2022. A total of 80 participants were enrolled, with 41 in the experimental insufflation group, and 39 in the standard insufflation group. Baseline differences did not exist between groups for prior abdominal surgeries, medical comorbidities, leading edge of prolapse, age, or body mass index. Although median preoperative pain was recorded as zero for both groups, the standard insufflation group did report a statistically higher pain level in the postoperative period. Furthermore, women in the experimental/lower insufflation group used statistically fewer morphine milliequivalents immediately after surgery as well as after discharge. There were no apparent operative problems significantly associated with lower insufflation pressures, as operative time, estimated blood loss,","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010003","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":"Executive Summary of the Ovarian Cancer Evidence Review Conference","authors":"William Burke, Joel Barkley, Emily Barrows, Rebecca Brooks, Kimberly Gecsi, Kathryn Huber-Keener, Myrlene Jeudy, Shirley Mei, Julia Sage O’Hara, David Chelmow","doi":"10.1097/01.ogx.0000993692.30944.ce","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993692.30944.ce","url":null,"abstract":"ABSTRACT Ovarian cancer has the 17th highest incidence among all cancers in the United States; however, it is the deadliest gynecologic cancer and the fifth most common cause of cancer-related death in women in the United States. The Centers for Disease Control and Prevention funded the American College of Obstetricians and Gynecologists (ACOG) to create educational materials for clinicians on the early diagnosis and prevention of gynecologic cancers. This article is an evidence summary based on ACOG's extensive literature review on the early diagnosis and prevention of ovarian cancer. An expert panel was recruited from the Society for Academic Specialists in General Obstetrics and Gynecology and the Society of Gynecologic Oncology to review and summarize evidence from articles published between January 2000 and October 2021. Topics used to frame the literature review included the epidemiology of ovarian cancer, risk factors, prevention and risk reduction, screening strategies and early detection, health disparities, diagnosis and care coordination by primary care providers, and special considerations. The Ovarian Cancer Evidence Review Conference occurred in February 2022 where the expert panel and stakeholder professional and patient advocacy organizations discussed their findings and drafted summaries to develop educational materials. Review of the epidemiology revealed that in 2022 there were 19,880 new cases of ovarian cancer, 12,810 women died of ovarian cancer, 5-year survival is 49.7% and correlates strongly with stage at diagnosis, and fewer than 10% of women with stage 1 disease will have recurrence. Risk factors for ovarian cancer include older age, inactivity, nulliparity, early menarche, late menopause, postmenopausal hormone therapy, genetic mutations such as BRCA1 and BRCA2 , and endometriosis. Risk-reducing bilateral salpingo-oophorectomy reduces incidence of ovarian cancer by 80% in BRCA1 and BRCA2 carriers (95% confidence interval, 0.12–0.39) and is recommended by ACOG for women at increased risk of ovarian cancer. Contraception, physical activity, and lactation may help reduce the risk of ovarian cancer. The most common methods studied for screening include transvaginal ultrasonography, bimanual palpation, and measuring tumor marker CA-125. The Risk of Ovarian Cancer Algorithm uses CA-125 and transvaginal ultrasound to estimate the risk of ovarian cancer based on age and change in CA-125; however, it is still being studied, and no established screening method exists for asymptomatic women. Several organizations including ACOG support identifying women at high risk and subsequent genetic counseling. Symptoms of ovarian cancer are nonspecific and include abdominal distention and pain, and while workup should include ultrasonography and CA-125 measurement, no high-quality studies have compared imaging, biomarkers, risk algorithms, or multimodal risk assessment tools for the primary evaluation of patients with high-risk symptoms. R","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010152","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":"Individual and Family Determinants for Quality of Life in Parents of Children With Inborn Errors of Metabolism Requiring a Restricted Diet: A Multilevel Analysis Approach","authors":"Abdoulaye Ouattara, Noemie Resseguier, Aline Cano, Pascale de Lonlay, Jean-Baptiste Arnoux, Anais Brassier, Manuel Schiff, Samia Pichard, Alexandre Fabre, Celia Hoebeke, Nathalie Guffon, Alain Fouilhoux, Pierre Broué, Guy Touati, Dries Dobbelaere, Karine Mention, Francois Labarthe, Marine Tardieu, Loïc de Parscau, Francois Feillet, Chrystele Bonnemains, Alice Kuster, Philippe Labrune, Magalie Barth, Lena Damaj, Delphine Lamireau, Julie Berbis, Pascal Auquier, Brigitte Chabrol","doi":"10.1097/01.ogx.0000979660.79986.29","DOIUrl":"https://doi.org/10.1097/01.ogx.0000979660.79986.29","url":null,"abstract":"ABSTRACT Inborn errors of metabolism (IEMs) requiring a restricted diet can have a significant impact on both children and their caregivers. Previous research has shown conflicting findings in the quality of life (QoL) of caregivers specifically, as many factors can influence daily interactions: home care demands, the potential for acute health crises and hospitalization, dietary constraints, medications, and others. Influencing factors have previously been reported to include emotional, adaptive, and socioeconomic factors, and previous research has varied greatly in sample characteristics, methods of collecting data and measuring QoL, and methods of analysis. This study was performed to clarify previous findings and provide a clearer picture of QoL in parents of children with IEMs requiring a restricted diet compared with the general population based on parent self-report. The final analysis included 785 parents of 578 children with IEMs requiring a restricted diet. Quality of life was assessed using the World Health Organization Quality of Life–BREF and was compared with age- and sex-matched control subjects from the general population. Parents of children with IEMs requiring a restricted diet in this study population experienced a significantly lower QoL in the areas of physical health (mean, −6.09 [SD, 15.01]) and social relationships (mean, −6.82 [SD, 17.71]), as well as a significantly higher QoL in psychological health (mean, +3.10 [SD, 14.25]). Multivariate models were examined to determine factors responsible for these differences in QoL; parental anxiety was negatively associated with all QoL domains. Other factors negatively associated with at least 1 domain included being a father (physical health and social relationships), older parent (physical and psychological health), having an education higher than high school (psychological health), and using more social support–seeking coping strategies (physical health and environment). Factors positively associated with at least 1 domain included having an education level higher than high school (environment), being a working parent (physical and psychological health, environment), and using more positive thinking coping strategies (psychological health). Child-related factors negatively associated with parental QoL included having at least 1 disease complication (social relationships and environment) and a higher number of hospital medical providers (physical health). A child being older positively impacted parental QoL in the environment domain. It is not uncommon for parents of children with chronic diseases or impairments to experience a lower QoL. In this study, some aspects of QoL were enhanced by the demands of caregiving, and some were negatively impacted. Discrepancies in previous literature may be partially attributed to varying tests, variable characteristics within a sample (eg, longer time since diagnosis), or differences in analysis methods. The results in this study indicate a","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388490","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":"Changing Practices in the Surgical Management of Adnexal Torsion: An Analysis of the National Surgical Quality Improvement Program Database","authors":"Hannah T. Ryles, Christopher X. Hong, Uduak U. Andy, Monique R. Farrow","doi":"10.1097/ogx.0000000000001195","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001195","url":null,"abstract":"ABSTRACT Ovarian torsion occurs when the ovary twists on its own supporting ligaments, resulting in ischemia and possible necrosis. This is a surgical emergency to restore adnexal perfusion, and even in the setting of a necrotic-appearing ovary, conservative management with detorsion alone does not increase postoperative complications compared with oophorectomy. Traditionally, oophorectomy was performed in these cases, and despite the new evidence supporting ovarian conservation, oophorectomy remains common. Despite updated guidelines by the American College of Obstetricians and Gynecologists (ACOG) in 2016, it is unclear to what extent practice patterns have changed in the years since. This retrospective cohort study aimed to describe the trend in surgical management of ovarian torsion between 2008 and 2020 and to describe the changes in management before and after the publication of the updated ACOG guidelines. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify women aged 18 to 50 years who underwent surgery for adnexal torsion between 2008 and 2020. Patients were classified as having undergone oophorectomy or ovarian conservation using ICD codes, and patients undergoing concurrent surgeries or procedures related to pregnancy or unrelated to adnexal torsion were excluded. Patients were then grouped into pre-ACOG guidelines (2008–2016) and post-ACOG guidelines (2017–2020). Patient demographics, clinical data, perioperative characteristics, and 30-day postoperative adverse events were queried and compared between year cohorts and surgical management groups. The primary outcome was proportion of oophorectomies, described as the number of oophorectomies over the total number of all torsion surgeries per year, with a 95% confidence interval (CI). Multivariable regression analysis was conducted to determine the odds of oophorectomy versus ovarian conservation between year cohorts while controlling for confounders. A total of 1791 patients were included in this study, with 402 (22.4%) in the 2008–2016 cohort and 1389 (77.6%) in the 2017–2020 cohort. Across both groups, 542 patients (30.3%) underwent ovarian conservation, and 1249 (69.7%) underwent oophorectomy. The overall proportion of oophorectomies was similar between the 2008–2016 and 2017–2020 cohorts (71.9% vs 69.1%; adjusted odds ratio, 0.94; 95% CI, 0.71–1.25). When evaluating the effects of time on odds of oophorectomy, a significant decrease in the odds of oophorectomy performed successively each year over the entire study period was found (average decrease, −1.6%/year; 95% CI, −3.0% to −0.22%), although the yearly successive decrease in the odds of oophorectomy remained similar before and after 2017. The median hospital length of stay was longer, and the hospital admission rates were high in the oophorectomy group compared with the ovarian conservation group. The results of this study demonstrate that 69.7% of surgeries for a","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388492","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}