Obstetrics and gynecology最新文献

{"title":"ACOG Committee Statement No. 22: Anticipatory Counseling Regarding Ovarian-Factor Fertility Decline.","authors":"","doi":"10.1097/aog.0000000000006078","DOIUrl":"https://doi.org/10.1097/aog.0000000000006078","url":null,"abstract":"Fertility, or the capacity to produce a child, declines with age as the ovaries undergo a natural decrease in follicle count related to oocyte atresia. However, patients significantly overestimate the likelihood of pregnancy at all ages. It is important that health care professionals educate patients regarding the natural decline in ovarian reserve and quality of egg follicles throughout their reproductive lifespans. Patients who are interested in becoming pregnant also should be educated on non-age-related factors that may accelerate ovarian decline to optimize and more completely understand their reproductive health and family-building opportunities. Despite the existence of resources on ovarian decline and non-age-related factors affecting fertility, more evidence-based resources on ovarian decline are needed for both patients and health care professionals.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"11 1","pages":"e98-e104"},"PeriodicalIF":7.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female Sexual Function and Dysfunction.","authors":"Maya V Roytman, Rebecca L Barnett, Rachel S Rubin","doi":"10.1097/AOG.0000000000006073","DOIUrl":"10.1097/AOG.0000000000006073","url":null,"abstract":"<p><p>Female sexual function and dysfunction is an often-overlooked component within clinical visits. Female sexual disorders are classified by the International Society for the Study of Women's Sexual Health and Fourth International Consultation on Sexual Medicine along the following categories: hypoactive sexual desire disorder, female sexual arousal disorder, female orgasm disorder, and genitopelvic pain disorder. Although more attention has been given to sexual health and developing options for treating dysfunction in recent years, significant knowledge gaps remain in addressing sexual health concerns as part of patient-centered care. Assessing female sexual function consists of obtaining a comprehensive clinical history and performing a thorough physical examination of the pelvic floor and vulvovaginal anatomy. Causes of sexual dysfunction include biologic, psychologic, interpersonal, and sociocultural risk factors. A nuanced approach incorporating evidence-based guidelines and tailored treatment plans that align with the patient's personal goals helps optimize patient sexual health outcomes.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"645-659"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine Transposition for Fertility Preservation and Ovarian Conservation in Patients Undergoing Pelvic Radiotherapy.","authors":"Shant Apelian, Adriana Vest, Maya Yasukawa, Jody Wellcome, Adrian Kohut, Anthony N Imudia, Richard Tuli, Matthew L Anderson, Thomas Rutherford, Vaagn Andikyan","doi":"10.1097/AOG.0000000000005954","DOIUrl":"10.1097/AOG.0000000000005954","url":null,"abstract":"<p><p>Because pelvic malignancies and their treatments often compromise reproductive potential, the need for effective fertility preserving strategies has become increasingly important. Although traditional options offer varying success, most do not aim to maintain uterine reproductive function. Uterine transposition is an innovative surgical technique designed to preserve fertility by safeguarding both the uterus and ovaries in patients undergoing pelvic radiotherapy. This approach involves temporarily repositioning the uterus and ovaries outside the radiation field, with reimplantation after treatment. Since its first successful use in 2015, uterine transposition has been used across different types of cancer and age groups, including prepubertal patients. Early clinical outcomes have been promising, with high rates of ovarian function preservation, menstrual resumption, and successful pregnancies, including spontaneous fertilizations. Additionally, the procedure has demonstrated an acceptable safety profile, with most complications being minor and manageable, although concerns remain regarding uterine ischemia and vascular integrity postreimplantation. The overall findings support its potential as a viable fertility preserving option. However, further research is necessary to refine patient selection, evaluate long-term reproductive outcomes and complications, and address challenges related to uterine perfusion and implantation.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"679-689"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgender Vulvar and Clitoral Anatomy: A Guide for Gynecologists.","authors":"Sara Rahman, Cecile A Ferrando","doi":"10.1097/AOG.0000000000005973","DOIUrl":"10.1097/AOG.0000000000005973","url":null,"abstract":"<p><strong>Background: </strong>It is important for gynecologists to understand postoperative anatomy to provide inclusive and competent care to patients who have undergone gender-affirming vaginoplasty. The neoclitoris and neovula differ from cisgender anatomy. This article and associated video address these knowledge gaps to enhance gynecologic care for transgender patients.</p><p><strong>Technique: </strong>We review the steps of penile inversion vaginoplasty, focusing on the creation of the neoclitoris and neovulva. The key differences and similarities between cisgender and transgender clitoral anatomy are highlighted. A detailed examinator of the neurovascular components emphasizes their role in sensation and function.</p><p><strong>Experience: </strong>The senior author, a board-certified urogynecologist, has performed nearly 300 vulvoplasty and vaginoplasty procedures. Many transgender patients face barriers to competent gynecologic care. We created this video to bridge those gaps by enhancing gynecologist's understanding of gender-affirming surgery and postoperative anatomy.</p><p><strong>Conclusion: </strong>A thorough understanding of transgender anatomy and function enables gynecologists to provide high-quality care in an inclusive and supportive environment.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"758-763"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence and Gynecologic Surgery.","authors":"Grace M Pipes, Andrew J Hung, Kenneth H Kim","doi":"10.1097/AOG.0000000000006052","DOIUrl":"10.1097/AOG.0000000000006052","url":null,"abstract":"<p><p>Artificial intelligence (AI) has the potential to revolutionize health care. Within obstetrics and gynecology, it has proven to be useful for diagnostics and outcome predictions, particularly within maternal-fetal medicine and reproductive endocrinology and infertility. Artificial intelligence also has been used to harness the massive data sets produced by surgery, particularly robotic-assisted surgery, that are difficult to interpret with traditional statistical methods. Gynecologic surgery is a burgeoning area for AI application to improve the field's surgical outcomes through preoperative planning, intraoperative guidance, and training and credentialing. With a promising future, we must address limitations of current studies such as small data sets and lack of standardization of data collection as well as present mechanisms of explainability to ensure patient safety. In a rapidly evolving field, this narrative review summarizes the current literature on AI application to gynecologic surgery.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"672-678"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACOG Clinical Practice Update: Elimination of the DATA-Waiver Program.","authors":"","doi":"10.1097/AOG.0000000000006066","DOIUrl":"10.1097/AOG.0000000000006066","url":null,"abstract":"<p><p>This Clinical Practice Update provides revised guidance related to an update to the requirements related to the elimination of the DATA-Waiver program. This document is a focused update of related content in Committee Opinion No. 711, Opioid Use and Opioid Use Disorder in Pregnancy (Obstet Gynecol 2017;130:e81-94).</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e105-e108"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's Hot in Gynecologic Surgery Circa 2025.","authors":"Cheryl B Iglesia,Kenneth H Kim,Cara R King","doi":"10.1097/aog.0000000000006089","DOIUrl":"https://doi.org/10.1097/aog.0000000000006089","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"101 1","pages":"613-614"},"PeriodicalIF":7.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Counseling Tool for Returning to Sexual Activity After Pelvic Reconstructive Surgery.","authors":"Lauren Caldwell, Shunaha Kim-Fine, Danielle D Antosh, Katherine Husk, Kate V Meriwether, Jaime B Long, Christine A Heisler, Patricia L Hudson, Svjetlana Lozo, Shilpa Iyer, Emily E Weber LeBrun, Rebecca G Rogers","doi":"10.1097/AOG.0000000000005938","DOIUrl":"10.1097/AOG.0000000000005938","url":null,"abstract":"<p><strong>Objective: </strong>To create a standardized counseling tool for return to sexual activity after pelvic reconstructive surgery.</p><p><strong>Methods: </strong>An expert panel created an initial counseling tool based on the conceptual framework previously developed in a rigorous qualitative analysis of women's experience of their first sexual encounters after pelvic reconstructive surgery. This instrument was then refined through cognitive patient interviews. Women who had previously undergone reconstructive surgery for pelvic organ prolapse or urinary incontinence and returned to sexual activity were recruited from four clinical sites across the United States and Canada for participation in cognitive interviews. Participants reviewed proposed counseling statements and were asked to describe their meaning, suggest any necessary changes, and rate their importance. Summaries of the ongoing cognitive interviews were periodically presented to the working group for discussion, and the instrument was revised accordingly. Interviews were conducted until no new substantive comments were made.</p><p><strong>Results: </strong>Nineteen cognitive patient interviews were conducted, and three rounds of modifications were made to the initial counseling tool. Modifications included merging multiple counseling statements to avoid redundancy and eliminating statements that were not considered important by patients. Patients consistently rated statements about the safety of resuming intercourse and anticipated discomfort with initial sexual encounters as very important.</p><p><strong>Conclusion: </strong>We developed a novel, patient-centered counseling tool for the return to sexual activity after pelvic reconstructive surgery using a previously established conceptual framework and cognitive patient interviews. It addresses an important surgical outcome for patients and offers surgeons a concise, high-value counseling tool.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e80-e84"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Living Donor Uterus Transplantation.","authors":"Masato Tamate, Giuliano Testa, Laura Divine, Johanna Bayer, Liza Johannesson","doi":"10.1097/AOG.0000000000005987","DOIUrl":"10.1097/AOG.0000000000005987","url":null,"abstract":"<p><strong>Background: </strong>For women with absolute uterine factor infertility, uterus transplantation represents the closest solution to normal gestation and delivery. It is a temporary transplant; the uterine graft is removed after completion of childbearing. The uterus transplant journey involves multiple surgical and medical steps.</p><p><strong>Technique: </strong>The surgical steps include living or deceased donor hysterectomy, transplant of the uterine graft, cesarean delivery, and graft hysterectomy. The medical steps include immunosuppressive treatment, in vitro fertilization, and pregnancy. In this video, we show a living donor uterus transplant, including donor hysterectomy, back-table preparation of the uterine graft, and recipient transplant surgery. The video highlights the surgical steps of the procedure.</p><p><strong>Experience: </strong>Between September 2016 and January 2025, 36 women underwent uterus transplantation at Baylor University Medical Center, resulting in the birth of 26 children to date.</p><p><strong>Conclusion: </strong>Uterus transplantation is associated with successful births of healthy children.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"764-768"},"PeriodicalIF":4.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Review and Meta-analysis.","authors":"Yannay Khaikin,Praniya Elangainesan,Eliot Winkler,Kuan Liu,Amanda Selk,Mark H Yudin","doi":"10.1097/aog.0000000000006092","DOIUrl":"https://doi.org/10.1097/aog.0000000000006092","url":null,"abstract":"OBJECTIVETo evaluate the effectiveness of intravaginal vitamin C in the treatment and prevention of bacterial vaginosis compared with control or antibiotics.DATA SOURCESElectronic databases (MEDLINE, EMBASE, Cumulated Index in Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials), Google Scholar, clinical trial registries, and gray literature were searched for articles in any language from inception to May 2025.METHOD OF STUDY SELECTIONWe included randomized trials involving nonpregnant patients and intravaginal vitamin C as treatment for acute bacterial vaginosis or prevention of recurrence. Covidence software was used for study screening.TABULATION, INTEGRATION, AND RESULTSRisk of bias was assessed with the Cochrane Risk of Bias 2 tool. The primary outcome was clinical or microbiologic cure or recurrence. Results were reported as risk ratios (RRs) with 95% CIs. Certainty in conclusions was reported with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Nine trials (n=1,107) were included. Eight evaluated primary treatment of bacterial vaginosis, with a maximum follow-up of 30 days. Most trials used a vitamin C dose of 250 mg daily for 6 days. Among these trials, four compared vitamin C with control (placebo or no treatment) and four with metronidazole. Only one trial, comparing vitamin C with placebo, assessed prevention of recurrence after antibiotic cure. We found a higher proportion of short-term cure (1-3 weeks) in the vitamin C group compared with control (66% vs 42%, RR 1.57, 95% CI, 1.03-2.39; low-certainty evidence) and metronidazole (62% vs 52%, RR 1.20, 95% CI, 1.03-1.41; very low-certainty evidence). Recurrence of bacterial vaginosis was lower in the vitamin C group compared with the placebo group at 6 months (16% vs 32%, RR 0.50, 95% CI, 0.27-0.93; low-certainty evidence).CONCLUSIONTreatment with intravaginal vitamin C (250 mg daily for at least 6 days) may increase cure for bacterial vaginosis in the short term and may prevent recurrence; however, additional randomized trials are needed, particularly to evaluate recurrence beyond 1 month.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42024611533.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"13 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}