Obstetrics and gynecology最新文献

{"title":"Tailored Prenatal Care Delivery for Pregnant Individuals: ACOG Clinical Consensus No. 8.","authors":"","doi":"10.1097/aog.0000000000005889","DOIUrl":"https://doi.org/10.1097/aog.0000000000005889","url":null,"abstract":"Prenatal care is one of the most common preventive services in the United States; it is designed to improve the health and well-being of pregnant and birthing individuals and their children through evidence-based services. Despite the prevalence of prenatal care, formalized models of prenatal care delivery have changed little since they were first published in 1930. The purpose of this Clinical Consensus document is to offer guidance on a transformative approach to the provision of prenatal care in three key areas: 1) addressing unmet social needs, 2) frequency of prenatal visits and monitoring, and 3) incorporation of telemedicine and alternative care modalities. Implementing a sustainable paradigm shift in a century-old care-delivery approach will take time; however, this document will guide maternity care professionals and their teams in the use of new prenatal care delivery models.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"38 1","pages":"565-577"},"PeriodicalIF":7.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849565","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":"Quality-Improvement Strategies for Safe Reduction of Primary Cesarean Birth: ACOG Committee Statement No. 17.","authors":"","doi":"10.1097/aog.0000000000005888","DOIUrl":"https://doi.org/10.1097/aog.0000000000005888","url":null,"abstract":"The nulliparous, term, singleton, vertex (NTSV) cesarean birth rate is a metric that may be used to evaluate obstetric care and compare performance across similar hospitals and regions. Safe reduction of primary cesarean birth prevents the need for future cesarean births and associated maternal morbidity risk. Quality-improvement methodologies such as optimizing culture of care; practice environment; data collection and monitoring, including monitoring of data by race and ethnicity; and proactive management and planning for known and unanticipated drivers of cesarean birth may safely reduce NTSV cesarean birth rates. Obstetrician-gynecologists should engage with patients in informed decision making, informed consent, and birth preference conversations, particularly related to induction of labor and cesarean birth, to support equitable and respectful obstetric care and outcomes related to NTSV cesarean birth.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"17 1","pages":"542-552"},"PeriodicalIF":7.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849564","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":"Access to Obstetric and Gynecologic Care for Patients With Disabilities: ACOG Committee Statement No. 18.","authors":"","doi":"10.1097/aog.0000000000005879","DOIUrl":"https://doi.org/10.1097/aog.0000000000005879","url":null,"abstract":"Although the Americans with Disabilities Act has been the law for more than 30 years, individuals with disabilities still face substantial barriers to health care and are at higher risk of receiving inadequate care than those without disabilities. It is important that obstetrician-gynecologists are aware of best practices for caring for their patients with disabilities, as well as how to adjust their offices, workflows, and practice patterns to be inclusive of all patients. Obstetrician-gynecologists and other reproductive health care professionals should understand the barriers that prevent disabled people from accessing reproductive health care. This is critical in identifying inequities and informing patient-centered approaches to services. Patients with disabilities should have access to the same health care as all patients, including all age-appropriate screening tests. It is important that health care teams acknowledge their inherent biases and offer and facilitate access to appropriate care, including recommended screening tests. Increasing training and exposure to individuals with different disabilities during medical training programs will not only help improve the lack of experience, but also help challenge the implicit and explicit biases that currently exist in health care.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"13 1","pages":"553-563"},"PeriodicalIF":7.2,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849566","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":"A Tribute to James (Jim) R. Scott, MD (1937-2025).","authors":"Robert M Silver","doi":"10.1097/aog.0000000000005962","DOIUrl":"https://doi.org/10.1097/aog.0000000000005962","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"48 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926331","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":"Cardiovascular Disease After Hysterectomy in the Nurses' Health Study and Nurses' Health Study II.","authors":"Viengneesee Thao,Bijan Borah,Elizabeth A Stewart,Leslie V Farland,Shannon K Laughlin-Tommaso,Zaraq Khan,Thais D Coutinho,Sarah L Cohen Rassier","doi":"10.1097/aog.0000000000005902","DOIUrl":"https://doi.org/10.1097/aog.0000000000005902","url":null,"abstract":"OBJECTIVETo examine long-term risk of cardiovascular disease (CVD) after undergoing hysterectomy with or without oophorectomy.METHODSParticipants in the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHS II) (N=239,907) were grouped based on history of no surgery, hysterectomy alone, or hysterectomy with bilateral oophorectomy, and further categorized by use or nonuse of estrogen. The primary outcome was the risk of CVD (combined incidence of fatal and nonfatal myocardial infarction, coronary artery bypass graft and stroke) among the groups. Data were analyzed by multivariable Cox proportional hazards model, stratified by age to estimate adjusted hazard ratios (aHRs). Models controlled for menopausal hormone therapy as well as race, marital status, family income, personal and family history of relevant health conditions, alcohol consumption, physical activity, healthy eating index, body mass index (BMI), and parity.RESULTSAfter pooling the NHS and NHS II participants, the risk of CVD was higher among all participants who had hysterectomy before age 50 years compared with no surgery. Specifically, those who underwent hysterectomy before age 46 years and did not use estrogen had a 21.0% increased risk of CVD compared with no surgery (aHR 1.21, 95% CI, 1.04-1.40). Furthermore, among estrogen users who had hysterectomy and bilateral oophorectomy, those from the youngest two age groups (younger than 46 years and 46-50 years) had higher risk of CVD (aHR 1.26, 95% CI, 1.16-1.37; aHR 1.11, 95% CI, 1.01-1.22, respectively) compared with no surgery. Non-estrogen users who had hysterectomy with bilateral oophorectomy from all but the oldest age group (older than 60 years) experienced higher risk of CVD compared with no surgery.CONCLUSIONYounger age at time of hysterectomy, with or without oophorectomy, is associated with higher risk of CVD. Notably, use of estrogen does not appear to mitigate deleterious effects of hysterectomy with oophorectomy before age 50 years.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"26 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143926338","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":"Coronavirus Disease 2019 (COVID-19) Vaccination and Spontaneous Abortion.","authors":"Sangini S Sheth,Gabriela Vazquez-Benitez,Malini B DeSilva,Jingyi Zhu,Elisabeth M Seburg,Anna E Denoble,Matthew F Daley,Darios Getahun,Nicola P Klein,Kimberly K Vesco,Stephanie A Irving,Jennifer C Nelson,Joshua T B Williams,Simon J Hambidge,James G Donahue,Heather S Lipkind,Elyse O Kharbanda","doi":"10.1097/aog.0000000000005904","DOIUrl":"https://doi.org/10.1097/aog.0000000000005904","url":null,"abstract":"OBJECTIVETo examine the association between coronavirus disease 2019 (COVID-19) vaccination and spontaneous abortion.METHODSWe conducted a case-control study of clinically adjudicated spontaneous abortions (case group) occurring between January 19, 2021, and October 27, 2021, and live births (control group). Patients aged 16-49 years at eight Vaccine Safety Datalink sites who had singleton pregnancies, one or more prenatal visits, continuous health plan enrollment, and spontaneous abortion (fetal loss between 6 and less than 20 weeks of gestation) or live birth were eligible. A random sample of eligible patients with spontaneous abortions was adjudicated to confirm pregnancy outcome, outcome date, and gestational age at fetal death; patients in the adjudicated spontaneous abortion case group were matched 1:2 on Vaccine Safety Datalink site, maternal age, and pregnancy start date with eligible patients with live births. Vaccine exposure was considered from pregnancy start to spontaneous abortion date or equivalent gestational age for the matched live births (index date). Conditional logistic regression was used to evaluate the association between COVID-19 vaccination in pregnancy and spontaneous abortion; secondary analyses explored associations by dose number, vaccine manufacturer, and vaccination within 6 weeks of the spontaneous abortion.RESULTSMatched analyses included 296 patients in the spontaneous abortion case group and 592 in the live birth control group. There was no association between spontaneous abortion and COVID-19 vaccination (adjusted odds ratio [aOR] 0.85, 95% CI, 0.56-1.30). There was also no association between spontaneous abortion and dose number compared with no vaccine (one dose: aOR 0.81, 95% CI, 0.39-1.70; two doses: aOR 0.84, 95% CI, 0.51-1.38; vaccine manufacturer: Moderna aOR 0.59, 95% CI, 0.29-1.19 and Pfizer-BioNTech aOR 0.97, 95% CI, 0.57-1.66; or vaccine exposure window of 6 weeks before spontaneous abortion or index date: aOR 0.87, 95% CI, 0.53-1.44).CONCLUSIONThere was no observed association between COVID-19 vaccination in pregnancy and spontaneous abortion. Findings support the safety of COVID-19 vaccination in early pregnancy.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"23 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902968","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":"Placenta Accreta Spectrum, Present and Future: The Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop Summary.","authors":"Christina M Duzyj,Brett D Einerson,Yalda Afshar,Karin A Fox,Antonio F Saad,Daniela A Carusi,Christina L Herrera,Deirdre J Lyell,Alfred Z Abuhamad,Michaela K Farber,Anne C Roberts,Sebastian R Hobson,Loic Sentilhes,Baha M Sibai,Koji Matsuo,Kristen Terlizzi,Scott A Shainker,Robert M Silver,Helena C Bartels,Thomas D Shipp,Marilyn Huang,Alison G Cahill,Jason D Wright,George R Saade,Monica Longo","doi":"10.1097/aog.0000000000005929","DOIUrl":"https://doi.org/10.1097/aog.0000000000005929","url":null,"abstract":"Placenta accreta spectrum (PAS) disorder poses significant risks to maternal health, given the complexities of screening, diagnosis, and management. To address these challenges, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) hosted a workshop on June 10-11, 2024, bringing together expert health care professionals, researchers, stakeholders, and patient advocates to identify knowledge gaps, with an overarching goal of informing future research and best practices for PAS. Key discussions revolved around the resources and infrastructure needed to advance screening, diagnosis, and clinical management of PAS, alongside ways to enhance collaboration across disciplines. Participants considered strategies to optimize existing research resources and explored opportunities to strengthen partnerships between the NICHD and key stakeholders to achieve mutual objectives. The workshop-attended by representatives from the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Pan-American Society for the Placenta Accreta Spectrum, the National Accreta Foundation, the American Institute of Ultrasound in Medicine, and the Society of Gynecologic Oncology-aimed to foster consensus on essential PAS topics and to identify clinical and research priorities in all phases of PAS care. Additionally, a critical focus of the workshop was to enhance understanding of patient experiences and needs, recognizing that patient perspectives are essential for informing future research and improving outcomes.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"58 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902983","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":"Follow-Up After Treatment for Cervical Precancers: Prevention Is Ongoing.","authors":"Michelle J Khan","doi":"10.1097/aog.0000000000005892","DOIUrl":"https://doi.org/10.1097/aog.0000000000005892","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"31 1","pages":"458-460"},"PeriodicalIF":7.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849550","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":"Leaving Placenta In Situ for Management of Placenta Accreta Spectrum Disorder.","authors":"Farah H Amro,Edgar A Hernandez-Andrade,Ramesha Papanna,Sarah T Mehl,Elias Kassir,Eleazar E Soto-Torres,Han-Yang Chen,Abigail S Zamorano,Rosa A Guerra,Sean C Blackwell,Baha M Sibai","doi":"10.1097/aog.0000000000005926","DOIUrl":"https://doi.org/10.1097/aog.0000000000005926","url":null,"abstract":"OBJECTIVETo evaluate maternal outcomes when leaving the placenta in situ for placenta accreta spectrum (PAS) according to planned surgical management.METHODSWe conducted a single-center retrospective cohort study of patients with PAS managed by leaving the placenta in situ from January 2015 to October 2024. At our center, patients are given options other than cesarean hysterectomy for the management of PAS. These include leaving the placenta in situ for either planned uterine preservation or planned delayed hysterectomy. We analyzed maternal outcomes with leaving the placenta in situ, including risk of infection, significant bleeding resulting in hysterectomy, blood transfusion rates, and serious maternal morbidity. We also analyzed outcomes according to planned procedure (uterine preservation or delayed hysterectomy) and final procedure performed (successful uterine preservation or interval hysterectomy).RESULTSOf 180 patients with antenatal diagnosis of PAS, 50 were planned for leaving the placenta in situ: seven (14%) underwent cesarean hysterectomy because of antepartum or intraoperative hemorrhage, and 43 (86%) were managed by leaving the placenta in situ. In the 43 managed with leaving the placenta in situ, five (12%) had bleeding necessitating a hysterectomy, and four (9%) had endometritis. There were no cases of venous thromboembolism or maternal death. Twenty-nine patients were planned for uterine preservation, and 14 were planned for delayed hysterectomy. Among the 29 patients planned for uterine preservation, 13 (45%) were successful, with median time to expulsion or resorption of 17 weeks, and 16 (55%) underwent interval hysterectomy (9/16 indicated and 7/16 patient request). According to the final procedure performed, compared with the 30 patients who ultimately underwent an interval hysterectomy, those with successful uterine preservation (n=13) had lower median estimated total blood loss (700 mL vs 1,950 mL, P<.01), blood transfusion rates (31% vs 73%, P<.01), and blood transfusion exceeding 4 units (8% vs 47%, P=.01). Five patients had subsequent pregnancies, with no placenta previa or PAS. When analyses were conducted by planned procedure (planned uterine preservation vs planned interval hysterectomy), there were no differences in median estimated total blood loss, blood transfusion rates, and blood transfusion exceeding 4 units.CONCLUSIONThe majority of patients with PAS who were managed by leaving the placenta in situ did not experience complications of infection or bleeding necessitating hysterectomy. Leaving placenta in situ may be appropriate to offer as an alternative to cesarean hysterectomy in those desiring uterine preservation or those who have PAS with concern for life-threatening bleeding if cesarean hysterectomy is performed. These results should be interpreted with caution given the small sample size, which could preclude detection of rare but potentially serious complications.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"33 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876487","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":"Evidence-Based Perioperative Management of Placenta Accreta Spectrum Disorder.","authors":"Jennifer B Gilner,Uma Deshmukh","doi":"10.1097/aog.0000000000005920","DOIUrl":"https://doi.org/10.1097/aog.0000000000005920","url":null,"abstract":"Placenta accreta spectrum (PAS) disorder, characterized by failure of the abnormally adherent placenta to detach from the uterus after delivery, is a leading cause of severe maternal morbidity. Despite its relatively low incidence, disproportional contributions to perinatal hemorrhage, massive transfusion, and emergency hysterectomy underscore the critical need for development of evidence-based surgical management strategies for PAS. There is clear benefit to preoperative management of anemia, as well as preparation for intraoperative resuscitation with blood products and cell salvage. Several tenets of normal cesarean delivery should be maintained in PAS delivery such as the use of neuraxial anesthesia until delivery, prophylactic antibiotics, mechanical thromboprophylaxis intraoperatively, and administration of tranexamic acid if excessive bleeding occurs. Elements of surgical management distinctive to PAS and accepted as best practice include the following: planning delivery at centers with experienced teams when PAS is suspected antenatally, global intraoperative uterine and pelvic survey on entry into the abdominal cavity to assess for anatomic distortion or abnormal vascularity, selection of hysterotomy site for delivery well away from the placental margin, and direct visual assessment of the placental relationship with the myometrium after neonatal delivery and during the start of uterine involution. Other morbidity-reducing strategies such as routine cystoscopy with or without ureteral stent placement, unconventional transverse abdominal entry, hysterotomy extension with surgical staplers, and endovascular hemorrhage reduction tactics involving aortic or iliac balloon occlusion and multivessel arterial embolization remain experimental and require further research.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"12 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876446","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}