Obstetrics and gynecology最新文献

{"title":"Recognizing the Work of Accretologists Worldwide.","authors":"Scott Shainker,Lisa Zuckerwise","doi":"10.1097/aog.0000000000005930","DOIUrl":"https://doi.org/10.1097/aog.0000000000005930","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"53 1","pages":"579-580"},"PeriodicalIF":7.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065564","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":"Clinical and Radiologic Evolution in Conservative Management of Placenta Accreta Spectrum Disorder.","authors":"April M Griffith, Susan E Dalton, Anne M Kennedy, Paula J Woodward, Brett D Einerson","doi":"10.1097/AOG.0000000000005931","DOIUrl":"10.1097/AOG.0000000000005931","url":null,"abstract":"<p><strong>Background: </strong>Placenta accreta spectrum (PAS) often results in significant maternal morbidity and mortality. Cesarean hysterectomy is the standard treatment in the United States but can be surgically complex and resource-intensive, with significant morbidity. In other countries, conservative management (ie, cesarean delivery with retention of the placenta) is offered as a potentially less morbid option for treatment. Limited data exist to guide postdelivery care of patients undergoing conservative management.</p><p><strong>Cases: </strong>We describe the imaging and clinical findings of six conservatively managed cases of PAS in the weeks after delivery. Imaging findings, including placental cystic changes and development of intrauterine gas, are correlated with the clinical course, time to complete resolution or intervention, and laboratory trends.</p><p><strong>Conclusion: </strong>Our findings present an expected timeline of postdelivery care for patients with PAS undergoing conservative management, which can help guide future protocols for conservative management of PAS.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT05139498.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 6","pages":"739-748"},"PeriodicalIF":5.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Placenta Accreta Spectrum Disorder After Prior Non-Cesarean Delivery Uterine Surgery: A Systematic Review and Meta-analysis.","authors":"Ru Yang, Lizi Zhang, Lu Sun, Jianli Wu, Shilei Bi, Miao Hu, Shijun Luo, Fang He, Jingsi Chen, Lin Yu, Qiying Zhu, Dunjin Chen, Lili Du","doi":"10.1097/AOG.0000000000005824","DOIUrl":"10.1097/AOG.0000000000005824","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between previous non-cesarean uterine surgery and placenta accreta spectrum (PAS) in subsequent pregnancies.</p><p><strong>Data sources: </strong>PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov , CNKI (China National Knowledge Infrastructure), and Wan-fang Database were searched from inception to April 2024, supplemented by manual searches.</p><p><strong>Methods of study selection: </strong>Studies included prospective, retrospective cohort, case-control, and cross-sectional studies involving pregnant women diagnosed with PAS and reporting at least one risk factor associated with previous uterine surgery.</p><p><strong>Tabulation, integration, and results: </strong>Two authors independently screened potentially eligible studies and extracted data. The quality of the studies was assessed with the Newcastle-Ottawa Scale. The pooled odds ratios (ORs), adjusted ORs, and their 95% CIs were estimated with fixed- or random-effects models if the heterogeneity ( I2 ) was high. Sensitivity analyses were conducted to account for potential study bias. The main measures were myomectomy, uterine artery embolization, dilatation and curettage, hysteroscopic adhesiolysis, abortion, endometrial ablation, and operative hysteroscopy. A total of 38 studies involving 7,353,177 participants were included in the systematic review, with an overall prevalence of PAS of 0.16%, and 31 studies were included in the meta-analysis. Prior non-cesarean uterine surgeries were associated with PAS in subsequent pregnancy (pooled OR 2.29, 95% CI, 1.43-3.68). Distinct associations between specific uterine surgery and PAS included myomectomy (OR 2.29, 95% CI, 1.77-2.97), uterine artery embolization (OR 43.16, 95% CI, 20.50-90.88), dilatation and curettage (OR 2.28, 95% CI, 1.78-2.93), hysteroscopic adhesiolysis (OR 7.72, 95% CI, 4.10-14.53), abortion (OR 1.65, 95% CI, 1.43-1.92), endometrial ablation (OR 20.26, 95% CI, 17.15-23.93), and operative hysteroscopy (OR 3.10, 95% CI, 1.86-5.18).</p><p><strong>Conclusion: </strong>Prior non-cesarean uterine surgery is associated with a significantly increased odds for development of PAS in subsequent pregnancy, and the risk varies depending on the types of uterine surgery.</p><p><strong>Systematic review registration: </strong>PROSPERO: CRD42024552210.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"628-638"},"PeriodicalIF":5.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-Related Mortality in California Due to Obstetric Hemorrhage.","authors":"Paula Krakowiak, Christine H Morton, Christy McCain, Dan Sun, Deepika Mathur, Alexander J Butwick, Neeru Gupta, Malini A Nijagal, Amanda Williams, Marla Seacrist, Laurence E Shields, Carolina Reyes, Miranda Klassen, Elizabeth Yznaga, Elliott K Main","doi":"10.1097/AOG.0000000000005847","DOIUrl":"10.1097/AOG.0000000000005847","url":null,"abstract":"<p><strong>Objective: </strong>To identify underlying causes, contributing factors, and quality-improvement opportunities of pregnancy-related hemorrhage deaths.</p><p><strong>Methods: </strong>The California Pregnancy-Associated Mortality Review examined pregnancy-related hemorrhage deaths in California that occurred in 2014-2018. Data were abstracted from multiple sources (vital records, hospital encounter data, medical records, and coroner or autopsy reports). A multidisciplinary expert panel reviewed all case summaries. Data from reviews were aggregated to determine underlying causes of death, preventability, contributing factors, and quality-improvement opportunities at the patient, clinician, facility, and system levels.</p><p><strong>Results: </strong>During the study period, there were 2,409,732 live births and 49 pregnancy-related hemorrhage deaths. Placenta accreta spectrum accounted for 16 (32.7%) of deaths; intra-abdominal bleeding and uterine atony each accounted for 10 deaths (20.4%). Compared with the California birth population, a significantly higher proportion of women who died were born in China (14.3% vs 3.9%); were 35 years of age or older (49.0% vs 21.9%); had two or more prior births (57.4% vs 29.1%); had cesarean deliveries (74.4% vs 31.8%); or delivered at hospitals with fewer than 1,200 births per year (33.3% vs 12.2%) (all P <.05). The committee determined that 63.3% of all hemorrhage deaths were highly preventable with substantial variation by cause. Clinician-, facility-, and system-level contributing factors were noted in 88.9% of cases and included delayed response or escalation (77.8%), delayed recognition (72.2%), and insufficient quantities of blood products used (52.8%). Corresponding quality-improvement opportunities included timely hemorrhage risk assessment; increased vigilance for identifying signs and symptoms of hemorrhage; escalation of care and aggressive management; preparation for hemorrhage complications and ongoing training for all hospitals, particularly low-resource facilities; and adherence to severe hemorrhage protocols.</p><p><strong>Conclusion: </strong>Obstetric hemorrhage remains a leading cause of pregnancy-related mortality and has multiple causes with various levels of preventability. Optimizing system-based approaches for hemorrhage preparedness, detection, and clinical management is critical to reduce preventable deaths from hemorrhage, especially among patients who do not respond to first-line treatment.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"700-709"},"PeriodicalIF":5.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414882","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":"Endometrium-Free Closure Technique During Cesarean Delivery for Reducing the Risk of Niche Formation and Placenta Accreta Spectrum Disorders.","authors":"Clarel Antoine, Jessica A Meyer, Jenna Silverstein, Julia Buldo-Licciardi, Chen Lyu, Ilan E Timor-Tritsch","doi":"10.1097/AOG.0000000000005813","DOIUrl":"10.1097/AOG.0000000000005813","url":null,"abstract":"<p><strong>Objective: </strong>To examine the prevalence and severity of postcesarean residual niche, evaluated using saline infusion sonohysterography, in an expanded cohort of women with one prior cesarean delivery and to assess the effect of uterine closure technique on the risk of placenta accreta spectrum (PAS) disorders.</p><p><strong>Methods: </strong>This secondary analysis includes 70 patients who underwent saline infusion sonohysterography after one prior cesarean delivery. Patients were grouped according to hysterotomy closure technique: two-layer endometrium-free closure (technique A), and two- or one-layer routine closures (technique B). Niche dimensions and residual myometrial thickness were measured. The primary outcome was clinically significant niche (depth larger than 2 mm), a risk factor for PAS. Groups were compared using χ 2 , unpaired t test, Kruskal-Wallis, and logistic regression with significance at P <.05.</p><p><strong>Results: </strong>There were 33 patients in the technique A group and 37 patients in the technique B group. Technique A was associated with smaller niche dimensions ( P =.018 for width, .005 for depth, and .002 for length), and exhibited thicker residual myometrial thickness (8.5 mm vs 5.5 mm, P =.041) and a lower incidence of clinically significant niches. The odds of having a clinically significant niche were 27 times higher in the technique B group (adjusted odds ratio 27.1, 95% CI, 4.35-168.81, P <.001).</p><p><strong>Conclusion: </strong>Uterine closure techniques are associated with the development and size of postcesarean residual niches, which are critical risk factors for PAS disorders. Use of an endometrium-free closure technique during primary cesarean delivery is associated with a reduced risk of future niche formation and PAS complications.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"674-682"},"PeriodicalIF":5.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952441","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":"Adverse Childhood Experiences and Postcesarean Opioid Use: Does Labor Status Matter? [ID 985].","authors":"Jordan Burgess,Noor Joudi,Elizabeth B Sherwin,Nidhee Reddy,Janet Hurtado,Danielle Panelli","doi":"10.1097/aog.0000000000005916.043","DOIUrl":"https://doi.org/10.1097/aog.0000000000005916.043","url":null,"abstract":"INTRODUCTIONAdverse childhood experiences (ACEs) are associated with increased pain and opioid use after cesarean delivery (CD). Because prior trauma could affect pain perception related to labor, we examined the relationship between ACEs and postpartum opioid use stratified on presence of labor.METHODSThis was a prospective cohort study of postpartum people aged 18 years or older who underwent CD for a singleton pregnancy. Participants completed a validated ACE questionnaire 24-48 hours postpartum. Opioid use was measured as total opioid consumption throughout postpartum hospitalization, in oral milligram morphine equivalents (MMEs), divided by length of stay. We defined moderate-to-high opioid use as MME consumption in the 50th percentile or higher. Fisher's exact test and Spearman correlation coefficients evaluated the association between ACEs and opioid use, stratified by labor prior to CD.RESULTSAmong 134 participants, 58% had an unlabored CD and 41% had a history of one or more ACEs. In unlabored CD only, one or more ACEs were associated with moderate-to-high opioid consumption (63% versus 38%, P=.04). Similarly, when evaluated continuously, ACEs were positively correlated with opioid consumption in unlabored CD (r=0.32, P=.01) but not labored CD (r=0.1, P =0.44).CONCLUSIONS/IMPLICATIONSAdverse childhood experiences were associated with increased opioid use in unlabored CD only. This contrasted with our hypothesis that people with trauma histories would be at greater risk of having re-emergence (manifesting as increased pain and opiate use) after a labored cesarean. Additional research is needed to understand the role of ACEs as an effect modifier in the relationship between labor and postcesarean pain.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"28 1","pages":"13S"},"PeriodicalIF":7.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065623","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":"Predicting Placenta Accreta Spectrum Disorder Through Machine Learning Using Metabolomic and Lipidomic Profiling and Clinical Characteristics.","authors":"Sarah Miller, Deirdre Lyell, Ivana Maric, Samuel Lancaster, Karl Sylvester, Kevin Contrepois, Samantha Kruger, Jordan Burgess, David Stevenson, Nima Aghaeepour, Michael Snyder, Elisa Zhang, Keyla Badillo, Robert Silver, Brett D Einerson, Katherine Bianco","doi":"10.1097/AOG.0000000000005922","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005922","url":null,"abstract":"<p><strong>Objective: </strong>To perform metabolomic and lipidomic profiling with plasma samples from patients with placenta accreta spectrum (PAS) to identify possible biomarkers for PAS and to predict PAS with machine learning methods that incorporated clinical characteristics with metabolomic and lipidomic profiles.</p><p><strong>Methods: </strong>This was a multicenter case-control study of patients with placenta previa with PAS (case group n=33) and previa alone (control group n=21). Maternal third-trimester plasma samples were collected and stored at -80°C. Untargeted metabolomic and targeted lipidomic assays were measured with flow-injection mass spectrometry. Univariate analysis provided an association of each lipid or metabolite with the outcome. The Benjamini-Hochberg procedure was used to control for the false discovery rate. Elastic net machine learning models were trained on patient characteristics to predict risk, and an integrated elastic net model of lipidome or metabolome with nine clinical features was trained. Performance using the area under the receiver operating characteristic curve (AUC) was determined with Monte Carlo cross-validation. Statistical significance was defined at P<.05.</p><p><strong>Results: </strong>The mean gestational age at sample collection was 33 3/7 weeks (case group) and 35 5/7 weeks (control group) (P<.01). In total, 786 lipid species and 2,605 metabolite features were evaluated. Univariate analysis revealed 31 lipids and 214 metabolites associated with the outcome (P<.05). After false discovery rate adjustment, these associations no longer remained statistically significant. When the machine learning model was applied, prediction of PAS with only clinical characteristics (AUC 0.685, 95% CI, 0.65-0.72) performed similarly to prediction with the lipidome model (AUC 0.699, 95% CI, 0.60-0.80) and the metabolome model (AUC 0.71, 95% CI, 0.66-0.76). However, integration of metabolome and lipidome with clinical features did not improve the model.</p><p><strong>Conclusion: </strong>Metabolomic and lipidomic profiling performed similarly to, and not better than, clinical risk factors using machine learning to predict PAS among patients with PAS with previa and previa alone.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 6","pages":"721-731"},"PeriodicalIF":5.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078667","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":"Current and Future Trends in Performance of Vaginal Hysterectomy in the United States.","authors":"Veronica Lerner,Ling Chen,Xiao Xu,Evan Myers,Jason D Wright","doi":"10.1097/aog.0000000000005945","DOIUrl":"https://doi.org/10.1097/aog.0000000000005945","url":null,"abstract":"OBJECTIVETo describe the current and future use of vaginal hysterectomy in the United States for benign indications.METHODSIn this retrospective cohort study using data from the PINC AI Healthcare Database, we analyzed patients who underwent hysterectomy for benign indications from 2006 to 2020. Hysterectomy was classified as abdominal, vaginal, or minimally invasive (laparoscopic or robotic-assisted). Demographic and clinical characteristics, as well as surgeon and hospital characteristics and practice settings associated with the performance of vaginal hysterectomy, were estimated using multivariable models. To examine trends in the route of hysterectomy for benign indications, we plotted a trajectory to 2030 estimated from the vector autoregressive moving average processes model.RESULTSA total of 1,558,107 patients-including 852,356 (54.7%) who underwent minimally invasive hysterectomy, 472,234 (30.3%) who underwent abdominal hysterectomy, and 233,517 (15.0%) who underwent vaginal hysterectomy-were identified. The rate of vaginal hysterectomy declined from 22.6% in January 2006 to 8.3% in December 2020. Vaginal hysterectomy was more commonly performed in hospitals with a high volume of prolapse and incontinence cases and by surgeons who performed a high number of hysterectomies for prolapse and incontinence and who are high-volume. The rate of vaginal hysterectomy was projected to decline to 7.3% by January 2030. By January 2030, vaginal hysterectomy was estimated to be used in 11.9% of patients undergoing hysterectomy for prolapse and in 3.5% of hysterectomies for other indications. For all indications, a minimally invasive hysterectomy will be the most common route of surgery.CONCLUSIONThe performance of vaginal hysterectomy has declined substantially and is expected to fall to fewer than 8% of hysterectomies by 2030.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"20 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122077","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":"Prophylactic Oral Cephalexin and Metronidazole Compared With Placebo After Cesarean Delivery to Reduce Infection Complications in Women With Obesity: A Randomized Controlled Trial.","authors":"Antonio F Saad,Brett Goldman,Nicholas Spencer,Maggie Kuhlmann,Mollie McDonnold,George R Saade","doi":"10.1097/aog.0000000000005936","DOIUrl":"https://doi.org/10.1097/aog.0000000000005936","url":null,"abstract":"OBJECTIVETo compare prophylactic oral cephalexin and metronidazole with placebo for 48 hours after cesarean delivery following membrane rupture on the frequency of composite infection morbidity postpartum among pregnant individuals with obesity.METHODSThis randomized, double-blind clinical trial was conducted at two medical centers from August 2017 to August 2023. We enrolled women with obesity (pregnancy body mass index [BMI] 30 or higher) and ruptured membranes (for 4 hours or more) undergoing cesarean delivery who were also receiving standard intravenous preoperative prophylaxis with cefazolin and azithromycin. Participants were assigned randomly to receive either oral cephalexin (500 mg) and metronidazole (500 mg) or an identical placebo every 8 hours for 48 hours after their cesarean delivery. The primary outcome was a composite of infection complications, defined as a composite of endometritis, surgical site infection, or other postcesarean infections (pelvic septic thrombosis, abdominal or pelvic abscess based on radiologic diagnosis) within 30 days after cesarean delivery. With an anticipated relative risk reduction of 50% and a two-sided α=.05 with 80% power and a 1:1 ratio of exposed to unexposed, a total sample size of 302 participants was planned to detect a reduction in the primary outcome from 25% in the placebo group to 12.5% in the antibiotic group.RESULTSOf the 321 women who were randomized (mean±SD age 27.5±6.1 years, mean±SD BMI 38.4±6.8), 160 received cephalexin-metronidazole and 161 received placebo with a total of 284 (88.5%) who completed the study per protocol. The overall rate of the composite infection outcome was 6.2% (95% CI, 3.8-9.5%). In the cephalexin-metronidazole group, 9 women (5.6%) developed the composite compared with 11 women (6.8%) in the placebo group (difference 1.2%, 95% CI, -2.5% to 5.0%; odds ratio 0.81, 95% CI, 0.33-2.02; P=.64). No serious adverse events, including allergic reactions, were reported in either group.CONCLUSIONIn women with obesity undergoing cesarean delivery with an extended-spectrum preoperative antibiotic regimen that included azithromycin, the addition of a postoperative 48-hour course of oral cephalexin and metronidazole did not significantly lower the rate of infection complications within 30 days after delivery.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov, NCT03187106.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"137 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122062","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":"Self-Collection for Human Papillomavirus Testing in Clinical Settings: An Opportunity to Reflect on the Disconnect Between Guidelines and Clinical Practice.","authors":"Christopher M Mayer,Isabel C Scarinci,Warner K Huh","doi":"10.1097/aog.0000000000005941","DOIUrl":"https://doi.org/10.1097/aog.0000000000005941","url":null,"abstract":"Cervical cancer remains a preventable yet significant public health concern, particularly among rural, racial and ethnic minority, and LGBTQ+ (lesbian, gay, bisexual, transgender, queer+) populations who are more likely to be unscreened or underscreened. The recent draft guidance by the U.S. Preventive Services Task Force of human papillomavirus (HPV) self-collection for cervical cancer screening offers a transformative opportunity to overcome barriers to traditional cervical cancer prevention methods. Clinician collection and self-collection show strong agreement with HPV test results; however, clinician collection is still more sensitive than self-collection for CIN 2 or worse detection. Human papillomavirus self-collection at health care facilities, as recommended, addresses patient-centric challenges such as embarrassment, discomfort, and logistical constraints, thereby enhancing accessibility and engagement. Despite its potential, self-collection is currently approved by the U.S. Food and Drug Administration only for health care settings, limiting its reach and utility in underserved areas. To maximize the effect of self-collection, targeted educational campaigns for both clinicians and patients are essential to ensure proper utilization. At the patient level, strategies such as mobile clinics and mailed HPV testing kits could improve access, particularly among populations that, despite all other efforts, have not been reached. Clear guidelines at both the system and clinician levels regarding ordering responsibility, result notification for patients, follow-up protocols, specimen processing, and health insurance coverage at each step will be essential for successful implementation.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"79 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122063","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}