Obstetrics and gynecology最新文献

{"title":"Pregnancy-Related Complications in Osteogenesis Imperfecta.","authors":"Mathis Collier, Pierre Hannoun, Valérie Cormier-Daire, Jean-Marc Treluyer, Alexandra Benachi, Eugénie Koumakis","doi":"10.1097/AOG.0000000000005957","DOIUrl":"10.1097/AOG.0000000000005957","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate obstetric and perinatal outcomes of pregnancies among patients with osteogenesis imperfecta using the French National Health Insurance Database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study. Pregnancies were identified with an algorithm specifically developed for the French National Health Insurance Database to identify delivery stays using a combination of International Classification of Diseases, Tenth Revision (ICD-10) discharge codes and medical procedures. Exposure was osteogenesis imperfecta status based on the occurrence of ICD-10 code Q780 5 years before conception or during pregnancy. Outcomes included pregnancy, delivery, postpartum, and fetal complications based on hospital discharge data and reimbursements of medical procedures, medical devices, and drugs. Multivariable logistic regression analysis was performed, adjusted for multiple pregnancies per participant with generalized estimating equations.</p><p><strong>Results: </strong>The cohort included 8,850,969 pregnancies (5,823,322 patients) between January 2012 and December 2023. In total, 408 pregnant individuals (4.6/100,000) were identified with osteogenesis imperfecta. Compared with pregnant individuals without osteogenesis imperfecta, pregnant individuals with osteogenesis imperfecta had increased risks of antepartum hemorrhage (adjusted risk ratio [RR] 1.78, 95% CI, 1.01-3.14), chorioamnionitis (adjusted RR 2.79, 95% CI, 1.17-6.64), malpresentation (adjusted RR 1.65, 95% CI, 1.19-2.30), and preterm delivery (adjusted RR 2.11, 95% CI, 1.62-2.74). Cesarean delivery rates were notably higher in pregnant individuals with osteogenesis imperfecta (adjusted RR 2.59, 95% CI, 2.34-2.88), including among nulliparous individuals (adjusted RR 2.50, 95% CI, 2.22-2.81). Osteogenesis imperfecta was associated with major congenital anomalies (adjusted RR 5.04, 95% CI, 3.97-6.39 overall; adjusted RR 1.67, 95% CI, 1.09-2.56 when osteogenesis imperfecta was excluded from the congenital anomaly definition), especially cardiac anomalies. Postpartum analysis indicated no significant increase in fracture rates compared with prepregnancy periods.</p><p><strong>Conclusion: </strong>In this nationwide cohort study, osteogenesis imperfecta was associated with both maternal and fetal complications. These findings underscore the need for specialized, multidisciplinary management of pregnancies in patients with osteogenesis imperfecta.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234691","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":"12 Steps Toward Sustainability in Gynecologic Surgery.","authors":"Rebecca Schneyer,Kacey Hamilton,Ogechukwu Ezike,Raanan Meyer,Katharine Ciesielski,Matthew Siedhoff,Mireille Truong,Kelly Wright","doi":"10.1097/aog.0000000000006012","DOIUrl":"https://doi.org/10.1097/aog.0000000000006012","url":null,"abstract":"Surgery is a major driver of climate change due to carbon emissions. Single-use materials and tools account for the largest environmental effects. In this Video 1, we present 12 strategies to promote sustainability in the gynecology operating room, with a focus on minimizing single-use, disposable products: 1) reduce glove changes, 2) custom surgical packs, 3) reusable scrub caps, 4) avoid disposable energy devices, 5) stainless steel manipulators, 6) reusable suction irrigators, 7) alternatives to specimen-retrieval bags, 8) minimize single-use plastic trocars, 9) avoid advanced access platforms, 10) make the most of every suture, 11) use a laparoscope for cystoscopy, and 12) minimize red bag waste. Throughout the video, we present data to support our recommendations. Each of these strategies represents a small step, but, added together, they can make a big difference in our environmental effect as surgeons. A toolkit with additional resources is available in Appendix 1, available online at http://links.lww.com/AOG/E234.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"7 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652744","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":"Implementation of Human Papillomavirus Self-Collection and Barriers to Follow-Up Among Unhoused Individuals in Texas: The EMPOWER Study.","authors":"Parisa N Fallah,Paige Bowman,Christopher Tran,Virginia Chen,Monica Pippin,Melissa L Varon,Ellen Baker,Jessica Milan,Susan L Parker,Jennifer Lezama-Sierra,Mark F Munsell,Nerlyne Desravines,Isaac Lavie,Samantha Batman,Jane Montealegre,Kathleen M Schmeler,M Yvette Williams-Brown,Mila P Salcedo","doi":"10.1097/aog.0000000000006003","DOIUrl":"https://doi.org/10.1097/aog.0000000000006003","url":null,"abstract":"OBJECTIVEAlthough cervical cancer rates are low in the United States, certain populations experience disproportionate incidence and mortality attributable to inadequate access to screening, diagnosis, or treatment. High-risk human papillomavirus (HPV) self-collection is an effective strategy to increase uptake of cervical cancer screening; however, its effectiveness among unhoused individuals is unknown. The objective of this study was to assess the feasibility of HPV self-collection among unhoused individuals and to identify barriers to follow-up diagnosis and treatment.METHODSThis is a single-arm feasibility trial. Unhoused individuals aged 25 years or older were prospectively enrolled in Austin, Texas, at community resource centers. They were offered brief education about cervical cancer and the opportunity to screen with high-risk HPV self-collection. Samples were sent to a commercial laboratory for testing. Result notification occurred in person or by telephone. Participants with high-risk HPV-positive results were navigated to follow-up with colposcopy. All participants answered an exit survey.RESULTSFrom May to October 2024, 89 participants were enrolled, of whom 87 collected samples. There were six invalid samples (6.9%), two of which were recollected. Of the 83 valid samples, 21 (25.3%) were positive for high-risk HPV and 62 (74.7%) were negative for high-risk HPV. Only 46 of 87 participants who collected samples (52.9%) received their results despite multiple attempts to contact them. Of the 21 participants with high-risk HPV-positive results, four (19.0%) have undergone colposcopy. There were numerous barriers to follow-up care.CONCLUSIONOur results suggest that it is feasible to implement high-risk HPV self-collection among unhoused individuals; however, there are significant barriers to follow-up for those who test positive. Although high-risk HPV self-collection may improve cervical cancer screening rates among underscreened populations, follow-up diagnosis and treatment of precancerous lesions are necessary to prevent cervical cancer. Future research is needed to identify strategies to decrease loss to follow-up rates.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov, NCT06109870.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"109 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652936","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":"Comprehensive Review of Endometriosis Care.","authors":"Erin T Carey, Jacqueline M K Wong, Zaraq Khan","doi":"10.1097/AOG.0000000000006004","DOIUrl":"10.1097/AOG.0000000000006004","url":null,"abstract":"<p><p>Endometriosis is an estrogen-dependent, chronic inflammatory disorder characterized by the presence of endometrium-like tissue outside the uterus, affecting approximately 10% of individuals of reproductive age. It contributes to chronic pelvic pain, dysmenorrhea, and subfertility, resulting in substantial societal economic burdens. Genetic and environmental risk factors have been identified, and recent research suggests that endometriosis functions as a systemic disease affecting nonreproductive systems and increasing susceptibility to other health conditions. Various phenotypes-superficial peritoneal endometriosis, ovarian endometriomas, and deep endometriosis-may develop under different mechanisms, yet the relationship between these presentations remains unclear. Diagnosis relies on clinical evaluation, imaging, and surgical staging, and the advent of advanced ultrasonography and magnetic resonance imaging has helped to enhance accuracy. Although medical management focuses on hormonal modulation to alleviate symptoms, surgical intervention remains a critical tool for refractory symptoms. Postoperative care and patient education are essential to manage recurrence and to improve quality of life. Current research emphasizes the need for comprehensive, interdisciplinary approaches to endometriosis management, incorporating novel diagnostic tools, diverse therapeutic avenues, and patient-centered care models. Addressing disparities in treatment access is essential to improving outcomes. To achieve this, recruiting and analyzing data from racially, socioeconomically, and geographically diverse cohorts will reveal how disease presentation and treatment efficacy vary across populations. Continued efforts in research and health care policy are necessary to develop effective and personalized strategies in managing endometriosis.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659787","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":"Stakeholder Perspectives of New Tailored Prenatal Care Delivery.","authors":"Asavari Rajpurkar,Yannet Daniel,Christopher M Zahn,Mark Turrentine,Lauren Lott,Lamiya Ahmed,Alex F Peahl","doi":"10.1097/aog.0000000000006005","DOIUrl":"https://doi.org/10.1097/aog.0000000000006005","url":null,"abstract":"OBJECTIVETo evaluate obstetric stakeholders' attitudes and implementation considerations regarding the adoption of key components of a newly tailored prenatal care recommendation-PATH (Plan for Appropriate Tailored Healthcare in Pregnancy).METHODSWe conducted a national listening tour that used qualitative focus groups from March 2022 to June 2023. We recruited a national sample of obstetric care clinicians, patients, advocates, policymakers, and payers using maximum variation sampling. We explored core PATH domains, including 1) addressing social needs, 2) telemedicine and remote monitoring, and 3) targeted visit schedules. Participants were queried about their perceived barriers to adopting new recommendations and needed supports. We performed a qualitative content analysis to identify positive attitudes, concerns, and multilevel implementation considerations for each recommendation.RESULTSIn total, 102 obstetric stakeholders participated in nine focus groups from 10 obstetric care organizations, seven patient advocacy and equity organizations, nine policy and public health organizations, and four payer groups. Participants broadly supported the idea of care tailoring and raised important concerns about unintended inequities and negative health outcomes that could arise with inappropriate application of the model. Participants affirmed that addressing social needs is crucial to improving prenatal care access and pregnancy outcomes but identified barriers including insufficient resources and support for interprofessional collaboration. Telemedicine and remote monitoring were widely accepted to improve care access and efficiency, but participants worried that limited access to digital infrastructure could exacerbate existing health disparities. Although participants recognized that targeted visit schedules could enhance visit attendance, care flexibility, and resource equity, some worried about the potential for missed services and worse health outcomes. Across all recommendations, participants identified patient-, clinic-, and policy-level considerations to improve the implementation of new prenatal care models.CONCLUSIONPATH is an acceptable and feasible care model with the potential to improve the quality, equity, and efficacy of prenatal care. Multilevel implementation considerations must be integrated with routine use of PATH to promote sustainability across patient populations and settings.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"153 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652817","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":"Recommendations From the Women's Preventive Services Initiative on Breast Cancer Screening for Women at Average Risk and Patient Navigation Services for Breast and Cervical Cancer Screening.","authors":"Catherine T Witkop,Carla Picardo,Alexis Vosooney,Heidi D Nelson,Amy G Cantor,Sarah Son,Michelle Collins,Susan Hoffstetter,Alayne Markland,Dorianne Mason,Erin Mackay,Mary Rosser,Annamarie Streilein,Amy Weil,Francisco Garcia,Susan M Kendig,Amir Qaseem,Diana Ramos,Alina Salganicoff,Julie K Wood,Nancy O'Reilly,Christopher Zahn,Kimberly D Gregory, ","doi":"10.1097/aog.0000000000006011","DOIUrl":"https://doi.org/10.1097/aog.0000000000006011","url":null,"abstract":"The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"52 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652862","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":"Success of Methotrexate for the Management of Recurrent Compared With Primary Ectopic Pregnancy: A Systematic Review and Meta-analysis.","authors":"Shreya Bhat,Sameer Bhat,Sikhar Sircar","doi":"10.1097/aog.0000000000006013","DOIUrl":"https://doi.org/10.1097/aog.0000000000006013","url":null,"abstract":"OBJECTIVETo compare the efficacy of intramuscular (IM) methotrexate in patients with recurrent compared with primary ectopic pregnancy.DATA SOURCESSystematic searches of the MEDLINE, EMBASE, and Scopus databases were conducted in February 2025.METHODS OF STUDY SELECTIONThis meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All English-language, full-text studies in which adult patients (18 years of age or older) were treated with IM methotrexate and stratified by their history of a previous ectopic pregnancy were included. Patients with at least one prior ectopic pregnancy, regardless of which fallopian tube was affected and how it was managed, were defined as having recurrent ectopic pregnancy. We excluded studies that did not report patients requiring further treatment, those in which medical management through alternative routes (other than IM) or therapies were studied, and those investigating nontubal ectopic pregnancy or heterotopic pregnancies.TABULATION, INTEGRATION, AND RESULTSTwo investigators independently identified studies using the eligibility criteria. The primary outcome was treatment success, characterized by the complete resolution of ectopic pregnancy without the need for further treatment. The efficacy of single-dose and multidose (comprising both two doses and fixed multidose, ie, two or more doses) IM methotrexate regimens was evaluated. Outcomes were reported as relative risk (RR) and 95% CI. From 6,349 search results, 15 observational studies comprising 3,944 patients (502 recurrent, 3,442 primary ectopic pregnancy) were included. Administration of a single dose of IM methotrexate was significantly less successful in patients with recurrent compared with those with primary ectopic pregnancy (RR 0.79, 95% CI, 0.63-1.00, P=.050). However, there was no statistical difference in success for patients receiving multidose treatment (RR 1.14, 95% CI, 0.71-1.84, P=.590).CONCLUSIONCurrent observational data suggest that patients with recurrent ectopic pregnancy should be considered for multidose IM methotrexate to achieve similar rates of success compared with primary ectopic pregnancy.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42025642895.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"679 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652938","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":"Association of Intimate Partner Violence Around the Time of Pregnancy With Postpartum Visits.","authors":"Denise V D'Angelo,Lauren B Zapata,Jesse L Coe,Yanet Ruvalcaba,Ceiara M Hyde,Kara Tsukerman,Letitia Williams,Sarah Huber-Krum","doi":"10.1097/aog.0000000000006002","DOIUrl":"https://doi.org/10.1097/aog.0000000000006002","url":null,"abstract":"OBJECTIVETo examine the association between experiencing emotional or physical intimate partner violence (IPV) around the time of pregnancy and having a postpartum visit.METHODSWe conducted a secondary analysis of data from 2016 to 2021 from PRAMS (Pregnancy Risk Assessment Monitoring System), a population-based surveillance system that collects self-reported information about experiences before, during, and after pregnancy among women with a recent live birth. We used multivariable logistic regression to estimate the prevalence of experiencing emotional or physical IPV around the time of pregnancy and associations with having a postpartum visit.RESULTSIn seven jurisdictions with information on emotional IPV (n=30,333), 3.3% (95% CI, 3.0-3.6) of women with a recent live birth reported experiencing any emotional violence 12 months before pregnancy, during pregnancy, or after pregnancy; for these women, the prevalence of having a postpartum visit was 91.4% (95% CI, 90.9-91.9). Any emotional IPV was associated with lower odds of having a postpartum visit (adjusted odds ratio [aOR] 0.74; 95% CI, 0.55-0.99). In 48 jurisdictions with information on physical IPV (n=224,957), 3.3% (95% CI, 3.2-3.5) of women with a recent live birth reported physical violence 12 months before pregnancy or during pregnancy; for these women, the prevalence of having a postpartum visit was 90.2% (95% CI, 90.0-90.4). Any physical IPV was associated with lower odds of having a postpartum visit (aOR 0.63; 95% CI, 0.57-0.69). Among women who had a postpartum visit, 34.2% (95% CI, 29.0-39.0) of those who experienced emotional IPV and 35.1% (95% CI, 33.2-37.1) of those who experienced physical IPV were not asked about IPV by a health care professional during the visit.CONCLUSIONExperiencing emotional or physical IPV around the time of pregnancy was associated with lower odds of having a postpartum visit. Conducting screenings at various encounters such as telehealth, pediatric visits, or home health visits and ensuring availability of standard protocols and trainings for IPV screening and referrals may increase support for and identification of women experiencing IPV.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"14 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652806","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":"Etiology, Natural History, and Management of Recent Advances in Molar Pregnancy.","authors":"Antonio Braga,Ross Berkowitz,Neil Horowitz","doi":"10.1097/aog.0000000000005998","DOIUrl":"https://doi.org/10.1097/aog.0000000000005998","url":null,"abstract":"Molar pregnancy is a rare reproductive anomaly that globally affects 1:1,000-1,500 pregnancies. It is caused by aberrant fertilization and can be associated with medical complications or progress to postmolar gestational trophoblastic neoplasia. Molar pregnancy presents with two distinct entities, complete and partial hydatidiform mole, which differ in their clinical, genetic, and prognostic aspects. Maternal age and history of molar pregnancy are the main risk factors for the occurrence of molar pregnancy. Early diagnosis of molar pregnancy by ultrasonography is associated with a decrease in medical complications but not decreased postmolar gestational trophoblastic neoplasia. After the diagnosis of a presumed molar pregnancy, patients should be referred to an expert with experience taking care of molar pregnancy or to a reference center for uterine evacuation and postmolar follow-up, which facilitates early diagnosis of gestational trophoblastic neoplasia. Weekly human chorionic gonadotropin measurement is essential to confirm remission and to identify cases of gestational trophoblastic neoplasia that will require further treatment. To maintain the reliability of this tumor marker, hormonal contraception is indicated during postmolar follow-up. The postmolar follow-up should extend for 1 month and from 3 to 6 months after remission in cases of partial and complete hydatidiform mole, respectively. The reproductive outcomes after molar pregnancy are comparable with those of the general population, except for the higher occurrence of recurrent molar pregnancy, affecting 1.0-2.0% of subsequent pregnancies. The considerable psychosocial repercussions of molar pregnancy require a multidisciplinary approach to minimize the repercussions of this disease on mental health.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"22 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603851","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":"Prediction of Treatment Failure After Excisional Treatment of Cervical Precancer: A Systematic Review and Meta-analysis.","authors":"Leandro Bomans,Arianis Tatiana Ramirez,Peter Hillemanns,Murat Gultekin,Marc Arbyn","doi":"10.1097/aog.0000000000005997","DOIUrl":"https://doi.org/10.1097/aog.0000000000005997","url":null,"abstract":"OBJECTIVETo evaluate the diagnostic accuracy and clinical utility of posttreatment tests to predict treatment failure after excisional treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+).DATA SOURCESElectronic databases (EMBASE, PubMed MEDLINE) were searched for studies published from January 1975 to August 2024 assessing the occurrence of treatment failure in women who underwent excisional treatment for histologically confirmed CIN 2+ lesion.METHODS OF STUDY SELECTIONPreviously published meta-analyses were extended and updated. A total of 1,802 studies were reviewed. Studies that assessed the diagnostic accuracy of the margin status, cytologic testing, combination of cytology and high-risk human papillomavirus (HPV), or combination of margin status and high-risk HPV compared with high-risk HPV testing were included. The primary outcome was treatment failure (residual or recurrent CIN 2+) and the absolute and relative diagnostic accuracy to predict this outcome. Studies with at least 18 months of follow-up were included.TABULATION, INTEGRATION, AND RESULTSForty-six studies and 20,385 women were included in the analysis. Treatment failure occurred in 6.6% of patients. The pooled sensitivity and specificity of high-risk HPV testing were 86.8% and 80.5%, respectively. Cytology had a sensitivity of 70.8% and a specificity of 85.7%, pooled from 34 studies. Compared with high-risk HPV testing in the same studies, cytology was 6.5% more specific (95% CI, 1.024-1.108) but 21.3% less sensitive (95% CI, 0.702-0.882). Assessment of the margin status was 39.9% less sensitive (95% CI, 0.532-0.678) but similarly specific (95% CI, 0.970-1.069) to high-risk HPV testing in 29 studies, with a pooled sensitivity and specificity of 48.9% and 82.5%, respectively. Co-testing with cytology and high-risk HPV was similarly sensitive (95% CI, 0.992-1.061) but 10.5% less specific (95% CI, 0.850-0.944) compared with high-risk HPV testing in 16 studies, with a pooled sensitivity and specificity of 94.7% and 69.9%, respectively. The pooled sensitivity and specificity of co-testing with margin status and high-risk HPV were 96.9% and 55.7%, respectively, 6.6% more sensitive (95% CI, 1.021-1.114) but 26.7% less specific (95% CI, 0.637-0.844) than high-risk HPV testing in eight studies. Involved resection margins, abnormal cytology, and a positive high-risk HPV test result were associated with a failure risk of 16.1%, 29.0%, and 26.1%, respectively. Women with negative margins, normal cytology, and a negative high-risk HPV test result had a failure risk of 3.6%, 2.3%, and 0.9%, respectively. The risk of treatment failure was highest for women with involved margins and a positive high-risk HPV test result (45.3%) and lowest for women with negative margins and a negative high-risk HPV test result (0.3%). Abnormal cytology and a positive high-risk HPV test result increased the risk of treatment failure to 42%, whereas normal cytology and a negative high-risk HP","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"101 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603807","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}