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":"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":"Contemporary Placenta Accreta Spectrum Disorder Incidence and Risk Factors.","authors":"Alesha White,Mishel Malik,Jessica E Pruszynski,Quyen N Do,Catherine Y Spong,Christina L Herrera","doi":"10.1097/aog.0000000000005919","DOIUrl":"https://doi.org/10.1097/aog.0000000000005919","url":null,"abstract":"OBJECTIVETo establish contemporary rates of maternal morbidity and placenta accreta spectrum (PAS) based on history of cesarean delivery and placental location at a single institution.METHODSThis is a retrospective cohort study conducted between January 2011 and May 2024. All patients who delivered by cesarean were included. Maternal demographics and morbidities, including rates of PAS, placenta previa, transfusion, and hysterectomy, were compared according to the increasing number of cesarean deliveries. The effect of low-lying placenta or placenta previa and their respective locations were also analyzed. Odds ratios were calculated for risk of PAS and hysterectomy on the basis of number of cesarean deliveries and the placental location in the lower uterine segment.RESULTSA total of 44,608 cesarean deliveries were performed. With increasing number of cesarean deliveries, patients were older (33.3±5.3 years), were more frequently Black, and had a lower median gestational age at the time of delivery (38 weeks, interquartile range 37-39 weeks, all P<.001). With increasing cesarean deliveries, rates of PAS (0.03% vs 0.3% vs 0.8% vs 1.7% vs 2.8%, P<.001), hysterectomy (0.5% vs 0.5% vs 1.2% vs 2.6% vs 4.2%, P<.001), and blood transfusion and total operative time increased. Rates of anterior placenta previas (0.35% vs 0.29% vs 0.49% vs 0.89% vs 1.09%, P<.001) and low-lying placentas (0.09% vs 0.06% vs 0.12% vs 0.28% vs 0.44%, P<.001) also increased. The rate of PAS in the setting of placenta previa and low-lying placenta increased with increasing cesarean deliveries, at 2.22%, 28.9%, 62.5%, 64.9%, and 43.8% (P<.001) and 0%, 10.3%, 15.4%, 17.6%, and 33.3% (P=.001). Odds ratios for PAS were significantly higher with increasing cesarean deliveries and anterior placenta previa or anterior low-lying placenta.CONCLUSIONMorbidity increases with increasing number of successive cesarean deliveries, likely secondary to increasing rates of abnormal placentation, PAS, and worsening adhesive disease. Placental location in the context of low-lying placenta or placenta previa is important in determining PAS risk, especially in cases with an anterior component.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"108 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849551","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":"Accreta Ready: Mastering Abdominopelvic Packing for Crisis Situations.","authors":"Kathryn S Brown,Lillian Goodman,Gaby García,Brett D Einerson,Jennifer E Kaiser","doi":"10.1097/aog.0000000000005908","DOIUrl":"https://doi.org/10.1097/aog.0000000000005908","url":null,"abstract":"Although diffuse, ongoing bleeding due to refractory coagulopathy is not frequently encountered in obstetric surgery, patients with placenta accreta spectrum undergoing cesarean hysterectomy are at uniquely high risk for this occurrence. Therefore, obstetrician-gynecologists (ob-gyns) should be familiar with strategies to manage these rare but critical surgical situations. Abdmoinopelvic packing, a surgical technique in which the bowel is protected with a plastic drape before the peritoneal cavity is pressure-packed with laparotomy sponges and, finally, adhesive tape and sump drains are used to create negative pressure in the packed space, can be a lifesaving tool in the management of coagulopathy in the setting of catastrophic hemorrhage. To better prepare ob-gyns to perform abdominopelvic packing, we created an innovative, low-fidelity, low-cost simulation, which we demonstrate in this Video 1. JOURNAL/obsgy/04.03/00006250-990000000-01250/inline-graphic1/v/2025-04-16T082440Z/r/image-tiff.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"9 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849552","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":"Local Resection After Cesarean Delivery for Placenta Accreta Spectrum Disorder: A Systematic Review and Meta-analysis.","authors":"Shinya Matsuzaki,Brett D Einerson,Loic Sentilhes,Baha M Sibai,George R Saade,Antonio F Saad,Kazuya Mimura,Satoko Matsuzaki,Alexandre Buckley de Meritens,Sebastian R Hobson,Joseph G Ouzounian,Robert M Silver,Jason D Wright,Koji Matsuo","doi":"10.1097/aog.0000000000005921","DOIUrl":"https://doi.org/10.1097/aog.0000000000005921","url":null,"abstract":"OBJECTIVETo compare maternal and surgical outcomes between local resection and immediate hysterectomy after cesarean delivery in patients with placenta accreta spectrum.DATA SOURCESFour public databases (PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials) were systematically searched for relevant publications up to July 31, 2024. Because the Cochrane Library included all the identified clinical trials, it was unnecessary to search ClinicalTrials.gov. The search strategy included the terms \"placenta accreta\" or \"placenta accreta spectrum\" and \"pregnancy outcomes\" and related key words about local resection and cesarean hysterectomy.METHODS OF STUDY SELECTIONWith the use of established inclusion criteria, 4,889 studies were reviewed. The included studies evaluated surgical and maternal outcomes associated with immediate hysterectomy compared with local resection.TABULATION, INTEGRATION, AND RESULTSData extraction was conducted with the Patient/Population, Intervention, Comparison, Outcome, and Study design framework. Both fixed-effects and random-effects models were used to synthesize the findings. A total of 11 studies published between 2018 and 2024 were analyzed (nine retrospective studies, one randomized controlled trial, and one prospective cohort study). The quality of the included studies was globally low, and 7 of 11 studies had severe bias. The immediate hysterectomy group had a significantly higher prevalence of placenta percreta compared with the local resection group (69.4% vs 44.3%, P&lt;.01). In contrast to immediate hysterectomy, local resection yielded improved surgical outcomes, demonstrated by the following metrics: transfusion rate (six studies, 375 vs 205 patients, odds ratio [OR] 0.47, 95% CI, 0.29-0.75), estimated blood loss (seven studies, 416 vs 246 patients, mean difference -396 mL, 95% CI, -534 to -257), urologic complications (seven studies, 408 vs 241 patients, OR 0.18, 95% CI, 0.10-0.33), and intensive care unit admission (three studies, 87 vs 79 patients, OR 0.19, 95% CI, 0.07-0.53). One study recorded three maternal deaths: two in the immediate hysterectomy group and one in the local resection group. The results of subgroup analyses focused on patients with severe forms of placenta accreta spectrum (placenta increta and percreta) were similar in the overall analysis.CONCLUSIONIn this systematic review and meta-analysis, eligible studies comparing the local resection with immediate hysterectomy at cesarean hysterectomy for placenta accreta spectrum were overall low quality because of the lack of intention-to-treat information. Despite these limitations, local resection for placenta accreta spectrum may possibly be an option for appropriately selected patients to reduce surgical morbidity. Because the indication criteria, safety, surgical techniques, and necessity of adjunctive therapies for local resection remain understudied, further prospective studies are warranted.SYSTEMATIC REVIEW ","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"9 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849554","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":"Advances in Imaging for Placenta Accreta Spectrum Disorder.","authors":"Jerri Waller,Alireza Shamshirsaz,Alfred Abuhamad","doi":"10.1097/aog.0000000000005905","DOIUrl":"https://doi.org/10.1097/aog.0000000000005905","url":null,"abstract":"Placenta accreta spectrum (PAS) is a disorder secondary to abnormal development of placental trophoblasts, resulting in invasion of the maternal uterine tissue beneath the placenta. The incidence of PAS continues to rise as a result of several factors, with the most common being the increasing number of cesarean deliveries. The diagnosis of PAS carries significant increased risk of maternal morbidity and mortality from maternal hemorrhage, surgical complications, and need for critical care services. Accurate prenatal diagnosis is critical to ensure optimized resources and surgical planning before delivery. Advances in ultrasonography, magnetic resonance imaging, and computed tomography, which have improved antenatal diagnosis, are described in this article.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"5 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822470","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":"Mandy: A Patient's Story of Placenta Accreta Spectrum Disorder.","authors":"Kristen Terlizzi,Brett D Einerson","doi":"10.1097/aog.0000000000005909","DOIUrl":"https://doi.org/10.1097/aog.0000000000005909","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"75 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822764","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 Criteria for Measuring Severe Maternal Morbidity in Placenta Accreta Spectrum Disorder.","authors":"Brett D Einerson,Sarah Rae Easter,Daniela Carusi,Alex J Butwick,Jason D Wright,Eric Jauniaux,Loïc Sentilhes,John C P Kingdom,Deirdre J Lyell,Robert M Silver,Lisa C Zuckerwise","doi":"10.1097/aog.0000000000005910","DOIUrl":"https://doi.org/10.1097/aog.0000000000005910","url":null,"abstract":"Placenta accreta spectrum (PAS) is associated with significant maternal morbidity, but inconsistent outcome reporting across studies hampers meaningful comparisons of management approaches. This statement proposes standardized criteria for measuring severe maternal morbidity and mortality (SMM) for PAS, distinguishing true complications from expected interventions in care. Traditional SMM definitions are problematic for PAS research because they classify anticipated interventions such as hysterectomy and blood transfusions as complications. Through collaborative expert consensus, we identified outcomes that represent unexpected events with significant health consequences for inclusion in a composite primary outcome. The proposed SMM for PAS definition includes maternal death, transfusion of 8 or more units of packed red blood cells, unplanned return to the operating room, specific organ injuries, prolonged mechanical ventilation, pulmonary complications, acute renal failure, prolonged vasopressor use, circulatory support requirements, acute coronary syndrome requiring intervention, cardiac arrest, thromboembolism, and neurologic events. This composite outcome avoids bias toward specific management approaches, relies on objective criteria to limit interpretation variations, and excludes procedures reflecting institutional protocols rather than complications. By standardizing outcome reporting in PAS research, this definition aims to facilitate meaningful comparisons between studies, to generate evidence-based guidelines, and ultimately to improve patient care.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"6 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822763","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}