Obstetrics and gynecology最新文献

{"title":"Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis.","authors":"Nikolaos Kathopoulis, Anastasia Prodromidou, Athanasios Douligeris, Michail Diakosavvas, Dimitrios Zacharakis, Konstantinos Kypriotis, Ioannis Chatzipapas, Themos Grigoriadis, Athanasios Protopapas","doi":"10.1097/AOG.0000000000005695","DOIUrl":"10.1097/AOG.0000000000005695","url":null,"abstract":"<p><strong>Objective: </strong>To accumulate the currently available literature on the safety and efficacy of the use of knotless barbed sutures for the reconstruction of the uterine wall during laparoscopic myomectomy based on comparison with traditional suture studies.</p><p><strong>Data sources: </strong>We searched PubMed/Medline, Scopus, ClinicalTrials.gov, and Google Scholar up to February 29, 2024.</p><p><strong>Methods of study selection: </strong>Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PICO criteria, we included all English-language, full-text articles that evaluated the perioperative outcomes of patients who had laparoscopic myomectomy and repair of the uterine wall defect with either barbed or traditional (extracorporeal or intracorporeal sutures).</p><p><strong>Tabulation, integration, and results: </strong>The application of barbed sutures resulted in significantly reduced operative time (2,111 patients, mean difference -12.04 minutes, 95% CI, -16.94 to -7.14, P <.001). This was also reflected when suturing time was separately analyzed (437 patients, mean difference -6.04 minutes, 95% CI, -7.43 to -4.65, P <.001) The mean difference in hemoglobin levels before and after surgery was significantly lower in the barbed suture group (1,277 patients, mean difference -0.40 g/dL, 95% CI, -0.72 to -0.09, P <.01) This was also observed in case of estimated blood loss, which was found to be lower in the barbed suture group (1,823 patients, mean difference -47.22 mL, 95% CI, -78.54 to -15.90, P =.003). Finally, the barbed suture group presented lower transfusion rates (1,217 patients, odds ratio 0.43, 95% CI, 0.19-1.00, P =.05). Concerning visual analog scale (VAS) score as evaluated by the surgeons for surgical difficulty, the control group proved to be more technically challenging compared with the barbed sutures group (184 patients, mean difference -1.66 95% CI, -2.37 to -0.94, P <.001). The VAS score for pain at 24 hours postoperatively, postoperative complication rates, and length of hospital stay were similar for both groups. Regarding reproductive outcomes, there was no difference in pregnancy, live birth, and birth complication rates.</p><p><strong>Conclusion: </strong>The use of barbed sutures during laparoscopic myomectomy presents many clinical benefits for the patient and the surgeon in terms of shorter operative and suturing time, less estimated blood loss, and ease of use. This pioneer technology may contribute to the expansion of laparoscopy on more complex myomectomies.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD42023477304.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e81-e100"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988496","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":"Rising Stillbirth Rates Related to Congenital Syphilis in the United States From 2016 to 2022.","authors":"Aliza Machefsky, Kaitlin Hufstetler, Laura Bachmann, Lindley Barbee, Kathryn Miele, Kevin O'Callaghan","doi":"10.1097/AOG.0000000000005700","DOIUrl":"10.1097/AOG.0000000000005700","url":null,"abstract":"<p><strong>Objective: </strong>To identify trends in stillbirth rates attributed to congenital syphilis in the United States by describing congenital syphilis-related stillbirths and comparing characteristics of pregnant people who had congenital syphilis-related stillbirths with those of people who had preterm and full-term liveborn neonates with congenital syphilis.</p><p><strong>Methods: </strong>Cases of congenital syphilis reported to the Centers for Disease Control and Prevention during 2016-2022 were analyzed and categorized as stillbirth, preterm live birth (before 37 weeks of gestation), or term live birth (37 weeks or later). Cases with unknown vital status or gestational age were excluded. Frequencies were calculated by pregnancy outcome, including pregnant person demographics; receipt of prenatal care; syphilis stage and titer; and timing of prenatal care, testing, and treatment.</p><p><strong>Results: </strong>Overall, 13,393 congenital syphilis cases with vital status and gestational age were reported; of these, 853 (6.4%) were stillbirths. The number of congenital syphilis-related stillbirths increased each year (from 44 to 231); the proportion of congenital syphilis cases resulting in stillbirth ranged from 5.2% to 7.5%. Median gestational age at delivery for stillborn fetuses was 30 weeks (interquartile range 26-33 weeks). People with congenital syphilis-related stillbirths were more likely to have titers at or above 1:32 (78.9% vs 45.5%; P <.001) and to have received no prenatal care (58.4% vs 33.1%; P <.001) than people with liveborn neonates with congenital syphilis. The risk of stillbirth was twice as high in persons with secondary syphilis compared with those with primary syphilis (11.5% vs 5.7%, risk ratio 2.00; 95% CI, 1.27-3.13). Across all congenital syphilis cases, 34.2% of people did not have a syphilis test at their first prenatal visit.</p><p><strong>Conclusion: </strong>Stillbirths occurred in more than 1 in 20 pregnancies complicated by congenital syphilis. Risk factors for stillbirth included high titers, secondary stage, and lack of prenatal care. If the prevalence of congenital syphilis continues to rise, there will be a corresponding increase in the overall stillbirth rate nationally.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"493-500"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988499","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":"Correlation of Polycystic Ovarian Syndrome Phenotypes With Pregnancy and Neonatal Outcomes.","authors":"Jessica L Chan, Richard S Legro, Esther Eisenberg, Margareta D Pisarska, Nanette Santoro","doi":"10.1097/AOG.0000000000005702","DOIUrl":"10.1097/AOG.0000000000005702","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare pregnancy and neonatal outcomes in women with hyperandrogenic polycystic ovarian syndrome (PCOS) phenotypes compared with nonhyperandrogenic PCOS phenotypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective cohort study of participants in the PPCOS (Pregnancy in Polycystic Ovary Syndrome) I and II randomized controlled trials; all of the participants met the National Institutes of Health diagnostic criteria for PCOS and were then sorted into three of the four Rotterdam criteria categories based on medical interview, demographics, physical examination, and laboratory data. The two hyperandrogenic (A and B) Rotterdam categories were compared with the nonhyperandrogenic phenotype of PCOS (phenotype D). Our outcomes of interest were clinical pregnancy, pregnancy loss, live birth, obstetric complications (including preterm labor, preeclampsia, gestational diabetes, intrauterine growth restriction, and premature rupture of membranes), and neonatal outcomes (including jaundice, respiratory distress syndrome, neonatal hospitalization, and neonatal infection).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 1,376 participants included in the study, 1,249 (90.8%) had hyperandrogenic PCOS phenotypes compared with 127 (9.2%) nonhyperandrogenic PCOS (nonhyperandrogenic PCOS). Compared with participants with nonhyperandrogenic PCOS, those with hyperandrogenic PCOS had higher body mass index (BMI) (35.5±8.9 vs 31.9±9.3 kg/m 2 , P &lt;.001), fasting insulin (21.6±27.7 vs 14.7±15.0 micro-international units/mL, P &lt;.001), and homeostatic model assessment for insulin resistance score (5.01±9.1 vs 3.4±4.1, P =.0002). Age and race were similar between groups. Months attempting pregnancy were greater in participants with hyperandrogenic PCOS compared with nonhyperandrogenic PCOS (41.8±37.3 vs 33.9±32.0). The proportion of participants who achieved pregnancy (29.9% vs 40.2%, P =.02) and live birth rates (20.1% vs 33.1%, P =.001) were lower among those with hyperandrogenic PCOS compared with nonhyperandrogenic PCOS, although pregnancy loss rates did not differ significantly (23.9% vs 32.3%, P =.06). The hyperandrogenic PCOS group had lower odds of live birth compared with the nonhyperandrogenic PCOS group (odds ratio [OR] 0.51, CI, 0.34-0.76), even after adjusting for BMI (adjusted odds ratio [aOR] 0.59, CI, 0.40-0.89). The hyperandrogenic PCOS group also had lower odds of achieving pregnancy compared with the nonhyperandrogenic PCOS group (OR 0.63, CI, 0.44-0.92); however, this association was no longer significant after adjusting for BMI (aOR 0.74, CI, 0.50-1.10). The overall low prevalence of prenatal complications and neonatal outcomes precluded a meaningful comparison between the two groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Participants with hyperandrogenic PCOS achieved lower rates of pregnancy and live birth compared with those with nonhyperandrogenic PCOS. Evaluating distinct PCOS phenotypes may allow for individualize","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"543-549"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036462","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":"Body Mass Index Changes Among Adolescents and Young Adults Using the Etonogestrel Contraceptive Implant.","authors":"Hunter J Wernick, Mahmoud Abdel-Rasoul, Elise D Berlan, Andrea E Bonny","doi":"10.1097/AOG.0000000000005712","DOIUrl":"10.1097/AOG.0000000000005712","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate body mass index (BMI) over 36 months among adolescents and young adults using the etonogestrel implant compared with those using depot medroxyprogesterone acetate (DMPA) and a control group.</p><p><strong>Methods: </strong>We conducted a retrospective longitudinal cohort study of postmenarchal adolescents and young adults assigned female at birth. The etonogestrel implant and DMPA groups initiated etonogestrel or DMPA between January 1, 2010, and December 31, 2017. Adolescents and young adults in the control group were prescribed a weight-neutral contraceptive or no contraceptive during the same timeframe. The primary outcome of BMI over time was estimated and compared between study groups with inverse probability of treatment weighting linear mixed-effects modeling. Changes in BMI weight category (underweight or normal weight, overweight, obesity) at 12, 24, and 36 months were also explored.</p><p><strong>Results: </strong>Among the 20,409 eligible patients, 860 initiated etonogestrel, 1,817 initiated DMPA, and 17,732 made up the control group. Compared with individuals in the control group, those in the etonogestrel group had a significantly higher mean BMI difference at 9 months (+0.5, P <.01); at 36 months, the mean BMI difference was +1.0 ( P <.01). Compared with individuals in the control group, those in the DMPA group had higher mean BMI at 6 months (+0.3, P <.01); at 36 months, the mean BMI difference was +1.3 ( P <.01). Regardless of weight changes, increases in BMI weight categories were rare in all groups.</p><p><strong>Conclusion: </strong>Adolescent and young adult patients who initiated the etonogestrel implant demonstrated BMI changes like those on DMPA and higher than control patients; however, these differences may not be clinically concerning. This study provides important information that can help in counseling adolescent and young adult patients about expectations when starting and using etonogestrel.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"553-561"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142110137","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":"Prenatal Care Utilization and Birth Outcomes After Expansion of the National Health Service Corps.","authors":"Yanlei Ma, Olesya Baker, Fang Zhang, Carrie Cochran-McClain, Anjali J Kaimal, Hao Yu","doi":"10.1097/AOG.0000000000005704","DOIUrl":"10.1097/AOG.0000000000005704","url":null,"abstract":"<p><strong>Objective: </strong>The National Health Service Corps (NHSC) attracts clinicians to Health Professional Shortage Areas (HPSAs) through scholarships and loan repayments. Since 2009, the NHSC workforce, including maternity care clinicians, has substantially expanded. This study evaluates the association between NHSC expansion and prenatal care and birth outcomes.</p><p><strong>Methods: </strong>In this quasi-experimental study, we adopted a generalized difference-in-differences design to compare changes in prenatal care and birth outcomes from 2005 to 2019 using birth certificate data. Counties designated as HPSAs without any NHSC maternity care clinicians throughout the study period were control counties, and those without such clinicians before 2009 but receiving them after 2009 were treated counties. Outcome measures include a count variable of number of prenatal visits and four dichotomous variables: prenatal care initiation in the first trimester, adequacy of prenatal care, preterm birth, and low birth weight. We estimated negative binomial models for number of prenatal visits and linear probability models for the dichotomous outcomes, adjusting for maternal characteristics, non-NHSC clinician density, and state-level policies. Stratified analyses were also conducted on the basis of birthing people's demographics and county-level characteristics.</p><p><strong>Results: </strong>Our sample comprised 12,980,111 live births between 2005 and 2019 by individuals residing in 1,254 HPSA counties without any NHSC maternity care clinicians before 2009, including 222 counties that received such clinicians after 2009. Compared with control counties, pregnant people in treated counties experienced significant increases in prenatal visits (211 more prenatal visits relative to baseline of 11,226 visits per 1,000 births, P <.001) and in the likelihood of receiving adequate prenatal care (1.43 percentage point increase relative to baseline of 67.0 percentage points, P <.01). Although the NHSC expansion improved prenatal care use for all racial and ethnic groups, pregnant people residing in urban and high social vulnerability areas benefited most. Improvements in birth outcomes were observed only among certain subgroups such as a 0.91 percentage point reduction in preterm birth (relative to baseline of 12.6 percentage points, P <.001) and a 0.87 percentage point reduction in low birth weight (relative to baseline of 8.2 percentage points, P <.05) among pregnant people living in full-county HPSAs.</p><p><strong>Conclusion: </strong>The NHSC expansion since 2009 was associated with increases in prenatal care utilization, particularly among vulnerable populations. Although improvements were not observed in birth outcomes overall with NHSC expansion, modest reductions were observed in preterm birth and low birth weight in subsets of the population.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"526-535"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11499018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036465","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":"Self-Determination of Eligibility for Medication Abortion Without Ultrasonography Using a History-Based Tool: LMP-SURE.","authors":"Courtney Kerestes, Mary Tschann, Marit Pearlman Shapiro, Erin Berry, Lori Gawron, Reni Soon, Bliss Kaneshiro","doi":"10.1097/AOG.0000000000005675","DOIUrl":"10.1097/AOG.0000000000005675","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate a self-screening eligibility tool for medication abortion without an ultrasonogram.</p><p><strong>Methods: </strong>We designed a patient-administered, five-question screening tool (LMP-SURE) that assesses gestational age plus factors associated with misdating or ectopic pregnancy. We recruited participants without prior ultrasonograms from family planning clinics in Alaska, Hawai'i, Idaho, and Utah to complete a brief survey including LMP-SURE and then obtained ultrasound dating by chart review. We compared eligibility for medication abortion by ultrasonogram with eligibility by the LMP-SURE screening tool.</p><p><strong>Results: </strong>We consented 1,026 participants; 781 met eligibility requirements and completed the tool. Using the LMP-SURE tool, we identified 493 participants (65.1%) eligible for medication abortion without an ultrasonogram. The LMP-SURE tool sensitivity (ability to correctly identify a patient ineligible for medication abortion) was 83.8% (95% CI, 73.1-90.8), specificity (ability to correctly identify a patient eligible for medication abortion) was 70.0% (95% CI, 66.4-73.3), likelihood ratio (-) (probability of someone eligible by LMP-SURE to be ineligible by ultrasonogram vs eligible by ultrasonogram) was 0.23 (95% CI, 0.13-0.40), and percentage of false-negatives was 1.5%. Only 11 patients (1.5%) who met eligibility for medication abortion without an ultrasonogram by the LMP-SURE tool were found ineligible for medication abortion by their ultrasonogram. Of those with conflicts, six (0.8%) had a gestational age beyond 77 days. The two participants (0.3%) diagnosed with ectopic pregnancies both required ultrasonograms by LMP-SURE.</p><p><strong>Conclusion: </strong>This patient-facing, brief, history-based screening tool can safely minimize the need for ultrasonogram before medication abortion.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"457-463"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141760155","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":"Excellent Performance of a Brief Self-Screening Tool for Medication Abortion Eligibility May Give Patients More Options.","authors":"Stephanie Teal","doi":"10.1097/AOG.0000000000005719","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005719","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"144 4","pages":"454-456"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505003","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":"Effects of Antihypertensive Therapy During Pregnancy on Postpartum Blood Pressure Control.","authors":"Samantha L Martin, Hui-Chien Kuo, Kim Boggess, Lorraine Dugoff, Baha Sibai, Kirsten Lawrence, Brenna L Hughes, Joseph Bell, Kjersti Aagaard, Kelly S Gibson, David M Haas, Lauren Plante, Torri D Metz, Brian M Casey, Sean Esplin, Sherri Longo, Matthew Hoffman, George R Saade, Janelle Foroutan, Methodius G Tuuli, Michelle Y Owens, Hyagriv N Simhan, Heather A Frey, Todd Rosen, Anna Palatnik, Susan Baker, Phyllis August, Uma M Reddy, Wendy Kinzler, Emily J Su, Iris Krishna, Nicki Nguyen, Mary E Norton, Daniel Skupski, Yasser Y El-Sayed, Dotun Ogunyemi, Zorina S Galis, Namasivayam Ambalavanan, Suzanne Oparil, Ronald Librizzi, Leonardo Pereira, Everett F Magann, Mounira Habli, Shauna Williams, Giancarlo Mari, Gabriella Pridjian, David S McKenna, Marc Parrish, Eugene Chang, Sarah Osmundson, JoAnne Quinones, Erika Werner, Jeff M Szychowski, Alan T N Tita","doi":"10.1097/AOG.0000000000005715","DOIUrl":"10.1097/AOG.0000000000005715","url":null,"abstract":"<p><strong>Objective: </strong>To compare differences in postpartum blood pressure (BP) control (BP below 140/90 mm Hg) for participants with hypertension randomized to receive antihypertensive treatment compared with no treatment during pregnancy.</p><p><strong>Methods: </strong>This study was a planned secondary analysis of a multicenter, open-label, randomized controlled trial (The CHAP [Chronic Hypertension and Pregnancy] trial). Pregnant participants with mild chronic hypertension (BP below 160/105 mm Hg) were randomized into two groups: active (antihypertensive treatment) or control (no treatment unless severe hypertension, BP 160/105 mm Hg or higher). Study outcomes were BP control below 140/90 mm Hg (primary) and medication nonadherence based on a composite score threshold (secondary) at the 6-week postpartum follow-up visit. Participants without follow-up BP measurements were excluded from analysis of the BP control outcome. Participants without health care professional-prescribed antihypertensives at delivery were excluded from the analysis of the adherence outcome. Multivariable logistic regression was used to adjust for potential confounders.</p><p><strong>Results: </strong>Of 2,408 participants, 1,684 (864 active, 820 control) were included in the analysis. A greater percentage of participants in the active group achieved BP control (56.7% vs 51.5%; adjusted odds ratio [aOR] 1.22, 95% CI, 1.00-1.48) than in the control group. Postpartum antihypertensive prescription was higher in the active group (81.7% vs 58.4%, P <.001), and nonadherence did not differ significantly between groups (aOR 0.81, 95% CI, 0.64-1.03).</p><p><strong>Conclusion: </strong>Antihypertensive treatment of mild chronic hypertension during pregnancy was associated with better BP control below 140/90 mm Hg in the immediate postpartum period.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"536-542"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292400","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":"Management of Red Cell Alloimmunization in Pregnancy.","authors":"Kenneth J Moise, Elizabeth A Abels","doi":"10.1097/AOG.0000000000005709","DOIUrl":"10.1097/AOG.0000000000005709","url":null,"abstract":"<p><p>Rhesus immune globulin has resulted in a marked decrease in the prevalence of RhD alloimmunization in pregnancy; however, antibody formation to other red cell antigens continues to occur. Evaluation for the presence of anti-red cell antibodies should be routinely undertaken at the first prenatal visit. If anti-red cell antibodies are detected, consideration of a consultation or referral to a maternal-fetal medicine specialist with experience in the monitoring and treatment of these patients is warranted. Cell-free DNA can be used to determine fetal red cell antigen status to determine whether the pregnancy is at risk of complications from the red cell antibodies. First-time sensitized pregnancies are followed up with serial maternal titers, and, when indicated, serial Doppler assessment of the peak systolic velocity in the middle cerebral artery should be initiated by 16 weeks of gestation. When there is a history of an affected fetus or neonate, maternal titers are less predictive of fetal risk; if the fetus is antigen positive, serial peak systolic velocity in the middle cerebral artery measurements should be initiated by 15 weeks of gestation because intraperitoneal intrauterine blood transfusions can be used at this gestation if needed. The mainstay of fetal therapy involves intrauterine transfusion through ultrasound-directed puncture of the umbilical cord with the direct intravascular injection of red cells. A perinatal survival rate exceeding 95% can be expected at experienced centers. Neonatal phototherapy and \"top-up\" transfusions attributable to suppressed reticulocytosis often are still required for therapy after delivery.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"465-480"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988497","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":"Fellowship for Academic Generalists in Obstetrics and Gynecology: Is It Overdue?","authors":"Alexandra M Abbate, Andrea K Knittel, David M Haas, Tiffany A Moore Simas, Lee A Learman, Jessica L Bienstock, Abimbola O Famuyide, Jeffrey F Peipert, Mostafa A Borahay","doi":"10.1097/AOG.0000000000005706","DOIUrl":"10.1097/AOG.0000000000005706","url":null,"abstract":"<p><p>Academic specialists in general obstetrics and gynecology are clinicians practicing the full breadth of the specialty while also contributing to medical education and scientific discovery. Residency programs in obstetrics and gynecology provide exposure to research training that is variable but frequently limited. This creates challenges for junior faculty and in many cases limits their research productivity, typically measured by published original research articles and grant funding. This frequently disadvantages academic specialists in promotion compared with their subspecialty fellowship-trained colleagues. A few research fellowship programs were recently launched to address this issue. However, these programs are not uniform and encounter challenges such as sustainable funding. In this article, building on knowledge from current academic specialist fellowship programs, we discuss the needs, challenges, and proposed solutions. We also propose some details needing further discussion among the academic obstetrics and gynecology community. We discuss how such fellowships can integrate with current development and training opportunities such as the Women's Reproductive Health Research award, Building Interdisciplinary Research Careers in Women's Health award, other K and K-type career development programs, NIH T32 grants, and clinical research courses for obstetricians and gynecologists. Academic specialist fellowship programs can have synergy with other women's health fellowship programs offered by other specialties. They can additionally leverage institutional resources. We conclude by summarizing a proposed model for academic specialist research fellowship programs.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e75-e80"},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036463","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}