Obstetrics and gynecology最新文献

{"title":"Temporal Trends in Obstetric Care Availability Among U.S. Hospitals by Region and Hospital Setting.","authors":"Koji Matsuo,Bonnie B Song,Jennifer A Yao,Brian T Nguyen,Mariya Kobayashi,Shinya Matsuzaki,Kazuhide Matsushima,Laila I Muderspach,Joseph G Ouzounian","doi":"10.1097/aog.0000000000005952","DOIUrl":"https://doi.org/10.1097/aog.0000000000005952","url":null,"abstract":"In this serial cross-sectional study of more than 4,500 hospitals identified in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project National Inpatient Sample, the annual number of obstetric care-providing hospitals decreased by 231, from 2,895 to 2,664, corresponding to an 8.0% decrease over the 7-year period from 2016 to 2022 (Ptrend<.001). The Midwest region (11.2%) had the largest decrease in the annual number of obstetric care-providing hospitals, followed by the West region (9.3%) (both, Ptrend<.001). The annual number of urban nonteaching and rural-setting obstetric care-providing hospitals decreased by 37.5% and 11.2%, respectively (both, Ptrend<.001). In contrast, the annual number of urban teaching obstetric care-providing hospitals increased by 18.8% (Ptrend<.001). When region and hospital setting were combined, the decrease in obstetric care-providing hospitals was more prominent in urban nonteaching hospitals across the four U.S. regions, ranging 31.6% in the South to 55.7% in the Northeast (P=.048). Increasing numbers of urban teaching obstetric care-providing hospitals were higher in the West and South regions (23.9% and 22.3%, respectively) compared with the Northeast and Midwest regions (15.2% and 12.9%, respectively) (P=.017). This nationwide assessment suggests that the decreases in obstetric care-providing hospitals in the United States appear to be more pronounced in the Midwest and West regions. Moreover, the increasing number of urban teaching hospitals possibly implies that care of pregnant people is gradually shifting toward and relying more on obstetric residency program-based practice.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"33 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122079","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":"Intrapartum Doula Support and Cesarean Delivery Rates: A Systematic Review and Meta-analysis.","authors":"Yasmin Dias,Nnenna E Achebe,Michelle M Doering,Catalina Montiel,Rachel Paul,Megan Lawlor,Angela Tatum Malloy,Cindy McMillian,Taleah Frazier,Venus Standard,Shaconna Haley,Rachel Urrutia,Jennifer H Tang,Jaime Slaughter-Acey,Antonina Frolova,Nandini Raghuraman,Jeannie C Kelly,Ebony B Carter","doi":"10.1097/aog.0000000000005937","DOIUrl":"https://doi.org/10.1097/aog.0000000000005937","url":null,"abstract":"OBJECTIVETo estimate the association between doula support and cesarean delivery compared with standard of care.DATA SOURCESWe conducted a systematic review of randomized controlled trials (RCTs) and observational studies comparing in-person intrapartum doula support with standard care. We searched studies published in Ovid Medline, Embase.com, Scopus, Cochrane Central, and ClinicalTrials.gov before August 30, 2024. The primary outcome was cesarean delivery. Secondary outcomes included operative vaginal delivery, low 5-minute Apgar score, and regional anesthesia.METHODS OF STUDY SELECTIONTitles, abstracts, and articles were screened and reviewed by two authors. Eighteen studies were included in the final analysis (n=367,662): eight RCTs (n=2,497) and 10 observational studies (n=365,165). The primary analysis was restricted to RCTs. Additional analyses were limited to studies that were observational, high quality (Downs and Black quality score in top quartile), or RCTs conducted in the United States.TABULATION, INTEGRATION, AND RESULTSRandom-effects models were used to calculate pooled relative risks (RRs) and weighted mean difference. Heterogeneity was assessed with the Cochran Q test and I2 statistic. Intrapartum doula support was associated with a lower rate of cesarean delivery compared with standard care in RCTs (n=7, 17.5% doula support vs 23.6% standard care, pooled RR 0.71, 95% CI, 0.53-0.95). However, there were substantial study heterogeneity (I2=60.1%) and borderline evidence of small-study effects, which could suggest publication bias (Harbord test P=.046). Patients receiving intrapartum doula support in RCTs had significantly lower rates of operative vaginal delivery (n=5, 7.9% doula support vs 13.2% standard care, pooled RR 0.64, 95% CI, 0.44-0.94, I2=46.0%) but no difference in low 5-minute Apgar score (n=3, 1.6% doula support vs 4.1% standard care, pooled RR 0.47, 95% CI, 0.16-1.34; I2=0%) or regional anesthesia (n=7, 57.3% doula support vs 69.5% standard care, pooled RR 0.64, 95% CI, 0.36-1.12, I2=98.75%). Findings were similar in a sensitivity analysis limited to high-quality studies. Doula support was associated with lower cesarean delivery rates among all subgroup analyses except RCTs in the United States (four studies, 16.1% doula support vs 22.2% standard care, pooled RR 0.71, 95% CI, 0.47-1.06).CONCLUSIONIntrapartum doula support was associated with lower rates of cesarean delivery. Results were consistent across study types and when limited to high quality studies; however, significant heterogeneity and concern for publication bias were noted.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42023423577.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"57 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Carbon Footprint and Cost Analysis of Uterine Manipulators for Hysterectomy.","authors":"Alexandra I Melnyk,Nathalia Silva de Souza Lima Cano,Stephanie Glass Clark,Melissa M Bilec,Amanda Artsen","doi":"10.1097/aog.0000000000005949","DOIUrl":"https://doi.org/10.1097/aog.0000000000005949","url":null,"abstract":"OBJECTIVETo evaluate the environmental effects and cost of four different uterine manipulators using life cycle assessment and life cycle costing.METHODSLife cycle assessment, which evaluates the environmental effects of a product or process throughout its life cycle, including production, use, and disposal, was performed on a reusable stainless-steel manipulator, two disposable manipulators, and a hybrid manipulator with both reusable and disposable pieces. Uncertainty in data was addressed through Monte Carlo analysis. Life cycle costing was conducted concurrently, incorporating procurement, sterilization, and waste removal costs and excluding capital equipment costs. Costs were estimated from institutional contracts, labor, materials, and energy use. The primary outcome of this study was the environmental footprint of four uterine manipulators. Secondarily, we compared the global warming potential (kilograms of CO2-equivalents) and costs (U.S. dollars) associated with the production, use, sterilization, and disposal of these manipulators over 300 hysterectomies, the approximate life of the reusable manipulator.RESULTSThe reusable stainless-steel manipulator had the lowest carbon footprint and environmental effect in every category. The disposable manipulators had global warming emissions 4.24 and 2.39 times higher than the reusable manipulator, and the hybrid had emissions 3.76 times higher at 15 uses. Sterilization contributed most of the effects for the reusable manipulator, and production contributed the most for the other devices. The reusable manipulator had the highest up-front costs, but over 300 uses saved the institution $16,000-43,000 compared with the other devices.CONCLUSIONThe reusable stainless-steel uterine manipulator had the lowest carbon footprint and cost compared with the disposable and hybrid devices over their life cycles. Health care leadership should invest in reusable devices; clinicians should prioritize reusable options; and industry partners should innovate and manufacture stainless-steel instruments to help decarbonize the health care system.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"31 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of Cognitive, Sleep, and Mood Changes in the Menopausal Transition: Beyond Vasomotor Symptoms.","authors":"Makeba Williams,Pauline M Maki","doi":"10.1097/aog.0000000000005914","DOIUrl":"https://doi.org/10.1097/aog.0000000000005914","url":null,"abstract":"Complaints of brain fog, mood changes, and sleep disruption are common in the menopause transition. These symptoms can negatively affect overall health, quality of life, productivity, and relationships. This narrative review addresses the epidemiology, underlying mechanisms, and treatment options associated with changes in cognition, mood, and sleep during the menopause transition. The goal is to help health care professionals recognize these symptoms, provide information and support to their patients, and use an evidence-based approach to managing these symptoms.","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":"144122064","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 Between Patient-Reported Social Needs and Birth Outcomes After Implementation of Universal Screening.","authors":"Nigel Madden,Irene Li Quan,Joe Feinglass,Lynn M Yee","doi":"10.1097/aog.0000000000005942","DOIUrl":"https://doi.org/10.1097/aog.0000000000005942","url":null,"abstract":"OBJECTIVETo evaluate the association between patient-reported social needs and birth outcomes in a large cohort of pregnant people after implementation of a universal screening program.METHODSWe conducted a retrospective cohort evaluation of a quality-improvement initiative including 20,480 pregnant people who had social determinants of health screening during pregnancy between May 2021 and July 2023. The primary exposure was one or more patient-reported social needs. Multivariable models evaluated the association between reporting one or more social needs and maternal and neonatal birth outcomes, controlling for sociodemographic and clinical risk factors. A subgroup analysis examined these outcomes among individuals with Medicaid insurance.RESULTSOf 20,480 screened patients, 856 (4.2%) reported at least one social need during pregnancy. Among these patients who reported multiple needs, 21.1% reported transportation needs, 22.5% reported medication unaffordability, 27.2% reported food insecurity, 12.7% reported housing insecurity, and 33.8% reported mental health care needs. On adjusted analyses, reporting at least one social need was significantly associated with risk of severe maternal morbidity (adjusted incident rate ratio 1.55, 95% CI, 1.03-2.32) and low birth weight (adjusted incident rate ratio 1.34, 95% CI, 1.09-1.64). Among individuals with Medicaid insurance (n=4,671), 11.6% reported at least one social need, and the association with severe maternal morbidity (adjusted odds ratio [aOR] 1.83, 95% CI, 1.09-3.07) was greater. In addition, in patients with Medicaid insurance, reporting at least one social need was associated with more than twofold increased odds of preeclampsia (aOR 2.28, 95% CI, 1.16-4.50).CONCLUSIONPatient-reported social needs were associated with adverse birth outcomes, particularly among pregnant people with Medicaid insurance. Findings underscore the potential importance of health system quality improvement and social care outreach initiatives to improve pregnancy-related health.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"31 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122060","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 Between Breastfeeding and Long-Term Risk of Cardiovascular Disease.","authors":"Christine Field,William A Grobman,Jiqiang Wu,Anna Palatnik,Mark B Landon,Denise Scholtens,William Lowe,Nilay S Shah,Jami Josefson,Sadiya Khan,Kartik K Venkatesh","doi":"10.1097/aog.0000000000005943","DOIUrl":"https://doi.org/10.1097/aog.0000000000005943","url":null,"abstract":"OBJECTIVETo estimate whether breastfeeding is associated with the estimated risk of long-term atherosclerotic cardiovascular disease (ASCVD) and whether this association varies with prior gestational diabetes mellitus (GDM).METHODSWe conducted a secondary analysis from the prospective HAPO (Hyperglycemia and Adverse Pregnancy Outcome) Follow-Up Study. The exposure was any breastfeeding (yes or no). The primary outcomes, measured 10-14 years after delivery with the Framingham Risk Score, were estimated ASCVD risk (composite of fatal and nonfatal coronary heart disease and stroke) over the subsequent 10- and 30-year time periods. Multivariable linear regression models were used and adjusted for baseline pregnancy covariates: field center, age, body mass index (BMI), height, smoking and alcohol use, parity, and time from delivery to ASCVD risk assessment. Secondarily, we examined whether the association between breastfeeding and ASCVD varied by GDM status (effect modification).RESULTSOf 4,540 individuals, the median age was 30.6 years at baseline. More than three-fourths (79.7%) reported breastfeeding, which did not vary by GDM status (79.5% vs 81.0%). At 10-14 years after delivery (median 11.6 years), individuals who breastfed had a lower estimated risk of ASCVD over the subsequent 10 years (2.3% vs 2.5%, adjusted β -0.13, 95% CI, -0.25 to -0.02) and 30 years (6.2% vs 6.9%, adjusted β -0.36, 95% CI, -0.66 and -0.05). The association between breastfeeding and estimated ASCVD risk varied significantly by GDM status: The protective effect of breastfeeding was greater for individuals with GDM for estimated 10-year ASCVD risk (GDM: adjusted β -0.52, 95% CI, -0.98 and -0.05; no GDM: adjusted β -0.09, 95% CI, -0.20 and -0.02; interaction P=.004) and 30-year ASCVD risk (GDM: adjusted β -1.33, 95% CI, -2.53 and -0.14; no GDM: adjusted β -0.25, 95% CI, -0.54 and 0.03; interaction P=.003).CONCLUSIONBreastfeeding, particularly after an individual had GDM, was associated with a lower estimated risk of long-term ASCVD. These findings indicate the potential benefit of breastfeeding for long-term cardiovascular health, especially among those with GDM.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"19 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130748","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":"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":"Detection of Human Papillomavirus DNA on Red Blood Cells in Patients With Cervical Cancer.","authors":"Sue Li,Emily Oatman,Janos Tanyi,Sarah H Kim,Lori Cory,Nilam S Mangalmurti","doi":"10.1097/aog.0000000000005932","DOIUrl":"https://doi.org/10.1097/aog.0000000000005932","url":null,"abstract":"Red blood cells (RBCs) have the potential to bind and harbor viral DNA, providing a novel approach to detecting human papillomavirus (HPV). Red blood cells incubated with fluorescently labeled HPV CpG acquired HPV DNA in a concentration-dependent manner. Red blood cells incubated with HPV-positive cervical cancer cells (CaSki cell line) acquired HPV 16 DNA detected by quantitative polymerase chain reaction (PCR). Consistent with these results, HPV 16 DNA was detected by quantitative PCR on RBCs from five patients with cervical cancer or dysplasia but not on healthy control RBCs. Detection of HPV 16 DNA on RBCs from patients with cervical cancer underscores the potential of RBC-bound DNA as a substrate for future blood-based HPV screening.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"5 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065627","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}