Obstetrics and gynecology最新文献

{"title":"Biology and Pathophysiology of Placenta Accreta Spectrum Disorder.","authors":"Yalda Afshar,Lior Kashani Ligumsky,Helena C Bartels,Deborah Krakow","doi":"10.1097/aog.0000000000005903","DOIUrl":"https://doi.org/10.1097/aog.0000000000005903","url":null,"abstract":"Placenta accreta spectrum (PAS) disorders present a significant clinical challenge, characterized by abnormal placental adherence to the uterine wall secondary to uterine scarring. With the rising global cesarean delivery rates, the incidence of this iatrogenic disorder has increased, underscoring the critical need for an understanding of its pathophysiology to inform management and prevention strategies. Normal placentation depends on tightly regulated extravillous trophoblast invasion into the decidua, spiral artery remodeling, interactions with the extracellular matrix, and immune modulation. Uterine scarring disrupts this balance, creating an environment deficient in key regulatory signals required for coordinated implantation and decidualization. In PAS, the loss of inhibitory decidual cues and deficient boundary limits permits unrestrained trophoblast into the abnormal decidual environment. Dysregulated signaling, along with an inflammatory milieu in scarred tissues, exacerbates abnormal placental development. Current prenatal imaging focuses on the appearance of excessive fibrinoid deposition, extracellular matrix remodeling, and incomplete spiral artery transformation as surrogates of PAS risk stratification. Emerging single-cell RNA sequencing and proteomic profiling offer insights into biomarkers and pathways that enable targeted interventions. Preventive efforts should prioritize reducing cesarean delivery rates to limit uterine scarring. Advances in regenerative medicine and bioengineering, including extracellular matrix-modulating biomaterials, growth factor therapies, and antifibrotic interventions, hold promise for improving scar healing and reducing PAS risk. This review bridges foundational science and clinical application, emphasizing the importance of the underlying placental biology and pathophysiology to make a clinical difference in detecting, treating, and preventing PAS. Addressing drivers of abnormal placentation is critical for improving maternal and neonatal outcomes with this increasingly prevalent iatrogenic condition.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"34 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822469","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":"Update on Management and Outcomes of Monochorionic Twin Pregnancies.","authors":"Lynn L Simpson","doi":"10.1097/AOG.0000000000005891","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005891","url":null,"abstract":"<p><p>The management of multiple pregnancies complicated by monochorionicity continues to evolve as new investigations support a change in clinical practice to optimize outcomes. Monochorionic twins are at risk of unique conditions such as monoamnionicity, conjoined twinning, twin reversed arterial perfusion sequence, twin-twin transfusion syndrome, twin anemia-polycythemia sequence, unequal placental sharing with discordant twin growth or selective fetal growth restriction, and single-twin death that puts co-twins at risk of death or neurologic injury attributable to the shared placenta. Contemporary practice guidelines recommend serial ultrasonographic surveillance of monochorionic pregnancies to increase the early detection of problems and timely management decisions that may include increased surveillance, selective reduction or pregnancy termination, referral for in utero treatment, or earlier delivery than initially planned. Improvements in prenatal diagnosis and antenatal testing and advances in fetal therapy have contributed to more favorable outcomes in these complicated monochorionic gestations.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780709","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":"Pregnancy-Induced Hypertension and Association With Future Autoimmune Diseases.","authors":"Yu-Hsiang Shih, Chiao-Yu Yang, Chia-Chi Lung","doi":"10.1097/AOG.0000000000005871","DOIUrl":"10.1097/AOG.0000000000005871","url":null,"abstract":"<p><strong>Objective: </strong>To explore the associations between hypertensive disorders of pregnancy and the subsequent development of autoimmune diseases.</p><p><strong>Methods: </strong>This retrospective cohort study used TriNetX, a federated network of real-world data. Using the Global Collaborative Network data, we collected electronic medical records from 102 health care organizations with 131 million patient records from 2006 to 2020. The study assessed the risk of autoimmune diseases in women aged 16-45 years. Two cohorts were compared: the pregnancy-induced hypertension cohort, which included women with gestational hypertension, preeclampsia, or eclampsia, and the normotensive pregnancy cohort. Women with preexisting autoimmune diseases or hypertension and those with complications occurring before 20 weeks of gestation were excluded. Propensity score matching was used to ensure balanced cohorts. The primary outcome was the long-term risk of autoimmune diseases during a follow-up period of up to 18 years. The secondary outcome evaluated the association between the risk of autoimmune diseases and both the patient's age and the severity of pregnancy-induced hypertension.</p><p><strong>Results: </strong>The prevalence of pregnancy-induced hypertension was found to be 13.4%. After propensity score matching, among 289,564 women, those with pregnancy-induced hypertension demonstrated a significantly higher risk of developing autoimmune diseases during long-term follow-up. The risk of systemic lupus erythematosus was notably higher (hazard ratio 1.87, 95% CI, 1.60-2.18), along with elevated risks of multiple sclerosis, Addison disease, antiphospholipid syndrome, inflammatory bowel disease, mixed connective tissue disease, and rheumatoid arthritis. Subgroup analysis revealed that women of advanced maternal age with pregnancy-induced hypertension had a similar risk of developing autoimmune diseases compared with younger women. In addition, the risk of these autoimmune diseases increased with the severity of pregnancy-induced hypertension.</p><p><strong>Conclusion: </strong>Women with a history of pregnancy-induced hypertension face a higher long-term risk of autoimmune diseases, emphasizing the need for ongoing monitoring and preventive care.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"426-434"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524036","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":"Clinical Performance of Cell-Free DNA for Fetal RhD Detection in RhD-Negative Pregnant Individuals in the United States.","authors":"Julio F Mateus-Nino, Julia Wynn, Jenny Wiggins-Smith, J Brett Bryant, J Kris Citty, J Kyle Citty, Samir Ahuja, Roger Newman","doi":"10.1097/AOG.0000000000005850","DOIUrl":"10.1097/AOG.0000000000005850","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the performance of a cell-free DNA (cfDNA) assay that uses next-generation sequencing with quantitative counting templates for the clinical detection of the fetal RHD genotype in a diverse RhD-negative pregnant population in the United States.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted in four U.S. health care centers. The same next-generation sequencing quantitative counting template cfDNA fetal RhD assay was offered to nonalloimmunized RhD-negative pregnant individuals as part of clinical care. Rh immune globulin (RhIG) was administered at the discretion of the clinician. The sensitivity, specificity, and accuracy of the assay were calculated considering the neonatal RhD serology results.</p><p><strong>Results: </strong>A total of 401 nonalloimmunized RhD-negative pregnant individuals who received clinical care in the period from August 2020 to November 2023 were included in the analysis. The D antigen cfDNA result was 100% concordant with the neonatal serology, resulting in 100% sensitivity, 100% positive predictive value (95% CI, 98.6-100% for both), 100% specificity, and 100% negative predictive value (95% CI, 97.4-100% for both). There were 10 pregnant individuals in whom the cfDNA analysis identified a non- RHD gene deletion, including RhDΨ (n=5) and RHD-CE-D hybrid variants (n=5). Rh immune globulin was administered antenatally to 93.1% of pregnant individuals, with cfDNA results indicating an RhD-positive fetus compared with 75.0% of pregnant individuals with cfDNA results indicating an RhD-negative fetus, signifying that clinicians were using the cfDNA results to guide pregnancy management.</p><p><strong>Conclusion: </strong>This next-generation sequencing with quantitative counting templates cfDNA analysis for detecting fetal RhD status is highly accurate with no false-positive or false-negative results in 401 racially and ethnically diverse pregnant individuals with 100% follow-up of all live births. This study and prior studies of this assay support a recommendation to offer cfDNA screening for fetal Rh status as an alternative option to prophylactic RhIG for all nonalloimmunized RhD-negative individuals, which will result in more efficient and targeted prenatal care with administration of RhIG only when medically indicated.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"402-408"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524043","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":"Repair of Traumatic Uterine Avulsion of a Gravid Uterus.","authors":"Kirie M Psaromatis, Ashley R Lopez, Amanda M Murray","doi":"10.1097/AOG.0000000000005864","DOIUrl":"10.1097/AOG.0000000000005864","url":null,"abstract":"<p><strong>Background: </strong>Although the fundus is the most likely location of rupture in the gravid uterus, the isthmus is the weakest point, leaving it vulnerable to avulsion during blunt pelvic trauma. We describe a case of uterine avulsion in a gravid patient that was repaired in an attempt to preserve future fertility.</p><p><strong>Case: </strong>A 19-year-old primigravid woman in her second trimester presented with uterine body avulsion from the cervix after motor vehicle collision. After evacuation of the pregnancy, repair consisted of circumferential interrupted sutures with digital confirmation of cervical patency. On follow-up imaging, normal anatomy appeared restored, with no residual abnormalities noted. We recommended the use of long-acting reversible contraception postoperatively, as well as special considerations for future pregnancies, such as prelabor caesarean delivery and maternal-fetal medicine subspecialist referral.</p><p><strong>Conclusion: </strong>A gravid uterus may be particularly prone to avulsion at the isthmus, and similar techniques as those described previously in cases of nongravid uterine avulsion may be used in an attempt to preserve future fertility.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e131-e134"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524048","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":"Primary Care Utilization Within 1 Year After a Facilitated Postpartum-to-Primary Care Transition.","authors":"Arlin Delgado, Pichliya Liang, Tierra Bender, Alaka Ray, Kaitlyn E James, Ishani Ganguli, Jessica L Cohen, Mark A Clapp","doi":"10.1097/AOG.0000000000005848","DOIUrl":"10.1097/AOG.0000000000005848","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of a behavioral science-informed intervention designed to facilitate postpartum-to-primary care transitions on primary care visits and screenings within 1 year postpartum for individuals with chronic conditions or pregnancy conditions with long-term health risks.</p><p><strong>Methods: </strong>This was a planned secondary analysis of a randomized controlled trial of a behavioral science-informed intervention designed to increase primary care practitioner (PCP) visits within 4 months postpartum compared with routine care. The intervention included default PCP visit scheduling with nudge reminders and use of tailored language. The primary outcome for this secondary analysis was attending an annual examination or health care maintenance visit with a PCP within 1 year postpartum. Visits with a PCP for any reason and receipt of screenings or services by a PCP (eg, weight, blood pressure, mood screening) were also compared. Outcomes were compared between groups with χ 2 testing.</p><p><strong>Results: </strong>All 353 participants were followed through 1 year after their due dates: 173 in the control group and 180 in the intervention group. More patients in the intervention group attended an annual examination with a PCP within 1 year compared with the control group (59.0% vs 39.3%, P <.001) and had a PCP visit for any reason (72.8% vs 61.3%, P =.02). A significantly higher rate of mental health disorder screening was observed in the intervention group (63.9% vs 55.5%, P =.046); significant differences in other screenings were not observed.</p><p><strong>Conclusion: </strong>This relatively simple and low-cost intervention designed to facilitate transition from postpartum to primary care within the first 4 months demonstrated benefits for PCP engagement within the first year postpartum.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT05543265.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 4","pages":"409-416"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674336","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":"Prediction of Hepatitis C Virus Perinatal Transmission in Pregnant Individuals With Hepatitis C Virus Infection.","authors":"Grecio J Sandoval, George R Saade, Brenna L Hughes, Rebecca G Clifton, Uma M Reddy, Anna Bartholomew, Ashley Salazar, Edward K Chien, Alan T N Tita, John M Thorp, Torri D Metz, Ronald J Wapner, Vishakha Sabharwal, Hyagriv N Simhan, Geeta K Swamy, Kent D Heyborne, Baha M Sibai, William A Grobman, Yasser Y El-Sayed, Brian M Casey, Samuel Parry, George A Macones, Mona Prasad","doi":"10.1097/AOG.0000000000005872","DOIUrl":"10.1097/AOG.0000000000005872","url":null,"abstract":"<p><p>Our objective was to develop a prediction model for hepatitis C virus (HCV) infection perinatal transmission to improve triage for neonatal follow-up. This was a secondary analysis of HCV antibody-positive participants who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network multicenter observational study of HCV infection in pregnancy. Among 432 participants, the perinatal transmission rate was 6.0% (95% CI, 4.0-8.7%). The prediction model was developed and included two factors: maternal HCV RNA titer greater than 10 6 international units/mL and having had any antepartum bleeding. Using this model, the area under the curve for perinatal transmission was 0.76 (95% CI, 0.67-0.86). Probabilities of perinatal transmission of HCV infection ranged from 1.5% (a pregnant individual with HCV RNA 10 6 international units/mL or less and no antepartum bleeding) to 28.5% (a pregnant individual with an HCV RNA titer greater than 10 6 international units/mL and antepartum bleeding). Our results provide data to aid in clinical counseling of pregnant individuals with positive HCV antibodies. Additional research is needed to externally validate this prediction model.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"449-452"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524035","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":"Prenatal Cannabis Use and Depressive Symptoms.","authors":"Taylor L Pitt, Amanda A Allshouse, Pilyoung Kim, Gwen McMillin, Robert M Silver, Judith H Chung, William A Grobman, David M Haas, Brian M Mercer, Samuel Parry, Uma M Reddy, George R Saade, Hyagriv N Simhan, Torri D Metz","doi":"10.1097/AOG.0000000000005860","DOIUrl":"10.1097/AOG.0000000000005860","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether cannabis use during pregnancy was associated with depressive symptoms and whether ongoing use beyond the first trimester and higher amounts of cannabis use were associated with increased depressive symptoms.</p><p><strong>Methods: </strong>This was a secondary analysis of the nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be) study with participants enrolled from October 2010 to September 2013 at eight academic centers. Individuals with pregnancy outcome data who completed the EPDS (Edinburgh Postnatal Depression Scale) in the first and third trimesters and had available frozen stored urine samples were included. Cannabis exposure was ascertained by urine immunoassay for THC-COOH (11-nor-9-carboxy-delta-9-tetrahydrocannabinol); positive results were confirmed with liquid chromatography tandem mass spectrometry. Cannabis exposure groups for the primary analysis were classified as any exposure (positive urine assay at any of the three time points: 6 0/7-13 6/7 weeks of gestation, 16 0/7-21 6/7 weeks, and 22 0/7-29 6/7 weeks) or no exposure. In a secondary analysis, cannabis exposure was classified as no, only first trimester, or ongoing exposure beyond the first trimester. The primary outcome was depressive symptoms (EPDS score higher than 10) at 22-29 weeks of gestation. The association between cannabis exposure and later depressive symptoms was assessed with multivariable logistic. In an exploratory analysis, first-trimester urine THC-COOH was quantified to determine whether heavier use was associated with greater odds of depressive symptoms later in pregnancy.</p><p><strong>Results: </strong>Of 10,038 nuMoM2b participants, 8,424 met the inclusion criteria, and 6.4% (n=535) were exposed to cannabis. Of those exposed, 32.1% (n=172) had only first-trimester exposure, and 67.9% (n=363) had ongoing exposure. Any cannabis use was not significantly associated with later depressive symptoms (adjusted odds ratio [aOR] 1.3, 95% CI, 0.97-1.6) compared with no exposure. However, ongoing exposure beyond the first trimester was associated with later depressive symptoms (aOR 1.6, 95% CI, 1.2-2.2). Higher levels of urine THC-COOH in the first trimester and across pregnancy were associated with increased odds of subsequent depressive symptoms.</p><p><strong>Conclusion: </strong>Any cannabis exposure was not associated with later-pregnancy increased depressive symptoms. However, ongoing use beyond the first trimester and higher levels of cannabis metabolite in first-trimester urine were associated with greater odds of depressive symptoms in later pregnancy. Directionality of this association cannot be determined given the study design.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"417-425"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524046","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":"Long-Term Changes to Cardiovascular Biomarkers After Hormone Therapy in the Women's Health Initiative Hormone Therapy Clinical Trials.","authors":"Matthew Nudy, Aaron K Aragaki, Xuezhi Jiang, JoAnn E Manson, Aladdin H Shadyab, Su Yon Jung, Lisa W Martin, Robert A Wild, Catherine Womack, Charles P Mouton, Jacques E Rossouw, Peter F Schnatz","doi":"10.1097/AOG.0000000000005862","DOIUrl":"10.1097/AOG.0000000000005862","url":null,"abstract":"<p><strong>Objective: </strong>To assess the long-term changes in cardiovascular biomarkers during the WHI (Women's Health Initiative) hormone therapy (HT) clinical trials of conjugated equine estrogens (CEE) alone and CEE plus medroxyprogesterone acetate (MPA).</p><p><strong>Methods: </strong>HT trial participants from the CEE alone (n=1,188, 0.625 mg/d CEE or placebo) and the CEE+MPA (n=1,508, 0.625 mg/d CEE plus continuous 2.5 mg/d MPA or placebo) trials provided blood samples at baseline and after 1, 3, and 6 years. Low-density lipoprotein cholesterol (LDL-C; primary endpoint), high-density lipoprotein cholesterol (HDL-C), triglycerides, total cholesterol, lipoprotein(a), glucose, insulin, and homeostatic model assessment for insulin resistance were measured. Repeated-measures regression models estimated the geometric means of each log-transformed biomarker by restricted maximum likelihood. A constant treatment effect across visits was used to estimate the overall effect, expressed as a ratio of geometric means, and was complemented with geometric means (95% CIs) by randomization group and corresponding ratios of geometric means (95% CI; HT vs placebo) at each visit.</p><p><strong>Results: </strong>During the intervention phase of the CEE-alone trial, randomization to CEE reduced LDL-C by 11% over 6 years (ratio of geometric means 0.89, 95% CI, 0.88-0.91, P <.001). The overall reduction in LDL-C was similar for CEE+MPA relative to placebo (ratio of geometric means 0.88, 95% CI, 0.86-0.89, P <.001). Relative to placebo, HDL-C and triglycerides were 13.0% and 7.0% higher with CEE and CEE+MPA, respectively. The homeostatic model assessment for insulin resistance decreased by 14.0% and 8.0% for CEE-alone and CEE+MPA trial participants, respectively. Relative to placebo, lipoprotein(a) decreased by 15.0% and 20.0% for participants randomized to CEE alone and CEE+MPA, respectively.</p><p><strong>Conclusion: </strong>Lipoprotein(a), LDL-C, and homeostatic model assessment for insulin resistance were lower and HDL-C levels were higher for HT compared with placebo. Triglycerides increased in both the CEE and CEE+MPA trials, however. Future research should assess whether other progestogens attenuate the effect of estrogen on HDL-C. These results may be used to counsel younger menopausal women with bothersome symptoms who are deciding whether to initiate oral HT within the context of published effects of oral HT on rates of cardiovascular events.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT00000611.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"357-367"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524013","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":"Medicaid Expansion, Uninsurance Rates, and Catastrophic Costs at the Time of Emergency Gynecologic Surgery.","authors":"Kristen Carrillo-Kappus, Benjamin Albright, Shakthi Unnithan, Alaattin Erkanli, Haley Moss","doi":"10.1097/AOG.0000000000005852","DOIUrl":"10.1097/AOG.0000000000005852","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the effect of Medicaid expansion on uninsurance rates and catastrophic charges from emergency surgical management of ectopic pregnancy and ovarian torsion using difference-in-difference analysis and to evaluate for racial and ethnic disparities.</p><p><strong>Methods: </strong>We conducted a retrospective cohort analysis using 2012-2018 State Inpatient Data and State Ambulatory Surgery and Services Databases in four states: Kentucky and Maryland (expansion) and Florida and North Carolina (nonexpansion). Patients undergoing surgical management of ovarian torsion or ectopic pregnancy were included. Logistic regression models were used controlling for year and expansion type; a difference-in-difference treatment indicator was used to evaluate changes in uninsurance rates and catastrophic spending (hospital charges more than 10% of estimated annual median income) among those uninsured. We then examined race and ethnicity for those uninsured before and after expansion by state.</p><p><strong>Results: </strong>A total of 594,116 patients were included. Before expansion, the percent of patients uninsured was higher in nonexpansion states (6.5%) compared with expansion states (5.1%). After expansion, the percent uninsured decreased from 5.1% to 2.4% in expansion states compared with 6.5% to 5.3% in nonexpansion states. The interaction between expansion year and Medicaid expansion status was significant ( P <.001). Pre-expansion percent catastrophic charges among uninsured patients were higher in nonexpansion states compared with expansion states (96.7% vs 85.7%). After expansion, the percent catastrophic financial burden remained higher at 96.9% in nonexpansion states compared with 82.5% in expansion states. The interaction between expansion year and Medicaid expansion status was significant ( P <.001). The uninsured gap between Black or African American and White patients in expansion states after expansion was 0.5%-relatively unchanged-compared with 11.6% for Hispanic and non-Hispanic patients, an increase from 8.3% before expansion.</p><p><strong>Conclusion: </strong>Medicaid expansion was associated with reductions in uninsured hospitalizations and catastrophic charges after gynecologic surgical emergencies and was associated with differences between Hispanic and non-Hispanic patients.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"377-385"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524014","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}