Obstetrics and gynecology最新文献

{"title":"ACOG Clinical Consensus No. 10: Cannabis Use During Pregnancy and Lactation.","authors":"","doi":"10.1097/aog.0000000000006053","DOIUrl":"https://doi.org/10.1097/aog.0000000000006053","url":null,"abstract":"Cannabis refers to all products derived from the plants Cannabis sativa, Cannabis indica, and Cannabis ruderalis and is the most commonly used illicit drug under U.S. federal law. With increasing social acceptability, accessibility, and legalization in many states, the prevalence of cannabis use among pregnant and lactating individuals has increased significantly. Substance use in pregnancy, including cannabis use, has been associated with adverse outcomes such as spontaneous preterm birth, low birth weight, and developmental delay. Obstetrician-gynecologists and other obstetric health care professionals should be aware of the possibility of pregnant and lactating patients' use of cannabis and be prepared to counsel and screen all patients and use evidence-based strategies to reduce cannabis use.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"78 1","pages":"600-611"},"PeriodicalIF":7.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083630","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":"ACOG Committee Statement No. 20:Ethical Considerations With Telehealth in Obstetrics and Gynecology.","authors":"","doi":"10.1097/aog.0000000000006044","DOIUrl":"https://doi.org/10.1097/aog.0000000000006044","url":null,"abstract":"The term \"telehealth\" is used to describe technology-enhanced health care frameworks that allow traditional clinical diagnosis and monitoring to be delivered or facilitated by technology. The terms \"telemedicine,\" \"connected health,\" and \"digital health\" are also used to describe similar technological applications in health care. These frameworks may include services such as virtual visits, remote patient monitoring, and mobile health care. Relying on the core ethical principles can assist obstetrician-gynecologists in ethical conduct or interpretation of these novel technologies as they arise. In this Committee Statement, we discuss the ethical implications and relevant questions involved in the increasing adoption of telehealth in obstetrics and gynecology and how best to ensure that these new modalities align with the foundational bioethical principles of beneficence, nonmaleficence, autonomy, and justice.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"55 1","pages":"572-582"},"PeriodicalIF":7.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083632","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":"Notice of Retraction: \"Prevalence of Adverse Perinatal Outcomes in Adolescent Pregnancy With a Stricter Blood Pressure Cutoff: 130/80 Versus 140/90 mm Hg [ID 1713]\".","authors":"Daniel Puente-Delgadillo,Diego A Ortega-Moreno,Andrés M Ortiz","doi":"10.1097/aog.0000000000006034","DOIUrl":"https://doi.org/10.1097/aog.0000000000006034","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"75 1","pages":"e79"},"PeriodicalIF":7.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083629","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":"Peripartum Urinary Incontinence and Overactive Bladder.","authors":"Moiuri Siddique, Lisa Hickman, Lauren Giugale","doi":"10.1097/AOG.0000000000005993","DOIUrl":"10.1097/AOG.0000000000005993","url":null,"abstract":"<p><p>Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) and symptoms of urgency, frequency, and nocturia are prevalent during pregnancy and the postpartum period but often are underestimated. Overactive bladder, including UUI, affects nearly 65% of patients during pregnancy. Postpartum SUI particularly is associated with mood disorders. Despite the association, many women delay seeking care. Effective treatments for urinary incontinence are available, and timely peripartum screening supports early intervention and enhances quality of life.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"466-472"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560698","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":"Optimal Mode of Delivery for Individuals With Low-Risk Term Breech Presentation.","authors":"Ruchira Sharma, Emily B Rosenfeld, Cande V Ananth","doi":"10.1097/AOG.0000000000005992","DOIUrl":"10.1097/AOG.0000000000005992","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the risks of neonatal and maternal adverse outcomes in individuals with low-risk, singleton, term breech presentation associated with vaginal compared with cesarean delivery in a contemporary cohort in the United States.</p><p><strong>Methods: </strong>We conducted a propensity score analysis to evaluate adverse neonatal and maternal outcomes associated with mode of delivery among individuals with breech presentation at term. We used U.S. vital statistics data, which included information on all live births from 2015 to 2020. The eligible cohort was restricted to individuals who delivered a liveborn singleton, nonanomalous neonate at term. The treatment was vaginal or cesarean delivery. Composite neonatal and maternal outcomes were examined using a propensity score analysis to create groups based on mode of delivery with a 5-to-1 match of cesarean to vaginal deliveries. The composite neonatal outcome included neonatal mortality, 5-minute Apgar score less than 4, seizures or serious neurologic dysfunction, neonatal intensive care unit admission, or assisted ventilation 6 hours or longer. The composite maternal outcome included uterine rupture, maternal transfusion, intensive care unit admission, unplanned hysterectomy, or perineal lacerations.</p><p><strong>Results: </strong>Of 23,118,953 singleton births, 375,500 term, nonanomalous, breech live births were identified. Of these, 5.1% (95% CI, 5.0-5.2; n=19,256) were vaginal deliveries. After propensity score matching, the final cohort comprised 96,095 patients, including 17,558 vaginal deliveries and 78,537 cesarean deliveries. The risks of the composite adverse neonatal outcome were 7.2% in the vaginal delivery group, compared with 6.3% in the cesarean delivery group (risk difference [RD] 1.0; 95% CI, 0.9-1.2; doubly robust odds ratio 1.14; 95% CI, 1.06-1.22). The primary contributor to neonatal morbidity within the vaginal breech cohort was 5-minute Apgar score less than 4 (RD 1.6; 95% CI, 1.4-1.9). Other neonatal outcomes were not different. Neonatal mortality rates were 0.4% (n=67) for vaginal births and 0.1% (n=102) for cesarean births (RD 0.3; 95% CI, 0.2-0.4). The risk of the composite adverse maternal outcome (excluding perineal lacerations) was 0.3% for vaginal births and 0.5% for cesarean breech births (RD -0.4, 95% CI, -0.5 to -0.3).</p><p><strong>Conclusion: </strong>Although term vaginal breech delivery was associated with slightly higher odds of the composite adverse neonatal outcome compared with cesarean delivery, the absolute risk remains low. Short-term maternal outcomes were better for individuals who underwent vaginal delivery compared with cesarean delivery, after exclusion of perineal lacerations.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"524-532"},"PeriodicalIF":4.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560697","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":"Female Sexual Function and Dysfunction.","authors":"Maya V Roytman, Rebecca L Barnett, Rachel S Rubin","doi":"10.1097/AOG.0000000000006073","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006073","url":null,"abstract":"<p><p>Female sexual function and dysfunction is an often-overlooked component within clinical visits. Female sexual disorders are classified by the International Society for the Study of Women's Sexual Health and Fourth International Consultation on Sexual Medicine along the following categories: hypoactive sexual desire disorder, female sexual arousal disorder, female orgasm disorder, and genitopelvic pain disorder. Although more attention has been given to sexual health and developing options for treating dysfunction in recent years, significant knowledge gaps remain in addressing sexual health concerns as part of patient-centered care. Assessing female sexual function consists of obtaining a comprehensive clinical history and performing a thorough physical examination of the pelvic floor and vulvovaginal anatomy. Causes of sexual dysfunction include biologic, psychologic, interpersonal, and sociocultural risk factors. A nuanced approach incorporating evidence-based guidelines and tailored treatment plans that align with the patient's personal goals helps optimize patient sexual health outcomes.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150258","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":"Projected Shortages and Distributional Challenges of Obstetrician-Gynecologists in the United States, 2025-2035.","authors":"William F Rayburn,Imam M Xierali","doi":"10.1097/aog.0000000000006079","DOIUrl":"https://doi.org/10.1097/aog.0000000000006079","url":null,"abstract":"Precision in obstetrician-gynecologist (ob-gyn) workforce planning requires comprehensive projections of supply and demand. Using the Health Workforce Simulation Model from the Health Resources & Services Administration and publicly available datasets, we assessed the adequacy of the number of ob-gyns across all U.S. states to forecast changes from 2025 to 2035. In 2025, the national supply met 93.4% of the demand, with significant geographic disparities. By 2035, all but six states are projected to experience inadequate supplies of ob-gyns, with a particularly severe shortfall in nonmetropolitan areas. Mitigation strategies include expanding the ob-gyn pipeline, retaining the existing workforce, integrating advanced-practice clinicians using technology to extend reach, and optimizing care-delivery models.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"100 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140356","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":"Optimizing Shared Decision Making for Neonatal Resuscitation at Periviability.","authors":"Luke A Gatta,Emily A Morris,Allison M McCarthy,Sarah S Osmundson","doi":"10.1097/aog.0000000000006070","DOIUrl":"https://doi.org/10.1097/aog.0000000000006070","url":null,"abstract":"The delivery of a fetus at the threshold of viability presents clinicians and families with profound medical and ethical dilemmas, particularly regarding whether to initiate neonatal resuscitation. Although professional societies advocate for shared decision making in this context, the practical implementation of this model is challenged by unpredictable outcomes, regional or institutional variability, and human biases. This manuscript explores the theoretical foundations, contemporary evidence, and best practices for shared decision making in the setting of periviability. Supported by research from palliative and critical care medicine, this manuscript then considers how to elicit patient values within shared decision-making conversations, emphasizing preparation, interdisciplinary collaboration, and scenario-based discussion over listing risk-benefit statistics. Tools to support shared decision making, such as the neonatal outcomes calculator and visual decision aids, are discussed with caution for their appropriate application. Lastly, the article covers shared decision making when resuscitation is offered in settings where available interventions fall outside established standards of care. Ultimately, this review aims to support obstetrician-gynecologists in providing goal-concordant, ethically appropriate care at the threshold of viability by equipping them with communication strategies that respect patient autonomy while maintaining professional integrity in the complex and emotionally charged setting of periviability.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"14 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140355","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":"Relationship Between Maternal Death and Infant Outcomes in a Longitudinal, Population-Based Dataset.","authors":"Eugene Declercq,Chia-Ling Liu,Howard J Cabral,Ndidiamaka Amutah-Onukagha,Sunah Hwang,Hafsatou Diop","doi":"10.1097/aog.0000000000006071","DOIUrl":"https://doi.org/10.1097/aog.0000000000006071","url":null,"abstract":"OBJECTIVETo estimate the association between pregnancy-associated death or severe maternal morbidity and infant outcomes.METHODSWe conducted a retrospective cohort study using Massachusetts statewide data from 1999 to 2021. The dataset included hospital records longitudinally linked to births and maternal and infant death records. The primary exposures were pregnancy-associated death (deaths during pregnancy or in the year postpartum), severe maternal morbidity, and pregnancy-associated death after severe maternal morbidity. The main outcomes were infant death in the first year and, for those infants who survived, hospitalization in the first year of life. Bivariate and robust Poisson regression analyses through generalized estimating equations regression were used to estimate the association between the exposures and outcomes.RESULTSOf 1,617,054 live births in Massachusetts between 1999 and 2020, there were 474 pregnancy-associated deaths. Pregnancy-associated death ratios were highest among individuals who were aged 40 years or older (49.3/100,000), who were non-Hispanic Black (43.0/100,000), who had public insurance (51.1/100,000), or who had a parity of four or more (80.6/100,000). Among individuals experiencing severe maternal morbidity (745.3/100,000), those who had a hospital encounter associated with opioid use (721.2/100,000) or a documented prepregnancy comorbidity (200.7/100,000) had the highest pregnancy-associated death ratios. In cases of pregnancy-associated death, the infant mortality rate per 1,000 live births was 55.0 (95% CI, 34.9-75.2) compared with 4.0 (95% CI, 3.9-4.1) when the mother survived. When the pregnancy-associated death followed severe maternal morbidity, the infant mortality rate was 87.9 per 1,000 live births (95% CI, 29.7-146.1). After a pregnancy-associated death, when a full-term infant survived to 1 year of age, there was a 35% greater likelihood of rehospitalization in the first year of life (adjusted risk ratio 1.35, 95% CI, 1.01-1.82) than when the mother did not die.CONCLUSIONPregnancy-associated death was associated with infant death and worse health of surviving children in the first year of life, further demonstrating the far-reaching consequences of maternal deaths and the clear link between maternal and infant health.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"86 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140395","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":"Platelet-Rich Plasma for Genitourinary Syndrome of Menopause in Breast Cancer Survivors.","authors":"Anita H Chen,Emanuel C Trabuco,Saranya Chumsri,Jacqueline M Thielen,Jeffrey L Cornella,Shane A Shapiro,Michael G Heckman,Reagan E Dukes,Jennifer R Arthurs,Sophia G Blumenfeld,Johnny Yi","doi":"10.1097/aog.0000000000006081","DOIUrl":"https://doi.org/10.1097/aog.0000000000006081","url":null,"abstract":"OBJECTIVETo assess the safety and feasibility of injection of autologous platelet-rich plasma (PRP) into the vagina and posterior fourchette and to evaluate 6-month efficacy for treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors.METHODSWe conducted a prospective, single-arm pilot study of breast cancer survivors (stage 0-III) who reported vaginal dryness with or without dyspareunia. Participants underwent a one-time treatment with 7 mL autologous PRP injected throughout the vaginal canal and posterior fourchette into 35 sites. The primary outcome was to assess safety and feasibility. Secondary outcomes included VMI (Vaginal Maturation Index), VHI (Vaginal Health Index), VAS/VuAS (Vaginal and Vulvar Assessment Scales), DIVA (Day-to-Day Impact of Vaginal Aging questionnaire), FSFI (Female Sexual Function Index), and UDI-6 (Urogenital Distress Inventory-Short Form) scores. Vaginal caliber was measured with silicone dilators. Patient Global Impression of Improvement (PGI-I) was assessed with a 7-point Likert scale.RESULTSTwenty participants were treated; mean±SD age and body mass index (BMI) were 53.6±7.5 years and 27.2±4.6, respectively. Most had hormone receptor-positive breast cancer (85.0%), and of those, 65.0% were taking an aromatase inhibitor. All participants completed the planned protocol. Treatment adverse events included vaginal spotting, irritation, discharge, burning, cramping, and mild pain, all resolving within 24 hours. No serious adverse events occurred. VAS/VuAS, FSFI, UDI-6, DIVA, VHI, and total scores showed significant improvement from baseline to 6 months; the VMI change was nonsignificant. At 6 months, 90.0% of patients had an increase in vaginal caliber as measured by change in dilator size, and 95.0% noted improvement of symptoms on PGI-I.CONCLUSIONA single treatment of autologous PRP injected diffusely through the vaginal canal and posterior fourchette is safe and feasible. In this uncontrolled pilot trial, at 6 months, treatment significantly improved GSM symptoms, sexual function, urinary symptoms, and quality of life in breast cancer survivors, including those on aromatase inhibitors.CLINICAL TRIAL REGISTRATIONClnicalTrials.gov, NCT04535323; Cancer.gov, NCT04535323.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"2 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083634","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}