Obstetrics and gynecology最新文献

{"title":"Use of Atropine, Ondansetron, and Ketorolac in Suspected Amniotic Fluid Embolism.","authors":"Luis D Pacheco,Shannon M Clark,Karin Fox,Melissa E Bauer,Steven L Clark","doi":"10.1097/aog.0000000000006095","DOIUrl":"https://doi.org/10.1097/aog.0000000000006095","url":null,"abstract":"Amniotic fluid embolism (AFE) is a rare, life-threatening obstetric event associated with extremely high maternal and perinatal morbidity and mortality with no known definitive pathophysiologic pathway. Current recommended management strategies are mainly supportive and include high-quality cardiopulmonary resuscitation and prompt delivery of the potentially viable fetus to improve neonatal survival and maternal resuscitation. More recently, case reports have described success in the resuscitation of patients with presumed AFE with a protocol that includes intravenous administration of atropine (1 mg), ondansetron (8 mg), and ketorolac (30 mg). The currently available evidence for the use of atropine, ondansetron, and ketorolac to treat AFE is limited, consisting of only case reports. As a result, the potential harms, including worsening of bleeding or coagulopathy, worsening kidney function, maternal tachycardia, cardiac arrhythmias, and myocardial injury, with the use of atropine, ondansetron, and ketorolac in cases of suspected AFE must be considered. We caution against the widespread use of this protocol for suspected cases of AFE and remind clinicians of the many disappointing histories of medical interventions later discredited. We recommend that adequately oxygenating, supporting blood pressure, treating heart failure, and aggressively managing coagulopathy remain the mainstays of therapy and should be recognized as the standard of care.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"104 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351851","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":"Use of Artificial Intelligence-Based Software to Aid in the Identification of Ultrasound Findings Associated With Fetal Congenital Heart Defects.","authors":"Jennifer Lam-Rachlin,Rajesh Punn,Sarina K Behera,Miwa Geiger,Matthias Lachaud,Nadine David,Sara Garmel,Nathan S Fox,Andrei Rebarber,Greggory R DeVore,Carolyn M Zelop,Matthew K Janssen,Kendra R Sylvester-Armstrong,John Kennedy,Jessica Spiegelman,Mia Heiligenstein,Roger Bessis,Sadia Mobeen,Farnaaz Kia,Caroline Friedman,Stephanie Melka,Bertrand Stos,Malo De Boisredon,Eric Askinazi,Valentin Thorey,Christophe Gardella,Marilyne Levy,Alisa Arunamata","doi":"10.1097/aog.0000000000006087","DOIUrl":"https://doi.org/10.1097/aog.0000000000006087","url":null,"abstract":"OBJECTIVETo evaluate whether artificial intelligence (AI)-based software was associated with enhanced identification of eight second-trimester fetal ultrasound findings suspicious for congenital heart defects (CHDs) among obstetrician-gynecologists (ob-gyns) and maternal-fetal medicine specialists.METHODSA dataset of 200 fetal ultrasound examinations from 11 centers, including 100 with at least one suspicious finding, was retrospectively constituted (singleton pregnancy, 18-24 weeks of gestation, patients aged 18 years or older). Only examinations containing two-dimensional grayscale cines with interpretable four-chamber, left ventricular outflow tract, and right ventricular outflow tract standard views were included. Seven ob-gyns and seven maternal-fetal medicine specialists reviewed each examination in randomized order both with and without AI assistance and assessed the presence or absence of each finding suspicious for CHD with confidence scores. Outcomes included readers' performance in identifying the presence of any finding and each finding at the examination level, as measured by the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity. In addition, reading time and confidence were evaluated.RESULTSThe detection of any suspicious finding significantly improved for AI-aided compared with unaided readers with a significantly higher AUROC (0.974 [95% CI, 0.957-0.990] vs 0.825 [95% CI, 0.741-0.908], P=.002), sensitivity (0.935 [95% CI, 0.892-0.978] vs 0.782 [95% CI, 0.686-0.878]), and specificity (0.970 [95% CI, 0.949-0.991] vs 0.759 [95% CI, 0.630-0.887]). AI assistance also resulted in a significant decrease in clinician interpretation time and increase in clinician confidence score (226 seconds [95% CI, 218-234] vs 274 seconds [95% CI, 265-283], P<.001; 4.63 [95% CI, 4.60-4.66] vs 3.90 [95% CI, 3.85-3.95], P<.001, respectively).CONCLUSIONThe use of AI-based software to assist clinicians was associated with enhanced identification of findings suspicious for CHD on prenatal ultrasonography.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"111 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305396","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. 21: Access to Contraception.","authors":"","doi":"10.1097/aog.0000000000006075","DOIUrl":"https://doi.org/10.1097/aog.0000000000006075","url":null,"abstract":"Access to desired contraception is essential to the health and well-being of those who can get pregnant; a reproductive justice framework that acknowledges the interconnectedness of social and structural forces on sexual and reproductive health is key to the equitable provision of contraception to all patients. Obstetrician-gynecologists should be aware of social and structural barriers to care and the potential for bias and be prepared to address the most common misperceptions about contraceptive methods in a way that is age appropriate and compatible with the patient's health literacy. Payers (state, federal, and private insurance), hospitals, and health care systems should include all U.S. Food and Drug Administration-approved methods on formulary and should ensure access to all contraceptive methods without cost sharing or copays.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"104 1","pages":"e88-e97"},"PeriodicalIF":7.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305404","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":"Extended-Release Buprenorphine for Treatment of Opioid Use Disorder During Pregnancy and Postpartum.","authors":"Nia Bhadra-Heintz,Rebecca Schapiro,Navid Roder,Emily Casey,Julia Carney,Judy Chertok,Margaret Lowenstein","doi":"10.1097/aog.0000000000006091","DOIUrl":"https://doi.org/10.1097/aog.0000000000006091","url":null,"abstract":"Buprenorphine use in pregnancy and postpartum for individuals with opioid use disorder (OUD) decreases maternal and fetal morbidity and mortality. Extended-release buprenorphine overcomes barriers to sublingual buprenorphine, but very limited data are available regarding use in the perinatal period. We aimed to describe extended-release buprenorphine uptake and associated recovery and pregnancy outcomes in a case series of 15 pregnant and postpartum individuals with OUD. Reasons for extended-release buprenorphine initiation included nausea, burdensome multiple daily dosing of sublingual buprenorphine, and persistent cravings. Postinitiation, all patients demonstrated increased buprenorphine adherence, total cessation of nonprescribed opioids, and a reduction in other substance use. There were no identified maternal or neonatal side effects. Our data provide early evidence for safety, adherence, and reduced substance use among perinatal patients with OUD treated with extended-release buprenorphine.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"2 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305399","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":"Gestational and Pregestational Diabetes Screening Changes in Early Pregnancy and Perinatal Outcomes.","authors":"Mara Greenberg,Yeyi Zhu,Jun Shan,Monique M Hedderson,Amanda Ngo,Charles P Quesenberry,Assiamira Ferrara","doi":"10.1097/aog.0000000000006090","DOIUrl":"https://doi.org/10.1097/aog.0000000000006090","url":null,"abstract":"OBJECTIVETo evaluate an initiative to decrease gestational diabetes (GDM) screening rates before 24 weeks of gestation and to increase early-pregnancy hemoglobin A1C (Hb A1C) testing for undiagnosed pregestational diabetes and the association of this change with perinatal complications.METHODSAll patients with live births and without overt diabetes who delivered between 2018 and 2022 were included. We performed an interrupted time series analysis to examine perinatal outcomes associated with the recommended changes. To reflect the level of exposure to recommended changes that started April 2020, delivery dates were categorized into three time periods: T1, unexposed (January 1, 2018-March 31, 2020); T2, partially exposed (April 1-December 31, 2020); and T3, fully exposed (January 1, 2021-December 31, 2022). The primary outcome was a composite including large-for-gestational-age birth weight, cesarean delivery, preeclampsia, severe maternal morbidity, preterm birth, shoulder dystocia, neonatal hypoglycemia, and neonatal intensive care unit admission.RESULTSAmong 221,068 delivering individuals, early GDM screening rates decreased from 31.1% in T1 to 20.6% in T2 and 4.3% in T3 (standardized mean difference [SMD] T3 vs T1, -0.75), and Hb A1C testing increased from 12.3% to 23-35.2% (SMD T3 vs T1, 0.56). There was no change in the prevalence of the composite primary outcome: 43.1% in T1, 44.2% in T2, and 45.2% in T3 (SMD T3 vs T1, 0.04). Interrupted time series analysis adjusted for covariates showed no change in risk of the composite outcome during T1 (percent change/4 weeks, 0.06 [95% CI, -0.01 to 0.13]), T2 (0.02 [95% CI, -0.21 to 0.25]), or T3 (-0.02 [95% CI, -0.26 to 0.23]).CONCLUSIONA decrease in early GDM screening accompanied by increased early Hb A1C testing did not influence perinatal outcomes.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"46 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305398","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":"Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence.","authors":"","doi":"10.1097/aog.0000000000006102","DOIUrl":"https://doi.org/10.1097/aog.0000000000006102","url":null,"abstract":"This Clinical Practice Update provides new guidance on the use of sexual partner therapy in the management of bacterial vaginosis based on new research findings and a growing body of evidence implicating sexual activity as an important method of infection transmission. This document is a focused update of related content in Practice Bulletin No. 215, Vaginitis in Nonpregnant Patients (Obstet Gynecol 2020;135:e1-17).","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305397","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":"Recurrence of High-Grade Vulvar Intraepithelial Neoplasia After Treatment With Excision Compared With Imiquimod.","authors":"Hadley Reid,Stephanie Alimena,Andrea Pelletier,Georgia Seidman,Lawrence Hsu Lin,Shuk On Annie Leung,Carlos Parra Herran,Sarah Feldman","doi":"10.1097/aog.0000000000006094","DOIUrl":"https://doi.org/10.1097/aog.0000000000006094","url":null,"abstract":"OBJECTIVETo evaluate long-term recurrence rates and time to first recurrence for human papillomavirus (HPV)-associated high-grade vulvar intraepithelial neoplasia (VIN) by initial treatment.METHODSThis was a retrospective cohort study of patients treated with excision, imiquimod, or laser for HPV-associated VIN grade 2-3 at a high-risk colposcopy center. We collected demographic, clinical, and longitudinal pathology data. Given the small number (n=15), the cohort of patients treated with laser were excluded from analyses. We performed χ2 and Wilcoxon rank-sum tests to compare the rates of recurrence and median time to first recurrence by treatment modality. Univariate and multivariate analyses were conducted to compare predictors of recurrence and time to recurrence. Multivariate models were adjusted for side effects or barriers to imiquimod use, lesion focality, and initial histology based on significant findings in the univariate models.RESULTSThree hundred fifteen patients met the criteria for inclusion, 231 treated with excision and 84 with imiquimod. Median follow-up time from initial diagnosis was 36 months. Recurrence rates and median time to recurrence with imiquimod (40.5% and 7.4 months) and excision (34.6% and 11.3 months, P=.34, P=.38) did not differ significantly. In univariate analysis, positive margins (odds ratio [OR] 4.68, 95% CI, 2.53-8.62), multifocal disease (OR 2.27, 95% CI, 1.19-4.33), and presence of carcinoma in situ on initial diagnosis (OR 6.21, 95% CI, 1.45-26.6) were predictors of recurrence after excision. Only the presence of side effects or barriers to imiquimod use (OR 2.46, 95% CI, 1.01-6.02) was significant in the univariate model for recurrence after imiquimod. No significant difference remained for the odds of recurrence after treatment with imiquimod compared with excision in the multivariate model (OR 1.28, 95% CI, 0.77-2.14); there was similarly no significant difference in the multivariate model of time to recurrence (hazard ratio 1.41, 95% CI, 0.86-2.30).CONCLUSIONIn appropriately selected patients, imiquimod appears to have outcomes similar to those of excision for the prevention of recurrent HPV-associated VIN.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"9 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305731","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":"Zuranolone and Brexanolone for the Treatment of Postpartum Depression.","authors":"","doi":"10.1097/aog.0000000000006093","DOIUrl":"https://doi.org/10.1097/aog.0000000000006093","url":null,"abstract":"This Clinical Practice Update provides revised guidance on the use of brexanolone and zuranolone in the postpartum period for depression that has onset in the third trimester or within 4 weeks postpartum. This document is a focused update of related content in Clinical Practice Guideline No. 5, Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum (Obstet Gynecol 2023;141:1262-88) and replaces the August 2023 Practice Advisory, Zuranolone for the Treatment of Postpartum Depression.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"85 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254580","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":"Clinician Perspectives on Navigating Conversations Around Racial Disparities in Obstetrics.","authors":"Eileen Wang-Koehler,Oluwadamilola Oshewa,Sindhu K Srinivas,Abike T James,Rebecca F Hamm","doi":"10.1097/aog.0000000000006085","DOIUrl":"https://doi.org/10.1097/aog.0000000000006085","url":null,"abstract":"OBJECTIVEDiscussions around racial disparities in obstetrics occur in varied silos including the media, communities, and medical institutions. Yet, whether and how these discussions occur in the context of the patient-clinician relationship is unknown. We sought to explore clinician perspectives on conversations with patients regarding racial disparities in maternal health using a qualitative approach.METHODSWe enrolled perinatal clinicians (N=14) across two hospitals within one academic health system from August 2023 to March 2024, purposively sampled by self-identified race or ethnicity and role until thematic saturation was achieved. Semistructured interviews using the Health Equity Implementation Framework evaluated prior experience with and optimization of disparities counseling, focusing on patient-clinician race concordance, comfort levels, barriers, ideal circumstances, and recommended content for conversations about racial disparities in maternal health. Interviews were coded with a content analysis approach by two coders with high interrater reliability (κ>0.8).RESULTSClinicians universally recognized the effect of race, specifically racism, on U.S. maternal outcomes. Conversations about racial disparities most frequently arose 1) when Black patients voiced fears of dying or concerns about bias in their care or 2) in the context of recommending aspirin for preeclampsia risk reduction. Black clinicians felt more comfortable with these discussions, attributed to lived experience and practice. Although most clinicians agreed that conversations with patients about racial disparities are important, they identified barriers such as fear of patient reactions (particularly with discordant race), time constraints, and unclear actionable response.CONCLUSIONOur findings, along with ongoing work on the patient perspective, highlight the need for respectful, informed conversations centering patient experiences. As awareness of racial disparities grows, perinatal clinicians must develop capabilities for discussing race constructively, practicing relationship-centered care, and promoting psychologic safety for Black patients.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"22 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209194","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 in Patients With Cystic Fibrosis.","authors":"Beth L Pineles,Raksha Jain,Traci M Kazmerski,Jennifer L Taylor-Cousar,Christina Chambers,Kimberly L Foil,Andrea H Roe,Sylvia E Szentpetery","doi":"10.1097/aog.0000000000006084","DOIUrl":"https://doi.org/10.1097/aog.0000000000006084","url":null,"abstract":"Cystic fibrosis (CF) is an autosomal recessive, monogenic disorder that affects individuals of all races and ethnicities. It was historically viewed as a pediatric disease, but with comprehensive care and therapeutic advances, adults with CF now outnumber children living with CF in the United States, and the median predicted life expectancy is approximately 61 years. Since 2010, a new drug class called CF transmembrane conductance regulator (CFTR) modulators has emerged and led to improved health outcomes for most people with CF in the United States. These new medications have likely contributed to a doubling of pregnancies among women with CF in recent years. In the setting of increased fertility, people with CF should consider contraception when pregnancy is not desired. For people with CF who are seeking pregnancy, preconception consultation with expertise in maternal-fetal medicine and genetics and a dedicated CF team is important because of the increased morbidity among pregnant people with CF. Breastfeeding is possible and encouraged when taking CFTR modulators, although the pediatrician should monitor the infant for possible side effects given established transfer through breast milk. Single-gene noninvasive prenatal testing is emerging and offers a new strategy to screen for fetal CF, which is increasingly important with emerging evidence that transplacental transfer of CFTR modulators may delay, prevent, or reverse multiple CF manifestations for the fetus with CF. Research is ongoing to study pregnancy and parenthood in the modern era in people with CF.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"32 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209197","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}