Obstetrics and gynecology最新文献

{"title":"Uterine Transposition for Fertility Preservation and Ovarian Conservation in Patients Undergoing Pelvic Radiotherapy.","authors":"Shant Apelian, Adriana Vest, Maya Yasukawa, Jody Wellcome, Adrian Kohut, Anthony N Imudia, Richard Tuli, Matthew L Anderson, Thomas Rutherford, Vaagn Andikyan","doi":"10.1097/AOG.0000000000005954","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005954","url":null,"abstract":"<p><p>Because pelvic malignancies and their treatments often compromise reproductive potential, the need for effective fertility preserving strategies has become increasingly important. Although traditional options offer varying success, most do not aim to maintain uterine reproductive function. Uterine transposition is an innovative surgical technique designed to preserve fertility by safeguarding both the uterus and ovaries in patients undergoing pelvic radiotherapy. This approach involves temporarily repositioning the uterus and ovaries outside the radiation field, with reimplantation after treatment. Since its first successful use in 2015, uterine transposition has been used across different types of cancer and age groups, including prepubertal patients. Early clinical outcomes have been promising, with high rates of ovarian function preservation, menstrual resumption, and successful pregnancies, including spontaneous fertilizations. Additionally, the procedure has demonstrated an acceptable safety profile, with most complications being minor and manageable, although concerns remain regarding uterine ischemia and vascular integrity postreimplantation. The overall findings support its potential as a viable fertility preserving option. However, further research is necessary to refine patient selection, evaluate long-term reproductive outcomes and complications, and address challenges related to uterine perfusion and implantation.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560700","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":"Urinary Incontinence and Menopausal Symptom Burden.","authors":"Erica Qiao, Haley Burns, Maria I Rodriguez, Sara B Cichowski","doi":"10.1097/AOG.0000000000005994","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005994","url":null,"abstract":"<p><p>Urinary incontinence (UI) is a common midlife symptom that often co-occurs with other menopausal changes. In this cross-sectional survey of 2,084 Oregon residents (approximately 30% rural), 45.8% reported UI. Menopause symptoms burden, measured by the Menopause Rating Scale, was higher for every UI subtype (all P<.001). Moderate-to-severe menopause burden increased adjusted odds of stress, urgency, and mixed UI 2-fold to 13-fold (P<.001). Reported evaluation and treatment rates were low across all UI subtypes (2.0-14.6%), and it remains unclear how often participants were screened or asked about symptoms by health care professionals. This highlights the need to address both actual and perceived gaps in menopause and continence care through proactive, patient-centered screening.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560699","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":"Coding, Billing, and Clinician Training for Detailed Fetal Anatomy Ultrasound in the First Trimester.","authors":"","doi":"10.1097/AOG.0000000000006006","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006006","url":null,"abstract":"<p><p>This Clinical Practice Update provides revised guidance on the coding, billing, and training for detailed fetal anatomy ultrasound in the first trimester. This document is a focused update of related content in Practice Bulletin No. 175, Ultrasound in Pregnancy (Obstet Gynecol 2016;128:e241-56).</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560693","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":"Living Donor Uterus Transplantation.","authors":"Masato Tamate, Giuliano Testa, Laura Divine, Johanna Bayer, Liza Johannesson","doi":"10.1097/AOG.0000000000005987","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005987","url":null,"abstract":"<p><strong>Background: </strong>For women with absolute uterine factor infertility, uterus transplantation represents the closest solution to normal gestation and delivery. It is a temporary transplant; the uterine graft is removed after completion of childbearing. The uterus transplant journey involves multiple surgical and medical steps.</p><p><strong>Technique: </strong>The surgical steps include living or deceased donor hysterectomy, transplant of the uterine graft, cesarean delivery, and graft hysterectomy. The medical steps include immunosuppressive treatment, in vitro fertilization, and pregnancy. In this video, we show a living donor uterus transplant, including donor hysterectomy, back-table preparation of the uterine graft, and recipient transplant surgery. The video highlights the surgical steps of the procedure.</p><p><strong>Experience: </strong>Between September 2016 and January 2025, 36 women underwent uterus transplantation at Baylor University Medical Center, resulting in the birth of 26 children to date.</p><p><strong>Conclusion: </strong>Uterus transplantation is associated with successful births of healthy children.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560695","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":"https://doi.org/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":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","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":"Peripartum Urinary Incontinence and Overactive Bladder.","authors":"Moiuri Siddique, Lisa Hickman, Lauren Giugale","doi":"10.1097/AOG.0000000000005993","DOIUrl":"https://doi.org/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":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","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":"Gestational Weight Gain and Hypertensive Disorders of Pregnancy With Prepregnancy and Early Pregnancy Glucagon-Like Peptide-1 Receptor Agonist Exposure.","authors":"Nishita Pondugula, Jennifer F Culhane, Lisbet S Lundsberg, Caitlin Partridge, Audrey A Merriam","doi":"10.1097/AOG.0000000000005995","DOIUrl":"10.1097/AOG.0000000000005995","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the associations among peripregnancy glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure with hypertensive disorders of pregnancy (HDP) and gestational weight gain.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study that included patients who delivered between 2014 and 2024 and had GLP-1RA exposure up to 1 year before pregnancy. Participants were identified through electronic medical record query with manual medical record abstraction to confirm exposure stop dates. Exposure to GLP-1RAs was classified by indication: pregestational diabetes mellitus or weight management. Unexposed control groups for each indication cohort were identified from an existing institutional data repository from 2021 to 2022. Demographic and clinical characteristics and obstetric outcomes were compared. The two primary outcomes were gestational weight gain and HDP. Gestational weight gain was quantified as below, meeting, or exceeding recommended gestational weight gain. Crude odds ratios and adjusted odds ratios (aORs) were estimated using multivariable modeling. Regression analysis was stratified as GLP-1RA exposure prepregnancy only or during pregnancy.</p><p><strong>Results: </strong>We included 243 patients who were exposed to GLP-1RA up to 1 year before pregnancy, with 65.4% having evidence of use during pregnancy. Overall, 103 (42.4%) patients used GLP-1RA for pregestational diabetes and 140 (57.6%) patients used it for weight management, compared with 175 unexposed patients in the pregestational diabetes control group and 200 unexposed patients in the weight-management control group (body mass index [BMI] 30-39.9: n=100; BMI 40 or higher: n=100). Exposure to GLP-1RAs was not associated with gestational weight gain in the pregestational diabetes cohort but was associated with decreased odds of gestational weight gain below recommendations (aOR 0.38, 95% CI, 0.18-0.80) in the weight-management cohort. Exposure to GLP-1RAs was associated with lower odds of HDP when compared with unexposed individuals with pregestational diabetes (aOR 0.52, 95% CI, 0.30-0.90) and with unexposed individuals who were undergoing weight management (aOR 0.51, 95% CI, 0.30-0.87). These associations were slightly more robust among patients exposed during pregnancy.</p><p><strong>Conclusion: </strong>In individuals undergoing weight management, peripregnancy GLP-1RA exposure was associated with decreased risk of gestational weight gain below recommendations, which may reflect rebound weight gain after cessation. Peripregnancy GLP-1RA exposure was associated with lower odds of developing HDP for both the pregestational diabetes and weight-management cohorts. Additional studies are needed to guide GLP-1RA use in pregnancy and to better elucidate any risks of exposure.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560694","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":"Transgender Vulvar and Clitoral Anatomy: A Guide for Gynecologists.","authors":"Sara Rahman, Cecile A Ferrando","doi":"10.1097/AOG.0000000000005973","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005973","url":null,"abstract":"<p><strong>Background: </strong>It is important for gynecologists to understand postoperative anatomy to provide inclusive and competent care to patients who have undergone gender-affirming vaginoplasty. The neoclitoris and neovula differ from cisgender anatomy. This article and associated video address these knowledge gaps to enhance gynecologic care for transgender patients.</p><p><strong>Technique: </strong>We review the steps of penile inversion vaginoplasty, focusing on the creation of the neoclitoris and neovulva. The key differences and similarities between cisgender and transgender clitoral anatomy are highlighted. A detailed examinator of the neurovascular components emphasizes their role in sensation and function.</p><p><strong>Experience: </strong>The senior author, a board-certified urogynecologist, has performed nearly 300 vulvoplasty and vaginoplasty procedures. Many transgender patients face barriers to competent gynecologic care. We created this video to bridge those gaps by enhancing gynecologist's understanding of gender-affirming surgery and postoperative anatomy.</p><p><strong>Conclusion: </strong>A thorough understanding of transgender anatomy and function enables gynecologists to provide high-quality care in an inclusive and supportive environment.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507175","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":"Goals and Priorities of Community Members Regarding the Federally Mandated Medicaid Sterilization Policy.","authors":"Kavita Shah Arora, Suzanna Larkin, Jessie Milne, Gloria Carmona Clavijo, Quiara Shade, Susie Williamson, Susan Dorr Goold","doi":"10.1097/AOG.0000000000005988","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005988","url":null,"abstract":"<p><strong>Objective: </strong>To describe the opinions of community members who are potentially eligible for Medicaid insurance regarding the 30-day sterilization waiting period.</p><p><strong>Methods: </strong>This mixed-methods study consisted of 10 informed deliberation sessions with 85 Michigan residents with low income (aged 21-51 years) between April and June 2024 to explore and describe their thoughts about the waiting period and suggested revisions to the policy. The deliberation sessions included policy education, expert questions and answers, facilitator-led discussion, and a small-group exercise on potential policy options. Participants completed presurveys and postsurveys measuring knowledge and opinions about contraception and the Medicaid sterilization policy and validated scales regarding contraceptive autonomy, health care experience, and discrimination.</p><p><strong>Results: </strong>Deliberators favored replacing the current policy with a revised policy that includes a reduced or eliminated waiting period that applies to all individuals, not solely to those with Medicaid insurance. They also recommended revising the informed consent process for clarity, accessibility, openness to discussion, and timeliness.</p><p><strong>Conclusion: </strong>Groups with low income who engaged in informed deliberations recommended replacing the current policy, indicating that the policy does not serve the goals of the communities most affected.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507161","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":"Influenza Vaccination During Pregnancy and Infant Influenza in the First 6 Months of Life.","authors":"Ousseny Zerbo, Sharareh Modaressi, Kristin Goddard, Bruce Fireman, Nicola P Klein","doi":"10.1097/AOG.0000000000005986","DOIUrl":"10.1097/AOG.0000000000005986","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of influenza vaccination during pregnancy against influenza in infants during their first 6 months of life.</p><p><strong>Methods: </strong>We conducted a cohort study among pregnant individuals enrolled in Kaiser Permanente Northern California (KPNC) and their infants. We followed all infants from birth until the first occurrence of a polymerase chain reaction test result positive for influenza, the infant reached age 6 months, death, disenrollment from KPNC, or the end of the study on December 31, 2022. We used Cox regression to compare the hazard of influenza in infants whose mothers were vaccinated against influenza during pregnancy with those whose mothers were unvaccinated. Hazard ratios (HRs) were adjusted for calendar time, maternal sociodemographic and comorbidities. Vaccine effectiveness was calculated as 100% (1-adjusted HR). We evaluated the association between vaccination and infant influenza outcomes any time during pregnancy and by trimester of vaccination.</p><p><strong>Results: </strong>Of the 245,498 infants included in the study, 46.0% were born to vaccinated mothers. The incidence of influenza was lower among infants of vaccinated mothers than unvaccinated mothers (0.12% vs 0.30%). After adjusting for covariates, vaccination during pregnancy was associated with a reduction in infant influenza in any clinical setting by 44.4% (95% CI, 31.4-54.9%). Vaccination during the first trimester was associated with a reduction in infant influenza by 11.3%, a reduction of 51.5% during the second trimester, and a reduction of 59.3% during the third trimester. The differences in vaccine effectiveness estimates that compared the first and second trimesters ( P =.02) and compared the first and third trimesters ( P <.001 were statistically significant.</p><p><strong>Conclusion: </strong>Influenza vaccination during pregnancy was associated with a reduction in infant influenza infection by 44.4%. The reduction in infant influenza infection was greater when vaccination occurred in the second or third trimester, compared with the first trimester.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e36-e42"},"PeriodicalIF":5.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507162","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}