Obstetrics and gynecology最新文献

{"title":"Maternal and Neonatal Hemorrhage From Vitamin K Deficiency in the Setting of Crohn Disease in Pregnancy.","authors":"Sydney Lammers, Nicholas A Iovino, Antoinette Pusateri, Andrea Snyder, Madalina Butnariu, Heather A Frey, Jacob Skeans","doi":"10.1097/AOG.0000000000005870","DOIUrl":"10.1097/AOG.0000000000005870","url":null,"abstract":"<p><strong>Background: </strong>Patients with inflammatory bowel disease, particularly Crohn disease (CD), are at increased risk of fat malabsorption and fat-soluble vitamin deficiencies. Vitamin K is a fat-soluble vitamin that plays a critical role in blood coagulation. Vitamin K deficiency during pregnancy can lead to severe maternal and neonatal hemorrhagic complications.</p><p><strong>Case: </strong>We report the case of a patient with severe CD requiring extensive bowel resection who acquired vitamin K deficiency during pregnancy. During pregnancy, the patient experienced epistaxis, easy bruising, and intermittent gum bleeding. The patient and neonate experienced significant hemorrhagic morbidity secondary to vitamin K deficiency after cesarean delivery at 35 3/7 weeks of gestation for nonreassuring fetal well-being.</p><p><strong>Conclusion: </strong>Vitamin K deficiency is a rare complication of CD that can result in life-threatening maternal and neonatal outcomes. Clinicians caring for patients with severe CD with prior bowel resection and risk factors for fat malabsorption should consider screening for vitamin K deficiency during pregnancy.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e127-e130"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573533","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":"Diagnosis and Management of Carpal Tunnel Syndrome During Pregnancy.","authors":"Molly E Milano, Margaret V Pennington, Asif M Ilyas","doi":"10.1097/AOG.0000000000005845","DOIUrl":"10.1097/AOG.0000000000005845","url":null,"abstract":"<p><p>Carpal tunnel syndrome (CTS) represents a constellation of symptoms that can occur as a result of compression of the median nerve as it traverses through a constrained space at the level of the wrist. It is the most common compressive mononeuropathy in the human body. Patients frequently present with similar history and physical examination findings, most commonly consisting of numbness of the hand that is worse at nighttime. Although CTS is one of the more common conditions seen by hand, orthopedic, or plastic surgeons, patients often first report symptoms to their primary or obstetric care clinician. In this review, we describe the pathophysiology of CTS in pregnant patients, summarize the best methods for diagnosing this condition, and review the recommended treatment options. This review provides a practical strategy that can be used by both primary care and obstetric care clinicians in diagnosing and treating pregnant patients with CTS.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"439-448"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365371","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":"Diagnostic Algorithms for Adnexal Masses in the Hands of a Novice Operator.","authors":"Luigi A De Vitis, Gabriella Schivardi, Leah Grcevich, Ilaria Capasso, Diletta Fumagalli, Sarju Dahal, Antonio Lembo, Daniel M Breitkopf, Shannon K Laughlin-Tommaso, Angela J Fought, Noah E Johnson, Melanie P Caserta, Jennings J Clingan, Giovanni D Aletti, Andrea Mariani, Annie T Packard, Carrie L Langstraat","doi":"10.1097/AOG.0000000000005853","DOIUrl":"10.1097/AOG.0000000000005853","url":null,"abstract":"<p><strong>Objective: </strong>To compare the performance of four commonly used algorithms to differentiate benign from malignant adnexal masses when used by a novice operator.</p><p><strong>Methods: </strong>Women with adnexal masses treated at Mayo Clinic, Rochester, Minnesota, in 2019 were identified retrospectively. Patients were included if they underwent surgery within 3 months of diagnosis or had at least 10 months of follow-up. A nonexpert operator (European Federation of Societies for Ultrasound in Medicine and Biology level I) classified each lesion using ADNEX (Assessment of Different Neoplasias in the Adnexa), two-step strategy (benign descriptors followed by ADNEX), O-RADS (Ovarian-Adnexal Reporting and Data System) 2019, and O-RADS 2022. The primary outcome measure was the area under the receiver operating characteristic curve (AUC) compared across the four algorithms.</p><p><strong>Results: </strong>A total of 556 women were included in the analyses: 452 with benign and 104 with malignant masses. The AUCs of ADNEX, the two-step strategy, O-RADS 2019, and O-RADS 2022 were 0.90 (95% CI, 0.87-0.94), 0.91 (95% CI,0.88-0.94), 0.88 (95% CI,0.84-0.91), and 0.88 95% CI, (0.84-0.91), respectively. The two-step strategy performed significantly better than the O-RADS algorithms ( P =.005 and P =.002). With all the algorithms, the observed malignancy rate was 1.9-2.2% among lesions categorized as almost certainly benign, twofold higher than the expected less than 1.0%. Lesions wrongly classified as almost certainly benign were borderline tumors (n=4) and metastases (n=3).</p><p><strong>Conclusion: </strong>In the hands of a novice operator, all algorithms performed well and were able to distinguish benign from malignant lesions. Although the two-step strategy performed slightly better than the O-RADSs, the difference did not appear to be clinically meaningful. The malignancy rate among lesions classified as almost certainly benign was unexpectedly high at 1.9-2.3%, approximately double the expected rate of less than 1.0%.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"368-376"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524008","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":"Fragmented Care and Guideline-Concordant Treatment in Locally Advanced Cervical Cancer.","authors":"Audrey Mvemba, Jessica Liang, Megan Swanson, Emi Yoshida, Stefanie Ueda, Katherine Fuh, Lee-May Chen, Stephanie Cham","doi":"10.1097/AOG.0000000000005869","DOIUrl":"10.1097/AOG.0000000000005869","url":null,"abstract":"<p><strong>Objective: </strong>To characterize and estimate rates of fragmented care, to investigate its association with the receipt of guideline-concordant treatment, and to evaluate treatment components at risk with fragmented care.</p><p><strong>Methods: </strong>This is a single-institution retrospective study of patients with locally advanced cervical cancer (stage IB3-IVA) from January 2003 to September 2023. We stratified patients into fragmented and nonfragmented care groups based on receipt of all care at our institution or if they received any component of care outside of our institution. The primary outcome, receipt of guideline-concordant treatment , was defined as a composite of 1) completion of treatment within 56 days, 2) completion of brachytherapy, and 3) receipt of concurrent chemotherapy. Demographic and treatment data were collected, including the Social Vulnerability Index (SVI), a census tract-based measure of disadvantage. Univariate and multivariate analyses were performed.</p><p><strong>Results: </strong>Two hundred eighty-six patients were identified; 75.5% received fragmented care. Those receiving nonfragmented care were significantly more likely to receive guideline-concordant treatment than those receiving fragmented care (71.4% vs 50.9%, P =.003). This was driven primarily by rates of timely completion (81.4% vs 60.6%, P =.001). Univariate analysis indicated that fragmented care (odds ratio [OR] 0.42, 95% CI, 0.23-0.74) and Medicaid insurance (OR 0.40, 95% CI, 0.20-0.78) were significantly associated with lower odds of guideline-concordant treatment. Multivariate analyses controlling for a priori confounders of insurance type and SVI showed that fragmented care (OR 0.45, 95% CI, 0.23-0.90) and Medicaid insurance (OR 0.42, 95% CI, 0.19-0.89) were independently associated with lower odds of guideline-concordant treatment. Multivariate analysis controlling for demographic covariates found even lower odds of receiving guideline-concordant treatment in those who received fragmented care (OR 0.39, 95% CI, 0.18-0.84) and who had Medicaid insurance (OR 0.35, 95% CI, 0.16-0.78).</p><p><strong>Conclusion: </strong>More than 75% of patients received fragmented care, which had a significant clinical effect and was associated with significantly lower rates of guideline-concordant treatment.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"387-394"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524010","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":"Vancomycin Concentrations in Umbilical Cord Blood After Intrapartum Exposure.","authors":"Sarah A Coggins, Kelly C Wade, Kevin M Watt, Kevin J Downes, Karen M Puopolo","doi":"10.1097/AOG.0000000000005843","DOIUrl":"10.1097/AOG.0000000000005843","url":null,"abstract":"<p><p>Little is known about the fetal-neonatal pharmacokinetics of maternally administered, weight-based vancomycin dosing for group B streptococcus (GBS) intrapartum antibiotic prophylaxis. Our objective was to quantify vancomycin concentrations in umbilical cord blood at birth after weight-based maternal intrapartum vancomycin administration and to assess cord blood vancomycin levels relative to the established GBS clinical minimum inhibitory concentration (MIC) breakpoint. Using a convenience sample of stored sera from our biorepository, we measured vancomycin levels in umbilical cord blood from 26 neonates after maternal intrapartum vancomycin exposure. Most neonates (24/26, 92.3%; 95% CI, 74.9-99.1%) had vancomycin cord blood levels above the MIC breakpoint (1 microgram/mL or higher) for GBS.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"435-438"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Comorbidities and Inpatient Postpartum Permanent Contraception Completion.","authors":"Mary D Carmody, Abby L Schultz, Kristen A Berg, Brooke W Bullington, Emily S Miller, Margaret Boozer, Tania Serna, Jennifer L Bailit, Kavita Shah Arora","doi":"10.1097/AOG.0000000000005844","DOIUrl":"10.1097/AOG.0000000000005844","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether comorbidities (defined as both medical conditions and peripartum complications) are associated with inpatient postpartum permanent contraception by tubal surgery completion.</p><p><strong>Methods: </strong>This is a secondary analysis of a multisite retrospective cohort study of patients who had documented plans for permanent contraception. Our primary outcome was inpatient completion of postpartum permanent contraception by tubal surgery. We used univariable and multivariable logistic regression analyses to examine associations between aggregate and individual comorbidities and the attainment of inpatient postpartum permanent contraception.</p><p><strong>Results: </strong>In this study of 2,226 pregnant people, 53.4% of patients received postpartum permanent contraception by the time of hospital discharge, and 70.8% of patients had documented comorbidities. Although patients with medical conditions initially had lower odds of permanent contraception completion compared with those without any comorbidities (adjusted odds ratio [aOR] 0.77, 95% CI, 0.64-0.93), this association was no longer significant after adjusting for multiple comparisons (adjusted P =.06). This association also was not significant for patients with peripartum complications (aOR 0.86, 95% CI, 0.64-1.16, adjusted P =.42). Similarly, when individual comorbidities were assessed, patients with hypertension (aOR 0.80, 95% CI, 0.65-0.97, adjusted P =.06), mental health diagnoses (aOR 0.80, 95% CI, 0.66-0.96, adjusted P =.06), and elevated body mass index (BMI, 40 or higher) (aOR 0.77, 95% CI, 0.63-0.95, adjusted P =.06) had no significant differences in odds of immediate permanent contraception attainment after adjusting for multiple comparisons.</p><p><strong>Conclusions: </strong>Though the balance of risks and benefits is imperative for surgical care, it is imperative that modifiable barriers to desired permanent contraception are mitigated. There were no statistically significant differences in inpatient postpartum permanent contraception attainment for patients with medical conditions in our study; however, further study is needed to better elucidate the complex relationships between medical comorbidities and contraception.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"395-401"},"PeriodicalIF":5.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143365317","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":"Association Between the Social Vulnerability Index and Adverse Pregnancy Outcomes.","authors":"Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade","doi":"10.1097/AOG.0000000000005890","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005890","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between the Social Vulnerability Index (SVI) and racial disparities in pregnancy outcomes across U.S. counties and to quantify these racial disparities.</p><p><strong>Methods: </strong>This was a cross-sectional study using restricted Centers for Disease Control and Prevention data sets, including natality data sets, fetal death data sets, and all-cause mortality data sets from 2016 to 2021. We limited analyses to Black or White individuals aged 15-44 years from 3,114 U.S. counties. Participants were categorized into quartiles based on county-level SVI. The primary outcome was maternal mortality rate while pregnant or within 42 days of the end of pregnancy, and secondary outcomes were pregnancy-related mortality while pregnant or within 365 days of the end of pregnancy, stillbirth, and preterm birth. Mixed-effect generalized linear models with negative binomial distribution were used to quantify disparities, using difference-in-difference analysis to measure the difference in outcomes between Black and White individuals across different levels of social vulnerability (first quartile as referent).</p><p><strong>Results: </strong>A total of 20,189,328 individuals were included, distributed across SVI quartiles as follows: first quartile 2,558,131, second quartile 4,945,774, third quartile 6,827,503, and fourth quartile 5,857,920. Black individuals experienced significantly higher rates of maternal mortality, pregnancy-related mortality, stillbirth, and preterm birth compared with White individuals regardless of SVI quartiles. Difference-in-difference analyses demonstrated that disparities in maternal mortality rate were significantly larger in the second, third, and fourth quartiles compared with the first quartile (difference-in-difference 14.22 [95% CI, 2.11-26.33], 12.53 [95% CI, 1.26-23.81], and 18.82 [95% CI, 6.67-30.98], respectively). A worsening disparity in pregnancy-related mortality was observed in the fourth quartile, whereas disparities in stillbirth and preterm birth did not show significant differences across SVI quartiles.</p><p><strong>Conclusion: </strong>Racial disparities in maternal mortality intensified in counties with higher social vulnerability. These findings underscore the need for targeted interventions to address social determinants of health.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730878","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":"Telehealth Medication Abortion: Comparing Advance-Provision Patients With Pregnant Patients.","authors":"Anna E Fiastro, Elissa Brown, Peyton Smith, Erin K Thayer, Rebecca Gomperts, Emily M Godfrey","doi":"10.1097/AOG.0000000000005886","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005886","url":null,"abstract":"<p><strong>Objective: </strong>To compare characteristics of patients ordering abortion medications from a telehealth service for potential future use (advance provision) with characteristics of patients ordering medications to terminate a current pregnancy.</p><p><strong>Methods: </strong>This cross-sectional study used electronic medical records from a U.S. clinician-supported asynchronous telehealth service to compare patient characteristics (including pregnancy status, age, number of children, race and ethnicity, social vulnerability, residential urbanicity, and reason for choosing telehealth) of individuals requesting abortion medications for future use with those of individuals ordering medications to terminate a current pregnancy in 25 U.S. states and the District of Columbia from August 2021 to March 2023. Comparisons were made with the Pearson χ 2 test and Wilcoxon rank-sum test ( P <.05).</p><p><strong>Results: </strong>During the 20-month period, 3,252 advance-provision patients and 21,317 pregnant patients received abortion medications from a clinician-supported telehealth service. Of advance-provision patients, 72.2% identified as White compared with 42.4% of pregnant patients ( P <.001). Mean ages for advance-provision patients and pregnant patients were 31 and 27 years, respectively ( P <.001). Fewer advance-provision patients (38.4%) resided in high-vulnerability counties compared with pregnant patients (48.7%) ( P <.001). The top reasons that patients chose advance provision included personal choice (81.0%) and concern for future legal restrictions (70.5%).</p><p><strong>Conclusion: </strong>We observed substantial demand for advance provision of abortion medications through telehealth throughout the year and across geographies; notable surges in demand were associated with key political events. Advance-provision patients differ from pregnant patients and do not represent the demographics of those who traditionally have limited access to abortion care. Advance provision of abortion medications through telehealth warrants further study as restrictions on abortion persist and service models shift away from reliance on in-person access to clinicians.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670516","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":"Efficacy of Fractionated Carbon Dioxide Laser for the Treatment of Genitourinary Syndrome of Menopause: A Systematic Review and Meta-analysis.","authors":"Raquel Vizán-Chaguaceda, Raquel Leirós-Rodríguez, Pablo Hernandez-Lucas","doi":"10.1097/AOG.0000000000005885","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005885","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the short-term effectiveness of fractional CO2 laser for the treatment of genitourinary syndrome of menopause.</p><p><strong>Data sources: </strong>Systematic review was performed of PubMed, Scopus, Web of Science, Cinhal, MEDLINE, and ClinicalTrials.gov.</p><p><strong>Methods of study selection: </strong>The included studies had to meet the following criteria: 1) The sample consisted exclusively of women diagnosed with genitourinary syndrome of menopause; 2) at least one group in the sample underwent treatment with fractional CO2 laser; 3) the control group received simulated fractional CO2 laser therapy, topical hormonal treatment, or a topical gel lubricant; 4) the studies evaluated outcomes related to sexual function, urinary symptoms, or the quality of the vaginal epithelium; and 5) the study design was a randomized controlled trial. The exclusion criterion specified that participants should not have a history of any type of cancer or prior treatment with a different type of laser.</p><p><strong>Tabulation, integration, and results: </strong>Two reviewers independently screened articles for eligibility and extracted data. Difference in mean differences and their 95% CIs were calculated as the between-group difference in means divided by the pooled SD. The I2 statistic was used to determine the degree of heterogeneity. The 11 articles included in the review had a group receiving fractional CO2 laser therapy and a control group receiving simulated fractional CO2 laser, topical hormonal treatment, or topical gel lubricant. The meta-analyses indicated that fractional CO2 laser is effective for improving sexual function through increased sexual desire, arousal, lubrication, orgasms, and sexual satisfaction; reducing pain during sexual activity (standardized mean difference 0.51, P=.021); and improving urinary function by reducing the frequency and magnitude of urinary leakage and frequency of urination (standardized mean difference 0.51, P<.001).</p><p><strong>Conclusion: </strong>Fractional CO2 laser is associated with statistically significant improvements in the short-term treatment of sexual and urinary symptoms but not vaginal epithelium quality. The clinical significance of these changes is unclear.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD42023435636.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Levonorgestrel-Releasing Intrauterine System Exposure Duration and Breast Cancer Incidence.","authors":"Jin-Sung Yuk, Myoung Hwan Kim, Sang Hee Yoon, Gwan Hee Han, Ji Hyun Noh","doi":"10.1097/AOG.0000000000005881","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005881","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between the duration of levonorgestrel-releasing intrauterine system (LNG-IUS) use and breast cancer risk in Korean women.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Korean National Health Insurance Claims database from 2013 to 2022. A total of 2,094,029 women aged 30-49 years with initial diagnoses of endometriosis, uterine leiomyomas, or abnormal uterine bleeding between 2014 and 2017 were included in the study. Propensity score matching was applied to create balanced cohorts of LNG-IUS users and nonusers. Cox proportional hazards models were used to evaluate the association between LNG-IUS exposure duration and breast cancer incidence.</p><p><strong>Results: </strong>A total of 61,010 women were included in the study cohort. The incidence rate of breast cancer in LNG-IUS group was 223 cases per 100,000 person-years compared with 154 cases per 100,000 person-years in the non-LNG-IUS group. Use of LNG-IUS was linked to an increased breast cancer risk (hazard ratio [HR] 1.38, 95% CI, 1.192-1.585). Analysis of LNG-IUS use over time suggests that early initiation is associated with an increased risk of breast cancer, which may decrease over time (less than 3 years: early HR 5.40, 95% CI, 4.037-7.216; less than 3 years: late HR 1.04, 95% CI, 0.547-1.994; 3-4.9 years: early HR 3.44, 95% CI; 2.671-4.431; 3-4.9 years: late HR 1.75, 95% CI; 1.12-2.723; 5 years or more: HR 1.77, 95% CI, 1.26-2.479).</p><p><strong>Conclusion: </strong>The LNG-IUS may be associated with an increased risk of breast cancer among women with abnormal uterine bleeding, endometriosis, or leiomyomas, with the risk being particularly elevated during the initial years of use.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625559","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}