Obstetrics and gynecology最新文献

{"title":"Hospital Context and Strategies for Cesarean Delivery Quality Improvement.","authors":"Michelle H Moniz, Shawna N Smith, Molly J Stout, Shelytia Cocroft, Jessi Ems, Jourdan Triebwasser, Alex F Peahl, Denise Parrish, Stephanie Ludlow, Marisa Wetmore, Megan Danielson, Daniel Almirall, Xilin Chen, Lisa Kane Low","doi":"10.1097/AOG.0000000000006448","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006448","url":null,"abstract":"<p><strong>Objective: </strong>To compare hospitals with lower nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates against those with higher rates, with a goal of identifying key organizational contextual factors and strategies for cesarean delivery quality improvement (QI) efforts.</p><p><strong>Methods: </strong>We conducted a comparative multiple case study of hospitals participating in the Obstetrics Initiative, a statewide quality collaborative funded by Blue Cross Blue Shield of Michigan and Blue Care Network. Hospitals with more than 1,000 annual births were purposively selected from sites with low cesarean delivery rates (defined as an NTSV cesarean delivery rate of 25% or lower) and those with high cesarean delivery rates (defined as a rate of 28% or higher) to represent diverse regions and health systems. In 2023, we conducted semi-structured key informant interviews during site visits from February to April. Data collection and analysis were guided by the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change's constructs and strategies. Qualitative content analysis was used to identify contextual barriers, facilitators, and hospital improvement strategies. Consolidated Framework for Implementation Research constructs with nonneutral associations in at least one third of sites were retained and classified as broadly influential and were assigned a quantitative rating (from -2, barrier, to +2, facilitator). Descriptive contextual scores were calculated by summing site-level construct ratings. Cross-case synthesis and thematic analysis were used to elucidate patterns across low- and high-rate hospitals.</p><p><strong>Results: </strong>We interviewed 110 clinicians and administrators across five hospitals with low cesarean delivery rates and 12 hospitals with high cesarean delivery rates. Fifteen contextual factors, which include 11 hospital conditions and four improvement processes, differentiated low-rate and high-rate hospitals. Compared with high-rate hospitals, low-rate hospitals had higher descriptive contextual scores, reflecting more frequent facilitators and fewer barriers. Hospitals with high cesarean delivery rates had differing combinations of barriers, suggesting that each faced a unique pattern of challenges. Thematically, low-rate sites demonstrated a higher perceived value of evidence-based medicine and cesarean delivery rate QI, more supportive leadership and structural characteristics, stronger cultures of collaboration and learning, and more robust processes for QI teaming, planning, engagement, and evaluation. We identified 28 core strategies consistently observed among hospitals with low rates and nine context-dependent strategies that may help address site-specific barriers.</p><p><strong>Conclusion: </strong>Lower NTSV cesarean delivery rates were associated with a more favorable organizational context and more robust improvement processes. The hospi","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183407","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":"Treatment Failure After Laparoscopic Radiofrequency Ablation Compared With Myomectomy.","authors":"Katherine S Brito, Michael Schembri, Ram Parvataneni, Shira Varon, Naghmeh Salamat-Saberi, Craig J Sobolewski, Soyini Hawkins, Nicole Williams, Shawn Tassone, Antoinette Allen, Vanessa L Jacoby, L Elaine Waetjen","doi":"10.1097/AOG.0000000000006444","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006444","url":null,"abstract":"<p><strong>Objective: </strong>To compare treatment failure and factors associated with failure between laparoscopic radiofrequency ablation (RFA) of leiomyomata and laparoscopic myomectomy.</p><p><strong>Methods: </strong>We analyzed data from the multicenter prospective ULTRA (Uterine Leiomyoma Treatment with Radiofrequency Ablation) study, which investigated laparoscopic RFA and laparoscopic myomectomy for symptomatic uterine leiomyomata. Our primary outcome was receipt of any subsequent procedure (surgical failure) for leiomyomata within 2 years of the procedure. Our secondary outcome was composite failure (surgical failure or any self-reported failure, eg, continued leiomyomata symptoms affecting quality of life) within 2 years of the procedure. Odds ratios (ORs) were generated from multivariable logit models adjusting for a priori selected covariates.</p><p><strong>Results: </strong>We identified significant baseline differences between our groups. The RFA group (n=231) was older and had higher body mass index (BMI), gravidity, and parity than the myomectomy group (n=110). In the RFA group, 15.2% experienced surgical failure compared with 3.8% in the myomectomy group (adjusted odds ratio [aOR] 4.17; 95% CI, 1.39-12.50), and 46.4% experienced composite failure in the RFA group compared with 25.5% in the myomectomy group (aOR 3.18; 95% CI, 1.80-5.60). Submucosal leiomyomata were associated with failure in the RFA group (OR 2.76; 95% CI, 1.21-6.28); there was a nonsignificant trend toward failure in the myomectomy group (OR 3.00; 95% CI, 0.99-9.05). Lateral leiomyomata were associated with higher odds of RFA failure (OR 2.49; 95% CI, 1.32-4.69), but no leiomyoma position was associated with myomectomy failure.</p><p><strong>Conclusion: </strong>Laparoscopic RFA of leiomyomata is associated with higher odds of surgical and composite failure compared with laparoscopic myomectomy at 2 years, even after adjusting for baseline differences between groups.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT02100904.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183357","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":"Trends in Hypertensive Disorders of Pregnancy Rates by Race and Ethnicity in the United States, 2016–2024","authors":"Ronald Anguzu,Anna Palatnik","doi":"10.1097/aog.0000000000006445","DOIUrl":"https://doi.org/10.1097/aog.0000000000006445","url":null,"abstract":"To evaluate contemporary trends in hypertensive disorders of pregnancy (HDP) prevalence by race and ethnicity, we conducted a cross-sectional study of 33,363,927 U.S. live births from 2016 through 2024 using National Vital Statistics System data. Age-standardized HDP rates increased by 74%, from 62.7 to 109.1 per 1,000 live births (average annual percent change 7.2%; p&lt;0.001), with an inflection point occurring in 2021. This increment occurred across all racial and ethnic groups, with the highest relative increases among non-Hispanic Asian (9.7% annually) and Multiracial individuals (7.9% annually). By 2024, absolute HDP rates were highest among non-Hispanic American Indian or Alaska Native individuals (143.7/1,000) and non-Hispanic Black individuals (132.7/1,000).","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"32 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088272","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":"Closing the Gap in Menopause Education","authors":"Laura Baecher-Lind,Carrie Champine,Katherine T. Chen,Silka Patel,Jonathan Schaffir,Shireen Madani Sims,Tammy Sonn,Alyssa Stephenson-Famy,Jill M. Sutton,Hedwige Saint Louis,Christine Kim,representing the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee (APGO UMEC)","doi":"10.1097/aog.0000000000006446","DOIUrl":"https://doi.org/10.1097/aog.0000000000006446","url":null,"abstract":"Menopause is a universal experience among women and all those seeking gynecologic care, yet most physicians—including obstetrician–gynecologists—report inadequate training on menopause-related care. As a result, people experiencing menopause often navigate the physical, social, and emotional challenges that accompany menopause on their own. The vacuum left by health care professionals in menopause care is increasingly filled by unregulated and potentially harmful recommendations from social media and the wellness industry. Medical educators in medical schools and residency programs must accelerate and amplify efforts in menopause education to ensure that health care professionals are able to meet the needs of patients seeking care for menopause-related concerns.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"26 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088271","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":"Racial and Ethnic Disparities in Treatment Initiation and Survival Among Patients With Endometrial Cancer","authors":"Yu Chen Lin,Omar Garcia-Rodriguez,Carol Boxtha,Kea Turner,Amir Alishahi Tabriz,Mian M. Shahzad,Jessica Y. Islam","doi":"10.1097/aog.0000000000006443","DOIUrl":"https://doi.org/10.1097/aog.0000000000006443","url":null,"abstract":"OBJECTIVE: To assess the associations of time to treatment initiation and overall survival with race and ethnicity by socioeconomic status (SES) among women with advanced endometrial cancer. We also aimed to evaluate the role of social and clinical determinants in time to treatment initiation and overall survival. METHODS: We conducted a retrospective cohort study using the Flatiron Health Research Database among adult women diagnosed with advanced (stages III–IV) endometrial cancer or who developed recurrence between 2013 and 2022. The main outcomes included delayed treatment initiation (more than 6 weeks) and all-cause mortality. Primary exposures included race and ethnicity and quintiles of area-level SES (Yost Index). We computed adjusted prevalence ratios with 95% CIs using multivariable modified Poisson regressions to assess racial and ethnic disparities in time to treatment initiation, and we computed adjusted hazard ratios (HRs) using Cox proportional hazards models to assess disparities in mortality. All models were adjusted for sociodemographic factors, comorbidities, and cancer and histology characteristics. RESULTS: Among the 4,177 women included in this study, the racial and ethnic composition included 68.1% non-Hispanic White, 15.2% non-Hispanic Black, 5.3% Hispanic/Latina, and 2.2% non-Hispanic Asian. The median time to treatment initiation was 26 days, and the median survival time was 3.1 years. After adjustments for participant characteristics, delayed treatment initiation was associated with living in areas of the lowest SES quintile among non-Hispanic Black (adjusted prevalence ratio 1.07, 95% CI, 1.00–1.13) and Hispanic/Latina (adjusted prevalence ratio 1.12, 95% CI, 1.00–1.25) participants compared with non-Hispanic White participants. We observed an inverted moderating effect on all-cause mortality in which non-Hispanic Black participants living in areas of the highest SES quintile had a higher risk of death compared with non-Hispanic White participants (adjusted HR 2.49, 95% CI, 1.55–4.00). CONCLUSION: Our findings demonstrated that racial and ethnic disparities in treatment initiation and survival persist among women with advanced endometrial cancer and are significantly modified by socioeconomic factors.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088273","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":"Carrier Screening Insights From a Maternal-Fetal Medicine Practice.","authors":"Jordana L Graifman, Lawrence D Platt","doi":"10.1097/AOG.0000000000006291","DOIUrl":"10.1097/AOG.0000000000006291","url":null,"abstract":"<p><p>Carrier screening is used to determine reproductive risk for autosomal recessive or X-linked conditions, and its clinical implementation varies widely. We evaluated recurring clinical patterns observed at an independent, university-affiliated, high-volume maternal-fetal medicine center in Los Angeles receiving referrals from diverse practice settings. In our view, carrier screening is far too frequently performed later than ideal, which narrows timelines for partner testing, prenatal diagnosis, and decision making and increases patient distress. Carrier screening practices differ by referring clinician, resulting in inequities in detecting genetic risk. Within a single couple, partners are often screened on discordant panels (and sometimes sequentially, maternal-first), which delays risk clarification and increases the chance of misinterpretation. Based on these observations, we believe prepregnancy carrier screening should be prioritized; otherwise, carrier screening should be performed as early as possible in pregnancy with concurrent partner testing. We also believe patients should receive counseling on the benefits and limitations of all available screening options to preserve patient autonomy.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"463-470"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148605891","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":"In Reply.","authors":"Claire Schultz, Nicole Larrea","doi":"10.1097/AOG.0000000000006406","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006406","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"148 4","pages":"e272-273"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081706","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":"Laser Therapy: Balancing Innovation With Evidence-Based Practice.","authors":"Angela Liang, Kathryn Welch","doi":"10.1097/AOG.0000000000006419","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006419","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"148 4","pages":"448-450"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081724","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":"Variation in Postdischarge Opioid Prescribing After Childbirth and Associated Procedures.","authors":"Kyle R Latack, Ellery Sarosi, Michelle H Moniz, Vidhya Gunaseelan, Jennifer F Waljee, Mark C Bicket, Courtney D Townsel, Lisa Kane Low, Alex F Peahl","doi":"10.1097/AOG.0000000000006332","DOIUrl":"10.1097/AOG.0000000000006332","url":null,"abstract":"<p><p>Current practice guidelines for postpartum pain management lack specific recommendations for opioid prescribing after vaginal births or vaginal births with associated procedures such as operative vaginal birth (ie, forceps, vacuum-assisted birth) and repair of third- or fourth-degree lacerations. This study used adjusted logistic regression models to assess between-hospital variation in opioid prescribing rates and prescription amounts in oral morphine equivalents (OMEs) for vaginal births with associated procedures. We performed a retrospective cohort study across 67 hospitals of 14,690 opioid-naive, nulliparous patients with term births, of whom 7.2% (n=1,053) had operative vaginal births and 4.9% (n=724) had third- or fourth-degree lacerations. In total, 1.8% of patients (n=269) received an opioid prescription, with a median amount of 60 OMEs (IQR 37.5-75). Prescription rate was higher for third- or fourth-degree laceration (11.6%), and prescription amount was highest for operative birth (75 OMEs, IQR 45-90 OMEs). At a hospital level, the largest range of proportion of patients receiving discharge opioid prescriptions was for third- or fourth-degree lacerations (0-66.7%) and the largest amount was for operative birth (25-135 OMEs). Opioid prescribing after vaginal births with associated procedures is higher than for routine vaginal birth and marked by variation among hospitals, highlighting an opportunity for standardization.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"534-538"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056067","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 Clinical Practice Update: Salpingectomy for the Prevention of Epithelial Ovarian Cancer.","authors":"","doi":"10.1097/AOG.0000000000006400","DOIUrl":"10.1097/AOG.0000000000006400","url":null,"abstract":"<p><p>This Clinical Practice Update provides updated information further supporting the benefit of complete, bilateral salpingectomy at the time of obstetric and gynecologic surgery and to expand the availability of salpingectomy during nongynecologic abdominopelvic surgery for the primary prevention of epithelial ovarian cancer. This document updates Committee Opinion No. 774, Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention (Obstet Gynecol 2019;133:e279-84).</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e275-e280"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796185","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}