Obstetrics and gynecology最新文献

{"title":"Uterine Rupture Trends in Patients Pursuing Trial of Labor After Cesarean in the United States from 2010 to 2022.","authors":"Lillian H Goodman, Amanda A Allshouse, Torri D Metz, Ann M Bruno","doi":"10.1097/AOG.0000000000005882","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005882","url":null,"abstract":"<p><p>National rates of trial of labor after cesarean (TOLAC) have increased, but the risk of uterine rupture remains. Clinical practice- and patient-level changes also have occurred in the past decade, and an evaluation of contemporary uterine rupture rates is needed. Using natality files available in the National Vital Statistics System from 2010 to 2022, we conducted a repeated cross-sectional analysis to evaluate U.S. trends in uterine rupture and perinatal outcomes among individuals undertaking TOLAC. Temporal trends were characterized using joinpoint regression, with average annual percent change (AAPC) and 95% CI reported. There were 2,888 uterine ruptures (0.28%) among 1,016,073 included deliveries. The rate of uterine rupture increased over time, from 0.20% in 2010 to 0.37% in 2022 (AAPC 6.2, 95% CI, 4.3-8.7). Although rates of uterine rupture increased over time, it remains a rare event with a low absolute risk.</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":"143625575","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":"Payer-Based Segregation in Obstetrics and Gynecology Ambulatory Care: Implications for Quality, Safety, and Equity.","authors":"Suzanna Larkin, Erika Harness, Kavita Shah Arora, Neena Qasba, Arina Chesnokova, Erika Banks, Karen George, Kavita Vinekar","doi":"10.1097/AOG.0000000000005883","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005883","url":null,"abstract":"<p><p>Separation of patients by insurance status in ambulatory care settings is a long-standing practice in academic medicine. This payer-based segregation of patients between resident and faculty outpatient practices may lead to inequitable quality of care. Informed by replies to a free-response text question for residents and program directors within the 2023 U.S. obstetrics and gynecology in-service examination, we provide commentary on this structural inequity within obstetrics and gynecology. The purpose of this commentary is to discuss the differences in patient population served, gaps in resources in resident clinics, quality of care and moral injury, limited continuity of care, and training and supervision. Further work is needed to guide systemic integration efforts and to explore the effects of program integration on patient health outcomes. We nonetheless urge academic medical centers to consider organizational shifts toward payer-integrated care.</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":"143625561","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 Before and After the Removal of Race and Ethnicity from the Vaginal Birth After Cesarean Calculator.","authors":"Annika Hikade, Kelly Nichols, Katherine Ahrens","doi":"10.1097/AOG.0000000000005880","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005880","url":null,"abstract":"<p><p>We conducted a population-based retrospective cohort study and performed interrupted time series analyses to examine whether the removal of race and ethnicity from the vaginal birth after cesarean (VBAC) calculator was associated with changes in rates of trial of labor after cesarean (TOLAC) and VBAC in the United States. After the calculator revision, rates of TOLAC and VBAC in the overall eligible population and among the four largest racial and ethnic groups (Hispanic, non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White) (rate ratios ranged from 0.99 to 1.04, and all 95% CIs included the null) were unchanged. Rates of successful VBAC among Hispanic (75.0%), non-Hispanic Asian (71.0%), and non-Hispanic Black (67.0%) people remained lower compared with non-Hispanic White people (77.2%). More work is needed to address the significant racial disparities that persist for TOLAC outcomes.</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":"143625574","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":"Frequency of Preconception and Prenatal Cannabis Use and Nausea and Vomiting in Pregnancy.","authors":"Kelly C Young-Wolff, Felicia W Chi, Cynthia I Campbell, Stacey E Alexeeff, Deborah Ansley, Alyssa Vanderziel, Gwen T Lapham","doi":"10.1097/AOG.0000000000005884","DOIUrl":"10.1097/AOG.0000000000005884","url":null,"abstract":"<p><p>This cross-sectional study analyzed associations between preconception and prenatal cannabis use and first-trimester nausea and vomiting in pregnancy (NVP) using data from 356,343 pregnancies in a large health care system (2011-2022). Prevalence of preconception and prenatal cannabis use was 11.3% (2.7% daily, 2.4% weekly, 6.3% monthly or less) and 6.5% (0.7% daily, 0.7% weekly, 1.4% monthly or less, 3.7% positive toxicology with no self-reported use), respectively. Based on International Classification of Diseases diagnostic codes, 3.6% of patients were diagnosed with severe NVP and 16.0% with mild NVP. Self-reported preconception daily cannabis use was associated with greater odds of mild (adjusted odds ratio [aOR] 1.68, 95% CI, 1.59-1.77) and severe (aOR 2.61, 95% CI, 2.40-2.84) NVP when compared with individuals without preconception use. Self-reported weekly cannabis use was associated with greater odds of mild (aOR 1.26, 95% CI, 1.19-1.34) and severe (aOR 1.73, 95% CI, 1.57-1.90) NVP compared with no preconception use. Similarly, self-reported prenatal daily cannabis use was associated with greater odds of mild (aOR 1.97, 95% CI, 1.79-2.17) and severe (aOR 3.80, 95% CI, 3.28-4.39) NVP compared with no prenatal use. Self-reported weekly cannabis use was associated with greater odds of mild (aOR 1.85, 95% CI, 1.68-2.03) and severe (aOR 2.87, 95% CI, 2.47-3.34) NVP compared with individuals without prenatal use. This study found that preconception and prenatal cannabis use were associated with increased odds of both mild and severe NVP during the first trimester, with the highest odds observed among individuals using cannabis daily before or during early pregnancy. Findings underscore the need for patient education and medically appropriate therapies for NVP management.</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":"143625560","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":"Guideline-Concordant Surveillance After Treatment for High-Grade Cervical Dysplasia.","authors":"Victoria Wang, Jacquelyn M Lykken, Jasmin A Tiro, Rebecca B Perkins, Jennifer S Haas, Claudia Werner, Sarah C Kobrin, Sarah Feldman","doi":"10.1097/AOG.0000000000005877","DOIUrl":"10.1097/AOG.0000000000005877","url":null,"abstract":"<p><strong>Objective: </strong>To quantify how many patients treated for high-grade cervical dysplasia completed guideline-concordant surveillance.</p><p><strong>Methods: </strong>We retrospectively analyzed patients aged 30-65 treated for high-grade cervical dysplasia (cervical intraepithelial neoplasia 2 or worse) at two PROSPR II METRICS (Population-based Research to Optimize the Screening Process Multi-level Optimization of the Cervical Cancer Screening Process in Diverse Settings & Populations sites) (Massachusetts General Brigham, Parkland Health) from 2010 to 2019. The primary outcome was receipt of two negative co-tests after treatment within 30 months (allowing 6-month scheduling leeway).</p><p><strong>Results: </strong>Among 3,146 patients treated for high-grade dysplasia, most were aged 30-39 years (Massachusetts General Brigham 58.9%, Parkland Health 60.9%) and had no or few known comorbidities (Massachusetts General Brigham 81.2%, Parkland Health 85.6%). Race and ethnicity, insurance status, and socioeconomic status reflected broader patient population demographics. Only half of the patients (45.5%) completed two surveillance co-tests after treatment within 30 months (Massachusetts General Brigham 55.3%, Parkland Health 40.6%), among whom a third received at least one subsequent abnormal co-test result (Massachusetts General Brigham 30.9%, Parkland Health 31.6%). Patients who completed two co-tests were under observation longer than those who did not complete two co-tests (median Massachusetts General Brigham 64.9 months vs 33.1 months, median Parkland Health 63.9 months vs 41.8 months). Among patients who completed two co-tests, the timing of surveillance co-testing was largely concordant with guidelines (median [interquartile range] time to first co-test: Massachusetts General Brigham 6.4 [5.1-9.2] months, Parkland Health 10.1 [6.6-12.6] months; median [interquartile range] time between first and second co-test: Massachusetts General Brigham 8.5 [6.0-12.6] months, Parkland Health 12.0 [8.0-13.5] months). Overall, 16 patients (0.5%) were diagnosed with cervical cancer after treatment for high-grade dysplasia (median [interquartile range] time from treatment to cancer diagnosis 14.9 [3.8-45.9] months).</p><p><strong>Conclusion: </strong>Approximately half of patients did not receive guideline-concordant surveillance after treatment for high-grade dysplasia, and one-third had a subsequent abnormal co-test result. Patients with high-grade cervical dysplasia are at elevated risk of subsequent abnormalities and should continue to be closely monitored. Additional systematic monitoring is needed to ensure guideline-compliant surveillance after dysplasia treatment.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573531","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 Antepartum, Delivery, and Postpartum Venous Thromboembolism.","authors":"Olivia Kola, Yongmei Huang, Mary E D'Alton, Jason D Wright, Alexander M Friedman","doi":"10.1097/AOG.0000000000005818","DOIUrl":"10.1097/AOG.0000000000005818","url":null,"abstract":"<p><strong>Objective: </strong>To assess trends in risk for obstetric venous thromboembolism (VTE).</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the 2008-2019 Merative MarketScan Commercial Claims and Encounters and Medicaid Multi-State databases. Women aged 15-54 years with a delivery hospitalization and health care enrollment from 1 year before pregnancy to 60 days after delivery were identified. Risk for VTE during pregnancy from 2009 to 2019 was analyzed with joinpoint regression, with trends reported as the average annual percent change (APC). Venous thromboembolism events were identified with diagnosis codes along with pharmacy receipt of anticoagulants. Additionally, the association between risk factors for VTE and VTE events was evaluated with log-Poisson regression models with unadjusted and adjusted risk ratios (aRR) with 95% CIs as measures of association.</p><p><strong>Results: </strong>Among 1,970,971 pregnancies, there were 5,270 VTE events, of which 35.5% (n=1,871) included a pulmonary embolism diagnosis and 64.5% (3,399) included a deep vein thrombosis diagnosis, alone. Risk for VTE increased significantly during pregnancy over the study period, with an APC of 9.2% (95% CI, 5.7-12.9%). Rates of VTE also increased individually during the antenatal period (APC 8.2%, 95% CI, 3.7-12.9%), during delivery hospitalizations (APC 12.2%, 95% CI, 7.4-17.3%), during the postpartum period (APC 8.4%, 95% CI, 5.9-11.0%), and individually for vaginal and cesarean delivery hospitalizations. Trends analyses individually for pulmonary embolism (APC 12.4%, 95% CI, 8.6-16.4%) and deep vein thrombosis (APC 7.6%, 95% CI, 4.0-11.3%) also demonstrated significant increases. In adjusted analyses for VTE, obesity (aRR 1.91, 95% CI, 1.78-2.05), chronic heart disease (aRR 3.14, 95% CI, 2.93-3.37), tobacco use (aRR 1.61, 95% CI, 1.34-1.95), asthma (aRR 1.46, 95% CI, 1.33-1.60), and preeclampsia (aRR 1.44, 95% CI, 1.31-1.58) were the factors associated the greatest increased adjusted relative risk.</p><p><strong>Conclusion: </strong>Risk for obstetric VTE increased significantly over the study period. Risk increased during the antenatal, delivery, and postpartum periods and for both cesarean and vaginal delivery.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e98-e106"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922449","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":"Read the Room.","authors":"Victoria Diamond","doi":"10.1097/AOG.0000000000005829","DOIUrl":"10.1097/AOG.0000000000005829","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e122"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008104","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":"Evaluation and Management of Congenital Cytomegalovirus Infection.","authors":"Elif Coskun, Fatima Kakkar, Laura E Riley, Andrea L Ciaranello, Malavika Prabhu","doi":"10.1097/AOG.0000000000005840","DOIUrl":"10.1097/AOG.0000000000005840","url":null,"abstract":"<p><p>The purpose of this review is to serve as an update on congenital cytomegalovirus (CMV) evaluation and management for obstetrician-gynecologists and to provide a framework for counseling birthing people at risk for or diagnosed with a primary CMV infection or reactivation or reinfection during pregnancy. A DNA virus, CMV is the most common congenital viral infection and the most common cause of nongenetic childhood hearing loss in the United States. The risk of congenital CMV infection from transplacental viral transfer depends on the gestational age at the time of maternal infection and whether the infection is primary or nonprimary. Although the risk of congenital CMV infection is lower with infection at earlier gestational ages, clinical sequelae are more severe with maternal infections earlier in gestation. At present, routine screening for maternal CMV infection is not recommended by U.S. guidelines. When maternal primary infection is confirmed in early pregnancy, emerging data support consideration of maternal antiviral therapy to prevent congenital CMV infection. When congenital CMV infection is confirmed, typically after an abnormal prenatal ultrasound result, there are more limited data on the utility of maternal antiviral therapy. Universal newborn screening for congenital CMV infection is not mandatory in most U.S. states at present. Newborns diagnosed with congenital CMV infection undergo an extensive evaluation to determine whether neurologic symptoms are present, which guides postnatal evaluation and management. In this review, we discuss the diagnosis and management of maternal CMV infection, the risk and diagnosis of congenital CMV infection, prevention and potential treatment of congenital CMV infection in utero, and neonatal congenital CMV infection diagnosis and management.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"297-306"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029278","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":"Weight and Procedural Abortion Complications: A Systematic Review.","authors":"Hayley V McMahon, Regan A Moss, Naya Pearce, Sakshi Sehgal, Zeling He, Monica Kriete, Zoë Lucier-Julian, Sara K Redd, Whitney S Rice","doi":"10.1097/AOG.0000000000005821","DOIUrl":"10.1097/AOG.0000000000005821","url":null,"abstract":"<p><strong>Objective: </strong>To systematically assess the existing empiric evidence regarding a potential relationship between higher body weight and procedural abortion complications.</p><p><strong>Data sources: </strong>EMBASE, MEDLINE, CINAHL, Web of Science, Google Scholar, and Clinicaltrials.gov were searched.</p><p><strong>Methods of study selection: </strong>Our search identified 409 studies, which were uploaded to Covidence for review management; 133 duplicates were automatically removed. A team of two reviewers screened 276 studies, and a third reviewer resolved conflicts. Studies were included if they 1) consisted of peer-reviewed research published between 2010 and 2022, 2) were conducted in the United States, 3) included people with a higher body weight (body mass index [BMI] 30 or higher) in the study sample, and 4) assessed at least one outcome of procedural abortion safety stratified by a measure of body weight.</p><p><strong>Tabulation, integration, and results: </strong>We extracted study data using Covidence and calculated an odds ratio for each study to facilitate the synthesis of results. Six studies assessing a total of 38,960 participants were included. No studies found a significant relationship between procedural abortion complications and higher body weight overall. Subgroup analysis from one study identified a significant increase in complications specifically among participants with BMIs higher than 40 who had second-trimester abortions. All studies used a retrospective cohort design and fulfilled Newcastle-Ottawa Scale criteria to be considered good quality. Studies varied in terms of clinical settings, patient populations, gestations assessed, clinician training levels, and care protocols.</p><p><strong>Conclusion: </strong>Overall, higher body weight was not associated with an increased risk of procedural abortion complications in the included studies. The practice of referring patients undergoing procedural abortion with a higher body weight for hospital-based care is not based on recent safety evidence. On the contrary, this practice threatens the health of people with a higher body weight by potentially delaying their access to abortion care, extending their pregnancies into later gestations, and blocking their ability to access an abortion altogether.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"307-315"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922455","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":"A New Way Forward for Women's Health Research at the National Institutes of Health: A Roadmap From the National Academies of Sciences, Engineering, and Medicine's Consensus Report.","authors":"Michelle P Debbink, Methodius G Tuuli, Amy Geller, Alina N Salganicoff, Sheila P Burke, Angeles Alvarez Secord","doi":"10.1097/AOG.0000000000005841","DOIUrl":"10.1097/AOG.0000000000005841","url":null,"abstract":"<p><p>Despite efforts to address inequities, research on women's health conditions (defined as those that uniquely or differently affect women and female individuals) remain significantly understudied. As directed by Congress, the National Institutes of Health (NIH) Office of Research on Women's Health requested the National Academies of Sciences, Engineering, and Medicine (National Academies) to conduct an assessment of the state of women's health research at the NIH. The findings of the National Academies committee include: 1) a significant funding inequity, with less than 8% of the total NIH grant budget for fiscal year 2023 allocated to women's health research; 2) a need for improved strategic NIH-wide priority setting, oversight, and adherence to existing policies to support women's health research; 3) a need for a specific institute for research on conditions specific to women's health; and 4) a need for sufficient training and additional funding to grow and retain the women's health research workforce. The National Academies committee recommends restructuring women's health research at the NIH by creating a new Women's Health Research Institute and cross-disciplinary Women's Health Research Fund, including greater accountability and an infusion of new funds to support both research and career development in women's health. The combination of the new institute, greater prioritization and accountability, and new funding would lead to more rapid innovations and advancements, with the ultimate goal of improving women's health and well-being, which, in turn, improves the well-being of families and communities and bolsters a vibrant, healthier society.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"273-280"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952425","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}