Obstetrics and gynecology最新文献

{"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":"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}

{"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13695440/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of Treated Syphilis Before Pregnancy and Risk of Congenital Syphilis.","authors":"J Drew Toppin, Shannon McCloskey, Talia Suner, Brian James, Meenakshi Mishra, Mariella Gastanduy, Joseph R Biggio, Frank B Williams","doi":"10.1097/AOG.0000000000006314","DOIUrl":"10.1097/AOG.0000000000006314","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the odds of congenital syphilis in neonates of mothers with a history of adequately treated prepregnancy syphilis compared with those with no prepregnancy history of syphilis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of deliveries within a large multihospital health care system in the southern United States from January 2015 to December 2023. Pregnant individuals were stratified based on whether there was a prepregnancy history of adequately treated syphilis infection. Propensity score full matching was performed, retaining all 382 patients with prior treated syphilis, with covariates including maternal age, neighborhood Area Deprivation Index, tobacco use, insurance payer, prenatal visits, and gestational age at delivery. The primary outcome was congenital syphilis as defined by Centers for Disease Control and Prevention case criteria; secondary outcomes included maternal syphilis infection during pregnancy and neonatal administration of a single intramuscular dose of penicillin-G.</p><p><strong>Results: </strong>Among 57,925 pregnancies, 382 patients (0.66%) had a history of adequately treated syphilis before pregnancy. Congenital syphilis occurred in 26 of 382 (6.8%) pregnancies in women with prior treated syphilis compared with 40 of 57,543 (0.1%) without (adjusted odds ratio [aOR] 19.61; 95% CI, 4.57-84.25). This is equivalent to 6,806 per 100,000 live births in those with a prior history compared with 70 per 100,000 live births in those with no prior history. Maternal syphilis reinfection occurred in 68 of 382 (17.8%) with prior treated syphilis compared with 258 of 57,543 (0.4%) without (aOR 11.92; 95% CI, 5.89-24.10).</p><p><strong>Conclusion: </strong>A history of treated syphilis infection before pregnancy was associated with dramatically increased risks of congenital syphilis and maternal syphilis reinfection during pregnancy. These findings challenge assumptions about the protective effects of prior treatment and support enhanced surveillance strategies for this high-risk population.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"539-545"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841149","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 Treatment Compared with Topical Clobetasol for Lichen Sclerosus: A Randomized Controlled Trial.","authors":"Julia M Hecken, Ilana Shoham, Clemens B Tempfer, Günther A Rezniczek","doi":"10.1097/AOG.0000000000006326","DOIUrl":"10.1097/AOG.0000000000006326","url":null,"abstract":"<p><strong>Objective: </strong>To compare low-density fractional microablative carbon dioxide (CO 2 ) laser treatment with topical clobetasol propionate for symptom control in women with vulvar lichen sclerosus (LS).</p><p><strong>Methods: </strong>We conducted a prospective, randomized, open-label trial that included women with symptomatic LS. Participants were randomized to three courses of CO 2 laser treatment every 3 weeks or to a 3-month regimen of tapered topical clobetasol propionate 0.05%. The primary outcome was the change in the BIP (burn-itch-pain) score (range 0-30) from baseline to 3 months. Secondary outcomes included physician-rated visual improvement and overall improvement, and disease-specific quality of life (QOL). Ninety participants per group provided 90% power to detect a 2-point between-group BIP score difference (SD 4; 2-sided α=0.05). Analyses were intention-to-treat. Prespecified multivariable linear regression adjusted for baseline symptom severity, age, body mass index (BMI), smoking status, previous corticosteroid use, and disease duration.</p><p><strong>Results: </strong>Between November 2021 and March 2025, 245 women were randomized (laser: n=123; clobetasol propionate: n=122). At 3 months, symptom improvement was greater in the laser group (median ΔBIP score -8 [IQR -13 to-3]) than in the clobetasol propionate group (-5 [IQR, -10.75 to 0]; P =.007). In the multivariable analysis, laser treatment remained independently associated with greater symptom improvement (adjusted β, -2.90; 95% CI, -4.64 to -1.15; P =.001). Physician-rated visual improvement and overall improvement, and disease-specific QOL change favored laser therapy. Both treatments were generally well tolerated, with no serious treatment-related adverse events. During an exploratory postrandomization phase after the 3-month primary endpoint assessment, participants could choose to cross over to the alternative treatment. Patients who crossed over from clobetasol propionate to laser experienced additional symptom improvement from 3 to 6 months. Results were robust to sensitivity analyses for missing outcome data.</p><p><strong>Conclusion: </strong>Laser treatment resulted in greater symptom improvement than clobetasol propionate therapy for women with vulvar LS. Sequential treatment with clobetasol propionate followed by CO 2 laser may further improve clinical symptoms.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT05010421.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"451-461"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148056111","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 Delivery Mode and Postpartum Psychiatric Conditions.","authors":"Samantha L Kruger, Nicola Perlman, Elizabeth B Sherwin, Cecilia B Leggett, Yasser Y El-Sayed, Deirdre J Lyell, Elliott K Main, Katherine L Wisner, Pervez Sultan, Stephanie A Leonard, Danielle M Panelli","doi":"10.1097/AOG.0000000000006321","DOIUrl":"10.1097/AOG.0000000000006321","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between mode of delivery and incidence of new postpartum maternal psychiatric conditions in a national obstetric cohort.</p><p><strong>Methods: </strong>This was an observational cohort study of individuals with singleton live births in the United States (2008-2022) identified from the Merative™ MarketScan® Commercial Database using International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification codes. Individuals with a psychiatric diagnosis preceding delivery and those with preterm births before 37 weeks of gestation were excluded. The exposure was mode of delivery, categorized as 1) spontaneous vaginal, 2) successful operative vaginal delivery (OVD), 3) planned cesarean, 4) unplanned cesarean without OVD attempt, 5) and unplanned cesarean after failed OVD attempt. The primary outcome was a new diagnosis of depression, anxiety, posttraumatic stress, or other serious psychiatric condition or a new antidepressant prescription within 6 months postpartum. Multivariable Poisson regression models with robust SEs estimated associations between mode of delivery and postpartum psychiatric conditions, first for any psychiatric condition and then separately by each condition.</p><p><strong>Results: </strong>Of 934,524 included births, 66% were spontaneous vaginal, 4% were successful OVD, 14% were planned cesareans, 15% were unplanned cesareans without OVD attempt, and 1% were unplanned cesareans after failed OVD attempt. Compared with spontaneous vaginal births, postpartum psychiatric conditions were higher after planned cesarean births (11.4% vs 9.2%, adjusted risk ratio [RR] 1.19, 95% CI, 1.17-1.21), unplanned cesarean births without OVD (10.8% vs 9.2%, adjusted RR 1.16, 95% CI, 1.14-1.18), and unplanned cesarean births with failed OVD (10.9% vs 9.2%, adjusted RR 1.26, 95% CI, 1.18-1.35). Postpartum psychiatric condition risks were similar between individuals with spontaneous vaginal births and those with successful OVDs (9.2% vs 9.2%, adjusted RR 1.00, 95% CI, 0.97-1.03).</p><p><strong>Conclusion: </strong>Postpartum psychiatric conditions were increased after cesarean deliveries, planned or unplanned, but not after successful OVDs. Results suggest that cesarean delivery may be associated with an increased risk of psychiatric conditions and warrants closer surveillance postpartum.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e257-e265"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988395","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":"You Should Write This Up.","authors":"Abbey Donahue","doi":"10.1097/AOG.0000000000006392","DOIUrl":"10.1097/AOG.0000000000006392","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"269-271"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685363","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":"Modernizing the Analysis of Migraine With Aura, Oral Contraceptives, and Risk of Stroke: Correction","authors":"Nancy Z. Fang,Alison B. Edelman,Jillian T. Henderson","doi":"10.1097/aog.0000000000006409","DOIUrl":"https://doi.org/10.1097/aog.0000000000006409","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"29 1","pages":"e274-e274"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149022340","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":"Endometrial Polyps.","authors":"Michelle N Han, Malcolm G Munro","doi":"10.1097/AOG.0000000000006232","DOIUrl":"10.1097/AOG.0000000000006232","url":null,"abstract":"<p><p>Endometrial and endocervical polyps are common intrauterine lesions characterized by focal overgrowth of glands and stroma. Prevalence increases with age, obesity, ovulatory disorders, and tamoxifen use. The lesions may be asymptomatic or linked to infertility, abnormal uterine bleeding (AUB), or cancer, a rare diagnosis in the early reproductive years. Polyps frequently cause postmenopausal bleeding; before menopause, the typical presenting AUB symptom (AUB-polyp) is intermenstrual bleeding. The role that polyps play in infertility or in reducing the success of assisted reproductive techniques remains unclear. Diagnosis usually begins with transvaginal ultrasonography (TVUS), confirmed, at least for endometrial polyps, by sonohysterography, an office technique readily performed by the gynecologist. Color Doppler and power Doppler may help distinguish benign polyps from those with premalignant or malignant histology, but neither has been demonstrated to be equivalent to histopathologic evaluation. Expectant management might be suitable for small, asymptomatic polyps. Still, for most, hysteroscopic polypectomy is an effective and safe procedure that is preferably performed in an office or clinic environment without the need for systemic anesthesia. This approach reduces the direct costs of care and socioeconomic effects on the patient. Medical treatments, such as a levonorgestrel-releasing intrauterine device, may alleviate symptoms or reduce postsurgical recurrence but are not considered first-line options. Where there is ready access to TVUS, we recommend TVUS and sonohysterography for diagnosis, allowing hysteroscopic polypectomy to be reserved for those known to have polyps based on these highly sensitive and specific diagnostic techniques.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"489-507"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444653","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}