Obstetrics and gynecology最新文献

{"title":"Anatomic Foundations of Surgery on the Female Perineum.","authors":"Annetta M Madsen,Anne G Sammarco,John O L DeLancey,Marlene Corton","doi":"10.1097/aog.0000000000006065","DOIUrl":"https://doi.org/10.1097/aog.0000000000006065","url":null,"abstract":"Although it is difficult to achieve expertise in surgical anatomy of the female perineum, this is essential for patient counseling, clinical decision making, and surgical safety. Education of female pelvic anatomy has often relied on historical illustrations that contain inaccuracies and omissions. Therefore, the Society of Gynecologic Surgeons Pelvic Anatomy Group was established to promote accuracy through standardization of terminology, to explore anatomy through three-dimensional magnetic resonance imaging (MRI) technology, and to disseminate knowledge through the development of a website that uses the human body as a primary source of education. This review by members of the Pelvic Anatomy Group highlights a part of this work by using clinical photos, cadaver dissections, and MRIs to discuss an anatomic approach to common surgical scenarios involving the vulva and perineum.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"49 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995663","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":"Allostatic Load Mediates Associations Between Race and Ethnicity and Hypertensive Disorders of Pregnancy.","authors":"Mitali Ray,Lacey W Heinsberg,Rebecca B McNeil,William A Grobman,Amir Lueth,Robert M Silver,C Noel Bairey Merz,Lisa D Levine,Lynn M Yee,Daniel E Weeks,Yvette P Conley,Janet M Catov","doi":"10.1097/aog.0000000000006062","DOIUrl":"https://doi.org/10.1097/aog.0000000000006062","url":null,"abstract":"OBJECTIVETo evaluate whether chronic stress exposure, measured by allostatic load (a biological measure of chronic stress embodiment, including stressors exacerbated by structural inequities [eg, structural racism]) and patient-reported perceived stress in the first trimester of pregnancy, mediates the association between self-identified race and ethnicity and hypertensive disorders of pregnancy (HDP).METHODSThis was a secondary analysis of data from nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a large prospective cohort study. We evaluated self-identified race and ethnicity as an independent variable (non-Hispanic Black, Hispanic, Asian, non-Hispanic White), and our outcome of interest was HDP (ie, gestational hypertension, preeclampsia or eclampsia). Allostatic load was operationalized with regression- and count-based approaches. Perceived stress was collected with the Cohen perceived stress scale. We investigated allostatic load and perceived stress and used causal mediation analyses with a counterfactual approach to evaluate whether they mediated the association between self-identified race and ethnicity and HDP, adjusting for age and tobacco use. Mediation analyses were conducted for each minoritized racial and ethnic group compared with non-Hispanic White participants.RESULTSThe sample included 645 participants who developed HDP and 2,438 participants without HDP or other adverse pregnancy outcome. Allostatic load and perceived stress varied by race and ethnicity; HDP varied by allostatic load but not perceived stress. Allostatic load was a partial mediator exclusively in the comparison of non-Hispanic Black and non-Hispanic White participants (0.027, 95% CI, 0.013-0.040, P<.001; 28.9%). Perceived stress was not a significant mediator.CONCLUSIONFirst-trimester allostatic load mediated the association between self-identified race and ethnicity and HDP for non-Hispanic Black and non-Hispanic White participants. This mediation effect was not observed in other racial and ethnic comparisons. These results demonstrate a physiologic pathway through which racism may contribute to adverse pregnancy outcomes and suggest that interventions targeting allostatic load reduction could help address racial and ethnic disparities in HDP.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"16 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995631","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":"Sustained Vaginal Stent Placement in the Surgical Management of Shortened Vaginal Length.","authors":"Sonia Bhandari Randhawa,Joseph I Schaffer,Melissa Mauskar,Marlene M Corton","doi":"10.1097/aog.0000000000006046","DOIUrl":"https://doi.org/10.1097/aog.0000000000006046","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"49 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995632","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":"Updates in Clinical Management of Recurrent Urinary Tract Infections.","authors":"Nazema Y Siddiqui,Megan S Bradley","doi":"10.1097/aog.0000000000006060","DOIUrl":"https://doi.org/10.1097/aog.0000000000006060","url":null,"abstract":"Urinary tract infections (UTIs) are common and burdensome in women. Here, we discuss challenges with our current models of care and how evolving insights into the female urogenital microbiome have advanced the understanding of how we diagnose, treat, and prevent recurrent UTIs in nonpregnant adult women. Traditional care models attribute recurrent UTIs mainly to gastrointestinal sources, resulting in significant emphasis on eradicating pathogens with potential overreliance on antibiotics. Evidence now shows that the bladder harbors a complex microbiome, with interactions between the urinary and vaginal environments and immune mechanisms at the bladder mucosal surface influencing infection susceptibility. Thus, in updated models of care, more emphasis is placed on enhancing the protective microbiome. This may be especially important in postmenopausal women, who experience microbiome shifts that increase vulnerability to recurrent infections, underscoring the role of estrogen therapy and microbiome-supportive interventions. Updated treatment approaches emphasize antimicrobial stewardship, advocating for confirmation of the diagnosis and delayed antibiotic initiation when safe, and judicious use of antibiotics for symptom relief. Prevention strategies highlight the importance of vaginal estrogen, methenamine salts, and other supplements rather than exclusive reliance on prophylactic antibiotics. Ongoing research into emerging therapies such as UTI vaccines and bacteriophage drugs may further decrease our reliance on antibiotics in the future. This clinical update underscores the need for individualized care plans that balance effective infection management while minimizing antibiotic-related harms, emphasizing a holistic, microbiome-centered approach to recurrent UTI prevention and treatment.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"72 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995630","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":"A Call to Action From the American Gynecological & Obstetrical Society.","authors":"Ronald D Alvarez,Marcelle I Cedars,Barbara A Goff,Christos Coutifaris","doi":"10.1097/aog.0000000000006050","DOIUrl":"https://doi.org/10.1097/aog.0000000000006050","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"65 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959988","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":"A Call to Action From the American Gynecological & Obstetrical Society.","authors":"Ronald D Alvarez, Marcelle I Cedars, Barbara A Goff, Christos Coutifaris","doi":"10.1097/AOG.0000000000006050","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006050","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963456","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":"Cost Effectiveness of Salpingectomy Compared With Vasectomy for Permanent Contraception.","authors":"Amy Pearson,Katerina Shvartsman,Wu Zeng,Jill Brown","doi":"10.1097/aog.0000000000006042","DOIUrl":"https://doi.org/10.1097/aog.0000000000006042","url":null,"abstract":"OBJECTIVETo evaluate the cost effectiveness of salpingectomy compared with vasectomy for couples seeking permanent contraception.METHODSWe developed a decision tree model that used TreeAge to evaluate the cost effectiveness of vasectomy compared with salpingectomy for a hypothetical cohort of 800,000 people, the number of male and female patients who undergo permanent contraception procedures in the United States annually. Effectiveness was expressed in quality-adjusted life-years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY gained or lost. We derived costs, probabilities, and utilities from the literature, and estimated the incremental cost-effectiveness ratio (ICER) between the two strategies. We completed a probabilistic sensitivity analysis with 10,000 simulations and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000. Secondary outcomes included the number of unintended pregnancies, ovarian cancer cases, and ovarian cancer deaths.RESULTSSalpingectomy was not a cost-effective strategy, with an ICER of $143,769 per QALY gained compared with vasectomy. Probabilistic sensitivity analysis showed that the chance of vasectomy being cost effective was 81.5% but decreased to 14.7% with a WTP threshold of $200,000. Annually, salpingectomy was associated with 1,215 fewer unintended pregnancies, 6,085 fewer ovarian cancer cases, and 4,921 fewer ovarian cancer deaths compared with vasectomy.CONCLUSIONSalpingectomy is not cost effective compared with vasectomy at a WTP threshold of $100,000, despite lower unintended pregnancy rates and societal ovarian cancer burden. Shared decision making, including a discussion of the long-term health benefits of salpingectomy, is important for couples deciding on permanent contraception procedures.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"18 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959989","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":"Cost Effectiveness of Salpingectomy Compared With Vasectomy for Permanent Contraception.","authors":"Amy Pearson, Katerina Shvartsman, Wu Zeng, Jill Brown","doi":"10.1097/AOG.0000000000006042","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006042","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the cost effectiveness of salpingectomy compared with vasectomy for couples seeking permanent contraception.</p><p><strong>Methods: </strong>We developed a decision tree model that used TreeAge to evaluate the cost effectiveness of vasectomy compared with salpingectomy for a hypothetical cohort of 800,000 people, the number of male and female patients who undergo permanent contraception procedures in the United States annually. Effectiveness was expressed in quality-adjusted life-years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY gained or lost. We derived costs, probabilities, and utilities from the literature, and estimated the incremental cost-effectiveness ratio (ICER) between the two strategies. We completed a probabilistic sensitivity analysis with 10,000 simulations and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000. Secondary outcomes included the number of unintended pregnancies, ovarian cancer cases, and ovarian cancer deaths.</p><p><strong>Results: </strong>Salpingectomy was not a cost-effective strategy, with an ICER of $143,769 per QALY gained compared with vasectomy. Probabilistic sensitivity analysis showed that the chance of vasectomy being cost effective was 81.5% but decreased to 14.7% with a WTP threshold of $200,000. Annually, salpingectomy was associated with 1,215 fewer unintended pregnancies, 6,085 fewer ovarian cancer cases, and 4,921 fewer ovarian cancer deaths compared with vasectomy.</p><p><strong>Conclusion: </strong>Salpingectomy is not cost effective compared with vasectomy at a WTP threshold of $100,000, despite lower unintended pregnancy rates and societal ovarian cancer burden. Shared decision making, including a discussion of the long-term health benefits of salpingectomy, is important for couples deciding on permanent contraception procedures.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963474","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":"Artificial Intelligence and Gynecologic Surgery.","authors":"Grace M Pipes, Andrew J Hung, Kenneth H Kim","doi":"10.1097/AOG.0000000000006052","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006052","url":null,"abstract":"<p><p>Artificial intelligence (AI) has the potential to revolutionize health care. Within obstetrics and gynecology, it has proven to be useful for diagnostics and outcome predictions, particularly within maternal-fetal medicine and reproductive endocrinology and infertility. Artificial intelligence also has been used to harness the massive data sets produced by surgery, particularly robotic-assisted surgery, that are difficult to interpret with traditional statistical methods. Gynecologic surgery is a burgeoning area for AI application to improve the field's surgical outcomes through preoperative planning, intraoperative guidance, and training and credentialing. With a promising future, we must address limitations of current studies such as small data sets and lack of standardization of data collection as well as present mechanisms of explainability to ensure patient safety. In a rapidly evolving field, this narrative review summarizes the current literature on AI application to gynecologic surgery.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963515","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 Disparities in Endometriosis and Pelvic Pain Treatment Within an Integrated Health Care Delivery System.","authors":"Eve F Zaritsky,Lue-Yen Tucker,Eden Hen,Aliyya J Childs,Miranda L Ritterman Weintraub,Carla Wicks","doi":"10.1097/aog.0000000000006045","DOIUrl":"https://doi.org/10.1097/aog.0000000000006045","url":null,"abstract":"OBJECTIVETo assess disparities in medical and surgical management of endometriosis and pelvic pain disorders, focusing on Black individuals and individuals from other racial and ethnic groups within an integrated health care delivery system.METHODSWe conducted a retrospective cohort study of women aged 18 years or older with a pelvic pain disorder, including endometriosis, pelvic pain, dysmenorrhea, and dyspareunia, coded in the electronic health record (EHR) between 2012 and 2019 within Kaiser Permanente Northern California. Demographic, clinical, and treatment characteristics were assessed overall and by patient race and Black compared with other racial and ethnic groups as coded in the EHR.RESULTSOf 15,164 eligible women, 1,707 (11.3%) were Black and 13,457 (88.7%) were non-Black, including 44.4% White patients, 13.8% Asian patients, 24.8% Hispanic patients, and 5.7% patients from other or unknown racial and ethnic groups. Black compared with non-Black women were younger (median [interquartile range] age 36 years [28-44 years] vs 37 years [30-45 years], P<.001), had a higher median [interquartile range] body mass index (BMI) (29.8 [25.2-35.9] vs 26.0 [22.7-30.7], P<.001), and had similar parity. Compared with non-Black women, a higher proportion of Black women received hormonal therapy (56.2% vs 51.9%, P=.001), pain medications (55.4% vs 44.7%, P=.001), and surgery (25.5% vs 23.0%, P=.02). A smaller proportion of all non-White women were referred to a pelvic pain physician specialist compared with White women (P=.001), with Black women referred at lower rates (14.9% vs 18.4%, P=.001).CONCLUSIONBlack women in this integrated health care system received more hormonal, pain, and surgical management for endometriosis than non-Black women. However, there was a lower referral rate to pelvic pain physician specialists among all non-White women compared with White women, which highlights the need to better understand care allocation.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930213","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}