Obstetrics and gynecology最新文献

{"title":"Why Gynecologists Must Become Anal Cancer-Prevention Specialists.","authors":"Nadi Nina Kaonga, Mary Grace Tadros, Patricia Jeudin, Elizabeth Stier, Christine Conageski, Michelle Khan, Lisa Flowers","doi":"10.1097/AOG.0000000000006322","DOIUrl":"10.1097/AOG.0000000000006322","url":null,"abstract":"<p><p>Anal cancer incidence is rising in the United States, with the fastest increases among older women, a population not traditionally considered high risk. Despite its shared human papillomavirus etiology with cervical cancer, clinical capacity for anal cancer screening and prevention remains limited, even though the disease is largely preventable. Gynecologists are uniquely positioned to address this preventable gap. The principles of anal cancer prevention correspond with established gynecologic practice. Expanding gynecologic presence in anal cancer prevention efforts represents a logical, workforce-ready strategy to detect and treat anal cancer precursors and thereby limit the incidence of cancer, though collaboration and a multi-disciplinary approach are key.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e266-e268"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988431","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":"Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis.","authors":"Carolina Alves Felippe, Sinrraim Dos Santos Chaves Ruiz, Rebeca Ferreira de Souza, Aliny Silva de Lima, Priscila Luiza Dos Santos, Pandora Eloa Oliveira Fonseca, Ingryd de Almeida Silva, Carlos Roberto Montes-de-Oca-Saucedo, Ana Cecília Oliveira Santana, Jasmina Veta Darkovski, Hadas Rachel Matlaw, Laura Fonseca Queiroz","doi":"10.1097/AOG.0000000000006344","DOIUrl":"10.1097/AOG.0000000000006344","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize evidence on the benefit-risk profile of antenatal corticosteroid (ACS) exposure in twin pregnancies and to explore effect modification by gestational age at birth.</p><p><strong>Data sources: </strong>PubMed, Embase, ClinicalTrials.gov , and Cochrane Central Register of Controlled Trials (from inception to October 2025) were searched using terms for twin pregnancy or multiple gestation and antenatal corticosteroids (eg, betamethasone, dexamethasone).</p><p><strong>Methods of study selection: </strong>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PROSPERO CRD420251275650), we included a randomized controlled trial (RCT) and observational studies comparing ACS exposure with no ACS in twin pregnancies and reporting neonatal outcomes. Observational studies were eligible if they reported sufficient raw outcome data to permit quantitative synthesis. Primary outcomes were neonatal mortality and neonatal hypoglycemia; key secondary outcomes included neonatal intensive care unit (NICU) or special care unit admission and major respiratory outcomes. Risk of bias was assessed with version 2 of the Cochrane Risk of Bias tool and Risk of Bias in Non-randomized Studies of Interventions.</p><p><strong>Tabulation, integration, and results: </strong>Random-effects meta-analyses were conducted to estimate risk ratios (RRs) with 95% CIs. Heterogeneity was assessed with the I2 statistic, and small-study effects were evaluated when feasible. Prespecified subgroup analyses examined gestational age (less than 34 weeks vs 34 or more weeks). Sixteen studies (18,367 neonates, 8,723 ACS exposed) were included. Overall, the certainty of evidence was moderate to low. Exposure to ACS was not significantly associated with a reduction in neonatal mortality (RR 0.77, 95% CI, 0.59-1.01). Antenatal corticosteroid was not associated with a reduction in respiratory distress syndrome (RDS) overall (RR 1.11, 95% CI, 0.81-1.52), and gestational age-stratified analyses were nonsignificant. Exposure to ACS was associated with increased supplemental oxygen requirement (RR 1.72, 95% CI, 1.07-2.74), neonatal hypoglycemia (RR 1.80, 95% CI, 1.30-2.51), and NICU or special care unit admission (RR 1.33, 95% CI, 1.07-1.64), with consistent hypoglycemia effects across gestational ages.</p><p><strong>Conclusion: </strong>In twin pregnancies, ACS exposure was not consistently associated with improved neonatal outcomes, with no overall reduction in RDS and neonatal mortality. Associations with increased risks of hypoglycemia, oxygen requirement, and NICU or special care unit admission were observed. Given the moderate-to-low certainty of the available evidence, these findings should be interpreted cautiously.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD420251275650.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"434-444"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148164013","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":"Prepregnancy Insulin Resistance and Fertility and Pregnancy Outcomes in Women With Polycystic Ovarian Syndrome.","authors":"Bo Hyon Yun, Seok Kyo Seo, Jacqueline Yano Maher, Tazim Dowlut-McElroy, Veronica Gomez-Lobo","doi":"10.1097/AOG.0000000000006318","DOIUrl":"10.1097/AOG.0000000000006318","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether prepregnancy insulin resistance and its improvement during ovulation induction are associated with fertility and pregnancy outcomes in women with polycystic ovarian syndrome (PCOS).</p><p><strong>Methods: </strong>This secondary analysis used data from PPCOS II (Pregnancy in Polycystic Ovary Syndrome II), a multicenter randomized trial. This analysis included women aged 18-40 years with PCOS who were undergoing ovulation induction with clomiphene citrate or letrozole. Insulin resistance was assessed at screening and at end-of-treatment visits by using the homeostatic model assessment of insulin resistance (HOMA-IR), the quantitative insulin sensitivity check index, and the glucose-to-insulin ratio. The primary outcome was clinical pregnancy, and secondary outcomes included gestational diabetes mellitus (GDM), preeclampsia, and preterm delivery.</p><p><strong>Results: </strong>Among 746 women, higher prepregnancy HOMA-IR quartiles were associated with decreased ovulation (93.5% vs 87.8% vs 75.4% vs 73.8%; P <.001, P for trend <.001), lower clinical pregnancy (36% vs 25.5% vs 23.52% vs 26.5%; P =.005, P for trend=.001) and live-birth rates (35.5% vs 19.7% vs 20.3% vs 18.2%; P <.001, P for trend <.001), and higher risk of GDM (13.8% vs 15.4% vs 22.5% vs 45.7%; P =.002, P for trend <.001). Women in the highest HOMA-IR quartiles experienced delayed first ovulation and more frequent obstetric complications, especially increased risks of GDM. Improvement in the HOMA-IR during treatment was associated with increased odds of clinical pregnancy and reduced risk of preeclampsia.</p><p><strong>Conclusion: </strong>Prepregnancy insulin resistance is associated with impaired fertility and increased pregnancy complications in women with PCOS. Assessment and improvement of insulin resistance before fertilization may enhance reproductive success and reduce obstetric risk.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT00719186.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"556-563"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988454","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":"Intrauterine Balloon Tamponade Duration for Postpartum Hemorrhage: A Randomized Controlled Trial","authors":"Paul Berveiller,Patrick Rozenberg,Paul Guerby,Charles Garabédian","doi":"10.1097/aog.0000000000006405","DOIUrl":"https://doi.org/10.1097/aog.0000000000006405","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":"272-272"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020719","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":"Biologic Disease-Modifying Antirheumatic Drug Use During Pregnancy and Lactation.","authors":"Caroline H Siegel, Lisa R Sammaritano","doi":"10.1097/AOG.0000000000006193","DOIUrl":"10.1097/AOG.0000000000006193","url":null,"abstract":"<p><p>Autoimmune rheumatic diseases (ARDs) are chronic diseases characterized by periods of flare and remission. Autoimmune rheumatic diseases are often diagnosed in reproductive-aged women, and treatment decisions must factor in pregnancy potential and intent. Well-controlled maternal disease in the prepregnancy period and during pregnancy portends improved maternal and fetal outcomes. Although conventional immunosuppressant and agents remain a mainstay of treatment, use of biologic disease-modifying antirheumatic drugs (bDMARDs), either alone or in combination with conventional agents, is increasingly common. Multiple professional societies have published formal evidence-based guidelines with recommendations for ARD treatment during pregnancy and lactation. This review focuses on the use of bDMARDs during pregnancy and lactation and the safety of infant vaccination after in utero exposure; we synthesize current evidence, summarize guideline recommendations, and present practical management strategies. In general, guidelines support the use of bDMARDs during pregnancy and in the postpartum period to maintain disease control. Among biologic classes, tumor necrosis factor inhibitors have the most robust evidence establishing safety for use during pregnancy and lactation. Safety data for newer agents with differing targets or mechanisms of action are often lacking. Teratogenicity is unlikely; large-molecule monoclonal antibodies do not cross the placenta until after organogenesis. The main concerns with treatment during pregnancy are potential effects on the neonatal immune system and other unknown consequences of in utero exposure. Risks of treatment are often outweighed by benefits, especially for maternal disease refractory to other pregnancy-compatible options. Additional research is needed to inform individualized counseling and shared decision making.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"471-488"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146227643","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":"Patient-Specific Pessaries After Suboptimal Outcomes With Standard Pessary Use.","authors":"Christopher X Hong, Derek Sham, Shufei Zhang, Cara McDougall, Golafsoun Ameri","doi":"10.1097/AOG.0000000000006287","DOIUrl":"10.1097/AOG.0000000000006287","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate fitting success, continuation of use, and adoption patterns of patient-specific pessaries among individuals with prior unsuccessful or suboptimal outcomes with standard pessaries.</p><p><strong>Methods: </strong>We conducted a retrospective case series of patients who underwent fitting of a patient-specific pessary between February 2024 and September 2025 across 18 clinical sites in Canada. All fittings, design selections, and outcomes were recorded in a centralized cloud-based platform. Eligibility included symptomatic pelvic organ prolapse with current or prior pessary use or previous unsuccessful fittings. Clinicians could design up to two pessaries per round with iterative refinement. The primary outcome was successful use , defined as the patient's decision to retain and continue using the pessary after up to two fitting rounds and a 4-week home trial.</p><p><strong>Results: </strong>A total of 113 patients underwent fitting of a patient-specific pessary. Initial fitting success was achieved in 87 patients (77.0%, 95% CI, 68.5-83.7%). Of these, 69 (79.3%, 95% CI, 69.7-86.5%) elected to continue using the device after the home trial. Twenty-six patients (23.0%) were not successfully fitted in the first round, of whom seven pursued a second round; four were successfully fitted, and three continued use after the home trial. Overall, 72 of 113 patients (63.7%, 95% CI, 54.5-72.1%) retained and continued using their patient-specific pessary at the final follow-up.</p><p><strong>Conclusion: </strong>Patient-specific pessaries achieved high fitting success and continuation rates among individuals who previously had unsuccessful or suboptimal outcomes with standard pessaries. These findings support the clinical utility of individualized devices as a nonsurgical treatment option for pelvic organ prolapse.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"547-555"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278203","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":"Antenatal Corticosteroids in Twin Pregnancies","authors":"Jennifer Grasch,Maged M. Costantine","doi":"10.1097/aog.0000000000006423","DOIUrl":"https://doi.org/10.1097/aog.0000000000006423","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"78 1","pages":"432-433"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149022339","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 Severe Perioperative Surgical Morbidity With Cesarean Delivery and Postpartum Readmission.","authors":"Alexander Butwick, Rebecca J Baer, Naghma Farooqi, Vasiliki Tatsis, Olof Stephansson, Kelli Ryckman, Dana R Gossett, Sasha Hernandez, Justin Brandt, Laura Jelliffe-Pawlowski","doi":"10.1097/AOG.0000000000006319","DOIUrl":"10.1097/AOG.0000000000006319","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between severe perioperative surgical morbidity with cesarean delivery and postpartum readmission.</p><p><strong>Methods: </strong>This was a retrospective cross-sectional study using linked birth certificate and maternal discharge data for patients who underwent cesarean delivery in any California hospital between October 2015 and October 2021. Severe perioperative surgical morbidity is an index characterized by severe surgical complications occurring during hospitalization for cesarean delivery, identified using International Classification of Diseases, Tenth Revision diagnosis and procedure codes for severe surgical complications. The primary outcome was all-cause postpartum readmission within 42 days after hospital discharge. Readmission rates were quantified for patients with and without severe perioperative surgical morbidity, and generalized estimating equations were used to estimate adjusted relative risks (aRRs), adjusted risk differences (aRD), and 95% CIs, accounting for patient- and hospital-level factors. In secondary analysis, the association was assessed separately for prelabor and intrapartum cesarean deliveries.</p><p><strong>Results: </strong>The study population included women who had undergone 703,079 cesarean deliveries. The readmission rate was higher among those with severe perioperative surgical morbidity compared with those without severe perioperative surgical morbidity (469.4/10,000 [95% CI, 428.0-511.0] vs 165.3/10,000 [95% CI, 162.3-168.3]). Severe perioperative surgical morbidity was associated with a twofold increased risk of readmission (aRR 2.22; 95% CI, 2.00-2.46). The aRD for patients with severe perioperative surgical morbidity was an excess of two readmissions (2.5; 95% CI, 2.1-3.0/100 cesarean deliveries) compared with patients without severe perioperative surgical morbidity. Wound infection was the most common diagnosis at readmission among patients with severe perioperative surgical morbidity (77/10,000; 95% CI, 60.5-95.3). The risk of readmission was similar among patients with severe perioperative surgical morbidity and without severe perioperative surgical morbidity who underwent intrapartum cesarean delivery (aRR 2.35; 95% CI, 2.09-2.65) and prelabor cesarean delivery (aRR 2.03; 95% CI, 1.72-2.40).</p><p><strong>Conclusion: </strong>Nearly 1 in 20 patients undergoing cesarean delivery who experience severe perioperative surgical morbidity undergoes postpartum readmission, with a twofold increased readmission risk at 42 days after discharge. Patients with severe perioperative surgical morbidity may benefit from targeted follow-up to reduce postpartum admission.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"525-533"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147942463","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":"Milestones in Motion: Red Cell Alloimmunization.","authors":"Kenneth J Moise","doi":"10.1097/AOG.0000000000006385","DOIUrl":"10.1097/AOG.0000000000006385","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"427-431"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579505","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":"Primary Prevention of Ovarian Cancer With Salpingectomy: The Time is Now!","authors":"Jason D Wright","doi":"10.1097/AOG.0000000000006421","DOIUrl":"10.1097/AOG.0000000000006421","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"445-447"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796166","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}