Obstetrics and gynecology最新文献

{"title":"Training Future Obstetrician-Gynecologists: Time for Tweaks or for Transitions?","authors":"Richard L Berkowitz, Howard Minkoff","doi":"10.1097/AOG.0000000000005838","DOIUrl":"10.1097/AOG.0000000000005838","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e117-e121"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029285","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":"Associated Trends in Obesity and Endometrioid Endometrial Cancer in the United States.","authors":"Alex A Francoeur, Cheng-I Liao, Jenny Chang, Caitlin R Johnson, Kiran Clair, Krishnansu S Tewari, Daniel S Kapp, John K Chan, Robert E Bristow","doi":"10.1097/AOG.0000000000005814","DOIUrl":"10.1097/AOG.0000000000005814","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the correlation in temporal trends in obesity and endometrioid endometrial cancer incidence in the United States using two comprehensive national databases.</p><p><strong>Methods: </strong>This is a cohort study in which data on endometrioid endometrial cancer were obtained from the U.S. Cancer Statistics from 2001 to 2018 and corrected for hysterectomy and pregnancy. Data on obesity were collected from the NHANES (National Health and Nutrition Examination Survey) database from 1988 to 2018. Average annual percentage changes (AAPCs) were used to describe trends. Pearson correlation coefficients ( r ) were calculated to examine the relationship between trends. SEER*Stat 8.3.9.2 and joinpoint regression program 5.2.0 were used for statistical analysis.</p><p><strong>Results: </strong>From U.S. Cancer Statistics data, 586,742 cases of endometrioid cancer were identified from 2001 to 2018. The average annual increase in endometrioid cancer was as follows: Hispanic 1.37% (95% CI, 1.14-1.60, P <.001), Black 1.30% (95% CI, 1.04-1.57, P <.001), and White -0.17 (95% CI, -0.91 to 0.58, P =.656). Women aged 20-29 years had a 4.48% annual increase (95% CI, 3.72-5.25, P <.001) and women aged 30-39 years had a 3.00% annual increase in rates (95% CI, 2.65-3.36, P <.001). According to the NHANES data, the prevalence of obesity in 2018 in adult women was as follows: Black 56.80%, Hispanic 44.10%, and White 40.90%. An examination of trends by age showed that women aged 20-29 years had the highest annual rise in obesity compared with other age groups (AAPC 7.36%, 95% CI, 4.0-10.8, P <.05). Strong and statistically significant correlations between endometrioid cancer and obesity trends were noted for Black ( r =0.78, P =.01) and Hispanic ( r =0.91, P <.001) women, as well as women aged 20-29 years ( r =0.72, P =.03) and 30-39 years ( r =0.88, P =.001).</p><p><strong>Conclusion: </strong>The current data demonstrate a temporal association between the increasing incidence of obesity and endometrioid endometrial cancer, and this effect disproportionately affects younger women and Black and Hispanic women.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e107-e116"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922394","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 of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome.","authors":"Khalil M Chahine, Megan C Shepherd, Baha M Sibai","doi":"10.1097/AOG.0000000000005819","DOIUrl":"10.1097/AOG.0000000000005819","url":null,"abstract":"<p><strong>Objective: </strong>To describe the presentation, outcomes, and management strategies for cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, or HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.</p><p><strong>Methods: </strong>This was a case series of individuals with subcapsular liver hematoma managed at a single level IV center over a 10-year period, from 2013 to 2024. Presenting signs and symptoms, laboratory findings, time of onset, management strategies, acute perinatal and maternal outcomes, and long-term outcomes such as subsequent pregnancies were reviewed in the medical record and recorded. Data were summarized using descriptive statistics, with results reported as means, standard deviations, and ranges. Categorical variables were summarized as counts and percentages.</p><p><strong>Results: </strong>There were 13 cases of subcapsular liver hematoma associated with preeclampsia, eclampsia, and HELLP syndrome between 2013 and 2024. In 10 of the 13 pregnancies (76.9%), delivery was preterm. The most common presenting symptoms were epigastric or right upper quadrant pain (53.8%), followed by abdominal distention (38.5%). Diagnosis of subcapsular liver hematoma was made in the antepartum period for six patients and was made in the postpartum for seven patients. The diagnosis was confirmed in all cases by computed tomography. Conservative management with close hemodynamic monitoring and transfusion of blood and blood products was sufficient in 11 (84.6%) patients; two patients underwent surgical exploration. The mean duration of hospital stay was 10 days (range 2-21 days). Maternal complications included pleural effusions, acute kidney injury, and pulmonary edema. There were no maternal deaths. There were four stillbirths and no neonatal deaths. Four people had five subsequent pregnancies; delivery was preterm in all five pregnancies, two pregnancies were complicated by subsequent HELLP syndrome, and one patient developed recurrent subcapsular liver hematoma.</p><p><strong>Conclusion: </strong>Subcapsular liver hematoma is a rare complication of preeclampsia, eclampsia, and HELLP syndrome that is associated with substantial maternal and perinatal morbidities. Conservative management with hemodynamic monitoring and transfusion of blood and blood products was sufficient for management in the majority of cases. All subsequent pregnancies resulted in preterm births.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"335-342"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952427","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":"Role of Glucagon-Like Peptide-1 Receptor Agonists in People With Infertility and Pregnancy.","authors":"Johanna Finkle, Brian C Brost","doi":"10.1097/AOG.0000000000005825","DOIUrl":"10.1097/AOG.0000000000005825","url":null,"abstract":"<p><p>Obesity is a chronic condition that causes significant morbidity and mortality in people in the United States and around the world. Traditional means of weight loss include diet, exercise, behavioral modifications, and surgery. New weight loss medications, glucagon-like peptide-1 receptor agonists, are revolutionizing the management of weight loss but have implications for fertility and pregnancy. Obesity is associated with infertility and may affect response to ovulation induction medications. In pregnancy, obesity increases the risks of spontaneous abortion, birth defects, gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, and stillbirth. Lifestyle changes alone for weight loss have not improved outcomes. Glucagon-like peptide-1 receptor agonists and new medications targeting gut hormones can help people achieve their weight loss goals but are contraindicated in pregnancy. Obstetrician-gynecologists should work with patients to manage these medications before they become pregnant, between pregnancies, and after delivery.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"286-296"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029282","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":"Serial Total Bile Acid Measurements in Intrahepatic Cholestasis of Pregnancy.","authors":"Minhazur R Sarker, Gladys A Ramos, Lauren Ferrara, Chelsea A Debolt","doi":"10.1097/AOG.0000000000005846","DOIUrl":"10.1097/AOG.0000000000005846","url":null,"abstract":"<p><p>Although peak serum total bile acid (TBA) levels guide management of intrahepatic cholestasis of pregnancy (ICP), whether ICP progresses in severity and when or how to assess bile acid levels serially remains unclear. We conducted a secondary analysis of a single-institution retrospective cohort study to assess bile acid trends across pregnancy among individuals diagnosed with ICP and to evaluate whether there was progression to higher ICP severity. We defined ICP severity as mild (peak TBA less than 40 micromol/L), moderate (peak TBA between 40 and 100 micromol/L), or severe (peak TBA 100 micromol/L or greater). Among the 1,188 patients with ICP in our cohort, 354 (29.8%) had repeat bile acid level measurements. Of those patients, 88 (24.9%) progressed to higher ICP severity that may have resulted in changes to delivery timing. Further studies are needed to determine whether serial assessment of bile acid levels with potential reclassification of ICP severity improves outcomes.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"343-345"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067133","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":"Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis.","authors":"Artur Menegaz de Almeida, Paloma Oliveira, Lucca Lopes, Marianna Leite, Victória Morbach, Francinny Alves Kelly, Ítalo Barros, Francisco Cezar Aquino de Moraes, Alexandra Prevedello","doi":"10.1097/AOG.0000000000005812","DOIUrl":"10.1097/AOG.0000000000005812","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficacy and safety of fezolinetant and elinzanetant for vasomotor symptoms in menopausal women.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, and Cochrane databases were systematically searched until August 22, 2024. Because the Cochrane Library included all the identified randomized controlled trials (RCTs), it was unnecessary to search ClinicalTrials.gov . The following words made up the search strategy, which was applied to the three databases: fezolinetant, elinzanetant, vasomotor symptoms, and menopause.</p><p><strong>Methods of study selection: </strong>Only RCTs comparing fezolinetant and elinzanetant with placebo for vasomotor symptoms in menopausal women were included.</p><p><strong>Tabulation, integration, and results: </strong>We extracted the number of patients, mean age, body mass index (BMI), and number of patients who underwent oophorectomy. Data were examined with the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed with I2 statistics. R 4.3.2 was used for statistical analysis. Seven RCTs with 4,087 patients were included in the analysis. Fezolinetant and elinzanetant were associated with diminished vasomotor symptom frequency: fezolinetant 30 mg (mean difference 2.16, 95% CI, 1.54-2.79, I2 =0%), fezolinetant 45 mg (mean difference 2.54, 95% CI, 1.86-3.21, I2 =0%), and elinzanetant 120 mg (mean difference 2.99, 95% CI, 1.74-4.23, I2 =0%). Both drugs also showed a decrease in vasomotor symptom severity: fezolinetant 30 mg (mean difference 0.20, 95% CI, 0.09-0.33, I2 =0%), fezolinetant 45 mg (mean difference 0.24, 95% CI, 0.13-0.34, I2 =0%), and elinzanetant 120 mg (mean difference 0.36, 95% CI, 0.26-0.46, I2 =0%). Elinzanetant 120 mg showed a significant improvement in sleep quality (mean difference 4.65, 95% CI, 3.73-5.56, I2 =0%). Elinzanetant 120 mg was associated with the occurrence of drug-related adverse events (11.70% vs 20.75%, risk ratio [RR] 0.57, 95% CI, 0.39-0.82, I2 =19%) and headache (2.54% vs 8.0%, RR 0.32, 95% CI, 0.16-0.64, I2 =0%).</p><p><strong>Conclusion: </strong>In this meta-analysis, consistent results suggest that fezolinetant and elinzanetant are associated with beneficial outcomes in menopausal women with vasomotor symptoms. Elinzanetant provided a larger effect size in vasomotor symptom frequency and severity reduction and greatly improved sleep quality compared with fezolinetant.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD42023469952.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"253-261"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922412","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":"Addressing the Menopause Health Needs of Military Service Members: A Call to Action.","authors":"Jill Brown, Katerina Shvartsman, Jezreelyn Bulaklak, Catherine Witkop, Monica Lutgendorf","doi":"10.1097/AOG.0000000000005801","DOIUrl":"10.1097/AOG.0000000000005801","url":null,"abstract":"<p><p>The menopause transition represents a significant life phase for people assigned female at birth marked by various physical and psychological changes. For military service members and veterans, this transition can be even more complex because of unique factors related to military service. A tradition of excluding women from service before reaching the age of the menopause transition has left the Military Health System unprepared to address the specific health needs of this population. The lack of attention to menopause needs of military service members is evidenced by the absence of menopause-related research in the active-duty population and a dearth of menopause-specific research in the veteran population. White House Executive Order 14120 on Advancing Women's Health Research and Innovation has highlighted the urgent need for focused research and improved health care delivery tailored to the menopause needs of military individuals and veterans. By addressing these gaps, we can better support the health and well-being of military service members in the menopause transition, ultimately improving operational readiness and retention. Because military service members and veterans often rely on the private sector for health care, it is incumbent on all health care professionals and systems to consider their unique health care needs related to midlife and menopause.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"247-252"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786390","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":"Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease.","authors":"Binglin Li, Yan Wang, Ruijuan Chen","doi":"10.1097/AOG.0000000000005836","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005836","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 3","pages":"e124"},"PeriodicalIF":5.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468584","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":"Nationwide Assessment of Gestational Age Distribution at Delivery for Patients With Placenta Accreta Spectrum Disorder.","authors":"Koji Matsuo, Brett D Einerson, Shinya Matsuzaki, Fay F Pon, Zaira N Chavez Jimenez, Jennifer A Yao, Alexandre Buckley de Meritens, Savvy Benipal, Matthew B Givens, Rachel S Mandelbaum, Joseph G Ouzounian, Robert M Silver, Jason D Wright","doi":"10.1097/aog.0000000000005849","DOIUrl":"https://doi.org/10.1097/aog.0000000000005849","url":null,"abstract":"To assess the distribution of gestational age at delivery for patients with placenta accreta spectrum (PAS) in the United States.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"19 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462611","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 Care Utilization Within 1 Year After a Facilitated Postpartum-to-Primary Care Transition.","authors":"Arlin Delgado, Pichliya Liang, Tierra Bender, Alaka Ray, Kaitlyn E James, Ishani Ganguli, Jessica L Cohen, Mark A Clapp","doi":"10.1097/AOG.0000000000005848","DOIUrl":"10.1097/AOG.0000000000005848","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of a behavioral science-informed intervention designed to facilitate postpartum-to-primary care transitions on primary care visits and screenings within 1 year postpartum for individuals with chronic conditions or pregnancy conditions with long-term health risks.</p><p><strong>Methods: </strong>This was a planned secondary analysis of a randomized controlled trial of a behavioral science-informed intervention designed to increase primary care practitioner (PCP) visits within 4 months postpartum compared with routine care. The intervention included default PCP visit scheduling with nudge reminders and use of tailored language. The primary outcome for this secondary analysis was attending an annual examination or health care maintenance visit with a PCP within 1 year postpartum. Visits with a PCP for any reason and receipt of screenings or services by a PCP (eg, weight, blood pressure, mood screening) were also compared. Outcomes were compared between groups with χ2 testing.</p><p><strong>Results: </strong>All 353 participants were followed through 1 year after their due dates: 173 in the control group and 180 in the intervention group. More patients in the intervention group attended an annual examination with a PCP within 1 year compared with the control group (59.0% vs 39.3%, P<.001) and had a PCP visit for any reason (72.8% vs 61.3%, P=.02). A significantly higher rate of mental health disorder screening was observed in the intervention group (63.9% vs 55.5%, P=.046); significant differences in other screenings were not observed.</p><p><strong>Conclusion: </strong>This relatively simple and low-cost intervention designed to facilitate transition from postpartum to primary care within the first 4 months demonstrated benefits for PCP engagement within the first year postpartum.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT05543265.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416897","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}