Obstetrics and gynecology最新文献

{"title":"Adverse Maternal Outcomes Among People With Human Immunodeficiency Virus (HIV) Using Antiretroviral Therapy in Botswana.","authors":"J Sroda Agudogo,Maya Jackson-Gibson,Annliz Macharia,Bridgette Wamakima,Katlego Boikanyo,Modiegi Diseko,Judith Mabuta,Sarah J Hanson,Mercy Nassali,Dudu Rubgega,Indira Ranaweera,Joseph Makhema,Anna M Modest,Michele R Hacker,Rebecca Zash,G Justus Hofmeyr,Roger L Shapiro,Rebecca Luckett","doi":"10.1097/aog.0000000000006039","DOIUrl":"https://doi.org/10.1097/aog.0000000000006039","url":null,"abstract":"OBJECTIVEThis study aimed to evaluate maternal outcomes in a large cohort with high prevalence of human immunodeficiency virus (HIV) infection in Botswana after implementation of a treat-all policy.METHODSIn this retrospective cohort study, data were collected from the medical record at the time of discharge from November 2021 to December 2023. Outcomes were recorded in the Tsepamo Birth Outcomes Surveillance and Safe Birth studies at Princess Marina Hospital in Botswana. We evaluated maternal mortality and obstetric morbidities by HIV status, including preeclampsia, eclampsia, hemorrhage, infection, and acute pulmonary or cardiac conditions at the time of hospital discharge.RESULTSWe included 11,754 participants; 2,201 (18.7%) were pregnant people with HIV infection. Ninety-seven percent (2,135) were on antiretroviral therapy (ART) at time of delivery; 1,996 (93.5%) of those with a known ART regimen were on dolutegravir, tenofovir disoproxil fumarate, and lamivudine. Of the 1,090 people with HIV infection with known CD4 counts, 757 (69.4%) had more than 500 cells/microliter, and only 42 (3.9%) had fewer than 200 cells/microliter. Of 1,524 people with HIV infection with known viral loads, 1,436 (94.2%) were undetectable on initial testing. There were no statistically significant differences in incidence of hemorrhage (90 [4.1%] vs 370 [3.9%], adjusted risk ratio [RR] 0.93, 95% CI, 0.73-1.17), infection (38 [1.7%] vs 126 [1.3%], adjusted RR 1.56, 95% CI, 0.97-2.51), eclampsia (6 [0.3%] vs 28 [0.3%], adjusted RR 1.12, 95% CI, 0.50-2.53), acute pulmonary or cardiac conditions (15 [0.7%] vs 43 [0.4%], adjusted RR 1.22, 95% CI, 0.65-2.27), transfusion of 2 or more units of packed red blood cells (33 [36.7%] vs 110 [29.8%], P=.21), additional uterotonics (48 [53.3%] vs 173 [47.1%], P=.29), use of tranexamic acid (31 [ 34.4%] vs 106 [29.0%], P=.31), intensive care unit admission (4 [0.2%] vs 10 [0.1%], P=.31), mechanical ventilation (3 [0.1%] vs 6 [0.1%], P=.38), pressor support (2 [0.1%] vs 2 [0.0%], P=.16), or mortality (5 [0.2%] vs 11 [0.1%], adjusted RR 1.44, 95% CI, 0.46-4.57) in people with HIV infection compared with those without HIV infection. There were few notable differences, including a slightly reduced risk of preeclampsia (184 [8.4%] vs 818 [8.6%], adjusted RR 0.84, 95% CI, 0.71-0.98) and, although rare, an increased risk of uterine rupture (12 [0.5%] vs 8 [0.1%], adjusted RR 6.54, 95% CI, 2.33-18.33) in people with HIV infection compared with those without HIV infection.CONCLUSIONThere was little difference in adverse maternal obstetric outcomes between people with and those without HIV infection in the treat-all era with integrase strand inhibitors (primarily dolutegravir); notable exceptions included a slightly reduced risk of preeclampsia and, although rare, an increased risk of uterine rupture in those with HIV infection.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"83 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930216","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":"Comparative Age-Stratified Analysis of Live-Birth Outcomes in Primary Embryo Transfer to Assess the Effect of Preimplantation Genetic Testing for Aneuploidy.","authors":"Sarah F Wang,David B Seifer","doi":"10.1097/aog.0000000000006047","DOIUrl":"https://doi.org/10.1097/aog.0000000000006047","url":null,"abstract":"OBJECTIVETo investigate whether the perceived advantages of preimplantation genetic testing for aneuploidy (PGT-A) are attributable to genetic testing itself or to transferring a thawed frozen embryo into a receptive endometrium. We compared live-birth and cumulative live-birth outcomes across three groups: primary frozen embryo transfer (FET) with PGT-A, FET without PGT-A, and fresh transfers in initial autologous assisted reproductive technology (ART) cycles.METHODSWe performed a retrospective analysis from the 2014-2020 Society for Assisted Reproductive Technology Clinic Outcome Reporting System database, comparing success rates of primary FET with PGT-A, FET without PGT-A, and fresh transfers. Live birth, cumulative live birth, and miscarriage rates were compared, with primary transfer defined as the first transfer after the index retrieval. Live-birth rate was defined as the likelihood of live birth from the first transfer; cumulative live-birth rate was the likelihood of a live birth from all transfers within 1 year of the initial retrieval. Multivariate logistic regression determined the association of live birth with FET with PGT-A, FET without PGT-A, and fresh transfers while controlling for various demographic and clinical factors.RESULTSWe examined 263,521 first autologous ART cycles between 2014 and 2020 that resulted in primary embryo transfer. The live-birth rate was 56.0% for FET with PGT-A, 48.3% for FET without PGT-A, and 39.8% for fresh transfers (P<.001). Cumulative live-birth rates were similar between the two frozen strategies (74.1% with PGT-A vs 74.0% without PGT-A, P=.66); both were higher than fresh transfers (60.0%, P<.001). In patients younger than age 38 years, cumulative live-birth rates were higher for FETs without PGT-A (P<.01). In those 38 years and older, PGT-A was associated with higher cumulative success (P<.001). Regression analysis demonstrated that FET, regardless of PGT-A use, was associated with higher odds of live birth across all age groups, whereas PGT-A conferred additional benefit only in patients aged 35 years or older, with increasing advantage with advancing age.CONCLUSIONPrimary FETs were associated with better outcomes than fresh transfers. Although PGT-A use improved outcomes for older patients, no overall benefit was seen in younger patients. These findings bring into question the perceived advantage of PGT-A over FETs without PGT-A, particularly in those younger than age 38 years, in whom FET without PGT-A demonstrated a higher cumulative live-birth rate compared with cycles with PGT-A. These data highlight the need for cautious consideration of PGT-A utilization for initial transfer, especially in younger age groups.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930219","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":"Small-for-Gestational-Age Birth Weight Risk Stratification Using First-Trimester Fetal Cardiac Parameters.","authors":"Rebecca Horgan,Elena Sinkovskaya,Erkan Kalafat,George Saade,Alfred Abuhamad","doi":"10.1097/aog.0000000000006040","DOIUrl":"https://doi.org/10.1097/aog.0000000000006040","url":null,"abstract":"OBJECTIVETo apply unsupervised machine learning techniques to first-trimester fetal cardiac data to enhance early risk stratification of small-for-gestational-age (SGA) birth weight.METHODSThis was a prospective cohort study that enrolled patients up to 13 6/7 weeks of gestation without fetal, umbilical cord, or placental abnormalities. At the first-trimester ultrasonogram, the chest area, heart area, ventricular inlet lengths, and spectral and color Doppler of the atrioventricular valves were assessed. An unsupervised machine learning technique, k-means clustering, was applied to sort fetuses into risk groups for SGA birth weight, defined as a birth weight less than the 10th percentile for gestational age. Candidate variables were selected with regression analyses, and the elbow method was used to determine the optimal number of clusters. Cumulative rates of outcomes were plotted with Kaplan-Meier analysis, and model performance was tested with area under the curve values with repeated cross-validation.RESULTSSix hundred seventeen pregnancies were included in the analysis, with 45 (7.3%) patients delivering a neonate with SGA birth weight. z-scores of the chest area (P=.031) and tricuspid valve E/A ratio (P<.001) showed an independent association with SGA birth weight and were used in the clustering algorithm. An unsupervised machine learning algorithm blinded to the outcome identified three risk clusters: low (n=202), intermediate (n=217), and high (n=198). The rates of SGA birth weight (1.2%, 5.4%, and 14.4%, respectively, P<.001) and nonreassuring fetal heart rate tracings (3.6%, 5.4%, and 8.6%, respectively, P=.039) differed significantly among the three risk clusters. Area under the curve values of the model in cross-validation samples were 0.71 (95% CI, 0.64-0.77). Using the low-risk cluster as a threshold, the model specificity was 95.5% and sensitivity was 35.0% for ruling out SGA birth weight. The negative predictive value for ruling out SGA birth weight was 99.0%.CONCLUSIONUnsupervised machine learning of first-trimester fetal cardiac parameters can effectively stratify risk for SGA birth weight.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"29 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930214","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 Over-the-Counter Availability of Progestin-Only Contraceptive Pills in Abortion-Restrictive and Abortion-Protective Settings.","authors":"Jill K Kumasaka,Ava D Mandelbaum,Alison B Edelman,Aaron B Caughey,Maria I Rodriguez","doi":"10.1097/aog.0000000000006048","DOIUrl":"https://doi.org/10.1097/aog.0000000000006048","url":null,"abstract":"OBJECTIVETo determine the cost effectiveness of a policy change making a progestin-only contraceptive pill available over-the-counter (OTC).METHODSWe created a decision analytic model to determine the cost effectiveness of making an OTC progestin-only contraceptive pill available in the United States in two distinct policy environments: one in which abortion is legal and available and one in which abortion is restricted. Our theoretical population included 1,000,000 women at risk of unintended pregnancy over 1 year. We adopted the societal and payer perspective and obtained probabilities, utilities, and costs from the literature. We set the cost-effectiveness threshold at a standard $100,000 per quality-adjusted life-year (QALY). Our primary outcome was the incremental cost-effectiveness ratio.RESULTSIn a theoretical cohort of 1,000,000 women at risk of unintended pregnancy, having an oral contraceptive pill available OTC was a dominant strategy in both settings; it reduced costs and improved QALYs. In settings in which abortion was available, having an OTC progestin-only contraceptive pill was associated with a $976-million reduction in costs and an increase of 14,153 QALYs. An OTC progestin-only contraceptive pill strategy would no longer be cost effective if more than 70% of OTC progestin-only contraceptive pill users discontinued usage; OTC progestin-only contraceptive pills would be cost effective for insurers to cover until the monthly cost exceeds $250 per pill pack in an abortion-protective setting.CONCLUSIONThe availability of an OTC progestin-only contraceptive pill is a cost-effective strategy in abortion-protective and abortion-restrictive settings.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"10 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930103","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":"Severe Perioperative Surgical Morbidity With Cesarean Delivery.","authors":"Alexander Butwick,Rebecca J Baer,Naghma Farooqi,Olof Stephansson,Laura Jelliffe-Pawlowski","doi":"10.1097/aog.0000000000006041","DOIUrl":"https://doi.org/10.1097/aog.0000000000006041","url":null,"abstract":"OBJECTIVETo evaluate the prevalence and risk factors for severe perioperative surgical morbidity among patients undergoing cesarean delivery.METHODSThis was a retrospective cross-sectional study of patients who underwent cesarean delivery in any California hospital between 2016 and 2021. Linked birth certificate and maternal discharge data identified cesarean delivery hospitalizations. We constructed a composite index for severe perioperative surgical morbidity, including intra-abdominal or pelvic visceral and vascular injuries, hysterectomy, pelvic or retroperitoneal hematoma, wound complications, ileus or bowel obstruction, acute peritonitis, and shock. Severe perioperative surgical morbidity prevalence was quantified overall and stratified by prelabor and intrapartum cesarean deliveries. We developed a multivariable Poisson log-linear regression model to identify independent risk factors for severe perioperative surgical morbidity. In secondary analyses, severe perioperative surgical morbidity prevalence and risk factors were assessed separately by prelabor and intrapartum cesarean delivery.RESULTSAmong 594,655 cesarean deliveries, 10,182 (171/10,000, 95% CI, 168-175) had severe perioperative surgical morbidity. The most common categorized morbidities were wound complications (59/10,000, 95% CI, 57-61); bladder, genitourinary, or pelvic injury (45/10,000, 95% CI, 43-47); ileus or bowel obstruction (33/10,000, 95% CI, 32-35); shock (15/10,000, 95% CI, 14-16); and intraoperative bowel injury (14/10,000, 95% CI, 13-15). Severe perioperative surgical morbidity prevalence was higher among patients undergoing intrapartum compared with prelabor cesarean delivery (203/10,000, 95% CI, 198-209 vs 146/10,000, 95% CI, 142-150). Patients with placenta accreta spectrum disorder had the highest severe perioperative surgical morbidity risk (adjusted risk ratio 15.3, 95% CI, 14.0-16.7).CONCLUSIONNearly 1 in 60 patients who undergo cesarean delivery in California experienced severe perioperative surgical morbidity, with a higher prevalence occurring among intrapartum compared with prelabor cesarean deliveries. These findings underscore the need for systematic measurement and evaluation of surgical quality of care among patients undergoing cesarean delivery to identify opportunities for morbidity reduction.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"2 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930217","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":"Glucagon-Like Peptide-1 Receptor Agonists in Gynecologic Surgery.","authors":"Richard Hsu,Esther Han,Sarah Swartz,Michelle Pacis","doi":"10.1097/aog.0000000000006035","DOIUrl":"https://doi.org/10.1097/aog.0000000000006035","url":null,"abstract":"Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly expanded beyond their initial role in diabetes management to become prominent agents for weight loss and metabolic optimization. A growing number of patients receiving these therapies are presenting for gynecologic surgery. This narrative review summarizes current evidence on GLP-1 RAs, including their mechanisms of action, clinical benefits, and perioperative considerations, with particular attention to their effects on gastric emptying and the associated risk of aspiration. Early recommendations advised routine discontinuation of GLP-1 RAs before surgery because of theoretical concerns about delayed gastric emptying. However, recent multisociety guidance supports continued use for most patients, with individualized risk assessment and perioperative strategies such as preoperative liquid diets for those at higher risk. These evolving recommendations reflect a shift toward balancing the metabolic and weight loss benefits of GLP-1 RAs with perioperative safety considerations. As clinical experience with these agents grows, ongoing research and multidisciplinary collaboration remain essential to ensure optimal outcomes for patients undergoing gynecologic surgery.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"8 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850966","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":"Postpartum Diuretics for Hypertensive Disorders of Pregnancy: A Systematic Review and Meta-analysis.","authors":"Emma Trawick Roberts,Johanna Quist-Nelson,Elana Jaffe Brotkin,Mehrnaz Salehi,Suneet P Chauhan,Baha M Sibai,Michal Fishel Bartal","doi":"10.1097/aog.0000000000006032","DOIUrl":"https://doi.org/10.1097/aog.0000000000006032","url":null,"abstract":"OBJECTIVETo systematically review the use of diuretics to reduce postpartum hypertension among individuals with hypertensive disorders of pregnancy.DATA SOURCESMEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials were searched through June 2024 (PROSPERO CRD42021288277).METHODS OF STUDY SELECTIONRandomized controlled trials investigating postpartum diuretic use in individuals with hypertensive disorders of pregnancy with 20 or more participants per arm were included. Primary outcomes were hypertension within 2 weeks postpartum and mean systolic or diastolic blood pressure after treatment. Secondary postpartum outcomes included severe maternal morbidity, use of additional antihypertensives, readmission, hypertension at 6 weeks postpartum, and breastfeeding. Risk of bias was assessed with the Cochrane handbook. A random-effects meta-analysis model used the restricted maximum-likelihood estimated treatment effects with relative risk (RR)/mean difference and 95% CIs.TABULATION, INTEGRATION, AND RESULTSOf 469 records reviewed, 10 randomized controlled trials were included (1,815 individuals: 906 intervention, 909 control). Interventions included furosemide (five trials, N=958), torsemide (one trial, N=118), combined furosemide-antihypertensive drug (three trials, N=670), and combined thiazide-angiotensin-converting enzyme inhibitor (one trial, N=67). Seven trials were at high risk of bias. Diuretic use was associated with a reduction in hypertension within 2 weeks postpartum (five trials, N=1,055, pooled RR 0.54, 95% CI, 0.39-0.74; number needed to treat [NNT] 4). There was no difference in mean systolic or diastolic blood pressure after treatment with diuretics; there was also no difference in severe maternal morbidity, readmissions, or any other secondary outcomes. When analysis was restricted to trials at low risk of bias, the reduction in postpartum hypertension was not significant (two trials, N=502, RR 0.62, 95% CI, 0.36-1.09).CONCLUSIONDiuretics were associated with a reduction in immediate postpartum hypertension in individuals with hypertensive disorders of pregnancy (NNT 4), although this reduction was not observed when analysis was restricted to trials at low risk of bias. Further studies are needed to assess the role of diuretics in treating postpartum hypertension.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42021288277.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"746 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850963","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":"Risk of Self-Harm Among Individuals Diagnosed With Endometriosis.","authors":"Peter Thiel,Olga Bougie,Jessica Pudwell,Jonas Shellenberger,Maria P Velez,Ally Murji","doi":"10.1097/aog.0000000000006030","DOIUrl":"https://doi.org/10.1097/aog.0000000000006030","url":null,"abstract":"Endometriosis is a chronic inflammatory condition that has been linked to mental health outcomes. We conducted a population-based, retrospective, matched cohort study using administrative health data (2010-2022) from Ontario, Canada, to assess the risk of self-harm, overdose, and suicide in patients with endometriosis, accounting for prior psychiatric utilization. The cohort included 56,053 patients with endometriosis and 112,106 individuals in a matched control group. The primary outcome was a composite of intentional self-harm, overdose, and suicide. Endometriosis was associated with a higher risk of the composite outcome (adjusted hazard ratio 1.42, 95% CI, 1.27-1.59), particularly among individuals with no or minimal prior psychiatric care. These findings highlight the importance of considering mental health needs for patients newly diagnosed with endometriosis.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"48 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850962","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":"Dating Discrepancies on Research Ultrasonography and Risk of Pregnancy Loss in a Prospective Cohort.","authors":"Alexandra C Sundermann,Elizabeth A Jasper,Suchita E Kumar,Katherine E Hartmann,Digna R Velez Edwards","doi":"10.1097/aog.0000000000006031","DOIUrl":"https://doi.org/10.1097/aog.0000000000006031","url":null,"abstract":"OBJECTIVETo estimate the risk associated with discrepancies between last menstrual period (LMP)-based and ultrasound-based gestational dating and pregnancy loss in a prospective cohort of individuals of normal fertility who underwent standardized early-pregnancy ultrasonography.METHODSParticipants in a community-based, prospective pregnancy cohort were recruited preconceptionally or in early pregnancy. Participants underwent standardized research ultrasonography targeted for the sixth week of gestation. We calculated the magnitude of lag between ultrasound-based age and LMP-based age at the research ultrasonogram. Cox proportional-hazards models were used to estimate the association between this difference and pregnancy loss. To assess for effect modification, analyses were stratified by week of research ultrasonogram, developmental features observed on the ultrasonogram, and menstrual regularity.RESULTSAmong 4,935 participants, the median difference between LMP-based and ultrasound-based gestational age on the research ultrasonogram was 1 day (interquartile range -1 to 5 days), and 9.3% of pregnancies ended in loss. Risk of pregnancy loss increased exponentially with each additional day ultrasound-based dating lagged LMP-based dating (P<.001). This association persisted when stratified by week of ultrasonography and was more pronounced among pregnancies with a measurable crown-rump length. Ultrasound-based gestational age lagging LMP-based gestational age by more than 3 days was associated with a fivefold increased risk of pregnancy loss (adjusted hazard ratio [HR] 5.34, 95% CI, 4.37-6.52), and a lag of more than 5 days was associated with a greater than sixfold increased risk (adjusted HR 6.99, 95% CI, 5.78-8.44). These findings persisted when analyses were restricted to individuals with regular cycles and certain LMP dates.CONCLUSIONIncreasing lag between ultrasound-based dating and LMP-based dating among asymptomatic patients was strongly associated with pregnancy loss risk. This clinically quantifiable measure can inform concern for pregnancy loss before symptom onset among individuals with a certain LMP.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"12 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851109","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":"Intrahepatic Cholestasis of Pregnancy Recurrence in a Subsequent Pregnancy.","authors":"Henri M Rosenberg,Minhazur R Sarker,Gladys A Ramos,Angela Bianco,Lauren Ferrara,Chelsea A DeBolt","doi":"10.1097/aog.0000000000006033","DOIUrl":"https://doi.org/10.1097/aog.0000000000006033","url":null,"abstract":"Reported recurrence rates of intrahepatic cholestasis of pregnancy (ICP) range from 40% to 90% based on prior literature, but data remain limited. In a retrospective cohort, we aimed to evaluate the rate of ICP recurrence and risk factors associated with recurrence. Among 104 patients with ICP in an index pregnancy, 46 experienced recurrence (44%) of ICP in subsequent pregnancy. A peak total bile acid (TBA) level greater than 40 micromoles/L in the index pregnancy was significantly associated with ICP recurrence; shorter interpregnancy intervals were associated with lower risk. These findings contribute to the literature on the risk of ICP recurrence in a modern, racially diverse cohort and highlight elevated TBA level as a predictor of recurrence.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"42 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144851203","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}