Obstetrics and gynecology最新文献

{"title":"Association Between Racial Segregation of Labor and Delivery Services and Utilization of Trial of Labor and Vaginal Birth After Cesarean.","authors":"Max Jordan Nguemeni Tiako, Adebayo Adesomo, Jaewhan Kim, Michelle P Debbink","doi":"10.1097/AOG.0000000000006313","DOIUrl":"10.1097/AOG.0000000000006313","url":null,"abstract":"<p><strong>Objective: </strong>Trial of labor after cesarean (TOLAC) offers an opportunity to mitigate maternal morbidity disparities, which are associated with cesarean delivery rates as well as with racial segregation in obstetric care. This study sought to assess the association between the proportion of births to Black individuals at a hospital and the likelihood of low-risk patients undergoing TOLAC and achieving vaginal birth after cesarean (VBAC).</p><p><strong>Methods: </strong>This is a retrospective cohort study of 2017-2019 Nationwide Inpatient Sample deliveries with a history of prior cesarean delivery. We categorized hospitals by the proportion of births to Black individuals: high (top 5%), medium (6-25%), or low (reference), urban-rural status, and teaching status. Primary outcomes were TOLAC and VBAC odds. We used propensity score-matching and performed weighted hierarchical logistic regressions adjusting for maternal age, race and ethnicity, ZIP code median household income quartile, obstetric comorbidity index, hospital delivery volume, and bed size.</p><p><strong>Results: </strong>A total of 1,734,919 deliveries to low-risk individuals with prior cesarean deliveries were included. One-fifth of these patients (19.7%, n=341,165) attempted labor, among whom 81.4% (n=227,775) delivered vaginally. Compared with low Black-serving hospitals, patients at high Black-serving hospitals had higher TOLAC (adjusted odds ratio [aOR] 1.51, 95% CI, 1.36-1.67) and VBAC odds (aOR 1.24, 95% CI, 1.07-1.43). Black (vs White) patients had lower VBAC odds (aOR 0.88, 95% CI, 0.78-0.98). Among urban teaching hospitals, the TOLAC and VBAC probabilities at high Black-serving hospitals were 25% (95% CI, 22-28%) and 75% (95% CI, 72-78%), respectively, compared with 18% (95% CI, 16-19%) and 70% (95% CI, 67-72%), respectively, at low Black-serving hospitals. Black patients at high Black-serving hospitals had a 72% (95% CI, 69-74%) VBAC probability compared with 67% (95% CI, 64-70%) at low Black-serving hospitals.</p><p><strong>Conclusion: </strong>Low-risk patients with prior cesarean deliveries had higher odds of TOLAC and VBAC at high Black-serving hospitals. Black (vs White) patients remained less likely to deliver vaginally but had higher chances at high Black-serving hospitals compared with low Black-serving hospitals. Future work should investigate institutional factors that may reduce cesarean deliveries and increase TOLAC and VBAC success, given the significant contribution of cesarean delivery to disparities in maternal morbidity.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"516-524"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13467723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147948884","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":"A Prospective, Multi-Site Study of Performance of Cell-Free DNA Testing for Recessive Conditions in a Large, General-Risk Pregnancy Population.","authors":"Eliza R McElwee, Julia Wynn, Shannon Rego, Andrew Haddad, Rachel Levan, Jennifer Hoskovec, Rebecca Crowe, Jalonna Robinson, Jesslyn Payne, Susan Shondel, Jennifer Byrnes, Kylan Hill, Jenny Wiggins-Smith, L Cristina Filetti, Stephanie Tims, Kelly Helton, Andre Hall, Jesus Alvarez Perez, Andrew S Haddad, Swati Verma, Emily E Hardisty, Jennifer L Czerwinski, Sunbola S Ashimi, Neeta L Vora, Akila Subramaniam","doi":"10.1097/AOG.0000000000006403","DOIUrl":"10.1097/AOG.0000000000006403","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical performance of cell-free DNA (cfDNA) screening as a primary screening tool for autosomal recessive conditions in a large, prospective, general-risk population.</p><p><strong>Methods: </strong>We conducted a prospective analysis of pregnant individuals who underwent carrier screening with a reflex cfDNA fetal risk assessment at nine participating U.S. institutions. The conditions evaluated included cystic fibrosis, spinal muscular atrophy, and beta and alpha hemoglobinopathies. The cfDNA results were categorized as high risk (at least 1-in-4 predicted fetal risk) or low risk. Test performance metrics were calculated using Wilson Score 95% CIs.</p><p><strong>Results: </strong>There were 2,403 cfDNA results among 2,212 pregnant carriers with singleton pregnancies at a gestational age of at least 10 weeks at participating sites (188 individuals were carriers for more than one condition). The neonatal or fetal outcome was known for 2,369 (98.6%) cfDNA results. A cfDNA fetal risk of at least 1 in 4 was returned for 1.3%, and the cfDNA fetal risk test had a specificity of 99.5%, a negative predictive value of 99.9%, a sensitivity of 94.4%, and a positive predictive value (PPV) of 58.6%.</p><p><strong>Conclusion: </strong>In this large, racially and ethnically diverse general-risk pregnant carrier sample, cfDNA fetal risk assessment accurately distinguished high-risk and low-risk pregnancies with greater PPV than traditional carrier screening, without requiring a partner sample. Combined with prior peer-reviewed studies that assessed cfDNA fetal risk screens, these findings support the possibility of cfDNA fetal risk assessment as a primary screen to identify pregnancies at high risk for autosomal recessive conditions.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"509-515"},"PeriodicalIF":5.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759331","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":"Improving Pregnancy Outcomes Through Better Prenatal Care Data and Metrics.","authors":"Alex F Peahl, Mary Elmore DeMott, Jessica M Yaser, Gregor A Horvath, Elizabeth Bondi-Kelly, Hayley Falk, David M Haas, Chloé E Hill, Julie Simmons Ivy, Elizabeth E Krans, Lisa Kane Low, Michelle H Moniz, Maria Muzik, Julia C Phillippi, Roger D Smith, Shawna Smith, Molly J Stout, Jenna Wiens, Kara Zivin, Giselle E Kolenic","doi":"10.1097/AOG.0000000000006437","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006437","url":null,"abstract":"<p><p>Despite the critical importance of prenatal care for the prevention of maternal morbidity in the United States, relatively few resources are dedicated to improving its quality. This omission is driven in part by an absence of detailed prenatal care data: global insurance payments, the dispersion of services across multiple care settings, and a focus on more costly inpatient care delivery have limited our ability to measure and improve prenatal care quality. The upcoming unbundling of prenatal care billing in January 2027 and the changing Centers for Medicare & Medicaid Services requirements for digital quality measures present an important opportunity to improve insights into prenatal care delivery and associated outcomes. In this manuscript, we identify limitations in current prenatal care metrics and data sources (eg, electronic health record data and insurance claims) that must be addressed. We provide a framework to ensure that prenatal care metrics and associated data yield actionable insights to improve health outcomes and the patient experience of care.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081726","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":"Surgical, Reproductive, and Child Developmental Outcomes After 10 Years of Uterus Transplantation in the United States.","authors":"Kathleen E O'Neill, Leigh A Humphries, Margaret Rush, Elliott G Richards, Tommaso Falcone, Jessica R Walter, Nawar Latif, Samir Abu-Gazala, Samantha D Fry, Paige M Porrett, Giuliano Testa, Liza Johannesson","doi":"10.1097/AOG.0000000000006440","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006440","url":null,"abstract":"<p><strong>Objective: </strong>To review the surgical, reproductive, and child developmental outcomes after uterus transplants performed in the United States over the past decade.</p><p><strong>Methods: </strong>In this prospective cohort study, data on donors, recipients, and children born after uterus transplantation were collected at the four centers performing uterus transplants in the United States from February 2016 to December 2025. Interventions included donor hysterectomy, uterus transplantation, postoperative immunosuppression and monitoring, fertility and obstetric care, recipient graft hysterectomy, and neonatal and pediatric follow-up. Survival analyses evaluated trends and compared outcomes between living donor and deceased donor transplants.</p><p><strong>Results: </strong>Among 60 uterus transplants, the most common indication was Mayer-Rokitansky-Küster-Hauser syndrome (n=52), followed by prior hysterectomy (n=6), dysfunctional uterus (n=1), and androgen insensitivity syndrome (n=1). Most transplants (42, 70.0%) involved living donors; 18 (30.0%) involved deceased donors. No life-threatening complications or mortality occurred. Complications necessitating reoperation occurred in 17 of 60 recipients (28.3%), including graft loss attributable to vascular thrombosis, and in 6 of 42 living donors (14.3%), including ureteral injury and vaginal cuff dehiscence. As of December 2025, 42 of 60 recipients (70.0%) had achieved at least one live birth or ongoing clinical pregnancy, and nine (15.0%) had two live births. Among the 48 neonates born, median gestational age at delivery was 36 5/7 weeks (IQR 34 3/7-37 1/7 weeks), with 58.3% born preterm. Neurodevelopment was normal at discharge and 6 months; at 3-year follow-up (n=29), two children had been diagnosed with autism, and no other diagnoses or growth disorders were observed.</p><p><strong>Conclusion: </strong>Uterus transplantation offers a viable path to childbearing for women with absolute uterine factor infertility. These aggregate data from active U.S. programs provide a contemporary reference for clinicians counseling patients on treatment options.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081638","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 Clearer View of the Organizations Directing Obstetrics and Gynecology Graduate Medical Education.","authors":"Gabriella Gosman, Amy E Young, Meredith Alston, Laura Huth, Erika Banks, Mary Cameron Tallman, Michael Geria, AnnaMarie Connolly","doi":"10.1097/AOG.0000000000006441","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006441","url":null,"abstract":"<p><p>This article explores the purpose and scope of three key organization types in the field of obstetrics and gynecology that guide residency and fellowship training and establish training requirements: 1) the certifying boards, 2) the specialty societies, and 3) the residency and fellowship training program accrediting bodies. Each organization type plays a distinct role in the training, certification, and professional development of obstetricians and gynecologists in the United States. An awareness of these unique roles and scopes is crucial to understanding how these organizations independently and collaboratively work to advance the shared goal of excellence in obstetrics and gynecology graduate medical education and improved health outcomes.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081698","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":"Obstetric Care Coding: Time for Change.","authors":"Lisa G Hofler, John P Horton, Eilean L Attwood, Lisa Satterfield","doi":"10.1097/AOG.0000000000006442","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006442","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081705","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: Preterm Birth","authors":"Cynthia Gyamfi-Bannerman","doi":"10.1097/aog.0000000000006435","DOIUrl":"https://doi.org/10.1097/aog.0000000000006435","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"14 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020721","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: Gestational Diabetes","authors":"Erika F. Werner","doi":"10.1097/aog.0000000000006433","DOIUrl":"https://doi.org/10.1097/aog.0000000000006433","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"227 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149022386","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":"Effectiveness of Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas Compared With Myomectomy on Symptoms and Health-Related Quality of Life","authors":"Antoinette Allen,Michael Schembri,Ram Parvataneni,L. Elaine Waetjen,Shira Varon,Naghmeh Salamat-Saberi,Henry Garza,Kimberly A. Kho,Craig J. Sobolewski,Soyini Hawkins,Nicole Williams,Shawn Tassone,Vanessa L. Jacoby","doi":"10.1097/aog.0000000000006432","DOIUrl":"https://doi.org/10.1097/aog.0000000000006432","url":null,"abstract":"OBJECTIVE: To compare changes in symptom severity and health-related quality of life (HRQOL) after laparoscopic radiofrequency ablation (RFA) and myomectomy for the treatment of uterine leiomyomas. METHODS: The ULTRA (Uterine Leiomyoma Treatment With Radiofrequency Ablation) study is a multicenter prospective cohort study of premenopausal women with symptomatic uterine leiomyomas undergoing laparoscopic RFA or myomectomy. Participants completed validated patient-reported outcome measures, including the UFS-QOL (Uterine Fibroid Symptom and Health-Related Quality of Life questionnaire), at baseline and at 6-month intervals for up to 24 months after treatment. Changes from baseline in symptom severity and HRQOL domains were evaluated with propensity-weighted repeated-measures models to account for potential treatment selection bias and within-subject correlation over time. RESULTS: A total of 401 participants were included (237 with RFA, 164 with myomectomy) with a mean±SD age of 39.2±6.9 years; 53% (n=210) identified as Black. Three hundred eighty-six participants provided follow-up outcome measures. Participants had a median of two leiomyomas (interquartile range 1–15) and substantial baseline symptom burden, with a mean±SD SSS (Symptom Severity Scale) score of 61±23 and HRQOL score of 41±26). Both treatment groups demonstrated significant and sustained improvements in symptoms and HRQOL over the 24-month follow-up period. In propensity-weighted models, the myomectomy group experienced greater reductions in SSS (−33.0 vs −27.7, difference −5.27, P =.028) and greater improvements in HRQOL (34.92 vs 28.29, difference −6.62, P =.011) compared with RFA. These differences were below the threshold for minimal clinically important changes in SSS (10 points) and HRQOL (20 points). At interim 6-month assessments, myomectomy showed modestly greater improvements in functional subdomains such as activities, control, and self-consciousness; however, these differences diminished and were not observed at 24 months. CONCLUSION: Both laparoscopic RFA and myomectomy significantly improve leiomyoma-related symptoms and HRQOL over 2 years. Although myomectomy demonstrates slightly greater improvements in some domains, overall differences between treatments are small and do not exceed the threshold change scores for clinically important differences at 2 years of follow-up. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT0210094.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"86 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020720","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":"Effect of Hip Extension Compared With Usual Positioning on Perineal Lacerations During First Vaginal Delivery","authors":"Marti D. Soffer,Kaitlyn E. James,Pichliya Liang,Arlin Delgado,Matthew H. Mossayebi,Margaret Hamp,Molly R. Siegel,Mark A. Clapp,Anjali J. Kaimal,William H. Barth","doi":"10.1097/aog.0000000000006438","DOIUrl":"https://doi.org/10.1097/aog.0000000000006438","url":null,"abstract":"OBJECTIVE: To determine the effect of hip extension at the time of crowning on perineal lacerations and obstetric anal sphincter injuries. METHODS: This was a randomized, pragmatic, nonblinded clinical trial. Participants included nulliparous patients aged 18 years or older with singleton term gestations with nonanomalous fetuses. Immediately before crowning, participants in the intervention group were directed to lower their legs, extending the angle of their hips. Participants in the usual care group were undirected and typically delivered in the flexed position. The primary outcome was a composite of significant perineal lacerations , defined as second-degree, third-degree, or fourth-degree lacerations. Secondary outcomes included the rates of obstetric anal sphincter injuries and perineal lacerations as an ordinal outcome. Analyses were planned on intention-to-treat (ITT) and as-treated bases. RESULTS: In total, 1,206 participants delivered vaginally after randomization. The primary composite of significant perineal lacerations was not significantly different in the ITT analysis (66.2% usual care vs 66.6% intervention, P =.89). Twenty-five percent of those randomized to the intervention were not adherent. In unadjusted as-treated analyses, lower rates of significant perineal lacerations (62.7% extension vs 68.7% flexion, P =.03) and obstetric anal sphincter injuries (5.2% extension vs 9.9% flexion, P =.004) were observed; these differences were not significant after adjustments. Ordinal comparison of lacerations in the as-treated analysis demonstrated a protective shift in the laceration distribution curve, with more intact perineums and fewer obstetric anal sphincter injuries among those in the extension group (unadjusted P =.006, adjusted P =.03). CONCLUSION: Extension of the hips did not reduce significant perineal lacerations at the time of term vaginal delivery in nulliparous patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT04616170.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"2 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020722","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}