Obstetrics and gynecology最新文献

{"title":"Incidence of Vaginal Intraepithelial Neoplasia After Hysterectomy for Cervical Cancer or Cervical Intraepithelial Neoplasia: A Systematic Review and Meta-analysis.","authors":"Rui Li,Li-Fei Sun,Rui-Zhe Li,Zhao-Yun Wang,Ke-Xin Li,Ru-Tie Yin","doi":"10.1097/aog.0000000000006026","DOIUrl":"https://doi.org/10.1097/aog.0000000000006026","url":null,"abstract":"OBJECTIVETo investigate the incidence of vaginal intraepithelial neoplasia (VAIN) 1+ in patients after hysterectomy for cervical intraepithelial neoplasia (CIN) or cervical cancer.DATA SOURCESA systematic search was conducted in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to January 2025.METHODS OF STUDY SELECTIONWe identified 7,234 studies, 48 of which were included in the meta-analysis. The primary outcome was the incidence of pathologically confirmed VAIN 1+ (VAIN 1, 2, or 3 or vaginal cancer) in patients after hysterectomy for CIN or cervical cancer; the secondary outcome was the clinicopathologic characteristics of these patients. Single-proportion meta-analysis was performed to estimate the incidence and 95% CIs of VAIN 1+.TABULATION, INTEGRATION, AND RESULTSA total of 18,959 patients who underwent hysterectomy for CIN or cervical cancer were included. The overall pooled incidence of VAIN 1+ was 2.7% (95% CI, 1.8-3.7%). The incidences of VAIN and vaginal cancer were 2.7% (95% CI, 1.7-3.7%) and 0.3‰ (95% CI, 0.0-1.0‰), respectively. The incidence of VAIN increased gradually in more recent studies compared with studies published before 2000.CONCLUSIONNearly 3 of every 100 women develop VAIN 1+ after hysterectomy for CIN or cervical cancer. The rate of vaginal dysplasia has significantly increased over time.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42023433781.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"16 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796791","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":"Key Management Considerations in Obstetric Anesthesiology.","authors":"Holly B Ende,Brian T Bateman","doi":"10.1097/aog.0000000000006022","DOIUrl":"https://doi.org/10.1097/aog.0000000000006022","url":null,"abstract":"Obstetricians, midwives, nurses, and anesthesiologists collaborate daily to care for patients on the labor and delivery unit. Effective communication among these team members is essential for optimal patient care. This article aims to provide context and explanation for key aspects of obstetric anesthesia management to support conversations and engagement between obstetric and anesthesia teams.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"732 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796781","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":"Low-Risk Cesarean Delivery Rates by County of Birth in the United States.","authors":"Rachael J Beer,Michelle J K Osterman,Lauren M Rossen","doi":"10.1097/aog.0000000000006028","DOIUrl":"https://doi.org/10.1097/aog.0000000000006028","url":null,"abstract":"Healthy People 2030 aims to decrease low-risk cesarean delivery rates to 23.6% in the United States. In 2023, the national rate was 26.6%, though rates vary widely by state and hospital. This suggests a need for localized geographic estimates to identify places with higher burden. We modeled 2023 low-risk cesarean delivery rates by county of birth using birth certificate data and hierarchical Bayesian models that spatially smooth unstable estimates. We found considerable variation in rates, with county rates ranging from 5.8% to 53.4%. Counties in the West had lower rates than those in the Midwest, South, and Northeast. County rates increased with urbanicity. Only 47.7% (985) of counties had rates meeting the Healthy People 2030 target.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"15 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796945","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":"Predictors of Persistent Pain After Hysterectomy for Chronic Pelvic Pain: A Systematic Review.","authors":"Meenal Misal,Ethan M Balk,Megan S Orlando,Charlotte Pickett,Stacy M Lenger,Anne E Porter,Sunil Balgobin,Randa J Jalloul,Diana Encalada-Soto,Mamta M Mamik,Ankita Gupta","doi":"10.1097/aog.0000000000006023","DOIUrl":"https://doi.org/10.1097/aog.0000000000006023","url":null,"abstract":"OBJECTIVETo systematically review predictors associated with persistent pain after hysterectomy performed for individuals with chronic pelvic pain.DATA SOURCESPubMed and EMBASE were queried from inception to July 2, 2024, searching for human subject studies investigating hysterectomy performed for chronic pelvic pain.METHODS OF STUDY SELECTIONDouble independent screening for studies of chronic pelvic pain was performed by members of the Systematic Review Group of the Society of Gynecologic Surgeons. We included longitudinal observational studies (prospective or retrospective) and randomized controlled trials (RCTs). Data were extracted with risk-of-bias assessment with the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Extractions were reviewed by a second researcher. We conducted restricted maximum-likelihood meta-analyses of effect sizes as feasible.TABULATION, INTEGRATION, AND RESULTSOne RCT and six cohort studies met the inclusion criteria. The overall quality of the studies was fair to good. The incidence of persistent pelvic pain after hysterectomy ranged widely, from 12% to 68%. Younger age was associated with increased likelihood of persistent pain after hysterectomy (summary odds ratio [OR] 1.39, 95% CI, 1.11-1.75; five studies, N=11,165). Ovarian conservation was not significantly associated with persistent pain (OR 2.04, 95% CI, 0.67-6.18; three studies). Endometriosis was variably associated with persistent pain, with two studies finding an association (summary OR 1.18, 95% CI, 1.06-1.31), whereas two other studies found that stage III or greater endometriosis was not associated with persistent pain (summary OR 0.99, 95% CI, 0.45-2.21). Multiple predictors of interest were evaluated by single studies, limiting the ability to draw aggregate conclusions.CONCLUSIONHigh proportions of patients undergoing hysterectomy for chronic pelvic pain experience persistent postoperative pain. Although there is heterogeneity among study design and clinical factors examined and some associations should be interpreted with caution, persistent pelvic pain was associated with younger age at the time of hysterectomy.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42024530836.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796789","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 the Reverse Sequence Algorithm Compared With the Traditional Algorithm for Syphilis Screening Among Pregnant Women.","authors":"Enrique M Saldarriaga,Emily D Pollock,David A Jackson,Thomas L Gift,Lindley A Barbee,Laura H Bachmann,Ian H Spicknall","doi":"10.1097/aog.0000000000006019","DOIUrl":"https://doi.org/10.1097/aog.0000000000006019","url":null,"abstract":"OBJECTIVEThe traditional syphilis screening algorithm, which involves a nontreponemal assay followed by confirmatory treponemal testing, has been challenged by an alternative approach known as the reverse sequence algorithm. The latter reverses the order of the tests and incorporates a second treponemal test for discordant results. Although the reverse sequence may offer operational advantages, there is a need for formal cost-effectiveness analyses to compare these two syphilis screening alternatives.METHODSWe conducted cost-effectiveness analyses from the health care sector perspective to compare the reverse sequence with the traditional algorithm. We employed a decision tree for pregnant women in prenatal care that included the possibility of congenital syphilis outcomes. A simulated a cohort of 10,000 people was screened over 1 year to estimate total costs and quality-adjusted life-years (QALYs) under each algorithm. We estimated incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to identify influential parameters affecting the ICERs and to conduct scenario analyses.RESULTSDuring prenatal care, the reverse sequence detected four more cases, overtreated 185 more individuals, and prevented 0.42 more congenital syphilis cases (ICER $463,735/QALY gained), when compared with the traditional algorithm. Sensitivity analyses revealed that syphilis prevalence had the greatest effect on the ICER. To achieve ICERs below $50,000/QALY gained, syphilis prevalence would need to exceed 6% during prenatal care.CONCLUSIONOur analysis indicates that, under likely parameter values, the reverse sequence algorithm is equally effective but more costly than the traditional algorithm and therefore not cost effective. Although treponemal test automation may offer potential savings in laboratory costs, these are outweighed by overtreatment costs.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"20 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence for the Detection of Fetal Ultrasound Findings Concerning for Major Congenital Heart Defects.","authors":"Carolyn M Zelop,Jennifer Lam-Rachlin,Alisa Arunamata,Rajesh Punn,Sarina K Behera,Matthias Lachaud,Nadine David,Greggory R DeVore,Andrei Rebarber,Nathan S Fox,Marjorie Gayanilo,Sara Garmel,Philippe Boukobza,Pierre Uzan,Hervé Joly,Romain Girardot,Laurence Cohen,Bertrand Stos,Malo De Boisredon,Eric Askinazi,Valentin Thorey,Christophe Gardella,Marilyne Levy,Miwa Geiger","doi":"10.1097/aog.0000000000006027","DOIUrl":"https://doi.org/10.1097/aog.0000000000006027","url":null,"abstract":"OBJECTIVETo evaluate the performance of an artificial intelligence (AI)-based software to identify second-trimester fetal ultrasound examinations suspicious for congenital heart defects.METHODSThe software analyzes all grayscale two-dimensional ultrasound cine clips of an examination to evaluate eight morphologic findings associated with severe congenital heart defects. A data set of 877 examinations was retrospectively collected from 11 centers. The presence of suspicious findings was determined by a panel of expert pediatric cardiologists, who determined that 311 examinations had at least one of the eight suspicious findings. The AI software processed each examination, labeling each finding as present, absent, or inconclusive.RESULTSOf the 280 examinations with known severe congenital heart defects, 278 (sensitivity 0.993, 95% CI, 0.974-0.998) had at least one of the eight suspicious findings present as determined by the fetal cardiologists, highlighting the relevance of these eight findings. We then evaluated the performance of the AI software, which identified at least one finding as present in 271 examinations, that all eight findings were absent in five examinations, and was inconclusive in four of the 280 examinations with severe congenital heart defects, yielding a sensitivity of 0.968 (95% CI, 0.940-0.983) for severe congenital heart defects. When comparing the AI to the determination of findings by fetal cardiologists, the detection of any finding by the AI had a sensitivity of 0.987 (95% CI, 0.967-0.995) and a specificity of 0.977 (95% CI, 0.961-0.986) after exclusion of inconclusive examinations. The AI rendered a decision for any finding (either present or absent) in 98.7% of examinations.CONCLUSIONThe AI-based software demonstrated high accuracy in identification of suspicious findings associated with severe congenital heart defects, yielding a high sensitivity for detecting severe congenital heart defects. These results show that AI has potential to improve antenatal congenital heart defect detection.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"160 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796897","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":"Pregnancy-Related Mortality in California Due to Obstetric Hemorrhage.","authors":"Thomas T Klumpner, David E Arnolds, Joanna A Kountanis, Douglas A Colquhoun, Kevin K Tremper","doi":"10.1097/AOG.0000000000005982","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005982","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 2","pages":"e53-e54"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075869","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":"In Reply.","authors":"Laurence E Shields, Carolina Reyes, Elliott K Main, Alexander J Butwick, Neeru Gupta, Paula Krakowiak","doi":"10.1097/AOG.0000000000005983","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005983","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 2","pages":"e54"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075789","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":"Perinatal Health in U.S. Communities Without Maternity Care.","authors":"Julia D Interrante, Katy Backes Kozhimannil","doi":"10.1097/AOG.0000000000005996","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005996","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 2","pages":"179-180"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075811","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":"Pregnancy-Related Mortality in California due to Obstetric Hemorrhage.","authors":"Carlo Pancaro","doi":"10.1097/AOG.0000000000005981","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005981","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 2","pages":"e53"},"PeriodicalIF":4.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075860","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}