Obstetrics and gynecology最新文献

{"title":"Prenatal Care Clinician Preferences Among Patients With Spanish-Preferred Language.","authors":"Haylie M Butler, Maria Bazan, Luis Rivera, Kevin E Salinas, Michele R Hacker, Sophia DeLevie-Orey, Molly R Siegel, Elysia Larson, Rose L Molina","doi":"10.1097/AOG.0000000000005697","DOIUrl":"10.1097/AOG.0000000000005697","url":null,"abstract":"<p><strong>Objective: </strong>To measure what patients with Spanish language preference and limited English proficiency value most when selecting a prenatal care clinician.</p><p><strong>Methods: </strong>A discrete choice experiment was administered at two large academic medical centers in Boston, Massachusetts. Participants were identified by electronic medical record, had preferred Spanish language and self-identified limited English proficiency, and either were pregnant with a completed fetal anatomy scan or had given birth within the past 12 months at the time of the study. The discrete choice experiment consisted of eight attributes to consider when selecting a prenatal care clinician: clinician Spanish proficiency, type of interpreter used, interpersonal dynamics (ie, making patients feel seen, heard, and cared for), cultural concordance, continuity of care, shared decision making, distance from home, and wait times for appointments. Descriptive statistics of demographic variables were calculated. Hierarchical Bayesian models were used to analyze discrete choice experiment data.</p><p><strong>Results: </strong>The attributes that were most important to 166 participants when choosing their prenatal care clinician were interpersonal dynamics within the patient-clinician dyad and clinician Spanish language proficiency (average importance 21.4/100 and 20.8/100, respectively). Of lowest importance were wait time to receive an appointment and continuity of care (average importance 5.1 and 6.1, respectively). Although participants highly preferred that their clinician be \"fluent or near fluent in Spanish,\" the second most preferred option was having a clinician with only basic Spanish proficiency rather than a more advanced level of Spanish proficiency with some misunderstandings.</p><p><strong>Conclusion: </strong>Our study demonstrates the importance of positive clinician-patient interpersonal dynamics and language-concordant care for patients with Spanish language preference in prenatal care. Promoting equitable patient-centered care for patients with limited English proficiency requires responding to preferences regarding clinician language proficiency and demonstrating attentiveness, empathy, and concern for prenatal care experiences.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988498","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":"Bryann Bromley, Lawrence D Platt","doi":"10.1097/AOG.0000000000005714","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005714","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505014","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":"Evaluation of Statewide Program to Reduce Cesarean Deliveries Among Nulliparous Individuals With Singleton Pregnancies at Term Gestation in Vertex Presentation.","authors":"Melissa G Rosenstein, Shen-Chih Chang, Curisa M Tucker, Christa Sakowski, Stephanie A Leonard, Elliott K Main","doi":"10.1097/AOG.0000000000005696","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005696","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of statewide efforts to reduce nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates in California.</p><p><strong>Methods: </strong>This was a population-based study of all NTSV births in California from 2015 to 2019. In 2015, all California hospitals with NTSV cesarean delivery rates above the 23.9% Healthy People 2020 target were invited to join a CMQCC (California Maternal Quality Care Collaborative)-sponsored, 3-year, multifaceted collaborative or a system-level quality collaborative to safely support vaginal birth. We examined the cesarean delivery rate overall and by participation or nonparticipation in a collaborative program. Secondarily, for hospitals that started with an NTSV cesarean delivery rate above 23.9%, we compared patient-level, hospital-level, and obstetric management characteristics between hospitals that met the Healthy People 2020 target (cesarean delivery rate below 23.9%) in 2019 and those that did not.</p><p><strong>Results: </strong>There were 758,268 NTSV births at 238 hospitals. Annual mean NTSV cesarean delivery rates decreased among all racial and ethnic groups statewide and among all patients, regardless of payer, maternal age, or body mass index (BMI). The decrease in cesarean delivery was driven largely by a decrease in the frequency of cesarean delivery performed for labor dystocia (14.9% in 2015 to 12.8% in 2019) and from cesarean delivery before the onset of labor (4.2% in 2015 to 3.3% in 2019). For hospitals that started with an NTSV cesarean delivery rate above 23.9%, NTSV cesarean delivery rates among 80 hospitals participating in the CMQCC had a mean±SD decline of 6.9±5.9%, 13 hospitals participating in the system-level collaborative had a 5.0±4.5% decline, and those not participating in any collaborative had a 2.1±6.0% decline. In multivariable analysis, there was no association between meeting the Healthy People target and any of the hospital-level factors or aggregated patient-level characteristics. Rates of induction of labor increased in both groups and were not associated with a change in cesarean delivery rates.</p><p><strong>Conclusion: </strong>Hospitals in California between 2015 and 2019 with a wide variation in institutional and patient characteristics successfully reduced their NTSV cesarean delivery rates. Reduction in the NTSV cesarean delivery rate at hospitals that started above the Healthy People target was not associated with differences in patient characteristics but rather a reduction in cesarean deliveries for labor dystocia and cesarean deliveries performed before the onset of labor.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505002","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":"Oocyte Cryopreservation in Transgender and Gender-Diverse Individuals With or Without Prior Testosterone Use.","authors":"Sarah Capelouto Cromack,Jessica R Walter,Kristin N Smith,Jennifer Elvikis,Sarah E Bazzetta,Kara N Goldman","doi":"10.1097/aog.0000000000005749","DOIUrl":"https://doi.org/10.1097/aog.0000000000005749","url":null,"abstract":"To evaluate oocyte cryopreservation among transgender and gender-diverse adolescents and young adults with or without prior testosterone exposure, we performed a retrospective cohort study of all patients younger than age 35 years referred for oocyte cryopreservation through our formal fertility-preservation program from 2014 to 2023. The number of patients referred and pursuing fertility preservation increased over time. Among the 93 patients referred, 37 pursued oocyte cryopreservation (31 testosterone-naïve and six testosterone-exposed). Among the latter, neither length of time on testosterone before presentation nor duration off testosterone before retrieval (minimum 2 months) were associated with the number of mature oocytes frozen. When comparing testosterone-naïve with testosterone-exposed individuals, there was no difference in number of oocytes retrieved (median 28 vs 32, P=0.43) or mature oocytes frozen (21 vs 21, P=0.95).","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329299","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":"Second-Line Uterotonics for Uterine Atony: A Randomized Controlled Trial.","authors":"Naida M Cole,Jimin J Kim,Mario I Lumbreras-Marquez,Kara G Fields,Laura Mendez-Pino,Michaela K Farber,Daniela A Carusi,Paloma Toledo,Brian T Bateman","doi":"10.1097/aog.0000000000005744","DOIUrl":"https://doi.org/10.1097/aog.0000000000005744","url":null,"abstract":"OBJECTIVETo evaluate the comparative efficacy of two of the most commonly used second-line uterotonics-methylergonovine maleate and carboprost tromethamine.METHODSWe conducted a double-blind randomized trial at two large academic perinatal centers in patients undergoing nonemergency cesarean delivery with uterine atony refractory to oxytocin, as diagnosed by the operating obstetrician. The intervention included administration of a single dose of intramuscular methylergonovine or carboprost intraoperatively at diagnosis. The primary outcome, uterine tone on a 0-10 numeric rating scale 10 minutes after study drug administration, was rated by operating obstetricians blinded to the drug administered. Secondary outcomes included uterine tone score at 5 minutes, administration of additional uterotonic agents, other interventions for uterine atony or hemorrhage, quantitative blood loss, urine output, postpartum change in serum hematocrit, transfusion, length of hospital stay, adverse drug or transfusion reactions, and postpartum hemorrhage complications. A sample size of 50 participants per group was planned to detect a 1-point difference (with estimated within-group SD of 1.5) in the mean primary outcome with 80% power at a two-sided α level of 0.05 while accounting for potential protocol violations.RESULTSA total of 1,040 participants were enrolled, with 100 randomized to receive one of the study interventions. Mean±SD 10-minute uterine tone scores were 7.3±1.7 after methylergonovine and 7.6±2.1 after carboprost, with an adjusted difference in means of -0.1 (95% CI, -0.8 to 0.6, P=.76). Additional second-line uterotonics were required in 30.0% of the methylergonovine arm and 34.0% in the carboprost arm (adjusted odds ratio 0.72, 95% CI, 0.27-1.89, P=.505), and geometric mean quantitative blood loss was 756 mL (95% CI, 636-898) and 708 mL (95% CI, 619-810) (adjusted ratio of geometric means 1.06, 95% CI, 0.86-1.31, P=.588), respectively. No differences were detected in the occurrence of other interventions for uterine atony or postpartum hemorrhage.CONCLUSIONNo difference was detected in uterine tone scores 10 minutes after administration of either methylergonovine or carboprost for refractory uterine atony, indicating that either agent is acceptable.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov, NCT03584854.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329310","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":"Uterine Leiomyomas and Reproduction.","authors":"Elizabeth A Pritts","doi":"10.1097/AOG.0000000000005748","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005748","url":null,"abstract":"<p><p>There is a prevailing opinion by gynecologists, much of it based on expert opinion or anecdotal evidence, that myomas are detrimental to pregnancy. Newer data challenge much of this dogma, but incorrect assumptions remain. Although not impeccable, multiple data address the correlation between myomas and reproduction, and some emerging evidence addresses surgical removal of these myomas and subsequent outcomes. A thorough literature search was performed, and the amassed data were analyzed to answer some of our most important queries about the role that myomas play in pregnancy and delivery. Uterine leiomyomas ultimately decrease in size during late pregnancy and postpartum. Spontaneous abortion rates are similar in women with and without leiomyomas. The data addressing leiomyoma effects on preterm prelabor rupture of membranes, placental abruption, cesarean delivery, and postpartum hemorrhage rates are conflicting, but the best evidence does not show a significant correlation compared with women without myomas. Preterm delivery rates are elevated in women with leiomyomas. Myomectomy does not decrease preterm deliveries and may increase this risk. Women with myomectomies have increased elective cesarean delivery rates and more blood loss at delivery compared with women with leiomyomas in situ.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351158","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":"Survival After Simple Compared With Radical Hysterectomy for Patients With Early-Stage Cervical Cancer.","authors":"David Viveros-Carreño,Nuria Agusti,Chi-Fang Wu,Alexander Melamed,Roni Nitecki Wilke,Alexa Kanbergs,René Pareja,Abigail S Zamorano,J Alejandro Rauh-Hain","doi":"10.1097/aog.0000000000005743","DOIUrl":"https://doi.org/10.1097/aog.0000000000005743","url":null,"abstract":"OBJECTIVETo assess the effect on overall survival of simple hysterectomy with lymph node staging compared with radical hysterectomy with lymph node staging for patients with early-stage cervical cancer.METHODSWe conducted a retrospective cohort study of patients in the National Cancer Database diagnosed with early cervical carcinoma of 2 cm or smaller (stage IA1 with lymphovascular space invasion through IIA1, International Federation of Gynecology and Obstetrics staging) from 2010 to 2019. After 1:1 propensity score matching, we compared patients who underwent simple hysterectomy with lymph node staging and those with radical hysterectomy with lymph node staging. The variables used for matching were age, tumor size, race and ethnicity, lymphovascular space invasion, year of diagnosis, Charlson-Deyo comorbidity score, histology, and surgical approach. The primary outcome was overall survival at the end of follow-up. Secondary outcomes included 30-day readmission rate and 30- and 90-day mortality rates.RESULTSIn total, 4,167 patients met the inclusion criteria, of whom 2,637 patients (63.3%) underwent radical hysterectomy and lymph node staging and 1,530 patients (36.7%) underwent simple hysterectomy and lymph node staging. After propensity score matching, 1,529 patients in each group were included. There was no statistically significant difference in overall survival between patients who underwent simple hysterectomy and those who underwent radical hysterectomy (hazard ratio 1.25, 95% CI, 0.91-1.73, P=.17). Subgroup analysis by histology, lymphovascular space invasion, tumor size, and surgical approach did not reveal statistically significant differences in overall survival according to hysterectomy type. The hysterectomy groups also did not significantly differ in 30-day readmission rate (4.6% vs 4.2%, P=.73), 30-day mortality rate (0.1% vs 0%, P=.14), or 90-day mortality rate (0.1% vs 0.1%, P=.93).CONCLUSIONPatients with low-risk cervical cancer could undergo less radical surgery without a negative effect on their oncologic outcomes.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":7.2,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142329301","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":"False-Positive Human Immunodeficiency Virus-1 Test Results With Rapid Seroreversion After Third-Trimester Tdap Booster Vaccination.","authors":"Karl O A Yu, Seth R Glassman, Heather M Link","doi":"10.1097/AOG.0000000000005726","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005726","url":null,"abstract":"<p><strong>Background: </strong>False-positive and false-negative results in human immunodeficiency virus (HIV) testing are expected at some frequency. False-positive results have been reported in association with various conditions, including pregnancy, autoimmune disease, and infection. We present an atypical case of a pregnant patient receiving false-positive HIV results for both screening and antibody confirmatory tests after a recent routine vaccination.</p><p><strong>Case: </strong>A 34-year-old woman, G4P1021, with a negative first-trimester HIV test result received a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) booster at 35 2/7 weeks of gestation. Test results at 36 2/7 weeks of gestation were positive in both HIV-1/2 antigen-antibody screening and a confirmatory HIV-1 antibody differentiation immunoassay, but follow-up test results at 36 5/7 weeks and later were negative. Repeat testing and erythrocyte typing confirmed that this was not a result of laboratory error or specimen mishandling. HIV antiretroviral therapy was started and was later discontinued. A scheduled primary cesarean delivery performed at 39 1/7 weeks of gestation due to breech presentation was uncomplicated.</p><p><strong>Conclusions: </strong>False-positive results in HIV screen and confirmation testing were associated with receipt of a Tdap vaccine booster 7 days prior. This test result pattern is similar to that seen very rarely in previous cases, and the rapid seroreversion to negative suggests an acute immunologic trigger leading to a falsely reactive antibody. Clinicians should be aware of the potential for false-positive HIV test results in patients who recently received vaccination or with other immune triggers and retest at a short interval if suspected.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292401","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":"Management of Vulvovaginal Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.","authors":"Erin E Ross, Rachel C Knapp, Marcia A Ciccone, Warren L Garner, T Justin Gillenwater, Haig A Yenikomshian","doi":"10.1097/AOG.0000000000005725","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005725","url":null,"abstract":"<p><p>Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) is an autoimmune process resulting in painful epidermal sloughing that can involve the vulva and vagina. Current guideline recommendations are based on expert opinion and may not reflect modern management of SJS/TEN in burn centers. We performed a retrospective chart review of 34 female patients treated for SJS/TEN at our burn center from 2015 to 2023. Cases frequently involved the vulva (83.3%) and vagina (56.0%), though pelvic examination often was limited. For eight patients with confirmed vulvovaginal lesions, there were no direct sequelae of SJS/TEN requiring intervention. In the modern era of SJS/TEN management in burn centers, interventions such as steroids may not be needed.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292402","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":"Tamsulosin and Time to Spontaneous Void After Hysterectomy: A Randomized Controlled Trial.","authors":"Martina Gabra, Christine Hall, Lelan McCann, Jeenal Shah, Ismael Jones, Aaron Masjedi, Stephanie Runke, Chiu-Hsieh Hsu, Andrea Aguirre","doi":"10.1097/AOG.0000000000005724","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005724","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether a single preoperative dose of tamsulosin reduces the time to postoperative void and time to discharge in patients who are undergoing minimally invasive hysterectomy.</p><p><strong>Methods: </strong>This single-center, block-randomized, placebo-controlled, double-blind superiority trial evaluated the effect of 0.4 mg tamsulosin compared with placebo on the time to void after hysterectomy. Patients who underwent outpatient minimally invasive hysterectomy were randomized to a single dose of tamsulosin or placebo 1 hour before surgery. All participants underwent a standardized backfill void trial to eliminate discrepancies in bladder volume that would otherwise affect the time to void. For our primary aim, we planned to enroll 150 participants to show a 30-minute reduction in the time to postoperative void (80% power, α<0.05). The secondary aim was to compare the time to discharge from the postanesthesia care unit.</p><p><strong>Results: </strong>From June 2021 through January 2023, 344 patients were screened, and 150 were included in the final data analysis: 77 in the tamsulosin group and 73 in the placebo group. The time to spontaneous void was not different between the tamsulosin and placebo groups (106 minutes vs 100 minutes, P=.5). In addition, there was no statistical difference in time to discharge from the postanesthesia care unit (144 minutes vs 156 minutes, P=.4). Demographics and surgical details were not different between each group.</p><p><strong>Conclusion: </strong>A single dose of tamsulosin preoperatively does not lead to a decrease in postoperative time to void or time to discharge in patients undergoing minimally invasive hysterectomy for benign conditions.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov, NCT04859660.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":5.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142292405","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}