Obstetrics and gynecology最新文献

{"title":"Clinical Outcomes of Bilateral Oophorectomy Compared With Ovarian Preservation in Patients With Intravenous Leiomyomatosis Who Underwent Hysterectomy.","authors":"Peipei Shi,Jing Peng,Xiaoyue Chen,Cong Lu,Shuangdi Li,Tingting Li,Jiarong Zhang,Sheng Yin","doi":"10.1097/aog.0000000000006018","DOIUrl":"https://doi.org/10.1097/aog.0000000000006018","url":null,"abstract":"OBJECTIVEIntravenous leiomyomatosis is a rare, histologically benign yet biologically aggressive smooth muscle tumor. Previous studies have indicated that ovarian hormones may play a crucial role in the pathogenesis of intravenous leiomyomatosis. However, the question of whether the deprivation of ovarian estrogen, including bilateral oophorectomy, reduces tumor recurrence in intravenous leiomyomatosis remains unclear.METHODSThis retrospective cohort study, conducted across multiple centers in China from August 2003 to July 2023, focused on premenopausal patients with intravenous leiomyomatosis who underwent hysterectomy. Patients were categorized into either the bilateral oophorectomy group or the ovarian preservation group. The study compared disease-free survival (DFS) between these two groups. Univariate and multivariate analyses were employed to identify factors associated with DFS.RESULTSThe study included 219 patients, with 132 (60.3%) in the bilateral oophorectomy group and 87 (39.7%) in the ovarian preservation group. Generally, patients in the bilateral oophorectomy group were older, were more likely to have given birth, and had a higher proportion of extrauterine disease compared with those in the ovarian preservation group. Kaplan-Meier curves showed significantly lower recurrence rates in the bilateral oophorectomy group compared with the ovarian preservation group (P=.01). The cumulative recurrence rates at 3 years, 5 years, and 10 years were 0.8%, 2.6%, and 4.0%, respectively, in the bilateral oophorectomy group and 9.0%, 10.3%, and 14.0%, respectively, in the ovarian preservation group. Multivariate analysis for DFS demonstrated that ovarian preservation significantly increased the risk of tumor recurrence (adjusted hazard ratio 0.14, 95% CI, 0.04-0.52, P=.003).CONCLUSIONSimultaneous bilateral oophorectomy may reduce the risk of tumor recurrence for premenopausal women diagnosed with intravenous leiomyomatosis who undergo hysterectomy.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756128","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":"Use of Nonsurgical Hemorrhage-Control Devices for Postpartum Hemorrhage Management.","authors":"","doi":"10.1097/aog.0000000000006024","DOIUrl":"https://doi.org/10.1097/aog.0000000000006024","url":null,"abstract":"This Clinical Practice Update provides revised guidance on the use of nonsurgical hemorrhage-control devices. This document is a focused update of related content in Practice Bulletin No. 183, Postpartum Hemorrhage (Obstet Gynecol 2017;130:e168-86).","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"248 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756125","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":"An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates.","authors":"","doi":"10.1097/aog.0000000000006020","DOIUrl":"https://doi.org/10.1097/aog.0000000000006020","url":null,"abstract":"This Clinical Practice Update provides guidance related to management of the umbilical cord at birth based on recently published data regarding short, medium, and long deferral of cord clamping; cord milking; and immediate cord clamping in preterm neonates. In this document, the terms \"deferred\" and \"delayed\" are used interchangeably as they relate to management of the cord at birth. This document updates Committee Opinion No. 814, Delayed Umbilical Cord Clamping After Birth (Obstet Gynecol 2020;136:e100-6).","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"23 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701230","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":"Canadian Management of Serous Tubal Intraepithelial Carcinoma.","authors":"Elisabeth Spénard,Michelle Jacobson,Marjan Rouzbahman,Lien Hoang,Katherine Grondin,Martin Koebel,Janice Kwon,Kimberly Stewart,Marie Plante,Ly-Ann Teo-Fortin,Danielle Vicus,Anna Cameron,Patti Power,Ada Hsieh,Tomer Feigenberg,Lua Eiriksson,Diane Provencher,Walter Gotlieb,Katharina Kieser,Sophia Pin,Alon Altman,Marcus Q Bernardini","doi":"10.1097/aog.0000000000006016","DOIUrl":"https://doi.org/10.1097/aog.0000000000006016","url":null,"abstract":"OBJECTIVETo assess the management and outcomes of patients diagnosed with an isolated serous tubal intraepithelial carcinoma lesion across Canada.METHODSThis retrospective study included consecutive patients with an isolated serous tubal intraepithelial carcinoma lesion diagnosed between 2006 and 2020 at 15 Canadian centers. Cases underwent multicenter panel pathology review.RESULTSOf 107 patients, 41 serous tubal intraepithelial carcinoma cases (38.3%) were identified at prophylactic surgery for germline pathogenic variants, 36 (33.6%) at surgery for suspicion of malignancy, and 30 (28.0%) at surgery for benign conditions. Treatment groups included observation (n=62, 57.9%), staging surgery (n=35, 32.7%), and adjuvant chemotherapy (n=10, 9.3%). Median follow-up was 55.5 months (interquartile range 30.26-82.07 months). Overall, nine patients developed high-grade serous carcinoma. The cumulative incidence of high-grade serous carcinoma was not significantly different between treatment groups (P=.181); however, no patient treated with chemotherapy developed high-grade serous carcinoma. The cumulative incidence of high-grade serous carcinoma was 1.1% (95% CI, 0.1-5.3%) at 2 years and 5.7% (95% CI, 1.8-13.1%) at 5 years. No significant predictive factors were found on univariate analysis. After multicenter pathology review of 59 cases (55.1%), consensus diagnosis was reached: 45 (76.3%) with serous tubal intraepithelial carcinoma, three (5.1%) with serous tubal intraepithelial lesion, seven (11.9%) with high-grade serous carcinoma, and two (3.4%) with normal tissue. Of the cases reviewed, only 1 of 45 patients (2.2%) with confirmed serous tubal intraepithelial carcinoma developed high-grade serous carcinoma at 73 months, indicating a 5-year cumulative incidence of cancer of 2.6% (95% CI, 0.2-11.7).CONCLUSIONManagement of serous tubal intraepithelial carcinoma varied across centers. The 5-year cumulative incidence of high-grade serous carcinoma after isolated serous tubal intraepithelial carcinoma was 5.7%, consistent with recent literature. However, multicenter pathology review revealed initial underdiagnosed high-grade serous carcinoma, and 5-year cumulative incidence of high-grade serous carcinoma after confirmed serous tubal intraepithelial carcinoma decreased to 2.6%, underscoring the importance of diagnostic confirmation by expert pathologists to guide accurate management.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701363","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":"Handheld Point-of-Care Ultrasonography for Gynecology: Insights Into Space Travel Through Parabolic Flight.","authors":"Begum Mathyk,Shawna Pandya,Heather Wright Beatty,Matthew L Anderson,Adrian Kohut","doi":"10.1097/aog.0000000000006009","DOIUrl":"https://doi.org/10.1097/aog.0000000000006009","url":null,"abstract":"BACKGROUNDImaging plays a critical role in evaluating gynecologic emergencies. However, access to such technology is limited in austere environments such as spaceflight. Portable point-of-care ultrasonography (POCUS) offers rapid diagnostic capabilities potentially useful for supporting women's health. However, the feasibility of using portable POCUS for gynecological imaging in spaceflights characterized by shifts in weightlessness has not been previously evaluated.INSTRUMENTTransabdominal ultrasonography was undertaken to assess the feasibility of using portable POCUS for gynecologic scans during a parabolic flight.EXPERIENCEDespite rapidly alternating gravitational changes and the close proximity of other crew members, a participant successfully obtained clear diagnostic images of the uterus and measured three-dimensional bladder volumes during a parabolic flight aboard a Falcon 20 aircraft without privacy concerns. During the hypergravity phase (approximately 2 G) of the flight, heavier upper-extremity movement and probe positioning created challenges to successful imaging. However, minimizing head movement helped to stabilize the vestibular system during gravity changes, successfully mitigating symptoms such as vertigo, nausea, and dizziness. This strategy facilitated smoother transitions between gravitational forces and enabled the participant to obtain uterine imaging during the microgravity phase of the flight.CONCLUSIONThe use of a handheld portable POCUS device is feasible during parabolic flight, establishing an important precedent useful for supporting women's health in space. Future technology needs to incorporate training models, augmented reality, and advanced artificial intelligence-based tools to direct self-scanning capabilities for participants who do not have medical experience.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701364","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":"Testosterone for the Treatment of Hypoactive Sexual Desire Disorder in Perimenopausal and Postmenopausal Women.","authors":"Juliana M Kling","doi":"10.1097/aog.0000000000006015","DOIUrl":"https://doi.org/10.1097/aog.0000000000006015","url":null,"abstract":"Although there is no androgen deficiency diagnosis for women, research demonstrates that testosterone treatment can be modestly beneficial in treating appropriately selected postmenopausal women with distressing low desire, also known as hypoactive sexual desire disorder (HSDD). Current data do not support the role of testosterone treatment in supporting bone health or brain health or improving energy or cognition in women, and only limited research supports its benefit for HSDD treatment in women of late reproductive age. No current U.S. Federal Drug Administration-approved formulation of testosterone is available for women in the United States because of a lack of long-term safety data. However, two clinical guidelines now provide expert guidance on testosterone treatment and monitoring in women for HSDD. This narrative review presents the data and summarizes the guidelines in a clinically relevant format to make the information accessible to clinicians treating cisgender women with HSDD seeking testosterone treatment.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"706 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701231","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 Artificial Intelligence-Assisted Colposcopy in a Resource-Limited Population.","authors":"Yining Chang,Tingyuan Li,Qiang Zhou,Dianju Kang,Lingling Zhu,Jingjing Yang,Qiongxiu Kou,Huijuan He,Yulin Zhou,Qiong Liao,Jingchang Du,Xiaoping Yu,Yuqian Zhao","doi":"10.1097/aog.0000000000006014","DOIUrl":"https://doi.org/10.1097/aog.0000000000006014","url":null,"abstract":"OBJECTIVEThis study evaluates the performance of artificial intelligence (AI) colposcopy in detecting cervical cancer and precancerous lesions in real-world scenarios within resource-limited areas.METHODSThis is a cross-sectional study. Participants with positive human papilloma virus results or who were cytologic positive were referred for colposcopy, during which AI colposcopy was implemented. Biopsies were performed for positive findings suggested by either the colposcopist or the AI system. For the analysis, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve for detecting cervical intraepithelial neoplasia (CIN) 2+ and CIN 3+. Histopathology was the gold standard for disease diagnosis.RESULTSA total of 825 women underwent colposcopy, with 99 (12.0%) diagnosed with CIN 2+ and 53 (6.4%) with CIN 3+. Positive findings were reported in 392 women (47.5%) under conventional colposcopy and 640 (77.6%) with AI colposcopy. The sensitivity for detecting CIN 2+ was significantly higher for AI colposcopy (96.0%) and AI-assisted colposcopy (100%) than for conventional colposcopy (85.9%, P=.026, P<.001, respectively). In postmenopausal women, the sensitivities of AI colposcopy (94.3%) and AI-assisted colposcopy (100%) surpassed that of conventional colposcopy (77.4%, P=.026, P<.001, respectively). Artificial intelligence-assisted colposcopy also significantly enhanced the sensitivity of junior colposcopists with less than 10 years of clinical experience, achieving 100% compared with 84.6% by conventional colposcopy (P=.001), and improved detection in women with a squamocolumnar junction that was not visible (100% vs 70.4%, P=.004). For CIN 3+, the sensitivity of AI-assisted colposcopy was superior to that of conventional colposcopy (100% vs 86.8%, P=.013). In postmenopausal women, the sensitivities of both AI colposcopy and AI-assisted colposcopy were 100%; however, the sensitivity of conventional colposcopy was 77.8% (P=.023).CONCLUSIONArtificial intelligence-assisted colposcopy enhances sensitivity in detecting CIN 2+ and CIN 3+, particularly among postmenopausal women. Moreover, it improves the diagnostic performance of junior colposcopists and improves detection in women with a squamocolumnar junction that is not visible.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"29 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701232","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":"Conversion Rate for Robotic-Assisted Gynecologic Cancer Surgery.","authors":"Peter Scalia,Gabriel Levin,Tomer Bar Noy,Shannon Salvador,Melica Nourmoussavi Brodeur,Walter Gotlieb,Susie Kit Lau","doi":"10.1097/aog.0000000000006017","DOIUrl":"https://doi.org/10.1097/aog.0000000000006017","url":null,"abstract":"Our objective was to identify the rate of and reasons for conversion from robotic-assisted surgery to laparotomy for patients with gynecologic cancers. A retrospective analysis was conducted of all consecutive robotic surgeries for gynecologic cancers performed at a tertiary cancer center between December 2007 and December 2022. Data were stratified based on cancer type (endometrial, ovarian, cervical, and \"other\") and body mass index (BMI). Reasons for conversion were categorized as specimen removal, anesthesia-related, organ or vessel injury, advanced metastatic disease, and equipment malfunction. The conversion rate was 2.4% (55/2,328) overall and 0.5% for endometrial cancer after excluding mini-laparotomies performed solely to remove large specimens. The predominant reason for conversion in ovarian cancer was disease invasion into surrounding structures not amenable to robotic resection. No association was found between conversion rates and BMI or age.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"14 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701228","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 Complications in Osteogenesis Imperfecta.","authors":"Mathis Collier, Pierre Hannoun, Valérie Cormier-Daire, Jean-Marc Treluyer, Alexandra Benachi, Eugénie Koumakis","doi":"10.1097/AOG.0000000000005957","DOIUrl":"10.1097/AOG.0000000000005957","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate obstetric and perinatal outcomes of pregnancies among patients with osteogenesis imperfecta using the French National Health Insurance Database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study. Pregnancies were identified with an algorithm specifically developed for the French National Health Insurance Database to identify delivery stays using a combination of International Classification of Diseases, Tenth Revision (ICD-10) discharge codes and medical procedures. Exposure was osteogenesis imperfecta status based on the occurrence of ICD-10 code Q780 5 years before conception or during pregnancy. Outcomes included pregnancy, delivery, postpartum, and fetal complications based on hospital discharge data and reimbursements of medical procedures, medical devices, and drugs. Multivariable logistic regression analysis was performed, adjusted for multiple pregnancies per participant with generalized estimating equations.</p><p><strong>Results: </strong>The cohort included 8,850,969 pregnancies (5,823,322 patients) between January 2012 and December 2023. In total, 408 pregnant individuals (4.6/100,000) were identified with osteogenesis imperfecta. Compared with pregnant individuals without osteogenesis imperfecta, pregnant individuals with osteogenesis imperfecta had increased risks of antepartum hemorrhage (adjusted risk ratio [RR] 1.78, 95% CI, 1.01-3.14), chorioamnionitis (adjusted RR 2.79, 95% CI, 1.17-6.64), malpresentation (adjusted RR 1.65, 95% CI, 1.19-2.30), and preterm delivery (adjusted RR 2.11, 95% CI, 1.62-2.74). Cesarean delivery rates were notably higher in pregnant individuals with osteogenesis imperfecta (adjusted RR 2.59, 95% CI, 2.34-2.88), including among nulliparous individuals (adjusted RR 2.50, 95% CI, 2.22-2.81). Osteogenesis imperfecta was associated with major congenital anomalies (adjusted RR 5.04, 95% CI, 3.97-6.39 overall; adjusted RR 1.67, 95% CI, 1.09-2.56 when osteogenesis imperfecta was excluded from the congenital anomaly definition), especially cardiac anomalies. Postpartum analysis indicated no significant increase in fracture rates compared with prepregnancy periods.</p><p><strong>Conclusion: </strong>In this nationwide cohort study, osteogenesis imperfecta was associated with both maternal and fetal complications. These findings underscore the need for specialized, multidisciplinary management of pregnancies in patients with osteogenesis imperfecta.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234691","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":"12 Steps Toward Sustainability in Gynecologic Surgery.","authors":"Rebecca Schneyer,Kacey Hamilton,Ogechukwu Ezike,Raanan Meyer,Katharine Ciesielski,Matthew Siedhoff,Mireille Truong,Kelly Wright","doi":"10.1097/aog.0000000000006012","DOIUrl":"https://doi.org/10.1097/aog.0000000000006012","url":null,"abstract":"Surgery is a major driver of climate change due to carbon emissions. Single-use materials and tools account for the largest environmental effects. In this Video 1, we present 12 strategies to promote sustainability in the gynecology operating room, with a focus on minimizing single-use, disposable products: 1) reduce glove changes, 2) custom surgical packs, 3) reusable scrub caps, 4) avoid disposable energy devices, 5) stainless steel manipulators, 6) reusable suction irrigators, 7) alternatives to specimen-retrieval bags, 8) minimize single-use plastic trocars, 9) avoid advanced access platforms, 10) make the most of every suture, 11) use a laparoscope for cystoscopy, and 12) minimize red bag waste. Throughout the video, we present data to support our recommendations. Each of these strategies represents a small step, but, added together, they can make a big difference in our environmental effect as surgeons. A toolkit with additional resources is available in Appendix 1, available online at http://links.lww.com/AOG/E234.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"7 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652744","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}