Obstetrics and gynecology最新文献

{"title":"RhD-Positive Whole Blood for Patients With Reproductive Potential After Two Randomized Trials of Prehospital Trauma Resuscitation.","authors":"Jeremy W Jacobs, Jeannie Callum, Brian D Adkins, Elizabeth A Abels, Sheharyar Raza, Deva Sharma, Allison P Wheeler, Sarah S Osmundson, David M Chooljian, Garrett S Booth","doi":"10.1097/AOG.0000000000006431","DOIUrl":"10.1097/AOG.0000000000006431","url":null,"abstract":"<p><p>Low-titer group O whole blood is increasingly used in civilian trauma resuscitation and is usually RhD-positive because RhD-negative whole blood is scarce. For RhD-negative patients and patients of unknown RhD type who retain reproductive potential, transfusion of RhD-positive red cells can cause anti-D alloimmunization and place a future pregnancy at risk for hemolytic disease of the fetus and newborn, a harm that may emerge years after the trauma encounter. The ethical and clinical justification for accepting this risk has depended on the idea that whole blood provides a survival advantage large enough to outweigh the possibility of future reproductive harm. However, two recently published randomized trials of prehospital traumatic hemorrhage found no survival advantage for whole blood over component therapy. Reflecting this evidence, RhD-positive whole blood is ethically unjustified for RhD-negative patients with reproductive potential when compatible products are available. The reproductive harm is distinctive in being preventable through product selection, concentrated in patients who cannot consent during resuscitation, and often compounded by limited access to obstetric care. Institutions should default patients with reproductive potential to RhD-negative products when available until the RhD type is confirmed, guarantee standardized and cost-free follow-up when RhD-incompatible transfusion occurs, and ensure ethical standards within trial protocols.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977361","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: Hypertension and Preeclampsia","authors":"Baha M. Sibai","doi":"10.1097/aog.0000000000006425","DOIUrl":"https://doi.org/10.1097/aog.0000000000006425","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"204 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923211","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":"Episiotomy and Anal Sphincter Injury During Operative Vaginal Delivery in a U.S. Cohort","authors":"Alexis A. Doyle,Amanda A. Allshouse,Torri D. Metz,Rosa J. Speranza","doi":"10.1097/aog.0000000000006426","DOIUrl":"https://doi.org/10.1097/aog.0000000000006426","url":null,"abstract":"OBJECTIVE: To evaluate the association between episiotomy and obstetric anal sphincter injury during operative vaginal delivery (OVD) in a diverse, modern U.S. cohort. METHODS: This was a secondary analysis of patients who had OVD of a term, cephalic singleton neonate in the MFMU APEX (Maternal-Fetal Medicine Units Assessment of Perinatal Excellence) cohort. The primary outcome was obstetric anal sphincter injury defined as a third- or fourth-degree perineal laceration, and the exposure was episiotomy. Multivariable logistic regression adjusted for length of the second stage of labor, maternal age, body mass index (BMI), and birth weight. We tested for interaction in the association between episiotomy type and obstetric anal sphincter injury by OVD type and vaginal delivery history. RESULTS: Among 5,277 participants, 3,453 had vacuum-assisted vaginal delivery and 1,824 had forceps-assisted vaginal delivery. Episiotomy was performed in 1,704 deliveries (32.3%) (n=1,301 midline, n=384 mediolateral, n=19 unknown type). Obstetric anal sphincter injury incidence was 20.1% (95% CI, 19.0–21.2). As a main effect, odds of obstetric anal sphincter injury were higher among patients with episiotomy compared with those with no episiotomy (adjusted odds ratio 1.45, 95% CI, 1.25–1.67). There was a significant interaction between type of episiotomy and obstetric anal sphincter injury by OVD type ( P &lt;.001) and by vaginal delivery history ( P =.02); in this model, midline episiotomy during vacuum-assisted vaginal delivery compared with no episiotomy was associated with higher odds of obstetric anal sphincter injury for patients with or without prior vaginal delivery, and mediolateral episiotomy was associated with lower odds of obstetric anal sphincter injury for patients without prior vaginal delivery for both vacuum-assisted and forceps-assisted vaginal delivery. CONCLUSION: Mediolateral episiotomy was associated with lower odds of obstetric anal sphincter injury for patients without previous vaginal delivery undergoing OVD. In contrast, midline episiotomy was associated with increased odds of obstetric anal sphincter injury for vacuum-assisted vaginal delivery regardless of vaginal delivery history. These findings are consistent with several previous studies conducted in settings with different baseline rates of OVD and episiotomy and suggest that further investigation is warranted to identify patients who may derive benefit from mediolateral episiotomy before OVD.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"51 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148923208","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":"Combined Oral Contraception.","authors":"Ciara E Hutchison, Mitchell D Creinin","doi":"10.1097/AOG.0000000000006424","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006424","url":null,"abstract":"<p><p>Combined oral contraceptives (COCs), oral contraceptives containing an estrogen and a progestin, are a common, effective, and generally well-tolerated form of contraception with a wide variety of noncontraceptive benefits. Combined oral contraceptives have been most limited by the potential severe adverse event of venous thromboembolism throughout their history and development. In recent years, natural-estrogen-containing COCs have emerged with an improved safety profile while maintaining high efficacy and should likely be recommended as first line for new-start patients. It is important for clinicians to understand the evolution of COC regimens and the specific hormones within each formulation to best optimize benefits while minimizing risks to patients.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.1,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888236","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":"Thyroid Function Throughout Pregnancy in Women With Subclinical Hypothyroidism or Hypothyroxinemia.","authors":"Lauren H Theilen, Lisa Mele, Alan M Peaceman, Uma M Reddy, Michael W Varner, John M Thorp, George R Saade, Alan T N Tita, Dwight J Rouse, Baha M Sibai, Maged M Costantine, Steve N Caritis, Brian M Casey","doi":"10.1097/AOG.0000000000006373","DOIUrl":"10.1097/AOG.0000000000006373","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate thyroid status throughout pregnancy among women identified as having subclinical hypothyroidism or hypothyroxinemia before 20 weeks of gestation.</p><p><strong>Methods: </strong>This is a secondary analysis of two parallel, multicenter, placebo-controlled randomized clinical trials in which participants with subclinical hypothyroidism (elevated thyroid-stimulating hormone [TSH], normal free thyroxine [FT 4 ]) or hypothyroxinemia (normal TSH, low FT 4 ) were identified before 20 weeks of gestation to evaluate whether treatment with levothyroxine would improve offspring intelligence at age 5. Thyroid function testing was performed monthly, and participants returned 1 year after delivery for follow-up testing. For this analysis, we included only participants in the placebo groups. Follow-up thyroid function tests were analyzed separately for the subclinical hypothyroidism and hypothyroxinemia groups. The Cochran-Armitage trend test in linear proportions was used to examine associations of subsequent test results with baseline thyroid peroxidase antibody status. Multivariate Cox regression modeling was used to examine time to first normal thyroid function test result and the association with thyroid peroxidase antibody status and other characteristics.</p><p><strong>Results: </strong>A total of 326 of 338 (96.4%) participants in the subclinical hypothyroidism group and 254 of 261 (97.3%) in the hypothyroxinemia group underwent monthly testing. Most participants in both groups had at least one subsequent normal thyroid function test result in pregnancy (88.7% of participants in the subclinical hypothyroidism group and 61.4% of participants in the hypothyroxinemia group, P <.001). Development of overt hypothyroidism during the pregnancy was uncommon in either group (8/326 [2.5%] and 5/254 [2.0%] for subclinical hypothyroidism and hypothyroxinemia groups, respectively). There was no correlation between thyroid peroxidase antibody status and subsequent test results for either group ( Ptrend =.18 and 1.0 for the subclinical hypothyroidism and hypothyroxinemia groups, respectively).</p><p><strong>Conclusion: </strong>Most untreated pregnant women who initially test positive for subclinical hypothyroidism or hypothyroxinemia do not have sustained abnormal results throughout the remainder of the pregnancy. Strategies to screen and treat these women in early pregnancy may result in the treatment of patients whose test results would spontaneously revert to normal.</p><p><strong>Clinical trial registration secondary analysis: </strong>ClinicalTrials.gov , NCT00388297.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"383-390"},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579491","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":"Obstetric Cerclage.","authors":"","doi":"10.1097/AOG.0000000000006379","DOIUrl":"10.1097/AOG.0000000000006379","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this document is to provide evidence-based indications, surgical techniques, alternatives, and management strategies for cervical cerclage in pregnancy.</p><p><strong>Target population: </strong>Patients with an indication for cervical cerclage, including cervical insufficiency, prior obstetric history, and cervical shortening.</p><p><strong>Methods: </strong>This guideline was developed using an a priori protocol in conjunction with a writing team consisting of three maternal-fetal medicine subspecialists appointed by the American College of Obstetricians & Gynecologists' (ACOG's) Committee on Clinical Practice Guidelines-Obstetrics. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.</p><p><strong>Recommendations: </strong>This Clinical Practice Guideline provides recommendations for cervical cerclage indications, surgical approach, and management, as well as alternative therapies. Recommendations are classified by strength and evidence quality.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"148 3","pages":"e194-e212"},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796157","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":"Ovarian Vein Thrombosis Associated With Oral Contraceptives and Anomalous Renal Venous Drainage.","authors":"Ryu J Mori-Iwatate, Haruka Santa, Shuichiro Sagara, Munehiro Yoshitomi, Hitoshi Koga","doi":"10.1097/AOG.0000000000006346","DOIUrl":"10.1097/AOG.0000000000006346","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e159"},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227002","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":"Oral and Vaginal Probiotics and Pregnancy Outcomes in Women With Infertility: A Systematic Review and Meta-analysis.","authors":"Maedeh Moradi, Jessica A Grieger, Yilin Tong, Leonie K Heilbronn","doi":"10.1097/AOG.0000000000006356","DOIUrl":"10.1097/AOG.0000000000006356","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between oral and vaginal probiotic use and pregnancy outcomes in women with infertility.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, Emcare, Web of Science, Scopus, and ClinicalTrials.gov were searched from database inception to December 28, 2025.</p><p><strong>Methods of study selection: </strong>Randomized controlled trials or observational studies that evaluated the use of probiotic administration compared with either a control group or standard care in women with infertility were eligible for inclusion. Study eligibility, data extraction, risk of bias (Cochrane Risk of Bias tool and Risk of Bias in Non-Randomized Studies-of Interventionstool), and certainty of evidence (GRADE [Grading of Recommendations Assessment, Development and Evaluation]) were conducted independently by two authors. The primary outcomes were biochemical and clinical pregnancy rate, live-birth rate, and miscarriage rate among clinical pregnancies and preterm birth. A meta-analysis was performed, and the results were reported as risk ratios (RRs) with 95% CIs.</p><p><strong>Tabulation, integration, and results: </strong>A total of 16 studies including 2,339 women met the eligibility criteria for the meta-analysis. Among women with infertility, oral probiotic supplementation was associated with higher biochemical pregnancy rates (RR 1.27, 95% CI, 1.01-1.60), higher clinical pregnancy rates (RR 1.71, 95% CI, 1.01-2.91), and higher live-birth rates (RR 1.24, 95% CI, 1.01-1.51). Vaginal probiotics were associated with a reduced risk of miscarriage only (RR 0.57, 95% CI, 0.38-0.84).</p><p><strong>Conclusion: </strong>There was a modest association between oral probiotic supplementation and early and clinical pregnancy rates and vaginal probiotics and the reduction of miscarriage; however, the quality of evidence was low to very low.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD42025626181.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"352-364"},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278044","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":"Hantavirus and Pregnancy: What Obstetricians Need to Know.","authors":"Sonja A Rasmussen, Dana M Meaney-Delman, Ali S Khan, Denise J Jamieson","doi":"10.1097/AOG.0000000000006365","DOIUrl":"10.1097/AOG.0000000000006365","url":null,"abstract":"<p><p>A recent cluster of cases of severe respiratory illness due to Andes hantavirus (ANDV) infection highlights the need for obstetricians to understand hantavirus infection, including its implications during pregnancy. We have summarized English-language reports indexed in PubMed that describe hantavirus infection in pregnancy. Although we did not identify any published cases of ANDV infection in pregnancy, reports of ANDV infection among nonpregnant individuals as well as other types of hantavirus infection in pregnancy can help inform diagnosis, management, and prevention in pregnancy. Patients with hantavirus infection can deteriorate rapidly after the onset of respiratory symptoms and often require supportive care in an intensive care unit. Therefore, it is critical that clinicians have a high index of suspicion for hantavirus infection based largely on travel and exposure history. The primary mode of prevention for hantavirus infection is to avoid contact with rodents and their excreta. Because there are no effective therapies for hantavirus infection, treatment is supportive.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"341-351"},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258636","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":"The Role of Molecular Characterization in Precision Medicine in Endometriosis.","authors":"Indel Travis Niles, Martina Scialabba, Roxanne Lacouline Boulanger, Gaëlle Akiki, Sarah-Slim Diwan, Shuk On Annie Leung, Andrew Zakhari, Basile Tessier-Cloutier, Dong Bach Nguyen","doi":"10.1097/AOG.0000000000006352","DOIUrl":"10.1097/AOG.0000000000006352","url":null,"abstract":"<p><p>Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows in other parts of the body. It affects roughly 1 in 10 women of reproductive age, often causing severe pelvic pain and infertility. Despite how common it is, patients frequently wait nearly a decade for an accurate diagnosis, and current treatments often rely on trial and error rather than targeted science. This review simplifies the complex biologic \"blueprint\" of the disease to explain why it behaves the way it does. Recent research shows that endometriosis is more than a one-dimensional hormonal imbalance; it involves several key biologic factors, including genetic drivers, hormonal status, and physical changes such as neuroangiogenesis or fibrosis. Currently, no simple laboratory test or biomarker can predict how the disease will progress, largely because of the heterogeneity and small, retrospective nature of studies. To move toward personalized medicine, larger, more diverse studies that connect each patient's specific genetic profile to their symptoms and disease phenotype are needed. By mapping these molecular details, we can progress toward faster diagnoses, tailored care to each individual's disease burden, and recurrence risk stratification and surgical planning based on molecular characteristics.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"295-305"},"PeriodicalIF":5.1,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278213","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}