Obstetrics and gynecology最新文献

{"title":"Late-Onset Postpartum Hypertension After Normotensive Pregnancy.","authors":"Colleen Sinnott, Lisbet Lundsberg, Jennifer Culhane, Caitlin Partridge, Anna E Denoble","doi":"10.1097/AOG.0000000000005751","DOIUrl":"10.1097/AOG.0000000000005751","url":null,"abstract":"<p><p>To better inform efforts to improve and extend postpartum care, we sought to estimate the incidence of de novo hypertension up to 6 months postpartum in patients without evidence of hypertension during pregnancy or immediately postpartum. This retrospective cohort study included all patients delivering within an academic health care system. All blood pressure (BP) measurements from fertilization to 6 months postpartum were obtained from the electronic medical record and used to identify patients who remained normotensive throughout pregnancy and in the first 6 weeks postpartum. By 6 months postpartum, nearly one-fifth of this large, previously normotensive cohort had developed BP abnormalities per American College of Cardiology-American Heart Association criteria. These findings underscore the importance of optimizing the transition from obstetrics to primary care in the postpartum period.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"95-98"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372450","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":"Screening Characteristics of Hemoglobin and Mean Corpuscular Volume for Detection of Iron Deficiency in Pregnancy.","authors":"Hui Xiao Chao, Travis Zack, Andrew D Leavitt","doi":"10.1097/AOG.0000000000005753","DOIUrl":"10.1097/AOG.0000000000005753","url":null,"abstract":"<p><p>Iron deficiency in pregnancy remains underdiagnosed despite professional society recommendations for first-trimester complete blood count (CBC) screening. To determine the effectiveness of the CBC hemoglobin and mean corpuscular volume (MCV) to identify iron deficiency in pregnancy, we conducted a retrospective analysis of 20,550 pregnancies from 2009 to 2022 at the University of California, San Francisco, obstetrics clinics. A total of 16,547 (80.5%) pregnant individuals had first-trimester screening CBC; 345 (2.1%) had a coincident ferritin test. Hemoglobin level less than 11 g/dL and MCV level less than 80 fL each had sensitivity of only 30% (95% CI, 20-41%) to detect first-trimester iron deficiency (ferritin level less than 30), corresponding to a negative likelihood ratio of 0.90 (95% CI, 0.77-1.05) and 0.85 (95% CI, 0.73-0.99), respectively. More than 50% of the 1,749 women with documented iron deficiency anytime during pregnancy were neither anemic nor microcytic at the time of diagnosis.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"91-94"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372451","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":"Effects of Routine Catheterization on Urinary Tract Infection Rates After Minor Gynecologic Surgeries.","authors":"Salina Zhang, Deepasri Ananth, Lyn Haselton, Jenifer Byrnes","doi":"10.1097/AOG.0000000000005788","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005788","url":null,"abstract":"<p><p>This pilot study describes urinary tract infection (UTI) rates after routine single catheterization during minor gynecologic surgeries at a tertiary care community hospital. Records from 762 patients from 2021 were reviewed, including procedures such as hysteroscopy, loop electrosurgical excision procedure, and dilation and curettage. Findings revealed a 42.4% catheterization rate, with a significantly higher proportion of catheterized patients having UTIs (5.6%) compared with noncatheterized patients (2.5%). This study suggests that catheterization, unless medically necessary, should be avoided to reduce nosocomial infection risk. These results advocate for reconsidering current practices to enhance patient care and minimize preventable UTIs.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 1","pages":"15-16"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818571","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":"Preparing for Disasters: Addressing Critical Obstetric and Gynecologic Needs of Patients: ACOG Committee Statement No. 15.","authors":"","doi":"10.1097/AOG.0000000000005778","DOIUrl":"10.1097/AOG.0000000000005778","url":null,"abstract":"<p><p>Large-scale catastrophic events, either natural or human-influenced, highlight the requisite for emergency plans that specifically address the needs of obstetric and gynecologic patients. Pregnant, postpartum, and lactating individuals and their newborns and infants can be adversely affected by disasters and disaster-related environmental conditions. Obstetrician-gynecologists and other health care professionals have a unique role in developing and carrying out an emergency preparedness plan that addresses safety and medical needs in the event of a disaster.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 1","pages":"e58-e62"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818682","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":"Combining Ultrasonography and Endometrial Aspiration as a One-Stop Screening for Endometrial Neoplasia.","authors":"Ohad Rotenberg, Georgios Doulaveris, Gary L Goldberg, Malte Renz, Kathleen Whitney, Leeann Dar, Noam Rotenberg, Haotian Wu, Thierry Van den Bosch, Pe'er Dar","doi":"10.1097/AOG.0000000000005752","DOIUrl":"10.1097/AOG.0000000000005752","url":null,"abstract":"<p><strong>Objective: </strong>To assess the performance of simultaneous endometrial aspiration and sonohysterography to screen for endometrial cancer or hyperplasia in women aged 50 years or older.</p><p><strong>Methods: </strong>We conducted a prospective study from February 2014 to October 2020 at the ultrasound unit of a large urban academic medical center. The study included 1,635 women aged 50 years or older referred for endometrial evaluation, with follow-up through January 2021. Participants underwent saline infusion sonohysterography combined with ultrasound-guided endometrial aspiration. The primary outcome measured was a diagnosis of endometrial cancer or hyperplasia within 1 year from screening. The diagnostic accuracy of the combined evaluation method, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), was assessed.</p><p><strong>Results: </strong>Of 1,170 women who completed the study protocol, 82 (7.0%) had endometrial cancer and 42 (3.6%) had endometrial hyperplasia. Of all patients who developed cancer during the follow-up period, 85.5% were diagnosed within 1 year after evaluation. The application of simultaneous endometrial aspiration and sonohysterography together demonstrated a sensitivity of 99.1%, specificity of 24.9%, PPV of 11.8%, and NPV of 99.6%. Using a theoretical sequential approach, assuming an endometrial aspiration is performed only in patients determined to be high risk by sonohysterography, demonstrated a sensitivity of 93.4%, specificity of 99.9%, PPV of 99.0%, and NPV of 99.3%.</p><p><strong>Conclusion: </strong>Simultaneous endometrial aspiration and sonohysterography is an effective one-stop outpatient screening tool for detecting endometrial cancer and hyperplasia in women aged 50 years or older. With the integration of two screening modalities into a single procedure, simultaneous endometrial aspiration and sonohysterography may overcome the limitations inherent in each of the currently recommended methods individually, potentially improving patient prognosis and streamlining the diagnostic process.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"801-809"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400893","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":"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":"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":" ","pages":"e125-e128"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","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":"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":" ","pages":"826-828"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","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":"Effects of Prophylactic Oxytocin on Bleeding Outcomes in Women Undergoing Dilation and Evacuation: A Randomized Controlled Trial: Correction.","authors":"","doi":"10.1097/AOG.0000000000005782","DOIUrl":"10.1097/AOG.0000000000005782","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"144 6","pages":"e139"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731276","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":"Intramural Leiomyomas and Fertility: A Systematic Review and Meta-Analysis.","authors":"Alex C Sundermann, Katherine E Hartmann","doi":"10.1097/AOG.0000000000005764","DOIUrl":"10.1097/AOG.0000000000005764","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"144 6","pages":"e135"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11819907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731311","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":"Hysterectomy at a Young Age: A Reasonable Option or a Recipe for Regret?","authors":"Olga Bougie","doi":"10.1097/AOG.0000000000005766","DOIUrl":"10.1097/AOG.0000000000005766","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"144 6","pages":"755-756"},"PeriodicalIF":5.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142731279","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}