Obstetrics and gynecology最新文献

{"title":"Coronavirus Disease 2019 (COVID-19) Vaccination and Spontaneous Abortion.","authors":"Sangini S Sheth,Gabriela Vazquez-Benitez,Malini B DeSilva,Jingyi Zhu,Elisabeth M Seburg,Anna E Denoble,Matthew F Daley,Darios Getahun,Nicola P Klein,Kimberly K Vesco,Stephanie A Irving,Jennifer C Nelson,Joshua T B Williams,Simon J Hambidge,James G Donahue,Heather S Lipkind,Elyse O Kharbanda","doi":"10.1097/aog.0000000000005904","DOIUrl":"https://doi.org/10.1097/aog.0000000000005904","url":null,"abstract":"OBJECTIVETo examine the association between coronavirus disease 2019 (COVID-19) vaccination and spontaneous abortion.METHODSWe conducted a case-control study of clinically adjudicated spontaneous abortions (case group) occurring between January 19, 2021, and October 27, 2021, and live births (control group). Patients aged 16-49 years at eight Vaccine Safety Datalink sites who had singleton pregnancies, one or more prenatal visits, continuous health plan enrollment, and spontaneous abortion (fetal loss between 6 and less than 20 weeks of gestation) or live birth were eligible. A random sample of eligible patients with spontaneous abortions was adjudicated to confirm pregnancy outcome, outcome date, and gestational age at fetal death; patients in the adjudicated spontaneous abortion case group were matched 1:2 on Vaccine Safety Datalink site, maternal age, and pregnancy start date with eligible patients with live births. Vaccine exposure was considered from pregnancy start to spontaneous abortion date or equivalent gestational age for the matched live births (index date). Conditional logistic regression was used to evaluate the association between COVID-19 vaccination in pregnancy and spontaneous abortion; secondary analyses explored associations by dose number, vaccine manufacturer, and vaccination within 6 weeks of the spontaneous abortion.RESULTSMatched analyses included 296 patients in the spontaneous abortion case group and 592 in the live birth control group. There was no association between spontaneous abortion and COVID-19 vaccination (adjusted odds ratio [aOR] 0.85, 95% CI, 0.56-1.30). There was also no association between spontaneous abortion and dose number compared with no vaccine (one dose: aOR 0.81, 95% CI, 0.39-1.70; two doses: aOR 0.84, 95% CI, 0.51-1.38; vaccine manufacturer: Moderna aOR 0.59, 95% CI, 0.29-1.19 and Pfizer-BioNTech aOR 0.97, 95% CI, 0.57-1.66; or vaccine exposure window of 6 weeks before spontaneous abortion or index date: aOR 0.87, 95% CI, 0.53-1.44).CONCLUSIONThere was no observed association between COVID-19 vaccination in pregnancy and spontaneous abortion. Findings support the safety of COVID-19 vaccination in early pregnancy.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"23 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902968","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":"Association Between Levonorgestrel-Releasing Intrauterine System Exposure Duration and Breast Cancer Incidence.","authors":"Jin-Sung Yuk, Myoung Hwan Kim, Sang Hee Yoon, Gwan Hee Han, Ji Hyun Noh","doi":"10.1097/AOG.0000000000005881","DOIUrl":"10.1097/AOG.0000000000005881","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between the duration of levonorgestrel-releasing intrauterine system (LNG-IUS) use and breast cancer risk in Korean women.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the Korean National Health Insurance Claims database from 2013 to 2022. A total of 2,094,029 women aged 30-49 years with initial diagnoses of endometriosis, uterine leiomyomas, or abnormal uterine bleeding between 2014 and 2017 were included in the study. Propensity score matching was applied to create balanced cohorts of LNG-IUS users and nonusers. Cox proportional hazards models were used to evaluate the association between LNG-IUS exposure duration and breast cancer incidence.</p><p><strong>Results: </strong>A total of 61,010 women were included in the study cohort. The incidence rate of breast cancer in LNG-IUS group was 223 cases per 100,000 person-years compared with 154 cases per 100,000 person-years in the non-LNG-IUS group. Use of LNG-IUS was linked to an increased breast cancer risk (hazard ratio [HR] 1.38, 95% CI, 1.192-1.585). Analysis of LNG-IUS use over time suggests that early initiation is associated with an increased risk of breast cancer, which may decrease over time (less than 3 years: early HR 5.40, 95% CI, 4.037-7.216; less than 3 years: late HR 1.04, 95% CI, 0.547-1.994; 3-4.9 years: early HR 3.44, 95% CI; 2.671-4.431; 3-4.9 years: late HR 1.75, 95% CI; 1.12-2.723; 5 years or more: HR 1.77, 95% CI, 1.26-2.479).</p><p><strong>Conclusion: </strong>The LNG-IUS may be associated with an increased risk of breast cancer among women with abnormal uterine bleeding, endometriosis, or leiomyomas, with the risk being particularly elevated during the initial years of use.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"523-531"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625559","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":"Update on Management and Outcomes of Monochorionic Twin Pregnancies.","authors":"Lynn L Simpson","doi":"10.1097/AOG.0000000000005891","DOIUrl":"10.1097/AOG.0000000000005891","url":null,"abstract":"<p><p>The management of multiple pregnancies complicated by monochorionicity continues to evolve as new investigations support a change in clinical practice to optimize outcomes. Monochorionic twins are at risk of unique conditions such as monoamnionicity, conjoined twinning, twin reversed arterial perfusion sequence, twin-twin transfusion syndrome, twin anemia-polycythemia sequence, unequal placental sharing with discordant twin growth or selective fetal growth restriction, and single-twin death that puts co-twins at risk of death or neurologic injury attributable to the shared placenta. Contemporary practice guidelines recommend serial ultrasonographic surveillance of monochorionic pregnancies to increase the early detection of problems and timely management decisions that may include increased surveillance, selective reduction or pregnancy termination, referral for in utero treatment, or earlier delivery than initially planned. Improvements in prenatal diagnosis and antenatal testing and advances in fetal therapy have contributed to more favorable outcomes in these complicated monochorionic gestations.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"486-502"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780709","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":"PUBLICATIONS: May 2025.","authors":"","doi":"10.1097/AOG.0000000000005887","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005887","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 5","pages":"541"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975267","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":"Telehealth Medication Abortion: Comparing Advance-Provision Patients With Pregnant Patients.","authors":"Anna E Fiastro, Elissa Brown, Peyton Smith, Erin K Thayer, Rebecca Gomperts, Emily M Godfrey","doi":"10.1097/AOG.0000000000005886","DOIUrl":"10.1097/AOG.0000000000005886","url":null,"abstract":"<p><strong>Objective: </strong>To compare characteristics of patients ordering abortion medications from a telehealth service for potential future use (advance provision) with characteristics of patients ordering medications to terminate a current pregnancy.</p><p><strong>Methods: </strong>This cross-sectional study used electronic medical records from a U.S. clinician-supported asynchronous telehealth service to compare patient characteristics (including pregnancy status, age, number of children, race and ethnicity, social vulnerability, residential urbanicity, and reason for choosing telehealth) of individuals requesting abortion medications for future use with those of individuals ordering medications to terminate a current pregnancy in 25 U.S. states and the District of Columbia from August 2021 to March 2023. Comparisons were made with the Pearson χ 2 test and Wilcoxon rank-sum test ( P <.05).</p><p><strong>Results: </strong>During the 20-month period, 3,252 advance-provision patients and 21,317 pregnant patients received abortion medications from a clinician-supported telehealth service. Of advance-provision patients, 72.2% identified as White compared with 42.4% of pregnant patients ( P <.001). Mean ages for advance-provision patients and pregnant patients were 31 and 27 years, respectively ( P <.001). Fewer advance-provision patients (38.4%) resided in high-vulnerability counties compared with pregnant patients (48.7%) ( P <.001). The top reasons that patients chose advance provision included personal choice (81.0%) and concern for future legal restrictions (70.5%).</p><p><strong>Conclusion: </strong>We observed substantial demand for advance provision of abortion medications through telehealth throughout the year and across geographies; notable surges in demand were associated with key political events. Advance-provision patients differ from pregnant patients and do not represent the demographics of those who traditionally have limited access to abortion care. Advance provision of abortion medications through telehealth warrants further study as restrictions on abortion persist and service models shift away from reliance on in-person access to clinicians.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"533-540"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670516","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":"Serial Total Bile Acid Measurements in Intrahepatic Cholestasis of Pregnancy.","authors":"William M Huang","doi":"10.1097/AOG.0000000000005898","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005898","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 5","pages":"e148-e149"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005240","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":"Placenta Accreta Spectrum, Present and Future: The Eunice Kennedy Shriver National Institute of Child Health and Human Development Workshop Summary.","authors":"Christina M Duzyj,Brett D Einerson,Yalda Afshar,Karin A Fox,Antonio F Saad,Daniela A Carusi,Christina L Herrera,Deirdre J Lyell,Alfred Z Abuhamad,Michaela K Farber,Anne C Roberts,Sebastian R Hobson,Loic Sentilhes,Baha M Sibai,Koji Matsuo,Kristen Terlizzi,Scott A Shainker,Robert M Silver,Helena C Bartels,Thomas D Shipp,Marilyn Huang,Alison G Cahill,Jason D Wright,George R Saade,Monica Longo","doi":"10.1097/aog.0000000000005929","DOIUrl":"https://doi.org/10.1097/aog.0000000000005929","url":null,"abstract":"Placenta accreta spectrum (PAS) disorder poses significant risks to maternal health, given the complexities of screening, diagnosis, and management. To address these challenges, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) hosted a workshop on June 10-11, 2024, bringing together expert health care professionals, researchers, stakeholders, and patient advocates to identify knowledge gaps, with an overarching goal of informing future research and best practices for PAS. Key discussions revolved around the resources and infrastructure needed to advance screening, diagnosis, and clinical management of PAS, alongside ways to enhance collaboration across disciplines. Participants considered strategies to optimize existing research resources and explored opportunities to strengthen partnerships between the NICHD and key stakeholders to achieve mutual objectives. The workshop-attended by representatives from the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Pan-American Society for the Placenta Accreta Spectrum, the National Accreta Foundation, the American Institute of Ultrasound in Medicine, and the Society of Gynecologic Oncology-aimed to foster consensus on essential PAS topics and to identify clinical and research priorities in all phases of PAS care. Additionally, a critical focus of the workshop was to enhance understanding of patient experiences and needs, recognizing that patient perspectives are essential for informing future research and improving outcomes.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"58 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902983","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":"Association Between the Social Vulnerability Index and Adverse Pregnancy Outcomes.","authors":"Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade","doi":"10.1097/AOG.0000000000005890","DOIUrl":"10.1097/AOG.0000000000005890","url":null,"abstract":"<p><strong>Objective: </strong>To assess the association between the Social Vulnerability Index (SVI) and racial disparities in pregnancy outcomes across U.S. counties and to quantify these racial disparities.</p><p><strong>Methods: </strong>This was a cross-sectional study using restricted Centers for Disease Control and Prevention data sets, including natality data sets, fetal death data sets, and all-cause mortality data sets from 2016 to 2021. We limited analyses to Black or White individuals aged 15-44 years from 3,114 U.S. counties. Participants were categorized into quartiles based on county-level SVI. The primary outcome was maternal mortality rate while pregnant or within 42 days of the end of pregnancy, and secondary outcomes were pregnancy-related mortality while pregnant or within 365 days of the end of pregnancy, stillbirth, and preterm birth. Mixed-effect generalized linear models with negative binomial distribution were used to quantify disparities, using difference-in-difference analysis to measure the difference in outcomes between Black and White individuals across different levels of social vulnerability (first quartile as referent).</p><p><strong>Results: </strong>A total of 20,189,328 individuals were included, distributed across SVI quartiles as follows: first quartile 2,558,131, second quartile 4,945,774, third quartile 6,827,503, and fourth quartile 5,857,920. Black individuals experienced significantly higher rates of maternal mortality, pregnancy-related mortality, stillbirth, and preterm birth compared with White individuals regardless of SVI quartiles. Difference-in-difference analyses demonstrated that disparities in maternal mortality rate were significantly larger in the second, third, and fourth quartiles compared with the first quartile (difference-in-difference 14.22 [95% CI, 2.11-26.33], 12.53 [95% CI, 1.26-23.81], and 18.82 [95% CI, 6.67-30.98], respectively). A worsening disparity in pregnancy-related mortality was observed in the fourth quartile, whereas disparities in stillbirth and preterm birth did not show significant differences across SVI quartiles.</p><p><strong>Conclusion: </strong>Racial disparities in maternal mortality intensified in counties with higher social vulnerability. These findings underscore the need for targeted interventions to address social determinants of health.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"503-510"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730878","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":"Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder.","authors":"Daniel W Cramer","doi":"10.1097/AOG.0000000000005896","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005896","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 5","pages":"e146-e147"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045445","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":"Oncologic Outcomes of Laparoscopic Radical Hysterectomy Incorporating Modified Tumor-Free Techniques.","authors":"Ruijuan Chen, Cong Wang, Binglin Li","doi":"10.1097/AOG.0000000000005894","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005894","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 5","pages":"e145-e146"},"PeriodicalIF":5.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972217","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}