Obstetrics and gynecology最新文献

{"title":"National Trends in Prepregnancy Cardiometabolic Risk and Counseling: An Analysis of the Pregnancy Risk Assessment Monitoring System, 2016-2022.","authors":"Megan M McLaughlin, Catherine Lee, Neda Ghaffari, Juan M Gonzalez Velez, Alexis L Beatty","doi":"10.1097/AOG.0000000000005990","DOIUrl":"10.1097/AOG.0000000000005990","url":null,"abstract":"<p><strong>Objective: </strong>To assess national U.S. trends in self-reported prepregnancy cardiometabolic risk factors and counseling about improving cardiometabolic health.</p><p><strong>Methods: </strong>We analyzed data from the Centers for Disease Control and Prevention's PRAMS (Pregnancy Risk Assessment Monitoring System), a nationally representative population-based survey of postpartum individuals who had live births from 2016 to 2022. We identified prepregnancy cardiometabolic risk factors (obesity, overweight, hypertension, diabetes mellitus, smoking cigarettes or electronic cigarettes). We then tested for age-standardized trends in both cardiometabolic risk factors and prepregnancy counseling using logistic regression with survey year as a continuous variable. We examined whether patient sociodemographic factors were associated with self-reported prepregnancy counseling about cardiometabolic health, adjusting for clinical characteristics.</p><p><strong>Results: </strong>Among 225,431 participants (weighted n=11,052,761), the majority (61.6%) reported having at least one prepregnancy cardiometabolic risk factor and 14.8% reported having two or more risk factors. Only 38.4% of individuals had optimal prepregnancy cardiometabolic health (no risk factors). The age-standardized prevalence of having a cardiometabolic risk factor increased from 59.1% in 2016 to 62.8% in 2022 ( P <.001) and was driven by an increase in the prevalence of obesity from 22.4% to 28.4% ( P <.001). Only 58.3% reported receiving any type of prepregnancy counseling about cardiometabolic risk, with screening for smoking most common (54.4%), followed by counseling about maintaining a healthy weight (26.9%), counseling about improving health before pregnancy (21.4%), and counseling about controlling medical conditions such as diabetes or high blood pressure (10.4%). Lower income, lower education, rural residence, and no health insurance were associated with lower odds of being counseled about cardiometabolic health.</p><p><strong>Conclusion: </strong>Prepregnancy cardiometabolic risk factors were common among U.S. birthing people and have increased over time. Self-reported prepregnancy counseling about cardiometabolic health remains suboptimal, and there were disparities by income, education, geography, and insurance status.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"422-433"},"PeriodicalIF":4.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560696","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":"Uterine Transposition for Fertility Preservation and Ovarian Conservation in Patients Undergoing Pelvic Radiotherapy.","authors":"Shant Apelian, Adriana Vest, Maya Yasukawa, Jody Wellcome, Adrian Kohut, Anthony N Imudia, Richard Tuli, Matthew L Anderson, Thomas Rutherford, Vaagn Andikyan","doi":"10.1097/AOG.0000000000005954","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005954","url":null,"abstract":"<p><p>Because pelvic malignancies and their treatments often compromise reproductive potential, the need for effective fertility preserving strategies has become increasingly important. Although traditional options offer varying success, most do not aim to maintain uterine reproductive function. Uterine transposition is an innovative surgical technique designed to preserve fertility by safeguarding both the uterus and ovaries in patients undergoing pelvic radiotherapy. This approach involves temporarily repositioning the uterus and ovaries outside the radiation field, with reimplantation after treatment. Since its first successful use in 2015, uterine transposition has been used across different types of cancer and age groups, including prepubertal patients. Early clinical outcomes have been promising, with high rates of ovarian function preservation, menstrual resumption, and successful pregnancies, including spontaneous fertilizations. Additionally, the procedure has demonstrated an acceptable safety profile, with most complications being minor and manageable, although concerns remain regarding uterine ischemia and vascular integrity postreimplantation. The overall findings support its potential as a viable fertility preserving option. However, further research is necessary to refine patient selection, evaluate long-term reproductive outcomes and complications, and address challenges related to uterine perfusion and implantation.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560700","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":"Urinary Incontinence and Menopausal Symptom Burden.","authors":"Erica Qiao, Haley Burns, Maria I Rodriguez, Sara B Cichowski","doi":"10.1097/AOG.0000000000005994","DOIUrl":"10.1097/AOG.0000000000005994","url":null,"abstract":"<p><p>Urinary incontinence (UI) is a common midlife symptom that often co-occurs with other menopausal changes. In this cross-sectional survey of 2,084 Oregon residents (approximately 30% rural), 45.8% reported UI. Menopause symptoms burden, measured by the Menopause Rating Scale, was higher for every UI subtype (all P <.001). Moderate-to-severe menopause burden increased adjusted odds of stress, urgency, and mixed UI 2-fold to 13-fold ( P <.001). Reported evaluation and treatment rates were low across all UI subtypes (2.0-14.6%), and it remains unclear how often participants were screened or asked about symptoms by health care professionals. This highlights the need to address both actual and perceived gaps in menopause and continence care through proactive, patient-centered screening.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"402-404"},"PeriodicalIF":4.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560699","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":"ACOG Clinical Practice Update: Coding, Billing, and Clinician Training for Detailed Fetal Anatomy Ultrasound in the First Trimester.","authors":"","doi":"10.1097/AOG.0000000000006006","DOIUrl":"10.1097/AOG.0000000000006006","url":null,"abstract":"<p><p>This Clinical Practice Update provides revised guidance on the coding, billing, and training for detailed fetal anatomy ultrasound in the first trimester. This document is a focused update of related content in Practice Bulletin No. 175, Ultrasound in Pregnancy (Obstet Gynecol 2016;128:e241-56).</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"438-441"},"PeriodicalIF":4.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560693","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":"Gestational Weight Gain and Hypertensive Disorders of Pregnancy With Prepregnancy and Early Pregnancy Glucagon-Like Peptide-1 Receptor Agonist Exposure.","authors":"Nishita Pondugula, Jennifer F Culhane, Lisbet S Lundsberg, Caitlin Partridge, Audrey A Merriam","doi":"10.1097/AOG.0000000000005995","DOIUrl":"10.1097/AOG.0000000000005995","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the associations among peripregnancy glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure with hypertensive disorders of pregnancy (HDP) and gestational weight gain.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study that included patients who delivered between 2014 and 2024 and had GLP-1RA exposure up to 1 year before pregnancy. Participants were identified through electronic medical record query with manual medical record abstraction to confirm exposure stop dates. Exposure to GLP-1RAs was classified by indication: pregestational diabetes mellitus or weight management. Unexposed control groups for each indication cohort were identified from an existing institutional data repository from 2021 to 2022. Demographic and clinical characteristics and obstetric outcomes were compared. The two primary outcomes were gestational weight gain and HDP. Gestational weight gain was quantified as below, meeting, or exceeding recommended gestational weight gain. Crude odds ratios and adjusted odds ratios (aORs) were estimated using multivariable modeling. Regression analysis was stratified as GLP-1RA exposure prepregnancy only or during pregnancy.</p><p><strong>Results: </strong>We included 243 patients who were exposed to GLP-1RA up to 1 year before pregnancy, with 65.4% having evidence of use during pregnancy. Overall, 103 (42.4%) patients used GLP-1RA for pregestational diabetes and 140 (57.6%) patients used it for weight management, compared with 175 unexposed patients in the pregestational diabetes control group and 200 unexposed patients in the weight-management control group (body mass index [BMI] 30-39.9: n=100; BMI 40 or higher: n=100). Exposure to GLP-1RAs was not associated with gestational weight gain in the pregestational diabetes cohort but was associated with decreased odds of gestational weight gain below recommendations (aOR 0.38, 95% CI, 0.18-0.80) in the weight-management cohort. Exposure to GLP-1RAs was associated with lower odds of HDP when compared with unexposed individuals with pregestational diabetes (aOR 0.52, 95% CI, 0.30-0.90) and with unexposed individuals who were undergoing weight management (aOR 0.51, 95% CI, 0.30-0.87). These associations were slightly more robust among patients exposed during pregnancy.</p><p><strong>Conclusion: </strong>In individuals undergoing weight management, peripregnancy GLP-1RA exposure was associated with decreased risk of gestational weight gain below recommendations, which may reflect rebound weight gain after cessation. Peripregnancy GLP-1RA exposure was associated with lower odds of developing HDP for both the pregestational diabetes and weight-management cohorts. Additional studies are needed to guide GLP-1RA use in pregnancy and to better elucidate any risks of exposure.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560694","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":"Living Donor Uterus Transplantation.","authors":"Masato Tamate, Giuliano Testa, Laura Divine, Johanna Bayer, Liza Johannesson","doi":"10.1097/AOG.0000000000005987","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005987","url":null,"abstract":"<p><strong>Background: </strong>For women with absolute uterine factor infertility, uterus transplantation represents the closest solution to normal gestation and delivery. It is a temporary transplant; the uterine graft is removed after completion of childbearing. The uterus transplant journey involves multiple surgical and medical steps.</p><p><strong>Technique: </strong>The surgical steps include living or deceased donor hysterectomy, transplant of the uterine graft, cesarean delivery, and graft hysterectomy. The medical steps include immunosuppressive treatment, in vitro fertilization, and pregnancy. In this video, we show a living donor uterus transplant, including donor hysterectomy, back-table preparation of the uterine graft, and recipient transplant surgery. The video highlights the surgical steps of the procedure.</p><p><strong>Experience: </strong>Between September 2016 and January 2025, 36 women underwent uterus transplantation at Baylor University Medical Center, resulting in the birth of 26 children to date.</p><p><strong>Conclusion: </strong>Uterus transplantation is associated with successful births of healthy children.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560695","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":"Postpartum Pharmacologic Thromboprophylaxis and Venous Thromboembolism in a U.S. Cohort.","authors":"William H Kutteh","doi":"10.1097/AOG.0000000000005966","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005966","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 1","pages":"e8-e9"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030329","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":"Cervical Ripening in Pregnancy: ACOG Clinical Practice Guideline No. 9.","authors":"","doi":"10.1097/AOG.0000000000005951","DOIUrl":"10.1097/AOG.0000000000005951","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this document is to review current methods for cervical ripening and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. This document focuses on cervical ripening in individuals with term, singleton, vertex pregnancies with membranes intact, because this is the population in whom most studies were conducted. For more information on recommended timing of delivery based on maternal, fetal, and obstetric conditions and on labor management, refer to: American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 831, Medically Indicated Late-Preterm and Early-Term Deliveries (1); Practice Bulletin No. 217, Prelabor Rupture of Membranes (2); Obstetric Care Consensus No. 10, Management of Stillbirth (3); Practice Bulletin No. 205, Vaginal Birth After Cesarean Delivery (4); and Clinical Practice Guideline No. 8, First and Second Stage Labor Management (5).</p><p><strong>Target population: </strong>Individuals with term, singleton, vertex pregnancies with membranes intact.</p><p><strong>Methods: </strong>This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two maternal-fetal medicine subspecialists and one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics. ACOG medical librarians completed a comprehensive literature search for primary literature within the Cochrane Library, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, Ovid MEDLINE, and PubMed and searched for guidelines from ACOG and other organizations. 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 includes an overview of cervical ripening indications, contraindications, and methods and provides recommendations for pharmacologic, mechanical, and combination method cervical ripening in individuals with term, singleton, vertex pregnancies with membranes intact. Recommendations are classified by strength and evidence quality.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 1","pages":"148-160"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023861","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 Future of Cervical Cancer Screening Is Now.","authors":"Ana I Tergas, Mark H Einstein","doi":"10.1097/AOG.0000000000005960","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005960","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 1","pages":"3-5"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023878","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":"Our Time, Our Fight: Protecting Care, Promoting Wellness, and Leading Change.","authors":"Steven J Fleischman","doi":"10.1097/AOG.0000000000005959","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005959","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 1","pages":"21-26"},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023848","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}