AJOG global reports最新文献

{"title":"Eclampsia risk prediction across diverse U.S. populations using CDC data: machine learning versus ACOG checklists","authors":"Anne F. Minsart MD, PhD, MPH ,&nbsp;Marwa Alhaj Ahmad MSc ,&nbsp;Lisbeth Waagstein MSc, MPH ,&nbsp;Rivalin Aho Glele MSc, MPH ,&nbsp;Nadirah Ghenimi MD, PhD, MPH","doi":"10.1016/j.xagr.2026.100646","DOIUrl":"10.1016/j.xagr.2026.100646","url":null,"abstract":"<div><h3>Background</h3><div>Various tools are employed in clinical practice to predict (pre)eclampsia. Artificial intelligence offers a promising approach for identifying people at risk. More data is needed on models trained for diverse populations.</div></div><div><h3>Objective</h3><div>This study aimed to develop machine learning prediction models for eclampsia utilizing CDC data from 3.6 million births in 2022, compare them to the American College of Obstetrics and Gynecology (ACOG) checklist, and assess their applicability to various population subgroups.</div></div><div><h3>Study design</h3><div>Machine learning models were trained on predictors outlined by the ACOG, and available pregnancy characteristics in vital statistics. The best model was then applied on 6 subsets—American Indian or Alaska, Hawaiian Native or Other Pacific Islander, Asian, Black/African American, mixed heritage, lower income, and being born abroad.</div></div><div><h3>Results</h3><div>The ACOG checklist applied on this cohort had a true-positive rate of 81.4% for predicting eclampsia and a false-positive rate of 68.9%. Logistic regression, Random Forest, LightGBM and XGBoost achieved an Area-under-the-receiver-operating-characteristic-curve of 0.64, recall rates around 50% and false-positive rates around 25%. The Area-under-the-receiver-operating-characteristic-curve was lower among individuals identifying as Black/African American, American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander, and those born abroad or with lower income.</div></div><div><h3>Conclusion</h3><div>The ACOG checklist had a very high false-positive rate but achieved a high detection rate, while requiring less computational resources than the machine learning models. Demographic biases and variability in machine learning model performance highlight the need for external validation tailored to specific populations.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100646"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147850287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperpyrexia with hemodynamic instability after sublingual misoprostol: case report and literature review","authors":"Paola A. Castellanos MD ,&nbsp;Juan C. Ureña MD ,&nbsp;Angie J. Acero MD ,&nbsp;Víctor S. Rangel MD","doi":"10.1016/j.xagr.2026.100647","DOIUrl":"10.1016/j.xagr.2026.100647","url":null,"abstract":"<div><div>Misoprostol is widely used in obstetric practice for the prevention and treatment of postpartum hemorrhage due to its uterotonic efficacy, oral administration, and stability at room temperature. Although generally considered safe, rare but severe adverse reactions have been reported. We present the case of a 27-year-old woman who developed hyperpyrexia (41°C), hemodynamic instability, hypoxemia, and generalized seizures shortly after receiving 1000 µg of sublingual misoprostol for postpartum uterine atony. Life-threatening differential diagnoses, including sepsis, pulmonary thromboembolism, eclampsia, and amniotic fluid embolism, were excluded. The patient required intensive supportive care, with complete clinical recovery and no sequelae. A review of the literature shows that similar cases are uncommon but share features such as sublingual administration, high doses, and a self-limited course with supportive management. This report highlights the importance of recognizing misoprostol-induced hyperpyrexia to guide appropriate management and avoid unnecessary interventions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100647"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147850288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A unique triple association: intravascular leiomyomatosis, benign metastasizing leiomyoma, and early-stage endometrial carcinoma","authors":"Taha Berk Çimen MD,&nbsp;Murat Cengiz MD,&nbsp;Onur Can Zaim MD,&nbsp;Bilal Esat Temiz MD,&nbsp;Murat Gültekin MD,&nbsp;Utku Akgor MD","doi":"10.1016/j.xagr.2026.100639","DOIUrl":"10.1016/j.xagr.2026.100639","url":null,"abstract":"<div><div>Intravascular leiomyomatosis (IVL) and benign metastasizing leiomyoma (BML) are uncommon variants of uterine smooth muscle tumors that can demonstrate extrauterine spread despite their benign histological appearance. Both lesions are known to be estrogen-dependent, yet their coexistence with gynecologic malignancies—particularly endometrial carcinoma—is exceedingly rare. We present a 51-year-old postmenopausal woman who was admitted with progressive abdominal distension and ecchymotic skin changes over the abdominal wall. Radiologic evaluation revealed a large retroperitoneal mass with multiple solid pelvic lesions. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and resection of a para-aortic mass. Histopathological examination identified 3 concurrent entities: intravascular leiomyomatosis confined to the uterus, benign metastasizing leiomyoma involving para-aortic lymph nodes, and an incidental FIGO stage IA1 endometrioid adenocarcinoma confined to an endometrial polyp. Immunohistochemistry confirmed smooth muscle differentiation (Desmin, h-caldesmon), retained FH expression, low proliferative index (Ki-67 ≈ 2%–3%), and wild-type p53 pattern. Postoperative recovery was uneventful, and adjuvant hormonal suppression with letrozole was initiated. The patient remains disease-free during 6 months of follow-up. This case represents an exceptionally rare triple coexistence of IVL, BML, and early-stage endometrial carcinoma. Recognition of such unique associations broadens the understanding of estrogen-dependent uterine neoplasms and emphasizes the need for thorough histopathological and immunohistochemical evaluation. A multidisciplinary approach with long-term hormonal surveillance is recommended to detect recurrence or additional hormone-responsive lesions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100639"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometrial osseous metaplasia presenting as a suspected intrauterine device: diagnostic pitfalls and hysteroscopic management—case report","authors":"Fabio Noriel Rojas Rojas MD ,&nbsp;Víctor S. Rangel MD","doi":"10.1016/j.xagr.2026.100643","DOIUrl":"10.1016/j.xagr.2026.100643","url":null,"abstract":"<div><div>Endometrial osseous metaplasia is a rare cause of abnormal uterine bleeding that can mimic an intrauterine foreign body on imaging, leading to diagnostic uncertainty. We report a 48-year-old woman with long-standing abnormal uterine bleeding, prior term vaginal deliveries, and no history of uterine instrumentation or pregnancy loss. Transvaginal ultrasound suggested an intrauterine device. Diagnostic hysteroscopy revealed a firm, whitish, cylindrical lesion with multiple projections anchored at the isthmus and tightly adherent to the myometrium, precluding complete removal due to perforation risk. Representative biopsies were obtained with minimal bleeding. Histopathology confirmed mature bone consistent with endometrial osseous metaplasia, without malignancy or foreign material. The patient experienced symptomatic improvement post-procedure and had an uncomplicated outpatient follow-up. A brief review of the literature indicates that although most cases are linked to prior obstetric events or uterine instrumentation, osseous metaplasia can occur in their absence and may present as an apparent intrauterine device on ultrasound. This report underscores the importance of considering osseous metaplasia in the differential diagnosis of abnormal uterine bleeding and highlights hysteroscopy as the definitive diagnostic and therapeutic approach to obtain targeted tissue and guide management while avoiding unnecessary interventions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100643"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147850285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of labor is not associated with decreased rates of breastfeeding in late preterm pregnancies","authors":"Alice Sutton MD ,&nbsp;Daniella Rogerson MD, MS ,&nbsp;Samantha Thomson MD ,&nbsp;Gina Frugoni MD ,&nbsp;Cynthia Gyamfi-Bannerman MD, MS","doi":"10.1016/j.xagr.2026.100637","DOIUrl":"10.1016/j.xagr.2026.100637","url":null,"abstract":"<div><h3>Background</h3><div>Some studies suggest that induction of labor at term is associated with lower rates of breastfeeding than spontaneous labor.</div></div><div><h3>Objective</h3><div>Our objective was to evaluate whether late preterm medically indicated induction of labor is associated with decreased rates of breastfeeding and/or increased rates of breastfeeding complications at the time of discharge from the delivery hospitalization.</div></div><div><h3>Study Design</h3><div>This secondary analysis of a randomized trial of individuals at high risk for late preterm delivery, defined as delivery between 34+0 and 36+6 weeks, included nonanomalous, singleton pregnancies and excluded those with unlabored cesareans or preterm prelabor rupture of membranes. The parent study collected detailed data on breastfeeding and the presence of breastfeeding difficulties, defined as issues in milk production or infant feeding. Subjects with incomplete breastfeeding data were additionally excluded. Participants undergoing late preterm indicted inductions were compared to those who presented with spontaneous preterm labor. The primary outcome, the rate of breastfeeding, was compared between groups. Breastfeeding difficulties were also compared. Baseline demographics were compared using bivariable analyses. We fit logistic regression models to adjust for confounders related to breastfeeding.</div></div><div><h3>Results</h3><div>Two thousand one hundred thirty participants were included. Spontaneous and induction groups were similar in age, tobacco use, gestational diabetes, and insurance type but the induced group had higher body mass index, rates of chronic hypertension and hypertensive disorders of pregnancy (HDP). The rate of breastfeeding did not differ in induced vs spontaneous participants (69.0% vs 68.7%, <em>P</em>=.90). However, breastfeeding difficulties were more common in the induced group in unadjusted analyses (38.8% vs 32.3%, <em>P=</em>.01). After adjusting for confounders, neither breastfeeding rates nor breastfeeding difficulties were different between groups. Of note, government insurance was an independent risk factor for low breastfeeding rates and induction was associated with a decreased rate of cesarean delivery</div></div><div><h3>Conclusion</h3><div>Medically indicated late preterm labor induction was not associated with decreased rates of breastfeeding or increased breastfeeding problems at time of discharge from the delivery hospitalization. Those with government funded insurance may need additional breastfeeding support.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100637"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147797432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided radiofrequency ablation of an intramural fibroid in a woman desiring fertility with coexisting focal adenomyosis: a case report","authors":"Francesco G. Martire MD, PhD,&nbsp;Claudia d’Abate MD,&nbsp;Eugenia Costantini MD,&nbsp;Ilaria Ianes MD,&nbsp;Emilio Pieri MD,&nbsp;Lorenza Minisci MD,&nbsp;Maria De Bonis MD,&nbsp;Lucia Lazzeri MD, PhD,&nbsp;Errico Zupi MD","doi":"10.1016/j.xagr.2026.100645","DOIUrl":"10.1016/j.xagr.2026.100645","url":null,"abstract":"<div><h3>Objective</h3><div>To report the reproductive outcome after ultrasound-guided radiofrequency ablation (RFA) in a woman with an intramural uterine fibroid and coexisting focal adenomyosis who experienced infertility and desired pregnancy.</div></div><div><h3>Design</h3><div>Case report.</div></div><div><h3>Patient</h3><div>A 40-year-old nulligravid woman with heavy menstrual bleeding, dysmenorrhea, and a history of infertility, defined by failure to conceive after more than 12 months of unprotected intercourse. Transvaginal ultrasound demonstrated a FIGO type 3 intramural fibroid distorting the endometrial cavity and associated focal anterior adenomyosis.</div></div><div><h3>Intervention</h3><div>Ultrasound-guided transvaginal RFA of the intramural fibroid.</div></div><div><h3>Main Outcome Measures</h3><div>Changes in fibroid volume and uterine cavity morphology on ultrasound, improvement of clinical symptoms, and reproductive outcome.</div></div><div><h3>Results</h3><div>The procedure was completed without complications. Follow-up ultrasound showed progressive fibroid volume reduction of 76.9% at 6 months, migration of the lesion away from the endometrial cavity, restoration of normal cavity anatomy, and improvement of sonographic features of focal adenomyosis. Menstrual symptoms improved significantly. Spontaneous conception subsequently occurred, resulting in an uncomplicated term vaginal delivery.</div></div><div><h3>Conclusion</h3><div>This case suggests that ultrasound-guided RFA may represent a minimally invasive, uterus-sparing option for selected women with intramural fibroids and coexisting focal adenomyosis associated with infertility.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100645"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of tetanus toxoid immunization among pregnant women in Somaliland: evidence from the 2020 nationwide survey using a zero-inflated negative binomial model","authors":"Hamda Jama Yousuf MD,&nbsp;Mohamed Hussein Egeh MD,&nbsp;Ahmed Abdirahman Farah MD,&nbsp;Ali Ahmed Hussein MD,&nbsp;Abdiasis Aden Omer MD","doi":"10.1016/j.xagr.2026.100641","DOIUrl":"10.1016/j.xagr.2026.100641","url":null,"abstract":"<div><h3>Background</h3><div>Tetanus toxoid (TT) immunization is a critical public health intervention for reducing maternal and neonatal mortality. Despite global recommendations, TT coverage remains low in several low- and middle-income countries, including Somaliland.</div></div><div><h3>Objective</h3><div>This study aims to assess the prevalence and determinants of TT immunization among pregnant women in Somaliland using the 2020 Somaliland Demographic Health Survey.</div></div><div><h3>Methods</h3><div>A cross-sectional analytic study was conducted using the 2020 Somaliland Demographic Health Survey. Data from 2584 women aged 15 to 49 years. STATA 17 was used for analysis. Descriptive statistics were used to examine immunization coverage. The chi-square test was used to identify bivariate associations between TT uptake and explanatory variables. Given the nature of the count outcome and high proportion of zeros, a zero-inflated negative binomial regression model was applied. The result was interpreted using incidence rate ratios with 95% confidence intervals. The model with the lowest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was selected as the best fit.</div></div><div><h3>Results</h3><div>Only 14.24% of pregnant women received at least two TT doses, while 73.03% received none. Antenatal care (ANC) attendance (IRR=3.93; 95% CI: 3.32–4.66), wealth index, maternal employment (IRR=0.41; 95% CI: 0.23–0.75 for unemployed), institutional delivery, and distance to health facility (IRR=1.17; 95% CI: 1.02–1.34) were significantly associated with TT uptake. Regional disparities and media exposure were associated with a slightly lower rate of TT uptake.</div></div><div><h3>Conclusion</h3><div>TT immunization among pregnant women in Somaliland is alarmingly low and shaped by both socio-demographic and reproductive health factors. Targeted interventions should focus on expanding ANC coverage, reducing geographic and economic barriers, empowering women, enhancing awareness through media, and improving physical access to healthcare facilities. These findings are aligned with Sustainable Development Goal 3 in Somaliland.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 2","pages":"Article 100641"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147850289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intimate hygiene practices during pregnancy with demographic and preterm birth associations: a large cohort study","authors":"Josef Alexander Locher MBChB, MMED ,&nbsp;Amy Wise MBBCh, MMED ,&nbsp;Renate Strehlau MBBCh, PhD","doi":"10.1016/j.xagr.2025.100592","DOIUrl":"10.1016/j.xagr.2025.100592","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Intimate hygiene practices during pregnancy can influence maternal and neonatal health outcomes. Limited data exist on these practices among South African women. This study aimed to characterize intimate hygiene practices among pregnant women in Johannesburg and examine associations with demographic factors and preterm birth.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A secondary analysis was conducted on data from 18,076 pregnant women enrolled in the Group B Streptococcus Correlates of Protection Cohort Study in Johannesburg, South Africa. Participants completed questionnaires detailing their intimate hygiene practices, including frequency, methods, and products used. Statistical analyses assessed the prevalence of these practices, their association with demographic characteristics (age, race, education, occupation, dwelling type, parity, and HIV status), and preterm birth outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The mean age was 28.4 years (range 18–49). Most participants were Black (93.0%), single (80.4%), unemployed (64.7%), and resided in urban areas (70.7%). They reported a median intimate cleaning frequency of 14 times per week (IQR 8–14). Over half (53.3%) practiced douching, and 48.4% added products to their bathwater.&lt;/div&gt;&lt;div&gt;Race was significantly associated with adding bathwater products (&lt;em&gt;P&lt;/em&gt;&lt;.00001). White women (44.3%) had the highest proportion adding products. Tertiary-educated mothers were more likely to add products (27.0%, &lt;em&gt;P&lt;/em&gt;=.0041). Students had the highest rate of product use (28.7%, &lt;em&gt;P&lt;/em&gt;=.0018). Urban participants were more likely to add products (25.2%) than semi-urban women (23.2%, &lt;em&gt;P&lt;/em&gt;=.025).&lt;/div&gt;&lt;div&gt;Douching was also significantly associated with race (&lt;em&gt;P&lt;/em&gt;&lt;.00001), with the “Other” category (65.1%) reporting the highest rate. Women with no schooling had the highest douching rate (53.2%, &lt;em&gt;P&lt;/em&gt;=.0006). Semi-urban mothers douched the most frequently (53.4%, &lt;em&gt;P&lt;/em&gt;&lt;.00001). Marital status was significantly associated with douching (&lt;em&gt;P&lt;/em&gt;&lt;.00001), with the highest prevalence among single women (45.8%). Occupation was also significantly associated with douching (&lt;em&gt;P&lt;/em&gt;=.016), with students having the highest douching prevalence (28.7%).&lt;/div&gt;&lt;div&gt;A significant association was observed between gestational age and the addition of products to bathwater for deliveries between 34 and &lt;37 weeks compared to term deliveries (&lt;em&gt;P&lt;/em&gt;=.045). Women who did not add products were more likely to deliver at term, while those who added products had a higher likelihood of delivering preterm. For deliveries &lt;34 weeks compared to 34–&lt;37 weeks, women who did not add products were more likely to deliver at 34–&lt;37 weeks (&lt;em&gt;P&lt;/em&gt;=.02).&lt;/div&gt;&lt;div&gt;For deliveries at &lt;34 weeks compared to 34–&lt;37 weeks, women who douched were less likely to deliver at &lt;34 weeks, while those who did not douche had lower proportions of deliveries at ","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100592"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in planned and successful vaginal delivery after a cesarean delivery by body mass index: a population-based cohort study","authors":"Emily Gray MD ,&nbsp;Mary M. Brown PhD ,&nbsp;Christy G. Woolcott PhD ,&nbsp;John Fahey MMath ,&nbsp;Victoria M. Allen MD, MSc ,&nbsp;Heather M. Scott MD ,&nbsp;Sarka Lisonkova MD, PhD ,&nbsp;Azar Mehrabadi PhD","doi":"10.1016/j.xagr.2025.100595","DOIUrl":"10.1016/j.xagr.2025.100595","url":null,"abstract":"<div><h3>Background</h3><div>Previous literature suggests that pregnant individuals with obesity have fewer planned and successful vaginal births following a previous cesarean delivery. Concern is growing that discrimination based on body mass index (BMI) and comorbidities associated with BMI, rather than BMI itself, are primarily responsible for these findings.</div></div><div><h3>Objective</h3><div>To describe disparities in planning and having a successful vaginal delivery after a previous cesarean delivery by BMI status.</div></div><div><h3>Study Design</h3><div>This population-based cohort study included all singleton pregnancies ≥37 weeks’ gestation from 2003 to 2021 in Nova Scotia, Canada, with one previous cesarean and without contraindications for a trial of labor. Adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated using Poisson regression, incorporating inverse probability weighting to account for confounding by demographic characteristics and co-morbidities.</div></div><div><h3>Results</h3><div>Among 12 646 deliveries, approximately 31% experienced pre-pregnancy obesity. Of those with obesity, 34% planned a vaginal birth compared to 44% of those without obesity (aRR: 0.82, 95% CI: 0.78, 0.86). Higher BMI classification was associated with a reduced likelihood of planned vaginal delivery: class I: 37%, aRR: 0.88 (95% CI: 0.82, 0.94); class II: 32%, aRR: 0.81 (95% CI: 0.74, 0.89); class III: 26%, aRR 0.65 (95% CI: 0.56, 0.75). Among those planning a vaginal delivery, those with obesity were less likely to have a vaginal birth compared to those without obesity (57% vs 69%; aRR: 0.87, 95% CI: 0.82, 0.92); successful vaginal birth was less likely as BMI increased.</div></div><div><h3>Conclusion</h3><div>Obesity was associated with reduced planned and successful vaginal delivery after a previous cesarean delivery and the association was most pronounced at higher BMI after accounting for demographic characteristics and co-morbidities. While discrimination based on BMI was unmeasured, notable disparities in planning and having a vaginal delivery by BMI suggest that training for health care providers and the availability of appropriate infrastructure may help optimize care for this population.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100595"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple conservative surgery for placenta accreta spectrum without parametrial invasion: a novel uterus-sparing approach","authors":"Anh Duy Nguyen PhD ,&nbsp;Ha Thi Thu Nguyen PhD ,&nbsp;Thuy Bien Nguyen MD ,&nbsp;Dat Tuan Do PhD ,&nbsp;Giang Thi Tra Duong MD ,&nbsp;Thanh Hoang Luong MD","doi":"10.1016/j.xagr.2026.100606","DOIUrl":"10.1016/j.xagr.2026.100606","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Placenta accreta spectrum (PAS) is a life-threatening condition often managed by cesarean hysterectomy, resulting in numerous negative impacts on women's health. Most PAS cases do not involve parametrial invasion and may not require aggressive or complex surgical approaches. However, no simplified uterus-sparing technique exists for this subgroup. Therefore, we developed a novel surgical approach, “Simple Conservative surgical Approach for Placenta Accreta Spectrum – SCAPAS,” tailored for PAS without parametrial invasion. SCAPAS included eight main steps.</div></div><div><h3>OBJECTIVES</h3><div>To evaluate the efficacy and safety of SCAPAS in conservative surgical management of women with PAS without parametrial invasion.</div></div><div><h3>STUDY DESIGN</h3><div>This prospective study was conducted from January 2022 to June 2023 at Hanoi Obstetrics and Gynecology Hospital. Sixty-three women with PAS without suspected parametrial invasion, according to the prenatal ultrasound staging system for PAS disorder, underwent elective cesarean delivery using the SCAPAS technique at ≥35 weeks of gestation. Maternal and fetal outcomes were collected. Successful cases were defined as those achieved uterine conservation following SCAPAS without any life-threatening complications.</div></div><div><h3>RESULTS</h3><div>Of the 63 cases, 74.6% were patients under 35, and 66.7% had a history of two or more cesarean sections. The majority of women were diagnosed with PAS2 (69.8%). The success rate of SCAPAS was 85.7%. Success rates for placenta accreta, increta, and percreta were 100%, 82.4%, and 81.8%, respectively. The overall median intraoperative blood loss was 1200 mL (range 400–2500 mL), and the median duration of surgery was 80 minutes (range 35–124 minutes), with a mean interval from skin incision to fetal delivery was 30 minutes. Bladder injury and mild wound infections occurred in 6.3% (4/63) and 4.8% (3/63) cases, respectively. No patient required re-laparotomy. Total 20.6% of newborns had an Apgar score of less than 7 at 1 minute, but all recovered after 5 minutes.</div></div><div><h3>CONCLUSIONS</h3><div>SCAPAS is a simple, safe, and effective surgical approach for conservative management of PAS without suspected parametrial invasion. Further studies are needed to develop a preoperative classification based on location, area, and degree of invasion to improve outcomes in PAS patients.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 1","pages":"Article 100606"},"PeriodicalIF":0.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}