AJOG global reports最新文献

{"title":"Preoperative prediction of the need for postoperative adjuvant therapy in stage IB cervical cancer using tumor size measured on magnetic resonance imaging and serum squamous cell carcinoma antigen levels","authors":"Michihide Maeda MD, PhD,&nbsp;Miho Kitai MD,&nbsp;Masashi Akada MD,&nbsp;Yusaku Shimizu MD,&nbsp;Eri Yamabe MD,&nbsp;Reisa Kakubari MD,&nbsp;Shinya Matsuzaki MD, PhD,&nbsp;Tsuyoshi Hisa MD,&nbsp;Shinsuke Koyama MD, PhD,&nbsp;Seiji Mabuchi MD, PhD","doi":"10.1016/j.xagr.2026.100671","DOIUrl":"10.1016/j.xagr.2026.100671","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Radical hysterectomy is widely performed for stage IB cervical cancer; however, a substantial number of patients require postoperative adjuvant therapy, resulting in dual-modality treatment. This study evaluated the predictive value of tumor size measured on magnetic resonance imaging (MRI) and serum squamous cell carcinoma (SCC) antigen levels for the need for postoperative adjuvant therapy.</div></div><div><h3>METHODS</h3><div>We retrospectively analyzed 191 patients with stage IB cervical SCC who underwent radical hysterectomy. Patients were also analyzed in a stage IB1 to IB2 cohort. The cut-off values of preoperative tumor size measured on MRI and serum SCC antigen levels for the need for postoperative adjuvant therapy were determined using receiver operating characteristic curve analysis.</div></div><div><h3>RESULTS</h3><div>A total of 104 patients (54.5%) received postoperative adjuvant therapy. Large tumor size measured on MRI and elevated serum SCC antigen levels were predictors of the need for postoperative adjuvant therapy. The optimal cut-off values were 3.2 cm and 2.3 ng/mL in the overall cohort, and 2.4 cm and 2.3 ng/mL in the stage IB1 to IB2 cohort. Patients were stratified into three risk groups according to the number of predictive factors. In the low-risk group (no predictors), 20 of 86 patients (23.3%) required postoperative adjuvant therapy. In the intermediate-risk group (one predictor), 46 of 64 patients (71.9%) required adjuvant therapy. In the high-risk group (two predictors), 38 of 41 patients (92.7%) received adjuvant therapy. Similar trends were observed in the stage IB1 to IB2 cohort, with increasing rates of adjuvant therapy across risk groups.</div></div><div><h3>CONCLUSION</h3><div>Preoperative tumor size measured on MRI and serum SCC antigen levels are useful predictors of the need for postoperative adjuvant therapy in stage IB cervical SCC. Their combination could assist in treatment planning and patient counseling.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100671"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148642983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal psychiatric symptoms and the continuum of breastfeeding in an urban university hospital population","authors":"Swati Jain MD,&nbsp;Tomilowo Abijo PhD,&nbsp;Edwin W. Powell PhD,&nbsp;Sindile Dlamini M.Div.,&nbsp;Ethan Kellogg MD,&nbsp;Inez Reeves MD","doi":"10.1016/j.xagr.2026.100674","DOIUrl":"10.1016/j.xagr.2026.100674","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Breastfeeding has well-established public health benefits. We investigated the impact of perinatal psychiatric symptoms on reduced breastfeeding rates in an urban university community.</div></div><div><h3>OBJECTIVE</h3><div>This study investigates the relationship between perinatal psychiatric screening of symptoms on plans, initiation, and continuation of breastfeeding.</div></div><div><h3>STUDY DESIGN</h3><div>Pregnant women ≥18 years recruited from our urban academic clinic completed “My Mood Monitor (M-3)”, a validated psychiatric screening tool, and a breastfeeding questionnaire in 3 phases: second trimester (I- plans), postdelivery (II- initiation), and postpartum (III-continuation). Data were analyzed to establish the relationship between breastfeeding, maternal demographics, and the M-3 screening at these corresponding time points.</div></div><div><h3>RESULTS</h3><div>Although 86.3% (N=82) of our cohort planned to breastfeed, 76.1 % (N<em>=</em>54) initiated, and 43.4 % (N=23) continued breastfeeding. Early entry into prenatal care (≤12 weeks) was significantly associated with plans to breastfeed (*<em>P</em>=.02). At phase II, there was some association (<strong>⁺</strong><em>P</em>=.065) between mothers with positive anxiety screening and breastfeeding, which became significant at continuation (<strong>*</strong><em>P</em>=.014). Positive anxiety screening was significantly associated with postpartum discontinuation of breastfeeding (<em>P</em>=.019).</div></div><div><h3>CONCLUSION</h3><div>Early screening for identification and referral for diagnoses with treatment plans for psychiatric symptoms of perinatal anxiety, especially following delivery, may improve breastfeeding rates in urban minorities.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100674"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148730844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Male partner involvement in antenatal care: implications for maternal health services in Juba, South Sudan","authors":"Zechariah J. Malel FCOG,&nbsp;Ezbon WApary MPH,&nbsp;Alnazir Osman Abdalla,&nbsp;Esraa Ahmed Mohammed,&nbsp;Yak Ring Tong Yak,&nbsp;Moses Mangar Aleth,&nbsp;Bok Phillip Nhial Bok,&nbsp;Mohammed Eissa Mohammed","doi":"10.1016/j.xagr.2026.100679","DOIUrl":"10.1016/j.xagr.2026.100679","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Male partner involvement in antenatal care (ANC) is recognized as an important strategy for improving maternal and neonatal health outcomes. Active participation of male partners enhances support for pregnant women, promotes timely healthcare utilization, and improves adherence to ANC recommendations. Despite these benefits, male involvement in ANC remains low in many settings. This study assessed the level of male partner involvement, influencing factors, and partner knowledge regarding ANC services in Juba County, South Sudan.</div></div><div><h3>OBJECTIVE</h3><div>To assess the level of male partner involvement in antenatal care and its association with maternal healthcare utilization among women attending maternal health services in Juba County, South Sudan.</div></div><div><h3>STUDY DESIGN</h3><div>A facility-based cross-sectional study was conducted from November to December 2025 among women attending ANC services in the selected public health facilities in Juba County, South Sudan. Data were collected using structured questionnaires to assess the level of male partner involvement in ANC visits and factors influencing participation. Descriptive statistics and logistics analyses were performed, with statistical significance set at <em>P</em>&lt;.05 to identify the associated factors.</div></div><div><h3>RESULTS</h3><div>Overall, 50.4% (95% confidence intervals: 45.7–55.5) of women reported being accompanied by their male partners to at least one ANC visit. Significant factors influencing male involvement included women’s education level, partner’s age, partner’s education level, health worker encouragement, and a welcoming ANC environment (<em>P</em>&lt;.05). The main barrier to involvement was work-related commitments (59.6%). Women whose partners had secondary level education and greater awareness of maternal health were more likely to report male participation in ANC visits.</div></div><div><h3>CONCLUSION</h3><div>Male partner involvement in ANC remains inadequate, potentially limiting improvements in maternal and neonatal health outcomes. Educational attainment and supportive health facility practices were associated factors with male with participation. Interventions aimed at increasing male awareness, addressing cultural barriers, and creating male-friendly ANC services are needed to enhance participation and support safer pregnancies and childbirth.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100679"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148776596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From integration to use: a qualitative study of barriers and facilitators to postpartum family planning use in northeast Ethiopia—a multistakeholder perspective","authors":"Delelegn Tsegaye Zikie MSc,&nbsp;Misra Abdulahi Ahmed PhD,&nbsp;Gurmesa Tura Debelew PhD","doi":"10.1016/j.xagr.2026.100680","DOIUrl":"10.1016/j.xagr.2026.100680","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>Although postpartum family planning (PPFP) is widely implemented in every health facility, many pregnancies are still unintended and closely spaced, contributing to maternal mortality. This study aimed to explore the barriers and facilitators of postpartum contraceptive use in northeast Ethiopia.</div></div><div><h3>OBJECTIVE</h3><div>To explore barriers and facilitators to PPFP use in northeast Ethiopia</div></div><div><h3>STUDY DESIGN</h3><div>A qualitative study was conducted in northeast Ethiopia. A total of 13 in-depth interviews and 12 key informant interviews were conducted among different stakeholders. Participants were recruited using a heterogeneous purposive sampling technique. Data were collected through semi-structured interview guides until data saturation was achieved. The study was conducted from March to April 2023. All audio recordings were transcribed into Amharic, and the verbatim transcripts were translated into English. The data were coded, subcategories identified, and organized into main themes—conventional content analysis with an inductive approach using ATLAS. TI version 7 software was done.</div></div><div><h3>RESULTS</h3><div>The barriers to postpartum contraceptive use were health system constraints, service provider attitudes and competencies, limited knowledge and misconceptions among women, socio-cultural challenges, obstacles to health service utilization, and security problems, whereas the facilitators were strong community support, use of women’s development groups and conferences, regular offsite mentorship, donor support, and involvement of satisfied role model family planning users.</div></div><div><h3>CONCLUSION</h3><div>The barriers to contraceptive use identified were service provider-related gaps, limited knowledge, security problems, misconceptions, inconsistent contraceptive supply, socio-cultural problems, health system, and community barriers. Regular offsite mentoring, donor support, and engagement of women’s development groups were the facilitators of PPFP use.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100680"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148843271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning analysis of perceived healthcare access barriers among women of reproductive age in Sub-Saharan Africa: using demographic and health surveys","authors":"Fentahun Bikale Kebede MPH,&nbsp;Abraham Keffale Mengistu MSc","doi":"10.1016/j.xagr.2026.100668","DOIUrl":"10.1016/j.xagr.2026.100668","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>In Sub-Saharan Africa (SSA), women of reproductive age face significant barriers to accessing healthcare, undermining progress towards Universal Health Coverage. Understanding the complex determinants of this multifaceted problem requires advanced analytical approaches.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to identify and rank the key predictors of perceived healthcare access barriers among women in SSA using a multi-country dataset and an interpretable machine learning (ML) framework.</div></div><div><h3>Study Design</h3><div>We analyzed recent Demographic and Health Survey data from 28 SSA countries (n=467,965 women). A composite measure of healthcare access barriers was used as the outcome. After preprocessing and feature selection, eight ML models were trained and evaluated. The best-performing model was interpreted using SHapley Additive exPlanations (SHAP).</div></div><div><h3>RESULTS</h3><div>The pooled prevalence of perceived healthcare access barriers ranges from 17.8% (95% CI, 17.0–18.6%) in South Africa to 72.1% (95% CI, 71.6–72.7%) in Malawi. The Light Gradient Boosting Machine (LightGBM) was the top-performing model (Accuracy:65.2%, F1-score: 72.8%, ROC-AUC:68.2%, and PR-AUC: 72.9%). SHAP analysis identified the wealth index as the most powerful predictor, followed by use of internet, media exposure, mobile phone ownership, and educational level. Lower socioeconomic status and limited access to information and communication technologies were strongly associated with greater access barriers</div></div><div><h3>CONCLUSION</h3><div>The findings underscore that socioeconomic and digital inclusion factors are paramount in determining healthcare access. This highlights the need for integrated strategies that go beyond health-sector solutions to address underlying social and economic determinants. This study provides an evidence-based, actionable ranking of the determinants of perceived healthcare access problems. The results can inform targeted policies on poverty alleviation, digital inclusion, and education to reduce disparities and advance equitable healthcare access for women in SSA.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100668"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148657680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the complexities of out-of-state abortion training in the United States Post-Dobbs","authors":"Kristyn Brandi MD, MPH,&nbsp;Emily Claymore MPH,&nbsp;Kristin Simonson MA,&nbsp;Jema Turk PhD, MA, MPA,&nbsp;Jody Steinauer MD, PhD","doi":"10.1016/j.xagr.2026.100676","DOIUrl":"10.1016/j.xagr.2026.100676","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>In the United States<strong>,</strong> the <em>Dobbs v. Jackson Women's Health Organization (Dobbs)</em> decision has implications not just for patient care, but for abortion training. Consequently, training programs in states with abortion bans are developing out-of-state training rotations by partnering with programs in abortion-accessible states. It is unclear what barriers exist for trainees, sending and receiving site faculty as they develop and manage out-of-state training rotations.</div></div><div><h3>OBJECTIVE</h3><div>This study aims to understand the perspectives of trainees and faculty as they navigate the post-<em>Dobbs</em> landscape and develop out-of-state training relationships.</div></div><div><h3>STUDY DESIGN</h3><div>This qualitative study interviewed trainees, faculty from states with abortion bans considering sending trainees for abortion training (\"Sending Sites\") and faculty from states supportive of abortion that are receiving trainees (“Receiving Sites”). Interviews were conducted over Zoom, transcribed, and interview transcripts were analyzed utilizing Nvivo software for thematic qualitative analysis.</div></div><div><h3>RESULTS</h3><div>We interviewed 9 trainees, 8 sending sites faculty and 5 receiving sites faculty across the country. Faculty in states with abortion bans noted many barriers to establishing an out-of-state rotation including funding and legal support. Receiving sites were worried about integrating outside trainees and making sure they got enough experience without negatively impacting their home trainees’ training. Regardless of rotation length and level of participation, all trainees reported positive experiences with out-of-state training.</div></div><div><h3>CONCLUSION</h3><div>Despite barriers to developing out-of-state training rotations, trainees value the opportunity to obtain abortion training. Efforts should be made to improve facilitation of out-of-state training opportunities in the post-<em>Dobbs</em> medical landscape.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100676"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148730403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a clinical prediction model for pathological upgrade from endometrial atypical hyperplasia to endometrial cancer: a retrospective Eastern Chinese cohort study","authors":"Chong Fan MS,&nbsp;Xiangjun Zhang MS,&nbsp;Mengshan Li MS,&nbsp;Wenting Wang MS,&nbsp;Zhenzhen Li MS,&nbsp;Qianqian Lu MS,&nbsp;Fang Teng MD,&nbsp;Lili Ge MD","doi":"10.1016/j.xagr.2026.100670","DOIUrl":"10.1016/j.xagr.2026.100670","url":null,"abstract":"<div><h3>BACKGROUD</h3><div>Endometrial cancer (EC), the most prevalent gynecologic malignancy in developed countries, often arises from endometrial atypical hyperplasia (EAH). Thus, how to predict EAH combined with EC before total hysterectomy is particularly important.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to identify preoperative predictors of pathological upgrade from EAH to EC and develop a clinical prediction model.</div></div><div><h3>STUDY DESIGN</h3><div>This retrospective cohort study analyzed 519 patients who underwent hysterectomy with EAH diagnosed on biopsy. Postoperative pathology classified patients into the EAH (n=413) or EC (n=106) group. Demographic, clinical, laboratory, and imaging data were compared. Multivariate logistic regression and ROC analyses identified risk factors and model performance.</div></div><div><h3>RESULTS</h3><div>In this study, 20.42% (106/519) of cases with EAH were confirmed as EC after hysterectomy. The number of EC patients with stage Ia, Ib, II, and III were 91 (85.85%), 10 (9.43%), 1 (0.94%), and 4 (3.78%), respectively. Lymph node metastasis was observed in 2.83% (3/106) of the patients. The EC group exhibited significantly higher mean age (51.44 vs 49.63 years, <em>P</em>=.042), BMI (25.74 vs 24.80 kg/m², <em>P</em>=.038), and endometrial thickness (1.05 vs 0.93 cm, <em>P</em>=.003). Metabolic markers [fasting glucose: 5.65 vs 5.30 mmol/L, <em>P</em>=.002; total cholesterol (TC): 5.34 vs 4.82 mmol/L, <em>P</em>&lt;.0001] and coagulation indices (fibrinogen: 2.81 vs 2.44 g/L, <em>P</em>&lt;.0001) were elevated in the EC group. Multivariate analysis identified six independent predictors: endometrial thickness (OR=2.894, <em>P</em>=.010), hemoglobin (OR=1.025, <em>P</em>=.020), human epididymis protein 4 (OR=1.023, <em>P</em>&lt;.0001), TC (OR=1.607, <em>P</em>=.003), fibrinogen (OR=2.573, <em>P</em>=.001), and Lymphocyte-to-Monocyte Ratio (OR=1.210, <em>P</em>=.013). The six-factor combined model achieved an AUC of 0.794 (95% CI: 0.739–0.849), with 75.9% sensitivity and 73.0% specificity. Among the 255 patients (49.13%) who underwent preoperative magnetic resonance imaging (MRI) in our hospital, 49 were diagnosed with EAH and 54 with EC. The postoperative pathological concordance rates were 77.55% (38/49) for EAH and 77.78% (42/54) for EC. The combined model integrating MRI with hemoglobin, TC, and fibrinogen levels achieved an AUC of 0.871 (95% CI: 0.819–0.922), with a sensitivity of 69.6% and a specificity of 89.4%. The optimal cut-off values were &gt;135.500 g/L for hemoglobin, &gt;4.855 mmol/L for TC, and &gt;2.910 g/L for fibrinogen.</div></div><div><h3>CONCLUSION</h3><div>We established novel preoperative prediction models that integrates endometrial, metabolic, coagulation, inflammatory parameters, with the inclusion or exclusion of MRI features to identify co-existing endometrial carcinoma in atypical hyperplasia.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100670"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148730842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of uterocervical angle combined with phosphorylated insulin-like growth factor binding protein-1 testing for preterm delivery and adverse neonatal outcomes","authors":"Nguyen Xuan My MD, MSc,&nbsp;Pham Ba Nha MD, PhD,&nbsp;Nguyen Thai Giang MD, PhD,&nbsp;Luong Hoang Thanh MD, MSc","doi":"10.1016/j.xagr.2026.100682","DOIUrl":"10.1016/j.xagr.2026.100682","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;div&gt;Preterm birth is a leading cause of perinatal morbidity. While transvaginal cervical length (CL) is the standard screening tool for symptomatic women, its low specificity frequently leads to overtreatment and unnecessary hospital admissions. Although the uterocervical angle (UCA) and phosphorylated insulin-like growth factor binding protein-1 (phIGFBP-1) are recognized as strong independent predictors, the clinical value of integrating these biomechanical and biochemical markers into a single triage model remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;div&gt;To investigate the predictive accuracy of a combined model incorporating UCA, CL, and the phIGFBP-1 test for spontaneous preterm delivery, and to evaluate its clinical utility and association with neonatal outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;div&gt;A cohort study was conducted on 130 pregnant women presenting with symptoms of threatened preterm labor. The latency period (time-to-delivery) was analyzed using Kaplan–Meier survival curves and a multivariable Cox proportional hazards regression model. Diagnostic accuracy was compared utilizing receiver operating characteristic curves. Clinical utility was evaluated by the number of preventable hospitalization days, and neonatal outcomes were compared based on the phIGFBP-1 test results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;div&gt;The combined predictive model significantly improved diagnostic accuracy, achieving an excellent area under the curve of 0.776 compared to 0.731 for CL alone (&lt;em&gt;P&lt;/em&gt;&lt;.001). Multivariable Cox regression identified a positive phIGFBP-1 test as the strongest independent factor accelerating preterm delivery (hazard ratio=1.675, &lt;em&gt;P&lt;/em&gt;=.006), whereas CL (&lt; 25 lt; 25 mm) and cervical funneling lost statistical significance. Kaplan–Meier analysis demonstrated that the longest latency period belonged to the lowest-risk group (narrow UCA and negative phIGFBP-1). Utilizing this combined model as a triage tool could have helped low-risk patients avoid 34 unnecessary hospital bed days and unwarranted exposure to tocolytics and corticosteroids. Furthermore, a positive phIGFBP-1 test was closely associated with adverse neonatal outcomes, including a significantly lower birth weight (2582.98±518.52 g vs 2899.26±400.57 g, &lt;em&gt;P&lt;/em&gt;&lt;.001) and reduced 1- and 5-minute Apgar scores (&lt;em&gt;P&lt;/em&gt;&lt;.001 and &lt;em&gt;P&lt;/em&gt;=.002, respectively).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;CONCLUSION&lt;/h3&gt;&lt;div&gt;Integrating the UCA and the biochemical marker (phIGFBP-1) provides superior predictive accuracy for preterm delivery compared to the traditional CL measurement. This protocol not only optimizes healthcare resource allocation by safely reducing unnecessary hospitalizations but also effectively identifies pregnancies at risk for adverse neonatal outcomes. More importantly, it empowers physicians to confidently triage low-risk groups, thereby restricting medication overuse, minimizing unnecessary admission rates, and mit","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100682"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148843272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating a “see-and-treat” approach with opportunistic human papilloma virus deoxyribonucleic acid (HPV DNA) based cervical cancer screening in India: a retrospective cross-sectional study","authors":"Sripriya Rao BE,&nbsp;Mayank Chhabra MPH, MBA,&nbsp;Jagadish Kudkuli PhD,&nbsp;Milan Toraskar MBA,&nbsp;Aswathy G. Nath MS, DNB,&nbsp;Devu Prakash MBBS,&nbsp;Shweta Srivastava MBA,&nbsp;Wahengbam Imo Singh MSW,&nbsp;Malini Chandrasekharan MBBS, DO,&nbsp;Kunal Oswal MPH,&nbsp;Jaganjeet Randhawa BDS, MPH,&nbsp;Venkataramanan Ramachandran PhD","doi":"10.1016/j.xagr.2026.100678","DOIUrl":"10.1016/j.xagr.2026.100678","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>India lacks an organized national cervical cancer screening program, and while the World Health Organization (WHO) recommends human papillomavirus (HPV) deoxyribonucleic acid (DNA) testing as the primary modality, large-scale evidence on implementation via decentralized treatment pathways in India is limited. We evaluated the effectiveness of opportunistic high-risk HPV (hrHPV) DNA screening, assessing prevalence, genotype distribution, self-testing acceptance, and the diagnostic performance of a community-based “see-and-treat” approach.</div></div><div><h3>OBJECTIVE</h3><div>To evaluate the prevalence and genotype distribution of hrHPV and assess the diagnostic accuracy, treatment compliance, and clinical viability of a decentralized “see-and-treat” approach within a large-scale opportunistic screening program across 20 Indian states.</div></div><div><h3>STUDY DESIGN</h3><div>In this retrospective cross-sectional study (January 2022–December 2025), 62,868 women aged 25 to 65 years were enrolled across 20 Indian states via community outreach (75.1%) and hospital-based network (24.9%). Screening utilized clinician-collected or self-collected (10.5%) samples tested via the Cobas 6800 system. hrHPV-positive women were triaged by colposcopy and managed through a decentralized “see-and-treat” approach using thermal ablation (TA) or Large Loop Excision of the Transformation Zone (LLETZ). Primary outcomes included HPV prevalence, diagnostic accuracy (AUC), and treatment compliance.</div></div><div><h3>RESULTS</h3><div>Overall HPV prevalence was 8.5% (5,354/62,868), with significant regional variation (11.3% in Delhi NCR to 4.7% in Kerala). Non-16/18 high-risk genotypes accounted for 54.6% of infections. Positivity peaked at ages 26 to 30 years (10.1%) and had a minor peak at 51 to 55 years (8.4%). The see-and-treat modality demonstrated high diagnostic accuracy (AUC 0.95; sensitivity 0.98; specificity 0.91) with a program efficacy of 81.2% with 16.3% overtreatment and 21.1% undertreatment. Treatment compliance in the community sub-cohort was 51.3% (1,957/3,813). We identified five women with invasive cancers and 7.8% CIN III (28/357), 9.0% CIN II (32/357), and 26.3% CIN I (94/357) of the histopathology sub-group.</div></div><div><h3>CONCLUSION</h3><div>Opportunistic hrHPV screening integrated with decentralized “see-and-treat” is a clinically robust strategy for LMICs. Significant regional heterogeneity requires tailored, state-specific policies and digital linkage-to-care frameworks to overcome compliance barriers and meet WHO 2030 cervical cancer elimination goals.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100678"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148776597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting lifetime cervical cancer screening among sexually active women in low- and middle-income countries using machine learning models: evidence from Demographic and Health Surveys","authors":"Fentahun Bikale Kebede MPH,&nbsp;Kusse Urmale Mare MPH,&nbsp;Fetlework Gubena Arage MPH,&nbsp;Ayele Tiyou MPH,&nbsp;Getachew Teshale MPH,&nbsp;Abenezer Zenebe Kebede MPH,&nbsp;Nebyu Lakew Tefera MPH,&nbsp;Amanuel Worku MSc,&nbsp;Bewuketu Terefe MPH","doi":"10.1016/j.xagr.2026.100669","DOIUrl":"10.1016/j.xagr.2026.100669","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Cervical cancer poses a major health risk in low- and middle-income countries (LMICs), with high morbidity and mortality among women. It is largely preventable through screening and early treatment, but underused programs lead to a heavy burden. The goal is to identify key factors influencing screening, reveal inequities, and improve policies in resource-limited areas.</div></div><div><h3>METHODS</h3><div>Using recent Demographic and Health Surveys (DHS) data from 19 LMICs, this study estimated lifetime cervical cancer screening among women aged 15 to 49 years. Missing data were removed, and class balancing was performed with synthetic minority oversampling technique. GridSearch optimized hyperparameters before dividing data into training and validation sets. Multiple machine learning algorithms predicted lifetime screening, including decision trees, random forests, gradient boosting, extra trees, XGBoost, LightGBM, and catBoost classifiers. Model performance was evaluated using accuracy, recall, precision, F1 score, and receiver operating characteristics area under the curve.</div></div><div><h3>RESULTS</h3><div>The analysis of 261,371 women aged 15 to 49 from the DHS found that random forest achieved 80% accuracy, 87% precision, 80% recall, and an 80% F1 score, while extra trees achieved 79%, 87%, 79%, and 83%. Key predictors included household size, wealth, women’s age, and education. Ensemble methods such as random forests and extra trees demonstrated strong generalization, making them useful for targeted interventions.</div></div><div><h3>CONCLUSION</h3><div>Ensemble algorithms such as random forests and extra trees predict lifetime cervical cancer screening with ∼80% accuracy in LMICS. The study emphasizes targeted awareness, education, and age-sensitive screening. Findings will be tested in other populations to support clinical decision systems.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"6 3","pages":"Article 100669"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148642982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}