AJOG global reports最新文献

{"title":"Antenatal experiences of pregnant women with cardiac conditions: a systematic review and meta-synthesis","authors":"Jasmine X. Kiley BSc ,&nbsp;Annabelle Corlett BA ,&nbsp;Emma Mitchell-Sparke MPhil ,&nbsp;Brittany Jasper MD ,&nbsp;Tabitha Wishlade MSc ,&nbsp;Catriona Bhagra MD ,&nbsp;Sara Wetzler MD ,&nbsp;Catherine E. Aiken MBBChir, PhD","doi":"10.1016/j.xagr.2025.100522","DOIUrl":"10.1016/j.xagr.2025.100522","url":null,"abstract":"<div><h3>Objective</h3><div>Cardiovascular conditions are the leading cause of maternal mortality in high-income countries. We aim to inform supportive care that addresses the needs of pregnant women with cardiac conditions.</div></div><div><h3>Data Sources</h3><div>Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsychINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via Proquest were searched, database inception-June 2024.</div></div><div><h3>Study Eligibility Criteria</h3><div>Studies with qualitative components describing experiences of pregnant women with any cardiac condition globally.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>The Critical Appraisal Skills Programme checklist for qualitative research was employed to perform quality assessment. Inductive coding and thematic analysis were conducted using NVivo software.</div></div><div><h3>Results</h3><div>Thirteen qualitative studies met the inclusion criteria for meta-synthesis. We identified 3 key themes pertaining to the pregnancy experience of women with cardiac conditions, including patient-provider risk perception matching, importance of communication, and peer influence. Women with established versus new cardiac diagnoses in pregnancy had differences in their experiences. Depending on their own perception of risk, women noted over-medicalization or dismissal by their providers. Our findings also showed that some women sought peer support through online support groups, which either provided a sense of community and hope, or were anxiety-inducing.</div></div><div><h3>Conclusions</h3><div>It is critical for women and providers to have nuanced and personalized discussions about the risk of cardiac conditions during pregnancy. Experience of pregnancy differs amongst women with new or pre-existing cardiac conditions and is based on women’s appraisal of their pregnancy’s risk level. Reaching an agreement in risk perception is crucial to strengthen the patient-provider relationship and provide a basis for women to feel secure during their pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100522"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322263","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":"Does obstetric violence influence institutional delivery utilization? Prevalence of fear of institutional delivery on subsequent pregnancy among mothers who gave birth in the past 12 months at Honkolo Wabe District, Arsi Zone Ethiopia, 2023","authors":"Solomon Seyife Alemu MSc ,&nbsp;Getu Amsalu Erqu MSc ,&nbsp;Dereje Diriba Woyessa MSc ,&nbsp;Lema Fikadu Wedajo MSc","doi":"10.1016/j.xagr.2025.100520","DOIUrl":"10.1016/j.xagr.2025.100520","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>One of the issues that contribute to the increase in home births among mothers is the fear of giving birth in an institution. Although delivery services are free in Ethiopia, about half of women chose not to use them because they were afraid of giving birth in a hospital. Home deliveries are the leading cause of morbidity and mortality among mothers and newborns in Ethiopia. One of the major reasons why mothers choose not to give birth in medical facilities is due to fear of an institutional delivery. Nevertheless, no research has been conducted on Ethiopians’ fear of institutional delivery.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to assess the prevalence of fear of institutional delivery and associated factors among postnatal mothers.</div></div><div><h3>STUDY DESIGN</h3><div>Between May 1, 2023, and June 1, 2023, 423 postpartum mothers in Ethiopia’s Honkolo Wabe district participated in a cross-sectional survey. A straightforward random sampling procedure was used to choose study participants. Data were gathered using a standardized questionnaire that was pretested and given by an interviewer in person. To find factors linked to the fear of institutional delivery, bivariate and multivariate analyses were performed. A <em>P</em> value of &lt;.05 with a 95% confidence interval was designated as the level of statistical significance.</div></div><div><h3>RESULTS</h3><div>The overall prevalence of fear of institutional delivery was 43.9% (95% confidence interval, 39.9%–48.2%). Obstetrical violence (adjusted odds ratio, 2.42 [95% confidence interval, 1.20–4.19]), number of children (adjusted odds ratio, 0.39 [95% confidence interval, 0.19–0.82]), poor knowledge on the importance of intuitional delivery (adjusted odds ratio, 2.20 [95% confidence interval, 1.39–3.49]), and a negative attitude toward skilled healthcare services (adjusted odds ratio, 2.13 [95% confidence interval, 1.15–3.94]) were significantly associated factors for fear of childbirth at health facilities.</div></div><div><h3>CONCLUSION</h3><div>Our study found that the prevalence of fear of institutional delivery is high. Therefore, healthcare providers, health extension workers, and other concerned bodies should work on increasing mothers’ knowledge the importance of institutional delivery and their awareness of skilled birth. Similarly, respectful maternity care should be performed in accordance with attracting mothers to health institutions.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100520"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306493","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":"Performance of hysteroscopy in diagnosing chronic endometritis and the role of intra- and inter-observer variability: a prospective study of 70 cases","authors":"Ahmed Halouani MD ,&nbsp;Haithem Aloui MD ,&nbsp;Rim Hamdaoui MD ,&nbsp;Yassine Masmoudi MD ,&nbsp;Amel Triki MD ,&nbsp;Anissa Ben Amor MD ,&nbsp;Lazhar Halouani MD","doi":"10.1016/j.xagr.2025.100515","DOIUrl":"10.1016/j.xagr.2025.100515","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic endometritis (CE) is a persistent inflammation of the endometrium often implicated in female infertility. Histological examination with immunohistochemical (IHC) analysis of the plasma cell marker CD138 is the gold standard for diagnosing this condition.</div></div><div><h3>Methods</h3><div>This prospective, multicentered, observational study was conducted from June 6, 2021, to August 8, 2022. We evaluated the diagnostic sensitivity and specificity of hysteroscopy (HSC) using the standardized criteria of Cicinelli et al, which include micro polyps, focal hyperemia, diffuse hyperemia, stromal edema, strawberry aspect, and hemorrhagic spots. We also assessed intra- and inter-observer variability in the hysteroscopic diagnosis of CE.</div></div><div><h3>Results</h3><div>The prevalence of CE diagnosed by IHC analysis of CD138 expression was 42.9%. The performance of HSC in diagnosing CE was moderate, with a sensitivity of 47.5%, specificity of 64.38%, positive predictive value of 50%, and negative predictive value of 62.05%. The inter-observer agreement for hysteroscopic diagnosis of CE was strong (<em>κ</em>=0.62), while intra-observer agreement was moderate (<em>κ</em>=0.58).</div></div><div><h3>Conclusion</h3><div>HSC is not the examination of choice for diagnosing CE. An endometrial biopsy using the Novak curette with IHC analysis of CD138 expression is a more sensitive and less costly diagnostic method.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100515"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297831","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":"Prediction of preeclampsia before 11th week of gestation: a secondary analysis of the ASPIRIN trial","authors":"Gabriela Capdeville MD ,&nbsp;Andrea Godinez-Medina MD ,&nbsp;Diana Y. Copado-Mendoza MD ,&nbsp;Sandra Acevedo-Gallegos MD ,&nbsp;Mario R. Rodriguez-Bosch MD ,&nbsp;Yubia Amaya-Guel MD ,&nbsp;Maria J. Rodriguez-Sibaja MD ,&nbsp;Mario I. Lumbreras-Marquez MD, MMSc","doi":"10.1016/j.xagr.2025.100521","DOIUrl":"10.1016/j.xagr.2025.100521","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Early screening for preeclampsia is crucial for preventing adverse maternal and fetal events. Current first-trimester algorithms for predicting preeclampsia are designed to evaluate individual risk between 11.0 and 13.6 weeks of gestation based on various maternal characteristics while integrating biophysical and biochemical features. However, there is limited information regarding risk assessment during earlier stages of pregnancy (i.e., &lt;11.0 weeks gestation).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To develop a prediction model for preeclampsia/eclampsia before 11.0 weeks of gestation as a proof-of-concept in a secondary analysis of the ASPIRIN trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;This study is a secondary analysis of the ASPIRIN trial, a multinational, randomized, double-blind, placebo-controlled trial. The ASPIRIN trial database, obtained from NICHD DASH, included 11,976 nulliparous pregnant women aged 18–40 with gestational ages of 6.0–13.6 weeks at randomization. Participants were assigned to receive either aspirin (81 mg/day) or placebo until 36.0 weeks or delivery. This secondary analysis included pregnancies delivered at ≥20.0 weeks, excluding those in the aspirin group or with gestational ages ≥11.0 weeks at enrollment. The composite outcome was preeclampsia/eclampsia, as reported in the ASPIRIN trial. Predictor variables available in the dataset included maternal age, education (4 levels), body mass index (BMI kg/m&lt;sup&gt;2&lt;/sup&gt;), gravidity, baseline hemoglobin, baseline systolic blood pressure, and baseline diastolic blood pressure. Logistic regression, with logarithmic transformation for continuous variables, was used to develop the model. The area under the ROC curve with a 95% confidence interval (CI) estimated via bootstrap resampling (1,000 iterations) and the &lt;em&gt;P&lt;/em&gt;-value of the Hosmer-Lemeshow statistical test are reported as discrimination and calibration measures. This study used the entire available sample using a complete case approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 3421 participants met the inclusion criteria, with a cumulative incidence of preeclampsia/eclampsia of 2.9% (99/3,421). Maternal age (21.96 ± 4.13 vs 20.86 ± 3.21, &lt;em&gt;P&lt;.&lt;/em&gt;001) and BMI (22.49 ± 4.77 vs 20.79 ± 3.55, &lt;em&gt;P&lt;.&lt;/em&gt;001) were significantly higher in the preeclampsia/eclampsia group. Gravidity was lower (&lt;em&gt;P=.&lt;/em&gt;023), and hemoglobin levels were slightly elevated (11.88 ± 1.52 g/dL vs 11.50 ± 1.61 g/dL, &lt;em&gt;P=.&lt;/em&gt;019) in the preeclampsia/eclampsia group. Educational level (&lt;em&gt;P=.&lt;/em&gt;070), systolic blood pressure (&lt;em&gt;P=.&lt;/em&gt;720), and diastolic blood pressure (&lt;em&gt;P=.&lt;/em&gt;390) showed no significant differences between groups. The logistic regression model yielded an AUC of 0.69 (95% CI 0.63–0.74), and the Hosmer-Lemeshow test &lt;em&gt;P&lt;/em&gt;-value was 0.094, indicating acceptable discrimination and calibration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This proof-of-concept log","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100521"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281115","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":"Intra-abdominal hemorrhage following ultrasound-guided transvaginal oocyte retrieval: Retrospective analysis of 25 cases","authors":"Lin Chen MD ,&nbsp;Huanxiao Zhang MD ,&nbsp;Yanwen Xu MD ,&nbsp;Zengyan Wang MD","doi":"10.1016/j.xagr.2025.100508","DOIUrl":"10.1016/j.xagr.2025.100508","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal hemorrhage (IAH) is a rare but potentially life-threatening complication of ultrasound-guided transvanginal oocyte pick up (OPU). Despite the widespread use of OPU in assisted reproductive technology, minor hemorrhages may remain undetected without vigilant monitoring, potentially escalating to severe bleeding. This study aims to elucidate the clinical characteristics, risk factors, and management outcomes of IAH following OPU.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 25 hospitalized patients who developed IAH within 7 days post-OPU at a university-affiliated hospital between 2010 and 2021. Data on demographics, clinical presentations, laboratory findings, treatment modalities, and reproductive outcomes were systematically reviewed.</div></div><div><h3>Results</h3><div>The incidence of IAH was 0.05% (95% CI, 0.03%–0.07%). Symptoms typically manifested within 12 hours post-OPU, with abdominal pain and distension being most common. Hemoglobin (Hb) and hematocrit (Hct) reductions averaged 26.50±13.32 mg/dL and 7.70±3.66%, respectively. Seventeen patients were managed conservatively, while 8 required surgical intervention. Notably, 52% of patients achieved live births, with no adverse pregnancy outcomes linked to IAH.</div></div><div><h3>Conclusion</h3><div>IAH is a rare but life-threatening OPU complication. Extended postoperative monitoring is critical for early diagnosis, with conservative management as the first-line approach.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100508"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280485","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":"Obstetricians’ experiences with remote monitoring programs for hypertensive disorders","authors":"Kortney F. James PhD, RN ,&nbsp;Molly Waymouth MPH ,&nbsp;Gabriela Alvarado PhD ,&nbsp;Ateev Mehrotra MD ,&nbsp;Lori Uscher-Pines PhD","doi":"10.1016/j.xagr.2025.100513","DOIUrl":"10.1016/j.xagr.2025.100513","url":null,"abstract":"<div><h3>Background</h3><div>Despite widespread use in primary care, remote patient monitoring (RPM) in obstetrics for hypertensive disorders in pregnancy remain limited. Little is known about the specific modalities, perceived impact, and integration of RPM into standard practice in obstetrics.</div></div><div><h3>Objective</h3><div>To explore obstetricians’ experiences with RPM for hypertensive disorders in the perinatal period and barriers in implementation, and to identify promising practices to overcome these barriers.</div></div><div><h3>Study Design</h3><div>This qualitative study, conducted from September to October 2024, involved semi-structured interviews with 20 obstetricians across the United States, who represented different practice settings and RPM program models. We developed a qualitative codebook and conducted thematic analysis informed by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework.</div></div><div><h3>Results</h3><div>Five key themes emerged from interviews: (1) Barriers to Engagement; (2) Perceptions of Clinical Benefit; (3) Financial Hurdles in RPM Utilization; (4) Navigating Workflow and Data Challenges; and (5) Liability Concerns in RPM. RPM programs varied substantially in their eligibility criteria, timing within the perinatal period, data transfer methods, staffing models, and workflow. The major barriers included financial constraints (eg, insurance coverage and equipment costs), complex workflows, liability concerns related to 24/7 monitoring and response, and patient-level barriers (eg, technology literacy, language, and anxiety). Obstetricians used several strategies to overcome these challenges, including having patients bring their cuffs to the office to validate accuracy, assigning dedicated staff or partnering with a vendor to streamline workflows, coupling RPM with additional services like pregnancy education to improve adherence, and training staff so not all issues (eg, medication titration) require escalation to obstetricians. Despite the challenges, participants generally valued RPM and observed benefits in both clinical outcomes and patient engagement.</div></div><div><h3>Conclusion</h3><div>These findings highlight the need for context-specific approaches to enhance the accessibility and effectiveness of RPM for managing hypertensive disorders in the perinatal period.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100513"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255248","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":"Applying social vulnerability index to examine social disparities in patients undergoing hysterectomy","authors":"Andrew Tannous MD ,&nbsp;Jessica Floyd MD ,&nbsp;Jeanelle Sheeder PhD ,&nbsp;Saketh Guntupalli MD","doi":"10.1016/j.xagr.2025.100516","DOIUrl":"10.1016/j.xagr.2025.100516","url":null,"abstract":"<div><h3>Background</h3><div>The social vulnerability index (SVI) measures socioeconomic hardship, with high SVI indicating high susceptibility. We applied the SVI to characterize and compare patients who underwent abdominal versus minimally invasive hysterectomy.</div></div><div><h3>Objective</h3><div>To evaluate whether high social vulnerability, as measured by SVI, was associated with a lower likelihood of undergoing minimally invasive hysterectomy compared to abdominal hysterectomy.</div></div><div><h3>Study Design</h3><div>This was a retrospective cohort study conducted across 4 hospitals within a single health system in Colorado. The study included patients who underwent hysterectomy for any indication between 2013 and 2018. Patient addresses were geocoded to estimate overall SVI and its 4 sub-domains: Socioeconomic, Housing/Disability, Race/Minority, and Housing/Transportation. These data were analyzed to evaluate for an association between SVI and surgical approach to hysterectomy.</div></div><div><h3>Results</h3><div>Among 2,619 patients, 86% underwent MIH (87.3% non-Hispanic White [NHW]; 76.6% non-Hispanic Black [NHB]; 82.5% Hispanic). Patients undergoing MIH were more likely to be NHW, ASA class I or II, and less likely to have diabetes, hypertension, or receive care within a tertiary referral center (<em>P</em>&lt;.05). While MIH was not associated with high overall SVI (<em>P</em>=.07), patients undergoing abdominal hysterectomy were more likely to have high SVI in race/minority and housing/transportation sub-domains (<em>P</em>=.006 and <em>P</em>=.01, respectively). Significant differences in age, comorbidities, BMI class, hospital setting, route of hysterectomy were observed across all race/ethnic groups (<em>P</em>&lt;.001).</div><div>Multivariable logistic regression analysis showed that high overall SVI or high SVI in either race/minority or housing/transportation sub-domains was not significantly associated with MIH. However, age (aOR 0.97; [0.97−0.98]), NHW race/ethnicity (aOR 1.49; [1.14−1.94]), hospital setting within a tertiary referral center (aOR 0.29; [0.22−0.38]), and ASA class I (aOR 1.6; [1.05−2.46]) were independent predictors of MIH.</div></div><div><h3>Conclusion</h3><div>Age, race/ethnicity, hospital setting, and ASA class were found to be stronger independent predictors of MIH than SVI. Because race/ethnicity and hospital setting are independently associated with SVI based on prior study, we suspect that including these variables in the analysis weakened the observed independent association between SVI and route of hysterectomy. Further research is required to understand the underlying mechanisms driving surgical disparities, which may include systemic, institutional, or provider-level factors.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100516"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255250","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":"Racial, ethnic, and neighborhood disparities in diagnosis of perinatal psychiatric illness","authors":"Jessica C. Rohr PhD ,&nbsp;Pedro T. Ramirez MD ,&nbsp;Farhaan S. Vahidy PhD, MBBS, MPH, FAHA ,&nbsp;Alok Madan PhD, MPH","doi":"10.1016/j.xagr.2025.100511","DOIUrl":"10.1016/j.xagr.2025.100511","url":null,"abstract":"<div><h3>Background</h3><div>Rates of maternal morbidity and mortality are a global health crisis, and perinatal psychiatric illness is the most common morbidity in pregnancy. Racial, ethnic, and socioeconomic disparities in perinatal psychiatric illness contribute to disparities in maternal morbidity and mortality. There is limited data on diagnosis rates across race/ethnicity and neighborhood deprivation.</div></div><div><h3>Objective</h3><div>To identify prevalence of perinatal psychiatric illness diagnosis and determine differences based on race, ethnicity, and neighborhood deprivation.</div></div><div><h3>Study design</h3><div>This cross-sectional study included women who gave birth between 2020 and 2023 at a Houston Methodist hospital. Houston Methodist is a hospital system serving the greater Houston area. During the study period, 20 015 women received perinatal care from and delivered at a Houston Methodist system hospital. The first birth per individual was used for analyses. 2 women were removed due to missing data. A final 20 013 were eligible for inclusion. Variables of interest included neighborhood deprivation, defined as a score on the Area Deprivation Index, a validated socioeconomic measure, and self-reported race and ethnicity as reported in electronic health record. The main a priori outcome was any psychiatric illness diagnosed between estimated date of conception and 3 months postpartum.</div></div><div><h3>Results</h3><div>The sample was distributed across race and ethnicity, with 2 098 (10.5%) Asian, 2 893 (14.5%) Black, 5 208 (26.0%) Hispanic White, 8 218 (41.1%) non-Hispanic White, and 1596 (8.0%) other. Mean age of women included in our analyses was 30.50 years (SD= 5.33). Perinatal psychiatric illness was diagnosed in 19.1% of patients. Non-Hispanic White women were diagnosed at the highest rates (24.8%), while Asian women were diagnosed at the lowest rates (9.1%). Rates trended higher as area deprivation increases across the total sample. However, this trend only held for non-Hispanic White women, for whom higher deprivation has significantly higher prevalence rates than lower deprivation (30.6% vs 18.7%, <em>P</em>&lt;.001).</div></div><div><h3>Conclusions</h3><div>One in five women in our study was diagnosed with perinatal psychiatric illness. Our stratified findings were inconsistent with previous reports of higher symptom burden in women of color. Neighborhood deprivation has differential impact depending on race/ethnicity, highlighting the importance of accounting for sociocultural variables when analyzing prevalence.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100511"},"PeriodicalIF":0.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255249","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":"Obstetric violence informed by theories of intersectionality, oppression, and power dynamics—a Ghanaian’s perspectives","authors":"Ephraim Senkyire MSN ,&nbsp;Gloria Senkyire B-TECH ,&nbsp;Ernestina Asiedua PhD ,&nbsp;Victor Tawose-Adebayo MSC ,&nbsp;Magdalena Ohaja PhD","doi":"10.1016/j.xagr.2025.100505","DOIUrl":"10.1016/j.xagr.2025.100505","url":null,"abstract":"<div><div>This essay explores obstetric violence (OV) from a Ghanaian perspective, applying theories of intersectionality, oppression, and power dynamics to critically analyze its causes and manifestations. OV, defined as mistreatment during childbirth, includes acts of physical abuse, nonconsensual care, discrimination, and breaches of privacy. Despite efforts to reduce maternal mortality in Ghana, systemic challenges persist, contributing to a high prevalence of OV, particularly among vulnerable groups such as adolescents, the socioeconomically disadvantaged, and ethnic minorities. The essay highlights that midwives, while essential to maternal care, often operate within oppressive healthcare systems characterized by poor resourcing, rigid hierarchies, and systemic gender bias. Through the lens of intersectionality, the study reveals how overlapping social identities—such as age, ethnicity, and socioeconomic status—influence women’s vulnerability to mistreatment. Oppressed group theory explains how midwives, themselves marginalized within patriarchal and medically dominated structures, may internalize oppression and perpetuate violence toward patients. Foucault’s theory of power and knowledge is used to illustrate how institutional norms and knowledge hierarchies empower midwives to exercise control over birthing women, often compromising women’s autonomy and dignity. The essay further discusses how systemic issues, including underinvestment in healthcare infrastructure, inadequate training on respectful maternity care, and normalization of abusive practices, contribute to the persistence of OV. It calls for comprehensive reforms such as empowering midwives through education and leadership training, decentralizing healthcare authority, promoting respectful maternity care practices, and addressing systemic inequities. Raising awareness, fostering accountability, and embedding patient-centered care principles into healthcare institutions are critical steps toward eliminating OV. Ultimately, the essay argues that addressing OV in Ghana requires not only confronting individual behaviors but dismantling the deeper structural and institutional forces that sustain power imbalances and systemic oppression. Empowering both midwives and birthing women is essential for transforming maternity care and advancing equitable, respectful maternal health outcomes in Ghana.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263238","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":"The feasibility and surgical outcomes of robotic vaginal natural orifice transluminal endoscopic single port hysterectomy for benign gynecologic diseases: a systematic review and meta-analysis","authors":"Greg Marchand MD, FACS, FICS, FACOG ,&nbsp;Hollie Ulibarri BS ,&nbsp;Amanda Arroyo BS ,&nbsp;Daniela Gonzalez Herrera BS ,&nbsp;Brooke Hamilton BS ,&nbsp;Kate Ruffley BS ,&nbsp;Mckenna Robinson BS ,&nbsp;Ali Azadi MD, FACOG, FPMRS","doi":"10.1016/j.xagr.2025.100512","DOIUrl":"10.1016/j.xagr.2025.100512","url":null,"abstract":"<div><h3>Objective</h3><div>Vaginal natural orifice transluminal endoscopic surgery (vNOTES) combines vaginal surgery with single-port laparoscopy, providing a minimally invasive technique designed to overcome the challenges in traditional vaginal surgery. Several authors have now described techniques for performing these procedures with robotic assistance (R-vNOTES). We aim to evaluate the surgical outcomes and the safety of R-vNOTES hysterectomy in patients with benign diseases.</div></div><div><h3>Data Sources</h3><div>We searched six major databases from their inception through October 2024 for studies analyzing the surgical outcomes of hysterectomy by R-vNOTES in cases with benign gynecologic diseases.</div></div><div><h3>Study eligibility criteria</h3><div>We included all primary research studies that included at least one of our selected outcomes and did not include surgeries for malignant conditions.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Study quality was appraised using the National Heart, Lung, and Blood Institute quality assessment tools. Data synthesis was accomplished using OpenMetaAnalyst and RevMan software. Mean difference and 95% confidence intervals were used for continuous outcomes following inverse variance analyses. Dichotomous outcomes were analyzed using an odds ratio and 95% confidence intervals.</div></div><div><h3>Results</h3><div>Ultimately 10 eligible studies were included in our synthesis, including two studies that compared the R-vNOTES technique to robot-assisted laparoscopic hysterectomy (RALH) performed for the same indications. Our overall pooled analysis demonstrated that the operation time of R-vNOTES was 142 minutes, with an estimated blood loss of 67 mL. The overall length of hospital stay among the included studies was 2.04 days. We found an approximate decrease of 1.4 grams of hemoglobin after surgery. The incidence of conversion was 1.3%, and the complication rate was 13.3%. We found, R-vNOTES was to have a shorter operative time (<em>P</em>&lt;.001) and lower blood loss than RALH (<em>P</em>=.002), with no significant differences seen between the cohorts in total hospital stay (<em>P</em>=.29) or complication rates (<em>P</em>=.98).</div></div><div><h3>Conclusion</h3><div>Initial data shows that R-vNOTES seems to be a feasible minimally invasive technique with comparable outcomes and a favorable safety profile. Compared to RALH, R-vNOTES was associated with a shorter operation time and less blood loss.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100512"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255306","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}