American journal of obstetrics and gynecology最新文献

{"title":"Cerebral infarcts, edema, hypoperfusion and vasospasm in preeclampsia and eclampsia.","authors":"Lina Bergman, Daniel Hannsberger, Sonja Schell, Henrik Imberg, Eduard Langenegger, Ashley Moodley, Richard Pitcher, Stephanie Griffith-Richards, Owen Herrock, Roxanne Hastie, Susan P Walker, Stephen Tong, Johan Wikström, Catherine Cluver","doi":"10.1016/j.ajog.2024.10.034","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.034","url":null,"abstract":"<p><strong>Background: </strong>Eclampsia, a serious pregnancy complication, is associated with cerebral edema and infarctions but the underlying pathophysiology remains largely unexplored.</p><p><strong>Objectives: </strong>To assess the pathophysiology of eclampsia using specialized magnetic resonance imaging that measures diffusion, perfusion, and vasospasm.</p><p><strong>Study design: </strong>This was a cross-sectional study recruiting consecutive pregnant women between April 2018 to November 2021 at Tygerberg Hospital, Cape Town, South Africa. We recruited women with eclampsia, preeclampsia, and normotensive pregnancies who underwent magnetic resonance imaging after birth. Main outcome measures were cerebral infarcts, edema, and perfusion using intravoxel incoherent motion imaging and vasospasm using magnetic resonance imaging angiography. The imaging protocol was established before inclusion.</p><p><strong>Results: </strong>Forty-nine women with eclampsia, 20 with preeclampsia and 10 normotensive women were included. Cerebral infarcts were identified in 34% of eclamptic, 5% of preeclamptic (risk difference (RD) 0.29; 95% confidence interval (CI) 0.06 to 0.52, p=0.012) and in no normotensive controls. Eclamptic women were more likely to have vasogenic cerebral edema compared to preeclamptic (80% vs 20%, RD 0.60; CI 0.34 to 0.85, p<.001) and normotensive women (RD 0.80; CI 0.47 to 1.00, p<.001). Diffusion was increased in eclampsia in the parietooccipital white matter (mean difference (MD) 0.02 x10^-3 mm²/s, CI 0.00 to 0.05, p=0.045) and the caudate nucleus (MD 0.02 x10^-3 mm²/s, CI 0.00 to 0.04, p=0.033) when compared to preeclamptic women. Diffusion was also increased in eclamptic women in the frontal (MD 0.07 x10^-3 mm²/s, CI 0.02 to 0.12, p=0.012) and parietooccipital white matter (MD 0.05 x10^-3 mm²/s, CI 0.02 to 0.07, p=0.03) and the caudate nucleus (MD 0.04 x10^-3 mm²/s, CI 0.00 to 0.07, p=0.028) when compared to normotensive women. Perfusion was decreased in edematous regions. Hypoperfusion was present in the caudate nucleus in eclampsia (MD -0.17 x10^-3 mm²/s, CI -0.27 to -0.06, p=0.003) when compared to preeclampsia. There were no signs of hyperperfusion. Vasospasm was present in 18% of eclamptic, 6% of preeclamptic and none of the controls.</p><p><strong>Conclusions: </strong>Eclampsia is associated with cerebral infarcts, vasogenic cerebral edema, vasospasm and decreased perfusion, all not usually evident on standard clinical imaging. This may explain why some have cerebral symptoms and signs despite having normal conventional imaging.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of endometrial cancer-related bleeding in virtual visits.","authors":"Elizabeth J Suh-Burgmann, Holly Finertie, Nickolas Nguyen, Sarah Dolisca, Julie A Schmittdiel","doi":"10.1016/j.ajog.2024.10.032","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.032","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study.","authors":"Alizée Froeliger, Catherine Deneux-Tharaux, Lola Loussert, Hanane Bouchghoul, Anne Laure Sutter-Dallay, Hugo Madar, Loïc Sentilhes","doi":"10.1016/j.ajog.2024.10.031","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.031","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The prevalence and risk factors of postpartum depression after cesarean delivery remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an EPDS cutoff value of 11 or higher.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval (CI), 14.9-18.0%) with an EPDS score of 13 or higher and 23.1% (95%CI, 21.4-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were pre-pregnancy characteristics such as young age (aOR 0.83, 95%CI 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (aOR 2.58, 95%CI 1.85-3.59 for North Africa; aOR 1.57, 95%CI 1.09-2.26 for Sub-Saharan Africa and aOR 1.99, 95%CI 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (aOR 1.70, 95%CI 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (aOR 1.36, 95%CI 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (aOR 1.73, 95%CI 1.32-2.26) and bad memories of delivery on day 2 postpartum (aOR 1.67, 95%CI 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (aOR 0.73, 95%CI 0.53-0.97).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Around one woman in six had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situatio","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed cord clamping in preterm twin infants: a systematic review and meta-analysis.","authors":"Lily Chartrand, Keith J Barrington, Philippe Dodin, Andréanne Villeneuve","doi":"10.1016/j.ajog.2024.10.024","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.024","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effects of delayed cord clamping (DCC) versus early cord clamping (EDD) on all-cause in-hospital mortality and selected morbidities among preterm twin neonates.</p><p><strong>Data sources: </strong>A search of PubMed, Ovid Medline, Embase, Cochrane database, Web of Science and CINAHL was conducted in December 2023 for studies comparing DCC to ICC in preterm twin neonates.</p><p><strong>Study eligibility criteria: </strong>Studies were deemed eligible if they included preterm twin neonates (< 37 weeks of gestation), compared delayed (≥ 30 seconds) vs early (<30 seconds) umbilical cord clamping at delivery and described at least one outcome of interest. Outcomes of interest were mortality, maternal hemorrhage, transfusion, severe interventricular hemorrhage (grade III or IV), bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity (stage IV or receiving treatment) and length of hospital stay.</p><p><strong>Study appraisal and synthesis methods: </strong>Two reviewers independently selected the studies, assessed bias and extracted data. Risk ratio and mean difference with 95% confidence intervals were determined by fixed effects models, heterogeneity by I² statistics.</p><p><strong>Results: </strong>Five studies compared DCC vs ECC in 2075 infants. Meta-analysis showed a significant reduction in mortality [(RR) 0.70 (95% CI 0.53-0.93)], a significant decrease in the risk of red blood cell transfusion [(RR) 0.42 (95% CI 0.28 - 0.64)] as well as a lower risk of retinopathy of prematurity [(RR) 0.50 (95% CI 0.26-0.96)] with DCC in twin population. DCC had no impact on the incidence of intraventricular hemorrhage [(RR) 1.01 (95% CI 0.79, 1.28)], of bronchopulmonary dysplasia [(RR) 0.67 (95% CI 0.36, 1.24)], of necrotizing enterocolitis [(RR) 1.02 (95% CI 0.60, 1.73)]. There was no significant effect on length of hospital stay [-0.10 (-0.20, -0.00)]. None reported maternal hemorrhage.</p><p><strong>Conclusion: </strong>DCC may decrease mortality risk in preterm twin infants without affecting major neonatal morbidities. Further evidence is needed to support its safety in preterm twins.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-trimester uterine artery pulsatility index and preeclampsia risk pregnancies after artificial frozen embryo transfer: analysis of over 27,000 pregnancies.","authors":"Valeria Donno, Pilar Prats, Ignacio Rodriguez, Nikolaos P Polyzos","doi":"10.1016/j.ajog.2024.10.033","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.033","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accumulating evidence indicates that pregnancies after Artificial Cycle Frozen Embryo Transfer are associated with an increased risk of preeclampsia. Uterine Artery Doppler, along with maternal factors and serum biomarkers, is a crucial biomarker for first-trimester preeclampsia screening, aiding in identifying \"high-risk\" patients. Guidelines strongly recommend administering aspirin (150mg/day) in these women, owing to robust evidence demonstrating a 62% reduction in the incidence of preeclampsia. Although previous studies suggested lower Uterine Artery Pulsatility Index after Frozen Embryo Transfer, no previous studies explored the impact of the type of endometrial preparation in Uterine Artery Doppler or its influence on estimating 1&lt;sup&gt;st&lt;/sup&gt;-trimester preeclampsia risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The study aims to evaluate the possible impact of endometrial preparation for frozen embryo transfer on the Uterine Artery Pulsatility Index during the first-trimester preeclampsia screening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This is a retrospective single-center study including 27289 singleton pregnancies (naturally conceived or after assisted reproductive treatment) who underwent the 1&lt;sup&gt;st&lt;/sup&gt;-trimester ultrasound screening at our University Hospital between January 2010 and May 2023. Overall, 27289 pregnancies were included: 23410 naturally conceived and 3879 following assisted reproductive technologies including 391 after ovulation induction and intrauterine insemination, 888 in-vitro fertilization and fresh embryo transfer, and 2600 natural or artificial frozen embryo transfer cycles. An Analysis of covariance (ANCOVA) was conducted to assess if there is an association between the UtAPI value and the mood of conception, adjusting for confounding factors (age, weight, smoking, and oocyte donation).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, pregnancies after artificial frozen embryo transfer demonstrated significantly lower 1st-trimester Uterine Artery Pulsatility Index as compared with all other modes of conception in a multivariable regression analysis adjusted for age, weight, smoking, and oocyte donation. The percent difference was 22.6 [CI95%: 20,6; 24,5] compared to naturally conceived pregnancy, 24.5 [CI95%:20,7; 28,1] to Ovulation Induction or intrauterine insemination, 24.8 [CI95%: [22,9; 27,6] to fresh Embryo Transfer and 21.7 [CI95%: [17,6; 25,5] compared to Natural Cycle Frozen Embryo Transfer. When calculating the risk for initiating preventive aspirin administration, the number of patients with increased risk (&gt;1/100) who initiated prophylactic aspirin was significantly lower in the artificial cycle frozen embryo transfer group (7.8% vs 16.0% in natural cycle p&lt;0.001 vs. 11.0% in Fresh embryo transfer p=0.01 vs. 10.5% in ovulation induction or intrauterine insemination p=0.14 vs. 9,3% in naturally conceived pregnancy p=0.03). Surprisingly although significantly fewer patients were con","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum pharmacologic thromboprophylaxis needs more evidence.","authors":"Ann M Bruno, Torri D Metz","doi":"10.1016/j.ajog.2024.10.030","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.030","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between infertility and cervical insufficiency in nulliparous women- the contribution of fertility treatment.","authors":"Lili Meng, Sara Öberg, Anna Sandström, Marie Reilly","doi":"10.1016/j.ajog.2024.10.035","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.035","url":null,"abstract":"<p><strong>Background: </strong>Pregnancies conceived through assisted reproduction have been associated with increased risks of adverse pregnancy and delivery outcomes, including cervical insufficiency (CI). Despite CI being a significant cause of late miscarriage or preterm birth, there are minimal published data on the associations of infertility (with or without fertility treatment) with CI. This study uses Swedish national health registers to examine the associations between infertility, assisted reproduction and CI in nulliparous women.</p><p><strong>Methods: </strong>This population-based case-control study is based on data from Swedish national health registers. Using the information on parity and multiple gestation in the Medical Birth Register, singleton pregnancies of nulliparous women were extracted and linked to the National Patient Register and the National Quality Register for Assisted Reproduction. Using diagnostic codes for CI and procedural codes for cervical cerclage, a total of 2662 CI cases were identified for deliveries in the 21-year period, 1992-2012. A reference group of 26,620 controls were extracted from the population of non-cases using simple random sampling.. Infertility was classified using a woman's report of difficulty conceiving for at least one year. Fertility treatment was assessed through self-reported variables in the Medical Birth Register and fertility treatment registration in the National Quality Register for Assisted Reproduction.</p><p><strong>Results: </strong>On adjusting for maternal characteristics and medical history, infertility was associated with CI, overall (adjusted odds ratio (aOR) ) 1.91 (1.53, 2.39) and in the subgroup of non-users of fertility treatment (aOR) 1.60 (1.21, 2.12), compared to women without infertility. Among women with infertility, pregnancies conceived with the aid of fertility treatment had higher risk of CI than naturally-conceived pregnancies (aOR 1.49 (1.05, 2.10). In the subgroup of women with infertility and no history of miscarriage, the use of fertility treatment was associated with CI (aOR 3.48 (2.02. 5.98)). No association was found between fertility treatment and CI in the pregnancies of women with infertility and a history of miscarriage.</p><p><strong>Conclusions: </strong>From this study, we conclude that CI in nulliparous women is associated with both infertility and its treatment. For infertile women, the risk of CI following fertility treatment was seen only in those with no history of miscarriage, providing crucial information for improving risk assessment and management strategies for preterm birth prevention in populations availing of fertility treatment.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Clinical Management of Drug Allergies in Obstetrics and Gynecology: An Expert Review.","authors":"Martina S Burn, Jason Kwah, Moeun Son","doi":"10.1016/j.ajog.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.025","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Drug allergies, specifically antibiotic allergies, are frequently encountered in obstetrics and gynecology as10% of the United States population reports a penicillin allergy. This poses a particular challenge to the obstetrician-gynecologist as beta-lactam antibiotics are indicated as first-line therapy for the treatment and prevention of most specialty-specific infections. Alternative antibiotic use in the setting of a reported allergy, is not benign and has been associated with increased cesarean delivery, endometritis, wound complications, and increased lengths of hospital stay in pregnant patients, increased Group B Streptococcus sepsis, neonatal length of stay and neonatal lab draws in neonates born to allergic patients and increased surgical site infections in gynecologic patients. Furthermore, alternative antibiotic use leads to increased antibiotic resistance, toxicity and healthcare cost. . Administration of antibiotics in a patient with a history of a Type I immediate hypersensitivity reaction, however, poses the risk of anaphylaxis with repeat exposure. Fortunately, over 90% of patients who report a penicillin allergy are not truly allergic and would tolerate penicillins if administered. This can be due to either mislabeling of the index reaction as an allergy (when it was due to a drug intolerance or a viral exanthem) or due to waning Immunoglobulin E-mediated immunity over time. Given this, allergy evaluation is widely recommended, even in pregnancy. Allergy evaluation involves a detailed patient history and when appropriate allergy testing with skin testing and/or oral challenge. These tools when used appropriately have been found to be safe and effective in gravid as well as non-gravid individuals and result in increased use of first line antibiotics. Furthermore, even in the setting of a true penicillin allergy, cross-reactivity with cephalosporins is extremely low and estimated at 2-3% among patients with a verified penicillin allergy and significantly lower than this among patients with an unverified penicillin allergy. Guidelines support routine use of cephalosporins without testing or additional precautions in patients with an unverified nonanaphylactic penicillin allergy as well as routine use of structurally dissimilar cephalosporins (specifically ancef) even in patients with an anaphylactic penicillin allergy. In cases where there is no appropriate alternative antibiotic than to the one which the patient is allergic such as with syphilis in a penicillin allergic pregnant patient, desensitization can be performed. This process involves temporary induction of drug tolerance through exposure of small amounts of the allergen until a therapeutic dose is achieved and has been safely performed in pregnancy. Desensitization requires expert supervision and is most often performed in the intensive care setting with a multidisciplinary team. The other two most common antibiotic allergies encountered in obstetrics and gynecology ","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of BRCA1 Testing in Prenatal Screening: Broader Genetic Considerations Needed.","authors":"Bilan Li, Dan Shan","doi":"10.1016/j.ajog.2024.10.028","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.028","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of BRCA1 testing in prenatal screening: broader genetic considerations needed - a response.","authors":"Shayan M Dioun, Jason D Wright, Melissa K Frey","doi":"10.1016/j.ajog.2024.10.027","DOIUrl":"https://doi.org/10.1016/j.ajog.2024.10.027","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":null,"pages":null},"PeriodicalIF":8.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}