American journal of obstetrics and gynecology最新文献

{"title":"Evaluating the impact of the second-stage and pushing duration on maternal and neonatal outcomes: A systematic review and meta-analysis.","authors":"Diana Aboukhater,Misa Hayasaka,Natsume Furukawa,Sora Jones,Katherine L Grantz,Tetsuya Kawakita","doi":"10.1016/j.ajog.2025.07.014","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.014","url":null,"abstract":"OBJECTIVESThis systematic review and meta-analysis aimed to investigate the association between the duration of the second stage of labor-including both total duration and the active pushing-and adverse maternal and neonatal outcomes, stratified by parity.DATA SOURCESWe conducted a comprehensive literature search of MEDLINE, Embase, and Cochrane databases from inception through October 2024.STUDY ELIGIBILITY CRITERIAEligible studies reported maternal or neonatal outcomes related to second-stage duration or pushing duration, with data stratified by parity. Studies involving multiple gestations and those with prior cesarean deliveries were excluded.STUDY APPRAISAL AND SYNTHESIS METHODSTwo independent reviewers performed data extraction and quality assessments; disagreements were resolved by a third reviewer. Cesarean delivery was prespecified as the primary maternal outcome, while other maternal and neonatal outcomes were analyzed as secondary outcomes. To quantify the association between prolonged second-stage or pushing duration (≥60 min) and each outcome, we performed post-hoc random-effects meta-analyses (Mantel-Haenszel) restricted to outcomes for which ≥2 eligible studies used <60 min as the reference category. Thus, only those studies meeting this criterion were pooled.RESULTSIn total, 26 studies met the inclusion criteria: 18 retrospective cohort studies, 1 prospective cohort study, 6 secondary analyses of clinical trials, and 1 randomized controlled trial. Among nulliparous individuals, a second stage exceeding 1 hour was associated with increased risks of cesarean delivery, blood transfusion, perineal laceration, and chorioamnionitis; pushing beyond 1 hour was similarly associated with cesarean delivery and postpartum hemorrhage. Comparable trends were observed in multiparous individuals. Across both parity groups, neonatal intensive care unit (NICU) admission was more frequent when the second stage exceeded 1 hour. In nulliparous individuals, pushing beyond 60 minutes was significantly associated with a low 5-minute Apgar score and NICU admission. Only one study specifically evaluated pushing duration among multiparous individuals, finding no significant associations with neonatal morbidity.CONCLUSIONEvidence indicates maternal and neonatal morbidity begins to rise within the first hour of the second stage and climbs with further prolongation, though the exact tipping point varies. Active pushing ≥60 min was associated with an increased risk of maternal morbidity, while neonatal effects are less certain; in nulliparas, we found an increased neonatal morbidity with pushing ≥60 min. Because the pooled estimates rely on a small, clinically heterogeneous subset of studies, these findings should be viewed with caution. Future studies should examine the individualized approach to determine the optimal timing of intervention, stratified by parity and epidural status, to refine duration guidelines.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613086","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":"Once Gestational diabetes, always Gestational diabetes? Maternal and neonatal outcomes of pregnancies with gestational diabetes preceding non gestational diabetes pregnancy- A retrospective cohort study.","authors":"Yael Shalev-Rosenthal,Eran Hadar,Adam Rosenthal,Shai Ram,Hila Shalev-Ram,Shir Danieli-Gruber,Anat Pardo,Anat Shmueli","doi":"10.1016/j.ajog.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.010","url":null,"abstract":"BACKGROUNDThere is limited information about maternal and neonatal outcomes of pregnant individuals without gestational diabetes mellitus (GDM), who were diagnosed with GDM in the preceding pregnancy.OBJECTIVETo investigate whether individuals previously diagnosed with GDM but not in subsequent pregnancy present similar diabetes-related complications, despite the lack of diagnosis Study Design: A retrospective cohort design was employed, including individuals with at least two consecutive births at a tertiary Medical Center between July 2012 and December 2022. Participants were categorized into three groups: individuals with GDM in both pregnancies (group 1), GDM in the first pregnancy but not in the subsequent pregnancy (group 2), and no GDM in both pregnancies (group 3). Groups were compared for various diabetes-related complications.RESULTSThe study population comprised 19,703 individuals . Group 2 showed higher rates of macrosomia (OR 1.4, 95% CI 1.01-1.92, p=0.03) large-for-gestational-age (LGA) (OR 1.6, 95% CI 1.2-2.0, p<0.01) and preeclampsia (OR 2.35, 95% CI 1.32-4.15, p<0.01) when compared to group 3. Rates of LGA macrosomia and preeclampsia were similar between group 1 and 2. The composite maternal-neonatal adverse outcome was significantly elevated in groups 1 and 2 compared to group 3 (OR 1.48, 95% CI 1.23-1.77, p<0.01 and OR 1.91, 95% CI 1.58-2.3, p<0.01; respectively). In a multivariate regression, the adjusted OR (accounting for BMI before 2nd birth, age at 2nd birth and parity) for composite maternal-neonatal outcomes was 1.75 (95% CI 1.36-2.25, p<0.01) and 1.30 (95% CI 1.01-1.67, p=0.03) in groups 1 and 2 respectively, compared to group 3. Elective cesarean delivery rate was higher in groups 1 (22%) and 2 (13%) compared to group 3 (8.7%). However, the rate was also significantly higher in group 1 versus 2. Preterm birth rates were higher in group 1 (OR 1.7, 1.2-2.3, p<0.01) but not 2, when compared to group 3.CONCLUSIONSIndividuals with a history of GDM in a previous pregnancy but not in subsequent pregnancy are at increased risk of diabetes-related complications, including preeclampsia, macrosomia, and LGA. The findings suggest that these individuals may have underlying insulin resistance, as well as other, still occurring, risk factors and their absence of a GDM diagnosis does not eliminate the risk of adverse outcomes. .","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144613026","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":"Pregnancy outcomes following medical versus surgical treatment of tubal ectopic pregnancy: a population-based retrospective cohort study.","authors":"A Rosen,L Palma,M Ordon,N Melamed,R Saskin,A Page,A Murji,J Kroft","doi":"10.1016/j.ajog.2025.07.008","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.008","url":null,"abstract":"BACKGROUNDTubal ectopic pregnancy (TEP) is a common cause of maternal morbidity and mortality in the first trimester. Multiple effective treatment options are available for tubal ectopic, including medically with methotrexate, and surgically with salpingectomy or salpingotomy. In general, medical management is preferred because it is thought to be less invasive and less morbid, but long-term fertility and recurrence outcomes between the two management strategies are unclear and inconsistently reported in the literature.OBJECTIVEThe current study aims to determine future birth outcomes in patients being treated medically and surgically for tubal ectopic pregnancy. Maternal morbidity including recurrent tubal ectopic pregnancy and treatment complications were also compared. A sub-analysis was conducted between salpingectomy and salpingotomy for the patients treated surgically.STUDY DESIGNThis population-based retrospective cohort study used validated, large administrative datasets from Ontario, Canada, a single payer publicly funded healthcare system. Patients were included who were treated for ectopic pregnancy between January 1st 2008 and December 31st 2019 and compared based on type of treatment, medical versus surgical. Baseline characteristics were collected and compared using standardized differences. Multivariable logistic regression was used to determine if there was an association between treatment type and outcomes.RESULTS17, 090 cases of TEP were reported, 8 204 managed medically, 8 737 managed surgically and 149 receiving both treatments. Patients receiving medical management had a 51.6% future live birth rate, compared to 45.1% with surgical management and a recurrent TEP rate of 7.4% compared to 6.4% respectively. After controlling for baseline characteristics, future live birth rate was higher in the group treated with methotrexate compared to surgically (OR 1.3, CI1.22-1.38, p<0.001). The recurrence rate was also higher in the group treated with methotrexate compared to surgery (OR 1.17 CI 1.04-1.32, p<0.001). The incidence of tubal ectopic pregnancy in Ontario increased during the study period, and with time a larger proportion of patients were treated medically. The medical management failure rate was 15.3%. Overall, healthcare utilization was higher in the group treated with methotrexate.CONCLUSIONThe present study demonstrates that, for patients with tubal ectopic pregnancy, medical management with methotrexate has potential for increased live birth rate compared to treatment with surgery. This comes at the cost of increased risk of tubal ectopic recurrence, and increased healthcare utilization.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"23 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612820","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":"Corrigendum to \"Noninvasive prediction models of intra-amniotic infection in women with preterm labor\" published in the \"Am J Obstet Gynecol 2023 Jan;228(1):78.e1-78.e13.","authors":"Teresa Cobo,Xavier P Burgos-Artizzu,M Carmen Collado,Vicente Andreu-Fernández,Ana B Sanchez-Garcia,Xavier Filella,Silvia Marin,Marta Cascante,Jordi Bosch,Silvia Ferrero,David Boada,Clara Murillo,Claudia Rueda,Júlia Ponce,Montse Palacio,Eduard Gratacós","doi":"10.1016/j.ajog.2025.06.045","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.045","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"12 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604028","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":"Evaluation of a new prediction model for the estimation of risk of obstetric anal sphincter injuries.","authors":"Kristin André,Andrea Stuart,Karin Källén","doi":"10.1016/j.ajog.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.005","url":null,"abstract":"BACKGROUNDObstetric anal sphincter injuries are complications to vaginal birth with potential to cause substantial maternal morbidity. Prediction of these injuries might help to improve maternal care but also antenatal counselling and patient information. Previous attempts to create prediction models have in many cases involved variables only known post-partum which limit their use in an antenatal setting. Other models include parameters that are not applicable to a Northern European population.OBJECTIVETo develop and validate a clinically useful model for prediction of risk of obstetric anal sphincter injuries.STUDY DESIGNThe model was developed using a retrospective nationwide cohort from the Swedish Medical Birth Registry consisting of 1,209,421 deliveries between 2005-2016. After exclusion criteria (caesarean section, forceps delivery, missing data) were applied, the data set was randomly divided into a development data (n=422,011) set and a validation data set (n=422,010). Using the development data set all variables were assessed with univariable analysis with modified Poisson regression analysis. A prediction model was then built by multivariate analysis using modified Poisson regression where vaiables with p= <0.2 were included. Both forwards and backwards selection were used and variables with p= >0.05 were excluded. Validation was performed by evaluating the agreement of the predicted and true observed rate of obstetric anal sphincter injuries after the prediction model was applied to the validation data set.RESULTSPrimiparity, previous cesarean delivery, previous sphincter injury, increasing age, increasing birth weight and maternal origin from Sub Saharan Africa or South/ Southeast Asia were all antenatal variables associated with increased risk of obstetric anal sphincter injury. Smoking, increasing maternal height and BMI appeared to lower the risk. Vacuum extraction also increased the risk of sphincter injury. We developed one model including previously mentioned antenatal parametres and one also including vacuum extraction. The final prediction model including instrumental delivery can be used for predicting the risk of sphincter injury for delivery with or without vacuum extraction with higher accuracy. This model had good discrimination with AUC 0.79 (95% CI 0.78-0.79) and was able to predict risks up to 24% with good to moderate accuracy.CONCLUSIONUsing antenatally available data, obstetric anal sphincter injuries can be predicted with moderate certainty. This prediction model has been externally validated and can be used for individualised antenatal counselling as well as identifying persons at high risk where preventative strategies might improve outcomes. Further validation in other populations outside of Scandinavia is recommended before clinical implementation.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"107 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604030","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":"Clinical outcomes following implementation of an operative vaginal birth safety bundle: A prospective observational study and time-series analysis.","authors":"Sasha M Skinner,Peter Neil,Nadine Murray,John Regan,Arunaz Kumar,Ben W Mol,Ryan J Hodges,Daniel L Rolnik, ","doi":"10.1016/j.ajog.2025.07.013","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.013","url":null,"abstract":"BACKGROUNDPoor outcomes from operative vaginal birth are associated with failure to recognize malposition, lack of interdisciplinary communication and deviation from accepted guidelines. We implemented a safety bundle including routine intrapartum ultrasound, a structured time-out and procedural checklist, birth experience survey, and a postnatal debrief pathway.OBJECTIVESTo compare clinical outcomes from operative vaginal birth before and after the implementation of a safety bundle at Monash Health, Melbourne, Australia.STUDY DESIGNWe compared clinical outcomes pre- versus post-bundle implementation for all women having an operative vaginal birth or fully-dilated cesarean of a term singleton cephalic non-anomalous fetus at Monash Health. Data were prospectively collected following bundle implementation from August 2022 to August 2024 and compared to a historical control cohort from November 2019 to November 2021, before the initial pilot of the bundle. We performed an interrupted time-series analysis to assess change in outcome trends over time. The primary outcome was a composite of neonatal morbidity, including Apgar score &lt;7 at five minutes, cord lactate &gt;8mmol/L, significant birth trauma, intubation or cardiac compressions, therapeutic cooling, and neonatal intensive care unit admission.RESULTSWe included 2,427 and 2,914 births meeting the inclusion criteria in the post- and pre-bundle periods, respectively. Following bundle implementation, mothers were older (30.5 ± 4.8 vs. 30.1 ± 4.9, p=.006), at a slightly later gestational age (39.5 [38.7, 40.3] vs. 39.4 [38.5, 40.2], p=.003), it was more common for specialist obstetricians to attend the birth (56.1% vs. 47.7%, p&lt;.001), for ultrasound to be performed (55.8% vs. 5.0%, p&lt;.001) and for vaginal station to be low (54.1% vs. 49.4%, p=.001), whilst it was less common to have occiput anterior position (71.2% vs. 74.4%, p=.03) or missing documentation of clinical assessment (0.8% vs. 3.4%, p&lt;.001). There were no significant differences in rates of forceps, vacuum, or fully-dilated cesarean overall; however, following implementation there were more cesareans without attempted OVB (9.5% vs. 7.8%, p=.03), fewer births with ≥four tractions or ≥two cup detachments (5.8% vs. 8.5%, p&lt;.001) and less unsuccessful OVB (6.3% vs. 8.3%, p=.005). There were no significant differences in the pre-defined neonatal composite morbidity (14.2% vs. 13.9%, p=.80); however, there were significantly fewer neonates delivered in an unexpected position (0.7% vs. 2.8%, p&lt;.001), lower rates of severe neonatal birth trauma (1.3% vs. 2.5%, p&lt;.001) and lower rates of neonatal intensive care admissions (1.8% vs. 2.7%, p=.02). There were higher rates of postpartum hemorrhage &gt;1000 mL (17.6% vs. 15.2%, p=0.02), but no differences in blood transfusions (3.7% vs. 3.8%, p=0.96) or obstetrical anal sphincter injury (4.8% vs. 5.4%, p=0.38). Interrupted time-series analysis demonstrated significant step reductions in fully-dilated cesar","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"22 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604032","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":"The Impact of Parity on Uterine Rupture in Patients With and Without Prior Cesarean: A Retrospective Analysis of Risk Variation in Women with and Without Previous Cesarean.","authors":"Shanny Kolp Asis,Elad Miron,Oshrit Shtossel,Adi Ashkenazi Katz,Olena Minich,Limor Vaknin Geron,Oz Gavish","doi":"10.1016/j.ajog.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.004","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"92 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604024","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":"Reverse Løvset maneuver for shoulder dystocia.","authors":"Sindre Grindheim,Johanne Kolvik Iversen,Stig Hill,Ferenc Macsali,Elham Baghestan,Ragnhild Skagseth,Jörg Kessler","doi":"10.1016/j.ajog.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.012","url":null,"abstract":"Shoulder dystocia is an obstetric emergency associated with fetal morbidity and mortality. Mechanical obstruction and failure of the rotation of the fetal shoulders prevents their descent into the pelvis. Current management strategies work by increasing the relative pelvic diameters, rotating the fetal shoulders into a more favorable pelvic diameter, or by reducing the fetal biacromial diameter. We present the Reverse Løvset maneuver that was initially described in 1948, by the Norwegian obstetrician Jørgen Løvset. It is a powerful internal rotational maneuver that differs from the more widely known maneuvers. It allows for a higher rotational force onto the fetus without increasing the strain on the brachial plexus, fetal long bones or the perineum. The clinician needs to use the hand of which the palm faces the fetal back. The whole hand is inserted into the vagina at the 6 o'clock position and continues along the fetal back until it reaches the posterior axilla. The index and middle fingers then grip the posterior axillary fold in a hook-like grip, avoiding the axillary fossa. The other hand fixates the wrist of the operating hand. As the clinician rotates their upper body away from the arm holding the fetal torso, while holding the operating wrist, elbow and shoulder stable, a rotational force is transferred to the fetal body. The posterior shoulder is rotated so that the fetus moves towards a \"belly down\" position, simultaneously dislodging the anterior shoulder from behind the maternal symphysis. This \"cork screw\" like rotation is continued up to 180 degrees until descent of the fetal body is felt. An effective transmission of the rotational force is achieved by the correct grip on the muscularly prominent posterior axillary fold adjacent to the strong and relatively stiff posterior thorax of the fetus.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"34 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604033","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":"Impact of Social Determinants of Health on Fecal Incontinence Treatment In Older Women.","authors":"Priyanka Kadam Halani,Lauren Wilson,Lauren A Cadish,Jonathan C Routh,Jennifer Anger","doi":"10.1016/j.ajog.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.006","url":null,"abstract":"OBJECTIVEMany women with fecal incontinence (FI) do not seek care despite the availability of effective treatments. Factors influencing care-seeking for FI are not well elucidated, and the role of social determinants of health (SDOHs) in FI treatment utilization is unknown. Our primary aim was to determine the association between SDOHs and treatment utilization among Medicare beneficiaries with FI. We secondarily aimed to determine the baseline treatment utilization rate and to determine factors associated with FI treatment utilization.STUDY DESIGNWe conducted a retrospective cohort study of Medicare beneficiaries with FI based on 2010-2018 claims data from a 5% national sample. Women with FI were identified by diagnosis codes, and those receiving treatment were identified by Current Procedural Terminology codes for pelvic floor physical therapy with biofeedback, sacral neuromodulation, anal sphincteroplasty, percutaneous tibial nerve stimulation, and anal procedures. Comorbidity was assessed via the Charlson comorbidity index. SDOHs were defined by the Social Vulnerability Index (SVI), a census-based score accounting for factors such as socioeconomic status, disability, ethnicity, language, housing type, and transportation by county. SVI is reported as a percentile rank, with higher percentiles reflecting greater vulnerability. Additional SDOH variables analyzed included Medicaid dual eligibility status, per capita income, and proportion of the population below poverty level. The association between SDOHs and treatment for FI was evaluated using Cox proportional hazards models.RESULTSWe identified 33,010 women with a diagnosis of FI, of whom 3,160 (9.6%) underwent treatment. Treatment modalities included anal procedures (6.5%), sacral neuromodulation (2.4%), percutaneous tibial nerve stimulation (0.9%), anal sphincteroplasty (0.4%), and pelvic floor physical therapy with biofeedback (0.1%). Those who did not undergo treatment were older, more commonly Medicaid dual eligible, had lower per capita incomes, higher poverty rates, and higher Charlson comorbidity index scores (all p&lt;0.01, Table 1). Higher SVI scores (HR 0.88, 95% CI 0.79-0.97), Medicaid dual eligibility (HR 0.45, 95% CI 0.39-0.52), and residence in high poverty counties (HR 0.82, 95% CI 0.74-0.9) were associated with lower likelihood of treatment, whereas higher income was associated with greater likelihood of treatment (HR 1.44, 95% CI 1.3-1.59). The association between treatment and Medicaid dual eligibility (HR 0.91, 95% CI 0.82-1.01), income (HR 1.41, 95% CI 1.27-1.56), and poverty rate (HR 0.86, 95% CI 0.78-0.95) persisted after accounting for patient characteristics; the association between SVI and treatment did not. Increasing age (HR 0.96, 95% CI 0.96-0.97), Black race (HR 0.82, 95% CI 0.7-0.97), higher Charlson comorbidity index (HR 0.65, 95% CI 0.06-0.70), depression (HR 0.66, 95% CI 0.53-0.81), immobility (HR 0.36, 95% CI 0.22-0.61), and loose stools (HR 0.87, 95% CI 0.79-0","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"44 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144593883","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":"Vaginal progesterone decreases the risk of preterm birth and adverse perinatal outcomes in singleton gestations with a midtrimester sonographic short cervix (≤25 mm) and without a history of spontaneous preterm birth.","authors":"Agustin Conde-Agudelo,Roberto Romero,Eduardo DA Fonseca,Sonia S Hassan,Kypros H Nicolaides","doi":"10.1016/j.ajog.2025.07.003","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.003","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"697 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578589","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}