American journal of obstetrics and gynecology最新文献

{"title":"Can treatment-modified outcomes establish the net benefit of risk-guided aspirin prophylaxis (Letter-to-the-Editor)?","authors":"Jiali Xu, Wangfang Yu","doi":"10.1016/j.ajog.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.001","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890467","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":"Cross-border reproductive care and limitations in third-party reproduction surveillance (Letter-to-the-Editor).","authors":"Sarah Milbrandt","doi":"10.1016/j.ajog.2026.08.046","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.046","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890441","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":"Treatment-modified outcomes and the net benefit of risk-guided aspirin prophylaxis (Reply to Letter-to-the-Editor).","authors":"Daniel L Rolnik, David Wright, Kypros H Nicolaides","doi":"10.1016/j.ajog.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.002","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890577","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 Trajectories and MRI-Based Triage of Uterine Leiomyoma Molecular Subtypes: A Large-Scale Retrospective Analysis of 720 Genotyped Tumors.","authors":"Xueyan Liu, Fei Ya, Mengling Zhao, Yong Zhang, Shuping Yan, Bijun Li, Lulu Si, Hanlin Fu, Yana Liu, Ruixia Guo","doi":"10.1016/j.ajog.2026.08.045","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.045","url":null,"abstract":"<p><strong>Background: </strong>Uterine leiomyomas are genetically heterogeneous, yet the clinical and prognostic implications of their primary molecular drivers remain poorly integrated into surgical practice.</p><p><strong>Objective: </strong>This study aims to characterize the clinical phenotypes and pharmacogenomic responses of major molecular subtypes and evaluate the predictive value of T2-weighted magnetic resonance imaging (T2WI) for surgical prognosis.</p><p><strong>Study design: </strong>We enrolled premenopausal women who underwent myomectomy or hysterectomy at the Department of Gynaecology, the First Affiliated Hospital of Zhengzhou University from January 2019 to June 2025. All leiomyomas were molecularly genotyped as MED12-mutant, HMGA2-overexpressing, FH-deficient, or triple-negative (3X, not belonging to the MED12-mutant, HMGA2-overexpressing, or FH-deficient genotypes). First, clinical and morphological characteristics were compared across the full cohort (n = 720). Second, a pharmacogenomic subset of patients receiving pre-operative gonadotropin-releasing hormone agonist (GnRHa) (n = 84) was analyzed for genotype-specific volume reduction. Third, a subset of 502 patients receiving myomectomy and completing a follow-up of more than 12 months was analyzed for genotype-specific re-intervention risk. Finally, an imaging \"gold standard\" consisting of 461 patients with pre-operative magnetic resonance imaging (MRI) and long-term follow-up post-myomectomy was used to assess surgical re-intervention rates via Kaplan-Meier estimators.</p><p><strong>Results: </strong>HMGA2 tumors were most likely to be solitary and submucosal (FIGO type 0-2), while FH-deficient cases showed the highest rates of multiple tumors (≥5). MED12-mutant tumors demonstrated significantly lower GnRHa-induced volume reduction compared to 3X variants (P = 0.009). The FH group exhibited the highest surgical re-intervention rate, a trend that was even more pronounced after excluding patients receiving post-operative GnRHa. MRI analyses revealed that low T2WI signal intensity was highly specific for MED12 mutations, whereas a \"mixed high\" signal was prognostically indicative for FH deficiency and correlated with a higher surgical re-intervention rate.</p><p><strong>Conclusions: </strong>Molecular subtypes of uterine leiomyomas dictate distinct clinical behaviors. MED12 mutations predict hormonal therapy resistance, while FH deficiency signals aggressive recurrence. A T2-weighted MRI-based classification system showed some phenotype-genotype relationships, although these findings require validation in independent cohorts.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886255","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":"Neonatal outcomes in gestational diabetes trials: What clinicians should consider when interpreting treatment effects.","authors":"Christian Göbl, Tina Linder, Latife Bozkurt, Silke Wegener, Iris Dressler-Steinbach, Martina Mittlböck, Johan Jendle, Tanja Groten, Andrea Tura","doi":"10.1016/j.ajog.2026.08.044","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.044","url":null,"abstract":"<p><p>Determining whether treatment of gestational diabetes mellitus benefits the newborn is central to clinical guidelines and patient counseling. However, the conclusions drawn from major trials may depend not only on the biological effect of treatment, but also on the neonatal outcomes and fetal growth standards selected. Composite endpoints can obscure or exaggerate treatment effects when they combine events that differ in clinical importance, frequency, or responsiveness to treatment. Similarly, different definitions of fetal overgrowth can substantially alter the reported prevalence of large- and small-for-gestational-age infants and therefore the apparent balance between treatment benefit and possible overtreatment. This review examines landmark and illustrative studies, including ACHOIS, MFMU, HAPO, TOBOGM, DipGluMo, Big Baby, and GRACE, together with methodological literature on composite outcomes and birth weight classification. Across these studies, treatment effects were sometimes driven by a single frequent component, masked by biochemical or rare outcomes, or altered by the growth chart applied. Absolute birth weight thresholds are transparent but do not account for gestational age or infant sex, whereas percentile-based definitions provide adjustment but yield different results across GROW, INTERGROWTH-21st, WHO, and other standards. Clinicians and investigators should therefore assess neonatal benefit using clinically coherent outcomes reported individually, together with prespecified measures of fetal growth and potential treatment-related harm. Absolute birth weight thresholds and percentile-based measures, including both large- and small-for-gestational-age outcomes, should be reported together, with explicit specification of the growth chart and sensitivity analyses using alternative standards.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872658","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":"Intra-amniotic Categories of Preterm Prelabor Rupture of Membranes: Gestational Age-Specific Distribution, Amniotic fluid Microbial Profiles, and Neonatal Outcomes.","authors":"Marian Kacerovsky, Ctirad Andrys, Radka Bolehovska, Rudolf Kukla, Jan Maly, Helena Hornychova, Bo Jacobsson, Ivana Musilova","doi":"10.1016/j.ajog.2026.08.038","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.038","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preterm prelabor rupture of membranes (PROM) comprises four intra-amniotic categories defined by the presence or absence of intra-amniotic inflammation and microbial invasion of the amniotic cavity. Their gestational age distribution, amniotic fluid microbial profiles, and associated perinatal and neonatal outcomes have not been comprehensively characterized.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The primary aim was to determine the gestational age-dependent prevalence, amniotic fluid microbial profiles, and short-term perinatal and neonatal outcomes of the intra-amniotic categories. The secondary aim was to evaluate the feasibility of identifying these categories in pregnancies complicated by preterm PROM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This single-institution cohort study included women with singleton pregnancies complicated by preterm PROM between 23&lt;sup&gt;0/7&lt;/sup&gt; and 36&lt;sup&gt;6/7&lt;/sup&gt; weeks of gestation who underwent transabdominal amniocentesis at admission. Intra-amniotic inflammation was assessed by measuring amniotic fluid interleukin-6 concentrations using a point-of-care test or an automated electrochemiluminescence immunoassay and was defined as an elevated interleukin-6 concentration at or above the platform-specific threshold. Microbial invasion of the amniotic cavity was assessed by microbiologic analysis of amniotic fluid using culture and molecular methods and was defined as the detection of microorganisms and/or their nucleic acids in amniotic fluid. Based on the presence or absence of these conditions, women were classified into four intra-amniotic categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 961 pregnancies, 158 (17%) had intra-amniotic infection, 70 (7%) had sterile intra-amniotic inflammation, 106 (11%) had microbial invasion of the amniotic cavity without inflammation, and 627 (65%) had amniotic fluid negative for inflammation and microorganisms; their distribution varied with gestational age. Overall, 64 microbial species were identified in amniotic fluid, with Ureaplasma spp. accounting for nearly two-thirds of all microbial detections. The unadjusted frequencies of early-onset neonatal sepsis were 12% (19/154), 4% (3/68), 5% (5/106), and 2% (14/624) in the intra-amniotic infection, sterile intra-amniotic inflammation, microbial invasion without inflammation, and negative amniotic fluid for inflammation and microorganisms categories, respectively (P &lt; 0.0001). In a focused analysis comparing intra-amniotic infection with the remaining three categories combined, intra-amniotic infection was associated, after adjustment, with higher odds of early-onset neonatal sepsis (adjusted odds ratio, 3.4; 95% confidence interval, 1.7-7.0; P &lt; 0.001) and serious composite adverse perinatal outcome (adjusted odds ratio, 2.0; 95% confidence interval, 1.1-3.4; P = 0.02). Among pregnancies with microbial invasion of the amniotic cavity, bacteria other than Ureaplasma spp. in amniotic fluid were associat","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863144","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":"Chorioamnionitis, acidemia and encephalopathy: what the design permits, and what remains actionable in labour (Letter-to-the-Editor).","authors":"Boujenah Jeremy, Bruno Carbonne","doi":"10.1016/j.ajog.2026.08.039","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.039","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863058","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":"Fetal inflammation and hypoxia: two hits, one vulnerable brain (Reply to Letter-to-the-Editor).","authors":"Mikko Tarvonen, Austin Ugwumadu, Sture Andersson","doi":"10.1016/j.ajog.2026.08.040","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.040","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863050","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":"Suprapubic descent angle: taking the parameter forward (Letter-to-the-Editor).","authors":"Ilenia Mappa, Giuseppe Rizzo","doi":"10.1016/j.ajog.2026.08.041","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.041","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863163","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 context and future evaluation of the suprapubic descent angle (Reply to Letter-to-the-Editor).","authors":"Shin Hashiramoto, Ryu Matsuoka, Akihiko Sekizawa","doi":"10.1016/j.ajog.2026.08.042","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.042","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856811","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}