American journal of obstetrics and gynecology最新文献

{"title":"Doxycycline versus levofloxacin combined with tinidazole for treating chronic endometritis: a randomized controlled trial.","authors":"Yue Liu,Zijun Zhao,Xiaorui Jiang,Xiao You,Dacheng Qu","doi":"10.1016/j.ajog.2025.07.045","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.045","url":null,"abstract":"BACKGROUNDThe spontaneous cure rate of chronic endometritis (CE) is very low, and doxycycline alone or a combination of levofloxacin and tinidazole are the two most widely used antibiotic regimens for treating CE. However, there is currently no consensus regarding the optimal antibiotic regimen.OBJECTIVEThis study aimed to assess the effectiveness and safety of doxycycline alone and levofloxacin combined with tinidazole as antibiotic therapies for CE.STUDY DESIGNIn this parallel randomized controlled trial (RCT) comparing two antibiotic therapies for CE, 172 patients with CE diagnosed using CD138 were randomly divided into treatment and control groups. Levofloxacin combined with tinidazole was administered to the treatment group, whereas doxycycline alone was administered to the control group. Repeated hysteroscopy and endometrial biopsies were performed during the first menstrual proliferative period after antibiotic therapy to evaluate the resolution of CE. The one-course cure rate for CE, based on the conversion of CD138 expression from positive to negative, and the incidence of adverse reactions were compared between the groups.RESULTSA total of 160 patients were enrolled, with 79 in the treatment group and 81 in the control group. After one course of antibiotic therapy, there was no difference in the CE cure rate between the groups (84.8% vs. 77.8%) (P = 0.255). In the subgroup analysis based on CE severity, there were no differences between the groups, regardless of whether CE was mild (88.9% vs. 83.7%) (P = 0.464) or severe (79.4% vs. 68.8%) (P = 0.322). In the intent-to-treat analysis (n=172), the cure rates were 77.9% (67/86) and 73.3% (63/86) in the treatment and control groups, respectively, showing no difference between the groups (P = 0.595). The incidence of adverse reactions was significantly higher in the treatment group (11.6% vs. 2.3%) (P < 0.05) in the safety analysis.CONCLUSIONThe two antibiotic therapy regimens were effective and safe for treating CE. The study did not find a statistically significant difference in cure rate between the two antibiotic therapy groups. Doxycycline alone is recommended as the first-line treatment because of the lower incidence of adverse reactions.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"11 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769703","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":"Towards the inclusion of transgender and non-binary residents among Obstetrics and Gynecology residency programs across the nation: a needs assessment.","authors":"L Streeter,E Barrera,M Adler,E Redwood,E R Boskey,N Pollock,J Abbott","doi":"10.1016/j.ajog.2025.07.041","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.041","url":null,"abstract":"OBJECTIVEGiven increasing numbers of matriculating transgender/non-binary (TGNB) medical students, this study aims to evaluate for current strengths and barriers towards inclusion of incoming TGNB trainees in obstetrics and gynecology (OB/GYN) residency programs and identify opportunities for improvement.STUDY DESIGNAn online survey was distributed from May to November 2023 to healthcare providers affiliated with accredited OB/GYN residency programs in the United States. The survey explored program demographics, interpersonal interactions, physical space, and provision of gender-affirming care. Descriptive statistics and a logistic regression of quantitative responses were analyzed. Thematic content analysis was used to examine open-ended responses.RESULTSAmong 294 OB/GYN programs accredited in 2023, 127 participated, representing all US regions. 69% of respondents identified as faculty or ancillary staff and 57% stated that they have been affiliated with their residency program for five or more years. 27 programs (21.3%) had a TGNB resident prior to and/or at the time of survey completion, of whom 7 programs (6%) identified having at least one TGNB individual who was a race other than White. 123 programs (97%) agreed that OB/GYN programs have a duty to provide an inclusive workplace environment for TGNB residents, and 73 programs (57.4%) felt prepared to support an incoming TGNB resident. Logistic regression found that having a TGNB resident at the residency, offering pronoun pins to healthcare providers, and providing easily accessible gender neutral bathrooms were associated with program readiness to support a TGNB resident. Qualitative analysis identified seven common themes exploring barriers and facilitators for providing an inclusive workplace environment for TGNB residents.CONCLUSIONAlthough nearly all providers acknowledged the importance of creating an inclusive environment for TGNB residents, close to half of participants felt their programs were unprepared to do so. This study identifies relevant and feasible opportunities for improved gender identity inclusivity within the workplace. Recommendations are summarized in a toolkit (Appendix B) for residency programs working to build a supportive work environment.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"26 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766018","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":"A Phase 3, multicenter, randomized, placebo-controlled trial of monthly oral ibrexafungerp to reduce the incidence of recurrent vulvovaginal candidiasis.","authors":"Oluwatosin Goje,Nkechi E Azie,David A Angulo,Ryan Sobel,Paul Nyirjesy,Jack D Sobel","doi":"10.1016/j.ajog.2025.07.040","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.040","url":null,"abstract":"BACKGROUNDRecurrent vulvovaginal candidiasis develops in 5-9% of people assigned female at birth and has a serious impact on quality of life. Oral ibrexafungerp is a first-in-class, non-azole, triterpenoid antifungal approved in the United States for the treatment of postmenarchal females with acute vulvovaginal candidiasis and for the reduction in the incidence of recurrent vulvovaginal candidiasis.OBJECTIVE(S): This Phase 3 study (CANDLE) describes the efficacy and safety of monthly oral ibrexafungerp vs placebo for reducing the incidence of recurrent vulvovaginal candidiasis.STUDY DESIGNParticipants with a history of recurrent vulvovaginal candidiasis experiencing an acute infection episode (confirmed by positive potassium hydroxide test) received 3 doses of oral fluconazole (150 mg once-daily every 3 days). Those who had a culture-confirmed vulvovaginal candidiasis from the screening sample, achieved significant resolution of signs and symptoms (composite Vulvovaginal Signs and Symptoms score ≤2) following fluconazole treatment, and continued to meet all study eligibility criteria entered a maintenance phase. In the maintenance phase, eligible participants were randomized (1:1) to oral ibrexafungerp (300 mg twice-daily for one day) or placebo, which was repeated once every 4 weeks for a total of 6 treatments (until Week 20). Efficacy was assessed by the percentage of participants with no mycologically-proven recurrence and the percentage of participants with clinical success (a participant with a Test-of-Cure [Week 24] evaluation and no recurrence; mycologically-proven, presumed, or suspected) by Test-of-Cure (4 weeks after last study drug dose). Safety and tolerability assessments included incidence of adverse events and treatment discontinuations. Participants were further assessed for recurrence during a 12-week follow-up phase.RESULTSIn the intent-to-treat population, 70.8% (n=92/130) of participants who received ibrexafungerp and 58.5% (n=76/130) who received placebo had no mycologically-proven recurrence by Test-of-Cure (relative risk: 1.22; 95% confidence interval: 1.032, 1.430; P=0.019). The proportion of participants who achieved clinical success by Test-of-Cure was 65.4% (n=85/130) with ibrexafungerp and 53.1% (n=69/130) with placebo (relative risk: 1.24; 95% confidence interval: 1.034, 1.486; P=0.020). The benefit of ibrexafungerp over placebo was sustained over the 4 months following last study drug dose for both the no mycologically-proven recurrence (65.4% [n=85/130] vs 53.8% [n=70/130]; relative risk: 1.22; 95% confidence interval: 1.021, 1.456; P=0.029) and clinical success (57.7% [n=75/130] vs 46.2% [n=60/130]; relative risk: 1.26; 95% confidence interval: 1.017, 1.555; P=0.034) endpoints. Overall, 64.6% (n=84/130) of participants who received ibrexafungerp and 58.5% (n=76/130) of participants who received placebo experienced ≥1 treatment-emergent adverse event. Treatment-related adverse events occurred in 14.6% (n=19/130) of","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766025","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":"Formation of the placental membranes and pathophysiological origin of associated Great Obstetrical Syndromes.","authors":"Graham J Burton,Eric Jauniaux,Ashley Moffett","doi":"10.1016/j.ajog.2025.07.039","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.039","url":null,"abstract":"Formation of the smooth membranes is an essential phase of human placentation to allow safe rupture of the chorionic sac and birth of the fetus without damaging the placenta. The membranes form through regression of two-thirds of the villi that cover the early gestational sac shortly after implantation. Regression is associated with locally high levels of oxidative stress secondary to partial onset of the maternal arterial circulation to the placenta. Onset starts preferentially in the peripheral zone from ∼6-8 weeks of gestation, reflecting the lesser extent of plugging of maternal spiral arteries by endovascular trophoblast in this region. Plugging is part of the arterial remodeling essential to control adequate and even perfusion of the placenta. As the chorionic sac expands extensive necrosis occurs in the overlying decidua capsularis, which consequently makes no contribution to the mature membranes. Once the sac fuses with the decidua parietalis lining the opposite wall of the uterus, at around 16 weeks of gestation, the cytotrophoblast cells of the chorionic epithelium proliferate and form a stratified epithelium with features reminiscent of the skin barrier. A sharp demarcation exists between this epithelium and the cells of the decidua parietalis in the mature membranes, with no evidence of trophoblast migration. Pre-term premature rupture of the membranes and pre-term labor are associated with deficient remodeling of the spiral arteries that is mediated by extravillous trophoblast derived from the cytotrophoblastic shell. The resultant placental malperfusion causes maternal and placental oxidative stress, as in the other Great Obstetrical Syndromes (GOS), causing release of pro-inflammatory cytokines and stimulating uterine contractility. Deficient remodeling is also likely a proxy marker for poor development of the cytotrophoblastic shell. The shell anchors the gestational sac at the maternal-placental interface post-implantation, and weakness of this interface predisposes to subchorionic hemorrhage. Hemorrhages that abut the membranes may induce local inflammation, senescence and weakening. Ensuring normal development of the cytotrophoblastic shell is therefore essential to prevent the GOS. At this stage of pregnancy, placental development is supported by histotrophic nutrition from the decidua. Hence, optimising endometrial function prior to conception should become a health-care priority.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"56 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756129","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":"Prenatal Diagnosis of Fetal Brain Asymmetry with Normal Amniotic Fluid Genetic Testing: A Somatic Variant in the Brain.","authors":"Ritsuko Kimata Pooh,Kyoko Itoh,Masayuki Endo,Hirotsugu Fukuda,Masayoshi Takeda,Osamu Shimokawa,Yoichi Matsubara","doi":"10.1016/j.ajog.2025.07.037","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.037","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"26 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720090","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":"AJOG MFM Table of Contents","authors":"","doi":"10.1016/S0002-9378(25)00435-1","DOIUrl":"10.1016/S0002-9378(25)00435-1","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 2","pages":"Page A9"},"PeriodicalIF":8.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703973","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":"Information for readers","authors":"","doi":"10.1016/S0002-9378(25)00434-X","DOIUrl":"10.1016/S0002-9378(25)00434-X","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 2","pages":"Page A7"},"PeriodicalIF":8.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703972","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":"AJOG GR Table of Contents","authors":"","doi":"10.1016/S0002-9378(25)00436-3","DOIUrl":"10.1016/S0002-9378(25)00436-3","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 2","pages":"Page A10"},"PeriodicalIF":8.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703974","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":"Birth Weight as a Proxy for the Emerging Correlation Between Postpartum Hemorrhage and Inflammation (Letter-to-the-Editor).","authors":"Michele Orsi,Ottavio Cassardo,Carlo Airola","doi":"10.1016/j.ajog.2025.07.031","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.031","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"127 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720338","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":"Primum non nocere: why to use ultrasound to predict when instrumental vaginal delivery is feasible (Reply to Letter-to-the-Editor).","authors":"Tullio Ghi,Veronica Falcone,Andrea Dall'Asta","doi":"10.1016/j.ajog.2025.07.034","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.034","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"38 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144720095","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}