American journal of obstetrics and gynecology最新文献

{"title":"Statistical and procedural interpretation of randomized emergency cervical cerclage strategies (Reply to Letter-to-the-Editor)","authors":"Katarzyna Kosińska-Kaczyńska, Robert Brawura-Biskupski-Samaha","doi":"10.1016/j.ajog.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.014","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"16 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148755117","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":"Statistical and procedural interpretation of randomized emergency cervical cerclage strategies (Reply to Letter-to-the-Editor).","authors":"Katarzyna Kosińska-Kaczyńska, Robert Brawura-Biskupski-Samaha","doi":"10.1016/j.ajog.2026.08.014","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.014","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757610","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":"Feasibility of fetoscopic spina bifida repair using a human umbilical cord meningeal patch: a nonrandomized clinical trial.","authors":"Ramesha Papanna, Stephen A Fletcher, Lovepreet K Mann, Eric P Bergh, Mary T Austin, Sen Zhu, Neha Agarwal, Ashley Salazar, Dejian Lai, Jonathan S Feinberg, Elisa Garcia, Sami Backley, Jimmy Espinoza, Jerrie S Refuerzo, Anthony Johnson, KuoJen Tsao","doi":"10.1016/j.ajog.2026.08.011","DOIUrl":"10.1016/j.ajog.2026.08.011","url":null,"abstract":"<p><strong>Background: </strong>Open in-utero spina bifida repair surgery yields suboptimal long-term motor outcomes in affected children and high maternal risks due to hysterotomy. Minimally invasive fetoscopic repair could reduce maternal risks associated with hysterotomy. Using a cryopreserved human umbilical cord graft as a meningeal patch for neurosurgical closure of the neural tube defect could improve motor function by reducing spinal cord tethering after surgery.</p><p><strong>Objective: </strong>This study assesses the surgical feasibility of fetoscopic spina bifida repair using human umbilical cord as a meningeal patch and reports perinatal and 12-month outcomes. Long-term motor outcomes are being evaluated in an ongoing efficacy trial.</p><p><strong>Study design: </strong>The Fetoscopic NEOX Cord 1K Spina Bifida Repair nonrandomized clinical trial (NCT04243889) evaluated the feasibility of fetoscopic spina bifida repair using NEOX Cord 1K human umbilical cord graft as a meningeal patch under a Food and Drug Administration (FDA) Investigational Device Exemption at a quaternary center between September 2020 and May 2023. Pregnant patients with spina bifida in the fetus who were eligible for open in-utero spina bifida repair were offered participation. Fetoscopic spina bifida repair surgery was performed using a minimally invasive approach via laparotomy and three-port uterine entry. During fetoscopic repair, the human umbilical cord patch was sutured circumferentially over the neural placode, followed by primary skin closure or closure with a human umbilical cord patch. The primary outcome was successful surgical closure, as determined by 3 independent pediatric neurosurgeons who reviewed intraoperative images. Perinatal and 12-month outcomes are reported, including gestational age at delivery, preterm premature rupture of membranes, mode of delivery, and cerebrospinal fluid diversion at birth and by 12 months. These outcomes are compared with a historical cohort who underwent open repair at the same center from 2011 to 2020.</p><p><strong>Results: </strong>Of 53 eligible patients, 50 consented, and 49 underwent fetoscopic repair. The historical open-repair cohort consisted of 110 cases. Surgical closure was successful in all 49 fetoscopic cases. Vaginal delivery rates were higher in the fetoscopic repair than in the open repair group (53% vs 1%, P<0.001). There were no fetal or neonatal deaths after fetoscopic repair but 3 (2.7%) neonatal deaths after open repair. Gestational age at delivery, rates of preterm premature rupture of membranes and cerebrospinal fluid diversion, and other perinatal and 12-month outcomes were comparable between groups.</p><p><strong>Conclusion: </strong>Fetoscopic spina bifida repair using human umbilical cord as a meningeal patch is feasible and, by avoiding hysterotomy, may permit vaginal delivery and reduce maternal morbidity. Perinatal and 12-month outcomes were comparable to a historical open-repair coho","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757551","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":"Intrapartum sonography for difficult labor.","authors":"Ilenia Mappa, Giuseppe Rizzo","doi":"10.1016/j.ajog.2026.08.012","DOIUrl":"10.1016/j.ajog.2026.08.012","url":null,"abstract":"<p><p>Difficult labor-protracted or arrested dilatation in the first stage, arrest of descent in the second stage, and the decision whether to attempt an assisted vaginal delivery-accounts for a large proportion of intrapartum cesarean deliveries and for most of the maternal and neonatal morbidity attributable to instrumental delivery. The decisions made in these situations rest almost entirely on 3 pieces of information obtained by digital vaginal examination: the position of the fetal occiput, the attitude of the fetal head, and the station of the leading bony point. Digital examination is uncomfortable, must be repeated, and is least reliable when the clinical stakes are highest. Caput succedaneum, molding, deflection of the head, and a high presenting part obscure the sutures and fontanelles on which the examination depends, and the ischial spines are palpated rather than visualized. Studies comparing digital examination with sonography before assisted vaginal delivery have reported discordant assessments of occiput position in approximately one-fifth to one-third of examinations, and digital estimation of station is similarly imprecise, particularly in the presence of substantial caput. Sonography in labor is performed with the curvilinear transducer, which is already available on most labor wards, requires a small number of images, and is better tolerated by women than repeated digital examinations. This article is written for general obstetricians, laborists, and residents who manage labor but who do not routinely scan during labor, rather than for clinicians who are already practicing intrapartum sonography. It is organized around 3 clinical situations in which a scan may change management-an uncertain fetal head position, slow or arrested labor, and the period immediately before an assisted vaginal delivery-and around 5 clinical questions that arise within them. The 5 questions, and the sonographic answer to each, are: what is the position of the fetal head, answered by transabdominal identification of the midline cerebral echo, orbits, cerebellum, and cervical spine; if the occiput is posterior, is spontaneous rotation likely, as suggested by the orientation of the fetal spine; is the head well flexed and is it asynclitic, quantified by the occiput-spine angle in occiput-anterior and occiput-transverse positions and by the chin-to-chest angle in occiput-posterior positions; how low is the head and has it engaged, quantified transperineally by the angle of progression and the head-perineum distance; and is the head descending during pushing, assessed by serial measurements and by the direction of the fetal head. The evidence supporting these measurements is uneven and should be described accurately. Sonographic determination of occiput position is more accurate than digital examination. Of note, 2 randomized trials show that adding a scan improves the accuracy with which the position is known, and 1 randomized trial reported more accurat","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762780","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":"Intrapartum Sonography for Difficult Labor","authors":"Ilenia Mappa, Giuseppe Rizzo","doi":"10.1016/j.ajog.2026.08.012","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.012","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"278 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148755118","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":"Feasibility of Fetoscopic Spina Bifida Repair Using a Human Umbilical Cord Meningeal Patch: A Nonrandomized Clinical Trial","authors":"Ramesha Papanna, Stephen A. Fletcher, Lovepreet K. Mann, Eric P. Bergh, Mary T. Austin, Sen Zhu, Neha Agarwal, Ashley Salazar, Dejian Lai, Jonathan S. Feinberg, Elisa Garcia, Sami Backley, Jimmy Espinoza, Jerrie S. Refuerzo, Anthony Johnson, KuoJen Tsao","doi":"10.1016/j.ajog.2026.08.011","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.011","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"41 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148755119","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 and histological chorioamnionitis, particularly when associated with funisitis, attenuate intrapartum fetal heart rate responses and increase vulnerability to hypoxic-ischemic brain injury at milder degrees of acidemia","authors":"Mikko TARVONEN, Antoniya GEORGIEVA, Christopher LEAR, Austin UGWUMADU, Vedran STEFANOVIC, Riina JERNMAN, Leena HAATAJA, Alistair GUNN, Sture ANDERSSON","doi":"10.1016/j.ajog.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.009","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"31 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715542","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":"Development and clinical validation of an objective assessment tool for robotic-assisted and laparoscopic hysterectomy","authors":"Freweini Martha Tesfai, Valentina Iacobelli, Dhivya Chandrasekaran, Anne Lanceley, Maria Acien Isabel, Jessica Preshaw, Dan Bala, Matteo Pavone, Nicolò Bizzarri, Andrea Rosati, Pietro Mascagni, Nicolas Padoy, Lorenzo Arboit, Hersha Patel, Renato Seracchioli, Ertan Saridogan, Mohamed Mabrouk, Denis Querleu, Violante Di Donato, Lise Lecointre, Jeffrey Ahmed, Arvind Vashisht, Diego Raimondo, Ilaria Capasso, Virginia Vargiu, Joao Casanova, Francesco Taliente, Danail Stoyanov, Anna Fagotti, Nader Francis","doi":"10.1016/j.ajog.2026.08.010","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.010","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"9 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148716945","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":"Critique of an EMG-Guided Botulinum Toxin Trial for Vestibulodynia (Letter-to-the-Editor)","authors":"Tahira Nasreen, Saima kiran, Hafiza Qurat Ul Ain, Humaira Kousar","doi":"10.1016/j.ajog.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.007","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"102 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148716944","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 developmental venous anomaly with varix mimicking an intracranial hemorrhage.","authors":"Efrat Hadi, Eran Kassif, Omer Bar-Yosef, Michal Berkenstadt, Shoshana Greenberger, Boaz Weisz, Shai Shrot","doi":"10.1016/j.ajog.2026.08.008","DOIUrl":"10.1016/j.ajog.2026.08.008","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148710890","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}