American journal of obstetrics and gynecology最新文献

{"title":"Older maternal age at first delivery as a risk factor for pelvic organ prolapse: what we know.","authors":"Hannah A Zabriskie, Micah J Drummond, Ingrid E Nygaard, Carolyn W Swenson","doi":"10.1016/j.ajog.2025.03.006","DOIUrl":"10.1016/j.ajog.2025.03.006","url":null,"abstract":"<p><p>Older chronological age and vaginal childbirth are widely accepted risk factors of pelvic organ prolapse. However, considerably less attention has been given to the impact of maternal age at first delivery. Ample research has demonstrated the deleterious effects of age on the musculoskeletal system, including the loss of muscle mass and strength as well as diminished recovery after stress. Little research has evaluated the role of these local muscle changes in the development of pelvic organ prolapse when childbearing is delayed. As the average age of first-time mothers continues to increase, evaluating age at first delivery as a predictor of pelvic organ prolapse development is highly relevant. In this review, we present the evidence demonstrating that increased maternal age increases pelvic organ prolapse risk. Additionally, evidence regarding the effects of age at first delivery on mechanisms of pelvic organ prolapse including pelvic muscle dysfunction, levator ani defects, and genital hiatus enlargement is presented.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596061","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":"Preference, adherence and acceptability of three non-medicated intravaginal rings of differing external diameters: a randomized, crossover trial.","authors":"Barbara A Friedland, Jessica M Sales, Jessica Atrio, Marlena G Plagianos, J Brady Burnett-Zieman, Shakti Shetty, Nicole Roselli, Renee Rolston, Ann Gottert, Karina Avila, Irene V Bruce, Caio Sant'Anna Marinho, Michelle Nguyen, Ruth Merkatz, Lisa B Haddad","doi":"10.1016/j.ajog.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.03.001","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;No empirical data support the 54-58mm external diameter of intravaginal rings (rings) currently available and in development for contraception and other indications. Understanding how external diameter affects preference, adherence, and acceptability is critical for optimizing future product development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Our primary objectives were to determine which of three non-medicated rings of differing external diameters was preferred and yielded the highest adherence. Secondary objectives were comparing acceptability, patterns of adherence, and safety of the three rings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;In an open-label, three-way crossover trial, healthy, HIV-uninfected, monogamous, sexually active, non-pregnant,18-40-year-old cisgender women and their male partners in Atlanta, GA and the Bronx, NY were randomly assigned to the sequence of using three non-medicated silicone rings (46mm, 56mm, 66mm external diameters)continuously for approximately 30 days each (90 days total; November 2021-December 2022). We tested whether end of study preference for any of the three rings was greater than 0.33 (binomial proportion, exact test). We used mixed-effect regression models with random intercepts by participant to compare adherence (ring never out for longer than 30 minutes in 24 hours); and probability of removals (including reasons for removal), expulsions, and the ring being out of the vagina all day, per ring, per day of use with the 56mm ring as the reference group; and to compare scores on a novel 19-item acceptability scale with items related to ease and experience of use, and impact on sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;23/24 women completed the study (median age 26.7 years [SD 3.78]). Most were college graduates (92%), White (63%), non-Hispanic (79%), single (79%), and nulliparous (92%). At study end, 59% preferred the smallest (46mm) ring versus 18% each for the 56mm and 66mm rings (p=0.0045). The proportion of participants who were adherent did not differ significantly by ring (46mm, 78%; 56mm, 75%; 66mm, 59%; p=0.30), however, odds of expulsion were higher for the 46mm (OR 5.72, 95% CI: 1.25-26.1) and 66mm (OR 25.9, 95% CI: 6.11-109) rings than the 56mm ring. The 66mm ring also had greater odds of being out (removal or expulsion, any length of time) than the 56mm ring (OR 6.50, 95% CI 3.46-12.2). Mean acceptability scale scores were identical (4.54/5) for the 46mm and 56mm (smallest and medium) rings and significantly higher than the largest, 66mm ring (3.94/5; p&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;Although the 46mm ring was preferred by more women and had higher rates of adherence compared to the other two rings, the 56mm ring was rated as equally acceptable with significantly fewer reports of expulsions/removals compared to the other two rings. These data confirm that the current 54-58mm diameter of vaginal rings on the market and in development is accepta","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596063","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 ‘Changes in use of progesterone after the PROLONG trial: a physician survey’","authors":"Itamar Futterman ,&nbsp;Laura Gilroy ,&nbsp;Nawras Zayat ,&nbsp;Kimen Singh Balhotra ,&nbsp;Jeremey Weedon ,&nbsp;Howard Minkoff","doi":"10.1016/j.ajog.2025.01.009","DOIUrl":"10.1016/j.ajog.2025.01.009","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"232 4","pages":"Page 408"},"PeriodicalIF":8.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key actions to improve linkage to care for pregnant and postpartum women with hepatitis C.","authors":"Neil Gupta, Lindsey Hiebert, John W Ward","doi":"10.1016/j.ajog.2024.10.018","DOIUrl":"10.1016/j.ajog.2024.10.018","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e120"},"PeriodicalIF":8.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455866","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":"Should we focus on endometrial-free closure technique?","authors":"Carry Verberkt, Sanne I Stegwee, Judith A F Huirne","doi":"10.1016/j.ajog.2024.10.012","DOIUrl":"10.1016/j.ajog.2024.10.012","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e109-e110"},"PeriodicalIF":8.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455868","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":"Commentary on distinct obstetrical characteristics and maternal mortality in patients with HELLP syndrome vs severe preeclampsia.","authors":"Supreet K Raina, Keisha Callins","doi":"10.1016/j.ajog.2024.10.015","DOIUrl":"10.1016/j.ajog.2024.10.015","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e117"},"PeriodicalIF":8.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455862","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":"School performance in offspring born to mothers with hyperemesis gravidarum.","authors":"Martha Veber Fogh, Rikke Wiingreen, Anne Ostenfeld, Tine Dalsgaard Clausen, Lone Krebs, Olav Bjørn Petersen, Gorm Greisen, Christina Engel Hoei-Hansen, Mads Langager Larsen","doi":"10.1016/j.ajog.2025.02.041","DOIUrl":"10.1016/j.ajog.2025.02.041","url":null,"abstract":"<p><strong>Background: </strong>Hyperemesis gravidarum is characterized by severe nausea, vomiting, and potentially undernutrition during pregnancy. Despite affecting up to 3% of all pregnancies, little is known about the impact of hyperemesis gravidarum on the cognitive development of the child.</p><p><strong>Objective: </strong>We aimed to compare the school performance of offspring exposed to hyperemesis gravidarum during pregnancy with their nonexposed counterparts and siblings.</p><p><strong>Study design: </strong>We conducted a population-based cohort study including all liveborn children, born in Denmark between January 1, 1986, and December 31, 2005. We included 1,162,249 offspring, of which 12,720 (1.1%) had been exposed in utero to a maternal diagnosis of hyperemesis gravidarum. The 2 coprimary outcomes were mean grade point average in the final year of elementary school (ninth grade, 15-16 years) and a composite outcome of low school performance, defined as a mean grade point average below 4 or no registered mean grade point average. The difference in mean grade point average was evaluated using uni- and multivariable linear mixed models and differences in proportions of the binary outcomes were compared using uni- and multivariable logistic regression models.</p><p><strong>Results: </strong>Of the exposed offspring, 29.3% had low school performance compared to 25.7% of the nonexposed group. After adjustment for confounders (birth year, maternal age, multiple pregnancies, parity, maternal education, maternal smoking, and sex), we found that exposed offspring had increased odds of low school performance (odds ratio 1.19, 95% confidence interval 1.14-1.24). Furthermore, the exposed group had a lower mean grade point average of 6.55 compared with 6.78 in the nonexposed group, yielding an adjusted mean difference of -0.18 (-0.22 to -0.14). However, within-sibling analyses, comparing exposed offspring with their unexposed siblings (same mother), revealed no increased odds of low school performance (adjusted odds ratio 0.98 [0.92-1.04]) or difference in mean grade point average (-0.02 [-0.08 to 0.05]).</p><p><strong>Conclusion: </strong>We found a small association between in utero exposure to hyperemesis gravidarum and low school performance. However, no difference in school performance was observed between exposed and unexposed siblings, indicating that the association could be attributed to genetics or other familial factors rather than hyperemesis gravidarum.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536476","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":"Funisitis increases the risk of death or cerebral palsy in extremely preterm infants.","authors":"Viral G Jain, Nehal A Parikh, Matthew A Rysavy, Vivek V Shukla, Shampa Saha, Susan Hintz, Alan Jobe, Waldemar A Carlo, Namasivayam Ambalavanan","doi":"10.1016/j.ajog.2025.02.038","DOIUrl":"10.1016/j.ajog.2025.02.038","url":null,"abstract":"<p><strong>Background: </strong>The relationship between histological chorioamnionitis (inflammation of fetal membranes) and funisitis (inflammation of umbilical cord), both commonly associated with preterm birth, with subsequent development of cerebral palsy remains controversial.</p><p><strong>Objective: </strong>To determine if extremely preterm infants (<27 weeks) exposed to histological chorioamnionitis or funisitis are at a higher risk of death or cerebral palsy compared to those without these exposures.</p><p><strong>Study design: </strong>Multicenter cohort study of prospectively collected data of preterm infants in the National Institute of Child Health and Development Neonatal Research Network. Infants born 2012 to 2019 who were 22 to 26^6/7 weeks of gestation, received active treatment, and had placental pathology available were included. Because preterm birth, as measured by gestational age, lies on the causal pathway for cerebral palsy, we used mediation analysis to evaluate whether the indirect mediated effect of gestational age on death or cerebral palsy contributed to the relationships of histological chorioamnionitis and funisitis with death or cerebral palsy.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the composite outcome of death or cerebral palsy defined by the Amiel-Tison standardized exam and Gross Motor Function Classification System ≥1 at 22 to 26 months corrected age.</p><p><strong>Results: </strong>A total of 6949 infants met the eligibility criteria. Of these, 3971 (57%) infants had histological chorioamnionitis, and 2978 (43%) did not have histological chorioamnionitis. About 90% (6248/6949) of infants had follow-up and complete cerebral palsy data. Similarly, 1057 (28%) infants had funisitis, and 2689 (72%) did not have funisitis. Of these, primary outcome data were available for 87% (3267/3746) infants. On multivariable analysis, histological chorioamnionitis was not associated with death or cerebral palsy (relative risk: 0.98 [95% confidence interval: 0.91, 1.05]). Exposure to funisitis was associated with a higher risk of death or cerebral palsy (relative risk: 1.09 [1.01, 1.21]) that was primarily mediated by preterm birth. There was a higher risk of cerebral palsy among surviving infants exposed to funisitis (relative risk: 1.23 [1.04, 1.51]) compared to those without funisitis. This association was partially (40%) mediated by preterm birth (relative risk: 1.08 [1.05, 1.12]), but the major effect (60%) appears to be a direct adverse effect of funisitis exposure on cerebral palsy development (relative risk: 1.13 [0.97, 1.40]).</p><p><strong>Conclusion: </strong>Funisitis was associated with an increased risk of the combined outcome of death or cerebral palsy. In surviving infants, the direct adverse effects of funisitis appear to lead to cerebral palsy, independent of preterm birth.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536460","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":"Optimizing patient selection and technique for occiput posterior vacuum extraction: reply.","authors":"Andrea Dall'Asta, Veronica Falcone, Tullio Ghi","doi":"10.1016/j.ajog.2025.02.037","DOIUrl":"10.1016/j.ajog.2025.02.037","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530929","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":"Key points for analyzing longitudinal twin growth discordance patterns and adverse perinatal outcomes.","authors":"Xin Li, Xue Xiao, Tianjiao Liu","doi":"10.1016/j.ajog.2025.02.034","DOIUrl":"10.1016/j.ajog.2025.02.034","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522454","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}