American journal of obstetrics and gynecology最新文献

{"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<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}

{"title":"US Medical Student Health Insurance Coverage for Fertility Services.","authors":"Priyanka Gokhale,Sara Grace Melendez,Brian C Brajcich,Jacqueline C Lee","doi":"10.1016/j.ajog.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.002","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"21 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578588","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":"Surveillance of Monochorionic Twins for Detection of Twin-Twin Transfusion Syndrome and Twin Anemia Polycythemia Sequence: A North American Fetal Therapy Network (NAFTNet) Consensus Statement: NAFTNet consensus on monochorionic pregnancy surveillance.","authors":"Clifton O Brock,Ahmet A Baschat,Julie S Moldenhauer,Greg Ryan,Anthony Johnson","doi":"10.1016/j.ajog.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.001","url":null,"abstract":"The Society for Maternal Fetal Medicine (SMFM) recently released updated clinical guidelines on the ultrasound surveillance and clinical management of monochorionic (MC) twin pregnancies. The North American Fetal Therapy Network (NAFTNet) has supported but has not endorsed these guidelines. In this document we suggest an enhanced ultrasound surveillance strategy for timely detection of twin-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS) in MC pregnancies. We provide specific recommendations that depart from the SMFM guidelines. The rationale for these recommendations includes a conceptual framework for complications of MC twins, a review of Doppler studies in the diagnosis of TTTS and a review of the pathophysiology, clinical management and prognosis of TAPS.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"21 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578590","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 Validation of a Histology-Specific Natural History Model of Ovarian Cancer.","authors":"Sayaka Ishizawa,Maryam Eghbalizarch,Renu S Nargund,Seyyed Mostafa Mousavi Janbeh Sarayi,Jiangong Niu,Mehdi Hemmati,Maddie Tumbarello,Andrew J Schaefer,Karen Lu,Sharon H Giordano,Larissa A Meyer,Iakovos Toumazis","doi":"10.1016/j.ajog.2025.06.063","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.063","url":null,"abstract":"BACKGROUNDOvarian cancer is the second leading cause of death from gynecologic cancers, yet no effective screening program exists for the general population. Past screening trials evaluated the effectiveness of annual ovarian cancer screening and concluded that it does not yield significant mortality reduction. Future investments on ovarian cancer screening trials would require convincing preliminary evidence on the effectiveness of interventions of interest. Simulation modeling offers an effective, fast, cost-efficient, and safe approach to gain insights on the effectiveness of interventions, that is increasingly being used to inform guidelines for cancer screening programs. Models that simulate the natural progression of diseases in the absence of any intervention, commonly referred to as natural history models (NHMs), are the cornerstone of such analyses because they provide a reference point for evaluating interventions. Currently, no histology-specific NHM exists for ovarian cancer despite significant differences among subtypes.OBJECTIVEDevelop and validate a histology-specific ovarian cancer NHM.STUDY DESIGNWe developed NHMs for the most common histological subtypes of epithelial ovarian cancer: high-grade serous carcinoma, low-grade serous carcinoma, mucinous carcinoma, clear cell carcinoma, endometrioid carcinoma, carcinosarcoma, and not otherwise specified. Each NHM simulates the natural progression of ovarian cancer from disease's onset until death from any cause. We modeled ovarian cancer progression as a state-transition model comprising of 13 mutually exclusive and collectively exhaustive health states. We informed the model input parameters using observed, nationally representative estimates, whenever possible. Unobserved parameters (e.g., preclinical transitions) were estimated through calibration to histology-specific data from the Surveillance, Epidemiology, and End Results (SEER) registry. We validated the NHMs on the control arms of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and the United Kingdom Collaborative Trial on Ovarian Cancer Screening (UKCTOCS) trials, in terms of ovarian cancer incidence and mortality rates, and stage distribution at diagnosis. Differences between observed and estimated outcomes were assessed using traditional statistical tests.RESULTSThe calibrated NHMs reproduced the observed SEER data (range of weighted root mean square error (RMSE) across histological subtypes: 0.0081 to 0.0185) as well as individual calibration targets; survival after diagnosis, stage distribution at diagnosis, and age distribution at diagnosis (ranges of RMSE across histological subtypes: 0.0029 to 0.0204, 0.0005 to 0.0203, and 0.0637 to 0.0816, respectively). The NHMs reproduced PLCO's observed incidence and mortality rates, and stage at diagnosis (p-value=0.411 for incidence, p-value=0.195 for mortality, and p-value=0.200 for stage distribution at diagnosis) and UKCTOCS's observed ovarian cancer ","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"685 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568491","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":"Adverse outcomes during delivery hospitalizations among patients with an intellectual or developmental disability diagnosis.","authors":"Manasa G Rao, Timothy Wen, Mary D'Alton, Teresa C Logue, Alexander Friedman, Noelia Zork","doi":"10.1016/j.ajog.2025.06.064","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.064","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564248","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":"Reproductive factors and the risk of incident peripheral arterial disease hospitalisation or death: A cohort study of UK Biobank participants.","authors":"Anna-Louise Pouncey, Mark Woodward, Katie Harris, Rebecca Kelly","doi":"10.1016/j.ajog.2025.06.062","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.062","url":null,"abstract":"<p><strong>Objectives: </strong>Associations between reproductive factors and risk of peripheral arterial disease (PAD) are not well established. This study examined reproductive factors and hormone use in relation to incident PAD risk in women.</p><p><strong>Study design: </strong>UK Biobank cohort study, excluding participants with prior diagnosis of PAD. Self-reported reproductive factors included were age at menarche, parity-related factors (including live birth, miscarriages, stillbirths, abortions), menopause-related factors (including reproductive years, age at menopause, hysterectomy and oophorectomy) and exogenous hormone use (including OCP and HRT use). Participant baseline data were linked with hospital admission data and the national death register to identify first record of PAD. Poisson regression estimated sex-specific incidence rates (IRs) of PAD per 10,000 person years and Cox proportional hazard regressions estimated confounder-adjusted hazard ratios (adjHRs) linking reproductive factors with incident PAD. The association between number of children and PAD was also examined for men and compared between the sexes.</p><p><strong>Results: </strong>Over a median follow-up of 13·2 years 2,942/272,557 women and 5,432/227,403 men developed PAD. Early and late menarche (age <12 and >14 years) was associated with increased PAD risk (adj HR 1·43 95% CI[1·32, 1·55], p<·001, 1·36 [1·23, 1·49], p<·001, respectively). Reduction in PAD risk was observed for an older age at first birth (adjHR 0·95 [0·94, 0·96], p<·001, per year). While, cumulative increased PAD risk was observed per miscarriage (adjHR 1·06 [1·01, 1·11] p=·027), per stillbirth (adjHR 1·18 [1·03, 1·36] p=·014) and per abortion (adjHR 1·09 [1·01, 1·18], p=·028). A longer duration of reproductive years, later natural menopause, and use of oral contraceptives (adjHR 0·85 [0·78, 0·93], p<·001) were associated with reduced PAD risk. Hysterectomy or oophorectomy were associated with increased PAD risk (adjHR 1·24 [1·13, 1·35], p<·001, 1·24 [1·10, 1·39], p<·001, respectively). Associations between the number of children and PAD were U-shaped and similar for both sexes, with a multiple-adjusted HR of 1·13 ([1·00, 1·25], p=·041) for women and 1·25 ([1·16, 1·34], p<·001) for men, with 4 or more children.</p><p><strong>Conclusions: </strong>Reproductive factors are associated with increased risk of PAD and should be considered in future risk stratification.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558814","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":"Effect of transabdominal versus transvaginal cerclage on preterm birth and neonatal outcomes among patients with history of cervical insufficiency.","authors":"Chelsea J Messinger, Sonia Hernández-Díaz, Albert Hofman, Natalie Sadlak, Jon Einarsson, Thomas McElrath","doi":"10.1016/j.ajog.2025.06.049","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.049","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The 2020 Multicentre Abdominal vs. Vaginal Randomised Intervention of Cerclage (MAVRIC) trial found that transabdominal cerclage placed via open laparotomy reduces the risk of spontaneous preterm birth before 32 weeks relative to transvaginal cerclage in a very high-risk obstetric population. It is not known whether the results of MAVRIC generalize to obstetric populations with fewer risk factors, on average, for recurrent spontaneous preterm birth, or to patients without history of failed transvaginal cerclage (an inclusion criterium in MAVRIC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;1) To estimate the effect of transabdominal cerclage versus transvaginal cerclage on early preterm delivery (&lt;34 weeks) among patients with history of cervical insufficiency at a quaternary care center; 2) To estimate the effect within a subgroup of patients without history of failed transvaginal cerclage; 3) To describe associated complications of placement and delivery and neonatal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We identified a cohort of adult singleton pregnancies who received history-indicated cerclage at a quaternary care center in the United States. The cohort consisted of 1) patients with a history of ≥1 spontaneous deliveries (birth or fetal loss) &lt;28 weeks, and 2) patients with a history of failed transvaginal cerclage, defined as ≥1 spontaneous preterm deliveries &lt;34 weeks with cervical cerclage in situ. All eligible patients who received transabdominal cerclage were compared to a sample of eligible patients who received transvaginal cerclage. We performed survival analysis with inverse probability weights to adjust for potential sources of bias. Effects were estimated as risk difference (RD), risk ratio (RR), and 95% confidence intervals (CI). Subgroup analyses were performed among patients without a history of failed transvaginal cerclage. The risks of surgical, delivery, and neonatal outcomes were described.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;188 patients were included, of whom 87 received transabdominal cerclage (99% laparoscopic) and 101 received transvaginal cerclage. Twenty-six patients (30%) with transabdominal cerclage had no history of failed transvaginal cerclage, the majority of whom had additional clinical reasons why transabdominal cerclage was offered. After adjusting for confounding, the adjusted risk of early preterm delivery was 5.5% in the transabdominal group (95% CI: 2.0%, 9.4%) and 18.7% in the transvaginal group (95% CI: 6.8%, 31.4%), RD = -13.1% (95% CI: -26.6%, -0.5%), RR = 0.30 (95% CI: 0.10, 0.94). Among patients without history of failed transvaginal cerclage (N=104 total, N=26 in transabdominal group), the RD was -12.6% (-21.6%, -4.1%). Risks of placement and delivery complications were comparable across groups but included a few serious uterine complications in the transabdominal cerclage group. Neonatal intensive care unit admission occurred in 35% and 23% of neonates in the transabdom","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615829","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}