American journal of obstetrics and gynecology最新文献

{"title":"Is it niche healing or just amenorrhea? Re-interpreting the superiority of LNG-IUS (Letter-to-the-Editor).","authors":"Kuang-Yen Lee,Ying-Cheng Chiang,Bor-Ching Sheu","doi":"10.1016/j.ajog.2026.04.033","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.033","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"69 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147753285","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":"EVALUATION OF WEIGHT CHANGE DURING OVARIAN STIMULATION TREATMENT.","authors":"Simone Elder,Kerry Flannagan,Phillip Romanski,Laura Zalles,Cassandra Roeca","doi":"10.1016/j.ajog.2026.04.027","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.027","url":null,"abstract":"BACKGROUNDThe number of women undergoing ovarian stimulation for either in vitro fertilization or planned oocyte cryopreservation for conception or fertility preservation has remarkably increased over the past decade. Prior to undergoing ovarian stimulation, patients are typically counseled about risks, including medication reactions, surgical risks, and anticipated number of oocytes from each cycle based on ovarian reserve testing. One possible side effect that is a common concern among patients is what amount of weight change might be expected during the treatment cycle. However, there is very limited data on how much weight can change during modern ovarian stimulation treatment cycles.OBJECTIVETo determine the mean weight change for patients undergoing ovarian stimulation and to evaluate whether this differed in patients diagnosed with ovarian hyperstimulation syndrome and/or those undergoing multiple cycles.STUDY DESIGNRetrospective cohort study of 22,106 antagonist ovarian stimulation cycles with weight collected prior to stimulation and on day of retrieval (n= 8,332); or post-retrieval (n=13,774) from January 1, 2017 to December 31, 2023. Main outcome was mean weight fluctuation (kg) from baseline weight during ovarian stimulation. P values were obtained from linear regression models fitted with GEE.RESULTSMean weight gain for the entire cohort was 0.64 ± 1.64 kg, ranging from -2.3 to 6.8 kg. Smaller initial body mass index and higher oocytes retrieved were associated with greater weight gain. Weight gain among patients diagnosed with ovarian hyperstimulation was 47% higher than patients who did not develop ovarian hyperstimulation syndrome (0.94 kg vs. 0.64 kg), but this difference was not statistically significant (p=0.08). There was no difference in time of return to baseline weight in patients with ovarian hyperstimulation syndrome vs. those without ovarian hyperstimulation syndrome after retrieval. There was no difference in return to baseline weight in those with higher number of oocytes retrieved (≥10) vs those with lower number of oocytes retrieved (<10). For patients that underwent multiple cycles, there was no difference in the weight gained in each subsequent cycle compared to the first cycle.CONCLUSION(S)Our study is the first large cohort to report weight changes during antagonist ovarian stimulation cycles, which was on average modest and temporary. Patients of low body mass index, recipients of dual trigger, and ≥10 oocytes retrieved exhibited higher weight gain.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"151 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751277","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":"Early pregnancy oxylipin markers of inflammation and oxidative stress are associated with small-for-gestational-age birth and specific phenotypes of fetal growth restriction.","authors":"Kelly K Ferguson,Barrett M Welch,Danielle R Stevens,Paige A Bommarito,Ginger L Milne,John D Meeker,Matthew L Edin,Darryl C Zeldin,David E Cantonwine,Thomas F McElrath","doi":"10.1016/j.ajog.2026.04.032","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.032","url":null,"abstract":"BACKGROUNDFetal growth restriction places the fetus at risk for stillbirth, perinatal mortality and severe morbidity, yet the disease remains difficult to diagnose, predict, and treat. Homeostasis of inflammation and oxidative stress is critical to the establishment of a healthy pregnancy, and biomarkers of these processes could contribute to these goals. Oxylipins are derived from polyunsaturated fatty acids and act as key mediators of this homeostasis and thus may be promising tools for understanding the etiology of fetal growth restriction and possible therapeutic targets.OBJECTIVEExamine the association between early pregnancy oxylipin biomarkers of inflammation and oxidative stress and SGA and LGA birth as well as ultrasound-based phenotypes of fetal growth restriction.STUDY DESIGNIn a case-cohort study of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births (N=901), we measured 24 oxylipins in plasma and urine collected at ∼10 weeks gestation. We examined associations between oxylipins and SGA (n=248) and LGA birth (n=241) as our primary endpoints. As a secondary approach, we explored associations between oxylipins and phenotypes of SGA and LGA births that were characterized based on longitudinal fetal growth measures.RESULTSA primary urinary metabolite of the pro-inflammatory thromboxane-A2 was associated with SGA birth (OR=1.43, 95% Confidence Interval [CI]=1.20, 1.72). In secondary analyses, the thromboxane metabolite was most strongly associated with a phenotype of late-pregnancy growth restriction. Additionally, the urinary isoprostanes were associated with increased odds of an early-pregnancy growth restriction phenotype. For example, a 5-series isoprostane was associated with higher odds (OR=2.22, 95% CI=1.34, 3.69) of early-pregnancy growth restriction compared to appropriate for gestational age. For LGA births, associations were not significant after false discovery rate correction.CONCLUSIONAssociations between circulating oxylipins in early pregnancy and SGA birth may reflect disturbances in the balance of inflammation and oxidative stress, processes that are critical to the establishment of pregnancy and healthy fetal growth. These associations differed based on SGA phenotype, i.e., early- vs. late-pregnancy growth restriction, providing possible insights into distinct etiologies. Oxylipins may be useful targets for early prediction and/or intervention on fetal growth restriction.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"11 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751279","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":"Grandmaternal smoking during pregnancy and grandoffspring stillbirth risk: clarifying residual confounding (Reply to Letter-to-the-Editor).","authors":"Eduardo Villamor,Amanda K Miglin,Sven Cnattingius","doi":"10.1016/j.ajog.2026.04.031","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.031","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739102","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":"The Fetal Medicine Foundation preeclampsia screening at the population-level (Letter-to-the-Editor).","authors":"Emmanuel Bujold,Daniel L Rolnik,Kypros H Nicolaides","doi":"10.1016/j.ajog.2026.04.028","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.028","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"25 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739103","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":"Beyond direct exposure: rethinking multigenerational risk transmission in stillbirth (Letter-to-the-Editor).","authors":"Zahide Küçük","doi":"10.1016/j.ajog.2026.04.030","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.030","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"68 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739104","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":"Response to the remarks to Fetal Medicine Foundation preeclampsia screening at population level.","authors":"Núria Mans-Gallart,Daniel Axelsson,Caroline Lilliecreutz","doi":"10.1016/j.ajog.2026.04.029","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.029","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"136 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147739101","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 randomized controlled trial comparing remote blood pressure monitoring with office-based blood pressure monitoring for women at high risk of preeclampsia.","authors":"Theepika Rajkumar,Annemarie Hennessy,Renuka Shanmugalingam,Wenpeng You,Alison Canty,Wendy Pickup,Daniela Potter,Kaley Butten,Marlien Varnfield,Angela Makris","doi":"10.1016/j.ajog.2026.04.025","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.025","url":null,"abstract":"BACKGROUNDWomen at high risk for developing preeclampsia are recommended to have additional blood pressure surveillance, but frequent outpatient attendances are demanding for patients and the healthcare system. It is unclear whether remote blood pressure monitoring can replace conventional office-based monitoring and improve healthcare utilisation without increasing the signal for harm.OBJECTIVETo evaluate the effects of substituting clinic blood pressure monitoring with remote blood pressure monitoring on fetal and maternal outcomes, and healthcare utilisation, in pregnant women at high risk of developing preeclampsia.STUDY DESIGNUnblinded, non-inferiority, multicentre randomized controlled trial, with recruitment between July 2022 and February 2024 from 3 metropolitan hospitals in Australia. Participants were pregnant women at high-risk of developing preeclampsia based on clinical risk factors or combined first trimester screening tests, who are routinely referred to a specialist hypertension service for extra blood pressure surveillance, in addition to standard antenatal care. Women randomised to usual care attended these specialist hypertension clinics in-person, with frequency of appointments dictated by clinical need. Women randomised to remote blood pressure monitoring, in addition to receiving routine antenatal care, measured their own blood pressure using an automated blood pressure machine with data transmitted via a smartphone application for specialist review. The primary outcome was a perinatal composite of adverse events of at least one of perinatal loss, high-level neonatal care for over 48 hours or a small-for-gestational age baby (&lt;10th centile for fetal weight). The primary outcome was assessed in the intention-to-treat population. The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p).RESULTS270 women were included in the final analysis (intervention n=132, usual care n=138; mean age 34, 60.4% from a self-reported non-Caucasian ethnic group). There was no difference in the primary outcome [hazard ratio (HR) 1.0, 95%CI 0.57-1.76; p=0.99]. There was also no difference in secondary fetal and maternal outcomes. The intervention group had fewer total antenatal attendances (median [inter-quartile range (IQR)]: 14 [10-17]) compared to usual care (16 [13-20]; p&lt; 0.01), as well as fewer planned outpatient appointments (median [IQR]: 10 [8-12] vs. 13 [10-16]; p&lt;0.01), without an associated increase in unscheduled hospital presentations. Women undertaking remote blood pressure monitoring were less likely to be admitted to hospital for any cause [HR 0.54, 95% confidence interval (CI) 0.30-0.97; p=0.04], as well as specifically for hypertension [HR 0.41, 95%CI 0.19-0.88, p=0.02]. More antihypertensive prescriptions filled per patient in the intervention arm compared to usual care (median [IQR]: 5 [3-9] vs. 3 [2-5]; p&lt;0.01).CONCLUSIONSCompared to usual care, remote blood pre","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"5 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735262","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":"Vacuum-Induced Tamponade Using Urological Catheters for Postpartum Hemorrhage.","authors":"E Ranieri,S Kalimeris,N Ochsenbein,C Haslinger","doi":"10.1016/j.ajog.2026.04.026","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.026","url":null,"abstract":"Postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality worldwide, most often due to uterine atony. We present a novel, low-cost surgical solution for atonic PPH: the Urological-Catheter Vacuum-Induced Tamponade (U-CaVIT) procedure. U-CaVIT uses a readily available 3-way urological catheter connected to a standard vacuum suction device to induce uterine contraction and evacuation of intrauterine blood. In our initial series of 20 women with severe PPH (median blood loss 1.8 L), U-CaVIT successfully stopped hemorrhage in 17 cases (85%) where first-line uterotonics and tranexamic acid had failed. Additional embolization was necessary in 3 women: in 2 of them, U-CaVIT application was not successful due to uterine malformations (uterus arcuate and subseptus). The device was applied after vaginal delivery or during cesarean (before uterine closure) with equal feasibility. The catheter is inserted into the uterine cavity (transvaginally or through the hysterotomy) and connected via tubing to a vacuum pump (-70 kPa suction), while the catheter's balloon is inflated with up to 80 mL saline to ensure a seal. Suction is applied for about 1 hour to facilitate uterine contraction and hemostasis. Ultrasound allows monitoring of correct placement and the absence of intrauterine blood accumulation. No device-related injuries or infections occurred. Only three patients required transfusion, and hospital stays were modest despite significant hemorrhage. This simple vacuum-tamponade approach can rapidly control atonic PPH, including cases refractory to medication, and expands the toolkit for managing severe postpartum bleeding.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"32 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147735263","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":"Reducing the long-term impact of cesarean scar defects: a focus on prevention.","authors":"Sarah P Walker,Helena C Bartels,Davor Jurkovic,Eric Jauniaux","doi":"10.1016/j.ajog.2026.04.024","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.024","url":null,"abstract":"As cesarean delivery rates continue to rise worldwide, the long-term obstetric and gynecological complications associated with cesarean scar defects are becoming increasingly prevalent. These include cesarean scar ectopic pregnancies, placenta previa accreta, secondary subfertility, chronic pelvic pain, and intermenstrual bleeding. The objective of this review is to evaluate how the optimization of the hysterotomy location in relation to myometrial thickness and uterine vascularity, together with an appropriate uterine closure technique, could reduce the long-term impact of cesarean scar defects. A wide range of closure techniques have been described, with substantial heterogeneity in study design, outcome measures, and follow-up intervals, limiting definitive conclusions. Emerging evidence suggests that unlocked, interrupted, purse-string, and endometrium-free sutures, along with the use of monofilament or barbed sutures, may reduce cesarean scar formation and thus the risks of scar placentation in subsequent pregnancies. These approaches may promote better healing by reducing tissue compression and ischemia, unlike continuous, locked, endometrium-inclusive sutures, which may impair perfusion. Increasing attention to endometrium-free closure and precise anatomical realignment highlights the importance of meticulous surgical technique in contemporary obstetrics. Surgical repair of cesarean scar defects improves outcomes in patients with chronic gynecological symptoms and subfertility. However, evidence supporting its role in preventing obstetric complications in subsequent pregnancies remains limited, in part because such complications are rare. Moreover, cesarean scar defect repair requires removing the scar tissue and reconstruction using healthy myometrium, which may theoretically increase the risk of dehiscence or uterine rupture in subsequent pregnancies. A key knowledge gap in much of the existing literature is its focus on imaging-defined cesarean scar defects rather than on patient-centered long-term gynecological symptoms. Well-designed, multi-arm studies that incorporate standardized postpartum imaging to characterize uterine remodeling over time are essential for identifying best practices. While resource-intensive, advancing this field could improve long-term patient outcomes and reduce healthcare costs.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147733841","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}