American journal of obstetrics and gynecology最新文献

{"title":"Supporting informed decisions about tubal sterilization with a patient-facing website: a randomized trial.","authors":"Eleanor Bimla Schwarz, Hannah Begna, Agatha Okobi, Amy Chiang, Kelly Treder, Rebecca L Sudore","doi":"10.1016/j.ajog.2026.10.003","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.003","url":null,"abstract":"<p><strong>Background: </strong>Interest in permanent contraception has increased in the US since the 2022 Dobbs decision restricted access to abortion in many states. Despite use of the federally mandated \"consent for sterilization\" form HHS-687, one of every five US patients who undergo tubal sterilization subsequently reports a desire to reverse their tubal sterilization, indicating that efforts to ensure informed decision-making before permanent contraceptive procedures remain needed.</p><p><strong>Objectives: </strong>To increase access to desired contraceptive services and knowledge of long-acting contraceptive options, we developed and evaluated the efficacy of a patient-facing educational website for patients considering tubal sterilization.</p><p><strong>Study design: </strong>We enrolled 350 individuals considering tubal sterilization in a randomized controlled trial. Participants allocated to the intervention group reviewed the \"Advancing Access\" website while the \"attention control\" group reviewed the federal sterilization consent form HHS-687 and Planned Parenthood's tubal sterilization website. Follow-up data was collected within 1 week and 3 months following the website review. The study's primary outcome was a multidimensional measure of access to reproductive health services measured 3 months after website review that assessed awareness, availability, affordability, acceptability, and belief that a given method of birth control was safe given their personal health status, with attention to 6 methods (tubal sterilization, vasectomy, IUD, implant, emergency contraception, and abortion pills). Secondary outcomes included contraceptive knowledge and preferences. We used Chi-square and t-tests to compare study groups, and multivariable linear regression models to assess the robustness of the intervention effects, after controlling for participant age, education, race/ethnicity, marital status, history of pregnancy, and region of residence.</p><p><strong>Results: </strong>The average age of the 350 study participants was 33 +/- 7 years. Most (55%, 192/350) had publicly funded health insurance, and 67% (237/350) had annual household incomes below $60,001. On enrollment, average perceived access (52% vs 53%, p=0.46) and average contraceptive knowledge scores (42% vs 41% of questions answered correctly, p=0.67) were similarly low in both study groups. Three months after enrollment, the intervention group had greater perceived access to birth control (62% vs 58%, p=0.02; adjusted mean difference 3.24, 95% CI: 1.81-4.67). Within 1 week of reviewing the study materials, the intervention group showed significantly greater improvement in average contraceptive knowledge scores (68% vs 52% of questions answered correctly, P<0.001) that persisted at 3 months (61% vs 52%, p < 0.001; adjusted mean difference 2.00, 95% CI: 0.21-3.79). At 3-months, tubal sterilization remained the most commonly preferred method in both study groups (30% intervention ","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134754","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":"Contraceptive use and GLP-1 receptor agonists: an intersection of metabolic and reproductive health.","authors":"Halina M Yee, Leo L Han","doi":"10.1016/j.ajog.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.005","url":null,"abstract":"<p><p>The growing overlap of glucagon-like peptide-1 receptor agonists and contraceptive use in women of reproductive age warrants a comprehensive understanding of the pharmacokinetic and pharmacodynamic interactions of these two drug classes. Studies that evaluate the two are limited, and significant knowledge gaps remain regarding interactions. This narrative review synthesizes the current body of literature surrounding glucagon-like peptide receptor agonists and hormonal contraception and their effects on the female reproductive tract. It defines potential interactions between the two classes of medication across the female reproductive tract, and highlights gaps in knowledge. Lastly, this review underscores the need for healthcare providers to incorporate contraceptive counseling as a routine component of care when initiating glucagon-like peptide 1 agonists.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134847","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":"Transcutaneous electrical nerve stimulation for pain management during intrauterine device insertion: a randomized controlled trial.","authors":"Lauren H Kus, Catherine R Statis, Meghana Kudrimoti, AmberJean P Hansen, Meghan Proehl, Shanell Morrison-Buckley, Ariella Goldman, Tessa Madden, Monica V Dragoman","doi":"10.1016/j.ajog.2026.10.006","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pain during intrauterine device (IUD) insertion is a significant patient concern. Current pharmacologic strategies inadequately address procedural pain, highlighting the need for rigorous evaluation of novel approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether high-frequency transcutaneous electrical nerve stimulation (TENS) reduces pain with IUD insertion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a double-blind randomized controlled trial in which 98 participants undergoing LNG 52 mg or CuT380A IUD insertion received either active high-frequency TENS or sham TENS. We measured pain using a 100-mm visual analog scale (VAS) at multiple time points during the procedure. The primary outcome was pain at the time of IUD insertion. Participants completed a pre-procedure survey asking about demographic and reproductive characteristics, anticipated pain, and anxiety. We asked participants post-procedure about satisfaction with pain during procedure and the TENS device. Clinicians completed a post-procedure survey asking about their perception of participant pain and ease of insertion. We estimated a total sample size of 98 to achieve 80% power to detect a 20 mm difference in pain scores, with 10% attrition/protocol deviation and 15% inflation to account for nonparametric distribution. We performed an intention-to-treat analysis and calculated mean pain scores and standard deviations. We used t-tests to compare mean pain scores at the time of IUD insertion and chi-square tests to compare categorical variables. We dichotomized parity as nulliparous (no prior delivery) vs. parous (any delivery greater than 20 weeks).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between March 2024 and April 2025, we screened 150 participants and enrolled 99 individuals (active n=49; sham n=50) with one post-randomization exclusion. Baseline characteristics were similar, with a median age of 29 years and just over half having had a previous birth (53.1%). Pain at the time of IUD insertion did not differ between active and sham TENS groups (50.8 ± 26.9 mm vs 50.6 ± 29.2 mm; p=0.97). We also observed no differences in procedure duration. Nulliparous participants reported higher pain scores overall compared to parous individuals, but we detected no difference in pain scores relative to treatment intervention within groups (nulliparous - active 58.8 ± 28.7 mm, sham 59.3 ± 25.5 mm, p=0.95; parous - active 43.5 ± 23.3 mm vs. sham 43.2 ± 30.6, p=0.97). While clinician estimates and participant-reported maximum-pain scores were mildly correlated (Pearson's correlation coefficient = 0.41), there was a significant difference between mean clinician-estimated and participant-reported maximum pain scores (p&lt;0.001), 48.9 ± 26.8 mm vs. 60.5 ± 25.2 mm, respectively. Participants undergoing IUD insertions perceived as difficult by clinicians reported higher mean pain scores than those perceived as easy (71.6 ± 24.2 mm vs. 56.0 ± 24.4 mm, respectively; p","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134854","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":"Vulvar Lichen Sclerosus as a Risk Factor for Birth-related Perineal Tear","authors":"Cecilie Hagen Andersen,Rikke Badsberg Sloth,Louise Thomsen Schmidt Arenholt,Søren Lundbye-Christensen,Anne Vingaard Olesen,Lisandra Stein Bernardes","doi":"10.1016/j.ajog.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.004","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"480 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088287","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":"Methodological considerations of NBN-associated ovarian cancer risk (Letter-to-the-Editor)","authors":"Jiashuai Wang,Shasha Qiu","doi":"10.1016/j.ajog.2026.09.040","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.040","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"16 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088288","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":"NBN is associated with an increased risk of ovarian cancer (Reply to Letter-to-the-Editor)","authors":"Subhasheenee Ganesan,Caitlin T. Fierheller,D.Gareth Evans,Ranjit Manchanda","doi":"10.1016/j.ajog.2026.09.041","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.041","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"155 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088285","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":"Screening for large-for-gestational-age fetuses: from a single measurement to a clinical pathway (Letter-to-the-Editor)","authors":"A. Farina,P.I. Cavoretto,K.H. Nicolaides","doi":"10.1016/j.ajog.2026.10.018","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.018","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"111 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208762","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":"Survival Outcomes of Ovarian-Sparing Surgery for Early-Stage Adult Granulosa Cell Tumor","authors":"Fiamma L. Van Biema,Yongmei Huang,Delanie Ludmir,Kevin J. Rouse,Shayan Dioun,Alexander Buckley de Meritens,Thomas Randall,Tarah Pua,Caryn M. St. Clair,June Y. Hou,Koji Matsuo,Dawn L. Hershman,Jason D. Wright,Xiao Xu","doi":"10.1016/j.ajog.2026.09.044","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.044","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"225 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088284","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":"Geographic Accessibility and Calendar Period in Gynecologic Cancer Stage at Diagnosis (Reply to Letter-to-the-Editor)","authors":"Michael R. Desjardins","doi":"10.1016/j.ajog.2026.09.043","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.043","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"24 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088291","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 “Neonatal mortality in the United States is related to location of birth hospital versus home rather than the type of birth attendant” American Journal of Obstetrics and Gynecology 223 (2020) 254.e1–254.e8","authors":"Amos Grünebaum,Laurence B. McCullough,Brooke Orosz,Frank A. Chervenak","doi":"10.1016/j.ajog.2026.09.032","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.032","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"41 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088289","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}