American journal of obstetrics and gynecology最新文献

{"title":"From Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS): What Obstetricians and Gynecologists Need to Know.","authors":"Mahnaz Bahri Khomami, Kathy M Hoeger, Heather Huddleston, Shruthi Mahalingaiah, Helena J Teede, Anuja Dokras","doi":"10.1016/j.ajog.2026.08.024","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.024","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) has been renamed polyendocrine metabolic ovarian syndrome (PMOS) following a multistep international consensus process endorsed by 56 professional and patient organizations. The new name corrects a longstanding misnomer. The characteristic ovarian morphology reflects numerous arrested antral follicles, not pathologic cysts, and the legacy term has reinforced an overly ovarian and fertility-centered view of a lifelong endocrine-metabolic condition. For obstetrician-gynecologists (OBGYNs), this reframing has immediate clinical relevance. PMOS affects approximately 10%-13% of reproductive-age women, yet it remains underdiagnosed and inconsistently documented in routine care. It is associated with insulin resistance, hyperandrogenism, ovulatory dysfunction, psychological morbidity, and cardiometabolic risk across the life course. During pregnancy, PMOS is linked to higher risks of miscarriage, gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, preterm birth, fetal growth restriction, low birthweight, and small-for-gestational-age infants, with many associations persisting after adjustment for age and body mass index. Despite this evidence, PMOS is not routinely captured as an obstetric risk modifier at the first obstetric visit, nor is it consistently embedded in antenatal decision-support pathways. Patients also remain inconsistently screened and counseled for psychological, metabolic, and long-term cardiometabolic risks. This Special Report discusses the rationale for the PCOS-to-PMOS rename, reviews evidence linking PMOS with adverse pregnancy and offspring outcomes and outlines practical implications for obstetric and gynecologic care. Diagnostic criteria remain unchanged; namely, two of the following three: irregular menstrual cycles and ovulatory dysfunction, clinical or biochemical hyperandrogenism, and elevated anti-Müllerian hormone (AMH) levels or multiple follicles on ovarian ultrasound in adults. What changes is the clinical frame. OBGYNs are uniquely positioned to improve earlier diagnosis, risk recognition, counseling, and coordinated care from adolescence through menopause and beyond.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849648","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":"Fetoscopic Visualization of Meconium-Mediated Spinal Cord Injury in Fetal Myelomeningocele.","authors":"Ifeoma Ogamba-Alphonso, Julia Kim, Christina Sarris, Barbara Coons, Erin Lonergan, Martin Chavez, Jose L Peiro","doi":"10.1016/j.ajog.2026.08.033","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.033","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838790","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 Call For Standardized Placental Dye Injection And Postnatal Evaluation In Monochorionic Twins After Single Fetal Demise (Reply to Letter-to-the-Editor).","authors":"Mathies Rondagh, Sylke Steggerda, Enrico Lopriore","doi":"10.1016/j.ajog.2026.08.029","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.029","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838824","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":"Age Differences in Clitoral-Vestibular Bulb Anatomy Across the Adult Lifespan.","authors":"Shaniel T Bowen, Pamela A Moalli, Arijit Dutta, Krystyna Rytel, Francisco J Gomez Rivas-Vazquez, Holly E Richter, Mark E Lockhart, Sara Perelmuter, Deborah C Marshall, Mercedes Balcells, Elazer R Edelman, Steven D Abramowitch","doi":"10.1016/j.ajog.2026.08.030","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.030","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is sparse normative data on clitoral-vestibular bulb anatomy and how it changes with aging, despite growing evidence of the latter playing a notable role in female sexual function and other pelvic symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To identify age-related differences in clitoral-vestibular bulb anatomy (dimensions, position, shape) among women across the adult lifespan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This was a retrospective study of pelvic magnetic resonance images of women (≥18 years) without pelvic floor disorder/dysfunction symptom indications (pelvic organ prolapse, urinary incontinence/pain, fecal incontinence/pain, dyspareunia) and with normal pelvic anatomy (radiographically normal reproductive, genitourinary, or gastrointestinal systems). Participants were categorized into the following age groups: Young Adult (18-34 years), Early Midlife (35-49 years), and Older Adult (≥50 years). Axial images of participants in the supine position at rest were acquired for medical indications. The clitoral-vestibular bulb complex, vagina, and urethra were manually segmented to construct 3-dimensional anatomical models. Computational methods quantified clitoral-vestibular bulb dimensions, position, vaginal-urethral distances, and shape (given by principal component scores obtained from a statistical shape model). Age differences in clitoral-vestibular bulb measures were evaluated using Bonferroni-corrected one-way multivariate and univariate analyses of covariance, with adjustments for body mass index and parity. Age-related correlations were assessed using Spearman's rank correlation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 134 women were analyzed (median [range] age, 39 [19-80] years): 47 Young Adult, 46 Early Midlife, and 41 Older Adult women. All Young Adult and Early Midlife women were premenopausal, whereas 27 (71%) of Older Adult women were postmenopausal. Older Adult women had a shorter clitoral body length than Early Midlife women (24.1 mm vs 27.9 mm; P=.006). Overall, smaller vestibular bulb volume was associated with increasing age (P=.04). Older Adult women had a more caudally positioned (lower in the pelvis) clitoral-vestibular bulb complex than Early Midlife women (-21.0 mm vs -17.6 mm; P&lt;.001) and Young Adult women (-21.0 mm vs -17.9 mm; P&lt;.001). Across the entire cohort, increasing age correlated with a shorter clitoral body length (ρ=-0.21; P=.01), smaller vestibular bulb volume (ρ=-0.20; P=.02), and a more dorsally (ρ=-0.22; P=.01) and caudally (ρ=-0.43; P&lt;.001) positioned clitoral-vestibular bulb complex, whereas clitoral volume remained unchanged (ρ=-0.03; P=.73). The shape analysis revealed that age predominantly affected the vestibular bulbs, which became more medially positioned (closer together) (ρ=-0.28; P=.001) and proportionally smaller relative to the clitoris (ρ=-0.28; P=.001) with advancing age.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Increasing age was weakly correlated w","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838778","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 Regarding Probiotics for Prevention of Recurrent Spontaneous Preterm Delivery (Letter-to-the-Editor).","authors":"Çağdaş Nurettin Emeklioğlu","doi":"10.1016/j.ajog.2026.08.031","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.031","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838853","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":"Universal Aspirin Dispensation for Prevention of Preeclampsia in a High-Risk Population.","authors":"Elaine Duryea, Anne Ambia, Jessica Pruszynski, Joyce Miller, Sharon Hubbard, Carrie Berge, David Nelson, Catherine Spong","doi":"10.1016/j.ajog.2026.08.036","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.036","url":null,"abstract":"<p><strong>Background: </strong>Hypertensive disorders of pregnancy are a major cause of maternal morbidity and mortality. Aspirin therapy has shown benefit in high-risk populations; however, current characteristic-based screening approaches are cumbersome, and risks of aspirin exposure are low, making universal prescribing appealing.</p><p><strong>Objective: </strong>To report the effect of universal aspirin dispensation for preeclampsia prevention in a population with a high rate of hypertensive disorders.</p><p><strong>Study design: </strong>This observational cohort study includes all deliveries between April 2020 to July 2025 at Parkland Health, a high-volume obstetric service with community clinics capable of directly dispensing medication during prenatal visits. Patients who initiated prenatal care by 16 weeks gestation received 162mg aspirin daily beginning August 3, 2022, prior to this date aspirin was not recommended regardless of risk factors. Deliveries during the washout period (8/3/2022 - 2/3/2023) were excluded. The primary outcome was preeclampsia with severe features, which was a clinical diagnosis characterized by administration of magnesium sulfate for severe hypertension, lab abnormalities, or eclampsia.</p><p><strong>Results: </strong>Two cohorts of 18,457 patients, before and after aspirin implementation, were compared. Patients in the aspirin epoch had a lower incidence of preeclampsia with severe features (6.9% vs. 5.1%, p<0.001), aOR 0.65(0.60-0.72). Additionally, the time to diagnosis of preeclampsia with severe features was longer in the aspirin epoch, p<0.001. Patients with chronic hypertension were also less likely to develop preeclampsia with severe features aOR 0.72 (0.59-0.86)) in the aspirin epoch. The rate of abruption, postpartum hemorrhage, and neonatal complications did not increase in the aspirin epoch. Pharmacy data confirmed at least 14,754 (80.4%) patients with a prenatal visit ≤ 16 weeks received aspirin during the later epoch, with median 180 tablets dispensed.</p><p><strong>Conclusions: </strong>Universal dispensation of 162mg aspirin daily at the first prenatal visit in a population with a high rate of hypertensive disorders was associated with a population-level reduction in the development of preeclampsia with severe features in patients with and without chronic hypertension, without an increase in abruption or postpartum hemorrhage. This study demonstrates the possible benefit of a universal approach to aspirin prescribing in high-risk populations, especially if direct dispensation is performed.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838846","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":"Clarifying key reporting elements in a systematic review of intravaginal electrical stimulation for urinary incontinence (Letter-to-the-Editor).","authors":"Jiyu Zhao, Jing Yan","doi":"10.1016/j.ajog.2026.08.034","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.034","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838808","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":"Center effects and concomitant interventions in probiotic prevention of recurrent spontaneous preterm delivery (Reply to Letter-to-the-Editor).","authors":"Shigeru Saito, Satoshi Yoneda, Shintaro Iwamoto","doi":"10.1016/j.ajog.2026.08.032","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.032","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823975","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 role of placental anastomoses in severe brain injury after fetal demise in monochorionic twins: a multicenter retrospective study (Letter-to-the-Editor).","authors":"Rishika Das, Shadjay Ap","doi":"10.1016/j.ajog.2026.08.028","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.028","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823961","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":"Providing context behind reporting elements of a systematic review exploring urogynaecological neurostimulation. (Reply to Letter-to-the-Editor).","authors":"Ritesh Rikain Warty","doi":"10.1016/j.ajog.2026.08.035","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.08.035","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824045","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}