American journal of obstetrics and gynecology最新文献

{"title":"Effect of aspirin on biomarker profile in women at high-risk for preeclampsia: a reply.","authors":"Long Nguyen-Hoang, Liona C Poon","doi":"10.1016/j.ajog.2025.06.053","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.053","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526025","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":"Study design and data analysis considerations for postpartum blood pressure outcomes.","authors":"Christina A Penfield, Megan C Oakes, Jennifer A McNulty","doi":"10.1016/j.ajog.2025.06.051","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.051","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526028","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":"Abortion trends in Southern Illinois after the Dobbs v. Jackson Women's Health Organization decision.","authors":"Jayme Trevino, Rachel Paul, Erin King, Jennifer A Reeves, David L Eisenberg, Tessa Madden","doi":"10.1016/j.ajog.2025.06.046","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.046","url":null,"abstract":"<p><strong>Background: </strong>The Dobbs v. Jackson Women's Health Organization (Dobbs) decision in June 2022 significantly changed the landscape of abortion care in the United States. Characterizing the changes in regional abortion provision is imperative to understanding the impact of Dobbs on patients seeking abortion and the clinics providing care.</p><p><strong>Objective: </strong>To examine changes in gestational duration, one-way driving distance, and abortion volume pre- and post-Dobbs.</p><p><strong>Study design: </strong>This retrospective cohort study used clinic-level administrative data to examine changes in abortion provision from June 2021 to June 2023 at two outpatient abortion clinics in Southern Illinois. We included all induced abortions performed up to 23 weeks, 6 days gestational duration. We compared patient characteristics between pre- and post-Dobbs using appropriate bivariate tests. To account for underlying trends over time, we used segmented regression analyses to examine changes in mean gestational duration (weeks) at time of abortion, mean one-way driving distance (miles) from patients' home zip code to the clinic, and number of abortions before and after the Dobbs decision. We conducted segmented regressions stratified by one-way driving distance, race, and Area Deprivation Index national percentile to explore disparities in access after Dobbs. All segmented regressions adjusted for seasonal variation and controlled for autocorrelation.</p><p><strong>Results: </strong>In total, 29,165 abortions occurred during the study period: 11,631 pre-Dobbs and 17,534 post-Dobbs (51% increase). The monthly number of abortions increased by 349.2 (95%CI: 120.7, 557.8) post-Dobbs and remained stable. The mean gestational duration increased from 8.3±3.8 weeks pre-Dobbs to 8.9±4.0 in the 12 months post-Dobbs (p<0.001) and the proportion of abortions occurring at 12 weeks or later increased from 14.5% (n=1,689) to 18.1% (n=3,176), p<0.001. The monthly average gestational duration increased 1.1 weeks (95%CI: 0.6, 1.6) immediately post-Dobbs and subsequently decreased -0.1 weeks (95% CI: -0.2, -0.1) over time. The mean one-way driving distance pre-Dobbs was 82.87 ± 132.34 miles and increased to 193.95 ± 206.50 post-Dobbs (p<0.001). The monthly mean one-way driving distance increased 108.0 miles (95%CI: 93.2,122.8) post-Dobbs and then decreased over the remainder of the study period (-6.9 miles, 95%CI: -8.2, -5.5).</p><p><strong>Conclusions: </strong>At two abortion clinics in Southern Illinois, the 12-month period post-Dobbs was associated with a substantial increase in abortion volume, a small increase in gestational duration, and patients traveling farther for care compared to pre-Dobbs. These findings highlight the impact on patient care caused by the rapidly changing abortion landscape in the U.S.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511410","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":"Can AI Improve the Readability of Patient Education Information in Gynecology?","authors":"Naveena R Daram, Rose A Maxwell, Josette D'Amato, Jason C Massengill","doi":"10.1016/j.ajog.2025.06.047","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.047","url":null,"abstract":"<p><strong>Background: </strong>The American Medical Association recommends that patient information be written at a 6^th grade level to increase accessibility. However, most existing patient education materials exceed this threshold, posing challenges to patient comprehension. Artificial Intelligence (AI), particularly large language models (LLMs), presents an opportunity to improve the readability of medical information. Despite the growing integration of AI in healthcare, few studies have evaluated the effectiveness of LLMs in generating or improving readability of existing patient education materials within gynecology.</p><p><strong>Objective: </strong>To assess the readability and effectiveness of patient education materials generated by ChatGPT, Gemini, and CoPilot compared to American College of Obstetricians and Gynecologists (ACOG) and UpToDate.com. Additionally, to determine whether these LLMs can successfully adjust the reading level to a 6^th-grade standard.</p><p><strong>Study design: </strong>This cross-sectional study analyzed ACOG, UpToDate, and LLM-generated content, evaluating LLMs for two tasks: (1) independent LLM-generated materials and (2) LLM-enhanced versions reducing existing patient information to 6^th-grade level. All materials were assessed for basic textual analysis and readability using eight readability formulas. Two board-certified OBGYNs evaluated blinded patient education materials for accuracy, clarity, and comprehension. ANOVA was used to compare textual analysis and readability scores, with Tukey post-hoc tests identifying differences for both original and enhanced materials. An alpha threshold of p<.004 was used to account for multiple comparisons.</p><p><strong>Results: </strong>LLM-generated materials were significantly shorter (mean word count 407.9 vs. 1132.0; p<.001) but had a higher proportion of difficult words (36.7% vs. 27.4%; p<.001). ACOG and UpToDate materials averaged 9th and 8.6 grade levels respectively, while AI-generated content reached a 10.6 grade level (p=0.008). Although CoPilot and Gemini improved readability when prompted, no LLM successfully reached the 6th-grade benchmark, and ChatGPT increased reading difficulty.</p><p><strong>Conclusions: </strong>LLMs generated more concise patient education materials but often introduced more complex vocabulary, ultimately failing to meet recommended health literacy standards. Even when explicitly prompted, no LLM achieved the 6th-grade reading level required for optimal patient comprehension. Without proper oversight, AI-generated patient education materials may create the illusion of simplicity while reducing true accessibility. Future efforts should focus on integrating health literacy safeguards into AI models before clinical implementation.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511421","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":"Co-administration of combined oral contraceptives and psychotropic drugs - risk of contraceptive failure and adverse events.","authors":"Tanja Boehnke, Christian Franke, Anja Bauerfeind, Klaas Heinemann, Katja Koelkebeck, Cornelia Kolberg-Liedtke","doi":"10.1016/j.ajog.2025.06.048","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.048","url":null,"abstract":"<p><strong>Background: </strong>Combined oral contraceptives (COCs) and psychotropic drugs (PDs) are commonly used drugs in the female population. Yet, the quantity and quality of previous studies on drug interactions between these two medications is limited.</p><p><strong>Objectives: </strong>To provide a detailed overview of the concomitant use of COCs and PDs and its potential risk of contraceptive failure and adverse events (AEs) in routine clinical practice.</p><p><strong>Study design: </strong>A pooled analysis of four large, prospective, multinational cohort studies comprising new users of COCs with and without concomitant PD intake. We used exact matching (variable 1:10 ratio) on region, smoking status, age, and Body Mass Index (BMI) groups. Contraceptive failure and selected AEs occurring within six months after COC initiation were expressed by incidence rates per 100 women-years, crude, and adjusted Cox regression hazard ratios with 95% confidence intervals (CIs) separately for Europe and the United States.</p><p><strong>Results: </strong>After matching, 8081 COC+PD users (Europe: 2271, United States: 5810) and 70,009 COC-only users (Europe: 22,685, United States: 47,324) were considered for analysis. No significant difference was found for the risk of contraceptive failure between COC+PD and COC-only users. The hazard ratios adjusted for age, BMI, medical history, oral contraceptive user status (i.e., first-time ever user, switcher, restarter after intake break), and education level were 1.4 (95% CI, 0.56 - 3.52) for Europe and 0.8 (95% CI, 0.55 - 1.09) for the United States. The risk of adverse events was 1.5-fold higher in COC+PD users than in COC-only users (Europe: 1.5 [95% CI, 1.13 - 2.02]; United States: 1.5 [95% CI, 1.22 - 1.88]). Most AEs were related to the digestive and genitourinary systems.</p><p><strong>Conclusions: </strong>No difference in the risk of contraceptive failure was found for COC+PD and COC-only users, while COC+PD users tend to experience more AEs.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511422","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":"HPV infection of endocervical reserve cells is underestimated in the natural history of cervical cancer.","authors":"Olaf Reich, Sigrid Regauer","doi":"10.1016/j.ajog.2025.06.044","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.044","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504465","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":"Doppler ultrasound changes in twin anemia polycythemia sequence treated with fetoscopic laser surgery.","authors":"M J A van de Sande, F Slaghekke, M C Haak, E J T Verweij, C C M M Lap, E Lopriore, L S A Tollenaar","doi":"10.1016/j.ajog.2025.06.042","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.042","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504464","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":"Obstetric Anal Sphincter Injury: Counseling for Future Deliveries.","authors":"Madeline Freeman, Natasha G Rich, Lisa C Hickman, Katie Propst","doi":"10.1016/j.ajog.2025.06.037","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.037","url":null,"abstract":"<p><p>This article provides a comprehensive review of counseling in subsequent deliveries for patients with a history of obstetric anal sphincter injury (OASI). Patients with prior OASI are at increased risk for recurrent OASI compared to other multiparous patients, however, the rates of primary and recurrent OASI are similar at 4.4-11% and 3.7-13.4%, respectively. Subsequent delivery care includes a review of the index delivery course, acute postpartum complications, OASI sequelae, and patient risk factors. Counseling should include understanding the patient's values and preferences, a risk-benefit discussion of delivery modalities, and an appropriate recommendation for the subsequent mode of delivery. There are no absolute contraindications to subsequent vaginal delivery, and newer data suggests appropriate mode of delivery selection results in stable pelvic floor functional status. This highlights the importance of counseling for shared decision-making for future delivery planning.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504466","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":"Clinical experience of a fetal post-mortem imaging service using microfocus computed tomography.","authors":"Ian C Simcock,Audrey Lamouroux,Susan C Shelmerdine,Neil J Sebire,J Ciaran Hutchinson,Owen J Arthurs","doi":"10.1016/j.ajog.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.035","url":null,"abstract":"BACKGROUNDPost-mortem imaging is becoming a more acceptable part of perinatal autopsy, particularly for early gestation or small fetuses where conventional autopsies may be challenging and rejected by parents.OBJECTIVE(S)The purpose of this study was to establish the relative diagnostic yield of microfocus computed tomography (Micro-CT) as part of less invasive autopsy in fetuses below 24 weeks gestation.STUDY DESIGNWe completed a single center, retrospective study of 7 years of 1007 consecutive unselected perinatal autopsies (2016 - 2023) for fetuses below 300g. Micro-CT was offered as an option to all referred fetuses below 300 g body weight; all parents gave fully informed written consent.RESULTSWe imaged 1007 fetuses with mean 17.9 weeks gestation and 92.4g body weight, categorized according to mode of death. A diagnosis was made due to a range of examinations including Micro-CT, conventional autopsy, external and placental examination in 51.1% (515 / 1007), with a fetal cause in 212 / 1007 (21.1%); for example cardiac septal abnormalities or neural tube defects, placental cause in 264 / 1007 (26.2%); for example placental abruption or chorioamnionitis, or elements of both in 39 / 1007 (3.9%). The single most important diagnostic contributor was the placental examination (353 cases; 35.1%). Micro-CT image quality enabled a diagnosis in 598 / 1007 cases (59.4%), higher in miscarriage (80.3%) and termination of pregnancy (74.9%) than in utero deaths (41.4%), where maceration did not reduce the overall tissue state to non-diagnostic. The overall micro-CT abnormality detection rate, where an abnormality was identified, was 312 / 1007 (31%), highest in termination of pregnancy (80.7%) vs spontaneous miscarriage (17.9%). Only 43 fetuses required additional invasive autopsy (an autopsy \"avoidance rate\" of 95.7%; 964 / 1007). Median turnaround time was 18 days (range 13 - 23 days).CONCLUSION(S)The combination of a routine external examination, placental assessment and micro-CT post-mortem imaging reached a diagnosis in early gestation fetuses in over 50%, similar to historical cohorts. This was achieved within 3 weeks, with an autopsy avoidance rate of 96%, in line with parental consent.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"235 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487919","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":"Implications of a biopsy-first approach to endometrial cancer detection.","authors":"Adeola Olaitan,Nicola Macdonald","doi":"10.1016/j.ajog.2025.06.039","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.039","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"70 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487942","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}