American journal of obstetrics and gynecology最新文献

{"title":"Non-industry-funded randomized controlled trial of Erbium-YAG Laser to treat Female Stress Urinary Incontinence (Reply to Letter-to-the-Editor).","authors":"Patricia Lee,Lesley Carr,Rose Kung,Sender Herschorn","doi":"10.1016/j.ajog.2025.09.015","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.015","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"67 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059197","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 critical appraisal of the double-blind randomized controlled trial of Er:YAG vaginal laser for stress urinary incontinence (Letter-to-the-Editor).","authors":"Fatih Aktoz,Marco Gambacciani,C Tamer Erel","doi":"10.1016/j.ajog.2025.08.095","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.08.095","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"134 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059192","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":"From Siloed Clinics to Systemic Change: Improving Healthcare for Trafficking Survivors.","authors":"Jaya Prakash,Julia Geynisman-Tan","doi":"10.1016/j.ajog.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.017","url":null,"abstract":"Specialized clinics for human trafficking survivors have emerged as a response to the complex healthcare needs for this population. While these clinics provide essential, trauma-informed care, they may inadvertently create systemic challenges by siloing survivors, introducing logistical barriers, and shifting responsibility away from the broader healthcare workforce. Drawing lessons from historical health epidemics, such as the HIV/AIDS crisis of the 1980s, this paper critiques the unintended consequences of trafficking-specific clinics. It examines how these clinics may reinforce stigma, limit survivors' access to comprehensive care, and perpetuate gaps in provider preparedness. We call for a balanced approach, advocating for the integration of trafficking-informed care into standard healthcare delivery systems while leveraging specialized clinics as transitional models. Recommended actions include 1) training all providers in trauma-informed care, 2) embedding universal screening protocols, 3) improving accessibility through coordinated case management systems, and 4) involving survivors in service design. By addressing these challenges, the healthcare system can better meet the needs of trafficking survivors while building a sustainable, equitable care framework.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"34 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059196","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":"Effectiveness and safety of assisted vaginal birth and second stage caesarean section: a systematic review and meta-analysis of real-world contemporary data.","authors":"Marcus Cabrera-Dandy,Maria Regina Torloni,Mario Merialdi,Elena Greco,Stamatina Iliodromiti","doi":"10.1016/j.ajog.2025.09.022","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.022","url":null,"abstract":"OBJECTIVETo synthesize evidence on the effectiveness of different instruments for assisted vaginal birth (AVB) and to assess the prevalence of maternal and neonatal adverse outcomes associated with AVB and second-stage cesarean section (SCS).DATA SOURCESA comprehensive search was conducted in Cochrane, Embase, and MEDLINE to identify randomized controlled trials, cross-sectional, and cohort studies published between January 2001 and December 2023.STUDY ELIGIBILITY CRITERIAStudies published in English, Spanish, French, or Italian with >30 participants, conducted in any type of healthcare facility, and reporting operative procedures in the second stage of labor were eligible if they included at least one outcome of interest for women undergoing AVB and/or SCS.STUDY APPRAISAL AND SYNTHESIS METHODSTwo independent reviewers conducted study selection, data extraction, and quality assessment. Meta-analyses of proportions were performed using random-effects models, and heterogeneity was assessed using the I2 statistic.RESULTSA total of 241 studies, involving 751,242 participants, were included, of which 231 were observational and 10 randomized controlled trials (RCT). Prevalence estimates for AVB failure and adverse outcomes varied widely. Vacuum extraction (VE) had a significantly higher failure rate than forceps (7.60% vs. 3.26%, p<0.01), but a lower prevalence of obstetric anal sphincter injury (4.73% vs. 7.99%, p<0.01). Spatula use was associated with a lower prevalence of neonatal cephalohematoma compared to VE (0.73% vs. 5.45%, p<0.01) and forceps (0.73% vs. 3.54%, p<0.01), but a higher prevalence of postpartum hemorrhage compared to VE (10.77% vs. 5.46%, p<0.0001). Compared to AVB, SCS was associated with significantly higher rates of NICU admission (17.18% vs. 6.64% forceps, 6.07% VE, p<0.001), low Apgar scores (6.01% vs. 2.43% forceps, 2.05% VE, p<0.01), skull fractures (1.54% vs. 0.27% for both, p<0.05), and neonatal death (1.95% vs. 0.31% for both, p<0.01).CONCLUSIONContemporary data reveal wide variability in the prevalence of failed AVB and adverse maternal and neonatal outcomes following operative delivery in the second stage of labor. While AVB carries specific risks, it may offer advantages over emergency SCS, particularly regarding neonatal outcomes.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059191","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":"Uterine Cancer Diagnosis at Age 65: Onset of Medicare Eligibility and Impact of Medicaid Expansion.","authors":"Kevin J Rouse,Ling Chen,Tracy M Layne,Xiao Xu,Nina A Bickell,Goli Samimi,Jason D Wright,Evan R Myers","doi":"10.1016/j.ajog.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.018","url":null,"abstract":"BACKGROUNDUterine cancer, for which diagnosis is based on evaluation of symptoms, most commonly postmenopausal bleeding, is one of the few cancers in the United States with rising incidence and mortality. Inability to access diagnostic services due to lack of insurance coverage may lead to delayed diagnosis and inferior outcomes.OBJECTIVEThe aim of the study was to examine whether the onset of Medicare eligibility at age 65 was associated with a spike in the incidence of uterine cancer and whether this association was attenuated by Medicaid expansion through the Affordable Care Act (ACA).STUDY DESIGNThe ecological study used cancer registry data from the Surveillance, Epidemiology, and End Results (SEER) program to estimate the incidence rate of uterine cancer among women aged 55-74 from 2000 to 2021 in the United States. Second order polynomial modeling was used to fit the association between age (in single years) and incidence rate at the population level while excluding age 65 to identify the expected incidence rate at age 65 in the absence of a spike. The expected uterine cancer incidence rate at age 65 was generated from the model and compared to the observed rate at age 65 in the overall sample. Similar analyses were also conducted further stratified by stage, race/ethnicity, pre-ACA (2004-2013) versus post ACA (2014-2021) period and states' Medicaid expansion status.RESULTSIn the overall sample, the observed uterine cancer incidence rate at age 65 was 108.2 cases per 100,000 woman-years (95% confidence interval (CI) 106.4-110.1), which exceeded the expected rate projected from the polynomial model (102.5, 95% CI 101.4-103.5). A similar pattern was observed in analysis stratified by stage at diagnosis and by race/ethnicity. The spike in incidence at age 65 diminished in Medicaid expansion states in the post-ACA period but persisted in non-expansion states.CONCLUSIONOnset of Medicare eligibility at age 65 was associated with a spike in uterine cancer diagnoses, which appeared to be mitigated by Medicaid expansion. These findings underscore the importance of insurance coverage in facilitating timely uterine cancer diagnoses.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"28 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059193","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 Combined Use of Cervical Ultrasound and Deep Learning Improves the Detection of Patients at Risk for Spontaneous Preterm Delivery.","authors":"Emilie P F Sejer,Paraskevas Pegios,Manxi Lin,Zahra Bashir,Camilla B Wulff,Anders N Christensen,Mads Nielsen,Aasa Feragen,Martin G Tolsgaard","doi":"10.1016/j.ajog.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.012","url":null,"abstract":"BACKGROUNDPreterm birth is the leading cause of neonatal mortality and morbidity. While ultrasound-based cervical length measurement is the current standard for predicting preterm birth, its performance is limited. Artificial intelligence (AI) has shown potential in ultrasound analysis, yet few small-scale studies have evaluated its use for predicting preterm birth.OBJECTIVETo develop and validate an AI model for spontaneous preterm birth prediction from cervical ultrasound images and compare its performance to cervical length.STUDY DESIGNIn this multicenter study, we developed a deep learning-based AI model using data from women who underwent cervical ultrasound scans as part of antenatal care between 2008 and 2018 in Denmark. Indications for ultrasound were not systematically recorded, and scans were likely performed due to risk factors or symptoms of preterm labor. We compared the performance of the AI model with cervical length measurement for spontaneous preterm birth prediction by assessing the area under the curve (AUC), sensitivity, specificity, and likelihood ratios. Subgroup analyses evaluated model performance across baseline characteristics, and saliency heat maps identified anatomical features that influenced AI model predictions the most.RESULTSThe final dataset included 4,224 pregnancies and 7,862 cervical ultrasound images, with 50% resulting in spontaneous preterm birth. The AI model surpassed cervical length for predicting spontaneous preterm birth before 37 weeks with a sensitivity of 0.51 (95% CI 0.50-0.53) versus 0.41 (0.39-0.42) at a fixed specificity at 0.85, p<0.001, and a higher AUC of 0.75 (0.74-0.76) versus 0.67 (0.66-0.68), p<0.001. For identifying late preterm births at 34-37 weeks, the AI model had 36.6 % higher sensitivity than cervical length (0.47 versus 0.34, p<0.001). The AI model achieved higher AUCs across all subgroups, especially at earlier gestational ages. Saliency heat maps indicated that in 54% of preterm birth cases, the AI model focused on the posterior inner lining of the lower uterine segment, suggesting it incorporates more data than cervical length alone.CONCLUSIONSTo our knowledge, this is the first large-scale, multicenter study demonstrating that AI is more sensitive than cervical length measurement in identifying spontaneous preterm births across multiple characteristics, 19 hospital sites, and different ultrasound machines. The AI model performs particularly well at earlier gestational ages, enabling more timely prophylactic interventions.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"36 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056675","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":"Postnatal healing of cesarean scar: an ultrasound study.","authors":"Maria Ivan,Amrita Banerjee,Charlotte Colley,Amos Tetteh,Natalie Greenwold,Davide Casagrandi,Davor Jurkovic,Anna L David,Raffaele Napolitano","doi":"10.1016/j.ajog.2025.09.013","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.013","url":null,"abstract":"BACKGROUNDImpaired healing of cesarean delivery scars results in long-term complications, including scar niche formation, which may adversely impact future pregnancies and lead to gynaecological symptoms such as postmenstrual spotting, dysmenorrhea and chronic pelvic pain. Moreover, there is increasing evidence that a cesarean delivery scar located close to or within the cervix is associated with an increased risk of subsequent spontaneous preterm birth. The factors influencing cesarean birth scar location and healing remain poorly understood.OBJECTIVE(S)We explored the impact of antenatal, intrapartum, intraoperative and postnatal factors on cesarean scar sonographic healing, location and morphology after cesarean delivery in labor.STUDY DESIGNThis prospective observational cohort study recruited women who underwent cesarean delivery during active labor (cervical dilation 4-10 cm) at University College London Hospital, UK (January 2021-October 2022). Transvaginal ultrasound was performed 4 to 12 months postpartum to evaluate cesarean delivery scar characteristics and location relative to the internal cervical os. Indicators of impaired scar healing were presence of a scar niche (depth ≥2mm) and/or a healing ratio (residual/adjacent myometrial or cervical thickness) of ≤0.5. Regression analysis assessed the associations between clinical variables and cesarean scar parameters.RESULTSCesarean delivery scars were identified in 96.8% of women recruited (90/93). Advanced labor cesarean delivery (8-10 cm dilatation) was associated with an eight-fold increased likelihood of a scar located at or caudal to the internal os (RR 7.77; 95% CI 2.59, 23.39; p&lt;0.001) compared to cesarean birth performed earlier in labor (4-7 cm dilatation). Cervical dilatation and fetal station at surgery significantly influenced scar position relative to the internal cervical os (p&lt;0.001). For each 1cm increase in cervical dilatation during labor, the scar was positioned 0.88mm more caudally on the uterus or cervix (95%CI 0.62, 1.14; p&lt;0.001). Similarly, for each 1cm descent of the fetal part within the maternal pelvis, the cesarean scar was located 1.5mm more caudally on the uterus or cervix (95%CI 0.71, 2.33; p&lt;0.001). The niche prevalence was 37.8% (34/90), of which 67.6% (23/24) had a healing ratio ≤0.5. Risk factors for suboptimal scar healing included BMI ≥ 25, increased uterine artery vascular Doppler resistance, gestational age &gt; 40 weeks, the use of locking sutures during surgery and cesarean delivery scar location caudal to the internal os on postnatal ultrasound (p&lt;0.05). Uterine scars, situated cranial to the internal os, had significantly larger niche dimensions compared to those located within the cervix, at or caudal to the internal os (p&lt;0.05).CONCLUSION(S)Advanced cervical dilatation and low fetal station at emergency cesarean delivery in labor are independent predictors of cesarean scar location near or within the cervix, and these cervical scars heal less wel","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"164 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056652","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":"Levonorgestrel intrauterine system vs. hysteroscopic niche resection for postmenstrual spotting: a three-year randomized trial follow-up.","authors":"Lirong Yan,Chenfeng Zhu,Wei Xia,Yang Wang,Chuqing He,Qian Zhu,J A F Huirne,Ben W Mol,Jian Zhang","doi":"10.1016/j.ajog.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.011","url":null,"abstract":"OBJECTIVEBuilding on previous findings demonstrating that both the 52-mg levonorgestrel intrauterine system (LNG-IUS) and hysteroscopic niche resection significantly reduced niche-related postmenstrual spotting, with over 70% of patients achieving ≥50% reduction at six months and LNG-IUS showing superior efficacy beyond 9 months, this study evaluates the long-term effectiveness of both treatments in reducing niche-related postmenstrual spotting over36 months.STUDY DESIGNThis three-year follow-up stems from a single-center randomized trial. Women experiencing postmenstrual spotting after cesarean delivery, with Magnetic Resonance Imaging (MRI) -confirmed niche depth ≥ 2.0 mm and residual myometrium ≥ 2.2 mm, and without plans to conceive within one year, were randomized to receive either the 52-mg LNG-IUS or hysteroscopic niche resection. Main outcome of this long-term follow-up was the proportion of women achieving ≥50% reduction in spotting from baseline at 36 months. Secondary outcomes, including menstrual patterns, spotting discomfort, chronic pelvic pain, and satisfaction with treatment, were assessed at 18, 24, 30, and 36 months.RESULTSA total of 208 women were randomized (104 in each group), with 93 (89.4%) in the LNG-IUS group and 89 (85.6%) in the hysteroscopic niche resection group completing the three-year follow-up. At 36 months, 98.9% of women in the LNG-IUS group and 51.7% in the hysteroscopic group achieved a 50% reduction in spotting (RR, 1.91 [95% CI, 1.56 - 2.34]; p < 0.001). Spotting decreased progressively over time in the LNG-IUS group through 36 months (Ptrend = 0.001), whereas the hysteroscopic group showed reduction only until 24 months (p=0.007), followed by a slight increase. A significant time-treatment interaction was observed (p = 0.007), with LNG-IUS demonstrating superior spotting reduction from 24 months onward Additionally, the LNG-IUS group had fewer postmenstrual spotting days, total bleeding days (p < 0.001), and less pelvic pain (p < 0.010) from six months onward, with the difference widening over time. During the follow-up, 20 women in the LNG-IUS group reported hormone-related side effects, and two experienced partial expulsions. In the hysteroscopic group, five pregnancies were reported (three unintended, two planned) CONCLUSION: Over36 months, the 52-mg LNG-IUS was superior to hysteroscopic niche resection for reducing postmenstrual spotting, pelvic pain, and discomfort, while also offering contraceptive benefits in women with symptomatic niche. We recommend LNG-IUS as a first-line treatment for niche-related spotting in reproductive-age women with no fertility desire for at least the next year.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056651","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":"Insights into the Impact of BMI on Post-Treatment CIN3+ Risk (Letter-to-the-Editor).","authors":"Kuan-Ju Huang","doi":"10.1016/j.ajog.2025.09.005","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.005","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"24 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043749","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 the complex relationship between obesity and post-treatment CIN3+: Evidence gaps and clinical research priorities (Reply to Letter-to-the-Editor).","authors":"Megan A Clarke,Nicolas Wentzensen","doi":"10.1016/j.ajog.2025.09.004","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.09.004","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"21 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043752","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}