American journal of obstetrics and gynecology最新文献

{"title":"Uptake and outcomes associated with outpatient hysterectomy in Ontario, Canada.","authors":"Steven Habbous, Alinah Surani, Nicholas A Leyland, Ally Murji, Erik Hellsten","doi":"10.1016/j.ajog.2026.09.018","DOIUrl":"10.1016/j.ajog.2026.09.018","url":null,"abstract":"<p><strong>Objective: </strong>Hysterectomy is the second most common procedure performed among women and is increasingly being performed using minimally invasive techniques. In the this study, we examine the uptake of outpatient hysterectomy in the population of Ontario.</p><p><strong>Study design: </strong>We performed a retrospective population-based cohort study using administrative databases for all elective hysterectomies performed in Ontario, Canada between 2010 and 2024. We estimated the percentage of outpatients admitted and compared outpatients with inpatients on 90-day readmissions, 6-month complications, and 30-day perioperative health system costs. We used logistic regression to evaluate factors associated with the outpatient setting. To evaluate the association of outpatient setting on outcomes, we used propensity weighting.</p><p><strong>Results: </strong>After exclusions, a total of 228,934 patients were included. The number of hysterectomies decreased from 16,484 in fiscal year 2010/2011 to 14,748 in fiscal year 2019/2020, followed by a sharper decline during the COVID-19 pandemic and a recovery by fiscal year 2024/2025, with 16,195 procedures performed. The proportion (and number) of hysterectomies performed in the outpatient setting has increased since 2010, reaching 38% by fiscal year 2024/2025. Since 2021, of the 18,281 procedures with outpatient intent, 15,743 (86%) were completed as outpatient procedures and the remaining 2538 (14%) were subsequently admitted on the procedure date. Outpatients were younger, healthier, received surgery earlier in the day, required less operating time, received total laparoscopic-assisted vaginal hysterectomy (67% vs 27% for inpatients) or total laparoscopic hysterectomy (26% vs 15% for inpatients), and were treated by female surgeons and surgeons with greater experience (P<.0001 for all). There was substantial regional variation in the provision of outpatient hysterectomy, ranging from 0% to 100% across hospitals and surgeons. Outpatients were less likely to be readmitted within 90 days of surgery (readmissions: 676 [3.6%] outpatients vs 2076 [5.4%] inpatients; adjusted risk ratio, 0.83 (95% confidence interval, 0.74-0.93); P=.0009). Between surgery and 30 days postoperatively, outpatient hysterectomy cost the healthcare system $2546 less than inpatient hysterectomy.</p><p><strong>Conclusion: </strong>There has been a substantial uptake of outpatient hysterectomy in Ontario since 2010, with close to 40% of cases being performed as day surgery, with reassuring clinical outcomes and lower health system costs.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001200","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":"Diagnostic versus therapeutic thresholds for cervical lesions in persistent high-risk papillomavirus infection (reply to letter to the editor).","authors":"Joona Hulmi, Ilkka Kalliala, Annu Heinonen","doi":"10.1016/j.ajog.2026.09.010","DOIUrl":"10.1016/j.ajog.2026.09.010","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001130","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-spectrum validation is needed for cell-free RNA-based preoperative risk stratification (letter to the editor).","authors":"Tong Wang, Ran Tong, Zhixiang Huang","doi":"10.1016/j.ajog.2026.09.013","DOIUrl":"10.1016/j.ajog.2026.09.013","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001170","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":"An uninformative trial, not an equivalent one (Reply to Letter-to-the-Editor).","authors":"Katarzyna Kosińska-Kaczyńska, Robert Brawura-Biskupski-Samaha, Dorota Sys","doi":"10.1016/j.ajog.2026.09.024","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.024","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001188","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":"Persistence of activity restriction recommendations in U.S. pregnancy despite professional society guidance.","authors":"Beth L Pineles, Sarah Lindley, Maria A Fernandez, Gladys Smith, Ellen C Caniglia, Stefanie N Hinkle, Sunni L Mumford, Enrique F Schisterman, Lisa D Levine","doi":"10.1016/j.ajog.2026.09.006","DOIUrl":"10.1016/j.ajog.2026.09.006","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982215","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":"Patients at risk for preterm delivery: only 1 in 4 deliver within 24 hours of initial magnesium sulfate for fetal neuroprotection.","authors":"Natav Hendin, Moti Gulersen, Matthew J Blitz, Burton Rochelson, Frank A Chervenak, Eran Bornstein","doi":"10.1016/j.ajog.2026.09.005","DOIUrl":"10.1016/j.ajog.2026.09.005","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975492","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":"Risk factors for wound complications after second-degree tears or episiotomy - a secondary analysis of the REPAIR study.","authors":"Kathrine Perslev, Niels Klarskov, Thomas Bergholt, Hanna Jangö","doi":"10.1016/j.ajog.2026.09.004","DOIUrl":"10.1016/j.ajog.2026.09.004","url":null,"abstract":"<p><strong>Background: </strong>Risk factors for perineal wound complications have primarily been studied in women with obstetric anal sphincter injuries, whereas data in women with second-degree tears and episiotomy are limited.</p><p><strong>Objective: </strong>To identify risk factors for clinically relevant wound complications following second-degree perineal tear or episiotomy. We hypothesized that obstetric and repair-related factors would be associated with an increased risk of wound complications.</p><p><strong>Study design: </strong>This cohort study was based on data from a randomized controlled trial conducted at a university hospital in the Capital Region of Denmark from March to December 2023. A total of 442 women with second-degree perineal tears or episiotomy were included and randomized to prophylactic antibiotics or placebo. For this secondary analysis, participants were analyzed as a single cohort. Candidate variables were selected based on prior literature and clinical relevance. Multivariable logistic regression was performed, and results are presented as adjusted odds ratios with 95% confidence intervals.</p><p><strong>Results: </strong>Out of the 442 women in the study, 433 came for the initial consultation, of whom 55 (12.7%) had a clinically relevant wound complication. Prolonged active second stage of labor (adjusted odds ratio, 2.25; 95% confidence interval, 1.11-4.46) and deep tear (adjusted odds ratio, 2.11; 95% confidence interval, 1.10-4.24) were associated with increased risk of wound complications. Doctor involvement in suturing was also associated with the outcome (adjusted odds ratio, 2.47; 95% confidence interval, 1.20-4.96). Prophylactic amoxicillin-clavulanic acid reduced the risk of wound complications (adjusted odds ratio, 0.34; 95% confidence interval, 0.18-0.65). Episiotomy was not independently associated with the outcome in adjusted analysis (adjusted odds ratio, 2.01; 95% confidence interval, 0.92-4.21) but was retained in the model because it remained borderline associated with the outcome and has consistently been identified as a relevant risk factor in previous studies.</p><p><strong>Conclusion: </strong>In this exploratory analysis, prolonged active second stage of labor and deep tear were associated with increased risk of wound complications. Doctor involvement in suturing was also associated with the outcome, although this finding may reflect residual confounding by tear complexity. Prophylactic antibiotics were protective. These findings may support targeted postpartum follow-up in high-risk women.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966069","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":"Prenatal imaging features of supratentorial subpial hemorrhage.","authors":"Efrat Hadi, Shai Shrot, Jonathan Weidenfeld, Chava Rosen, Leah Leibovitch, Chen Hoffmann, Eran Kassif","doi":"10.1016/j.ajog.2026.09.003","DOIUrl":"10.1016/j.ajog.2026.09.003","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944099","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":"Management of multiple sclerosis during pregnancy and the reproductive years in 2026: an expert clinical review.","authors":"Alexandra Balshi, Ruth Dobson, Maria Houtchens, Kylie McConville, Thomas F McElrath, A Dessa Sadovnick, Martha Tesfalul, Kerstin Hellwig, Riley Bove","doi":"10.1016/j.ajog.2026.08.043","DOIUrl":"10.1016/j.ajog.2026.08.043","url":null,"abstract":"<p><p>Women's neurology and obstetrics/gynecology experts convened to consolidate the best available evidence on multiple sclerosis management in reproductive-aged women, especially regarding the use of multiple sclerosis disease-modifying therapies surrounding pregnancy and lactation. To update 2014 clinical recommendations, an expert clinical review informed by a systematic literature search of PubMed, LactMed, and ClinicalTrials.gov was conducted utilizing keywords \"multiple sclerosis\" and \"pregnancy.\" A total of 774 papers were screened for inclusion. To provide updated guidelines, 2 reviewers prioritized studies according to strength of evidence and relevance to validating/updating our clinical management recommendations. To provide updated information about pregnancy and lactation safety of available multiple sclerosis disease-modifying therapies, an additional reviewer synthesized all available studies. All authors then reviewed data to craft consensus guidelines. We encourage collaborative care models to optimize symptom control, social support, and maternal wellbeing before, during, and after pregnancy. In most cases, multiple sclerosis is not associated with increased risks of adverse pregnancy outcomes, although some studies have reported slightly elevated risks of lower birthweight, preterm birth, and operative delivery. With appropriate monitoring, MS disease activity can often be minimized throughout the childbearing period by continuation or strategic timing of many disease-modifying therapies to optimize maternal disease control while minimizing fetal risk. The postpartum period represents a period of increased medical and psychological risk, and close follow-up is recommended. After childbearing is complete, gynecological care can shift to prevention and management of gynecological complications (disease-modifying therapy-associated infections and risk of cervical dysplasia) and of the menopausal transition.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910533","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":"Incidence, survival, and symptoms at recurrence among vulvar cancer patients treated with curative intent: a population-based cohort study.","authors":"Louise Krog, Tine H Schnack, Ligita P Frøding, Katrine Fuglsang, Peter Christensen, Liselotte P Due, Mogens Groenvold, Lars Dyrskjøt, Pernille T Jensen","doi":"10.1016/j.ajog.2026.08.047","DOIUrl":"10.1016/j.ajog.2026.08.047","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Vulvar cancer is a rare and mutilating disease with a high recurrence rate. Prior studies have reported relatively favorable survival rates after primary disease, while survival after recurrence is poor. Yet there is limited knowledge on recurrence and survival patterns following primary diagnosis, first, and second recurrence. Although many recurrences are local, their detection may be challenged by limitations in self-examination and inadequate knowledge of symptoms. Consequently, further knowledge of symptoms preceding a vulvar cancer recurrence may improve understanding of early manifestations to inform patient education and support early detection and treatment of recurrent disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In this study, we aimed to describe recurrence incidences for first, second, and third recurrence, estimate overall survival following primary diagnosis, first, and second recurrence, and identify symptoms preceding first recurrence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;We conducted a population-based nationwide cohort study in Denmark. All patients with primary vulvar squamous cell carcinoma who were prospectively registered in the Danish Gynecological Cancer Database during 2011 to 2022 and who underwent curatively intended treatment were included. Data were validated and enriched with data from hospital charts. The cumulative incidences of first, second, and third recurrence were estimated using the Aalen-Johansen estimator, accounting for death before recurrence as a competing event. Overall survival was estimated by the Kaplan-Meier method. Symptom analyses were descriptive and included symptom frequencies stratified by recurrence location and visual exploration of symptom co-occurrence using selected 2×2 tables and bar-chart summaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 800 patients with a median follow-up of 68.8 months (interquartile range 39.7-104.9). The cumulative incidence of first recurrence was 19.2% (95% confidence interval, 16.6-22.1) at 24 months and 35.0% (95% confidence interval 31.3-38.8) at 120 months. The 5-year overall survival following primary diagnosis was 73.3% (95% confidence interval, 69.9-76.3), decreasing to 38.2% (95% confidence interval, 31.5-44.9) following the first recurrence, though only to 49.8% (95% confidence interval, 40.1-58.7) following the first isolated local recurrence. More than half of the patients with a recurrence had an isolated local recurrence (n=149, 58.9%), one fourth had a distant recurrence (n=60, 23.7%), and only a few had either a locoregional (n=17, 6.7%) or an isolated regional recurrence (n=22, 8.7%). Median time from completion of primary treatment to local, locoregional, regional, or distant recurrence was 24.5 (interquartile range , 10.5-43.7), 7.0 (interquartile range, 3.9-23.7), 8.1 (interquartile range, 4.9-13.3), and 9.0 (interquartile range, 4.8-19.4) months, respectively. Nearly all patients with a local, locoregional","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904583","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}