American journal of obstetrics and gynecology最新文献

{"title":"Improving epidemiology synthesis of postpartum complications: methodological considerations","authors":"Jeffrey N. Bone PhD, Janny Xue Chen Ke MD MSc FRCPC, Mike Wong MD FRCPC, Justine Dol PhD, Anthony Chau MD MSc FRCPC, Brendan Carvalho MBBCh FRCA, Qian Zhang MPH, Pervez Sultan MBChB FRCA MD(Res)","doi":"10.1016/j.ajog.2025.06.031","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.031","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"45 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337717","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":"Recommended Standardized Terminology Related to the Clitoris and Vestibular Bulbs Based on a Structured Medical Literature Review.","authors":"Julia K Shinnick,Peter C Jeppson,Donna Mazloomdoost,Sunil Balgobin,Audra Jolyn Hill,Kavita Mishra,Katarzyna Bochenska,Saifuddin T Mama,Thomas Wheeler,Ethan M Balk,Marlene M Corton,John Delancey","doi":"10.1016/j.ajog.2025.06.025","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.025","url":null,"abstract":"BACKGROUNDThere is lack of consensus related to anatomy terminology used to describe the clitoris and vestibular bulbs.OBJECTIVETo report the current state of clitoral and vestibular bulb anatomy terminology in medical literature and compare it to Terminologia Anatomica (TA). The secondary objective is to propose standardized terminology to describe clitoral and vestibular bulb anatomy.STUDY DESIGNPubMed was searched from inception through May 19, 2025 to identify studies reporting on the anatomy of the human clitoris and vestibular bulbs. Studies were included if they had full-text versions available in English and described clitoral anatomy. Articles describing endocrinologically or surgically altered clitoral anatomy were excluded. Select textbooks containing information related to gynecologic anatomy and information collected through prior projects of the SGS Pelvic Anatomy group were also included. Terminology related to the clitoris was extracted, reviewed, and categorized. Through group consensus, categorized terms were deemed accepted, controversial (requiring further description), rejected, or proposed as new terminology.RESULTSLiterature search yielded 4738 abstracts and 4 textbooks, which were supplemented with an additional 33 abstracts and 6 textbooks. Ultimately, 184 full text manuscripts and 10 textbooks were included. Six-hundred eighty-seven terms that described 22 well-defined components of the clitoris and vestibular bulbs were identified. Seven terms were categorized as controversial, 6 were rejected, and 2 new terms- clitoral-vestibular septum and clitoral root -are proposed. Regarding the vascular supply to the clitoris, 8 controversial terms were identified and 1 term was rejected. Regarding clitoral innervation, 4 terms were deemed controversial, 5 were rejected, and 1 new term is proposed- spongiosus nerve of the vestibular bulb. Eleven terms described the lymphatic drainage of the clitoris, none were deemed controversial or rejected. Expanding current TA terminology to describe the homologous female structures is recommended for the following terms: Cavernous spaces of corpora cavernosa (A09.4.01.022); Cavernous spaces of corpus spongiosum (A09.4.01.023); Trabeculae of corpora cavernosa (A09.4.01.020); Tunica albuginea of corpora cavernosa (A09.4.01.017); Tunica albuginea (A09.1.01.009).CONCLUSIONCurrently, terminology used to describe the anatomy of the human clitoris and vestibular bulbs varies. Adoption of standardized terminology can improve communication between anatomists, medical professionals, and learners.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"241 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337493","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 medication abortion with vs without screening ultrasonography or pelvic examination.","authors":"Leah R Koenig, Elizabeth G Raymond, Ushma D Upadhyay, Laura J Frye, Bliss Kaneshiro, Christy M Boraas, Catherine E Oldenburg, David V Glidden","doi":"10.1016/j.ajog.2025.06.013","DOIUrl":"10.1016/j.ajog.2025.06.013","url":null,"abstract":"<p><strong>Background: </strong>Before the COVID-19 pandemic, clinicians in the United States routinely required in-person screening tests such as ultrasonography or pelvic examination for medication abortion care. To minimize physical contact during the pandemic, clinicians began providing \"no-test\" medication abortion care, which can improve access by facilitating care from a broader range of clinicians, lowering costs, and reducing wait times. Despite evidence that medication abortion without in-person screening tests is safe and effective, screening ultrasound and pelvic examination remain common when medication abortion care is provided in person.</p><p><strong>Objective: </strong>In this cohort study, we compared the effectiveness and safety of medication abortion provided with and without in-person screening tests, specifically ultrasonography or pelvic examination.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of medication abortions provided as a part of regular clinical practice by 3 US clinics from February 2020-January 2021. Clinics abstracted medical record data for all patients with gestations <77 days who had neither screening ultrasonography nor pelvic examination (\"no-test\" group) and a random sample who had either test (\"screening test\" group). Participating clinics provided medication abortion care both with and without screening tests during the study period, and patients were screened either in person or via telehealth in both study groups. We imputed missing data and used inverse-probability-of-treatment-weighted logistic regression to compare abortion effectiveness (complete abortion without additional treatment), safety (abortions not involving major adverse events), emergency department visits, and abortions inadvertently provided beyond 77 days (a commonly used pregnancy duration limit for medication abortion) between study groups.</p><p><strong>Results: </strong>We included 649 abortions with and 1727 abortions without screening tests. Patients who obtained medication abortion without screening ultrasonography or pelvic examination had lower average pregnancy durations (48 vs 50 days, P<.001), were more likely to be White (43% vs 32%, P<.001), were less likely to reside in urban areas (78% vs 83%, P=.004), were more likely to receive abortion medications by mail (35% vs 1%, P<.001), and were more likely to pay out-of-pocket for abortion costs (62% vs 55%, P=.002). Abortion outcomes were documented for 72% of the screening test group and 58% of the no-test group (P<.001). After imputing missing outcome data, we found similar effectiveness (95.3% vs 93.4%; risk difference, -1.9% [95% confidence interval, -6.9%, 3.1%]) and safety (99.8% vs 98.7%; risk difference, -1.1% [95% confidence interval, -2.9%, 0.7%]) between the screening test and no-test groups. Complete case analyses also found similar effectiveness (95.8% vs 94.1%; risk difference, -1.7% [-4.4%, 1.1%]) and safety (100.0% vs 99.2%","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293196","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":"Prediction of successful labor induction using 15-hydroxyprostaglandin dehydrogenase in cervicovaginal fluid.","authors":"Yusuke Ueda,Haruta Mogami,Yuki Tomono,Masato Kurokawa,Yoshitsugu Chigusa,Satoshi Morita,Eiji Kondoh","doi":"10.1016/j.ajog.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.026","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"268 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337495","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":"AJOG GR Table of Contents","authors":"","doi":"10.1016/S0002-9378(25)00324-2","DOIUrl":"10.1016/S0002-9378(25)00324-2","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 1","pages":"Page A8"},"PeriodicalIF":8.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307316","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":"Information for readers","authors":"","doi":"10.1016/S0002-9378(25)00322-9","DOIUrl":"10.1016/S0002-9378(25)00322-9","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 1","pages":"Page A6"},"PeriodicalIF":8.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307314","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":"2024 AJOG Top Reviewers","authors":"","doi":"10.1016/S0002-9378(25)00392-8","DOIUrl":"10.1016/S0002-9378(25)00392-8","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 1","pages":"Page A9"},"PeriodicalIF":8.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307317","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":"AJOG MFM Table of Contents","authors":"","doi":"10.1016/S0002-9378(25)00323-0","DOIUrl":"10.1016/S0002-9378(25)00323-0","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"233 1","pages":"Page A7"},"PeriodicalIF":8.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307315","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":"Late preterm prelabor rupture of membrane (>33 weeks): the risk of intraamniotic inflammation and fetal inflammation is influenced by the cervical microbial ecosystem and cervical inflammation.","authors":"Marian Kacerovsky, Filip Vrbacky, Jana Matulova, Radka Bolehovska, Rudolf Kukla, Ladislava Pavlikova, Magdalena Holeckova, Marek Lubusky, Ivana Musilova, Bo Jacobsson, Antonin Libra","doi":"10.1016/j.ajog.2025.06.017","DOIUrl":"10.1016/j.ajog.2025.06.017","url":null,"abstract":"<p><strong>Background: </strong>Approximately 25% to 30% of pregnancies with late preterm prelabor rupture of membranes are complicated by the development of fetal inflammatory response syndrome, which is characterized by elevated levels of interleukin 6 in fetal blood. Fetal inflammatory response syndrome represents a serious condition that can induce temporary or persistent changes in multiple essential fetal organs. Most importantly, fetal inflammatory response syndrome may impact infant neurodevelopment and increase the risk of neuropsychiatric disorders.</p><p><strong>Objective: </strong>To characterize the cervical microbial ecosystem and cervical fluid interleukin 6 levels in late preterm prelabor rupture of membrane (34 0/7 - 36 6/7 weeks) with respect to intraamniotic inflammation and microbial invasion of the amniotic cavity and the development of fetal inflammatory response syndrome.</p><p><strong>Study design: </strong>This retrospective cohort study included women with singleton pregnancies complicated by late preterm prelabor rupture of membrane, in whom amniocentesis was performed at admission to assess intraamniotic environment. Cervical fluid samples were collected using Dacron swabs upon admission. The samples were used for DNA isolation with sequencing of 16S ribosomal RNA gene and analysis of interleukin 6 levels. The cervical microbiota was classified based on the relative abundance of Lactobacillus species. Interleukin 6 levels in cervical fluid were measured using electrochemiluminescence. Fetal inflammatory response syndrome was defined as the concentration of interleukin 6 >11.0 pg/mL in umbilical cord blood.</p><p><strong>Results: </strong>A total of 114 women with late preterm prelabor rupture of membrane were included in this study. In total, 378 microbial taxa were identified in the cervical samples. Dominant abundance (≥50%) of Lactobacillus iners and the depletion (<50%) of Lactobacillus spp. were the most prevalent cervical ecosystems in women with intraamniotic infection (63% [5/8]) and microbial invasion of the amniotic cavity without inflammation (82% [9/11), respectively. Women whose fetuses developed fetal inflammatory response syndrome had a lower prevalence of Lactobacillus crispatus dominant cervical microbiota (2% [1/42] vs 43% [31/72]); P<.0001) and higher prevalences of Lactobacillus iners dominant (38% [16/42] vs 19% [14/92]; P=.05) and Lactobacillus spp. depleted cervical microbiotas (55% [23/42] vs 32% [23/72]; P=.02), compared to those whose fetuses did not develop fetal inflammatory response syndrome. In the group of women with amniotic fluid negative for inflammation and microorganisms, fetal inflammatory response syndrome was associated with a lower prevalence of Lactobacillus crispatus dominant microbiota (0% [0/25] vs 46% [29/63]; P<.0001) and a higher prevalence of Lactobacillus iners dominant microbiota (44% [11/25] vs 20% [13/63]; P=.04). Cervical fluid interleukin 6 levels were highest in wo","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293198","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":"Assessment of risk for small for gestational age at midgestation to define subsequent care.","authors":"Ioannis Papastefanou, Argyro Syngelaki, Vasileios Logdanidis, Ranjit Akolekar, Kypros H Nicolaides","doi":"10.1016/j.ajog.2025.06.016","DOIUrl":"10.1016/j.ajog.2025.06.016","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have demonstrated that a competing risks model for the prediction of small-for-gestational-age neonates has a superior performance than traditional risk scoring methods. The Fetal Medicine Foundation fetal and neonatal population weight charts are derived from sonographic estimated fetal weight rather than birthweight because a large proportion of neonates born before term result from pathologic pregnancy. The individualized risk assessment for small for gestational age at midgestation could be the basis of an antenatal plan that aims to improve the management of preterm pregnancies with small for gestational age with minimum resources.</p><p><strong>Objective: </strong>This study aimed to stratify subsequent assessments after 24 weeks of gestation based on the estimated risk of delivery of small-for-gestational-age neonates at <28, <32, and <36 weeks of gestation using the combination of maternal risk factors, with estimated fetal weight and uterine artery pulsatility index (triple test) assessed at midgestation. The rationale of the study is that pregnancies at high risk of small for gestational age at <28, <32 and <36 weeks of gestation would require ultrasound examinations at 26, 30, and 33 weeks of gestation, respectively.</p><p><strong>Study design: </strong>The study cohort was derived from a prospective, nonintervention study in women with singleton pregnancies attending for a routine ultrasound scan between 19 0/7 and 23 6/7 weeks of gestation in 2 United Kingdom maternity hospitals. The competing risks model was used to estimate the individual patient-specific risks of delivery of a small-for-gestational-age neonate at <36 weeks of gestation from the triple test. Different risk cutoffs were used with the intention of detecting 80%, 85%, and 90% of cases of delivery with small for gestational age at <28, <32, and <36 weeks of gestation. Discrimination measures using sensitivities, specificities, and positive and negative predictive values were computed for different risk cutoffs. The calibration of risks of delivery of small for gestational age at <36 weeks of gestation was assessed by plotting the observed incidence of small for gestational age against the predicted incidence.</p><p><strong>Results: </strong>The study population of 134,443 singleton pregnancies contained 16,813 pregnant women (12.51%) who subsequently delivered small-for-gestational-age neonates with birthweights of <10th percentile, as defined by the Fetal Medicine Foundation chart, including 196 (0.15%), 566 (0.42%), and 1787 (1.33%) pregnant women who delivered at <28, <32, and <36 weeks of gestation, respectively. Using the Fetal Medicine Foundation chart to define small for gestational age, if the objective of screening was to identify approximately 80% of cases of delivery of small-for-gestational-age neonates with birthweights of <10th percentile at <28, <32, and <36 weeks of gestation, the respective screen-positi","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293173","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}