American journal of obstetrics and gynecology最新文献

{"title":"I feel pain, not pressure: a personal and methodological reflection on pain during cesarean delivery.","authors":"Rachel Somerstein","doi":"10.1016/j.ajog.2025.06.036","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.036","url":null,"abstract":"<p><p>Cesarean delivery is one of the most common operations in the world, and a growing number of cesarean deliveries are performed in the United States each year. Despite the operation's relative safety, pain during cesarean delivery is common, ranging from 1.2% of births to more than a third of births depending on the institution, how pain during cesarean delivery is measured, and the type of analgesia used. The intensity of pain during a cesarean delivery varies as well, and evidence suggests that its frequency may be underreported. Yet, intraoperative pain poses serious risks for mothers' wellbeing, particularly because it can trigger childbirth-related posttraumatic stress disorder, which, in turn, hurts mothers psychologically and physiologically and impairs their capacity to bond with their babies. Despite how common pain during cesarean delivery is and in spite of its consequences, there is a lack of widespread agreement on how to prevent or to treat intraoperative pain and few examples of patient-narrated experiences of it. In this Special Article, I sought to contribute my own experience with intraoperative pain during a cesarean delivery, the development of childbirth-related posttraumatic stress disorder, and the use of Eye Movement Desensitization and Reprocessing for treatment. I also reviewed the evolution of the literature on pain during cesarean delivery from surrogate markers of pain to studies that focused on patients' reports of pain during cesarean delivery, a methodological shift that will expand the identification and treatment of intraoperative pain. I introduce geographer Nancy Hiemstra's notion of periscoping, a method used to identify problems or voices that may be hidden from view and propose that such methods, although useful, may miss capturing such subjective experiences as pain. I then propose that the recent focus on patient-reported pain is emblematic of a paradigm shift in maternal care to devote greater attention to women's pain. The implications of this paradigm shift might include not only addressing intraoperative pain but also present clinicians and researchers with an opportunity to focus on other common but similarly overlooked aspects of cesarean birth that may benefit from patient-centered inquiry and methodological approaches. These include the difficulties of postpartum recovery and the limitations that cesarean deliveries can place on family size. I close by highlighting the gap between cesarean delivery as a routine procedure and patients' experiences of it-an opportunity for clinicians to recognize and address, through prenatal and postpartum education, the short- and long-term major and minor consequences of cesarean birth.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144870893","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 relationship between virtual antenatal care and pregnancy outcomes in a diverse UK inner-city population: a group-based trajectory modeling approach using routine health records.","authors":"Kathryn V Dalrymple, Florence Tydeman, Jeffrey N Bone, Lucilla Poston, Tisha Dasgupta, Alice McGreevy, Milly G Wilson, Abigail Easter, Asma Khalil, Sara L White, Sergio A Silverio, Lisa Long, Daghni Rajasingam, Hiten D Mistry, Peter von Dadelszen, Laura A Magee","doi":"10.1016/j.ajog.2025.08.004","DOIUrl":"10.1016/j.ajog.2025.08.004","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic resulted in major reconfiguration of maternity services, particularly an increase in virtual antenatal care.</p><p><strong>Objective: </strong>We explored associations between virtual antenatal care trajectories and pregnancy outcomes.</p><p><strong>Study design: </strong>Pregnancy and birth outcome data were obtained from a multiethnic and socioeconomically deprived UK inner-city population before and during the pandemic (with and without lockdown). Data were collected using a health record data linkage from the Born in South London cohort. Antenatal care was characterized by the number of outpatient contacts during 6 gestational windows: 0 to 14⁺⁶, 15 to 20⁺⁶, 21 to 27⁺⁶, 28 to 32⁺⁶, 33 to 36⁺⁶, and ≥37 weeks' gestation. In each window, the proportion of virtual antenatal care was grouped into quartiles, and group-based trajectory modeling was used to extract virtual antenatal care trajectories. Associations between these trajectories and pregnancy outcomes were explored using adjusted multinominal logistic regression.</p><p><strong>Results: </strong>The analysis included 34,114 mother-child dyads (October 2018-July 2023). Group-based trajectory modeling suggested 4 trajectories of virtual antenatal care contacts: low and stable virtual care throughout pregnancy (Trajectory 0; n=27,751 pregnancies, 81.3%), high first trimester virtual care (Trajectory 1; n=832, 2.4%), high second trimester virtual care (Trajectory 2; n=2,410, 7.1%), and high third trimester virtual care (Trajectory 3; n=3,121, 9.2%). Following adjustment, compared with the low and stable group (Trajectory 0), high second trimester virtual care was associated with less gestational hypertension (adjusted relative risk ratio, 0.84; 95% confidence interval, 0.74-0.96) and assisted vaginal birth (0.87 [0.76-1.00]), and more premature births (<37 weeks, 1.21 [1.02-1.44]), labor induction (1.13; 1.02-1.25), breech presentation (1.92; 1.02-3.62), and postpartum hemorrhage (1.14; 1.00-1.30). Similarly, compared to the low and stable group (Trajectory 0), high third trimester virtual care had less gestational hypertension (0.84 [0.73, 0.96]), more premature births (<37 weeks; 1.35; 1.16-1.58) and elective (1.54; 1.38-1.72) or emergency (1.21; 1.01-1.34) cesarean sections, and neonatal intensive care admissions (1.28; 1.09-1.50); fewer third-degree/fourth-degree vaginal tears (0.82; 0.75-0.90); and less early infant skin-to-skin contact (0.82; 0.73-0.92) and breastfeeding (0.90; 0.81-0.99).</p><p><strong>Conclusion: </strong>A higher proportion of virtual care contacts in antenatal care in the second or third trimesters was associated with a greater risk of adverse pregnancy outcomes.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144843994","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 ultrasound to inform the surgical approach to cesarean delivery in patients at high risk for placenta accreta spectrum disorders.","authors":"Rozi Aditya Aryananda,Theophilus K Adu-Bredu,Nareswari Imanadha Cininta,Clement Twumasi,Savitree Pranpanus,Conrado Milani Coutinho,Bayu Priangga,Qurrata Akyuni,Heleen J van Beekhuizen,Albaro Jose Nieto-Calvache,José Miguel Palacios-Jaraquemada,Cheria Valentina,Erry Gumilar Dachlan,Grace Ariani,Christoph C Lees,Hans Duvekot","doi":"10.1016/j.ajog.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.08.005","url":null,"abstract":"BACKGROUNDUterine sparing surgery has become an option for patients with placenta accreta spectrum disorders. The decision to perform a cesarean hysterectomy versus uterine sparing surgery is made intraoperatively. This study was undertaken to assess the value of ultrasound markers in predicting hysterectomy.OBJECTIVETo describe ultrasound markers associated with the need for cesarean hysterectomy in patients at risk of placenta accreta spectrum.STUDY DESIGNThis was an analysis of a prospectively collected data of high risk placenta accreta spectrum patients between September 2023 and August 2024. Ultrasound examination was performed by an expert focusing on the diagnosis of placenta accreta spectrum. All patients were counselled regarding the management options available at our center, namely uterine-sparing surgery and hysterectomy. All patients opted for a uterine sparing surgery if safe and technically feasible. The final choice of surgical management approach was solely based on the intraoperative topography which describes the size and location of the abnormally adhered placenta. The primary outcome was the need for hysterectomy despite a preoperative plan for uterine-sparing surgery.RESULTSA total of 123 participants were enrolled: 93 placenta accreta spectrum cases and 30 non-placenta accreta scar dehiscence cases. Uterine sparing surgery was successful in 74 out of 93(79.6%) placenta accreta spectrum cases and 100% non-placenta accreta scar dehiscence cases. Least Absolute Shrinkage and Selection Operator penalised regression revealed intracervical hypervascularity >50%, distorted urinary bladder wall, and parametrial hypervascularity as the most influential predictors for hysterectomy. This best-fitted model achieved accuracy of 94% (95% CI: 81.3% - 99.3%) after model cross-validation. The combination of intracervical hypervascularity >50% and distorted bladder wall had the highest predictive probability for hysterectomy, with a value of 0.87 (95% CI: 0.81 - 0.93), sensitivity of 96.0% (95% CI 89.0 - 99.0%) and specificity of 92.0%(95% CI 62.0 - 100.0).CONCLUSIONComprehensive preoperative ultrasound can reasonably predict the appropriate surgical approach to placenta accreta spectrum. This can be achieved by assessing intracervical hypervascularity and a distorted urinary bladder wall using a combination of transabdominal, transvaginal, and color Doppler ultrasound techniques, as these signs have a strong correlation with the need for hysterectomy in a cohort where the intention to treat was uterine sparing surgery.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"8 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812960","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":"Reassessing Survival Outcomes: A Closer Look at the Randomized Trial on Minimally Invasive Surgery for Endometrial Cancer (Letter-to-the-Editor).","authors":"Kuan-Ju Huang,Dan-Yun Liu,Chu-Chun Huang","doi":"10.1016/j.ajog.2025.08.002","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.08.002","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"10 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805733","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":"Ultrasound Screening for Vasa Previa: A Systematic Review and Meta-Analysis.","authors":"Bridget Donovan,Giulia Bonanni,Ali Javinani,Paul Bain,Ethan Litman,Elizabeth Lucarelli,Richard Bronsteen,Anthony Odibo,Alireza A Shamshirsaz,Yinka Oyelese","doi":"10.1016/j.ajog.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.08.003","url":null,"abstract":"OBJECTIVETo evaluate the prenatal detection of vasa previa (VP) and perinatal survival in studies that implemented standardized protocols of prospective second-trimester ultrasound screening protocols followed by ultrasound confirmation in the third trimester.DATA SOURCESPubMed/MEDLINE, Web of Science, EMBASE, Global Health, and Global Index Medicus were searched from inception to February 16, 2024.STUDY ELIGIBILITYWe included cohort studies that implemented standardized second-trimester ultrasound protocols - either universal or targeted - for VP screening, with third-trimester ultrasound confirmation and verification at delivery, over at least one year. Eligible studies reported both the total number of pregnancies screened and the number of confirmed VP cases. Protocols included assessment of placental cord insertion, cervical region imaging, and transvaginal color Doppler in at-risk patients. We excluded first-trimester-only screening, case reports, reviews, conference abstracts, and overlapping populations.STUDY APPRAISAL AND SYNTHESIS METHODSTwo reviewers independently screened studies and extracted data, with discrepancies resolved by consensus. Risk of bias was assessed using QUADAS-2. Meta-analyses of sensitivity, specificity, and perinatal survival were conducted using fixed-effects models with inverse-variance weighting using R version 4.4.0 (R Core Team, 2024). Heterogeneity was assessed with chi-square, τ2, and I2 statistics. Sensitivity analyses excluded studies with high risk of bias. Publication bias was evaluated using funnel plots and Egger's test.RESULTSOf 1,817 publications, 19 met inclusion criteria, encompassing 779,845 pregnancies and 505 VP cases (1 in 1,544). Of these, 494 (97.8%) were diagnosed prenatally. The pooled sensitivity of standardized second-trimester ultrasound screening - with third-trimester confirmation - was 1.00 (95% CI: 0.99-1.00; I2 = 0%), and specificity was also 1.00 (95% CI: 1.00-1.00; I2 = 0%), based on 774,937 pregnancies and 11 false positives. Perinatal survival among prenatally diagnosed cases ranged from 87.5% to 100%, with a pooled survival rate of 98.15% (95% CI: 88.30%-100.00%; I2 = 0%). Results remained consistent after excluding studies at high risk of bias. No evidence of publication bias was found.CONCLUSIONSStandardized screening for VP is associated with a high detection rate and high perinatal survival, with minimal false-positive and false-negative rates. These findings make a strong case for standardized screening for VP.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805732","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":"Long-term oncological outcomes support the use of robotic-assisted surgery in endometrial cancer (Reply to Letter-to-the-Editor).","authors":"Elina Kivekäs,Synnöve Staff,Minna M Mäenpää","doi":"10.1016/j.ajog.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.08.001","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144802538","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 Stark (Misgav Ladach) Cesarean Delivery A Streamlined Surgical Technique: Development, Rationale and Clinical Outcomes.","authors":"Michael Stark","doi":"10.1016/j.ajog.2025.07.048","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.048","url":null,"abstract":"BACKGROUNDCesarean delivery (CD) rates have risen globally, yet many steps of the procedure remain unstandardized. Wide variation in abdominal and uterine incisions, peritoneal handling, and closure techniques hinders meaningful comparisons of outcomes. To improve outcomes and facilitate comparison among surgeons and hospitals, a standardized surgical approach was developed at the Misgav Ladach Hospital through an iterative, critical evaluation of each operative step. Guided by minimally invasive surgical principles, the method favors gentle separation along natural anatomical planes, reducing trauma and the need for dissection. Only essential steps were retained and optimized, resulting in what is now termed the Stark (Misgav Ladach) Cesarean technique. Over 30 years of implementation, both in low- and high-resource settings, has demonstrated superior outcomes compared with conventional methods. These include shorter skin-to-delivery time, reduction in blood loss and febrile morbidity, fewer adhesions and decreased need for analgesics.OBJECTIVEThis article aims to describe the surgical steps and rationale of the Stark (Misgav Ladach) Cesarean Delivery as a guideline suggestion for the global implementation of this method and as a model for standardization for other surgical procedures.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792131","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":"Treatment of Traumatic Birth Experience with Postpartum Early Eye Movement Desensitization and Reprocessing Therapy: A Randomized Clinical Trial.","authors":"Yvette M G A Hendrix,Maria G van Pampus,Amy Hofman,Jens Henrichs,Henriëtte E van der Horst,Ad de Jongh","doi":"10.1016/j.ajog.2025.07.051","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.051","url":null,"abstract":"BACKGROUNDA traumatic birth experience can have negative consequences for both mother and infant, including developing (symptoms of) posttraumatic stress disorder, postpartum depression, difficulties in mother-infant bonding, fear of childbirth, or reduced quality of life.OBJECTIVESThis study aimed to investigate the effectiveness and safety of early trauma-focused therapy, specifically eye movement desensitization and reprocessing therapy, in reducing symptoms and incidence of posttraumatic stress disorder at nine weeks postpartum in women with a traumatic birth experience, compared with care as usual (controls).STUDY DESIGNA randomized controlled trial was conducted in a hospital and 25 midwifery practices in Amsterdam, the Netherlands, enrolling women within fourteen days postpartum who reported a traumatic birth experience. The participants received two eye movement desensitization and reprocessing therapy sessions of 60 min per session (treatment group) or two telephone calls (controls) between two and five weeks postpartum. The primary outcome was symptoms of posttraumatic stress disorder at nine weeks postpartum measured by the self-report questionnaire PTSD Checklist for DSM-5 (PCL-5, cutoff ≥29 indicative of posttraumatic stress disorder) and the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), a structured interview. Secondary outcomes included symptoms of depression, mother-infant bonding, fear of childbirth, quality of life, and breastfeeding rates.RESULTSOf 10,963 women screened, 861 reported a traumatic birth experience and 151 participants were randomly assigned (1:1) to the treatment group (n=76) or control group (n=75). After randomization, seven participants withdrew informed consent and one participant was inaccessible leaving 74 participants in the treatment group and 69 in the control group for intention-to-treat analyses. The treatment group showed a larger reduction in PCL-5 scores than the control group (adjusted mean difference on square root scale =-0.82, 95% CI -1.24 to -4.04; P <0.001, mean difference =-8.7 points). Square root transformed CAPS-5 symptom severity scores were significantly lower in the treatment group (adjusted mean difference=-0.73, 95% CI -1.23 to -0.23, P =0.004, mean difference =-3.8 points). The incidence of probable posttraumatic stress disorder decreased more in the treatment group (39.2% (n=29) to 11.1% (n=8)) than in controls (44.9% (n=31) to 29.2% (n=19)); adjusted odds ratio=0.32, 95% CI 0.14 to 0.73; P =0.006. However, posttraumatic stress disorder diagnosis rates per CAPS-5 were not significantly different between groups: three participants (4.2%) in the treatment group versus six participants (9.1%) in the control group, P =0.310. Eye movement desensitization and reprocessing therapy reduced depressive symptoms (P <0.001), symptoms of mother-infant bonding difficulties (P =0.008), fear of childbirth (P =0.001), and quality of life in the psychological domain (P =0.006). No differences","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"31 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792142","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":"Aspirin Continuation Trial: Response to Feedback and Areas for Future Study (Reply to Letter-to-the-Editor).","authors":"Virginia Y Watkins,Brenna Hughes","doi":"10.1016/j.ajog.2025.07.053","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.053","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"26 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777816","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":"Optimizing Postpartum Cardiovascular Care: Reflections on Aspirin Continuation Trials (Letter-to-the-Editor).","authors":"Zheying Huang,Longfei You","doi":"10.1016/j.ajog.2025.07.052","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.07.052","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777817","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}