Pub Date : 2025-12-11DOI: 10.1097/aog.0000000000006146
Emily A Donelan,Alexandra Morgan,Jessica Densmore,Kelsey Murray,Molly Hanlon Taub,Mandy Martel,Caitlin Yazel,Joel Bradley,Ella A Damiano
Despite rapidly advancing progress in some areas of pregnancy care, cohesion and interprofessional communication during labor management are dangerously protracted in modern obstetrics. Current discrepancies in national guidelines among professional organizations-specifically the American College of Obstetricians & Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses-create conditions for the breakdown of interprofessional teamwork on the labor unit, leading to dystocia both of labor and communication. This article highlights areas of agreement and disagreement between published documents from each professional organization that lead to conflict at the bedside. We propose a purposeful national program of guideline reconciliation in concert with our professional organizations to help bridge these gaps. Finding common ground in current evidence will allow teams to restore trust and ensure collaborative care for patients.
{"title":"Professional Guideline Discrepancies as a Barrier to Labor Progress and Teamwork.","authors":"Emily A Donelan,Alexandra Morgan,Jessica Densmore,Kelsey Murray,Molly Hanlon Taub,Mandy Martel,Caitlin Yazel,Joel Bradley,Ella A Damiano","doi":"10.1097/aog.0000000000006146","DOIUrl":"https://doi.org/10.1097/aog.0000000000006146","url":null,"abstract":"Despite rapidly advancing progress in some areas of pregnancy care, cohesion and interprofessional communication during labor management are dangerously protracted in modern obstetrics. Current discrepancies in national guidelines among professional organizations-specifically the American College of Obstetricians & Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses-create conditions for the breakdown of interprofessional teamwork on the labor unit, leading to dystocia both of labor and communication. This article highlights areas of agreement and disagreement between published documents from each professional organization that lead to conflict at the bedside. We propose a purposeful national program of guideline reconciliation in concert with our professional organizations to help bridge these gaps. Finding common ground in current evidence will allow teams to restore trust and ensure collaborative care for patients.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"38 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1097/aog.0000000000006150
Kathryn C Welch,Hope K Haefner,Natalie A Saunders
The rate of vulvar cancer rates is rising, with high-grade squamous intraepithelial lesions, also known as vulvar intraepithelial neoplasia, and differentiated vulvar intraepithelial neoplasia representing key premalignant precursors to vulvar squamous cell carcinoma. Recent advances in classification and understanding of its causes-both human papillomavirus (HPV) associated and HPV independent-have significant implications for the diagnosis and management of these conditions. This review summarizes the evolving terminology, pathogenesis, clinical presentation, and current treatment strategies for vulvar squamous precancers, emphasizing the importance of distinguishing between the two major precancer subtypes to guide appropriate care.
{"title":"Precancerous Squamous Lesions of the Vulva.","authors":"Kathryn C Welch,Hope K Haefner,Natalie A Saunders","doi":"10.1097/aog.0000000000006150","DOIUrl":"https://doi.org/10.1097/aog.0000000000006150","url":null,"abstract":"The rate of vulvar cancer rates is rising, with high-grade squamous intraepithelial lesions, also known as vulvar intraepithelial neoplasia, and differentiated vulvar intraepithelial neoplasia representing key premalignant precursors to vulvar squamous cell carcinoma. Recent advances in classification and understanding of its causes-both human papillomavirus (HPV) associated and HPV independent-have significant implications for the diagnosis and management of these conditions. This review summarizes the evolving terminology, pathogenesis, clinical presentation, and current treatment strategies for vulvar squamous precancers, emphasizing the importance of distinguishing between the two major precancer subtypes to guide appropriate care.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"170 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1097/aog.0000000000006142
Jonathan Zipursky,Ria Garg,Tianru Wang,Rachela Smith,Ping Li,Simone N Vigod,Tara Gomes,Mina Tadrous
OBJECTIVETo evaluate whether postpartum domperidone use is associated with new-onset psychosis and other severe mental health outcomes.METHODSWe conducted a retrospective cohort study of people who filled a prescription for domperidone within 56 days of delivery between March 1, 2006, and March 1, 2022, in Ontario, Canada. Those who filled a domperidone prescription were matched 1:1 based on propensity score to an equal number of those who did not. The primary outcome was any health care contact for incident psychosis in the subsequent 365 days, with a secondary outcome of any psychiatric emergency department (ED) visit or hospitalization. Cox proportional hazards regression was used to compare outcome risk between people who initiated domperidone and those who did not.RESULTSWe identified 2,237,806 births, and 7,096 (0.3%) were followed by the individuals filling a publicly funded domperidone prescription within 56 days postpartum. After exclusions, 4,629 domperidone-exposed and 116,644 unexposed individuals remained. Overall, 4,585 domperidone-exposed individuals were propensity score matched to an equal number who were unexposed, resulting in good balance across all measured baseline characteristics. Compared with matched postpartum individuals who did not initiate domperidone, domperidone use was not associated with psychosis (6.4/1,000 person-years vs 6.4/1,000 person-years; hazard ratio [HR] 1.00, 95% CI, 0.60-1.67) in the postpartum period. We found no association between domperidone use and ED visits or hospital admissions with mental health diagnoses (38.0/1,000 person-years vs 43.4/1,000 person-years, HR 0.88, 95% CI, 0.71-1.08).CONCLUSIONInitiation of domperidone postpartum was not associated with an increased risk of new-onset psychosis or ED visits or hospital admissions with mental health diagnoses.
{"title":"Domperidone Use in Lactation and Risk of Severe Postpartum Mental Health Outcomes.","authors":"Jonathan Zipursky,Ria Garg,Tianru Wang,Rachela Smith,Ping Li,Simone N Vigod,Tara Gomes,Mina Tadrous","doi":"10.1097/aog.0000000000006142","DOIUrl":"https://doi.org/10.1097/aog.0000000000006142","url":null,"abstract":"OBJECTIVETo evaluate whether postpartum domperidone use is associated with new-onset psychosis and other severe mental health outcomes.METHODSWe conducted a retrospective cohort study of people who filled a prescription for domperidone within 56 days of delivery between March 1, 2006, and March 1, 2022, in Ontario, Canada. Those who filled a domperidone prescription were matched 1:1 based on propensity score to an equal number of those who did not. The primary outcome was any health care contact for incident psychosis in the subsequent 365 days, with a secondary outcome of any psychiatric emergency department (ED) visit or hospitalization. Cox proportional hazards regression was used to compare outcome risk between people who initiated domperidone and those who did not.RESULTSWe identified 2,237,806 births, and 7,096 (0.3%) were followed by the individuals filling a publicly funded domperidone prescription within 56 days postpartum. After exclusions, 4,629 domperidone-exposed and 116,644 unexposed individuals remained. Overall, 4,585 domperidone-exposed individuals were propensity score matched to an equal number who were unexposed, resulting in good balance across all measured baseline characteristics. Compared with matched postpartum individuals who did not initiate domperidone, domperidone use was not associated with psychosis (6.4/1,000 person-years vs 6.4/1,000 person-years; hazard ratio [HR] 1.00, 95% CI, 0.60-1.67) in the postpartum period. We found no association between domperidone use and ED visits or hospital admissions with mental health diagnoses (38.0/1,000 person-years vs 43.4/1,000 person-years, HR 0.88, 95% CI, 0.71-1.08).CONCLUSIONInitiation of domperidone postpartum was not associated with an increased risk of new-onset psychosis or ED visits or hospital admissions with mental health diagnoses.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"152 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1097/aog.0000000000006147
Jin Qin,Gladys Martinez,Hunter K Holt,Sameer V Gopalani,Katrina F Trivers,Jacqueline W Miller,Virginia Senkomago,George F Sawaya
OBJECTIVETo examine preferences for human papillomavirus (HPV) specimen self-collection, and collection location, in a nationally representative sample of reproductive-aged women in the United States.METHODSThis cross-sectional analysis used household population-based data from the National Survey of Family Growth (January 2022-December 2023) and was limited to women aged 21-49 years without a history of hysterectomy or cervical cancer (sample n=4,465). Survey weights and design variables were applied to generate nationally representative population frequencies and percentages of preference for HPV self-collection compared with clinician collection, and preference for collection location (ie, at home or in office).RESULTSAmong eligible U.S. women, 42.9% preferred HPV self-collection, 28.5% preferred clinician collection, and 28.6% expressed no preference. An estimated 41.7 million (71.5%) U.S. women aged 21-49 years were open to HPV self-collection (either preferring it or having no preference), including 9.7 million women who were underscreened or never screened. Among women who were open to HPV self-collection, more than half (52.1%) preferred self-collection at home, 14.7% preferred to do self-collection in a doctor's office, and 33.2% had no preference for location. More underscreened or never-screened women preferred HPV self-collection (54.0%) and at-home collection (59.3%) compared with those who were up to date with screening (40.3% and 50.2%, respectively, P<.001). Preference for self-collection also varied by race and Hispanic origin, education, income, parity, sexual orientation, and prior experience of nonvoluntary vaginal intercourse.CONCLUSIONIn this nationally representative study, more than 7 in 10 U.S. women aged 21-49 years were open to HPV self-collection for cervical cancer screening, with more than half favoring at-home collection. Preference was higher among women who were not up to date with screening. These findings provide timely evidence to inform future policy decisions and implementation strategies to improve access to cervical cancer screening.
{"title":"Preferences Among U.S. Women for Cervical Cancer Screening with Self-Collected Specimens for Human Papillomavirus Testing.","authors":"Jin Qin,Gladys Martinez,Hunter K Holt,Sameer V Gopalani,Katrina F Trivers,Jacqueline W Miller,Virginia Senkomago,George F Sawaya","doi":"10.1097/aog.0000000000006147","DOIUrl":"https://doi.org/10.1097/aog.0000000000006147","url":null,"abstract":"OBJECTIVETo examine preferences for human papillomavirus (HPV) specimen self-collection, and collection location, in a nationally representative sample of reproductive-aged women in the United States.METHODSThis cross-sectional analysis used household population-based data from the National Survey of Family Growth (January 2022-December 2023) and was limited to women aged 21-49 years without a history of hysterectomy or cervical cancer (sample n=4,465). Survey weights and design variables were applied to generate nationally representative population frequencies and percentages of preference for HPV self-collection compared with clinician collection, and preference for collection location (ie, at home or in office).RESULTSAmong eligible U.S. women, 42.9% preferred HPV self-collection, 28.5% preferred clinician collection, and 28.6% expressed no preference. An estimated 41.7 million (71.5%) U.S. women aged 21-49 years were open to HPV self-collection (either preferring it or having no preference), including 9.7 million women who were underscreened or never screened. Among women who were open to HPV self-collection, more than half (52.1%) preferred self-collection at home, 14.7% preferred to do self-collection in a doctor's office, and 33.2% had no preference for location. More underscreened or never-screened women preferred HPV self-collection (54.0%) and at-home collection (59.3%) compared with those who were up to date with screening (40.3% and 50.2%, respectively, P<.001). Preference for self-collection also varied by race and Hispanic origin, education, income, parity, sexual orientation, and prior experience of nonvoluntary vaginal intercourse.CONCLUSIONIn this nationally representative study, more than 7 in 10 U.S. women aged 21-49 years were open to HPV self-collection for cervical cancer screening, with more than half favoring at-home collection. Preference was higher among women who were not up to date with screening. These findings provide timely evidence to inform future policy decisions and implementation strategies to improve access to cervical cancer screening.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1097/aog.0000000000006145
Allison Avrich Ciesla,Victoria Lazariu,Janet A Watts,Gabriela Vazquez-Benitez,Kristin Dascomb,Stephanie A Irving,Nicola P Klein,Shaun J Grannis,Toan C Ong,Sarah W Ball,Malini DeSilva,Tamara Sheffield,Daniel Bride,Joshua Van Otterloo,Julie Arndorfer,Allison L Naleway,Padma Koppolu,Bruce Fireman,John Hansen,Julius Timbol,Brian E Dixon,Colin Rogerson,William Fadel,Michelle A Barron,David Mayer,Catia Chavez,Yan Zhuang,Angela Cheung,Lawrence Reichle,Karthik Natarajan,Amanda B Payne,Ruth Link-Gelles,Ousseny Zerbo
Pregnant women are at higher risk of severe coronavirus disease 2019 (COVID-19) compared with nonpregnant women of reproductive age. During 2023-2024, the Centers for Disease Control and Prevention recommended COVID-19 vaccination for everyone aged 6 months or older, including pregnant women. Using a test-negative design, we assessed the effectiveness of 2023-2024 COVID-19 vaccines against COVID-19-associated emergency department (ED) and urgent care setting encounters among pregnant women aged 18-45 years presenting for care with COVID-19 symptoms from September 2023 to August 2024. Vaccine effectiveness against COVID-19-associated ED and urgent care encounters of one 2023-2024 COVID-19 vaccine dose was 58% (95% CI, 24-77%) among pregnant women and 37% (95% CI, 29-44%) among nonpregnant women of the same age. The 2023-2024 COVID-19 vaccines were associated with a decrease in COVID-19-associated ED and urgent care encounters among pregnant women and nonpregnant women of reproductive age.
{"title":"Effectiveness of 2023-2024 Coronavirus Disease 2019 (COVID-19) Vaccines in Pregnant Women.","authors":"Allison Avrich Ciesla,Victoria Lazariu,Janet A Watts,Gabriela Vazquez-Benitez,Kristin Dascomb,Stephanie A Irving,Nicola P Klein,Shaun J Grannis,Toan C Ong,Sarah W Ball,Malini DeSilva,Tamara Sheffield,Daniel Bride,Joshua Van Otterloo,Julie Arndorfer,Allison L Naleway,Padma Koppolu,Bruce Fireman,John Hansen,Julius Timbol,Brian E Dixon,Colin Rogerson,William Fadel,Michelle A Barron,David Mayer,Catia Chavez,Yan Zhuang,Angela Cheung,Lawrence Reichle,Karthik Natarajan,Amanda B Payne,Ruth Link-Gelles,Ousseny Zerbo","doi":"10.1097/aog.0000000000006145","DOIUrl":"https://doi.org/10.1097/aog.0000000000006145","url":null,"abstract":"Pregnant women are at higher risk of severe coronavirus disease 2019 (COVID-19) compared with nonpregnant women of reproductive age. During 2023-2024, the Centers for Disease Control and Prevention recommended COVID-19 vaccination for everyone aged 6 months or older, including pregnant women. Using a test-negative design, we assessed the effectiveness of 2023-2024 COVID-19 vaccines against COVID-19-associated emergency department (ED) and urgent care setting encounters among pregnant women aged 18-45 years presenting for care with COVID-19 symptoms from September 2023 to August 2024. Vaccine effectiveness against COVID-19-associated ED and urgent care encounters of one 2023-2024 COVID-19 vaccine dose was 58% (95% CI, 24-77%) among pregnant women and 37% (95% CI, 29-44%) among nonpregnant women of the same age. The 2023-2024 COVID-19 vaccines were associated with a decrease in COVID-19-associated ED and urgent care encounters among pregnant women and nonpregnant women of reproductive age.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"19 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145728374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1097/aog.0000000000006141
Murat Erden,Sahar Rehman,Chien Oh,Benjamin M Schwartz,Rosanne M Kho
Fertility preservation is a critical consideration in the care of reproductive-aged patients with gynecologic cancers, yet referral to reproductive specialists remains low, indicating a gap between guidance and practice. We compared 28 clinical guidelines that addressed fertility-sparing management of endometrial, cervical, and ovarian cancers, and reviewed diagnostic workup, eligibility thresholds, surgical approaches, and surveillance protocols. Recommendations were synthesized into stage-specific pathways to delineate areas of consensus, highlight discrepancies, and map evidence gaps. There is broad agreement across multiple independent guidelines to support fertility-sparing treatment for carefully selected patients with: grade 1, stage IA endometrioid endometrial carcinoma; stage IA1-IB1 cervical tumors measuring less than 2 cm without high-risk features; and borderline ovarian tumors and most malignant germ cell tumors. Recommendations for higher stage disease and uncommon histologies, however, diverge and remain inconsistent. Overall guideline quality was moderate to high but frequently relied on limited evidence or expert opinion outside early-stage, low-risk conditions. Synthesizing current guidance clarifies areas where practice can be standardized and prospective data are needed. Embedding routine fertility counseling and referral into standardized pathways is an important step to improve uptake while maintaining oncologic safety and preserving fertility potential.
{"title":"Fertility-Sparing Treatments in Patient With Gynecologic Cancers.","authors":"Murat Erden,Sahar Rehman,Chien Oh,Benjamin M Schwartz,Rosanne M Kho","doi":"10.1097/aog.0000000000006141","DOIUrl":"https://doi.org/10.1097/aog.0000000000006141","url":null,"abstract":"Fertility preservation is a critical consideration in the care of reproductive-aged patients with gynecologic cancers, yet referral to reproductive specialists remains low, indicating a gap between guidance and practice. We compared 28 clinical guidelines that addressed fertility-sparing management of endometrial, cervical, and ovarian cancers, and reviewed diagnostic workup, eligibility thresholds, surgical approaches, and surveillance protocols. Recommendations were synthesized into stage-specific pathways to delineate areas of consensus, highlight discrepancies, and map evidence gaps. There is broad agreement across multiple independent guidelines to support fertility-sparing treatment for carefully selected patients with: grade 1, stage IA endometrioid endometrial carcinoma; stage IA1-IB1 cervical tumors measuring less than 2 cm without high-risk features; and borderline ovarian tumors and most malignant germ cell tumors. Recommendations for higher stage disease and uncommon histologies, however, diverge and remain inconsistent. Overall guideline quality was moderate to high but frequently relied on limited evidence or expert opinion outside early-stage, low-risk conditions. Synthesizing current guidance clarifies areas where practice can be standardized and prospective data are needed. Embedding routine fertility counseling and referral into standardized pathways is an important step to improve uptake while maintaining oncologic safety and preserving fertility potential.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1097/aog.0000000000006135
Ann Oluloro,Mindy Pike,Tiffany Luu,Adrienne Moore,Soledad Jorge,Kemi M Doll
OBJECTIVETo characterize the presenting comorbidity profile of patients with uterine cancer by race and ethnicity and use real-world data to quantify expected effects of common comorbidity eligibility criteria on uterine cancer trial accrual.METHODSThis observational, cross-sectional study used the Vizient Clinical Data Base to identify individuals aged 18 years or older with a uterine cancer diagnosis from 2002 to 2021. Demographic variables and comorbidity diagnoses were identified by International Classification of Diseases, Ninth and Tenth Revision codes and used to construct Charlson, Elixhauser, and National Cancer Institute comorbidity indices. Summary theoretical ineligibility rates were calculated by race based on a modified set of comorbidity-eligibility criteria. Ineligibility rates were compared between groups and differences assessed with logistic regression.RESULTSWe identified 384,093 patients with uterine cancer; 70.0% of the patients were non-Hispanic White, 13.4% were non-Hispanic Black, 7.1% were of unknown race, and 2.8% were non-Hispanic Asian. Across all comorbidity indices, non-Hispanic Black individuals persistently had the highest scores among all racial groups. Comorbidity prevalence varied significantly by race. Non-Hispanic Black individuals had the highest rates of renal failure (11.6%), diabetes (23.4%), and hypertension (49.8%) compared with non-Hispanic White and non-Hispanic Asian individuals. In modeling analyses, non-Hispanic Black individuals had twofold higher odds of trial exclusion based on comorbidities than non-Hispanic White individuals (adjusted odds ratio [aOR] 2.06; 95% CI, 2.02-2.10). Those of unknown race had slightly higher odds (aOR 1.02; 95% CI, 0.99-1.05) and non-Hispanic Asians slightly lower odds (aOR 0.98; 95% CI, 0.94-1.02) of being ineligible relative to non-Hispanic White individuals.CONCLUSIONFor patients with uterine cancer, comorbidity prevalence and comorbidity index scores varied by race. This results in differences in trial eligibility at baseline before any patient engagement. Quantifying the distribution of comorbidities is critical because it allows us to statistically anticipate how individual comorbidity eligibility criteria may hamper the accrual of patients from minoritized groups. This, in turn, can support equity efforts to plan trial eligibility criteria and targeted recruitment.
{"title":"Association Between Comorbidity and Clinical Trial Enrollment for Patients With Uterine Cancer.","authors":"Ann Oluloro,Mindy Pike,Tiffany Luu,Adrienne Moore,Soledad Jorge,Kemi M Doll","doi":"10.1097/aog.0000000000006135","DOIUrl":"https://doi.org/10.1097/aog.0000000000006135","url":null,"abstract":"OBJECTIVETo characterize the presenting comorbidity profile of patients with uterine cancer by race and ethnicity and use real-world data to quantify expected effects of common comorbidity eligibility criteria on uterine cancer trial accrual.METHODSThis observational, cross-sectional study used the Vizient Clinical Data Base to identify individuals aged 18 years or older with a uterine cancer diagnosis from 2002 to 2021. Demographic variables and comorbidity diagnoses were identified by International Classification of Diseases, Ninth and Tenth Revision codes and used to construct Charlson, Elixhauser, and National Cancer Institute comorbidity indices. Summary theoretical ineligibility rates were calculated by race based on a modified set of comorbidity-eligibility criteria. Ineligibility rates were compared between groups and differences assessed with logistic regression.RESULTSWe identified 384,093 patients with uterine cancer; 70.0% of the patients were non-Hispanic White, 13.4% were non-Hispanic Black, 7.1% were of unknown race, and 2.8% were non-Hispanic Asian. Across all comorbidity indices, non-Hispanic Black individuals persistently had the highest scores among all racial groups. Comorbidity prevalence varied significantly by race. Non-Hispanic Black individuals had the highest rates of renal failure (11.6%), diabetes (23.4%), and hypertension (49.8%) compared with non-Hispanic White and non-Hispanic Asian individuals. In modeling analyses, non-Hispanic Black individuals had twofold higher odds of trial exclusion based on comorbidities than non-Hispanic White individuals (adjusted odds ratio [aOR] 2.06; 95% CI, 2.02-2.10). Those of unknown race had slightly higher odds (aOR 1.02; 95% CI, 0.99-1.05) and non-Hispanic Asians slightly lower odds (aOR 0.98; 95% CI, 0.94-1.02) of being ineligible relative to non-Hispanic White individuals.CONCLUSIONFor patients with uterine cancer, comorbidity prevalence and comorbidity index scores varied by race. This results in differences in trial eligibility at baseline before any patient engagement. Quantifying the distribution of comorbidities is critical because it allows us to statistically anticipate how individual comorbidity eligibility criteria may hamper the accrual of patients from minoritized groups. This, in turn, can support equity efforts to plan trial eligibility criteria and targeted recruitment.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"129 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145674132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-04DOI: 10.1097/aog.0000000000006140
Chidimma Azubuike,Amy Deng,Amie Goodin
Clinical guidelines recommend avoiding cannabinoids, including cannabidiol (CBD), during pregnancy and lactation. Use of CBD is widespread, but prevalence in pregnancy and among women of reproductive age is not well documented. We conducted a cross-sectional analysis using data from the 2022 and 2023 National Survey on Drug Use and Health, with incorporation of survey sampling weights to estimate the prevalence of CBD use. Similar proportions of pregnant women and reproductive-aged women reported ever using CBD in 2022 (353.4 vs 365.1, respectively) and in 2023 (323.4 [95% CI, 259.2-387.6] vs 361.3 [95% CI, 353.6-367.0], respectively) per 1,000 population. More reproductive-aged women had used CBD within the past 30 days compared with pregnant women in 2022 (121.3 vs 43.9, respectively) and in 2023 (113.2 [95% CI, 107.4-118.9] vs 39.3 [95% CI, 16.2-62.4], respectively) per 1,000 population. Due to unknown effects of CBD during pregnancy and prevalent use, clinicians should screen for CBD use to facilitate counseling patients against use in pregnancy and while breastfeeding.
临床指南建议在怀孕和哺乳期避免使用大麻素，包括大麻二酚（CBD）。CBD的使用很普遍，但在怀孕和育龄妇女中的流行情况没有很好的记录。我们使用2022年和2023年全国药物使用和健康调查的数据进行了横断面分析，并结合调查抽样权重来估计CBD使用的流行程度。在2022年（353.4 vs 365.1）和2023年（323.4 [95% CI, 259.2-387.6] vs 361.3 [95% CI, 353.6-367.0]）每1000人报告使用过CBD的孕妇和育龄妇女比例相似。与2022年（121.3比43.9）和2023年（113.2 [95% CI, 107.4-118.9]比39.3 [95% CI, 16.2-62.4]）的孕妇相比，在过去30天内使用过CBD的育龄妇女更多。由于CBD在怀孕期间的未知影响和普遍使用，临床医生应该筛查CBD的使用，以方便咨询患者在怀孕和哺乳期间不要使用CBD。
{"title":"Nationwide Prevalence of Cannabidiol Use in Pregnancy and in Women of Reproductive Age.","authors":"Chidimma Azubuike,Amy Deng,Amie Goodin","doi":"10.1097/aog.0000000000006140","DOIUrl":"https://doi.org/10.1097/aog.0000000000006140","url":null,"abstract":"Clinical guidelines recommend avoiding cannabinoids, including cannabidiol (CBD), during pregnancy and lactation. Use of CBD is widespread, but prevalence in pregnancy and among women of reproductive age is not well documented. We conducted a cross-sectional analysis using data from the 2022 and 2023 National Survey on Drug Use and Health, with incorporation of survey sampling weights to estimate the prevalence of CBD use. Similar proportions of pregnant women and reproductive-aged women reported ever using CBD in 2022 (353.4 vs 365.1, respectively) and in 2023 (323.4 [95% CI, 259.2-387.6] vs 361.3 [95% CI, 353.6-367.0], respectively) per 1,000 population. More reproductive-aged women had used CBD within the past 30 days compared with pregnant women in 2022 (121.3 vs 43.9, respectively) and in 2023 (113.2 [95% CI, 107.4-118.9] vs 39.3 [95% CI, 16.2-62.4], respectively) per 1,000 population. Due to unknown effects of CBD during pregnancy and prevalent use, clinicians should screen for CBD use to facilitate counseling patients against use in pregnancy and while breastfeeding.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1097/AOG.0000000000006096
Dehlia Moussaoui, Michele A O'Connell, Charlotte V Elder, Sonia R Grover, Ken C Pang
{"title":"Characteristics of Menstrual Suppression and Its Association With Mental Health in Transgender Adolescents: Correction.","authors":"Dehlia Moussaoui, Michele A O'Connell, Charlotte V Elder, Sonia R Grover, Ken C Pang","doi":"10.1097/AOG.0000000000006096","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006096","url":null,"abstract":"","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 6","pages":"925-927"},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-30DOI: 10.1097/AOG.0000000000006106
Ann M Bruno, Amanda A Allshouse, Torri D Metz
<p><strong>Objective: </strong>To evaluate the association between maximum oxytocin dose and uterine rupture among individuals undertaking a trial of labor after cesarean (TOLAC). Secondarily, to evaluate the association between total time on oxytocin and time at maximum oxytocin dose and uterine rupture.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Assessment of Perinatal Excellence study, an observational cohort of deliveries after 23 weeks of gestation across 25 U.S. hospitals from 2008 to 2011. Individuals with a singleton, cephalic, live fetus who had one prior cesarean delivery and were undertaking TOLAC, including those undergoing spontaneous, augmented, or induced labor, were included. Those with a contraindication to TOLAC or a fetus with an anomaly or known genetic abnormality were excluded. The exposure was intrapartum oxytocin dose in milli-international units per minute (milli-international units/min), assessed both categorically (0, 1-20, more than 20 milli-international units/min) and continuously. The primary outcome was uterine rupture. Secondary outcomes were vaginal birth after cesarean (VBAC), blood transfusion, and intensive care unit (ICU) admission. Trends in outcomes by oxytocin were assessed using the Cochran-Armitage trend test. Multivariable modeling estimated the association between maximum oxytocin dose (both as a categorical and continuous variable) and outcomes. The duration of any oxytocin, the duration at the maximum dose of oxytocin, and outcomes were assessed.</p><p><strong>Results: </strong>Of 5,201 individuals undergoing TOLAC, 3,406 (65.5%) received 0 milli-international units/min of oxytocin, 1,659 (31.9%) received 1-20 milli-international units/min, and 136 (2.6%) received more than 20 milli-international units/min. The majority of the cohort (n=3,391) entered spontaneous labor; 1,076 patients received augmentation and 733 were induced. The range of maximum oxytocin doses was 0-60 milli-international units/min. There were 37 cases of uterine rupture (0.7%, 95% CI, 0.5-0.9%). The frequency of uterine rupture by maximum oxytocin dose category was 0.2% (n=7) with no oxytocin (0 milli-international units/min), 1.6% (n=27) with an oxytocin dose of 1-20 milli-international units/min, and 2.2% (n=3) with oxytocin doses greater than 20 milli-international units/min. Higher maximum oxytocin doses were associated with a trend of an increase in uterine rupture (P<.001 Cochran-Armitage test of trend). In adjusted modeling, maximum oxytocin doses of 1-20 milli-international units/min and doses greater than 20 milli-international units/min were associated with uterine rupture (adjusted odds ratio [aOR] 8.82, 95% CI, 3.61-21.6; and aOR 11.0, 95% CI, 2.67-45.3, respectively), compared with 0 milli-international units/min; however, a higher maximum dose (more than 20 milli-interna
{"title":"Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean.","authors":"Ann M Bruno, Amanda A Allshouse, Torri D Metz","doi":"10.1097/AOG.0000000000006106","DOIUrl":"10.1097/AOG.0000000000006106","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between maximum oxytocin dose and uterine rupture among individuals undertaking a trial of labor after cesarean (TOLAC). Secondarily, to evaluate the association between total time on oxytocin and time at maximum oxytocin dose and uterine rupture.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network Assessment of Perinatal Excellence study, an observational cohort of deliveries after 23 weeks of gestation across 25 U.S. hospitals from 2008 to 2011. Individuals with a singleton, cephalic, live fetus who had one prior cesarean delivery and were undertaking TOLAC, including those undergoing spontaneous, augmented, or induced labor, were included. Those with a contraindication to TOLAC or a fetus with an anomaly or known genetic abnormality were excluded. The exposure was intrapartum oxytocin dose in milli-international units per minute (milli-international units/min), assessed both categorically (0, 1-20, more than 20 milli-international units/min) and continuously. The primary outcome was uterine rupture. Secondary outcomes were vaginal birth after cesarean (VBAC), blood transfusion, and intensive care unit (ICU) admission. Trends in outcomes by oxytocin were assessed using the Cochran-Armitage trend test. Multivariable modeling estimated the association between maximum oxytocin dose (both as a categorical and continuous variable) and outcomes. The duration of any oxytocin, the duration at the maximum dose of oxytocin, and outcomes were assessed.</p><p><strong>Results: </strong>Of 5,201 individuals undergoing TOLAC, 3,406 (65.5%) received 0 milli-international units/min of oxytocin, 1,659 (31.9%) received 1-20 milli-international units/min, and 136 (2.6%) received more than 20 milli-international units/min. The majority of the cohort (n=3,391) entered spontaneous labor; 1,076 patients received augmentation and 733 were induced. The range of maximum oxytocin doses was 0-60 milli-international units/min. There were 37 cases of uterine rupture (0.7%, 95% CI, 0.5-0.9%). The frequency of uterine rupture by maximum oxytocin dose category was 0.2% (n=7) with no oxytocin (0 milli-international units/min), 1.6% (n=27) with an oxytocin dose of 1-20 milli-international units/min, and 2.2% (n=3) with oxytocin doses greater than 20 milli-international units/min. Higher maximum oxytocin doses were associated with a trend of an increase in uterine rupture (P<.001 Cochran-Armitage test of trend). In adjusted modeling, maximum oxytocin doses of 1-20 milli-international units/min and doses greater than 20 milli-international units/min were associated with uterine rupture (adjusted odds ratio [aOR] 8.82, 95% CI, 3.61-21.6; and aOR 11.0, 95% CI, 2.67-45.3, respectively), compared with 0 milli-international units/min; however, a higher maximum dose (more than 20 milli-interna","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 6","pages":"843-850"},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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