Pub Date : 2025-12-01DOI: 10.1097/AOG.0000000000006099
Effective communication between physicians and patients is the cornerstone of the patient -physician relationship. Effective communication practices can build positive relationships, enable sharing power, and lead to mutual trust. Moreover, effective patient -physician communication improves patient experiences and health outcomes. The building blocks of relationship-centered communication include acknowledgment of a patient's identity and experiences, clarity of information, patient activation and participation, knowledge-related power and authority, emotional proximity and shared experiences, and managing health care and relational goals. In practical terms, this translates to communication behaviors that demonstrate humility to close the patient -physician relationship distance and achieve effective communication, particularly for marginalized patient populations.
{"title":"Effective Patient-Physician Communication.","authors":"","doi":"10.1097/AOG.0000000000006099","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006099","url":null,"abstract":"<p><p>Effective communication between physicians and patients is the cornerstone of the patient -physician relationship. Effective communication practices can build positive relationships, enable sharing power, and lead to mutual trust. Moreover, effective patient -physician communication improves patient experiences and health outcomes. The building blocks of relationship-centered communication include acknowledgment of a patient's identity and experiences, clarity of information, patient activation and participation, knowledge-related power and authority, emotional proximity and shared experiences, and managing health care and relational goals. In practical terms, this translates to communication behaviors that demonstrate humility to close the patient -physician relationship distance and achieve effective communication, particularly for marginalized patient populations.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"146 6","pages":"e115-e126"},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655061","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: 2025-07-21DOI: 10.1097/AOG.0000000000005957
Mathis Collier, Pierre Hannoun, Valérie Cormier-Daire, Jean-Marc Treluyer, Alexandra Benachi, Eugénie Koumakis
Objective: To evaluate obstetric and perinatal outcomes of pregnancies among patients with osteogenesis imperfecta using the French National Health Insurance Database.
Methods: We conducted a retrospective cohort study. Pregnancies were identified with an algorithm specifically developed for the French National Health Insurance Database to identify delivery stays using a combination of International Classification of Diseases, Tenth Revision (ICD-10) discharge codes and medical procedures. Exposure was osteogenesis imperfecta status based on the occurrence of ICD-10 code Q780 5 years before conception or during pregnancy. Outcomes included pregnancy, delivery, postpartum, and fetal complications based on hospital discharge data and reimbursements of medical procedures, medical devices, and drugs. Multivariable logistic regression analysis was performed, adjusted for multiple pregnancies per participant with generalized estimating equations.
Results: The cohort included 8,850,969 pregnancies (5,823,322 patients) between January 2012 and December 2023. In total, 408 pregnant individuals (4.6/100,000) were identified with osteogenesis imperfecta. Compared with pregnant individuals without osteogenesis imperfecta, pregnant individuals with osteogenesis imperfecta had increased risks of antepartum hemorrhage (adjusted risk ratio [RR] 1.78, 95% CI, 1.01-3.14), chorioamnionitis (adjusted RR 2.79, 95% CI, 1.17-6.64), malpresentation (adjusted RR 1.65, 95% CI, 1.19-2.30), and preterm delivery (adjusted RR 2.11, 95% CI, 1.62-2.74). Cesarean delivery rates were notably higher in pregnant individuals with osteogenesis imperfecta (adjusted RR 2.59, 95% CI, 2.34-2.88), including among nulliparous individuals (adjusted RR 2.50, 95% CI, 2.22-2.81). Osteogenesis imperfecta was associated with major congenital anomalies (adjusted RR 5.04, 95% CI, 3.97-6.39 overall; adjusted RR 1.67, 95% CI, 1.09-2.56 when osteogenesis imperfecta was excluded from the congenital anomaly definition), especially cardiac anomalies. Postpartum analysis indicated no significant increase in fracture rates compared with prepregnancy periods.
Conclusion: In this nationwide cohort study, osteogenesis imperfecta was associated with both maternal and fetal complications. These findings underscore the need for specialized, multidisciplinary management of pregnancies in patients with osteogenesis imperfecta.
{"title":"Pregnancy-Related Complications in Osteogenesis Imperfecta.","authors":"Mathis Collier, Pierre Hannoun, Valérie Cormier-Daire, Jean-Marc Treluyer, Alexandra Benachi, Eugénie Koumakis","doi":"10.1097/AOG.0000000000005957","DOIUrl":"10.1097/AOG.0000000000005957","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate obstetric and perinatal outcomes of pregnancies among patients with osteogenesis imperfecta using the French National Health Insurance Database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study. Pregnancies were identified with an algorithm specifically developed for the French National Health Insurance Database to identify delivery stays using a combination of International Classification of Diseases, Tenth Revision (ICD-10) discharge codes and medical procedures. Exposure was osteogenesis imperfecta status based on the occurrence of ICD-10 code Q780 5 years before conception or during pregnancy. Outcomes included pregnancy, delivery, postpartum, and fetal complications based on hospital discharge data and reimbursements of medical procedures, medical devices, and drugs. Multivariable logistic regression analysis was performed, adjusted for multiple pregnancies per participant with generalized estimating equations.</p><p><strong>Results: </strong>The cohort included 8,850,969 pregnancies (5,823,322 patients) between January 2012 and December 2023. In total, 408 pregnant individuals (4.6/100,000) were identified with osteogenesis imperfecta. Compared with pregnant individuals without osteogenesis imperfecta, pregnant individuals with osteogenesis imperfecta had increased risks of antepartum hemorrhage (adjusted risk ratio [RR] 1.78, 95% CI, 1.01-3.14), chorioamnionitis (adjusted RR 2.79, 95% CI, 1.17-6.64), malpresentation (adjusted RR 1.65, 95% CI, 1.19-2.30), and preterm delivery (adjusted RR 2.11, 95% CI, 1.62-2.74). Cesarean delivery rates were notably higher in pregnant individuals with osteogenesis imperfecta (adjusted RR 2.59, 95% CI, 2.34-2.88), including among nulliparous individuals (adjusted RR 2.50, 95% CI, 2.22-2.81). Osteogenesis imperfecta was associated with major congenital anomalies (adjusted RR 5.04, 95% CI, 3.97-6.39 overall; adjusted RR 1.67, 95% CI, 1.09-2.56 when osteogenesis imperfecta was excluded from the congenital anomaly definition), especially cardiac anomalies. Postpartum analysis indicated no significant increase in fracture rates compared with prepregnancy periods.</p><p><strong>Conclusion: </strong>In this nationwide cohort study, osteogenesis imperfecta was associated with both maternal and fetal complications. These findings underscore the need for specialized, multidisciplinary management of pregnancies in patients with osteogenesis imperfecta.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"851-859"},"PeriodicalIF":4.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12622252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1097/aog.0000000000006130
Amy M Solsman,Torri D Metz,Josh Benton,Shana Godfred-Cato
We conducted a statewide, retrospective cohort study to evaluate the association between maternal receipt of the respiratory syncytial virus (RSV) vaccine and preterm birth. All individuals who delivered a singleton neonate in Utah and were between 32 0/7 and 36 6/7 weeks of gestation from September 2023 to February 2024 were included and followed up until delivery. Overall, 2,733 of 24,213 individuals (11.3%) received the vaccine. Vaccine receipt was associated with lower odds of preterm birth (5.5% vaccinated group vs 6.8% unvaccinated group, adjusted odds ratio 0.80, 95% CI, 0.67-0.95). Receipt of the RSV vaccine was not associated with any adverse birth outcomes, including hypertensive disorders of pregnancy, low birth weight, or fetal or infant death. These findings support the safety of this vaccine in pregnancy, which is known to prevent neonatal severe lower respiratory tract disease.
{"title":"Maternal Respiratory Syncytial Virus Vaccination and Preterm Birth: A Utah Statewide Retrospective Cohort Study.","authors":"Amy M Solsman,Torri D Metz,Josh Benton,Shana Godfred-Cato","doi":"10.1097/aog.0000000000006130","DOIUrl":"https://doi.org/10.1097/aog.0000000000006130","url":null,"abstract":"We conducted a statewide, retrospective cohort study to evaluate the association between maternal receipt of the respiratory syncytial virus (RSV) vaccine and preterm birth. All individuals who delivered a singleton neonate in Utah and were between 32 0/7 and 36 6/7 weeks of gestation from September 2023 to February 2024 were included and followed up until delivery. Overall, 2,733 of 24,213 individuals (11.3%) received the vaccine. Vaccine receipt was associated with lower odds of preterm birth (5.5% vaccinated group vs 6.8% unvaccinated group, adjusted odds ratio 0.80, 95% CI, 0.67-0.95). Receipt of the RSV vaccine was not associated with any adverse birth outcomes, including hypertensive disorders of pregnancy, low birth weight, or fetal or infant death. These findings support the safety of this vaccine in pregnancy, which is known to prevent neonatal severe lower respiratory tract disease.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"1 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599764","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 : 2025-11-25DOI: 10.1097/aog.0000000000006133
Andrea L Deierlein,Hedda L Boege,Lauren T Berube,Rachel Ryan,Cheryl R Stein
OBJECTIVETo examine the receipt of screening, services, and counseling during prepregnancy reproductive health, prenatal care, and postpartum care visits by disability status among people with recent live births in the United States.METHODSCross-sectional data were from 24 states in PRAMS (Pregnancy Risk Assessment Monitoring System) that included the WGSS (Washington Group Short Set of Questions) on Disability (October 2018-December 2020). Participants reported receipt of screening, services, and counseling during prepregnancy reproductive health care visits, prenatal care visits, and a postpartum checkup at 4-6 weeks postdelivery. Associations between the extent of disability (some and a lot of difficulty vs none) and components of health care visits were estimated using modified Poisson regression, adjusted for sociodemographic characteristics (adjusted prevalence ratios [aPRs] and 95% CIs).RESULTSA total of 41,027 participants were included in analyses; 33.7% (n=14,047) reported having some difficulty and 6.2% (n=2,714) reported having a lot of difficulty. Differences were observed for screening, services, and counseling received at health care visits by disability status. During prepregnancy reproductive health care visits, people with any difficulty reported similar receipt of care as those with no difficulty, with the exception of a lower prevalence of discussions about improving their health (aPR 0.92; 95% CI, 0.86-0.98) and sexually transmitted infections (aPR 0.89; 95% CI, 0.83-0.95). During prenatal and postpartum visits, people with any difficulty had a lower prevalence of discussions about lifestyle behaviors, pregnancy weight gain and weight loss, interpersonal violence, mental health, breastfeeding, and birth control, as well as being tested for diabetes (aPR ranged from 0.72-0.99).CONCLUSIONPerinatal health care visits provide opportunities to improve health and assist in the transition to parenthood. Our findings highlight the need for strategies to reduce barriers to care for people with disabilities and facilitate effective communication during visits.
{"title":"Receipt of Screening, Services, and Counseling During Perinatal Health Care Visits by Disability Status in the United States, 2018-2020.","authors":"Andrea L Deierlein,Hedda L Boege,Lauren T Berube,Rachel Ryan,Cheryl R Stein","doi":"10.1097/aog.0000000000006133","DOIUrl":"https://doi.org/10.1097/aog.0000000000006133","url":null,"abstract":"OBJECTIVETo examine the receipt of screening, services, and counseling during prepregnancy reproductive health, prenatal care, and postpartum care visits by disability status among people with recent live births in the United States.METHODSCross-sectional data were from 24 states in PRAMS (Pregnancy Risk Assessment Monitoring System) that included the WGSS (Washington Group Short Set of Questions) on Disability (October 2018-December 2020). Participants reported receipt of screening, services, and counseling during prepregnancy reproductive health care visits, prenatal care visits, and a postpartum checkup at 4-6 weeks postdelivery. Associations between the extent of disability (some and a lot of difficulty vs none) and components of health care visits were estimated using modified Poisson regression, adjusted for sociodemographic characteristics (adjusted prevalence ratios [aPRs] and 95% CIs).RESULTSA total of 41,027 participants were included in analyses; 33.7% (n=14,047) reported having some difficulty and 6.2% (n=2,714) reported having a lot of difficulty. Differences were observed for screening, services, and counseling received at health care visits by disability status. During prepregnancy reproductive health care visits, people with any difficulty reported similar receipt of care as those with no difficulty, with the exception of a lower prevalence of discussions about improving their health (aPR 0.92; 95% CI, 0.86-0.98) and sexually transmitted infections (aPR 0.89; 95% CI, 0.83-0.95). During prenatal and postpartum visits, people with any difficulty had a lower prevalence of discussions about lifestyle behaviors, pregnancy weight gain and weight loss, interpersonal violence, mental health, breastfeeding, and birth control, as well as being tested for diabetes (aPR ranged from 0.72-0.99).CONCLUSIONPerinatal health care visits provide opportunities to improve health and assist in the transition to parenthood. Our findings highlight the need for strategies to reduce barriers to care for people with disabilities and facilitate effective communication during visits.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"20 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599965","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 : 2025-11-25DOI: 10.1097/aog.0000000000006128
Maya Gross,Kemi M Doll,Isabel Rodriguez,Soledad Jorge
OBJECTIVETo evaluate referral patterns and care delay for the growing population of patients with limited English proficiency (LEP) who seek treatment with gynecologic oncologists.METHODSThis is a retrospective cohort study of all patients seen by gynecologic oncologists at a National Cancer Institute-designated cancer center from 2013 to 2024 (referral cohort). Our primary outcome was the time to receipt of first treatment after the initial referral, by LEP status (among patients receiving treatment with a gynecologic oncologist-the treatment cohort) and with delay categorized using 4- and 6-week cutoffs. We compared referral patterns and sociodemographic, clinical, and temporal data by LEP status, defined as documented need for an interpreter. We employed χ2 tests for categorical variables and two-sided t tests or Mann-Whitney U tests for continuous variables. Multivariable linear regression was performed.RESULTSOf 9,915 patients seen for consultation, 5.8% (n=573) had LEP. Patients with LEP were significantly more likely to have referrals originating from the emergency department (6.5% vs 1.0%, P<.001), require multiple referrals to a gynecologic oncologist before initial consultation (9.4% vs 5.1%, P<.001), and be referred to other obstetrics and gynecology specialties before reaching gynecologic oncology (15.9% vs 8.7%, P<.001). Of 5,329 patients who received treatment with gynecologic oncologists, those with LEP were more likely to experience delays in receiving treatment after the initial diagnosis-related referral (63.2% with LEP vs 52.4% without LEP waiting more than 4 weeks, P<.001; 43.5% with LEP vs 35.7% without LEP waiting more than 6 weeks, P<.001). The time from consultation to treatment did not differ by language status. After adjusting for race, insurance status, and ethnicity, the time from referral to treatment remained 16.0% longer for patients with LEP.CONCLUSIONIn this large, diverse cohort, patients with LEP experienced inequitable, cumulative health care delays. Inefficient referral patterns created delay before initial gynecologic oncology consultation.
目的评价越来越多的英语水平有限（LEP）的妇科肿瘤患者的转诊模式和护理延迟。方法：本研究是一项回顾性队列研究，纳入2013年至2024年在美国国家癌症研究所指定癌症中心妇科肿瘤学家就诊的所有患者（转诊队列）。我们的主要结局是首次转诊后接受第一次治疗的时间，根据LEP状态（接受妇科肿瘤医生治疗的患者-治疗队列）和延迟分类，使用4周和6周的截止时间。我们比较了转诊模式和社会人口统计、临床和时间数据的LEP状态，定义为需要翻译的记录。分类变量采用χ2检验，连续变量采用双侧t检验或Mann-Whitney U检验。进行多变量线性回归。结果就诊的9915例患者中，5.8% （n=573）有LEP。LEP患者更有可能从急诊科转诊（6.5% vs 1.0%， P<.001），在首次会诊前需要多次转诊妇科肿瘤科医生（9.4% vs 5.1%， P<.001），在转诊到妇科肿瘤科之前，更有可能转诊到其他妇产科专科（15.9% vs 8.7%， P<.001）。在接受妇科肿瘤医生治疗的5329例患者中，LEP患者在初始诊断相关转诊后更有可能延迟接受治疗（LEP患者63.2% vs未LEP患者52.4%，P< 0.001； LEP患者43.5% vs未LEP患者35.7%，等待时间超过6周，P< 0.001）。从咨询到治疗的时间没有因语言状况而异。在调整了种族、保险状况和种族后，LEP患者从转诊到治疗的时间仍然长16.0%。结论：在这个庞大的、多样化的队列中，LEP患者经历了不公平的、累积的医疗延误。低效的转诊模式造成了初次妇科肿瘤会诊的延误。
{"title":"Delay in Care for Gynecologic Oncology Patients With Limited English Proficiency.","authors":"Maya Gross,Kemi M Doll,Isabel Rodriguez,Soledad Jorge","doi":"10.1097/aog.0000000000006128","DOIUrl":"https://doi.org/10.1097/aog.0000000000006128","url":null,"abstract":"OBJECTIVETo evaluate referral patterns and care delay for the growing population of patients with limited English proficiency (LEP) who seek treatment with gynecologic oncologists.METHODSThis is a retrospective cohort study of all patients seen by gynecologic oncologists at a National Cancer Institute-designated cancer center from 2013 to 2024 (referral cohort). Our primary outcome was the time to receipt of first treatment after the initial referral, by LEP status (among patients receiving treatment with a gynecologic oncologist-the treatment cohort) and with delay categorized using 4- and 6-week cutoffs. We compared referral patterns and sociodemographic, clinical, and temporal data by LEP status, defined as documented need for an interpreter. We employed χ2 tests for categorical variables and two-sided t tests or Mann-Whitney U tests for continuous variables. Multivariable linear regression was performed.RESULTSOf 9,915 patients seen for consultation, 5.8% (n=573) had LEP. Patients with LEP were significantly more likely to have referrals originating from the emergency department (6.5% vs 1.0%, P<.001), require multiple referrals to a gynecologic oncologist before initial consultation (9.4% vs 5.1%, P<.001), and be referred to other obstetrics and gynecology specialties before reaching gynecologic oncology (15.9% vs 8.7%, P<.001). Of 5,329 patients who received treatment with gynecologic oncologists, those with LEP were more likely to experience delays in receiving treatment after the initial diagnosis-related referral (63.2% with LEP vs 52.4% without LEP waiting more than 4 weeks, P<.001; 43.5% with LEP vs 35.7% without LEP waiting more than 6 weeks, P<.001). The time from consultation to treatment did not differ by language status. After adjusting for race, insurance status, and ethnicity, the time from referral to treatment remained 16.0% longer for patients with LEP.CONCLUSIONIn this large, diverse cohort, patients with LEP experienced inequitable, cumulative health care delays. Inefficient referral patterns created delay before initial gynecologic oncology consultation.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"117 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145599765","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 : 2025-11-20DOI: 10.1097/aog.0000000000006123
Sawsan As-Sanie,Whitney T Ross,Sara R Till
Chronic pelvic pain (CPP) is a complex and often debilitating condition that affects 15-26% of women worldwide. It is defined as pain perceived to originate from pelvic organs or structures that typically lasts longer than 6 months and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. Chronic pelvic pain is not a single disease but rather a symptom with many potential causes, with most patients having multiple contributing conditions. This article provides an overview of the evaluation and management of CPP for obstetrician-gynecologists. We recommend an organ system-based approach to diagnosis, recognizing that any combination of gynecologic, gastrointestinal, musculoskeletal, urologic, neurologic, and vascular sources is a possible cause. Effective management integrates behavioral, pharmacologic, and surgical strategies tailored to the suspected pain mechanisms in each patient. Educating patients about pain physiology, including the interaction between peripheral pathology and central pain amplification, is essential. Although CPP is not always curable, patients can experience significant and meaningful improvement in pain, function, and quality of life through long-term interdisciplinary support. Establishing a strong therapeutic relationship, validating patients' experiences, and empowering patients to take an active role in their care are central to effective management. Shared decision making, collaborative goal setting, and establishing clear expectations support sustained engagement and functional improvement.
{"title":"Evaluation and Treatment of Chronic Pelvic Pain.","authors":"Sawsan As-Sanie,Whitney T Ross,Sara R Till","doi":"10.1097/aog.0000000000006123","DOIUrl":"https://doi.org/10.1097/aog.0000000000006123","url":null,"abstract":"Chronic pelvic pain (CPP) is a complex and often debilitating condition that affects 15-26% of women worldwide. It is defined as pain perceived to originate from pelvic organs or structures that typically lasts longer than 6 months and is often associated with negative cognitive, behavioral, sexual, and emotional consequences. Chronic pelvic pain is not a single disease but rather a symptom with many potential causes, with most patients having multiple contributing conditions. This article provides an overview of the evaluation and management of CPP for obstetrician-gynecologists. We recommend an organ system-based approach to diagnosis, recognizing that any combination of gynecologic, gastrointestinal, musculoskeletal, urologic, neurologic, and vascular sources is a possible cause. Effective management integrates behavioral, pharmacologic, and surgical strategies tailored to the suspected pain mechanisms in each patient. Educating patients about pain physiology, including the interaction between peripheral pathology and central pain amplification, is essential. Although CPP is not always curable, patients can experience significant and meaningful improvement in pain, function, and quality of life through long-term interdisciplinary support. Establishing a strong therapeutic relationship, validating patients' experiences, and empowering patients to take an active role in their care are central to effective management. Shared decision making, collaborative goal setting, and establishing clear expectations support sustained engagement and functional improvement.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"106 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559169","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 : 2025-11-20DOI: 10.1097/aog.0000000000006127
Meredith Matone,Max Jordan Nguemeni Tiako,Doug Strane,Xianqun Luan,Zachary Meisel
OBJECTIVETo assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure.METHODSRetrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use, defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population.RESULTSOf 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43).CONCLUSIONOpioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.
{"title":"Postpartum Persistent Opioid Use After Opioid Exposure for Childbirth.","authors":"Meredith Matone,Max Jordan Nguemeni Tiako,Doug Strane,Xianqun Luan,Zachary Meisel","doi":"10.1097/aog.0000000000006127","DOIUrl":"https://doi.org/10.1097/aog.0000000000006127","url":null,"abstract":"OBJECTIVETo assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure.METHODSRetrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use, defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population.RESULTSOf 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43).CONCLUSIONOpioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"54 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559165","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 : 2025-11-20DOI: 10.1097/aog.0000000000006129
Anna P Staniczenko,Julie Robin Dean,Kristin Voegtline,Charlene Thomas,Sajjad Abedian,Evan Sholle,Steven Yen,Julia Cron,Lauren M Osborne,Heather S Lipkind,Moeun Son
OBJECTIVETo evaluate whether there is an association between the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) score and postpartum care attendance.METHODSThis is a retrospective cohort study of patients who delivered at 20 0/7 weeks of gestation or later at any of three hospitals within a New York City health care system from January 1, 2022, to February 1, 2024, and had at least one prenatal outpatient visit at an affiliated site before delivery. The primary outcome was at least one outpatient in-person obstetric visit within 12 weeks of delivery. The exposure was CDC-defined SVI score, with a validated technique for geocoding patient addresses used to assign overall SVI score and SVI theme scores. The SVI score was categorized into quartiles representing low to high social vulnerability. Demographic, medical, and obstetric factors were examined with univariable and multivariable logistic regression.RESULTSOf 21,539 eligible patients, 14,026 (65.1%) attended an in-person postpartum visit within 12 weeks of delivery. In-person postpartum visit attendance was documented in 2,147 (50.3%) of those with high social vulnerability, 3,020 (64.4%) of those with medium-to-high SVI score, 4,568 (70.6%) of those with low-to-medium SVI score, and 4,191 (70.6%) of those with low SVI score. In univariable analysis, both medium-to-high SVI score and high SVI score were associated with lower odds of attending a postpartum visit (odds ratio [OR] 0.75 [95% CI, 0.70-0.82] and 0.42 [95% CI, 0.39-0.46], respectively) compared with those with low SVI score. These associations were also detected among the SVI socioeconomic, household composition, and racial and ethnic minority themes but not housing type and transportation theme. However, only high SVI score was associated with decreased odds of attending an in-person postpartum visit in multivariable models (adjusted OR 0.85 [95% CI, 0.78-0.94]).CONCLUSIONA high SVI score was associated with lower likelihood of in-person postpartum visit attendance within 12 weeks of delivery.
{"title":"Social Vulnerability Index and Its Association With Postpartum Care Attendance.","authors":"Anna P Staniczenko,Julie Robin Dean,Kristin Voegtline,Charlene Thomas,Sajjad Abedian,Evan Sholle,Steven Yen,Julia Cron,Lauren M Osborne,Heather S Lipkind,Moeun Son","doi":"10.1097/aog.0000000000006129","DOIUrl":"https://doi.org/10.1097/aog.0000000000006129","url":null,"abstract":"OBJECTIVETo evaluate whether there is an association between the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI) score and postpartum care attendance.METHODSThis is a retrospective cohort study of patients who delivered at 20 0/7 weeks of gestation or later at any of three hospitals within a New York City health care system from January 1, 2022, to February 1, 2024, and had at least one prenatal outpatient visit at an affiliated site before delivery. The primary outcome was at least one outpatient in-person obstetric visit within 12 weeks of delivery. The exposure was CDC-defined SVI score, with a validated technique for geocoding patient addresses used to assign overall SVI score and SVI theme scores. The SVI score was categorized into quartiles representing low to high social vulnerability. Demographic, medical, and obstetric factors were examined with univariable and multivariable logistic regression.RESULTSOf 21,539 eligible patients, 14,026 (65.1%) attended an in-person postpartum visit within 12 weeks of delivery. In-person postpartum visit attendance was documented in 2,147 (50.3%) of those with high social vulnerability, 3,020 (64.4%) of those with medium-to-high SVI score, 4,568 (70.6%) of those with low-to-medium SVI score, and 4,191 (70.6%) of those with low SVI score. In univariable analysis, both medium-to-high SVI score and high SVI score were associated with lower odds of attending a postpartum visit (odds ratio [OR] 0.75 [95% CI, 0.70-0.82] and 0.42 [95% CI, 0.39-0.46], respectively) compared with those with low SVI score. These associations were also detected among the SVI socioeconomic, household composition, and racial and ethnic minority themes but not housing type and transportation theme. However, only high SVI score was associated with decreased odds of attending an in-person postpartum visit in multivariable models (adjusted OR 0.85 [95% CI, 0.78-0.94]).CONCLUSIONA high SVI score was associated with lower likelihood of in-person postpartum visit attendance within 12 weeks of delivery.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"35 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559144","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 : 2025-11-13DOI: 10.1097/AOG.0000000000006105
Spencer C Darveau, Naima T Joseph, Laura E Riley
Vector-borne diseases, including dengue, Zika virus, chikungunya, and Oropouche, pose significant health risks during pregnancy, with potential adverse outcomes for both mother and fetus. As a result of expanding vector habitats, there is increasing likelihood that obstetricians will encounter these illnesses in their clinical practice. This clinical guidance aims to provide evidence-based recommendations for the diagnosis and management of tropical vector-borne diseases in pregnant individuals, emphasizing clinical risk stratification based on epidemiologic risk factors. The clinical overlap with other obstetric syndromes such as intrauterine inflammation and infection underscores the importance of early detection to mitigate adverse pregnancy outcomes. Discussion of preventive measures, including vector control, the use of repellents, and vaccination, is included.
{"title":"Differentiating and Managing Emerging Tropical Vector-Borne Diseases During Pregnancy.","authors":"Spencer C Darveau, Naima T Joseph, Laura E Riley","doi":"10.1097/AOG.0000000000006105","DOIUrl":"https://doi.org/10.1097/AOG.0000000000006105","url":null,"abstract":"<p><p>Vector-borne diseases, including dengue, Zika virus, chikungunya, and Oropouche, pose significant health risks during pregnancy, with potential adverse outcomes for both mother and fetus. As a result of expanding vector habitats, there is increasing likelihood that obstetricians will encounter these illnesses in their clinical practice. This clinical guidance aims to provide evidence-based recommendations for the diagnosis and management of tropical vector-borne diseases in pregnant individuals, emphasizing clinical risk stratification based on epidemiologic risk factors. The clinical overlap with other obstetric syndromes such as intrauterine inflammation and infection underscores the importance of early detection to mitigate adverse pregnancy outcomes. Discussion of preventive measures, including vector control, the use of repellents, and vaccination, is included.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513611","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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