Obstetrics and gynecology最新文献

In 2003, the U.S. Food and Drug Administration (FDA) issued a black box warning on menopausal hormone therapy (MHT) products based on putative harm of secondary outcomes and incompletely collected and adjudicated data from the Women's Health Initiative (WHI) oral conjugated equine estrogens and medroxyprogesterone acetate study. Despite the specific parameters and limitations of the WHI study, these warnings were inappropriately generalized across all doses, formulations, and routes of administration, including local vaginal therapies, under the mandate to prescribe the "lowest effective dose for the shortest duration." After 22 years of clinical controversy, the U.S. Department of Health and Human Services and the FDA announced removal of the boxed warning on November 10, 2025. This decision was based on the FDA's independent and comprehensive review of the scientific literature, deliberations from an expert panel on July 17, 2025, and a 60-day public comment period. The FDA's transition to product-specific labeling, the removal of the mandate for the lowest effective dose for the shortest duration, and the inclusion of guidance on the optimal timing of MHT initiation within 10 years of menopause or before age 60 years, represent critical steps toward evidence-based menopause management. By replacing misleading information with accurate data, this regulatory shift facilitates individualized benefit-risk assessments and empowers shared decision making. Ultimately, these updates ensure that MHT use is optimized for the specific needs of each patient, integrating modern risk assessment with the latest clinical evidence to improve long-term health outcomes.

Objective: To examine the growth of obstetrics and gynecology residency programs and positions compared with other core medical specialties over the past 20 years.

Methods: Obstetrics and gynecology, family medicine, emergency medicine, internal medicine, general surgery, psychiatry, pediatrics, and anesthesiology match data were obtained from the National Resident Matching Program from 2005 to 2024. Generalized least-squares regression models accounting for autocorrelation and heteroskedasticity were used to obtain yearly changes in the number of positions offered and number of programs for each specialty, as well as P values comparing the trends relative to obstetrics and gynecology before and after 2015 (the year of the transition to a single accreditation system).

Results: Between 2005 and 2015, obstetrics and gynecology residency positions increased at an average annual rate of 1.0%, along with a slight decline in the number of programs (-0.5%). In contrast, from 2016 onward, obstetrics and gynecology residency positions increased by approximately 1.3% annually, with a 2.9% growth in programs. Up to 2015, obstetrics and gynecology experienced significantly slower growth in residency positions compared with almost all other specialties (P≤.05 in all instances) apart from family medicine and surgery. During that same period up to 2015, obstetrics and gynecology programs grew more slowly than emergency medicine, psychiatry, anesthesiology, and combined anesthesiology. Beginning in 2016, all specialties except family medicine, internal medicine, and combined anesthesia increased residency positions at significantly higher rates than obstetrics and gynecology (P≤.05). Since 2016, the growth of residency programs has remained slower for obstetrics and gynecology compared with family medicine, emergency medicine, internal medicine, and psychiatry.

Conclusion: Obstetrics and gynecology residency growth has lagged behind that of other specialties both before and since the single accreditation system transition in 2015, highlighting a persistent gap in capacity to meet increasing demand. These findings highlight the need for focused efforts to match the growth of obstetrics and gynecology residency positions and programs with the expanding health care demands.

Objective: To evaluate the clinical utility and methodologic validity of noninvasive prenatal testing (NIPT) for dominant single-gene disorders by performing a systematic review and meta-analysis.

Data sources: From database inception through April 2025, we explored PubMed, EMBASE, Cochrane Library, and Web of Science.

Method of study selection: Studies that reported NIPT panels to screen for dominant single-gene disorders with confirmation testing and involved at least 50 cases were included. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for study appraisal. Clinical utility was evaluated by using positivity rate and positive predictive value (PPV), with pooled estimates calculated through fixed- or random-effects models. Methodologic validity was assessed through sensitivity and specificity by using a bivariate random-effects model and summary receiver operating characteristic curve analysis.

Tabulation, integration and results: Ten articles comprising 12,577 cases were included. Positivity rate and PPV were calculated from nine studies, with sensitivity and specificity from seven studies. The pooled positivity rate was 2.2% (95% CI, 0.8-5.6%), and pooled PPV was 93.8% (95% CI, 86.4-97.3%). The bivariate model yielded a pooled sensitivity of 94.5% (95% CI, 85.7-98.0%) and specificity of 99.7% (95% CI, 98.8-99.9%), with an area under the curve of 0.98 (95% CI, 0.94-0.99). Subgroup analysis revealed positivity rates of 0.3% in low-risk populations, 1.2% in mixed-risk populations, and 6.0% in high-risk populations. High heterogeneity was observed in the positivity rate analysis (I2=96%). In contrast, heterogeneity was low (I2=16%) for PPV but with publication bias being detected (P=.004).

Conclusion: Noninvasive prenatal testing panels for dominant single-gene disorders achieve a high PPV with high sensitivity and specificity.

Systematic review registration: PROSPERO, CRD42024571768.

The care of young women with breast cancer can be influenced by pregnancy and desire for future fertility. Here, we provide an overview of breast cancer management in young women with special emphasis on gestational breast cancer and postpartum breast cancer, which are now understood to be distinct clinical entities with disparate outcomes. Typically, breast cancer is detected in young women after self-identification of a breast mass. The initial workup consists of diagnostic breast ultrasonogram and mammogram. Breast cancer treatments vary by histologic subtype of cancer and stage. Chemotherapy and surgery are safe during pregnancy, and it is now known that pregnant women with breast cancer have oncologic outcomes equivalent to those of nonpregnant women when treated according to standard of care. Postpartum breast cancer, however, has higher rates of metastatic disease and mortality. In general, breastfeeding can be safely continued during treatment with appropriate counseling and guidance from a breastfeeding medicine expert. Similarly, fertility preservation and future fertility can be safely pursued with appropriate interventions in young women with breast cancer.

Objective: To evaluate cabergoline's efficacy at decreasing lactation symptoms after early second-trimester abortion or pregnancy loss.

Methods: This is a multisite, double-blind, gestational-age stratified superiority trial that compared cabergoline 1 mg once with placebo for preventing bothersome breast symptoms immediately after uterine evacuation. We enrolled pregnant people at 16-20 weeks of gestation who were English- or Spanish-speaking and without contraindication to the study drug. Participants received cabergoline within 4 hours of uterine evacuation or fetal expulsion and, at baseline and at multiple time points through 2 weeks postprocedure, completed a validated electronic survey that assessed breast symptoms, side effects, and bother. Our primary outcome was breast symptoms (a composite of engorgement, milk leakage, tenderness, and need for pain relief) on day 4; we planned to enroll 30 participants in each gestational duration strata to show a 40% difference in breast symptoms (80% power, α=0.049).

Results: After screening 145 patients from February 2024 through May 2025, we enrolled 69 eligible participants. Baseline demographics were balanced between groups: Median gestational duration was 18 weeks (range 16 0/7-19 6/7 weeks), 53.0% were nulliparous, 63.6% self-identified as Hispanic, and 68.2% had public insurance. On day 4, significantly fewer participants who received cabergoline reported any breast symptoms compared with placebo (50.0% vs 88.2%, P<.001) (primary outcome) and fewer participants reported significant bother from breast symptoms (3.1% vs 20.6%, P=.05) (secondary outcome). These differences persist even in the earlier gestational duration strata.

Conclusion: Cabergoline is an effective and well-tolerated medication to prevent breast symptoms after early second-trimester abortion or pregnancy loss.

Clinical trial registration: ClinicalTrials.gov: NCT06029673.

The current treatment of provoked vestibulodynia involving neuroproliferation is often complete vestibulectomy; however, less invasive treatments are biologically plausible, yet lack study. The International Society for the Study of Women's Sexual Health, the National Vulvodynia Association, the Gynecologic Cancers Research Foundation, and Tight Lipped, a grassroots nonprofit organization that supports people with chronic vulvovaginal and pelvic pain, collectively sponsored a conference, the Vulvodynia Therapeutic Research Summit, held in April 2024. The primary objective of the Vulvodynia Therapeutic Research Summit was to identify options for further research of the treatment of provoked vestibulodynia through expert consensus. After the conference, attendees scored the presented therapeutics in rank order, leading to a hierarchy of merit. Fifteen therapeutic options were presented and ranked in order of most promising to least promising for further study on treating the neuroinflammation of provoked vestibulodynia. The top identified therapeutics for further research were: 1) ketotifen fumarate (mast cell stabilizer with potential to prevent mast cell activation), 2) resiniferatoxin (transient receptor vanilloid 1 agonist causing chemo-inactivation of nerve terminals), 3) specialized pro-resolving mediators or strategies to boost their levels (eg, maresin 1 and 1-trifluoromethoxy-phenyl-3-[1-propionylpiperidin-4-yl] urea), 4) luteolin (flavonoid with potent anti-inflammatory, antioxidant, and neuroprotective properties), 5) alpha-lipoic acid (antioxidant with nerve-specific anti-inflammatory and mast cell stabilizing qualities), and 6) NGFR121W -SNAP IR700 trimer exposed to near-infared light (photoablation targeting nociceptors and sparing surrounding tissue). This executive summary describes the rationale for identifying specific pharmacologic agents and medical devices as targets for research directed toward treatment of the neuroinflammatory process found in the vestibular mucosa of provoked vestibulodynia.