AJOG global reports最新文献

{"title":"Performance of hysteroscopy in diagnosing chronic endometritis and the role of intra- and inter-observer variability: a prospective study of 70 cases","authors":"Ahmed Halouani MD ,&nbsp;Haithem Aloui MD ,&nbsp;Rim Hamdaoui MD ,&nbsp;Yassine Masmoudi MD ,&nbsp;Amel Triki MD ,&nbsp;Anissa Ben Amor MD ,&nbsp;Lazhar Halouani MD","doi":"10.1016/j.xagr.2025.100515","DOIUrl":"10.1016/j.xagr.2025.100515","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic endometritis (CE) is a persistent inflammation of the endometrium often implicated in female infertility. Histological examination with immunohistochemical (IHC) analysis of the plasma cell marker CD138 is the gold standard for diagnosing this condition.</div></div><div><h3>Methods</h3><div>This prospective, multicentered, observational study was conducted from June 6, 2021, to August 8, 2022. We evaluated the diagnostic sensitivity and specificity of hysteroscopy (HSC) using the standardized criteria of Cicinelli et al, which include micro polyps, focal hyperemia, diffuse hyperemia, stromal edema, strawberry aspect, and hemorrhagic spots. We also assessed intra- and inter-observer variability in the hysteroscopic diagnosis of CE.</div></div><div><h3>Results</h3><div>The prevalence of CE diagnosed by IHC analysis of CD138 expression was 42.9%. The performance of HSC in diagnosing CE was moderate, with a sensitivity of 47.5%, specificity of 64.38%, positive predictive value of 50%, and negative predictive value of 62.05%. The inter-observer agreement for hysteroscopic diagnosis of CE was strong (<em>κ</em>=0.62), while intra-observer agreement was moderate (<em>κ</em>=0.58).</div></div><div><h3>Conclusion</h3><div>HSC is not the examination of choice for diagnosing CE. An endometrial biopsy using the Novak curette with IHC analysis of CD138 expression is a more sensitive and less costly diagnostic method.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100515"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of preeclampsia before 11th week of gestation: a secondary analysis of the ASPIRIN trial","authors":"Gabriela Capdeville MD ,&nbsp;Andrea Godinez-Medina MD ,&nbsp;Diana Y. Copado-Mendoza MD ,&nbsp;Sandra Acevedo-Gallegos MD ,&nbsp;Mario R. Rodriguez-Bosch MD ,&nbsp;Yubia Amaya-Guel MD ,&nbsp;Maria J. Rodriguez-Sibaja MD ,&nbsp;Mario I. Lumbreras-Marquez MD, MMSc","doi":"10.1016/j.xagr.2025.100521","DOIUrl":"10.1016/j.xagr.2025.100521","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Early screening for preeclampsia is crucial for preventing adverse maternal and fetal events. Current first-trimester algorithms for predicting preeclampsia are designed to evaluate individual risk between 11.0 and 13.6 weeks of gestation based on various maternal characteristics while integrating biophysical and biochemical features. However, there is limited information regarding risk assessment during earlier stages of pregnancy (i.e., &lt;11.0 weeks gestation).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To develop a prediction model for preeclampsia/eclampsia before 11.0 weeks of gestation as a proof-of-concept in a secondary analysis of the ASPIRIN trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;This study is a secondary analysis of the ASPIRIN trial, a multinational, randomized, double-blind, placebo-controlled trial. The ASPIRIN trial database, obtained from NICHD DASH, included 11,976 nulliparous pregnant women aged 18–40 with gestational ages of 6.0–13.6 weeks at randomization. Participants were assigned to receive either aspirin (81 mg/day) or placebo until 36.0 weeks or delivery. This secondary analysis included pregnancies delivered at ≥20.0 weeks, excluding those in the aspirin group or with gestational ages ≥11.0 weeks at enrollment. The composite outcome was preeclampsia/eclampsia, as reported in the ASPIRIN trial. Predictor variables available in the dataset included maternal age, education (4 levels), body mass index (BMI kg/m&lt;sup&gt;2&lt;/sup&gt;), gravidity, baseline hemoglobin, baseline systolic blood pressure, and baseline diastolic blood pressure. Logistic regression, with logarithmic transformation for continuous variables, was used to develop the model. The area under the ROC curve with a 95% confidence interval (CI) estimated via bootstrap resampling (1,000 iterations) and the &lt;em&gt;P&lt;/em&gt;-value of the Hosmer-Lemeshow statistical test are reported as discrimination and calibration measures. This study used the entire available sample using a complete case approach.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 3421 participants met the inclusion criteria, with a cumulative incidence of preeclampsia/eclampsia of 2.9% (99/3,421). Maternal age (21.96 ± 4.13 vs 20.86 ± 3.21, &lt;em&gt;P&lt;.&lt;/em&gt;001) and BMI (22.49 ± 4.77 vs 20.79 ± 3.55, &lt;em&gt;P&lt;.&lt;/em&gt;001) were significantly higher in the preeclampsia/eclampsia group. Gravidity was lower (&lt;em&gt;P=.&lt;/em&gt;023), and hemoglobin levels were slightly elevated (11.88 ± 1.52 g/dL vs 11.50 ± 1.61 g/dL, &lt;em&gt;P=.&lt;/em&gt;019) in the preeclampsia/eclampsia group. Educational level (&lt;em&gt;P=.&lt;/em&gt;070), systolic blood pressure (&lt;em&gt;P=.&lt;/em&gt;720), and diastolic blood pressure (&lt;em&gt;P=.&lt;/em&gt;390) showed no significant differences between groups. The logistic regression model yielded an AUC of 0.69 (95% CI 0.63–0.74), and the Hosmer-Lemeshow test &lt;em&gt;P&lt;/em&gt;-value was 0.094, indicating acceptable discrimination and calibration.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;This proof-of-concept log","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100521"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-abdominal hemorrhage following ultrasound-guided transvaginal oocyte retrieval: Retrospective analysis of 25 cases","authors":"Lin Chen MD ,&nbsp;Huanxiao Zhang MD ,&nbsp;Yanwen Xu MD ,&nbsp;Zengyan Wang MD","doi":"10.1016/j.xagr.2025.100508","DOIUrl":"10.1016/j.xagr.2025.100508","url":null,"abstract":"<div><h3>Background</h3><div>Intra-abdominal hemorrhage (IAH) is a rare but potentially life-threatening complication of ultrasound-guided transvanginal oocyte pick up (OPU). Despite the widespread use of OPU in assisted reproductive technology, minor hemorrhages may remain undetected without vigilant monitoring, potentially escalating to severe bleeding. This study aims to elucidate the clinical characteristics, risk factors, and management outcomes of IAH following OPU.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 25 hospitalized patients who developed IAH within 7 days post-OPU at a university-affiliated hospital between 2010 and 2021. Data on demographics, clinical presentations, laboratory findings, treatment modalities, and reproductive outcomes were systematically reviewed.</div></div><div><h3>Results</h3><div>The incidence of IAH was 0.05% (95% CI, 0.03%–0.07%). Symptoms typically manifested within 12 hours post-OPU, with abdominal pain and distension being most common. Hemoglobin (Hb) and hematocrit (Hct) reductions averaged 26.50±13.32 mg/dL and 7.70±3.66%, respectively. Seventeen patients were managed conservatively, while 8 required surgical intervention. Notably, 52% of patients achieved live births, with no adverse pregnancy outcomes linked to IAH.</div></div><div><h3>Conclusion</h3><div>IAH is a rare but life-threatening OPU complication. Extended postoperative monitoring is critical for early diagnosis, with conservative management as the first-line approach.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100508"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144280485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetricians’ experiences with remote monitoring programs for hypertensive disorders","authors":"Kortney F. James PhD, RN ,&nbsp;Molly Waymouth MPH ,&nbsp;Gabriela Alvarado PhD ,&nbsp;Ateev Mehrotra MD ,&nbsp;Lori Uscher-Pines PhD","doi":"10.1016/j.xagr.2025.100513","DOIUrl":"10.1016/j.xagr.2025.100513","url":null,"abstract":"<div><h3>Background</h3><div>Despite widespread use in primary care, remote patient monitoring (RPM) in obstetrics for hypertensive disorders in pregnancy remain limited. Little is known about the specific modalities, perceived impact, and integration of RPM into standard practice in obstetrics.</div></div><div><h3>Objective</h3><div>To explore obstetricians’ experiences with RPM for hypertensive disorders in the perinatal period and barriers in implementation, and to identify promising practices to overcome these barriers.</div></div><div><h3>Study Design</h3><div>This qualitative study, conducted from September to October 2024, involved semi-structured interviews with 20 obstetricians across the United States, who represented different practice settings and RPM program models. We developed a qualitative codebook and conducted thematic analysis informed by the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework.</div></div><div><h3>Results</h3><div>Five key themes emerged from interviews: (1) Barriers to Engagement; (2) Perceptions of Clinical Benefit; (3) Financial Hurdles in RPM Utilization; (4) Navigating Workflow and Data Challenges; and (5) Liability Concerns in RPM. RPM programs varied substantially in their eligibility criteria, timing within the perinatal period, data transfer methods, staffing models, and workflow. The major barriers included financial constraints (eg, insurance coverage and equipment costs), complex workflows, liability concerns related to 24/7 monitoring and response, and patient-level barriers (eg, technology literacy, language, and anxiety). Obstetricians used several strategies to overcome these challenges, including having patients bring their cuffs to the office to validate accuracy, assigning dedicated staff or partnering with a vendor to streamline workflows, coupling RPM with additional services like pregnancy education to improve adherence, and training staff so not all issues (eg, medication titration) require escalation to obstetricians. Despite the challenges, participants generally valued RPM and observed benefits in both clinical outcomes and patient engagement.</div></div><div><h3>Conclusion</h3><div>These findings highlight the need for context-specific approaches to enhance the accessibility and effectiveness of RPM for managing hypertensive disorders in the perinatal period.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100513"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying social vulnerability index to examine social disparities in patients undergoing hysterectomy","authors":"Andrew Tannous MD ,&nbsp;Jessica Floyd MD ,&nbsp;Jeanelle Sheeder PhD ,&nbsp;Saketh Guntupalli MD","doi":"10.1016/j.xagr.2025.100516","DOIUrl":"10.1016/j.xagr.2025.100516","url":null,"abstract":"<div><h3>Background</h3><div>The social vulnerability index (SVI) measures socioeconomic hardship, with high SVI indicating high susceptibility. We applied the SVI to characterize and compare patients who underwent abdominal versus minimally invasive hysterectomy.</div></div><div><h3>Objective</h3><div>To evaluate whether high social vulnerability, as measured by SVI, was associated with a lower likelihood of undergoing minimally invasive hysterectomy compared to abdominal hysterectomy.</div></div><div><h3>Study Design</h3><div>This was a retrospective cohort study conducted across 4 hospitals within a single health system in Colorado. The study included patients who underwent hysterectomy for any indication between 2013 and 2018. Patient addresses were geocoded to estimate overall SVI and its 4 sub-domains: Socioeconomic, Housing/Disability, Race/Minority, and Housing/Transportation. These data were analyzed to evaluate for an association between SVI and surgical approach to hysterectomy.</div></div><div><h3>Results</h3><div>Among 2,619 patients, 86% underwent MIH (87.3% non-Hispanic White [NHW]; 76.6% non-Hispanic Black [NHB]; 82.5% Hispanic). Patients undergoing MIH were more likely to be NHW, ASA class I or II, and less likely to have diabetes, hypertension, or receive care within a tertiary referral center (<em>P</em>&lt;.05). While MIH was not associated with high overall SVI (<em>P</em>=.07), patients undergoing abdominal hysterectomy were more likely to have high SVI in race/minority and housing/transportation sub-domains (<em>P</em>=.006 and <em>P</em>=.01, respectively). Significant differences in age, comorbidities, BMI class, hospital setting, route of hysterectomy were observed across all race/ethnic groups (<em>P</em>&lt;.001).</div><div>Multivariable logistic regression analysis showed that high overall SVI or high SVI in either race/minority or housing/transportation sub-domains was not significantly associated with MIH. However, age (aOR 0.97; [0.97−0.98]), NHW race/ethnicity (aOR 1.49; [1.14−1.94]), hospital setting within a tertiary referral center (aOR 0.29; [0.22−0.38]), and ASA class I (aOR 1.6; [1.05−2.46]) were independent predictors of MIH.</div></div><div><h3>Conclusion</h3><div>Age, race/ethnicity, hospital setting, and ASA class were found to be stronger independent predictors of MIH than SVI. Because race/ethnicity and hospital setting are independently associated with SVI based on prior study, we suspect that including these variables in the analysis weakened the observed independent association between SVI and route of hysterectomy. Further research is required to understand the underlying mechanisms driving surgical disparities, which may include systemic, institutional, or provider-level factors.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100516"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial, ethnic, and neighborhood disparities in diagnosis of perinatal psychiatric illness","authors":"Jessica C. Rohr PhD ,&nbsp;Pedro T. Ramirez MD ,&nbsp;Farhaan S. Vahidy PhD, MBBS, MPH, FAHA ,&nbsp;Alok Madan PhD, MPH","doi":"10.1016/j.xagr.2025.100511","DOIUrl":"10.1016/j.xagr.2025.100511","url":null,"abstract":"<div><h3>Background</h3><div>Rates of maternal morbidity and mortality are a global health crisis, and perinatal psychiatric illness is the most common morbidity in pregnancy. Racial, ethnic, and socioeconomic disparities in perinatal psychiatric illness contribute to disparities in maternal morbidity and mortality. There is limited data on diagnosis rates across race/ethnicity and neighborhood deprivation.</div></div><div><h3>Objective</h3><div>To identify prevalence of perinatal psychiatric illness diagnosis and determine differences based on race, ethnicity, and neighborhood deprivation.</div></div><div><h3>Study design</h3><div>This cross-sectional study included women who gave birth between 2020 and 2023 at a Houston Methodist hospital. Houston Methodist is a hospital system serving the greater Houston area. During the study period, 20 015 women received perinatal care from and delivered at a Houston Methodist system hospital. The first birth per individual was used for analyses. 2 women were removed due to missing data. A final 20 013 were eligible for inclusion. Variables of interest included neighborhood deprivation, defined as a score on the Area Deprivation Index, a validated socioeconomic measure, and self-reported race and ethnicity as reported in electronic health record. The main a priori outcome was any psychiatric illness diagnosed between estimated date of conception and 3 months postpartum.</div></div><div><h3>Results</h3><div>The sample was distributed across race and ethnicity, with 2 098 (10.5%) Asian, 2 893 (14.5%) Black, 5 208 (26.0%) Hispanic White, 8 218 (41.1%) non-Hispanic White, and 1596 (8.0%) other. Mean age of women included in our analyses was 30.50 years (SD= 5.33). Perinatal psychiatric illness was diagnosed in 19.1% of patients. Non-Hispanic White women were diagnosed at the highest rates (24.8%), while Asian women were diagnosed at the lowest rates (9.1%). Rates trended higher as area deprivation increases across the total sample. However, this trend only held for non-Hispanic White women, for whom higher deprivation has significantly higher prevalence rates than lower deprivation (30.6% vs 18.7%, <em>P</em>&lt;.001).</div></div><div><h3>Conclusions</h3><div>One in five women in our study was diagnosed with perinatal psychiatric illness. Our stratified findings were inconsistent with previous reports of higher symptom burden in women of color. Neighborhood deprivation has differential impact depending on race/ethnicity, highlighting the importance of accounting for sociocultural variables when analyzing prevalence.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100511"},"PeriodicalIF":0.0,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric violence informed by theories of intersectionality, oppression, and power dynamics—a Ghanaian’s perspectives","authors":"Ephraim Senkyire MSN ,&nbsp;Gloria Senkyire B-TECH ,&nbsp;Ernestina Asiedua PhD ,&nbsp;Victor Tawose-Adebayo MSC ,&nbsp;Magdalena Ohaja PhD","doi":"10.1016/j.xagr.2025.100505","DOIUrl":"10.1016/j.xagr.2025.100505","url":null,"abstract":"<div><div>This essay explores obstetric violence (OV) from a Ghanaian perspective, applying theories of intersectionality, oppression, and power dynamics to critically analyze its causes and manifestations. OV, defined as mistreatment during childbirth, includes acts of physical abuse, nonconsensual care, discrimination, and breaches of privacy. Despite efforts to reduce maternal mortality in Ghana, systemic challenges persist, contributing to a high prevalence of OV, particularly among vulnerable groups such as adolescents, the socioeconomically disadvantaged, and ethnic minorities. The essay highlights that midwives, while essential to maternal care, often operate within oppressive healthcare systems characterized by poor resourcing, rigid hierarchies, and systemic gender bias. Through the lens of intersectionality, the study reveals how overlapping social identities—such as age, ethnicity, and socioeconomic status—influence women’s vulnerability to mistreatment. Oppressed group theory explains how midwives, themselves marginalized within patriarchal and medically dominated structures, may internalize oppression and perpetuate violence toward patients. Foucault’s theory of power and knowledge is used to illustrate how institutional norms and knowledge hierarchies empower midwives to exercise control over birthing women, often compromising women’s autonomy and dignity. The essay further discusses how systemic issues, including underinvestment in healthcare infrastructure, inadequate training on respectful maternity care, and normalization of abusive practices, contribute to the persistence of OV. It calls for comprehensive reforms such as empowering midwives through education and leadership training, decentralizing healthcare authority, promoting respectful maternity care practices, and addressing systemic inequities. Raising awareness, fostering accountability, and embedding patient-centered care principles into healthcare institutions are critical steps toward eliminating OV. Ultimately, the essay argues that addressing OV in Ghana requires not only confronting individual behaviors but dismantling the deeper structural and institutional forces that sustain power imbalances and systemic oppression. Empowering both midwives and birthing women is essential for transforming maternity care and advancing equitable, respectful maternal health outcomes in Ghana.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The feasibility and surgical outcomes of robotic vaginal natural orifice transluminal endoscopic single port hysterectomy for benign gynecologic diseases: a systematic review and meta-analysis","authors":"Greg Marchand MD, FACS, FICS, FACOG ,&nbsp;Hollie Ulibarri BS ,&nbsp;Amanda Arroyo BS ,&nbsp;Daniela Gonzalez Herrera BS ,&nbsp;Brooke Hamilton BS ,&nbsp;Kate Ruffley BS ,&nbsp;Mckenna Robinson BS ,&nbsp;Ali Azadi MD, FACOG, FPMRS","doi":"10.1016/j.xagr.2025.100512","DOIUrl":"10.1016/j.xagr.2025.100512","url":null,"abstract":"<div><h3>Objective</h3><div>Vaginal natural orifice transluminal endoscopic surgery (vNOTES) combines vaginal surgery with single-port laparoscopy, providing a minimally invasive technique designed to overcome the challenges in traditional vaginal surgery. Several authors have now described techniques for performing these procedures with robotic assistance (R-vNOTES). We aim to evaluate the surgical outcomes and the safety of R-vNOTES hysterectomy in patients with benign diseases.</div></div><div><h3>Data Sources</h3><div>We searched six major databases from their inception through October 2024 for studies analyzing the surgical outcomes of hysterectomy by R-vNOTES in cases with benign gynecologic diseases.</div></div><div><h3>Study eligibility criteria</h3><div>We included all primary research studies that included at least one of our selected outcomes and did not include surgeries for malignant conditions.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Study quality was appraised using the National Heart, Lung, and Blood Institute quality assessment tools. Data synthesis was accomplished using OpenMetaAnalyst and RevMan software. Mean difference and 95% confidence intervals were used for continuous outcomes following inverse variance analyses. Dichotomous outcomes were analyzed using an odds ratio and 95% confidence intervals.</div></div><div><h3>Results</h3><div>Ultimately 10 eligible studies were included in our synthesis, including two studies that compared the R-vNOTES technique to robot-assisted laparoscopic hysterectomy (RALH) performed for the same indications. Our overall pooled analysis demonstrated that the operation time of R-vNOTES was 142 minutes, with an estimated blood loss of 67 mL. The overall length of hospital stay among the included studies was 2.04 days. We found an approximate decrease of 1.4 grams of hemoglobin after surgery. The incidence of conversion was 1.3%, and the complication rate was 13.3%. We found, R-vNOTES was to have a shorter operative time (<em>P</em>&lt;.001) and lower blood loss than RALH (<em>P</em>=.002), with no significant differences seen between the cohorts in total hospital stay (<em>P</em>=.29) or complication rates (<em>P</em>=.98).</div></div><div><h3>Conclusion</h3><div>Initial data shows that R-vNOTES seems to be a feasible minimally invasive technique with comparable outcomes and a favorable safety profile. Compared to RALH, R-vNOTES was associated with a shorter operation time and less blood loss.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100512"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone mineral density changes during use of progestin-only contraceptives: a rapid review of recent evidence","authors":"Blake Erhardt-Ohren MPH ,&nbsp;Ndola Prata MD, MSc ,&nbsp;Scott Rosenblum MS","doi":"10.1016/j.xagr.2025.100509","DOIUrl":"10.1016/j.xagr.2025.100509","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this paper is to consolidate existing evidence and identify knowledge and research gaps on the bone health effects of progestin-only oral contraception, injectables, hormonal intrauterine devices, and implants. implementation.</div></div><div><h3>Data sources</h3><div>We searched PubMed, CINAHL, Web of Science, and The Cochrane Library for conference abstracts, original research articles, systematic reviews, and meta-analyses published between 05 May 2012 and 31 August 2023.</div></div><div><h3>Study eligibility criteria</h3><div>We limited results to any study design published as a conference abstract, original research study, meta-analysis, or systematic review in English-language peer-reviewed journals.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Two independent reviewers screened item titles. One reviewer read all abstracts and full papers, and a second reviewer confirmed alignment with a 5% sample of each. One reviewer extracted relevant information into Excel with a 5% sample review by another research team member. We reviewed the references for all included items and screened potentially relevant items in the same manner as described above. Subject matter experts contributed additional items. We assessed items using the Mixed Methods Appraisal tool.</div></div><div><h3>Results</h3><div>The search strategy yielded 32 items, most of which explored the use of intra-muscular depot medroxyprogesterone acetate 150mg. We found a clear association between any use of depot medroxyprogesterone acetate and bone mineral density loss. This negative effect seems to be more common among younger women and women on antiretrovirals. There is, however, evidence to suggest that bone loss can be restored after depot medroxyprogesterone acetate discontinuation. Hormonal intrauterine device and implant users do not seem to experience bone mineral density loss.</div></div><div><h3>Conclusions</h3><div>While there is a clear association between bone mineral density loss and depot medroxyprogesterone acetate injectable use, treatment during contraceptive use and bone health restoration following discontinuation are not adequately researched. In this review, we provide evidence that bone health can be partially or completely restored after depot medroxyprogesterone acetate discontinuation, identify opportunities to learn more about depot medroxyprogesterone acetate injectables and bone health during and after use, and find gaps in knowledge on potential associations between bone health and other progestin-only contraceptives.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 3","pages":"Article 100509"},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived, objective, and applied numeracy among pregnant women engaged in home blood pressure monitoring in Ghana","authors":"Emma R. Lawrence MD ,&nbsp;Sanaya Irani BS ,&nbsp;Betty Nartey MPH ,&nbsp;Brittney Collins BS ,&nbsp;Elorm Segbedzi-Rich MD ,&nbsp;Andrea Pangori MS ,&nbsp;Titus K. Beyuo MD ,&nbsp;Cheryl A. Moyer PhD ,&nbsp;Jody R. Lori PhD ,&nbsp;Samuel A. Oppong MD","doi":"10.1016/j.xagr.2025.100468","DOIUrl":"10.1016/j.xagr.2025.100468","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders of pregnancy are associated with poor maternal and neonatal outcomes. Since elevated blood pressure is often a first presenting sign, a major function of antenatal care is frequent blood pressure monitoring. A newer approach to this—patient-performed home monitoring—has not been widely implemented in low- and middle-income countries, including Ghana. Patient numeracy levels that are sufficient to understand and interpret home blood pressure values are a critical component of a successful home monitoring intervention.</div></div><div><h3>Objective</h3><div>To evaluate perceived, objective, and applied numeracy to identify elevated blood pressure values among pregnant women engaged in home blood pressure monitoring in Ghana.</div></div><div><h3>Study Design</h3><div>Participants were 80 pregnant women at a tertiary hospital in Accra, Ghana. After training, participants engaged in home blood pressure monitoring for 2 to 4 weeks. A post-monitoring survey evaluated confidence and experience interpreting blood pressure values, a validated numeracy scale, and interpretation of blood pressure monitor outputs—half with numbers only and half with both numbers and colors. Mean correct responses on numbers only and numbers and colors outputs were compared. Linear regression evaluated predictors of correct interpretation of blood pressures.</div></div><div><h3>Results</h3><div>On a validated numeracy scale, mean score was 16.73 (SD: 6.01) out of 25, with 73.8% (n=59) having numeracy. Perceived ability was high, with 70.9% (n=56) definitely believing they could interpret blood pressures values. However, on objective evaluation, only 36.3% (n=29) correctly identified the cutoff for elevated systolic and 26.3% (n=21) for elevated diastolic blood pressure values. Out of eight displayed blood pressure monitor outputs, correct identification was significantly higher on outputs with both numbers and colors (μ=7.19, σ=0.81) compared to numbers only (μ=6.54, σ=1.35). On an adjusted linear regression, only scores on the numeracy scale had a significant yet small association with correctly identifying blood pressure monitor outputs (β 0.07, <em>P</em>=.025).</div></div><div><h3>Conclusion</h3><div>Home blood pressure monitoring would benefit from monitors with both numerical and color-coded output. Focused training, rather than education level or general numeracy, may best predict blood pressure interpretation.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"5 2","pages":"Article 100468"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}