American journal of obstetrics and gynecology最新文献

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IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-20 DOI: 10.1016/s0002-9378(26)00092-x

引用次数: 0

AJOG GR Table of Contents AJOG GR目录表

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-20 DOI: 10.1016/s0002-9378(26)00093-1

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Evaluating an asynchronous self-screening and patient-education tool for medication abortion without ultrasound. 评估非超声药物流产的异步自我筛查和患者教育工具。

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-20 DOI: 10.1016/j.ajog.2026.03.013

Mary Tschann,Reni Soon,Bliss Kaneshiro,Melissa Natavio,Brandi Mikami,Marit Pearlman-Shapiro

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Information for readers 读者资讯

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-20 DOI: 10.1016/s0002-9378(26)00091-8

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First-trimester serum placental growth factor and risk of severe maternal morbidity and mortality. 妊娠早期血清胎盘生长因子与严重产妇发病率和死亡率的风险。

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-19 DOI: 10.1016/j.ajog.2026.03.014

Joel G Ray,Maria P Velez,Yuguang Kang,Tianhua Huang,Natalie Dayan,Jennifer A Jairam,Ziv Harel

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Methodological considerations in probiotic therapy for vulvovaginal candidiasis research (Reply to Letter-to-the-Editor). 外阴阴道念珠菌病研究中益生菌治疗的方法学考虑（回复编辑信）。

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-19 DOI: 10.1016/j.ajog.2026.03.010

Rongdan Chen,Wei Qing,Shenghai Wu

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Social vulnerability and management of early pregnancy loss. 社会脆弱性和早期妊娠损失的管理。

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-19 DOI: 10.1016/j.ajog.2026.03.011

Lyndsey S Benson,Vanessa Dalton,Brian Madden,Xilin Chen,Hari Nathan,Michelle Moniz

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Strain Specificity and Host Microenvironment: Essential Considerations in Probiotic Therapy for Vulvovaginal Candidiasis (Letter-to-the-Editor). 菌株特异性和宿主微环境：外阴阴道念珠菌病益生菌治疗的基本考虑（致编辑信）。

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-19 DOI: 10.1016/j.ajog.2026.03.009

Shaojing Xu,Sizhuo Chen

引用次数: 0

Deep learning for Evaluation and Prediction of TecHnical Skills in robotic-assisted vaginal cuff closure (DEPTHS) study. 深度学习在机器人辅助阴道袖带闭合（深度）研究中的技术技能评估和预测。

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-19 DOI: 10.1016/j.ajog.2026.03.015

Freweini Tesfai,Jialang Xu,Dimitrios Anastasiou,Runlong He,Matthew Boal,Yekaterina Aranan,Gita Lingam,Diya Shah,Danail Stoyanov,Dhivya Chandrasekaran,Evangelos Mazomenos,Nader Francis

BACKGROUNDTo support surgical education, there has been an increasing focus on integrating surgical data, including surgical motion, activity and process understanding, to develop predictive models to assess surgical skills.OBJECTIVEWe aimed to develop deep learning models to predict technical errors and generic surgical skills based on fine grained analysis during robotic-assisted vaginal cuff closures as part of a hysterectomy METHODS: We conducted a multi-centre prospective observational cohort study of robotic-assisted total hysterectomy performed between 2023-2025. Vaginal cuff closure video segments, recorded on the Touch Surgery Video platform via the DS1 computer, were extracted and double-annotated by two trained surgeons: errors via Objective Clinical Human Reliability Analysis (OCHRA) and global skill via modifiable GEARS (mGEARS). Three deep-learning pipelines were developed two critical surgical tasks: Surgical Video Error Detection (SVED) via temporal modelling models, and surgical skill assessment via few-shot surgical skill assessment and a multimodal learning.RESULTSA total of 40 videos including 667 minutes, (1201654 frames), from two centres were analysed. Eleven surgeons performed the vaginal cuff closure (3 beginners 5 intermediates, 3 experts). Inter-rater reliability was good for both mGEARS: ICC = 0.807, p=.001 and OCHRA error counts ICC : 0.712, p=.010). Median mGEARS was 21.0 (IQR 19.1-24.6) and median errors 25.0 (IQR 16.3-31.5). Level of experience showed significant correlation to mGEARS: Kruskal Wallis test was <0.002. Significant correlations were found between operative time and mGEARS and OCHRA: rs=-0.534, p<0.001, and rs = 0.421, p=.007. Few-shot experiments showed that, in the 5-shot setting, the model achieves a performance of 81.70% accuracy and 81.30% F1- score. Complementing this, the multimodal skill assessment model achieved excellent agreement with manual assessment ratings: rs = 0.85 ± 0.02; MAE = 1.85 ± 0.16.CONCLUSIONThis proof-of-concept shows that deep learning can objectively score generic surgical skill and initial flag frame-level errors in vaginal cuff closure videos, aligning with validated objective assessment tools. Although larger, multi-centre datasets remain essential, these results lay groundwork for Artificial Intelligence driven quality monitoring and evidence-based credentialing in minimally invasive gynecological surgery.

背景：为了支持外科教育，人们越来越关注整合手术数据，包括手术运动、活动和过程理解，以开发预测模型来评估手术技能。目的：我们旨在开发基于细粒度分析的深度学习模型，以预测作为子宫切除术一部分的机器人辅助阴道袖带闭合过程中的技术错误和一般手术技能。方法：我们对2023-2025年间进行的机器人辅助全子宫切除术进行了一项多中心前瞻性观察队列研究。阴道袖带闭合视频片段通过DS1计算机录制在Touch Surgery视频平台上，由两名训练有素的外科医生提取并双重注释：通过客观临床人类可靠性分析（OCHRA）进行错误注释，通过可修改的GEARS （mGEARS）进行全局技能注释。三个深度学习管道开发了两个关键的手术任务：通过时间建模模型的手术视频错误检测（SVED），以及通过少镜头手术技能评估和多模态学习的手术技能评估。结果分析了来自两个中心的40个视频，共667分钟（1201654帧）。11名外科医生实施阴道袖带闭合术（初学者3名，中级术者5名，专家3名）。两个mGEARS的评分者间信度都很好：ICC = 0.807, p= 0.001， OCHRA错误计数ICC: 0.712, p= 0.010)。中位mGEARS为21.0 (IQR为19.1-24.6)，中位误差为25.0 （IQR为16.3-31.5）。经验水平与mGEARS呈显著相关：Kruskal Wallis检验<0.002。手术时间与mGEARS、OCHRA有显著相关性：rs=-0.534, p<0.001; rs= 0.421, p= 0.007。少弹实验表明，在5弹设置下，该模型的准确率达到81.70%，F1-得分达到81.30%。此外，多模态技能评估模型与人工评估评分非常吻合：rs = 0.85±0.02；Mae = 1.85±0.16。结论该概念验证表明，深度学习可以客观地对阴道袖带闭合视频中的一般手术技能和初始标记帧级错误进行评分，与经过验证的客观评估工具一致。尽管更大的、多中心的数据集仍然是必不可少的，但这些结果为人工智能驱动的质量监测和微创妇科手术的循证认证奠定了基础。

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The association between first trimester iron deficiency without anemia and the development of iron-deficiency anemia prior to childbirth. 妊娠早期无贫血缺铁性贫血与分娩前缺铁性贫血的关系

IF 9.8 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-03-19 DOI: 10.1016/j.ajog.2026.03.012

Nicole Konecke,Tracy L Jackson,Irving Angeles,Iman I Sigman,Crystal F Ware,Ashley E Benson,Joseph J Shatzel,Nandini Raghuraman,Molly J Stout,Ann M Bruno,Steven Fein,Carolyn Webster,Michael Auerbach,Jamie O Lo,Methodius G Tuuli,Adam K Lewkowitz

OBJECTIVETo decrease the risk of adverse maternal and neonatal outcomes,1,2 iron therapy is recommended for pregnant people with iron deficiency anemia (IDA).1 To support our ongoing multicenter randomized trial on the optimal iron therapy for antenatal IDA (NCT05462704),3 we initiated universal ferritin screening, though this practice is not currently recommended.4 Nevertheless, perhaps because normal pregnancy physiology may cause first trimester iron deficiency without anemia (IDWA), defined as ferritin <30 ng/mL with hemoglobin (Hgb) ≥ 11 g/d, to progress to IDA,5 a clinical consensus based on expert opinion recommended treating iron deficiency in pregnancy regardless of anemia.6 Here, we examine the association between first trimester IDWA and the development of IDA later in pregnancy.METHODSOur pregnant patients receive a complete blood count and ferritin as part of their intake obstetric laboratory panel and are prescribed prenatal vitamins with iron. In this prospective cohort study, individuals with singleton first-trimester gestations who obtained an intake obstetric laboratory panel from February 2023 to July 2025 were included. Those with anemia were excluded. The primary outcome was IDA prior to childbirth, defined as being prescribed intravenous or oral iron therapy at any gestational age or progression to IDA before delivery. Secondary outcomes are described in Table 2. Relative risks (RR) were calculated adjusting for race and ethnicity. This study was IRB-approved.RESULTSAmong 511 people, 46 (9%) had first trimester IDA and were excluded, while 129 (25%) had first trimester IDWA, and 336 (66%) were iron replete and non-anemic. Those with IDWA were more likely to be Hispanic or Native American than those who were iron replete and non-anemic, despite similar age, parity, and BMI (Table 1). After adjusting for race/ethnicity, those with first trimester IDWA were at nearly two-fold higher risk of developing IDA prior to childbirth (IDWA n=87 (67%) versus iron-replete, non-anemic n=118 (35%), adjusted RR 1.91 (95% Confidence Interval [CI] 1.57, 2.31). There was no difference in secondary outcomes (Table 2).CONCLUSIONSUniversal screening for iron deficiency by adding ferritin to obstetric intake labs identified that first trimester IDWA affects one in four people in our clinics. Of those with first trimester IDWA, the majority (67%) developed IDA before childbirth, corresponding to nearly two-fold increased risk compared to those who were iron-replete, non-anemic in the first trimester. These findings demonstrate that first trimester IDWA has high likelihood of progressing to IDA, for which treatment is recommended.1,2 This study's strengths included its prospective design, its diverse patient population, and low risk of loss-to-follow-up as everyone in our cohort received all perinatal care within our healthcare system. Limitations include excluding those screened for iron deficiency after the first trimester due to late initiation of

目的：为降低孕产妇和新生儿不良结局的风险，建议对缺铁性贫血（IDA）孕妇进行铁治疗为了支持我们正在进行的关于产前IDA最佳铁治疗的多中心随机试验（NCT05462704），我们启动了普遍的铁蛋白筛查，尽管这种做法目前不被推荐然而，可能是因为正常的妊娠生理可能导致妊娠早期无贫血缺铁性贫血（IDWA），定义为铁蛋白<30 ng/mL，血红蛋白(Hgb)≥11 g/d，发展为IDA 5，基于专家意见的临床共识建议在妊娠期间治疗缺铁，无论是否贫血在这里，我们研究了妊娠早期IDWA与妊娠后期IDA发展之间的关系。方法孕妇接受全血细胞计数和铁蛋白检测作为产科实验室检查的一部分，并给予含铁的产前维生素。在这项前瞻性队列研究中，纳入了从2023年2月至2025年7月接受产科实验室检查的单胎妊娠早期妊娠个体。贫血者排除在外。主要终点是分娩前的IDA，定义为在任何胎龄或分娩前进展为IDA时给予静脉注射或口服铁治疗。次要结局见表2。相对危险度（RR）是根据种族和民族来计算的。这项研究是irb批准的。结果511例患者中，46例（9%）有妊娠早期IDA， 129例（25%）有妊娠早期IDWA， 336例（66%）为铁充足且无贫血。尽管年龄、胎次和BMI相似，但IDWA患者更有可能是西班牙裔或美洲原住民，而非缺铁和非贫血的患者（表1）。在对种族/民族进行调整后，妊娠早期IDWA患者在分娩前发生IDA的风险高出近两倍(IDWA n=87(67%)，而铁含量高，非贫血的n=118(35%)，调整后的RR为1.91（95%置信区间[CI] 1.57, 2.31）。次要结局无差异（表2）。结论通过在产科摄入实验室中添加铁蛋白对缺铁进行普遍筛查发现，在我们的诊所中，有四分之一的人在妊娠早期缺铁。在妊娠早期IDWA患者中，大多数（67%）在分娩前发生IDA，与妊娠早期补铁、非贫血的患者相比，其风险增加了近两倍。这些发现表明，妊娠早期IDWA发展为IDA的可能性很高，因此建议进行治疗本研究的优势包括前瞻性设计，患者群体多样化，随访损失风险低，因为我们队列中的每个人都在我们的医疗保健系统内接受了所有围产期护理。局限性包括排除那些由于产前护理开始较晚（尽管他们可能有较高的IDA1风险）而在妊娠早期进行缺铁筛查的人，在美国完成研究（这限制了全球环境的普遍性），以及我们的分析没有按贫血严重程度分层。然而，这些发现表明，在妊娠早期识别IDWA提供了一个机会，以防止明显的IDA和潜在的下游围产期发病率。

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