Pub Date : 2025-02-01Epub Date: 2024-07-14DOI: 10.1016/j.ajog.2024.07.013
Frank A Chervenak, Amos Grünebaum
{"title":"Rethinking \"Obstetric violence\": a misnomer indeed.","authors":"Frank A Chervenak, Amos Grünebaum","doi":"10.1016/j.ajog.2024.07.013","DOIUrl":"10.1016/j.ajog.2024.07.013","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e52"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-06DOI: 10.1016/j.ajog.2024.08.003
Greggory R DeVore, Bardo Polanco, Wesley Lee, Jeffrey Brian Fowlkes, Emma E Peek, Manesha Putra, John C Hobbins
{"title":"Restricted physical activity and maternal rest improve fetal growth.","authors":"Greggory R DeVore, Bardo Polanco, Wesley Lee, Jeffrey Brian Fowlkes, Emma E Peek, Manesha Putra, John C Hobbins","doi":"10.1016/j.ajog.2024.08.003","DOIUrl":"10.1016/j.ajog.2024.08.003","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e63"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-08DOI: 10.1016/j.ajog.2024.08.001
Gabriela M Weigel, George N Baison, Linda Mihalov, Tariro Mupombwa
Background: The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are a cause for clinical concern.
Objective: This study aimed to estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women and to evaluate risk factors associated with their presence.
Study design: This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women who underwent a hysterectomy for uterovaginal prolapse. Patients were excluded if they underwent a hysterectomy for other indications, including postmenopausal bleeding. Following chart review, eligible patients who received care at a single site in Washington state from 2009 to 2018 were included. The primary outcome was the presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression.
Results: Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13±10 mm and 1.4±1.5 mm, respectively. Most cases (78%) had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); 1 had endometrial carcinoma and 1 had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and those without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis. A multivariate logistic regression showed that the presence of polyps was independently associated with a high body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P=.02) and use of menopausal hormone therapy (odds ratio, 1.67; 95% confidence interval, 1.02-2.72; P=.04).
Conclusion: Asymptomatic postmenopausal women who underwent hysterectomy for uterovaginal prolapse exhibited a high prevalence of endometrial polyps. Those who used menopausal hormone therapy and who had a high body mass index were at a higher risk for developing endometrial polyps. Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.
{"title":"Prevalence of and risk factors for endometrial polyps among asymptomatic postmenopausal women with uterovaginal prolapse.","authors":"Gabriela M Weigel, George N Baison, Linda Mihalov, Tariro Mupombwa","doi":"10.1016/j.ajog.2024.08.001","DOIUrl":"10.1016/j.ajog.2024.08.001","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of endometrial polyps among asymptomatic, postmenopausal women is not well defined. There is no clear clinical consensus on how to manage endometrial polyps in this population and whether these polyps truly are a cause for clinical concern.</p><p><strong>Objective: </strong>This study aimed to estimate the prevalence of endometrial polyps among asymptomatic (without bleeding), postmenopausal women and to evaluate risk factors associated with their presence.</p><p><strong>Study design: </strong>This cross-sectional study assessed the prevalence of endometrial polyps among asymptomatic, postmenopausal women who underwent a hysterectomy for uterovaginal prolapse. Patients were excluded if they underwent a hysterectomy for other indications, including postmenopausal bleeding. Following chart review, eligible patients who received care at a single site in Washington state from 2009 to 2018 were included. The primary outcome was the presence of endometrial polyps on pathology. Risk factors associated with polyp prevalence were subsequently assessed using univariate analysis and multivariate regression.</p><p><strong>Results: </strong>Of the 317 eligible women identified, endometrial polyps were identified in 106 women (33.4%). The average polyp size and endometrial thickness was 13±10 mm and 1.4±1.5 mm, respectively. Most cases (78%) had solitary polyps. Premalignant and malignant lesions were found in 2 cases (1.89%); 1 had endometrial carcinoma and 1 had endometrial intraepithelial neoplasia. Baseline clinical and demographic characteristics were similar between patients with and those without endometrial polyps, including the presence of fibroids, endometriosis, and adenomyosis. A multivariate logistic regression showed that the presence of polyps was independently associated with a high body mass index (odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P=.02) and use of menopausal hormone therapy (odds ratio, 1.67; 95% confidence interval, 1.02-2.72; P=.04).</p><p><strong>Conclusion: </strong>Asymptomatic postmenopausal women who underwent hysterectomy for uterovaginal prolapse exhibited a high prevalence of endometrial polyps. Those who used menopausal hormone therapy and who had a high body mass index were at a higher risk for developing endometrial polyps. Although the risk for malignancy seems to be low, more investigation is warranted to truly quantify the lifetime risk. For now, expectant management may be a reasonable approach for incidentally found, asymptomatic polyps.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"196.e1-196.e6"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-17DOI: 10.1016/j.ajog.2024.08.020
Chloe N Matovina, Allie Sakowicz, Emma C Allen, Mayán I Alvarado-Goldberg, Danielle Millan, Emily S Miller
{"title":"Effect of COVID-19 pandemic on postpartum depression and contraception.","authors":"Chloe N Matovina, Allie Sakowicz, Emma C Allen, Mayán I Alvarado-Goldberg, Danielle Millan, Emily S Miller","doi":"10.1016/j.ajog.2024.08.020","DOIUrl":"10.1016/j.ajog.2024.08.020","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e48"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-19DOI: 10.1016/j.ajog.2024.08.021
Giulia M Muraca
{"title":"Defining mode of delivery as 'instrumental vaginal delivery': are results generalizable to both forceps and vacuum?","authors":"Giulia M Muraca","doi":"10.1016/j.ajog.2024.08.021","DOIUrl":"10.1016/j.ajog.2024.08.021","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e53"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-08-27DOI: 10.1016/j.ajog.2024.08.038
Avir Sarkar, Aabir Humam, Huda Faisal, Iffat Maab
{"title":"First trimester anomaly scan in the national screening program.","authors":"Avir Sarkar, Aabir Humam, Huda Faisal, Iffat Maab","doi":"10.1016/j.ajog.2024.08.038","DOIUrl":"10.1016/j.ajog.2024.08.038","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e81"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-05-07DOI: 10.1016/j.ajog.2024.04.052
Lauren J Ewington, Oliver Hugh, Emily Butler, Siobhan Quenby, Jason Gardosi
<p><strong>Background: </strong>Pregnancies with large-for-gestational-age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options, including expectant management, induction of labor, and cesarean delivery. For women to make an informed decision about birth, antenatal detection of large for gestational age is essential.</p><p><strong>Objective: </strong>To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth.</p><p><strong>Study design: </strong>In this retrospective cohort study, we analyzed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound-estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication and a subgroup where the reason for the scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW percentile for estimated fetal weight as well as neonatal weight. In addition, we tested the performance of an uncustomized standard, with Hadlock fetal weight >90th percentile and neonatal weight >4 kg. We calculated diagnostic characteristics for the whole population and groups with different maternal body mass indexes.</p><p><strong>Results: </strong>The study cohort consisted of 26,527 pregnancies, which, on average, had a scan at 36+4 weeks gestation and delivered 20 days later at a median of 39+3 weeks (interquartile range 15). In total, 2241 (8.4%) of neonates were large for gestational age by customized percentiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th percentile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with a sensitivity of 77.1% and false positive rate of 36.0%. When comparing subgroups from low (<18.5 kg/m<sup>2</sup>) to high body mass index (>30 kg/m<sup>2</sup>), sensitivity increased from 55.6% to 67.8%, false positive rate from 5.2% to 11.5%, and positive predictive value from 32.1% to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4 kg), and of these, 1058 (40.9%) were large for gestational age (>90th percentile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized than uncustomized standards for low body mass index (<18.5; diagnostic odds ratio, 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ratio, 16.2 vs 8.8).</p><p><strong>Conclusion: </strong>Late third-trimester ultrasound estimation of fetal weight for any indication has a good ability to identify and predict
{"title":"Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study.","authors":"Lauren J Ewington, Oliver Hugh, Emily Butler, Siobhan Quenby, Jason Gardosi","doi":"10.1016/j.ajog.2024.04.052","DOIUrl":"10.1016/j.ajog.2024.04.052","url":null,"abstract":"<p><strong>Background: </strong>Pregnancies with large-for-gestational-age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options, including expectant management, induction of labor, and cesarean delivery. For women to make an informed decision about birth, antenatal detection of large for gestational age is essential.</p><p><strong>Objective: </strong>To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth.</p><p><strong>Study design: </strong>In this retrospective cohort study, we analyzed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound-estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication and a subgroup where the reason for the scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW percentile for estimated fetal weight as well as neonatal weight. In addition, we tested the performance of an uncustomized standard, with Hadlock fetal weight >90th percentile and neonatal weight >4 kg. We calculated diagnostic characteristics for the whole population and groups with different maternal body mass indexes.</p><p><strong>Results: </strong>The study cohort consisted of 26,527 pregnancies, which, on average, had a scan at 36+4 weeks gestation and delivered 20 days later at a median of 39+3 weeks (interquartile range 15). In total, 2241 (8.4%) of neonates were large for gestational age by customized percentiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th percentile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with a sensitivity of 77.1% and false positive rate of 36.0%. When comparing subgroups from low (<18.5 kg/m<sup>2</sup>) to high body mass index (>30 kg/m<sup>2</sup>), sensitivity increased from 55.6% to 67.8%, false positive rate from 5.2% to 11.5%, and positive predictive value from 32.1% to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4 kg), and of these, 1058 (40.9%) were large for gestational age (>90th percentile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized than uncustomized standards for low body mass index (<18.5; diagnostic odds ratio, 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ratio, 16.2 vs 8.8).</p><p><strong>Conclusion: </strong>Late third-trimester ultrasound estimation of fetal weight for any indication has a good ability to identify and predict","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"210.e1-210.e10"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140896753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-07-27DOI: 10.1016/j.ajog.2024.07.032
Jianfang Liao, Juan Cao
{"title":"Agnostic identification of plasma biomarkers.","authors":"Jianfang Liao, Juan Cao","doi":"10.1016/j.ajog.2024.07.032","DOIUrl":"10.1016/j.ajog.2024.07.032","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e49"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-09-30DOI: 10.1016/j.ajog.2024.09.104
Sebastián Lavanderos, Valeria Puebla, Osman Barboza
{"title":"Endometriosis of the Bartholin gland in a patient with deep endometriosis.","authors":"Sebastián Lavanderos, Valeria Puebla, Osman Barboza","doi":"10.1016/j.ajog.2024.09.104","DOIUrl":"10.1016/j.ajog.2024.09.104","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"232-234"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-29DOI: 10.1016/j.ajog.2024.10.032
Elizabeth J Suh-Burgmann, Holly Finertie, Nickolas Nguyen, Sarah Dolisca, Julie A Schmittdiel
{"title":"Detection of endometrial cancer-related bleeding in virtual visits.","authors":"Elizabeth J Suh-Burgmann, Holly Finertie, Nickolas Nguyen, Sarah Dolisca, Julie A Schmittdiel","doi":"10.1016/j.ajog.2024.10.032","DOIUrl":"10.1016/j.ajog.2024.10.032","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":"e40-e44"},"PeriodicalIF":8.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142556915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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