Pub Date : 2026-02-01DOI: 10.1016/j.ajog.2025.08.088
Rosa F. Drummond MD, Karl E. Seif MD, Arielle J. Higgs MD, E. Albert Reece MD, PhD, MBA
Pregestational diabetes complicates 1% to 2% of all pregnancies. Achievement of euglycemia prevents adverse maternal, fetal, and neonatal outcomes. Insulin is the first line and the backbone of diabetes treatment in and out of pregnancy, but the delicate balance between stringent control and hypoglycemia, along with the complexity and interruption of multiple injections per day, continues to make glycemic control challenging. The ideal basal insulin has a flat pharmacodynamic profile with minimal variability and is relatively easy for patients and clinicians to use. Insulin analogs, such as insulins glargine and detemir, are the most common basal insulins used in pregnancy at this time, but insulin degludec, which has advantages like prolonged duration of action in the nonpregnant population, was recently shown to be equally as effective as detemir in pregnancy. The ease of a once-daily injection without an increased risk of hypoglycemia is attractive to patients and clinicians who wish to simplify insulin regimens. Furthermore, there are current clinical trials evaluating once-weekly basal insulin regimens in the general population. This would decrease basal injections from a minimum of 365 per year to 52 per year, potentially increasing adherence and improving glycemic control. This review will discuss the evidence for insulin degludec in pregnancy as well as discuss the potential benefits and drawbacks of once-weekly ultralong-acting basal insulins in pregnancy.
{"title":"Diabetes in pregnancy and major new advances in diabetes care using long-acting and ultralong-acting insulins","authors":"Rosa F. Drummond MD, Karl E. Seif MD, Arielle J. Higgs MD, E. Albert Reece MD, PhD, MBA","doi":"10.1016/j.ajog.2025.08.088","DOIUrl":"10.1016/j.ajog.2025.08.088","url":null,"abstract":"<div><div>Pregestational diabetes complicates 1% to 2% of all pregnancies. Achievement of euglycemia prevents adverse maternal, fetal, and neonatal outcomes. Insulin is the first line and the backbone of diabetes treatment in and out of pregnancy, but the delicate balance between stringent control and hypoglycemia, along with the complexity and interruption of multiple injections per day, continues to make glycemic control challenging. The ideal basal insulin has a flat pharmacodynamic profile with minimal variability and is relatively easy for patients and clinicians to use. Insulin analogs, such as insulins glargine and detemir, are the most common basal insulins used in pregnancy at this time, but insulin degludec, which has advantages like prolonged duration of action in the nonpregnant population, was recently shown to be equally as effective as detemir in pregnancy. The ease of a once-daily injection without an increased risk of hypoglycemia is attractive to patients and clinicians who wish to simplify insulin regimens. Furthermore, there are current clinical trials evaluating once-weekly basal insulin regimens in the general population. This would decrease basal injections from a minimum of 365 per year to 52 per year, potentially increasing adherence and improving glycemic control. This review will discuss the evidence for insulin degludec in pregnancy as well as discuss the potential benefits and drawbacks of once-weekly ultralong-acting basal insulins in pregnancy.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 297-309"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938906","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.08.032
Mabel B. Lee MD , Mehrnaz Siavoshi MS, MPH , Lorna Kwan MPH , Lindsay Kroener MD
<div><h3>Background</h3><div>In 2012, oocyte cryopreservation was no longer deemed experimental by the American Society of Reproductive Medicine. Since then, awareness and utilization of planned oocyte cryopreservation have become much more widespread. However, little is known regarding current national trends and the rate of warming and utilization of cryopreserved oocytes.</div></div><div><h3>Objective</h3><div>To assess national trends in planned oocyte cryopreservation, subsequent oocyte utilization, and outcomes of oocyte warming cycles.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study with data from all patients reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System undergoing cryopreservation of autologous oocytes for fertility preservation only between the years 2014 and 2021 and all linked oocyte warming cycles. Statistical analyses were performed using linear regression tests.</div></div><div><h3>Results</h3><div>The number of patients undergoing planned oocyte cryopreservation has increased exponentially, with 4153 patients in 2014 compared to 16,436 in 2021 (<em>P</em><.01). There is a decrease in the age of patients undergoing planned oocyte cryopreservation over time, with a mean age of 36.0 years in 2014 compared to 34.9 years in 2021 (<em>P</em><.01). Subsequent return for utilization of cryopreserved oocytes within a 5- to 7-year follow-up period from planned oocyte cryopreservation cycles occurring between 2014 and 2016 was low, with only 852 patients (5.7%) returning for oocyte warming. The likelihood of returning increased with advancing patient age at the time of oocyte cryopreservation, while the mean time to oocyte warming significantly decreased with increasing patient age at the time of oocyte cryopreservation, except in patients >42 years (<em>P</em><.01). Of patients who returned for oocyte warming, 78.5% (n=669) obtained a usable embryo, while 21.5% (n=183) had no usable embryos. Of those with usable embryos, 64.2% (n=547) had a fresh embryo transfer, 46.1% (n=393) had embryos for cryopreservation, and only 14.3% of patients (n=122) opted for a freeze-all approach. Of the 393 patients with cryopreserved embryos, 115 (29.3%) returned for a frozen embryo transfer. The cumulative live birth rate of all patients undergoing oocyte warming was 28.9%, with live birth rate decreasing with an increasing age at the time of oocyte cryopreservation.</div></div><div><h3>Conclusion</h3><div>Since the availability of oocyte cryopreservation reporting for fertility preservation only, planned oocyte cryopreservation has increased exponentially. Mean age at the time of oocyte retrieval has decreased, reflecting interest in the procedure among younger patients, but there has been minimal change in distribution by race/ethnicity and geographic region. Despite the increase in oocyte cryopreservation, return for oocyte warming over a 5- to 7-year follow-up period was low,
{"title":"Elective fertility preservation: a national database study on trends in oocyte cryopreservation and oocyte utilization over a 5- to 7-year follow-up period","authors":"Mabel B. Lee MD , Mehrnaz Siavoshi MS, MPH , Lorna Kwan MPH , Lindsay Kroener MD","doi":"10.1016/j.ajog.2025.08.032","DOIUrl":"10.1016/j.ajog.2025.08.032","url":null,"abstract":"<div><h3>Background</h3><div>In 2012, oocyte cryopreservation was no longer deemed experimental by the American Society of Reproductive Medicine. Since then, awareness and utilization of planned oocyte cryopreservation have become much more widespread. However, little is known regarding current national trends and the rate of warming and utilization of cryopreserved oocytes.</div></div><div><h3>Objective</h3><div>To assess national trends in planned oocyte cryopreservation, subsequent oocyte utilization, and outcomes of oocyte warming cycles.</div></div><div><h3>Study Design</h3><div>Retrospective cohort study with data from all patients reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System undergoing cryopreservation of autologous oocytes for fertility preservation only between the years 2014 and 2021 and all linked oocyte warming cycles. Statistical analyses were performed using linear regression tests.</div></div><div><h3>Results</h3><div>The number of patients undergoing planned oocyte cryopreservation has increased exponentially, with 4153 patients in 2014 compared to 16,436 in 2021 (<em>P</em><.01). There is a decrease in the age of patients undergoing planned oocyte cryopreservation over time, with a mean age of 36.0 years in 2014 compared to 34.9 years in 2021 (<em>P</em><.01). Subsequent return for utilization of cryopreserved oocytes within a 5- to 7-year follow-up period from planned oocyte cryopreservation cycles occurring between 2014 and 2016 was low, with only 852 patients (5.7%) returning for oocyte warming. The likelihood of returning increased with advancing patient age at the time of oocyte cryopreservation, while the mean time to oocyte warming significantly decreased with increasing patient age at the time of oocyte cryopreservation, except in patients >42 years (<em>P</em><.01). Of patients who returned for oocyte warming, 78.5% (n=669) obtained a usable embryo, while 21.5% (n=183) had no usable embryos. Of those with usable embryos, 64.2% (n=547) had a fresh embryo transfer, 46.1% (n=393) had embryos for cryopreservation, and only 14.3% of patients (n=122) opted for a freeze-all approach. Of the 393 patients with cryopreserved embryos, 115 (29.3%) returned for a frozen embryo transfer. The cumulative live birth rate of all patients undergoing oocyte warming was 28.9%, with live birth rate decreasing with an increasing age at the time of oocyte cryopreservation.</div></div><div><h3>Conclusion</h3><div>Since the availability of oocyte cryopreservation reporting for fertility preservation only, planned oocyte cryopreservation has increased exponentially. Mean age at the time of oocyte retrieval has decreased, reflecting interest in the procedure among younger patients, but there has been minimal change in distribution by race/ethnicity and geographic region. Despite the increase in oocyte cryopreservation, return for oocyte warming over a 5- to 7-year follow-up period was low,","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 432-439"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938953","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.10.015
Todd Rockwood PhD, Kyle Rudser PhD, Leslie Rickey MD, Alayne D. Markland DO, Peter Scal PhD, Jerry L. Lowder MD, Emily S. Lukacz MD, Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium
{"title":"Abbreviated version of the Bladder Health Scales for women's research","authors":"Todd Rockwood PhD, Kyle Rudser PhD, Leslie Rickey MD, Alayne D. Markland DO, Peter Scal PhD, Jerry L. Lowder MD, Emily S. Lukacz MD, Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium","doi":"10.1016/j.ajog.2025.10.015","DOIUrl":"10.1016/j.ajog.2025.10.015","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages e42-e53"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319254","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.05.046
Lara S. Lemon PharmD, PhD, Beth Quinn RN, Hyagriv N. Simhan MD, MS
{"title":"Intricacies of studying doula care","authors":"Lara S. Lemon PharmD, PhD, Beth Quinn RN, Hyagriv N. Simhan MD, MS","doi":"10.1016/j.ajog.2025.05.046","DOIUrl":"10.1016/j.ajog.2025.05.046","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Page e56"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245742","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.06.044
Olaf Reich MD, Sigrid Regauer MD
{"title":"Human papillomavirus infection of endocervical reserve cells is underestimated in the natural history of cervical cancer","authors":"Olaf Reich MD, Sigrid Regauer MD","doi":"10.1016/j.ajog.2025.06.044","DOIUrl":"10.1016/j.ajog.2025.06.044","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Page e57"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504465","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.10.003
Birgitte K. Sundet MD , Meryam Sugulle MD, PhD , Daniel P. Jacobsen PhD , Vibeke Bratseth PhD , Sheryl Palmero MSc , Kristine M. Kindberg MD , Ragnhild M. Helseth MD, PhD , Tove Lekva PhD , Thor Ueland PhD , Shahana Balakumaran , Heidi E. Fjeldstad MD, PhD , Ida G. Lunde PhD , Anne Cathrine Staff MD, PhD
<div><h3>Background</h3><div>Neutrophil extracellular traps consist of DNA and protein and are secreted by neutrophils upon activation. They are stable structures but may be degraded by deoxyribonucleases. Neutrophil extracellular traps can induce endothelial dysfunction, an important feature of the preeclampsia pathophysiology. However, the levels of neutrophil extracellular traps biomarkers and deoxyribonuclease in the maternal circulation during preeclampsia, gestational hypertension, and fetal growth restriction, as well as potential associations to placental dysfunction, remain to be elucidated.</div></div><div><h3>Objective</h3><div>We aimed to investigate levels of circulating neutrophil extracellular traps biomarkers and deoxyribonuclease in women with early-onset and late-onset preeclampsia, gestational hypertension, and isolated fetal growth restriction compared to clinically healthy pregnancies. Additionally, we aimed to compare these biomarkers with circulating placental dysfunction biomarkers and maternal as well as fetal clinical proxies of placental dysfunction in women with preeclampsia.</div></div><div><h3>Study design</h3><div>Plasma and serum samples from women categorized as having early-onset preeclampsia (n=49), late-onset preeclampsia (n=202), gestational hypertension (n=105), isolated fetal growth restriction (n=50), and normotensive, euglycemic controls (n=1126) were analyzed by immunoassays for the circulating neutrophil extracellular traps biomarkers citrullinated histone H3 and myeloperoxidase-DNA and deoxyribonuclease and for the placental dysfunction biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor. The Kruskal-Wallis H test was used to compare biomarker levels across groups. Post hoc pairwise comparisons were conducted using Dunn's test, with Bonferroni correction applied to adjust for multiple comparisons. In women with early-onset and late-onset preeclampsia, the residuals were not normally distributed. Therefore, univariable and multivariable quantile (median) regression for estimating models for the conditional median function were used to study associations between our biomarkers of interest and proxies for placental dysfunction. A 2-sided <em>P</em> value of <.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Women with early-onset and late-onset preeclampsia, but not gestational hypertension or isolated fetal growth restriction, had lower median levels of circulating citrullinated histone H3 (both adjusted <em>P</em><.001) and deoxyribonuclease (both adjusted <em>P</em><.001) compared to controls. Women with late-onset preeclampsia had lower myeloperoxidase-DNA (adjusted <em>P</em><.001) compared to controls. Univariable regression analyses within the preeclampsia group revealed positive associations between citrullinated histone H3 and placental growth factor (<em>P</em>=.004) and negative associations between citrullinated histone H3 and s
{"title":"Predelivery maternal circulating neutrophil extracellular traps and deoxyribonuclease in placental dysfunction and preeclampsia","authors":"Birgitte K. Sundet MD , Meryam Sugulle MD, PhD , Daniel P. Jacobsen PhD , Vibeke Bratseth PhD , Sheryl Palmero MSc , Kristine M. Kindberg MD , Ragnhild M. Helseth MD, PhD , Tove Lekva PhD , Thor Ueland PhD , Shahana Balakumaran , Heidi E. Fjeldstad MD, PhD , Ida G. Lunde PhD , Anne Cathrine Staff MD, PhD","doi":"10.1016/j.ajog.2025.10.003","DOIUrl":"10.1016/j.ajog.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>Neutrophil extracellular traps consist of DNA and protein and are secreted by neutrophils upon activation. They are stable structures but may be degraded by deoxyribonucleases. Neutrophil extracellular traps can induce endothelial dysfunction, an important feature of the preeclampsia pathophysiology. However, the levels of neutrophil extracellular traps biomarkers and deoxyribonuclease in the maternal circulation during preeclampsia, gestational hypertension, and fetal growth restriction, as well as potential associations to placental dysfunction, remain to be elucidated.</div></div><div><h3>Objective</h3><div>We aimed to investigate levels of circulating neutrophil extracellular traps biomarkers and deoxyribonuclease in women with early-onset and late-onset preeclampsia, gestational hypertension, and isolated fetal growth restriction compared to clinically healthy pregnancies. Additionally, we aimed to compare these biomarkers with circulating placental dysfunction biomarkers and maternal as well as fetal clinical proxies of placental dysfunction in women with preeclampsia.</div></div><div><h3>Study design</h3><div>Plasma and serum samples from women categorized as having early-onset preeclampsia (n=49), late-onset preeclampsia (n=202), gestational hypertension (n=105), isolated fetal growth restriction (n=50), and normotensive, euglycemic controls (n=1126) were analyzed by immunoassays for the circulating neutrophil extracellular traps biomarkers citrullinated histone H3 and myeloperoxidase-DNA and deoxyribonuclease and for the placental dysfunction biomarkers soluble fms-like tyrosine kinase-1 and placental growth factor. The Kruskal-Wallis H test was used to compare biomarker levels across groups. Post hoc pairwise comparisons were conducted using Dunn's test, with Bonferroni correction applied to adjust for multiple comparisons. In women with early-onset and late-onset preeclampsia, the residuals were not normally distributed. Therefore, univariable and multivariable quantile (median) regression for estimating models for the conditional median function were used to study associations between our biomarkers of interest and proxies for placental dysfunction. A 2-sided <em>P</em> value of <.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>Women with early-onset and late-onset preeclampsia, but not gestational hypertension or isolated fetal growth restriction, had lower median levels of circulating citrullinated histone H3 (both adjusted <em>P</em><.001) and deoxyribonuclease (both adjusted <em>P</em><.001) compared to controls. Women with late-onset preeclampsia had lower myeloperoxidase-DNA (adjusted <em>P</em><.001) compared to controls. Univariable regression analyses within the preeclampsia group revealed positive associations between citrullinated histone H3 and placental growth factor (<em>P</em>=.004) and negative associations between citrullinated histone H3 and s","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 550-569"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311533","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}
<div><h3>Background</h3><div>In many countries, antenatal maternal risk stratification and individualization of subsequent pregnancy care are ubiquitous. However, because of the dynamic nature of pregnancy and emergence of new risk factors as gestation progresses, it is unclear whether this approach results in better pregnancy outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the relationship between antenatal maternal risk stratification and maternal and perinatal outcomes, and to ascertain if planned birth at 39 weeks of gestation resulted in better pregnancy outcomes at term.</div></div><div><h3>Study Design</h3><div>This was a retrospective cohort study of 1,167,372 singleton births at ≥37<sup>+0</sup> weeks’ gestation, conducted from 2000 to 2021 in Queensland, Australia. Women were stratified into 3 risk categories (high, intermediate, or low) in accordance with recommendations from international guidelines. The study outcomes were severe adverse maternal outcome, perinatal mortality (antepartum stillbirth, intrapartum stillbirth, and neonatal death), severe neonatal neurologic morbidity, and maternal–infant separation. Multivariable logistic regression models were built to determine odds ratios for the effect of maternal risk strata on study outcomes and the effect of planned birth (either induction of labor or scheduled cesarean delivery) at 39<sup>+0</sup> to 39<sup>+6</sup> weeks compared with expectant management.</div></div><div><h3>Results</h3><div>A total of 468,710 (40.2%) women were categorized as low-risk, 324,650 (27.8%) as intermediate-risk, and 374,012 (32.0%) as high-risk. Compared with low-risk women, the odds of severe maternal adverse outcome, perinatal mortality, severe neonatal neurologic morbidity, and maternal–infant separation were increased in the intermediate- and high-risk groups, with the highest odds in the high-risk cohort. The probability of severe adverse maternal outcome was lowest at 39<sup>+0</sup> to 39<sup>+6</sup> weeks for all risk categories. Regardless of maternal risk stratum, the probability of perinatal mortality was lowest at 39<sup>+0</sup> to 40<sup>+6</sup> weeks, the probability of severe neonatal neurologic morbidity was lowest at 38<sup>+0</sup> to 39<sup>+6</sup> weeks, and the nadir for maternal–infant separation occurred at 39<sup>+0</sup> to 40<sup>+6</sup> weeks. For all study outcomes, the probability of an adverse outcome increased from 40<sup>+0</sup> weeks onward regardless of risk category.</div></div><div><h3>Conclusion</h3><div>The risks of severe maternal and perinatal outcomes including maternal–infant separation are directly associated with antenatally determined maternal risk strata. Women in the high-risk category had the highest odds of all adverse outcomes. However, compared with expectant management, planned birth at 38<sup>+0</sup> to 39<sup>+6</sup> weeks, especially by scheduled cesarean delivery, was associated with the lowest odds of ad
{"title":"Maternal risk stratification and planned birth improve pregnancy outcomes at term: a population-based cohort study","authors":"Cynthia Wong MBBS , Kylie Crawford PhD , Jesrine Hong MRCOG , Shannyn Rosser FRANZCOG , Vicki Flenady PhD , Susannah Leisher MA, PhD , Robert Silver MD , Sailesh Kumar FRCS, FRCOG, FRANZCOG, DPhil (Oxon)","doi":"10.1016/j.ajog.2025.10.005","DOIUrl":"10.1016/j.ajog.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>In many countries, antenatal maternal risk stratification and individualization of subsequent pregnancy care are ubiquitous. However, because of the dynamic nature of pregnancy and emergence of new risk factors as gestation progresses, it is unclear whether this approach results in better pregnancy outcomes.</div></div><div><h3>Objective</h3><div>This study aimed to investigate the relationship between antenatal maternal risk stratification and maternal and perinatal outcomes, and to ascertain if planned birth at 39 weeks of gestation resulted in better pregnancy outcomes at term.</div></div><div><h3>Study Design</h3><div>This was a retrospective cohort study of 1,167,372 singleton births at ≥37<sup>+0</sup> weeks’ gestation, conducted from 2000 to 2021 in Queensland, Australia. Women were stratified into 3 risk categories (high, intermediate, or low) in accordance with recommendations from international guidelines. The study outcomes were severe adverse maternal outcome, perinatal mortality (antepartum stillbirth, intrapartum stillbirth, and neonatal death), severe neonatal neurologic morbidity, and maternal–infant separation. Multivariable logistic regression models were built to determine odds ratios for the effect of maternal risk strata on study outcomes and the effect of planned birth (either induction of labor or scheduled cesarean delivery) at 39<sup>+0</sup> to 39<sup>+6</sup> weeks compared with expectant management.</div></div><div><h3>Results</h3><div>A total of 468,710 (40.2%) women were categorized as low-risk, 324,650 (27.8%) as intermediate-risk, and 374,012 (32.0%) as high-risk. Compared with low-risk women, the odds of severe maternal adverse outcome, perinatal mortality, severe neonatal neurologic morbidity, and maternal–infant separation were increased in the intermediate- and high-risk groups, with the highest odds in the high-risk cohort. The probability of severe adverse maternal outcome was lowest at 39<sup>+0</sup> to 39<sup>+6</sup> weeks for all risk categories. Regardless of maternal risk stratum, the probability of perinatal mortality was lowest at 39<sup>+0</sup> to 40<sup>+6</sup> weeks, the probability of severe neonatal neurologic morbidity was lowest at 38<sup>+0</sup> to 39<sup>+6</sup> weeks, and the nadir for maternal–infant separation occurred at 39<sup>+0</sup> to 40<sup>+6</sup> weeks. For all study outcomes, the probability of an adverse outcome increased from 40<sup>+0</sup> weeks onward regardless of risk category.</div></div><div><h3>Conclusion</h3><div>The risks of severe maternal and perinatal outcomes including maternal–infant separation are directly associated with antenatally determined maternal risk strata. Women in the high-risk category had the highest odds of all adverse outcomes. However, compared with expectant management, planned birth at 38<sup>+0</sup> to 39<sup>+6</sup> weeks, especially by scheduled cesarean delivery, was associated with the lowest odds of ad","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 507-522"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311535","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.10.004
Jianwei Zuo BS , Fei Feng PhD , Zhuhui Wang MS , James A. Ashton-Miller PhD , John O.L. DeLancey MD , Jiajia Luo PhD
<div><h3>Background</h3><div>Accurately outlining (“segmenting”) pelvic organs from magnetic resonance imaging scans is crucial for studying pelvic organ prolapse. The labor-intensive process of segmentation that identifies which pixels correspond to a particular organ in magnetic resonance imaging datasets imposes a substantial bottleneck on training artificial intelligence to do automated segmentation techniques, underscoring a need for methods that can operate effectively with minimal prelabeled data.</div></div><div><h3>Objective</h3><div>The aim of this study is to introduce a novel semi-supervised learning process that uses limited data annotation in pelvic magnetic resonance imaging to improve automated segmentation. By effectively using both labeled and unlabeled magnetic resonance imaging data, our approach seeks to improve the accuracy and efficiency of pelvic organ segmentation, thereby reducing the reliance on extensive labeled datasets for artificial intelligence model training.</div></div><div><h3>Study Design</h3><div>The study used a semi-supervised deep learning framework for uterus and bladder segmentation, in which a model is trained using both a small number of expert-outlined structures and a large number of unlabeled scans, leveraging the information from the labeled data to guide the model and improve its predictions on the unlabeled data. It involved 4103 magnetic resonance images from 48 female subjects. This approach included self-supervised learning of image restoration tasks for feature extraction and pseudo-label generation, followed by combined supervised learning on labeled images and unsupervised training on unlabeled images. The method's performance was evaluated quantitatively using the Dice Similarity Coefficient, Average Surface Distance, and 95% Hausdorff Distance. For statistical analysis, 2-tailed paired <em>t</em>-tests were conducted for comparison.</div></div><div><h3>Results</h3><div>This framework demonstrated the capacity to achieve segmentation accuracy comparable to traditional methods while requiring only about 60% of the typically necessary labeled data. Specifically, the semi-supervised approach achieved Dice Similarity Coefficients of 0.84±0.04, Average Surface Distances of 13.98±0.93, and 95% Hausdorff Distances of 2.15±0.40 for the uterus and 0.92±0.05, 2.51±0.83, and 2.88±0.17 for the bladder, respectively (<em>P</em> value <.001 for all), outperforming both the baseline supervised learning and transfer learning models. Additionally, 3-dimensional reconstructions using the semi-supervised method exhibited superior details in the visualized organs.</div></div><div><h3>Conclusion</h3><div>This study's semi-supervised learning framework wherein the full use of unlabeled data markedly reduces the necessity for extensive manual annotations, achieving high segmentation accuracy with substantially fewer labeled images that can enhance clinical evaluation and advance medical image analysis by reduc
{"title":"Semi-supervised deep learning for uterus and bladder segmentation on female pelvic floor magnetic resonance imaging with limited labeled data","authors":"Jianwei Zuo BS , Fei Feng PhD , Zhuhui Wang MS , James A. Ashton-Miller PhD , John O.L. DeLancey MD , Jiajia Luo PhD","doi":"10.1016/j.ajog.2025.10.004","DOIUrl":"10.1016/j.ajog.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Accurately outlining (“segmenting”) pelvic organs from magnetic resonance imaging scans is crucial for studying pelvic organ prolapse. The labor-intensive process of segmentation that identifies which pixels correspond to a particular organ in magnetic resonance imaging datasets imposes a substantial bottleneck on training artificial intelligence to do automated segmentation techniques, underscoring a need for methods that can operate effectively with minimal prelabeled data.</div></div><div><h3>Objective</h3><div>The aim of this study is to introduce a novel semi-supervised learning process that uses limited data annotation in pelvic magnetic resonance imaging to improve automated segmentation. By effectively using both labeled and unlabeled magnetic resonance imaging data, our approach seeks to improve the accuracy and efficiency of pelvic organ segmentation, thereby reducing the reliance on extensive labeled datasets for artificial intelligence model training.</div></div><div><h3>Study Design</h3><div>The study used a semi-supervised deep learning framework for uterus and bladder segmentation, in which a model is trained using both a small number of expert-outlined structures and a large number of unlabeled scans, leveraging the information from the labeled data to guide the model and improve its predictions on the unlabeled data. It involved 4103 magnetic resonance images from 48 female subjects. This approach included self-supervised learning of image restoration tasks for feature extraction and pseudo-label generation, followed by combined supervised learning on labeled images and unsupervised training on unlabeled images. The method's performance was evaluated quantitatively using the Dice Similarity Coefficient, Average Surface Distance, and 95% Hausdorff Distance. For statistical analysis, 2-tailed paired <em>t</em>-tests were conducted for comparison.</div></div><div><h3>Results</h3><div>This framework demonstrated the capacity to achieve segmentation accuracy comparable to traditional methods while requiring only about 60% of the typically necessary labeled data. Specifically, the semi-supervised approach achieved Dice Similarity Coefficients of 0.84±0.04, Average Surface Distances of 13.98±0.93, and 95% Hausdorff Distances of 2.15±0.40 for the uterus and 0.92±0.05, 2.51±0.83, and 2.88±0.17 for the bladder, respectively (<em>P</em> value <.001 for all), outperforming both the baseline supervised learning and transfer learning models. Additionally, 3-dimensional reconstructions using the semi-supervised method exhibited superior details in the visualized organs.</div></div><div><h3>Conclusion</h3><div>This study's semi-supervised learning framework wherein the full use of unlabeled data markedly reduces the necessity for extensive manual annotations, achieving high segmentation accuracy with substantially fewer labeled images that can enhance clinical evaluation and advance medical image analysis by reduc","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 461-470"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314640","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 : 2026-02-01DOI: 10.1016/S0002-9378(25)00947-0
{"title":"AJOG MFM Table of Contents","authors":"","doi":"10.1016/S0002-9378(25)00947-0","DOIUrl":"10.1016/S0002-9378(25)00947-0","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Page A7"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098501","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 : 2026-02-01DOI: 10.1016/j.ajog.2025.05.045
Avir Sarkar MD, DNB, Bijoya Mukherjee MS, DNB, Subrat Panda MD, Amiya Das MS, DNB, Priyanka Mondal MS, Suman Sandeep Samal MBBS
{"title":"Quantifying an association between doula care with maternal and neonatal outcomes: a critical appraisal","authors":"Avir Sarkar MD, DNB, Bijoya Mukherjee MS, DNB, Subrat Panda MD, Amiya Das MS, DNB, Priyanka Mondal MS, Suman Sandeep Samal MBBS","doi":"10.1016/j.ajog.2025.05.045","DOIUrl":"10.1016/j.ajog.2025.05.045","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Page e55"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245744","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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