<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}
Pub Date : 2026-02-01DOI: 10.1016/j.ajog.2025.10.033
Celeste S. Royce MD , Tammy Sonn MD , Laura Baecher-Lind MD, MPH , Katherine T. Chen MD, MPH , Angela Fleming DO , Christine Kim MD , Silka Patel MD , Hedwige Saint Louis MD, MPH , Jonathan Schaffir MD , Shireen Madani Sims MD , Alyssa Stephenson-Famy MD , Jill M. Sutton MD , the Undergraduate Medicine Education Committee, Association of Professors Of Gynecology And Obstetrics
Trauma-informed medical education extends the principles of trauma-informed care into medical training to foster awareness and sensitivity to trauma, aiming to avoid further harm. Trauma-informed care is patient-centered, emphasizes shared decision-making, and promotes safety, empowerment, and healing within physician–patient relationships. Similarly, trauma-informed medical education promotes a safe learning environment in which learners and educators share mutual respect and responsibilities for achieving educational goals. Trauma is a common human experience, with substantial portions of the population experiencing adverse events. Medical students also report high rates of childhood trauma. Medical education itself can exacerbate trauma, affecting learners’ cognitive load, emotional resilience, and capacity to learn. The sensitive nature of obstetrics and gynecology makes it particularly relevant for a trauma-informed approach. Despite this need, trauma-informed training is sparse in medical education. Notably, few trauma-informed care curricula focus on obstetrics and gynecology, especially at the clerkship level. Incorporating trauma-informed medical education in obstetrics and gynecology curricula can enhance understanding of gynecologic and obstetric conditions’ trauma-related pathophysiology. Clinical training should involve trauma-informed patient interactions, sensitive history taking, and examinations. Beyond obstetrics and gynecology, trauma-informed medical education should permeate the entire medical educational continuum, shaping academic and administrative cultures. Developing and studying the impact of trauma-informed medical education will support both learners and the patients they serve.
{"title":"Integrating trauma-informed approaches into obstetrics and gynecology medical education: a framework for safer learning and care","authors":"Celeste S. Royce MD , Tammy Sonn MD , Laura Baecher-Lind MD, MPH , Katherine T. Chen MD, MPH , Angela Fleming DO , Christine Kim MD , Silka Patel MD , Hedwige Saint Louis MD, MPH , Jonathan Schaffir MD , Shireen Madani Sims MD , Alyssa Stephenson-Famy MD , Jill M. Sutton MD , the Undergraduate Medicine Education Committee, Association of Professors Of Gynecology And Obstetrics","doi":"10.1016/j.ajog.2025.10.033","DOIUrl":"10.1016/j.ajog.2025.10.033","url":null,"abstract":"<div><div>Trauma-informed medical education extends the principles of trauma-informed care into medical training to foster awareness and sensitivity to trauma, aiming to avoid further harm. Trauma-informed care is patient-centered, emphasizes shared decision-making, and promotes safety, empowerment, and healing within physician–patient relationships. Similarly, trauma-informed medical education promotes a safe learning environment in which learners and educators share mutual respect and responsibilities for achieving educational goals. Trauma is a common human experience, with substantial portions of the population experiencing adverse events. Medical students also report high rates of childhood trauma. Medical education itself can exacerbate trauma, affecting learners’ cognitive load, emotional resilience, and capacity to learn. The sensitive nature of obstetrics and gynecology makes it particularly relevant for a trauma-informed approach. Despite this need, trauma-informed training is sparse in medical education. Notably, few trauma-informed care curricula focus on obstetrics and gynecology, especially at the clerkship level. Incorporating trauma-informed medical education in obstetrics and gynecology curricula can enhance understanding of gynecologic and obstetric conditions’ trauma-related pathophysiology. Clinical training should involve trauma-informed patient interactions, sensitive history taking, and examinations. Beyond obstetrics and gynecology, trauma-informed medical education should permeate the entire medical educational continuum, shaping academic and administrative cultures. Developing and studying the impact of trauma-informed medical education will support both learners and the patients they serve.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 291-296"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145404558","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.2025.09.036
Haifaa Kashkari MD , Prakesh S. Shah MD , Jehier K. Afifi MD , Eugene Yoon MSc , Joan M. Crane MD , Sarah D. McDonald MD , Marc Beltempo MD , Walid I. El-Naggar MD
Background
Deferred cord clamping reduces mortality in preterm infants. However, there is a controversy about whether deferred cord clamping is as effective in cesarean delivery as in vaginal delivery.
Objective
This study aimed to compare the mortality and short-term outcomes of extremely preterm singleton infants who received deferred cord clamping after cesarean delivery with those who received deferred cord clamping after vaginal delivery and those who received early cord clamping after cesarean delivery.
Study Design
A national retrospective review of maternal, perinatal, and neonatal data of preterm infants born at <29 weeks of gestation who were admitted to units participating in the Canadian Neonatal Network between January 2015 and December 2022 was conducted. The rates and trends of deferred cord clamping (≥ 30 seconds) were evaluated, and the outcomes of infants who received deferred cord clamping after cesarean delivery were compared with (a) those who received deferred cord clamping after vaginal delivery and (b) those who received early cord clamping (<30 seconds) after caesarean delivery. The primary outcome was hospital mortality/severe brain injury (defined as grade 3/4 intraventricular hemorrhage and/or periventricular leukomalacia). Multivariate regression models with generalized estimating equations were used to account for clustering of infants within each site after adjusting for potential confounders.
Results
Of 6137 infants included in the study, 1952 (31.8%) received deferred cord clamping after cesarean delivery, 1804 (29.4%) received deferred cord clamping after vaginal delivery, and 2381 (38.8%) received early cord clamping after cesarean delivery at a median gestational age of 27 (interquartile range, 25–28), 26 (interquartile range, 25–28) and 26 (interquartile range, 25–28) weeks, respectively. There was a slow increase in the practice of deferred cord clamping in cesarean delivery from 32% in 2015 to approximately 50% in 2021–2022. After adjustment for potential confounders, infants who received deferred cord clamping after cesarean delivery had lower odds of a composite of mortality/severe brain injury (281/1952 [14%]) than those who received deferred cord clamping after vaginal delivery (347/1804 [19%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.54–0.87]) and those who received early cord clamping after cesarean delivery (543/2381 [23%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.57–0.83]). Deferred cord clamping after cesarean delivery was not associated with changes in other adverse short-term outcomes.
Conclusion
Deferred cord clamping was associated with a reduction in a composite of mortality/severe brain injury in singleton preterm infants born at <29 weeks of gestation via cesarean delivery.
{"title":"Umbilical cord management in extremely preterm infants born by cesarean delivery","authors":"Haifaa Kashkari MD , Prakesh S. Shah MD , Jehier K. Afifi MD , Eugene Yoon MSc , Joan M. Crane MD , Sarah D. McDonald MD , Marc Beltempo MD , Walid I. El-Naggar MD","doi":"10.1016/j.ajog.2025.09.036","DOIUrl":"10.1016/j.ajog.2025.09.036","url":null,"abstract":"<div><h3>Background</h3><div>Deferred cord clamping reduces mortality in preterm infants. However, there is a controversy about whether deferred cord clamping is as effective in cesarean delivery as in vaginal delivery.</div></div><div><h3>Objective</h3><div>This study aimed to compare the mortality and short-term outcomes of extremely preterm singleton infants who received deferred cord clamping after cesarean delivery with those who received deferred cord clamping after vaginal delivery and those who received early cord clamping after cesarean delivery.</div></div><div><h3>Study Design</h3><div>A national retrospective review of maternal, perinatal, and neonatal data of preterm infants born at <29 weeks of gestation who were admitted to units participating in the Canadian Neonatal Network between January 2015 and December 2022 was conducted. The rates and trends of deferred cord clamping (≥ 30 seconds) were evaluated, and the outcomes of infants who received deferred cord clamping after cesarean delivery were compared with (a) those who received deferred cord clamping after vaginal delivery and (b) those who received early cord clamping (<30 seconds) after caesarean delivery. The primary outcome was hospital mortality/severe brain injury (defined as grade 3/4 intraventricular hemorrhage and/or periventricular leukomalacia). Multivariate regression models with generalized estimating equations were used to account for clustering of infants within each site after adjusting for potential confounders.</div></div><div><h3>Results</h3><div>Of 6137 infants included in the study, 1952 (31.8%) received deferred cord clamping after cesarean delivery, 1804 (29.4%) received deferred cord clamping after vaginal delivery, and 2381 (38.8%) received early cord clamping after cesarean delivery at a median gestational age of 27 (interquartile range, 25–28), 26 (interquartile range, 25–28) and 26 (interquartile range, 25–28) weeks, respectively. There was a slow increase in the practice of deferred cord clamping in cesarean delivery from 32% in 2015 to approximately 50% in 2021–2022. After adjustment for potential confounders, infants who received deferred cord clamping after cesarean delivery had lower odds of a composite of mortality/severe brain injury (281/1952 [14%]) than those who received deferred cord clamping after vaginal delivery (347/1804 [19%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.54–0.87]) and those who received early cord clamping after cesarean delivery (543/2381 [23%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.57–0.83]). Deferred cord clamping after cesarean delivery was not associated with changes in other adverse short-term outcomes.</div></div><div><h3>Conclusion</h3><div>Deferred cord clamping was associated with a reduction in a composite of mortality/severe brain injury in singleton preterm infants born at <29 weeks of gestation via cesarean delivery.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 471-479"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181177","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.2025.09.033
Alessandro Lucidi MD , Eric Jauniaux MD, PhD , Danilo Buca MD , Albaro Jose Nieto-Calvache MD , Asma Khalil MD , Giuseppe Rizzo MD, PhD , Jose Palacios-Jaraquemada MD, PhD , Conrado Coutinho MD, PhD , Maria Elena Flacco MD, PhD , Lamberto Manzoli MD, PhD , Francesco D’Antonio MD, PhD
Objective
This study aimed to report the outcomes between patients who underwent emergency supracervical abdominal hysterectomy and those who underwent emergency total hysterectomy for postpartum hemorrhage.
Data Sources
A systematic search was performed on Medline, Embase, and Cochrane Library from January 2000 to December 2024 using Medical Subject Headings terms and key words related to peripartum hysterectomy and maternal outcomes.
Study Eligibility Criteria
This study included observational cohort and case-control studies of patients who underwent supracervical hysterectomy vs total hysterectomy for postpartum hemorrhage within 24 hours of delivery and studies exclusively reporting cases with placenta accreta spectrum, case reports, conference abstracts, and studies with <10 cases per arm.
Methods
This study had 2 independent reviewers to screen studies, extract data, and assess the quality of studies using the Newcastle-Ottawa Scale. Head-to-head meta-analyses were performed using random-effects models. Heterogeneity (I2) and publication bias were assessed.
Results
A total of 25 studies were included, analyzing 1478 patients (715 patients in the supracervical hysterectomy group and 763 patients in the total hysterectomy group). No significant difference was found in maternal mortality (P=.532), intensive care unit admission (P=.415), reoperation (P=.884), or major complications (P>.05). Supracervical hysterectomy was associated with a lower risk of ureteric injuries (odds ratio, 0.38 [95% confidence interval, 0.18–0.77]; P=.007), reduced estimated blood loss (mean difference, −446.03 mL [95% confidence interval, −747.72 to −144.35]; P=.004), fewer blood transfusions (mean difference, −1.46 units [95% confidence interval, −2.37 to −1.14]; P=.002), and shorter operative time (mean difference, −53.22 minutes [95% confidence interval, −86.48 to −19.95]; P=.002).
Conclusion
Supracervical hysterectomy seems to offer advantages over total hysterectomy in postpartum hemorrhage cases, particularly in reducing ureteric injuries, operative time, and blood loss. However, heterogeneity and lack of standardized placenta accreta spectrum diagnostic criteria limit the generalizability of the findings. Future research with standardized protocols is required to refine surgical decision-making.
目的比较经宫颈上（SCAH）和全腹（TAH）围生期急诊子宫切除术（EPH）治疗产后出血（PPH）患者的预后。资料来源系统检索2000年1月至2024年12月在Medline、Embase和Cochrane Library中检索与围产期子宫切除术和产妇结局相关的MeSH术语和关键词。研究设计：观察性队列研究和病例对照研究。人群：分娩24小时内发生紧急SCAH与TAH的PPH患者。排除标准：专门报道胎盘增生谱（PAS）病例的研究、病例报告、会议摘要和研究（0.05）。SCAH与输尿管损伤风险降低相关（OR: 0.38, 95% CI 0.18-0.77; p=0.007）。减少估计失血量（EBL） （MD: -446.03 mL, 95% CI -747.72至-144.35;p=0.004）。输血减少（MD: -1.46单位，95% CI -2.37 ~ -1.14; p=0.002）。更短的手术时间（MD: -53.22 min, 95% CI: -86.48 ~ -19.95; p=0.002）结论：在急诊PPH病例中，SCAH似乎比TAH更具优势，特别是在减少输尿管损伤、手术时间和失血方面。然而，异质性和缺乏标准化的PAS诊断标准限制了结果的普遍性。未来的研究需要标准化的方案来完善手术决策。
{"title":"Outcome of supracervical compared to total hysterectomy for emergency peripartum hemorrhage: a systematic review and meta-analysis","authors":"Alessandro Lucidi MD , Eric Jauniaux MD, PhD , Danilo Buca MD , Albaro Jose Nieto-Calvache MD , Asma Khalil MD , Giuseppe Rizzo MD, PhD , Jose Palacios-Jaraquemada MD, PhD , Conrado Coutinho MD, PhD , Maria Elena Flacco MD, PhD , Lamberto Manzoli MD, PhD , Francesco D’Antonio MD, PhD","doi":"10.1016/j.ajog.2025.09.033","DOIUrl":"10.1016/j.ajog.2025.09.033","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to report the outcomes between patients who underwent emergency supracervical abdominal hysterectomy and those who underwent emergency total hysterectomy for postpartum hemorrhage.</div></div><div><h3>Data Sources</h3><div>A systematic search was performed on Medline, Embase, and Cochrane Library from January 2000 to December 2024 using Medical Subject Headings terms and key words related to peripartum hysterectomy and maternal outcomes.</div></div><div><h3>Study Eligibility Criteria</h3><div>This study included observational cohort and case-control studies of patients who underwent supracervical hysterectomy vs total hysterectomy for postpartum hemorrhage within 24 hours of delivery and studies exclusively reporting cases with placenta accreta spectrum, case reports, conference abstracts, and studies with <10 cases per arm.</div></div><div><h3>Methods</h3><div>This study had 2 independent reviewers to screen studies, extract data, and assess the quality of studies using the Newcastle-Ottawa Scale. Head-to-head meta-analyses were performed using random-effects models. Heterogeneity (<em>I</em><sup><em>2</em></sup>) and publication bias were assessed.</div></div><div><h3>Results</h3><div>A total of 25 studies were included, analyzing 1478 patients (715 patients in the supracervical hysterectomy group and 763 patients in the total hysterectomy group). No significant difference was found in maternal mortality (<em>P</em>=.532), intensive care unit admission (<em>P</em>=.415), reoperation (<em>P</em>=.884), or major complications (<em>P</em>>.05). Supracervical hysterectomy was associated with a lower risk of ureteric injuries (odds ratio, 0.38 [95% confidence interval, 0.18–0.77]; <em>P</em>=.007), reduced estimated blood loss (mean difference, −446.03 mL [95% confidence interval, −747.72 to −144.35]; <em>P</em>=.004), fewer blood transfusions (mean difference, −1.46 units [95% confidence interval, −2.37 to −1.14]; <em>P</em>=.002), and shorter operative time (mean difference, −53.22 minutes [95% confidence interval, −86.48 to −19.95]; <em>P</em>=.002).</div></div><div><h3>Conclusion</h3><div>Supracervical hysterectomy seems to offer advantages over total hysterectomy in postpartum hemorrhage cases, particularly in reducing ureteric injuries, operative time, and blood loss. However, heterogeneity and lack of standardized placenta accreta spectrum diagnostic criteria limit the generalizability of the findings. Future research with standardized protocols is required to refine surgical decision-making.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 321-349"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140362","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}
Low-impact laparoscopy, a surgical protocol using mini-laparoscopic instruments and low and stable pneumoperitoneal pressure, was developed as a minimally invasive approach to mitigate local and systemic effects of laparoscopy. However, its real clinical impact is still poorly documented.
Objective
To evaluate low-impact laparoscopy impact on the postoperative recovery quality 6 hours after laparoscopic hysterectomy compared to conventional laparoscopy.
Study Design
Single-center, double-blinded, randomized controlled trial, conducted between December 2019 and August 2023, evaluating different approaches for outpatient laparoscopic hysterectomies.
Sixty-eight adult patients scheduled for outpatient laparoscopic hysterectomy were included and randomized into 2 groups: low-impact laparoscopy with mini-trocars and low peritoneal pressure or conventional laparoscopy with standard-sized trocars and higher peritoneal insufflation pressure.
The primary outcome was recovery quality 6 hours after laparoscopic hysterectomy, assessed with the multidimensional Postoperative Quality of Recovery Scale. Secondary outcomes were: Analgesia Nociception Index–guided intraoperative remifentanil administration, intraoperative pain stimulation, postoperative pain intensity, opioid use, surgeon-assessed surgical conditions, adverse events, time to discharge, and patient satisfaction.
Results
Two homogeneous groups were obtained. Protocol deviations attributable to surgical difficulties requiring larger instruments and higher pneumoperitoneal pressures to complete the intervention occurred in 6 low-impact laparoscopy–group patients. Recovery quality 6 hours after laparoscopic hysterectomy was comparable for the low-impact laparoscopy and conventional groups (10/34 [29%] and 8/34 [24%] of patients recovered their preoperative Postoperative Quality of Recovery Scale values, respectively; P=.58). The low-impact laparoscopy group had lower intraoperative pain stimulation, with less remifentanil consumption. Postoperative pain intensity at rest and coughing and morphine requirement, adverse event, same-day discharge, and patient satisfaction rates did not differ between the 2 groups. Surgical conditions were deemed poorer in the low-impact laparoscopy group.
Conclusion
Despite slightly less intraoperative pain stimulation, attesting to its minimally invasive nature, low-impact laparoscopy did not appear to improve 6 hours after laparoscopic hysterectomy recovery compared to conventional laparoscopy. Surgical conditions were rated poorer for the low-impact laparoscopy group. Low-impact laparoscopy does not seem to provide any clinical benefit.
{"title":"Recovery after low-impact laparoscopic hysterectomy: a randomized controlled clinical trial","authors":"Karim Bouattour MD , Christine Louis-Sylvestre MD , Richard Berry MD , Yael Levy-Zauberman MD , Jean-Marc Lacombe MSc , Marlène Cherruault MD , Olivier Montandrau MD , Marc Beaussier MD, PhD","doi":"10.1016/j.ajog.2025.08.090","DOIUrl":"10.1016/j.ajog.2025.08.090","url":null,"abstract":"<div><h3>Background</h3><div>Low-impact laparoscopy, a surgical protocol using mini-laparoscopic instruments and low and stable pneumoperitoneal pressure, was developed as a minimally invasive approach to mitigate local and systemic effects of laparoscopy. However, its real clinical impact is still poorly documented.</div></div><div><h3>Objective</h3><div>To evaluate low-impact laparoscopy impact on the postoperative recovery quality 6 hours after laparoscopic hysterectomy compared to conventional laparoscopy.</div></div><div><h3>Study Design</h3><div>Single-center, double-blinded, randomized controlled trial, conducted between December 2019 and August 2023, evaluating different approaches for outpatient laparoscopic hysterectomies.</div><div>Sixty-eight adult patients scheduled for outpatient laparoscopic hysterectomy were included and randomized into 2 groups: low-impact laparoscopy with mini-trocars and low peritoneal pressure or conventional laparoscopy with standard-sized trocars and higher peritoneal insufflation pressure.</div><div>The primary outcome was recovery quality 6 hours after laparoscopic hysterectomy, assessed with the multidimensional Postoperative Quality of Recovery Scale. Secondary outcomes were: Analgesia Nociception Index–guided intraoperative remifentanil administration, intraoperative pain stimulation, postoperative pain intensity, opioid use, surgeon-assessed surgical conditions, adverse events, time to discharge, and patient satisfaction.</div></div><div><h3>Results</h3><div>Two homogeneous groups were obtained. Protocol deviations attributable to surgical difficulties requiring larger instruments and higher pneumoperitoneal pressures to complete the intervention occurred in 6 low-impact laparoscopy–group patients. Recovery quality 6 hours after laparoscopic hysterectomy was comparable for the low-impact laparoscopy and conventional groups (10/34 [29%] and 8/34 [24%] of patients recovered their preoperative Postoperative Quality of Recovery Scale values, respectively; <em>P</em>=.58). The low-impact laparoscopy group had lower intraoperative pain stimulation, with less remifentanil consumption. Postoperative pain intensity at rest and coughing and morphine requirement, adverse event, same-day discharge, and patient satisfaction rates did not differ between the 2 groups. Surgical conditions were deemed poorer in the low-impact laparoscopy group.</div></div><div><h3>Conclusion</h3><div>Despite slightly less intraoperative pain stimulation, attesting to its minimally invasive nature, low-impact laparoscopy did not appear to improve 6 hours after laparoscopic hysterectomy recovery compared to conventional laparoscopy. Surgical conditions were rated poorer for the low-impact laparoscopy group. Low-impact laparoscopy does not seem to provide any clinical benefit.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 449-460"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960108","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.2025.10.002
Angela C. Nolin MD , Sage Atkins BS , Amanda Brucker PhD , Leyi Sun MB , Stephanie V. Blank MD , Jason D. Wright MD , Sharonne Holtzman MD , Isabel Chess BA , Aliza Vattakalam , Evan R. Myers MD, MPH , Laura J. Havrilesky MD, MHSc
<div><h3>Background</h3><div>Professional society guidelines endorse the use of ultrasound to evaluate an initial episode of postmenopausal bleeding, with endometrial sampling reserved for patients with an endometrial thickness exceeding 4 mm. However, the data supporting this ultrasound-based approach are derived from cohort studies with minimal racial and ethnic diversity.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate rates of adequate endometrial visualization, prompt guideline-concordant care, and identify risk factors for lack of timely indicated sampling in a multi-institutional cohort of patients who underwent ultrasound to evaluate postmenopausal bleeding.</div></div><div><h3>Study Design</h3><div>Patients aged ≥45 years who underwent transvaginal ultrasound for an initial coding-based diagnosis of postmenopausal bleeding were eligible for this retrospective cohort study. Ultrasound findings of the endometrium were classified as thin (endometrium ≤4 mm), thick (endometrium >4 mm), or inadequate (endometrium not completely visualized). Associations between clinicodemographic factors, ultrasound findings, and follow-up patterns were analyzed. We defined care as guideline-concordant if patients with a thin endometrium on the index ultrasound did not undergo biopsy, or if those with a thick or inadequately visualized endometrium received indicated endometrial sampling within 3 months after the index ultrasound. We analyzed outcomes using univariable and multivariable logistic regressions.</div></div><div><h3>Results</h3><div>A total of 3614 patients were included in the study (48.4% non-Hispanic White, 28.5% non-Hispanic Black, 9.6% Hispanic, 3.0% Asian, and 10.4% other/missing). Rates of inadequate ultrasound examination varied between racial/ethnic cohorts (non-Hispanic White 5.9%, non-Hispanic Black 18.8%, Hispanic 12.7%, and Asian 9.2%). Uterine fibroids were present in 71.5% (737/1031) of non-Hispanic Black patients, as opposed to 43.3% (757/1750) of non-Hispanic White patients, and were strongly associated with lower odds of adequate ultrasound (odds ratio, 0.29 [95% confidence interval, 0.23–0.38]; <em>P</em><.001). Rates of endometrial sampling were 53.5% (209/391) after an inadequate ultrasound and 75.3% (1329/1765) after a thickened endometrium finding. Guideline-concordant care rates were 85.7% for non-Hispanic White (1500/1750), 78.0% for non-Hispanic Black (804/1031), 83.6% for Hispanic (290/347), and 82.7% for other/unknown (402/83) patients. Compared with non-Hispanic White patients, non-Hispanic Black patients were less likely to receive guideline-concordant care (adjusted odds ratio, 0.64 [95% confidence interval, 0.52–0.78]).</div></div><div><h3>Conclusion</h3><div>Non-Hispanic Black patients with postmenopausal bleeding have a higher rate of inadequate ultrasound examination due to fibroids and are less likely to receive prompt guideline-concordant care. An ultrasound-based workup of postmenopaus
背景：专业协会指南支持使用超声来评估绝经后出血的初始发作，子宫内膜厚度超过4mm的患者保留子宫内膜取样。然而，支持这种基于超声的方法的数据来自种族和民族多样性最小的队列研究。目的：我们旨在评估充分的子宫内膜显像率和及时符合指南的护理，并确定缺乏及时指示抽样的多机构队列患者接受超声评估绝经后出血的危险因素。研究设计年龄≥45岁的经阴道超声诊断绝经后出血的患者符合本回顾性队列研究的条件。超声显示子宫内膜分为薄（子宫内膜≤4mm）、厚（子宫内膜bbb4mm）和不充分（子宫内膜未完全可见）。分析了临床人口学因素、超声检查结果和随访模式之间的关系。我们将符合指南的护理定义为薄子宫内膜或在超声检查后3个月内接受指示的子宫内膜取样。我们使用单变量和多变量逻辑回归分析结果。结果共纳入3614例患者（非西班牙裔白人48.4%，非西班牙裔黑人28.5%，西班牙裔9.6%，亚洲3.0%，其他/缺失10.4%）。不同种族/族裔人群的超声检查不足率不同（非西班牙裔白人5.9%，非西班牙裔黑人18.8%，西班牙裔12.7%，亚裔9.2%）。71.5%（737/1031）的非西班牙裔黑人患者存在子宫肌瘤，而43.3%（757/1750）的非西班牙裔白人患者存在子宫肌瘤，这与较低的超声检查几率密切相关（OR 0.29 [95% CI 0.23-0.38] p<0.001）。超声不充分的子宫内膜取样率为53.5%(209/391)，子宫内膜增厚的子宫内膜取样率为75.3%（1329/1765）。非西班牙裔白人（1500/1750）的护理率为85.7%，非西班牙裔黑人（804/1031）为78.0%，西班牙裔（290/347）为83.6%，其他/未知（402/83）为82.7%。与非西班牙裔白人患者相比，非西班牙裔黑人患者接受指南一致性护理的可能性较小（aOR 0.64 [95% CI 0.52-0.78]）。结论(S)绝经后出血的非西班牙裔黑人患者由于肌瘤而超声检查不充分的比例较高，并且不太可能及时得到符合指南的护理。绝经后出血的超声检查有延迟子宫内膜癌诊断的风险，并可能导致结果的种族差异。绝经后出血的普遍活检方法可能被认为减少变异，并改善指南一致性护理。
{"title":"Performance of ultrasound and rates of guideline-concordant care in a diverse postmenopausal bleeding cohort","authors":"Angela C. Nolin MD , Sage Atkins BS , Amanda Brucker PhD , Leyi Sun MB , Stephanie V. Blank MD , Jason D. Wright MD , Sharonne Holtzman MD , Isabel Chess BA , Aliza Vattakalam , Evan R. Myers MD, MPH , Laura J. Havrilesky MD, MHSc","doi":"10.1016/j.ajog.2025.10.002","DOIUrl":"10.1016/j.ajog.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Professional society guidelines endorse the use of ultrasound to evaluate an initial episode of postmenopausal bleeding, with endometrial sampling reserved for patients with an endometrial thickness exceeding 4 mm. However, the data supporting this ultrasound-based approach are derived from cohort studies with minimal racial and ethnic diversity.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate rates of adequate endometrial visualization, prompt guideline-concordant care, and identify risk factors for lack of timely indicated sampling in a multi-institutional cohort of patients who underwent ultrasound to evaluate postmenopausal bleeding.</div></div><div><h3>Study Design</h3><div>Patients aged ≥45 years who underwent transvaginal ultrasound for an initial coding-based diagnosis of postmenopausal bleeding were eligible for this retrospective cohort study. Ultrasound findings of the endometrium were classified as thin (endometrium ≤4 mm), thick (endometrium >4 mm), or inadequate (endometrium not completely visualized). Associations between clinicodemographic factors, ultrasound findings, and follow-up patterns were analyzed. We defined care as guideline-concordant if patients with a thin endometrium on the index ultrasound did not undergo biopsy, or if those with a thick or inadequately visualized endometrium received indicated endometrial sampling within 3 months after the index ultrasound. We analyzed outcomes using univariable and multivariable logistic regressions.</div></div><div><h3>Results</h3><div>A total of 3614 patients were included in the study (48.4% non-Hispanic White, 28.5% non-Hispanic Black, 9.6% Hispanic, 3.0% Asian, and 10.4% other/missing). Rates of inadequate ultrasound examination varied between racial/ethnic cohorts (non-Hispanic White 5.9%, non-Hispanic Black 18.8%, Hispanic 12.7%, and Asian 9.2%). Uterine fibroids were present in 71.5% (737/1031) of non-Hispanic Black patients, as opposed to 43.3% (757/1750) of non-Hispanic White patients, and were strongly associated with lower odds of adequate ultrasound (odds ratio, 0.29 [95% confidence interval, 0.23–0.38]; <em>P</em><.001). Rates of endometrial sampling were 53.5% (209/391) after an inadequate ultrasound and 75.3% (1329/1765) after a thickened endometrium finding. Guideline-concordant care rates were 85.7% for non-Hispanic White (1500/1750), 78.0% for non-Hispanic Black (804/1031), 83.6% for Hispanic (290/347), and 82.7% for other/unknown (402/83) patients. Compared with non-Hispanic White patients, non-Hispanic Black patients were less likely to receive guideline-concordant care (adjusted odds ratio, 0.64 [95% confidence interval, 0.52–0.78]).</div></div><div><h3>Conclusion</h3><div>Non-Hispanic Black patients with postmenopausal bleeding have a higher rate of inadequate ultrasound examination due to fibroids and are less likely to receive prompt guideline-concordant care. An ultrasound-based workup of postmenopaus","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 400-416"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277302","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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