American journal of obstetrics and gynecology最新文献

英文中文

Early risk assessment and aspirin prophylaxis did not reduce preterm preeclampsia in Sweden: a population-based study 在瑞典，早期风险评估和阿司匹林预防并没有减少早产子痫前期：一项基于人群的研究

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.10.028

Núria Mans-Gallart MD , Sara Carlhäll MD, PhD , Eric Hildebrand MD, PhD , Daniel Axelsson MD, PhD , Caroline Lilliecreutz MD, PhD (Associate professor)

Background

Preeclampsia is a substantial cause of maternal and perinatal morbimortality, with complications becoming more severe the earlier it manifests during pregnancy. The Fetal Medicine Foundation has developed a method that combines anamnestic risk factors and biochemical and biophysical tests to assess the individual risk of developing preterm preeclampsia. Previous studies have demonstrated that the combination of the Fetal Medicine Foundation method with the use of aspirin significantly reduces the prevalence of preterm preeclampsia. To our knowledge, no published studies have applied this method to an entire population before.

Objective

To evaluate the prevalence of preterm preeclampsia, defined as preterm birth with a preeclampsia diagnosis, before and after the Fetal Medicine Foundation method was introduced in an unselected Swedish population.

Study Design

This population-based, retrospective cohort study included 61,840 deliveries from 5 obstetric units in Sweden from 2012 to 2022. Two cohorts were defined: one before and one after the implementation of the Fetal Medicine Foundation method. The primary outcome was the prevalence of preterm preeclampsia. The analysis followed an intention-to-treat approach. The intervention cohort comprised 30,777 women. Individuals with a risk score of ≥1:100 were considered high risk and were subsequently recommended a daily dose of 150 mg of aspirin until 36 weeks of gestation or until the onset of preeclampsia.

Results

No significant reduction in the prevalence of preterm preeclampsia was observed (adjusted odds ratio, 1.13; 95% confidence interval, 0.9–1.5) but a tendency toward an increase in term preeclampsia rates was noted (adjusted odds ratio, 1.14; 95% confidence interval, 1.00–1.30). No other differences in obstetrical or neonatal outcomes were found between the cohorts (P=not significant, not significant). The Fetal Medicine Foundation method was successfully conducted in more than 85% of the pregnant population.

Conclusion

The implementation of the Fetal Medicine Foundation method showed no reduction in preterm birth combined with preeclampsia in this intention-to-treat analysis. The Fetal Medicine Foundation method was both feasible and well accepted in this unselected population, demonstrating its applicability in routine clinical practice. Further population-based studies using a per-protocol approach are needed to evaluate the efficacy of aspirin prophylaxis among individuals identified as high risk according to the Fetal Medicine Foundation method.

背景子痫前期是孕产妇和围产期死亡率的重要原因之一，其并发症在妊娠期越早出现越严重。胎儿医学基金会开发了一种方法，结合了健忘的风险因素和生化和生物物理测试，以评估个人患早产先兆子痫的风险。先前的研究表明，胎儿医学基金会的方法与阿司匹林的使用相结合，可显著降低早产子痫前期的患病率。据我们所知，以前没有发表过将这种方法应用于整个人群的研究。目的评估在未选择的瑞典人群中引入胎儿医学基金会方法前后早产子痫前期（定义为伴有子痫前期诊断的早产）的患病率。研究设计：这项基于人群的回顾性队列研究包括2012年至2022年瑞典5个产科单位的61840例分娩。定义了两个队列：一个在实施胎儿医学基金会方法之前，一个在实施之后。主要结局是早产子痫前期的患病率。分析遵循意向治疗方法。干预队列包括30,777名妇女。风险评分≥1:100的个体被认为是高风险的，随后建议每日服用150mg阿司匹林，直到妊娠36周或直到子痫前期发作。结果早产子痫前期患病率未见显著降低（校正优势比1.13,95%可信区间0.9-1.5），但足月子痫前期患病率有上升趋势（校正优势比1.14,95%可信区间1.00-1.30）。在队列之间未发现产科或新生儿结局的其他差异（P=不显著，不显著）。胎儿医学基金会方法在85%以上的妊娠人群中成功实施。结论在意向治疗分析中，胎儿医学基金会方法的实施并未减少早产合并先兆子痫的发生率。胎儿医学基金会方法在这一非选择性人群中既可行又被广泛接受，表明其在常规临床实践中的适用性。根据胎儿医学基金会的方法，需要进一步的基于人群的研究，使用每个方案的方法来评估阿司匹林在高危个体中的预防效果。

{"title":"Early risk assessment and aspirin prophylaxis did not reduce preterm preeclampsia in Sweden: a population-based study","authors":"Núria Mans-Gallart MD , Sara Carlhäll MD, PhD , Eric Hildebrand MD, PhD , Daniel Axelsson MD, PhD , Caroline Lilliecreutz MD, PhD (Associate professor)","doi":"10.1016/j.ajog.2025.10.028","DOIUrl":"10.1016/j.ajog.2025.10.028","url":null,"abstract":"<div><h3>Background</h3><div>Preeclampsia is a substantial cause of maternal and perinatal morbimortality, with complications becoming more severe the earlier it manifests during pregnancy. The Fetal Medicine Foundation has developed a method that combines anamnestic risk factors and biochemical and biophysical tests to assess the individual risk of developing preterm preeclampsia. Previous studies have demonstrated that the combination of the Fetal Medicine Foundation method with the use of aspirin significantly reduces the prevalence of preterm preeclampsia. To our knowledge, no published studies have applied this method to an entire population before.</div></div><div><h3>Objective</h3><div>To evaluate the prevalence of preterm preeclampsia, defined as preterm birth with a preeclampsia diagnosis, before and after the Fetal Medicine Foundation method was introduced in an unselected Swedish population.</div></div><div><h3>Study Design</h3><div>This population-based, retrospective cohort study included 61,840 deliveries from 5 obstetric units in Sweden from 2012 to 2022. Two cohorts were defined: one before and one after the implementation of the Fetal Medicine Foundation method. The primary outcome was the prevalence of preterm preeclampsia. The analysis followed an intention-to-treat approach. The intervention cohort comprised 30,777 women. Individuals with a risk score of ≥1:100 were considered high risk and were subsequently recommended a daily dose of 150 mg of aspirin until 36 weeks of gestation or until the onset of preeclampsia.</div></div><div><h3>Results</h3><div>No significant reduction in the prevalence of preterm preeclampsia was observed (adjusted odds ratio, 1.13; 95% confidence interval, 0.9–1.5) but a tendency toward an increase in term preeclampsia rates was noted (adjusted odds ratio, 1.14; 95% confidence interval, 1.00–1.30). No other differences in obstetrical or neonatal outcomes were found between the cohorts (<em>P</em>=not significant, not significant). The Fetal Medicine Foundation method was successfully conducted in more than 85% of the pregnant population.</div></div><div><h3>Conclusion</h3><div>The implementation of the Fetal Medicine Foundation method showed no reduction in preterm birth combined with preeclampsia in this intention-to-treat analysis. The Fetal Medicine Foundation method was both feasible and well accepted in this unselected population, demonstrating its applicability in routine clinical practice. Further population-based studies using a per-protocol approach are needed to evaluate the efficacy of aspirin prophylaxis among individuals identified as high risk according to the Fetal Medicine Foundation method.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 570-578"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382830","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}

引用次数: 0

Information for readers 读者资讯

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/S0002-9378(25)00946-9

引用次数: 0

The role of amniocentesis in preterm prelabor rupture of the membranes: tailoring personalized therapies with precise risk profiles using amniotic fluid specimens 羊膜穿刺术在早产产前胎膜破裂中的作用：使用羊水标本精确的风险概况定制个性化治疗（致编辑的信）。

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.07.022

Fan Jiang MD, Dong-Zhi Li MD

引用次数: 0

Prophylactic oxytocin dose following vaginal birth to prevent postpartum hemorrhage: a systematic review and dose-response meta-analysis 阴道分娩后预防性催产素剂量预防产后出血：一项系统评价和剂量-反应荟萃分析。

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.09.034

Vanessa Hébert RM, MA , Rohan D'Souza MD, PhD , Nancy Santesso PhD , Dena Zeraatkar PhD , Irina Oltean MSc , Meagan Furnivall RM, MSc , Behnam Sadeghirad PhD , Elizabeth K. Darling RM, PhD

Objective

A systematic review and dose-response meta-analysis assessing the effect of different oxytocin prophylaxis doses on preventing postpartum hemorrhage after vaginal birth.

Data sources

MEDLINE, Embase, CINAHL, Web of Science, Global Health, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov (inception–June 9, 2025), along with reference lists of eligible trials.

Study eligibility criteria

Randomized controlled trials comparing different intravenous or intramuscular doses of prophylactic oxytocin, or a single prophylactic dose with no oxytocin, following vaginal birth were included.

Study appraisal and synthesis methods

Two authors independently evaluated studies for inclusion and risk of bias. A random-effects dose-response meta-analysis was conducted using a one-stage approach with a restricted maximum likelihood heterogeneity estimator and modeled using restricted cubic splines to detect departure from linearity. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation methodology. Sufficient data were available to undertake a dose-response meta-analysis for blood loss ≥1000 mL, mean blood loss, blood transfusion, and use of additional uterotonics.

Results

13 studies involving 8961 participants were included, with oxytocin doses ranging from 2.5 to 80 IU. A J-shaped, nonlinear relationship was observed for blood loss ≥1000 mL, mean blood loss, and use of additional uterotonics. Doses of 4 to 10 IU resulted in 6 to 7 fewer individuals per 1000 experiencing blood loss ≥1000 mL (high certainty; risk with no oxytocin: 19 per 1000 individuals), likely 10 to 12 fewer individuals per 100 requiring additional uterotonics (moderate certainty; risk with no oxytocin: 26 per 100 individuals), but likely resulted in little to no difference in mean blood loss (moderate certainty). Lower doses (2.5–3 IU) likely reduced the risk of severe blood loss (moderate certainty) and may reduce additional uterotonic use (low certainty). At 20 IU, the risk of severe blood loss was probably reduced (moderate certainty), with possible diminishing returns at higher doses (low certainty). Additional uterotonics may increase at doses ≥20 IU (low certainty). No dose-response relationship was observed for blood transfusion.

Conclusion

Available evidence suggests the optimal range for oxytocin prophylaxis after vaginal birth is 4 to 10 IU, with lower doses within this range offering the best balance of efficacy and safety. However, limitations in the evidence base, including narrow dose ranges, under-representation of high-risk populations, and inconsistent reporting of safety outcomes, highlight the need for further research across clinical contexts.

目的通过系统评价和剂量-反应荟萃分析，评价不同剂量催产素预防阴道分娩后产后出血的效果。数据来源medline， EMBASE， CINAHL, Web of Science, Global Health, CENTRAL and ClinicalTrials.gov（成立于2025年6月9日），以及符合条件的试验参考列表。研究资格标准：随机对照试验比较阴道分娩后静脉注射或肌肉注射不同剂量的预防性催产素，或单剂量预防性不注射催产素。方法两位作者独立评估了研究的纳入和偏倚风险。随机效应剂量-反应荟萃分析采用单阶段方法，使用受限最大似然异质性估计器，并使用受限三次样条进行建模，以检测偏离线性。使用GRADE方法评估证据的确定性。有足够的数据可用于对失血量≥1000 mL、平均失血量、输血和额外使用子宫强张进行剂量反应荟萃分析。结果纳入13项研究，涉及8,961名受试者，催产素剂量从2.5到80 IU不等。失血量≥1,000 mL、平均失血量与额外使用子宫强张剂呈j型非线性关系。剂量为4至10 IU导致每1000人中失血量≥1000 mL的个体减少6至7人（高确定性；无催产素的风险：每1000人中19人），每100人中需要额外子宫强张的个体可能减少10至12人（中等确定性；无催产素的风险：每100人中26人），但可能导致平均失血量几乎没有差异（中等确定性）。较低剂量（2.5-3 IU）可能降低严重失血的风险（中等确定性），并可能减少额外的子宫扩张使用（低确定性）。在20iu时，严重失血的风险可能会降低（中等确定性），而在较高剂量时可能会减少（低确定性）。当剂量≥20iu时，额外的子宫强直剂可能会增加（低确定性）。输血无剂量-反应关系。结论阴道分娩后预防使用催产素的最佳剂量范围为4 ~ 10 IU，在此范围内较低的剂量可达到疗效和安全性的最佳平衡。然而，证据基础的局限性，包括狭窄的剂量范围，高风险人群的代表性不足，以及安全性结果的不一致报告，突出了在临床背景下进一步研究的必要性。

{"title":"Prophylactic oxytocin dose following vaginal birth to prevent postpartum hemorrhage: a systematic review and dose-response meta-analysis","authors":"Vanessa Hébert RM, MA , Rohan D'Souza MD, PhD , Nancy Santesso PhD , Dena Zeraatkar PhD , Irina Oltean MSc , Meagan Furnivall RM, MSc , Behnam Sadeghirad PhD , Elizabeth K. Darling RM, PhD","doi":"10.1016/j.ajog.2025.09.034","DOIUrl":"10.1016/j.ajog.2025.09.034","url":null,"abstract":"<div><h3>Objective</h3><div>A systematic review and dose-response meta-analysis assessing the effect of different oxytocin prophylaxis doses on preventing postpartum hemorrhage after vaginal birth.</div></div><div><h3>Data sources</h3><div>MEDLINE, Embase, CINAHL, Web of Science, Global Health, Cochrane Central Register of Controlled Trials, and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> (inception–June 9, 2025), along with reference lists of eligible trials.</div></div><div><h3>Study eligibility criteria</h3><div>Randomized controlled trials comparing different intravenous or intramuscular doses of prophylactic oxytocin, or a single prophylactic dose with no oxytocin, following vaginal birth were included.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>Two authors independently evaluated studies for inclusion and risk of bias. A random-effects dose-response meta-analysis was conducted using a one-stage approach with a restricted maximum likelihood heterogeneity estimator and modeled using restricted cubic splines to detect departure from linearity. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation methodology. Sufficient data were available to undertake a dose-response meta-analysis for blood loss ≥1000 mL, mean blood loss, blood transfusion, and use of additional uterotonics.</div></div><div><h3>Results</h3><div>13 studies involving 8961 participants were included, with oxytocin doses ranging from 2.5 to 80 IU. A J-shaped, nonlinear relationship was observed for blood loss ≥1000 mL, mean blood loss, and use of additional uterotonics. Doses of 4 to 10 IU resulted in 6 to 7 fewer individuals per 1000 experiencing blood loss ≥1000 mL (high certainty; risk with no oxytocin: 19 per 1000 individuals), likely 10 to 12 fewer individuals per 100 requiring additional uterotonics (moderate certainty; risk with no oxytocin: 26 per 100 individuals), but likely resulted in little to no difference in mean blood loss (moderate certainty). Lower doses (2.5–3 IU) likely reduced the risk of severe blood loss (moderate certainty) and may reduce additional uterotonic use (low certainty). At 20 IU, the risk of severe blood loss was probably reduced (moderate certainty), with possible diminishing returns at higher doses (low certainty). Additional uterotonics may increase at doses ≥20 IU (low certainty). No dose-response relationship was observed for blood transfusion.</div></div><div><h3>Conclusion</h3><div>Available evidence suggests the optimal range for oxytocin prophylaxis after vaginal birth is 4 to 10 IU, with lower doses within this range offering the best balance of efficacy and safety. However, limitations in the evidence base, including narrow dose ranges, under-representation of high-risk populations, and inconsistent reporting of safety outcomes, highlight the need for further research across clinical contexts.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 350-389"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153519","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}

引用次数: 0

Supplement use and weight loss for polycystic ovary syndrome: how much weight should we give the information we see on TikTok? 多囊卵巢综合征的补充剂使用和减肥：我们应该给我们在TikTok上看到的信息多少权重？

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.09.052

Rose Darcy BS, Alison Almgren-Bell BA, Jessica Almgren-Bell BA, Sarah Capelouto Cromack MD, Christina E. Boots MD, MSCI, Mary Ellen Pavone MD, MSc

引用次数: 0

Corrigendum to ‘Expanded noninvasive prenatal screening for dominant single-gene disorders: proof-of-concept, performance, and challenges’ American Journal of Obstetrics & Gynecology (2025) 233/6 [673-674] 《美国妇产科杂志》（2025）233/6[673-674]《显性单基因疾病的扩展无创产前筛查：概念验证、性能和挑战》的勘误表。

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.11.021

Songchang Chen PhD , Wenqiu Xu PhD , Li Zhang PhD , Xiaorui Luan PhD , Mengdi Liu MS , Hong You MS , Weihui Shi PhD , Xuanyou Zhou PhD , Zhen Yang PhD , Yun Yang MD , Chenming Xu PhD

引用次数: 0

AJOG GR Table of Contents AJOG GR目录表

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/S0002-9378(25)00948-2

引用次数: 0

Optimization of antenatal antibiotics based on an amniocentesis-based management in preterm prelabor rupture of membranes below 32 weeks 基于羊膜穿刺术的32周以下早产胎膜破裂处理的产前抗生素优化（回复编辑信）。

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.07.023

Teresa Cobo PhD, Victoria Aldecoa PhD

引用次数: 0

Long-term lymphedema and quality of life following lymph node staging in early cervical cancer: 3-year follow-up in the prospective multicenter SENTIREC CERVIX study 早期宫颈癌淋巴结分期后的长期淋巴水肿和生活质量：前瞻性多中心SENTIREC宫颈研究的3年随访

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.09.020

Eva B. Ostenfeld PhD , Sarah M. Bjørnholt PhD , Sara E. Sponholtz PhD , Ligita P. Frøding PhD , Katrine Fuglsang PhD , Algirdas Markauskas MD , Erik Parner PhD , Pernille T. Jensen PhD

<div><h3>Background</h3><div>Pelvic lymphadenectomy is the gold standard in nodal staging in cervical cancer but increases the risk of leg lymphedema. Sentinel lymph node mapping is a less invasive technique that enables accurate detection of nodal metastases, although evidence confirming its oncologic safety has yet to be established. Knowledge of chronic leg lymphedema and quality of life following pelvic lymphadenectomy or sentinel lymph node mapping is essential for informing treatment and survivorship strategies in women with cervical cancer, but current evidence is limited.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate long-term leg lymphedema after sentinel lymph node mapping alone and sentinel lymph node mapping with pelvic lymphadenectomy in women with cervical cancer, and to examine risk factors for leg lymphedema and condition-specific quality of life among patients with leg lymphedema at 12-month follow-up.</div></div><div><h3>Study Design</h3><div>This national prospective cohort study included patients with early-stage cervical cancer who underwent radical surgery, including sentinel lymph node mapping (2017–2021). In case of tumors >20 mm, backup pelvic lymphadenectomy was performed. Patients completed validated patient-reported outcome questionnaires before surgery and at 3, 12, 24, and 36 months postoperatively. Leg lymphedema was assessed using the European Organisation for Research and Treatment of Cancer cervix cancer module (QLQ-CX24), supplemented by 8 single items from the European Organisation for Research and Treatment of Cancer item library addressing lymphedema of the legs, genitals, and groin. Quality of life was reported according to the LYMQOL (Lymphoedema Quality of Life) tool and the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-CX24 modules. Mean difference scores from baseline to each follow-up were estimated with 95% confidence intervals, defining a change of ≥8 points as clinically important. Linear regression models were used to examine predictors of leg lymphedema 12 months postoperatively. We evaluated quality of life within LYMQOL domains in patients with lymphedema and analyzed domain trends using multiple linear regression. We compared quality of life between patients with and without leg lymphedema using guidelines for interpretation of clinically important differences.</div></div><div><h3>Results</h3><div>Among 109 women who underwent sentinel lymph node mapping alone, the leg lymphedema mean score differences from baseline to 3, 12, and 36 months were 6 (95% confidence interval, 2–10), 10 (95% confidence interval, 5–15), and 15 (95% confidence interval, 7–22), respectively. At similar time points, 77 women reported substantial leg lymphedema after sentinel lymph node mapping with pelvic lymphadenectomy, with mean score differences of 18 (95% confidence interval, 11–25), 29 (95% confidence interval, 21–37), and 21 (95% confidence interval, 11–32). Th

盆腔淋巴结切除术（PL）是宫颈癌淋巴结分期的金标准，但会增加腿部淋巴水肿（LL）的风险。前哨淋巴结（SLN）定位是一种侵入性较小的技术，能够准确检测淋巴结转移，尽管尚未有证据证实其肿瘤学安全性。了解慢性LL和PL或SLN定位后的生活质量（QOL）对于确定宫颈癌妇女的治疗和生存策略至关重要，但目前的证据有限。目的：评估宫颈癌妇女单独SLN定位和SLN定位+ PL后的长期LL。进一步，在12个月的随访中检查LL的危险因素和LL患者的病情特异性生活质量。这项全国前瞻性队列研究纳入了接受根治性手术的早期宫颈癌患者，包括SLN定位（2017-2021）。当肿瘤直径大于20 mm时，行后备PL。患者在手术前和术后3、12、24和36个月完成有效的患者报告结果问卷。LL由欧洲癌症研究和治疗组织（EORTC）宫颈癌模块（QLQ-CX24）评估，并由EORTC项目库中的8个单个项目补充，这些项目涉及腿部、生殖器和腹沟的淋巴水肿。根据淋巴水肿生活质量（lyqol）工具、EORTC QLQ-C30和QLQ-CX24模块报告生活质量。从基线到每次随访的平均差异评分以95%置信区间（ci）估计，将8分或更多的变化定义为临床显著性。采用线性回归模型检验术后12个月的预测因素。我们评估了淋巴水肿患者的lyqol域内的生活质量，并使用多元线性回归分析了域的趋势。我们使用解释临床重要差异的指南来比较有LL和没有LL患者的生活质量。结果在109名单独进行SLN定位的女性中，从基线到3、12和36个月的LL平均评分差异分别为6 （95% CI: 2-10）、10 （95% CI: 5-15）和15 （95% CI: 7-22）。在相似的时间点，77名女性在SLN定位+ PL后报告了严重的LL，平均评分差异为18 (95% CI: 11-25), 29 （95% CI: 21-37）和21 （95% CI: 11-32）。无论淋巴结切除程度如何，3个月的LL评分与12个月的LL评分呈正相关。BMI预测单独SLN制图后的LL，而放化疗与备份PL后的淋巴水肿相关。12个月随访时报告的淋巴水肿与几个生活质量方面的损害相关，包括疲劳、疼痛、身体、认知、社交和性功能。结论宫颈癌患者长期LL以SLN作图+ PL为主，单纯SLN作图者较少。三个月LL评分预测持续淋巴水肿，这与一些生活质量症状和功能的恶化显著相关。我们的研究结果为该领域提供了新的知识，支持了微创手术方法，并可能使共同决策和生存干预成为可能。

{"title":"Long-term lymphedema and quality of life following lymph node staging in early cervical cancer: 3-year follow-up in the prospective multicenter SENTIREC CERVIX study","authors":"Eva B. Ostenfeld PhD , Sarah M. Bjørnholt PhD , Sara E. Sponholtz PhD , Ligita P. Frøding PhD , Katrine Fuglsang PhD , Algirdas Markauskas MD , Erik Parner PhD , Pernille T. Jensen PhD","doi":"10.1016/j.ajog.2025.09.020","DOIUrl":"10.1016/j.ajog.2025.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic lymphadenectomy is the gold standard in nodal staging in cervical cancer but increases the risk of leg lymphedema. Sentinel lymph node mapping is a less invasive technique that enables accurate detection of nodal metastases, although evidence confirming its oncologic safety has yet to be established. Knowledge of chronic leg lymphedema and quality of life following pelvic lymphadenectomy or sentinel lymph node mapping is essential for informing treatment and survivorship strategies in women with cervical cancer, but current evidence is limited.</div></div><div><h3>Objective</h3><div>This study aimed to evaluate long-term leg lymphedema after sentinel lymph node mapping alone and sentinel lymph node mapping with pelvic lymphadenectomy in women with cervical cancer, and to examine risk factors for leg lymphedema and condition-specific quality of life among patients with leg lymphedema at 12-month follow-up.</div></div><div><h3>Study Design</h3><div>This national prospective cohort study included patients with early-stage cervical cancer who underwent radical surgery, including sentinel lymph node mapping (2017–2021). In case of tumors >20 mm, backup pelvic lymphadenectomy was performed. Patients completed validated patient-reported outcome questionnaires before surgery and at 3, 12, 24, and 36 months postoperatively. Leg lymphedema was assessed using the European Organisation for Research and Treatment of Cancer cervix cancer module (QLQ-CX24), supplemented by 8 single items from the European Organisation for Research and Treatment of Cancer item library addressing lymphedema of the legs, genitals, and groin. Quality of life was reported according to the LYMQOL (Lymphoedema Quality of Life) tool and the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-CX24 modules. Mean difference scores from baseline to each follow-up were estimated with 95% confidence intervals, defining a change of ≥8 points as clinically important. Linear regression models were used to examine predictors of leg lymphedema 12 months postoperatively. We evaluated quality of life within LYMQOL domains in patients with lymphedema and analyzed domain trends using multiple linear regression. We compared quality of life between patients with and without leg lymphedema using guidelines for interpretation of clinically important differences.</div></div><div><h3>Results</h3><div>Among 109 women who underwent sentinel lymph node mapping alone, the leg lymphedema mean score differences from baseline to 3, 12, and 36 months were 6 (95% confidence interval, 2–10), 10 (95% confidence interval, 5–15), and 15 (95% confidence interval, 7–22), respectively. At similar time points, 77 women reported substantial leg lymphedema after sentinel lymph node mapping with pelvic lymphadenectomy, with mean score differences of 18 (95% confidence interval, 11–25), 29 (95% confidence interval, 21–37), and 21 (95% confidence interval, 11–32). Th","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 417-431"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077857","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}

引用次数: 0

Uterine cancer diagnosis at age 65: onset of Medicare eligibility and impact of Medicaid expansion 65岁子宫癌诊断：医疗保险资格的开始和医疗补助扩张的影响。

IF 8.4 1区医学 Q1 OBSTETRICS & GYNECOLOGY

American journal of obstetrics and gynecology

Pub Date : 2026-02-01 DOI: 10.1016/j.ajog.2025.09.018

Kevin J. Rouse MS , Ling Chen MD, MPH , Tracy M. Layne PhD, MPH , Xiao Xu PhD , Nina A. Bickell MD, MPH , Goli Samimi PhD, MPH , Jason D. Wright MD , Evan R. Myers MD, MPH

Background

Uterine cancer, for which diagnosis is based on evaluation of symptoms, most commonly postmenopausal bleeding, is one of the few cancers in the United States with rising incidence and mortality. Inability to access diagnostic services due to lack of insurance coverage may lead to delayed diagnosis and inferior outcomes.

Objective

The aim of the study was to examine whether the onset of Medicare eligibility at age 65 was associated with a spike in the incidence of uterine cancer and whether this association was attenuated by Medicaid expansion through the Affordable Care Act.

Study design

This ecological study used cancer registry data from the Surveillance, Epidemiology, and End Results program to estimate the incidence rate of uterine cancer among women aged 55 to 74 from 2000 to 2021 in the United States. Second order polynomial modeling was used to fit the association between age (in single years) and incidence rate at the population level while excluding age 65 to identify the expected incidence rate at age 65 in the absence of a spike. The expected uterine cancer incidence rate at age 65 was generated from the model and compared to the observed rate at age 65 in the overall sample. Similar analyses were also conducted further stratified by stage, race and ethnicity, pre-Affordable Care Act (2004–2013) versus post-Affordable Care Act (2014–2021) period and states' Medicaid expansion status.

Results

In the overall sample, the observed uterine cancer incidence rate at age 65 was 108.2 cases per 100,000 woman-years (95% confidence interval, 106.4 to 110.1), which exceeded the expected rate projected from the polynomial model (102.5; 95% confidence interval, 101.4–103.5). A similar pattern was observed in analysis stratified by stage at diagnosis and by race and ethnicity. The spike in incidence at age 65 diminished in Medicaid expansion states in the post-Affordable Care Act period but persisted in nonexpansion states.

Conclusion

Onset of Medicare eligibility at age 65 was associated with a spike in uterine cancer diagnoses, which appeared to be mitigated by Medicaid expansion. These findings underscore the importance of insurance coverage in facilitating timely uterine cancer diagnoses.

背景：原发性癌症的诊断基于对症状的评估，最常见的是绝经后出血，是美国为数不多的发病率和死亡率上升的癌症之一。由于缺乏保险覆盖而无法获得诊断服务，可能导致诊断延误和预后不佳。目的：本研究的目的是研究65岁开始享有医疗保险资格是否与子宫癌发病率激增相关，以及通过平价医疗法案（ACA）扩大医疗补助是否减弱了这种关联。研究设计：生态研究使用来自监测、流行病学和最终结果（SEER）项目的癌症登记数据来估计2000年至2021年美国55-74岁女性子宫癌的发病率。二阶多项式模型用于拟合年龄（单年）与人口水平发病率之间的关系，同时排除65岁以确定65岁时没有高峰的预期发病率。根据该模型得出65岁时子宫癌的预期发病率，并与总体样本中65岁时观察到的发病率进行比较。类似的分析还进一步按阶段、种族/民族、ACA实施前（2004-2013年）与ACA实施后（2014-2021年）以及各州医疗补助扩张状况进行了分层。结果在整个样本中，观察到的65岁子宫癌发病率为108.2例/ 10万妇女年（95%置信区间（CI） 106.4 ~ 110.1），超过了多项式模型预测的预期发病率（102.5,95% CI 101.4 ~ 103.5）。在按诊断阶段和种族/民族分层的分析中观察到类似的模式。在后aca时期，在医疗补助扩大的州，65岁人群的发病率高峰有所下降，但在未扩大的州，这一现象依然存在。结论：65岁开始的医疗保险资格与子宫癌诊断的激增有关，这似乎被医疗补助计划的扩大所缓解。这些发现强调了保险覆盖在促进子宫癌及时诊断中的重要性。

{"title":"Uterine cancer diagnosis at age 65: onset of Medicare eligibility and impact of Medicaid expansion","authors":"Kevin J. Rouse MS , Ling Chen MD, MPH , Tracy M. Layne PhD, MPH , Xiao Xu PhD , Nina A. Bickell MD, MPH , Goli Samimi PhD, MPH , Jason D. Wright MD , Evan R. Myers MD, MPH","doi":"10.1016/j.ajog.2025.09.018","DOIUrl":"10.1016/j.ajog.2025.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Uterine cancer, for which diagnosis is based on evaluation of symptoms, most commonly postmenopausal bleeding, is one of the few cancers in the United States with rising incidence and mortality. Inability to access diagnostic services due to lack of insurance coverage may lead to delayed diagnosis and inferior outcomes.</div></div><div><h3>Objective</h3><div>The aim of the study was to examine whether the onset of Medicare eligibility at age 65 was associated with a spike in the incidence of uterine cancer and whether this association was attenuated by Medicaid expansion through the Affordable Care Act.</div></div><div><h3>Study design</h3><div>This ecological study used cancer registry data from the Surveillance, Epidemiology, and End Results program to estimate the incidence rate of uterine cancer among women aged 55 to 74 from 2000 to 2021 in the United States. Second order polynomial modeling was used to fit the association between age (in single years) and incidence rate at the population level while excluding age 65 to identify the expected incidence rate at age 65 in the absence of a spike. The expected uterine cancer incidence rate at age 65 was generated from the model and compared to the observed rate at age 65 in the overall sample. Similar analyses were also conducted further stratified by stage, race and ethnicity, pre-Affordable Care Act (2004–2013) versus post-Affordable Care Act (2014–2021) period and states' Medicaid expansion status.</div></div><div><h3>Results</h3><div>In the overall sample, the observed uterine cancer incidence rate at age 65 was 108.2 cases per 100,000 woman-years (95% confidence interval, 106.4 to 110.1), which exceeded the expected rate projected from the polynomial model (102.5; 95% confidence interval, 101.4–103.5). A similar pattern was observed in analysis stratified by stage at diagnosis and by race and ethnicity. The spike in incidence at age 65 diminished in Medicaid expansion states in the post-Affordable Care Act period but persisted in nonexpansion states.</div></div><div><h3>Conclusion</h3><div>Onset of Medicare eligibility at age 65 was associated with a spike in uterine cancer diagnoses, which appeared to be mitigated by Medicaid expansion. These findings underscore the importance of insurance coverage in facilitating timely uterine cancer diagnoses.</div></div>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"234 2","pages":"Pages 440-448"},"PeriodicalIF":8.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059193","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}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

American journal of obstetrics and gynecology

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀