Pub Date : 2026-01-16DOI: 10.1016/j.ajog.2026.01.008
Ka Wang Cheung,Tiffany Sin-Tung Au,Tin Yan Phoebe Chao,Mimi Tin Yan Seto
OBJECTIVEThis study aimed to investigate the differences in transvaginal cervical length (TVCL) after 24+0 weeks of gestation between women with spontaneous preterm birth (SPTB) and term birth and the predictive accuracy of third trimester TVCL in the prediction of SPTB among asymptomatic women.DATA SOURCESA systematic search of published literature was performed in PubMed, MEDLINE, and the Cochrane Library through June 2025. There was no language restriction.STUDY ELIGIBILITY CRITERIACohort or cross-sectional studies reporting on TVCL measurements after 24+0 week of gestation in asymptomatic women with both SPTB and term births that allowed the construction of 2 x 2 contingency tables were included. We excluded abstracts, studies with duplicated data, symptomatic women, twin pregnancies, or transabdominal cervical length measurement. (PROSPERO registration number: CRD42024538449) Study appraisal and synthesis methods: T.S.T.A. and T.Y.P.C searched for and selected studies independently. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. Mean differences in TVCL measurements between SPTB and term populations were calculated using the inverse variance method with the random-effects model. Subgroup analyses on gestational age, TVCL measurement technique, populations and type of cohort studies were performed. Predictive accuracy of various TVCL cut-offs were evaluated using the DerSimonian-Laird random-effects model. Youden index was calculated to identify the optimal TVCL cut-off.RESULTSA total of 3641 published articles were identified and 16 studies consisting of 26776 pregnancies met the inclusion criteria. All studies excluded iatrogenic PTB. Women with SPTB had a significantly shorter TVCL at 24+0 to 28+6 weeks (<37 weeks: MD=-5.47, 95% CI=-7.52 to -3.43, p<0.001; <34 weeks: MD=-7.85, 95% CI=-10.33 to -5.37, p<0.001) and 27+0 to 32+6 weeks (<37 weeks: MD=-4.41, 95% CI=-6.45 to -2.36, p<0.001; <34 weeks: MD=-7.75, 95% CI=-10.55 to -4.94, p<0.001), compared to women with term birth. The TVCL at 31+0 to 36+6 was comparable between the two groups (<37 weeks: MD=-4.71, 95% CI=-10.13 to 0.72, p=0.09). These observations were consistently seen among women with or without risk factors of SPTB, and irrespective of the TVCL measurement method. A TVCL cut-off of 25.5-26.0mm after 24+0 weeks had the highest positive likelihood ratio of 7.75 to predict SPTB, with pooled sensitivity of 0.74, specificity of 0.92, negative likelihood ratio of 0.31 and diagnostic odds ratio of 28.1 CONCLUSIONS: Women with SPTB had a significantly shorter TVCL after 24+0 weeks of gestation, compared to those who delivered at term. A cut-off of 25.5mm between 24+0 and 32+6 weeks may be used to identify women at risk of SPTB.
{"title":"Predictive Value of Cervical Length Measured After 24 Weeks for Spontaneous Preterm Birth: Systematic Review and Meta-Analysis.","authors":"Ka Wang Cheung,Tiffany Sin-Tung Au,Tin Yan Phoebe Chao,Mimi Tin Yan Seto","doi":"10.1016/j.ajog.2026.01.008","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.008","url":null,"abstract":"OBJECTIVEThis study aimed to investigate the differences in transvaginal cervical length (TVCL) after 24+0 weeks of gestation between women with spontaneous preterm birth (SPTB) and term birth and the predictive accuracy of third trimester TVCL in the prediction of SPTB among asymptomatic women.DATA SOURCESA systematic search of published literature was performed in PubMed, MEDLINE, and the Cochrane Library through June 2025. There was no language restriction.STUDY ELIGIBILITY CRITERIACohort or cross-sectional studies reporting on TVCL measurements after 24+0 week of gestation in asymptomatic women with both SPTB and term births that allowed the construction of 2 x 2 contingency tables were included. We excluded abstracts, studies with duplicated data, symptomatic women, twin pregnancies, or transabdominal cervical length measurement. (PROSPERO registration number: CRD42024538449) Study appraisal and synthesis methods: T.S.T.A. and T.Y.P.C searched for and selected studies independently. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. Mean differences in TVCL measurements between SPTB and term populations were calculated using the inverse variance method with the random-effects model. Subgroup analyses on gestational age, TVCL measurement technique, populations and type of cohort studies were performed. Predictive accuracy of various TVCL cut-offs were evaluated using the DerSimonian-Laird random-effects model. Youden index was calculated to identify the optimal TVCL cut-off.RESULTSA total of 3641 published articles were identified and 16 studies consisting of 26776 pregnancies met the inclusion criteria. All studies excluded iatrogenic PTB. Women with SPTB had a significantly shorter TVCL at 24+0 to 28+6 weeks (<37 weeks: MD=-5.47, 95% CI=-7.52 to -3.43, p<0.001; <34 weeks: MD=-7.85, 95% CI=-10.33 to -5.37, p<0.001) and 27+0 to 32+6 weeks (<37 weeks: MD=-4.41, 95% CI=-6.45 to -2.36, p<0.001; <34 weeks: MD=-7.75, 95% CI=-10.55 to -4.94, p<0.001), compared to women with term birth. The TVCL at 31+0 to 36+6 was comparable between the two groups (<37 weeks: MD=-4.71, 95% CI=-10.13 to 0.72, p=0.09). These observations were consistently seen among women with or without risk factors of SPTB, and irrespective of the TVCL measurement method. A TVCL cut-off of 25.5-26.0mm after 24+0 weeks had the highest positive likelihood ratio of 7.75 to predict SPTB, with pooled sensitivity of 0.74, specificity of 0.92, negative likelihood ratio of 0.31 and diagnostic odds ratio of 28.1 CONCLUSIONS: Women with SPTB had a significantly shorter TVCL after 24+0 weeks of gestation, compared to those who delivered at term. A cut-off of 25.5mm between 24+0 and 32+6 weeks may be used to identify women at risk of SPTB.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"54 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994931","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 : 2026-01-16DOI: 10.1016/j.ajog.2026.01.011
Yibin Lin,Xiao Chen,Yang Sun
{"title":"Prognostic role of immunohistochemical and molecular markers in no specific molecular profile endometrial cancer (Letter-to-the-Editor).","authors":"Yibin Lin,Xiao Chen,Yang Sun","doi":"10.1016/j.ajog.2026.01.011","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.011","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"121 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994952","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}
OBJECTIVEVulvovaginal candidiasis and recurrent vulvovaginal candidiasis significantly impair women's quality of life and psychological well-being. Although numerous randomized controlled trials have explored probiotics as alternative or adjunctive therapies, their clinical efficacy remains inconclusive. This meta-analysis systematically assessed the therapeutic value of probiotics for these infections among non-pregnant women.DATA SOURCESCochrane Library, PubMed, EMBASE, ClinicalTrials.gov and Web of Science were searched from inception to October 12, 2025.STUDY ELIGIBILITY CRITERIAEligible studies were randomized controlled trials enrolling non-pregnant women with vulvovaginal candidiasis or recurrent vulvovaginal candidiasis. Three comparisons were analyzed: (1) probiotics combined with antifungal drugs versus antifungal drugs (with or without placebo); (2) probiotics alone versus antifungal drugs; and (3) probiotics alone versus placebo. The primary outcomes were cure and recurrence rate.STUDY APPRAISAL AND SYNTHESIS METHODSRelative Risk (RR) and 95% Confidence Interval (95%CI) were calculated using the Mantel-Haenszel method. Random- or fixed-effects models were applied depending on heterogeneity assessed by the chi-squared test.RESULTSFourteen studies met the inclusion criteria. In Comparison 1, according to low and very low-certainty evidence, combination therapy significantly improved short-term (<1 month) mycological cure (RR=1.19, 95% CI: 1.03-1.36, P=0.02) and clinical cure (RR=1.41, 95% CI: 1.14-1.74, P=0.001), and reduced 6-month recurrence (RR=0.20, 95% CI: 0.05-0.83, P=0.03), with no long-term benefit (P>0.05). For recurrent vulvovaginal candidiasis, combination therapy improved the 3-month combined mycological and clinical cure rate (RR=8.00, 95% CI: 2.06-31.07, P=0.003), with no sustained effect (P>0.05). In Comparison 2, probiotics alone had no short-term difference from antifungal drugs (P>0.05), whereas antifungal therapy achieved higher long-term mycological cure (RR=0.52, 95% CI: 0.32-0.85, P=0.009, very low-certainty evidence). In Comparison 3, probiotics alone significantly improved the 6-month mycological cure of recurrent vulvovaginal candidiasis compared with placebo (RR=12.64, 95% CI: 1.77-90.01, P=0.01, low-certainly evidence).CONCLUSIONEvidence of very low and low-certainty indicates, probiotics combined with antifungal drugs provided a potential adjunctive strategy to enhance conventional antifungal therapy. While probiotics alone showed limited efficacy compared with antifungal drugs but may be a beneficial alternative or preventive option in selected cases. Future high-quality trials are warranted to define optimal probiotic strains, treatment durations, and long-term outcomes.
{"title":"Probiotics for the treatment of vulvovaginal candidiasis in non-pregnant women: A systematic review and meta-analysis of randomized controlled trials.","authors":"Rongdan Chen,Wei Qing,Nuo Xu,Liping Wang,Zhenhua Chen,Muxuan Chen,Shenghai Wu","doi":"10.1016/j.ajog.2026.01.009","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.009","url":null,"abstract":"OBJECTIVEVulvovaginal candidiasis and recurrent vulvovaginal candidiasis significantly impair women's quality of life and psychological well-being. Although numerous randomized controlled trials have explored probiotics as alternative or adjunctive therapies, their clinical efficacy remains inconclusive. This meta-analysis systematically assessed the therapeutic value of probiotics for these infections among non-pregnant women.DATA SOURCESCochrane Library, PubMed, EMBASE, ClinicalTrials.gov and Web of Science were searched from inception to October 12, 2025.STUDY ELIGIBILITY CRITERIAEligible studies were randomized controlled trials enrolling non-pregnant women with vulvovaginal candidiasis or recurrent vulvovaginal candidiasis. Three comparisons were analyzed: (1) probiotics combined with antifungal drugs versus antifungal drugs (with or without placebo); (2) probiotics alone versus antifungal drugs; and (3) probiotics alone versus placebo. The primary outcomes were cure and recurrence rate.STUDY APPRAISAL AND SYNTHESIS METHODSRelative Risk (RR) and 95% Confidence Interval (95%CI) were calculated using the Mantel-Haenszel method. Random- or fixed-effects models were applied depending on heterogeneity assessed by the chi-squared test.RESULTSFourteen studies met the inclusion criteria. In Comparison 1, according to low and very low-certainty evidence, combination therapy significantly improved short-term (<1 month) mycological cure (RR=1.19, 95% CI: 1.03-1.36, P=0.02) and clinical cure (RR=1.41, 95% CI: 1.14-1.74, P=0.001), and reduced 6-month recurrence (RR=0.20, 95% CI: 0.05-0.83, P=0.03), with no long-term benefit (P>0.05). For recurrent vulvovaginal candidiasis, combination therapy improved the 3-month combined mycological and clinical cure rate (RR=8.00, 95% CI: 2.06-31.07, P=0.003), with no sustained effect (P>0.05). In Comparison 2, probiotics alone had no short-term difference from antifungal drugs (P>0.05), whereas antifungal therapy achieved higher long-term mycological cure (RR=0.52, 95% CI: 0.32-0.85, P=0.009, very low-certainty evidence). In Comparison 3, probiotics alone significantly improved the 6-month mycological cure of recurrent vulvovaginal candidiasis compared with placebo (RR=12.64, 95% CI: 1.77-90.01, P=0.01, low-certainly evidence).CONCLUSIONEvidence of very low and low-certainty indicates, probiotics combined with antifungal drugs provided a potential adjunctive strategy to enhance conventional antifungal therapy. While probiotics alone showed limited efficacy compared with antifungal drugs but may be a beneficial alternative or preventive option in selected cases. Future high-quality trials are warranted to define optimal probiotic strains, treatment durations, and long-term outcomes.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"56 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145993045","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 : 2026-01-12DOI: 10.1016/j.ajog.2026.01.007
Olivia H. Chang MD MPH, J.Eric Jelovsek MD MMEdMSDS
{"title":"Addressing the limitations of observational studies on native-tissue apical prolapse surgery with hysterectomy or hysteropexy (Reply to Letter-to-the-Editor)","authors":"Olivia H. Chang MD MPH, J.Eric Jelovsek MD MMEdMSDS","doi":"10.1016/j.ajog.2026.01.007","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.007","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"247 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956985","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 : 2026-01-12DOI: 10.1016/j.ajog.2025.12.068
Elizabeth A. Stewart MD, Sateria Venable B Arch, Bijan J. Borah PhD, Fern J. Webb PhD, Shannon K. Laughlin-Tommaso MD MPH, Suzette J. Bielinski PhD MEd, Michelle L. McGowan PhD, Felicity T. Enders PhD, Kedra Wallace PhD, Lori A. Bilello PhD, Joyce E. Balls Berry PhD MPE, Sarah L. Cohen Rassier MD MPH, Andrew M. Kaunitz MD, Gregory K. Lewis MD, Michelle Y. Louie MD MSCR, Megan A. Allyse PhD
Uterine fibroids (leiomyomas or myomas) are a major issue for individuals with a uterus as well as a disease with profound disparities for Black/African American (Black) individuals. These disparities have roots in early gynecologic practice where procedures such as forced sterilizations and hysterectomy without consent were common in some areas. The COllaboration for EQuity in Uterine Leiomyomas (COEQUaL) Specialized Center for Health Disparities and Uterine Fibroids is funded by the National Institutes of Health. Using the research framework of the National Institute on Minority Health and Health Disparities, informed by the historic legacy of gynecologic surgery, COEQUaL aims to provide values-congruent care to all individuals with the goal of improving outcomes for all and reduction or elimination of disparities for Black individuals with fibroids.
{"title":"Fibroids and Health Disparities: The COllaboration for EQuity in Uterine Leiomyomas (COEQUaL) Specialized Center","authors":"Elizabeth A. Stewart MD, Sateria Venable B Arch, Bijan J. Borah PhD, Fern J. Webb PhD, Shannon K. Laughlin-Tommaso MD MPH, Suzette J. Bielinski PhD MEd, Michelle L. McGowan PhD, Felicity T. Enders PhD, Kedra Wallace PhD, Lori A. Bilello PhD, Joyce E. Balls Berry PhD MPE, Sarah L. Cohen Rassier MD MPH, Andrew M. Kaunitz MD, Gregory K. Lewis MD, Michelle Y. Louie MD MSCR, Megan A. Allyse PhD","doi":"10.1016/j.ajog.2025.12.068","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.068","url":null,"abstract":"Uterine fibroids (leiomyomas or myomas) are a major issue for individuals with a uterus as well as a disease with profound disparities for Black/African American (Black) individuals. These disparities have roots in early gynecologic practice where procedures such as forced sterilizations and hysterectomy without consent were common in some areas. The COllaboration for EQuity in Uterine Leiomyomas (COEQUaL) Specialized Center for Health Disparities and Uterine Fibroids is funded by the National Institutes of Health. Using the research framework of the National Institute on Minority Health and Health Disparities, informed by the historic legacy of gynecologic surgery, COEQUaL aims to provide values-congruent care to all individuals with the goal of improving outcomes for all and reduction or elimination of disparities for Black individuals with fibroids.","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"31 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956987","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 : 2026-01-10DOI: 10.1016/j.ajog.2026.01.006
Xiyin Yang,Xiaoyan Wang
{"title":"Apples and Oranges? Baseline Imbalance in Hysteropexy vs Hysterectomy Comparisons (Letter-to-the-Editor).","authors":"Xiyin Yang,Xiaoyan Wang","doi":"10.1016/j.ajog.2026.01.006","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.006","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"57 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956090","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 : 2026-01-09DOI: 10.1016/j.ajog.2025.12.072
Katariina Laine,Sari Räisänen,Kathrine Fodstad
{"title":"Obstetric anal sphincter injuries in spontaneous vaginal births in nulliparous pregnant individuals: a 21-year cohort study based on real-world data (Reply to Letter-to-the-Editor).","authors":"Katariina Laine,Sari Räisänen,Kathrine Fodstad","doi":"10.1016/j.ajog.2025.12.072","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.072","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"29 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949776","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 : 2026-01-08DOI: 10.1016/j.ajog.2025.12.038
Thomas J Garite
{"title":"A tribute upon the passing of Dr Edward J. Quilligan.","authors":"Thomas J Garite","doi":"10.1016/j.ajog.2025.12.038","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.038","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"263 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937655","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 : 2026-01-08DOI: 10.1016/j.ajog.2025.12.070
Michelle Valenti,Karen C Schliep,Madeline Paulsen,Rachael B Hemmert,C Matthew Peterson,Melissa A Furlong,Zelieann R Craig,Anna Z Pollack,Leslie V Farland
OBJECTIVETo evaluate pre-operative serum AMH levels among women with and without incident endometriosis and to assess whether levels differ by surgical staging and typology.STUDY DESIGNThe Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study was conducted between 2007-2009. The ENDO study consisted of an operative and population cohort (n=600). Only those in the ENDO operative cohort from the Utah site were used for this analysis and included women ages 18-44 that were scheduled for gynecologic surgery irrespective of clinical indication (n=476). AMH levels were measured from stored serum collected prior to surgery using a quantitative enzyme-linked immunosorbent assay. After excluding participants with missing outcome data (n=51), unilateral oophorectomy (n=8), or those within the population cohort (n=69), 348 participants remained for the analysis. Surgically confirmed endometriosis diagnosis, staging (ASRM I-IV), and typology (superficial, deep, ovarian) were ascertained by the operative report. Outliers for AMH (>14.0 ng/mL) were excluded from the analyses and AMH was log transformed. Multivariable linear regression models adjusted for age (squared and continuous), body mass index, serum cotinine levels, and exogenous hormonal contraceptive use were conducted. The percentage difference in AMH calculated by (exp(β)-1) *100 and 95% confidence intervals were reported.RESULTSCompared to those without endometriosis, incident endometriosis diagnosis had lower AMH levels (-19.8%, 95% CI: -37.0, 1.0), however this association was not statistically significant. Stage III-IV disease was associated with a 40.1% lower AMH levels (95% CI: -58.9, -12.7). Ovarian endometriomas was most strongly associated with lower AMH levels (-54.3%, 95% CI: -69.4, -31.8) and was more pronounced among those with infertility (-72.6% 95% CI -85.4, -48.5). Deep (-24.1%, 95% CI: -48.2, 11.0) and superficial (-15.5%, 95% CI: -34.6, 9.3) endometriosis also showed a pattern toward lower AMH but findings were not statistically significant. Compared to those with a post-operative diagnosis of normal pelvis, incident endometriosis was associated with 26.8% lower AMH levels (95% CI -44.6, -3.4). Stage III-IV were associated with 47.8% lower AMH levels (95% CI -65.8, -23.2) and all subtypes of endometriosis were statistically significantly associated with lower levels of AMH when compared to those with a post-operative diagnosis of normal pelvis (Ovarian: -60.8% 95% CI -74.4; -39.9; Deep: -34.3% 95% CI -56.2; -1.4 Superficial: -24.8% 95% CI -43.9, -0.8).CONCLUSION(S)Ovarian, as well as moderate to severe (Stage III-IV) endometriosis were associated with statistically significantly lower AMH levels compared to those without endometriosis. Compared to those with a post-operative diagnosis of normal pelvis, incident endometriosis and moderate to severe stages (Stage III-IV) had statistically significantly lower AMH levels. Additionally, typology (deep, ovarian, and super
目的评价发生和未发生子宫内膜异位症的妇女术前血清AMH水平，并评估其水平是否因手术分期和类型而不同。研究设计子宫内膜异位症：自然史、诊断和结果（ENDO）研究于2007-2009年进行。ENDO研究包括手术组和人群组（n=600）。只有来自犹他州的ENDO手术队列的患者被用于本分析，包括年龄在18-44岁，无论临床指征如何均计划进行妇科手术的女性（n=476）。采用定量酶联免疫吸附法测定术前收集的血清AMH水平。在排除结果数据缺失（n=51）、单侧卵巢切除术（n=8）或人群队列（n=69）的参与者后，仍有348名参与者用于分析。手术证实子宫内膜异位症的诊断、分期（ASRM I-IV）和类型（浅表、深部、卵巢）由手术报告确定。AMH的异常值（> - 14.0 ng/mL）被排除在分析之外，AMH被对数转换。对年龄（平方和连续）、体重指数、血清可替宁水平和外源性激素避孕药使用进行校正的多变量线性回归模型。用(exp(β)-1) *100和95%置信区间计算AMH的百分比差异。结果与未患子宫内膜异位症的患者相比，诊断为子宫内膜异位症的患者AMH水平较低（-19.8%,95% CI: -37.0, 1.0），但这种相关性无统计学意义。III-IV期疾病与AMH水平降低40.1%相关（95% CI: -58.9, -12.7）。卵巢子宫内膜异位瘤与较低的AMH水平相关性最强（-54.3%,95% CI: -69.4, -31.8），在不孕症患者中更为明显（-72.6%,95% CI: -85.4, -48.5）。深层（-24.1%,95% CI: -48.2, 11.0）和浅表（-15.5%,95% CI: -34.6, 9.3）子宫内膜异位症也表现出较低AMH的模式，但研究结果无统计学意义。与术后骨盆诊断正常的患者相比，子宫内膜异位症的发生率与AMH水平降低26.8%相关（95% CI -44.6, -3.4）。III-IV期与AMH水平降低47.8%相关（95% CI -65.8, -23.2），与术后诊断为骨盆正常的患者相比，所有子宫内膜异位症亚型与AMH水平降低有统计学意义（卵巢：-60.8% 95% CI -74.4; -39.9；深部：-34.3% 95% CI -56.2; -1.4浅表：-24.8% 95% CI -43.9, -0.8）。结论(S)卵巢，以及中度至重度（III-IV期）子宫内膜异位症与无子宫内膜异位症患者相比，AMH水平显著降低。与术后诊断骨盆正常的患者相比，发生子宫内膜异位症和中重度（III-IV期）患者的AMH水平有统计学意义上的显著降低。此外，类型（深层、卵巢和浅表）与AMH水平的降低有统计学意义相关，然而，这种关联可能是由所有亚型的卵巢子宫内膜异位瘤的存在所驱动的。这些发现与先前的研究一致，并表明子宫内膜异位症病变本身，独立于手术干预，影响AMH水平。
{"title":"Incident endometriosis diagnosis and anti-müllerian hormone (AMH): how surgical staging and typology relate to serum AMH levels.","authors":"Michelle Valenti,Karen C Schliep,Madeline Paulsen,Rachael B Hemmert,C Matthew Peterson,Melissa A Furlong,Zelieann R Craig,Anna Z Pollack,Leslie V Farland","doi":"10.1016/j.ajog.2025.12.070","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.12.070","url":null,"abstract":"OBJECTIVETo evaluate pre-operative serum AMH levels among women with and without incident endometriosis and to assess whether levels differ by surgical staging and typology.STUDY DESIGNThe Endometriosis: Natural History, Diagnosis, and Outcomes (ENDO) Study was conducted between 2007-2009. The ENDO study consisted of an operative and population cohort (n=600). Only those in the ENDO operative cohort from the Utah site were used for this analysis and included women ages 18-44 that were scheduled for gynecologic surgery irrespective of clinical indication (n=476). AMH levels were measured from stored serum collected prior to surgery using a quantitative enzyme-linked immunosorbent assay. After excluding participants with missing outcome data (n=51), unilateral oophorectomy (n=8), or those within the population cohort (n=69), 348 participants remained for the analysis. Surgically confirmed endometriosis diagnosis, staging (ASRM I-IV), and typology (superficial, deep, ovarian) were ascertained by the operative report. Outliers for AMH (>14.0 ng/mL) were excluded from the analyses and AMH was log transformed. Multivariable linear regression models adjusted for age (squared and continuous), body mass index, serum cotinine levels, and exogenous hormonal contraceptive use were conducted. The percentage difference in AMH calculated by (exp(β)-1) *100 and 95% confidence intervals were reported.RESULTSCompared to those without endometriosis, incident endometriosis diagnosis had lower AMH levels (-19.8%, 95% CI: -37.0, 1.0), however this association was not statistically significant. Stage III-IV disease was associated with a 40.1% lower AMH levels (95% CI: -58.9, -12.7). Ovarian endometriomas was most strongly associated with lower AMH levels (-54.3%, 95% CI: -69.4, -31.8) and was more pronounced among those with infertility (-72.6% 95% CI -85.4, -48.5). Deep (-24.1%, 95% CI: -48.2, 11.0) and superficial (-15.5%, 95% CI: -34.6, 9.3) endometriosis also showed a pattern toward lower AMH but findings were not statistically significant. Compared to those with a post-operative diagnosis of normal pelvis, incident endometriosis was associated with 26.8% lower AMH levels (95% CI -44.6, -3.4). Stage III-IV were associated with 47.8% lower AMH levels (95% CI -65.8, -23.2) and all subtypes of endometriosis were statistically significantly associated with lower levels of AMH when compared to those with a post-operative diagnosis of normal pelvis (Ovarian: -60.8% 95% CI -74.4; -39.9; Deep: -34.3% 95% CI -56.2; -1.4 Superficial: -24.8% 95% CI -43.9, -0.8).CONCLUSION(S)Ovarian, as well as moderate to severe (Stage III-IV) endometriosis were associated with statistically significantly lower AMH levels compared to those without endometriosis. Compared to those with a post-operative diagnosis of normal pelvis, incident endometriosis and moderate to severe stages (Stage III-IV) had statistically significantly lower AMH levels. Additionally, typology (deep, ovarian, and super","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"170 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947232","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}
{"title":"Challenges in Defining the Primary Outcome for Postpartum Hemorrhage (Reply to Letter-to-the-Editor).","authors":"Anne-Sophie Boucherie,Anne Rousseau,Patrick Rozenberg","doi":"10.1016/j.ajog.2026.01.005","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.01.005","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":"29 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937657","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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