BACKGROUND: Recent randomized evidence suggesting that simple hysterectomy is non-inferior to radical hysterectomy in cervical cancer patients with low-risk disease has invigorated questions about the safety of a minimal...BACKGROUND: Recent randomized evidence suggesting that simple hysterectomy is non-inferior to radical hysterectomy in cervical cancer patients with low-risk disease has invigorated questions about the safety of a minimally invasive approach in this population. OBJECTIVE: To determine whether the association between surgical approach and oncologic outcomes varied by disease risk group. STUDY DESIGN: Population-based retrospective cohort study of cervical cancer patients undergoing primary radical hysterectomy by a gynecologic oncologist from 2006 to 2017 in Ontario, Canada. Analyses were stratified by disease risk group, with patients classified as low-risk (depth of invasion <10mm and maximum tumour diameter <20mm) or high-risk (depth of invasion >10mm or maximum tumor diameter >20mm) according to pathologic CCTG CX.5-SHAPE criteria. Overlap propensity score weighted survival models were used to examine the association between surgical approach and oncologic outcomes, adjusting for demographic, clinical, and pathologic factors. RESULTS: We identified 903 patients with median age 44 years (interquartile range, IQR 38-53) and follow-up 10 years (IQR 7-13). In low-risk patients (N=621), minimally invasive radical hysterectomy was not associated with all-cause death (HR 0.88, 95% CI 0.39-2.01, p=0.76), cervical cancer death (1.15, 95% CI 0.27-4.87, p=0.85), or recurrence (HR 0.88, 95% CI 0.4-1.91, p=0.74) compared to open radical hysterectomy. In high-risk patients (N=282), minimally invasive radical hysterectomy was associated with significantly increased all-cause death (HR 3.22, 95% CI 1.37-7.58, p=0.008), cervical cancer death (HR 4.88, 95% CI 1.50-15.83, p=0.008), and recurrence (HR 2.32, 95% CI 1.01-5.34, p=0.048) compared to open radical hysterectomy. CONCLUSION: The relationship between surgical approach and oncologic outcomes appeared to vary by disease risk group. Minimally invasive radical hysterectomy may not be associated with adverse oncologic outcomes in patients with low-risk disease, but recurrence and death were uncommon in this subgroup. Additional studies are needed to confirm whether minimally invasive surgery remains safe in a low-risk population defined by strict SHAPE criteria.
BACKGROUND: Understanding national trends and disparities in infertility treatment utilization and modalities is crucial for equitable reproductive care. We examined age-standardized rates of infertility treatment utiliz...BACKGROUND: Understanding national trends and disparities in infertility treatment utilization and modalities is crucial for equitable reproductive care. We examined age-standardized rates of infertility treatment utilization and specific treatment modalities among birthing individuals in the U.S. from 2011 to 2022, and assessed differences by race/ethnicity, socioeconomic status, and geographic region. OBJECTIVES: To identify how trends in infertility treatment utilization among birthing individuals have changed in the United States from 2011 to 2022, and how utilization differ by treatment modalities, race, ethnicity, socioeconomic status, and geographic region. STUDY DESIGN: We performed a serial cross-sectional analysis using birth certificate data on live births (2011-2022) from the National Center for Health Statistics. Outcomes included infertility treatment utilization and modalities, including assisted reproductive technology (ART) and fertility-enhancing drugs and insemination (non-ART). We estimated age-standardized rates, average annual percent change (APC), and adjusted odds ratios (aOR) by race, ethnicity, socioeconomic status, and geographic region. RESULTS: From 2011 to 2022, age-standardized rates of infertility treatment utilization among 40,053,571 birthing individuals with live births increased from 1.55% to 2.18 % (APC: 2.81% [95% CI 2.15%-3.56%]), with non-ART decreasing (APC: -1.05% [-1.99% to -0.04%]) and ART increasing (APC: 6.01% [5.22%-6.94%]). In 2022, rates of infertility treatment utilization were the lowest among American Indian/Alaska Native in 2022 (0.76%), followed by Black (0.93%), Hispanic (0.98%), Multiracial (1.91%), White (2.89%), and Asian/Pacific Islander individuals (3.01%). After adjusting for covariates, non-White birthing individuals had significantly lower odds of infertility treatment (aOR ranged 0.46-0.84) than White counterparts. Disparities were marked by socioeconomic status: infertility treatment utilization was lowest among those used Medicaid insurance (0.34% vs 2.55% non-Medicaid) and those with a high school education or less (0.52% vs 2.37% college-educated). Compared with the Northeast (3.23%), the South (1.49%), West (2.25%), and Midwest (2.39%) had consistently lower rates of infertility treatment in 2011-2022. Similar patterns were observed by treatment modality. CONCLUSION: Among U.S. birthing individuals with live births (2011-2022), birth-certificate-recorded infertility treatment usage increased, with opposing trends in non-ART versus ART. Significant racial, ethnic, socioeconomic, and geographic disparities highlight opportunities to improve infertility care accessibility and equity.
Froeliger A, Deneux-Tharaux C, Loussert L
… +4 more, Laure Sutter-Dallay A, Madar H, Sentilhes L, Tranexamic Acid for Preventing Postpartum Hemorrhage Following a Vaginal Delivery (TRAAP) study group
Am J Obstet Gynecol
· 2026 Jun · PMID 42361947
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BACKGROUND: Childbirth can be experienced as traumatic and lead to posttraumatic stress symptoms (PSS). The evolution of childbirth-related PSS remains poorly documented. OBJECTIVES: We aimed to characterize PSS trajecto...BACKGROUND: Childbirth can be experienced as traumatic and lead to posttraumatic stress symptoms (PSS). The evolution of childbirth-related PSS remains poorly documented. OBJECTIVES: We aimed to characterize PSS trajectories after vaginal delivery and identify associated risk factors. STUDY DESIGN: Ancillary cohort of the TRanexamic Acid for Preventing postpartum hemorrhage after vaginal delivery (TRAAP) trial in 15 French university hospitals (2015-2016) including women delivering vaginally after 35 weeks' gestation. After randomization, characteristics of the labor and delivery were prospectively collected. PSS were assessed at day 2 and 2 months postpartum using the self-administered Impact of Event Scale-Revised (IES-R) questionnaire. Four trajectories were defined: asymptomatic (IES-R <22 at both time points), recovered (≥22 at day 2; <22 at 2 months), emerging (<22 at day 2; ≥22 at 2 months), and persistent (≥22 at both). Prevalences were corrected for nonresponse using inverse probability weighting. Risk factors were assessed using multivariable logistic regression. RESULTS: Among 3891 women, 2344 (60.2%) completed the IES-R at both assessments. Corrected prevalences were 83.4% (81.8-85.0) asymptomatic, 11.0% (9.7-12.4) recovered, 2.1% (1.6-2.8) emerging, and 3.5% (2.7-4.4) persistent. Among women with PSS at day 2, persistent symptoms compared with recovery were associated with younger age (aOR 0.8; 95%CI 0.6-0.9), non-European origin (aOR 1.8; 95%CI 1.2-2.6), psychiatric history (aOR 1.9; 95%CI 1.2-2.4), bad memories of delivery (aOR 2.4; 95%CI 1.3-4.6), and hemoglobin <9 g/dL at day 2 (aOR 1.8; 95%CI 1.1-2.7). Among women without PSS at day 2, emerging symptoms compared with asymptomatic trajectories were associated with previous abortion (aOR 2.6; 95%CI 1.6-3.9), hospitalization during pregnancy (aOR 2.8; 95%CI 1.4-4.7), labor induction (aOR 1.7; 95%CI 1.1-2.8), bad memories of delivery (aOR 3.7; 95%CI 1.4-5.6), and fatigue at day 2 (aOR 2.2; 95%CI 1.4-3.5), while epidural analgesia reduced the risk (aOR 0.2; 95%CI 0.1-0.7). CONCLUSION: About 1 in 20 women present an unfavorable PSS trajectory up to 2 months after a term vaginal delivery. The risk factors for a persistent trajectory were notably preexisting vulnerabilities, bad memories of delivery and postpartum anemia at day 2 postpartum, whereas emerging trajectories were more closely associated with obstetric risk factors. These findings may help inform potential postpartum PTSD screening strategies and highlight targets for preventive efforts.
Wise LA, Kuan KE, Nillni YI
… +7 more, Noel N, Bond JC, Lovett SM, Kuriyama AS, Howe CJ, Rothman KJ, Boynton-Jarrett R
Am J Obstet Gynecol
· 2026 Jun · PMID 42342098
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BACKGROUND: Adverse childhood experiences (ACEs) have been associated with several long-term health outcomes, yet their relation to polycystic ovary syndrome (PCOS)-renamed as polyendocrine metabolic ovarian syndrome (PM...BACKGROUND: Adverse childhood experiences (ACEs) have been associated with several long-term health outcomes, yet their relation to polycystic ovary syndrome (PCOS)-renamed as polyendocrine metabolic ovarian syndrome (PMOS) in 2026-is understudied. ACEs may influence PCOS risk via disruption of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. METHODS: We used cross-sectional data to evaluate the association between early life adversities and self-reported PCOS in Pregnancy Study Online (PRESTO), a North American preconception cohort of females aged 21-45 years enrolled during 2013-2025. At enrollment, participants completed a baseline questionnaire to ascertain socio-demographics, behavioral factors, and medical history. Thirty days after enrollment, participants completed a supplemental questionnaire that included the Behavioral Risk Factor Surveillance System's 8-item ACE module and Brief Trauma Questionnaire (BTQ). Participants reported physician-diagnosed PCOS on baseline and follow-up questionnaires during preconception. We fit modified Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusting for age, race, ethnicity, childhood financial hardship, and highest level of parental education. We used inverse probability weights to account for supplemental questionnaire non-response. RESULTS: Among 10,856 participants, 52% and 26% reported 1-3 and ≥4 ACEs, respectively; 1,169 (10.8%) reported a PCOS diagnosis. Self-reported PCOS prevalence ranged from 7.4% (no ACEs) to 14.2% (≥4 ACEs). Weighted and fully-adjusted PRs for 1-3 and ≥4 (vs. 0) ACEs were 1.33 (95% CI: 1.11-1.60) and 1.64 (95% CI: 1.33-2.01), respectively (per 1-ACE increase: PR=1.08, 95% CI: 1.05-1.11). Specific ACEs associated with the largest increase in PCOS prevalence included: sexual abuse (PR=1.82, 95% CI: 1.45-2.29, parental interpersonal violence (PR=1.68, 95% CI: 1.29-2.17), emotional abuse (PR=1.54, 95% CI: 1.28-1.86), physical abuse (PR=1.52, 95% CI: 1.21-1.90), household mental illness (PR=1.46, 95% CI: 1.21-1.77), and parental separation/divorce (PR=1.43, 95% CI: 1.15-1.77). Results based on BTQ-derived measures of childhood sexual and physical abuse were consistent with those based on ACE measures. CONCLUSIONS: In this North American cross-sectional study, higher exposure to early life adversities was associated with a higher lifetime prevalence of self-reported physician-diagnosed PCOS. These findings add to growing evidence that childhood adversities may have lasting effects on gynecologic health and underscore the need for attention to early life stressors in understanding PCOS.
Rondagh M, Zwinkels LCM, Spekman JA
… +13 more, Lewi L, Russo F, Lanna M, Casati D, Herling L, Sirotkina M, Slaghekke F, van der Meeren LE, van Klink JMM, de Vries LS, Groene SG, Steggerda SJ, Lopriore E
Am J Obstet Gynecol
· 2026 Jun · PMID 42331081
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BACKGROUND: Monochorionic twins share a single placenta with vascular anastomoses including arterio-arterial and veno-venous anastomoses, which are low-resistance, superficial and bidirectional anastomoses. Following sin...BACKGROUND: Monochorionic twins share a single placenta with vascular anastomoses including arterio-arterial and veno-venous anastomoses, which are low-resistance, superficial and bidirectional anastomoses. Following single fetal demise, the survivor is at risk of brain injury due to acute exsanguination through arterio-arterial and veno-venous anastomoses into the low-pressure circulation of the deceased cotwin. OBJECTIVES: To assess whether the number and diameter of arterio-arterial and veno-venous anastomoses are associated with severe brain injury in the survivor following single fetal demise. The secondary objective was to evaluate the placental angioarchitecture and to identify potential additional placental risk factors for severe brain injury in monochorionic twin pregnancies after fetal demise. STUDY DESIGN: Multicenter retrospective study including all monochorionic twin dye-injected placentas of pregnancies with spontaneous single or double fetal demise. Pregnancies were excluded in case of twin anemia polycythemia sequence, selective feticide, demise following laser surgery for twin-twin transfusion syndrome. A potential association between the number and diameter of arterio-arterial and veno-venous anastomoses and the presence of severe brain injury was assessed using univariable logistic regression analyses corrected for multiple testing (q-values). RESULTS: A total of 75 placentas of monochorionic twin pregnancies were included in the analysis, including 43 cases of single fetal demise and 32 cases of double fetal demise. Severe brain injury occurred in 25% (19/75) of pregnancies. In the overall cohort, arterio-arterial and veno-venous anastomoses were present in 89% (17/19) and 68% (13/19) of placentas from twins with severe brain injury, compared to 77% (43/56) and 46% (26/56) without severe brain injury, respectively. Placentas of twins with severe brain injury showed larger diameter of the arterio-arterial anastomoses (mean 2.5 mm, 95% CI, 1.7-3.3 vs 1.6 mm, 95% CI, 1.2-2.0; p<0.01), and larger veno-venous anastomoses (mean 3.0 mm; 95% CI, 1.6-4.5 vs 1.5 mm; 95% CI, 0.9-2.1, p=0.02). The total number of arterio-arterial and/or veno-venous anastomoses (median 2 vs 1; p<0.01) and their cumulative total diameter (mean 5.8 mm, 95% CI, 3.9-7.7 vs 3.1 mm, 95% CI, 2.1-4.0; p<0.01) were also larger in the pregnancies with severe brain injury. Discordant insertions were more common in pregnancies with severe brain injury (47% vs 20%; p=0.03). In logistic regression, diameter of the arterio-arterial (OR 1.58, 95% CI, 1.11-2.26; q=0.02), the presence of veno-venous anastomoses (OR 3.47, 95% CI, 1.10-10.96; q=0.04), diameter of the veno-venous (OR 1.36, 95% CI, 1.09-1.69; q=0.01), and total diameter of arterio-arterial and veno-venous anastomoses (OR 1.27, 95% CI, 1.09-1.48; q=0.01) were associated with severe brain injury in the survivor after fetal demise. In analyses restricted to survivors after single fetal demise only no significant associations were found. CONCLUSIONS: In this exploratory analysis, severe brain injury after single or double fetal demise is associated with presence and number of veno-venous anastomoses, and diameter of the arterio-arterial and veno-venous anastomoses. In analyses restricted to single fetal demise, no significant associations were observed, likely due to limited statistical power.
Gootzen TA, Norquist BM, Wilke RN
… +10 more, Hoppenreijs B, TUBA WISP Hysterectomy Consortium, van Gelder MM, Kets CM, Simons M, Lu KHD, Swisher EM, Hermens RP, Steenbeek MP, de Hullu JA
Am J Obstet Gynecol
· 2026 Jun · PMID 42323120
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BACKGROUND: BRCA1/2 pathogenic variant (PV) carriers are advised to undergo a risk-reducing salpingo-oophorectomy (RRSO) between the ages of 35 to 45 due to their increased risk of tubo-ovarian cancer. A concurrent hyste...BACKGROUND: BRCA1/2 pathogenic variant (PV) carriers are advised to undergo a risk-reducing salpingo-oophorectomy (RRSO) between the ages of 35 to 45 due to their increased risk of tubo-ovarian cancer. A concurrent hysterectomy may be performed at the time of RRSO. Currently, the international execution of hysterectomy during risk-reducing surgery and the factors guiding related decision-making are unknown. METHODS: We conducted a mixed-methods study. First, we executed a quantitative analysis with data from the WISP and TUBA-WISP II study, both prospective preferential trials assessing surgical strategies for tubo-ovarian cancer prevention. Data was collected via electronic case report forms. Concurrent hysterectomy during RRSO was compared between Europe, North- and South America, and Australia using Kruskal-Wallis tests. We used univariable logistic regression models to estimate the association of personal and prevention-related characteristics with the execution of hysterectomy at RRSO in women from North- and South America. Subsequently, we conducted focus group interviews with gynecologic providers from 12 countries who provide preventive care for individuals at increased risk of tubo-ovarian cancer to identify indications, barriers, and facilitators for the execution of hysterectomy with RRSO. RESULTS: In the quantitative analysis we included 2181 participants, of which 1647 (75.5%) were from Europe, 498 (22.8%) from North-and South America, and 36 (1.7%) from Australia. Execution of hysterectomy at RRSO differed substantially between continents, with an execution of 48.8% in North- and South America, 14.2% in Australia, and 2.8% in Europe (p<0.001). Execution of concurrent hysterectomy at RRS in women from North- and South America occurred more often in women with a BRCA1 PV compared to a BRCA2 PV (adjusted odds ratio 0.4 (95% confidence interval 0.2-0.7). In the qualitative analysis, we interviewed 23 healthcare providers and identified 31 barriers and 32 facilitators regarding hysterectomy execution during RRSO. A total of eight different indications were mentioned, but opinions varied on the validity and weight given to each indication. Providers indicated that important barriers or facilitators for concurrent hysterectomy included a lack of clear guidelines, cultural variation between countries, (lack of) consensus within departments, and different interpretation of the endometrial cancer risk. CONCLUSIONS: Internationally, there is a large variation in execution of hysterectomy during risk-reducing surgery with frequent utilization in North and South America, and rare utilization in Europe. This could be explained by the interpretation of indications for hysterectomy by providers, which might be explained by cultural variation, the absence of clear guidelines, and limited scientific evidence.
Meriwether KV, Constantine M, Jiwani A
… +3 more, Misquez-Solis C, Ferraro E, Brakey HR
Am J Obstet Gynecol
· 2026 Jun · PMID 42276499
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OBJECTIVES: Despite many available treatments for female chronic pelvic pain (FCPP), there is limited patient success, engagement, or compliance with therapy. No current methods allow providers to effectively collect and...OBJECTIVES: Despite many available treatments for female chronic pelvic pain (FCPP), there is limited patient success, engagement, or compliance with therapy. No current methods allow providers to effectively collect and integrate patient perspectives into treatment choice for female chronic pelvic pain (FCPP). We aimed to leverage former qualitative stakeholder input on FCPP treatment choice, patient advisory group (PAG) input, and Q-methodology to translate patient viewpoints around FCPP treatment into measurable patient viewpoints to guide treatment choice. STUDY DESIGN: We used Q-methodology to translate qualitative data formerly collected from stakeholders in FCPP treatment into measurable patient preference profiles. PAG members interpreted previously collected qualitative data from FCPP stakeholders, and their guidance formulated Q-set statements in English and Spanish. Patients with FCPP performed Q-sort of these statements. PAG input then guided interpretation of factor analyses of Q-sorts to form relevant patient preference profiles for FCPP and provided preliminary mapping to certain treatments that may resonate with patients aligned with each preference profile. RESULTS: We engaged 11 PAG members, and 47 patients completed Q-sort. The authors and the PAG analyzed, interpreted, and described five factors (patient preference profiles) to measure FCPP treatment viewpoints. We titled these patient preference profiles as the "Self-empowered Realist," the "Fearless Escalator," the "Careful Scientist," the "Trusting Optimist," and "Eager to Move On," with each patient having a certain alignment with each of these viewpoints. These factors map to possible treatments that align with a patient's viewpoint as they align with one or more of these patient preference profiles. We described the perspectives associated with each patient preference profile to allow for future use of these profiles to inform instruments to measure patient preferences in FCPP treatment navigation. CONCLUSIONS: We translated patient perspectives on FCPP treatment into five measurable, nuanced patient preference profiles. We plan to use these patient preference profiles to guide treatment option counseling for FCPP in future studies.