Am. J. Obstet. Gynecol. [JOURNAL]
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200 papers
Optimizing delivery timing of large-for-gestational-age fetuses based on major labor complications (reply to letter to the editor).
Cavoretto PI, Nicolaides KH, Farina A
Am J Obstet Gynecol · 2026 Jun · PMID 42269846 · Publisher ↗
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Cesarean-risk curves and induction timing after 36-week large-for-gestational-age screening (letter to the editor).
Chang Y
Am J Obstet Gynecol · 2026 Jun · PMID 42269845 · Publisher ↗
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Open Boari Flap Teaching Simulation using a Porcine Model.
Mezes CM, Wood NJ, Tunitsky-Bitton E … +1 more , El Haraki AS
Am J Obstet Gynecol · 2026 Jun · PMID 42269844 · Publisher ↗
Ureteral injury is an uncommon but serious complication of gynecologic surgery, with most injuries occurring in the distal 4-5 cm of the ureter. These injuries may require advanced reconstructive techniques, such as uret...
Ureteral injury is an uncommon but serious complication of gynecologic surgery, with most injuries occurring in the distal 4-5 cm of the ureter. These injuries may require advanced reconstructive techniques, such as ureteroneocystostomy with a Boari flap, to achieve a tension-free repair. Due to the rarity of this complication, OB/GYN trainees have limited exposure to ureteral reimplantation and Boari flap creation. We developed and validated a high-fidelity simulation model for Boari flap creation with ureteral reimplantation using freshly harvested porcine bladders. Trainees (16 urogynecology fellows and two OB/GYN residents) first viewed an author-produced instructional video detailing procedural steps. Under supervision, participants then performed the procedure: distal ureter transection and spatulation; creation of a U-shaped bladder flap; formation of a submucosal tunnel; ureteral advancement and anastomosis; ureteral catheter placement; and two-layer bladder closure. Face validity and confidence in describing the steps of the procedure was assessed with pre- and post-simulation questionnaires. All participants reported increased confidence, with 56% agreeing and 44% strongly agreeing they felt confident describing the procedural steps after performing the simulation. Among 18 participants, 61% had never observed ureteral reimplantation, and none had performed it previously. The figure contains still images from the instructional video, illustrating key procedural steps from flap creation to final bladder closure. The accompanying video provides a detailed, step-by-step demonstration of the technique and serves as a visual guide to complement the hands-on simulation experience. This reproducible simulation fills a critical gap in surgical education by offering realistic, tactile exposure to Boari flap creation with ureteral reimplantation. Incorporating this model into OB/GYN training programs can improve procedural familiarity, technical skill, and understanding of this complex ureteral repair procedure.
Assessment of laparotomy conversion, unplanned readmission, and perioperative mortality for minimally invasive surgery in endometrial cancer.
Keymeulen S, Lee MW, Friedman EL … +7 more , Erfani H, Lee AJ, Juarez KE, Yao JA, Ouzounian AJ, Roman LD, Matsuo K
Am J Obstet Gynecol · 2026 Jun · PMID 42263927 · Publisher ↗
BACKGROUND: Conversion to laparotomy during minimally invasive hysterectomy for endometrial cancer has been an active area of research interest. Such data are scarce within a more contemporary study period. OBJECTIVE: Th...
BACKGROUND: Conversion to laparotomy during minimally invasive hysterectomy for endometrial cancer has been an active area of research interest. Such data are scarce within a more contemporary study period. OBJECTIVE: The primary objective was to compare laparotomy conversion rates between robotic-assisted and conventional laparoscopic hysterectomy for endometrial cancer; the secondary objective was to assess unplanned readmission and perioperative mortality per surgical modality. STUDY DESIGN: This comparative effectiveness study queried the Commission-on-Cancer's National Cancer Database. The study population included 210,615 patients with stage I-III endometrial cancer who underwent upfront minimally invasive hysterectomy from 2012 to 2023. Exposure was intent-level surgical modality comparing robotic-assisted and conventional laparoscopic hysterectomy (n=164,137 and n=46,478, respectively). The primary outcome measure was laparotomy conversion, defined as open surgery at the per-procedure level; the secondary outcome measures included unplanned post-discharge readmission and perioperative mortality within 30 days of the index anti-cancer surgery. Temporal trends were assessed with linear segment regression model. The exposure-outcome association was assessed in propensity score inverse probability of treatment weighting cohort to reduce the differences in baseline clinico-pathological characteristics between the two surgical modality groups, created with a multivariable generalized linear model with Poisson distribution. A classification-tree was constructed to visualize the patterns of clinico-pathological characteristics associated with laparotomy conversion. RESULTS: Over the 12-year study period, laparotomy conversion rates decreased from 2.1% to 1.0% in the robotic-assisted hysterectomy group (average annual percentage change -5.1%, 95% confidence interval [CI] -7.6% to -3.1%) and from 9.0% to 4.8% in the conventional laparoscopic hysterectomy group (average annual percentage change -6.1%, 95%Cl -7.3% to -4.9%). Larger tumor size was associated with higher laparotomy conversion rate for both surgical modalities: inflection points for increasing laparotomy conversion rates were 5 cm and 4 cm for robotic-assisted and conventional laparoscopic surgery, respectively. In the weighted model, robotic-assisted hysterectomy was associated with a 78% lower laparotomy conversion rate compared to conventional laparoscopic hysterectomy (1.5% vs 6.3%, incidence rate ratio [IRR] 0.22, 95%CI 0.21 to 0.24). Unplanned readmission (16.9 vs 19.0 per 1,000, IRR 0.89, 95%Cl 0.83 to 0.96) and perioperative mortality (2.0 vs 2.6 per 1,000, IRR 0.80, 95%Cl 0.65 to 0.99) rates were also lower for robotic-assisted hysterectomy compared to conventional laparoscopic hysterectomy. A classification-tree identified 20 unique clinico-pathological patterns associated with laparotomy conversion, of which three patterns exceeded 10%. All three patterns had conventional laparoscopic hysterectomy for tumor size of 6 cm or greater, whereas robotic-assisted surgery for tumor size of smaller than 4 cm had a rate of 1% or less. CONCLUSION: The results of this study suggested that among the Commission-on-Cancer-affiliated hospitals in the United States, laparotomy conversion during minimally invasive hysterectomy for endometrial cancer has decreased. While limited by potential confounding by surgeon- or patient-related factors, these data suggest that surgeons who preferentially perform robotic-assisted hysterectomy may have associated lower rates of laparotomy conversion, unplanned post-discharge readmission, and perioperative mortality compared to those who perform conventional laparoscopic hysterectomy. Whether perioperative morbidity differs by a surgeon's preferred practice for minimally invasive surgery warrants further evaluation.
Maternal Mortality, Birthweight and Immunogenetics: An Evolutionary Framework for Obstetric Risk.
Ettinghausen L, Moffett A
Am J Obstet Gynecol · 2026 Jun · PMID 42250788 · Publisher ↗
Human childbirth is hazardous compared with other primates, where both perinatal and maternal mortality remain a major global challenge despite advances in neonatal and obstetric care. The concept of the obstetric dilemm...
Human childbirth is hazardous compared with other primates, where both perinatal and maternal mortality remain a major global challenge despite advances in neonatal and obstetric care. The concept of the obstetric dilemma frames the evolutionary trade-off between the requirements of bipedal locomotion, which constrains pelvic dimensions, and the need to deliver a neonate with a relatively large cranium. The limits of the maternal pelvis increase the risk of obstructed labour for larger babies, whilst smaller babies are vulnerable to other causes of mortality such as growth restriction or failure to thrive post-natally. This means that birthweight is subject to stabilising selection. Contributing to the regulation of birthweight and placental function are interactions between Killer Immunoglobulin-like Receptors (KIR) on maternal uterine Natural Killer (NK) cells and fetal Human Leukocyte Antigen-C (HLA-C) molecules expressed on invading extravillous trophoblast (EVT) cells. Distinct KIR-HLA genetic combinations are associated with specific reproductive outcomes. Maternal inhibitory KIR with fetal HLA-C2 group allotypes are associated with impaired trophoblast invasion, defective spiral artery remodelling and increased risk of great obstetrical syndromes (GOS), such as pre-eclampsia. However, these same inhibitory interactions may enhance maternal resistance to certain pathogens. In contrast, activating KIR-HLA interactions seem to be protective against GOS but appear to confer weaker pathogen resistance. The persistence of both activating and inhibitory KIR variants binding different HLA-C groups therefore reflects stabilising selection. This immunogenetic interplay adds another dimension to the obstetric dilemma providing a framework for understanding the evolutionary origins of childbirth by linking the evolutionary pressures of a large fetal brain, constraints on pelvic dimensions, stabilising selection on birthweight, and responses to infection. These ideas can help understand the complex evolutionary origins of obstetric risk seen today for many conditions including pre-eclampsia, obstructed labour, stillbirth, fetal growth restriction and preterm labour. We speculate how modern medical care during childbirth will affect the frequency of these conditions in future.
Outcome of cesarean scar ectopic pregnancy continued to viability: Data from the International CSEP Registry.
Agten AK, Brunnschweiler E, Timor-Tritsch I … +15 more , Jurkovic D, Huirne J, Bartels HC, El-Haieg D, Coutinho CM, Agostini A, Nieto-Calvache AJ, Prefumo F, Buonomo F, Cordoba M, Ross J, Pateisky P, Ajjawi S, Manegold-Brauer G, CSEP collaborative network
Am J Obstet Gynecol · 2026 Jun · PMID 42248443 · Publisher ↗
BACKGROUND: Cesarean scar ectopic pregnancy is a rare but serious complication of a prior cesarean section, in which the gestational sac implants within the previous uterine cesarean scar. Cesarean scar ectopic pregnancy...
BACKGROUND: Cesarean scar ectopic pregnancy is a rare but serious complication of a prior cesarean section, in which the gestational sac implants within the previous uterine cesarean scar. Cesarean scar ectopic pregnancy carries a substantial risk of severe maternal morbidity, including life-threatening hemorrhage and hysterectomy. OBJECTIVE: The aim of this study is to describe the course of cesarean scar ectopic pregnancies that were managed expectantly and identify which ultrasound findings were associated with peripartum hysterectomy. STUDY DESIGN: An international registry was established to collect ultrasound and clinical data on diagnosis and management of cesarean scar ectopic pregnancy. Data is stored anonymously on a digital secure platform. This study included first-trimester, live cases that were managed expectantly or in which the patient declined pregnancy termination. Numbers of cases reaching viability, developing placenta accreta spectrum and requiring peripartum hysterectomy were collected. Twenty-one centers across 13 countries contributed data for this specific analysis. Descriptive statistical methods were applied. RESULTS: Between August 29, 2018, and December 31, 2023, 708 cases were recorded, of which 593 were excluded due to pregnancy termination or non-viability. Of the remaining 115 cases, 38 (33.0%) resulted in pregnancy loss between 13+0 and 22+6 weeks, while 77 (67.0%) progressed to ≥23+0 weeks. Live births occurred in 77/115 (67.0%) cases. A total of 50/115 (43.5%) women underwent peripartum hysterectomy, including 7/115 (6.1%) before 23 weeks. A first trimester residual myometrial thickness of below 2.5 mm identified 80% (16/20) of women requiring peripartum hysterectomy with a sensitivity of 64%, specificity of 75% and positive predictive value of 76%. Enhanced subplacental vascularity in the scar area was significantly more frequent in the hysterectomy group in 25/29 cases (86.2%) compared to those who retained their uterus with 13/22 cases (59.1%) (OR 4.13, [95%CI1.09; 18.4, p=0.04]). CONCLUSION: Expectant management of cesarean scar ectopic pregnancy carries a substantial risk of 2 trimester loss and peripartum hysterectomy. A residual myometrial thickness <2.5mm and enhanced subplacental vascularity at first trimester ultrasound is associated with an increased risk of hysterectomy. These findings underscore the importance of early and detailed ultrasound evaluation to identify high-risk cases, guide patient counselling, and optimize management strategies to mitigate maternal morbidity.
Combinational tocolysis: evaluating lower-dose combinations of nifedipine, indomethacin, and aminophylline for tocolytic synergism in pregnant human myometrium.
Hossain MR, Paul M, Smith R … +1 more , Paul JW
Am J Obstet Gynecol · 2026 Jun · PMID 42248442 · Publisher ↗
BACKGROUND: Tocolytics, such as nifedipine, indomethacin, and aminophylline, often cause side effects that limit their clinical usefulness. It is possible that effective tocolysis could be achieved by combining tocolytic...
BACKGROUND: Tocolytics, such as nifedipine, indomethacin, and aminophylline, often cause side effects that limit their clinical usefulness. It is possible that effective tocolysis could be achieved by combining tocolytics with synergistic actions so that doses of individual agents can be reduced, concurrently reducing the likelihood of off-target side effects. Since these drugs act through markedly different signaling pathways to inhibit myometrial contractions, it was hypothesized that nifedipine, indomethacin, and aminophylline in combinations would produce tocolytic synergism, which might have clinical value. OBJECTIVE: To evaluate whether nifedipine, indomethacin, and aminophylline produce tocolytic synergisms when applied in dual and triple combinations on pregnant human myometrial tissue strips undergoing spontaneous rhythmic contractions ex vivo. STUDY DESIGN: Myometrial strips generating spontaneous contractions were treated with IC (25% inhibitory concentration) or IC (50% inhibitory concentration) concentrations of 3 different dual tocolytic combinations: nifedipine+indomethacin, nifedipine+aminophylline, and indomethacin+aminophylline or one triple combination: nifedipine+indomethacin+aminophylline. The area under the curve for the baseline contractility (100%) (pretreatment) and following combination treatment (post-treatment) was measured for 1 hour. For each tocolytic combination, the expected percent inhibition was calculated based on the individual tocolytic effects using the Bliss Independence Model and then compared with the experimentally observed inhibition. The combinational effect was considered synergistic if the experimentally observed inhibition (IC and IC) scores were significantly greater than the theoretically expected (IC and IC) inhibition scores. RESULTS: Contraction inhibition was significantly greater than expected for the dual combinations of nifedipine+indomethacin (n=6) (eg, IC score [0.72] vs IC score [0.86]; P=.0003) and nifedipine+aminophylline (n=6) (eg, IC score [0.72] vs IC score [0.92]; P=.0002), confirming synergism, whereas the dual combination of indomethacin+aminophylline produced only an additive effect (n=6) (eg, IC score [0.68] vs IC score [0.74]; P=.25). The triple combination of nifedipine+indomethacin+aminophylline (n=6) also yielded tocolytic synergism (IC score [0.51] vs IC score [0.73]; P=.0004) and achieved near-complete inhibition of ex vivo contractility when constituent drugs were applied to myometrial strips at just IC concentrations. CONCLUSION: Of the 4 combinations examined, nifedipine+indomethacin, nifedipine+aminophylline, and nifedipine+indomethacin+aminophylline demonstrated synergism. The combination of indomethacin+aminophylline exhibited only an additive effect. Given the narrow therapeutic indications for tocolysis-primarily limited to short-term (≤48 hours) use to facilitate antenatal corticosteroid administration and maternal transfer-the synergistic lower-dose combinations identified here may enable more effective and safer tocolysis. These findings support further clinical investigation of combinational tocolysis to improve preterm birth outcomes while minimizing maternal and fetal adverse effects.
The effect of myo-inositol supplementation on gestational diabetes mellitus prevention: a systematic review and meta-analysis.
Poyatos-León R, Martínez-Vizcaíno V, Sequí-Domínguez I … +3 more , Sanabria-Martínez G, Díez Fernández A, Martínez-Hortelano JA
Am J Obstet Gynecol · 2026 Jun · PMID 42242341 · Publisher ↗
OBJECTIVE: To assess the effectiveness of myo-inositol supplementation during pregnancy or the preconception period in preventing gestational diabetes mellitus among women without preexisting diabetes. DATA SOURCES: Comp...
OBJECTIVE: To assess the effectiveness of myo-inositol supplementation during pregnancy or the preconception period in preventing gestational diabetes mellitus among women without preexisting diabetes. DATA SOURCES: Comprehensive searches were performed in PubMed, Web of Science, Scopus, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov from inception through April 2025. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials enrolling women without preexisting diabetes, either pregnant or planning conception within 6 months, were included. Eligible studies compared myo-inositol supplementation with placebo or standard care. STUDY APPRAISAL AND SYNTHESIS METHODS: Random-effects meta-analyses were conducted to calculate pooled relative risks and 95% confidence intervals. Heterogeneity was quantified with the I statistic. Sensitivity analyses, including leave-one-out testing, were performed to evaluate the influence of individual studies. Risk of bias was evaluated using the Cochrane Handbook criteria. RESULTS: Twelve randomized controlled trials comprising 4765 women met inclusion criteria. Most trials were of moderate to high quality, with some concerns regarding bias. Myo-inositol supplementation substantially reduced the risk of gestational diabetes mellitus compared with control groups, corresponding to a 44% risk reduction. No significant differences were observed in secondary maternal outcomes, including hypertensive disorders and cesarean delivery, or neonatal outcomes such as macrosomia, preterm birth, and neonatal hypoglycemia. CONCLUSION: Myo-inositol supplementation in pregnancy or preconception lowers the risk of gestational diabetes mellitus in women without preexisting diabetes. These findings support myo-inositol as a promising, safe, and accessible preventive strategy for gestational diabetes and reinforce its potential role in improving maternal metabolic health.
Vaginal hysterectomy is still superior to laparoscopic hysterectomy for benign indications (letter to the editor).
Paily VP, Najeeb F, Varghese F
Am J Obstet Gynecol · 2026 Jun · PMID 42242340 · Publisher ↗
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Multidisciplinary placenta accreta spectrum program reduces intensive care unit utilization without racially disparate outcomes.
Eluobaju D, Vaught A, Forrest AD … +3 more , Finney A, Prichett L, Martin KL
Am J Obstet Gynecol · 2026 Jun · PMID 42242339 · Publisher ↗
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Vaginal hysterectomy vs laparoscopic hysterectomy for benign indications (reply to letter to the editor).
Meyer R, Siedhoff MT, Wright KN
Am J Obstet Gynecol · 2026 Jun · PMID 42242338 · Publisher ↗
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Twin-Twin Transfusion Syndrome and Related Monochorionic Disorders: Historical Perspectives, Current Controversies, and Evidence-Based Opportunities.
Mari G
Am J Obstet Gynecol · 2026 Jun · PMID 42229559 · Publisher ↗
Twin-twin transfusion syndrome remains a major cause of morbidity and mortality in monochorionic twin pregnancies, arising from placental vascular anastomoses and representing a frequent indication for referral to fetal...
Twin-twin transfusion syndrome remains a major cause of morbidity and mortality in monochorionic twin pregnancies, arising from placental vascular anastomoses and representing a frequent indication for referral to fetal therapy centers. Despite advances in ultrasound assessment and fetoscopic laser therapy, variability in diagnostic thresholds, Doppler interpretation, and recognition of overlapping phenotypes-particularly twin anemia-polycythemia sequence and selective fetal growth restriction-continues to complicate clinical decision-making and limits meaningful comparison of outcomes across centers. Differences in the definition of polyhydramnios further contribute to this inconsistency, as traditional staging criteria remain widely applied, whereas gestational age-specific thresholds are commonly used in international studies. This expert review synthesizes current evidence regarding the placental vascular basis of twin-twin transfusion syndrome and related monochorionic phenotypes, including overlap phenotypes, and examines the evolution of diagnostic definitions, Doppler assessment, and treatment strategies. Ongoing uncertainty remains, particularly regarding prognostic heterogeneity in advanced-stage disease. This variability may partly reflect heterogeneous Doppler abnormalities grouped within the same stage, as well as by overlap phenotypes involving twin anemia-polycythemia sequence and selective fetal growth restriction. An evidence-informed framework is presented that integrates placental vascular anatomy, Doppler findings, and overlap phenotypes with Quintero staging to improve interpretation and promote consistency in classification and clinical communication. Developed before the broader recognition of overlap phenotypes and contemporary approaches to Doppler and amniotic fluid assessment, the staging system continues to provide a structural foundation that can be interpreted in the context of emerging evidence. The proposed framework preserves that foundation while refining interpretation in light of evolving understanding of disease heterogeneity and overlap phenotypes. It is intended as a complementary and hypothesis-generating approach rather than a prescriptive management system; prospective validation is required.
Addressing clinical and methodological considerations in semi-supervised pelvic magnetic resonance imaging segmentation (reply to letter to the editor).
Zuo J, Ashton-Miller JA, DeLancey JOL … +1 more , Luo J
Am J Obstet Gynecol · 2026 May · PMID 42217664 · Publisher ↗
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Antihuman leukocyte antigen antibodies and risk of fetal growth restriction.
Hannoun P, Verdoux M, Jollet I … +8 more , Taupin JL, Zuber J, Bonneaudeau B, Brossard P, Thévenin S, Grimaldi L, Benachi A, Lafarge X
Am J Obstet Gynecol · 2026 May · PMID 42217663 · Publisher ↗
BACKGROUND: Fetal growth restriction is a major cause of stillbirth, neonatal morbidity, and long-term cardiovascular and neurodevelopmental complications. While placental dysfunction is central to many cases, a substant...
BACKGROUND: Fetal growth restriction is a major cause of stillbirth, neonatal morbidity, and long-term cardiovascular and neurodevelopmental complications. While placental dysfunction is central to many cases, a substantial proportion remains unexplained. Chronic inflammatory placental lesions, such as chronic histiocytic intervillositis or massive perivillous fibrin deposition, are associated with fetal growth restriction and have been interpreted as possible manifestations of maternal antifetal rejection mediated by the human leukocyte antigen system. Maternal antihuman leukocyte antigen antibodies have been associated with chronic chorioamnionitis and preterm birth, but their relationship with fetal growth restriction has not been evaluated at the population level. OBJECTIVE: To assess whether maternal antihuman leukocyte antigen antibody levels are associated with fetal growth restriction and to explore their relationship with obstetric history. STUDY DESIGN: We conducted a retrospective cohort study in women screened for antihuman leukocyte antigen antibodies between 2010 and 2020, using a blood donor cohort. Obstetric history was obtained by questionnaire. Antihuman leukocyte antigen antibodies were analyzed as continuous and categorical variables, using a threshold of ≥1000 for higher levels. Multivariable logistic regression models were adjusted for maternal age at pregnancy, body mass index, and number of pregnancies. RESULTS: Among 574 women, 103 (17.9%) reported a history of fetal growth restriction. Fetal growth restriction was more frequent in women with antihuman leukocyte antigen antibody levels ≥1000 than in those with lower levels (22.0% vs 15.3%). Higher antibody levels were independently associated with fetal growth restriction (adjusted odds ratio, 1.57; 95% confidence interval, 1.02-2.41). No association was observed with overall obstetric complications. Antibody levels increased with the number of prior pregnancies (adjusted odds ratio, 3.06; 95% confidence interval, 1.77-5.27) and decreased with time since the last pregnancy (adjusted odds ratio, 0.93; 95% confidence interval, 0.88-0.97). CONCLUSION: Higher maternal antihuman leukocyte antigen antibody levels were associated with fetal growth restriction, supporting the hypothesis that alloimmune mechanisms may contribute to a subset of growth-restricted pregnancies. These results are hypothesis-generating and do not support routine antihuman leukocyte antigen antibody testing in clinical practice at this stage. Further prospective studies are needed to determine whether this pathway could help refine the evaluation of unexplained fetal growth restriction.
Long-term risk of hypothyroidism after thyroid abnormalities identified in pregnancy.
Henricks C, Farid S, Starnes V … +4 more , McIntire D, Bryant M, Nelson DB, Cunningham FG
Am J Obstet Gynecol · 2026 May · PMID 42214715 · Publisher ↗
BACKGROUND: When thyroid analytes are assessed during pregnancy, subclinical hypothyroidism and thyroid peroxidase antibodies may be identified in otherwise asymptomatic individuals. However, the long-term risk of progre...
BACKGROUND: When thyroid analytes are assessed during pregnancy, subclinical hypothyroidism and thyroid peroxidase antibodies may be identified in otherwise asymptomatic individuals. However, the long-term risk of progression to overt hypothyroidism in this population remains poorly defined. Understanding this trajectory is essential for informing long-term thyroid surveillance strategies. OBJECTIVE: To determine the long-term incidence and timing of overt hypothyroidism among individuals with subclinical hypothyroidism, thyroid peroxidase antibodies, or both identified during pregnancy and to compare that risk against matched normothyroid controls. STUDY DESIGN: This retrospective cohort study included 718 individuals with subclinical hypothyroidism, thyroid peroxidase antibodies, or both identified during early pregnancy at a single tertiary-care public health system between 2000 and 2003. Participants were followed for up to 25 years, with a median follow-up time of approximately 21 years. Overt hypothyroidism was defined by an elevated thyroid-stimulating hormone with low free thyroxine, a documented diagnosis, or initiation of levothyroxine. Cumulative incidence was compared across antenatal thyroid phenotype groups using Kaplan-Meier methods and Cox proportional hazards models adjusted for age. A nested matched cohort analysis compared outcomes between individuals with antenatal thyroid abnormalities and normothyroid controls. RESULTS: During the follow-up period, 238 of 718 participants (33.1%) developed overt hypothyroidism. Progression occurred in 82 of 155 (52.9%) individuals with both subclinical hypothyroidism and thyroid peroxidase antibodies, compared with 27 of 108 (25.0%) with subclinical hypothyroidism alone and 129 of 455 (28.4%) with thyroid peroxidase antibodies alone (P<.001). Individuals with both abnormalities had the highest cumulative incidence and the shortest time to progression. In the nested matched cohort analysis, overt hypothyroidism developed in 34 of 118 (28.8%) individuals with antenatal thyroid abnormalities compared with 12 of 118 (10.2%) normothyroid controls (P<.001). CONCLUSION: Approximately one in 3 individuals with subclinical hypothyroidism, thyroid peroxidase antibodies, or both during pregnancy developed overt hypothyroidism over 25 years-nearly 3 times the rate of matched normothyroid controls. The risk was greatest among those with both abnormalities. These findings support consideration of phenotype-guided long-term thyroid surveillance in this population.
Semi-supervised pelvic magnetic resonance imaging segmentation (letter to the editor).
Yadakere Manu M, Devaraju S, B M P
Am J Obstet Gynecol · 2026 May · PMID 42214714 · Publisher ↗
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2026 International Society for the Study of Vulvovaginal Disease terminology for vulvar intraepithelial neoplasia and squamous intraepithelial lesions.
Day T, Scurry J, Parra-Herran C … +7 more , Fragomeni SM, Berry LK, Bevilacqua F, Preti EP, Sui L, Heller DS, Preti M
Am J Obstet Gynecol · 2026 May · PMID 42214713 · Publisher ↗
The 2026 International Society for the Study of Vulvovaginal Disease terminology for vulvar intraepithelial neoplasia and squamous intraepithelial lesion requires p16 and p53 immunohistochemistry for classification into...
The 2026 International Society for the Study of Vulvovaginal Disease terminology for vulvar intraepithelial neoplasia and squamous intraepithelial lesion requires p16 and p53 immunohistochemistry for classification into human papillomavirus-associated or human papillomavirus-independent disease. p16 and p53 are tumor suppressor proteins; block positive p16 staining is a surrogate marker for genomic integration of oncogenic human papillomavirus, while null or overexpressed p53 staining correlates with TP53 mutation. Human papillomavirus-associated and human papillomavirus-independent vulvar intraepithelial neoplasia represent 2 distinct entities with different diagnostic considerations, treatments, surveillance strategies, and prognoses. The designation of 'neoplasia' vs 'lesion' reflects biological behavior, with neoplasia signifying an established risk of progression to cancer. Human papillomavirus-associated disease maintains a 2-tier nomenclature: human papillomavirus-associated vulvar intraepithelial neoplasia for precursors to vulvar squamous cell carcinoma vs low-grade squamous intraepithelial lesion and condyloma for transient human papillomavirus manifestations. While human papillomavirus-associated vulvar intraepithelial neoplasia is preferred, high-grade squamous intraepithelial lesion is retained as acceptable in some settings to maintain consistency with nomenclature for analogous lesions across the lower genital tract. Human papillomavirus-independent disease almost always arises from longstanding lichen sclerosus. The updated terminology for human papillomavirus-independent precursors to squamous cell carcinoma is human papillomavirus-independent vulvar intraepithelial neoplasia, subcategorized as p53 mutant or p53 wild type. Verrucous vulvar intraepithelial neoplasia is a subtype of p53 wild type human papillomavirus-independent vulvar intraepithelial neoplasia and the usual precursor to verrucous carcinoma. Vulvar aberrant maturation encompasses human papillomavirus-independent lesions of uncertain neoplastic potential arising in lichen sclerosus that raise concern for but are not diagnostic of human papillomavirus-independent vulvar intraepithelial neoplasia. Collaboration between clinicians and pathologists is essential to achieve accurate diagnosis, optimal individualized treatment, and consistent application of this terminology in practice and research.
Association between surgical volume and postoperative complications following posterior deep infiltrating endometriosis surgery: A nationwide population-based study.
Pivano A, Pauly V, Pirro N … +3 more , Boyer L, Berbis J, Agostini A
Am J Obstet Gynecol · 2026 May · PMID 42202939 · Publisher ↗
BACKGROUND: Deep infiltrating endometriosis predominantly affects the posterior pelvic compartment and often requires complex surgical procedures, which are associated with a significant risk of postoperative complicatio...
BACKGROUND: Deep infiltrating endometriosis predominantly affects the posterior pelvic compartment and often requires complex surgical procedures, which are associated with a significant risk of postoperative complications. Limited evidence is available regarding the influence of center case volume on surgical outcomes. OBJECTIVE: To assess the association between center case volume and the risk of severe postoperative complications following posterior deep infiltrating endometriosis surgery during the initial hospital stay or upon readmission occurring within 90 days. STUDY DESIGN: A population-based cohort study using the French national medico-administrative database (Program of Medicalization of Information Systems - a comprehensive nationwide hospitalization database based on diagnosis-related groups). The study included all hospital stays for posterior deep-infiltrating endometriosis surgery in France between January 1, 2021, and December 31, 2023. The primary outcome was the occurrence of at least one severe postoperative complication during the initial hospital stay or during a readmission within 90 days. Postoperative complications were defined using the International Classification of Diseases, Tenth Revision (ICD-10) codes and classified according to the Clavien-Dindo classification; severe postoperative complications were defined as grade III-V. Annual hospital surgical volume for posterior deep infiltrating endometriosis was categorized into two levels based on spline function visualization derived from successive logistic regression models. The association between hospital volume and outcomes was assessed using multivariate logistic regression with generalized estimating equations to account for the hospital-cluster effect, adjusting for all covariates (i.e., radical or conservative surgery, surgical approach, patient age, previous endometriosis surgery within 3 years, presence of surgical procedures associated, Charlson Comorbidity index [0 vs ≥1], and type of healthcare institution). The intraclass correlation coefficient was calculated to estimate the percentages of complication variability explained by the center effect. Results are presented as adjusted odds ratios (ORs), with their 95% confidence intervals (95% CIs) and p-values. RESULTS: A total of 15,364 hospital stays for posterior deep-infiltrating endometriosis surgery were reported. Among these, 658 (4.3%) involved at least one severe postoperative complication (Clavien grade III-V). The optimal cut point was 40 hospital stays per year. Centers with fewer than 40 hospital stays per year had a severe postoperative complication rate of 318/6,005 (5.3%), compared with 340/9,359 (3.6%) in centers with ≥40 hospital stays per year. In multivariable analysis, a surgical volume ≥40 hospital stays per year was associated with a reduced risk of severe complications (aOR, 0.83; 95% CI, 0.70-0.99; p = 0.03). CONCLUSIONS: A center's surgical case volume has a significant positive impact on patient outcomes after posterior deep infiltrating endometriosis surgery. The rates of severe postoperative complications or readmissions within 90 days decreased as center case volume increased.
Does the order of ablation of vein-to-vein placental connections during fetoscopic laser photocoagulation affect outcomes in twin-twin transfusion syndrome?
Chmait RH, Korst LM, Llanes AS … +4 more , Chon AH, Monson MA, Kontopoulos EV, Quintero RA
Am J Obstet Gynecol · 2026 May · PMID 42178085 · Publisher ↗
OBJECTIVE: To assess whether the sequence of laser occlusion of vein-to-vein placental anastomoses is associated with fetal survival after laser photocoagulation for twin-twin transfusion syndrome. STUDY DESIGN: This pos...
OBJECTIVE: To assess whether the sequence of laser occlusion of vein-to-vein placental anastomoses is associated with fetal survival after laser photocoagulation for twin-twin transfusion syndrome. STUDY DESIGN: This post hoc analysis used data from the Sequential Trial, a randomized controlled trial comparing sequential vs selective laser photocoagulation techniques. Within this trial, a nested randomization assigned patients with superficial anastomoses (ie, artery-to-artery or vein-to-vein) to ablation of these anastomoses either at the beginning or at the end of surgery. For this analysis, we compared survival in patients with vein-to-vein anastomoses with a reference group lacking superficial anastomoses. Variables associated with survival were included in multiple logistic regression models, including the nested assignment to "Ablated First" vs "Ablated Last." RESULTS: Of 642 trial patients, 64 (10%) had at least one vein-to-vein anastomosis (range, 1-3). Donor live birth was 421/466 (90.3%) in the No Superficial Anastomoses group and 48/64 (75.0%) in the vein-to-vein group (P=.001). Among the 64 patients with vein-to-vein anastomoses, 28 (43.8%) were randomized to Ablated First and 36 (56.3%) to Ablated Last. Donor survival in the No Superficial Anastomoses, Ablated First, and Ablated Last groups was 90.3%, 82.1%, and 69.4%, respectively (P<.001). Recipient survival was 94.2%, 96.4%, and 86.1% (P=.128). In adjusted models, the Ablated Last group had lower odds of donor survival (adjusted odds ratio, 0.24 [0.10-0.58]; P=.002) and recipient survival (adjusted odds ratio, 0.30 [0.10-0.92]; P=.035) compared with the No Superficial Anastomoses group. CONCLUSION: In this post hoc exploratory analysis, end-of-procedure treatment of vein-to-vein anastomoses for twin-twin transfusion syndrome was associated with lower donor and recipient survival.
Tissue adherence and pressure parameters in vacuum-induced uterine tamponade techniques (Reply to Letter-to-the-Editor).
Ranieri E, Haslinger C
Am J Obstet Gynecol · 2026 May · PMID 42176970 · Publisher ↗
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