Am. J. Obstet. Gynecol. [JOURNAL]
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200 papers
Menstrual cycle patterns during acute and long COVID-19 infection among a cohort of individuals with regular menstrual cycles.
Boniface ER, Alvergne A, Darney BG … +3 more , Benhar E, van Lamsweerde A, Edelman A
Am J Obstet Gynecol · 2026 Jul · PMID 41825703 · Full text
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Parvovirus B19 infection in pregnancy: perinatal outcomes derived from a systematic review and meta-analysis.
Sorrenti S, Deuster E, D'Antonio F … +2 more , Di Mascio D, Khalil A
Am J Obstet Gynecol · 2026 Mar · PMID 41819197 · Publisher ↗
OBJECTIVE: The main aim of this study was to evaluate fetal and perinatal outcomes of Parvovirus B19 infection in pregnancy, focusing on the differences between characteristics of the recent disease outbreak (2023-2024)...
OBJECTIVE: The main aim of this study was to evaluate fetal and perinatal outcomes of Parvovirus B19 infection in pregnancy, focusing on the differences between characteristics of the recent disease outbreak (2023-2024) compared to the previous waves. The results should inform clinical management strategies by providing an updated and comprehensive assessment of the literature. DATA SOURCES: MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and CINAHL databases, from 2000 to April 2025. STUDY ELIGIBILITY CRITERIA: Studies including cases of maternal and/or fetal Parvovirus B19 infection, reporting perinatal outcomes, were included. SYNTHESIS METHOD: We performed a meta-analysis of pooled proportions using a random-effects model; for dichotomous outcomes, logit-transformed proportions were analyzed using generalized linear mixed models. For continuous outcomes (cumulative mean values), random-effects models of mean differences were applied. All outcomes were described in the study cohort, and a second analysis comparing cases from the most recent wave (2023-2024) and older cases was also performed by random-effects meta-regression analysis. RESULTS: Forty-four studies were included in the final analysis, and the total study population encompassed 3221 women and 748 fetuses with Parvovirus B19 infection. The rate of intrauterine demise among fetal infections was 38.7% (95% confidence interval, 27.3-51.6), whereas among maternal infections it was lower (7.3%; 95% confidence interval, 4.6-11.3). Intrauterine transfusion was performed in 34.9% of cases (95% confidence interval, 21.9-50.7) of fetal infections and in 15.3% of cases of maternal infection (95% confidence interval, 7.9-27.6). Ultrasound signs of anemia among infected fetuses included hydrops (58.7%; 95% confidence interval, 38.8-76.2), cardiomegaly (39.0%; 95% confidence interval, 26.3-53.4), hepatic involvement (10.8%; 95% confidence interval, 6.1-18.4), and fetal growth restriction (9.5%; 95% confidence interval, 5.0-17.2). The rate of abnormal neuroimaging was high among fetuses that had prenatal magnetic resonance imaging (28.6%; 95% confidence interval, 17.0-43.9). No significant difference was observed in the rate of intrauterine demise (odds ratio, 0.84; 95% confidence interval, 0.46-1.54; P=.58) or ultrasound signs of fetal anemia (odds ratio, 1.13; 95% confidence interval, 0.82-1.56; P=.46) between the new and the previous waves. The rate of intrauterine transfusions was higher in the recent wave; however, statistical significance was not reached (odds ratio, 1.74; 95% confidence interval, 0.90-3.34; P=.09). CONCLUSION: Parvovirus B19 infection in pregnancy is associated with high perinatal morbidity and mortality. Nevertheless, no significant differences were observed in the rate of intrauterine demise during the recent outbreak of the disease (2023-2024) compared to the previous waves. In clinical practice, findings from this systematic review can inform patients about the rate of adverse outcomes, depending on their status (maternal or fetal infection or fetal infection requiring intrauterine transfusion). In cases of maternal infection, the rate of intrauterine demise is much lower than that in the case of confirmed fetal infection. Finally, the high rate of abnormal brain findings when fetal magnetic resonance imaging was performed in cases of intrauterine transfusion may be relevant to clinicians as reflecting the potential role of adding this second-level imaging method to improve prenatal diagnosis of these cases. Large multicenter studies are needed to evaluate the impact of prenatal therapeutic interventions and the role of prenatal neuroimaging in these cases.
Comparative effectiveness of intravenous remifentanil, epidural anesthesia, and a 2-step analgesic approach for external cephalic version: a large prospective single-center cohort study.
Aiartzaguena A, Rodríguez L, Quintana E … +5 more , Centeno MDM, Osuna C, Carreras M, Serna RM, Burgos J
Am J Obstet Gynecol · 2026 Mar · PMID 41794314 · Publisher ↗
BACKGROUND: Among the analgesic strategies used during external cephalic version, neuraxial anesthesia is the only approach that has consistently demonstrated higher vaginal delivery rates. However, neuraxial analgesia e...
BACKGROUND: Among the analgesic strategies used during external cephalic version, neuraxial anesthesia is the only approach that has consistently demonstrated higher vaginal delivery rates. However, neuraxial analgesia encompasses a heterogeneous range of techniques, and higher complication rates have been reported compared with other approaches. OBJECTIVE: This study aimed to compare the success of external cephalic version, modes of delivery, maternal pain, and complications using 3 strategies: intravenous analgesia with remifentanil, epidural anesthesia, and a stepwise approach in which epidural anesthesia was administered only if intravenous analgesia was unsuccessful. STUDY DESIGN: We conducted a single-center, consecutive 3-phase cohort study including 1963 singleton pregnancies undergoing an external cephalic version: 558 with intravenous remifentanil (Group 1, 2012-2015), 665 with intravenous remifentanil followed by epidural anesthesia 2 to 3 days later if unsuccessful (Group 2, 2016-2019), and 730 under epidural anesthesia (Group 3, 2020-2024), yielding 2218 procedures, 1233 with intravenous remifentanil and 985 with epidural anesthesia. All procedures followed a standardized protocol, performed or supervised by experienced obstetricians, with continuous presence of anesthesiologists. Ritodrine was administered for tocolysis, or atosiban when contraindicated. Outcomes included success of the external cephalic version, mode of delivery, maternal pain (0-10 numerical scale), any analgesia-related complications, and procedural-related obstetric complications including vaginal bleeding, abnormal fetal heart rate patterns, hospital admission, or any event that led to a delivery. Chi-square test was used for comparison, with significance at P<.05. RESULTS: Success rates were highest with epidural anesthesia (70.0%, 511/730), compared with intravenous remifentanil (52.2%, 291/558) and the stepwise approach (65.2%, 440/675; P<.001). This was reflected in vaginal delivery rates of 72.2% (526/730), 64.0% (342/534), and 66.1% (444/672), respectively (P=.005). Maternal pain was substantially lower under epidural, with 78.3% of women reporting no or minimal pain, whereas this proportion fell to 49.2% in the remifentanil group and to 36.2% in the 2-step approach (P<.001). Adverse effects of anesthesia were generally uncommon and clinically mild, but higher with epidural anesthesia (P<.001). Maternal hypotension was the main complication under epidural anesthesia (16.1%, 159/985), followed by dizziness (3.7%, 36/985), neither associated with significant obstetric clinical consequences. Procedural complications were rare, but more common with epidural anesthesia, and overall, highest among patients undergoing the 2-step approach (P=.264). Vaginal bleeding occurred in 3.6% (35/985) of epidural cases and 4.3% (53/1233) with remifentanil (P=.052). Abnormal fetal heart rate patterns were more frequent with epidural (3.6%, 35/985) than with remifentanil (1%, 12/1233) (P<.001). Procedure-related hospital admissions were uncommon and similar (3.6%, 35/985 vs 3.6%, 45/1233). Procedure-related deliveries and urgent cesareans were rare, but higher with epidural (1.4%, 15/985) than with remifentanil (0.5%, 6/1233) (P=.021). CONCLUSION: In this study, a single attempt with epidural anesthesia was the most effective strategy for external cephalic version, achieving the highest success and vaginal delivery rates while providing superior maternal pain control, but with higher complications. These findings may help support more informed counseling and shared decision-making when discussing analgesic options for external cephalic version.
Trachelectomy in decline: national trends, outcomes, and academic output across 3 major databases.
Levin G, Gilbert L, Pareja R … +4 more , Fumagalli D, Ribeiro R, Meyer R, Ramirez PT
Am J Obstet Gynecol · 2026 Jul · PMID 41791563 · Publisher ↗
BACKGROUND: In 2021, the ConCerv study provided the first prospective evidence that fertility-sparing surgery, including conization or simple hysterectomy, was safe in low-risk cervical cancer, and recurrence rates remai...
BACKGROUND: In 2021, the ConCerv study provided the first prospective evidence that fertility-sparing surgery, including conization or simple hysterectomy, was safe in low-risk cervical cancer, and recurrence rates remained low, although oncologic outcomes were not the primary endpoint. OBJECTIVE: This study aimed to examine temporal trends in 2 fertility-sparing procedures for cervical cancer (trachelectomy and conization) along with associated oncologic outcomes and patterns of academic productivity via 3 separate datasets. STUDY DESIGN: This was a retrospective study of 3 separate database, integrating clinical data from the National Cancer Database (2004-2022; for oncologic outcomes and surgical trends), perioperative outcomes from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files (2012-2022; for postoperative complications), and scholarly output from the Web of Science Core Collection (2000-2025; for bibliometric analysis). In the National Cancer Database, we identified two cohorts of patients aged 18 to 45 years with cervical cancer, irrespective of histologic subtype, who were managed with conservative surgery and nodal staging: the first cohort underwent trachelectomy (radicality not specified), whereas the second cohort underwent conization. Temporal trends were examined using annual procedure counts, proportional utilization, and annual percentage change. Clinicopathologic characteristics were descriptively summarized and compared using appropriate parametric or nonparametric tests and chi-squared tests, with Bonferroni correction for multiple comparisons. Overall survival was analyzed in node-negative cases using Kaplan-Meier and log-rank methods, and treatment effects were evaluated with multivariate Cox regression adjusted for stage, histology, surgical margins, and tumor size, reporting hazard ratios with 95% confidence intervals. RESULTS: A total of 1841 patients underwent conservative surgery with lymph node assessment, including 911 trachelectomies (49.5%) and 930 conizations (50.5%). Patients who underwent trachelectomy were younger than those who underwent conization (median: 31 vs 33 years, respectively; P<.001). The number of lymph nodes examined was significantly greater in the trachelectomy cohort than in the conization cohort (15 vs 10, respectively; P<.001). Trachelectomy had a lower proportion of squamous cell carcinoma (465/911 [51.0%]) than conizations (570/930 [61.3%]), and adenocarcinoma was more common among patients who underwent trachelectomy (371/911 [40.7%]) than those who underwent conization (327/930 [35.2%]) (P<.001). In absolute numbers, trachelectomy use increased from 2004 to the mid-2010s, peaking in 2016, but subsequently demonstrated a steady and sustained decline through 2022. Among the whole cohort, the proportion of patients treated with trachelectomy declined from 64.0% in 2011 to 33.3% in 2022 (P<.001). The 10-year overall survival was similar between the groups (93.4% vs 92.3%; log-rank P=.39). In Cox regression, trachelectomy was not associated with overall survival (hazard ratio, 1.02 [95% confidence interval, 0.56-1.86]). Bibliometric analysis identified 1585 trachelectomy-related publications, which peaked in 2021 (n=128) and declined thereafter. Original research comprised 58.0% and reviews 15.6% of publications. CONCLUSION: Trachelectomy use has decreased significantly in recent years, and overall survival was high in both cohorts. This alignment of excellent overall survival with changing practice patterns underscores an ongoing transition toward less radical surgery.
Reframing modifiable risk factors driving racial disparities in postoperative outcomes following benign hysterectomy (letter to the editor).
Yuan X, Pan K, He Y
Am J Obstet Gynecol · 2026 Jul · PMID 41791562 · Publisher ↗
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Associations between self-reported mood-related symptoms and early contraceptive method discontinuation.
Wallis B, Carter G, Gimbel LA … +2 more , Wright E, Sanders J
Am J Obstet Gynecol · 2026 Mar · PMID 41791561 · Publisher ↗
OBJECTIVE: There have been mixed findings regarding the psychological impacts of hormonal contraceptive methods. Some studies suggest negative mood symptoms with hormonal methods, while others report improved mood or no...
OBJECTIVE: There have been mixed findings regarding the psychological impacts of hormonal contraceptive methods. Some studies suggest negative mood symptoms with hormonal methods, while others report improved mood or no effect. To better inform clinical counseling, this study examines associations between self-reported mood-related symptoms and contraception discontinuation within the first 6 months of use, accounting for self-reported baseline mood symptoms and method type. STUDY DESIGN: This secondary analysis uses data from the HER Salt Lake initiative, a prospective cohort study of 4425 individuals initiating a new contraceptive method between September 2015 and March 2017. Participants were followed for 3 years, with method switching and discontinuation offered at no cost. Surveys were administered at baseline and at months 1, 3, and 6, capturing self-reported mood-related symptoms in the prior 4 weeks, contraceptive use status, and reasons for discontinuation. Chi-square tests examined the self-reported reasons for discontinuation across method types. Mixed effects logistic regression models evaluated the effect of self-reported baseline mood-related symptom burden on discontinuation, stratified by hormone category (ie, progestin-only, combined hormone, and nonhormonal) and controlling for baseline symptom frequency. Given the small sample size of those who discontinued their methods in the first 6 months, no additional covariates were included to avoid overfitting. RESULTS: Among participants who discontinued their method within 6 months (n=880), 28% of progestin-only users (110/389), 21% of combined hormonal users (80/386), and 10% of nonhormonal users (11/105) self-reported mood-related symptoms (ie, moodiness and/or depressive symptoms) as a contributing reason for discontinuation (P=<.001). Within progestin-only users, self-reported mood-related discontinuation was highest for the implant (40%; 34/86), followed by the injection (33%; 49/147), hormonal intrauterine device (25%; 22/88), and progestin-only pill (7.4%; 5/68). Individuals with self-reported frequent (experienced moodiness and/or depression once a week to a couple of days a week) to daily (experienced moodiness and/or depression every day) baseline symptoms were less likely to discontinue a progestin-only method (odds ratio, 0.63; 95% confidence interval, 0.44-0.92), whereas no significant association was found among users of nonhormonal (odds ratio, 1.56; 95% confidence interval, 0.44-5.52) or combined hormonal methods (odds ratio, 2.62; 95% confidence interval, 0.56-12.2). This suggests a possible moderating effect between preexisting symptom burden, method type, and (dis)continuation behaviors. CONCLUSION: A higher proportion of individuals using progestin-only contraception reported mood-related symptoms as a reason for discontinuation within the first 6 months compared to those using combined or nonhormonal methods. However, self-reported baseline mood-related symptoms were associated with lower discontinuation rates among progestin-only users, indicating a complex interaction between mood symptom burden, method choice, and (dis)continuation behaviors. These findings underscore the need for nuanced patient counseling, acknowledging mood-related concerns as legitimate and potentially method-specific, and for future research to explore these relationships using validated mood assessment tools and longer-term outcomes.
Venous thromboembolism with combined oral contraceptives based on estrogen and progestin content: a disproportionality analysis of the United States Food and Drug Administration Adverse Event Reporting System database.
Raskin L, Didembourg M, Dogne JM … +4 more , Locquet M, Creinin MD, Beaudart C, Douxfils J
Am J Obstet Gynecol · 2026 Jul · PMID 41791560 · Publisher ↗
BACKGROUND: Disproportionality analyses using pharmacovigilance databases permit comparisons between products for rare outcomes, such as venous thromboembolism with combined oral contraceptives. OBJECTIVE: To compare the...
BACKGROUND: Disproportionality analyses using pharmacovigilance databases permit comparisons between products for rare outcomes, such as venous thromboembolism with combined oral contraceptives. OBJECTIVE: To compare the proportionality reporting rate of venous thromboembolic adverse events in the Food and Drug Administration Adverse Reporting System database between 2 body-identical estrogen combined oral contraceptives available in the United States, 17β-estradiol valerate/dienogest and estetrol/drospirenone, and combined oral contraceptives containing ethinyl estradiol. STUDY DESIGN: We extracted individual case safety reports and adverse events from the Food and Drug Administration Adverse Reporting System database from its inception to October 2024. We performed a proportionality reporting rate analysis of venous thromboembolic events associated with various combined oral contraceptives as compared to reference standards of ethinyl estradiol/levonorgestrel combined oral contraceptives and the entire therapeutic class. Secondarily, we assessed the proportionality reporting rate with drospirenone-only pills and norethindrone-only pills. RESULTS: Compared to ethinyl estradiol/levonorgestrel, we found lower proportionality reporting rates with estetrol/drospirenone (0.54; 95% confidence interval, 0.30-0.99) and 17β-estradiol valerate/dienogest (0.79 [5]; 95% confidence interval, 0.65-0.97), which were similar to the proportionality reporting rates for drospirenone-only pills (0.64; 95% confidence interval, 0.55-0.74) and norethindrone-only pills (0.69; 95% confidence interval, 0.60-0.79). Ethinyl estradiol/drospirenone had the highest proportionality reporting rate at 5.18 (95% confidence interval, 4.95-5.42). Using the entire therapeutic class as reference, we similarly found lower proportionality reporting rates with estetrol/drospirenone (0.17; 95% confidence interval, 0.09-0.31) and 17β-estradiol valerate/dienogest (0.25; 95% confidence interval, 0.21-0.30), both of which were similar to the proportionality reporting rate observed for drospirenone-only pills (0.20; 95% confidence interval, 0.17-0.23) and norethindrone-only pills (0.21; 95% confidence interval, 0.19-0.24); the highest proportionality reporting rate, for ethinyl estradiol/drospirenone, was 4.52 (95% confidence interval, 4.41-4.63). CONCLUSION: Combined oral contraceptives containing body-identical estrogens, estetrol, and 17β-estradiol have lower proportions of venous thromboembolism reports than ethinyl estradiol-based pills and are similar to progestin-only pills. These findings suggest a potentially safer thrombotic profile of body-identical estrogen-based combined oral contraceptives.
The impact of body mass index on misoprostol dosing for labor induction: a comparison of vaginal and buccal dosage forms.
Bynarowicz TM, Bhamidipalli SS, Flannery KM … +3 more , Daggy JK, Quinney SK, Haas DM
Am J Obstet Gynecol · 2026 Mar · PMID 41791559 · Publisher ↗
BACKGROUND: Despite the increasing prevalence of obesity, strategies to manage induction of labor in obese patients remains underinvestigated. OBJECTIVE: This study aimed to determine whether the number of doses to achie...
BACKGROUND: Despite the increasing prevalence of obesity, strategies to manage induction of labor in obese patients remains underinvestigated. OBJECTIVE: This study aimed to determine whether the number of doses to achieve active labor differed across body mass index categories for buccal misoprostol vs vaginal misoprostol during labor induction. STUDY DESIGN: This was a secondary analysis of the Induction with MisoPROsotol: Oral mucosa versus Vaginal Epithelium study (identification number: NCT02408315), a triple-blinded, placebo-controlled randomized controlled trial of vaginal misoprostol vs buccal misoprostol in term patients undergoing labor induction. The primary outcome for this analysis was the number of doses of misoprostol needed for active labor (defined as a cervical dilation of at least 6 cm). The participants were grouped into 3 body mass index categories (nonobese: ≤29 kg/m; obese: 30-40 kg/m; morbidly obese: ≥41 kg/m). Groups were compared using the Wilcoxon signed-rank test and chi-squared or Fisher exact test. Generalized linear models were used to adjust for ethnicity, race, dosing route, and indication for labor induction. Significance was defined as P<.05. RESULTS: Of 299 participants with complete data, 63 (21%) had a body mass index of ≤29 kg/m, 165 (55%) had a body mass index between 30 and 40 kg/m, and 71 (23%) had a body mass index of ≥41 kg/m. The groups did not differ in age, race, gestational age, nulliparity, initial Bishop score, or route of dosing. There were significantly more non-Hispanic participants in the obese categories (P=.02). A higher proportion of participants with obesity or morbid obesity had diabetes mellitus (6.4% in the nonobese group vs 13.9% in the obese group vs 14.1% in the morbidly obese group) or a hypertensive disorder (7.9% in the nonobese group vs 24.9% in the obese group vs 26.8% in the morbidly obese group) as the primary indication for labor induction (P=.03). In the univariate analysis, compared with the nonobese group, more doses of misoprostol were needed to achieve active labor in the obese and morbidly obese groups when dosed buccally (2.1 vs 2.8 vs 2.9, respectively; P=.01) but not when dosed vaginally (1.9 vs 2.1 vs 2.3, respectively; P=.21). The rates of vaginal delivery in <24 hours, cesarean delivery, or cesarean delivery for fetal distress did not significantly differ across body mass index category or dosing route. When adjusting for indication for labor induction and self-reported race/ethnicity, buccal dosing required more doses to achieve active labor, regardless of body mass index (24% more expected doses; P<.005). Similarly, when controlling for indication for labor induction and self-reported race/ethnicity, obesity was independently associated with requiring more doses for active labor for both dosage routes (body mass index of 30-40 kg/m: 24% more expected doses; confidence limits of 1.01-2.68; P<.047; body mass index of ≥41 kg/m: 28% more expected doses; confidence limits of 0.99-3.09; P<.05). CONCLUSION: Obesity (body mass index of ≥30 kg/m) was associated with the need for more misoprostol doses to achieve active labor. In addition, buccal dosing was independently associated with a higher number of doses than vaginal dosing, especially in patients with obesity.
Validity evidence for the Essentials in Minimally Invasive Gynecologic Surgery laparoscopic skills: correlation with the Global Operative Assessment of Laparoscopic Skills.
Grace Chen CC, Bar-El L, Long JB … +7 more , Frost A, King CR, Katz A, Moawad NS, Levy B, Wu H, Lerner V
Am J Obstet Gynecol · 2026 Jul · PMID 41785985 · Publisher ↗
BACKGROUND: The Essentials in Minimally Invasive Gynecologic Surgery manual skills examination is a new qualifying examination for board certification in obstetrics and gynecology. The aim of this study is to examine the...
BACKGROUND: The Essentials in Minimally Invasive Gynecologic Surgery manual skills examination is a new qualifying examination for board certification in obstetrics and gynecology. The aim of this study is to examine the validity evidence for the use of Essentials in Minimally Invasive Gynecologic Surgery as a summative evaluation by assessing performance of laparoscopic tasks (sleeve transfer, circle cut, extracorporeal knot tying, intracorporeal knot tying, and running stitch) using a previously studied global rating scale for laparoscopic surgery (Global Operative Assessment of Laparoscopic Skills). STUDY DESIGN: Expert laparoscopic educators evaluated video recordings of participants performing laparoscopic exercises from the Essentials in Minimally Invasive Gynecologic Surgery construct validation trial using the modified Global Operative Assessment of Laparoscopic Skills (depth perception, bimanual dexterity, efficiency, and tissue handling), scoring them on a 5-point anchored Likert scale with higher scores indicating better performance. Spearman's correlation tests were used to assess correlations among scores, and Wilcoxon rank-sum tests were used to compare groups. Weight kappa statistics were calculated to assess inter-rater agreement. All statistical analyses were conducted on R 4.3.1. RESULTS: We included 144 participants: 54 postgraduate year 1 residents, 55 postgraduate year 3 residents, 20 American Board of Obstetrics and Gynecology-certified obstetrics and gynecology attendings, and 15 American Board of Obstetrics and Gynecology-certified obstetrics and gynecology attendings who completed a Minimally Invasive Gynecologic Surgery fellowship. We demonstrated that more proficient participants achieved higher Global Operative Assessment of Laparoscopic Skills scores. There were weak to moderate negative correlations between Global Operative Assessment of Laparoscopic Skills scores and time to task completion as well as total number of errors for each exercise (r=0.55-0.70, P<.001; r=0.28-0.55, P=.003 to P<.001, respectively). Participants who passed Essentials in Minimally Invasive Gynecologic Surgery scored better on Global Operative Assessment of Laparoscopic Skills (passed: median individual item Global Operative Assessment of Laparoscopic Skills scores (interquartile range) 3 to 3.5 [2, 4] vs failed: 1 to 2 [1, 3], P<.001-.08). CONCLUSION: More experienced participants and participants who passed Essentials in Minimally Invasive Gynecologic Surgery perform laparoscopic Essentials in Minimally Invasive Gynecologic Surgery exercises with better skills. Importantly, those who passed Essentials in Minimally Invasive Gynecologic Surgery performed at a corresponding Global Operative Assessment of Laparoscopic Skills score of at least 3 (range, 1-5) for all the items (depth perception, bimanual dexterity, efficiency, and tissue handling). Given that Global Operative Assessment of Laparoscopic Skills are easy to use and widely available, while Essentials in Minimally Invasive Gynecologic Surgery metrics are proprietary and cannot be accessed, Global Operative Assessment of Laparoscopic Skills can be used as a proxy for the Essentials in Minimally Invasive Gynecologic Surgery passing score during preparation. In addition, our study adds to the body of validity evidence, further supporting Essentials in Minimally Invasive Gynecologic Surgery as a summative evaluation for obstetrics and gynecology trainees.
Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines.
Febles M, Scott G, Gillon T … +5 more , Pels A, Klepp K, Costa ML, von Dadelszen P, Magee LA
Am J Obstet Gynecol · 2026 Mar · PMID 41780627 · Publisher ↗
OBJECTIVE: This systematic review updates a 2020 analysis of clinical practice guidelines regarding hypertensive disorders of pregnancy, aiming to both support evidence-based practice and inform future research. DATA SOU...
OBJECTIVE: This systematic review updates a 2020 analysis of clinical practice guidelines regarding hypertensive disorders of pregnancy, aiming to both support evidence-based practice and inform future research. DATA SOURCES: Searches were conducted in Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials. The search strategy used combinations of keywords and Medical Subject Headings terms relating to "pregnancy," "hypertension," "hypertensive disorders of pregnancy," and "guidelines," alongside Boolean operators to refine the search. Language and date filters were applied to restrict the results to documents published from January 2015 to January 2025 and in eligible languages. STUDY ELIGIBILITY CRITERIA: We included international and national clinical practice guidelines published between 2015 and 2025, in English, Dutch, French, German, Norwegian, or Spanish. STUDY APPRAISAL AND SYNTHESIS METHODS: A comprehensive search of bibliographic databases and gray literature identified 23 clinical practice guidelines, including 15 updates and 8 newly identified guidelines. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool was used to assess guideline characteristics. Data abstraction was by 2 independent reviewers, with disagreement resolved by consensus, with a third reviewer resolving outstanding difference of opinion. The results are presented descriptively. RESULTS: Half of clinical practice guidelines were scored as being 'clinically useful', while the other half were scored as useful with modifications, using the AGREE II score. Notable evolution since 2020 includes greater consistency in recommending antihypertensive treatment for nonsevere hypertension in women with chronic hypertension (endorsed by 9 clinical practice guidelines; advice remains more discordant for women with either gestational hypertension or preeclampsia) and improved guidance regarding maternal and fetal monitoring for women either at an increased risk of or with (endorsed by 9 clinical practice guidelines) preeclampsia, although the former remains underaddressed. Aspirin dosage (for preeclampsia prevention) recommendations, while still varied, now fall within a more consistent range of 75 to 162 mg/d. Persistent inconsistencies remain in the definition of 'severe' preeclampsia, timing of birth for preterm preeclampsia, and specific aspirin dosages and timing for commencement. CONCLUSION: While several areas of consensus exist between clinical practice guidelines, variability persists in key recommendations, and establishing auditable standards is essential for effective implementation. Where discrepancies reflect insufficient or inconclusive evidence, further research is paramount to support robust guideline development to optimize pregnancy outcomes.
The accuracy of the soluble fms-like tyrosine kinase 1/placental growth factor ratio assay in predicting time to delivery in patients with suspected preeclampsia.
Wilson S, Carson E, Fu L … +4 more , Yip PM, Hladunewich MA, Kingdom J, Melamed N
Am J Obstet Gynecol · 2026 Mar · PMID 41780626 · Publisher ↗
OBJECTIVE: Preeclampsia is a leading cause of maternal and fetal morbidity and mortality, but its clinical course is often difficult to predict. This can make management decisions, such as admission and administration of...
OBJECTIVE: Preeclampsia is a leading cause of maternal and fetal morbidity and mortality, but its clinical course is often difficult to predict. This can make management decisions, such as admission and administration of antenatal corticosteroids, challenging. Abnormal levels of the angiogenic proteins soluble fms-like tyrosine kinase 1 and placental growth factor have been shown to improve the diagnostic accuracy for preeclampsia. However, data on their accuracy in predicting time to delivery are limited. The objective of the present study was to fill this critical gap. STUDY DESIGN: A retrospective cohort study of patients with a singleton pregnancy in a single center evaluated for suspected preeclampsia using the Roche Elecsys soluble fms-like tyrosine kinase 1/placental growth factor ratio assay between 2020 and 2023. Modified Poisson regression and Cox regression survival analysis were used to estimate the association between the soluble fms-like tyrosine kinase 1/placental growth factor ratio and the risk of delivery within 7 days. The soluble fms-like tyrosine kinase 1/placental growth factor ratio was interpreted as low risk (≤38), moderate risk (>38-85), or high risk (>85). RESULTS: A total of 503 patients met the study criteria. The preeclampsia rate was 39.8% (n=200). The soluble fms-like tyrosine kinase 1/placental growth factor ratio was inversely associated with the testing-to-delivery time (Spearman's Rho, -0.63 [the confidence interval is -0.73 to 0.63]). Survival analysis revealed that moderate-risk and high-risk ratios were associated with shorter testing-to-delivery intervals than a low-risk ratio (adjusted hazard ratio, 1.7 [95% confidence interval, 1.2-2.3] and adjusted hazard ratio, 5.1 [95% confidence interval, 3.8-6.9], respectively). A low-risk ratio (≤38) was associated with a high negative predictive value for birth within 7 days (89% [95% confidence interval, 83%-96%]), especially when found before 34 weeks (99% [95% confidence interval, 97%-100%]). The positive predictive value of a high-risk ratio (>85) for delivery within 7 days was 65% (95% confidence interval, 56%-75%). To achieve a more clinically relevant positive predictive value of 80%, higher soluble fms-like tyrosine kinase 1/placental growth factor ratio cutoff values were required: 365 in the overall cohort, 368 in cases tested before 34 weeks, and 300 in those tested at ≥34 weeks. CONCLUSION: The soluble fms-like tyrosine kinase 1/placental growth factor ratio is a useful prognostic tool for predicting time to delivery in patients with suspected preeclampsia and can therefore guide management decisions, such as admission and the administration of antenatal corticosteroids.
Laparoscopic transabdominal cerclage: preconception versus postconception placement.
Kass SL, Brenner E, Hotz M … +3 more , Pachtman Shetty S, Lee JY, Nimaroff ML
Am J Obstet Gynecol · 2026 Jul · PMID 41765068 · Publisher ↗
BACKGROUND: Cervical insufficiency is a major contributor to spontaneous preterm birth and second-trimester pregnancy loss. Transabdominal cerclage is recommended for patients with a history of failed vaginal cerclage or...
BACKGROUND: Cervical insufficiency is a major contributor to spontaneous preterm birth and second-trimester pregnancy loss. Transabdominal cerclage is recommended for patients with a history of failed vaginal cerclage or when vaginal cerclage is not anatomically feasible. Laparoscopic transabdominal cerclage has emerged as a minimally invasive alternative to open transabdominal cerclage. However, data comparing obstetric and surgical outcomes based on the timing of laparoscopic transabdominal cerclage placement before vs during pregnancy. OBJECTIVE: Primary aims were to evaluate whether laparoscopic transabdominal cerclage placement before vs during pregnancy is associated with differences in delivery at or beyond 34 weeks' gestation and neonatal survival rates. Secondary aims were to evaluate other obstetric and surgical outcomes. STUDY DESIGN: This retrospective cohort study included patients who underwent laparoscopic transabdominal cerclage for cervical insufficiency at 3 tertiary care centers within a single hospital system between January 1, 2008 and December 31, 2023. Patients were grouped by timing of cerclage placement: before pregnancy and during pregnancy. Prespecified primary outcomes were delivery at ≥34 weeks' gestation and neonatal survival at hospital discharge. Secondary outcomes included gestational age at delivery, birthweight, preterm prelabor rupture of membranes, spontaneous preterm birth, operative time, estimated blood loss, and perioperative complications. Statistical analysis included chi-square or Fisher's exact tests for categorical variables and t tests or Mann-Whitney U tests for continuous variables, with significance set at P<.05. RESULTS: Sixty nine patients met inclusion criteria, including 40 who underwent laparoscopic transabdominal cerclage before pregnancy and 29 who underwent the procedure during pregnancy. The proportion of patients delivering at ≥34 weeks' gestation (30/40 [75%] vs 26/29 [90%]; P=.12) was similar between groups, as was neonatal survival at hospital discharge (35/40 [90%] vs 27/29 [93%]; P>.99). Median gestational age at delivery was slightly earlier in the preconception group (36.6 weeks vs 37.0 weeks, P=.02), although this difference was <7 days and thus not considered clinically meaningful. The incidence of spontaneous preterm birth was higher in the preconception group, while rates of preterm prelabor rupture of membranes did not differ. Operative time, estimated blood loss, and perioperative complications were similar between groups. CONCLUSION: Laparoscopic transabdominal cerclage placement before or during pregnancy was associated with similar gestational age at delivery and high neonatal survival rates in this cohort. These findings support individualized counseling regarding timing of laparoscopic transabdominal cerclage placement while recognizing that limited power, particularly for rare outcomes such as neonatal death, restricts the ability to exclude clinically meaningful differences.
A subclinical cytokine storm is present before the clinical diagnosis of amniotic fluid embolism: implications for the prediction and prevention of maternal death.
Romero R, Meyyazhagan A, Gudicha DW … +5 more , Chaiworspongsa T, Awonuga AO, Tarca AL, Gomez-Lopez N, Hassan SS
Am J Obstet Gynecol · 2026 Jul · PMID 41765067 · Publisher ↗
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Second-stage and pushing duration: the need for individualized management.
Aboukhater D, Kawakita T
Am J Obstet Gynecol · 2026 Feb · PMID 41763381 · Publisher ↗
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Management of second stage and active pushing: time duration and beyond.
Politi S, Dall'Asta A
Am J Obstet Gynecol · 2026 Feb · PMID 41763380 · Publisher ↗
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Ultrasound assessment of true fetal head descent for optimizing operative vaginal delivery.
Hashiramoto S, Takita H, Suzuki Y … +5 more , Sekiya A, Mukai Y, Nakamura T, Matsuoka R, Sekizawa A
Am J Obstet Gynecol · 2026 Feb · PMID 41763379 · Publisher ↗
BACKGROUND: Accurate assessment of fetal head descent during labor is fundamental to the safe performance of operative vaginal delivery. However, conventional evaluation by digital vaginal examination is subjective and p...
BACKGROUND: Accurate assessment of fetal head descent during labor is fundamental to the safe performance of operative vaginal delivery. However, conventional evaluation by digital vaginal examination is subjective and prone to interobserver variability. Although intrapartum transperineal ultrasound has improved objectivity by quantifying the presenting part of the fetal head, these assessments may not reliably reflect the vertical level of the largest fetal head diameter, particularly in the presence of fetal head molding and caput succedaneum. The suprapubic descent angle was recently introduced as a transabdominal ultrasonographic parameter designed to address this limitation by indexing the position of the largest head diameter. Nevertheless, evidence regarding its external validity and reproducibility in independent clinical settings remains limited. OBJECTIVE: To externally validate the suprapubic descent angle as an ultrasonographic marker of fetal head descent in operative vaginal delivery and to assess its correlation with digital examination and established intrapartum ultrasound parameters. STUDY DESIGN: This prospective cohort study was conducted at a tertiary perinatal center between January and December 2025. Women with singleton, term, cephalic pregnancies undergoing operative vaginal delivery were consecutively enrolled. Intrapartum ultrasound was performed immediately before delivery. The suprapubic descent angle was measured offline by examiners blinded to labor progress and delivery outcomes. Correlations between the suprapubic descent angle and other measures of fetal head descent were analyzed using appropriate correlation coefficients. Measurement reproducibility was assessed using intraobserver and interobserver intraclass correlation coefficients and Bland-Altman analysis. Sensitivity analyses were performed in cases with occiput anterior fetal head position to evaluate the potential influence of rotation on measurement agreement. RESULTS: A total of 191 women were included, yielding 375 ultrasound images for analysis. The suprapubic descent angle demonstrated strong inverse correlations with digital station (r=-0.85; 95% confidence interval, 0.83-0.88), angle of progression (r=0.83; 95% confidence interval, 0.80-0.86), and transperineal ultrasound station (r=-0.85; 95% confidence interval, 0.82-0.88). Measurement reproducibility was excellent, with an intraobserver intraclass correlation coefficient of 0.985 (95% confidence interval, 0.930-0.977; P <.001) and an interobserver intraclass correlation coefficient of 0.960 (95% confidence interval, 0.930-0.977; P <.001), accompanied by narrow limits of agreement. In sensitivity analyses restricted to occiput anterior cases, agreement further improved, indicating reduced measurement variability when fetal head malrotation was absent. CONCLUSION: The suprapubic descent angle is a feasible, highly reproducible, and externally valid ultrasonographic measure of fetal head descent in operative vaginal delivery. By more closely reflecting the vertical level of the largest fetal head diameter, the suprapubic descent angle provides clinically complementary information to digital examination and transperineal ultrasound assessment. Incorporating this parameter into intrapartum evaluation may enhance risk stratification and support more informed decision-making during operative vaginal delivery by helping to identify potential overestimation of fetal head descent using conventional assessment methods. Outcome-focused studies are warranted to determine suprapubic descent angle-based thresholds that predict delivery success and procedure-related complications.
Corrigendum to "Impact of exercise training during pregnancy on maternal biomarkers: a systematic review": American Journal of Obstetrics & Gynecology (2025) Article in press.
Redondo-Delgado P, Santos-Lozano A, Maroto-Izquierdo S
Am J Obstet Gynecol · 2026 Mar · PMID 41760166 · Publisher ↗
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Identifying the risk of spontaneous preterm birth after term singleton cephalic birth, by mode of birth, cervical dilatation, and incision extensions at cesarean section: a cohort study.
Sadler L, Wadsworth M, Dawes L … +4 more , Wimsett J, Hunter B, Burgess W, Groom K
Am J Obstet Gynecol · 2026 Jul · PMID 41759608 · Publisher ↗
BACKGROUND: Increasing evidence links cesarean section, especially at full dilatation, to subsequent spontaneous preterm birth. However, many studies to date lack sufficient detail to determine the impact of advancing ce...
BACKGROUND: Increasing evidence links cesarean section, especially at full dilatation, to subsequent spontaneous preterm birth. However, many studies to date lack sufficient detail to determine the impact of advancing cervical dilatation in labor, the effect on spontaneous preterm birth at gestations under 32 weeks, and data to support a mechanism of effect. OBJECTIVE: To confirm an independent association between mode of birth and subsequent spontaneous preterm birth at gestations <37, <32, and <28 weeks, including by cervical dilatation, and to explore any impact of unintended uterine incision extension at cesarean section. STUDY DESIGN: An observational cohort study from 2008 to 2021 from a single tertiary hospital in Auckland, New Zealand, including 20,499 consecutive live birthing pairs where the index pregnancy was a term cephalic singleton and the subsequent pregnancy a live birth from 20 weeks of gestation. The primary outcome was spontaneous preterm birth at thresholds 37, 32, and 28 weeks. Data were ascertained and extracted from an electronic maternity database and clinical records. Univariable and multivariable statistical techniques were employed with adjustments for ethnicity, nulliparity, birthweight and gestation at index birth, interpregnancy interval, and age and smoking at subsequent birth. Spontaneous preterm birth, dilatation at cesarean, and unintended uterine incision extension were identified from clinical records, where not available in routinely collected data sources. RESULTS: Participant index births included 10,309 unassisted vaginal births, 4132 assisted vaginal births, 2139 prelabor cesareans, and 3919 in-labor cesareans; 1302 at 0 to 4 cm, 943 at 5 to 7 cm, 743 at 8 to 9 cm, and 931 at full cervical dilatation. The spontaneous preterm birth rate among subsequent births was 3.1% (636/20,499). The risk of spontaneous preterm birth after in-labor cesarean section was elevated at all gestation thresholds compared to vaginal birth. Risk increased with advancing cervical dilatation at cesarean (<5 cm: relative risk, 1.0; 95% confidence interval, 0.7-1.4; 5-7 cm: relative risk, 1.8; 95% confidence interval, 1.3-2.5; 8-9 cm: relative risk, 1.8; 95% confidence interval, 1.3-2.6; full dilatation: relative risk, 2.0; 95% confidence interval, 1.5-2.7). Cesareans at full dilatation were particularly associated with greater risk of spontaneous preterm birth before 32 weeks (relative risk, 4.5; 95% confidence interval, 2.6-7.8) and 28 weeks (relative risk, 7.7; 95% confidence interval, 3.9-15.3). Cervical dilatation ≥5 cm remained independently associated with more than 2-fold increased risk of spontaneous preterm birth at <37 weeks, independent of uterine incision extensions and other confounders. Uterine incision extensions were identified in 387 (6.4%) cesareans and were not independently associated with spontaneous preterm birth (adjusted relative risk, 0.9; 95% confidence interval, 0.5-1.7) unless extending through the cervix and into the vagina (adjusted relative risk, 5.1; 95% confidence interval, 1.8-14.5). CONCLUSION: Cesarean section in labor (>5 cm cervical dilatation), and particularly at full dilatation, is a risk factor for subsequent spontaneous preterm birth. Uterine incision extension into the cervix and vagina during cesarean is an independent risk factor for subsequent spontaneous preterm birth.
How to avoid placental transection during low transverse cesarean delivery for anterior placenta previa.
Nieto-Calvache AJ, Palacios-Jaraquemada JM, Basanta N … +5 more , Suarez-Revelo MA, Benavides-Calvache JP, Meade P, Lopez-Franco MJ, Burgos-Luna JM
Am J Obstet Gynecol · 2026 Jul · PMID 41759607 · Publisher ↗
Placenta previa, particularly when anterior, is a major risk factor for postpartum hemorrhage and may necessitate transplacental fetal extraction during cesarean delivery, which increases maternal and fetal blood loss. S...
Placenta previa, particularly when anterior, is a major risk factor for postpartum hemorrhage and may necessitate transplacental fetal extraction during cesarean delivery, which increases maternal and fetal blood loss. Standard strategies to minimize bleeding, such as fundal uterine incisions (when placenta accreta spectrum is suspected) or intraoperative ultrasonographic guidance, may be technically demanding, time-consuming, or unavailable in emergencies or resource-limited settings. Controlled separation and mobilization of a placental edge to avoid placental laceration offers a simple, reproducible technique to extract the fetus through a standard low transverse uterine incision without transecting the placenta. The procedure begins with prenatal mapping of the placental edge closest to the planned hysterotomy. A low transverse segmental hysterotomy is then performed, followed by controlled placental separation toward the nearest placental edge, rupture of the amniotic sac, exteriorization of the detached placental edge, and routine fetal extraction. Avoiding placental transection can reduce maternal blood loss, facilitate delayed cord clamping, and decrease neonatal anemia associated with difficult extractions. Graphic material in the text illustrates the additional bleeding caused by conventional transplacental extraction, emphasizing the potential clinical advantage of this maneuver. It also illustrates the full surgical sequence, from prenatal planning to intraoperative execution. This technique can be incorporated into low-cost, simulation-based training programs and has minimal impact on the incision-to-delivery interval when performed by trained personnel. Although the benefits of this maneuver require confirmation in larger studies, it represents a practical, low-complexity alternative for fetal delivery in anterior placenta previa and other complex scenarios, such as the presence of uterine fibroids, supporting its inclusion in the obstetrical surgical armamentarium.
Genotype and age shape the risk of persistent high-risk human papillomavirus infections.
Numminen E, Leino A, Karhula Q … +6 more , Fonagy V, Seiskari T, Paloniemi M, Kholová I, Kares S, Louvanto K
Am J Obstet Gynecol · 2026 Jul · PMID 41759606 · Publisher ↗
BACKGROUND: Persistent high-risk human papillomavirus infection detected in cervical cancer screening warrants follow-up, yet genotype-specific persistence times and progression risks remain poorly defined. This knowledg...
BACKGROUND: Persistent high-risk human papillomavirus infection detected in cervical cancer screening warrants follow-up, yet genotype-specific persistence times and progression risks remain poorly defined. This knowledge is critical for risk assessment and management of persistent human papillomavirus infections. OBJECTIVE: To evaluate genotype-specific clearance rates and subsequent cervical disease risks for 14 persistent high-risk human papillomavirus genotypes over long-term follow-up, focusing on clearance patterns and implications for follow-up strategies. STUDY DESIGN: We analyzed 35,084 women from the Finnish national cervical cancer screening program (2017-2019, Tampere region). Human papillomavirus-positive samples were genotyped using the Seegene Anyplex II HPV28 Detection assay to identify 14 individual high-risk human papillomavirus genotypes. Persistence was defined as detection of the same genotype 0.5 to 4 years apart. Genotypes were grouped by carcinogenic risk, and multiple-genotype infections were categorized by the most oncogenic type; separate analyses of single-type infections were conducted. Women with mild cytology (Negative for Intraepithelial Lesion or Malignancy or Atypical Squamous Cells of Undetermined Significance) at baseline were followed through 2023 to assess genotype-specific persistence and progression to high-grade lesions or worse. Clearance of infections was evaluated using the Kaplan-Meier estimates and Cox regression. RESULTS: Among 2006 high-risk human papillomavirus-positive women with Negative for Intraepithelial Lesion or Malignancy/Atypical Squamous Cells of Undetermined Significance cytology, 884 (44.1%) women had a persistent high-risk human papillomavirus infection. Human papillomavirus 52 showed the highest persistence (52.2%) followed by human papillomavirus 58 (50.5%), human papillomavirus 31 (50.4%), and human papillomavirus 16 (48.9%). Overall, 22.3% (n=197) of persistent infections progressed to precancerous lesions, with the highest proportions of high-grade lesions or worse observed among human papillomavirus 16, 58, and 33 (42.9%, 31.5%, and 31.3%, respectively). Younger women (aged <45 years) exhibited significantly higher progression for Group 1 (human papillomavirus 16, 18, and 45) and Group 2 (human papillomavirus 31, 33, 52, and 58) genotypes compared with older women (36.7 vs 14.3% and 34% vs 10.8%, respectively). Less oncogenic Group 3 genotypes (human papillomavirus 35, 39, 51, 56, 59, 66, and 68) had a significantly lower risk of progression compared with Group 1 regardless of age (hazard ratio, 0.32; 95% confidence interval, 0.20-0.52) in 6-year follow-up. 65.3% of persistent high-risk human papillomavirus infections cleared spontaneously, and Group 3 genotypes were associated with faster clearance compared with Group 1 (hazard ratio, 1.43; 95% confidence interval, 1.11-1.84). CONCLUSION: Persistent infections with human papillomavirus 16, 58, 33, and 52 were associated with the highest risks of progression, whereas Group 3 genotypes frequently persisted without leading to precancerous lesions. Younger women demonstrated an approximately 3-fold higher progression rate compared with older women. These findings suggest that persistence alone may not uniformly reflect oncogenic potential. Incorporating genotype-specific and age-specific risk stratification into screening and follow-up protocols could enhance risk assessment, thereby enabling more precise targeting of resources and minimizing unnecessary interventions.
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