American Journal of Obstetrics and Gynecology

BACKGROUND: Recent evidence demonstrates the effectiveness of the levonorgestrel 52mg intrauterine device (IUD) for emergency contraception compared to the copper (Cu T380A) IUD. One-year pregnancy and continuation rates after IUD placement for emergency contraception remain understudied. OBJECTIVE: (s): We compared one-year pregnancy and IUD continuation rates and reasons for discontinuation among emergency contraception users randomized to the levonorgestrel 52mg IUD or a copper IUD...

BACKGROUND: A positive urine fentanyl toxicology test may have significant consequences for peripartum individuals, yet the extent to which fentanyl in a labor epidural may lead to such a positive test is poorly characterized. OBJECTIVE: To quantify the extent to which neuraxial fentanyl in labor neuraxial analgesia can lead to a positive peripartum maternal or neonatal urine toxicology test. STUDY DESIGN: We performed a prospective cohort study of pregnant participants planning a vaginal delivery with neuraxial analgesia...

OBJECTIVES: To compare the prognostic accuracy of intrapartum transperineal ultrasound (ITU) measures of fetal descent prior to operative vaginal birth (OVB) in predicting complicated or failed procedure. DATA SOURCES: We performed a predefined systematic search in Medline, Embase, CINAHL and Scopus from inception to June 10, 2022. STUDY ELIGIBILITY CRITERIA: We included studies assessing the following ITU measures prior to OVB to predict procedure outcome: Angle of progression, head direction, head-perineum distance, head-symphysis distance, midline angle and/or progression distance...

BACKGROUND: Patients with congenital heart disease (CHD) are at high risk for peripartum cardiac morbidity, yet data are limited on the impact of duration of labor on cardiac outcomes. Prolonged labor is a known risk factor for maternal morbidity, but the impact of prolonged labor on cardiac outcomes in patients with CHD has not been evaluated. OBJECTIVE: Our objective was to evaluate the association between prolonged labor (≥24 hours) with peripartum adverse maternal cardiac outcomes in pregnant patients with CHD...

BACKGROUND: Fertility-sparing treatment in patients with cervical cancer should, in principle, follow identical algorithms to that in patients without future reproductive plans. In recent years, a trend towards non-radical procedures such as conization or simple trachelectomy has become apparent in medical literature, because of their associations with better pregnancy outcomes. However, the published reports included small numbers of patients and heterogenous treatment strategies to ascertain safety of such approaches...

Adnexal masses are identified in pregnant patients at a rate of 2 to 20 in 1000, approximately 2 to 20 times more frequently than in the age-matched general population. The most common types of adnexal masses in pregnancy requiring surgical management are dermoid cysts (32%), endometriomas (15%), functional cysts (12%), serous cystadenomas (11%), and mucinous cystadenomas (8%). Approximately 2% of adnexal masses in pregnancy are malignant. While most adnexal masses in pregnancy can be safely observed and around 70% spontaneously resolve, a minority warrant surgical intervention due to symptoms, risk of torsion, or suspicion for malignancy...

BACKGROUND: Women with a BRCA1/2 pathogenic variant are advised to undergo premenopausal risk-reducing salpingo-oophorectomy after completion of childbearing, to reduce their risk of ovarian cancer. Several studies reported less sexual pleasure one to three years after a premenopausal oophorectomy. However, the long-term effects of a premenopausal oophorectomy on sexual functioning are unknown. OBJECTIVE: Our aim was to study long-term sexual functioning in women at increased familial risk of breast/ovarian cancer who underwent a risk-reducing salpingo-oophorectomy either before the age of 46 years (premenopausal group), or after the age of 54 years (postmenopausal group)...

OBJECTIVE: (s): To examine recent trends in preterm birth (PTB) and its clinical subtypes by maternal race/ethnicity among singleton births. STUDY DESIGN: Kaiser Permanente Southern California electronic health records (EHR) for all singleton births between 2009-2020 (n=427,698) were used to examine PTB trends and their subtypes (spontaneous [SPTB] and iatrogenic [IPTB]). Data on preterm labor triage extracted from EHRs using Natural Language Processing (NLP) were used to define PTB subtypes...

BACKGROUND: Previous studies have established the association between intertwin birthweight discordance and hypertensive disorders of pregnancy. However, longitudinal fetal size discordance in relation to gestational hypertension or preeclampsia remains unclear. OBJECTIVE: This study aimed to compare the patterns of estimated fetal weight (EFW) discordance throughout gestation among normotensive, gestational hypertension and preeclampsia, and to evaluate the association between crown-rump length (CRL) discordance at 11-14 weeks of gestation and hypertensive disorders of pregnancy...

BACKGROUND: Serum uric acid (SUA) level is elevated in polycystic ovary syndrome (PCOS), however, the relationship between SUA level and reproductive outcomes in PCOS women remains unclear. OBJECTIVE: To investigate the association between SUA level and the reproductive outcomes in women with PCOS undergoing in-vitro fertilization or intracytoplasmic sperm injection (IVF or ICSI) embryo transfer cycles. STUDY DESIGN: This was a retrospective cohort study performed in a university-affiliated reproductive medicine center...

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BACKGROUND: Preterm birth is the leading cause of infant morbidity and mortality worldwide. Elevated levels of oxidative stress have been associated with an increased risk of delivering preterm. However, most studies testing this hypothesis have been conducted in racially and demographically homogenous study populations, which do not reflect the diversity within the United States. OBJECTIVE: We leveraged four cohorts participating in the Environmental influences on Child Health Outcomes Program to conduct the largest study to date examining biomarkers of oxidative stress and preterm birth (N=1,916)...

No abstract text is available yet for this article.

Our understanding and management of gestational hypertension and its variants is significantly hampered by a reliance on antiquated terminology and on practice recommendations based largely on tradition rather than outcomes-based evidence. Not surprisingly, this condition remains a major contributor to maternal and neonatal morbidity and mortality, with little improvement seen over the past half century except as it relates to better newborn care. Reliance on a binary classification of vastly disparate types and degrees of organ dysfunction (severe or not severe) and the use of non-physiologic and largely arbitrary gestational age cutoffs are particularly problematic...

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BACKGROUND: Women with multiple pregnancies are at risk for maternal complications, such as preterm birth. Hazardous working conditions, e.g. physically demanding work and long and irregular working hours, might increase the risk of preterm birth. OBJECTIVE: The primary objective of this study is to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective is to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine (NVAB)...

OBJECTIVES: To systematically determine and compare the incidence of anal incontinence between the individual grades of OASI. DATA SOURCES: OVID Medline, Embase and the Cochrane Library were searched from January 2000 to April 2021. STUDY ELIGIBILITY CRITERIA: Observational studies investigating the incidence of anal incontinence following OASI graded using the Sultan Classification were eligible for inclusion. To allow comparison between individual tears grades (3a, 3b, 3c, 4th ) a network meta-analysis was performed using Stata (version 15...

BACKGROUND: Cerebral palsy is more common in preterm infants than in full-term infants. While there is still no clear evidence that fetal heart rate monitoring effectively reduces cerebral palsy incidence, it is helpful to estimate the timing of brain injury leading to cerebral palsy and the causal relationship with delivery based on the fetal heart rate evolution patterns. Understanding the relationship between the timing and the type of brain injury can help in utilizing preventive measures in obstetric care...