American Journal of Obstetrics and Gynecology

BACKGROUND: The American Academy of Blood Banks recommends single-unit red cell transfusion protocols across medicine to reduce transfusion complications and use of a scarce resource. There is minimal data regarding single-unit protocols within obstetrics. OBJECTIVE: We aimed to compare a single- vs. multiple-unit transfusion protocol for treatment of hemodynamically stable postpartum anemia. STUDY DESIGN: We performed a randomized trial comparing initial transfusion with 1 unit of packed red blood cells [pRBCs] (single-unit protocol) to 2 units of pRBCs (multiple-unit protocol) from 3/2018-7/2019...

OBJECTIVE: The study aims to validate an enhanced recovery after surgery (ERAS) protocol in gynecological surgery both for benign and malignant disease (endometrial cancer and advanced ovarian cancer) and to measure the adherence to ERAS items in a randomized trial setting. STUDY DESIGN: In this trial (NCT03347409), we randomly assigned patients to undergo standard perioperative care or ERAS protocol. The primary outcome is a shorter length of stay in favor of ERAS...

INTRODUCTION: Proliferative endometrium has been reported in 15% of endometrial biopsies of women 50 and older. In contrary to endometrial hyperplasia, proliferative endometrium has not been associated with risk of endometrial cancer. We sought to report on the long-term outcome of postmenopausal women diagnosed with proliferative endometrium. METHODS: Retrospective cohort study of 1808 women 55 and older who underwent endometrial sampling between 1/1997-12/2008...

BACKGROUND: Adverse reproductive health outcomes are well-documented among people experiencing homelessness and housing instability. Little is known about abortion outcomes among this population. OBJECTIVE: To investigate the relationship between housing status and abortion outcomes, and whether gestational age mediates this relationship. STUDY DESIGN: Our sample comprised 1903 individuals who had abortions at an urban clinic in San Francisco, California from 2015 to 2017...

PURPOSE: The COVID-19 pandemic has resulted in unprecedented challenges for the oncology community. For people living with cancer, treatments are interrupted, surgeries cancelled and regular oncology evaluations rescheduled. People with cancer and their physicians must balance plausible fears of COVID-19 and cancer treatment with the consequences of delaying cancer care. We aim to evaluate the experience of women with ovarian cancer during the COVID-19 pandemic. METHODS: Women with a current or prior diagnosis of ovarian cancer completed an online survey focusing on treatment interruptions and quality of life (QOL)...

No abstract text is available yet for this article.

BACKGROUND: In women with a singleton pregnancy and sonographic short cervix in mid-gestation, vaginal administration of progesterone reduces the risk of early preterm birth and improves neonatal outcomes, without any demonstrable deleterious effects on childhood neurodevelopment. In women with twin pregnancies the rate of spontaneous early preterm birth is 10-times higher than in singletons and in this respect all twins are at increased risk of preterm birth. However, six trials in unselected twin pregnancies reported that vaginal progesterone from mid-gestation had no significant effect on the incidence of early preterm birth...

No abstract text is available yet for this article.

BACKGROUND: Retained placenta affects 2-3.3% of all vaginal deliveries and is one of the leading causes of postpartum hemorrhage worldwide. Despite the prevalence of this condition, there is limited guidance on how to manage retained placenta. OBJECTIVE: A systematic review and meta-analysis were performed to evaluate the efficacy of pharmacologic interventions for the management of retained placenta. STUDY DESIGN: PubMed, ClinicalTrials.gov, Cochrane Library, Web of Science and Scopus were searched for full text publications in English...

BACKGROUND: The current literature regarding the recommended mode of delivery in monochorionic-diamniotic (MCDA) twins is limited by small numbers, retrospective studies, and comparisons of outcomes of MCDA gestations to those of dichorionic-diamniotic (DCDA) gestations, instead of outcomes of trial of labor versus elective cesarean delivery for MCDA twins. OBJECTIVE: To compare perinatal and maternal outcomes of planned-cesarean delivery and planned-vaginal delivery in MCDA twin pregnancies using the Twin Birth Study data...

BACKGROUND: Twin pregnancies with dilated cervix in the second trimester are at increased risk of pregnancy loss and early preterm birth; currently there is no proven therapy to prevent preterm birth in this group of women. OBJECTIVE: To determine if physical exam indicated cerclage reduces the incidence of preterm birth in asymptomatic women with twin gestations and cervical dilation diagnosed before 24 weeks of pregnancy. STUDY DESIGN: Multicenter, parallel-group, open-label, randomized controlled trial of women with twin pregnancy, and asymptomatic cervical dilation from 1-5 cm between 16 0/7 to 23 6/7 weeks were enrolled from 7/2015 to 7/2019 in 8 centers...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE: Maternal oxygen (O2 ) administration for Category II electronic fetal monitoring (EFM) is a widely used intrauterine resuscitation technique, despite a paucity of evidence on its ability to improve EFM patterns. We investigated the effect of intrapartum O2 administration on Category II EFM patterns. STUDY DESIGN: This is a secondary analysis of a randomized trial conducted from 2016-2017, in which patients ≥ 37 weeks in active labor with Category II EFM were assigned to 10 L/min O2 by facemask or room air (RA) until delivery...

Gender equity in medicine and surgery has recently received widespread attention. Unlike other surgical specialties which remain majority male, Obstetrics and Gynecology has been a majority women field of medicine for nearly a decade and women have comprised the majority of trainees since the 1990s. Despite a critical mass of women, biases related to gender persist in the field. Professional and behavioral expectations of men and women gynecologists remain different for patients and workplace colleagues. Gender discrimination and sexual harassment are still experienced at high rates by both trainees and Obstetricians/Gynecologists in practice...

BACKGROUND: To accommodate passage through the birth canal, the fetal skull is compressed and reshaped, a phenomenon known as molding. The fetal skull bones are separated by membranous sutures which facilitate compression and overlap, resulting in a reduced diameter. This increases the probability of a successful vaginal delivery. Fetal position, presentation, station and attitude can be examined with ultrasound, but fetal head molding has not been previously studied with ultrasound. OBJECTIVE: To describe ultrasound assessed fetal head molding in a population of nulliparous women with slow progress in the second stage of labor, and to study associations with fetal position and delivery mode...

BACKGROUND: Loop electrosurgical excision procedure (LEEP) may be performed under local anesthesia (LA) or general anesthesia (GA) and practice patterns differ worldwide. No randomized head-to-head comparison has been published to confirm or refute either practice. OBJECTIVE: To compare LEEP under LA versus GA regarding patient satisfaction and procedure-related outcomes such as rates of involved margins, complications, pain, and blood loss. METHODS: Consecutive women referred to our colposcopy unit were recruited...

BACKGROUND: Menopausal vasomotor symptoms (VMS, i.e., hot flushes and night sweats) have been associated with unfavorable risk factors and surrogate markers of cardiovascular disease (CVD), but their association with clinical CVD events is unclear. We aimed to examine the associations between different component of VMS and timing of VMS and risk of CVD. STUDY DESIGN: We harmonized and pooled individual-level data from 23 365 women in six prospective studies which contributed to the InterLACE consortium...

BACKGROUND: Breast cancer risk has been extensively studied in women with genetic predisposition, i.e. BRCA1/2. Though there are guidelines for performing bilateral salpingo-oophorectomies in individuals with specific genetic risks, oophorectomies are also performed in many average-risk women. The risk of breast cancer in average risk women who undergo hysterectomy with bilateral salpingo-oophorectomy for benign indications is less clear. OBJECTIVE: We aim to estimate breast cancer risk following hysterectomy with and without concomitant bilateral salpingo-oophorectomy for benign indications...

No abstract text is available yet for this article.