American Journal of Obstetrics and Gynecology

BACKGROUND: Intrauterine devices (IUDs) are effective and safe, long-acting reversible contraceptives, but risk of uterine perforation occurs with an estimated incidence of 1-2 per 1,000 insertions. EURAS-IUD, a European prospective observational study that enrolled 61,448 participants (2006-2012), found that women breastfeeding at the time of device insertion or with the device inserted ≤36 weeks postpartum had higher risk of uterine perforation. APEX-IUD (Association of uterine Perforation and EXpulsion of IUD) is a Food and Drug Administration-mandated study designed to reflect current United States clinical practice...

The COVID-19 pandemic exposed weaknesses in multiple domains and widened gender-based inequalities across the world. It also stimulated extraordinary scientific achievement, bringing vaccines to the public in under a year. In this article, we discuss the implications of current vaccination guidance for pregnant and lactating women, whether their exclusion from the first wave of vaccine trials was justified, and if a change in the current vaccine development pathway is necessary. Pregnant and lactating women were not included in initial SARS-CoV-2 vaccine trials...

BACKGROUND: In singleton pregnancies studies investigating cell-free DNA (cfDNA) in maternal blood have consistently reported high detection rate (DR) and low false positive rate (FPR) for the three common fetal trisomies (trisomy 21, 18 and 13). The potential advantages of non-invasive prenatal testing (NIPT) in twin pregnancies are even greater than in singletons, in particular lower need for invasive testing and consequent fetal loss rate. However, several organisations do not recommend cfDNA in twin pregnancies and call for larger prospective studies...

BACKGROUND: Maternal mortality is higher among Black compared to White people in the United States. Whether Black-White disparities in maternal in-hospital mortality during the delivery hospitalization vary across hospital types (Black-serving vs. non-Black-serving and teaching vs. non-teaching) and whether overall maternal mortality differs across hospital types is not known. OBJECTIVES: 1) Determine whether risk-adjusted Black-White disparities in maternal mortality during the delivery hospitalization vary by hospital types - this is analysis of disparities in mortality within hospital types...

BACKGROUND: There are two known pathways for tumorigenesis of vulvar squamous cell carcinoma (VSCC) - a human papillomavirus (HPV) dependent pathway characterized by p16 overexpression and an HPV-independent pathway linked to lichen sclerosus, characterized by TP53 mutation. A correlation of HPV dependency with a favourable prognosis has been proposed. OBJECTIVE: The objective of the study was to further understand the role of HPV and p53 status in VSCC and characterize its clinical relevance...

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No abstract text is available yet for this article.

Amniotic fluid embolism is a rare syndrome characterized by sudden cardiorespiratory collapse during labor or soon after delivery. Because of its rarity, many obstetrical providers have no experience managing amniotic fluid embolism and may therefore benefit from a cognitive aid such as a checklist. We present a sample checklist for the initial management of amniotic fluid embolism based on standard management guidelines. We also suggest steps that each facility can take to implement the checklist effectively...

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are more likely to experience several pregnancy complications including hypertensive disorders, gestational diabetes mellitus, and preterm births than women without PCOS. However, at present there is limited research whether PCOS is associated with both anxiety and depression during pregnancy, and whether this augments a woman's risk of postpartum depression, particularly among high-risk populations who have limited access to care...

BACKGROUND: Intra-amniotic infection or inflammation (IAI) is common in early preterm birth and associated with significant neonatal lung morbidity due to fetal exposure to pro-inflammatory cytokines and infectious organisms. Amniotic fluid interleukin-8 (IL-8), a pro-inflammatory cytokine, was previously correlated with development of neonatal bronchopulmonary dysplasia, but whether amniotic fluid cytokines or placental pathology more accurately predicts neonatal lung pathology and morbidity is unknown...

In 2020, endometrial cancer continues to be the most common gynecologic malignancy in the United States. The majority of endometrial cancer is low-grade, and nearly one out of every eight low-grade endometrial cancer diagnoses occurs in women younger than 50 with early-stage disease. The incidence of early-stage, low-grade endometrial cancer is increasing in particular among women in their 30s. Women with early-stage, low-grade endometrial cancer generally have a favorable prognosis, and hysterectomy-based surgical treatment alone can often be curative...

BACKGROUND: Induction of labor is one of the most common interventions in modern obstetrics and its frequency is expected to continue to increase. There is inconsistency as to how failed induction of labor is defined, however, the majority of studies, define success as the achievement of vaginal delivery. Induction of labor in nulliparous women poses an additional challenge with a 15-20% incidence of failure, ending in emergency operative deliveries. The Bishop score has been traditionally used before decisions for induction of labor...

No abstract text is available yet for this article.

OBJECTIVE: Residency applicants view social media as a valuable and professional resource, with a recent review reporting that 10% of respondents reported that a program's social media profile would influence their residency choices.1 The purpose of this study was to quantify the number of obstetrics and gynecology (OBGYN) residency programs with an Instagram or Twitter account, and to investigate if the program type and size impacts the likelihood of having one of these accounts. With little research on the state of residency programs' social media presence, this is an opportune time to focus on these social media platforms given the popularity of #MedStudentTwitter and Instagram...

OBJECTIVE: In 5-30% of cases, endometrial cancer occurs in women age 45 or younger. A valid option for women desiring fertility is primary hormonal treatment, such as oral megestrol acetate (MA) alone or combined with hysteroscopic resection1 , or levonorgestrel-releasing intrauterine system (LNG-IUS); however, 20-30% and 41% patients undergoing progestin-based treatments alone failed to achieve complete response (CR) and recur2 . The current knowledge is drawn from observational cohort studies on small series of patients for which long follow-up is rare3 ...

BACKGROUND: Safety warnings about power morcellation in 2014 considerably changed hysterectomy practice, especially for laparoscopic supracervical hysterectomy that typically requires morcellation to remove the corpus uteri while preserving the cervix. Hospitals might vary in how they responded to the safety warnings and altered hysterectomy procedures to avoid use of power morcellation. Yet there has been little data on how hospitals differ in their practice changes. OBJECTIVES: To examine whether hospitals varied in their use of laparoscopic supracervical hysterectomy after safety warnings about power morcellation and compare the risk of surgical complications at hospitals that had different response trajectories in use of laparoscopic supracervical hysterectomy...

The acute rise in maternal morbidity and mortality in the United States is in part due to an increasingly medically complex obstetric population. An estimated 1-3% of all obstetric patients require intensive care, making the timely delivery and availability of critical care imperative. The shifting landscape in obstetric acuity places a burden on obstetric providers, many of whom have limited experience in identifying and responding to critical illness. The Levels of Maternal Care definitions by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) designate hospitals based on the availability of obstetric resources and highlight the need for critical care resources and expertise...