for Journals by Title or ISSN
for Articles by Keywords
help

Publisher: Elsevier   (Total: 3034 journals)

 A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Showing 1 - 200 of 3034 Journals sorted alphabetically
AASRI Procedia     Open Access   (Followers: 15)
Academic Pediatrics     Hybrid Journal   (Followers: 19, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 16, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 81, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 23, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 27, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 4)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 5, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 322, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 3)
Acta Biomaterialia     Hybrid Journal   (Followers: 25, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription  
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 200, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 9, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription   (Followers: 1)
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 22, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 5, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 4)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 3)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 4, SJR: 0.383, h-index: 19)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 2)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 4, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 3)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 5)
Additive Manufacturing     Hybrid Journal   (Followers: 7, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 20)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 122, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 24, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 3)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 6, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 21, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 3, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 25, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 24, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 8, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 18, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 16, SJR: 0.223, h-index: 22)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 11)
Advances in Digestive Medicine     Open Access   (Followers: 4)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 22)
Advances in Ecological Research     Full-text available via subscription   (Followers: 39, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 25, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 7)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 40, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 3)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 8)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 43, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 14)
Advances in Genetics     Full-text available via subscription   (Followers: 15, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 20, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 24)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 34, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 3, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 4)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 4)
Advances in Life Course Research     Hybrid Journal   (Followers: 7, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 16, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 5, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 22)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 10)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 21, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 13)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 8)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 4)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 18)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 19, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 58)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 5, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 2, SJR: 0.1, h-index: 2)
Advances in Space Research     Full-text available via subscription   (Followers: 337, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 8)
Advances in Surgery     Full-text available via subscription   (Followers: 6, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 15)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 43, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 5, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 309, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 4, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 7, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 393, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 30, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 38, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access  
Agriculture and Natural Resources     Open Access   (Followers: 1)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 50, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 9, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 5)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access  
Algal Research     Partially Free   (Followers: 8, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 3)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 6, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 46, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 3)
American Heart J.     Hybrid Journal   (Followers: 46, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 45, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 34, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 6, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 30, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 24, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 44, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 180, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 54, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 2)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 23, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 23, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 21, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 33, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 5)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 51, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 3)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 2, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 38, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 161, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 8, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 10)
Anesthésie & Réanimation     Full-text available via subscription  
Anesthesiology Clinics     Full-text available via subscription   (Followers: 21, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access  
Animal Behaviour     Hybrid Journal   (Followers: 151, SJR: 1.907, h-index: 126)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 1.151, h-index: 83)
Animal Reproduction Science     Hybrid Journal   (Followers: 5, SJR: 0.711, h-index: 78)
Annales d'Endocrinologie     Full-text available via subscription   (SJR: 0.394, h-index: 30)
Annales d'Urologie     Full-text available via subscription  
Annales de Cardiologie et d'Angéiologie     Full-text available via subscription   (SJR: 0.177, h-index: 13)
Annales de Chirurgie de la Main et du Membre Supérieur     Full-text available via subscription  
Annales de Chirurgie Plastique Esthétique     Full-text available via subscription   (Followers: 2, SJR: 0.354, h-index: 22)
Annales de Chirurgie Vasculaire     Full-text available via subscription   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last   [Sort by number of followers]   [Restore default list]

Journal Cover American Journal of Obstetrics and Gynecology
  [SJR: 2.255]   [H-I: 171]   [180 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9378
   Published by Elsevier Homepage  [3034 journals]
  • The importance of publishing trials with negative results
    • Authors: Ingrid Nygaard
      Pages: 541 - 542
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Ingrid Nygaard


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.03.014
       
  • Clinical trials and tribulations: 17OHPC and preventing recurrent preterm
           birth
    • Authors: David Young
      Pages: 543 - 546
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): David Young


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.04.018
       
  • A profile of Dr Edward J. Quilligan
    • Authors: Roberto Romero
      Pages: 547 - 551.e3
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Roberto Romero


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.04.031
       
  • Group prenatal care
    • Authors: Sara E. Mazzoni; Ebony B. Carter
      Pages: 552 - 556
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Sara E. Mazzoni, Ebony B. Carter
      Patients participating in group prenatal care gather together with women of similar gestational ages and 2 providers who cofacilitate an educational session after a brief medical assessment. The model was first described in the 1990s by a midwife for low-risk patients and is now practiced by midwives and physicians for both low-risk patients and some high-risk patients, such as those with diabetes. The majority of literature on group prenatal care uses CenteringPregnancy, the most popular model. The first randomized controlled trial of CenteringPregnancy showed that it reduced the risk of preterm birth in low-risk women. However, recent meta-analyses have shown similar rates of preterm birth, low birthweight, and neonatal intensive care unit admission between women participating in group prenatal care and individual prenatal care. There may be subgroups, such as African Americans, who benefit from this type of prenatal care with significantly lower rates of preterm birth. Group prenatal care seems to result in increased patient satisfaction and knowledge and use of postpartum family planning as well as improved weight gain parameters. The literature is inconclusive regarding breast-feeding, stress, depression, and positive health behaviors, although it is theorized that group prenatal care positively affects these outcomes. It is unclear whether group prenatal care results in cost savings, although it may in large-volume practices if each group consists of approximately 8–10 women. Group prenatal care requires a significant paradigm shift. It can be difficult to implement and sustain. More randomized trials are needed to ascertain the true benefits of the model, best practices for implementation, and subgroups who may benefit most from this innovative way to provide prenatal care. In short, group prenatal care is an innovative and promising model with comparable pregnancy outcomes to individual prenatal care in the general population and improved outcomes in some demographic groups.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.006
       
  • Preventing human papillomavirus–related cancers: we are all in this
           together
    • Authors: Sarah Dilley; Isabel Scarinci; David Kimberlin; J. Michael Straughn
      Pages: 576 - 579.e1
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Sarah Dilley, Isabel Scarinci, David Kimberlin, J. Michael Straughn
      Human papillomavirus–related cancers, which include cervical, vulvovaginal, anal, and oropharyngeal cancers, are on the rise in the United States. Although the human papillomavirus vaccine has been on the market for 10 years, human papillomavirus vaccination rates are well below national goals. Research identified many barriers and facilitators to human papillomavirus vaccination, and provider recommendation remains the most important factor in parental and patient decisions to vaccinate. While much of the burden of human papillomavirus vaccine provision falls on pediatricians and primary care providers, they cannot do it alone. As clinicians who care for a large proportion of human papillomavirus–related conditions, obstetrician-gynecologists and other women’s health care providers must share the responsibility for vaccination of eligible patients. Obstetrician-gynecologists can support the efforts to eradicate human papillomavirus–related disease in their patients and their families via multiple avenues, including providing the human papillomavirus vaccine and being community leaders in support of vaccination.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.026
       
  • Sperm washing with intrauterine insemination and preexposure prophylaxis:
           an innovative approach to treating HIV-serodiscordant couples
    • Authors: Lauren Z. Safier; Lisa C. Grossman; Mark V. Sauer; Nataki C. Douglas
      Pages: 617 - 618
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Lauren Z. Safier, Lisa C. Grossman, Mark V. Sauer, Nataki C. Douglas


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.038
       
  • Robotic-assisted vs traditional laparoscopic surgery for endometrial
           cancer: a randomized controlled trial
    • Authors: Thumuluru Kavitha Madhuri; Simon Butler-Manuel
      First page: 619
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Thumuluru Kavitha Madhuri, Simon Butler-Manuel


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.01.031
       
  • Antiplatelet therapy before or after 16 weeks’ gestation for
           preventing preeclampsia
    • Authors: Stéphanie Roberge; Suzanne Demers; Emmanuel Bujold
      Pages: 620 - 621
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Stéphanie Roberge, Suzanne Demers, Emmanuel Bujold


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.01.034
       
  • Transabdominal ultrasound for cervical length screening (or not?)
    • Authors: Santosh Pandipati; C. Andrew Combs; Alan Fishman
      Pages: 621 - 622
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Santosh Pandipati, C. Andrew Combs, Alan Fishman


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.019
       
  • Lifetime cancer risk and combined oral contraceptives: the Royal College
           of General Practitioners’ Oral Contraception Study
    • Authors: Lisa Iversen; Selvaraj Sivasubramaniam; Amanda J. Lee; Shona Fielding; Philip C. Hannaford
      Pages: 580.e1 - 580.e9
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Lisa Iversen, Selvaraj Sivasubramaniam, Amanda J. Lee, Shona Fielding, Philip C. Hannaford
      Background Oral contraceptives have been used by hundreds of millions of women around the world. Important questions remain regarding the very long-term cancer risks that are associated with oral contraception. Despite previous research, important questions remain about the safety of these contraceptives: (1) How long do endometrial, ovarian, and colorectal cancer benefits persist? (2) Does combined oral contraceptive use during the reproductive years produce new cancer risks later in life? (3) What is the overall balance of cancer among past users as they enter the later stages of their lives? Objectives The purpose of this study was to examine the very long-term cancer risks or benefits associated with the use of combined oral contraceptives, including the estimated overall life-time balance. Study Design The 46,022 women who were recruited to the UK Royal College of General Practitioners’ Oral Contraception Study in 1968 and 1969 were observed for up to 44 years. Directly standardized rates of specific and any cancer were calculated for “ever” and “never” users of combined oral contraceptives; data were standardized for age, parity, social class, and smoking. Attributable risk and preventive fraction percentages were calculated. Poisson regression that adjusted for the same variables was used to estimate incidence rate ratios between ever and never users and to examine effects by time since last oral contraceptive use. Results There were 4661 ever users with at least 1 cancer during 884,895 woman-years of observation and 2341 never users with at least 1 cancer during 388,505 woman-years of observation. Ever use of oral contraceptives was associated with reduced colorectal (incidence rate ratio, 0.81; 99% confidence interval, 0.66–0.99), endometrial (incidence rate ratio, 0.66; 99% confidence interval, 0.48–0.89), ovarian (incidence rate ratio, 0.67; 99% confidence interval, 0.50–0.89), and lymphatic and hematopoietic cancer (incidence rate ratio, 0.74; 99% confidence interval, 0.58–0.94). An increased risk of lung cancer was seen only among ever users who smoked at recruitment. An increased risk of breast and cervical cancer that was seen in current and recent users appeared to be lost within approximately 5 years of stopping oral contraception, with no evidence of either cancer recurring at increased risk in ever users with time. There was no evidence of new cancer risks appearing later in life among women who had used oral contraceptives. Thus, the overall balance of cancer risk among past users of oral contraceptives was neutral with the increased risks counterbalanced by the endometrial, ovarian, and colorectal cancer benefits that persist at least 30 years. Conclusion Most women who choose to use oral contraceptives do not expose themselves to long-term cancer harms; instead, with some cancers, many women benefit from important reductions of risk that persist for many years after stopping.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.002
       
  • Postoperative maintenance levonorgestrel-releasing intrauterine system and
           endometrioma recurrence: a randomized controlled study
    • Authors: Yi-Jen Chen; Teh-Fu Hsu; Ben-Shian Huang; Hsiao-Wen Tsai; Yen-Hou Chang; Peng-Hui Wang
      Pages: 582.e1 - 582.e9
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Yi-Jen Chen, Teh-Fu Hsu, Ben-Shian Huang, Hsiao-Wen Tsai, Yen-Hou Chang, Peng-Hui Wang
      Background According to 3 randomized trials, the levonorgestrel-releasing intrauterine system significantly reduced recurrent endometriosis-related pelvic pain at postoperative year 1. Only a few studies have evaluated the long-term effectiveness of the device for preventing endometrioma recurrence, and the effects of a levonorgestrel-releasing intrauterine system as a maintenance therapy remain unclear. Objective The objective of the study was to evaluate whether a maintenance levonorgestrel-releasing intrauterine system is effective for preventing postoperative endometrioma recurrence. Study Design From May 2011 through March 2012, a randomized controlled trial including 80 patients with endometriomas undergoing laparoscopic cystectomy followed by six cycles of gonadotropin-releasing hormone agonist treatment was conducted. After surgery, the patients were randomized to groups that did or did not receive a levonorgestrel-releasing intrauterine system (intervention group, n = 40, vs control group, n = 40). The primary outcome was endometrioma recurrence 30 months after surgery. The secondary outcomes included dysmenorrhea, CA125 levels, noncyclic pelvic pain, and side effects. Results Endometrioma recurrence at 30 months did not significantly differ between the 2 groups (the intervention group, 10 of 40, 25% vs the control group 15 of 40, 37.5%; hazard ratio, 0.60, 95% confidence interval, 0.27–1.33, P = .209). The intervention group exhibited a lower dysmenorrhea recurrence rate, with an estimated hazard ratio of 0.32 (95% confidence interval, 0.12–0.83, P = .019). Over a 30 month follow-up, the intervention group exhibited a greater reduction in dysmenorrhea as assessed with a visual analog scale score (mean ± SD, 60.8 ± 25.5 vs 38.7 ± 25.9, P < .001, 95% confidence interval, 10.7–33.5), noncyclic pelvic pain visual analog scale score (39.1 ± 10.9 vs 30.1 ± 14.7, P = .014, 95% confidence interval, 1.9–16.1), and CA125 (median [interquartile range], –32.1 [–59.1 to 14.9], vs –15.6 [–33.0 to 5.0], P = .001) compared with the control group. The number-needed-to-treat benefit for dysmenorrhea recurrence at 30 months was 5. The number of recurrent cases requiring further surgical or hormone treatment in the intervention group (1 of 40, 2.5%, 95% confidence interval, –2.3% to 7.3%) was significantly lower than that in the control group (8 of 40, 20%, 95% confidence interval, 7.6–32.4%; P = .031). Conclusion Long-term maintenance therapy using a levonorgestrel-releasing intrauterine system is not effective for preventing endometrioma recurrence.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.008
       
  • Prolonged use of the etonogestrel implant and levonorgestrel intrauterine
           
    • Authors: Colleen McNicholas; Erin Swor; Leping Wan; Jeffrey F. Peipert
      Pages: 586.e1 - 586.e6
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Colleen McNicholas, Erin Swor, Leping Wan, Jeffrey F. Peipert
      Background The subdermal contraceptive implant and the 52-mg levonorgestrel intrauterine device are currently Food and Drug Administration approved for 3 and 5 years of use, respectively. Limited available data suggested both of these methods are effective beyond that time. Demonstration of prolonged effectiveness will improve the cost-effectiveness of the device, and potentially patient continuation and satisfaction. Objective We sought to evaluate the effectiveness of the contraceptive implant and the 52-mg hormonal intrauterine device in women using the method for 2 years beyond the current Food and Drug Administration–approved duration. Study Design We initiated this ongoing prospective cohort study in January 2012. We are enrolling women using the contraceptive implant or 52-mg levonorgestrel intrauterine device for a minimum of 3 and 5 years, respectively (started intrauterine device in ≥2007 or implant in ≥2009). Demographic and reproductive health histories, as well as objective body mass index, were collected. Implant users were offered periodic venipuncture for analysis of serum etonogestrel levels. The primary outcome, unintended pregnancy rate, was calculated per 100 woman-years. We analyzed baseline demographic characteristics using χ2 test and Fisher exact test, and compared serum etonogestrel levels stratified by body mass index using the Kruskal-Wallis test. Results Implant users (n = 291) have contributed 444.0 woman-years of follow-up. There have been no documented pregnancies in implant users during the 2 years of postexpiration follow-up. Calculated failure rates in the fourth and fifth years for the implant are calculated as 0 (1-sided 97.5% confidence interval, 0–1.48) per 100 woman-years at 4 years and 0 (1-sided 97.5% confidence interval, 0–2.65) per 100 woman-years at 5 years. Among 496 levonorgestrel intrauterine device users, 696.9 woman-years of follow-up have been completed. Two pregnancies have been reported. The failure rate in the sixth year of use of the levonorgestrel intrauterine device is calculated as 0.25 (95% confidence interval, 0.04–1.42) per 100 woman-years; failure rate during the seventh year is 0.43 (95% confidence interval, 0.08–2.39) per 100 woman-years. Among implant users with serum etonogestrel results, the median etonogestrel level was 207.7 pg/mL (range 63.8-802.6 pg/mL) at the time of method expiration, 166.1 pg/mL (range 67.9 25.0–470.5 pg/mL) at the end of the fourth year, and 153.0 pg/mL (range 72.1-538.8 pg/mL) at the end of the fifth year. Median etonogestrel levels were compared by body mass index at each time point and a statistical difference was noted at the end of 4 years of use with overweight women having the highest serum etonogestrel (195.9; range 25.0-450.5 pg/mL) when compared to normal (178.9; range 87.0-463.7 pg/mL) and obese (137.9; range 66.0-470.5 pg/mL) women (P = .04). Conclusion This study indicates that the contraceptive implant and 52-mg hormonal intrauterine device continue to be highly effective for at least 2 additional years of use. Serum etonogestrel evaluation demonstrates median levels remain above the ovulation threshold of 90 pg/mL for women in all body mass index classes.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.01.036
       
  • Impact of surgical training on the performance of proposed quality
           measures for hysterectomy for pelvic organ prolapse
    • Authors: Emily R. Adams-Piper; Noelani M. Guaderrama; Qiaoling Chen; Emily L. Whitcomb
      Pages: 588.e1 - 588.e5
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Emily R. Adams-Piper, Noelani M. Guaderrama, Qiaoling Chen, Emily L. Whitcomb
      Background Recent healthcare reform has led to increased emphasis on standardized provision of quality care. Use of government- and organization-approved quality measures is 1 way to document quality care. Quality measures, to improve care and aid in reimbursement, are being proposed and vetted in many areas of medicine. Objectives We aimed to assess performance of proposed quality measures that pertain to hysterectomy for pelvic organ prolapse stratified by surgical training. The 4 quality measures that we assessed were (1) the documentation of offering conservative treatment of pelvic organ prolapse, (2) the quantitative assessment of pelvic organ prolapse (Pelvic Organ Prolapse-Quantification or Baden-Walker), (3) the performance of an apical support procedure, and (4) the performance of cystoscopy at time of hysterectomy. Study Design Patients who underwent hysterectomy for pelvic organ prolapse from January 1 to December 31, 2008, within a large healthcare maintenance organization were identified by diagnostic and procedural codes within the electronic medical record. Medical records were reviewed extensively for demographic and clinical data that included the performance of the 4 proposed quality measures and the training background of the primary surgeon (gynecologic generalist, fellowship-trained surgeon in Female Pelvic Medicine and Reconstructive Surgery, and “grandfathered” Female Pelvic Medicine and Reconstructive Surgery). Data were analyzed with the use of descriptive statistics. Inferential statistics with chi-squared tests were used to compare performance rates of quality measures that were stratified by surgical training. Probability values <.05 were considered statistically significant. Results Six hundred thirty patients who underwent hysterectomy for pelvic organ prolapse in 2008 had complete records available for analysis. Fellowship-trained surgeons performed 302 hysterectomies for pelvic organ prolapse; grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed 98 hysterectomies, and gynecologic generalist surgeons performed 230 hysterectomies. Fellowship-trained surgeons had the highest performance rates for individual quality measures (91.4–98.7%) and cumulative performance of all measures (80.8% of cases). Grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed significantly fewer measures (80.6–95.9% performance rate for individual measures; 65.3% cumulatively for all measures) than fellowship-trained surgeons and more than gynecologic generalists (64.3–70% for individual measures; 29.1% cumulatively for all measures). There was an association between surgeon training background and number of hysterectomies performed for pelvic organ prolapse, with specialist surgeons performing more hysterectomies. When quality measure performance was stratified by surgeon volume, similar significant associations were found, with high-volume surgeons performing more quality measures than low-volume surgeons. Conclusion Within a large healthcare maintenance organization, fellowship-trained Female Pelvic Medicine and Reconstructive Surgery surgeons were more likely to perform proposed quality measures in women who underwent hysterectomy for pelvic organ prolapse compared with those surgeons without such training. Grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed measures more frequently than gynecologic generalists but less than fellowship-trained surgeons. Further study is indicated to correlate the proposed quality measures with clinical outcomes.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.004
       
  • Two-year continuation of intrauterine devices and contraceptive implants
           in a mixed-payer setting: a retrospective review
    • Authors: Jessica N. Sanders; David K. Turok; Lori M. Gawron; Amy Law; Lonnie Wen; Richard Lynen
      Pages: 590.e1 - 590.e8
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Jessica N. Sanders, David K. Turok, Lori M. Gawron, Amy Law, Lonnie Wen, Richard Lynen
      Background As the popularity of long-acting reversible contraception increases, so does the need for accurate data on method continuation in diverse clinical settings. We determined 2-year continuation rates for the levonorgestrel 52-mg intrauterine device, the copper T380A intrauterine device, and the 68-mg etonogestrel contraceptive implant in an academic healthcare system with mixed-payer reimbursement. Objective The purpose of this study was to examine the proportion and characteristics of women who continue intrauterine device and implant use to 2 years and to relate continuation to device type when controlling for patient characteristics. Study Design This retrospective chart review assessed University of Utah Healthcare System patients who had an intrauterine device or contraceptive implant inserted between January 1, 2004, and December 31, 2012. We identified users and dates of insertions and removals by querying billing, medication, and procedural data in the Electronic Data Warehouse. Multivariable Poisson regression was conducted to estimate incidence risk ratios and to relate the probability of 2-year continuous use to device type. Results Data on 8603 device insertions were obtained with the following distribution: levonorgestrel 52-mg intrauterine devices (6459; 75.1%), copper T380A intrauterine devices (1136; 13.2%), and 68-mg etonogestrel implant (1008; 11.7%). Two-year continuation rates were 77.8%, 73.1%, and 75.9%, respectively. There was no statistical difference in 2-year continuation between levonorgestrel 52-mg intrauterine device users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0–1.1) and 68-mg etonogestrel implant users (adjusted risk ratio, 1.1; 95% confidence interval, 1.0–1.1) compared with copper device users, after we controlled for age, Hispanic ethnicity, payer type, and year of insertion. Older-age, self-pay, or public payer insurance (reference commercial payer) and Hispanic ethnicity were associated with 2-year continuation. Conclusion Three-quarters of women with an intrauterine device or implant continue using it for 2 years. In this cohort, the 2-year continuation rates were 77.8%, 73.1%, and 75.9% for the levonorgestrel 52-mg intrauterine device, copper T380A intrauterine device, and 68-mg etonogestrel implant, respectively.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.003
       
  • The effect of a uterine manipulator on the recurrence and mortality of
           endometrial cancer: a multi-centric study by the Italian Society of
           Gynecological Endoscopy
    • Authors: Stefano Uccella; Matteo Bonzini; Mario Malzoni; Francesco Fanfani; Stefano Palomba; Giovanni Aletti; Giacomo Corrado; Marcello Ceccaroni; Renato Seracchioli; Fevzi Shakir; Annamaria Ferrero; Roberto Berretta; Raffaele Tinelli; Enrico Vizza; Giovanni Roviglione; Lucia Casarella; Eugenio Volpi; Ettore Cicinelli; Giovanni Scambia; Fabio Ghezzi
      Pages: 592.e1 - 592.e11
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Stefano Uccella, Matteo Bonzini, Mario Malzoni, Francesco Fanfani, Stefano Palomba, Giovanni Aletti, Giacomo Corrado, Marcello Ceccaroni, Renato Seracchioli, Fevzi Shakir, Annamaria Ferrero, Roberto Berretta, Raffaele Tinelli, Enrico Vizza, Giovanni Roviglione, Lucia Casarella, Eugenio Volpi, Ettore Cicinelli, Giovanni Scambia, Fabio Ghezzi
      Background Although widely adopted, the use of a uterine manipulator during laparoscopic treatment of endometrial cancer represents a debated issue, and some authors hypothesize that it potentially may cause an increased risk of relapse, particularly at specific sites. Objective Our aim was to evaluate the risk and site of disease recurrence, overall survival, and disease-specific survival in women who had laparoscopic surgery with and without the use of a uterine manipulator. Study Design Data were reviewed from consecutive patients who had laparoscopic surgery for endometrial cancer staging in 7 Italian centers. Subjects were stratified according to whether a uterine manipulator was used during surgery; if so, the type of manipulator was identified. Multivariable analysis to correct for possible confounders and propensity score that matched the minimize selection bias were utilized. The primary outcome was the risk of disease recurrence. Secondary outcomes were disease-specific and overall survival and the site of recurrence, according to the use or no use of the uterine manipulator and to the different types of manipulators used. Results We included 951 patients: 579 patients in the manipulator group and 372 patients in the no manipulator group. After a median follow-up period of 46 months (range,12–163 months), the rate of recurrence was 13.5% and 11.6% in the manipulator and no manipulator groups, respectively (P=.37). Positive lymph nodes and myometrial invasion of >50% were associated independently with the risk of recurrence after adjustment for possible confounders. The use of a uterine manipulator did not affect the risk of recurrence, both at univariate (odds ratio, 1.18; 95% confidence interval, 0.80–1.77) and multivariable analysis (odds ratio, 1.00; 95% confidence interval, 0.60–1.70). Disease-free, disease-specific, and overall survivals were similar between groups. Propensity-matched analysis confirmed these findings. The site of recurrence was comparable between groups. In addition, the type of uterine manipulator and the presence or not of a balloon at the tip of the device were not associated significantly with the risk of recurrence. Conclusion The use of a uterine manipulator during laparoscopic surgery does not affect the risk of recurrence and has no impact on disease-specific or overall survival and on the site of recurrence in women affected by endometrial cancer.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.01.027
       
  • Prediction of cesarean delivery in the term nulliparous woman: results
           from the prospective, multicenter Genesis study
    • Authors: Naomi Burke; Gerard Burke; Fionnuala Breathnach; Fionnuala McAuliffe; John J. Morrison; Michael Turner; Samina Dornan; John R. Higgins; Amanda Cotter; Michael Geary; Peter McParland; Sean Daly; Fiona Cody; Pat Dicker; Elizabeth Tully; Fergal D. Malone
      Pages: 598.e1 - 598.e11
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Naomi Burke, Gerard Burke, Fionnuala Breathnach, Fionnuala McAuliffe, John J. Morrison, Michael Turner, Samina Dornan, John R. Higgins, Amanda Cotter, Michael Geary, Peter McParland, Sean Daly, Fiona Cody, Pat Dicker, Elizabeth Tully, Fergal D. Malone
      Background In contemporary practice many nulliparous women require intervention during childbirth such as operative vaginal delivery or cesarean delivery (CD). Despite the knowledge that the increasing rate of CD is associated with increasing maternal age, obesity and larger infant birthweight, we lack a reliable method to predict the requirement for such potentially hazardous obstetric procedures during labor and delivery. This issue is important, as there are greater rates of morbidity and mortality associated with unplanned CD performed in labor compared with scheduled CDs. A prediction algorithm to identify women at risk of an unplanned CD could help reduced labor associated morbidity. Objective In this primary analysis of the Genesis study, our objective was to prospectively assess the use of prenatally determined, maternal and fetal, anthropomorphic, clinical, and ultrasound features to develop a predictive tool for unplanned CD in the term nulliparous woman, before the onset of labor. Materials and Methods The Genesis study recruited 2336 nulliparous women with a vertex presentation between 39+0 and 40+6 weeks’ gestation in a prospective multicenter national study to examine predictors of CD. At recruitment, a detailed clinical evaluation and ultrasound assessment were performed. To reduce bias from knowledge of these data potentially influencing mode of delivery, women, midwives, and obstetricians were blinded to the ultrasound data. All hypothetical prenatal risk factors for unplanned CD were assessed as a composite. Multiple logistic regression analysis and mathematical modeling was used to develop a risk evaluation tool for CD in nulliparous women. Continuous predictors were standardized using z scores. Results From a total enrolled cohort of 2336 nulliparous participants, 491 (21%) had an unplanned CD. Five parameters were determined to be the best combined predictors of CD. These were advancing maternal age (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.09 to 1.34), shorter maternal height (OR, 1.72; 95% CI, 1.52 to 1.93), increasing body mass index (OR, 1.29; 95% CI, 1.17 to 1.43), larger fetal abdominal circumference (OR, 1.23; 95% CI, 1.1 to 1.38), and larger fetal head circumference (OR, 1.27; 95% CI, 1.14 to 1.42). A nomogram was developed to provide an individualized risk assessment to predict CD in clinical practice, with excellent calibration and discriminative ability (Kolmogorov–Smirnov, D statistic, 0.29; 95% CI, 0.28 to 0.30) with a misclassification rate of 0.21 (95% CI, 0.19 to 0.25). Conclusion Five parameters (maternal age, body mass index, height, fetal abdominal circumference, and fetal head circumference) can, in combination, be used to better determine the overall risk of CD in nulliparous women at term. A risk score can be used to inform women of their individualized probability of CD. This risk tool may be useful for reassuring most women regarding their likely success at achieving an uncomplicated vaginal delivery as well as selecting those patients with such a high risk for CD that they should avoid a trial of labor. Such a risk tool has the potential to greatly improve planning hospital service needs and minimizing patient risk.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.017
       
  • The preterm cervix reveals a transcriptomic signature in the presence of
           premature prelabor rupture of membranes
    • Authors: Sofia Makieva; Aurelija Dubicke; Sara F. Rinaldi; Emma Fransson; Gunvor Ekman-Ordeberg; Jane E. Norman
      Pages: 602.e1 - 602.e21
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Sofia Makieva, Aurelija Dubicke, Sara F. Rinaldi, Emma Fransson, Gunvor Ekman-Ordeberg, Jane E. Norman
      Background Premature prelabor rupture of fetal membranes accounts for 30% of all premature births and is associated with detrimental long-term infant outcomes. Premature cervical remodeling, facilitated by matrix metalloproteinases, may trigger rupture at the zone of the fetal membranes overlying the cervix. The similarities and differences underlying cervical remodeling in premature prelabor rupture of fetal membranes and spontaneous preterm labor with intact membranes are unexplored. Objectives We aimed to perform the first transcriptomic assessment of the preterm human cervix to identify differences between premature prelabor rupture of fetal membranes and preterm labor with intact membranes and to compare the enzymatic activities of matrix metalloproteinases-2 and -9 between premature prelabor rupture of fetal membranes and preterm labor with intact membranes. Study Design Cervical biopsies were collected following preterm labor with intact membranes (n = 6) and premature prelabor rupture of fetal membranes (n = 5). Biopsies were also collected from reference groups at term labor (n = 12) or term not labor (n = 5). The Illumina HT-12 version 4.0 BeadChips microarray was utilized, and a novel network graph approach determined the specificity of changes between premature prelabor rupture of fetal membranes and preterm labor with intact membranes. Quantitative reverse transcription–polymerase chain reaction and Western blotting confirmed the microarray findings. Immunofluorescence was used for localization studies and gelatin zymography to assess matrix metalloproteinase activity. Results PML-RARA-regulated adapter molecule 1, FYVE-RhoGEF and PH domain-containing protein 3 and carcinoembryonic antigen-ralated cell adhesion molecule 3 were significantly higher, whereas N-myc downstream regulated gene 2 was lower in the premature prelabor rupture of fetal membranes cervix when compared with the cervix in preterm labor with intact membranes, term labor, and term not labor. PRAM1 and CEACAM3 were localized to immune cells at the cervical stroma and NDRG2 and FGD3 were localized to cervical myofibroblasts. The activity of matrix metalloproteinase-9 was higher (1.22 ± 4.403-fold, P < .05) in the cervix in premature prelabor rupture of fetal membranes compared with preterm labor with intact membranes. Conclusion We identified 4 novel proteins with a potential role in the regulation of cervical remodeling leading to premature prelabor rupture of fetal membranes. Our findings contribute to the studies dissecting the mechanisms underlying premature prelabor rupture of fetal membranes and inspire further investigations toward the development of premature prelabor rupture of fetal membranes therapeutics.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.009
       
  • Twenty-four percent of patients with clinical chorioamnionitis in preterm
           gestations have no evidence of either culture-proven intraamniotic
           infection or intraamniotic inflammation
    • Authors: Kyung Joon Oh; Sun Min Kim; Joon-Seok Hong; Eli Maymon; Offer Erez; Bogdan Panaitescu; Nardhy Gomez-Lopez; Roberto Romero; Bo Hyun Yoon
      Pages: 604.e1 - 604.e11
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Kyung Joon Oh, Sun Min Kim, Joon-Seok Hong, Eli Maymon, Offer Erez, Bogdan Panaitescu, Nardhy Gomez-Lopez, Roberto Romero, Bo Hyun Yoon
      Background Recent studies on clinical chorioamnionitis at term suggest that some patients with this diagnosis have neither intraamniotic infection nor intraamniotic inflammation. A false-positive diagnosis of clinical chorioamnionitis in preterm gestation may lead to unwarranted preterm delivery. Objective We sought to determine the frequency of intraamniotic inflammation and microbiologically proven amniotic fluid infection in patients with preterm clinical chorioamnionitis. Study Design Amniocentesis was performed in singleton pregnant women with preterm clinical chorioamnionitis (<36 weeks of gestation). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8 concentration. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture; intraamniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration of >23 ng/mL. Nonparametric and survival techniques were used for analysis. Results Among patients with preterm clinical chorioamnionitis, 24% (12/50) had neither microbiologic evidence of intraamniotic infection nor intraamniotic inflammation. Microbial invasion of the amniotic cavity was present in 34% (18/53) and intraamniotic inflammation in 76% (38/50) of patients. The most common microorganisms isolated from the amniotic cavity were the Ureaplasma species. Finally, patients without microbial invasion of the amniotic cavity or intraamniotic inflammation had significantly lower rates of adverse outcomes (including lower gestational age at delivery, a shorter amniocentesis-to-delivery interval, acute histologic chorioamnionitis, acute funisitis, and significant neonatal morbidity) than those with microbial invasion of the amniotic cavity and/or intraamniotic inflammation. Conclusion Among patients with preterm clinical chorioamnionitis, 24% had no evidence of either intraamniotic infection or intraamniotic inflammation, and 66% had negative amniotic fluid cultures, using standard microbiologic techniques. These observations call for a reexamination of the criteria used to diagnose preterm clinical chorioamnionitis.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.035
       
  • Is cerebroplacental ratio a marker of impaired fetal growth velocity and
           adverse pregnancy outcome?
    • Authors: Asma Khalil; José Morales-Rosello; Naila Khan; Mintu Nath; Priya Agarwal; Amar Bhide; Aris Papageorghiou; Basky Thilaganathan
      Pages: 606.e1 - 606.e10
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Asma Khalil, José Morales-Rosello, Naila Khan, Mintu Nath, Priya Agarwal, Amar Bhide, Aris Papageorghiou, Basky Thilaganathan
      Background The cerebroplacental ratio has been proposed as a marker of failure to reach growth potential near term. Low cerebroplacental ratio, regardless of the fetal size, is independently associated with the need for operative delivery for presumed fetal compromise and with neonatal unit admission at term. Objective The main aim of this study was to evaluate whether the cerebroplacental ratio at term is a marker of reduced fetal growth rate. The secondary aim was to investigate the relationship between a low cerebroplacental ratio at term, reduced fetal growth velocity, and adverse pregnancy outcome. Study Design This was a retrospective cohort study of singleton pregnancies in a tertiary referral center. The abdominal circumference was measured at 20–24 weeks’ gestation and both abdominal circumference and fetal Dopplers recorded at or beyond 35 weeks, within 2 weeks of delivery. Abdominal circumference and birthweight values were converted into Z scores and centiles, respectively, and fetal Doppler parameters into multiples of median, adjusting for gestational age. Abdominal circumference growth velocity was quantified using the difference in the abdominal circumference Z score, comparing the scan at or beyond 35 weeks with the scan at 20–24 weeks. Both univariable and multivariable logistic regression analyses were performed to investigate the association between low cerebroplacental ratio and the low abdominal circumference growth velocity (in the lowest decile) and to identify and adjust for potential confounders. As a sensitivity analysis, we refitted the model excluding the data on pregnancies with small-for-gestational-age neonates. Results The study included 7944 pregnancies. Low cerebroplacental ratio multiples of median was significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 2.10; 95% confidence interval, 1.71–2.57, P <0.001) and small for gestational age (adjusted odds ratio, 3.60; 95% confidence interval, 3.04–4.25, P < .001). After the exclusion of pregnancies resulting in small-for-gestational-age neonates, a low cerebroplacental ratio multiples of the median remained significantly associated with both low abdominal circumference growth velocity (adjusted odds ratio, 1.76; 95% confidence interval, 1.34–2.30, P < .001) and birthweight centile (adjusted odds ratio, 0.99; 95% confidence interval, 0.998–0.995, P < .001). The need for operative delivery for fetal compromise was significantly associated with a low cerebroplacental ratio (adjusted odds ratio, 1.40; 95% confidence interval, 1.10–1.78, P = .006), even after adjusting for both the umbilical artery pulsatility index multiples of the median and middle cerebral artery pulsatility index multiples of median. The results were similar, even after the exclusion of pregnancies resulting in small-for-gestational-age neonates (adjusted odds ratio, 1.39; 95% confidence interval, 1.06–1.84, P = .018). Low cerebroplacental ratio multiples of the median remained significantly associated with the risk of operative delivery for presumed fetal compromise (P < .001), even after adjusting for the known antenatal and intrapartum risk factors. These associations persisted, even after the exclusion of small-for-gestational-age births. In appropriate-for-gestational-age–sized fetuses, abdominal circumference growth velocity was significantly lower in those with a low cerebroplacental ratio multiples of the median than in those with normal cerebroplacental ratio multiples of the median (P < .001). Conclusion The cerebroplacental ratio is a marker of impaired fetal growth velocity and adverse pregnancy outcome, even in fetuses whose size is considered appropriate using conventional biometry.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.005
       
  • Topical application of recombinant activated factor VII during cesarean
           delivery for placenta previa
    • Authors: Birgit T.B.G. Schjoldager; Emmeli Mikkelsen; Malene R. Lykke; Jørgen Præst; Anne-Mette Hvas; Lars Heslet; Niels J. Secher; Jannie D. Salvig; Niels Uldbjerg
      Pages: 608.e1 - 608.e5
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Birgit T.B.G. Schjoldager, Emmeli Mikkelsen, Malene R. Lykke, Jørgen Præst, Anne-Mette Hvas, Lars Heslet, Niels J. Secher, Jannie D. Salvig, Niels Uldbjerg
      Background During cesarean delivery in patients with placenta previa, hemorrhaging after removal of the placenta is often challenging. In this condition, the extraordinarily high concentration of tissue factor at the placenta site may constitute a principle of treatment as it activates coagulation very effectively. The presumption, however, is that tissue factor is bound to activated factor VII. Objective We hypothesized that topical application of recombinant activated factor VII at the placenta site reduces bleeding without affecting intravascular coagulation. Study Design We included 5 cases with planned cesarean delivery for placenta previa. After removal of the placenta, the surgeon applied a swab soaked in recombinant activated factor VII containing saline (1 mg in 246 mL) to the placenta site for 2 minutes; this treatment was repeated once if the bleeding did not decrease sufficiently. We documented the treatment on video recordings and measured blood loss. Furthermore, we determined hemoglobin concentration, platelet count, international normalized ratio, activated partial thrombin time, fibrinogen (functional), factor VII:clot, and thrombin generation in peripheral blood prior to and 15 minutes after removal of the placenta. We also tested these blood coagulation variables in 5 women with cesarean delivery planned for other reasons. Mann-Whitney test was used for unpaired data. Results In all 5 cases, the uterotomy was closed under practically dry conditions and the median blood loss was 490 (range 300-800) mL. There were no adverse effects of recombinant activated factor VII and we did not measure factor VII to enter the circulation. Neither did we observe changes in thrombin generation, fibrinogen, activated partial thrombin time, international normalized ratio, and platelet count in the peripheral circulation (all P values >.20). Conclusion This study indicates that in patients with placenta previa, topical recombinant activated factor VII may diminish bleeding from the placenta site without initiation of systemic coagulation.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.024
       
  • Recurrent obstetric anal sphincter injury and the risk of long-term anal
           incontinence
    • Authors: Hanna Jangö; Jens Langhoff-Roos; Susanne Rosthøj; Abelone Sakse
      Pages: 610.e1 - 610.e8
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Hanna Jangö, Jens Langhoff-Roos, Susanne Rosthøj, Abelone Sakse
      Background Women with an obstetric anal sphincter injury are concerned about the risk of recurrent obstetric anal sphincter injury in their second pregnancy. Existing studies have failed to clarify whether the recurrence of obstetric anal sphincter injury affects the risk of anal and fecal incontinence at long-term follow-up. Objective The objective of the study was to evaluate whether recurrent obstetric anal sphincter injury influenced the risk of anal and fecal incontinence more than 5 years after the second vaginal delivery. Study Design We performed a secondary analysis of data from a postal questionnaire study in women with obstetric anal sphincter injury in the first delivery and 1 subsequent vaginal delivery. The questionnaire was sent to all Danish women who fulfilled inclusion criteria and had 2 vaginal deliveries 1997–2005. We performed uni- and multivariable analyses to assess how recurrent obstetric anal sphincter injury affects the risk of anal incontinence. Results In 1490 women with a second vaginal delivery after a first delivery with obstetric anal sphincter injury, 106 had a recurrent obstetric anal sphincter injury. Of these, 50.0% (n = 53) reported anal incontinence compared with 37.9% (n = 525) of women without recurrent obstetric anal sphincter injury. Fecal incontinence was present in 23.6% (n = 25) of women with recurrent obstetric anal sphincter injury and in 13.2% (n = 182) of women without recurrent obstetric anal sphincter injury. After adjustment for third- or fourth-degree obstetric anal sphincter injury in the first delivery, maternal age at answering the questionnaire, birthweight of the first and second child, years since first and second delivery, and whether anal incontinence was present before the second pregnancy, the risk of flatal and fecal incontinence was still increased in patients with recurrent obstetric anal sphincter injury (adjusted odds ratio, 1.68 [95% confidence interval, 1.05–2.70), P = .03, and adjusted odds ratio, 1.98 [95% confidence interval, 1.13–3.47], P = .02, respectively). More women with recurrent obstetric anal sphincter injury reported affected the quality of life because of anal incontinence (34.9%, n = 37) compared with women without recurrent obstetric anal sphincter injury (24.2%, n = 335), although this difference did not reach statistical significance after adjustment (adjusted odds ratio, 1.53 [95% confidence interval, 0.92–2.56] P = .10). Conclusion Women opting for vaginal delivery after obstetric anal sphincter injury should be informed about the risk of recurrence, which is associated with an increased risk of long-term flatal and fecal incontinence.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.010
       
  • Maternal obesity and major intraoperative complications during cesarean
           delivery
    • Authors: Marcela C. Smid; Catherine J. Vladutiu; Sarah K. Dotters-Katz; Kim A. Boggess; Tracy A. Manuck; David M. Stamilio
      Pages: 614.e1 - 614.e7
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Marcela C. Smid, Catherine J. Vladutiu, Sarah K. Dotters-Katz, Kim A. Boggess, Tracy A. Manuck, David M. Stamilio
      Background Multiple studies have demonstrated an association between maternal obesity and postoperative complications, but there is a dearth of information about the impact of obesity on intraoperative complications. Objective To estimate the association between maternal obesity at delivery and major intraoperative complications during cesarean delivery (CD). Methods This is a secondary analysis of the deidentified Maternal-Fetal Medicine Unit Cesarean Registry of women with singleton pregnancies. Maternal body mass index (BMI) at delivery was categorized as BMI 18.5 to 29.9 kg/m2, BMI 30 to 39.9 kg/m2, BMI 40 to 49.9 kg/m2, and BMI ≥ 50 kg/m2. The primary outcome, any intraoperative complication, was defined as having at least 1 major intraoperative complication, including perioperative blood transfusion, intraoperative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, repeat laparotomy, and hysterectomy. Log-binomial models were used to estimate risk ratios of intraoperative complication in 2 models: model 1 adjusting for maternal race, and preterm delivery <37 weeks; and model 2 adjusting for confounders in Model 1 as well as emergency CD, and type of skin incision. Results A total of 51,218 women underwent CD; 38% had BMI 18.5 to 29.9 kg/m2, 47% BMI 30 to 39.9 kg/m2, 12% BMI 40 to 49.9 kg/m2 and 3% BMI ≥ 50 kg/m2. Having at least 1 intraoperative complication was uncommon (3.4%): 3.8% for BMI 18.5 to 29.9 kg/m2, 3.2% BMI 30 to 39.9 kg/m2, 2.6% BMI 40 to 49.9 kg/m2 and 4.3% BMI ≥ 50 kg/m2 (P < .001). In the fully adjusted model 2, women with BMI 40 to 49.9 kg/m2 had a lower risk of any intraoperative complication (adjusted risk ratio [ARR], 0.76; 95% confidence interval [CI], 0.64 to 0.89) compared with women with BMI 18.5 to 29.9 kg/m2. Women with BMI 30 to 39.9 kg/m2 (ARR, 0.93; 95% CI, 0.84 to 1.03) had a similar risk of any intraoperative complication compared with nonobese women. Among super obese women, there was evidence of effect modification by emergency CD. Compared with nonobese women, neither super obese women undergoing nonemergency CD (ARR, 1.13; 95% CI, 0.84 to 1.52) nor those undergoing emergency CD (ARR, 0.59; 95% CI, 0.32 to 1.10) had an increased risk of intraoperative complication. Conclusion In contrast to the risk for postcesarean complications, the risk of intraoperative complication does not appear to be increased in obese women, even among those with super obesity.

      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.02.011
       
  • Vasa previa with an intact amniotic membrane
    • Authors: Shinya Matsuzaki; Masayuki Endo; Tadashi Kimura
      Pages: 616.e1 - 616.e2
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Shinya Matsuzaki, Masayuki Endo, Tadashi Kimura


      PubDate: 2017-05-29T22:57:43Z
      DOI: 10.1016/j.ajog.2017.03.003
       
  • Metformin, the aspirin of the 21st century: its role in gestational
           diabetes, prevention of preeclampsia and cancer, and the promotion of
           longevity
    • Authors: Roberto Romero; Offer Erez; Maik Hüttemann; Eli Maymon; Bogdan Panaitescu; Agustin Conde-Agudelo; Percy Pacora; Bo Hyun Yoon; Lawrence I. Grossman
      Abstract: Publication date: Available online 12 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Roberto Romero, Offer Erez, Maik Hüttemann, Eli Maymon, Bogdan Panaitescu, Agustin Conde-Agudelo, Percy Pacora, Bo Hyun Yoon, Lawrence I. Grossman
      Metformin is everywhere. Originally introduced in clinical practice as an anti-diabetic agent, its role as a therapeutic agent is expanding to include treatment of pre-diabetes, gestational diabetes, polycystic ovarian disease, and more recently, experimental studies, as well as observations in randomized clinical trials, suggest that metformin could have a place in the treatment or prevention of preeclampsia. This article provides a brief overview of the history of metformin in the treatment of diabetes, reviews the results of meta-analyses of metformin in gestational diabetes, and the treatment of obese non-diabetic pregnant women to prevent macrosomia. We highlight the results of a randomized clinical trial in which metformin administration in early pregnancy did not reduce the frequency of large-for-gestational-age infants (primary endpoint), but did decrease the frequency of preeclampsia (a secondary endpoint). The mechanisms by which metformin may prevent preeclampsia include a reduction in the production of anti-angiogenic factors (soluble vascular endothelial growth factor receptor-1 and soluble endoglin), and improving endothelial dysfunction, probably through an effect on the mitochondria. Another potential mechanism whereby metformin may play a role in the prevention of preeclampsia is its ability to modify cellular homeostasis and energy disposition, mediated by mTOR. Metformin has a molecular weight of 129 Dalton, and therefore, readily crosses the placenta. There is considerable evidence suggesting that this agent is safe during pregnancy. New literature on the role of metformin in the prevention of cancer, a chemotherapeutic adjuvant, and in prolonging life and protecting against aging, is briefly reviewed. Herein we discuss the mechanisms of action and potential benefits of metformin.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.06.003
       
  • A mouse model of antepartum stillbirth
    • Authors: Anum Rahman; Lindsay S. Cahill; Yu-Qing Zhou; Johnathan Hoggarth; Monique Y. Rennie; Mike Seed; Christopher K. Macgowan; John C. Kingdom; S. Lee Adamson; John G. Sled
      Abstract: Publication date: Available online 12 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Anum Rahman, Lindsay S. Cahill, Yu-Qing Zhou, Johnathan Hoggarth, Monique Y. Rennie, Mike Seed, Christopher K. Macgowan, John C. Kingdom, S. Lee Adamson, John G. Sled
      Background Many stillbirths of normally-formed fetuses in the third trimester could be prevented via delivery if reliable means to anticipate this outcome existed. However, since the etiology of these stillbirths is often unexplained and, although the underlying mechanism is presumed to be hypoxia from “placental insufficiency”, the placentas often appear normal on histopathologic examination. Gestational age is a risk factor for antepartum stillbirth, with a rapid rise in stillbirth rates after 40 weeks gestation. We speculate that a common mechanism may explain antepartum stillbirth in both the late-term and post-term periods. Mice also show increasing rates of stillbirth when pregnancy is artificially prolonged. The model therefore affords an opportunity to characterize events that precede stillbirth. Objective To prolong gestation in mice and monitor fetal and placental growth and cardiovascular changes. Study Design From E15.5 to E18.5, pregnant CD-1 mice received daily progesterone injections to prolong pregnancy by an additional 24-hour period (to embryonic day 19.5). To characterize fetal and placental development, experimental assays were performed throughout late gestation (E15.5 to E19.5), including post-natal day 1 pups as controls. In addition to collecting fetal and placental weights, we monitored fetal blood flow using Doppler ultrasound and examined the feto-placental arterial vascular geometry using microcomputed tomography. Evidence of hypoxic organ injury in the fetus was assessed using magnetic resonance imaging and pimonidazole immunohistochemistry. Results At E19.5, mean fetal weights were reduced by 14% compared with control post-natal day 1 pups. Ultrasound biomicroscopy showed that fetal heart rate and umbilical artery flow continued to increase at E19.5. Despite this, the E19.5 fetuses had significant pimonidazole staining in both brain and liver tissue, indicating fetal hypoxia. Placental weights at E19.5 were 21% lower than at term (E18.5). Microcomputed tomography showed no change in quantitative morphology of the feto-placental arterial vasculature between E18.5 and E19.5. Conclusions Prolongation of pregnancy renders the murine fetus vulnerable to significant growth restriction and hypoxia due to differential loss of placental mass rather than any compromise in feto-placental blood flow. Our data are consistent with a hypoxic mechanism of antepartum fetal death in human term and post-term pregnancy and validates the inability of umbilical artery Doppler to safely monitor such fetuses. New tests of placental function are needed to identify the late-term fetus at risk of hypoxia in order to intervene by delivery to avoid antepartum stillbirth.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.06.009
       
  • A Randomized Trial of Motivational Interviewing and Facilitated
           Contraceptive Access to Prevent Rapid Repeat Pregnancy among Adolescent
           Mothers
    • Authors: Jack Stevens; Robyn Lutz; Ngozi Osuagwu; Dana Rotz; Brian Goesling
      Abstract: Publication date: Available online 12 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Jack Stevens, Robyn Lutz, Ngozi Osuagwu, Dana Rotz, Brian Goesling
      Background Most interventions designed to reduce teen pregnancy rates have not focused on pregnant and/or parenting adolescents. Therefore, a large randomized controlled trial was conducted regarding a motivational interviewing program entitled Teen Options to Prevent Pregnancy in a low income sample of adolescent mothers. This program recommended monthly sessions between a participant and a registered nurse over 18 months. This program also featured facilitated birth control access through transportation assistance and a part-time contraceptive clinic. Objective The impact of this program on rapid repeat pregnancies at 18-months post-enrollment was evaluated. Study Design Five hundred ninety-eight adolescent females were enrolled from seven obstetrics/gynecology clinics and five postpartum units of a large hospital system in a Midwestern city. Each participant was enrolled at least 28 weeks pregnant or less than 9 weeks postpartum. Each participant was randomized to either the Teen Options to Prevent Pregnancy intervention or a Usual Care control condition. Intervention participants averaged 4.5 hours of assistance. Participants were contacted by blinded research staff at 6 months and 18 months to complete self-report surveys. Differences in outcomes between the intervention and control groups were assessed using ordinary least-squares regression. Results There was an 18.1 percent absolute reduction in self-reported repeat pregnancy in the intervention group relative to the control group (20.5% versus 38.6%%; p < .001). There was a 13.7 percent absolute increase in self-reported long-acting reversible contraception use in the intervention group relative to the control group (40.2% versus 26.5%, p = .002). There was no evidence of harmful effects of the intervention on sexual risk behaviors, such as having sexual intercourse without a condom or greater number of partners. Conclusions The Teen Options to Prevent Pregnancy program represents one of the few evidence-based interventions to reduce rapid repeat teen pregnancy. This relatively brief intervention may be a viable alternative to more time-intensive programs that adolescent mothers may be unable or unwilling to receive.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.06.010
       
  • Reproductive Rights Advocacy: Not Just for the Family Planning Community
    • Authors: Cara C. Heuser; Karen J. Gibbins; Marcela C. Smid; D. Ware Branch
      Abstract: Publication date: Available online 10 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Cara C. Heuser, Karen J. Gibbins, Marcela C. Smid, D. Ware Branch
      Women and families benefit from access to the full spectrum of reproductive care, including family planning services. We commend our family planning colleagues on their tireless dedication to preserve the rights of women through advocacy. While several of our perinatology peers have also set an example by dedication to these issues, advocacy for patient access to reproductive care options has not been a focus of the larger perinatology community. The time has come for individual perinatologists, as well as the overall perinatology community, to join them and do the work needed to preserve access to safe care, including contraception and abortion services. In this call to action, we detail several ways that individuals and the community can become more involved in working for reproductive rights.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.06.006
       
  • Persistence of Fimbrial Tissue on the Ovarian Surface Following
           Salpingectomy
    • Authors: Carmen Gan; Rashna Chenoy; Dhivya Chandrasekaran; Elly Brockbank; Antony Hollingworth; Sotiris Vimplis; Alexandra C. Lawrence; Arjun R. Jeyarajah; David Oram; Nandita Deo; Jamna Saravanamuthu; Sarah S. Lam; Asma Faruqi; Naveena Singh; Ranjit Manchanda
      Abstract: Publication date: Available online 10 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Carmen Gan, Rashna Chenoy, Dhivya Chandrasekaran, Elly Brockbank, Antony Hollingworth, Sotiris Vimplis, Alexandra C. Lawrence, Arjun R. Jeyarajah, David Oram, Nandita Deo, Jamna Saravanamuthu, Sarah S. Lam, Asma Faruqi, Naveena Singh, Ranjit Manchanda
      Background Salpingectomy is recommended as a risk-reducing strategy for epithelial tubo-ovarian cancer. The gold standard procedure is complete tubal excision. Objective To assess the presence of residual fimbrial/tubal tissue on ovarian surfaces following salpingectomy. Design Prospective analysis of patients undergoing salpingo-oophorectomy +/- hysterectomy for benign indications, early cervical cancer or low risk endometrial cancer at a UK National Health Service Trust. Salpingectomy +/- hysterectomy was performed initially, followed by oophorectomy within the same operation. Separately retrieved tubes and ovaries were serially sectioned and completely examined histologically. The main outcome measure was histologically identified fimbrial/ tubal tissue on ovarian surface. Chi-square/Fisher’s exact tests evaluated categorical variables (SPSS-23). Results 25 consecutive cases (mean age= 54.8 years (SD=5.0), comprising 41 adnexae (9= unilateral, 16= bilateral) were analysed. 17 (68.0%), 5 (20.0%) and 3 (12.0%), procedures were performed by consultant gynaecologists, subspecialty/specialist trainees and consultant gynaecological oncologists respectively. 12/25 (48.0%) were laparoscopic and 13/25 (52.0%) involved laparotomy. 4/25 (16.0%, CI: 4.5%, 36.1%) patients or 4/41 (9.8%, CI: 2.7%, 23.1%) adnexae showed residual microscopic fimbrial tissue on the ovarian surface. Tubes/ ovaries were free of adhesions in 23 cases. Two cases had dense adnexal adhesions but neither had residual fimbrial tissue on the ovary. Residual fimbrial tissue was not significantly associated with surgical route or experience; (consultant= 3/20 (15%), trainee= 1/5 (20%), p=1.0). Conclusion Residual fimbrial tissue remains on the ovary following salpingectomy in a significant proportion of cases and could impact the level of risk-reduction obtained.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.06.004
       
  • Reply to Letter # L17-052AR1
    • Authors: Haim Arie Abenhaim; Amira El-Messidi; Andrea R. Spence
      Abstract: Publication date: Available online 9 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Haim Arie Abenhaim, Amira El-Messidi, Andrea R. Spence


      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.05.065
       
  • The prevalence of active tuberculosis infection among pregnant women is
           not increasing in the United States
    • Authors: Jason L. Salemi; Hamisu M. Salihu
      Abstract: Publication date: Available online 8 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Jason L. Salemi, Hamisu M. Salihu


      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.05.064
       
  • Urine leakage during sexual activity among ethnically diverse,
           community-dwelling middle-aged and older women
    • Authors: Nagambika Munaganuru; Stephen K. van den Eeden; Jennifer Creasman; Leslee L. Subak; Lisa Strano-Paul; Alison J. Huang
      Abstract: Publication date: Available online 8 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Nagambika Munaganuru, Stephen K. van den Eeden, Jennifer Creasman, Leslee L. Subak, Lisa Strano-Paul, Alison J. Huang
      Background Urinary incontinence is associated with decreased female sexual function, but little is known about the prevalence, predictors, and impact of urine leakage during sexual activity among women in the community. Objective To evaluate the prevalence and impact of urine leakage during sex in ethnically-diverse, community-dwelling midlife and older women. Study design Urinary incontinence and sexual function were assessed by structured questionnaire in a multi-ethnic, community-based cohort of women enrolled in Kaiser Permanente Northern California, an integrated healthcare delivery system in California. All women were aged 40 to 80 years and sampled from one of four racial/ethnic groups (20% Black, 20% Latina, 20% Asian, and 40% non-Latina White). Differences in frequency, bother, and fear of urine leakage during sexual activity were examined among women with monthly, weekly, and daily urinary incontinence and across different types of urinary incontinence (stress-, urgency-, mixed-, and other- type urinary incontinence), using chi-square tests. Independent risk factors for urine leakage during sexual activity were identified through multivariable logistic regression. Results Of the 509 women who reported being sexually active and having at least monthly urinary incontinence, 127 (25%) reported experiencing any urine leakage during sex during the past three months. Nineteen percent reported being subjectively bothered by leakage during sex, and 16% reported restricting sexual activity due to fear of leakage. Women with more frequent underlying urinary incontinence were more likely to report experiencing or being bothered by leakage during sex as well as restricting sexual activity due to fear of leakage (p<0.001 for all). Participants with predominantly stress or mixed type urinary incontinence were more likely to report experiencing leakage during sex and being subjectively bothered by this leakage (p<0.002 for all). Factors independently associated with leakage during sex were depression (OR=1.96, 1.20-3.20), symptomatic pelvic organ prolapse (OR=2.10, 1.11-3.98), mixed vs. urgency type urinary incontinence (OR=3.16, 1.70-5.88), stress vs. urgency type urinary incontinence (OR=1.94, 1.01-3.70), and frequency of sexual activity (OR=1.63, 1.05-2.55), but not age or race/ethnicity. Conclusions Up to a quarter of women with at least monthly urinary incontinence in the community may experience urine leakage during sexual activity. Many incontinent women who leak urine during sex remain sexually active, indicating that preservation of sexual function should still be a priority in this population. Among incontinent women, depression, pelvic organ prolapse, and stress- mixed-type urinary incontinence may be associated with urine leakage during sexual activity.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.05.069
       
  • Objectively measured short sleep duration and later sleep midpoint in
           pregnancy are associated with a higher risk of gestational diabetes
    • Authors: Francesca L. Facco; William A. Grobman; Kathryn J. Reid; Corette B. Parker; Shannon M. Hunter; Robert M. Silver; Robert C. Basner; George R. Saade; Grace W. Pien; Shalini Manchanda; Judette M. Louis; Chia-Ling Nhan-Chang; Judith H. Chung; Deborah A. Wing; Hyagriv N. Simhan; David M. Haas; Jay Iams; Samuel Parry; Phyllis C. Zee
      Abstract: Publication date: Available online 7 June 2017
      Source:American Journal of Obstetrics and Gynecology
      Author(s): Francesca L. Facco, William A. Grobman, Kathryn J. Reid, Corette B. Parker, Shannon M. Hunter, Robert M. Silver, Robert C. Basner, George R. Saade, Grace W. Pien, Shalini Manchanda, Judette M. Louis, Chia-Ling Nhan-Chang, Judith H. Chung, Deborah A. Wing, Hyagriv N. Simhan, David M. Haas, Jay Iams, Samuel Parry, Phyllis C. Zee
      Background Experimental and epidemiologic data suggest that among non-pregnant adults, sleep duration may be an important risk factor for chronic disease. Although pregnant women commonly complain of poor sleep, few studies have objectively evaluated the quality of sleep in pregnancy or have explored the relationship between sleep disturbances and maternal and perinatal outcomes. Objectives Our objective was to examine the relationship between objectively assessed sleep duration, timing and continuity (measured via wrist actigraphy) and maternal cardiovascular and metabolic morbidity specific to pregnancy. Study Design This was a prospective cohort study of nulliparous women. Women were recruited between 16 0/7 and 21 6/7 weeks’ gestation. They were asked to wear a wrist actigraphy monitor and to complete a daily sleep log for a seven consecutive-day period. The primary sleep exposure variables were the averages of the following over the total valid nights (minimum 5, maximum 7 nights): short sleep duration during the primary sleep period (< 7 hours/night), late sleep midpoint (midpoint between sleep onset and sleep offset > 5 AM), and top quartile of minutes of wake time after sleep onset (WASO) and sleep fragmentation index. The primary outcomes of interest were a composite of hypertensive disorders of pregnancy (mild, severe, or superimposed preeclampsia; eclampsia; or antepartum gestational hypertension) and gestational diabetes (GDM). Chi-square tests were used to assess associations between sleep variables and categorical baseline characteristics. Crude odds ratios and 95% confidence intervals were estimated from univariate logistic regression models to characterize the magnitude of the relationship between sleep characteristics and hypertensive disorders of pregnancy and GDM. For associations that were significant in univariate analysis, multiple logistic regression was used to explore further the association of sleep characteristics with pregnancy outcomes. Results Nine-hundred and one eligible women consented to participate. Of these women 782 submitted valid actigraphy studies. Short sleep duration and a later sleep midpoint were associated with an increased risk of GDM (OR 2.24, 95% CI 1.11, 4.53; OR 2.58, 95% CI 1.24, 5.36, respectively) but not of hypertensive disorders. A model with both sleep duration and sleep midpoint as well as their interaction term revealed that while there was no significant interaction between these exposures, the main effects of both short sleep duration and later sleep midpoint with GDM remained significant (aOR 2.06, 95% CI 1.01, 4.19; aOR 2.37, 95% CI 1.13, 4.97, respectively). Additionally, after adjusting separately for age, BMI and race/ethnicity, both short sleep duration and later sleep midpoint remained associated with GDM. No associations were demonstrated between the sleep quality measures (WASO, sleep fragmentation) and hypertensive disorders or GDM. Conclusions Our results demonstrate a relationship between short sleep duration and later sleep midpoint with GDM. Our data suggest independent contributions of these two sleep characteristics to the risk for GDM in nulliparous women.

      PubDate: 2017-06-13T13:54:15Z
      DOI: 10.1016/j.ajog.2017.05.066
       
  • Reply
    • Authors: Minna Kari; Nieminen Johanna
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): Minna M. Mäenpää, Kari Nieminen, Johanna U. Mäenpää


      PubDate: 2017-06-13T13:54:15Z
       
  • Reply
    • Authors: David Stamilio
      Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6
      Author(s): David M. Stamilio


      PubDate: 2017-06-13T13:54:15Z
       
  • Information for Readers
    • Abstract: Publication date: June 2017
      Source:American Journal of Obstetrics and Gynecology, Volume 216, Issue 6


      PubDate: 2017-05-29T22:57:43Z
       
  • March 2017 (vol. 216, no. 3, page 250)
    • Abstract: Publication date: Available online 8 May 2017
      Source:American Journal of Obstetrics and Gynecology


      PubDate: 2017-05-10T04:45:25Z
       
 
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
Fax: +00 44 (0)131 4513327
 
Home (Search)
Subjects A-Z
Publishers A-Z
Customise
APIs
Your IP address: 107.22.63.172
 
About JournalTOCs
API
Help
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-2016