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OBSTETRICS AND GYNECOLOGY (207 journals)                  1 2 | Last

Showing 1 - 200 of 207 Journals sorted alphabetically
Acta Obstétrica e Ginecológica Portuguesa     Open Access   (Followers: 1)
Acta Obstetricia et Gynecologica Scandinavica     Hybrid Journal   (Followers: 16)
Advances in Neonatal Care     Hybrid Journal   (Followers: 48)
Advances in Reproductive Sciences     Open Access   (Followers: 3)
Advances in Sexual Medicine     Open Access   (Followers: 7)
African Journal for Infertility and Assisted Conception     Open Access   (Followers: 1)
African Journal of Midwifery and Women's Health     Full-text available via subscription   (Followers: 13)
African Journal of Reproductive Health     Open Access   (Followers: 8)
Aktuální Gynekologie a Porodnictví     Open Access   (Followers: 1)
American Journal of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 3)
American Journal of Obstetrics and Gynecology     Hybrid Journal   (Followers: 286)
American Journal of Perinatology     Hybrid Journal   (Followers: 40)
American Journal of Perinatology Reports     Open Access   (Followers: 18)
American Journal of Reproductive Immunology     Hybrid Journal   (Followers: 6)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Archives of Gynecology and Obstetrics     Hybrid Journal   (Followers: 19)
Asian Pacific Journal of Reproduction     Open Access   (Followers: 1)
Australian and New Zealand Journal of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 52)
Best Practice & Research Clinical Obstetrics & Gynaecology     Hybrid Journal   (Followers: 34)
Biology of Reproduction     Full-text available via subscription   (Followers: 11)
Birth     Hybrid Journal   (Followers: 40)
Birth Defects Research Part B: Developmental and Reproductive Toxicology     Hybrid Journal   (Followers: 8)
BJOG : An International Journal of Obstetrics and Gynaecology     Partially Free   (Followers: 313)
British Journal of Midwifery     Full-text available via subscription   (Followers: 92)
Case Reports in Obstetrics and Gynecology     Open Access   (Followers: 11)
Case Reports in Perinatal Medicine     Hybrid Journal   (Followers: 11)
Clínica e Investigación en Ginecología y Obstetricia     Full-text available via subscription  
Clinical Lactation     Open Access   (Followers: 23)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Obstetrics & Gynecology     Full-text available via subscription   (Followers: 28)
Clinics in Perinatology     Full-text available via subscription   (Followers: 24)
Contemporary OB GYN - Obstetrics-Gynecology & Women's Health     Full-text available via subscription   (Followers: 5)
Contraception     Hybrid Journal   (Followers: 20)
Contraception : X     Open Access   (Followers: 1)
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
Current Obstetrics and Gynecology Reports     Hybrid Journal   (Followers: 4)
Current Opinion in Obstetrics & Gynecology     Hybrid Journal   (Followers: 13)
Current Women's Health Reviews     Hybrid Journal   (Followers: 5)
Early Human Development     Hybrid Journal   (Followers: 13)
Ecography     Hybrid Journal   (Followers: 28)
EMC - Ginecología-Obstetricia     Full-text available via subscription   (Followers: 1)
European Clinics in Obstetrics and Gynaecology     Hybrid Journal   (Followers: 5)
European Journal of Contraception & Reproductive Health Care     Hybrid Journal   (Followers: 5)
European Journal of Obstetrics & Gynecology and Reproductive Biology     Hybrid Journal   (Followers: 29)
European Journal of Obstetrics & Gynecology and Reproductive Biology : X     Open Access  
Expert Review of Obstetrics & Gynecology     Hybrid Journal   (Followers: 5)
Fertility and Sterility     Full-text available via subscription   (Followers: 77)
Fertility Research and Practice     Open Access   (Followers: 2)
Fertility Science and Research     Open Access  
Fetal and Maternal Medicine Review     Hybrid Journal   (Followers: 6)
Fetal Diagnosis and Therapy     Full-text available via subscription   (Followers: 12)
Ginekologia i Perinatologia Praktyczna     Hybrid Journal  
Ginekologia Polska     Open Access  
Global Reproductive Health     Open Access   (Followers: 1)
gynäkologie + geburtshilfe     Full-text available via subscription   (Followers: 2)
Gynäkologisch-geburtshilfliche Rundschau     Full-text available via subscription   (Followers: 1)
Gynakologische Endokrinologie     Hybrid Journal  
Gynecologic and Obstetric Investigation     Full-text available via subscription   (Followers: 5)
Gynecologic Oncology     Hybrid Journal   (Followers: 28)
Gynecologic Oncology Reports     Open Access   (Followers: 11)
Gynecologic Oncology Research and Practice     Open Access   (Followers: 1)
Gynecological Endocrinology     Hybrid Journal   (Followers: 5)
Gynecological Surgery     Open Access   (Followers: 4)
Gynécologie Obstétrique & Fertilité     Full-text available via subscription   (Followers: 1)
Gynécologie Obstétrique Fertilité & Sénologie     Hybrid Journal   (Followers: 1)
Gynecology     Open Access  
Gynecology and Minimally Invasive Therapy     Open Access  
Gynecology Obstetrics & Reproductive Medicine     Open Access   (Followers: 1)
Health Care For Women International     Hybrid Journal   (Followers: 8)
Human Reproduction     Hybrid Journal   (Followers: 76)
Human Reproduction Open     Open Access   (Followers: 2)
Human Reproduction Update     Hybrid Journal   (Followers: 18)
Hypertension in Pregnancy     Hybrid Journal   (Followers: 9)
Indian Journal of Gynecologic Oncology     Hybrid Journal  
Indonesian Journal of Obstetrics and Gynecology     Open Access  
Infectious Diseases in Obstetrics and Gynecology     Open Access   (Followers: 5)
International Journal of Anatomical Variations     Open Access  
International Journal of Childbirth     Hybrid Journal   (Followers: 8)
International Journal of Gynecological Cancer     Hybrid Journal   (Followers: 24)
International Journal of Gynecological Pathology     Hybrid Journal   (Followers: 9)
International Journal of Gynecology & Obstetrics     Hybrid Journal   (Followers: 26)
International Journal of Neonatal Screening     Open Access   (Followers: 3)
International Journal of Obstetric Anesthesia     Full-text available via subscription   (Followers: 15)
International Journal of Obstetrics, Perinatal and Neonatal Nursing     Full-text available via subscription  
International Journal of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 15)
International Journal of Reproductive Medicine     Open Access   (Followers: 6)
International Urogynecology Journal     Hybrid Journal   (Followers: 4)
Italian Journal of Anatomy and Embryology     Open Access   (Followers: 1)
Journal de Gynécologie Obstétrique et Biologie de la Reproduction     Full-text available via subscription  
Journal für Gynäkologische Endokrinologie / Schweiz     Hybrid Journal  
Journal für Gynäkologische Endokrinologie/Österreich     Hybrid Journal  
Journal of Assisted Reproduction and Genetics     Hybrid Journal   (Followers: 6)
Journal of Basic and Clinical Reproductive Sciences     Open Access   (Followers: 1)
Journal of Breast Health     Open Access  
Journal of Clinical Gynecology and Obstetrics     Open Access   (Followers: 7)
Journal of Endometriosis and Pelvic Pain Disorders     Hybrid Journal  
Journal of Evidence-based Care     Open Access   (Followers: 8)
Journal of Family Planning and Reproductive Health Care     Hybrid Journal   (Followers: 12)
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 3)
Journal of Gynecologic Surgery     Hybrid Journal   (Followers: 1)
Journal of Gynecological Research and Obstetrics     Open Access   (Followers: 2)
Journal of Gynecology Obstetrics and Human Reproduction     Hybrid Journal   (Followers: 1)
Journal of Human Lactation     Hybrid Journal   (Followers: 31)
Journal of Human Reproductive Sciences (JHRS)     Open Access   (Followers: 3)
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Maternal and Child Health     Open Access  
Journal of Maternal-Fetal & Neonatal Medicine     Hybrid Journal   (Followers: 40)
Journal of Midwifery     Open Access   (Followers: 3)
Journal of Midwifery & Women's Health     Hybrid Journal   (Followers: 66)
Journal of Midwifery and Reproduction     Open Access   (Followers: 5)
Journal of Midwifery and Reproductive Health     Open Access   (Followers: 15)
Journal of Minimally Invasive Gynecology     Full-text available via subscription   (Followers: 11)
Journal of Neonatal-Perinatal Medicine     Hybrid Journal   (Followers: 14)
Journal of Obstetric Anaesthesia and Critical Care     Open Access   (Followers: 22)
Journal of Obstetric, Gynecologic, & Neonatal Nursing     Hybrid Journal   (Followers: 36)
Journal of Obstetrics and Gynaecology     Hybrid Journal   (Followers: 34)
Journal of Obstetrics and Gynaecology Canada     Hybrid Journal   (Followers: 1)
Journal of Obstetrics and Gynaecology Research     Hybrid Journal   (Followers: 9)
Journal of Obstetrics and Gynecology of India     Hybrid Journal   (Followers: 4)
Journal of Obstetrics and Women's Diseases     Open Access  
Journal of Pediatric and Adolescent Gynecology     Full-text available via subscription   (Followers: 3)
Journal of Perinatal Education     Hybrid Journal   (Followers: 5)
Journal of Perinatal Medicine     Hybrid Journal   (Followers: 13)
Journal of Perinatology     Hybrid Journal   (Followers: 7)
Journal of Psychosomatic Obstetrics & Gynecology     Hybrid Journal   (Followers: 3)
Journal of Reproduction and Contraception     Full-text available via subscription   (Followers: 4)
Journal of Reproductive and Infant Psychology     Hybrid Journal   (Followers: 24)
Journal of Reproductive Biotechnology and Fertility     Open Access   (Followers: 2)
Journal of Reproductive Health and Medicine     Full-text available via subscription   (Followers: 2)
Journal of Reproductive Immunology     Hybrid Journal   (Followers: 2)
Jurnal Kebidanan Midwiferia     Open Access  
Jurnal Ners     Open Access  
La Revue Sage-Femme     Full-text available via subscription  
Majalah Obstetri & Ginekologi     Open Access  
Maternal Health, Neonatology and Perinatology     Open Access   (Followers: 9)
Menopause     Hybrid Journal   (Followers: 14)
Menopause International     Hybrid Journal   (Followers: 9)
MHR: Basic science of reproductive medicine     Hybrid Journal   (Followers: 1)
Middle East Fertility Society Journal     Open Access   (Followers: 3)
Midwifery     Hybrid Journal   (Followers: 74)
Midwifery Today     Full-text available via subscription   (Followers: 18)
Nascer e Crescer : Birth and Growth Medical Journal     Open Access  
Neonatal Network - Journal of Neonatal Nursing     Hybrid Journal   (Followers: 26)
Neonatology     Full-text available via subscription   (Followers: 48)
Nepal Journal of Obstetrics and Gynaecology     Open Access   (Followers: 2)
OA Women's Health     Open Access   (Followers: 1)
Obstetric Anesthesia Digest     Full-text available via subscription   (Followers: 2)
Obstetric Medicine     Hybrid Journal   (Followers: 8)
Obstetrical & Gynecological Survey     Hybrid Journal   (Followers: 14)
Obstetrics & Gynecology     Partially Free   (Followers: 94)
Obstetrics and Gynaecology Forum     Full-text available via subscription   (Followers: 1)
Obstetrics and Gynecology Clinics of North America     Full-text available via subscription   (Followers: 21)
Obstetrics and Gynecology International     Open Access   (Followers: 8)
Obstetrics, Gynaecology & Reproductive Medicine     Full-text available via subscription   (Followers: 17)
Open Journal of Obstetrics and Gynecology     Open Access   (Followers: 5)
Paediatric and Perinatal Epidemiology     Hybrid Journal   (Followers: 9)
Perinatología y Reproducción Humana     Open Access   (Followers: 1)
Perspectives On Sexual and Reproductive Health     Hybrid Journal   (Followers: 7)
Placenta     Hybrid Journal   (Followers: 2)
Postgraduate Obstetrics & Gynecology     Full-text available via subscription   (Followers: 1)
Proceedings in Obstetrics and Gynecology     Open Access   (Followers: 4)
Progresos de Obstetricia y Ginecología     Full-text available via subscription   (Followers: 1)
Reprodução & Climatério     Open Access   (Followers: 1)
Reproduction     Full-text available via subscription   (Followers: 7)
Reproduction Fertility and Development     Hybrid Journal   (Followers: 5)
Reproductive Biology and Endocrinology     Open Access   (Followers: 4)
Reproductive BioMedicine Online     Full-text available via subscription   (Followers: 7)
Reproductive Endocrinology     Open Access   (Followers: 3)
Reproductive Health     Open Access   (Followers: 2)
Reproductive Health Matters     Open Access   (Followers: 5)
Reproductive Medicine and Biology     Open Access   (Followers: 3)
Reproductive Sciences     Hybrid Journal   (Followers: 1)
Research and Reports in Neonatology     Open Access   (Followers: 5)
Research in Obstetrics and Gynecology     Open Access   (Followers: 2)
Research Journal of Obstetrics and Gynecology     Open Access   (Followers: 5)
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics     Open Access  
Revista Chilena de Obstetricia y Ginecologia     Open Access   (Followers: 1)
Revista Cubana de Obstetricia y Ginecología     Open Access  
Revista Internacional de Andrología     Full-text available via subscription  
Revista Peruana de Ginecología y Obstetricia     Open Access  
Revue de médecine périnatale     Hybrid Journal   (Followers: 1)
Scientific Journal of Hamadan Nursing & Midwifery Faculty     Open Access   (Followers: 1)
Seksuologia Polska     Full-text available via subscription  
Seminars in Breast Disease     Hybrid Journal   (Followers: 1)
Seminars in Perinatology     Hybrid Journal   (Followers: 22)
Seminars in Reproductive Medicine     Hybrid Journal  
Sexes     Open Access  
Siklus : Journal Research Midwifery Politeknik Tegal     Open Access   (Followers: 2)
South African Journal of Obstetrics and Gynaecology     Open Access   (Followers: 2)
Southern African Journal of Gynaecological Oncology     Open Access   (Followers: 1)
Sri Lanka Journal of Obstetrics and Gynaecology     Open Access   (Followers: 1)
Systems Biology in Reproductive Medicine     Hybrid Journal  
Taiwanese Journal of Obstetrics and Gynecology     Open Access   (Followers: 1)
Teratology Studies     Open Access  
Thai Journal of Obstetrics and Gynaecology     Open Access  
The Obstetrician & Gynaecologist     Hybrid Journal   (Followers: 7)
The Practising Midwife     Full-text available via subscription   (Followers: 9)
Trends in Urology Gynaecology & Sexual Health     Hybrid Journal   (Followers: 2)
Tropical Journal of Obstetrics and Gynaecology     Open Access   (Followers: 2)

        1 2 | Last

Similar Journals
Journal Cover
Obstetrics & Gynecology
Journal Prestige (SJR): 2.563
Citation Impact (citeScore): 3
Number of Followers: 94  
 
  Partially Free Journal Partially Free Journal
ISSN (Print) 0029-7844 - ISSN (Online) 1873-233X
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Getting Risk Prediction Right
    • Authors: Bateman; Brian T.; Robinson, Julian N.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • An Expanded Obstetric Comorbidity Scoring System for Predicting Severe
           Maternal Morbidity
    • Authors: Leonard; Stephanie A.; Kennedy, Chris J.; Carmichael, Suzan L.; Lyell, Deirdre J.; Main, Elliott K.
      Abstract: imageOBJECTIVE: To develop and validate an expanded obstetric comorbidity score for predicting severe maternal morbidity that can be applied consistently across contemporary U.S. patient discharge data sets.METHODS: Discharge data from birth hospitalizations in California during 2016–2017 were used to develop the score. The outcomes were severe maternal morbidity, defined using the Centers for Disease Control and Prevention index, and nontransfusion severe maternal morbidity (excluding cases where transfusion was the only indicator of severe maternal morbidity). We selected 27 potential patient-level risk factors for severe maternal morbidity, identified using International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes. We used a targeted causal inference approach integrated with machine learning to rank the risk factors based on adjusted risk ratios (aRRs). We used these results to assign scores to each comorbidity, which sum to a single numeric score. We validated the score in California and national data sets and compared the performance to that of a previously developed obstetric comorbidity index.RESULTS: Among 919,546 births, the rates of severe maternal morbidity and nontransfusion severe maternal morbidity were 168 and 74 per 10,000 births, respectively. The highest risk comorbidity was placenta accreta spectrum (aRR of 30.5 for severe maternal morbidity and 54.7 for nontransfusion severe maternal morbidity) and the lowest was gestational diabetes mellitus (aRR of 1.06 for severe maternal morbidity and 1.12 for nontransfusion severe maternal morbidity). Normalized scores based on the aRR were developed for each comorbidity, which ranged from 1 to 59 points for severe maternal morbidity and from 1 to 36 points for nontransfusion severe maternal morbidity. The overall performance of the expanded comorbidity scores was good (C-statistics were 0.78 for severe maternal morbidity and 0.84 for nontransfusion severe maternal morbidity in California data and 0.82 and 0.87, respectively, in national data) and improved on prior comorbidity indices developed for obstetric populations. Calibration plots showed good concordance between predicted and actual risks of the outcomes.CONCLUSION: We developed and validated an expanded obstetric comorbidity score to improve comparisons of severe maternal morbidity rates across patient populations with different comorbidity case mixes.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Neonatal and Maternal Composite Adverse Outcomes Among Low-Risk
           Nulliparous Women Compared With Multiparous Women at 39–41 Weeks of
           Gestation
    • Authors: Chauhan; Suneet P.; Rice, Madeline Murguia; Grobman, William A.; Bailit, Jennifer; Reddy, Uma M.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M. Jr; Caritis, Steve N.; Prasad, Mona; Tita, Alan T. N.; Saade, George R.; Sorokin, Yoram; Rouse, Dwight J.; Tolosa, Jorge E.; for the Eunice Kennedy Shriver National Institute of Child Health Human Development (NICHD Maternal-Fetal Medicine Units (MFMU Network
      Abstract: imageOBJECTIVE: To estimate whether the frequency of adverse maternal and neonatal outcomes differs between low-risk nulliparous and multiparous women at 39–41 weeks of gestation.METHODS: This is a secondary analysis of an observational obstetrics cohort of maternal–neonatal dyads at 25 hospitals. Low-risk women with nonanomalous singletons who delivered between 39 0/7 and 41 6/7 weeks of gestation were included. The composite neonatal adverse outcome included 5-minute Apgar score less than five, ventilator support or cardiopulmonary resuscitation, seizure, hypoxic ischemic encephalopathy, sepsis, bronchopulmonary dysplasia, persistent pulmonary hypertension, necrotizing enterocolitis, birth injury or perinatal death. The composite maternal adverse outcome included infection, third- or fourth-degree perineal laceration, thromboembolism, transfusion of blood products, or maternal death. Small for gestational age (SGA), large for gestational age (LGA), and shoulder dystocia requiring maneuvers were also evaluated. Multivariable regression was used to estimate adjusted relative risks (aRRs) and adjusted odds ratios (aORs) with 95% CIs.RESULTS: Of the 115,502 women in the overall cohort, 39,870 (34.5%) met eligibility criteria for this analysis; 18,245 (45.8%) were nulliparous. The risk of the composite neonatal adverse outcome (1.5% vs 1.0%, aRR 1.80, 95% CI 1.48–2.19), composite maternal adverse outcome (15.1% vs 3.3%, aRR 5.04, 95% CI 4.62–5.49), and SGA (8.9% vs 5.8%, aOR 1.45, 95% CI 1.33–1.57) was significantly higher in nulliparous than multiparous patients. The risk of LGA (aOR 0.65, 95% CI 0.60–0.71) and shoulder dystocia with maneuvers (aRR 0.68, 95% CI 0.60–0.77) was significantly lower in nulliparous rather than multiparous patients.CONCLUSION: The risk of composite adverse outcomes and SGA among low-risk nulliparous women at 39–41 weeks of gestation is significantly higher than among multiparous counterparts. However, nulliparous women had a lower risk of shoulder dystocia with maneuvers and LGA.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Placenta Accreta Spectrum Without Placenta Previa
    • Authors: Carusi; Daniela A.; Fox, Karin A.; Lyell, Deirdre J.; Perlman, Nicola C.; Aalipour, Soroush; Einerson, Brett D.; Belfort, Michael A.; Silver, Robert M.; Shamshirsaz, Alireza A.
      Abstract: imageOBJECTIVE: To evaluate placenta accreta spectrum with and without placenta previa with regard to risk factors, antepartum diagnosis, and maternal morbidity.METHODS: We conducted a retrospective cohort study of pathology-confirmed placenta accreta spectrum deliveries with hysterectomy from two U.S. referral centers from January 2010–June 2019. Maternal, pregnancy, and delivery characteristics were compared among placenta accreta spectrum cases with (previa PAS group) and without (nonprevia PAS group) placenta previa. Surgical outcomes and a composite of severe maternal morbidities were evaluated, including eight or more blood cell units transfused, reoperation, pulmonary edema, acute kidney injury, thromboembolism, or death. Logistic regression was used with all analyses controlled for delivery location.RESULTS: Of 351 deliveries, 106 (30%) had no placenta previa at delivery. When compared with the previa group, nonprevia placenta accreta spectrum was less likely to be identified antepartum (38%, 95% CI 28–48% vs 87%, 82–91%), less likely to receive care from a multidisciplinary team (41%, 31–51% vs 86%, 81–90%), and less likely to have invasive placenta increta or percreta (51% 41–61% vs 80%, 74–84%). The nonprevia group had more operative hysteroscopy (24%, 16–33% vs 6%, 3–9%) or in vitro fertilization (31%, 22–41% vs 9%, 6–13%) and was less likely to have had a prior cesarean delivery (64%, 54–73% vs 93%, 89–96%) compared with the previa group, though the majority in each group had a prior cesarean delivery. Rates of severe maternal morbidity were similar in the two groups, at 19% (nonprevia) and 20% (previa), even after controlling for confounders (adjusted odds ratio for the nonprevia group 0.59, 95% CI 0.30–1.17).CONCLUSION: Placenta accreta spectrum without previa is less likely to be diagnosed antepartum, potentially missing the opportunity for multidisciplinary team management. Despite the absence of placenta previa and less placental invasion, severe maternal morbidity at delivery was not lower. Broader recognition of patients at risk for placenta accreta spectrum may improve early clinical diagnosis and patient outcomes.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • A Uterus-Preserving Treatment for Uncontrollable Postpartum Hemorrhage:
           Esike's Technique
    • Authors: Esike; Chidi Ochu Uzoma
      Abstract: imageBACKGROUND: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide, with uterine atony responsible in 80% of cases. In intractable cases, hysterectomy is the final treatment, but it has complications. Many doctors in developing countries with high maternal mortality rates from postpartum hemorrhage can perform cesarean deliveries but cannot perform hysterectomy. Patients with postpartum hemorrhage who need hysterectomy in these countries will die in such cases, whereas, if doctors know this simple, easily learned technique, such patients may survive.TECHNIQUE: Esike's technique is a uterine-compression method that uses supplies generally available at delivery hospitals. Six sutures are placed in the lower uterine segment, three anteriorly and three posteriorly. Starting with the middle sutures, the sutures are tied at the fundus with the help of an assistant to provide uterine compression. The more laterally placed sutures are then tied similarly, resulting in uterine compression and stoppage of postpartum hemorrhage.EXPERIENCE: Esike's technique was used in controlling life-threatening, uncontrollable postpartum hemorrhage in 18 women and was successful in 16 (89%) without requiring hysterectomy.CONCLUSION: Esike's technique is effective in controlling life-threatening postpartum hemorrhage and can be used in low-resource settings with commonly available supplies and performed by doctors with a common level of training.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Two Intraoperative Techniques for Midurethral Sling Tensioning: A
           Randomized Controlled Trial
    • Authors: Brennand; Erin A.; Wu, Guosong; Houlihan, Sara; Globerman, Dobrochna; Gagnon, Louise-Helene; Birch, Colin; Hyakutake, Momoe; Carlson, Kevin V.; Al-Shankiti, Hanan; Robert, Magali; Lazare, Darren; Kim-Fine, Shunaha; for the Calgary Women's Pelvic Health Research Group
      Abstract: imageOBJECTIVE: To evaluate whether the use of a Mayo Scissor as a suburethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in different rates of abnormal bladder outcomes 12 months after retropubic midurethral sling surgery.METHODS: The MUST (Mid-Urethral Sling Tensioning) trial was a block-randomized, double-blind, multicenter clinical trial that allocated women to have their retropubic midurethral slings tensioned by Scissor or Babcock technique. The primary outcome (abnormal bladder) was a composite of persistent stress urinary incontinence (SUI), overactive bladder, and urinary retention. Secondary outcomes included outcomes of the composite, postoperative catheterization, incontinence-related questionnaires, repeat incontinence treatment, and uroflowmetry. Sample size of 159 in each arm (N=318) was planned for a superiority trial, hypothesizing a 10% difference in primary outcome.RESULTS: From September 2015 to December 2017, 506 women were screened and 318 were randomized. Baseline characteristics were similar in each arm. At 12 months, 253 (79.6%) women provided information on primary outcome: 40 of 128 (31.3%) patients with midurethral slings tensioned by Scissor experienced abnormal bladder, compared with 23 of 125 (18.4%) of those with midurethral slings tensioned by Babcock (P=.018, relative difference 12.9%). Secondary analyses favored Babcock for median duration of catheterization and the proportions of women experiencing urinary retention requiring sling lysis. Uroflowmetry parameters suggest the Scissor technique is more restrictive. Rates of mesh erosion were lower for the Scissor arm. No differences occurred in proportions of women experiencing patient reported persistent SUI after surgery.CONCLUSION: Abnormal bladder outcomes were 12.9% less frequent for women with midurethral slings tensioned by Babcock. Both techniques provided a comparable patient reported cure for SUI at 12 months. Women with midurethral slings tensioned by Scissors experienced more intervention for obstruction, whereas those with midurethral slings tensioned by Babcock experienced higher rates of mesh erosion. This information about how the postoperative courses differ allows surgeons to better counsel patients preoperatively or tailor their choice of technique.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02480231.FUNDING SOURCE: Boston Scientific.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Characteristics Associated With Treatment Failure 1 Year After Midurethral
           Sling in Women With Mixed Urinary Incontinence
    • Authors: Sung; Vivian W.; Richter, Holly E.; Moalli, Pamela; Weidner, Alison C.; Nguyen, John N.; Smith, Ariana L.; Dunivan, Gena; Ridgeway, Beri; Borello-France, Diane; Newman, Diane K.; Mazloomdoost, Donna; Carper, Benjamin; Gantz, Marie G.; for the Eunice Kennedy Shriver National Institute of Child Health Human Development Pelvic Floor Disorders Network*
      Abstract: imageOBJECTIVE: To evaluate characteristics associated with treatment failure 1 year after midurethral sling in women with mixed urinary incontinence.METHODS: Four hundred three women who participated in a randomized trial that compared midurethral sling and behavioral and pelvic floor muscle therapy (combined group) against midurethral sling alone for mixed incontinence with 1 year of follow-up data were eligible for this planned secondary analysis. Overall treatment failure was defined as meeting criteria for subjective failure, objective failure, or both. Subjective failure was defined as not meeting the minimal clinically important difference for improvement on the UDI (Urogenital Distress Inventory)-total score (26.1 points). Objective failure was not achieving 70% improvement on mean incontinence episodes of any type per day or having undergone any additional treatment for urinary symptoms at 12 months postoperative. Logistic regression models for treatment failure were constructed. Independent variables included site and treatment group, and clinical and demographic variables based on bivariate comparisons (P
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Sexual Activity and Dyspareunia 1 Year After Surgical Repair of Pelvic
           Organ Prolapse
    • Authors: Lukacz; Emily S.; Sridhar, Amaanti; Chermansky, Christopher J.; Rahn, David D.; Harvie, Heidi S.; Gantz, Marie G.; Varner, R. Edward; Korbly, Nicole B.; Mazloomdoost, Donna; for the Eunice Kennedy Shriver National Institute of Child Health Human Development Pelvic Floor Disorders Network (PFDN
      Abstract: imageOBJECTIVE: To describe sexual activity and risks for dyspareunia after pelvic organ prolapse surgery.METHODS: This was a secondary analysis of data from four randomized trials conducted between 2002 and 2018. Standard assessments and validated measures of sexual function were assessed at baseline and at 12 months postoperatively. Anterior apical surgeries were grouped by approach: transvaginal native tissue repairs, transvaginal mesh or graft-augmented repairs, and abdominal sacrocolpopexy. Additional surgeries, which included posterior repair, hysterectomy, and slings, were analyzed. Bivariate analyses and logistic regression models identified risk factors for postoperative dyspareunia.RESULTS: Of the 1,337 women enrolled in the trials, 932 had sufficient outcome data to determine dyspareunia status. Of these before surgery, 445 (47.8%) were sexually active without dyspareunia, 89 (9.6%) were sexually active with dyspareunia, 93 (10.0%) were not sexually active owing to fear of dyspareunia, and 305 (32.7%) were not sexually active for other reasons. At 12 months, dyspareunia or fear of dyspareunia was present in 63 of 627 (10.0%); occurred de novo in 17 of 445 (3.8%) and resolved in 136 of 182 (74.7%). Multivariable regression demonstrated baseline dyspareunia as the only factor associated with postoperative dyspareunia (adjusted odds ratio 7.8, 95% CI 4.2–14.4). No other factors, including surgical approach, were significantly associated with postoperative dyspareunia. Too few had de novo dyspareunia to perform modeling.CONCLUSION: Dyspareunia is common in one in five women before undergoing prolapse surgery. Surgical repair resolves dyspareunia in three out of four women with low rates of de novo dyspareunia at less than 4%. Preoperative dyspareunia appears to be the only predictor of postoperative dyspareunia.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT00065845, NCT00460434, NCT00597935, and NCT01802281.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Health-Related Quality of Life Improvements in Patients With Endometriosis
           Treated With Elagolix
    • Authors: Taylor; Hugh S.; Soliman, Ahmed M.; Johns, Beverly; Pokrzywinski, Robin M.; Snabes, Michael; Coyne, Karin S.
      Abstract: imageOBJECTIVE: To evaluate the effects of elagolix on clinically meaningful improvements in health-related quality of life (HRQOL) measured by the EHP-30 (Endometriosis Health Profile-30).METHODS: Data from two phase III trials of elagolix for moderate to severe pain associated with endometriosis were pooled and analyzed as three groups: placebo, elagolix 150 mg once daily, or elagolix 200 mg twice daily. Patients were administered the EHP-30 questionnaire at baseline, and at months 1, 3, and 6 of treatment. Previously established responder definitions were applied to determine percentages of patients with clinically meaningful EHP-30 improvements. The probability of meeting EHP-30 responder definitions with elagolix compared with placebo at months 3 and 6 was determined by Poisson regression analysis, controlling for baseline scores.RESULTS: At month 6, the probabilities of meeting EHP-30 subscale responder definitions for pain, control and powerlessness, self-image, social support, emotional well-being, and sexual intercourse were 169% (adjusted relative risk [aRR]: 2.69, 95% CI 2.26–3.21), 129% (aRR 2.29, 95% CI 1.96–2.67), 80% (aRR 1.80, 95% CI 1.54–2.11), 70% (aRR 1.70, 95% CI 1.47–1.97), 67% (aRR 1.67, 95% CI 1.45–1.92), and 62% (aRR 1.62, 95% CI 1.36–1.92) greater, respectively (all P
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • ASCCP Risk-Based Colposcopy Recommendations Applied in Thai Women With
           Atypical Squamous Cells of Undetermined Significance or Low-Grade Squamous
           Intraepithelial Lesion Cytology
    • Authors: Phianpiset; Rattiya; Ruengkhachorn, Irene; Jareemit, Nida; Ittiamornlert, Pornprom; Chaopotong, Pattama; Hanamornroongruang, Suchanan; Horthongkham, Navin
      Abstract: imageOBJECTIVE: To compare the proportion of cervical intraepithelial neoplasia (CIN) 2 or worse pathology among different risk strata according to the ASCCP when applied in women who had atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL) cervical cytology; to assess performance of colposcopy; and to assess the independent predictors for detected CIN 2 or worse pathology.METHODS: This is a secondary analysis of a previous prospective study, which included Thai women with ASC-US or LSIL cytology who underwent high-risk human papillomavirus (HPV) testing and subsequent colposcopy with directed biopsy. Patients were classified as lowest-risk, intermediate-risk, or highest-risk based on cervical cytology, high-risk HPV testing, and colposcopic impression. The proportion of CIN 2 or worse pathology and associated prognostic factors were analyzed.RESULTS: Of 697 women, 103 (14.8%), 573 (82.2%) and 21 (3%) were classified into lowest-risk, intermediate-risk, and highest-risk groups, respectively. The proportion of CIN 2 or worse pathology was 1%, 11.2%, and 61.9% in those same groups, respectively (P
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Gynecologic Care in Women With Down Syndrome: Findings From a National
           Registry
    • Authors: Smith; Anna J. B.; Applebaum, Jeremy; Tanner, Edward J.; Capone, George T.
      Abstract: imageOBJECTIVE: To estimate receipt of recommended gynecologic care, including cancer screening and menstrual care, among women with Down syndrome in the United States.METHODS: We conducted a retrospective cohort study of women participating in DS-Connect, the National Institute of Health's registry of women with Down syndrome. Using 2013–2019 survey data, we estimated the proportion of women receiving recommended age-appropriate well-woman care (Pap tests, mammogram, breast examination, pelvic examination) and compared receipt of gynecologic care to receipt of other preventive health care. We also estimated proportion receiving care for menstrual regulation.RESULTS: Of 70 participants with Down syndrome, 23% (95% CI 13–33) of women received all recommended gynecologic components of a well-woman examination. Forty-four percent (95% CI 32–56) of women aged 18 years and older reported ever having a gynecologic examination, and 26% (95% CI 15–37) reported ever having a Pap test. Of women aged 40 years or older, 50% (95% CI 22–78) had had a mammogram. Fifty-two percent (95% CI 41–65) had tried medication for menstrual regulation, and 89% (95% CI 81–96) received all recommended components of nongynecologic routine health care.CONCLUSION: Women with Down syndrome received gynecologic care, including cancer screening, at lower-than-recommended rates and at substantially lower rates than other forms of health care. Efforts to improve gynecologic care in this vulnerable population are needed.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Botulinum Toxin A as a Treatment for Provoked Vestibulodynia: A Randomized
           Controlled Trial
    • Authors: Haraldson; Philip; Mühlrad, Hanna; Heddini, Ulrika; Nilsson, Kent; Bohm-Starke, Nina
      Abstract: imageOBJECTIVE: To evaluate pain reduction after two injections of 50 units botulinum toxin A compared with placebo for provoked vestibulodynia.METHODS: We conducted a double-blinded, placebo-controlled randomized trial of 50 units botulinum toxin A or placebo injected in the bulbocavernosus muscles twice, 3 months apart, in women with provoked vestibulodynia. Primary outcome was self-reported dyspareunia or pain at tampon use on a visual analog scale (VAS, 0–100). Secondary outcomes were pain at weekly tampon insertion (VAS score), reduction of pelvic floor hypertonicity (measured with a vaginal manometer), adverse events, and sexual function and distress. A sample size of 38 participants for each group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (0–100) (mean score range 56–76±31 SD).RESULTS: Between May 2016 and June 2018, 124 women with provoked vestibulodynia were assessed, and 88 were randomized to botulinum toxin A (BTA group, n=44) or placebo (placebo group, n=44). Primary outcome showed a lower but statistically nonsignificant pain rating by 7 VAS units (95% CI −15.0 to 0.4) in the BTA group compared with the placebo group. Secondary results showed a significant decrease in pain at weekly tampon insertion by 11 VAS units (95% CI −16.6 to 6.0) with botulinum toxin A injection. The vaginal manometer measured lower maximum contraction strength by 7 mm Hg (95% CI −12.7 to −2.4) and lower 10-second endurance strength by 4 mm Hg (95% CI −7.72 to −1.16) in the BTA group compared with the placebo group. No changes were observed for sexual function and distress, but there was a significant increase in women attempting vaginal intercourse in the BTA group (0.27, 95% CI 0.06–0.48). No severe adverse events were reported.CONCLUSION: Twice-repeated injections of 50 units of botulinum toxin A in women with provoked vestibulodynia did not reduce dyspareunia or pain at tampon use, but secondary outcomes suggested positive effects of the treatment.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773641.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Radical Trachelectomy for the Treatment of Early-Stage Cervical Cancer: A
           Systematic Review
    • Authors: Smith; Evan S.; Moon, Ashley S.; O'Hanlon, Robin; Leitao, Mario M. Jr; Sonoda, Yukio; Abu-Rustum, Nadeem R.; Mueller, Jennifer J.
      Abstract: imageOBJECTIVE: To assess surgical, oncologic, and pregnancy outcomes in patients undergoing radical vaginal, abdominal, or laparoscopic trachelectomy for the treatment of early-stage cervical cancer, using a methodic review of published literature.DATA SOURCES: PubMed, EMBASE, and Cochrane Library sources, including ClinicalTrials.gov, were searched from 1990–2019 with terms “cervical cancer” and “(vaginal, abdominal, open, minimally invasive, or laparoscopic) radical trachelectomy.” Grey literature and unpublished data were omitted.METHODS OF STUDY SELECTION: After removal of duplicates from a combined EndNote library of results, 490 articles were reviewed using Covidence software. Two reviewers screened titles and abstracts, and then screened full texts. Selection criteria included articles that reported radical trachelectomy with lymph node assessment as primary therapy for cervical carcinoma, with stated follow-up intervals and recurrences.TABULATION, INTEGRATION, AND RESULTS: Variables of interest were manually extracted into an electronic database. A total 47 articles that reported on 2,566 women met inclusion criteria. Most tumors were of squamous histology (68.5%), stage IB1 (74.8%), 2 cm or less (69.2%), and without lymphovascular invasion (68.8%). Of planned trachelectomies, 9% were converted intraoperatively to hysterectomy. Separated by route of trachelectomy, 58.1%, 37.2%, and 4.7% were performed using radical vaginal, abdominal, and laparoscopic approaches, respectively. With median follow-up of 48 months (range 2–202 months) across studies, median recurrence rate was 3.3% (range 0–25%); median time to recurrence was 26 months (range 8–44 months). Median 5-year recurrence-free and overall survival were 94.6% (range 88–97.3%) and 97.4% (range 95–99%), respectively. The posttrachelectomy pregnancy rate was 23.9%, with a live-birth rate of 75.1%.CONCLUSION: Radical trachelectomy for fertility-preserving treatment of cervical cancer is widely reported in the literature, though publications are mainly limited to case reports and case series. Reported follow-up periods infrequently meet standard oncologic parameters but show encouraging recurrence-free and overall survival rates and pregnancy outcomes. Higher-level evidence needed for meta-analysis is lacking.SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019132443.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Lesbian Women Undergoing Assisted Reproduction: Diverse, But Not Different
    • Authors: Kim; Ashley S.; Sax, Megan R.; Pavolvic, Zoran J.; Jabara, Sami I.; DeCherney, Alan H.
      Abstract: imageThe use of assisted reproduction among women in relationships with other women has increased in the United States over the past decade as a result of increased legal access and social acceptance. Despite this shift, limited studies currently exist to guide optimal fertility care for this growing patient population of women seeking assisted reproduction. In this Commentary, assisted reproduction will be meant to include ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF). Conflicting studies suggest that self-identified lesbian women may demonstrate an increased prevalence of polycystic ovarian syndrome. Most available studies find that a woman's sexual orientation does not affect the outcome of fertility treatment. Self-identified lesbian women undergoing donor sperm IUI and IVF have similar pregnancy and live-birth rates as heterosexual women. Better evidence regarding patient demographics and comorbidities, underlying etiologies of subfertility, and assisted reproductive outcomes among women building families with other women is needed to optimize care.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Opioid Prescription and Persistent Opioid Use After Ectopic Pregnancy
    • Authors: Wall-Wieler; Elizabeth; Shover, Chelsea L.; Hah, Jennifer M.; Carmichael, Suzan L.; Butwick, Alexander J.
      Abstract: imageOBJECTIVE: To evaluate outpatient opioid dispensing and the incidence of persistent opioid use after ectopic pregnancy.METHODS: This cohort study used U.S. employer-based claims data to identify opioid-naïve individuals experiencing ectopic pregnancy from November 1, 2008, to September 30, 2015. Treatment was categorized as surgical, medical (using methotrexate), or unknown. New opioid prescriptions were defined as prescriptions filled from 1 week before to 1 week after an ectopic pregnancy treatment. For those who filled a new opioid prescription, we calculated the incidence and risk factors for persistent opioid use, defined as having filled at least one opioid prescription both from 8 to 90 days after treatment and from 91 to 365 days after treatment.RESULTS: Of the 15,338 individuals in our study, 7,047 (45.9%, 95% CI 45.2–46.7%) filled an opioid prescription at the time of treatment, of whom 4.1% (95% CI 3.6–4.6%) developed persistent opioid use. The risk of persistent opioid use was lower among those who had surgical compared with medical treatment (3.7% and 6.8%, respectively; relative risk [RR] 0.54, 95% CI 0.38–0.77). Variables most strongly associated with persistent opioid use were a history of benzodiazepine use (RR 1.99; 95% CI 1.43–2.78; adjusted relative risk [aRR] 1.57, 95% CI 1.11–2.22), antidepressant use (RR 1.91, 95% CI 1.45–2.53; aRR 1.53, 95% CI 1.08–2.18), and a pre-existing pain disorder (RR 1.58, 95% CI 1.26–1.99; aRR 1.47, 95% CI 1.16–1.85) in the year before treatment.CONCLUSION: New opioid use is common after an ectopic pregnancy; approximately 4% of those with new opioid use develop persistent opioid use, with the rate higher in those treated medically. New pain-management guidelines need to be developed to prevent persistent opioid use after ectopic pregnancy.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Polysubstance Use Among Pregnant Women With Opioid Use Disorder in the
           United States, 2007–2016
    • Authors: Jarlenski; Marian P.; Paul, Nicole C.; Krans, Elizabeth E.
      Abstract: imageOBJECTIVE: To assess trends in polysubstance use among pregnant women with opioid use disorder in the United States.METHODS: We conducted a time trend analysis of pooled, cross-sectional data from the National Inpatient Sample, an annual nationally representative sample of U.S. hospital discharge data. Among 38.0 million females aged 15–44 years with a hospitalization for delivery from 2007 to 2016, we identified 172,335 pregnant women with an International Classification of Diseases, Ninth Revision, Clinical Modification or International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of opioid use disorder. Polysubstance use among pregnant women with opioid use disorder was defined as at least one co-occurring diagnosis of other substance use, including alcohol, amphetamine, cannabis, cocaine, sedative, or tobacco. We fit weighted multivariable logistic regression models to produce nationally representative estimates, including an interaction between year and rural compared with urban county of residence; controlled for age, race, and insurance type. Average predicted probabilities and 95% CIs were derived from regression results.RESULTS: Polysubstance use among women with opioid use disorder increased from 60.5% (95% CI 58.3–62.8%) to 64.1% (95% CI 62.8%–65.3%). Differential time trends in polysubstance use among women with opioid use disorder were found in rural compared with urban counties. Large increases in amphetamine use occurred among those in both rural and urban counties (255.4%; 95% CI 90.5–562.9% and 150.7%; 95% CI 78.2–52.7%, respectively), similarly to tobacco use (30.4%; 95% CI 16.9–45.4% and 23.2%; 95% CI 15.3–31.6%, respectively). Cocaine use diagnoses declined among women with opioid use disorder at delivery in rural (−70.5%; 95% CI −80.4% to −55.5%) and urban (−61.9%; 95% CI −67.6% to −55.1%) counties. Alcohol use diagnoses among those with opioid use disorder declined −57% (95% CI −70.8% to −37.7%) in urban counties but did not change among those in rural counties.CONCLUSION: Over the past decade, polysubstance use among pregnant women with opioid use disorder has increased more rapidly in rural compared with urban counties in the United States, with amphetamines and tobacco use increasing most rapidly.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Insurance-Associated Disparities in Opioid Use and Misuse Among Patients
           Undergoing Gynecologic Surgery for Benign Indications
    • Authors: Huang; Yongmei; Jacobson, Judith S.; Tergas, Ana I.; Ananth, Cande V.; Neugut, Alfred I.; Hershman, Dawn L.; Wright, Jason D.
      Abstract: imageOBJECTIVE: To compare perioperative use and persistent postoperative opioid use among Medicaid-insured women and commercially insured women who underwent gynecologic surgery for benign indications.METHODS: The Truven Health MarketScan database, a nationwide data source collecting commercial insurance claims across all states and Medicaid insurance claims from 12 states, was used to identify opioid-naïve women without cancer aged 18–64 years who underwent common gynecologic surgeries from 2012 to 2016 and filled a prescription for an opioid perioperatively. Persistent opioid use was defined as filling an opioid prescription 90–180 days after the surgery. Opioid use disorder (OUD) was defined as hospitalizations or emergency department visits for opioid dependence, misuse, or overdose. Multivariable models were developed to examine the insurance-associated disparity in persistent opioid use and OUD.RESULTS: A total of 31,155 Medicaid-insured women and 270,716 commercially insured women were identified. Medicaid-insured women received greater quantities of opioids and for longer durations than did commercially insured women. Persistent postoperative opioid use was identified in 14.1% of Medicaid-insured women and 5.8% of commercially insured women (P
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Care for Incarcerated Pregnant People With Opioid Use Disorder: Equity and
           Justice Implications
    • Authors: Ahlbach; Chris; Sufrin, Carolyn; Shlafer, Rebecca
      Abstract: imageWith the simultaneous rise in maternal opioid use disorder (OUD) and the incarceration of pregnant people in the United States, we must ensure that prisons and jails adequately address the health and well-being of incarcerated pregnant people with OUD. Despite long-established, clear, and evidence-based recommendations regarding the treatment of OUD during pregnancy, incarcerated pregnant people with OUD do not consistently receive medication treatment and are instead forced into opioid withdrawal. This inadequate care raises multiple concerns, including issues of justice and equity, considerations regarding the legal and ethical obligations of the provision of health care, and violations of the medical and legal rights of incarcerated people. We offer recommendations for improving care for this often-ignored group.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Implementing Couple’s Human Immunodeficiency Virus Testing and
           Counseling in the Antenatal Care Setting
    • Authors: Momplaisir; Florence; Finley, Emily; Wolf, Sandra; Aaron, Erika; Inoyo, Itoro; Bennett, David; Seyedroudbari, Sara; Groves, Allison
      Abstract: imageOBJECTIVE: To describe a pilot implementation of couple’s human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States.METHODS: We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We assessed relationship characteristics, HIV risk-related behaviors and concordance of couples' sexual agreement (ie, mutual agreement about sexual risk behaviors that are permissible within or outside of their relationship). Acceptability of couple’s HIV testing and counseling (ie, format, quality of the sessions, ability to meet their needs) was assessed after completing the session. Barriers and facilitators to couple’s HIV testing and counseling were assessed at the individual-level among decliners and participants and at the clinic-level among members of the care team.RESULTS: Dyadic data were collected from 82 individuals (41 couples). Most partners (n=56, 68%) did not have a sexual agreement or had differing expectations about their sexual agreement. Partners with a concordant sexual agreement (n=26) felt more confident working with their partners on condom use when having sex outside of their relationship (P=.008) and were more likely to agree with their partner to get tested regularly for HIV or sexually transmitted infections (P=.015). Acceptability was high, with a rating of 93 or more (out of 100) among all items. Individual-level barriers to couple’s HIV testing and counseling included difficulty bringing the male partner for counseling and a perception by either member of the couple that they were at low-risk for HIV. At the clinic level, need for training, staff turnover, and integration of couple’s HIV testing and counseling in the clinic flow presented as barriers, whereas commitment by the clinic leadership facilitated the couple’s HIV testing and counseling program.CONCLUSION: Despite barriers, couple’s HIV testing and counseling can be implemented in antenatal clinics and is a highly acceptable method of HIV testing.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Reproductive Travel of Intended Parents for Delivery of Gestational
           Carrier Pregnancies
    • Authors: Swanson; Kate; Letourneau, Joseph M.; Kuppermann, Miriam; Einerson, Brett D.
      Abstract: imageOBJECTIVE: To explore the role of reproductive travel (travel to another state or country for reproductive services) for intended parents at the time of delivery of gestational carrier pregnancies and to analyze the sociodemographic characteristics of those who build families through gestational surrogacy.METHODS: We conducted a cross-sectional study of births involving gestational surrogacy in Utah from 2009 to 2018. Data were obtained from birth certificates. State and country of residence were collected for intended parents, and the legal climates of these locations were assessed by reviewing laws at the time. Sociodemographic characteristics were compared among intended parents, parents with pregnancies resulting from assisted reproductive technology (ART) without gestational surrogacy, and parents with spontaneous pregnancies.RESULTS: A total of 361 gestational carrier pregnancies resulted in the birth of at least one liveborn neonate during the study period, involving 715 intended parents. Additionally, 50,434 parents delivered children after nonsurrogacy ART, and 950,460 parents delivered children after spontaneous fertilization. Many intended parents (17.2%) lived in countries outside of the United States, the majority of which (69.9%) had laws against surrogacy. Of those who lived within the United States, 57.4% lived outside of Utah, but only 15.9% lived in states that banned compensated surrogacy. Statutes in Utah support compensated and uncompensated gestational surrogacy. Intended parents were significantly older than parents with both nonsurrogacy ART pregnancies and spontaneous pregnancies (median age 38, 31, and 29 years, respectively) and had higher levels of education; 70.2% of intended parents had a bachelor's degree or above, compared with 48.2% of parents with nonsurrogacy ART pregnancies and 33.1% of parents with spontaneous pregnancies.DISCUSSION: A majority of intended parents live outside of Utah, which may be an important consideration for health care professionals caring for women with gestational carrier pregnancies. However, most intended parents live in places that do not have laws banning surrogacy, suggesting that there may be other reasons that intended parents travel for delivery.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Outpatient Foley Catheter for Induction of Labor in Nulliparous Women: A
           Randomized Controlled Trial
    • Authors: Ausbeck; Elizabeth B.; Jauk, Victoria C.; Xue, Yumo; Files, Pamela; Kuper, Spencer G.; Subramaniam, Akila; Casey, Brian M.; Szychowski, Jeff M.; Harper, Lorie M.; Tita, Alan T.
      Abstract: imageOBJECTIVE: To assess whether outpatient cervical ripening with a transcervical Foley catheter in nulliparous women undergoing elective labor induction shortens the time from admission to delivery.METHODS: We performed a randomized controlled trial of patients with singleton pregnancies undergoing elective labor induction at 39 weeks of gestation or more with a modified Bishop score less than 5. Women were randomized 1:1 to outpatient or inpatient transcervical Foley. In the outpatient group, the Foley was inserted the day before admission for scheduled induction; insertion was performed at scheduled admission in the inpatient group. The primary outcome was duration of time from admission to the labor and delivery unit to delivery. With 80% power and a two-sided α of 0.05, a sample size of 126 was estimated to detect at least a 5-hour mean difference in time from admission to delivery between groups from a baseline duration of 19±10 hours.RESULTS: From May 2018 to October 2019, 126 women were randomized, 63 in each group. Baseline characteristics were balanced between groups, except that body mass index (31±5.4 vs 34±7.5, P=.01) and group B streptococcus colonization (31% vs 54%, P=.01) were lower in the outpatient group. The time from admission to delivery was shorter in the outpatient group (17.4±7.4 vs 21.7±9.1 hours, P
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Toxicology Testing in Pregnancy: Evaluating the Role of Social Profiling
    • Authors: Perlman; Nicola C.; Cantonwine, David E.; Smith, Nicole A.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Travel Time to Access Obstetric and Neonatal Care in the United States
    • Authors: Roa; Lina; Uribe-Leitz, Tarsicio; Fallah, Parisa N.; Williams, Wendy; Jarman, Molly P.; Bergmark, Regan W.; Boatin, Adeline A.; Molina, Rose L.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Reducing the Risk for Postpartum Depression in Adolescent Mothers: A
           Randomized Controlled Trial
    • Authors: Phipps; Maureen G.; Ware, Crystal F.; Stout, Robert L.; Raker, Christina A.; Zlotnick, Caron
      Abstract: imageOBJECTIVE: To estimate the effect of an interpersonal therapy-based intervention on reducing the risk of postpartum depression in adolescents.METHODS: A randomized controlled trial enrolled 250 pregnant adolescents who were aged 18 years or younger at conception. The initial sample size calculation estimated 276 participants (324 with attrition) were needed to detect a 50% reduction in risk of the primary outcome, postpartum major depressive episode, with an alpha of 0.05% and 80% power. An interim analysis by the Data Safety and Monitoring Committee informed a revision in the sample size target to 250. Participants were randomized to the intervention (n=129) or a time-matched control group (n=121) who attended sessions about pregnancy topics. Each group received five prenatal sessions and a postpartum booster session. A structured diagnostic interview was administered at baseline and specific time points through 12-months postpartum to assess for major depressive episode onset.RESULTS: Participants were recruited from December 2011 to May 2016 through urban prenatal care sites in the state of Rhode Island. Of the 250 participants, 58% identified as Hispanic and 20% as black or African American. The rate of major depressive episode by 12 months postpartum was 7.0% (95% CI 2.3–11.7%) in the control group and 7.6% (95% CI 2.5–12.7%) in the intervention group, with no significant difference between groups at any time point (P=.88 by log-rank test).CONCLUSION: No benefit was shown between the intervention and control groups in the rates of major depressive episode, which is likely related to a lower than predicted rate of this outcome in the control group (7.6% actual vs 25% predicted). Enhanced local community resources available to pregnant and parenting adolescents during the study period may be an explanation for this result.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01482832.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Re-examining the Meis Trial for Evidence of False-Positive Results
    • Authors: Sibai; Baha; Saade, George R.; Das, Anita F.
      Abstract: imageU.S. Food and Drug Administration (FDA)–approved 17α-hydroxyprogesterone caproate therapy is currently available to reduce recurrent preterm birth in the United States. This commentary reviews the original landmark Meis trial (“Prevention of Recurrent Preterm Delivery by 17 Alpha-Hydroxyprogesterone Caproate”), which led to conditional approval of 17α-hydroxyprogesterone caproate by the FDA in 2011. The recent PROLONG (Progestin's Role in Optimizing Neonatal Gestation) trial failed to confirm the original findings. The Meis trial was rigorously designed and conducted, with highly statistically significant results that should not be undermined by the negative results of PROLONG. Given that the United States has among the highest preterm birth rates in the world and that the predominant enrollment in PROLONG was outside the United States, the results of the “old” Meis trial should not be summarily dismissed. It would be detrimental to high-risk pregnant patients to inappropriately prioritize results of PROLONG over the Maternal-Fetal Medicine Units Network’s Meis trial (funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development). We assert PROLONG was underpowered, based on substantially lower observed preterm birth rates than anticipated, and therefore was a false-negative study, rather than the Meis trial being a false-positive study. Careful assessment of these two trials is critical as removal of 17α-hydroxyprogesterone caproate from the U.S. marketplace may have substantial effects on public health.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Connect the Dots—September 2020
    • Authors: McLeod; Corinne; Wannamaker, Louise Ross; Criscione, Lily T.; Chescheir, Nancy C.
      Abstract: imageNo abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Placenta Accreta Spectrum Disorder: Uterine Dehiscence, Not Placental
           Invasion
    • Authors: Palacios-Jaraquemada; José Miguel; D'Antonio, Francesco
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Placenta Accreta Spectrum Disorder: Uterine Dehiscence, Not Placental
           Invasion
    • Authors: Sabre; Alexander
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • In Reply
    • Authors: Einerson; Brett D.; Comstock, Jessica; Silver, Robert M.; Branch, D. Ware; Woodward, Paula J.; Kennedy, Anne
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vertical
           Transmission in Neonates Born to Mothers With Coronavirus Disease 2019
           (COVID-19) Pneumonia
    • Authors: Malhotra; Yogangi; Rossberg, Max C.; Bajaj, Komal; Shtern, Angela; Moore, Robert M.
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Examining Inequities Associated With Changes in Obstetric and Gynecologic
           Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic
    • Authors: Isquick; Sarah; Knittel, Andrea K.; Premkumar, Ashish
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • In Reply
    • Authors: Onwuzurike; Chiamaka; Meadows, Audra R.; Nour, Nawal M.
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • External Cephalic Version: ACOG Practice Bulletin Number 221
    • Authors: Baxi; Laxmi
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • In Reply
    • Authors: Zahn; Christopher M.; Olson Koutrouvelis, Gayle L.; Turrentine, Mark A.
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Executive Summary of the Early-Onset Breast Cancer Evidence Review
           Conference
    • Authors: Temkin; Sarah M.; Terplan, Mishka
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • In Reply
    • Authors: Chelmow; David; Pearlman, Mark D.; Young, Amy; Bozzuto, Laura; Dayaratna, Sandra; Jeudy, Myrlene; Kremer, Mallory; Scott, Dana Marie; O'Hara, Julia Sage
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Symptoms and Critical Illness Among Obstetric Patients With Coronavirus
           Disease 2019 (COVID-19) Infection
    • Authors: Shobiye; Damilola M.; Zhang, Jianrong; Fok, Louis; Zhao, Yueming; Sun, Jie; Xu, Zhiheng
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • In Reply
    • Authors: Andrikopoulou; Maria; Friedman, Alexander M.
      Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome: Correction
    • Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Ovarian Cancer After Prophylactic Salpingectomy in a Patient With Germline
           BRCA1 Mutation: Correction
    • Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Evaluation of a Novel Course in Pre-hospital Emergency Obstetrics for US
           Army Special Forces Medics [11G]: Correction
    • Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Effectiveness of Maternal Safety Bundle for Obstetric Hemorrhage at a
           Large U.S. Military Hospital [15M]: Correction
    • Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Improving Access for Patients Undergoing Gonadotoxic Therapy: Creation of
           a Formal Fertility Preservation Program [25A]: Correction
    • Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • ACOG Publications: September 2020
    • Abstract: No abstract available
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Robot-Assisted Surgery for Noncancerous Gynecologic Conditions: ACOG
           COMMITTEE OPINION SUMMARY, Number 810
    • Abstract: ABSTRACT: For noncancerous conditions, such as hysterectomy, a minimally invasive approach to gynecologic surgery has well-documented advantages—including faster return to normal activities, decreased length of stay, and better quality of life—compared with an abdominal approach. Although the quality of data for robot-assisted surgery is still low to moderate, the use of robot-assisted surgery has rapidly increased since its approval, which highlights the need to develop effective and thoughtful strategies for its implementation. Reporting of adverse events currently is voluntary and nonstandardized; therefore, the true rate of complications is not known. Adoption of new surgical techniques should be driven by what is best for the patient and by evidence-based medicine, rather than external pressures. Although training in robot-assisted surgery increasingly is incorporated into obstetric and gynecologic residency programs, exposure to and training with robotic devices varies nationally. Obstetrician–gynecologists not previously trained in robot-assisted surgery can acquire the necessary skills through independent robot-assisted training programs and through courses offered and accredited by organizations such as the American College of Obstetricians and Gynecologists, the Society of Gynecologic Surgeons, the American Association of Gynecologic Laparoscopists, the Society of Gynecologic Oncology, and the American Urogynecologic Society. Ongoing quality assurance is essential to ensure appropriate use of the technology and, most importantly, patient safety. Well-designed studies are needed to determine which patients are most likely to benefit from robot-assisted surgery over other minimally invasive approaches.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Anorectal Disorders: Clinical Updates in Women’s Health Care Primary and
           Preventive Care Review
    • Authors: Hancock; Kevin J.; Gajjar, Aakash H.
      Abstract: : Anorectal disorders can have overlapping symptoms, which sometimes can make it difficult to establish a diagnosis. Obtaining a detailed history and performing a physical examination are vital to establish the correct diagnosis and to outline appropriate treatment for anorectal disorders. Obstetrician–gynecologists often are the primary care providers and may be the only medical professional a woman sees; therefore, they should be knowledgeable regarding anorectal pathology, recommended dietary and lifestyle changes, and appropriate referral guidelines. This monograph reviews benign and malignant anorectal conditions to aid obstetrician–gynecologists in diagnosis and management of anorectal disease and to provide guidance regarding a referral to a gastroenterologist or a colorectal surgeon.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
  • Robot-Assisted Surgery for Noncancerous Gynecologic Conditions: ACOG
           COMMITTEE OPINION, Number 810
    • Abstract: ABSTRACT: For noncancerous conditions, such as hysterectomy, a minimally invasive approach to gynecologic surgery has well-documented advantages—including faster return to normal activities, decreased length of stay, and better quality of life—compared with an abdominal approach. Although the quality of data for robot-assisted surgery is still low to moderate, the use of robot-assisted surgery has rapidly increased since its approval, which highlights the need to develop effective and thoughtful strategies for its implementation. Reporting of adverse events currently is voluntary and nonstandardized; therefore, the true rate of complications is not known. Adoption of new surgical techniques should be driven by what is best for the patient and by evidence-based medicine, rather than external pressures. Although training in robot-assisted surgery increasingly is incorporated into obstetric and gynecologic residency programs, exposure to and training with robotic devices varies nationally. Obstetrician–gynecologists not previously trained in robot-assisted surgery can acquire the necessary skills through independent robot-assisted training programs and through courses offered and accredited by organizations such as the American College of Obstetricians and Gynecologists, the Society of Gynecologic Surgeons, the American Association of Gynecologic Laparoscopists, the Society of Gynecologic Oncology, and the American Urogynecologic Society. Ongoing quality assurance is essential to ensure appropriate use of the technology and, most importantly, patient safety. Well-designed studies are needed to determine which patients are most likely to benefit from robot-assisted surgery over other minimally invasive approaches.
      PubDate: Tue, 01 Sep 2020 00:00:00 GMT-
       
 
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